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Las fisuras labio-máxilo-palatinas (FLMP) son malformaciones congénitas que requieren de un manejo quirúrgico complejo para devolver un correcto funcionamiento del sistema estomatognático. Sin embargo, aún no existe un consenso sobre qué modalidad quirúrgica representa los mejores resultados y sus efectos a largo plazo en el desarrollo esqueletal y funcional de los individuos. El objetivo de este trabajo fue describir mediante la información científica disponible; el efecto de los diferentes protocolos quirúrgicos para el cierre de la FLMP sobre el crecimiento y desarrollo esqueletal de los pacientes. Se realizó una búsqueda de la literatura en bases de datos Pubmed, Cochrane y Epistemonikos, contemplando estudios desde el año 2013 hasta la actualidad. Se obtuvieron un total de 999 estudios encontrados. Una vez aplicados los criterios de inclusión y exclusión, se seleccionaron 13 estudios. El tratamiento quirúrgico de las FLMP consiste en procedimientos complejos que implican alteraciones en el desarrollo esqueletal de los individuos intervenidos a largo plazo. Las discrepancias en el desarrollo esqueletal de los pacientes empiezan a detectarse durante la dentición mixta. Es recomendable extender el seguimiento hasta la etapa de la pubertad y adultez, ya que podría demostrar diferencias significativas entre las diferentes cronologías quirúrgicas empleadas.
Cleft Lip and Palate (CLP) belong to a group of congenital anomalies that require complex surgical management, in order to restore the normal function of the stomatognathic system. However, there is no consensus that determines which surgical technique is better according to its outcomes and long- term effects on the skeletal and functional development of treated individuals. The objectives of this study are To describe, using the available scientific information, the effect of the different surgical protocols regarding CLP closure, on the skeletal and functional development patients undergoing surgery. A research of the available information was made in three different databases: PubMed, Cochrane and Epistemonikos. This research included articles released since the year 2013 onwards. A total of 999 studies were found. Once exclusion and inclusion criteria were applied, 13 studies were selected. Surgical treatment of CLP consists of complex procedures which imply long-term skeletal alterations in undergoing patients. These skeletal discrepancies are first detected during the mixed dentition phase. It is recommended to extend patient follow-up up until puberty and adulthood, as it might demonstrate significant differences among the different surgical approaches.
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RESUMEN Este artículo tiene como objetivo describir las distintas formas de percibir el cuerpo como territorio en mujeres que ejercen la prostitución en el sector de La Veracruz en Medellín (Colombia) a partir de sus narrativas. Este corresponde a un estudio cualitativo de nivel descriptivo enmarcado en el paradigma interpretativo hermenéutico y el método fenomenológico clásico. Para la recolección de la información se emplearon como técnicas una entrevista semiestructurada y la cartografía social. Los datos se analizaron a través de un proceso de codificación que permitió la identificación de categorías emergentes con apoyo del software Atlas Ti. Los resultados muestran que desde la visión que tienen las mujeres que ejercen la prostitución es posible percibir el cuerpo como un espacio que está integrado por lo emocional, lo conductual, lo expresivo y lo vivencial que se reconoce así mismo como un territorio que puede ser habitado y cambiante, que la historicidad de este y los conflictos que le atraviesan, le permiten ser reconocido como una herramienta de lucha, constancia e interpretación.
ABSTRACT The article aims to describe the different ways of perceiving the body as territory in women who practice prostitution in the sector of La Veracruz in Medellín (Colombia) from their narratives. This corresponds to a qualitative study of a descriptive level framed in the hermeneutic interpretive paradigm and the classical phenomenological method. For the collection of information, a semi-structured interview and social cartography were used as techniques. The data was analyzed through a coding process that allowed the identification of emerging categories with the support of the Atlas Ti software. The results show that from the vision that women who practice prostitution have, it is possible to perceive the body as a space that is integrated by the emotional, the behavioral, the expressive and the experiential that recognizes itself as a territory that can be inhabited. and changing, that the historicity of this and the conflicts that go through it, allow it to be recognized as a tool of struggle, perseverance and interpretation.
