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Objective:To observe the influence of methylprednisolone in the respiratory mechanical parameters in the elderly patients undergoing major surgeries with general anesthesia intubation after mechanical ventilation,and to investigate whether methylprednisolone can improve the respiratory system degenerative diseases and benefit the mechanical ventilation. Methods:Sixty patients undergoing elective line laparotomy were divided into experimental group and conrol group (n=30) according to their wishes.The patients in experimental group receieved intravenous injection of methylprednisolone 1 mL (40 mg) after endotracheal intubation,and the patients in control group receieved 1 mL intravenous saline water injection.The airway peak pressure (Ppeak), airway platform (Pplat), lung compliance (Compl), and airway resistance (Raw) of the patients in two groups were recorded at the time of immediately before administration and 10,20,30,40 min after administration.The arterial blood oxygen partial pressure(PaO2),arterial blood CO2 partial pressure(PaCO2),CO2 partial pressure at the end of breathe out(PetCO2) of the patients were detected at the time of immediately before administration and 20 min after administration.Results:Compared with before administration, the respiratory mechanics parameters of the patients in control group 10,20,30,40 min after administration had no statistically significant differences (P>0.05);the Comple of the patients in experimental group was singnificantly increased (P0.05);the PaCO2 and PetCO2 of the patients in experimental group 20 min after administration were decreased(P<0.05),and the PaO2 was increased(P<0.05).Compared with control group,the PaCO2 and PetCO2 of the patients in experimental group 20 min after administration were decreased(P<0.05),and the PaO2 was increased(P<0.05).Conclusion:Methylprednisolone can obviously reduce PaCO2,Peak, and Pplat and increase PaO2 and Compl;methylprednisolone has possibility in improving the adverse effects of degenerative disease of respiratory system on general anesthesia in the elderly patients.
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The donors' complete autonomy and voluntariness for donation is the core of ethical acceptability of living organ transplantation.Deep in the donors' heart,the awareness of self-respect and the altruism are two contradictory tendencies both in psychology and behavior.As the existence of the tension of self-respect awareness and altruism,it becomes particularly difficult and complex for the living organ donors to make autonomous decisions.This paper analyzed the tension of self-respect awareness and altruism,discussed the emotional and ethical contradictory,and proposed some suggestions based on this,hoping to provide a good internal environment and external support for the potential donors to make reasonable free decisions and guarantee the ethics of living organ transplantation.
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Objective:To explore the effect of family education in medical ethics education, further to study on the influence of parenting pattern on medical students′ competitive attitude. Methods: A sample of 550 college students was selected with the method of stratified random sampling. The subjects were invested using Egna Minnan Barndoms Uppfostran and Competitive Attitude Scale. Results: Good parenting pattern contributes to the form of benign com petitive attitude. Parents′denial and mother′s favor have predictive effect on benign competition atti-tude. Father′sdenial, father′s over-protection, and mother′s over-interference have predictive effecton vicious competition attitude. Conclusion:In the family education of medical students ,parents should change the education concept in order to form a good competitive attitude.
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The elderly in the community who is the focus of the family doctor services , because of his special physical and mental condition , their demands for health care services showing the features of dependence , Recur-rence and urgency .Therefore, as the provided entity of community health service , the family doctor should care for the elderly in the community .In order to promote the realization of Healthy aging , we can build the system of the humane care for the elderly in the community , through the education and guidance of health、conducting psychologi-cal counseling , providing emotional support、building family sickbeds , providing regular visits、emphasizing clinical narrative, establishing mutual participation model and other measures .
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Establishing and perfecting the family doctor system should adhere to the following ethical princi-ples:the principle of public welfare, fairness and efficiency principle, the combination of comprehensive care prin-ciple, attaches great importance to the precautionary principle, the principle of family support, social participation principle. In the horizon, life ethics, puts forward suggestions for the development of family doctor system:impro-ving humanism quality of family physicians,calling the humanistic concern in the process of family doctor service increasing the government's policy support,increase the health resources into, adjust the health insurance policies, guide the community residents in the family doctor first.
