Knowledge towards Physical Medicine and Rehabilitation among Training Doctors and Medical Students at the Mohammed VI University Hospital of Marrakech

The aim of our study is to evaluate the knowledge regarding physical medicine and rehabilitation among physicians in training and medical students at the Mohammed VI University Hospital in Marrakech, to approach the knowledge, attitudes, and practices of doctors regarding physical medicine and rehabilitation and evaluate the knowledge in theoretical training related to PRM among the students. We conducted a monocentric cross-sectional analytical study, using a web-based anonymous survey, carried out among 558 undergraduate student and training doctors, randomly selected in the form of a survey on the knowledge towards Physical Medicine and rehabilitation. We received 558 survey duly completed by students of the Faculty of Medicine and Pharmacy of Marrakech (62.4%) and training doctors (37.6%). The mean age of the participants was 24.53 ± 3.9 years, with extremes ranging from 17 to 39 years. 52.7% of the participants were from the former educational reform, The predominance of participation was remarkable among pediatricians 23%, The population who knew PRM was the majority (79.3%), 40.7% of the participants were unaware of the availability of a PRM department at Mohamed VI University Hospital, 0.5% of all training doctors and medical students questioned strongly agreed with the sufficiency of their training in disability management were belonging to the new reform, 84.1% of participants had never attended or referred a patient to the PRM department. 23.2% of training doctors affirmed the referral of patients to PRM for further management. Despite the essential role of PRM in the management of diseases, it remains little known by training doctors and medical students. This lack of knowledge of PRM reflects the lack of the undergraduate and postgraduate of the medical education in the field of rehabilitation.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

A Barefoot Doctor’s Manual as a“Medical Bible”:Medical Politics and Knowledge Transmission in China

This paper examines the origin,compilation,and circulation of A Barefoot Doctor’s Manual(Chijiao yisheng shouce赤脚医生手册),exploring the relationship between medical politics and knowledge transmission in China,and its impact on the promotion of Chinese medicine across the world.Barefoot doctors were a special group of rural medical practitioners active in a very special socio-political context.Various editions of barefoot doctor manuals and textbooks were published across China after the first publication of the Manual in 1969.The publication of these manuals and textbooks became an indelible hallmark of the“Cultural Revolution”(1966–1976),when political publications predominated.The Manual was not only a guide for barefoot doctors in their daily study and practice,but also a primary source of medical knowledge for ordinary people.In the middle of the 1970s,the Manual was translated into many languages and published worldwide.This paper argues that the publication of A Barefoot Doctor’s Manual embodied a public-oriented mode of knowledge transmission that emerged and was adopted during a very specific era,and though it was eventually substituted by a mode of training embedded in the formal medical education system,it demonstrated the impact of politics on medicine and health in the context of resource scarcity and low literacy.Changes in China’s geopolitical status,the West’s pursuit of alternative approaches to medicine and health,and the World Health Organization’s(WHO’s)concern over health universality and equity all contributed to the translation and circulation of the Manual,facilitating the dissemination of Chinese medicine worldwide.The paper thus presents empirical and theoretical contributions to research on the relationship between medical politics and knowledge transmission in China.

Factors associated with psychological distress of medical doctor in Kagawa prefecture, Japan: a pilot study

Objective: We evaluated the psychological distress of medical doctor using a 6-item instrument (the K6) in Kagawa prefecture, Japan. Methods: A total of 284 medical doctors (236 men and 48 women) were analyzed in a cross-sectional investigation study. The association between psychological distress and clinical factors were evaluated by the K6 instrument, with psychological distress defined as 13 or more points out of a total of 24 points. Results: A total of 17 doctors (6.0%) as defined as psychological distress. The significant relationships between the K6 score and age, experience duration as clinician were not noted. The K6 score in subjects with consciousness of suicide was significantly higher than that without. In addition, the K6 score in subjects without cooperation with specialists was higher than those without, but not at a significant level. Conclusions: Some factors i.e. consciousness of suicide and cooperation with specialists might be associated with psychological distress, as assessed by the K6 instrument, in medical doctor in Kagawa prefecture, Japan.

