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Julia H. Vermylen Gordon J. Wood Elaine R. Cohen Jeffrey H. Barsuk William C. McGaghie Diane B. Wayne 《Journal of pain and symptom management》2019,57(3):682-687
Introduction
Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.Innovation
An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS.Outcomes
A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing.Comments
We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes. 相似文献105.
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The study of parenting practices on child food consumption has often been characterized as having great utility but lacking in theory. In contrast, the theory of planned behavior (TPB) has often been suggested to be limited in its utility. To address these gaps, interpersonal constructs – the concepts of active parental guidance (e.g., nutrition education) and restrictive parental guidance (e.g., rule-setting) – were integrated as antecedents to the original TPB variables in predicting child fruits and vegetables (FV) consumption. We surveyed 210 child/adolescent participants, aged between 10 and 16 in Singapore. Results from structural equation modeling showed that the integrative TPB model displayed an acceptable fit. Parental active guidance was associated with all three proximal predictors of behavior. Our results suggest that there are promising contributions to the theory of planned behavior in predicting child food consumption behavior by considering interpersonal antecedents. 相似文献
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Neil Ryan Johanna Wall Emma J Crosbie Mark Arends Tjalling Bosse Saimah Arif Asma Faruqi Ian Frayling Raji Ganesan Ye L Hock Raymond McMahon Ranjit Manchanda W Glenn McCluggage Pinias Mukonoweshuro Gerhard van Schalkwyk Lucy Side John H Smith Bruce Tanchel D Gareth Evans C Blake Gilks Naveena Singh 《Histopathology》2019,75(6):813-824
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Sandeep Kumar Shukla Ajay Kumar Sharma Vanya Gupta M.H. Yashavarddhan 《Journal of tissue viability》2019,28(4):218-222
Wound inflammation is a rapid and highly orchestrated process that significantly impacts the wound healing cascade. Consequent to injury, a series of events set off that include inflammatory, proliferation and maturation phases leading to wound closure and restoration of normal skin integrity. Stimuli causing stress to host immune system or induce inflammatory response include tissue damage and pathogenic microbial infection.Several evidences points towards the positive role of inflammation as it essential to fight against the attack of invading pathogens and to remove dead tissues from the site of injury. Besides its positive role, prolonged inflammation is injurious and may result in deregulated stages of the wound healing which may lead to excessive scarring. Achieving balance in inflammatory cascade is one of the challenging tasks for development of a wound healing drug.This review mainly focuses on the pharmacological control of inflammation by agents which critically balance the inflammatory cascade. However, none of the agent is available in the healthcare market which exclusively plays a role in wound repair. In this review we shall explore different factors or agents affecting inflammation in wound healing. This information might be helpful in designing and development new process, technologies or drugs for better management of wound care. In addition, understanding the effect of inflammation on the outcome of the healing process will serve as a significant milestone in the area of pathological tissue repair. 相似文献
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M.P. Pereira C. Zeidler T. Nau S. Bobko A.W.M. Evers S. Garcovich M. Gonalo J.A. Halvorsen J. Lambert F.J. Legat T. Leslie M. Metz L. Misery K. Nordlind A. Reich G. Schneider H. Stnder M. Streit J.C. Szepietowski J. Wallengren E. Weisshaar S. Stnder 《Journal of the European Academy of Dermatology and Venereology》2019,33(2):263-266