肿瘤综合治疗中的系统观

进入 2 0世纪之后 ,医学渐渐进入理性阶段。随着对肿瘤本质认识的不断深入 ,更由于肿瘤局部治疗方法的停滞不前 ,恶性肿瘤逐渐地被看成为一种全身性疾病。由此而来 ,肿瘤治疗观念便发生了明显的转向 ,肿瘤综合治疗观应运而生。纵观恶性肿瘤治疗方法的历史发展与衍变 ,不难看出 ,肿瘤外科学、肿瘤放射治疗学、肿瘤化学治疗学构成了现代肿瘤治疗学的三大支柱。三种手段互有特点 ,互为补充。从治疗效应看 ,外科手术和放射治疗都为局部治疗的方法。因此 ,肿瘤外科学家和放射肿瘤学家对肿瘤概念结构认识极为相似 ,两者都认为恶性肿瘤发生在局部 ,…     

当前恶性肿瘤治疗存在的问题与失误

恶性肿瘤的临床治疗发展迅速,在取得巨大成绩的同时,也存在着一些失误：其一是广泛存在的过度治疗,由于相当一相分肿瘤患者并不能得益于临床治疗,但几乎所有虱都不倒外地去接治疗,其结果必是这种部分患者受治疗之基。其二是肿瘤治疗目的的不明确,提高肿瘤患者的生存质量并延长生存其工没落到实处,治疗没有长远规划;其三是只注重治疗这一外因,忽视肿瘤因有生物学特性这一内因及肿瘤治疗中的免疫机制;预防是最好的治疗,而目     

恶性肿瘤的过度治疗及其防范

恶性肿瘤的过度治疗涉及到手术、放疗、化疗、靶向治疗、生物治疗等多个方面,严重影响了患者的生存质量。造成这一现象的原因是多方面的：患者由于对肿瘤的恐惧而形成过分关注;医生未及时更新治疗观念,过于注重对肿瘤的彻底杀伤,并对自己行医的过分保护;医院的不恰当管理。为了促进肿瘤治疗环境的合理化,我们应该防范过度治疗,加强宣传教育,完善医德医风,促进医疗改革的顺利完成。倡导合理、受益性治疗,使患者达到长期带瘤生存的目的。     

宽恕治疗中的几个误区及其应用展望

宽恕被界定为被冒犯者的亲社会动机的转变过程, 它有助于被冒犯者消除愤怒情绪, 提升积极的情感体验。宽恕治疗是针对被冒犯者, 并试图帮助他们放弃报复和回避等消极应对方式, 以积极的方式来处理因冒犯而造成的伤害的一种心理治疗方法。然而, 在临床应用中, 对宽恕治疗还存在一些误区, 这些误区主要表现为以下三点：(1)宽恕冒犯者就是和冒犯者和解; (2)宽恕治疗会导致道德化和宗教化的倾向; (3)宽恕只是治疗的工具, 不是治疗的目标。在对这些误区加以澄清的基础上, 提出宽恕治疗在理论、研究和实践方面的应用与展望。     

肿瘤姑息治疗的全程介入

恶性肿瘤严重威胁人类健康,肿瘤本身以及针对肿瘤的治疗不仅会对患者的生理和心理产生重要影响,同时也会对照顾患者的家人产生各种心理影响。现有医疗条件下短时间内难以提高治愈率,就应更加注重将姑息治疗贯穿于肿瘤治疗的始终,不仅要及早介入,甚至延伸至居丧期。在肿瘤治疗过程中不断对肿瘤患者进行评估和适时调整姑息治疗策略,可有效地提高患者生活质量同时降低医疗成本,最终患者能够在不同阶段和各种治疗手段中获得最大受益。     

从系统论看肿瘤的生物靶向性治疗

肿瘤的生物靶向性治疗是恶性肿瘤治疗的新方法,其试图通过在基因水平上调节与肿瘤发生、发展有密切联系的生命物质来达到治愈肿瘤的目的。但临床运用中,生物靶向性治疗的疗效与我们的想象相去甚远。本文运用系统论的观点,分析目前生物靶向性治疗中存在的问题及寻求可能解决的方法。     

解读《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》

肿瘤专业工作者不仅要关注患者的抗癌治疗,同时也要关注他们的康复与姑息治疗,骨转移是肿瘤患者的常见转移病灶。《恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识》（2007年版）适时地对恶性肿瘤骨转移及骨相关疾病提出了指导性意见,体现了肿瘤的综合治疗原则,其特点为：（1）多学科合作的结晶;（2）以高级别循证医学证据为基础;（3）突出了实践性和可操作性。和一切“诊断规范”一样,《共识》一方面对指导肿瘤科及其他相关科室医师们的临床实践发挥积极作用,同时又需要在实践中继续得到检验。     

大肠癌常见诊疗误区解析

大肠癌是最常见的恶性肿瘤之一.尽管近年诊疗水平不断提高,但在临床诊疗工作中,仍存在一些误区.本文主要针对肠镜检查的必要性、肝转移是否能手术治疗、术后辅助化疗的适应证、靶向药物的适应证以及K-RAS基因检测的必要性等5方面进行分析.逐步规范大肠癌的诊断和治疗,提高大肠癌综合治疗水平.     

