人性化照护对乳腺癌患者癌因性疲乏和生活质量的影响

目的：探讨人性化照护对乳腺癌化疗患者癌因性疲乏与生活质量的影响。方法将70例乳腺癌化疗患者随机分为研究组和对照组,对照组采用化疗常规护理,研究组在护理过程中实行人性化照护,应用简易疲乏量表（ BFI）和生活质量量表（ QOL）评估、分析护理前后两组患者的癌因性疲乏与生活质量。结果实施人性照护后,研究组癌因性疲乏与生活质量得分均高于对照组（P＜0．05）,研究组生活质量得分高于护理前（P＜0.05）,照护后疲乏程度与护理前比较无差异（P＞0.05）,对照组护理前后生活质量得分比较无差异（P＞0.05）,癌因性疲乏程度加重（P＜0.05）。结论人性化照护可减轻或消除乳腺癌患者癌因性疲乏,显著提高患者生活质量。     

General practitioners' attitudes to randomised clinical trials for women with breast cancer

OBJECTIVE: To determine general practitioners' attitudes to randomised clinical trials for women with breast cancer. DESIGN: Cross-sectional survey with structured face-to-face interviews conducted between December 1997 and May 1998. PARTICIPANTS: A random sample of GPs in central Sydney. MAIN OUTCOME MEASURES: GPs' attitudes to referring women with breast cancer to specialists who enrol patients in randomised clinical trials, and to randomised clinical trials in general. RESULTS: 85 of 158 GPs (54%) consented to be interviewed. Of these 85 GPs, 47% stated that they would refer a woman with breast cancer to a specialist who was likely to enrol the woman in a clinical trial; 50% believed that clinical trials increase knowledge about treatment options; and 15% thought that randomised trials may make a valuable scientific contribution. However, 43% of GPs expressed concerns that their patients may be disadvantaged, 39% said that they wanted optimum treatment for their patients, 18% that they would want to know what the trial was about, and 12% were worried about ethical considerations. CONCLUSIONS: Many of the GPs in this survey have concerns about randomised clinical trials for women with breast cancer. Improved communication between specialists and GPs about the conduct of and treatments offered in clinical trials for breast cancer may change this attitude.     

Who goes where? A prospective study of referral patterns within a newly established primary care team

Background

Since the introduction of primary care teams, referral patterns of General Practitioners (GPs) in Ireland have not been studied.

Aims

To study the referral patterns of GPs within a primary care team (PCT) to allied health care professionals in a PCT and to secondary care. To identify indirect referral pathways. To study variation in individual GP referral patterns.

Method

Questionnaire based survey. Statistical analysis was carried out using Epi Info version 3.5.1.

Results

Of 3,166 consultations, 2,841 (89.7%) were dealt with by the GP and required no referral, 107 (3.4%) were referred within the PCT, and 218 (6.9%) were referred elsewhere. Therefore, 93.1% of consultations were managed in primary care alone. Ninety percent of GPs refer patients to the PCT. Indirect referrals constituted 17% of all outpatient referrals. Females have significantly higher referral rates than males. Referral rates of GPs in single-handed practices are higher than GPs in group practices.

Conclusions

GPs alone can manage the vast majority of presentations in general practice. Greater GP access to diagnostic and therapeutic interventions may reduce outpatient referrals. GPs in group practices may collectively have greater experience and expertise and therefore can manage more patients in primary care. There is a significant variation in referral rates between both genders.     

护理干预对乳腺癌患者癌性疲乏与生活质量的影响

目的：探讨系统的护理干预对乳腺癌患者癌性疲乏及生活质量的影响。方法：选择2010年1月～2011年6月间我院接受治疗的乳腺癌患者96例,随机分为研究组和对照组,每组各48例。对照组采用常规的乳腺癌护理,研究组在此基础上,进行系统的癌性疲乏护理。应用Piper疲乏量表和生活质量问卷,分别在干预前、干预20 d后,评估两组患者的疲乏程度和生活质量。结果：干预前两组的癌性疲乏及生活质量得分比较,差异无统计学意义（P〉0.05）;干预后,研究组癌性疲乏及生活质量得分均优于对照组（P〈0.05）;对照组干预后生活质量的得分与干预前比较,差异无统计学意义（P〉0.05）,癌性疲乏程度加重（P〈0.05）;研究组干预后生活质量得分均高于干预前（P〈0.05）,疲乏程度与干预前比较,差异无统计学意义（P〉0.05）。结论：系统的护理干预可以显著提高乳腺癌患者的生活质量,降低癌性疲乏的程度,有利于患者的康复。     

