实施癌痛规范化治疗的临床实践意义

目的：分享云南省肿瘤医院在全国“癌痛规范化治疗示范病房”创建活动中,实施癌痛诊疗的经验,进一步促进云南省癌痛规范化治疗。方法：回顾我院创建“癌痛规范化治疗示范病房”的历程,以癌痛患者规范化治疗为手段,以控制癌痛症状,提高癌痛患者的生活质量为目的,以安全质量为要求,总结创建“癌痛规范和治疗示范病房”的具体实施、癌痛诊疗流程及经验。结果：在创建“癌痛规范化治疗示范病房”的活动中,规范了医护对于癌痛患者的诊疗,改善了癌痛患者的症状,有效地缓解患者癌症疼痛,效果较为突出。经过全院努力,于2012年通过了卫生部首批“癌痛规范化治疗示范病房”评审。结论：我院“癌痛规范化治疗示范病房”的创建,能够进一步规范医护对于癌痛患者的诊疗,促进医师合理用药;同时,通过对患者及家属的宣教,进一步促进了惠者的依从性,从根苯上减轻了癌痛患者的痛苦,改善了患者的生活质量。此项目是一项民生工程、惠民工程,是一项使癌痛患者真正受益的工程,需要继续推广。     

安徽省肿瘤治疗中心癌痛规范化治疗工作成效显著

安徽省肿瘤治疗中心全面落实原卫生部及原卫生厅创建癌痛规范化治疗示范病房要求。自2011年以来,在全省范围组织开展癌痛规范化治疗示范病房创建工作,并以此为切入点,带动恶性肿瘤规范化治疗水平的提高。     

医院肿瘤科癌痛治疗规范性评价与改进效果研究

目的 分析我院肿瘤科不同病房和医生癌痛治疗的规范性。方法 以我院肿瘤科2019—2020年期间的1564例癌痛治疗病例为研究对象,建立偏最小二乘判别分析(PLS-DA)模型评价不同病房和医生癌痛治疗的规范性。以肿瘤科2021年期间的747例癌痛治疗病例为研究对象,评估改进效果。结果 2019—2020年,肿瘤科一病房的癌痛治疗规范性整体优于二病房和三病房,某主任中医师癌痛治疗规范性水平整体较高。2021年,不同病房和医生癌痛治疗的规范性水平得到了整体提高。结论 癌痛治疗规范性评价有助于推进我院“癌痛规范化治疗示范医院”的创建工作。     

创建“癌痛规范化治疗示范病房”的经验体会

<正>癌痛是由肿瘤所致的疼痛,是长期困扰肿瘤患者的一个重要问题,已被作为"第五生命体征"来处理[1]。全世界每年新发癌症患者1 000余万,每年至少有500万癌症患者在遭受疼痛的折磨,70%的晚期癌症患者认为癌痛是主要症状,30%具有难以忍受的剧烈疼痛[2],为使癌痛患者能够接受规范化治疗,减轻癌痛的折磨,提高生存质量,同时提高医务人员对癌痛的认识,2011年卫生部开始在全国开展"创建癌痛规范化治疗示范病房"活动。     

延伸性护理服务在创建癌痛规范化病房中的作用观察

目的：探讨延伸性护理服务在创建癌痛规范化病房中的作用效果的观察。方法：调查2011-2013年期间81例非住院的晚期患者需要口服阿片类药物的癌痛控制情况,按照随机数字表法将其分为观察组41例和对照组40例,两组患者住院期间均根据卫生部癌痛诊疗规范予以止痛治疗,疼痛控制、稳定,疼痛评分≤3分予以出院,观察组患者出院后继续提供延伸性的护理服务（包括出院后每周一次的电话随访,提供24 h服务电话,每月举办一次病友会）,观察两组患者在非住院期间疼痛控制的情况。结果：观察组的重度、中度和轻度疼痛发生率均明显低于对照组,差异均有统计学意义（P〈0.05）。结论：为非住院的患者提供延伸性护理服务能够明显提高癌痛的控制率,在创建癌痛规范化病房中起到重要作用。     

福州总医院肿瘤科成功创建“癌痛规范化治疗示范病房”

正疼痛是癌症患者恐惧的核心。许多晚期癌症患者最大的心愿仅仅是"减轻疼痛",对此,福州总医院提升癌痛规范化治疗水平,致力于打造"无痛病房",今年2月正式被授予福建省第二批"癌痛规范化治疗示范病房"称号。据悉,国家卫生主管部门于2011年在全     

望江县医院荣获"安徽省癌痛规范化治疗示范病房"星级单位

近日,望江县医院被省卫计委授予"安徽省癌痛规范化治疗示范病房"星级单位,以表彰该县医院肿瘤科为肿瘤病患者治疗服务所取得的成绩.     

