Thoughts on Pediatric Chinese Patent Medicines Based on Clinical Application Characteristics / 中国实验方剂学杂志

The common diseases in pediatrics department include respiratory diseases, digestive diseases, immune system diseases, and skin system diseases. Bronchitis, bronchial asthma, pneumonia and other respiratory diseases are common pediatric diseases, mainly with the symptoms of fever, cough, and runny nose, and are mostly related to children's physical weakness. Pediatric digestive diseases mainly include anorexia, vomiting, diarrhea and constipation. Skin system diseases mainly include tinea diseases such as tinea capitis, tinea pedis, and tinea corporis, allergic diseases such as urticaria and eczema, scorpions, sunburn and other skin diseases. Children are special groups for drug use, as their body is in the stage of growth and development and their organs are not yet mature, with strong susceptibility to disease, low stress ability, and not sensitive to drug reactions. Therefore, special requirements shall be noticed on the drug use and dosage. Children are the future of the country, but we have so many problems in pediatric drug use. It is worth pondering about pediatric drug use. Chinese patent medicine is a traditional Chinese medicine preparation in the forms of pills, powder, cream, pellet, and oral liquid, which is processed according to the laws and prescriptions of traditional Chinese medicine and the rule of syndrome differentiation and treatment experience, mostly of a compound preparation. This is the essence of medical practice after thousands of years of experience. At present, the commonly used dosage forms for Chinese patent medicine are tablets, pills, capsules, oral liquids and powders. Pediatric Chinese patent medicines have the advantages of mild nature, ease of use, stable content, controllable dose-effect, and exact curative effect, so they are widely used in clinical applications. In order to ensure the effectiveness and safety of pediatric Chinese patent medicine, we should strictly grasp some considerations on pediatric Chinese patent medicine due to the particularity of pediatric patients. This paper would analyze the problems in the application of pediatric Chinese patent medicines and the corresponding countermeasures to improve the accessibility of pediatric medication.

Vivencias de los pasantes de enfermería, en la resolución de problemas clínicos / Experiences of unregistered nursing graduates while solving clinical problems / Vivências dos estagiários de enfermagem, na resolução de problemas clínicos

Objetivo: Comprender las vivencias de los pasantes de enfermería, en la resolución de problemas clínicos, a través de su descripción e interpretación. Métodos: Estudio cualitativo, descriptivo e interpretativo, tradición fenomenológica, método fenomenológico, técnica: Entrevista semiestructurada a profundidad a 8 pasantes de enfermería asignadas a un Hospital de Sinaloa, México; instrumento: Guía de entrevista, selección de participantes: Intencional hasta saturación teórica, carta de consentimiento informado y protección de la intimidad y confidencialidad, con base en el Código de Ética de las y los enfermeros de México y Declaración de Helsinki. Análisis de contenido tipo temático de acuerdo a Souza Minayo, del que emergieron 4 categorías. Resultados: Del análisis se seleccionó la categoría "Resolver problemas, un arte profesional", con las subcategorías: a) Incertidumbre y ambigüedad en la identificación y resolución del problema; b) Percepción del problema como caso único; c) Presencia de conflicto de valores en la resolución del problema, y d) Saber práctico, aprender al observar, reflexionar y hacer. Conclusiones: Al inicio del servicio social, los pasantes de enfermería muestran dificultad no solo para identificar y solucionar problemas clínicos, sino para comprender el significado de resolver problemas desde su conceptualización. Sin embargo, a punto de concluir su servicio social, empieza a emerger en ellos el arte de la enfermería, puesto que ya son capaces de identificar y dar solución a situaciones de cuidados que se presentan en los pacientes.