Diallyl disulfide and diallyl trisulfide in garlic as novel therapeutic agents to overcome drug resistance in breast cancer

Breast cancer is one of the leading causes of cancer-related deaths in women worldwide. It is a cancer that originates from the mammary ducts and involves mutations in multiple genes. Recently, the treatment of breast cancer has become increasingly challenging owing to the increase in tumor heterogeneity and aggressiveness, which gives rise to therapeutic resistance. Epidemiological, population-based, and hospital-based case-control studies have demonstrated an association between high intake of certain Allium vegetables and a reduced risk in the development of breast cancer. Diallyl disulfide (DADS) and diallyl trisulfide (DATS) are the main allyl sulfur compounds present in garlic, and are known to exhibit anticancer activity as they interfere with breast cancer cell proliferation, tumor metastasis, and angiogenesis. The present review highlights multidrug resistance mechanisms and their signaling pathways in breast cancer. This review discusses the potential anticancer activities of DADS and DATS, with emphasis on drug resistance in triple-negative breast cancer (TNBC). Understanding the anticancer activities of DADS and DATS provides insights into their potential in targeting drug resistance mechanisms of TNBC, especially in clinical studies.     

The misuse of mammography in the management of breast cancer revisited

A second study of the use of mammography as a diagnostic procedure in women with breast symptoms is reported. In a two-year period during which 468 patients with a new diagnosis of breast cancer were seen, 238 women had undergone mammography before referral to the Department of Radiation Oncology, Westmead Hospital. For 73 (30.7%) patients the mammographic report was falsely negative. Among those 73 patients with a falsely negative mammographic report, 40 women experienced a mean treatment delay of 12.7 months (range, three to 60 months). A negative mammographic result was significantly (P less than 0.001) more likely to be obtained in younger women. When the women with an initially negative mammographic result represented, they did so with disease of a more advanced stage. This, we contend, is related to the delay in their definitive treatment as caused by the first falsely negative mammographic report. Theoretical calculations are presented; under varying conditions of sensitivity and specificity, these show that, even with the addition of specialist opinion, significant proportions of patients with breast cancer will have a mammographic result which is falsely reassuring. The identification of these subsets depends on histological or cytological examination of the tumour. This is a decision that best is made, in our opinion, by a specialist in breast-cancer management.     

Knowledge and attitudes of men about prostate cancer

OBJECTIVE: To ascertain the current level of understanding among older men about prostate cancer, including treatment options and their potential side effects. DESIGN AND SETTING: Questionnaires administered by general practitioners in five general practices in the Perth metropolitan and regional areas of Western Australia. PARTICIPANTS: Convenience sample of 503 men aged 40-80 years, with or without prostate cancer, presenting for routine consultations between January and August 2006. MAIN OUTCOME MEASURE: Knowledge and attitudes of men about prostate cancer, and predictors of knowledge. RESULTS: Eighty per cent of men did not know the function of the prostate, and 48% failed to identify prostate cancer as the most common internal cancer in men. Thirty-five per cent had no knowledge of the treatments for prostate cancer and 53% had no knowledge of the side effects of treatments. Asked how they would arrive at a decision about treatment, 70% said they would ask the GP or specialist for information on all their options and then decide themselves. CONCLUSION: There is a deficit in knowledge about prostate cancer among men in the at-risk age group, encompassing areas that could delay diagnosis and treatment. Overall, the men preferred some GP or specialist involvement in treatment decision making.     

