Can endoscopists accurately self-assess performance during simulated colonoscopic polypectomy? A prospective,cross-sectional study

BackgroundThe aim of this study was to establish if endoscopists can reliably self-assess their ability to perform simulated colonic polypectomy.MethodsNovices, intermediates, advanced, and experts performed a video-recorded polypectomy task using the Welsh Institute for Minimal Access Therapy (WIMAT) colonoscopy suitcase simulator. This involved removal of a simple polyp (A) and a complex polyp (B). Participants self-assessed themselves using a Direct Observation of Polypectomy Skills (DOPyS) assessment form. Two blinded, independent, Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accredited assessors graded each performance using the same DOPyS scoring. The Spearman coefficient was used to determine the correlation between self and assessors' scores.ResultsEighty participants completed the task. There was a weak correlation between assessors' scores and self-assessment scores for all groups (novices: ρ = −.44, P = .85; intermediates: ρ = −.16, P = .51; advanced: ρ = .16, P = .50; and experts: ρ = .07, P = .76). There was a strong correlation between scores from assessor 1 and 2 for polyp A (ρ = .80, P ≤ .01) and polyp B (ρ = .80, P ≤ .01).ConclusionsThe correlation between self-assessment and assessors' scores is weak. Novices and intermediates underestimate performance, whereas advanced and experts overestimate performance. Regular feedback may improve accuracy.     

医院评审自评工作的实践与体会

介绍了医院深入领会理解新一轮评审的精神实质,坚持“以评促建、以评促改、评建并举、重在内涵”的工作方针,围绕“质量、安全、服务、管理、绩效”,体现“以病人为中心”,以医疗品质和医疗服务绩效作为自评的重点,认真组织开展自我评价的实践.通过不断强化医院内涵建设,在建立健全院科两级质量管理责任体系、实现医疗质量和安全的持续改进、促进医院可持续发展等方面取得一定成效.医院评审自评完善并检验了医院质量管理体系建设,而完善的质量管理体系建设又对医院评审自评提供了有力支撑.     

Discrepancies between physician interview and a patient self-assessment questionnaire after surgery for pelvic organ prolapse

The objective of this article was to investigate whether there were discrepancies between the physician interview and a patient's self-assessment questionnaire on the functional results after surgery for pelvic organ prolapse. Before their follow-up appointment, 79 patients were sent a validated urogynaecological questionnaire. At the follow-up visit, the physician interviewed the patients using a checklist with ten symptoms and scored the items as present or absent. Seventy-two patients (91.1%) attended the follow-up visit and had completed the questionnaire. There was poor to slight agreement between the interview score and the self-reported responses to the questionnaire on all items. This was illustrated by low kappa coefficients. The physician was more optimistic about the outcome of the operation than was justified according to the answers to a patient self-assessment questionnaire. We therefore recommend the use of validated questionnaires to evaluate surgical outcome because they provide a more realistic (objective) view of the functional results.     

北京市18~79岁居民体质量管理现状及影响因素分析

背景 体质量管理不应仅局限于特殊人群,应在所有成年人中倡导维持健康体质量。通过了解成年人体质量管理的意愿、现状、措施及影响因素,可为进一步面向大众推广合理、科学且易于执行的健康体质量管理模式提供依据。 目的 了解北京市18~79岁居民健康体质量管理现状及影响其实施体质量管理的因素。 方法 于2017年8—12月,采用多阶段分层抽样法在北京市16区抽取13 188例18~79岁常住居民为研究对象,采用自设问卷对其进行调查,收集居民体质量自我评价、12个月内体质量变化情况及所采取的体质量控制措施等方面的资料。比较不同特征人群实施体质量管理者的占比情况。对于实施体质量管理者,分析其采用的体质量管理方法,并比较不同性别、年龄人群所采取的体质量管理方法的差异。探讨实施体质量管理者与未实施体质量管理者在日常饮食习惯、身体活动情况上的差异,采用多因素逐步Logistic回归分析影响居民实施体质量管理的因素。 结果 13 188例调查对象中,3 947例（29.93%）12个月内实施了体质量管理。不同体质量管理实施情况居民性别、婚姻状况、文化程度、糖尿病患病情况、现在吸烟情况、身体活动情况、主动接受健康体检情况、体质量自我评价正确情况、12个月内体质量变化情况和BMI分组情况比较,差异有统计学意义（P<0.05）。3 947例12个月内实施体质量管理者中：饮食控制〔87.31%（3 446/3 947）〕与体育锻炼〔78.34%（3 092/3 947）〕是广泛应用的体质量管理方法;男性将体育锻炼、吸烟作为体质量控制措施者占比高于女性（P<0.001）,女性将饮食控制和服用减重药物作为体质量控制举措者占比高于男性（P<0.05）;不同年龄组别人群通过体育锻炼、吸烟的方式管理体质量者占比比较,差异有统计学意义（P<0.05）;2 668例（67.60%）居民采用饮食控制与体育锻炼相结合的方式管理体质量,60~79岁组中采取此种组合方式管理体质量者占比高于18~44、45~59岁组（P<0.001）;625例（15.83%）仅依靠饮食控制来管理体质量,18~44岁组中仅依靠饮食控制来管理体质量者占比高于45~59、60~79岁组（P<0.001）。实施体质量管理的居民摄入新鲜蔬菜水果不足者及红肉摄入过多者占比明显低于未实施体质量管理的居民（P<0.05）;控制体质量的居民每周进行≥150 min中等强度及以上身体活动者占比高于未控制体质量的居民（P<0.001）;控制体质量的居民业余静态行为时间≥4 h/d者占比高于未控制体质量的居民（P<0.001）。多因素Logistic回归结果显示,年龄<60岁、女性、在婚/同居、具有较高文化程度（初中及以上）、现在未吸烟、7 d内饮酒、身体活动不足、主动接受体检、能够正确评估自我体质量、12个月内体质量增/减≥2.5kg、BMI级别为非体质量过低者更可能实施体质量管理（P<0.001）。 结论 在体质量管理方法上,北京市18~79岁居民倾向于采取控制饮食、增加运动量的方式,但仍存在运用不利于健康的方法管理体质量等问题。在引导居民养成正确的体质量管理行为时,应考虑到性别、年龄、文化程度等多种因素对其行为形成的影响,有针对性地制定个性化的体质量管理方案。     

