麻醉科医师在晚期癌痛治疗中的作用

1986年WHO推出的“三阶梯”癌痛镇痛用药方案目前在临床工作中存在误区。麻醉科医师必须明确在晚期癌痛治疗转变中的责任和义务:具有专业能力、保健与防病能力,消除使用阿片类药物成瘾恐惧症;团队协作能力、新技术的评估能力,实行跨学科综合姑息保健;遵循生物心理社会医学模式,对晚期癌痛患者实施人文关怀。不仅会运用药物和医疗技术手段,还需配合心理和社会方面进行全面的诊疗,更好地为患者服务。     

黄老之学天道环周与《黄帝内经》营卫运行理论的建构

通过对黄老之学中“天道环周”思想的内涵及其萌芽、发展和成熟的表述,以及《黄帝内经》中有关营卫运行的概括,分析两者在思维方式和理论构建等方面的相似性,“天道环周”对《黄帝内经》中营卫运行理论的形成具有重要影响。     

Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders

We investigated body vigilance, cardiac anxiety, and the mediating role of interoceptive fear on pain in patients with non-cardiac chest pain (NCCP; a syndrome of chest pain in the absence of identifiable organic etiology). Patients were more attentive to cardiac-congruent sensations than cardiac-incongruent sensations (e.g., gastrointestinal, cognitive dyscontrol; p's < .001). Patients with a DSM-IV Axis I anxiety or mood disorder were more body vigilant compared to patients who did not have a disorder (p's < .05). Patients with anxiety disorders were particularly vigilant to and fearful of cardiac sensations relative to patients without anxiety disorders. Latent variable path models examined the extent that interoceptive fear mediated the association between body vigilance and cardiac anxiety on chest pain. Within each model, diagnostic status, body vigilance, and cardiac anxiety were exogenous and predicted interoceptive fear that in turn predicted pain. Separate models examined body vigilance and cardiac anxiety, and both models fit the data well. Findings showed partial mediation for the body vigilance factor, and full mediation for the cardiac anxiety factor. Interoceptive fear played a mediating role in both models. The syndrome of NCCP may persist partly due to conscious hypervigilance to and fear of cardiac-congruent body sensations, particularly among anxious patients.     

Development of motor imagery ability in children with developmental coordination disorder – A goal-directed pointing task

Children with developmental coordination disorder (DCD) have difficulties with the predictive control of movements. This was shown in studies that target motor imagery and motor planning, and appears to become particularly evident with increases in task complexity. In this study, we used a complex mental chronometry paradigm to examine the development of motor imagery ability in children with DCD, using a longitudinal design. Thirty children were included in the DCD group (aged 6–11 years) and age- and gender-matched to 30 controls. The DCD group had a Movement Assessment Battery for Children-2 score ≤16th percentile and the control group ≥25th percentile. Results of this study showed that children with DCD indeed had a significantly lower correlation between executed and imagined movements. Importantly, the increase in the correlation and linear fit during subsequent measurements was comparable for the DCD and control group. Together, these findings suggest a delayed developmental onset of motor imagery ability in DCD, but a similar rate of development over time compared to the control group. Based on these results, it seems likely that explicit motor imagery instructions can be used to improve predictive control in children with DCD.     

The effects of monitoring environment on problem-solving performance

While effective and efficient solving of everyday problems is important in business domains, little is known about the effects of workplace monitoring on problem-solving performance. In a laboratory experiment, we explored the monitoring environment’s effects on an individual’s propensity to (1) establish pattern solutions to problems, (2) recognize when pattern solutions are no longer efficient, and (3) solve complex problems. Under three work monitoring regimes—no monitoring, human monitoring, and electronic monitoring—114 participants solved puzzles for monetary rewards. Based on research related to worker autonomy and theory of social facilitation, we hypothesized that monitored (versus non-monitored) participants would (1) have more difficulty finding a pattern solution, (2) more often fail to recognize when the pattern solution is no longer efficient, and (3) solve fewer complex problems. Our results support the first two hypotheses, but in complex problem solving, an interaction was found between self-assessed ability and the monitoring environment.     

Suicide risk in the detachment from reality: failures in the quest for love that saves

Suicide is among the leading causes of death worldwide, accounting for almost one million annual deaths globally. The author presents an exploration into the suicidal mind using Freud's cathexis and decathexis theory. This model describes the patient’s withdrawal from reality and the need to gratify libidinal and aggressive drives in the internal world. Theories and beliefs of other authors are used to introduce the importance of early disturbed relationships with parental figures. Working with the particular subtype of suicidal patient described in this essay may be a challenge for clinicians. A psychodynamic approach may help in the understanding of the patient’s complex and private world of psychological pain. If unresolved, the patient’s conflicts may precipitate suicide.     

Acute pain disrupts prospective memory cue detection processes

Prospective memory refers to the planning, retention, retrieval, and execution of intentions for future behaviours and it is integral to the enterprise of daily living. Although prospective memory relies upon retrospective memory and executive processes often disrupted by pain, limited research has explored the influence of acute or chronic pain on the ability to complete prospective memory tasks. In the present study we investigated the influence of acute pain on prospective memory tasks that varied in their demands on executive processes (i.e., non-focal versus focal prospective memory cues). Complex-span working memory tasks were also administered to examine whether individual differences in working memory capacity moderated any negative impact of pain on prospective memory. Acute pain significantly impaired prospective memory performance in conditions that encouraged non-focal strategic processing of prospective memory cues, but not in conditions that encouraged more spontaneous focal processing. Individual differences in working memory capacity did not moderate the effect of acute pain on non-focal prospective memory. These findings provide new insights into prospective memory dysfunction created by painful experiences.     

Blame game in private investigation reports: The case of Deloitte examination at Telenor VimpelCom

Business and public organisations hire fraud examiners to conduct private investigations when there is suspicion of misconduct or financial crime. Fraud examiners carry out their investigation based on a mandate. Often, individuals in the organisation are suspects. The blame game hypothesis is concerned with factors that cause blame attribution to some individuals but not to others. In this case study, only executives were blamed who had not disclosed corruption information to a major shareholder and to the chief executive officer.