PBL教学法在肝胆外科临床见习中的应用研究

临床见习是医学生由理论学习到临床实践的桥梁,为临床实习和今后的临床工作打下基础,具有非常重要的意义.肝胆外科的见习在外科见习中占有重要地位,同时肝胆外科同其他医学学科一样,整体水平不断发展,知识更新日益加快,因此也对肝胆外科的见习教学提出新的要求.     

在人体解剖学教学中实施临床见习的探讨

人体解剖学是学习临床医学的重要的基础课程。在传统的教学模式下,缺乏解剖学知识与临床实践的联系,而临床见习是理论联系实践的桥梁,因而可以在解剖学教学中实施临床见习。本文阐述了在解剖学教学中实施临床见习的必要性。     

七年制医学生消化内科临床见习带教体会

七年制医学生基础知识扎实、自学能力强,但临床分析和解决问题的实际工作能力欠缺,而临床见习是医学生理论联系实际的纽带和桥梁。因此,努力提高临床见习的带教效果,对于医学生理解、巩固所学基础知识,为临床实习奠定良好的实践基础至关重要。现结合我科多年带教七年制学生见习的具体情况,探讨如何提高七年制医学生临床见习的带教效果。1传统消化内科见习带教中的困难和缺陷消化内科理论课学时多、专业性强,学习内容多、概念抽象,使学生理解较困难。过去见习带教中大部分时间以教师讲课为主,学生多处于被动地位,部分学生出现厌烦、兴趣不浓…     

医学生临床见习教学的伦理困境及其解决

临床见习是医学生从理论学习到临床实践的重要转折,全面而系统的临床实习是医学生接受实践检验、巩固和加强所学理论知识,培养独立工作能力的一个十分重要的阶段。本文根据临床见习教学特点,分析当前临床教学和医学生临床见习中存在的伦理学难题,并就如何解决进行探讨。     

浅谈医疗体制变革过程中外科临床见习教改的体会

随着医疗体制变革和学生扩招政策的实施，传统的临床见习教学模式越来越不能适应新形势的需要。为了缓解医疗和教学之间日益突出的矛盾，保证临床见习的教学质量，作者在外科临床见习教学过程中进行了新的尝试，总结如下。     

疫情防控常态化下对留学生临床见习带教的探索与思考

新冠疫情常态化防控形势下,留学生的临床见习带教面临诸多问题,疫情防控期间让留学生进行安全有效的临床见习成为新的挑战与机遇.本文探讨了新冠疫情常态化防控背景下留学生见习带教的常见模式及存在的不足之处,以期为国内医学留学生的临床带教提供参考.     

教学医院如何带教神经外科见习医生的几点体会

临床见习是医学生由基础向临床过渡的重要阶段，尽管同学们初涉临床，学习热情高涨，有新鲜感，但由于中枢神经系统解剖关系复杂，如何带教神经外科见习医生，对神经外科医生来说是一个挑战。现将作者在神经外科见习带教中的—些体会总结如下。     

以理论考核分析指导神经科见习方案调整

临床医学本科见习是医科教学中基础理论向临床实践转变的关键.该研究通过理论考核的卷面分析,评估本科生在神经病学理论学习中对整体理论及各个知识点掌握的情况,调整神经科见习教学策略,再通过见习结束的综合考核分析,了解医学生见习掌握的情况以及临床思维的建立.     

眼科临床见习带教体会

临床见习是医学教学中的重要环节,是理论与实践相结合的第一步,是使学生获得临床感性认识并培养其能力的一种重要教学形式,在现代医学教学中起着承前启后的重要作用.眼科临床见习阶段的主要目的就是通过临床获得感性知识,并对其在课堂中所学的理论知识进行验证和巩固,初步培养学生的临床实践能力[1].眼科临床见习专业性较强,疾病检查中常需特殊的仪器和方法,如裂隙灯显微镜、眼底镜、眼压计、视野检查、眼底荧光血管造影等,相对较难掌握.本文就如何提高学生的积极性和眼科学临床见习课的教学质量报告如下.     

