运用比较治疗学方法促进JORRP治疗决策科学化

为了儿童复发性呼吸道乳头状瘤病的有效治疗,通过对目前国内对该病所报道的一些主要治疗方法进行比较和分析.用比较治疗学的理念及方法来指导和规范儿童复发性呼吸道乳头状瘤病治疗的临床决策,以期能在目前条件下提高病人的治疗效果、降低医疗费用及提高生活质量.     

原发性开角型青光眼局部药物治疗的比较及决策最优化

通过对目前治疗原发性开角型青光眼局部降眼压药物的作用机制、治疗效果、不良反应、药品价格及使用方便程度进行综合的比较分析,运用比较治疗学的理论和方法来指导和规范该类青光眼局部药物治疗的临床决策,以期提高治疗效果、减少并发症、降低费用及提高患者的生存质量。     

颅脑手术戒毒后动机形成障碍的原因分析

通过回顾性研究以往行颅脑手术进行戒毒治疗的病例资料,进而分析双侧伏核射频毁损术后吸毒患者动机形成障碍的原因.我们发现,272例患者中有16例存在术后反馈动机形成障碍,表现为:注意力下降10例,主动性下降7例,交流减少6例,兴趣减少3例,12例多种障碍类型并存.3例伴有其他并发症者症状较轻.4例术后CT或MRI结果提示平均毁损灶体积约12mm×10mm×7mm.3个月以上的心理行为治疗可减轻障碍程度.通过分析,我们认为该类并发症与毁损灶的部位过深、体积过大、反复用药后奖赏阈升高有关,通过靶点精确定位、毁损体积控制可能达到收益和风险的平衡.     

早期大肠癌内镜下治疗与手术治疗的比较

大肠癌是常见的恶性肿瘤,提高其总体疗效的有效途径是早期诊断和治疗。外科手术和内镜下治疗是目前临床上常用的治疗早期大肠癌的有效方法。针对两者的优缺点,本文利用比较治疗学相关原理和方法,从其适应证、疗效、并发症及费用等方面进行比较,以获得启示,为临床实践提供指导。     

早期大肠癌内镜下治疗与手术治疗的比较

大肠癌是常见的恶性肿瘤,提高其总体疗效的有效途径是早期诊断和治疗.外科手术和内镜下治疗是目前临床上常用的治疗早期大肠癌的有效方法.针对两者的优缺点,本文利用比较治疗学相关原理和方法,从其适应证、疗效、并发症及费用等方面进行比较,以获得启示,为临床实践提供指导.     

年龄相关性黄斑变性治疗的比较分析

从治疗原理、费用、疗效、不良反应等方面对年龄相关性黄斑变性的不同治疗方法进行比较和分析,为患者进行治疗上的选择提供帮助,同时指导和规范该类疾病治疗的临床决策,以期能在目前条件下不仅提高病人的治疗效果和生活质量同时又达到降低医疗费用的目的。     

年龄相关性黄斑变性治疗的比较分析

从治疗原理、费用、疗效、不良反应等方面对年龄相关性黄斑变性的不同治疗方法进行比较和分析,为患者进行治疗上的选择提供帮助,同时指导和规范该类疾病治疗的临床决策,以期能在目前条件下不仅提高病人的治疗效果和生活质量同时又达到降低医疗费用的目的.     

腹主动脉瘤的外科治疗决策

腹主动脉瘤破裂是最常见、最凶险的疾病之一。提高对其治疗的临床决策水平至关重要。比较传统开腹修复治疗和血管腔内修复治疗的优缺点,以最佳证据为指导,选出最佳方案应用于临床实践。以人为本,做出科学决策,从而降低医疗费用及提高疗效及患者生活质量。     

腹主动脉瘤的外科治疗决策

腹主动脉瘤破裂是最常见、最凶险的疾病之一.提高对其治疗的临床决策水平至关重要.比较传统开腹修复治疗和血管腔内修复治疗的优缺点.以最佳证据为指导,选出最佳方案应用于临床实践.以人为本,做出科学决策,从而降低医疗费用及提高疗效及患者生活质量.     

