慕课在产科住院医师规范化培训中的应用

目的产科住院医师工作繁忙,很难进行大规模的规范化培训,因此需要形式灵活、不受时间和场地限制的先进的培训方法。慕课是通过互联网平台进行的由国家教育部门重点推荐的教育模式,文章将慕课应用于产科住院医师培训工作,探讨其教学效果。方法选择在科室进行住院医师规范化培训的医师,随机分为实验组(100人)和对照组(100人),对照组采用常规小讲座、临床实践方法进行住院医师规范化培训,实验组采用慕课教学模式,3个月后,比较两组住院医考试成绩和住院医主观评价结果。结果实验组住院医理论考试成绩和和技能考试成绩均显著优于对照组,差异有统计学意义(P<0.05);实验组住院医对慕课主观评价较高。结论慕课将传统被动的授课模式改为积极主动的学习模式,利用碎片化时间学习,并重视个性化教学,在产科住院医师规范化培训过程中起到了很好的效果。     

Peri-operative tobacco cessation interventions: a systematic review and meta-analysis

Tobacco smoking is associated with a substantially increased risk of postoperative complications. The peri-operative period offers a unique opportunity to support patients to stop tobacco smoking, avoid complications and improve long-term health. This systematic review provides an up-to-date summary of the evidence for tobacco cessation interventions in surgical patients. We conducted a systematic search of randomised controlled trials of tobacco cessation interventions in the peri-operative period. Quantitative synthesis of the abstinence outcomes data was by random-effects meta-analysis. The primary outcome of the meta-analysis was abstinence at the time of surgery, and the secondary outcome was abstinence at 12 months. Thirty-eight studies are included in the review (7310 randomised participants) and 26 studies are included in the meta-analysis (5969 randomised participants). Studies were pooled for subgroup analysis in two ways: by the timing of intervention delivery within the peri-operative period and by the intensity of the intervention protocol. We judged the quality of evidence as moderate, reflecting the degree of heterogeneity and the high risk of bias. Overall, peri-operative tobacco cessation interventions increased successful abstinence both at the time of surgery, risk ratio (95%CI) 1.48 (1.20–1.83), number needed to treat 7; and 12 months after surgery, risk ratio (95%CI) 1.62 (1.29–2.03), number needed to treat 9. More work is needed to inform the design and optimal delivery of interventions that are acceptable to patients and that can be incorporated into contemporary elective and urgent surgical pathways. Future trials should use standardised outcome measures.     

社会力量参与公立互联网医院建设激励与约束机制研究

社会力量具备相应的经济基础和技术条件,对于公立互联网医院体系建设具有积极的促进作用。但是实践中仍然存在商业模式不完善、监管制度不健全等问题。基于经济学契约理论要义,提出在坚持激励与约束机制并举、平衡公私益关系的前提下,通过完善医保政策、构建互联网医疗服务价格分类管理机制来促进社会力量向医疗服务公益性目标回归,并通过构建完善的监督体制来约束部分社会力量的盲目逐利性行为。     

Temporal associations between morningness/eveningness,problematic social media use,psychological distress and daytime sleepiness: Mediated roles of sleep quality and insomnia among young adults

The extant literature has suggested relationships between an individual's chronotype (in relation to morningness/eveningness) and several outcomes, including addictive disorders, psychological distress and daytime sleepiness. Moreover, sleep quality has been proposed to be a mediator in the aforementioned relationships. Consequently, the aim of the present study was to investigate the complex relationship between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness, with the potential mediators of sleep quality and insomnia. All participants (N = 1,791 [30.1% males]; mean age = 27.2 years, SD = 10.1) completed a battery of psychometric scales, including a reduced version of the Morningness‐Eveningness Questionnaire (at baseline), the Pittsburgh Sleep Quality Index and Insomnia Severity Index (1 month after baseline assessment), the Bergen Social Media Addiction Scale, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale (2 months after baseline assessment). The impacts of morningness‐eveningness on problematic social media use, anxiety, depression and daytime sleepiness were found in the mediation models. Furthermore, the mediated effects of insomnia and sleep quality were observed. The present study's results emphasize the importance of promoting healthy sleep habits and sleep hygiene behaviours, and that of early detection of sleep problems among individuals who have the eveningness chronotype, because this would significantly improve their health outcomes.     