医学生见习阶段应注重临床思维能力的培养

临床见习阶段是医学生理论联系实践的主要环节，也是培养自己临床思维的重要时期，正确的临床思维是正确诊治疾病的法宝，所以作为医学生，临床见习阶段就应开始注重自己临床思维能力的培养。     

肿瘤专业学生放疗机房见习思考

如何在硬件有限的情况下使肿瘤专业学生在较短时间内对"生僻"的放疗机房有一个清晰的了解,是一个值得广大教师考虑的问题。作者结合自己的带教经验,从学习的目的、见习顺序、见习内容和带教老师的要求四个方面阐述了自己的观点。指出(1)见习是一种不亚于课堂教学的学习活动,一定要有明确的目的。(2)放射治疗是一个分步连续的过程,见习一定要有合理的顺序。(3)见习内容一定要连续。(4)带教的见习老师应该对新技术有所了解。     

A multiple family group intervention for first‐time juvenile offenders: Comparisons with probation and dropouts on recidivism

This study evaluated a multiple‐family group‐intervention program (MFGI) for first‐time juvenile offenders. The recidivism rate for subjects who completed the MFGI (the Family Solutions Program) was compared to recidivism rates of two other groups of first‐time juvenile offenders. Using logistic regression analysis predicting who will recidivate, juvenile first offenders who were placed on probation (N = 95) were 9.3 times more likely to re‐offend compared to the Family Solutions Program (FSP) graduates (N = 267). Families referred to FSP but who dropped out (most never attended the 10 session program) (N = 93) also were 4.4 times more likely to re‐offend compared to FSP graduates. An intent‐to‐treat model comparing the combined group of FSP graduates and dropouts with the probation group indicated that a youth in the probation group was 8.1 times more likely to re‐offend than a youth referred to the FSP. Results indicating better outcomes on recidivism for FSP graduates were significant for both male and female youths. Implications for policy and practitioners are discussed. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 177–200, 2004.     

Development of Standards and Criteria for the Selection, Training, and Evaluation of Athletic Training Approved Clinical Instructors

OBJECTIVE: To develop standards and associated criteria for the selection, training, and evaluation of athletic training approved clinical instructors (ACIs). DESIGN AND SETTING: A previously developed set of 7 physical therapy clinical instructor standards/criteria and 2 additional standards/criteria developed through a review of the literature were systematically adapted, judged, and revised through a Delphi technique. SUBJECTS: Athletic training education experts currently employed as program directors for entry-level Commission on Accreditation of Allied Health Education Programs-accredited athletic training educational programs and who had the following: a doctoral degree, at least 5 years of supervising athletic training students, and familiarity/experience with clinical instruction in various athletic training clinical education settings. MEASUREMENTS: We used panelists' critiques and ratings to make sequential revisions in a series of 3 Delphi rounds. Standards were rated as to whether they were clear, necessary, and appropriate. We rated criteria for the associated standard as to whether they were useful, helpful, clear, specific, and consistent. RESULTS: We developed a final set of 7 standards and 50 associated criteria to measure these standards. The accepted standards include the following: legal and ethical behavior, communication skills, interpersonal relationships, instructional skills, supervisory and administrative skills, evaluation of performance, and clinical skills and knowledge. CONCLUSIONS: The 7 standards and associated criteria developed in this research project could be used not only for selecting, training, and evaluating an ACI but also for developing an understanding of the requirements of clinical education in general. Further research should include validating these standards/criteria among athletic training ACIs representing different types of clinical settings.     

