Tele-education by an orthopedic specialist increased the confidence in orthopedics of a general practitioner at a rural solo-practice clinic / Journal of Rural Medicine

Objective: General practitioners in rural clinics are required to deal with musculoskeletal problems, but they often lack the confidence. We aim to confirm changes in their confidence in orthopedic practices after using tele-education.Materials and Methods: We conducted tele-education in orthopedic practices from June 1, 2022, to November 30, 2022. Using a teleconference system, the first author, an orthopedic specialist, provided tele-education training to an independent general practitioner in a rural clinic. We adopted a 7-point Likert scale to assess the general practitioner’s confidence levels. In pre- and post-research, the counts and confidence levels in the scale were assessed for 18 types of orthopedic practices each month. Furthermore, we interviewed the general practitioner to examine the factors influencing their confidence.Results: The confidence levels increased for all measurement items. The most experienced orthopedic practice was “Advising on daily care for musculoskeletal problems”, with confidence levels increasing from 3 to 6. The least experienced orthopedic practice was “Manipulative reduction of radial head subluxation”, with confidence levels increasing from 4 to 5. The factors that influenced the change in confidence levels were regular feedback and unrestricted availability of consultations.Conclusion: Tele-education in orthopedics may enhance general practitioners’ confidence in orthopedic practices.

Hospice Care with Chinese Characteristics from the Perspective of Comparison between Chinese and Western Cultures / 中国医学伦理学

Due to the difference of cultural background, the psychological, social and spiritual needs of dying people are very different, so there are great differences in the care and nursing concept of dying people in different countries and nationalities. In order to construct the modern hospice care, we should actively learn from the western experience, but more important is to dig the local ideological resources from the traditional culture, build a set of caring care theory and practice rooted in China and originated from the concept of a good end of Chinese traditional culture, with the characteristics of the times and the cultural confidence of the Chinese nation, serving the Chinese people, and with Chinese characteristics.

Is the Bland-Altman plot method useful without inferences for accuracy, precision, and agreement?

ABSTRACT OBJECTIVE This study aims to propose a comprehensive alternative to the Bland-Altman plot method, addressing its limitations and providing a statistical framework for evaluating the equivalences of measurement techniques. This involves introducing an innovative three-step approach for assessing accuracy, precision, and agreement between techniques, which enhances objectivity in equivalence assessment. Additionally, the development of an R package that is easy to use enables researchers to efficiently analyze and interpret technique equivalences. METHODS Inferential statistics support for equivalence between measurement techniques was proposed in three nested tests. These were based on structural regressions with the goal to assess the equivalence of structural means (accuracy), the equivalence of structural variances (precision), and concordance with the structural bisector line (agreement in measurements obtained from the same subject), using analytical methods and robust approach by bootstrapping. To promote better understanding, graphical outputs following Bland and Altman's principles were also implemented. RESULTS The performance of this method was shown and confronted by five data sets from previously published articles that used Bland and Altman's method. One case demonstrated strict equivalence, three cases showed partial equivalence, and one showed poor equivalence. The developed R package containing open codes and data are available for free and with installation instructions at Harvard Dataverse at https://doi.org/10.7910/DVN/AGJPZH. CONCLUSION Although easy to communicate, the widely cited and applied Bland and Altman plot method is often misinterpreted, since it lacks suitable inferential statistical support. Common alternatives, such as Pearson's correlation or ordinal least-square linear regression, also fail to locate the weakness of each measurement technique. It may be possible to test whether two techniques have full equivalence by preserving graphical communication, in accordance with Bland and Altman's principles, but also adding robust and suitable inferential statistics. Decomposing equivalence into three features (accuracy, precision, and agreement) helps to locate the sources of the problem when fixing a new technique.

The influence of psychological readiness of athletes when returning to sport after injury

