厄洛替尼联合全脑放疗治疗非小细胞肺癌脑转移的临床效果

目的观察厄洛替尼联合全脑放疗(WBRT)治疗非小细胞肺癌脑转移临床意义。方法随机将收治的46例非小细胞肺癌脑转移患者分为两组。对照组给予WBRT治疗,观察组在对照组的基础上给予厄洛替尼治疗。比较两组疗效。结果观察组总有效率、中位生存时间及1年生存率等均显著优于对照组,差异有统计学意义(P﹤0.05)。结论厄洛替尼联合WBRT治疗非小细胞肺癌脑转移疗效理想,可明显提高病人的生存时间。     

康艾辅助序贯放化疗治疗晚期非小细胞肺癌对患者预后(生存率等)及生活质量的影响分析

目的探讨药物联合化疗序贯吉非替尼治疗晚期非小细胞肺癌对患者预后及生活质量的影响。方法收集2012年1月至2014年6月来我院就诊的患者192例,随机分为试验组和对照组,每组96例。试验组给予药物联合化疗序贯吉非替尼治疗,对照组仅给予药物联合化疗治疗,观察两组患者治疗预后及生活质量差异。结果试验组患者治疗预后结局优良率、生存率及生活质量均明显高于对照组,分别经卡方检验或t检验比较,差异均有统计学意义(P0.05)。结论康艾辅助吉西他滨联合顺铂序贯放疗治疗晚期非小细胞肺癌可有效改善患者预后和生活质量。     

吉非替尼联合同步放疗治疗表皮生长因子受体突变型晚期非小细胞肺癌的临床观察

目的探讨吉非替尼联合同步放疗治疗表皮生长因子受体突变型晚期非小细肺癌(non-small cell lung cancer,NSCLC)的疗效、不良反应及生存情况。方法将2008年1月—2014年2月收治的表皮生长因子受体(epithelial growth factor receptor,EGFR)突变型晚期非小细肺癌患者分为同步组60例和序贯组38例,同步组采用吉非替尼联合同步放疗治疗(吉非替尼250 mg/d),而序贯组采用先服用吉非替尼直至疾病进展,再进行放疗。统计两组的疗效、不良反应、无进展生存时间(progression-free survival,PFS)、总生存期(overall survival,OS)、1年生存率和2年生存率,利用R×C表的χ2检验和2×2表的χ2检验分析相关数据。结果在同步组中出现缓解(partial response,PR)、进展(progress of disease,PD)、有效(response rate,RR)和疾病控制(disease control rate,DCR)的比例分别为76.67%、1.67%、86.67%和98.33%,而在序贯组出现PR、PD、RR和DCR的比例分别55.26%、15.79%、65.79%和84.21%。有消化道反应的患者在同步组和序贯组的比例分别为68.33%和47.37%,而有转氨酶升高的患者则分别为23.33%和5.26%。患者出现PR、PD、RR、DCR、消化道反应、转氨酶升高和2年生存率在同步组与序贯组之间的差异有统计学意义(P0.05)。完全缓解、部分缓解、稳定和进展的构成比在两组间的差异有统计学意义(P0.05)。结论治疗EGFR突变型晚期非小细肺癌采取吉非替尼联合同步放疗的方案是可取的。     

埃克替尼在晚期非小细胞肺癌靶向治疗中的疗效观察

目的 观察晚期非小细胞肺癌靶向治疗中埃克替尼的应用效果,掌握埃克替尼临床疗效。方法 随机选取2021年1月-2022年4月本院收治的44例晚期非小细胞肺癌患者作为本次研究对象,并采取随机抽签法将其划分为研究组与对照组,两组患者均接受化学治疗。对照组行常规化疗治疗,研究组在常规化疗基础上接受埃克替尼治疗。比较分析两组患者临床特征与疗效相关性、客观缓解率、疾病控制率、症状缓解时间、疾病进展时间、平均生存时间、不良反应发生率。结果 EGFR、EGFR突变类型、吸烟室与晚期非小细胞肺癌密切相关,不同指标下晚期非小细胞肺癌靶向治疗患者客观缓解率存在确切差异(P<0.05)。研究组CR、PR高于对照组,SD、PD小于对照组,客观缓解率与疾病控制率优于对照组(P<0.05)。治疗后,研究组病症缓解时间少于对照组,疾病进展时间与平均生存时间高于对照组,组间差异确切(P<0.05)。治疗后,研究组不良反应发生率低于对照组,两组差异明显(P<0.05)。结论 埃克替尼在晚期非小细胞肺癌靶向治疗中的疗效突出,能够切实减少并发症,延长患者生存时间,提高患者晚期疗效。     

克唑替尼治疗ALK阳性晚期非小细胞肺癌的体会

目的:探讨克唑替尼治疗ALK阳性晚期非小细胞肺癌的疗效.方法:选择某医院进行治疗的ALK阳性晚期非小细胞肺癌患者60例,按照随机数字的方法将患者分为对照组与观察组,每个组30例,对照组患者给予多西他赛,观察组患者给予克唑替尼,对比治疗的效果.结果:观察组患者的治疗有效率高于对照组,差异具有统计学意义(P＜0.05),在治疗过程中,两组患者所发生的各类不良反应数据差异均无统计学意义(P＞0.05),对照组患者的无进展生存时间均数为6.880个月,95％CI为5.428～8.333个月,观察组患者的无进展生存时间均数为9.257个月,95％CI为8.118～10.397个月,差异具有统计学意义(P＜0.05).结论:利用克唑替尼治疗ALK阳性晚期非小细胞肺癌患者,可以提升治疗效果,提高无进展生存率,值得进行推广.     

