Effect of two preclinical curricula on NBME Part I examination performance

The Michigan State University College of Human Medicine conducts two preclinical medical education programs. In Track I (lecture-based), students attend classes 24 hours per week, and lecture time totals 908 hours over a 50-week period. In Track II (problem-based), students attend classes only 12 hours per week, and lecture time totals 112 hours over the same 50-week period. Institution of the Part I examination of the National Board of Medical Examiners (NBME) as a graduation requirement provided an opportunity to compare the performances of students in both tracks. When students from each track with similar Science Problems subtest scores on the Medical College Admission Test were compared, no significant differences were observed in the students' total scores or pass rate on the NBME examination. However, there were significant differences in scores on the microbiology subtest of the NBME examination, with the Track I students achieving higher scores. The 1984 report of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine of the Association of American Medical Colleges stressed the need to examine critically and consider reducing the scheduled instructional and lecture hours in preclinical medical education programs. In the study reported here, the authors demonstrated that reduction of scheduled instructional time, when replaced by a guided problem-solving program, is not detrimental to students' performance on the NBME Part I examination.     

Student performance on the NBME Part II subtest and subject examination in obstetrics-gynecology

Clerkship directors in obstetrics-gynecology often use the National Board of Medical Examiners (NBME) norms to evaluate third-year medical students' performance on the NBME obstetrics-gynecology subject examination. A comparison of the scores of 342 students at the Medical College of Georgia School of Medicine showed that the students performed significantly better on the NBME subject examination than on the Part II subtest in obstetrics-gynecology. These results concur with the findings of the NBME, which advises directors wishing to adjust the criterion group norms to determine the average difference observed in a school's performance on the two examinations and to use that difference or some portion of it in their interpretation of percentile scores on the subject examination. Additional analyses revealed that a single, linear weight may inappropriately adjust these scores, that student performance on the Part II subtest depends on specialty choice (obstetrics-gynecology versus all others), and that time and sequence of the clerkship were unrelated to the students' performance on the two examinations.     

Preclinical curriculum characteristics and institutional performance on NBME. Part I

A study was conducted that analyzed the relationship between various characteristics of the preclinical curriculum and institutional performance on the Part I examination of the National Board of Medical Examiners (NBME) at a sample of 85 U.S. medical schools. Total scheduled hours per week was the single curriculum characteristic having a positive and significant relationship with institutional NBME examination performance. However, when the data were controlled by medical school selectivity in admissions and institutional policy on the taking of the examination, total scheduled hours per week failed to make a significant contribution to the prediction of performance. The results were viewed as failing to provide support and justification for intense preclinical curriculum loads on the basis that this would enhance NBME examination performance. The authors conclude that simple comparisons of schools on the basis of mean NBME examination performance are meaningless unless the entering abilities of students and school policies on the examination are taken into account. The authors also suggest that those schools that prescribe heavy and intense preclinical curriculum loads should reexamine those policies in light of recommendations of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine.     

Performance on NBME Part I examination in relation to policies regarding use of test

From 1971 to 1983, a number of administrative decisions were made at the University of Oklahoma College of Medicine regarding the National Board of Medical Examiners (NBME) Part I examination. Students' performance on this examination was found to be associated with administrative decisions that required (a) a passing score for promotion, (b) the student to take the examination, and (c) the student to take an integrated basic sciences review course. A modest improvement in student performance was noted when passage of the examination was made mandatory. The introduction of a review course into the curriculum effected a major upward change in scores that has persisted despite the removal of all requirements to pass, or even take, the Part I NBME examination.     

Policies of U.S. medical schools on the use of the NBME Part I and Part II examinations

The study reported here provides information on National Board of Medical Examiners (NBME) examination policies from all U.S. medical schools (n = 67) that require students to pass the examination. Most of these schools have similar policies on use of a 380 total score as the passing level for the NBME Part I examination, allowing three attempts to pass the examination, interrupting a student's progress into the clinical curriculum upon failure of the examination, officially providing time for preparation for taking the test, and requiring students to pass the Part II examination.     

A scoring model for predicting the prognosis of severe viral hepatitis

The prognosis of patients with severe viral hepatitis is concerned by clinicians, patients and their relatives. Manythe prognosis of patientsfactors may influence on with this disease. Many studies on the prognosis of severe viral hepatitis by multiple logistic regression analysis have shown generally consistent results. Previouly we established a scoring model of severe viral hepatitis (SMSVH) by logistic regression analysis.     

新生儿高胆红素血症风险矩阵的建立和作用

目的利用新生儿小时胆红素曲线结合临床风险因素评分,建立联合风险量化矩阵模型,预测贵州省新生儿高胆红素血症的发生风险。方法选取该院产科出生的5 250 例足月儿和近足月儿,连续记录其出生后168 h的经皮胆红素（TCB）值。将出生后72 h内对应的危险区TCB测定值作为预测指标,建立联合风险量化矩阵。结果使用二次方程对TCB 曲线进行二次曲线拟合,结果显示,TCB 水平在24～48 h内上升速率最快,而后逐渐降低。单因素分析结果显示,胎龄、分娩方式、胎膜早破及喂养方式与72 h后TCB 高危险区有关。多因素结果显示,72 h后TCB 高危险区与出生体重、分娩方式、胎膜早破及喂养方式有关联。胎龄为36.01～39.99周的研究对象处于72 h后高危险区的可能性是胎龄≥40.00周研究对象的1.73 倍;剖宫产出生的新生儿与顺产比较,处于高危险区的可能性可降低51%;与混合人工喂养相比,人工喂养的研究对象处于高危险区的可能性较大[OR=2.173（95%CI：1.267,3.683）]。建立联合风险量化矩阵模型,分 12 个区。通过释然比水平高低,将12 个区组分为4 个风险水平,用以预测新生儿高胆红素的发生可能性。结论基于联合风险量化矩阵和新生儿小时胆红素百分位数曲线,将新生儿分为4 个风险水平,可对新生儿TCB水平变化开展精准随访,有效预防新生儿黄疸的发生。     

