被过度治疗害死的肝癌病人——一位肿瘤科医生给病人的贴心话

病人手术后20多天才做骨扫描,发现癌细胞已经出现骨转移。其实,专业医生都很清楚,出现骨转移的病人,通过微创和介入治疗效果更好一些。遗憾的是,骨扫描这个最重要的检查被忽视了。手术之后,病人就再也没能站起来,后续的化疗、放疗,又使肝功能急剧下降,导致消化道、口腔、鼻腔出血。一个看似积极的治疗方案,就这样加速了病情恶化,让生命过早地走向了终点。     

当医生成为病人时——一位心脏科医生的思考

2007年夏天,我被确诊罹患卵巢癌盆腔转移,经手术及化疗治愈.本文为首次将自己作为病人的经历与感想写下. 首先我感恩自己生于现代医学发达的时代,能及早发现癌症并获得有效的治疗且愈后至今良好.我展望未来的时候,看到更加早期发现癌症以及增加个体化治疗的必要性,在进一步提升治愈率的同时尽量减少对病人生活质量的损害.     

性命相托--一位医生的心里话

我是一家二级甲等综合医院最普通的临床大夫,工作仅仅五六年,这在医生的队伍里,资历是非常浅的.不过所幸的是我在病房、门诊、急诊甚至120急救车和SARS病房都工作过,更庆幸的是能够在各种情况下和绝大部分的病人乃至家属建立起比较和谐的医患关系.     

浅析住院恶性肿瘤临终病人家属对我院安宁护理的满意度及其对策

目的 了解住院恶性肿瘤病人家属对我院安宁护理工作满意度的情况，以进一步提高临终病人生命质量。方法 2000年1月至2003年12月间，我院共收治晚期恶性肿瘤临终病人109例，我们通过家属调查他们对安宁护理的满意度，将所得的资料进行统计分析并落实相应的措施。结果 家属对医务人员满意率达100％，对安宁护理工作评估满意率占90．82％，对社会关怀满意率占83．79％，对疾病采取积极治疗态度占22．02％。结论 安宁护理是提高临终病人的生命质量，实现“优死”的重要途径，临终病人及其家属的需求和愿望是相当复杂的，不仅需要专业医护人员的努力，也需要社会各方面的关心和支持。     

上海市临汾医院2001～2003年安宁病区恶性肿瘤病人医疗费用问题的讨论与对策

目的 评价收治晚期恶性肿瘤病人安宁护理的经济效益，为临终关怀，安宁护理的学科伦理和发展进一步提出建议。方法 对2001～2003年间所收治93例晚期恶性肿瘤病人的平均住院日、人均治疗费用进行分析。结果 2001～2003年安宁病区收治的处于临终阶段晚期恶性肿瘤病人平均住院日3a分别是59．9d，73．8d，46．5d，日均费用3a分别为135．66元，119．59元，139．42元；医疗保险住院者人均费用分别为8501．14元，7183．04元，6430．31元；自费病人均治疗费用分别为5084．46元，4516．59元，848．42元；医疗保险晚期恶性肿瘤住院者人均费用为7371．49元，自费为3483．16元(1：0．47)。结论 安宁护理经济方便、适宜、公平性强，特别对晚期恶性肿瘤病人提供的临终关怀良好的环境，值得进一步发展，但其发展受到当前医疗体制的制约，在病区管理、入院标准、收费、伦理和社会保障等方面有待探索。     

The Combiome Hypothesis: Selecting Optimal Treatment for Cancer Patients

Existing approaches for cancer diagnosis are inefficient in the use of diagnostic tissue, and decision-making is often sequential, typically resulting in delayed treatment initiation. Future diagnostic testing needs to be faster and optimize increasingly complex treatment decisions. We envision a future where comprehensive testing is routine. Our approach, termed the “combiome,” combines holistic information from the tumor, and the patient's immune system. The combiome model proposed here advocates synchronized up-front testing with a panel of sensitive assays, revealing a more complete understanding of the patient phenotype and improved targeting and sequencing of treatments. Development and eventual adoption of the combiome model for diagnostic testing may provide better outcomes for all cancer patients, but will require significant changes in workflows, technology, regulations, and administration. In this review, we discuss the current and future testing landscape, targeting of personalized treatments, and technological and regulatory advances necessary to achieve the combiome.     

