Medical consequences of violence: a two-year prospective study from a primary care accident and emergency department in Norway

Objective - To assess the medical consequences of violence from the perspective of a primary care accident and emergency department. Design - Prospective observational study. Setting - Bergen Legevakt (AED). Subjects - All assault victims treated at the AED 1994-96. Main outcome measures - Diagnoses, treatments, number of consultations at the AED, sickness certificates, rates of admittances to hospitals, referrals to specialists and injury severity ratings using Abbreviated Injury Scale (AIS) and Shepherd's injury severity scale. Results - 1803 assault victims were registered, 433 (24%) females and 1370 (76%) males. Most injuries were of slight severity, corresponding to AIS 0 to 1 (82%) or Shepherd's scale 0 to 1 (74%). Bruises/contusions and cuts/lacerations dominated. The majority of patients did not receive any specific treatment at the AED and they were not given sickness certificates, but 11% were admitted to hospitals and 30% were referred to specialists. Males were more likely to be seriously injured than females. Conclusion - Most physical injuries caused by violence and treated at a primary care accident and emergency department are minor.     

肿瘤患者医用粘胶相关性皮肤损伤风险评估量表的编制及信效度检验

目的 编制肿瘤患者医用粘胶相关性皮肤损伤风险评估量表,并检验其信效度。 方法 在文献分析、小组讨论及2轮专家咨询的基础上编制量表。采用便利抽样法,选取2021年3月—7月河南省3所三级甲等医院肿瘤内科收治的306例患者进行问卷调查,检验量表的信效度。结果 该量表包括患者因素、既往史、实验室检查、皮肤状态、粘胶性质、治疗周期及导管维护因素7个维度,共25个条目。探索性因子分析共提取7个公因子,累计方差贡献率为77.52%,各条目在其所属公因子上的载荷值为0.63~0.96;量表水平的内容效度指数为0.91,条目水平的内容效度指数为0.81~1.00;量表预测肿瘤患者医用粘胶相关性皮肤损伤发生风险的受试者操作特征曲线下面积为0.87（P<0.001, 95%CI为0.72~0.83）,截断值为27.50分。量表的Cronbach’s α系数为0.81,折半信度为0.55。 结论 该研究构建的风险评估量表具有良好的信效度,可用于评估肿瘤患者发生医用粘胶相关性皮肤损伤的风险。     

北美国际护理诊断定义与分类(2018-2020)修订解读

将北美国际护理诊断定义与分类(2018-2020)中护理诊断的名称、护理诊断的定义与护理诊断的指标与北美国际护理诊断定义与分类(2015-2017)进行了比较,从护理诊断的名称变更、定义与指标的修订,了解全球护理发展趋势.我国护士可参照北美国际护理诊断定义与分类(2018-2020),对临床病情判断精准性的提高、建立本土化的护理诊断分类系统及找到护理科研的选题素材,起到积极的意义.     

Medical errors: impact on clinical laboratories and other critical areas

The Institute of Medicine (IOM) report (1999) stated that the prevalence of medical errors is high in today's health care system. Some specialties in health care are more risky than others. A varying blunder/error rate of 0.1–9.3% in clinical diagnostic laboratories has been reported in the literature. Many of these errors occur in the preanalytical and postanalytical phases of testing. It has been suggested that the errors occurring in clinical diagnostic laboratories are smaller in number than those occurring elsewhere in a hospital setting. However, given the quantum of laboratory tests used in health care, even this small rate may reflect a large number of errors. The surgical specialties, emergency rooms, and intensive care units have been previously identified as areas of risk for patient safety. Though the nature of work in these specialties and their interdependence on clinical diagnostic laboratories presents abundant opportunities for error-generating behavior, many of these errors may be preventable. Appropriate attention to system factors involved in these errors and designing intelligent system approaches may help control and eliminate many of these errors in health care.     

Models of learning, training and progress evaluation of medical students

Medical education has changed during the last century. Teachercentred medical education has been replaced by a studentcentred one. Some general educational principles have been adopted in medicine faculties, leading to more active students involved in learning, and interactive methods have been introduced, and the role of experience has been focused. Disciplinebased medical education is inadequate for developing comprehensive competence and doctoring. Integrated multidisciplinary learning, together with new clerkship approaches and organization, represent the future of medical education. Continuing, comprehensive, assessment can measure progression in knowledge, skills, attitudes and values. Progress test have recently been introduced in some medical school as a reliable tool for assessing the progressive performance of students in time and monitoring the entire learning process.     