大肠癌常见诊疗误区解析

大肠癌是最常见的恶性肿瘤之一。尽管近年诊疗水平不断提高,但在临床诊疗工作中,仍存在一些误区。本文主要针对肠镜检查的必要性、肝转移是否能手术治疗、术后辅助化疗的适应证、靶向药物的适应证以及K-RAS基因检测的必要性等5方面进行分析。逐步规范大肠癌的诊断和治疗,提高大肠癌综合治疗水平。     

恶性肿瘤本质的认识和治疗模式的改变

通过对恶性肿瘤本质的认识,肿瘤的治疗已进入综合治疗的阶段,多种治疗方法相互结合才能扬长避短,临床医生应该有计划、合理地应用现有的各种治疗手段来治愈更多的患者.     

Characteristics, Services, and Outcomes of Treatment for Women

This paper analyzes the demographic and pretreatment characteristics of maleand female participants in the National Treatment Improvement Evaluation Study,including the women's treatment experiences and the outcomes of various types of substance abuse treatment. Follow-up of a multisite sample of 1,374 women and 3,037 men indicates minimal differences exist between menand women in the outcomes of five modalities of substance abuse treatment. Treatment appears to reduce women's drug and alcohol use and illegal activities and increase their levels of employment. Demographic and pretreatment characteristics are only modestly associated with differences in treatment outcomes, and differential service receipt has inconsistent effects on outcomes.     

Treatment Populations,Services, and Outcomes for Cocaine and Crack-Cocaine Dependence

This paper analyzes demographic and other pretreatment characteristics, measures of treatment services received, and treatment outcomes of participantsin the National Treatment Improvement Evaluation Study (NTIES), a large-scale longitudinal study of substance abuse treatment (D. R. Gerstein et al., 1997; R. A. Johnson & D. R. Gerstein, 2000). The focus here is those treated primarily for cocaine powder or crack-cocaine dependence, compared with those in treatment for other substances, particularly heroin. Crack-dependent users tend to be female and black, older than primary marijuana or alcohol users but younger than those in treatment for heroin. Primary cocaine powder or crack users are likely to have entered treatment under pressure from the criminal justice system. After treatment there are substantial reductions in use of cocaine powder and crack, especially among participants with fewer prior treatment episodes and lower pretreatment intensity of use. Longer duration and intensity of treatment result in greater reductions in cocaine and crack use.     

Relationships Between Treatment Components, Client-Level Factors, and Positive Treatment Outcomes

How different amounts and components of treatment affect substance abuse treatment outcomes is fundamentally important to evaluating current treatment practices and recommending improvements. Through a secondary analysis of data from the National Treatment Improvement Evaluation Study (NTIES), the present study examined the relationships between treatment components, client-level factors, and positive treatment outcomes. Several components were shown tohave significant effects on the odds of a positive outcome, over and above the effects of client background characteristics. Depending on treatment modality, these included length of stay; whether or not clients reported seeing their treatment plan hours per month in group and individual counseling; utilization ofeducational, vocational, and other ancillary services; use of antianxiety and drug and alcohol medications; and client matching. Several interactions between client-level factors and treatment components were also observed. Studylimitations are discussed, followed by implications for policy and practiceand suggestions for further research.     

Behavioral versus Behavioral and Pharmacological Treatment in ADHD Children Attending a Summer Treatment Program

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.     

治疗目标定位与临床决策

治病如用兵,治疗皮肤病亦一样。临床实践中,许多皮肤科医生忽略了皮肤病的病机治疗,导致了起效慢、疗效差、病程迁延的结果。皮肤病的治疗应包括病因治疗、病机治疗、症状治疗、支持辅助治疗,四者缺一不可、协同互补;应用中可根据疾病矛盾的转化,分清先后主次,灵活调整组合,即运筹帷幄,辨证施治,辨病、辨症、辨药、辨方,“以正合取奇胜”,以求取得最快、最好、最稳定持久的疗效。     

无效治疗--医者的困扰

关于无效治疗的争论越来越受到社会各方面的重视,但由于各自的利益和出发点不同,社会各方对无效治疗的观察角度和侧重点不同。从医务工作者的角度,就无效治疗的概念、判定及无效治疗实施过程中的利益冲突和解决对策进行讨论。     

失眠症治疗的最新进展

失眠是睡眠障碍之一,主要表现为睡眠时间减少、入睡困难、入睡后易惊醒、醒后不易再入睡等。本文主要探讨了失眠的非药物治疗,包括睡眠约束,光疗法,认知治疗,松弛疗法和行为治疗。     

Might Relationship “Techniques” Extend the Reach, Efficacy, and Efficiency of the Psychotherapies? The Challenge of Treatment-Resistant Outpatients

Study-based clinical observations and two premises are presented as indications for a need to identify therapeutic relationship techniques or the like that can extend the reach and efficiency of the psychotherapies. The premises are: (1) advances in psychotherapy practice and research now highlight one of the field's most longstanding challenges, signified by terms like treatment resistance; and (2) some proportion of outpatients whose problems are resistant to the psychotherapies (and medications) have marked limitations in the capacity to relate positively and productively to others, including therapists. Thus, ironically, they cannot optimally utilize a treatment modality that largely has developed to ameliorate problems relating to others.     

Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.