背景门诊医生是医院诊疗活动主要提供者，门诊医生的积极情绪及有效的医患沟通方式是优质医疗服务的保证。目的 比较门诊医生经验性沟通与GLTC沟通的医生情绪状态和沟通细节完成情况，为今后提高医生沟通技巧、改善医生情绪状态提供参考。方法 于2021年7月—2022年1月，在江苏省南京市随机抽取4家三级综合医院中6个科室的24名门诊医生为研究对象，并选取符合患者纳入标准的门诊医患沟通场景作为沟通细节完成情况的观察场景。对所有纳入的同一批次门诊医生先开展个人经验式沟通方案（记为经验沟通组），然后开展门诊GLTC医患沟通方案培训，一周后开展门诊GLTC沟通方案（记为GLTC组），比较经验沟通组、GLTC组沟通前后简明心境量表（BPOMS）各维度的得分情况及沟通细节要点完成率情况。结果 经验沟通组医生沟通后BPOMS的疲劳维度得分高于沟通前（P<0.05）；沟通后GLTC组医生BPOMS的疲劳、困惑维度得分低于经验沟通组（P<0.05）;GLTC组的和蔼注视（接待）、礼貌语言（接待）、微笑（接待）、不轻易打断患者、适时点头回应、安抚、告知必要性、耐心（实验检查）、征询患者意见、耐心（诊疗与交流）、通俗讲解、语言安慰、态度友善、起身（结束与交代）、和蔼注视（结束与交代）、礼貌语言（结束与交代）、微笑（结束与交代）等沟通细节要点的完成率高于经验沟通组（P<0.05）。结论 和门诊经验性沟通相比，门诊GLTC沟通更能改善医生情绪状态，缓解医生疲劳，同时相应沟通细节完成率提高，部分沟通细节完成率仍有提升空间。

Background Under the background of new medical science,the deep integration of information technology and medical education is encouraged to train first-class medical talents to serve the construction of healthy China.Currently,empathy training in doctor-patient communication mainly consists of simulated communication and group discussion,with less reliance on artificial intelligence technology for learning.Objective To develop a system for teaching and evaluating doctor-patient communication empathy language.This system will be used in course teaching to pave the way for future doctor-patient communication empathy teaching methods.Carry out teaching applications to enhance the communication and empathy language expression skills of medical students and doctors,and gather feedback to optimize and improve the system.Methods Between September 2021 and February 2022,the research group focus on utilizing iFlytek speech recognition technology and the empathy semantic recognition algorithm.A system called the"Doctor-patient Communication Virtual Simulation Teaching and Evaluation System of empathic language"was developed using 10 typical cases of doctor-patient communication,demonstrations of empathic language,a semantic database of empathic language,empathic language skills,and an overall scoring standard.A total of 950 students from Nanjing Medical University,including 515 undergraduates,102 medical doctoral students,and 333 clinicians participating in doctor-patient communication courses or training,were selected as the research subjects from March to May 2022.Based on this system,the Doctor-patient Communication Skills Course(2 class hours)teaching experiment was conducted at Nanjing Medical University.A self-designed questionnaire was used to gather information on the subjects'understanding of empathetic language connotations,their improved empathetic language skills,their perception of system ease of use,and their perception of how the system integrates into the rationality of teaching.NVivo software was used to analyze the subjects'feedback,comments,and suggestions.Results Following the implementation of the system,there were statistically significant differences in the mastery of empathic language connotation,the degree of enhancement of empathic language ability,the degree of convenience of the system,and the degree of integration of the system into teaching rationality among undergraduate students,clinicians,and medical doctoral students(P<0.05).76.1%(723/950)of the participants evaluated that they had"fully mastered"or"highly mastered"the connotation of empathic language.93.8%(891/950)of the study subjects indicated that the system could"significantly enhance"or"somewhat enhance"the empathic language ability,and 89.5%(850/950)of the study subjects rated the convenience of the system as"very convenient"or"relatively convenient".95.1%(903/950)of the study subjects rated the degree of cognition of the rationality of integrating the system into teaching as"very reasonable"or"relatively reasonable".The top five words mentioned in the feedback and suggestions are communication,pronunciation,teaching,program,and standard.Conclusion This system can help improve medical student and doctors'ability to empathize in doctor-patient communication by learning from individual cases and applying those lessons more broadly.Additionally,the use of an autonomous teaching evaluation system frees up the constraints of time and space in teacher-student interactions.The system's standardized teaching method has received positive and rational feedback from participants,indicating its potential for a wide range of applications.However,the system is still in the early stages of exploration and requires further refinement.

