我国乙肝抗病毒治疗现状与思考

针对目前乙肝的抗病毒治疗现状以及临床用药的情况,对目前乙肝抗病毒治疗中存在的问题进行思考,就如何选择治疗方法提出医疗原则,认为治疗应该体现安全、有效、经济的原则.     

我国乙肝抗病毒治疗现状与思考

针对目前乙肝的抗病毒治疗现状以及临床用药的情况,对目前乙肝抗病毒治疗中存在的问题进行思考,就如何选择治疗方法提出医疗原则,认为治疗应该体现安全、有效、经济的原则。     

晚期癌症患者治疗决策的思考

现代医疗尚无法治愈所有晚期癌症。现实与期望之间的较大差距,挑战晚期癌症治疗的临床决策。WHO强调为防止资源滥用,应确保抗癌治疗只用于可获益阶段。对于晚期癌症患者的治疗决策,除遵循规矩原则和循证医学证据原则外,还应该遵循尊重患者意愿、社会公平的美德原则。大多数癌症患者需要接受姑息治疗。姑息治疗为患者及家属提供既简便又经济的医疗服务。     

重型肝炎治疗方案的理性选择

针对我国重型肝炎治疗现状,对重型肝炎常用的以及部分有争议的治疗药物和方法进行分析和讨论,就如何选择治疗方案提出医疗原则,认为应采取内科治疗-人工肝-肝移植的综合治疗模式,结合患者的治疗愿望及经济承受力,理性地选择治疗方案,以期达到合理、有效和经济的目的.     

重型肝炎治疗方案的理性选择

针对我国重型肝炎治疗现状,对重型肝炎常用的以及部分有争议的治疗药物和方法进行分析和讨论,就如何选择治疗方案提出医疗原则,认为应采取内科治疗-人工肝-肝移植的综合治疗模式,结合患者的治疗愿望及经济承受力,理性地选择治疗方案,以期达到合理、有效和经济的目的。     

下腰痛综合征的诊治与人文思想

下腰痛是一种常见的骨科病症,轻者可影响患者生活,重者可使患者丧失劳动力。它的发病原因有很多,治疗方法各有不同。在下腰痛的诊断中要按照适度医疗的原则选择合适的检查;在下腰痛的治疗中须按照最优化医疗的原则选择最佳的治疗方案。在治疗中要注意结合人文思想来提高下腰痛的治疗效果。     

论德沃金的医疗资源分配思想

德沃金医疗资源分配思想试图超越平等主义与自由至上主义的对立,解决个人责任与社会责任的矛盾,德沃金主张在医疗资源分配领域,平等优先于自由,强调政府的责任也强调个人责任,他提倡谨慎的保险原则.谨慎的保险原则根据利益和风险对治疗的预期价值进行权衡,谨慎的保险原则可以确定个人和国家医疗支出的限度和方式.     

医生提供治疗的道德义务及其限制

医学伦理学对医生提供治疗的道德义务的边界关注不足,导致临床实践中医生能否拒绝提供特定的治疗常有疑问。医生提供治疗的道德义务可以通过有利原则证成,但在超常的风险和超常的负担下,医生提供治疗将从道德义务转换为道德理想。当患者的医疗要求超出了有利原则的适用范围时,医生不再有提供治疗的道德义务;但在判断有利原则的适用范围时,无效与否不是一个适切的区分,应当根据当时的医疗水平来判断。医生提供治疗的义务还要与尊重、公正等原则的要求相权衡;当患者的人格和良知未得到应有的尊重时,医生有权在符合比例原则的情况下拒绝提供治疗,但对立足于资源不足的临床决策应当慎之又慎。     

精神障碍患者非自愿住院医疗法律规制之原则

基于对社会权利秩序的维护和对精神障碍患者个体权利的恢复,非自愿住院医疗有存在的必要性,但又涉及到对自由权的剥夺,衡平其中的矛盾在于对非自愿住院医疗进行正当的法律规制,探讨了精神障碍患者非自愿住院医疗法律规制应当遵循的法定原则、法律价值权衡原则、最小限制原则、比例原则、医疗目的原则和司法审查原则.     

“医疗经济绩效”至上消解医院宗旨的启示

"医疗经济绩效"机制具有医家"逐利"性质,是"医家利益"型医疗消费的典型表现,在一定程度上对医院宗旨有消解作用。"医疗经济绩效"至上造成医学人道主义信仰缺失,玷污善良总原则,助长从医人员的随意行医行为,诋毁医德"红利"和医生美德,衰败"医师职业精神",向患者树敌,推崇VIP服务使医疗资源分配不合理、不公平。这些都是消解医院宗旨的危险因素,其将"医家利益"转嫁给医疗消费者,直接引发了医患之间的利益差别、利益矛盾和利益冲突。"医疗经济绩效"至上与消解医院宗旨的因果关系毋容置疑。     

Evaluation of resistance to change under different disrupter conditions in children with autism and severe intellectual disability

Translational research inspired by behavioral momentum theory in the area of developmental disabilities has shown effects in individuals over a range of functioning levels. In the current study, behavioral momentum was assessed in 6 children diagnosed with autism and severe intellectual disability. In a repeated measures design, participants were exposed to relatively rich versus lean reinforcement contingencies in a multiple schedule with food reinforcers. This was followed by exposure to each of four disrupting conditions: prefeeding, presentation of a concurrent alternative stimulus, presentation of a movie, and the presence of a researcher dispensing response-independent reinforcers on a variable-time schedule. Consistently greater resistance to disruption in the component with the richer schedule occurred with the alternative stimulus disrupter but not with the other disrupters. These results suggest parameters that may be more (or less) effective if behavioral momentum inspired techniques are to be exploited in therapeutic environments.     

