Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part I. Views of surviving spouse on effects of the service on the patient.

The surviving spouses of 34 patients who died of cancer at St Christopher''s Hospice have been interviewed about 13 months after the patient''s death. The information given is compared with that obtained from 34 spouses of patients dying from cancer in other hospitals and matched with the St Christopher''s group. Patients at St Christopher''s were less often thought to have suffered severe pain and other distress than at other hospitals, but pain relief was not bought at the cost of drug-induced confusion and patients at St Christopher''s remained more mobile than at other hospitals. Hospice patients were more aware of chapel services and prayers than at other hospitals. None was said to have been upset by these and 66% were glad of them. Despite the frequency of deaths in the Hospice, patients at St Christopher''s were no more likely to be thought to have been ''upset'' by such events than patients elsewhere or to have found their interactions with other patients anything but helpful.     

'Hospice' versus 'hospital' care--re-evaluation after 10 years as seen by surviving spouses

This study compares terminal cancer care in 1967-69 with care in 1977-79 as evaluated by surviving spouses of patients who died in St Christopher's Hospice and other local hospitals. Patients and their surviving spouses reported less personal distress in both settings in 1977-79 than in 1967-69 and the patients were also thought to have suffered less pain. These differences were found before, during and, in surviving spouses, after the period of terminal care. They were confirmed in subsamples of 30-34 patients matched for age, sex, socio-economic status and duration of terminal period. Improvements may be attributable to the training in terminal care provided by staff of the Hospice since 1967 and augmented in its Study Centre which was opened in 1973. Although pain and distress in the patient is no longer a major problem in either setting, spouses in 1977-79 remain less anxious at St Christopher's Hospice than at other hospitals; they play a larger part in the care of the patient and are in closer contact with staff before and after bereavement.     

Comparison of asthmatic patients admitted to hospital from health districts experiencing high and low asthma mortality rates.

Geographical variation in asthma mortality rates within the United Kingdom could be a reflection of variability in effectiveness of medical care services, or epidemiological variation. In order to ascertain whether differing hospital admission processes could contribute to this variation, asthmatic patients admitted from two districts, experiencing above and below average mortality rates were compared. The present study was part of a cohort study of 1,200 consecutive acute adult admissions in 1987/88. In the main study, social data and information on referral were collected by interview for all patients. The admitting doctors'' perception of the patient''s severity was assessed on the basis of the severity of symptoms, and likelihood of morbidity or mortality if the patient was not admitted. Further information on asthmatic patients (treatment and physiological measurements) was retrieved from the notes. Sixty-six asthmatic patients resident in Wandsworth (a district with high asthma mortality rates) were admitted to St George''s Hospital or St James'' Hospital (WW) and 31 patients resident in East Surrey (ES) (a district with low asthma mortality rates) were admitted to the East Surrey Hospital (ESH). Notes were obtained on 55 (83%) and 27 (87%) of patients in the two districts, respectively. WW received significantly more patients by self-referral: 68% of patients called an ambulance or came directly to casualty compared with 30% in ES (chi-squared = 13.7, d.f. = 2, P = < 0.001). There was a tendency for more admissions to ESH to be taking oral steroids (chi-squared = 3.2, d.f. = 1, P = 0.07). Patients admitted in WW tended to have more severe disease: 39 (85%) of patients admitted to WW had peak expiratory flow less than 200 1/minute on admission compared to 14 (58%) in ES (chi-squared = 6, d.f. = 1, P = 0.01). In WW the mean first recorded peak expiratory flow on admission was 154 1/minute compared to 172 1/minute in ES; their mean peak flow on discharge was 318 1/minute compared with 377 1/minute in ES. Twenty-one (38%) of admissions in WW were considered to be very urgent by the admitting hospital doctor compared to four (15%) in ESH (chi-squared = 4.67, d.f. = 1, P = 0.03). This opportunistic study found that, in an area experiencing high mortality rates, more patients with severe disease were admitted to hospital compared to a low mortality area. This does not appear to be due to differing hospital practices but rather to increased levels of morbidity in the community. As patients with more severe asthma are at a greater risk of dying, these finding reinforce the need to standardize asthma treatment in the community.     

Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part II. Self assessments of effects of the service on surviving spouses

Self-assessments of 34 spouses of patients who had died from cancer at St Christopher's Hospice were compared with self-assessments of a matched group of spouses of patients who had died in other hospitals in the vicinity. The spouses of St Christopher's patients differed significantly from the comparison group in spending more time at the hospital, talking to more members of staff, other patients and visitors, reporting less anxiety and psychosomatic accompaniments of anxiety before (but not after) the patient's death and being less worried about pain, others hurting or harming the patient or about revealing their own fears to the patient. The institutional ideals of the Hospice were characterized as: 'The hospital is like a family', 'Nothing is too much trouble' and 'Don't worry'.     

8例临床级脐带间充质干细胞治疗放射性肺纤维化的观察

目的 观察临床级脐带间充质干细胞(clinical grade umbilical cord mesenchymal stem cell,UC-MSC)治疗放射性肺纤维化(radiation-induced pulmonary fibrosis,RPF)的安全性和有效性.方法 从2014年1月至2016年6月共入组8例RPF患者,其中2例乳腺癌,6例肺癌.通过支气管镜对RPF病灶部位灌洗后单次注入脐带间充质干细胞(1×106/kg),观察治疗前及治疗后第3天、3个月、6个月的临床症状、血液指标和圣乔治呼吸问卷(St George's respiratory questionnaire,SGRQ)、6 min步行距离(six-minute walk distance,6MWD)、肺功能指标、相关炎症因子、CT肺密度的变化情况.结果 8例患者均能耐受UC-MSC治疗,6例患者自觉气促、咳嗽等症状有所好转,圣乔治呼吸问卷评分有差异(P＜0.05),血常规、C反应蛋白、肝肾功指标治疗前后无明显变化,转化生长因子-β1(transforming growthfactor-β1,TGF-β1)在治疗后有下降趋势,但差异无统计学意义(P＞0.05),CT肺密度自身治疗前后比较有下降.结论 UC-MSC治疗RPF对患者的肝肾等主要脏器无损害,且能够减轻患者的临床症状和降低肺纤维化密度,但其确切的治疗效果及机制需更加严谨的研究进一步证实.     

皮格马利翁效应在围手术期肺癌患者呼吸功能锻炼中的应用

目的探讨应用皮格马利翁效应对围手术期肺癌患者呼吸功能锻炼的影响。方法将96例围手术期肺癌患者按照入科时间先后顺序,随机选为观察组48例,对照组48例。对照组给予常规呼吸功能锻炼指导。观察组在入科时就应用皮格马利翁效应实施呼吸功能锻炼指导。观察两组住院期间平均每次锻炼时间、每天锻炼次数及术后5 d内咳嗽排痰的主动性。结果观察组每次锻炼平均时间较对照组长、每天锻炼次数较对照组多(P0.05)。观察组术后咳嗽排痰也较对照组积极、主动。结论应用皮格马利翁效应能提高患者呼吸功能锻炼的依从性,最大效能地发挥患者主观能动性。     

Perianal Paget's disease.

Paget''s disease involves the ducts of apocrine glands and the overlying epidermis and is considered to be locally neoplastic. It is capable of developing into invasive carcinoma and in this event the prognosis is poor. The perianal skin may be affected by Paget''s disease. This is a rare disorder and the four patients who have been seen with this disease at St Mark''s Hospital since 1930 are described.     

Audit of an inner city coronary unit.

The performance of the St Mary''s Hospital London W2 coronary care unit was studied in each of 2 years, 1969 and 1975, results of which could be compared with each other and with national figures from the annual reports of the Hospital In-patient Enquiry. In 1975 the admissions were 42% more than in 1969; the increase was confined to mild cases over 45 years of age, and was out of proportion to national trends. The hospital fatality rate was unchanged and when age-standardized was 69% and 78% of contemporaneous national rates. In both years, 50% of the patients admitted came from outside the health district and 10% of local admissions were visitors from abroad. In 1975 there was an increased proportion of ex-smokers among the patients and more gave a history of previous myocardial infarction. The value and limitations of this kind of surveillance of a clinical unit are argued.     

