Research progress on psychotherapy for dental anxiety / 口腔疾病防治

@#Dental anxiety refers to the unique tension, worry and even fear of dental treatment, which may lead to patients refusing to receive treatment and missing the best time for treatment. With the development of bio-psycho-social medical models, psychotherapy has gradually become the optimal treatment for dental anxiety. This article reviewed the etiology, evaluation and psychotherapy of dental anxiety. Research has shown that uncomfortable dental treatment experience is the main cause of dental anxiety, which is commonly assessed using questionnaires in clinical practice. Psychotherapy for dental anxiety is a noninvasive, widely applicable treatment without side effects, mainly including improving the treatment environment and service attitude, behavior therapy, and cognitive therapy, which has been shown to effectively alleviate dental anxiety in patients. However, psychotherapy for dental anxiety is highly demanding for dentists, which hinders its promotion and application. At the same time, the psychotherapeutic mechanism of dental anxiety is not clear and remains to be further elucidated by large-scale and high-quality randomized controlled studies.

Una aproximación al modelo médico hegemónico como representación social del colectivo enfermero / An approach to the hegemonic medical model as a social representation of the nursing collective

El artículo reporta la tesis doctoral de uno de los autores cuyo objetivo fue describir percepciones de licenciados en enfermería respecto del modelo médico hegemónico (MMH) y su relación con la gestión de enfermería. La investigación tuvo enfoque hermenéutico, nivel descriptivo, y diseño transversal. Se utilizó un muestreo voluntario de 93 licenciados en enfermería cursantes de posgrado en una universidad privada Argentina, que se desempeñan en organizaciones sanitario-asistenciales del Área Metropolitana de Buenos Aires. Se aplicó un análisis cualitativo de contenido, coherente con el método comparativo continuo de la Teoría Fundamentada. Se hallaron 26 categorías perceptuales que dan cuenta de la presencia del MMH en las organizaciones sanitario asistenciales. Estos hallazgos, constituyen un avance en el conocimiento de los modos mediante los cuales el MMH es percibido por licenciados en enfermería, y confirmaron una variedad de aportes teóricos previos sobre el mismo, así como sobre las representaciones socialesAU.

The article reports the doctoral thesis of one of the authors whose objective was to describe the perceptions of nursing graduates regarding the hegemonic medical model (HMM) and its relationship with nursing management. The research had a hermeneutic approach, descriptive level, and transversal design. A voluntary sample of 93 graduate nursing students in a private university in Argentina who work in health care organizations in the Metropolitan Area of Buenos Aires, was used. A qualitative content analysis wasAU.

Application of narrative medical model in communication with cancer patients with low education level / 四川精神卫生

ObjectiveTo investigate the application value of narrative medical model in communication with cancer patients with low education level. MethodsRetrospective analysis was performed on 80 cancer patients with low education level who were hospitalized in West China Hospital of Sichuan University from March 2019 to April 2020. They were randomly divided into control group （n=40） and observation group （n=40）. The control group received conventional nursing intervention， while the observation group received narrative medical nursing mode intervention. Both groups received intervention for 6 months. The Self-rating Anxiety Scale （SAS）， Self-rating Depression Scale （SDS）， Morisky Medication Adherence Scale （MMAS-8）， Social Support Rating Scale （SSRS） and self-designed knowledge of the disease and cognition questionnaire were used for evaluation before and after intervention. ResultsAfter intervention， the SAS and SDS scores of observation group were lower than those of control group （t=7.493， 8.314， P<0.01）. After intervention， medication compliance of observation group was higher than that of control group （χ2=4.012， P=0.045）. SSRS subscale score and total score were higher than those in control group （t=2.198， 7.548， 2.664， 4.248， P<0.05 or 0.01）. After intervention， the mastery rate of knowledge about the disease and the excellent and good rate of cognitive behavior in observation group were higher than those in control group （χ2=4.588， 5.541， P<0.05）. ConclusionThe narrative medical model is of certain application value in communication with cancer patients with low education level. It can better improve the patients’ negative emotions， social support， and knowledge and cognition of the disease.

