“儿科一日病房”的思考

“儿科一日病房”的思考杭州市第二人民医院（３１００１５）李珊,王可子我院儿科自１９９４年１月创办“一日病房”以来,不到一年的时间已接受八千多人次的病人治疗,较受病儿及家长的欢迎,经济效益与社会效益均有一定程度地提高。开设“儿科一日病房”实际上扩大了急...     

儿科重症监护室中放弃治疗的相关问题研究

随着现代伦理学、生命质量和生命价值理论的发展,对于儿科重症监护室中部分病情危重且不可避免地将出现影响其远期生存质量的后遗症的患儿来说,选择放弃治疗可能更符合伦理学及患儿的最佳利益。对儿科重症监护室中部分患儿放弃治疗的实施过程、必备条件、常见原因、实施对象、相关伦理学及法律问题进行了探讨,以求为临床诊疗提供理论参考。     

儿科病房抗生素耐药情况调查及干预对策

调查儿科病房送检标本中优势细菌分布情况及耐药率,272株优势菌中产β-内酰胺酶菌占69.5%,其主要原因是儿科抗生素使用率明显高于成人,且较多的应用β-内酰胺类抗生素,分析儿科抗生素应用现状及危害,并提出抗生素滥用的干预对策。     

儿科病房抗生素耐药情况调查及干预对策

调查儿科病房送检标本中优势细菌分布情况及耐药率,272株优势菌中产β-内酰胺酶菌占69.5%,其主要原因是儿科抗生素使用率明显高于成人,且较多的应用β-内酰胺类抗生素,分析儿科抗生素应用现状及危害,并提出抗生素滥用的干预对策.     

不同剂量重组人干扰素α2b注射液对小儿病毒性肺炎的疗效研究

探讨不同剂量重组人干扰素α2b注射液治疗小儿病毒性肺炎的临床疗效。将病毒性肺炎患儿106例随机分为高剂量组、低剂量组和对照组。三组均接受病毒性肺炎常规治疗,高剂量组和低剂量组加用重组人干扰素α2b注射液20万U/kg·次、10万U/kg·次静脉滴注,疗程1周。高剂量组、低剂量组症状改善时间短于对照组,总有效率明显高于对照组(P0.05),高剂量组、低剂量组总有效率、住院时间无统计学差异,三组不良反应发生率无统计学差异(P0.05)。治疗后高剂量组患儿T细胞亚群优于低剂量组患儿,低剂量组患儿T细胞亚群优于对照组患儿(P0.05)。结果表明重组人干扰素α2b注射液可以调节患儿T细胞亚群,治疗小儿病毒性肺炎效果较好。但10万U/kg·次和20万U/kg·次临床疗效并无统计学差异。     

尽快实现临床呼吸病学与相关学科的整合

阐述了对临床呼吸病学进行整合的必要性,并分别从呼吸病学与临床相关学科、呼吸病学与临床流行病学、预防医学、城市大医院与社区医疗、成人呼吸病防控与儿科呼吸病等方面进行整合的可能与方式.     

早期儿科名家成长经历对儿科医学教育的启示

我国儿科医学人才紧缺,为了优化当前儿科医学教育,运用历史文献分析法,介绍诸福棠、高镜朗、陈翠贞、颜守民四位早期儿科名家的成长经历,分析他们的儿童期、青年期、中年期成长特点和学术成就,提出对当前儿科医学教育的启示。建议要激发学生早期专业兴趣、鼓励探究和创新意识、增加境外学习机会、推行"5+3"培养模式。建议运用好儿科学名家资源,激励学生传承儿科学名家热爱儿童、心怀天下的精神,吸引更多学生投身儿科医学事业。     

