The role of the therapeutic relationship in the association between interpersonal behaviors and outcome: Comparison of two competing models

Objective: The patient–therapist relationship may be the mechanism behind the effect of pretreatment interpersonal patient behaviors on the outcome of psychotherapy for depression, or the factor determining for whom interpersonal behaviors affect outcome. We seek to establish which of these two alternatives receives empirical support. Method: We conducted a secondary analysis of the findings from the Treatment for Depression Collaborative Research Program to examine two alternative models. First, a deterministic model, in which clients’ ability to create satisfactory interpersonal relationships affects their ability to build a strong therapeutic relationship, which in turn affects outcome; and second, a compensation model, in which patients in a treatment focusing on interpersonal mechanisms of change and not in placebo, who compensate for their maladaptive pretreatment interpersonal behaviors by building a strong therapeutic relationship, benefit from treatment more than do patients who cannot build such relationship. Results: The compensation, rather than the deterministic model, was supported, suggesting that the interpersonal behavior–outcome association is significantly moderated by the therapeutic relationship in interpersonal psychotherapy and not in placebo. Conclusions: Findings support an optimistic view whereby patients seeking treatment for maladaptive interpersonal behaviors can achieve good outcomes if work on interpersonal relationships is conducted in the presence of a strong therapeutic relationship.

Clinical or methodological significance of this article: This study highlights an important optimistic view in which patients with maladaptive interpersonal style who can form a strong therapeutic relationship can benefit from treatment focusing on interpersonal relationships.     

负荷多普勒超声评价法乐氏四联症根治术后肺动脉反流的血液动力学反应

本文通过应用负荷多普勒超声无创方法评价法乐氏法乐氏四联症术后患者的运动耐量和肺动脉反流(PR)对血液动力学反应的影响。31例与按年龄、性别和体表面积的大小相匹配的20例正常志愿者作对照研究。在次极量仰卧运动中测量最大心率、心率血压双乘积、最大运动耐量指数。用多普勒超声测量静息和次极量仰卧运动时主动脉血流平均加速度、心脏指数、左室短轴缩短率及其它静息时的超声指标。结果显示:术后患者右室增大,与PR程度呈正相关,最大心率反应、氧消耗量和最大运动耐量指数较正常对照组均有降低(P<0.001)。按PR程度,将本组病例分成无、轻度、中度和重度PR组,无PR和轻度PR组的血液动力学反应接近正常,重度PR组有显著低心输出量反应,无PR组的最大运动耐量指数也低于正常对照组。法乐氏四联症术后患者运动耐量降低和血液动力学反应异常与PR相关,PR的产生与右室流出道重建方式有关。     

Client Accounts of Corrective Experiences in Psychotherapy: Implications for Clinical Practice

The Patient Perceptions of Corrective Experiences in Individual Therapy (PPCEIT; Constantino, Angus, Friedlander, Messer, & Moertl, 2011) posttreatment interview guide was developed to provide clinical researchers with an effective mode of inquiry to identify and further explore clients’ firsthand accounts of corrective and transformative therapy experiences and their determinants. Not only do findings from the analysis of client corrective experience (CE) accounts help identify what and how CEs happen in or as a result of psychotherapy, but the measure itself may also provide therapists with an effective tool to further enhance clients’ awareness, understanding, and integration of transformative change experiences. Accordingly, we discuss in this afterword to the series the implications for clinical practice arising from (a) the thematic analysis of client CE accounts, drawn from a range of clinical samples and international research programs and (b) the clinical effect of completing the PPCEIT posttreatment interview inquiry. We also identify directions for future clinical training and research.     

