Psychosocial knowledge and allopathic medicine: Points of convergence and departure

The past 15 years have witnessed a call for allopathic medicine to incorporate psychosocial perspectives into education and clinical practice. While a biopsychosocial perspective has influenced academic medicine in areas such as primary care and psychiatry, its direct impact on clinical medicine has been questionable. One barrier to the incorporation of psychosocial information into medicine which has only recently received attention has been different cultural assumptions which govern medicine versus the social-behavioral sciences. These assumptions are examined in the context of four issues: knowledge paradigms, models of education, acculturation of psychosocial knowledge into medicine, and patient autonomy. This cultural analysis provides a vantage point for understanding similarities as well as points of divergence between psychosocial and biomedical knowledge and practice.     

Cognitive function after open-heart surgery: Are postoperative neuropsychological deficits caused by cardiopulmonary bypass?

Despite the many technological developments in arterial perfusion and cardiac surgical procedures, open-heart surgery is still believed to pose a significant risk for cerebral injury. There are several potential causes of brain damage during open-heart surgery, including prolonged or severe arterial hypotension, as well as emboli emanating from the cardiopulmonary bypass circuit or the operative field. This article reviews the available neuropsychological studies of outcome following cardiac valve replacement and coronary artery bypass grafting. Because both procedures are life-saving operations, the research in this area has been quasi-experimental and fraught with methodological problems. Nonetheless, the findings converge to suggest that cognitive dysfunction occurs after open-heart surgery, and that the deficits are attributable, at least in part, to factors specific to the operation or to the patient being maintained on cardiopulmonary bypass. Preliminary findings suggest that embolization is the primary cause of perioperative deficits in uncomplicated operations. Studies have also consistently found preoperative deficits in this population, suggesting that neuropsychological dysfunction is caused by severe chronic cardiac disease as well as open-heart surgery.     

Local and global factors of similarity in visual search

Effects of the similarity between target and distractors in a visual search task were investigated in several experiments. Both familiar (numerals and letters) and unfamiliar (connected figures in a 5 × 5 matrix) stimuli were used. The observer had to report on the presence or absence of a target among a variable number of homogeneous distractors as fast and as accurately as possible. It was found that physical difference had the same clear effect on processing time far familiar and for unfamiliar stimuli: processing time decreased monotonically with increasing physical difference. Distractors unrelated to the target and those related to the target by a simple transformation (180° rotation, horizontal or vertical reflection) were also compared, while the physical difference was kept constant. For familiar stimuli, transformational relatedness increased processing time in comparison with that fort unrelated stimulus pairs. It was further shown in a scaling experiment that this effect could be accounted for by the amount of perceived similarity of the target-distractor pairs. For unfamiliar stimuli, transformational relatedness did have a smaller and less pronounced effect. Various comparable unrelated distractors resulted in a full range of processing times. Results from a similarity scaling experiment correlated well with the outcome of the experiments with unfamiliar stimuli. These results are interpreted in terms of an underlying continuum of perceived similarity as the basis of the speed of visual search, rather than a dichotomy of parallel versus serial processing.