论医患法律关系中的惩罚性赔偿

文章从立法功能的角度确认了《消费者权益保护法》惩罚性赔偿具有保护弱者的目的．并通过对我国医患双方的现状分析，认为医疗机构的经营者和患者的弱者地位已经在法理上构成医疗服务这种消费关系，并认为可以在医患法律关系中针对医疗欺诈行为适用惩罚性赔偿。     

The Shift From Sentinel Lymph Node Biopsy Performed Either Before or After Neoadjuvant Systemic Therapy in the Clinical Negative Nodes of Breast Cancer Patients. Results,and the Advantages and Disadvantages of Both Procedures

Background

In patients with breast cancer who are candidates for neoadjuvant therapy (NAT), the timing of when to perform sentinel lymph node biopsy (SLNB) remains under discussion. The aim of this study was to compare the advantages and disadvantages of SLNB performed before and after NAT.

Selecting Breast Cancer Patients for Chemotherapy: The Opening of the UK OPTIMA Trial

The mortality from breast cancer has improved steadily over the past two decades, in part because of the increased use of more effective adjuvant therapies. Thousands of women are routinely treated with intensive chemotherapy, which can be unpleasant, is expensive and is occasionally hazardous. Oncologists have long known that some of these women may not need treatment, either because they have a low risk of relapse or because they have tumour biology that makes them less sensitive to chemotherapy and more suitable for early adjuvant endocrine therapy. There is an urgent need to improve patient selection so that chemotherapy is restricted to those patients who will benefit from it. Here we review the emerging technologies that are available for improving patient selection for chemotherapy. We describe the OPTIMA trial, which has just opened to recruitment in the UK, is the latest addition to trials in this area, and is the first to focus on the relative cost-effectiveness of alternate predictive assays.     

The Comparison of the Advantages of Neoadjuvant Chemoradiotherapy versus Postoperative Chemoradiotherapy: Outcomes in Esophageal Cancer Patients

Background and Objectives

Esophageal cancer is the eighth most common type of cancer worldwide. For the treatment of which, surgical intervention alone or with neoadjuvant chemoradiotherapy or chemotherapy is recommended. In this study, we aimed to compare the benefits of neoadjuvant chemoradiotherapy versus postoperative chemoradiotherapy.

Patients and Methods

We collected data regarding 325 patients admitted for esophageal cancer to Qaem Hospital, Mashhad, Iran, during 2006–2016. The participants were divided into two groups of neoadjuvant and postoperative adjuvant therapies. Chi-square, McNemar, Kaplan-Mayer, and multivariate regression tests were performed using SPSS.

Results

Gender, age, stage of the disease, tumor grade and location, disease histopathology, and the recurrence showed no significant differences between the two groups (P ? 0.05), but there was a significant association between the two types of treatment in terms of postoperative complications (P = 0.03). We followed up 147 patients postoperatively and found no significant differences between the groups (P ? 0.05).

Conclusion

No conclusion can be drawn on whether there are any advantages in adjuvant chemoradiotherapy over neoadjuvant approaches. Further confirmatory trials, particularly randomized trials, are necessary before any recommendations can be made.

     

靶向治疗药物特罗凯的药代动力学优势

厄洛替尼(特罗凯)是一种小分子口服表皮生长因子受体酪氨酸激酶抑制剂,与另一种EGFR抑制剂吉非替尼迥异的是,厄洛替尼与靶点的亲和力更高、特异性更强,且在大型随机Ⅲ期临床研究(BR.21)中已经证实其作为二/三线治疗可显著延长各类型NscLc患者的生存期.目前,厄洛替尼已经在世界范围内超过50个国家被批准用于晚期NscLc的二/线治疗.本文就药代动力学方面厄洛替尼的优势加以阐述.