Violencia en la formación médica / Violence in Medical Training

Resumen: El propósito del trabajo es aportar elementos de análisis que ayuden a comprender, de una manera más amplia, la violencia dentro de la formación médica, ya que la mayoría de los trabajos sobre el tema se enfocan en las consecuencias de esta, por ejemplo, las afecciones físicas y psicológicas de los hechos violentos sobre el médico en formación. El artículo parte de los conceptos de violencia propuestos por Galtung, quien identifica la violencia directa, la estructural y la cultural. Después se describe el modelo médico hegemónico como escultor de la cultura médica y su efecto sobre la práctica médica y la enseñanza de la medicina. Posteriormente, se puntualiza sobre el habitus médico y el currículum oculto, como elementos de la cultura médica; el primero considerado como una forma de pensamiento de ese personal que justifica el uso de la violencia; y el segundo, como aquel aprendizaje sobre la estructura, la organización y la función de las instituciones de salud. Después se nombran las características de las instituciones como espacios donde se cristaliza una práctica médica organizada de manera rígida, jerárquica y vertical, y nos detenemos en el conflicto trabajador-estudiante. Todas ellas son, en conjunto, condiciones necesarias para la aparición de la violencia directa en la formación médica.

Abstract: The purpose of this work is to provide elements to understand, in a broad way, the violence within medical training, since most of the work on the subject focuses on its consequences: for example, the physical and psychological conditions of violent acts in the medical training. The article begins with the concept of violence proposed by Galtung, that points out direct violence, structural violence and cultural violence. Then, it describes the hegemonic medical model as a sculptor of medical culture and its effect on medical practice and medical education. Afterwards, it describes the medical habitus and the hidden curriculum, two elements of the medical culture. The first one refers to how the medical personnel justifies the use of violence, the second one refers to what is taught about the structure, organization and function of the health institutions. Then, the article reviews the characteristics of the health institutions as spaces where an organized medical practice is crystallized in a rigid, hierarchical and vertical manner. We then focus on the worker/student conflict. These conditions are necessary for the appearance of direct violence in the medical training.

Mística, yerbas santas y solidaridad: memoria del cuidado no médico de la lepra en Agua de Dios / Mystique, Holy Herbs and Solidarity: Memory of Non-Medical Care of Leprosy in Agua de Dios / Mística, ervas santas e solidariedade: memória do cuidado no médico da lepra em Agua de Dios

Resumen Introducción: La representación social de la lepra como una enfermedad del pasado, el carácter local que la circunscribe a los sanatorios y el escaso contacto de trabajadores de la salud foráneos con la enfermedad hace pensar que el conocimiento sobre su cuidado ha circulado entre generaciones de una manera más o menos confinada. Ese saber que incorpora no solo conocimiento biomédico, sino expresiones en saberes, creencias, prácticas, relatos, los actores que las construyen y recrean y su relación compleja con las dinámicas de inserción en el territorio, se constituye hoy, en sí mismo, en un patrimonio vivo, que merece ser narrado. Desarrollo: Se parte de comprender la memoria de los cuidados no médicos de la lepra en Agua de Dios, por medio de un estudio etnográfico, cuyos resultados permiten proponer dos expresiones. La primera involucra a agentes de salud no médicos y su relación con los sujetos de cuidado; que muestra que el cuidado demanda no solo conocimiento científico, sino también disposiciones particulares de los sujetos, como capacidad de escucha, observación, paciencia y trascendencia, acompañadas de un posicionamiento y negociación cotidianos en el territorio. La segunda está compuesta por las alternativas de cuidado intermediadas por otros agentes con saberes autorizados, que agrupan una amplia farmacopea relacionada con el uso de plantas medicinales, referencias a curanderos y prácticas solidarias de tutoría entre pacientes y relaciones de su bienestar con el medio ambiente. Conclusiones: Todas estas expresiones de cuidado desafían los discursos y prácticas canónicas de la biomedicina alrededor de esta enfermedad.

