目的 探讨心理资本和组织支持感在工作场所暴力影响儿科护士职业倦怠中的作用机制.方法 2022年4-5月,采用便利抽样方法,使用工作场所暴力量表、心理资本量表、组织支持感量表和职业倦怠量表对山西省某三甲儿童医院的417名儿科护士进行问卷调查,比较不同人口学特征护士职业倦怠水平的差异,用Pearson相关分析各量表得分之间的相关关系,用Bootstrap方法验证变量间的中介效应.结果 儿科护士的职业倦怠发生率为66.91％(279/417).不同年龄、婚姻状况、聘用形式、日均工作时长、月平均收入、科室的儿科护士的职业倦怠得分差异有统计学意义(P＜0.05),以年龄31～40岁、已婚、非正式在编、急诊科、日均工作时长高、月平均收入低的儿科护士的职业倦怠水平较高.工作场所暴力与心理资本、组织支持感为负相关(r=-0.269、-0.303,P＜0.01),与职业倦怠为正相关(r=0.418,P＜0.01),心理资本、组织支持感与职业倦怠为负相关(r=-0.543、-0.543,P＜0.01),心理资本与组织支持感为正相关(r=0.488,P＜0.01).中介效应分析显示:组织支持感和心理资本单独作为中介变量以及共同作为链式中介变量的间接效应均显著,中介效应值为0.095、0.044、0.043,分别占总效应的22.51％、10.42％、10.18％.结论 儿科护士的职业倦怠水平较高.工作场所暴力通过心理资本、组织支持感的中介作用以及两者的链式中介作用影响职业倦怠.医院管理者可通过提高儿科护士的心理资本和组织支持感来缓解工作场所暴力对职业倦怠的影响.

医学本质上是一门人学,患者角色具有整体性和主体性的特征,随着科学技术的进步和社会发展,当前的患者角色出现了异化.从四个层面剖析患者角色异化的具体表现,有社会学意义上患者角色的客体化和患者边界的模糊化,技术意义上患者角色的物化和患者疾痛的指标化,法学意义上患者生命健康权的挑战和知情同意权的异化,经济学意义上患者角色的工具化和患者主体性的脆弱化.进而提出技术与人文相协调,回归患者的本然、关切患者的需要是现代医学发展的应有之义.

人体器官移植技术的发展给无数器官功能衰竭患者带去了重生的希望,人体器官捐献与移植需要各级红十字会、人体器官获取组织、医疗机构等的共同努力,医务社会工作者作为新生力量也逐渐发挥自身作用.通过总结医务社会工作介入公民逝世后器官捐献的专业优势,提出医务社会工作者可以通过明确有无捐献意愿并对家属提供危机介入服务、协助家属完成捐献事宜并举行告别仪式、跟踪回访并开展哀伤辅导活动等实务工作为捐献者及家属提供专业服务.针对实务过程中遇到的问题,提出扩大医务社会工作者的规模并完善其管理,提高社会对医务社会工作的认知度及为开展后期服务提供全方位支持的建议.

人体器官移植技术是20世纪生命医学科学的重大进展,挽救了众多器官功能衰竭患者的生命,具有划时代的意义.随着原国家卫生部2010年启动公民逝世后器官捐献(Chinese Organ Donation after Citizen's Death,CODCD)试点工作,2013年在全国范围内推广开展,原国家卫生计生委于2013年 8月出台了《人体捐献器官获取与分配管理规定(试行)》(以下简称《规定(试行)》),要求公民逝世后捐献器官的获取和分配由人体器官获取组织(organ procurement organization,OPO)按照相关规定实施,OPO正式进入了我国器官捐献与移植的历史舞台 [1].

罕见病患者群体作为"脆弱人群",其医疗权、健康权的维护应受到更多关注.通过梳理我国现行罕见病医疗保障政策,发现存在的问题,如诊疗体系尚未健全、药品可及性有限、多层次保障体系尚未成熟等,结合生命至上、公正、共济三项伦理原则的思考,从政府、医院、社会三个主体视角探寻完善罕见病医疗保障政策的合理路径,提出"政府引导、维护公正;社会共担、温暖互助;医院关怀、敬畏生命"的对策和建议.营造尊重、公正、互助、和谐的氛围,切实解决罕见病患者群体看病难、看病贵等现实问题.

