Does physical exercise improve obstacle negotiation in the elderly? A systematic review

BackgroundPhysical exercise improves walking in the elderly but much less is known about its effect on more challenged gait, such as obstacle negotiation. We conducted a systematic review to discuss the effects of regular physical exercise on kinematics and kinetics of obstacle negotiation in the elderly.MethodsA comprehensive literature search revealed 859 citations for review, whereof 206 studies entered the full-text analysis. After application of inclusion and exclusion criteria, 13 studies were included in this systematic review.FindingsMost of them presented a reasonable quality (average 0.68) but none of them reached the level of a randomized control trial. Interventions were heterogeneous, with training periods lasting from 5 days to 10 months. Studies assessed obstacle negotiation basically considering 3 types of testing paradigm, namely a walkway with either a single obstacle crossing, or with multiple obstacles, or else a treadmill with an obstacle avoidance task under time pressure.InterpretationIn general, longer training programs had better results and very short ones were not effective. A weekly frequency of 2–3 times was the most common among the studies showing positive effects. Regardless of exercises types performed, most of them were effective and so far, there is no consensus about the best exercise for improving obstacle negotiation. A lack of studies on this topic still is evident. Including a record of fall score can further help in deciding which programs are to be preferred.     

剧本对话模式的问诊第二课堂实训效果分析

目的 探讨剧本对话模式在问诊第二课堂实训中的效果,以提高问诊教学的质量。方法 将本院14级临床医学专业五年制学生69人,随机分为对照组和实验组,前者34人,按照传统方法医院问诊训练,后者35人,采用校内剧本对话模式问诊实训,比较两种教学方法的效果差异。结果 实验组与对照组总分比较无明显差异,P>0.05,没有统计学意义；分析问诊各个环节,主诉、沟通能力等2个环节,实验组与对照组比较有明显差异,P＜0.05,具有统计学意义；其它环节实验组与对照组比较无明显差异,P>0.05,没有统计学意义。结论 采取剧本对话模式的问诊第二课堂实训,效果良好,与对照组的床旁问诊实训效果相当,且显著提高了学生的学习积极性,训练了临床思维,全面提高了本课程教学质量。     

卫生法学专业法律诊所教学体系的构建

起源于美国的法律诊所教育以对学生进行法学实践技能教育为目的,在全面培养学生理论联系实际的能力和锻炼各项实用的职业技能方面具有积极作用。我国目前的卫生法学专业在培养学生的实务能力方面存在不足,法律诊所教育对此有较好的弥补作用。因此,本文借鉴美国高校在开展法律诊所教育中积累的专业划分细致、开展校外诊所、注重先期培训、评价机制独特等实践经验,从法律诊所的定位、校内校外双培制、师资队伍的建设、评价机制的确定等方面探讨构建一套科学合理的卫生法学专业法律诊所教学体系。     

浙江省临床医学硕士专业学位研究生与住院医师规范化培训并轨培养模式的质量分析和对策研究

目的 完善浙江省临床医学硕士专业学位研究生培养与住院医师规范化培训并轨的培训体系，以期提高医学研究生的职业素质。方法 通过文献法和专家访谈制定调查问卷，获得77名临床规培研究生资料，以柯氏评估的反映层、学习层、行为层、成果层为切入点，对规培效果进行评价。采用SPSS 20.0进行统计分析，柯氏评分采用均数±标准差，定性资料采用率或构成比；评分比较采用t检验，多组人群的评分比较采用方差分析。 结果 反应层规培态度值为9.26±1.08，规培内容值为29.29±4.36，规培师资带教教师积极性的值为11.13±2.17，规培感受值为17.38±3.10，说明住院医师对培训的总体满意度较高，但培训师资、考核及薪酬满意度较低。学习层规培前后，医学知识、临床思维及操作技能考试等成绩差异有统计学意义（P＜0.05）。行为层显示规培生行为前后均发生了明显的改变（P＜0.05），在查房、处理常见病等能力方面有较多提高。成果层显示77名规培生均无医疗事故和投诉，全部通过年度考核，100%参与课题研究。结论 规培研究生总体对培训的计划，内容，方式等感到比较满意，但存在信息反馈不及时、带教教师积极性不高、缺乏有效竞争机制等问题。柯氏评估模型从整体视角对研究生规培进行全面客观的评估，可以引入到研究生规培的效果评价中来。     

Training interventions for healthcare providers offering group-based patient education. A scoping review

ObjectivesTo provide overview of research on training interventions for healthcare providers aimed at promoting competencies in delivering group-based patient education.MethodsA systematic literature search identified relevant studies. Data was extracted on training details, study design, outcomes and experiences. Results were summarized and qualitative data analyzed using content analysis.ResultsTwenty-seven studies exploring various training interventions were included. Ten studies used qualitative methods, eight quantitative and nine mixed methods. Use of a comparison group, validated instruments and follow-up measures was rare. Healthcare providers’ reactions to training were mostly positive. Several studies indicated positive short-term effects on self-efficacy and knowledge. Results on observed skills and patient outcomes were inconclusive. Results on healthcare providers’ experience of delivery of group-based patient education following training were categorized into 1) Benefits of training interventions, 2) Barriers to implementation and 3) Delivery support.ConclusionsFurther evaluation of training for healthcare providers delivering group-based patient education is needed before conclusions on training efficacy can be drawn. The results indicate an expanding research field still in maturation.Practice implicationsEfficacy studies evaluating theoretically grounded training with clear attention on group facilitation and follow-up support are needed. Inclusion of validated instruments and long-term outcomes is encouraged.     

