肿瘤合并感染新冠肺炎患者临床分析及疫情期间肿瘤患者的管理建议

目的:探讨分析肿瘤合并新冠病毒感染患者情况并提出自己的思考与建议。方法:通过统计2020年1月至2020年3月期间纳入的313名本院肿瘤科在新冠疫情期间肿瘤合并感染新冠肺炎患者情况，汇总临床资料，分析患者肺部影像学特点，总结肿瘤合并新冠肺炎病毒感染患者临床特征、预后及转归等，并提出自己建议。结果:科室总共313名患者住院，5名新冠感染患者，新冠病毒肺炎发生率为1.6%，这比之前所报道的武汉市新冠病毒普通人群发生率0.37%要高接近3倍，肿瘤合并新冠患者死亡率接近20%。结论:对于疫情结束初期病房应尽量减少患者非必要往返医院次数，实行肿瘤患者分层管理，加强轻症患者随访，线上管理等；而对于住院患者，则采取缓冲分诊模式，做好病房消毒隔离以及管理，避免感染，减少肿瘤病房新型冠状病毒爆发概率。     

Debate: COVID-19 and psychological well-being of children and adolescents in Italy

Italy was the first country in Europe to deal with COVID-19. Measures taken by the government to contain the spread of the virus were based mainly on quarantine and social distancing, with dramatic economic, social and psychological consequences. Since March, Italian children and adolescents are facing school closures, which have caused a disruption in the daily lives of millions of young people and their families. To date, despite the slow reopening, the government has decided to maintain school closures for the entire academic year, leaving the future of young people in uncertainty. There is already some evidence that quarantine and social isolation are having negative impact on children's and adolescents' psychological well-being. Moreover, this situation will mainly affect those children and adolescents with pre-existing vulnerabilities and those suffering of mental disorders. It is imperative to keep young people’s needs at the core of reconstruction plans, allowing them to return to school safely, and providing them with some strategies to heal and dealing with this stressful and potentially traumatic situation.     

Split-course hypofractionated radiotherapy for aged and frail patients with head and neck cancers. A retrospective study of 75 cases

PurposeTo assess the efficacy and the tolerance of a split course hypofractionated (SCH) radiotherapy (RT) protocol in head and neck cancer (HNC) for eldery and/or unfit patients (pts).Patients and methodsPts with HNC treated by SCH-RT in two institutions were included retrospectively. The main SCH RT regimen was two courses of 30 grays (Gy)/10 fractions separated by 2–4 weeks, without any systemic therapy.ResultsBetween February 2012 and January 2019, 75 consecutive patients were analyzed. The median age was 80 years (range: 45.7–98.2) and 53 (70.7%) were men. Sixty-one (81.3%) pts had stage III/IV disease and 54 (72%) had at least two comorbidities. All of them were treated with intensity-modulated radiotherapy. Median follow-up was 10.6 months (range: 3.1–58.3). Local control at 12 and 24 months was 72.8% IC95%[62–85.5] and 51.7% IC95%[38.1–70.1] respectively. Progression free survival (PFS) at 12 and 24 months were 47.7% IC95%[37.4–60.8] and 41% IC95%[15–36.4] respectively, with a median of 11.5 months IC95%[8.9–17]. OS at 12 and 24 months were 60.4% IC95%[50–73.1] and 41% IC95%[30.6–54.9] respectively, with a median of 19.3 months IC95%[11.9–25.8]. Acute and late grade 3 or higher toxicities occurred for 6 (8%) and 3 (4%) pts.ConclusionThe present SCH-RT regimen seems effective, well-tolerated and could represent an alternative to palliative strategies for pts deemed unfit for standard exclusive RT.     