非小细胞肺癌患者应用吉非替尼治疗的疗效和毒副反应分析

目的探讨非小细胞肺癌患者应用吉非替尼治疗的疗效和毒副反应。方法选取我院收治的非小细胞肺癌患者60例,采用盲选法分为对照组与观察组,对照组患者应用培美曲塞治疗,观察组患者给予吉非替尼治疗,对比两组患者治疗效果、生存期及毒副反应情况。结果观察组近期疗效与对照组相比差异具有统计学意义(P0.05);观察组1年生存率较对照组高(P0.05),无进展生存期较对照组长(P0.05);观察组毒副反应发生率低于对照组(P0.05)。结论非小细胞肺癌患者应用吉非替尼治疗的近期疗效显著,生存期长,有临床应用价值。     

安罗替尼胶囊治疗晚期非小细胞肺癌的有效性

目的探究安罗替尼胶囊治疗晚期非小细胞肺癌的有效性。方法从我院2018年6月-2019年6月选取44例晚期非小细胞肺癌患者,将患者随机分成两组,每组22例,一组为对照组,使用安慰剂。另一组为观察组,使用安罗替尼胶囊。观察比较两组患者的无进展生存期(progression free survival,PFS)、总生存期(overall survival,OS),以及治疗安全性。结果观察组患者的无进展生存期(PFS)和总生存期(OS)高于对照组,差异具有统计学意义(P <0.05)。观察组患者的不良反应发生率为27.27%,对照组为22.73%,两组差异无统计学意义(P> 0.05)。结论安罗替尼胶囊有利于晚期非小细胞肺癌的治疗,能够有效延长患者的无进展生存期、总生存期,并且有一定的安全性。     

吉非替尼治疗晚期非小细胞肺癌的临床疗效及不良反应

目的观察吉非替尼治疗晚期非小细胞肺癌的临床效果,同时探究其对相关不良反应发生的影响作用。方法抽取在本院接受治疗的90例晚期非小细胞肺癌做分组调查,依据治疗方案的不同将厄洛替尼治疗的45例患者作为对照组,吉非替尼治疗的45例作为观察组,观察两组患者治疗效果。结果观察组治疗有效率为93. 33%,控制率为100. 00%,对照组治疗有效率为60. 00%,控制率为86. 67%,观察组患者平均咳嗽、疼痛、厌食、乏力消失时间均明显小于对照组,观察组45例患者中,1例患者发生恶心、1例患者发生皮肤干燥、1例患者发生腹泻情况,对照组45例患者中,2例患者发生恶心,1例患者发生皮肤干燥,1例患者发生腹泻情况。结论在晚期非小细胞肺癌的治疗中,可选择多种治疗方案,而在药物治疗方面,吉非替尼有助于提升整体治疗效果,同时促进患者各项病状的改善,且不会发生严重不良反应,安全性较高。     

吉非替尼联合培美曲塞治疗EGFR突变型肺腺癌临床观察

目的肺腺癌患者具有较高的表皮生长因子受体(epidermal growth factor receptor,EGFR)突变发生率,吉非替尼治疗肺腺癌具有较好的疗效。本研究探讨吉非替尼单用及联合培美曲塞治疗EGFR突变晚期肺腺癌疗效及预后。方法选取2015-01-15-2018-01-15本院收治的EGFR突变型晚期肺腺癌患者90例为研究对象,按照性别、年龄组间匹配的原则分为观察组和对照组,各45例,对照组单用吉非替尼治疗,观察组在此基础上联合使用培美曲塞治疗,比较两组疗效及预后。结果观察组治疗有效率为66.67%,高于对照组的28.89%,χ~2=12.870,P<0.001;观察组疾病控制率为77.78%,高于对照组的48.89%,χ~2=8.086,P=0.004。观察组不良反应发生率为31.11%,对照组为20.00%,差异无统计学意义,χ~2=0.257,P=0.612。观察组中位无进展生存期(progression free survival,PFS)为12.59个月,对照组中位PFS为6.82个月,差异有统计学意义,P<0.001。结论吉非替尼联合培美曲塞治疗EGFR突变型晚期肺腺癌疗效较佳,疾病控制率较高,预后良好,不良反应可耐受。     

三维适形放疗联合吉非替尼治疗局部晚期肺腺癌的临床观察

目的观察吉非替尼联合适形放射治疗局部晚期肺腺癌的疗效及不良反应。方法 70例局部晚期肺腺癌患者随机分为吉非替尼联合适形放射治疗组(治疗组)和单纯适形放射治疗组(对照组)各35例。放疗采用6MVX线三维适形放射治疗,2.0Gy/次,1次/d,5次/周,DT66～72Gy。治疗组同步口服吉非替尼,从放疗第1天开始,连服2月。胸部病灶按WHO实体瘤疗效评价标准在放疗30天内经胸部增强CT扫描评价近期疗效,急性副反应及晚期并发症按照RTOG标准进行评价。结果治疗组有效率(CR+PR)为88.6%,对照组有效率为62.9%,两组有效率比较,差异有统计学意义(χ2=6.29,P<0.05);治疗组1、2、3年生存率分别为65.7%、37.1%、22.9%,对照组1、2、3年生存率分别为40.0%、14.3%、5.7%,两组同期生存率比较,差异均有统计学意义(χ2=4.64、4.79、4.20,P<0.05)。吉非替尼组主要不良反应为Ⅰ/Ⅱ度皮疹、腹泻。结论吉非替尼联合适形放射治疗局部晚期肺腺癌能提高患者的生存率,并未增加毒性反应。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.