Counseling Chemically Dependent Chronic Pain Patients in an Integrated Care Setting

This article identifies the chronic pain population and explores a holistic integrated approach to treatment and its appropriateness for counseling the chronic pain patient with substance use disorders.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.     

The Unmet Educational Agenda in Integrated Care

One of the reasons integrated care has not become a dominant service delivery model is the unmet training agenda. This article argues that the typical mental health professional is not trained to adequately address the challenges of integrated care. To insure competency both a macro and clinical training agenda are needed. At the macro-level, mental health professionals need to understand healthcare economics and basic business principles as any integrated care service delivery system is embedded and driven by economic forces. Integrated care practitioners also need some basic business skills to understand these forces and to create and manage a financially viable system, given the future flux of the system. Traditional mental health professionals also do not have the clinical skills to implement integrated care. Integrated care is not simply placing a traditionally trained mental health professional and letting them practice specialty mental health in a medical setting. Thus, the special skills needed in integrated care are enumerated and discussed. Finally, a new degree program is described as it is time given the huge need and advantages of integrated care to develop specialty training in integrated care.     

The Experience of Foster Care and Long-Term Attachment

Abstract

There are almost half a million children currently in foster care in the United States. The purpose of this paper is to study the linkage between foster care alumni and long-term attachment. In this qualitative study, six foster care alumni were interviewed. Nine themes emerged: trauma, stolen childhood, relationship style, trust issues, anxieties, current parenting concerns, broken system, coping strategies, and implications for counseling. The results of this study indicate that there are attachment implications for foster care alumni and that the experience of being in foster care was generally perceived as negative.     

Justice and Long-Term Care: A Theological Ethical Perspective

The relevance of justice for the current debate on long-termcare is explored on the basis of demographic and economic data,especially in the U.S. and Germany. There is a justice questionconcerning the quality and availability of long-term care fordifferent groups within society. Mapping the justice debateby discussing the two main opponents, John Rawls and RobertNozick, the article identifies fundamental assumptions in boththeories. An exploration of the biblical concept of the "optionfor the poor" and its influence on a new "ecumenical socialteaching from below" leads to the conclusion that a Christianethical account of long-term care will argue for a system thatguarantees decent care to every citizen. The German model ofSoziale Pflegeversicherung is presented as one possible optionfor putting this ethical guideline into political practice.In a final reflection, the role of religious affiliation forlong-term care is discussed by looking at empirical data andby naming seven dimensions of faith-driven long-term care.     

Primary Care and Clinical Psychology: Assessment Strategies in Medical Settings

There is ample evidence regarding medical-psychological comorbidity to consider clinical psychology as a viable component of health care services in medical settings. Psychologists can become valuable assets to primary care physicians who treat a high number of primary psychiatric cases as well as medical cases with secondary psychological symptoms. Psychologists who function in hospital-based clinics as well as affiliates with primary care (PC) offices can provide empirically supported assessment services that can make treatment more effective and efficient. Multiple studies indicate high prevalence rates of psychiatric patients in PC settings using various instruments. This paper reviews selected assessment tools that have established diagnostic validity and reliability that can be both strategic for patient care and useful to reinforce psychologist collaboration with primary care physicians (PCP).     

伦理关怀与社区管理

社会结构在变化 ,我们的思想理念及社会有效管理也必须随之变化。社区是社会公民生养栖息的主要场所 ,又是一定生活群体的精神共同体的培养凝聚基地 ,更重要的是社区在现代已发展为社会管理中新的基层平台。伦理关怀在社区管理中的更多介入 ,在探索新的社会管理模式方面 ,尤其在凝聚整合社会向心力方面发挥着重要作用。     

The Accuracy of the DSM-IV Pain Disorder and the ICD-10 Persistent Somatoform Pain Disorder in Chronic Pain Patients

Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems.Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant evidence of a mixed psychosomatic condition.Conclusion. The results suggest a broad somatoform classification, with subgroups based on personality characteristics taking a stress—coping model into account, including interpersonal attachment behaviour. An alternative model of a diagnostic approach is presented.     

Pain,Care, and the Body: A Response to de Vignemont

Frédérique de Vignemont argues on the basis of several empirical counterexamples that Bain and Klein are wrong about the relationship between pain and bodily care. I argue that the force of the putative counterexamples is weak. Properly understood, the association between pain and care is preserved in a way that is consistent with both de Vignemont's own views and the empirical facts.     

Listening to People with Dementia: A Pastoral Care Perspective

SUMMARY

Pastoral and Spiritual Care approaches to the reduction of depression in residential aged care facilities are considered. They are examined through specific one-to-one pastoral care, through a pastoral care person in the team approach to care and through a one-to-many relationship for group spiritual and religious activities. The suggestions in this article are offered as extensions to a manual, Challenge Depression, on managing depression in residential aged care as a way of including pastoral and spiritual care as part of an integrated approach and as part of a stand alone approach of pastoral care.     

