Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News

Introduction

Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.

Stage line diagram: An age‐conditional reference diagram for tracking development

This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and disease staging), psychology (stages of cognitive development), human development (pubertal stages) and chronic diseases (stages of dementia). Transition probabilities between successive stages are modeled as smoothly varying functions of age. Age‐conditional references are calculated from the modeled probabilities by the mid‐P value. It is possible to eliminate the influence of age by calculating standard deviation scores (SDS). The method is applied to the empirical data to produce reference charts on secondary sexual maturation. The mean of the empirical SDS in the reference population is close to zero, whereas the variance depends on age. The stage line diagram provides quick insight into both status (in SDS) and tempo (in SDS/year) of development of an individual child. Other measures (e.g. height SDS, body mass index SDS) from the same child can be added to the chart. Diagrams for sexual maturation are available as a web application at http://vps.stefvanbuuren.nl/puberty . The stage line diagram expresses status and tempo of discrete changes on a continuous scale. Wider application of these measures scores opens up new analytic possibilities. Copyright © 2009 John Wiley & Sons, Ltd.     

人工智能应用于糖尿病视网膜病变的文献计量学分析

背景 近年来,人工智能（AI）在医学领域发展迅速,在糖尿病视网膜病变（DR）中的应用范围不断扩展。目的 通过文献计量分析总结AI在DR领域的应用情况,阐明AI在DR领域相关研究的现状、热点和新兴趋势,以期为未来的研究提供思路。方法 以Web of Science数据库为来源,检索建库至2022-11-04的AI应用于DR领域的相关文献,运用CiteSpace软件对纳入文献进行发文量、国家、机构、作者、共被引和关键词的文献计量学分析。结果共获得1 770篇文献,2011年1月至2022年11月发文量总体呈上升趋势,2021年发文量达峰值（402篇）。中国是发文量（440篇）位居第1的国家,英国为中心性（0.26）最高的国家。机构合作网络图谱共纳入436家机构,以中山大学和首都医科大学为代表。作者合作网络图谱共纳入601位作者,以JIA Y L和HWANG T为代表。GULSHAN V、ABRàMOFF M D与TING D W 3位高被引作者对该领域做出了重要贡献。Ophthalmology、Invest Ophth Vis Sci和Ieee T Med Imaging是AI应用于DR领...     

体视化技术及其在医学图像中的应用

在 B超图片中由于存在较多的噪声干扰 ,同时手术治疗对于医用图像有较高的要求 ,而依据传统的面图形学等方法重建出来的三维图像 ,远远不能满足其要求。而体视化技术研究含有物体内部信息的体数据的表示、操作和显示等问题 ,体数据比表面包含的信息更丰富、更完整 ,因而必将在三维医学图像领域得到广泛的应用。     

DICOM数据的三维重建与协同可视化系统的开发

复杂手术常需多科医生协商制定综合性治疗方案,网络协同三维可视化软件可使方案制定直观而精确。我们采用VTK工具包对DICOM格式CT图像数据进行三维重建并作网格简化,将结果所得多边形网格模型无缝集成到用HOOPS/3DAF所开发的图形系统进行显示,并用HOOPS/Stream工具包转成适合网络传输的HSF无损压缩流文件,再用HOOPS/NET工具包实现基于Client/Server架构的协同三维交互可视化系统。所得三维重建结果清晰,协同三维可视化操作实时度高。本研究实现了一个协同手术仿真开发平台,该架构易于进一步添加模拟手术操作与修复体设计功能。     

医疗卫生机构气候韧性和环境可持续评价工具研究进展

目的 气候变化给医疗卫生机构带来诸多不确定性威胁,医疗卫生机构亟需提高自身的气候韧性并采取积极的应对措施,如何系统评价医疗卫生机构应对气候变化的能力成为应对气候变化挑战的工作重点。方法 使用范围综述筛选医疗卫生机构气候韧性和环境可持续评价工具相关文献和最新进展,并对密切相关的文献采用引文检索拓展研究范围。结果 借鉴国际经验已开发出适用于我国的《绿色医院建筑评价标准》,但对于医疗卫生机构气候韧性的指南和要求仍在探索中。国际上已经发展了三套较完整的工具包和指南,并已探索性开展了实地应用,包括加拿大的医疗卫生机构气候变化韧性工具包、美国的可持续和气候韧性医疗卫生机构工具包,以及世界卫生组织的气候韧性和环境可持续性的医疗卫生机构指南。结论 医疗卫生机构气候韧性和环境可持续能力评价工具构建是开展脆弱性评估和干预的基础,应积极借鉴国外相关经验开发适宜我国的评价工具,以增强机构和人员应对气候变化的能力。     

Dietary Aspects to Incorporate in the Creation of a Mobile Image-Based Dietary Assessment Tool to Manage and Improve Diabetes

Diabetes is the seventh leading cause of death in United States. Dietary intake and behaviors are essential components of diabetes management. Growing evidence suggests dietary components beyond carbohydrates may critically impact glycemic control. Assessment tools on mobile platforms have the ability to capture multiple aspects of dietary behavior in real-time throughout the day to inform and improve diabetes management and insulin dosing. The objective of this narrative review was to summarize evidence related to dietary behaviors and composition to inform a mobile image-based dietary assessment tool for managing glycemic control of both diabetes types (type 1 and type 2 diabetes). This review investigated the following topics amongst those with diabetes: (1) the role of time of eating occasion on indicators of glycemic control; and (2) the role of macronutrient composition of meals on indicators of glycemic control. A search for articles published after 2000 was completed in PubMed with the following sets of keywords “diabetes/diabetes management/diabetes prevention/diabetes risk”, “dietary behavior/eating patterns/temporal/meal timing/meal frequency”, and “macronutrient composition/glycemic index”. Results showed eating behaviors and meal macronutrient composition may affect glycemic control. Specifically, breakfast skipping, late eating and frequent meal consumption might be associated with poor glycemic control while macronutrient composition and order of the meal could also affect glycemic control. These factors should be considered in designing a dietary assessment tool, which may optimize diabetes management to reduce the burden of this disease.     

Is ‘Omega Sign’ anatomical endoscopic enucleation of the prostate technique reproducible?

We aimed to evaluate the learning curve of the surgically standardised ‘Omega Sign’ anatomical endoscopic enucleation (AEEP) of the prostate surgery technique for junior surgeons. This study is a retrospective comparison of cases that underwent AEEP by a mentor surgeon and three junior surgeons who have completed their learning curve. A video-based laser enucleation of the prostate assessment tool (LEAT) composed of 8 steps of the technique was used to assess a senior surgeon and junior surgeons’ surgical compatibility and consistency. The surgeon who defined Omega Sign technique was determined as group 1, and cases by three junior surgeons were identified as group 2. The end points were to assess the reproducibility and repeatability and operative post-operative outcomes of the technique. 55 patients’ videos were rated by five experienced endourologists. There was no significant difference in LEAT scores between the groups among all steps. The most symmetry was found in the 1st and 3rd steps. Inter-rater consistency was also high for each step, with no statistically significant difference between the evaluators. The standardised anatomical ‘Omega Sign’ technique is reproducible for the junior surgeons. The operative steps can be performed with high consistency, and the functional and perioperative outcomes are comparable with the senior surgeon.