终末期肾病患者替代治疗方法的临床决策

血液透析、腹膜透析和肾移植是终末期肾病患者替代治疗的主要方法,三种治疗方法各有优缺点.临床上应根据患者原发病因、替代治疗并发症、卫生经济学、生存质量、所在地医疗条件、非医疗因素等作出科学临床决策,最大限度延长患者生命,提高生存质量.     

糖尿病患者的正念疗法

本文回顾了正念干预在糖尿病领域的应用进展,分析了正念干预的核心内容、作用机制,糖尿病患者正念干预具体实施过程及身心干预效果。分析表明,作为非药物治疗手段主导或辅助药物治疗方式可改善血糖控制、降低糖尿病患者的心血管危险因素、缓解糖尿病伴周围神经病变性疼痛、改善饮食行为,减轻体重、心理健康及情绪调节,以提高慢性疾病患者自我管理能力和生存质量、减少住院日及降低总的医疗费用等方面,是非常有益的尝试,且是一种很有前景的替代治疗方法。     

老龄化社会中ICU的困境面面观

高龄、且长期罹患多种疾病的患者,病情一旦进展到必须接受有创机械通气的阶段,则康复机会极小,生存质量极差,不应划入急性可逆性范畴;而应转入社区医疗,加强现代健康观、死亡观教育,提供多种解决方案,不必一概纳入全方位支持监护系统,更不应常规给予有创机械通气、CRRT、亚低温治疗、肠内及肠外营养作为长期替代治疗。     

老龄化社会中ICU的困境面面观

高龄、且长期罹患多种疾病的患者,病情一旦进展到必须接受有创机械通气的阶段,则康复机会极小,生存质量极差,不应划入急性可逆性范畴;而应转入社区医疗,加强现代健康观、死亡观教育,提供多种解决方案,不必一概纳入全方位支持监护系统,更不应常规给予有创机械通气、CRRT、亚低温治疗、肠内及肠外营养作为长期替代治疗.     

早期前列腺癌治疗的临床决策

早期前列腺癌治疗方法多种多样,临床医生根据患者不同的病理分期、分级及身体条件,做出符合患者个体的临床治疗决策,以期在目前条件下达到最佳治疗效果,降低医疗费用及提高生活质量。     

早期前列腺癌治疗的临床决策

早期前列腺癌治疗方法多种多样,临床医生根据患者不同的病理分期、分级及身体条件,做出符合患者个体的临床治疗决策,以期在目前条件下达到最佳治疗效果,降低医疗费用及提高生活质量.     

鼻咽癌的姑息治疗

鼻咽癌诊断的复杂性及诊断水平的限制,很多的患者确诊时已是中晚期。姑息治疗作为一种新的医疗模式,能减轻鼻咽癌患者的痛苦,提高生存质量。姑息治疗的发展将提高癌症治疗效果,为患者带来希望。     

鼻咽癌的姑息治疗

鼻咽癌诊断的复杂性及诊断水平的限制,很多的患者确诊时已是中晚期.姑息治疗作为一种新的医疗模式,能减轻鼻咽癌患者的痛苦,提高生存质量.姑息治疗的发展将提高癌症治疗效果,为患者带来希望.     

生存质量在晚期肿瘤疗效评价中的思考

传统的肿瘤疗效评价方法多采用治愈率、生存率等指标来衡量。随着传统医学模式向生物一心理一社会医学模式转变,生存质量越来越受到重视。生存质量从一个新的角度评价治疗效果,更重视患者的主观感受,而不是仅将临床客观指标作为评价标准,能更客观地指导治疗方案的选择。     

临床心理干预对白血病患者生存质量影响研究

本研究按随机和匹配的原则,将64名白血病患者分入干预组和对照组。对于干预组进行了为期1 5天的临床心理干预,对照组仅接受相应的医学治疗和护理。以欧洲癌症研究与治疗组织编制的肿瘤患者生存质量量表(EORTCQLQ -C30 )为指标,观察临床心理干预对白血病患者生存质量的影响。结果发现,与对照组相比,干预组患者生存质量显著改善     

Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors

Given the rise in chronic kidney disease (CKD) in both children and adults, CKD has recently been targeted as a public health priority. Childhood onset kidney disease is generally a noncurable and progressive condition that leads to kidney failure by early adulthood. Fortunately, improved identification of kidney problems allows for early intervention, which is thought to slow progression toward end-stage renal disease. In addition, medical interventions for pediatric end-stage renal disease have also improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, CKD causes both direct and indirect insults to a variety of organ systems. This paper reviews recently published studies pertaining to the neurocognitive and psychosocial impact of CKD on children of various ages and at various stages of kidney failure. Specific attention is focused on summarizing peer reviewed research that describes associations between kidney functioning and cognitive functioning, language acquisition, visual spatial abilities, memory, and executive functioning. In addition, peer reviewed research describing psychosocial outcomes associated with CKD related to academic achievement, social-behavioral functioning, and quality of life are summarized. The authors also identified disease-specific factors that likely mediate neurocognitive outcomes (e.g., anemia, hypertension, cardiovascular) and endorse the importance of continued interdisciplinary research collaborations that will provide a better understanding of the mechanisms responsible for improved neurocognitive functioning after transplantation. The authors conclude this review by describing a multicenter, prospective, longitudinal, National Institutes of Health funded study that is currently examining the developmental outcomes of children with mild to moderate CKD. The authors speculate that the Chronic Kidney Disease in Children Prospective Cohort Study (CKiD) findings will provide additional evidence-based guidance for clinicians and researchers working with children and adolescents with deteriorating kidney function to improve medical and developmental outcomes.     

