对编写上海市医学影像科(放射科)住院医师规范化培训教材的思考与探讨

始于2010年的上海市住院医师规范化培训模式是我国新的医师培养模式,经历3年的实践及完善,从制度及培训基地建设与管理、培训模式及教学经验等方面均取得了可喜的成绩。鉴于放射科住院医师在一定程度上的特殊性,本文以我院放射科基地为例,从基地医师的教育及知识背景、后续的继续教育及职业规划等方面对编写上海市医学影像科(放射科)住院医师规范化培训教材的必要性及可行性进行了分析与探讨,然后对编写此教材的定位、知识体系、参编人员构成、教材编写中的注意事项等提出了具体的看法并进行了初步探讨,供各基地教学实施过程中借鉴,共同推动上海市医学影像科(放射科)住院医师规范化工作,提高医学影像学(放射科)规范化培训医师的整体水平。     

规范医学影像诊断报告书写,提高医学生及住院医师临床技能

医学影像诊断报告是正确行使医疗行为和保证医疗质量的依据,书写高质量的医学影像学诊断报告是医学生及住院医师必须掌握的一项基本功和基本技能。本文将结合我院长期的医学生及住院医师临床教学经验和实际,以神经系统影像报告为例,从医学影像诊断报告的重要性、医学生及住院医师医学影像诊断报告技能教学的现状、规范化医学影像报告书写技能的培养、评估、反馈和评价进行探讨,以期在医学生和住院医师的培养中提高其临床技能,供广大同道在医学教育与实践中借鉴和改进。     

Play to Become a Surgeon: Impact of Nintendo WII Training on Laparoscopic Skills

Background

Video-games have become an integral part of the new multimedia culture. Several studies assessed video-gaming enhancement of spatial attention and eye-hand coordination. Considering the technical difficulty of laparoscopic procedures, legal issues and time limitations, the validation of appropriate training even outside of the operating rooms is ongoing. We investigated the influence of a four-week structured Nintendo® Wii™ training on laparoscopic skills by analyzing performance metrics with a validated simulator (Lap Mentor™, Simbionix™).

Methodology/Principal Findings

We performed a prospective randomized study on 42 post-graduate I–II year residents in General, Vascular and Endoscopic Surgery. All participants were tested on a validated laparoscopic simulator and then randomized to group 1 (Controls, no training with the Nintendo® Wii™), and group 2 (training with the Nintendo® Wii™) with 21 subjects in each group, according to a computer-generated list. After four weeks, all residents underwent a testing session on the laparoscopic simulator of the same tasks as in the first session. All 42 subjects in both groups improved significantly from session 1 to session 2. Compared to controls, the Wii group showed a significant improvement in performance (p<0.05) for 13 of the 16 considered performance metrics.

Conclusions/Significance

The Nintendo® Wii™ might be helpful, inexpensive and entertaining part of the training of young laparoscopists, in addition to a standard surgical education based on simulators and the operating room.     

Impact of a Multifaceted and Clinically Integrated Training Program in Evidence-Based Practice on Knowledge,Skills, Beliefs and Behaviour among Clinical Instructors in Physiotherapy: A Non-Randomized Controlled Study

Background and Purpose

Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs), are responsible for supervising physiotherapy students. For CIs to role model evidence-based practice (EBP) they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students.

Methods

We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1) The Adapted Fresno test (AFT), 2) the EBP Belief Scale and 3) the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations.

Results

In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1), p<0.001) and the EBP Beliefs scale (mean difference = 8.1, 95% CI (3.1 -13.2), p = 0.002), but not for the EBP Implementation scale (mean difference = 1.8. 95% CI (-4.5-8.1), p = 0.574). Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only.

Conclusions

A multifaceted and clinically integrated training program in EBP was successful in improving EBP knowledge, skills and beliefs among CIs. Future studies need to ensure long-term EBP behaviour change, in addition to assessing CIs’ abilities to apply EBP knowledge and skills when supervising students.     

