儿科护士急救课程情景模拟和在线培训效果的前瞻性研究

目的 比较情景模拟训练和网上教学在急救技能和知识方面的效果。方法 将94名儿科护士随机分为两组：情景模拟训练组和网上教学组。前者接受90 min的情景刺激训练,包括15 min的心肺复苏训练,50 min的高保真场景录像的急救技能训练,以及25 min的反馈和讨论;后者接受30 min的视频训练,包括急救准备、插管辅助、喉罩气道置入、自充式简易呼吸器置袋、除颤器的使用等。在培训前和培训后的1 h内,根据急救知识测试(FAKT)和急救技能测试(FAST)进行了问卷调查。对培训时间和培训费用进行了比较。对情景模拟和在线急救培训的94名护士在培训后2周内的工作进行基于问卷调查的服务满意度评估。结果 两组培训前的FAST和FAKT得分差异无统计学意义(P>0.05),培训后两组的FAST和FAKT得分均有明显提高(P<0.05)。而情景模拟训练组训练后的FAST和FAKT分数明显高于在线教学组(P<0.05)。情景模拟训练组每位学员的平均训练时间为90 min,高于在线教学组45 min。情景刺激组每位学员的培训费用为270.00元,高于网上教学组的150.00元。79.35...     

基于急诊综合平台的工作坊教学模式研究

目的探讨基于急诊综合平台的工作坊教学模式对医学生急救能力的培训效果。方法将进入急诊科学习的40名医学生根据入科成绩,参考学历层次、年龄和性别进行两两配对,随机将一个分配至对照组,另一个分配至试验组,每组20人。对照组采用以带教老师为中心的传统带教方法进行教学培训,试验组采用急诊科综合平台工作坊模式进行教学,两组学员连续培训1.5个月,比较两组学员在急救理论、技能、设备操作和院外急救知识方面的出科考核成绩,以及对教学模式的反馈评分。结果两组学员入科考核时的理论和技能成绩均未达到及格水平,对照组和试验组学员在分数上无统计学差异(P>0.05),研究具有可比性。经培训后,对照组学员急救理论、技能、设备操作、院外急救知识的得分分别为(70.33±6.26)、(73.87±5.27)、(58.93±7.28)、(57.49±5.37)分,试验组学员在此四个方面的得分分别为(78.64±5.93)、(82.65±7.11)、(78.82±6.36)、(75.80±8.67)分,试验组出科成绩明显优于对照组,差异具有统计学意义(P<0.01)。出`科时对照组对教学的反馈评分为(70.13±3.28)分,试验组学员对教学的评分为(85.75±5.62)分,两组比较,差异具有统计学意义(t=10.735,P<0.01)。结论急.诊综合平台工作坊教学模式是一种培养医学生急救能力的有效教学模式。     

汶川地震期间医院规范化培训护士地震认知及心理健康状况分析

目的了解汶川大地震期间震区规范化培训护士掌握地震相关知识的情况及心理健康状况,为提高培训内容的针对性提供参考依据。方法采用自设问卷及抑郁自评量表（SOS）、焦虑自评量表（SAS）对随机整群抽取的200名2006、2007和2008年级的在校规范化培训护士进行调查。结果73．02％的规范化培训护士对地震的相关知识及避震的措施基本不了解,26．98％的规范化培训护上基本了解。被试规范化培训护士抑郁总分为44．88±9．38,显著高于全国常模[（41．88±10．57）,u=2．31,P〈0．05];焦虑总分为（34．19±4．30）,显著高于国内常模[（29．78±10．07）,U=3．23,P〈0．011;学员组间焦虑和抑郁得分比较,2006级学员得分最高,显著高于其他两个年级（均P〈0．01）;2007级与2008级学员之间无统计学差异。结论地震对规范化培训护士心理健康影响较大,启动灾难相关知识及应对的培训与教育十分必要。     

男科医生显微外科技术培训模式的探讨

目的 探索男科医生显微外科技术培训模式的量化评估方式,探讨男科医生显微外科技术培训模式。方法 选择至北京大学第三医院男科进行显微手术培训的30名学员作为研究对象。采取理论和实践教学相结合的培训模式,培训后及时进行考核,并且采取意见反馈方式来评估培训效果。结果 全部学员均掌握显微器械的正确操作方式,并熟练地掌握了基本的显微操作技巧。第一天考核的输精管-输精管吻合的成功率达93.3%,第二天补考的学员也全部通过。对于较难的输精管-附睾吻合的成功率,第一天考核成功率为83.3%,第二天补考后成功率为93.3%。参加培训的所有学员均给予了最高的满意度反馈。结论 我们采取操作培训和动物实验的分阶段考核方式,量化考核标准,以此提高显微培训水平,该男科医生显微外科技术培训模式值得推广。     

