实习医生临床技能操作短期集中培训的可行性分析

探索临床技能培训和提高学生临床实践能力的有效方法.通过培训前考核、观看教学片、指导教师示范、模拟练习、现场点评、培训后考核等方式,比较培训前后考核成绩.通过短期集中培训,使实习生在临床技能方面快速提高.学生们很快掌握了临床基本技能操作规范,为更好地投入到临床实习打下了良好的基础.     

Electrocardiogram Interpretation Training and Competency Assessment in Emergency Medicine Residency Programs

OBJECTIVES: To determine the type of electrocardiogram (ECG) interpretation instruction in emergency medicine (EM) residency programs, the use and perceived value of teaching modalities and resources, and the methods used to assess competency of ECG interpretation. METHODS: An interactive survey instrument was posted on the Internet using SurveySuite, Inc., software and e-mailed to program directors (PDs) of all 125 Accreditation Council for Graduate Medical Education-approved U.S. EM residency programs. Responses are reported in total numbers and percentages. RESULTS: Ninety-nine of 125 PDs completed the online survey (response rate, 79.2%). Emergency department instruction (99%), case-based lectures (98%), and didactic lectures (98%) were most commonly used to teach interpretation of ECGs, followed by computer-based instruction (34%) and ECG laboratory (12%). The majority of programs (53%) spent more than eight hours on formal ECG lectures per year, while 11% spent less than three hours. Observation during clinical time (99%), lecture time (76%), and hypothetical cases (57%) were the most common ways to determine competency in reading ECGs, while clinical observation and hypothetical cases were perceived as the most valuable. The most commonly used resource was personal or departmental ECG files (91%), and this had the highest perceived value. The majority of PDs were comfortable with residents' abilities to read ECGs by the third year (96%) and fourth year (91%) of residency. CONCLUSIONS: These data suggest that EM PDs believe that EM residency is adequately preparing graduates to interpret ECGs. This goal is achieved through a variety of methods.     

血管介入仿真模拟器在心血管医生冠状动脉介入技术规范化培训中的作用

目的明确Angiomemor（美国Simbionix公司生产）血管介入仿真模拟器是否有助于冠状动脉造影技术的掌握和提高。方法选取16名无血管放射介入经验的心血管医生，接受相同课时的冠状动脉介入造影理论培训后，按随机表编码随机分为模拟器培训组与非培训组各8名，模拟器培训组8名医生接受Angiomemor血管介入仿真模拟器培训，模拟冠状动脉造影操作，非培训组8名心血管医生未接受仿真模拟器培训。在随后的真实临床环境中操作冠状动脉造影时，评价2组医生冠状动脉造影操作过程中错误的频数、平均造影时间、造影剂使用量及术中放射线剂量。结果相对于非培训组，模拟器培训组医生在冠状动脉造影操作中错误频数减少62．5％、平均造影时间减少44．0％、造影剂使用量减少44．0％，术中平均放射线曝光时间减少了57．7％，平均X线累计曝光剂量减少51．6％，单位面积X线累计曝光剂量减少了52．4％。结论Angiomemor血管介入仿真模拟器有助于医生较快地熟练掌握冠状动脉造影技术，是冠状动脉介入规范化培训的重要辅助手段之一。     

新兵训练对女性月经的影响

目的探讨新兵训练对女性月经的影响。方法女性新兵200名,参加队列和体能训练3个月,分别记录训练前、训练中、训练后的月经、体质量状况及心理评估。结果新兵训练中的月经周期异常率、经期异常率和痛经发生率均明显高于新兵训练前,体质量明显减轻,差异有显著性意义(P<0.05)。新兵训练结束转入正常部队生活1年后,月经周期异常率、经期异常率、痛经发生率均有明显下降(P<0.05)。结论新兵训练对女性月经有明显影响,其影响是功能性、暂时性和可逆性的,并非器质性损害。     

Guidelines for Trials of Behavioral Treatments for Recurrent Headache, First Edition: American Headache Society Behavioral Clinical Trials Workgroup

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidelines are complementary to and modeled after guidelines for pharmacological trials published by the International Headache Society, but they address methodologic considerations unique to behavioral and other nonpharmacological treatments. Explicit guidelines for evaluating behavioral headache therapies are needed as the optimal methodology for behavioral (and other nonpharmacologic) trials necessarily differs from the preferred methodology for drug trials. In addition, trials comparing and integrating drug and behavioral therapies present methodological challenges not addressed by guidelines for pharmacologic research. These guidelines address patient selection, trial design for behavioral treatments and for comparisons across multiple treatment modalities (eg, behavioral vs pharmacologic), evaluation of results, and research ethics. Although developed specifically for behavioral therapies, the guidelines may apply to the design of clinical trials evaluating many forms of nonpharmacologic therapies for headache.     