39例蒽环类及紫杉类耐药晚期乳腺癌应用GP方案与NP方案治疗的疗效观察

目的对于晚期乳腺癌,三线药物治疗（即蒽环类及紫杉类治疗）失败,采用GP方案（吉西他滨联合顺铂）与NP方案（长春瑞滨联合顺铂）,观察近期疗效和不良反应。方法将既往曾接受蒽环类及紫杉类药物治疗失败的39例晚期乳腺癌患者随机分组,GP方案组20例,NP方案组19例,化疗2周期后评价疗效,有效者继续化疗。结果 GP组与NP组总有效率分别为40.09%和42.11%,两组比较差异无统计学意义（P〉0.05）。主要不良反应为骨髓抑制及消化道反应,两组比较差异无显著性（P〉0.05）。结论对于三线药物治疗（即蒽环类及紫杉类治疗）失败的晚期乳腺癌,GP方案与NP方案治疗的近期疗效得到肯定,而且不良反应也可以忍受。     

Referral patterns, clinical examination and the two-week-rule for breast cancer: a cohort study

Introduction

Current NHS guidelines require patients with suspected breast cancer to be seen urgently at a specialist breast clinic. The aim of this study was to assess referral patterns and clinical findings of patients referred to a specialist breast clinic.

Materials and Methods

A prospective database was maintained for consecutive patients referred. Symptoms and clinical findings in primary and secondary care were recorded. Correlation with final diagnoses was made. Tertiary referral patients were excluded.

Results

1098 patients attended a specialist breast clinic over six months. 588 (54%) were referred as urgent, 285 (26%) routinely and 225 (20%) were unspecified. 492 (45%) patients were referred with the incorrect referral priority. 42 patients were unexamined in primary care. Examination findings in primary and secondary care correlated in only 487 (46%) patients. Examination in primary care when compared with secondary care was highly sensitive for detecting breast lumps, but specificity was low. 86 patients (8%) were diagnosed with breast cancer, 72 (84%) were referred urgently, 6 (7%) routinely and 8 (9%) as unspecified priority. Regardless of the clinical expertise of the referrer, sensitivity and specificity of the two-week guidelines for cancer are low.

Conclusions

Examination findings in primary and secondary care correlate in only 46% of referrals. Additionally, 55% of referrals were of the correct priority. The two-week rule guidelines have poor sensitivity and specificity for cancer. The safest and fairest policy would be to abandon the concept of urgent referral criteria and see all patients in a timely fashion. Alternatively, simplifying the referral criteria would improve sensitivity and specificity for cancer without leading to increased waiting times.     

General practitioners' experiences of managing patients with chronic leg ulceration

OBJECTIVE: To understand general practitioners' experiences of managing patients with chronic leg ulceration, thus informing future strategies to improve leg ulcer care in general practice, Australia. DESIGN: Qualitative study using phenomenology and in-depth interviewing. PARTICIPANTS AND SETTING: Maximum variation sample of 12 GPs working in the Perth and Hills Division of General Practice between September and December 2004. MAIN OUTCOME MEASURE: Themes in participants' experiences of leg ulcer care. FINDINGS: Participants regarded leg ulcer management as an integral part of general practice. They expressed a desire to maintain their involvement, yet relied on nursing assistance. They perceived that ulcer care was usually straightforward and successful. Approaches to management appeared to differ significantly from that outlined in current guidelines. Instead, participants valued accessibility of care for the patient, awareness of patient context and regular review. Occasional problems with non-healing ulcers were experienced, and, in these situations, specialist opinion was appreciated. CONCLUSION: This study highlights fundamental differences between GP and specialist conceptualisation of leg ulcer care. For GPs, it identifies key areas of ulcer management that could be improved. For specialists, it suggests that widespread implementation of traditional guidelines may not be appropriate or acceptable. New approaches to leg ulcer management in general practice are likely to need a combination of education, human resources and practical support.     

AT方案与GP方案治疗晚期乳腺癌近期疗效观察

目的比较AT方案与GP方案治疗晚期乳腺癌的临床疗效、毒副反应及临床受益反应（CBR）。方法Ⅲ-Ⅳ期乳腺癌患者70例，分为AT组（ADM＋TAX）38例，GP组（GEM＋DDP）32例。结果AT组有效率60．5％（23／38），CBR率55．3％（21／38）；GP组有效率56．3％（18／32），CBR率50．0％（16／32），组间疗效及CBR差异无显著性（P〉0．05），主要毒副作用为骨髓抑制、消化道反应和神经毒性，均为可逆性。结论AT方案和GP方案对于复发或有远处转移的晚期乳腺癌疗效确切，毒副作用可以耐受，均可作为一线治疗方案应用。     

