Dreyfus scale-based feedback increased medical students’ satisfaction with the complex cluster part of a interviewing and physical examination course and improved skills readiness in Taiwan

Shiau-Shian Huang,Chia-Chang Huang,Ying-Ying Yang,Shuu-Jiun Wang,Boaz Shulruf,Chen-Huan Chen 한국보건의료인국가시험원 2019 보건의료교육평가 Vol.16 No.-

PurposeIn contrast to the core part of the clinical interviewing and physical examination (PE) skills course, corresponding to the basic, head-to-toe, and thoracic systems, learners need structured feedback in the cluster part of the course, which includes the gastrointestinal, neuromuscular, and musculoskeletal systems. This study evaluated the effects of using Dreyfus scale-based feedback, which has elements of continuous professional development, instead of Likert scale-based feedback in the cluster part of training in Taiwan. MethodsInstructors and final-year medical students in the 2015-2016 classes of National Yang-Ming University, Taiwan comprised the regular cohort, whereas those in the 2017-2018 classes formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback, rather than Likert scale-based feedback, was used in the cluster part of the course. ResultsIn the cluster part of the course in the regular cohort, pre-trained standardized patients rated the class climate as poor, and students expressed low satisfaction with the instructors and course and low self-assessed readiness. In comparison with the regular cohort, improved end-of-course group objective structured clinical examination scores after the cluster part were noted in the intervention cohort. In other words, the implementation of Dreyfus scale-based feedback in the intervention cohort for the cluster part improved the deficit in this section of the course. ConclusionThe implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster part of the clinical interviewing and PE skills course. Simultaneously, this new intervention achieved the goal of promoting medical students’ readiness for interviewing, PE, and self-directed learning.

Effects of a simulation-based blended training model on nurses’ treatment decision-related knowledge about oral cancer in Taiwan: a pilot survey

Chia-Chang Huang,Shiau-Shian Huang,Ying-Ying Yang,Shou-Yen Kao 한국보건의료인국가시험원 2021 보건의료교육평가 Vol.18 No.-

The present study aimed to evaluate the effects of virtual reality (VR) simulations combined with bedside assignments on nurses’ self-efficacy in providing pre-treatment educational services. Between March 2019 and November 2020, we conducted a study of VR educational materials that were developed to cover information about the treatment of oral cancers. The effects of the VR simulation, the thinking-path tracking map method, and bedside assignments on the nurses’ treatment decision-related knowledge were evaluated in a ward for oral cancer patients at Taipei Veterans General Hospital, Taipei, Taiwan. The blended training model significantly increased nurses’ familiarity (P<0.01) and confidence (P<0.03) regarding their knowledge of treatments and treatment decision-related knowledge. This model also significantly increased their confidence in their skills in bedside pre-treatment education for admitted oral cancer patients (P<0.002). Oral cancer-specific VR materials enhanced the effectiveness of skills training among nurses in the oral cancer ward.

The tyrosine kinase inhibitor nintedanib activates SHP-1 and induces apoptosis in triple-negative breast cancer cells

Chun-Yu Liu,Tzu-Ting Huang,Pei-Yi Chu,Chun-Teng Huang,Chia-Han Lee,Wan-Lun Wang,Ka-Yi Lau,Wen-Chun Tsai,Tzu-I Chao,Jung-Chen Su,Ming-Huang Chen,Chung-Wai Shiau,Ling-Ming Tseng,Kuen-Feng Chen 생화학분자생물학회 2017 Experimental and molecular medicine Vol.49 No.-

