医学教育环境评估量表在我国口腔医学生中应用的信度与效度分析

目的：评价医学教育环境评估量表（DREEM）在我国口腔医学生中应用的信度和效度。方法：采用DREEM量表中文版在重庆医科大学口腔医学本科生中进行问卷调查,最终对调查结果进行统计学分析,考评量表的信度和效度。其中信度采用内部一致性信度和分半信度进行分析;效度采用探索性因素分析和收敛效度进行分析。采用SPSS 22.0软件包对数据进行信度和效度检验。结果：共回收有效问卷260份。量表总的Cronbach α系数为0.936,Guttman 分半信度系数为0.816。经过探索性因子分析,提取5个因子,累积贡献率达47.071%,显示量表存在预想的连带关系和逻辑关系。量表的Spearman等级相关系数为0.447~0.556之间。结论：医学教育环境评估量表在我国口腔医学生中应用具有良好的信度和效度,可在我国口腔医学教育环境的评价中进一步推广应用。     

改良迷你临床演练方法在口腔正畸科考核中的初步应用

目的探讨将Tweed分析法与迷你临床演练（Mini-CEX）相结合,建立适用于口腔正畸专科的临床考核方案的效果。 方法通过将Mini-CEX方法与正畸学Tweed分析表进行结合,并补充细化评分表,从而建立了一种新型口腔正畸学教学考核方法,称为改良Mini-CEX考核。于2019年9月,从上海交通大学医学院附属第九人民医院口腔正畸科随机选取6名在培口腔专科培训医师作为考生,对考生进行改良Mini-CEX考核,由5名正畸专家对其表现进行打分。应用SPSS 21.0软件对打分结果进行统计,计算肯德尔和谐系数（W）并进行显著性检验。 结果不同考官在评价同一考生时,考官间的打分具有显著的一致性（W₁ = 0.742,P₁ = 0.001;W₂ = 0.666,P₂ = 0.003;W₃ = 0.720,P₃ = 0.001;W₄ = 0.628,P₄ = 0.004;W₅ = 0.555,P₅ = 0.011;W₆ = 0.330,P₆ = 0.1293）。在医疗面谈、体格检查、临床判断、卫生教育、组织效能和整体表现6项,打分具有显著的一致性（W₁ = 0.620,P₁ = 0.008;W₂ = 0.588,P₂ = 0.012;W₃ = 0.885,P₃<0.001;W₄ = 0.625,P₄ = 0.008;W₅ = 0.835,P₅ = 0.001;W₆ = 0.930,P₆<0.001）,仅人文关怀一项未通过一致性检验（W = 0.147,P = 0.598）。 结论改良Mini-CEX具有标准程序,建立明确的得分细节,可以考核全面、获得公正客观,在不同考官间具有良好一致性,适用于当前口腔正畸学的考核与评价。     

Psychological distress,job satisfaction,and work engagement among Palestinian teachers: a cross-sectional study

Background

Work engagement is a positive, fulfilling affective and motivational state of work-related wellbeing and a protective factor for workers' mental health. The aim of the present study was to examine the association between psychological distress (conceptualised as the target variable), job satisfaction, and work engagement in contexts of low-intensity warfare and political violence. According to the salutogenic perspective, the relationship between job satisfaction and psychological distress is influenced by the level of work engagement.

炎症性肠病患者治疗依从性影响因素调查与分析

目的:调查炎症性肠病(IBD)患者的治疗依从性现状,分析其影响因素。方法:采用问卷调查法对82例IBD患者发放自行设计的治疗依从性问卷,对其一般资料及影响因素进行调查。结果:IBD患者服药依从性和生活方式依从性相对较高,而定期复查和适当锻炼的依从性较差。患者是否参加自我管理项目的教育和患者的文化程度是其治疗依从性的主要影响因素(P0.05)。结论:应加强对IBD患者的健康教育,尤其应加强对文化程度较低患者治疗依从性相关知识的宣教。     

Telemedicine and type 1 diabetes: Is technology per se sufficient to improve glycaemic control?

AimIn the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA_1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA_1c?MethodsEach patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as “high users” if the proportion of “informed” meals using the IDA exceeded 67% (median) and as “low users” if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA_1c levels.ResultsAmong the high users, the proportion of informed meals remained stable from baseline to the end of the study 6 months later (from 78.1 ± 21.5% to 73.8 ± 25.1%; P = 0.107), but decreased in the low users (from 36.6 ± 29.4% to 26.7 ± 28.4%; P = 0.005). As expected, HbA_1c improved in high users from 8.7% [range: 8.3–9.2%] to 8.2% [range: 7.8–8.7%] in patients with (n = 26) vs without (n = 30) the benefit of telemonitoring/teleconsultation (−0.49 ± 0.60% vs −0.52 ± 0.73%, respectively; P = 0.879). However, although HbA_1c also improved in low users from 9.0% [8.5–10.1] to 8.5% [7.9–9.6], those receiving support via teleconsultation tended to show greater improvement than the others (−0.93 ± 0.97 vs −0.46 ± 1.05, respectively; P = 0.084).ConclusionThe Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.     

Majority Vote and Other Problems when using Computational Tools

Computational tools are essential for most of our research. To use these tools, one needs to know how they work. Problems in application of computational methods to variation analysis can appear at several stages and affect, for example, the interpretation of results. Such cases are discussed along with suggestions how to avoid them. The applications include incomplete reporting of methods, especially about the use of prediction tools; method selection on unscientific grounds and without consulting independent method performance assessments; extending application area of methods outside their intended purpose; use of the same data several times for obtaining majority vote; and filtering of datasets so that variants of interest are excluded. All these issues can be avoided by discontinuing the use software tools as black boxes.     

Quantification of Myocardial Blood Flow in Absolute Terms Using 82Rb PET Imaging: The RUBY-10 Study

ObjectivesThe purpose of this study was to compare myocardial blood flow (MBF) and myocardial flow reserve (MFR) estimates from rubidium-82 positron emission tomography (⁸²Rb PET) data using 10 software packages (SPs) based on 8 tracer kinetic models.BackgroundIt is unknown how MBF and MFR values from existing SPs agree for ⁸²Rb PET.MethodsRest and stress ⁸²Rb PET scans of 48 patients with suspected or known coronary artery disease were analyzed in 10 centers. Each center used 1 of 10 SPs to analyze global and regional MBF using the different kinetic models implemented. Values were considered to agree if they simultaneously had an intraclass correlation coefficient >0.75 and a difference <20% of the median across all programs.ResultsThe most common model evaluated was the Ottawa Heart Institute 1-tissue compartment model (OHI-1-TCM). MBF values from 7 of 8 SPs implementing this model agreed best. Values from 2 other models (alternative 1-TCM and Axially distributed) also agreed well, with occasional differences. The MBF results from other models (e.g., 2-TCM and retention) were less in agreement with values from OHI-1-TCM.ConclusionsSPs using the most common kinetic model—OHI-1-TCM—provided consistent results in measuring global and regional MBF values, suggesting that they may be used interchangeably to process data acquired with a common imaging protocol.