Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPC...Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.展开更多
BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Sys...BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry,many studies have compared its efficacy and safety to conventional anesthesia.However,very few studies have compared single tooth anesthesia(STA)and traditional local anesthesia.AIM To compare pain rating,changes in blood pressure,and heart rate during the local anesthetic injection.The secondary objectives were to measure the patients’level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.METHODS A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study.The patients were evaluated for their general physical status and oral clinical findings before enrollment.Information regarding perceived pain,changes in heart rate and blood pressure,and patients’satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.RESULTS No significant difference was noted in perceived pain(P=0.59)and systolic blood pressure(P=0.09)during anesthetic injection using both traditional and STA techniques.STA patients had a significantly higher heart rate during anesthesia,although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia.During the restorative procedure,less pain was perceived by STA patients on the Wong-Baker FACES pain scale,which was statistically significant(P<0.001).Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future(P=0.04).CONCLUSION STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.展开更多
Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from th...Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.展开更多
Radiotherapy has a not well-established role in the pre-operative and in the post-operative setting in gastric cancer(GC) patients. Randomized trials report controversial outcomes and impact on survival. In the D2 loc...Radiotherapy has a not well-established role in the pre-operative and in the post-operative setting in gastric cancer(GC) patients. Randomized trials report controversial outcomes and impact on survival. In the D2 loco-regional node resection era, after a wellperformed radical surgery, local treatment using radiotherapy combined to chemotherapy should be considered for locally advanced GC. Prognostic factors could help the better selection of subgroups that present high risk of loco-regional recurrence. Then, the addition of radiotherapy could improve the diseasefree survival and also quality of life. There are no large prospective studies that have assessed specific factors predicting for recurrence or survival, but only retrospective series, some of them including high number of patients with homogeneous characteristics. In locally advanced GC adding radiotherapy to the postoperative chemotherapy seems to improve outcomes and quality of life. Prognostic factors such as T-stage, N-status, nodal ratio, and other histological factors should be considered to submit patients to postoperative combined treatment. Larger prospective series are necessary to investigate the role of combined chemoradiation after radical D2-resection, especially in locally advanced GC. Further prospective investigations are needed to suggest prognostic factors that have significant impact on survival and recurrence, improving the management and outcomes, particularly in locally advanced GC patients.展开更多
Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and an...Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia(RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient's home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderly.展开更多
目的:探究本土化认知促进治疗在认知障碍老年患者中的临床治疗效果。方法:采用简易智能状态检查量表筛选出20例认知障碍老年患者,采取为期7周的本土化认知促进治疗对其进行非药物干预,共进行14个主题活动。将干预前、中、后老年住院患...目的:探究本土化认知促进治疗在认知障碍老年患者中的临床治疗效果。方法:采用简易智能状态检查量表筛选出20例认知障碍老年患者,采取为期7周的本土化认知促进治疗对其进行非药物干预,共进行14个主题活动。将干预前、中、后老年住院患者的主观认知下降量表(subjective cognitive decline questionnaire 9,SCD-Q9)、简易智能状态检查量表(mini-mental state examination,MMSE)、康奈尔痴呆抑郁量表(cornell scale for depression in dementia,CSDD)、神经精神量表(neuropsychiatric inventory scale,NPI)和生活自理能力(activities of daily living,ADL)评估结果进行对比分析。结果:本土化认知促进治疗干预后老年住院患者的MMSE、CSDD、ADL、NPI评分比较,差异均有统计学意义(P均<0.05)。结论:本土化认知促进治疗能改善老年住院患者的焦虑抑郁情绪、生活自理能力、生命质量、神经精神症状,本土化的认知促进治疗方案,可以进行临床推广。展开更多
