中医学本质论

文章在东、西方哲学、逻辑、科学技术史、医学等领域进行了广泛的比较研究,从构筑一门科学知识体系(范式)的本体论和方法论两个层面,对中、西医学理论体系进行了深入的比较研究,发现西方医学是观察和分类在其中起主要作用,形成的把握了人体结构-功能层面生命规律的经验科学。中医学是观察和模式推理在其中起主要作用,形成的把握了人体现象-状态层面生命规律的理论科学。     

Towards case-based performance measures: uncovering deficiencies in applied medical care

Measures are designed to evaluate the processes and outcomes of care associated with the delivery of clinical (and non‐clinical) services. They allow for intra‐ and interorganizational comparison to be used continuously to improve patient health outcomes. The use of performance measures always means to abstract the complex reality (medical scenarios and procedures) in order to provide an understandable and comparable output. Measures can focus on global performance. The more detailed data are available the more specific judgements with respect to the appropriateness of clinical decision‐making and implementation of evidence are feasible. Externally reported measures are intended both to inform and lead to action. By providing this information, deficiencies in patient care and unnecessary variations in the care process can be uncovered. Such variations have contributed to disparities in morbidity and mortality. The developments in information technology, especially world‐wide interconnectivity, standards for electronic data exchange and facilities to store and manage large amounts of data, offer the opportunity to analyse health‐relevant information in order to make the delivery of healthcare services more transparent for consumers and providers. Global performance measures, such as the overall life expectancy (mortality) in a country, can give a rough orientation of how well health systems perform but they do not offer general solutions nor spe‐cific insights into care processes that have to be improved. In contrast to population‐based measures, case‐based performance measures use a defined group of patients depending on specific patient characteristics and features of disease. By means of these measures we are able to compare the number of patients that receive a necessary medical procedure against those patients who do not. The use of case‐based measures is a bottom‐up approach to improve the overall performance in the long run. They are not only a tool for global orientation but can offer a straightforward link to the areas of deficient care and the underlying procedures. Performance measures are relevant to providers as well as consumers, from their own individual perspective. Cased‐based measures focus on the management of individual patient. This approach to performance measurement can inform physicians in a meaningful and constructive way by monitoring their individual performance and by pointing out possible areas of improvement.     

运用案例教学模式与传统教学模式对中医专业学生进行心电图诊断教学的效果对比研究

目的运用案例教学模式与传统教学模式对中医专业学生进行心电图教学,对比教学效果.方法将学生分为实验组和对照组,分别采用案例教学模式和传统教学模式进行教学,最后进行心电图诊断考核及问卷调查,对比教学效果.结果实验组教学效果良好,优于对照组.结论用案例教学模式进行心电图教学能明显提高教学效果.     

口腔正畸病例库的建立及其在教学中的应用

目的建立口腔正畸病例资料库并将其应用于案例教学,提高教学质量。方法利用Winceph软件平台,收集临床病人的详细资料,建立病例资料信息库。在正畸实验课中选择典型病例以小组形式进行讨论,从多个方面进行考查并评价教学效果。结果对于教学内容的理解和掌握,在实验课1周后测试计分明显高于实验课前,具有显著统计学意义;在头影测量读数方面,手工描图法和使用Winceph软件相比无统计学差异,但计算机可以节省时间;调查问卷提示大部分学生喜欢案例教学。结论选择资料库中的典型病例应用于正畸实验教学,在改善教学效果,提高教学效率方面有着重要的意义,但对于案例教学方法的实施步骤和评估标准还需要进一步的改进和完善。     

Analysis of medical malpractice claims to improve quality of care: Cautionary remarks

Medical malpractice claims can be analysed to gain insights aimed at improving quality of care. However, using medical malpractice claims in medical research raises epistemological and methodological concerns related to certain features of the litigation process. Medical research should therefore approach medical malpractice claims with caution. Taking one recent study as a an example, this article insists on three areas of concern: (a) the quantity of legal materials available for analysis; (b) the content of the legal materials available for analysis; and (c) the ways in which the content of the legal materials should be analysed and the types of inferences that it can support. The article concludes with general recommendations for future medical research that would incorporate medical malpractice claims. These recommendations centre around recognizing the qualitative dimension of legal reasoning.     