通过参与观察研究和文献梳理,总结当前我国公民逝世后器官捐献伦理审查存在的问题,如审查机构不明确、审查时间滞后、审查形式有缺陷、审查内容及标准不具体、审查监管不足等.依据人体器官捐献的伦理原则及我国相关法律法规和文件规定,针对谁来审查、何时审查、怎样审查、审查什么、如何监管5个问题提出规范伦理审查的建议,以期加强器官捐献伦理审查制度建设和伦理委员会审查能力建设,促进我国器官捐献与移植工作由高速度增长向高质量发展转型.

动物实验是医学人才培养的重要手段、医学科学研究的基本途径,加强实验动物福利伦理审查既是保护实验动物福利的有效措施,又关系到动物实验结果的科学性.结合山西医科大学实验动物福利伦理审查实践,梳理高等医学院校实验动物福利伦理审查存在的问题,如审查的被动性和滞后性、研究者认知的模糊性,提出保障实验动物福利伦理审查全覆盖、注重实验动物福利伦理跟踪审查、提供实验动物福利伦理咨询服务、完善实验动物从业人员资质管理体系的建议.

目的 了解医务人员遭受医院暴力的现状,分析医院暴力行为发生的影响因素,探究医院暴力的预防措施.方法 通过问卷调查的方法收集山西省医务人员遭受医院暴力情况等相关数据,采用SPSS软件进行数据分析.结果 医院暴力事件的发生率为68.51％,其中以语言暴力为主.单因素分析结果显示,性别(x2=8.845,P=0.003)、学历(x2=39.396,P＜0.001)、工作年限(x2=8.463,P=0.037)、医院级别(x2=5.612,P=0.018)、工作岗位(x2=23.813,P＜0.001)、科室(x2=33.486,P＜0.001)均有统计学意义.多因素logistic回归分析结果显示,与本科以下比较,本科(OR=2.687)和硕士及以上(OR=2.131)医务人员遭受医院暴力风险更大,与职能科室比较,妇产科(OR=3.623)和急诊科(OR =4.019)医务人员遭受医院暴力风险更大.结论 医务人员遭受医院暴力的风险性高,造成严重的身心伤害,有关部门应采取相应的预防措施减少暴力事件的发生.

肾移植是目前治疗终末期肾疾病最理想的方法之一，活体肾移植具有组织配型相容性高、供肾质量好、排斥反应发生率低等诸多优点，但同时会对供者健康带来不可避免的损害，必须加强伦理审查和制度约束。为有效缓解器官来源匮乏这一世界器官移植的难题，小肾癌供肾评估成为近年来学者们探讨的领域之一。本文根据器官移植的伦理原则和规范，以尊重、不伤害、有利、公正四原则为指导，具体分析小肾癌活体供肾移植中供、受者双方的自主性及利弊得失，对此类肾移植的临床实践及伦理审查提出建议。

The development of modern medicine calls for the return of medical humanistic spirits,and it is in-evitable to strengthen medical humanistic education.This paper compared the current situation of medical humanis-tic education between Chinese and American medical colleges from the construction of teaching staff,the establish-ment of curriculum system,and teaching method and evaluation.It put forward some suggestions for the dilemma of the development of medical humanistic education according to the actual medical education in our country,and ex-plored the reform paths of medical humanistic education in our country.

医学院校人文教育的目的,是使医学生成为"健康关怀者",即在医学生时期"关怀常人",在医生时期"善待病人",以此为教育目标,本文提出"全人、全面、全程、全时、全方位"的"五全"健康人文教育理念,采取综合性教育手段和措施,对医学生进行人文素质教育,使医学生早期实践人文、同步认识人文、深厚养成人文.

As a kind of mass media,medical drama is a bridge for the communication between medicine and communities.It enables patients and society having a better understanding of medicine,hospitals and doctors.Therefore,it should take the social responsibility of spreading the health culture.By analyzing the differences between Chinese and American medical dramas in playwriting,production and dissemination,this paper suggested that domestic medical drama should learn from the development experiences of American medical dramas,pursuing the seriousness of the medical profession,showing the limited nature of medical technology,facing to the inevitability of medical errors and reflecting the connotation of medical professionalism in the principles of respecting science and facts,reverencing for life and advocating humanities.Good medical drama should have local characteristics and be rooted in Chinese culture and play a leading role in health culture communication.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">人体试验研究及临床医疗中某些特殊的诊疗实施都必须履行知情同意原则,在某些特定情形下患者（受试者）的知情同意权需由代理人行使,即代理同意。代理同意由代理主体做出知情同意决策,其代理意见的有效性关乎被代理人的生命健康。通过梳理代理同意在实践中存在的主要问题,基于生命医学伦理的尊重自主原则、有利原则,参照代理决策的"事先指令或预嘱-替代判断-最佳利益"三个标准进行代理意见的有效性分析,提出规范代理同意的实践应当完善立法、明确代理同意的原则,发挥伦理委员会的职能,避免代理同意形式化。</span>