The Impact of a Shipboard Weight Control Program

DENNIS, KAREN E., KAREN W. PANE, BRENDA K. ADAMS, AND BING BING QI. The impact of a shipboard weight control program. Obes Res. 1999;7:60–67. Objective : The specific aim was to determine whether a multifaceted approach to weight loss and physical readiness could be implemented onboard a deployed combatant ship of the U.S. Navy. Research Methods and Procedures : Thirty-nine men (31±6 years old, mean±standard deviation) assigned to the USS ENTERPRISE (CVN 65) during a 6-month Mediterranean deployment who had failed their previous Physical Readiness Test due to excessive body weight (108±11 kg overweight) were randomly assigned to nutrition, cognitivebehavioral obesity treatment plus exercise or to the Navy's usual treatment (control), which is exercise alone. Results : Outcomes for the treatment group were significantly better than the controls, with 8.6±5.0 vs. 5.0±4.1 kg weight loss, 8% vs. 5% reduction in original body weight, and body fat loss of 7% vs. 5%. Triglycerides declined significantly greater in the treatment group than the controls (145 mg/dL to 109 mg/dL vs. 146 mg/dL to 145 mg/dL, p<0.05), whereas depression and eating behaviors significantly improved among treated men. Problematic environmental factors were the limited variety of heart healthy foods in the galley, short meal breaks, and long mess hall lines that led to eating snacks from vending machines and frequent port calls. Discussion : Although greater weight loss than would be expected of a Navy usual care group diluted the treatment effect, the treated men still fared significantly better. The physical readiness implication of this research has the potential to impact Navy health promotion programs and policy, the health and well-being of its personnel, and the Navy's ability to meet mission requirements.     

A Communicative Approach to Using Computers for Cultivating Cognitive Skills and Communication in Young Children

An analysis of a child's cognitive activity in the use of computers may be carried out with respect to the child's verbalization of the objective world in the presence of one other person or several people. This approach [1-3] also includes the dialogic nature of learning, and thus differs fundamentally from investigations that examine development only in individual problem solving. In contrast to the approach of Soviet investigators, who stress the role of social situations in the formation of individual concepts in a person, the dominant approach in the USA has, until quite recently, been child-oriented in all areas of learning and in child psychology.     

Health risk assessment of occupational exposure to styrene depending on the type of industry: Data from the Workplace Environmental Monitoring Program in Korea

Data from the Workplace Environmental Monitoring Program was used to evaluate the concentrations and risk of occupational exposure to styrene in different industries to identify which industries should be prioritized for styrene exposure management. Risk assessments were conducted for the five industries with several workplaces that mostly use styrene: motor vehicle and motorcycle maintenance and repair services, other chemical product manufacturing, ship and boat building, basic chemical manufacturing, and plastic products manufacturing. The highest central tendency exposure was found in the plastic products manufacturing industry (10.14 mg/m³). In addition, the hazard quotient (HQ) for central tendency exposure exceeded 1 only in the plastic products manufacturing industry. Almost two-thirds (62.2%) of workplaces in the plastic products manufacturing industry have an HQ exceeding 1. We conclude that workers in the plastic products manufacturing industry are at the highest risk for styrene exposure, and those in motor vehicle and motorcycle maintenance and repair service and basic chemical manufacturing are at the lowest risk. These results show that styrene exposure could be most effectively managed by prioritizing control measures in the plastic products manufacturing industry.     