针灸干预对肺癌化疗患者不良反应影响的研究进展

<正>随着我国人口规模的增加和老龄化进程的加快,癌症发病例数约占全球的23.7%,癌症的发病率和死亡率均呈逐渐上升趋势^[1]。有数据^[2]显示,2022年我国新发癌症约482万例,死亡病例约321万例,其中肺癌最为常见。癌症重在尽早发现,根据患者的疾病分期、适应证、合并症等情况确定治疗方案,进行针对性治疗。     

针对性护理干预对非小细胞肺癌胸腔镜手术患者中的应用研究

目的?探讨对非小细胞肺癌胸腔镜手术患者给予针对性护理干预后获得的临床效果。?方法?选择我院2015年7月～2018年3月收治的94例非小细胞肺癌患者作为研究对象；抽签法分组后明确胸腔镜手术期间各组护理方式，对照组47例给予传统护理，观察组47例给予传统护理+针对性护理；比较两组手术护理结果。结果 观察组 FEV1、FVC 以及 FEV1/FVC 分别为（1.73±0.45）L、（65.59±13.53）L 和（61.06±13.42）%，对照组分别为（1.36±0.29）L、（54.13±12.43）L 和（51.39±12.29）%，观察组患者肺功能指标明显高于对照组，差异有统计学意义（P<0.05）；观察组的并发症发生率为2.13%，明显低于对照组的25.53%，差异有统计学意义（P<0.05）；观察组社会功能、心理功能、躯体功能以及生活状态评分分别为（31.55±0.61）分、（35.55±4.59）分、（47.61±1.53）分以及（19.59±0.76）分，对照组分别为（28.89±0.06）分、（25.69±4.06）分、（40.31±1.29）分以及（15.43±1.51）分，观察组生活质量各项评分均明显高于对照组（P<0.05）。?结论?临床对非小细胞肺癌患者在实施胸腔镜手术期间，针对性护理干预措施的采用，在肺功能改善、并发症减少以及生活质量提升方面，效果确切，可对患者预后能力提升以及病情快速好转奠定基础，充分表明针对性护理应用的可行性。     

West Indian amblyopia.

A series of 21 patients admitted to St Thomas'' Hospital, Medical Ophthalmology Unit, with a diagnosis of West Indian or West African amblyopia is reported. Patients were investigated for haematological, biochemical, serological, and radiological abnormalities and particular attention was paid to dietary history. Patients admitted in recent years also underwent neurophysiological investigations. No definite correlation between visual loss and dietary or family history was found, and there was no evidence that the improvement in vision which occurred in just under half the patients on follow-up was related to treatment with hydroxocobalamin or multivitamins. Visual-evoked responses in 4 patients showed a prolonged latency suggesting optic nerve demyelination, while in only one case was the electro-oculogram definitely subnormal. These findings contrast with those in ''toxic'' amblyopias and suggest that the syndrome of West Indian amblyopoa may be due to bilateral optic nerve demyelination of unknown aetiology rather than the effect of toxic substances or nutritional deficiency on the retina.     

外周血淋巴细胞/单核细胞比值、中性粒细胞/淋巴细胞比值与EGFR突变肺癌及其转移的相关性研究

目的 探讨初诊为肺癌时的外周血淋巴细胞/单核细胞比值（lymphocyte/monocyte ratio,LMR）、中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio,NLR）与表皮生长因子受体（epidermal growth factor receptor,EGFR）突变阳性及其转移的相关性。方法 回顾性分析301例、348例的肺癌EGFR突变阳性、阴性患者的基本临床特征及炎性指标。观察炎性指标在不同EGFR突变状态、转移状态的差异,用受试者工作特征（receiver operating characteristic,ROC）曲线评价其能否作为鉴别EGFR突变及转移的临床指标。结果 在肺癌EGFR突变患者中女性、未吸烟、腺癌分别占61.8%、75.1%、92.4%。与阴性比较,EGFR突变阳性患者的LMR值明显升高,取界值为2.88时,其敏感度、特异性分别为64.7%、为56.6%。与未发生远处转移患者比较,NLR值在EGFR突变的远处转移患者中明显升高,当界值在2.14时,敏感度为74.7%,特异性为64.0%。NLR与EGFR突变阳性肺癌患者的TNM分期分别呈正相关,LMR则相反。NLR与EGFR突变阳性的肺癌患者的骨转移、脑转移、肿瘤指标如CEA、CA125之间存在显著相关性。结论 肺癌EGFR突变常见于女性未吸烟腺癌特征,LMR、NLR在鉴别EGFR突变及远处转移具有参考价值。     

