从大肠癌诊疗看医学整合

过去的几十年里,在全世界范围内关于大肠癌的预防和治疗在不断地综合发展,如今治疗结直肠癌的方式不仅仅局限于外科的手术切除治疗.结直肠癌已经成为了一种需要应用预防、内科、外科和姑息治疗相结合的方式进行治疗的疾病.因此,通过多学科途径进行大肠癌的预防和治疗非常必要.在很大程度上,目前应用的诊治技术正在逐步应用于大肠癌的早期诊断和个体化治疗,这将是医学不可避免的发展趋势.     

腹腔镜在结直肠肿瘤手术中应用的回顾与思考

以腹腔镜为代表的微创外科技术迅速发展并取得了良好的临床效果。腹腔镜手术治疗结直肠癌存在较大争议,全盘否定或盲目应用都会影响腹部外科的发展。腹腔镜结直肠癌切除术都有其适应证并且对医生提出了更高的技术要求。随着腹腔镜技术的不断发展和完善,腹腔镜在结直肠癌手术的应用有广阔的发展空间。     

腹腔镜在结直肠肿瘤手术中应用的回顾与思考

以腹腔镜为代表的微创外科技术迅速发展并取得了良好的临床效果.腹腔镜手术治疗结直肠癌存在较大争议,全盘否定或盲目应用都会影响腹部外科的发展.腹腔镜结直肠癌切除术都有其适应证并且对医生提出了更高的技术要求.随着腹腔镜技术的不断发展和完善,腹腔镜在结直肠癌手术的应用有广阔的发展空间.     

肠癌肝转移综合治疗的现状和展望

结直肠癌肝转移是影响结直肠癌预后的重要因素,目前提倡综合治疗,以手术为核心,辅以化疗、靶向治疗、局部治疗(放疗、介入治疗等).随着新药的研发,新技术的应用,个体化治疗、转化治疗的开展,其预后显著改善.而生物心理社会医学模式同样使患者获益.本文对结直肠癌肝转移的综合治疗进行综述.     

结直肠癌多学科专家组诊疗模式

结直肠癌多学科专家组诊疗模式(colorectal cancer multidisciplinary team,CRC-MDT),最早始于英国,它以病人为中心,多个学科共同参与诊治过程,制定出最适合病情的多模式相结合的科学合理的诊疗方案。此后,结直肠癌多学科专家组诊疗模式逐渐在德国、法国、意大利、美国等医疗中心相对集中的国家得到推广和完善。北京大学人民医院胃肠外科于2002年成立了包括内科、外科,病理科、影像科等8个学科专家组成的胃肠MDT。越来越多的临床实践证实,结直肠癌多学科专家组的诊疗方案,更具有科学性和合理性,明显改善结直肠癌病人预后,增加了患者的临床获益。目前,结直肠癌多学科专家组诊疗模式在世界范围内已经成为现代医院医疗体系的重要组成部分。结直肠癌MDT模式不只是对患者进行多学科会诊,而是对整个医疗过程全程指导,促进学科间的交流,增进学科间了解。在欧美CRC-MDT发展完善的地区,人们的目光不仅关注MDT在结直肠癌诊治中的应用,而且注意到了MDT作为一套宏观的医疗管理模式,在结直肠癌诊治流程运作中的社会效益、经济学价值的推动作用。     

结直肠癌多学科专家组诊疗模式

结直肠癌多学科专家组诊疗模式(colorectal cancer multidisciplinary team,CRC-MDT),最早始于英国,它以病人为中心,多个学科共同参与诊治过程,制定出最适合病情的多模式相结合的科学合理的诊疗方案.此后,结直肠癌多学科专家组诊疗模式逐渐在德国、法国、意大利、美国等医疗中心相对集中的国家得到推广和完善.北京大学人民医院胃肠外科于2D02年成立了包括内科、外科,病理科、影像科等8个学科专家组成的胃肠MDT.越来越多的临床实践证实,结直肠癌多学科专家组的诊疗方案,更具有科学性和合理性,明显改善结直肠癌病人预后,增加了患者的临床获益.目前,结直肠癌多学科专家组诊疗模式在世界范围内已经成为现代医院医疗体系的重要组成部分.结直肠癌MDT模式不只是对患者进行多学科会诊,而是对整个医疗过程全程指导,促进学科间的交流,增进学科间了解.在欧美CRC-MDT发展完善的地区,人们的目光不仅关注MDT在结直肠癌诊治中的应用,而且注意到了MDT作为一套宏观的医疗管理模式,在结直肠癌诊治流程运作中的社会效益、经济学价值的推动作用.     

