广州居民新型冠状病毒肺炎知信行状况调查

目的了解广州市应急健康传播教育后,居民对新型冠状病毒肺炎(NCP)的知信行情况,为下一步开展新冠肺炎疫情宣传防控工作提供依据。方法 2020年2月,采用滚雪球抽样方法对195 282名居民新冠肺炎知信行情况进行问卷调查,使用SPSS 23.0对数据进行描述性分析。结果居民对新冠肺炎病相关知识的知晓率和个人防护行为执行率相对较高,分别为(70.73%～98.92%)和(88.87%～98.30%),差异均有统计学意义(χ²=143 783.668,P <0.001;χ²=22 679.015,P <0.050)。绝大部分居民愿意配合政府实施相关防控措施(98.90%～99.78%),差异有统计学意义(χ²=3 364.959,P <0.001)。结论居民对新冠肺炎相关基本知识知晓率和个人防护行为执行率相对较高,应对居民的知信行进行动态监测,为后续防控措施制定和实施提供参考。     

A national survey on the impact of the COVID-19 pandemic upon burnout and career satisfaction among neurosurgery residents

The coronavirus disease 2019 (COVID-19) pandemic has posed significant changes to resident education and workflow. However, the impact of the pandemic on U.S. neurosurgery residents has not been well characterized. We investigated the impact of the COVID-19 pandemic on U.S. neurosurgery resident workflow, burnout, and career satisfaction. In 2020, a survey evaluating factors related to career satisfaction and burnout was emailed to 1,374 American Association of Neurological Surgeons (AANS) residents. Bivariate and multivariate (logistic) analyses were performed to characterize predictors of burnout and career satisfaction. 167 survey responses were received, with a response rate (12.2%) comparable to that of similar studies. Exclusion of incomplete responses yielded 111 complete responses. Most respondents were male (65.8%) and White (75.7%). Residents reported fewer work hours (67.6%) and concern that COVID-19 would impair their achievement of surgical milestones (65.8%). Burnout was identified in 29 (26.1%) respondents and career satisfaction in 82 (73.9%) respondents. In multivariate analysis, burnout was significantly associated with alterations in elective rotation/vacation schedules (p = .013) and the decision to not pursue neurosurgery again if given the choice (p < .001). Higher post-graduate year was associated with less burnout (p = .011). Residents displayed greater career satisfaction when focusing their clinical work upon neurosurgical care (p = .065). Factors related to COVID-19 have contributed to workflow changes among U.S. neurosurgery residents. We report a moderate burnout rate and a paradoxically high career satisfaction rate among neurosurgery residents. Understanding modifiable stressors during the COVID-19 pandemic may help to formulate interventions to mitigate burnout and improve career satisfaction among residents.     

Évaluation d’un support d’aide à l’analyse de l’électrocardiogramme par les internes des urgences

AimElectrocardiogram (ECG) is a routine examination in emergency medicine (EM), however the level of resident's interpretations is inhomogeneous and sometimes insufficient. We have developed a support to assist in the interpretation of ECG in emergency situations. Our main objective was to assess whether this new tool improved the rate of good interpretations by residents of EM departments (EMD). The secondary objectives were to assess whether it improved the rate of good triages, the level of certainty of residents, and to study its impact according to the seniority of the resident.Patients and methodMulti-center, before-and-after study, carried out with existing residents in the different EMD dependent of a single university hospital center. The evaluation was conducted in two stages: an initial analysis of 17 ECGs without tool and a new analysis using the tool.ResultsOut of a target population of 68 residents, 41 (60 %) were included. The tool significantly improved the correct reading rate from 46 % without the tool to 68 % (P < 0.001). The rate of correct triage (56 % vs. 64 %) and diagnostic certainty (54 vs. 66 on a scale of 0 to 100) were also significantly improved (P < 0.001). The more experienced residents were generally more efficient in pre-testing, but the tool improved results regardless of seniority.ConclusionThe development of a simple support to assist in the interpretation of ECGs improves the rate of good interpretations among residents in EMD.     

Shared decision making seen through the lens of professional identity formation

The finding in the article by Driever et al.; "Shared decision,making: Physicians' preferred role, usual role and their perception of its key components" of lower preferred and practiced SDM role in residents in favour of a paternalistic role, compared to their more seasoned colleagues deserves more in depth, qualitative research.Because our residents are tomorrows doctors, I would strongly encourage the authors of this insightful article to consider research focused on residents as the next step in their research on SDM and to see this future research through a 'medical-education-PIF-lens'. The multi-level professionalism framework, designed as a framework for reflection and development in medical education might be of help is this future research.     

