Summary and clinical application of Zhuang medicine medicated thread moxibustion

Zhuang medicine medicated thread moxibustion is a kind of external therapy with ethnic medicine characteristics that spreads in Guangxi Zhuang region.It has a wide range of clinical application and significant curative effect,and can be used to treat diseases such as internal medicine,surgery,dermatology,gynecology,pediatrics,and five sense organs.Through reviewing and combing the literature on the Zhuang medicine medicated thread moxibustion in recent years,this paper summarizes and prospects its clinical application,with a view to further explaining the basic principles and application rules of Zhuang medicine medicated thread moxibustion and digging its clinical value.

Evaluation of Blood Pressure Control Medicines Using Health and Medical Checkup Data in Japan: Alternative Methods for Randomized Controlled Trials

Background: Many people take medicines to control high blood pressure (BP), or hypertension. Randomized clinical trials (RCT) are usually used for the evaluation of effects of medicines. However, RCT have some serious problems. Data and Methods: We evaluated the effects of BP medicines in Japan using a dataset containing 113,979 cases. We employed four statistical methods in the analysis. First, we simply compared the systolic blood pressure (SBP) of individuals with and without BP medicines. We then used a regression model with a dummy variable, representing taking medicines or not. We replaced the dummy variable by its expected value, and estimated the regression model again. Finally, we selected individuals who had both taken and not taken medicines at different times. The effect of sample selection was also considered in the estimation. Results: For the simple comparison, SBP with BP medicines was 11 mmHg higher than without medicines. In the next regression analysis, SBP with BP medicines was still 5 mmHg higher. When the dummy variable was replaced by its expected value, SBP with medicines decreased by 7 mmHg. For individuals taking medicines at some times and not at others, SBP decreased by 9 and 8 mmHg in models with and without a sample bias correction, respectively. Conclusion: The methods eliminated some problems of RCT and might be attractive. However, we obtained contradictory conclusions depending on the statistical methods employed, despite using the identical dataset. Statistical methods must be selected carefully to obtain a reliable evaluation. Limitations: The dataset was observatory, and the sample period was only 3 years.

Pushing the frontiers of military medical excellence:updates,progress and future needs

Since its establishment in 2014,Military Medical Research has come a long way in becoming a premier journal for scientific articles from various different specialties,with a special emphasis on topics with military relevance.The field of military medicine may be obscure,and may not be readily encountered by the typical clinician on a day-today basis.This journal aims not only to pursue excellence in military research,but also to keep current with the latest advancements on general medical topics from each and every specialty.This editorial serves to recap and synthesize the existing progress,updates and future needs of military medical excellence,discussing foremostly the unique traits of literature published in this journal,and subsequently presenting the discourse regarding wartime and peacetime medicine,the role of the military in a public health emergency,as well as wound healing and organ regeneration.Special attention has been devoted to military topics to shed light on the effects of Chemical,Biological,Radiological and Explosive warfare,environmental medicine and military psychiatry,topics which rarely have a chance to be discussed elsewhere.The interconnectedness between military combat and soldier physical and mental well-being is intricate,and has been distorted by pandemics such as coronavirus disease 2019(COVID-19).This journal has come a long way since its first article was published,steadily contributing to the existing knowledge pool on general medical topics with a military slant.Only with continuous research and sharing,can we build upon the work of the scientific community,with hopes for the betterment of patient care.

Defensive medicine:It is time to finally slow down an epidemic

Defensive medicine is widespread and practiced the world over, with serious consequences for patients, doctors, and healthcare costs. Even students and resi-dents are exposed to defensive medicine practices and taught to take malpractice liability into consideration when making clinical decisions. Defensive medicine is generally thought to stem from physicians' perception that they can easily be sued by patients or their relatives who seek compensation for presumed medical errors. However, in our view the growth of defensive medicine should be seen in the context of larger changes in the conception of medicine that have taken place in the last few decades, undermining the patient–physician trust, which has traditionally been the main source of professional satisfaction for physicians. These changes include the following: time directly spent with patients has been overtaken by time devoted to electronic health records and desk work; family doctors have played a progressively less central role; clinical reasoning is being replaced by guidelines and algorithms; the public at large and a number of young physicians tend to believe that medicine is a perfect science rather than an imperfect art, as it continues to be; and modern societies do not tolerate the inevitable morbidity and mortality. To finally reduce the increasing defensive behavior of doctors around the world, the decriminalization of medical errors and the assurance that they can be dealt with in civil courts or by medical organizations in all countries could help but it would not suffice. Physicians and surgeons should be allowed to spend the time they need with their patients and should give clinical reasoning the importance it deserves. The institutions should support the doctors who have experienced adverse patient events, and the media should stop reporting with excessive evidence presumed medical errors and subject physicians to "public trials" before they are eventually judged in court.

