‘It was all intertwined’: Illness representations and self-management in patients with cancer and anxiety/depression

Objective: Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals’ multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression.

Design: A semi-structured qualitative research design with theoretical thematic analysis.

Main Outcome Measures: Multimorbid illness representations, coping behaviours, and self-management strategies.

Results: In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants’ most challenging illness also discussed.

Conclusions: People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.     

The role of stressful life events on the cortisol reactivity patterns of breast cancer survivors

Objective: Atypical patterns of cortisol secretion following an acute stressor have been commonly reported in breast cancer survivors. Stressful life events have been associated with blunted acute cortisol levels in other populations. The purpose of this study was to explore the role of stressful life events on cortisol secretion patterns of breast cancer survivors following an acute stressor.

Design: The Trier Social Stress (TSST) was used to elicit a moderate stress response in breast cancer survivors (n = 19) and a control group (n = 17). Saliva samples were collected before, during and after the TSST to provide cortisol concentrations. During recovery, we recorded the frequency and subjective impact of stressful life events in the past year using the Life Experience Survey.

Results: Simple regressions analyses were performed; results suggest no group differences between the total number of stressful life events and their subjective impact. However, the total number of stressful life events as well as their subjective impact correlated negatively with the peak cortisol concentration in breast cancer survivors.

Conclusions: The cumulative effect of stressful life events, positive and negative, may impact the endocrine stress system of breast cancer survivors more so than that of women with no history of cancer.     

Exploring definitions of bullying among personality disordered patients in a maximum‐secure hospital

The current study explored the perceptions of staff and patients concerning how patient‐to‐patient bullying should be defined and what behaviours it should include. Participants were randomly selected from the Personality Disorder Unit of a maximum secure hospital. A total of sixty interviews were conducted (30 staff and 30 patients). Problems in attempting to utilise definitions of bullying developed for use in other contexts, i.e., schools, were identified. Patients and staff presented with similar views about how it should be defined: both felt that aggression did not have to be repeated or severe in order to be classed as bullying, that bullying could be accidental, that the power imbalance between perpetrator and victim was not always explicit and, finally, that victims could provoke bullies unintentionally. Indirect (i.e. covert) forms of aggression were less likely to be considered bullying than direct (i.e. overt) forms. A number of differences were found between staff and patients regarding how bullying was conceptualised. Staff were more likely than patients to hold the belief that some patients liked being bullied, and appeared to acknowledge a broader definition of bullying than patients, accounting for a wider range of aggressive behaviours. A number of similarities between the current study and previous prison‐based research were found. The implications of these findings for current research and the value in attending to prison‐based research are highlighted. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

目前形势下临床教学问题的探讨与改革

当前医疗大环境的改变,社会评价的影响及病人的维权、自我保护意识等使临床教学工作发生了很大变化.需要我们采取相应的变革,注重病历的书写,基本功的培训,语言能力的指导和改变查房的方式,以完成培养新一代合格医生的任务.     

终末期癌症病人诊治中的心理特征与人文关怀

在诊治终末期癌症病人过程中不仅要关心他们的躯体方面,更要关心他们的心理方面,在诊治过程中要根据他们的独特的心理特征来进行人文心理关怀,维持生命质量和保证他们应有的人格尊严.     

Nature,extent, and causes of bullying among personality‐disordered patients in a high‐secure hospital

The present study explored the perceptions and experiences of the nature, extent and causes of bullying among personality‐disordered patients, with a subsidiary aim of exploring differences in perceptions between staff and patients. The sample was selected from the Personality Disorder Unit of a high secure hospital. The total sample consisted of 60 participants, 30 patients and 30 staff. Participants engaged in a semi‐structured interview based on that developed by Brookes [1993] and modified by Ireland and Archer [1996] and Ireland [2002a]. The interview assessed their perceptions and experiences of patient‐to‐patient bullying. One fifth of patients and staff reported that they had seen a patient being bullied in the previous week. One‐fifth of patients reported that they had been bullied in the previous week and less than one tenth reported that they had bullied others. The most frequent types of bullying reported were theft‐related, verbal abuse, being made to do chores, physical assaults and intimidation. One fifth of the sample reported that sexual abuse took place. Victims were generally perceived to be ‘easy targets’ that were vulnerable, either physically or emotionally. Staff identified a wider range of victim types than patients. The results highlight how patient‐to‐patient bullying does occur and is an important issue worthy of further research. A number of similarities were found between the current findings and those of prison‐based research suggesting that both hospitals and prisons share a number of environmental similarities that help to explain why bullying takes placed in secure forensic settings. Aggr. Behav. 30:229–242, 2004. © 2004 Wiley‐Liss, Inc.     

食管癌内镜技术最优化原则的思考

随着消化内镜及其配件的不断更新和内镜医师操作技术的进步,消化内镜在食管癌的应用从诊断为主发展到诊断与治疗并重.回顾历史,医疗需求是医学科学进步的强大动力,科学技术进步推动医学的发展,内镜技术的发展促进了食管癌诊断与治疗水平的最优化.     

慢性心力衰竭与恶性肿瘤发病机制的理论比较

阐明慢性心力衰竭的病理生理机制对制定防治策略具有重要的作用.根据"内因"与"外因"的辩证关系,借鉴时肿瘤发病机制的一些认识,从另外一个角度对慢性心力衰竭的发病机制进行细致的剖析,以期为临床防治提供一个全新的方向.     

从混沌角度浅谈凋亡悖论

细胞凋亡是生命科学研究的热点之一,随着近年来研究的愈加深入,新的发现对传统凋亡机制及观念提出了挑战,凋亡悖论应运而生。凋亡悖论的提出是一个值得深入探讨的哲学问题,表明需要对当前科学研究中的还原论方法和线性思维方式进行深刻反思,这提示对于生命现象这类复杂系统科学研究需要混沌思维。     

丙酸睾丸酮对MCF－7荷瘤裸鼠肿瘤生长的影响及临床意义

观察不同剂量丙酸睾丸酮对MCF-7荷瘤裸鼠肿瘤生长的影响,并探讨其可能机制和临床意义。构建MCF-7荷瘤裸鼠,再用不同浓度的丙酸睾丸酮（50mg／kg,400mg／kg）及化疗药物（表阿霉素）进行干预,比较各组实验鼠肿瘤的生长情况,并用微粒子发光法检测裸鼠血清睾丸酮的含量,用流式细胞技术检测肿瘤中雄激素受体的表达。发现...