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INTRODUCCIÓN: La siguiente revisión bibliográfica se realizó con el propósito de reconocer las características clínicas y radiográficas que deben ser evaluadas para el diagnóstico de las reabsorciones radiculares externas incluyendo también sus tratamientos. METODOLOGÍA: Se llevó a cabo una búsqueda en las bases de datos MEDLINE/PubMed, Cochrane Library y Google Scholar bajo el término , incluyendo estudios experimentales y revisiones bibliográficas desde 2010 a 2022 en español e inglés, incluyendo finalmente 17 artículos. RESULTADOS: Los resultados obtenidos señalaron que cada tipo de reabsorción radicular externa presenta características clínicas específicas que las diferencian. Estas diferencias son: para la reabsorción externa inflamatoria la vitalidad pulpar negativa; para la reabsorción externa de reemplazo la ausencia de movilidad y percusión metálica; para la reabsorción externa cervical una coloración rosada de la corona; la reabsorción externa superficial no presenta ningún tipo de sintomatología clínica y la reabsorción de colapso apical transitorio presenta un cambio de coloración transitorio. CONCLUSIÓN: Las reabsorciones radiculares externas requieren un diagnóstico preciso y temprano. Se debe realizar un examen clínico con énfasis en sondaje, coloración, movilidad y pruebas de vitalidad.
INTRODUCTION: The following bibliographic review was carried out with the purpose of recognizing the clinical and radiographic characteristics that must be considered in the diagnosis of external root resorption, including treatments. METHODS: A bibliographic search was carried out in PubMed/Medline, Cochrane Library and Google Scholar databases under the term "external root resorption", from 2010 to 2022 in Spanish and English. Experimental studies and bibliographic reviews were selected, and finally 17 articles were included. RESULTS: The results obtained indicated that each type of resorption presents specific clinical characteristics that differentiate them, these are: for external inflammatory resorption a negative pulp vitality; for replacement external resorption the absence of mobility and metallic percussion; for cervical external resorption a pink coloration of the crown; superficial external resorption does not present any type of clinical symptoms and transient apical collapse presents a transient change in color. CONCLUSION: External root resorptions require accurate and early diagnosis. A clinical examination should be performed with emphasis on the following: probing, coloration, mobility, and vitality tests.
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Humanos , Resorción Radicular/terapia , Resorción Radicular/diagnóstico por imagenRESUMEN
Maintaining the continuity of the 'self' is crucial for finding meaning and ensuring psychological well-being. However, the traumatic encounter with cancer disrupts the normal flow of life stories, challenging coherence. Beyond its physical toll, cancer challenges one's sense of self, identity and overall psychological resilience. As personal narratives unfold, encompassing evolving life stories from one's reconstructed past to the present and envisioned future, inherently reflecting the dynamic conception of self, it becomes imperative to investigate how these narratives shape self-concept and resilience throughout the intricate emotional and psychological landscape of the cancer journey. This narrative review explores the intricate relationship among personal narratives, self-concept and psychological resilience in the context of cancer. The study draws on various theoretical constructs, encompassing self-concept, coping, narrative identity, and psychological resilience theories, to provide a comprehensive exploration of the psychological processes involved. Incorporating insights from both Western and Indian philosophical traditions, the review not only enriches the theoretical framework but also emphasizes the practical implications for healthcare practices. Integrating narrative resilience principles into medical education and advocating for culturally sensitive approaches are deemed essential for advancing patient-centred care. The study underscores both practical and theoretical contributions to psycho-oncology, emphasizing the need for personalized narrative interventions, empathetic healthcare strategies, longitudinal studies and innovative technologies that recognize and support the intricate interplay between personal narratives, self-concept and psychological resilience in the cancer survivorship journey.
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Objective To explore the impact of the three-level assistance model based on the narrative nursing theory on the mental health status of medical staff.Methods 140 medical staff working in a third class hospital in Xiangyang City were selected as the research object.The three-level assistance model based on narrative nursing theory was used to intervene them from September 2021 to July 2022.The symptom self-assessment scales before and after the intervention were compared.Results Before the intervention,the total score of SCL-90(156.37±32.56)points and the scores of various symptom factors of medical staff were higher;After the intervention,the total score of SCL-90(133.35±43.48)points and the scores of various symptom factors were lower than those before the intervention and the difference was statistically significant(P<0.05).Conclusion The three-level assistance model based on narrative nursing theory can reduce the total score of SCL-90 and the scores of various symptom factors,improve the mental health status and mental health level.
