基于概念隐喻理论的中医藏象学说考察

从"隐喻认知"的角度研究中医藏象学说。本文以"五行藏象"模型为例,认为五行藏象体系是一个基于人类经验体验构建的概念隐喻系统;是基于"可能世界"的类比;是一种"隐喻重描";是一个"信念系统"。本文提出中医藏象学说研究的重点不是寻找其客观物质基础,而是要对其特有的语言进行分析,要注重揭示中医脏腑概念在那些层面是可核实的,以及隐喻认知在中医藏象学说的形成过程中扮演的重要角色。     

Enhancing Educational Scholarship Through Conceptual Frameworks: A Challenge and Roadmap for Medical Educators

Historically, health sciences education has been guided by tradition and teacher preferences rather than by the application of practices supported by rigorous evidence of effectiveness. Although often underutilized, conceptual frameworks—theories that describe the complexities of educational and social phenomenon—are essential foundations for scholarly work in education. Conceptual frameworks provide a lens through which educators can develop research questions, design research studies and educational interventions, assess outcomes, and evaluate the impact of their work. Given this vital role, conceptual frameworks should be considered at the onset of an educational initiative. Use of different conceptual frameworks to address the same topic in medical education may provide distinctive approaches. Exploration of educational issues by employing differing, theory-based approaches advances the field through the identification of the most effective educational methods. Dissemination of sound educational research based on theory is similarly essential to spark future innovation. Ultimately, this rigorous approach to medical education scholarship is necessary to allow us to establish how our educational interventions impact the health and well-being of our patients.     

Challenges of combining work and unpaid care,and solutions: A scoping review

The number of people who combine work and unpaid care is increasing rapidly as more people need care, public and private care systems are progressively under pressure and more people are required to work for longer. Without adequate support, these working carers may experience detrimental effects on their well‐being. To adequately support working carers, it is important to first understand the challenges they face. A scoping review was carried out, using Arksey and O’Malley's framework, to map the challenges of combining work and care and solutions described in the literature to address these challenges. The search included academic and grey literature between 2008 and 2018 and was conducted in April 2018, using electronic academic databases and reference list checks. Ninety‐two publications were mapped, and the content analysed thematically. A conceptual framework was derived from the analysis which identified primary challenges (C1), directly resulting from combining work and care, primary solutions (S1) aiming to address these, secondary challenges (C2) resulting from solutions and secondary solutions (S2) aiming to address secondary challenges. Primary challenges were: (a) high and/or competing demands; (b) psychosocial/‐emotional stressors; (c) distance; (d) carer's health; (e) returning to work; and (f) financial pressure. This framework serves to help those aiming to support working carers to better understand the challenges they face and those developing solutions for the challenges of combining work and care to consider potential consequences or barriers. Gaps in the literature have been identified and discussed.     

Mixing Metaphors in Pharmacy Education is a Bad Solution for Students

Scholarly discussion has recently been directed toward the negative effects of consumerism in pharmacy education. Frequently in these discussions, the metaphor of student-as-customer is cited as an indicator of such consumer mentality. However, the customer metaphor is more deeply entangled in the thinking on this matter than has been acknowledged, even for those who roundly criticize its use. A richer understanding of the power of metaphor and of the fiducial obligations that underlie professionalism can help to create educational paradigms more likely to meet the best interests of students, faculty members, and the general public.     

Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework

Background: Occupational therapists’ are increasingly working with communities and providing services at the community level. There is, however, a lack of conceptual frameworks to guide this work.

Aim: The aim of this article is to present a new conceptual framework for community-centered practice in occupational therapy.

Material and Method: The conceptual framework was developed from qualitative multi-case research on exemplars of community participation. The first was, a network of Canadian food security programs, and the second, a rural Australian community banking initiative. Key themes were identified from across the case studies, and cross-case findings interpreted using occupational therapy and occupational science knowledge, and relevant social theory. The outcome is a four-stage, occupation-focused, community-centered practice framework.