通过行为和脑活动指标揭示landau—kleffner综合征患者语言损伤汇流的证据：一项病例研究

目的：评估1例landau—kleffner综合征（LKS）男性患儿的语言能力，同时评估该患儿由癫痫所致局灶性脑活动紊乱与认知功能和语言能力缺损之间的关系。该患儿的局灶性脑活动紊乱是由癫痫引发的。方法：本研究包括以下几项评估，采用电活动定位和PET分析癫痫的病灶、采用神经心理学方法评估患者的认知功能以及应用ERPs评估患者的言语感知技巧（辨别语音和重音信号）。结果：患者的癫痫病灶定位在左上颞叶。神经心理学评估表明患者出现言语和非言语功能分离，同时言语能力低于正常水平。通过对语音和重音信号的处理，记录到的ERPs表明两种信号的处理过程是不对称的：音素的不同会导致失匹配负波组分（MMN）的出现，但是重音方式的不同却不会导致该组分出现。结论：本研究资料集中表明，患者表现出选择性的语言系统损伤，其中言语工作记忆系统损伤尤为严重。上述结果提示，患者的语言系统出现损伤，至少部分是由于神经网络的局灶性紊乱所致，而后者正是工作记忆系统的基础。意义：LKS是一种儿童期出现的语言功能紊乱，在发育过程中如果出现基本神经环路严重受损，该疾病可以作为研究此时语言系统损伤情况的一个模型。     

ARIMA模型与GRNN模型对肺结核发病率预测的对比研究

目的 比较自回归移动平均(ARIMA)模型与广义回归神经网络(GRNN)模型对于肺结核发病率的预测性能.方法 根据我国2004年1月至2012年12月的肺结核逐月发病率数据资料,应用Eviews 7.0.0.1建立ARIMA模型,应用Matlab 7.1的神经网络工具箱建立GRNN模型;选取2013年肺结核逐月发病率数据对两种预测模型进行检验,比较预测结果.结果 ARIMA模型和GRNN模型的Theil不等系数(TIC)分别是0.034和0.059,说明ARIMA模型对我国2013年肺结核逐月发病率的拟合程度优于GRNN模型,ARIMA模型相对误差绝对值仅为GRNN模型的57.19％.结论 ARIMA预测模型更适合用于我国肺结核发病率的预测;建议尝试组合模型预测肺结核发病率.     

血小板输注无效列线图预测模型的构建

目的：构建并验证血小板输注无效的列线图模型。方法：选取2019 年1月至12月于温州医科大学附属第二医院育英儿童医院收治的174例血小板输注患者,其中46例血小板输注无效,128例血小板输注有效,收集患者临床资料,包括年龄、性别、多次妊娠、活动性出血、皮肤黏膜出血、脾肿大、发热、ABO血型、输注血小板次数、血小板抗体和血小板计数。采用单因素、多因素Logistic回归分析探讨血小板输注无效的危险因素,构建列线图,并进行验证。结果：多因素Logistic回归分析结果显示：女性（OR =2.43,95%CI =1.08～5.44,P =0.031）、血小板抗体阳性（OR =4.46,95%CI =1.11～17.85,P =0.035）、发热（OR =2.42,95%CI =1.03～5.71,P =0.042）、脾肿大（OR =2.14,95%CI =1.01～5.92,P =0.045）、输注血小板3 次以上（OR =4.90,95%CI =2.10～11.42,P =0.002）是血小板输注无效的危险因素,由此建立列线图模型。模型经内部验证（Bootstrap重抽样500次）后,预测血小板输注无效的ROC曲线下面积为0.858。结论：本研究构建的血小板输注无效列线图预测模型准确性良好,有良好的校准度与区分度。     

基于卓越绩效管理模式下共用护理单元绩效分配方案的应用

目的 探讨基于卓越绩效管理模式下共用护理单元绩效分配方案的应用价值.方法 选择深圳市坪山区人民医院2014年3月至2017年3月神经外科、呼吸内科、消化内科共用护理单元护理人员23人,实施卓越绩效管理模式下绩效分配方案,比较实施前后护理人员满意度、患者满意度、护理人员流失率和护理人员出勤率.结果 实施后护理人员对工作强度与压力、个人与专业发展机会、工作能力被认可、与上级沟通、与同事关系及工作氛围、工作待遇与同工同酬方面满意率分别为91.3%、87.0%、95.7%、87.0%、91.3%、87.0%,明显高于实施前的43.5%、47.8%、52.2%、43.5%、56.5%、52.2%,差异均具有统计学意义(P<0.05);患者对护理服务态度满意率、对护理技术水平满意率、对健康知识的知晓率、对健康教育宣教满意率、对解决问题的满意率实施后分别为87.0%、95.0%、91.0%、95.0%、91.0%,均明显高于实施前的62.0%、68.0%、67.0%、63.0%、68.0%,差异均具有统计学意义(P<0.05);实施前护理人员流失率为17.4%,明显高于实施后的0,差异具有统计学意义(P<0.05);实施前护理人员日常出勤率为60.9%,明显低于实施后的100.0%,差异具有统计学意义(P<0.05).结论 卓越绩效管理模式下共用护理单元跨科收治患者,可有效整合医院床位资源,避免资源浪费,建立适合的共用护理单元绩效考核标准,可有效提高护理工作人员满意度,提高出勤率,避免人才流失.