大肠癌的综合治疗

结直肠癌是最常见的消化道恶性肿瘤之一,发病率和死亡率在全球仍呈上升趋势,严重威胁着人类的健康。对于如何提高大肠癌治疗效果的研究一直受到关注。随着治疗方法的进步,大肠癌的治疗趋向个体化、多元化、规范化,而最有效的治疗措施是根据患者个体化的具体病情进行综合治疗。本文将对大肠癌手术治疗、化疗、放疗、对症治疗、中医中药治疗等综合治疗方面的研究逐一论述。     

老年人心力衰竭的治疗原则

老年心力衰竭患者的治疗应遵循下列基本原则：综合治疗,即对所有心力衰竭的病因、诱因、临床症状、血流动力学异常、内环境改变和各种临床合并症的全面治疗;个体化治疗,即要根据每名患者的具体病情特点,采取个体化的治疗方案;同时重视用药指导和日常生活管理。     

局灶性脑梗死治疗时间窗的影响因素

局灶性脑梗死的治疗时间窗并非是固定的、统一的,而是一个个体化的、动态的过程。其影响因素众多,主要包括侧支循环、血压、卒中类型、年龄和并发症等。在治疗中,把具体患者的治疗时窗个体化,针对缺血病理生理各个环节综合治疗将给脑梗死患者带来更大的益处。     

难治性肝泡型包虫病的多学科个体化治疗

肝泡型包虫病(HAE)是一种严重危害中国西部人群的人畜共患寄生虫病,严重影响患者的生活质量。近年来随着根治性手术切除率的不断提高,以往认为无法根治性切除的晚期HAE患者也有根治的可能,但部分无法根治性切除的患者仍然存在并发症多、生存质量差等问题,因此HAE被认为是难治性、复杂性疾病。单纯传统专业组讨论的经验性诊治模式不能准确地应用多个学科临床技能全方位专业化、规范化的诊治策略,无法满足晚期难治性HAE的治疗;多个学科协作诊治模式能够有机地结合目前各项治疗方式的优点,制订合理的个体化综合治疗方案。对当前HAE多学科个体化治疗作一综述,认为多学科协作综合个体化治疗是晚期难治性HAE的首选治疗方法,是患者获得长期生存的最佳手段。     

重症急性胰腺炎32例护理体会

重症急性胰腺炎（SAP）病死率高。过去以手术治疗为主，近年来多主张行个体化综合治疗。2005年5月～2009年6月，我院对32例SAP患者采用非手术个体化综合治疗与护理，疗效满意。现将护理体会报告如下。     

57例存活二年以上晚期肝癌临床分析

目的研究多模式治疗晚期肝癌长期生存因素。方法对1990年至2001年收治的372例尚有肝动脉化学栓塞(TACE)指征的晚期肝癌患者中生存2年以上患者进行回顾性分析,分析包括治疗方法在内影响生存率的相关因素。结果主要影响因素是年龄、肿瘤大小、肿瘤数量、门脉癌栓、肝内外转移、肝功能ChildPugh分级、肝脏储备功能和治疗模式。在所有病例中存活2年以上者57例(15.32%),其中行个体化综合序贯治疗占48例(20.25%),9例(6.67%)单用TACE治疗。结论在众多因素中,个体化综合序贯治疗是改善晚期肝癌患者长期生存的关键因素。     

肺血栓栓塞症的个体化治疗

肺血栓栓塞症(PTE)是一种涉及多学科的疾病,结合PTE患者的易患因素评估,病情严重性分层,合并症以及相关的全因死亡风险进行个体化治疗十分必要.文章参考国内外最新文献,对不同严重性分层的PTE的个体化治疗方案、治疗时间以及特殊类型PTE的治疗进行总结,旨在帮助临床医生综合分析,进一步优化PTE的治疗策略.     

