Evaluation of an interactive virtual surgical rotation during the COVID‐19 pandemic

ObjectiveTo evaluate medical student and attending surgeon experiences with a novel interactive virtual Otolaryngology ‐ Head and Neck Surgery (OHNS) medical student elective during the COVID‐19 pandemic.Study DesignA virtual OHNS elective was created, with three components: (1) interactive virtual operating room (OR) experience using live‐stream video‐conferencing, (2) telehealth clinic, (3) virtual didactics.SettingOHNS Department at the University of Pennsylvania (May 2020 to June 2020).MethodsSix medical students from the University of Pennsylvania; five attending otolaryngologists. Two surveys were designed and distributed to participating medical students and attending surgeons. Surveys included 5‐point Likert scale items, with 1 indicating “not at all” and 5 indicating “very much so”.ResultsResponse rate was 100% for both surveys. Students on average rated the educational value of the telehealth experience as 4.2 ± 1.2, and the virtual OR experience as 4.0 ± 0.6. Most students (n = 5, 83%) indicated that they had enough exposure to faculty they met on this rotation to ask for a letter of recommendation (LOR) for residency if needed, while attending surgeons had an average response of 3.0 ± 1.0 when asked how comfortable they would feel writing a LOR for a student they met through the rotation. A majority of students (n = 4, 67%) felt they connected enough with faculty during the rotation to ask for mentorship. Half the students (n = 5, 50%) indicated that the rotation allowed them to evaluate the department''s culture either “extremely well” or “somewhat well”.ConclusionsOverall, participating students described this innovative virtual surgical rotation as an educationally and professionally valuable experience. With the continued suspension of visiting student rotations due to the COVID‐19 pandemic, this virtual model may have continued relevance to medical education.     

The optimal timing for the interval to surgery after short course preoperative radiotherapy (5 ×5 Gy) in rectal cancer - are we too eager for surgery?

BackgroundThe improved overall survival (OS) after short course preoperative radiotherapy (SCPRT) using 5 × 5 Gy reported in the early rectal cancer trials could not be replicated in subsequent phase III trials. This original survival advantage is attributed to poor quality of surgery and the large differential in local recurrence rates, with and without SCPRT. Immuno-modulation during and after SCPRT and its clinical implications have been poorly investigated. We propose an alternative explanation for this survival benefit in terms of immunological mechanisms induced by SCPRT and the timing of surgery, which may validate the concept of consolidation chemotherapy.Material and methodsWe reviewed randomized controlled trials (RCTs) and studies of SCPRT from 1985 to 2019. We aimed to examine the precise timing of surgery in days following SCPRT and identify evidence for immune modulation, neo-antigens and memory cell induction by radiation.ResultsConsiderable variability is reported in randomised trials for median overall treatment time (OTT) from start of SCPRT to surgery (8–14 days). Only three early trials showed a benefit in terms of OS from SCPRT, although the level of benefit in preventing local recurrence was consistent across all trials. Different patterns of immune effects are observed within days after SCPRT depending on the OTT, but human leukocyte antigen (HLA)-1 expression was not upregulated.ConclusionsSCPRT has a substantial immune-stimulatory potential. The importance of the timing of surgery after SCPRT may have been underestimated. An optimal interval for surgery after 5 × 5 Gy may lead to better outcomes, which is possibly exploited in total neoadjuvant therapy schedules using consolidation chemotherapy. Individual patient meta-analyses from appropriate SCPRT trials examining outcomes for each day and prospective trials are needed to clarify the validity of this hypothesis. The interaction of SCPRT with tumour adaptive immunology, in particular the kinetics and timing, should be examined further.     

Split-course hypofractionated radiotherapy for aged and frail patients with head and neck cancers. A retrospective study of 75 cases

PurposeTo assess the efficacy and the tolerance of a split course hypofractionated (SCH) radiotherapy (RT) protocol in head and neck cancer (HNC) for eldery and/or unfit patients (pts).Patients and methodsPts with HNC treated by SCH-RT in two institutions were included retrospectively. The main SCH RT regimen was two courses of 30 grays (Gy)/10 fractions separated by 2–4 weeks, without any systemic therapy.ResultsBetween February 2012 and January 2019, 75 consecutive patients were analyzed. The median age was 80 years (range: 45.7–98.2) and 53 (70.7%) were men. Sixty-one (81.3%) pts had stage III/IV disease and 54 (72%) had at least two comorbidities. All of them were treated with intensity-modulated radiotherapy. Median follow-up was 10.6 months (range: 3.1–58.3). Local control at 12 and 24 months was 72.8% IC95%[62–85.5] and 51.7% IC95%[38.1–70.1] respectively. Progression free survival (PFS) at 12 and 24 months were 47.7% IC95%[37.4–60.8] and 41% IC95%[15–36.4] respectively, with a median of 11.5 months IC95%[8.9–17]. OS at 12 and 24 months were 60.4% IC95%[50–73.1] and 41% IC95%[30.6–54.9] respectively, with a median of 19.3 months IC95%[11.9–25.8]. Acute and late grade 3 or higher toxicities occurred for 6 (8%) and 3 (4%) pts.ConclusionThe present SCH-RT regimen seems effective, well-tolerated and could represent an alternative to palliative strategies for pts deemed unfit for standard exclusive RT.     

护理学专业本科生的自我认同现象分析

目的 明确护理专业本科生的自我认同型态及变化趋势.方法 基于现象学原理,调查学生针对"过去、现在、将来的我"三个主题的自我表述,对内容加以质性分析.结果 (1)过去的我呈现"依赖型、幼稚型、理想/目标型";(2)现在的我呈现"自立型、探索/成熟型、迷茫型";(3)将来的我呈现"贡献社会/自我实现、成熟成功"的确定型及"重新定位、留有余地、自得其乐"的未确定型;(4)自我变化趋势呈现"渐进式"和"迂回式".结论 对迷茫型需予以关注.     