优质护理干预对肺结核患者用药依从性的作用

目的对优质护理干预对肺结核患者用药依从性的作用进行观察。方法选择本院收治的120例肺结核患者作为本次研究的纳入对象,选取时间段为2017年1月-2018年1月,随机将这些患者划分为两组,甲组60例,乙组60例,采用常规护理方式护理甲组患者,在此基础上,应用优质护理干预的方式护理乙组患者,对两组患者的治疗依从性进行分析和比较。结果在经过精心的护理之后,甲组中23例完全依从,23例部分依从,14例不依从,总依从率达到了76.7%,乙组中37例完全依从,21例部分依从,2例不依从,总依从率达到了96.7%。乙组在总依从率方面相对于甲组而言更高(P <0.05)。结论采用优质护理干预的方式护理肺结核患者具有很好的效果,能够使患者的用药依从性得以显著提升,从而进一步保障患者的治疗效果。     

互动式歌唱表演对轻中度阿尔茨海默病患者抑郁、精神行为和运动训练参与率的影响

目的 观察互动式歌唱表演对轻中度阿尔茨海默病（AD）患者抑郁、精神行为症状及运动训练参与率的影响。方法 选取符合入组条件≥60周岁AD患者63例，随机分为研究组（31例）和对照组（32例）。所有受试患者常规药物治疗及常规运动训练，对照组接受被动性音乐治疗，研究组接受以互动歌唱为主的主动性音乐治疗，1次/d，每次1小时，每周训练5天，持续干预6个月。于治疗前、治疗1个月后、治疗3个月后、治疗6个月后分别采用康奈尔痴呆抑郁量表（CSDD）评分、阿尔茨海默病病理行为（BEHAVE AD）评分、参与率进行评估。结果 治疗1个月、3个月后，研究组CSDD评分较治疗前均降低（P<0.05）；治疗6个月后，研究组患者CSDD评分较治疗前、治疗1个月、3个月后均显著降低（P<0.05），且与对照组比较差异有统计学意义（P<0.05）。治疗1个月、3个月后，研究组BEHAVE AD评分较治疗前均降低（P<0.05）；治疗6个月后，研究组患者BEHAVE AD评分较治疗前、治疗1个月、3个月后均显著降低（P<0.05），且与对照组比较差异有统计学意义（P<0.05）。治疗6个月后，两组运动训练参与率组间比较差异有统计学意义（P<0.05）。结论 互动式歌唱表演可能对改善轻中度AD患者的抑郁和精神行为症状有着积极的疗效，同时对提高受试者运动训练的参与率可能有着更积极的疗效。     

Prevalence and correlates of depressive symptoms in secondary school children in Dhaka city,Bangladesh

ABSTRACT

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh.

Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms.

Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15–16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast.

Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.     

Patient's Perspectives on the Notion of a Good Death: A Systematic Review of the Literature

ContextThere is no clear definition of what constitutes a good death or its features. Patients, caregivers, physicians, and relatives have different notions of a good death. Discussions have been driven by academic perspectives, with little research available on the patients' perspectives.ObjectivesTo explore the notions of a good death from the patients' perspective.MethodsA systematic literature search was conducted up to November 2017 using CINAHL®, MEDLINE®, EMBASE®, and PsycINFO® databases. Search terms used were “quality of death,” “good death,” “quality of dying,” or “good dying.” Scientific empirical studies that included the exploration of the notion of a good death in adult patients with advanced and life-threatening diseases were selected separately by two researchers. Hawker's et al. criteria were used to assess the quality of articles. The analysis was conducted using a thematic analysis.ResultsTwo thousand six hundred and fifty two titles were identified; after elimination of duplicates, screening, and final selection, 29 relevant publications remained for analysis. Sample populations included patients with terminal diseases (AIDS, cardiovascular disease, and cancer). Core elements for a “good death” included control of pain and symptoms, clear decision-making, feeling of closure, being seen and perceived as a person, preparation for death, and being still able to give something to others; whereas other factors such as culture, financial issues, religion, disease, age, and life circumstances were found to shape the concept across groups. Studies agree on the individuality of death and dying while revealing a diverse set of preferences, regarding not only particular attributes but also specific ways in which they contribute to a good death.ConclusionsAlthough sharing common core elements, patients' notions of good death are individual, unique, and different. They are dynamic in nature, fluctuating within particular groups and during the actual process of dying. Formal and informal caregivers should carefully follow-up and respect the patient's individual concepts and preferences regarding death and dying, while attending to shared core elements, to better adjust clinical decisions.