浅谈“百病皆在调气血”在哈氏妇科的应用

气血理论是中医重要理论，妇科疾病应首调其气血，哈氏妇科是全国中医妇科十大流派之一，诊治疾病独具特色，哈孝廉教授宗古人"百病皆在调气血"思想，治疗崩漏、产后身痛、滑胎等妇科常见疾病，疗效显著，值得深入学习与探讨。     

A mechanism for gratitude development in a child

Most scholars consider gratitude as a moral emotion, with only few seeing it as a character trait. As a result, no systematic mechanism has ever been attempted to develop gratitude in children. Given the social issue of widespread lack of gratitude in the one-child generations of China, this article attempts to outline a mechanism of parental moral education for gratitude development. The mechanism is underpinned by love, induction and discipline; and theoretically justified in accordance with key psychological and sociological theories, such as Piaget's theory of moral development, Kohlberg's moral stages theory, attachment theory, Hoffman's internalisation theory, Rest's social justice theory and Baumrind's parenting styles theory. The benefits and potential risks of each strategy of the mechanism are addressed.     

Les théories du complot : l’envers du mythe totémique dans le lien social

ObjectivesThe current explosion of conspiracy theories is an undeniable dimension of present-day social bonds. We aim to understand some of the unconscious stakes underlying the conspiratorial ideation and to shed light upon the reasons why it is a topical issue in our modern society.MethodsBy relying on psychoanalytical knowledge that allows us to study the psychic functions of the myth, we will compare different conspiracy formations to those of the mythical narrative to bring into resonance these two fictional modalities. Freud's totemic myth, through its structure, sheds a particular light on the functions that regulate jouissance and that organize history, as well as social bonds.ResultsThe conspiracy discourse will prove to be the underside of the Freudian myth of Totem and Taboo. The text presenting the myth of the primal horde will reveal the structure of the conspiracy discourse as its negative. Indeed, this myth offers a symbolic ur-fiction, and its imaginary counterpart determines the conspiratorial grammar based on the question: “who profits from the crime?” As in a hall of mirrors, the countless conspiracies will appear as the shadow of a crime, always returning in an imaginary mode due to a lack of symbolization. The system that the conspiracy theory seeks to unveil will then be regarded as the reverse of an arrangement structured by the myth.DiscussionWe discuss the link between scientific discourse and the intensification of conspiracy theories’ presence in our modern society. Indeed, Lacan notices how the mythical dimension is repressed by scientific discourse. Such repression would produce, as a result, imaginary versions of the myth. Thus, the conspiracy theory will be regarded as a structural effect of scientific discourse rather than as anti-science.ConclusionsThe conspiracy theory turns out to be a social symptom linked to scientific discourse. It is the social staging of damage suffered that transforms the coordinates of a symbolic loss, no longer organized by a myth, into an imaginary stolen jouissance.     

Implementation of Telehealth: Normalization Process Theory and NoMAD-Ex.

This nurse practitioner–led project facilitated integration of telehealth services in a women’s clinic. Normalization Process Theory and the Normalization Measures Development (NoMAD) instrument were identified as tools. The NoMAD survey was augmented with a request for 2–3 sentences of explanation for each item. These data were then evaluated using inductive content analysis to identify specific facilitators and barriers. Results were presented to an interdisciplinary team charged with the responsibility of making modifications to the existing telehealth workflow. The resultant workflow was piloted for 30 encounters and statistically significant improvement in average NoMAD score was demonstrated on repeat survey.     

Economic Burden of Patient-Reported Penicillin Allergy on Total Hip and Total Knee Arthroplasty

IntroductionSelf-reported penicillin allergies in patients undergoing total joint arthroplasty often results in the use of second-line prophylactic antibiotics. A higher risk of prosthetic joint infection (PJI) is associated with suboptimal antibiotics vs first generation cephalosporins, which have historically been grouped with other beta-lactam antibiotics such as penicillin for potential allergic reactions. This study evaluates the economic burden of self-reported penicillin allergies in total joint arthroplasty (TJA).MethodsData from studies reporting true incidence of IgE-mediated penicillin allergies, infection-free survivorship of TJA, and cost of PJI attributed to use of second-line antibiotics were obtained. Projected cost of preoperative penicillin allergy testing and potentially avoidable PJI associated with second-line antibiotic usage were calculated. This was compared with projected cost of PJI in the current state to estimate cost savings.ResultsImplementation of preoperative penicillin allergy testing leads to a potential savings of nearly $37 million to payors in the first year based on 1-year survivorship. This savings increases to $411.6 million over a 10-year span and $1.18 billion over a 20-year span.ConclusionPreoperative penicillin allergy testing or risk stratification via thorough history should be implemented as standard of care for patients with self-reported penicillin allergies before TJA and would result in decreased cost of PJI.     

Learning theories and principles in surgical education and technical learning

What is important to think about in surgical education and technical skills training? Technical skills training is grounded in social cognitive theory and the concepts of modeling and self-efficacy. Cognitive and nontechnical learning is critical to supplement the overall proficiency of the surgical learner in performing an operation. Technical learning is cemented by deliberate practice and there is benefit to productive struggle and failure. External cognitive load should be minimized to maximized operative skills advancement.