Is There Any Ideal of ‘High Quality Care’ Opposing ‘Low Quality Care’? A Deconstructionist Reading

The expressions ‘high quality care’ and ‘low quality care’ are cognitive and linguistic artefacts that help to structure people’s lives and thinking; for example, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has no meaning without low quality care. Through a ‘deconstructionist reading,’ this article discusses limitations of categorising the quality of care as either high or low. The limitations of this ‘binary opposition’ can include a lack of defining attributes; vagueness and fuzziness at the ‘boundaries’ between high quality care and low quality care; concealment of quality as a continuum; and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce.     

医学院校就业指导课程体系的解构与重建

医学院校就业指导课程的开设对提升医学生的就业竞争力具有积极作用,目前就业指导的课程体系建设普遍存在着一些问题。本文从加强就业指导的师资队伍建设、重构就业指导的课程内容与讲授方法、保证就业指导课程的经费支出与设施建设三方面阐述了高等医学院校就业指导课程体系重构的策略。     

Evidence-based practice: a deconstruction and postmodern critique: book review article

This paper discusses the significance of postmodernism for healthcare practice, specifically the discourse known as 'evidence-based practice'. It considers two texts, both of which present postmodern analyses of contemporary issues. One text presents a deconstruction of evidence-based practice in an attempt to reveal its 'true' nature, which is portrayed as one that does not respect research paradigms other than the randomised controlled trial, merely pays lip service to expertise and fails to connect with the real nature of clinical practice. The second text considers the accusation that absolute relativism implied by postmodern approaches may permit an 'anything goes' mentality and provide succour to those advocating unacceptable practices. A 'defence' of postmodernism in relation to the accusation that it encourages holocaust denial is used to consider further the nature and limitations of postmodern critiques of evidence-based practice. This review concludes that postmodernism fundamentally challenges the apparent 'objectivity' of evidence-based practice but it does not challenge the fundamental rules for acquiring and testing evidence. Rather it is the selection of questions to be asked and answered by evidence-based practice/practitioners that is the true limitation. This is the ground upon which fruitful argument can be had about the significance of evidence without undermining the requirement that there be evidence and standards to judge such evidence.     

21世纪医学信息检索工具的解构与重组研究

简要介绍了"解构论"原理和医学信息检索发展概况,指出了检索工具解构与重组的必要性,重点论述了对检索工具解构和重组的内容、方法及其实践效果.     

国医大师周仲瑛教授辨治乳腺癌临证医案经验

目的：研究周仲瑛教授临床治疗乳腺癌经验及规律。方法：采用Medcase数据处理平台,运用频数规则方法对周仲瑛教授临床治疗乳腺癌的医案进行解构分析,并结合结果运用辨治规律。结果：本研究涉及病例316例,1 664诊次,临床症状429种,病机181条,药物344种,药物种类覆盖10大类。结论：周仲瑛教授认为乳腺癌病性总属本虚标实、虚实夹杂,主要病位在肝肾,涉及脾、胃等脏腑;核心证型为气阴两伤、肝肾两虚等;治疗乳腺癌常用药物多为清热类和益气养阴类药物,祛邪药物使用多于扶正药物。