Make a CHANGE: optimising communication and pain management decisions

The major objectives of the CHANGE PAIN International Advisory Board are to enhance understanding of chronic pain and to develop strategies for improving pain management. At its second meeting, in November 2009, evidence was presented that around one person in five in Europe and the USA experiences chronic pain, and the delay before referral to a pain specialist is often several years. Moreover, physicians' pharmacological approach to chronic pain is inconsistent, as evidenced by the huge variation in treatment between different European countries. It was agreed that efficient communication between physician and patient is essential for effective pain management, and that efficacy/side-effect balance is a key factor in choosing an analgesic agent. The multifactorial nature of chronic pain produces various physical and psychological symptoms, so the management of chronic pain should be tailored to the individual. Pharmacological therapy must be matched to the causative mechanisms responsible, or it is likely to prove ineffective and risk the development of a 'vicious circle'; doses are increased because of inadequate pain relief, but this increases side-effects so doses are reduced, pain relief is then inadequate, so doses are increased, and so on. Pain management decisions should not therefore be based solely on the severity of pain. Based on the concept of individual treatment targets (ITT), the CHANGE PAIN Scale was adopted - a simple, user-friendly assessment tool to improve communication between physician and patient. The 11-point NRS enables the patient to rate the current pain intensity and to set a realistic individual target level. On the reverse are six key parameters affecting the patient's quality of life; clinicians simply need to agree with patients whether improvement is needed in each one. Regular use can establish the efficacy and tolerability of pain management, and the rate of progress towards individual treatment targets.     

风险管理在儿科护理管理中的临床价值

目的探讨风险管理在儿科护理管理中的临床价值。方法选取本院2012年4月～2013年4月儿科患者238例,根据护理方法不同分为两组,常规护理患儿119例为对照组,风险管理患儿119例为观察组,比较两组患儿风险情况、护理满意度情况。结果观察组风险发生率明显低于对照组,观察组住院环境满意度、护理管理满意度、护士业务能力满意度均明显高于对照组,差异均有统计学意义（P〈0．05）。结论在儿科护理管理中,风险管理可明显降低风险发生率,提高患儿护理满意度。     

Clinical management of mantle cell lymphoma in the elderly

ABSTRACT

Introduction: Mantle cell lymphoma (MCL) is a disease with an indolent histology, but mostly aggressive clinical course. While treatment can yield more promising results in younger patients, the disease is most diagnosed at a median age of approximately 70 years, and treatment in this group still presents a major challenge for oncohematologists. Unfortunately, due to comorbidities and poorer general status, the implementation of intensive treatment approaches with the cytarabine-based regimens and autologous stem cell transplantation is generally not possible, and the disease remains incurable, especially in elderly patients.

Areas covered: In this paper, the authors discuss the therapeutic options available for older patients with MCL in the first line and relapsed/refractory settings, indicating new therapeutic options, which may achieve longer remissions and overall survival.

Expert opinion: Although great progress has been made in the treatment of MCL in recent years, there remains a need for new treatment lines which can allow improved patient outcomes. Novel agents targeting altered the signal transduction pathways in MCL cells may offer more promise than traditional chemotherapy or immunochemotherapy and are currently being tested in clinical trials.     

“两个中心”的人性化护理管理的临床实践

目的：提高医护质量,为患者提供最佳服务,增强医院人的凝聚力,树立医护人好形象。方法：实施人性化管理,并建立良好公共关系,实行弹性排班、护理层级、流程管理、表格化简化护理记录。结果：人性化管理优势较为明显。结论：有合格的护士才有合格的质量,有满意的护士才有满意的患者,有满意的护士和满意的患者才能实现高护理质量。     

Clinical efficacy of bupropion in the management of smoking cessation

Nicotine addiction is a chronic relapsing condition that can be difficult to treat. Until recently, pharmacological options for the treatment of tobacco dependence were primarily limited to nicotine replacement therapy (NRT). Sustained-release bupropion (bupropion SR) is the first non-nicotine pharmacological treatment approved for smoking cessation. Bupropion SR is recommended for first-line pharmacotherapy alongside NRT in the updated US Clinical Practice Guidelines and the UK Health Education Authority Guidelines. The UK National Institute of Clinical Excellence recommends NRT and bupropion SR for smokers who have expressed a desire to quit smoking. This review presents evidence that bupropion SR is an effective first-line therapy for smoking cessation in a wide range of patient populations. It is associated with significantly higher smoking cessation rates compared with placebo in patients with or without a history of prior bupropion SR or NRT use, and its effect is independent of gender. Bupropion SR treatment is effective in the prevention of relapse to smoking in those patients who have successfully quit, and re-treatment is effective in smokers who recommence smoking after a previous course of bupropion SR. Bupropion SR treatment relieves the symptoms of craving and nicotine withdrawal, and attenuates the weight gain that often occurs after smoking cessation. Data collected from motivational support programmes and employer-based studies provide strong evidence of the effectiveness of bupropion SR as an aid to smoking cessation in 'real life' situations, and confirm the efficacy seen in clinical trials.     

