从中医“虚”论治原发性骨质疏松症与OPG/RANK/RANKL信号通路的相关性

原发性骨质疏松症(primary osteoporosis,POP)是现代临床中常见的骨科疾病,其归属于中医学之"骨痿""骨痹""骨枯"等范畴。随着中医药事业的发展,中医学在POP的治疗中应用愈加广泛,且疗效显著,已受到学界的广泛认可。但遗憾的是,其缺乏现代研究理论依据的支撑。随着分子生物学的发展,OPG/RANK/RANKL信号通路的发现对中医学治疗此病具有重要意义。故笔者将从中医"虚"理论出发,并以中医学脏腑辨证理论为基础,借助现代分子生物学的研究成果OPG/RANK/RANKL信号通路,揭示中医治疗POP的OPG/RANK/RANKL信号通路表达机制,以期为中医学治疗POP提供科学理论依据。     

Diagnostic d’un souffle systolique cardiaque chez un jeune patient asymptomatique : une évaluation des pratiques professionnelles en médecine militaire d’expertise

The finding of a systolic heart murmur is common in medical military practice. Albeit often benign among young healthy adults, it can reveal a valvular or a cardiac disease, which could worsen during workout or expose to risk of a sudden death. This study aims to evaluate the diagnostic efficiency of the military general practitioner when discovering a systolic murmur among young asymptomatic patients.Materials and methodsDuring one year, this study involved all the general practitioners of the medical military centres of Brittany and the cardiologists of the military hospital in Brest. It prospectively enrolled a cohort of all military asymptomatic patients under 40, without any underlying known heart condition. Military general practitioners listed, thanks to an anonymous form, the main features of the systolic murmur and of the ECG and proposed an auscultatory diagnosis: innocent or organic murmur. Then cardiologists did the same and finally performed a transthoracic echocardiography giving the diagnosis.ResultsFifty-eight patients were referred, 5 not meeting the inclusion criteria. Of the 53 patients included, military general practitioners found 46 innocent murmurs and 7 organic ones. Cardiologists found 51 innocent murmurs and 2 organic. Transthoracic echocardiography just took on one organic murmur (linked with a bicuspid aortic valve), spotted by the specialist, though judged innocent by the general practitioner.DiscussionMost of innocent murmurs diagnosed by general practitioners (45/46) were confirmed. Regarding the seven organic murmurs, the main selected criteria (intensity over 3, orthostatic persistence, diffuse irradiation) are mostly in accordance with the literature, proving right medical instincts. Authors propose a practical management of systolic murmurs among asymptomatic young patients.ConclusionMilitary general practitioners seem to master symptoms of organic murmur. This assessment argues for a promotion of a holistic clinical examination, which will help not only to rationalize the use of transthoracic echocardiography in economic terms but also to value the medical expertise.     

护士的职业认同在工作满意度与离职意愿间的中介作用

目的分析护士的职业认同在工作满意度与离职意愿间的中介作用。方法采用方便抽样方法选取237名临床护士,对其进行一般人口统计学的调查,并进行职业认同量表、工作满意度量表和离职意愿量表的测量。结果临床护士的工作满意度和职业认同总体水平不高,已婚和低职称临床护士的工作满意程度较低;相关分析表明,工作满意度、职业认同与离职意愿之间呈显著相关(r=0.12~0.67,P0.05或0.01)。临床护士的职业认同、工作满意度均可直接负向预测其离职意愿;工作满意度还以职业认同为中介变量,间接负向预测离职意愿。结论职业认同是工作满意度与离职意愿间的部分中介因素。就离职意愿影响因素制订干预策略,提升护士的职业认同水平和工作满意度,进而有效降低其离职意愿。     

妇产儿童医院手术室护士职业价值观与角色认知的相关性研究

【】目的：了解妇产儿童医院手术室护士职业价值观与其角色认知水平,并探讨其相关性,为培养和引导积极的职业价值观提供依据。方法：采用角色认知问卷和护士职业价值观量表对成都市两家三甲妇产儿童医院87名手术室护士进行调查。结果：手术室护士职业价值观与角色认识具有部分相关性,角色认知的正向维度与职业价值观总分及其各维度均存在显著正相关性,其中与行动主义最为相关;角色认知的负向维度与职业价值观的相关性不明显。结论：妇产儿童医院手术室护士职业价值观总体得分较高,角色认知水平较高,角色认知水平能部分预测职业价值观。可根据相应影响因素进行合理干预,以提高护士的角色认知水平,提升对职业价值观的认同。     

