重症免疫性血小板减少性紫癜紧急救治方案的探讨

为了探讨重症免疫性血小板减少性紫癜(ITP)的治疗方案,回顾性分析118例接受激素(92例)或丙种球蛋白(16例)或rhTPO(10例)治疗患者的临床资料,分析疗效及不良反应。结果显示:(1)激素组、丙种球蛋白组和rhTPO组总有效率分别为76.1%、81.3%和70%,组间差异无统计学意义。复发组有效率(67.3%)明显低于初治组(83.3%,P0.05),PAIgG伴PAIgM升高组有效率明显低于不伴PAIgM升高组(P0.05);(2)血小板达峰时间:激素组为(5.70±3.68)d,丙种球蛋白组为(4.31±0.75)d,rhTPO组为(5.00±1.63)d,激素组与丙种球蛋白组间差异有统计学意义(P0.05);(3)不良反应:激素组均出现类库欣综合征表现,丙种球蛋白组未见不良反应,1例(10%)rhTPO组患者出现轻度转氨酶增高。总之,丙种球蛋白和rhTPO治疗成人重症ITP疗效好,不良反应轻微。     

重症免疫性血小板减少性紫癜紧急救治方案的探讨

为了探讨重症免疫性血小板减少性紫癜(ITP)的治疗方案,回顾性分析118例接受激素(92例)或丙种球蛋白(16例)或rhTPO(10例)治疗患者的临床资料,分析疗效及不良反应.结果显示:(1)激素组,丙种球蛋白组和rhTPO组总有效率分别为76.1%、81.3%和70%,组间差异无统计学意义.复发组有效率(67.3%)明显低于初治组(83.3%,P<0.05),PAIgG伴PAIgM升高组有效率明显低于不伴PAIgM升高组(P<0.05);(2)血小板达峰时间:激素组为(5.70±3.68)d,丙种球蛋白组为(4.31±0.75)d,rhTPO组为(5.00±1.63)d,激素组与丙种球蛋白组间差异有统计学意义(P<0.05);(3)不良反应:激素组均出现类库欣综合征表现,丙种球蛋白组未见不良反应,1例(10%)rhTPO组患者出现轻度转氨酶增高.总之,丙种球蛋白和rhTPO治疗成人重症ITP疗效好,不良反应轻微.     

鼓室注射类固醇激素治疗难治性突发性感音神经性聋方法的比较与分析

目前对于难治性突发性感音神经性聋治疗的临床研究主要为鼓室内局部激素的使用。本文通过检索国内报道的相关文献,采用比较治疗学的原理对其疗效及安全性进行比较和分析,旨在寻求一种较为有效、安全的鼓室给药方法,为临床治疗决策提供有效的证据,以提高难治性突聋的治疗效果。     

鼓室注射类固醇激素治疗难治性突发性感音神经性聋方法的比较与分析

目前对于难治性突发性感音神经性聋治疗的临床研究主要为鼓室内局部激素的使用.本文通过检索国内报道的相关文献,采用比较治疗学的原理对其疗效及安全性进行比较和分析,旨在寻求一种较为有效、安全的鼓室给药方法,为临床治疗决策提供有效的证据,以提高难治性突聋的治疗效果.     

不同促排卵方案对高龄人群人工授精的临床疗效分析

探讨不同促排卵方案对高龄人群人工授精治疗临床疗效分析。收集高龄患者进行促排卵同时行人工授精,共396周期。分别采用克罗米酚+促性腺激素(CC+HMG)150周期、来曲唑+促性腺激素(LE+HMG)126周期、促性腺激素(HMG)120周期,三种促排卵方案同时行人工授精治疗。比较不同促排卵方案组之间临床治疗效果的差异。CC+HMG组妊娠率10.7%,LE+HMG组妊娠率13.5%、HMG组妊娠率8.3%,三组促排卵方案的妊娠率、异位妊娠率、多胎率差异无统计学意义(P0.05),但LE+HMG方案组,有着较低的流产率、HCG日更好的内膜厚度、更少的HMG用量。促排卵药物的使用是影响人工授精妊娠率的重要因素之一。     

乙型肝炎病毒相关性肾炎抗病毒治疗进展

乙型肝炎病毒（HBV）相关性肾炎是与HBV感染相关的肾脏疾病,病理类型多为膜性肾病、膜增殖性肾小球肾炎等,临床表现常为肾病综合征或大量蛋白尿。由于发病机理尚不清楚,既往多采用激素等免疫抑制剂治疗,但临床效果不理想。由于该病和HBV感染有关,随着抗病毒药物治疗慢性乙型肝炎病毒感染取得较好疗效,已有研究应用干扰素、拉米夫定...     