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BackgroundNarrative exposure therapy （NET）， an integration of narrative therapy and exposure therapy， has been shown to be effective in relieving the symptoms of post-traumatic stress disorder （PTSD）， which can help patients gain a deeper understanding of their trauma and is also considered to be quite safe. PTSD is highly prevalent in children and adolescents， while the effectiveness of NET intervention varies among the subjects. ObjectiveTo systematically evaluate the effectiveness of NET for PTSD in children and adolescents， so as to provide references for the clinical application of NET. MethodsOn August 1， 2022， the Cochrane Library， PubMed， Web of Science， CINAHL， China National Knowledge Infrastructure （CNKI）， SinoMed， VIP and Wanfang database were searched from their inception to June 2022. Search was conducted with the use of a combination of medical subject heading and free text terms， and randomized controlled trials relevant to NET for PTSD in children and adolescents were collected. Then the quality of the controlled trials was evaluated according to the Cochrane Collaboration's tool for assessing risk of bias （2011）， and Meta-analysis was performed using RevMan 5.4 software. ResultsNine randomized controlled trials involving 394 children and adolescents with PTSD were included. Meta-analysis showed that NET and relaxation therapy reported comparable symptom relief in PTSD patients within 1 to 3 months after intervention （SMD=0.22， 95% CI： -0.84~1.28） and at 6 months after intervention （SMD=0.21， 95% CI： -0.75~1.17）， while NET provided greater PTSD symptom relief than routine therapy both within 1 to 3 months after intervention （SMD=-0.66， 95% CI： -1.04~-0.27） and at 6 months after intervention （SMD=-0.77， 95% CI： -1.36~-0.19）， with statistically significant differences. Regarding the alleviation of depressive symptoms， the effect was similar between NET and routine therapy within 1 to 3 months after intervention （SMD=-0.39， 95% CI： -0.98~0.21） and at 6 months after intervention （SMD=-0.74， 95% CI： -2.23~0.75）. No statistical difference was demonstrated between NET and routine therapy in relieving psychological distress （SMD=-0.54， 95% CI： -2.14~1.07） and suppressing hyperorexia （SMD=-0.17， 95% CI： -0.54~0.19） 1 to 3 months after intervention. ConclusionNET yields a better outcome and a medium- and long-term effectiveness in alleviating symptoms of PTSD in children and adolescents compared with routine therapy， while it does not offer any significant advantages in improving depression symptoms， psychological distress and hyperorexia.
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By integrating the concept of narrative medicine and relevant models and tools into the Doctor-patient Communication course， this paper expounds the connotation of narrative medicine under the context of “new medicine” and “big health” and the practical significance of the shift to narrative in Doctor-patient Communication course in three aspects： academic frontier， social needs and practical needs. This paper analyzes the four dimensions of innovation that narrative medicine， as the frontier of the discipline， historical accumulation， educational philosophy and professional skills， provides for the Doctor-patient Communication course， and explores the effective path to realize the narrative transformation of the course. It is expected to achieve the purpose of forging students’ humanistic medical skills and literacy through teaching innovation， realizing the coordination of medical education and competency orientation， adapting to the psychological and social increase， the change of people and health， and promoting the reform of the supply side of medical talents.
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In Can Xue’s novel Barefoot Doctor，a group of barefoot doctors and their medical environment are constructed，which is different from the historical reality.It is a romantic projection of this profession under new orientalism and the imagination and depiction of ideal medical practices.In this world，barefoot doctor is an attractive profession that coexists harmoniously with patients and the environment，co-creating a beautiful and meaningful life. The novel mirrors Can Xue’s view of nature. Analyzing the novel by the narrative medicine framework proposed by the Peking University narrative medicine team， it is found that the philosophy and the ways of doctoring of the barefoot doctors in the novel reveal a naturalist view of medicine， which is also the embodiment of the ideals of the medical humanities.
