Common cancer-related symptoms among GP patients Opportunistic screening in primary health care

Objective - To study the occurrence of symptoms related to the five most common forms of cancer among patients regularly visiting primary care. To estimate the proportion of symptoms needing GP examination, and the number of tumours thus diagnosed. Design - Patients with some form of non-malignant chronic disease received a letter with information about cancer-related symptoms along with an invitation to regular check-up. The letter described the most common symptoms of breast, colorectal, lung, prostate and skin cancers. Setting - 12 health centres in Kalmar County, Sweden. Subjects - 5200 patients aged over 40 years. Results - One patient in 13 reported cancer-related symptoms to the GP. Women reported more symptoms than men, and almost half of them had had symptoms at previous check-ups. The GP was able to explain 7 out of 10 patients' symptoms directly. When other symptoms were examined, 8 cancers were diagnosed as well as 6 pre-malignant tumours, corresponding to 3 tumour diagnoses per 1000 check-ups. Conclusion ? While attending regular check-ups, patients may not report symptoms which cause anxiety and sometimes indicate serious diseases. It is possible to widen the perspective and link both primary and secondary prevention of certain cancers to the check-up.     

Newsletter number three - 2002

Patients who experience body symptoms in response to psychosocial stress are a challenge for the general practitioner (GP). This paper is a contribution to the improved treatment of these patients. It presents a specific psychosocial treatment model provided by the GP including the following steps: (a) taking a thorough symptom history, conducting a psychosocial anamnesis and exploring the patient's own perception of the illness, (b) developing alternative perceptions of the illness by understanding the psycho-physiological relationship; and (c) reducing the impact of psychosocial stress. The application of these specific techniques requires a trustful, helping alliance between the doctor and the patient and cooperation with mental health services.     

Characteristics of frequent attenders in different age and sex groups in primary health care

Objective. To explore depression from a gender perspective, by capturing depressed women's and men's formulations of their experiences and understanding of their situation. Design. Qualitative interview study. Setting. A healthcare centre in northern Sweden. Subjects. Eighteen patients who had been diagnosed with depression and treated for at least 6 months were interviewed in depth, both women and men of different ages and social status. Open questions were posed around the themes of Malterud's key questions, focusing especially on how the informants conveyed their experiences. Interviewing and qualitative data analysis went on simultaneously. Results. The experience of depression held similarities for men and women, but the outward manifestations differed by gender as well as socioeconomic status. Though experiences of high demands underlay the narratives of all informants, home or work had different priority. Men talked more easily about physical distress – often the heart – than about emotions. Women verbalized more readily emotional distress – shame and guilt – while physical symptoms often revolved around the stomach. Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement. Conclusion. As clinicians we must listen attentively not only to the manifest but to the avoided or unarticulated. By doing so we might counteract normative gender patterns that highlight the depression of women and conceal that of men.     

重症监护室患者主动筛查多重耐药菌的定植、感染状况分析

〔摘 要〕 目的：对重症监护室（ICU）患者的多重耐药菌实施主动筛查,分析其定植与感染状况。 方法：选取 2018 年 1 月至 2019 年 12 月五邑中医院 100 例在 ICU 进行诊治的患者作为研究对象,对患者实施多重耐药菌主动筛查,分析不同 种类多重耐药菌的分布情况及入住 ICU 不同时间点的定植、感染状况。 结果：患者入住 ICU 48 h 内、48 h 后均有多重耐药 菌的感染与定植状况出现,菌株定植、感染情况集中出现在入 ICU 48 h 内,且多数为产超广谱 β– 内酰胺酶（ESBLs）大肠 埃希菌。ESBLs 大肠埃希菌的定植率、感染率均高于其他菌株,差异均具有统计学意义（P ＜ 0.05）。 结论：ESBLs 大肠 埃希菌是本院 ICU 患者主要的定植多重耐药菌,对 ICU 患者的多重耐药菌及时进行主动筛查,并根据实际情况进行有效的 消毒隔离处理,有助于避免病菌大规模传播和感染。     

Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

Dexmedetomidine, a highly selective and potent alpha2-adrenergic agonist, has a potentially useful role as a sedative agent in patients requiring intensive care. As part of a larger European multicentre trial, a total of 119 postoperative cardiac and general surgical patients requiring ventilation and sedation in an intensive care unit were enrolled in four centres in the United Kingdom. One hundred and five patients were randomly allocated to receive either dexmedetomidine or placebo with rescue sedation and analgesia provided by midazolam and morphine, respectively. Compared with the control group, intubated patients receiving dexmedetomidine required 80% less midazolam [mean 4.9 (5.8) microg.kg-1.h-1 vs. 23.7 (27.5) microg.kg-1.h-1, p < 0.0001], and 50% less morphine [11.2 (13.4) microg.kg-1.h-1 vs. 21.5 (19.4) microg.kg-1.h-1,p = 0.0006]. Cardiovascular effects and adverse events could be predicted from the known properties of alpha-2 agonists. In conclusion, dexmedetomidine is a useful agent for the provision of postoperative analgesia and sedation.     

强化他汀降脂与传统降脂治疗进展性脑卒中的对比研究

目的对进展性脑卒中患者采用强化他汀治疗与传统降脂治疗行疗效对比研究,探讨强化治疗方案的临床应用价值。方法收集我院2013-09—2014-07收治的120例进展性脑卒中患者,随机分为对照组和观察组各60例。对照组予氟伐他汀钠缓释片40mg/d(常规降脂治疗),观察组予氟伐他汀钠缓释片80mg/d(强化降脂治疗),2周后观察血脂变化与临床疗效,比较2组治疗前后的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)与高密度脂蛋白胆固醇(HDL-C)水平及NIHSS评分。结果治疗前2组血脂水平无显著性差异,治疗后TC、LDL-C水平均显著降低(P0.05),HDL-C的表达水平则显著升高。与对照组相比,观察组疗效更明显,NIHSS评分降低幅度更大(P0.05)。2组不良反应发生率差异无统计学意义(P0.05)。结论进展性脑卒中患者采用强化他汀方案治疗安全有效,有较高临床应用价值。     

高血压脑出血合并高血糖患者围手术期护理体会

目的探讨脑出血围手术期合并高血糖患者的临床护理方法。方法对我院脑外科收治的44例高血压脑出血合并糖尿病患者实施术前、术中和术后护理,观察患者的临床效果和术后恢复状况。结果本组总有效率93.2%。生活能力:级12例(27.3%),级19例(43.2%),级8例(18.2%),级4例(9.1%),Ⅴ级1例(2.3%)。结论高血压脑出血合并高血糖患者加强围手术期护理可提高临床效果,促进术后恢复,提高患者生活能力。     

Sepsis in the intensive care unit

Sepsis remains a major cause of mortality in intensive care. The past 10 years has seen a more uniform, worldwide approach to the management of sepsis, severe sepsis and septic shock. This has resulted in improved survival. It is important to recognize the early symptoms and signs of sepsis; the confused, hypoxic, hypotensive patient with pyrexia, tachycardia, tachypnoea and leucocytosis. Examination must include finding a source for infection and early drainage or debridement. Next take appropriate cultures, and give fluids and broad-spectrum antibiotics. If the picture does not improve over the next 6 hours step-up the treatment to include urine output, blood gases for base excess, lactate, haemoglobin, and glucose. These will guide the management of vasopressors, insulin, fluids, transfusion and bicarbonate. If the hypotension persists (septic shock) the patient should be moved to intensive care. Steroids should be added and additional inotropes. This should be instituted with 24 hours of the start of sepsis. Further advanced care may include mechanical ventilation which requires special consideration. Prevention by screening, stopping cross-infection and appropriate use of antibiotics remains the first priority.