ICU长期机械通气患者撤机困难的因素分析

为探讨ICU长期机械通气患者撤机困难的原因,回顾性分析大连医科大学附属第一医院重症医学科的62例长期机械通气患者的临床资料,回顾撤机过程,分析其撤机成功或失败的原因。结果显示,62例长期机械通气患者,34例成功撤机;10例死亡;18例因各种原因出现撤机困难,其中运动神经元病1例,脑外术后2例,间质性肺病4例,慢性阻塞性...     

重症医学科患者安全——一个需要关注的问题

随着重症医学的发展,重症医学科暴露的患者安全问题已逐步引起人们关注。重症医学科患者安全问题与医务人员职业倦怠、医患关系、团队合作、科室管理等因素密切相关,提高科室高效管理、加强团队建设、提高人文素养等措施是重要有效的解决办法。     

Speaking the other's language: imitation as a gateway to relationship

Imitation offers a gateway to relationship. This paper seeks to explore that capacity by describing the therapeutic approach of ‘Intensive Interaction’. The research literature on imitation contains relatively little about imitation used in an intervention capacity, concentrating instead on the emergence of imitative abilities during infant and child development. The paper therefore describes the case of a young man with severe autism, for whom Intensive Interaction was successful in bringing him into interpersonal engagement with others. The author provides an account as to why imitation should be so effective in this regard. Overall, the paper aims to stimulate questions about how imitation can best be conceived and studied. Copyright © 2006 John Wiley & Sons, Ltd.     

BRIEF HIERARCHICAL ASSESSMENT OF POTENTIAL TREATMENT COMPONENTS WITH CHILDREN IN AN OUTPATIENT CLINIC

Seven parents conducted assessments in an outpatient clinic using a prescribed hierarchy of antecedent and consequence treatment components for their children's problem behavior. Brief assessment of potential treatment components was conducted to identify variables that controlled the children's appropriate behavior. Experimental control via a brief reversal was achieved for 6 of the 7 children, (1 child continued to behave appropriately following initial improvement in behavior). For these 6 children, improved behavior occurred with changes in treatment components. Our results extend previous studies of direct assessment procedures conducted in outpatient clinic settings.     

A BRIEF COMPONENT ANALYSIS OF POTENTIAL TREATMENT PACKAGES IN AN OUTPATIENT CLINIC SETTING WITH YOUNG CHILDREN

The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.     

Medical Crisis Counseling on a Pediatric Intensive Care Unit: Case Examples and Clinical Utility

The intensive care unit is one of the most stressful and demanding work sites of the pediatric psychologist. The rapid changes in health status that necessitate stays on the intensive care unit often constitute an emotional roller coaster ride for both family members and the staff caring for their child. The Medical Crisis Counseling (MCC) intervention model is a useful approach to providing psychological support in the pediatric intensive care setting. A representative year's worth of consultation requests from the multidisciplinary intensive care unit of a large urban pediatric hospital is described and discussed in the context of the MCC model.     

用比较治疗学的观点谈早期2型糖尿病的胰岛素强化治疗

现在越来越多的证据显示短期胰岛素强化治疗可以使血糖接近正常,并明显改善胰岛β细胞功能,但是也有专家认为这种胰岛素治疗的代价比能带来的好处更多。本文运用比较治疗学的观点就这一问题进行了探讨,并强调了胰岛素强化治疗在早期2型糖尿病治疗中的重要意义。     

新生儿重症监护室（NICU）中放弃治疗的决策

随着现代主义哲学与伦理学,尤其是生命价值理论对"放弃治疗"的支持,以及相关科学标准和程序法则的建立,对于新生儿重症监护室中的一部分病情危重且又预后不良的新生儿来说,理应作出放弃治疗的决策。但在实施的过程中,存在许多困难,医生有客观告知的义务,但最后的决策权仍在患儿父母。从NICU中放弃治疗的对象、依据、医院面临的困境、决策的实施以及解决实施过程中矛盾冲突的对策方面加以讨论。     

Cost Comparison of Early Intensive Behavioral Intervention and Special Education for Children with Autism

The financial implications of the increased prevalence of autism, though rarely discussed, will be extremely important to society. We compared the costs associated with 18 years of special education to the costs associated with the implementation of an average of 3 years of Discrete Trial Training as an Early Intensive Behavioral Intervention (EIBI) in an effort to minimize the need for special education. Our results indicate that the state of Texas would save $208,500 per child across eighteen years of education with EIBI. When applied to the conservative estimate of 10,000 children with autism in Texas, the State would save a total of $2.09 billion with EIBI. Implications for taxpayers, policymakers, and treatment are discussed.