The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is c...The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.展开更多
Objectives To validate the reliability of the Chinese version of the Consultation and Relational Empathy(CARE)in physician-standardized patient(SP)encounter.We also tried to examine the agreement between video-based r...Objectives To validate the reliability of the Chinese version of the Consultation and Relational Empathy(CARE)in physician-standardized patient(SP)encounter.We also tried to examine the agreement between video-based ratings and in-room ratings,as well as the agreement between the faculty ratings and SP ratings.Methods The CARE was translated into Chinese.Forty-eight anesthesia residents were recruited to make preoperative interview in SP-counter.Performance of each resident was graded by in-room raters,video raters and SP raters.Consistency between different raters was examined.Results The Chinese-CARE measure demonstrated high scale reliability with a Cronbach's alpha value of 0.95 and high consistency in the in-room ratings in intraclass correlation(coefficient=0.888,P<0.001).Despite a good consistency in intraclass correlation,video ratings were significantly higher than in-room ratings(39.6±7.1 vs.24.0±10.0,P<0.001),and Wilcoxon signed-rank test indicated that the pass/fail rate was significantly higher based on video ratings than based on in-room ratings(45/48 vs.22/48,P<0.001).SP ratings had a moderate consistency with in-room faculty ratings(coefficient=0..568,P<0.001),and there was no significant difference between the pass/fail rates based on the in-room ratings and SP ratings(22/48vs.28/48,P=0.12).Conclusions The Chinese-CARE measure is reliable in the assessment of empathy during preoperative anesthesia interview.In-room and video ratings are not equivalent,while SP may provide a feasible alternative for the faculty rater in the assessment of communication skills with an appropriate measure.展开更多
BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education ...BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.展开更多
Purpose: Aim of this single center study was to determine whether elderly patients benefit from individualized treatment not excluding full standard therapy. Additionally predictive and prognostic factors influencing ...Purpose: Aim of this single center study was to determine whether elderly patients benefit from individualized treatment not excluding full standard therapy. Additionally predictive and prognostic factors influencing outcome in this patient’s population were evaluated. Material and Methods: Between 1997 and 2010, 119 patients equal or older than 60 years were enrolled in this retrospective review. All patients had neuropathology confirmed diagnosis of glioblastoma. Treatment outcome concerning progression free survival was measured by MRI. For evaluation of O6-Methylguanin-DNA-methyltransferase (MGMT) Methylation-specific PCR was used. The log rank test and the Cox proportional hazards model were used to analyze the data. Factors considered in univariate and multivariate analyses included age, gender, Karnofsky performance scale (KPS), extent of resection, treatment with radioand chemotherapy and MGMT status. Survival probabilities were estimated by means of the Kaplan Meier method. Results: Multivariate analysis demonstrated age, KPS and treatment more than surgery as prognostic factors for survival and sex, KPS, type of surgery and standard treatment as independent factors for PFS. MGMT status revealed no difference in survival between the methylated and unmethylated tumours in the whole study population (12.7 and 12.0, respectively). Surgery had an impact on survival with a significant advantage for complete resection. Conclusion: Extent of resection is essential even in elderly patients. Full standard treatment should be offered to elderly GBM patients with good clinical performance, there is no reason to withhold radioor chemotherapy from these patients. MGMT promotor methylation of the tumour is not relevant for treatment decision.展开更多
