Con: anesthesia for children in the developing world should be delivered by medical anesthetists

Surgical care for pediatric patients in poor countries is severely limited by the availability of surgeons, healthcare resources and investment in anesthesia services. Where a surgical service exists, a shortage of trained medical anesthetists limits the care that can be delivered. Where no doctors are available to administer anesthesia, some countries have utilized nonmedical anesthesia providers to provide a service. These providers should be integrated with, and supported by, their medical colleagues to ensure safe practice. Action at governmental level is required to resolve the difficult issues described in this paper.     

Breast-conserving therapy in low-literacy patients in a developing country

Abstract: The purpose of this study was to determine the frequency with which low-literacy patients in a developing country chose their treatment plan. In this study, data for 312 patients admitted to different hospitals in Egypt were reviewed regarding their disease stage, optimal management plan, and treatment. It was found that the majority of patients were primarily concerned with keeping their breasts, regardless of the disease stage.      

Pro: anesthesia for children in the developing world should be delivered by medical anesthetists

Outcomes from pediatric surgery when carried out by trained pediatric anesthetists are excellent. This is not the case when the anesthesia provider is poorly trained. The presence of pediatric anesthetists is not only the norm but considered mandatory for children below the age of 2–3 years in developed countries. There are many reasons why trained anesthetists are not readily available in developing countries – migration to greener pastures, inadequate training facilities, poor remuneration and support services being some of them. These problems should be addressed but safety of the children should not be compromised. One should not condone poor standards to deprive children of safe anesthesia and the caregiver of much needed self-respect.     

Impact of a surgical oncologist on general surgery residency training program

BACKGROUND: To assess the impact of adding a surgical oncologist to our faculty we examined the operative experience in our program before and after the addition. METHODS: Operative case numbers reported to the American Board of Surgery over a 10-year period were analyzed. This time period encompassed 5 years before and after the addition of a surgical oncologist to our faculty. All defined category case numbers were examined using t test analysis. Significance was defined as a P value of less than 0.05. RESULTS: The overall caseload increased in the time period after the faculty addition. There was a statistically significant increase in skin/soft tissue, breast, esophagus, small intestine, large intestine, live, spleen, and endocrine cases. No statistical significance was seen in head/neck, stomach, pancreas, and biliary cases. CONCLUSIONS: The addition of a surgical oncologist to our faculty coincides with a statistically significant increase in areas of skin/soft tissue, breast, esophagus, small intestine, large intestine, liver, spleen, and endocrine. Other areas not statistically significant may reflect referral patterns or this particular oncologist's preferences of practice.     

The stability of emotional symptoms among disaster victims in a developing country

This stability of emotional distress following a major disaster in Colombia was evaluated in a 2-year follow-up of a representative subsample of 40 adult victims of the Armero disaster in Colombia. The utilization of the Self-Reporting Questionnaire indicated an increase of emotional distress from 55% to 78%. However, the mean neurotic subscale score, the most frequent neurotic symptoms, the strongest predictors of emotional distress, and the symptom-profiles of distressed victims were essentially the same.     

Impact of a novel education curriculum on surgical training within an academic training program

BACKGROUND: The training of the 21st century surgeon has become increasingly complex with the Accreditation Council for Graduate Medical Education (ACGME) core competency requirements and work-hour restrictions. Herein we report the two-year results of a novel problem-based learning education module at a large academic surgery program. METHODS: All data were prospectively collected from 2004 to 2006 on all categorical residents in the department of surgery (n = 42). Analysis was performed to identify any correlation between class attendance and American Board of Surgery In-Service Training Exam (ABSITE) score performance (percentile change). All data were reported as a mean with a standard error of the mean. Categorical variables were analyzed using a paired Student's t-test. A bivariate correlation was calculated using Spearman's rho correlation. RESULTS: When comparing the 2004 scores (pre-program) to 2006 scores, there was significant score improvement (P 相似文献   

