关键词： career choice   medical students   primary care   procedure-oriented specialties  

摘要： Objectives There are many factors that influence medical students' (MS) decisions when choosing a career. Some prominent factors include life-work balance, indebtedness, and flexibility of work hours. Whereas the expression of empathy has many positive correlates with a trusting and meaningful physician-patient interaction, only a few studies have analyzed the association of MS empathy expression and primary care residency selection. The results of these studies about the relationship of MS expression of empathy and their selection of primary care specialties have been conflicting, depending on the empathy instrument used. In addition, there have been other variables that have affected career decision making in more recent years not previously encountered. The objectives of our study were to analyze the association of The George Washington University School of Medicine and Health Sciences (GWU) MS Interpersonal Reactivity Index (IRI) scores and their residency selection, to compare our results with previous studies to determine whether the IRI provided more definitive relationships between empathy and career choice, and to assess whether our results confirmed the theoretical construct linking empathy with primary care physicians. Methods GWU third-year MS (MS3s), representing the classes of 2008-2011, completed the perspective taking and empathy subscales of the IRI, which measure cognitive and affective empathy, respectively. MS empathy scores for individual specialty were compared to those scores in internal medicine (IM) using a linear regression model. Empathy scores for patient-oriented versus technology-oriented specialties and primary versus surgical specialties were compared using the independent t test. Results A total of 593 (77.5%) MS3s had mean IRI scores of 45.1 (standard error 4.8), higher than a recent study involving MS. There were no significant differences between patient- and technology-oriented specialties (-0.65 to 0.88), primary care versus sur

摘要： Estimates in a 1989 study indicated that physicians in the United States were unable to reach a diagnosis that accounted for their patient's symptoms in up to 90% of outpatient patient encounters. Many proponents of artificial intelligence (Al) see the current process of moving from clinical data gathering to medical diagnosis as being limited by human analytic capability and expect Al to be a valuable tool to refine this process. The use of Al fundamentally calls into question the extent to which uncertainty in medical decision making is tolerated. Uncertainty is perceived by some as fundamentally undesirable and thus, for them, optimal decision making should be based on minimizing uncertainty. However, uncertainty cannot be reduced to zero;thus, relative uncertainty can be used as a metric to weigh the likelihood of various diagnoses being correct and the appropriateness of treatments. Here, the authors make the argument, using as examples the experiences of 2 Al systems, IBM Watson on Jeopardy and Watson for Oncology, that medical decision making based on relative uncertainty provides a better lens for understanding the application of Al to medicine than one that minimizes uncertainty. This approach to uncertainty has significant implications for how health care leaders consider the benefits and trade-offs of Al-assisted and Al-driven decision tools and ultimately integrate Al into medical practice.

关键词： assumption   cost-effectiveness analysis   distribution   equity   population preference   QALY   QALY-equivalence assumption   sensitivity analysis   social value  

摘要： Objectives: Cost-effectiveness analyses (CEA) are based on the value judgment that health outcomes (eg, quantified in quality adjusted life-years;QALYs) are all equally valuable irrespective of their context. Whereas most published CEAs perform extensive sensitivity analysis on various parameters and assumptions, only rarely is the influence of the QALY-equivalence assumption on cost-effectiveness results investigated. We illustrate how the integration of alternative social value judgments in CEA can be a useful form of sensitivity analysis. Methods: Because varicella-zoster virus (VZV) vaccination affects 2 distinct diseases (varicella zoster and herpes zoster) and likely redistributes infections across different age groups, the program has an important equity dimension. We used a costeffectiveness model and disentangled the share of direct protection and herd immunity within the total projected QALYs resulting from a 50-year childhood VZV program in the UK. We use the UK population's preferences for QALYs in the vaccine context to revalue QALYs accordingly. Results: Revaluing different types of QALYs for different age groups in line with public preferences leads to a 98% change in the projected net impact of the program. The QALYs gained among children through direct varicella protection become more important, whereas the QALYs lost indirectly through zoster in adults diminish in value. Weighting of vaccine-related side effects made a large difference. Conclusions: Our study shows that a sensitivity analysis in which alternative social value judgments about the value of health outcomes are integrated into CEA of vaccines is relatively straightforward and provides important additional information for decision makers to interpret cost-effectiveness results.

关键词： 英语   少儿读物  

ISBN: (纸本)9787568293105

摘要： 本书一本语言类读物，是根据原版书籍《快乐王子和其他故事》进行改写的中英文对照读物。《快乐王子和其他故事》是英国作家奥斯卡·王尔德的童话故事集著作。 本书中包含五篇童话，分别为《快乐王子》《夜莺与玫瑰》《自私的巨人》《忠实的朋友》和《了不起的火箭》。王尔德采用童话的体裁形式，以童话为“面具”，对现实社会的丑恶与冷酷进行揭露和抨击。这是其童话最主要的特点，也是其童话的重要价值。 《快乐王子和其他故事》语言清新优美，诗意浓郁，是世界童话中的上乘之作。其与王尔德的另一童话集《石榴之家》被誉为用英语写成的最美的童话。

关键词： Johrei   Universal energy   Seeds   Complementary alternative treatment   Mokichi Okada   Placebo effect  

