建立医学模拟训练中心 培养高素质医学人才

介绍了汕头大学医学院利用其医学模拟训练中心先进的设施,在临床教学中使用标准化病人、多种教学模型、高端智能化综合模拟人以及虚拟腹腔镜等,对医学生和住院医师进行临床技能训练的做法。指出医学模拟训练中心的建立,架起了医学生早期接触临床的桥梁,为提高医学生综合素质的有效途径之一,并在临床医师培训中发挥重要作用。     

我院静脉输液状况横断面调查

目的 分析静脉输液技术的临床应用情况,为静脉输液管理和护理安全提供决策依据.方法 采用横断面调查方法,设计静脉输液临床应用调查问卷,对本院53个科室130个护理单元进行分层整群抽样调查.结果 本次调查25个护理单元735位住院患者,静脉输液率为88.9％,不同年龄及治疗方式组间比较无统计学差异;5种输液通路中,套管针使用率37.4％,PICC 37.0％主要应用于肿瘤化疗患者;静脉输液并发症发生率4.9％.结论 静脉输液在临床应用普遍,呈现多途径、长留置的趋势,应加强专科培训和质量管理,合理应用静脉输液导管,以减少并发症.     

Toxicity associated with long-term intravenous heroin and cocaine self-administration in the rat

Laboratory rats were given unlimited access to intravenous cocaine hydrochloride or heroin hydrochloride. Animals self-administering cocaine quickly developed a pattern of episodic drug intake, with periods of excessive cocaine self-administration alternating with brief periods of abstinence. Subjects allowed continuous access to intravenous heroin showed stable drug self-administration, with a gradual increase in daily heroin intake over the first two weeks of testing. The general health of the animals became markedly different: those self-administering heroin maintained grooming behavior, pretesting body weight, and a good state of general health; rats self-administering cocaine tended to cease grooming behavior, to lose up to 47% of their pretesting body weight, and to show a pronounced deterioration in general health. The mortality rate for 30 days of continuous testing was 36% for animals self-administering heroin and 90% for those self-administering cocaine. These results suggest that cocaine is a much more toxic compound than heroin when animals are given unlimited access to intravenous drug.     

实施护士岗位资质准入方法的探讨

目的：探讨对护士岗位采用准入方法。方法：制汀护理专业岗前、岗位培训内容,并以此为基础建立护士岗位准入标准,明确了由科室申请、临床部审核、护理部审批的准入流程。结果：维持了较高的护士岗位准入率,提高了护士的技术操作水平,减轻了护士上岗后的压力,确保了护理质量。结论：制定的准入标准要符合专业发展要求,同时也要做好事先的宣传动员,采用因人施教的方法,与自身待遇相结合极大促进了本方法的成功实施。     

两种血管通路装置在肝衰竭患者临床护理中的应用研究

目的观察两种血管通路装置,经外周置入中心静脉(PICC)和静脉留置针在长期、连续输液治疗的肝衰竭患者中的实用性。方法采用病例对照研究方法,对97例肝衰竭静脉输液患者进行PICC和静脉留置针对照治疗。结果两组比较,PICC组液体外渗率、导管脱出率、局部感染率低。结论对肝衰竭患者实施PICC置管,效果更安全、舒适。     

呼吸内科专科医师规范化培训模式探索

总结广州呼吸疾病研究所呼吸内科专科医师培训基地在平台构建、准入标准、培训方法、教学交流平台的构建等方面工作开展的情况,探讨适合我国呼吸内科专科医师规范化培训的模式和方法.     

中医学本科学生岗位适应能力培训考核方式的探索与实践

为确保学生在进入临床前先过理论关,让其尽快适应后期临床教学环境,提高其临床学习能力,我院在医学生进入临床前将'岗前培训'与'实习准入考试'相结合,并通过'以考代训'、'考训结合'的方式,强化医学生的基本理论、基础知识的巩固和提升,通过对'实习准入考核制度'的探索和实践,形成适合中医学生的实习前临床能力培养目标和评价体...     

Staphylococcus aureus endocarditis complicated by bilateral pneumothorax

Staphylococcus aureus is the most common cause of endocarditis in intravenous drug users. The organism gains access by intravenous injection or from the direct invasion of skin at injection sites. Known for its aggressiveness, the right sided endocarditis that ensues can lead to complications such as pulmonary abscesses and even death. We report the unusual case of an intravenous drug abuser, who following the occurrence of extensive pulmonary abscesses, developed bilateral pneumothoraces within a few days.     