公立医院职称评审社会化研究

对现行公立医院评审制度进行阐述并分析其存在的主要问题。面对当前现实,在保留公立医院职称制度的前提下,对职称评审制度提出改革建议。建议采取社会化的评审方式,以打破公立医院和行政机关对于职称评审的垄断。从公立医院职称评审主体、标准、程序、公开化、法治化和信息化等六个方面论述了评审社会化改革的路径。     

Incorporating Peer Assessments within a Clinical Practicum Course: Insights from a Clinical Faculty Initiative

IntroductionPeer assessments have been used within health professional programs to provide some degree of judgment of professional behavior and to facilitate feedback among peers. In an attempt to further support the clinical learning of our students, the clinical education team at the Odette Cancer Centre initiated a pilot to introduce peer assessments as a part of strategies for learning and engagement within laboratory sessions. The aim of our work was to retrospectively review peer assessments completed during these sessions in an attempt to identify professional behaviors, both positive and negative, and subsequently correlate the assessments with observed behaviors noted, both formally and anecdotally, within clinical faculty assessments. Further to this, our team attempted to explore student perceptions on the impact of peer assessments to their own learning.MethodsStudents in the final year of a 3-year undergraduate medical radiation sciences program were asked to assess their peers during laboratory sessions using a modified version of an assessment tool previously known to the students, the Assessment of Readiness for Clinical tool. Students (N = 14) were required to evaluate each of their peers who participated in the same session and provide supporting comments for their rating. For each student, responses from peer assessors were anonymized and collated. Comments and numerical ratings on the peer assessments were compared. The student assessments were subsequently compared with similar measures extracted from faculty assessments. Students also participated in a debriefing session to provide feedback regarding the integration of these assessments within the learning sessions and the potential impact they had on their own professional behaviors.ResultsThe majority of students rated their peers in all criteria at a score of 2 (performed or surpassed expectations). There was some correlation between numerical ratings and comments written in the assessments. Comments on peer assessments were in concordance with observations extracted from previous assessments by clinical faculty and teachers for 71% of the students. Students expressed a favorable attitude toward the use of the peer assessments but did not find the numerical ratings useful and instead valued supporting constructive comments that cited specific examples for improvement.ConclusionsPeer assessments were found to be of some benefit to the learning of our students, particularly the anecdotal supporting comments that accompanied the ratings. However, their use must be accompanied by formalized training and guidelines to teachers and learners as well as a careful consideration of the tool chosen to ensure the most purposeful impact on behavior change.     

新形势下护理带教应强化护生下临床前职业风险意识和医院暴力的自我保护教育

【】目的：在目前护患纠纷和医院暴力发生率不断上升的背景下,探讨对护生实施下临床前职业风险和医院暴力自我保护培训的必要性和对策。方法：根据以往带教经验和国内外文献报道,结合护生普遍具有的特点,分析新形势下护生面临的职业风险和医院暴力情况,阐述对护生进行培训的具体做法和取得的效果。结果：通过培训,护生增加了法律意识,提高了自我保护能力,以及和患者沟通的信心。结论：对护生下临床前进行职业风险意识和自我保护教育,在当今形势下,是对护生自身、医院和患者都负责任的做法,值得坚持和推广。     

Psychological distress and professional help‐seeking: a prospective national study

The study focuses on use of different healthcare providers in connection with elevated levels of psychological distress. The study used a prospective design based on two waves of a national health survey. Participants were Icelandic citizens, age 18–75, randomly drawn from the National Register (N = 1592). Distressed individuals chose a wide range of providers. The choice of provider was based in part on the type of distress experienced, although most individuals turned to the general medical sector. Psychophysiological symptoms were primarily related to visiting physicians (other than psychiatrists). Depression was related to visiting psychiatrists, and anxiety was related to visiting psychiatrists, psychologists and nurses. Anger/aggression was primarily related to visiting clergy. Between 10% and 16% of distressed individuals did not receive any help from the formal healthcare system within 1 year. Studies addressing professional help‐seeking for psychological distress should closely consider the various factors facilitating and hampering use of health services for different forms of distress.