Training Staff in an Adolescent Inpatient Psychiatric Unit in Positive Approaches to Managing Aggressive and Harmful Behaviour: Does it Improve Confidence and Knowledge?

This study examined the implementation of a model of managing aggressive and harmful behaviour in an adolescent in-patient psychiatric unit. This model, Positive Behaviour Management, replaced a previous model, Control and Restraint, which was considered unsuitable. Both models included the use of physical interventions, and the research into such techniques is considered. The aims of the study were to evaluate the effects of three training courses on staff confidence in managing aggressive behaviour, knowledge about good practice and staff satisfaction with the new model. A multiple baseline design was used to examine change before, during and after the training period, and at one-year follow-up. The study found that staff confidence increased significantly following training but had returned to baseline levels by the time of follow-up. Staff knowledge significantly increased during the study periods but did not appear to be directly linked to the training courses, and was maintained at one-year follow-up. Staff reported significantly higher levels of satisfaction with the new model than with the previous model, which were maintained at follow-up. The findings of the study and the difficulties encountered are discussed in relation to similar findings elsewhere.     

Day-case laparoscopy: a comparison of prophylactic opioid, NSAID or local anesthesia for postoperative analgesia

BACKGROUND: The study was aimed to evaluate the analgesic efficacy, postoperative comfort, recovery characteristics and side effects of three different analgesic agents administered prophylactically. METHODS: Eighty patients undergoing day-case minor operative laparoscopy were randomly allocated into four groups to receive tenoxicam 20 mg i.v. (Group T), fentanyl 100 microg i.v. (Group F), 5 ml of bupivacaine 2.5 mg/ml for infiltration of trocar sites (Group B), 30, 10 and 5 min before incision respectively. Bupivacaine, 35 ml, 2.5 mg/ml was also administered into the pelvic cavity in Group B. Group P received only placebo. Postoperative pain, analgesic requirements, first response to verbal stimulus, first analgesic requirement, ability to walk without help, to drink and to void, blood pressures, SpO2 and respiration rates were recorded in the PACU. Postoperative pain was evaluated by verbal rating scale. Pain scores, analgesic requirements and side effects were evaluated by telephone calls until the 48th postoperative hour. RESULTS: Postoperative pain scores were lower and time to requirement of rescue analgesics was longer in groups F and B compared to Group P. In the PACU, analgesic requirements were lower in Group B, compared to Group P. Nausea and vomiting were increased in Group F. CONCLUSION: Tenoxicam 20 mg i.v. was found to be ineffective whereas bupivacaine was superior to other groups in reducing pain and analgesic requirements. Bupivacaine also increased time to first analgesics and obtained better recovery characteristics, underlining its value in prophylactic pain management compared to the other two agents.     

Monitoring the development of clinical skills during training in a clinical placement

Background The education and training of health care practitioners has undergone recent reform, and indicate that curricula should place emphasis on the development of clinical skills and attitude. The purpose of this study was two‐fold: to define the key skills necessary for a competent dietetic student practitioner and to devise a reliable assessment tool to measure and track performance in these key skill areas throughout the period of clinical placement. Methods Key clinical skills were identified by a concensus group of experienced dietitians and academic practitioners. An assessment tool was then developed to measure these attributes in 43 students undertaking clinical placement at a number of training centres in Scotland. Development of skills was tracked for the entire duration of placements using the novel assessment tool. The assessment tool used a visual analogue scale (VAS) as the measuring score. Results A high level of skill attainment was equated with high VAS scores. Performance in three of the four key skills (written skills: r = 0.762, P ≤ 0.001; interviewing skills: r = 0.697, P < 0.001; and dietary assessment technique: r = 0.697, P ≤ 0.001) showed impressive correlation co‐efficients, indicating a striking and significant positive correlation with the length of training. A high skill performance level attainment was achieved by week 16/17 of training. Conclusion The authors are confident that the assessment tool is valid and reliable and measures skill performance objectively. A high level of skill attainment was observed in most students by about the mid‐point in training: this allows the student to consolidate these skills in the latter stages of training which is in keeping with educational and practice philosophy of placement learning outcomes.     

