老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性。老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗。目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观。本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生。     

老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性.老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗.目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观.本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生.     

晚期癌症患者灵性健康的影响因素

梳理了灵性和灵性健康的相关概念,总结了灵性健康对晚期癌症患者生命质量、负性情绪、健康状况等方面的重要意义,分析了晚期癌症患者灵性健康的主要影响因素为患者年龄、性别等一般人口学特征,晚期癌症患者的宗教/文化信仰、焦虑和抑郁等负性情绪、癌性疲乏、癌性疼痛、生活态度以及晚期癌症患者照顾者的灵性水平等。指导医务人员在护理晚期癌症患者时如何有效提高患者的灵性健康,并为晚期癌症患者整体护理质量提供有效依据。     

癌症疼痛治疗中麻醉药品的应用现状及对策

麻醉药品在癌症疼痛治疗中发挥着日益重要的作用,包括我国在内的大多数发展中国家在应用麻醉药品控制癌症疼痛方面存在很多不足,与西方发达国家相比有一定差距。为早日实现“让中国癌症患者不痛”的目标,广大医务工作者应积极更新观念,掌握癌症疼痛的治疗原则与方法;积极倡导改善癌痛治疗不足的现状。同时加大宣传力度,取得患者家属和相关部门的理解、支持,努力保障癌痛病人获得止痛治疗的权利。     

癌症疼痛治疗中麻醉药品的应用现状及对策

麻醉药品在癌症疼痛治疗中发挥着日益重要的作用,包括我国在内的大多数发展中国家在应用麻醉药品控制癌症疼痛方面存在很多不足,与西方发达国家相比有一定差距.为早日实现"让中国癌症患者不痛"的目标,广大医务工作者应积极更新观念,掌握癌症疼痛的治疗原则与方法;积极倡导改善癌痛治疗不足的现状.同时加大宣传力度,取得患者家属和相关部门的理解、支持,努力保障癌痛病人获得止痛治疗的权利.     

癌痛规范化治疗的制约因素分析

癌痛严重影响中晚期癌症患者生活质量,通过使用第三阶梯强阿片类止痛药物,绝大部分患者疼痛能得到很好的控制。微观上,癌痛治疗的疗效与患者及医务人员的认识程度密切相关,也与医院麻醉科等其他科室的参与程度有关。宏观上,社会人文、经济、政策管理等方面的不足都制约着癌痛规范化治疗的有效实施。癌痛的规范化治疗是一项管理措施,需要进行疼痛评估、家庭支持及宗教组织的参与帮助等。我们国家在文化、经济、教育等各个方面取得长足进步时,癌痛治疗会更加规范、合理、人性化。     

癌痛的治疗和人文关怀

大多数癌症病人会受到不同程度的癌痛困扰.癌痛治疗已成为癌症姑息治疗的一项重要内容,癌痛的科学评估与规范治疗对于改善病人的生存质量具有重要意义,同时在治疗过程中应当突出"人本思想",体现"人文关怀",尊重生命,关爱健康,减轻痛苦,尊重患者的权利和隐私,体现人道主义精神.     

癌痛的治疗和人文关怀

大多数癌症病人会受到不同程度的癌痛困扰。癌痛治疗已成为癌症姑息治疗的一项重要内容,癌痛的科学评估与规范治疗对于改善病人的生存质量具有重要意义,同时在治疗过程中应当突出“人本思想”,体现“人文关怀”,尊重生命,关爱健康,减轻痛苦,尊重患者的权利和隐私,体现人道主义精神。     

晚期癌症患者生存质量评估体系建立及放弃治疗与安乐死的合法化

癌症的病因涉及一系列不同的基因和引起突变的各种遗传和环境因素.其发病的内在因素是细胞内的病毒感染或由于原癌基因突变产生的活跃癌基因.环境致癌论已普遍被人关注.癌症村是环境因素所致的一种群体疾病现象.晚期癌症患者的生存质量令人堪忧.切合晚期癌症患者生命意义治疗的研究越来越显示出其价值.医生有权对癌症晚期患者进行生存质量评估后做出放弃治疗的医嘱.建立一套完善的生存质量评估体系是临床决策放弃治疗和合法化安乐死的前提.正确而适当的临床放弃治疗和合法化安乐死是人性化选择的需要.     

