Complémentation ou supplémentation en oligo-éléments : qui,pourquoi, comment ?

Trace elements (TE) are essential for biological and physiological functions. They come from food or artificial nutrition. Maintaining or restoring an optimal status is an objective that participates in the nutritional prevention of chronic pathologies. In the hospitalized patient, detecting and fighting deficits will promote faster recovery and reduce infectious complications. In the case of deficient dietary intakes which cannot be corrected by the one nutrition or artificial feeding, the use of suitable trace element supplements is essential. This review presents the main causes and consequences of trace element deficiencies in the general population and in hospital patient, as well as the biological and clinical markers of these deficits. It provides, on the basis of the current recommendations, a practical overview of the conditions for complementation or repletion by oral, enteral or parenteral route, avoiding toxicity with proposals for diagnostic methods and therapeutic interventions.     

Pilot Investigation into the Use of an Anthropomorphic Breast Sonography Phantom as a Training and Assessment Tool

A device for the training and quantitative assessment of the competency of trainee radiologists in the technically challenging area of breast sonography was developed and evaluated. Currently, suitable commercially available devices are lacking, and there is a growing realization that the reliance on direct exposure to patients for learning may not represent best practice from either the trainees' or patients' perspective. Three devices (PI, PII and PIII) were designed to produce very realistic sonographic images of breast morphology with a range of embedded pathologies. The pilot evaluation used a case study research design to evaluate the role of the anthropomorphic breast sonography training device in training and assessment in a clinical environment. Through the case study, it was possible to evaluate the process and relationships when using this type of training intervention for a small group of radiology resident trainees. The investigation involved a baseline assessment of trainees' (n = 4) ability to detect and characterize all lesions in PI, followed by a 4-wk training period on PII and a post-training assessment using PIII. The evaluation revealed an improvement of 30% ± 8% in the trainee's performance from pre- to post-training. It was expected that the performance of the trainees would improve as the training phantom described in this study aligns with the learning theory of constructivism and fits the ideal specifications of a medical training device in terms of its realism and facilitation of self-directed learning and deliberate practice of the trainees. The device provides a useful platform upon which training and assessment can be facilitated.     

探索性研究子宫输卵管超声造影中输卵管通而不畅的分级方法及其临床意义

目的 探索性研究子宫输卵管超声造影中输卵管通而不畅的分级方法及其临床意义。     

第1年外科住院医师客观结构化临床考试的实施及评价

目的 探讨第1年外科住院医师采用客观结构化临床考试进行年终考核的效能、合理性，根据考试结果改进培训和考试的形式及内容。 方法 31名第1年外科住院医师参与考核。考核共设病例分析、污染伤口换药、石膏固定术、腹腔镜模拟器基础技能、不规则创面清创缝合术等5站，各站均采用百分制，每站考核15分钟。考后即刻问卷调查住院医师对此次考核的意见和看法，共发放调查问卷31份，回收31份。测算各考站的难度、区分度、信度，考站间进行相关性分析。 结果 OSCE平均成绩74.66±4.39，OSCE总体难度为0.747，区分度为0.578，信度为0.402。第1站难度最低，第5站难度最大。各站的区分度均＞0.400。第2、4站信度偏低。1、2站间和1、4站间存在中等程度相关，其余各站间无明显相关性。住院医师的问卷调查显示第4、5站被认为最难，第2站被认为最简单，第4站对临床最有帮助，考核中住院医师第2站表现最好，第5站表现最差。结论 客观结构化临床考试能够有效评价住院医师培训效果。模拟复杂临床情景的考题更能考核出住院医师的实际临床能力。考后还需要客观评价考核效能，并根据住院医师的主观评价动态调整培训内容和考核形式。     

老年胆总管结石合并2型糖尿病患者多学科协作模式下行腹腔镜胆总管探查术的疗效分析

目的探讨老年胆总管结石合并2型糖尿病患者在多学科协作模式(MDT)下行腹腔镜胆总管探查术的安全性及临床效果。方法选取2014年12月~2016年12月期间在我科行腹腔镜下胆囊切除+胆总管探查取石术的患者98例,其中年龄大于60岁合并2型糖尿病患者46例为实验组,年龄小于60岁且未合并糖尿病的患者52例为对照组。比较两组手术时间、术中出血量、术后住院时间及并发症发生率。结果 98例患者均治愈出院,无死亡病例。实验组住院时间大于对照组(P0.05),两组在手术时间、术中出血量及并发症方面比较,差异无统计学意义(P0.05)。结论老年胆总管结石合并2型糖尿病的患者在多学科协作模式下控制好血糖及相关基础疾病,行腹腔镜下胆总管探查取石术效果良好,可以达到与年龄小于60岁且未合并糖尿病的患者一样的治疗效果,是安全、有效且微创的一种手术方式。     

如何运用系统评价结果进行临床实践

循证医学实践需要高质量证据。系统评价/Meta分析通过立题、检索文献、筛选文献、评价文献质量、收集资料、分析资料、解释结果、更新原有评价等严格系统的制作过程,确保研究结果和结论的真实性和可靠性,因此被公认为论证强度最高的证据。然而临床医生在将其具体应用于临床实践之前还需考虑该系统评价结果是否适用于你的患者,是否包含了所有可能的重要结果,其干预措施对患者的诊治益处在临床上是否重要,对患者是否利大于弊,此外,还需要考虑所需治疗费用以及患者的价值取向。循证医学临床实践因需要而产生,同时它也因为真实性、患者的个体化以及疾病的复杂性而不断更新。也正是因为它的缺陷性和不完美性,循证临床实践才具有更广阔的发展空间。     

Communication skills training for health care professionals improves the adult orthopaedic patient’s experience of quality of care

Rationale: Despite the fact that communication has become a core topic in health care, patients still experience the information provided as insufficient or incorrect and a lack of involvement. Objective: To investigate whether adult orthopaedic patients’ evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods: The study was designed as an intervention study offering professionals training in communicating with patients and colleagues. The outcome was measured by assessing patients’ experience of quality of care. Data were collected by means of a questionnaire and analysed using a linear regression model. Approval was obtained from the Danish Data Protection Agency. Results: A total of 3133 patients answered the questionnaire, 1279 before staff had attended courses and 1854 in the postcourse period, with response rates of 67.8 and 77.8%, respectively. After the course period, significant increases in responses indicating ‘considerable’ improvement were recorded for 15/19 questions, nonsignificant increases were registered for 3/19 questions and a statistically significant decrease for one question. Study limitations: This being an effectiveness study, it is deemed that the organizational changes taking place during the study period constitute no serious limitation. Response rates were comparable to those of other studies. Conclusion: Patients show increased satisfaction with the quality of health care after professionals have attended a communication skills training course, even when implemented in an entire department. Practice implications: We recommend that healthcare professionals are trained in patient‐centred communication and that training is extended to the entire organization.