Developing a measure of blind patients’ interactions with their healthcare providers

BackgroundPeople who are blind (PWB) are often perceived as being incompetent with common tasks and functions. When patients detect that their healthcare providers (HCPs) have negative perceptions of them, they often report less satisfaction with their healthcare and disengage in their own healthcare.ObjectiveA scale assessing the experiences of PWB interacting with HCPs was developed and validated across two studies.MethodsIn Study 1, 144 participants completed the scale and provided feedback. In Study 2, 214 participants completed the scale and 4 additional scales to assess construct validity.ResultsAn exploratory factor analysis in Study 1 revealed a two-factor model consisting of General Quality of Health Care (30.5% variance explained) and Stereotype Content-related items (9.4% variance explained). Study 2 confirmed and validated this two-factor structure (RMSEA (90% CI) = 0.068 (0.057, 0.079), CFI = 0.898, SRMR = 0.066, AIC = 14568.902).ConclusionsThis scale is one of the first tools developed from the perspectives of PWB. Results from these studies highlight and elaborate on how PWB perceive that they are viewed by their HCPs in terms of competence and how they perceive to be treated by these HCPs. This scale can be used in training HCPs to better serve their patients with disabilities.     

Professional values development during a baccalaureate nursing degree completion program

Faculty recognized a need to further study professional values development in registered nurses during a baccalaureate degree completion program. Study participants were surveyed at the beginning and conclusion of their program using the Nurses Professional Values Scale – Revised (NPVS-R) with several additional open-ended questions. The results supported that associate degree–prepared nurses returning to school possess a level of professional values similar to nurses with a baccalaureate degree.     

改革开放以来中医药文化发展的演进与特点探析＊

中医药文化是中医药事业发展的根基和灵魂，社会主义文化建设的重要组成。本文考察改革开放40年以来中医药文化发展的演进过程，从“社会矛盾—政策方针—中医药文化发展”的中观视角，构建了中医药文化发展分析模型，发现中医药文化先后经历了资产化发展（1978年-21世纪初）、情景化发展（21世纪初-中国共产党第十八次全国代表大会（中共十八大）前后）、生态化发展（中共十八大至今）三个阶段，每个阶段中医药文化发展的策略、重点和面临的问题具有明显的不同特点。因此，本文提出以社会矛盾为导向，优化政策引导，构建中医药文化生态体系，从个人、社会和国家发展的不同层面采取多元双向发展路径，推进健康中国发展，提升文化自信，打造文化强国。     

Beyond the hashtag – An exploration of tweeting and replies at the European Society of Surgical Oncology 39th clinical conference (ESSO39)

IntroductionPrevious studies of conference tweeting have focused on tweets that used the conference hashtag. The aim of this study was to document responses beyond a specific conference hashtag.MethodsObservational study exploring replies to tweets for the 39th meeting of ESSO (ESSO39), Rotterdam, 9–11 October 2019. An extract of #ESSO39 tweets was obtained using NodeXL. Replies to these tweets were identified by viewing the tweets via Twitter.com.ResultsThere were 210 tweets posted using the #ESSO39 hashtag by 64 tweeters. However, extending the analysis to include responses that did not use the hashtag, tweets using the hashtag only represent 54% of all tweets posted or quoted at the conference, and only 49% of the tweeters posting content or quoted in tweets. Based on this study of ESSO39 therefore roughly half of tweets and contributors to conference tweeting were not captured by focusing simply on the conference hashtag (#ESSO39). Mentioning another tweeter(s) in a tweet or response was associated with more retweets, as was including the hashtag in replies.ConclusionsTwitter activity at medical conferences extends beyond the conference hashtag. Almost half of the tweeting was beyond the hashtag. To increase visibility of tweets, conference delegates should include the conference hashtag and mention other tweeters in their tweets and responses. Searching for tweets is an active process requiring users to click into replies. Twitter and third-party social media tools should improve identification and display of responses, showing the branching structure of replies and quoting tweets in real time.     

