Objective To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.
Objective Through studying a diabetic patient accompanied with pancreatic cancer by means of evidence-based clinical practice, to find out the relationship between diabetes mellitus and cancer and whether the long-acting insulin glargine increases the risk of cancer or not, which is regarded as a disputable hot issue at present. Methods Such databases as The Cochrane Library (Issue 3, 2010), OVID-EBM Reviews (1991 to Sept. 2010), MEDLINE (1950 to Sept. 2010) and CNKI (2000 to Sept. 2010) were retrieved to collect high quality clinical evidence, and the best therapy was formulated in accordance with the willingness of patients themselves. Results Eight randomized controlled trials (RCTs), four meta-analyses and one RCT meta-analysis were included. The evidence indicated that: a) Diabetes mellitus was kind of related to the occurrence of malignancies; b) There was no evidence at present showing the relationship between long-acting insulin glargine and cancer; c) Strictly controlling of blood sugar did not increase the risk of tumorigenesis, but hyperglycemia causing cancer was proofless; and d) Whether the diabetic patient with cancer should stop taking long-acting insulin glargine or not should require suggestions from specialists rather than patients themselves. Conclusion No evidence at present shows that tumorigenesis is related to diabetes mellitus, long-acting insulin glargine and strict controlling of blood sugar. It is necessary to require more evidence to decide whether the therapy should be adjusted or not for the diabetic patient with cancer who is in the process of glargine therapy.
【摘要】 目的 了解老年恶性肿瘤患者的抑郁状况及引起抑郁的因素，并针对抑郁的主要因素制定多层次、全方位、科学的护理干预措施，改善老年恶性肿瘤患者的抑郁心理，提高其生活质量。 方法 对2009年12月-2010年4月183例老年恶性肿瘤患者分别应用一般资料调查表和 Brink的老年抑郁量表（GDS）进行调查。从文化程度，疾病认识程度，对社会、家庭支持的满意度，付费方式等方面进行了比较和分析。 结果 老年恶性肿瘤患者的抑郁患病率为80.87%。明显高于一般老年人及老年慢性病患者；而不同文化程度、对疾病认知程度、患者对社会、家庭支持的满意度与抑郁情绪的发生有一定的关系（Plt;0.05）。 结论 护理人员需加强对患者的疾病知识的健康教育，努力提高患者的社会支持满意度，以减轻患者的抑郁情绪。【Abstract】 Objective To explore the state and the etiology of depression in patients with geratic malignant tumor, and to develop the global and scientific nursing management for patient with geratic malignant tumor, and improve the patients′ depression and life quality. Methods A total of 183 patients with geratic malignant tumor from December 2009 to April 2010 were investigated by questionnaire survey with Brink′s geratic-depression-scale (GDS). The education level, disease′s awareness level, satisfaction level for family and scocial supports, and the payment mode were analyzed. Results Depressive prevalence in malignant tumor patients (80.87%) was much higher than that in the normal elder people (10%-15%) and in the patients with chronic disease (31.0%). Different education level, disease′s awareness level, satisfaction level for family and social supports were related to the depressive prevalence (Plt;0.05). Conclusion Nursing faculty should enhance the health education to the patients with geratic malignant tumor, increase the satisfaction for social support and decrease their depression.