目的 探寻公立医院医务人员对于医疗人文服务能力的认知,结合统计数据进行讨论、分析并提出针对性建议.方法 自行设计调查问卷,在江苏省南京、苏中、苏北、苏南四地区公立医疗机构随机抽取的825名医务人员进行问卷调查,采用SPSS21.0分析数据.结果 医务人员对医学人文熟悉认知均分为3.64分;医学人文服务能力构成要素认知中,医患沟通能力占比最高(90.82％);不同人口特征医务人员对仪容举止能力、医患沟通能力、照护患者能力等维度认知存在差异(P<0.05);外科医生的医学人文重要性认知低于其他四个科室(P<0.05).结论 医务人员需要提高医疗人文服务能力,不同类别人员人文差异性认知需调整,公立医院需明确医疗人文服务的评价要素及标准,并着重解决认知差异,提升医疗人文服务能力,加快人文医院建设,促进医疗人文服务能力提升,此外,还需要通过课程思政提升高校医学人文教育质量.

为探讨医学专业学位研究生人文素养培养的可行模式,该研究对22名医学专业研究生导师和74名医学专业学位研究生实施导师团队言传身教的人文素养培养模式,通过对导师、研究生及患者进行问卷调查对比人文素养培养前后的相关情况来评估培养效果.该模式实施后,导师和研究生的共情能力、倾听能力都有所提升,职业认同感也更强,而且研究生同患者的关系也更和谐.研究发现,实施导师团队言传身教的人文素养培养模式不仅成本较低而且高效、可行,可为临床研究生人文素养的培养提供参考.

学科结构作为学科建设的核心,在促进医学人文学科繁衍兴盛上有着不可忽视的作用.通过整理中国学者对中国医学人文学科结构的划分来初步探讨中国医学人文下位学科的存在,并初步验证"构建医学门类下医学人文一级学科,并以横向关联为基准形成医学人文下位学科"观点的合理性与可行性.同时,提出面向中国当前社会发展需要,借鉴中国学科专业目录划分所含理念与准则来对中国医学人文学科结构进行厘定的观点,为后续研究作铺垫.

"双一流"建设背景下,高校多学科交叉融合的创新型研究生培养对推进新一轮教育领域面向国家重大战略需求具有重要意义.本文以南京医科大学为例,对涉及专业学位研究生培养的招生选拔、培养目标、课程教学、专业实践、导师指导、资源配置等方面进行调查分析,以期为多学科交叉融合背景下专业学位创新型研究生的培养提供借鉴意义.

目的:探索门诊个人经验沟通方式和门诊GLTC(医方示善-医方倾听-医患交流-医患合作)沟通方式应用后对患者情绪和需要所带来的影响,了解患者就医需要,提高医患沟通效率.方法:在南京医科大学医学人文能力实验室开展门诊沟通实验,医生分别以两种方式与模拟患者群体沟通,期间患者填写相关情绪量表,收集到的数据资料采用SPSS 21.0进行统计分析.结果:不同沟通方式的学生患者在紧张、生气、抑郁维度分值存在差异(P<0.05);GLTC方式应用后两类患者情绪分值存在差异(P<0.05),且96.67％的患者认为医生表现优良;词频分析显示医务人员耐心、解决问题等是患者诊疗中的重点需要.结论:门诊GLTC医患沟通方式更能够稳定患者情绪,尤其是生气维度.在实际医患沟通中,标准化患者的情绪控制能力比学生患者稳定,这与患者社会阅历有关;安抚患者情绪要以患者需要为导向,同时也要保障该沟通方式的执行力.

