Guidelines for Traditional Chinese Medicine Diagnosis and Treatment of Metastatic Colorectal Cancer / 中国实验方剂学杂志

Colorectal cancer is one of the most common malignant tumors of digestive tract. In 2020， 1.93 million new cases of colorectal cancer were diagnosed globally， ranking third in the global incidence spectrum， and 930 000 new deaths were reported， ranking second in the global cause of death spectrum. Meanwhile， the medical cost of metastatic colorectal cancer is the highest among all stages. A large number of studies have demonstrated that traditional Chinese medicine（TCM） treatment can bring clinical benefits to patients with metastatic colorectal cancer with unique efficacy. In order to further standardize the TCM diagnosis and treatment for metastatic colorectal cancer and improve the level of TCM diagnosis and treatment， Xiyuan Hospital， China Academy of Chinese Medical Sciences， together with other relevant units in China， according to the guideline development process of the World Health Organization Handbook for Guideline Development and the relevant requirements of the Clinical Evidence Grading Criteria on TCM Based on Evidence Body， the Regulations for Group Standards of China Association of Chinese Medicine and others， combined with the characteristics of TCM diagnosis and treatment and the actual situation in China， the Guidelines for TCM Diagnosis and Treatment of Metastatic Colorectal Cancer was developed in accordance with the Catalogue of TCM Diagnosis and Treatment Plans for 105 Diseases in 24 Specialties issued by Department of Medical Administration of National Administration of TCM.

Una reflexión necesaria sobre la habilidad solucionar problemas clínicos / A necessary reflection on the skill solving clinical problems

El desarrollo de las habilidades relacionadas con los problemas clínicos ocupa un lugar central en el proceso de enseñanza-aprendizaje de la educación médica, por su especial significado en la actuación profesional del médico general. Debido a la ausencia de dicha habilidad en el currículo de la carrera de medicina, se realizó el presente estudio de reflexión con el objetivo de fundamentar la incorporación de esta al sistema de habilidades del método clínico en la educación médica cubana. Por otra parte, se definió la habilidad en cuestión y se determinaron sus invariantes funcionales, que al formar parte de un procedimiento metodológico, facilitan su integración al sistema de métodos de enseñanza-aprendizaje a utilizar en las diferentes formas de organización de las asignaturas que integran la disciplina principal del plan de estudio D

The development of skills related to clinical problems occupies a central site in the teaching-learning process of medical education, due to its special meaning in the general doctor professional performance. Due to the absence of this skill in the curriculum of the medicine career, this reflection study was carried out with the objective of supporting its incorporation to the skills system of the clinical method in the Cuban medical education. On the other hand, the skill in question was defined and its functional invariants were determined; that when being part of a methodological procedure, facilitate their integration to the system of teaching-learning methods to be used in the different forms of organization of the subjects that integrate the main discipline of the study plan D

Necesidades de aprendizaje en bioética de residentes y especialistas de Nefrología en Cuba / The needs of bioethics learning in specialists and residents in nephrology specialty in Cuba

Introducción: La enfermedad renal, como proceso crónico tratable pero progresivo a la terminalidad, condiciona la necesidad de que los médicos conozcan y apliquen el enfoque bioético en su desempeño profesional. Objetivo: Identificar las necesidades de aprendizaje en aspectos bioéticos por médicos especialistas y residentes en Nefrología. Material y Métodos: Estudio descriptivo de corte transversal con 81 médicos (41 especialistas y 40 residentes) en tres servicios de Nefrología del país entre 2014-2015. Se utilizó una encuesta estructurada para la recogida de la información y se emplearon diferentes métodos cuantitativos y cualitativos para el procesamiento de la información. En el procesamiento estadístico se empleó el software R. Resultados: Los cuatros principios de la Bioética anglosajona fueron reconocidos como importante para la práctica profesional dentro del hospital (9.4 puntos), así como la implicación personal en su aplicación (9.89 puntos) sin diferencias significativas entre especialistas y residentes. Se reconoce falta de capacitación en diferentes temas relacionados con la Bioética como: cuidados paliativos (82,75 por ciento), habilidades comunicativas (80,2 por ciento), principio de proporcionalidad terapéutica (72,83 por ciento), conflictos ético-clínicos (72,83 por ciento), planes de cuidados continuos en estos pacientes (76,54 por ciento), cuidados avanzados y al final de la vida (81,18 por ciento) y prevención del Burnout (81,48 por ciento), mayores en residentes que en los especialistas, en especial, la proporcionalidad terapéutica (p= 0.007) y los conflictos ético-clínicos (p= 0.029). Conclusiones: Se otorga gran importancia a los aspectos bioéticos aplicados a la práctica nefrológica. Se identifican necesidades de aprendizaje modificables en áreas específicas mediante planes de perfeccionamiento educativo en el postgrado(AU)

Introduction: Chronic kidney disease as a treatable process but progressive to end stage, determines the need for physicians know and apply a bioethical focus on their professional performance. Objective: To identify learning needs in bioethical issues by nephrologists. Material and Methods: A descriptive cross-sectional study with 81 physicians (41 specialists and 40 residents) in three nephrology services in the country between 2014-2015 was performed. A structured questionnaire for collecting information and different quantitative and qualitative methods for processing information was used. For the statistical processing, R software was used. Results: Anglo-Saxon bioethics' four principles were recognized as important for professional practice at the hospital (9.4 points) as well as personal involvement in its implementation (9.89 points) with no significant differences between specialists and residents. Lack of training is recognized in various bioethics issues such as palliative care (82.75 percent), communication skills (80.2 percent), therapeutic principle of proportionality (72.83 percent), ethical-clinical conflicts (72, 83 percent), continuous care plans in these patients (76.54 percent), advanced care and end of life (81.18 percent) and prevention of Burnout (81.48 percent), higher in residents than in specialists; especially therapeutic proportionality (p = 0.007) and clinical - ethical conflict (p = 0.029). Conclusions: Great importance to bioethical aspects applied to nephrology practice is granted. Customizable learning's needs are identified in specific areas through education plans development during post graduated learning(AU)

Winnicott clínico / Winnicott as a clinician

De início, o presente artigo apresenta, de maneira esquemática, a concepção freudiana dos distúrbios que fazem parte do domínio de aplicação da psicanálise. Em seguida, dedica-se, de modo mais detalhado, ao estudo da teoria winnicottiana da etiologia, natureza, classificação, solubilidades e de procedimentos de resolução desse mesmo tipo de problemas clínicos. Um dos resultados obtidos é um conjunto de evidências adicionais a favor da tese de que Winnicott operou uma mudança paradigmática na psicanálise.

This paper begins with an outline of the Freudian view of the disorders that are dealt with in psychoanalysis. It then describes in a more detailed manner the Winnicottian theory of the etiology, nature, classification, solutions, and procedures for resolving those same kinds of clinical problems. One of the results obtained is a set of additional evidence for the thesis that Winnicott performed a paradigm shift in psychoanalysis.