个体化饮食教育对糖尿病患者的干预效应

目的 探讨个体化饮食教育的有效方法及干预效应。方法 对102例住院糖尿病患者采用自身对照方法，在接受个体化饮食治疗教育前后以自行设计的饮食相关知识评价问卷等评分、空腹血糖（FPG）、餐后2小时血糖（2hPG）。结果 饮食教育后患者饮食治疗的理论知识评分、对食物的重量、体积、容积等实物认识的评分以及评分优秀率均较教育前明显提高（P均〈0．01），通过教育、饮食、运动、药物等综合治疗，患者的FPG、2hPG明显降低（P〈0．01）。结论 对糖尿病患者实施个体化饮食教育干预是必要的、可行的和有效的。     

阻塞性睡眠呼吸暂停的个体化治疗：机遇与挑战

阻塞性睡眠呼吸暂停(OSA)是一种异质性疾病,其在临床表现、发病机制及治疗反应等方面存在个体差异。基于临床特征和病理生理机制分型可更好地识别不同患者,从而针对不同病因开展个体化综合治疗以提高治疗效果。目前,OSA的个体化治疗在国内的应用仍处于初级阶段,机遇与挑战并存。     

局灶性脑梗死治疗时间窗的影响因素

局灶性脑梗死的治疗时间窗并非是固定的，统一的，而是一个个体化的，动态的过程，其影响因素众多，主要包括侧支循环，血压，卒中类型，年龄和并发症等。在治疗中，把具体患者的治疗时窗个体化，针对缺血病理生理各个环节综合治疗将人脑梗死患者带来更大的益处。     

A brief historical and theoretical perspective on patient autonomy and medical decision making: Part II: The autonomy model

As part of a larger series addressing the intersection of law and medicine, this essay is the second of two introductory pieces. Beginning with the Hippocratic tradition and lasting for the next 2,400 years, the physician-patient relationship remained relatively unchanged under the beneficence model, a paternalistic framework characterized by the authoritative physician being afforded maximum discretion by the trusting, obedient patient. Over the last 100 years or so, in response to certain changes taking place in both research and clinical practice, the bioethics movement ushered in the autonomy model, and with it, a profoundly different way of approaching decision making in medicine. The shift from the beneficence model to the autonomy model is governed legally by the informed consent doctrine, which emphasizes disclosure to patients of information sufficient to permit them to make intelligent choices regarding treatment alternatives. As this legal doctrine became established, philosophers identified an inherent value in respecting patients as autonomous agents, even where patient choice seems to conflict with the physician's duty to act in the patient's best interests. Whereas the beneficence model presumed that the physician knew what was in the patient's best interests, the autonomy model starts from the premise that the patient knows what treatment decision is in line with his or her true sense of well-being, even where that decision is the refusal of treatment and the result is the patient's death.     

Bone fractures in the haemophilic patient

The goal of modern fracture treatment is to obtain an optimal outcome, with the patient's return to full activity as soon as possible. Nowadays, internal stabilization is indicated in most displaced fractures in adults, whereas external fixation remains the best choice for initial stabilization with severe soft-tissue injuries. If a fracture is correctly treated in a haemophilic patient, it will progress to consolidation in a similar time-frame to fractures occurring in the general population.     

重视老年结核病的个体化治疗

老年人结核发病逐渐增多,其化疗用药安全范围变窄。应根据患者病情、全身状况和院外用药史、药敏试验结果选择最佳个体化治疗方案。同时注意并发症的治疗、营养支持和免疫治疗。     

Insulin pump therapy, should we consider it more often?

Erratic blood glucose control, hypoglycaemia unawareness and optimisation of glycaemic control during pregnancy are widely recognised indications for commencing diabetic patients on continuous subcutaneous insulin infusion (CSII) using an insulin pump. In patients without such a specific condition, the benefit of CSII over other forms of intensified treatment on glycaemic control and hypoglycaemic rate is generally viewed as too modest to warrant a change of regimen. However, the impact of the treatment regimen on psychosocial parameters is often undervalued, at least in randomised trials. This is unfortunate as quality of life and treatment satisfaction probably determine the patient's preferences more than metabolic parameters. To truly appreciate all potential benefits of either strategy (CSII or injection therapy), these data are urgently required. In the meantime, doctors should keep an open eye for the specific needs of the individual patient to find the best treatment available for that person.     

