医院实施平衡记分卡过程中医生文化的作用

本研究表明医生的态度对于医院绩效的改变是至关重要的。积极的医生文化有助于医院成功实施平衡记分卡。在医院的运营中,承认医生的核心地位,获得医生的支持,对于医院工作的顺利开展是至关重要的。

文学治疗的原理及实践

从文化生态角度看，文学艺术的功能在于维系作为语言符号动物的人的精神生存和健康。本文以“文学治疗”概括这一功能，从三方面展开论述：１、现代性语境中的治疗主题及其从宗教、哲学向文学的转移。在１９世纪，哲学取代宗教而面对“文化医生”的呼唤。２０世纪，因“哲学的终结”，诊断和治疗文化痼疾和个体心理障碍的重任又有转向文学的迹象。２、文学治疗的可能与现实。以泰戈尔和川端康成的创作为例说明文学治疗的两种可能：治疗他人与治疗自己。３、作者和医生之间的转换与互动。对弃医从文和以文为医现象的对比分析中拓展文学与医学之间的双向对话，重估身兼诗神与医神的阿波罗神话。

Psychotherapy with American Indians

American Indians are a substantial minority in both the United States and Canada and present with a disproportionate share of mental health and behavioral health problems. While a large proportion of the native population resides on reservations that are self-managed and have few non-Indian residents, professional health services are mostly provided by clinicians from the dominant culture. The essay tries to highlight specific historical, sociological, and cultural variables the clinician must be aware of to work effectively in this setting. Particular emphasis is placed on using a flexible, eclectic approach, and a case vignette is included to illustrate the principle.

Comparison and analysis of the source culture and the target culture of the TCM intercultural communication

In the process of TCM intercultural communication, as a source culture, TCM embodies the essences of excellent traditional Chinese culture by absorbing the essence of Confucianism, Daoism and Buddhism and gradually evolving into a profound philosophical and cultural system during its long development, meanwhile, it has accumulated tremendous medical achievements and has been abundant in famous doctors in almost all dynasties. In short, TCM is profound both in medical practice and philosophy and culture, which endows TCM the characteristics of cultural essence and medical uniqueness, in addition to its scientific nature which has been proved historically, all of the above-mentioned factors form the basis and guarantee of the TCM intercultural communication, in which TCM is a source culture. In contrast, the western culture shows significant difference as a target culture, from which the western medicine is developed. The major differences manifest in： western culture distinguishes mankind from heaven while traditional Chinese culture believes in the harmony between man and nature; the difference between micro rational thinking and overall perceptual thinking; the difference between individual standard and organic whole. Despite the great difference, western society welcomes TCM due to its unique effect, therefore, it is of vital significance to compare and analysis the two ends of the TCM intercultural communication, namely the source culture and the target culture, to find effective means to promote the TCM intercultural communication. The current tendency of the integration of TCM and western medicine has proved the possibility and feasibility of TCM intercultural communication.

Thoughts on Promoting TCM Intercultural Communication in UK

Due to the differences in culture and system and the influence of migration policy, etc., the spread of TCM in UK faces lots of difficulties. Therefore, to promote the TCM intercultural communication, we need to enhance the publicity of TCM cultural tastes, to strengthen the construction of TCM education system in addition to making full use of Chinese students in UK.

2016年兰州市中西医临床医生职场孤独感的影响因素

目的了解中医和西医临床医生职场孤独感影响因素的异同。方法以职场孤独感量表、职业生活问卷、院内医院内团队组织气氛问卷、医生版医患关系问卷和中医文化认同问卷等为评定工具,对2016年兰州市3所三甲医院中320名医生进行评估。采用相关和回归等统计方法进行数据分析。结果同情心满足和组织气氛与职场孤独感呈显著负相关(-0.522≤r≤-0.264,P<0.01);工作倦怠和医患关系与职场孤独感呈显著正相关(0.270≤r≤0.520,P<0.01);中医临床医生的职场孤独感与中医文化认同呈显著负相关(r=-0.344,P<0.01);科室领导与沟通、工作协调与前景对2组医生的职场孤独感均具有解释作用(β=-0.242、0.278、-0.230、0.144,均P<0.05);同情心满足和中医文化认同对中医临床医生的职场孤独感具有解释作用(β=-0.295、-0.218,均P<0.05);工作倦怠、医患理解与交流对西医临床医生的职场孤独感具有解释作用(β=0.300、-0.301,均P<0.05)。结论影响中医和西医临床医生职场孤独感的因素有共同点也有差异性,其中组织气氛对2组医生职场孤独感影响作用具有共同点;同情心满足和中医文化对中医临床医生的职场孤独感具有独特的影响作用;而工作倦怠对西医临床医生的职场孤独感具有独特的影响作用。

Cardiff acne disability index： cross-cultural translation in Korean and its relationship with clinical acne severity, pathological patterns, and general quality of life

