Improved food intake and reduced nausea and vomiting in patients given a restricted diet while receiving cisplatin chemotherapy.

Administration of cisplatin alone or in combination with other cytotoxic agents commonly produces intractable nausea and vomiting, which is currently controlled through high-dose antiemetic drugs. However, patients often refuse continued therapy because of suboptimal control of nausea and vomiting and substantial decline in nutritional status. In this pilot study, 19 patients receiving cisplatin were evaluated for nausea and vomiting, amount of food intake, and subjective assessment of well-being. The study group received a colorless, odorless, predetermined meal three times daily; the meal included cottage cheese, apple sauce, vanilla ice cream, and other selected foods. Control-group patients selected their own meal. Study-group patients exhibited higher overall food intake, decreased nausea and vomiting, and a higher scored estimation of well-being. The findings of this preliminary study indicate that the study diet helps provide nutrition care to cancer patients receiving cisplatin chemotherapy and helps create an atmosphere where the patient believes he or she has some control in the treatment outcome.     

Baseline nutritional assessment in advanced cancer patients receiving palliative chemotherapy

Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients with cancer. Weight loss and malnutrition are recognized to result from multifactorial processes, which if assessed and managed appropriately may lead to improved treatment outcome. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The aim of this study was to investigate the use of various fundamental assessment tools that could be applied to the routine clinical evaluation of nutritional status in patients with advanced solid malignancies before treatment with palliative chemotherapy. We investigated the interrelationships between biochemical indices, anthropometric measures, and a nutritional screening tool, the Mini-Nutritional Assessment, in 73 patients. Many of these measures were highly interrelated, but the baseline history of weight loss in these patients was strongly correlated to the Mini-Nutritional Assessment (MNA) score (P < 0.0005). In turn, baseline weight loss and the MNA score were strongly correlated to serum C-reactive protein (a marker of acute-phase response). In some patients, malnutrition was linked to disease- or treatment-related upper digestive tract morbidity. Testing for the serum concentration of C-reactive protein at baseline may identify a subset of patients for whom a decline in nutritional status is linked to the presence of an active inflammatory response, a recognized precursor of cachexia     

胃肠外营养支持在癌症病人化疗中应用的评价

目的：观察胃肠外营养支持对化疗药物消化道副反应所致的营养状况下降的影响。方法：选取在第一治疗周期中出现Ⅱ度及Ⅱ度以上消化道副反应的病人为观察对象，在其第二周期配合化疗的同时采用胃肠外营养支持。以第一周期为空白对照，对每个观察对象分别在两个治疗周期进行营养状况评价，评价方法为ＳＧＡ法，统计方法为单向质反应医学序贯试验。结果：当第３３例病人进入观察时，反应曲线与阳性方程一相交。结论：化疗期间合使用胃肠     

胃肠外营养支持治疗在恶性肿瘤化疗中的应用

恶性肿瘤病人通常因伴有厌食或机械性梗阻妨碍正常进食。抗癌化疗带来的消化道副反应更影响病人对热量和营养素的摄取，但恶性肿瘤病人对热量和蛋白质的需求量反而增加［‘j。因此化疗病人常消瘦，体质下降，需要科学地使用胃肠外营养支持治疗手段。本文就与化疗配合实施的胃肠外营养支持治疗方法及有关问题探讨如下。一、胃肠外营养概念又称静脉营养。通过周围静脉或中心静脉输入能量及各种营养素的一种营养支持治疗方法。是按照病人的生理需要输入包括脂肪、碳水化合物、氨基酸、维生素、电解质、微量元素和水的全部营养物质，是全面的、…     

Improved access to mental health evaluation for patients with developmental disabilities using telepsychiatry

The Cedars-Sinai Telepsychiatry Clinic uses a collaborative-care model to treat patients with developmental disabilities. We examined its practice in four areas: patient characteristics, clinical care, symptom severity and diagnostic outcomes to describe the care provided and the population seen in the telepsychiatry clinic. In a chart review, 45 out of 126 cases were selected and evaluated at three times: initial evaluation, year one and year three. Most of the patients (84%) had an intellectual disability, 55% had a pervasive developmental disorder and 71% spoke approximately 50 words or less. Prior to the initial assessment, none of the patients were diagnosed with anxiety or mood disorders, while almost one-third of patients received one of these diagnoses in the telepsychiatry clinic. Patients were seen six times on average in the first year and three times in the second and third years. The telepsychiatrist recommended a change in the patient's medication for 82% of patients at initial assessment, 41% at year one and 46% at year three. The review suggests that telepsychiatry evaluations can be valuable for patients with developmental disabilities, providing diagnostic clarity and specific recommendations that can be implemented by the primary care physician.     

