Study on a job competence evaluation system for resident physicians (including integrated postgraduates) receiving standardized training.

BACKGROUND: Standardized training for resident physicians is the primary form of postgraduate medical education, and it plays a pivotal role in healthcare safety and industry stability. Currently, it has garnered significant attention from healthcare institutions. METHODS: By conducting a comprehensive literature review and a Delphi consultation in June 2022 for which 40 experts in clinical medicine, public health, and other related fields in China were invited. The indicators were adjusted according to the results of the consultation, and the final indicator weights were determined through an analytic hierarchy process. RESULTS: The response rate was 100%, and the expert authority coefficient was 0.879. The consistency among the experts on the tertiary indicators, as measured by Kendall's W, was 0.675 (χ2 = 42.516, p < 0.001). Based on the results of the expert consultation, a job competence evaluation system for resident physicians (including integrated postgraduates) receiving standardized training was established, which included 6 primary indicators, 18 secondary indicators, and 116 tertiary indicators. The weights for the primary indicators, namely professional quality, skills and knowledge, patient care, communication and collaboration, teaching skills, and lifelong learning, were 0.313, 0.248, 0.181, 0.083, 0.066, and 0.110, respectively. The top three secondary indicators in terms of combined weights were clinical skills (0.122), professional ethics (0.120), and professional dedication (0.109). The three tertiary indicators with the highest scores were "maintains collaboration with peers and colleagues in patient treatment," "has clinical thinking skills, makes diagnosis and treatment decisions based on analysis of evidence, and has the ability to administer suitable treatments," and "abides by laws and discipline and refuses to seek personal gains in medical practice"; their combined weights were 0.035, 0.028, and 0.027, respectively. CONCLUSION: This study has established a concrete, objective, and quantifiable competency assessment index system for standardized training of clinical resident physicians (including integrated postgraduates). This system provides a foundation for the quantitative evaluation of the competency of clinical resident physicians (including integrated postgraduates) undergoing standardized training.

Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study.

Background: The health benefits and risks of dietary supplement use are controversial. Objective: To evaluate the association among dietary supplement use, levels of nutrient intake from foods and supplements, and mortality among U.S. adults. Design: Prospective cohort study. Setting: NHANES (National Health and Nutrition Examination Survey) data from 1999 to 2010, linked to National Death Index mortality data. Participants: 30 899 U.S. adults aged 20 years or older who answered questions on dietary supplement use. Measurements: Dietary supplement use in the previous 30 days and nutrient intake from foods and supplements. Outcomes included mortality from all causes, cardiovascular disease (CVD), and cancer. Results: During a median follow-up of 6.1 years, 3613 deaths occurred, including 945 CVD deaths and 805 cancer deaths. Ever-use of dietary supplements was not associated with mortality outcomes. Adequate intake (at or above the Estimated Average Requirement or the Adequate Intake level) of vitamin A, vitamin K, magnesium, zinc, and copper was associated with reduced all-cause or CVD mortality, but the associations were restricted to nutrient intake from foods. Excess intake of calcium was associated with increased risk for cancer death (above vs. at or below the Tolerable Upper Intake Level: multivariable-adjusted rate ratio, 1.62 [95% CI, 1.07 to 2.45]; multivariable-adjusted rate difference, 1.7 [CI, -0.1 to 3.5] deaths per 1000 person-years), and the association seemed to be related to calcium intake from supplements (≥1000 mg/d vs. no use: multivariable-adjusted rate ratio, 1.53 [CI, 1.04 to 2.25]; multivariable-adjusted rate difference, 1.5 [CI, -0.1 to 3.1] deaths per 1000 person-years) rather than foods. Limitations: Results from observational data may be affected by residual confounding. Reporting of dietary supplement use is subject to recall bias. Conclusion: Use of dietary supplements is not associated with mortality benefits among U.S. adults. Primary Funding Source: National Institutes of Health.

Altered resting state connectivity in right side frontoparietal network in primary insomnia patients.

