Review article: Goals‐of‐care discussions for adult patients nearing end of life in emergency departments: A systematic review

Goals‐of‐care discussions at end‐of‐life are associated with increased patient satisfaction and reduced treatment burdens, reduced family and healthcare worker distress and healthcare costs, while achieving equal life‐expectancy. It is unclear how goals‐of‐care discussions should occur. The objective of the study was to determine which patients could benefit, requirements, content, documentation, and harms and benefits of emergency medicine goals‐of‐care discussions. We sought primary evidence on goals‐of‐care discussions in EDs with adult patients nearing end‐of‐life, published in English after 1989. Data sources included Medline, Embase, PsycINFO, CINAHL, Web of Science and reference lists of included articles. One thousand nine hundred and twenty abstracts were screened, five articles selected. There was no consensus on the meaning of goals‐of‐care, which is often confused with advanced care planning and treatment limitation. Emergency clinicians can identify most patients needing discussions following training. There was no evidence for how to involve stakeholders, nor how to adapt conversations to meet cultural and linguistically diverse needs. Expert panels have suggested requirements and content for conversations with little supporting evidence. There was no evidence for how emergency conversations differ to those in other settings, nor for harms or benefits for holding goals‐of‐care conversations in EDs. Increased ED goals‐of‐care conversations increased hospice referral and reduced in‐patient admissions. Most studies were of moderate quality only, outcomes were not standardised and sample sizes were small. ‘Goals‐of‐care’ is used inconsistently across the literature. This is the first systematic review regarding goals‐of‐care discussions in EDs. Further research is needed on all aspects of these conversations.     

The design and psychometric evaluation of the emergency medical services resilience scale (EMSRS)

IntroductionThe nature of pre-hospital emergency medical care can expose healthcare workers to significant stresses that might lead to psychological problems such as job burnout and impaired resilience. A valid and reliable tool is, therefore, needed to investigate resilience in emergency medical services (EMS) personnel. This study was conducted to design a tool for assessing the resilience of emergency medical personnel in Iran and to examine the psychometric properties of the designed tool.MethodsThis methodological study was conducted in two phases: A qualitative stage with individual interviews and a review of literature to generate items, and a quantitative stage of psychometric evaluations that assessed the face, content, and construct validity of the tool. The reliability of the tool was also assessed using the internal consistency and test-retest methods.ResultsExploratory factor analysis was used to design a 31-item scale with a six-factor structure. These six factors, i.e. job motivation, communication challenges, social support, remaining calm, self-management, and consequences of stress, explained 51.8% of the variance. The scale’s Cronbach's alpha coefficient and intraclass correlation coefficient were calculated as 0.91 and 0.85, respectively.ConclusionThe scale developed on the resilience of EMS personnel can be used as a valid and reliable tool for assessing resilience in EMS personnel. It can also assist emergency service managers to plan courses to improve their staff’s resilience.     

“血浊”理论在中医现代化中的作用及启示

文章总结了前期有关血浊理论的成果，提出血浊理论是应现代疾病谱系变化而提出的新的"中医理论"，用血浊理论指导中医临床可以纳入检验医学等更多的现代诊疗手段，扩展中医四诊范畴，配合"援药理论"，初步形成了适应现代临床的"理法方药"系统，为指导治未病提供了良好的时代落脚点，为中医现代化提供了良好的理论典范和启示。     

师承教育在医教协同创新中医人才培养中的作用

中医师承教育是当今社会中医传承的主要方式,其培养了大量的中医优秀人才,促进中医药文化和中医学术思想传播,是现代中医药发展不可缺少的组成部分。但近代以来,人们脑海中逐渐形成了以西方医学为体系的思维模式时,中医学教育该如何的发展与传承。针对这一现象,我们分析了现代院校教育与师承教育的特点,阐述师承教育在现代中医人才培养中的作用,以期探讨高等中医药院校教育改革的模式。     

海洋生物医用材料的临床应用和安全性评价

目的： 对海洋生物医用材料在医疗领域的应用情况和海洋生物材料来源医疗器械的安全性评价趋势进行分析，为推进该材料的临床转化提供参考。方法： 归纳海洋生物医用材料的分类和应用，介绍该材料的安全性评价的程序要点，探讨其安全性评价中面临的挑战。结果与结论： 常用的海洋生物医用材料主要为多糖和蛋白质，在创伤修复和组织工程领域应用广泛。海洋生物医用材料具有生物活性和良好的生物相容性，对此类材料的安全性评价应根据材料特性和预期用途，科学制定评价程序和选择检验方法。     

Measuring spatio-temporal accessibility to emergency medical services through big GPS data

Medical accessibility is an important indicator for evaluating the effectiveness of public health services. However, the previous medical accessibility studies mainly focus on spatial accessibility without considering temporal variation in population distribution which is significant for evaluating access to emergency medical service (EMS). This paper proposes a model of spatio-temporal accessibility to EMS called ST-E2SFCA based on adapting the enhanced two-step floating catchment area (E2SFCA) method. We apply our method to the greater Tokyo area for a large volume of GPS dataset with millions of users and compare the accessibility difference over space and time. To evaluate our model, we also analyze the distinction of our model over different weight sets and compare the performance of ST-E2SFCA with the traditional E2SFCA. The result shows that our method can illustrate the temporal difference and is suitable for measuring the spatio-temporal accessibility to EMS, thus can guide the hospital location selection and urban planning.     

对构建德智体美劳全面发展的新医科人才体系的思考

通过分析"新医科"发展趋势以及目前我国医疗供给侧改革的内在需求与人的全面发展之间的紧密联系,提出立德树人、以智启人、以体育人、以美成人、以劳塑人是"新医科"对医学人才培养的主要途径。在此要求之下,医学高等院校应适应全民健康的目标和社会保健服务的需求,坚持本科教育服务地方经济社会的理念,加强大健康教育与全面素质教育,着力培养符合社会需要的、全面发展的新医科人才。     

温病学教学中的“三全育人”战略

温病学是中医学四大经典课程之一,是基础理论向临床实践过渡的桥梁课程,对于中医药高校学生具有重要意义。“三全育人”战略是高校思想政治工作的重点,新时期,我们应把“三全育人”战略贯穿温病学教育教学全过程和各环节,全员全过程全方位为培养具有坚实的温病理论知识和技能、医德高尚的现代化应用型中医药人才服务。