Triple-negative breast cancer (TNBC) remains difficult to treat and urgently needs new therapeutic options. Nintedanib, a multikinase inhibitor, has exhibited efficacy in early clinical trials for HER2-negative breast cancer. In this study, we examined a new molecular mechanism of nintedanib in TNBC. The results demonstrated that nintedanib enhanced TNBC cell apoptosis, which was accompanied by a reduction of p-STAT3 and its downstream proteins. STAT3 overexpression suppressed nintedanib-mediated apoptosis and further increased the activity of purified SHP-1 protein. Moreover, treatment with either a specific inhibitor of SHP-1 or SHP-1-targeted siRNA reduced the apoptotic effects of nintedanib, which validates the role of SHP-1 in nintedanib-mediated apoptosis. Furthermore, nintedanib-induced apoptosis was attenuated in TNBC cells expressing SHP-1 mutants with constantly open conformations, suggesting that the autoinhibitory mechanism of SHP-1 attenuated the effects of nintedanib. Importantly, nintedanib significantly inhibited tumor growth via the SHP-1/p-STAT3 pathway. Clinically, SHP-1 levels were downregulated, whereas p-STAT3 was upregulated in tumor tissues, and SHP-1 transcripts were associated with improved disease-free survival in TNBC patients. Our findings revealed that nintedanib induces TNBC apoptosis by acting as a SHP-1 agonist, suggesting that targeting STAT3 by enhancing SHP-1 expression could be a viable therapeutic strategy against TNBC.

Equal Z standard-setting method to estimate the minimum number of panelists for a medical school’s objective structured clinical examination in Taiwan: a simulation study

Ying-Ying Yang,Pin-Hsiang Huang,Ling-Yu Yang,Chia-Chang Huang,Chih-Wei Liu,Shiau-Shian Huang,Chen-Huan Chen,Fa-Yauh Lee,Shou-Yen Kao,Boaz Shulruf 한국보건의료인국가시험원 2022 보건의료교육평가 Vol.19 No.-

Purpose Undertaking a standard-setting exercise is a common method for setting pass/fail cut scores for high-stakes examinations. The recently introduced equal Z standard-setting method (EZ method) has been found to be a valid and effective alternative for the commonly used Angoff and Hofstee methods and their variants. The current study aims to estimate the minimum number of panelists required for obtaining acceptable and reliable cut scores using the EZ method. Methods The primary data were extracted from 31 panelists who used the EZ method for setting cut scores for a 12-station of medical school’s final objective structured clinical examination (OSCE) in Taiwan. For this study, a new data set composed of 1,000 random samples of different panel sizes, ranging from 5 to 25 panelists, was established and analyzed. Analysis of variance was performed to measure the differences in the cut scores set by the sampled groups, across all sizes within each station. Results On average, a panel of 10 experts or more yielded cut scores with confidence more than or equal to 90% and 15 experts yielded cut scores with confidence more than or equal to 95%. No significant differences in cut scores associated with panel size were identified for panels of 5 or more experts. Conclusion The EZ method was found to be valid and feasible. Less than an hour was required for 12 panelists to assess 12 OSCE stations. Calculating the cut scores required only basic statistical skills.

Development of primary cell cultures from the adult xylem-feeding leafhopper, Kolla paulula, as a tool for studying Wolbachia biology

Rong-Jen Shiau,Yu-Der Wen,Hsien-Tzung Shih,Shin-Yi Chen,Chiou-Chu Su,Wei-Huang Tsai 한국응용곤충학회 2011 Journal of Asia-Pacific Entomology Vol.14 No.4

Xylophagous leafhoppers are vectors of xylem-limited plant pathogens such as citrus variegated chlorosis (CVC) and Pierce's disease, which cause Xylella diseases. Currently, no cure for Xylella diseases exists. The objective of endosymbiont control using Wolbachia pipientis is to reduce the populations of insect vectors,potentially preventing the expansion of Xylella diseases. The purpose of this study was to establish primary cell cultures from adult xylem-feeding leafhoppers to study Wolbachia biology. Cells from adult male and female Kolla paulula (Walker) (Hemiptera: Membracoidea: Cicadellinae) were successfully cultured in Dulbecco's Modified Eagle Medium containing 20% fetal bovine serum and were maintained for more than 6 months. Cells of both male and female adults are round and semi-attached. The doubling times for male and female K. paulula cells are approximately 8 and 10 days, respectively. The presence of Wolbachia in K. paulula cell cultures was detected by polymerase chain reaction (PCR) amplification of Wolbachia surface protein (wsp) gene. The cell cultures developed in this study may be useful in studying interactions between Wolbachia and its hosts of different genders.