某新运行核电站所在地居民核辐射风险认知调查分析

目的 了解某新运行的核电站不同距离范围内居民对核辐射风险认知水平，探讨影响对核电认知的因素。方法 采用分层整群随机抽样方法，以该核电站所在地区50 km范围内外共2017名居民为调查对象，采用《核电站所在地区核辐射风险认知调查表》进行面对面调查问卷。结果 共回收有效问卷1952份，在辐射知识认知情况方面，认为在医院做影像检查时受到电离辐射照射、认为不同放射性物质的半衰期不同，50 km范围内均高于50 km范围外的正确回答率，差异均有统计学意义（P < 0.05）。在核电站认知情况方面，认为日本福岛核电站事故对我国居民健康有影响、担心核电站发生严重事故和损害身体健康的比率，50 km范围内均高于50 km范围外，差异均有统计学意义（P < 0.05）。在核辐射应急认知情况方面，认为发生核事故时应当服用稳定性碘的正确回答率、对中央政府和当地政府处理各种突发事件能力认可率的比较，50 km范围内的调查结果均高于50 km范围外，差异均有统计学意义（P < 0.05）。在核辐射影响认知情况方面，认为核电站对所在地区环境影响较大、希望了解核电站的相关信息，50 km范围内均高于50 km范围外的正确回答率，差异均有统计学意义（P < 0.05）。结论 应当通过多种途径加强核电站周围居民的核辐射知识的宣传教育，提升核辐射知识的正确认知水平。     

Bariatric surgery outcomes when assisted by fellows and residents: an MBSAQIP analysis of 477,670 patients

BackgroundPrevious reports of bariatric surgery outcomes when cases are assisted by residents and/or fellows have been inconclusive.ObjectiveTo compare bariatric surgery outcomes for cases with surgical trainees (ST; residents and fellows) versus nonsurgical trainees (nST; all other assistants) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Registry.SettingAcademic teaching.MethodsThe MBSAQIP Registry was reviewed (2015–2017) for Roux-en-Y gastric bypass, sleeve gastrectomy, and revision surgery based on ST and nST status. Univariate, multivariate logistic regression, and propensity matching analyses were performed.ResultsOf 477,670 cases, 26.8% were performed with ST. For ST patients 79.9% were female (versus 80.3% nST) and mean body mass index was 45.2 ± 8 kg/m² (versus 45.0 ± 8.1 kg/m² nST). Overall, 31.7% of patients underwent Roux-en-Y gastric bypass (versus 25.7% nST), 65.9% underwent sleeve gastrectomy (versus 71.6% nST), and 2.4% of patients had revision surgery (versus 2.7% nST). After matching, no difference in 30-day mortality was observed between groups. However, ST patients had higher incidence of deep vein thrombosis (P = .004), pulmonary embolism (P = .005), superficial surgical site infection (P < .0001), postoperative sepsis (P = .005), blood transfusions (P = .0307), nonoperative interventions (P = .004), 30-day readmission rates (P < .0001), and longer operative times (P < .0001), but lower 30-day reoperation rates (P = .0001).ConclusionOverall, there was no difference observed in 30-day mortality between the ST and nST groups. However, despite lower 30-day reoperation rates, ST patients exhibited higher rates of postoperative deep vein thrombosis, pulmonary embolism, superficial surgical site infection, postoperative sepsis, blood transfusions, 30-day readmission rates, and longer operative times than nST patients.     

住院医师规范化培训带教师资评价指标探讨

目的探索住院医师规范化培训(简称"住培")学员对带教师资评价的调查问卷指标设置、调查实施和效果分析,以提升带教质量。方法通过论证制定评价指标的量表,设置"为人师表和帮助融入科室团队、帮助学员制定学习计划和需要、带教的实施和质量、适时恰当给予学员反馈"等5个维度,安排每6个月、3个月和1个月以电子问卷的形式对住培学员进行调查,采集学员对带教师资的评价意见,对设定指标进行统计分析。结果每个月开展一次问卷调查得到的回收率最优;问卷总平均分为(90.89±0.62)分,信度系数为0.90,反映了住培学员对带教师资的整体满意度良好,评价指标内部一致性和稳定性较好。结论本研究的调查具有良好的信度,对于管理部门了解师资带教情况,改进培训教学质量具有参考意义。     

广州市黄埔区居民合理用药素养现状及影响因素研究

目的 了解广州市黄埔区居民合理用药素养水平及其影响因素,为今后制定有效的干预措施和政策提供科学依据。方法 采用多阶段分层抽样方法,抽取广州市黄埔区18~69岁常住居民进行问卷调查,收集调查对象的基本情况、合理用药素养及用药教育需求信息,采用c²检验和Logistic回归方法进行统计分析。结果 有效调查2 534位居民,男性1 082人（占42.7%）,女性1 452人（占57.3%）;户籍以广州市为主（占80.8%）;年龄以25~34岁居多（占30.6%）;个人平均月收入主要为2 000~4 999元（占46.6%）;文化程度以本科为主（占36.8%）;职业以其他企事业单位人员居多（占31.0%）;医疗保险多为城镇职工医保（占69.8%）。具备合理用药素养者738人,合理用药素养具备率为29.1%。Logistic回归分析结果显示：年龄25~34岁（OR=1.645）、35~44岁（OR=1.620）、文化程度为大专（OR=2.797）、本科（OR=3.675）、硕士及以上（OR=5.448）、职业为医务人员（OR=7.521）者,其具备合理用药素养的可能性较高。97.5%（2 470/2 534）的居民认同用药教育的重要性,82.8%（2 097/2 534）的居民愿意接受用药教育,28.7%（728/2 534）的居民曾接受过用药教育。结论 黄埔区居民合理用药素养水平较低,主要影响因素为年龄、文化程度和职业,居民用药教育需求大;建议围绕居民常见用药认知误区,以低文化程度者为重点人群,采取有针对性的综合干预措施,以提高合理用药素养水平。