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201.
研究术后镇痛对创伤患者围术期细胞因子IL 6、TNFα和胰岛素抵抗(IR)的影响.选取60例患者,随机分为两组,A组患者应用一次性术后镇痛泵,加入舒芬太尼2.5μg/kg+盐酸托烷司琼4mg,用生理盐水稀释至100ml,2ml/h持续注入.B组患者为术后根据临床需要临时给予杜冷丁每次50mg~100mg肌肉注射,每日不超过3次.发现两组患者术后镇痛效果比较,A组患者舒适程度要优于B组,随访患者无与药物相关的不良反应.术后两组患者血浆IL-6、TNF-α水平均开始升高,术后12h左右达峰值,24h后开始回落,但均明显高于术前.血糖和血胰岛素值也在术后升高,术后24h左右达峰值,之后逐渐回落.ISI在术后开始降低,术后24h降到最低,之后逐渐回升,但均低于术前,说明IL-6、TNF-α水平升高与创伤后胰岛素抵抗有相关性.A组患者术后12h、24h、36h、48h的血糖、血胰岛素、IL-6、TNF-α水平与B组比较明显降低,而且术后48h基本可以恢复术前水平.应用舒芬太尼术后镇痛可以通过抑制血浆中IL-6和TNF-α水平,从而抑制围术期胰岛素抵抗,降低应激反应,从而达到减轻免疫抑制和降低或缩短IR时间的目的. 相似文献
202.
Tuckett D 《The International journal of psycho-analysis》2011,92(6):1367-1390
The underlying concern of this paper is that psychoanalysis as practised today is in danger of losing its specificity and so losing its way. The author suggests this is possible for three reasons: the problem analysts face in responding to the strong emotional demands the great majority of patients necessarily place on them, the unintended consequences of the apparent success of 'here and now technique' and the absence of good clinical theory. The paper mainly discusses the author's ideas about some core elements of the clinical theory that all psychoanalysts must use when they are working and proposes (at the risk of being facile) some relatively simple heuristics related to them which are meant to be helpful. Recalling Kurt Lewin's maxim that 'there is nothing so practical as a good theory', he will suggest that continuous reflection on how one is using theory in daily practice is highly practical, if the theory is good enough. Theory in fact is a necessary 'third' in psychoanalytic practice which, if kept in sufficient working order close enough to clinical experience, provides an ongoing and very necessary check on our sense of reality. But, of course, as a third it can, like reality itself, be the focus of both love and hate with equally problematic consequences. The paper starts with a clinical example of a difficult but apparently successful analysis reaching its end, which will be used throughout the paper to illustrate and elaborate the theoretical ideas set out. 相似文献
203.
Behavioral momentum theory provides a quantitative account of how reinforcers experienced within a discriminative stimulus context govern the persistence of behavior that occurs in that context. The theory suggests that all reinforcers obtained in the presence of a discriminative stimulus increase resistance to change, regardless of whether those reinforcers are contingent on the target behavior, are noncontingent, or are even contingent on an alternative behavior. In this paper, we describe the equations that constitute the theory and address their application to issues of particular importance in applied settings. The theory provides a framework within which to consider the effects of interventions such as extinction, noncontingent reinforcement, differential reinforcement of alternative behavior, and other phenomena (e.g., resurgence). Finally, the theory predicts some counterintuitive and potentially counterproductive effects of alternative reinforcement, and can serve as an integrative guide for intervention when its terms are identified with the relevant conditions of applied settings. 相似文献
204.
In Experiment 1, 4 pigeons were trained on a multiple chain schedule in which the initial link was a variable-interval (VI) 20-s schedule signalled by a red or green center key, and terminal links required four responses made to the left (L) and/or right (R) keys. In the REPEAT component, signalled by red keylights, only LRLR terminal-link response sequences were reinforced, while in the VARY component, signalled by green keylights, terminal-link response sequences were reinforced if they satisfied a variability criterion. The reinforcer rate for both components was equated by adjusting the reinforcer probability for correct REPEAT sequences across sessions. Results showed that initial- and terminal-link responding in the VARY component was generally more resistant to prefeeding, extinction, and response-independent food than responding in the REPEAT component. In Experiment 2, the REPEAT and VARY contingencies were arranged as terminal links of a concurrent chain and the relative reinforcer rate was manipulated across conditions. For all pigeons, initial-link response allocation was biased toward the alternative associated with the VARY terminal link. These results replicate previous reports that operant variation is more resistant to change than operant repetition (Doughty & Lattal, 2001), and show that variation is preferred to repetition with reinforcer-related variables controlled. Behavioral momentum theory (Nevin & Grace, 2000) predicts the covariation of preference and resistance to change in Experiments 1 and 2, but does not explain why these aspects of behavior should depend on contingencies that require repetition or variation. 相似文献
205.
