EYESi手术模拟器培训不同手术经验眼科医师的对比研究

目的比较住院医师和主治医师应用EYESi手术模拟器进行前节夹持和抗抖动模拟训练的操作情况。方法在首都医科大学附属北京友谊医院眼科住院医师培训基地选择10个住院医师和5个主治医师参加试验。每位参加者总共完成EYESi手术模拟器夹持和抗抖动第四级训练模式重的6个试验任务,15个参加者总共完成90个试验任务。结果主治医生获得了统计学上显著更高的总得分(夹持P=0.02和抗抖动P=0.01),完成任务时间(夹持P=0.006和抗抖动P=0.0014)和眼内操作的时间(夹持P=0.005和抗抖动P=0.007)更少,切口张力更小(夹持P=0.003和抗抖动P=0.001)。此外,夹持模块中晶体损伤更少(P=0.001),角膜损伤更少(P=0.03)。在抗抖动模块中主治医生操作更精确,出现的错误(超差百分比)更少(P=0.03),在平均抖动值方面两组医师没有显著差异(P=0.08)。结论 EYESi手术模拟器对培训和评估年轻眼科医师前节显微手术技能有明显的可操作性和有效性。主治医师较住院医师完加持和抗抖动模块训练的成绩更好,更有效率,差错出现也更少。     

浅谈编写全国医师输血定期考核大纲和题库的经验简

国内对取得执业医师资格后的临床医师一直未进行规范统一的复核.2011年起,中国医师协会配合卫计委对全国各临床专业的医师进行定期考核,以此统一测评临床医师的执业水平.现报告全国医师输血定期考核大纲及题库的编写过程,并总结经验,以便发挥借鉴作用.     

淀粉样变性分型的研究进展简

淀粉样变性是由蛋白结构异常造成的一组疾病.淀粉样物质在不同脏器沉积进而影响脏器功能.根据致病蛋白种类可将淀粉样变性分为多种亚型,每种亚型的临床表现、治疗方案和预后都不尽相同.传统的免疫荧光和免疫组织化学分型方法存在抗体种类有限、背景染色干扰等问题,具有一定的误诊率.最近,以蛋白质组学为基础的激光显微切割联合质谱分析技术（LMD/MS）被成功应用于淀粉样变性分型.本文就淀粉样变性分型方法的最新研究进展进行综述.     

临床技能培训与考核中心管理工作路径初探简

临床技能培训考核中心,是医学生学习、考核临床操作规范,继而顺利过渡到真实病人操作的重要实践平台。更好地发挥技能中心的作用,促进培训、考核工作效率及质量的提高,已成为当前各医院临床技能中心管理工作的重点。该研究通过总结、分析,采用小组讨论法,初步探索出一套技能培训考核中心管理工作路径。经实际运行检验．证明该工作路径科学、有效,提高了技能中心的管理水平,值得推广和进一步探索、完善。     

导管未闭合并肺动脉高压的对比研究简

目的对比研究介入封堵与外科手术治疗婴幼儿动脉导管未闭合并肺动脉高压（PDA）的临床疗效,探讨应用国产封堵器介入治疗婴幼儿PDA的临床价值和安全性。方法2010年1月至2012年12月采用国产封堵器介入封堵治疗的婴幼儿PDA患者52例,同期采用外科手术治疗的PDA患者48例,比较两种方法的疗效、主要并发症及远期疗效等。结果两种疗法的技术成功率（介入组98．1％、外科组97．9％）无显著性差异（P〉0．05）,介入组有1例封堵未成功择期行外科手术治疗,外科组有1例PDA结扎术后残余漏择期又行介入封堵治疗;主要并发症发生率有显著性差异（P〈0．05）（介入封堵组1．96％、外科手术组14．6％）,介入封堵组有1例发生三尖瓣关闭不全,外科手术组并发症有7例：进行性血胸二次开胸止血2例,肺不张2例,气胸1例,喉返神经损伤1例,刀口感染1例,术后接受输血8例、呼吸机辅助通气16例,介入组无1例接受输血和呼吸机辅助通;术后住院时间介入组平均（4．3±1．2）d,外科组平均（11．2±3．3）d,两组比较均有显著性差异（P〈0．05）;两组远期随访均生存良好,肺动脉压力下降程度及心功能改善情况无显著性差异（P〉0．05）。结论国产封堵器介入治疗婴幼儿PDA安全可靠,具有良好的临床可行性和安全性,创伤小、并发症少,住院时间短,可作为婴幼儿PDA治疗的首选方法。     

玻璃体切割术治疗视网膜玻璃体疾病的手术要点简

目的总结玻璃体切割术治疗视网膜玻璃体疾病的临床效果和手术要点。方法对91例（99眼）视网膜玻璃体疾病行玻璃体切割术病例进行分析,探讨玻璃体切割术的手术要点、时机、联合治疗的必要性。结果术后视力较术前有不同程度提高82眼,占82．8％;无明显提高17眼,占17．2％。结论玻璃体切割术是治疗视网膜玻璃体疾病的有效方法,握手术技术和要点,并规范围手术期的管理,可在县级医院开展。     

Performances on simulator and da Vinci robot on subjects with and without surgical background

Abstract

Objective: To assess whether previous training in surgery influences performance on da Vinci Skills Simulator and da Vinci robot.

