从肾功能衰竭的治疗革新审视医学科技的内在张力

肾功能衰竭的治疗方法作为人类战胜疾病的一种工具,随着人类对疾病本质认识的不断深化而随之不断更新。每一种治疗手段都有其特定的时空性,在治疗肾功能衰竭过程中,医务工作者应当在尊重患者意愿的基础上,优化组合治疗方法以期发挥最佳的治疗效果。     

Attachment in donor‐conceived adults: Curiosity,search, and contact

Donor‐conceived (DC) people represent a unique population with atypical family structures. This study examined whether individual differences in attachment predict adults' self‐reported curiosity about their donor conception identity, as well as attempts to find the donor and establish contact. Data were collected from 488 DC people from the Donor Sibling Registry (DSR). People who were high in attachment‐related anxiety were more curious than others about their donor conception. Despite this curiosity, however, highly anxious people were more disengaged from donor conception and were not more likely than others to search for or have made contact with their donor. These findings suggest that insecure attachment—particularly attachment anxiety—may contribute to people's willingness to incorporate donor conception into their identities.     

我国器官移植中供体不足的原因分析及对策

器官移植对于挽救晚期脏器功能衰竭病人的生命具有极其重要的意义,我国器官移植起步较晚,多种因素限制器官移植的发展,其中供体不足是关键因素之一.分析器官移植中供体不足的原因,认为冲破传统观念的束缚,加大宣传力度,加快立法步伐是我国器官移植中供体不足亟待解决的问题.     

Psychological experiences of renal transplant patients: A qualitative analysis

Introduction: Organ‐sourcing developments now permit increasing numbers of renal transplants. Recipients commonly experience negative affect pre‐ and/or post‐transplant yet research on patient experience is lacking. Aims: This study aims to develop theory based on the lived experience of recipients, and to guide psychological and support interventions by counsellors and professional carers for the benefit of patients. Methods: A sample of eight participants was interviewed about their transplant experiences. The interview data were analysed using grounded theory methodology. Uniquely the research was conducted by a renal transplant patient, which potentially adds interpretive insight. Results: The central finding is that the issues facing transplant patients before and after transplant may be summarised as living with paradox and conflict. Thus, recipients may need to juxtapose anger/sadness about losses with an adaptive attitude to making the most of a second chance at life, and negotiate a positive relationship with an ‘alien’ organ. Conclusions/implications: The study offers evidence‐based guidance to counsellors supporting recipients to adjust to a changing sense of self, and to form adaptive relationships with self, others and the new kidney. Finally the research recommends action on improving awareness of and access to counselling and other supports for renal transplantees, and the need for in‐depth experiential research in this expanding area.     

Psychosocial and Biomedical Predictors of Attention and Memory in End-Stage Renal Disease Patients

This study examined the neurocognitive functioning of 554 end-stage renal disease (ESRD) patients to determine the underlying factor structure of tests of attention and memory and to assess the differential impact of psychosocial and biomedical variables on these factors. Analysis revealed three underlying factors: Sustained Attention, Focused Attention, and Memory Recall. Hierarchical regression analyses revealed that psychosocial and biomedical variables were most strongly related to the Focused Attention factor. Education, vocabulary score, age, race, age by creatinine, creatinine, and renal replacement therapy accounted for 30% of variance in Focused Attention; sex, depression, and hypertension were unrelated. After controlling for demographic and medical variables, type of renal replacement therapy was a statistically, but not clinically, significant predictor of Focused Attention, with peritoneal dialysis associated with better attentional performance relative to hemodialysis. The potential relationship between focused attention and compliance is discussed.     

Noncompliance in end-stage renal disease: A threat to quality of care and cost containment

Noncompliance to treatment regimen after kidney transplantation is a threat to health outcomes and cost containment. Although there are methodological challenges to obtaining reliable compliance data, the results of noncompliance are increased morbidity and mortality in posttransplant patients. In addition, recent research suggests that patients who incur repeated rejection episodes leading to graft failure have higher levels of medical utilization. Some psychosocial factors related to compliance and medical utilization are potentially modifiable through cognitive-behavioral intervention.     

Introduction to the special issue on “psychological research and practice in organ transplantation”

This paper provides a brief overview of articles in this Special Issue on Psychological Research and Practice in Organ Transplantation. The articles provide empirical information on the psychological adaptation of transplant candidates and recipients, as well as addressing the myriad ethical and clinical issues evident in the field of organ transplantation. Heart, liver, lung, kidney, and bone marrow transplantation for children and adults has increased in frequency in recent years, and the articles address the need for more sophisticated and comprehensive assessment of psychological concomitants. The Guest Editor's Top Ten list of research needs which transplantation psychologists might further address is discussed in this article.     

Evaluation of a Family Systems Intervention for Managing Pediatric Chronic Illness: Mastering Each New Direction (MEND)

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness.     

T1期肾细胞癌保留肾单位手术安全切除边距的研究

探讨保留肾单位手术治疗T1期肾细胞癌时肿瘤周围组织的安全切缘,并评价术中评价（IE）肿瘤切缘方法的效果。T1期肾癌根治术标本50例,连续组织切片检查包膜完整性及多中心病灶。回顾21例肾部分切除术患者的临床病理资料,IE方法为切除肿瘤后从顶部到肿瘤基底部沿最长轴切开,肉眼观察。肿瘤直径和包膜完整性为多中心灶的显著相关因素（P〈0.05）。21例肾部分切除术患者切缘范围为1mm~10mm均阴性,随访12个月~118个月（平均35个月）,均无瘤存活。IE评价术中切缘情况安全有效,对于IE观察假包膜完整者,切缘3mm~5mm即可,如观察假包膜不完整,切缘应达到5mm~10mm。     

索拉非尼治疗晚期肾癌的临床研究

探讨索拉非尼治疗晚期转移性肾癌的疗效和毒副反应.我院门诊收治的晚期肾癌患者共70例,服用索拉非尼,每个月进行1次疗效评价,每2个月进行一次影像学评价.70例患者中完全缓解(CR)0例、部分缓解(PR)2例、稳定(SD)40例、疾病进展(PD)1例,死亡27例.中位无进展生存期(PFS) 18(6～65)个月,中位总生存期(OS) 12个月.1年、2年、3年生存率分别为83.7％、40.9％、18.7％.有轻中度的不良反应,因此,索拉非尼对晚期肾癌有良好的治疗效果,并且药物副反应轻.