Ling Feng,Professor of Neurosurgery of Xuanwu Hospital, Capital Medical University

I founded the Chinese Medical Volunteers(CMV)in 2017 to join the national fight against poverty.Reaching out along the Silk&Road is also one of ourtasks.Our CMV is open to foreign doctors.We organised a CMV action in Xinjiang Uygur Autonomous Region in 2018.European medical professors were very happy to join our CMV,becoming our foreign participants.

肌骨超声进修医师的教学实践探索

继续教育是提高超声医师亚专业技术能力的重要途径和手段,肌骨超声发展迅速,临床应用范围不断拓展,已成为临床多学科重要的影像学评估手段,但目前我国肌骨超声尚未得到普遍推广,很多基层医院的医师对肌骨超声一知半解。肌骨超声有自身的特殊性,集解剖、病理、临床及超声为一体,除对解剖结构进行诊断外,还涉及功能评估,因此教学难度大。进修学习是快速掌握肌骨超声的重要手段。文章结合多年肌骨进修医师的带教经验,将肌骨进修医师培训分4个阶段:相关理论知识学习、规范化操作学习、临床常见疾病学习和临床观摩及患者检查。文章分别总结了每一阶段的教学特点、侧重点和带教方法,兼顾基础知识、技能操作和临床思维培养,以更好地提升进修医师的继续教育质量。

小说《赤脚医生》中的医学人文关怀和叙事医学

残雪的小说《赤脚医生》中构建了一个不同于历史现实中的赤脚医生群体和他们的行医环境,是新东方主义下对这一职业的浪漫投射,更是对理想医疗实践的想象和刻画。在这个世界中,赤脚医生是一个令人向往的职业,与患者和环境和谐共生,共同创造了美好、有意义的生活。小说体现了残雪的自然观,利用北京大学叙事医学团队的叙事医学基本概念模型对小说进行解读,揭示书中赤脚医生们的医疗哲学和医疗行为体现出的自然的医学观,与医学人文精神和医学人文关怀一脉相承。

医共体模式下家庭医生签约服务的困境与进路探析

文章结合安徽、福建、浙江等医共体先行省份的实践经验,发现医共体模式下家庭医生服务团队逐渐壮大,签约内容更加丰富,能获得更多医保支持以及县域内优质资源。然而,如何促进家庭医生签约服务走深走实,仍然面临着医共体内“人、财、物”利益协同方面的挑战。在持续推进医共体建设的过程中,应进一步为家庭医生团队提供资源保障,以医保为杠杆激发家庭医生的服务动力,同时注意防止“虹吸”。

张德英从痰论治痤疮验案举隅

[目的]总结张德英教授从痰证角度治疗痤疮的特色及经验。[方法]通过跟随张教授门诊临证学习,整理张教授治疗痤疮的病案,选取三则典型验案,结合中医经典理论,分析、总结张教授对痰证理论的独到见解及临床经验。[结果]张教授从当今人们的体质状况及痤疮发病特点出发,指出痤疮的病因病机为痰热或痰火上犯头面胸等处,局部肉腐而发病。根据痰浊生于中焦脾胃,为土家实邪,在治疗上可以通过泻土降浊、繁木制土、化土生金的方法达到化痰的目的,再加以清热药物,从而清化上焦痰热之邪,使痤疮得以治愈。同时需注意到五行相互关系,痰浊太盛则易克伐肾水而致肾虚,在治疗上祛痰降浊为先,痰浊去除后再补益肾水方可有效,甚或有些患者不需补肾,而肾自慢慢恢复。[结论]张教授对痰证理论认识独特,指出痤疮病机多为痰火或痰热郁于肌表,肉腐而成。治疗当以清化痰热为主。痰为土家之邪,化痰之法除泻土之外,根据五行理论,还有繁木制土、生金消土之法,其临床疗效显著,值得临床推广应用。

