Efectos de las Técnicas de Cierre de Fisura Labio-Máxilo-Palatina sobre el Crecimiento y Desarrollo Esqueletal: Una Revisión Narrativa

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.

Características clínicas y radiográficas de reabsorciones radiculares externas / Clinical and radiographic characterization of external root resorption

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.

Studies on the Influence of Three-level Assistance Model Based on Narrative Nursing Theory on the Mental Health of Medical Staff / 昆明医科大学学报

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.

Factors influencing medical narrative competence and its correlation with psychological resilience in pediatric staff / 中华医学教育探索杂志

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.

Effectiveness of narrative exposure therapy for post-traumatic stress disorder in children and adolescents： a Meta-analysis / 四川精神卫生

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.

The significance and path of narrative turn in the course of “doctor-patient communication” / 中国医学伦理学

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.

Medical humanities and narrative medicine in novel Barefoot Doctor / 中国医学伦理学

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.

Multiple narrative presentation methods of De Xin Ji Medical Case from the perspective of narrative medicine / 中国医学伦理学

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.

Traumatic narrative foreclosure and narrative care in the context of narrative medicine / 中国医学伦理学

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.

A qualitative study on the influencing factors of anticipatory grief among family caregivers of terminal-stage cancer patients in the context of narrative medicine / 中国医学伦理学

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.

Concept of Osler’s patient view and doctor-patient narrative community in narrative medicine / 中国医学伦理学

In the context of modern medicine， it’s difficult for doctors lacking narrative thinking to get into the hearts of patients and offer high-quality medical service. Precise classification terms and decontextualized abstract language have become communication barriers between doctors and patients， creating an atmosphere of unusual indifference and fear during the medical process. William Osler， the father of modern medicine， emphasized that doctors should respect the individuality of patients， and advocated that doctors should use life-oriented language to provide humanistic care to patients. This echoes the concept of the “doctor-patient narrative community” in the construction of the Chinese narrative medicine system. As a brand new clinical humanistic practice path， narrative medicine focuses on the keyword “narrative” and revolves around the theme of “inter-subjective relationship” in the medical context， advocates that doctors switch flexibly in the two references of science and life， achieve visual fusion with patients and their families， pay attention to patients’ life experiences， and establish narrative connections with them. On this basis， it can achieve two-way narrative interaction， build a harmonious doctor-patient narrative community， and thus enhance the patient’s medical experience.

Practical study on the integration of life narratives into care services for cancer patients / 中国医学伦理学

This paper took the “see your life story” - volunteer service project of the cancer patient care program of the First Affiliated Hospital of Guangzhou Medical University as an example， and explored the application of life narrative in the care service of cancer patients. The project adopted the multi-dimensional volunteer service model of “doctors and nurses + volunteers + social workers + patient friends”，used the life narrative method， and guided the three groups of cancer patients， patient caregivers， and oncology medical staff to tell their life stories through medical volunteers. Finally， these life stories were delivered in diversified ways， such as physical picture books， interview stories， and sharing meetings. The connection between patients can be promoted in the form of sharing， so that patients and caregivers can get support， and truly achieve to impact life with life. This paper selected the cases in life story books， deeply analyzed the important role of life narrative in promoting the physical and mental recovery of cancer patients， as well as provided reference suggestions for improving patients’medical experience and promoting the cultural development of public hospitals.

Analysis of the current situation and influencing factors of clinical nurses’ medical narrative competence / 中国医学伦理学

ObjectiveTo investigate the current situation of medical narrative competence of clinical nurses，analyze its influencing factors，and provide a theoretical basis for improving the medical narrative competence of nurses. MethodsA total of 1，511 nurses from different hospitals in Shaanxi Province were selected as the research object from May 30，2023，to June 30，2023，by using the convenience sampling method. The general information questionnaire and the Medical Narrative Competence Scale were used to investigate the current situation of nurses’ medical narrative competence and analyze the influencing factors. ResultsThe total score of the medical narrative competence of clinical nurses was （152.75±23.98）. Multiple linear regression showed that implementation of humanistic care for patients in clinical practice familiarity with narrative medicine，views on narrative nursing，narrative-related practical experience，sense of identity and accomplishment in the nursing profession，satisfaction with nursing work，and being employed in a gynecology department were the influencing factors of nurses’ medical narrative competence. ConclusionThe medical narrative competence of clinical nurses was above average. Hospital managers should provide targeted training based on their influencing factors，care for nurses’ mental health，reduce nurses’ professional pressure，and improve nurses’ job satisfaction，to improve their medical narrative competence and promote professional growth.

Exploration and practice of humanistic care in children’s fever clinics from the perspective of narrative medicine / 中国医学伦理学

To explore the application of humanistic care in children’s fever clinics， the children’s fever clinics of Guangzhou Women and Children’s Medical Center conducted relevant research using narrative medicine as a guiding concept. This paper elaborated on the medical humanistic dilemmas and narrative care needs in children’s fever clinics， and focused on exploring the practice paths of narrative medicine in pediatric with Chinese characteristics from five dimensions， including the cultivation of nursing staff’s abilities of professional narrative and humanistic care， the establishment of health lectures featuring narrative patient education， the alleviation of medical anxiety for children and their families， related support of narrative nursing， and caring services. The aim was to improve the narrative care ability of nurses in children’s fever clinics， develop methods for pediatric patients that can eliminate the fear of seeking medical treatment， and protect children’s physical and mental health. A carrier of care， support， and emotional expression can be provided for parents. The foundation for nursing staff to achieve professional growth through narrative reflection can be laid. Thus， it can assist in establishing a life narrative community relationship between doctors and patients， and jointly explore the meaning of life.

The Status, Problems and Countermeasures of Narrative Medicine’s Clinical Practice in China / 中国医学伦理学

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.

Interpretation of Traditional Chinese Medicine Culture in Jing Xian’s Yi Xue Cong Zheng Lun from the Perspective of Narrative Medicine / 中国医学伦理学

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".

The Ethical Value of Hospice Narrative Doulas in the Context of Great Health / 中国医学伦理学

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.

Narrative Empowerment for Medical Students in Narrative Medicine Education in Public Health Crises / 中国医学伦理学

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.

Application of Narrative Education in Nursing Education in China / 中国医学伦理学

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.

Research Progress of Parallel Chart and Its Application in Traditional Chinese Medicine / 中国医学伦理学

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.