Arterial pulsation on a human patient simulator improved students’ pulse assessment

Even with basic cardiovascular lectures, undergraduates do not usually experience the reality of palpation and, therefore, cannot integrate their physiological knowledge. We created a pulse training scenario of human patient simulators (HPS) to recognize and assess the normal and arrhythmic pulse of the radial artery. All 25 participants were recruited as volunteers to the study from the School of Allied Health Sciences, Kitasato University. Participants received training in radial palpation of arrhythmias on HPS. The test scenario included 10 arrhythmic pulses combined with normal pulses and weak pulses. The average examination scores significantly improved, from 23.8 ± 2.8 of the pretest to 72.9 ± 3.4 of the posttest (mean and SE, N = 25, p < 0.00001). A questionnaire and general written comments for the palpation training were positive. The palpation training improved the participants’ assessment of radial pulses.

Implementation of Level-3 Autonomous Patient-Specific Quality Assurance with Automated Human Interactive Devices

Purpose: Patient-specific quality assurance (PSQA) requires manual operation of different workstations, which is time-consuming and error-prone. Therefore, developing automated solutions to improve efficiency and accuracy is a priority. The purpose of this study was to develop a general software interface with scripting on a human interactive device (HID) for improving the efficiency and accuracy of manual quality assurance (QA) procedures. Methods: As an initial application, we aimed to automate our PSQA workflow that involves Varian Eclipse treatment planning system, Elekta MOSAIQ oncology information system and PTW Verisoft application. A general platform, the AutoFrame interface with two imbedded subsystems—the AutoFlow and the PyFlow, was developed with a scripting language for automating human operations of aforementioned systems. The interface included three functional modules: GUI module, UDF script interpreter and TCP/IP communication module. All workstations in the PSQA process were connected, and most manual operations were automated by AutoFrame sequentially or in parallel. Results: More than 20 PSQA tasks were performed both manually and using the developed AutoFrame interface. On average, 175 (±12) manual operations of the PSQA procedure were eliminated and performed by the automated process. The time to complete a PSQA task was 8.23 (±0.78) minutes for the automated workflow, in comparison to 13.91 (±3.01) minutes needed for manual operations. Conclusion: We have developed the AutoFrame interface framework that successfully automated our PSQA procedure, and significantly reduced the time, human (control/clicking/typing) errors, and operators’ stress. Future work will focus on improving the system’s flexibility and stability and extending its operations to other QA procedures.

The Alzheimer’s Dementia Patients’ Observed Illness Course and Experience in Ghana and Care Lessons to Be Learnt: A Mental Health Professional’s Perspective

Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

Human Care Theory and Influences on the Life Quality Index of Cancer Patients in Household Life

To investigatetheinfluences of the application of human care theory on the life quality and happiness of cancer patients after they receiveda community nursing care which was implemented by the human care theory. The quality life and the happiness index of 93 patients with cancer living in the six communities in Jillin were assessed, the assessment of the life quality was based on a life quality scale (SF-36) and that of the happiness index was based on Memorial University of Newfoundland Scale of Happiness (MUNSH). The community nurses cared for these patients by applying the theory of human care and the life quality and the happiness index of the patients were observed after the care. The results showed that there were significant differences in the score of 5 dimensions in the eight dimensions of the life quality between before the care and after the care (<0.05), and there were significant differences in the average sores of the positive emotion, positive experience, negative emotion, negative experience and level of happiness included in the happiness index between before the care and after the care (<0.05), suggesting that the theory of human care can be used for the care of patients with cancer and the application of the theory can effectively improve the life quality and the happiness index of the patients, strengthen their problem-solving abilities and let them have a positive attitude towards their lives.