前列腺癌联合治疗策略研究

根据《每日电讯报》的报道,前列腺癌患者应该在接受激素治疗的同时也接受放射治疗。报道说,科学家们建议联合治疗的方法应该被看作是前列腺癌的治疗标准,从而取代现在的单纯以激素治疗的方法。这篇报道基于一项对患有局部晚期前列腺癌的男性患者的最新研究。癌症只在前列腺的局部有扩散,而在身体的其他部分没有转移。研究者将875位患者随机分成两组,其中一组只用标准的激素治疗方法,另一组除了激素治疗以外辅助一段时间的放射治疗。     

巴曲酶联合甲泼尼龙治疗突发性耳聋疗效分析

分析巴曲酶治疗平坦型突发性耳聋联合应用甲泼尼龙的疗效.巴曲酶+激素组,共38例,平均听阈75.1dB.巴曲酶组,共16例,平均听阈74.7dB.两组治疗前后平均听阈差无统计学差异(t=0.063,P＞0.05).提示联合应用甲泼尼龙(24mg,5天)对巴曲酶治疗平坦型突发性耳聋不能降低患者治疗后听阈.     

乳腺癌内分泌治疗新的研究结果对临床实践的影响

乳腺癌内分泌治疗对于激素受体(HR)阳性患者是一种副作用小、疗效确切的手段,但内分泌治疗仍有许多困惑有待进一步研究。早期绝经前患者卵巢功能抑制(OFS)的选择对象、时机及疗程上;早期绝经后患者内分泌治疗是否在5年~10年的基础上继续延长;晚期乳腺癌内分泌治疗耐药深深困扰着乳腺科医生,解决内分泌耐药的问题将对临床实践产生巨大影响。本文就新的研究结果对以上的问题的临床实践的影响作一探讨。     

曲安奈德鼓室给药治疗突聋疗效分析

观察曲安奈德鼓室给药治疗突聋的疗效.92例不耐受激素全身给药的突聋患者随机分成对照组(44例静滴金纳多和能量制剂)和实验组(48例附加曲安奈德鼓室给药),治疗前后比较听力.结果实验组和对照组治疗后听力提高为35.50 db±15.61 db和17.26 db±10.46 db,有效率为79.55％和52.50％,差异显著.曲安奈德鼓室给药治疗突聋疗效显著.     

Motivation and anxiety for dental treatment: Testing a self-determination theory model of oral self-care behaviour and dental clinic attendance

The present study: (1) developed a Self-Regulation Questionnaire for Dental Treatment (SRQDT) based on Self-Determination Theory (SDT; Deci and Ryan, Psychol Inq 11:227–268, 2000), and (2) used it to test a SDT process model of oral self-care behaviours and dental clinic attendance. Patients’ perceptions of autonomy supportive (relative to controlling) dental professionals were expected to be positively associated with patients’ psychological needs satisfaction in treatment, which was expected to be positively related to relative autonomous motivation for dental treatment and perceived dental competence, and negatively related to anxiety for dental treatment. In turn, relative autonomous motivation for dental treatment and perceived dental competence were expected to be positively associated with oral self-care behaviours and dental clinic attendance. Anxiety for dental treatment was expected to be negatively related to dental clinic attendance and positively linked to putting off making a dental clinic appointment. Confirmatory factor analysis of the 5 factor SRQDT model fit the data very well, and a structural equation model supported the hypothesized process model.     

护理观察在临床决策中的作用

在临床护理过程中,护士应充分利用护理工作的独特优势,从护理常规观察入手,使用望闻问切等观察手段,注重多向思维及病人的个性化特征,对病人实施全程观察,适时准确的观察患者细微的重要症状与体征变化,为及时正确的临床诊疗提供充分的、有效的信息,使护理观察能够在临床决策中发挥重要作用。     

进展期胃癌术后生存质量影响因素探讨

胃癌是我国发病率和病死率较高的恶性肿瘤,且住院病例90％以上为中晚期。因此预后不佳。近年来在进展期胃癌诊断和治疗方面有较大进展,尤其是人们对术后生存质量的重视。本文初步探讨了进展期胃癌术后生存质量的影响因素：如患者一般状况、手术方式、术后辅助放化疗和中医药治疗等。     

The Genetic Counselor in the Pediatric Arrhythmia Clinic: Review and Assessment of Services

There are minimal data on the impact of genetic counselors in subspecialty clinics, including the pediatric arrhythmia clinic. This study aimed to describe the clinical encounters of a genetic counselor integrated into a pediatric arrhythmia clinic. In the 20 months between July 2015 and February 2017, a total of 1914 scheduled patients were screened for indications relevant for assessment by a genetic counselor. Of these, the genetic counselor completed 276 patient encounters, seeing 14.4% of all patients in clinic. The most expected and common indications for genetic counselor involvement were related to suspicion for primary heritable arrhythmia conditions, though patients seen in this clinic display a wide range of cardiac problems and many additional indications for genetic evaluation were identified. Roughly 75% (211/276) of encounters were for personal history of confirmed/suspected heritable disease, including cardiac channelopathies, cardiomyopathies, ventricular arrhythmias, and congenital heart defects, and 25% (65/276) were for family history of disease, including long QT syndrome and sudden unexplained death. Overall, this study shows that about 1 in 7 patients seen in a pediatric arrhythmia clinic have indications that likely benefit from genetic counselor involvement and care. Similar service delivery models embedding genetic counselors in pediatric arrhythmia clinics should be encouraged, and this model could be emulated to increase patient access to genetic counseling services.     