团队合作对4838例居家癌痛患者疼痛管理的效果与思考

通过对大连医科大学附属第一医院宁养院2001年3月～2013年11月收治的4838例癌痛患者进行调查,总结归纳居家癌痛患者的疼痛控制情况,探索癌痛患者的疼痛管理方法,结果提示依靠团队合作在居家条件下免费向癌痛患者及其家属提供身体、心理、社会和精神全方位的照顾和支持,即理想的疼痛管理是“整体性疼痛”与“整体性痛苦”的治疗,不仅针对临床疼痛症状,还必须处理相关因素。     

癌痛治疗指南解析

对多国成人癌痛指南进行检索、回顾,发现近年癌痛治疗领域新进展和各国普遍遵循的共同原则,为临床医生改进癌痛治疗提供参考。采用现有的互联网临床实践指南检索平台,对成人癌痛指南进行检索,分析各国指南的异同之处,重点对疼痛评估、WHO三阶梯药物治疗及辅助治疗进行比较、归纳。全面的癌痛评估是指痛治疗的必要前提,也是众多癌痛指南强调的重点;按疼痛程度选择三阶梯镇痛药物仍是药物止痛的基本原则;口服途径是止痛治疗的首选给药途径;第一阶梯药物中阿司匹林的应用逐渐淡化,NSAIDs的毒性反应受到关注;第二阶梯药物的选择更灵活。应根据疼痛性质、患者的具体情况合理选择复合制荆。吗啡仍是强阿片类药物中的首选,可用于中、重度疼痛的治疗。因此,我国成人癌痛治疗需要改进,应重点推广全面的疼痛评估,提倡根据患者的具体情况合理、灵活的选择三阶梯药物,个体化治疗是止痛治疗的关键。     

伊斯兰教临终关怀与癌性疼痛心理治疗的探讨

如何利用伊斯兰教的信仰关怀、情感关怀和死亡关怀“三关怀”,提高癌症患者临终关怀质量和癌性疼痛心理治疗效果,作者根据在宁夏回族地区癌症患者中开展临终关怀的五年实践体会,从临终关怀的宗旨和目的出发,探讨了伊斯兰教的临终关怀之信仰关怀、情感关怀和死亡关怀三种形式和内容,解释了癌性疼痛的原因、疼痛的主观和客观影响因素及心理治疗的常用方法和原则,总结了在宁夏回族地区开展临终关怀应用伊斯兰教的信仰关怀、情感关怀和死亡关怀”三关怀”与癌性疼痛心理治疗之间的关系。     

The development and analysis of tutorial dialogues in AutoTutor Lite

The goal of intelligent tutoring systems (ITS) that interact in natural language is to emulate the benefits that a well-trained human tutor provides to students, by interpreting student answers and appropriately responding in order to encourage elaboration. BRCA Gist is an ITS developed using AutoTutor Lite, a Web-based version of AutoTutor. Fuzzy-trace theory theoretically motivated the development of BRCA Gist, which engages people in tutorial dialogues to teach them about genetic breast cancer risk. We describe an empirical method to create tutorial dialogues and fine-tune the calibration of BRCA Gist’s semantic processing engine without a team of computer scientists. We created five interactive dialogues centered on pedagogic questions such as “What should someone do if she receives a positive result for genetic risk of breast cancer?” This method involved an iterative refinement process of repeated testing with different texts and successively making adjustments to the tutor’s expectations and settings in order to improve performance. The goal of this method was to enable BRCA Gist to interpret and respond to answers in a manner that best facilitated learning. We developed a method to analyze the efficacy of the tutor’s dialogues. We found that BRCA Gist’s assessment of participants’ answers was highly correlated with the quality of the answers found by trained human judges using a reliable rubric. The dialogue quality between users and BRCA Gist predicted performance on a breast cancer risk knowledge test completed after exposure to the tutor. The appropriateness of BRCA Gist’s feedback also predicted the quality of answers and breast cancer risk knowledge test scores.     

Better No Longer to Be

Abstract

David Benatar argues that coming into existence is always a harm, and that – for all of us unfortunate enough to have come into existence – it would be better had we never come to be. We contend that if one accepts Benatar’s arguments for the asymmetry between the presence and absence of pleasure and pain, and the poor quality of life,² one must also accept that suicide is preferable to continued existence, and that his view therefore implies both anti-natalism and pro-mortalism³. This conclusion has been argued for before by Elizabeth Harman – she takes it that because Benatar claims that our lives are ‘awful’, it follows that ‘we would be better off to kill ourselves’ (Harman 2009: 784). Though we agree with Harman’s conclusion, we think that her argument is too quick, and that Benatar’s arguments for non-pro-mortalism⁴ deserve more serious consideration than she gives them. We make our case using a tripartite structure. We start by examining the prima facie case for the claim that pro-mortalism follows from Benatar’s position, presenting his response to the contrary, and furthering the dialectic by showing that Benatar’s position is not just that coming into existence is a harm, but that existence itself is a harm. We then look to Benatar’s treatment of the Epicurean line, which is important for him as it undermines his anti-death argument for non-pro-mortalism. We demonstrate that he fails to address the concern that the Epicurean line raises, and that he cannot therefore use the harm of death as an argument for non-pro-mortalism. Finally, we turn to Benatar’s pro-life argument for non-pro-mortalism, built upon his notion of interests, and argue that while the interest in continued existence may indeed have moral relevance, it is almost always irrational. Given that neither Benatar’s anti-death nor pro-life arguments for non-pro-mortalism work, we conclude that pro-mortalism follows from his anti-natalism, As such, if it is better never to have been, then it is better no longer to be.     

