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The dissection theatre of the future is already in routine operation 未来的解剖手术室已在常规操作中
Pub Date : 2021-01-01 DOI: 10.15761/hec.1000186
Franz A. Fellner
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引用次数: 0
Genetic approach in personalized medicine in type 2 diabetes 2型糖尿病个体化治疗的遗传方法
Pub Date : 2021-01-01 DOI: 10.15761/hec.1000188
A. Coppola, F. Pacifici, D. Pastore, D. Della-Morte, D. Lauro, G. Donadel
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by hyperglycemia commonly associated with insulin resistance at high risk of renal, neurological and cardiovascular complications. It is defined as a multifactorial etiology disease where genetic predisposition and lifestyle play an important role in pathophysiology and onset. Recently, genome wide association studies (GWAS) have been widely used to identify deregulated expression of T2DM related genes and genetic risk factors that can contribute, together with environmental and behavior factors, to T2DM onset. Since its dual feature, anti-diabetic effective therapy need to acknowledge the genetic contribution to T2DM pathophysiology. The pharmacological treatment of T2DM depends on blood glucose levels and/or glycated hemoglobin (HbAc1): well-compensated patients with normal HbA1c levels are, generally, treated with oral hypoglycemic drugs, such as metformin, associated with a diet that limits carbohydrate intake. Conversely, the uncompensated patient, with high levels of HbAc1 is generally treated with insulin or other new generation drugs or a combination of them. Given the multifactorial nature of T2DM, recent studies have identified personalized therapy as a powerful means to refine the effectiveness of the therapy itself, paving the way for precision medicine.
2型糖尿病(T2DM)是一种以高血糖为特征的慢性代谢性疾病,通常与胰岛素抵抗相关,伴有肾脏、神经系统和心血管并发症的高风险。它被定义为一种多因素病因疾病,遗传易感性和生活方式在病理生理和发病中起重要作用。近年来,全基因组关联研究(GWAS)被广泛用于鉴定T2DM相关基因和遗传风险因素的失调控表达,以及环境和行为因素对T2DM发病的影响。由于其双重特征,有效的抗糖尿病治疗需要认识到遗传对2型糖尿病病理生理的贡献。2型糖尿病的药物治疗取决于血糖水平和/或糖化血红蛋白(HbAc1):正常糖化血红蛋白水平的补偿良好的患者通常使用口服降糖药治疗,如二甲双胍,并结合限制碳水化合物摄入的饮食。相反,HbAc1水平高的无代偿患者通常使用胰岛素或其他新一代药物或它们的组合治疗。鉴于2型糖尿病的多因素性质,最近的研究已经确定个性化治疗是一种强有力的手段,可以提高治疗本身的有效性,为精准医疗铺平道路。
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引用次数: 0
How do clinical staff in a large metropolitan hospital respond to disclosures of family violence? 大型大都会医院的临床工作人员如何应对家庭暴力的披露?
Pub Date : 2021-01-01 DOI: 10.15761/hec.1000187
Nadine Rudd, K. Willis, K. Felmingham, Toni D Withiel, Caroline A. Fisher
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引用次数: 2
Final year medical and social worker student's socio-political & religious backgrounds compared to the general public: The person-in-the-professional 最后一年医学和社会工作者学生的社会政治和宗教背景与一般公众相比:专业人士
Pub Date : 2021-01-01 DOI: 10.15761/hec.1000189
C. Pritchard
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引用次数: 0
From clinical guidelines to clinical care -- employee involvement makes a positive difference to implementation. 从临床指南到临床护理,员工的参与对实施产生了积极影响。
Pub Date : 2020-08-14 DOI: 10.22541/au.159741542.25593058
L. Kleve, L. Skarstein, I. Elgen
Objectives Implementation of new knowledge into routine care is a complex endeavour. Involving employees in the change process, good planning and communication as well as a commitment to training has been highlighted as important factors for successful implementation. Acknowledging change as a process may also be helpful. The aim of this paper was to describe the initial phase of the implementation process in changing to evidence-based practisepractices within a child and adolescent mental health service. Method Prior to the five-year project, an external service evaluation was carried out. The employees expressed a need for a clear direction from management to guide their clinical practice. A vision and strategy for the service was developed. Employees participated in the process of developing clinical standards during the first phase of implementation. Results Fixsen’s four stage model and the PSDA circle were used to guide the implementation process. The employees developed a template for a clinical standard based on national and international clinical guidelines. During the period, 17 clinical standards were established and 10 new evidence-based methods were implemented. All service leads (13) and a group of senior clinicians (32) were invited to participate in an evaluation five years after the initial service evaluation. There was overall agreement that the mental health service was developing positively providing high quality services for children and adolescents. In addition, both groups agreed that the introduction of clinical standards was important in ensuring quality care. Conclusion Involving employees in the implementation process seemed to be an important factor in changing a mental health service.
