神经导航在颅内胶质瘤显微手术的应用

目的　评价神经导航在颅内胶质瘤显微手术的应用价值。方法　应用神经导航系统进行颅内胶质瘤显微手术 30例。结果　用神经导航系统进行胶质瘤及其周围解剖结构定位准确 ,平均注册误差 (2 .5± 0 .4 )mm。术后近期复查CT或MR证实胶质瘤全切率 83.3% ,手术时间和住院日较常规开颅手术缩短。结论　 (1)神经导航定位精确 ,有助于手术计划的精确实施。 (2 )实时导航颅内胶质瘤显微手术 ,有助于达到微侵袭效果和提高胶质瘤全切除率。 (3)摸索一套减少靶点漂移的经验。     

经鼻垂体瘤68例切除及CT、MRI、神经导航分析

目的：探讨垂体瘤的治疗方法。方法：使用显微镜结合CT、MRI及神经导航系统行经鼻蝶手术。结果：68例病人无一人死亡，其中尿崩为7％左右，且为一过性，复发2例。结论：熟知局部解剖，利用CT、MRI及导航技术，不断提高手术技巧，有助于进一步降低经蝶垂体瘤手术并发症的发生。     

神经导航在经蝶垂体腺瘤显微切除术中的应用

目的探讨神经导航系统在经蝶垂体腺瘤显微切除术中的应用价值。方法对21例垂体腺瘤患者实施导航指引的经蝶入路手术。结果神经导航系统能准确指引手术进行,术中无一例损伤颈内动脉等重要结构,术后患者临床症状均有所改善,并发症少。结合术中镜下所见、术后复查影像及随访资料,肿瘤全切率达90.5%,复发率仅4.8%。结论经蝶入路的垂体瘤导航手术能提供实时的三维解剖信息,准确指导手术进行,安全性好,肿瘤全切除率高,并发症少。     

神经外科手术中应用超声导航系统

立体定向神经外科已有近百年的历史。早在1908年，Horsley和Clark就将脑立体定向手术用于动物实验。大约40年后，Spiegel把该项技术引入临床。又过了40年（1986年），Robert等首先报道了神经导航技术。神经影像导航技术是将立体定向技术与现代神经影像学技术和显微外科技术通过高性能计算机结合起来，达到颅内目标的无框架精确定位，并能实时动态跟踪指示靶点。     

甲状腺良性肿瘤手术常规解剖喉返神经与否的探讨

目的研究甲状腺良性肿瘤手术中是否需要常规解剖喉返神经，常规解剖神经与减少神经损伤有无必然联系。方法选取180例甲状腺良性肿瘤，分别采用不显露喉返神经和常规显露喉返神经的手术方法进行手术。结果两组手术方式对喉返神经的保护无明显差别。结论减少喉返神经损伤的关键是要具备良好的颈部解剖知识，熟悉喉返神经的正常解剖及变异，术中根据患者的具体情况进行仔细操作，以及直视下稳妥地处理神经周围组织。是否常规暴露喉返神经应根据手术方式、术中情况进行选择，没有必要遵循一个固定模式。     

我国神经导航手术开展现状的调查

目的:了解我国神经导航手术开展现状、应用潜力以及存在的问题。方法:自行设计《我国神经外科导航技术应用现状问卷调查表》,对国内80余所医院神经导航使用情况进行调查,最后使用excel和SPSS13作数据分析。结果:神经导航技术在我国逐步得到广泛应用,我国医院神经导航设备占有率低,国产导航设备市场份额极小。结论:神经导航技术的应用,可协助神经外科医生有效地进行手术。医院的经济状况是阻碍推广应用神经导航手术的主要原因,研制和生产我国自主创新的神经导航设备具有重大的意义。     

融合DTI及BOLD成像在脑功能区肿瘤神经导航术中的应用

目的探讨弥散张量成像技术(DTI)融合血氧水平依赖成像技术(BOLD)指导脑功能区肿瘤神经导航手术的临床应用价值。方法我院在2011年12月-2015年12月收治37例涉及运动区的脑肿瘤患者,按随机数字表法将其分为试验组(DTI融合BOLD影像导航)19例及对照组(仅DTI影像导航)18例,两组患者均行脑功能区肿瘤神经导航术,利用SPSS 19.0统计两组患者手术效果及预后情况。结果对照组肿瘤全切率50%低于试验组肿瘤全切率73.68%(P<0.05);对照组术后致残率61.11%高于试验组术后致残率36.84%(P<0.05);预后评估:对照组KPS评分(79.11±13.14)分低于试验组KPS评分(90.00±4.88)分,对照组优良率38.90%低于试验组优良率63.20%(P<0.05)。结论 DTI联合BOLD技术应用于功能区脑肿瘤的导航手术,能更清晰地显示脑功能区的解剖学信息,有利于最佳手术入路及手术方案的设计,对提高肿瘤的全切率及最大限度地保留运动功能具有重要的价值。     

