新生儿疼痛管理方法与培训现状

总结了目前新生儿疼痛管理方法与培训现状.疼痛管理方法包括非药物性止痛方法如口服蔗糖水、非营养性吸吮、襁褓包裹及袋鼠式护理等,药物镇痛如瑞芬太尼与丙泊酚用于小儿气管插管及其他;培训现状包括权威教科书上缺少关于新生儿疼痛管理知识、缺乏特异性调查问卷、缺乏专业师资及培训机构.认为在新生儿的治疗护理中医护人员要坚持科学的认识论,把握医学伦理学的要求,在日常的治疗护理中体现对新生儿的人文关怀,才能进一步提高医疗护理质量,达到医院与患者的双赢.     

Agency and pain: An exploration

The notion of agency has become particularly prominent in social‐science writing. This article identifies some of the weaknesses in the ways it has been employed in contemporary anthropology. It criticises the assumptions of self‐empowerment, responsibility, and constructivism that are held to be essential to moral agency in much of that usage. Present‐day conceptions of agency in this literature introduce—whether intentionally or not—a triumphalist vision of history. Drawing on recent neuro‐physiological research, religious history and ethnography, it focuses on pain in order to think about agency in other than triumphalist terms. Triumphalist versions of agency, the article argues, are not only inherently questionable, they also distract our attention away from the need to understand how different traditions articulate the idea of living sanely in a world that is inevitably painful.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

Focusing on Educational Outcomes

National education goals, content standards, and national tests are the hot topics of the day in educational reform. Special services personnel eventually will be faced with these issues, and can either be part of the discussion from the beginning, or wait and have to deal with someone else's decisions. In this article, we highlight some recent national and state educational reform activities and their probable implications for students with disabilities. We explain in brief the impetus behind the thrust toward an outcomesbased approach to education, and summarize the response of the National Center on Educational Outcomes for Students with Disabilities to this push. Possible ways in which special service providers can act to influence the focus on outcomes are described.     

Strategic and Automatic Threat Processing in Chronic Musculoskeletal Pain: A Startle Probe Investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear‐based mechanisms play an important role in attentional biases for pain‐related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear‐based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between‐group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.     

Theological and Ethical Reflections on Men and Violence: Toward a New Understanding of Masculinity

Abstract

This paper explores the reasons why men express violence against women, children and other men, suggesting that men's violence represents one of the darkest features of masculinity. The way men are socialized and conditioned requires and produces violent behaviors that are destructive to men themselves as well as to women, children, and the earth. The author proposes the need to re-envision masculinity to enable men and women to create communities in which people are encouraged to participate in ‘adventurous partnering for peace’.     

Alcohol Use,Problem Drinking and Health Risk Factors Among South African Youths

The aim of this study was to assess the prevalence and associated factors of problem drinking among South African youth (18–24 years). A cross-sectional population-based household survey was conducted using a multi-stage stratified cluster sampling approach. The total sample included 3123 participants (age range 18–24 years, 45.4% women) from four of nine provinces in South Africa. Results indicate that current alcohol was relatively more common among male (40.7%) than female youths (21.3%). Similarly, hazardous or harmful drinking was more prevalent among males (24.3%) than among women (12.9%). In multivariable analyses among men and women high on sexually permissiveness had hazardous or harmful alcohol use. Lifestyle including high peer pressure, and spending more nights away in a week were associated with hazardous or harmful alcohol use.     

临终患者不同救治态度的转归及影响因素分析

分析ICU终末期患者不同救治方式的临床转归及其影响因素。根据患者家属救治态度分为三组,1组明确要求积极救治;2组要求维持现有治疗;3组放弃所有治疗。结果发现积极还是放弃治疗的选择与患者家属经济状况明显相关,家庭经济条件较好的患者家属倾向于选择积极治疗,经济差者倾向于选择放弃治疗。1组患者ICU住院时间长、日均费用最高,...     

Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process

Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A “treatment responder” analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period.