A virtual reality intervention to improve the understanding and empathy for people with dementia in informal caregivers: results of a pilot study

ABSTRACT

Objective: Informal caregivers often experience psychological distress due to the changing functioning of the person with dementia they care for. Improved understanding of the person with dementia reduces psychological distress. To enhance understanding and empathy in caregivers, an innovative technology virtual reality intervention Through the D'mentia Lens (TDL) was developed to experience dementia, consisting of a virtual reality simulation movie and e-course. A pilot study of TDL was conducted.

Methods: A pre-test–post-test design was used. Informal caregivers filled out questionnaires assessing person-centeredness, empathy, perceived pressure from informal care, perceived competence and quality of the relationship. At post-test, additional questions about TDL's feasibility were asked.

Results: Thirty-five caregivers completed the pre-test and post-test. Most participants were satisfied with TDL and stated that TDL gave more insight in the perception of the person with dementia. The simulation movie was graded 8.03 out of 10 and the e-course 7.66. Participants significantly improved in empathy, confidence in caring for the person with dementia, and positive interactions with the person with dementia.

Conclusion: TDL is feasible for informal caregivers and seems to lead to understanding of and insight in the experience of people with dementia. Therefore, TDL could support informal caregivers in their caregiving role.     

Bewertung der ärztlichen Ausbildung an der McMaster Universität,Kanada, anhand des Konzepts der „Fallmethode“

Summary Students of three different levels and the chairman of the MD-Program evaluated the educational system of McMaster University, Canada, using the six criteria of the case method as defined by Renschler. This analysis provided a very differentiated evaluation of the McMaster curriculum, demonstrating a systematic progress of learning methods from the second to the last phase.The instrument showed differences in the ratings of the demonstrative lectures between the chairman and the students. Free access to patients and responsibility, gradually growing during the 3-year program, are important features of the educational system. The problem-based system provides a unique integration of acquiring theoretical knowledge in the basic sciences through clinical problem solving which was highly rated in all analysed phases. Ratings given by the interviewed students for evaluation of documented work were lower than expected by the chairman and the authors. The results are discussed in relationship to the McMaster Philosophy and to the conditions of studying medicine in America and in Germany.

     

提高口腔组织病理学实验课教学质量的措施探讨

目的:口腔组织病理学是理论与实践密切结合的一门课程,实验教学在病理教学中占有重要地位.本研究旨在摸索一套行之有效的实验教学方法和模式,有效提升口腔组织病理学实验教学质量及学生观察、思维、分析和解决问题的能力.方法:教研室通过自编并及时更新《口腔组织病理学实验教学指导》,出版实验课辅导书《口腔组织病理学实验与理论教学彩色袖珍图谱》,增加病例样本量,提高及增加教学切片及示教片的质与量,运用互联网+的新教学模式,营造自主学习环境,以机考代替单纯切片考试,建立新的实验课考核评价方法等一系列措施,打造全方位、多层次、立体化的实验教学模式.结果:学生对实验教学改革给予高度肯定,所采取的措施在丰富教学内容、激发学习兴趣、促进自主学习等方面起到了积极作用.机考在检验学生掌握专业知识的系统性及全面性方面显著优于传统考试(P＜0.05).结论:多举措并举有效提高了《口腔组织病理学》实验课的教学质量,使学生面对纷繁复杂的疾病有一个思路清晰、富有逻辑的思考,将学过的各科理论知识充分融会贯通.     

本科毕业护士与医生合作态度的调查分析

目的 调查某三甲医院住院部本科毕业护士与医生的合作态度,分析二者差异,为营造良好的医护合作氛围提供参考依据.方法 采用Jefferson医护合作态度量表对某三甲医院住院部96名护理本科毕业护士及52名医生进行现场调查.结果 本科毕业护士与住院医生的医护合作态度得分均较高,医护合作态度积极.本科毕业护士在条目“医护之间有很多重叠的职责”得分低于医生,差异有统计学意义;在“医生的权利”维度,护士得分较高,差异有统计学意义;2组在“医疗与护理工作内容”及“护士的自主权”总分上表现出较高一致性.结论 护士和医生之间的医护合作态度总体是积极的,多数护士认为医护工作中有很多的职责是共同的,但是彼此在工作中的沟通还不够理想.可通过医护整体查房、病案讨论等方式增加医护间沟通,加强医护人员团队合作精神,营造良好的医护合作氛围.     

Investigation of the Dynamic Stiffness of Poroelastic and Asphalt Concrete Layers under In Situ and Laboratory Conditions

Compounds with lower dynamic stiffness are a better solution from the tyre/road noise point of view. The article presents the constructed test stand for the evaluation of dynamic stiffness both in in situ and in laboratory conditions. As a result of the tests, it was found that poroelastic pavements have a much lower dynamic stiffness (from 138.3 to 143.0 dB re. 1 N/m) compared to the asphalt concrete pavement (150.3 dB re. 1 N/m). In the group of poroelastic pavements, lower dynamic stiffness is characteristic for pavements with a binder course of porous asphalt. The results of the research are a contribution to further work on the influence of the dynamic stiffness of the pavements on the tyre/road noise level. The conducted measurements and analysis of the results prove the usefulness of the proposed test stand for determining the dynamic stiffness of bituminous mixtures in laboratory and field conditions. This is confirmed by the coherence between the force and acceleration signals at the level of at least 0.96—which indicates a very good validation of the test results with a random error lower than ±5% with 90% confidence level.