目的将新知识应用于日常护理是一项复杂的工作。让员工参与变革过程,良好的规划和沟通以及对培训的承诺被强调为成功实施的重要因素。承认变化是一个过程也会有所帮助。本文的目的是描述在儿童和青少年心理健康服务中转变为循证实践的实施过程的初始阶段。方法在项目实施前,进行外部服务评价。员工们表示需要管理层给他们一个明确的方向来指导他们的临床实践。制定了该服务的远景和战略。在实施的第一阶段,员工参与了临床标准的制定过程。结果采用Fixsen四阶段模型和PSDA循环来指导实施过程。员工们根据国家和国际临床指南制定了临床标准模板。在此期间,制定了17项临床标准,实施了10项新的循证方法。所有的服务负责人(13名)和一组资深临床医生(32名)被邀请参加初步服务评估五年后的评估。人们普遍认为,心理健康服务正在积极发展,为儿童和青少年提供高质量的服务。此外,两组都同意引入临床标准对确保高质量的护理很重要。结论让员工参与实施过程是改变心理健康服务的重要因素。
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引用次数: 0
Tackling childhood obesity in the community using a participatory action research project with local children and young people 通过与当地儿童和青少年的参与性行动研究项目,解决社区儿童肥胖问题
Pub Date : 2020-01-10 DOI: 10.15761/HEC.1000169
K. Dharmarajah, M. Fawcett, S. Blackstock, A. Soni, M. Watson, M. Blair
Introduction: Co-production of health services is becoming more routine with young people but such involvement in research lags behind, especially in the field of health promotion research. Our aim was to co-design and test a community intervention with parents and children focused on changing lifestyle behaviours which might contribute to childhood obesity on a deprived local housing estate in London. Methods: Within the context of an established integrated care collaborative, we supported parent and child volunteers to co-design and deliver a health and well- being intervention for local children. This was in the form of a 6-week “sprint” of exercise and healthy living activities. The subsequent evaluation was carried out by two children who were trained in basic qualitative and quantitative research methods by us. They designed, conducted and analysed data from intervention participants with repeat follow-up and analysis at 2 years. Results : Twenty-six children were recruited with 12 completing the programme and 7 followed up for 2 years. Young people aged 12 and older universally felt they could communicate their views better in a focus group led by a local young person with established trust and agency. We observed the value of our peer evaluator’s contribution to the design process and their insights during analysis. Post programme there were improvements in physical activity and nutrition scores in participants using validated scores, and themes relating to healthy living which were retained at 2 years. Discussion: The use of participatory evaluation in a citizen-driven intervention allowed us to breakdown barriers such as ?? within hard to reach communities, as well as enabling more meaningful results. We have demonstrated the desirability and acceptability of participatory research with children and young people. This intervention also reinforces that small, community–designed and delivered initiatives have the power to effect behaviour change sustained at 2 years.
引言:与年轻人共同生产医疗服务正变得越来越常规,但这种参与研究的程度滞后,尤其是在健康促进研究领域。我们的目标是与父母和儿童共同设计和测试一项社区干预措施,重点是改变生活方式行为,这可能会导致伦敦一个贫困的当地住宅区的儿童肥胖。方法:在已建立的综合护理协作的背景下,我们支持家长和儿童志愿者共同设计并为当地儿童提供健康和幸福干预。这是一项为期6周的运动和健康生活活动“冲刺”。随后的评估由两名接受了我们基本定性和定量研究方法培训的儿童进行。他们设计、进行和分析了干预参与者的数据,并在2岁时进行了重复随访和分析。结果:招募了26名儿童,其中12人完成了该方案,7人随访2年。12岁及以上的年轻人普遍认为,在一个由当地年轻人领导的焦点小组中,他们可以更好地表达自己的观点,并建立信任和代理关系。我们观察了同行评估人员对设计过程的贡献的价值,以及他们在分析过程中的见解。项目结束后,参与者的体力活动和营养得分有所改善,使用了经验证的分数,以及与健康生活相关的主题,这些主题在2岁时保留下来。讨论:在公民驱动的干预中使用参与式评估使我们能够打破诸如??在难以到达的社区内,以及促成更有意义的结果。我们已经证明了儿童和青年参与性研究的可取性和可接受性。这种干预措施还强化了社区设计和实施的小型举措有能力在2年内实现行为改变。
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引用次数: 1
International medical graduates (imgs) in Canada and the Netherlands: Can the Dutch learn from Canadian experiences? A survey among academic stakeholders in Canada 加拿大和荷兰的国际医学毕业生:荷兰能从加拿大的经验中学习吗?加拿大学术利益相关者调查
Pub Date : 2020-01-10 DOI: 10.15761/HEC.1000170
P. Herfs, S. Bhuiyan
International Medical Graduates (non-Canadians with medical degrees obtained outside Northern America) often face challenges in securing employment as medical doctors when entering a new country. By exploring the policy of Canadian authorities in dealing with IMGs, the researchers tried to learn lessons for IMG policies in the Netherlands. In the Spring of 2016 a Dutch researcher specialized in migration of non-European doctors in the Netherlands visited selected medical schools in Canada (Quebec, Ontario, Alberta, British Columbia) and the Medical Council of Canada. The purpose of this visit was to explore the opportunities for International Medical Graduates (IMGs) to continue practice in their medical profession after migration to Canada. Canada is well known for the way it deals with highly skilled migrants. The research question was: What best practices or policies about IMGs in Canada could possibly be adopted by the Netherlands?