Association Between Hypnotizability,Perceived Self‐Efficacy,and Provider Contact in a Healthy College Student Sample: An Analogue Adherence Study1

This study examines the relationship between hypnotizability, perceived self‐efficacy, provider contact, and participants' ability to complete an analogue task modeled after HIV medication schedules. Participants (n=74) completed the Hypnotic Induction Profile, received instructions designed to manipulate their perceptions of self‐efficacy, and assigned to provider contact conditions (high vs. low). Participants were given jellybeans, a schedule for consuming them, and report logs. A main effect for susceptibility was found, such that participants rated high in susceptibility were more successful in following the schedule than those low in susceptibility. This is consistent with previous research that found initial positive responses to therapeutic interventions among highly hypnotizable psychiatric patients. Suggestions for modifying adherence interventions depending on level of hypnotizability.     

Gay men's experiences of therapy

Fourteen gay men were interviewed using a structured interview schedule to explore their experiences of being in therapy. Particular importance was given to their perceptions of how their sexual orientation impinged on the counselling process and how their assumptions about counsellor sexual orientation affected the therapeutic relationship. The limitations of using structured interviews in qualitative research are acknowledged. Some significant findings were made, which were not well documented in the literature, such as the impact on the therapeutic relationship of internalised homophobia within gay men themselves. These findings hold the potential to inform counselling practice with gay male clients. Recommendations are made in relation to both practice and further research.     

浅谈认知行为治疗在肥胖治疗中的研究与应用

肥胖的治疗方法多种多样,各自具有不同的针对性和疗效特点,如何选择是一个最佳的治疗方案这是一个富有争议的话题。近年来,在肥胖心理学研究成果的基础上,发展了一系列的认知行为治疗方法,也开始应用于肥胖的治疗之中。不少追踪研究表明,该方法对于肥胖的长期疗效较佳,表现出广泛的应用前景。     

Positive conditioned suppression: an explanation in terms of multiple and concurrent schedules

Rats performed under a baseline variable-interval schedule of food presentation. A response-independent food schedule was then superimposed on the baseline schedule for different periods of time across different conditions. The response-independent schedule operated for the whole session in some conditions, intermittently for sixty second periods in some, and intermittently for ten-second periods in others. Under these latter two sets of conditions, the response-independent food schedule was stimulus correlated and alternated with the baseline schedule according to a multiple schedule. Response-independent food presentations always suppressed responding. The degree of suppression tended to increase the longer the period of response-independent food. Control conditions, in which the superimposed schedule was response-dependent, rather than response-independent, did not produce response suppression. The results fit an analysis of positive conditioned suppression phenomena in the context of multiple and concurrent schedule effects.     

Behavior under large values of the differential-reinforcement-of-low-rate schedule

Pigeons pecked a key and rats pressed a lever for food reinforcement under large values of the differential-reinforcement-of-low-rate schedule. Each subject was tested under 10 different schedule values ranging from 1 to 45 min and was exposed to each schedule value at least twice. The mean interresponse time and mean interreinforcement time increased with the schedule value according to power functions. Response-probability functions were computed for schedule values below 20 min and showed an increase in response probability as a function of time since the last response in most cases. Mean responses per reinforcer increased as a function of schedule value for the rats, but decreased as a function of schedule value for the pigeons. The proportion of responses with interresponse times shorter than 1 sec were an increasing function of schedule value for the pigeons, but did not vary as a function of schedule value for the rats.     

中西医学方法对变应性鼻炎疗效比较

本文分别从中医学和西医学体系对变应性鼻炎疗效进行分析比较。西医学主要不足：病理机制和治疗方案的公理化,缺乏关注病前状态,缺乏整体观。中医学主要特点：整体观念、形神合一、辩证理念。中西医学均存在优势和不足。中西医学结合是今后诊治变应性鼻炎的发展方向。     

Free-operant performance on variable interval schedules with a linear feedback loop: no evidence for molar sensitivities in rats

Four experiments examined rats' sensitivity to molar and molecular factors on instrumental schedules of reinforcement. Rats were exposed to a variable interval schedule with a positive feedback loop (VI+), such that faster responding led to a shorter interreinforcement interval. In Experiments 1 and 2, rats responded faster on a variable response (VR) schedule than on either a VI schedule matched for reinforcement rate or a VI+ schedule matched for the feedback function. In Experiment 3, rats responded no differently on a VI schedule than they did on a VI+ schedule with equated rates of reinforcement. In Experiment 4, rats responded faster on a VI+ schedule with an interresponse time requirement yoked to that experienced on a VR schedule, than on a VI+ schedule with the same feedback function as the VR schedule. Taken together these results suggest that rats are more sensitive to the molecular than the molar properties of the schedules.     

Some factors controlling preference between fixed-ratio and variable-ratio schedules of reinforcement

A multiple schedule of food reinforcement for key-pecking was arranged which consisted of nine fixed-ratios, each of which operated in the presence of a different stimulus. Pigeons could complete a given fixed-ratio within the multiple schedule or, by pecking a second key, could switch from the fixed-ratio schedule to a variable-ratio schedule consisting of the same nine ratios. Stable switching behavior was established which did not maximize simple probability or rate of reinforcement. Instead, the subjects showed a stable preference for the variable-ratio schedule of food reinforcement. Increasing the number of responses required to switch, and removing the occasions on which reinforcement was delivered after a single response in the variable schedule, decreased the number of switches to the variable schedule. Periods of delay interposed between a completed switch and the availability of reinforcement after one response in the variable schedule also decreased switching to the variable schedule, particularly at long delay intervals.