• 【腹腔镜Roux-en-Y胃搭桥手术学习曲线的评估。】 复制标题 收藏 收藏
    DOI:10.1016/j.soard.2005.01.003 复制DOI
    作者列表:Shin RB
    BACKGROUND & AIMS: BACKGROUND:The literature reports that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75-100 cases. This aim of the present study was to evaluate the safety and feasibility of shortening the learning curve for performing LRYGBP by an experienced laparoscopic surgeon. METHODS:This study analyzed retrospectively the first 100 consecutive LRYGBP cases performed by an experienced laparoscopic surgeon between April 2003 and September 2003. The surgeon performed these cases after first assisting in 30 cases, and the first 4 cases were proctored by an experienced laparoscopic bariatric surgeon. Two cases done after previous gastric stapling and Nissen fundoplication were excluded from the study. Outcome variables included operative time, complications, conversion, and mortality. RESULTS:For the first 100 LRYGBP patients, the mean age was 42.6 years (range, 22-62 years) and mean body mass index (BMI) was 47.6 kg/m2 (range, 36-71.8). The complications included 1 case of intestinal leak, 1 case of small bowel obstruction, 6 cases of gastrojejunal stenosis, 8 cases of wound infection, 1 case of wound seroma, and 2 cases of pulmonary embolism, resulting in 1 mortality. One case was converted to an open technique. Over the second 50 cases, there was a significant reduction in mean operative time, to 73 minutes (range, 39-145 minutes) from 113 minutes (range, 54-238 minutes) (P < .0001). However, despite the reduction in complication frequency (no gastrointestinal leak or obstruction, 2 cases of gastrojejunal stenosis, 2 cases of wound infection, no pulmonary embolism/deep venous thrombosis, and no mortality), there was no significant correlation between the mortality, conversion, and complication rates and the surgeon's experience. CONCLUSION:A bariatric surgical practice incorporating LRYGBP can be safely done by an experienced laparoscopic surgeon. With appropriate advanced laparoscopic skills, preparatory steps, proctorship, and adequate volume of cases, the learning curve for performing LRYGBP can be reduced to 50 cases. Further experience is associated with a significant reduction in operative time with acceptable mortality, complication, and conversion rates.
    背景与目标: 背景:文献报道腹腔镜Roux-en-Y胃旁路术(LRYGBP)的学习曲线约为75-100例。本研究的目的是评估由经验丰富的腹腔镜外科医生缩短进行LRYGBP学习曲线的安全性和可行性。
    方法:本研究回顾性分析了2003年4月至2003年9月由经验丰富的腹腔镜外科医生进行的前100例连续LRYGBP病例。在首次协助30例患者之后,外科医生进行了这些病例,前4例病例由经验丰富的腹腔镜肥胖手术医师指导。该研究排除了先前进行胃吻合术和尼森胃底折叠术后完成的两个病例。结果变量包括手术时间,并发症,转化率和死亡率。
    结果:前100名LRYGBP患者的平均年龄为42.6岁(范围22-62岁),平均体重指数(BMI)为47.6 kg / m2(范围36-71.8)。并发症包括肠漏1例,小肠梗阻1例,胃空肠狭窄6例,伤口感染8例,伤口血清肿1例和肺栓塞2例,导致1例死亡。一个案例被转换为开放技术。在后50例中,平均手术时间从113分钟(54-238分钟)减少到73分钟(39-145分钟)(P <.0001)。然而,尽管并发症发生率降低(无胃肠道渗出或阻塞,2例胃肠空肠狭窄,2例伤口感染,无肺栓塞/深静脉血栓形成,无死亡率),但死亡率,转化率之间无显着相关性。 ,并发症发生率和外科医生的经验。
    结论:有经验的腹腔镜外科医生可以安全地进行结合了LRYGBP的减肥手术。借助适当的高级腹腔镜检查技巧,准备步骤,指导以及适当的病例数量,可以将进行LRYGBP的学习曲线减少到50例。进一步的经验可以显着减少手术时间,并具有可接受的死亡率,并发症和转化率。
  • 【将质量和安全纳入医学和护理学校课程并促进共同学习的努力的结果。】 复制标题 收藏 收藏
    DOI:10.1377/hlthaff.2011.0121 复制DOI
    作者列表:Headrick LA,Barton AJ,Ogrinc G,Strang C,Aboumatar HJ,Aud MA,Haidet P,Lindell D,Madigosky WS,Patterson JE
    BACKGROUND & AIMS: :Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.