国际医学毕业生(在北美以外获得医学学位的非加拿大人)在进入一个新国家时,在确保医生就业方面经常面临挑战。通过探索加拿大当局处理IMG的政策,研究人员试图为荷兰的IMG政策吸取教训。2016年春季,一位专门研究荷兰非欧洲医生移民的荷兰研究人员访问了加拿大(魁北克、安大略、阿尔伯塔、不列颠哥伦比亚)的一些医学院和加拿大医学委员会。此次访问的目的是探索国际医学毕业生(IMG)在移民加拿大后继续从事医学专业的机会。加拿大以处理高技能移民的方式而闻名。研究问题是:荷兰可能会采用加拿大IMG的哪些最佳实践或政策?
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引用次数: 0
"7C" principle and "Alcohol" method towards persevering control of COVID-19 infection in China “7C”原则和“酒精”方法在中国持续控制新冠肺炎感染
Pub Date : 2020-01-01 DOI: 10.15761/HEC.1000171
Linghang Wang
2020 spring festival was and will be the most impressive festival to all Chinese people, due to the bitter memories but extraordinary courage to fight against the PHEIC announced by WHO on Feb 4th. Chinese scientists confirmed the pathogen in a very short time and Chinese government take enormous efforts to control the epidemic, locking down Wuhan and Hubei Province, dispatching thousands of medical doctors and nurses to Hubei to reduce the disease burden on local medical system. Many of them on the ground level work seven days a week without a break; the happy time accompanying with “alcohol” seems far away from their daily life, even COVID-19 cannot tolerate 75% ethanol.
2月4日,世界卫生组织宣布抗击国际关注的突发公共卫生事件(PHEIC),中国人民有了痛苦的回忆,却有了非凡的勇气,2020年春节过去并将是所有中国人印象最深刻的节日。中国科学家在很短的时间内确认了病原体,中国政府采取了巨大的措施控制疫情,封锁了武汉和湖北,派遣了数千名医生和护士前往湖北,以减轻当地医疗系统的疾病负担。他们中的许多人在基层每周工作7天,没有休息;与“酒精”相伴的快乐时光似乎离他们的日常生活很遥远,即使是COVID-19也不能忍受75%的酒精。
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引用次数: 0
Should didactic methods be subject of institutional policy? Reflections of a retired teacher 教学方法应该成为制度政策的主体吗?一位退休教师的感想
Pub Date : 2020-01-01 DOI: 10.15761/HEC.1000168
Jochanan Benbas
Background: Medical schools are replacing the traditional "teacher-centered" instruction that casts students as passive recipients of lectures by "learner-centered" methods that entail student involvement. Some schools have adopted learner-centered methods as institutional policy. Objective: To describe the author's teaching approaches at two Israeli medical schools in the 1970s - 1990s, and explore the pros and cons of a policy that requires from faculty to use a single teaching method. Observations: Students were interested in lectures that summarized clinical knowledge and in experiences aimed at imparting clinical skills . However, students appeared to be bored by lectures that they perceived as clinically irrelevant , or as preaching values . In such domains challenging small groups of students to cope with a specific task was more effective in achieving the learning objective. Implications: Different topics may require different teaching methods. The author proposes to familiarize faculty with the strengths and weaknesses of lectures, flipped classrooms, problem- and inquiry-based learning; develop guidelines for assessing the effectiveness of these teaching methods; and encourage faculty to choose the method with which they feel comfortable, and which they consider optimal for the subject to be taught.