Background: Injuries are a common occurrence in sports participation; however, they have the potential to be accompanied by negative thoughts and feelings, which may play a part in the athletes' state of mind when they return to their sport. Assessing the degree to which this occurs provides an opportunity to evaluate and address athletes' state of mind before their return to play. Objectives: To determine if athletes are psychologically ready to return to play after an injury and if there are differences in fear avoidance behaviour between those who were and were not ready to return. Methods: Eighty-eight athletes participated in this descriptive survey. Athletes' confidence to return to play was measured by the Injury-Psychological Readiness to Return to Play (I-PRRS) questionnaire and their fear avoidance was measured by the Athlete Fear Avoidance Questionnaire (AFAQ). Results: Fifty injured athletes with a mean age of 23.3±4.0 years old responded to the I-PRRS and the AFAQ questionnaires. The average I-PRRS score was 46.5±9.1 AU. The evidence suggests that 60% of the athletes were not ready to return to sport (41.0±7.5 AU), whereas 40% were ready to return (54.8±3.1 AU). The difference in scores was not significant. The relationship between the AFAQ scores and the I-PRRS score for the 'ready' and 'not ready' groups was not significant (p=0.066). The mean AFAQ score (26.1±8.6 AU) for the 'not ready' group is marginally greater than the mean AFAQ score (21.6±7.5 AU) for the 'ready' group. There was a negative correlation between psychological readiness to return to sport and athletic fear avoidance (r =-0.508, p<0.001). Conclusion: There needs to be a greater utilisation of psychological assessment tools like the Injury-Psychological Readiness to Return to Play (I-PRRS) questionnaire, which can assist the athlete's support team, who can help identify athletes who are apprehensive about returning to sport after injury.

Estado de vacunación en pacientes con riesgo de enfermedades invasoras por bacterias capsuladas en un hospital pediátrico de Buenos Aires / Vaccination status in patients at risk for invasive disease with encapsulated bacteria at a children's hospital in the City of Buenos Aires

Introducción. El Ministerio de Salud contempla vacunas específicas para personas con riesgo elevado de infecciones invasoras por bacterias capsuladas (BC). En la actualidad se desconoce el cumplimiento del programa. El objetivo fue evaluar el estado de vacunación para BC en ≤ 18 años con factores de riesgo. Población y métodos. Estudio observacional, analítico, mediante encuesta a padres de ≤ 18 años con VIH, asplenia y/o déficit de complemento que concurrieron al vacunatorio de un hospital pediátrico de octubre de 2020 a septiembre de 2021. Se recabaron datos sociodemográficos y clínicos. Se evaluó el estado de vacunación para BC: neumococo, meningococo y Haemophilus influenzae b (Hib), calendario regular y antigripal. Se administró la escala de reticencia a la vacunación (ERV): rango 10-50. Se analizó la asociación entre las variables estudiadas y la vacunación para BC mediante regresión logística (OR, IC95%). Se utilizó la base datos REDCap® y STATA vs14®. Resultados. Participaron 104 sujetos, media 9,9 años (DE 4,4). Asplenia: 91,3 %, VIH: 7,6 % y déficit de complemento: 0,9 %. Nivel socioeconómico: pobreza relativa: 38,4 %, seguido por clase media: 37,5 %. Estado de vacunación completa para meningococo: 45 %, neumococo: 42 %, Hib: 97 %. El 77,9 % tenía al día el calendario regular y el 61,5 %, el antigripal. Media ERV: 41,9 (DE 3,2). No se encontraron asociaciones significativas entre las variables y el estado de vacunación para BC. Conclusiones. Un elevado porcentaje no tenía vacunación completa para BC, tampoco el calendario regular y antigripal. La confianza en la vacunación de los cuidadores fue elevada.

Introduction. The Ministry of Health has established specific vaccines for people at high risk for invasive infections with encapsulated bacteria (EB). There is currently no information about compliance with the vaccination schedule. Our objective was to assess EB vaccination status in subjects ≤ 18 years with risk factors. Population and methods. Observational, analytical study with a survey to parents of subjects aged ≤ 18 years with HIV, asplenia and/or complement deficiency attending a vaccination center at a children's hospital between October 2020 and September 2021. Sociodemographic and clinical data were collected. Their vaccination status for the EB pneumococcus, meningococcus, and Haemophilus influenzae type b (Hib), their regular vaccination and flu vaccination schedules were assessed. The vaccine hesitancy scale (VHS) was administered: range 10­50. The association between the study variables and EB vaccination was analyzed using logistic regression (OR, 95% CI). The REDCap® database and the STATA® v.14 software were used. Results. A total of 104 subjects participated; mean age: 9.9 years (SD: 4.4). Asplenia: 91.3%, HIV: 7.6%, and complement deficiency: 0.9%. Socioeconomic level: relative poverty: 38.4%, followed by middle class: 37.5%. Complete vaccination status: meningococcal vaccine 45%, pneumococcal vaccine: 42%, Hib: 97%. The regular vaccination and flu vaccination schedules were up-to-date in 77.9% and 61.5% of cases, respectively. Mean VHS score: 41.9 (SD: 3.2). No significant associations were observed between variables and EB vaccination status. Conclusions. A high percentage of subjects had not completed neither their EB vaccination nor their regular or their flu vaccination schedules. Caregivers' confidence in vaccines was high.