Patient Safety Culture Post Covid-19 Pandemic: In Perspective of Millennials Human Capital Issues

Background: Patient safety is the core task of any healthcare business. As medical harm caused by hospitalisation is still on the rise and patient safety culture is a struggle. We aim to determine the nature of patient safety culture in a private hospital and explore some unique human resource problems in Malaysia. Methods: In our case study, we use the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire to measure the 12 dimensions of patient safety culture. The survey received 281 respondents (76% response rate) from all the millennial frontline healthcare providers, including doctors, nurses and allied healthcare providers. The result of the survey was used as the basis to further explore the problems in this hospital. In-depth interviews, observation and document reviews were conducted in relation to human resource problems. This study used IBM SPSS 26 for Windows for statistical analysis and Atlas ti.8 for qualitative analysis of open comments. We used Interpretive Phenomenological Interpretation for analysis of data after triangulation. Results: The overall average positive response rate for the 12 patient safety culture dimensions of the HSOPSC survey was 64%. The result showed that the staff feels positively toward patient safety culture in this hospital. The dimension that received good performance is “Manager expectation”, “Management support for patient safety” and “Organisational learning”. The dimension with the poor performance was “Staffing”, “Frequency of error reporting”, “Teamwork across units”, and “Handoff and transitions”. The open comments indicated inadequate staffing and nursing retention issues. Interviews, observation and document reviews related to staffing reveal high turnover rates among millennial nurses, high overtime and on-call rates, chaotic units with procedures, doctors’ round, admission and discharges mainly in medical and surgical units causing distraction. Poor shared governance is the biggest challenges that need immediate attention post Covid-19 pandemic. Conclusions: The HSOPSC measurement gave valuable insights on patient safety culture in a private hospital in Malaysia. The overall perception of patient safety culture was satisfactory. The poor positive response rate for “Staffing” dimension and the open comments suggests a need for an urgent need for retention and human resource management strategies to prevent brain drain due to high turnover rates, especially among millennial nurses. The key factors causing dissatisfaction and brain drain among nurses are the lack of shared governance.

人性化护理对胃癌患者全胃切除术后的干预效果

目的探究胃癌患者行全胃切除术后应用人性化护理的临床效果。方法随机选取2019年1月—2021年2月福建医科大学附属协和医院收治的100例接受全胃切除术治疗的胃癌患者为研究对象,按随机数表法分为对照组(n=50)和研究组(n=50),分别在术后给予常规护理和人性化护理,对比护理干预效果。结果护理后,研究组患者的躯体功能、认知功能、社会功能、角色功能和情绪功能评分分别为(78.45±8.99)分、(85.43±8.22)分、(86.34±7.33)分、(87.31±7.11)分和(87.34±5.33)分,均显著高于对照组,差异有统计学意义(t=10.353、7.172、6.822、4.378、8.548,P均<0.05)。同时,研究组患者的护理满意度和不良反应发生率分别为96.00%和4.00%,均优于对照组,差异有统计学意义(χ^(2)=4.000、5.005,P均<0.05)。结论在胃癌患者全胃切除术后开展人性化护理,可降低不良反应发生率,提高护理满意度并改善患者生活质量。

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

血液透析护理人力资源配置方法探索与现况调查

目的探索血液透析护理人力资源配置计算方法,了解血液透析护理人力资源配置现状,为医疗行政部门完善相关管理政策提供依据。方法建立血液透析护理人力资源配置护患比计算方法,采用自行设计的调查问卷对陕西省178所医院血液透析室护理人力资源情况进行调查。结果陕西省血液透析室全天护患比为1∶6.09(4.93,7.03),达到时点护患比1∶6.67的医院122所(68.54%)。不同性质、等级、开设班次医院全天护患比达标率比较,差异有统计学意义(均P<0.05)。81.46%医院血液透析护理人力资源年实际配置总人数达到理论配置总人数。结论陕西省血液透析总体护理人力配置及时点护理人力资源配置整体基本达标。建议在血液透析护理人力配比及各班次时点排班时,参考时点护患比临界值及护士人力资源总体配置数量计算方法,合理安排护理人力,以减轻护士工作压力,确保患者的透析质量和安全。

