Practice of Significant Event Analysis as a Vehicle of Remediation for Learners with Recognized Misconducts / 医学教育

Significant event analysis (SEA) is a method of reflecting on the cause of things in a semi-structural manner and utilizing the analysis in the planning of subsequent improvement measures. SEA can be applied to a wide variety of events. In the field of medicine, it is widely used as a tool for promoting patient safety by medical teams in nations such as the United Kingdom. In Japan, the subjects of SEA mainly reflect on their own behavior (reflection) to learn from their experience. Unlike the results of observations done by third parties, the results of self-reflection cannot be denie by the subjects. Therefore, this method is particularly suitable for events in which the actor has been greatly moved emotionally.　The first paper presents an individual SEA method that utilizes individual reflection to improve behavior, the second paper introduces a group SEA method to share lessons learned from individual reflections.

A protocol on Information-Motivation-Behavioural Skills Risk of Intensive Phase Treatment Interruption Among Pulmonary Tuberculosis Patients in Urban Districts, Selangor

@# Despite advancement of treatment modalities, Tuberculosis (TB) treatment interruption rate has globally accelerating, calling for greater framework shifting towards psychosocial intervention. Similarly, Selangor state had reported the perturbing TB treatment interruption rate, which was figured persistently above 10% in the interval year of 2014 to 2018, thus signifies an empirical assessment on Information-Motivation-Behavioural skills (IMB) determinants of TB intensive phase treatment. This study aims to determine the time to intensive phase TB treatment interruption and its prognostic factors among newly diagnosed pulmonary Tuberculosis (PTB) smear positive patients in urban district Selangor. Methods: A multi-centric prospective cohort study will recruit 695 newly diagnosed PTB smear positive patients at treatment centres in urban districts, Selangor. This study will utilize validated self-administered questionnaire and standardised data collection form (PROFORMA). At baseline, we will elicit information on IMB models constructs, additionally on socio-demographics, health service factors and clinical characteristics. Meanwhile, four points follow up will be executed to retrieve information on treatment status and time varying effects of body weight, treatment side effects, symptoms improvement and internalised stigma. Finally, survival analysis will be computed to identify the time to intensive phase treatment interruption and its prognostic factors. Conclusion: This study will enlighten IMB model determinants of intensive phase treatment interruption, hence to endeavour psychosocial elements in designing time relevant public health strategies in TB case management. Tuberculosis; Treatment interruption; Survival; Time to event analysis; IMB model

Glaucoma Progression Detection by Retinal Nerve Fiber Layer Measurement Using Scanning Laser Polarimetry: Event and Trend Analysis

PURPOSE: To evaluate the use of scanning laser polarimetry (SLP, GDx VCC) to measure the retinal nerve fiber layer (RNFL) thickness in order to evaluate the progression of glaucoma. METHODS: Test-retest measurement variability was determined in 47 glaucomatous eyes. One eye each from 152 glaucomatous patients with at least 4 years of follow-up was enrolled. Visual field (VF) loss progression was determined by both event analysis (EA, Humphrey guided progression analysis) and trend analysis (TA, linear regression analysis of the visual field index). SLP progression was defined as a reduction of RNFL exceeding the predetermined repeatability coefficient in three consecutive exams, as compared to the baseline measure (EA). The slope of RNFL thickness change over time was determined by linear regression analysis (TA). RESULTS: Twenty-two eyes (14.5%) progressed according to the VF EA, 16 (10.5%) by VF TA, 37 (24.3%) by SLP EA and 19 (12.5%) by SLP TA. Agreement between VF and SLP progression was poor in both EA and TA (VF EA vs. SLP EA, k = 0.110; VF TA vs. SLP TA, k = 0.129). The mean (+/-standard deviation) progression rate of RNFL thickness as measured by SLP TA did not significantly differ between VF EA progressors and non-progressors (-0.224 +/- 0.148 microm/yr vs. -0.218 +/- 0.151 microm/yr, p = 0.874). SLP TA and EA showed similar levels of sensitivity when VF progression was considered as the reference standard. CONCLUSIONS: RNFL thickness as measurement by SLP was shown to be capable of detecting glaucoma progression. Both EA and TA of SLP showed poor agreement with VF outcomes in detecting glaucoma progression.

