Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast (...) outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Background Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. Methods A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items (...) to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. Results The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Conclusions Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. Trial registration The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

We investigated whether, in the emergency department, educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video (...) illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention ) than in the control group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores. Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients’ perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients. We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed that had experimental or observational study design and involved adult trauma patients. Studies involving (...) informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach. A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information. Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients. (shrink)

Background: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. Methods: A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility (...) data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression. Results: Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of "personal information overheard by others", being "seen by irrelevant persons", having "unintentionally heard inappropriate conversations from healthcare providers", and experiencing "providers' respect for my privacy". There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis. Conclusions: Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction. (shrink)

Tiere haben erstaunliche kognitive Fähigkeiten, ein diesen Fähigkeiten entsprechendes Bewußtsein und Formen des Selbstbewußtseins. Das Denken in diskreten Einheiten von Urteilen scheint ihnen jedoch nicht zugänglich zu sein, damit auch nicht die Unterscheidung von Bejahung und Verneinung und von wahr und falsch. Wie ist das Denken und damit das objektive Erkennen beim Menschen entstanden? Welche Rolle spielt das Gehirn bei Mensch und Tier? Wir Menschen leben in zwei Welten, die paradoxerweise zugleich eine ist. Das Tageslicht, Gerüche, die Hauswand, an der (...) wir entlanggehen und die wir nicht durchschreiten können diese unsere Lebenswelt unterscheidet sich zunächst nicht von der des Hundes, der uns begleitet. Tiere nehmen sinnlich wahr wie wir, sie erschrecken wie wir bei einem lauten Geräusch, sie zeigen dieselbe freudige Erregung wie wir. Zugleich gibt es für uns eine andere, wiewohl identische Welt, von der die Tiere offenbar nichts wissen: Wir Menschen machen die Dinge zu Objekten der Erkenntnis; dieselbe Sonne, die uns blendet und die sich im Tageslauf langsam von Osten nach Westen bewegt, steht, so erkennen wir, fest im Zentrum des Planetensystems. Wir spüren die Kälte, aber wir erkennen in ihr zugleich die Ursache der Eisbildung; kein Tier weiß, was eine Ursache ist, kein Tier kann sich wundern, und auch denken kann es nicht. These: Natürlich können Tiere denken. "Ach, Sie werden es nicht glauben, aber unser Leo versteht jedes Wort." Gegenthese: Natürlich können Tiere nicht denken. Es fehlen ihnen vor allem zwei Voraussetzungen des Urteilens und Denkens: Sie verfügen über keine geeigneten Begriffe, und sie kennen keine gemeinsame Öffentlichkeit, die durch das Zeigen geschaffen und im Urteil vertieft wird. (shrink)

This paper explores the cooperation mechanisms for the prisoner’s dilemma game, a canonical example for studying cooperation mechanisms, with Bayesian games. By the approach allowing simultaneous moves with the assumption that the players might be self-interested or norm-following, we establish four possible Bayesian game models, all of which are cooperation mechanisms for the prisoner’s dilemma game except for the model in which one of the two players must be self-interested.

本书包括:古朝鲜三国及统一新罗时期、高丽时期、朝鲜王朝(李朝)时期、近代时期四编。.

Natural selection is a general process that operates in different populations. To characterise natural selection as a mechanism within the framework of the new mechanistic philosophy, it is required to identify a pertinent phenomenon for which natural selection is responsible. Firstly, every case identified by evolutionary biologists as instances of natural selection must align with this mechanistic characterisation. Secondly, natural selection should genuinely be responsible for the attributed phenomenon. While philosophers often posit producing adaptation as the quintessential phenomenon, Pérez-González and (...) Luque challenge this perspective, contending that not all instances of natural selection are cases where natural selection produces adaptation. This paper further supports Pérez-González and Luque’s objection and demonstrates that natural selection is also not responsible for the increased frequency of traits with a greater expected number of offspring. Furthermore, the paper argues that even if there is a phenomenon that allows for the mechanistic characterisation of natural selection to encompass all instances, it is improbable that natural selection assumes responsibility for it. Consequently, characterising natural selection as a mechanism emerges as an implausible stance. (shrink)

本书研究了西方科学哲学中的八个主要问题,即:认知意义的判断标准、归纳与验证、科学说明模型及其问题、科学的发展模式、科学划界、科学实在论、科学与价值、社会科学哲学。.

Vādanyāya is one of the representative works of Dharmakīrti. It is concerned with debate logic and deals with win-or-lose reasoning rules in the broad sense of logic. In this paper, we will concentrate our discussion on Dharmakīrti’s theory of nigrahasthāna (fault) in his debate logic, a key issue in Vādanyāya. First, we point out that the justification of three logical reasons as proof conditions of debate constitutes the rational point of departure for Dharmakīrti’s debate logic. Second, we analyze the differences (...) between Dharmakīrti’s and the Naiyāyika’s notion of debate and point out that Dharmakīrti’s ‘debate’ involves two parties (the disputant and the opponent) attempting to rationally refute the other’s opinion to persuade the other to change their wrong ideas. Last, based on the discussion of Dharmakīrti’s concept of debate logic, we identify seven types of nigrahasthāna in Vādanyāya with regard to the two parties of a debate (the disputant and the opponent). (shrink)

分: 哲学与时代精神、现代自然科学与辩证唯物主义、马克思主义哲学与宗教等9个专题。.