Material and methods: In this prospective study, thirty-seven participants (11 medical students, 17 residents, and 9 attending surgeons) without previous experience in laparoscopy and robotic surgery performed 26 exercises at da Vinci Skills Simulator. Thirty-five then executed a suture using a da Vinci robot.

Results: The overall scores on the exercises at the da Vinci Skills Simulator show a similar performance among the groups with no statistically significant pair-wise differences (p?<?.05). The quality of the suturing based on the unedited videos of the test run was similar for the intermediate (7 (4, 10)) and expert group (6.5 (4.5, 10)), and poor for the untrained groups (5 (3.5, 9)), without statistically significant difference (p?<?.05).

Conclusion: This study showed, for subjects new to laparoscopy and robotic surgery, insignificant differences in the scores at the da Vinci Skills Simulator and at the da Vinci robot on inanimate models.     

Lack of transfer of skills after virtual reality simulator training with haptic feedback

Background and objective: Virtual reality (VR) simulators enrich surgical training and offer training possibilities outside of the operating room (OR). In this study, we created a criterion-based training program on a VR simulator with haptic feedback and tested it by comparing the performances of a simulator group against a control group.

Material and methods: Medical students with no experience in laparoscopy were randomly assigned to a simulator group or a control group. In the simulator group, the candidates trained until they reached predefined criteria on the LapSim^® VR simulator (Surgical Science AB, Göteborg, Sweden) with haptic feedback (Xitact^TM IHP, Mentice AB, Göteborg, Sweden). All candidates performed a cholecystectomy on a porcine organ model in a box trainer (the clinical setting). The performances were video rated by two surgeons blinded to subject training status.

Results: In total, 30 students performed the cholecystectomy and had their videos rated (N?=?16 simulator group, N?=?14 control group). The control group achieved better video rating scores than the simulator group (p?Conclusions: The criterion-based training program did not transfer skills to the clinical setting. Poor mechanical performance of the simulated haptic feedback is believed to have resulted in a negative training effect.     

Assessment potential of a new suture simulator in laparoscopic surgical skills training

Background: The skills necessary for performing effective laparoscopic suturing are difficult to acquire; as a result, simulators for learning these skills are rapidly becoming integrated into surgical training. The aim of the study was to verify whether a new hybrid simulator has the potential to measure skill improvement in young, less experienced gastroenterological surgeons.

Material and methods: The study included 12 surgeons (median age, 29 (27–38)] years; 11 men (91.7%), one woman (8.3%)) who participated in a two-day laparoscopic training seminar. We used the new simulator before and after the program to evaluate individual performance. Skills were evaluated using five criteria: volume of air pressure leakage, number of full-thickness sutures, suture tension, wound area, and performance time.

Results: Air pressure leakage was significantly higher after than before the training (p?=?.027). The number of full-thickness sutures was significantly higher post-training (p?p?=?.011). Wound opening areas were significantly smaller post-training (p?=?.018). Performance time was significantly shorter post-training (p?=?.032).

Conclusions: Our study demonstrated the assessment quality of this new laparoscopic suture simulator.     

自助密闭式戴无菌手套法在外科手术中的应用

目的探讨自助密闭式戴无菌手套法在外科手术中的应用效果。方法将100名手术人员分为观察组51名,采用自助密闭式戴手套法;对照组49名,采用传统戴手套法;观察两组人员戴手套时手套卷边率和术中袖口暴露率。结果观察组手套卷边率、术中袖口暴露率低于对照组,两组比较,均P0.05,差异具有统计学意义。结论自助式戴手套法可有效防止戴无菌手套过程中手套卷边率和术中袖口暴露率,从而降低手术切口感染风险和医护人员职业危害。     

机动车船模拟训练器在静脉输液培训中的应用

目的探讨模拟机动车船动态条件下护士静脉输液训练效果。方法对30名护士进行机动车船模拟训练,包括能力素质评估、适应性训练、动作分解训练和动作合成训练4个阶段,并与传统训练方法进行比较。结果护士静脉输液操作成绩和满意度均高于对照组(P0.01或P0.05)。结论模拟战时和突发应急事件环境组织训练,提高了护士综合素质和应对突发事件的能力。     

双唇畸形的外科治疗

目的：比较两种手术方法治疗双唇畸形的效果。方法：①唇部肥厚粘膜切除术，②摘除唇部小涎腺并修正粘膜的长度外形。结果：采用唇肥厚组织切除术满意率约57．1％。采用唇腺摘除术加粘膜修整术满意率100％，解剖外形恢复正常。结论：唇腺摘除术较为准确可靠，是易于掌握的手术方法，效果且稳定。     

