The quality of communication between parents and adolescent children in the case of parental cancer.

BACKGROUND: This study was designed to investigate: (i) parent-adolescent communication in families of cancer patients; (ii) relationships between parent-adolescent communication and posttraumatic stress symptoms (PTSS) in adolescent children; and (iii) associations between parents' illness characteristics and parent-adolescent communication. PATIENTS AND METHODS: A total of 212 adolescents completed the Impact of Event Scale and Parent-Adolescent Communication Scale. RESULTS: Adolescents communicated less openly with mothers with cancer than controls with mothers; this was the only significant difference with the reference group. Daughters communicated more openly with ill parents than with healthy parents. More open communication with healthy parents was related to fewer PTSS in daughters. More problem communication with both parents was related to more PTSS in both sons and daughters. Sons reported more problems in communication with ill parents in case of more intensive treatment or recurrent disease. Daughters experienced less open communication with both parents when ill parents received more intensive treatment. Time since diagnosis was not related to parent-adolescent communication. Multivariate analyses showed that communication patterns specifically affected PTSS of daughters. Problem communication with the healthy parent was the strongest predictor of intrusion while problem communication with the ill parents was the strongest predictor of avoidance. CONCLUSIONS: Parent-adolescent communication in families of cancer patients differs little from that in families not confronted with parental cancer. Problem communication outweighed lack of openness with respect to development of PTSS. Recurrent disease and intensive treatment regimens affected parent-adolescent communication negatively.     

Impact of EGFR expression on colorectal cancer patient prognosis and survival.

BACKGROUND: Epidermal growth factor receptor (EGFR) is overexpressed in many types of cancers, especially colorectal cancer (CRC), and seems to reflect more aggressive histological and clinical behaviors. The aim of this study was to evaluate EGFR immunohistochemical reactivity in CRC biopsies, and to analyze its relationship with various histological and clinical characteristics and survival. PATIENTS AND METHODS: A composite EGFR score, obtained by multiplying the grade (% positive cells) by the intensity of labeling (0-9) was used to define patients with low or high EGFR expression whose clinicopathological features were then compared. Univariate tests and multivariate Cox proportional hazards model were applied for data analysis. RESULTS: Tissue sections from 150 CRC patients with a median follow-up of 40 months were examined. Median patient age at diagnosis was 70 years (range 38-89 years). EGFR reactivity was positive for 143 patients (97%) and high for 118 (80%). According to multivariate analysis, EGFR overexpression was significantly associated with tumor stage, with a higher percentage of EGFR overexpression in T3 than T4 (P=0.003) and not with overall survival. CONCLUSIONS: EGFR was overexpressed in this CRC patient population and was significantly associated with TNM (tumor-node-metastasis) stage T3. In the context of a new therapeutic strategy using EGFR-targeted therapies, although EGFR remains a controversial prognostic factor, this expression-stage association may play a crucial role in a decision to initiate an adjuvant treatment.     

脑卒中患者医院感染调查分析及护理对策

目的为了解脑卒中患者医院感染的发生和易感因素,有针对性地采取预防措施. 方法调查2001年1月～2002年12月,收住的202例脑卒中患者的医院感染,并设对照组进行对照分析. 结果发生医院感染34例、42例次,感染率为16.83%,例次感染率为20.79%;感染部位以下呼吸道和泌尿道感染最常见,构成比分别为38.1%、30.95%,感染组、非感染组在应用抗生素、侵入性操作、年龄、住院天数比较,两组均存在着显著性差异.结论脑卒中患者医院感染发生率明显高于我院两年平均医院感染率4.03%,明显高于卫生部医院感染管理规范中医院感染发生率应在3%～8%的规定范围,脑卒中患者是医院感染的高危人群,应成为重点防护对象.     

