基层全科医生集中培训糖尿病知识存在的问题及影响因素分析

目的了解基层全科医生集中培训糖尿病知识存在的问题,探索有效的培训方式。方法选取2017年1月北京市平谷区平谷镇、大华山镇等13个社区参加的由首都医科大学附属北京友谊医院平谷医院内分泌科举办的1次2学时《2013年版中国2型糖尿病防治指南》集中培训活动基层全科医生129名。根据培训内容设计糖尿病防治指南知识测试题,制定题干相同但答案顺序不同的试卷A(培训前)和试卷B(培训后),在培训前后对参训医生进行测试。采用配对t检验、成组t检验或单因素方差分析2次测试的错题数或错题变化量,了解培训效果及存在问题,采用多因素方差分析培训效果的影响因素。结果 129名医生参加培训,收回127名医生的有效试卷193份,其中66名同时完成A、B卷,46名只完成A卷,15名只完成B卷。112份A卷错题数(7.97±3.86),81份B卷错题数(4.68±3.17),错题数明显减少(t=6.30,P0.01)。66名同时完成A、B卷,A卷错题数(8.03±4.04),B卷错题数(4.45±3.21)(t=8.68,P0.01),培训前后变化明显,其中女性错题数减少明显。说明1次集中培训对基层医生糖尿病知识水平的提高有帮助。分析错题数的影响因素,结果发现,非临床专业、职称偏低人员培训后错题数明显减少,非临床专业人员培训效果更好。结论基层全科医生集中培训糖尿病知识总体上有效果,但缺乏足够重视,不能全程参加培训。需探索其他培训形式或根据基层全科医生的不同特点制定个性化培训方案,尤其对非临床专业和职称偏低人员进行重点培训。     

临床实践技能培训在预防医学生诊断学教学中的作用

目的分析和讨论将临床实践技能培训应用于预防医学生诊断学教学的作用。方法在我校预防医学系2015级中随机选取94名学生进行抽签分组,分成了各47例的A组和B组。其中A组在诊断教学中加强临床实践技能培训,而B组在诊断教学中采用传统的授课方式,最后对94名学生进行毕业技能成绩考核和诊断学成绩考核,比较两组学生的成绩结果,对教学成绩进行评估;并对两组学生进行问卷调查,统计授课方式对课堂情况的影响情况。结果根据调查结果显示,A组的诊断学教学方式的应用在增加专业兴趣等方面均优于B组(P0.05);并且A组学生的毕业技能考核成绩和诊断学考核成绩在80分以上的比例明显高于B组(P0.05)。结论临床实践技能培训教学方式是诊断学课程的重点内容,可以作为教学的基础,可以增加学生实际操作能力,不仅提升了教学的质量水平,而且有利于学生以后在医疗工作中有突出表现。     

阶梯式教学法在实习护士培训考核中的应用与效果评价

目的探析阶梯式教学法在实习护士培训考核中的应用与效果评价。方法选取2018年7月-2019年4月在我院实习的60名护士作为主要对象,采用数字随机表法分组,各30名。对照组采用传统方法进行考核培训,观察组采用阶梯式教学法进行考核培训,对两组实习护士的考核成绩、自我评价及实习护士满意度等进行对比。结果观察组实习护士的基础理论成绩、案例分析成绩和实践操作成绩明显高于对照组,有显著差异;观察组实习护士的专业知识掌握程度、操作技能熟悉程度、护患沟通能力、理论与实践结合能力均高于对照组,有显著差异;患者对观察组实习护士护理工作的满意度显著高于对照组,有显著差异。结论在实习护士护理培训考核中应用阶梯式教学法可提高实习护士的各项成绩,实习护生的自我评价更高,可激发实习护士的积极性和主动性,值得推广应用。     

