诊断学问诊训练软件的开发与应用

目的：为了帮助医学生掌握规范的问诊方法和技巧,设计诊断学问诊训练软件。方法：收集临床典型病例资料,按照问诊规范和要求设计“问”和“答”,采用VisualC＋＋设计软件,包含输入模块,应答模块,参考答案模块和管理模块。结果：设计了一个通过文本输入和输出,逐步应答,自动运行的模拟问诊软件,并在实习学生中应用,收到良好教学效果。结论：把病案文字资料转换成软件,为问诊实践教学探讨了一个新途径。     

Ethical nursing practice: inquiry-in-action

Although the need to theorize ethics within the complexities of nursing practice has been identified within the nursing literature, to date the link between ethics epistemology and specific nursing actions has received limited attention. In particular, little exploration has been carried out to examine how nurses 'know' what is ethical and the knowledge they draw upon to inform their nursing actions within the complexities of their everyday practice. This study describes a participatory inquiry project that focused on developing and articulating an epistemology of ethics while in the midst of everyday nursing work. Epistemological and methodological insights are discussed in light of the challenges nurses face in contemporary healthcare contexts.     

Journeying from the philosophical contemplation of constructivism to the methodological pragmatics of health services research

AIM: This paper presents our journey through a contemplation of the philosophical origins of constructivism to consider its role as an active methodology in qualitative research. METHOD: The first part of the paper summarizes the philosophical background of constructivism and the five principles underpinning this paradigm as described through the works of Guba and Lincoln. The philosophical roots of constructivism are then compared with postpositivism, critical realism and participatory inquiry. The paper moves on to consider their common methodological steps, before examining how the constructivist research strategy is being adopted and adapted within the pragmatics of health service research. Recent studies will be drawn upon to illustrate the use of constructivist methodology. CONCLUSION: Questions are raised about the role of philosophy and the extent to which it should or does underpin or influence qualitative research strategies. We believe that if researchers gain an understanding of both philosophy and methodology a richer and more robust study is likely to result.     

中医理论对儿童性早熟分析调查的报告

目的 运用中医理论探讨儿童性早熟的病因,病机和防治措施.方法 根据"横断面调查"法,对本市2所学校1200名儿童(其中:每个年龄组各调查400名,分城市和农村两个对照组、男女对半)的身高、体重、胸围、第二性征发育情况等,进行调查、测量、归纳、分析、统计、整理.结果 随着社会的发展,儿童性早熟的发病率呈明显上升的趋势,而且城市比农村发病率高,中医认为这与肝、肾二脏功能及天癸的期至有关.结论 祖国医学揭示该病的发病率呈明显上升趋势的根源和科学地辩析了该病的病因病机,对临床辩治和开展儿童心理素质教育提供丰富的理论依据.     

The idea of nursing science

BACKGROUND: In response to the question of the idea of nursing as a legitimate science, Edwards (1999) claims that it does not qualify as a legitimate science. He bases his claim on the assumption that legitimate science must be empirical. Edwards defends his claim based on the lack of consensus and development in nursing philosophy during the past 40 years and, as he describes it, the lack of ends (or truth) of nursing science. AIM: The aim of this response is to refute Edwards' conclusion. The basis for this refutation is twofold. First, legitimate science includes both empirical and non-empirical scientific methods. Second, evidence of development of a nursing school of philosophical thought is found in the nursing literature. DISCUSSION: Empirical science is only one mode of inquiry in nursing. Philosophical and non-empirical methodologies are gaining increasing importance as modes of scientific inquiry. I therefore contend that nursing would be better served to continue applying an offensive effort into integrating all applicable modes of scientific inquiry into the discipline.     

“The Wall that Stops the Outside Coming In”: Exploring Infinity and Other “Difficult” Concepts with a Preschooler

At the centre of many debates about 'developmentally appropriate practice' (NAEYC & NAECS, 1991) is the issue of difficulty and challenge. In this study we examine one preschooler's (Amy) conversations with the first author in an attempt to re-think what we as educators consider difficult for this age group. The informal interviews from which the data are drawn provide a window into mathematical queries which interest or puzzle Amy at those times, as well as the ways in which she challenges the interviewer mathematically. It is evident from these task-based conversations that topics which primary teachers and caregivers might traditionally avoid, such as 'infinity' and 'negative numbers', were concepts this four-year-old's inquiry brought into view. The authors argue that we find ways to give prominence to individual children's questioning of mathematical ideas and in turn, pause to reconsider what is 'difficult' mathematics for the early years.     

Social poetics as research and practice: living in and learning from the process of research

This paper is both a report of research work carried out by one author of the paper with the other involved in a supervisory role, and a reflection on methodology that was an emergent property of the research process. The research question arose when professional preunderstandings about schizophrenia as a biological disturbance were bracketed as a Husserlian form of phenomenology was adopted. The initial study focused on the meanings three individuals attached to being diagnosed with a mental illness and being involved in psychiatric treatment systems. The exploration of meanings led to the researcher being guided by one study participant in relation to a suitable framework for making sense of her lived experience of being entangled in psychiatric systems. This involved an appreciation of the poetics of interpersonal interaction that was simultaneously fuelled by the researcher's reading of social poetics in psychology. Thus, the research became a hermeneutic inquiry, focused upon the text of one participant (Beth)1 and the psychiatric system that she and colleagues encountered. Beth's psychiatric predicament was described by a loss of 'self', psychiatric interrogation, and positive and negative features of immersion in the system. A byproduct of taking a poetic approach was that the participant found the research process therapeutic. Thus, social poetics encouraged a beneficial blurring of the boundaries between research and practice. In both arenas, social poetics can lead to a different level of understanding. This is contradictory to mainstream approaches to research that value objectivity with a strict division between the researcher and the subjects, with the aim of producing scientific knowledge.     

互联网查询检验报告的研究与实践

目的使患者便捷地获得检验报告。方法：开发检验报告网上查询系统，与HIS、LIS系统进行数据交换。结果：用户从医院门户网站进入登录界面注册后，可以查询检验报告，系统会向用户发送新出检验报告通知。结论该系统的实施节省了患者的成本，在很大程度上改善了患者的就医体验，并且减少了医疗成本，在落实新医改要求方面进行了有益的探索。     

Getting Real

We cannot know how our physical selves affect our patients and the course of an analysis. I tackle this topic through a case study of one patient's responses to my weight loss. For a patient's perspective, I use Margaret Little's accounts of her analyses with Ella Freeman Sharpe and D.W. Winnicott. She describes her struggle to verbalize the reality she sees in their appearance. Little, along with additional readings from Ferenczi and Levenson, helps me consider my relationship with my patient and identify a need for bolder inquiry about my changing body. I embark on an experiment with this patient, and the outcome surprises me. The treatment opens up and my inquiry yields an enactment with fresh historical data and new insight.