Effects of training on odor judges scoring intensity

Objective:  This pilot study was intended to test whether a training protocol improved validity of odor judges (OJs), with or without experience, and whether odorant types differed in error proneness.
Methods:  The OJs (four experienced, two inexperienced) completed a 4-phase training protocol based on the American Society of Testing and Materials standards (ASTM): (i) introduction to sensory scales, n-butanol reference, sniffing techniques; (ii) pretraining measurements; 20 samples of varying intensities of four unpleasant and three pleasant odorants; (iii) exercises assessing quality, intensity, ranking, and matching; and (iv) post-training measurements.
Main outcome measures:  Subjects' intensity scores were analyzed as the absolute difference from the 'true' intensity (ASTM n-butanol standard) using repeated measures ANOVA.
Results:  Training significantly ( P  = 0.02) reduced OJ errors. Experienced and novice judges did not differ in average errors ( P  = 0.99), or in improvement in error from pre- to post-training ( P  = 0.94). Improvement was consistent from pre- to post-training for all odorants except dimethylsulfide for which errors worsened ( P  = 0.01). Unpleasant and pleasant odorants differed ( P  = 0.006) in error. After removing water the effects of water control scores from the pleasant odorants, the difference was not significant ( P  = 0.26).
Conclusions:  The OJs improved in their ability to assess odor intensity irrespective of previous experience. Training is recommended for all OJs prior to research trials.     

论医药卫生法学专业学生实务能力的培养

加强医药卫生法学专业学生实务能力的培养,是实现医药卫生法学专业培养目标的需要.在教学中,通过运用案例教学法、讨论式教学法,开展模拟法庭、第二课堂活动,组织临床见习、毕业实习等途径,培养即有法律知识又有医药卫生知识的复合型人才.     

护理本科生双导师制带教模式的实践

目的 探索适合护理本科生的临床带教模式.方法 将2001级和2000级护理本科生分为实验组(n=24)和对照组(n=38),对照组给予传统带教模式带教,实验组采用双导师制带教模式,即每名学生在临床实习期间,由1名临床专科导师负责其本科室专科知识方面的指导,1名全程导师负责其实习全过程的督导及检查工作,护理部在学生实习结束前进行带教满意率测评及实习效果评价,并与对照组进行比较.结果 两组对医院带教很满意率、学生护理理论、操作技能考核成绩、论文书写优良率比较,差异有显著性意义(均P＜0.01).结论 双导师制可提高带教质量,是受学生好评和欢迎的带教模式.     

耐热锻炼对人体热暴露时血浆丙二醛和中分子物质含量的影响

本文报告热习服对血浆丙二醛和中分子物质含量的影响。15名健康男子,平均年龄21.8±0.7岁,于平均气温27.3±1.2℃负重行军90min,2周内共锻炼11次(天)。标准热暴露试验对比表明获得了热习服,肛温和心率增值大大降低(P<0.01和P<0.05)。锻炼期前、后标准试验时血浆丙二醛含量降幅分别为29.4%(P<0.01)和30.1%(P<0.01),而中分子物质含量增幅分别为6.3%(P<0.05)和9.2%(P<0.01)。热前、后血浆丙二醛含量较锻炼期前仅分别降低5.5和6.5%(P>0.05),而中分子物质含量分别降低18.3和16.1%(P<0.01),可见,热习服后血浆丙二醛和中分子物质含量没有同步降低。     

Hypertrophy without increased isometric strength after weight training

Summary Eight men (20–23 years) weight trained 3 days week^–1 for 19 weeks. Training sessions consisted of six sets of a leg press exercise (simultaneous hip and knee extension and ankle plantar flexion) on a weight machine, the last three sets with the heaviest weight that could be used for 7–20 repetitions. In comparison to a control group (n = 6) only the trained group increased (P<0.01) weight lifting performance (heaviest weight lifted for one repetition, 29%), and left and right knee extensor cross-sectional area (CAT scanning and computerized planimetry, 11%, P<0.05). In contrast, training caused no increase in maximal voluntary isometric knee extension strength, electrically evoked knee extensor peak twitch torque, and knee extensor motor unit activation (interpolated twitch method). These data indicate that a moderate but significant amount of hypertrophy induced by weight training does not necessarily increase performance in an isometric strength task different from the training task but involving the same muscle group. The failure of evoked twitch torque to increase despite hypertrophy may further indicate that moderate hypertrophy in the early stage of strength training may not necessarily cause an increase in intrinsic muscle force generating capacity.