Triangulation for the assessment of clinical nursing skills: A review of theory, use and methodology

Aim

To review the use and usefulness of the methodological strategy of triangulation in the assessment of skill in nursing curricula.

Design

Systematic search of the literature relevant to the definition and assessment of skill, reliability and validity of assessment methods and triangulation of assessment strategies.

Data sources

One hundred and twenty papers from nursing, medical, educational and social scientific databases, relevant websites and relevant books were reviewed. Forty papers were included based on their relevance to the theory and methodology of clinical skills assessment of health care professionals, particularly nurses. Papers concerning vocational skills assessment and the assessment of skill in school children were excluded.

Results

There is a current imperative within the field of health care professional education to assess clinical skills and to quantify this assessment. However, clinical skill, as it relates to cognition, is poorly defined concept and may be viewed as a quality of the practitioner and, as such, is difficult to quantify. Very many methods of assessing clinical skill have been documented and there are inherent issues in ensuring both reliability and validity of these assessment strategies for clinical skill. This has led commentators to suggest that the process of triangulation should be employed.

Conclusions

The paper fundamentally questions whether the concept of triangulation can be applied to skills assessment without dependable measures of reliability and validity of the tools of assessment and concludes that the process of applying multiple modes of assessment should not be confused with the process of triangulation.     

The Simulation Team Assessment Tool (STAT): development, reliability and validation

Introduction

Simulation sessions prepare medical professionals for pediatric emergencies. No validated tools exist to evaluate overall team performance. Our objective was to develop and evaluate the inter-rater reliability and validity of a team performance assessment tool during simulated pediatric resuscitations.

Methods

We developed the Simulation Team Assessment Tool (STAT) which evaluated 4 domains: basic assessment skills, airway/breathing, circulation, and human factors. Scoring of each element was behaviorally anchored from 0 to 2 points. Two teams of resuscitation experts and two teams of pediatric residents performed the same simulated pediatric resuscitation. Each team was scored by six raters using the STAT. Intraclass correlation coefficients (ICC) were calculated to assess inter-rater reliability. Overall performance and domain scores between expert and resident teams were compared using repeated measures of analysis of variance to assess construct validity.

Results

ICCs for overall performance were 0.81. Domain ICCs were: basic skills 0.73, airway/breathing skills 0.30, circulation skills 0.76, human factors 0.68. Expert versus resident average scores were: overall performance 84% vs. 66% (p = 0.02), basic skills 73% vs. 55% (p < 0.01); airway 80% vs. 75% (p = 0.25), circulation 90% vs. 69% (p = 0.02), human factors 89% vs. 66% (p = 0.02).

Conclusions

The STAT's overall performance, basic skills, circulation, and human factors domains had good to excellent inter-rater reliability, discriminating well between expert and resident teams. Similar performance in the airway/breathing domain among all teams magnified the impact of a small number of rater disagreements on the ICC. Additional study is needed to better assess the airway/breathing domain.     

《侵权责任法》系列讲座之五:过错、医疗损害责任及医疗事故的界定及概念解析

过错是侵权法的核心问题,注意义务是界定过失的基准。确定医疗机构承担侵权赔偿责任不应当要求具备违法行为、损害事实、因果关系和医疗过失四个要件。医疗事故的判定应采取客观标准认定行为人的过失,此认定过失的客观标准应取"中等偏上"标准,即一个合理的、谨慎的人的行为标准。行为人基于当时的情况,履行了所应履行的具体的结果预见义务或结果回避义务,纵使具体的危害仍然发生,也不能要求行为人负过失责任。     

Knowledge,attitudes and beliefs about medical cannabis among the medical students of the Belarus State Medical University

Cannabis for medical purposes is prohibited in Belarus. Given that some countries have begun prescribing medical cannabis (MC) to certain categories of patients, a cross-sectional study was undertaken at the Belarusian State Medical University (BSMU) to determine the readiness of medical students to use cannabis in their future practice. 333 students responded to the questionnaire to find out their knowledge, attitudes and beliefs about MC. The data were analyzed using Pearson chi-squared test for categorical variables. Findings show most medical students prepared to recommend MC for patient treatment and believe it has benefits for physical or mental health purposes. The survey respondents believe MC can be effective for treatment -23.5 % for glaucoma to 76.9 % for chronic pain. Study results evidence that 83.1 % of the students receive no formal education about medical cannabis and 87.5 % believe professionals should have formal training about the substance.     