Development of a Learning-Oriented Computer Assisted Instruction Designed to Improve Skills in the Clinical Assessment of the Nutritional Status: A Pilot Evaluation

Computer assisted instruction (CAI) is an effective tool for evaluating and training students and professionals. In this article we will present a learning-oriented CAI, which has been developed for students and health professionals to acquire and retain new knowledge through the practice. A two-phase pilot evaluation was conducted, involving 8 nutrition experts and 30 postgraduate students, respectively. In each training session, the software developed guides users in the integral evaluation of a patient’s nutritional status and helps them to implement actions. The program includes into the format clinical tools, which can be used to recognize possible patient’s needs, to improve the clinical reasoning and to develop professional skills. Among them are assessment questionnaires and evaluation criteria, cardiovascular risk charts, clinical guidelines and photographs of various diseases. This CAI is a complete software package easy to use and versatile, aimed at clinical specialists, medical staff, scientists, educators and clinical students, which can be used as a learning tool. This application constitutes an advanced method for students and health professionals to accomplish nutritional assessments combining theoretical and empirical issues, which can be implemented in their academic curriculum.     

Jamie's Ministry of Food: Quasi-Experimental Evaluation of Immediate and Sustained Impacts of a Cooking Skills Program in Australia

Objective

To evaluate the immediate and sustained effectiveness of the first Jamie''s Ministry of Food Program in Australia on individuals'' cooking confidence and positive cooking/eating behaviours.

Methods

A quasi- experimental repeated measures design was used incorporating a wait-list control group. A questionnaire was developed and administered at baseline (T1), immediately post program (T2) and 6 months post completion (T3) for participants allocated to the intervention group, while wait -list controls completed it 10 weeks prior to program commencement (T1) and just before program commencement (T2). The questionnaire measured: participants'' confidence to cook, the frequency of cooking from basic ingredients, and consumption of vegetables, vegetables with the main meal, fruit, ready-made meals and takeaway. Analysis used a linear mixed model approach for repeated measures using all available data to determine mean differences within and between groups over time.

Subjects

All adult participants (≥18 years) who registered and subsequently participated in the program in Ipswich, Queensland, between late November 2011- December 2013, were invited to participate.

Results

In the intervention group: 694 completed T1, 383 completed T1 and T2 and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237 completed T1 and 149 completed T1 and T2 assessments. Statistically significant increases within the intervention group (P<0.001) and significant group*time interaction effects (P<0.001) were found in all cooking confidence measures between T1 and T2 as well as cooking from basic ingredients, frequency of eating vegetables with the main meal and daily vegetable intake (0.52 serves/day increase). Statistically significant increases at T2 were sustained at 6 months post program in the intervention group.

Conclusions

Jamie''s Ministry of Food Program, Australia improved individuals'' cooking confidence and cooking/eating behaviours contributing to a healthier diet and is a promising community-based strategy to influence diet quality.     

儿科医师医患沟通能力培养的实践探讨

无锡市人民医院儿童医院不断挖掘潜力,多角度、全方位拓展儿科医师医患沟通能力的培养途径,从培养沟通先进理念,提升沟通专业技能,完善沟通管理机制,营造沟通良好氛围四个方面入手,增强儿科医师的医患沟通能力,构建和谐的医患关系,营造良好的就医氛围。

     

Transfer RNA: Evidence for decreasing size variation during evolution

Summary Electrophoresis of the total transfer RNA fraction from six different sources:E. coli, brewer's yeast, wheat embryo, carp liver, rabbit liver and rat liver, was performed in a 20% polyacrylamide gel. Clear evidence was demonstrated for a decreasing tRNA size variation during evolution. Thus, two parameters seem to be involved in maintaining the necessary degree of tRNA variability: mainly tRNA size variation in lower organisms, and increased tRNA modification in higher organisms.This paper is dedicated to Prof. A. Butenandt on the occasion of his 70th birthday.     

