The role of “improv” in health professional learning: A scoping review

Background: The use of improvizational theater (“improv”) in health professional education (“medical improv”) is an emerging field. However, optimal curricular design features and learning outcomes have not yet been systematically described.

Objective: To synthesize evidence on learning outcomes and curricular design elements of improvizational theater training in health professions education.

Methods: A literature search with keywords “Improv” and “Improvisational Theatre” was undertaken in January 2016 in Ovid MEDLINE, CINHAL, EMBASE, SCOPUS, Web of Science, and ERIC, with an accompanying gray literature search. Four authors coded and achieved consensus on themes relating to curricular design elements and learning outcomes, which were mapped onto the CanMEDS framework.

Results: Seven articles met inclusion criteria. Key curricular design features included (i) facilitators with dual clinical and theater expertise; (ii) creating a low-stakes environment; and (iii) engaging in debrief to highlight clinical relevance. Improv curricula were found to impact most CanMEDS roles, including: Medical Expert (comfort with uncertainty); Leader (team management); Scholar (feedback, self-reflection); Communicator (empathy, active listening, non-verbal communication); Collaborator (culture of trust); and Professional (resiliency and confidence). Mechanisms by which improv may promote acquisition of these professional competencies, and the utility of improv in areas such as interprofessional team development, leadership, and wellness and resiliency are discussed.     

A phase I study investigation of metabolism,and disposition of [ 14 C]-anlotinib after an oral administration in patients with advanced refractory solid tumors

Anlotinib is a novel oral multi-targeted receptor tyrosine kinase inhibitor, which selectively inhibits VEGFR2/3, FGFR1-4, PDGFR α/β, c-kit, and Ret. It shows antitumor effect in patients with advanced refractory solid tumors. The detailed absorption, metabolism, and excretion pathways of anlotinib have not yet been fully investigated. Six male patients were enrolled and divided into two groups. Group A (containing two patients) received 14.15 mg/80 µCi/subject [14C]-anlotinib hydrochloride. Group B (containing four patients) received 14.15 mg/120 µCi/subject [14C]-anlotinib hydrochloride. The blood, urine, and feces of all the six patients after orally administration of [14C]-anlotinib were collected. The absorption, metabolism, and excretion of [14C]-anlotinib were investigated, and the efficacy and safety of anlotinib were evaluated. In plasma, the average time to peak concentration (Tmax) of total radioactivity was 4.42 h and the average peak concentration (Cmax) of total radioactivity was 18.80 ng Eq./g. The average values of AUC0-last, AUC0-∞, and MRT0-t were 4071 h.ng Eq./g, 13,555 h.ng Eq./g, and 125 h, respectively. The average recovery of total radioactivity (TRA) in urine and feces was 62.03%, accounting for 48.52% and 13.51% in feces and urine of the total dosage, respectively. The parent drug, a carboxylic metabolite (M30), and mono-oxidation products (M46/M66) were major drug-related components in human plasma. Oxidative metabolism played the major role in drug clearance in human. The major metabolic pathways include oxidative deamination to M2, mono-oxidation to M1, and the formation of M30. Adverse events occurred in five patients and severe adverse events (SAE) occurred in one. Tumor response were evaluated as stable disease (SD) in three, partial response (PR) in one, and progressive disease (PD) in one of the patients, respectively. Anlotinib had a good pharmacokinetic profile with rapid absorption, long half-life, and extensive hepatic metabolism. The adverse events and efficacy were as expected.     

基于MRI动态图像观察吞咽时器官动度对头颈部肿瘤调强放疗靶区影响

目的 利用MRI技术连续采集头颈部肿瘤患者吞咽时图像,观察并测量软腭、舌、喉的运动规律及最大活动度。方法 随机选取2018年7月-10月在中国医学科学院肿瘤医院接受调强放疗的原发头颈部恶性肿瘤20例患者,其中男17例、女3例,中位年龄58.5岁(28~78岁)。20例患者中鼻咽癌7例,口腔癌3例,口咽癌5例,下咽癌3例,鼻腔鼻旁窦2例。根据AJCC第八版分期Ⅰ-Ⅱ期患者2例,Ⅲ期8例,Ⅳ期10例。结果 吞咽时软腭向上移动移动距离为(1.06±0.31) cm且服从正态分布,向后移动距离为(0.83±0.24) cm且近似正态分布。舌体向后移动距离为(0.77±0.22) cm,且服从正态分布。含压舌板行图像采集患者舌上移位移为0,无压舌板患者舌体中位上移距离为1.23 cm (0.59~1.41 cm)。喉向上移动距离为(1.14±0.22) cm且服从正态分布,向前移动的中位距离为0.4 cm (0.27~0.90 cm)。结论 吞咽运动有可能发生于头颈部肿瘤患者放疗过程中,并引起大体肿瘤体积(GTV)及周围正常组织移动;因此在制定放疗计划时应注意GTV至PGTV的个体化外放距离,以保证肿瘤处方剂量。     

