对医学工程技术人员岗位培训方式的探讨

本文对如何开展医学工程技术人员的培训进行了分析，并提出了一些具体的办法。     

Change in knowledge of midwives and obstetricians following obstetric emergency training: a randomised controlled trial of local hospital, simulation centre and teamwork training

Objectives  To explore the effect of obstetric emergency training on knowledge. Furthermore, to assess if acquisition of knowledge is influenced by the training setting or teamwork training.
Design  A prospective randomised controlled trial.
Setting  Training was completed in six hospitals in the South West of England, UK and at the Bristol Medical Simulation Centre, UK.
Population  Midwives and obstetric doctors working for the participating hospitals were eligible for inclusion in the study. A total of 140 participants (22 junior and 23 senior doctors, 47 junior and 48 senior midwives) were studied.
Methods  Participants were randomised to one of four obstetric emergency training interventions: (1) 1-day course at local hospital, (2) 1-day course at simulation centre, (3) 2-day course with teamwork training at local hospital and (4) 2-day course with teamwork training at simulation centre.
Main outcome measures  Change in knowledge was assessed by a 185 question Multiple-Choice Questionnaire (MCQ) completed up to 3 weeks before and 3 weeks after the training intervention.
Results  There was a significant increase in knowledge following training; mean MCQ score increased by 20.6 points (95% CI 18.1–23.1, P < 0.001). Overall, 123/133 (92.5%) participants increased their MCQ score. There was no significant effect on the MCQ score of either the location of training (two-way analysis of variants P = 0.785) or the inclusion of teamwork training ( P = 0.965).
Conclusions  Practical, multiprofessional, obstetric emergency training increased midwives' and doctors' knowledge of obstetric emergency management. Furthermore, neither the location of training, in a simulation centre or in local hospitals, nor the inclusion of teamwork training made any significant difference to the acquisition of knowledge in obstetric emergencies.     

Development and evaluation of an allocation committee to distribute community placements on an equitable basis between universities: Our experience with the University Placement Allocation Committee

The present paper outlines the development and evaluation of an allocation committee to distribute community placements on an equitable basis between universities. Although based on our experience in South Australia with the University Placement Allocation Committee (UPAC), the primary goal is to outline the steps that would be useful if placement coordinators at other universities in Australia decided to establish and maintain an allocation committee. A survey of field supervisors was also conducted and field supervisors endorsed UPAC as a constructive mechanism for allocating community placements.     

Effect of Psoas Training on Postmenopausal Lumbar Bone Loss: A 3-Year Follow-Up Study

The present study completed a previous randomized trial that demonstrated the protective effect of 1-year psoas training on lumbar bone loss in postmenopausal women. Computerized tomography had been carried out at the beginning (CT1) and at the end (CT2) of this trial. In the present study, 67 women having completed the first trial were asked to practice psoas exercises (60 hip flexions in sitting position with a 5 kg weight on the knee) for 2 additional years with a third CT control at the end of this period (CT3). The aim of this complementary study was to assess the compliance rate and long-term effect on bone of daily psoas muscle training over a longer period. Twenty-one women performed this daily psoas training for 3 years from CT1 to CT3, and 14 acted as controls during the same period. Fourteen women were controls during the first year (from CT1 to CT2) but practiced psoas training during the following 2 years (from CT2 to CT3). Four women were psoas trained during the first year (from CT1 to CT2) and subsequently crossed over to the control group for the last 2 years. The compliance rate was 42%, with an attendance rate of 88%. The lumbar bone loss was lower in the 21 women trained over the 3 years (−3.26 ± 28.45 mg/cm³) than in the 14 untrained women (−16.79 ± 8.51 mg/cm³) (P= 0.02). The bone loss was not significantly reduced between the two periods of the study in the 12 women having been controls from CT1 to CT2 and having crossed over to the active training group from CT2 to CT3. Psoas training may be effective against lumbar bone loss. We conclude that specific training may play a contributing role in the preventive strategy to avoid osteoporosis. Received: 23 February 1996 / Accepted: 25 October 1996     

运动训练对雄性大鼠垂体─性腺轴功能的影响

本研究通过使用自己制造的大鼠流动水游泳池，对雄性大鼠进行了６周递增负荷的游泳训练，以此来探讨运动训练对大鼠垂体－性腺轴功能的影响，结果显示：与安静对照大鼠相比，训练大鼠的一般状态较差，血清睾酮水平显著降低（Ｐ＜０．０５），血清睾酮／皮质酮比值平均降低了３０％以上；而血清ＬＨ和ＦＳＨ水平未见明显变化。通过对大鼠睾丸组织ＬＨ／ＣＧ受体的测定，显示运动训练虽未引起其最大结合量的改变，却能使其解离常数显著升高（Ｐ＜０．０５）。提示此种训练可能通过降低睾丸ＬＨ／ＣＧ受体对垂体分泌ＬＨ的亲和力，从而影响睾酮的合成。     

使用颗粒状自体松质骨植骨的寰枢椎后路融合术

介绍一种在头环背心保护下用颗粒状自体松质骨植骨的寰枢椎后路融合术。对３４例寰枢椎不稳的病人施行了寰枢椎后路融合术。用头环背心维持寰椎的复位，将颗粒状的自体松质骨植于寰椎后弓和枢椎椎板的背面，不用内固定，直至植骨融合。３１例病人获得了随访，平均随访时间３０个月，其中２９例融合成功，术后头不背心固定时间平均为１３周，有３例出现了寰椎再移位。颗粒状自体松质骨比块状的全层骨更有利于融合。用头环背心的外固定     

Dislocation of the second through fifth carpometacarpal joints

We report a case of dislocation of the second through fifth carpometacarpal joints and review the mechanism of injury and radiographic findings in such injuries.     

Laparoscopic colorectal surgery in Great Britain and Ireland – Where are we now?

OBJECTIVE: We aimed to gather information from the members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to assess trends in the current practice of laparoscopic colorectal surgery. METHODS: A postal questionnaire survey of the members of ACPGBI. RESULTS: The response rate was 37% (200/540). Only 45 surgeons currently perform laparoscopic colorectal work in Great Britain and Ireland mainly right hemicolectomy and laparoscopic stoma formation, of these about one third practiced laparoscopy for benign colorectal conditions only. The majority (68%) of surgeons had enough resources at their place of work, but further training seemed to be a major issue. Nearly 22% of surgeons had not had any formal training. Only 50% of surgeons trained their specialist registrars. The incidence of conversion rate was not different for benign or malignant conditions and also did not appear to be related to the duration of experience. Only four surgeons had noted port a site recurrence during the past 10 years. Seventy-five percent (150/200) felt that laparoscopic colorectal work could be carried out safely in a District General Hospital. CONCLUSION: Laparoscopic colorectal surgery was being performed by a small minority of members of the ACPGBI although more surgeons had started to work in this field in recent years. The main areas of concern appeared to be a wide variation in the range of experience as indicated by the number of operations performed and limited formal training for consultants.     

Getting to Dissemination

The combination of a stage model of psychotherapy and treatment manualization has been a major step forward in treatment development and efficacy testing, but not in dissemination. I argue that the technological model of treatment development makes research on the practical application of these technologies difficult. If we continue on our present course, research on dissemination will be uncommon, expensive, and largely irrelevant to the practical issues that need to be faced. It makes more sense to proceed directly to dissemination research. Alternative methods, including manipulated training designs, will permit this, but these fundamentally challenge the implicit assumptions of the stage model.