误诊误治病例所致医疗纠纷分析——附3例报告

当前医疗科技发展的相对性、疾病规律本身的复杂多变性、医生医疗知识的局限性等,导致了临床误诊误治的不可避免性,而医院发生的医疗纠纷事件中,大多是由于误诊误治所致。通过对3例误诊病例及所致医疗纠纷的分析,指出临床误诊误治的客观性、主观性及不可避免性。同时提示临床医师在疾病诊治过程中,随时更新医疗知识,注意疾病的鉴别诊断,及时完善相关的辅助检查,积极治疗,减少对疾病的延误诊治,减轻病人痛苦,改善医患关系,从而减少医疗纠纷。     

无痛人流不同麻醉的比较

为了更好地实行无痛人流,提高无痛人流的镇痛效果、降低麻醉风险及提高患者满意度,用比较治疗学的理念及方法对目前国内报道的一些主要无痛人流的麻醉方法进行比较和分析。结果发现镇静药丙泊酚与强效镇痛药复合应用于无痛人流安全有效。比较治疗学方法有助于无痛人流不同麻醉的临床抉择。     

团体心理咨询对提高大学生自信心的效果研究

本研究探讨了团体心理咨询在提高大学生自信心方面的作用。我们精心设计了团体心理咨询活动的过程,并在活动前后用五种量表对团体成员进行了测量。通过分析量表测量结果及其他定性研究方法,我们发现：（１）团体心理咨询可以有效地提高大学生的自信心。（２）团体心理咨询在发展性目标上也是有效的。本研究结果对今后的团体心理咨询研究及其应用具有一定的参考价值。     

Equivalence relations and the reinforcement contingency

Where do equivalence relations come from? One possible answer is that they arise directly from the reinforcement contingency. That is to say, a reinforcement contingency produces two types of outcome: (a) 2‐, 3‐, 4‐, 5‐, or n‐term units of analysis that are known, respectively, as operant reinforcement, simple discrimination, conditional discrimination, second‐order conditional discrimination, and so on; and (b) equivalence relations that consist of ordered pairs of all positive elements that participate in the contingency. This conception of the origin of equivalence relations leads to a number of new and verifiable ways of conceptualizing equivalence relations and, more generally, the stimulus control of operant behavior. The theory is also capable of experimental disproof.     

Effects of methylphenidate on sensitivity to reinforcement in children diagnosed with attention deficit hyperactivity disorder: an application of the matching law

The behavior of children diagnosed with attention deficit hyperactivity disorder (ADHD) has been hypothesized to be the result of decreased sensitivity to consequences compared to typical children. The present study examined sensitivity to reinforcement in 2 boys diagnosed with ADHD using the matching law to provide more precise and quantitative measurement of this construct. This experiment also evaluated the effects of methylphenidate (MPH) on sensitivity to reinforcement of children with ADHD. Subjects completed math problems to earn tokens under four different variable-interval (VI) schedules of reinforcement presented in random order under both medicated and nonmedicated conditions. Results showed that, in the medicated condition, the matching functions for both subjects resulted in higher asymptotic values, indicating an overall elevation of behavior rate under these conditions. The variance accounted for by the matching law was also higher under the medicated conditions, suggesting that their behavior more closely tracked the changing rates of reinforcement while taking MPH compared to placebo. Under medicated conditions, the reinforcing efficacy of response-contingent tokens decreased. Results are discussed with respect to quantifying behavioral changes and the extent to which the drug interacts with prevailing contingencies (i.e., schedule values) to influence behavioral variability.     

Human choice in concurrent ratio-interval schedules of reinforcement.

Seven undergraduates participated in a concurrent-choice experiment with monetary reinforcers. Response-independent analogues of variable-interval and variable-ratio schedules were used to assess whether subjects would maximize reinforcement rate. The optimal pattern of behavior, in terms of maximizing reinforcement rate, involved a large bias toward the ratio alternative, with only occasional sampling of the interval schedule. Most experiments with pigeons, however, demonstrate matching of response rates to reinforcement rates, with only slight biases for the ratio schedule. Although subjects in the present experiment allocated more time to the ratio alternative than required by matching, the magnitude of the bias did not approximate that predicted by a maximizing account. After exposure to clock stimuli correlated with the operation of each schedule, 1 subject's behavior did show a substantial level of bias, increasing the total number of reinforcers obtained, and lay at a point between the predictions of matching and maximizing. The other subjects, however, continued to respond less optimally. The present results can be accounted for by a view of matching that incorporates the effects of delayed reinforcement.     

Formation of transitivity in conditional matching to sample by pigeons

Four homing pigeons were trained over 5 months in a zero-delay, “arbitrary” matching-to-sample procedure with sample and comparison stimuli presented on any of three response keys. Birds were also required to complete a fixed-ratio 10 requirement on both sample and comparison stimuli to terminate their presentation. The procedure resulted in the establishment of relations that were not specifically trained and that can be characterized by the property of transitivity in a stimulus equivalence context. This result was in contrast with the findings obtained from most previous research with nonhuman subjects.     

Beyond the logic of Lemma: the oneness of life and its environment,the oneness of within and without

In this paper the ‘analyst as a citizen in the world’ is understood as the analyst interconnecting and harmonising with his or her environment, including not only society, but also nature and the universe. In this sense, Buddhism teaches the Oneness of Life and its Environment, and links are made between Mahayana Buddhism and Jung's understanding of the Self and individuation. The Logic of Lemma in the Flower Ornament Sutra indicates that all phenomena in the world can merge with each other without losing individuality; ten stages are described from the Lotus Sutra and links are made with the development in respect to the ego; Kenji Miyazawa and his work are given as examples to illustrate this. Causality and synchronicity are explored in terms of the interaction between the individual and the environment, and three examples are given where sometimes individual, egoic, causality is more of a feature and sometimes synchronicity has a greater prominence. The paper ends with an examination of tree drawings, made over a period of 50 years by junior high school students, which indicates the way that these individuals have portrayed themselves and their relation to their environment.     

Cultural identity in Siberia and in analytical practice

This paper discusses the main features of Siberian identity formed throughout the historical development of Siberia under the influence of social, economic, geographical, climatic, and other factors. Siberian cultural identity is closely connected with the mythology and ancient religion of the indigenous peoples of Siberia – shamanism, whose rituals, images, symbols, and motifs are often manifested in the clients’ dreams. Following an in‐depth study of Siberian history and culture, I formulate a complex of homelessness rooted in a deep collective trauma that left its imprint on people’s psyche. Three clinical cases presented in the paper reveal a deep relationship between cultural complexes and collective traumas on the one hand, and individual complexes and traumas, on the other. My psychotherapeutic practice shows that a client’s awareness of their history and culture brings them closer to the meaning and source of their suffering, which, in turn, helps them find their own way of individuation, rather than relive the transgenerational trauma of their ancestors.