重症感染非抗感染措施的思考

近年来严重感染与感染性休克治疗策略的主要进展是对强化血糖控制、糖皮质激素等疗法的再评价.同时,也出现了诸如血管加压素、他汀类药物、选择性口腔/肠道脱污染等新的治疗措施,并取得了一定成果.本文对相关研究进展进行综述,以阐明集束化策略和管理水平的提高可能是最终降低重症感染病死率的关键.     

肝硬化门脉高压症断流术后感染的防治策略

肝硬化门脉高压症断流术后感染的防治策略可概括为:增强机体免疫力,重视无菌操作,预防性使用抗生素,积极治疗出现的感染。常见术后感染包括:膈下积液、脓肿,自发性腹膜炎(SBP)或腹水感染,门静脉血栓性静脉炎,切口及其他部位感染,真菌感染,脾切除术后爆发性感染和脾热。     

肝硬化门脉高压症断流术后感染的防治策略

肝硬化门脉高压症断流术后感染的防治策略可概括为:增强机体免疫力,重视无菌操作,预防性使用抗生素,积极治疗出现的感染.常见术后感染包括:膈下积液、脓肿,自发性腹膜炎(SBP)或腹水感染,门静脉血栓性静脉炎,切口及其他部位感染,真菌感染,脾切除术后爆发性感染和脾热.     

慢性乙型肝炎治疗路线图的评价——应答指导的临床治疗策略

慢性乙型肝炎治疗路线图是根据患者对抗病毒药物应答的不同、用病毒及其抗原水平在治疗的整个过程中对患者进行科学管理、制定治疗策略、确定治疗时间的一种优化治疗方案。本文将从它的可行性和意义、重要性、治疗策略的确定及在临床上应用的局限性等方面进行论述。     

糖皮质激素治疗脓毒血症的策略

脓毒症是由感染所致的破坏性的全身炎症反应综合征,进一步发展可导致多器官功能障碍综合征,甚至休克,成为危重患者最主要的死亡原因之一。糖皮质激素是脓毒症的重要辅助药物,其治疗机制在于其抑制机体的炎症反应,但其使用剂量、疗程、时间一直存在争议。本文通过回顾糖皮质激素在治疗脓毒症的发展历程,深入探讨糖皮质激素治疗脓毒血症的治疗策略。     

慢性乙型肝炎治疗路线图的评价——应答指导的临床治疗策略

慢性乙型肝炎治疗路线图是根据患者对抗病毒药物应答的不同、用病毒及其抗原水平在治疗的整个过程中对患者进行科学管理、制定治疗策略、确定治疗时间的一种优化治疗方案.本文将从它的可行性和意义、重要性、治疗策略的确定及在临床上应用的局限性等方面进行论述.     

助推手卫生的行为干预策略

保持手卫生是感染防控的重要策略, 但是如何提高其依从性成为预防传染性疾病和减少医疗机构获得性感染的一大挑战。以行为科学为基础的手卫生助推干预以更“隐性”的方式将洗手转变为一种可自动触发的行为习惯, 弥补了以知识分享和健康宣教为主的传统手卫生干预策略的诸多局限性。基于影响机制的不同, 手卫生助推干预策略可分为提供决策信息、优化决策选项、影响决策结构、提醒决策方向4个大类的框架体系。多模式助推策略的有效性也已在实践中得到印证, 但目前还非常缺乏在中国社会文化情境下开展的助推洗手行为的干预研究, 今后可尝试基于行为科学理论有针对性地在医院、学校和社区等公共场所开展此类干预研究和实践, 为感染防控、疾病预防和改善公共健康做出相应的贡献。     

早期胃癌的外科治疗策略

胃癌根治术目前仍为绝大多数胃癌患者的主要治疗手段。在我国,大多数胃癌患者确诊时已处于进展期,进展期胃癌外科治疗目前已趋于规范。然而,早期胃癌的治疗策略及外科治疗方式的选择,以及实施过程中仍存在诸多问题。规范化治疗是影响胃癌患者预后的重要因素,临床医生应根据个体化治疗原则,为患者选择最佳的临床治疗策略。本文重点探讨早期胃癌的类型及生物学意义、内镜治疗策略、外科治疗策略、手术适应证把握、术后随访策略等相关问题。     

