THE ‘OTHER 23 HOURS’: SPECIAL PROBLEMS OF PSYCHOTHERAPY IN A ‘SPECIAL’ HOSPITAL

In this paper, I describe and discuss the complexities of being a therapist in a maximum security forensic psychiatric hospital, working with patients who have committed acts of serious violence, and who also suffer from severe mental illness and personality disorders. I suggest that profound disturbances in the patient's inner world get played out in triangular disputes between the patient, the therapist and other professionals working in the hospital. I also describe how real events in the life of the institution impact on the therapeutic process, and the importance for the therapist of reflection on the ‘other 23 hours’ that the patient lives outside of therapy. Finally, I raise some ethical dilemmas that arise for therapists working in such settings, where the stated therapeutic aim is not only treatment but also the containment and prevention of future violence.     

中西医糖尿病分型分期对治疗学指导作用比较

糖尿病已成为一种严重威胁公众健康的疾病，其发病率、病死率和致残率均高。本文通过比较中西医学糖尿病的分型分期对治疗学的指导作用，探讨中西医结合更好地防治糖尿病的可行性。中医强调整体观念和针对个体的辩证论治。而西医强调群体化治疗并能迅速改善代谢紊乱，中西医结合发挥各自的优势可以有效地进行糖尿病及其并发症的治疗。     

TIME FOR LOVE: The Place of Marriage and Children in the Thought of Stanley Hauerwas

In essays written throughout his career, Stanley Hauerwas has unfolded a Christian vision of the marriage bond and the presence of children that seeks insistently to place these seemingly natural bonds within the new family of God that is the church. I examine his understanding, aiming to appreciate the Christian vision displayed while also suggesting that his emphasis on the new thing God does in the church is sometimes allowed to absorb and thereby lose the distinctive significance of the created bonds of marriage and family.     

Special Treatment? Flexibilities in the Politics of Regenerative Medicine’s Gatekeeping Regimes in the UK

ABSTRACT

Emerging flexibilities are apparent in gatekeeping regimes applicable to regenerative medicine products, raising issues about the extent to which and forms in which such flexibilities might promote emerging products as a sector warranting special treatment, in the context of recent policy developments in the UK and wider European Union. Concepts of ‘gatekeeping’, ‘gatekeeping regimes’ and ‘gateways’ can point to the ways in which regulatory institutions, health technology assessment organisations, and national planners and purchasers of health services together define and control entry to the medical product marketplace and the adoption of products into the public health-care system. Flexibilities in existing regimes and new gateways are a way of maintaining ‘connection’ between gatekeeping regimes and technoscientific innovation in order to steer innovation pathways. The gateways concept has affinity with that of Callon’s ‘obligatory passage points’. A wide set of recent policy documents show that the measures promoted exhibit a range of alternative gateways that are being constructed around central, legal, restrictive gatekeeping regimes. However, it would be easy to overestimate the significance of these developments as relaxations that would favour innovative producers and their products on a large scale with wide public health impacts. The concepts of gatekeeping regimes and gateways enable understanding of hybrid developments of exceptions and exemptions to dominant regimes which bridge across the arenas of market regulation, health technology assessment and health-care system planning. These arenas are being drawn closer together as a means of politically managing stakeholders’ aims in the UK, EU and other innovating biomedical health systems globally.     

Rhythmic Auditory Music Stimulation increases task-distraction during exercise among cardiac rehabilitation patients: A secondary analysis of a randomized controlled trial

ObjectiveThe aim of this study was to determine the mechanisms by which Rhythmic Auditory Music Stimulation (RAMS) improves exercise among patients participating in cardiac rehabilitation.Methods168 English speaking patients over the age of 18 years, were recruited from the Cardiac Rehabilitation and Prevention Program. Participants were randomly assigned to one of three groups (n = 56 each) as part of a 12-week intervention: (1) RAMS (2) preference-based audiobooks, or (3) white noise or silence audio-controls. All participants received an iPod with the audio intervention to maintain blinding. Study outcomes included pace-deviation between actual vs. prescribed exercise, self-reported arousal, perceived exertion, task-attentiveness during exercise and perceptual experiences associated with the audio-content itself.Trial registryClinicaltrials. gov NCT02946060.ResultsAn individual's actual exercise pace was highly correlated with their prescribed exercise pace, with no significant differences in pace deviation across interventions (P = 0.61). Patients randomized to RAMS or audiobooks reported significantly lower arousal scores during exercise (P = 0.01), lower exercise-attentiveness (P < 0.001), and modestly lower perceived exertion (P = 0.06) during exercise than did controls. Participants assigned to RAMS and audiobooks reported being more attentive to, and happy with, their overall audio-experiences during exercise than controls (P < 0.001).ConclusionsRAMS playlists and audiobooks induced a mood-enhancing task-distraction effect during exercise. Such findings may underscore the potential benefits of preference-based audio-content during exercise.     

