慢性乙型肝炎诊断和治疗方法学探讨

探讨慢性乙型肝炎诊断和治疗的方法学。仔细谨慎评价病毒载量等指标,客观准确地把握治疗时机,重视情绪障碍和营养不当,恰当选择抗病毒治疗方案。尽力形成慢性乙型肝炎诊断和治疗的完善方法系统。     

新医改中就医文化的迷乱与重建

新医改以来,我国医疗卫生事业取得长足发展,但越级就诊、趋高就医、被动健康、医患矛盾等现实问题却依然严峻,究其原因可能是居民就医文化建设的滞后。在深入剖析就医文化概念内涵、结构维度和价值功能的基础上,从医疗价值认知和就医文化选择的双重视角出发,阐释就医文化对居民就医行为和就医秩序的深远影响,针对当前居民就医文化的迷乱现象,提出落实分级诊疗制度、强化就医文化宣教、共建和谐医患关系以及优化医疗资源配置等建设路径,旨在推动居民就医文化的科学化、理性化转型,为规范社会就医秩序、增进群众健康获得感和助力健康中国战略提供参考。

     

医患共同决策在腮腺肿瘤诊治中的应用

通过分析医患共同决策（shared decision-making, SDM）模式在口腔颌面外科腮腺肿瘤诊治中的临床应用效果,旨在深化对医生−患者共同决策、医生−患者−家属共同决策以及医生间共同决策的理解。在临床实践中,注重共同决策过程可显著提升患者及家属的参与度,实现决策权的共享,从而制定个性化、精准化的腮腺肿瘤诊疗策略。并结合腮腺肿瘤患者的教育背景、家庭状况及多学科诊疗建议,总结SDM在口腔颌面外科临床实践中的应用特点,以期提高口腔颌面外科医师对SDM的运用能力。     

敦煌遗书“注病”探微

敦煌遗书作为莫高窟藏经洞遗留下来的瑰宝,所涵括的古医籍大大丰富了隋唐前后医学典籍,有着极大的学术研究价值,特别是其中涉及“注病”的记载,为研究南北朝至隋唐时期传染病诊疗体系的演变提供了关键性史料。“注病”作为古代传染病的一个缩影,与后世之肺痨、寄生虫感染等有着紧密的演变关系。梳理敦煌遗书中涉及“注病”的内容,对相关条文进行汇集分析,以填补注病治疗在南北朝到隋唐时期演变发展的空白,丰富古代传染病的发展史。

     

On the use of fluency training in the behavioral treatment of autism: a commentary

The substantial demand for behavior-analytic treatment of early childhood autism has been associated with rapid dissemination of treatment procedures to practitioners and caregivers. This level of demand could plausibly induce premature dissemination of treatments that do not yet have sufficient empirical support. We argue that this might have happened with the use of fluency training for learners with autism and identify four areas of research that are necessary to ensure that dissemination efforts are better matched to the available empirical support for this instructional strategy.     

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。     

异位妊娠保守治疗患者的心理特点和影响因素分析

观察异位妊娠保守治疗患者的心理特点及其影响因素。选取海南省三所医院中在妇科住院的异位妊娠保守治疗患者80例,采用一般情况问卷和状态特质焦虑量表(STAI)对患者的心理特点和影响因素进行分析。患者入院时的状态焦虑(S-AI)水平高于正常人(P0.05),多元线性回归分析结果显示,患者产生焦虑情绪与婚姻、生育史、有无子女、经济状况有关。异位妊娠保守治疗患者焦虑情绪的产生是生理、心理以及社会等方面的综合因素造成,而心理问题的准确评估是优选心理护理对策的前提,为心理干预的实施奠定了基础。     

Stepped care for obsessive-compulsive disorder: An open trial

This study evaluated the effectiveness and treatment costs associated with a stepped care protocol of exposure and response prevention (EX/RP) for obsessive-compulsive disorder (OCD). In the current open trial, patients (N = 14) began with self-directed EX/RP and minimal therapist guidance over the course of six weeks (Step 1). During this phase of treatment, no therapist-directed exposures were conducted. Those who did not respond optimally to Step 1 went on to Step 2, which consisted of 15 sessions of twice-weekly therapist-directed exposures. Results of this study show promise for stepped care utilizing EX/RP for some patients with OCD, with a response rate of 88% and a 60% reduction on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score among treatment completers. Significant improvements were found in Y-BOCS from pre to post-treatment for both Step 1 and Step 2 completers. Forty-five percent of participants (n = 5) responded following completion of Step 1, resulting in reduced cost of treatment among these participants. All participants who responded to Step 1 maintained acute gains during the brief follow-up period. Limitations include a small sample size and high attrition rate.     

Sleep locus of control and computerized cognitive-behavioral therapy (cCBT)

This study investigated the relationship between sleep locus of control and sleep in a secondary data analysis. Participants were 100 adults with chronic insomnia previously involved in a randomized controlled trial of 5 weeks of computerized cognitive-behavioral therapy (cCBT). Additionally, a sample of 46 completers of an in-person group for insomnia were utilized as a comparison group. At pre-treatment, participants completed the Sleep Locus of Control Scale, the Insomnia Severity Index, the Pre-Sleep Arousal Scale, 7 days of sleep diaries, and participated in structured interviews to assess for psychiatric and medical conditions. Measures were re-administered at post-treatment and at a 4 week follow-up. Results showed that sleep locus of control mediated the impact of cCBT on insomnia severity at follow-up. cCBT more than waiting list control or a convenience sample of individuals treated with in-person CBT, enhanced an internal sleep locus of control. Implications are that sleep locus of control may be an important variable to assess in the internet context and that internet programs for insomnia may want to consider amplifying or giving priority to interventions which enhance an internal sleep locus.     

Predictors of Partner Engagement in PTSD Treatment

A telephone survey was conducted to identify predictors of treatment engagement in 83 cohabitating female partners of 83 Vietnam theater veterans with combat-related post-traumatic stress disorder (PTSD). The survey assessed veterans for their trauma history and PTSD symptoms. Partners were assessed for caregiver burden, patient–partner involvement, PTSD treatment engagement, self-efficacy relating to PTSD, beliefs about benefits of PTSD treatment, and PTSD treatment barriers. Significant predictors of partner PTSD treatment engagement were the couple’s income, patient–partner involvement, and partner caregiver burden. These findings have implications for family interventions that may increase partner PTSD treatment engagement and improve PTSD treatment outcome.