Clinical Medication Review and Falls in Older People—What Is the Evidence Base?

Background: This paper reports findings from a literature review undertaken to assess the current evidence base for clinical medication review and falls in older people. This forms part of a larger, organisational supported project design work-stream, where the objectives are to define the operational details for clinical medication review as part of multi-factorial assessment for elderly fallers in the community. Patients will be identified and targeted through an integrated care pathway mapping and elderly patient care screening service. Objective: A review of national and best practice guidance to help our understanding of how clinical medication review could be optimised. Methods: A PubMed database search was undertaken with search terms including “elderly” and “falls” and “medicines” followed by study of relevant publications in English and including cited referenced publications within selected papers. Results: Our findings were that both medication over-use and under-use in the elderly occur frequently and can be harmful. Many drugs commonly used by older persons have not been systematically studied as risk factors for falls. The screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START), validated for assessment of potentially inappropriate prescribing in the elderly, offer the possibility of provision of a structured clinical medication review to patients, with a need for more research on the impact of the STOPP START interventions on both the rates of falls and risk of falls in the elderly.

中医特色护理门诊医护协作出诊实践分析

目的 探讨脾胃病专科中医特色护理门诊医护协作出诊开展的可行性及成效。方法 运用医院选拔原则确定出诊护师,与专科医师合作开设脾胃病专科中医特色护理门诊。通过对2023年医护协作出诊和2019年护师单独出诊的脾胃病专科中医特色护理门诊就诊患者进行问卷调查,分析对医疗护理服务的满意度。结果 脾胃病专科中医特色护理门诊医护协作出诊开展以来,护理门诊量由2019年的35人次/月上升到2023年的148人次/月,出诊时间由2019年的1次/周增设至2023年的3次/周。2023年护理门诊医护协作出诊的就诊患者对医疗护理服务的满意度高于2019年护师单独出诊,差异有统计学意义(P<0.05)。结论 脾胃病专科中医特色护理门诊医护协作出诊的开展,拓展了中医护理服务内涵,满足患者日益增长的个体化、多元化需求,提高患者对医疗护理服务的满意度。

新医科背景下ICU应用型医学人才培养探索与思考

新医科背景下的应用医学人才培养,其本质是培养理念、路径及目标的创新与传承,亦是培养模式的新变革。重症医学科(ICU)作为临床科室中极为关键且特殊的学科领域,承载着危急重症医学的临床、教学及科研工作,ICU作为临床应用型医学人才的培养高地,其更应该顺应新时代所提出的新要求、新趋势。该研究立足于新医科背景,通过深入剖析我国ICU人才培养现状,以期探讨新医科背景下应用型医学人才培养的时代要求,并探索新医科背景下ICU应用型人才培养的模式,旨在为新时期我国应用型医学人才培养提供有益启鉴。

临床护士医学叙事能力现状及影响因素分析

目的了解临床护士医学叙事能力现状并分析其影响因素,为提升护士医学叙事能力提供理论依据。方法采用便利抽样法,于2023年5月30日至6月30日选取陕西省内不同医院的1511名护士为研究对象,采用一般资料调查表、医学叙事能力量表对护士医学叙事能力现状进行调查并分析影响因素。结果临床护士医学叙事能力总分为(152.75±23.98)。多重线性回归显示,在临床中对患者实施人文关怀的情况,对叙事医学的熟悉程度、对叙事护理的看法、是否有叙事相关实践经历、对护理工作的满意度、就职科室为妇科科室是护士医学叙事能力的影响因素。结论临床护士医学叙事能力处于中等偏上水平,医院管理者应根据其影响因素,给予针对性的培训,关爱护士心理健康,减轻护士职业压力,提高护士的工作满意度,以进一步提升其医学叙事能力水平,助力专业成长。