延续性护理对乳腺癌患者术后癌性疲乏及生活质量改善的作用

目的 探讨延续性护理对乳腺癌患者术后癌性疲乏及生活质量的改善作用。方法 选择2017年1月～2019年12月我院收治的乳腺癌患者103例,均采用手术治疗,随机分为两组,对照组52例给予常规出院指导,研究组51例在对照组的基础上给予延续性护理,比较两组术后癌性疲乏评分及生活质量评分。结果 干预后不同时间研究组术后癌性疲乏得分均低于对照组,差异有统计学意义(P0.05)。干预后研究组躯体状况、社会和家庭状况、功能状况、情感状况、乳腺癌特异模块及生活质量总分均高于对照组,差异有统计学意义(P0.05)。结论 延续性护理可有效改善乳腺癌患者术后癌性疲乏,提高患者的生活质量,临床价值较高。     

信息技术在肿瘤姑息治疗中的应用研究

阐述了信息技术与肿瘤姑息治疗的关系,分析肿瘤患者的行为干预、肿瘤治疗与疗效评价、肿瘤治疗数据流与信息系统的现状。提出以信息技术为基础,通过对可及信息的挖掘,以循证医学的方法,在对病人状况进行综合分析的基础上,构建以病人为中心的行为干预方法将有利于促进提升肿瘤姑息治疗的效果,延长寿命,提高生存质量;同时,借助现代信息技术,采用追踪研究的方法,通过获取肿瘤治疗的纵向资料,建立不同患者的数据库和肿瘤治疗疗效评价指标,分析同类肿瘤相关干预措施的效果,可为肿瘤治疗的循证决策提供依据。     

早期心理干预对乳腺癌患者生活质量的影响

目的探讨早期心理干预对乳腺癌患者生活质量的影响。方法收集2008年1月～2010年6月在我院住院治疗的女性乳腺癌患者120例,随机将其分为常规护理组与心理干预组,各60例。常规护理组采用常规护理,心理干预组在常规护理组的基础上采用心理干预,比较两组干预前后癌症康复评价简表（CABES-SF）与总体幸福感量表（GWB）评分。结果干预前常规护理组与心理干预组患者CABES-SF总分比较,差异无统计学意义（均P〉0.05）。干预后心理干预组CABES-SF总分较干预前降低,且低于常规护理组,差异均有统计学意义（均P〈0.05）。常规护理组干预前后GWB评分差异无统计学意义（P〉0.05）,心理干预组心理干预后GWB评分明显升高,差异有统计学意义（P〈0.05）。结论早期进行心理干预能改善乳腺癌患者预后生活质量与幸福感     

Intracystic breast carcinoma: case study and review

Breast carcinoma is the most common cancer in women, the second leading cause of cancer-related mortality in women, and the leading cause of death from cancer in women between the ages of 40 and 44. While cystic breast disease is the most frequent cause of benign breast masses, intracystic breast cancers are rare. We present a case of a postmenopausal woman with a large cystic breast carcinoma with its interesting radiologic and cytopathologic findings and review the literature.     

肺功能检查技术如何在基层医疗卫生服务中更好地应用——附重点问题专家解答

慢性呼吸系统疾病患病率持续上升,严重危害我国国民身体健康和生命安全。肺功能检查是慢性呼吸系统疾病重要的筛查和诊断技术,但长期以来未受到足够重视,特别是在我国基层医疗卫生机构。为什么要重视基层医疗卫生机构的肺功能检查:(1)慢性阻塞性肺疾病(以下简称慢阻肺)发病呈现高态势,预测至2060年死于慢阻肺及其相关疾病的人数将超过540万人/年,已成为严重影响我国国民健康的公共卫生问题之一;(2)肺功能检查是“金标准”,在基层医疗卫生机构开展肺功能检查,并通过早期强化治疗,可以延缓肺功能下降。那么全科医生团队进行肺功能检查的优势及可做工作有哪些呢?(1)全科医生团队扎根基层,给慢性病的长期随访管理带来了诸多便利,且“生物-心理-社会医学模式”更有利于其对患者进行健康照顾;(2)全科医生可通过采取形式多样的健康教育,增强居民对慢性呼吸系统疾病的防控意识,从而提高居民进行肺功能检查的依从性;(3)全科医生可发挥主观能动性,主动对辖区居民,特别是有危险因素的高危人群进行早期肺功能筛查,把握最佳治疗时机而从降低疾病负担;(4)开展家庭医生签约,为患者建立呼吸健康档案,对不同严重程度的慢阻肺患者进行分级管...     

