Utilization of a training portfolio in thoracic and cardiovascular surgery: the example of the French platform-EPIFORM

Thoracic and cardiovascular surgery requires learning both theoretical knowledge and technical skills. In this surgical field, several disparities exist between the different training programs around the world. This report describes the implementation of a portfolio in the teaching and assessment of French trainees in Thoracic and Cardiovascular surgery, following an electronic logbook model, aiming to improve the training program. The French surgical course is a twelve semesters’ curriculum divided in 3 parts, each part containing knowledge, technical skills and behaviors objectives to be validated, defined by the French College of Thoracic and Cardiovascular surgery. The competencies are marked in the logbook, following a declarative model where the surgical trainee fills every surgical procedure attended (all or part) if he/she has observed, partially or fully performed, or supervised another trainee. All the surgical procedures are linked to theoretical e-learning lessons and each e-learning lesson includes a self-evaluation. This constitutes a competency-based assessment model with milestones both for surgeon trainees and their mentors. This portfolio also contains complementary tools such as an automated publication point calculation, a formatted curriculum vitae generator, and several contact tools between trainees. Implementation of a dedicated portfolio following an electronic logbook model appears to be a relevant pedagogic tool and survey element in the thoracic and cardiovascular surgery training program. Its use may lead to potential educational benefits for the trainee, reliable competency assessment for the supervising surgeon and for scientific society or national college.     

Continuity of care in patients with type 2 diabetes in Croatian primary care setting during COVID-19 pandemic: A retrospective observational study

AimTo examine the differences in the continuity of health care for type 2 diabetic patients before and during COVID pandemic in family medicine depending on whether the physician who provided care finished vocational training in family medicine or not.MethodsThis retrospective longitudinal research lasted from 2018 to 2020 in eight family medicine practices on 648 patients with type 2 diabetes diagnosed before 2018, and without Sars-Cov2 infection in previous medical history in Zagreb, Croatia. Follow-up parameters (HbA1c, LDL, eGFR, blood pressure, BMI, eye fundus and neurological findings, number of check-ups and vaccination against the flu) were noted before (2018, 2019), and in the COVID period (2020) in the care of family medicine specialists (FMPs) and without it (FMPws).ResultsNo differences were found between the gender and age of patients. A decrease was seen in existing laboratory findings (64–47%, P < 0.001), eye fundus check-ups (39–37%, P = NS), neurologist check-ups (28–25%, P = NS) and FMP check-ups (382–321, P < 0.001) during the COVID period with significant differences between FMPs and FMPws. Significant changes were seen in LDL cholesterol (2.7–2.4 mmol/L, P < 0.001) and eGFR (83–80 ml/min/1.73 m2, P = 0.002), but BMI, blood pressure and HbA1c (>7% had 42% of patients) values did not differ during the COVID period.ConclusionAccording to the observed parameters, the continuity of care for diabetic patients in Zagreb has worsened during the COVID pandemic but remained significantly better in care of FMPs than in FMPws, without differences in achieving target values of follow-up parameters.     

医学生临床技能培训指标体系的探索与实践

目的：为提高本院临床实习医学生的培养质量,制订科学合理的符合医学生实习需要的临床技能培训指标体系,探索其推广应用的可行性。方法随机抽取2013年7月~2014年7月进入本院实习的医学生50名作为改革组,按照临床技能培训指标体系进行培养考核,与2011年7月~2013年7月常规培养的50名学员(对照组)考核成绩进行比较。结果改革组考核成绩较对照组有明显提高,两者比较,差异有统计学意义(P<0.01)。结论医学生临床技能培训指标体系注重医学生个体化培养,较常规培养模式更加完善,有显著优越性,应向全院各科室进一步推广。     

对新护士进行积极心理健康知识培训的效果研究

目的：探讨对新护士进行积极心理健康(PMH)知识培训的效果。方法选择本院2014年7~9月新入职的26名护士,对其进行PMH知识培训,于培训前后采用幸福进取者问卷(HEIQ)和护生职业认同调查问卷(NSPIQ)评价培训效果。结果培训前,新护士HEIQ、NSPIQ评分的总分为(3.48±0.41)、(101.43±12.85)分,培训后分别为(4.21±0.58)、(127.05±15.16)分,培训前后比较,差异有统计学意义(t=5.24、6.57,P<0.01)。结论对新护士进行PMH知识培训能够提高其职业认同感。     

Effects of aerobic training and resistance training in reducing cardiovascular disease risk for patients with prediabetes: A multi-center randomized controlled trial