基于复合型人才培养为导向的多元化教学在肝胆胰外科进修医师培训中的应用

目的探讨基于复合型人才培养为导向的多元化教学方法在肝胆胰外科进修医师培训中应用价值。方法选取2020年12月至2022年10月郑州大学第一附属医院肝胆胰外科进修的56名医师为研究对象。采用多元化教学方式对56名肝胆胰外科进修医师进行培训,应用理论知识及临床技能考试了解多元化的教学效果,采用调查问卷了解进修医师对多元化教学的满意度和医疗水平提升情况。结果培训后,进修医师的理论知识及临床技能评分高于培训前(P<0.05)。进修医师对多元化教学满意度评分为(4.43±0.50)分。培训后,15名(26.7%)进修医师所在医院增加了腹腔镜设备,12名(21.4%)进修医师所在医院增加了胆道镜设备。培训后,39名(69.6%)进修医师所在医院增加了外派进修医师人数,54名(96.4%)进修医师增加微信学术公众号。培训后,进修医师三、四级及腹腔镜手术占比高于培训前(P<0.05)。结论基于复合型人才培养为导向的多元化教学模式提升肝胆胰外科进修医师理论水平、临床技能及医疗水平,提高教学满意度,是一种行之有效的医学教育方法。

医学美学教育在医疗美容专业研究生培养中的必要性探究

医学美学教育在医疗美容专业研究生的培养中占有非常重要的地位,但往往容易被导师和学生忽视。文章通过笔者多年在医疗美容行业积累的临床经验和培养学生的心得,将医疗美容专业研究生的培养和医学美学标准的树立结合起来,重点探讨了医学美学的特殊性,以及医疗美容专业研究生如何培养科学的医学美学观等内容。文章详细阐述了医学美学的本质,医学美学的特殊性,以及研究生如何树立科学的医学美学观,这些将为培养高质量的医疗美容专业硕士研究生,促进科学的医学美学标准在美容行业的树立提供理论基础,最终实现国内医疗美容事业的高质量发展,满足广大人民群众对医美日益增加的需求,保障求美者的生命健康权。

由医方言语导致的医疗纠纷类型分析及应对建议

医生语言表达水平会直接影响信息传递和沟通效果。近20年来,有大量研究以量表的形式对医护人员和患者进行“医患沟通”相关问卷调查,但关于医患沟通实际应用和医患纠纷实例分析的研究较少。以某三甲医院《投诉登记本》为研究素材,总结出因医方语言产生的医疗纠纷的五种原因,分别为医方语气生硬、肢体语言失当;治疗方案沟通不明确;无法回答患者的问题;不同医生说辞相悖;病情预判与病情发展差距大。通过分析此类纠纷的处理要点,以期运用在今后的医学生医患沟通课程或医生语言技巧培训中,优化医患沟通,推动医患关系向好发展。

案例分析教学法联合教师标准化病人在卒中后神经源性膀胱临床沟通教学中的应用

目的探讨案例分析教学法(case-basedlearning,CBL)联合教师标准化病人(teacher-standardized patient,TSP)在卒中后神经源性膀胱医患沟通教学中的应用效果。方法纳入首都医科大学附属北京天坛医院接受规范化培训的60名住院医师,随机分为对照组和试验组。对照组采用传统以授课为导向的教学法,试验组采用CBL联合TSP的教学方法。教学内容为卒中后神经源性膀胱的医患沟通,共计12学时。教学结束后使用TSP和医患沟通技能评价量表(set the stage,elicit information,give information,understand the patient’s perspective,and end the encounter;SEGUE)评估住院医师的医患沟通能力。结果对照组和试验组在年龄、性别、入组前理论考试分数及操作考试分数方面差异无统计学意义。教学结束后,试验组在SEGUE的问诊准备[(4.6±0.6)分vs.(3.7±0.8)分,P<0.0001]、信息采集[(8.6±1.1)分vs.(7.3±0.9)分,P<0.0001]、信息提供[(3.7±0.5)分vs.(3.3±0.6)分,P=0.0099]、患者理解[(3.5±0.4)分vs.(2.4±0.7)分,P<0.0001]及总分[(22.1±1.5)分vs.(18.5±2.0)分,P<0.0001]方面均显著高于对照组,在问诊结束[(1.7±0.6)分vs.(1.7±0.5)分,P=0.6305]方面与对照组差异无统计学意义。结论采用CBL联合TSP的教学方法能够显著提高住院医师在卒中后神经源性膀胱医患沟通方面的能力。这一教学策略有望成为医学教育中提高医患沟通技能的有效手段,从而提高医疗服务质量。

