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Excellence in teaching and learning is fundamental to the provision of quality training for doctors and for this a sound knowledge of the principles of adult learning theory is important. We present an educational course in head and neck trauma skills for emergency medicine (EM) registrars, using the pedagogical principle of active learning. Our aim was to provide trainees with skills in the evaluation and management of hard and soft tissue injuries to the head, neck, and mouth. Active learning has been shown to provide a superior experience in classrooms, creating a ‘deep’ understanding of the material. To maximise learning, we used these principles to develop small group seminars led by a diverse range of teachers that allowed trainees to acquire hands-on skills. Questionnaires that were completed before and after the course showed an appreciable educational impact. We conclude that innovative teaching methods facilitate the sharing of knowledge that will benefit patient care.  相似文献   
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Musculoskeletal sarcomas are rare cancers with an incidence of less than 1% of all cancers. Management of these tumors requires multidisciplinary care comprising of numerous specialists. Critical decisions following collaborative discussion among treating specialists followed by timely communication and starting prompt treatment are vital in delivering care in such rare sarcomas. While musculoskeletal surgeons, radiologists, and clinical oncologists are well known, the role of specialist nurses has been less described. They form a vital pillar in any tertiary sarcoma service by assisting in collaborative care, having consultations in nurse-led clinics, offering psychological support, imparting details of treatment to patient and helping in palliative care. This narrative review focuses on the role of trained specialist nurses in a tertiary sarcoma service and gives insight into their vital role in delivering timely, coordinated, effective care.  相似文献   
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Primary care has been dubbed the “de facto” mental health system of the United States since the 1970s. Since then, various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs. Despite increases in collaborative care implementation and reimbursement, prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb. Meanwhile, primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether, citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available, high false-positive results, and small treatment effects. In this perspective, a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care. In addition, we propose systemic changes to improve the dissemination of mental health treatment in primary care.  相似文献   
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目的 探讨协同式早期运动干预在腹腔镜结直肠癌手术患者中的应用效果。方法 使用随机数字表法将2020年5月-2021年5月于笔者所在医院进行腹腔镜结直肠癌手术的84例患者分为对照组和干预组,各42例。对照组术后采用常规运动干预,干预组术后采用协同式早期运动干预。比较2组术后恢复情况、身体状况、术后并发症发生情况。结果 干预组首次下床活动时间、术后排气时间、术后排便时间均早于对照组(χ2=11.823,P=0.001;χ2=4.687,P=0.001;χ2=7.611,P=0.001),术后7d干预组的多维度疲劳量表评分低于对照组(t=2.000,P=0.049),杜克活动指数高于对照组(t=2.256,P=0.027),2组术后并发症发生率比较,差异无统计学意义(χ2=0.343,P=0.558)。结论 协同式早期运动干预能够促进腹腔镜结直肠癌手术患者术后恢复,改善身体状况,值得推广应用。  相似文献   
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BackgroundWorkforce reform has placed a significant focus on the role of non-medical prescribers in the healthcare system. Pharmacists are trained in pharmacology and therapeutics, and therefore well placed to act as non-medical prescribers.ObjectivesTo assess the safety and accuracy of inpatient medication charts within a pharmacist collaborative prescribing model (intervention), compared to the usual medical model (control) in the emergency department (ED). Another objective compared venous thromboembolism (VTE) risk assessment and prescribing, between intervention and control groups.MethodsAdult patients in ED referred for hospital admission were randomised into control or intervention by a block randomisation method, until the required sample size was reached. Medication charts were audited retrospectively by an independent auditor, using validated audit forms.ResultsIntervention group medication charts contained significantly fewer prescribing errors, omissions and discrepancies compared to the control group, and improved documentation of adverse drug reactions. VTE risk assessment and prescribing had higher guideline concordance in the intervention group compared to the control group.ConclusionsThis collaborative prescribing trial showed excellent results in safety and accuracy of pharmacist prescribing when compared to the usual medical model of prescribing. The admitting medical practitioner and extended scope pharmacist prescriber worked as a collaborative team in emergency, which improved Australian national prescribing safety indicators.  相似文献   
