A national post-Match webinar panel improves knowledge and preparedness of medical students interested in vascular surgery training

BackgroundThe current shortage of vascular surgeons is projected to worsen. Compared with other surgical residency programs, integrated vascular surgery residency (IVSR) offers fewer training positions and attracts fewer applicants. As a result, only a few medical students from each school match into the specialty, and conventional resources like Match panels are not available to students interested in vascular surgery. We hypothesize that a national post-Match panel webinar will improve medical students' knowledge of the IVSR application process.MethodsA panel of four recently matched medical students shared their experiences on their successful Match into an IVSR through a 65-minute-long national webinar. Data were collected from students who attended the webinar through anonymous online surveys before and after the panel discussion. The participants' self-reported understanding of the IVSR was assessed using a 5-point Likert scale for 11 questions. Objective knowledge of the IVSR Match process was assessed using five data-based questions. All prewebinar and postwebinar responses were paired and compared using bivariate analysis.ResultsA total of 76 participants completed both the prewebinar and postwebinar surveys. The majority of respondents were first-year medical students (51.3%) and attended medical school in the Northeast (38.2%). Among these respondents, 57.6% indicated that their home institution had an IVSR program, 44.7% had an active vascular surgery interest group (VSIG), 14.5% had previously attended a vascular surgery conference, and 28.9% were very likely to apply into an IVSR. After the webinar, more students correctly identified the number of currently existing IVSR training positions (76.3% vs 89.5%; P = .002), duration of IVSR (56.6% vs 85.5%; P < .001), and median Step 1 score (50% vs 84.2%; P < .001) and minimum number of applications (38.2% vs 65.8%; P < .001) recommended for a successful Match into IVSR. Students who had a VSIG at their home institution were found to have a better baseline knowledge of the IVSR based on their higher aggregate scores on the data-based questions (3.4 ± 1 vs 1.9 ± 1.2; P < .001) compared with those without one.ConclusionsA national webinar run by recently matched students can effectively improve medical students' understanding of the IVSR application process. Students with a VSIG at their institutions have a better baseline knowledge of IVSR. In addition to expanding the VSIG, instituting an annual national postmatch webinar may help students become better prepared applicants and improve the overall application pool.     

Evaluation of optimised 3D turbo spin echo and gradient echo MR pulse sequences of the knee at 3T and 1.5T

IntroductionTo investigate the impact of parameter optimisation for novel three-dimensional 3D sequences at 1.5T and 3T on resultant image quality.MethodsFollowing institutional review board approval and acquisition of informed consent, MR phantom and knee joint imaging on healthy volunteers (n = 16) was performed with 1.5 and 3T MRI scanners, respectively incorporating 8- and 15-channel phased array knee radiofrequency coils. The MR phantom and healthy volunteers were prospectively scanned over a six-week period. Acquired sequences included standard two-dimensional (2D) turbo spin echo (TSE) and novel three-dimensional (3D) TSE PDW (SPACE) both with and without fat-suppression, and T21W gradient echo (TrueFISP) sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured for knee anatomical structures. Two musculoskeletal radiologists evaluated anatomical structure visualisation and image quality. Quantitative and qualitative findings were investigated for differences using Friedman tests. Inter- and intra-observer agreements were determined with κ statistics.ResultsPhantom and healthy volunteer images revealed higher SNR for sequences acquired at 3T (p-value <0.05). Generally, the qualitative findings ranked images acquired at 3T higher than corresponding images acquired at 1.5T (p < 0.05). 3D image data sets demonstrated less sensitivity to partial volume averaging artefact (PVA) compared to 2D sequences. Inter- and intra-observer agreements for evaluation across all sequences ranged from 0.61 to 0.79 and 0.71 to 0.92, respectively.ConclusionBoth 2D and 3D images demonstrated higher image quality at 3T than at 1.5T. Optimised 3D sequences performed better than the standard 2D PDW TSE sequence for contrast resolution between cartilage and joint fluid, with reduced PVA artefact.Implications for practiceWith rapid advances in MRI scanner technology, including hardware and software, the optimisation of 3D MR pulse sequences to reduce scan time while maintaining image quality, will improve diagnostic accuracy and patient management in musculoskeletal MRI.     

兴趣班参与护理学基础实验室管理的实践与效果分析

目的：研究探讨兴趣班参与护理学基础实验室管理模式的实践与效果。方法选取我校2013级5个班护理学员326人作为研究对象,按照是否参加学校组织的护理实验兴趣班分为研究组和对照组,对照组按照常规方法进行实验室管理,研究组学员参加学校开设的兴趣班,并学习相关缝纫、维修技能。结果研究组学员通过参加兴趣班,护理操作考核成绩、实验器械掌握程度均高于对照组（分别t=4.632、t=4.291,P<0.05）;实验室备品平均更新时间高于对照组（t=4.925,P<0.05）;实验室备品的消耗费用则明显低于对照组（t=5.637,P<0.05）,研究组学员教学满意度为98.41%,显著的高于对照组的75.67%（χ2=26.7076,P<0.05）。结论通过在护理基础教学中开展兴趣班参与实验室管理的实践,能够使学员直接参与到实验室的管理中来,增强节约意识,对于提高学员的护理操作能力,降低实验室运行成本具有重要的意义。     

