医院公共空间环境对病人心理的影响分析

医院公共空间设置应契合使用者对医院总体空间的使用需求,分析其心理、生理和行为特点,满足病人生理、心理和行为的需求。充分考虑病人对空间环境的响应度,对不同空间类型应提供多样支持,关注空间环境对病人的生理、心理和行为的影响,顺应医疗流程,防止和控制交叉感染。     

From chaos and insecurity to understanding and coping: experienced benefits of a group-based education programme for people with chronic fatigue syndrome

The aim of this study was to elicit participants' experiences with a multidisciplinary patient education programme and their views regarding the usefulness of the programme. Focus group interviews were conducted with 10 participants immediately and nine months following participation in the programme and analysed using thematic analysis. Initially, the participants experienced confusion and insecurity regarding coping with the illness. Participation in the programme appeared to promote understanding, acceptance and coping through gaining greater knowledge, learning coping strategies and exchanging experiences, as well as receiving understanding and acceptance. Thus, the programme was experienced to be a beneficial intervention. However, the participants expressed a need for more guidance or follow-up to maintain the practice of coping strategies for better coping with their illness.     

Childhood trauma from a patient and a psychoanalyst perspective: linking chronic depression to relational multiple trauma

The relationship between multiple childhood trauma, as well as adversity, and chronic depression has been reported repeatedly. However, there is a lack of clinical differentiations of these findings. We complemented patient self-ratings, using the Childhood Trauma Questionnaire (CTQ), with psychoanalysts’ perspectives in order to provide finer grained clinical differentiations of the trauma behind chronic depression. These differentiations connect the trauma scales with early relational experiences. We developed a bespoke instrument derived from psychoanalytic trauma concepts. A subsample of 52 cases of chronically depressed patients alongside their 24 psychoanalysts was taken from the LAC depression study, in order to complement patient and psychoanalyst ratings. Our results confirm the connection between multiple childhood trauma and chronic depression. Besides relational trauma, the psychoanalysts’ perspective found separation trauma and transgenerational transmission of trauma to be significant. These traumatic relationships seem to precede and accompany adverse life events and/or traumatic experiences. They may even prevent adequate coping and/or processing of such experiences. Patient interview material from study intake and five-year follow-up further provides an insight into the changes the trauma narratives undergo throughout time. These changes emerged due to a joint reconstruction of the meaning of traumatic experiences throughout the course of the psychoanalytic process.     

Medical psychotherapy consultation: psychoanalytic psychiatry for the patient and professional

An NHS Mental Health Trust Medical Psychotherapy Consultation Service using psychoanalytic psychiatry to help the patient and professional is described. The Consultation Service established in 2000 is offered to secondary acute and community mental health teams and primary care. The service was evaluated as a basis for regional and national development. Between 2006 and 2013, 87 consultations from 210 were sampled to ascertain demographic and diagnostic profiles and outcomes of the consultation process. We conducted an online survey of local consultant psychiatrists’ views about the service, and undertook a thematic analysis of the free text comments. We also conducted a survey of members of the Royal College of Psychiatrists’ Medical Psychotherapy Faculty to ascertain whether similar consultation services existed elsewhere in the UK and had been evaluated. The Leeds model of psychoanalytic consultation – a ‘consultation sandwich’ – is described. From a psychoanalytic perspective, the work of consultation is seen as an extension of the dynamic field of the analytic situation. This paper develops the concept of a bastion – an omnipotent reserve in and between the patient and professional derived from adhesive identifications leading to stuck relationships. The adhesive identification in the patient and professional acts like a ‘grievance glue’ – a mutual manifestation in a last bastion of painful limitations not faced, losses not grieved.     

Du secret médical aux dossiers de santé électroniques. Réflexions juridiques sur la protection des données de santé

Health data give rise to a plurality of qualifications. The exercise players are forced this not unusual for the legal system. In the case of health data, especially when these data are processed through folders to which several categories of actors need access, it may still be problematic. Electronic medical records, in which the authorities have in recent years invested a lot of hope and money, fail to cross the course of a generalization though it was presented as being beneficial for our public health system and financing of health spending. Without exaggerating the extent of social problems related to the interpretation and application of standards, it is reasonable to think that they are partly responsible for this fact. After presenting the two great bodies of norms which where initially protecting personal health data, this paper develops the analysis of their confrontation before highlighting the status of one of the most complex issues in this field, that is the people's consent to the various treatments that their data may be subject of.     

