以问题为基础学习教学法在八年制学员眼科临床实习中的应用

目的：探讨以问题为基础学习(problem-based learning,PBL)教学法在临床医学专业八年制学员眼科学临床实习过程中的教学效果。

方法：以2013-01/2014-03在第四军医大学西京医院眼科实习的40名临床医学专业八年制学员为研究对象,随机分为PBL教学组(PBL组)和传统教学组(对照组),每组20名。PBL组采用PBL教学法引导实习学员主动参与实习过程,以实习学员为主体; 对照组采用传统教学法以教师为主导引导学员完成临床实习。最后通过问卷调查、出科考试成绩分析等综合评价不同教学方法的实习效果。

结果：出科考试成绩分析中,PBL组的问答题、病例分析题和总成绩的分数均明显高于对照组(P<0.05); 选择题和名词解释的得分与对照组无显著差异(P>0.05)。实习学员对教学效果的自评指标中,在提高学员综合分析能力、学习主动性和实习效果等方面PBL组均明显优于对照组(P<0.05); 在激发学员兴趣和对教学法满意度方面PBL组略强于对照组,但统计学差异不显著(P>0.05)。教员对实习生的评价指标中,PBL组在实习前充分积极准备、实习中全面准确表达观点、临床思维逻辑性等方面均明显好于对照组(P<0.05); 在与患者沟通能力方面两组间差异不显著(P>0.05)。

结论：PBL教学法适用于临床医学专业八年制学员在眼科的实习教学,PBL教学法能够较好训练学员的临床综合分析能力,有助于其主动解决临床实际问题能力的培养。     

河南省医学高等专科学校学生视力现状及影响因素调查

目的 了解河南省医学专科学校学生视力现状及视力低下的影响因素,为预防和控制学生视力低下提供科学依据.方法 运用E字型国际标准对数视力表和自行设计的《大学生近视预防相关问题调查问卷》,对调查对象进行检测、调查和统计分析.结果 口腔医学专业学生的平均双眼裸眼视力明显高于临床医学专业学生(P＜0.01),护理专业学生的平均双眼裸眼视力高于药学专业学生(P＜0.05).被调查者视力低下的检出率为90.30％,女生视力低下率(92.12％)明显高于男生(87.96％).被调查者中视力正常学生回答“阅读时眼睛应与书报保持的距离”的正确率为56.57％,视力低下学生回答的正确率为53.06％.在回答“书写时指尖应与笔尖保持的距离”时,视力正常学生回答的正确率为69.48％,而视力低下的学生回答的正确率为66.18％.不同视力的被调查者每天玩电子游戏时间的差异有统计学意义(P＜0.05).被调查者每周保持锻炼0～2次者、被调查者锻炼时间在30 min以内者、多锻炼状态不出汗者的性别差异均有显著统计学意义(均为P＜0.01).经常打乒乓球、羽毛球者视力低下率为57.14％,经常参加其他项目锻炼者视力低下率为71.93％,二者差异有统计学意义(P＜0.05).视力低下的学生更不喜欢吃动物肝脏、红萝卜、豆类及豆制品和绿叶蔬菜,而视力正常的学生更不喜欢喝含糖饮料,二者差异有显著统计学意义(P＜0.01).结论 被调查者视力低下率高于全国平均水平.欠缺正确的用眼知识、长时的不良用眼行为、缺乏必要的锻炼、不均衡的饮食习惯等是影响视力低下的主要危险因素.     

虚拟现实技术在眼科领域的应用现状及研究进展

虚拟现实（VR）技术作为科技热词为人们所熟知。同时VR技术与眼视觉研究相关联,VR技术的进步对现代眼科领域的发展有促进作用。目前已经有许多研究表明VR在眼科医师的培养及相关眼病视觉研究等领域有着实际的应用价值和实践空间。笔者就目前VR在眼科各领域具体的应用作一系统综述,分析VR与眼科领域的可连通性,同时在已取得成果的基...     

Effect of obstructive sleep apnoea on retinal microvascular function: a randomised controlled trial

Graefe's Archive for Clinical and Experimental Ophthalmology - Retinal microvascular endothelial dysfunction is thought to be of importance in the development of ocular vascular diseases....     

从医学生视角看眼科见习期间裂隙灯训练的必要性

目的：基于医学生视角评估裂隙灯生物显微镜(以下简称“裂隙灯”)训练的必要性,对眼科见习期间的医学生裂隙灯训练达成共识。

方法：在中山大学117名2017级临床医学专业学生中,开展见习前后对照研究。所有医学生在眼科见习期间均接受裂隙灯训练。使用自行设计的问卷调查,评估学生对裂隙灯教学的个人认知、个人需求与建议,并对眼科见习前后学生在这些方面的得分进行比较。此外,通过眼科见习后的学生主观评价来评估裂隙灯训练的效果。每个条目评分采用Likert 5级评分法。采用IBM SPSS 软件(版本 20.0; SPSS Inc.,Chicago,IL,USA)进行统计分析。

