秦汉"小儿医"略议

为了探讨秦汉时期“小儿医”方面的医学成就,通过文献梳理、解析的方法,研究认为:《汉书.艺文志》“经方十一家”著录《妇人婴儿方》;马王堆帛书《五十二病方》中可见针对“婴儿索痉”、“婴儿病间(痫)”、“婴儿瘛(瘈)”的病方;张仲景著《金匮要略方论》有《小儿疳虫蚀齿方》、《救小儿卒死而吐利不知是何病方》等;《史记.扁鹊仓公列传》关于名医淳于意的事迹,涉及二十多个病例,其中有医治“婴儿小子病”的记录;华佗医治的病例中,也有儿科疾病。看来,有学者以为“中国传统医学中的幼科或儿科,初萌唐宋”的意见,可以有所修正。     

Intersex Mental Health and Social Support Options in Pediatric Endocrinology Training Programs

ABSTRACT

The birth of a child with an intersex condition is often an emotionally stressful event for parents. Preparation and ongoing support systems could be beneficial to both parents and children and would alleviate some of the shame and isolation associated with intersex conditions. To assess the extent to which psychological support is available, a short e-mail survey on this topic was sent to the directors of 50 pediatric endocrinology fellowship training programs (PEFTPs), who are most likely to evaluate and treat intersex children and their parents. Of the 29 PEFTPs that responded, 69% offer psychological support and 58% have a mental health specialist on staff. However, only 19% of patients or families receive emotional support during diagnosis and only 15% receive support after diagnosis. We found two barriers that prevent patients and families from receiving psychological help from their intersex care team. First, there is a lack of training for mental health professionals regarding the needs of intersex patients and families. Second, some families refuse help even though it is offered. This study reveals that further research is needed to overcome these two barriers regarding mental health treatment of intersex patients and families.     

Examining the Experiences of Fathers of Children with a Life-Limiting Illness

Families who have a child diagnosed with a life-limiting illness (LLI) face substantial challenges resulting from the complexity and devastating impact of the condition and potential closeness of death. The experiences of fathers of a child with LLI have been understudied; therefore, this study explored the stresses, experiences, and strategies of these fathers, including their perceptions about support needs. Based on grounded theory, in-depth semi-structured interviews were conducted with 18 fathers of children with LLI. Six fathers had experienced the death of their child. The overarching themes were stresses, means of coping, and perceived needs for support. Generally, fathers in this study struggled relative to discursive and internalized notions of fathers as providers and protectors for their children, combined with an inability to ease their child’s vulnerability to LLI. Participants were engaged in the care of their child with LLI, but several felt marginalized by health care providers in care planning and staff/family communication. Some fathers recognized and valued their support network while others had few supports. Some described personal growth and desired to help other fathers. Practice implications and recommendations include renewed application of family-centered care, overcoming presumptions about fathers’ roles, and recognizing the impact of LLI beyond physical health.     

Mothers’ Experience of Post-Traumatic Growth in Pediatric Kidney Transplantation

ABSTRACT

Parenting a child with chronic kidney disease has a profound impact on the parental caregivers across social, emotional, and physical functioning. As the survival rates for children with chronic kidney disease increase, the demands on parents caring for these children intensify. The aim of this study was to understand the lived experience of being a mother of a child who has undergone kidney transplantation. Seven mothers caring for children with chronic kidney disease in Ontario, Canada participated in in-depth interviews that were analyzed according to the principles of hermeneutic phenomenology. The present study presents the findings concerning post-traumatic growth: personal strength, new possibilities, enhanced relationships, appreciation of life and spiritual change. Recognizing positive aspects of stressful situations and the potential for growth can impact the practice of social workers and other health-care professionals. Ultimately the assistance that is provided to parent caregivers can be improved with a better understanding of the whole experience.     

