以Peplau人际关系理论为基础的干预模式对肺癌化疗患者心理状态、主观幸福感及生活质量的影响

目的 探讨以Peplau人际关系理论为基础的干预模式对肺癌化疗患者心理状态、主观幸福感及生活质量的影响.方法 将136例肺癌患者根据不同干预方案分为对照组(n=71)和观察组(n=65),对照组患者给予常规干预,观察组患者给予常规干预+以Peplau人际关系理论为基础的干预模式.比较两组患者干预前后的心理状态、主观幸福感及生活质量改善情况.结果 观察组患者下床活动时间、肛门排气时间、肠鸣音恢复时间、住院时间均明显短于对照组(P﹤0.01).干预后,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显低于本组干预前(P﹤0.01);且观察组患者SAS、SDS评分均明显低于对照组(P﹤0.01).干预后,两组患者主观幸福感各维度评分均明显高于本组干预前(P﹤0.01);且观察组患者主观幸福感各维度评分均明显高于对照组(P﹤0.01).干预后,两组患者生活质量(QOL)量表各维度评分均明显高于本组干预前(P﹤0.01);且观察组患者QOL量表各维度评分均明显高于对照组(P﹤0.01).对照组患者不良反应总发生率为63.38％(45/71),高于观察组的46.15％(30/65)(P﹤0.05).结论 对肺癌化疗患者实施以Peplau人际关系理论为基础的干预模式,可改善患者心理状态,提高主观幸福感及生活质量,临床应用前景广阔.     

预见性模式干预联合呼吸训练在食管癌手术患者中的应用效果

目的 分析预见性模式干预联合呼吸训练在食管癌手术患者中的应用效果.方法 依据术后干预方法不同将95例食管癌患者分为观察组(n=51)和对照组(n=44),对照组患者给予呼吸训练,观察组患者给予呼吸训练联合预见性模式干预.比较两组患者的呼吸功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1),计算FEV1/FVC]、自我效能感[自我效能量表(SESMS)]、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]和并发症发生情况.结果 干预后,观察组患者FVC、FEV1水平均明显高于对照组,FEV1/FVC明显低于对照组(P﹤0.01);两组患者SESMS量表各维度评分均高于本组干预前(P﹤0.05),且观察组患者SESMS量表各维度评分均高于对照组(P﹤0.05).干预后,两组患者EORTC QLQ-C30量表评分均高于本组干预前,且观察组患者EORTC QLQ-C30量表评分高于对照组(P﹤0.05).观察组患者并发症总发生率为3.92％,低于对照组患者的15.91％(P﹤0.05).结论 预见性模式干预联合呼吸训练可改善食管癌患者的呼吸功能,提高自我效能及生活质量.     

叙事疗法对肺癌患者疼痛应激、心理弹性和生活质量的影响

目的 探讨叙事疗法对肺癌患者疼痛应激、心理弹性和生活质量的影响.方法 依据干预方法将120例肺癌患者分为观察组(n=65)和对照组(n=55),对照组患者给予常规宣教心理疏导,观察组患者在此基础上给予五步式叙事疗法干预.干预前后,比较两组患者的疼痛应激因子[血清P物质、去甲肾上腺素(NE)、皮质醇、前列腺素E2(PGE2)]水平、情绪状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)和正负性情绪量表(PANAS)]、心理弹性[心理弹性量表(CD-RISC)]、生活质量[简明健康状况调查问卷(SF-36)].结果 干预后,两组患者P物质、NE、皮质醇、PGE2水平均明显低于本组干预前(P﹤0.01),且观察组患者P物质、NE、皮质醇、PGE2水平均明显低于对照组(P﹤0.01).干预后,两组患者PA分量表评分均明显高于本组干预前(P﹤0.01),SAS、SDS和NA分量表评分均明显低于本组干预前(P﹤0.01),且观察组患者PA分量表评分明显高于对照组(P﹤0.01),SAS、SDS和NA分量表评分均明显低于对照组(P﹤0.01).干预后,两组患者SF-36量表各维度评分、CD-RISC量表各维度评分及总分均明显高于本组干预前(P﹤0.01),且观察组患者SF-36量表各维度评分、CD-RISC量表各维度评分及总分均明显高于对照组(P﹤0.01).结论 叙事疗法可有效降低肺癌患者的疼痛应激水平,减轻焦虑、抑郁等负性情绪,增强心理弹性,提高生活质量.     

