Homogenization Construction of Three-Level Teaching Bases for General Practice Medicine Under the Internet+Model

With the continuous expansion of medical student enrollment,the number of clinical teaching bases is gradually increasing.However,there are significant differences in clinical teaching management models and teaching levels among different bases.Most clinical teaching bases have incomplete teaching management systems,inadequate teaching management institutions,insufficient teaching personnel,and inadequate implementation of teaching rules and regulations.This article combines the construction practice of three-level clinical teaching base of the General Medicine College and the First Affiliated Hospital of Xi’an Medical University.We establish a standardized management system for the three-level clinical teaching base;implement a teaching supervision system and strengthen the monitoring of teaching quality;adopt multiple evaluations to test the effectiveness of clinical teaching implementation;explore the path of homogenization construction of teaching bases in terms of unified teacher training,promoting the development of teacher teaching abilities with equal quality and excellence,and providing a reference for improving the quality of medical talent training.

The Inheritance and Development of Chinese Narrative Medicine Practice to the Philosophical Wisdom of Traditional Chinese Medicine

Starting from the inheritance and promotion of Chinese life philosophy and traditional Chinese medicine wisdom by Chinese narrative medicine practice,this paper discusses the inheritance and echo relationship between the“close textual reading ability”in Chinese narrative medicine practice and the“four diagnoses”in traditional Chinese medicine wisdom,narrative mediation and the“mind-body holistic philosophy”in traditional Chinese medicine,and narrative wisdom and Dao Sheng in Chinese life philosophy.Meanwhile,by analyzing the stories of contemporary doctors’practice of narrative intelligence,this paper expounds that Chinese narrative medicine is a new model of medical education and clinical practice based on the absorption of Chinese traditional life wisdom and the essence of traditional Chinese medicine culture,and the integration of western narrative medicine concepts.It also advocates Chinese scholars to actively build the discipline of“narrative traditional Chinese medicine,”constantly translate the academic achievements to foreign countries,and create a good narrative ecology of traditional Chinese medicine.

Comments on Nigel Wiseman s A Practical Dictionary of Chinese Medicine(Ⅰ)——On the“Word-for-word”Literal Approach to Translation

Comments were made on the ＂word-for-word＂ literal translation method used by Mr. Nigel Wiseman in A Practical Dictionary of Chinese Medicine. He believes that only literal translation can reflect Chinese medical concepts accurately. The so-called ＂word-for-word＂ translation is actually ＂English-word-for- Chinese-character＂ translation. First, the authors of the dictionary made a list of Single Characters with English Equivalents, and then they gave each character of the medical term an English equivalent according to the list. Finally, they made some minor modifications to make the rendering grammatically smoother. Many English terms thus produced are confusing. The defect of the word-for-word literal translation stems from the erroneous idea that a single character constitutes the basic element of meaning corresponding to the notion of ＂word＂ in English, and the meaning of a disyllabic or polysyllabic Chinese word is the simple addition of the constituent characters. Another big mistake is the negligence of the polysemy of Chinese characters. One or two English equivalents can by no means cover all the various meanings of a single character which is a polysemous monosyllabic word. Various examples were cited from this dictionary to illustrate the mistakes.

Comments on Nigel Wiseman's A Practical Dictionary of Chinese Medicine (Ⅱ) ——On the Use of Western Medical Terms to Express the Concepts of Traditional Chinese Medicine

Mr. Wiseman believes that Western medical terms chosen as equivalents of Chinese medical terms should be the words known to all speakers and not requiring any specialist knowledge or instrumentation to understand or identify, and strictly technical Western medical terms should be avoided regardless of their conceptual conformity to the Chinese terms. Accordingly, many inappropriate Western medical terms are selected as English equivalents by the authors of the Dictionary, and on the other hand, many ready-made appropriate Western medical terms are replaced by loan English terms with the Chinese style of word formation. The experience gained in solving the problems of translating Western medical terms into Chinese when West- ern medicine was first introduced to China is helpful for translating Chinese medical terms into English. However, the authors of the Dictionary adhere to their own opinions, ignoring others＂ experience. The English terms thus created do not reflect the genuine meaning of the Chinese terms, but make the English glossary in chaos. The so-called true face of traditional Chinese revealed by such terms is merely the Chinese custom of word formation and metaphoric rhetoric. In other words, traditional Chinese medicine is not regarded as a system of medicine but merely some Oriental folklore.

