胃癌术后复发的临床分析

目的探讨胃癌术后复发的主要原因和形式以及复发后的冶疗方法。方法回顾性分析1996～2002年收治的64例胃癌术后复发病人的临床资料。结果64例病人中，早期复发占12．5％（8／64），中期复发占67．2％（43／64），晚期复发占20．3％（13／64）；胃癌术后复发的病人中Ⅲ期胃癌占56．3％（36／64）；再手术23例，其中根治性切除17例，早期复发切除率12．5％（1／8），中期复发切除率37．2％（16／43），晚期复发切除率46．2％（6／13）。结论术后复发与肿瘤分化程度、病理分期有关，首次手术应强调无瘤原则，复发者应注意有无手术指征，采取包括手术在内的综合冶疗措施，以改善病人的生活质量及预后。     

频复发肾病综合征复发因素探析

儿童频复发肾病综合征(简称FRNS,包括频反复)指原发性肾病综合征经糖皮质激素标准疗程后能缓解,但半年内复发(反复)≥2次,1年内复发≥3次。小儿肾病综合征(NS)复发率相当高,据统计25%￣43%呈频复发[1]。经多次复发后,部分患儿对激素敏感性逐渐下降,最终可能导致慢性肾功能不全。因此应积极寻找FRNS复发因素,采取相应对策控制和减少复发,改善患儿预后。复发主要因素有:1基因表达基因多态性被认为是基因表达的重要决定因素。apoE的3种主要异构体E2、E3、E4分别由位于一个基因位点的3个等位基因ε2、ε3、ε4编码。Kimsd[2]对190例NS患…     

直肠癌根治术后局部复发的诊治

1 复发时间和复发部位复发时间为术后4个月-7年，平均18个月，其中复发在1年内8例，1-3年17例，3年以上5例。复发部位为吻合口复发11例，盆腔淋巴结复发14例，盆腔脏器复发5例。     

尿路结石复发80例随访调查

近年来，我们无选择性对80例复发性尿路结石的患者进行随访调查，男64例，女16例，最小年龄13岁，最大年龄71岁，其中2例患者开放手术后复发行ESWL术后又复发2次，1例患者开放手术后复发又行ESWL术后复发1次。ESWL治疗40例次，开放取石术后复发45例次，见表1。     

精神分裂症92例复发调查

精神分裂症是一种患病率、复发率、致残率较高，疾病负担较重的慢性迁延性疾病，约50％～80％因病情复发而再次住院。为了解引起精神分裂症患者复发的相关因素，我们进行了回顾性调查分析，旨在为预防复发提供参考依据。     

两例白血病复发患者的克隆演化

两例白血病复发患者的克隆演化徐兵周淑芸刘启发孙竞目前发现部分白血病复发时，其基因型和免疫表型发生改变，白血病克隆的演化可能是某些白血病复发的根本原因。近年我院收治的白血病患者中，有２例可能是由于克隆演化而导致白血病复发。现报告如下。病例资料１例１，女...     

直肠癌术后局部复发因素分析

目的：探讨直肠癌术后局部复发的可能因素。方法：将直肠癌切除术后局部复发２８例与无复发３０例的临床资料进行对比分析。结果：直肠癌肿瘤们于腹膜反折以上术后复发８例，腹膜及折以下２０例（Ｐ〈０．０５），Ｍｉｌｅ‘ｓ术后复发１１例，Ｄｉｘｏｎ术后复发１７例（Ｐ〉０．０５）。术后正规化疗或放疗与非治疗者比较差异有显著意义（Ｐ〈０．０１）。结论：直脾性癌发生的部位和术后有否正规化疗或放疗是影响其术后局部复发的     

直肠癌Dixon切除术后局部复发因素探讨

本文通过对８８例直肠癌行Ｄｉｘｏｎ切除术后２８例局部复发病例进行了分析，提出了术后局部复发与年龄，组织学分类，Ｄｕｋｅｓ分期，直肠癌侵犯肠壁的程度，直肠癌与下切缘距离，有无淋巴结清除术，有无进行来瘤处理七大因素有关。     