基于模式分类的中医医案分析技术

中医药经历数千年的发展,已积累了大量数据,特别是从古到今的医案数据,但这些数据因没有用现代信息手段整理、分析,而不能为中医药的科学研究提供支持。本文将模式分类技术应用于医案数据的分析中,从已知的病症推断出所属的证型。该方法能够进行自动学习,不需要专家的辅助即可从医案中学习到病症和证型的联系。     

Global Diversification in Medicine Regulation: Insights from Regenerative Stem Cell Medicine

ABSTRACT

Medicine regulation worldwide has undergone a process of regulatory diversification. The evidence-based medicine (EBM) paradigm, centered on multi-phase randomized controlled trials, is increasingly contested and replaced by new models of clinical validation. To explain these changes, STS research has cited just a few factors, e.g. growing pressure form health consumers; the role of pharmaceutical companies to lobby for fast, affordable drug development; the influence of neoliberal ideas and libertarian advocacy of deregulation; and the agency of national governments to enable domestic innovation opportunities in the context of global competition and inequalities. Those factors individually cannot account for the increasing variation in medicine regulation at both national and global levels. Instead it is helpful to integrate elements of existing explanations into a framework with four pairs of conflicting regulatory choices, which play a central role in the formation of medicine regulation. We use this framework to compare regulatory changes in the USA, European Union, China, India, Argentina, and Japan. Across these jurisdictions, the case studies illustrate four dynamics of diversification. Key regulatory concepts such as evidence, risk, safety, efficacy, responsibility and accountability acquire different meanings, reshaping medicine innovation in far-reaching and often contradictory ways. The boundaries between medical research and healthcare provision, commerce and humanitarian service, as well as state control and medical self-regulation are re-defined.     

Surface electromyography-based biofeedback and knee rehabilitation: A review of the literature

The number of total knee arthroplasties (TKA) performed yearly is rapidly increasing. Additionally, upwards of 50% of patients who receive TKA never achieve a full functional recovery. This suggests considerable room for improvement. This need for improvement expands beyond TKA as similar effects are noted across knee injuries. Electromyography-based biofeedback (EMGBF) involves the delivery of feedback based on the activity of targeted muscle. By providing feedback contingent on changes in muscle amplitude, EMGBF may be an effective tool for strengthening quadricep muscles. This review aims to evaluate the utility of sEMGBF during physical therapy for various knee injuries. All studies were evaluated for the effectiveness of sEMGBF at improving muscle strength, range of motion, and reducing pain. Most studies reviewed found that including sEMGBF in physical therapy produced greater clinical benefits for patients than exercise alone. Further research is necessary to determine the best practice for including EMGBF in physical therapy.     

Alter-Standardizing Clinical Trials: The Gold Standard in the Crossfire

ABSTRACT

The international landscape of medical research is in the midst of a process of diversification and change. The randomized controlled trial (RCT), long considered the global gold standard for clinical research, has become increasingly contested and is partly replaced by alternative methodologies, standards and forms of evidence. The contours of mainstream medical research are changing as a result. Regulatory paradigms and standards are, literally, being rewritten, at a global level. The evidence-based medicine (EBM) hierarchy of evidence is redefined. This special issue explores these developments through the concept of ‘alter-standardization’. The term refers to the processes, controversies and negotiations through which multiphase RCTs and the EBM system are challenged and gradually superseded by alternative methodological and regulatory forms and standards. This special issue examines the conceptual, practical and theoretical implications of these changes, and the ways in which these transformations influence the situation and possibilities of patients, knowledge producers, physicians, large pharmaceutical corporations, smaller biotech companies, as well as regulatory bodies, civil societal organizations and national health care systems. The articles in this special issue make use of comparative and historical perspectives that focus on scientific, social, economic and regulatory developments in the European Union, China, India, Japan, Argentina, the UK and the USA. They show that the alter-standardizing of clinical trials arises in a pluralistic way, that is driven by a variety of often conflicting factors, developments and expectations. These changes reflect a broad transformation in the culture and politics of biomedicine today, with implications for the ways in which new medicinal products, devices, procedures and technologies are developed, approved for clinical use, sold to consumers, and licensed by health care systems.