目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部...目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部浸润麻醉+静脉自控镇痛(PCIA),对照组给予局部浸润麻醉+PCIA。比较2组手术前后血浆缓激肽(BK)、前列腺素E2(PGE2)、P物质(SP)、β内啡肽(β-ep)、强啡肽(Dyn),术后12、24、48 h VAS评分,麻醉药物使用情况及不良反应。结果术后2组血浆BK、PGE2、SP、β-ep、Dyn水平与同组术前比较,差异有统计学意义(P<0.01)。观察组血浆BK、PGE2、SP水平低于对照组(P<0.05),β-ep、Dyn水平高于对照组(P<0.05)。静息VAS评分:术后12、24、48 h,2组间VAS评分比较,差异无统计学意义(F=0.694,P=0.406);组内各时间点VAS评分比较,差异有统计学意义(F=256.6,P<0.01)。活动VAS评分:术后12、24、48 h,2组间VAS评分比较,差异有统计学意义(F=7.072,P=0.008);组内各时间点VAS评分比较,差异有统计学意义(F=300.885,P<0.01)。观察组首次按压时间晚于对照组(P<0.01),PCIA总按压次数少于对照组(P<0.01),补救镇痛例数少于对照组,但差异无统计学意义(P>0.05)。观察组术后恶心、呕吐发生率低于对照组(P<0.05);2组头晕、嗜睡、呼吸抑制、瘙痒发生率比较,差异无统计学意义(P>0.05)。结论电针预处理可增强TKA患者术后局部浸润麻醉+PCIA的镇痛效果。展开更多
文摘Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.
文摘BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry,many studies have compared its efficacy and safety to conventional anesthesia.However,very few studies have compared single tooth anesthesia(STA)and traditional local anesthesia.AIM To compare pain rating,changes in blood pressure,and heart rate during the local anesthetic injection.The secondary objectives were to measure the patients’level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.METHODS A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study.The patients were evaluated for their general physical status and oral clinical findings before enrollment.Information regarding perceived pain,changes in heart rate and blood pressure,and patients’satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.RESULTS No significant difference was noted in perceived pain(P=0.59)and systolic blood pressure(P=0.09)during anesthetic injection using both traditional and STA techniques.STA patients had a significantly higher heart rate during anesthesia,although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia.During the restorative procedure,less pain was perceived by STA patients on the Wong-Baker FACES pain scale,which was statistically significant(P<0.001).Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future(P=0.04).CONCLUSION STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.
文摘Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.
文摘Radiotherapy has a not well-established role in the pre-operative and in the post-operative setting in gastric cancer(GC) patients. Randomized trials report controversial outcomes and impact on survival. In the D2 loco-regional node resection era, after a wellperformed radical surgery, local treatment using radiotherapy combined to chemotherapy should be considered for locally advanced GC. Prognostic factors could help the better selection of subgroups that present high risk of loco-regional recurrence. Then, the addition of radiotherapy could improve the diseasefree survival and also quality of life. There are no large prospective studies that have assessed specific factors predicting for recurrence or survival, but only retrospective series, some of them including high number of patients with homogeneous characteristics. In locally advanced GC adding radiotherapy to the postoperative chemotherapy seems to improve outcomes and quality of life. Prognostic factors such as T-stage, N-status, nodal ratio, and other histological factors should be considered to submit patients to postoperative combined treatment. Larger prospective series are necessary to investigate the role of combined chemoradiation after radical D2-resection, especially in locally advanced GC. Further prospective investigations are needed to suggest prognostic factors that have significant impact on survival and recurrence, improving the management and outcomes, particularly in locally advanced GC patients.