An evaluation of stereoacuity (3D vision) in practising surgeons across a range of surgical specialities

BackgroundJudging depth is important in surgery. Although there are several cues that permit depth perception, stereoacuity has been singled out as a possible predictor of surgical ability. However, it is not clear whether high-grade stereoacuity is necessary for a career in surgery. To help answer this, we aimed to evaluate stereoacuities in practising surgeons across a range of surgical specialities.MethodsWe recorded stereoacuity values on 66 surgeons working at a London teaching hospital using three standard stereotests: Titmus, TNO and Frisby. There were 36 Trainees and 30 Consultants, covering 12 surgical specialities.ResultsMedian stereoacuities (with range) for the whole group were: 40 s arc on Titmus (40–800), 30 s arc on TNO (15–480) and 20 s arc on Frisby (20–600). Four surgeons had no recordable stereoacuity on TNO, and one was also unrecordable on Titmus. Three of these four were Consultants. Depending on the test used, high-grade stereopsis was found in 74%–83% of surgeons while reduced stereopsis was found in 2%–14% of surgeons.ConclusionWhile we found that most surgeons in current NHS practice have high-grade stereoacuity, there are also surgeons with reduced stereopsis and some with no stereopsis. The findings do not therefore support the assertion that high-grade stereopsis is a universal requirement for a career in surgery. It would be difficult to justify setting a stereoacuity criterion for entrance into a surgical training programme.     

儿科护士疼痛管理知识培训课程设计及实施效果评价

目的 评价实施儿科护理人员疼痛知识培训课程的效果,为有效提高儿童疼痛管理质量提供依据。 方法 采用类实验设计和方便抽样法选取符合纳入标准的170例儿科护士作为研究对象,对其实施儿科护理人员疼痛知识培训。培训前后采用儿科护士疼痛知识与态度调查问卷(pediatric nurses′ knowledge and attitudes survey regarding pain, PNKAS)对其进行问卷调查,比较培训前后儿科护士疼痛知识水平、态度的变化。 结果 培训前后,儿科护士疼痛管理知识总分及各维度(疼痛一般知识、疼痛评估、药物镇痛、镇痛措施及案例分析部分)得分比较,差异均具统计学意义。 结论 儿科护士既往缺乏疼痛管理教育及培训,疼痛管理知识培训可有效提高儿科护士疼痛知识水平,同时改变其疼痛管理过程存在的错误观念。     

A review of breastfeeding training intervention studies that evaluate staff knowledge outcomes in NICU

BackgroundThe NICU environment presents many barriers for mothers to provide breast milk for their infants. In order to succeed, mothers require advice and assistance from healthcare staff, however some staff lack the necessary knowledge and skills to support them. This review evaluates studies of breastfeeding education interventions on staff knowledge outcomes.MethodsA systematic search of the literature was conducted. Research studies that measured NICU staff knowledge outcomes of training were included.ResultsFrom 94 studies identified, four were included, each demonstrated significant positive effects on staff knowledge outcomes following a breastfeeding educational intervention in NICU. There were no RCTs, three studies used a pre and post-test design, and one used a post-test only design. One study performed a time series analysis of knowledge, staff attitudes and beliefs and two studies conducted an audit of breastfeeding rates.ConclusionsThis review identified a lack of good quality evidence on the effectiveness of breastfeeding educational interventions for staff in NICU. Future research should address the breastfeeding education needs of multidisciplinary healthcare staff in NICU through large, well-conducted RCTs.     

Supporting people with young onset dementia and their families: An evaluation of a training course for care workers

This article reports the findings of an evaluation of a training course for care workers who care for people with dementia in the community. Twenty-four care workers participated in the training which took place in London and Surrey, United Kingdom. The training had a significant positive impact on participants’ confidence in understanding the experiences and social care needs of people with young onset dementia (YOD) and their families. Participants also perceived that the training would help them improve their working practice by furthering their understanding of practical approaches to supporting and caring for people with dementia in general. Additionally, participants reported many ways in which they perceived being able to specifically support and empower people with YOD. It was concluded that the short training course improved knowledge and confidence for care workers on dementia care, and specifically in understanding how to support people with YOD and their families. Dementia specific training should be considered by service managers as a way of potentially increasing care worker job satisfaction.