Psychosomatic Medicine and Evidence-Based Surgery:Reflections and Perspectives

This article reflects on the need for psychosomatic medicine research in the field of surgery by complementing psychological/psychiatrist approaches with a physician’s(particularly surgeon’s)point of view.Focusing on esthetic/cosmetic surgery,a broader notion of“psychosomatic surgery”is also used regarding plastic surgery as well as examples of vascular and general surgery.Relevant literature reviews are utilized to gain a more comprehensive bio-psycho-social perspective.By providing a deeper understanding in the specialty areas,it makes a case for evidence-based practice by shedding light on psychosomatic medicine research on surgery in the United States with cross-cultural implications.

Clinical Practice Guideline of Traditional Medicine for Primary Osteoporosis

BACKGROUND Primary osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue,leading to enhanced bone fragility and a consequent increase in fracture risk. Primary osteoporosis is particularly common in senile persons and in postmenopausal women.It ranks the fifth of diseases in the modern society.

Making Evidence-based Decisions in the Clinical Practice of Integrative Medicine

In 1948, the first clinical paper adopting the protocol of randomized and controlled design was published in British Medical Journal by Bradford Hill,a noted British biostatistician, who introduced rigorous theory of mathematical statistics into clinical design the first time and successfully evaluated the therapeutic effect of streptomycin on tuberculosis.

Clinical Practice Guideline of Chinese Medicine for Chronic Gastritis

Chronic gastritis （CG） is an inflammatory condition of the gastric mucosa, induced by various causes. A commonly-seen disease in clinical practice, it is found in about 80%-90% of patients undergoing gastroscopic examination. The prevalence rate in the general population remains unclear. It is generally considered that its incidence rate accords with Helicobacter. pylori infection rate and the prevalence of CG is 30%-80% in China. Possible etiological factors include H. pylori infection, smoking, drinking alcohol, food allergies, duodenal juice reflux, drug-induced injuries, heredity, immunity, and radiation.^[1-8].

Integrative Medicine in Clinical Practice:From Pattern Differentiation in Traditional Chinese Medicine to Disease Treatment

Pattern(syndrome) differentiation is the key theory in traditional Chinese medicine(TCM) and the important diagnostic principle for TCM therapy.More and more medical researchers recognize that the combination of disease diagnosis in biomedicine and pattern differentiation in TCM is essential for the clinical practice, and it has been a common practice model in China since it will produce better clinical effects.

Evidence-Based Chinese Medicine Clinical Practice Guideline for Stomach Pain in Hong Kong

Stomach pain in Chinese medicine（CM） is a very common disorder in clinical practice and it has been listed as one of the pilot three conditions in Hong Kong to develop evidence-based CM clinical practice guidelines（CM CPGs）. The aim of this stomach Pain CPG is to summarize the treatment methods of stomach pain with CM and evaluate reasonably, then to guide local licensed CM practitioners and provide beneficial reference for social medical decision makers and patients. In this manuscript, we defined stomach pain in CM and the category of chronic gastritis in Western medicine. The clinical manifestation, CM pattern classification, and CM intervention including herbal medicine treatment based on pattern differentiation, symptomatic treatment, acupuncture treatment, regulation and nursing were illustrated.

Assessing the Quality of the First Batch of Evidence-Based Clinical Practice Guidelines in Traditional Chinese Medicine

Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Methods: Evidence-based CPGs in TCM supported by the World Health Organization Western Pacific Regional Office (WHO/WPRO) and whose development was organized by the China Academy of Chinese Medical Sciences were identified and manually retrieved. CPGs were assessed using the AGREE instrument, and the data in each CPG were analyzed in terms of the six domains in the AGREE instrument: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Results: Twenty-eight CPGs were identified, of which 26 were included in the study. The AGREE instrument rated the 26 CPGs in terms of the six domains. The assessment results showed the following average scores: for editorial independence, 84.16%; for rigor of development, 80.95%; for scope and purpose, 79.96%; for clarity and presentation, 70.88%; for stakeholder involvement, 61.28%; for applicability, the average score was only 27.09%. In summary, nine CPGs were rated as "strongly recommended", six as "recommended with provision or alternation", and 11 as "unsure". Conclusion: Most of the first batch of Chinese evidence-based CPGs in TCM had significant shortcomings in applicability. It is suggested that special attention be paid to enhancing the quality of applicability when developing evidence-based CPGs in TCM.

Improving Clinical Practice Guideline Development in Integration of Traditional Chinese Medicine and Western Medicine

Integration of traditional Chinese medicine （TCM） and Western medicine （WM）, or called as integrative medicine （IM） in China, came into being in 1950s as a new form of medicine. IM emphasizes the combination of both conventional WM and TCM alternative approaches to address all aspects of health and illness.（1） The major practice in IM includes the integration of disease diagnosis in WM and pattern classification （or syndrome differentiation） in TCM, and the integration of WM interventions and TCM interventions.