腰椎间盘突出症两种手术方式治疗住院费用分析

比较腰椎间盘突出症单纯减压手术与减压并植骨融合手术所需费用,探讨腰椎间盘突出症手术治疗医疗费用的影响因素,为患者选择合理的手术方案提供依据。选择某专科医院2005年1月至2007年10月期间851例行单纯减压手术与242例减压并植骨融合术的病例,对其手术时间、术中出血量、术后住院时间、术后抗菌素使用时间、住院各项费用进行比较。材料费、药费、手术费、床位费是影响住院总费用的主要因素。腰椎间盘突出症的患者可根据自身的经济条件、所患疾病的具体情况在两种手术方式之间权衡决定最适宜的手术方案。     

肺癌早期综合诊疗思考

通过分析目前肺癌患者5年生存率徘徊在10%,这一现实问题,可以得到一些重要启示和思考。今后肺癌治疗发展方向将是完善个体化、多学科早期综合治疗模式;利用基因芯片技术开展肺癌早期诊断,对肺癌高危人群开展大规模普查;开展靶向性、高效低毒、抗耐药性的肺癌治疗药物研究,进行肺癌逆转的分子干预治疗和分子阻断治疗,要用早期综合地手段诊疗肺癌。     

A Grammar of Love

Abstract

Recently researchers in the family therapy field have encouraged a focus on aspects of therapy common across all models that are important to therapeutic change. The purpose of this study was to build on the “common factors” literature by exploring clients' perspectives of what was useful to their therapeutic experience. Quantitative and qualitative measures were used to collect data from 41 clients who participated in therapy at a university-based family therapy clinic. Quantitative results indicated that therapeutic relationship, client motivation, extratherapeutic factors, and hope and expectancy accounted for 49% of the variance of clients' perception of change and 73% of the variance of clients' perceptions of therapy helpfulness. Qualitative results indicated the therapeutic relationship to be the most helpful aspect of clients' therapeutic experience.     

The performance of a simple motor task with kinaesthetic sense loss

Two related studies were carried out, to test the suitability of the nerve compression block as a technique in the investigation of kinaesthesis in motor skills.

In both studies a key tapping task was used. Each experimental group was composed of six volunteer subjects. It was found that kinaesthetic sensation was eliminated after pressure had been applied for 20-25 min., but muscle power was not seriously affected at this stage of the block. The results also showed a pronounced performance decrement in the absence of kinaesthetic feedback, and that this decrement was not due to emotional or other disturbances caused by the experimental procedure. The loss of tactile sensation was also observed.     

Revisiting Bordin's Theory on the Therapeutic Alliance: Implications for Family Therapy

Because of the belief that relationships are a major contributor to problems as well as the avenue for bringing about change, the alliance between therapists and clients is important in family therapy. Writings and ideas on the therapeutic alliance from psychoanalytic theory were used by Edward Bordin to develop a working theory in 1979, and later adapted to the field of family therapy. However, the adaptation did not account for many variables unique and important to family therapy. This article describes the therapeutic alliance and the necessity of creating a theory of therapeutic alliance that accounts for family therapy concepts. Future ideas for scholarship are presented.     

Sensory and motor impairment in the nerve compression block

Recently nerve compression block as a method of investigating movement control without kinaesthetic feedback has been questioned on the grounds that motor impairment (as measured by nerve conduction parameters) is a confounding factor. In order to clarify the relationship between sensory and motor function, behavioural data was obtained on both at systematic time intervals throughout the duration of the block. The findings indicated that significant decrements in tapping measures occurred somewhat earlier in the time course of the block than decreases in kinaesthetic discrimination. Also, contrary to assumption, the majority of subjects ceased to perform prior to total kinaesthetic loss. The data suggest that motor impairment is a “crucial” issue (Laszlo, 1966) in the use of this technique, and provide further behavioural support for the neurological findings of Kelso, Stelmach and Wanamaker (1974).     

