《黄帝内经》水模型化推理研究

模型化推理是指以模型特别是思维模型为中介或工具,由一个或几个前提推出结论的思维方法。《黄帝内经》由于其历史条件的限定,较多地采用了天然实物模型进行推理,而水与人类生活密切相关,自然也就成了人类认识事物乃至人体生命活动的最为普遍的天然模型。通过阐述水模型与《黄帝内经》血脉气血循环、经脉气血运行、十二经脉体系建构、六淫病因认识、气血津液病机以及相关临床诊治思维的关系,分析指出《黄帝内经》天然模型化推理具有直观性、经验性、功能性、非结构性、整体全息性、时序性等特征。     

Enfermement carcéral,confinement socio-sanitaire et moyens d’évasion. Danser sa peine et au-delà…

Jail incarceration and social confinement due to a sanitary stay-at-home law against the ongoing COVID-19 pandemic are compared to the introduction of dance workshops for imprisoned women charged with long sentences, then followed by an outside performance Soul Kitchen. The whole experience, organized by a famous contemporary choreographer Angelin Preljocaj, is filmed by Valérie Müller, producing Danser sa peine (To dance her sentence/her sorrow), nominated for an award. The sessions are planned: two hours and a half, 2 times a week, for four months, no technique required. A group of five women start with ordinary easy functional movements, gaining in innovative and expressive qualities, spatial perceptions, feelings and interpersonal interactions, lead by A. Preljocaj in a helpful and empathic mood. At the same time, he discovers the cooking authorization in their jail cell. The relevant results shift into a dynamic successful piece Soul Kitchen (2019) performed in town (Dance Festival in Montpellier, south of France) with dancing and cooking occurrences on stage. It makes sense, specially about self-esteem, body image and positive opinion from the audience. The women's physical and psychological states linked with a long lack of space and sensitivity… move to a better self-balance and feelings of well-being. In a similar state of mind, the French confined population – youth to elderly – try to find different and imaginative strategies at home as moving in a restrictive area, enjoying family cooking… through trainings provided by Internet, looking for reducing anxiety, depressive disorders and other social problems. A panel of situations goes from deleterious conflictual relationships, dramatic isolation, to funny and positive ones using creativeness to escape, facing the disruption of daily life.     

Using Systems Thinking to train future leaders in global health

Systems Thinking provides a useful set of concepts and tools that can be used to train students to be effective and innovative global health leaders in an ever-changing and often chaotic world. This paper describes an experiential, multi-disciplinary curriculum that uses Systems Thinking to frame and analyse global health policies and practices. The curriculum uses case studies and hands-on activities to deepen students’ understanding of the following concepts: complex adaptive systems, dynamic complexity, inter-relationships, feedback loops, policy resistance, mental models, boundary critique, leverage points, and multi-disciplinary, multi-sectoral, and multi-stakeholder thinking and action. A sample of Systems Thinking tools for analysing global health policies and practices are also introduced.     

中华中医药学会中医标准化工作机制创新研究思路和发展模式探讨

创新是完善和发展的前提和过程。在中华中医药学会承担政府职能、制定技术标准的新的历史时期,面对新的机遇和挑战,笔者认为,学会在中医标准化工作机制创新方面,应紧紧立足于当前工作状态,在分析问题,解决问题和明确目标、任务和发展需求的基础上,进行发展模式探索。在分析上述内容之后,笔者认为,中华中医药学会中医药标准化机制创新研究思路和发展模式主要应集中在管理机制、运行机制、实施监督机制和人才培养机制等四个主要方面。     

妇科医师的创新思维与人性

医疗行为中一切有别于传统，更加有益于病家身心康复的方法都是有意义的创新，创新中既包含对历史的传承与肯定，也包含对历史的背叛与否定，本质则是对传统思想与行为的背叛。虽然临床医学中一切新事物都源于临床创新思想，但是创新结果并不一定符合科学与人文精神，一切新事物都需要经历临床实践检验而完善。临床创新研究就是从临床发现问题，并应用科学智慧妥善巧妙解决问题，即在临床存在的问题与理想解决的方法之间建立新思想描绘的桥梁，研究的过程就是桥梁建设的过程，需要科学的方法、艰苦的实践，由此而铺就通向成功的道路。创新的起点必然是思想的解放和人文的关怀，人性是人类天然具备的基本精神属性，善恶并存，是支配行为最强大、最根本的原动力，人性不可随意放纵，如果无拘无束，则人性之恶无从制约；人性亦不可持久压抑，如果彻底禁锢，必然积愤难平而束缚创造力。     