表象训练在虚拟现实内镜模拟器培训胃镜初学者中的应用

目的:探讨表象训练在胃镜技能获得中的作用.方法:分层抽样法抽取我校08级临床医学专业男学员30人,随机分为3组.A组(n=10)在常规模拟器练习过程中加入表象训练,B组(n=10)进行常规模拟器练习,C组(n=10)不做任何练习.完成培训结束时所有学员操作病例1,模拟器给出的评分,比较3组间的考核评分.所有学员接受培训前、后心理测评,评价心理状态是否稳定.结果:比较3组考核成绩显示,3组间总分差异有统计学意义,3组组间两两比较显示差异有统计学意义,其中A组优于B组,A组优于C组,B组优于C组.进一步分析差异原因,结果表明,安全性评分和准确性评分、残气量评分、患者痛苦指数评分、操作时间评分A、B、C3组间差异均有统计学意义;而A、B组两组之间比较,只有残气量评分、操作时间评分差异有统计学意义.结论:表象训练可提高使用虚拟现实内镜模拟器培训胃镜技能的效果,教学方法容易实施,学员容易掌握,是一种可行性较高的教学辅助方法.     

PBL教学模式在儿科住院医师规范化培训教学中的应用

目的探讨PBL教学模式在儿科住院医师规范化培训教学中的应用及效果。方法选择2018年1～10月在我院进行规范化培训的儿科住院医师46名,采用随机数字法分为两组,每组23名。对照组规培医生采用传统教学模式规培,观察组规培医生采用PBL教学模式规培,比较两组规培医生的临床能力、考核成绩及他们对教学的满意度。结果儿科轮转结束出科时,观察组规培医生的职业道德、医疗安全、评判性思维能力、沟通协作能力评分均高于对照组,理论考核、操作考核、书写病历考核得分均显著高于对照组,对教学的满意度(95.65%)显著高于对照组(65.22%),差异有统计学意义(P0.05)。结论应用PBL教学模式对儿科住院医师进行规范化培训教学,可有效提高规培医师的临床能力及考核成绩,提高规培医师对教学的满意度,促使规培医师尽快胜任临床儿科工作。     

内镜仿真模拟系统用于内镜医师初学者胃镜培训的研究

目的评价内镜仿真模拟系统用于内镜医师初学者胃镜培训的可行性。方法将胃镜初学者分为2组,A组4名学员,接受内镜仿真模拟系统培训,B组4名学员,接受传统的内镜培训。培训结束后,比较2组学员在最初10名查体者胃镜检查中的独立完成率、辅助完成率和不能完成率。结果2组在性别、年龄、学历以及工作年限上差异无统计学意义。模拟系统培训组的独立完成检查率以及辅助完成检查率显著高于传统组,而不能完成检查率明显低于传统组。结论内镜仿真模拟系统可用于胃镜培训,减少学习弯路,降低学习费用,值得推广。     

吉林省城市社区老年人急救自救能力需求

目的了解吉林省城市社区老年人急救自救能力需求现状。方法随机选取吉林省城市社区300名老年人进行问卷调查,内容包括常见急危重病症和意外伤害的急救自救知识和服务需求。老年人自救急救服务需求率采用因子分析方法进行分析,影响因素采用有序结果的累积优势Logistic回归分析。结果仅14%接受过急救自救培训;家庭常见病急救、危重病急救、常见外伤急救和家庭意外急救的自救急救需求率分别为81.8%、62.5%、66.7%、60.0%。对急救自救知识的总体需求率为62.9%;社区老人急救自救服务需求率受到性别(OR=0.436,95%CI:0.197～0.965)、年龄(OR=0.431,95%CI:0.197～0.965)和独居(OR=2.775,95%CI:1.225～6.285)的影响。结论城市社区老人急救自救能力培训需求强烈,目前急救自救培训率低,应制定有针对性的急救自救能力培训方案,提高城市社区老人急救自救能力,挽救生命。     

心肺复苏技能培训效果在心脏病患者家属与一般人群间的比较

目的:比较在社区居民不同对象进行心肺复苏技能培训的效果。方法:将心力衰竭(心衰)患者亲属作为亲属组,与一般人群组成的普通组(对照组)进行比较,两组人群经过同样培训后,进行相同的知识、技能考核,利用知识问卷分数、技能操作分数、生命体征判断正确率、心肺复苏操作准确率等观察指标进行培训效果评价。结果:亲属组各项指标均显著高于普通组(均P0.05)。结论:在社区人群急救培训中,组织者只有针对特定人群进行特定内容的教育与培训,才能达到应有的效果。     

