BACKGROUND & AIMS: BACKGROUND:Because inguinal hernia repair is difficult for third-year students to comprehend, a 2-dimensional paper-cut was developed to teach the concepts of inguinal hernia in a time-effective manner before students' observation of herniorrhaphy in the operating room. METHODS:Using Adobe Illustrator 5.5 for MacIntosh, a 2-dimensional inexpensively printed paper-cut was created to allow students to perform their own simulated hernia repair before observing surgery. The exercise was performed using a no.15 scalpel or an iris scissors and was evaluated by comparing 10-question pre-tests and post-tests. RESULTS:Seventy-five students performed the exercise, most completing it within 15 minutes. The mean pre-test score was 7.4/10 and the mean post-test score was 9.1/10. Students performing the paper-cut reported better understanding when observing actual herniorrhaphy. CONCLUSIONS:A 2-dimensional paper-cut ("surgical origami") may be a time-effective method to prepare students for the observation of hernia repair.

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BACKGROUND & AIMS: :The lack of substantial research in the area of clinical teaching would suggest that this 'heart' of the nursing student's professional education has long been neglected. Employing a qualitative descriptive methodology, this study explored the teaching activities that nine clinical instructors said they implemented during the direct client care period and the teaching activities that these nine clinical instructors said they would implement in response to a specific scenario of a clinical teaching event. The unstructured interviews revealed that clinical instructors: (a) noted role modelling the greatest number of times as a teaching activity but implemented it less frequently; (b) used verbalizations in the form of telling, asking, saying, discussing or talking as the primary teaching activity in the clinical area and in response to the specific scenario; (c) do not have opportunities to see other clinical instructors teaching in the clinical area; (d) have difficulty separating teaching activities and evaluation activities; (e) are eclectic in their use of learning theories; and (f) find articulating teaching activities that they implement during the direct client care period to be a complex task.

背景与目标： : 在临床教学领域缺乏实质性的研究表明，长期以来一直忽略了护生专业教育的 “心脏”。本研究采用定性描述性方法，探讨了九名临床讲师表示他们在直接客户护理期间实施的教学活动，以及这九名临床讲师表示他们将针对临床教学事件的特定场景实施的教学活动。非结构化访谈显示，临床讲师 :( a) 注意到角色建模作为教学活动的次数最多，但实施频率较低; (b) 以讲述，询问，说，讨论或谈话作为临床领域的主要教学活动，并针对具体情况; (c) 没有机会看到临床领域的其他临床讲师教学; (d) 难以分离教学活动和评估活动; (e) 在学习理论的使用上不拘一格; (f) 发现他们在直接服务客户期间实施的明确教学活动是一项复杂的任务。

BACKGROUND & AIMS: BACKGROUND:Patient satisfaction, one of the main components of quality of care, is a crucial phenomenon for the overall health care delivery system. Even though a number of studies have been conducted about patient satisfaction in different health services, studies in radiology services are flimsy in Ethiopia. This study aimed at assessing patient satisfaction towards radiological service and associated factors in Hawassa University Teaching and Referral hospital. METHODS:An institution based cross-sectional study was conducted among 321 adult patients presented for radiological service in the study area using stratified sampling technique. Patient satisfaction was measured using SERVQUAL (Service Quality) tool that consisted of seven items: accessibility, quality of radiological service, courtesy of radiology staff, existence of good communication with service provider and desk worker, physical environment and privacy technique. Exit interviews of patients were conducted using a structured and pretested questionnaire. Data was collected by three grade ten completed trained data collectors from May 12 to May 28, 2016. Multiple logistic regressions were used to identify independent factors associated with patient satisfaction on radiological services using SPSS version 21. RESULTS:The overall patient satisfaction towards radiological service was 71.6%. Satisfaction to accessibility of the service was 84.5% while it was 80.6% to courtesy of the staff. Similarly, 81.6% reported satisfied with quality of the service and 59.4% and 71% of reported satisfied with physical environment and radiological service provider respectively. On the other hand, 99.7% of the respondents were dissatisfied with privacy of the service. The study revealed that patients who attended primary school (AOR = 0.317, 95% CI: 0.11-0.88), unemployed patients (AOR = 0.067, 95% CI: 0.007-0.622) and patients who had short waiting time to enter into examination room less than one hour (AOR = 4.12, 95% CI: 1.4-11.62) were factors associated with patients satisfaction. CONCLUSION:This study found that majority of respondents was satisfied with the radiological services. Respondent's education level, occupation as well as duration of time taken to enter into examination room were important factors influencing the satisfaction condition. Hence, concerted effort is needed to constantly improve on patient satisfaction to better radiology returns arising from improved patient patronage. It is recommended to give great care and attention to clients during radiological examination procedure and also suggested that the department should decrease time taken to enter into examination room. On the other hand, the reasons behind more educated clients were less satisfied with radiologic service than more educated respondents need further investigation.