协同管理模式对白血病化疗患者营养状况、生活质量和不良反应的影响

目的 探讨协同管理模式对白血病化疗患者营养状况、生活质量和不良反应的影响.方法 根据干预方法将124例白血病化疗患者分为观察组和对照组,每组62例,对照组患者给予常规干预,观察组患者给予协同管理模式干预.比较两组患者的体重变化、营养指标[白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)]、生活质量[Spitzer生活质量指数(QLI)]和不良反应发生情况.结果 干预后,两组患者的体重均重于本组干预前(P﹤0.05),且观察组患者的体重重于对照组(P﹤0.05).干预后,两组患者ALB、PA、Hb水平均高于本组干预前(P﹤0.05),且观察组患者ALB、PA、Hb水平均高于对照组(P﹤0.05).干预后,两组患者QLI量表各维度评分及总分均高于本组干预前(P﹤0.05),且观察组患者QLI量表各维度评分及总分均高于对照组(P﹤0.05).观察组患者感染、脱发发生率均低于对照组(P﹤0.05).结论 协同管理模式可明显改善白血病化疗患者的营养状况,提高生活质量,减少不良反应.     

早期呼吸功能训练对肺癌根治术术后患者肺功能及生活质量的影响

目的 探讨早期呼吸功能训练对肺癌根治术术后患者肺功能及生活质量的影响.方法 按随机数字表法将110例肺癌根治术术后患者分为观察组和对照组,各55例,对照组患者术后给予常规护理干预,观察组患者在此基础上给予呼吸功能锻炼.干预前和干预3个月后,比较两组患者的肺功能指标[第一秒用力呼吸容积(FEV1)、用力肺活量(FVC)、FEV1/FVC]、血气分析指标(血氧饱和度、血氧分压)、生活质量;干预后,比较两组患者的并发症发生情况.结果 干预后,两组患者FEV1水平、FVC水平、FEV1/FVC、血氧饱和度和血氧分压均高于本组干预前(P﹤0.05),且观察组患者FEV1水平、FVC水平、FEV1/FVC、血氧饱和度和血氧分压均高于对照组(P﹤0.05).干预后,两组患者简明健康状况调查问卷(SF-36)各维度评分和总分均高于本组干预前(P﹤0.05),且观察组患者SF-36量表各维度评分和总分均高于对照组(P﹤0.05).干预后3个月,观察组患者的并发症总发生率为9.09％,低于对照组的23.64％(P﹤0.05).结论 早期呼吸功能训练可明显改善肺癌根治术术后患者的肺功能及生活质量,降低并发症发生率.     

纽曼系统模式在肺癌行肺动脉介入治疗患者中的应用效果

目的 探讨纽曼系统模式在肺癌行肺动脉介入治疗患者中的应用效果.方法 采用随机数字表法将128例行肺动脉介入术治疗的肺癌患者随机分为对照组(n=61)和观察组(n=67),对照组患者给予常规护理干预,观察组患者在此基础上给予纽曼系统护理模式干预.干预前后,采用简明健康状况调查问卷(SF-36)评估两组患者的生活质量,采用简明心境状态量表(POMS)评估两组患者的负性情绪.干预期间评估两组患者的治疗依从性和护理满意度.结果 干预后,两组患者SF-36量表各维度评分均高于护理前(P﹤0.05),且观察组患者SF-36量表各维度评分均高于对照组(P﹤0.05).干预后,两组患者POMS量表各维度评分均低于本组干预前(P﹤0.05),且观察组患者POMS量表各维度评分均低于对照组(P﹤0.05).观察组患者的治疗总依从率为100％,明显高于对照组患者的65.57％(P﹤0.01),对护理的总满意率为94.03％,明显高于对照组患者的70.49％(P﹤0.01).结论 纽曼系统护理模式可明显提高肺癌肺动脉介入术治疗患者的生活质量、缓解负性情绪,有利于提高患者的依从性和护理满意度.     

疼痛改善性干预对恶性骨肿瘤患者术后疼痛、睡眠质量、心理状态及生活质量的影响

目的 探讨疼痛改善性干预对恶性骨肿瘤患者术后疼痛、睡眠质量、心理状态及生活质量的影响。方法 根据术后干预方法的不同将106例恶性骨肿瘤患者分为对照组和观察组,每组53例,对照组患者进行骨科常规护理,观察组患者在骨科常规护理的基础上实施疼痛改善性干预。比较两组患者的疼痛情况[数字评价量表（NRS）评分]、睡眠质量[匹兹堡睡眠质量指数（PSQI）评分]、心理状态[焦虑自评量表（SAS）和抑郁自评量表（SDS）评分]、生活质量[世界卫生组织生存质量测定量表简表（WHOQOL-BREF）评分]及护理服务满意度[纽卡斯尔护理服务满意度量表（NSNS）评分]。结果 术后6、12、24、48 h,观察组患者的NRS评分均明显低于对照组（P﹤0.01）。干预后,两组患者的PSQI、SAS、SDS评分均低于本组干预前,且观察组患者的PSQI、SAS、SDS评分均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者WHOQOL-BREF各维度评分均高于本组干预前,且观察组患者WHOQOL-BREF各维度评分均高于对照组,差异均有统计学意义（P﹤0.05）。观察组患者的护理满意度优于对照组（P﹤...     