颅内动脉瘤介入治疗的多模式阶段培训结果调查

目的评估颅内动脉瘤血管内介入治疗多模式阶段培训的效果。方法 2014年9月至2016年3月,首都医科大学宣武医院神经外科共接收26名针对出血性脑血管病培训的进修医师,学员均来自于全国三甲以上医院的神经外科。在为期1年的四阶段临床培训过程中,采用多模式教学方式,在基础理论、操作技能、专题讲座、继续教育及科研论文写作等方面,加强进修医师相关的理论和技能学习。进修医师培训结束即进行统一的笔试和技能考核,以百分制计分,≥85分为优秀。在培训结束学员返回原单位工作12个月后,以问卷形式,对26名进修医师介入治疗技能进行回访调查。结果 26名学员均顺利通过结业考核,其中22名(84.6%)学员成绩优秀。在培训后的12个月内,学员均能熟练的独立完成脑血管造影诊断操作,16名(61.5%)学员能够独立完成动脉瘤的栓塞治疗,25名学员(96.2%)能够进行围手术期的相关处理。结论在颅内动脉瘤介入治疗培训方面,多模式阶段培训取得良好的效果,进修医师的理论基础和实际操作能力显著进步,但训练模式仍需进一步完善。     

2017年江苏省重要寄生虫病防控技术培训效果分析

目的 评估2017年江苏省重要寄生虫病防控技术培训对于提升基层专业技术人员寄生虫病防控意识及检测水平的效果。方法 采用理论授课和实践操作相结合的方式对从事寄生虫病防治的基层专业技术人员进行培训,培训结束后分别对学员进行理论和镜检技能考核。结果 共有13个市132名学员参加了培训,无学员缺考。总成绩平均分为118.36分,苏北、苏中和苏南地区学员总考核成绩间差异有统计学意义（[χ2]=13.38,P < 0.01）,苏北地区学员成绩显著高于苏中（P < 0.001）和苏南地区（P = 0.016）。理论考核平均分为79.05分,及格率为92.4%;苏北、苏中、苏南地区学员理论考核成绩间差异有统计学意义（[χ2]= 14.51,P < 0.01）,苏北地区学员成绩显著高于苏中（P < 0.001）和苏南地区（P = 0.009）。镜检考核平均分为39.32分,及格率为89.4%;苏北、苏中、苏南地区学员镜检考核成绩间差异无统计学意义（F = 2.37,P = 0.09）。7种寄生虫虫卵检出率间差异有统计学意义（[χ2]= 31.23,P < 0.01）;其中卫氏并殖吸虫卵检出率最高,为75%;血吸虫和布氏姜片吸虫虫卵检出率较低,分别为51.5%和54.5%;鞭虫、未受精蛔虫、华支睾吸虫和带绦虫虫卵检出率分别为71.2%、65.9%、72.7%、72.0%。结论 专业技术培训提升了江苏省基层专业技术人员对于重要寄生虫病的防控意识及病原学检测水平,为下一步开展重点寄生虫病防控工作提供了技术保障。     

Non-resuscitative first aid training and assessment for junior secondary school students: A pre-post study

School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11–13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students’ role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student''s age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.     

Effects of exercise training in the elderly on the occurrence and time to onset of cardiovascular diagnoses

To examine the long-term effects of aerobic exercise on the occurrence and time to onset of cardiovascular diagnoses, 184 initially healthy older subjects were randomized into either a long-term exercise group (Group A, n = 80), a short-term exercise group (Group B, n = 42), or a contract control group (Group C, n = 62). After completion of two years in the study, data on new cardiovascular diagnoses and time to onset of these diagnoses in each of the three groups were compared. The occurrence rates for new onset diagnoses were as follows: Group A, 2.5%; Group B, 2%; and Group C, 13%; the average time to onset was greatest for the long-term exercisers and shortest for the contact control group (P less than or equal to .02). The results suggest that a regular program of exercise may have cardiovascular benefits for those over 60 years of age.     