Abstract Introduction: The social representation of leprosy as a disease from the past, its local character that circumscribes it to the sanatoria, and the scarce contact of health workers with it suggest that the knowledge about its care has circulated between generations more or less confined. This confined knowledge, which incorporates not only biomedical knowledge but also expressions in knowledge, beliefs, practices, stories, the actors that construct and recreate them and their complex relationship with the dynamics of insertion in the territory in a living heritage, deserves to be narrated. Development: We begin by understanding the memory of the non-medical care of leprosy in Agua de Dios, through an ethnographic study, whose results allow us to propose two expressions of these. The first one, involving the non-medical health agents (especially nurses) and its relationship with care subjects, showed that this demands particular dispositions from the subjects as listening ability, observation, patience, and transcendence, accompanied by daily positioning and negotiation in the territory. The second is the care alternatives mediated by other agents with authorized knowledge that group a wide pharmacopeia related to the use of medicinal plants; references to healers and solidarity practices of mentoring between patients and relationships of their well-being with the environment. Conclusions: All these expressions of care challenge the discourses and canonical practices of biomedicine around this disease.

Resumo Introdução: A representação social da lepra como uma doença do passado, seu carácter local que a circunscreve aos sanatórios, e o escasso contato de trabalhadores da saúde estrangeiros com a doença, faz pensar que o conhecimento sobre seu cuidado, tem circulado entre gerações de uma maneira mais ou menos confinada. Esse saber "confinado", que incorpora não só conhecimento biomédico, senão expressões em saberes, crenças, práticas, relatos, os atores que as constroem e recriam e sua relação complexa com as dinâmicas de inserção no território, constitui-se hoje em si mesmo, em um patrimônio vivo, que merece ser narrado. Desenvolvimento: Partimos de compreender a memória dos cuidados não médicos da lepra em Agua de Dios, através de um estudo etnográfico, cujos resultados nos permitem propor duas expressões destes. A primeira que envolve agentes de saúde não médicos e sua relação com os sujeitos de cuidado, mostrou que esta demanda não só conhecimento "científico", mas também disposições particulares dos sujeitos como capacidade de escuta, observação, paciência e transcendência, acompanhadas de um posicionamento e negociação cotidianos no território. A segunda a constituem as alternativas de cuidado intermediadas por outros agentes com saberes "autorizados" que agrupam uma ampla farmacopeia relacionada com o uso de plantas medicinais; referências a curandeiros e práticas solidárias de tutoria entre pacientes e relações de seu bem-estar com o meio ambiente. Conclusões: Todas estas expressões de cuidado, desafiam os discursos e práticas canónicas da biomedicina ao redor desta doença.

Experience in circumcision of children aged 3-6 years under the intervention of modern holistic medical model / 国际外科学杂志

Objective Under the intervention of modern holistic medical model,the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years.Methods A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017.The patients were divided into control group and experimental group by completely randomized grouping,there were 1 006 cases in each group.The children in the control group were treated with a single biomedical model,which was completed according to the conventional flow-type operation.The children in the experimental group adopted the modern holistic medical model,and the full modern holistic medical model intervention was performed before,during and after the operation.The medical treatment process highlighted the overall humanistic care for the children.The age of the control group was (4.19 ± 1.75) years old,and the age of the children in the experimental group was (4.26 ±1.68) years old.The operation time,the degree of surgical pain [with the pain visual analogue scale (VAS)],the postoperative complications (including postoperative hemorrhage,penile edema,infection,wound rupture),wound healing time,surgery satisfaction rate and fear level of children were compared between the two groups.Measurement data were expressed as mean ± standard deviation (Mean ± SD),t-test was used for comparison between groups;Chi-square test was used to compare the count data.Results In the control group,the operation time was (9.26 ± 1.87) min,the surgical pain VAS was (2.59 ±0.72),postoperative bleeding was 38 (3.8％),severe penile edema was 78 (7.8％),and infection was 12 (1.2％),wound rupture was 32 cases (3.2％),the wound healing time was (20.4 ± 2.56) d,and the surgical satisfaction rate was 67.4％.In the experimental group,the operation time of was (6.15 ± 1.23) min,the surgical pain VAS was (1.71 ± 0.54),postoperative bleeding was 6 cases (0.6％),severe penile edema was 12 cases (1.2％),and infection was 8 cases (0.8％),wound rupture was 2 cases (0.2％),the healing time was (15.2 ± 3.16) d,and the operation satisfaction rate was 98.8％.The operation time,surgical pain VAS,postoperative bleeding,severe penile edema,wound splitting rate,healing time and surgical satisfaction rate were statistically significant (P ＜ 0.05),and there was no statistical difference in wound infection rate between the two groups (P ＞ 0.05).The fear level of children in the experimental group was superior to the control group at levels 0,1,2 and 3,the difference was statistically significant (P ＜ 0.05).Conclusions Under the intervention of modern holistic medical model,the child's operation process is smooth,the children and parents have good subjective feelings,no obvious fear,good compliance,high satisfaction,good objective clinical effect,and positively improve the relationship between doctors and patients.The society has won a good reputation and deserves to be promoted clinically.