上海远郊农村地区癌痛治疗现状及影响因素分析

癌痛是晚期癌症患者最常见的伴随症状之一。20世纪80年代初,世界卫生组织(WHO)倡导的"三阶梯止痛"方法,已成为癌痛规范化治疗最基本和最常用的方法。2011年卫生部在全国开展癌痛规范化治疗示范病房创建活动,大部分二、三级医院癌痛治疗有了质的提高,然而社区卫生服务中心的癌痛诊治现状仍不容乐观。该文就上海远郊农村地区癌痛治疗的现状作详尽的阐述,并分析其影响因素。在此基础上,提出着力加强远郊农村地区癌痛规范化治疗能力建设的重要性,大力推广"三阶梯止痛"适宜技术,真正实现WHO提出的"让癌症患者不痛"的目标。     

江苏省癌痛规范化治疗病房质控管理实践与思考

癌痛是晚期肿瘤患者最恐惧的症状之一,往往超出对肿瘤疾病本身的恐惧,对患者的躯体和精神造成了巨大的伤害,甚至使患者丧失了生存的意愿[1,2].2011年原卫生部办公厅印发关于"开展癌痛规范化治疗示范病房"创建活动通知,计划三年时间在全国范围内创建150个"示范病房".2016年原国家卫生和计划生育委员会发文要求继续推进癌...     

创建“癌痛规范化治疗示范病房”的实践与体会

通过学习相关文件及评审标准,建立癌痛护理小组,编制癌痛规范化治疗培训手册,制订护士培训制度、癌痛护理规程及操作流程,建立癌痛患者宣教制度及随访制度等,提高了护士癌痛管理的技能,使患者对癌痛知识的知晓率及治疗的依从性提高。     

Evaluating the relationship between pain presentation and health-related quality of life in outpatients with metastatic or recurrent neoplastic disease

Because cancer pain can in many cases be intermittent, the presence or absence of pain in ambulatory care patients on any given clinic visit may not be an accurate characterization of the impact of pain on functioning or health-related quality of life (HRQOL). The purpose of this study was to describe the relationship between temporal aspects of pain presentation and HRQOL among 187 stage III/IV cancer patients using the Brief Pain Inventory and the EORTC QLQ-C30. A total of 43% of patients reported pain the previous week, with 22% reporting no pain at the time of assessment. Differences between three pain groups (No Pain, Past Pain, and Current Pain) were significant for global HRQOL and five dimensions of HRQOL. Severity of pain was also associated with each dimension of HRQOL. This study highlights the complex relationship between pain presentation and HRQOL. The findings support the continuing need for detailed pain assessments among cancer patients treated in ambulatory care settings. Specifically, standardized, self-report measures of cancer pain that include ‘frequency’ as well as severity may be the most accurate approach to capture the impact of pain on HRQOL. This revised version was published online in June 2006 with corrections to the Cover Date.     

192名住院病人HPV感染相关知识与态度及行为现状

目的了解衡阳市三级甲等医院住院病人人乳头瘤病毒感染(HPV)相关知识、态度和行为现状,为宣传HPV感染及宫颈癌防治知识提供实验依据。方法随机抽取衡阳市三级甲等医院住院病人200例。将192份有效问卷数据录入Epidata导入SPSS18.0软件,并进行统计处理。结果 192名调查对象(男94名,女98名)对HPV、尖锐湿疣、宫颈癌和宫颈癌预防方法知晓率分别是25%、49%、83.3%、37.5%,对HPV携带人群、HPV与尖锐湿疣及宫颈癌相关性认知水平分别为54.2%、41.7%和33.3%;有94名病人(49%)愿意主动了解HPV感染预防方法,年龄、性别、文化程度和家庭收入都在一定程度上影响HPV感染知晓率、HPV相关知识认知水平及预防HPV感染主动性。结论住院病人HPV感染和HPV相关知识知晓率和认知水平偏低,应加强防治HPV感染和宫颈癌的宣传教育。     

