“医信融合”视域下复合型医学人才培养目标及效果评价

培养“医信融合”复合型医学人才是医学高等教育在新时代信息技术发展背景下的历史使命。在引入“医信融合”教育理念的基础上，提出“医信融合”教育的人才培养目标及其内容体系，并据此构建了“医信融合”人才培养质量评价指标，提出了培养效果评价方法。介绍“医信融合”教育人才培养效果的评价方法，对山西医科大学“医信融合”教学效果进行实证分析，从而为“医信融合”教育实践提供借鉴。     

Confidentiality and cultural competence? The realities of engaging young British Pakistanis and Bangladeshis into substance use services

Aims: This paper focuses on the reasons for the under-representation of British South Asians in substance use services. Based on a small-scale evaluation of a substance use service that delivers targeted outreach support within two predominantly Pakistani and Bangladeshi communities in the north west of England, this paper contributes to the debate around how substance use services can best engage with young British Pakistani and Bangladeshi substance users.

Methods: Semi-structured interviews (with six staff members, 18 young Pakistani and Bangladeshi service users, and 18 stakeholders and partner agencies), a detailed ethnographic observation of the service, and an analysis of routinely collected quantitative monitoring data.

Findings: The paper highlights the importance of what Fountain terms low threshold/open access services. Alongside this, the paper argues that the building of trust and confidence in a substance use service is a key when it comes to engaging with young Pakistani and Bangladeshi substance users. Yet this necessary process takes time: something that is at odds with the current trend towards short-term funding regimes and ‘quick wins’.

Conclusions: The paper concludes by advocating the need for, not only a diverse range of engagement strategies, but also a longer term approach when it comes to developing and delivering substance use services aimed at successfully engaging with this particular group of substance users.     

住院医师规范化培训中引入Mini-CEX的实践

目的　观察对住院医师规范化培训部分学员使用Mini-CEX进行临床教学的效果。方法选取我院2015级住培学员40名，随机分为对照组和实验组，每组20人。2015年10月至2018年4月，对照组采用传统教学；实验组在传统教学基础上结合Mini-CEX活动，实验组每人在每个轮转科室至少进行2次Mini-CEX。毕业时应用改良的Mini-CEX评分量表、病例答辩和OSCE三种考核方法对两组学员进行测评。针对实施过Mini-CEX的教师和学员分别发放问卷，进行满意度调查。采用SPSS 18.0对数据进行统计分析，组间比较采用独立样本t检验，组内前后比较采用配对样本t检验。结果 Mini-CEX测评显示，两组学员各项临床能力毕业成绩均高于入学成绩，实验组学员毕业成绩优于对照组，实验组学员成绩提高分数大于对照组提高分数，差异均有统计学意义（P＜0.05）。病例答辩显示，实验组学员平均成绩为（81.16±3.75）分，优于对照组的（70.13±3.88）分，差异有统计学意义（t= -9.140，P=0.000）。OSCE考核显示，实验组平均总分为（96.300±4.681），优于对照组的（91.775±3.227）分，差异有统计学意义（t=-3.559，P=0.001）。共发放调查问卷80份，其中教师40份、学员40份，结果显示教师满意率达95.0%、学员满意率达92.5%。结论　Mini-CEX应用于住院医师规范化培训临床带教中，有利于提高学员的临床思维、医患沟通和人文关怀能力。     

Practicalities in doctorate research of using grounded theory methodology in understanding nurses’ behaviours when caring for culturally diverse patients

This article provides a critical review of how grounded theory methodology was used to explore student and registered nurses' experiences of caring for culturally diverse patients, as part of a doctorate of philosophy. It illustrates how a continuous cycle of data collection, constant comparative analysis and theoretical sampling was operationalised and explains how these methods were consistent with classic grounded theory methodology. It describes how a theory of resigned Indifference was generated, which explains how nurses used a raft of disengagement strategies as a means of dealing with their uncertainties, during cross cultural encounters. Disengagement was allowed and sometimes even facilitated within clinical practice and as a result nurses became indifferent to people they knew little about and appeared resigned that this was acceptable. This study highlights the need for greater consideration into how cultural competence development is taught, learnt and more importantly, applied in clinical practice. The detailed explanation of the methodology and methods used is intended to provide a practical guide for researchers considering using the methodology. It describes how new insights into nurses’ behaviours towards culturally diverse patients were generated, which has relevance and utility for practising nurses and nurse educators.     

