如何减少医疗差错

医疗差错是危及医疗安全、制约医疗质量、影响医患关系、引发医患纠纷的核心问题,是医院管理的重点和难点.本文通过对医疗差错的分析和美国七大减少医疗差错的借鉴来探讨如何结合我国医院的实际来有效地减少医疗差错的发生.     

进行中任务加工类型对前瞻记忆TAP效应的影响

该研究采用基于双重任务的实验研究范式,采用双字词作为实验材料,考察了知觉和语义两种进行中任务加工类型对前瞻记忆TAP效应的影响。结果发现：进行中任务加工类型对前瞻记忆绩效的TAP效应有显著影响。当进行中任务为知觉加工时,前瞻记忆任务的绩效存在显著的TAP效应;当进行中任务为语义加工时,前瞻记忆任务绩效的TAP效应没有出现。     

Genetic Testing and Parkinson Disease: Assessment of Patient Knowledge,Attitudes, and Interest

The most common genetic contributor to late-onset Parkinson disease (PD) is the LRRK2 gene. In order to effectively integrate LRRK2 genetic testing into clinical practice, a strategy tailored to the PD population must be developed. We assessed 168 individuals with PD for baseline knowledge of genetics, perceived risk, and interest and opinions regarding genetic counseling and testing. Most participants felt that they were familiar with general genetics terms but overall knowledge levels were low, with an average score of 55%. The majority of participants thought it was likely they inherited a PD gene (72%), believed genetic testing for PD would be useful (86%), and were interested in genetic testing (59%) and genetic counseling (56%). However, only a few participants had heard of any genetic tests for PD (29%) or LRRK2 (10%). There appears to be a significant level of interest in genetics and genetic testing within the PD population, but a considerable deficit in genetics knowledge and an over-estimation of risk. Genetic education and counseling tools to address these needs were developed to provide patients with the ability to make informed and knowledgeable genetic testing decisions.     

Cortical electrophysiological network dynamics of feedback learning

Understanding the neurophysiological mechanisms of learning is important for both fundamental and clinical neuroscience. We present a neurophysiologically inspired framework for understanding cortical mechanisms of feedback-guided learning. This framework is based on dynamic changes in systems-level oscillatory synchronization, reflecting changes in synaptic plasticity between stimulus-processing and motor areas that are modulated in a top-down fashion by different areas of the prefrontal cortex. We make new and testable predictions for how large-scale cortical networks support learning from feedback. Testing these predictions may provide new insights into the basic mechanisms underlying learning and how these mechanisms may be impaired in clinical disorders in which feedback learning is compromised.     

Cognitive abilities in adolescent-limited and life-course-persistent criminal offenders

T. E. Moffitt's (1993a) hypothesis that adolescent-limited criminal offenders will have higher scores on tests of cognitive ability than life-course-persistent offenders was tested with 12 tests of cognitive ability given to a large and diverse sample of delinquent juveniles whose arrest records were collected over 20 years. This is the first investigation to empirically evaluate this proposal with longitudinal data obtained from a sample for a long enough time to distinguish life course patterns of crime. This study provided only partial support for Moffitt's hypothesis because the results varied by ethnicity. We found relatively consistent support for the hypothesis for Caucasians and Hispanics but no support for the hypothesis for African Americans. These findings are interpreted in terms of differences in developmental contexts for individual ethnic groups.     

Self-esteem, self-serving cognitions, and health risk behavior

The current article reviews prospective and experimental research on the relation between self-esteem and perceptions of vulnerability. These studies demonstrate that individuals with high self-esteem who engage in risk behavior often utilize a variety of self-serving cognitive strategies that protect them from fully acknowledging their vulnerability to the potential negative consequences of their behavior; e.g., they minimize their estimates of personal risk and overestimate the prevalence of the risk behavior among their peers. The article also provides data on an additional self-serving cognitive strategy employed by adolescents with high self-esteem--alteration of perceptions of others' reactions to their own risk behavior. Finally, the article reviews the emerging literature on the relation between these cognitive strategies and maladaptive health behavior, and proposes that whether these strategies are maladaptive depends on the nature of the threat and the availability of opportunities to engage in compensatory self-enhancement.     

