Ethical and Professional Challenges Posed by Patients with Genetic Concerns: A Report of Focus Group Discussions with Genetic Counselors, Physicians, and Nurses

Ninety-seven physicians, nurses, and genetic counselors from four regions within the United States participated in focus groups to identify the types of ethical and professional challenges that arise when their patients have genetic concerns. Responses were taped and transcribed and then analyzed using the Hill et al. (1997, Counsel Psychol 25:517–522) Consensual Qualitative Research method of analysis. Sixteen major ethical and professional domains and 63 subcategories were identified. Major domains are informed consent; withholding information; facing uncertainty; resource allocation; value conflicts; directiveness/nondirectiveness; determining the primary patient; professional identity issues; emotional responses; diversity issues; confidentiality; attaining/maintaining proficiency; professional misconduct; discrimination; colleague error; and documentation. Implications for practitioners who deal with genetic issues and recommendations for additional research are given.     

Treating Depression in Older Medical Patients with Psychotherapy

This purpose of this paper is to discuss the effectiveness of psychotherapy for treating depression in older, primary care patients. This paper highlights the feasibility of implementing psychotherapy in primary care settings, patient preference for psychotherapy, and the utility of primary care versions of therapy in treating depression in older adults. The discussion is supported with examples from three ongoing research projects, specifically the San Francisco General Hospital Depression in Late Life Study, the Hartford Foundation/California Healthcare Foundation IMPACT study, and the NIMH PROSPECT study. The findings presented here support the value of offering psychotherapy as a treatment alternative in primary care medicine.     

Mechanical knowledge does matter to tool use even when assessed with a non-production task: Evidence from left brain-damaged patients

In the literature on apraxia of tool use, it is now accepted that using familiar tools requires semantic and mechanical knowledge. However, mechanical knowledge is nearly always assessed with production tasks, so one may assume that mechanical knowledge and familiar tool use are associated only because of their common motor mechanisms. This notion may be challenged by demonstrating that familiar tool use depends on an alternative tool selection task assessing mechanical knowledge, where alternative uses of tools are assumed according to their physical properties but where actual use of tools is not needed. We tested 21 left brain-damaged patients and 21 matched controls with familiar tool use tasks (pantomime and single tool use), semantic tasks and an alternative tool selection task. The alternative tool selection task accounted for a large amount of variance in the single tool use task and was the best predictor among all the semantic tasks. Concerning the pantomime of tool use task, group and individual results suggested that the integrity of the semantic system and preserved mechanical knowledge are neither necessary nor sufficient to produce pantomimes. These results corroborate the idea that mechanical knowledge is essential when we use tools, even when tasks assessing mechanical knowledge do not require the production of any motor action. Our results also confirm the value of pantomime of tool use, which can be considered as a complex activity involving several cognitive abilities (e.g., communicative skills) rather than the activation of gesture engrams.     

罕见病患者的权利保障：论争与辨析

充分保障罕见病患者是国家文明程度的重要体现。尽管各国通过法律和制度,力促罕见病患者平等医疗权的实现,但由于发病率低导致治疗成本高,患者权利仍难获保障。学界围绕是否要保障及如何保障展开了激烈论争。当代西方学者的研究集中于：如何优先保障罕见病患者的平等医疗权,让社会接受罕用药低成本效益的正当性。他们提出以平等原则、营救原则取代成本效益原则进行资源分配,或跨越实体公正原则,遵循程序公正原则。这些辩护与尝试虽未让各国各界达成共识,但为罕见病患者权利保障研究提供了伦理指引与道德基础。

     

明清文本对痨病病人社会形象的建构

痨病作为一种慢性传染性疾病,其在明清时的社会形象不仅与今日不同,且在不同文本中的形象亦有差别。既有辛劳过度、内心抑郁难解、感情忠贞不二等正面形象,又有会传染给他人、需要常年被照顾、纵欲过度等负面形象。明清医学认为痨病的病因多样,且痨病的传染性有其独特的传染逻辑,使得多样的痨病病人形象成为可能。通过对明清不同文本中痨病病人形象的解构,认为书写者在书写文本时,自由选择了更能凸显其书写目的的痨病病人形象。这也启示我们,今日应当破除笼罩在病人周围的重重意义之网,关心病人的疾痛和体验。

     

癌症患者满意度测评：层面理论的应用

目的：探讨癌症患者的满意度状况,构建癌症患者满意度量表,以期为癌症病人的临床心理干预提供参考依据。方法：应用层面理论构建癌症患者满意度量表,对85例癌症病人进行调查,将所得数据进行统计分析。结果：层面理论可以用于患者满意度调查;患者满意度结构呈柱状分布。结论：基本完成了癌症患者满意度评定量表的设计和编制。     