女性乳腺癌患者自我感受负担与生活质量的相关性研究

目的 调查女性乳腺癌患者自我感受负担和生活质量状况,并探讨两者之间相关性。 方法 采用便利抽样法选取2014年1月至2016年12月在南京市第一医院肿瘤内科住院的120例女性乳腺癌患者作为研究对象,采用一般资料调查表、自我负担量表及乳腺癌患者生活质量量表进行问卷调查。 结果 乳腺癌患者的自我感受负担总分为(31.36±10.21)分,生活质量总分为(64.68±11.47)分,患者自我感受负担总分及各维度得分与生活质量总分及各模块得分均呈负相关,均差异有统计学意义(均P<0.05)。 结论 女性乳腺癌患者普遍存在着自我感受负担,生活质量水平较低。降低患者自我感受负担有助于提高患者生活质量。     

我国中西部4省(自治区)农村老年人生活满意度状况及其影响因素分析

目的了解我国中西部地区农村老年人生活满意度及其影响因素。方法采用多阶段整群抽样方法对在甘肃、青海、山西和新疆4个省(自治区)16个项目县抽取的84个行政村共1145名农村老年人进行调查。结果在1145名老年人中,对生活感到满意或很满意的有876人(76.5%)。有偶同居的老年人满意度为78.3%,年收入在8000元以上的老年人满意度为86.1%,自评健康状况好的老年人满意度为82.7%,较其他条件者差异有统计学意义(P<0.05)。多因素非条件Logistic回归分析结果显示,经济状况(3000～4999元/年OR=1.899,95%CI:1.136～3.174;5000～8000元/年OR=2.000,95%CI:1.094～3.656)、自评健康状况(自评"中"OR=0.611,95%CI:0.409～0.913;自评"差"OR=0.709,95%CI:0.504～0.996)和焦虑/沮丧状况("没有或偶尔"OR=1.977,95%CI:1.047～3.736)综合影响着老年人的生活满意度。结论我国中西部地区农村老年人的自评生活满意度较高,但仍受到多种因素影响,应积极开展健康教育,强化自我保健意识,并进一步完善养老保障体系,提高老年人生活满意度。     

Workers' perspectives on low back pain recurrence: "it comes and goes and comes and goes, but it's always there"

Although various measures of low back pain (LBP) recurrence have been proposed, none have been tested to determine if they are consistent with what those with LBP perceive a “recurrence” to be. To further the understanding of LBP recurrence and how to measure it, we examined how individuals with a history of LBP describe their back pain experiences. A qualitative approach was chosen and six mixed-gender focus groups were conducted. Discussions were facilitated by two researchers and structured around predetermined questions. All four authors were involved in the data analysis and thematic congruence was achieved through an iterative process of coding and discussion. Participants included 31 individuals (14 female, 17 male), with ages ranging from early 20s to mid 70s. When asked about LBP recurrence, participants had difficulty understanding the concept. There was a sense that, although the pain may disappear, the condition was always there. Three states were defined: “normal,” “flared-up,” and “attack.” “Normal” could include experiencing pain, but generally represented a tolerable state. “Flared-up” was associated with increased pain, the use of strategies to overcome difficulties, and modified participation. “Attack” state was described as severely disabled: “I just have to lay there.” Participants described their experiences in a way that is consistent with the idea that LBP is a fluctuating and disabling health condition. Results cast doubt on the validity of currently available measures of LBP recurrence.     

Multi-rater feedback with gap analysis: An innovative means to assess communication skill and self-insight

Objective

Multi-rater assessment with gap analysis is a powerful method for assessing communication skills and self-insight, and enhancing self-reflection. We demonstrate the use of this methodology.

Methods

The Program for the Approach to Complex Encounters (PACE) is an interdisciplinary simulation-based communication skills program. Encounters are assessed using an expanded Kalamazoo Consensus Statement Essential Elements Checklist adapted for multi-rater feedback and gap analysis. Data from a representative conversation were analyzed.

Results

Likert and forced-choice data with gap analysis are used to assess performance. Participants were strong in Demonstrating Empathy and Providing Closure, and needed to improve Relationship Building, Gathering Information, and understanding the Patient's/Family's Perspective. Participants under-appraised their abilities in Relationship Building, Providing Closure, and Demonstrating Empathy, as well as their overall performance. The conversion of these results into verbal feedback is discussed.

Conclusions

We describe an evaluation methodology using multi-rater assessment with gap analysis to assess communication skills and self-insight. This methodology enables faculty to identify undervalued skills and perceptual blind spots, provide comprehensive, data driven, feedback, and encourage reflection.

Practice implications

Implementation of graphical feedback forms coupled with one-on-one discussion using the above methodology has the potential to enhance trainee self-awareness and reflection, improving the impact of educational programs.