主题：PHOTO

Nov. 20, 2009 -- Forget aspirin and ibuprofen. A new pain reliever is decidedly less medical: a photo of a loved one.

A new study shows that just looking at a picture of a loved one can help reduce pain. Holding a loved one's hand also helps reduce pain.

The study included 25 women, mostly students at UCLA, who had been in good relationships with their boyfriends for at least six months. The women received heat stimuli to the forearm. Then they reported their pain levels while looking at pictures of their boyfriends, while looking at a picture of stranger, and while looking at a picture of a chair.

They also received stimuli and reported pain levels while holding hands with their boyfriends, while holding hands with a stranger, and while holding a squeeze ball.

Sarah Master, PhD and colleagues from the UCLA department of psychology found that the boyfriends' "presence" -- whether holding their hands or just seeing their photos -- reduced the participants' pain ratings.

"This changes our notion of how social support influences people," study co-researcher Naomi Eisenberger, PhD, assistant professor of psychology and director of UCLA's Social and Affective Neuroscience Laboratory, says in a news release. "Typically, we think that in order for social support to make us feel good, it has to be the kind of support that is very responsive to our emotional needs. Here, however, we are seeing that just a photo of one's significant other can have the same effect."

The researchers offer a bit of practical advice: If your loved one can't be with you when you are going through a painful experience, try bringing his or her picture along.

　　研究者于第94届美国放射医学会科学集会与年会上发表，在进行断层扫描（CT）时，包括病患头部的照片可以增加放射科医师对于细部的注意力，且增加放射科医师对于病患感觉的热情，许多有专业缺乏感觉的现象。
　　
　　来自以色列耶路撒冷Shaare Zedek医学中心的放射科住院医师Yehonatan N. Turner医师表示，放射科医师感觉已经从病患照护中排除了，他说他团队的发现，由六位资深放射科医师判读的96个CT检验结果。放射科医师们在三种场景下判读影像两次，当他们在第一次看片子前，给他们看病患的相片，但是在第二次判读影像时，就没有提供相片；或是在第一次看片子的时候，没有提供相片，直到第二次看片子时才提供相片；或是在两次判读片子前，都提供病患相片。
　　
　　Turner医师报告，当CT影像在有病患相片的情况下判读时，判读结果的字数显著较多，且相较于没有附上照片时，意外的发现多了将近两倍。
　　
　　他评论，主观地，放射科医师说他们感到有更多的热情，且他们感觉相片包含了与病例相关重要的资讯，应该被包括在CT影像中。
　　
　　Turner医师指出，放射科医师告诉他，相片可以降低病患误差，这给了疾病严重度的影像，且使得每张CT扫描是独特的。相片增加放射科医师对照护提供的建议，我们相信这可以改善医师的表现。
　　
　　西雅图华盛顿大学放射学教授Eric Stern医师向Medscape放射学表示，包括相片可能不会改变对于病患的整体印象或是处理，但这看起来似乎使得医师对于细节更加注意，且人性化了这些病例。
　　
　　当然也有反面的看法。他提醒，引入病患的相片使得医师在判读上有误差。Stern医师指出，没有匿名的情况下，可能会有误差；照片降低客观度，因为这清楚地影响放射科医师的行为。我们发现在过去的研究中，于影像研究中，导入病患的照片前后，提供给病患的治疗选择不同。
　　
　　Stern医师提醒，除此之外，意外发现的增加不见得是好事。这可以代表没有根据的检验，且有相当的花费，且可能增加病患的发病率，例如因为伪阳性的判读而进行切片。
　　
　　意外异常的发现可以导致下游的不良预后。这可以是件好事，例如侦测到额外的癌症，或是这可能是件坏事，就像对于良性病灶过度的检验。
　　
　　Turner医师承认照片可能导入医师的误差，且那有所有影像研究对于导入病患照片的担忧。
　　
　　Stern医师承认，导入病患照片是个有趣的作法。然而，这是个小型研究，且这项研究的发现在被建议于影像研究中导入相片的政策之前，需要进一步地确认这项发现。
　　
　　Turner医师与Stern医师表示没有相关资金上的往来。

RSNA 2008: Patient Photo With Radiology Images Increases Length, Depth of Radiologist's Report

By Martha Kerr
Medscape Medical News

Including a headshot of the patient taken at the time of a computed tomography (CT) scan increases the radiologist's attention to detail and increases the empathy the radiologist feels for the patient, which many in the field feel is lacking in their specialty, researchers reported here at the 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

"Radiologists feel removed" from patient care, radiology resident Yehonatan N. Turner, MD, from the Department of Radiology at Shaare Zedek Medical Center, in Jerusalem, Israel, said in announcing his team's findings of 96 CT exams read by 6 senior radiologists. The radiologists read images twice in 1 of 3 scenarios: they were shown the patient's photo before the first viewing but not before the second viewing; they were not shown the patient's photo before the first viewing but were shown the photo before the second viewing; or they were not shown the patient's photo before either viewing.

When the CT image was read with a photo attached, the summary consisted of significantly more words and the number of incidental findings was approximately double what it was when no photo was attached, Dr. Turner reported.

"Subjectively, radiologists said they felt more empathy...and they felt the photo contained important information relevant to the case and that it should be included with the CT images," he commented.

"The photo could decrease patient errors, it gives a picture of the severity of illness...and makes each CT scan unique," Dr. Turner said the radiologists told him. "The photo increases recommendations for care [by the radiologist] and we believe it improves physician performance."

"Including the photo probably wouldn't change the overall impression or management of a patient, but it does seem to result in a more meticulous attention to detail and it humanizes the case," Eric Stern, MD, professor of radiology at the University of Washington, in Seattle, told Medscape Radiology.

"There is a counter argument. Introducing a photo introduces physician bias," he cautioned. "Without anonymity, there is bias.... The picture decreased objectivity because it clearly affected [the radiologists' behavior]," Dr. Stern pointed out. "We've seen in previous studies that treatment options offered to the patient differ before and after a photo is included with imaging studies."

In addition, an increase in incidental findings might not be a positive thing. "It can mean unwarranted testing with a substantial cost and possibly increased patient morbidity, such as in the case of a biopsy for a false-positive reading," Dr. Stern cautioned.

"Finding incidental abnormalities can lead to adverse outcomes downstream. It can be a good thing, such as when extra cancers are detected, or it can be a bad thing, like an extensive work-up for benign findings."

Dr. Turner acknowledged that the photos can introduce physician bias and that that has been a concern of his about including a patient's photograph with all imaging studies.

"Including a photograph is an intriguing approach," Dr. Stern acknowledged. "However, this is a small study and the findings need to be validated before we can recommend a policy of including a patient's photo with imaging studies," Dr. Stern said.

Dr. Turner and Dr. Stern disclosed no relevant financial relationships.

RSNA 2008: 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America: Scientific Session A10-07: Scientific Session M12-03. Presented December 2, 2008.