Stressful life events, bipolar disorder, and the "kindling model"

A common misconception is that bipolar disorder is an endogenous process. However, previous research suggests a role for life events in the onset of and recovery from bipolar episodes. Yet, there remains some question as to whether the relationship between life events and onset changes over the course of the disorder as a result of the number of episodes an individual has experienced. Using a rigorous interview measure of stressful life events, the current study tested the kindling model (R. M. Post, 1992), which theorizes that major life events play a diminishing role over the course of illness in bipolar patients. Analyses revealed that the number of episodes experienced does not appear to have a significant effect on bipolar 1 patients' reactivity to external stressors. In addition, the results suggest that a more complex relationship exists among age, stress, and onset of new episodes than can be adequately explained by the kindling model.     

Stress and immune system function in a newspaper's newsroom

Data were collected on 10 newswriters in a newspaper's newsroom. These included self-reported stress ratings and saliva samples for secretary immunoglobulin A (IgA) analysis. The stress ratings and saliva samples were taken initially and after three 30-min. periods. The first time period was a baseline measure and involved the workers engaging in their usual tasks. At Time 2 music was presented for 30 min. while workers engaged in their normal activities. At Time 3 workers resumed their normal duties. Findings showed an increase in IgA that was not statistically significant, a reduction in stress during the music period that was statistically significant, and a statistically significant negative correlation between stress and IgA.     

Persistent neuroendocrine changes in multiple hormonal axes after a single or repeated stressor exposures

Many researchers have studied acute responses to stress in animals and how they are modified by prior stressor exposure, but relatively few have examined whether responses to stressors might last for prolonged periods of time. We have previously demonstrated that trough plasma corticosterone levels in rats are elevated for three to five days after single or repeated exposures to mild restraint and inescapable tailshock. The current study measured other aspects of the adrenal axis, and activity in other neuroendocrine systems, 24 hours after one or three consecutive exposures to the same stress paradigm. The data indicated persistent activation of the adrenal axis and prolactin levels, whereas the thyroid and reproductive hormone axes were inhibited after either one or three stress sessions. These changes are remarkable in that one would have expected acute responses to even intense stressors to have ended within hours after the end of the stressor. It will be important to understand the interactions among these responding neuroendocrine systems and to know how long such persistent changes last. Finally, it will be critical to understand the relative contributions of neuroendocrine and psychological factors in maintaining these persistent neuroendocrine changes after exposure to intense stressors.     

A cGMP-dependent protein kinase gene, foraging, modifies habituation-like response decrement of the giant fiber escape circuit in Drosophila

The Drosophila giant fiber jump-and-flight escape response is a model for genetic analysis of both the physiology and the plasticity of a sensorimotor behavioral pathway. We previously established the electrically induced giant fiber response in intact tethered flies as a model for habituation, a form of nonassociative learning. Here, we show that the rate of stimulus-dependent response decrement of this neural pathway in a habituation protocol is correlated with PKG (cGMP-Dependent Protein Kinase) activity and foraging behavior. We assayed response decrement for natural and mutant rover and sitter alleles of the foraging (for) gene that encodes a Drosophila PKG. Rover larvae and adults, which have higher PKG activities, travel significantly farther while foraging than sitters with lower PKG activities. Response decrement was most rapid in genotypes previously shown to have low PKG activities and sitter-like foraging behavior. We also found differences in spontaneous recovery (the reversal of response decrement during a rest from stimulation) and a dishabituation-like phenomenon (the reversal of response decrement evoked by a novel stimulus). This electrophysiological study in an intact animal preparation provides one of the first direct demonstrations that PKG can affect plasticity in a simple learning paradigm. It increases our understanding of the complex interplay of factors that can modulate the sensitivity of the giant fiber escape response, and it defines a new adult-stage phenotype of the foraging locus. Finally, these results show that behaviorally relevant neural plasticity in an identified circuit can be influenced by a single-locus genetic polymorphism existing in a natural population of Drosophila.