全人源抗大别班达病毒抗体的制备及功能鉴定

目的:从发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)恢复期患者的外周血单核细胞(peripheral blood mononuclear cell,PBMC)中,获得大别班达病毒(Dabie bandavirus,DBV)特异性抗体序列,制备全人源DBV抗体。方法:用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测恢复期患者血浆抗体效价,挑取恢复期患者PBMC样本进行磁珠富集,经流式细胞仪分选获得能够结合DBV糖蛋白的特异性单个B细胞,经B细胞受体(B cell receptor,BCR)测序获得抗体序列,进行单链抗体的原核表达,采用蛋白免疫印迹、ELISA和体外中和实验鉴定抗体的表达、结合能力和中和活性。结果:共收集25例SFTS恢复期患者血液样本,血浆中均发现了DBV糖蛋白和核衣壳蛋白的抗体。选取样本进行流式分选和BCR测序,分析后共获得6个单链抗体,对DBV均具有良好的结合能力和中和活性。结论:成功表达了6个与DBV具有中和作用的全人源抗DBV抗体。

基于人体骨骼关键点的心血管患者康复训练动作评估方法

为解决心血管患者日常康复训练依赖于康复中心专业医务人员现场指导的问题,围绕获得支撑心血管患者自主康复训练的动作评估系统,提出了基于人体骨骼关键点的心血管患者康复训练动作评估方法(ASRT-PHS)。首先,根据心血管患者的康复训练动作规范拍摄构建了康复训练动作数据集;然后,引入基于深度学习的检测器和姿态估计器采集人体位置信息与人体关键点信息,并将提取结果输入到卷积神经网络中进行动作识别;接着,通过关节距离比值计算、关节角度阈值计算与标准动作判断,构建基于关节距离比值的动作切分模型和基于动作关节角度阈值的动作评估模型;最后,通过测试ASRT-PHS在不同关节角度阈值和不同动作识别方法下的动作切分与评估性能,得出了ASRT-PHS的最优工作参数。测试结果表明,ASRT-PHS在动作识别、动作切分与动作评估中的准确率分别达到92.78%、77.6%和87%。此外,真实心血管患者案例测试表明,原型系统的动作评估平均准确率为71.3%,为患者居家自主康复训练提供了可行的智能辅助系统。

“一对一”人性化指导护理在糖尿病患者中的应用

目的在糖尿病患者实施“一对一”人性化指导护理,分析其护理效果。方法抽取2021年1月—2023年12月我院糖尿病患者60例为本次研究对象,依据随机抽签法将其分为对照组(常规护理,n=30)和观察组(“一对一”人性化指导护理,n=30)。比较两组患者血糖水平、护理依从性、心理状态评分以及自护能力评分。结果护理后,观察组空腹血糖、餐后2 h血糖及糖化血红蛋白水平、SAS及SDS评分均低于对照组(均P<0.05);护理后,观察组自我概念、自我责任感、自我护理技能、健康知识水平等自护能力评分及护理总依从性均高于对照组(均P<0.05)。结论“一对一”人性化指导护理在糖尿病患者中,能够有效改善患者血糖水平,缓解心理状态,提升护理依从性与自护能力评分。

人性化护理对急诊糖尿病合并高血压危象的临床分析

目的探讨糖尿病合并高血压危象患者采用人性化护理的临床效果。方法选取2019年4月—2022年2月无锡市惠山区人民医院收治的64例糖尿病合并高血压危象患者作为研究对象,按照随机数表法分为对照组和观察组,每组32例。对照组实施常规护理,观察组则在常规护理的基础上采用人性化护理干预。比较两组患者的血糖水平、血压数值、焦虑和抑郁状况。结果干预后,观察组的血压数值显著低于对照组,差异有统计学意义(P<0.05);对照组护理12周后空腹血糖、餐后2 h血糖和糖化血红蛋白水平均显著高于观察组,差异有统计学意义(P均<0.05);观察组的焦虑自评量表、抑郁自评量表评分均显著低于对照组,差异有统计学意义(P均<0.05)。结论人性化护理措施的有效开展,能显著调节患者血压值,改善其各项血糖指标水平,还可明显改善其不良情绪,提高患者生活质量。

