Danger and safety: The analyst as analytic subject

Abstract

This paper considers questions of danger and safety in the analytic relationship in light of the contemporary recognition of analysis as a co-participatory process. In the interest of safety, the psychoanalyst has the responsibility to be persistently curious, particularly about the problems derived from his contact with the analysand. Information about the analyst's impact must be taken to heart; it must be experientially considered. As the process unfolds, the analyst presumes that a portion of its effect will be negative. The analyst aspires not to preempt all negative impact but to create an analytic environment in which the analysand's conscious and unconscious communications about impact may be attended to. The analyst's ability to receive such information is crucial in the establishment of a reliable process capable of addressing and surviving the unanticipated dangers that inevitably emerge and securing the analysand for further self articulation. The analyst can simultaneously attend to being the analyst and being a subject of analysis by regarding all communications from the analysand as representing, at least in part, interpretations of the analyst and the analyst's participation. Illustrative material is presented.     

红色标识腕带在急诊危重患者安全管理中的应用

为使急诊危重症患者得到及时、快捷、有效的救治,确保急救绿色通道畅通,保证医疗护理安全,2007年7月起,我院急诊科开展了“红色标识腕带”服务.凡佩戴红色标识腕带的急诊危重患者在院内接受就诊、挂号、缴费、检查、治疗、用药、用血、手术、住院等一系列流程中,享有全程优先特权.红色标识腕带的应用不仅起到了准确的身份识别的作用,更增强了医护人员的急救服务意识,尤其缩短了危重患者的急诊等候时间,有效地减少了纠纷,提升了抢救成功率,提高了医院整体的急诊工作效率和急救服务水平,在急诊安全管理中具有非常重要的意义.     

Effects of listening to music, and of using a handheld and handsfree telephone on cycling behaviour

The effects of listening to music on cycling behaviour were evaluated. Twenty-five participants completed a track on a bicycle while listening to music with two standard earbuds, with one earbud, and with two in-earbuds. Conditions with high tempo music and loud volume were also included in the experiment, as were two mobile phone conditions, one in which participants operated the phone hand held and one handsfree condition.Cycle speed was not affected by listening to music, but was reduced in the telephone conditions. In general the response to auditory signals worsened when participants listened to music, in particular when listening with in-earbuds loud auditory stop signals were missed in 68% of the cases. However, when listening with only one standard earbud performance was not affected. In the conditions when participants listened to high volume and to high tempo music, the auditory stop signal was also heard in significantly fewer cases. Completing a task on the mobile phone, using both handheld and handsfree sets, resulted in increased response time to an auditory stop signal and also reduced overall auditory perception. Furthermore, handsfree operation only had minor advantages opposed to hand held operation, with only response time to an auditory stop signal resulting in faster performance. This is likely to be related to the fact that both hands could be used for braking.It is concluded that listening to music worsens auditory perception, in particular if in-earbuds are used. Furthermore, both handheld and handsfree operation of mobile phones has a negative effect on perception, potentially forming a threat to cyclist traffic safety.     

When technology tells you how you drive––truck drivers’ attitudes towards feedback by technology

Behavior based safety approaches have proven effective in reducing accidents in industrial settings, but cannot easily be extended to commercial driving. For considerable periods of working time, truck drivers are alone, and do not interact with peers. It might be possible to use data gathered by new in-vehicle technology to provide real-time and post-shift feedback to drivers about their driving behavior. This paper reports the results of focus group interviews conducted with subject matter experts from the trucking industry (truck drivers, supervisors, managers, and other involved persons, such as insurance industry safety professionals). The focus groups discussed safety critical behaviors in commercial driving, the best way to provide feedback to truck drivers, and benefits of feedback by technology as well as concerns drivers and operators may have regarding monitoring and feedback systems. The focus group discussions showed that, in general, drivers would like to receive more feedback and that feedback by technology is acceptable, if designed and implemented properly. In addition, the participants had many suggestions on how to properly design and implement such systems.     

单纯胰腺移植是治疗1型糖尿病的最终选择吗

单纯胰腺移植作为一种治疗尚未出现严重并发症的1型糖尿病的方法尚未在临床上普及,目前它还面临着众多的制约因素,导致其发展非常缓慢,就临床单纯胰腺移植的现状、存在的问题以及相关思考进行阐述.     