BOPPPS模型用于非医务人员心肺复苏培训的研究

目的 探讨BOPPPS模型用于非医务人员心肺复苏培训的教学效果。方法 选择2021年2月—12月中国人民解放军第三O五医院采用BOPPPS模型进行心肺复苏培训的非医务人员200例作为BOPPPS组,另选择2020年2月—12月采用传统培训模式进行心肺复苏培训的非医务人员52例作为非BOPPPS组。对比两组学习效果,并评估两组受训者对心肺复苏培训的满意度。结果 BOPPPS组和非BOPPPS组心肺复苏培训合格率均达到100%。BOPPPS组心肺复苏培训后优秀率、受训者满意度均显著高于非BOPPPS组,差异有统计学意义(P<0.05)。结论 运用BOPPPS模型教学模式,可有效提升心肺复苏培训效果,提升非医务人员院前急救能力,应用价值较高,值得推广借鉴。     

智能反馈报告系统培训与传统培训在公众心肺复苏技能培训中的效果差异

目的 探讨社会公众心肺复苏（CPR）技能培训新模式,研究比较运用智能反馈报告系统培训模式与传统急救培训模式在公众CPR急救技能培训中的培训效果。方法 选取2021年—2022年在韶关市应急救护指挥中心申请要求开展CPR﹠AED急救技能培训的5 272名受训人员为研究对象,随机分为试验组和对照组,试验组（n=1 286）运用智能反馈报告系统培训模式,对照组（n=1 286）采用传统急救培训模式教学,培训结束前统一采用挪度无线技能报告系统（PC）对受训学员CPR技能主要指标进行客观考核,比较两组培训效果;两组各选择300名学员于培训后6个月和12个月进行培训合格率的比较,分析不同时间段CPR技能保留水平,探讨最佳复训时间。结果 运用智能反馈报告系统培训与传统急救培训模式培训效果（包括培训后6个月、12个月）比较,差异具有显著性意义（P<0.001）。培训后的6个月和12个月,智能反馈报告系统培训合格率更高（P<0.001）。结论 运用智能反馈报告系统培训较传统急救培训模式培训效果更好,是确保CPR技能培训质量和深受市民喜爱的培训新模式,有广泛的社会应用与推广价值。     

1例儿童大面积严重犬咬伤全麻下综合治疗分析

目的探讨全麻下对儿童大面积严重犬伤进行综合治疗的优势方法对1例6岁大面积严重犬伤患儿进行无痛模式下伤口冲洗、注射狂犬患者免疫球蛋白、清创缝合、注射狂犬病疫苗,术后予以抗炎、消肿,并进行心理干预治疗。结果术后伤口均一期愈合,心理测试良好。结论全麻下无痛原则和术后的心理干预的综合治疗在治疗儿童大面积严重犬伤的临床中值得推广。     

壳聚糖护肤液促进大鼠伤口愈合的研究

目的 探讨壳聚糖护肤液促进伤口愈合的作用。 方法 在大鼠背部伤口模型上用药,对壳聚糖护肤液组（A组）、碱性成纤维细胞生长因子组（B组）、生理氯化钠溶液组（C组）进行两两对照,肉眼观察伤口愈合时间,并于伤后3、7、14 d,取皮肤修复组织行光镜观察。结果 A组愈合时间为（17.3 ± 1.35） d,B组为（18.2 ± 1.15） d,C组为（24.0 ± 1.37） d。A组与B组的愈合时间差异无统计学意义（P > 0.05）,A组、B组与C组的愈合时间差异有统计学意义（P < 0.05）;壳聚糖护肤液在伤口愈合的早期促进毛细血管芽和血管内皮细胞生成,中期促进成纤维细胞和胶原纤维生成,后期使胶原纤维排列有序。结论 壳聚糖护肤液具有较好的促进伤口愈合的作用。     

