Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

要注意中药对肝的损伤作用

含有生物碱类、皂苷类、萜类、毒蛋白类、重金属类成分的中药易致急性肝损伤.中药对肝脏损伤的原因及机制较为复杂,可能与药物对肝脏的直接毒性或特异性体质有关.此外,中药炮制方法、给药途径、剂型、剂量、疗程及配伍不当也会引起药物性肝损伤.中药所致的药物性肝损伤的诊断主要依据用药史、发病的时间、过程和临床表现并排除其他因素.治疗可选用还原型谷胱甘肽、S-腺苷蛋氨酸、多烯磷脂酰胆碱、熊去氧胆酸、水飞蓟素等药物,重症可选择人工肝脏支持治疗.     

CBL、PBL及Seminar结合的立体教学模式的应用和思考——临床医学八年制呼吸科床旁教学实践中的应用

临床医学八年制内科学床旁教学应用传统的教学模式及基于案例的学习（CBL）单一教学方法难以满足教学要求.将CBL与基于问题的学习（PBL）及研讨会（Seminar）结合的立体教学模式应用于呼吸科的床旁教学实践中,激发了学生学习的积极性、创新性,培养了学生良好的团队合作精神和临床思维模式,提高了学生们解决临床问题的能力,并能加深师生互动交流,达到教学相长的目的.     

用达尔文医学的观点看待近视眼的发生和治疗

从近视眼的进化史来看,伴随人类生活方式的改变,眼睛对近距离信息摄取的需求膨胀是近视眼形成的终因.在漫长的人类历史中,近视眼获得的每一种益处,都伴随着相应的代价.而达尔文医学关于生物进化的不完美性决定了近视眼的进化适应和代价将长期共存.因此,从治疗模式来看,应该摒弃达尔文医学固有的消极性而考虑生物的整体性和生态性.近视眼的中医和基因治疗正是避免了达尔文医学治疗模式的理论消极性,而且融入了其有关生物进化、遗传与环境统一的部分理念,可能成为近视眼治疗的候选策略.     

我国转化医学发展现状的思考

转化医学在当今世界发展迅速,虽然在我国起步较晚,但取得了巨大的成就,建立了许多转化医学研究机构,积极开展合作交流,但不可避免地存在一些问题,诸如创新能力不足、顶层设计不够和人才缺乏等,为此提出相应对策和未来发展的前景,同时指出转化医学在我国不仅是学术问题,而且是社会问题.     

Biases in intuitive reasoning and belief in complementary and alternative medicine

Very little is known about the reasoning underlying beliefs in complementary and alternative medicine (CAM). This study examined whether CAM beliefs can be better explained with intuitive reasoning, paranormal beliefs and ontological confusions of physical, biological and mental phenomena than with 12 variables that have typically been used to explore the popularity of CAM, namely gender, education, income, age, health, desire to control treatment, satisfaction with conventional medicine and world view (unconventional, feministic, environmentalist, exotical and natural). A representative sample of Finnish people (N = 1092) participated in the study. The results showed that intuitive thinking, paranormal beliefs and ontological confusions predicted 34% of the variation in CAM beliefs, whereas the 12 other variables increased the prediction only by 4%. The results help to explain individual, cultural and situational differences in the popularity of CAM and to differentiate between CAM statements that can be scientifically examined from those that cannot.     

Confidentiality protection in consulting with modern medicine following use of traditional medicine: perspectives of South African clients

This study explored the confidentiality values and needs of clients of traditional medicine practitioners who also consulted with modern medical care facilities. Participants were 12 clients of traditional healers who were also receiving modern medicine services (9 males; Sotho, Sepedi and Tswana speaking). The clients responded to an in-depth interview on their confidentiality values, needs and consultations with traditional and modern medicine, in the absence of a formal referral between the two systems. Data were thematically analysed using Tesch's (1990 Tesch, R. (1990). Qualitative Research: Analysis types and software tools. Bristol, PA: Falmer. [Google Scholar]) open coding method. Results indicated that clients valued their rights to confidentiality being respected by modern medicine and when also consulting with traditional healers. The clients also expressed concern about being ostracised by nurses for consulting traditional healers. Consultation confidentiality with regard to traditional medicine is important with traditionalist Africans.     

Chapter 8: “Always Green and Full of Sap”: Facilitating Wholeness in Aging

SUMMARY

Wholeness in aging is difficult to define, especially in the face of physical disability or catastrophic illness. How one meets the challenges of aging depends upon numerous physical, emotional, and spiritual factors. Rehabilitation may play an important role in restoring wholeness to those with physical disabilities. Likewise, a physical fitness program may lessen some of the effects of aging, helping the older person maintain a higher quality of life. The lived theologies of the older patients and their caregivers also interact, providing an important ground of connection in rediscovery of wholeness as well. Ultimately, our most important role as healthcare providers is to help our older patients regain and maintain this multidimensional wholeness even in times of physical challenge.     

Psychotherapy without the self–a Buddhist perspective,by Mark Epstein

This article seeks to explore how John Rolland's Family Systems Illness Model can be utilized by counselling psychologists working with individuals or families experiencing medical problems. Based on systemic theory the model provides a psychosocial typology of illness and examines how the demands of an illness over time can provide a number of hurdles to be overcome by the client and his/her family. Specific examples and techniques are described to illustrate how the application of the model can be used to guide the interventions employed in a counselling session. the model applies a biopsychosocial approach to health care, and the applicability of this within a British NHS healthcare setting is discussed with the conclusion that such an approach may be in its infancy in this country. Limitations and ideas for expansion of the model from chronic physical illness into spheres of mental health are discussed.     

Hispanic use of juramentos and Roman Catholic Priests as auxiliaries to abstaining from alcohol use/misuse

This self-administered mail survey study conducted along the US–Mexico border replicates and expands on research conducted in Florida regarding the prevalence of juramento use as an intervention technique for alcohol misuse. Juramentos are pledges to abstain from alcohol use for a time determined by the user. The pledge is usually to the Virgin of Guadalupe and is often done in the presence of a Roman Catholic Priest. As in Florida, the majority of Priests along the border reported they were familiar with the practice of juramentos and had already witnessed at least one. The majority of Priests who had done juramentos viewed them as effective. Since the vast majority of Priests indicated that they would begin or continue witnessing juramentos, this makes juramentos and Roman Catholic Priests a viable culturally sensitive aide for treatment among Hispanics, in particular those of Mexican descent.