儿科学混合式教学中的医学教育环境感知与学生学习自主性的关系研究

目的分析基于儿科学混合式教学的医学教育环境感知与学生学习自主性的关系。方法选取武汉大学第一临床学院临床专业、已完成儿科学混合式教学课程学习的学生作为研究对象,采用教育环境评估量表(Dundee ready education environment measure,DREEM)和大学生学习自主性量表进行医学教育环境感知和学习自主性调查。结果临床医学生的医学教育环境感知整体较好,各维度得分率比较,学生对教师的知觉>对学习的知觉>对学术的知觉>对环境的知觉>社交和自我知觉。学生的自我调控、学习策略、内容与环境、学习动机和学习自主性量表总分得分率分别为67.85%、72.86%、65.56%、70.63%和68.97%。相关分析显示,DREEM量表、大学生学习自主性量表的内部各维度得分与各量表总分均呈正相关,各维度得分之间均呈正相关(P<0.05),且大学生学习自主性量表各维度得分、总分与DREEM量表各维度得分及总分也均呈正相关(P<0.05)。结论基于儿科学混合式教学的临床医学生的医学教育环境感知整体较好,学习自主性可且与教育环境感知密切相关。在混合式教学实施过程中,不断优化教学内容、提升教师教学素养和积极改善医学教育环境,将有助于提升临床医学生对医学教育环境的满意度及学习兴趣和自主学习能力,更高效地促进医学教育教学改革的持续性发展。

基于医防融合预防医学专业临床课程的教学改革

在新冠疫情期间,我国采用医防结合的策略,在较短的时间内控制了疫情,充分展示了预防医学与临床医学融合的重要性。在大卫生、大健康的理念指引下,通过优化预防医学专业临床课程教学体系,改善教学方法,整合教学内容,将“课程思政”建设贯穿始终,促进预防医学专业临床综合素养水平的全面提升,对构建“医防融合”公共卫生人才培养模式具有一定意义。

基于临床实践问题培养研究生创新能力的探讨

培养创新型高层次复合型医学人才是目前临床医学研究生教育的重要目标。临床实践是培养学生实际工作能力的重要环节,因此基于临床实践—发现问题—解决问题的科研实验设计对临床医学研究生科研能力的培养至关重要,基于解决临床实践问题的创新引导教学将可能显著提升临床医学研究生科研创新能力。文章对发掘临床实践问题与培养科研创新能力的脱钩原因进行剖析,对发掘临床实践问题与培养临床医学研究生科研创新能力的新型引导教学模式的研究进展进行综述,探讨应对策略及措施,以期为临床医学研究生的科研素质培养提供新思路。

置信专业活动在神经内科住培模式构建中的研究与实践

第三代医学教育改革的特点是强调以胜任力为导向的医学教育,但仍存在着无法忽视的不足,因此文章引入了置信专业活动这一概念。置信专业活动是指在临床环境中监督者通过观察和衡量后可以信任并委托给学员的专业活动,这一活动可以高效并且可靠地帮助监督者判断住培学员的能力,并促进住培学员能力的提升。目前为止,我国神经内科现有形成性评价体系仍不全面,无法有效地评价住院医师规范化培训(以下简称“住培”)学员在临床工作中的能力,国内也没有神经内科住培相关的置信专业活动。文章立足2020—2023年国内外临床医学教育相关研究,借鉴国际经验并结合我国实践经验分析置信专业活动的发展起源、现状、阻碍和前景,为我国神经内科住培模式构建的研究与实践提供思路及方向。

新医科背景下中医临床实践混合教学评价研究

目的:在线上与线下相融合的背景下针对多元化体系评价方式进行研究探索,以达到迭代临床实践课程教学目的 .方法:比较以融入形成性评价为核心的混合教学模式与结果导向式终结性评价的线下传统教学模式的学生成绩,同时通过问卷调查获取两种教学模式学生满意度反馈.结论:以融入形成性评价为核心的混合教学模式对学生成绩的提高与满意度反馈更具有促进作用.

陈华教授传承浙派中医儿科学术特色治疗小儿肺系疾病经验探析

[目的]总结陈华教授传承浙派中医儿科学术特色治疗小儿肺系疾病的经验。[方法]通过随师临证,研究浙派儿科学术特点,从病因病机、遣方用药等方面阐释陈师治疗小儿肺系疾病的临床经验及方药特色,并通过临床验案加以佐证。[结果]陈师诊疗小儿肺系疾病的经验可概括为融通中西,谨守病机;四望一听,尤重望诊;分期论治,善用和清;用药轻灵,顾护脾胃。所列案例为小儿急性上呼吸道感染的典型案例,急性感染期解表清里,迁延反复期益气养阴,缓解恢复期补肺健脾,疗效显著。[结论]陈师小儿肺系疾病的诊治经验,不仅有较高临床实用价值,更是对浙派中医儿科学术特色的传承和发展。