25436例动物致伤患者的流行病学分析与诊治

目的 分析和总结25 436例动物致伤患者的致伤和流行病学特点、暴露预防处置措施,为动物致伤防治提供科学依据。方法 收集兵器工业五二一医院2018年1月—2020年12月共25 436例动物致伤患者资料,综合分析动物致伤患者人群分布特征、致伤临床特征和暴露后预防相关因素,进行对比分析。结果 23 456例动物致伤患者,年均8 493例,平均占我院急诊外科门诊的15.43%,占急诊科门诊量9.43%。其中Ⅱ级暴露2 780例（10.93%）,Ⅲ级暴露22 555例（88.67%）,首次暴露20 211例（79.46%）,再次暴露5 225例（20.54%）;接受伤口规范性外科处置17 055例（67.05%）,全部接受暴露后狂犬病疫苗接种预防,其中选择Vero(Vero细胞纯化)疫苗17148例（67.56%）,HDCV（人二倍体细胞）疫苗8 230例（32.56%）,接受狂犬病人免疫球蛋白注射10 107例（44.52%）;疫苗接种后出现不良反应共计387例,其中Vero疫苗接种后不良反应309例（0.18%）,HDCV疫苗接种后不良反应78例（0.01%）。结论 动物致伤患者是急诊外...     

仿真情景模拟教学在儿科医务人员急救知识培训中的效果分析

目的通过仿真模拟急救知识培训提升医务人员急救能力,以期进一步提高儿科急救技术能力。方法采取随机抽样法选取2019年湖南省儿童医院1456名医务人员为研究对象,实施仿真情景模拟教学法开展急救知识教学,培训前后采用自制《应急技能相关知识问卷》对培训对象儿科急救知识进行测评,利用问卷星平台设置考卷,比较培训效果,通过统计答题用时判断其培训前后急救反应能力。结果培训后不同职称、年龄、职业等特征医务人员急救知识知晓水平、答题用时明显提高,差异具有统计学意义(P<0.05),急救系统医务人员与其他系统比较优势明显,培训后知识得分达(98.36±15.04)分。结论仿真情景模拟教学对于儿科医务人员急救知识水平提升具有积极的意义,能有效提升其急救反应能力,可进一步推广实施。     

Primary prevention in health care employees: a prospective intervention study with a 3-year training period

Irritant contact dermatitis is a mayor problem in health care employees. Because educational programs have shown convincing success in certain occupations (e.g. in hairdressers), this study investigates the effect of a special training program in health care trainees. 521 trainees from 14 nursing schools in Central Germany were randomly divided in 2 groups, (i) an intervention group with a regular teaching protocol regarding all aspects of primary prevention and (ii) a control group without any further teaching. Morphological changes of the hands, use of hand care creams and knowledge regarding skin care were evaluated regularly during their 3 years lasting training period (1999-2002). In the intervention group, we found at the end of the 3-year training period a significant better skin condition of the hands than in the control group: a 3-year prevalence of morphological skin changes of 66.7% versus 89.3%. The unteached trainees (control group) had an odds ratio (OR) of 4.8 [95% confidential interval (CI): 2.9-7.8] for developing any skin changes on the hands after 3 years. Besides the effect of the teaching, the history of hand dermatitis before the study start was an independent risk factor for development of further hand dermatitis [OR 1.9, 95% CI: 1.0-3.6). Age and sex showed no influence on the skin condition. Atopic constitution had an influence on the development of skin changes only at the evaluation after 18 month. The observed effect in the intervention group may best be explained by different behaviour of the trainees, e.g. the amount of hand washing was reduced, while procedure of hand disinfection remained unchanged compared with the control group. However, the amount of used skin care cream did not differ between the both groups. This study shows that primary prevention of skin disease by regularly teaching during the training period of medical employees can effectively reduce the risk of development of irritant skin changes of the hands. Therefore, teaching and continuous motivation regarding preventive individual and collective measures during the training of medical staff should be an obliged part of the curriculum.     