论药物治疗安全：药疗错误的科学定位与安保革新

面对越来越多的最普遍的一种医疗错误—药物治疗错误,以及由此带给患者的身体损害和经济损失,必须对药疗错误进行科学定位和对患者安全保障体系与措施的革新。本文不在于详尽地论述药疗错误和安保的革新,而是通过对药疗错误的科学定位,提出对药疗错误的预防优先和以医者与患者为中心的药疗安全保障,强调重在研究和应用与药疗安全问题相关的健康信息技术和改变认知与处理药。总的认为:关于药疗安全与药疗错误,执行安全措施的障碍和改善药疗管理的当前和可能的机制以及我们应当知道什么和可以怎样做为好。     

安全文化的内容、影响因素及作用机制

安全文化研究反映了现代安全管理向社会控制的发展。大多研究在态度与价值观水平上采用问卷调查的方式研究安全文化,也称安全气氛研究,不同研究中安全文化的维度结构差异很大;另一种研究取向则主张采用各种定性方法研究组织现象背后的基本意会。民族文化、生产特点与组织环境等因素都对安全文化产生影响,而安全文化则通过个体变量影响组织的安全绩效。该文进一步分析了研究分歧的原因以及组织水平研究中变量整合水平问题。文章认为,应该采用三角方法来测量安全文化,弄清它的原因及结果,以指导安全管理实践。     

The tendency of drivers to pass other vehicles

The purpose of this study was to assess the speed differential threshold—if there is one—at which drivers decide to pass a lead vehicle. Drivers in a simulator encountered vehicles in front that were programmed to travel at speeds that were similar, slightly below, or even slightly above the drivers’ own speed. The study involved a total of 152 such passing opportunities. In almost all of the encounters with slower vehicles (traveling at speeds slower than 3 km/h of the driver) they passed them, and in two thirds of the encounters when the lead vehicles were moving at their speed they passed them too. Most surprising was that in 50% of the encounters drivers passed the lead vehicle when it was traveling faster than their average speed. In these situations drivers actually increased their own speed substantially to accomplish the passing maneuver, despite the fact that not passing the lead vehicle would not have caused any delays. The tendency to pass appears to be related to the drivers’ own speed variability: the more variable the driver’s speed the more likely he or she was to pass the vehicle ahead even when its speed was greater than their average speed. The results are interpreted in terms of (a) driver aggression, and (b) association of car following with added effort, attention overload, or risk. The latter explanation implies that the tendency to pass vehicles may be reduced with the introduction of in-vehicle technologies such as adaptive cruise control.     

Exploring the beliefs underpinning drivers’ intentions to comply with speed limits

Using the theory of planned behaviour (TPB; [Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl, J. Beckmann (Eds.), Action control: From cognition to behavior (pp. 11–39). Berlin: Springer-Verlag.]) as a theoretical framework, the present study was designed to: (a) identify the beliefs underpinning drivers’ intentions to comply with speed limits, and (b) test the expectancy-value theory held to underpin those beliefs. A sample of drivers (N = 598) completed questionnaires designed to measure TPB variables with respect to compliance with speed limits. The results of hierarchical multiple regression analyses provided support for the expectancy-value theory held to underpin each behavioural beliefs (outcome beliefs X outcome evaluations), normative beliefs (referent beliefs X motivation to comply), and control beliefs (control frequency beliefs X control power beliefs). Belief targets for road safety countermeasures that aim persuade drivers to comply with speed limits were also identified by selecting those beliefs that were the statistically significant predictors of direct TPB measures (attitudes, subjective norm, perceived control) and intention. Theoretical and practical implications of the results are discussed.     

介入手段与病人安全

卫生保健背景下,影响病人安全有4个基本要素或环节:规范做法、产品、操作和系统。这4个环节中任一出错,都会对病人安全带来直接的损害或不良影响,对它们进行有效控制就会使医疗错误降低到最低限度,使病人获得最大化的安全和收益。探讨介入诊疗手段在这4个方面对病人安全的潜在威胁。