多模式健康宣教对肝癌经导管动脉栓塞化疗患者生活质量的影响

目的 探讨多模式健康宣教对肝癌经导管动脉栓塞化疗(TACE)患者生活质量的影响.方法 按照健康宣教方式不同将210例肝癌TACE患者分为观察组和对照组,每组105例,对照组患者给予常规健康教育,观察组患者给予多模式健康宣教.干预前和干预1个月,比较两组患者负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、健康知识掌握度、自我效能、遵医行为和生活质量[癌症患者生命质量测定量表(QLICP)].结果 干预后,两组患者SDS、SAS评分低于本组干预前(P﹤0.05),健康知识掌握度、自我效能和遵医行为评分均高于本组干预前(P﹤0.05),且观察组患者SDS、SAS评分均低于对照组(P﹤0.05),健康知识掌握度、自我效能和遵医行为评分均高于对照组(P﹤0.05).干预后,观察组患者QLICP量表各维度评分及总均分均高于本组干预前和对照组(P﹤0.05).观察组患者的满意度为96.19％,明显高于对照组患者的85.71％(P﹤0.01).结论 多模式健康宣教能够有效改善肝癌TACE患者焦虑、抑郁等负性情绪,改善治疗依从性、自我效能和生活质量.     

基于同伴支持的PDCA循环管理对宫颈癌术后康复进程及负性情绪的影响

目的 探究基于同伴支持的PDCA循环管理对宫颈癌术后康复进程及负性情绪的改善作用.方法将96例宫颈癌患者随机分为观察组和对照组,每组48例.对照组患者采用常规的PDCA循环管理,观察组患者在对照组的基础上予以同伴支持.观察并比较两组患者自护能力、负性情绪、生活质量、性功能以及护理满意度.结果 干预后,两组患者自护能力量表(ESCA)中健康知识、自我概念、自护技能、责任感评分及总分均明显高于本组干预前(P﹤0.01),且观察组均明显高于对照组(P﹤0.01).干预后,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显低于本组干预前(P﹤0.01),且观察组均明显低于对照组(P﹤0.01).干预后,两组患者简明健康状况调查问卷(SF-36)中角色功能、认知功能、躯体功能、社会功能及情绪功能评分均明显高于本组干预前(P﹤0.01),且观察组均明显高于对照组(P﹤0.01).观察组患者术后性交疼痛、阴道干涩发生率均低于对照组,护理满意度高于对照组,差异均有统计学意义(P﹤0.05).结论 基于同伴支持的PDCA循环用于宫颈癌患者术后康复进程中效果较理想,显著提高患者自护能力,有效缓解患者负性情绪,改善患者生活质量以及性功能障碍等,同时有利于提高护理满意度,值得在临床实践中推广使用.     

激励式心理干预在皮肤癌患者围手术期中的应用

目的 探讨激励式心理干预在皮肤癌患者围手术期中的应用效果.方法 依据干预方式将102例皮肤癌患者分为对照组和观察组,每组51例,对照组患者围手术期给予常规护理干预,观察组患者在此基础上给予激励式心理干预.比较两组患者的负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、生活质量、疼痛程度[数字疼痛评分法(NRS)]、睡眠质量[匹兹堡睡眠质量指数(PSQI)]、并发症发生情况和满意度.结果 干预后,两组患者SAS、SDS、NRS、PSQI评分均低于本组干预前(P﹤0.05),且观察组患者SAS、SDS、NRS、PSQI评分低于对照组(P﹤0.05).干预后,两组患者生活质量量表各维度评分均高于本组干预前(P﹤0.05),且观察组患者生活质量量表各维度评分均高于对照组(P﹤0.05).观察组并发症总发生率为5.88％,低于对照组患者的19.61％(P﹤0.05),总满意率为90.20％,明显高于对照组患者的60.78％(P﹤0.01).结论 激励式心理干预可缓解皮肤癌患者的焦虑、抑郁情绪,改善睡眠质量,提高生活质量,降低术后并发症发生率,提高患者的满意度.     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Sarcopenia is associated with survival in patients with urothelial carcinoma treated with systemic chemotherapy

International Journal of Clinical Oncology - Sarcopenia impacts perioperative outcomes and prognosis in various carcinomas. We aimed to investigate whether sarcopenia at the time of chemotherapy...     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体）,对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法,具有实时、经济、简便易行等优点。     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs