EORTC QLQ—C30及其在胸部肿瘤患者生命质量研究中的应用

生命质量研究是近年来肿瘤研究的热点之一,其主要作用评价治疗效果,选择治疗方案;应用于抗肿瘤新药筛选;用于预测患者预后和远期生存状态。EORTC QLQ-C30及其子量表在世界范围内被应用于胸部肿瘤治疗和研究当中并取得了较好效果,为评价食管癌和肺癌的各种治疗方法提供了一个较好的参考标准,同时对提高食管癌和肺癌的治疗水平和改善病人生命质量起到了一定的推动作用。     

胸腔镜肺切除术治疗肺部恶性肿瘤的合理性

通过回顾近年电视胸腔镜手术(VATS)在治疗非小细胞肺癌的进展,得出以下结论:在有经验的胸外科医师手中,VATS肺叶切除术是一种安全有效、死亡率和并发症发生率很低的术式。VATS肺叶切除是一种完全的肺部肿瘤切除手术,在有选择的早期病例可以达到与开胸手术一样的生存率。但这种术式并不适用于全部肺部恶性肿瘤和所有胸外科医师。     

电视胸腔镜在肺癌治疗中面临问题的思考

电视胸腔镜是一种新兴技术,顺应了生物—心理—社会医学模式变革的要求,但在实际应用中有其局限性,尤其在肺癌治疗中尚存在较大的争议。分析该技术产生的背景、临床应用价值及发展前景,用一分为二和“扬弃”方法比较新旧技术的优与劣,并用实践论对新技术进行检验。     

Reactions to Organizational Alcohol Testing and Treatment Programs

We used organizational justice theory to explore reactions to employer-sponsored alcohol testing and alcohol treatment policies among a sample (N = 1,777) of the employed public in a western state. Level of alcohol use and safety-sensitivity of the job were related to the perceived fairness of alcohol testing. In addition, voluntary treatment policies were rated more positively than coerced or monitored policies in terms of fairness and organizational attractiveness. Alcohol use moderated the effects of treatment policy on perceived fairness and organizational attractiveness, although the effect sizes were small. These results support the use of organizational justice theory to explain reactions to organizational alcohol testing and treatment and provide a basis for future research in this area.     

Using the Nominal Group Technique to Identify the Problems Experienced by Persons Living with Severe Physical Disabilities

Changes in health care have dramatically curtailed services to people with severe physical disability and their families. This has placed a greater burden of responsibility on those who live with these conditions and have ongoing care needs. Yet little is known about the subjective problems, challenges, and solutions reported by these people. We demonstrate how the nominal group technique can be used to obtain consumer-oriented information germane to these individuals and their concerns. We conducted nominal group technique meetings with 2 groups for persons with physical disability and a third with a group for family members in caregiving roles. We demonstrate how focus groups can be conducted with the nominal group technique to identify problems experienced by individuals who live with severe physical disability. Recommendations for using the nominal group technique with client populations are presented, and implications for clinical practice are discussed.     

Gait symmetric adaptation: Comparing effects of implicit visual distortion versus split-belt treadmill on aftereffects of adapted step length symmetry

Understanding gait adaptation is essential for rehabilitation, and visual feedback can be used during gait rehabilitation to develop effective gait training. We have previously shown that subjects can adapt spatial aspects of walking to an implicitly imposed distortion of visual feedback of step length. To further investigate the storage benefit of an implicit process engaged in visual feedback distortion, we compared the robustness of aftereffects acquired by visual feedback distortion, versus split-belt treadmill walking. For the visual distortion trial, we implicitly distorted the visual representation of subjects’ gait symmetry, whereas for the split-belt trial, the speed ratio of the two belts was gradually adjusted without visual feedback. After adaptation, the visual feedback or the split-belt perturbation was removed while subjects continued walking, and aftereffects of preserved asymmetric pattern were assessed. We found that subjects trained with visual distortion trial retained aftereffects longest. In response to the larger speed ratio of split-belt walking, the subjects showed an increase in the size of aftereffects compared to the smaller speed ratio, but it steeply decreased over time in all the speed ratios tested. In contrast, the visual distortion group showed much slower decreasing rate of aftereffects, which was evidence of longer storage of an adapted gait pattern. Visual distortion adaptation may involve the interaction and integration of the change in motor strategy and implicit process in sensorimotor adaptation. Although it should be clarified more clearly through further studies, the findings of this study suggest that gait control employs distinct adaptive processes during the visual distortion and split-belt walking and also the level of reliance of an implicit process may be greater in the visual distortion adaptation than the split-belt walking adaptation.     

