目标教学在前列腺超声诊断技术带教中的应用价值研究

目的探讨目标教学在前列腺超声诊断技术带教中的应用效果。方法选择2017年1月-2018年12月于我院进行前列腺超声诊断技术培训的影像学专业学生80例,根据入院时间先后顺序分为研究组与对照组,每组40例。对照组医学生采用常规教学法带教,研究组医学生采用目标教学法带教,比较两组带教效果。结果研究组医学生的超声诊断仪使用(94.12±2.73)分、超声扫查技巧(92.81±5.06)分、操作技能(90.83±5.11)分、超声图像表现掌握(91.96±3.67)分均高于对照组(P<0.05)。研究组医学生的总体满意度CEQ评分(8.22±0.24)分高于对照组的(5.25±0.30)分,两组比较差异具有统计学意义(P<0.05)。结论目标教学在前列腺超声诊断技术带教中的应用效果良好,可有效提高医学生的操作能力,提高医学生对带教模式的肯定度。     

Specifics and Operational Procedures of the Psychological Assistance Hotline during the COVID-19 Pandemic in China

Psychological hotlines became the most convenient and feasible way to provide psychological intervention for the needy after the outbreak of COVID- 19. Hotlines assisting in defeating the coronavirus functioned quite differently from general psychological hotlines and face-to-face counseling. This article discusses the specificity of hotlines of this kind, including appropriate operational procedures that include the overall assessment and the empathetic understanding of the clients, a quick focus on goals, and real-world oriented assistance. Major administrative and ethical concerns are also addressed.     

普外科专业研究生临床技能和科研能力的思考

医学研究生的教育是培养高层次卫生人才的主要途径之一。我国目前医学研究生学位类型分为两种:"医学科学学位"和"医学专业学位"。普外科专业研究生的培养目标是培养出专业技能过硬和具有科研素质和创新精神的普外科医生。通过分析学校普外科专业研究生培养过程中影响临床技能和科研素养提升的因素,探讨促进两者均衡发展的有效方法以及今后普外科专业研究生的培养方向,制定多元化专业理论与技能培养计划、充分利用导师的直接指导及现代网络信息化办公教学,搭建科研平台积极鼓励普通外科专业研究生参与科研,努力提高普通外科专业研究生临床技能及科研创新思维水平。     

Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007–2013

Setting: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya.Objectives: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors.Design: Retrospective cross-sectional study using routine programme data.Results: During the study period, 2635 women delivered at the RMC: 50% were aged 16–24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births.Conclusion: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions.     

The Effectiveness of Preventative Mass Vaccination Regimes Against the Incidence of Highly Pathogenic Avian Influenza on Java Island,Indonesia

We conducted an operational research study involving backyard and semicommercial farms on Java Island, Indonesia, between April 2008 and September 2009 to evaluate the effectiveness of two preventive mass vaccination strategies against highly pathogenic avian influenza (HPAI). One regimen used Legok 2003 H5N1 vaccine, while the other used both Legok 2003 H5N1 and HB1 Newcastle disease (ND) vaccine. A total of 16 districts were involved in the study. The sample size was estimated using a formal power calculation technique that assumed a detectable effect of treatment as a 50% reduction in the baseline number of HPAI‐compatible outbreaks. Within each district, candidate treatment blocks with village poultry populations ranging from 80 000 to 120 000 were created along subdistrict boundary lines. Subsequently, four of these blocks were randomly selected and assigned one treatment from a list that comprised control, vaccination against HPAI, vaccination against HPAI + ND. Four rounds of vaccination were administered at quarterly intervals beginning in July 2008. A vaccination campaign involved vaccinating 100 000 birds in a treatment block, followed by another 100 000 vaccinations 3 weeks later as a booster dose. Data on disease incidence and vaccination coverage were also collected at quarterly intervals using participatory epidemiological techniques. Compared with the unvaccinated (control) group, the incidence of HPAI‐compatible events declined by 32% (P = 0.24) in the HPAI‐vaccinated group and by 73% (P = 0.00) in the HPAI‐ and ND‐vaccinated group. The effect of treatment did not vary with time or district. Similarly, an analysis of secondary data from the participatory disease and response (PDSR) database revealed that the incidence of HPAI declined by 12% in the HPAI‐vaccinated group and by 24% in the HPAI + ND‐vaccinated group. The results suggest that the HPAI + ND vaccination significantly reduced the incidence of HPAI‐compatible events in mixed populations of semicommercial and backyard poultry.     

Biomarkers of immune tolerance in liver transplantation

The liver exhibits intrinsic immune tolerogenic properties that contribute to a unique propensity toward spontaneous acceptance when transplanted, both in animal models and in humans. Thus, in contrast to what happens after transplantation of other solid organs, several years following liver transplantation a significant subset of patients are capable of maintaining normal allograft function with histological integrity in the absence of immunosuppressive drug treatment. Significant efforts have been put into identifying sensitive and specific biomarkers of tolerance in order to stratify liver transplant recipients according to their need for immunosuppressive medication and their likelihood of being able to completely discontinue it. These biomarkers are currently being validated in prospective clinical trials of immunosuppression withdrawal both in Europe and in the United States. These studies have the potential to transform the clinical management of liver transplant recipients by mitigating, at least in part, the burden of lifelong immunosuppression.     

护理迷你临床演练评估量表在急诊科护生护理技能教学中的应用

目的探讨护理迷你临床演练评估量表(nursing-mini-clinical evaluation exercise,Nursing-Mini-CEX)在急诊科护生护理技能教学中的应用效果。方法选取2018年9月至2019年8月在本院急诊科实习的护生72人,共12个实习批次,每批次6人,实习前应用SPSS 21.0软件将12个实习批次分别随机分配一个数字,将随机数进行排序,前6位对应的批次为对照组,后6位对应的批次为观察组。对照组采用传统护理带教方法;观察组在对照组基础上结合Nursing-MiniCEX进行操作技能的教学,两组护生急诊科实习时间均为4周。于实习第4周对两组护生操作进行考核和测评其人文关怀能力。结果观察组护生操作考核成绩(90.56±1.75)分高于对照组(85.39±3.51)分,差异有统计学意义(t=7.911,P<0.001)。观察组护生人文关怀能力总分(175.72±15.47)分高于对照组(168.08±13.83)分,差异有统计学意义(t=2.209,P=0.030)。结论将Nursing-Mini-CEX应用于急诊科护生护理技能教学中有助于提高护生的操作技能水平和人文关怀能力。     

Are HIV-positive presumptive tuberculosis patients without tuberculosis getting the care they need in Zimbabwe?

Setting: Emakhandeni Clinic provides decentralised and integrated tuberculosis (TB) and human immunodeficiency virus (HIV) care in Bulawayo, Zimbabwe.Objectives: To compare HIV care for presumptive TB patients with and without TB registered in 2013.Design: Retrospective cohort study using routine programme data.Results: Of 422 registered presumptive TB patients, 26% were already known to be HIV-positive. Among the remaining 315 patients, 255 (81%) were tested for HIV, of whom 190 (75%) tested HIV-positive. Of these, 26% were diagnosed with TB and 71% without TB (3% had no TB result recorded). For the 134 patients without TB, antiretroviral treatment (ART) eligibility data were recorded for 42 (31%); 95% of these were ART eligible. Initiation of cotrimoxazole preventive therapy (CPT) and ART was recorded for respectively 88% and 90% of HIV-positive patients with TB compared with respectively 40% and 38% of HIV-positive patients without TB (P < 0.001).Conclusion: Presumptive TB patients without TB had a high HIV positivity rate and, for those with available data, most were ART eligible. Unlike HIV-positive patients diagnosed with TB, CPT and ART uptake for these patients was poor. A ‘test and treat’ approach and better service linkages could be life-saving for these patients, especially in southern Africa, where there are high burdens of HIV and TB.