    背景与目标: :医疗保健方面的改进缓慢,部分原因是医生和护士缺乏提高质量,患者安全和跨专业团队合作的技能。本文报道了Josiah Macy Jr. Foundation和医疗保健改善研究所的“质量与安全重组”倡议,该倡议旨在将改善和患者安全纳入医疗和护理学校课程。在2009-10学年的一个学年中,该计划支持了教室,模拟中心和临床护理环境中的新学习活动(其中87%是跨专业的,涉及医学和护理学的学生),涉及六所大学的1,374名学生。这项工作产生了本文中介绍的见解,其中的学习目标需要跨专业的教育;如何为所有学生创建基于临床的改进学习;以及如何证明对学生的行为,组织实践和对患者的好处的影响。该计划的一个普遍遇到的限制因素是缺乏足够数量的临床教师来准备教授改善护理的知识。而且,此类计划缺乏强有力的评估策略,这表明未来的研究议程值得资助。
  • 【多发性硬化症的记忆和学习障碍。 MRI病变与神经心理相关。】 复制标题 收藏 收藏
    DOI:10.1016/0720-048x(91)90034-s 复制DOI
    作者列表:Izquierdo G,Campoy F Jr,Mir J,Gonzalez M,Martinez-Parra C
    BACKGROUND & AIMS: :Thirty-five patients with definite multiple sclerosis (MS) were studied. They underwent neuropsychological testing and magnetic resonance imaging (MRI). The MRI findings at different brain areas levels were compared with the neuropsychological findings. A quantitative system was used to measure MRI-MS lesions. In this series, a positive correlation was established between memory and learning disturbances measured by Battery 144, and the lesions measured by MRI (total, hemispheric and, particularly, periventricular lesions). MRI can detect MS lesions, and this study shows that a correlation between MRI and neuropsychological findings is possible if quantitative methods are used to distinguish different MS involvement areas in relation to neuropsychological tasks. These findings suggest that hemispheric lesions in MS produce cognitive disturbances and MRI could be a useful tool in predicting memory and learning impairment.
    背景与目标: :研究了35例明确的多发性硬化症(MS)患者。他们接受了神经心理学测试和磁共振成像(MRI)。将不同大脑区域水平的MRI检查结果与神经心理学检查结果进行比较。定量系统用于测量MRI-MS病变。在这个系列中,通过电池144测量的记忆和学习障碍与通过MRI测量的病变(总,半球,尤其是脑室病变)之间建立了正相关。 MRI可以检测MS病变,这项研究表明,如果使用定量方法区分与神经心理学任务相关的不同MS累及区域,则MRI与神经心理学发现之间可能存在关联。这些发现表明,MS的半球病变会产生认知障碍,而MRI可能是预测记忆和学习障碍的有用工具。
  • 【行动中学习:通过行动学习来开发安全改进功能。】 复制标题 收藏 收藏
    DOI:10.1016/j.nedt.2013.07.008 复制DOI
    作者列表:Christiansen A,Prescott T,Ball J
    BACKGROUND & AIMS: :Patient safety is one of the greatest challenges facing health care today and nurses are well placed to find opportunities for enhancing care and making it safer. Nurse education has an important role to play in ensuring future professions have capabilities and confidence to meet this challenge however this requires new pedagogies in nurse education. This paper reports on an initiative to develop the safety improvement and leadership capabilities of final year nursing students using Action Learning to support students to undertake a safety improvement project in the clinical setting. A qualitative, interpretive research approach was used to explore students' experiences of participation in Action Learning. 52 nursing students from a UK University participated in the study. Student accounts of their experiences were generated through focus group and individual interviews and data were subject to thematic analysis. Findings are discussed in relation to three categories including "creating an enabling environment", "learning through action and reflection" and "the emergence of safety improvement and leadership practices." The study findings provide valuable insights into how AL processes can engender personal leadership capabilities and support students to make a valuable contribution to safer care practices, both as students and as future health care professionals.
    背景与目标: :患者的安全性是当今医疗保健面临的最大挑战之一,护士已准备好寻找机会来加强护理并使其更加安全。护士教育在确保未来的职业具有应对这一挑战的能力和信心方面可发挥重要作用,但这需要在护士教育中采用新的教学法。本文报告了一项旨在通过行动学习来发展最终护理学生的安全改进和领导能力的倡议,以支持学生在临床环境中开展安全改进项目。使用定性,解释性研究方法来探索学生参与行动学习的经验。来自英国大学的52名护理专业学生参加了这项研究。通过专题小组对学生的经历进行描述,并通过专题访谈对个人访谈和数据进行分析。讨论了与三个类别有关的发现,包括“创造有利的环境”,“通过行动和反思进行学习”以及“安全改进和领导实践的出现”。研究结果为AL过程如何增强个人领导能力和支持学生(无论是作为学生还是将来的医疗保健专业人员)对更安全的护理实践做出了宝贵的贡献提供了宝贵的见解。
  • 5 Motor learning: the FoxP2 puzzle piece. 复制标题 收藏 收藏

    【运动学习:FoxP2拼图。】 复制标题 收藏 收藏
    DOI:10.1016/j.cub.2008.02.048 复制DOI
    作者列表:Teramitsu I,White SA
    BACKGROUND & AIMS: :Mutation of the DNA-binding region of the FOXP2 protein causes an inherited language disorder. A recent study provides the first data on mice with this mutation, which exhibit deficits in motor-skill learning and abnormal properties of neural circuits that contribute to these skills.