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This paper mainly discussed the present situation of the pension mode transformation from traditional family pension to social pension. The existing ethical issues in pension institution include: old filial piety thought deeply rooted;institutional care services cannot be carried out caused by unfair distribution balance; humanistic thought of human ethical care implementation does not do well; some agencies have occasional bad behavior. Therefore, this paper proposed some advices based bioethical perspective:for old people and their children, advo-cate the new filial piety;pension institutions not only improving the quality of the hardware but also should strength-en humanistic ethics concern;establish and perfect the laws and regulations, combining the rule of law with moral and ethical;the relevant government departments should insist on and strengthen the principle of fair justice.
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With a long duration of the CHB, patients who have economic pressures and physical problems will get changes in their psychological status, which are involved in the development of the disease. Moreover, poor thera-py compliance and insight of their disease, negative mood of anxiety and depression also have effects the prognosis of disease. Therefore, mental factors play a vital important role in the development and prognosis of CHB patients, health education and mental intervention are the most effective way to avoid the psychological disorder of patients.
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Through the brief introduction of the concept of the mobile medical , this paper pointed out that the ethical issues that exist:health data reliability problems , the patient′s privacy protection , the protection of intellec-tual property rights issues , is involved in the problem of illegal practice medicine , online consulting the legal re-sponsibility of the doctor -patient relationship to define problems , make the reductionism , highlighted the defect of mind-body dualism and instrumental rationality overflow problem .And from the technical level , the law , the poli-cy level and consciousness discusses the related countermeasures .
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In recent years , with the development of medical health and the progress of economy , the citizens'demands for daily health are improved continually , and health services need to be rapid development .However , in the principle of medical ethics and humanism humanistic care of patients , it is easy to ignore the other two key as-pects -the medical staff and patients with the family .This paper analyzed the emotion and psychology of patients'families and medical staff in caring for the patients and corresponding solutions , so that the three can effective communication to build a harmonious doctor -patient relationship , and then promote patient recovery and be advan-tageous to the long-term development of the reform of health services .
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Objective To investigate the effect of diabetes mellitus on neuromuscular blocking effect of cisatracurium in patients. Methods Forty ASA Ⅱ patients, aged 30-64 yr, weighing 44-90 kg, scheduled for neurosurgical operation under general anesthesia, were assigned into 2 groups (n = 20 each): type 2 diabetes mellitus group (group D) and non-diabetes mellitus group (group ND). General anesthesia was induced with midazolam,fentanyl and etomidate. Neuromuscular block was assessed with Epoch XP nerve electrophysiology monitor. A train-of-four stimulation of ulnar nerve was used. Cisatracurium 0.15 mg/kg was injected intravenously over 5 s after T1 was maintained at 100%. Tracheal intubation was performed after the onset of the muscle relaxant. Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg - 1 · h - 1 and remifentanil 0.1-0.3μg· kg - 1 · min - 1. The effect of inmbation was evaluated and graded. The onset time, clinical duration, recovery time and recovery index were recorded. Results The onset time was significantly longer in group D than in group ND ( P ＜ 0.05). There was no significant difference in the clinical duration, recovery time and recovery index and intubation effect grade between the two groups ( P ＞ 0.05). Conclusion Diabetes can prolong the onset time of cisatracurium, but has no effect on the clinical duration and recovery time.