浅谈特发性肺纤维化命名及治疗对策的变迁

特发性肺纤维化是一种原因不明 ,以弥漫性肺泡炎和肺泡结构紊乱 ,最终导致肺纤维化为特征的进行性下呼吸道疾病。追溯特发性肺纤维化的历史 ,起初是由美国学者Ｈａｍｍａｎ和Ｒｉｃｈ于 194 9年首先命名的 ,两位学者总结了 1935年间 4例于半年内死亡的严重呼吸困难、紫绀患者的肺部病理改变 ,将其命名为“急性弥漫性肺间质纤维化” ,此后Ｌｉｅｂｏｗ等人针对较上述患者病情更为缓渐的病例 ,提出脱屑性间质性肺炎 ,寻常性间质性肺炎等名称 ,196 4年 ,Ｓｃａｄｄｉｎｇ根据肺组织形态学变化 ,提出纤维化性肺泡炎的称谓 ,后来为区别于原因已明…     

曹辛之诗歌艺术浅析

曹辛之是"九叶诗派"的主要诗人之一,其早期诗歌深受闻一多浪漫主义诗风的影响,后期诗歌则偏向于现实主义风格,即以政治抒情为主,理想主义为辅,且略带讽刺意味。曹辛之在诗歌中鲜明地体现出了自身经历和自我心灵,使其诗歌艺术具有特殊的气质。     

1232年金末汴京大疫探析

公元1232年在金朝的都城——汴京发生了一场极为罕见的特大疫情。据多种历史文献记载,此次大疫死亡人数达百万以上。这次大疫的爆发与当时的自然环境、社会环境密切相关,论述了大疫爆发的前因、经过及后果,对大疫的发生过程作了较详细地考索,并进一步分析了疫情的性质。     

放疗诱发恶性肿瘤的临床研究与思考

放射治疗是目前许多恶性肿瘤的重要的有效治疗手段,但放射线本身具有诱发恶性肿瘤的远期效应。随着治疗手段的提高,长期生存的患者逐渐增多,放射诱发肿瘤的病例也在逐年增加,需要引起人们的重视。本文对放射治疗诱发第二恶性肿瘤进行综述和辩证思考。     

The relationship between the amount of face-to-face contact and partners' reports of domestic violence frequency

This investigation examines the relationship between partners' amount of face-to-face contact and partners' frequency of domestic violence. Men entering a domestic violence treatment program (N = 134) and their intimate partners were asked to complete the Conflict Tactics Scale (CTS) at the beginning of treatment and 12 months after treatment completion concerning partner violence during the previous year. Partners were also asked to identify days during the year before and the year after treatment during which they did not have face-to-face contact. Results indicated that at both baseline and 12-month posttreatment follow-up, the number of days of face-to-face contact was significantly related to verbal aggression and physical violence. However, after controlling for physical violence, the relationship between the number of days of face-to-face contact and verbal aggression was not significant; the relationship between the number of days of face-to-face contact and physical violence remained significant, even after controlling for verbal aggression.     

Second year treatment outcome of alcoholics treated by individualized behavior therapy: Results

Second year treatment outcome results are reported for 69 of 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal. and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results found that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. Individual drinking profiles are presented for all subjects. Only subjects treated by IBT with a goal of controlled drinking engaged in a substantial amount of limited, non-problem drinking during the second year interval, and those subjects also had more abstinent days than subjects in any other group. The nature of adequate follow-up procedures and measures is discussed. Implications of these findings for alcoholism treatment are considered.     

Functional analysis and treatment of problem behavior related to mands for rearrangement

This study is a systematic replication of a functional analysis (FA) of the relation between mands and problem behavior. We extended treatment approaches for this problem behavior function, and describe the treatment of problem behavior related to mands for rearrangement demonstrated by a 12‐year‐old girl with autism spectrum disorder and Smith‐Magenis syndrome. The mands consisted of requests for others to change their body positioning or proximity, or rearrange items back to their original position. An FA confirmed the relation between problem behavior and mand compliance, and functional communication training with extinction decreased problem behavior and increased functional communication responses. Problem behavior remained low as gradually longer nonreinforcement periods were introduced using a multiple schedule.     

An Examination of Addiction Treatment Completion by Gender and Ethnicity

The authors examined the discharge status of all clients admitted to an intensive outpatient facility over the course of 1 year, specifically exploring differences based on client gender and ethnicity. The article also argues the need for more culturally sensitive addiction treatment and addresses some alternative approaches.     

