Medical Crisis Counseling on a Pediatric Intensive Care Unit: Case Examples and Clinical Utility

The intensive care unit is one of the most stressful and demanding work sites of the pediatric psychologist. The rapid changes in health status that necessitate stays on the intensive care unit often constitute an emotional roller coaster ride for both family members and the staff caring for their child. The Medical Crisis Counseling (MCC) intervention model is a useful approach to providing psychological support in the pediatric intensive care setting. A representative year's worth of consultation requests from the multidisciplinary intensive care unit of a large urban pediatric hospital is described and discussed in the context of the MCC model.     

The Role of Cardioprotective Avoidance Beliefs in Noncardiac Chest Pain and Associated Emergency Department Utilization

This study examined cardioprotective avoidance beliefs and general panic/agoraphobia variables among 45 Emergency Department patients with a primary complaint of noncardiac chest pain (NCCP) in the absence of coronary artery disease or other medical explanation. Cardioprotective beliefs about the dangerousness of work and physical activity were assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). Additional measures assessed complaints of cardiac distress and panic, anxiety sensitivity, panic-related beliefs, agoraphobic avoidance, and depressive symptoms. Hierarchical regression analysis indicated that cardiac distress symptoms are a function of panic symptoms and cardioprotective beliefs concerning both physical activity and work, with 62% of the total variance explained. The predictors also explained 57% of the variance in Emergency Department utilization, which was significantly related to cardiac distress symptoms, number of illnesses, and work-avoidance beliefs. Neither outcome was related to demographics, depression symptoms, general anxiety sensitivity, general panic cognitions, or agoraphobic avoidance. Results suggest that current behavioral understandings of NCCP might be advanced by further examination of cardiac-specific avoidance beliefs and behavior and the potential role these factors play in both symptom experience and medical utilization.     

The Three Crises: Science, History, and Plurality

Modern religions are confronted by three crises: the scientific evolution, the historical revolution, and the pluralistic revolution. The development of each of these diverse revolutions in Western intellectual history has posed serious challenges to traditional conceptions of religious authority. This paper seeks to briefly elucidate the nature of each of these revolutions and their significance for religious traditions. While the specific challenges posed are separate, the revolutions share common traits. Additionally, it is not enough for a religious tradition to deal with only one of the crises; to proceed into the next stage of religious reflection, it must deal with them all.     

Metaphors and models in medicine

This paper aims to show how medical scientists may use metaphor in ways closely parallel to poets. Those who believe metaphor has any role at all in science may describe its use in various ways. Associationists think metaphors are based upon likenesses, and collapse the notions of model and metaphor together. But, as an example from the work of Louis Pasteur suggests, metaphor need not be based upon likenesses. Rather it may play a role in making possible a model'sexplanatory significance. Models may presuppose metaphors. The Pasteur example also suggests metaphor may play a part in creating likenesses through its role in classification and reclassification. It is in these ways that the use of metaphor in medical science most closely parallels that in poetry.     

Technology and the management of trust in insurance medicine

This article deals with the question how technologycontributed to the performing of objective assessmentsof health risks and to the public trust in theinsurance institution. Many authors have pointed tothe relevance of medical or statistical technologywith regard to the constitution of objectivity,because these technologies should be capable ofdiminishing the influence of social interactions – the``human element' – on the process of producingknowledge about health risks. However, in this articleit is shown that the constitution of objective riskassessments and public trust cannot be seen as theproduct of one particular type of technology, but thatit is the product of a socio-technical network, inwhich several heterogeneous elements becomeinterrelated and interdependant. The historicalreconstruction of this network also sheds a new lighton the role of `the human element' in the constitutionof objectivity and trust. It shows that elements inthe network which regulate the social interactionbetween the subjects involved are of no lessimportance to generate trust than technologies whichtend to abstract from this interaction. In otherwords, objective and subjective elements areintertwined much more than is often recognized, andpublic trust is to a fairly large degree depends onconventions in social interaction.     

Technology in Medicine: Ontology,Epistemology, Ethics and Social Philosophy at the Crossroads

In reference to the different approaches in philosophy(of medicine) of the nature of (medical) technology,this article introduces the topic of this specialissue of Theoretical Medicine and Bioethics, that is,the way the different forms of medical technologyfunction in everyday medical practice. The authorselaborate on the active role technology plays inshaping our views on disease, illness, and the body,whence in shaping our world.     

军校医学生心理应激影响因素的通径分析

目的探讨军校医学生心理应激的影响因素及其相互作用方式。方法选用军校医学生日常困扰评定量表、应付方式问卷、特质焦虑问卷、自尊量表和流调中心用抑郁量表对935名军校医学生进行测试，采用SPSS10．0对数据进行统计分析。结果日常困扰主要通过间接作用影响军校医学生的心理应激；自尊和特质焦虑对心理应激具有直接作用和间接作用。应付方式是日常困扰、个性特点影响心理应激的中间环节。结论维护军校医学生的身心健康，可以把优化其个性结构，加强应对训练作为一个切入点。     

Style and responsibility: Medicine in postmodernity

To what extent can postmodern developments be observed in modern medicine and which theories of postmodern philosophy can we draw on with regard to medicine's theoretical problem? This article explores these questions with special emphasis on the epistemological status of medicine, the concept of disease, and the anthropological model. It is examined whether medicine's inherent duty to act can be questioned in the light of the plurality that characterizes postmodernity. It is concluded that, according to postmodern philosophy, medicine should be characterized by a justified variety of paradigms. Cooperation within the variety must continue to be guaranteed, always in favor of the constitutive moral duty of medicine.     

Medical crisis counseling: A new service delivery model

The diagnosis or exacerbation of a chronic illness, the aftermath of a serious accident, or worries about future in the context of illness or debilitating injury are all examples of medical crises that pose significant coping challenges. Too often, traditional approaches to psychotherapy have been unable to respond the most urgent needs of people confronting such crises. Medical crisis counseling is a specialized approach to addressing the needs of individuals and families confronted by the difficulties of coping with losses or changes, as well as the challenge of living with long-term illness. This paper describes the medical crisis counseling model in contrast with other more traditional intervention approaches.     

AN ANALYSIS OF AND INTERVENTION IN THE SEXUAL TRANSMISSION OF DISEASE

Sexually transmitted diseases are a serious threat to the public health. Indeed, when an individual seeks medical treatment for a sexually transmitted disease, health authorities frequently attempt to identify, procure, and treat that individual's sexual contact(s). We conducted a comparative analysis of three alternative approaches to tracing the sexual partners of individuals diagnosed as having a sexually transmitted disease. The first approach involved counseling individuals (n = 27) infected with either gonorrhea or nongonococcal urethritis and exhorting them to procure their sexual partners for treatment. In addition to counseling, the second and third approaches involved distributing “occasion cards” for patients to use when informing sexual contacts of the need for treatment. Moreover, in the second approach, the counselor (a nurse or physician) informed infected patients (n = 19) that they and their partners could waive the $3 clinic fee contingent upon the partners seeking treatment within 1 week. In the third approach, the counselor asked infected persons (n = 19) to accept a follow-up telephone contact if their sexual partners failed to seek treatment within 1 week. The third approach was most effective. Ninety percent of the partners identified through this approach sought treatment, versus only about 60% of the partners in the other two conditions. The third approach was also the least expensive, costing about $2.95 to procure each partner for treatment.