针灸推拿专业培养模式的改革与实践

随着经济的发展和社会的进步,针灸推拿学科近年来发展迅速。培养优秀的针灸推拿专业人才,必须深化教育改革。本文结合教学实践,着重从目标体系、课程体系、教育教学方法体系和考核评价体系等四个方面进行了讨论：（1）从确定人才培养目标,人才培养目标体系的建立,两方面探讨构建特色专业人才培养目标体系;（2）构建以传承、实践、创新、应用为主干的核心课程体系;（3）构建课程教学与课外实践紧密结合的教育教学方法体系主要分为以下三方面工作：①实施理论课程教学改革,优化学习过程②构建与培养目标相适应的实验教学体系,加强实践创新能力培养③优化校内实训和社会实践相结合的实践教学体系,强化课外实践效果;（4）构建校内培养过程与社会认同相结合的评价体系主要分以下两个方面：①完善校内培养过程评价制度建立②培养质量的社会认同评价。     

Dignity and Narrative Medicine

Critiques of the dehumanising aspects of contemporary medical practice have generated increasing interest in the ways in which health care can foster a holistic sense of wellbeing. We examine the relationship between two areas of this humanistic endeavour: narrative and dignity. This paper makes two simple arguments that are intuitive but have not yet been explored in detail: that narrative competence of carers is required for maintaining or recreating dignity, and that dignity promotion in health care practice is primarily narrative in form. The multiple meanings that dignity has in a person’s life are what give the concept power and can only be captured by narrative. This has implications for health care practice where narrative work will be increasingly required to support patient dignity in under-resourced and over-subscribed health care systems.     

Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions

Background

Clinical practice guidelines have been a popular tool for the improvement of health care through the implementation of evidence from systematic research. Yet, it is increasingly clear that knowledge alone is insufficient to change practice. The social, cultural, and material contexts within which practice occurs may invite or reject innovation, complement or inhibit the activities required for success, and sustain or alter adherence to entrenched practices. However, knowledge translation (KT) models are limited in providing insight about how and why contextual contingencies interact, the causal mechanisms linking structural aspects of context and individual agency, and how these mechanisms influence KT. Another limitation of KT models is the neglect of methods to engage potential adopters of the innovation in critical reflection about aspects of context that influence practice, the relevance and meaning of innovation in the context of practice, and the identification of strategies for bringing about meaningful change.

Discussion

This paper presents a KT model, the Critical Realism and the Arts Research Utilization Model (CRARUM), that combines critical realism and arts-based methodologies. Critical realism facilitates understanding of clinical settings by providing insight into the interrelationship between its structures and potentials, and individual action. The arts nurture empathy, and can foster reflection on the ways in which contextual factors influence and shape clinical practice, and how they may facilitate or impede change. The combination of critical realism and the arts within the CRARUM model promotes the successful embedding of interventions, and greater impact and sustainability.

Conclusion

CRARUM has the potential to strengthen the science of implementation research by addressing the complexities of practice settings, and engaging potential adopters to critically reflect on existing and proposed practices and strategies for sustaining change.     

Effects of Clinical Preceptorship on Career and Practice Site Choices

To evaluate the effects of primary care preceptorships on the choices of career site and specialization, graduates of the University of Utah School of Medicine, 1972 through 1975, were questioned. Most practicing physicians who elected preceptorship training rated the experiences as valuable, but not important enough to be required. Physicians based their decisions for an urban practice on medical factors; rural areas were chosen more for personal reasons. In addition, data showed that the size of the respondents'' hometowns was not associated with their choice in the size of their practice site nor their specialty. Respondents also reported that their medical school training was deficient in preparing them for the economic and psychosocial aspects of medical practice. Many Utah graduates are participating as clinical faculty or as preceptors for medical institutions and indicated that for their particular communities family physicians, obstetricians-gynecologists and pediatricians are still needed.     

Norwegian Physicians' Knowledge of and Opinions about Evidence-Based Medicine: Cross-Sectional Study

Objective

To answer five research questions: Do Norwegian physicians know about the three important aspects of EBM? Do they use EBM methods in their clinical practice? What are their attitudes towards EBM? Has EBM in their opinion changed medical practice during the last 10 years? Do they use EBM based information sources?

Design

Cross sectional survey in 2006.

Setting

Norway.

Participants

966 doctors who responded to a questionnaire (70% response rate).

Results

In total 87% of the physicians mentioned the use of randomised clinical trials as a key aspect of EBM, while 53% of them mentioned use of clinical expertise and only 19% patients'' values. 40% of the respondents reported that their practice had always been evidence-based. Many respondents experienced difficulties in using EBM principles in their clinical practice because of lack of time and difficulties in searching EBM based literature. 80% agreed that EBM helps physicians towards better practice and 52% that it improves patients'' health. As reasons for changes in medical practice 86% of respondents mentioned medical progress, but only 39% EBM.

