毛德文教授运用“调肝理脾”法治疗慢性肝病经验总结

慢性肝病进展缓慢,常常得不到患者足够的重视而造成复杂的病情甚至发展为肝衰竭。而肝、脾二脏在中医的生理、病理上相互作用,相互影响,在现代医学研究当中亦被证明二者息息相关。毛德文教授在长期诊治肝病的过程当中,强调了慢性肝病作为肝病的早期发展阶段更应尽早干预。他认为肝脾不和与慢性肝病关系密切,慢性肝病的核心病机是肝脾功能失调,其基本治疗原则为调和肝脾。而调肝理脾法属于中医治疗八大法之“和法”的范畴,其指导下的“培土涵木法”与“抑木扶土法”用于治疗慢性肝病能取得较好的临床疗效。本文试从调肝理脾的理论基础及临床应用两大方面介绍毛德文教授治疗慢性肝病的丰富经验。     

超声诊断小儿肠套叠的价值及体会

目的探讨超声诊治小儿肠套叠的价值及方法。方法回顾分析该院2009年6月至2012年11月间诊断肠套叠的86例患儿声像图特征,并结合X线空气灌肠、手术和病理结果,分析超声诊断价值及方法。结果超声诊断肠套叠,横切面呈＂靶环征＂、纵切面呈＂套筒征＂特异性高,诊断正确率可达100%。仔细观察套叠包块结构,详细描述声像图特征及相关测量数据,可为临床治疗方案的选择提供客观依据。结论超声特别是高频超声在肠套叠诊治中具有重要临床应用价值。     

Nurses’ knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study

BackgroundIntraosseous access is an effective and safe option when difficult vascular access occurs. The knowledge, competence, and clinical experience of nurses are collectively essential for the successful implementation of this approach in clinical practice. Education and clinical learning are the main pillars supporting this new practice to ensure patient safety. The aim of this study was to identify the nurses’ knowledge and clinical experience of intraosseous access and the factors associated with the adoption of this procedure.MethodsA cross-sectional study was carried out from October to December 2020. A convenience sample of 432 nurses from four Italian hospitals were involved. A structured questionnaire was used to assess the nurses’ knowledge of the intraosseous access guidelines and their clinical experience.ResultsMost participants were female (71.5%) with more than 10 years of experience (63.7%) working in an emergency (38.9%) and medical (37.7%) setting. Most of the participants demonstrated their knowledge of the use of a device e.g., it is used if vascular access is not rapidly achieved in a child (83.1%) and the boluses of liquids required in the intraosseous procedure (72.7%). A few participants reported having placed intraosseous access (3.5%). A higher level of educational preparation and working in emergency and paediatric settings were associated with increased knowledge.ConclusionsOur findings highlighted a sub-optimal level of knowledge of the IO procedure, little experience of this practice in clinical contexts, also associated with a lack of adequate protocols and devices available to nurses. Nurses need to develop their knowledge and practice the skill clinically to embed this practice. University and nurse educators should emphasise the relevance of this practice in nursing education and training, so as to improve the nursing care practice and level of patient safety.     

晚期癌症患者痛苦体验：一项丧失与疏离死亡相关的质性研究

目的 深入了解晚期癌症患者痛苦体验,为制定个体化的干预措施提供依据。方法 采用描述性现象学的方法,进行目的性抽样,于2022年4月至6月对湖南省某三级肿瘤专科医院的安宁疗护病房的15例晚期癌症患者进行半结构式深度访谈。采用Colaizzi 7步分析法对资料的分析、归纳与主题提炼。结果 晚期癌症患者痛苦体验可分为3个主题、9个亚主题:丧失相关痛苦(自我完整性丧失、自我尊严感丧失、自我价值感丧失、生命意义丧失);疏离相关痛苦(社会关系疏离、情感联结疏离);死亡相关痛苦(想到死亡充满恐惧、面对死亡不安焦虑、期待死亡结束痛苦)。结论 晚期癌症患者的痛苦体验涵盖丧失、疏离、死亡多个维度,具有多样性和个体性,应提供有针对性的干预措施,从而提高其生活质量。     

Mental health service users’ experiences of an education intervention based on a European Union project: A comparison between nine European countries