癌症病人的生活质量及心理干预研究

本研究在前期研究的基础上进一步探讨癌症病人的生活质量状况和心理干预的效果。运用病例对照实验设计 ,选用生活质量问卷 (QLQ C3 0 )作为主要测查工具 ,采用两因素混合实验方差分析统计方法 ,对 1 2 0名住院化疗病人进行了比较分析。结果显示 :躯体功能 (PF)、角色功能 (RF)、情绪功能(EF)、认知功能 (CF)和整体生活质量 (QL)得分在治疗前后和实验与对照组之间的交互作用均显著和非常显著 ;症状量表和单项症状中交互作用显著和非常显著的有 :疲乏 (FA)、呼吸困难 (DY)、失眠 (SL)、食欲丧失 (AP)。因此 ,化疗对病人的生活质量有明显的影响 ,经心理干预后癌症病人的各种功能状况和症状得到不同程度的改善。     

Attentional distractor interference may be diminished by concurrent working memory load in normal participants and traumatic brain injury patients

A reduction in congruency effects under working memory (WM) load has been previously described using different attentional paradigms (e.g.,  and ). One hypothesis is that different types of WM load have different effects on attentional selection, depending on whether a specific memory load demands resources in common with target or distractor processing. In particular, if information in WM is related to the distractors in the selective attention task, there is a reduction in distraction (Kim et al., 2005). However, although previous results seem to point to a decrease in interference under high WM load conditions (Kim et al., 2005), the lack of a neutral baseline for the congruency effects makes it difficult to differentiate between a decrease in interference or in facilitation. In the present work we included neutral trials in the task introduced by Kim et al. (2005) and tested normal participants and traumatic brain injury patients. Results support a reduction in the processing of distractors under WM load, at least for incongruent trials in both groups. Theoretical as well as applied implications are discussed.     

Bullying among mentally‐ill patients detained in a high‐secure hospital: an exploratory study of the perceptions of staff and patients into how bullying is defined

The present study is the first to explore patient‐to‐patient bullying within a secure psychiatric hospital housing mentally‐ill patients. Its main aim was to provide an outline of the perceptions held by both patients and staff with regards to patient‐to‐patient bullying as opposed to providing an objective study of bullying. The total sample comprised 104 participants, 44 patients and 60 staff. These were sampled from wards housing male patients and wards housing female patients. All participants took part in a semi‐structured interview based on that developed by Ireland and Ireland [2003] and Ireland [2005, 2004]. One quarter of participants stated they had seen a patient being bullied in the previous week, with staff perceiving a higher extent of bullying than patients. Differences between wards were minimal. It was predicted that theft‐related bullying would be reported most frequently, that staff would identify a wider range of bullying behaviours than patients and that direct forms of aggression would be identified more readily as bullying than indirect forms. All predictions were supported. Problems in attempting to obtain a definition of bullying were also identified, with participants operating broader definitions than those found in the school‐based literature. For example, bullying was not generally considered a repeated form of aggression, the severity of the aggression or provocative behaviour of the victim were not defining features, and it was felt bullying could be accidental. In summary, the current study highlights how patient‐to‐patient bullying does occur in services housing mentally‐ill patients and that researching the behaviour may require the adoption of broader hospital‐specific definitions of bullying. Aggr. Behav. 32:1–13, 2006. © 2006 Wiley‐Liss, Inc.     

Determinants and Barriers to Participation in an Internet Based Recovery Program for Cardiac Patients

Patients hospitalized for coronary heart disease were offered a home recovery program utilizing the Internet. About one-half of the patients interviewed chose to enlist in this program. Participants and non-participants did not differ significantly according to medical risk and diagnostic factors, lifestyle and some demographic variables (principally marital status, sex, and race). However, those who owned personal computers and/or were familiar with the Internet, who were in higher socioeconomic strata, and were younger than age 65 were strongly more likely to participate. Internet instruction and computers (for those who had none) were provided to participants. Those who were lent computers—29% of the program participants—were more often female, without any college training, and less confident about using the Internet. As the public becomes increasingly more familiar with personal computer technology these potential barriers to its use may eventually disappear. The present study evaluated a fairly resolute method to introduce an Internet program to many recovering patients who were unfamiliar with this technology. However, other innovative and perhaps more aggressive ways of making those most in need of such valuable health-related information and resources can be tested in the near future.