Enhancing the care of children with chronic diseases through the narratives of patient,physician, nurse and carer

We tested the hypothesis that a narrative approach may enhance a bio‐psycho‐social model (BPS) in caring for chronically ill children. Forty‐eight narratives were collected from 12 children with six different medical conditions, their mothers, physicians, and nurses. By a textual analysis, narratives were classified on their predominant focus as disease (biological focus), illness (psychologic focus), or sickness (social focus). Sixty‐one percent of narrative’ text were classified as illness, 28% as disease and 11% as sickness. All narratives had a degree of illness focus. Narratives by patients and physicians on the one hand, and nurses’ and mothers’ on the other were disease focused. Narratives were also evaluated with respect to the type of medical condition: Illness was largely prevalent in all but Crohn’s disease and HIV infection, the latter having a predominance of sickness most probably related to stigma. Narrative exploration proved a valuable tool for understanding and addressing the needs of children with complex conditions. Narrative approaches allow identification of the major needs of different patients according to health conditions and story tellers. In the narratives, we found a greater illness and disease focus and surprisingly a low sickness focus, except with HIV stories. Narrative medicine provides a tool to strengthen the BPS model in health care.     

The transmission of attachment across generations: The state of art and new theoretical perspectives

The paper reviews the body of research testing the intergenerational transmission of attachment and the theoretical shift from the linear or mediation model (van IJzendoorn, 1995), according to which parental sensitivity is the main factor responsible for the correspondence between maternal and infant's attachment, to the ecological model of the transmission of attachment (van IJzendoorn & Bakermans‐Kranenburg, 1997). This latter model has prompted researchers, over time, to identify potential mediators, other than caregiver's sensitivity, of the established association between parental representations regarding attachment and infant's attachment, as well as the potential moderators of the transmission process. Each of these two research domains will be carefully explored; lastly new perspectives on the intergenerational transmission of attachment and relevant areas of research needing more investigation are highlighted.     

镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料,并将患者分为2006年组和2007年纽,用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病,气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别;与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短,镇痛与镇静剂应用时间均缩短,Ramsay评分降低,病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。     

Habituation and migraine

The most reproducible and ubiquitous interictal abnormality of the migraineurs’ brain is lack of habituation in neuronal information processing. The underlying mechanisms are uncertain. Increased neuronal excitability, decreased inhibition or decreased pre-activation levels have all been proposed as possible culprits.The present review summarizes the available data on habituation in migraine patients obtained with different methodological approaches. We will discuss the change of habituation level over the migraine cycle and we will show that these data congruently indicate that the sensory cortices of migraineurs react excessively to repetitive, but not to a small series of stimuli.Although the precise cellular and molecular mechanisms of this hyper-responsivity must still be determined, we will describe experimental data suggesting that a dysrhythmic thalamo-cortical activity due to inadequate monoaminergic control might be a plausible explanation.     

Electrophysiology in neuropsychiatric research: a network perspective

A growing number of anatomic and physiologic studies have shown that parallel sensory and motor information processing occurs in multiple cortical areas. These findings challenge the traditional model of brain processing, which states that the brain is a collection of physically discrete processing modules that pass information to each other by neuronal impulses in a stepwise manner. New concepts based on neural network models suggest that the brain is a dynamically shifting collection of interpenetrating, distributed, and transient neural networks. Neither of these models is necessarily mutually exclusive, but each gives different perspectives on the brain that might be complementary. Each model has its own research methodology, with functional magnetic resonance imaging supporting notions of modular processing, and electrophysiology (eg, electroencephalography) emphasizing the network model. These two technologies might be combined fruitfully in the near future to provide us with a better understanding of the brain. However, this common enterprise can succeed only when the inherent limitations and advantages of both models and technologies are known. After a general introduction about electrophysiology as a research tool and its relation to the network model, several practical examples are given on the generation of pathophysiologic models and disease classification, intermediate phenotyping for genetic investigations, and pharmacodynamic modeling. Finally, proposals are made about how to integrate electrophysiology and neuroimaging methods.