不同教学方法在超声医学示教过程中的应用

为了更好地适应现代医学教育的发展,各医学院校对于影像学专业超声医学示教方法进行了较大调整,结合超声医学教学的特殊性,着重于实践,激发学生学习兴趣,培养医学生实践能力。本文总结了近年来不同教学方法在超声医学示教过程中的应用进展,旨在探讨如何改进教学手段,提高教学质量。     

示教反示教系统在《临床护理实践技能》课程中的应用

近年来,由于护理专业招生人数的不断增加,各大高校护理师资、实验设备和实验场所都面临着巨大的挑战,传统的教学手段和教学环境显然已经不能满足这些变化的需要,如何将多媒体资源有效运用于高校护理实训教学中已成为当务之急。     

改进超声教学方法的初步体会

随着超声诊断新技术的不断出现和诊断仪器的迅速发展、普及,超声诊断已成为医学影像诊断的重要组成部分,受到临床广泛的应用。了解其诊断原理,掌握适应证是对一个临床医学生的基本要求。超声教学课时在增加,改进超声教学方法,提高教学质量势在必行,我们在几年超声诊断教学中进行了一些尝试,收到了良好的效果。1应用计算机多媒体辅助教学以往的超声教学主要是通过老师讲授,板书、挂图或绘图的方式来完成。超声诊断学本身是一门形态学科,需要从观察图像来认识病变,它强调直观形象、真实具体,如果教学手段上仍沿用以往的方式,就有很大的局限性,…     

对比示教法在护生操作示教中的应用

[目的]观察对比示教法在护生实习过程中对护生操作水平的影响以及护生对这一示教方法的看法。[方法]将60名实习护生以实习小组为单位,采用抽签的方法随机分为观察组和对照组,每组30名,挑选测量生命体征为示教与考察项目,对照组采用传统的教师示教方法,观察组采用对比示教法,对比两组护生出科考试成绩,并访谈护生对对比示教方法的感受与体会。[结果]观察组护生出科操作考试成绩高于对照组(P0.05);观察组护生在体会报告中对比示教方法表示肯定。[结论]对比示教法可提高护生操作水平,并且受到护生欢迎。     

多普勒超声在肝癌诊断中的应用进展

现代影像技术(如ＣＴ、ＭＲ、ＵＳ)的发展,使肝脏局限性占位病变的检出率,特别对小于3.0ｃｍ的占位病变的检出率有了很大提高[1]。现代超声仪可检出肝内0.5～1.0ｃｍ的占位病变。但对这些局限性占位病变的定性诊断,如对早期肝癌(ｈｅｐａｔｏｃｅｌｌｕｌａｒｃａｒｃｉｎ...     

超声造影在卵巢肿瘤中的应用进展

超声检查是卵巢肿瘤的首选手段。在卵巢肿瘤的超声诊断中,最有效的方法是探查营养肿瘤的血管,血管变化往往早于肿瘤本身被发现。超声造影因在探查肿瘤微血管灌注方面的优势受到了研究者的重视,为早期诊断卵巢恶性肿瘤提供了新思路。     

超声新技术在甲状腺结节诊断中的应用进展

随着超声检查仪的不断改进和探头分辨力的提高,体检和临床发现的无症状甲状腺结节患者不断增加.临床调查显示,4.0%~8.0%的成年人触诊可发现甲状腺结节,而超声检查发现甲状腺结节者约40%~50%,其中5.0%~6.5%的结节在当时或以后的随访中证实为恶性[1-3].     

