Issues Involving Informed Consent for Research Participants with Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia which is estimated to impact 350,000 people over 65 years of age in Canada. The lack of effective treatment and the growing number of people who are expected to be diagnosed with Alzheimer’s disease in the near future are compelling reasons why continued research is in this area is necessary. With additional research, there needs to be greater recognition of the complexity of seeking ongoing informed consent from those with Alzheimer’s disease. This complexity is because the impairment of memory and cognitive ability does not diminish in a linear manner, but rather fluctuates between periods of impairment and relatively normal cognitive lucidness. There is limited discussion in the guidelines of those progressing from early stages of Alzheimer’s disease who have intermittent cognitive function. Guidelines to research and Research Ethics Boards require further development to facilitate researcher including those with Alzheimer’s disease while protecting this growing pool of potential participants.     

Impulsivity as a predictor of newly-diagnosed peptic ulcer disease: A prospective cohort study

We examined the role of impulsivity in the development of peptic ulcer disease (PUD). The subjects were initially healthy 4636 hospital employees aged 19–62 who responded to a questionnaire on personality, health habits, mental health, and PUD in 1998 and 2000. We used multivariate logistic analyses to determine the relationship between impulsivity and newly-diagnosed PUD among those employees who did not have PUD at baseline. Impulsivity was assessed with the Karolinska Scale of Personality. High level of impulsivity was associated with increased 2-year incidence of doctor-diagnosed PUD after adjustment of age, gender, education and shift work (odds ratio = 2.42, 95% confidence interval = 1.21–4.82). Additional adjustment for the effects of smoking, alcohol consumption, BMI, physical activity, minor psychiatric morbidity and diagnosed depression and other psychiatric disease had little effect on this relationship. The present study suggests that impulsivity may be a risk factor for the development of PUD.     

呼吸危重症临床决策中的若干问题

在临床实践中,呼吸危重症的诊断和治疗存在着一些不同的观点。就其中某些热点问题,如慢性阻塞性肺疾病合并哮喘的诊断和机械通气的指征、肺栓塞的诊断、急性呼吸窘迫综合征的治疗、呼吸重症监护病房的建设和呼吸危重症的伦理学问题进行阐述,以期提高对呼吸危重症的认识。     

从能量观疾病

能量在机体的各种离子、分子、细胞、器官、组织、系统间协调分布,共同维持着健康状态。某一病因作用于人体后,“协调分布”会被不同程度地打破,当超过一定的阈值,就会产生疾病。对于人体,各种能量的直接表现形式和能量的携带者——各种营养物质,都与疾病之间有着千丝万缕的联系。从“能量”角度,我们既可进一步探讨尚未阐述清楚的疾病发生机制,又可以设计更为完美的治疗方案与医学仪器。     

非传统理念指导下的传统技术导致应用医学重大课题的突破--关于2005年诺贝尔生理学或医学奖

发现幽门螺杆菌(Helicobacter pylori,以下简称Hp)导致慢性胃炎和消化性溃疡,是沃伦和马歇尔获得2005年诺贝尔医学奖的原因.他们在1982年得出的这一假说,违反了关于这一类慢性病传统的发病机制理念.可能因为这一理念的反传统性,其假说被世界同行基本接受大概经历了20年时间.值得强调的是,对HP的观察、分离、培养、鉴定和人体试验,以及它与疾病相关的诊断、治疗、临床流行病学等研究,应用的都是传统的医学技术.从而表明,即使到了20世纪80年代,传统技术仍能导致诺贝尔奖级科研成果的出现.     

Depression in Women with Heart Disease: The Importance of Social Role Performance and Spirituality

Compared with men, women are more likely to experience depression, and depression increases risk of morbidity and mortality in individuals with heart disease. Psychosocial interventions have been developed for depressed patients with heart disease; however, women's experience of chronic disease differs from men's and women may benefit from interventions tailored to address their difficulties. Spirituality and social roles have been related to depressive symptoms in other populations. To identify the relationship between depression and spirituality and social role performance (i.e., role concerns, role rewards and confidence in ability to fulfill roles) in women with heart disease, we assessed depressive symptoms, spirituality, social role functioning and medical history in 125 women with heart disease. After controlling for age and severity of medical conditions, spirituality, role confidence and role concerns were significantly associated with depressive symptoms. Consideration of spirituality and aspects of social role performance may be important when developing psychosocial interventions for depressed women with heart disease.     

诺贝尔生理学或医学奖美国获得者学术条件背景分析

在诺贝尔生理学或医学奖105年的历史中,美国分别占了颁奖年度的52.08%,获奖成果的44.87%,获奖人数的48.91%.形成这些科学家学术优势积累和美国国家科技竞争优势的学术条件背景是:适宜的宏观政策,充足的经费投入,成功的人才政策,根本的教育改革和创新的科技管理.     

用科学的证据和科学的管理指引心血管疾病的防治

心血管疾病的防治不仅仅是心血管医生的问题,还是一个在循证医学引领下的一个全民生活方式改变的问题,也需要多学科相关专业的联盟,涉及心血管疾病治疗规范的形成与普及,对于疾病发生、发展各个阶段的科学管理更是冠心病的防治效果的重要保障。本文针对心血管病冠心病预防的具体实施,从几方面打开了一个全新的视野。     

控制心血管疾病的根本出路在于预防

心血管疾病的根本发病基础是动脉粥样硬化血栓形成,在这一认识基础上,近年来在冠心病预防方面提出了一系列颠覆性的概念,如“冠心病等危症“、“心血管疾病是代谢性血管疾病”等。本文以全新的理念、形象地描述、深入地分析,从动脉粥样硬化血栓形成的各个阶段,阐述了冠心病综合预防在控制冠心病过程中的重要作用。     

替代指标在心血管疾病临床决策中的正确认识

在心血管疾病临床试验中,替代指标常用于评价干预措施的疗效。但替代指标在心血管疾病临床试验中非常复杂,因此,心血管医生在解读和评价心血管疾病临床试验的结果时,应正确认识替代指标的内涵、应用背景及其局限性,同时,还应客观地评价相关替代指标的证据强度,以寻找最好的医学证据指导其临床决策和实践。