干扰素治疗慢性乙型肝炎管理策略初探

在慢性乙肝抗病毒治疗中干扰素作为一线治疗取得了一定的疗效.在治疗过程中通过选择合适的慢性乙肝患者、监测疗效、确立个体化的疗程和剂量、及时监测不良反应和恰当的处理和最大限度的提高患者的依从性可使干扰素的疗效达到最大化.     

慢性乙肝治疗路线图和HBV DNA、HBeAg、HBsAg定量的监测意义

慢性乙型肝炎病毒感染呈世界分布并且引起不良结局,是极为严重的健康问题。慢性乙型肝炎治疗最重要的目标是长期抑制病毒以改善预后,防止出现肝硬化、肝衰竭和肝癌。目前,抗病毒药物主要有干扰素和口服核苷（酸）类似物,核苷（酸）类似物的缺点主要在于长期治疗中出现耐药。路线图概念被用于监测耐药预测疗效。HBV DNA定量水平被作为路线图较好的监测指标。由于血清转换率及清除率过低,HBeAg、HBsAg定量检测不适合用于路线图监测,但对于使用聚乙二醇干扰素的慢性乙肝患者,可作为预测治疗应答的指标。     

慢性乙肝治疗路线图和HBV DNA、HBe Ag、HBs Ag定量的监测意义

慢性乙型肝炎病毒感染呈世界分布并且引起不良结局,是极为严重的健康问题.慢性乙型肝炎治疗最重要的目标是长期抑制病毒以改善预后,防止出现肝硬化、肝衰竭和肝癌.目前,抗病毒药物主要有干扰素和口服核苷(酸)类似物,核苷(酸)类似物的缺点主要在于长期治疗中出现耐药.路线图概念被用于监测耐药预测疗效.HBV DNA定量水平被作为路线图较好的监测指标.由于血清转换率及清除率过低,HBeAg、HBsAg定量检测不适合用于路线图监测,但对于使用聚乙二醇干扰素的慢性乙肝患者,可作为预测治疗应答的指标.     

干扰素治疗慢性乙型肝炎临床评价

干扰素治疗慢性乙型肝炎已有20多年历史,由于其抑制病毒复制和强大的免疫调节作用,以及具有疗程确定,不引起病毒变异耐药,显效后疗效持久的特点,是慢性乙型肝炎抗病毒治疗的首选药物之一。多项试验证明聚乙二醇化干扰素治疗慢性乙型肝炎的疗效优于普通干扰素和核苷类似物。本文就有关干扰素单用、联合核苷类似物和序贯疗法治疗慢性乙型肝炎的临床研究和HBV基因型对干扰素疗效的影响做简要综述。     

慢性乙型肝炎抗病毒治疗的策略

抗病毒治疗是慢性乙型肝炎治疗的关键,有效的抗乙型肝炎病毒药物主要有干扰素和核苷（酸）类似物。单药抗病毒治疗可获得较好的疗效,便于监测、管理;联合抗病毒治疗增加抗病毒疗效尚难肯定,更无法避免耐药发生,并可导致多药耐药、增加药物副作用和治疗费用。因此,优选单药进行抗病毒治疗才是目前理想的方案。     

关于慢性乙肝病毒携带者治疗问题的商榷

从乙型肝炎病毒(HBV)在体内存在的不同阶段、乙型肝炎发病机制及目前抗病毒治疗现状对慢性乙肝病毒携带者治疗问题进行了初步探讨,提出了绝大多数慢性乙肝病毒携带者不需要治疗的理由,以指导患者和医务人员解决相关问题。     

关于慢性乙肝病毒携带者治疗问题的商榷

从乙型肝炎病毒(HBV)在体内存在的不同阶段、乙型肝炎发病机制及目前抗病毒治疗现状对慢性乙肝病毒携带者治疗问题进行了初步探讨,提出了绝大多数慢性乙肝病毒携带者不需要治疗的理由,以指导患者和医务人员解决相关问题.     

两种方法治疗慢性乙型肝炎合并轻度脂肪肝的疗效分析

探讨阿德福韦酯联合双歧杆菌四联活菌片对脂肪肝合并慢性乙型肝炎抗病毒疗效影响。选择2011年1月至2014年4月在笔者所在医院门诊就诊的HBeAg阳性慢性乙肝合并非酒精性脂肪肝(NAFLD)患者50例随机分为2组,A组采用单纯阿德福韦酯抗病毒治疗48周,B组采用阿德福韦酯联合双歧杆菌四联活菌片治疗48周,分析2组疗效。B组在治疗48周时其病毒学应答和生化学应答率上明显高于A组,且B组在改善肝脏脂肪化疗效上明显优于A组。对脂肪肝合并慢性乙型肝炎患者,在抗病毒治疗同时加用双歧杆菌调节肠道微生物环境,可提高该类患者病毒学应答率和生化学应答率,同时还可改善肝脏脂肪化程度。     

乙肝治疗路线图与核苷类药物的耐药管理

慢性乙肝治疗的路线图介绍了对核苷类似物耐药的监测时间和处理方法。本文首先介绍了耐药评价的时间点,大多可以采用治疗后12周和24周的评估。如果出现耐药,针对不同情况可以采用换用或者加用没有交叉耐药的不同核苷类似物处理。     

优化乙肝治疗方案真实评价治疗效果

目前乙肝治疗比较混乱,给患者带来许多损失,优化乙肝治疗方案,是从患者病情出发,实施个体化治疗,目标是安全、有效、经济和适度,处于抗病毒最佳时机的患者可以考虑使用干扰素或拉米夫定;乙肝病毒携带者暂时禁止使用药物治疗;急性乙肝只给与基本治疗,待其自愈.实施优化方案,杜绝各种各样的商业广告;凡是尝试性治疗,一律按照新药临床验证程序进行,一律实行免费.治疗乙肝的疗效最终取决于持久、完全效应,不应局限在病毒阴转或肝功正常上.     

