骨科护理带教应用情景模拟教学法对教学质量的影响

目的探讨在骨科护理带教中应用情景模拟教学法对教学质量的影响。方法按照随机采样的方式,将我院2018年1月—2020年1月骨科接收的实习护生110名作为研究对象。根据教学方式的差异,将其划分为对照组(n=55,采取传统护理带教方案)、观察组(n=55,采取情景模拟教学法)。从理论知识掌握状况和操作能力水平来进行教学质量评估,且评估两组护生对带教的满意度。结果观察组实习护生的理论知识与操作能力评分相较于对照组更高,差异有统计学意义(P<0.05);观察组实习护生对护理带教满意度高于对照组,差异有统计学意义(P<0.05)。结论在骨科护理带教中,运用情景模拟教学法,能够有效地优化教学质量和护生的学习态度。     

优质护理服务在护理临床带教中的效果分析

目的探究在护理临床带教中使用优质护理服务理念的效果。方法随机抽取我院2017年2月—2018年2月40名护生(对照组,应用传统带教模式)及2018年3月—2020年3月40名护生(观察组,应用优质护理服务理念开展临床带教)作为观察对象,对比两组护生考核成绩、综合实习能力(语言沟通能力、分析解决问题能力及应急能力)评分。结果观察组护生护理理论知识、护理技能考核成绩均高于对照组,P<0.05;观察组护生语言沟通能力、分析解决问题能力及应急能力得分较对照组更高,P<0.05。结论在护理临床带教中使用优质护理服务理念更有助于护生掌握护理知识及技能,提升其综合能力,教学效果更佳。     

情景模拟和PBL教学法在内分泌科临床教学中的应用

目的探讨情景模拟和PBL教学在内分泌科临床教学实践中的应用效果。方法选取内分泌科实习的医学生90例为研究对象,2017年9月—2018年2月的30名学生编入A组,采用传统方法进行带教;2018年3月—2018年8月的30名学生编入B组,在传统教学基础上,联合PBL教学;2018年9月—2019年2月的30名学生编入C组,在传统教学基础上,联合情景模拟教学,观察3组教学效果。结果B组和C组理论成绩均高于A组(P<0.05),B和C组理论成绩差异无统计学意义(P>0.05)。B组和C组技能操作成绩均高于A组(P<0.05),技能操作考试成绩C组高于B组(P<0.05)。B组和C组学生学习兴趣明显高于A组(P<0.05)。结论在传统教学基础上增加情景模拟和PBL教学,能明显增加学生兴趣,提高学习主动性,提高理论成绩和技能操作能力。     

标准化病人教学视频联合PCMC教学模式在感染科的应用

目的探讨标准化病人教学视频联合问题导向临床医学教学模式(PCMC)在感染科护理教学中的应用。方法于2018年9月—2019年1月将学校2017级42~47六个班级共计60名学生作为研究对象,42~44班为观察组(n=30),45~47班为对照组(n=30)。对照组采用标准化病人教学视频教学,观察组在上述教学模式基础上增加使用PCMC教学模式,比较两组最终考核成绩及教学满意度。结果观察组理论知识考核成绩及专业技能考核成绩均高于对照组,差异有统计学意义(P<0.05);观察组教学满意度比对照组高,差异有统计学意义(P<0.05)。结论标准化病人教学视频联合PCMC教学模式可显著提高感染科学生理论知识及专业技能成绩,提升教学满意度。     

Plasma acyl-carnitines,bilirubin, tyramine and tetrahydro-21-deoxycortisol in Parkinson's disease and essential tremor. A case control biomarker study

Background and purposeGiven the overlapping clinical manifestations and pathology, the differentiation between essential tremor (ET) and Parkinson's disease (PD) is difficult. Our aims were to examine the plasma metabolomics profiling and their association with motor and non-motor symptoms (NMS) in patients with PD, and to determine differences between de novo PD compared to moderate-advanced PD vs. controls and patients with ET.MethodsPlasma samples were collected from 137 subjects including 35 age matched controls, 29 NOVO-PD, 35 PD and 38 ET patients. PD severity, motor and NMS including cognitive function were assessed using the UPDRS, NMS and PD cognitive rating scales, respectively. Metabolomics analysis was performed by UPLC-ESI-QToF-MS followed by unsupervised multivariate statistics. The area under the curve of the biomarkers according to distribution of their concentrations and the diagnosis of PD (NOVO-PD, advanced PD) vs ET and healthy controls was used as a measurement of diagnostic ability.ResultsSeveral acyl-carnitines, bilirubin, tyramine and tetrahydro-21-deoxycortisol (THS) presented good predictive accuracy (AUC higher than 0.8) for differentiating de novo PD and advanced PD from controls and ET, suggesting an alteration in the lipid oxidation pathway. In multivariate regression analysis, metabolite levels were not significantly associated with motor and NMS severity in PD.ConclusionsDiverse acyl-carnitines, bilirubin, tyramine and some adrenal gland derived metabolites are suggested as potential biomarkers able to distinguish between PD from controls and ET.     