品管圈在降低血液透析血管通路感染率中的应用

目的:探讨品管圈活动对降低血液透析患者血管通路感染率的作用.方法:成立QCC活动小组,收集2014年3月-2015年2月的数据设定目标值,进行原因分析,制定相应措施并实施.结果:通过开展品管圈活动,降低了血管通路的感染率;圈成员在团队合作,沟通能力、责任心、运用品管圈的能力由大幅度提高.结论:运用QCC能降低血液透析的感染率.     

A study of quality of life in cancer patients receiving palliative chemotherapy.

Although primary treatment for cancer has been associated with psychosocial distress, less research has focused on patients with advanced disease. Traditionally, the outcomes of treatment have been assessed using biomedical criteria, including tumour regression, progression and survival. It is argued that these data are inadequate to understand the impact of cancer upon the patient. Instead, quality of life considerations are crucial when treatments are aversive, especially when the aims are palliative rather than curative. Fifty-three patients with advanced breast cancer or ovarian cancer were studied prospectively for 6 months to assess whether the site and method of chemotherapy administration influenced their quality of life. Patients received palliative chemotherapy either at home or in hospital. Quality of life was operationalized as measurement of anxiety, depression, self-esteem, health locus of control, physical performance and symptoms. In addition, semi-structured interviews explored social roles, relationships, and perceptions of treatment. Hospital administered chemotherapy was perceived to be most distressing. Regression analysis indicated that anxiety and depression accounted for most of the variance in quality of life. Patients who died during the study 13 (24%) experienced considerable psychological and physical morbidity. Women over 60 years, experienced less psychological and physical distress. Quality of life broadens the criteria by which cancer treatments are evaluated, to include the experience of the patient.     

膀胱癌术后吡柔比星灌注化疗的护理

为总结盐酸吡柔比星膀胱灌注化疗预防膀胱癌术后复发的护理经验,本文对45例膀胱癌术后行盐酸吡柔比星膀胱灌注化疗患者的护理进行分析总结,认为适当的心理护理、合理的药物稀释浓度、严格的无菌操作、灌注时不断变换体位、合理的药物保留时间及合理的疗程是保证灌注化疗效果,减少化疗副作用的重要保证.     

Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy

ObjectivesFatigue is the most frequently reported symptom experienced by cancer patients and has a profound effect on their quality of life (QOL). The study aimed to determine the impact of fatigue on QOL among breast cancer patients receiving chemotherapy and to identify the risk factors associated with severe fatigue incidence.MethodsThis was an observational prospective study carried out at multiple centers. In total, 172 breast cancer patients were included. The Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire was used to measure QOL, while the Brief Fatigue Inventory (BFI) was used to assess the severity of fatigue.ResultsThe total average mean and standard deviation of QOL were 84.58±18.07 and 4.65±1.14 for BFI scores, respectively. A significant association between fatigue and QOL was found in linear and multiple regression analyses. The relationships between fatigue severity and cancer stage, chemotherapy dose delay, dose reduction, chemotherapy regimen, and ethnicity were determined using binary logistic regression analysis.ConclusionThe findings of this study are believed to be useful for helping oncologists effectively evaluate, monitor, and treat fatigue related to QOL changes.     

营养干预在宫颈癌患者同步放化疗中的作用分析

目的分析营养干预在宫颈癌患者同步放化疗中的作用。方法将2014年1月至2015年8月内蒙古自治区人民医院72例宫颈癌患者分为营养干预组和对照组,每组各36例。营养干预组在放化疗期间给予营养干预,而对照组不给予营养干预,观察两组患者的生存质量及对放化疗的耐受情况。结果营养干预组放疗完成率为100%,患者化疗周期数为(4.58±0.81)周期;对照组放疗完成率为83.3%,患者化疗周期数为(3.81±0.73)周期,营养干预组耐受放化疗的情况好于对照组,并且生存质量明显高于对照组(P0.05)。结论宫颈癌患者同步放化疗期间给予营养干预能有效提高其生存质量和对放化疗的耐受性。     

Fungal colonization of haematological patients receiving cytotoxic chemotherapy: emergence of azole-resistant Saccharomyces cerevisiae