The large global outbreak of coronavirus disease 2019(COVID-19)has seriously endangered the health care system in China and globally.The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 in...The large global outbreak of coronavirus disease 2019(COVID-19)has seriously endangered the health care system in China and globally.The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists.Currently,the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit(ICU)physicians,who lack the required professional knowledge,training,and practice in critical care medicine,especially in terms of continuous monitoring of the respiratory function,intervention,and feedback on treatment effects.This clinical problem needs an urgent solution.Therefore,here,we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine.Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists,highlight the key patients,timely detection of disease progression,and early and appropriate intervention and organ function support,and thus improve the prognosis.Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19.The approaches suggested herein will facilitate the timely detection of disease progression,and thus ensure the provision of early and appropriate intervention and organ function support,which will eventually improve the prognosis.展开更多
Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthca...Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthcare institutions can ensure efficient and sustainable service delivery.Utilization management encompasses various strategies,including prior authorization,concurrent review,and clinical pathways,to enhance care quality,manage expenses,and streamline resource use.The benefits of utilization management include cost containment,improved care standards,and the implementation of consistent treatment guidelines,thereby increasing the overall efficiency and effectiveness of healthcare delivery.展开更多
Background:In recent years,with the gradual expansion of the scale of medical education,the shortage of medical teaching resources and the reluctance of patients to cooperate with teaching have become increasingly pro...Background:In recent years,with the gradual expansion of the scale of medical education,the shortage of medical teaching resources and the reluctance of patients to cooperate with teaching have become increasingly prominent.Objective:To explore the application effect of student standardized patient(SSP)in the clinical teaching of acute abdomen.Methods:Fifty-four fifth-year general medical students from class 1826 of the general department of The First Affiliated Hospital of Xi’an Medical University were selected as the research subjects and randomly divided into two groups,with 27 students in the experimental teaching group,and the remaining 27 students in the conventional teaching group.The experimental teaching group adopted the SSP teaching approach.The SSPs were generated from the training students of the hospital through the recruitment and training process of SSP.In this study,seven qualified SSPs were selected for the clinical teaching of acute abdomen.At the end of the course,a periodic assessment was held.The rank sum test was used to compare the excellent and good rates between the two groups,while t-test was used to compare the difference between the two groups.Results:The results showed that the excellent and good rate of the experimental teaching group was significantly higher than that of the conventional group,in which the difference between the two groups was statistically significant(p<0.05).In terms of the assessment results,the theoretical scores and skills scores of the experimental teaching group were better than those of the conventional teaching group,in which the differences between the two groups were statistically significant(p<0.05).Conclusion:Through the training of SSP for acute abdomen and its application in surgical teaching and examination,the superiority of SSP is emphasized.Although there are still some shortcomings in the application of SSP in clinical teaching,it is a relatively new and effective teaching method,and it will play an increasingly critical role in clinical skills training pertaining to the medical specialty.展开更多
目的探讨案例分析教学法(case-basedlearning,CBL)联合教师标准化病人(teacher-standardized patient,TSP)在卒中后神经源性膀胱医患沟通教学中的应用效果。方法纳入首都医科大学附属北京天坛医院接受规范化培训的60名住院医师,随机分...目的探讨案例分析教学法(case-basedlearning,CBL)联合教师标准化病人(teacher-standardized patient,TSP)在卒中后神经源性膀胱医患沟通教学中的应用效果。方法纳入首都医科大学附属北京天坛医院接受规范化培训的60名住院医师,随机分为对照组和试验组。对照组采用传统以授课为导向的教学法,试验组采用CBL联合TSP的教学方法。教学内容为卒中后神经源性膀胱的医患沟通,共计12学时。教学结束后使用TSP和医患沟通技能评价量表(set the stage,elicit information,give information,understand the patient’s perspective,and end the encounter;SEGUE)评估住院医师的医患沟通能力。结果对照组和试验组在年龄、性别、入组前理论考试分数及操作考试分数方面差异无统计学意义。教学结束后,试验组在SEGUE的问诊准备[(4.6±0.6)分vs.(3.7±0.8)分,P<0.0001]、信息采集[(8.6±1.1)分vs.(7.3±0.9)分,P<0.0001]、信息提供[(3.7±0.5)分vs.(3.3±0.6)分,P=0.0099]、患者理解[(3.5±0.4)分vs.(2.4±0.7)分,P<0.0001]及总分[(22.1±1.5)分vs.(18.5±2.0)分,P<0.0001]方面均显著高于对照组,在问诊结束[(1.7±0.6)分vs.(1.7±0.5)分,P=0.6305]方面与对照组差异无统计学意义。结论采用CBL联合TSP的教学方法能够显著提高住院医师在卒中后神经源性膀胱医患沟通方面的能力。这一教学策略有望成为医学教育中提高医患沟通技能的有效手段,从而提高医疗服务质量。展开更多
文摘The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.
基金the Undergraduate Teaching Reform Project from Peking Union Medical College(Grant number:2017zlgc0102).
