肝癌的个体化治疗策略

肝细胞癌（肝癌）治疗手段已较10年前有较大变化,但国内尚缺乏较为统一的治疗指南。制定治疗指南的工作需以生存为主要评价指标,并采用临床病理指标或生物学指标将患者分类,然后比较各种治疗方案对该类患者生存的影响。     

重症急性胰腺炎预防抗生素治疗的争议

重症急性胰腺炎伴随高病死率,细菌和真菌感染是其导致死亡的主要原因之一。目前治疗一般采取预防性抗生素治疗,但预防性抗生素治疗又可能会加重二重感染。目前研究结果数量有限,结果不一。是否应该应用预防抗生素治疗仍然存在争议,期待更多设计合理的随机对照试验。     

常见吸毒患者的临床麻醉处理

毒品滥用患者给医疗管理和临床工作带来诸多复杂性和特殊性。对吸毒患者围术期麻醉诊疗要兼顾所惠外科疾惠与毒品对吸食者的身心影响,有效地控制戒断症状和毒性反应,综合评估,辨证施为。     

Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial

Previous studies on Internet-based treatment with minimal to moderate therapist guidance have shown promising results for a number of specific diagnoses. The aim of this study was to test a new approach to Internet treatment that involves tailoring the treatment according to the patient’s unique characteristics and comorbidities.A total of 54 participants, regardless of specific anxiety diagnosis, were included after an in-person, semi-structured diagnostic interview and randomized to a 10 week treatment program or to a control group. Treatment consisted of a number of individually-prescribed modules in conjunction with online therapist guidance. Significant results were found for all dependent measures both immediately following treatment and at 1 and 2 year intervals. Mean between-group effect size including measures of anxiety, depression and quality of life was Cohen’s d = 0.69 at post-treatment, while the mean within-group effect size was d = 1.15 at post-treatment and d = 1.13 and d = 1.04 at 1 and 2 year follow-up respectively.The tentative conclusion drawn from these results is that tailoring the Internet-based therapy can be a feasible approach in the treatment of anxiety in a homogeneous population.     

Multiple family groups for adult cancer survivors and their families: a 1-day workshop model

With marked advances in early detection and aggressive multimodality treatment, many adult cancers are now associated with good prognoses for disease-free survival. A burgeoning literature examining posttreatment quality-of-life issues has highlighted the numerous challenges experienced by patients and families in the aftermath of cancer treatment, further underscoring a need for new family-based psychosocial support interventions for cancer survivors and their families. This paper describes the clinical protocol for one such intervention, a 1-day "workshop" version of a multiple family group (MFG) for head and neck cancer survivors and their families. Data are reported from our experiences in running five 1-day workshops. Families uniformly reported that they were highly satisfied with their MFG participation, leading us to conclude that the abbreviated 1-day MFG model we are advocating is a promising family-focused support intervention for cancer survivors and their families.     

重症免疫性血小板减少性紫癜紧急救治方案的探讨

为了探讨重症免疫性血小板减少性紫癜(ITP)的治疗方案,回顾性分析118例接受激素(92例)或丙种球蛋白(16例)或rhTPO(10例)治疗患者的临床资料,分析疗效及不良反应。结果显示:(1)激素组、丙种球蛋白组和rhTPO组总有效率分别为76.1%、81.3%和70%,组间差异无统计学意义。复发组有效率(67.3%)明显低于初治组(83.3%,P0.05),PAIgG伴PAIgM升高组有效率明显低于不伴PAIgM升高组(P0.05);(2)血小板达峰时间:激素组为(5.70±3.68)d,丙种球蛋白组为(4.31±0.75)d,rhTPO组为(5.00±1.63)d,激素组与丙种球蛋白组间差异有统计学意义(P0.05);(3)不良反应:激素组均出现类库欣综合征表现,丙种球蛋白组未见不良反应,1例(10%)rhTPO组患者出现轻度转氨酶增高。总之,丙种球蛋白和rhTPO治疗成人重症ITP疗效好,不良反应轻微。     

老年高血压治疗决策的个体化和系统化

高血压是严重危害老年人健康的常见病,老年人高血压临床症状及特点与中青年高血压有显著不同,在诊断治疗中应注重老年人血压升高的病理生理特点及机制,在老年高血压的治疗决策中运用个体化和系统论的原则,选择个体最优化综合治疗决策,启思和引导老年高血压研究水平的纵深发展,积极有效地改善老年人的生活质量。     

老年人行结肠镜检查相关问题探讨

结肠镜检查是一项广泛用于临床的直观有效的诊断结肠疾病的方法。对于整体机能减退的老年人来说,我们可从结肠镜前准备工作中的三个方面:肠道准备用药的比较选择、基础合并症的处理以及医患交流和心理护理提高老年患者对结肠镜的耐受性。     

血液病治疗中的人文关怀

新医学模式指出人文关怀在医疗服务中有重要意义。目前我们在血液病治疗中对人文关怀重视不够。由于大部分血液系统疾病起病隐匿,发病机制不清,病程长,并发症多,所以预后差,再加上治疗费用高,社会角色转变困难,很容易使患者产生焦虑、抵触、恐惧、多疑、抑郁等心理问题,并影响和谐医患关系的建立。人文关怀有助于缓解患者的心理问题,促进良好医患关系的建立,加速疾病的恢复,提高患者的生存质量。     

搞好哮喘控制是一项长期而艰巨的任务

哮喘在全世界是一个严重的公共卫生问题。当哮喘未控制时,哮喘可以影响患者的日常生活质量,甚至可以致命。搞好哮喘控制工作是一项长期而艰巨的任务,在实际工作中应推广以“哮喘临床控制”为核心的哮喘治疗循环模式,即评估患者的哮喘控制水平、治疗并达到哮喘控制、监测并维持哮喘控制。