Findings: The Community-Centred Practice Framework can be used by occupational therapists to understand and apply a community-centered practice approach. The four stages are: (1) Community Identity, (2) Community Occupations, (3) Community Resources and Barriers, and (4) Participation Enablement.

Conclusions: Further research is needed to trial and critically evaluate the framework, to assess its usefulness as a robust, occupation-focused, frame of reference to guide community-centered practice in occupational therapy.

Significance: The proposed framework should assist occupational therapists to conceptualize community-centered practice, and to utilize and apply theory.     

A recipe for mealtime resilience for families living with dementia

To date, research delving into the narratives of persons living with dementia is limited. Taking part in usual mealtime activities such as preparing food can sustain the identity of persons living with dementia. Yet if capacity for mealtime activities changes, this can put a strain or demand on the family, which must adjust and adapt to these changes. The aim of this study was to develop an in‐depth story of resilience in one family living with dementia that was experiencing mealtime changes. Thematic narrative analysis following the elements of Clandinin and Connelly's (2000) 3D narrative inquiry space was used. One family's dementia journey was highlighted using the metaphor of a baking recipe to reflect their story of resilience. Developing positive strategies and continuing to learn and adapt were the two approaches used by this resilient family. Reminiscing, incorporating humour, having hope and optimism, and establishing social support were specific strategies. This family continued to learn and adapt by focusing on their positive gains and personal growth, accumulating life experiences, and balancing past pleasures while adapting to the new normal. Future work needs to further conceptualise resilience and how it can be supported in families living with dementia.     

The Nexus Between the Documentation of End-of-Life Wishes and Awareness of Dying: A Model for Research,Education and Care

The convergence of medical treatment that can extend life with written medical orders that make it possible to refuse such treatment brings the differential dynamics of contemporary end-of-life decision making into sharp focus. Communication between families and clinicians can be confusing, uncertain, and pressured when death is imminent. These situations create distress that ultimately influences the end-of-life experience for people who are dying and those who care for them. This article presents the analysis of the decisional dynamics that emerge from the intersection of the patient-family-provider awareness that death is near with the presence or absence of documentation of expressed wishes for end-of-life care. A heuristic analysis was conducted with data from three studies about urgent decision making at the end of life. Original study data included 395 surveys, in-depth interviews with 91 prehospital (paramedics and emergency medical technicians), and content analysis of 100 Medical Orders for Life Sustaining Treatment forms that led to the development of an overarching conceptual model of decision making. Four decisional contexts emerged from the intersection of awareness of dying and documentation of wishes: 1) Aware Documented, 2) Aware Undocumented, 3) Unaware Documented, and 4) Unaware Undocumented. This generalizable model, which is agnostic of setting, can help clinicians more astutely recognize the clinical situation when death is imminent, assess patients and caregivers, and intervene to help focus conversation and direct decision making. The model can also inform research, education, and care for people in some of the most vulnerable moments of life.     

飞机驾驶舱概念设计阶段工效评价用人体几何模型

目的：基于飞机驾驶舱设计需要,建立适合其工效分析用的人体几何模型。方法：首先进行人体表面划分,确定曲面数据来源、人体曲面表示、人体的关节自由度、局部坐标系及人体各节段的质心位置和大小,最后利用三维造型软件显著人体几何模型。结果:按上述方法生成的人体几何模型可模拟基本的工效分析动作,包括人体头颅转动和手、脚运动后的最终姿态。结论：人体几何模型适于目前研究和工程的需要。     

医院智能化指数概念模型研究

目的/意义 构建医院智能化指数概念模型,为医院智能化程度量化评价奠定基础,助力医院智能化建设。方法/过程 介绍智能化内涵,阐述医院信息化建设评价标准体系,从结构－功能－效果角度切入,考量医院智能化应用。结果/结论 构建包含智能化基础、智能化能力和智能化效果3个一级指标、8个二级指标、33个三级指标的医院智能化指数概念模型,作为持续改进医疗服务的工具,通过定期评估医院智能化水平,可促进医疗质量和患者体验提升,助力医院高质量发展。