152例老年大肠癌临床病理学特征与预后

目的探讨老年人大肠癌的临床病理学特征与预后。方法总结1993年7月-2000年12月间收治的65岁以上老年人大肠癌152例，分析其临床特点、病理学特征和生存率。结果152例老年人大肠癌中，合并其他疾病者101例（66．5％1；Dukes分期：B、C期116例（76．3％）。病理类型：腺癌131例（86．2％），其中高、中分化腺癌83例，低分化腺癌48例；黏液腺癌13例（8．5％）；印戒细胞癌3例（2．0％）；息肉恶变5例（3．3％）；合并大肠息肉25例（16,4哟；多原发性大肠癌2例（1．3％）；术后1年生存率90．2％，3年生存率76．8％，5年生存率55．4％。结论目前老年大肠癌发病率逐渐增高，临床分期以进展期为主，病理类型主要为高、中分化腺癌，手术根治率高，预后较好，但应注意合并大肠息肉及多发原发性大肠癌的发生。     

慢性萎缩性胃炎的中医辨治

慢性萎缩性胃炎是临床常见病和多发病,本文从病因病机、治疗原则和辨证分型等几个方面叙述该病的治疗。     

创建全国社区卫生服务示范区 促进儿童保健事业发展

宝安区于1996年初在全省率先开展社区卫生服务,始终树立大卫生观念,坚持预防为主、中西医并重的原则,以社区文明建设为指导方针,以促进健康为目的,提供了以个人为中心、家庭为单位、社区为范围、老幼妇残为重点人群的卫生服务。经过多年的努力,全区现建有社区卫生服务中心(站)115个,覆盖人口160多万,已形成覆盖全区的社区卫生服务网络,并于2004年11月通过了全国社区卫生服务示范区的评估。     

流动人口孕妇社区管理研究

目的了解北京市流动人口孕产妇社区管理现状,建立适合流动人口特点的孕妇保健社区管理模式。方法在北京市朝阳区、海淀区、丰台区的城乡结合部5个社区,采用专题小组讨论的方法,了解现有社区孕产妇保健管理情况采用社区流动车,为686名流动人口孕妇提供免费卫生服务。结果研究地区妇幼保健人员数量不足,管理流动人口难度大,而社区计划生育部门网络健全。在社区相关部门的配合下,实施社区流动检查车服务形式,定期到社区为流动人口孕妇提供免费服务,受到群众的欢迎,取得良好效果。结论各级政府应为流动人口孕产妇保健给予政策上的支持和必要的资金、人力投入,建立社区流动人口管理协作机制,使流动车持续发展下去。     

宁夏农村村级卫生服务现状分析

目的了解宁夏农村村级卫生服务的基本现状。方法采用普查的方法，自行设计调查表。对宁夏石嘴山市惠农县辖区内26个村卫生室进行卫生服务现状调查。结果平均每村有0．92所卫生室，村卫生室房屋简陋。规模小，平均业务用房为56．55m^2；村卫生室医疗设备简陋，乡村医生文化程度偏低，10年内没有参加过培训；村卫生室办医型式个体占92．3％，医疗质量无人管理，乡村医生资格准入没有严格标准和程序。结论乡村医生的医疗技术水平低；村卫生室卫生服务功能低下，绝大多效为私人诊所。难以满足农民基本就医需求。     

Use of brief psychiatric screening measures in a primary care sample

Patients seen in primary medical clinics report higher rates of major depression [Pérez-Stable et al., 1990: Arch Intern Med 15:1083-1088], and panic disorder [Sherbourne et al., 1996b: Von Korff et al., 1987: Arch Gen Psychiatry 44:152-156] than the general population. Primary care staff therefore need efficient methods of identifying patients with psychiatric disorders. The current study evaluates the use of several brief psychiatric screening measures for identifying patients with major depression and/or anxiety disorders. Participants were 213 primary care patients who received the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Anxiety Inventory (BAI), and two new instruments, the Autonomic Nervous System Questionnaire (ANS) for assessing panic disorder and the Social Phobia Questionnaire (SPQ) for assessing social phobia. Participants received both the screening instruments and a structured diagnostic interview. Results suggest that the CES-D is a useful measure for detecting psychopathology, but it is not particularly specific to depression, the ANS was a highly sensitive and reasonably specific measure for panic disorder, and the SPQ was reasonably sensitive and specific for social phobia. The BAI was a relatively poor screening measure that added no significant information beyond the other measures.     