文摘Objectives To validate the reliability of the Chinese version of the Consultation and Relational Empathy(CARE)in physician-standardized patient(SP)encounter.We also tried to examine the agreement between video-based ratings and in-room ratings,as well as the agreement between the faculty ratings and SP ratings.Methods The CARE was translated into Chinese.Forty-eight anesthesia residents were recruited to make preoperative interview in SP-counter.Performance of each resident was graded by in-room raters,video raters and SP raters.Consistency between different raters was examined.Results The Chinese-CARE measure demonstrated high scale reliability with a Cronbach's alpha value of 0.95 and high consistency in the in-room ratings in intraclass correlation(coefficient=0.888,P<0.001).Despite a good consistency in intraclass correlation,video ratings were significantly higher than in-room ratings(39.6±7.1 vs.24.0±10.0,P<0.001),and Wilcoxon signed-rank test indicated that the pass/fail rate was significantly higher based on video ratings than based on in-room ratings(45/48 vs.22/48,P<0.001).SP ratings had a moderate consistency with in-room faculty ratings(coefficient=0..568,P<0.001),and there was no significant difference between the pass/fail rates based on the in-room ratings and SP ratings(22/48vs.28/48,P=0.12).Conclusions The Chinese-CARE measure is reliable in the assessment of empathy during preoperative anesthesia interview.In-room and video ratings are not equivalent,while SP may provide a feasible alternative for the faculty rater in the assessment of communication skills with an appropriate measure.
文摘BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.
文摘Purpose: Aim of this single center study was to determine whether elderly patients benefit from individualized treatment not excluding full standard therapy. Additionally predictive and prognostic factors influencing outcome in this patient’s population were evaluated. Material and Methods: Between 1997 and 2010, 119 patients equal or older than 60 years were enrolled in this retrospective review. All patients had neuropathology confirmed diagnosis of glioblastoma. Treatment outcome concerning progression free survival was measured by MRI. For evaluation of O6-Methylguanin-DNA-methyltransferase (MGMT) Methylation-specific PCR was used. The log rank test and the Cox proportional hazards model were used to analyze the data. Factors considered in univariate and multivariate analyses included age, gender, Karnofsky performance scale (KPS), extent of resection, treatment with radioand chemotherapy and MGMT status. Survival probabilities were estimated by means of the Kaplan Meier method. Results: Multivariate analysis demonstrated age, KPS and treatment more than surgery as prognostic factors for survival and sex, KPS, type of surgery and standard treatment as independent factors for PFS. MGMT status revealed no difference in survival between the methylated and unmethylated tumours in the whole study population (12.7 and 12.0, respectively). Surgery had an impact on survival with a significant advantage for complete resection. Conclusion: Extent of resection is essential even in elderly patients. Full standard treatment should be offered to elderly GBM patients with good clinical performance, there is no reason to withhold radioor chemotherapy from these patients. MGMT promotor methylation of the tumour is not relevant for treatment decision.
基金Supported by The National Natural Science Foundation of China,No.81770276Nn10 Program of Harbin Medical University Cancer Hospital+1 种基金Novel Coronavirus Pneumonia Emergency Treatment and Diagnosis Technology Research Project of Heilongjiang Provincial Science and Technology DepartmentScientific Research Project of Heilongjiang Health and Family Planning Commission,No.2018086。
文摘The large global outbreak of coronavirus disease 2019(COVID-19)has seriously endangered the health care system in China and globally.The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists.Currently,the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit(ICU)physicians,who lack the required professional knowledge,training,and practice in critical care medicine,especially in terms of continuous monitoring of the respiratory function,intervention,and feedback on treatment effects.This clinical problem needs an urgent solution.Therefore,here,we propose a series of clinical strategies for non-ICU physicians aimed at the standardization of the management of non-critically ill patients with COVID-19 from the perspective of critical care medicine.Isolation management is performed to facilitate the implementation of hierarchical monitoring and intervention to ensure the reasonable distribution of scarce critical care medical resources and intensivists,highlight the key patients,timely detection of disease progression,and early and appropriate intervention and organ function support,and thus improve the prognosis.Different management objectives are also set based on the high-risk factors and the severity of patients with COVID-19.The approaches suggested herein will facilitate the timely detection of disease progression,and thus ensure the provision of early and appropriate intervention and organ function support,which will eventually improve the prognosis.