This essay examines the depiction of French ragout in eighteenth-century English literature, arguing that the dish reflects social apprehension regarding ideological, cultural, and military conflicts between England and France. This essay first traces a brief history of ragout, along with an overview of the dish’s cultural connotation and complexity, in eighteenth-century English society. It next delves into the concept of eighteenth-century English Francophobia, demonstrating that this sentiment was a mixture of national pride and anxiety amid England’s identity crisis under the (...) potential French cultural threat. Finally, the essay examines ragout in eighteenth-century English literature and identifies the dish as the target of French pretension and cultural invasion. This research highlights the fact that eighteenth-century English authors’ satirical portrait of ragout underscored xenophobic gastronomy and cautioned against a simple interpretation of the dish. The caricature and representation of ragout as a feminized, artificial, and laughable dish reinforces eighteenth-century English writers’ concern for the invasion of foreign culture by emphasizing the contrast between authentic ‛Anglo’ meat consumption and ‛Franco’ sophistication. (shrink)

本书主要是针对我国当前改革建设的实践,运用马克思主义的哲学原理,加以深入的论述,特别是关于改革与社会心理、人的本质和人的价值、思维方式的变革、宗教等问题的论述、有新意、有深度。.

Why Lazarus Laughed explicates the essential doctrine shared by the traditions of Zen Buddhism, Advaita, and Tantra. Wei Wu Wei has become an underground spiritual favorite whose fans anxiously await each reissued book.

Why did Marx declare the revolution permanent? A careful examination of the celebrated passages from March 1850 in their immediate rhetorical context shows that he intended to affirm the tactical principles laid down earlier in the Communist Manifesto – as opposed to standard ‘anti-stagist’ interpretations that present the Permanenz locution of 1850 as a break with these principles. Among such principles: keeping eyes firmly fixed on the prize – the permanent final goal of a complete overhaul of society – is (...) essential to maintaining a proper perspective on history’s way-stations, that is, the necessary but subordinate revolutionary tasks and allies; and public declaration of the permanent goal is essential for preserving the independence of the workers’ movement and thus for carrying out the proletariat’s world-historical mission of creating a classless society. (shrink)

This commentary is an exploration of emotion by a therapist. It focuses on how emotion is managed in the stories of growing up and living with atypical sex anatomies—how (much) is emotion (not) discussed, and what are the effects of forestalling emotive dialogue. Emotion care in the narratives is often sidelined in favor of medical doings. Rather than creating a haven to keep normative pressures at bay, so as to enable the affected parents, adolecents and adults to process their situations, (...) some of the storytellers reveal how medicine has concentrated its efforts on the erasure and silencing of their bodily differences. The most frequently mentioned emotion management strategy is ‘stonewalling’, as some of the affected children and adults were silently left to take in what was reflected in the eyes of the large number of people inspecting their naked bodies. Emotional suffering continued for many years for some individuals. An apology might ease suffering but is rarely bestowed. Learning to become more comfortable with emotion may open up more possibilities for helpful conversations between care users and providers and within families. Feelings of joy became more available to the storytellers who as adults learned to embrace their differences and connected with like–minded people. (shrink)

Critical discussion of Lenin’s What Is to Be Done? is hindered by a series of historical myths. Issues such as the following need to be studied more empirically and more critically: Did the attitudes of early readers of WITBD? reflect Lenin’s alleged ‘worry about workers’? Did the events of 1905 cause Lenin to renounce his earlier views about the workers and about party-organisation, giving rise to disputes with Bolshevik activists? Did either Lenin or Trotsky ever rethink and reject the ideological (...) positions that Karl Kautsky defended before World-War I? These and related issues are addressed with close attention to source-material. (shrink)

Kautsky’s Road to Power was received in very different ways in Germany and Russia. In Germany, it earned Kautsky hostility from the trade-unionists on the right of the party and the radicals on the left. Later writers dismiss the book as preaching “revolutionary passivity.” In Russia, the Bolsheviks immediately seized on the book as an endorsement of specifically Bolshevik positions. After the war broke out, they used it to show that Kautsky was a renegade who did not live up to (...) his stated views. In the end, Road to Power helped inspire Kautsky’s greatest fans turned fiercest foes to make what he considered a tragic mistake: the October revolution. (shrink)

本书分“德治论坛”、“全球化与伦理问题论坛”、“青少年道德教育论坛”三部分,收录了“儒家伦理与道德义务的权利性条件”、“生命伦理学的前沿问题”、“荀子的生态伦理思想”、“科技时代性伦理问题的向度”等文 章。.