Genetic testing for inherited breast and ovarian cancer syndromes: important concepts for the primary care physician

The remarkable advances in the area of genetic testing are transforming the way clinical medicine is practised. In the case of the inherited breast-ovarian cancer syndrome the ability to engage in genetic testing of BRCA genes has raised novel issues over caring for patients who are at increased risk for these malignancies. The primary care physician is likely to play a pivotal role in identifying such persons. As only 10-15% of all breast cancers are caused by directly heritable mutations, cultivating the ability to identify those who may be at increased risk is an important skill for the primary care physician. Once it is established that an individual is at risk of BRCA mutation, the physician must understand the potential benefits and drawbacks of the various genetic BRCA tests. Taking such factors into account leads to the development of an appropriate plan for evaluation. Careful attention must also be paid to social and psychological issues that may affect patients and their families.     

Psychiatry in general practice. A pilot scheme using the liaison-attachment model.

OBJECTIVE: To improve the quality and accessibility of psychiatric service in the primary care setting. DESIGN: Under the liaison-attachment model, a senior psychiatry trainee provided psychiatric consultations part-time in general practice over an 18-month period. Patients regarded by the participating doctors as having significant psychiatric problems were referred to the trainee for consultation. SETTING: Four group general practices, involving 18 doctors, took part in the scheme. PARTICIPANTS: During the study 172 patients with a wide spectrum of diagnoses were assessed. Near the end of the 18-month period the participating general practitioners provided their evaluations of the scheme. INTERVENTION: In almost all cases standard treatment was provided in the primary care setting and administered by either a general practitioner, the trainee or both working collaboratively together. OUTCOME MEASURES: The general practitioners evaluated the results of the consultations and the effect of the service on their referral patterns. They also rated the overall impact of the scheme on their own knowledge and skills, the quality of care, and its accessibility. RESULTS: The quality of outcome, if known, was regarded as satisfactory in 88% of cases. The reported frequency of referrals to psychiatrists in private practice dropped significantly. The participating doctors perceived improvements in their own abilities to deal with psychiatric problems and regarded the quality and accessibility of psychiatric care to be enhanced by the scheme. CONCLUSIONS: The psychiatric liaison-attachment model, developed in Britain, is applicable and effective in the Australian primary care setting.     

Consultations and referrals for dyspepsia in general practice--a one year database survey

OBJECTIVE—Dyspepsia usually presents first in primary care. There are many reasons for referral including urgent problems (for example, haematemesis and melaena), treatment failure, or to exclude serious pathology. Referral will change the population characteristics of primary and secondary care dyspeptics. Many of the guidelines for primary care dyspepsia, however, are based on secondary care research on these referred patients. The aim of this study was to describe the prevalence of dyspepsia in general practice, the characteristics of patients presenting with dyspepsia in primary care, and the clinical and non-clinical determinants of referral in these patients.
DESIGN—Cross sectional survey of the consultation records of patients presenting with dyspepsia in primary care during a one year period.
METHODS—Dyspeptic patients who consulted their general practitioner (GP) in 1997 were selected on the basis of International Classification of Primary Care codes using a computer search among 20 sentinel practices affiliated with the Utrecht Network of General Practitioners. Cross tables and logistic regression analysis were carried out to reveal patient characteristics and determinants of referral.
RESULTS—The prevalence of dyspepsia presenting in primary care in 1997 was 3.4% (1740/48958). These patients were usually not referred during the first consultation. Men, elderly patients, and patients with a previous history of dyspepsia were referred to secondary care more frequently than other dyspeptic patients. Patients diagnosed with both irritable bowel syndrome and dyspepsia were at risk of being referred most.
CONCLUSION—Dyspepsia is a frequently occurring complaint in primary care and patients are usually treated by their GP. Besides clinically relevant reasons for referral, dyspeptic patients with irritable bowel syndrome seem to be more "at risk" of being referred to secondary care than other dyspeptic patients. The differences between primary and secondary care dyspeptic patients should be taken into account when interpreting research for guideline purposes. Further research is needed to clarify the background of the relation between irritable bowel syndrome and dyspepsia and its influence on referral.