肾移植术后并发原发性肺癌的单中心研究

目的 回顾性分析肾移植术后原发性肺癌的临床特点及预后.方法 自1988年1月~2015年4月期间,2793例患者在我院接受肾移植手术.14例(0.5%)患者随后发展为肺癌,其中10例(71.4%)接受了手术治疗.结果 肾移植时患者的平均年龄为50.2±8.3岁.14例肺癌患者中,10例(71.4%)有吸烟史.9例(64.3%)为偶然发现,而有症状者仅为5例.从移植手术到肺癌诊断的平均时间间隔为65.7±20.1个月.统计结果显示,不同肿瘤分期病人的生存率具有统计学差异(P=0.001).随访期间有11例死于肿瘤转移或器官衰竭,3例存活.肺癌诊断后的总体5年生存率为17.9%.结论 肾移植术后原发性肺癌的危险性可能高于一般人群.肾移植术后常规胸部检查可早期发现原发性肺癌,对于及早施行手术、改善预后很有必要.     

Comparison of prescribing and adherence patterns of anti-osteoporotic medications post-admission for fragility type fracture in an urban teaching hospital and a rural teaching hospital in Ireland between 2005 and 2008

Introduction

Poor adherence reduces the potential benefits of osteoporosis therapy, lowering gains in bone mineral density resulting in increased risk of fractures.

Aim

To compare prescribing and adherence patterns of anti-osteoporotic medications in patients admitted to an urban teaching hospital in Ireland with a fragility type fracture to patients admitted to a rural hospital in the North Western region.

Methodology

We identified all patients >55 years admitted to Sligo General Hospital between 2005 and 2008 with a fragility fracture (N = 744) using the hospital in-patient enquiry system (HIPE). The medical card number of those patients eligible for the primary care reimbursement services scheme (PCRS) facilitated the linkage of the HSE-PCRS scheme database to the HIPE database which enabled a study to identify persistence rates of patients prescribed osteoporosis therapy after discharge. The results were compared to the findings of a similar study carried out in St. James’s Hospital, Dublin.

Results

The 12 months post-fracture prescribing increased from 11.0 % (95 % CI 9.6, 12.4) in 2005 to 47 % (95 % CI 43.6, 50.3) in 2008 in the urban setting and from 25 % (95 % CI 21.5, 28.9) to 39 % (95 % CI 34.5, 42.7) in the rural setting. Adherence levels to osteoporosis medications at 12 months post-initiation of therapy was <50 % in both study groups. Patients on less frequent dosing regimes were better adherers.

Conclusion

The proportion of patients being discharged on anti-osteoporosis medications post-fragility fracture increased between 2005 and 2008 in both patient groups. Sub-optimal adherence levels to osteoporosis medications continue to be a major concern.     

Reprimo基因3'非翻译区839位点多态性与肺癌发生的关联

目的  探讨Reprimo基因3''非翻译区839位点单核苷酸多态性改变与肺癌发生的关系。方法  基因分型用TAKARA的MightyAmp DNA 聚合酶法,分别检测36例肺癌患者（癌症组）和23例非癌患者（对照组）的Reprimo基因3''非翻译区839位点G >C分布,运用χ2检验、Logistic 回归分析和Armitage’s 趋势检验等分析基因多态性、患者性别、吸烟与否和年龄与肺癌发生的相关性。结果  两组标本经Hardy-Weinberg平衡检测,对照组在Reprimo基因3''非翻译区839位点G >C基因型观测(理论)频数为0,22,1（5.26,11.48,6.26）,差异有统计学意义（P =0.000）,癌症组的基因型观测(理论)频数为6,29,1(11.67,17.65,6.67),差异有统计学意义（P =0.000）;经Logistic 回归分析,基因多态性、年龄是危险因素,基因多态性、年龄和吸烟与否在肺癌发生中不存在交互作用（P >0.05）;经Armitage’s 趋势检验差异无统计学意义（χ2=3.56,P =0.059）。结论  Reprimo基因3''非翻译区839位点G >C单核苷酸位点多态性与肺癌发生具有一定的相关性。