Manual-Based Treatment: An Essential Ingredient of Clinical Practice in the 21st Century

Wilson (this issue) raises several thought-provoking issues pertaining to the use of manual-based treatments (MBTs) in clinical practice. Based on my experiences as a researcher of manual-based treatments for social phobia and as a clinical psychologist in independent practice, I share my perspective on several of Wilson's points. Comorbid conditions do not appear to hinder the outcomes of MBTs for social phobia, and participants in controlled clinical trials do not appear very different from persons who refuse or are excluded from participation. Manuals can be written in a manner that retains a great deal of flexibility for the clinician, and these manuals may be productively employed in clinical settings. Proper implementation of MBTs requires experience with the disorder of interest and a strong background in theories of psychopathology and therapy technique.     

The impact of a brief RNR-based training on Turkish juvenile probation officers' punitive and rehabilitative attitudes and recidivism risk perceptions

The present quasi-experimental study examined the impact of a brief training program based on the risk–need–responsivity (RNR) model on Turkish juvenile probation officers' (JPOs) punitive and rehabilitative attitudes toward justice-involved youth and recidivism risk perceptions. Fifty-nine JPOs were recruited through three probation offices in Istanbul, Turkey. Thirty-six JPOs, who received a 1-day training in the RNR model of offending behavior, were compared to JPOs in a wait-list control condition (n = 23). Participants in both conditions completed surveys at baseline and 1-week posttraining. Mixed-factorial analysis of variances revealed a significantly higher decrease in JPOs' punitive attitudes from pre- to posttest, in the training condition compared to the control group, with a medium effect size. Rehabilitative attitudes decreased in both conditions, while recidivism risk perceptions did not change from pre- to posttest in either condition. Future research could expand on these promising results using a more intensive training program and a randomized-controlled design in a larger sample of JPOs.     

Translational Applications of Personality Science for the Conceptualization and Treatment of Psychopathology

Utilizing personality science within clinical assessment and intervention can aid in treatment planning. General personality constructs also are related to clinically relevant areas of dysfunction. However, personality continues to be underutilized in clinical settings. This article reviews current literature pertaining to the clinical applications of personality with a focus on dimensional models such as the Five‐Factor Model. With the advent of a dimensional personality model in DSM‐5, the clinical use of traits is an important topic of exploration. This review discusses the clinical significance of personality and personality pathology in various aspects of living (i.e., functioning, physical health, mental health), clinical applications and utility within clinical and treatment settings, and future research directions, as well as suggestions for further utilization of personality traits.     

Clinical Equivalence: A Step,A Misstep,or Just a Misnomer?

Most current approaches to assess clinical significance and clinical equivalence rely principally on concepts and methods drawn from population statistics, yet these strategies fall far short of the qualitative nature of the judgments rendered by clinicians. Just as the construct of clinical diagnosis in research settings bene-fitted by drawing upon the so-called LEAD standard (longitudinal, expert, all data) to achieve research diagnoses with the greatest clinical credibility, the concepts of "clinically significant change" or "clinically equivalent to normal" need similar standards. As an alternative, for future purposes of assessing clinical significance, I recommend the application of a "SMARTER" standard, as follows: (a) whenever possible, the method should use standardized measures, (b) it should address all relevant outcomes across settings, raters, and domains; and (c) it should make use of trained expert clinicians, trained to achieve reliability.     

海洛因依赖者复吸相关因素的前瞻性研究

目的：了解海洛因依赖者戒毒后的转归,分析复吸相关因素。方法：随访178名劳教的海洛因依赖者出所后6个月的情况,比较复吸者和戒断者的一般人口学科、临床特征、成瘾严重程度、伴发的精神疾病等方面的差异。结果：随访到的149（83．7％）的资料显示,22．8％保持戒断,46．3％复吸,29．5％正在强制戒毒、劳教或自愿戒毒,1．3％死亡。复吸与家庭中有其他吸毒者、无强烈戒毒愿望、伴有反社会人格障碍、示参加康复治疗和入教前ASI中海洛因滥用、家庭社会关系、违法犯罪三个因子分、静脉使用毒品等有关。结论：海洛因依赖者劳教后的复吸率较高,复吸与家庭生活环境、戒毒愿望、既往海洛因依赖程度、反社会人格障碍等有关,据此制定预防复吸治疗具有重要意义。     

Clinical prediction rules in practice: review of clinical guidelines and survey of GPs

Background

The publication of clinical prediction rules (CPRs) studies has risen significantly. It is unclear if this reflects increasing usage of these tools in clinical practice or how this may vary across clinical areas.

