47例鼻出血经30°鼻内镜下电凝治疗分析

目的探讨30°鼻内镜下电凝治疗对鼻出血患者的临床疗效。方法选择47例反复鼻出血患者,采用30°鼻内镜下直接寻找出血点,局部采取电凝治疗,观察患者治疗前后鼻腔的变化。结果所有患者检查治疗中均发现有鼻腔黏膜毛细血管瘤,在鼻内镜下呈现暗红色或鲜红色,丘样突起或明显的赘生物状,吸引器轻触即出现渗血或喷射状出血,且发现嗅沟近中甲头部中隔面27例,鼻中隔、鼻底部10例,下鼻甲2例,下鼻道7例,蝶筛隐窝1例。结论 30°鼻内镜下电凝止血治疗反复鼻出血疗效显著,是临床治疗鼻出血的最佳方法之一。     

360度反馈法在肾病风湿科护士绩效考核中的应用

目的探讨360度反馈法在肾病风湿科护士工作绩效考核中的应用及效果。方法制订护士工作360度评估表并进行全员培训，对全科护士分别从医生、护士、实习生、患者及其家属的角度进行全方位考核、评价，针对问题提出改进措施。结果实施360度反馈法后，提高了护士绩效考核成绩，差异具有统计学意义（P〈0．01）；发表论文2篇、获国家专利2项、1人获得海口市科技先进个人奖。结论360度反馈法对全科护士进行全方位考核、评价，可以提高护士工作积极性。     

30°改良会阴侧切术在限制性会阴切开中的应用

目的探讨"30°改良会阴侧切术"在限制性会阴切开中的临床作用。方法在行阴道分娩限制性会阴切开过程中,将需要追加会阴侧切的100例单胎、头位、足月低危初产妇作为研究对象,根据随机数字表法分为观察组和对照组,每组50例。观察组给予30°改良会阴侧切,对照组给予传统的45°会阴后侧切。两组产妇均配以"慢出胎头、慢娩肩"原则。比较两组产妇会阴伤口撕裂情况、产时伤口出血量、产后伤口疼痛程度及持续时间、伤口愈合程度。结果 30°改良会阴侧切术损伤小,出血量少、疼痛轻、愈合好。结论在实行限制性会阴切开过程中,对需要追加侧切的妇女,30°改良会阴侧切和传统45°会阴后侧切有同样防止会阴严重撕裂伤的作用,同时减轻了产妇的损伤,提高了产科质量。     

Chemical compositions and anti-influenza activities of essential oils from Mosla dianthera

Ethnopharmacological relevance

Mosla dianthera as an aromatic herb is used in folk medicine for the treatment of cough, colds, fever, bronchitis, nasal congestion and headache.

Aim of the study

To characterize chemical compositions and to evaluate the anti-influenza effects of essential oils of M. dianthera (MDEO) in influenza virus A (IVA) infected mice.

Materials and methods

MDEO was obtained by hydrodistillation and analysed by gas chromatography-mass spectrometry (GC-MS). ICR mice were treated with MDEO for 5 consecutive days at doses of 90-360 mg/kg after post-infected. Levels of Serum IL-4 and IFN-γ were assayed by ELISA. Levels of MOD, SOD, TAOC and GSH-Px in lung tissue were determined by colorimetric method.

Results

GC-MS analysis revealed the presence of 29 components that account for 97.74% of phenolic sesquiterpenes and aromatic compounds. The major compounds were elemicin (16.51%), thymol (14.77%), β-caryophyllene (14.49%), iso-elemicin (9.22%), asarone (6.09%) and α-caryophyllene (5.26%). It had significant effects on decreasing lung viral titers, inhibiting pneumonia, reducing levels of serum IFN-γ and IL-4, and enhancing antioxidant activity in the lung tissue of IVA infected mice.

Conclusions

MPE could exhibit therapeutical effects in IVA infected mice as a suppressor of IVA replication and inflammatory mediators and a promoter of antioxidant potentials. Therefore, MDEO could provide a safe and effective therapeutic candidate for treatment of influenza and its subsequent viral pneumonia.     