SECOND INTERNATIONAL CONFERENCE ON GENERAL PRACTICE/FAMILY MEDICINE

With the establishment of the Chinese Society of Gener-al Practice this year, the Chinese Medical Association (CMA)held the 2nd International Conference on GeneralPractice/Family Medicine in Beijing from November 1 to 3, 1993. Attended were over 300 physicians from all over Chinaincluding Taiwan, Hong Kong and Macao and from abroad.

Medicinal Plant Use in Ghana: Advancement and Challenges

In Ghana, the use of medicinal plants is a known and an acceptable practice common to all the regions and ethnic groups, with about 60% to 70% of Ghanaians depending on traditional medicine for their healthcare needs. Even though medicinal plants are all over the country and are of great benefits to a lot of Ghanaians, there is little or no proper documentation on medicinal plants use in Ghana;how it all started and where it is today, as well as what is being done to promote its use and some challenges being faced with its use as a country. This paper therefore sought to assess and compile generally, Medicinal plants use in Ghana;focusing on the use of some plant medicine, development and advancement in the herbal medicine practice, as well as associated challenges. Available literature and information on medicinal plants use in Ghana were compiled by searching through electronic database such as Google Scholar, PubMed, Science direct, SciFinder and other relevant websites, as well as books and reports. A brief history, measures taken to develop and advance plant medicine use and some specific challenges facing plant medicine practice and use in the county have been discussed in detail in this write-up. This compilation is believed to bring to book the value of some medicinal plants in Ghana and the efforts being made to promote herbal drugs to complement orthodox medication.

Guidelines on common cold for Traditional Chinese Medicine based on pattern differentiation

OBJECTIVE: To establish the guidelines on common cold treated with Traditional Chinese Medicine (TCM) in terms of pattern identification. METHODS: The guidelines were formulated by using the basic patterns of common cold in ChinaPharmacopeia integrated with findings from systematic literature review and the experts' consensus on the issue in question. RESULTS: Common cold was divided into four patterns in the guidelines. The medications were recommended respectively: Ganmaoqingre granule for wind-cold exterior syndrome,Yinqiaojiedu granule for wind-heat exterior syndrome, Huoxiangzhengqi Wan for summer-heat dampness exterior syndrome and Shensu Wan for wind-cold exterior syndrome accompanied with Qi deficiency. CONCLUSION: The guidelines were primarily derived from the practice experience of TCM and the experts' consensus. The process was not strictly evidence-based because of lacking enough clinical studies. Further refinement of the guidelines should be needed as more studies are available.

The role of the teaching practice in undergraduate medical education: A perspective from the United States of America

This article describes and reflects on the role of teaching practices in undergraduate medical education on the basis of teaching experience in the United States of America.China in particular,but also other family medicine-emerging countries,continues to embark on a path of creating and embracing a family medicine-centric system.The purpose of this article is to provide a US perspective on teaching priorities and strategies for medical students,and how these fit into a larger structure of the family medicine clinical clerkship.We emphasize knowledge,clinical skills,clinical behaviors,and strategies for succeeding as a preceptor.We introduce key aspects of the University of Michigan family medicine clerkship and the highly effective structure provided by the leadership of the course directors.This organizational structure provides a framework for implementing the family medicine clerkship for teaching medical students.As China and other family medicine-emerging countries increasingly embrace the discipline,we hope these ideas will provide a meaningful reference.

Toward Evidence-Based Chinese Medicine：Status Quo,Opportunities and Challenges

How to test the treatments of Chinese medicine（CM） and make them more widely accepted by practitioners of Western medicine and the international healthcare community is a major concern for practitioners and researchers of CM.For centuries,various approaches have been used to identify and measure the efficacy and safety of CM.However,the high-quality evidence related to CM that produced in China is still rare.Over the recent years,evidence-based medicine（EBM） has been increasingly applied to CM,strengthening its theoretical basis.This paper reviews the past and present state of CM,analyzes the status quo,challenges and opportunities of basic research,clinical trials,systematic reviews,clinical practice guidelines and clinical pathways and evidence-based education developed or conducted in China,pointing out how EBM can help to make CM more widely used and recognized worldwide.