Long-term improvement in coping skills following multimodal treatment in war veterans with chronic PTSD

Due to the long-lasting and resistant symptoms characteristic of chronic combat posttraumatic stress disorder (PTSD), its treatment is complex and often requires a tailored therapeutic approach incorporating both psychotherapy and pharmacotherapy. A multimodal approach of psychoeducative, sociotherapeutic, and dynamically oriented trauma-focused groups is described. We assessed the short- and long-term effectiveness of this therapeutic program by monitoring its impact on PTSD symptoms, depression, neurotic symptoms, coping skills, and quality of life for three years. The findings revealed short-term reduction in the symptoms of PTSD and depression, while the long-term results were manifested as the increased use of all coping mechanisms and a greater level of obsession.     

THE USE OF PEER MONITORS TO REDUCE NEGATIVE INTERACTION DURING RECESS

The negative interactions of a mildly retarded child, Dennis, were reduced in three daily recess periods, withthe use of a point system. Adult monitors initiatedthe intervention inthe morning recess; reductions achieved during adult monitoring were maintained in that recess during two subsequent conditions: peer monitoring and self-monitoring. Dennis' negative interactions were reduced next inthe afternoon recess by peer monitors. Again, reductions were maintained during a subsequent self-monitoring condition. Finally, duringthe noon recess, Dennis was trained to serve as a peer monitor for Ed, a moderately retarded classmate. Dennis' rate of negative interactions quickly decreased following his appointment as a peer monitor. The results show that a point system, originally designed for adult monitoring, can be adapted without loss of program effectiveness for peer monitoring or self-monitoring. The results also suggest that classmates who serve as peer monitors may benefit significantly from their role. The conditions under which these therapeutic effects occur andthe role that treatment order effects may play in this process require further investigation.     

Patient‐focused research supported practices in an intensive family therapy unit

The aim of this study is to explain how families evaluate and describe the use of two measures, the session rating scale and the outcome rating scale, in order to monitor therapeutic work. This study is methodologically based on modifications of methodical hermeneutics and consensual qualitative research. The results confirm the feasibility of these scales although some difficulties were identified. The analysis of the family interviews identified four conversational processes: communicating, focusing, structuring and exploration. These arise through the application of the scales, indicating their usefulness as conversational tools. In general, it is suggested that all the measurements and tools applied can be seen as therapeutic tools that are especially useful for establishing conversations and strengthening collaboration between service users and therapists. This brings the practice of monitoring therapeutic work into close contact with postmodern‐oriented forms of therapy.     

An Ethical Exploration of Barriers to Research on Controlled Drugs

We examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may, however, limit research on their considerable therapeutic potential. We review the surprisingly sparse literature and address the particular ethical concerns pertinent to research with illicit and addictive substances, such as undue inducement, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. We consider the perspectives of key research stakeholders and explore whether they may be infected with bias. We conclude by proposing an empirical research agenda to provide an evidentiary basis for ethical reasoning.     

循环肿瘤细胞的研究进展

循环肿瘤细胞（circulating tumor cells,CTCs）指自发或因诊疗操作由实体瘤或转移灶释放进入外周血循环的肿瘤细胞。CTCs能被看作液体活检,具有实时监测功能,是一种非侵入性的新型诊断工具,有助于早期发现肿瘤的微转移,可评估预后,在治疗的监测及个体化治疗上具有重要的临床意义。     

An expert consensus on the most effective components of cognitive behavioural therapy for adults with depression: a modified Delphi study

ABSTRACT

Designing new approaches to delivering cognitive behavioural therapy (CBT) requires an understanding of the key components. This study aimed to establish an expert consensus on the effective components of CBT for depressed adults. An international panel of 120 CBT experts was invited to participate in a modified Delphi study. Thirty-two experts participated in round 1; 21 also provided data in round 2. In round 1, experts rated the effectiveness of 35 content and process components. A priori rules identified components carried forward to round 2, in which experts re-rated items and final consensus items were identified. Consensus was achieved for nine content components (ensuring understanding; developing and maintaining a good therapeutic alliance; explaining the rationale for CBT; eliciting feedback; identifying and challenging avoidant behaviour; activity monitoring; undertaking an initial assessment; relapse prevention methods; homework assignments); and three process components (ensuring therapist competence; scheduling sessions flexibly; scheduling sessions for 45–60 mins). Five of the twelve components identified were generic therapeutic competences rather than specific CBT items. There was less agreement about the effectiveness of cognitive components of CBT. This is an important first step in the development of novel approaches to delivering CBT that may increase access to treatment for patients.     

‘The essay method’ a qualitative method for studying therapeutic dialogues

ABSTRACT

This paper presents a qualitative research method for analysing therapeutic dialogues called ‘the essay method’. A central part of the method uses the format of the literary essay as a model. The method consists of a close monitoring of clinical material guided by an overall psychoanalytic/psychodynamic theoretical frame. It combines both clinical details and global patterns of clinical material and is especially fitted for studying relational qualities of psychotherapeutic dialogues. In this paper, the background for qualitative analysis in studying psychoanalytic material is discussed, and the procedures for using the method are demonstrated. A study of therapeutic competence in a group of student therapists is used as an example of the method in practice, demonstrating that the essay method may have potential for revising theory and establishing new concepts based on empirical findings. The essay method is compared with other qualitative methods, and it is argued that it is suitable for psychoanalytic research.     

The Ethics of Smart Pills and Self-Acting Devices: Autonomy,Truth-Telling,and Trust at the Dawn of Digital Medicine

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care.