促排卵治疗及其风险的探讨

促排卵药物在临床中的广泛应用,给不孕患者带来了希望,另一方面促排卵带来的风险也越来越引起人们的重视,如卵巢过度刺激综合征(OHSS)、妊娠并发症、出生缺陷和肿瘤等.因此,用哲学的观点客观地看待促排卵的成效与风险之间的关系有助于临床医生进一步提高促排卵安全性的认识,做出正确的决策.     

老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性。老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗。目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观。本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生。     

结直肠癌诊断模式的若干思考

结直肠癌是常见的消化道恶性肿瘤,然而在临床上得到诊断时大多已经到了中晚期,错过了最佳的治疗时机。近年来,随着基因相关技术及生物信息技术的迅猛发展,结直肠癌诊断方法得到不断改进,但早期诊断仍不尽如人意。因此现有的诊断模式值得我们去深思,从哲学意义上探索更为完善的诊断模式。     

“三阶梯”止痛原则临床实践20年

WHO癌痛“三阶梯”止痛原则发布20年来,经过医患双方上亿人次的临床实践,取得了巨大成功。人类对癌性疼痛乃至良性疼痛的认识,从来没有如此深刻;有关止痛的实践也从来没有如此广泛。作者回顾了“三阶梯”原则的产生背景和历史功绩,指出了“三阶梯”原则在实践中丰富和发展的必要性。作者建议,今后我国癌症止痛应“临床勇于实践,用药讲究技巧,工作重点下移”。     

关于晚期肿瘤患者临终关怀问题的探讨

分析了晚期肿瘤患者临终关怀的重要意义和特殊性,论述了临终关怀的主要内容,探讨了临终关怀中的伦理问题,特别是对是否告知患者实情和是否应该放弃治疗等问题进行了深入讨论和分析。并提出晚期肿瘤患者的临终关怀,要从生理、心理、社会、伦理等多方面、多角度关爱患者,帮助患者认识生命价值,理解生命意义,提高生存质量。     

Bayesian Risk Assessment in Genetic Testing for Autosomal Dominant Disorders with Age-Dependent Penetrance

Risk assessment is an essential component of genetic counseling and testing, and the accuracy of risk assessment is critical for decision making by consultands. However, it has been shown that genetic risk calculations may have high error rates in practice. Risk calculations for autosomal dominant disorders are frequently complicated by age-dependent penetrance and sensitivities of less than 100% in genetic testing. We provide methods of risk calculation for prototypical pedigrees of a family at risk for an autosomal dominant disorder with age-dependent penetrance. Our risk calculations include scenarios in which the sensitivity of genetic testing is less than 100%, and in which the sensitivity of genetic testing varies for different family members at risk. Our Bayesian methods permit autosomal dominant disease probabilities to be calculated accurately, taking into account all relevant information. Our methods are particularly useful for hereditary cancer syndromes, in which genetic testing can seldom achieve 100% sensitivity. Our methods can be applied to many different scenarios, including those where the sensitivity of genetic testing varies for different family members at risk. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.     

Living with Hereditary Non-polyposis Colorectal Cancer; Experiences from and Impact of Genetic Testing

Hereditary non-polyposis colorectal cancer (HNPCC) is one of our most common cancer syndromes and an increasing number of individuals live in families with verified hereditary cancer. We conducted an interview study to explore experiences from and perceived impact on life after genetic testing for HNPCC. Three major themes emerged: reactions and emotions, family relations and implications for life. Among the reactions described were suspecting heredity, feelings of guilt, the importance of experiential knowledge, and coping strategies. The impact on family relations was related to perceived responsibility for conveying information, encountering different reactions among family members, and difficulties in communication and relations. The implications described included uncertainty, adaptation, new choices and changes in life, family planning issues, and experiences of surveillance programs. We suggest that the themes and sub-themes identified should be taken into account during genetic counselling in order to facilitate the spread of information and to prepare family members for the impact on life that knowledge about hereditary cancer may have.     

Illness, disease and sin: the connection between genetics and spirituality.

The New Testament, while rejecting any superficial connection between illness and sin, does not reject a possible connection between illness and a person's relationship with God. An example can be seen in the story of the young blind man who was healed (St. John 9:3). His blindness does not result from any fault he or his parents had committed but apparently from God's wish to reveal his own healing power. The inner blindness of the Pharisees is a different type of blindness far more difficult to heal. The blind young man was actually healed, not only in body but also in soul. Such miraculous healings are rare nowadays. However, if one takes a closer look at modern genetics and psycho-neuro-immunological findings, one may come to a better understanding of how miracle healings are linked to man's inner life and therefore also to his religiousness. Many diseases have genetic backgrounds. Defective genes, however, do not necessarily lead to subsequent illness. Genes have to be switched on or off. Only activated genes trigger pathological change. The human brain and all of man's thinking and feeling are intimately connected with such activations. We may thus conclude that both inner life and religious outlook on life are relevant to the origin and development of diseases.     

The social epidemiologic concept of fundamental cause

The goal of research in social epidemiology is not simply conceptual clarification or theoretical understanding, but more importantly it is to contribute to, and enhance the health of populations (and so, too, the people who constitute those populations). Undoubtedly, understanding how various individual risk factors such as smoking and obesity affect the health of people does contribute to this goal. However, what is distinctive of much on-going work in social epidemiology is the view that analyses making use of individual-level variables is not enough. In the spirit of Durkheim and Weber, S. Leonard Syme makes this point by writing that just “as bad water and food may be harmful to our health, unhealthful forces in our society may be detrimental to our capacity to make choices and to form opinions” conducive to health and well-being. Advocates of upstream (distal) causes of adverse health outcomes propose to identify the most important of these “unhealthful forces” as the fundamental causes of adverse health outcomes. However, without a clear, theoretically precise and well-grounded understanding of the characteristics of fundamental causes, there is little hope in applying the statistical tools of the health sciences to hypotheses about fundamental causes, their outcomes, and policies intended to enhance the health of populations. This paper begins the process of characterizing the social epidemiological concept of fundamental cause in a theoretically respectable and robust way.