结果：共有116名(99.1%)医学生完成了调查。见习前的平均得分为19.99±3.03分,显示学生对裂隙灯用途的认知水平高; 见习后的得分显著增加至22.97±2.37分(P<0.001)。对于个人需求的平均得分,见习后高于见习前(24.62±3.15 vs 23.60±2.36,P=0.009)。此外,86.2%的学生见习后认为裂隙灯实操训练有助于显著改善见习质量。大于四分之三的被调查学生倾向于增加裂隙灯训练时间(见习前后分别为76.7%和77.6%)。

结论：在眼科见习中,医学生更偏好于裂隙灯训练实操; 鉴于对改善见习质量的潜在作用,应在眼科见习中推荐该训练。     

Foldable vs rigid lenses after phacoemulsification for cataract surgery: a randomised controlled trial

Purpose

To compare the outcomes of phacoemulsification with either a 2.5-mm clear corneal incision and a foldable intraocular lens (IOL) or a 5-mm sclerocorneal tunnel incision and a rigid polymethyl methacrylate (PMMA) IOL.

Methods

In a prospective, randomised clinical trial of phacoemulsification cataract surgery, 1200 patients received either a foldable hydrophilic acrylic IOL through a 2.5-mm corneal incision or an inexpensive rigid PMMA IOL via a 5-mm sclerocorneal tunnel. Intra- and post-operative data and visual acuity at discharge, 6 weeks, and 1 year follow-up were analysed.

Results

At 1 year after surgery, 996 (83.0%) patients were followed up with an uncorrected visual acuity of 6/18 or better in 90.3% of the foldable and 94.3% in the rigid IOL group (risk ratio (RR) 0.96, 95% confidence intervals (CI) 0.92–0.99). Poor outcome (best-corrected acuity 6/60 or worse) occurred in 1.0% and 0.4%, respectively (RR 4.28, 95% CI 0.48–38.18). The surgical cost of consumables and overall surgical time were similar in both groups; however, the cost of the foldable IOL was eight times higher than the PMMA IOL. Posterior capsule opacification was more common in the rigid IOL group at 12 months (36.1% vs 23.3%); however, this did not affect post-operative vision.

Conclusion

In the hands of experienced cataract surgeons, phacoemulsification with implantation of a foldable or a rigid IOL gives excellent results. Using an inexpensive rigid PMMA IOL will make phacoemulsification more affordable for poor patients in low- and middle-income countries.     

眼科学继续医学教育模式的思考及探索

继续医学教育贯穿于医者的终身职业生涯,是医务人员不断提高自身业务水平的关键。然而,目前眼科继续医学教育仍面临对象多样性、内容复杂性、形式化突出、知识技术更新快、多学科交叉及青年医生手术培养困局等难题。正面与反面教育结合、人文与专业教育结合、理论与实践教育结合、国内与国外教育结合、听课与授课教育结合、公益与商业模式结合、科室与小组模式结合、传统与新兴模式结合、医生与医技护理结合,是我们在眼科继续医学教育中进行的初步探索。（眼科, 2014, 23： 351-354）     

Postoperative astigmatism after intracapsular cataract surgery: results of a randomised controlled trial in Nepal

PURPOSE: Postoperative astigmatism following intracapsular cataract extraction with or without anterior chamber intraocular lens implantation is reported as an outcome from a randomised controlled trial. METHODS: Five hundred and two of 1002 eyes randomised to intracapsular cataract extraction with anterior chamber intraocular lens (ICCE/AC IOL) and 417 of 998 eyes to intracapsular cataract extraction with aphakic spectacles (ICCE/AS) were seen for objective refraction one year after surgery. The prevalence and axis of astigmatism were evaluated using univariate analysis. Logistic regression was used to compare the postoperative astigmatism between the groups. RESULTS: Acceptable astigmatism (-0.5 to 0.0 DCyl) in the AC IOL group was found in 60 (12.0%) patients (95% CI 9.1%-14.9%) and in the aphakic spectacles group (AS) in 69 (16.5%) patients (95% CI 12.9%-20.1%), moderate astigmatism (-1.0 to-1.5 DCyl) was found in 153 (30.4%) patients (95% CI 26.4-34.6%) in ACIOL group and in 288 (69.1%) patients (95% CI 64.6%-73.6%) in AS group; and large astigmatism (-2.0 to - 8.0 D Cyl) was found in 289 (57.6%) patients (95% CI 53.1%-61.6%) in ACIOL group and in 60 (14.4%) patients (95% CI 11.0% 17.8%) in AS group. Large astigmatism was approximately four times more common in the ICCE/AC IOL group compared to ICCE/AS group. In both groups, most patients had "against-the-rule" astigmatism, 446 (88.8%) (95%CI 86.0%-91.6%) in AC IOL group and 348 (83.5%) (95%CI 79.9%-87.1%) in AS group. CONCLUSION: Astigmatism is common after intracapsular cataract extraction. Insertion of an anterior chamber IOL increases the risk of astigmatism.     