患者隐私保护在实习护生伦理敏感与亲社会行为间的中介效应

目的探讨实习护生的患者隐私保护在伦理敏感性和亲社会行为间的中介作用,为采取针对性措施提高实习护生亲社会行为提供参考。方法以方便抽样方法,选取湖南省6所三甲医院的实习护生543人为调查对象,采用中文版护生伦理敏感性量表、患者隐私保护量表和亲社会倾向测量问卷进行调查。结果实习护生的患者隐私保护能力、伦理敏感性和亲社会行为得分分别为(111.58±13.18)分、(39.75±6.88)分、(95.79±15.69)分;伦理敏感性与患者隐私保护能力、亲社会行为呈正相关,患者隐私保护能力与亲社会行为呈正相关(均P<0.05);患者隐私保护能力在伦理敏感性与亲社会行为之间起部分中介作用,中介效应占总效应的41.89%。结论实习护生的患者隐私保护能力、伦理敏感性、亲社会行为均处于中等偏上水平,患者隐私保护在实习护生伦理敏感性与亲社会行为间起部分中介作用。建议学校与医院采取针对性措施提高实习护生的患者隐私保护能力和伦理敏感性,帮助提升其亲社会行为,进而提升护理服务质量。

ESP机能数字人系统应用于机能实验学教学探索

为进一步提升虚拟仿真实验的教学效果,广州医科大学机能实验中心将电子标准化病人(electronic standardized patient,ESP)机能数字人实验教学系统应用于机能实验学课程的虚拟仿真教学,并对其实施效果进行了问卷调查。学生对该系统的总体满意度为93.8%。调查表明,这种新型的虚拟仿真实验教学系统值得进一步的应用与探索。

人类免疫缺陷病毒/艾滋病抗病毒治疗患者的基线CD4^(+)T淋巴细胞计数对抗病毒治疗后免疫功能重建的影响

目的探讨人类免疫缺陷病毒/艾滋病(HIV/AIDS)患者的基线CD4^(+)T淋巴细胞计数对抗病毒治疗后免疫功能重建的影响,为判断抗病毒治疗的效果提供依据。方法选取2019—2022年赣州市755例抗病毒治疗24周以上的HIV/AIDS患者的临床资料,采集外周血进行CD4^(+)T淋巴细胞计数和病毒载量检测。根据抗病毒治疗24周后的CD4^(+)T淋巴细胞计数将患者分为免疫重建良好组(≥200个/μl)和免疫重建不良组(<200个/μl)。多因素分析采用二分类logistic回归,采用受试者工作特征(ROC)曲线评估模型的预测价值。结果755例患者中,614例(81.3%)免疫重建良好,141例(18.7%)免疫重建不良。病毒学指标显示有617例(81.7%)病毒学抑制成功,138例(18.3%)病毒学抑制失败。免疫重建不良组中基线CD4^(+)T淋巴细胞计数>500个/μl占比低于免疫重建良好组,差异有统计学意义(P<0.05)。单因素分析结果显示,免疫重建与性别、年龄、治疗时间和基线CD4^(+)T淋巴细胞计数有关,差异有统计学意义(P<0.05)。logistic回归模型进行多因素分析结果显示,性别女(β=-0.642,OR=0.526,95%CI:0.288~0.962)、治疗时间1~2年(β=-0.538,OR=0.584,95%CI:0.383~0.890)、基线CD4^(+)T淋巴细胞计数200~500个/μl(β=-2.761,OR=0.063,95%CI:0.035~0.116)及基线CD4^(+)T淋巴细胞计数>500个/μl(β=-3.206,OR=0.041,95%CI:0.010~0.169)是免疫重建不良的独立保护因素(P<0.05)。年龄>50岁(β=1.554,OR=4.730,95%CI:1.028~21.751)是免疫重建不良的独立危险因素(P<0.05)。基于基线CD4^(+)T淋巴细胞计数的模型对免疫重建不良预测的ROC曲线下面积为0.834(P<0.05)。结论性别、年龄、抗病毒治疗时间和基线CD4^(+)T淋巴细胞计数是HIV/AIDS患者免疫功能重建的独立影响因素。

