The Use of Standardized Patient Encounters for Evaluation of a Clinical Education Program on the Development of HIV/AIDS-Related Clinical Skills

Abstract

The success of medical education is traditionally gauged by performance on written examinations. However, clinical proficiency in real-world situations is difficult to assess by written examinations alone. We developed a novel evaluation tool to measure the development of HIV-specific clinical skills using Standardized Patient Encounters (SPEs). Trainees were evaluated at baseline and after an HIV clinical training module by (1) self-reported confidence with HIV-specific clinical skills and (2) performance assessments using SPEs. Case scenarios were designed to incorporate unique issues associated with HIV that may present to a primary care provider. SPEs were scored based on written documentation including problem list and plan as well as a review of the videotapes by HIV specialists evaluating key elements of clinical skills and decision making. Improvements were noted in multiple facets of the encounters. The use of SPEs enables evaluation of clinical training interventions on the development of HIV-related clinical skill sets.     

代谢综合征患者血清Apelin水平增高

探讨代谢综合征(MS)患者血清Apelin的变化.用ELISA法测定血清Apelin.MS组Apelin明显升高(P＜0.01),2型糖尿病MS组Apelin明显高于糖调节受损MS组和超重或肥胖者[(475.8±37.3对451.5±54.3及430.3±52.1)ng/L,P＜0.01].多元逐步回归分析显示,胰岛素抵抗、体重指数和总胆固醇是Apelin独立相关因素.MS多种代谢组分异常与Apelin升高密切相关,可能是胰岛素抵抗加重所致.     

糖尿病夏科足临床特点分析

目的总结糖尿病夏科足的临床特点,提高临床医师对于本病的认识。方法回顾性分析11例2型糖尿病夏科足患者的临床特点。结果 11例患者中,男7例,女4例;平均年龄(60±11)岁;平均糖尿病病程16年;全部合并神经病变而无下肢血管病变;单侧足病变10例,双足病变1例;3例发病前有明确的外伤史。影像学表现为足部骨质破坏7例,关节间隙变窄6例,软组织肿胀3例,关节半脱位2例,关节融合2例,碎骨1例。11例患者一入院均遵医嘱限制活动。对足溃疡给予积极清创,换药。根据细菌培养及药敏试验结果选用抗生素治疗。10例合并足溃疡病例中,1例截趾后愈合,3例愈合,5例好转,1例自动出院后失访。3例出院后有足溃疡的复发。结论早期识别并给予制动等措施有助于足溃疡愈合和减缓夏科足畸形的发展。     

Role of theories in school-based diabetes care interventions: A critical review

BACKGROUNDDiabetes is one of the most common chronic diseases of childhood. School plays an essential role in the management of student diabetes, which reduces the risk of short- and long-term diabetes complications and ensures that students are well-positioned for optimal academic performance and growth.AIMThe aim of this review was to systematically identify and synthesize the literature concerning theory-based diabetes care interventions in K-12 schools in the United States. It critically assessed the specific role of theories and associated essential constructs in intervention design, implementation, outcome measurement, and evaluation.METHODSRelevant literature was identified by keyword searches of the Cochrane Library, PubMed, and Web of Science.RESULTSFour interventions met the eligibility criteria and were included in the review. Of those, two evaluated online diabetes education programs for school personnel and the other two assessed in-person interventions. Three studies adopted a one-group pre-post study design, and the remaining one adopted a one-shot case-study design. Three of the interventions adopted social cognitive theory, and the remaining one was guided by the diffusion of innovations theory. Three studies identified core constructs of a theory as predictors of behavioral change. Two used theory to select or develop intervention techniques. Two studies used theory to customize participant intervention techniques. Two studies discussed their findings in the context of theory. No study used theory to select potential intervention participants.CONCLUSIONIn conclusion, despite the value of theory in intervention design and evaluation, theory-based diabetes interventions at school remain scarce. Future research may seek ways to better integrate theory and empirical research.     

Clearing hepatitis C virus with direct antiviral agents reduces cardiovascular events in patients with prediabetes. Commentary to Sasso and colleagues

Liver health is a key determinant of cardiovascular risk (CVR). Hepatic fibrosis is the shared common result of chronic hepatitis, irrespective of aetiology. Fibrosis profoundly distorts liver tissue architecture and perturbs hepatic physiology, dictates the course of chronic liver disease and is increasingly recognized as a CVR factor. The relative weights of pre-diabetes and hepatic fibrosis as risk factors for major adverse cardiac events (MACE) in patients with HCV remain an open issue. Sasso and Colleagues answered this research question by treating approximately half of 770 HCV positive pre-diabetic patients with direct antiviral agents (DAAs), while the rest served as historical controls. Data have shown that achieving HCV clearance with DAAs was associated with a 60% reduced risk of MACE, thereby implying that this antiviral strategy is recommended in HCV positive pre-diabetic patients, regardless of the severity of liver disease and concurrent CVR factors. This study paves the way for additional studies addressing the molecular patho-mechanisms and changes in the clinical spectrum involved in cardio-metabolic protection following HCV eradication in patients with pre-diabetes.     