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BACKGROUND & AIMS: INTRODUCTION:This study aimed to assess whether the method of teaching endodontology influenced the quality of root fillings made by undergraduate students. MATERIALS AND METHODS:The method of teaching endodontology at our institution was revised. Changes concerned: the programme (ie method of clinical training and summative assessment), and the supervision whilst performing root canal treatment on patients. An intermediate cohort (N=91) comprised partly students attending the former programme (involving patients) and partly students attending the revised programme (without patients). After succeeding in the summative assessment, the quality of the first root filling made by the student in a patient under supervision of either a general dental practitioner or an endodontist was evaluated according to pre-determined criteria. Data were analysed using Cohen's Kappa, Chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests. RESULTS:Sixty-two per cent (47 of 76) of root fillings made by students who attended the revised programme were of good quality, in comparison with 47% (seven of 15) of those made by students who attended the former programme (P=.274). Less complex treatments had better quality root fillings if students were supervised by endodontists (88% (14 of 16) good quality) than supervised by general dental practitioners (59% (22 of 37) good quality) (P=.045). Complex treatments did not differ in quality of root fillings for the supervision types (P=.825). CONCLUSION:The quality of root fillings made by students who attended the revised programme seems at least as high as that of those who attended the former programme. Higher quality root fillings might be obtained under supervision of endodontists than under supervision of general dental practitioners.

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BACKGROUND & AIMS: OBJECTIVE:To describe the timing of cardiac arrest detection in relation to episodes of Medical Emergency Team (MET) review and routine nursing observations. DESIGN AND SETTING:Retrospective observational study in a university-affiliated hospital. PATIENTS:279 cardiac arrests involving ward patients MEASUREMENTS AND RESULTS:Cardiac arrests were allocated to one of 24 1-h intervals (24:00-00:59, 01:00-01:59, etc.). The actual hourly rate of cardiac arrests was related to the expected average hourly rate. Peak levels of cardiac arrest detection occurred during times of routine overnight nursing clinical observations between 02:00 and 03:00 (OR 3.06) and 06:00-07:00 (OR 1.95). The lowest level of cardiac arrest detection occurred between 20:00 and 21:00 (OR 0.42). After introduction of the MET there were 162 cardiac arrests, 28% of which occurred shortly after an initial MET call. The odds ratio for risk of cardiac arrest during periods of lowest MET activation (24:00-08:00) when compared with periods of highest MET activation (16:00-24:00) was 2.26. CONCLUSIONS:Cardiac arrest detection in our hospital is episodic with peak levels corresponding to periods of overnight routine nursing observations following a period when patient review is likely to be low. After the introduction of the MET there was an inverse link between detection of cardiac arrests and levels of MET activation over the 24-h period. Increased overnight utilization and earlier MET activation may further reduce the incidence of cardiac arrests at our hospital.

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BACKGROUND & AIMS: :A set of specimens has been collected, preserved, and organized specifically for the teaching of forensic pathology, odontology, and anthropology. Plastination of soft tissue, whole organs, bones, and teeth has proven valuable in preserving delicate, friable, and calcined specimens. The dry, odorless, biologically inert specimens are durable and resistant to damage caused by handling. Subtle features of soft tissue pathology are well preserved. Patterned injuries change due to shrinkage, but remain easily recognizable. Plastinated whole jaws are still readily identifiable from antemortem records. Radiographic density is essentially unchanged. Putrid and charred specimens become quite manageable.