儿童口腔专业继续教育改革的启示

随着我国对儿童牙医的需求量越来越大,面对更新快速的医学知识,为了保持理论知识和临床技能与时俱进,继续医学教育已然成为儿童口腔专科医师的首选。新疆维吾尔自治区人民医院作为一所省级三级甲等综合医院,每年承担着全疆各地基层医生的继续教育工作,同时也会派遣医生前往国内顶尖医院进修学习。通过在北京大学口腔医院儿童口腔科进修学习过程,归纳总结北大口腔儿科进修生培养模式和特点及其与儿童口腔专业发展趋势相适应的转变。这种以能力为导向的个性化培养模式、多种教学方法相结合运用,加强临床实践规范,注重科研与临床相结合的进修生训练模式,值得借鉴。同时北大口腔儿科营造的良好学习氛围深深影响着进修生,从被动学习到主动学习的转变也值得思考与借鉴。

基于多元数据挖掘探讨国医大师干祖望治疗鼻炎的用药规律

目的使用多元技术分析挖掘国医大师干祖望治疗鼻炎的用药规律。方法选取1984年4月-2001年2月干祖望教授于江苏省中医院诊治鼻炎的临床医案,采用频次统计、共现次数、关联规则、剂量分析、聚类分析等多角度揭示药物之间的潜在关系,结合热力图、谱系图、复杂网络等可视化结果进行直观展现。结果纳入医案数据1080例,涉及处方1044首,中药281味。高频药物有辛夷、白术、白芷等;药味以甘、苦、辛为主,药性主要为寒、温,多归肺经和肝经。药物功效分类排名前3位为解表药、清热药、补虚药。低频药物中出现以食代药,自加荸荠、海蜇、海带等。此外,防风-黄芪-白术、苍耳子-薄荷-辛夷-白芷等为核心药对,石菖蒲与白芷的用药剂量较为离散,茯苓用药剂量低于药典标准值。通过综合分析最终获得四类方剂,玉屏风散与脱敏汤治疗过敏性鼻炎,苍耳子散与鼻渊合剂治疗鼻窦炎,升清流气饮治疗耳鸣,四君子汤、参苓白术散、异功散、补中益气汤等用于健脾益气。结论本研究深入挖掘药物之间的潜在关联,全面探索干祖望教授治疗鼻炎的用药经验,弥补了单一研究的高频局限性与数据偏差性。

聊城地区医护人员安宁疗护认知及态度调查分析

目的调查聊城地区医护人员对安宁疗护的认知及态度现状,并分析相关影响因素,为进一步开展安宁疗护服务提供参考。方法采取便利抽样方法,于2022年1—6月选取404名聊城地区各级医院的医护人员为研究对象,进行安宁疗护知识及态度问卷调查,利用统计学方法进行相关影响因素分析。结果聊城地区医护人员安宁疗护的知识得分为(13.02±4.10)分,平均得分率为65.10%,态度得分为(38.67±5.64)分,平均得分率为64.50%。年龄(41~50)岁、接受过教育培训、医治或护理过中晚期患者、了解伦理道德和文化习俗与知识得分成正相关(P<0.05)。年龄(>50岁)、职称(副高级职称)、岗位(医疗)、医治或护理过中晚期患者会对态度得分产生显著的正向影响关系(P<0.05)。结论聊城地区医护人员对安宁疗护的认知和态度处于中等水平,加强建设规范的安宁疗护体系有助于提高医护人员的安宁疗护认知及态度水平。