Meta-análisis de la escala de capital intelectual: implicaciones para hacer frente a la pandemia del COVID-19

Introducción: la medición del capital intelectual como activo intangible se ha establecido a partir de una escala de seis dimensiones relacionada con formación, academia, laboral, profesional, sindical y organizativa. La pandemia ha generado estudios que muestran diferencias significativas entre estas dimensiones, abriendo la discusión sobre la validez metaanalítica. Objetivo: realizar una revisión documental, sistemática y metaanalítica, con una muestra de artículos publicados entre 2014 y 2021 en revistas indexadas en repositorios internacionales. Materiales y métodos: se realizó un estudio documental, sistemático y metaanalítico sobre una muestra de artículos publicados en repositorios internacionales en los últimos dos años. Se utilizó la Escala de Capital Intelectual, considerando sus dimensiones reportadas en la literatura. Resultados: se estableció la estructura y los umbrales de los efectos aleatorios, calculados mediante la ecuación para establecer el parámetro delta, considerando sus intervalos de confianza para la corrección de errores de muestreo y estimación, así como las diferencias entre grupos. Conclusión: se recomienda extender la revisión de la literatura hasta agosto de 2021, para poder contrastar ambas revisiones, y establecer así la validez metaanalítica de la escala, y discutir sus implicaciones en la era COVID-19.

Introduction: the measurement of intellectual capital as an intangible asset has been established from a scale of six dimensions related to training, academia; labor, professional, union, and organizational. The pandemic has generated studies that show significant differences between these dimensions, opening the discussion on meta-analytic validity. Objective: to carry out a documentary, systematic and meta-analytical review with a sample of articles published from 2014 to 2021 in journals indexed in international repositories. Materials and methods: a documentary, systematic and meta-analytical study was carried out on a sample of articles published in international repositories in the last two years. The Intellectual Capital Scale was used, considering its dimensions reported in the literature. Results: the structure and thresholds of the random effects were established, calculated by means of the equation to establish the delta parameter, considering their confidence intervals for correction of sampling and estimation errors, as well as differences between groups. Conclusion: it is recommended to extend the review of the literature until August 2021 in order to be able to contrast both reviews to establish the meta-analytic validity of the scale and discuss its implications in the COVID-19 era.

General education of foreign students in colleges and universities of traditional Chinese medicine: a case study of Shanghai University of TCM / 中华医学教育探索杂志

The number of foreign students studying Chinese medicine in China has always been the first in the rank of natural sciences foreign students studying in China. They are mostly from developing countries, keen on Chinese traditional culture, and prefer practical specialties such as acupuncture. The general education of overseas students majoring in traditional Chinese medicine can help them learn professional knowledge and integrate into Chinese society more rapidly, which promotes the global spread of Chinese culture. In the nearly 20 years of general education for foreign students, Shanghai University of Traditional Chinese Medicine has made clear the teaching ideas and guidelines, strengthened the construction of teachers, attached importance to the feedback of students, adjusted the curriculum with the times, encouraged the experience complementary among brother colleges, and further promoted international exchanges. Especially, the courses such as the History of Chinese Medicine, have achieved good teaching results. To actively carry out general education for foreign students in Chinese medicine colleges and Confucius Institutes of Traditional Chinese Medicine around the world is not only conducive to the cultivation of talents of traditional Chinese medicine in the world, but also an effective way to inherit and develop traditional Chinese medicine.

The Value and Path of Fine Traditional Chinese Culture in Cultivating New Era Medical Ethics and Style / 中国医学伦理学

Cultivating new era medical ethics and style with the fine traditional Chinese culture (TCC) is foundation of the construction of medical ethics and style in the new era, which can fundamentally rectify the alienation of medical ethics and style in modern medicine. It can cultivate the new era medical staff’s benevolence of "putting the people and the people’s lives as the first place", the dedication spirit of "value justice over profit", the humanistic feelings of "putting oneself in other’s shoes", the medical innovation of "facing people’s health", the world responsibility of building a community of human health. Cultivating medical ethics and style in the new era with fine TCC means achieving creative transformation and innovative development of fine TCC, fundamentally nourishing and nurturing medical ethics and style in the whole process. It is important to firm cultural confidence, continue to make great efforts to inherit and promote the fine TCC, especially the traditional Chinese medicine culture; strengthen cultural education, build an "antique" education system of medical ethics and style, and focus on integration and innovation to improve the effectiveness of medical ethics and medical style cultivation in the new era.