老年高血压的临床特点及治疗策略

高血压严重影响老年人的健康,是老年人发生脑卒中、冠心病、心肌梗塞、充血性心衰、肾功能衰竭等疾病的主要危险因素之一。但我国高血压病的预防率、控制率、治疗率均较低,并且发病率、并发症及死亡率高。本文就老年高血压的特点及治疗作一综述,旨在为老年高血压患者的临床诊治提供一定帮助。     

护生在临床实习中护患沟通障碍的分析及对策

目的探讨护生在临床实习中护患沟通障碍的因素及应对措施,提高护生的护患沟通能力。方法2005年11月~2006年9月对我科实习的护生57人采用自行设计问卷进行调查,内容为护生在临床实习中是否存在护患沟通障碍及影响护患沟通的因素。结果调查结果显示护生在临床实习中均存在不同程度的护患沟通障碍。表现在护生知识缺乏,技术操作不熟练,自信心缺乏,病人对护生的不信任,病人不配合,病人文化程度低等。结论通过分析护生护患沟通障碍的原因并采取相应措施,提高护生的护患沟通能力及临床实习质量。     

世界卫生组织耐药结核病治疗整合指南(2020年版)解读

1993年结核病被世界卫生组织宣布为"全球公共卫生紧急事件"。在复杂和严峻的大背景下,世界卫生组织发布了耐药结核病治疗整合指南(2020年版),相信有助于加速推动终止结核病策略的进程,扭转当前耐药结核病防治的被动局面。本文分别从异烟肼耐药结核病、含贝达喹啉全口服短程方案治疗耐多药结核病(MDR-TB)和利福平耐药结核病...     

Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions

Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.     

The interactive work of narrative elicitation in person‐centred care: Analysis of phone conversations between health care professionals and patients with common mental disorders

IntroductionNarratives play a central part in person‐centred care (PCC) as a communicative means of attending to patients'' experiences. The present study sets out to explore what activities are performed and what challenges participants face in the interactive process of narrative elicitation, carried through in patient‐professional communication in a remote intervention based on PCC.MethodsData were gathered from a randomized controlled trial (RCT) in a Swedish city where health care professionals (HCPs) conducted remote PCC for patients on sick leave due to common mental disorders. A sample of eleven audio‐recorded phone conversations between HCPs and patients enroled in the RCT were collected and subjected to conversation analysis.ResultsThree interactive patterns in narrative elicitation were identified: Completed narrative sequences driven by the patient, question‐driven narrative sequences guided by the HCP, and narrative sequences driven as a collaborative project between the patient and the HCP. In the question‐driven narrative sequences, communication was problematic for both participants and they did not accomplish a narrative. In the other two patterns, narratives were accomplished but through various collaborative processes.ConclusionThis study provides insight into what challenges narrative elicitation may bring in the context of a remote PCC intervention and what interactive work patients and HCP need to engage in. Importantly, it also highlights tensions in the ethics of PCC and its operationalization, if the pursuit of a narrative is not properly balanced against the respect for patients'' integrity and personal preferences. Our findings also show that narrative elicitation may represent an interactive process in PCC in which illness narratives are jointly produced, negotiated and transformed.Patient or Public ContributionStakeholders, including patient representatives, were involved in the design of the main study (the RCT). They have been involved in discussions on research questions and dissemination throughout the study period. They have not been involved in conducting the present study.     

临床中护患沟通的重要性及技巧

护患沟通是指护士与患者及其家属、陪护人员之间的意见、观点、情感和信息的交流与传递。随着医学模式的转变,护理模式也从“疾病护理模式”向“整体护理模式”转变,这就深刻地影响了护理工作的重点和范围。护理工作的重点从以疾病与技术为中心转变到以服务对象为中心;护理照顾的服务对象从对个体扩展到团体、社会及整个未来社会。这些转变大大地丰富了护理教育的内涵,对未来护理人才综合素质提出了更高的要求,而具有良好的人际沟通能力是诸多素质中所必备的。良好的护患沟通有利与护患关系的和谐和护理质量的提高,可以减少和防范护惠纠纷的发生,提高患者满意度。