Is romantic partner betrayal a form of traumatic experience? A qualitative study

According to a growing body of research, betrayal by a romantic partner is increasingly considered as a form of interpersonal trauma. Between 30% and 60% of betrayed individuals experience symptoms of post-traumatic stress disorder (PTSD), depression and anxiety to clinically meaningful levels. From a clinical perspective, this constellation of symptoms can be conceptualized as a stressor-related adjustment disorder. Yet, no qualitative research has examined the association between romantic betrayal and traumatic stress from the perspective of betrayed individuals. Face-to-face semi-structured interviews were conducted with 13 participants who had completed a clinical trial for a new treatment for adjustment disorder stemming from betrayal. Data were analysed using thematic content analysis. Although betrayal was experienced as a shocking and destabilizing event, and participants used trauma or ‘feeling traumatized’ as a metaphor to describe their experience, few had constructed their reaction as traumatic stress. In fact, participants reported experiencing difficulties understanding the intensity of their experience. However, when exposed to external sources (e.g., books and interviews by psychologists and researchers) that used a trauma and PTSD framework to explain the effects of betrayal, participants reported feeling clarity, validation and relief. Findings are discussed in the light of theoretical and clinical implications.     

Effects of participatory workplace improvement program on stress-related biomarkers and self-reported stress among university hospital nurses: a preliminary study

Although participatory workplace improvement programs are known to provide favorable effects on high stress occupations like nursing, no studies have confirmed its effect using biomarkers. The aim of this study was to determine whether a participatory workplace improvement program would decrease stress-related symptoms as evaluated by biomarkers and self-reported stress among hospital nurses. Three actions to alleviate job stress, which were determined through focus group interviews and voting, were undertaken for two months. A total of 31 female Japanese nurses underwent measurement of inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) at three-time points; before the program (T1), within a week after the completion of the program (T2), and three months after the program (T3). A series of inflammatory markers (Interferon-γ, Interleukin (IL)-6, and IL-12/23p40) decreased significantly at T2, and IL-12/23p40 and IL-15 significantly decreased at T3 compared to T1, while ANA and PJS remained unchanged. Our participatory program exerted beneficial effects in reducing inflammatory responses, but not for ANA and PJS. Further investigations with a better study design, i.e., a randomized controlled trial, and a larger sample size are warranted to determine what exerted beneficial effects on inflammatory markers and why other outcomes remained unchanged.     

Barriers and facilitators to uptake and promotion of influenza vaccination among health care workers in the community in Beijing,China: A qualitative study

BackgroundIn the prevention and control of influenza, it is important for healthcare workers (HCWs) to be vaccinated and recommend influenza vaccines to their patients. However, there is limited evidence on the factors influencing uptake and promotion of influenza vaccination to patients among HCWs in China.MethodsWe conducted in-depth interviews among HCWs in community health centers, including general practitioners (GPs) and preventive health workers (PHWs), during January to February 2017. A total of 21 individuals, purposively selected from six community health centers covering central districts and remote suburbs in Beijing, were interviewed using semi-structured topic guides. Thematic analysis was used to analyze the interviews and coding framework was developed both inductively and deductively.ResultsIdentified factors influencing influenza vaccine uptake included knowledge, perception and recognition, and prior experience of vaccine uptake. All PHWs conservatively recommended influenza vaccine because of concerns about potential patient–doctor disputes. GPs rarely recommended vaccination under their own initiative because vaccine promotion was not their duties. Notably, we found that the division of work was an underlying reason for the different behaviors regarding vaccine uptake and promotion between GPs and PHWs.ConclusionsOur findings highlighted a combination of misconceptions and cognitive biases limiting influenza vaccine uptake among HCWs in China. Our findings indicate that promotion of health education regarding influenza vaccination should be implemented among HCWs. Importantly, the division of work greatly affects the behaviors of HCWs. GPs, who are at the front line in the doctor–patient relationship, have a critical role in influenza vaccination programs.     