背景:医学院正在用需要学生参与的“以学生为中心”的方法取代传统的“以教师为中心”的教学方式,这种教学方式使学生成为讲课的被动接受者。一些学校将以学生为中心的方法作为制度政策。目的:描述作者在20世纪70年代至90年代在两所以色列医学院的教学方法,并探讨要求教师使用单一教学方法的政策的利弊。观察:学生对总结临床知识的讲座和旨在传授临床技能的经验感兴趣。然而,学生们似乎对那些他们认为与临床无关或宣扬价值观的讲座感到厌烦。在这些领域,挑战学生小组来处理特定的任务在实现学习目标方面更有效。启示:不同的主题需要不同的教学方法。作者建议让教师熟悉授课、翻转课堂、问题型和探究型学习的优缺点;制定评估这些教学方法有效性的指导方针;并鼓励教师选择他们觉得舒服的方法,以及他们认为最适合该学科的教学方法。
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引用次数: 0
Knowledge, attitude and practice of Saudi citizens towards complementary and traditional medicine 沙特公民对补充医学和传统医学的知识、态度和做法
Pub Date : 2020-01-01 DOI: 10.15761/HEC.1000172
A. El-Olemy, Tamer Aboushanab, M. Alqaed
Background : The use of complementary and traditional medicine (C&TM) is rising among public around the world, and this epidemiological trend is attributed to diverse cultural belief systems. C&TM in the Kingdom of Saudi Arabia (KSA), like the rest of the world, is widely used among members of society. Objective: The aim of this study was to explore knowledge, attitudes and practice (KAP) of Saudi citizens towards C&TM. Methods : A cross-sectional study enrolled a random sample of 1116 Saudi citizens from different regions of KSA during January, 2020. Their responses were recorded on a self-designed and self-administered structured questionnaire consists of 14 questions. Results : 48% of the studied subjects reported that they have knowledge of the treatments used in C&TM. Herbal remedy, cupping, cautery, roquia and therapeutic medical massage were the commonest therapies used in the following order. 52% of participants relied on family and friends as a source of C&TM information, followed by the internet, study, reading and social media. 87% of community members reported that they didn’t have confidence in everything that is published on social media about C&TM. 82% of participants support the opening of C&TM clinics in primary health care centers. 47% of the society believes that awareness and educational campaigns about C&TM treatments are weak. 64% confirmed that they or one of their family members previously used one of the C&TM treatments, while 60% do not consult a specialist or pharmacist before using any of these treatments. 46% believe that C&TM is safe and medically effective, with 87% of individuals who have previously used C&TM reporting that they have not experienced any complications while using complementary therapies. 50% of participants indicated that C&TM helped treat some incurable diseases, most important of which are strokes, infections, joint pain, sciatica, bone fractures, and mental illnesses. Conclusion : Overall, majority of participants showed good knowledge and favourable attitudes towards T&CM along with its good practice. They rely on family and friends as a source of information. They reported that C&TM helped treat some incurable diseases. T&CM needs its integration into conventional medicine along with mandatory awareness and educational campaigns to further improve their KAP.
背景:在世界范围内,补充医学和传统医学的使用正在增加,这一流行病学趋势归因于不同的文化信仰体系。在沙特阿拉伯王国(KSA),与世界其他国家一样,C&TM在社会成员中广泛使用。目的:本研究旨在探讨沙特公民对C&TM的知识、态度和实践(KAP)。方法:一项横断面研究于2020年1月随机招募了来自沙特阿拉伯不同地区的1116名沙特公民。他们的回答被记录在一个由14个问题组成的自我设计和自我管理的结构化问卷上。结果:48%的研究对象报告说他们知道中医的治疗方法。草药、拔罐、烧灼、酒饮和医疗按摩是最常用的治疗方法。52%的参与者将家人和朋友作为C&TM信息的来源,其次是互联网、学习、阅读和社交媒体。87%的社区成员表示,他们对社交媒体上发布的关于C&TM的所有内容都没有信心。82%的参与者支持在初级卫生保健中心开设C&TM诊所。47%的社会人士认为,对中医治疗的认识和教育活动薄弱。64%的人证实他们或他们的一个家庭成员以前使用过一种C&TM治疗,而60%的人在使用任何这些治疗之前没有咨询专家或药剂师。46%的人认为C&TM是安全的,在医学上是有效的,87%以前使用过C&TM的人报告说,他们在使用补充疗法时没有出现任何并发症。50%的参与者表示,C&TM有助于治疗一些无法治愈的疾病,其中最重要的是中风、感染、关节痛、坐骨神经痛、骨折和精神疾病。结论:总体而言,大多数参与者对T&CM及其良好的实践表现出良好的知识和良好的态度。他们依靠家人和朋友作为信息来源。他们报告说,C&TM有助于治疗一些不治之症。T&CM需要融入传统医学,同时开展强制性的认识和教育活动,以进一步改善他们的KAP。
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引用次数: 3
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Health education and care
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