Information structuring improves recall of emergency discharge information: a randomized clinical trial

This article examines the extent to which structuring Emergency Department discharge information improves the ability to recall that information, and whether such benefits interact with relevant prior knowledge. Using three samples of students with different levels of prior medical knowledge, we investigated the amount of information recalled after structured vs. non-structured presentation of information. Across all student samples, the structured discharge information led to a relative increase in recalled items of 17% compared to non-structured discharge information (M = 9.70, SD = 4.96 vs. M = 8.31, SD = 4.93). In the sample with least medical knowledge, however, the structured discharge information resulted in a relative increase in recall by 42% (M = 8.12 vs. M = 5.71). These results suggest that structuring discharge information can be a useful tool to improve recall of information and is likely to be most beneficial for patient populations with lower levels of medical knowledge.     

普通儿科住院患者自动出院的原因分析

单中心回顾性调查2011年1月~2012年11月普通儿科住院患儿自动出院1 088例,自动出院率18.7%（1 088/5 827）,其主要原因集中在症状或体征改善、经济困难、家庭因素、依从性差、医患矛盾、疗效欠佳、病房环境差、转院治疗等.儿科住院患者选择自动出院是对医疗制度与管理、医疗水平、服务态度、沟通技巧、家庭背景、社会救助等因素的综合考量.做好社会、医疗机构和医疗制度三方面积极救助环节是改善医患矛盾、减少患儿自动出院的有效措施.     

Frontline Healthcare Staffs’ Experience of Organizing Complex Hospital Discharges: An Ethnographic Study

Existing studies show that nurses often experience moral distress when the care they deliver to patients does not meet their professional values. We draw on ethnographic data collected in June 2015 from one acute care trust in England and present how frontline healthcare staff experience organizing complex hospital discharges. Our findings demonstrate how problems with the panel responsible for allocating funding for National Health Service continuing healthcare cases contributed to healthcare staff experiencing moral distress. Our findings offer a basis for further research on how other aspects of the complex hospital discharge-planning process may contribute to nurses’ experiencing moral distress.     

Marginalia on Sequent Calculi

The paper discusses the relationship between normal natural deductions and cutfree proofs in Gentzen (sequent) calculi in the absence of term labeling. For Gentzen calculi this is the usual version; for natural deduction this is the version under the complete discharge convention, where open assumptions are always discharged as soon as possible. The paper supplements work by Mints, Pinto, Dyckhoff, and Schwichtenberg on the labeled calculi.     

The ability to tickle oneself is associated with level of psychometric schizotypy in non-clinical individuals

A recent study (Lemaitre et al., 2016, Consciousness and Cognition, 41, 64–71) found that non-clinical individuals who scored highly on a psychometric scale of schizotypy were able to tickle themselves. The present study aimed to extend this finding by investigating whether the ability to tickle oneself was associated with level of psychometric schizotypy considered as a continuous variable. One hundred and eleven students completed the Schizotypal Personality Questionnaire (SPQ). A mechanical device delivered tactile stimulation to participants’ palms. The device was operated by the experimenter (External) or the participant (Self). Participants were asked to rate the intensity, ticklishness and pleasantness of the stimulation. A significant association was observed between participants’ tactile self-suppression (External minus Self) and their score on the SPQ. These results suggest that the ability to suppress the tactile consequences of self-generated movements varies across the general population, and maps directly onto the personality dimension of schizotypy.     

Examples of real world engineering ethics problems

Nine examples are presented illustrating the kinds of problems encountered in actual practice by conscientious engineers. These cases are drawn fom the records of the IEEE Ethics Committee, and from the experience of the ethics help-line initiated recently by the Online Ethics Center for Engineering and Science. They range from situations in which companies try to cheat one another to those in which human health and safety are jeopardized. In one case, an engineer learned that even a quiet resignation can prove very costly in a personal sense. Some ways in which professional societies might make ethical practice of engineering somewhat easier are mentioned. An carlier, shorter version of this paper was presented at the International Conference on Ethics in Engineering and Computer Science, Case Western Reserve University, Cleveland, March 21–24, 1999, and can be accessed on line at http://onlineethics.org/cases/unger.html. In all cases described in this paper, the names of individuals and organizations have been suppressed or fictionalized. Professor Unger was Chairman of the IEEE (Institute of Electrical and Electronics Engineers) Ethics Committee (1997–1998).     

Negotiating time: the significance of timing in ending inpatient work

This paper discusses work with young people during their stay on an NHS psychiatric inpatient unit, especially focusing on the end of treatment and the appropriate timing of discharge into the community. When approaching the end of an admission, various factors are considered that seem particularly relevant to the decision of when a young person may be ready to leave and cope with the transition back to life outside the unit. Indications of medical stability, in patients where this has been an issue, is a factor of prime importance. Other important factors include family functioning; the availability of adequate ongoing local CAMHS support for the child and family; suitable school provision; and the identity of the child within a peer group. The reality of NHS resources and the demand for inpatient beds is another pressing consideration. The young person's own motivation emerges as crucial at this stage – towards the end of treatment – not only in terms of what is said, and therefore evident verbally, but also through signs of internal shifts in the child that indicate a capacity to re-engage with life outside in a lasting way. Decisions about when to stop are taken with all this in mind and when the decision does not seem straightforward, it can provoke considerable anxiety in the multi-disciplinary team. Clinical material from psychotherapy with a young adolescent boy with anorexia nervosa is used to illustrate some of the dilemmas.     

A hierarchical model of operational anticipation windows in driving an automobile

Driving an automobile is an example of a goal-directed activity with high complexity in which different behavioral elements have to be integrated and brought into a sequential order. On the basis of the reafference principle and experimental results on temporal perception and cognitive control, we propose a hierarchical model of driving behavior, which can also be adapted to other goal-directed activities. Driving is conceived of as being controlled by anticipatory neuronal programs; if these programs are disrupted by unpredictable stimuli, which require an instantaneous reaction, behavioral control returns after completion of the reactive mode to the anticipatory mode of driving. In the model different levels of anticipation windows are distinguished which, however, are interconnected, in a bi-directional way: (a) Strategic level with a representation of the driving activity from the beginning to reaching the final goal; (b) Segmented tactical level with the sequence of necessary milestones to reach the goal; (c) Maneuver level where actions like passing another car or keeping a lane are controlled; (d) Short-term integration level of a few seconds which allows immediate anticipations; and (e) Synchronization level for sensorimotor control and complexity reduction within neuronal assemblies. A flow diagram schematically describes different driving situations stressing the anticipatory mode of control. In a pilot experiment with 20 subjects using a virtual driving situation in a car simulator predictions of the model could be verified, i.e., subjects showed a significant preference for the anticipatory mode of driving.     

触觉刺激对触觉注意启动作用的研究

目的：探讨触觉刺激对触觉注意的影响,以揭示选择性注意的机制。方法：利用在体电生理记录技术,记录了288个丘脑腹侧基底核（ventrobasal nuleus of thalamus,VB）神经元放电活动,并着重考察了不同强度触觉刺激对丘脑神经元细胞自发放电活动的影响。结果发现：触觉刺激对大部分的触觉神经元的自发放电活动均有抑制性影响。提示触觉刺激降低背景噪声可能是触发选择性触觉注意的神经机制。