急性肾损伤肾脏替代治疗模式的临床决策

急性肾损伤是指病程3个月内的,包括血、尿、组织学及影像学检查所见的肾脏结构与功能异常。目前,急性肾损伤肾脏替代治疗的模式尚无明确定论。常用的模式有间断性血液透析、持续性肾脏替代治疗、杂合式肾脏替代治疗、腹膜透析。临床上应根据患者的年龄、病因、病情危重程度、所在医院的条件和经济状况等选择合适的治疗模式。     

Mispredicting and misremembering: patients with renal failure overestimate improvements in quality of life after a kidney transplant

OBJECTIVE: People tend to overestimate the impact that future events will have on their quality of life. In the case of a medical treatment like kidney transplant, this should result in biased predictions--overestimates of how much the transplant will benefit quality of life. The authors surveyed kidney transplant patients, both before and after transplant, to test whether they would overestimate the benefits of a successful transplant for their quality of life. DESIGN: The authors interviewed 307 patients on a waiting list for cadaveric renal or renal-pancreatic transplant, and 195 patients one year after a successful transplant. A sub sample of patients were interviewed both before and after transplant. MAIN OUTCOME MEASURES: The survey included measures of quality of life, both in terms of an overall estimate (0-100), and across sub domains, including health, employment, and travel. RESULTS: Cross-sectional results suggested that overall quality of life improved after transplant, but the predictions of pretransplant patients overestimated the magnitude of the improvement (p < .01). In addition, patients predicted large improvements in specific life domains that did not change. These results were confirmed in longitudinal, prospective analyses. Additional analyses showed that posttransplant patients recalled their pretransplant quality of life to be much lower than what they had reported at the time. CONCLUSION: Consistent with an impact bias, patients substantially overestimated the benefits of a successful kidney transplant, both in terms of predictions of life after treatment, and in their memories of QOL before the transplant.     

Religious,Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making

Religion and spirituality have always played a major and intervening role in a person’s life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient’s religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient’s values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients’ varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.     

Cognitive-behavior therapy for depressed cancer patients in a medical care setting

Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.     

慢性肾衰竭患者的人文关怀

慢性肾衰竭是一种长期的消耗性疾病,随着医学的进步,患者的生存时间明显延长,死亡率显著下降,但其并不能完全用以衡量医疗效果,保持良好的生理,心理及社会功能才是治疗的理想目标。这需要医务人员对患者实行有效的人文关怀,积极的心理治疗,提高患者的心理承受力和适应力,在延长患者生命的同时,改善和提高其生存质量。     

关于阴茎移植的伦理问题

随着医学科学的发展,器官移植日趋成熟,不仅使患者延长了生命,更大大提高了生活质量。阴茎移植是器官移植和免疫学发展的结晶,是异体器官移植领域内新的突破,为阴茎缺失的患者带来了新生,对患者心理、家庭和社会有着重大影响。但目前异体阴茎移植刚刚起步,技术尚不成熟,且阴茎是一特殊器官,涉及到的伦理道德问题很多,我们试图从受者、供者、医生和法律等方面讨论阴茎移植所面临的伦理道德问题,希望阴茎移植能真正造福于人类。     

Is there an association between severity of illness and psychiatric symptoms in patients with chronic renal failure?

Chronic renal failure (CRF) is a frequent condition in elderly subjects, and it is associated with psychiatric comorbidity, especially depressive symptoms. Purpose of the present research was to compare patients with different severity of chronic kidney disease (CKD) in terms of psychiatric symptoms. One hundred CKD subjects were randomly selected among those attending the Department of Nephrology, University of Milan. The patients were evaluated through the following rating scales: Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Symptom Checklist (SCL-90), Kidney Disease Quality of Life- Short Form (KDQOL-SF) and Cumulative Illness Rating Scale (CIRS). A multivariable linear regression analysis was performed considering eGFR as continuous-dependent variable and rating scale scores as independent variables. A worse eGFR significantly correlated with the score about the effects of kidney disease on daily life (r = 0.25, p = 0.01) and the burden of kidney disease (r = 0.18, p = 0.05). Statistical significance of kidney disease on daily life persisted also in the final multivariate model (t = 2.04, p = 0.04). Severity of renal dysfunction seems to influence few psychiatric outcomes, particularly those related to quality of life and daily functioning. This result might depend on the over-worrying derived from the necessity to start a renal replacement therapy in the near future.     

Body-image,quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.     

如何成为一名优秀的骨科医生

目前,由于医疗模式的转变,除了对患者本身疾病的治疗外,患者的满意程度和生命质量也成为衡量治愈率高低的一个标准。因此,加强医护人员培养教育,提升医疗服务质量任重而道远。这篇文章探讨了成为一名优秀的临床医护人员所应具备的品质和能力特征。