Preferences for in-person disclosure: Patients declining telephone disclosure characteristics and outcomes in the multicenter Communication Of GENetic Test Results by Telephone study

Telephone disclosure of cancer genetic test results is noninferior to in-person disclosure. However, how patients who prefer in-person communication of results differ from those who agree to telephone disclosure is unclear but important when considering delivery models for genetic medicine. Patients undergoing cancer genetic testing were recruited to a multicenter, randomized, noninferiority trial (NCT01736345) comparing telephone to in-person disclosure of genetic test results. We evaluated preferences for in-person disclosure, factors associated with this preference and outcomes compared to those who agreed to randomization. Among 1178 enrolled patients, 208 (18%) declined randomization, largely given a preference for in-person disclosure. These patients were more likely to be older (P = 0.007) and to have had multigene panel testing (P < 0.001). General anxiety (P = 0.007), state anxiety (P = 0.008), depression (P = 0.011), cancer-specific distress (P = 0.021) and uncertainty (P = 0.03) were higher after pretest counseling. After disclosure of results, they also had higher general anxiety (P = 0.003), depression (P = 0.002) and cancer-specific distress (P = 0.043). While telephone disclosure is a reasonable alternative to in-person disclosure in most patients, some patients have a strong preference for in-person communication. Patient age, distress and complexity of testing are important factors to consider and requests for in-person disclosure should be honored when possible.     

护患联合网络模拟见习在内科护理学教学的应用

目的 探讨内科护理学护患联合网络模拟见习教学的方法和效果。方法 将2018级护理专业418名护生设为模拟见习组,实施护患联合网络模拟见习教学,即采取真实患者和护患情景模拟相结合的教学方法。2017级417名设为对照组,常规进行实地见习。结果 见习后,两组护生学习成绩差异无统计学意义(P>0.05);模拟见习组的自主学习能力、临床沟通能力和合作学习能力较见习前显著提升(均P<0.05);模拟见习组80.00%以上护生对护患联合网络见习表示满意,认为提高了内科护理学专业知识和能力。结论 护患联合网络见习可获得实地见习效果,同时能提高护生的综合能力,能作为护生见习的可选方式。     

虚实结合法在静脉注射实训教学中的应用

目的探讨虚实结合法在静脉注射实训教学中的应用效果。方法选取2017级护理专业1班46名学生为观察班,2班43名学生为对照班。在静脉注射实训教学中,分别采用虚实结合法和传统实训教学法进行教学。实训结束后,对两班学生进行实训理论知识考核、技能操作考核和问卷调查,综合评估实训教学效果。结果观察班理论及技能考核成绩显著高于对照班(均P<0.01)。问卷调查显示,观察班学生对本班实训教学法赞同率显著高于对照班(均P<0.01)。结论运用虚实结合法进行静脉注射实训教学能显著提高实训教学效果。     

口腔材料学不同教学模式的探讨

目的 比较口腔材料学的线上、线下以及线上线下混合式教学模式的教学效果，促进网络化教学模式在口腔教学中的应用。方法 随机选取上海交通大学口腔医学院口腔专业学生为研究对象；其中2016级39名学生采用传统线下教学；2017级44名学生采用线上教学模式；2018级49名学生开展线下教学结合线上网课的混合式教学模式。对3个班级学生的考试成绩(平均分、优秀率、良好率、合格率和不及格率）进行比较和统计，分析线上线下混合式教学模式的教学实践及教学效果。结果 传统线下教学学生的成绩为(70.77±15.59）分，优秀率为15%，不及格率为20%；线上教学学生的成绩为(66.25±15.85）分，优秀率为2%，不及格率为30%；混合式教学模式的学生的成绩为(78.98±11.64）分，优秀率为29%，不及格率为0%；3组学生的平均分差异具有统计学意义(P<0.05），与单一线上和线下教学模式相比，线上线下混合式教学模式能明显提高学生考试成绩的优秀率，降低不及格率。结论 单纯线上或线下的教学模式均各有利弊，两者混合式教学模式能更好地提升教学质量和教学效果。     

The association of opening K–12 schools with the spread of COVID-19 in the United States: County-level panel data analysis

This paper empirically examines how the opening of K–12 schools is associated with the spread of COVID-19 using county-level panel data in the United States. As preliminary evidence, our event-study analysis indicates that cases and deaths in counties with in-person or hybrid opening relative to those with remote opening substantially increased after the school opening date, especially for counties without any mask mandate for staff. Our main analysis uses a dynamic panel data model for case and death growth rates, where we control for dynamically evolving mitigation policies, past infection levels, and additive county-level and state-week “fixed” effects. This analysis shows that an increase in visits to both K–12 schools and colleges is associated with a subsequent increase in case and death growth rates. The estimates indicate that fully opening K–12 schools with in-person learning is associated with a 5 (SE = 2) percentage points increase in the growth rate of cases. We also find that the association of K–12 school visits or in-person school openings with case growth is stronger for counties that do not require staff to wear masks at schools. These findings support policies that promote masking and other precautionary measures at schools and giving vaccine priority to education workers.

Does opening K–12 schools lead to the spread of COVID-19? Do mitigation strategies such as mask-wearing requirements help reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at school? These are important policy-relevant questions in countries with low vaccination rates, especially given the emerging variants of concern with higher transmission rates. If in-person school openings substantially increase COVID-19 cases, then local governments could promote mitigation measures at schools (universal and proper masking, social distancing, and handwashing) to lower the risk of COVID-19 spread. Furthermore, the governments could prioritize vaccines for education workers and elderly parents in the case of in-person school openings. This paper uses county-level panel data on K–12 school opening plans and mitigation strategies together with foot traffic data to investigate how an increase in visits to K–12 schools is associated with a subsequent increase in COVID-19 cases in the United States.     

Characteristics of hospital controls according to willingness to participate in a cancer genetic epidemiologic research in China

Objective: Studies on participants’ willingness to be interviewed in-person and donate blood specimens for genetic cancer research are few and most have been conducted in Western countries. Little information exists about the willingness to participate in genetic cancer research in China. Methods: In 2009-2010, 560 hospital controls, matched to incidence cases by age, gender and residency, were randomly selected from outpatients attending the Health Examination Centre at the China Medical University’s teaching hospital in Northeast China. Demographic and lifestyle characteristics were measured using a validated questionnaire by face-to-face interview and 5 ml blood samples were collected from consenting participants. A 7-point ‘willingness to participate’ scale was developed for use by the interviewer to record the levels of ease or difficulty experienced in recruiting each participant. The willingness to participate was compared between different subgroups of participants. Results: The participation rate was 96.1% among the hospital controls. Characteristics associated with willingness to participate were age (≥ 60 years) and tertiary education. Weaker associations with gender and malignancies in first degree relatives were not statistically significant. The factors not strongly or significantly associated with willingness to participate were income, marital status, body mass index, smoking, passive smoking, alcohol consumption, tea drinking, or physical activity. Conclusion: This study suggests that while there is general acceptance of participation in genetic cancer epidemiologic research in China across subgroups of outpatient hospital controls, younger age and education are associated with increased willingness to participate, while lifestyle factors generally had little impact.