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De Xin Ji Medical Case， in a narrative and discussion manner， emerged the doctors’attention to the temporal aspect of life， the shaping of personality， the promotion of plot and the intersubjectivity and ethics of treatment， as well as displayed rich storytelling characteristics. Based on the perspective of doctors， the author Xie Xinghuan conducted multiple-dimensional narrative reflections from perspectives of the relationship between doctors and patients and society， patient compliance， as well as self-medical behavior， which presented the doctor’s introspection and deep understanding of human nature. By depicting the interactive details between the characters， the medical case showed the relationship between doctors and patients， doctors and other doctors， and doctors and disciples， which not only contained the core connotation of narrative medicine， but also highlighted the unique cultural attributes of traditional Chinese medicine diagnosis and treatment.
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In the context of Chinese narrative medicine， narrative foreclosure is an abnormal state in the process of life narrative， which is the “fractured or stagnation of the life narrative process”. Based on analyzing the characteristics and performance of typical traumatic narrative foreclosures in literary works and clinical reality， this paper proposed that narrative care is of great significance for the traumatic subject to get out of narrative foreclosures and re-enter the narrative process of mental and physical comfort. “Narrative care” is a way of care in which medical staff or educator in health institutions use their narrative capital and narrative wisdom to establish interpersonal narrative connections with themselves， their families， and service or education recipients， so as to nourish subjects in narrative foreclosure and help them get out of life’s dilemmas. Narrative caregivers assist the traumatic subjects in gaining the restorative power to repair the fractured narrative process of life through the construction of a narrative community， getting out of isolation， achieving growth， and restoring overall health.
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Objective@# To evaluate the intervention effectiveness of broken window effect combined with narrative nursing on non-suicidal self-injury (NSSI) in adolescents, so as to provide the basis for NSSI prevention in adolescents.@*Methods@#Totally 134 adolescents with NSSI admitted to Mental Health Center of the Affiliated Hospital of Anhui West Health Vocational College from January 2022 to December 2023 were enrolled and randomly assigned into the control and treatment group. All were given narrative nursing and routine care, and the adolescents in the treatment group were given additional intervention based on broken window effect. The effects were evaluated using Self-Rating Depression Scale (SDS), Hamilton Depression Scale (HAMD), Self-Rating Idea of Suicide Scale (SIOSS), Ottawa Self-injury Inventory-Functions (OSI-F) and Nursing Satisfaction Scale, and the two groups were compared before and after intervention.@*Results@#The treatment and control groups comprised 67 cases each, had a median age of 14.12 (interquartile range, 2.01) years and 14.10 (interquartile range, 1.52) years, included 71.64% and 68.66% girls, and 79.10% and 74.63% junior high school students, respectively. There were no statistically significant differences between the treatment and control groups in terms of gender, age or educational level (all P>0.05). The results of analysis of variance for repeated measures showed that there were interactions between time and group for SDS, HAMD and SIOSS scores (all P<0.05), and the decrease in scores before and after intervention was greater in the treatment group than in the control group. After intervention, the SDS, HAMD, SIOSS score and incidence of suicidal behaviors in the treatment group were all lower than the control group [SDS: (32.54±1.27) vs. (44.25±2.23); HAMD: (10.54±1.83) vs. (18.73±1.89); SIOSS: (10.37±2.20) vs. (15.76±1.62); incidence of suicidal behavior: 14.93% vs. 32.84%; all P<0.05]. The nursing satisfaction rate was significantly higher in the treatment group than in the control group (98.51% vs. 88.06%, P<0.05).@*Conclusion@#The broken window effect combined with narrative nursing would improve the depressive symptoms in adolescents with NSSI, and reduce the suicidal ideation and self injury.
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By reviewing the research context of narrative medicine in China in the past five years and sorting out the development status of narrative medicine in clinical practice in China, this paper pointed out the reasons why narrative medicine is difficult to implement in clinical practice in China at present. It mainly includes three points: the awareness of narrative medicine within the clinical medical community is not high; the humanities community focuses on the development of narrative medicine in medical education, resulting in rather scarce research on narrative medicine based on clinical practice; the research objects of narrative medicine are too narrow, ignoring the importance of the public and the front-line clinical personnel in the clinical practice of narrative medicine. Accordingly, this paper proposed corresponding countermeasures: it is advocated to investigate the awareness of narrative medicine in clinical medicine and the public, and it is suggested to list them as important objects of narrative medicine education. At the same time, it is recommended that the relationship between narrative medicine and doctor-patient communication should be clarified theoretically to guide the construction of a harmonious doctor-patient relationship in clinical practice.