卫生技术评估在医疗领域的开展

介绍了卫生技术评估的基本概念以及对医疗卫生领域的影响,并指出在开展评估过程中应注意的几个问题。     

医院药学服务与人文关怀

医院药学服务是医院医疗服务中的重要组成部分,药师在医院人文服务中起着重要作用。本文阐述了人文关怀在医院药学服务中的实施,指出药师在日常工作中的每个环节都要为患者提供充满人文关怀的服务,并指出了现在医院药学服务的人文关怀中存在的困难及解决办法。     

加强管理，改善流动人口卫生保健服务利用

为改善流动人口卫生保健服务利用水平,通过现场调查、焦点组访谈和二级资料提取等定性定量研究方法收集上海流动人口卫生保健服务利用情况的资料。在对上海流动人口卫生保健服务利用现状、存在的问题和利用障碍进行了分析的基础上,提出了加强管理,改善流动人口卫生保健服务利用的8项建议。     

Guidelines to Integrate Spirituality and Spiritual Care in Occupational Therapy Education: A Modified Delphi Study

This modified Delphi study aimed to develop educational guidelines for integrating spirituality and spiritual care into occupational therapy education. The first round comprised a self-administered questionnaire, the second round used a face-to-face workshop, and last round reviewed the developed educational guidelines, which reached the highest agreement and median values greater than 3.25. A panel of 18 comprised occupational therapy educators, clinicians, and nursing experts were recruited. A total of 126 out of 142 items reached the highest agreements from the panel participants, categorized based on the content knowledge-based, importance, skills, ethics, pedagogical approaches, teaching and learning strategies, and assessment of student learning.     

Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development

Critical-care decision making is highly complex, given the need for health care providers and organizations to consider, and constructively respond to, the diverse interests and perspectives of a variety of legitimate stakeholders. Insights derived from an identified set of ethics-related considerations have the potential to meaningfully inform inclusive and deliberative policy development that aims to optimally balance the competing obligations that arise in this challenging, clinical decision-making domain. A potential, constructive outcome of such policy engagement is the collaborative development of an as-fair-as-possible dispute resolution process that incorporates an appropriated-justified, defensible critical-care obligation threshold.     

医患间的人际冲突与管理策略

医患间人际冲突是影响医患关系的重要因素,它对医患关系不仅能够产生消极的结果,还能够产生建设性的结果。分析了医患间人际冲突的本质、来源、影响以及冲突管理策略,旨在促进人们通过理解冲突的本质和产生的原因,实行有效的冲突管理策略,使冲突得到建设性解决,促进良好的医患关系的建立。     

Preventing Depression Among Early Adolescents in the Primary Care Setting: A Randomized Controlled Study of the Penn Resiliency Program

This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events. PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to previous PRP studies and research on the dissemination of psychological interventions. An erratum to this article is available at .     

Pain intensity and pain unpleasantness in triathletes: A study examining their associations with pain catastrophizing and pain expectations

ObjectiveTriathletes represent a growing and unique population of individuals willing to endure significant mental and physical stress to practice the sport they love. However, little is known about the pain experienced while training for and competing in a triathlon and how psychological factors influence this experience. This study will assess pain experienced by triathletes in training and competition, and investigate the association between pain catastrophizing and pain expectations with triathlon pain intensity and pain unpleasantness.DesignIn this observational study, a sample of 261 triathletes completed two online surveys before and after participating in a triathlon.ResultsModerate levels of pain intensity and pain unpleasantness were reported during training and competition. Pain catastrophizing was positively associated with expected and actual triathlon pain unpleasantness, but not with pain intensity. Expected pain intensity was also significantly associated with pain intensity experienced while competing, whereas expected pain unpleasantness was significantly related to both triathlon pain intensity and unpleasantness. Finally, regression analysis revealed pain catastrophizing and pain expectations to be unique predictors of triathlon pain intensity and pain unpleasantness.ConclusionThis study highlights the important role of psychological factors in triathletes' experience of pain and could eventually help tailor interventions aimed at improving the practice of triathlon.     

Optimal Scoring of the Multidimensional Pain Inventory in a Chronic Pain Sample

The Multidimensional Pain Inventory (MPI) is one of the most commonly used self-report instruments in pain settings. The MPI can be used to classify patients into three clusters or its nine scales can be treated as dimensions in efforts to understand patient heterogeneity. Previous research suggests the existence of a fourth cluster, whose members have been labeled ‘repressors,’ that emerges with the addition of a defensiveness scale to the MPI. The current paper compared the abilities of MPI cluster and dimensional models with and without a measure of defensiveness to capture variability in validating variables related to personality, psychopathology, physical functioning, and treatment outcome in a chronic pain sample. Results suggest that dimensional models consistently outperform cluster models in explaining variance in outcome variables, and that the addition of a measure of defensiveness increments the validity offered by the MPI scales. Implications for the assessment of pain patients are discussed.