Shared learning in practice placements for health and social work students in East London: a feasibility study

A voluntary organisation providing family support and mental health services carried out an enquiry into the feasibility of setting up placements in primary care for students from professional qualifying courses in community nursing, social work and occupational therapy to experience shared practice learning in their placement. Consultation with a range of courses from two universities in London and with GP practices and other primary care agencies in East London established that there was wide support for the idea from practitioners, managers and academic teachers. It was recommended that a small number of pilot placements be set up. It was acknowledged that the diversity of placement requirements across the spectrum of professional education is a limiting factor in bringing students together for practice learning. The authors suggest that in the longer term, the development of an interprofessional approach to practice learning will require structural changes to professional courses so as to bring their placement requirements more into line with each other.     

Design principles for the use of simulation as an aid in interventional cardiology training

Learning complex skills through simulation is a goal for training physicians in specialties such as interventional cardiology, where traditional training puts patients at risk. Intuitively, interactive simulation of anatomy, pathology and therapeutic actions should lead to shortening of the learning curve for novice or inexperienced physicians. An accurate recreation of the interactions among anatomy, pathology and therapeutic actions is a necessary, but not sufficient, condition for the development of a simulation-based training system. In addition to real-time graphic interactivity coupled with haptic response, a successful training tool will require features of a 'learning system' such as: an embedded curriculum, functionality that allows rehearsal and practice, hypertext links to educational information, personal archiving, and instructor review and testing capabilities. We describe how such a system might look for the field of interventional cardiology, and suggest that designing a simulation with both technical and pedagogical fidelity is essential in developing simulation-based training systems in any field of medicine.     

Newsletter number three - 2002

Patients who experience body symptoms in response to psychosocial stress are a challenge for the general practitioner (GP). This paper is a contribution to the improved treatment of these patients. It presents a specific psychosocial treatment model provided by the GP including the following steps: (a) taking a thorough symptom history, conducting a psychosocial anamnesis and exploring the patient's own perception of the illness, (b) developing alternative perceptions of the illness by understanding the psycho-physiological relationship; and (c) reducing the impact of psychosocial stress. The application of these specific techniques requires a trustful, helping alliance between the doctor and the patient and cooperation with mental health services.     

Molecular detection and quantification of pertussis and correlation with clinical outcomes in children

Pertussis is an under-recognized serious infection. Conventional cultures are insensitive and of limited utility after antibiotic exposure. We corroborated the utility of real-time polymerase chain reaction (PCR) as a diagnostic tool in pertussis and investigated its role as a prognostic tool by evaluating its benefit in the quantification of pertussis bacterial load. All pertussis-positive PCR tests (n = 104) submitted over 5 years were collected for retrospective study. PCR cycle threshold was compared to quantitative culture in 43. Compared to PCR, the sensitivity of culture was 41%. Our PCR assay reliably quantified bacterial load and was quantitatively reproducible. Higher bacterial load correlated with longer duration of hospitalization (P = 0.0003), and multivariate logistic regression models demonstrated this association to be independent. The study confirmed PCR as a superior diagnostic tool in pertussis. PCR quantification of bacterial load at initial diagnosis predicts later clinical disease severity, suggesting a potential benefit of PCR as a prognostic tool in pertussis.     

Testing fidelity to a new psychological intervention for family members of substance misusers during implementation in Italy

Providing treatment and help to family members of people with alcohol and drug problems is a new approach. In the UK, a new intervention—the ‘5‐Step Method’— has been developed, which has shown positive results in reducing family members' symptoms and improving their coping. This method has been utilized in Italy, also with positive results. This paper analyses 52 treatment reports compiled by the treating professionals, to examine how well the method has been introduced into the Italian sociocultural context. Information about the intervention from these treatment reports was grouped into categories by independent judges. These categories were analysed using univariate statistics, followed by multivariate dynamic analysis using STATIS, a multidimensional statistical methodology capable of analysing the temporal phenomenon (over the five sessions) in question. This methodology examined the resulting 3‐way matrix: cases, variables, and time. The analysis shows that the training was effective: the trained personnel did deliver the five steps and did do in each step what was suggested in the manual. It also suggests that some overall strategies, such as giving family members a plan and proposing up to five sessions with the family member are very helpful interventions. Suggestions for improving both the intervention, and for incorporating instruction in this method as part of initial professional training, are made.     

