Further examination of discriminated functional communication

One child with developmental disabilities was taught to mand for attention by saying "excuse me." Treatment effects were extended to multiple training contexts by teaching the participant to attend to naturally occurring discriminative stimuli through differential reinforcement of communication during periods of the experimenter's nonbusy activities (e.g., reading a magazine). Results are discussed in terms of future research on the generalization and maintenance of functional communication in the natural environment.     

EFFECTS OF TREATMENT INTEGRITY FAILURES DURING DIFFERENTIAL REINFORCEMENT OF ALTERNATIVE BEHAVIOR: A TRANSLATIONAL MODEL

Differential reinforcement of alternative behavior (DRA) is used frequently as a treatment for problem behavior. Previous studies on treatment integrity failures during DRA suggest that the intervention is robust, but research has not yet investigated the effects of different types of integrity failures. We examined the effects of two types of integrity failures on DRA, starting with a human operant procedure and extending the results to children with disabilities in a school setting. Human operant results (Experiment 1) showed that conditions involving reinforcement for problem behavior were more detrimental than failing to reinforce appropriate behavior alone, and that condition order affected the results. Experiments 2 and 3 replicated the effects of combined errors and sequence effects during actual treatment implementation.     

Translating intentions into nutrition behaviors via planning requires self-efficacy: evidence from Thailand and Germany

A first step towards the improvement of daily dietary behaviors is forming an intention to change one's nutrition. However, an intention by itself is not sufficient for successful action. Rather, to translate intentions into behavior, careful planning is recommended. Thus, planning constitutes a mediator between the intention and the behavior. However, if a person lacks self-efficacy, this mediation might fail. Previous research in Costa Rica and South Korea has identified perceived self-efficacy as a moderator of the intention-planning-behavior relationship. To examine further the moderator role of self-efficacy, two additional studies were designed in Thailand and Germany. Study 1 surveyed 1718 Thai university students in terms of a low-fat diet; Study 2 surveyed 1140 German internet users in terms of their fruit and vegetable consumption at two measurement points in time, 6 months apart. Intentions served as predictor, planning as mediator, self-efficacy as moderator, and behaviors as outcomes. First, intentions were translated into nutrition behaviors by planning. Second, self-efficacy moderated this mediation in both studies: The strength of the mediated effect increased along with levels of self-efficacy, even when accounting for baseline behaviors. For planning to mediate the intention-behavior relation, people must not harbor self-doubts. If they lack self-efficacy, intentions are not well translated into nutrition behavior through planning.     

要注意中药对肝的损伤作用

含有生物碱类、皂苷类、萜类、毒蛋白类、重金属类成分的中药易致急性肝损伤.中药对肝脏损伤的原因及机制较为复杂,可能与药物对肝脏的直接毒性或特异性体质有关.此外,中药炮制方法、给药途径、剂型、剂量、疗程及配伍不当也会引起药物性肝损伤.中药所致的药物性肝损伤的诊断主要依据用药史、发病的时间、过程和临床表现并排除其他因素.治疗可选用还原型谷胱甘肽、S-腺苷蛋氨酸、多烯磷脂酰胆碱、熊去氧胆酸、水飞蓟素等药物,重症可选择人工肝脏支持治疗.     

布氏杆菌病诊治体会

加强对布氏杆菌病流行病学资料、临床特点、诊断、治疗、预后及本病误诊误治的前因后果等方面的认识,回顾性分析潍坊医学院附属医院近两年收治的28例布氏杆菌病病例,并总结布氏杆菌病在诊断、治疗等方面的特点.经查阅国内外资料分析所得,近20余年,布氏杆菌病发病率呈上升趋势,传播途径复杂,临床表现无特异性,易误诊误治;利福平、四环素及喹诺酮药物疗效肯定,治愈率高.临床医师须加强对本病的全面认识,提高诊断率并提供规范治疗、减轻患者心理及精神负担.     