    背景与目标: :FOXP2蛋白的DNA结合区的突变会导致遗传性语言障碍。最近的一项研究提供了具有这种突变的小鼠的首批数据,这些小鼠表现出运动技能学习的缺陷和有助于这些技能的神经回路异常特性。
  • 【学习和巩固帕金森氏病中的视觉运动适应性。】 复制标题 收藏 收藏
    DOI:10.1016/j.parkreldis.2008.02.012 复制DOI
    作者列表:Marinelli L,Crupi D,Di Rocco A,Bove M,Eidelberg D,Abbruzzese G,Ghilardi MF
    BACKGROUND & AIMS: :We have previously shown in normal subjects that motor adaptation to imposed visual rotation is significantly enhanced when tested few days later. This occurs through a process of sleep-dependent memory consolidation. Here we ascertained whether patients with Parkinson's disease (PD) learn, improve, and retain new motor skills in the same way as normal subjects. We tested 16 patients in early stages of PD and 21 control subjects over two days. All subjects performed reaching movements on a digitizing tablet. Vision of the limb was precluded with an opaque screen; hand paths were shown on the screen with the targets' position. Unbeknownst to the subjects, the hand path on the screen was rotated by 30 degrees . In experiment 1, patients taking dopaminergic treatment and controls adapted to rotation with targets appearing in an unpredictable order. In experiment 2, drug-naïve patients and controls adapted to rotation in a less challenging task where target's appearance was predictable. Patients and controls made similar movements and adapted to rotation in the same way. However, when tested again over the following days, controls' performance significantly improved compared to training, while patients' performance did not. This lack of consolidation, which is present in the early stages of the disease and is independent from therapy, may be due to abnormal homeostatic processes that occur during sleep.
    背景与目标: :我们之前在正常受试者中显示,几天后进行测试后,运动适应视觉旋转的能力会大大增强。这是通过依赖于睡眠的内存合并过程来发生的。在这里,我们确定帕金森氏病(PD)的患者是否以与正常受试者相同的方式学习,改善和保留新的运动技能。我们在两天内测试了PD早期的16例患者和21例对照对象。所有对象均在数字化平板电脑上进行了移动动作。不透明的屏幕无法显示四肢的视力;屏幕上显示了目标位置的手形路径。被摄对象不知道,屏幕上的手部路径旋转了30度。在实验1中,接受多巴胺能治疗和控制的患者适应了旋转,并且靶标以无法预测的顺序出现。在实验2中,没有药物治疗的患者和对照组在难以预测的任务中适应了旋转,其中目标的出现是可预测的。患者和对照者进行相似的运动,并以相同的方式适应旋转。但是,在接下来的几天中再次进行测试时,与训练相比,对照组的表现显着改善,而患者的表现却没有。这种缺乏固结的现象是在疾病的早期阶段出现的,并且与治疗无关,这可能是由于睡眠期间发生的异常体内平衡过程引起的。
  • 【了解环境几何:关联模型。】 复制标题 收藏 收藏
    DOI:10.1037/0097-7403.33.3.191 复制DOI
    作者列表:Miller NY,Shettleworth SJ
    BACKGROUND & AIMS: :K. Cheng (1986) suggested that learning the geometry of enclosing surfaces takes place in a geometric module blind to other spatial information. Failures to find blocking or overshadowing of geometry learning by features near a goal seem consistent with this view. The authors present an operant model in which learning spatial features competes with geometry learning, as in the Rescorla-Wagner model. Relative total associative strength of cues at a location determines choice of that location and thus the frequencies of reward paired with each cue. The model shows how competitive learning of local features and geometry can appear to result in potentiation, blocking, or independence, depending on enclosure shape and kind of features. The model reproduces numerous findings from dry arenas and water mazes.
    背景与目标: :K Cheng(1986)建议,学习封闭表面的几何形状是在对其他空间信息不了解的几何模块中进行的。未能通过目标附近的要素找到阻碍或过度学习几何学习的现象似乎与此视图一致。作者提出了一个操作模型,其中与Rescorla-Wagner模型一样,学习空间特征与几何学习竞争。某个位置的提示的相对总关联强度决定了该位置的选择,并因此决定了与每个提示配对的奖励频率。该模型显示了根据局部形状和特征种类,竞争性学习局部特征和几何形状会如何导致增强,阻断或独立性。该模型重现了来自干竞技场和迷宫般的大量发现。
  • 【向其他国家学习:卫生政策的随时待命工具。】 复制标题 收藏 收藏
    DOI:10.1258/jhsrp.2007.007146 复制DOI
    作者列表:Nolte E,Ettelt S,Thomson S,Mays N
    BACKGROUND & AIMS: :Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.
