The associations of illness perceptions and self-efficacy with psychological well-being of patients in preparation for joint replacement surgery

Patient well-being on referral to surgery likely affects their surgical experience yet few studies examine pre-surgical correlates of well-being. Guided by the Common Sense Model of Self-Regulation and Social Cognitive theory, this study examined whether illness and emotional representations, general and domain self-efficacy were associated with pre-surgical well-being. The pre-surgical assessment of a three-wave prospective study is reported. Fifty-four hip and knee replacements patients (mean age = 69.33; SD = 8.57) were recruited in the pre-surgery educational clinic at a UK general hospital. Patients completed a questionnaire-pack including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, and the Short Form of Psychological Well-Being Index. Multiple hierarchical regression analyses showed that above and beyond demographic and clinical characteristics, negative emotional representations were associated with lower psychological well-being while strong general self-efficacy beliefs were positively related to psychological well-being. Independent of demographic and clinical characteristics, joint replacement patients’ psychological well-being was associated with their cognitions and emotional reactions to their condition before surgery. Early interventions could potentially target these modifiable factors to improve pre-surgical well-being in this group of patients, with potential for additional post-surgical benefit.     

Cognitions supportive of child molestation

The examination of child molesters' thoughts about themselves and other people, particularly their young victims, has been pursued irregularly over the past four decades. A summary of theory and empirical research from a number of fields (e.g., clinical psychology, social psychology, sociology of deviance) is reported in this critical review. Theoretical attempts to account for cognitions of adults who have sex with children have been sparse. Empirical efforts, on the other hand, have been more numerous and, with some exceptions, there is convergence in number of research findings. Clinical implications for professionals who work with sexual abusers of children are presented.     

人工椎间盘置换术中的循证医学证据

循证医学（evidence—based medicine,EBM）作为一门新兴的交叉学科越来越广泛地被用来进行临床评估和决策。人工椎间盘置换技术的发展为椎间盘退行性病变的治疗提供了符合现代医学模式的新方法。循证医学在人工椎间盘置换研究中的应用不仅有助于为其提供可信、有力的临床证据,而且有丰富的哲学内涵。     

The cause is worse: Remeeting Jocasta1

This paper will help bring Jocasta, a fi gure relatively neglected by psychoanalytic theory, whose lens upon her son has left her to the side, into greater focus. It is not that Jocasta is completely ignored but rather that, when studied, she appears as the dangerous, castrating, forbidden woman to be placated or avoided at all costs. So, although she stands at center stage as the fulcrum of Oedipus's destruction, it is never as a mother longing for her son. The author contends that Jocasta is the personifi cation of an ongoing developmental need on the part of all mothers to separate from their children coupled with a universal longing for reunion. As with Oedipus, Jocasta—a character in a play—is an example of the perverse outcome of forbidden gratifi cations; but also, as with Oedipus, she is the fi gurative presentation of normal variations on a theme.     

Repression, transference and reconstruction

Whereas Peter Fonagy almost dismisses the importance of repression and the recovery of repressed and suppressed memory, the author believes that the analysis of repression retains importance in clinical psychoanalysis. Transference is a return of the repressed, with repressed memories embedded within a fundamental unconscious fantasy constellation. Moreover, transference is an essential, but not the only, route to the understanding and analysis of the patient. Nor should transference be confused with the real or new analytic relationship. The author does not regard the dynamic unconscious as definitely registered and retrieved in procedural memory, awaiting further research. A focus on the present 'self with other' model of therapeutic action neglects pathogenesis and the importance of childhood and its psychoanalytic reconstruction.     

Response to Peter Fonagy

Peter Fonagy highlights the therapeutic efficacy of new experience, 'a way of being with the other', while the author gives priority to interpretation, insight into and the working through of unconscious conflict. The recovery of the repressed memories and fantasies of childhood is now an intermediate goal of psychoanalysis, largely superseded by transference interpretation and genetic reconstruction. Transference, like symptoms, is a return of the repressed. The author believes Fonagy's theoretical and technical focus on the non-conscious, rather than the dynamic unconscious, devalues the persisting influence and pathogenic significance of the infantile unconscious.     

Unconscious fantasy (or phantasy) as clinical concept

A clinical phenomenology of the concept ‘unconscious fantasy’ attempts to describe it from a ‘bottom‐up’ perspective, that is, from the immediate experience of the analyst working in session. Articles of psychoanalytic authors from different persuasions are reviewed, which taken as a whole would shed some light on how the concept of unconscious fantasy takes shape in the analyst's mind during the session with the patient. A clinical phenomenology in three steps is described. Each step is illustrated by clinical material. Current controversies around the concept of unconscious fantasy (or phantasy) are still trapped in the discussion about if and how they are really unconscious. The strategy to describe from a ‘bottom‐up’ perspective the process of how the analyst's mind embraces the idea that an emerging phenomenon in the relationship with the patient can be defined as ‘unconscious fantasy’, allows us to elude the question as to whether or not we believe that unconscious fantasies exist at all, since we are neither required to assert or deny such a prior existence in order to describe the process of elaboration which, in the end, does formulate a fantasy as fantasy.     

成人股骨头坏死的治疗进展

股骨头坏死（ONFH）是一种进展性和致残性疾病,保存自身股骨头是临床治疗所追求的最理想目标,早中期的治疗方案主要采用非手术疗法和保髋的姑息性手术,目前为止还没有一种治疗方法能达到理想的治疗效果。近年来,骨髓间充质于细胞（MSCs）移植治疗ONFH是目前研究热点之一,有望成为一种有效的治疗方法,晚期行人工髋关节置换术是唯一的和最佳的选择。因此,早期诊断,采用综合性治疗方案保全自身髋关节是治疗本病的主要方向。     

人工颈椎间盘置换术能否取代ACDF

目前颈椎病的治疗主要采用切除病变椎间盘和椎体间融合的手术方法,而人工颈椎间盘置换术的临床应用预示着脊柱外科治疗学新纪元的开始。简要介绍了Byran人工颈椎间盘置换术,对其临床效果进行了随访和分析,总结了人工颈椎间盘置换术的治疗优势和临床应用中的问题。客观评价了人工颈椎间盘技术,为临床决策提供了实践依据。