Jonathan W. Pinkston R. J. Lamb 《Journal of the experimental analysis of behavior》2012,98(3):273-282
When given to pigeons, the direct‐acting dopamine agonist apomorphine elicits pecking. The response has been likened to foraging pecking because it bears remarkable similarity to foraging behavior, and it is enhanced by food deprivation. On the other hand, other data suggest the response is not related to foraging behavior and may even interfere with food ingestion. Although elicited pecking interferes with food capture, it may selectively alter procurement phases of feeding, which can be isolated in operant preparations. To explore the relation between operant and elicited pecking, we provided pigeons the opportunity to earn different reinforcer magnitudes during experimental sessions. During signaled components, each of 4 pigeons could earn 2‐, 4‐, or 8‐s access to grain for a single peck made at the end of a 5‐min interval. In general, responding increased as a function of reinforcer magnitude. Apomorphine increased pecking for 2 pigeons and decreased pecking for the other 2. In both cases, apomorphine was more potent under the component providing the smallest reinforcer magnitude. Analysis of the pattern of pecking across the interval indicated that behavior lost its temporal organization as dose increased. Because apomorphine‐induced pecking varied inversely with reinforcer magnitude, we conclude that elicited pecks are not functionally related to food procurement. The data are consistent with the literature on behavioral resistance to change and suggest that the effects of apomorphine may be modulated by prevailing stimulus—reinforcer relationships. 相似文献
206.
Contingent Resistances Methodology: Analyzing Resistance in Parents' and Daughters' Choice of an All‐Girl Middle School 下载免费PDF全文
Nancy J Bell Kimberly Corson Emilia Baron 《Journal of community & applied social psychology》2014,24(2):153-166
Contemporary perspectives on dominance and resistance as multifaceted and dialogical call for a similarly dialogical methodology, as reflected in Saukko's concept of contingent resistances. Compared to much of the past resistance research, contingent resistances sets forth an expanded vision of dialogicality in research design and in the interpretation of actor's meanings. Our purpose is to illustrate three implications of this methodology: (i) polyvocality—a comparison of perspectives of two groups of actors; (ii) consideration of the full range of meanings relevant to the action with particular attention to reactions from the local context; and (iii) interpretations of resistance that are firmly grounded in narrators' meanings. The analysis is based on interviews with parents and their young adolescent daughters about their decision to attend a new all‐girl college‐preparatory public school located in southwestern USA. Expanding on past studies of girls' school choice, we show how parents and daughters create different meanings of this decision, largely based on interactions with their peers. Although both parents and daughters emphasized academic opportunity as their main reason for the school choice, daughters, unlike parents, were confronted with violating peer femininity/heteronormativity norms. Thus, the decision required resistance on the part of daughters in a way that it did not for parents. We view contingent resistances as a useful methodological framework in a range of areas where questions of resistance are at stake. Copyright © 2013 John Wiley & Sons, Ltd. 相似文献
207.
《Journal of couple & relationship therapy》2013,12(3-4):95-101
SUMMARY This article articulates the major premises of Sheldon Z. Kramer's book, Transforming the Inner and Outer Family: Humanistic and Spiritual Approaches to the Mind-Body Systems Therapy(The Haworth Press, Inc., 1995). This overview briefly introduces and explains the power of meditation in psychotherapy, meditation and the use of the body, creating congruent communication, working with incongruence in couples and bridging the inner and outer couple. 相似文献
208.
《Cognitive behaviour therapy》2013,42(5):369-384
ABSTRACTClient motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing. 相似文献
209.
Leonard Shengold 《Scandinavian Psychoanalytic Review》2013,36(2):87-93
Some people are possessed by a need for, and an inordinate intensity of narcissistic promise. The prospect of entitlement can be conscious or unconscious. Being made happy (and being rescued from difficulties) is expected to be guaranteed and brought about by a current psychic representation (imago) of a parental figure from early childhood. This kind of symbiotic tie is illustrated by clinical material from a patient, and by two heroines of Ibsen's plays: Nora, from The Doll's House, and Hedda Gabler, from the play of the same name. The three women have different reactions to the non-fulfillment of what the patient called “THE PROMISE.” 相似文献
210.