Using goal setting, task clarification, and feedback to increase the use of the hands-free technique by hospital operating room staff

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间。即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理。我们则采用小别量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的剂量。结果,有部分患者完全摆脱了胰岛素。我们对糖尿病的再认识是建立在对多脏器活检的基础之上。我们的活检结果表明,糖尿病肾病存在着免疫损伤。糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果。我们尝试用小剂量的免疫抑制剂环孢菌素A（25mgbid）治疗糖尿病眼底出血,取得了不错的疗效,也证实糖尿病眼底病变是一种血管炎,与自身免疫病变有关。其他的器官还包括垂体、大脑的血管、糖尿病足、冠心病、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿病,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积。这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在。为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病。应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效。唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红素升高,而也有一部分患者总胆红素不升高。     

USING DIFFERENTIAL REINFORCEMENT TO DECREASE ACADEMIC RESPONSE LATENCIES OF AN ADOLESCENT WITH ACQUIRED BRAIN INJURY

The present study investigated the effects of contingency‐specifying rules and a token economy to decrease the latency to comply with academic instructions by a 16‐year‐old girl with acquired brain injury. Results showed that treatment was successful in reducing academic response latencies. These results replicate previous research in which differential reinforcement was used to decrease slow responding to academic tasks.     

Deficits in executed and imagined aiming performance in brain-injured children

Motor disorders are a frequent consequence of acquired brain injury (ABI) in children and much effort is currently invested in alleviating these deficits. The aim of the present study was to test motor imagery (MI) capabilities in children with ABI (n=25) and an age- and gender-matched control group (n=25). A computerized Virtual Radial Fitts Task (VRFT) was used to investigate the speed-accuracy trade-offs (or Fitts' law) that occur as target size is varied for both executed and imagined performance. In the control group, the speed for accuracy trade-off for both executed and imagined performance conformed to Fitts' law. In the ABI group, only executed movements conformed to Fitts' law. These findings suggest that children with ABI show an inferior ability to imagine the time needed to complete goal-directed movements with differential difficulty levels.     

Introducing the concept of spirit injury in education‐to‐work transitions

This paper introduces the topic of spiritual injury and the possible influences and relationships it might share with education‐to‐work transitions of young adults. Students of both dominant and minority cultural backgrounds were interviewed to gain a detailed understanding of how perceptions of transitions came about. Further, I sought to understand what role spirituality and experiences of spirit injury have in the decision‐making processes.     

Impaired embodiment and intersubjectivity

This paper considers the importance of the body for self-esteem, communication, and emotional expression and experience, through the reflections of those who live with various neurological impairments of movement and sensation; sensory deafferentation, spinal cord injury and Möbius Syndrome (the congenital absence of facial expression). People with severe sensory loss, who require conscious attention and visual feedback for movement, describe the imperative to use the same strategies to reacquire gesture, to appear normal and have embodied expression. Those paralysed after spinal cord injury struggle to have others see them as people rather than as people in wheelchairs and have been active in the disability movement, distinguishing between their medical impairment and the social induced disability others project onto them. Lastly those with Möbius reveal the importance of the face for emotional expression and communication and indeed for emotional experience itself. All these examples explore the crucial role of the body as agent for social and personal expression and self-esteem.     

Psychological aspects of scuba diving injuries: Suggestions for short-term treatment from a psychodynamic perspective

Dive medicine is described as an area of practice in which psychologists may choose to expand their clinical service and research activities. The author argues that most research studying risk behavior and sports take into account biological, behavioral or cognitive approaches, while ignoring unconscious conflict in risk-taking and injury management. The present paper uses a psychodynamically-oriented, interview-based approach to studying psychological reactions to decompression sickness in three experienced scuba divers. Brief interventions and their outcomes are described.     

脑外伤患者内隐记忆康复护理可行性研究

探讨脑外伤患者在高强度练习和准确反馈条件下,内隐学习知识效应和底层规则迁移易化能力。结果发现：①脑外伤患者在汉字整体偏好深加工的非显著特征学习与对照组一样有效;在笔划浅加工的显著特征学习,明显低于对照组;在自由回忆和再认的重复测验中,患者组与对照组存在显著性差异。②脑外伤患者学习记忆具有整体性、直观性、模糊抽象性、无意识性等特点。③脑外伤患者存在着内隐学习知识效应和内隐知识学习效应,且随着训练强化和训练方法的改进,有增强和外显记忆转化的趋势。     

EFFECT OF SUPPORTED EMPLOYMENT ON THE VOCATIONAL OUTCOMES OF PERSONS WITH TRAUMATIC BRAIN INJURY

This paper reports the job placement of 5 males with severe traumatic brain injury. An individual placement model of supported employment was used. All individuals were placed in competitive employment and received staggered intervention over time by trained employment specialists. A multiple baseline design across persons was used to evaluate results. All individuals had been unable to work consistently or at all in competitive work environments. The range of wages was $4.25 to $5.00 per hour with an average of 339 hours of employment specialist intervention time required per case. The major problems experienced by employment specialists were insubordinate and disruptive behaviors as well as other inappropriate social behaviors displayed at the job site.     

Predictors of Unintentionally Severe Harm During Nonsuicidal Self‐Injury

This study aimed to identify predictors of unintentionally severe injury during nonsuicidal self‐injury (NSSI). The authors examined 3 potential predictors in a sample of 102 college students: addictive qualities of NSSI, impulsivity, and dissociation. Both impulsivity and addictive qualities of NSSI were associated with unintentionally severe injury during NSSI. In a logistic regression, only addictive qualities of NSSI emerged as a significant predictor of unintentionally severe injury during NSSI. Implications for counseling and research are discussed.