心理干预对肺癌患者围术期的影响

为探讨心理干预对行肺叶切除术的肺癌患者应激反应及麻醉苏醒期的影响。选择60例患者随机分为对照组（A）与干预组（B）。A组常规术前准备,B组增加心理干预,结果A组较B组麻醉前心率快、血压高,苏醒期躁动发生率高,拔管时间长,儿茶酚胺增加;恶心、呕吐发生率无差异。可见心理干预能减少应激反应,利于麻醉手术及术后康复。     

外科手术在ⅢA期非小细胞肺癌治疗中的作用

ⅢA期非小细胞肺癌治疗方式存在争议,对于N1期患者,外科手术被广泛接受,对于N2期患者,国内外存在一定的分歧。对于N2期患者,外科手术治疗的效果主要取决于纵隔淋巴结转移情况,微灶转移和单站淋巴结转移患者,外科手术治疗效果比较满意,多站淋巴结转移患者外科手术治疗效果较差,而是需要做行根治性的放化疗。     

肺癌外科治疗方法和观念的演变

人类采用外科方法治疗肺癌已有100余年的历史.肺癌的外科治疗从最初非解剖性的肿瘤烧灼切除,发展到了全肺切除以及肺叶、支气管袖式肺叶、支气管肺动脉袖式肺叶切除、气管隆突切除重建等多种术式.近来,体外循环和微创技术也被应用到了肺癌的外科治疗领域,使肺癌的外科治疗技术有了极大发展.肺癌外科治疗中有关规范化手术、淋巴结清扫以及外科在小细胞肺癌中的地位等观念也有了澄清和转变.在今天肺癌外科治疗方法的发展已几近极致,而肺癌的外科治疗水平又裹足不前的情况下,回顾肺癌外科治疗方法和观念的演变、探讨未来的发展就有较为重要的现实意义.     

Personalized Occupational Transformations: Narratives from Two Occupational Therapists’ Experiences with Complex Therapeutic Processes

Recovery and occupation-centered practices with persons with severe psychiatric disabilities involve many dynamic issues and processes. This study aimed to develop an understanding of how the therapeutic process unfolds in occupational therapy among persons with severe psychiatric disabilities living in sheltered or supported housing. Repeated interviews were conducted with two occupational therapists working in sheltered and supported housing facilities. Narrative analysis was used to analyze their stories. The findings reveal “personalized occupational transformations” describing significant events of interaction establishing therapeutic processes to promote personal agency and social recovery while targeting meaningful activities based on each resident’s wishes.     

Older adults’ experiences of internet-based vestibular rehabilitation for dizziness: A longitudinal study

Objective: Factors influencing engagement with self-managed rehabilitation are not well understood, but evidence suggests they may change over time. Despite increasing digitalisation of self-managed interventions, little is known about the role of internet-based interventions in patients’ experiences of self-directed rehabilitation. This longitudinal qualitative study investigated individuals’ ongoing experiences of internet-guided, self-managed rehabilitation within the context of rehabilitation for dizziness.

Methods: Eighteen adults aged fifty and over who experienced dizziness used the ‘Balance Retraining’ internet intervention for six weeks. Participants took part in semi-structured telephone interviews at two-week intervals to explore their experiences. Data were inductively thematically analysed.

Results: The internet intervention was reported to facilitate engagement with rehabilitation exercises, providing motivation to continue through symptom reduction and simple but helpful strategies. It was perceived as informative, reassuring, visually pleasing and easy to use. Barriers to engagement included practicalities, symptoms and doubts about exercise efficacy. Participants’ perceptions did not always remain consistent over time.

Conclusion: The internet intervention may be a feasible method of supporting self-managed vestibular rehabilitation. More generally, longitudinal findings suggest that appearance-related perceptions of online interventions may be especially important for initial engagement. Furthermore, intervention features targeting self-efficacy seem important in overcoming barriers to engagement.     

微创手术治疗肺癌面临问题的思考

作为一种新兴技术,微创外科手术治疗肺癌备受争议.运用唯物辩证法的基本原理,分析这种技术产生的背景、临床应用价值及发展前景,并与传统手术方法作了客观辨证的比较.认为微创外科治疗肺癌,在临床应用有其积极意义,值得肯定.     

胸腔镜下非小细胞肺癌的外科治疗：一项原则和两个基本点

胸腔镜下肺叶切除术目前已经成为早期非小细胞肺癌外科治疗的首选手术方式。随着胸腔镜手术技巧和手术器械的不断发展,胸腔镜下肺叶切除术的方式千变万化。但不管采取何种手术方式,手术指征的严格把握,手术步骤的规范化是必须要遵循的。本文将从这些方面进行阐述。     

The Public Vocation of Lutheran Churches and the Rehabilitation of Zimbabwean Female Ex‐Prisoners

Abstract : This paper investigates the public role of the Lutheran churches in general. It also explores the role played by the Lutheran Church in Zimbabwe in its quest to rehabilitate female ex‐prisoners. The outcome of the study reveals that the Lutheran Church in Zimbabwe has been conspicuous in its absence regarding the rehabilitation of female ex‐prisoners. This negates the legacy of Martin Luther on the Church's public role; hence I recommend that the Zimbabwean Lutheran Church must take its rightful place in public discourse.     

晚期非小细胞肺癌化疗的冷思考

晚期非小细胞肺癌提倡以化疗为主综合治疗,可以延长生存期,提高生存率。但目前化疗取得的疗效虽然较既往有提高,但提高生存期有限,且在药效经济学方面存在争议,缓解症状的作用也有限,联合靶向治疗的疗效也在观望中。临床肿瘤学工作者应正确认识,以循证医学为指导,开展规范化化疗,同时也注重个体化化疗,并期待晚期非小细胞肺癌化疗的新突破。     

医学对急性呼吸窘迫综合征（ARDS）的认识

ARDS是一个临床综合征,其特征是炎症性肺水肿,严重的低氧血症,僵硬肺和弥漫性内皮和上皮损伤。既往50年中,特别是SARS在全球暴发以来,对ARDS病因、生理学、组织学和管理上有了重大的进展。然而,尽管围绕ARDS的研究显著增加,依然有许多重要问题亟待解决。