运动区胶质瘤的显微手术治疗

目的探讨术中磁共振和功能神经导航两种技术手段对运动区胶质瘤手术治疗的影响。方法回顾性分析2008年1月～2011年1月我院治的115例运动区胶质瘤患者的临床特点、诊治经过及长期随访结果。115例患者中,男∶女=68∶47,术前根据临床表现和影像特点选择手术方法和切除策略。其中功能神经导航辅助术中磁共振下切除肿瘤78例（磁共振组）,单纯功能神经导航指导下切除肿瘤37例（导航组）,术后根据病理学诊断,给予患者标准化治疗;结果收治的115例患者均行手术治疗,根据术中磁共振扫描及术后72h内复查MRI证实核磁组病例手术全切率达91.0%,导航组为59.5%;术后早期并发症发生率磁共振组为3.8%,导航组为10.8%;术后随访5～52个月,患者1年生存率磁共振组为93.9%,导航组为80.6%;结论运动区胶质瘤在手术全切率方面与其他部位胶质瘤接近,但由于胶质瘤靠近运动区,术前临床表现及术后功能缺失均以运动功能障碍为主,与单纯功能神经导航技术相比,功能神经导航辅助术中磁共振技术的应用使运动区胶质瘤的手术全切率及术后功能保留率明显提高。     

复旦大学附属中山医院神经导航技术治复杂颅颈畸形成功

复旦大学附属中山医院神经外科运用复旦大学数字医学研究中心自主研发的神经导航手术系统，开展神经导航引导下经口腔入路畸形齿状突切除手术，治疗患者复杂颅颈畸形获得成功。目前患者已康复出院。     

面神经的角神经解剖学分析

目的本文将对人面神经的角神经进行解剖学分析,从而了解面神经的角神经解剖学具体位置,为临床于人面部皱眉肌、降眉肌以及降眉间肌进行相关去神经化手术寻找合适的手术入路,为手术的安全性提供必要的保证。方法对13例人体新鲜头部标本进行临床解剖,解剖应在显微器械下完成,待面神经的角神经具体位置找出后,观察面神经的角神经周围血管与其关系,并对面神经的角神经至面部皱眉肌、降眉肌以及降眉间肌之间的入肌点进行寻找,同时可对面神经的角神经在人体面部行走全程以及入肌点的位置关系进行记录,并给予照相留存。结果角神经III型所占比例最高,为57.69%,与角神经I型、角神经II型所占比例对比分析具有统计学意义,且P〈0.05;角神经I型与角神经II型所占比例无统计学意义,且P〉0.05。结论临床上对角神经的解剖学位置及其周边关系,能够为寻找直接、简便人面部皱眉肌、降眉肌以及降眉间肌进行相关去神经化手术适宜入路提供可靠依据,从而提高此类手术的安全性,保障患者的治疗效果及生活质量,值得临床推广应用。     

Identifying and training effective clinical teachers--new directions in clinical teacher training

Decisions about recruitment of clinical teachers and about the content of clinical teacher training programs are complex. This article aims to identify core components that reflect the characteristics of effective clinical teachers and effective clinical teaching in the ambulatory setting. These are grouped into four thematic categories--personal attributes, educational theory and principles, core clinical teaching skills, and mentored instructional activities.     

A skin cancer training programme: evaluation of a postgraduate training for family doctors

This study aimed to evaluate the effectiveness of a postgraduate skin cancer training programme in improving family doctors' levels of knowledge and clinical practice. Forty-one of 59 family doctors (69% consent) who enrolled in the training programme agreed to participate in its evaluation. Approximately half of the doctors were allocated to the 'intervention' group, and the others were in the 'waiting-list' control group. Pre- and post-test data were collected to assess changes in doctors' knowledge, perceived confidence and clinical practice. The training programme involved three sessions, including an information/education session, a practical session at the local Melanoma Unit, and a practical surgical procedures session. There were significant improvements in the proportion of (i) accurate diagnoses, which were made when lesions were presented on colour slides with an accompanying case history; (ii) lesions presented on colour slides in which the correct management of the lesion was identified; and (iii) doctors who felt very or extremely confident in their ability to advise patients on screening frequency, to advise patients on the signs of skin cancer, and to decide whether changes in lesions were malignant. The only improvement observed in the doctors' clinical practice was a significant increase from pre- to post-test in the proportion of pathology request forms on which a diagnosis of the specimen was attempted by doctors in the intervention group compared to those in the control group. The results of this study indicate that whilst significant improvements in knowledge are achievable through postgraduate programmes, clinical practice is much more difficult to change.     