超声检查在急诊医学中的应用价值

随着超声诊断技术广泛用于临床,促进了急诊超声医学的进展,使很多急性疾病和意外创伤患者在最短的时间内得到及时的诊断和有效的救治。现将我院2004年元月至2005年10月间急诊B超检查并经临床证实的66例分析报告如下。     

超声检查在肛瘘诊断中的应用进展

肛瘘是最常见的肛周疾病之一,但因其发病率高、手术失败率高及一次手术治愈率低而成为临床诊治的难点。随着超声检查技术的应用,在一定程度上提高了对肛瘘的定性诊断能力。本文就各种超声检查技术在肛瘘诊断中的应用价值进行综述。     

超声空化在医学中的应用

超声空化作为一种新型技术在医学中的应用越来越广泛，其在医学中的作用也越来越被人们所重视。本文主要介绍了超声空化在几种医疗技术中的应用，并对其在医学中的发展进行了预测。     

以问题为导向的教学方法在影像专业实习带教中的应用价值探讨

以问题为导向的教学方法(problem-based learning,PBL)通过创设真实的问题情境,锻炼学生自主学习与解决问题的能力,目前已在各学科教学中得到广泛应用,获得一致肯定.该教学方法能够激发学生学习兴趣,培养医学生良好的学习习惯和能力.但是在超声专业PBL教学中也存在一些问题,缺乏典型的超声影像资料是主要问题之一.针对这一问题,我们开发了一套简单、方便的超声影像数据库收集与自动归类系统,并将之应用到以临床思维为导向的影像系实习医生PBL教学中,获得了一定的经验与体会.     

超声诊断学实习教学面临的几点问题与应对措施

针对超声诊断学实习教学面临的问题,提出相关的应对措施。教学医院超声诊断实习教学内容多而实习时间短、带教模式特殊、且临床与教学工作矛盾突出。专人负责,合理安排,强化基本功,注重诊断思维锻炼,课内与课外结合、操作与图像分析结合,有助于解决以上问题。     

A proposed new clinical assessment framework for diagnostic medical ultrasound students

Current financial pressures within higher education institutions (HEIs) are driving new ways of delivering education and assessment. New technological developments are facilitating opportunities to rethink traditional educational methods and explore more innovative, effective approaches. Set against a background of increasing pressures to integrate technology to enhance learning, both in higher education and the NHS, education is moving towards greater integration of technology. Ultrasound education is an area which is currently being reviewed in many HEIs, as these programmes are expensive to administer for the relatively low numbers of students involved. Within ultrasound education, rigorous assessment of clinical competence is an area which is particularly expensive to undertake, and methods used in many training programmes are potentially unsustainable for HEIs in the current economic climate. In addition, clinical assessment methods used are often criticised for the difficulties encountered in trying to exclude subjectivity from the process, and ensure equity across all assessments. A new framework is therefore proposed, which has recently been accredited within a HEI ultrasound training programme by the Consortium for the Accreditation of Sonographic Education (CASE), and has been piloted during 2013. One of the components of this approach is the incorporation of an ultrasound simulator, which will help to standardise assessments and ensure students are assessed over a range of pathologies, rather than only those randomly presenting on the day of assessment. This paper discusses details of the newly accredited assessment process.     

用循证医学思想指导超声诊断学实习教学

循证医学是一种新的医学教育模式。本文探讨在超声诊断学实习教学中,引入循证医学的理念、原则和方法,培养学生的临床思维,帮助学生掌握自我更新医学知识和临床技能的方法和技巧。     

阴道超声联合腹部B超对宫外孕的诊断价值分析

目的:分析阴道超声联合腹部B超对宫外孕的诊断价值。方法:选择本院收治的宫外孕患者68例,收治时间2018年3月至2019年3月,将全部患者分为对照组与观察组(各34例),对照组患者实施阴道超声检查,观察组患者实施阴道超声联合腹部B超检查。对比两组患者宫外孕检查率;对比两组患者诊断情况。结果:观察组患者宫外孕确诊率为97.06%,对照组患者宫外孕确诊率为82.35%,观察组患者宫外孕确诊率显著高于对照组患者(P<0.05);观察组患者疾病检出率及包块检出率均高于对照组患者,误诊率低于对照组患者(P<0.05)。结论:阴道超声联合腹部B超对宫外孕的诊断价值更为显著,利于提高宫外孕确诊率,降低误诊率。     

