论药物治疗安全：药疗错误的科学定位与安保革新

面对越来越多的最普遍的一种医疗错误—药物治疗错误,以及由此带给患者的身体损害和经济损失,必须对药疗错误进行科学定位和对患者安全保障体系与措施的革新。本文不在于详尽地论述药疗错误和安保的革新,而是通过对药疗错误的科学定位,提出对药疗错误的预防优先和以医者与患者为中心的药疗安全保障,强调重在研究和应用与药疗安全问题相关的健康信息技术和改变认知与处理药。总的认为:关于药疗安全与药疗错误,执行安全措施的障碍和改善药疗管理的当前和可能的机制以及我们应当知道什么和可以怎样做为好。     

循证医学在精神分裂症治疗中的应用

目前对精神分裂症的治疗未取得令人满意的疗效.循证医学是遵循科学证据的临床医学,是临床流行病学和现代信息学与临床医学结合的典范.将循证医学应用在精神分裂症的治疗中,有利于提高精神分裂症的治疗效果.     

药物、心理及联合治疗缓解抑郁症之比较

针对抑郁症治疗完全缓解率低,运用临床思维方法,依靠循证医学证据,首先分析了抗抑郁药物的选择、优化、更换和联合用药的治疗效益.然后辩证分析并比较了药物与心理治疗,以及药物与心理治疗的单独与联合应用对重性抑郁急性和长期治疗的疗效,以及严重重性抑郁、严重慢性抑郁的短期和长期疗效以及费用效益,为确定治则、选择治法提供帮助.     

我国行政诉讼缺席判决制度存在缺陷的原因

我国行政诉讼缺席判决制度是不完整的,制度本身也存在着不协调,最终流于形式。本文认为立法宗旨的错误定位、对缺席判决的性质认识不清,以及对其功能把握不准、沿用民事诉讼的规定,决定了行政诉讼缺席制度的设置不科学,必然存在一定的缺陷。     

劳思光与牟宗三、唐君毅的科学观比较

“五四新文化运动”以来,科学的价值一直被高举,认为引入科学需要打倒中国传统文化.以牟宗三、唐君毅为核心的港台新儒家以及劳思光均在此背景之下,对于科学的价值与定位进行了讨论.从科学与道德的关系、对社会科学的理解以及对科学的理论效力的理解入手,比较牟宗三、唐君毅与劳思光的科学观,则可以发现劳思光已经走出港台新儒家的形上学思...     

肿瘤个体化药物治疗研究探讨

肿瘤个体化药物治疗可提高治疗疗效,避免药物的毒副作用和医疗资源的浪费.影响肿瘤药物治疗疗效有多方面因素,主要与肿瘤本身的生物学特性和肿瘤患者个体生物学特性有关.通过对这些特性的研究,可获得用于指导肿瘤个体化药物治疗客观检测指标.     

理性思考转基因植物生产药物

转基因植物生产药物是植物栽培、基因工程与分子医学三者相结合而发展起来的.目前还没有足够科学证据表明转基因植物具有长远的安全性.利用转基因植物生产药物技术是"双刃剑",应辩证分析安全性,要全面了解其试验和应用范围的可控性、安全评价方法的科学性、应急处理措施的可操作性、安全管理的严格性.     

辩证看待老年人的药物应用

老年人的用药具有特殊性和复杂性,每位医师在做出临床决策时,应具有人文精神和辩证的思维方式,使哲学思维与科学思维密切结合,应用这种方式,重点探讨了老年人的个体化用药、注重整体、顺势而治、侧重治未病与自然疗法,从而为老年人提供人性化的最优化治疗,降低药源性损害.     

心血管药物相互作用与细胞色素P450酶关系的探讨

细胞色素P450(cytochrome P450,CYP450)酶系,是人体中与药物代谢密切相关的重要酶系之一,90%以上的药物的氧化是由P450酶催化的.多药合用对机体P450酶的影响,能造成临床上显著的药物相互作用.基于P450独特的功能和特点,可以预测、控制药物的相互作用,并可能解释某患者对特定治疗方案的反应.该文从细胞色素P450分类及其各自的催化特点,心血管药物相互作用与细胞色素P450酶的关系方面进行探讨,为指导临床安全、合理的用药,增加患者依从性提供参考.     