文摘Normal aging is a process that involves loss of functional reserve of most organ systems of the human body, most significantly: cardiovascular, pulmonary, renal and nervous systems. Advancements in both surgery and anesthesia have made it possible to operate more safely on the elderly population and those older patients with multiple severe co-morbidities that were not routinely possible in the recent past. Regional anesthesiologist have proven to be instrumental in this regard as regional anesthetic/analgesic techniques may now permit surgeons to operate on the elderly who were not ideal surgical candidates or unable to tolerate general anesthesia. In addition, regional techniques provide alternatives that may optimize acute pain control and reduce the incidence of devastating side effects during the perioperative period such as: myocardial infarction, pulmonary embolism, pneumonia, and also increases the opportunity to allow for early ambulation and shorter hospital stays. These anesthetic options now provide the elderly patient with better medical care alternatives, but also can show a significant financial impact on health care system resources. Further understanding on aging molecular biology, physiology and pathophysiology, together with technical improvements of regional anesthetic techniques will continue to make it safer and more efficacious to operate on the elderly population with evidence of reduced morbidity and mortality. Although there is only anecdotal evidence that regional anesthesia(RA) improves survival, there is little doubt that RA plays an important role in perioperative optimization of pain control and decreases pain management complications as well as a reduction in healthcare costs. Beyond traditional operating rooms, elderly patients may increasingly benefit from RA and acute pain management in Emergency Rooms, medical clinics and even within a patient's home. Therefore, the focus of this review is directed toward geriatric patients and beneficial effects of RA on outcomes in the elderly.
文摘目的:探究本土化认知促进治疗在认知障碍老年患者中的临床治疗效果。方法:采用简易智能状态检查量表筛选出20例认知障碍老年患者,采取为期7周的本土化认知促进治疗对其进行非药物干预,共进行14个主题活动。将干预前、中、后老年住院患者的主观认知下降量表(subjective cognitive decline questionnaire 9,SCD-Q9)、简易智能状态检查量表(mini-mental state examination,MMSE)、康奈尔痴呆抑郁量表(cornell scale for depression in dementia,CSDD)、神经精神量表(neuropsychiatric inventory scale,NPI)和生活自理能力(activities of daily living,ADL)评估结果进行对比分析。结果:本土化认知促进治疗干预后老年住院患者的MMSE、CSDD、ADL、NPI评分比较,差异均有统计学意义(P均<0.05)。结论:本土化认知促进治疗能改善老年住院患者的焦虑抑郁情绪、生活自理能力、生命质量、神经精神症状,本土化的认知促进治疗方案,可以进行临床推广。
文摘目的观察电针术前预处理对全麻下行全膝关节置换术(TKA)患者术后镇痛的效果。方法选取2022年10月—2022年12月于徐州市中心医院首次全麻下行单侧TKA患者96例,用随机数字法将患者分为观察组、对照组,各48例。观察组给予电针预处理+局部浸润麻醉+静脉自控镇痛(PCIA),对照组给予局部浸润麻醉+PCIA。比较2组手术前后血浆缓激肽(BK)、前列腺素E2(PGE2)、P物质(SP)、β内啡肽(β-ep)、强啡肽(Dyn),术后12、24、48 h VAS评分,麻醉药物使用情况及不良反应。结果术后2组血浆BK、PGE2、SP、β-ep、Dyn水平与同组术前比较,差异有统计学意义(P<0.01)。观察组血浆BK、PGE2、SP水平低于对照组(P<0.05),β-ep、Dyn水平高于对照组(P<0.05)。静息VAS评分:术后12、24、48 h,2组间VAS评分比较,差异无统计学意义(F=0.694,P=0.406);组内各时间点VAS评分比较,差异有统计学意义(F=256.6,P<0.01)。活动VAS评分:术后12、24、48 h,2组间VAS评分比较,差异有统计学意义(F=7.072,P=0.008);组内各时间点VAS评分比较,差异有统计学意义(F=300.885,P<0.01)。观察组首次按压时间晚于对照组(P<0.01),PCIA总按压次数少于对照组(P<0.01),补救镇痛例数少于对照组,但差异无统计学意义(P>0.05)。观察组术后恶心、呕吐发生率低于对照组(P<0.05);2组头晕、嗜睡、呼吸抑制、瘙痒发生率比较,差异无统计学意义(P>0.05)。结论电针预处理可增强TKA患者术后局部浸润麻醉+PCIA的镇痛效果。