One-session therapist directed exposure vs two forms of manual directed self-exposure in the treatment of spider phobia

Fifty-two patients with spider phobia, fulfilling the DSM-III-R criteria for simple phobia, were assessed with behavioral, physiological and self-report measures. They were randomly assigned to five different treatment conditions: (1) one session therapist-directed exposure (maximum 3 hours), (2) specific manual-based treatment in the home, (3) specific manual-based treatment at the clinic, (4) general manual-based treatment in the home and (5) general manual-based treatment at the clinic. The results show that therapist-directed one-session treatment was significantly more effective than three of the manual-based treatments, both at the post-treatment and follow-up stages. Specific manual-based treatment at the clinic was significantly more successful than the other manual-based treatments, but only at follow-up. The proportion of clinically significant improved patients at follow-up was 80% in the therapist-directed group compared to 63% for the specific manual-based treatment at the clinic, 10% for specific manual-based treatment in the home, 9% for general manual-based treatment in the home, and 10% for general manual-based treatment at the clinic. The conclusion that can be drawn is that one-session therapist-directed treatment is the treatment of choice for spider phobia but manual-based treatment is a good alternative in some cases.     

Ex-hospital clients evaluate their aftercare experiences

Seventy-two previously hospitalized clients of an inner-city community clinic, assigned to three treatment groups - medication-only, medication plus individual therapy, and medication plus therapy plus group experiences - evaluated their respective aftercare programs by responding to five questions. As compared with the others, medication-only clients were less inclined to see either the clinic or the medication as preventing rehospitalization, were alone in reporting that the clinic was responsible for preventing rehospitalization to the extent that the medication was effective, and responded to the question of rehospitalization by emphasizing worsening symptoms. Others emphasized therapy failure. Clients agreed with the professionals - aftercare should not be medication alone.     

Challenging the Frontiers of Community Psychology: A South African Experience

The development of community psychology is of vital importance in South Africa because of the historical context, questions about the relevance of mainstream western psychology and the current social change in the country in the post-apartheid era. Accordingly successful community psychology practices for a South Africa in transition need greater dissemination for access and utilization in the communities. This article draws on the community work conducted at the Itsoseng Clinic to show how and why community psychology could be made more relevant to the new South Africa. The Itsoseng Clinic is a psychology clinic that is situated in the township of Mamelodi. The clinic provides several services including counselling, psychometric assessment, psycho educational workshops, and HIV/AIDS pre and post-test counselling. The clients and community that the clinic serves are of low socio-economic status and struggle with a lack of material and personnel resources. The individuals working within the Itsoseng Clinic represent a diversity that is in itself a valuable resource for supporting the core activities of the clinic. This article explores various themes that were identified within the research study such as, making community, entering the ecology of life, closing the divide and bridging the boundaries.     

Burn-out

At first the concept of burnout will be critically reflected in the context of the discussion in a position paper of the German Society for Psychiatry Psychotherapy and Neurology. An investigation of preventive stress management interventions at the workplace will be reported. The treatment concept of the day clinic of the Department for Psychosomatic Medicine and Psychotherapy of the Munich-Harlaching hospital for occupational stress-related disorders will be presented. An empirical study of the effectiveness of this treatment will be reported comparing patients with occupational stress-related disorders (n?=?95) to other patients treated in the day clinic during the same time interval (n?=?154). Furthermore, a qualitative analysis of 102 patient charts with occupational stress-related disorders will be described. Two case histories typical for mental health disease with burnout syndrome are presented to illustrate the conclusions.     

Neuropsychological characteristics and test behaviors of boys with early onset conduct problems.

School-age children and adolescents with conduct problems typically exhibit deficits in verbal IQ, language abilities, and executive functions. This study examined the extent to which this pattern was evident in a clinic group of preschool boys with early onset conduct problems who met criteria for oppositional defiant disorder (ODD) with and without attention deficit hyperactivity disorder (ADHD). A 2nd question focused on the strength of relation between clinic boys' uncooperative or inattentive test behaviors and their test performance. As expected, the clinic boys showed a neuropsychological profile highly similar to the one found in older conduct problem populations. Verbal tests distinguished clinic from matched comparison boys even after controlling for observers' ratings of disruptive behavior during testing. Clinic boys with ODD and ADHD had lower verbal and executive function scores than clinic boys with ODD alone. After general vocabulary knowledge and test behavior were controlled, clinic boys were found to have poorer vocabularies for describing affective states than comparison group boys.     

Telepsychiatry services at a tribally run behavioral health clinic

Telepsychiatry provides a helpful resource to rural, poor, and isolated communities for whom traditional psychiatry may not be an option. Focusing on a tribally run behavioral health clinic, this article describes the clinic's transition from traditional psychiatry to telepsychiatry and then delineates benefits and challenges of telepsychiatry in this setting. Telepsychiatry is recommended based on the experiences of this clinic serving a large southwestern Native American community. (PsycINFO Database Record (c) 2012 APA, all rights reserved).