Clinical reasoning and medical education: Scoping Review

This review aims at identifying research trends in medical education focused on clinical reasoning and argumentation for the resolution of specific problems in the area of medicine. A systematic literature review was performed comprising articles from 2015 to 2019 with the keywords; Clinical Reasoning and Medical Education. A total of 191 articles were initially found, of which 52 were analyzed as they were in accordance with the criteria designed for the study. Most studies had a qualitative design and, although they were focused on the teaching process, there was a fundamental recognition of the student in the design of strategies and methods. The theoretical and thematic categories most addressed were new trends in teaching strategies, resolution of medical practice problems, and the decrease in diagnostic error. This type of study allows the delimitation of fields of research, and clarifies the state of progress, approaches, and interests of researchers dedicated to this particular area. It is concluded that the investigation of teaching practices that lead to the promotion of argumentation in students has become a field of exploration, and introduces new perspectives in relation to the training process. This supports the need to integrate the method into teaching and learning processes of health sciences, as well as in the theoretical and methodological developments resulting from research on specific didactics.     

A qualitative grounded theory study of the conceptions of clinical practice in osteopathy – A continuum from technical rationality to professional artistry

How practitioners conceive clinical practice influences many aspects of their clinical work including how they view knowledge, clinical decision-making, and their actions. Osteopaths have relied upon the philosophical and theoretical foundations upon which the profession was built to guide clinical practice. However, it is currently unknown how osteopaths conceive clinical practice, and how these conceptions develop and influence their clinical work. This paper reports the conceptions of practice of experienced osteopaths in the UK.A constructivist grounded theory approach was taken in this study. The constant comparative method of analysis was used to code and analyse data. Purposive sampling was employed to initially select participants. Subsequent theoretical sampling, informed by data analysis, allowed specific participants to be sampled. Data collection methods involved semi-structured interviews and non-participant observation of practitioners during a patient appointment, which was video-recorded and followed by a video-prompted reflective interview.Participants' conception of practice lay on a continuum, from technical rationality to professional artistry and the development of which was influenced by their educational experience, view of health and disease, epistemology of practice knowledge, theory–practice relationship and their perceived therapeutic role.The findings from this study provide the first theoretical insight of osteopaths' conceptions of clinical practice and the factors which influence such conceptions.     

Electronic recording and reporting system for tuberculosis in China: experience and opportunities

Tuberculosis (TB) surveillance in China is organized through a nationwide network of about 3200 hospitals and health facilities. In 2005, an electronic Tuberculosis Information Management System (TBIMS) started to be phased in to replace paper recording. The TBIMS collects key information on TB cases notified in TB care facilities, and exchanges real-time data with the Infectious Disease Reporting System, which covers the country’s 37 notifiable diseases. The system is accessible to authorized users at every level of the TB network through a password-protected website. By 2009 the TBIMS achieved nationwide coverage. Completeness of data on patient bacteriological end points improved remarkably over time. Data on about a million active TB cases, including drug-resistant TB, are included each year. The sheer scale of the data handling and the intricate functions that the China TBIMS performs makes it stand apart from the electronic information systems for TB adopted in other countries.     

基于证据推理及评估用例的信息系统安全评估模型

为了实现信息系统安全评估的规范准确,根据评估过程的实际需要,在《信息系统安全保障评估框架》标准基础上建立了证据推理模型,把系统的安全等级、评估规约、直接证据融合入模型之中。引入软件测试理论中测试用例的概念构造评估用例,定义了安全指标的3种类型,提出了基于这3种类型的评估规则,最后给出了模型的实现方式。从实例分析可以看出,该评估方法提高了评估工作的规范性,减少了人为因素对评估结果的影响。