Effectiveness of a minimal virtual motivational interviewing training for first years medical students: differentiating between pre-test and then-test

BackgroundShifting towards patient-centeredness, medical doctors need patient-centered communication skills. Motivational Interviewing (MI) is an evidence-based, collaborative, goal-oriented communication technique to strengthen a person’s own motivation and commitment to change. The purpose of this study is to evaluate the effectiveness of a brief virtual role-play MI-training program on MI-knowledge and skills in first-year undergraduate medical students, making use of both a pre-test and a then-test (retrospective pre-test) to check for response shift in evaluating the educational intervention.MethodsFour 10–15 min MI-game-based training conversations embedded in the Kognito Conversation Platform? were offered to the students using a single-group Interrupted Time Series design.ResultsParticipants included 339 undergraduate medical students (RR= 83.1%). The one-hour MI virtual training proved effective in two ways: participants gained knowledge and skills, and increased awareness of the existing intrinsic knowledge and skill they already possess to communicate with future patients in a patient-centered way.ConclusionA brief one-hour MI-training simulation can be effective even if offered at an early stage during medical education. Furthermore, response shift varied and was not present in all students.Practice ImplicationThe addition of a then-test to the study design reveals results that otherwise would not have been found.     

Strategies for vaccine-product innovation: Creating an enabling environment for product development to uptake in low- and middle-income countries

Vaccine-product innovations that address barriers to immunization are urgently needed to achieve equitable vaccine coverage, as articulated in the new Immunization Agenda 2030 and the Gavi 5.0 strategy. In 2020, the Vaccine Innovation Prioritisation Strategy (VIPS) prioritized three innovations, namely microarray patches (MAPs), heat-stable and controlled-temperature chain (CTC) enabled liquid vaccine formulations and barcodes on primary packaging. These innovations were prioritized based on the priority immunization barriers that they may help overcome in resource constrained contexts, as well as by considering their potential impact on health, coverage and equity, safety, economic costs and their technical readiness and commercial feasibility. VIPS is now working to accelerate the development and lay the foundation for future uptake of the three priority vaccine-product innovations, with the long term-goal to ensure equitable vaccine coverage and increased impact of vaccines in low- and middle- income countries.To inform our strategic planning, we analyzed four commercially available vaccine product-innovations and conducted interviews with individuals from 17 immunization organizations, and/or independent immunization experts. The findings are synthesized into an ‘innovation conundrum’ that describes the challenges encountered in developing vaccine-product innovations and a vaccine-product innovation ‘theory of change’, which highlights actions that should be undertaken in parallel to product development to incentivize sustainable investment and prepare the pathway for uptake and impact.     

New thoughts on the diagnosis and treatment of patients with diabetes mellitus in relation to coronavirus disease

The coronavirus disease 2019 (COVID-19) outbreak that occurred in late 2019 has posed a huge threat to the health of all humans, especially for individuals who already have diabetes mellitus (DM). DM is one of the most serious diseases that affect human health, with high morbidity and rates of complications. Medical scientists worldwide have been working to control blood sugar levels and the complications associated with sugar level alterations, with an aim to reduce the adverse consequences of acute and chronic complications caused by DM. Patients with DM face great challenges during the pandemic owing to not only changes in the allocation of medical resources but also their abnormal autoimmune status, which reduces their resistance to infections. This increases the difficulty in treatment and the risk of mortality. This review presents, from an epidemiological viewpoint, information on the susceptibility of patients with DM to COVID-19 and the related treatment plans and strategies used in this population.     

