足踝部创伤后畸形的修复决策

足踝部创伤后遗畸形是临床上最常见也是最棘手的病症之一。作为人体活动的支撑和力学传导支柱,足踝创伤后畸变将造成连锁的踝关节、膝关节、髋关节和脊柱的退变,最后严重影响患者的生活质量。因此,需要运用哲学体系的思路和理念来指导此类病症的临床诊治,以求获得最佳的远期疗效。本文根据足踝部不同部位创伤后遗畸形的治疗作一综合性论述,为临床作基本的指导。     

整形外科的临床治疗决策分析

在生物心理社会医学模式下,以循证医学为基础的共享型临床决策成为主导。整形外科疾病有着诊断容易、治疗方法多样、效果不一、患者年龄小、心理脆弱、大众认知有一定误区等特点,更需要在情感和实践上体现对患者的理解和尊重,真正实现医生患者共同参与的共享型临床决策。     

自由基与脑卒中治疗决策的系统思维

脑卒中是神经系统疾病中最常见的危重急症,为全世界人口死亡的三大原因之一。脑卒中的早期治疗及其细节正确与否直接决定患者的预后。近年来,自由基在脑卒中后继发性脑损害的作用日益受到重视,自由基损害贯穿于脑卒中早期治疗的整个过程,脑卒中的治疗决策有必要着眼于机体内自由基的系统特征,从系统整体出发进行最优化的科学思维。     

Psychoeducation for hypochondriasis: a comparison of a cognitive-behavioural approach and a problem-solving approach

In this study, two 6-week psychoeducational courses for hypochondriasis are compared, one based on the cognitive-behavioural approach, and the other on the problem-solving approach. Effects of both courses on hypochondriacal complaints, depression, trait anxiety, and number of problems encountered in daily life, are measured pre-treatment, post-treatment, and at 1- and 6-month follow-up. Participants (N=48, of whom 4 dropped out), suffering from DSM-IV hypochondriasis, were randomized into one of the two course conditions. Results showed beneficial effects of both courses. Few differential treatment effects were found: in both conditions all effect measures decreased significantly over time (p<0.01). However, between- and inter-individual variability in decrease-patterns was of considerable size, leading to large deviations from the mean pattern. Acceptability and feasibility of both courses were rated highly by their respective participants. It is concluded that both courses can be considered equally beneficial and effective over time, with the effects evident immediately after treatment and maintained over the follow-up period.     

Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement

Although the effectiveness of cognitive-behavioral treatment in posttraumatic stress disorder (PTSD) is well established, few studies examined its effects on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study [Ba?og lu, M., Salciog lu, E., Livanou, M., Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waitlist controlled trial. Journal of Traumatic Stress, 18, 1-11] a single session of behavioral treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study we examined the effects of treatment on each PTSD symptom and which symptoms improved early in treatment. Because the intervention focused solely on behavioral avoidance, we hypothesized that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance. These findings imply that live exposure to fear cues designed to enhance sense of control might be sufficient for recovery from PTSD.     

单纯疱疹性角膜炎治疗的思考

单纯疱疹病毒性角膜炎是目前最常见的严重角膜病之一,近几年来其发病率有明显上升的趋势。由于其重症病例所占比例较高,复发率高,严重威胁视功能,故对本病的治疗方法的研究,已成为眼科亟待解决的课题。纵观目前研究的深入及治疗方法的多元化,拟对本病治疗的创新性进行论述。     

浅析当前临床科学决策的几个影响因素

随着循证医学在我国的发展和"医疗举证责任倒置"等相关法律的实施,我国临床医生在进行诊治决策时已逐步向临床科学决策迈进。而防御性医疗、不健全的医疗制度及相关法律等却严重影响着这一科学决策的转变过程。只有有效解决了导致干扰科学决策的各种社会影响因素,如扩大基本医疗保险的覆盖率,实施医疗风险保险制度,提高医务人员认知和职业素质,保障行医安全等,临床科学决策的真正落实就大有希望。     

Unfair treatment and self-regulatory focus

Ample correlational evidence exists that perceived unfair treatment is negatively related to well-being, health, and goal striving but the underlying process is unclear. We hypothesized that effects are due in part to contextual priming of prevention focus and the negative consequences of chronic prevention-focused vigilance. Indeed, reasonable responses to unfair treatment—to avoid situations in which it occurs or if this is not possible, confront it head on—fit prevention self-regulatory focus response patterns. Results from three experiments support this notion. Priming stigmatized social category membership heightened students’ prevention (not promotion) focus (n = 117). Priming non-stigmatized social category membership (i.e., white) did not change prevention focus (n = 46). Priming prevention (not promotion) increased perceptions of unfair treatment (and aroused prevention-relevant fight or flight responses) in response to a negative ambiguous job situation among low and moderate income adults (n = 112).     

Ministers’ Perceptions of Depression: A Model to Understand and Improve Care

While depression is a significant worldwide health problem, fewer than half of individuals seek care. Faith-based communities may play an important role in improving the knowledge of and linkage to depression care. Focus groups of Caucasian and African-American clergy were conducted to explore these issues. Using a grounded theory approach five themes emerged, including explanatory models of depression, barriers and facilitators to care, and recommendations for involving religious communities. A model of depression care pathways was constructed that integrates secular and spiritual approaches. The findings highlight the need for targeted interventions to build trust between clergy and mental health professionals. Teresa L. Kramer, Ph.D., is Chief Psychologist and Associate Professor of Psychiatry in the College of Medicine, University of Arkansas for Medical Sciences in Little Rock. She has conducted research in child, adolescent and adult mental health assessment, outcomes, and quality of care. Her current research on adolescent depression is funded through a Research Career Development Award from the National Institute of Mental Health. She is currently developing faith-based programs to educate ministers and their congregations about depression-related illness. Dean Blevins, Ph.D., teaches in the Department of Psychiatry, College of Medicine, at the university and is associated with the Center for Mental Health & Outcomes Research, Central Arkansas Veterans Healthcare System, and the South Central Mental Illness, Research, and Clinical Center in Little Rock. Terri L. Miller, Ph.D., also teaches in the Department of Psychiatry. Martha Phillips, Ph.D., is at the Department of Human Services in Little Rock. Vanessa Davis and Billy Burris are employed at the Division of Behavioral Health Services, also in Little Rock.     

一期前后联合入路治疗上颈椎畸形

回顾9例因颅底凹陷症合并其它畸形在我科接受一期经口咽齿状突切除、后路枕骨大孔减压、寰枢椎或枕颈融合术治疗的,临床资料,观察该术式对脊髓功能、枕颈部稳定性的影响及其临床疗效。本组术前诊断均为颅底凹陷症合并邻近结构畸形。所有患者均接受前后联合入路手术。末次随访JOA评分15±1分。影像学检查示齿状突残留基底部均位于钱氏线以下,脊髓减压充分,寰枢间、枕颈间植骨均获坚强融合,融合时间平均3．9±1.1个月。因此一期前后路联合手术治疗颅底凹陷症,脊髓减压充分,重建稳定性后骨融合好,治疗效果满意。