咳嗽与咳嗽治疗

咳嗽是临床上常见的症状之一,其对人们健康的影响是辩证的,咳嗽治疗也是辩证的。有需要止咳的,有需要治疗但不是止咳治疗的,有不需要治疗的,还有要鼓励患者咳嗽的。临床上遇到咳嗽患者时,要用辩证的观点进行治疗,辨证施治,用哲学观来看待问题,最终才能解决问题。     

法国中医拉维耶的天地人诊疗体系及西方实践

法国中医汉学家拉维耶是西方继承和发展传统中医文化和医疗实践的集大成者,他运用训诂学方法考辩中医经典相关概念和术语的含义,试图通过理解象形文字和会意文字与中国古人建立对话。他通过研究中国古代天文学、《易经》和《黄帝内经》等传统中医基础理论,以中国三才思想为基础,创立独特的天地人诊疗体系。天地人分别类比人的精神、物质和社会层面,拉维耶从中医整体观出发,认为疾病的病因、诊断和治疗可以分为精神、心理和身体三个层次,以此为基础建立了天地人三才辨证施治的中医理论,其理论和实践在西方广泛传播。

     

在线问诊平台医患交互模式研究

基于乔哈里视窗理论,从开放区、隐秘区和盲目区三个维度对海量医患交互数据进行聚类与界定,得到5种医患交互模式：沟通不足型、封闭交流型、患者主导型、患者独白型和医患平等型。采用统计分析和会话分析方法进一步研究发现：医生回复时间、患者扩展回答质量、医生回答详尽及明确程度、医患问答的话轮交叠度是不同模式下影响患者满意度的关键因素。最后,从信息质量、会话结构、生命关怀、信任关系四个层面针对三方主体提出建议,以期为提升医患交互质量、构建和谐医患关系、提供优质在线问诊服务提供思路。

     

The Straw Thing of Fallacy Theory: The Standard Definition of 'Fallacy'

Hamblin held that the conception of 'fallacy' as an argument that seems valid but is not really so was the dominant conception of fallacy in the history of fallacy studies. The present paper explores the extent of support that there is for this view. After presenting a brief analysis of 'the standard definition of fallacy,' a number of the definitions of 'fallacy' in texts from the middle of this century – from the standard treatment – are considered. This is followed by a review of the definitions of 'fallacy' in the earlier history of logic books, including those of Aristotle, Whately, Mill and De Morgan. The essay concludes that there is scarcely any support for Hamblin's view that this particular definition of 'fallacy' was widely held.     

Cognitive therapy for social phobia: individual versus group treatment

Cognitive-behavioural group treatment is the treatment of choice for social phobia. However, as not all patients benefit, an additional empirically validated psychological treatment would be of value. In addition, few studies have examined whether a group treatment format is more effective than an individual treatment format. A randomized controlled trial addressed these issues by comparing individual cognitive therapy, along the lines advocated by Clark and Wells (Clark, D.M. and Wells, A., 1995. A cognitive model of social phobia. In: R. G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds.), Social Phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford.), with a group version of the treatment and a wait-list control condition. 71 patients meeting DSM-IV criteria for social phobia participated in the trial, 65 completed the posttreatment assessment and 59 completed a six-month follow-up. Social phobia measures indicated significant pretreatment to posttreatment improvement in both individual and group cognitive therapy. Individual cognitive therapy was superior to group cognitive therapy on several measures at both posttreatment and follow-up. The effects of treatment on general measures of mood and psychopathology were less substantial than the effects on social phobia. The results suggest that individual cognitive therapy is a specific treatment for social phobia and that it's effectiveness may be diminished by delivery in a group format.     

An Open Trial of Acceptance and Commitment Therapy With Exposure and Response Prevention in an Intensive Outpatient Setting for Adults With OCD

Intensive outpatient treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness are limited. The effectiveness of IOP treatment for adults with OCD using combined acceptance and commitment therapy (ACT) and exposure and response prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for 3 weeks. Measures were collected at pretreatment, 1-week, 2-weeks, posttreatment, and at 1-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety, and stress significantly decreased through treatment and participants ended treatment below clinical range for psychological inflexibility and nonclinical to mild range for depression, anxiety, and stress. The results of this study provide preliminary support for the effectiveness of ACT and ERP in an intensive outpatient setting for adults with OCD. The focus of this paper is on the clinical application of this treatment.     

THE INFLUENCE OF BEHAVIOR PRECEDING A REINFORCED RESPONSE ON BEHAVIOR CHANGE IN THE CLASSROOM1

The influence of behavior that immediately precedes a reinforced target response on the effectiveness of a reinforcement contingency was examined in two experiments with mentally retarded children in a special-education classroom. Two reinforcement schedules were examined in each experiment. For each schedule, a prespecified period of attentive behavior served as the target response. The schedules differed in whether inattentive or attentive behavior was required immediately to precede the target response. These schedules were examined with one child in a simultaneous treatment design using praise as the reinforcer (Experiment I), and with two children in separate reversal designs using tokens as the reinforcer (Experiment II). While attentive behavior increased under each schedule, the increase was greater when attentive rather than inattentive behavior preceded the reinforced response. The results indicated that the effect of a contingency may be determined not only by the specific response reinforced but also by the behavior that immediately precedes that response.     

PEER TRAINING OF SAFETY-RELATED SKILLS TO INSTITUTIONAL STAFF: BENEFITS FOR TRAINERS AND TRAINEES

A peer training program, in which experienced staff trained new staff, was evaluated as a method for teaching and maintaining safety-related caregiver skills in an institutional setting for the developmentally disabled. Three sets of safety-type skills were assessed in simulated emergency situations: responding to facility fires, managing aggressive attacks by residents, and assisting residents during convulsive seizures. Using a multiple-baseline research design, results indicated that the peer training program was an effective method of training the three types of emergency skills to new direct care staff. The program also appeared effective in improving the skills of the peer trainers. Perhaps most importantly, results indicated that if experienced staff functioned as peer trainers for particular emergency skills, then their proficiency in those skills maintained over time whereas their proficiency declined in emergency skills for which they did not act as peer trainers. Social validity information collected from available staff 23 months after the program was completed supported the utility of the training in terms of staff responses during actual emergencies. Also, acceptability measures indicated that staff liked participating in the program. However, some inconsistencies between staff verbal reports and performance-based measures of acceptability were noted. Results are discussed regarding the overall effectiveness of the peer training program, the importance of maintenance strategies for safety-related skills, and the need for multidimensional analyses of staff acceptability in staff training/management research.     

老年高血压治疗决策的个体化和系统化

高血压是严重危害老年人健康的常见病,老年人高血压临床症状及特点与中青年高血压有显著不同,在诊断治疗中应注重老年人血压升高的病理生理特点及机制,在老年高血压的治疗决策中运用个体化和系统论的原则,选择个体最优化综合治疗决策,启思和引导老年高血压研究水平的纵深发展,积极有效地改善老年人的生活质量。     

重症急性胰腺炎预防抗生素治疗的争议

重症急性胰腺炎伴随高病死率,细菌和真菌感染是其导致死亡的主要原因之一。目前治疗一般采取预防性抗生素治疗,但预防性抗生素治疗又可能会加重二重感染。目前研究结果数量有限,结果不一。是否应该应用预防抗生素治疗仍然存在争议,期待更多设计合理的随机对照试验。