Depression among caregivers of the frail elderly in urban Japan

A cross-sectional study was conducted in order to investigate the various factors related to the depression in caregivers of the elderly in need of care in urban Japan. The caregivers answered a self-administered questionnaire about various factors that may affect their depression, and also completed a Center for Epidemiologic Studies Depression Scale evaluation (CES-D). Compared with non-depressed caregivers, depressed caregivers attended the elderly longer, while time spent for physical caregiving did not differ between the two groups. Even after controlling confounding factors, time of attending the elderly was an independent factor related to caregiver's depression.     

药学信息工作适应药学服务实践的思考

药学服务是20世纪90年代迅速崛起的一种全新的工作模式,在我国正处于推广和普及阶段。而药学信息工作是药学服务所有工作的中心和基础。因此,不断拓展药学信息工作对开展药学服务实践至关重要。     

Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer).

BACKGROUND: First-line chemotherapy regimens suitable for elderly advanced breast cancer patients are still not defined. PATIENTS AND METHODS: Women with stage III or IV breast cancer aged > or =70 years were enrolled in a phase II study aimed to evaluate both activity and toxicity of weekly paclitaxel. Among 46 planned patients, at least 18 responses and not more than seven unacceptable toxic events are required for a favourable conclusion. Paclitaxel 80 mg/m(2) was administered weekly for 3 weeks every 28 days. RESULTS: Unacceptable toxicity occurred in seven out of 46 patients evaluated for toxicity [15.2%; exact 95% confidence interval (CI) 7.6% to 28.2%] and was represented by one case of febrile neutropenia, one case of severe allergic reaction and five cases of cardiac toxicity. Among 41 patients evaluated for response, a complete response occurred in two (4.9%) patients and a partial response in 20 (48.8%), with an overall response rate of 53.7% (exact 95% CI 38.7% to 67.9%). The median progression-free survival was 9.7 months (95% CI 8.5-18.7) and median survival was 35.8 months (95% CI 19-not defined). CONCLUSIONS: Weekly paclitaxel is highly active in elderly advanced breast cancer patients. Data on cardiovascular complications, however, indicate the need for a careful monitoring of cardiac function before and during chemotherapy.     

Vinorelbine and prednisone in frail elderly patients with intermediate-high grade non-Hodgkin's lymphomas.

BACKGROUND: Frail patients with non-Hodgkin's lymphoma (NHL) are generally excluded from clinical trials and not even treated. The aim of this study was to evaluate the efficacy and tolerability of vinorelbine and prednisone in frail elderly patients with NHL. PATIENTS AND METHODS: Thirty consecutive frail elderly patients were entered in a phase II study with vinorelbine 25 mg/m2 i.v. on days 1 and 8 and oral prednisone 30 mg total dose on days 1-8 for six cycles. Criteria of frailty were age > or =80 years, or age > or =70 years and three or more comorbidities of grade 3 or at least one comorbidity of grade 4 according to the Cumulative Illness Rating Scale (CIRS), or not self-sufficient or the presence of one or more geriatric syndromes. RESULTS: Of 30 evaluable patients, three (10.0%) achieved a complete response (CR), nine (30.0%) showed a partial response (PR), while 10 presented with stable disease and eight with progressive disease. The median duration of CR was 29 months (range 5-36 months), and the median duration of PR was 1 month (range 1-22 months). Three patients had grade 3 neutropenia and one had grade 4. One grade 4 neurotoxicity was observed. Three patients died because of heart failure within 28 days of therapy, and one patient died after 4 days because of rapid progression. The median overall survival was only 10 months. CONCLUSION: Vinorelbine and prednisone is a relatively non-toxic combination with modest activity in frail patients with NHL. If initial aggressive chemotherapy has been excluded, this combination could be tried to obtain a temporary palliation.