Objective: Through their own description and interpretation to understand the experiences of unregistered nursing graduates while solving clinical problems. Methods: This is a qualitative, descriptive and interpretative study. With a phenomenological tradition and method, this study uses in-depth structured interviews on eight unregistered nursing graduates assigned to a hospital in Sinaloa, Mexico. The main instrument is the interview guide. The selection of participants was intentional until theoretical saturation was reached. Based on the Nurses Ethics Code of Mexico, and also on the Helsinki Declaration, participants were given informed consent documentation as well as protection of their intimacy and confidentiality. From a thematic type content analysis which was aligned with Souza Minayo guidelines, four categories emerged. Results: From the category "Problem solving, a professional art" four sub-categories were proposed: (a) uncertainty and ambiguity while identifying and solving a problem; (b) perception of the problem as a unique case; (c) presence of conflict of values during the resolution of the problem; and (d) practical knowledge-learning while watching, realizing and doing. Conclusions: At the beginning of their social service, unregistered nursing graduates show difficulties, not only to identify and solve clinical problems, but also to understand the meaning of solving the problems based on their own conceptualization. However, as they near the end of their social services, the art of nursing gradually emerges from them as they manifest better performances at identifying and solving the diverse care situations of their patients.

Objetivo: Compreender as vivências dos estagiários de enfermagem, na resolução de problemas clínicos, a través de sua descrição e interpretação. Métodos: Estudo qualitativo, descritivo e interpretativo, tradição fenomenológica, método fenomenológico, técnica: entrevista semiestruturada a profundidade a oito estagiários de enfermagem assignados a um Hospital de Sinaloa, México, instrumento: Guia de entrevista, seleção de participantes: intencional até saturação teórica, carta de carta de consentimento informado e proteção da intimidade e confidencialidade, com base no Código de Ética das e dos enfermeiros do México e a Declaração de Helsinki. Análise de conteúdo tipo temático de acordo a Souza Minayo, da qual emergiram as quatro categorias. Resultados: Da análise selecionou-se a categoria "Resolver problemas, uma arte profissional", com as subcategorias: a) Incerteza e ambiguidade na identificação e resolução do problema, b) Percepção do problema como caso único, c) Presença de conflito de valores na resolução do problema, e d) Saber prático, aprender observando, refletir e fazer. Conclusões: No início do estágio, os estagiários de enfermagem mostram dificuldade não só para identificar e solucionar problemas clínicos, senão para compreender o significado de resolver problemas desde sua conceptualização. Porém, quase por concluir seu estágio, começa a emergir neles a arte da enfermagem, visto que já são capazes de identificar e dar solução a situações de cuidados que se apresentam nos pacientes.

Teaching and Assessing Clinical Reasoning Skills.

Clinical reasoning is a core competency expected to be acquired by all clinicians. It is the ability to integrate and apply different types of knowledge, weigh evidence critically and reflect upon the process used to arrive at a diagnosis. Problems with clinical reasoning often occur because of inadequate knowledge, flaws in data gathering and improper approach to information processing. Some of the educational strategies which can be used to encourage acquisition of clinical reasoning skills are: exposure to a wide variety of clinical cases, activation of previous knowledge, development of illness scripts, sharing expert strategies to arrive at a diagnosis, forcing students to prioritize differential diagnoses; and encouraging reflection, metacognition, deliberate practice and availability of formative feedback. Assessment of clinical reasoning abilities should be done throughout the training course in diverse settings. Use of scenario based multiple choice questions, key feature test and script concordance test are some ways of theoretically assessing clinical reasoning ability. In the clinical setting, these skills can be tested in most forms of workplace based assessment. We recommend that clinical reasoning must be taught at all levels of medical training as it improves clinician performance and reduces cognitive errors.

Introduction of Problem-Based Preclerkship Clinical Training in Internal Medicine / 医学教育

To increase the safety and effectiveness of clinical clerkships, we have developed a 4-week preclinical training program, “Problem-Based Clinical Training, ” based on the concept of problem-based learning with the aim of encouraging life-long self-directed learning. The first week is a preparation period for clinical practice in which students are trained in problem-solving skills, basic-practice skills, and clinical reasoning. The second and third weeks are a practical training period in which students learn how be in charge of a patient's care. The fourth week was a problem-solving period without practical training in which students learned to solve problems. The students were encouraged to record daily “problem notes” describing problems and “problem solving notes” summarizing problems solved. To emphasize lessons learned, the students also presented and discussed problems. Evidence-based medicine was used as a tool for problem solving. Furthermore, medical record training based on the problem-oriented system using evaluations by other students encouraged self-development to improve clinical practice and the medical record. This curriculum should be effective for mastering the skills of self-directed learning and for motivating for advancement due to consideration of contributable proposals for the patients.