Self-reported confidence in general competencies and skills of clinical clerks of a private medical school for SY 2021-2022: A cross-sectional study / The Health Sciences Journal

Introduction@#During the COVID-19 pandemic, medical schools shifted to blended learning. This study aimed to determine the demographic and level of confidence of a private medical school’s clinical clerks of School Year 2021-2022 on general competencies and skills. @*Methods@#The study aimed to identify the skills that exhibited the highest and lowest levels of confidence among a group of 139 clinical clerks. Additionally, it sought to examine whether there were significant differences in confidence levels based on sex and prior clinical experience. An analytical cross-sectional study design was employed using a Google Form as the data collection tool.@*Results@#The clerks were most confident in handwashing, and least in NGT insertion, performing digital rectal examination (DRE), and suturing. Females were more confident in history taking of obstetric and gynecologic, surgical, and medical patients, physical examination of pediatric patients, and preparing a discharge summary, while males were more confident in performing digital rectal examination. Clerks with prior medical experience were significantly more confident in foley catheter insertion, intravenous insertion, blood extraction, suturing, and performing essential intrapartum and newborn care (EINC) than those without. The results aligned with previous studies since clerks with prior experience were able to practice the skills in a psychomotor sense.@*Conclusion@#The study revealed significant differences in the confidence level on the competencies and skills for medical practice between sex and prior medical experience.

MinerVa: A high performance bioinformatic algorithm for the detection of minimal residual disease in solid tumors / 生物医学工程学杂志

How to improve the performance of circulating tumor DNA (ctDNA) signal acquisition and the accuracy to authenticate ultra low-frequency mutation are major challenges of minimal residual disease (MRD) detection in solid tumors. In this study, we developed a new MRD bioinformatics algorithm, namely multi-variant joint confidence analysis (MinerVa), and tested this algorithm both in contrived ctDNA standards and plasma DNA samples of patients with early non-small cell lung cancer (NSCLC). Our results showed that the specificity of multi-variant tracking of MinerVa algorithm ranged from 99.62% to 99.70%, and when tracking 30 variants, variant signals could be detected as low as 6.3 × 10 -5 variant abundance. Furthermore, in a cohort of 27 NSCLC patients, the specificity of ctDNA-MRD for recurrence monitoring was 100%, and the sensitivity was 78.6%. These findings indicate that the MinerVa algorithm can efficiently capture ctDNA signals in blood samples and exhibit high accuracy in MRD detection.

Cognitive abilities and medical students' practice of physical exams: A quasi-experimental study

ABSTRACT BACKGROUND: To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching. OBJECTIVE: To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory. DESIGN AND SETTING: A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil. METHODS: A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction). RESULTS: Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000). CONCLUSION: Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.

Validation of Blood Transfusion Risk Scores (TRACK and TRUST) in a Cardiac Surgery Service in Brazil

ABSTRACT Introduction: Transfusion of red blood cells is recurrent in cardiac surgery despite the well-established deleterious effects. Identifying patients with higher chances of requiring blood transfusion is essential to apply strategic preventive measures to reduce such chances, considering the restricted availability of this product. The most used risk scores to predict blood transfusion are the Transfusion Risk and Clinical Knowledge (TRACK) and Transfusion Risk Understanding Scoring Tool (TRUST). However, these scores were not validated for the Brazilian population. The objective of this study was to assess the accuracy of TRACK and TRUST scores in estimating the need for postoperative transfusion of red blood cell concentrates (TRBCC) after cardiac surgery. Methods: A clinical retrospective study was conducted using the database of a Brazilian reference service composed of patients operated between November 2019 and September 2021. Scores were compared using Mann-Whitney U test. Hosmer-Lemeshow goodness of fit test assessed calibration of the scores. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC). All analyses considered a level of significance of 5%. The study was approved by the research ethics committee (CAAE 55577421.4.0000.5201). Results: This study assessed 498 patients. Only the TRACK score presented good calibration (P=0.238; TRUST P=0.034). AUC of TRACK was 0.678 (95% confidence interval 0.63 to 0.73; P<0.001), showing a significant accuracy. Conclusion: Between the scores analyzed, only the TRACK score showed a good calibration, but low accuracy, to predict postoperative TRBCC after cardiac surgery.