The significance of preoperative chemotherapy for early gastric carcinoma

In order to achieve a complete prognosis for early gastric carcinoma, a greater effort must be made to improve its present treatment, considering the small percentage of patients who still die from recurrence despite the prompt initiation of surgery. Over the past 9 years, 26 patients with early gastric carcinoma have undergone surgical resection after receiving preoperative chemotherapy in the form of oral 5-FU or 5-DFUR in our institute. The effectiveness of preoperative chemotherapy was evaluated by histopathological examination of the resected stomachs. Of a total of 24 patients with depressed type gastric cancer, 19 were histologically found to have a cancerless area within the cancerous lesion, 8 of whom were classified as being over Grade 1b. Gross changes were observed in 13 of these 24 patients. The frequency of multiple early gastric cancer occurring in patients who had not received chemotherapy was 11.6%, whereas in those who had received chemotherapy it was 3.8%. The findings of this study thus indicate that preoperative chemotherapy is useful for reducing minute cancer foci and microscopic metastatic lesions.     

Use of ultrasound-guided percutaneous needle biopsy in the diagnosis of mediastinal tumors

We herein report the usefulness of ultrasoundguided percutaneous needle biopsy for histological diagnosis in 18 patients with mediastinal tumors. Computed tomography revealed these tumors to be in contact with the chest wall. The preoperative diagnosis was thymoma in 7 patients, germinoma in 5, neurogenic tumor in 3, and other in 3. The most commonly encountered indication for an ultrasound-guided percutaneous needle biopsy was an anterior mediastinal lesion (78%; 14 of 18 patients). In 16 (89%) of the 18 patients, the biopsy diagnosis corresponded to the post-operative diagnosis. No complications were encountered in any of the patients. This new technique of ultrasound-guided percutaneous needle biopsy is both relatively simple and highly accurate and may thus be useful for outpatients. Preoperative ultrasound-guided percutaneous needle biopsy is thus considered to be a safe and reliable method for the histological diagnosis of mediastinal tumors, and a good alternative to traditional biopsy techniques such as mediastinoscopy or thoracotomy.Presented at the 11th Biennial Asian Congress on Thoracic and Cardiovascular Surgery, Kuala Lumpur, Malaysia, November, 21–25, 1993.     

不同术前放射治疗剂量在下咽鳞癌综合治疗中的意义

目的　探讨下咽鳞癌不同术前放射治疗剂量对综合治疗的影响。方法　回顾性分析2 0 1例 (男 181例 ,女 2 0例 ;年龄 32～ 75岁 )经术前放射治疗 手术综合治疗 (R S)的下咽鳞癌 (1997年UICC分期Ⅰ期 6例 ,Ⅱ期 14例 ,Ⅲ期 4 7例 ,Ⅳ期 134例 ) ,其中梨状窝 173例 ,咽后壁 19例 ,环后 9例。 12 4例术前放射治疗 4 0Gy ,77例术前放射治疗 5 0Gy ;放射治疗后 2周左右给予手术治疗。结果　术前放射治疗 4 0Gy组 5年生存率为 39.7% ,5 0Gy组为 5 5 .4 % (P <0 .0 5 )。术前放射治疗 4 0Gy组放射治疗相关性术后并发症发生率为 2 6 .6 % ,5 0Gy组为 15 .6 % (P <0 .0 5 )。术前放射治疗 4 0Gy组喉功能保留率为 38.7% ,5 0Gy组为 4 2 .9% (P >0 .0 5 )。术前放射治疗 4 0Gy组区域复发率为 2 8.2 % ,5 0Gy组为 2 9.9% (P >0 .0 5 )。结论　术前放射治疗 5 0Gy较 4 0Gy能提高下咽鳞癌的远期生存率 ,且不增加放射治疗引起的术后并发症 ,并有望增加喉功能的保留率。     

Treatment of oesophageal cancer with preoperative chemoradiotherapy may increase operative mortality

