围手术期患者的抗栓治疗

抗栓治疗的患者接受外科手术时面临栓塞和出血双重风险,本文就临床常用抗栓药物的药理特性、围手术期患者抗栓治疗需要注意的问题以及解决方案作一概述。     

口腔正畸治疗中的医患交流初探

口腔正畸治疗时间长,患者依从性难以保证,这时医患交流对于治疗就尤为重要。正畸治疗各阶段良好的医患交流可以统一医患双方对矫治目标的理解差异,增进患者的信任感,争取患者最大程度的积极配合,防止错袷复发,减少医疗纠纷,取得令医患双方更加满意的矫治效果。     

Moral development, executive functioning, peak experiences and brain patterns in professional and amateur classical musicians: interpreted in light of a Unified Theory of Performance

This study compared professional and amateur classical musicians matched for age, gender, and education on reaction times during the Stroop color-word test, brainwaves during an auditory ERP task and during paired reaction-time tasks, responses on the Gibbs Sociomoral Reflection questionnaire, and self-reported frequencies of peak experiences. Professional musicians were characterized by: (1) lower color-word interference effects (Stroop task), (2) faster categorization of rare expected stimuli (P3b), and a trend for faster processing of rare unexpected stimuli (P3a), (3) higher scores on the Sociomoral Reflection questionnaire, and (4) more frequent peak experiences during rest, tasks, and sleep. Both groups had high values on the Brain Integration Scale. These findings are interpreted in light of a Unified Theory of Performance, which posits that effectiveness in any area is influenced by one’s level of mind-brain development—emotional, cognitive, moral, ego and cortical development—with higher mind-brain development supporting greater effectiveness in any domain.     

癌症化疗患者护患沟通环节流程化模式初探

在癌症化疗患者的整体护理中,护患沟通较之躯体护理更具挑战性,表现为沟通难做、效果难评、学生难带、绩效难考。作者尝试一种模式,把护患沟通的各环节工作流程化、任务表格化,即首先按精心设计的流程及内容完成针对性调查,找出影响与患者沟通的有关因素及患者最为关注的问题,针对性地运用各种沟通技巧逐一沟通,实现护患沟通的个体化和差异化,同时使护患沟通环节工作有模式、效果有评价、教学有路径、考核有标准。     

创业警觉性、既有知识、创业经历对大学生创业机会识别的影响

采用“新手—创业经验丰富者” 对比范式,分别以114名在校无创业经历大学生和94名创业大学生作为被试,通过不同被试对自编复杂机会情景的反应搜集其对机会识别的表现,同时探讨了大学生创业警觉性、既有知识对创业机会识别的影响。结果表明：两类大学生创业警觉性、既有知识差异显著,创业大学生明显好于一般大学生。两类大学生在创业警觉性的三个维度以及既有知识的两个维度上均存在显著性差异,创业大学生均显著优于于一般大学生。创业大学生既有知识对机会识别具有显著影响;一般大学生创业警觉性对机会识别具有显著影响。此外,大学生既有知识可能通过警觉性影响机会识别。     

Computerised cognitive‐behaviour therapy (cCBT) and older people: A pilot study to determine factors that influence willingness to engage with cCBT

Objective: The aim of this study was to explore whether older people with depression and/or anxiety were potentially willing to engage with computerised cognitive‐behaviour therapy (cCBT). Method: A short questionnaire was sent to 60 service users aged 65+ who were identified as having anxiety and/or depression. Results: There was a 63.3% response rate for the questionnaire. Almost half of the respondents said they would be interested in using cCBT, and would be willing to learn the necessary computer skills. Conclusions: This pilot study suggests that older people with anxiety and/or depression may be willing to engage with cCBT. However, a number of important factors are highlighted that would need to be considered in deciding whether to develop access to cCBT for older people.     

Learning from experience: Examining the impact of client work upon two trainee therapists

This qualitative research study, focusing on the learning and change of two trainee therapists over a nine‐month period, was conducted by the trainees themselves. In collecting and analysing their data, the researchers made use of the heuristic methodology, to which some of the principles of the co‐operative inquiry methodology were added. The findings shed light on some of the ways in which trainee counsellors and psychotherapists might learn through their work with clients, the forms and contexts in which this learning may arise, and how the learning might affect the trainees. The findings additionally highlight some of the possible benefits of engaging in research for trainee counsellors and psychotherapists, in terms of their roles as practitioners. These include positive changes in the ways in which they work with clients, and changes in the ways they think about their practice.     

The client as expert: Researching hindering experiences in counselling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.     

Clients talk about their experience of the process of counselling

The purpose of this study was to ascertain clients’ experiences of their counselling. This was done through use of a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in agency located in a mid-sized city in New Zealand. Several themes were identified and discussed in relation to the literature on clients’ perceptions of their own counselling. Specifically, clients were asked to comment on whether their counselling was effective, how much of their improvement was due to counselling versus other factors, the quality of the relationship with their counsellor, specific in-counselling events that were helpful or unhelpful, and how their counselling was terminated. Implications for practice were suggested.     

误诊误治病例所致医疗纠纷分析——附3例报告

当前医疗科技发展的相对性、疾病规律本身的复杂多变性、医生医疗知识的局限性等,导致了临床误诊误治的不可避免性,而医院发生的医疗纠纷事件中,大多是由于误诊误治所致。通过对3例误诊病例及所致医疗纠纷的分析,指出临床误诊误治的客观性、主观性及不可避免性。同时提示临床医师在疾病诊治过程中,随时更新医疗知识,注意疾病的鉴别诊断,及时完善相关的辅助检查,积极治疗,减少对疾病的延误诊治,减轻病人痛苦,改善医患关系,从而减少医疗纠纷。