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BackgroundMedication Assisted Treatment for Opioid Dependence (MATOD) is clinically effective and cost effective, yet a lack of MATOD prescribers in the community limits access to this treatment in Australia. These shortages are often greatest in regional and rural areas.Objective(s)The Enhancing Pharmacist Involvement in Care (EPIC)-MATOD study will evaluate clinical and implementation outcomes among people with opioid dependence receiving MATOD through a collaborative pharmacist-prescriber model of care across multiple sites in a regional location (encompassing a mix of metropolitan and non-metropolitan areas) of Victoria, Australia.Methods and analysisThe EPIC-MATOD study is a prospective, multisite, implementation trial of collaborative MATOD care. Pharmacists and prescribers will be recruited through the local network of opioid pharmacotherapy providers. Patients will be recruited through participating healthcare providers. After induction into the collaborative care model, patients and healthcare professionals will be followed up over 6- (patients) and 12-months (pharmacists and prescribers) in a hybrid implementation-efficacy study, with outcomes mapped to the RE-AIM framework. The primary clinical efficacy endpoint is patient retention in treatment at 26 weeks. The primary implementation outcome is treatment capacity, based on prescriber time required to provide treatment through collaborative care compared with traditional care. Secondary clinical endpoints include attendance for dosing and clinical reviews, substance use, mental and physical health and overall well-being. Implementation costs, acceptability, and provider engagement in collaborative care will be used as secondary implementation outcome indicators. Time and costs associated with collaborative care, and health service utilisation, will also be estimated.Project impactThe study will provide important information on outcomes and acceptability of collaborative care for MATOD, as well as the cost and key considerations in delivering a collaborative model of care in Australia and other countries where similar treatment barriers exist.  相似文献   
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While we often engage in conversational reminiscing with loved ones, the effects of these conversations on our memory performance remain poorly understood. On the one hand, Wegner's transactive memory theory predicts that intimate groups experience benefits from remembering together. On the other hand, research on collaborative recall has shown costs of shared remembering in groups of strangers—at least in terms of number of items recalled—and even in intimate groups there is heterogeneity in outcomes. In the current research, we studied the effects of particular communicative features in determining the outcomes of collaborative recall in intimate groups. We tested 39 older, long‐married couples. They completed a non‐personal recall task (name all the countries in Europe) and a personal recall task (name all your mutual friends), both separately and together. When they collaborated, we recorded their conversation. We coded for specific “communication variables” and obtained measures of “conversational style.” Overall, we found two clusters of communication variables positively associated with collaborative success: (a) cuing each other, responding to cues, and repeating each other; and (b) making positive statements about memory performance and persisting with the task. A negative cluster of behaviors—correcting each other, having uneven expertise, and strategy disagreements—was associated with less interactive, more “monologue” style of collaboration, but not with overall recall performance. We discuss our results in terms of the importance of different conversational processes in driving the heterogeneous outcomes of group remembering in intimate groups, suggesting that a focus on recall output alone limits our understanding of conversational remembering.  相似文献   
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BackgroundInclusion Health aims to address and prevent the health harms of extreme inequity faced by excluded groups, including those affected by homelessness, drug addiction, imprisonment, and sex work. Engagement workshops with these groups have shown discordance between published research and what research they think is important. We aimed to involve these excluded groups and the wider service, policy, charity, and academic community who work with them to co-develop research and advocacy priorities.MethodsUsing a co-production approach, we held a 1-day event in London, UK, that involved inclusive, participatory, and consensus-building activities. We facilitated workshops on preventing exclusion, improving services for excluded groups, and escaping exclusion. We recorded participants’ views as observations, field notes, and ranked-lists of problems and suggested solutions. Professional artists captured frustrations and hopes for the future by drawing a visual representation. We conducted rapid thematic analysis of discussions on the day and triangulated these sources of information to develop research and advocacy priorities.FindingsApproximately 100 people attended, with at least 20 people with experience of exclusion. The other participants represented the National Health Service, various charity organisations, national, regional, and local government representatives, and several academic institutions. Emerging priorities included the following: tackling the upstream causes of exclusion (political determinants, poverty, and traumatic childhoods); addressing public and professional ignorance, indifference, and stigma by creating inclusion-focused public messages; making services more accessible and integrated through infrastructure (eg, national registries of services); putting excluded groups at the heart of health research, service development, and decision making, through the development of training for recruitment and co-design; and creating better routes out of exclusion.InterpretationDespite challenges in finding a common language, co-production effectively developed an Inclusion Health agenda aligned with the perceived needs of excluded groups and those who work with them. Funding agencies and the public health community should deliver this research agenda to improve the health and lives of people affected by exclusion.FundingUniversity College London Grand Challenges.  相似文献   
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