AimsAerobic training (AT) and resistance training (RT) can reduce blood glucose and type 2 diabetes risk, and increase muscle mass for prediabetes patients. However, the impact of long-term AT and RT on cardiovascular disease (CVD) risk remains unclear. The purpose of this study was to investigate the impact of AT and RT on CVD risk reduction in prediabetes patients.Materials and methods248 prediabetes patients were enrolled in this multi-center randomized controlled trial (RCT). Patients were randomly divided into 3 groups: RT (n = 82), aerobic training (AT (n = 83)), and control group (n = 83). Participants in RT and AT groups had moderate RT or AT 3 times a week (150 min/week) under supervision in 3 research centers for 24 months. Primary outcome was CVD risk measured by Framingham Risk Score (FRS) and The Chinese 10-year ischemic cardiovascular disease (ICVD) risk assessment tool. Secondary outcomes included in HOMA2-IR, HbA1c, blood pressure and serum lipid profile.ResultsBoth RT and AT groups experienced a significant reduction in HOMA2-IR, HbA1c, LDL-C, TC, SBP, and DBP at the end of 12 and 24 months. Compared to the control group, Both RT and AT groups had significant reduction of the Chinese 10-year ICVD risk (P < 0.05), but FRS CVD risk declined significantly only in the AT group (all P < 0.05). Although FRS CVD risk decreased more in the RT group than in the control group, the difference was not statistically significant. After adjusting for age, gender, statin use, BMI, and WHR, in COX’s proportional hazard model, RT (HR = 0.419, P = 0.037) and AT (HR = 0.310, P = 0.026) were protective factors for CVD risk in prediabetes patients. 24-month RT and AT decreased respectively 58.1% and 69.0% of CVD risk (10-year ICVD risk assessment) in prediabetes patients.ConclusionsThis study demonstrated that 24-month moderate AT reduces the Chinese 10-year ICVD risk and FRS CVD risk in prediabetes patients. RT groups had significant reduction of CVD risk (10-year ICVD risk assessment) in prediabetes patients.Trial registrationClinical trial registration number: NCT 02561377.Date of registration24/09/2015.     

Activity training on the ground in children with cerebral palsy: Systematic review and meta-analysis

Purpose: To systematically review the evidence about whether activity training on the ground is effective on activity or participation in children with cerebral palsy. Methods: Randomized controlled trials (RCTs) were searched in databases using relevant keywords. RCTs were included with children (≤18 years) with cerebral palsy who received activity training on the ground only or activity training on the ground combined with another type of physiotherapy. Outcome measures classified as measures of activity or participation according to the International Classification of Functioning, Disability, and Health were analyzed. Results: Nine RCTs (257 participants) were included in this review. Individual studies resulted in conflicting results when activity training on the ground was compared to no intervention. Based on meta-analysis, activity training on the ground was not more effective than no intervention (standardized mean difference [SMD]: 0.18; confidence interval [CI]: ?1.49 to 1.86) or other therapies (SMD: ?0.09; CI: ?0.86 to 0.69) (I² > 75%) on improving activity or participation. Results from a single study demonstrated that activity training on the ground combined with other physiotherapy intervention was not more effective than no intervention (SMD: ?0.18 CI: ?0.89 to 0.54). Conclusions: The available evidence shows little effect of activity training on the ground on activity or participation in children with cerebral palsy, suggesting that rigorous trials with larger samples and larger “dosage” of activity training on the ground are needed in the future.     

神经干刺激疗法联合康复训练对脑卒中患者下肢运动功能的影响分析

目的:分析神经干刺激疗法联合康复训练对脑卒中患者下肢运动功能的影响。方法:将56例脑卒中恢复期患者随机分为2组,每组28例。2组患者均予以一般的内科药物治疗及康复训练,在此基础上,对照组采取常规针刺治疗,观察组采取神经干刺激疗法,比较2组患者治疗前及治疗4周后的Fugl-Meyer运动功能(FMA)下肢部分评分、Fugl-Meyer平衡功能评分(FBS)及改良Barthel指数(MBI)评分。结果:经过4周的治疗后,2组FMA下肢部分评分、FBS及MBI评分均较治疗前有显著提高(均P0.05),而观察组的各项指标的提高程度相对于对照组更明显(P0.05)。结论:神经干刺激疗法联合康复训练对脑卒中患者的下肢运动功能、平衡功能及日常生活活动能力(ADL)有显著改善效果,可提高患者的生活自理能力,改善生活质量,治疗价值显著,值得在临床上推广。     

计算机辅助训练对轻度认知功能障碍的干预性研究

目的：探究计算机辅助训练对轻度认知功能障碍(MCI)的干预性研究。方法：连续收集年龄≥60岁的轻度认知功能障碍（MCI）患者100例,随机分为治疗组与对照组各50例,对照组给予健康宣教与危险因素控制,治疗组在对照组的基础上联合计算机辅助认知训练,每周3次,每次30min,共6个月。在治疗前、治疗后3、6、12个月,采用蒙特利尔认知评估量表（MoCA）和工具性日常生活能力（IADL）量表进行评价。结果：在治疗3、6、12个月后,治疗组MoCA值均明显高于干预前及同时间对照组（P＜0.01）,在治疗6个月、12个月时对照组MoCA值较干预前明显升高（P＜0.01）,2组之间存在交互作用（F=158.6,P＜0.01）。治疗12个月后,2组IADL评分均明显高于治疗前（P＜0.01）,且治疗组的IADL明显高于对照组（P＜0.01）。结论：对MCI患者进行早期筛查、健康宣教、危险因素控制及计算机辅助认知功能训练的综合干预,可有效改善认知功能障碍,减缓认知功能障碍发展,提高生活质量。