Social isolation as a punishment procedure: a controlled study

Contingent social isolation was investigated as a punishment procedure for the disruptive behavior of emotionally disturbed children in a classroom setting. The methodological limitations of previous studies were outlined, and alternatives adopted. Within a reversal and multiple baseline design, contingent social isolation was found to be an effective and relatively specific punisher. By introducing a new observation procedure, “pseudo-timeout”, it was determined that the punishing effect of social isolation was not attributable to observation artifact. A means for resolving the terminological confusion in the present use of timeout and social isolation was recommended.     

病人自主权及其保障条件

病人自主权是病人的基本人权之一,是保障其生存权与健康权的基本条件,也是医学人道主义的重要内容。同时,在医疗活动的权力制衡中,代表病人权利的权力是必不可少的要素之一。因此,病人自主权必须受到充分的尊重。病人自主权要想得到充分的保障,必须以全民的权利意识觉醒为条件,以完善的法制与法治为保障,并要符合健康目的,遵从科学规律。     

Assessing pain behaviour of low-back pain patients in real time: concurrent validity and examiner sensitivity

Several systems for measuring pain behaviour have been developed for clinical settings. The present study reports on a real-time system for coding five categories of pain behaviour for low-back pain patients: guarding, touching, sounds, words, and facial expression. Unique features of the system are the use of refined measures of facial expression and integration of the measurements with a standardized physical examination. 176 sub-acute and chronic low-back pain patients underwent a physical examination while their pain behaviour was coded. Concurrent measures of subjective pain, medically-incongruent signs, and independent global ratings of pain behaviour were taken. Analyses indicated that the pain behaviours, particularly guarding and facial expression, varied systematically with the alternative measures, supporting the concurrent validity of the behaviour observation system. While pain behaviours, especially use of words and facial expressions, were significantly associated with the examiners' independent ratings, the strength of the associations suggested that, in the absence of direct training, examiners' performance was relatively poor. Implications for training of clinicians in detecting pain behaviour are discussed.     

A History Which Began to Be Told: A Clinical Case

This article aims to reflect on the possible contributions of psychoanalysis in relation to severely disturbed patients by means of the presentation of a clinical case. Beginning with the family history, the evolutionary process of the symptoms and identification movements of the patient are analysed. The observation of the transference dynamics is emphasised, showing how the desire of the analyst and his privileged listening will allow the patient some level of possible subjective structure.     

Psychiatric Patients’ Evaluation of the Efficacy of Obeah vs. Western Medicine in Treating Their Mental Illness

This study sought to determine any potential benefits in psychiatric patients’ use of traditional medicine in their treatment. Participants were 51 Jamaican patients who self-reported on concurrent use of western and alternative medicine. They completed the Jamaican Healthcare Perception Questionnaire. Data were analysed using the chi-square test of differences between proportions. Findings indicated that 58.8% of patients incorporated traditional medicine in their treatment. These were less likely to agree with the diagnosis given by the formal practitioner and that his treatment was effective or to rate the quality of service of the formal practitioner as being satisfactory. Patients believed alternative medicine should be incorporated into the healthcare system.     

La Direction des affaires juridiques et des droits des patients de l’AP–HP et la première vague de la pandémie Covid-19

To facilitate the analysis and the management of claims related to the last Covid-19 pandemic, the DAJ of the AP–HP constituted a medical group assisted by lawyers intending to review the scientific knowledge and organizational measures during the first wave of this pandemic. This group brought together medical doctors with both scientific expertise in the main specialties requested during this viral infection and knowledge of repairing bodily damage. Based on the data provided by the hospital dashboards and the collection of hospital procedures for Covid-19 and non-Covid-19 patients, the goal of this group was to assess the level of scientific knowledge and organizational measures respectively at the start of the epidemic, its peak and at the end. During the three periods of this pandemic the main changes observed included a greater selectivity on admissions with increasing consideration on the patient's comorbidity; a continual evolution in drug management and more rigorous isolation measures with interruption of visiting rights. The target was to prevent contamination of the non-infected persons with an obsession to protect healthcare workers. The absence of selection for patients requiring intensive care for compensation of their respiratory failure forced AP–HP to double the number of intensive care beds and to refer some patients in other regions. In a context of unstable scientific knowledge and evolving organizational measures, the collection of these data should facilitate the management of claims related to Covid19 during the first wave of this pandemic and open a prospective study for the next pandemic.     