基于梅毒核酸疫苗pcD/Tp92的不同接种策略

目的 评估基于梅毒核酸疫苗pcD/Tp92的各接种优化策略对新西兰兔梅毒螺旋体(Tp)皮肤感染的免疫保护效应.方法 核酸疫苗pcD/Tp92采用2次肌内注射免疫或肌内注射初免鼻饲加强的免疫方式结合黏膜佐剂CpG ODN及Tp92重组蛋白,分别或联合免疫新西兰兔.酶联免疫吸附法(ELISA)检测各接种策略组免疫期间(0~8周)兔特异性抗体产生及变化水平,免疫8周后兔鼻咽部、阴道黏膜SIgA产生水平及兔脾细胞IL-2、γ干扰素(IFN-γ)诱导水平,噻唑蓝法(MTT)检测兔脾淋巴细胞增殖水平.记录各组在初次免疫后第10周兔皮下接种Tp标准株感染后接种部位感染早期皮损的变化.结果 采用pcD/Tp92核酸疫苗肌内注射初免,CpG-ODN联合Tp92重组蛋白抗原鼻饲新西兰兔加强免疫的接种策略组(C2组)分别与pcD/Tp92疫苗肌注组(A2组),pcD/Tp92疫苗肌注初免,pcD/Tp92鼻饲加强免疫组(B1组)或结合黏膜佐剂CpG ODN联合免疫的接种策略组(B2组)相比,既能促进pcD/Tp92核酸疫苗在兔体内免疫期间(8周)诱生更高特异性抗体水平(C2组:1.825±0.175;A2组:1.372±0.322;B1组:0.893±0.297;B2组:1.294±0.124;P<0.05),IL-2(C2组:154.7±14.6;A2组:112.3±13.4;B1组:76.6±21.5;B2组:97.3±18.7;P<0.05)及IFN-γ(C2组:277.4±24.4;A2组:232.8±25.3;B1组:165.7±22.6;B2组:211.3±24.6;P<0.05)分泌水平,以及更高的T细胞增殖分化水平(SI C2组:3.57±0.24;A2组:3.08±0.22;B1组:2.12±0.14;B2组:2.88±0.18;P<0.05),还能刺激更高的黏膜特异性SIgA抗体,导致最低Tp感染部位皮损Tp阳性率(6.67%)及溃疡病灶形成率(6.67%)从而达到有效的保护作用.结论 pcD/Tp92核酸疫苗肌内注射初免,CpG ODN联合Tp92重组蛋白鼻饲加强免疫的接种策略能在新西兰兔体内诱导最强的黏膜免疫和免疫保护效应.     

Assessing the assessments: U.K. dermatology trainees' views of the workplace assessment tools

Background  The workplace assessments, direct observation of procedural skills (DOPS), mini-clinical evaluation exercise (mini-CEX) and multisource feedback (MSF, formerly known as 360° appraisal), are now mandatory during dermatology specialist training in the U.K. The opinions of those undergoing such assessments in any medical specialty have rarely been sought.
Objectives  To collate the experience and views of U.K. dermatology trainees on the three workplace assessments.
Method  A questionnaire was circulated in autumn 2006 to all U.K. dermatology specialist registrars (SpRs) registered as members of the British Association of Dermatologists ( n  =   269).
Results  A total of 138 responses were received (51%). Seventeen SpRs had not experienced any of the assessments; 92 had undergone MSF, 95 DOPS and 54 mini-CEX. The total experience of the respondents amounted to a minimum of 251 DOPS, 122 MSF and 142 mini-CEX. Trainees appreciated the formative aspects of the assessments, especially feedback and training opportunities, although not all trainees reported receiving useful feedback. MSF was praised for the insights that it provides. All of the assessments were found to be time-consuming and difficult to organize. DOPS and mini-CEX carried a degree of stress and artificiality. Concerns were raised over the possibility of victimization by MSF raters. Discussion of performance in the assessments was rarely prominent in trainees' annual summative reviews.
Conclusions  Trainees appreciate the formative benefits which derive from the assessments, namely feedback, reassurance of satisfactory performance and, in the case of DOPS and mini-CEX, additional one-to-one training from consultants. Some problems came to light. The issues raised will not be unique to dermatology and other specialties should take note.     

Benefits of simulation using standardized patients for training dermatology residents in breaking bad news

IntroductionSimulation in healthcare is a rapidly developing teaching method in the training of technical procedures. It is also used to enable caregivers to learn how to inform patients of serious illness and complex health status. However, its use is not widespread in the field of dermatology. This study investigated the utility of simulation as regards disclosing melanoma diagnosis, taking resident physician satisfaction as a primary endpoint.Materials and methodsFifteen dermatology residents were recruited as trainees. Four scenarios were allocated based on length of residency. An introductory briefing was held prior to the training sessions. Debriefing took place on completion of the diagnosis disclosure consultation. The participants completed questionnaires after the simulation session, after debriefing, and 3 months after the simulation session. The primary endpoint was usefulness of the session felt by trainees several months after the simulation.ResultsThe majority of participants (93.3%) thought the session helped with stress management, improved their attitude and control over their reaction (86.6%), and improved their communication skills (100%). They rated the usefulness of the simulation at 7.79/10 on average (range: 5–10).DiscussionAccording to our findings the resident physicians involved, particularly those with the least experience, were satisfied with this type of learning technique. Any difficulties encountered by these residents were brought to light and addressed during debriefing.ConclusionThere would appear to be real benefits to be reaped from simulation, whatever the stage of medical training at which it takes place. Simulation should become an increasingly important part of contemporary pregraduate specialty programs.     

