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Storylines of family medicine Ⅴ:ways of thinking—honing the therapeutic self

Family Medicine and Community Health 2024年第S3期12卷 43-51页

作者： William B Ventres Leslie A Stone Johanna F Shapiro Cynthia Haq Jéssica R B Leao Donald E Nease Jr Liz Grant Stewart W Mercer John C M Gillies Pablo González Blasco Maria Auxiliadora C De Benedetto Graziela Moreto Marcelo R Levites Jennifer E DeVoe William R Phillips Jane M Uygur Thomas R Egnew Colette S Stanley Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA Family Medicine University of California Irvine School of MedicineIrvineCaliforniaUSA Faculty of Medicine University of Sao PauloSao PauloBrazil Family Medicine University of Colorado Anschutz Medical Campus School of MedicineAuroraColoradoUSA Usher Institute Edinburgh Medical SchoolUniversity of EdinburghEdinburghUK SOBRAMFA-Medical Education and Humanism Sao PauloBrazil Family Medicine Oregon Health&Science University School of MedicinePortlandOregonUSA Family Medicine University of Washington School of MedicineSeattleWashingtonUSA General Practice Royal College of Surgeons in IrelandDublinIreland General Internal Medicine Geriatrics&Palliative MedicineTulane University School of MedicineNew OrleansLouisianaUSA

Storylines of Family Medicine is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅴ:ways of thinking—honing the therapeutic self’,authors present the following sections:‘Reflective practice in action’,‘The doctor as drug—Balint groups’,‘Cultivating compassion’,‘Towards a humanistic approach to doctoring’,‘Intimacy in family medicine’,‘The many faces of suffering’,‘Transcending suffering’and‘The power of listening to stories.’May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.

关键词： illustration dimensions suffering

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Physical activity in older people with cardiac co-morbidities

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Journal of Geriatric Cardiology 2018年第8期15卷 557-558页

作者： Jun-Ming Liew Shyh Poh Teo The Chinese University of Hong Kong Shatin New Territories Hong Kong China geriatrics and palliative unit Department of Internal Medicine RIPAS Hospital Bandar Seri Begawan Brunei Darussalam

The World Health Organisation （WHO） launched a global action plan on physical activity to provide a frame- work of policy actions to increase physical activity in June 2018. Physical activity is an effective intervention for pre- vention and management of non-communicable diseases including cardiac disease, regardless of age. We hoped this letter would remind readers of the importance of physical activity in older people, particularly those with cardiac co-morbidities.

关键词： Cardiac eomorbidities Older people Physical activity

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Survey of <i>C. difficile</i>-Specific Infection Control Policies in Local Long-Term Care Facilities

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International Journal of Clinical Medicine 2014年第7期5卷 414-419页

作者： Laurie Archbald-Pannone Department of Internal Medicine Division of General Medicine Geriatrics and Palliative Care Division of Infectious Diseases and International Health University of Virginia Charlottesville USA

Introduction: The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the united States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. Methods: IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and

关键词： Clostridium difficile Infection Infection Control Policies Long-Term Care Facilities

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Symptom clusters and quality of life among patients with advanced heart failure

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Journal of Geriatric Cardiology 2016年第5期13卷 408-414页

作者： Doris SF Yu Helen YL Chan Doris YP Leung Elsie Hui Janet WH Sit The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong China Department of Medicine and geriatrics Shatin Hospital Hong Kong China

Objectives To identify symptom clusters among patients with advanced heart failure （HF） and the independent relationships with their quality of life （QoL）. Methods This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale （ESAS） and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hier- archical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. Results The patients were at an advanced age （82.9± 6.5 years）. Three distinct symptom clusters were identified： they were the distress cluster （including shortness of breath, anxiety, and depression）, the decondition cluster （fatigue, drowsiness, nausea, and reduced appetite）, and the discomfort cluster （pain, and sense of generalized discomfort）. These three symptom clusters accounted for 63.25% of variance of the patients＇ symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress （β = -0.635, P 〈 0.001）, the decondition （β = -0.148, P = 0.01）, and the discomfort （β = -0.258, P 〈 0.001） symptom clusters independently predicted their QoL. Conclusions This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.