Risk of second primary malignancies in women with papillary thyroid cancer

Second malignancies in women diagnosed with thyroid cancer are of concern given the young average age at diagnosis and excellent survival. Data from the California Cancer Registry were used to evaluate the risk of second primary cancers among a retrospective population-based cohort of 10,932 women diagnosed with papillary thyroid cancer between 1988 and 1999. Follow-up was calculated from 2 months until the diagnosis of a second primary cancer, death, loss to follow-up, or December 31, 1999, whichever occurred first. Standardized incidence ratios, based on age-specific cancer incidence rates for California women, were calculated. During a total of 50,938 person-years of follow-up (mean: 4.7 years), 279 women developed a second primary cancer. The incidence of invasive breast cancer was not elevated compared with California women overall (standardized incidence ratio (SIR) = 0.9, 95% confidence interval (CI): 0.7, 1.1) or when stratified by age, race/ethnicity, follow-up, or radiation treatment. An excess of in situ breast cancer (SIR = 1.6, 95% CI: 1.0, 2.4), kidney cancer (SIR = 3.9, 95% CI: 2.2, 6.3), and melanoma (SIR = 2.1, 95% CI: 1.3, 3.2) limited to the first 5 years after diagnosis was observed. Women with papillary thyroid cancer are at increased risk of in situ, but not invasive, breast cancer, kidney cancer, and melanoma.     

山东省诸城市2010年居民恶性肿瘤死亡情况分析

目的对诸城市2010年居民恶性肿瘤死亡情况进行分析,为制定恶性肿瘤的防治措旅提供科学依据。方法应用死亡率、标化死亡率、构成比等对死因登记报告信息系统中诸城市2010年恶性肿瘤死亡资料进行分析。结果2010年诸城市居民恶性肿瘤死亡率178．60／10万,标化死亡率105．81／10万,居全死因首位,占全死因的23．19％;男性高于女性,性别比值为1．92;前3位恶性肿瘤死因依次为肺癌、肝癌和胃癌,占恶性肿瘤死亡总数的70．68％。结论恶性肿瘤已成为诸城市居民的主要致死疾病之一,肺癌、肝癌、胃癌是造成居民死亡的主要恶性肿瘤,是今后我市恶性肿瘤防控工作的重点。     

Cancer Ward 12: art,medical science,literature and life

Cancer Ward 12 is an ongoing creative project concerned with expressing and articulating, through art, the physical, emotional and social impact of a cancer diagnosis. The first stage of the project was carried out through an artist residency on the general oncology ward, locally known as Ward 12, at Singleton Hospital in Swansea, Wales, in November 2016, and this led to a public exhibition of artwork, launched in Swansea in May 2017. This paper focuses on the methodology and rationale behind the Cancer Ward 12 project, and on the nature of the relation between creative practice and medical science.     

武汉东西湖区输入性疟疾流行病学及临床特点

目的探讨武汉市东西湖区收治的输入性疟疾流行病学和临床特征。方法对2015年2月至2016年12月武汉市医疗救治中心收治的输入性疟疾患者流行病学资料、临床表现、诊治情况等进行描述性分析。结果共收集37例输入性疟疾,恶性疟35例(94.59%),卵形疟2例(5.41%);除发热外,畏寒占54.05%、寒战48.65%、出汗29.73%、头痛37.84%、恶心呕吐62.16%、腹泻18.92%、肌肉酸痛13.51%;此组患者误诊率54.05%;经青蒿琥酯、双氢青蒿素哌喹及伯喹联合治疗,第4d内体温恢复正常者占90.91%,第6d外周血涂片疟原虫检查转阴者占84.38%,至23d累计32例(86.49%)患者治愈出院,复燃1例(2.70%)。结论输入性疟疾以恶性疟为主,患者临床表现复杂多样,并发症多;必须加强疟疾诊断防治知识教育和镜检技能培训和考核,保持对输入疟疾的发现与诊治能力。青蒿素类药物联合治疗输入性疟疾疗效可靠应予坚持。     

