Assessment of a Large-Scale Peer Learning Program’s Value by Manual Review of Case Submissions

ObjectivePrior studies used submission numbers or report addendum rates to measure peer learning programs’ (PLP) impact. We assessed the educational value of a PLP by manually reviewing cases submitted to identify factors correlating with meaningful learning opportunities (MLOs).MethodsThis institutional review board–exempted, retrospective study was performed in a large academic radiology department generating >800,000 reports annually. A PLP facilitating radiologist-to-radiologist feedback was implemented May 1, 2017, with subsequent pay-for-performance initiatives encouraging increasing submissions, >18,000 by 2019. Two radiologists blinded to submitter and receiver identity categorized 336 randomly selected submissions as a MLO, not meaningful, or equivocal, resolving disagreements in consensus review. Primary outcome was proportion of MLOs. Secondary outcomes included percent engagement by subspecialty clinical division and comparing MLO and report addendum rates via Fisher’s exact tests. We assessed association between peer learning category, pay-for-performance interventions, and subspecialty division with MLOs using logistic regression.ResultsOf 336 PLP submissions, 65.2% (219 of 336) were categorized as meaningful, 27.4% (92 of 336) not meaningful, and 7.4% (25 of 336) equivocal, with substantial reviewer agreement (86.0% [289 of 336], κ = 0.71, 95% confidence interval 0.64-0.78). MLO rate (65.2% [219 of 336]) was five times higher than addendum rate (12.9% [43 of 333]) for the cohort. MLO proportion (adjusted odds ratios 0.05-1.09) and percent engagement (0.5%-3.6%) varied between subspecialty divisions, some submitting significantly fewer MLOs (P < .01). MLO proportion did not vary between peer learning categories.ConclusionEducational value of a large-scale PLP, estimated through manual review of case submissions, is likely a more accurate measure of program impact. Incentives to enhance PLP use did not diminish the program’s educational value.     

植物-土壤反馈对刺五加幼苗次生代谢产物的影响

目的:研究植物-土壤反馈对刺五加幼苗根、茎、叶次生代谢产物的影响。方法:通过温室盆栽试验,分别对未种植过刺五加的土壤(1组),连续3年种植刺五加的土壤(2组)和多年种植刺五加的土壤(3组),分别种植刺五加1年生幼苗,并对其根、茎、叶的次生代谢产物进行分析。结果:L-苯丙氨酸,原儿茶酸,刺五加苷B,绿原酸,咖啡酸,刺五加苷E,异嗪皮啶,芦丁,金丝桃苷,槲皮素在多年生长刺五加土壤种植,对刺五加幼苗叶和根均有显著性差异,但在茎中绿原酸和刺五加苷E无显著性差异。其中刺五加苷E,异嗪皮啶,芦丁和金丝桃苷在多年生刺五加土壤种植的幼苗叶中未检出。在刺五加幼苗的根中,多数次生代谢产物呈现正反馈;在刺五加幼苗的茎中,咖啡酸,刺五加苷E,金丝桃苷,槲皮素呈现负反馈;在刺五加幼苗的叶中多数次生代谢产物呈现正反馈。结论:植物和土壤在刺五加幼苗生长过程不同部位呈现出不同的反馈情况,整体而言,未种植过刺五加的土壤对刺五加幼苗的次生代谢产物更具优势。研究结果为阐述植物-土壤反馈对刺五加的影响提供研究基础,并为人工栽培刺五加提供了理论依据和技术支持。     