Factors Predicting Early Major Adverse Events in the Intensive Care Unit After Successful Cardiac Surgery for Congenital Heart Disease in Full-Term Neonates

ABSTRACT Objective: In this study, we aimed to evaluate the factors affecting major adverse event (MAE) development after full-term neonatal cardiac surgery. Methods: This study was conducted retrospectively on newborns who underwent congenital heart surgery between June 1, 2020, and June 1, 2022. MAE was defined as the presence of at least one of the following: cardiac arrest, unplanned reoperation, emergency chest opening, admission to the advanced life support system, and death. The role of blood lactate level, vasoactive inotropic score (VIS), and cerebral near-infrared spectroscopy (NIRS) changes in predicting MAE was investigated. Results: A total of 240 patients (50% male) were operated during the study period. The median age of patients was seven days (interquartile range 3-10 days). MAE was detected in 19.5% of the cases. Peak blood lactate levels >7 mmol/liter (area under the curve [AUC] 0.72, 95% confidence interval [CI] [0.62-0.82], P<0.001, sensitivity 76%, specificity 82%, positive predictive value [PPV] 88%) was an independent risk factor for MAE (odds ratio [OR] 2.7 [95% CI 1.3-6]). More than 30% change in NIRS value during the operative period (AUC 0.84, 95% CI [0.80-0.88], P<0.001, sensitivity 65%, specificity 85%, PPV 90%) was a strong predictor of MAE. VIS > 10 was an independent risk factor (AUC 0.75, 95% CI [0.70-0.84], P<0.001, sensitivity 86%, specificity 80%, PPV 84%) and strongly predicted MAE (OR 1.4 [95% CI 0.9-5]). Conclusion: Cerebral NIRS changes > 30%, high blood lactate levels, and VIS score within the 48 hours may help to predict the development of MAE in the postoperative period.

Intención de aceptación a la vacunación contra la COVID-19 en sectores vulnerables del Ecuador

Introducción: La COVID-19 causó que varios sectores profesionales hayan tenido que enfrentarlo en primera línea, viéndose afectados ante la vulnerabilidad de contraer el virus. A pesar de la baja tasa de mortalidad de los momentos actuales y la poca saturación de pacientes con COVID-19 en los centros de salud, la aplicación de una cuarta dosis de inoculación ha generado posturas diferentes entre varios países. Objetivo: Determinar si el personal considerado con altos riesgos de vulnerabilidad de la ciudad de Santo Domingo de los Colorados, en Ecuador, tiene intenciones favorables para la aplicación de la cuarta dosis de la vacuna contra la COVID-19. Método: Se desarrolló un estudio cuantitativo de alcance correlacional y diseño transversal. Un cuestionario conformado por 16 preguntas midió las variables: riesgo de contagio, conocimiento percibido sobre la vacuna, confianza sobre la vacuna e intención de vacunarse; el cual fue aplicado a 375 participantes. Los análisis estadísticos fueron desarrollados a través de Excel y Statistical Package for Social Sciences 21 (SPSS 21). Resultados: Los análisis estadísticos evidenciaron que el riesgo de contagio (β=0,178**), el conocimiento percibido sobre la vacuna (β=0,218**) y la confianza sobre la vacuna (β=0,192**) se correlacionan significativamente con la intención de vacunarse, ante lo cual se evidencia la necesidad de recibir una cuarta dosis de inoculación por parte de los sectores vulnerables. Conclusiones: Esta es la primera investigación que expone resultados respecto a la intención de vacunación en las personas vulnerables y pone en evidencia la intención de acceder a una cuarta dosis de inoculación.

Introduction: COVID-19 caused healthcare professional workers have faced the pandemic on the frontline at the risk of being infected with the virus. Despite the low mortality rate at present and the low presence of patients with COVID-19 in health care centers, the application of a fourth booster dose has generated different positions among several countries. Objective: To determine whether personnel considered being at high risk of vulnerability in the city of Santo Domingo de los Colorados, Ecuador, have favorable intentions for receiving the fourth booster dose of the COVID-19 vaccine. Method: A quantitative study of correlational scope and cross-sectional design was developed. A questionnaire consisting of 16 questions measured the following variables: risk of infection, perceived knowledge of the vaccine, confidence in the vaccine and intention to be vaccinated; this questionnaire was applied to 375 participants. Statistical analyses were developed using the microsoft Excel spreadsheed and Statistical Packagefor Social Sciences 21 (SPSS 21). Results: Statistical analyses showed that the risk of infection (β=0.178**), perceived knowledge about the vaccine (β=0.218**) and confidence about the vaccine (β=0.192**) are significantly correlated with the intention to be fully vaccinated, thus showing the need for a fourth booster dose by vulnerable sectors. Conclusion: This is the first research that presents results regarding the intention to vaccinate vulnerable people and highlights the intention to access a fourth booster dose.