关键词： Advanced heart failure palliative care model Quality of life Symptom clusters

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Treatment of colorectal cancer in the elderly

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World Journal of Gastrointestinal Oncology 2015年第10期7卷 204-220页

作者： Monica Millan Sandra Merino Aleidis Caro Francesc Feliu Jordi Escuder Tani Francesch Colorectal Surgery unit Department of Surgery Joan XXIII University Hospital Department of Medical Oncology Joan XXIII University Hospital and St. Joan de Reus University Hospital Department of geriatrics and palliative Care Joan XXIII University Hospital (GiPSS)

Colorectal cancer has a high incidence, and approxi-mately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients(> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are underrepresented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.

关键词： Colorectal cancer Surgery Chemotherapy Radiotherap

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Quality of life and palliative care needs of elderly patients with advanced heart failure

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Journal of Geriatric Cardiology 2016年第5期13卷 420-424页

作者： Helen YL Chan Doris SF Yu Doris YP Leung Aileen WK Chan Elsie Hui The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong China Department of Medicine and geriatrics Shatin Hospital Hong Kong China

Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.

关键词： Assessment Heart failure palliative care The elderly

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Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence

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Open Journal of Obstetrics and Gynecology 2014年第14期4卷 809-816页

作者： Thomas L. Wheeler II Jana D. Illston Alayne D. Markland Patricia S. Goode Holly E. Richter Department of Obstetrics and Gynecology University of South Carolina School of Medicine-Greenville Greenville USA Division of Gerontology Geriatrics and Palliative Care University of Alabama at Birmingham Birmingham USA Department of Obstetrics and Gynecology University of Alabama at Birmingham Birmingham USA

Objective: Urinary incontinence (UI) impacts all aspects of life activities. This study aims to characterize change in mobility within the community utilizing the Life Space Assessment (LSA) questionnaire in women undergoing non-surgical UI treatment. Methods: This prospective cohort study, performed from July 2007 to March 2009, followed women seeking non-surgical UI treatment from an outpatient tertiary-care clinic and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satisfaction Question (PSQ) were obtained post-treatment. The women were treated with multi-component behavioral and/or pharmacologic therapies, and we hypothesized that LSA would improve with treatment. Repeated measures analysis with Tukey’s HSD and backwards selection linear regression model were performed. Results: 70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI were recruited. LSA score decreased from baseline to 2 months (mean ± SD;63 ± 29 to 56 ± 28, p < 0.001) and was sustained at 6 and 12 months (54 ± 28, 54 ± 28). UDI scores improved from 36 ± 23 to 25 ± 24, p < 0.001, at 2 months, and improvement persisted at 6 and 12 months (22 ± 22, 21 ± 24). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p = 0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p = 0.002), and 6-point for African American race (p = 0.048). Conclusion: Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement.

关键词： Urinary Incontinence Life-Space Depression Mobility Community-Dwelling Women

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CRISPR-mediated genome editing and human diseases

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Genes & Diseases 2016年第4期3卷 244-251页

作者： Liquan Cai Alfred L.Fisher Haochu Huang Zijian Xie Marshal l Institute for Interdisciplinary Research(MIIR) Marshall UniversityWeisberg Engineering ComplexMarshall University1628 Third AvenueHuntingtonWV 25703USA University of Texas Health Science Center at San Antonio Department of MedicineDivision of GeriatricsGerontologyand Palliative MedicineSan AntonioTX 78229USA GRECC South Texas VA Healthcare SystemSan AntonioTX 78229USA Committee on Immunology Section of RheumatologyDepartment of MedicineKnapp Center for Lupus and Immunology ResearchUniversity of ChicagoChicagoIL 60637USA