加力时间对快速扩弓效果的影响初探

目的 采用不同加力时间进行正畸快速扩弓治疗,探讨不同加力时间对快速扩弓治疗的影响和作用,为正畸临床治疗提供依据.方法 纳入111例行快速扩弓治疗的连续病例,根据性别分组,男性组55例,女性组56例;平均年龄:男性(11.2±2.1)岁、女性(11.4±2.7)岁,均采用相同固定快速扩弓装置.每组分为0、3、6、9、12、15、18、21点8个时间点亚组加力,每组加力方式相同,每日加力9.8 N.通过模型分析测量扩弓量,并进行余弦拟合及方差分析.结果 每组8个时间点亚组正畸扩弓量符合余弦函数拟合昼夜节律规律.快速扩弓治疗的扩弓量峰值出现在21点,男性第一磨牙区扩弓量为(6.85±0.10)mm,女性为(6.81±0.15)mm;男性尖牙区扩弓量为(5.75±0.12)mm,女性为(5.54±0.14)mm.而扩弓量谷值出现在9点,男性第一磨牙区扩弓量为(5.88±0.15)mm,女性为(5.76±0.10)mm;男性尖牙区扩弓量为(4.26±0.19)mm,女性为(4.17±0.10)mm.每组8个时间点亚组扩弓量差异均有统计学意义(P＜0.05).结论 不同加力时间可以影响正畸扩弓治疗的效果.快速扩弓治疗较适合在21点前后加力.     

唾液对Free-edge托槽摩擦力的影响

目的：研究唾液对Free-edge托槽摩擦力的影响。方法槽沟为0．56mm×0．71mm的Free-edge方丝弓托槽和直丝弓托槽与4种不锈钢丝（0．45mm和0．50mm圆丝,0．43mm＆#215;0．64mm和0．48mm×215;0．64mm方丝）及2种结扎方式（全翼结扎及中间翼结扎）组合,每种组合分别在干燥和唾液环境中进行摩擦力实验,记录托槽与弓丝间滑动时的摩擦力。结果在全翼结扎时,Free-edge方丝弓托槽和直丝弓托槽在唾液环境中的摩擦力显著高于在干燥环境中的摩擦力（P＜0．05）;在中间翼结扎时,Free-edge托槽在2种环境中的摩擦力无显著差别;Free-edge托槽结扎中间翼时的摩擦力显著低于结扎全翼时的摩擦力（P＜0．01）。结论唾液增加了Free-edge托槽在全翼结扎时的摩擦力。     

成人牙周创伤致切牙移位伴牙槽骨吸收的正畸治疗

[目的]探讨正畸治疗成人牙周创伤致切牙移位伴牙槽骨吸收患者的临床疗效.[方法]选择成人牙周创伤致切牙移位伴牙槽骨吸收患者51例,比较正畸矫治前后的牙周袋深度(PPD)、临床牙冠的长度(CCL)、根尖到牙槽骨最低水平线的距离(MBL)、牙根长度(RL)的变化.[结果]PPD、CCL明显减低,MBL明显增加,RL无明显变化...     

A 2-year outcome audit of a versatile orthodontic bone anchor

Abstract

A case report is presented of monozygotic twins with variable expression of hypodontia. DNA fingerprinting was used to confirm monozygosity, and this evidence supports the theory that genetic coding is not the sole controlling factor in tooth agenesis. It is suggested that DNA fingerprinting should be considered the gold standard for determination of monozygosity.     

微型双皮质双偶支抗种植体夺牙齿移动中的支抗作用

目的观察微型双皮质种植体双侧支抗对狗后牙近中移动的影响,评价微型双皮质双侧支抗种植体作为正畸支抗的可行性.方法取成年beagle犬5只,在一侧下颌第二前磨牙两牙根近抗力中心处植入微型双皮质双侧支抗种植体(实验侧),另一侧相对部位植入相同直径的微型单皮质支抗种植体(对照侧).对第四前磨牙施加100 g近远中方向力.实验侧用2根相同的钛镍螺旋弹簧双侧加载,对照侧用1根钛镍螺旋弹簧单侧加载.测量加载前、加载间隔2周时第一磨牙中央尖到第四前磨牙牙尖距离(M1-P4),尖牙牙尖到第一磨牙中央尖的距离(CA-M1),尖牙牙尖到种植体颊侧端距离(CA-IB).加载3个月后,测量种植体骨结合率(BIC).结果单皮质支抗种植体有1颗初期稳定性较差,在1周内松动脱落,5颗双皮质支抗种植体在整个加载过程中保持稳定.双皮质侧第四前磨牙近中位移为(3.92±0.22)mm,单皮质侧为(2.03±0.15)mm,两者比较有显著性差异(P＜0.05).硬组织切片显示种植体骨界面未见炎性细胞,两组种植体骨结合相似.结论微型双皮质双侧支抗种植体能提供稳定的双侧正畸支抗,在前移后牙时能提供双侧加载力点.