综合三甲医院护士长心血管急救技能培训及效果探讨

目的：通过分析某综合三甲医院护士长心血管急救技能培训考核成绩,探讨影响护士长培训效果的因素,提出改进、完善培训制度的措施。方法分类统计50名受训护士长的考核成绩,采用SPSS 13．0统计软件进行分析,结合问卷调查结果,分析影响考核成绩的相关因素,从而研究应对措施。结果大专以下学历护士长与大专（含大专）以上学历护士长相比差异无统计学意义（P＞0．05）;但任职时间大于5年（含5年）的与小于5年的相比、急救科室与非急救科室相比差异均有统计学意义（P＜0．05）。问卷调查显示,培训总体满意度超过90％,其中对授课方式和导师授课情况的满意度最高。结论心血管急救培训可以从参训人员分组、培训方法和培训条件等方面改进和完善。     

电极放置位置对表面肌电信号特征的影响

目的:探讨不同电极放置位置对表面肌电(sEMG)信号特征的影响。方法:健康男性大学生14名,分别采用50%、70%和90%最大随意收缩力量(MVC)强度静态屈肘运动诱发肱二头肌疲劳,同步采集肱二头肌上三个不同电极位置上的sEMG信号,采用线性和非线性信号分析方法,计算线性指标平均肌电值(AEMG)和平均功率频率(MPF)以及非线性指标C(n)和DET%。结果:电极位置只对sEMG的四个测试指标的均值产生影响,对其变化斜率无明显影响,而四个指标的变化斜率中,除AEMG变化斜率对负荷强度无明显区分度外,其余三个指标对负荷强度均有良好区分度。结论:采用MPF、C(n)和DET%变化斜率作为评价局部肌肉疲劳的客观指标,既可以忽略电极放置位置对sEMG的影响,又对不同负荷强度有良好区分度。     

阶梯式培训考核在提高年轻护士人文素养中的应用

目的：探讨阶梯式培训考核在提高年轻护士伦理人文素养中的效果。方法2013年起在新护士入院后三年内,通过先简单后复杂、先规范化常规后专科特色的模拟、案例操作的阶梯式培训考核方法,比较以前护理人员的人文素养考核、考核优秀率和患者满意度。结果新的培训考核方法让年轻护士在临床操作考核中显著提高了护理人员以病人为中心的服务意识,考核优秀率31．25％,高于前一年考核的优秀率19．82％,具有显著差异性（P＜0．05）;在患者对护理人员满意度调查比较中,具有显著优势（P＜0．05）。结论新的培训考核方法,显著提高了年轻护士的自身素质和医德修养,在临床实际操作中能更好的注重人文关怀,做好护患沟通,提高了护士在临床工作中的判断能力、急救能力、交流能力、灵活应变能力和突发事件的应急处理能力。对年轻护士在实际工作中处理好医患关系、医际关系、提高临床实践工作能力和病人的综合满意度具有重要价值。     

不同证型功能性消化不良患者胃容受性及胃排空功能差异的临床研究

目的 通过液体营养餐负荷实验结合B超检查,探讨分析不同证型功能性消化不良（FD）患者胃容受性舒张及排空功能的差异。方法 入选74例研究对象,健康者14例（HS组）,FD患者60例（脾虚气滞型33例,脾虚湿阻型16例,脾阳虚型11例）。所有研究对象均进行液体营养餐负荷实验,结合VAS视觉评分,记录阈值和最大饮入量;并且通过超声测量,比较不同证型的胃排空率及半排空时间。结果 FD组3种证型最大饮入量均低于HS组(P<0.05~0.01),脾虚湿阻型最大饮入量低于脾虚气滞、脾阳虚型(P<0.05);FD组3种证型与HS组比较,脾阳虚型餐后90min远端胃排空率低于HS组(P<0.05);脾虚湿阻型远端胃半排空时间较HS组、脾虚气滞型和脾阳虚型均延长(P<0.05)。结论 不同证型FD患者胃肠运动功能有差异,辨证为脾虚湿阻型患者减退更显著,为中医辨证施治提供理论依据。      

指南及专家共识在住院医规培中的重要性

本文讲述了探索与完善心血管专业住院医师规范化培训具体培训实施内容及标准的重要性,临床指南与专家共识无论对心血管内科专业医师还是规范化培训的住院医师都具有十分重要的作用,因此在住院医师规范化培训中应该引入国内外临床指南与专家共识的详细讲述。中国医科大学附属盛京医院心内科在住院医师规范化培训中,总结出讲解心血管专业临床指南与专家共识的具体培训内容与方法,取得良好效果。