摘要： Background: Johrei, a noncontact healing therapy that purportedly channels "universal energy", is an easily taught technique with numerous positive reports of healing in human trials. However, studies on humans have been limited by small sample sizes, the placebo effect and baseline differences between groups. Overcoming some of these limitations, this study evaluated the effect of Johrei on the physiological potential of lettuce seeds. Methods: Lettuce seeds were subjected to thermal stress and then treated with Johrei before and after two years of storage. The seedling emergence percentage, emergence speed index, classification score, percentage of viable seedlings and root and shoot dry mass of the treated seeds were determined. Results: Stress-treated seeds treated with Johrei had a greater seedling emergence percentage than those not treated with Johrei (p<0.0001). Johrei also resulted in a greater emergence speed index (p<0.0001), a higher percentage of viable seedlings with higher classification score (p<0.0001) and greater root and shoot dry mass regardless of the storage duration (p<0.0001). Conclusions: Johrei effectively preserved lettuce seed health, and the efficacy of Johrei can be assessed by evaluating its effects on the physiological potential of stress-treated seeds. Using live plants allows the influence of Johrei to be evaluated without interference from the placebo effect. Future studies should evaluate the influence of Johrei in primary aging processes in plants, such as cellular respiration by mitochondrial analysis, to gain insight into Johrei's mechanisms of action and enable inferences regarding similar cellular level processes that occur in humans. (c) 2020 Elsevier Inc. All rights reserved.

摘要： The practice of medicine is changing rapidly as a consequence of electronic health record adoption, new technologies for patient care, disruptive innovations that breakdown professional hierarchies, and evolving societal norms. Collectively, these have resulted in the modification of the physician's role as the gatekeeper for health care, increased shift-based care, and amplified interprofessional team-based care. Technological innovations present opportunities as well as challenges. Artificial intelligence, which has great potential, has already transformed some tasks, particularly those involving image interpretation. Ubiquitous access to information via the Internet by physicians and patients alike presents benefits as well as drawbacks: patients and providers have ready access to virtually all of human knowledge, but some websites are contaminated with misinformation and many people have difficulty differentiating between solid, evidence-based data and untruths. The role of the future physician will shift as complexity in health care increases and as artificial intelligence and other technologies advance. These technological advances demand new skills of physicians;memory and knowledge accumulation will diminish in importance while information management skills will become more important. In parallel, medical educators must enhance their teaching and assessment of critical human skills (e.g., clear communication, empathy) in the delivery of patient care. The authors emphasize the enduring role of critical human skills in safe and effective patient care even as medical practice is increasingly guided by artificial intelligence and related technology, and they suggest new and longitudinal ways of assessing essential noncognitive skills to meet the demands of the future. The authors envision practical and achievable benefits accruing to patients and providers if practitioners leverage technological advancements to facilitate the development of their critical human

关键词： advocacy   pediatrics   residency education   voting  

摘要： Objective Voting is one of our civic duties, yet many Americans do not vote, and physician voter participation is even lower than that of the general public. We aimed to explore pediatric residents' attitudes and behaviors in regard to voting and assess the impact of interventions aimed at increasing resident participation. Methods Pediatric residents were given preelection surveys regarding interest in voting, plans to vote in the November 2016 national election, and barriers to participation. Voting registration, election dates, and registration deadlines were disseminated before the election. Postelection surveys were distributed after the 2016 national election to pediatric residents regarding their voter participation, barriers to voting, and the effectiveness of our interventions. Results Fifty-one residents completed the presurvey and 49 completed the postsurvey (61% and 59% of total residents, respectively). Eighty-nine percent of residents surveyed planned to vote and 83% were registered to vote. The postsurveys indicated that only 69% of responding residents voted in the national election, far fewer than the 89% who planned to vote (z = 2.5, P < 0.05). The most common reasons for not voting were "no time off," "didn't get absentee ballot," and "not registered in state of residence." In total, 19 of 33 (58%) respondents indicated that interventions encouraged them to vote. Conclusions Intention to vote among participants was higher than voting participation;however, participants in this study voted at higher rates (69%) than the average citizen rates (61.4%). More than half of the residents who did vote indicated that the study interventions encouraged them to vote.

摘要： The rapid rise of cases of coronavirus disease 2019 (COVID-19) has led to the implementation of public health measures on an unprecedented scale. These measures have significantly affected the training environment and the mental health of health care providers and learners. Design thinking offers creative and innovative solutions to emergent complex problems, including those related to training and patient care that have arisen as a result of the COVID-19 pandemic. Design thinking can accelerate the development and implementation of solution prototypes through a process of inspiration, ideation, and implementation. Digital technology can be leveraged as part of this process to provide care and education in new or enhanced ways. Online knowledge hubs, videoconference-based interactive sessions, virtual simulations, and technology-enhanced coaching for health care providers are potential solutions to address identified issues. Limitations of this model include inherent bias toward utilitarian instead of egalitarian principles and the subsequent threat to diversity, equity, and inclusion in solutions. Although medical educators have embraced digital transformation during the COVID-19 pandemic, there is a need to ensure that these changes are sustained.