乙肝肝硬化肝胆湿热及肝肾阴虚证物质基础研究＊

目的 运用代谢组学技术分析乙肝肝硬化患者肝肾阴虚及肝胆湿热两种典型证候（同病异证）的血清差异代谢产物及其代谢通路，探寻虚、实两种典型证候的内在物质基础，以期从代谢水平上为中医证候分类提供客观依据。方法 对符合纳入标准的111例不同证候的乙肝肝硬化患者（肝胆湿热证40例，肝肾阴虚证41例，隐证(无证可辨）者30例）中医症状及体征进行描述性分析，发现两种不同证型的临床信息分布规律及证候特征；采用气相色谱-飞行时间质谱联用（GC-TOF/MS）技术对乙肝肝硬化患者，以及与之相匹配的60例健康人的血清样本进行检测，经非监督的主成分分析（Principal Components Analysis，PCA）、有监督的偏最小二乘判别分析（Partial Least Square Discriminant Analysis，PLS-DA）及监督的正交偏最小二乘法（Orthogonal Partial Least SquareDiscriminant Analysis，OPLS-DA）分析，找出与乙肝肝硬化疾病本身及其两种典型证候相关的差异性物质；运用MetaboAnalyst 3.0数据库，寻找并解析肝胆湿热及肝肾阴虚虚实两种证候间差异性物质的相关代谢通路。结果 （1）肝胆湿热证中出现频率较高（50%以上）的症状为小便色黄，口干，口苦，口臭或有异味等。肝肾阴虚证中出现频率较高的症状为口干、腰酸、乏力、腿软等。两证共见症/征为口干、尿黄、易怒、舌红。（2）各组间丙氨酸氨基转移酶（Alanine Aminotransferase,ALT）数值无统计学差异（P > 0.05）；与健康组比较，隐证组中白蛋白（Albumin，ALB），肝胆湿热证中总胆红素（Total Bilirubin，TBil）、直接胆红素（Direct Bilirubin，DBil）、谷草转氨酶（Aspartate Transaminase，AST）、碱性磷酸酶（Alkaline Phosphatase，ALP）、谷氨酰转肽酶（Gamma-Glutamyl Transpeptidase，GGT）、总胆汁酸（Total Biliary Acid，TBA）及ALB，肝肾阴虚证TBil、ALP、GGT、TBA、ALB值差异均有统计学意义（P < 0.05）；与隐证比较，肝胆湿热证TBil、DBil、AST、ALP、TBA、ALB，肝肾阴虚证TBA、ALB差异有统计学意义（P < 0.05）；肝胆湿热证与肝肾阴虚证相比，TBil、DBil差异有统计学意义（P < 0.05）。（3）代谢组学检测及代谢通路分析，发现各组之间代谢谱均有良好的区分，并获得各组间的差异性物质。发现肝胆湿热及肝肾阴虚两典型证的共同物质10个，去除疾病（隐证）的信息，则得到两证共同物质6个，涉及的代谢通路为甘氨酸、丝氨酸及苏氨酸代谢和苯丙氨酸代谢；同时，分别获得两证各自特异性的代谢物质各8个，分别涉及亚油酸代谢和甘氨酸、苏氨酸及丝氨酸代谢。结论 运用代谢组学技术，发现肝胆湿热及肝肾阴虚不同证之间既存在病的共同物质（同病），也存在证的差异物质（异证），从而在代谢层面上为中医证候分类的科学性提供科学依据。     

