肿瘤综合治疗中的循证医学和个体化治疗

现代医学模式已经由单纯的生物医学模式转变为"生物-心理-社会"医学模式,由经验医学转变为以证据为基础的循证医学(EBM),这一指导临床医学实践的新模式,在肿瘤的综合治疗中起到了重要的指导作用;同时"个体化治疗"也是肿瘤综合治疗中不可忽视的原则之一,在肿瘤的治疗中占有越来越重要的地位.在实际的临床工作中,"循证医学"和"个体化治疗"这两个概念并非相互对立,而是相辅相成、密不可分的,现代肿瘤专科医师,必须掌握这些概念并在实际工作中努力贯彻、综合运用,才能制定合理的肿瘤综合治疗方案,最大限度维护患者的利益、得到最佳的治疗效果.     

孕前-围产期个体化系统管理模式的实施效果评价

目的探讨在孕前—围产期实施个体化系统管理模式对围产期母婴健康的影响。方法选取在门诊进行孕前咨询或孕早期产前诊断的育龄妇女812例,用随机数字法平均分为观察组与对照组各406例,观察组实施全程个体化系统管理模式,对照组给予常规健康教育指导和母婴保健措施,两组产后42d进行对照分析。结果两组妊娠期并发症、妊娠结局、新生儿结局、新生儿畸形、母乳喂养成功率及产后母婴一般情况等方面进行比较,差异有统计学意义(P<0.05)。结论在孕前—围产期全程实施个体化系统管理模式能提高孕产妇的自我保健意识、降低妊娠期并发症、新生儿出生缺陷率及剖宫产率,提高纯母乳喂养率等在保障母婴健康诸多方面有显著效果。     

Individualized health behavior? Social structures, peer influences and life style as modifying factors of nutritional behavior of adolescents

Summary. Objective: Health behaviours are often explained as being determined by health knowledge, occupation, education and income. Yet, in increasingly individualized societies individuals are brought to develop personal strategies of orientation and behaviours, the later being detached from traditional status or class membership. The present study (secondary analysis) explores to what extent health behaviours are more or less individualized or still linked to social living conditions.Methods: Eating behaviours and social status are based on a 2001 questionnaire survey among 393 randomly selected adolescents from the city of Leipzig, Germany.Results: The findings show a distinct social patterning of eating behaviours. Those patterns can be explained as part of adolescents’ lifestyles. Findings also indicate that the patterns of eating behaviours are strongly linked to the social background of those adolescents.Conclusions: It is concluded that for adolescents raised in deprived social conditions it is more difficult to develop health preferences conducive for health promoting behaviours.Der Artikel basiert auf einem Vortrag mit ähnlichem Titel, der auf dem Kongress der Gesellschaft für Gesundheitspsychologie gehalten wurde. Dank geht an Heike Diefenbach, die mit kritischen Fragen hilfreich zur Seite stand.     

集群结合个体化的自我效能护理干预对血脂异常者运动依从性的影响

目的探讨集群结合个体化的的自我效能护理干预对血脂异常者运动依从性的影响。方法将随机抽取的两所高校77例血脂异常的教师分为两组,两组均进行1次4阶段式集群健康教育,试验组在此基础上增加个体化指导、集群自发小组锻炼和集群微信平台互动的自我效能护理干预。干预时间共3个月,并于干预后当天、干预后3个月和6个月对两组进行随访。结果干预后,试验组各时间点GSES评分均高于对照组(P0.05),运动达标率与对照组比较,有统计学差异(P0.01),且GSES评分与运动次数存在显著正相关,另外,试验组干预后6个月TC、TG和LDL-C水平低于对照组(P0.05)。结论集群结合个体化的的自我效能护理干预能够增强血脂异常者的自我效能感,改善运动依从性和血脂状况,可在血脂异常防治工作中进行推广应用。     

幽门螺杆菌个体化精准根治的研究进展

幽门螺杆菌（Helicobacter pylori,Hp）感染与消化道疾病及全身多个系统的发病相关,其感染率高、致病力强,威胁着人们的身体健康。近年来由于抗生素的滥用,抗生素耐药呈逐年上升趋势,从而导致Hp根除率下降,成为临床棘手的问题。近年来,为了努力提高Hp根除率,国内外学者做了积极探索,提出了“个体化”精准根除治...     