结直肠癌相关肿瘤标志物的最新研究进展

结直肠癌是最常见的恶性肿瘤之一。其起病隐匿、病死率较高,治疗成功的关键在于早期发现、早期诊断,结直肠癌相关肿瘤标志物曾为此做出了贡献。近年又发现了许多新的结直肠癌相关肿瘤标志物,其中有的已进入临床应用,还将有更多标志物为结直肠癌的早期诊断、疗效观察、预后判断和复发监测提供新思路和新方法。     

结直肠癌相关肿瘤标志物的最新研究进展

结直肠癌是最常见的恶性肿瘤之一.其起病隐匿、病死率较高,治疗成功的关键在于早期发现、早期诊断,结直肠癌相关肿瘤标志物曾为此做出了贡献.近年又发现了许多新的结直肠癌相关肿瘤标志物,其中有的已进入临床应用,还将有更多标志物为结直肠癌的早期诊断、疗效观察、预后判断和复发监测提供新思路和新方法.     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群。为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗。以往,手术治疗和化疗的应用随着年龄的增高而明显减少。我们一直以为老年人手术和化疗的效果不令人满意。近期的研究改变了这一认识。证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的。即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益。所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效。腹腔镜下结肠癌根治术是对老年人安全有效的手术技术。我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益。     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群.为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗.以往,手术治疗和化疗的应用随着年龄的增高而明显减少.我们一直以为老年人手术和化疗的效果不令人满意.近期的研究改变了这一认识.证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的.即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益.所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效.腹腔镜下结肠癌根治术是对老年人安全有效的手术技术.我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益.     

Personal growth initiative: Relation to Hedonia and Eudaimonia happiness among South African university students

This study examined the relationship between personal growth initiative (PGI) and hedonic and eudaimonic happiness among a sample of South African university students (N = 235; mean age = 20.38, SD = 1.55; female = 61.70%). Students completed measures on personal growth initiative, hedonic happiness, and eudaimonic happiness. Regression analysis indicated personal growth initiative to positively predict students’ reported scores on hedonic and eudaimonic measures. The findings underscore the importance of PGI among student populations in advancing well-being among university students. It is proposed that higher education student development and support services should tap into PGI as a resource for enhancing student self-directed change and happiness.     

A review of Evidence‐Based Evaluation of Measures for Assessing Social and Emotional Well‐Being in Indigenous Australians

Addressing low levels of social and emotional well‐being (SEWB) in Indigenous communities has been a national strategic priority for over 10 years and yet progress in assessing the impact of interventions has been slow. One of the key factors limiting the development of evidence‐based practice has been the lack of well‐validated instruments to assess SEWB and how it changes over time as a result of intervention. This article systematically reviews available measures, classifying them in terms of the evidence base that exists to support their use. It is concluded that there is an ongoing need to develop psychometrically sound, comprehensive, culturally appropriate measures to operationalise Indigenous SEWB at a population health, programme evaluation, and clinical level. It is suggested that seven pathways be followed to achieve this goal, including the need to recognise that the gold standard status for Indigenous measurement tools cannot be ascribed based on evidence‐based assessment criteria alone.     

对脊柱结核诊疗策略的思考

脊柱结核是临床常见病,其诊疗策略主要包括正确的诊断思路、合适的治疗选择。尤其重视非典型性脊柱结核的诊断,治疗方面要重视药物治疗、营养支持、休息制动等手段。对于需要手术治疗的患者,需个体化选择最适合的术式,且应完整理解并客观评估新技术的应用。     

Visual, kinaesthetic and cross-modal development: relationships to motor skill development

The ability of children between the ages of 5 and 10 years to match the length of lines within and between the modalities of vision and kinaesthesis was studied. No evidence was found for specific increases in cross-modal skill which could not be explained in terms of within-modal development. Performance in the perceptual task was related to measures of developing motor skill in the children. Substantial relationships were found between performance on the within-modal tasks and motor skill, but no significant relationships were found between cross-modal measures and motor skill development. It is concluded that the development of cross-modal integration is not a major determinant of motor skill development.     