Reliability,validity, and responsiveness of the Balance Evaluation Systems Test (BESTest) in individuals with multiple sclerosis

Background

The Balance Evaluation Systems Test (BESTest) measures various aspects of postural control, but little data exist in persons with multiple sclerosis (MS). The purpose of this study was to determine the psychometrics of the BESTest in MS.

三级甲等医院内科住院医师层配置和工作负担状况研究

目的调查某三级甲等医院内科各亚专科住院医师层配置和工作负担的现状与问题。方法调查医院内科各专科医师层配置与工作负担，并与卫生部属综合医院医师工作负担及《专科医师培训标准》比较，评价其住院医师层配置和工作负担现状。结果该院除血液科外，住院医师层（含规范化培训住院医师、进修医师和研究生）约占总医师人数的40％～70％；而在编医师仅占20％～50％。若仅考虑医院在编医师人数，则每名在编医师承担的床位数为5．33～15．53张。若仅考虑住院医师层，则每名医师负担的床位数为1．67～9．43张，人均每日担负住院床日为1．27～5．65日，人均每月管理病人数为5．75～17．29例。若考虑各科在编医师和住院医师层人员，各科医师人均负担床位数为1．32～5．87张，人均每日担负住院床日为1～3．63日，人均每月管理病人数为4．18～10．7例。与卫生部各专科培训病例数标准要求和较高要求比较显示：该院肾脏、呼吸、消化、神经内科和传染及感染科住院医师层人均每月管理的病例数超过培养标准的要求，内分泌科低于培养标准要求。结论该院内科各亚专科住院医师层人员配置相对稳定，但流动性大；医师人数不足，总体工作负担较重；各科住院医师层人均管理病例数多数超过卫生部专科医师培养标准要求，且科室差异明显。因此各专科住院医师层应根据工作负担需求合理配置。     

Reliability,minimal detectable change and measurement errors in knee extension muscle strength measurement using a hand-held dynamometer in young children

[Purpose] Few studies have assessed the reliability of muscle strength measurement using a hand-held dynamometer, specifically in Japanese young children. This study aims to investigate the reliability, minimal detectable change and measurement error in knee extension muscle strength measurements in young children using a hand-held dynamometer. [Participants and Methods] The study participants comprised 36 kindergarten-enrolled children of 3–6 years age. An experienced physiotherapist measured their isometric knee extension strength. Appropriate orientation and practices were performed prior to measurement. The same physiotherapist took the muscle measurements twice; and the maximum value was used as the muscle strength value. The measurements were repeated at intervals of approximately 30 min to verify reproducibility. [Results] The initial isometric knee extension strength was 10.6 ± 3.3 kgf and the Intra-class correlation coefficient (1,1) was 0.765. The standard error of measurement was 1.6 kgf and the minimal detectable change was 4.4 kgf. No significant systematic errors were observed. [Conclusion] Isometric knee extension strength measurement using a hand-held dynamometer in young children has good reliability with a low risk of systematic errors.     

我国专科医师培养与准入的现状、问题与对策

目的从医学教育制度、住院医师培养、执业医师管理的角度,分析我国专科医师培养和准入管理的现状与问题,提出解决问题的思路与对策,为建立我国专科医师制度提供科学依据.方法运用广义循证医学原理和方法,回顾性调查1996～2002年间我国医学教育招生情况、办学形式、专业构成、住院汉医师培养和专科医师培养的现状,提取数据后分析所存在的问题,提出对策和建议.结果截止2001年,我国共有医师164万人.1996～2002年,医学专业本科及大专招生比例稳步上升,中专医学专业逐年下降.已有30余万人参加医师资格考试,其中本科学历不足15%.约52 000人已完成规范化住院医师培养,65700余人正在接受培训.国内尚无规范的专科医师培养和准入制度.结论医学教育学制和办学形式多样,住院医师培养的软、硬件条件不成熟和缺乏专科医师培养体系是我国医师培养与管理的三大难题,也是导致我国医师队伍整体水平不高的主要原因.卫生部、教育部和财政部已联合立项资助"中国专科医师培养和准入制度研究",相关研究结果将陆续推出.