罗杰斯以人为中心疗法与道家思想的契合与背离

西方心理治疗理论在中国的发展必须经历一个与本土文化和实际相冲突或融合的过程，在心理治疗的本土化研究中，如何吸取西方理论研究和实证研究的丰硕成果，并结合本国传统的思想和文化精髓一直是关键问题，罗杰斯的以人为中心心理治疗方法是人本心理治疗的一个主要体系，本文主要从以下三个方面一人性观、治疗目标和治疗方法将其与中国传统道家思想进行一个比较，试图发现二者之间的契合和背离之处，作为以人为中心治疗本土化研究的一点思考。     

Prospective randomized trial of glucose-insulin-potassium in acute myocardial infarction. Effects on myocardial hemodynamics, substrates and rhythm.

Fifty consecutive patients admitted within 12 hours of the onset of symptoms of acute myocardial infarction were randomly assigned to treatment with intravenous glucose-insulin-potassium infusion (23 patients) or to a control group (0.5 N sodium chloride infusion) (27 patients). The glucose-insulin-potassium infusion consisted of 30 g glucose, 50 U regular insulin and 80 mEq KCl per liter infused at 1.5 ml/kg per hour for 2 days. Serial measurements were made of pulmonary arterial end-diastolic pressure, cardiac index, daily fluid intake and output, serum glucose, potassium, urea nitrogen, free fatty acids, osmolarity, creatine kinase-MB isoenzyme and cardiac rhythm. Although all patients admitted comatose died (three glucose-insulin-potassium recipients, one control subject), hospital mortality in patients admitted noncomatose was 0 percent (0 of 20) in glucose-insulin-potassium recipients versus 12 percent (3 of 26) in the control group (three deaths secondary to late pump failure). Glucose-insulin-potassium recipients experienced 4.9 ± 1.3 hours of three or more premature ventricular complexes/min compared with 11.1 ± 1.9 hours for control subjects (P < 0.02). Twelve control patients had 60 episodes of ventricular tachycardia compared with seven glucose-insulin-potassium recipients, who had 12 episodes of ventricular tachycardia. During glucose-insulin-potassium infusion, fluid intake and output, serum glucose and potassium were significantly increased compared with values in control subjects, blood urea nitrogen and free fatty acids were decreased, whereas osmolarity, pulmonary arterial end-diastolic pressure and cardiac index did not differ significantly from control values. Creatine kinase-MB infarct size averaged 124 ± 15 IU/liter in glucose-insulinpotassium recipients and 109 ± 14 IU/liter in control subjects (difference not significant).These data demonstrate that, in patients with acute infarction, glucose-insulin-potassium infusion (1) does not adversely alter hemodynamics, (2) reduces free fatty acids, (3) diminishes frequency of ventricular arrhythmias, but (4) has no demonstrable effect on infarct size as assessed with creatine kinase isoenzyme values. In this ongoing randomized clinical trial, the number of patients studied is too small to permit definite conclusions to be reached regarding the effect of glucose-insulin-potassium infusion on hospital survival.     

Practicing “Reflective listening” is a mandatory prerequisite for empathy

We must humbly acknowledge that the healthcare system is less and less about empathy despite interacting with patients is a prerequisite for care: shared decision making is the cornerstone for compliance to treatment and therefore its -effectiveness. Empathy is not about tricks, it is about “client-centred therapy” a term coined by Carl Rogers. The key is “reflective listening”. Simply summarize what the patient said by using his own words rather than paraphrasing and without digressing to other subjects. This reinforces patients’ own expressions of problems, recognition of concerns, complaints and, values and reveals potential misunderstanding of patient’s concerns. New technologies can help to understand patient’s experiences as a program for professionals caring for inflammatory bowel diseases: they receive on their a smartphone daily recurring messages such as “You have ten minutes to go to the toilet” and must send a photo of a lavatory door within few minutes.     