Epidemiological data on acupuncture and physical and rehabilitation medicine in the European Union

OBJETIVE: To know the prevalence of acupuncturists within physical and rehabilitation medicine specialists in Europe and their characteristics,as well as to analyze the pathologies treated and therapeutic techniques used.METHODS: This is a cross-sectional descriptive study based on a structured and closed questionnaire. The study was carried out from October 2011 to May 2014.RESULTS: A total of 115 specialists from 19 countries completed the questionnaire. The mean characteristics of the physical and rehabilitation medicine(PRM) specialists who are also acupuncturists in Europe were: women(62.6 %); mean age of47.91 years old; 4.20 years of physical and rehabilitation medicine school and 2.00 years of acupuncture training; 15.03 years of mean time of clinical practice as physical and rehabilitation medicine specialists and 10.42 years of experience as acupuncturists; 35.65 % had a doctorate(Ph D) degree,obtained at a mean age of 33.55 years old; working in a public hospital(80%); treating mainly neurological conditions(48.1%) and using mainly techniques such as kinesiotherapy(11.81%),orthosis(10.40%) and electrotherapy(9.92%). Acupuncture was applied by 32.2% of the participants mainly in musculoskeletal conditions(27.38%). A mean number of more than 20 patients a day were treated by47.04% of the specialists,being 41.8% of the patients(adults and children). Significant differences were found between the variables,acupuncture and gender(Pearson's correlation Index = 0.007).However,no differences were observed in relation to acupuncture and age,doctorate degree,years of clinical practice and workplace(all with P values >0.05).CONCLUSION: In the European area,physical and rehabilitation medicine specialists who are also acupuncturists are mainly female,middle-aged,with15 years of professional experience,Ph D holders,working in public hospitals,treating mainly neurological conditions with kinesiotherapy and acupuncture,and treating over 20 patients a day(adults and children) during a 7 h shift. Further epidemiological studies on PRM to provide more information regarding the real situation of this medical specialty and the possibility to open to Chinese traditional medicine techniques such as acupuncture are necessary.

Patient Feedback for Acupuncture Practice Improvement:A Survey from Mayo Clinic

Objective： To understand patient satisfaction with acupuncture appointment duration for the first and subsequent appointments in the plan of care, time spent with the acupuncture provider, willingness to pay for longer duration appointments, and lack of insurance coverage. Methods： Patients who were referred for an acupuncture consult to the Center for Integrative Medicine at Mayo Clinic were asked to participate in the survey in August 2014. Patients were given paper survey at time of appointment check-in and entered into Research Electronic Data Capture Survey database tool to reveal patient-reported outcomes. Results： In total, 104 of 329 patients receiving acupuncture treatment responded to the survey with a 32% response rate. Insight and recommended changes to the duration of the initial and subsequent appointments were obtained. Most patients reported that time spent with the provider（76 cases, 74%） and appointment length（74 cases, 68%） were ＂just right＂. Seventy cases（70%） of respondents indicated that they wanted longer treatment. Patients reported return appointments with duration of 30 min was not enough. Fifty-three patients（62%） were willing to pay for additional costs not covered by insurance. Conclusions： We used patient feedback to assess the acupuncture practice in a complementary and integrative medicine program. Most patients referred for the acupuncture consult appeared to be satisfied with the current level of practice. These findings were used to establish a quality improvement plan that may be implemented to improve patient satisfaction with the acupuncture practice.

Quality assessment of clinical guidelines in China： 1993-2010

Background Clinical practice guidelines （CPGs） play an important role in healthcare in China as well as in the world. However, the current status and trends of Chinese CPGs are unknown. The aim of this study was to systematically review the present situation and the quality of Chinese CPGs published in the peer-reviewed medical literature. Methods To identify Chinese CPGs, a systematic search of relevant literature databases （CBM, WANFANG, VIP, and CNKI） was performed for the period January 1978 to December 2010. We used the AGREE II instrument to assess the quality of the included guidelines. Results We evaluated 269 guidelines published in 115 medical journals from 1993 to 2010 and produced by 256 different developers. Only four guidelines （1%） described the systematic methods for searching and selecting the evidence, 14 （5%） guidelines indicated an explicit link between the supporting evidence and the recommendations, only one guideline used the Grading of Recommendations Assessment, Development and Evaluation （GRADE） system. Thirty-one guidelines （12%） mentioned updates and the average frequency of update was 5.5 years; none described a procedure for updating the guideline. From the assessment with the Appraisal of Guidelines for Research and Ecaluation II （AGREE II）, the mean scores were low for the domains ＂scope and purpose＂ （19%） and ＂clarity of presentation＂ （26%） and very low for the other domains （＂rigour of development＂ 7%, ＂stakeholder involvement＂ 8%, ＂applicability＂ 6% and ＂editorial independence＂ 2%）. Conclusions Compared with other studies on the quality of guidelines assessed with the AGREE instrument in other countries, Chinese CPGs received lower scores, which indicates a relatively poor quality of the guidelines. However, there was some increase over time.