团队合作对4838例居家癌痛患者疼痛管理的效果与思考

通过对大连医科大学附属第一医院宁养院2001年3月～2013年11月收治的4838例癌痛患者进行调查,总结归纳居家癌痛患者的疼痛控制情况,探索癌痛患者的疼痛管理方法,结果提示依靠团队合作在居家条件下免费向癌痛患者及其家属提供身体、心理、社会和精神全方位的照顾和支持,即理想的疼痛管理是“整体性疼痛”与“整体性痛苦”的治疗,不仅针对临床疼痛症状,还必须处理相关因素。     

晚期癌症患者家属的病情告知态度探究

本文采用自行设计的调查问卷,对200例晚期癌症患者家属进行问卷调查,以探讨晚期癌症患者家属对病情告知的态度。结果显示,认为病情应绝对保密者55例（27．5％）;暂时保密者107例（53．5%）;而不保密者38例（19．0％）。晚期癌症患者家属普遍采取“慈悲原则”,对患者病情持保密态度;癌症患者家属普遍缺乏病情告知策略。临床医生在执行知情同意时应该依据患者不同的家庭情况,有针对性地进行告知。     

临床检验科人文精神缺失及对策的思考

当今随着经济和社会的发展,在现有的医学教学模式、医疗体制和分配制度下,医院临床检验科越来越推崇医学技术主义和追求高额的经济利益,致使临床检验医生人文精神日益缺失,医生与患者之间最具人性的本质已被淹没,医患矛盾日益增加和凸显。如何以患者需求为导向,让患者满意,这迫切地需要在临床检验科加强人文素质教育,培育检验医生的“医者仁心”大医情怀,以减少和预防医患矛盾的发生,这是检验科管理者应该急需思考的问题。     

Psychoanalytic Psychotherapy for Severely Disturbed Borderline Patients: Observations on the Supervision Group of Psychotherapists

The authors describe the role of a supervision group of psychotherapists within a wider therapeutic field for severely disturbed borderline patients. The group concentrates on the transference and countertransference, seen according to Racker’s distinction between concordant and complementary identifications. The implications of the prevalence of the complementary identifications over the concordant identifications of the therapists to their patients and the resulting regression to primitive defense mechanisms can be counterbalanced by the group’s integrative functioning as receiver (1) of a variety of information about the patient, (2) of the therapist’s attempt to understand and synthesize, and (3) of the therapist’s countertransference reactions to his patient. The major discrepancies between the various conceptions of the borderline patients’ psychic world and the appropriate therapeutic technique to be applied are also discussed, as well as the way the group filters the information and integrates the therapeutic thought. It might be said, therefore, that, in the “inpatient” phase of the individual psychotherapy, the group of psychotherapists functions, for the patient and the treatment, in a synthesizing context, as it provides the therapist with a space of integration for his split-off part of self and object representations, which the therapist makes use of for his patient.*Members of the Athens University Project for Borderline Patients’ research team consisting of psychoanalysts and psychotherapists, Eginition Hospital, 74 Vas Sophias Avenue, Athens 11528, Greece.Maria Chatziandreou, M.D., is a member of the Hellenic Psychoanalytical Society.Haris Tsani, M.D., is a candidate of the Hellenic Psychoanalytical Society.Nikos Lamnidis, M.D., is a candidate of the Hellenic Psychoanalytical Society.Claire Synodinou, Ph.D., is a member of the Paris Psychoanalytical Society and an associate professor at Panteion University, Athens.Grigoris Vaslamatzis, M.D., is a training analyst of the Hellenic Society of Psychoanalytic Psychotherapy and an associate professor of psychiatry at Athens University.Address correspondence to: Maria Chatziandreou, M.D., 1-3, Skippi Street, 11525 Athens, Greece.     

职业精神与弱势病人

医学职业研究所对美国医生的现实行为的调查说明:医生们是相信且赞同职业精神在对待弱势病人方面的关键信条的;增强美国医生的职业精神的努力,也应该包括努力转变医生照顾弱势病人的行为方面。但是,增强职业精神的努力不仅要通过书本上的或理论上的教育,也应该包括致力于制定使医生更容易履行这些义务的实践政策,提供体制上的支持可使医生更容易做他们已经知道其应该做的行为。     

Social problem-solving in dual diagnosis patients

Social problem-solving skills among dual-diagnosis patients were compared to two control groups: psychiatric patients without substance abuse problems and community volunteers. A standardized, behavioral role-play test consisting of four scenarios representing interpersonal problems yielded two reliable dependent variables: (a) specificity, or elaboration, of the problem-solving response and (b) overall effectiveness of the response. Analyses of covariance (using a measure of intellectual function as the covariate) indicated that both dual-diagnosis patients and psychiatric controls were significantly poorer problem-solvers than were community controls. The overall pattern of the results indicated that deficits observed in a dual-diagnosis sample are not necessarily compounded due to the presence of the coexisting disorders. Implications of these findings, strengths and limitations of this study, and suggestions for future research are discussed.This research was supported in part by Grant DA04593-01 from the National Institute on Drug Abuse.Portions of this article were presented at the 22nd Annual Meeting of the Association for the Advancement of Behavior Therapy during November 1988 in New York.     

Does quality of sleep mediate the effect of depression on hopelessness?

The objectives of the study were to evaluate the relationship between sleep quality, depression, and hopelessness in advanced cancer patients and whether sleep quality mediated the effect of depression on hopelessness. The final sample consisted of 102 advanced cancer patients under palliative treatment. Patients completed the Greek Pittsburgh Sleep Quality Index, a sleep quality instrument, the Greek Beck Depression Inventory for measuring depression, and finally the Beck Hopelessness Scale. Patients' performance status was assessed by their overall physical functioning, as defined by the Eastern Cooperative Oncology Group. Depression was highly associated with hopelessness (r = .52, p<.001). Statistically significant associations were found between sleep quality with hopelessness (r = .37, p<.001), as well as with depression (r = .36, p<.001). Mediation analyses indicated that depression influenced hopelessness directly as well as indirectly by its effect on sleep quality. About 14.58% of the variation in hopelessness was explained by depression; 4% of the variance in hopelessness explained by depression was accounted for by the mediation pathway indicating that sleep quality mediated the relationship between depression and hopelessness. Similarly, in the reverse mediation analysis, depression mediated the relationship between sleep quality and hopelessness; 43% of the variation in hopelessness was explained by sleep quality. In conclusion, some of the effect of depression on hopelessness was mediated by sleep quality, but depression had a direct effect on hopelessness as well. Additionally, some of the effect of sleep quality on hopelessness was mediated by depression. The current findings are important because improving sleep quality by treating depression may contribute to decreased hopelessness scores and vice versa: Treating depression by improving sleep quality may also contribute to lower hopelessness scores.