长春瑞滨联合奈达铂治疗晚期非小细胞肺癌的临床观察

目的 观察长春瑞滨联合奈达铂治疗晚期非小细胞肺癌的疗效及不良反应.方法 60例晚期非小细胞肺癌（NSCLC）,随机化分为长春瑞滨（NVB）/奈达铂（NDP）（NN治疗组）,长春瑞滨（NVB）/顺铂（DDP）（NP对照组）,治疗2个周期后评价疗效.结果 NN组和NP组的有效率分别为43.8%和41.5%,中位生存期分别为9.2月和8.9月,差异均无统计学意义（P＞0.05）.两组消化道不良反应的发生率分别为30.0%和76.7%,NN组明显低于NP组（χ2=13.13,P＜0.01）.结论 NN方案治疗晚期NSCLC疗效不低于NP方案,选择NDP可明显降低消化道毒副反应,且不需要水化.可推荐作为晚期NSCLC的一线治疗选择.     

国产长春瑞滨联合顺铂治疗晚期非小细胞肺癌的疗效观察

目的观察国产长春瑞滨NVB(盖诺)加顺铂(PDD)联合化疗治疗晚期非小细胞肺癌(NSCLC)的疗效.方法化疗方案包括采用盖诺25 mg/m2静脉推注,第1、8天,顺铂20 mg/m2静脉滴注,第1～5天.结果40例病人进入本组临床试验,其中完全缓解(CR)1例,部分缓解(PR)17例,稳定(NC)19例,进展(PD)3例,总有效率为45.0%.中位缓解期5个月,中位生存期10个月.主要毒副反应为骨髓抑制,消化道反应及静脉炎.结论盖诺加顺铂联合化疗方案治疗晚期非小细胞肺癌的疗效较高,副反应患者可以耐受.     

国产长春瑞滨联合顺铂治疗晚期非小细胞肺癌的疗效观察

目的 观察国产长春瑞滨NVB（盖诺）加顺铂（PDD）联合化疗治疗晚期非小细胞肺癌（NSCLC）的疗效。方法 化疗方案包括采用盖诺25mg／m^2静脉推注，第1、8天，顺铂20mg/m^2静脉滴注，第1～5天。结果 40例病人进入本组临床试验。其中完全缓解（CR）1例，部分缓解（PR）17例，稳定（NC）19例，进展（PD）3例，总有效率为45．0％。中位缓解期5个月，中位生存期10个月。主要毒副反应为骨髓抑制，消化道反应及静脉炎。结论 盖诺加顺铂联合化疗方案治疗晚期非小细胞肺癌的疗效较高，副反应患者可以耐受。     

长春瑞滨联合顺铂治疗非小细胞肺癌临床疗效观察

目的 观察长春瑞滨和顺铂联合（NP方案）治疗晚期非小细胞肺癌（NSCLC）临床疗效。方法采用NP方案治疗NSCLC45例,男32例,女13例。长春瑞滨25mg／m^2,静注,第1、8天,顺铂35mg／m^2,静注,第1～3天。21d为一周期,治疗至少2个周期。其中腺癌20例,鳞癌22例,未分型3例;Ⅲ期27例,Ⅳ期18例;初治33例,复治12例。结果完全缓解5例;部分缓解16例;稳定14例;进展10例,总有效率46．67％。主要毒副反应为骨髓抑制,白细胞下降率为100％;局部静脉炎发生率为22％。采用深静脉给药可明显减轻静脉炎发生。结论长春瑞滨和顺铂联合治疗晚期非小细胞肺癌疗效肯定,费用较低,毒副反应与诺维本相近。     

长春瑞滨联合顺铂治疗晚期乳腺癌的疗效及毒副反应观察

[目的]观察长春瑞滨（盖诺）联合顺铂化疗方案治疗晚期乳腺癌的近期临床疗效与毒副反应。[方法]运用盖诺＋顺铂联合化疗方案治疗晚期乳腺癌共40例，连续治疗2周期后评价疗效与毒副作用，疗效及毒性判断参照WHO标准。[结果]有效率为55．0％，其中CR（完全缓解）1例，PR（部分缓解）21例，SD（稳定）13例，PD（进展）5例。主要毒副反应为胃肠道反应和骨髓抑制。[结论]长春瑞滨联合顺铂化疗方案对晚期乳腺癌有较好的疗效。毒副反应可以耐受，可作为晚期乳腺癌患者的二线治疗方案，值得临床推广。     

