科学分析临床试验结果维护公众健康

近20多年来,循证医学对推动我国疾病访治的科学化、规范化和现代化起到了积极推动作用。但以临床试验为基础的循证医学在我国的20年历程也出现了一些值得关注的问题。本文将向临床医生提供如下信息：如何正确分析临床试验结果,如何合理地将临床试验结果用于临床,以及如何向患者传递科学的医学信息,保护患者利益。     

以白求恩精神接诊老年口腔疾病患者

老年患者是口腔科门诊接诊患者中的特殊群体,本文从医学伦理学角度入手,从口腔疾病诊治中白求恩精神体现角度出发,对老年患者在进行口腔疾病治疗中的生理、心理状态进行分析,以白求恩“把救死扶伤、给患者解除生理及精神病痛,看作是自己最大的幸福”为指导原则。探讨如何能更有效的诊治老年患者口腔疾病,并更好的为老年口腔疾病患者服务。     

美国与知情同意有关的一些问题

知情同意是医疗保健和医学研究的一个基本的伦理学要求。这两种情况中,当医学研究的知情同意标准比医疗保健要求更加严格时,知情同意包含了3种要素：（1）告知病人或受试者该研究的性质。包括益处,危险和其他有关内容;（2）确保病人受试者理解所提供的信息;（3）得到病人或受试者自愿的同意,没有能力参与知情同意的病人包括患痴呆和危重病等无决断 能力的病人,这些病人属弱势病人。如要获许对他们的疾病进行研究,我们必须制定保护弱势受试者有效的伦理政策,提出了关于对痴呆病人、危重病人,脑死亡病人研究的伦理学政策。     

Chronic Sorrow in Caregiving Spouses of Patients with Alzheimer's Disease

The article focuses on the concept of chronic sorrow in a sample of individuals with Alzheimer's disease (AD) and their caregiving spouses. A study was designed to determine the long-term grief or chronic sorrow that develops in caregiving spouses and to increase knowledge of the nature of chronic sorrow. Utilizing the Burke Nursing Consortium for Research on Chronic Sorrow questionnaire and Lindgren's (1996) study as a prototype, the author discovered that repetitive feelings of sorrow and distress appear in caregivers when major disruptive changes occur in their lives due to the persistent demands caused by the illness. Continual coping skills are needed to keep caregivers from being mentally, emotionally, and physically depleted. The findings of this study are consistent with Lindgren's 1996 study of chronic sorrow in persons with Parkinson's disease.     

Object-location memory: A lesion-behavior mapping study in stroke patients

Object-location memory is an important form of spatial memory, comprising different subcomponents that each process specific types of information within memory, i.e. remembering objects, remembering positions and binding these features in memory. In the current study we investigated the neural correlates of binding categorical (relative) or coordinate (exact) position information with objects in memory. Therefore, an object-location memory battery was used, including different task conditions assessing object-location memory, i.e. memory for position information per se, and binding object information with coordinate and categorical position information. Sixty-one stroke patients with focal brain lesions were examined and compared with 77 healthy matched controls. The lesion subtraction method was used to define the area of overlap. Results indicate an important role of the left posterior parietal cortex in the binding of both categorical and coordinate positions with object information. Additionally, the hippocampus seems important for categorical object-location memory. This suggests that categorical and coordinate object-location memory depend on similar cognitive and neural systems.     

关注老年癌症止痛

虽然肿瘤的发病率在老年人并不低,但社会对老年人的关注度并不高。几乎所有肿瘤药物临床试验都把老年人排除在外,因此,不少药品说明书特别注明“缺乏老年人资料”。老年癌痛治疗领域也存在同样的问题。老年癌痛的病理生理及心理特点很独特,加之对老年癌病重视不够及缺乏正确评价,所以老年癌痛的研究相当复杂,因而癌痛的处理犹如癌症一样也需要综合治疗。癌痛治疗药物可分成两大类：非阿片类及阿片类药物。非阿片类药物中首选对乙酰氨基酚治疗轻度癌痛,非甾体类抗炎药,特别是选择性COX2抑制剂可在对乙酰氨基酚无效时应用。阿片类药物则广泛应用于中度到重度的癌痛治疗。辅助治疗药物包括三环抗抑郁药、抗惊厥药、苯二氮蕈类药物等。可用于癌痛三阶梯治疗的任一阶段,能够治疗特殊类型疼痛,改善癌痛以外的症状,增加主要药物镇痛效果,减轻副作用,但不推荐常规使用。总而言之,对于老年癌症患者更要强调以镇痛为主的姑息治疗,特别在重症老年患者,可能成为最重要的治疗,有时甚至是唯一有效妁治疗。     

Generalized Anxiety Disorder in Older Medical Patients: Diagnostic Recognition, Mental Health Management and Service Utilization

Background Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. Methods Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. Results Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, χ² (2, N = 225) = 4.75, p < .05. Conclusions Most patients with anxiety do not have anxiety or symptoms documented in their medical records.     

海洛因戒治者执行控制功能异常的电生理证据

执行控制障碍是成瘾的核心特征之一,对成瘾者的复发与康复治疗有重要影响。采用事件相关电位(ERP)技术分析海洛因戒治者和健康成年人在经典色-词Stroop任务中执行控制的大脑皮层时程动态变化。行为结果发现,两组被试的反应时均有显著的Stroop干扰效应,但无显著组间差异。ERP结果显示,戒治组不一致条件的平均波幅显著小于对照组;戒治组Stroop任务相关的N2效应和SP消失及N450效应衰减。研究结果表明,海洛因戒治者可能存在早期冲突监控加工障碍和晚期反应冲突解决加工异常。     

老年糖尿病患者人工髋关节置换术的围手术期处理体会

探讨老年糖尿病患者人工髋关节置换术围手术期的治疗方法。对2000年1月~2006年3月54例糖尿病患者行人工髋关节置换术进行术后随访,利用临床关节功能及放射学检查进行分析。54例手术患者血糖控制满意且顺利度过围手术期。按Harris评分标准,术后髋关节功能优良率分别为人工股骨头置换组74%(14/19),人工全髋关节置换组91%(32/35)。未发现感染及假体松动现象等并发症。老年糖尿病患者如果有髋关节置换手术指征,没有严重的并发疾病,在重视围手术期处理的情况下,可以行人工髋关节置换术,且疗效肯定。