基于CiteSpace的医科院校医疗纠纷课程的设计

目的 利用CiteSpace软件对有关医患关系、纠纷及教育的研究现状进行可视化分析,根据研究趋势对医科院校医疗纠纷课程进行设计。方法 在中国知网数据库中设置检索条件,主题词为“医患关系、医疗纠纷、医疗事故、教育”,时间范围不限,来源类别为全部期刊,仅看有全文的文献。使用CiteSpace软件对发文作者、机构、关键词进行可视化分析,对节点数据进行描述性分析。结果 共纳入文献46篇,年均发文量3篇。最早发文的作者为栾莹莉和李浩,最早发文的机构为吉林化工集团公司总医院二院。频次> 4次的关键词为医患关系、医疗纠纷、医学生,关键词聚类最大为医疗纠纷,最小为围生期。结论 关于医疗纠纷及教育的研究相对较少,研究主体多为医疗机构。因此,院校应加大相关研究力度,设置医疗纠纷课程,将防范医疗纠纷的关口前移。

人文关怀教育在消化内科专业硕士研究生内镜教学中的应用

消化内镜诊疗技术是消化内科医师的必备技能,专业型硕士研究生在住培期间掌握胃肠镜操作,更有利于以后的职业规划和发展。消化内镜作为一项侵入性操作,患者可能会产生畏惧、退缩、焦虑等不良情绪,人文关怀能有效安抚患者情绪,提高医患配合度,广东医科大学附属医院内镜中心结合自身实际,在内镜初学者的操作教学中融入人文关怀的内容,制定内镜人才人文培养方案,培养学员“以患者为中心”的人文理念,在入科时进行规范化的入科教育,加强医德医风教育,让学员学会换位思考,与患者有效沟通,同时培养学员的学习主观能动性,提高操作技能,让学员从思到言再到行,日积月累中将人文素养刻入日常工作中,现对本院医学和人文相融合的教育实践进行总结,为内镜医学人文教育提供参考。

人血白蛋白在住院患者中的临床使用情况调查

目的调查住院患者人血白蛋白使用情况,并结合指南及循证证据对其临床使用情况进行分析,为后续开展白蛋白使用合理性评价提供参考,以促进临床合理用药。方法随机抽取中国9个地区120家医院2016年1月—2020年12月住院患者使用人血白蛋白的数据,对人血白蛋白处方量、取药数量、消费金额、科室分布、适应证进行分析。结果共抽取处方756055张,人血白蛋白产品主要依赖进口。2016—2020年,人血白蛋白使用量呈稳态缓慢增加趋势。对9个地区平均每年每家医院处方量、取药数量及处方金额进行比较,排名前三位地区均为杭州、广州和成都,哈尔滨最低。人血白蛋白消耗巨大,平均每年每家医院消费金额207695~2213604元。9个地区处方量和处方金额排名前3位的科室主要集中在重症监护室(ICU)和外科系统;肿瘤处方占比最多,其次为心脏和肝脏疾病。结论人血白蛋白使用量巨大,部分适应证仍存在争议,需要进一步开展循证评价。有必要对人血白蛋白使用较多的科室和疾病领域开展专项点评,以降低不合理使用率,降低医疗成本,促进临床合理使用。

近10年我国叙事医学研究现状的共词分析

目的利用共词分析方法对近10年国内研究的叙事医学文献进行分析,探讨该领域的研究现状,为进一步研究奠定基础。方法在中国知网、万方、维普数据库以“叙事医学”为主题词,限定文献年限为2013—2022年,通过检索并纳入符合研究标准的文献,采用Bicomb2对下载文献进行关键词统计和分析,再使用Ucinet6.0及Netdraw绘制共现分析图,将高频关键词之间的共现关系可视化。结果共纳入文献565篇,提取高频关键词31个,通过共现关系图可见,目前国内叙事医学的研究热点包括中医学、护理学、全科医学、循证医学、医学伦理、临终关怀、慢性疾病、癌症等热门学科及疾病;提高医务人员共情以及人文关怀能力,改善医患沟通进而改善医患关系;做好医学人文教育、以平行病历和反思性写作培养叙事能力等;而有关老年医学、提高医务人员职业认同感、文学与医学相融合、对患者影响相关研究处于外围位置,相对较少。结论现阶段叙事医学在护理学、中医学、全科医学、慢性疾病以及癌症、医学人文教育、改善医患关系等领域已取得较多成果,未来可从叙事医学在多学科及疾病领域使用、尝试不同的培养方式、教生同步培养等方面进行深入探讨,以构建更加完善的叙事医学体系。