Examiner Differences in the Mini-Cex

Objective: The objective of this study was to analyze whether faculty ratings of residents, using the mini-CEX oral exam format, differed in stringency or were influenced by the clinical setting. It also sought to learn whether the examiners were satisfied with the format.Method: A mini-CEX encounter consisted of a single faculty member observing a resident conduct a focused history and physical examination in an inpatient, outpatient, or emergency room setting. After asking the resident for a diagnosis and treatment plan, the faculty member rated the resident and provided educational feedback. The encounters were intended to be short and occur as a routine part of the training, so each resident would be evaluated on many occasions by different faculty.Sample: Sixty-four attending physicians evaluated residents from five internal medicine training programs; data were analyzed for 355 mini-CEX encounters involving 88 residents.Results: There were not large differences among the examiners in their ratings. Moreover, there were not great differences among the ratings in terms of the training program with which the examiner was associated, the setting of the mini-CEX, or the nature of the patient. The examiners were generally satisfied with the format and their level of satisfaction was correlated with the residents' perceptions of the format.Conclusion: The mini-CEX adapts itself to a broad range of clinical situations, and these results show that it should produce roughly comparable scores over examiners and settings. This makes it a worthwhile device for evaluation at the local level.This revised version was published online in September 2005 with corrections to the Cover Date.     

Effect of regular training on the anthropometric parameters and urine steroids in childhood

The changes in the anthropometric data and urine steroid metabolites caused by regular training in children in two age groups (11 and 14 years old) were investigated. The skinfolds of older girls participating in regular athletic, swimming or soccer training were thinner compared with age-matched control groups (P < 0.01) and their body mass and constitution were lower (P < 0.05). In the other groups no significant differences were observable in the anthropometric parameters. The trained children in all groups had significantly higher exercise times on the cycle ergometer (P < 0.01, in young boysP < 0.05). The strength of their hands was lower in three trained groups: in younger boys (P < 0.05), in younger girls (P < 0.01) and in older girls (right handP < 0.01, left handP < 0.05). The urinary excretion of androsterone (P < 0.02), 11-ketopregnanetriol (P < 0.01) and pregnenetriol (P < 0.02) was decreased in the older trained girls; pregnenetriol was increased in younger boys (P < 0.05). Urinary excretion of cortisol metabolites was increased in trained boys [in younger boys: tetrahydrocorticosterone (P < 0.05) and 20-hydroxycortisol (P < 0.05); in older boys allotetrahydrocortisol (P < 0.02), cortisol (P < 0.05) and 20-hydroxycortisol (P < 0.05)]. There were no significant differences in the younger girls. In the trained older girls urinary excretion of cortisol metabolites was decreased: tetrahydrocortisone (P < 0.02), allotetrahydrocorticosterone (P < 0.01), tetrahydrocortisol (P < 0.05), -cortolone (P < 0.01), cortisol (P < 0.02), 6-hydroxycortisol (P < 0.01) and 20-hydroxycortisol (P < 0.05). A multivariate analysis of the data from the trained groups and sedentary, age-matched control groups showed that regular training has a significant effect on steroid excretion.     

骨应力性塑形改建的研究及其对新兵基础训练的指导意义

分组模拟训练的２８８只兔股骨标本病理观察及扭断试验结果表明,较大强度和时限训练的主导作用是加速骨塑形改建,增强抗骨折能力。分３组经３种方法训练的１８０只大鼠的胚骨上段病理切片及电镜观察表明,强化循环训练组的改建完成率（４１．７％）高于其它两组（２６．１％,２１．９％）,而应力性骨折发生率（１１．５％）则低于其它两组（２２．９％,１８．８％）。对１１２９名新兵１２周基础训练的前瞻性流行病学调查证实,下肢长管状骨经历约９周的应力性塑形改建期,训练的第２、７周出现的应力性骨折高发的双峰现象可随训练强度与时限的加大或减少,而提前或延迟出现。在训练中采用“强化循环训练法”将加速骨的塑形改建及降低应力性骨折发生率。     