文摘Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthcare institutions can ensure efficient and sustainable service delivery.Utilization management encompasses various strategies,including prior authorization,concurrent review,and clinical pathways,to enhance care quality,manage expenses,and streamline resource use.The benefits of utilization management include cost containment,improved care standards,and the implementation of consistent treatment guidelines,thereby increasing the overall efficiency and effectiveness of healthcare delivery.
基金Shaanxi Undergraduate and Higher Continuing Education Teaching Reform Research Project in 2021 by Shaanxi Education Department,“Construction and Practice of Faculty Construction and Quality Assurance System Based on Online Learning Platform for Clinical Faculty of Western Medical College”(Project Number:21BZ066)Education and Teaching Reform Research Project in 2020 by Xi’an Medical University,“Construction and Practice of‘Double-Qualified’Teaching Staff Construction and Quality Assurance System in Affiliated Hospitals Based on‘Clinical Teachers Online Learning Platform’”(Project Number:2020JG-02)。
文摘Background:In recent years,with the gradual expansion of the scale of medical education,the shortage of medical teaching resources and the reluctance of patients to cooperate with teaching have become increasingly prominent.Objective:To explore the application effect of student standardized patient(SSP)in the clinical teaching of acute abdomen.Methods:Fifty-four fifth-year general medical students from class 1826 of the general department of The First Affiliated Hospital of Xi’an Medical University were selected as the research subjects and randomly divided into two groups,with 27 students in the experimental teaching group,and the remaining 27 students in the conventional teaching group.The experimental teaching group adopted the SSP teaching approach.The SSPs were generated from the training students of the hospital through the recruitment and training process of SSP.In this study,seven qualified SSPs were selected for the clinical teaching of acute abdomen.At the end of the course,a periodic assessment was held.The rank sum test was used to compare the excellent and good rates between the two groups,while t-test was used to compare the difference between the two groups.Results:The results showed that the excellent and good rate of the experimental teaching group was significantly higher than that of the conventional group,in which the difference between the two groups was statistically significant(p<0.05).In terms of the assessment results,the theoretical scores and skills scores of the experimental teaching group were better than those of the conventional teaching group,in which the differences between the two groups were statistically significant(p<0.05).Conclusion:Through the training of SSP for acute abdomen and its application in surgical teaching and examination,the superiority of SSP is emphasized.Although there are still some shortcomings in the application of SSP in clinical teaching,it is a relatively new and effective teaching method,and it will play an increasingly critical role in clinical skills training pertaining to the medical specialty.
文摘目的探讨案例分析教学法(case-basedlearning,CBL)联合教师标准化病人(teacher-standardized patient,TSP)在卒中后神经源性膀胱医患沟通教学中的应用效果。方法纳入首都医科大学附属北京天坛医院接受规范化培训的60名住院医师,随机分为对照组和试验组。对照组采用传统以授课为导向的教学法,试验组采用CBL联合TSP的教学方法。教学内容为卒中后神经源性膀胱的医患沟通,共计12学时。教学结束后使用TSP和医患沟通技能评价量表(set the stage,elicit information,give information,understand the patient’s perspective,and end the encounter;SEGUE)评估住院医师的医患沟通能力。结果对照组和试验组在年龄、性别、入组前理论考试分数及操作考试分数方面差异无统计学意义。教学结束后,试验组在SEGUE的问诊准备[(4.6±0.6)分vs.(3.7±0.8)分,P<0.0001]、信息采集[(8.6±1.1)分vs.(7.3±0.9)分,P<0.0001]、信息提供[(3.7±0.5)分vs.(3.3±0.6)分,P=0.0099]、患者理解[(3.5±0.4)分vs.(2.4±0.7)分,P<0.0001]及总分[(22.1±1.5)分vs.(18.5±2.0)分,P<0.0001]方面均显著高于对照组,在问诊结束[(1.7±0.6)分vs.(1.7±0.5)分,P=0.6305]方面与对照组差异无统计学意义。结论采用CBL联合TSP的教学方法能够显著提高住院医师在卒中后神经源性膀胱医患沟通方面的能力。这一教学策略有望成为医学教育中提高医患沟通技能的有效手段,从而提高医疗服务质量。