团体社交技能训练对精神分裂症康复患者家庭关系的改善作用

目的探讨团体社交技能训练对精神分裂症康复患者家庭关系改善的效果。方法按照自愿原则,将101例精神分裂症康复期患者分为干预组56例,对照组45例。将两组患者均开放兴趣小组,每次活动确定1个主题,患者根据自己兴趣参与不同兴趣小组。干预组在此基础上采用封闭式团体社交技能训练,共6次,在3个月内完成。6次活动均有不同的主题。比较两组家庭关系、精神症状和精神残疾改善情况。结果第6个月末,干预组家庭关怀总分显著高于对照组,精神症状阳性和阴性症状总分显著低于对照组（均P〈0．01）。结论团体社交技能训练有助于改善家庭关系,促进患者康复。     

Appropriate training in paediatric nephrology for developing countries: hypothesis and proposals

Appropriate training in paediatric nephrology is a comprehensive approach designed to develop skills and capabilities to deal with the following basic components of medical care: (1) medical competence for clinical and research activities; (2) interpersonal relationships directed at maintaining patients' freedom and autonomy; and (3) adequate incorporation of technological, financial and managerial aspects of paediatric nephrology services. Inappropriate training causes frequent, dramatic and paradoxical negative feedback in developing countries: shortage of functioning medical equipment, skilled manpower and trained paediatric nephrologists co-exist with unused high-cost medical equipment and loss of skilled health care professionals. Appropriate training, tailored to the needs and resources of developing countries, could be an efficient way to develop high-quality paediatric nephrology care. Efficient training must develop self-reliant, self-sufficient and skilled health care professionals in the local economic, educational, technological and political context. Regional and international co-operation is essential to promote adequate training in paediatric nephrology. Developing countries lack an effective and accurate information communication network for selecting modern technology for paediatric nephrology. The development of this network, through international co-operation, is an urgent requirement.     

临床多站培训模式在新入职护士规范化培训的应用

目的探讨临床多站培训模式在新入职护士规范化培训的应用效果。方法将132名新入职护士采用随机数字表法分为4组,1、3组为对照组(67名),采用传统培训模式;2、4组为观察组(65名),采用临床多站培训模式。培训2年后采用客观结构化临床考核评价培训效果。结果观察组的护理体格检查、病史采集、沟通能力、临床评判思维、健康教育得分显著高于对照组,技能操作、理论知识考核成绩及对培训模式的满意度评分显著高于对照组(均P<0.01)。结论临床多站培训模式可提高新入职护士的临床实践能力,有利于其尽快适应临床护理工作,是一种系统、有效的培训模式。     

Con: pediatric anesthesia training in developing countries is best achieved by out of country scholarships

Medical migration is damaging health systems in developing countries and anesthesia delivery is critically affected, particularly in sub-Saharan Africa. 'Within country' postgraduate anesthesia training needs to be supported to encourage more doctors into the specialty. Open-ended training programs to countries that do not share the same spectrum of disease should be discouraged. Donor agencies have an important role to play in supporting sustainable postgraduate training programs.     

Effect of social class disparities on disease stage, quality of treatment and survival outcomes in breast cancer patients from developing countries

Abstract:  To assess the relationship between social class disparities on disease stage on presentation, quality of treatment, and survival outcome of breast cancer patients in Pakistan and compare our data with SEER (Surveillance, Epidemiology, and End Results) data from US on white and African-American women to evaluate differences in disease stage and survival outcomes. Patients were evaluated for age, tumor size, grade, receptor status, stage, and 5-year survival and were compared with SEER data. Socio-economic status was evaluated with financial income. Patients were divided in poor and middle/high groups. Excellent and comparable 5-year survival with SEER data was observed with localized disease in all groups from different strata. Advanced disease was more common in the disadvantaged group with negligible 5-year survivals. Development and implementation of early detection programs, public awareness, and clinical and breast self examination that are more pragmatic in the settings of countries with limited resources are essential.     