中医专业临床中药炮制学课程核心能力评价指标体系构建

目的构建中医专业临床中药炮制学课程核心能力评价指标体系,以期更加客观、全面地培养和评价学生的核心能力。方法研究小组基于教学内容和教学目标,并结合文献研究,拟订调查问卷,采用德尔菲法(Delphi)进行专家函询,形成中医专业的临床中药炮制学课程核心能力评价指标体系。结果专家函询问卷回收率为100%,各级指标的变异系数为0.067~0.481,协调系数为0.223~0.330。最终确立本轮采纳的评价指标体系:一级指标2项,二级指标9项,三级指标21项。结论中医专业临床中药炮制学课程核心能力评价指标体系科学可靠,能够客观、全面地为培养和评价中医专业本科生学习该课程的效果提供量化参考依据。

医学基础与临床融合发展教学团队建设现状分析与初步实践

全面加强医学类师资队伍建设对提升医学人才培养质量具有重要意义,也是推动医学基础与临床融合发展的关键路径。分析目前医学类师资队伍建设过程中面临的困境与挑战,以地方院校医学师资队伍建设为切入点,聚焦基础与临床融合发展的教学团队建设,探讨加强基础与临床融合发展教学团队建设的实现路径,总结加强基础与临床融合发展教学团队建设的实践经验,以期通过教学团队建设,为持续提升医学专业人才培养质量提供经验与支持。

思政元素在妇产科教学中的应用与实践

妇产科学是高校医学专业的一门必修课程,也是兰州大学临床医学院专业核心课程之一。妇产科教学融入思想政治教育,是新时代赋予医学教育的重大课题、是传统教学模式向融合模式的客观要求、是培育涵养高尚医德医风的现实需要、是广大患者对高质量服务的美好向往。通过增强课程思政教学的主动性、丰富课程思政教学的生动性、完善课程思政教学的评价体系的有效途径,潜移默化地将爱国主义、生命至上、职业素养、传统美德、爱护自我等思想政治元素融入妇产科教学之中,根植于学生脑海,内化于心、外化于行,更好地激发学生学习热情和价值认同,增强崇高职业的自豪感和任重道远的责任感,进而更好地践行救死扶伤,治病救人,全心全意为人民服务的初心和使命,更好地为患者提供科学、有效、人性的医疗服务。

临床实践指南在我国儿科临床中的运用与思考

临床实践指南作为一种决策工具,旨在缩小当前最佳医学证据与临床实践之间的差距。文章结合儿科学的特点,重点探讨了我国儿科临床实践指南存在的一些问题。首先,医学生和临床医生在循证医学理念方面存在不足,临床实践指南的接触时间相对较晚,对临床实践指南的了解不够充分。其次,临床实践指南的获取和利用存在困难,同时我国儿科医师的短缺以及他们面临的巨大工作负荷,为临床实践指南的应用带来了一定的障碍。为解决这些问题,高等医学教育应注重指南教学,培养学生循证观念和解决临床问题的能力。同时,相关部门应推广标准化指南,开发本土化指南评价工具和建立指南数据库,以促进指南在临床实践中的应用。为了促进儿科医学的发展,优化儿科医疗资源的配置,加快儿科人才队伍的建设也至关重要,只有提高儿科医学人才的工作热情和科研能力,才能推动儿科医学事业不断向前发展。

论医学人文实践形态

医学人文的实践形态在医学人文诸多形态中最具根本意义。医学人文的其他形态最终只有转化为实践过程并取得实践效果,医学人文的价值才可能得以真正体现,才能在医疗卫生的各层面和各领域发挥实际作用。临床医疗是医学人文实践的主场,医患关系是医学人文发挥作用的主阵地。医学人文之于社会卫生保健制度建构、医学教育及其改革等领域,都需要通过其实践形态及其运行过程,才能真正发挥作用。实践形态有效发挥作用,是医学人文的本质规定性。

从临床医学教育的角度探讨“医防融合”的实践

每一次重大新发传染病的大规模爆发,都给人类带来了巨大的灾难,也考验着一个国家的医疗和公共卫生的水平,也体现了紧急公共卫生事件下疾病预防的重要性,“医防融合”势在必行。为促进医防融合,从公立医院的角度出发,北京市卫生健康委员会于2020年12月1日发布了关于《北京市医防融合培训方案》的相关通知,正式开始对临床医生进行医防融合培训,提高临床医生对传染性疾病的早期识别与预防。借鉴该培训方法,从医学教育的角度出发,建议在临床医学本科生教育中增加公共卫生、预防医学等专业课程。此外,在临床医学硕士专业学位研究生的培养计划内增设医防融合的培训,推广临床医学博士、公共卫生硕士双学位培养等,均有助于医防融合的实施。增进公共临床专业学生对公共卫生的了解,在突发公共卫生事件面前提高应对能力。