Aim

To review clinical guidelines in selected areas and survey GPs in order to explore CPR usefulness in the opinion of experts and use at the point of care.

Design and setting

A review of clinical guidelines and survey of UK GPs.

Method

Clinical guidelines in eight clinical domains with published CPRs were reviewed for recommendations to use CPRs including primary prevention of cardiovascular disease, transient ischaemic attack (TIA) and stroke, diabetes mellitus, fracture risk assessment in osteoporosis, lower limb fractures, breast cancer, depression, and acute infections in childhood. An online survey of 401 UK GPs was also conducted.

Results

Guideline review: Of 7637 records screened by title and/or abstract, 243 clinical guidelines met inclusion criteria. CPRs were most commonly recommended in guidelines regarding primary prevention of cardiovascular disease (67%) and depression (67%). There was little consensus across various clinical guidelines as to which CPR to use preferentially. Survey: Of 401 responders to the GP survey, most were aware of and applied named CPRs in the clinical areas of cardiovascular disease and depression. The commonest reasons for using CPRs were to guide management and conform to local policy requirements.

Conclusion

GPs use CPRs to guide management but also to comply with local policy requirements. Future research could focus on which clinical areas clinicians would most benefit from CPRs and promoting the use of robust, externally validated CPRs.     

Antiviral Potency of HAART Regimens and Clinical Success Are Not Strictly Coupled in Real Life Conditions: Evidence from the MASTER-1 Study

Abstract

Purpose: To compare in a real clinical setting the largely unknown midterm clinical effectiveness of two protease inhibitor (PI)-based highly active antiretroviral therapy (HAART) regimens with different potency and tolerability profiles in naïve patients. Method: This study was a multicenter, open-label, randomized trial in naïve patients with less than 400 CD4+ cell count/μL, regardless of viral load. Treatment arms were hard gel capsule saquinavir (HGC-SQV)-based HAART (Arm A), with an expected more favorable tolerability profile, and indinavir (IDV)-based HAART (Arm B), with more potent virologic activity. While viro-immunological surrogate markers and World Health Organization (WHO) grade III toxicity (secondary endpoints) were regularly monitored, primary endpoints of the study were clinical and defined as any AIDS-defining event, AIDS-related death, WHO grade IV toxicity, drop outs, and protocol violations. Results: 262 consecutive patients were enrolled in the study from March 1, 1997 to December 31, 1997, in 24 different Italian clinical centers (132, Arm A; 130, Arm B). After 24 months of follow-up, patients who were enrolled in Arm B showed a significantly higher rate of virological success (75% had viremia below 500 copies/mL, CI = 12.9%, in the on-treatment analysis) and immunological gain (mean CD4+ cell count increase of 274 CD4+ cells/μL, SD = 234) when compared to patients enrolled in arm A (57%, CI = 15.5% and 223 CD4+ cells/μL, SD = 192; p = .0353 and .026, respectively). Despite the significant difference observed in surrogate markers, the number of total primary endpoints did not differ in the two groups (55 out of 132 in Arm A vs. 58 out of 130 person-years in Arm B; p = .86). Conclusion: Our results suggest that, after 24 months of follow-up in a real clinical setting, a PI-based HAART induces significant clinical benefits in naïve patients even in the absence of a complete suppression of viral replication. However, the long-term clinical impact of the possible accumulation of viral mutations in the presence of low-grade viral replication remains to be elucidated.