临终关怀与职业道德建设

自1967年7月,英国的西希里·桑德斯博士创建世界上第一所临终关怀院—圣克里斯多弗临终关怀院以来,临终关怀在西方国家得到了长足的发展和推广。我国自1988年10月在天津成立我国第一个临终关怀研究中心以来,我国各地先后建立了一些不同类型的临终关怀机构,服务质量逐步提高,从事临终关怀工作的队伍也逐渐扩大,并逐渐引起了全社会的关注。临终意味着死亡,临终护理是指对那些在医学上已经确定为无法治疗,将在3￣6个月内死亡的患者的护理。我国的临终护理起步较晚,与西方国家有着很大的差距,临终护理的教育也甚少。然而提倡整体护理,势必包含临…     

ICU肝癌患者终末期临终关怀的护理体会

1967年,英国的桑德斯博士在伦敦开办了世界上第一所为临终患者提供服务的"圣克里斯多福临终关怀院"。由此,"临终关怀"这一人性化理念,犹如星星之火,迅速传遍世界。临终关怀的服务对象是患有恶性和非恶性疾病的病重垂危患者[1]。2014年1月—2014年12月对佑安医院重症肝病科ICU20例肝癌患者实施终末期临终关怀。现将护理体会报道如下。1临床资料晚期肝癌患者共收治20例,其中男12例,女8     

临终关怀本土化发展的困境与出路

梳理了临终关怀在我国本土化发展的情况,分析了当前我国临终关怀还存在传统文化对临终关怀的影响;公费医疗报销问题;临终关怀团队成员基本素质与临终关怀的照护水平不高;并在此基础上提出了具有针对性的开展死亡教育;重塑＂孝道＂观;明确责任主体,完善法律、法规;多方筹措资金,拓宽融资渠道;打造优秀的临终关怀队伍的建议。     

护理在临终关怀中的地位和作用

临终关怀是社会文明的标志,是社会发展的需要。文章综合论述了临终关怀的概念和我国发展临终关怀的意义以及各国临终关怀的发展概况,并进一步探讨了护理工作在临终关怀中的地位和作用。     

在农村开展终末期癌症病人临终关怀的研究

目的了解和研究农村终末期癌症病人临终关怀现状,并亲自深入病人家中进行临终关怀,探索农村临终关怀的科学服务模式。方法设计并在农村对终末期癌症病人或家属进行问卷调查,掌握本地资料及相关情况;对各类临终关怀实施人员进行培训;走访各乡镇,深入病人家中开展临终关怀工作。结果基本掌握了本地农村临终关怀的现状;农村癌症病人年龄大、文化程度和收入水平偏低,对临终关怀的认知度低,甚至有极少数病人不愿接受临终关怀,有自杀念头。临终关怀实施人员经过培训,其专业知识和技能均得到了非常大的提高;经过临终关怀小组医护人员对临终病人进行健康教育、治疗干预后,有291人安详地、有尊严地走完了人生最后里程,有100多个临终关怀病人得到了缓解,有的放弃了自杀念头,生命质量得到了提高,受到了病人及家属的赞扬。结论我国城市临终关怀事业取得了较大进展,但在广大农村尚不够普及,需要积极探索,进一步开展这项工作,这对建设和谐社会具有重大意义。     

临终关怀与医务社会工作

描述了临终关怀与医务社会工作在实务运用及价值体现方面的紧密联系,介绍运用个案工作、小组工作、社区工作等医务社会工作方法介入临终关怀,针对临终患者、家属、不同群体等方面开展专业服务,分析目前我国医务社会工作在临终关怀服务中发挥实际作用局限的现状以及面临伦理、观念、技能等方面的困境,就临终关怀理念、团队建设等问题提出了社会工作推动临终关怀服务发展的建议.     

英国美国临终关怀的发展经验对我国的启示

介绍了英美两国临终关怀事业的发展情况,综合论述了我国临终关怀遇到的几个主要挑战性问题:临终关怀处于供不应求的矛盾状态中,临终关怀团队少、工作人员专业素质不高,现有主要临终关怀模式可操作性不强。基于我国的基本国情,参考英美两国临终关怀的发展经验,提出了有关筹资、死亡教育、医务人员培训以及发展以社区为主的多样化模式等建议。     

临终关怀护士的素质与培养

本文从护士在临终关怀服务中的作用、临终关怀护士的素质等几方面论述了从事临终关怀服务的护士应具备的素质,并就如何养成的途径作了探讨。     

晚期肿瘤患者临终关怀服务的现状分析

上世纪80年代始,晚期肿瘤患者的临终关怀在我国得到重视和发展.我国部分大、中城市陆续建立起一些临终关怀机构,但远远不能满足实际需求.本文对晚期肿瘤患者临终关怀服务的现状、发展情况及我国目前临终关怀的模式进行了综述,"政府主导,社区卫生全科团队提供、家庭参与"的晚期肿瘤患者居家临终关怀模式适合于我国国情.     

临终关怀本土化的伦理困境及其建构

以照护为主的思想在东西方国家里有悠久的历史,现代意义的临终关怀起源欧洲?由于传统文化?伦理观念等因素影响,临终关怀在我国本土化发展过程中,陷入了伦理困境?文章从探讨临终关怀的源起?发展以及内涵开始,对临终关怀本土化的伦理困境做出分析,从宏观?微观层面建构临终关怀伦理,以解决临终关怀本土化的伦理困境,促进临终关怀本土化?     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…