针对T细胞介导的胰岛自身免疫的治疗策略

1A型糖尿病是由T细胞所介导的器官特异性自身免疫性疾病。人们利用转基因技术、自身抗原疫苗接种、单克隆抗体治疗等新兴技术通过诱导自身免疫耐受,改变免疫调节因子,调节细胞凋亡等途径阻止了自身免疫反应对胰岛的攻击。这些针对其发病机制所提出的新型治疗策略让人们看到了治疗自身免疫型糖尿病的希望。     

人类辅助生殖技术中的诊疗策略及伦理

人类辅助生殖技术是医学领域的一门新兴学科,随着此项技术的逐步成熟,也伴随着出现了各种诊疗及伦理问题。探讨对不孕症夫妇诊疗过程中的心理关怀与策略、人类辅助生殖技术治疗过程中的诊疗策略及其引起的伦理及相关法律等问题,认为在实施此项技术的过程中需要更规范、合理和人性化的诊疗策略。     

Keeping adolescents safe from harm: management strategies of African-American families in a high-risk community

In this study, we investigated changes in parents' use of restrictive and promotive management strategies from early to middle adolescence. We also examined the antecedents of these changes and their effects on adolescents' achievement and mental health. Longitudinal data included 50 African American adolescents and their parents living in a low-income school district. There were three major findings. First, parents, on average, used less restrictive and promotive management strategies from early to middle adolescence. Second, parents who experienced increased depressive symptoms reported using more restrictive management strategies from early to middle adolescence. Third, adolescents whose parents increased their use of restrictive management strategies experienced more anger and lower grade point averages, whereas adolescents whose parents increased their use of promotive management strategies experienced less anger, higher grade point averages, and less absences from early to middle adolescence. These findings suggest that increasing parents' use of promotive rather than restrictive management strategies may be more beneficial in supporting the academic achievement and mental health of adolescents living in high-risk neighborhoods.     

气道管理与呼吸机相关性肺炎防治策略

气道管理是机械通气过程中的关键技术,人工气道管理各个环节的处理,关系到机械通气的顺利进行,对呼吸机相关性肺炎(VAP)有不同程度的直接或间接的影响。气道管理的策略应该注重局部和整体的关系,在全身调整的基础上细致地管理气道的各个环节,体现气道管理的艺术。本文结合最新的临床研究证据阐明气道管理与VAP防治的策略。     

Micro-breaks matter: A diary study on the effects of energy management strategies on occupational well-being

Organizational researchers and practitioners are increasingly interested in self-regulatory strategies employees can use at work to sustain or improve their occupational well-being. A recent cross-sectional study on energy management strategies suggested that many work-related strategies (e.g., setting a new goal) are positively related to occupational well-being, whereas many micro-breaks (e.g., listening to music) are negatively related to occupational well-being. We used a diary study design to take a closer look at the effects of these energy management strategies on fatigue and vitality. Based on conservation of resources theory, we hypothesized that both types of energy management strategies negatively predict fatigue and positively predict vitality. Employees (N = 124) responded to a baseline survey and to hourly surveys across one work day (6.7 times on average). Consistent with previous research, between-person differences in the use of work-related strategies were positively associated with between-person differences in vitality. However, results of multilevel analyses of the hourly diary data showed that only micro-breaks negatively predicted fatigue and positively predicted vitality. These findings suggest that taking micro-breaks during the work day may have short-term effects on occupational well-being, whereas using work-related strategies may have long-term effects.     

An analysis of the relationship of teachers' reported use of classroom management strategies on types of classroom interactions

The results of an investigation to determine teachers' reported use of classroom management strategies and their relationship to teacher and student interactions are presented. We interviewed 20 teachers to determine how they developed and used classroom management strategies, and then observed the interactions of these teachers with children with serious behavior disorders (SBD). Results identified two groups of teachers: one that scored high on planned use of the strategies, and one that scored low. Comparisons between the two groups of the interaction patterns revealed small, but statistically significant differences in the mean length and total percent time involved in positive interactions. The group reporting higher use of the management strategies engaged in positive interactions which were longer in duration than the interactions of the group reporting lower use. The results are discussed in terms of further research needs and implications for teacher training programs.     

