ClinicalAccess: A Clinical Decision Support Tool

ClinicalAccess is a new clinical decision support tool that uses a question-and-answer format to mirror clinical decision-making strategies. The unique format of ClinicalAccess delivers concise, authoritative answers to more than 120,000 clinical questions. This column presents a review of the product, a sample search, and a comparison with other point-of-care search engines.     

手法治疗158例胸椎小关节紊乱的临床分析

本文对158例胸椎小关节紊乱患者进行了病因诊断及手法机理的临床探讨,提出了胸椎突然旋转外力是导致该症的病因。其临床症状复杂,主要是由于小关节紊乱或滑膜嵌顿引起的局部炎症和刺激植物神经的结果。手法治疗效果显著,简单实用。     

Allied healthcare undergraduate education: international students at the clinical interface

The global movement of students in higher education is a relatively recent phenomenon, which has gained momentum in the last 30 years. Much research has been focused on the experiences of this population. Relatively little is known about international allied healthcare students who undertake clinical placements as part of their undergraduate course. This study explores students’ perceptions of their clinical experience. The chosen focus group method was prefaced by a pilot study; both were conducted within the allied healthcare school of a university in the UK. Four themes emerged from the study: communication, cultural differences, relationships with professionals and survival strategies. Communication referred to both the interaction with and between the students, their patients and fellow members of the multidisciplinary team. Cultural differences were expressed in the negotiation of differing cultures at the patient interface. A third theme was the students’ relationship with clinical professionals; within this, the relationship with the student’s clinical educator was paramount. Finally, survival strategies represented the advice students wished to impart to future international students to facilitate their clinical placement abroad.     

How can a clinical research approach contribute to knowledge-building for the teaching profession?

This article explains what clinical research is and why it is necessary. The term ‘clinical’ refers to an academic way of solving practical problems. Clinical research starts from a view of science that not only acknowledges the value of rational analysis and empirical research, but also acknowledges the need for human skills and connoisseurship. In education, skills and connoisseurship can be developed by being responsibly engaged in classrooms. The (tacit) knowledge acquired in classrooms enables researchers to perceive more relevant factors in practice and enables them to understand the problems of teaching better. Clinical research is a type of action research in the sense that it acknowledges the epistemic function of doing, thus emphasizing the need for integrating scholarship and craftsmanship.     

Attitudes to cadaveric organ donation in Irish preclinical medical students

There is a worldwide shortage of organs for transplantation. It has been shown that the attitude of healthcare professionals can improve the rates of organ donation, and that educational programs aimed at improving both attitudes and knowledge base of professionals can have positive outcomes. Although there has been research carried out on this topic, there has been none in Ireland. Anatomy dissection can be a stressor to medical students-we investigate the attitudes of Irish students to organ donation and how they change with exposure to anatomy dissection. A questionnaire was administered to first year students in the School of Medicine in University College Dublin, Ireland, three times over a nine-week period at the commencement of classes in an academic year. The attitudes of the students were positive throughout regarding organ donation by a stranger, a family member, or themselves. There was, however, a significant decrease in support for the donation of a family member's organs in a minority of students. Irish students' attitudes to postmortem organ donation are positive and are not changed by exposure to the dissecting room. There is support for the donation of organs, and willingness among students to donate their own organs and support donation by family members.     

Learning of musculoskeletal ligament stress testing in a gross anatomy laboratory

Human anatomy in physical therapy programs is a basic science course serving as a foundation for subsequent clinical courses. Integration of anatomy with a clinical emphasis throughout a curriculum provides opportunities for reinforcement of previously learned material. Considering the human cadaver laboratory as a fixed cost to our program, we sought opportunities to add value to the resource via vertical integration into a clinical skills course taught later in the curriculum. We designed an opportunity for second-year physical therapy students to revisit the human anatomy laboratory to study select clinical musculoskeletal tests and the associated anatomy in a clinically relevant context. Students performed select orthopedic ligament test on human cadavers, then incised specific structures and repeated the tests. Students were able to feel and visualize the function of pertinent anatomy associated with the clinical tests. Ninety-five percent of respondents reported that the ligament stress testing experience enhanced their understanding of orthopedic clinical tests with 91% reporting an enhanced understanding of anatomy related to specific clinical tests. Likewise, the experience was perceived as enjoyable and valuable with 86% of respondents reporting the experience as enjoyable and 100% responding the experience should continue as part of the curriculum.     

