ObjectiveTo explore the feasibility of introducing student-standardized patients in the teaching reform of medical nursing course. MethodsWe chose four classes of nursing students from grade 2012 between September and December 2014 as the research subjects.Cluster sampling was used to choose two classes of 84 nursing students randomly as trial group, who received student-standardized patients in their practical learning; while the rest 2 classes of 83 students were chosen as control group, who received traditional teaching method.The course scores and the effect evaluation were compared between the two groups. ResultsThe basic knowledge test score of the trial group 31.28±4.81 was not significantly different from that of the control group 32.10±2.15(P > 0.05).The case analysis test score of the trial group 54.36±3.45 was significantly higher than that of the control group 43.12±1.37(P < 0.05).The communication ability, health education ability, skill operation ability and professional quality score of nursing students in the trial group were also significantly higher than those in the control group (P < 0.05). ConclusionIntroducing student-standardized patients in practical teaching of medical nursing can improve the teaching effect and students' comprehensive ability.
Objective To investigate the clinical characteristics of prepapillary and preretinal vascular loops. Methods The clinical manifestation, results of the fundus fluorescein angiography, and the prognosis of 20 cases(24 eyes) with prepapillary and preretinal vascual loops were analyzed retrospectively. Results 66.7% of prepapillary and preretinal vascular loops were involved in one eye, and 95.8% of vascular loops were located within one optic disc diameter. There were different configuration types of the vascular loops. Among 20 cases(24 eyes) of the vascular loops, 70.8%(17 eyes) were arterial, 12.5%(3 eyes) were venous, and 16.7%(4 eyes) were both arterial and venous. 62.5% of eyes with prepapillary and preretinal vascular loops were associated with other congenital and developmental anomalies of retinal vascular vessels. Conclusion Most PRVL are arterial and superior to the optic disc. The serious distortion of the vascular loops may result in disturbance of blood flow in artery and retinal hemorrhage, which cause visual loss. (Chin J Ocul Fundus Dis, 1999, 15: 9-11)
Objective To evaluated the application effect of reverse digital modeling combined with three-dimensional (3D)-printed disease models in the standardized training of orthopedic residents focusing on pelvic tumors. Methods From August 2022 to August 2023, 60 orthopedic residents from West China Hospital, Sichuan University were randomly assigned to a trial group (n=30) and a control group (n=30). The trial group received instruction using reverse digital modeling and 3D-printed pelvic tumor models, while the control group underwent traditional teaching methods. Teaching outcomes were evaluated and compared between groups through knowledge tests, practical skill assessments, and satisfaction surveys. Results Before training, there was no statistically significant difference in knowledge tests or practical skill assessments between the two groups (P>0.05). After training, the trial group showed significantly better performance than the control group in knowledge tests (90.5±5.2 vs. 78.4±6.8, P<0.05), skill assessments (92.7±4.9 vs. 81.3±6.2, P<0.05), and satisfaction surveys (9.40±1.10 vs. 7.60±1.20, P<0.05). One month after training, the trial group still showed significantly better performance than the control group in knowledge tests (88.1±6.4 vs. 72.3±7.1, P<0.05) and skill assessments (90.3±5.8 vs. 75.6±6.9, P<0.05). Conclusions Reverse digital modeling combined with 3D printing offers an intuitive and effective teaching approach that improves comprehension of pelvic tumor anatomy and strengthens clinical and technical competencies. This method significantly enhances learning outcomes in standardized residency training and holds promise for broader integration into medical education.
Objective To analyze and compare the domestic quality standard and foreign quality standard of sodium hyaluronate (HA), and to expatiate on the critical process monitoring parameters. Methods Different quality standards of HA were compared by translating and sorting, and some experimental data were analyzed as well as the manufacturing practice was elaborated. Results Differences exist in raw materials standard or specifications of products between domestic and foreign, but the basic control points are concordant. Conclusion The company should set up reasonable and controllable quality standard based on quality requirements and related process characteristics so as to assure the safety and effectiveness of the clinical application.