Body weight gain results from a chronic excess of energy intake over energy expenditure. Accentuating endogenous energy expenditure has been accorded considerable attention ever since the presence of brown adipose tissue (BAT) in adult humans was recognized, given that BAT is known to increase energy expenditure via thermogenesis. Besides classic BAT, significant strides in our understanding of inducible brown adipocytes have been made regarding its development and function. While it is ideal to study BAT histologically, its relatively inaccessible anatomical locations and the inherent risks associated with biopsy preclude invasive techniques to evaluate BAT on a routine basis. Thus, there has been a surge in interest to employ non-invasive methods to examine BAT. The gold standard of non-invasive detection of BAT activation is 18F-fluorodeoxyglucose positron emission tomography (PET) with computed tomography (CT). However, a major limitation of PET/CT as a tool for human BAT studies is the clinically significant doses of ionizing radiation. More recently, several other imaging methods, including single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), infrared thermography (IRT)/thermal imaging and contrast ultrasonography (US) have been developed in hopes that they would allow non-invasive, quantitative measures of BAT mass and activity with lower costs. This review focuses on such methods to detect human BAT activation and white adipose tissue (WAT) browning to prompt the establishment of BAT-centric strategies for augmenting energy expenditure and combatting obesity. Clinical validation of these methods will most likely expand the scope and flexibility of future BAT studies.

With the appearance of the "biological-psychological-social" medical model, the purpose, value and significance of medicine are reviewed and reconsidered by the people, and the history of medicine becomes one of the core subjects in the medical humanist education, along with change of the teaching of general western medical history. Medical history is no longer the accumulation of the achievements of human knowledge and medical experience, the intellectual history of theorytransformation, and the history of reformation of medical technologies, but a concrete and colorful living situation, displayed by the scientists, physicians and normal peoplecommunity during the process of their consistent recognition and transformation on medicine. Therefore, the teaching of generalwestern medical history should adjust the compilation of teaching materials, update the educational concept, change the contents, methods of teaching and examination in order to lay stress on the cultural viewpoint and the function of humanity and quality of education.

Medical drama is acceptable by society groups and has irreplaceable social function as the mass media.In recent years,medical drama in China presents our situation in the doctor-patient relationship and the problems in it objectively.The hit of medical drama in China caused social debates about doctor-patient relationship.Doctor-patient communication is an important factor in a good doctor-patient relationship,and domestic and foreign medical drama build a communication bridge between hospital and social in the art style.This paper analyzes the doctor-patient misunderstanding,discusses the meaning of medical drama in doctor-patient communication to promote doctor-patient understanding really and comprehension truly,and then promote reconciliation from the medical drama doctor-patient communication in social responsibility.

目前,医患关系呈现双方信任缺失、信任基础脆弱的局面.以医务社会工作的角度为出发点,构建和谐医患关系,应从医方、患方以及医院和社会入手:调节心理压力,提升医务人员的沟通技能和人文素养;提供就医咨询服务,帮助制定合理的治疗方案,疏导不良情绪,整合社会资源;加强医院环境建设,树立良好的社会影响,普及健康知识,提供健康咨询.

医疗剧作为一种大众传播媒介,容易被社会群体所接受,具有不可替代的社会职能.近年来我国医疗剧客观地呈现了医患关系现状及存在的问题,医疗剧的热播引起了社会关于医患关系的热议.医患沟通是良好医患关系的重要因素,中外医疗剧用艺术的方式架起了医院和社会沟通的桥梁.从医疗剧在医患沟通中所承担的社会责任来剖析医患之间的误解,探讨医疗剧在医患沟通中的意义,真实促进医患了解,真诚促成医患理解,沟通促成医患和解.

医疗剧的概念起源于美国,是以医院或诊室为背景,以一个或几个医生为主线贯穿全剧的情节系列剧,如《急诊室的故事》(Emergency Room)、《实习医生格蕾》(Grey's Anatomy)、《周一清晨》(Monday Mornings),其中,《急诊室的故事》建立起来的“Professional(专业)+Personal(人性)”模式成为美国医疗剧的最重要的两大特点.中国医疗剧还处于起步阶段,近年来涌现出一批以《医者仁心》、《心术》、《感动生命》、《产科医生》等为代表的医疗题材电视剧,社会反响强烈.医疗剧中的典型案例、人物形象对于提升医学生人文素质具有潜移默化的影响,教育者应善于运用和发挥医疗剧在医学人文教育中的作用.