The emergency medicine training needs of rural general practitioners

This study aimed to identify the emergency medicine training needs of rural general practitioners (GPs) in the catchment area of the Hunter Rural Division of General Practice. The GPs were surveyed using a questionnaire in which they were asked about their confidence levels in a number of specific emergency medicine skills, and about the areas of emergency medicine that they saw as priorities for upskilling. More than a third of GPs who were responsible for on-call work at the hospital indicated that they had low levels of confidence in a number of their emergency medicine skills, in particular skills relating to paediatric emergencies, cardiovascular emergencies, and respiratory emergencies. These emergency medicine domains were also seen as high priorities for upskilling by the majority of the respondents. The study shows that rural doctors need the opportunity to access emergency medicine training that provides upskilling not only in the management of clinical problems, but also in practical procedures.     

A healthcare staff decision model considering the effects of staff cross‐training

In this study a staff planning model for a health service clinic has been developed and validated using an example case of a health service clinic. The primary purpose of this research is to develop a representative staff planning model which balances the cost and benefits of staff task flexibility through crosstraining for a healthcare facility. Additionally, legal requirements for task substitution in the healthcare industry have been considered in the model.     

简易鼻塞式CPAP治疗新生儿呼吸衰竭50例

目的：探讨简易鼻塞式持续呼吸道正压给氧对新生儿呼吸衰竭的治疗效果。方法：对５０例新生儿呼吸衰竭应用简易鼻塞式持续呼吸道正压给氧,并与４０例对照组进行比较。结果：治疗组治愈率为５２％;死亡率为２１％;对照组治愈率为２０％,死亡率为６７５％。两组比较Ｐ＜００１有极显著差异。结论：简易鼻塞式持续呼吸道正压给氧是基层治疗新生儿呼吸衰竭的最有效的方法,值得推广。     

Study to evaluate the effectiveness of stress management workshops on response to general and occupational measures of stress

This study was designed to evaluate the effectiveness of stress management training workshops within Zeneca Pharmaceuticals. The study was of cross-sectional design, comparing groups of workshop attendees and non-attendees. In addition, self-rated well-being scores of attendees were compared with results obtained pre-workshop and 2-3 months after the workshop. Employees participating in the study were drawn from the Manufacturing, Research and Development, Sales and Marketing sites of Zeneca Pharmaceuticals located in Cheshire, United Kingdom. Three hundred and ninety persons who had participated in stress management workshops since 1988 were matched for age, gender and department with an equal number of employees who had not attended stress management workshops. Outcome measures included self-rated well-being (as measured by the 30-question General Health Questionnaire), knowledge of company guidance on the management of stress in staff, and an assessment of coping strategies. Subjects who had not attended a stress management workshop were much more likely to have a poor understanding of the principles of management of stress in staff [odds ratio (OR) = 8.3; 95% confidence interval (CI) = 3.3-21.3] and more likely to have poor coping skills (OR = 2.8; CI = 1.3-6.1). However, mean scores for the two measures were similar in attendees and non-attendees. Self-rating of current well-being was strongly associated with the life-events score, but not related to workshop attendance. The study indicates that stress management training workshops reduce the prevalence of employees with a poor understanding of the principles of the management of stress in staff and with poor coping strategies. An improvement in the self-rated well-being observed shortly after the workshop was not sustained.     

某部军事训练伤前瞻性流行病学研究

目的：了解军事训练伤的发生规律与特点。方法：采用前瞻性流行病学研究方法,对某部１９９７年３月至２月的军事训练伤进行调查。结果：该部军事训练伤的年度发生率为３０．０４％,上半年训练伤的发生率明显高于下半年,训练伤的发生率随年龄增加而逐渐下降,不同单位训练伤的发生率不同。在训练伤病例中以关节扭伤所占比例最大（３３．２１％）,受伤部位以肘,腿,踝和腕部为主,受伤课目以战术训练和５公里越野跑等所占比例高（     

Prevention of anterior cruciate ligament injuries in soccer

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained normally and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the control group and 0.15 injuries per team per year in the proprioceptively trained group (P<0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players.