Referring patients to counsellors in primary care: Qualitative investigation of general practitioners’ perceptions

Despite growing evidence of the effectiveness of counselling in primary care, questions arise concerning the role of general practitioners in the referral process. This involves both liaison with counsellors and the management of people who do not wish to see counsellors. Respondents (n=23) in this qualitative study of general practitioners’ perceptions were clear about which patients should be referred to counsellors, based on guidelines. Additionally, these doctors perceived their role and skills as negotiating with their patients about referral to a counsellor, and managing patients who are either waiting to see a counsellor or who prefer not to see a counsellor. These doctors feel inadequately trained in managing this latter group, whose outcome they perceive as unclear. Despite this, respondents accept a role in ongoing support for their patients with consequent training issues for doctors and opportunities for liaison and mentoring by counsellors.     

A MULTIPLE-BASELINE ANALYSIS OF SOCIAL-SKILLS TRAINING IN CHRONIC SCHIZOPHRENICS

Social-skills training was applied to two male chronic schizophrenics. Component behaviors of social skill requiring modification were identified for each patient by rating videotapes of role-played interactions. Training involved instructions and feedback for one subject and instructions, feedback, and modelling for the second. Target behaviors were treated sequentially and cumulatively in a multiple-baseline format. Training was applied for both positive and negative assertion and for situations involving males and females. The results were positive for all behaviors for both patients. Follow-ups at 2, 4, 6, and 8 weeks after training indicated that most effects were maintained at near-treatment levels.     

BIOFEEDBACK,AUTOGENIC TRAINING,AND PROGRESSIVE RELAXATION IN THE TREATMENT OF RAYNAUD'S DISEASE: A COMPARATIVE STUDY

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26° to 17°C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. Results indicated that all patients improved during the first four weeks of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of the training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.     

脑外伤患者记忆功能的双重特征：损伤与保存

该研究探讨了中─重型闭合性脑外伤患者及对照被试（各１７名）在对单个汉字不同水平的加工后,其外显记忆（自由回忆、再认）和内隐记忆（汉字补笔起动效应）的若干特点。发现：患者组外显记忆受损而内隐记忆正常;两组被试在深层意义加工中的外显记忆均强于在浅层表面加工中的外显记忆,这种语义易化现象以耗费更多的认知努力为代价,其中患者组耗费的尤多,而记忆效率却不及对照组。综上,脑外伤患者记忆功能呈损伤和保存双重性。     

Outcomes of children with emotional disturbance in residential treatment for educational purposes

A study was conducted of the outcomes of all children and adolescents (N=114) with serious emotional disturbance who had been placed by school districts in residential treatment facilities for educational purposes over a three-year period. Both cost and outcome analyses were conducted. Cost analyses indicated a total annual expenditure in excess of $5 million, or $80,000 per youth per length of stay. Outcome analyses, consisting of ratings of outcomes and outcome interviews with special education directors, revealed that 63% of the youth had either made no or minimal progress, had been discharged with a negative outcome, or had run away. Positive outcomes were achieved in only 25% of the cases, measured by the students' return to school or placement into a vocational training program. Another 11% of the youth were making substantial progress. Analyses of the relationships between outcomes and cost revealed no relationship. However, positive outcomes were associated with shorter lengths of stay. Further, students in the positive outcome categories had more severe functioning deficits at intake than students in the negative outcome categories. The availability of community-based services for the student and family was the single most likely reason reported by special education directors for positive discharge status.     

Advance Directives Outside the USA: Are They the Best Solution Everywhere?

This article evaluates the potential role of advance directives outside of their original North American context. In order to do this, the article first analyses the historical process which has promoted advance directives in recent years. Next, it brings to light certain presuppositions which have given them force: atomistic individualism, contractualism, consumerism and entrepreneurialism, pluralism, proceduralism, and American moralism. The article next studies certain European cultural peculiarities which could affect advance directives: the importance of virtue versus rights, stoicism versus consumerist utilitarianism, rationalism versus empiricism, statism versus citizens' initiative, and justice versus autonomy.The article concludes by recognising that autonomy has a transcultural value, although it must be balanced with other principles. Advance Directives can have a function in certain cases. But it does not seem adequate to delegate to advance directives more and more medical decisions, and to make them more binding everyday. It is indispensable to develop other decision-making criteria.     

Clinical Frequencies Recording System: Standardizing staff observations by event recording

Certain aspects of staff performance and resident behavior are less adequately assessed by standardized time sampling procedures than by complete recording of the incidence of specified events. An approach to gathering such data through systematizing the observations of clinical staff — the Clinical Frequencies Recording System — is described. Scores from the Clinical Frequencies System reflect the rate per opportunity with which individual behaviors are performed, with computer summarization providing higher-level behavioral indexes for research and evaluation purposes. Staff training and system implementation are discussed, and reliability and validity data from a system employed on two different treatment units over a period of several years are presented.The research reported in this article was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

现代医学的有限与无奈

在充分肯定现代医学在取得巨大进步的同时,分别从疾病病因、发病机制、早期诊断、疗效和预后等8个方向阐述了现代医学在防治人类疾病中的局限性,并简要分析了产生这种局限性的原因。     

关于癌症病人知情权问题探讨

目前全球癌患者人数超过1000万,中国每年新增癌症病例约160万,探讨如何处理癌症病人的知情权问题,贴近社会公众,具有重要的现实意义.