Pulmonary rehabilitation

Any COPD patient with symptoms is a candidate for pulmonary rehabilitation. A careful assessment of the individual to determine the patient's precise disease process and needs is essential to outlining an appropriate treatment program. Following the sequence described in the ATS Statement on Pulmonary Rehabilitation included in the appendix to this article provides the best potential for successfully returning the patient to the highest level of function possible. An increase in the availability of pulmonary rehabilitation programs should allow more COPD patients to participate in this process, resulting in an enhanced ability to carry out daily activities, an improved quality of life, and a reduction in the long-term costs of caring for such individuals.     

The practitioner's dilemma: can we use a patient's race to predict genetics, ancestry, and the expected outcomes of treatment?

Recent research has identified genetic traits that can be used in a laboratory setting to distinguish among global population groups. In some genetic analyses, the population groups identified resemble groups that are historically categorized as "races." On the basis of these associations, some researchers have argued that a patient's race can be used to predict underlying genetic traits and from these traits, the expected outcomes of treatment. Others have questioned the use of race in this way, arguing that racially defined groups are so heterogeneous that predictions of individual characteristics derived from group averages are bound to be problematic. Practitioners today face the dilemma of translating this scientific debate into clinical decisions made 1 patient at a time. Is it or is it not appropriate to use a patient's self-identified "race" to help decide treatment? In contrast to the global population groups identified by genetic studies, the U.S. population has experienced substantial genetic admixture over time, weakening our ability to distinguish groups on the basis of meaningful genetic differences. Nonetheless, many researchers have suggested that these differences are still sufficient to identify racially specific uses for pharmaceutical and other treatments. A review of recent research on the treatment of hypertension and congestive heart failure finds that race-specific treatments of this type carry a substantial risk for treating patients--black or white--inappropriately, either by withholding a treatment that may be effective or by using a treatment that may be ineffective. Only by moving beyond historical concepts of "race" to examining a patient's individual socioeconomic, cultural, behavioral, and ancestral circumstances can a practitioner select the treatment that is most likely to be effective and in doing so, can best serve that patient's needs.     

Management of severe Alzheimer's disease and end-of-life issues

The quality of life of individuals with severe Alzheimer's disease requires attention to three main factors: (1) availability of meaningful activities, (2) optimal management of medical issues, and (3) appropriate treatment of psychiatric symptoms. Preservation of ambulation and comfort and avoidance of depression are significant interfaces between these three main factors. Formulation of an advance proxy plan is important for ensuring that the patient's previous wishes or best interests are considered when decisions about treatment strategies are made. Decisions regarding treatment strategies should take into consideration decreased effectiveness of several therapeutic approaches in this patient population. Hospice care is appropriate for the terminal stage of Alzheimer's disease, but palliative care also can be provided in other settings.     

On the dilemma of enigmatic refusal of life-saving therapy

When patients give no reason for refusing therapy (an enigmatic refusal), this creates the dilemma of whether or not to administer the therapy by force, especially when the therapy poses low risk and offers significant benefit. We argue that there is a duty to assess the patient's decision-making capacity, as well as attempt to understand a patient's reason(s) for refusing treatment. While some patients may not readily offer reasons for refusing treatment, this does not preclude an obligation for clinicians to inquire about such. The reasons for treatment refusal can be related to the patient's goals, values, fears, and mental state.     

Providing and monitoring quality service for smoking cessation in tuberculosis care.

All tobacco smokers should be identified and provided with a smoking cessation intervention (SCI) during tuberculosis (TB) treatment. To ensure that this occurs, the intervention process should be recorded and monitored. Monitoring is the best guarantee that care is standardised and offered equitably to all patients. It allows for evaluation of processes and outcomes so that population needs can be identified and appropriate techniques added or updated. In this article we propose steps for brief intervention as a part of the monitoring process, using model forms and suggested procedures for filling them in. The suggested forms are a modified TB treatment card that includes information about tobacco use, an SCI patient card to be added to the patient's TB treatment folder, SCI registers and SCI quarterly report forms and a tobacco use questionnaire for evaluation of services.