Mental health service users (MHSUs) often face difficulties in achieving successful participation in education; however, the tools that could help them succeed are rarely investigated. This study aimed to illuminate the experiences of MHSUs in an education intervention based on a European Union (EU) project. Their experiences are compared across nine EU countries. The data were collected through individual interviews with MHSUs (n = 47) at day activity centres that provide mental health services. An inductive content analysis was used as the method of analysis. Three main categories, which include seven subcategories, are revealed by the analysis. The main categories are as follows: (i) the factors related to MHSUs’ educational preparedness, (ii) the dimensions of the learning environment, and (iii) the effects of training intervention. The MHSUs’ experiences with the education intervention were similar across all countries. The findings showed that this education intervention is a multidimensional process. It contains social, mental, and physical dimensions linked to a learner and learning environment. These dimensions influence the MHSUs’ ability to participate in the education process. At its best, the education intervention supports the personal growth of MHSUs and prepares them for social integration. An education intervention can be a usable tool in the rehabilitation of MHSUs if the multidimensional nature of education is taken into consideration. Therefore, designing and executing education interventions requires the attendance of the MHSUs in cooperation with mental health and education professionals. Our findings suggest a tentative framework that can be used in designing and executing education for MHSUs.     

The learning experiences of immigrants who are graduates of an entry-level baccalaureate nursing program: A hermeneutic phenomenological study

International migration of individuals or families seeking to improve economic conditions or escape political oppression increases each year. With migrant movement, there is a need for appropriate health care to meet their health beliefs and cultural health traditions. Nurses comprise a large portion of the healthcare workforce and yet, the number of immigrant nurses educated in their adopted country remains low. The aim of this study was to understand the learning experiences of immigrant registered nurses who graduated from an entry-level baccalaureate nursing program in the United States. A hermeneutic phenomenological approach with a Gadamerian focus was utilized. Purposive sampling identified five immigrant graduates who were individually interviewed using several open-ended questions in a non-structured format. Analysis identified an overarching theme, “being on the outside.” Five subthemes emerged: harsh realities, disruptions, nurturance, resilience, and propagation. Recommendations from the interviews include: recognition and appreciation of each student, the nurse educator coming to know oneself first, followed by dialoguing with each student to perpetuate deeper understanding. Rather than accommodating the ethnically diverse immigrant nursing student through targeted interventions, the nurse educator should maintain an all-inclusive learning environment.     

Experiences of living with asthma – a focus group study with adolescents and parents of children with asthma

Objective: The goal for asthma treatment is that every individual, so far as possible, shall live without symptoms and exacerbations. Patients and health care professionals sometimes have different perceptions of what is important for achieving good quality of life. This work aims to describe the experiences among adolescents as well as those of parents with young children living with asthma. Methods: Four focus group interviews were performed, two with parents of young children and two with adolescents. The data were qualitatively analyzed, using Systematic Text Condensation. Result: Three themes relevant to the participants’ experiences of living with asthma were presented; strategies, frustrations and expectations. The adolescents wanted to be like their peers and developed their own strategies for self-management of asthma, which included not always taking medication as prescribed. The parents emphasized frustration regarding not being believed, lack of understanding feelings of loneliness, or anxiety. One identified expectation was that the participants wanted to be met with competence and understanding in asthma care from health care professionals. Another expectation expressed among parents was that teachers in nursery and primary schools should have more knowledge and understanding on how to care for children with asthma. Conclusion: Living with asthma leads to developing personal strategies in self-management of asthma. Moreover both parents and adolescents had expectations of being met by competent and understanding health care professionals. Developing a partnership between patients and health care professionals could be a successful way to improve the care of patients with asthma.     

‘Your whole life is lived through your teeth’: biographical disruption and experiences of tooth loss and replacement

The experience and meaning of tooth loss and replacement has varied historically and culturally but has received relatively little attention from social scientists. Our study set out to understand these experiences in the context of the arrival of newer, dental implant treatments. Semi‐structured qualitative interviews were carried out with 39 men and women who had experienced tooth loss and replacement. A thematic analysis was sensitised by previous sociological work on chronic illness, particularly Bury's notion of biographical disruption. We found that while for some individuals the loss of a tooth was relatively insignificant, for others it was devastating and disruptive. In seeking to understand this difference, the concept of biographical disruption was a helpful analytical tool. Our analysis identified two forms of disruption. The first related to the meanings of tooth loss (the neglected mouth) and denture wearing (a marker of old age). The second, embodied, disruption concerned the relationship between the self and mouth in those wearing dentures (the invaded, unreliable mouth) and could occur even where tooth loss and denture wearing had been biographically anticipated.