生物制剂治疗克罗恩病进展

克罗恩病是一种以累及消化道为主的复发性炎性疾病.生物制剂的使用为克罗恩病的治疗提供了新的方向.大量临床研究已证实生物治疗主要是抗TNF α单抗对诱导及维持克罗恩病临床缓解、预防并发症的发生有效.目前临床指南多建议对克罗恩病采取递增方案治疗,对重度患者可及早采取更为有效的包括生物治疗在内的治疗方式,但递减治疗方案在临床中的应用尤其是针对初次诊断者也越来越受到重视.目前早期及长期应用生物治疗的安全性及其是否能改变克罗恩病的自然病程证据尚不充分.应针对患者的不同情况,根据风险/效益研究来确定更合适的治疗方案.     

A Qualitative Exploration of Athletes' Past Experiences With Doping Prevention Education

The purpose of this study was to explore athletes' experiences with doping education and their recommendations to improve current education to create more effective doping prevention interventions. Following a constructivist approach, interviews were conducted with 21 athletes and analyzed inductively with thematic analysis. Six themes were identified relating to athletes' experiences with doping education and recommendations for improving it. Athletes commonly described receiving insufficient doping education during adolescence, highlighting the need for increased doping prevention efforts. Recommendations for future educational programs include addressing doping prevention collaboratively, implementing education at younger ages, and assuring the programs are engaging and interactive.     

Shaping Medical Students' Attitudes Toward Ethically Important Aspects of Clinical Research: Results of a Randomized,Controlled Educational Intervention

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics.     

Community-Based Participatory Research for Improved Mental Health

Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This article describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course challenges traditional research by introducing a collaborative process meant to encourage increased participation by special populations and narrow the parity gap in effective mental health treatment and services delivery.     

Psychiatry Residents' Attitudes on Ethics and Professionalism: Multisite Survey Results

Recent studies show that psychiatry residents express a relatively greater need for ethics curricula than their colleagues in other specialties. Such studies have been limited in their generalizability because they were conducted at one site. This study of 151 psychiatry residents at seven U.S. psychiatry programs aims to address that limitation. Residents were surveyed on issues pertaining to ethics and professionalism education. Participants were found to support such curricula during training and to value its relevance to the practice of psychiatry. Gender differences and the influence of the “hidden curriculum” on such results merit further study.     

The Influence of Temporal Orientation and Affective Frame on Use of Ethical Decision-Making Strategies

This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater strategy use. Likewise, a positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed.     

Barriers and Supports to Substance Abuse Service Use Among Homeless Adults

Although there is a great need for substance abuse services among the homeless, many homeless individuals do not use those services. This study examined barriers and supports related to service use. Participants recognized a need for treatment and significant barriers to accessing care.