Adopter quand on a une descendance biologique

Why adopt when you have biological descendants, and why adopt ostensibly by choosing a child from a black African country? This is the question we address in this article from a doctoral thesis in psychology supported in 2017 at the University of Lorraine. Although adoption has been the subject of much research, the scientific literature on “international adoption”, which will occupy us here, and which, at least in France, has tended to dry up in recent years, is very little provided. That is why, in order to open up avenues of research, we wanted to engage in an exploratory study of the appropriation that couples give in the after-the-fact to this adventure in which they engaged. Five couples were therefore interviewed in non-directive research interviews (Blanchet, 2003) conducted by the clinical psychologist involved in this thesis. This style of adoption is basically a “couple affair”, each couple being heard in three separate meetings in about a week. The first interview took place with the couple, the next two involving just the wife and then the husband. The interviews were recorded, then transcribed verbatim, finally analyzed thematically, through a relatively informal content analysis, and then pragmatically, using tools for analysis of the dialogue relating to enunciation (for example on people's deixis [Benveniste, 1966]) and dialogue management (e.g. the management of alternation and dialogical sequences (Trognon and Brassac, 1993; Trognon and Coulon, 2001; Trognon and Batt, 2010). This approach has identified many traits specific to those involved in the adventure of “international adoption”. Related, for example, to the individual and interindividual history of the members of the couple, the place that is devolved to the adopted child in the couple's imagination, and the commitment that both parents make in the common project. Their knowledge should prove to be useful to any professional who meets families who have experienced an international adoption.     

Chirurgie bariatrique et fantasmes de métamorphose

ObjectivesIn this study, we will show that the believing of an “identity metamorphosing” of the subject with obesity by bariatric surgery is a fantasy construction built by both patients and caregivers. We will analyze the reasons and the repercussions of these fantasies on the care, both on the patients’ subjective experiences and on caregivers’ practices. At last, we will propose the idea that the surgical event and his consequences will be inscribed, at the opposite of a “metamorphosis”, in a subjective continuity for the operated person, as the insistence of symptomatic expressions across and beyond the organic and compartmental changes linked to the surgery reflects it.Materiel and MethodsMost of the patients investigated for this study were treated with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass but some of them were not treated yet and expected for a surgery. In all cases (i.e. when they were not operated yet and when they were asking for a second surgery because in failure by gaining weight), they were brought to discuss on their surgery request. Surgery-experienced patients also have to comment the surgery's effects on their body and its image, their eating behaviors and their relationships with the others (companion, friends, family, etc.). For caregivers, the results are extracted from different clinical discussions about patients or about ways of caring all along the multidisciplinary support. Patients and caregivers were both asked to talk about their representations on bariatric surgery.ResultsWe observed two types of fantasies: “split” fantasy built by patients and “recovery” fantasy built by caregivers. The “split” fantasy is the believing of a magical and ideal surgery that allows “identity metamorphosing” of the subject with obesity. For these patients, “split” fantasies can be related to the desire of the other or can appear through weight's objectives. For the caregivers, and as “split” fantasies, “recovery” fantasies can be related to an idealization of the operation in itself and the obesity “psychiatrization”. On the other side, we have seen that some psycho-sensory symptoms emerged after surgery: patients present disgust for aliments they used to appreciate. By discussing with these patients, we realize that these aliments were associated with traumatic experiences and memories that potentially lead them to construct their obesity. These symptoms seem to be an opened-door to the operated subject's unconscious and are related to the subject's psychical continuity.ConclusionThe identity metamorphosing resulting from bariatric surgery is a fantasy built by both patients and caregivers. These fantasies have an influence on the medical support and potentially lead the treatment to failure. They should be identified and analyzed before the request, during the transformations due to the operation itself, and after weight stabilization (when the operated subject continues to reorganize his relationships to the other and to the culture pressure). Also, as the symptoms produced by bariatric surgery mobilize traumatic memories from before, they reveal a subjective truth: the traumatic past cannot be erased by body changes. And if the patient's past continues to be ignored by caregivers, it is condemned to repeat itself and potentially compromising the treatment at term. Thus, caregivers should be able to pay attention to the subjective continuity of the patient's history in order to ameliorate the reception and the accompaniment of persons with obesity in a bariatric surgery procedure.     

Le rapport de la schizophrénie au désir dans l’enseignement de Lacan

Objectives

In psychoanalytic research on psychosis, the tendency in Lacan's thinking, as well as among his readers and commentators, is to focus work on paranoia. However, it is here counterbalanced by a specific approach to schizophrenia. It is also against the current trend of positioning Desire in psychosis as a deficiency that we explore what might be the “desiring” economy of the schizophrenic.

产科病房护士评判性思维能力的培养

目的探讨提高产科病房护士评判性思维能力的方法。方法 采用知识培训、病例分析、护理查房、病例讨论、自我反思、模拟训练等策略,对产科病房护士进行为期1年的培训,采用中文版评判性思维能力测量表在培训前后进行测评,以观察培训效果。结果培训后产科病房护士评判性思维能力总分及各维度得分均高于培训前,差异有统计学意义(P均<0.01)。结论该培训策略的实施能有效提高产科病房护士的评判性思维能力。