恶性肿瘤病人经锁骨下静脉导管药盒植入的临床应用

目的:探讨经锁骨下静脉植入导管药盒系统的具体方法,提高成功率;探讨系统出现堵塞时的可能原因及处理办法.方法:为83例恶性肿瘤患者,通过锁骨下静脉植入导管药盒系统,观察术后使用情况.结果:83例患者均成功经锁骨下静脉植入导管药盒系统;5例使用过程中出现堵塞,处理后复通,并正常使用;2例使用1年后药盒损坏,局部渗液,手术取出.手术过程中未出现气胸、血胸、感染等并发症.结论:经锁骨下静脉植入导管药盒系统,是建立长期静脉通道安全有效的方法.     

成都市全科规范化培训住院医师医患沟通培训现状研究

目的 调查成都市全科规范化培训住院医师医患沟通培训需求、参加意愿等,根据相应的培训需求,制定以需求为导向的全科规培医生医患沟通培训课程体系提供参考及建议。 方法 采用问卷调查方法,对成都市于2019年3月期间正在接受全科规范化培训的住院医师共计386名学员进行横断面调查。 结果 所调查386人中,有359人(93.0%)认为需要在规范化培训期间开展医患沟通培训的相关课程;342人(88.6%)愿意参加医患沟通培训课程。学员对医患沟通主题培训的需求排名前三的是:如何与愤怒的患者沟通,占86.3%(333/386)、如何解释和告知病情,占81.6%(315/386)、告知坏消息,占78.2%(302/386);学员对医患沟通培训形式需求排名前三分别为:临床实践教学,占73.8%(285/386)、模拟教学,占67.6%(261/386)、专题讲座,占60.9%(235/386)。各项医患沟通培训形式的既往参加人数与期望参加人数之间差异均有统计学意义(均P<0.05)。 结论 全科规范化培训住院医生对医患沟通重视,需求明显。建议在沟通培训课程中添加“与愤怒患者的沟通”“解释和告知病情”“告知坏消息”等内容,同时减少理论教学,采用实践与模拟教学以增加医患沟通培训效果。      

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest,Nigeria

Introduction

Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria.

Methods

A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state.

Results

Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources.

Conclusion

Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.     

不同液体输注方法在新生儿液体外渗处理中的应用对比效果

目的探讨新生儿液体外渗的处理措施,总结临床防范液体外渗的经验。方法新生儿重症监护病房的患儿180例,根据入院顺序与家长意愿分为治疗组与对照组,每组各90例。治疗组采用静脉留置针（PIV）液体输注,对照组采用普通头皮针液体输注。结果治疗组并发症发生率为18.7%,对照组并发症发生率为64.7%,对照组的并发症发生率明显高于治疗组（P〈0.05）。治疗组的治疗持续时间明显长于对照组（P〈0.05）,患儿输液期间体重增长情况明显好于对照组（P〈0.05）。结论新生儿液体输注中发生外渗的情况比较常见,而PIV为新生儿静脉输液治疗提供了可靠的静脉通路,可以降低并发症,延长静脉治疗持续时间,并且保持新生儿发育正常,值得推广应用。     

明胶海绵颗粒栓塞治疗1例急性冠脉穿孔的抢救护理体会

总结1例冠脉穿孔患者应用明胶海绵颗粒栓塞抢救护理的体会。护理要点：包括心理护理;及时开通静脉通道;心包穿刺的术前准备、引流的护理及与术者的密切配合;生命体征的监测。本例患者经过及时抢救治疗,精心护理,痊愈出院。     

Getting back into the emergency department: diversifying general practice while relieving emergency medicine workforce shortages

New medical graduates expect to work in an environment that allows scope for flexibility and change across a career in medicine. Recruitment to general practice is adversely affected by its perceived limited scope of practice. Training in procedural and hospital skills is not difficult to access for general practice trainees, but complex and inconsistent credentialling criteria and protectionist attitudes among some specialist colleges mean that many skilled general practitioners are unable to utilise the full range of their skills in clinical practice. The discipline of emergency medicine is also experiencing difficulty in recruiting trainees. The employment of skilled GPs in emergency departments (including metropolitan departments) could improve vocational satisfaction for GPs and emergency physicians, and possibly also improve patient outcomes and flow through the emergency department.     

高渗盐液经骨髓腔通路复苏失血性休克犬凝血功能的变化

目的探讨不同复苏液经骨髓腔通路复苏失血性休克犬对凝血功能的影响。方法建立犬失血性休克模型,从胫骨骨髓腔输注小剂量7.5%氯化钠羟乙基淀粉40溶液（HSH）、生理盐水（NS）两种复苏液,测定复苏各时间点凝血酶原时间（PT）,活化部分凝血活酶时间（APTT）。结果失血性休克后,实验组PT、APTT延长,与对照（sham）组比较差异有统计学意义（P〈0.05）,实验组间比较差异无统计学意义（P〉0.05）;复苏后2 h,HSH组PT、APTT明显延长,与NS组比较差异有统计学意义（P〈0.05）;复苏后48 h实验组PT、APTT降至正常,与sham组比较差异无统计学意义（P〉0.05）,实验组间比较差异无统计学意义（P〉0.05）。结论经骨髓腔通路输注小剂量HSH复苏失血性休克,对凝血功能影响轻微,未出现严重的出血倾向,是一种安全、有效的复苏方案。     