男男性接触人群的自我效能对艾滋病知识行为影响分析

目的 研究男男性行为人群的一般自我效能对艾滋病知识行为影响,探索解决该人群“知行分离”的干预策略. 方法 采用应答者驱动（RDS）和网络招募调查对象,收集一般自我效能感、艾滋病防治知识、行为、HIV感染状况资料,用SPSS软件进行单因素和多因素分析. 结果 被调查者一般自我效能感较低.知识知晓率达84.79％,但最近一次同性肛交安全套使用率68.01％,安全套坚持使用率36.76％,HIV感染率2.99％.多因素分析显示,坚持使用安全套的影响因素为艾滋病防治知识得分、自我效能评分和年龄（OR=1.62、2.06和0.95）.自我效能评分越高,其最近一次同性行为时安全套使用率越高、HIV感染率越低.自我效能评分的影响因素为文化程度、月收入、本地MSM朋友数量、年龄,标准化回归系数分别为0.21、0.16、0.12和-0.13. 结论 自我效能感同时对艾滋病防治知识和安全套使用行为起到重要的促进和转化作用,提示增加自我效能是解决男男性行为人群“知行分离”的有效策略之一.     

Evidence of a healthy volunteer effect in the prostate, lung, colorectal, and ovarian cancer screening trial

Volunteers for prevention or screening trials are generally healthier and have lower mortality than the general population. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) is an ongoing, multicenter, randomized trial that randomized 155,000 men and women aged 55-74 years to a screening or control arm between 1993 and 2001. The authors compared demographics, mortality rates, and cancer incidence and survival rates of PLCO subjects during the early phase of the trial with those of the US population. Incidence and mortality from PLCO cancers (prostate, lung, colorectal, and ovarian) were excluded because they are the subject of the ongoing trial. Standardized mortality ratios for all-cause mortality were 46 for men, 38 for women, and 43 overall (100 = standard). Cause-specific standardized mortality ratios were 56 for cancer, 37 for cardiovascular disease, and 34 for both respiratory and digestive diseases. Standardized mortality ratios for all-cause mortality increased with time on study from 31 at year 1 to 48 at year 7. Adjusting the PLCO population to a standardized demographic distribution would increase the standardized mortality ratio only modestly to 54 for women and 55 for men. Standardized incidence ratios for all cancer were 84 in women and 73 in men, with a large range of standardized incidence ratios observed for specific cancers.     

Evaluation of mortality in hospitalized mental patients 1968-1982

Yearly, between 1968 and 1976, and every two years from 1976 to 1982, diagnostic data based on a national classification of mental disorders were homogeneously collected in French public psychiatric hospitals. The hospitalized population was estimated by the person-year method, using data on length of stay. The number of observed deaths was compared with the number of deaths expected (Standardized mortality ratio). The standardized mortality ratio (SMR) for psychiatric inpatients were found irregularly and slightly decreasing, except among women under 45: this SMR was higher in 1982 (9.6) than in 1968 (7.4). The SMR for neuroses, in the under 55 years age group, showed a regular increase especially among women. The SMR for psychoses and mental retardation was decreasing among men. For people aged more than 55 years the SMR was decreasing for all groups of diagnosis.     

Screening anxious-depressive symptoms and pain in medical inpatients

AIM: Several studies indicate a relationship among depression, anxiety, pain and hospitalization. Depression has a bidirectional relationship with cardiovascular disease, and it is observed in HIV-positive individuals, in cancer patients and it often complicates chronic pain. METHODS: In order to assess dimensionally depressive and anxious symptoms and pain in medical inpatients, 327 non-psychiatric inpatients were assessed using the Hospital Anxiety and Depression Scale (HADS) and Visual Analogical Scale (for pain, VAS). Inpatients were hospitalized for neurovascular disease, chronic medical illness, cancer, infectious disease, cardiovascular illness, orthopaedic surgery and general surgery. RESULTS: Very high anxiety levels were discovered in cardiovascular, general surgery, infectious and neurovascular patients, whereas depression levels were higher among cardiovascular and chronic patients. The highest levels of pain were found among patients admitted to the Oncology Unit and those suffering from chronic medical illness. A stronger, direct relationship was obtained between anxiety and depression than between pain and anxiety or depression. No statistical differences were found in men and women. Statistically speaking significant differences were found in wards. Pain is a significant predictive variable for anxiety and depression (P<0.001). CONCLUSION: Screening for anxiety and depression should be included in the clinical interview carried out by the nurse at the moment of admission to the ward.