Interpreting patients as a means of clinical practice: Introducing nursing hermeneutics

Background

The increased reference to hermeneutics from nursing scientists, researchers and academics has emphasized that interpretation has traditionally been a fundamental part of nursing practice. In nursing research a propensity for acquiring knowledge and understanding by using, multiple modalities has been demonstrated. In recent years, the use of hermeneutic phenomenology, has featured amongst these modalities. Hermeneutic phenomenology is an inquiry arm of, philosophical hermeneutics.

Objectives

To explore the hypotheses that the patient can be considered as “text” and as such to be, interpreted in order to gain information for decision-making in clinical practice.

Design

A qualitative approach (hermeneutic phenomenological) to nursing clinical practice.

Settings

The clinical case of a patient suffering from cancer is described in the paper who was treated, in an Oncology Centre in Cyprus.

Methods

A hermeneutical model of clinical decision-making in nursing is implemented in practice. The, model was initially used in medical practice; however it finds applications to nursing as well. According, to the model, a patient is perceived as a literary text which may be interpreted on four levels: (1) the, literal facts of the patient's body and the literal story told by the patient, (2) the nursing diagnostic, meaning of the literal data, (3) the praxis (the nursing interventions) emanating from the nursing, diagnosis, and (4) the change effected by the clinical encounter in both the patient's and nurse's lifeworlds.

Results

Nursing interventions were successfully informed by the interpretation process.     

《中国胰腺癌新辅助治疗指南(2020版)》解读

胰腺癌是高度恶性的消化系统肿瘤,预后极差。随着对胰腺癌生物学行为认识的不断深入及综合治疗理念的普及,新辅助治疗在胰腺癌治疗中的作用日益凸显。中华医学会外科学分会胰腺外科学组、中国研究型医院学会胰腺疾病专业委员会联合制定了《中国胰腺癌新辅助治疗指南(2020版)》,就胰腺癌新辅助治疗中的关键问题进行系统全面的阐述,为胰腺癌新辅助治疗的临床实践提供了参考依据。本文对指南中的新辅助治疗前准备、指征把握、方案选择、新辅助治疗后的再评估及手术策略等方面的内容进行解读,进一步探讨胰腺癌新辅助治疗存在的争议。     

2019 年NICE《大于16岁人群卒中和短暂性脑缺血发作的诊断和初期管理指南》解读（一）

英国国家卫生与临床优化研究所（NICE）于2008年7月发布了《急性卒中和短暂性脑缺血发作的诊断和最初管理指南》，但卒中的治疗发生了变化，在缺血性卒中血栓清除术方面出现了新的证据，且首次怀疑TIA时阿司匹林的使用、传统的危险分层在短暂性脑缺血发作（TIA）中的作用及TIA影像学成像的最佳策略等尚存在一些不确定性。所以NICE 2019年5月又公布了新版《大于16岁人群卒中和TIA的诊断和初期管理指南》，以补充阐释上述问题，为TIA（疑诊或确诊）和脑卒中急性发作后48 h的诊断和治疗提供最佳临床建议。NICE指南共有9条推荐意见，本文结合相关研究进展对其中的“1.1.1~1.4.8条”推荐意见进行解读，内容包括快速识别和诊断、疑诊TIA或急性非致残性卒中的影像学检查、急性卒中的专科处理、急性卒中溶栓和血栓清除术。通过对该指南的解读，可以为我国急诊科、神经科等临床医师的实践工作提供参考，优化临床疗效。     

Évaluation d’un support d’aide à l’analyse de l’électrocardiogramme par les internes des urgences

AimElectrocardiogram (ECG) is a routine examination in emergency medicine (EM), however the level of resident's interpretations is inhomogeneous and sometimes insufficient. We have developed a support to assist in the interpretation of ECG in emergency situations. Our main objective was to assess whether this new tool improved the rate of good interpretations by residents of EM departments (EMD). The secondary objectives were to assess whether it improved the rate of good triages, the level of certainty of residents, and to study its impact according to the seniority of the resident.Patients and methodMulti-center, before-and-after study, carried out with existing residents in the different EMD dependent of a single university hospital center. The evaluation was conducted in two stages: an initial analysis of 17 ECGs without tool and a new analysis using the tool.ResultsOut of a target population of 68 residents, 41 (60 %) were included. The tool significantly improved the correct reading rate from 46 % without the tool to 68 % (P < 0.001). The rate of correct triage (56 % vs. 64 %) and diagnostic certainty (54 vs. 66 on a scale of 0 to 100) were also significantly improved (P < 0.001). The more experienced residents were generally more efficient in pre-testing, but the tool improved results regardless of seniority.ConclusionThe development of a simple support to assist in the interpretation of ECGs improves the rate of good interpretations among residents in EMD.     

