Community Treatment of Child Sexual Abuse: A Survey of Practitioners in the National Child Traumatic Stress Network

Practitioners from numerous agencies who sought training in Trauma-Focused Cognitive-Behavioral Therapy in several regional sites under the auspices of the National Child Traumatic Stress Network completed a baseline survey to describe their backgrounds, settings, practices, attitudes, and perceived outcomes with sexually abused children and youth. The results documented a range of experiences and common treatment practices, and identified contributors to practitioners’ use of gradual exposure and perceived levels of positive treatment outcome. The results were not accounted for by geographic region or agency. The findings support recommendations to optimize research and training related to the dissemination of evidence-based treatments in the child abuse field. Portions of these data were presented at the Annual Meeting of the American Psychological Association, July, 2004, Honolulu, Hawaii.     

Child Welfare Recommendations to Improve Mental Health Services for Children who have Experienced Abuse and Neglect: A National Perspective

This study uses a key informant approach to understand the nature, extent, and quality of outpatient mental health services for children in the child welfare system (CWS) in the United States. We interviewed 89 county child welfare administrators to determine the status of outpatient mental health services and provide recommendations for enhancing care and service delivery. Developed for this study (Caring for Children in Child Welfare), the interview was incorporated in the second formal data collection wave (i.e., 18 months after study baseline assessment) of the National Survey of Child and Adolescent Well-Being. The results highlighted general variability in the degree to which these agencies used evidence-based interventions within outpatient services, demonstrated clinical expertise with this population, and met the needs of their families. Community agency use of evidence-based interventions was found to predict their effectiveness in improving clients’ mental health problems. Proposed suggestions for service improvement varied across domains and reflected the need for more communication/coordination, service access, options and resources, and practice refinements to accommodate families’ needs. We discuss the implications of these recommendations from CWS stakeholders for enhancing the service delivery system. We appreciate the assistance and consultation of Jennifer Rolls-Reutz, Barbara J. Burns, Barbara L. Baumann, Michael Hurlburt, and John Landsverk.     

Clinical oncology for pancreatic and biliary cancers: Advances and current limitations

In the early 2000s, the main stream of endoscopic ultrasonography (EUS) changed from a mechanical scanning method to electronic radial or linear scanning methods. Subsequently, useful applications in trans-abdominal ultrasonography came within reach of EUS. In particular, contrast-enhanced EUS (CE-EUS) and EUS-elastography became cutting-edge diagnostic modalities for pancreatic disorders. Each type of pancreatic disorder has characteristic hemodynamics. CE-EUS uses color Doppler flow imaging and harmonic imaging to classify pancreatic lesions. EUS-elastography can assess tissue hardness by measuring its elasticity. This parameter appears to correlate with the malignant potential of the lesions. Tissue elasticity studies can provide information on both its pattern and distribution. The former is the conventional method of morphological diagnosis, but it is restricted to observations made in a region of interest (ROI). The latter is an unbiased analysis that can be performed by image analysis software and is theoretically constant, regardless of the ROI. Though EUS-fine needle aspiration (FNA) is also a very useful diagnostic tool, there are several limitations. Diagnostic EUS-FNA of pancreatic cystic lesions has marginal utility mainly due to low sensitivity. Therefore, in particular, endoscopists should keep this limitation in mind.     

Knowledge integration: conceptualizing communications in cancer control systems

OBJECTIVE: This paper was prepared by the National Cancer Institute of Canada (NCIC) Working Group on Translational Research and Knowledge Transfer. The goal was to nurture common ground upon which to build a platform for translating what we know about cancer into what we do in practice and policy. METHODS: Methods included expert panels, literature review, and concept mapping, to develop a framework that built on earlier cancer control conceptualizations of communications that have guided researchers and end users. RESULTS: The concept of 'knowledge integration' is used to describe the resulting refinement and the nature of evidence necessary for decision-making to at the systems level. Current evidence for knowledge integration in cancer control is presented across the levels of individual, organizational and systems level interventions and across basic, clinical and population science knowledge bases. CONCLUSION: A systems-oriented approach to integrating evidence into action assists organizations to conduct research and policy and practice. PRACTICE IMPLICATIONS: Practitioners can use this framework to understand the challenges of implementing and evaluating cancer control strategies.     

Expression and role of cadherins in astrocytic tumors

Cadherins are Ca²⁺-dependent cell adhesion molecules that play an important role in tissue formation and morphogenesis in multicellular organisms. In recent years, there have been reports of cadherin involvement in tumor invasion and metastasis. Twenty-two surgical specimens and some cultured cells were studied by immunohistochemical staining. No significant difference was observed in the patients with anaplastic astrocytoma, whereas decreased expression of N-cadherin was detected at the time of recurrence in those with glioblastoma. In these groups, cerebrospinal fluid dissemination was found, and contralateral cerebral metastases and extracranial metastases were observed. We conclude that decreased N-cadherin expression at the immunohistochemically demonstrated time of recurrence correlates with tumor invasion and dissemination of cerebrospinal fluid.     