T3、T4期结直肠癌淋巴结转移危险因素分析

目的探讨T3、T4期结直肠癌患者淋巴结转移危险因素,为临床诊疗提供参考。方法回顾性分析2008年1月至2017年12月在空军军医大学西京消化病医院行结直肠癌根治术的1112例T3、T4期结直肠癌患者的临床病理资料,分析淋巴结转移状态与临床病理因素及肿瘤标志物的相关性,应用logistic多因素回归法分析淋巴结转移的相关危险因素。结果单因素分析结果显示,性别、年龄、肿瘤部位分层的结直肠癌患者间淋巴结转移率差异均无统计学意义(均P>0.05),淋巴结转移率在不同肿瘤长径[<5 cm和≥5 cm分别为37.75%(211/559)、52.26%(289/553),χ^2=23.666,P<0.01]、大体类型[浸润、溃疡、蕈伞、隆起分别为37.04%(20/54)、47.52%(432/909)、34.33%(23/67)、69.51%(57/82),χ^2=13.787,P=0.003]、分化程度[高、中、低分化分别为34.11%(102/299)、49.00%(317/647)、48.80%(81/166),χ^2=19.771,P<0.01]、错配修复缺陷(dMMR)[是和否分别为26.34%(64/243)、50.17%(436/869),χ^2=43.996,P<0.01]、神经侵犯[是和否分别为48.17%(421/874)、33.20%(79/238),χ^2=16.954,P<0.01]、脉管侵犯[是和否分别为79.16%(338/427)、23.65%(162/685),χ^2=327.493,P<0.01]以及术前癌胚抗原(CEA)[阳性(≥5 mg/ml)和阴性(<5 mg/ml)分别为52.87%(249/471)、39.16%(251/641),χ^2=20.162,P<0.01]和CA199[阳性(≥35 U/ml)和阴性(<35 U/ml)分别为59.33%(124/209)、41.64%(376/903),χ^2=21.465,P<0.01]分层患者间差异均有统计学意义。logistic多因素回归分析显示,脉管侵犯和术前CA199阳性是T3、T4期结直肠癌患者淋巴结转移独立危险因素(OR=13.006,95%CI 9.329~17.276,P<0.01;OR=2.194,95%CI 1.513~3.181,P<0.01),dMMR阳性是淋巴结转移的保护性因素(OR=0.279,95%CI 0.190~0.411,P<0.01)。结论脉管侵犯是T3、T4期结直肠癌患者淋巴结转移的主要危险因素。术前肿瘤标志物CA199的检测可以作为预测T3、T4期结直肠癌患者淋巴结转移状态的指标,一定程度上可为诊疗方案的制订提供参考。     

物联网技术融入《生物医学传感器》实验教学改革的探索与实践

近年来，物联网技术迅猛发展，为医学教育融入物联网技术、培养医工结合的跨学科人才，开辟了广阔前景。研究者在《生物医学传感器》课程实验教学中融入物联网技术，改革实验教学内容和方法，开发设计出基于物联网技术的生物医学传感器实验教学系统；使学生理解物联网在智能医疗设备方面的系统设计方法，培养学生的动手能力和创新能力；并取得初步教学成效。     

138例儿童颅外恶性生殖细胞肿瘤临床研究

目的:研究儿童恶性生殖细胞瘤（malignant germ cell tumor，MGCT）的临床及预后特征。方法:回顾性分析1998年1月至2016年1月上海儿童医学中心收治的初发颅外MGCT患儿138例。对患儿的临床特点、疗效及预后做综合分析。结果:按病理分期，Ⅰ期患儿5年总生存期（overall survival，OS）OS为100.00%，Ⅱ期患儿5年为94.44%，Ⅲ期5年OS为96.43%，Ⅳ期5年OS为88.73%。多因素分析显示，病理分期对生存率的影响有统计学差异（P<0.01），年龄、性别及部位对于生存率的影响无显著统计学差异。本研究中共有13例Ⅰ/Ⅱ期患儿接受手术后临床观察，有5例（38.5%）在2年内出现疾病复发进展的情况并接受化疗，目前均达到临床缓解。结论:通过以手术联合含铂类药物化疗并根据临床危险度的不同分层治疗MGCT瘤患儿，可得到较好的临床疗效。     

新型冠状病毒肺炎疫情期间肿瘤患者的健康教育管理

2019年12月，新型冠状病毒肺炎疫情在湖北武汉发生，并迅速向全国蔓延。新型冠状病毒肺炎疫情发生后，打破了很多患者原有的治疗计划，患者健康教育也受到了较大影响。在这样的特殊形势下，应提倡减少外出、避免人群聚集，缩短患者在院停留时间，因此如何做好肿瘤患者的健康教育成为了一个紧迫的问题。针对新型冠状病毒肺炎对肿瘤患者的影响，肿瘤患者健康教育的需求及重要性，疫情期间如何针对肿瘤患者采取更加合理的方式做好健康教育等问题，本文进行了简要的阐述。希望能够引发肿瘤健康教育工作者对新型冠状病毒肺炎疫情下如何实施肿瘤患者健康教育的思考，最大程度上降低疫情带来的不良影响，保证肿瘤患者健康教育的科学性、连贯性。