化疗在局部晚期鼻咽癌中的适度应用

鼻咽癌是我国高发恶性肿瘤之一,发病率为头颈部恶性肿瘤之首。鼻咽癌对放疗、化疗均敏感。单纯的放射治疗虽然能够使早期患者获得很好的局部控制率,但是对于局部晚期患者而言,其5年生存率难以令人满意,治疗失败主要是因为区域复发和远处转移。化学治疗对放疗起到了补充作用,临床应用目前主要有同期化疗、辅助化疗、诱导化疗三种。本文对过去20年间化疗在局部晚期鼻咽癌治疗中的应用归纳总结。     

妊娠合并结核临床诊治的决策

妊娠合并结核是一种对母婴健康危害极大的妊娠期疾病。在妊娠期结核病中,多数患者无明显症状,早期症状与妊娠期某些生理反应相似,加之妊娠与结核病的相互影响,x线、CT等重要的影像学检查受限,致使本病易被误诊或误治。某些抗结核药物对母婴的不良影响,使其治疗难以实施,由于结核病本身及治疗后可能对胎儿的影响,在临床上是否终止妊娠往往难以决策。本文就妊娠合并结核诊治过程中的相关问题进行综述,以期为临床诊治决策提供帮助。     

心力衰竭国内外指南浅析

近几年随着循证医学证据的不断增加,各国对心力衰竭指南进行了更新.主要是2012年欧洲心脏病学会(ESC)与心衰学会公布的心力衰竭新指南、2011年澳大利亚和新西兰慢性心力衰竭诊治指南、2010年英国国立健康与临床优化研究所(NICE)慢性心力衰竭诊治指南、2009美国心脏病学会(ACC)/美国心脏协会(AHA)实践指南工作组成人心力衰竭诊疗指南及2010年我国的急性心力衰竭指南等.各国指南对心力衰竭的诊断和治疗都提出了具体的意见和建议,其中不乏亮点,如对慢性心力衰竭患者更加重视血运重建的治疗作用、推荐心力衰竭治疗的一种新型β受体阻滞剂奈必洛尔等等.我们对以上几个指南做了浅要分析,以取长补短更规范的诊治心力衰竭患者.     

大剂量抗坏血酸静脉滴注治疗恶性肿瘤的进展

尽管30年前鲍林与卡梅伦曾经用静脉注射+口服大剂量维生素C(10克/天)治疗肿瘤患者,并验证抗坏血酸的抗癌功效,但梅约医疗中心的口服双盲试验否定了他们的结论.沉寂30年后,鲍林的继承者瑞欧丹通过不懈的努力用科学实验和医疗实践证明,通过静脉滴注大剂量抗坏血酸,令其在血浆达到一定浓度,可以杀死多种癌细胞,从而作为化疗药物可以有效治疗恶性肿瘤.30年来的临床实践现已总结为“瑞欧丹规程”.近年来,他们的成就受到美国主流医学和媒体的高度重视.与一般化疗药物相比,该法的好处是基本没有副作用,延长生存期,提高存活质量(QOF).这是一项重大科学发现和成就.该疗法的确立意义重大,将推动癌的治疗及预防,乃至其他疾病如冠心病、感染性疾病及炎症的治疗及预防,提高人类健康水平.     

Boys’ and girls’ involvement in science learning and their self‐efficacy in Taiwan

This cross‐sectional study investigated the significant differences in students’ self‐efficacy and their involvement in learning science. Nine hundred and twenty‐two elementary school fifth graders, 499 junior high school eighth graders, and 1455 senior or vocational high school eleventh graders completed the students’ questionnaire. Analyses of variance (ANOVAs) and independent t‐tests compared the significant similarities and differences across school levels and genders. The initial findings were as follows: A sharp decline in boys’ and girls’ self‐efficacy scores from elementary to secondary school levels; boys have significantly higher self‐efficacy scores than girls at vocational and senior high school levels; students with more involvement in science learning presented significantly higher self‐efficacy scores than those with less involvement. The significant discrepancies in terms of gender and age in students’ self‐efficacy and involvement in learning science need to be addressed. Implications and limitations are provided.