A Study of Similarities Between Bloodstain Pattern Analysis and Fire Investigation In Point View of Event Analysis / 대한법의학회지

Crime scene reconstruction is the use of scientific methods, physical evidence, deductive and inductive reasoning and their interrelationships to gain explicit knowledge of the series of events that surround the commission of a crime. Event analysis is the method of crime scene reconstruction. As disciplines of crime scene reconstruction, bloodstain pattern analysis and fire investigation have many common points. Comparing bloodstain pattern analysis with fire investigation in point view of event analysis helps us to further understand crime scene reconstruction as well as bloodstain pattern analysis and fire investigation themselves. We study event analysis and apply it to cases and we seek similarities and differences between bloodstain pattern analysis and fire investigation by analyzing the methodology of both of them. In a fire scene, the point with the greatest damage is the point where the fire burned longest, which is likely to be the origin. In bloodstained scenes this approach is reversed. The greatest bloodshed point is most likely the ending point of the incident and is likely at or near the point where the bloodshed started. Above this, there are other similarities between them. Mastering the crime scene reconstruction requires long time hard training. Thus if the fire investigation experts or arson experts among crime scene investigators join the field of bloodstain pattern analysis(or reverse), then there will be many synergy effects to both of them.

High risk behaviours following alcohol use in alcohol dependent men.

Background & objectives: Heavy alcohol drinking and propensity to risk taking behaviour may both be associated with the occurrence of high risk behaviour. The present study was carried out to examine the association between high risk behaviours and alcohol abuse among patients admitted to an inpatient facility for treatment of alcohol dependence syndrome. Methods: Using event analysis technique, the prevalence and type of high risk behaviour as a consequence of a heavy drinking episode was identified among heavy drinkers. Four types of high risk behaviour namely road traffic accidents, violence, self-injurious and risky sexual behaviour were studied. Patients with and without high risk behaviour were compared on measures of severity of drinking, sensation seeking and impulsivity using addiction severity index, sensation seeking scale and Baratt’s impulsivity scale respectively. Results: In 300 subjects with alcohol dependence syndrome, the most common high risk behaviour was road traffic accident following alcohol use. In 193 (64.3%) subjects heavy drinking episode was associated with high risk behaviours. Compared to those without high risk behaviours, the subjects with high risk behaviours had higher scores on sensation seeking scale and addiction severity index. Interpretation & conclusions: Our findings indicated that there was a high prevalence of high risk behaviour following an episode of heavy drinking in male patients with alcohol dependence syndrome. Both, severity of drinking and personality factors were associated with the occurrence of high risk behaviour as a consequence of heavy drinking.

Exploring students' impressions of community medicine clerkship experience by means of significant event analysis / 医学教育

Community medicine clerkships are said to be an important element of current undergraduate medical education. However, little is known about what medical students actually learn from them.Therefore, we performed a study by means of significant event analysis to examine what medical students had learned from 2-week community medicine clerkships.<BR>1) Students in 2006 took part in 2-week community medicine clerkships and then in sessions at the end of their clerkships to review their experiences.<BR>2) The review sessions were recorded, and the students'impressions were extracted and categorized.<BR>3) The depth of their impressions was categorized into 4 depth levels (describing, commenting, generalizing, and planning).<BR>4) Students gave their impressions of the medical system, the role of physicians, patient-centered care, role models, and clinical ethics, and the impressions of most students were at the levels of commenting and generalizing.<BR>5) Medical students learned system-based practice and medical professionalism during their community medicine clerkships, and significant event analysis was a valuable tool for understanding their experiences.