Resident perceptions of anatomy education: a survey of medical school alumni from two different anatomy curricula and multiple medical specialties

In 2004, the University of Michigan Medical School reduced its gross anatomy curriculum. To determine the effect of this reduction on resident perceptions of their clinical preparedness, we surveyed alumni that included residents from the original and new shortened curricula. A Likert-scale survey was sent to four classes of alumni. Respondents were compared in old curriculum (OC) and new curriculum (NC) groups, surgical specialty (SS) and nonsurgical specialty (NS) groups, and subgroups of SS and NS were compared for differences between OC and NC. Mean response scores were compared using independent samples T-tests. As a single population (n = 110), respondents felt their anatomy education prepared them well for residency, that a more robust anatomy curriculum would be helpful, that dissection was important to their residency preparation, and that a 4th year anatomy elective was effective in expanding their anatomy education and preparing them for residency. No significant difference existed between OC and NC groups, neither as a whole nor as SS and NS subgroups. The SS group felt dissection was more important to their residency preparation than the NS group (P = 0.001) and that a more robust anatomy curriculum would have better prepared them for residency (P = 0.001). Thirty percent of SS respondents who did not take a 4th year elective commented that they wish they had. Fourth year anatomy electives were highly valued by residents, and respondents felt that they should be offered to students as a way of revisiting anatomy following the 1st year of clinical training.     

中国的人体组成学研究:回顾与展望

人体组成学是人体生物学的分支学科之一,主要研究人体内诸多组分的含量与分布、组分之间的数量关系、在活体中测定人体组分的方法、以及体内外各种因素对组分含量的影响。研究人体组成不仅具有生物学意义,也与提高国民体质、增进健康、治疗疾病密切相关。进入21世纪以来,海峡两岸对人体组成的研究呈快速发展的态势,每年平均发表58篇论文,约占全世界此领域论文总数的3.9%。这表明两岸的人体组成学研究,已在世界上占有一席之地。中国对人体组成的研究主要集中在3个方面：对中国人群身体组成特点的研究、对运动与身体组成关系的研究、以及对疾病与身体组成关系的研究。未来,两岸的人体组成研究应该在多方位发展,特别是研究更多的身体组分（如骨骼肌与内脏脂肪组织）、应用先进的测定方法、以及探讨黄种人的身体组成特点。第9届国际人体组成学研讨会于2011年在杭州举行,这必将进一步促进海峡两岸人体组成学研究的发展。     

Using clinical guidelines to assess the potential value of laboratory medicine in clinical decision-making

IntroductionIt is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Cardiovascular disease (CVD) is the world’s most common cause of mortality, so this study reviewed all CVD guidelines published by five national/international authorities to determine what proportion of them recommended laboratory testing.Materials and methodsFive leading CVD guidelines were examined, namely the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ).ResultsA total of 101 guidelines were reviewed. Of the 33 individual ESC guidelines relating to CVD, 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. The same applied to 15/20 of NICE guidelines, 24/32 from the ACC and 15/16 from the AHF/CSANZ. Renal function and blood count testing were the most recommended (39 and 26 times), with lipid, troponin and natriuretic peptide measurement advocated 25, 19 and 19 times respectively.ConclusionsThis study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities. This provides an index to assess the potential value of laboratory medicine to healthcare.     

高职临床医学专业实习教学与管理问题及对策分析

临床实习的效果直接影响毕业生的专业素养和医疗服务水平。该文通过对高职临床医学专业实习存在的管理体制不健全、理论与实际脱节、实习教学模式与学生需求不符等问题的分析,提出推动医教深度融合、强化实习生在校期间的岗位适应能力培养、结合高职临床专业学生的职业定位、制定合理的实习培养模式等策略,以促进临床实习效果的提升。