鼻咽癌治疗研究进展

鼻咽癌是中国南方常见恶性肿瘤,治疗方法的不断改进和优化一直是鼻咽癌研究的重要课题。本文介绍了对鼻咽癌患者采取放射治疗、化学治疗、手术治疗和生物治疗4种治疗方法及其研究进展。放射治疗是鼻咽癌的主要治疗方式,诱导化学治疗加适形调强同步放/化疗已成为晚期鼻咽癌治疗推荐的标准方法,手术治疗可使部分残留和复发患者获益,生物治疗越来越凸显其重要作用。在鼻咽癌诊疗指南的指导下实施个体化治疗有助于提高患者的生存质量。     

Timing of individualized surgical intervention in Crohn’s disease

Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing incidence worldwide. Comprehensive therapy for CD focuses on symptom control and healing the intestinal mucosa to improve the quality of life and prevent complications. Surgical intervention plays a vital role in comprehensive therapy. However, deciding the optimal timing for surgical intervention has long been a focus of controversy. This review provides insights into the timing of surgery for CD and guides clinicians in daily treatment.     

Dose-controlled tDCS reduces electric field intensity variability at a cortical target site

BackgroundVariable effects limit the efficacy of transcranial direct current stimulation (tDCS) as a research and therapeutic tool. Conventional application of a fixed-dose of tDCS does not account for inter-individual differences in anatomy (e.g. skull thickness), which varies the amount of current reaching the brain. Individualised dose-control may reduce the variable effects of tDCS by reducing variability in electric field (E-field) intensities at a cortical target site.ObjectiveTo characterise the variability in E-field intensity at a cortical site (left primary motor cortex; M1) and throughout the brain for conventional fixed-dose tDCS, and individualised dose-controlled tDCS.MethodsThe intensity and distribution of the E-field during tDCS was estimated using Realistic Volumetric Approach to Simulate Transcranial Electric Stimulation (ROAST) in 50 individual brain scans taken from the Human Connectome Project, for fixed-dose tDCS (1 mA & 2 mA) and individualised dose-controlled tDCS targeting left M1.ResultsWith a fixed-dose (1 mA & 2 mA), E-field intensity in left M1 varied by more than 100% across individuals, with substantial variation observed throughout the brain as well. Individualised dose-control ensured the same E-field intensity was delivered to left M1 in all individuals. Its variance in other regions of interest (right M1 and area underneath the electrodes) was comparable with fixed- and individualised-dose.ConclusionsIndividualised dose-control can eliminate the variance in E-field intensities at a cortical target site. Assuming that the current delivered to the brain directly determines its physiological and behavioural consequences, this approach may allow for reducing the known variability of tDCS effects.     

个体化早期综合干预对代谢综合征患者康复效果的研究

目的 探讨对代谢综合征患者进行个体化早期综合护理干预的康复效果.方法 选取2009年3月至2010年3月在体检中心被确诊为代谢综合征的患者120例,随机分为研究组(个体化早期综合干预组)和对照组(常规干预组)各60例.对照组接受药物治疗和一般健康指导.研究组在常规护理干预的基础上针对个体状况早期进行心理、饮食、运动、生活方式、生活习惯、自我监测和家庭支持等综合干预.结果 研究组患者掌握健康知识情况、生活方式及生活习惯改变情况和各项异常指标改善情况明显优于对照组.结论 对代谢综合征患者进行个体化早期综合护理干预,能明显改善各项异常指标,提高患者生活质量.     

临床护生性格缺陷及个体化护理带教体会

目的:探讨针对护生的性格特点,采取不同特色的个体化带教的方法。方法:每位护生以两周为科室实习周期,通过两位科室分带教老师一对一带教,通过工作中的观察和沟通,了解其存在及潜在的性格缺陷,因人而异,因材施教。结果:护生出科时对老师的带教工作表示满意。结论:通过一对一个体化带教,能提高护生临床实习的积极性及带教效果。