ObjectiveTo explore influencing factors of doctor-patient information communication (DPIC) and to provide evidences for improving the situation of DPIC in China.MethodsTo screen influencing factors of DPIC based on grounded theory, we conducted an expert fractal analysis and semi-structured interviews among 8 schoolors engaged in medical humanities education and research, 20 senior doctors and 20 patients in three tertiary hospitals in Nanjing city using purposive sampling. With the coded influencing factors prelimilarily determined, we compiled a questionnaire. Then we conducted an on-site self-administered questionnaire survey among 2 727 medical professionals and 1 781 patients and their relatives recruited using cluster random sampling at tertiary hospitals in 23 municipalities/provinces across China during March – May 2016. We analyzed the data collected for weighting and ranking all influencing factor of DPIC by comprehensive and average impact scores calculated for each of the factors.ResultsOf the surveyed medical professionals and patients and their relatives, 45.9% and 44.1% reported a strong willingness to conduct DPIC; 75.9% and 71.4% affirmed the necessity of governmental agencies' role in DPIC; 49.0% and 53.9% evaluated the role of media and network in DPIC as very necessary; 21.6% and 18.0% approved representative role of medical associations in the process of DPIC but only 14.5% and 26.7% approved the representative role of consumers associations. There were significant disparities between medical professionals and patients and their relatives in attitudes towards DPIC and its relevant dimensions mentioned above (all P < 0.01). The rank order from high to low for impact scores of DPIC influencing factors was governmental administration (score = 3.69), demand for the communication (3.34), media and network (3.18), medical association (2.56), and consumer association (2.21) among the medical professionals; while among the patients and their relatives, the rank order was government administration (3.61), media and network (3.32), demand for the communication (3.25), consumer association (2.71), and medical association (2.47).ConclusionA good doctor-patient information communication comes from the joint efforts among medical staff, patients, government agencies, media and network, and relevant social organizations. The study result suggests that a comprehensive platform needs to be established to promote the communication.

Objective:To understand the emotional state of doctors and patients in the process of diagnosis and treatment,and clarify the emotional relationship between the two parties from the perspective of emotional infection theory,providing references for future doctor-patient communication and creating a good medical atmosphere.Methods:From March to April 2021,a questionnaire survey of doctor-patient emotional cognition was conducted in 9 public hospitals in Jiangsu Province and 1 public hospital in Shenzhen,and related data were analyzed by descriptive analysis,independent sample t-test,and χ2 test.Results:Compared with doctors,patients were more emotionally irritable and had difficulty concentrating （P＜0.05）;there were differences in the perception of emotional impact between doctors and patients （P＜0.05）;patients paid more attention to medical staff than medical staff （P＜0.05）;the demand for doctors is focused on increasing income,patient understanding and cooperation,and humanistic care （71.96%）,and the demand for patients is focused on significant treatment effects and doctor-friendly service attitudes （73.63%）.Conclusion:Doctors play a leading role in doctor-patient emotional infection,patients’ emotions can affect doctors,and patients take the perspective of each other as the guarantee of positive emotional infection.Doctors need to attach importance to service attitude,use emotional infection theory,learn relevant mature doctor-patient communication methods,and actively guide patients’ emotional trends.At the same time,multiple measures are taken to ensure the positive emotions of medical staff,so as to improve patients’ medical compliance and create a harmonious medical atmosphere.

在多重制度逻辑分析框架下,基于某公建民营护理院的发展历程,分析不同制度逻辑之间的交互作用,提出公建民营医养结合机构治理的有效策略.研究发现,公益、政府、市场和专业四重制度逻辑在机构发展各阶段起到了不同作用.因此,机构应灵活应对,通过秉持公益使命,发挥服务功能;链接政策资源,回应政府期待;整合社会力量,打造竞争优势等策略,主动整合不同制度逻辑的优势,实现资源获取、能力提升和良性成长.政府通过关注机构不同发展时期,出台政策,精准发力;合理制定签约期限,鼓励运营方投入;聚焦养老人才短缺,加大人才培养与供给;构建稳定合作机制,实现多方利益均衡.

Myopia has become an important public health problem to be solved urgently. Posterior chamber phakic implantable Collamer lens (ICL) implantation is one of the latest and safest products for myopia correction worldwide. This prospective cross-sectional case series aimed to observe changes in the macular retinal thickness, retinal nerve fiber layer (RNFL) thickness of para-optic disk region, and blood flow density after posterior ICL implantation in patients with high myopia using optical coherence tomography angiography (OCTA). A total of 67 eyes of 67 patients with high myopia, who underwent ICL implantation at The Affiliated Eye Hospital of Nanjing Medical University from January 2020 and December 2020, were included. The spherical equivalent (SE) of the operative eyes was >-6.00 D. The changes in vision, intraocular pressure (IOP), SE, and vault were observed pre-operatively, and follow-up were performed 1 week, 1 month, and 3 months. OCTA was used to observe the changes in the CRT, retinal thickness of paracentral fovea, FAZ, superficial and deep retinal blood flow density in the macular area, RNFL thickness of para-optic disk region, and blood flow density before and after ICL implantation. The uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) of the patients post-operation were significantly improved (P < 0.001). The IOP increased in comparison with other time points at 1 week post-operation (P < 0.05). There were no significant changes in CRT post-operation. The retinal thickness in the upper, lower, nasal, and temporal quadrants of the paracentral fovea increased significantly at 1 month and 3 months post-operation (P < 0.05). The FAZ area at all postoperative time points were decreased (P < 0.001). At 3 months post-operation, the blood flow density of the superficial and deep retinal layers in the upper, lower, and nasal macular area were significantly reduced (P < 0.05). At 1 month post-operation, the RNFL thickness in the temporal para-optic disk region and blood flow density were significantly reduced (P = 0.001 and P < 0.05, respectively). ICL implantation for highly myopic eyes led to an increase of the retinal thickness in the upper, lower, nasal, and temporal regions of the paracentral fovea; reduction of RNFL thickness in the temporal area of para-optic disk; decrease in FAZ area; and decrease in the blood flow density of some deep and superficial retinal layers as well as that of the temporal para-optic disk region.