The new TNM classification of lymph node metastasis minimises stage migration problems in gastric cancer patients

The present study aimed at investigating whether in gastric cancer patients stage migration occurs with extension of lymphadenectomy, when node metastases are staged according to the new pN classification (UICC 1997). The investigation involved 921 patients, who underwent R0 gastric resection for gastric cancer between 1988 and 1998 in three different Italian centres: Verona (n=236), Forlì (n=409), Siena (n=276). The relation among lymphadenectomy and pN category was assessed by Kendall's partial rank-order correlation coefficient, controlling for depth of tumour invasion. A direct evaluation of the Will Rogers phenomenon was accomplished in the Verona series, by comparing the number of positive nodes actually observed with the number of positive nodes which would have been retrieved by a less extended lymphadenectomy (D1). The number of positive nodes increased remarkably with the enlargement of lymphadenectomy, especially in pT2 patients (from 2.2+/-3.9 in D1 to 3.9+/-5.0 in D3) and in pT3/pT4 patients (from 5.1+/-5.9 in D1 to 11.3+/-12.6 in D3). Non-parametric statistics highlighted a weak (Kendall's partial T=0.128) but significant (P<0.001) correlation between pN category and extension of lymphadenectomy. In the direct analysis of the Verona series, 22 patients out of 230 (9.6%) migrated to a lower pN tier when ignoring positive nodes retrieved from the second and third level. This percentage increased to 39.1% (90 out of 230) when adopting the TNM 87 classification. In conclusion stage migration is of minor importance in gastric cancer patients, staged according to the new pN classification.     

罗杰斯人本主义教学模式在中医系学生检体诊断带教中的应用

现在的中医系学生随着科学的发展和社会的需要,开始学习西医课程。诊断学是学生们从理论走向临床的一个重要的桥梁课程。我院已带中医系学生多年,但是从既往带教学的教干了解到上检体诊断学课时学生容易感到枯燥无味,尤其对中医系学生有些同学因缺乏兴趣及对西医的不理解,从而不认真学习。我们尝试应用罗杰斯人本主义教学模式调动学生的积极性,得到了较好的效果。     

Stage migration vs immunology: The lymph node count story in colon cancer

Lymph node staging is of crucial importance for the therapy stratification and prognosis estimation in colon cancer. Beside the detection of metastases,the number of harvested lymph nodes itself has prognostic relevance in stage Ⅱ/Ⅲ cancers. A stage migration effect caused by missed lymph node metastases has been postulated as most likely explanation for that. In order to avoid false negative node staging reporting of at least 12 lymph nodes is recommended. However,this threshold is met only in a minority of cases in daily practice. Due to quality initiatives the situation has improved in the past. This,however,had no influence on staging in several studies. While the numbers of evaluated lymph nodes increased continuously during the last decades the rate of node positive cases remained relatively constant. This fact together with other indications raised doubts that understaging is indeed the correct explanation for the prognostic impact of lymph node harvest. Several authors assume that immune response could play a major role in this context influencing both the lymph node detectability and the tumor's behavior. Further studies addressing this issue are need. Based on the findings the recommendations concerning minimal lymph node numbers and adjuvant chemotherapy should be reconsidered.     

The gap between psychiatric practice and the medical model

The authors have attempted to pinpoint causes for the disparity between the information psychiatrists say they give to referring physicians and patients and the information the referring physicians and patients say they receive. Using questionnaires and open-ended interviews, this study has shown there was a highly significant discrepancy between the information patients said they received and what psychiatrists said they gave with respect to the rationale of treatment prognoses with or without treatment.This gap could be attributed to various factors, among them the unavailability of psychiatrists or lack of outcome studies. Moreover, this study tends to point out the sequential difference in the treatment of psychiatric outpatients, e.g. the patient is helped by his doctor through treatment to diagnose himself and that adherence to this psychiatric style of interviewing could be utilized by the primary physician to improve his rapport with patients and, perhaps, increase their knowledge and understanding of their own disease.As previously reported, residents in child psychiatry, working under the supervision of the senior author, were reluctant to commit themselves to a diagnostic framework and completely avoided formulating prognoses, even though they were accomplished in understanding and conveying clinical data. The primary aim of our work was to attempt to link our trainees psychiatric and medical identities, which appeared to be totally divergent. In all of the cases covered by our study the trainees failed to provide diagnoses to referring physicians 48% of the time and to patients 45% of the time.¹ Prognoses were never offered. We have attempted to elicit reasons for this divergence from standard medical practice.