操作技能直接观察评价在儿科住院医师规范化培训中的应用

探讨操作技能直接观察评估(DOPS)在儿科住院规范化培训医师临床技能操作培训中的应用价值。选择32名儿科住院规范化培训医师为研究对象，随机分为观察组和对照组，观察组采用DOPS考核方法，对照组使用传统方法考核，比较两组学生在小儿骨髓穿刺术操作的培训效果。应用DOPS后，观察组成绩高于对照组(P<0.05)，其操作技术等项目成绩明显提高(P< 0.05)。DOPS可作为儿科住院规范化培训小儿骨髓穿刺术的考核方法，有助于提高学生临床操作能力。     

某市儿童专科医院门诊患儿家属满意度调查

对某市儿童专科医院278名门诊患儿家属进行问卷调查,分析其满意度、就医需求以便更好地改进儿科医疗服务。58.27%的患儿是首诊患者。患儿家属对于医务人员服务态度及就诊环境很满意、满意的合计比例均在85%左右。对各项费用评价为合理以及很合理所占比例均低于50%。50.36%的患儿家属选择有经验的年长医生,33.81%选择先上网查询医生信息再挂号,60.43%一发现儿童出现异常就去医院。挂号难、做检查排队人多是患儿家属在医院遇到的最常见问题。医院需进一步加强服务意识,完善网络宣传途径;政府需整合资源,进一步推进儿科医联体建设。     

从宋代“婴戏画”看政府社会对儿童健康的重视

以儿童形象、生活、健康、教育、游戏等为题材的"婴戏画"是中国画的重要组成部分,不但受到人们的青睐,而且融入了大量的社会、文化、卫生医疗信息。宋代是"婴戏画"繁荣发展的黄金时期,有大量"婴戏画"问世。从医学审视的角度,通过"婴戏画"之特殊媒体所表达的重子意识、重视健康及教育等内涵,探讨宋政府为保证儿童健康所制定的各项政策法令和儿科疾病防治体系,以及社会力量对儿童的体恤和关心。     

任务驱动结合叙事医学教学模式在儿科临床实习中的应用

临床实习教学是医学教学环节中的重要内容,是培养医学生临床分析思维能力和实践技能的重要环节.任务驱动教学模式正逐渐引入医学教育.随着现代生物心理社会医学模式转变,以人文情怀为主的叙事医学成为了文学与医学联系的一个着力点.     

Defining the Research Category in Pediatric Phase I Oncology Trials

Clinical research studies in children are classified by risk into three major categories. These are as follows: a) minimal risk studies, b) more than minimal risk studies but with benefit, and c) studies with minor increase over minimal risk but with no benefit.

Pediatric Phase I oncology trials, which are conducted in a highly vulnerable population of severely ill children with cancer, are designed to establish safety and to determine the maximum tolerated dose (MTD), as well as establish dose limiting toxicity (DLT). These types of studies can be associated with significant risk. The research design of such high- risk studies, which comprise short-term treatments with varying doses, is generally not associated with any clinical benefit. Classification of the research category in these pediatric studies poses a special problem for the Institutional Review Board (IRB) with major implications for the consenting process. The challenges associated with the classification of such studies are discussed in this article.     

Codifying explicit and tacit practitioner knowledge in community social pediatrics organizations: Evaluation of the first step of a knowledge transfer strategy

In this article, we the present the evaluation of the first phase of a KT initiative, the codification of the tacit and explicit knowledge of community social pediatrics (CSP) practitioners. As increasing numbers of professionals began working in the CSP field, it became necessary to capture the know-how to make it better understood. This first phase of the initiative took advantage of one of the KM stages, the codifying process that is absent from KT models. The evaluation aim to answer the question: “What is the CSPs practitioners level of familiarity with the codification document, as well as their perceptions of its utility and its contribution to the understanding of the CSP model”. The results, show that most respondents had consulted the codification document and were able to describe in detail parts of it. The results also show that they considered it to be a useful and necessary tool to guide practices and helpful in understanding the model. The results of this evaluation is paving the way for the next steps of the KT initiative.