Introdução: O COVID-19 fez com que diversos setores profissionais o enfrentassem na linha de frente, sendo afetados pela vulnerabilidade de contrair o vírus. Apesar da baixa taxa de mortalidade atual e da baixa saturação de pacientes com COVID-19 nos centros de saúde, a aplicação de uma quarta dose de inoculação gerou posições diferentes entre vários países. Objetivo: Determinar se o pessoal considerado de alto risco de vulnerabilidade na cidade de Santo Domingo de los Colorados, no Equador, tem intenções favoráveis para a aplicação da quarta dose da vacina contra COVID-19. Método: Foi desenvolvido um estudo quantitativo com escopo correlacional e delineamento transversal. Um questionário composto por 16 questões mediu as variáveis: risco de contágio, conhecimento percebido sobre a vacina, confiança sobre a vacina e intenção de se vacinar; que foi aplicado a 375 participantes. As análises estatísticas foram realizadas no Excel e no Statistical Package for the Social Sciences 21 (SPSS 21). Resultados: As análises estatísticas mostraram que o risco de contágio (β=0,178**), o conhecimento percebido sobre a vacina (β=0,218**) e a confiança sobre a vacina (β=0,192**) estão significativamente correlacionados com a intenção de ser vacinado, o que evidencia a necessidade de receber uma quarta dose de inoculação por setores vulneráveis. Conclusões: Esta é a primeira pesquisa que expõe resultados sobre a intenção de vacinação em pessoas vulneráveis e evidencia a intenção de acessar uma quarta dose de inoculação.

Propiedades psicométricas de la Escala de Confianza Diádica en personas gays y lesbianas en pareja / Psychometric Properties of the Dyadic Trust Scale in Gay and Lesbian People with a Partner

Resumen El presente estudio tuvo como objetivo evaluar las propiedades psicométricas de la Escala de Confianza Diádica (ECD, Larzelere & Huston, 1980) en personas gays y lesbianas de Chile. Para ello, se evaluó una muestra de 360 personas chilenas gay o lesbianas involucradas en una relación de pareja. Los datos obtenidos proporcionan evidencia de que el instrumento se ajusta de manera aceptable a una estructura unidimensional y que es invariante entre personas gay y lesbianas. Adicionalmente, se identificó que posee una consistencia interna adecuada, así como una asociación inversa entre los niveles de confianza diádica y la ansiedad y evitación del apego. En conclusión, la ECD posee propiedades psicométricas adecuadas para la evaluación de la confianza diádica en personas gays y lesbianas en el contexto chileno.

Abstract The present study aimed to evaluate the psychometric properties of the Chilean version of the Dyadic Trust Scale (DTS, Larzelere & Huston, 1980). For this purpose, a sample of 360 Chilean gay or lesbian people involved in a couple relationship was evaluated. The data obtained provide evidence that the instrument conforms acceptably to a unidimensional structure and scores are invariant between gay and lesbian persons. Additionally, it has adequate internal consistency, as well as an inverse association between levels of dyadic trust and attachment anxiety and avoidance. In conclusion, the ECD has adequate psychometric properties for the assessment of dyadic trust in gay and lesbian persons in the Chilean context.

Are the COVID Warriors Confident about COVID Vaccine? A Survey among the Healthcare Workers of West Bengal to Explore their Perception about COVID-19 Vaccine and causes of Vaccine Hesitancy

Introduction : Deaths of Healthcare Workers (HCWs) from COVID-19 infection were reported from various parts of West Bengal months after rolling out of Vaccines for them. Empirical data suggested that those HCWs who died due to COVID- 19 were either not vaccinated or partially vaccinated. which points to Vaccine hesitancy among them. Objectives : (1) To study the perception of HCWs of West Bengal about COVID-19 Vaccine. (2) To determine the level of vaccine hesitancy and its causes among the study population. Methods : A cross sectional exploratory survey was conducted on 400 HCWs. A prevalidated questionnaire was administered which contained questions on profile of the study population, perception about COVID-19 Vaccine, Vaccine hesitancy. Results : 70% of the study population were nurses and only 13% were trained in COVID-19 Vaccination. 44% chose Mask as the most effective strategy to prevent COVID infection followed by Vaccination (36%), social distancing and sanitization. 37% HCWss were hesitant to take Vaccine when offered. Causes of Vaccine hesitancy as admitted by the study population - doubts about Vaccine effectiveness (56%), concern about side effects (30%), difficulty in availability of Vaccine (9%) and confusion about Vaccination strategy (5%). Conclusion : Vaccine confidence among HCWs can inspire the general public for a better coverage of Vaccine among all. The findings of this study will help the program managers to effectively plan strategies to enhance risk perception and Vaccine confidence among General Public.