超声模拟人在超声专业住院医师规范化培训中的应用

应用超声模拟人技能操作训练系统对超声专业住院医师进行规范化培训,内容包括检查前准备训练、仪器操作训练、标准切面训练、典型病例训练及人文关怀训练,超声模拟人技能操作训练系统作为一种新的教学工具,能改进并丰富住院医师规范化培训超声教学的方法,提高培训质量。     

A test of the hypothesis that diagnostic ultrasound disrupts myelination in neonatal rats

Neonatal rats were exposed or sham exposed for 30 min to pulsed ultrasound [2.25 MHz carrier frequency, 1 μs pulse length, 50 Hz pulse repetition frequency (PRF), 50 W/cm²I_max, 2 mW/cm² I_TA], euthanised and prepared for electron microscopic analysis of the nodes of Ranvier of the dorsal and ventral roots of the spinal cord. There was also a cage control. All materials were processed and scored blindly, evaluating whether perinodal myelin was normal. Rats from all regimens had areas of disrupted myelination. There was no statistically significant difference among the regimens for absence of myelination. The results did not confirm an earlier report that diagnostic ultrasound disrupts myelination in neonatal rats.     

The potential for enhancement of mouse melanoma metastasis by diagnostic and high-amplitude ultrasound

The potential for enhancement of the metastatic spread of cells from mouse melanoma tumors was examined for exposure to diagnostic ultrasound (DUS) and high-amplitude ultrasound (HAUS) without and with ultrasound (US) contrast agent. The melanoma cell line B16-D5, which is metastatic specifically to lung, was cultured and implanted on a hind leg of female C57/bl6 mice. For DUS, tumors were scanned using 1.5-MHz harmonic B-mode imaging with 1-Hz intermittent frame triggering at 2.1 MPa (equivalent MI = 1.7) in a 37 degrees C water bath. For HAUS, a 1.35-MHz focused transducer directed 1-ms bursts at 5 MPa to the tumor at a 1-Hz rate. A total dose of 1 mL/kg Optison was injected during exposures. Exposure without contrast agent received the same exposure followed by the contrast agent with the US off. The primary tumor was removed surgically one day after US. Lungs were removed after four weeks for evaluation of metastases. Experiments involved exposure without and with contrast agent in groups of 20 mice. For DUS, mean counts of 0.8 +/- 0.3 (standard error) and 1.3 +/- 0.9 (P = 0.62) metastases were found for groups exposed without and with contrast, respectively. For HAUS, mean counts of 3.4 +/- 1.2 and 5.9 +/- 1.7 (P = 0.35) metastases were found for groups exposed without and with contrast, respectively. The lack of effect of DUS exposure with contrast confirms a previous finding. However, the HAUS counts and incidence were significantly larger than the DUS results (P < 0.05) in a two-way analysis of variance. This indicates a potential for HAUS to enhance metastasis.     