    背景与目标: :卫生部认识到其他国家/地区强大的卫生系统信息可以为英国国家卫生服务局提供宝贵的经验,因此在2005年委托一个学术团队提供“国际医疗比较的待命服务”。这种新颖的方法来指导政策并回顾前两年的经验。它说明了卫生系统比较分析中有据可查的挑战。一个重要的问题是了解卫生系统的背景情况,以便解释现象并得出适当的政策结论。其他挑战包括学术兴趣和严格性之间的潜在紧张关系,以及需要及时分析以告知卫生部迅速变化的政策议程的挑战。所涉主题的多样性和性质以及快速的周转时间,意味着该基金必须认真权衡严格性和及时性,以确保报告的价值和相关性。强大的研究基础与国家专家的国际网络相联系,促进了以相对较低的成本提供高质量的分析。但是,只有为其他基础研究提供了范围,这样的安排才能维持下去。目前尚无关于英格兰对卫生保健政策制定影响的正式评估。这些知识对于开发其他地方的类似资源至关重要。
  • 【机器学习和生物医学领域的单词歧义消除:设计和评估问题。】 复制标题 收藏 收藏
    DOI:10.1186/1471-2105-7-334 复制DOI
    作者列表:Xu H,Markatou M,Dimova R,Liu H,Friedman C
    BACKGROUND & AIMS: BACKGROUND:Word sense disambiguation (WSD) is critical in the biomedical domain for improving the precision of natural language processing (NLP), text mining, and information retrieval systems because ambiguous words negatively impact accurate access to literature containing biomolecular entities, such as genes, proteins, cells, diseases, and other important entities. Automated techniques have been developed that address the WSD problem for a number of text processing situations, but the problem is still a challenging one. Supervised WSD machine learning (ML) methods have been applied in the biomedical domain and have shown promising results, but the results typically incorporate a number of confounding factors, and it is problematic to truly understand the effectiveness and generalizability of the methods because these factors interact with each other and affect the final results. Thus, there is a need to explicitly address the factors and to systematically quantify their effects on performance. RESULTS:Experiments were designed to measure the effect of "sample size" (i.e. size of the datasets), "sense distribution" (i.e. the distribution of the different meanings of the ambiguous word) and "degree of difficulty" (i.e. the measure of the distances between the meanings of the senses of an ambiguous word) on the performance of WSD classifiers. Support Vector Machine (SVM) classifiers were applied to an automatically generated data set containing four ambiguous biomedical abbreviations: BPD, BSA, PCA, and RSV, which were chosen because of varying degrees of differences in their respective senses. Results showed that: 1) increasing the sample size generally reduced the error rate, but this was limited mainly to well-separated senses (i.e. cases where the distances between the senses were large); in difficult cases an unusually large increase in sample size was needed to increase performance slightly, which was impractical, 2) the sense distribution did not have an effect on performance when the senses were separable, 3) when there was a majority sense of over 90%, the WSD classifier was not better than use of the simple majority sense, 4) error rates were proportional to the similarity of senses, and 5) there was no statistical difference between results when using a 5-fold or 10-fold cross-validation method. Other issues that impact performance are also enumerated. CONCLUSION:Several different independent aspects affect performance when using ML techniques for WSD. We found that combining them into one single result obscures understanding of the underlying methods. Although we studied only four abbreviations, we utilized a well-established statistical method that guarantees the results are likely to be generalizable for abbreviations with similar characteristics. The results of our experiments show that in order to understand the performance of these ML methods it is critical that papers report on the baseline performance, the distribution and sample size of the senses in the datasets, and the standard deviation or confidence intervals. In addition, papers should also characterize the difficulty of the WSD task, the WSD situations addressed and not addressed, as well as the ML methods and features used. This should lead to an improved understanding of the generalizablility and the limitations of the methodology.