The Influence of the Premedication Consult and Preparatory Information about Anesthesia on Anxiety among Patients Undergoing Cardiac Surgery

The present study examines the impact of patients' subjective evaluation of the premedication consult and of preparatory information about anesthesia on preoperative anxiety among patients undergoing cardiac surgery ( N = 93). The preparatory information concerned a flyer that contained information about treatment options, risks of surgery and expected outcomes with respect to anesthesiology. The data did not support the beneficial effect of the information on patients' anxiety levels above the standard procedure in which patients were solely visited by their anesthesiologist for a premedication consult. Anxiety reduction was related, however, to the perceived quality of the premedication consult. The more positively the interaction with the anesthesiologist was evaluated, the stronger the patients' anxiety reduction. In addition, the moderating impact of monitoring/blunting on preoperative anxiety was examined. High levels of monitoring and low blunting were associated with stronger anxiety reduction, regardless of whether patients received additional preparatory information or solely an oral consult. The implications of these findings for clinical practice are discussed.     

Experimental Task and Speaker Effects on Parent-Child Interactions of Aggressive and Depressed/Anxious Children

Parent-child interactions of aggressive and depressed/anxious clinic-referred children were observed during two different tasks: planning a vacation and discussing a conflict. Marked group differences were found as a function of the type of task, who was speaking (parent vs. child), and type of child psychopathology. Negative behaviors (e.g., Belittling and Blaming) were especially pronounced in the conflict task, whereas positive behaviors (e.g., Nurturing and Protecting) were more common in the planning task. Parents displayed other-directed behavior (e.g., Watching and Controlling), whereas children showed more self-directed behavior (e.g., Walling Off and Distancing), and patterns of child psychopathology interacted with task and speaker in theoretically important ways; for example, parents of aggressive children showed more Belittling and Blaming than their children in the conflict task, but not in the planning task. The findings highlight key factors that may need to be incorporated into models of parent-child interaction and child psychopathology.     

The categorical structure of knowledge for famous people (and a novel application of Centre-Surround theory)

Knowledge of familiar people is essential to guide social interaction, yet there is uncertainty about whether semantic knowledge for people is stored in a categorical structure as for objects. Four priming experiments using hard-to-perceive primes investigated whether occupation forms a category connecting famous persons in semantic memory. Primes were famous faces exposed for 17ms with masking, resulting in severely restricted awareness and thus precluding expectancy-based priming effects. Targets were consciously perceptible famous faces (Experiments 1-3), famous names (Experiment 3), or occupations (Experiment 4) representing either the same or different occupation to the prime. Significant priming demonstrated the operation of automatic processes, including spreading activation, among persons sharing a common occupation; this supports the categorical view. The direction of priming (faster/slower responses to same-occupation than different-occupation targets) was dependent on prime-target stimulus onset asynchrony (Experiments 1-3) and type of target (Experiment 4). This pattern of results is attributed to the Centre-Surround mechanism proposed by Carr and Dagenbach [Carr, T. H., & Dagenbach, D. (1990). Semantic priming and repetition priming from masked words: evidence for a centre-surround attentional mechanism in perceptual recognition. Journal of Experimental Psychology: Learning, Memory and Cognition, 16, 341-350]. These results support (a) the categorical structure of semantic knowledge for famous people and (b) the application of the Centre-Surround mechanism to the domain of person recognition.     

L’espoir dans la maladie chronique : représentations sociales de l’espoir chez les patients et soignants

Hope has a significant place in many literatures and most recently in health context. Nevertheless, there is still little research describing the distinct concepts and representations of hope in patients’ population. Hope is defined as perceived capability to derive pathways to desired goals, and motivate oneself via agency thinking to use those pathways. The main objective of this study is to explore the representation of hope, in the context of chronic disease, for both patients and health providers. For that purpose, we conducted the present study considering the social representation approach. The sample consisted of 67 chronic disease patients (mean age = 51.13 years; SD = 19.05; 68.70% female), 83 health care professionals (mean age = 35.32 years; SD = 11.49; 74.70% female) and 103 individuals from the general population (mean age = 30.41 years; SD = 13.85; 64.10% female). They completed two free associations task: write “everything that comes into your mind when you think about hope”, one in general and one in disease context. Free associations allowed us to identify shared conceptions of hope as well as intergroup variations in these representations. Associations with the word of hope produced by our respondents were depending on (a) the context (hope in disease or hope in general), and (b) the type of participant (patient, healthcare professionals or individuals from the general population). The results first indicate that hope, for all participants and whatever the context, refers to the beliefs of positive issues and perspectives. Moreover, dealing with a chronic disease seems to create, for the patients, a very specific representation of hope. It appears that when disease becomes serious and persistent, and when patients need to deal with uncertainty, hope is mainly described as a coping strategy, determined by specific objectives and resources.