Fungal colonization during cytotoxic chemotherapy was studied in 42 patients with a recent diagnosis of a haematological malignancy. In total, 2759 surveillance cultures were taken from the nostrils, throat, urine, stool and perineal region. Seven hundred and ninety-six positive surveillance cultures (28.9%) yielded 968 fungal isolates. The rate of fungal colonization did not differ between patients with acute leukaemia, patients with other haematological malignancies and control patients in the same ward at admission (71% vs. 67% vs. 80%). Patients with acute leukaemia were colonized at a significantly lower rate in samples from the throat (32%), urine (10%), stool (45%) and perineum (29%) taken during hospitalization when compared with other haematological patients (respective values 58%, 21%, 67% and 45%; P-values 0.001). This could be attributed to differences in the use of antifungal drugs. Although 21/42 (50%) of our patients had multiple-site fungal colonization at the end of follow-up, only one systemic Candida infection was diagnosed. Extensive use of antifungal treatment may have influenced the low incidence of systemic fungal infections during the follow-up. In addition to Candida species, Malassezia furfur, Geotrichum candidum and Saccharomyces cerevisiae were frequently isolated. The rate of S. cerevisiae isolation increased significantly over time after admission (1%, vs. 18% of isolates, P<0.001), suggesting hospital-acquired transmission. These isolates were highly resistant to azole antifungals (MIC90 128 microg/mL for fluconazole and 16 microg/ml, for itraconazole), and caused persistent multiple site colonization in 12 patients. Extensive use of antifungal agents in a haematological ward may keep the incidence of invasive fungal infections low in spite of heavy fungal colonization. However, there may be a risk of emergence of resistant fungal strains.     

核磁共振检查患者的心理护理

目的：保证病人顺利的完成核磁共振检查,更好地为临床服务。方法：将100例病人分成试验和对照两组,进行焦虑抑郁水平的测量。结果：检查前实施心理护理的试验组焦虑抑郁显著低于对照组。结论：对MRI检查病人实施心理护理是顺利完成检查的重要措施。     

老年肿瘤患者化疗后急性粒细胞缺乏症的救治

目的：探讨老年肿瘤患者化疗后急性粒细胞缺乏症的救治方案。方法：回顾性分析某院15例化疗后发生急性粒细胞缺乏的老年肿瘤患者的病历资料。结果：通过给予保护性隔离、强有力的抗菌药物、造血生长因子以及积极的支持治疗等措施，使14例(93．33％)患者救治成功，发热症状在3～儿d得到控制。结论：老年肿瘤患者化疗后出现粒细胞缺乏症时，在应用强有力广谱抗菌药物治疗的同时，应防止患者合并真菌感染；并应积极控制局部感染灶，应用粒细胞集落刺激因子促进白细胞恢复，加强支持治疗。     

血液透析血管通路的护理研究进展

血液透析是维持肾病患者生命的重要治疗方法,临床上主要应用在晚期肾病患者生命的维持治疗中.伴随时代的发展,人们的生活质量提高,饮食结构有所变化,这使得肾病患者数量不断升高,所以血液透析在现代医疗工作中发挥出了越来越重要的作用.大多数终末期肾病患者缺乏有效的疾病治愈方法,所以需要接受长期的血液透析治疗,在这一过程中,血管通...     

Delayed nephrologist referral and inadequate vascular access in patients with advanced chronic kidney failure

We sought to determine whether late referral to a nephrologist in patients with chronic renal failure influences the adequacy of vascular access for hemodialysis. We analyzed data describing all health care encounters for all Medicare and Medicaid patients with end-stage renal failure in New Jersey between January 1991 and June 1996. Patients were required to have been diagnosed with renal disease at least 1 year prior to onset of hemodialysis. In the resulting cohort of 2,398 incident hemodialysis patients, 35% had their first nephrologist consultation < or =90 days prior to initiation of dialysis. After controlling for demographic characteristics, socio-economic status and underlying renal disease, we found that patients who were referred to a nephrologist >90 days prior to onset of hemodialysis were 38% more likely to have undergone predialysis vascular access surgery than those who were referred to a nephrologist < or =90 days before dialysis [OR: 1.38; 95% CI (1.15; 1.64)]. Similarly, patients referred late were 42% more likely to require central venous access for hemodialysis compared to those seen by a nephrologist early [OR: 1.42; 95% CI (1.17; 1.71)]. Inadequate development of vascular access for renal replacement therapy in patients with late nephrologist referral unnecessarily contributes to the burden of disease experienced by this vulnerable patient population.