Computer-based video training is effective in teaching basic surgical skills to novices without faculty involvement using a self-directed,sequential and incremental program

IntroductionComputer-based video training (CBVT) of surgical skills overcomes limitations of 1:1 instruction. We hypothesized that a self-directed CBVT program could teach novices by dividing basic surgical skills into sequential, easily-mastered steps.MethodsWe developed a 12 video program teaching basic knot tying and suturing skills introduced in discrete, incremental steps. Students were evaluated pre- and post-course with a self-assessment, a written exam and a skill assessment.ResultsStudents (n = 221) who completed the course demonstrated significant improvement. Their average pre-course product quality score and assessment of technique using standard Global Rating Scale (GRS) were <0.4 for 6 measured skills (scale 0–5) and increased post-course to ≥3.25 except for the skill tying on tension whose GRS = 2.51. Average speed increased for all skills. Students’ self-ratings (scale 1–5) increased from an average of 1.4 ± 0.7 pre-elective to 3.9 ± 0.9 post-elective across all skills (P < 0.01).ConclusionSelf-directed, incremental and sequential video training is effective teaching basic surgical skills and may be a model to teach other skills or to play a larger role in remote learning.     

Sight saving strategies for developing nations: toward an appropriate philosophy of blindness treatment and prevention for ministries of health, international agencies and mission societies in developing nations

Saving the sight of millions of blind people in Developing Nations requires the development of an appropriate philosophy of blindness treatment and prevention. Guidelines are presented in this paper, emphasizing the importance of training national workers, using appropriate ophthalmic technology and promoting international cooperation of governments, development agencies, and mission societies.     

Laparoscopic skills laboratories: current assessment and a call for resident training standards

BACKGROUND: Numerous protocols for laparoscopic skills training using simulator-based laboratories have proven effective. However, little is known about the availability and uniformity of such facilities. The purpose of this study was to evaluate the prevalence, utilization, and costs of skills laboratories currently in use. METHODS: A survey was mailed to 253 general surgery program directors to determine the perceived value, prevalence, equipment, types of training, supervision, and costs of the labs. RESULTS: One hundred sixty-two (64%) programs completed the survey. Eighty-eight percent of responders consider skills labs effective in improving operating room performance; however, only 55% have skills labs. Of 89 programs with skills labs, 99% have videotrainer equipment (mean 3.8 trainers per lab, range 1 to 15); 46% have virtual reality trainer equipment (mean 1.7 trainers per lab, range 1 to 7). Eighty-two percent of programs teach basic skills using a variety of tasks (Rosser/Southwestern stations, MIST-VR, MISTELS, department-created); 96% teach suturing (intracorporeal, extracorporeal, suture devices). On average, residents train 0.8 hours per week (range 0 to 6). Training is mandatory in 55% and supervised in 73% of the programs. The mean development cost was 133,000 dollars (range 300 dollars to 1,000,000 dollars). CONCLUSIONS: While a large majority of program directors consider skills labs important, 45% of programs have no such facilities. Moreover, significant variability of equipment and training practices exist in currently available labs. Strategies are needed for more widespread implementation of skills labs, and standards should be developed to facilitate uniform adoption of validated curricula that reliably maximize training efficiency and educational benefit.     

安全训练观察程序在实习护生行为安全管理中的应用

目的探讨实习护生行为安全管理方法,以提高临床实践中的识险避险能力。方法按实习时间将2011年7月至2013年4月的实习护生587名作为对照组,采用传统教学法;2013年7月至2015年4月的实习护生533名作为实验组,在常规教学基础上实施安全训练观察程序。结果实验组不良事件发生率及锐器伤发生率显著低于对照组(均P0.01),手卫生认知、手卫生依从性率及技术操作规范合格率显著高于对照组(均P0.01)。结论将安全训练观察程序应用于护生临床实践环节中,有助于规范实习护生安全行为和技术操作,提高临床教学质量。     

血液净化护理专业学位研究生培养模式的初步构建

目的初步构建血液净化方向护理专业学位研究生培养模式,并探讨其毕业后与高级实践护士认证衔接的具体条件。方法在文献回顾、半结构访谈等方法基础上,运用德尔菲法对27位相关领域专家进行2轮函询。结果 2轮函询专家积极系数分别为90%和100%,专家权威系数0.78~0.98。最终形成4个一级指标(培养目标、培养过程、质量评价、衔接条件),16个二级指标和86个三级指标。结论本研究专家积极性和权威程度高,构建的培养模式体现血液净化护理专科特点,衔接条件内容明确具体,可为我国血液净化护理专业学位研究生的培养提供理论参考。