OBJECTIVE: To culturally translate the cardiff acne disability index(CADI) into Korean, and to examine its relationship with clinical acne severity,pathological patterns, and general quality of life(Qo L).METHODS: The CADI was culturally and lin-guistically translated into Korean via translation,back-translation, and face validity test process. Two hundred and fifty-four Korean adolescents were asked to complete the Korean version of the CADI(K-CADI), the Phlegm Pattern, the Cold-Heat Pattern, and the Korean version of the General Health Questionnaires. A clinician estimated acne severity for the adolescents, using the Korean Acne Grading System. Finally, reliability and validity of the K-CADI was examined, and the relationships between acne severity, Phlegm, Cold, and Heat patterns, and Qo L level were examined via pathway analysis.RESULTS: The K-CADI had satisfactory internal consistency(α = 0.827). The examination of construct validity indicated that the K-CADI had one factor(explaining 59.6% of the total variance). Pathway analysis showed satisfactory model fit(normal fit index = 0.960 and comparative fit index = 0.983),and acne-related Qo L was determinant to Phlegm,Heat, and Cold patterns(0.13-0.27 of β), and Phlegm and Heat patterns lowered one's Qo L level(0.17-0.34 of β).CONCLUSION: The K-CADI is a valid and reliable instrument. Phlegm and Heat patterns should be managed when treating acne since they have a moderating effect on general Qo L aggravation.

Arachnoid cell involvement in the mechanism of coagulation-initiated inflammation in the subarachnoid space after subarachnoid hemorrhage

Objective： To assess if arachnoid cells have the capability to present antigen and activate T-lymphocytes after stimulation by bloody cerebrospinal fluid （CSF）, and to illuminate the mechanism of coagulation-initiated inflammation in the subarachnoid space after subarachnoid hemorrhage （SAH）. Methods： Arachnoid cells were cultured, characterized, and examined by immunofluorescence for the basal expression of human leukocyte antigen-DR （HLA-DR）, Expression of HLA-DR, after co-culturing arachnoid cells in vitro with bloody CSF, was investigated by immunofluorescence and flow cytometry （FCM）. The variation of arachnoid cells＇ ultrastructure was observed by transmission electron microscope （TEM）. Arachnoid cells were co-cultured with peripheral blood mononuclear cells （PBMCs）. The content of soluble interleukin-2 receptor （slL-2r） in culture medium was detected by enzyme-linked immunosorbent assay （ELISA）. Results： （1） Arachnoid cells were successfully cultured for many passages. The immunofluorescent staining was positive for HLA-DR in over 95% of the human arachnoid cells. The punctate HI_A-DR was distributed in cytoplasm and not in the karyon. （2） After co-culturing arachnoid cells in vitro with bloody CSF, numerous particles with strong fluorescence appeared in the cytoplasm on Day 6. On Day 8, the quantity of particles and fluorescent intensity were maximal. FCM showed that the percentage of HLA-DR expressing cells was （2.5＋_0.4）% at the first 5 d, increasing to （60.8＋_3.6）% on Day 7. （3） After co-culturing arachnoid cells in vitro with bloody CSF, many lysosome and secondary lysosome particles were present in the cytoplasm. Hyperplasia of rough endoplasmic re- ticulum and enlarged cysts were observed, with numerous phagocytizing vesicles also observed at the edge of the arachnoid cells. （4） Arachnoid cells stimulated by bloody CSF were co-cultured in vitro with PBMCs. The content of slL-2r in the culture medium, having been maintained at around 1.30 ng/ml during the first 3 d, had increased by Day 4. The content of slL-2r peaked 7.53 ng/ml on Day 7 and then reduced gradually. Conclusions： （1） Basic HLA-DR expression is present in arachnoid cells. （2） After stimulation by bloody CSF, arachnoid cells have the potential to serve as antigen presenting cells （APCs） and the ability to activate T-lymphocytes, indicating that arachnoid cells are involved in the mechanism of coagulation-initiated inflammation in the subarachnoid space after SAH.

From solar terms to medical terms(Part Ⅰ): A first step with big data

The story of the Twenty-four Solar Terms(24-ST_s) is one of the most popular elements in Chinese culture, which has a profound influence on agriculture production, health care, and even daily life in both ancient and modern China. This traditional calendric system was invented by the Chinese ancestors through combining fundamental astronomical knowledge with climatic and phenological conditions in the Yellow River Basin some 2000 years ago. Although the basic philosophy of the 24-ST_s remains valid for the country as a whole to date, their regional robustness has been increasingly challenged by accumulating observational data in terms of temporal shift and spatial inhomogeneity. To tackle these issues, we propose to recalibrate the medically related critical timings of Great Heat and Great Cold in the classic ST system by using big meteorological data, and adjust them by introducing geographically correlated analytical models. As a result, a novel calendric system, called the Twenty-four Medical Terms(24-MT_s), has been developed as an upgraded version of the traditional 24-ST_s. The proposed 24-MT_s are characterized by two striking features with respect to the 24-ST_s: A varying duration of each MT instead of a fixed one for the ST, and a geographically dependent timing for each MT instead of a unified one for the entire nation. As such, the updated 24-MT_s are expected to provide a more realistic estimate of these critical timings around the year, and hence, a more precise guidance to agronomic planning and health care activity in China.