由新药临床试验中的依从性问题引发的思考

本文就如何看待新药临床试验中的依从性问题提出了自己的看法：应用整体观、认识论的方法辩证地分析、处理依从性问题,以保证临床试验的顺利进行和质量可靠;文中通过实例并结合当前的医改背景,对临床医疗工作中的医患关系提出一些启发和看法,建议医务人员从自身出发重视患者的依从性。     

Integrating Care for Persons, Not Only Diseases

Integrated care is geared toward enhancing usual care and decision-making for common combinations of medical and mental health conditions, including the behavioral health and behavioral change aspects. Yet even with comprehensive and well-integrated care for health conditions and well-coordinated teamwork in place, some patients do not engage or respond to care in the way clinicians would like or predict. This troubles patients and clinicians alike and may be chalked up informally to things like medical complexity (multiple co-existing conditions), mental health conditions (that complicate care), or simply the case being considered complex or difficult. It also raises the question of how to address person-specific factors that interfere with care of whatever conditions the patient may have, and invites behavioral health clinicians in medical settings to look beyond care of conditions to the care of persons, and to look beyond disease-specific care management protocols to master generic practices of care management across whatever conditions the person may have. This person-centered emphasis is intrinsic to the concept of the “patient-centered medical home” which has burst into animated discussion and demonstration among providers, health plans, government plans, employer purchasers, and professional associations across public and private entities. This represents an opportunity for collaborative care clinicians to help shape the national state of the art in medical home and includes a range of person-oriented (rather than disease-oriented) practices for care management, including working systematically with complex patients and difficult patient–clinician relationships.     

中医典籍中文化负载词的识别及翻译策略刍议

中医深植于中国传统文化中,英译过程存在大量文化对应空缺现象,因而中医典籍中文化负载词的翻译成为中医典籍外译的关键步骤和难点。提出了中医文化负载词的识别步骤和选词标准,进而提出中医典籍文化负载词的翻译策略。在中医文化负载词的识别步骤基础上,对中医典籍文化负载词的翻译策略进行了总结:中医药基本名词术语的文化负载词采用直译法;中国物质文化独有词语的负载词采用音译或音译加注;古汉语独有的文化负载词采用省译或意译。目的是通过中医典籍文化负载词的界定和提出的翻译策略推动中医典籍对外传播。     

医学人文应用能力的培养和评价——基于医师资格考试医学人文模块考试结果的反馈

为促进医学人文课程教学和评价,回顾分析临床类别医师资格考试医学人文模块不同年度和不同学科的平均掌握率。分析发现医学人文模块平均难度适当(63.3%,SD=25.2%),整体的平均掌握率均高于合格标准(D=3.3%,P=0.04),各年度平均掌握率比较稳定;医学伦理学掌握率显著高于医学心理学(D=11.7%,P=0.04)和卫生法规(D=9.7%,P=0.01),医学伦理学案例型试题平均掌握率显著好于非案例型试题(D=21.6%,P=0.00),为考试提供了效度证据。建议要不断完善医师资格考试医学人文模块的设计与评价,医学人文教育应更重视应用能力的培养,要以岗位胜任力为导向完善医学人文能力的评价。     

Improving adherence to medication regimens for children with asthma and its effect on clinical outcome.

We examined the effects of a combined education and token system intervention to improve adherence to inhaled corticosteroids for an 8-year-old girl and a 10-year-old boy with asthma. Adherence was measured by an electronic chronolog monitor, and disease outcome was assessed by repeated pulmonary function testing. A withdrawal design demonstrated improved adherence and, for 1 child, an associated improvement in pulmonary function occurred. Methodological and clinical implications are discussed, including variables other than adherence that may affect disease outcome.     

EFFECTS OF REINFORCER QUALITY ON BEHAVIORAL MOMENTUM: COORDINATED APPLIED AND BASIC RESEARCH

The high-probability (high-p) instructional sequence has been an effective treatment for noncompliance. However, treatment failures have also been reported. We hypothesized that the efficacy of the high-p treatment may be improved by using higher quality reinforcers for compliance to high-p instructions. The resistance of compliance to change was tested by varying reinforcer quality in two applied studies and a basic laboratory experiment. Experiment 1 tested the hypothesis that an increase in reinforcer quality for high-p compliance will increase the effectiveness of the high-p treatment when it fails to increase compliance. Experiment 2 assessed the effects of reinforcer quality on resistance of compliance to change by presenting successive low-p requests following the high-p treatment. A basic laboratory study (Experiment 3) was conducted to further isolate the relation between reinforcer quality and behavioral momentum. Two different liquid reinforcers (sucrose and citric acid solutions) were presented in a two-component multiple variable-interval variable-interval schedule followed by a single extinction test session. Results of all three experiments showed a generally consistent relationship between reinforcer quality and behavioral momentum.     

DEFINING CHILD NONCOMPLIANCE: AN EXAMINATION OF TEMPORAL PARAMETERS

This study examined compliance parameters for 53 clinic-referred and nonreferred children, ages 2 to 10 years. Although there were significant differences between the referred and nonreferred samples for percentage compliance, there were no significant differences between the referred and nonreferred samples in terms of initiation or completion latencies. The average initiation latency was 5.92 s, whereas 98% of the sample initiated compliance within 14 s. Younger children did take longer to complete tasks. Results suggest that the use of short latencies in defining noncompliance may represent overly conservative criteria.     

Interruption of phonological coding in conduction aphasia

A case study of conduction aphasia, investigating single word repetition, phonological coding, and short-term memory, is reported. Evidence from intact adults suggests that repetition can occur through either a lexical route or a direct auditory-articulatory link. For this conduction aphasic, E.A., the direct link was impaired, although the lexical route could be used to produce accurate single word repetition. Several experiments demonstrated a significant impairment in the generation and maintenance of an abstract phonological code. The consequences of a disruption of phonological coding on speech perception and on verbal short-term memory are discussed.