教学督导会诊在超声医学科住院医师规范化培训中的应用

目的总结住院医师规范化培训阶段的会诊需求概况,评价教学督导会诊在住院医师规范化培训阶段的作用。 方法回顾性收集2015年8月至2017年8月间于北京协和医院超声医学科参加北京市住院医师规范化培训的住院医师43名及其于2017年11月至2018年8月申请教学督导会诊的病例,随访申请教学督导会诊的病例,总结会诊原因和部位,参照病理或临床诊断,对会诊医师作出教学评价（技术操作、定位、定性）。采用χ²检验比较不同年资、不同学历住院医师申请会诊原因和部位的差异,并采用t检验比较应用教学督导会诊前、后3年以下住院医师客观结构化临床考试（OSCE）阶段考核平均成绩的差异。 结果43名住院医师共随访1727份会诊病例。第一、二、三年住院医师申请会诊次数占比分别为53.0%（915/1727）、42.9%（741/1727）、4.1%（71/1727）。住院医师申请会诊原因：定性70.9%（1224/1727）、技术操作22.7%（392/1727）、定位6.4%（111/1727）。第一、二、三年住院医师因技术操作原因申请会诊比例分别为26.9%（246/915）、18.6%（138/741）、11.3%（8/71）;因定位原因申请会诊比例分别为7.8%（71/915）、4.5%（33/741）、9.8%（7/71）;因定性原因申请会诊比例分别为65.3%（598/915）、76.9%（570/741）、78.9%（56/71）,不同年资住院医师申请会诊的原因不同,差异具有统计学意义（χ²=33.293,P＜0.001）。申请会诊的检查部位前三位为妇科27.9%（482/1727）、浅表器官23.3%（402/1727）和腹部20.1%（347/1727）,共占71.3%,不同年资住院医师申请会诊的部位不同,差异具有统计学意义（χ²=167.583,P＜0.001）。第一、二年住院医师申请会诊主要为腹盆腔脏器技术操作和定性,第三年住院医师申请会诊集中在浅表器官病变的定性。不同学历住院医师申请会诊部位分布不同,差异具有统计学意义（χ²=64.942,P＜0.001）,申请会诊原因分布差异无统计学意义（χ²=8.131,P=0.087）,平均申请会诊次数相近。97.7%（383/392）的技术操作问题通过教学督导会诊得到解决;教学督导会诊定位正确率73.0%（81/111）;定性正确率92.7%（1135/1224）。应用教学督导会诊后的住院医师OSCE成绩高于应用前［（85.7±6.6）分vs（75.7±7.5）分］,差异具有统计学意义（t=-2.426,P=0.036）。 结论随着住院医师年资增加,申请会诊次数减少。不同年资住院医师申请会诊的部位和原因不同。住院医师因技术操作原因申请会诊次数逐年下降,定性需求逐年增加。教学督导会诊能有效帮助住院医师解决技术操作难点、定位和定性,提升住院医师临床胜任力。     

Diagnostic value of different color ultrasound diagnostic method in endometrial lesions

BACKGROUNDEndometrial lesions include endometrial cancer and inferior fibroids. Among them, endometrial cancer as a malignant tumor seriously endangers the life and health of patients. Ultrasonography is an important means of diagnosing female reproductive system diseases, and it is of critical value for the early diagnosis of endometrial cancer. However, different ultrasound inspection programs have achieved different results. It is of great significance to choose a suitable inspection program.AIMTo explore the diagnostic efficacy of different ultrasonic examination methods in clinical endometrial lesions.METHODSThe 140 patients with endometrial lesions who were treated in our hospital from April 2018 to October 2019 were used as the research subjects. All patients underwent transvaginal color ultrasound and transabdominal color ultrasound. We compared the diagnostic coincidence and image display effects of the two different examination methods, and the endometrial thickness, blood flow, uterine effusion and resistance index of different diseases were observed by transvaginal color ultrasound.RESULTSThe diagnostic coincidence rate of all types of diseases of transvaginal color ultrasound was significantly higher than that of transabdominal color ultrasound (P = 0.001, 0.005, 0.001 and 0.001). In addition, the excellent and good rate of image display of transvaginal color ultrasound was higher than that of transabdominal color ultrasound (P = 0.001). There were significant differences in endometrial thickness in patients with different types of endometrial lesions through the transvaginal color examination (P = 0.001). The incidence rate of uterine effusion in patients with endometrial carcinoma was significantly higher than that in patients with other types of endometrial lesions (P = 0.001), and the rate of the blood flow was the highest (P = 0.001). The comparison of blood flow resistance index indicated that the blood flow resistance index in endometrial cancer patients was the lowest, which shows that the difference was statistically significant (P = 0.001).CONCLUSIONThe overall diagnostic efficacy of transvaginal color ultrasound in the clinical diagnosis of endometrial lesions is better than that of transabdominal color ultrasound, which held higher diagnostic coincidence rate and image display effect. There were significant differences in the thickness of the endometrium and the blood flow in different types of lesions.