Quality of life research in patients with rectal cancer: traditional approaches versus a problem-solving oriented perspective

The present paper critically appraises two recent overviews of the literature on rectal cancer and quality of life (QL). These reviews focus on the Anglo-American literature, largely neglect research from other countries, and provide little stimulus regarding future research directions. As an alternative perspective we propose the concept of problem-solving oriented QL research. The major theme is that the QL concept must be integrated into the clinical arena. To begin with, QL researchers must make themselves understandable. We outline several ways in which this can be achieved: (a) placing QL in a broader concept together with outcomes that are more familiar to clinicians; (b) depicting individual patients in the form of QL profiles; (c) clarifying the psychosocial/clinical correlates of particular QL scores of interest; and (d) conducting studies with a definitive practical goal in mind and integrating practitioners and patients into the study group. We illustrate the feasibility of such a research program by performance data from our Marburg-Biedenkopf field trial. Pursuing an ambitious research strategy that integrates experimental and applied research, the QL movement will have the chance to show that it is not merely l'art pour l'art, but indeed is beneficial to society. Received: 28 September 1998 / Accepted: 14 October 1998     

肾移植前后男性性生活状况比较

目的 :探讨肾移植前后男性性生活质量的变化。　方法 :将 86例男性肾移植病人分为低年龄组 (2 5～ 35岁 ,35例 )、中年龄组 (36～ 45岁 ,2 9例 )、高年龄组 (46～ 5 5岁 ,2 2例 ) 3组 ,分别调查病人患病前后、肾移植术后性生活能力、频率、性生活满意程度等性生活状况。　结果 :86例病人患病前均有性生活能力 ,患病后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 2 8.6 %,13.8和 9.1%。肾移植术后有性生活能力的 :低年龄组、中年龄组、高年龄组分别为 88.6 %、75 .9%和 6 3.6 %。　结论 :肾移植术后的性生活质量明显好于患病后 ,年龄越轻、恢复的越理想。     

医药团结合作 建设放心药房

总结了全国放心药店现场交流会后,全国各地放心药房建设的情况。强调了建设放心药房工作的意义,指出建设放心药房是中医医疗机构精神文明建设的重要部分,是落实中央指示,加强药品管理的具体行动,是加强中医医疗机构内涵建设的重要内容,是保证中医医疗质量的关键环节。对进一步做好放心药房建设工作提出了要求:规范进货行为,把好药品进货关;不断深化改革,加强内部管理;认真贯彻国家有关法规,继续整治药品回扣违法行为;加强医药团结合作,建立稳定的供需关系;加强领导,务求实效,使“放心药房”建设深入持久地开展下去。     

COPD患者营养状况与生活质量的关系

观察５６例男性慢性阻塞性肺病（ＣＯＰＤ）患者的体检营养指标，并分析其与生活质量的关系，实测体重占理想体重的百分比和生活质量测评表中的日常生活能力，社会活动情况，抑郁心理障碍等项评分有显著相关性（Ｐ〈０．０５），上臂中点肌肉臂围与日常生活能力和社会活动情况的评分的相关也有统计学意义（Ｐ〈０．０５）。提示改善ＣＯＰＤ患者的营养状况对提高生活质量有重要意义。     

试论门诊管理

结合门诊管理的实践,对如何加强门诊管理进行了论述。主要为:①掌握门诊特点,确定门诊管理重点;②做好工作计划,实施目标管理;③充分发挥门诊部办公室的作用,承上启下,及时协调;④健全门诊管理组织,完善门诊管理规定;⑤抓好服务质量,方便病人就医;⑥加强质量考核,确保门诊工作质量。     

APA微胶囊免疫隔离生物膜制备中的质量控制

为了优化制备条件, 简化工艺, 控制质量, 本文观测了APA(海藻酸盐-聚赖氨酸-海藻酸盐)微胶囊免疫隔离生物膜制备过程中部分物理因素和化学因素与质量的关系.结果表明: 微囊的粒径与静电微囊发生仪脉冲频率呈负相关; 与推进泵速度呈正相关; 与针头内径呈正相关.随着聚赖氨酸浓度的增加, 膜厚度显著增加.微囊的粒径不随聚赖氨酸成膜反应时间延长而改变, 但影响膜的厚度.柠檬酸钠的液化时间对微囊的粒径与厚度均无明显影响.通过优化制备条件, APA微胶囊免疫隔离生物膜将具有更好的通透性、柔韧性、生物相容性和强度.     

How many lymph nodes are necessary to stage early and advanced adenocarcinoma of the sigmoid colon and upper rectum?

The lymph-node yields in specimens resected for colorectal adenocarcinoma show considerable variations, raising the question whether the minimum lymph-node number recommended by the UICC (International Union Against Cancer) for pN0 classification represents an appropriate quality standard for specimen work-up. The number of pericolic lymph nodes recovered from 568 archival surgical colorectal carcinoma specimens located in the sigmoid or upper rectum showed a highly statistically significant correlation with both the pT category and the presence of metastases (P<0.0005). The median lymph-node yield in standardized (i.e., resembling in size surgically removed cancer specimens) tumor-free specimens obtained during autopsies was 13 lymph nodes, compared with 20.5 when diverticula were present and more than 30 in specimens with chronic inflammation or from patients with systemic infections. In 48 pT2 and pT3 carcinoma specimens prospectively dissected in the same way, median numbers of 18 (pT2) and 23 (pT3) lymph nodes were detected (range between 8 and 39 nodes). The lymph-node numbers recommended in previous studies and by the UICC often seem to be too low to declare a specimen free of metastases. Although the great variation in lymph-node counts requires the recovery of all lymph nodes for pN0 classification, recommendations considering the pT status and additional factors like diverticula and inflammatory changes can be useful as a quality standard for specimen work up.