健康中国战略与血吸虫病防控

本文梳理了新时期我国有关血吸虫病防控的政策变化，分析了健康中国战略背景与我国目前血吸虫病防治工作的关系，介绍了几种血防工作模式，并就当前血防工作面临的挑战提出相关建议，为今后我国制定有效血吸虫病防控策略提供参考。     

全身麻醉不同通气策略对腹腔镜结直肠癌根治术患者细胞免疫的影响

目的探讨腹腔镜结直肠癌根治术患者术中采用不同的通气策略对其细胞免疫的影响,为肿瘤患者预后提供参考。方法选择我院2017年8月～2018年12月择期拟行腹腔镜结直肠恶性肿瘤根治术患者75例,ASA分级Ⅰ或Ⅱ级,采用随机数字表法随机分为3组:低PaCO2组(L组),术中维持PaCO2(25±5)mmHg;正常PaCO2组(N组),术中维持PaCO2(40±5)mmHg和高PaCO2组(H组),术中维持PaCO2(55±5)mmHg,每组25例。各组患者均采用相同的麻醉诱导及维持方法。分别于手术前一天清晨(T0)、手术结束离开麻醉复苏室前5 min(T1)、术后24 h(T2)、72 h(T3)四个时点采血标本,流式细胞仪检测血液TH1/TH2值、MTT法检测NK细胞活性水平,ELISA检测IL-2及IFN浓度。结果与T0时点比较,三组患者T1～3时的TH1/TH2值、NK细胞活性、IL-2和IFN浓度均降低(P0.05);与L组比较,N组T1～3时点TH1/TH2值、NK细胞活性、IL-2和IFN浓度均显著降低(P0.05);与L组和N组相比,H组T1～3时TH1/TH2值、NK细胞活性、IL-2和IFN浓度均明显降低(P0.05)。结论腹腔镜结直肠癌根治术术中采用适度过度通气对患者细胞免疫功能具有一定保护作用。     

重症监护室护士的心理压力和应对措施

本院神经外科ICU患者病情危重,并发症多,家属情绪变化大,重症监护室护士每天承受着巨大的心理压力。其工作的性质要求护士不但要熟练掌握专业知识和技能,还要有高度的责任心、耐心、细心、爱心,做好心理护理和生活护理,还要有良好的语言沟通能力和健康的心理素质。如何缓解ICU护士的心理压力已引起护理同仁的关注。     

“治未病”思想在防治急性呼吸功能不全中的策略

"治未病"思想是祖国医学重要的宝藏之一,同时也是中医药学对现代预防医学理论的升华;急性呼吸不全是呼吸内科的难治病,发病急、预后差,运用"治未病"理论,结合中西医治疗急性呼吸不全的规范治疗,对提高疾病治愈率,减少并发症有重要意义。     

A neuropsychological comparison of obsessive-compulsive disorder and trichotillomania

BACKGROUND: Obsessive-compulsive disorder (OCD) and trichotillomania (compulsive hair-pulling) share overlapping co-morbidity, familial transmission, and phenomenology. However, the extent to which these disorders share a common cognitive phenotype has yet to be elucidated using patients without confounding co-morbidities. AIM: To compare neurocognitive functioning in co-morbidity-free patients with OCD and trichotillomania, focusing on domains of learning and memory, executive function, affective processing, reflection-impulsivity and decision-making. METHOD: Twenty patients with OCD, 20 patients with trichotillomania, and 20 matched controls undertook neuropsychological assessment after meeting stringent inclusion criteria. RESULTS: Groups were matched for age, education, verbal IQ, and gender. The OCD and trichotillomania groups were impaired on spatial working memory. Only OCD patients showed additional impairments on executive planning and visual pattern recognition memory, and missed more responses to sad target words than other groups on an affective go/no-go task. Furthermore, OCD patients failed to modulate their behaviour between conditions on the reflection-impulsivity test, suggestive of cognitive inflexibility. Both clinical groups showed intact decision-making and probabilistic reversal learning. CONCLUSIONS: OCD and trichotillomania shared overlapping spatial working memory problems, but neuropsychological dysfunction in OCD spanned additional domains that were intact in trichotillomania. Findings are discussed in relation to likely fronto-striatal neural substrates and future research directions.