神经外科锁孔手术两种备皮方法的临床研究

目的:探讨神经外科锁孔手术术前局部小范围剃毛备皮的可行性.方法:选择神经外科锁孔手术病人80例,随机分为观察组40例和对照组40例,对照组采用常规开颅手术的备皮方法.观察组术日剃除切口周围约3cm范围的头发,进行局部小范围剃毛备皮.比较观察组和对照组重复备皮率、备皮时病人的疼痛不适感、对病人产生的负性心理影响、备皮前后血压、脉搏的改变以及术后切口感染、颅内感染的发生率.结果:两种备皮方法病人重复备皮率、疼痛不适感、对病人产生的负性心理影响、对照组备皮前后血压、脉搏的改变等差异有统计学意义(均P<0.05),术后切口感染率、颅内感染率、观察组备皮前后血压、脉搏的改变差异无统计学意义(均P>0.05).结论:神经外科锁孔手术术日局部小范围剃毛备皮优于开颅手术的常规备皮方法.     

基于虚拟超声模型评价超声住院医师操作技能培训效果

目的探讨应用虚拟超声模型评价超声住院医师操作技能培训效果的价值。 方法选取在北京协和医院超声医学科参加住院医师规范化培训的2019级住院医师11人,应用虚拟超声模型考核腹部器官的7个正常超声切面和3个病例切面的显示,完成病灶最大切面的长径与短径共6个测量值的测量,并与高年资医师的测量值进行比较。经过2个月门诊实践练习后,再次应用虚拟超声模型进行考核。练习前后分别记为G0M组和G2M组（G,Group;M,Month）。应用Mann-Whitney U检验比较2组检查用时的差异,应用单样本t检验比较住院医师测量值与高年资医师测量值的差异,应用χ²检验（Fisher精确概率法）比较切面合格率和完成率的组间差异。 结果G0M组获取7个正常超声切面的合格率为59.46%（44/74）,检查用时为（8.18±2.96）min。G2M组71.43%的切面合格率均提高,合格率达到88.31%（68/77）,检查用时下降为（5.45±1.57）min,与G0M组相比差异均具有统计学意义（χ²=44.101,P＜0.001;t=-2.698,P=0.014）。G2M组对3个病例切面的完成率较G0M组提高,但组间差异无统计学意义（P均＞0.05）。G2M组对病例1和病例2的检查用时较G0M组减少［1.00（2.00,1.00）min vs 3.00（4.00,2.00）min;2.00（2.00,1.00）min vs 2.50（3.00,2.00）min］,2组间差异具有统计学意义（Z=-3.089、-2.061,P=0.002、0.039）。G2M组对病例3长径的测量准确性较G0M组下降,与高年资医师比较［（8.42±0.88）cm vs 9.45 cm］,差异具有统计学意义（t=-3.097,P=0.021）。 结论虚拟超声模型可用于评价超声住院医师初学阶段和练习期间的操作技能培训效果。     

结合案例分析对新护士进行操作培训的实践

目的：探讨结合案例分析对新护士进行护理操作培训的效果。方法：将2010年7月新进护士48名作为对照组,采用传统方法进行培训;将2011年7月新进护士50名作为观察组,结合案例分析进行培训,即针对基础护理操作项目,由带教老师收集临床护理操作中发生的相关缺陷案例,整编为操作带教案例,在带教中通过对缺陷案例进行演示和举一反三的分析讨论,促进新护士对操作的理解和掌握。结果：新护士对案例分析法操作培训满意率达90．0％～98．0％;观察组新护士操作理论、实践考试成绩优于对照组（P〈0．05,P〈0．01）;培训上岗后观察组护理操作差错发生例数较少。结论：结合案例分析的操作培训模式贴近临床,能促进新护士对操作的掌握以及正确解决临床护理操作中遇到的问题,增强护理操作安全意识,保障患者安全。     

Performance and perception of haptic feedback in a laparoscopic 3D virtual reality simulator

Abstract

Background: The benefit of haptic feedback in laparoscopic virtual reality simulators (VRS) is ambiguous. A previous study found 32% faster acquisition of skills with the combination of 3?D and haptic feedback compared to 2?D only. This study aimed to validate perception and effect on performance of haptic feedback by experienced surgeons in the previously tested VRS. Material and methods: A randomized single blinded cross-over study with laparoscopists (>100 laparoscopic procedures) was conducted in a VRS with 3?D imaging. One group started with haptic feedback, and the other group without. After performing the suturing task with haptics either enabled or disabled, the groups crossed over to the opposite setting. Face validity was assessed through questionnaires. Metrics were obtained from the VRS. Results: The haptics for ‘handling the needle’, ‘needle through tissue’ and ‘tying the knot’ was scored as completely realistic by 3/22, 1/22 and 2/22 respectively. Comparing the metrics for maximum stretch damage between the groups revealed a significantly lower score when a group performed with haptics enabled p?=?.027 (haptic first group) and p?<?.001(haptic last group). Conclusion: Haptic feedback in VRS has limited fidelity according to the tested laparoscopic surgeons. In spite of this, significantly less stretch damage was caused with haptics enabled.