《中医基础理论》多元化教学评价方式的构建与实践

《中医基础理论》是中医学课程体系中的主干课程,其教学质量对于中医学人才的总体培养质量具有举足轻重的作用。构建科学合理的教学评价方式是切实推进教学改革,提升教学质量的重要一环。文章论述了《中医基础理论》课程多元化教学评价方式的构建和具体实施方案,在整个《中基》教学过程的不同阶段合理地运用三种评价方式,进行全面客观和准确的判断评价,从而为师生"教"与"学"的切实改进和提升提供真实的依据。实践表明:多元化教学评价方式增强了学生学习的兴趣,提高了学生自主学习的积极性和能力,提高了学生运用知识分析和解决问题的能力,培育了学生的团队协作精神和创新思维;同时,激发了教师教学的热情,促进了教师教学理念、教学方法、教学手段以及专业知识的更新,提高了教师综合素质。本文对实践中存在的问题也进行了总结。     

Practicalities in doctorate research of using grounded theory methodology in understanding nurses’ behaviours when caring for culturally diverse patients

This article provides a critical review of how grounded theory methodology was used to explore student and registered nurses' experiences of caring for culturally diverse patients, as part of a doctorate of philosophy. It illustrates how a continuous cycle of data collection, constant comparative analysis and theoretical sampling was operationalised and explains how these methods were consistent with classic grounded theory methodology. It describes how a theory of resigned Indifference was generated, which explains how nurses used a raft of disengagement strategies as a means of dealing with their uncertainties, during cross cultural encounters. Disengagement was allowed and sometimes even facilitated within clinical practice and as a result nurses became indifferent to people they knew little about and appeared resigned that this was acceptable. This study highlights the need for greater consideration into how cultural competence development is taught, learnt and more importantly, applied in clinical practice. The detailed explanation of the methodology and methods used is intended to provide a practical guide for researchers considering using the methodology. It describes how new insights into nurses’ behaviours towards culturally diverse patients were generated, which has relevance and utility for practising nurses and nurse educators.     

小柴胡汤合当归芍药散加减治疗瘿病临证经验

目的:探讨崔书克教授对瘿病的病因病机的认识和治疗经验,为临床治疗提供经验和参考。方法:通过门诊跟师,整理崔教授多年来诊治本病的典型医案,通过研究分析其辨证思维和用药规律,试总结相关治疗经验,将理论与实践相结合,辅以具体验案加以佐证。结果:崔师擅用经方,结合多年临床经验,认为本病的治疗多从肝脾论治,运用小柴胡汤和当归芍药散加减治疗瘿病,不仅能够改善临床症状,而且能够既病防变,有效减缓该病的进一步发展。结论:崔教授治疗瘿病经验丰富且疗效显著,诊治特色鲜明,临证方法独特,对诊治该病具有指导意义。     

Hubs disruption in mesial temporal lobe epilepsy. A resting‐state fMRI study on a language‐and‐memory network

Mesial temporal lobe epilepsy (mTLE) affects the brain networks at several levels and patients suffering from mTLE experience cognitive impairment for language and memory. Considering the importance of language and memory reorganization in this condition, the present study explores changes of the embedded language‐and‐memory network (LMN) in terms of functional connectivity (FC) at rest, as measured with functional MRI. We also evaluate the cognitive efficiency of the reorganization, that is, whether or not the reorganizations support or allow the maintenance of optimal cognitive functioning despite the seizure‐related damage. Data from 37 patients presenting unifocal mTLE were analyzed and compared to 48 healthy volunteers in terms of LMN‐FC using two methods: pairwise correlations (region of interest [ROI]‐to‐ROI) and graph theory. The cognitive efficiency of the LMN‐FC reorganization was measured using correlations between FC parameters and language and memory scores. Our findings revealed a large perturbation of the LMN hubs in patients. We observed a hyperconnectivity of limbic areas near the dysfunctional hippocampus and mainly a hypoconnectivity for several cortical regions remote from the dysfunctional hippocampus. The loss of FC was more important in left mTLE (L‐mTLE) than in right (R‐mTLE) patients. The LMN‐FC reorganization may not be always compensatory and not always useful for patients as it may be associated with lower cognitive performance. We discuss the different connectivity patterns obtained and conclude that interpretation of FC changes in relation to neuropsychological scores is important to determine cognitive efficiency, suggesting the concept of “connectome” would gain to be associated with a “cognitome” concept.     