Expression of cadherin and CSF dissemination in malignant astrocytic tumors

Cadherins are Ca²⁺-dependent cell adhesion molecules that play an important role in tissue construction and morphogenesis in multicellular organisms. Because in recent years there have been reports of cadherin involvement in tumor metastasis, we conducted an immunostain for E-cadherin and N-cadherin monoclonal antibodies in paraffin-embedded surgical specimens of primary and recurrent lesions in 13 cases of glioblastoma and nine cases of anaplastic astrocytoma. No expression of E-cadherin was detected in the tumor cells. On the other hand, expression of N-cadherin was observed in malignant astrocytic tumor cells, but the N-cadherin positive rate tended to be less at the time of recurrence. Decreased expression of N-cadherin was detected at the time of recurrence in 11 of the 13 cases in the glioblastoma group. Cerebrospinal fluid (CSF ) dissemination and extracranial metastasis were observed in nine (81.8%) of these 11 patients. Therefore, we tried to analyze the clinical backgrounds and the N-cadherin positive rates by statistics. We concluded that decreased expression of N-cadherin at the time of recurrence correlates with dissemination in malignant astrocytic tumors. Received: 16 December 1998 / Accepted: 15 April 1999     

脑胶质瘤切除术后脑脊髓内播散转移:3例报道及国内文献复习

背景与目的:随着神经外科诊断和治疗技术的提高,原发灶局部的脑胶质瘤在一定程度上得以很好的控制,这样临床上发现脑胶质瘤术后脑、脊髓内播散转移的病例就多了起来,但针对这方面的临床研究目前还很少。本文通过分析脑胶质瘤切除术后发生脑、脊髓内播散病例的特性及其规律性,探讨其综合的治疗方法。方法:回顾性分析我院的3例以及国内各家医院报道的16例脑胶质瘤患者,19例患者均行实体肿瘤切除术。18例患者术后常规行外放射治疗,其中5例同时行化学治疗,2例行!-刀治疗。19例患者经上述综合治疗后发生了脑脊髓播散、转移。结果:原发脑胶质瘤部位:大脑半球9例(47.4%),小脑6例(31.6%),脑室系统4例(21.0%)。病理类型:星形细胞瘤12例(63.2%),髓母细胞瘤4例(21.0%),室管膜瘤2例(10.5%),胶质母细胞瘤1例(5.3%)。术后播散时间12天至5年,平均20.0个月。播散部位:脊髓12例(63.2%),对侧大脑半球4例(21.0%),脑干与间脑2例(10.5%),第三、四脑室2例(10.5%),胼胝体2例(10.5%)。12例再次行手术全部或大部切除病变,术后患者2年生存率是33%(4/12),6例采取非手...     

临床检验医学中的量值溯源

量值溯源可以提高检测结果的准确性,提高不同实验室检测结果的可比性,是衡量检验质量的重要手段.检验结果的溯源性将成为临床实验室的工作和检验试剂生产的重要质量指标.本文就以下几个方面进行分析讨论：①溯源性的概念和结构;②临床检验参考系统的现状;③检验工作中参考系统的建立;④量值传递过程的常见问题.     

探索以社区为基础的艾滋病防治关爱模式

[目的]探索以社区为基础的艾滋病防治关爱模式,减少社区居民、家庭对吸毒者和HIV感染者的歧视。[方法]建立目标人群(静脉吸毒者)档案、入户随访和例会制度;组织社区居民、目标人群及其家属开展丰富多彩的宣教、联谊活动;对吸毒者和HIV感染者实施情感交流、生活照顾、转介就业等。[结果]通过项目干预,吸毒人群建档率达70%以上,111个吸毒者和HIV感染者获得了生活救助;转介目标人群就业人数达75人;社区居民对艾滋病知识的知晓率达80%以上;新婚登记人员中接受艾滋病自愿咨询率和婚检时进行HIV检测率分别达67%和36%。[结论]利用社区资源,在社区内大力宣传艾滋病防治知识,对目标人群实施关怀和救助,营造社会对HIV/AIDS的支持性环境,是防治艾滋病的有效措施之一。     

医学生物理素质培养与评价的探讨

基础物理教学是培养人才科学素质的重要环节。要想提高教学质量，必须改进传统教学模式，改革评价方法。本文提出“渗透式”教学方法，并且利用属性识别理论对学生的物理学习进行综合评价。