中国医学科学院学报最新文献

The emergence of narrative medicine offers new possibilities for the research of bioethics.This paper proposes the concept of "life narrative ethics" and uses the three life attributes-natural life,spiritual life,and social life-as an analytical framework to reveal the ethical demands of life narratives in the finiteness of the physical body,the rupture of self-identity,and the transformation of social roles.On this basis,this paper distills four core principles:centering on life stories,dignity integration,interpretive humility,and reciprocal narrative relationships.These principles respectively establish the epistemological basis,value goals,attitude requirements,and practical approaches for ethical judgment.The applicability and explanatory power of these principles are analyzed through a case of a patient's death.This paper argues that life narrative ethics represents a progression from relational ethics to substantive value ethics,providing new theoretical tools and practical guidelines for medical practitioners to understand the patients' holistic lives and respond to their profound ethical demands.

Digital health has improved the efficiency of information processing while also changing how patients' illness narratives enter healthcare systems.Patient narrative flattening refers to the excessive compression of patient narratives during digital processing,whereby temporal trajectories,life contexts,value preferences,and other dimensions of illness experience are diminished.It is mainly manifested in the compression of narrative content during expression,the fragmentation of information in clinical documentation,and the fixation of information in subsequent use.Such flattening may constrain clinical understanding,affect clinical decision-making and patient-clinician interaction,and allow governance risks to accumulate when these data are further used in research,evaluation,and algorithmic applications.In the digital era,narrative medicine should attend to the loss of patient narratives in digital transformation and preserve their significance for clinical understanding and healthcare practice.

Ethical dilemmas in real-world medical settings expose the limitations of bioethics,represented by the "four-principle framework," in dynamic and personalized clinical decision-making.The development of narrative medicine provides more space for showcasing the unique context of life,alleviating the predicament of normative ethics.However,current ethical practices in narrative medicine have not responded to the theoretical problem of the lack of ontology,moral subject,and reflective process in principlism,calling for the further exploration of the moral issues inherent in the narrative process and outcomes.This paper,based on the ontology of life narrative,proposes a new understanding of narrative bioethics in healthcare.Through comparative analysis of an ethical case involving living organs,this paper demonstrates the necessity and challenges of shifting ethical decision-making from reflective equilibrium to narrative co-construction.

Objective To analyze the disease burden and trends of non-alcoholic steatohepatitis-associated hepatocellular carcinoma (NASH-HCC) in China,the globe,and regions with varying socio-demographic indices (SDI) from 1990 to 2021,thus providing theoretical support for the prevention and control of NASH-HCC. Methods Using the Global Burden of Disease Study 2021 database,we assessed the age-standardized incidence rate,prevalence rate,mortality rate,disability-adjusted life years (DALYs),and other disease burden metrics for NASH-HCC,along with their trends.Decomposition analysis and frontier analysis were performed to evaluate influencing factors and regional disparities. Results From 1990 to 2021,the age-standardized incidence rate of NASH-HCC in the globe increased from 0.36 per 100 000 to 0.49 per 100 000,while that in China rose from 0.48 per 100 000 to 0.54 per 100 000.All burden indicators in China showed lower growth rates than the global average.The burden increased most significantly in high-SDI regions and decreased in low-SDI regions.Decomposition analysis revealed that population aging was the primary driver of burden changes in China,while epidemiological shifts were the main factor contributing to global prevalence changes.Frontier analysis indicated that China ranked in the middle globally in terms of the effective gap between its age-standardized mortality rate,age-standardized DALY rate,and the theoretically optimal prevention and control level. Conclusions The global disease burden of NASH-HCC keeps rising,with the most significant increase occurring in high-SDI regions.There are substantial disparities in prevention and control capabilities across regions with different SDI.Comprehensive public health policies,targeted interventions,and effective treatment strategies must be developed to further enhance prevention and control efficacy.

Objective To address the insufficient educational-context explanation in postgraduate stress research and the limitation of standardized scales in capturing process-based difficulties in research training,this study constructs "parallel thesis" as a narrative tool for postgraduate education based on the text-generating logic of "parallel chart" in narrative medicine,and examines its value in identifying stressors among medical postgraduates. Methods Seventeen postgraduates from Jiangxi University of Chinese Medicine completed parallel thesis writing after a narrative workshop.Their texts were analyzed through constructivist grounded theory,including open,axial,and selective coding,followed by theoretical saturation testing. Results Twelve initial categories and five main categories were identified and further integrated into three core stressors:institutional,executive,and endogenous pressures.Institutional pressure involved graduation requirements,evaluation mechanisms,and career competition;executive pressure concerned research progress,supervisor interaction,and insufficient support;endogenous pressure involved goal ambiguity,self-doubt,and identity crisis. Conclusions Parallel thesis is not a simple conceptual transplantation from parallel chart,but a reconstructed narrative tool that transforms experience-oriented narrative medicine into data generation,stress identification,and support feedback in postgraduate education.It may supplement scale-based assessment and provide a replicable route for medical education reform and postgraduate support system building.