治疗性腹腔镜胃癌腹主动脉旁淋巴结清扫术的操作技巧及临床意义

目的探讨治疗性腹腔镜胃癌腹主动脉旁淋巴结清扫术的安全性和有效性。方法回顾性分析2017年1月至2018年12月就诊广东省中医院胃肠外科实施治疗性腹腔镜胃癌腹主动脉旁淋巴结术的6例病人基线资料、术中及术后短期结果。结果6例病人术前经影像学评估均存在第16组淋巴结转移,无其他远处转移,经转化治疗后,均达到部分缓解并顺利完成腹腔镜胃癌D2根治并腹主动脉旁淋巴结清扫术,术中1例因合并胰腺侵犯而联合行胰体尾+脾切除术,无中转开腹、腹腔出血、脏器损伤等并发症发生;中位手术时长482.5(445,510)min;中位淋巴结清扫总数、腹主动脉旁淋巴结(para-aortic lymph nodes,PALN)清扫总数及PALN阳性数目分别为50(16,80)枚、18(3,31)枚、3.5(0,15)枚,其中5例PALN病理阳性,1例阴性;术后1例出现胰瘘,1例胸腔积液,1例腹泻,Clavien-Dindo分级均为2级,经对症治疗后均好转出院;术后中位住院时间17(6,30)天,术后30天内无二次手术及死亡发生;中位随访时间13.25(10~18)月,3例病人因肿瘤复发死亡,术后存活时间10~18月,余3例均未见肿瘤复发转移。结论治疗性腹腔镜腹主动脉旁淋巴结清扫术在技术上是可行的,对于胃癌合并PALN转移的患者。     

Clinicians’ accounts of communication with patients in end-of-life care contexts: A systematic review

ObjectiveCommunication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians’ understandings of communication in end-of-life care.MethodsA systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms “palliative care,” “terminal care” or “end-of-life care,” and “communication”. Articles were assessed for quality using a modified JQI-QARI tool.ResultsThe findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication.ConclusionTraining needs for effective communication in end-of-life contexts are not currently being met.Practice ImplicationsClinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.     

How to stich? 90 degrees: The perfect angle

ObjectiveThis is a discussion about correct suturing techniques and implications that follow inappropriate suturing. We deconstruct the suturing needle angles and methods to be adopted to acquire the perfect needle angle to the tissue being sutured. A study of angles confirms that 90° is perceptible to the naked eye and easy to identify, making it an appropriate foundation to explain, communicate and teach the concepts in the wet-lab and the operating room.BackgroundThere is a lack of robust teaching regarding entry of the needle orthogonal to the tissue planes. In addition, objective methods of assessing angles of the needle relative to the tissue and consequences of inaccuracy are lacking. The authors aim to deconstruct the steps of suturing with the aim of demonstrating ninety degrees is the perfect suturing angle.Study designWe conducted a study to identify 90° (the perfect suturing angle) as an angle easy to identify with the naked eye. Angles from 86° to 94° and 41° to 49° were printed and presented to volunteers with the instruction to identify the angles of 90° and 45°.ResultsFifty-one volunteers replied to the 90° angle study and sixty-five volunteers replied to the 45° study. 92% correctly identified at least one 90° angle and 72% identified both the 90° angles. 63% identified at least one 45° angle and only 27% identified both the 45° angles presented to them. This supported our hypothesis that 90° is an angle that is readily identifiable to the human eye.ConclusionsObjective assessment of surgical skills and training should focus on the basic needle skills with particular emphasis on suturing angles, progressing to higher skills using low and intermediate fidelity models and correlating practice alongside the trainees' operative progress.     

Reflective practice in the teaching of communication skills

Reflective practice is encouraged in medical education in general and in teaching communication skills in particular to develop into a reflective practitioner. However, the term is complex to understand and multidimensional thus challenging to grasp, describe and teach. Furthermore, though used frequently little guidance exists on how to promote reflective ability in teaching communication skills. This paper builds on a keynote address delivered at the International Conference of Communication in Healthcare (ICCH 2019) and is based on the vast literature on reflection and the author’s personal experience as a researcher and educator. It discusses the components of reflective practice as well as exemplifies the importance of reflective practice to student’s capability to learn communication skills.