Experience in circumcision of children aged 3-6 years under the intervention of modern holistic medical model / 国际外科学杂志

Objective@#Under the intervention of modern holistic medical model, the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years.@*Methods@#A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017. The patients were divided into control group and experimental group by completely randomized grouping, there were 1 006 cases in each group. The children in the control group were treated with a single biomedical model, which was completed according to the conventional flow-type operation. The children in the experimental group adopted the modern holistic medical model, and the full modern holistic medical model intervention was performed before, during and after the operation. The medical treatment process highlighted the overall humanistic care for the children. The age of the control group was (4.19±1.75) years old, and the age of the children in the experimental group was (4.26±1.68) years old. The operation time, the degree of surgical pain [with the pain visual analogue scale (VAS)], the postoperative complications (including postoperative hemorrhage, penile edema, infection, wound rupture), wound healing time, surgery satisfaction rate and fear level of children were compared between the two groups. Measurement data were expressed as mean±standard deviation (Mean±SD), t-test was used for comparison between groups; Chi-square test was used to compare the count data.@*Results@#In the control group, the operation time was (9.26±1.87) min, the surgical pain VAS was (2.59±0.72), postoperative bleeding was 38 (3.8%), severe penile edema was 78 (7.8%), and infection was 12 (1.2%), wound rupture was 32 cases (3.2%), the wound healing time was (20.4±2.56) d, and the surgical satisfaction rate was 67.4%. In the experimental group, the operation time of was (6.15±1.23) min, the surgical pain VAS was (1.71±0.54), postoperative bleeding was 6 cases (0.6%), severe penile edema was 12 cases (1.2%), and infection was 8 cases (0.8%), wound rupture was 2 cases (0.2%), the healing time was (15.2±3.16) d, and the operation satisfaction rate was 98.8%. The operation time, surgical pain VAS, postoperative bleeding, severe penile edema, wound splitting rate, healing time and surgical satisfaction rate were statistically significant (P<0.05), and there was no statistical difference in wound infection rate between the two groups (P>0.05). The fear level of children in the experimental group was superior to the control group at levels 0, 1, 2 and 3, the difference was statistically significant (P<0.05).@*Conclusions@#Under the intervention of modern holistic medical model, the child′s operation process is smooth, the children and parents have good subjective feelings, no obvious fear, good compliance, high satisfaction, good objective clinical effect, and positively improve the relationship between doctors and patients. The society has won a good reputation and deserves to be promoted clinically.

Future development of evidence based traditional Chinese medicine:flat way to truth and kindness / 中国中药杂志

The three elements in evidence-based clinical decisions are " best clinical research evidence,physicians' personal experience,and patients' basic values and wishes". This concept coincides with the " bio-psycho-social" model of systematic medicine,and this is the key reason why evidence-based medicine has become the most important diagnostic and therapeutic system under the new medical model. However,there is no methodological support for the implementation of " respecting patients' basic values and wishes".As a result,this concept is difficult to be implemented in clinical practice,and has become the form of " patient or family member' s signature for consent". In narrative medicine,doctors are advocated to record details,psychological processes and even family members' feelings in non-technical language to form parallel medical records,and the key point is to achieve " empathy" between doctors and patients. This idea is consistent with traditional Chinese medicine( TCM),and also provides a practical operation method " to respect patients' basic values and wishes". Medicine is a discipline based on human science,with dual attributes of science and humanity. Humanistic care is the tradition of TCM,and also is one of the basic characteristics and core connotations in TCM. Therefore,in the development of evidence-based TCM,we should combine evidence-based medicine with narrative medicine,and inject humanistic care into evidence-based medicine with the concept and methodology of narrative medicine,so as to achieve the deep integration of science and humanity.

