Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News

Introduction

Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners.

Stage line diagram: An age‐conditional reference diagram for tracking development

This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and disease staging), psychology (stages of cognitive development), human development (pubertal stages) and chronic diseases (stages of dementia). Transition probabilities between successive stages are modeled as smoothly varying functions of age. Age‐conditional references are calculated from the modeled probabilities by the mid‐P value. It is possible to eliminate the influence of age by calculating standard deviation scores (SDS). The method is applied to the empirical data to produce reference charts on secondary sexual maturation. The mean of the empirical SDS in the reference population is close to zero, whereas the variance depends on age. The stage line diagram provides quick insight into both status (in SDS) and tempo (in SDS/year) of development of an individual child. Other measures (e.g. height SDS, body mass index SDS) from the same child can be added to the chart. Diagrams for sexual maturation are available as a web application at http://vps.stefvanbuuren.nl/puberty . The stage line diagram expresses status and tempo of discrete changes on a continuous scale. Wider application of these measures scores opens up new analytic possibilities. Copyright © 2009 John Wiley & Sons, Ltd.     

Does the shunt opening pressure influence the effect of shunt surgery in normal pressure hydrocephalus?

Summary Thirteen patients with normal pressure hydrocephalus were operated upon with an externally manoeuvrable shunt system (Sophy SU8) in order to investigate its influence on clinical outcome, intracranial pressure and cranial CT parameters. The opening pressure was set at high at surgery and lowered stepwise at intervals of three months to medium and low. The clinical condition, intracranial pressure and cranial CT parameters were examined at the end of the 3 months interval on each pressure level.The patients improved within the first 3 months inspite of an unchanged mean intracranial pressure and remained in a stable clinical condition during the rest of the study period. The intracranial pressure was significantly reduced at 9 months. The ventricular index, Evans index, temporal horn and third ventricle width were reduced 3 months post-operatively and did not change significantly during the rest of the study. The pre-operative third ventricle width was correlated to high psychometric test results after shunt surgery. Reduction in ventricular index, Evans index and third ventricle width after surgery correlated to improvement in psychometric scoring.The clinical improvement after shunt surgery for normal pressure hydrocephalus is seen within 3 months and is independent of the adjusted valve pressure.     

Psychological Assessment of the Headache Patient

Most clinicians agree that psychological factors are important considerations in the evaluation and treatment of headache patients. There has been a lack of systematic research, however, that has examined the relationship between these variables. Attention to such factors may become a greater concern as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is an inadequate response to usually effective treatment. In addition, there is no consensus as to the proper method to assess psychopathology in headache patients.     

Immunoglobulin mimicry by Hepatitis C Virus envelope protein E2

Hepatitis C virus (HCV) establishes persistent infection in the majority of infected individuals. The currently accepted hypothesis of immune evasion by antigenic variation in hypervariable region 1 (HVR1) of glycoprotein E2 does not however, explain the lack of subsequent immune recognition. Here, we show that the N-terminal region of E2 is antigenically and structurally similar to human immunoglobulin (Ig) variable domains. E2 is recognized by anti-human IgG antibodies and also possesses common amino acid (aa) sequence features of the conserved v-gene framework regions of human Ig light chains in particular but also heavy chains and T cell receptors. Using a position specific scoring system, the degree of similarity of HVR1 to Ig types correlated with immune escape and persistence in humans and experimentally infected chimpanzees. We propose a unique role for threshold levels of Ig molecular mimicry in HCV biology that not only advances our concept of viral immune escape and persistent infection but also provides insight into host-dependent disease patterns.     

图、词回忆中的序列位置效应及其年龄变化规律

目的：探讨图、词回忆中的首因和近因效应及其年龄变化规律。方法：采用多维记忆评估量表中的汉词回忆和图画回忆分测验对947人的连续年龄组的大样本进行测试，分析不同通道首因和近因效应的差异和年龄变化规律。结果：受试在汉词和图画自由回忆中，均呈现明显的系列位置效应；受试的首因和近因效应均随年龄的增长而增大。当发展到高峰后则随年龄的增长而减弱，各年龄组间比较有显著差异；首因和近因效应随年龄增长是不平行的，首因效应随年龄的增长变化较大。而近因效应的变化则相对较为平缓；两种不同呈现途径的比较发现，图画回忆的首因和近因效应均高于汉词回忆。结论：视觉和听觉呈现途径均呈现明显的系列位置效应，首因效应和近因效应的发展变化规律与记忆的发展变化规律是一致的。首因效应受年龄的影响较大，在有意义的图画回忆中首因效应和近因效应均高于汉词回忆。     

大学生身体意识量表的修订

目的:在Mckinley和Hyde的身体意识客体化量表(OBCS)基础上,进行量表的修订。方法:对432名大学生进行原始量表的测量,其中212名被试的结果作探索性因素分析,其余220名被试的结果作信、效度检验。结果:量表包含20个项目,三个分量表,分别是身体监视、身体羞耻感和控制信念。因素分析表明,三个分量表解释总方差的60.25%,各个项目载荷在0.623~0.824之间。重测信度为0.764~0.802,同质信度为0.861~0.875。与OBSC原量表相比,修订的大学生身体意识量表删减了4个项目。结论:经修订后,大学生身体意识量表具有较为满意的信、效度,可以在大学生中使用。     

Maslach倦怠量表-服务行业版在警察中的修订及应用分析

目的对Maslach倦怠量表-服务行业版(MBI-HSS)进行修订,并了解我国警察工作倦怠现状。方法采用MBI-HSS对4855名警察进行测试并对量表作出信、效度分析。结果修订后的量表保持原有的三维度结构,具有良好的结构效度(CFI=0.945,TLI=0.936,GFI=0.947,AGFI=0.930,NFI=0.942,IFI=0.945,RM-SEA=0.060),总量表和分量表的内部一致性信度、重测信度均大于0.70。综合三个维度的结果发现,男性警察的倦怠程度高于女性警察,警龄在6-15年的警察倦怠程度最严重,离异警察的倦怠程度高于已婚和未婚警察,学历低的警察倦怠程度较高。结论修订后的MBI-HSS可作为测量我国警察工作倦怠的有效工具。警察的工作倦怠在性别、警龄、婚姻状况、受教育程度方面存在差异。