“I’ll use it differently now”: using dual-systems theory to explore youth engagement with networked technologies

ObjectivesMany young Canadians experience high levels of networked connectivity, which some suggest may negatively impact their health. Adult monitoring has not been shown to be an effective long-term strategy for supporting young people in healthy engagement with tech. In this study, we explore the benefits of empowering young people to set healthy goals and monitor themselves. We engage with Shapka’s (2019) critique of dual-systems theory, and consider the relationship between the neurological and behavioural systems in relation to adolescent internet use.MethodsUsing a youth participatory action research approach, we co-designed a project with six adolescents to explore the ways that their use of networked technologies was affecting their lives by disconnecting and observing how the lack of networked connectivity changed their experiences. The youth used a media diary to track their use of devices both before and after disconnecting.ResultsThe main benefit of disconnecting appeared to be having the opportunity to reflect on one’s own use of networked devices. This enabled the participants to reconnect in a more intentional way. Findings support Shapka’s speculation that dual-systems theory, with a focus on regulation, may not be the most useful way of supporting adolescents in developing healthy habits around their wired tech.ConclusionAdolescent experiences of networked technologies are complex, yet they are able to navigate this landscape with intelligent strategies. Their self-directed exploration of disconnection helped them to become reflexive practitioners who were able to revisit their use of networked technologies with new insights and self-control.     

中医学应对疫病的历史回顾与思考

概要回顾中医学关于外感热病诊治规律的相关记载,总结其对外感热病中具有传染性特点的疫病病因、病机、传变及治疗的认识;结合新型冠状病毒肺炎的发病时间及主要临床表现,提出其属中医学“瘟疫”范畴,病位在肺,病因为感受“冬温之毒”,从口鼻而入,侵袭肺络;结合各地诊疗方案提出的证候特点及用药规律研究,指出疫毒袭肺、邪热壅肺、毒热闭肺为其核心病机;分析中药连花清瘟理论组方特点及相关临床与实验研究结果,佐证其在应对新型冠状病毒肺炎疫情中的临床价值。     

论中成药大品种与中医理论创新

中成药大品种具有临床价值大、科学价值强、市场价值高的基本特征,中成药大品种不仅是中药产业发展的核心引擎,也是中医药学术发展的重要内容,事关中医药事业与产业,意义重大。本文以中医理论创新与中药大品种为切入,在回顾中医理论创新研究方法与模式的基础上,强调有效方药的创制是理论创新研究成果的集中体现,并以风咳理论与苏黄止咳胶囊、络病理论与通心络胶囊为例予以说明。提出以中成药大品种为载体,实现中医理论创新研究的思路与策略,即在梳理和分析中成药大品种组方规律与功能主治的基础上,深度挖掘其蕴含的理论内涵,不仅强调普遍的理论认识,更应关注应用独特的药物及其配伍;不仅仅满足揭示中药作用的现代科学内涵,更应通过中成药大品种作用机制研究,探索未知或可能的新靶点、新通路和新机制,从而促进科学发现,引领医学研究方向。     

Game theoretical mapping of white matter contributions to visuospatial attention in stroke patients with hemineglect

White matter bundles linking gray matter nodes are key anatomical players to fully characterize associations between brain systems and cognitive functions. Here we used a multivariate lesion inference approach grounded in coalitional game theory (multiperturbation Shapley value analysis, MSA) to infer causal contributions of white matter bundles to visuospatial orienting of attention. Our work is based on the characterization of the lesion patterns of 25 right hemisphere stroke patients and the causal analysis of their impact on three neuropsychological tasks: line bisection, letter cancellation, and bells cancellation. We report that, out of the 11 white matter bundles included in our MSA coalitions, the optic radiations, the inferior fronto‐occipital fasciculus and the anterior cingulum were the only tracts to display task‐invariant contributions (positive, positive, and negative, respectively) to the tasks. We also report task‐dependent influences for the branches of the superior longitudinal fasciculus and the posterior cingulum. By extending prior findings to white matter tracts linking key gray matter nodes, we further characterize from a network perspective the anatomical basis of visual and attentional orienting processes. The knowledge about interactions patterns mediated by white matter tracts linking cortical nodes of attention orienting networks, consolidated by further studies, may help develop and customize brain stimulation approaches for the rehabilitation of visuospatial neglect.