Abstract Background: In recent years, China has witnessed a surge in medical disputes, mostly evoked by ineffective information communication between multiple parts, such as the media. Information communication is an important link in doctor-patient relationship. Few macroscopic, multi-dimensional, and large-sample studies about doctor-patient communication information have been conducted in China. The aim of this study was to investigate the demand for information communication among Chinese doctors and patients, and to explore associated factors.Methods: The questionnaire for this study was formed through literature and interviews. Based on a national survey conducted in 2016, this study included 2727 doctors and 1781 patients in 22 cities of China.Results: Our analysis showed that the respondents recognized the roles of the network and governments in doctor-patient information communication, and the medical staff had a stronger demand for information communication than patients. Furthermore, the medical stuff admitted the function of medical committees composed of experts and scholars, while the patients paid more trust to the media and consumer associations.Conclusion: Doctor-patient information communication is highly needed for doctors and patients in China. Governments, media, Internet, medical committees, consumer associations play critical roles in doctor-patient information communication.

Objective:To investigate and analyze the current situation of medical humanistic literacy and its influencing factors of freshmen (hereinafter referred to as freshmen) for master's degree in clinical medicine, so as to provide reference for optimizing medical humanistic education in colleges and universities.Methods:From September to November 2021, a cluster sampling method was used to select 1 589 freshmen enrolled in 2021 in Nanjing Medical University as the survey objects. According to the literature research and combined with the actual situation, a questionnaire was made to investigate the current situation of their medical humanistic literacy, and influencing factors were analyzed by the multiple linear regression.Results:A total of 1 572 freshmen participated in this study. The total score of medical humanistic literacy of freshmen was 84.23±8.18. The results of multiple linear regression analysis showed that the degree of understanding of traditional Chinese medical ethics ( b=0.300, P<0.001), the richness of medical humanities courses during undergraduate education ( b=0.097, P<0.001), the frequency of participating in voluntary practice ( b=0.088, P<0.001), the frequency of autonomous learning ( b=0.110, P<0.001), self-innovative thinking and awareness ( b=0.116, P<0.001) are all related to their medical humanistic quality. The above variables can explain the variation of master's medical humanities literacy (62.1%). Conclusions:The overall condition of the freshmen's medical humanities is good. The freshmen's understanding of traditional Chinese medical ethics, the medical humanities teaching resources and support obtained in the learning process, the ability of autonomous learning and innovative thinking are the influencing factors of their medical humanistic quality. Medical colleges can improve the medical humanistic literacy of the graduates by strengthening the study of traditional Chinese medical ethics, optimizing the humanities education resources and providing support from colleges and universities and establishing an independent learning model.

目的:医患关系问题,是哲学社会科学在健康中国和医疗卫生现实中突显的研究方向和重大问题.文章意在基于扎根理论的视角全面探索医患关系影响因素,为后续实证研究做准备.方法:根据扎根理论研究方法,依据目的性抽样原则选取医疗机构、医患管理部门、医务人员、患者进行访谈,选取关键词及篇名同含"医患关系"的文献建立数据库,结合Nvivo12软件,对中国大陆核心文献518篇论文筛选后的76篇医患关系文献及12篇访谈记录进行质性分析.结果:医患关系影响因素可归为医务人员、患方群体、医院与行业环境、政治与社会环境4个主范畴,每个范畴下还有相应11～ 15个不等的副范畴.结论:医患关系作为社会关系中基本、常见的一种关系,表现出很强的普遍性,具有与所有人相关联的必然属性,医患关系影响因素模型可以从"人""环境"两个维度着手构建,其中人的因素是主观能动因素,环境因素是重要辅助因素.

