心理行为干预对乳腺癌患者情绪反应及免疫功能的影响

按随机和匹配原则,将40名乳腺癌放疗患者分入干预组和对照组。对干预组患者进行为期4周的心理行为干预,对照组仅接受相应的医药治疗。以肿瘤病人情绪适应问卷(MAC)和免疫测试法研究患者干预前后的情绪反应和免疫功能,探讨心理行为干预对乳腺癌患者情绪反应和免疫功能的影响。结果发现,心理行为干预有利于提高患者NK细胞活性(NKCA);并有助于维持放疗期间患者的白细胞水平。     

Case Report—Loyalty, Legacy, and Ledger: Contextual Therapy in a Patient with a Family History of Ovarian Cancer

A client's emotional experiences and reactions to those experiences are influenced by his/her family of origin and direct or indirect interactions with various family members. Contextual therapists propose that a client's satisfaction with a relationship depends on the equity of his/her emotional interactions with family members. When relationships are inequitable, trust between individuals disintegrates. In order to reestablish trust in a relationship, a balance of interests must be restored. If not, imbalances may be passed down to future generations. A case of a woman with a family history of ovarian cancer is reviewed with the principles of contextual therapy in mind. In her family, several legacies have resulted in unbalanced relationships between family members that lead to difficulty in establishing trust within the genetic counseling session.     

晚期癌症患者治疗决策的思考

现代医疗尚无法治愈所有晚期癌症。现实与期望之间的较大差距,挑战晚期癌症治疗的临床决策。WHO强调为防止资源滥用,应确保抗癌治疗只用于可获益阶段。对于晚期癌症患者的治疗决策,除遵循规矩原则和循证医学证据原则外,还应该遵循尊重患者意愿、社会公平的美德原则。大多数癌症患者需要接受姑息治疗。姑息治疗为患者及家属提供既简便又经济的医疗服务。     

乳腺癌保乳手术的哲学思考

保乳手术基于乳腺癌是一种全身疾病的认识,符合医学发展的方向并最大程度地满足了患者对形体美的追求,保乳手术是早期乳腺癌手术的发展趋势,保乳治疗是多种疗法序贯应用的综合治疗。乳腺外科医师应及时转变治疗观念,以更大的责任心给予乳腺癌患者最好的治疗和更多的人文关爱。     

血管内皮生长因子与结直肠癌的研究

血管内皮生长因子（vascular endothelial growth factor,VEGF）是一高度特异作用于内皮细胞的糖蛋白,是目前发现的最重要的肿瘤血管生长因子之一。结直肠癌的生长、侵袭和转移与血管内皮生长因子有密切的关系,VEGF在结直肠癌治疗中的作用日益突出。本文就VEGF的功能、在结直肠癌中的表达和治疗的作用作一综述。     

贝叶斯统计方法的应用与现状

贝叶斯统计方法是心理学数据分析的热门方法。研究全面论述贝叶斯方法在心理学领域的应用与方向。现阶段贝叶斯方法以模拟研究为主,应用方向为心理学研究常用的项目反应理论、认知诊断、计算机自适应、结构方程模型。同时,评述发现贝叶斯方法正逐步被国内心理学研究者所接受。最后,文章讨论了当下贝叶斯统计在心理学研究中应用的局限性及可能的原因,建议统计学者开发界面友好的贝叶斯软件,并在心理学课程中加入贝叶斯知识。     

Assessment of the Use and Feasibility of Video to Supplement the Genetic Counseling Process: A Cancer Genetic Counseling Perspective

Cancer genetic counselors use a variety of teaching modalities for patient education. This survey of cancer genetic counselors assessed their use of educational videos and their recommendations for content of future videos. Thirty percent of respondents use videos for patient education. Cited benefits included reinforcement of information for clients and increased counselor efficiency. Of the 70% who do not use videos, predominant barriers included the perceived lack of an appropriate video, lack of space and/or equipment, and concern that videos are impersonal. Most respondents desired a video that is representative of the genetic counseling session, but emphasized the importance of using broad information. Content considered critical included the pros and cons of genetic testing, associated psychosocial implications, and genetic discrimination. The results of this exploratory study provide data relevant for the development of a cancer genetics video for patient education, and suggestions are made based on aspects of information processing and communication theories.     

Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

Alone with God

A patient deals with her cancer and its treatment through a life of the imagination, dreams and God. The author observes a toughness in her and strong feeling. She struggles to bear the aliveness of God as she wrestles with childhood memories of her own mother's death from the same disease. Prayers for her are experienced as sunbeam fibers and a kind of transfusion.     

A Comparison of Three Methods of Teaching Skin Self-Examinations

Skin self-examinations are essential for the early identification and treatment of skin cancers. However, little is known about the most effective methods for teaching skin cancer detection and skin self-examination. This study compared three skin cancer education methods that are commonly used in the primary care setting: viewing a videotape, reading brochures, and one-on-one instruction from a nurse practitioner. One hundred forty-three young adults were randomly assigned to one of the four conditions (educational intervention or wait list) and completed measures of skin cancer knowledge, ability to visually discriminate cancerous versus noncancerous skin growths, and behavioral ability to perform a skin self-examination immediately (Time 1) and 3 weeks (Time 2) after the educational intervention. Results showed that participants across all educational interventions had significantly higher skin cancer knowledge compared to those in the wait-list control group, and these knowledge scores were maintained for 3 weeks. Participants in the brochure condition scored significantly higher than participants in all other conditions on an observational measure of skin self-examination. Demographic variables, such as gender and ethnicity, were not found to be related to performance on any of the dependent measures. These findings provide preliminary evidence that knowledge of skin cancer may be enhanced through a variety of educational techniques and that written materials (e.g., brochures) may represent the minimal intervention level necessary for teaching adults how to perform thorough skin self-examinations.