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On the whole, the Yi Xue Cong Zheng Lun written by Jing Xian, a famous doctor in modern Liaoning, outlines the unique vision of the narrative medicine focusing on "benevolence". To be specific, the writing is good at constructing narrative projection, and makes full use of the essence of relevant traditional culture such as the body-country integration idea, the military strategy and tactics and the calligraphy aesthetics concept to create narrative schema. It focus on the concrete example narration of the cultural ideology of Traditional Chinese Medicine(TCM), such as the concept of interlinked viscera, the ideology that the characteristics of the treatment remain the same as the external properties of the disease, the compatibility of opposite and complementary and the idea of making prescriptions and selecting optimal Chinese herbal medicines. In addition, Jing Xian has constructed his professional identity as a doctor of TCM through in-depth narrative reflection. From the perspective of narrative medicine, the study of Yi Xue Cong Zheng Lun has certain instruction and reference significance in the inheritance of TCM culture, and can help to promote the in-depth exploration and multi-dimensiona reflection of "modern Liaoning TCM culture".
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Death is the last transitional rite in the life process. Whether for the life state, family ethics or social relations of both the dead or the living, death indicates a major change and hides a certain crisis. The bio-health narrative concept puts forward that any transitional rite of life process requires narrative intervention and narrative care, as does death. Under the guidance of the concept, the profession of narrative death-doula came into being. Using the narrative concept as a framework, hospice narrative doulas provide emotional, physical, mental support to the terminal stage subjects and their families by accompanying the dying at close range, listening to their life stories, helping them record and dictate their autobiographies, reconstructing and repairing interpersonal narrative connections, and even planning funeral details with the dying. The death narrative doulas will create a personalized and humanized ritual and process around death, restore the spirituality and humanity which has been lost in the modern medical context to death itself.
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Narrative competence is one of the factors to reflect humanistic literacy of doctors and nurses. According to the advice of many experts, the narrative competence should be improved from the stage of medical students through the two major tools including close reading of text and reflective writing. Based on the background of prevention and control of COVID-19 outbreak, this paper aimed to clarify the focus and methodology of close reading and reflective writing, that was, close reading was supposed to focus on the analysis of disease metaphors in classic literature and narrative function in clinical works and realism works, and writing tended to focus on the the differentiation of writing purpose and the writing guidance in different texts. The proper guidance plus solid training in close reading and writing will definitely lay a strong foundation for medical students in achieving humanistic quality.
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In recent years, through the research and practice of narrative education, certain results have been achieved.The application of narrative education has become an inevitable trend. In recent years, through the research and practical development of narrative education, some results have been achieved. In order to make narrative education not only meet the needs of contemporary nursing students, but also conform to the development of today’s nursing field, we should effectively cultivate the narrative ability of nursing professionals and promote effective communication between nurses and patients. Make up for the shortcomings of traditional teaching, and create a teaching model that is in line with the characteristics of Chinese social culture and nursing specialty; Improve the evaluation method and index system to test the effect of narrative education; Strengthening the educational scheme of theoretical knowledge and practical narration; Developing narrative education mode combining with evidence-based nursing in nursing teaching.
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With the rapid development of modern biomedicine, subjective factors such as human emotion and disease experience are diluted. Accurate data, programmed diagnosis and treatment process and other objective factors cut off the effective communication between doctors and patients, aggravating the already tense doctor-patient relationship and intensifying various conflicts in the clinic. In order to improve clinical humanistic care, medical and nursing workers have launched reflections and explorations. Narrative medicine is a new form of medical humanistic practice, while parallel chart, as an important way of its practice, records patients’ subjective experiences and painful feelings. It is of great theoretical significance and clinical value to sinicize narrative medicine and construct and promote parallel chart in Traditional Chinese Medicine (TCM) by studying the research progress of parallel chart in China and its application in TCM.
