重症感染非抗感染措施的思考

近年来严重感染与感染性休克治疗策略的主要进展是对强化血糖控制、糖皮质激素等疗法的再评价。同时,也出现了诸如血管加压素、他汀类药物、选择性口腔/肠道脱污染等新的治疗措施,并取得了一定成果。本文对相关研究进展进行综述,以阐明集束化策略和管理水平的提高可能是最终降低重症感染病死率的关键。     

辩证思维在重症急性胰腺炎治疗中的运用

重症急性胰腺炎的治疗水平在近几十年已有了很大的发展,但是SAP的死亡率依然居高不下,严重威胁患者生命。这类患者的病情复杂,需要运用多种治疗方法进行综合救治。从多种治疗方法中选择合适的方法并进行合理的治疗很难准确把握,需要我们用哲学的思维来看待胰腺炎的诊治,辩证地对其进行有针对性的治疗,从而提高重症急性胰腺炎的治疗水平。     

重型颅脑损伤围术期亚低温治疗路径——循证医学指导下的治疗抉择

早期动物实验研究表明亚低温能减轻脑损伤后的继发性损害,促进神经功能恢复,然而对其临床疗效不同研究结果不完全一致。本文应用循证医学思想,检索和评价国内外文献,为重型颅脑损伤患者制定了围术期亚低温实施方案。随访结果表明,亚低温可改善患者预后。     

学习障碍儿童情绪理解与同伴接受性*及社会行为的关系

该研究以90名学习障碍儿童为研究对象,探讨学习障碍儿童情绪理解与同伴接受性和社会行为的关系,比较情绪理解不同成分对同伴接受性和社会行为的影响作用。研究发现情绪理解不同成分对学习障碍儿童同伴接受性和社会行为具有不同程度的影响,具体表现为:1)基本情绪识别和自我意识情绪识别是学习障碍儿童同伴接受性的最佳预测变量;2)自我意识情绪识别和表情识别是学习障碍儿童问题行为的最佳预测变量;3)自我意识情绪识别、情绪内部原因理解、情绪隐藏理解、情绪改变理解和情绪外部原因理解是学习障碍儿童社会能力的最佳预测变量。     

Stress in Mothers with Intellectual Disabilities

Both low parental IQ and stress have been shown to be associated with parenting difficulties and adverse child outcomes. We examined stress in parents with low IQ as a potential contributor to their documented parenting problems. Eighty-two mothers with intellectual disabilities (IQ < 80; labelled as having mental retardation) were given the Parenting Stress Index and they were found to be enduring very high levels of overall stress (95th percentile), stress related to child characteristics (95th percentile), and stress related to other life experiences (90th percentile) as compared to the normative test group. We divided the 82 mothers with intellectual disabilities into three groups depending on the age of their children. The mothers with school-age children reported significantly higher stress than parents of infant/toddler and preschool children. A hierarchical regression analysis revealed that child age and living in a crowded environment were significant predictors of parenting stress. The results confirm that mothers with intellectual disabilities experience extreme stress that, together with other factors, may hinder adequate parenting.     

Accuracy of Effect Size Estimates From Published Psychological Experiments Involving Multiple Trials

The reporting of exaggerated effect size estimates may occur either through researchers accepting statistically significant results when power is inadequate and/or from repeated measures approaches aggregating, averaging multiple items, or multiple trials. Monte-Carlo simulations with input of a small, medium, or large effect size were conducted on multiple items or trials that were either averaged or aggregated to create a single dependent measure. Alpha was set at the .05 level, and the trials were assessed over item or trial correlations ranging from 0 to 1. Simulations showed a large increase in observed effect size averages and the power to accept these estimates as statistically significant increased over numbers of trials or items. Overestimation effects were mitigated as correlations between trials increased but still remained substantial in some cases. The implications of these findings for meta-analyses and different research scenarios are discussed.     

Correcting Overestimated Effect Size Estimates in Multiple Trials

In a simulation study, Brand, Bradley, Best, and Stoica (2011 Brand, A., Bradley, M. T., Best, L. A. and Stoica, G. 2011. Multiple trials may yield exaggerated effect size estimates. The Journal of General Psychology, 138: 1–11. [Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]) have shown that Cohen's d is notably overestimated if computed for data aggregated over multiple trials. Although the phenomenon is highly important for studies and meta-analyses of studies structurally similar to the simulated scenario, the authors do not comprehensively address how the problem could be handled. In this comment, we first suggest a corrective term d ^′ _c that includes the number and correlation of trials. Next, the results of a simulation study provide evidence that the proposed d_c′ results in a more precise estimation of trial-level effects. We conclude that, in practice, d ^′ _c together with plausible estimates of inter-trial correlation will produce a more precise effect size range compared to that suggested by Brand and colleagues (2011 Brand, A., Bradley, M. T., Best, L. A. and Stoica, G. 2011. Multiple trials may yield exaggerated effect size estimates. The Journal of General Psychology, 138: 1–11. [Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]).     

Naturalistic Decision-Making Task Processes in Multiprofessional Assessment of Disability

Evaluation of preschool children with complex disabilities is regarded as a group decision-making process. This process was studied in two tertiary-level multiprofessional groups in London, UK: one based in a neurodisability center and one organized by a school psychological service. The assessment discussions about two preschool children at each site were audio recorded. Each assessment was carried out over half a day by all the professionals simultaneously with the family. Postassessment interviews were held with each professional and family. Verbal protocol analysis captured the structure of each assessment through six TASK decision-making processes applied at three levels of reasoning and decision making. Sequential application of processes was found to be influenced by the occurrence of a series of three cycles of decision making within each assessment and the decomposition of the assessment task into distinct subproblems.     

Factors Predicting Attrition Within a Community Initiated System of Care

We designed this study to elucidate child, family, and service level characteristics that may influence attrition from a continuum of care developed and maintained by a community initiated collaboration of local clinics and agencies. Subjects included 117 children and adolescents referred to the Middlesex County system of care from 1992–1999. Data were collected through a retrospective case review. The strongest predictors of attrition from the system of care both before and after the establishment of an individualized service plan included depressed/isolated symptoms, substance abuse, general risk for psychiatric problems, number of referral reasons and urgency status at program intake. Among youth exiting residential placement, those completing recommended services were more likely to be returned home earlier or within the expected time frame than were dropouts. Our study presents important preliminary findings regarding characteristics related to treatment adherence within a community initiated systems of care.     

Sit Still and Pay Attention?

Sitting still while trying to pay attention implicitly reinforces the idea that to pay attention one should focus on a single aspect of the stimulus. Movement encourages attending to different aspects of the stimulus and as such is hypothesized to increase attention. We tested this with students from a traditional and a nontraditional school. Students were asked to observe and recall landmarks on a map. Students from the traditional school who viewed the map from multiple perspectives remembered more landmarks and locations than students who viewed the map from a single perspective. Students from a nontraditional school who are accustomed to movement while learning, did not show this effect. The experiment is discussed in terms of mindfulness theory.