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Objective To investigate the changes of phosphorylated CREB in spinal cord dorsal horn of rats underwent chronic compression of dorsal root ganglia (CCD) and effects of intrathecally administer NOS inhibitor L-NAME,AG or 7-NI and cGMP analogue 8-Br-cGMP on the expression of pCREB in dorsal horn and the changes in thermal hyperalgesia of rats.Methods 90 male adult Wistar rats were randomly divided into L-NAME,AG,8-Br-cGMP,7-NI,Cremophor and PBS groups.Different NOS inhibitors were injected intrathecally by microsyringe at the 5th day after CCD,the thermal paw withdrawal latencies were measured before injection and 0.5,2.0,6.0,12.0,24.0 h after treatment,the anti-nociceptive effects of agents were compared.The expression of pCREB was detected by immunohistochemical analysis 2 h after intrathecal injection.Results CCD significantly increased the expression of pCREB and pCREB positive neurons located in all laminae of bilateral spinal cord.The expression of pCREB in ispilateral and contralateral spinal cord showed no significant difference.Compared with PBS group,there was significant decreasing in number of pCREB positive neurons in L-NAME,AG and 7-NI groups(P
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BACKGROUND: The extracellular signal-related kinase(ERK) cascade is activated by its specific upstream kinase MAPK/ERK kinase(MEK) and identified as a critical regulator of cell growth, memory formation and long-term neuronal plasticity.OBJECTIVE: To investigate the role of ERK activation in establishment and maintenance of chronic neuropathic pain.DESIGN: A randomized controlled experiment based on the animals.SETTING: Department of Anesthesiology of a university-affiliated hospital.MATERIALS: The experiment was performed in the Medical Institute of Anesthesiology of Jiangsu Province from September 2003 to June 2004. Totally 115 male clean SD rats weighting 220 to 300 g were provided by the Experimental Animal Center of Xuzhou Medical Colleg e. The rats were raised in separate cages with natural lighting at 20 to 25 ℃, having free access to food and water.INTERVENTIONS: Five days after chronic constrictive injury(CCI) model was established, different doses of U0126 were intrathecally injected according to Mestre' s method. The control group received sterile intrathecal injection of 50 g/L dimethylsulfoxide.hyperalgesia by using von Frey filaments and thermal hyperalgesia stimulator activation and translocation of ERK in spinal cord dorsal horn by immunohistochemistry and Western blot analysis.RESULTS: CCI could increase the activity of EPK in spinal cord dorsal horn. Intrathecal injection of U0126 significantly attenuated CCI-induced mechanical and thermal hyperalgesia.CONCLUSION: Activation and translocation of ERK contribute to formation and maintenance of CCI-induced neuropathic pain.
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Research on conflict between doctor and patient on overseas involve to: Social role theory,doctor-patient exchange theory,asymmetric information theory and health care system.The domestic scholar from sociological,the medical technology,the medical information,the medical law system,the health care system and so on to research the conflict between doctor and patient.To research the multiple attribute of the relations between doctor and patient,from the interdependence system of the medicine drugs the medicine insurance the medicine treatment to study the reason of conflict between doctor and patient,is still the long-term topic which we faces.
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As the code of behavior, honest-trust has its theoretical foundation of ethics. From the point of view of morality-justice, honest-trust is the ethical code of behavior; from the point of view of utilitarianism, honest-trust is the basic demand for increasing social welfare; from the point of view of responsibility and right, honest-trust is the responsibility and right of social members. Nowadays society should construct the social environment and mechanism of honest-trust, which can not be limited in the views of morality-justice and utilitarianism, but should be constructed in term of managing society and based on the responsibility and right.
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Coincidence exists in the value selection,main form of human communication and imbalance between teacher-student relationship and doctor-patient relationship.Therefore,teacher-student relationship today will directhy have an impact on the future of doctor-patient relationship.Teachers should cultivate medical students'equality consciousness and communicating ability between doctors and patients by establishing equal relationship and good communication between teachers and stdents.
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Case teaching has evident characteristics compared with traditional theory teaching. This article expound the purpose,significance,teaching process and the noticeable problems of case teaching in medicaI ethics teaching.
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In recent years,excessive medical treatment draws common concern of medical ethics circles.Excessive medical treatment is not only an ethics problem,but also an economic phenomenton at the same time.The article thinks,economics displays of excessive medical treatment is a doctor leads the demand,the direct cause of formation is the medical demand lacking flexibility,the market environment is monopolizing competition.At last,articles proposed the ethics and economic countermeasure of checking excessive medical treatment.
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This article introduces the concept of organizational citizenship behavior(OCB) as well as the idea of medical professionalism,and analyzes the mutual relationship between OCB and medical professionalism.On the basis of introduction and comparison,medical professionalism obtains the enlightenment from previous studies on OCB.
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Doctors must carry out informed consent in medical treatment.However,to ensure patients' rights and interests mostly,this obligation needs exempted in some special cases.This article studies the insufficiency in the existing regulation on doctors' obligations exemption.It also lists some constructive suggestions based on the existing theory to solve this problem.