蝴蝶效应与临床思维——一例多器官衰竭患者诊疗反思

多器官衰竭或多器官功能障碍综合征在临床中尤其是急诊及重症监护室内常见,各种病因所致的疾病进展到一定程度均可导致多器官衰竭。在本案例中,一例老年男性患者,以急性腹泻起病,后短时间内进展为多器官衰竭。通过对该例患者病史总结、病理生理机制的探讨,以及对整个诊疗过程的反思,结合“蝴蝶效应”理论,总结出一种新的临床思维,并探讨“蝴蝶效应”理论在对该例患者的诊断、治疗甚至医患沟通方面所起到的作用,以期通过参考该案例,对以后的临床工作起到一定帮助。     

直觉思维在麻醉临床决策中的应用

围手术期麻醉医师面临问题的复杂性、动态性和模糊性,要求其在具备良好逻辑思维能力的同时,还要学会应用直觉思维来进行麻醉危机管理。通过决策判断的双加工理论模型探讨说明直觉思维在临床麻醉决策中的可应用性,并给出麻醉医师直觉思维的培养途径,提高麻醉医师的思考能力,增加应急处理课程和临床训练,重视临床经验的学习,营造良好的教学氛围。为了在围手术期更好地保证患者的安全,麻醉医师应重视直觉思维在临床麻醉决策中的应用。     

牙髓病治疗过程的历史回顾与哲学思考

牙髓病的发生原因遵循多因素的模式,牙髓病的治疗方案的研究历程顺应该病发生原因研究进程和认识,在牙髓病治疗过程中体现了技术更新的跃进方式更新和渐进形式更新,说明一项新技术替代原有技术,实现了旧质向新质的转换,而疾病的防治需要科学的策略和措施。     

医生健康素养认知调查及内涵探析

调查医生对健康素养概念及内涵、健康教育方式、存在问题等方面的认知情况。调查显示,一半以上的医生对健康素养了解程度一般,96.3%的医生认为病人的健康素养一般或差,96.7%的医生认为其有责任对病人进行健康教育,同时86.2%的医生认为医生健康素养与病人有区别。基于调查,提出医生健康素养应该具有双重属性,第一重属性为医生作为个体应该具备维持和促进自身健康的知识和能力;第二重属性为作为医生应该具备的本科室常见病相关健康教育知识、运用健康知识,针对病人健康问题进行有效沟通,提高病人健康素养水平的能力。

     

The role of magical thinking in forecasting the future

This article explores the role of magical thinking in the subjective probabilities of future chance events. In five experiments, we show that individuals tend to predict a more lucky future (reflected in probability judgements of lucky and unfortunate chance events) for someone who happened to purchase a product associated with a highly moral person than for someone who unknowingly purchased a product associated with a highly immoral person. In the former case, positive events were considered more likely than negative events, whereas in the latter case, the difference in the likelihood judgement of positive and negative events disappeared or even reversed. Our results indicate that this effect is unlikely to be driven by participants’ immanent justice beliefs, the availability heuristic, or experimenter demand. Finally, we show that individuals rely more heavily on magical thinking when their need for control is threatened, thus suggesting that lack of control represents a factor in driving magical thinking in making predictions about the future.     

空间推理的脑机制：一项ERP研究

记录14名正常成人完成四种空间推理及一种基线任务（记忆任务）时的事件相关电位,对空间推理的脑电活动情况进行考察。研究结果表明,在200ms-900ms窗口,推理任务比基线任务诱发更大的正成分。对不同推理任务的比较表明,具体与抽象材料的单模型推理诱发相似的波形;单模型与有效的双模型任务诱发的ERP成分明显不同,在300ms-600ms窗口,后者比前者诱发更大的正波;在200-600ms时间窗口,存在有效结论与无有效结论的双模型问题也诱发明显不同的ERP波形。研究的结果表明,推理与记忆涉及不同的加工要求,推理需要整合前提的信息,而记忆只需要储存前提信息。在解决双模型推理问题时,从200ms开始,被试就对刺激材料进行初步的加工与判断,随后对双模型问题采用有注解的单模型加工策略。另外,不同材料的空间推理任务之间的波形较为一致,表明视觉表象并未明显影响空间推理过程。     