How Best to Prevent Future Persons From Suffering: A Reply to Benatar

Abstract

David Benatar claims that everyone was seriously harmed by coming into existence. To spare future persons from this suffering, we should cease having children, Benatar argues, with the result that humanity would gradually go extinct. Benatar’s claim of universal serious harm is baseless. Each year, an estimated 94% of children born throughout the world do not have a serious birth defect. Furthermore, studies show that most people do not experience chronic pain. Although nearly everyone experiences acute pain and discomforts, such as thirst, these experiences have instrumental value. For example, when a person picks up a hot object, in response to the pain, the person releases the object, thereby preventing serious harm. The standard that Benatar uses to evaluate the quality of our lives is arbitrary, as I will demonstrate. His proposal that we phase humanity out of existence by ceasing to have children is misguided and an overreaction to the problem of human suffering. The ‘threshold conception of harm’, which is a targeted approach for preventing future persons from suffering, is a more sensible approach.     

EORTC QLQ—C30及其在胸部肿瘤患者生命质量研究中的应用

生命质量研究是近年来肿瘤研究的热点之一,其主要作用评价治疗效果,选择治疗方案;应用于抗肿瘤新药筛选;用于预测患者预后和远期生存状态。EORTC QLQ-C30及其子量表在世界范围内被应用于胸部肿瘤治疗和研究当中并取得了较好效果,为评价食管癌和肺癌的各种治疗方法提供了一个较好的参考标准,同时对提高食管癌和肺癌的治疗水平和改善病人生命质量起到了一定的推动作用。     

Two sorts of natural theology

Usually, natural theology is understood as the project of providing arguments for the existence of God. This project is endorsed by Moreland and Craig. McGrath, on the other hand, says that this project fails. In the first part of this article, I show how McGrath’s dismissal of arguments for the existence of God follows from his view of natural theology. In the second part, I argue that McGrath’s natural theology contains an accurate critique of Moreland and Craig’s way of doing natural theology, a critique that exposes two major problems in their treatment of the moral argument for the existence of God. In the third part, I propose a way of providing arguments for the existence of God that avoids the problems pointed out by McGrath, namely a way of arguing that seeks to show how theology may improve a certain non-theistic understanding of a natural phenomenon.     

A Both-And Approach: An Application of Narrative Interventions from a Modern Perspective

A contentious debate between the modern and postmodern epistemologies continue to wage on since the rise of constructivism and social constructionism in the 1990s. This debate has led to both modern and postmodernists falling into an either/or mindset. Others have proposed a solution, the both-and approach, that emphasizes integration of different therapeutic camps. Intentionality is a core component of this approach, as therapists must understand how employed interventions flow from the epistemology and theoretical orientation under which they operate. Another core component of this approach is tailoring the integration to the specific context of the client case. With this understanding and tailoring, therapists can utilize methods across the modern/postmodern divide, as they will coherently flow from their original epistemology and theoretical orientation. Applying methods from both modernism and postmodernism, then, enhances therapists’ therapeutic repertoire, allowing for more opportunities to adapt treatment to each client case. Altogether, the quality of services improve and the amount of clients therapists can help increases as well. This paper will provide an application of the both-and approach to a case study to provide an example of how the said method can be employed in therapy.

     

The role of spousal relationships in fibromyalgia patients’ quality of life

Fibromyalgia (FM) is a chronic pain syndrome that includes debilitating symptoms such as widespread pain and tenderness, fatigue, and poor physical functioning. Research has shown FM patients’ choice of coping style and relationship quality with their spouse can impact their mental quality of life (QoL), but no known study has examined the protective nature of relationship quality and coping behaviors on both patient physical and mental QoL in the context of chronic pain. We examined 204 patients with FM on the (a) roles of coping styles and relationship quality on patient quality of life, and (b) moderating effect of relationship quality on the association between negative coping style and patient QoL. A series of multiple regressions found patients’ coping styles were not significantly associated with physical QoL, but were significantly associated with mental QoL. Patients’ relationship quality with their spouse was significantly associated with mental QoL, but not physical QoL and no significant interactions with negative coping style were found. Our results emphasize the importance of coping styles and relationship quality between patients and their spouses in the context of chronic pain. Clinicians can incorporate the patient’s relationship as part of a more holistic approach to care and improving outcomes.