Variations in the provision of resuscitation equipment: survey of acute hospitals

Background: There are wide variations in survival after cardiopulmonary resuscitation. The aim of this survey was to describe how equipment provision of resuscitation trolleys was deployed in a range of clinical ward areas. Methods: The equipment in randomly selected resuscitation trolleys in all 14 South West Thames Region hospitals was surveyed. The gold standard for equipment provision was referenced from the document CPR Guidance for Clinical Practice and Training in Hospital. Results: There were significant differences in the provision of circulation equipment (p = 0.004) and in the rates of drug items present (p = 0.001). There was no significant difference in provision of airways equipment (p = 0.24) or immediate access items (p = 0.55). Conclusions: There are variations in the provision of resuscitation equipment in many clinical areas. Hospitals need to review the procedures for ensuring adequate provision of resuscitation equipment in all clinical areas.     

声刺激对昏迷患者苏醒影响的探讨

目的:应用定量脑电图(quantitative electroencephalogram,QEEG)δ+θ/α+β相对功率值、格拉斯哥昏迷评分(Glasgow coma scale,GCS)作为评价指标,来观察声刺激对脑外伤昏迷患者的促醒作用。方法:选择符合入选标准的40例颅脑外伤后昏迷患者。20例为在康复科、神经外科病房内,家属能够积极配合,有长期固定护理人员,经过正规声刺激疗法治疗的脑外伤昏迷患者(声刺激组);20例为在重症监护室内、康复科及神经外科病房内,家属配合度一般,经常更换护理人员,未经过正规声刺激治疗的脑外伤昏迷患者(对照组)。入组后跟踪观察1个月,比较两组患者GCS评分、δ+θ/α+β值有无差异。两组间除有无正规声刺激治疗外,余治疗无明显区别,且两组间在年龄、性别、外伤类型及病程等相匹配。结果:40例颅脑外伤昏迷患者中,声刺激组与对照组治疗后比较,GCS评分明显增大,有统计学差异(P<0.05)。声刺激组与对照组治疗后比较,δ+θ/α+β值明显减小,有统计学差异(P<0.05)。治疗前40例患者GCS评分为3~8分与δ+θ/α+β值呈负相关(r=-0.482,P=0.002,n=40),治疗后31例患者GCS评分为9~15分与δ+θ/α+β值呈负相关(r=-0.493,P=0.005,n=31)。结论:通过对δ+θ/α+β值及GCS评分的观察,说明声刺激法对颅脑外伤昏迷患者有明显的促醒作用。定量脑电图(δ+θ/α+β值)作为一种客观、量化的脑功能检测手段,对昏迷患者大脑功能状态的评估有重要的价值。     

美国西部伦理委员会(WIRB)培训体验

作者参加由WHO资助美国西部伦理委员会为期6个月的伦理培训,通过相关法律法规的培训,来阐述美国受试者保护的政府组织和相关法规,美国西部伦理委员会的运作、管理、实施程序以及值得借鉴之处.     

股静脉穿刺置管在重症脑血管病患者中的临床应用

目的探讨股静脉穿刺置管技术及护理在重症脑血管病（SCVD）患者中的临床应用。方法对2011年5月以来我科收治的50例SCVD患者使用了股静脉穿刺置管技术。结果50例股静脉穿刺置管患者，一次穿刺成功率98％，置管时间8-60d，未发生严重并发症。结论股静脉穿刺置管为SCVD患者的，临床救治、中心静脉压监测、静脉高营养输入及静脉穿刺困难患者建立了有效的静脉通道，减轻了周围静脉损伤，减少了穿刺次数，提高了护士的工作效率。     

Family medicine training--the international experience

Family medicine is undergoing dramatic transformation around the world. Its organisation, delivery, and funding are changing in profound ways. While the specifics of primary care reform vary, a common emerging strategy involves establishment of primary health care teams that provide improved access, use electronic records, are networked with other teams, and are paid using blended payment schemes. More family doctors are needed in all countries. New approaches beyond the traditional apprenticeships or residency programs will be required to meet global demand. Training of family doctors must change to prepare tomorrow's family physician for a different practice reality. Curricula are more competency-oriented, rather than time-focused. Today's trainees can anticipate a career that includes periodic reassessment of their knowledge base and competency. This article explores these trends and offers some strategies that have proved effective in various parts of the world for training increased numbers of qualified family doctors.