Priorities for content for a short-course on postoperative care relevant for low- and middle-income countries: an e-Delphi process with training facilitators

Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately affecting low- and middle-income countries. Various short courses have been developed to improve patient outcomes in low- and middle-income countries, but none specifically to address postoperative care and complications. We aimed to identify key features of a proposed short-course addressing this topic using a Delphi process with low- and middle-income country anaesthesia providers trained as short-course facilitators. An initial questionnaire was co-developed from literature review and exploratory workshops to include 108 potential course features. Features included content; teaching method; appropriate participants; and appropriate faculty. Over three Delphi rounds (panellists numbered 86, 64 and 35 in successive cycles), panellists indicated which features they considered most important. Responses were analysed by geographical regions: Africa, the Americas, south-east Asia and Western Pacific. Ultimately, panellists identified 60, 40 and 54 core features for the proposed course in each region, respectively. There were high levels of consensus within regions on what constituted core course content, but not between regions. All panellists preferred the small group workshop teaching method irrespective of region. All regions considered anaesthetists to be key facilitators, while all agreed that both anaesthetists and operating theatre nurses were key participants. The African and Americas regional panels recommended more multidisciplinary healthcare professionals for participant roles. Faculty from high-income countries were not considered high priority. Our study highlights variability between geographical regions as to which course features were perceived as most locally relevant, supporting regional adaptation of short-course design rather than a one-size-fits-all model.     

New Zealand Emergency Medicine Network: A collaboration for acute care research in New Zealand

The specialty of emergency medicine in Australasia is coming of age. As part of this maturation there is a need for high‐quality evidence to inform practice. This article describes the development of the New Zealand Emergency Medicine Network, a collaboration of committed emergency care researchers who share the vision that New Zealand/Aotearoa will have a world‐leading, patient‐centred emergency care research network, which will improve emergency care for all, so that people coming to any ED in the country will have access to the same world‐class emergency care.     

Twelve tips for developing,implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization’s educational mission and participants’ career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population’s health.     

神经生长因子和脑源性神经营养因子在脑胶质瘤内的表达

目的研究NGF(NeverGrowth Factor,神经生长因子)、BDNF(BrainDerivedNeurotrophicFactor,脑源性神经营养因子)在脑胶质瘤内的表达,探讨它们与肿瘤病理分级、实体肿瘤部位的关系,以及它们在肿瘤发生过程中的作用。方法通过免疫组织化学SP染色方法检测70例胶质瘤和5例正常脑组织中NGF和BDNF的表达。结果NGF和BDNF阳性细胞表达率明显高于正常脑组织内的表达,有统计学意义(P<0.05);在不同病理级别胶质瘤之间阳性细胞表达率也有差异,分别是:I级16.56%,11.24%;II级32.45%,18.23%;III级40.91%,21.44%;IV级24.71%,15.39%,正常脑组织内的表达率为7.06%,5.98%,且有统计学意义(P<0.05)。NGF和BDNF阳性细胞表达率在不同部位胶质瘤内各不相同,分别为:颞叶42.57%,24.19%;顶叶35.62%,20.09%;小脑28.67%,16.17%;额叶21.45%,12.42%,差异有显著性(P<0.05)。结论NGF和BDNF在脑胶质瘤内高表达;NGF和BDNF阳性细胞表达与胶质瘤的病理级别、肿瘤部位有关;NGF和BDNF可能参与了胶质瘤的发生。     

经皮穿刺气管切开术的急救效果分析

目的:观察并分析经皮穿刺气管切开术(PT)的急救效果。方法:从操作时间、术中出血、术后渗血、气道分泌物和切口愈合等五方面比较抢救成功的24例应用PT术和40例常规气管切开术患者的急救效果。结果:应用PT术呼吸道重建时间明显缩短,术中出血和术后渗血明显减少,伤口愈合明显加快,但对减少气道分泌物方面,与气管切开术无明显差异。结论:PT术安全可靠、简便省时,并发症少,可以明显提高急诊急救中呼吸道重建的效率。