奈达铂联合吉西他滨治疗晚期复治肺鳞癌的临床观察

目的:探究奈达铂联合吉西他滨治疗晚期复治肺鳞癌的临床观察.方法:选取2014年5月-2016年7月我院收治的晚期肺鳞癌复治患者84例,采用随机数表法分为观察组和对照组,对照组采用吉西他滨联合顺铂治疗,观察组采用吉西他滨联合奈达铂治疗,对比两组患者临床疗效及不良反应.结果:观察组患者治疗有效率40.48%与对照组35.71%相比差异无统计学意义(P>0.05);观察组患者中性粒细胞减少、恶心呕吐发生率低于对照组且差异有统计学意义(P<0.05),血小板下降发生率与对照组相比差异不显著(P>0.05).结论:奈达铂联合吉西他滨治疗晚期复治肺鳞癌临床疗效确切且不良反应少,具有一定的临床应用价值.     

吉非替尼联合吉西他滨和顺铂化疗方案用于晚期NSCLC患者的作用观察

目的:探究吉非替尼联合吉西他滨和顺铂化疗方案用于晚期NSCLC患者的临床疗效观察。方法:随机抽取本院60例晚期NSCLC患者,利用摸球法分为研究组(使用非替尼联合吉西他滨和顺铂化疗方案治疗)与对照组(使用吉西他滨和顺铂化疗方案治疗)。对比两组的治疗效果。结果:经治疗,研究组治疗有效率、疾病控制率以及1年生存率明显优于对照组;研究组患者头晕头痛、恶心呕吐、骨髓抑制、转氨酶增高以及脱发不良反应发生率明显低于对照组,两组差异显著(P 0.05)。结论:相较于单纯使吉西他滨和顺铂化疗方案,对晚期NSCLC患者非替尼联合吉西他滨和顺铂化疗方案治疗,具有较为理想的临床疗效,能够使患者的疼痛感得到有效降低,改善患者的生活质量,提高患者治疗有效率、疾病控制率以及1年的生存率,降低患者不良反应发生率,值得推广。     

载药微球支气管动脉化疗栓塞联合GP化疗对肺鳞癌患者短期疗效及预后的影响

目的 探讨肺鳞癌患者采用载药微球支气管动脉化疗栓塞联合GP(吉西他滨+顺铂)化疗的效果.方法 选择2017年1月—2018年12月本院收治的肺鳞癌患者42例,采用随机数字表法分为2组,各21例.对照组采用GP化疗方案,观察组采用载药微球支气管动脉化疗栓塞联合GP化疗.比较2组患者近期疗效、2年生存率、生活质量及安全性....     

化疗栓塞联合氩气刀及冷冻治疗中晚期中央型肺鳞癌近期疗效的研究

目的:探讨供血动脉化疗栓塞联合氩气刀及冷冻治疗中晚期中央型肺鳞癌的疗效、安全性和对肺功能改善影响.方法:161例中晚期中央型肺鳞癌随机分为供血动脉化疗栓塞联合氩气刀及冷冻治疗组(干预组)和单纯全身静脉化疗组(对照组),两组化疗方案均为GP方案(吉西他滨+顺铂).比较两组患者治疗6月后的临床疗效、不良反应发生及肺功能改善...     

顺铂联合吉西他滨或紫杉醇治疗晚期肺鳞癌临床观察

目的肺癌在世界范围内发病率与死亡率均位列恶性肿瘤首位,目前肺鳞癌尚无明确的驱动基因及靶向治疗药物,三代含铂双药化疗仍是晚期肺鳞癌的标准治疗。为探索高疗效低毒性的化疗方案,本研究比较吉西他滨联合顺铂与紫杉醇联合顺铂两种化疗方案治疗不能手术晚期肺鳞癌的临床疗效。方法选取山东省肿瘤医院(42例)和聊城市中医医院(34例)2013-07-01-2015-06-30收治的76例晚期肺鳞癌患者为研究对象,分析其临床资料,其中紫杉醇联合顺铂组(paclitaxel plus cisplatin,TP)38例,吉西他滨联合顺铂组(gemcitabine combined cisplatin,GP)38例,比较两组方案的临床疗效及安全性。结果 GP组客观缓解率为28.9%,高于TP组的26.3%,差异无统计学意义,χ~2=0.066,P=0.145;GP组无疾病进展生存期(progression-free-survival,PFS)为5.7个月,TP组为5.3个月,差异无统计学意义,χ~2=0.526,P=0.205;GP组总生存期(overall surviva,OS)为12.0个月,TP组为11.2个月,差异无统计学意义,χ~2=0.724,P=0.186。血液学毒性Ⅲ～Ⅳ度血小板减少发生率GP组为13.1%,TP组为5.3%,差异有统计学意义,χ~2=5.050,P=0.035;GP组非血液学毒性中脱发发生率为2.7%,低于TP组的81.5%,χ~2=61.011,P=0.024;周围神经障碍发生率为2.6%,低于TP组的23.7%,χ~2=10.209,P=0.013。其余血液学及非血液学毒性,两组比较差异无统计学意义。结论 GP组与TP组的化疗方案治疗晚期肺鳞癌的有效率相近。两组安全性有所差异,TP组的脱发及周围神经毒性发生率明显高于GP组。     