低年级医学生对老年人的态度及教育启示

为了解低年级医学生对老年人的态度及影响因素,对安徽省三所医学院校二年级医学本科生进行调查,调查内容包括人口学信息、对老年人的态度、医患沟通倾向、职业精神、对相关课程的评价等。结果显示,医学生对老年人态度量表的总评分为(3.32±0.43)分,态度量表的四个维度中为老年患者提供医疗服务得分最低。女性、以患者为中心的沟通倾向、良好的职业精神,均对老年人态度有正向影响,提示对医学生紧扣职业精神塑造、提高医患沟通技巧,将对老年人积极态度起到联动推动作用。医学院校应构建合理的课程体系,增强大健康人文类课程的吸引力,同时也应关注隐性课程的影响,提升医学生对老年人的积极态度,提高其从事老年医疗服务的意愿。

基于数据挖掘的刘启泉教授治疗慢性萎缩性胃炎用药规律及机制研究

目的 基于古今医案云平台及网络药理学方法,探讨刘启泉教授治疗慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)的组方规律及核心药物作用机制,为CAG的治疗提供客观依据。方法 收集刘启泉教授治疗CAG门诊处方,通过古今医案云平台挖掘相关用药规律,对核心药物组合活性成分及CAG潜在靶点进行网络药理学机制分析。结果 共纳入635份医案,涉及176味中药,有42味中药使用频次超过110次,主要为清热药、理气药、补虚药及活血化瘀药;结合高频药物、关联规则及聚类分析得到治疗CAG的核心药物组合为:蒲公英、延胡索、当归、茯苓、郁金、石菖蒲、白芍、莪术、香附。网络药理学分析表明核心药物组合中8-异戊烯基山奈酚、山柰酚、β-谷甾醇等活性成分作用于蛋白激酶B1(Proteinkinase B1,AKT1)、肿瘤抑制因子p53(Tumorsuppressorp53,Tp53)、白介素-6(Interleukin-6,IL-6)、肿瘤坏死因子(Tumor necrosis factor,TNF)等核心靶点;核心药物组合治疗CAG的潜在靶点主要富集在66个细胞组成、99种分子功能和683个生物过程中;生物学通路主要为癌症通路、白介素-17(Interleukin-17,IL-17)信号通路、TNF信号通路、磷脂酰肌醇3-激酶/蛋白激酶B(Phosphoinosi-tide 3-kinase/proteinkinase B,PI3K/Akt)信号通路、p53信号通路等。结论 通过数据挖掘方法较好体现了刘启泉教授治疗CAG的用药规律,即以“肝郁热毒血瘀”为核心病机,以调肝为先,解毒、活血、补虚并用;并初步揭示了刘启泉教授治疗CAG用药的多靶点作用机制,为临床应用提供参考。

主诊医师负责制提升医疗质量管理水平的探究

主诊医师负责制这一医疗管理制度在医疗服务工作中扮演着举足轻重的角色。其核心在于明确主诊医师对患者诊疗全过程的直接责任,这不仅简化了医疗服务流程,提高了效率,还显著促进了医疗质量管理水平的提升。主诊医师负责制也强化了医师的职业责任感和使命感,使他们更加关注患者的需求和满意度。文章将对主诊医师负责制的应用意义进行深入分析,并从医师培训与考核、诊疗流程优化、团队协作与沟通强化以及医疗质量管理机制完善等方面,探讨如何通过这一制度进一步提升医疗质量管理水平的实践策略,以期为广大医疗机构提供有益的参考和借鉴。

国医大师郭诚杰以“气血立论”“疏通调补”为法治疗产后缺乳撷英

产后缺乳是产妇乳汁分泌不足之病症,其病机关键在于乳汁无源以化和乳络壅滞不通两个方面。国医大师郭诚杰认为乳汁为冲任气血所化,根于先天肾气,为后天脾胃生化之气血所充养,赖于肝的疏泄。在临床中本病有虚、有实,更多见于虚实夹杂之证,治当首辨虚实,以气血为要,提出“疏、通、调、补”为法,以脾、胃、心、肝、肾诸脏腑为主调治,通过补脾胃、养心血、疏肝郁、益肾气,使气血调和、乳络通畅,最终达到乳汁多浓的效果。