The auditory N1 amplitude for task-irrelevant probes reflects visual interest

The present study examined the relationship between the amplitude of N1 component of event-related potentials (ERPs) elicited by task-irrelevant auditory probes and the observer's level of interest in co-occurring visual stimuli. Participants watched short animated video clips (about 400 s) played either forward (interesting) or backward (boring) accompanied by task-irrelevant sequence of auditory probes. The tone frequency of probes was fixed in a monotonous sequence condition but randomly varied in a variable sequence condition. The mean stimulus onset asynchrony of probes was 600 ms in both sequence conditions. Results showed that the N1 amplitude for probes in the variable sequence condition became smaller when participants watched interesting animated videos compared with their watching boring ones; a parallel effect was not observed in the monotonous sequence condition. Furthermore, analysis of sub-blocks (i.e., 360 s of the analysis time window for each animated video was divided into 20 s × 18 sub-blocks) showed a significant correlation between the forward-minus-backward differences in scored interest levels with the N1 amplitude in the variable sequence condition. This finding points to the possibility that the observer's interest can be estimated by neurophysiological data just for 20 s. The present study should remarkably extend the usability of the task-irrelevant probe technique.     

Insights into the methodology of radiography science

IntroductionThe aim of this article is to give an insight into radiography as a science and a discipline from the viewpoints of knowledge interest and methodological approach and design.MethodsOriginal articles published in Radiography (n = 184) and the Journal of Clinical Radiography and Radiotherapy (n = 10) at the timeline 2015 to 3/2017 were reviewed for research focus and the methodology used. To abstract the results, thematisation analysis was used.ResultsOut of 194 studies analysed, 99 (50%) were found to have a technical, 80 (42%) a practical and 15 (8%) a critical interest of knowledge. The research methodologies used did not rigorously fit into the methodological approach expected on the basis of the interest of knowledge.ConclusionRadiography as a science seems to have mostly a technical and practical interest of knowledge, but somewhat critical research is also being made. It seems to be a remarkably open and flexible science when it comes to the use of research methodologies. More discussion and research on the science name and paradigm is needed in order to strengthen the scientific status of radiography.     

Feasibility of extracellular volume quantification using dual-energy CT

ObjectiveTo assess the feasibility of dual energy CT (DECT) to derive myocardial extracellular volume (ECV) and detect myocardial ECV differences without a non-contrast acquisition, compared to single energy CT (SECT).MethodsSubjects (n = 35) with focal fibrosis (n = 17), diffuse fibrosis (n = 10), and controls (n = 9) underwent non-contrast and delayed acquisitions to calculate SECT-ECV. DECT-ECV was calculated using the delayed acquisition and the derived virtual non-contrast images. In the control and diffuse fibrotic groups, the entire myocardium of the left ventricle was used to calculate ECV. Two ROIs were placed in the focal fibrotic group, one in normal and one in fibrotic myocardium.ResultsMedian ECV was 33.4% (IQR, 30.1–37.4) using SECT and 34.9% (IQR, 31.2–39.2) using DECT (p = 0.401). For both techniques, focal and diffuse fibrosis had significantly higher ECV values (all p < 0.021) than normal myocardium. There was no systematic bias between DECT and SECT (p = 0.348). SECT had a higher radiation dose (1.1 mSv difference) than DECT (p < 0.001).ConclusionECV can be measured using a DECT approach with only a delayed acquisition. The DECT approach provides similar results at a lower radiation dose compared to SECT.     

兴趣诱导结合低液体量雾化吸入对哮喘急性发作患儿的影响

目的 探讨兴趣诱导结合低液体量雾化吸入对哮喘急性发作学龄前患儿的影响。方法 选择在我院急诊科接受雾化吸入治疗的90例哮喘急性发作学龄前患儿为研究对象,采用随机数字表法将其分为观察组和对照组,各45例,对照组给予常规雾化吸入及护理干预,观察组给予兴趣诱导干预,同时减少雾化吸入液体量,比较2组患儿的焦虑情绪、雾化吸入依从性、治疗效果以及家属的满意度。结果 观察组Spence儿童焦虑量表(Spence child anxiety scale,SCAS)评分明显低于对照组(t=2.066, P=0.042),雾化吸入时间短于对照组(t=2.568,P=0.012),患儿治疗依从性和治疗效果均优于对照组(Z=-2.392,P=0.017; Z=-2.374,P=0.018),家属对护理服务的满意度好于对照组(t=3.840,P<0.001)。结论 兴趣诱导结合低液体量雾化吸入有利于缓解患儿焦虑情绪,提高患儿雾化吸入依从性、临床疗效及家属对护理工作的满意度,值得临床推广。     

患者隐私权保护中的利益冲突与对策

论述了医疗活动中医务人员需要面对患者隐私权与医务人员的知情权、他人利益与患者隐私权保护、公共利益与患者隐私权保护三方面的冲突;提出保护患者隐私权的对策:提高保护患者的法律意识,自觉养成保护患者隐私的良好习惯,改善硬件条件、创造良好就诊环境。     

关于中医药临床研究伦理审查平台建设评估的思考

通过中医药临床研究伦理审查平台建设评估,发现目前医院伦理委员会在建设和发展中存在以下问题:工作缺乏较高的独立性、缺乏针对研究者的系统化伦理培训、多中心审查缺乏统一标准、临床研究后续监管力度不够、缺乏质量管理和利益冲突管理机制等.提出了规范医学伦理学培训、建立联合伦理委员会、制定地方标准、明确质量管理原则和利益冲突防范原则、探索实行伦理委员会认证等对策.