多元化联合教学模式在超声引导下疼痛介入治疗中的应用

目的探讨多元化联合教学模式在超声引导下疼痛介入治疗教学中的应用效果。方法选择2018年1月至2020年12月在北京大学第三医院疼痛科进修的30名医师作为研究对象,将其分为对照组与观察组;对照组采用常规教学模式;观察组采用多元化联合教学模式,比较两组医师技能考核成绩、教学质量评分和满意度评分。结果观察组医师技能考核成绩优良率为93.3%,高于对照组的73.3%(P<0.05);观察组医师对基础理论知识掌握、临床思维能力的提高、学习兴趣的激发、疾病诊治能力的提高4个方面的评分均高于对照组(P<0.01)。结论多元化联合教学模式可促进超声引导下疼痛介入治疗技能的提高,有利于提高学员的综合临床能力。     

Novice nurses’ experiences from teamwork in the emergency department: A qualitative content analysis

Background and aimTeamwork is assumed crucial in nursing. Nevertheless, nursing shortages in medical centers have thus far compelled nurse managers to use novice nurses. The present study aimd to explaining the challenges and experiences of novice nurses regarding teamwork in emergency departments.Materials and methodsUsing qualitative content analysis, 11 novice nurses working at emergency department, participated in this study. Data were collected with semi structured interview and analyzed by Graneheim and Lundman.ResultsThe data analysis led to the emergence of four themes of “essential teamwork skills development”, “contradictory relationships between team members”, “unpleasant feelings and experiences”, and, “personal growth and maturation during teamwork”.ConclusionFostering different personal aspects as prerequisites for teamwork, novice nurses will be able to deal with unpleasant feelings and experiences as well as contradictory relationships between team members in an effective manner. This challenging experience will thus give rise to personal growth and maturation during teamwork among them in emergency department.     

Nursing Home Resident Admission Characteristics and Potentially Preventable Emergency Department Transfers

ObjectivesTo determine which nursing home (NH) resident-level admission characteristics are associated with potentially preventable emergency department (PPED) transfers.DesignWe conducted a population-level retrospective cohort study on NH resident data collected using the Resident Assessment Instrument-Minimum Data Set Version 2.0 and linked to the National Ambulatory Care Reporting System for ED transfers.SettingWe used all NH resident admission assessments from January 1, 2017, to December 31, 2018, in Ontario.ParticipantsThe cohort included the admission assessment of 56,433 NH residents.MethodsPPED transfers were defined based on the International Classification of Disease, Version 10 (Canadian) We used logistic regression with 10-fold cross-validation and computed average marginal effects to identify the association between resident characteristics at NH admission and PPED transfers within 92 days after admission.ResultsOverall, 6.2% of residents had at least 1 PPED transfer within 92 days of NH admission. After adjustment, variables that had a prevalence of 10% or more that were associated with a 1% or more absolute increase in the risk of a PPED transfer included polypharmacy [of cohort (OC) 84.4%, risk difference (RD) 2.0%], congestive heart failure (OC 29.0%, RD 3.0%), and renal failure (OC 11.6%, RD 1.2%). Female sex (OC 63.2%, RD -1.3%), a do not hospitalize directive (OC 24.4%, RD -2.6%), change in mood (OC 66.9%, RD -1.2%), and Alzheimer's or dementia (OC 62.1%, RD -1.2%) were more than 10% prevalent and associated with a 1% or more absolute decrease in the risk of a PPED.Conclusions and ImplicationsThough many routinely collected resident characteristics were associated with a PPED transfer, the absence of sufficiently discriminating characteristics suggests that emergency department visits by NH residents are multifactorial and difficult to predict. Future studies should assess the clinical utility of risk factor identification to prevent transfers.     

Tasa de afectación de los márgenes quirúrgicos tras la cirugía conservadora de mama y estimación de los costes directos

ObjectiveAssessment of the reoperation rate in patients with positive resection margins after initial breast-conserving surgery for breast cancer and estimation of the cost to the hospital.Method146 patients with diagnosis of invasive breast cancer were included, who were initially intervened with conservative surgery by the Gynecology and Obstetrics Service of Hospital Universitario de Tarragona Juan XXIII (HUTJ23) during the years 2018 and 2019. We calculated the rate of involvement of the surgical margins of the resection piece after initial conservative surgery, establishing in which cases it was necessary to carry out a second resection, estimating the added direct costs of the second surgical procedure, and comparing them with the costs established by the Catalan Health Service according to the level of the hospital and the Diagnosis-Related Groups (DRG) established by the National Health System.ResultsThe rate of positive margins after initial conservative surgery was 20.55% and 19.17% patients underwent reoperation, generating a total expense of € 129.696,89, € 82.654,34 in conservative surgeries (€ 3.757,01 on average per patient) and € 47.042,55 in mastectomies (€ 6.720,36 on average per patient).ConclusionsMargin involvement after breast-conserving surgery is synonymous for reoperation, this involves a series of direct costs. It is advisable to control the factors related to affected margins to minimize their impact.     

神经内科实习医师血管超声教学的问题及改进方法

血管超声知识是神经内科实习同学的重要学习内容之一,但传统本科教学中对血管超声部分内容局限,使进入神经内科实习的医师血管超声基础知识薄弱,且还存在实践操作的缺乏、教学方式单一等问题,不能在短期内较好的理解及掌握血管超声知识,使得实习效果欠佳。本研究通过对神经内科实习医师血管超声教学中存在的问题进行分析,提出改进方法,可以通过加强实习医师对血管超声的解剖和血流动力学的学习,打牢基础知识,同时将实习医师进行分组,互为模特进行操作实践,在操作实践中加深理论知识的理解和应用。同时还可采用微课等多媒体教学方式,提高实习医师的学习兴趣,显著提高实习效果。     

唐代医学教育制度及教材

唐代不仅从中央到地方设立了医学专门教育机构,而且存在丰富多样的医学师徒相授和寺观宗教医学传播活动。医学教育类型多样,实施分科教学,呈现出多科性与专业性并存的特征;重视教学测评,与科举考试相结合,确立国家办学管理的地位。唐代医学教材建设取得显著成就,对医学教育人才培养发挥重要作用,它与医学教育制度一道对当代医学教育有一定的启示。     

Impact of pharmaceutical price controls on the cost of cardiovascular drugs: does essentiality matter?

ABSTRACT

Background

With the goal of improving the affordability of medicines, governments across the globe have instituted various forms of price controls. Since 2013, India has been regulating the prices of drugs included in its national list of essential medicines (NLEM). Here we evaluate the cost variations among available cardiovascular drugs and perform cost-analysis comparing essential and non-essential drugs.