Teachers' conflict management styles: The role of attachment styles and classroom management efficacy

Constructive conflict management strategies are important in maintaining a positive classroom environment yet little is known about interpersonal or school variables associated with teachers' use of such strategies with students. Teachers high in self-reported classroom management efficacy (CMEFF) and security of attachment (low on avoidance, anxiety) were predicted to endorse use of positive classroom management strategies (e.g., integrating, compromising) more than insecure teachers and those low in CMEFF. Teachers (N = 283) from eleven schools (seven elementary), largely female and white, responded to a questionnaire in their boxes (29.4% response rate). School and teacher demographic variables were included in a multivariate regression after preliminary analysis suggested that ignoring the multilevel structure of the data made little difference in results; school variances were small compared with teacher variances. CMEFF and years teaching had positive, significant effects on use of integrating and compromising strategies, while avoidance had negative effects on both and anxiety on integrating strategies. Implications for teacher development are discussed.     

Stigma Management of Male and Female Customers to a Non-Urban Adult Novelty Store

Previous studies on adult bookstores focused almost exclusively on stores located in large urban settings and confined most of their analyses to the behaviors of male customers. For the present study, ethnographic data were collected in an adult store located in a non-urban environment to examine the full range of behaviors of both females and males. Although adult store norms that were previously identified were also noted in this study, additional stigma management strategies and customer behaviors were observed. Additionally, patterns in the types of strategies employed were observed among men and women. Several hypotheses are offered to explain the range of stigma management strategies used.     

高一学生的错题管理行为

在三次团体焦点访谈基础上自编高中生错题管理行为调查问卷,对内蒙古某中学110位高一学生被试的错题管理行为进行了调查。结果表明:(1)高一学生被试普遍认识到了错题对于学习的影响,从情感上不回避错题,但对错题的价值认识不足,尤其缺乏良好的错题管理的意识与系统的错题管理策略;(2)学优生在错题管理观念与态度上显著优于普通生;(3)学优生与普通生在错题管理行为与策略上不存在显著差异。在某些管理行为上,前者显著优于后者;在个别管理策略的使用上,后者却显著优于前者。     

Examining classroom influences on student perceptions of school climate: The role of classroom management and exclusionary discipline strategies

There is growing emphasis on the use of positive behavior supports rather than exclusionary discipline strategies to promote a positive classroom environment. Yet, there has been limited research examining the association between these two different approaches to classroom management and students' perceptions of school climate. Data from 1902 students within 93 classrooms that were nested within 37 elementary schools were examined using multilevel structural equation modeling procedures to investigate the association between two different classroom management strategies (i.e., exclusionary discipline strategies and the use of positive behavior supports) and student ratings of school climate (i.e., fairness, order and discipline, student–teacher relationship, and academic motivation). The analyses indicated that greater use of exclusionary discipline strategies was associated with lower order and discipline scores, whereas greater use of classroom-based positive behavior supports was associated with higher scores on order and discipline, fairness, and student–teacher relationship. These findings suggest that pre-service training and professional development activities should promote teachers' use of positive behavior support strategies and encourage reduced reliance on exclusionary discipline strategies in order to enhance the school climate and conditions for learning.     

Strangers in a Strange Land Interaction Management on Internet Relay Chat

This article examines a set of interactions (logs) taken from the form of computer-mediated communication known as Internet Relay Chat (IRC). The authors were particularly concerned with the interaction management strategies adopted by the participants in the logs during the opening and closing phases of the interactions to develop interpersonal relationships and communicate socioemotional content, as illustrated by their attempts to initiate and/or close interactions with others using the medium. The article compares these strategies and their structure with those proposed for face-to-face (FTP) interactions and proposes an explanatory framework for the interaction management of opening and closing phases on IRC. It is suggested that interaction management in these phases of IRC logs is similar to that in casual group FTP interaction in terms of the general functions of the strategies used, but that the content, structure, and ordering of the strategies are subject to adaptation.     

Communicating in the real world: accounts from people who stammer

This qualitative study used in-depth interviews to explore the communicative experiences and coping strategies of 14 adults who stammer. Their accounts revealed that those participants with persistent developmental dysfluency felt that stammering had limited their lives especially in the areas of employment, education and self-esteem. All participants shared key styles of communicative management with avoidance and confrontation developing during childhood. The participants who had undertaken therapy during adulthood, relied upon a range of speech management techniques including self-evolved and therapeutic strategies. Many of the strategies regularly used by the respondents contributed to the limiting experience of stammering. This study highlights the experience of stammering on the individual, discusses the variety of strategies used to manage dysfluency and indicates the complexities of day-to-day communication. These findings are discussed in relation to speech and language therapy for adults who stammer.

Educational objectives: The reader will learn about and be able to give examples of: (1) the lived experience of stammering; (2) the communicative strategies used by adults; and (3) the situational management of stammering.