美沙酮在镇痛方面的临床应用

美沙酮于本世纪４０年代合成,是一种阿片受体激动剂。尽管现在临床上主要用于阿片成瘾的维持治疗,但因其镇痛效果明显,同时又具有多种不同于其他阿片类物质的特点,如:良好的胃肠道吸收性,代谢产物无活性,作用时间长,价格低廉,与其他μ受体激动剂有不完全的交叉耐受性等,因...     

临床药师在癌痛控制中的作用

癌痛治疗已经成为肿瘤内科治疗过程中较为棘手的问题,疼痛控制不佳往往会严重影响患者的生活质量。我院临床药师在癌痛控制工作中进行患者教育和疼痛评估,建立疼痛日记,为医生建议阿片类药物给药剂量,对不良反应进行监测并提出应对方案,将专业服务嵌入到临床医疗实践中,发挥了自己在癌痛控制中的作用。     

规范化药学服务模式在癌痛全程化管理中的应用研究

目的在癌痛全程化管理中建立规范的药学服务模式,提高药学服务的水平,优化院内外癌痛患者镇痛效果。方法通过反复讨论和修订,制订出一套实践性较强的药学服务流程,确立规范的药学服务模式,对患者进行全生命周期的动态管理,并使用一系列的评估量表,考察干预前后患者的疼痛控制、疼痛对生活的影响、用药依从性以及不良反应情况。结果 23名癌痛患者接受药学干预后的4个疼痛指标改善,即"过去24 h最严重的疼痛程度""最轻微的疼痛程度""平均的疼痛程度""调查当时的疼痛程度"评分分别降至(3.14±1.78)分、(0.82±0.91)分、(1.73±0.83)分、(1.55±1.50)分(P <0.01)。评价疼痛对生活的影响,干预后的7个条目的评分均有显著降低,患者日常生活质量得到明显改善,且差异有统计学意义。患者用药依从性评价为"好"的比例由13.04%上升至65.22%(P<0.01)。药物不良反应干预前后差异无统计学意义。结论建立了癌痛全程化管理中的规范化药学服务模式。实施后,患者的疼痛控制、日常生活质量及用药依从性得到明显改善。该模式有助于癌痛管理药学服务同质化,有促于推动临床药师参与癌痛管理的不断深入。     

氟吡汀在疼痛治疗中的应用

氟吡汀是一种新型非阿片类止痛药,为选择性神经元钾通道开放剂,具有止痛、松弛肌肉和保护神经的作用。其最主要的适应证为肌紧张相关性肌肉骨骼痛,可用于治疗各类急慢性疼痛,如腰背痛、头痛、癌痛等。作为止痛剂,氟吡汀疗效肯定,副作用小,具有良好的临床应用前景,本文主要对其在疼痛治疗领域的应用作一简要概括。     

人禽流感的临床应对

<正> 人类的发展史是一部与传染病斗争的历史。有人类文明纪录以来,传染病一直占各种人类疾病死亡率的首位,如1918年在欧洲一次流感就死亡4000万人。20世纪中叶发明的抗菌素对各种细菌性疾病取得疗效,细菌性肺炎、脑膜炎、败血症病死率因之下     

Clinical management of rivaroxaban-treated patients

Introduction: Until recently, only vitamin K antagonists (VKAs) were used for long-term anticoagulation. New oral anticoagulants, with pharmacokinetic and pharmacodynamic characteristics different to VKAs, are now available for some indications. Rivaroxaban (Xarelto®) is an oral Factor Xa inhibitor approved in many countries for long-term treatment of patients with atrial fibrillation or venous thromboembolism. This article is addressed to all professionals involved in the management of treated patients to highlight the characteristics of rivaroxaban and provide practical guidance on management of treated patients.

Areas covered: This article is based on a consensus of specialists involved in the management of anticoagulant treatment, including thrombosis experts, cardiologists, neurologists, emergency medicine specialists, and general practitioners. The authors performed a nonsystematic review of the literature, and expressed guidance statements based on the results of the review as well as personal experience.

Expert opinion: Availability of new anticoagulant drugs, including rivaroxaban, is an important step forward to allow easier, more effective, and safer long-term anticoagulation in patients in whom adequate anticoagulation is currently denied due to the limitations of VKAs. However, given their totally new properties, associated risks, and expected broad clinical use, expert professionals and manufacturers must urgently tackle a series of issues.     

下腔静脉后输尿管的诊治

目的 提高对下腔静脉后输尿管的诊断和治疗水平。方法 回顾性分析12例下腔静脉后输尿管患者的临床表现、影像学诊断和手术方式,并复习有关文献。结果 随访结果:8例右肾积水明显改善,4例右肾功能显著好转。结论 下腔静脉后输尿管的确诊主要应依据影像学检查,输尿管切断复位术是根本性治疗措施,利用腹腔镜技术的微创手术前景良好。