    背景与目标: 背景:字词歧义消除(WSD)在生物医学领域对于提高自然语言处理(NLP),文本挖掘和信息检索系统的精度至关重要,因为模棱两可的单词会对准确访问包含生物分子实体(例如基因)的文献产生负面影响蛋白质,细胞,疾病和其他重要实体。已经开发出自动技术来解决许多文本处理情况下的WSD问题,但是该问题仍然是一个具有挑战性的问题。有监督的WSD机器学习(ML)方法已应用于生物医学领域,并显示出令人鼓舞的结果,但是结果通常包含许多混杂因素,并且由于这些因素相互作用,真正了解这些方法的有效性和可推广性是有问题的彼此影响最终结果。因此,需要明确解决这些因素并系统地量化其对性能的影响。
    结果:设计了实验来测量“样本量”(即数据集的大小),“感官分布”(即歧义词的不同含义的分布)和“难易程度”(即歧义词的含义之间的距离)对WSD分类器的性能。支持向量机(SVM)分类器应用于自动生成的数据集,该数据集包含四个歧义生物医学缩写:BPD,BSA,PCA和RSV,这是由于它们各自含义上的差异程度不同而选择的。结果表明:1)增加样本大小通常会降低错误率,但这主要限于良好分离的感官(即,感官之间的距离较大的情况);在困难的情况下,需要极大地增加样本数量以略微提高性能,这是不切实际的; 2)当感官可分离时,感官分布对性能没有影响; 3)当多数感官超过90时%,WSD分类器并不比使用简单多数感官更好; 4)错误率与各种感官的相似性成正比; 5)当使用5倍或10倍交叉比对时,结果之间没有统计学差异验证方法。还列举了影响性能的其他问题。
    结论:将ML技术用于WSD时,有几个不同的独立方面会影响性能。我们发现将它们组合成一个单一的结果会模糊对基本方法的理解。尽管我们仅研究了四个缩写,但我们使用了一种完善的统计方法,该方法可以保证结果对于具有相似特征的缩写很可能是可推广的。我们的实验结果表明,为了了解这些ML方法的性能,至关重要的是,论文要报告基线性能,数据集中感官的分布和样本大小以及标准偏差或置信区间。此外,论文还应描述WSD任务的难度,WSD解决和未解决的WSD情况以及所使用的ML方法和功能。这应该导致人们对通用性和方法的局限性有了更好的了解。
  • 【广泛耐药结核病:我们是在学习历史还是在重复历史?】 复制标题 收藏 收藏
    DOI:10.1086/519292 复制DOI
    作者列表:Dukes Hamilton C,Sterling TR,Blumberg HM,Leonard M,McAuley J,Schlossberg D,Stout J,Huitt G
    BACKGROUND & AIMS: :Tuberculosis (TB) is an enormous global public health problem. Cases of extensively drug-resistant TB (XDR-TB) are being reported in increasing numbers across the globe. A large outbreak of XDR-TB associated with rapid and nearly universal mortality has been reported among patients with human immunodeficiency virus infection or acquired immunodeficiency disease in South Africa who have been receiving standard TB therapy and antiretrovirals. Epidemiologic features of this outbreak make it highly suspicious for health care-associated transmission. We urge the Infectious Diseases Society of America and its members to increase involvement in ongoing international TB prevention and treatment efforts and to develop a registry of experts in infection control and laboratory and disease management. We urge advocacy for increased funding for domestic and global TB control programs, including expanded access to sputum culture and drug susceptibility testing, as well as funding for TB clinical trials and research capacity. We believe that substandard TB diagnostic tests are not acceptable for TB control in resource-poor countries. We urge the development of shorter, less toxic TB treatment and prevention regimens. Funding of TB control and research should be reassessed to prevent budget cuts at a time when the disease is killing as many as 2 million people a year.
    背景与目标: 结核病(TB)是一个巨大的全球公共卫生问题。在全球范围内,越来越多的人报告了广泛耐药的结核病(XDR-TB)病例。在南非,已经接受标准结核病治疗和抗逆转录病毒药物治疗的人类免疫缺陷病毒感染或获得性免疫缺陷疾病患者中,广泛的XDR-TB暴发已被报道。该暴发的流行病学特征使其高度怀疑与卫生保健有关的传播。我们敦促美国传染病学会及其成员增加对正在进行的国际结核病预防和治疗工作的参与,并发展感染控制以及实验室和疾病管理方面的专家名录。我们敦促倡导为国内和全球结核病控制计划增加资金,包括扩大对痰培养和药物敏感性测试的访问,以及为结核病临床试验和研究能力提供资金。我们认为,在资源匮乏的国家,不合格的结核病诊断检测对于控制结核病是不可接受的。我们敦促开发更短,毒性更小的结核病治疗和预防方案。在结核病每年导致多达200万人死亡的时候,应该重新评估结核病控制和研究的资金,以防止预算削减。
  • 【收集经验丰富的专业知识来支持糖尿病患者的安全驾驶:一项由同伴在一项调查中评估的定性研究。】 复制标题 收藏 收藏
    DOI:10.1007/BF03262497 复制DOI
    作者列表:Burda MH,van der Horst F,van den Akker M,Stork AD,Mesters I,Bours S,Ploeg M,Winkens B,Knottnerus JA
    BACKGROUND & AIMS: BACKGROUND:Hypoglycemia is a frequent phenomenon in people being treated for diabetes mellitus, which can acutely disrupt driving performance. For the benefit of personal and public traffic safety, we decided to identify successful diabetes-related (SDR) behaviors to support safe driving for people with diabetes, from the perspective of experiential experts with diabetes mellitus. Experiential experts are people who can manage their own illness and conditions by developing expertise relevant to maintaining health and countering illness, and who are able to use this expertise to the benefit of peers. OBJECTIVE:The aim of our study was to objectify and systematize experiential expertise in terms of SDR behaviors, based on reports by experiential experts, to support safe driving for people with type 1 and type 2 diabetes mellitus. The emphasis was on preventing hypoglycemia as a short-term complication during driving. METHODS:We performed a mixed-methods study involving (i) semi-structured in-depth interviews with 33 experiential experts with diabetes mellitus from the Dutch Diabetes Association (DVN; Diabetesvereniging Nederland), in order to identify SDR behaviors regarding safe driving, and (ii) a validation study by means of a survey among a panel of 98 experiential experts (peers) from the DVN, to determine the extent to which they agreed with the communicability, importance, and feasibility of these behaviors for drivers with diabetes mellitus. RESULTS:We identified a comprehensive set of 11 SDR behaviors, differentiated into seven general and four specific behaviors, to support safe driving. The general behaviors concern the following topics: (i) acquiring knowledge and information; (ii) acquiring and using self-measuring of blood glucose (SMBG) equipment; (iii) knowing one's physical response pattern; (iv) obtaining knowledge about the medication used; (v) preventing long-term eye complications; (vi) influencing factors that can affect blood glucose; and (vii) renewal procedure for driving license. The four specific behaviors refer to the following topics: (i) measures to be taken before driving; (ii) responding effectively to hypoglycemia while driving; (iii) informing and instructing passengers; and (iv) preventing hypoglycemia in drivers with type 2 diabetes mellitus not using SMBG equipment. Key factors for safe driving proved to be the ability of drivers to anticipate and respond effectively to hypoglycemia while driving and to inform and instruct fellow passengers. Participants of the validation survey agreed to a considerable degree with the communicability, importance, and feasibility of these behaviors to support safe driving for people with diabetes mellitus. CONCLUSIONS:This study resulted in the identification and description of SDR behaviors to support safe driving. It proved possible to operationalize experiential expertise in terms of such behaviors. The next step is to have these behaviors validated by professional care providers in the field of diabetes, followed by translation into recommendations in self-management programs.
    背景与目标: 背景:低血糖症在接受糖尿病治疗的人们中很常见,会严重破坏驾驶性能。为了个人和公共交通安全,我们决定从经验丰富的糖尿病专家的角度确定成功的糖尿病相关(SDR)行为,以支持糖尿病人安全驾驶。经验丰富的专家可以通过发展与维护健康和对抗疾病有关的专业知识来管理自己的疾病和状况,并能够利用这些专业知识来为同行带来好处。
    目的:我们的研究目的是根据经验专家的报告,对SDR行为进行客观化和系统化的专门知识,以支持1型和2型糖尿病患者的安全驾驶。重点是预防驾驶过程中的短期并发症即低血糖症。
    方法:我们进行了一项混合方法研究,涉及(i)对来自荷兰糖尿病协会(DVN; Diabetesvereniging Nederland)的33位糖尿病专家进行的半结构化深度访谈,以确定与安全驾驶有关的SDR行为,以及(ii)通过对来自DVN的98位经验丰富的专家(同行)进行的调查来进行验证研究,以确定他们在多大程度上同意这些行为对于糖尿病驾驶员的可传播性,重要性和可行性。
    结果:我们确定了11种SDR行为的综合集合,分为7种一般行为和4种特定行为,以支持安全驾驶。一般行为涉及以下主题:(i)获取知识和信息; (ii)获取和使用自我测量的血糖仪(SMBG); (iii)了解一个人的身体反应方式; (iv)获得有关所用药物的知识; (v)预防眼部长期并发症; (vi)可能影响血糖的影响因素; (vii)驾驶执照的续签程序。四种具体行为涉及以下主题:(i)驾驶前应采取的措施; (ii)驾驶时有效应对低血糖; (iii)通知和指示乘客; (iv)预防不使用SMBG设备的2型糖尿病驾驶员的低血糖症。事实证明,安全驾驶的关键因素是驾驶员在驾驶时能够预见和有效应对低血糖以及告知和指导同伴的能力。验证调查的参与者在相当程度上同意这些行为的可传播性,重要性和可行性,以支持糖尿病人的安全驾驶。
    结论:本研究确定并描述了支持安全驾驶的SDR行为。事实证明,可以根据这种行为来操作经验专业知识。下一步是使这些行为得到糖尿病领域专业护理人员的验证,然后转化为自我管理计划中的建议。
  • 【向饥饿的学习者分发菜单:通过模拟学习可以成为学习的模拟吗?】 复制标题 收藏 收藏
    DOI:10.1080/01421590601042335 复制DOI
    作者列表:Bligh J,Bleakley A
    BACKGROUND & AIMS: :Simulation offers an important context for clinical education, providing a structured, safe and supportive environment bridging the classroom and the clinic. Two trends in the simulation community appear to be developing uncritically and without adequate evaluation. First, there is a fascination with seductive high-fidelity simulation realized through sophisticated technology. Second, simulation has increasingly appropriated learning in the psychological domain, such as communication skills, under the rationale of 'integration'. Developments in simulation activities have largely been made in a theoretical vacuum and where theory is invoked it is learning theory rather than theory of simulation. This paper introduces theories of simulation from cultural studies as a critical balance to the claims of the simulation community. Work-based and simulation-based learning could engage in a new dialogue for an effective clinical education.