内镜柔性器械腱鞘传动模型及实验研究

目的 建立内镜柔性器械腱鞘系统的推力传动模型，研究影响传动效率的关键因素。方法 建立腱鞘系统在器械推送作用下力和位移的传动模型并进行仿真计算；搭建腱鞘系统传动测试的实验平台以验证模型的准确性，研究传动速度、腱鞘直径比、弯曲半径等对传动效率的影响。结果 腱鞘传动过程中存在显著的非线性传递现象，传动模型仿真与实验结果基本符合；传动速度、腱鞘直径比、弯曲半径均对内镜柔性器械的推力传动有较大影响，对位移传动的影响相对小一些。结论 该模型可用于内镜柔性器械中腱鞘系统推力传动的计算，提供给医生器械工作末端的力反馈，以保证器械的安全操作和提高手术效果；在内镜柔性器械的精准控制中需要综合考虑传动速度、腱鞘传动比、弯曲半径等对运动传递的影响。     

Vibratory stimulus to the masseter muscle impairs the oral fine motor control during biting tasks

PurposeTo investigated the effect of vibratory stimulus on masseter muscles during oral fine motor biting tasks.MethodsSixteen healthy individuals (age: 24.5 ± 2.4 years) participated in experiment I during which the participants were asked to “hold and split” half a roasted peanut placed on a force transducer with their front teeth. The participant performed ten series with ten trials of the “hold and split” behavioral task while vibratory stimulus was applied on the masseter muscle every alternate series. Further, fourteen participants participated (age: 25.2 ± 4.8 years) in experiment II during which they performed a series each of the behavioral task at baseline, an adjusted baseline without and with vibration as well as with and without visual feedback. Hold and split forces along with the variability of hold force and duration and force rate during the split were measured.ResultsThe results of the study showed an increase in the magnitude of the hold force (P = 0.002), force rate during the split (P < 0.001) and a significant decrease in the duration of split (P < 0.001) due to the vibratory stimulus. However, there was no significant effect of the vibratory stimulus on the variability of hold forces (P = 0.879) or mean split force (P = 0.683) during the “hold and split” behavioral task. The results of experiment II also showed an increase in hold force due to the vibratory stimulus (P < 0.001).ConclusionsVibratory stimulus to the masseter muscles impairs the oral force control during a standardized biting task and provide further insight into the sensorimotor regulation of the masticatory system.     

基于时滞关联特征患者就诊反馈分析

抓取“微医网”医患评论数据，对其中时滞与患者满意度进行关联分析，并对评论内容进行主题挖掘，提取不同时滞区间内患者重点关注的内容。通过对患者评论文本不同时滞区间内容的分析，寻找满意度提升策略，以缓解医患关系。使用K-means将患者反馈数据根据就诊后时长反馈分为“短期”和“长期”，通过LDA主题提取模型，对满意度划分后的患者评论文本挖掘不同时滞区间内患者所关注的重点内容，将其差异进行对比分析发现，患者就诊满意度随着时滞呈现趋高现象，不同时滞文本显示患者评论维度大致相同，但随着时滞区间的转移，患者所关注的就诊体验内容也有所变化。     

What do quantitative ratings and qualitative comments tell us about general surgery residents’ progress toward independent practice? Evidence from a 5-year longitudinal cohort

Background

This study examines the alignment of quantitative and qualitative assessment data in end-of-rotation evaluations using longitudinal cohorts of residents progressing throughout the five-year general surgery residency.

心血管内科临床实习教学中引入微课的应用研究

目的 为了满足学生的个性化学习需求、推动教育信息化，探究“微课”教学模式在心血管内科临床实习教学中的应用情况。方法 纳入2016 年1-9月西安交通大学第二附属医院在心血管内科实习的学生98例，随机地将其分为对照组和观察组，对照组实习生进行传统实习教学，观察组实习生在传统实习教学中引入“微课”教学模式，对比两组在心血管内科实习的理论和技能考核成绩，并且进行对心内科实习教学满意度情况的调查。结果 观察组实习生的临床技能考核成绩显著高于对照组，差异有显著性(P<0.05)。并且，观察组对心血管内科教学方法满意度明显高于对照组，差异有显著性(P<0.05)。结论 将“微课”模式引入心血管内科临床实习教学中可显著增强实习生对临床操作技能的掌握，并且可增强实习生对心血管内科实习教学的满意度