糖尿病足诊疗与预防进展

糖尿病足是糖尿病的严重并发症,血管狭窄闭塞、神经病变和感染是主要的临床表现,本文主要从糖尿病足的定义、病因、病理生理、临床表现、检测方法、分级及治疗和预防进展方面进行总结。糖尿病足的诊治是个系统工程,单一的方法难以治愈,且治疗效果欠佳,故我们在临床上以预防为主,早期诊断,早期治疗。     

晚期癌症患者治疗决策的思考

现代医疗尚无法治愈所有晚期癌症。现实与期望之间的较大差距,挑战晚期癌症治疗的临床决策。WHO强调为防止资源滥用,应确保抗癌治疗只用于可获益阶段。对于晚期癌症患者的治疗决策,除遵循规矩原则和循证医学证据原则外,还应该遵循尊重患者意愿、社会公平的美德原则。大多数癌症患者需要接受姑息治疗。姑息治疗为患者及家属提供既简便又经济的医疗服务。     

The Teaching Alliance Inventory: Evaluating the student-instructor relationship in clinical and counselling psychology training

The Teaching Alliance Inventory (TAI) was developed to measure the quality of the student-instructor relationship in graduate clinical and counselling psychology classrooms. Based on Bordin's (1983) original concept of the alliance as fundamental to the change process in psychotherapy, we developed the TAI to measure aspects of the classroom relationship that may be fundamental to learning essential skills of counselling and clinical psychology. Factor analysis revealed six subscales, four representing interpersonal variables not evaluated in traditional teaching effectiveness measures. We demonstrated internal consistency and split-half reliability with a large sample of graduate students and described evidence for the scale's face validity and content validity. Construct validity was supported by significant correlations between the TAI and its subscales with an established measure of teaching effectives and its logically related subscales (SEEQ; Marsh, 1987 Marsh, HW. 1987. Students’ evaluations of university teaching: Research findings, methodological issues, and directions for future research. International Journal of Educational Research, 11(Whole Issue 3): 253–288.  [Google Scholar]). The TAI may supplement traditional assessments of instructor quality by providing feedback regarding interpersonal impact in the classroom.     

Bayesian Hierarchical Classes Analysis

Hierarchical classes models are models for N-way N-mode data that represent the association among the N modes and simultaneously yield, for each mode, a hierarchical classification of its elements. In this paper we present a stochastic extension of the hierarchical classes model for two-way two-mode binary data. In line with the original model, the new probabilistic extension still represents both the association among the two modes and the hierarchical classifications. A fully Bayesian method for fitting the new model is presented and evaluated in a simulation study. Furthermore, we propose tools for model selection and model checking based on Bayes factors and posterior predictive checks. We illustrate the advantages of the new approach with applications in the domain of the psychology of choice and psychiatric diagnosis. Iwin Leenen is now at the Instituto Mexicano de Investigación de Familia y Población (IMIFAP), Mexico. The research reported in this paper was partially supported by the Spanish Ministerio de Educación y Ciencia (programa Ramón y Cajal) and by the Research Council of K.U.Leuven (PDM/99/037, GOA/2000/02, and GOA/2005/04). The authors are grateful to Johannes Berkhof for fruitful discussions.     

辩证思维在头颈肿瘤诊治过程中的应用

辩证思维贯穿于整个临床诊疗过程中,每位医师在做出临床决策时,均自觉或不自觉地遵循着该原理。在头颈肿瘤的临床实践中,也应始终遵循辩证思维,使哲学思维和科学思维密切结合。合理、正确地运用辩证思维方法有助于深入认识头颈肿瘤疾病的发生、发展及演变过程,从而采取合理、有效的治疗措施。     

脑室系统血管畸形的诊断与治疗

为了增强对脑室系统的血管畸形的认识,回顾性总结24例脑室系统的血管畸形的基本临床资料。结果显示,除1例静脉畸形外,其余23例均接受手术,21例全切,2例部分切除,病理证实海绵状血管瘤13例,AVM10例,其中死亡1例。提示脑室系统血管畸形发病率低,出血及脑积水多见,手术切除是海绵状血管瘤和AVM的最佳选择,而静脉畸形应予保留。     

临床方法依然是神经内科医师最重要的诊断法宝

通过7例疑难、危重患者的诊治过程说明临床方法的重要性,在神经科疾病研究中尤为突出。忽视细致的病史采集和体查,常导致了诊疗的失误;面对种目繁多的检查,更需要以临床方法选择之;临床逻辑思维能力非常重要,正确的临床思维出新知。在实验室检查方法越来越多的今天,临床方法是神经内科医师最重要、方便、快捷、有效的诊断法宝,具有不可替代性。     

经皮肺活检对肺部病变的诊断价值

经皮肺活检技术应用已有100多年历史。随着影像技术的不断进步,目前已发展成为肺部疾病的重要诊断技术。本文综述了经皮肺活检对肺部病变的诊断价值。并探讨和比较了不同引导技术的特点,以及适应症、并发症及其处理。     

接纳与承诺疗法的理论背景、实证研究与未来发展

接纳与承诺疗法(Acceptance and Commitment Therapy, ACT)于上世纪90年代初由美国治疗师Steven C. Hayes提出。作为基于正念技术的第三代行为治疗理论之一, 该疗法以功能情境主义为哲学基础, 立足于人类认知和语言基本性质的实证研究, 旨在通过平衡接纳与改变来提高心理灵活性。临床研究已证明其在相当广泛的临床问题上都取得了良好效果, 并在与CBT等传统疗法的对比中展现优势。ACT的临床效果和技术细节可做进一步研究, 该疗法与CBT的融合及其在临床领域之外的应用也是未来的研究方向。     

学习与推行“恶性肿瘤诊治规范”是临床（肿瘤）医生紧迫而持久的任务

恶性肿瘤是迄今威胁人民生命健康最常见、最凶险的一大类疾病,关于它的诊断和治疗,既十分复杂而又涉及多学科协作,制定一种权威性的临床肿瘤诊治规范或指南,去规范临床(肿瘤)医生的医疗实践,有着多方面的重要意义,学习与贯彻指南需要采取一系列措施。