Objective To systematically review the conceptual evolution and research focus of narrative competence among healthcare professionals and to reveal the differences and complementary relationships between Chinese and English articles. Methods CiteSpace-based knowledge mapping was conducted on the articles related to narrative competence published between 2001 and 2025,including 103 articles from four major English databases (PubMed,Web of Science Core Collection,APA PsycINFO,and CINAHL) and 186 articles from three major Chinese databases (CNKI,Wanfang Data,and VIP).Keyword co-occurrence analysis was performed to identify research hotspots,and cluster analysis to reveal differences in research orientations between English and Chinese articles.Keyword bursts were detected to track the temporal trajectory of conceptual evolution. Results The concept of narrative competence shows a trend of evolving from abstract humanistic ideas to concrete clinical competencies.English articles focus more on theoretical construction and humanistic connotations,while Chinese articles emphasize application and operability,translating narrative competence into measurable core abilities. Conclusions The development of narrative competence follows a trajectory of "meta-concept-dimensionalization-operationalization framework".English and Chinese articles represent two complementary pathways:theoretical deepening and practical transformation.Future efforts should promote the standardization and localized integration of the conceptual framework,assessment tools,and training systems for narrative competence.

Narrative nursing is an important practical model for the implementation of humanistic nursing.This article reviews the origin and development of narrative nursing as well as its core concepts and theoretical connotations,and then elaborates on the conceptual definition and current development status of narrative nursing in traditional Chinese medicine (TCM).It summarizes the clinical applications of narrative nursing in the fields of disease management,health education,nurse-patient relationships,and nursing education,analyzes the existing problems in current practice,and makes an outlook on the future development trends.The aim is to provide a reference for the standardized and localized practice of TCM-featured narrative nursing and to contribute to the construction of a humanistic system and high-quality development of TCM nursing.

With the continuous advancement of medical imaging technologies,deep learning-based semantic segmentation has emerged as a key methodology in medical image analysis,achieving substantial progress in recent years.In particular,these techniques have demonstrated remarkable effectiveness in the automated identification and segmentation of lumbar spine-related diseases.This review provides a comprehensive overview of widely used deep learning-based semantic segmentation methods and systematically summarizes their recent applications in intervertebral disc segmentation,detection and classification of lumbar degenerative disorders,and quantitative analysis of lumbar intervertebral discs.Furthermore,the major challenges associated with current approaches in clinical and practical settings are discussed,and potential directions for future research and methodological improvements are highlighted.

Assessment is a critical link in the transition of narrative medicine education from concept to institutionalized curriculum,yet its methods have long faced challenges such as insufficient standardization,poor cross-institutional comparability,and a lack of long-term outcome tracking,while few studies have traced how this situation arose.Focusing on assessment in the educational measurement sense-the measurement of learners' outcomes,as distinct from the evaluation of programs as a whole-and adopting an abductive approach that infers epistemological foundations from actual assessment practices,this article divides the evolution of assessment methods in narrative medicine education since 2001 into three stages according to their epistemological foundations and methodological features.The first stage (2001-2008),grounded in phenomenology and constructivism,was dominated by qualitative text analysis such as reflective writing,emphasizing lived experience and reflection but lacking standardized,generalizable instruments.The second stage (2009-2016),responding to the evidence-based medicine paradigm and seeking disciplinary legitimacy,widely borrowed generic instruments such as the Jefferson Scale of Physician Empathy and the Maslach Burnout Inventory and made initial attempts at mixed methods,thereby exposing an epistemological conflict between positivism and interpretivism.The third stage (2017-present) has shifted toward developing specialized instruments for assessing narrative competence,reflecting a pragmatist integration of quantitative and qualitative approaches,though its maturation remains constrained by weak measurement standardization and the absence of long-term behavioral and clinical outcome assessment.This study suggests that the evolution of assessment methods in narrative medicine education is essentially an ongoing dialogue between humanistic and positivist epistemological traditions,through which the field continually clarifies its assessment aims and defines its disciplinary identity.

Through literature review and analysis of clinical practice cases,this paper proposes that narrative dialogue refers to the conscious expression and communication between physicians and patients,with a clear narrative orientation within specific clinical contexts.Its core lies in externalizing patients' implicit,unspoken suffering and establishing empathic connections.Narrative dialogue comprises four constituent elements-context,subject,orientation,and connection-and manifests distinct objectives and characteristics at three levels:value,narrative essence,and practice.This article synthesizes the general core principles and practical steps of narrative dialogue and argues that narrative dialogue constitutes a recognizable,analyzable,and teachable core component in the clinical practice of narrative medicine.It bridges narrative medicine theory with clinical practice and provides a new breakthrough point for the systematic construction of narrative medicine education and clinical paths.