急性心肌梗死中医治疗的两点策略——附临床资料回顾性分析

急性心肌梗死(AMI)是临床常见的急重症,现代医学已在循证医学基础上建立了诊疗指南,为临床诊治决策提供依据。相比而言,以辨证论治为特色的中医药缺乏循证依据。对AMI诊治过程中如何发挥中医药治疗的价值,认为不能停留在传统的概念上,应选择正确治疗策略,提高疗效。     

中西医结合治疗骨折的临床思维方法

骨科医生在骨折治疗中需要科学的方法论指导。系统论的思想应用于中西医结合治疗骨折,它能从人体的总体出发,在“动与静”、“筋与骨”、“内与外”、“人与物”四对矛盾的相互作用中,揭示损伤的性质和骨折愈合的规律,有助于获得骨折的最佳治疗原则,有助于提高认识水平和实践能力。     

早期复发性流产的系统论思考

早期复发性流产是妊娠期妇女较常见的疾病。根据系统论方法主要基本原则,分析其在早期复发性流产诊断治疗中的指导性作用。揭示在医学科学研究中自觉、主动地运用辩证思维方法和系统论科学方法,可以拓展我们的研究思路,为疾病的诊断治疗提供最佳方案。     

R．D．莱因对传统精神疾病诊疗观的变革

传统的精神疾病诊断以一种经验式的分类手册来诊断精神疾病,而莱因主张从存在主义——现象学的视角来理解精神疾病,认为家庭或社会才是精神疾病的真正来源。在精神疾病的治疗方面,莱因主张通过改变患者的生存环境来促使其进行自我恢复。莱因的思想推动了当代精神病学的变革与发展,具有重要的现实意义。     

证候存在的逻辑回答

2003年我国开始了农村合作医疗的重建工作,它直接关系到中国几亿农民的健康和利益,目前仍处于大规模的试点阶段。通过对部分试点地区的实地调查研究和文献资料分析,以及新型农村合作医疗在其具体的实施过程中存在问题的探讨,对进一步发展提出了相关的政策建议,希望能对这项制度稳健和可持续的发展有所裨益。     

乳腺癌保乳治疗的进展与临床选择

保乳治疗既能满足乳腺癌的治疗要求,又适于追求更高的生活质量,但应用时必须严格掌握适应证,还要充分考虑到病人及其家庭的经济和心理承受能力,医院的综合治疗条件等因素,充分做到科学性与人性化的高度结合,才能获得最佳临床效果。     

A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users

High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n = 28) or work-only (n = 28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p = .004; OR = 5.80, 95% CI = 2.03-16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence.     

Evidence Based Treatments for Bipolar Disorder in Children and Adolescents

Limited research has been devoted to developing and testing psychosocial treatments for bipolar disorder (BPD) in children and adolescents, a chronic and impairing mental illness that has received increased attention in recent years. Existing treatments are intended as adjuncts to medication, and share a family-based psychoeducation approach. Components of four treatments are discussed: family-focused treatment (FFT), the RAINBOW Program, multi-family psychoeducation groups (MFPG), and individual family psychoeducation (IFP). Evidence supporting each approach is detailed. Selected components of MFPG are described. A flowchart provides suggestions for sequencing interventions to maximize effectiveness. To illustrate the use of evidence-based treatment for children with BPD, a case example is provided.

Parental Refusal of Medical Treatment for a Newborn

Theoretical Medicine and Bioethics - When there is a conflict between parents and the physician over appropriate care due to an infant whose decision prevails? What standard, if any, should guide...     

Relationships between personal beliefs and treatment acceptability, and preferences for behavioral treatments

Background

The literature on preferences for behavioral interventions is limited in terms of understanding treatment-related factors that underlie treatment choice. The objectives of this study were to examine the direct relationships between personal beliefs about clinical condition, perception of treatment acceptability, and preferences for behavioral interventions for insomnia.

Methods

The data set used in this study was obtained from 431 persons with insomnia who participated in a partially randomized clinical trial and expressed preferences for treatment options. The data were collected at baseline. Logistic regression was used to examine the relationships between personal beliefs and treatment acceptability, and preferences. The relationships between personal beliefs and perception of treatment acceptability were explored with correlational analysis.

Results

Perception of treatment acceptability was associated with preferences. Persons viewing the option as convenient tended to choose that option for managing insomnia. Personal beliefs were not related to preferences. However, beliefs about sleep promoting behaviors were correlated with perceived treatment effectiveness.

Conclusions

Perception of treatment acceptability underlies expressed preferences for behavioral interventions. Personal beliefs about insomnia are not directly associated with preferences. Importance is highlighted for providing information about treatment options and exploring perception of each option's acceptability during the process of treatment selection.