遗传与环境在食管癌发生发展中的作用

食管癌是我国最常见的恶性肿瘤之一,有明显的地域分布特征,提示环境起着主要作用。但近年来有大量研究表明遗传因素在食管癌的发生中起着不可忽视的作用。食管癌是多种因素作用,多基因参与的疾病,是环境与遗传共同作用的结果。     

癌痛治疗中的辅助用药

辅助镇痛药物最初的用途都不是镇痛,但对癌痛患者却能起到缓解疼痛、降低麻醉药品用量、减轻大剂量麻醉药品带来的药物不良反应的作用。尤其适用于那些对阿片类药物不敏感或不仅对阿片类药物敏感的癌病病人。遗憾的是临床上通常在阿片类药物镇痛效果不理想的时候才考虑添加辅助用药,癌痛治疗还存在用药过于单一的弊端。因此,为了加强止痛治疗效果、优化治疗策略,必须充分重视癌痛治疗中的辅助用药。     

患者隐私杈的法学思考

结合法学理论、医疗实践和目前患者隐私权的法律保护现状,就侵权行为、民事责任的认定以及隐私权的限制等问题予以理论阐释,并提出了切实可行的保护措施,如建立健全相关法律法规、医务人员要增强法律保护意识等,以期为患者隐私权的保护提供有益的参考。     

Computerised cognitive‐behaviour therapy (cCBT) and older people: A pilot study to determine factors that influence willingness to engage with cCBT

Objective: The aim of this study was to explore whether older people with depression and/or anxiety were potentially willing to engage with computerised cognitive‐behaviour therapy (cCBT). Method: A short questionnaire was sent to 60 service users aged 65+ who were identified as having anxiety and/or depression. Results: There was a 63.3% response rate for the questionnaire. Almost half of the respondents said they would be interested in using cCBT, and would be willing to learn the necessary computer skills. Conclusions: This pilot study suggests that older people with anxiety and/or depression may be willing to engage with cCBT. However, a number of important factors are highlighted that would need to be considered in deciding whether to develop access to cCBT for older people.     

BENCHMARKS AFFECT PERCEPTIONS OF PRIOR DISABILITY IN A STRUCTURED INTERVIEW

Though covered under the Americans with Disabilities Act of 1990, job candidates with a record of a disability may be adversely evaluated. Two experiments demonstrate that subtle knowledge of a prior disability creates a bias that can be removed by a structured interview. A job candidate was labeled as having once suffered from depression, substance abuse, cancer, or no disability. The candidate who once suffered from depression or substance abuse was judged more negatively than a control candidate, while a cancer survivor was not. Though disabilities are not perceived equally, benchmarked rating scales can enhance attention to relevant behaviors, thus controlling the potential for bias.We thank Steven Gregson, Michael Records and Cynthia Strickland for their help with pilot studies. Shawn Bocketti is now with IBM, Stephen Maser is with Linkage Incorporated, and Craig Wennet is with the United States Coast Guard.     

肺癌早期综合诊疗思考

通过分析目前肺癌患者5年生存率徘徊在10%,这一现实问题,可以得到一些重要启示和思考。今后肺癌治疗发展方向将是完善个体化、多学科早期综合治疗模式;利用基因芯片技术开展肺癌早期诊断,对肺癌高危人群开展大规模普查;开展靶向性、高效低毒、抗耐药性的肺癌治疗药物研究,进行肺癌逆转的分子干预治疗和分子阻断治疗,要用早期综合地手段诊疗肺癌。     

The Survivor Health and Resilience Education (SHARE) Program: Development and Evaluation of a Health Behavior Intervention for Adolescent Survivors of Childhood Cancer

Few evidence-based health behavior interventions for adolescent survivors of childhood cancer currently exist. These interventions are necessary to address a range of lifestyle and behavioral factors (e.g., diet and physical activity, tobacco and alcohol use, excessive sun exposure) that may place survivors at increased risk for secondary cancers other chronic diseases. To address this need, the development and evaluation of a health promotion and disease prevention program for childhood cancer survivors is described, with an emphasis on the steps leading up to conducting a randomized controlled trial to test its efficacy. Data gathered from trial participants suggest the preliminary evaluation of the intervention is favorable. Trends and future directions in behavioral intervention research with childhood cancer survivors are discussed, along with the role of behavioral research in health promotion and disease prevention.     

国际麻醉药品的医疗消耗趋势

本文通过明晰的表格形式列出国际上不同国家历年麻醉药品的医疗消耗量,比较了发达国家与发展中国家的具体数据,并通过各国吗啡人均消耗量来揭示我国目前贯彻“癌症三阶梯止痛方案”与国际发达国家的差距。旨在强调对麻醉药品的管理,一方面要严格控制以免滥用造成危害,另一方面还要保证足够的医疗消耗。     

误诊误治病例所致医疗纠纷分析——附3例报告

当前医疗科技发展的相对性、疾病规律本身的复杂多变性、医生医疗知识的局限性等,导致了临床误诊误治的不可避免性,而医院发生的医疗纠纷事件中,大多是由于误诊误治所致。通过对3例误诊病例及所致医疗纠纷的分析,指出临床误诊误治的客观性、主观性及不可避免性。同时提示临床医师在疾病诊治过程中,随时更新医疗知识,注意疾病的鉴别诊断,及时完善相关的辅助检查,积极治疗,减少对疾病的延误诊治,减轻病人痛苦,改善医患关系,从而减少医疗纠纷。     

Survivin与子宫内膜癌的基因治疗的思考

子宫内膜癌是妇科常见的恶性肿瘤,发病机制不很清楚,早期诊断及治疗可改善预后,而目前的手术治疗方式损伤较大。Survivin是近年发现的新凋亡抑制基因,在多数恶性肿瘤组织中表达丰富,而在正常成人组织中不表达,这种表达特异性使其成为肿瘤诊断和基因治疗的新靶点。本文着重思考以Survivin为靶点的基因治疗方法在子宫内膜癌中的应用。