The being a patient effect: negative expectations based on group labeling and corresponding treatment affect patient performance

Patient studies provide insights into mechanisms underlying diseases and thus represent a cornerstone of clinical research. In this study, we report evidence that differences between patients and controls might partly be based on expectations generated by the patients’ knowledge of being invited and treated as a patient: the Being a Patient effect (BP effect). This finding extends previous neuropsychological reports on diagnosis threat. Participants with mild allergies were addressed either as patients or control subjects in a clinical study. We measured the impact of this group labeling and corresponding instructions on pain perception and cognitive performance. Our results provide evidence that the BP effect can indeed affect physiological and cognitive measures in clinical settings. Importantly, these effects can lead to systematic overestimation of genuine disease effects and should be taken into account when disease effects are investigated. Finally, we propose strategies to avoid or minimize this critical confound.     

家属参与授权教育对老年原发性高血压伴同型半胱氨酸血症患者管理中的应用

探讨家属参与授权教育对老年原发性高血压伴同型半胱氨酸血症患者的干预效果.选取120名老年原发性高血压伴同型半胱氨酸血症患者,随机分成试验组和对照组,每组60名,两组均采取相同的药物治疗,给予常规的授权教育模式.试验组在此基础上给予家属参与授权教育模式,为期6个月.试验组与对照组比较,总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（Hcy）及血压值低于对照组,差异有统计学意义（P＜0.05）;试验组的生存质量及满意度评分均高于对照组,两组差异有统计学意义（P＜0.05）.经过为期6个月的健康教育干预,这一模式取得了较好的效果.     

病耻感对于精神病患者的影响以及文化对策

本文分析三种类型歧视所造成的患者及其家属的痛耻感,论述我们应当如何利用适当的文化应对策略来消除歧视、减少病耻感,从而有效地克服病耻感对于患者及其家属的负面影响。文化差异与病耻感的形成直接相关,文化作为一个重要变量,影响着精神卫生问题以及相应的服务政策,深入研究和认识儒家文化的核心价值有助于减少对于精神病患者的歧视,帮助他们克服病耻感。中国道家文化推崇道法自然,无为而治,可以发展出有效的心理疗法,对于精神疾病是一剂对症的良药。     

Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.     

The utility of McGill pain questionnaire subscales for discriminating psychologica disorder in chronic pain patients

Abstract

The practice of separately scoring the sensory, affective and evaluative suhscules of the McGill Pain Questionnaire has not bccn unequivocally supported hy rcsearch, While there is moderate support for the three-factor Structure of this scale, recent studies have revealed strong intercorrelations among these factors and have not supported thcir differential predictive ahility. Present factor analytic results provide support for solutions involving a global factor in conjunction with either two or three subscale factors. The differential relationships of the sensory and affective factors to the Minnesota Multiphasic Personality Inventory and Zung Dcpression Inventory demonstrate support for the validity of separately scoring the two factors in chronic pain patients. Preliminary guidelines are provided for the clinical use of the MPQ to discriminate psychological disorder in chronic pain patients.     

Psychological factors in hiv testing among sexually transmitted disease clinic patients: An exploratory study

Abstract

Substantial numbers of persons at risk for HIV infection do not seek HIV testing and factors influencing testing decisions are not well understood. To identify psychological characteristics of persons who remain unwilling to receive HIV testing, we surveyed patients of an inner-city sexually transmitted disease (STD) clinic (n = 181). Participants completed an anonymous survey and were grouped on the basis of HIV testing history and compared on measures of testing perceptions, attitudes, and decision making influences. Results showed that untested participants feared testing and had a sense of not knowing if they needed to be tested. In contrast, participants who were getting tested believed that testing would help them feel better about their health. Results also showed that participants lacked accurate information about some HIV testing procedures. We conclude that identifying concerns which inhibit seeking HIV testing can be useful in developing effective methods of promoting HIV testing.     

对急危重症患者家属签署知情同意书中不同意的病例回顾分析

分析在急危重症患者中签署知情不同意的原因,探讨对策.选择我院2010年6月1日～2011年12月30日在ICU抢救已出院归档的急危重症患者家属签署的600份知情同意书中52份不同意的病例进行分析总结.52份病例的知情同意书签字不同意,原因多方面.知情不同意是患者或家属的权力,如何保障更好行使此权利,同时保障其健康是医务人员努力的目标,也需要对出现的问题进一步探讨.     

红色标识腕带在急诊危重患者安全管理中的应用

为使急诊危重症患者得到及时、快捷、有效的救治,确保急救绿色通道畅通,保证医疗护理安全,2007年7月起,我院急诊科开展了“红色标识腕带”服务.凡佩戴红色标识腕带的急诊危重患者在院内接受就诊、挂号、缴费、检查、治疗、用药、用血、手术、住院等一系列流程中,享有全程优先特权.红色标识腕带的应用不仅起到了准确的身份识别的作用,更增强了医护人员的急救服务意识,尤其缩短了危重患者的急诊等候时间,有效地减少了纠纷,提升了抢救成功率,提高了医院整体的急诊工作效率和急救服务水平,在急诊安全管理中具有非常重要的意义.