医疗政策中的性别权力不平等:农村宫颈癌筛查的建制民族志分析

用建制民族志方法,访谈甘肃武都地区6位参与过宫颈癌筛查的农村妇女,3位未参与过宫颈癌筛查的农村妇女,1位宫颈癌筛查项目负责人以及2位参与筛查工作的医师,分析了中国农村宫颈癌筛查政策的不足。研究结果显示,现有的政策只针对女性身体,没有涉及男性,忽略了对女性心理层面的关怀,且缺乏对过度医疗化的有效规定。因此,建议政策制定应该纳入女性的声音,突显心理关怀和性别平等,并且探索解决过度医疗化的有效方式。     

诊断技术增强与癌症恐慌考量

癌症危及生命,人们寄希望于“三早”战略能带来福音。随着诊断技术增强,癌症发病率急剧飙升,但人群中癌症死亡率却没有明显降低,而由此引发的癌症恐慌趋势日益加剧。当今对癌症二级预防战略仍存在很多争议,尤其是引发的过度诊断和过度治疗更是备受关注。“三早”问题的关键并非是其本身问题,而是在于如何解释和应用“三早”原则。肿瘤可以早发现,但绝不能早恐慌;癌症应该早治疗,但权衡利弊很重要。人们应该以自然的心态应对恐慌,以整合的理念解决现代肿瘤问题。     

医护患共同决策的影响因素及实施路径——以乳腺癌为例

医护患共同决策有利于帮助患者参与到临床治疗决策当中,提高患者依从性,改善治疗效果。这并非患者参与治疗决策的讨论与选择即可达到的。共同决策的有效实施需要医护人员、医院、患者及家属的共同参与。医护人员需要了解并分析影响患者参与共同决策的因素,加强彼此的沟通,鼓励帮助患者参与当中;而患者也需要具备一定的疾病相关知识才能更好地参与;医院作为医护人员与患者之间的载体,其所提供的恰当支持在共同决策中起着重要作用。医护人员应分析了解乳腺癌患者参与共同决策的现状,以促进医护患共同决策的有效实施,为乳腺癌患者的顺利诊疗多做贡献。     

非小细胞肺癌术后化疗循证医学证据引发的思考

肺癌是目前对人类生命威胁最大的恶性肿瘤之一.对非小细胞肺癌术后化疗的循证医学证据及由此引发的思考:对循证医学的局限性及认识真理的曲折性进行了阐述.     

Abortion, embryonic stem cell research, and waste

Can one consistently deny the permissibility of abortion while endorsing the killing of human embryos for the sake of stem cell research? The question is not trivial; for even if one accepts that abortion is prima facie wrong in all cases, there are significant differences with many of the embryos used for stem cell research from those involved in abortion—most prominently, many have been abandoned in vitro, and appear to have no reasonably likely meaningful future. On these grounds one might think to maintain a strong position against abortion but endorse killing human embryos for the sake of stem cell research and its promising benefits. I will argue, however, that these differences are not decisive. Thus, one who accepts a strong view against abortion is committed to the moral impermissibility of killing human embryos for the sake of stem cell research. I do not argue for the moral standing of either abortion or the killing of embryos for stem cell research; I only argue for the relation between the two. Thus the conclusion is relevant to those with a strong view in favor of the permissibility of killing embryos for the sake of research as much as for those who may strongly oppose abortion; neither can consider their position in isolation from the other.     

从胰腺移植到胰岛干细胞移植

糖尿病学家在胰腺及胰岛细胞移植领域进行了不懈的探索。胰腺移植和胰岛细胞移植的两大制约因素是可供移植的胰腺来源少且诱发受体免疫排斥反应而需应用免疫抑制剂。胰岛细胞制备、纯化技术以及免疫隔离技术的应用在一定程度上克服了上述两大制约因素，人们期待胰岛干细胞技术及其相关的基因技术的深入将这一技术趋于完善。     

Development and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence

This paper describes the development, content, and preliminary results of a group cognitive-behavioral therapy (CBT) for fear of cancer recurrence (FCR). A manualized CBT intervention was developed and offered to 38 patients with various cancer types and stages in two hospitals. Four weekly group CBT sessions were administered by two licensed psychologists as part of routine care. Patients completed self-report scales before the first treatment session and, a second time, 1 month after the last session.Overall, 33 patients had clinical levels of FCR at baseline. The participants’ satisfaction toward the group CBT for FCR was high. Significant reductions on the total score and most subscales of the Fear of Cancer Recurrence Inventory (FCRI) were observed, as well as significant improvements on most of the other psychological variables measured (i.e., insomnia, anxiety, depression, dysfunctional beliefs about cancer, and intolerance of uncertainty). In addition, 52% of the patients with clinical levels of FCR (FCRI-severity subscale score ≥ 13) at baseline no longer reached this clinical threshold at posttreatment.These preliminary results suggest that our group CBT for FCR is well accepted and feasible, and shows promising efficacy for decreasing FCR and improving other psychological variables among cancer patients. The next step is to investigate the efficacy of this minimal intervention in larger and controlled clinical trials, as well as its usefulness as part of a stepped care approach.This low-cost intervention is easy to implement in various clinical settings and has a strong potential to help large numbers of patients with FCR.     

Predictors of adherence to aerobic exercise in rectal cancer patients during and after neoadjuvant chemoradiotherapy

This pilot study explored predictors of adherence to exercise during and after neoadjuvant chemoradiotherapy (NACRT) in rectal cancer patients. Eighteen rectal cancer patients were prescribed three supervised aerobic exercise sessions/week during NACRT followed by ≥150 min/week of unsupervised aerobic exercise after NACRT. Although not statistically significant, adherence to supervised exercise during NACRT was meaningfully better for patients who were women (d = .82; P = .12), younger (d = ?.62; P = .30), married (d = .62; P = .42), with better mental health (r = .32; P = .21), fewer diarrhea symptoms (r = .48; P = .052), and higher anticipated enjoyment (r = .31; P = .23), support (r = .32; P = .22), and motivation (r = .31; P = .23). After NACRT, adherence was significantly better for patients who reported worse mental health (r = ?.56; P = .046) and meaningfully better for patients who were women (d = .54; P = .38), better educated (d = .77; P = .22), had no comorbidities (d = ?.63; P = .17), and exercised at baseline (d = 1.05; P = .12). Demographics, tumor side effects, and motivational variables may predict adherence to exercise during and after NACRT.     

末期癌症患者的临终关怀

临终关怀与末期癌症关系密切,末期癌症患者是临终关怀的主要对象,这也是姑息医学的主要内容。作为发展中的学科,本文对临终关怀的发展、目的、内容及其在末期癌症患者中的实施作一综述。     

台湾地区姑息医学制度的建立及法律实践

姑息治疗在提高晚期癌症患者生活质量、实施临终关怀、给予病人及其家属全面周到的照顾诸方面起着重要作用。在台湾,已为姑息治疗立法并实施了10年,积累了丰富的经验。这项法律本身及其细则、附件等配套文件使姑息治疗更加规范可行。研究规范的姑息治疗及台湾的相关法律可以帮助我们更好的理解姑息治疗的理念,帮助发展大陆同道构建有效实用的...