Exploration into the medical model of medical alliances specialized in chronic wounds / 中华医院管理杂志

This paper rounded up the resources and advantages leveraged by the hospital′s burn and plastic surgery department as a national key discipline. The department practiced medical services for chronic wounds in the regional hierarchical medical system for chronic wounds to promote the development medical alliances. IT development of the hierarchical medical network has achieved disease information sharing, namely centralized patients screening, patients referral confirmation, mutual recognition of test results, online consultation and treatment follow-up. Other achievements include standardization of medical criteria for chronic wounds by means of effective integration of resources imbalance within the network and improvement of internal medical regulations; elevation of primary level innovation capacity and services by means of high-caliber specialists working at primary institutions and mutual exchanges in between; effective medical cost control via guarantee system building, thus enhancing the public benefit nature of public hospitals. The paper also probed into problems and solutions expected in the way of promoting the chronic wound hierarchical medical system.

Exploration and practice of "combination of general practice with specialties" model in community health service institutions / 中华全科医师杂志

Community health service is an important part of the health system reform in the new period in China,the community health service institutions play important roles in promoting the health reform and the development ofthe national medical and health service.Shanghai Fenglin Subdistrict Community Health Service Center has integrated general practice with specialist care for the patients in community health service,this article summarizes the exploration and practice of the "combination of general practice with specialties" model in the community health service in order to provide reference for relevant medical institutions.

The application of 3D printing technique on the medical field / 中国医学装备

Numerous applications for three-dimensional (3D) printing are extended rapidly and expected to revolutionize manufacturing industry, as well as the various aspects of medical field. This paper summarizes the domestic and overseas literatures on 3D printing used in medical field, and shows several advantages of 3D printing technique in the application of medicine. The 3D bio-printing technique, however, still need time to be evolved. In addition, the orderly and efficient development of 3D printing within the medical field will ultimately depend on the formulation of relevant policies and regulations and ongoing evolution of technique itself, and it still need carry out more in-depth research and exploration for functional human tissue and organ with 3D printing.

Disputas inter-capitalistas, biomedicalización y modelo médico hegemónico / Disputas inter-capitalistas, biomedicalização e modelo médico hegemônico / Inter-capitalistic disputes, biomedicalization and hegemonic medical model

Este artículo se sitúa en el campo de estudio de los procesos productivos y de la transición tecnológica en el cuidado de salud. Examina la entrada del capital financiero en el sector salud y sus disputas con el complejo médico-industrial. Avanza en la comprensión de cómo los sectores capitalistas, que lideran la reestructuración productiva en salud, apuestan a la potencia de los procesos de creación de nuevas subjetividades en la transformación y consolidación del actual modelo médico hegemónico y en la producción/reproducción de modos de agenciamientos capitalísticos. Usamos el concepto de biomedicalización para entender la radicalización del proceso de medicalización, concepto que se viene mostrando insuficiente para comprender los cambios observados. Comprender estos fenómenos facilita reconocer resistencias y líneas de fuga que posibilitan apuestas no mercantilistas en salud, creadoras de autonomía y valorización de la vida individual y colectiva.

Este artigo situa-se no campo de estudo dos processos produtivos e da transição tecnológica da produção do cuidado em saúde. Examina a entrada do capital financeiro no setor saúde e suas disputas com o complexo médico-industrial. Avança na compreensão de como os setores capitalistas, que lideram a reestruturação produtiva na saúde, apostam na potência dos processos de criação de novas subjetividades na transformação e consolidação do atual modelo médico hegemônico e na produção/reprodução dos modos de agenciamentos capitalistas. Usamos o conceito de biomedicalização para entender a radicalização do processo de medicalização, que vem se mostrando insuficiente para compreender as mudanças observadas. A compreensão desses fenômenos facilita reconhecer resistências e linhas de fuga, que possibilitam apostas não mercantilistas na saúde, criadoras de autonomia e valorização da vida individual e coletiva.

This paper is situated on the field of study of the working/productive process and the technological transition in health care. It examines the entrance of financial capital groups in the health sector and their struggles with the medical-industrial complex. It puts forward a comprehension of how the capitalist sectors, leaders of the restructuration of the working process in health, bet on the power of the creation of new subjectivities in order to transform and consolidate the current hegemonic medical model and the production/reproduction of the ways of the capitalism's agency role. We use the concept of biomedicalization to understand a radical stage of medicalization, a commonly used concept, albeit insufficient to understand the observed changes. The comprehension of these phenomena allows the recognition of resistances and "lines of flight" that could allow for non-mercantilist options in health, which may create autonomy and reinforce the value of individual and collective life.