70°斜卧位腹腔镜治疗上尿路移行细胞癌

目的 探讨70°斜卧位经腹入路腹腔镜治疗上尿路移行细胞癌的临床效果.方法 2004年5月至2007年1月联合尿道电切镜、70°斜卧位经腹入路腹腔镜肾输尿管切除治疗上尿路移行细胞癌(TCC)31例,同时采用钛夹夹闭输尿管或输尿管肿瘤两端,下腹斜形切口取出标本.结果 31例手术均成功,无术中转开放;平均手术时间140 min,平均出血量80 ml,平均住院时间8 d,无尿漏、肠瘘等并发症发生.结论 70°斜卧位经腹入路腹腔镜肾输尿管全长切除术具有手术操作空间大、肾蒂血管处理简单、手术风险小、创伤轻、术后恢复快等优点,值得临床推广应用;但其对肿瘤播散、复发等的影响还需要长期的观察随访.     

我国医师胜任力模型的形成性评价：设计、实施与思考

2022年中国医师协会发布了包括6项核心胜任力在内的医师胜任力模型。基于工作场所的形成性评价是落实胜任力导向医学教育的重要方法。其中，以直接观察评价，如迷你临床演练（mini-clinical evaluation exercise，mini-CEX）、直视下操作技能评价（direct observation of procedural skills，DOPS）等，与多源评价（360度评价），对胜任力评价的覆盖面最广，置信职业行为（entrustable professional activities，EPAs）也值得探索。通过设计综合评价系统，成立临床胜任力评价委员会（clinical competency committee，CCC）以及加强医学教育的外部条件保证等有助于胜任力评价的实施。将胜任力导向医学教育向院校教育阶段延伸是提升医学教育质量的重要措施。     

医院管理干部360度考核测评的做法和体会

目的通过计算机网络完成年度干部360度全方位测评考核,摆脱手工操作的繁琐,达到考评数据的科学性、真实性、直观性、保密性,为干部的管理及领导层任免干部提供可靠的决策依据。方法应用计算机网络采用人机对话的形式,由测评人对被测评人的考评试卷内容进行逐一回答,通过计算机汇总,统计出每位被测评人的全方位测评成绩。结果连续三年对医院60余名管理干部360度考核测评,从上级、同级、下级、自评四个层面来看,上级和同级分数打分较低,下级和自评打分较高,敬业精神和思想品德方面打分稍高,总成绩90分以上达到优秀的占7·83%,80分以上良好的占54·68%,60分以上及格占34·37%,不及格3·12%。结论测评结果比较客观公正地反映了干部的业绩。     

Alarm reaction of pilosebaceous apparatus.

A series of histologic changes involving the pilosebaceous structures are described under the term "alarm reaction." The follicular manifestation of this phenomenon is characterized by regression of hair matrix, forming a well-defined nest of small basaloid cells found in various parts of the follicular canal. The sebaceous glands either become undifferentiated, forming a solid mass of stratified squamous epithelium, or the sebaceous lobules are taken into the follicular canal and into the surface keratin layer.     

Multi-rater feedback with gap analysis: An innovative means to assess communication skill and self-insight

Objective

Multi-rater assessment with gap analysis is a powerful method for assessing communication skills and self-insight, and enhancing self-reflection. We demonstrate the use of this methodology.

Methods

The Program for the Approach to Complex Encounters (PACE) is an interdisciplinary simulation-based communication skills program. Encounters are assessed using an expanded Kalamazoo Consensus Statement Essential Elements Checklist adapted for multi-rater feedback and gap analysis. Data from a representative conversation were analyzed.

Results

Likert and forced-choice data with gap analysis are used to assess performance. Participants were strong in Demonstrating Empathy and Providing Closure, and needed to improve Relationship Building, Gathering Information, and understanding the Patient's/Family's Perspective. Participants under-appraised their abilities in Relationship Building, Providing Closure, and Demonstrating Empathy, as well as their overall performance. The conversion of these results into verbal feedback is discussed.

Conclusions

We describe an evaluation methodology using multi-rater assessment with gap analysis to assess communication skills and self-insight. This methodology enables faculty to identify undervalued skills and perceptual blind spots, provide comprehensive, data driven, feedback, and encourage reflection.

Practice implications

Implementation of graphical feedback forms coupled with one-on-one discussion using the above methodology has the potential to enhance trainee self-awareness and reflection, improving the impact of educational programs.