Application of solution-focused approach on medication adherence in patients with cerebral ischemic stroke / 中国实用护理杂志

Objective:To explore the effect of solution-focused approach on medication adherence in patients with cerebral ischemic stroke.Methods:A total of 120 patients with cerebral ischemic stroke from May to August 2019 in the Second Affiliated Hospital of Harbin Medical University were divided into the experimental group and the control group by random digits table method with 60 cases in each group. The patients in the control group received the routine nursing in the hospital and extended nursing outside the hospital, while patients in the experimental group received the solution-focused approach based on the control group. The intervention effects of the two groups were evaluated by Morisky Medication Adherence Scale (MMAS-8), Beliefs about Medication Questionnaire(BMQ), Richard Gray's scoring method of medication compliance confidence and willingness to take medication, and the changes of blood pressure.Results:Finally, 57 cases were included in the control group and 58 cases in the experimental group. There was no significant difference in the scores of medication compliance between the two groups before intervention( P>0.05). The scores of the control group and the experimental group were 5.110 ± 1.194, 6.160 ± 1.064 at 1 month after intervention and 5.044 ± 1.010, 6.306 ± 0.685 at 3 months after intervention, the differences were statistically significant ( t=4.98, 7.83, both P<0.05).There was no significant difference in medication belief score, medication compliance confidence score, willingness to take medication score, systolic blood pressure and diastolic blood pressure between the control group and the experimental group before intervention( P>0.05). One month after intervention, those index mentioned above were (2.561 ±2.605) points, (7.123 ± 1.310) points, (6.368 ± 1.234) points, (131.86 ± 13.13) mmHg(1 mmHg=0.133 kPa), (84.33 ± 7.05) mmHg in the control group, and (4.345 ± 3.006) points, (7.603 ± 1.388) points, (6.948 ± 1.527) points, (126.52 ± 12.44) mmHg, (83.95 ± 8.07) mmHg in the experimental group. Three months after intervention, those index mentioned above were (1.667 ± 2.149) points, (6.737 ± 1.218)points, (5.702 ± 1.362) points, (130.47 ± 13.77) mmHg, (84.25 ± 7.71) mmHg in the experimental group, and (4.879 ± 2.760) points, (7.793 ± 1.321) points, (7.207 ± 1.373) points, (125.71 ± 11.18) mmHg, (82.98 ±7.41) mmHg in the control group. One month and three months after intervention, the scores of medication belief and willingness to take medication in the experimental group were higher than those in the control group, and the systolic blood pressure was lower than that in the control group. Three months after interevention, medication compliance confidence was higher than that in the control group. The differences were statistically significant ( t values were -2.24-6.96, all P < 0.05). Repeated measurement analysis of variance showed that there were interactions between the group effect and time effect of medication compliance, medication belief, medication compliance confidence, willingness to take medication and systolic blood pressure ( F values were 12.81-26.17, all P<0.05). Conclusions:Solution-focused approach can significantly improve patients' medication adherence, beliefs about medication, medication compliance confidence, willingness to take medication, and effectively control blood pressure fluctuations.

The Essential Connotation and Promotion Path of Self-Confidence in Traditional Chinese Medicine Cultural / 中国医学伦理学

The essential connotation of self-confidence in Traditional Chinese Medicine (TCM) culture includes three parts: the theoretical self-confidence of TCM represented by the overall concept and syndrome differentiation, the historical self-confidence that TCM has been in an important position for a long time in the history of medical development, and the realistic self-confidence that TCM has contributed to human health and safety, which reflect the profound historical roots and extensive mass foundation of TCM culture in China. However, due to the doubts of non-scientific theory, outdated theory and useless theory, the spread and development of TCM culture has also encountered reality dilemma. In order to achieve the fundamental purpose of improving the self-confidence of TCM culture, it is significant to eliminate these negative effects by optimizing the communication system, creatively transforming and innovatively developing TCM culture and upgrading the level of health services.

