对影响病人满意度相关因素的医学伦理思考

设计调查问卷对深圳某基层医院实施病人满意度调查及相关因素的医学伦理分析。结果显示病人满意度不高,门急诊病人的总满意度明显低于住院病人;病人对服务态度、就医环境和诊疗费用等都较不满意。其中医院未能遵循及时、准确、有效、择优和自主原则是主要影响因素。     

Elaboration et validation de tests de jugement situationnel comme outil de sélection professionnelle : guide méthodologique

Current views in personnel selection recognize the necessity for situational judgements tests (SJT) which are closed to the real work context of companies. The SJTs have also become a popular selection tool across Europe. SJTs are attractive because they show good validity, positive applicants reactions and can be cost effective to test large group of applicants at once. The aim of this paper is to describe a structured methodology for the elaboration of such test. Each stage is illustrated by examples and psychometrics validation issues are discussed.     

Bion’s discovery of alpha function: Thinking under fire on the battlefield and in the consulting room

This paper has traced Bion’s discovery of alpha function and its subsequent elaboration. His traumatic experiences as a young tank commander in World War I (overlaid on, and intertwined with, childhood conflicts) gave him firsthand exposure to very painful emotions that tested his capacity to manage. Later, in the 1950s, after his analysis with Melanie Klein and marriage to Francesca Bion, he undertook the analysis of psychotic patients and learned how they disassembled their ability to know reality as a defense against unbearable emotional truths in their lives. This led Bion to identify an aspect of dreaming that was necessary in order for reality experience to be given personal meaning so that one may learn from experience. Simultaneous with working out this new theory of dreaming, Bion also revisited his World War I experiences that had remained undigested and all these elements coalesced into a selected fact – his discovery of alpha function. In subsequent writings, Bion explored the constituent factors of alpha function, including the container/contained relationship, the PS?D balance, reverie, tolerated doubt and other factors which I have termed the ‘Constellation for Thinking’.     

Understanding alexithymia within a psychoanalytical framework

The object of this paper is to provide a metapsychological definition of alexithymia as described in 1967 in terms of operational thinking and negative hallucination. This is a familiar and established concept in the fields of psychopathology, psychology, and of clinical and psychosomatic medicine. From a psychoanalytic and psychosomatic point of view, the term is conceptually close to P. Marty's “operative thinking”, as described in 1963, even though we know they do not belong to the same epistemological field: on one hand Neuroscience, Psychiatry and the objectalization of the symptom at different levels, and on the other, as regards mechanical functioning, a psychoanalytic clinical approach within the dynamics of the relationship between transference and counter‐transference. The present authors consider that Freudian metapsychology, as now complexified by Andrè Green, allows for a metapsychological approach to alexithymia insofar as it relates to Marty's operative thinking. Thus does Green’s conceptualization of the mother’s negative hallucination, of negative introjection, of a psychically ‘dead (and insecure) mother’, now provide us with the opportunity to describe, in metapsychological terms, the genesis of this particular mode of psychical functioning. Given the mother’s negative hallucination produces a host structure as a background to negativity that will fit future object representations, we will assume that in the case of … future operational or alexithymic …?, this negative hallucination will pathologically and defensively involve the endo‐psychic perception of affect.     

Effects of Nonverbal Behavior on Perceptions of a Female Employee's Power Bases

Abstract

The authors extended a previous examination of the effects of nonverbal behavior on perceptions of a male employee's power bases (H. Aguinis, M. M. Simonsen, & C. A. Pierce, 1998) by examining the effects of nonverbal behavior on perceptions of a female employee's power bases. U.S. undergraduates read vignettes describing a female employee engaging in 3 types of nonverbal behavior (i.e., eye contact, facial expression, body posture) and rated their perceptions of the woman's power bases (i.e., reward, coercive, legitimate, referent, expert, credibility). As predicted, (a) direct eye contact increased perceptions of coercive power, and (b) a relaxed facial expression decreased perceptions of all 6 power bases. Also as predicted, the present results differed markedly from those of Aguinis et al. (1998) regarding a male employee. The authors discuss implications for theory, future research, and the advancement of female employees.     

Providing compensation promotes forgiveness for replaceable,but not irreplaceable,losses

ABSTRACT

The present study aimed to examine how the replaceability of a loss moderates the effectiveness of compensation. In Study 1, we sampled real-life experiences of experiential loss, material loss, or loss of materials to which the victims had special attachment, and assayed subsequent feelings toward the transgressor who caused the loss. The results showed that for those who reported losses of an experience or cherished material object, perpetrators’ offers of compensation did not facilitate forgiveness. In Study 2, by manipulating replaceability of hypothetical losses in vignettes, we showed that compensation for replaceable losses effectively elicits forgiveness from a victim, but compensation for irreplaceable losses is ineffective. A series of mediation analyses showed that the effect of replaceability on forgiveness is explained by the victim’s perception of whether their loss was sufficiently recovered. We discuss the function of compensation and its inherent limitations.     