洛铂和顺铂分别联合吉西他滨治疗晚期肺癌的疗效比较

目的探究洛铂和顺铂分别联合吉西他滨治疗晚期肺癌的临床效果。方法选取2015年7月-2017年7月湖南省某医院收治的180例晚期肺癌患者为研究对象。采用随机数字表法,将患者分为研究组与对照组,每组90例。给予对照组患者吉西他滨联合顺铂治疗;给予研究组患者吉西他滨联合洛铂治疗。比较2组患者的近期疗效、远期疗效及不良反应发生情况。结果2组患者治疗总有效率比较,差异无统计学意义(P0.05)。研究组患者缓解期及半数生存期为(6.64±1.88)个月及(9.98±2.24)个月,长于对照组的(5.11±1.47)个月及(7.64±1.28)个月,差异均有统计学意义(P0.05)。研究组患者骨髓抑制发生率为58.89%,高于对照组的32.22%,差异有统计学意义(P0.05)。研究组患者恶心/呕吐发生率为28.89%,低于对照组的54.44%,差异有统计学意义(P0.05)。结论吉西他滨分别联合洛铂和顺铂治疗晚期肺癌的近期疗效相当,但吉西他滨与洛铂联用的远期疗效更好。此外,这2种治疗方案的不良反应有所不同。因此,临床具体用药需要结合患者的实际情况。     

吉西他滨与多西他赛联合顺铂治疗晚期非小细胞肺癌的临床观察

[目的]比较吉西他滨与多西他赛联合顺铂方案治疗晚期非小细胞肺癌(NSCLC)的临床疗效及不良反应。[方法]62例晚期非小细胞肺癌患者完全随机分为两组,吉西他滨组30例给予吉西他滨联合顺铂化疗,多西他赛组32例给予多西他赛联合顺铂化疗。每周期评价不良反应,评价疗效。[结果]两组有效率分别为吉西他滨组46.7%和多西他赛组43.8%,两组之间有效率差异无统计学意义(P﹥0.05)。不良反应主要为骨髓抑制和肝功能损害,吉西他滨组白细胞产减少率为76.7%,多西他赛组为84.4%,两组差异无统计学意义(P﹥0.05);两组肝功能损害率分别为26.7%和34.4%,差异有统计学意义(P﹤0.05)。[结论]吉西他滨与多西他赛联合顺铂方案治疗晚期NSCLC均具有较好的疗效,且两者的疗效相似,不良反应可以耐受,可以作为临床一线治疗。     

培美曲塞与吉西他滨联合洛铂治疗复发性晚期卵巢癌的疗效比较

目的比较培美曲塞与吉西他滨联合洛铂治疗复发性晚期卵巢癌的临床疗效及不良反应。方法 70例复发性晚期卵巢癌患者根据数字表法随机分为2组,培美曲塞组(n=35例)采用培美曲塞+洛铂治疗,吉西他滨组(n=35例)采用吉西他滨+洛铂治疗。比较两组近期疗效、不良反应、疾病进展时间(TTP)、总生存期(OS)及1年生存率。结果培美曲塞组患者RR(37.14%)、DCR(65.71%)与吉西他滨组RR(34.29%)、DCR(62.86%)比较无显著性差异(均P>0.05);培美曲塞组白细胞下降、血小板下降、粒细胞下降及脱发等不良反应发生率均明显低于吉西他滨组(均P<0.05);培美曲塞组TTP(7.2±2.1个月)、OS(10.4±2.8个月)、1年生存率(13/35,37.14%)与吉西他滨组TTP(6.8±2.2个月)、OS(11.0±3.0个月)、1年生存率(12/35,34.29%)比较无显著差异性(均P>0.05)。结论培美曲塞联合洛铂治疗复发性晚期卵巢癌的临床疗效与吉西他滨联合洛铂化疗方案相似,但不良反应明显减少,患者耐受性好。     

吉西他滨联合奥沙利铂对多种化疗方案治疗失败后淋巴瘤患者的疗效及安全性评价

目的探讨多种化疗方案治疗失败后淋巴瘤患者采取吉西他滨联合奥沙利铂治疗的临床疗效与安全性。方法 66例经多种化疗方案治疗失败后的淋巴瘤患者,随机分为两组各33例。对照组采用吉西他滨治疗,观察组采用吉西他滨联合奥沙利铂治疗,比较两组的临床疗效、不良反应发生率以及6个月生存率。结果观察组的化疗总有效率和6个月生存率均显著高于对照组,差异有统计学意义(P <0.05)。两组化疗期间的不良反应发生率比较,差异无统计学意义(P>0.05)。结论对多种化疗方案治疗失败后的淋巴瘤患者采取吉西他滨联合奥沙利铂治疗临床疗效明显,安全性高。     

培美曲塞联合顺铂对晚期非小细胞肺癌的化疗效果和血清肿瘤标志物的影响

目的探讨培美曲塞联合顺铂治疗晚期非小细胞肺癌的临床疗效和对血清肿瘤标志物的影响。方法选择178例非小细胞肺癌患者随机分为观察组和对照组各89例,对照组采用吉西他滨+顺铂化疗方案,观察组采用培美曲塞+顺铂化疗方案,比较2组患者的化疗效果、不良反应发生率及血清肿瘤标志物水平。结果 2组的临床缓解率和疾病控制率差异均无统计学意义(P0.05);观察组贫血、血小板减少、皮疹、肝功能损害及放射性肺炎的发生率明显低于对照组,差异均有统计学意义(P0.05);与化疗前相比,2组化疗2个周期后CEA、CA125、NSE及CYFRA21-1水平均明显降低,差异均有统计学意义(P0.05)。结论培美曲塞联合顺铂治疗晚期非小细胞肺癌的化疗疗效与吉西他滨联合顺铂相当,但不良反应明显减少,且可明显降低患者血清肿瘤标志物水平,值得推广。     

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.