院前急救担架员配置及社会化服务方式探索

承担院前急救搬抬服务的担架员是院前急救医疗服务的重要组成部分,因各种各样的原因全国大部分急救单元不配备或少配备担架员,影响了院前急救工作效率。该文以青岛市院前急救为例,通过分析院前急救担架员的配置现状、存在问题及分析,提出合理配备院前急救担架员的必要性,并积极调研其他地市急救中心的做法,探索院前急救担架员社会化服务方式。     

Effects of single and combined exposure to lead and stress during pregnancy on offspring neurodevelopment

ObjectiveTo assess associations of single and combined exposures to lead and stress during different stages of pregnancy with offspring neurodevelopment.MethodsWe measured prenatal lead (maternal blood-lead in early-pregnancy and umbilical-cord-blood-lead) and maternal stress levels in Shanghai-Birth-Cohort from 2013 to 2016. Maternal stress was assessed using Center-for-Epidemiological-Studies-Depression-Scale and Self-Rating-Anxiety-Scale during mid-pregnancy. The Ages-Stages-Questionnaires-3 (at 6/12-months-of-age) and Bayley-III (at 24-months-of-age) were both used to assess neurodevelopment.ResultsA total of 2132 mother-child pairs with both prenatal lead and stress measurements were included. The geometric-means of blood-lead in early-pregnancy and cord-blood-lead were 1.46 μg/dL and 1.33 μg/dL, respectively. Among the study women, 1.89 % and 0.14 % were screened positive for depression and anxiety. Adjusting for related confounders, the combined exposures had stronger adverse associations with offspring social-emotional skills than single exposures; and the combined exposure in early-pregnancy was associated with greater neurodevelopmental differences than combined exposure around-birth, especially in social-emotion at 24 months-of-age [β (95 %CI): − 10.48(−17.42, −3.54) vs. − 5.95(−11.53, −0.36)].ConclusionsBoth single and combined prenatal exposures to lead/stress impaired infant neuro-development, and the effects of combined exposure may be more profound than single exposures. Combined exposure in early-pregnancy may be associated with worse neurodevelopmental outcomes than combined exposure around-birth, especially in social-emotional development.     

Development and Validation of the ACP-CAT for Assessing the Quality of Advance Care Planning Communication

ContextHigh-quality advance care planning (ACP) discussions are important to ensure patient receipt of goal-concordant care; however, there is no existing tool for assessing ACP communication quality.ObjectivesThe objective of this study was to develop and validate a novel instrument that can be used to assess ACP communication skills of clinicians and trainees.MethodsWe developed a 20-item ACP Communication Assessment Tool (ACP-CAT) plus two summative items. Randomized rater pairs assessed residents' performances in video-recorded standardized patient encounters before and after an ACP training program using the ACP-CAT. We tested the tool for its 1) discriminating ability, 2) interrater reliability, 3) concurrent validity, 4) feasibility, and 5) raters' satisfaction.ResultsFifty-eight pre/post-training video recordings from 29 first-year internal medicine residents at Mount Sinai Hospital were evaluated. ACP-CAT reliably discriminated performance before and after training (median score 6 vs. 11, P < 0.001). For both pre/post-training encounters, interrater reliability was high for ACP-CAT total scores (intraclass correlation coefficient or ICC = 0.83 and 0.82) and the summative items Overall impression of ACP communication skills (ICC = 0.73 and 0.80) and Overall ability to respond to emotion (ICC = 0.83 and 0.82). Concurrent validity was shown by the strong correlation between ACP-CAT total score and both summative items. Raters spent an average of 4.8 minutes to complete the ACP-CAT, found it feasible, and were satisfied with its use.ConclusionACP-CAT provides a validated measure of ACP communication quality for assessing video-recorded encounters and can be further studied for its applicability with clinicians in different clinical contexts.