直肠癌患者术后复发因素研究

目的 探讨影响直肠癌术后复发的因素，以便采取相应的措施来减少复发，提高患者的存活率。方法 对1992年4月至2004年4月我院直肠癌手术切除的病例291例，应用寿命表法和Kaplan-Meier法进行复发因素分析，采用Log-RankTest和Cox比例风险模型对影响复发的有关因素进行单因素分析和多因素分析。结果 复发146例，未复发145例。1年复发率23．04％，3年复发率44．60％，5年复发率50．79％，10年复发率55．09％。影响患者术后复发的主要因素包括年龄、性别、浸润深度和病理分期。结论 年龄、性别、浸润深度和病理分期是影响术后复发的主要因素。     

精神病人125例复发相关因素分析

目的 探索预防精神病人复发的相关对策。方法 对125例精神病人复发的相关因素进行调查分析。结果 年龄40岁以下，精神分裂症，病前性格内向和情绪不稳及精神病性格比例较高；复发相关因素为不依从医嘱，家庭矛盾，出院后无人照顾。结论 提高患对医嘱的依从性，培养其良好的心理素质，为其创造良好的生活环境，把出院后无人照顾的病人转介给社康机构，从而预防和减少精神病的复发，提高他们的生存质量。     

阅读疗法在围手术期患儿护理中的应用研究

目的 探讨阅读疗法对减轻患儿术后疼痛感、缓解患儿及陪护人员围手术期焦虑状态的干预效果.方法 选择2007年8月至2009年3月住院的患儿及陪护人员作为研究对象,2007年8月至2008年5月住院的153例患儿为对照组,2008年8月至2009年3月住院的153例患儿为干预组,对照组给予常规外科护理及疾病健康教育,干预组在对照组的基础上,接受阅读疗法-应用自行设计的"住院患儿阅读疗法读本"对干预组的153例住院患儿及陪护人员进行阅读干预,应用"改良耶鲁围手术期焦虑量表"(mYRAS)、"焦虑状态-特质问卷(STAI)"和FLACC量表、"Wong-Baker面部表情量表"分别比较2组患儿及陪护人员术前焦虑程度和2组患儿术后疼痛感受的差异性.结果 干预组和对照组患儿mYRAS评分结果分别是(35.875±4.441)分和(46.796±8.606)分,2组相比,评分结果差异显著.干预组和对照组陪护人员S-AI评分结果分别是(38.125±4.371)分和(49.901±7.420)分,2组相比,评分结果差异显著.术后1h,2组患儿Wong-Baker和FLACC评分结果相比,差异无统计学意义.术后6,24 h 2组患儿Wong-Baker和FLACC评分结果相比,干预组对疼痛的感受程度不论是主观评价还是客观评价均显著低于对照组.结论 阅读疗法能有效地改善患儿及陪护人员的焦虑水平,减轻患儿术后疼痛的感受,提高患儿的舒适度,有利于患儿术后康复.     

广州、东营两市7～18岁残疾儿童生长发育状况调查

目的了解广州、东营两市7～18岁残疾儿童(肢体残疾除外)的生长发育现状。方法采用定点普查的方法,对广州、东营两市7～18岁残疾儿童进行调查,通过测量残疾儿童身高和体重等指标,反映残疾儿童的生长发育现状。结果与同龄正常儿童相比,残疾儿童的身高、体重等普遍偏低,残疾儿童消瘦率男性为12.61%、女性为12.54%,生长迟滞率男性为31.41%、女性为34.49%。结论我国7～18岁残疾儿童生长发育状况较差,消瘦率和生长迟滞率均较高。     

Keystone Symposia: chemokines and chemokine receptors

Every other year the Keystone Symposia organises a meeting to discuss the state of the art in chemokine and chemokine receptor research. The focus of the meeting in the past has included the structural and functional identification of chemokines and their receptors. However, this year there was heavy emphasis on the role of chemokines on normal immune function and disease pathogenesis. A number of exciting results were presented and discussed, for example the role of chemokines and chemokine receptors in development and progression of tumours, induction and progression of auto-immunity, development of atherosclerosis and the resolution of infectious disease. The last session of the meeting was devoted to discussion of chemokine and chemokine receptor antagonists currently in preclinical development or Phase I clinical trials.     