了解江苏省医学院校学生医学人文素质与医学人文课程教学的相关性,为各院校改进医学人文教育提供依据和建议.采用问卷调查方式对江苏省七所医学院校学生医学人文素质及课程教学现状开展调查.结果显示,医学人文素质满分是168分,实际总分为(148.80±12.97)分,不同性别学生的医学人文素质得分差异有统计学意义.在课程教学方面,核心课程开设不全、学科融合不够,教学方法、考核方式结构不够优化,学生对医学人文师资队伍满意度不高.建议医学人文教育融入课程思政改革;优化课程和考核方式结构,强化实践教学;提升教学满意度,拓宽师资培养;丰富医学人文教育对象.

健康中国背景下,了解国内医患关系高影响力论文作者、机构、研究方法、研究热点分布情况,为进一步开展相关研究提供依据和参考.利用中国知网(CNKI)数据库中被引用超20次、被下载超100次的医患关系论文为数据来源,用CiteSpace软件进行文献计量分析.结果发现,医患关系高影响力论文总体呈现活跃趋势,数量逐年增多,但理论研究多实证研究少,研究视角相对较窄.医患关系研究学术价值与应用价值有待提升,学术生态圈建设相对欠缺,需要各级管理部门、研究者、学术期刊等多学科合作.

收集2017年1月1日至2019年12月31日在南京市妇幼保健院就诊的74038例孕产妇相关信息,以其分娩结局(即剖宫产和生理产)为切入点,分析3年剖宫产率的变化情况,并以2017年为基线,通过多因素分析探查政策施行当年和第二年的效果.总体上,3年在南京市妇幼保健院就诊的74038名孕产妇的剖宫产率呈现下降趋势(线性趋势卡方检验,χ2值为51.708,P<0.001),但根据孕产妇是否高龄(≥35岁)和是否首次分娩分为四类(非高龄非首次分娩孕产妇、非高龄首次分娩孕产妇、高龄非首次分娩孕产妇和高龄首次分娩孕产妇)后发现,仅有非高龄首次分娩孕产妇的剖宫产率存在下降趋势.在多因素分析中,2018年的剖宫产率为2017年的0.890倍,2019年的剖宫产率为2017年的0.869倍,一定程度上可以说明和反映《南京市高危孕产妇管理规范》对于控制35岁以下首次分娩孕产妇的剖宫产率有作用,但对于高危孕产妇的作用并未显现,还需进一步研究和政策完善.

在突发公共卫生事件中,如何迅速建立公众信任,将专业的医学信息通过合适的渠道和方式在社会传递是应急响应中的关键.文章通过分析网络新媒体的舆情指数,探讨在新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情中,形成社会热点的医学权威专家社会沟通事件的热度峰值与趋势特征,分析其信息传递的成效与社会传播特征.数据显示,由权威专家发声的医学信息引发了公众极高的关注度,呈现激增、持续高位的特征,且热点高峰值与疫情关键节点、专业信息发布时间轴呈密切相关.疫情下有效的医学信息传递需要在社会沟通发生的各个环节中体现权威性及专业性,在舆情数据支持下可获知公众真实反应,进一步优化重大疫情应急防控中的社会沟通策略.

医患关系作为复杂的社会关系,深深地嵌入到其所处的社会组织、关系、文化和制度系统中.政府部门和医疗机构制定和出台的各项医疗制度无疑对医患关系产生重要影响.利用制度分析与发展框架(IAD)解释医疗制度与医患行为者的关系,并从医疗制度的宏观层面和微观层面举例分析不同制度影响下医患双方互动的作用模式及产生的关系结果,识别医疗制度对行为者的影响路径,剖析医患关系紧张的深层次原因和形成机制,为医疗管理领域的理论研究和实践应用提供借鉴.

当今引领中国医学人文的价值观由古今中西方价值观交织而成,有冲突也有融合,新冠疫情全球流行背景下,中国优秀传统文化不断占据大众视野,中国医学人文的发展亟待正确价值观指引.比较中西方价值观内涵、中西方医学人文内涵,其中差异明显,不能简单融合各色价值观作为中国医学人文的价值引领,梳理出中国价值观发展的纵向脉络,厘清了中国特色社会主义核心价值观是凝聚古今中外优秀文化的精粹,并正在主导着现代中国社会的全局.中国医学人文领域更需要社会主义核心价值观引导其发展和创新的道路,成为中国医学人文思想的总纲,促进医学人文学科建设和医学人才培养.