Five myths about unacceptable behaviour in surgical education

Recent evidence of the occurrence of discrimination, bullying and sexual harassment in surgery and more generally within healthcare has led to widespread discussion about the effects of unacceptable behaviour in surgical education and practice. Despite accumulating evidence of the adverse effects of unacceptable behaviour in clinical practice, not only on health care professionals but on patient care and outcomes, many surgeons and other health care professionals continue to embrace false perceptions about appropriate professional behaviour, interactions and approaches to teaching within surgical departments and more generally within healthcare institutions. This article explores five misperceptions about unacceptable behaviour in surgical education and provides evidence that supports a change in practice.     

A latent state‐trait analysis of interoceptive accuracy

Interoceptive accuracy (IAc), that is, the ability to accurately perceive one's own bodily signals, is widely assumed to be a trait, although experimental manipulations such as stress may affect IAc. We used structural equation modeling to estimate the reliability of IAc, and the proportions of individual differences in IAc, explained by a trait and occasion‐specific effects of situation and person‐situation interactions. We assessed IAc in 59 healthy participants (40 women, M_Age = 23.4 years) on three consecutive measurement occasions, approximately 1 week apart, in a rest and poststress condition, using a heartbeat counting and a heartbeat discrimination task. The results showed fair temporal stability (intraclass correlation coefficients ≥ 0.38) and good reliability (Mdn = .63; range .49–.83) for both methods. While around 40% of the variance of a single IAc measurement could be explained by a trait, approximately 27% was accounted for by occasion‐specific effects of situation and person‐situation interaction. These results suggest that IAc measures are relatively consistent and that situations and person‐situation interactions impact IAc as measured at a certain point in time. An aggregation across at least two measurements is recommended when using IAc as a trait variable.     

Does the Race/Ethnicity or Gender of a Physician's Name Impact Patient Selection of the Physician?

This study's objective was to examine the extent to which individuals exhibit a preference for physicians based upon the race/ethnicity and gender of a physician's name. We conducted an online survey of 915 adults, who viewed a comparative display of four physicians' quality performance. We randomized the name of one physician, whose quality performance was equal to that of one physician and better than two other physicians, to be either typically African American male, African American female, white male, white female, or Middle Eastern (gender ambiguous). In regression models, participants more frequently selected the physician with the randomized name when displayed with a white male name, compared to when presented with an African American male, African American female, or Middle Eastern name (ORs ranging from .59 to .64). White and male study participants exhibited this pattern, while racial/ethnic minority participants did not. If the hypothetical choice bias observed here translates to people's actual selection of physicians, it could be a contributing factor for why women and racial/ethnic minority physicians have lower incomes than white male physicians.     

Risk Factors for Hospital Death of Patients with End-Stage Renal Disease Without Previous Diagnosis of Severe Chronic Renal Failure Arriving in an Emergency Situation at the Hospital

Objectives.?Many end stage renal disease (ESRD) patients get their first nephrologic care under critical clinical conditions and without previous diagnosis of chronic renal failure (CRF), a situation even worse than the late referral of CRF patients for nephrologic treatment. Data on these “nonreferred” patients are scarce. The objectives of this study were to assess clinical and laboratory features, the reasons for coming to the hospital and the factors associated with death in nonreferred ESRD patients first seen by a nephrologist in an emergency situation. Methods.?Retrospective study (04 1996–03 2000) using the medical records of patients diagnosed with ESRD at the nephrologic emergency visit in a university tertiary hospital. Clinical and laboratory parameters were reviewed. Patients were divided into two groups according to hospital outcome: survivors or nonsurvivors. Results.?There were 414 patients (12% of all nephrologic emergency visits), aged 49 ± 17 years, 266 males (64%) and 208 (55%) hypertensive. Mortality rate was 13.7% (54/393). When compared to survivors, nonsurvivors were older, used mechanical ventilation and vasoactive drugs more frequently, presented higher infection rate, and showed lower plasma creatinine. Multivariate logistic regression showed as factors independently associated with death: first nephrologic visit at intensive care unit, infection as cause for seeking medical care, and increasing age. Plasma creatinine above 10 mg/dL was a protective factor for death. Conclusions.?ESRD patients reaching dialysis in a nephrologic emergency situation presented high hospital mortality, which was mostly associated with their poor clinical condition at admission.     

体外冲击波碎石治疗单发输尿管结石及疗效预测

目的探讨体外冲击波碎石术（ESWL）治疗输尿管结石疗效的影响因素,并建立预测模型。方法2008年1月至2011年2月接受ESWL治疗的输尿管结石患者1116例,随访3个月。用X^2检验或t检验、秩和检验进行单因素分析来研究患者性别、年龄、身高、体重、病程、临床症状和结石特征等因素与疗效的关系,多因素分析采用Logistic逐步回归分析（Forward：LR法）,建立Logistic回归预测模型。结果ESWL单次治疗输尿管结石成功率84．3％（941／1116）。单因素分析发现结石部位、结石长短径及肾绞痛对疗效均有影响。Logistic回归分析则显示结石部位、结石长短径及肾绞痛决定治疗的成功率,预测模型对碎石成功率的解释力良好（X^2=117．434,P〈0．001）,并通过拟合优度检验（X^2=5．261,P=0．729）,预测总体准确率为83．8％。结论结石部位、结石长短径及肾绞痛是ESWL治疗输尿管结石成功率的重要决定因素。     

基于支持向量机超声多模态诊断肾疾病的研究

目的：比较支持向量机（support vector machine，SVM）和传统的Logistic回归构建基于常规超声、彩色多普勒超声和弹性成像多模态联合诊断肾脏疾病的诊断能力。 方法：收集有病理诊断的肾脏疾病患者94例及正常对照组109例，分别进行常规超声、彩色超声和剪切波弹性检查。建模的方法采用支持向量机和Logistic回归。其中SVM法根据随机数字法分为3：1两组，153例作为训练样本，进行单因素变量判断和模型建立，50例患者作为验证样本，用于评价根据训练样本建立的SVM模型预测效果。结果：共入组203例患者，Logistic回归中左肾皮质弹性硬度和右肾宽度进入回归方程，Logistic回归模型准确性83.74%，支持向量机模型的诊断准确性85.10%，二者具有相似的诊断能力。 结论：多模态超声具有较高的肾脏疾病诊断效能，支持向量机和Logistic模型具有相似的诊断能力。     

学习《精神科护理学》对改善护理专业学生精神疾病患者歧视态度和服务意愿的影响

目的分析学习《精神科护理学》对改善护理专业学生精神疾病患者歧视态度和服务意愿的影响。方法 2014年12月便利选取南京中医药大学学习《精神科护理学》课程的护理本科三年级学生共336人,在课程学习前后分别进行"歧视精神疾病患者评估量表"和"护理服务意愿评估表"的调查。结果课程学习前,护生歧视精神疾病患者评估量表各维度得分和总分与常模比较,差异无统计学意义(均P0.05);课程学习后,护生隔离、能力维度得分和总分低于学习前,为精神疾病患者提供护理服务意愿的得分高于学习前,差异均有统计学意义(均P0.05)。结论学习《精神科护理学》可以有效改善护生对精神疾病患者的歧视和误解,后期仍应在研究结果的基础上进一步开展相应的教学改革。