Death the great leveller? Towards a transcultural spirituality of dying and bereavement

Aims and objectives. This paper aims to provide a critical engagement with the subject of transcultural spirituality and nursing practice in the context of dying and bereavement. Background. There has been considerable interest in the subject of spirituality over the past decade, and a particular association between the study of death and the study of spirituality. The nursing literature has been at the forefront of these developments amongst health and social care professionals. Some of this literature has begun to address the issues raised for culturally competent practice and the significance of patients’ belief systems in the diverse cultural contexts with which nurses must engage in contemporary health care. However, the author argues that understanding of the range of contemporary spiritualities and transcultural practice is at an early stage. Methods. Transcultural spirituality is explored through a critical review of the literature, including the author's own published research on spiritual and philosophical issues in death, dying and bereavement. Conclusion. The conclusion is drawn that some common themes and approaches can be found which offer a framework to guide nursing practice with the individual patient and family. Relevance to clinical practice. In the absence of guidance, nurses struggle with implementing spiritual care in the fluid and complex context of contemporary spiritualities and frequently resort to broad categorizations. This paper opens up a way of connecting with the unique spiritual position of each patient.     

The status of training and education in information and computer technology of Australian nurses: a national survey

Aims and objectives. A study was undertaken of the current knowledge and future training requirements of nurses in information and computer technology to inform policy to meet national goals for health. Background. The role of the modern clinical nurse is intertwined with information and computer technology and adoption of such technology forms an important component of national strategies in health. The majority of nurses are expected to use information and computer technology during their work; however, the full extent of their knowledge and experience is unclear. Design. Self‐administered postal survey. Methods. A 78‐item questionnaire was distributed to 10,000 Australian Nursing Federation members to identify the nurses’ use of information and computer technology. Eighteen items related to nurses’ training and education in information and computer technology. Results. Response rate was 44%. Computers were used by 86·3% of respondents as part of their work‐related activities. Between 4–17% of nurses had received training in each of 11 generic computer skills and software applications during their preregistration/pre‐enrolment and between 12–30% as continuing professional education. Nurses who had received training believed that it was adequate to meet the needs of their job and was given at an appropriate time. Almost half of the respondents indicated that they required more training to better meet the information and computer technology requirements of their jobs and a quarter believed that their level of computer literacy was restricting their career development. Nurses considered that the vast majority of employers did not encourage information and computer technology training and, for those for whom training was available, workload was the major barrier to uptake. Nurses favoured introduction of a national competency standard in information and computer technology. Conclusions. For the considerable benefits of information and computer technology to be incorporated fully into the health system, employers must pay more attention to the training and education of nurses who are the largest users of that technology. Relevance to clinical practice. Knowledge of the training and education needs of clinical nurses with respect to information and computer technology will provide a platform for the development of appropriate policies by government and by employers.     

Necrotizing fasciitis of the neck due to an odontogenic infection: A case report

Deep fascial space infections of the neck are most frequently odontogenic in origin. We describe a case of odontogenic infection of the mandible which extended to the lateral pharyngeal space and resulted in a severe life-threatening necrotizing fasciitis of the neck. A 69-year-old nondiabetic male complained of dysphagia and a severe toothache of the lower left molar and was transported to the emergency ward. A CT scan revealed swelling of the peritonsillar, lateral pharyngeal and masticator space with narrowing of the airway of the middle pharynx. The patient underwent a tracheotomy with surgical drainage. The strap muscles, including the fascia, of the neck were necrotic. He was treated with a combination of ampicillin and clindamycin-2-P. On the second postoperative day, the patient's platelet count fell to 20,000/mm³. The patient was transfused with platelet concentrate, and given gamma globulin and gabexate mesilate, and his predisseminated intravascular coagulation (DIC) status improved. However, on the eight post operative day, progressive tissue necrosis of the face and neck was observed. Panipenem betamipron was started and continued for 20 days. A second extensive surgical debridement of the neck and face was carried out, and the patient ultimately recovered.Prevotella buccae, Streptococcus intermedius, Lactobacillus fermentum, L. casei, L. catenaforme, L. acidophilus, andBifidobacterium sp. were isolated from either the peritonsillar, submandibular, lateral pharyngeal or carotid space abscesses. We emphasize the importance of proper diagnosis, early surgical intervention and systemic antimicrobial chemotherapy to control this aggressive infectious disease.     