注重人才培养促进学科建设

介绍了温州医学院附属第二医院加强学科建设的具体举措,引进和培育技术骨干,创造人才成长环境,加强国内外技术联合,整合多种学科资源,坚持科研与临床和市场相结合,树立良好形象。经过上述努力,使科研总体实力明显增强,教学工作跃上了新台阶,学科队伍整体素质迅速提升,社会效益和经济效益显著提高。     

Reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors

Aims:   To evaluate reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors.
Methods:   A retrospective study was carried out in 30 infertile women with intramural myomas measuring ≥50 mm in diameter and treated using laparoscopy.
Results:   The overall rate of spontaneous intrauterine pregnancy was 50.0% (15 patients). Of 13 patients with infertility factors associated with the uterine myomas, three (23.1%) became pregnant, whereas 12 of 17 patients (70.6%) with no other associated infertility factor became pregnant. No uterine ruptures were observed. All pregnancies were spontaneous and 13 occurred within 1 year of the operation. In the 10 patients who gave birth by Cesarean section, no adhesions were found on the myomectomy scar.
Conclusions:   On the basis of these results, laparoscopic surgery for myomas appears to offer comparable results to laparotomy. In infertile patients with intramural myoma, pregnancy rates are affected by the presence of other infertility factors associated with the uterine myomas. (Reprod Med Biol 2006; 5 : 31–35)     

Train the trainers!

With the introduction of training programmes and logbooks for basic postgraduate training and subspecialty training, the European Board and College of Obstetrics and Gynaecology has given impulses to harmonise training in obstetrics and gynecology in the European Union. Current changes in the practice of medicine, among which the European Working Time Directive, numbers of surgical procedures decreasing, more demanding patients and a change in work ethos, challenge both trainers and trainees to optimise postgraduate training. For training to be effective and efficient, it is necessary to clearly define learning goals and outcomes and to create a stimulating educational environment. This requires trainers who (a) have knowledge of adult learning and educational theory and (b) will act as facilitators of the learning process of postgraduate trainees. Most of the doctors involved in postgraduate training have not had any formal formation to be a trainer. Teacher professionalisation offers the medical professional a framework to increase efficiency as a trainer. In this article, an introduction to educational practice for the medical professional is given. Several aspects of adult learning, such as the learning cycle, appraisal and assessment, and giving feedback, are discussed.     

氯诺昔康用于腹腔镜卵巢肿瘤切除术后镇痛的临床观察

目的:评价氯诺昔康持续静脉镇痛用于腹腔镜卵巢肿瘤切除术后的临床效果.方法:择期行腹腔镜卵巢切除术的患者60例,随机平均分为氯诺昔康组和对照组两组.氯诺昔康组(n=30)应用PCA镇痛(每次l mL,总量40 mg/48 h),并于手术结束前半小时静脉注射氯诺昔康8 mg.术后行疼痛评分(BCS)及不良反应的观察.对照组(n=30)为空白对照.结果:氯诺昔康组术后BCS评分显著高于对照组.两组的不良反应发生率无显著性差异.结论:腹腔镜卵巢肿瘤切除术后应用氯诺昔康静脉持续镇痛,效果确切,不良反应少.     

药学专业六年制学-硕连读培养模式探索

以新的视角、新的思维、新的观念来审视未来高等药学教育发展的趋势 ,建立新的药学教育观、人才观和质量观 ,这是新世纪对高等药学教育提出的更高要求。根据药学学科最新进展、发展趋势及国内外药学教育的发展动向 ,阐述了北京大学药学院药学专业六年一贯制 ,学 -硕连读研究型人才的培养目标及方案     

GMP 生产车间实训中的互动式教学

提高GMP生产车间实训的教学水平,在药物制剂工程专业的专业建设中极其重要。笔者将角色互换、教练施教、纠错竞赛、假如我是车间主任等多种互动式教学方式应用到GMP生产车间实训中,取得了令人满意的教学效果     

对高等院校大学生科研能力培养的思考

对我国高等院校的大学生科研活动进行了探索,提出培养大学生创新能力的科研活动方式及其在科研活动中应该注意的问题和相关的激励措施,对大学生科研能力和创新能力的培养具有实践意义。