烧伤创疡再生医疗技术治疗糖尿病患者足部深Ⅱ～Ⅲ度烫伤疗效分析

目的总结分析烧伤创疡再生医疗技术治疗糖尿病患者足部深Ⅱ～Ⅲ度烫伤的临床疗效。方法对2014年1月至2018年6月丰台区南苑医院烧伤创疡科收治的52例足部深Ⅱ～Ⅲ度烫伤合并糖尿病患者在全身综合治疗的基础上局部创面采用烧伤创疡再生医疗技术治疗,观察治疗效果。结果 52例患者中除9例患者创面未愈即出院外,其余43例患者均于创面完全愈合后出院,其中14例患者创面愈合时间为14～30 d,20例患者创面愈合时间为31～90 d,9例患者创面愈合时间为91～190 d。结论烧伤创疡再生医疗技术治疗糖尿病患者足部深Ⅱ～Ⅲ度烫伤,可有效促进创面愈合,减轻瘢痕增生,疗效显著,临床应用价值较高。     

Diabetes-related avoidable hospitalizations in Taiwan

BackgroundAn avoidable hospitalization (AH) is a condition that could have been prevented through effective treatment in outpatient care. Diabetes is often referred to as an ambulatory care-sensitive condition, and its associated hospitalizations are often referred to as avoidable hospitalizations. There are limited data on avoidable hospitalizations for individuals with diabetes in Taiwan.MethodWe used the National Health Interview Survey (NHIS) dataset to obtain diabetes-related avoidable hospitalizations for subjects aged above 12 years. We included data from 20,826 subjects who had completed the interview between 2004 and 2005. Data were collected from a total of 15,574 people, who had agreed to link their health information to the Taiwan National Health Insurance Research Database, including basic demographic variables, inpatient or outpatient medical events, admission date, discharge date, and diagnosis. The 1005 individuals who self-reported having diabetes or had at least 1 hospitalization or 2 physician service claims for diabetes mellitus with an ICD-9 diagnosis of 250 were included in the analysis. We divided those with diagnosis of diabetes into two groups: never hospitalized and hospitalized. The never hospitalized group served as the control group. We further identified hospitalized subjects with long-term complications due to diabetes (PQI-3) that included ICD-CM codes 250.4–250.9.ResultsThe mean ages of patients with diabetes-related long-term complications in the hospitalized and never hospitalized groups were 65 years and 58 years, respectively (p-value < 0.01). More than half (52%) of the patients with diabetes-related long-term complications had a body mass index (BMI) lower than 24. The hospitalized group also had lower educational status compared with that of patients in the never hospitalized group (equal to or lower than elementary school, 63% vs. 50%; junior high school, 23% vs. 14%; equal or higher than senior high school, 14% vs. 36%). Furthermore, hospitalized patients tended to have lower household monthly income, were unmarried, and did not have private medical insurance. There were no significance differences in ethnic composition between the groups. Interestingly, patients with frequent retinal examination, and those with lower body mass index had higher frequency of avoidable hospitalization (p < 0.01).ConclusionWe found that the following factors were associated with a higher frequency of avoidable hospitalization among patients with type 2 diabetes: elderly, male, lower body mass index, lower household income, non-exercise, higher disease comorbidity, and frequent retinal examination.     

Exposure to polychlorinated biphenyl-153 decreases incidence of autoimmune Type 1 diabetes in non-obese diabetic mice

Type 1 diabetes (T1D) incidence has been steadily rising across the globe. Exposure to persistent organic pollutants (POP) has been implied as one potential cause of increased T1D occurrence. Since data regarding the role of POP polychlorinated biphenyl-153 (PCB-153) in autoimmune T1D development in experimental animal models are lacking, this study sought to evaluate the effect of PCB-153 exposure on T1D development in a non-obese diabetic (NOD) mouse model. As T1D is an autoimmune, T-cell-dependent disease, PCB-153 effects on T-cells were studied as well. Pre-diabetic 8–9-week-old NOD mice were exposed to intraperitoneal injections of PCB-153 in a 10-day short- (subacute exposure; 0.5 or 50?mg/kg) or 16-week long-term (subchronic exposure; 0.125 or 12.5?mg/kg) fashion. A significant decrease in incidence of T1D was observed in both low- and high-dose subchronically exposed mice. Analysis of various immune parameters, including T-cell types and subtypes, T-cell proliferative responses – as well as their cytokine secretions, revealed that both short- and long-term exposure to PCB-153 caused significant immunosuppression. PCB-153-induced immunosuppression was reflected in reductions in levels of T helper (T_H)-type cells and their functions after subacute treatment with low- and high-dose PCB-153. In agreement, decreased levels of T_H cells, reduced proliferation and IL-2 secretion seemed to be a mechanism of PCB-153 action in the development of T1D in subchronically exposed mice. In conclusion, this study for the first time revealed the effects of PCB-153 on development of T1D, bridging the existing experimental knowledge gap regarding the association of non-dioxin-like PCBs and T1D.