A laboratory model for evaluating relapse of undesirable caregiver behavior

The success of behavioral treatments like functional communication training depends on their continued implementation outside of the clinical context, where failures in caregiver treatment adherence can lead to the relapse of destructive behavior. In the present study, we developed a laboratory model for evaluating the relapse of undesirable caregiver behavior that simulates two common sources of disruption (i.e., changes in context and in treatment efficacy) believed to affect caregiver treatment adherence using simulated confederate destructive behavior. In Phase 1, the caregiver's delivery of reinforcers for destructive behavior terminated confederate destructive behavior in a home‐like context. In Phase 2, the caregiver implemented functional communication training in a clinical context in which providing reinforcers for destructive or alternative behavior terminated confederate destructive behavior. In Phase 3, the caregiver returned to the home‐like context, and caregiver behavior produced no effect on confederate destructive or alternative behavior, simulating an inconsolable child. Undesirable caregiver behavior relapsed in three of four treatment‐adherence challenges.     

Economic Impact of the Statewide Implementation of an Evidence-Based Treatment: Multisystemic Therapy in New Mexico

Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings.     

Assessing the combined effects of resurgence and reinstatement in children diagnosed with autism spectrum disorder

Resurgence and reinstatement are laboratory models of relapse following treatments for problem behavior that arrange alternative sources of reinforcement, such as differential reinforcement of alternative behavior and noncontingent reinforcement. Resurgence models the elimination or reduction of reinforcers during treatment and reinstatement models the re‐presentation of reinforcers previously maintaining problem behavior. The present study examined individual and combined effects of resurgence and reinstatement in a translational model of treatment relapse with three children diagnosed with Autism Spectrum Disorder. We first reinforced and then extinguished an arbitrary response while providing access to a preferred toy to model a version of noncontingent reinforcement with extinction. In the following phases, we examined resurgence by removing the toy, reinstatement by presenting the training reinforcer response‐independently, and a combination of resurgence and reinstatement. Overall, relapse of target responding reliably exceeded functionally similar responses never reinforced in the experimental situation. Most importantly, relapse tended to be greater when combining resurgence and reinstatement than when assessing either alone. These findings support previous studies showing that combinations of operations can increase treatment relapse. This translational model arranging simulated problem behavior with arbitrary tasks provides a platform from which to thoroughly and systematically assess methods for understanding and improving behavioral treatments.     

疾病治疗与康复的自我效能模式及其意义

自我效能是指个体对其在特定情境中成功地完成某种活动的能力预期。患者的自我效能预期能以直接或间接的方式影响其行为表现和生理机能,从而影响到疾病治疗与康复效果。患者自我效能的形成与发展既受各种效能信息的影响,也受个体认知加工方式的影响。根据患者自我效能的形成与作用模式,可以采取不同的措施来提高患者的自我效能预期,发挥它在疾病治疗与康复中的作用。     

小儿重症肺炎的诊治策略

肺炎是儿童常见的呼吸道疾病,小儿重症肺炎及其导致的并发症特别全身炎症反应综合征和多脏器功能衰竭是严重威胁儿童健康和生命的重要原因。随着基础医学和临床医学的发展,人们的认识逐渐深入,防治水平也取得重要进展。但病原学的变迁,不恰当的临床监测和干预仍然影响着人们对该病的正确认识和处理。运用哲学的辩证思维来探讨小儿重症肺炎诊治中的若干问题,将为儿科临床工作提供新的指导。     

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。     

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。