Children’s rights and the non-identity problem

Abstract

Can appealing to children’s rights help to solve the non-identity problem in cases of procreation? A number of philosophers have answered affirmatively, arguing that even if children cannot be harmed by being born into disadvantaged conditions, they may nevertheless be wronged if those conditions fail to meet a minimal standard of decency to which all children are putatively entitled. This paper defends the tenability of this view by outlining and responding to five prominent objections that have been raised against it in the contemporary literature: (1) the identifiability objection; (2) the non-existence objection; (3) the waiving of rights objection, (4) the lack of legitimate complaint objection; and (5) the unfairness objection.     

The "Perceptual Wedge Hypothesis" as the basis for bilingual babies' phonetic processing advantage: new insights from fNIRS brain imaging

In a neuroimaging study focusing on young bilinguals, we explored the brains of bilingual and monolingual babies across two age groups (younger 4-6 months, older 10-12 months), using fNIRS in a new event-related design, as babies processed linguistic phonetic (Native English, Non-Native Hindi) and nonlinguistic Tone stimuli. We found that phonetic processing in bilingual and monolingual babies is accomplished with the same language-specific brain areas classically observed in adults, including the left superior temporal gyrus (associated with phonetic processing) and the left inferior frontal cortex (associated with the search and retrieval of information about meanings, and syntactic and phonological patterning), with intriguing developmental timing differences: left superior temporal gyrus activation was observed early and remained stably active over time, while left inferior frontal cortex showed greater increase in neural activation in older babies notably at the precise age when babies’ enter the universal first-word milestone, thus revealing a first-time focalbrain correlate that may mediate a universal behavioral milestone in early human language acquisition. A difference was observed in the older bilingual babies’ resilient neural and behavioral sensitivity to Non-Native phonetic contrasts at a time when monolingual babies can no longer make such discriminations. We advance the “Perceptual Wedge Hypothesis” as one possible explanation for how exposure to greater than one language may alter neural and language processing in ways that we suggest are advantageous to language users. The brains of bilinguals and multilinguals may provide the most powerful window into the full neural “extent and variability” that our human species’ language processing brain areas could potentially achieve.     

Training the brain: fact and fad in cognitive and behavioral remediation

Putatively safe and effective for improving cognitive performance in both health and disease, products purported to train the brain appeal to consumers and healthcare practitioners. In an increasingly health-centered society, these applications constitute a burgeoning commercial market. Sparse evidence coupled with lack of scientific rigor, however, leaves claims concerning the impact and duration of such brain training largely unsubstantiated. On the other hand, at least some scientific findings seem to support the effectiveness and sustainability of training for higher brain functions such as attention and working memory. In the present paper we provide a tectonic integration and synthesis of cognitive training approaches. Specifically, we sketch the relative merits and shortcomings of these programs, which often appeal to parents who must choose between side-effect-laden medication and other less conventional options. Here we examine how neuroplasticity allows the healthy as well the impaired to benefit from cognitive training programs. We evaluate the evidence and consider whether brain training can be a stand-alone treatment or an adjunct to pharmacotherapy, outline promising future prospects, and highlight what training outcomes are plausible in line with available data. Future research would determine whether the field of brain training realizes its potential to revolutionize education and rehabilitation or withers away engulfed in controversy.     

Insights into spared memory capacity in amnestic MCI and Alzheimer's Disease via minimal interference

Impairment on standard tests of delayed recall is often already maximal in the aMCI stage of Alzheimer's Disease. Neuropathological work shows that the neural substrates of memory function continue to deteriorate throughout the progression of the disease, hinting that further changes in memory performance could be tracked by a more sensitive test of delayed recall. Recent work shows that retention in aMCI patients can be raised well above floor when the delay period is devoid of further material - 'Minimal Interference'. This memory enhancement is thought to be the result of improved memory consolidation. Here we used the minimal interference/interference paradigm (word list retention following 10 min of quiet resting vs. picture naming) in a group of 17 AD patients, 25 aMCI patients and 25 controls. We found (1) that retention can be improved significantly by minimal interference in patients with aMCI and patients with mild to moderate AD; (2) that the minimal interference paradigm is sensitive to decline in memory function with disease severity, even when performance on standard tests has reached floor; and (3) that this paradigm can differentiate well (80% sensitivity and 100% specificity) between aMCI patients who progress and do not progress to AD within 2 years. Our findings support the notion that the early memory dysfunction in AD is associated with an increased susceptibility to memory interference and are suggestive of a gradual decline in consolidation capacity with disease progression.