Who is failing who? A survey exploration of the barriers & enablers to accurate decision making when nursing students’ competence is below required standards

Healthcare practice supports the achievement of programme learning outcomes for nursing students internationally. Within this context the issue of reluctance to fail nursing students, when warranted, is extensively examined within the literature with few definitive solutions emerging. Little is known about the perceived barriers that exacerbate this reluctance, or about factors that might enable and support nurses to fail students. To address this issue our study employed a non-experimental cohort study of nurses (n = 365) from two large teaching hospitals in the Republic of Ireland (ROI). Preceptors in this study clearly enjoyed their role with students, and received positive feedback from students. However, findings suggest that preceptors require more support from colleagues in providing comprehensive evidence in assessment. They also require additional training for providing negative feedback to students. A collaborative approach to competence assessment is recommended, whereby the professional burden can be borne by the team, and where students can engage in a holistic, reflective, learning experience that will ultimately improve their competence.     

胰腺癌免疫治疗的现状及前景CSCD

胰腺癌(胰腺导管腺癌)是一种恶性程度较高,诊断和治疗都较困难的消化系统恶性肿瘤。近年来,肿瘤免疫治疗在多种肿瘤中如黑色素瘤、膀胱癌、乳腺癌、非小细胞肺癌和肾癌等均取得了令人振奋的治疗效果,但是胰腺癌的免疫治疗策略尚在不断探索中。目前针对胰腺癌独特的肿瘤微环境设计了多种免疫治疗策略,包括强化/提高自身免疫反应(免疫调节剂、单克隆抗体、肿瘤疫苗和细胞治疗)以及抑制肿瘤免疫逃逸(免疫检查点抑制剂和肿瘤微环境)等。本文就胰腺癌免疫治疗的研究进展进行综述,着重探讨PD-1/PD-L1抑制剂在胰腺癌中的应用,并分析免疫治疗联合其他方式治疗胰腺癌的前景。     

How to stich? 90 degrees: The perfect angle

ObjectiveThis is a discussion about correct suturing techniques and implications that follow inappropriate suturing. We deconstruct the suturing needle angles and methods to be adopted to acquire the perfect needle angle to the tissue being sutured. A study of angles confirms that 90° is perceptible to the naked eye and easy to identify, making it an appropriate foundation to explain, communicate and teach the concepts in the wet-lab and the operating room.BackgroundThere is a lack of robust teaching regarding entry of the needle orthogonal to the tissue planes. In addition, objective methods of assessing angles of the needle relative to the tissue and consequences of inaccuracy are lacking. The authors aim to deconstruct the steps of suturing with the aim of demonstrating ninety degrees is the perfect suturing angle.Study designWe conducted a study to identify 90° (the perfect suturing angle) as an angle easy to identify with the naked eye. Angles from 86° to 94° and 41° to 49° were printed and presented to volunteers with the instruction to identify the angles of 90° and 45°.ResultsFifty-one volunteers replied to the 90° angle study and sixty-five volunteers replied to the 45° study. 92% correctly identified at least one 90° angle and 72% identified both the 90° angles. 63% identified at least one 45° angle and only 27% identified both the 45° angles presented to them. This supported our hypothesis that 90° is an angle that is readily identifiable to the human eye.ConclusionsObjective assessment of surgical skills and training should focus on the basic needle skills with particular emphasis on suturing angles, progressing to higher skills using low and intermediate fidelity models and correlating practice alongside the trainees' operative progress.