La jibarización del logos: cómo el reduccionismo médico puede matar / The jibarization of logos: how medical reductionism can kill

Resumen: En las últimas décadas se ha desencadenado una verdadera proliferación disciplinar y subdisciplinar tanto en el ámbito médico como en la ciencia en general. Esta tendencia podría ser parcialmente explicada por dos hechos diacrónicos e interconectados dialécticamente: la profundización de la división técnica, social e internacional del trabajo del mundo capitalista globalizado, y el triunfo del Programa Reduccionista, desarrollado principalmente por el empirismo lógico del Círculo de Viena. El presente trabajo tiene por objetivo ahondar el debate sobre los intrincados vínculos entre la medicina, la biología, la filosofía, el reduccionismo y el pensamiento complejo, a partir de la utilización de dos ejemplos: un informe de caso de la medicina actual y la situación experimentada por un afamado científico norteamericano, Stephen Jay Gould, a propósito de su primer cáncer, un mesotelioma abdominal. Hemos observado cómo los dos hechos históricos mencionados han venido operando como una súper estructura de ''pinza'', descuartizando y comprimiendo al mismo tiempo al objeto a conocer, a las teorías que permiten su estudio y al propio sujeto que recibe el conocimiento. Esta jibarización del logos constituye un verdadero problema para la salud pública desde el momento en que impacta, omnipresente, en el modelo médico hegemónico actual, propiciando actitudes potencialmente peligrosas para los diversos integrantes de los sistemas de salud.

Abstract: In recent decades, a disciplinary and subdisciplinary proliferation has triggered both in the medical fields and science in general. This trend may be partially explained by two diachronic, dialectically interconnected facts: the deepening of technical, social and international division of labor in the globalized capitalist world, and the triumph of the reductionist program, mainly developed by the logical empiricism of the Vienna Circle. This paper aims to deepen the debate on the intricate links between medicine, biology, philosophy, reductionism and complex thought, by using two examples: a case report of current medicine and the situation experienced by a famous American scientist, Stephen Jay Gould, about his first cancer, an abdominal mesothelioma. We have witnessed how the two above-mentioned historical facts have been operating as a super-structure like a pair of ''tweezers'', dismembering and compressing at the same moment the object of knowledge, the theories that allow their study, and the subject that receives the knowledge. This jibarization of logos is a real problem for public health, from the moment that it impacts, omnipresent, in the actual hegemonic medical model, leading to potentially dangerous attitudes to the various components of health systems.

Medical Integration from the Perspective of Humanistic Medicine:The Inevitability and the Leading Role of Holistic Integrated Medicine / 中国医学伦理学

Humanistic medicine is the contemporary essential characteristics of medicine,which is different from the ancient and modern medicine.The basic modality of humanistic medicine is integration,and the implementation of bio-psycho-social medical model is the basic content of humanistic medicine integration.Holistic integrated medicine is a clear understanding of the comprehensive modality of humanistic medicine,and leads and promotes the integration of humanistic medicine.The continuous improvement of the theoretical framework of holistic integrated medicine and its implementation in practice will promote the development of health care.

Improving humanistic knowledge for a new medical model / 基础医学与临床

With the economic development of science and technology advance,medical model,as the total understanding of health and disease at a certain historical period,has undergone several different phases:spirtualism medical model,mechanistic medical model,Biological Medical Model and biological-psychological-social medical model.Under the background of biologic and psychogenic society medicine,the professional quality of contemporary doctor faces new requirements and challenges.This article discusses the necessity,importance and approaches of intensifying research on humanistic knowledge which adapts to the transformation of medical model.

Practice Nursing Students' Professional Ethics Education: the Era Call in the Rise of Modern Medical Model / 中国医学伦理学

This paper discussed the reason of the rise of modern medical model and specially analyzed the necessity and urgency of strengthen the professional ethics education of the practice nursing students under modern medical model from four aspects.On this basis,this paper put forward the following path for optimizing the professional ethics education of the practice nursing students.It should formulate the standard of teachers scientifically and improve the system of reward and punishment.It should establish the class of professional ethics education and make professional ethics education run through the process of clinical practice to cultivate their good professional ethics.It should cultivate three kinds of consciousness and one idea of nursing student,so as to prompt them to provide patients quality service.