Target-Oriented Clinical Skill Enhancement (TOCSE) builds up confidence of fourth-year medical students during first-time patient encounter: An effective bridging tool after online didactic undergraduate classes during the COVID-19 pandemic

@#<jats:p>Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p<0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p<0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p<0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p<0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ± 1.22, p<0.001), closely followed by performing a complete history-taking (6.53 ± 1.19 to 7.89 ± 1.01, p<0.001). The most significant improvements in clinical confidence were seen in all the items in the Post-OPD with TOCSE than in the Post-OPD with no TOCSE versus Pre-OPD confidence scores. In addition, with TOCSE, the number of medical students who scored 7.50 and above was amplified more than 3 times (17.4% to 58.7%, p<0.001, Pre-OPD vs. Post-OPD with TOCSE, respectively). Conclusion: Target-Oriented Clinical Skill Enhancement (TOCSE) effectively builds up confidence during first-time patient encounters among fourth-year medical students taught online with hypothetical cases during their undergraduate classes. Key words: Target-Oriented Clinical Skill Enhancement, clinical confidence, clinical skill, fourth-year medical students, medical undergraduate challenge, online teaching in COVID-19 pandemic</jats:p>

Simulação clínica na retenção tardia de conhecimento e autoconfiança de profissionais de enfermagem: estudo quase-experimental / Clinical simulation in nursing professionals' late retention of knowledge and self-confidence: a quasi-experimental study / Simulación clínica en la retención a largo plazo del conocimiento y autoconfianza de profesionales de enfermería: estudio cuasiexperimental

RESUMO: Objetivo: Avaliar o efeito tardio do uso da simulação combinada a aula expositiva dialogada em comparação ao uso exclusivo da simulação na autoconfiança e no conhecimento de profissionais de enfermagem diante de situações de parada cardiopulmonar. Método: Quase experimento com pré e pós-teste. Amostra de conveniência de 53 profissionais de enfermagem divididos em grupos controle e experimental. Foram aplicados um questionário semiestruturado e a dimensão Autoconfiança da Escala de Satisfação e Autoconfiança na Aprendizagem. Q testes foram utilizados com valor de p≤ 0,05. Resultados: A autoconfiança aumentou de forma significativa entre os profissionais do grupo experimental (p=0,007) em relação ao controle (p=0,06). Nenhum dos grupos mostrou ganho significativo de conhecimento retido ao longo do tempo. Conclusão: Independentemente da forma como o método de simulação é empregado, ele representa uma estratégia pedagógica que pode possibilitar desenvolvimento e aprimoramento de autoconfiança e fixação tardia do conhecimento em relação a situações de parada cardiopulmonar.

ABSTRACT Objective: to evaluate the late effect of using combined simulation of a dialog lecture class, as compared to the exclusive use of simulation, on Nursing professionals' self-confidence and knowledge under cardiopulmonary arrest situations. Method: quasi-experimental with pre- and post-test. Convenience sample comprised by 53 Nursing professionals divided into control and experimental groups. A semi-structured questionnaire and the Self-confidence dimension of the Satisfaction and Self-Confidence in Learning Scale were applied. Q tests were used with p-value≤ 0.05. Results: self-confidence increased significantly among the professionals from the experimental group (p=0.007) in relation to the control group (p=0.06). None of the groups showed significant gains in retained knowledge over time. Conclusion: regardless of how the simulation method is employed, it represents a pedagogical strategy that can enable the development and improvement of self-confidence and late knowledge fixation in relation to cardiopulmonary arrest situations.

RESUMEN Objetivo: Evaluar el efecto a largo plazo del uso de la simulación combinada con una clase expositiva dialogada en comparación con el uso exclusivo de la simulación sobre la autoconfianza y el conocimiento de los profesionales de enfermería en situaciones de paro cardiorrespiratorio. Método: cuasi experimento con pre y post test. Muestra por conveniencia de 53 profesionales de enfermería divididos en grupos control y experimental. Se aplicó un cuestionario semiestructurado y la dimensión Autoconfianza de la Escala de Satisfacción y Autoconfianza en el Aprendizaje. Se utilizaron pruebas Q con p≤ 0,05. Resultados: La autoconfianza de los profesionales del grupo experimental (p=0,007) aumentó significativamente en comparación con la del grupo control (p=0,06). Ninguno de los dos grupos demostró un aumento significativo del conocimiento retenido a lo largo del tiempo. Conclusión: Independientemente de la forma en que se aplique el método de simulación, representa una estrategia pedagógica que puede posibilitar el desarrollo y mejora de la confianza en sí mismo y la fijación a largo plazo del conocimiento en relación a las situaciones de paro cardiorrespiratorio.