Training and assessment of laparoscopic skills.

Laparoscopic surgery is gaining popularity among the surgical community. While its prevalence expands, the need for reliable training and assessment tools is becoming increasingly important. Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. A consensus exists among physicians that establishment and evaluation of technical skill in surgical training programs are inadequate and in need of improvement. A validated, reliable bench model that could train and assess could be standardized and provide numerous benefits including determination of which medical students should consider a career in surgery, valuable feedback to residents, a tracking mechanism of resident performance, a possible certification and recertification tool, and to allow for interinstitutional comparison. To this end, several potentially successful bench models testing dexterity, hand-eye coordination, and depth perception have been developed. A few models have been proven to be both valid and reliable indicators of technical skill. Although the future remains uncertain, enough groundwork has been laid to begin incorporating technical skill training and assessment into surgical training programs.     

高温高湿环境下守岛官兵训练时脑血流和脑电生理的变化研究

目的 探讨高温高湿环境下守岛官兵训练前后脑血流和脑电生理的变化,为临床防治热致疾病提供依据.方法 从守岛官兵中随机抽取在常温常湿环境下温度(27.40±1.37)℃,湿度(50.25±6.76)%]新兵100名为常温新兵组,高温高湿环境下(温度≥35℃,湿度≥80%)新兵100名为高温新兵组;高温高湿环境下服役2～3 年的官兵100名为高温老兵组.受试者负重15 kg,分次在3000 m/15 min,5000 m/30 min和10 000 m/45 min内完成跑步训练.10 000 m训练后,根据受试者脑血流高低又分为脑血流增高组(24名)、脑血流降低组(46名)和脑血流正常组(230名).训练前后行经颅多普勒血流诊断仪和脑电图仪检测.结果 (1)3000 m训练后3组受试官兵脑平均血流速度(Vm)较训练前均显著增高(P＜0.01),但5000 m和10 000 m训练后,常温新兵组降低6%和16%,高温老兵组降低5%和15%,高温新兵组降低14%和31%,比常温新兵组和高温老兵组低(P＜0.01);(2)10 000 m训练前后3组脑电图均在正常范围,3组比较差异无统计学意义(P＞0.05);(3)10 000 m训练后脑血流增高组和降低组脑电图比正常血流组活跃(P＜0.01).结论 高温高湿环境下10 000 m训练对官兵的脑血流有较大的影响,但对脑电生理无影响,老兵在此环境下则表现出较好的热耐受力和适应性.     

综合心理干预对高原新兵训练伤的影响

目的探讨综合心理干预对高原新兵训练伤发生率的影响。方法1000名高原新兵随机分为心理干预组和对照组。在新兵训练期间,对心理干预组新兵,除常规的生理卫生教育和监督外,进行综合心理干预;利用症状自评量表(SCL-90)、焦虑自测量表(SAS)、抑郁自测量表(SDS),在新训开始和结束时,进行心理状态测定;并统计各组新兵训练伤发生情况。结果心理干预组战士在SCL-90中的躯体化、抑郁、焦虑、恐怖等项的分值,在SAS和SDS中的总分值明显低于对照组(P<0.05),心理干预组战士训练伤中的软组织损伤、骨关节损伤、训练伤总发生率均明显低于对照组(P<0.05)。结论适当的综合心理干预对于训练伤的预防有积极的作用。     

The first 50 years of military radiology 1895–1945

Following the discovery of X-rays in 1895 by Wilhelm Röntgen the value to the military surgeon of the new technique was soon realised. The localisation of retained bullets by radiography avoided inappropriate exploration of the wound. The X-rays were first used on casualties from the Abyssinian War of 1896 and the developing radiological technology was progressively applied to military surgery. In addition the needs of warfare stimulated the development of all aspects of radiology.     

基于“军卫一号”的干部医疗保健系统的设计

目的：在医院现有条件下设计一种干部医疗保健系统,建立医院与干休所之间的信息网络平台。方法：数据结构采用与＂军卫一号＂相同的表结构,通过网络通信完成中心医院的数据接收。结果：通过网络可以从上级医院获得老干部的在院诊疗信息,并将干休所采集到的医疗数据上传到中心医院。结论：干部医疗保健系统提高了军队干部医疗保健工作的管理质量,实现了医疗合作及患者健康信息共享。     

Complications of surgical endoscopy

Background: This study examines the notion that gastrointestinal endoscopy performed by supervised surgical residents is safe. Methods: We reviewed all gastrointestinal endoscopic procedures performed by surgical residents with faculty supervision for complications and deaths occurring up to 30 days following the procedures. Results: The overall complication rate for 9,201 upper and lower endoscopy procedures was 1.4% and 0.42%, respectively. Overall mortality rate was 0.76% for upper endoscopy and 0.6% for lower endoscopy. No mortality was a direct result of a procedure-related complication. Intestinal perforation, drug overdose, bleeding, and aspiration were the most common procedure-related complications. Each resident completed an average of 75 upper endoscopies and 79 lower endoscopies during their training period. Conclusions: Gastrointestinal endoscopy can be performed safely by surgical residents with appropriate supervision. The higher morbidity and mortality of upper endoscopy are most likely related to the underlying disease rather than the procedure. Awareness of common complications and application of appropriate precautions and instruction are critical for minimizing complications. Received 25 March 1996/Accepted: 24 April 1996     

聋儿自信心的培养

由于家庭教育方式不当，使许多聋儿胆小．懦弱，缺乏自信心。本文通过调查研究，分析了聋儿缺乏自信心的原因，并在实践的基础上归纳出提高聋儿自信心的几项措施。     

心理训练对高特质焦虑新兵生理指标和考核成绩的影响

目的研究心理训练对高特质焦虑新兵考核时生理指标和成绩的影响。方法采用个人评价问卷（PEI）、状态．特质焦虑问卷（STAI）和简易应对方式问卷对参加考核的新兵实施团体测试。将被试者分为对照组、低特质焦虑组、高特质焦虑组和干预组，对干预组进行自我评价、潜能开发、团队精神强化、应对方式的心理训练。测试考核前后生理指标差值及考核成绩的变化。结果干预组新兵军事考核前后收缩压、舒张压和脉搏三项生理差值与考核成绩明显优于高特质焦虑组（P〈0．05）。结论系统的心理训练可有效改善新兵对应激情景的生理和心理反应，提高作业绩效。     

成立护理技术小组 提高全院护士临床护理技能

目的对全院护士进行统一培训,提高全院护士的整体技术水平。方法由护理部负责,成立护理技术小组,对常见护理技术制定培训计划,培训、考核全院护士。结果全院所有护士的护理操作水平得到很大的提高。结论加强对护士的临床技术培训,是提高全院护士的临床技能的关键。     

Recovery of locomotion after chronic spinalization in the adult cat

Cats were spinalized (T13) as adults and were trained to walk with the hindlimbs on a treadmill. After 3 weeks to 3 months and up to 1 year depending on the animal, all were capable of walking on the plantar surface of the feet and support the weight of the hindquarters. Interactive training appeared to accelerate the recovery of locomotion and maintain smooth locomotor movements. Despite the obvious loss of voluntary control and equilibrium which the experimenter partially compensated for by maintaining the thorax and/or the tail, the cats could walk with a regular rhythm and a well-coordinated hindlimb alternation at speeds of 0.1-1.2 m/s. Cycle duration as well as stance and swing duration resembled those of normal cats at comparable speeds. The range of angular motion was also similar to that observed in intact cats as was the coupling between different joints. The EMG activity of the hindlimb and lumbar axial muscles also retained the characteristics observed in the intact animal. Some deficits such as a dragging of the foot in early swing and diminution of the angular excursion in the knee were seen at later stages. Thus, the adult spinal cat preparation is considered as a useful model to study the influence of different types of training and of different drugs or other treatments in the process of locomotor recovery after injury to the spinal cord.