CRISPR(Clustered Regularly Interspaced Short Palindromic Repeats)technology has emerged as a powerful technology for genome editing and is now widely used in basic biomedical research to explore gene *** recently,this technology has been increasingly applied to the study or treatment of human diseases,including Barth syndrome effects on the heart,Duchenne muscular dystrophy,hemophilia,b-Thalassemia,and cystic ***/Cas9(CRISPR-associated protein 9)genome editing has been used to correct diseasecausing DNA mutations ranging from a single base pair to large deletions in model systems ranging from cells in vitro to animals in *** addition to genetic diseases,CRISPR/Cas9 gene editing has also been applied in immunology-focused applications such as the targeting of C-C chemokine receptor type 5,the programmed death 1 gene,or the creation of chimeric antigen receptors in T cells for purposes such as the treatment of the acquired immune deficiency syndrome(AIDS)or promoting anti-tumor ***,this technology has been applied to the genetic manipulation of domesticated animals with the goal of producing biologic medical materials,including molecules,cells or organs,on a large ***,CRISPR/Cas9 has been teamed with induced pluripotent stem(iPS)cells to perform multiple tissue engineering tasks including the creation of disease models or the preparation of donor-specific tissues for *** review will explore the ways in which the use of CRISPR/Cas9 is opening new doors to the treatment of human diseases.

关键词： CRISPR DNA double-stranded break Genome editing Human diseases iPS cells

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Endoscopic radiofrequency ablation for malignant biliary obstruction

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World Journal of Gastrointestinal Oncology 2021年第10期13卷 1383-1396页

作者： Jana Jarosova Peter Macinga Alzbeta Hujova Jan Kral Ondrej Urban Julius Spicak Tomas Hucl Department of Gastroenterology and Hepatology Institute for Clinical and Experimental MedicinePraha 14021Czech Republic Department of Internal Medicine II–Gastroenterology and geriatrics University Hospital OlomoucFaculty of Medicine and DentristryPalacky University OlomoucOlomouc 77900Czech Republic

Cholangiocarcinoma and pancreatic cancer are the most common causes of malignant biliary *** majority of patients are diagnosed at a late stage when surgical resection is rarely *** these cases,palliative chemotherapy and radiotherapy provide only limited benefit and are associated with poor *** ablation(RFA)is a procedure for locoregional control of tumours,whereby a high-frequency alternating current turned into thermal energy causes coagulative necrosis of the tissue surrounding the *** subsequent release of debris and tumour antigens by necrotic cells can stimulate local and systemic *** development of endoluminal RFA catheters has led to the emergence of endoscopically delivered RFA,a treatment mainly used for malignant biliary strictures to prolong survival and/or stent *** indications include recanalisation of occluded biliary stents and treatment of intraductal ampullary adenoma or benign biliary *** article presents a comprehensive review of endobiliary RFA,mainly focusing on its use in patients with malignant biliary *** available data suggest that biliary RFA may be a promising modality,having positive impacts on survival and stent patency and boasting a reasonable safety ***,further studies with better characterised and stratified patient populations are needed before the method becomes accepted within routine clinical practice.

关键词： Radiofrequency Ablation Biliary Stenosis Cholangiocarcinoma Pancreatic cancer

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Gerontological nursing and community-care in Taiwan and its enlightening value

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中西医结合护理（中英文） 2017年第10期3卷 1-3页

作者： FAN Hui XIA Dazhen MEI Kewen 无 Department of geriatrics Jiangsu Province Hospital of TCMNanjingJiangsu 210029 Department of Nursing Nanjing Jiangning HospitalNanjingJiangsu 211100 Department of geriatrics jiangsu Province HospitalNanjingjiangsu 210029

By learning from the management experience in gerontological nursing,community-based and long-term care in Taiw an area.,this article proposed that nursing care should be based on patients' demand-orientation,and cultural inheritance of humanity and kindness,development of palliative care,and enhancement in community cooperation so as to improve management level and service quality in gerontological nursing and community-based care,and diversity in geriatric nursing culture.

关键词： gerontological nursing community-based care long-term care Taiw an area

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