Substance Use Disorder Treatment via Telemedicine During Coronavirus Disease 2019

Telemedicine has been effective at bridging the gap among patients, providers, and health systems. Authors from a large academic medical center in Baltimore, MD, anecdotally found that digital tools were beneficial in supporting substance use disorder recovery during a global pandemic. Audiovisual tools like Zoom (Zoom Video Communications, Inc, San Jose, CA) and Doximity (Doximity, Inc, San Francisco, CA), as well as increased frequency of communication with patients, have been most helpful to supporting recovery. The barriers noted were related to patient privacy and increased tendency of patients to avoid treatment, similar barriers as when treatment is provided in the clinic. The intent of this narrative is to discuss provider perspectives of benefits and barriers to telemedicine for substance use disorder treatment during the coronavirus disease 2019 pandemic.     

Hair hormones in male youth with internet gaming disorder

Objectives: Internet gaming disorder (IGD) is associated with altered physiological reactivity to psychosocial stress. Findings from a previous study on alterations of basal hypothalamic–pituitary–adrenal (HPA) axis functioning, indexed by differences in hair hormone levels (i.e., cortisol) in IGD patients compared to matched controls, were limited by a small sample size.

Methods: Following the protocol of the previous study, male patients with IGD (n?=?31) and controls (n?=?31) matched for age, educational status and smoking were recruited. Sociodemographic and clinical characteristics were assessed using structured interviews and self-reports. Hair samples were taken for the analysis of cortisol, cortisone, testosterone, progesterone, dehydroepiandrosterone (DHEA), and corticosterone.

Results: Groups showed no significant differences on cortisol (d?=??0.10, 95%CI (?0.60; 0.40)), cortisone (d?=??0.10, 95%CI (?0.60; 0.40)), testosterone (d?=??0.00, 95%CI (?0.51; 0.51)), progesterone (d?=??0.46, 95%CI (?0.96; 0.05)), DHEA (d?=??0.04, 95%CI (?0.54; 0.47)) or corticosterone (d?=??0.19, 95%CI (?0.69; 0.32)). Associations between hair hormone concentrations, symptom severity and sociodemographic variables were weak and did not survive correction for multiple testing.

Conclusions: Unlike other psychiatric disorders, effects of IGD and associated psychopathology on basal HPA axis functioning, indexed by hair hormone levels, are negligible. Future studies need to rule out potential effects of sex, age and long-term pathology on these findings.     

Information communication technology-enabled instrumental activities of daily living: a paradigm shift in functional assessment

Abstract

Purpose: Information Communication Technology, such as smartphones, apps, the internet, etc., has become all-pervasive in our society. To learn the impact of Information Communication Technology (ICT) on everyday functioning, specifically Instrumental Activities of Daily Living (IADL), an exploratory review was undertaken.

Methods: We identified how many primary IADL domains were substantially influenced by ICT, by examining primary IADL domains, in terms of traditional and ICT-enabled ways of completing these common tasks. The study further explored the implications of the pervasiveness of ICT and the ICT-enabled new normal in everyday functioning that underpins the need to redefine IADLs.

Results: This examination revealed that the impact of ICT on IADLs has been so profound, that it marks a paradigm shift in the way we assess IADL completion. Creation of the concept of “Electronic Instrumental Activities of Daily Living (eIADLs)” would be a first step in marking this paradigm shift, and would foster further advances for understanding the mechanisms underlying the ICT-based life style related outcome measurement in rehabilitation science.

• IMPLICATIONS FOR REHABILITATION

• The presence of Information Communication Technology (ICT) has substantially influenced the way we complete our Instrumental Activities of Daily Living (IADL). Indeed, the impact is so profound, that it marks a paradigm shift in the way we should assess and measure everyday functioning.

• Creation of the concept of eIADLs would be a first step in marking this paradigm shift, and would foster further advances for understanding the mechanisms underlying the ICT-based life style related outcome measurement in the rehabilitation sciences.