准确、完整的诊断与临床决策

正确的诊断是正确的临床决策的基础,正确的诊断依赖于详细的病史、准确全面的体格检查、合理的辅助检查资料的分析及正确的临床诊断思维方法.如果其中任何一项被忽视,临床医生可能会做出错误的诊断和错误的治疗,给病人造成不必要的损害.为了避免上述情况的发生,临床医生必须在掌握全面的临床资料的基础上,加以科学的综合分析,这样才能得出正确的诊断,给病人以正确的治疗.     

Medication as object

People experience and treat medication as though it were a person: in other words, as an object. Among the many symbolic meanings attributed to medication, this sort of personification, or object representation, is a meaning that medication is uniquely positioned to contain and convey: imbued with intentionality and influence, medication moves beyond the sphere of static, iconic representation and enters the changeable, dynamic object world of action, aim, and agency. Unlike more generic or stereotypic meanings, object representations attributed to medication may reflect the patient's specific dynamics and object relations. These representations are many and mutable, and take on shifting and overlapping forms that evolve with the analytic process. Medication may represent a third person within the framework of an analytic treatment, expanding the analytic dyad into a triad and offering new transference paradigms to explore. The defensive displacement of transferential qualities and attitudes, or split-off parts thereof, from the analyst onto medication can serve as a powerful resistance to the awareness of the transference to the analyst. Clinical examples illustrate the utility and importance of the analysis of medication as object, for both patient and analyst, with particular attention to the transference.     

Medication for Complex Posttraumatic Disorders

Treatment guidelines and reviews of outcome studies agree that drugs are valuable for moderation of irrational moods and impulsivity that interfere with thoughtfulness and cooperativeness. As such, they empower patients to make good use of psychotherapy for mastery of the risk of betrayal in intimate relationships, which is the typical recurrent traumatic event in complex posttraumatic disorders. Psychotherapy, for its part, has demonstrated correction and lasting remission of disorder in the aftermath of certain kinds of single trauma and promises further development to achieve similar efficacy for complex posttraumatic disorders. This article summarizes the strengths and limitations of each class of psychiatric drugs. It explains how the natural course of complex posttraumatic disorders greatly contaminates observations of medication efficacy and fosters unrealistic expectations for drug development.     

Psychotropic Medication Consultation in Schools

Abstract

Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the complexity of medication issues for school psychologists. Training programs are encouraged to examine current curricular requirements to insure that graduates are exposed to evidenced-based treatments including pharmacological approaches. It is vital that school psychologists examine their own competencies as they work to ethically and legally consult with families and physicians to improve adaptive functioning in school-aged populations.     

Medication dynamics in group psychotherapy

The use of medications in insight-oriented groups has not been adequately investigated. We report a group in which the anxiolytic buspirone appeared to be associated with attractiveness to the group in the face of impending therapists' termination. We feel that in this group, medications became a variable associated with group cohesiveness, served as a vehicle for the expression of group dynamics, and as an indicator of regression within the group. These observations suggest that, under certain circumstances, medications may become an important variable in the process and expression of group dynamics.They would like to thank Myron Pisetsky, M.D., for reading the original draft of this paper, and are also indebted to Daniel O'Neil, Ph.D., for his input.     

Clinical Strategies for Integrating Medication Interventions Into Behavioral Treatment for Adolescent ADHD: The Medication Integration Protocol

Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among adolescents enrolled in behavioral health services but remains undertreated, and the first-line treatment option, stimulant medication, is underutilized. To address this gap, this article introduces the Medication Integration Protocol (MIP): ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about integrating medication interventions into primary care; managing medication priorities for adolescents with multiple diagnoses, including substance use problems; and the compatibility of MIP with everyday practice conditions.     

心理护理对精神分裂症患者服药依从性的影响

探讨心理护理对精神分裂症缓解期患者服药依从性的影响.选取2008年1月至2009年12月在我院住院,符合精神分裂症临床诊断标准的精神分裂症患者98例,随机分为研究组(药物加心理护理)48例和对照组(药物治疗)5.例,进行为期1年的观察.入组时两组对治疗的依从性及BPRS,PSE,SDSS三种量表的评分差异无显著性(P>0.05),研究结束时,研究组患者BPRS,PSE,SDSS三种量表的评分与对照组比较均有显著性差异(P<0.01),研究组叶服药依从性优于对照组,差异有非常显著性(P<0.01).心理护理可以提高精神分裂症缓解期患者服药的依从性.