An investigation to ascertain whether or not time pressure influences the accuracy of final year student radiographers in abnormality detection when interpreting conventional appendicular trauma radiographs: A pilot study

IntroductionThere is an increasing demand on diagnostic imaging departments, a shortage of radiologists, and a backlog of images requiring a report across several trusts in the UK. A negative impact on performance can result in significant outcomes for the patient. The aim of this study is to ascertain whether decisions made under time pressure will affect the accuracy of the interpretation of conventional radiographs.MethodsFinal year undergraduate diagnostic radiography students were recruited [n = 21] and separated into three groups of seven at random, assigning time limits per image for a set of normal and abnormal conventional appendicular radiographs; 15 s (high pressure), 30 s (moderate pressure) and unlimited time (low pressure). Each image was assessed, and answers were recorded as normal or abnormal with an approximate location of the pathology.ResultsThe ANOVA test revealed no statistical significance amongst results. The mean accuracy was highest in the 15 s group (82.86%) and lowest in the unlimited time group (74.52%). The results also demonstrated a decrease in accuracy with increased image review times within the unlimited time group; with the quickest participant achieving 88.33% and the slowest, 56.67%.ConclusionThe results demonstrated no statistical significance. However, it is recommended to conduct a similar study using sufficient reporting practitioners to enable direct parallels to be drawn with statistical significance.Implications for practiceThe results signify an importance for imaging departments to manage the number of staff and their workload. Subsequently, this aims to ensure reporting practitioners work at their optimum stress level for efficient work performance.     

Reconsidering the minimally important difference: evidence of instability over time and across groups

Background Context

Underlying cognitive factors have been found to influence patients’ symptom experience. Current evidence suggests that concomitant changes in appraisal must be taken into account to accurately interpret change as measured by standard spine patient-reported outcomes (PROs).

《新型冠状病毒患者标本采集技术专家共识》解读

新型冠状病毒肺炎具有高传染性、长潜伏期、部分临床症状不明显或无症状的特点。确诊或排除新型冠状病毒感染肺炎依赖于对患者生物学标本进行的实验室检测。如何规范、高效、正确、安全地采集新型冠状肺炎相关标本,对提高检测结果的准确率和降低院内感染发生率十分重要,因此本文对《新型冠状病毒患者标本采集技术专家共识》进行解读,以供临床护理人员参考。     

孟德尔随机化研究应用于因果推断的影响因素及其结果解读面临的挑战

孟德尔随机化（Mendelian randomization,MR）研究使用遗传变异作为工具变量,推断暴露因素与结局之间的因果关系,能够有效克服混杂和反向因果问题所导致的偏倚。然而,MR研究中的工具变量须满足关联性、独立性和排他性3个核心假设。即使核心假设成立,MR研究在因果推断中的应用还受到其他局限性的影响。此外,MR研究结果的解读需要基于综合证据。本文将围绕MR研究应用于因果推断的影响因素和研究结果的解读进行综述,以期为MR研究结果应用提供指导。     

《医疗机构日间医疗质量管理暂行规定》的解读

日间医疗可以有效提高医疗资源利用效率。随着医疗技术的进步,日间医疗服务能力不断提高,服务范畴不断延伸,服务内涵更加丰富。《医疗机构日间医疗质量管理暂行规定》的发布,使我国日间医疗质量管理有了纲领性指导文件。《规定》首次明确了日间医疗的定义,从日间医疗质量管理的组织建设、制度规范、流程管理、监督管理等方面提出了基本要求。《规定》的出台,对推动日间医疗的规范化、科学化、同质化发展起到了积极促进作用。     

《世界卫生组织狂犬病专家磋商会第三版报告》更新与解读

2018年4月,世界卫生组织(World Health Organization,WHO)公布了《WHO狂犬病专家磋商会第三版报告》,总结和展示了近年来世界范围内在狂犬病免疫、预防、控制和国际间合作等方面的研究结果,在狂犬病病毒学、人类狂犬病防控、人用狂犬病疫苗及狂犬病免疫球蛋白使用、犬狂犬病防控等方面展示了新的证据,提出了新的更改和推荐意见。尤其在狂犬病病毒学、人用狂犬病疫苗和狂犬病免疫球蛋白使用方面进行了较大的修改,重点关注方案的可行性、疫苗接种程序的简化、成本效益的提高,并对以往未涉及的许多细节给出了明确推荐意见。提出到2030年在全球范围内消除由犬传播的人狂犬病病例的战略目标及其实施方案。作者就主要的更新内容进行解读,揭示其临床意义。