Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention

Patients’ expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients’ expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients’ expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists’ fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients’ expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients’ disability expectations and patients’ personal control expectations was moderated by patient’s level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients’ expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients’ health following cardiac surgery.     

“病人选医生”是推动医院改革的重大突破

随着卫生部《关于实行病人选医生促进医疗机构内部改革的意见》文件的下发,病人选医生已经成为加快医疗卫生机构改革的一个重大突破;具体分析它在深化医疗卫生机构改革过程中实现了几个方面的重大突破：一是病人选医生是建立新型的医患关系的重大突破;二是确立“以病人为中心”的服务模式的重大突破;三是建立一种新型的评价体系的重大突破;四是建立新型医疗劳动个人收入分配制度的重大突破。     

心理干预在放疗患者中的应用

探讨通过实施恰当的心理行为治疗,尤其是教育性干预措施,达到改善放疗患者情绪、提高其生活质量以及降低治疗负反应的效果.采用病例对照的临床研究方法,选用生活质量和心境问卷对160名正在进行放射治疗的住院癌症病人进行了心理干预的比较研究.结果表明,干预组患者的总体情绪和总体生活质量状况,比对照组患者有明显的改善,但愤怒、认知功能以及恶心呕吐症状在两组间的差异不显著;干预组组内比较中,角色功能没有显著性差别.其原因有待于进一步研究.     

Advance Directives Outside the USA: Are They the Best Solution Everywhere?

This article evaluates the potential role of advance directives outside of their original North American context. In order to do this, the article first analyses the historical process which has promoted advance directives in recent years. Next, it brings to light certain presuppositions which have given them force: atomistic individualism, contractualism, consumerism and entrepreneurialism, pluralism, proceduralism, and American moralism. The article next studies certain European cultural peculiarities which could affect advance directives: the importance of virtue versus rights, stoicism versus consumerist utilitarianism, rationalism versus empiricism, statism versus citizens' initiative, and justice versus autonomy.The article concludes by recognising that autonomy has a transcultural value, although it must be balanced with other principles. Advance Directives can have a function in certain cases. But it does not seem adequate to delegate to advance directives more and more medical decisions, and to make them more binding everyday. It is indispensable to develop other decision-making criteria.     

A MULTIPLE-BASELINE ANALYSIS OF SOCIAL-SKILLS TRAINING IN CHRONIC SCHIZOPHRENICS

Social-skills training was applied to two male chronic schizophrenics. Component behaviors of social skill requiring modification were identified for each patient by rating videotapes of role-played interactions. Training involved instructions and feedback for one subject and instructions, feedback, and modelling for the second. Target behaviors were treated sequentially and cumulatively in a multiple-baseline format. Training was applied for both positive and negative assertion and for situations involving males and females. The results were positive for all behaviors for both patients. Follow-ups at 2, 4, 6, and 8 weeks after training indicated that most effects were maintained at near-treatment levels.     

BIOFEEDBACK,AUTOGENIC TRAINING,AND PROGRESSIVE RELAXATION IN THE TREATMENT OF RAYNAUD'S DISEASE: A COMPARATIVE STUDY

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26° to 17°C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. Results indicated that all patients improved during the first four weeks of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of the training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.     

Clinical Frequencies Recording System: Standardizing staff observations by event recording

Certain aspects of staff performance and resident behavior are less adequately assessed by standardized time sampling procedures than by complete recording of the incidence of specified events. An approach to gathering such data through systematizing the observations of clinical staff — the Clinical Frequencies Recording System — is described. Scores from the Clinical Frequencies System reflect the rate per opportunity with which individual behaviors are performed, with computer summarization providing higher-level behavioral indexes for research and evaluation purposes. Staff training and system implementation are discussed, and reliability and validity data from a system employed on two different treatment units over a period of several years are presented.The research reported in this article was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

危重病人的权利

危重病人作为较特殊的病人,其种种权利因病情、行动和医院等方面的原因,使得实现起来困难,我国正是因为医院管理,医疗制度和伦行等原因使危重病人的权利的行使存在了许多障碍。     

脑外伤患者记忆功能的双重特征：损伤与保存

该研究探讨了中─重型闭合性脑外伤患者及对照被试（各１７名）在对单个汉字不同水平的加工后,其外显记忆（自由回忆、再认）和内隐记忆（汉字补笔起动效应）的若干特点。发现：患者组外显记忆受损而内隐记忆正常;两组被试在深层意义加工中的外显记忆均强于在浅层表面加工中的外显记忆,这种语义易化现象以耗费更多的认知努力为代价,其中患者组耗费的尤多,而记忆效率却不及对照组。综上,脑外伤患者记忆功能呈损伤和保存双重性。