Negative effects on medical students’ scores for clinical performance during the COVID-19 pandemic in Taiwan: a comparative study

Eunice Jia-Shiow Yuan,Shiau-Shian Huang,Chia-An Hsu,Jiing-Feng Lirng,Tzu-Hao Li,Chia-Chang Huang,Ying-Ying Yang,Chung-Pin Li,Chen-Huan Chen 한국보건의료인국가시험원 2023 보건의료교육평가 Vol.20 No.-

Purpose Coronavirus disease 2019 (COVID-19) has heavily impacted medical clinical education in Taiwan. Medical curricula have been altered to minimize exposure and limit transmission. This study investigated the effect of COVID-19 on Taiwanese medical students’ clinical performance using online standardized evaluation systems and explored the factors influencing medical education during the pandemic. Methods Medical students were scored from 0 to 100 based on their clinical performance from 1/1/2018 to 6/31/2021. The students were placed into pre-COVID-19 (before 2/1/2020) and midst-COVID-19 (on and after 2/1/2020) groups. Each group was further categorized into COVID-19-affected specialties (pulmonary, infectious, and emergency medicine) and other specialties. Generalized estimating equations (GEEs) were used to compare and examine the effects of relevant variables on student performance. Results In total, 16,944 clinical scores were obtained for COVID-19-affected specialties and other specialties. For the COVID-19-affected specialties, the midst-COVID-19 score (88.51–3.52) was significantly lower than the pre-COVID-19 score (90.14–3.55) (P<0.0001). For the other specialties, the midst-COVID-19 score (88.32–3.68) was also significantly lower than the pre-COVID-19 score (90.06–3.58) (P<0.0001). There were 1,322 students (837 males and 485 females). Male students had significantly lower scores than female students (89.33–3.68 vs. 89.99–3.66, P=0.0017). GEE analysis revealed that the COVID-19 pandemic (unstandardized beta coefficient=-1.99, standard error [SE]=0.13, P<0.0001), COVID-19-affected specialties (B=0.26, SE=0.11, P=0.0184), female students (B=1.10, SE=0.20, P<0.0001), and female attending physicians (B=-0.19, SE=0.08, P=0.0145) were independently associated with students’ scores. Conclusion COVID-19 negatively impacted medical students' clinical performance, regardless of their specialty. Female students outperformed male students, irrespective of the pandemic.

Effects of virtual reality training on decreasing the rates of needlestick or sharp injury in new-coming medical and nursing interns in Taiwan

Szu-Hsien Wu,Chia-Chang Huang,Shiau-Shian Huang,Ying-Ying Yang,Chih-Wei Liu,Boaz Shulruf,Chen-Huan Chen 한국보건의료인국가시험원 2020 보건의료교육평가 Vol.17 No.-

Purpose: Senior nursing and medical interns’ lack of familiarity and confidence with respect to practicing universal precaution for theprevention of occupational needlestick or sharp injuries may harm themselves. Trainees’ self-reported needlestick or sharp injury ratewas known to be especially high during the first 2 months of internship in Taiwan. This prospective cohort study aimed to assess the effect of newly developed virtual reality (VR) game, which uses Gagne’s learning model to improve universal precaution for needlestickor sharp injury prevention and decrease the rates of needle stick or sharp injuries in new-coming medical and nursing interns in Taiwan. Methods: From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational needlestick or sharp injury prevention was sought to be achieved through a game of right and wrong choices for safe orunsafe universal precaution behaviors. Results: In comparison with medical interns, a higher proportion of nursing interns had past experiences of deep occupational needlestick or sharp injury. Before VR training, the familiarity and confidence for needlestick or sharp injury prevention were higher amongnursing interns than medical interns. Trainees with past experiences of deep needlestick or sharp injury exhibited better performanceon the accuracy rate and time needed to complete 20 decisions than those without past experiences in VR practice. All trainees showedan improved performance after VR training. A high proportion of trainees reported that the VR-based training significantly decreasedtheir anxiety about needlestick or sharp injury prevention. Conclusion: This self-developed VR game system using Gagne’s flow improved universal precaution for needlestick or sharp injuryprevention and reduced the needlestick or sharp injury rates in the first 2 months of nursing and medical internship.