Objective To analyze the trend of standardized infection ratio (SIR) of surgical site infection (SSI) in small bowel surgery, objectively evaluate the effect of infection control, and provide evidence-based strategies for SSI prevention. Methods According to Centers for Disease Control and Prevention (CDC) / National Healthcare Safety Network (NHSN) surveillance definitions for specific types of infections and the monitoring methods of SSI events published by NHSN, the SSI and related risk factors of adult inpatients undergoing small bowel surgery in Yichang Central People’s Hospital between January 1, 2016 and December 31, 2022 were prospectively monitored. The inpatients undergoing small bowel surgery that meets the definition of International Classification of Diseases, 10th Revision Clinical Modifications/Procedure Coding System (ICD-10-CM/PCS), a multivariate binary logistic regression model was used to calculate the predicted infections in each year, the model included the risk factors for small bowel surgery in NHSN Complex Admission/Readmission (A/R) SSI Model with 7 years of surveillance data as the baseline. The SIR was calculated by dividing the number of observed SSI by the number of predicted SSI in each year. The Mid-P method was used to test the difference of SIR compared to the previous year, and the linear regression model was used to analyze the trend of SIR. Results A total of 2 436 patients were included, with 48 cases of deep incision infection and 49 cases of organ/cavity infection, and the overall incidence rate of infection was 4.0%. From 2016 to 2022, there were 151, 244, 222, 260, 320, 408, and 831 patients who underwent small bowel surgery, respectively. The Mid-P test showed that there was a significant difference in SIR from 2016 to 2019 (P<0.05), and there was an increase in 2018 compared with 2017. There was no significant difference in SIR compared to the previous year from 2019 to 2022 (P>0.05), and there was no significant difference in the trend of SIR of SSI (P=0.065). Conclusions From January 1, 2017, to December 31, 2022, advances have been made in SSI control practices of small bowel surgery in six consecutive years, except for 2018, but there was no annual downward trend from 2020 to 2022. The use of SIR provides a new approach for evaluating the quality of infection control.
ObjectiveTo analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF.MethodsThe clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI score×sFLR.ResultsA total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78% (20/72) in these 72 patients with HCC, which was 12.96% (7/54) and 72.22% (13/18) in the 54 patients with ALBI- Ⅰ grade and 18 patients with ALBI- Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=11.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI score×sFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773).ConclusionCompared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.
Objective To study the USA government’s administrative system about medical device standards as well as the standard making. Methods The relevant documents, regulations, website that USA Food and Drug Administration announced were extensively reviewed, knowing the USA medical device standards synthetically. Results The USA standards system of medical device included regulatory requirements and voluntary consensus standards. This article simply introduced the laws, regulations, performance standards and consensus standards. Conclusion The USA’s administrative system about medical device standards as well as many standards can be referenced.
Objective To establish a short-term mortality risk scoring standard for sepsis-associated acute respiratory distress syndrome (sARDS) and provide a reference tool for clinicians to evaluate the severity of sARDS patients. Methods A retrospective cohort study was conducted on sARDS patients admitted to the adult intensive care unit (ICU) of the First Affiliated Hospital, Hengyang Medical School, University of South China from January 1, 2013 to August 31, 2020. They were divided into a death group and a survival group according to whether they died within 28 days after admission to ICU. Clinical data of the patients was collected within 24 hours admitted to ICU. Related risk factors for mortality within 28 days after admission to ICU were screened out through univariate logistic regression analysis. A risk prediction model for mortality within 28 days after admission to ICU was established by multivariate logistic regression analysis. The Hosmer-Lemeshow χ2 test and the area under the receiver operating characteristic (ROC) curve were used to evaluate the model’s goodness-fit and accuracy in predicting 28-day mortality of the sARDS patients, respectively. Finally, the clinical prognosis scoring criteria 28-day mortality of the sARDS patients were established according to the weight coefficients of each independent risk factor in the model. Results A total of 150 patients were recruited in this study. There were 67 patients in the survival group and 83 patients in the death group with a 28-day mortality rate of 55.3%. Four independent risk factors for 28-day mortality of the sARDS patients, including invasive mechanical ventilation, the number