OBJECTIVE: This study investigated alterations of resting-state networks (RSNs) in primary insomnia patients as well as relationships between these changes and clinical features. METHODS: Fifty-nine primary insomnia patients and 53 healthy control subjects underwent a resting-state fMRI scan (rs-fMRI). Ten RSNs were identified using independent component analysis of rs-fMRI data. To assess significant differences between the two groups, voxel-wise analysis of ten RSNs was conducted using dual regression with FSL randomised non-parametric permutation testing and a threshold-free cluster enhanced technique to control for multiple comparisons. Relationships between abnormal functional connectivity and clinical variables were then investigated with Pearson's correlation analysis. RESULTS: Primary insomnia patients showed decreased connectivity in regions of the right frontoparietal network (FPN), including the superior parietal lobule and superior frontal gyrus. Moreover, decreased connectivity in the right middle temporal gyrus and right lateral occipital cortex with the FPN showed significant positive correlations with disease duration and self-rated anxiety, respectively. CONCLUSIONS: Our study suggests that primary insomnia patients are characterised by abnormal organisation of the right FPN, and dysfunction of the FPN is correlated with disease duration and anxiety. The results enhance our understanding of neural substrates underlying symptoms of primary insomnia from the viewpoint of resting-state networks. KEY POINTS: • Primary insomnia patients showed altered functional connectivity in the right FPN. • Middle temporal gyrus FC with FPN was significantly correlated with disease duration. • Lateral occipital cortex FC with FPN was significantly correlated with SAS scores.

Exploration and practice of humanistic education for medical students based on volunteerism.

Humanistic education aims to promote educated people's practical and conscious activities to enhance their humanity, cultivate ideal personalities, and realize personal and social values, to develop a humanistic spirit. The advancement of higher education in China has led to the proposal to strengthen scientific and humanistic education integration. Medicine is between science and humanities, shouldering the important task of training senior medical personnel, the quality of medical students will affect the quality of future medical and health work; thus, medical students must explore and practice humanistic education. Promoting and practicing volunteerism is a specific act of constructing spiritual civilization in the whole society, and it is also considered beneficial for improving citizens' sense of responsibility and dedication. Medical students' practice of volunteerism and help in society is a precise manifestation of humanistic care. This review summarizes medical students' exploration and practice of humanistic education in volunteering.

Structure and properties of halogen-free flame retardant and phosphorus-containing aromatic poly(1,3,4-oxadiazole)s fiber.

In order to improve the flame retardance of aromatic polyoxadiazole (p-POD) fiber, a series of phosphorus-containing PODs (pho-POD) were synthesized by introducing triaryl phosphine oxide (TPO) units into the main chains of p-POD using hydrazine sulfate, terephthalic acid and bis(p-carboxy)phenyl phosphine oxide (BCPPO) as monomers, and then halogen-free flame resistant pho-POD fibers were obtained from wet spinning. The structure and properties of the pho-POD fibers were characterized and measured in detail using the methods of wide-angle X-ray diffraction (WAXD), scanning electron microscopy (SEM), thermogravimetric analysis (TGA), the limiting oxygen index (LOI), oxygen bomb calorimeter, Pyrolysis-Gas Chromatography/Mass Spectrometry (Py-GC/MS) etc. The results show that the introduction of TPO units resulted in the weakening of the crystallization ability, the formation of the poriferous and lax interior structure, the slight decrease in the thermal stability and mechanical properties of the POD fibers. However, the value of LOI obviously increased from 28% to 35%, and the gross heat of combustion (GHC) decreased from 19.72 MJ kg-1 to 17.84 MJ kg-1 with the increase in the content of the BCPPO. Moreover, the combustion residue of pho-POD fiber revealed a smooth, dense and non-porous carbon layer, which could effectively play a role of oxygen barrier and enhance the flame resistance. From the above results, it can be concluded that the flame resistance of the POD fiber could be improved significantly after introducing the TPO unit. The results of Py-GC/MS illustrate that the TPO unit of pho-POD could inhibit the production of volatile products, which could be confirmed that the mechanism of enhancing the flame retardancy by introducing TPO units was mainly the flame retardation of the condensed phase.

Trends in Processed Meat, Unprocessed Red Meat, Poultry, and Fish Consumption in the United States, 1999-2016.

