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.     

医疗卫生机构气候韧性和环境可持续评价工具研究进展

目的 气候变化给医疗卫生机构带来诸多不确定性威胁,医疗卫生机构亟需提高自身的气候韧性并采取积极的应对措施,如何系统评价医疗卫生机构应对气候变化的能力成为应对气候变化挑战的工作重点。方法 使用范围综述筛选医疗卫生机构气候韧性和环境可持续评价工具相关文献和最新进展,并对密切相关的文献采用引文检索拓展研究范围。结果 借鉴国际经验已开发出适用于我国的《绿色医院建筑评价标准》,但对于医疗卫生机构气候韧性的指南和要求仍在探索中。国际上已经发展了三套较完整的工具包和指南,并已探索性开展了实地应用,包括加拿大的医疗卫生机构气候变化韧性工具包、美国的可持续和气候韧性医疗卫生机构工具包,以及世界卫生组织的气候韧性和环境可持续性的医疗卫生机构指南。结论 医疗卫生机构气候韧性和环境可持续能力评价工具构建是开展脆弱性评估和干预的基础,应积极借鉴国外相关经验开发适宜我国的评价工具,以增强机构和人员应对气候变化的能力。     

Dietary Aspects to Incorporate in the Creation of a Mobile Image-Based Dietary Assessment Tool to Manage and Improve Diabetes

Diabetes is the seventh leading cause of death in United States. Dietary intake and behaviors are essential components of diabetes management. Growing evidence suggests dietary components beyond carbohydrates may critically impact glycemic control. Assessment tools on mobile platforms have the ability to capture multiple aspects of dietary behavior in real-time throughout the day to inform and improve diabetes management and insulin dosing. The objective of this narrative review was to summarize evidence related to dietary behaviors and composition to inform a mobile image-based dietary assessment tool for managing glycemic control of both diabetes types (type 1 and type 2 diabetes). This review investigated the following topics amongst those with diabetes: (1) the role of time of eating occasion on indicators of glycemic control; and (2) the role of macronutrient composition of meals on indicators of glycemic control. A search for articles published after 2000 was completed in PubMed with the following sets of keywords “diabetes/diabetes management/diabetes prevention/diabetes risk”, “dietary behavior/eating patterns/temporal/meal timing/meal frequency”, and “macronutrient composition/glycemic index”. Results showed eating behaviors and meal macronutrient composition may affect glycemic control. Specifically, breakfast skipping, late eating and frequent meal consumption might be associated with poor glycemic control while macronutrient composition and order of the meal could also affect glycemic control. These factors should be considered in designing a dietary assessment tool, which may optimize diabetes management to reduce the burden of this disease.     

Is ‘Omega Sign’ anatomical endoscopic enucleation of the prostate technique reproducible?

We aimed to evaluate the learning curve of the surgically standardised ‘Omega Sign’ anatomical endoscopic enucleation (AEEP) of the prostate surgery technique for junior surgeons. This study is a retrospective comparison of cases that underwent AEEP by a mentor surgeon and three junior surgeons who have completed their learning curve. A video-based laser enucleation of the prostate assessment tool (LEAT) composed of 8 steps of the technique was used to assess a senior surgeon and junior surgeons’ surgical compatibility and consistency. The surgeon who defined Omega Sign technique was determined as group 1, and cases by three junior surgeons were identified as group 2. The end points were to assess the reproducibility and repeatability and operative post-operative outcomes of the technique. 55 patients’ videos were rated by five experienced endourologists. There was no significant difference in LEAT scores between the groups among all steps. The most symmetry was found in the 1st and 3rd steps. Inter-rater consistency was also high for each step, with no statistically significant difference between the evaluators. The standardised anatomical ‘Omega Sign’ technique is reproducible for the junior surgeons. The operative steps can be performed with high consistency, and the functional and perioperative outcomes are comparable with the senior surgeon.     

基于政策工具的我国三医联动政策量化分析

目的:对我国发布的27份三医联动政策文件的政策工具进行分析,探究我国三医联动政策体系的着重点与缺失点,为健全我国三医联动政策体系提供参考。方法;以我国2014—2019年发布的27份三医联动政策文件为研究对象,以政策工具为视角对纳入分析的政策文件进行摘录和编码,采用内容分析法和定量分析法对各项政策工具进行统计分析,并确定其运用情况。结果:260个政策编号中,需求型,供给型和环境型政策工具分别占6.9%、24.6%和68.5%;医疗、医保和医药政策工具分别占54.2%、24.6%和21.2%。由此可以看出,我国三医联动改革对环境现状的依赖程度较大,需求与供给政策相对不足,而医疗则是三医联动改革的核心关键点。结论:应适当增加需求型和供给型政策工具,着重解决医疗方面的重难点问题,促使医疗、医保、医药三个利益主体达成合力,形成“三医既联又动”的协同发展机制。     

Optimization of Process Parameters for the Laser Polishing of Hardened Tool Steel

In mold making, the mold surface roughness directly affects the surface roughness of the produced part. To achieve surface roughness below 0.8 μm, the cost of surface finish is high and time-consuming. One alternative to the different grinding and polishing steps is laser polishing (LP). This study investigates and models the LP of tool steel (X38CrMoV5-1-DIN 1.2343), typical for the mold industry, having an initial rough surface obtained by electrical discharge machining. The microstructures of the re-melted layer and heat-affected zone due to the LP process were also studied. Four parameters: the laser spot size, velocity, maximum melt pool temperature and overlapping were investigated via a design of experiments (DoE) approach, specifically a factorial design. The responses were line roughness (Ra), surface roughness (Sa), and waviness (Wa). The surface topography was measured before and after the LP process by white light profilometer or confocal microscopy. DoE results showed that the selected factors interact in a complex manner, including the interactions, and depend on the responses. The DoE analysis of the results revealed that the roughness is mainly affected by the velocity, temperature and overlap. Based on a first DoE model, an optimization of the parameters was performed and allowed to find optimum parameters for the LP of the rough samples. The optimum conditions to minimize the roughness are a spot size of 0.9 mm, a velocity of 50 mm/s, a temperature of 2080 °C and an overlap of 90%. By using these parameters, the roughness could be reduced by a factor of almost 8 from 3.8 µm to approximately 0.5 µm. Observations of the microstructure reveal that the re-melted layer consists of columnar grains of residual austenite. This can be explained by the carbon intake of the electro-machined surface that helps stabilize the austenitic phase.