我国社区卫生服务发展的障碍与对策研究

自1996年试点至今,我国社区卫生服务在政策支持、覆盖面、社区卫生服务站(点)的数量、人员的素质和群众的意识等都取得了令人瞩目的成绩.但是,我国的社区卫生服务尚处于初级阶段,在发展过程中还存在很多的问题,亟待采取有力的措施,克服存在的障碍,进一步完善我国的社区卫生服务体系.     

单纯性肾囊肿外科手术适应证的选择

单纯性肾囊肿是临床常见的肾脏疾病之一,临床常采用去顶减压术治疗,但外科治疗的适应证目前尚不统一。除症状性肾囊肿及由囊肿引起尿路梗阻外,对于高血压病合并肾囊肿者,如囊肿直径大于5cm,考虑囊肿有可能对高血压产生影响,因此,有必要采取外科治疗措施;但如果不合并高血压,是否一定需要治疗有待进一步探讨。肾囊肿对肾功能影响目前尚无定论,对于小于60岁的肾囊肿患者其肾功能下降可能与肾脏原发病变有关,应积极查找病因并密切随访。对于肾囊肿Bosniak分型为Ⅰ、Ⅱ、ⅡF型的患者,可以不需要手术治疗,密切随访;对于Ⅲ、Ⅳ型患者,应进行外科手术治疗。     

Military Enlistment Selection and Classification: Moving Forward

This article places the articles included in this special issue within the larger context of the objectives of a selection and classification system. It examines the full range of individual differences and how, until relatively recently, a focus on training success has led to an emphasis on the cognitive subset of these differences within the military. It describes how, consistent with a greater recognition of the importance of job performance, the research described in this issue has opened the door to expanded coverage of both cognitive and noncognitive attributes. It summarizes the methodological advances that have contributed to the efficacy of new noncognitive measures. It explores how popular approaches to the measurement of classification efficiency have led to unwarranted pessimism regarding the classification potential of multiattribute measures and discusses research indicating how much greater classification efficiency is possible with existing measures. Finally, it examines potentially fruitful areas of future research to better meet military objectives. These include development of an approach to performance measurement and validity transportation that makes future military classification research feasible; exploration of currently untapped individual-difference domains, particularly those that might differentially predict across job groupings; exploration of the interaction between cognitive and noncognitive attributes; and exploration of alternative measurement techniques.     

A Measure of the Stability of Activities in a Family Environment

The Stability of Activities in the Family Environment (SAFE) measure was developed to assess aspects of the construct of family stability. An earlier version of the SAFE was revised to improve its psychometric properties and better elaborate the construct that underlies the measure. College students completed the revised SAFE and other measures of family functioning with respect to their families of origin and measures of current adjustment. Findings support the reliability, internal consistency, and factor structure of the SAFE. It is suggested that the results of the factor analyses and findings that different aspects of family stability demonstrated different patterns of relationships to indices of family functioning, are consistent with the presumption guiding the development of the SAFE that families achieve stability in diverse ways. The validity of the SAFE was further supported by its relationship to measures of current self-esteem and depression.     

Novelty responding and behavioral development in young,developmentally delayed children

This study examined whether or not a measure of information processing ability based on the discrimination of novel and familiar stimuli was related to behavioral development among developmentally-delayed infants. Two samples of handicapped infants were administered multiple measures of visual novelty discrimination and a battery of assessments which were representative of available measures of development in infancy. The results indicated that, as a group, the developmentally delayed infants were capable of discriminating novel and familiar stimuli. Also, correlational analyses indicated that responding to novelty was related to developmental accessment performance in both samples. This finding is consistent with previous data which indicates that novelty response measures are associated with important individual differences in young children.     

Socio-economic status,executive functions,and theory of mind ability in adolescents: Relationships with language ability and cortisol

Socio-economic status (SES) is linked to the development of cognitive abilities, particularly language and executive processes. It is unclear whether these represent a single or independent correlates. We studied 110 Ecuadorian youths aged 12–17 with measures of SES, language, executive function, and theory of mind (ToM), a.k.a. mentalizing. A subsample gave hair samples to estimate recent cortisol levels. Restricting analyses to reliable measures, SES was highly associated with language skill, and to a lesser extent with executive function and ToM performance. However, those latter associations were attenuated and non-significant when language ability was controlled for statistically. Systemic cortisol levels were not associated with SES, but were significantly and negatively correlated with ToM, independent of variation in language skills. We conclude that language development underlies most of the impact of SES on executive function and ToM ability of adolescents, but that stress-related cortisol may have an independent, direct effect on mentalizing.