"仁"——医德的元德

医德是医学道德的简称,具言之,它是指医务人员在医疗卫生服务的职业活动中应该具备的仁爱、救死扶伤等的品德,是道德德目在医务人员身上的内化,也是对医务人员必须具备的最起码的要求.我们评价一个医生,首先是直面他的医德,医德是医生形象的体现,没有医德的医生即使技艺再高超,也算不上一个完整意义上的医生,"无德不成医".事实上一个医德低下的医生,他的技艺也不会高超的.     

未成年患者的同意能力研究

众所周知,医疗机构必须在取得成年患者的有效同意后才能实施医疗行为。而当患者是未成年人时,这种对医疗行为的同意是否有效呢?对此,国内外法学均未形成统一的定论。通过比较国外医事法学领域相对成熟的同意能力理论,初步建立我国未成年患者的同意能力理论体系,其中评估方法是关键。     

Successful Use of Peer Educators for Sharing Genetic Information

This study examined the impact of a genetics education module provided by Reach to Recovery peer volunteers. Participants included 113 women with confirmed breast cancer diagnoses. Eighty-eight of these women (78%) completed a baseline survey, participated in a peer-led intervention, and completed a follow-up survey. Approximately half of the women received an education module that included a genetic component, while the other half did not. Results indicated that women who received the genetics module had greater increases in genetics knowledge than the group that did not receive the module. However, follow-up interest in genetic testing was not significantly different between the two groups. Results indicate that a peer-led genetics module can increase knowledge about genetics. However, it does not appear to have a differential effect on genetic testing interest.     

Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Using Adult Learning Theory Concepts to Address Barriers to Cancer Genetic Risk Assessment in the African American Community

Utilization of cancer genetic risk assessment can be profoundly influenced by an individuals’ knowledge of risk assessment, attitudes regarding illness and healthcare, and affective reactions derived from social norms. Race and ethnicity play a powerful role in the development of an individual's attitudes and should be considered when attempting to understand a person's openness to cancer genetic risk assessment (Lannin et al., 1998). Until recently, however, cancer screening and prevention programs have been primarily based on data from studies conducted with the Caucasian population, yielding data that are not fully applicable to the African American community. In the last several years, research findings regarding African American's knowledge, attitudes, and feelings about genetic counseling and testing have grown (Matthews et al., 2000; Singer et al., 2004; Thompson et al., 2003). However, to the authors’ knowledge, these data have yet to be presented in a manner that both summarizes the barriers that African Americans have reported regarding cancer genetic risk assessment, while at the same time suggesting methods individual genetic counselors can utilize during community presentations to help address these barriers. This article will first summarize previous empirical findings regarding African Americans’ knowledge, attitudes, and feelings about cancer genetic risk assessment. The article will then apply adult learning theory to those findings to provide genetic counselors with practical, theory based techniques to apply toward community based educational programs with African American groups.     

Breast Cancer as Trauma: Posttraumatic Stress and Posttraumatic Growth

Diagnosis and treatment of cancer has been associated with both posttraumatic stress disorder (PTSD) symptoms and posttraumatic growth (PTG). This cross-sectional study sought to assess the frequency, common predictors, and interrelationships of PTSD symptoms and PTG in breast cancer survivors (n = 65). In this sample, symptoms of PTSD and reports of PTG were common and were not significantly related to one another. Greater social constraints on talking about breast cancer and perception of cancer as a traumatic stressor were associated with greater PTSD symptomatology. Younger age and perception of cancer as a traumatic stressor were associated with greater PTG. Findings suggest the central role of subjective appraisal in adjustment to cancer. Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes.     

Neuroticism and responses to social comparison among cancer patients

The present study examined how the effects of three audiotapes containing different types of social comparison information on the mood of cancer patients depended on the level of neuroticism. On the procedural tape, a man and woman discussed the process of radiation therapy, on the emotion tape, they focussed on emotional reactions to their illness and treatment, while on the coping tape they focussed on the way they had been coping. A validation study among 115 students showed that the tapes were perceived as they were intended. The main study was conducted among 226 patients who were about to undergo radiation therapy. Compared to patients in the control group, as patients were higher in neuroticism, they reported less negative mood after listening to the procedural and the coping tape. Furthermore, as patients were higher in neuroticism, they reported less negative mood after listening to the coping tape than to the emotion tape. Copyright © 2009 John Wiley & Sons, Ltd.     

癌痛治疗指南解析

对多国成人癌痛指南进行检索、回顾,发现近年癌痛治疗领域新进展和各国普遍遵循的共同原则,为临床医生改进癌痛治疗提供参考。采用现有的互联网临床实践指南检索平台,对成人癌痛指南进行检索,分析各国指南的异同之处,重点对疼痛评估、WHO三阶梯药物治疗及辅助治疗进行比较、归纳。全面的癌痛评估是指痛治疗的必要前提,也是众多癌痛指南强调的重点;按疼痛程度选择三阶梯镇痛药物仍是药物止痛的基本原则;口服途径是止痛治疗的首选给药途径;第一阶梯药物中阿司匹林的应用逐渐淡化,NSAIDs的毒性反应受到关注;第二阶梯药物的选择更灵活。应根据疼痛性质、患者的具体情况合理选择复合制荆。吗啡仍是强阿片类药物中的首选,可用于中、重度疼痛的治疗。因此,我国成人癌痛治疗需要改进,应重点推广全面的疼痛评估,提倡根据患者的具体情况合理、灵活的选择三阶梯药物,个体化治疗是止痛治疗的关键。     

探讨人乳头瘤病毒L1蛋白功能及其临床意义

高危型别人乳头瘤病毒（HPV）感染在宫颈癌发生发展中具有重要作用。由于HPV L1蛋白结构特征及其精确的抗原特性,在粘附宿主细胞、识别病毒受体、协助病毒DNA的入胞转运中均发挥重要作用。检测患者宫颈损伤组织中L1蛋白的表达将有助于对患者是否具有传染性进行评估。本文将深刻思考HPV L1功能及其在感染机体并引发癌变的机制,以期更好的解读宫颈癌发病原理并最终应用于,强床治疗。     

CD4＋CD25＋Foxp3＋调节性T细胞与肺癌的临床分期及化疗关系的研究

为了研究Treg与肺癌的临床分期及化疗的关系,分离52例初治肺癌患者化疗前后PBMC,以12例正常者为对照,荧光标记的单抗染色,流式细胞仪检测Treg占CD4＋T细胞的比值。结果显示肺癌患者该比值高于对照组,Ⅲ＋Ⅳ期的高于Ⅰ＋Ⅱ期。化疗疗效（SD＋PD）高于PR。因此,肺癌患者Treg比例较正常人升高,且分期越高该比值增加越明显;疗效差的该比值高于化疗有效病例。推测Treg升高与肺癌的发生、发展有关。