Conclusions

The results of the study indicate that Norwegian physicians have a limited knowledge of the key aspects of EBM but a positive attitude towards the concept. They had limited experience in the practice of EBM and were rather indifferent to the impact of EBM on medical practice. For solving a patient problem, physicians would rather consult a colleague than searching evidence based resources such as the Cochrane Library.     

Capturing real-life patient care in psoriatic arthritis and its risks: the challenge of analysing registry data

Studies based on registries continue to inform us of many relevant issues in the treatment of arthritic conditions and constitute more than just a supplement of clinical trial data. We can learn about long-term aspects of therapies beyond the scope of most clinical trials and about larger-scale toxicity. The downsides need to be considered in the interpretation of the results and include mainly the biases that are inherent when routine clinical practice is just observed and not steered by a protocol. However, using steered protocols in practice not only would facilitate post hoc analyses of clinical effectiveness, but (as we have learned from research in rheumatoid arthritis) can also improve outcomes of our patients.     

A university department's involvement with medical care in the Canadian North.

Both visiting consulting services and resident general practice services to the Churchill Health Centre in northern Manitoba are provided by the University of Manitoba through its northern medical unit. The roles of the university''s department of obstetrics and gynecology with regard to visiting consulting services include patient care, education and medical audit. This paper reviews the several aspects of this involvement over the period 1971 through 1977.     

Land use indicators in life cycle assessment

Purpose  

Inclusion of land use-related environmental aspects into LCA methodology has been under active development in recent years. Although many indicators have been developed and proposed for different aspects of land use (climate change, biodiversity, resource depletion and soil quality), many of indicators have, as yet, not been tested and compared in LCA applications. The aim of this study is to test the different LCIA indicators in practice in a case study of beer production.     

“环境工程微生物学”课程思政实践举措

课程思政在高校实现“三全育人”体系中发挥着重要的作用,是当前高校教学改革研究的热点之一。本文以环境工程专业“环境工程微生物学”课程为例,首先从课程思政元素发掘、提升教师课程思政能力、培养学生学习兴趣和重要保障等四方面对该课程思政开展具体实践;其次从提升学生课程思政理念、提高学生课程成绩及对全校课程思政的引领等方面展现课程思政的实践成效;最后结合教学实践对课程思政进行了讨论和展望。通过上述研究,以期为环境工程专业课程思政改革提供实践路径,为发挥专业课的育人机制提供参考。     

Re-embodying Sand Drawing and Re-evaluating the Status of the Camp: The Practice and Iconography of Women's Public Sand Drawing in Balgo,W.A.

The documentation of Aboriginal women's sand-drawing practice in Central Australia has to date been based largely on Munn's research amongst the Warlpiri at Yuendumu. Data from Kutjungka women from the Balgo area of Western Australia show that there are marked geographic differences in the styles of public sand drawing used by women from the two areas, as well as differences in gender coding between the two systems. The account of Balgo women's public sand drawing presented here uses methodologies grounded in recent developments in phenomenology, practice theory and embodiment theory, to examine layers of meaning encoded in this everyday practice. It suggests that women's public sand drawing in this area is linked to Kutjungka thought about the Dreaming, through webs of thought about the significance of penetrating the surface of the land, in some ways foreshadowing aspects of the women's ceremonial practices. This account suggests that the relationship between male and female ‘graphic’ systems may be more accurately described as dialogical than dichotomous.     

Whole Body Scanning in Medicine: I. Physical Aspects

Fundamental physical aspects of scanning the human body to determine in vivo radioisotope distribution are discussed, with special reference to the importance of collimator design and data display system. The pertinent details of a sensitive whole body scanner which has proved useful in clinical practice are described. The main features contributing to its versatility are: (1) fully automatic operation, (2) use of a 5″ diameter detector crystal with a focusing collimator, (3) provision to scale the scintiscan presentation to a convenient size, and (4) photographic recording of the scan.     

Inpatient Management: Variations in some Aspects of Practice in Scotland

Data for four aspects of inpatient management—namely, variations in length of stay, the time patients spend in hospital before or after operation, and the proportion of patients operated on in surgical units—show considerable variations in certain aspects of practice by Scottish consultants. It is suggested that there may be simple explanations for some of the observed variations. The differences could be due to great variation in the constraints encountered by the consultants in their work, or to wide differences of opinion about the optimum treatment for specific diagnoses.     

试论现代医院领导力的创新发展

领导力是现代医院实现创新转型的关键环节,其理论随着实践不断发展。文章分析了领导力的内涵和现代医院领导力的创新本质,并从组织文化、发展战略、信息化领导力和职业化管理四个方面探讨了领导力建设内容,并介绍了医院领导力建设成效以及下一步发展方向。     

Preregistration rotation including general practice at St Mary's Hospital Medical School.