Lines of Advance in Treating People of Color with Borderline Personality Disorder: Alloying the “gold” of Vocational Rehabilitation with the “Copper” of Psychodynamic Psychotherapy

People of color with borderline personality disorder (PoCwBPD), in particular African-Americans and Latinxs in the inner city, present a special population at risk for unemployment and long-term impairment in psychiatric and psychosocial recovery. A growing literature points to the need for comprehensive care that addresses the symptoms of the borderline syndrome alongside social, vocational, and educational achievement. This article paints a picture of the individual, communal, and systemic complexities involved in aiding PoCwBPD achieve psychosocial recovery. After contextualizing the historical and systemic forces that impact recovery for PoCwBPD, I discuss principles of intervention to assist clinicians tailor treatment to this population. Drawing on insights from Transference-Focused Psychotherapy, an evidence-based psychodynamic therapy for BPD, I offer a theoretical cultural adaptation for people of color. This article provides clinical vignettes to illustrate the resulting model, and shows that helping the patient engage in productive activity provides the foundation for exploratory work, which in turn addresses intrapsychic obstacles to psychosocial success.     

精神分裂症治疗的理性思辩

神经解剖、神经生化的研究进展为阐明精神分裂症的病理机制提供了基础,但在精神分裂症的发病中遗传学、环境中的生物学和社会心理因素亦不容忽视.依循系统论的整体性、稳定性观点,采取药物、心理与心理社会康复治疗的综合治疗是目前的最佳方案.     

Sense of Community in Clubhouse Programs: Member and Staff Concepts

Psychological sense of community within psychosocial rehabilitation clubhouse programs was examined using concept mapping with 18 members and 18 staff from 10 programs. Members identified four concepts: Recovery, social connections, membership, and tasks and roles. Members described hope and healing as aspects of recovery. Members' views on sense of community focused on the rehabilitation and social nature of the program. Staff also identified four concepts: Affiliation and support for members, shared experiences, clubhouse organization, and task and roles. The staff concept of clubhouse organization, which incorporated the ideas of leadership and organization of physical space and the concept of task and roles, was based on ideas of shared responsibility and clubhouse procedures. Staffs' views on sense of community strongly reflected their formal training in clubhouse principles. The relation of these concepts to McMillan and Chavis' theoretical framework for sense of community is discussed and recommendations for practice provided. Sandra E. Herman is now an independent program evaluation consultant. Catherine Ferguson is now an independent consultant on psychosocial programs.     

Functional Neuroimaging Studies of Cognitive Recovery After Acquired Brain Damage in Adults

The first two decades of cognitive neuroimaging research have provided a constant increase of the knowledge about the neural organization of cognitive processes. Many cognitive functions (e.g.working memory) can now be associated with particular neural structures, and ongoing research promises to clarify this picture further, providing a new mapping between cognitive and neural function. The main goal of this paper is to outline conceptual issues that are particularly important in the context of imaging changes in neural function through recovery process. This review focuses primarily on studies made in stroke and traumatic brain injury patients, but most of the issues raised here are also relevant to studies using other acquired brain damages. Finally, we summarize aset of methodological issues related to functional neuroimaging that are relevant for the study ofneural plasticity and recovery after rehabilitation. Deceased