of dysfunctional organs≥3, serum lactic acid≥4.3 mmol/L and the severity of ARDS. A risk prediction model for mortality within 28 days of the sARDS patients was established. The area under the ROC curve and 95% confidence interval (CI), sensitivity and specificity of the risk prediction model for 28-day mortality for the sARDS patients were 0.896 (95%CI 0.846 - 0.945), 80.7% and 82.1%, respectively, while that for acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were 0.865 (95%CI 0.805 - 0.925), 71.1% and 89.6%; for sequential organ failure assessment (SOFA) score were 0.841 (95%CI 0.7799 - 0.904), 68.7%, and 82.1%; for the prediction scores of lung injury were 0.855 (95%CI 0.789 - 0.921), 81.9% and 82.1%, respectively. It was indicated that the prediction accuracy of this risk prediction model of 28-day mortality maybe was better than that of APACHE-Ⅱ score, SOFA score and prediction score of lung injury. In addition, four risk factors were assigned as invasive mechanical ventilation (12 points), serum lactic acid≥4.3mmol /L (1 point), number of organs involved≥3 (3 points), and severity of ARDS (mild for 13 points, moderate for 26 points, severe for 39 points). Further more, the score of each patient was 13 - 55 points according to the scoring criteria, and the score grade was made according to the percentile method: 13 - 23 points for the low-risk group for 28-day mortality, 24 - 34 points for the medium-risk group for 28-day mortality, 35 - 45 points for the high-risk group for 28-day mortality, and over 45 points for the extremely high-risk group for 28-day mortality. According to the scoring criteria, the prognosis of the patients in this study was analyzed. The mortality probability of each group was 0.0% in the low-risk group, 13.8% in the medium-risk group, 51.9% in the high-risk group, and 89.7% in the extremely high-risk group, respectively. Conclusions The invasive mechanical ventilation, the number of involved organs≥3, serum lactic acid≥4.3 mmol /L and the severity of sARDS are independent risk factors for 28-day mortality of the sARDS patients. The scoring criteria may predict the risk of 28-day mortality for the sARDS patients.
摘要:目的: 通过分析地市级急救中心院前急救资料,探讨ICD10疾病分类方法在院前急救中的实用性。 方法 :回顾性分析2007年1~12月份自贡市急救中心出诊的全部有效急救患者的急诊诊断以及随访诊断,使用ICD10编码进行归类,比较疾病性别构成比。 结果 :全年院前急救4109例,排5位的疾病分别为损伤、中毒和外因的某些其他后果(484%)、循环系统疾病(170%)、消化系统疾病(81%)、呼吸系统疾病(64%)、精神和行为障碍(52%),损伤、中毒和外因的某些其他后果、循环系统疾病以及消化系统疾病出诊量男性多于女性(P＜005),耳和乳突疾病以及妊娠、分娩和产褥期疾病出诊量女性多于男性(P＜005)。 结论 :采用ICD10标准对院前急救病谱分类有进一步探讨的价值。Abstract: Objective: To investigate the value of ICD10 in prehospital care by the analysis of cases in Zigong Urgent Rescue Center. Methods : All cases of prehospital care during the year of 2007 were studied, whose emergency Diagnoses and followup diagnoses were recorded, and they were classified by international classification of diseases 10th revision (ICD10). The gender composition ratio of diseases was analyzed. Results : Four thousand one hundred and nine cases of prehospital care in 2007 were included. Topfive diseases were injury, poisoning and certain other consequences of external causes (484%), diseases of the circulatory system (170%), diseases of the digestive system (81%), diseases of the respiratory system (64%), and mental and behavioral disorders (52%) respectively. The amout of the male prehospital cases was more that of than the female’s in the diseases of injury, poisoning and certain other consequences of external causes, diseases of the circulatory system, diseases of the digestive system (P＜005); the amount of the female prehospital cases was more than that of the male’s in the diseases of the ear and mastoid process, pregnancy, childbirth and the puerperium (P＜005). Conclusion : Further research on the spectrum of diseases classified by ICD10 is valuable.
ObjectiveTo analyze the status of scientific papers published by clinical medicine postgraduates during the "double-track integration" training period. MethodsData of publications of 634 clinical medicine postgraduate students who were been trained in the "double-track integration" system in West China School of Medicine, Sichuan University from 2015 to 2017 were collected. The data of the papers published during the concurrent training and residency were retrospectively analyzed. Results634 postgraduates with master degree in clinical medicine published 1 038 papers in total. Students from 3 grades published 1.606, 1.554 and 1.785 papers on average respectively, and the overall average number of publications was 1.637 per person. The composition ratios of the journal types of articles were: SCI, 37.96%; MEDLINE, 6.55%; Chinese core journals, 55.49%. Statistical differences were found in the types of journals published in the three grades. The composition ratios of article types were: case report, 24.56%; review, 34.01%; original study, 41.43%. There was no statistical difference in the composition of article types in 3 grades. All 634 graduate students met the requirements for thesis publication and succeeded in completing the training. ConclusionsIn the "double-track integration" training system, postgraduates with master degree in clinical medicine can meet the training requirements of publishing relevant articles prior to graduation.