炭疽的早期识别及处理

炭疽是一种自古以来一直威胁着人类和动物健康的动物源性传染病。多年来人类炭疽在世界各地散发或局部地方性流行从未间断,我国广大农牧区也常有病例报道。炭疽的致病菌——炭疽芽孢杆菌,主要以芽孢的形式通过皮肤接触、饮食或吸入的方式感染人类和动物。其中皮肤炭疽最为常见,而肺炭疽因致死率极高、近年来成为潜在的生物恐怖袭击工具而引起高度的重视。目前的研究证实早期识别炭疽感染、及时有效的抗菌素治疗可大大降低炭疽的死亡率。本文根据近年来炭疽研究进展,对炭疽病原学特点及炭疽的早期识别和处理做一简要综述,供同道参考。     

Homosexuality as an issue in the psychoanalytic treatment of Lubavitch Chassidim

There is sparse literature on the psychoanalytic treatment of Chassidic Jews. The authors of this article, both secular nonobservant psychoanalysts, have spent over a decade working with Lubavitch Chassidim in the New York area. In the Lubavitch community, the sexes are separated at three years of age, leading to same-sex cohorts from then until marriage. As with all ultra-orthodox religious groups, homosexuality is viewed in Biblical terms as an abomination and yet, not surprisingly, it exists within this community. This article deals with the analysis of homosexual issues that appear in the treatment of both male and female Lubavitch Chassidim. We discuss how homosexuality is manifested, how it is viewed, denied, and rationalized, and the functions it serves in a subculture that is inherently homocentric. The need for parameters in classical technique is discussed as a necessity for successful psychoanalytic work with this population.     

Treatment manuals and the advancement of psychoanalytic knowledge: The Treatment Manual of the Tavistock Adult Depression Study

This paper has two aims: first, it seeks to understand the absence of treatment manuals in psychoanalysis. Secondly, it summarizes the treatment manual of the Tavistock Adult Depression Study, which describes the form of psychoanalytic psychotherapy whose effectiveness has been evaluated both in the Tavistock Adult Depression Study (TADS); and in the German Die Langzeittherapie bei chronischen Depressionen (LAC) Studie. Throughout the history of psychoanalysis, opinions about treatment manuals, empirical research and their antecedents have been deeply divided. After tracing the often polarized unfolding of these matters, the paper proposes that emotional and cognitive difficulties as well as scientific ones underpin their persistence. It is suggested that greater familiarity with them may lead to better combinations of outcome research and psychoanalysis: for example, the Tavistock manual seeks to match one account of the objects, aims, values, spirit and methods of psychoanalysis (as well as of connected forms of psychoanalytic psychotherapy); and also to meet what is required of treatment manuals by random allocation controlled trials. It has been a crucial element in the above studies of the outcome of long‐term psychoanalytic psychotherapies with chronically depressed patients. After describing the Tavistock Manual, the paper concludes suggesting that, if appropriately constructed, treatment manuals can make a contribution to the advancement of specifically psychoanalytic knowledge.     

Pilot Testing of an Online Training for Criminal Justice Professionals on Medication‐Assisted Treatment

There is widespread misunderstanding about medication‐assisted treatment (MAT) for opioid addiction. Although most MAT trainings target providers, criminal justice program staff and treatment referrers often determine offender placement. This article supports the efficacy of an online MAT training for criminal justice stakeholders.     

The Balancing Act—Ethical Issues in Parent Training Research: Confidentiality,Harm Reduction,and Methodology

Attention and disruptive behavior disorders present considerable challenges for children and their parents. These challenges have led to the development of parenting programs; however, there is a paucity of literature that discusses the ethical dilemmas parent training researchers face. This article reviews ethical principles and professional standards relevant to parent training research and provides case material to illustrate the challenge of balancing ethical adherence and empirical rigor using three ethical issues that commonly arise in parent training research. In particular, this article focuses on ethical issues surrounding confidentiality in a group setting, use of control groups, and limiting changes in medication/treatment status outside of the treatment protocol.     

Évaluation thérapeutique et obligation de soins

This article presents an application of therapeutic assessment in a mandatory treatment setting. Assessment has been traditionally considered as specially important in this setting. Following previous works (Chudzik & Aschieri, 2013) about the therapeutic relationship in this setting, we show that TA is useful to avoid some common pitfalls and make a real psychotherapeutic process possible. We consider the specificity of each step of TA in this setting and we illustrate it by a clinical case.     

Ethical Obligations and Clinical Goals in End-of-Life Care: Deriving a Quality-of-Life Construct Based on the Islamic Concept of Accountability Before God (Taklīf)

End-of-life medical decision making presents a major challenge to patients and physicians alike. In order to determine whether it is ethically justifiable to forgo medical treatment in such scenarios, clinical data must be interpreted alongside patient values, as well as in light of the physician's ethical commitments. Though much has been written about this ethical issue from religious perspectives (especially Christian and Jewish), little work has been done from an Islamic point of view. To fill the gap in the literature around Islamic bioethical perspectives on the matter, we derive a theologically rooted rubric for goals of care. We use the Islamic obligation for Muslims to seek medical treatment as the foundation for determining the clinical conditions under which Muslim physicians have a duty to treat. We next link the theological concept of accountability before God (taklīf) to quality-of-life assessment. Using this construct, we suggest that a Muslim physician is not obligated to maintain or continue clinical treatment when patients who were formerly of, or had the potential to be, mukallaf (the term for a person who has taklīf), are now not expected to regain that status by means of continued clinical treatment.     

Selecting the Right Tool For the Job

There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with prevailing norms governing human subjects research. Some maintain that only randomized controlled trials (RCTs) with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs.