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1.
[目的] 从“水象”视阈探讨肿瘤“瘀毒互结”病机,发挥中医药原创优势,为中医药治疗肿瘤提供具有中医原创特色的理论支撑。[方法] 通过象思维,从“水象”视阈,谈人体之血象于自然之水,人体经脉象于自然水系,探讨肿瘤“瘀毒”之“瘀”象于河道之“淤”,“瘀毒”之“毒”象于水体污染,并以河道淤泥堵塞及水体污染的治理方法归纳演绎出肿瘤“瘀毒互结”的治则治法。[结果] 以“水象”视阈观之,肿瘤“瘀毒互结”与河道淤堵、水体污染的发生发展过程,肿瘤治疗后机体正气的亏损与水系治理后生态环境的退化,均存在共同之“象”。水系治理的方针法则亦可类比运用于肿瘤“瘀毒”的治疗:河道之“淤”需顺水清淤,肿瘤“瘀毒”之“瘀”需化瘀通脉;水系污染需清污澄源,“瘀毒”之“毒”在解毒寻根;水系治理需重培土,“瘀毒”同治必重扶正;治水当按需制宜,治“瘀毒”应分期论治。[结论] “瘀毒互结”是肿瘤的一大核心病机,象思维是中医的原创思维,从“水象”视阈论证“瘀毒互结”病机,具有中医的原创特色。  相似文献   
2.
社会力量具备相应的经济基础和技术条件,对于公立互联网医院体系建设具有积极的促进作用。但是实践中仍然存在商业模式不完善、监管制度不健全等问题。基于经济学契约理论要义,提出在坚持激励与约束机制并举、平衡公私益关系的前提下,通过完善医保政策、构建互联网医疗服务价格分类管理机制来促进社会力量向医疗服务公益性目标回归,并通过构建完善的监督体制来约束部分社会力量的盲目逐利性行为。  相似文献   
3.
IntroductionThe aim of this pilot study was to implement a peer review programme to evaluate MRI images and protocols, with the goal of improving quality and standardising protocols.MethodA plan-do-check-act method of action research was adopted. A checklist was designed and two radiographers scored the images (Optimal, Diagnostic or Suboptimal). A sample of five Lumbar Spine examinations were selected and reviewed on two separate occasions, one month apart. A consultant radiologist also scored the selected examinations.ResultsThere was excellent intra-rater reliability for both observers. At first assessment, Cohen's weighted Kappa analysis indicated moderate inter-rater agreement (0.457) rising to substantial agreement (0.606) at second assessment. Variations in sequence parameter settings by the radiographers were noted. Feedback via educational sessions were implemented and enhancement of protocols were made.ConclusionsRadiographers manipulate many parameters during MRI examinations, and image quality can be degraded if sequences are not optimised. This may lead to misinterpretation.Initial results suggest peer review can result in improved image quality, better protocols, and improved staff confidence.There are opportunity costs involved in releasing staff from clinical work and time and resources required for image appraisal training, however we suggest this model can be extended to other departments and modalities as a healthcare improvement initiative.Implications for practiceInitial results suggest peer review processes performed by radiographers can result in improvement to protocols and image quality in MRI. With appropriate training, radiographers can implement and undertake appraisal of image quality in MRI as part of clinical governance. The purpose of feedback must be made clear, and good professional relationships should be forged to allow candid and supportive feedback with a focus on development and education.  相似文献   
4.
BackgroundEvidence suggests that stars in an organization, including academia, drive much of its productivity and reputation. There has been much said within academic pharmacy about recruitment, but little in regard to retaining its top faculty.ObjectiveTo identify perceptions among pharmacy faculty on how faculty are currently rewarded; what is done versus what should be done at their institution to recruit and retain star faculty; what is versus what should be done in developing faculty, and compare these perceptions across certain personal and work characteristics.MethodsA questionnaire survey designed in Qualtrics was distributed via email to a census sample of 3378 members comprising 2018 AACP list-servs. Faculty activities and organization actions were derived from literatures and pilot testing. Frequency distributions and Kruskal-Wallis tests were conducted to describe the data.ResultsResponses from 463 faculty indicated scholarly publishing as paramount for receipt of organizational rewards. They indicated that their organizations very infrequently employed action to retain star faculty. They indicated that more should be done to retain stars, and this was largely agreed upon by those in supervisory positions, even though there were a few differences between supervisors and non-supervisors over what is already being done. While there were differences in perception primarily by respondent institution type, there were many more similarities than differences of opinion about actions taken and that should be taken to retain star faculty.ConclusionsPharmacy faculty affirmed the salience of scholarly productivity in the allocation of organizational rewards and indicated that certain activities like high-quality clinical practice and good citizenship behaviors were less likely to result in recognition. The results offer considerations for faculty retention strategies and the need for administrators to communicate actions taken to retain star faculty.  相似文献   
5.
ABSTRACT

Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I demonstrate how health professionals have deployed indicators such as number of women and abortion type treated in government hospitals to demonstrate commitment to global mandates on reproductive rights. These indicators obscure discrimination against women suspected of illegal abortion as health workers negotiate obstetric treatment with the abortion law. By measuring hospitals’ capacity to keep women with abortion complications alive, post-abortion care (PAC) indicators have normalized survival as a state of reproductive well-being.  相似文献   
6.
Applications of biomedical R&D currently imply substantial societal concerns. This paper explores, based on semi‐structured interviews with scientists in Norway, how biomedical researchers experience and tackle such concerns in their daily work. It shows how ritualised routine responses to dislocatory moments help maintain order in the daily work of the interviewed scientists; they do not address directly but instead smooth over concerns by a ritualised way of using ethics. This may foreclose substantive reflection and function as a stabiliser for ‘business as usual’. Overall, the current way of responding to concerns as described by the interviewees may contribute to a depoliticisation of important issues. The paper contributes to sociological work on ethics by linking it to recent discussions on Responsible Research and Innovation (RRI) and by the empirical research presented. The insights can also help improve science policies such as RRI.  相似文献   
7.
ABSTRACT

Each year, over 600 youth under the age of 25 experience literal homelessness in Austin, Texas. Of these youth, 76% have a history of involvement with foster care or the juvenile justice system—far exceeding the rates of system involvement observed among homeless youth in other large communities in the United States (approximately 54%; Voices of Youth Count, 2017). Recently, Austin was selected by the U.S. Department of Housing & Urban Development as one of ten communities nationwide to participate in the Youth Homelessness Demonstration Program (YHDP), a federal initiative designed to effectively end youth homelessness by 2020. Youth with lived experience are central players in the development and implementation of Austin's response to the youth homelessness crisis. A group of twelve of these youth (the “Austin Youth Collective to End Youth Homelessness,” or AYC) serve as key decision-making partners within the Austin YHDP team. Representatives of the AYC are deeply involved at every level of the community planning process, from the development of youth-centric housing options to system redesign efforts to ensure that youth do not exit the foster care or juvenile justice systems to homelessness. The article provides an overview of the development and contributions of the AYC—including their programmatic recommendations and advocacy work—as well as key recommendations for communities looking to leverage youth voice at the systems level.  相似文献   
8.
The RH blood group system is the most important protein blood group system. Due to the high interest, often discoveries occurred in parallel and different groups used different nomenclatures. ISBT overtook the task to create nomenclatures both for antigens and alleles. Nevertheless, knowledge of internet resources is important to find the way among these alleles. Both general resources such as RESPIRE and gnomAD, allele‐oriented resource such as bloodantigens, erythrogene and HGMDB as well as dedicated resources such as the RHCE allele listing and the Human RhesusBase are presented.  相似文献   
9.
目的研制精准型乳腺标本收集器,提高乳腺麦默通微创旋切手术标本收集效果。方法将乳腺中心行乳腺麦默通微创旋切手术患者60例随机分为观察组与对照组各30例,观察组使用自制的精准型乳腺标本收集器收集术中乳腺肿物标本,对照组使用普通弯盘收集乳腺肿物标本,观察并统计两组手术时间、标本核对次数、术后标本处理时间及标本点位对应位置错误率。结果观察组手术时间、标本核对次数及术后标本处理时间显著低于对照组(均P 0. 05);术后标本点位对应位置错误率低于对照组,但差异无统计学意义。结论精准型标本收集器能精准收集乳腺标本组织,减少术后标本处理时间及标本点位对应放置的错误率,帮助术者便利、安全地处理手术标本,提高工作效率,降低安全隐患。  相似文献   
10.
Acromegaly can impair quality of life, but impact on patients’ daily life, needs and expectations have been poorly explored.

Objectives

To better understand the impact of acromegaly on patients’ daily life, and evaluate their needs and expectations.

Patients and methods

An on-line questionnaire survey of acromegaly patient and relative community members was conducted on the Carenity website.

Results

Twenty-five patients and 3 relatives, with a mean age of 48.9 years, responded. Diagnosis of acromegaly was recent (60% within 10 years). Signs at diagnosis were mainly clinical (fatigue, headache) and physical changes (acral enlargement). Reported complications comprised morphological changes (93%), bone and joint symptoms (75%) and metabolic disorders (75%). Pain and fatigue impacted the daily life of 61% and 54% patients, respectively. Acromegaly had strong impact on mood (79%), leisure (75%) and social life (71%). Patients mostly got information from specialized websites (71%), their endocrinologist (61%) and patient associations (54%). The information sought was patient testimony (82%), practical advice (64%), and information on clinical trials (61%) and treatments (50%). Patients wished to have patient-physician discussion groups (25%), and better knowledge of acromegaly on the part of those they were in contact with (25%).

Conclusion

Acromegaly has a major impact on patients’ daily life and mood. Patients wished their disease to be better known, and advocated setting up discussion groups. This study should encourage acromegaly education programs to adapt the services and information that are needed by acromegalic patients.  相似文献   
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