A rotation for the preregistration year which included medicine, surgery, and general practice started at St Mary''s Hospital Medical School in August 1981. Initially approved by London University for an experimental period of three years, in 1984 it became an established rotation subject to normal review. Special arrangements were made for clinical work, supervision, prescribing, teaching, and other aspects of the general practice component. Data relating to the general practice consultations of the nine participating house officers show that they obtained wide experience, and their comments on the post itself were generally favourable. The four months spent in general practice were needed to allow time for the house officers to adapt to the new setting but did not seem to have an important effect on their experience in medicine and surgery.     

Preregistration house officers in general practice.

OBJECTIVES--To obtain from house officers who had rotated through general practice in their pre-registration year their views about their experience; and, separately, to compare the overall hours and type of work performed by hospital based and general practice based house officers. DESIGN--Postal questionnaire; and self recording of working hours and duties during four consecutive weeks. SETTING--Inner London teaching hospital and nearby general practice. PARTICIPANTS--28 preregistration house officers in general practice, 1981-91; and 12 preregistration house officers, four each in medicine, surgery, and general practice. RESULTS--26 out of 28 questionnaires were returned (response rate 93%). Twelve respondents were following or thinking of following a career in general practice. Twenty five respondents were satisfied with the clinical and educational aspects of the general practice rotation and would recommend the rotation, and 25 thought four months was about the right length of time in general practice. With regard to hours and type of work performed, hospital based house officers worked on average 55.5 hours a week (excluding on call), with an average of 12.5 hours (22.5%) spent in clinical activities; general practice based house officers worked about 41 hours a week, of which 24 hours (58%) were in clinical activities. House officers in hospital received less than one hour''s specific teaching a week; those in general practice received nearly three hours'' a week. CONCLUSIONS--A preregistration rotation in general practice is a popular alternative to the hospital based rotation. Although this is a limited study, other medical schools should consider introducing general practice options for preregistration house officers.     

Comparison of parents' expectations and importance ratings for specific aspects of childbirth.

We examined parents'' expectations of many aspects of the birth experience and compared them with the importance they attached to these aspects. Expectation was defined as a respondent''s rating that a given practice would be reality, and importance was defined as a respondent''s rating of the personal importance of a practice were all options possible. Subjects in the last 6 to 8 weeks of pregnancy were asked by their obstetricians to complete a questionnaire; 231 mothers and 227 fathers responded, for a response rate of 95%. In each of six subcategories parents'' importance ratings significantly exceeded their expectation ratings. Certain items were rated as relatively less important postnatally than prenatally and by multigravid women than by primigravid women. Parents'' perceptions of available options reflect consistent discrepancy with what they wish were possible. However, increased efforts to inform parents of existing options and to provide the rationale for specific practices may reduce the discrepancy between importance and expectations. This would in turn heighten the likelihood of a psychologically positive birth experience for parents.     

Obstetric audit using routinely collected computerised data.

OBJECTIVE--To examine the use of routinely collected computerised data in clinical audit. DESIGN--Retrospective review of all analyses of obstetric practice based on a computerised data system from January 1983 to June 1988. SETTING--Maternity department of the regional referral hospital in Oxford. MAIN OUTCOME MEASURES--Congruence with the principles of clinical audit; that is, comparing clinical practice with previously agreed standards and changing practice to meet these standards if necessary. RESULTS--Over the five and a half years of the study the data formed the basis of 130 special inquiries into different aspects of obstetric practice. Most inquiries seemed to be aimed only at describing current activities and identifying trends. Genuine clinical audit was rare. Simple audits--for example, concerning induction for pregnancy after term--could be supported by the computerised data, but for detailed and wide ranging audits--for example, reducing antenatal clinic visits for low risk multiparas--the data had to be supplemented from other sources. CONCLUSIONS--Routinely collected computerised data enable ongoing clinical audit, but it becomes a reality only when clinicians agree on standards of practice and have a flexible attitude towards change. Even then, genuine clinical audits of obstetric practice demand more detailed and comprehensive data than are generally available on such systems.     

Closure of a human tissue biobank: individual,institutional, and field expectations during cycles of promise and disappointment

Biobanks are increasingly being established to act as mediators between patient-donors and researchers. In practice, some of these will close. This paper details the experiences of one such bank. We report interviews with the bank's staff and oversight group during the period when the bank ceased biobanking activity, reconfigured as a disseminator of best practice, before then closing altogether. The paper makes three distinct contributions: (i) to provide a detailed account of the establishment, operational challenges, and eventual closure of the bank, which makes clear the rapid turnover in a cycle of promise and disappointment; (ii) to explore this in terms of a novel analytical focus upon field, institutional, and individual expectations; and (iii) to use this typology to demonstrate how, even after the bank's closure, aspects of its work were reconfigured and reused in new contexts. This provides a unique empirical analysis of the under-reported issue of biobank closure.     

大川河鱼类区系及其群落生态结构的研究

鱼类区系及其群落生态结构,在理论和实践上都有十分重要的意义。但是,关于鱼类区系的生态结构问题,还未见详细报道。本文通过对大川河鱼类区系及其群落生态结构的分析,探讨鱼类区系及其群落生态结构的规律。