     

血清肿瘤M2型丙酮酸激酶诊断非小细胞肺癌的临床价值

目的 探讨血清肿瘤M2型丙酮酸激酶(M2-PK)在非小细胞肺癌(NSCLC)患者及肺部良性病变中的表达水平及其作为血清学标志物的临床价值.方法 选取2014年1月至2016年9月延安市人民医院呼吸内科收治的71例NSCLC患者(病例组)和48例肺部良性病变患者(对照组)为研究对象.采用ELISA法分别检测两组患者的血清M2-PK浓度,根据贝叶斯定量采用ROC曲线评价M2-PK鉴别NSCLC与肺部良性病变的敏感性、特异性及ROC曲线下面积.结果 病例组和对照组患者血清M2-PK呈偏态分布,中位数分别为21.6 U/mL和6.1 U/mL,对数据进行10为底数的对数转换后病例组和对照组M2-PK分别为(1.21±0.71)和(0.72±0.39),病例组显著高于对照组,差异有统计学意义(P<0.05);以血清M2-PK为参考诊断NSCLC的敏感性为78.1％,特异性为65.2％,ROC曲线下面积AUC=0.81(95％CI:0.74～0.89).结论 非小细胞肺癌患者血清M2-PK明显升高,可作为鉴别NSCLC与肺部良性病变的血清学标志物.     

肺癌致恶性胸腔积液的研究进展

肺癌是世界上发病率最高的恶性肿瘤,其中非小细胞肺癌是最常见的肺癌类型,恶性胸腔积液是晚期非小细胞肺癌的常见并发症之一。恶性胸腔积液是指在胸腔积液中发现恶性肿瘤细胞,如果通过内镜检查发现胸腔积液伴纵隔或胸膜表面转移性肿瘤,无论是否在胸腔积液中发现恶性肿瘤细胞,所有这些均可被诊断为恶性胸腔积液。恶性胸腔积液严重影响患者的生活质量和预后,影响患者的呼吸功能,从而导致患者呼吸困难等临床症状。临床治疗方式多样,依然难以取得较好疗效。如何选择适合患者的处置方法,需要综合其所患肺癌的病理类型、导致恶性胸腔积液的具体原因及患者的一般状态等。本文旨在探讨肺癌所致恶性胸腔积液的研究新进展,展望肺癌所致恶性胸腔积液的治疗方法、安全性及未来发展方向。     

SOME CLINICAL OBSERVATIONS ON CASES OF KERATOMALACIA IN MANCHURIA

Certain diseases are sometimes very common m one country and yet very rare in other. Keratomalacia is one such. During my three years'' stay in Europe attending Dr. Sym''s Eye Clinic in the Royal Infirmary of Edinburgh, Scotland, Dr. Bickerton''s Oinic in Liver- pooj, England, St. Paul''s Eye Hospital and Dr. Meller''s Eye Clinic in Vienna, Austria, I saw only five cases of Kcratornalacia in children and none at all in adults. In Manchuria, however, the disease is not infrequcntly seen. During the last ten years, 1924 t0 1933, out of 34,470 eye patients, 1,003 0r 2.g per cent were diagnosed as Kerato- malacia.     

非小细胞肺癌生存分析

[目的] 分析非小细胞肺癌预后的相关因素,为非小细胞肺癌的预后判断提供科学依据。[方法] 对具有明确组织学类型和临床分期的306例非小细胞肺癌患者,进行查阅病历并随访,从患者个体信息、患病情况、治疗方法等3个方面收集信息。[结果] 随访的306例患者中失访32人,随访率89.54%。患者总中位生存期为16个月,1、3、5年生存率分别为66%、16%、9%。多因素分析显示CEA水平、症状出现与就诊时间差、PS功能状态评分(PS评分)为预后的独立影响因素,卡氏功能状态(KPS)评分、手术为预后的保护性因素。[结论] 癌胚抗原(CEA)水平、症状出现与就诊时间差、KPS评分、PS评分、手术可作为判断非小细胞肺癌预后的指标。