背景与目标： : 已收集，保存和组织了一组标本，专门用于法医病理学，牙本质学和人类学的教学。事实证明，软组织，整个器官，骨骼和牙齿的塑化在保存细腻，易碎和煅烧的标本方面很有价值。干燥，无味，生物惰性的标本经久耐用，并且可以抵抗因处理而造成的损坏。软组织病理的细微特征得到了很好的保存。由于收缩，图案化的损伤会发生变化，但仍然很容易辨认。从死前记录中仍然可以很容易地识别出整个颌骨。射线照相密度基本不变。腐烂和烧焦的标本变得相当容易管理。

BACKGROUND & AIMS: :We sought to create a transcervical chorionic villus sampling model for teaching that would mimic a lifelike model. A model was created using silicone resembling the maternal interface. A cervix with an endocervical canal able to accommodate a catheter and a vagina was also created. Tap water was used as the amniotic fluid. Chorionic villus sampling was accomplished using this model with the actual ultrasound machines and environment as in the real model. This simulator allowed placental placement in different locations to increase the difficulty level as well as angulations and catheter handling. Given the low cost (less than $200), this model could be used indefinitely in a relaxed and controlled environment.

背景与目标： : 我们试图创建一个模仿逼真模型的经颈绒毛膜绒毛采样模型进行教学。使用类似于母体界面的有机硅创建了一个模型。还创建了具有宫颈内管的子宫颈，该子宫颈能够容纳导管和阴道。自来水被用作羊水。与实际模型一样，使用该模型与实际的超声机器和环境一起完成了绒毛膜绒毛采样。该模拟器允许胎盘放置在不同的位置，以增加难度水平以及角度和导管处理。考虑到低成本 (低于200美元)，该模型可以在宽松和受控的环境中无限期使用。

BACKGROUND & AIMS: BACKGROUND:Evidence-Based Reviews in Surgery (EBRS) is a program developed to teach critical appraisal skills to general surgeons and residents. The purpose of this study was to assess the use of EBRS by general surgery residents across Canada and to assess residents' opinions regarding EBRS and journal clubs. METHODS:We surveyed postgraduate year 2-5 residents from 15 general surgery programs. Data are presented as percentages and means. RESULTS:A total of 231 residents (58%, mean 56% per program, range 0%-100%) responded: 172 (75%) residents indicated that they know about EBRS and that it is used in their programs. More than 75% of residents who use EBRS agreed or strongly agreed that the EBRS clinical and methodological articles and reviews are relevant. Only 55 residents (24%) indicated that they used EBRS online. Most residents (198 [86%]) attend journal clubs. The most common format is a mandatory meeting held at a special time every month with faculty members with epidemiological and clinical expertise. Residents stated that EBRS articles were used exclusively (13%) or in conjunction with other articles (57%) in their journal clubs. Most respondents (176 of 193 [91%]) stated that journal clubs are very or somewhat valuable to their education. CONCLUSION:The EBRS program is widely used among general surgery residents across Canada. Although most residents who use EBRS rate it highly, a large proportion are unaware of EBRS online features. Thus, future efforts to increase awareness of EBRS online features and increase its accessibility are required. CONTEXTE:Le programme de revues factuelles en chirurgie EBRS (Evidence-Based Reviews in Surgery) a été mis au point pour enseigner aux chirurgiens et aux résidents en chirurgie générale les compétences nécessaires pour faire des évaluations critiques. Le but de cette étude était d'analyser l'utilisation des EBRS par les résidents en chirurgie générale au Canada et de leur demander leur opinion au sujet des EBRS et des clubs de lecture. MÉTHODES:Nous avons interrogé des résidents des années 2 à 5 rattachés à 15 programmes de chirurgie générale. Les données sont présentées sous forme de pourcentages et de moyennes. RÉSULTANTS:En tout, 231 résidents (58 %, moyenne de 56 % par programme, intervalle 0 %–100 %) ont répondu : 172 résidents (75 %) ont indiqué qu'ils connaissent les EBRS et que leur programme les utilise. Plus de 75 % des résidents qui utilisent les EBRS se sont dit d'accord ou tout à fait d'accord avec l'énoncé sur la pertinence des articles et revues cliniques et méthodologiques des EBRS. Seulement 55 résidents (24 %) ont dit utiliser les EBRS en ligne. La plupart des résidents (198 [86 %]) participaient à des clubs de lecture. Leur utilisation la plus courante prend la forme d'une réunion obligatoire tenue à un moment particulier tous les mois avec les enseignants de la faculté ayant une expertise épidémiologique et clinique. Les résidents ont indiqué que les EBRS étaient utilisés seuls (13 %) ou avec d'autres articles (57 %) dans leurs clubs de lecture. La plupart des répondants (176 sur 193 [91 %]) ont affirmé que leurs clubs de lecture sont très ou assez utiles pour leur formation. CONCLUSIONS:Le programme EBRS est largement utilisé par les résidents en chirurgie générale au Canada. Même si la plupart des résidents qui utilisent les EBRS leur accordent une cote élevée, une forte proportion ignore l'existence des possibilités web des EBRS. Il faudra donc travailler à mieux faire connaître les possibilités offertes par le programme EBRS sur le web et en faciliter l'accès.

