The Treatment Planning of Experienced Counselors: A Qualitative Examination

Using consensual qualitative research, the authors examined the treatment planning process of experienced counselors (N = 9). The data analysis resulted in 4 domains: assessment steps, clinical impressions, treatment factors, and treatment strategies. These domains describe the process used by experienced counselors in making clinical decisions and offer insight into the nature of clinical expertise and the need for further research on treatment planning.     

阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖糖尿病短期疗效

观察阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖2型糖尿病的短期疗效。将60例符合标准患者随机分为观察组和对照组各30例,均给予重组甘精胰岛素联合赖脯胰岛素强化治疗控制血糖,观察组同时给予阿卡波糖及二甲双胍口服,出院时进行疗效评价。观察组血糖达标时间、胰岛素用量少于对照组,餐时胰岛素停用比例大于对照组,差异有统计学意义（P＜0．05）;两组患者出院时体重较入院时均有所下降,观察组较对照组体重变化更明显（P＜0．01）。阿卡波糖、二甲双胍联合胰岛素类似物治疗方案,可作为初诊肥胖2型糖尿病治疗的理想方法之一。     

手术治疗单一局部复发或远处转移病灶乳腺癌的临床观察

探索手术治疗单一局部复发或唯一远处转移病灶乳腺癌的临床价值。收集2006年6月至2013年6月湖南省人民医院乳甲外科收治的64例局部复发或术后远处转移乳腺癌患者,其中28例为单发病灶病例。根据是否采取了包含手术的综合治疗,将其分为手术组与非手术组。回顾性分析两组的临床资料和随访数据,分析手术治疗局部复发或远处转移乳腺癌有无临床意义。结果28例都采取了含化疗的综合治疗,8例局部单发病灶与9例远处单一脏器转移病例进行了手术治疗。手术组的局部缓解率与控制率明显优于非手术组,均为100％。两组无进展生存时间（PFS）和总生存时间（（）S）比较,手术组明显长于非手术组;但在单一远处脏器转移手术组中0S没有优势。2年生存率方面手术组与非手术组比较有统计学意义。对于术后单一局部复发病灶或唯一远处脏器转移的乳腺癌患者,采取含手术的综合治疗方案能带来明显的PFS优势,若有手术机会和条件成熟,手术仍是不应放弃的有效治疗方法。     

Enhancing treatment effectiveness through social modelling: A pilot study

Objective: Medical treatments take place in social contexts; however, little research has investigated how social modelling might influence treatment outcomes. This experimental pilot study investigated social modelling of treatment effectiveness and placebo treatment outcomes.

Design: Fifty-nine participants took part in the study, ostensibly examining the use of beta-blockers (actually placebos) for examination anxiety. Participants were randomly assigned to observe a female confederate report positive treatment effects (reduced heart rate, relaxed, calm) or feeling no different.

Main outcome measures: Heart rate, anxiety and blood pressure were assessed, as were symptoms and attributed side effects.

Results: Heart rate decreased significantly more in the social modelling compared to control condition, p = .027 (d = .63), and there were trends towards effects in the same direction for both anxiety, p = .097 (d = .46), and systolic blood pressure, p = .077 (d = .51). Significant pre-post placebo differences in heart rate, anxiety and diastolic blood pressure were found in the social modelling group, ps < .007 (ds = .77–1.37), but not the control condition, ps > .28 (ds = .09–.59).

Conclusions: Social observation of medication effectiveness enhanced placebo effectiveness in heart rate, and showed a trend towards enhancing treatment effectiveness in both anxiety and systolic blood pressure. Social modelling may have utility in enhancing the effectiveness of many active medical treatments.     

Soins pénalement ordonnés et positionnements professionnels : des pratiques au carrefour de la Santé et de la Justice

At the crossroad of Health and Justice, penally ordered care underlies professional practices, the articulation of which can turn out to be delicate. Here we tackle the relevance and practical application of these measures. For that purpose, semi-directive interviews and field observations have been conducted with probation agents, judges (who follow up the way sentences are executed) and psychologists. The professionals’ comments and experiences show the complexity of these measures, which intend to make “care” into a recidivism prevention tool. Misconceptions appear about theory, practices and interprofessional relationships. The idea of “care” as a sole medical term appears to be ineffective and calls for the creation of new practices.     

Relating Coalition Capacity to the Adoption of Science-Based Prevention in Communities: Evidence from a Randomized Trial of Communities That Care

Coalition‐based efforts that use a science‐based approach to prevention can improve the wellbeing of community youth. This study measured several coalition capacities that are hypothesized to facilitate the adoption of a science‐based approach to prevention in communities. Using data from 12 coalitions participating in a community‐randomized trial of the prevention strategy Communities That Care (CTC), this paper describes select measurement properties of five salient coalition capacities (member substantive knowledge of prevention, member acquisition of new skills, member attitudes toward CTC, organizational linkages, and influence on organizations), as reported by coalition members, and examines the degree to which these capacities facilitated the community leader reports of the community‐wide adoption of a science‐based approach to prevention. Findings indicated that the five coalition capacities could be reliably measured using coalition member reports. Meta‐regression analyses found that CTC had a greater impact on the adoption of a science‐based prevention approach in 12 matched pairs of control and CTC communities where the CTC coalition had greater member (new skill acquisition) and organizational capacities (organizational linkages).     

Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders

Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity.     

The Role of Trauma in Conduct Disorder

Summary

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in the conduct disordered population, and trauma effects can help to account for many features of conduct disorder, including lack of empathy, impulsivity, anger, acting-out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention, and treatment implications are discussed.     

Blended courage: Moral and psychological courage elements in mental health treatment seeking by active duty military personnel

We propose that seeking mental health care in an environment with heightened stigma may combine elements of both psychological and moral courage. Interviews of 32 active duty US Army personnel about their process of seeking current mental health care were analyzed for themes of voluntary action, personal risk, and noble or worthwhile goals (benefits). Risks and benefits were divided into internal risks and benefits, characteristic of psychological courage; and external risks and benefits, characteristic of moral courage. Concerns about external risks were themes in all narratives, while concerns about internal risks were themes in only about half of narratives. Both internal and external benefits of treatment were themes in approximately three-quarters of the narratives, whereas doubts about internal (but not external) benefits were also expressed at a similar rate. Thus, participants described an act of blended courage, with social risks of moral courage taken for wellness goals of psychological courage.     

结核病诊治进展与科技革命

现代科技革命极大地促进了结核病各方面的发展.微生物学和免疫学的发展,揭示了结核病的病因、发病机制、病理生理的本质,分子生物学技术使结核病的基础研究不仅停留在器官、细胞水平,而是深入到蛋白质、核酸、基因的水平;基因治疗的方法可望从根本上治疗结核病.高新技术的产物如X线照片、电子计算机断层扫描、纤维支气管镜检查和新药的出现等极大地提高了临床诊治的能力.借助于各种先进的医疗设备而进行精确的诊断,基因治疗将成为一种崭新的治疗手段.