    背景与目标: :模拟为临床教育提供了重要的环境,为架设教室和诊所提供了结构化,安全和支持性的环境。在模拟社区中,有两种趋势似乎正在不加批判地发展,并且没有进行充分的评估。首先,对通过复杂技术实现的诱人的高保真度模拟着迷。其次,在“整合”的基本原理下,模拟越来越适合在心理学领域中进行学习,例如交流技巧。模拟活动的发展很大程度上是在理论真空中进行的,在其中调用理论的是学习理论而不是模拟理论。本文介绍了文化研究中的模拟理论,作为对模拟社区主张的重要平衡。基于工作和基于模拟的学习可以参与新的对话,以进行有效的临床教育。
  • 【P物质及其在控制学习,焦虑和功能恢复的神经机制中的作用。】 复制标题 收藏 收藏
    DOI:10.1054/npep.2000.0824 复制DOI
    作者列表:Hasenöhrl RU,Souza-Silva MA,Nikolaus S,Tomaz C,Brandao ML,Schwarting RK,Huston JP
    BACKGROUND & AIMS: :The neurokinin Substance P (SP) is widely distributed in the central nervous system and has been extensively studied in various functional aspects. This review focuses on the behavioral relevance of SP. Here we show that SP can have memory-promoting, reinforcing and anxiolytic-like effects when administered systemically or into the nucleus basalis of the ventral pallidum. These effects seem to be mediated via the SP-preferring NK(1)receptor and differentially related to N- versus C-terminal fragments of the undecapeptide. Secondly, SP injection into the ventral pallidum can lead to increases of acetylcholine in frontal cortex and dopamine in nucleus accumbens, suggesting that the hypermnestic, positively reinforcing and anxiolytic effects observed upon basal forebrain injection of SP are mediated by activation of the nucleus accumbens-ventral pallidum circuitry. Furthermore, SP and certain SP-fragments may not only be considered to have beneficial behavioral effects in normal animals, but can also prevent lesion-induced functional deficits and improve the speed of recovery. This indicates that SP agonists might also have a neuroprotective capacity in parallel with recovery-promoting actions.
    背景与目标: :神经激肽P(SP)广泛分布于中枢神经系统,并已在各个功能方面进行了广泛研究。这篇综述着重于SP的行为相关性。在这里我们表明,当全身或腹侧苍白球的核基底层给药时,SP可以具有促进记忆,增强和抗焦虑的作用。这些作用似乎是通过SP优先的NK(1)受体介导的,并且与十一肽的N端和C端片段差异相关。其次,向腹侧苍白球注射SP可导致额叶皮层中的乙酰胆碱和伏隔核中的多巴胺增加,表明基础前脑注射SP时观察到的高记忆力,正增强和抗焦虑作用是由伏隔核-腹侧神经的激活介导的。苍白的电路。此外,SP和某些SP片段不仅可以被认为在正常动物中具有有益的行为效果,而且还可以防止病变引起的功能缺陷并提高恢复速度。这表明SP激动剂可能还具有促进恢复作用的神经保护能力。
  • 【经颅多天的直流电刺激改善了新词汇的学习和维持。】 复制标题 收藏 收藏
    DOI:10.1016/j.cortex.2013.07.013 复制DOI
    作者列表:Meinzer M,Jähnigen S,Copland DA,Darkow R,Grittner U,Avirame K,Rodriguez AD,Lindenberg R,Flöel A
    BACKGROUND & AIMS: INTRODUCTION:Recently, growing interest emerged in the enhancement of human potential by means of non-invasive brain stimulation. In particular, anodal transcranial direct current stimulation (atDCS) has been shown to exert beneficial effects on motor and higher cognitive functions. However, the majority of transcranial direct current stimulation (tDCS) studies have assessed effects of single stimulation sessions that are mediated by transient neural modulation. Studies assessing the impact of multiple stimulation sessions on learning that may induce long-lasting behavioural and neural changes are scarce and have not yet been accomplished in the language domain in healthy individuals. METHOD:The present study probed the potential of atDCS to enhance language learning over multiple days by employing an explicit word learning paradigm. Forty healthy young participants were randomized to learning with either simultaneous atDCS or sham stimulation (N = 20/group; comparable regarding demographic variables and neurocognitive status). All participants acquired a novel vocabulary (familiar and novel object picture - non-word pairs) over five consecutive days. Two memory tasks (free recall; forced choice recognition tasks) were administered immediately after each training session. A one week follow-up tested the maintenance of learning success. RESULTS:Linear mixed effects model analysis revealed superior learning during atDCS compared to sham stimulation for both familiar and novel objects. atDCS yielded a steeper learning curve and significantly more pronounced learning at the end of the training during the recall task. During the recognition task, the atDCS group reached ceiling levels earlier and overall learning success was greater. For both tasks, beneficial atDCS effects were maintained during the follow-up assessment. CONCLUSIONS:The present study provides direct evidence that atDCS administered during multiple learning sessions facilitates language learning and that effects are maintained over time. This study contributes important novel information about the extent of stimulation effects in the healthy brain, thereby highlighting the potential of atDCS to enhance language recovery after stroke.