Trust in the medical profession and patient attachment style

Attachment style is a person’s approach to interpersonal relationships, which develops from early experiences with primary caregivers and can remain stable into adulthood. Depending on a person’s attachment style, the amount of trust one has in others can vary when forming relationships, and trust is important in formation of the patient–physician relationship. The purpose of this study was to see if there is an association between attachment style and trust in physicians in general. Participants were recruited from an emergency department (ED) and an online university participant pool, and completed short questionnaires assessing attachment style and trust in the medical profession. Results revealed that individuals with a fearful attachment style reported significantly lower levels of trust in the medical profession than those with a secure attachment style. ED participants also reported higher levels of trust in the medical profession in comparison to student participants. This study provides a better understanding of trust in the medical profession, and insight into future care for patients who have low trust.     

Is This Relevant? Physician Perceptions,Clinical Relevance,and Religious Content in Clinical Interactions

Despite wide support among physicians for practicing patient‐centered care, clinical interactions are primarily driven by physicians’ perception of relevance. While some will perceive a connection between religion and patient health, this relevance will be less apparent for others. I argue that physician responses when religious/spiritual topics come up during clinical interactions will depend on their own religious/spiritual background. The more central religion is for the physician, the greater his or her perception of religion's impact on health outcomes and his or her inclusion of religion/spirituality within clinical interactions. Using a nationally representative sample of physicians in the United States and mediated path models, I estimate models for five different physician actions to evaluate these relationships. I find that a physician's religious background is strongly associated with whether or not he or she thinks religion impacts health outcomes, which is strongly predictive of inclusion. I also find that not all of the association between inclusion and physicians’ religious background is mediated by thinking religion impacts health outcomes. Issues of religion's relevance for medicine are important to the degree that religious beliefs are an important dimension of patients’ lives.     

Identifying developmental stuttering and associated comorbidities in electronic health records and creating a phenome risk classifier

PurposeThis study aimed to identify cases of developmental stuttering and associated comorbidities in de-identified electronic health records (EHRs) at Vanderbilt University Medical Center, and, in turn, build and test a stuttering prediction model.MethodsA multi-step process including a keyword search of medical notes, a text-mining algorithm, and manual review was employed to identify stuttering cases in the EHR. Confirmed cases were compared to matched controls in a phenotype code (phecode) enrichment analysis to reveal conditions associated with stuttering (i.e., comorbidities). These associated phenotypes were used as proxy variables to phenotypically predict stuttering in subjects within the EHR that were not otherwise identifiable using the multi-step identification process described above.ResultsThe multi-step process resulted in the manually reviewed identification of 1,143 stuttering cases in the EHR. Highly enriched phecodes included codes related to childhood onset fluency disorder, adult-onset fluency disorder, hearing loss, sleep disorders, atopy, a multitude of codes for infections, neurological deficits, and body weight. These phecodes were used as variables to create a phenome risk classifier (PheRC) prediction model to identify additional high likelihood stuttering cases. The PheRC prediction model resulted in a positive predictive value of 83 %.ConclusionsThis study demonstrates the feasibility of using EHRs in the study of stuttering and found phenotypic associations. The creation of the PheRC has the potential to enable future studies of stuttering using existing EHR data, including investigations into the genetic etiology.     

Are animals moral?: Zhu Xi and Jeong Yakyong’s views on nonhuman animals

One significant feature of Jeong Yakyong’s丁若鏞 (1762–1836) thought is his deconstruction of Zhu Xi’s 朱熹 (1130–1200) moral universe based on li 理 and qi 氣. For Zhu Xi, the world in its entirety was a moral place, but Jeong Yakyong distinguished nonmoral domains from the moral domain. One question that follows in pursuing a comparison of their philosophies on this topic is what each thinker meant by ‘moral’ and, in particular, whether they meant the same thing. In this paper, I delve deeper into this topic by comparing their respective perspectives on whether nonhuman animals are moral. Interestingly, they held exactly opposite views: Zhu Xi believed that certain actions on the part of nonhuman animals manifest moral values, whereas Jeong Yakyong claimed that none of the actions of nonhuman animals has moral value. In comparing their views, I introduce Mark Rowlands’ distinction between ‘moral subjects’ and ‘moral agents.’