BACKGROUND: Accumulating evidence links excessive consumption of processed meat with an increased risk of obesity, diabetes, cardiovascular diseases, and some cancers. Yet, trends in consumption of different types of processed meat in the United States have not been quantified. OBJECTIVE: The aim of the study was to characterize trends in consumption of different types of processed meat among US adults in relation to the consumption of unprocessed red meat, poultry, and fish/shellfish in the past 18 years, and their purchase locations. DESIGN: Dietary data collected from US adults aged 20 years and older completing at least one valid 24-hour diet recall from nine cycles of the National Health and Nutrition Examination Survey (NHANES 1999-2016) were used to evaluate the trends in mean consumption of processed meat, unprocessed red meat, poultry, and fish/shellfish. PARTICIPANTS/SETTING: This was a nationally representative sample of 43,995 US adults aged 20 years and older. MAIN OUTCOME MEASURES: We measured survey-weighted, energy-adjusted mean consumption of processed meat, unprocessed red meat, poultry, and fish/shellfish. STATISTICAL ANALYSIS: Trends in mean intake were assessed by treating the 2-year survey cycle as a continuous variable in survey-weighted linear regression models. Changes in mean intake were computed as the difference in mean intake between the earliest (1999-2000) and latest (2015-2016) cycles. RESULTS: The mean consumption of processed meat among US adults remained unchanged in the past 18 years (mean change=4.22 g/wk; P trend=0.95). The top five processed meats consumed by US adults in 2015-2016 were luncheon meat (mean intake=73.3 g/wk), sausage (45.5 g/wk), hot dog (17.5 g/wk), ham (17.5 g/wk), and bacon (8.6 g/wk), accounting for 39.3%, 24.4%, 9.4%, 9.4%, and 4.6%, respectively, of the total processed meat consumption in the United States. During the same period, the mean consumption declined for unprocessed red meat (mean change= -56.7 g/wk; P trend<0.001) and increased for poultry (mean change=47.0 g/wk; P trend<0.001). The mean consumption of fish/shellfish did not change (mean change=1.55 g/wk; P trend=0.14). Stores and fast-food restaurants are primary purchase locations for processed meat. CONCLUSIONS: Despite growing public health concerns about processed meat consumption, there have been no changes in the amount of processed meat consumed by US adults over the last 18 years. Findings of this study can inform public health policy priorities for improving diet and reducing chronic disease burden in United States.

Altered gray matter volume in primary insomnia patients: a DARTEL-VBM study.

Previous neuroimaging studies have reported brain morphological alterations and the occurrence of mental disorders in primary insomnia (PI) patients. However, studies of the effect of disrupted sleep on brain structure have showed inconsistent results. In this study, DARTEL-VBM was used to evaluate the changes in gray matter volume from 60 PI patients and 53 controls. Voxel-wise statistics was performed in two ways. One is a more liberal statistical analysis using an uncorrected P < 0. 001 with 25 voxels, and the other one is a more conservative approach using a threshold of P < 0.05, corrected for multiple comparisons using the Gaussian random field (GRF) method. Partial correlation was used to analyze the relationship between abnormal volume and clinical features. PI patients had reduced gray matter volume primarily in the right middle cingulate cortex with correction (P < 0.05). Correlation analysis showed gray matter changes in the left middle cingulate cortex were negatively associated with self-ratings for anxiety and depression. This study showed that gray matter deficits in cingulate cortex in patients with insomnia, and the decreased gray matter volume may be associated with the difficulties in emotional management due to insomnia. Functional roles of the affected regions in emotion and regulation of sleep might provide supplementary evidence and guide further research that may facilitate understanding the mechanisms underlying insomnia.

Altered white matter microstructure identified with tract-based spatial statistics in irritable bowel syndrome: a diffusion tensor imaging study.

The neural mechanisms underlying the pathophysiology of irritable bowel syndrome(IBS) are far from being completely understood. The purpose of the present study was to investigate potential white matter (WM) microstructural changes and underlying causes for WM impairment in IBS using diffusion tensor imaging. The present prospective study involved 19 patients with IBS and 20 healthy controls. Whole-brain voxel-wise analyses of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were performed by tract-based spatial statistics (TBSS) to localize abnormal WM regions between the 2 groups. We found that IBS patients had significantly reduced FA (P < 0.05) in the splenium of the corpus callosum, the right retrolenticular area of the internal capsule and the right superior corona radiata. We also found increased MD (P < 0.05) in the splenium and body of the corpus callosum, the right retrolenticular area of the internal capsule, the right superior corona radiata and the right posterior limb of the internal capsule. In addition, IBS patients had significantly increased AD (P < 0.05) in the splenium of the corpus callosum, the bilateral retrolenticular area of the internal capsule and the left posterior limb of the internal capsule. We conclude that the WM microstructure is changed in IBS and the underlying pathological basis may be attributed to the axonal injury and loss. These results may lead to a better understanding of the pathophysiology of IBS.