AIMS: This phase II multicentric study evaluates a modified preoperative chemoradiotherapy schedule. METHODS: Patients <75 years with potentially resectable neoplasm were eligible. Treatment included an initial course of CDDP 100 mg/m2 (Day 1) and 5-FU CI 5000 mg/m2 (Days 1-5) followed by 45 Gy (Days 28-63) and 5-FU CI 5000 mg/m2 (Days 28-33), CDDP 75 mg/m2 (Day 56) and 5-FU CI 3750 mg/m2 (Days 56-61). Regional lymph nodes were irradiated. RESULTS: Nineteen patients were studied. Oesophagectomy was performed in 17. Clear margins were achieved in 16 of these. Eight patients showed a pathologic complete response (pCR). One patient died of infection during the preoperative treatment and four died due to acute surgical complications. The study was closed prematurely because of excessive mortality. Median follow-up was 19 months. Local and regional relapse occurred in one and three patients, respectively. Median time and actuarial 3-year of overall survival and progression free rates were 18.6 months and 28%, and 12.7 months and 10.4%, respectively. CONCLUSIONS: This schedule showed a high pCR, resectability and local control rate. Treatment-related mortality limits its clinical applicability, but further investigations are warranted.     

去粗取精去伪存真——宋立人教授谈本草文献研究

中医文献学是中医药学发展的先导,本草文献研究是中医文献研究中的一个最薄弱环节,这与我国历史悠久、地域广阔、各地药物使用情况不同有关。中药品种混乱、同名异物、真伪互用等现象的存在,不但影响了用药规范和药物的临床疗效,更严重地阻碍了中医药事业的发展,因此本草文献研究实乃当务之争。综合性本草的研究当以《证类本草》为起点,专题性本草可分食疗、炮制、民间药物、中药药性、中药药理、临床应用等类加以研究。在本草     

恒康正清在妇科手术前肠道准备中的应用

目的研究恒康正消口服灌肠剂在妇科手术前肠道准备中的应用，评价其耐受性及临床效果。方法我院妇科从2004年11月～2005年1月共有50例患者行妇科手术前接受恒康正清口服灌肠剂进行肠道准备。平均年龄51．2岁（29～75岁）。其中普通手术组16例，阴式手术组20例，恶性手术组14例。同期常规手术口服甘露醇行肠道准备10例为对照。术前1日给予恒康正清（甘露醇）口服，观察记录口服恒康正清过程中有无不适反应评价其耐受性。根据患者末次排便或灌肠排出物的性状及术中肠管胀气情况评判肠道准备的满意程度。术后观察患者有无腹胀，术后排气时间评价术后患者恢复情况。结果50例患者中，18例（36％）患者出现恶心、呕吐、腹痛、腹胀反应，但程度均较轻，患者可以耐受，未影响术前准备及手术。口服恒康正清普通手术组与对照组相比患者平均排便次数分别为6．0次和3．4次，两者比较差异有显著性，普通手术组满意率为81．3％，阴式手术满意率为95．0％。恶性手术组满意率为85．7％。普通手术组术后平均排气时间为40．5h，阴式手术组为铝．0h，恶性手术组为73．7h，前两组差异无显著性，但与恶性手术组相比差异有显著件。对照组平均排气时间为31．2h，与普通手术组相比差异无显著性。结论恒康正清口服肠道准备患者耐受性好．准备效果及术后患者恢复与甘露醇相比差异无显著性，适合妇科常用的手术前准备。     

Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances.

OBJECTIVES: To compare the causes of non-fatal work and non-work injuries and the places or environments where they occur. It has been suggested that many injuries may have similar etiologies on and off the job and thus involve some common prevention strategies. However lack of comparable data on work relatedness has prevented testing this proposition. METHODS: The National Health Interview Survey (NHIS) now collects information on the cause, location, and work relatedness of all medically attended injuries. National US estimates of non-fatal work and non-work injuries were compared by cause and place/location for working age adults (18-64 years). RESULTS: Overall 28.6% of injuries to working age adults were work related (37.5% among employed people). The causes and locations of many work and non-work injuries were similar. Falls, overexertion, and struck/caught by were leading causes for work and non-work injuries. Motor vehicle injuries were less likely to be work related (3.4% at work v 19.5% non-work) and overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults were less than 1% of work injuries and 1.8% of non-work injuries. Both work and non-work injuries occurred in every location examined-including the home where 3.5% of injuries were work related. CONCLUSIONS: Work and non-work injuries share many similarities suggesting opportunities to broaden injury prevention programs commonly restricted to one setting or the other. Comprehensive efforts to prevent both non-work and work injuries may result in considerable cost savings not only to society but also directly to employers, who incur much of the associated costs.