Performance Improvement of Offline Phase for Indoor Positioning Systems Using Asus Xtion and Smartphone Sensors

Sheng-Cheng Yeh,Yih-Shyh Chiou,Huan Chang,Wang-Hsin Hsu,Shiau-Huang Liu,Fuan Tsai 한국통신학회 2016 Journal of communications and networks Vol.18 No.5

Providing a customer with tailored location-based ser-vices (LBSs) is a fundamental problem. For location-estimationtechniques with radio-based measurements, LBS applications arewidely available for mobile devices (MDs), such as smartphones,enabling users to run multi-task applications. LBS information notonly enables obtaining the current location of an MD but also pro-vides real-time push-pull communication service. For indoor envi-ronments, localization technologies based on radio frequency (RF)pattern-matching approaches are accurate and commonly used. However, to survey radio information for pattern-matching ap-proaches, a considerable amount of time and work is spent in in-door environments. Consequently, in order to reduce the system-deployment cost and computing complexity, this article proposesan indoor positioning approach, which involves using Asus Xtionto facilitate capturing RF signals during an offline site survey. Thedepth information obtained using Asus Xtion is utilized to estimatethe locations and predict the received signal strength (RF informa-tion) at uncertain locations. The proposed approach effectively re-duces not only the time and work costs but also the computing com-plexity involved in determining the orientation and RF during theonline positioning phase by estimating the user’s location by usinga smartphone. The experimental results demonstrated that morethan 78% of time was saved, and the number of samples acquiredusing the proposed method during the offline phase was twice asmuch as that acquired using the conventional method. For the on-line phase, the location estimates have error distances of less than2.67 m. Therefore, the proposed approach is beneficial for use invarious LBS applications.

Numerical investigation into dynamic behavior of adjustable preload double-nut ball screw

Chuen-Ren Wang,De-Shin Liu,Chien-Hsun Huang,Ting-Nung Shiau 대한기계학회 2016 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.30 No.10

The dynamic behavior of a double-nut ball screw was investigated by means of ABAQUS 6.13© simulations based on a threedimensional model. The validity of the numerical model was demonstrated by comparing the simulation results obtained for the reaction force and torque acting on the flange of the nut with the experimental results. We found that the two sets of results deviated by no more than 5.87% given a screw rotating speed of 100 rpm. Simulations were performed to investigate the effects of the spacer width, screw rotating speed, steel ball radius and axial force on the torque acting on the nut flange. The results show that the torque increases with an increasing spacer width due to an increasing preload force. Moreover, the torque increases as the screw rotating speed increases to 700 rpm, but decreases at higher rotating speeds due to a greater centrifugal force. Ball wear prompts a reduction in the preload force and thus reduces disproportionately the torque acting on the flange following extended operation. For higher axial loads (> 100 N), the torque remains approximately constant during run-in (0.025~0.2 s). However, for lower loads, notable fluctuations in the torque occur.

Performance Improvement of Offline Phase for Indoor Positioning Systems Using Asus Xtion and Smartphone Sensors

Yeh, Sheng-Cheng,Chiou, Yih-Shyh,Chang, Huan,Hsu, Wang-Hsin,Liu, Shiau-Huang,Tsai, Fuan The Korea Institute of Information and Commucation 2016 Journal of communications and networks Vol.18 No.5

Providing a customer with tailored location-based services (LBSs) is a fundamental problem. For location-estimation techniques with radio-based measurements, LBS applications are widely available for mobile devices (MDs), such as smartphones, enabling users to run multi-task applications. LBS information not only enables obtaining the current location of an MD but also provides real-time push-pull communication service. For indoor environments, localization technologies based on radio frequency (RF) pattern-matching approaches are accurate and commonly used. However, to survey radio information for pattern-matching approaches, a considerable amount of time and work is spent in indoor environments. Consequently, in order to reduce the system-deployment cost and computing complexity, this article proposes an indoor positioning approach, which involves using Asus Xtion to facilitate capturing RF signals during an offline site survey. The depth information obtained using Asus Xtion is utilized to estimate the locations and predict the received signal strength (RF information) at uncertain locations. The proposed approach effectively reduces not only the time and work costs but also the computing complexity involved in determining the orientation and RF during the online positioning phase by estimating the user's location by using a smartphone. The experimental results demonstrated that more than 78% of time was saved, and the number of samples acquired using the proposed method during the offline phase was twice as much as that acquired using the conventional method. For the online phase, the location estimates have error distances of less than 2.67 m. Therefore, the proposed approach is beneficial for use in various LBS applications.