A meta-analysis of play therapy outcomes

A meta-analysis of play therapy outcomes with children was conducted to determine the overall effectiveness of play therapy and the variables related to effectiveness. Hierarchical linear modelling was used to analyse the data. The analysis showed an average treatment effect of 0.66 standard deviations. A strong relationship between treatment effectiveness and the inclusion of parents in the therapeutic process was reported. The duration of therapy also appeared to be related to treatment outcomes, with maximum effect sizes occurring after approximately 30 treatment sessions. Play therapy appeared to be as effective as non-play therapies in treating children experiencing emotional difficulties. Recommendations for future researchers focus on explaining therapeutic or participant characteristics that are related to treatment effectiveness.     

Engagement and the Therapeutic Relationship in Systemic Therapy

This paper is about the therapeutic relationship in systemic therapy and, more specifically, about engagement as a process. Beginning with some practice examples, a critique is made of the way in which both the therapeutic relationship and engagement have been under-theorized in systemic therapy. Two different sets of ideas are used to develop some thinking about the process of engagement: the notion of the 'good-enough' engagement as the environment or frame of therapy is developed, and the systemic concept of sequences is held alongside the psychoanalytic ideas of transference, countertransference and projective identification. This theory discussion is used to reflect on the original practice examples.     

Systemic family therapy can be manualized: research process and findings

Determining the efficacy of therapeutic interventions is becoming an increasing political and ethical necessity. Comparative therapeutic outcome trials are most powerful when there is a precise specification, or manualization, of the forms that therapies took. Manuals have begun to be developed for structural/behavioural family therapy and couple therapy. The development of these manuals is often reliant on experts' self-report, rather than a systematic analysis of the therapeutic process as it happens. This can limit their validity and applicability to standard clinical practice. In addition, no manuals exist which reflect less structured forms of family therapy aimed at incorporating systemic, postmodern and narrative frameworks. The feasibility of producing a workable manual that reflects the fluidity of such practices has been questioned.
A research project to systematically create and test such a manual is reported. Multiple data sources and research methods, primarily qualitative, were applied to generate a rich specification of the therapy. In reporting these results the contents of various aspects of the final manual are indicated. Procedures to ensure that the prescribed practice is consistent with a widely used approach to systemic family therapy are also described.
The manual will be an important tool for outcome research and therapeutic practice. The account of the research process should be helpful to researchers engaged in constructing a manual for other models of family therapy based on a rigorous analysis of actual practice. The manual itself is available for use by outcome researchers who wish to evaluate this widely used form of systemic family therapy.     

乳腺癌的现代与传统治疗模式的比较分析与思考

乳腺癌是女性最常见的恶性肿瘤之一,现代治疗模式已经广泛应用于临床。近年来,随着循证医学和基因相关技术及生物信息技术的不断发展,乳腺癌治疗方法得到不断改进,但远没有达到系统化、个体化、最优化的治疗目的。因此,现有的治疗模式值得我们去深思,并从哲学意义上探索更为完善的治疗模式。     

Practitioners' accounts of religious and spiritual dimensions in bereavement therapy

This study explores religious and spiritual dimensions in bereavement therapy through in-depth qualitative interviews with 12 therapists for whom bereavement work constituted a major part of their therapeutic role. Information was gathered on the conceptualization of religious and spiritual issues, the perceived influence of therapists' beliefs on their practice and the therapeutic processes that occur in work with religious and spiritual issues. Interpretative Phenomenological Analysis was used to analyse the data, examining associations between these areas as well as highlighting the diversity of experiences and viewpoints. The multi-dimensional role of the therapeutic relationship was highlighted by participants as well as the perceived limitations of many theoretical models of therapy and bereavement in working with religious or spiritual issues. Some therapeutic processes were described in terms of the exploration of belief systems that have been challenged by bereavement and the re-creation of personal meaning. Implications for therapeutic practice and further research are discussed.