Screening for amblyopia in preschool children: Results of a population-based,randomised controlled trial

INTRODUCTION The rationale for preschool vision screening programmes has recently been questioned. Evidence about the effects of early treatment is needed, but it is not known how early the target conditions can reliably be detected. In this study, an intensive programme comprising several different screening methods, used at different ages up to 37 months, was compared with the usual practice of visual surveillance and ad hoc referrals.

METHODS Two groups were randomly selected from children in a population birth cohort study. The control group (n = 1461) received visual surveillance only. The intervention group (n = 2029) was offered in addition a programme of regular visual assessments by orthoptists testing visual acuity, ocular alignment, stereopsis and non-cycloplegic photorefraction.

RESULTS The intervention group programme yielded more children with amblyopia (1.6% vs. 0.5%, p < 0.01), and was more specific (95% vs. 92%, p < 0.01), than the control programme. The individual components of the intervention programme were compared. The cover test and visual acuity tests were poorly sensitive until the children were 37 months, but were always >99% specific. Photorefraction was more sensitive than acuity testing at all ages below 37 months, with specificity >95% at 31 and 37 months.

CONCLUSIONS Photorefraction would have detected more children less than 37 months of age with straight-eyed amblyopia than did visual acuity testing, but with more false positives. At 37 months, photore-fraction plus a cover test would have been comparable in effectiveness to visual acuity testing plus a cover test.     

八年制医学教育的现状与改革

八年制医学教育的目的是培养适合我国国情的高素质医学人才.本文回顾了我国八年制医学教育的产生与发展;介绍了八年制医学教育改革中各个方面积极的探索,包括教师改革、教学理念改革、教学方法改革、教学手段变化和特色课程设置等;总结了我国目前八年制医学教育的现状;并探讨了进一步完善这一教育体系,提高八年制医学生素质的策略与方案.     

A randomised controlled trial of written information: the effect on parental non-concordance with occlusion therapy

BACKGROUND/AIMS: It is well documented that non-concordance with occlusion therapy is both substantial and a major factor leading to treatment failure. Parental understanding in previous work has been found to be poor in key areas such as the critical period and effect of age on prognosis. Research in other areas of medicine has shown that the level of understanding can have a direct effect on the level of concordance. The aims of this study were to assess the ability of educational material in the form of a leaflet, to improve parental understanding of amblyopia and occlusion, and subsequently increase concordance. METHODS: Parents of children aged between 1 and 7 years receiving a minimum of 1 hour of occlusion for amblyopia were recruited. A randomised controlled trial was undertaken where, on inclusion, the patients were randomised into a leaflet group, whose parents were issued with written educational material, and a control group whose parents did not receive the written information. Patients were paired and matched for age (<2 years difference) and amount of prescribed occlusion (no more than 1 hour difference). Concordance was monitored by a parental diary and knowledge and parental reasons for non-concordance were assessed by a questionnaire. Concordance was analysed by means of a concordance index and by calculating the proportion of non-concordant parents by setting a threshold of concordance at 80%. RESULTS: Parental knowledge was significantly greater in the leaflet group (88% had complete knowledge) compared to the control group (49% had complete knowledge) (p <0.001). There were also differences between the groups in the area of the treatment regimen, with errors only occurring in the control group (three patients occluded the incorrect eye), but this did not reach statistical significance. Concordance was significantly greater in the leaflet group (mean concordance index 0.85) compared to the non-leaflet group (mean concordance index (0.71) (p <0.001). Comparison of the proportion of non-concordant parents was also statistically different (p <0.005) at 0.23 (95% CI 0.13 to 0.35) for the leaflet group compared to 0.54 (95% CI 0.41 to 0.67) for the control group. CONCLUSION: A large proportion of patients would benefit by increasing parental knowledge in key areas such as the critical period, importance of occlusion, and potential negative consequences of not treating amblyopia. Written information is a simple, inexpensive, easy to implement, yet effective method of improving parental understanding and subsequent concordance.     

Randomised controlled trial of the effect of coloured overlays on the rate of reading of people with specific learning difficulties

A randomised controlled trial has demonstrated that, for selected children with reading difficulties, individually prescribed coloured filters reduce symptoms of asthenopia. In the present study, we investigate the effect of individually prescribed coloured overlays on the rate of reading. Subjects were 33 children and adults who: had consulted a specific learning difficulties clinic; had received treatment to normalise any conventional optometric and orthoptic anomalies; and subsequently reported symptomatic relief from coloured filters. These subjects carried out the Wilkins Rate of Reading Test (which assesses visual rather than linguistic factors) under two conditions: with their chosen coloured overlay and with a control filter. Steps were taken to ensure that a strong placebo effect was associated with the control overlay and, when asked which they preferred, subjects were not significantly more likely to prefer their coloured overlay than the control filter (p=0.11). Nonetheless, the rate of reading was significantly faster with the coloured overlay than with the control (p=0.0019). Further analyses support the conclusion that individually prescribed coloured filters can improve reading performance for reasons that cannot be solely attributed to conventional optometric factors or to placebo effects.