Discussion on the Training Mode of the Humanistic Quality of Applied Talents in Medical Colleges / 中国医学伦理学

Throughin-depth study and thinking ofthe current situation of medical education,this paper exploredtraining strategies of applied talents in medical colleges under the new situation.From the training ofapplication talents in medical colleges under new situation,we should focus on the current reality,learn experience.Combined with the characteristics of medical specialty,we should explore the model of strengthening the humanistic quality moral training of current medical application talents from the curriculum,teaching content selection,teachers' construction,environment shaping,teaching methods,assessment and evaluation,and thus to adapt to the medical mode conversion,alleviate the doctor-patient contradiction and promote medical students employments.

Problematizando o conceito de deficiência a partir das noções de autonomia e normalidade / Questioning the concept of disabilitybased on the notions of autonomy and normality

Resumo Trata-se de um estudo teórico conceitual para pensar a deficiência e alguns conceitos-base que são manejados para a caracterização da mesma. O objetivo do artigo é ampliar o olhar sobre a deficiência retirando-a de uma descrição que a reduza à doença. Para tanto, situamos historicamente os Disabilty Studies apresentando os Modelos Médico e Social da Deficiência e problematizamos os conceitos de autonomia e normalidade. Estes conceitos e seus correlatos – independência, funcionalidade e norma – são utilizados como fundamento tácito para diferenciar algumas variações corporais que são identificadas como estilos de vida diferentes de outras que são, muitas vezes, denominadas de deficiências. Concluímos afirmando que a deficiência pode ser analisada a partir de outras chaves de leitura que não a colocam como sinônimo de doença se considerarmos as noções de interdependência, normatividade e criação de si no mundo como conceitos básicos para descrevê-la.

Abstract This is a conceptual theoretical study to reflect upon disability and some basic concepts that are involved in its profiling. The scope of the article is to broaden the outlook upon disability removing it from a description that reduces it to an ailment. For this purpose, we situated the Disability Studies historically presenting the Medical and Social Models of Disability and problematized the concepts of autonomy and normality. These concepts and their correlated aspects – independence, functionality and the norm – are used as a tacit touchstone to differentiate some bodily variations that are identified as different lifestyles from others that are often called disabilities. We conclude by stating that disability can be analyzed based on other interpretations that do not construe it as a synonym for ailment if we consider the notions of interdependence, normativity and creation of the self in the world as basic concepts to describe it.

A New Theoretical Medical Model: The Four Dimensional Model.

Under the guide of the medical models, we clearly know the nature of many diseases. However, a lot of complicated diseases, the polygenic and multi-factorial diseases for example, are remained unexplained. Here, we proposed a new medical model, namely the Environment - Genetic - Homeostasis maintenance system (HMS) - Time medical model, which integrated four essential factors (environmental factor, genetic factor, HMS and time factor) of diseases together that can clearly clarify any diseases in form. Here, HMS is referred to the system involved in the maintaining of human homeostasis which is essential to the survival of a person and acts at the level of cell, tissue, organ and human body as a whole. Time factor mainly concerns age of people and duration of diseases. The integrative effects of the three factors decide the health status (disease, pre-disease, or health) of human body. As time goes, the possibility of catching a disease (determined by environments, genetics, and HMS) also dynamically changed. The model can fully explain pathogenesis of all diseases and health, and can be widely used in early diagnosis, treatment, prevention, and many aspects of any diseases. Therefore, it may change the modern medicine at many aspects.

"The cardiovascular professional graduate education on the base of ""Double Heart"" medicine edu-cation" / 中华医学教育探索杂志

The cardiovascular disease, accompanied by psychological disorder frequently, often re-quiresphysical and mental (double heart) treatment. The clinical teaching of cardiovascular graduate stu-dents is very important for cultivating qualified cardiovascular doctors. According to present situation, we improved the diagnosis rate and the doctor-patient communication skills by the strengthening of learning thedouble heart theory, the analysis ofdouble heart typical cases, and the clinical practice of double heart medical model. Accordingly, we enhanced the consciousness of double heart, which is helpful to reducing the conflicts between doctors and patients, promoted the rational use of medical resources, and fi-nally promoted the application ofdouble heartmedical model in clinical practice.