优化整合多种教学法在临床教学中的应用

临床教学是医学教育的重要组成部分,是医学生提高专业素质的根本保障。临床教学阶段对于医学生来讲至关重要,也是医学院和教学医院的工作重心。现代社会对医生的要求越来越高,而临床教学的质量直接关系到医学生的培养质量,因此提高临床教学水平势在必行。传统的以授课为基础的教学模式对学生临床技能、临床思维以及医德医风等医学基本素质的提高并不明显。近年来教育工作者以提高学生学习兴趣和综合能力为出发点,提出了多种新的教学方法,如以问题为中心教学法、以案例为中心教学法、情景模拟教学法、以小组为中心教学法等。笔者从实际应用出发、认真剖析各种教学法的优缺点,将其科学整合,应用于临床教学的不同阶段,切实有效地提高了临床教学效果。     

The Impact of a Funded Research Program on Music Education Policy

Sounds of Learning: The Impact of Music Education is a research program designed to allow researchers to examine the roles of music education in the lives of school-aged children to expand the understanding of music's role in a quality education. The NAMM Foundation, the sponsoring organization, has provided more than $1,000,000 to fund research on the impact of music education on student achievement and success in school; all aspects of a child's growth and development; the uses and functions of music in daily life; and home, school, and community environments. Quality research about the role and impact of music education conducted by experienced researchers who publish in rigorous, peer-reviewed, scientific research journals plays a vital role in moving a public policy agenda forward to achieve expanded access to music education for all children. The goal is that this research will inform policy debates and development to achieve policies that support opportunities for every child to experience the power and benefits of learning music.     

双因素理论在我院医师临床技能考核中的运用

将临床技能考核作为新的条件引入到专业技术职务评聘中是职称评聘工作的一个创新。要使考核的实施既达到加强医师队伍建设的目的,又不至影响医师工作积极性是实施者必须考虑的关键问题。文章介绍我院运依据“双因素理论”制定实施医师临床技能考核的一系列配套政策,在保障职工利益的同时激励其不断提高技术水平和职业水准,使技能考核在顺利引入的同时又取得明显效果,达到提高医院管理水平、加强医师队伍建设的目的。     

Taipei's Use of a Multi-Channel Mass Risk Communication Program to Rapidly Reverse an Epidemic of Highly Communicable Disease

Background

In September 2007, an outbreak of acute hemorrhagic conjunctivitis (AHC) occurred in Keelung City and spread to Taipei City. In response to the epidemic, a new crisis management program was implemented and tested in Taipei.

Methodology and Principal Findings

Having noticed that transmission surged on weekends during the Keelung epidemic, Taipei City launched a multi-channel mass risk communications program that included short message service (SMS) messages sent directly to approximately 2.2 million Taipei residents on Friday, October 12th, 2007. The public was told to keep symptomatic students from schools and was provided guidelines for preventing the spread of the disease at home. Epidemiological characteristics of Taipei''s outbreak were analyzed from 461 sampled AHC cases. Median time from exposure to onset of the disease was 1 day. This was significantly shorter for cases occurring in family clusters than in class clusters (mean±SD: 2.6±3.2 vs. 4.39±4.82 days, p = 0.03), as well as for cases occurring in larger family clusters as opposed to smaller ones (1.2±1.7 days vs. 3.9±4.0 days, p<0.01). Taipei''s program had a significant impact on patient compliance. Home confinement of symptomatic children increased from 10% to 60% (p<0.05) and helped curb the spread of AHC. Taipei experienced a rapid decrease in AHC cases between the Friday of the SMS announcement and the following Monday, October 15, (0.70% vs. 0.36%). By October 26, AHC cases reduced to 0.01%. The success of this risk communication program in Taipei (as compared to Keelung) is further reflected through rapid improvements in three epidemic indicators: (1) significantly lower crude attack rates (1.95% vs. 14.92%, p<0.001), (2) a short epidemic period of AHC (13 vs. 34 days), and (3) a quick drop in risk level (1∼2 weeks) in Taipei districts that border Keelung (the original domestic epicenter).

Conclusions and Significance

The timely launch of this systematic, communication-based intervention proved effective at preventing a dangerous spike in AHC and was able to bring this high-risk disease under control. We recommend that public health officials incorporate similar methods into existing guidelines for preventing pandemic influenza and other emerging infectious diseases.