Sexuality training for psychiatry residents: a national survey of training directors

The current status of training in human sexuality is relevant to all health care professionals. The purpose of the current study was to determine the extent of sexuality training offered in psychiatric residency programs. The training directors of psychiatry residencies were surveyed with regard to the number of expert faculty in sexuality training as well as resident exposure to seven related curricular areas. Of the 69 respondents, the majority reported expert faculty in sexual dysfunctions, sex therapy, therapy with gay/lesbian patients, and HIV/AIDS. For each sexuality topic, approximately 80% of programs reported curricula offerings through either didactics or clinical rotations. For didactics, most topics were presented in the context of a broader course. With the exception of HIV/AIDS, it was rare for programs to offer a clinical rotation involving sexuality issues. In conclusion, the majority of training programs in psychiatry provide curriculum offerings in sexuality training, primarily through didactic education. Results are discussed with regard to comparison to training in professional psychology and the need for assessment of sexuality training in health care professions generally.     

对医护人员开展临床医学工程知识培训的思考

目的:通过培训保证医院医疗设备的正常运转,确保临床医护人员的正常工作。方法:采取四种不同的方式对医护人员进行培训,包括厂家工程师培训,医院工程师培训,科室内部培训,医院年度培训。结果:医疗设备故障率明显降低,使用寿命延长,为医院创造了更大的经济效益,保障了患者的及时治疗。结论:由于医护人员缺乏临床医学工程的相关知识,对其进行培训十分必要。     

Clinical applications of relaxation training

Progressive muscle relaxation is a rational therapeutic alternative in such common functional syndromes as tension headache, migraine, and insomnia. Evidence of its efficacy and guidelines in clinical application are offered.     

临床医学技能培训中心的建立和完善

通过建立和完善临床医学技能培训中心，探讨临床医学实践教学的有效途径。我院自1999年以来陆续投资1500万元建造了临床技能培训中心，并有目的、有步骤地完善临床技能培训和考核中心的功能，为医学实践教学提供了设备完备、环境逼真、技能训练规范的教学环境；并结合教学对象及其教学目的、教学方式方法和师资状况，整合设置了不同类型的培训项目；开展不同层次的临床技能培训，为学员临床实践能力的提高奠定良好的基础。     

临床医学专业学位研究生的培养

临床医学研究生教育是国家培养高层次医学人于的重要途径,培养高层次医学人才已成为当务之急。确保培养出高质量的临床医学研究生,需要借鉴学习欧、美、日等先进发达国家的教育经验,突破旧的教育体制的束缚,加强临床医学研究生的独立学习及创新能力的培养。根据我国医学发展的特点,从多个方面注重对临床医学研究生的科研能力的培养,以及最终与临床实践相结合的能力训练。导师队伍建设是学科建设的灵魂,是整个研究生培养工作的关键。引进竞争机制,是促进和加强导师队伍的建设和发展的有效举措。     

Clinical placements cannot start in the third year of medical training

A solid knowledge base is essential in order for clinical placements that include some responsibilities to be meaningful. As it takes at least 3 years to discuss all principal organ systems, clinical placements should not commence after only two years. In addition, the limited numbers of patients and clinical teachers may be better reserved for full senior clinical placements.     

Audiology training in Nigeria--I: A training model

The purpose of this paper was to develop a model for preparing professional audiology personnel in a developing country (Nigeria). Professional audiologists in Nigeria are expected to provide basic and advanced audiologic services in hospitals, special schools for the hearing-impaired and to develop, conduct or supervise hearing conservation programs in regular school settings, industries as well as local government health centers. The competencies expected of students upon completing their professional programs are presented in the form of 'training modules' vis-a-vis basic science, medical educational, hearing conservation, aural rehabilitation and clinical practicum. Training implications of the modules are discussed with regards to the promise they hold for the preparation of audiology personnel particularly in developing countries.