    背景与目标: 简介:最近,人们越来越关注通过无创性脑刺激来增强人类潜能。特别是,阳极经颅直流电刺激(atDCS)已显示出对运动和更高的认知功能产生有益作用。但是,大多数经颅直流电刺激(tDCS)研究已经评估了由短暂神经调节介导的单个刺激阶段的效果。评估多种刺激对学习的影响的研究可能会导致持久的行为和神经变化,但目前尚缺乏健康人在语言领域进行的研究,这些研究尚未完成。
    方法:本研究探讨了atDCS通过采用显式单词学习范例在多天内增强语言学习的潜力。四十名健康的年轻参与者被随机分配到同时进行DCS或假刺激的学习中(N = 20 /组;在人口统计学变量和神经认知状态方面具有可比性)。所有参与者都连续五天获得了新颖的词汇表(熟悉的事物和新颖的事物图片-非单词对)。每次训练后,立即执行两个记忆任务(自由回忆;强制选择识别任务)。为期一周的随访测试了学习成功的维持情况。
    结果:线性混合效应模型分析显示,与熟悉刺激和新颖物体的假刺激相比,atDCS期间的学习效果更好。在召回任务期间的培训结束时,atDCS产生了更陡峭的学习曲线,并且学习效果明显提高。在识别任务期间,atDCS组更早达到最高级别,并且整体学习成功更大。对于这两项任务,在后续评估期间都保持了atDCS的有益效果。
    结论:本研究提供了直接的证据,表明在多次学习中使用atDCS可以促进语言学习,并且效果会随着时间的推移而保持。这项研究提供了有关健康大脑中刺激作用程度的重要新信息,从而突出了atDCS增强中风后语言恢复的潜力。
  • 【培训麻醉学住院医师为清醒的开颅手术提供麻醉:学习曲线并估计所需病例数。】 复制标题 收藏 收藏
    DOI:10.1016/j.jclinane.2013.01.012 复制DOI
    作者列表:Bilotta F,Titi L,Lanni F,Stazi E,Rosa G
    BACKGROUND & AIMS: STUDY OBJECTIVE:To measure the learning curves of residents in anesthesiology in providing anesthesia for awake craniotomy, and to estimate the case load needed to achieve a "good-excellent" level of competence. DESIGN:Prospective study. SETTING:Operating room of a university hospital. SUBJECTS:7 volunteer residents in anesthesiology. MEASUREMENTS:Residents underwent a dedicated training program of clinical characteristics of anesthesia for awake craniotomy. The program was divided into three tasks: local anesthesia, sedation-analgesia, and intraoperative hemodynamic management. The learning curve for each resident for each task was recorded over 10 procedures. Quantitative assessment of the individual's ability was based on the resident's self-assessment score and the attending anesthesiologist's judgment, and rated by modified 12 mm Likert scale, reported ability score visual analog scale (VAS). This ability VAS score ranged from 1 to 12 (ie, very poor, mild, moderate, sufficient, good, excellent). The number of requests for advice also was recorded (ie, resident requests for practical help and theoretical notions to accomplish the procedures). MAIN RESULTS:Each task had a specific learning rate; the number of procedures necessary to achieve "good-excellent" ability with confidence, as determined by the recorded results, were 10 procedures for local anesthesia, 15 to 25 procedures for sedation-analgesia, and 20 to 30 procedures for intraoperative hemodynamic management. CONCLUSIONS:Awake craniotomy is an approach used increasingly in neuroanesthesia. A dedicated training program based on learning specific tasks and building confidence with essential features provides "good-excellent" ability.
    背景与目标: 目的:测量麻醉学中为清醒开颅手术提供麻醉的居民的学习曲线,并评估达到“卓越”水平所需的病案负荷。
    设计:前瞻性研究。
    地点:大学医院的手术室。
    受试者:7名麻醉学志愿者。
    测量:居民接受了清醒开颅手术麻醉临床特征的专门培训计划。该程序分为三个任务:局部麻醉,镇静镇痛和术中血流动力学管理。在10个步骤中记录了每个居民每个任务的学习曲线。对个人能力的定量评估基于居民的自我评估得分和主治麻醉师的判断,并通过改良的12毫米李克特量表,报告的能力得分视觉模拟量表(VAS)进行评估。此功能的VAS分数介于1到12之间(即非常差,中等,中等,足够,良好,非常好)。还记录了咨询请求的数量(即居民要求提供实际帮助和完成程序的理论观念)。
    主要结果:每项任务都有特定的学习率。根据记录的结果确定,要有信心达到“优秀”能力所必需的操作数为:局部麻醉10例,镇静镇痛15到25例,术中血流动力学管理20到30例。
    结论:清醒颅骨切开术是一种越来越多地用于神经麻醉的方法。基于学习特定任务并建立具有基本特征的自信心的专门培训计划可提供“出色”的能力。

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