Active learning in head and neck trauma: outcomes after an innovative educational course

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.     

Understanding How Newly Implemented Rehabilitation Best Practices Are Sustained: A Realist Review

ObjectiveWe conducted a realist review to understand how (mechanism) and in what circumstances (context) evidence-based practices are sustained in rehabilitation (outcome).Data SourcesMEDLINE, Embase, reference lists, and targeted websites.Study SelectionTwo independent reviewers calibrated study selection; then 1 reviewer screened all titles and abstracts, while the second reviewer screened a random 20%. We repeated this process for full texts. We included 115 documents representing 61 implementation projects (8.9% of identified documents). Included documents described implementation projects in which physical therapists, occupational therapists, and/or speech-language pathologists were the target users of an evidence-based practice.Data ExtractionTwo reviewers repeated the independent process described in study selection to extract basic study and sustainability characteristics as well as context, mechanism, outcome, and strategy text.Data SynthesisUsing basic numerical analyses, we found that only 54% of evidence-based practices in rehabilitation are sustained. Furthermore, while authors who reported sustainability planning sustained the practice 94% of the time, sustainability planning in rehabilitation is rare (only reported 26% of the time). Extracted text was synthesized using the realist technique of inductive and deductive retroduction in which context, mechanism, outcome, and strategy text are combined into narrative explanations of how sustainability works. To inform these explanations, we applied normalization process theory and the theory of planned behavior. Collectively, the 52 identified narratives provide evidence for 3 patterns: (1) implementation and sustainability phases are interconnected, (2) continued use of the evidence-based practice can be interpreted as the ultimate sustainability outcome, and (3) intermediate sustainability outcomes (ie, fit/alignment, financial support, benefits, expertise) can become contextual features influencing other sustainability outcomes.ConclusionsImplementation teams can use the narrative explanations generated in this review to optimize sustainability planning. This can sustain practice changes and improve quality of care and patient outcomes. Future research should seek to iteratively refine the proposed narrative explanations.     

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

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。     

Features of Successful and Unsuccessful Collaborative Memory Conversations in Long‐Married Couples

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.     

Addressing the ethical grey zone in surgery: a framework for identification and safe introduction of novel surgical techniques and procedures

While the introduction of new surgical techniques can radically improve patient care, they may equally expose patients to unforeseen harms associated with untested procedures. The enthusiastic uptake of laparoscopic cholecystectomy in the early 1990s saw a dramatic increase in the rate of common bile duct injuries, and was described by Alfred Cuschieri as ‘the biggest unaudited free‐for‐all in the history of surgery’ due to ‘a lack of effective centralised control’. Whether a new surgical intervention is considered an acceptable ‘minor’ variation of an established procedure, or is sufficiently ‘novel’ to constitute experimentation on human subjects is often unclear. Furthermore, once a new technique is identified as experimental, there is no agreed protocol for safety evaluation in a first‐in‐human setting. In phase I (first‐in‐human) pharmacological trials only small, single arm cohorts of highly selected patients are enrolled in order to establish the safety profile of a new drug. This exposes only a small number of patients to the unknown or unforeseen risks that may be associated with a new agent, in a highly regulated and scientifically rigorous manner. There is no equivalent study design for the introduction of new and experimental surgical procedures. This article proposes a practical stepwise approach to the safe introduction of new surgical procedures that surgeons and surgical departments can adopt. It includes criteria for new surgical techniques which require formal prospective ethical evaluation, and a novel study design for conducting a safety evaluation at the ‘first in human’ stage.     

Adapting Gerontechnological Development to Hospitalized Frail Older People: Implementation of the ALLEGRO Hospital-Based Geriatric Living Lab

Gerontechnology aims at improving the functioning of older people and their carers in their daily lives as well as improving gerontological practices. To promote gerontechnology innovation in the hospital and bridge the gap between gerontechnology developers and hospitalized frail older patients, our objective was to create and implement a hospital-based geriatric living lab. We designed a hospital-based living lab, providing reflexive workshops bringing around the table gerontechnology users and developers, supplemented with an experimental hospital room receiving both the users and the devices to be tested. Three different types of users were distinguished: seriously ill older inpatients, professional hospital caregivers, and informal carers. Three different kinds of devices were also distinguished: prototypes under development, new services and/or care organizations, and new uses. Finally, we were able to open in 2018 the Angers Living Lab En GéRiatrie hOspitalière (ALLEGRO) hospital-based geriatric living lab. ALLEGRO offers the organization of "idea incubator workshops" for users and developers, together with one “experimental hospital room” equipped with validated devices to provide reference measures used as a standard to test the diagnostic efficacy of prototypes. The room is intended to accommodate one older inpatient with severe acute organic failures. No patient selection is planned at admission, apart from consent to research. Until now, no refusal to participate in a study was noted. In conclusion, we offer a new and unprecedented hospital-based geriatric living lab to improve hospital care for older inpatients and to promote successful aging through gerontechnology.     

多层次创新人才培养教学基地的建立

建立培养多层次创新人才标准化的教学基地。根据需求制定科学合理的培训方案,制定多层次创新人才的培养机制SOP,选用合适的教材和优秀的带教老师,依托先进实验室培训教学平台建设,实施激励约束和考核制度。建立了一整套多层次创新人才的培养制度,确立了多层次、多方向、多学科的带教老师。十年来培养应用型和研究型人才1197人,合格率100%,发表专业学术论文114篇。加强输血医学专业人才的培养至关重要,有必要在血液中心层建立多层次创新人才的培养机制和实施方法,需要与时创新,不断改进我们的模式和方法,为输血医学人才的培养提供有力的教学资源保证和优良的平台。