Perceived sources and levels of stress,general self-efficacy and coping strategies in clinical dental students

The aims of this study were to identify sources of stress among clinical students and to evaluate the students’ perceived levels of stress, general self-efficacy and effective coping strategies in a private dental school environment. The study group consisted of 130 undergraduate clinical dental students in a Turkish private dental school, during the academic year 2014–2015. The students were surveyed using modified version of the dental environment stress (DES) survey, the perceived stress scale, the general self-efficacy scale (G-SES) and the brief coping scale. Age, sex, year of study, history of psychiatric treatment and factors that affected the choice of dentistry were also recorded. Final year and female clinical dental students, who were found to be the most stressful students, had moderate to high perceived stress scores. Total and ‘Faculty and administration’ related DES scores increased with the year of study. Stressors related to ‘Workload’ and ‘Clinical training’ affected females more than males. G-SES scores were higher in male students and students, who had no history of psychiatric treatment. The most and the least common coping strategies were ‘Planning’ and ‘Substance abuse’, respectively. ‘Religion’ was found to be one of the main coping strategies. Stress factors affecting Turkish clinical dental students studying at private dental school differed from the previously reported stress factors affecting students studying at a governmental dental school. Advanced year and female students experienced more stress than the other students.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

A Summary Report of the Cost-Effectiveness of the Profession and Practice of Marriage and Family Therapy

This purpose of this paper is to provide a summary of the cost-effectiveness research for the profession and practice of marriage and family therapy. Studies based on four sources of data were considered: (1) a western United States HMO covering 180,000 subscribers; (2) the Kansas State Medicaid system with over 300,000 beneficiaries; (3) Cigna, a large Unites States health insurance benefits management company with more than nine million subscribers; and (4) a marriage and family therapy training clinic in the western United States serving approximately 300 individuals and families a year. Results from the studies support the potential for a medical offset effect after couple or family therapy, with the largest reduction occurring for high utilizers of health care. The studies also show that covering family therapy as a treatment option and marriage and family therapists as a provider group is not associated with significantly higher treatment costs. An application of cost-effectiveness methodology to medical family therapy is also considered.     

Treating PTSD in suicidal and self-injuring women with borderline personality disorder: development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure Protocol

This study focused on the development and pilot testing of a protocol based on Prolonged Exposure (PE) that can be added to Dialectical Behavior Therapy (DBT) to treat PTSD in suicidal and self-injuring individuals with borderline personality disorder (BPD). Women with BPD, PTSD, and recent and/or imminent serious intentional self-injury (n = 13) received one year of DBT with the DBT PE Protocol, plus three months of follow-up assessment. The treatment was associated with significant reductions in PTSD, with the majority of patients no longer meeting criteria for PTSD at post-treatment (71.4% of DBT PE Protocol completers, 60.0% of the intent-to-treat sample). A minority of patients (27.3%) engaged in intentional self-injury during the study. Improvements were also found for suicidal ideation, dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and social adjustment. There was no evidence that the DBT PE Protocol led to exacerbations of intentional self-injury urges or behaviors, PTSD, treatment dropout, or crisis service use. Overall, the results indicate that this integrated BPD and PTSD treatment is feasible to implement within one year of treatment, highly acceptable to patients and therapists, safe to administer, and shows promise as an effective intervention for PTSD in this complex and high-risk patient population.     

Examining the Relationship of Substance Use and Sexual Orientation

In this article we examine the effects of self-reported sexual orientation on substance abuse. Using data on a random sample of 6,713 individuals in Washington State, this study examines causes and correlates of substance use by sexual minorities, an at-risk and treatment underserved population. Logistic regression results indicate homosexual orientation is a significant positive predictor of past year marijuana use, past year hard drug use, past year binge drinking, and lifetime alcohol addiction. Bisexual orientation is a significant predictor of past year marijuana use, past year hard drug use, and past year binge drinking. Potential causal mechanisms for these elevated patterns of substance use are discussed.