紫杉醇单药与长春瑞滨联合顺铂一线治疗老年晚期非小细胞肺癌疗效的临床观察

目的观察紫杉醇单药与长春瑞滨联合顺铂一线治疗老年晚期非小细胞肺癌的疗效及毒副反应。资料和方法57例患者,均经病理或细胞学证实的Ⅲ期以上非小细胞肺癌,有可测量病灶,其中男29例,女28例,年龄65～75岁。病理分型为腺癌32例,鳞癌25例,TNM分期Ⅲ34倒,Ⅳ期23例。按所接受的方案分为紫杉醇单药组及顺铂联合长春瑞滨组,其中紫杉醇175mg·m^-2,静脉滴注大于3h;顺铂25mg·m^-2,静脉点滴,第一天至第三天,长春瑞滨25-30mg／m^2．21日为一周期（分别于第1、8日各给药1次）。每例患者治疗2周期以上.疗效及毒副作用评估按照WHO抗肿瘤药物客观疗效标准评价。总缓解（有效）率以CR＋PR计算。统计学处理两组相比,采用χ^2检验。结果紫杉醇单药组：完全缓解0例,部分缓解13例,稳定10例,有效率为43．3％。顺铂联合长春瑞滨组：完全缓解1例,部分缓解11例．稳定6例,有效率为44．4％。最常见的副反应为骨髓抑制、消化道反应、肾功能损害、便秘等,其中长春瑞滨联合顺铂纽便秘、肾毒性、外周静脉炎,Ⅲ～Ⅳ度骨髓抑制、胃肠道反应多于紫杉醇单药组.结论紫杉醇联单药治疗晚期非小细胞肺癌的疗效与长春瑞滨联合顺铂疗效相当,毒副反应轻可以耐受,是老年患者较理想的一线化疗方法。     

长春瑞滨联合化疗方案治疗晚期食道癌的临床观察

目的观察长春瑞滨(NVB)联合顺铂(DDP)、5-氟尿嘧啶(5-FU)(NPF方案)治疗晚期食道癌的近期疗效及毒副反应。方法经病理学确诊的晚期食道癌病人62例,随机分为两组,每组31例,实验组采用NPF方案化疗,对照组采用PF方案化疗,每3周重复一次,连用两周期评定疗效。结果实验组有效率高于对照组(64.5%vs41.9%,p<0.05)。主要毒副反应为骨髓抑制及消化道反应。结论长春瑞滨联合顺铂、5-氟尿嘧啶化疗方案治疗晚期食道癌疗效好,毒副反应能够赖受,值得进一步研究。     

NP方案化放疗治疗非小细胞肺癌疗效观察

目的 探讨长春瑞滨加顺铂(NP)序贯化放疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效和毒副反应。方法 46例局部晚期非小细胞肺癌患者,随机分成两组,每组23例,A组为单放组,B组为长春瑞滨加顺铂序贯化放疗组.两组均采用6MV-X射线放射治疗,原发病灶和临床可见的肺门纵隔淋巴结总量60~66Gy。B组先应用NP方案行3周期化疗,再行放疗,放疗结束后,再行1周期化疗。NVB25mg/m²,静注,第1、8天,DDP60mg/m²静推,第1天。结果 单纯放疗和长春瑞滨加顺铂的有效率分别为69.5%和86.9%,差异有统计学意义(P<0.05)。两组毒副反应无显著差异。结论 序贯化放疗治疗局部晚期非小细胞肺癌可提高有效率,毒副反应.有增加趋势。     

支气管动脉灌注长春瑞宾顺铂治疗非小细胞肺癌疗效分析

目的评价支气管动脉灌注(BAI)长春瑞宾(NVB)顺铂(DDP)治疗非小细胞肺癌(NSCLC)的近期疗效。方法对手术难度较大,难以手术切除或不愿意接受手术切除的非小细胞肺癌患者36例,用NVB+DDP行BAI共2次,每次间隔3w。结果经2次BAI后,其中CR4例,PR21例,有效率69.56%。结论支气管动脉灌注长春瑞宾顺铂治疗非小细胞肺癌具有较好的近期疗效。     

长春瑞滨与顺铂治疗转移性乳腺癌

目的:评价长春瑞滨联合顺铂(NP方案)治疗以前曾接受含阿霉素和多西紫杉醇治疗的转移性乳腺癌的疗效。方法:顺铂(75 mg/m2第1天)和长春瑞宾(25 mg/m2第1、8天),3周/次。2周期后评价疗效,化疗3~6周期。结果:CR5例(17.9%),PR10例(35.7%),SD7例(25%),PD6例(21.4%),总有效率(CR+PR)为53.6%。毒性反应主要为骨髓抑制、胃肠道反应。结论:顺铂/长春瑞滨方案对蒽环类和多西紫杉醇治疗失败的病人耐受性好且疗效较好。     

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.