Institutional creativity and pathologies of potential space: The modern university

Abstract

This paper proposes the applicability of object relations psychoanalytic conceptions of dialogue (Ogden, 1986 Ogden, T. 1986. The matrix of the mind, London: Karnac.  [Google Scholar], 1993 Ogden, T. 1993. “On potential space”. In In one's bones: The clinical genius of Winnicot, Edited by: Goldman, D. Northvale, NJ: Jason Aaronson.  [Google Scholar]) to thinking about relationships and relational structures and their governance in universities. It proposes that:

• the qualities of dialogic relations in creative institutions are the proper index of creative productivity; that is of, as examples, ‘thinking’ (Evans, 2004 Evans, M. 2004. Killing thinking: The death of the universities, London: Continuum.  [Google Scholar]), ‘emotional learning’ (Salzberger-Wittenburg et al., 1983 Salzberger-Wittenburg, I., Henry, G. and Osborne, E. 1983. The emotional experience of learning and teaching, London: Routledge.  [Google Scholar]) or ‘criticality’ (Barnett, 1997 Barnett, R. 1997. Higher education: A critical business, Buckingham: Open University Press.  [Google Scholar]);

• contemporary institutions' explicit preoccupation in assuring, monitoring and managing creative ‘dialogue’ can, in practice, pervert creative processes and thoughtful symbolic productivity, thus inhibiting students' development and the quality of ‘thinking space’ for teaching and research.

In this context the paper examines uncanny and perverse connections between Paulo Freire's (1972 Freire, P. 1972. Pedagogy of the oppressed, London: Penguin.  [Google Scholar]) account of educational empowerment and dialogics (from his Pedagogy of the oppressed) to the consumerist (see, for example, Clarke & Vidler, 2005 Clarke, J. and Vidler, E. 2005. Creating citizen-consumers: New labour and the remaking of public services. Public Policy and Administration, 20: 19–37.  [Google Scholar]) rhetoric of student empowerment, as mediated by some strands of managerialism in contemporary higher education. The paper grounds its critique of current models of dialogue, feedback loops, audit and other mechanisms of accountability (Power, 1997 Power, M. 1997. The Audit Society: Ritual's of verification, Oxford: Oxford University Press.  [Google Scholar]; Strathern, 2000 Strathern M. Audit cultures: Anthropological studies in accountability, ethics and the academy London Routledge 2000 [Crossref] , [Google Scholar]), in a close analysis of how creative thinking emerges.

The paper discusses the failure to maintain a dialogic space in humanities and social science areas in particular, exploring psychoanalytic conceptions from Donald Winnicott (1971 Winnicott, D. W. 1971. Playing and Reality, London: Routledge.  [Google Scholar]), Milner (1979 Milner, M. 1979. On not being able to paint, New York: International Universities Press.  [Google Scholar]), Thomas Ogden (1986 Ogden, T. 1986. The matrix of the mind, London: Karnac.  [Google Scholar]) and Csikszentmihalyi (1997 Csikszentmihalyi, M. 1997. Creativity, New York: Harper Perennial.  [Google Scholar]). Coleridge's ideas about imagination as the movement of thought between subjective and objective modes are discussed in terms of both intra- and inter-subjective relational modes of ‘dialogue’, which are seen as subject to pathology in the pathologically structured psychosocial environment. Current patterns of institutional governance, by micromanaging dialogic spaces, curtail the ‘natural’ rhythms and temporalities of imagination by giving an over-emphasis to the moment of outcome, at the expense of holding the necessary vagaries of process in the institutional ‘mind’. On the contrary, as this paper argues, creative thinking lies in sporadic emergences at the conjunction of object/(ive) outcome and through (thought) processes.