背景与目标：

BACKGROUND & AIMS: :Antibiotics are a significant cause of adverse events (AE), but few studies have focused on prescriptions in hospitalized patients. In infectious diseases departments, the high frequency and diversity of antibiotics prescribed makes AE post-marketing monitoring easier. The aim of our study was to assess the incidence and type of AE in the infectious diseases department of a French teaching tertiary-care hospital. The main characteristics of each hospitalization, including all antibiotics prescribed and any significant AE were recorded prospectively in the medical dashboard of the department. We included all patients having suffered an AE due to systemic antibiotics between January 2008 and March 2011. Among the 3963 hospitalized patients, 2682 (68%) received an antibiotic and 151/2682 (5.6%) suffered an AE. Fifty-two (34%) AE were gastrointestinal disorders, 32 (21%) dermatological, 20 (13%) hepatobiliary, 16 (11%) renal and urinary disorders, 13 (9%) neurological and 11 (7%) blood disorders. Rifampin, fosfomycin, cotrimoxazole and linezolid were the leading causes of AE. Sixty-two percent of the antibiotics causing an AE were stopped and 38% were continued (including 11% with a dose modification). Patients suffering from AE had an increased length of stay (18 vs 10 days, P < 0.001). Our data could help choosing the safest antibiotic when several options are possible.

背景与目标： : 抗生素是不良事件 (AE) 的重要原因，但很少有研究关注住院患者的处方。在传染病部门，处方抗生素的高频率和多样性使AE上市后监测更加容易。我们研究的目的是评估法国教学三级医院传染病科AE的发生率和类型。每次住院的主要特征，包括所有处方的抗生素和任何重要的AE，都在部门的医疗仪表板中进行了前瞻性记录。我们纳入了所有因2008年1月和2011年3月之间的全身性抗生素而患有AE的患者。在3963名住院患者中，2682 (68%) 接受了抗生素治疗，151/2682 (5.6%) 患有AE。52 (34%) AE是胃肠道疾病，32 (21%) 皮肤病学，20 (13%) 肝胆疾病，16 (11%) 肾脏和泌尿疾病，13 (9%) 神经系统疾病和11 (7%) 血液疾病。利福平、磷霉素、复方新诺明和利奈唑胺是不良事件的主要原因。停止60 2% 引起AE的抗生素并继续38% (包括剂量调整的11%)。患有AE的患者的住院时间增加 (18天vs 10天，P <0.001)。当有多种选择时，我们的数据可以帮助选择最安全的抗生素。