智能反馈装置对心肺复苏培训近期和远期效果的影响

目的探讨应用智能反馈装置对心肺复苏培训效果和远期技能保持的影响。方法研究共纳入142名研究对象,完成2015 AHA指南的单人成人心肺复苏指南的培训。培训完成后所有参与者随机分为反馈组和对照组。分组完成后在BLS导师指导下再进行CPR练习,对照组导师主要指导参与者提高CPR质量,反馈组导师除指导参与者提高CPR质量外,还要向参与者讲解反馈装置的使用,直至熟练操作。在完成操作练习后和1个月后组织所有参与者进行无反馈CPR考核。心肺复苏培训质量是通过心肺复苏的正确率平均按压深度、频率、胸廓回弹,按压指数和有效通气来定量。结果142名研究对象均完成此实验。反馈组的CPR培训质量高于对照组,差异有统计学意义(P<0.05);1个月后反馈组CPR质量较培训即刻后无显著下降,而对照组则有显著下降。结论智能反馈装置有助于提升心肺复苏培训质量和心肺复苏技能的保持。     

突发中毒事件卫生应急培训需求分析

目的对2011年～2012年国家卫生计生委在全国范围内开展的突发中毒事件卫生应急培训进行需求分析。方法培训学员在培训完毕后填写调查问卷。从培训资源评价、培训效果自我评价、培训建议等三方面对问卷内容进行统计分析。结果四川区域、浙江区域、河北区域培训班共培训来自25省（区、市）,覆盖了全国7个地区的省级和重点地市卫生应急管理人员和从事中毒临床救治、流行病调查处置、采样检测的业务骨干。在中级及以下职称学员中,不同地区学员在讲授内容满意度评价和收获大小评价上,差异均具有统计学意义,P〈0．05;在118条关于培训形式的建议中,有56．72％的人员建议分不同专业、有针对性的培训。结论建议今后的突发中毒事件卫生应急培训因地制宜,培训方式多样化,针对临床、检测和流行病学调查专业的人员分类培训。     

Confidence of pediatric trainees in dermatologic conditions,preferred learning styles,and suggested improvements to training

Dermatological conditions in children often present initially to general pediatricians. Senior pediatric trainees in the UK were surveyed regarding their experience and confidence in diagnosis and management with skin conditions, and their satisfaction with postgraduate training. Confidence was reasonable in common conditions but lower for emergencies, reflecting a lack of exposure, and satisfaction with training was low. On the job learning and clinic attendance were felt to be most beneficial, alongside learning from specialist review, however dermatologists were not found to be accessible. Informal learning methods are key within postgraduate education and educators must maximise learning opportunities. Dermatologists can play a vital role by encouraging trainees to learn from feedback following specialist review.     

The relationship between neutrophils and incisional wound healing

The systemic administration of granulocyte-macrophage colony-stimulating factor (GM-CSF) is used clinically to increase circulating neutrophils, but its wound healing effects after intraperitoneal treatment have not been studied yet. We planned to investigate the effect of neutrophils on wound healing under cyclophosphamide and GM-CSF treatment. Forty rats were divided into three groups: control group (group I, n = 12) receiving saline, group II (n = 14) receiving cyclophosphamide and group III (n = 14) receiving GM- CSF. The rats in all groups underwent incisional wounding and were euthanized after 7 days. Blood neutrophil counts and functions, tensile strengths and the hydroxyproline level of skin were determined, and a histopathological evaluation of healing was made. Neutrophil counts and phagocytosis significantly increased in group III and decreased in group II. Although the skin hydroxyproline level did not differ, there was a difference in tensile strength of the wounded skin between group II and group III. The wound score in group II was lower than that in groups III and I. As a result we suggest that systemically given GM-CSF - by increasing the neutrophil count and neutrophil phagocytosis index - can enhance the tensile strength of surgical incisions.