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OBJECTIVE To explore the effects of narrative pharmacy management on medication compliance， negative emotions， and quality of life in patients with cardiovascular disease complicated with negative emotions. METHODS A total of 49 patients with drug use problems and negative emotions attending the cardiovascular pharmacy clinic of Wuhan First Hospital from February to August 2023 were selected as the study objects， narrative pharmacy model was applied for patient management during their visits； pharmaceutical care and emotional management were performed after 2 weeks of treatment and a follow-up visit was conducted to evaluate and record the management effect one month later. RESULTS Adopting a narrative pharmacy management model， 49 patients were involved in 114 drug related consultation questions. Compared with the visit， after one month of management， the number of medication types taken by patients significantly decreased [4.00 （2.00， 6.00） vs. 3.00 （1.50， 5.00）， P＜0.05]， the incidence of adverse reactions significantly decreased （32.65% vs. 2.04%， P＜0.001）， the rate of blood pressure and lipid compliance significantly increased （30.61% vs. 95.92%， P＜0.001）， and the score of the patient’s medication compliance significantly improved （[ 3.94±2.44） vs. （6.78±2.07）， P＜0.01]. The depression score significantly decreased [3.00 （2.00， 4.50） vs. 2.00 （0.00， 3.00）， P＜0.001]， the anxiety score significantly reduced [3.00 （2.00， 4.50） vs. 1.00 （0.00， 2.00）， P＜0.001]， quality of life score was significantly improved [22.00 （19.00， 22.00） vs. 23.00 （23.00， 24.50）， P＜0.01]. In the satisfaction survey， there was a slight increase in the overall satisfaction proportion （91.84% vs. 97.96%， P＞0.05）. CONCLUSIONS The application of narrative pharmacy in cardiovascular pharmacy clinic can improve patient compliance， reduce adverse drug reactions， enhance the effectiveness of drug treatment， avoid drug interactions， effectively improve the anxiety and depression， and ultimately improve the quality of life.
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Objective:To investigate the medical narrative competence of pediatric staff, and analyze its influencing factors and correlation with psychological resilience, and to discuss strategies to improve narrative competence.Methods:From January 11 to February 25, 2022, by convenience sampling, we sampled pediatric personnel and those on refresher training at Children's Hospital, Zhejiang University School of Medicine for a questionnaire survey involving general information, the narrative competence scale, and the 14-item resilience scale. With the use of SPSS 26.0, the narrative competence of different populations was compared, and factors affecting narrative competence were determined through Pearson correlation analysis and multiple regression analysis.Results:A total of 361 valid questionnaires were included in this study, and there was significant differences in the narrative competence score between different ages, professional titles, working years, income levels, and whether they wrote parallel charts ( P<0.05). The total score of narrative competence of pediatric staffs was (147.13±18.76), and positively correlated with the total resilience score and the score of each dimension ( P≤0.001). The regression analysis showed that writing parallel charts and resilience could explain 53.10% of the variation in narrative competence ( P<0.001). Conclusions:Pediatric staff's narrative competence is at low or intermediate levels. Parallel chart writing and resilience training can improve narrative competence and promote a harmonious doctor-patient relationship.
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ObjectiveTo explore the influencing factors of anticipatory grief among family caregivers of terminal-stage cancer patients，and provide a reference for formulating intervention programs for anticipatory grief. MethodsAn interview outline was designed，and the descriptive qualitative research method was used.The aim was to select 11 family narrative caregivers of patients in the Department of Medical Oncology，Nanfang Hospital，Southern Medical University for semi-structured in-depth interviews.Based on the social ecology model，using the narrative theory of life and health as the framework，the content analysis method was adopted to analyze the data. ResultsA total of 3 themes and 12 sub-themes were extracted，including the influencing factors at the individual level （narrative literacy，cognitive level towards death，and sense of self-worth），the influencing factors at the interpersonal level （patient’s disease situation，education level，economic status，family narrative connection，peer narrative connection，and narrative connection between doctors and family members），and the influencing factors at the cultural policy level （social culture，physical environment of the ward，and policy level）. ConclusionAnticipatory grief was affected by multiple factors，and multi-dimensional narrative connection should be constructed from individual，interpersonal，family，social，and other levels to prevent caregivers from falling into a narrative lock of single caregiver identity，alleviate the impact of anticipatory grief on caregivers，and improve their quality of life.