Masterworks of art and chronic illness experiences in the elderly

AIM: This article presents findings of a qualitative study, conducted between 1997 and 2000, to investigate the plausibility of integrating masterworks of art with care of the chronically ill elderly, and to analyse perceptions about chronic illness among three groups: registered nurses, nursing students, and the elderly. BACKGROUND AND SIGNIFICANCE: Statistically the incidence of chronic illness increases in the elderly. Although pathophysiology of chronic illness is increasingly understood, few studies explore the experience of living with chronicity from the perspective of the elderly. Understanding and intervening appropriately for the elderly with chronic illness may contribute significantly to improving quality of life for this growing population. ETHICAL ISSUES AND APPROVAL: The study was approved through an Institutional Review Board. Facility permission and participant informed consent were obtained. Anonymity and confidentiality were protected. DESIGN: Using hermeneutic phenomenology and masterworks of art as a centre point for dialogue, the investigators explored the perceptions of nurses, students, and the elderly about living with a chronic illness. A purposive sample of 65 participants made up seven focus groups with which group interviews were conducted. Themes were explicated and analysed from audiotaped interviews until data saturation was reached. FINDINGS: Content analysis of focus group interviews revealed themes of social isolation, inevitable role change, and inertia-movement. Only the elderly acknowledged hope and a steadfast refusal to give up, while nurses and students viewed chronicity more negatively. Themes of social isolation and role change are consistent with other studies of the elderly. A paradox of inertia-movement in the chronically ill elderly has not been reported in the nursing literature. CONCLUSIONS: Paradoxical tension of inertia-movement in the chronically ill elderly appears to be linked to the broader concept of energy in nursing science, and to Parse's theory of human becoming. Masterworks of art can generate energy exchange between the elderly and caregivers, providing a plausible catalyst for meaningful interventions that transcend age and practice settings.     

Geriatric Oncology,Spirituality, and Palliative Care

Cancer is a major cause of morbidity and mortality for older individuals. Palliative care is essential to improve the outcome of cancer treatment in terms of quality of life and treatment satisfaction. This review examines the influence of spirituality on aging in general and on the management of older cancer patients. A spiritual perspective has been associated with successful aging, and with better tolerance of physical and emotional stress, including the ability to cope with serious diseases and with isolation. It has also been associated with decreased risk of suicide and depression. Gerotranscendence, the more urgent search for meaning by older than younger individuals, confirms the importance of spirituality in this phase of life. Spirituality has also improved the quality of life and reduced the risk of disease and death for the patient's caregiver. Addressing patient and caregiver spirituality may render the palliative care of cancer more effective and may also aid in detection and management of spiritual pain, which may prevent healing at the end of life.     

妊娠期糖尿病孕妇自我管理评价量表的研制及信效度检验

目的 研制妊娠期糖尿病孕妇自我管理评价量表并检测其信效度,为医护人员对该群体的健康教育及管理提供参考。方法 基于社会认知理论及健康赋权理论,通过半结构式访谈、文献回顾及2轮专家咨询形成初始量表;2018年11月—2019年3月便利选取226例妊娠期糖尿病孕妇进行调查,对量表进行项目分析及信效度检验。 结果 妊娠期糖尿病孕妇自我管理评价量表包括自我管理意识、孕期管理、血糖管理、资源利用4个维度,共32个条目,该量表的Cronbach’s α系数为0.939,折半信度为0.780,重测信度为0.903（P<0.05）,内容效度指数为0.927,探索性因子分析提取4个公因子,累计方差贡献率为55.636%。 结论 妊娠期糖尿病孕妇自我管理评价量表可信度高,可作为医护人员评估妊娠期糖尿病孕妇自我管理水平的工具。     

The problem drinker's lived experience of suffering: an exploration using hermeneutic phenomenology

Research in the area of problem drinking has traditionally relied on quantitative methodologies which view the problem from the researcher's perspective. The purpose of this hermeneutic-phenomenological study was to describe and understand the problem drinker's lived experience of suffering using a philosophy and research approach which preserves the uniqueness of the experience from the sufferer's point of view. The method involved conducting in-depth interviews with a sample of six problem drinkers. Interviews were analysed using an interpretive process, which aimed at generating a deeper understanding of the topic by facilitating a fusion of the world views of both participant and researcher. A reflexive journal recorded the involvement of the self of the researcher throughout the research process. Suffering was viewed as a spiralling vicious circle of physical, psychological, social and spiritual distress. Symptoms of physical dependence, shame and guilt emerged strongly as being both sequelae of heavy drinking and cues to further drinking bouts. Evoking memories of previous suffering through telling one's story was found to be an empowering and motivating force. The results have relevance to specialist and generic workers, who are urged to pay greater attention to the social, psychological and spiritual care of problem drinkers.