BACKGROUND & AIMS: BACKGROUND:Despite established international guidelines on preferred teaching components for ophthalmology in undergraduate curricula, with increasingly less specialty-based undergraduate teaching within curricula, teaching of core ophthalmology knowledge and skills may become marginalized. This survey aims to evaluate the current state of undergraduate ophthalmology teaching in Australasia and proximate Asian medical schools. METHODS:A questionnaire was developed to determine the content and extent of ophthalmology teaching in the undergraduate medical curriculum. The questionnaire was sent to 25 medical schools throughout Australasia and Asia. RESULTS:Nineteen of the 25 questionnaires were returned (76% response rate). Ophthalmology teaching programmes ranged from 2 to 20 days: five (26%) medical schools having one ophthalmology attachment; six schools (32%) two attachments; and the remainder three or more. Only seven of the schools taught all 13 ophthalmology topics recommended in current curriculum guidelines. Ocular examination (100%), lens and cataract (95%) and ocular manifestations of systemic disease (95%) were the most commonly taught topics, with intraocular tumours only covered by 10 schools (53%). Students in 14 schools (74%) attended ophthalmology operating theatre, but only two schools (11%) offered attendance at optometry clinics. Ten schools (53%) required a pass in ophthalmology to complete the academic year. CONCLUSION:Ophthalmology may increasingly be a small, or even absent, component of undergraduate medical curricula. Despite established international ophthalmology curriculum guidelines, this survey highlights significant lack of uniformity in their implementation.

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BACKGROUND & AIMS: BACKGROUND:Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. OBJECTIVES:To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. DESIGN:Nonrandomized controlled trial. SETTING:Service users' homes in East Yorkshire. PARTICIPANTS:Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. PROCEDURE:One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. ANALYSIS:Quantitative analysis of pre-post differences between the groups, using t-test. RESULTS:In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teachingand behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. CONCLUSION:Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.

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BACKGROUND & AIMS: :There is a paucity of data on Staphylococcus aureus epidemiology in Africa. Prevalence of nasal carriage and genetic diversity of S. aureus were determined among hospital staff (HS) and inpatients (IP) at the largest hospital in Ghana. In total, 632 nasal swabs were obtained from 452 IP and 180 HS in the Child Health Department (CHD) and Surgical Department (SD). S. aureus carriage prevalences were 13.9% in IP and 23.3% in HS. The chance of being a carrier was higher in HS (P=0.005) and IP staying ≤7 days in hospital (P=0.007). Resistance to penicillin (93%), tetracycline (28%) and fusidic acid (12%) was more common than for other agents (<5%). A higher chance of multidrug-resistant S. aureus carriage was observed among IP compared with HS (P=0.01). High genetic diversity was shown by spa typing, with 55 spa types found among 105 isolates; the predominant spa types were t355 (10%) and t084 (10%). MRSA was detected in six IP with an overall carriage prevalence of ca. 1.3%, but not in HS. All three MRSA isolates from SD belonged to ST88-SCCmec IV, and two of them displayed the same spa type and antibiograms; three MRSA isolates from CHD belonged to distinct lineages (ST88-SCCmec IV, ST8-SCCmec V and ST72-SCCmec V). Altogether, these data indicate a high diversity of S. aureus, low levels of MRSA carriage, and a higher chance of nasal carriage of multidrug-resistant S. aureus among IP compared with HS in this hospital.

背景与目标： : 非洲的金黄色葡萄球菌流行病学数据很少。在加纳最大医院的医院工作人员 (HS) 和住院患者 (IP) 中确定了鼻携带和金黄色葡萄球菌的遗传多样性。总共从儿童卫生部 (CHD) 和外科部门 (SD) 的452 IP和180 HS获得了632个鼻拭子。金黄色葡萄球菌携带率在IP中13.9%，在HS中23.3%。HS (P = 0.005) 和IP住院 ≤ 7天 (P = 0.007) 成为携带者的机会更高。对青霉素 (93%)，四环素 (28%) 和夫西地酸 (12%) 的耐药性比其他药物 (<5%) 更常见。与HS相比，在IP中观察到更高的多药耐药金黄色葡萄球菌携带的机会 (P = 0.01)。通过spa分型显示出很高的遗传多样性，在105个分离株中发现了55种spa类型; 主要的spa类型是t355 (10%) 和t084 (10%)。在6个IP中检测到MRSA，总体运输率约为1.3%，但在HS中未检测到MRSA。来自SD的所有三个MRSA分离株均属于ST88-SCCmec IV，其中两个显示相同的spa类型和抗生素图; 来自CHD的三个MRSA分离株属于不同的谱系 (ST88-SCCmec IV，ST8-SCCmec V和ST72-SCCmec V)。总之，这些数据表明，与该医院的HS相比，IP中金黄色葡萄球菌的多样性高，MRSA的携带水平低，并且鼻腔携带多药耐药金黄色葡萄球菌的机会更高。