急性左心衰患者50例院前急救临床分析

目的探讨急性左心衰患者院前急救的临床效果。方法回顾性分析98例急性左心衰患者的临床资料,其中院前急救组（A组）50例,自行来院就诊患者为对照组（B组）48例,对两组有效救治的时间、治疗效果及病死率进行比较。结果A组从发病到救治的时间显著早于B组[（10．52±2．11）min比（45．23±5．23）min．P〈0．05]。A组治疗1h后有效率优于B组,差异有统计学意义（96％比79％,P〈0．05）。A组24h内病死率明显低于B组的,差异有统计学意义（2．16％比4．52％,P〈0．05）。结论院前急救可较早改善急性左心衰患者的临床症状,阻止病情恶化,降低病死率。     

Comparison of medical ethical competencies of pregraduate third and sixth year students during their internal medical hospital rotations

PURPOSE: The study looks for medical students ethical understanding during their internal medicine hospital rotations. As a secondary purpose, the study screens if internal medicine ward provides an environment appropriate for pregraduate medical students ethical training. METHOD: Retrospective analysis and comparison of logbook writings from 2 different pregraduate groups of students : Group A = 29, third year medical students and Group B = 28, sixth year medical students, (that is last year pre-graduation).The task instructions were the same for the two groups : to identify and to analyse an ethical problem personally witnessed on the ward and to propose a solution either local or personal. Cognitive semantic units (CSU) were first drawn from the writings then subsequently analysed through two grids 1* according to fundamental principles (P) and 2* according to professional responsibilities (R). RESULTS: Students from group A produced a mean of 13,7 CSU per writing (total of 396 CSU) and those from Group B, 7,3. (total of 205 CSU) ; significant difference with P <0,004 between the 2 groups. Both identification of ethical dilemma itself and outbreaking it in (P) and (R) items and articulating solutions were significantly different between the 2 groups(P <0,004 Wilcoxon). Patient-physician relationship was predominantly present in both groups. While end-of-life and therapeutic issues were more prominent among group B, students of group A disagreed more with staff. Students of group B focused on external causes to excuse their demotivation (final exams'preparation), being more fatalist than cynical towards ethical issues. CONCLUSION: There is an erosion of clinical ethical sensitivity during pregraduate training. This study shows that internal medicine hospital rotation provides enough opportunities (both in number and in variety) to promote keen clinical ethical learning.     

Undergraduate musculoskeletal examination teaching by trained patient educators--a comparison with doctor-led teaching

BACKGROUND: To compare the core hand and knee examination skills gained by undergraduates taught either by trained patient educators (PEs) or by doctors. METHODS: A total of 50 final year medical students were randomized to receive training from PEs or doctors. Group A were taught hand examination by a PE with rheumatoid arthritis, and knee examination by a PE with osteoarthritis. Group B was taught hand and knee examination by a consultant rheumatologist plus an untrained patient with appropriate signs. All students were taught an established core skills set in small group workshops. Students then undertook two validated objective structured clinical examination (OSCE) stations with two blinded assessors. Pre- and post-teaching questionnaires established the students' self-reported levels of skills (SRS) and a student evaluation of teaching (SET). The study was analysed as an equivalence trial. A mean difference in OSCE scores of 10% was assumed to be of educational significance. RESULTS: Although the SET scores of both groups were high, the doctor-led group received higher scores. Aside from this, the two student groups did not differ significantly. There were no significant differences in mean hand OSCE (mean difference = 0.88, P = 0.28, 95% CI = -0.73 to 2.49) or knee OSCE (mean difference = 0.28, P = 0.7, 95% CI = -1.19 to 1.75) scores. Both the upper and lower confidence intervals for each mean difference fell within the 10% range (-2.8 to 2.8 for the hand, and -2.5 to 2.5 for the knee) and equivalence was assumed. CONCLUSIONS: Adequately trained PEs can deliver clearly structured undergraduate skills, teaching with equivalent learning outcomes to those of rheumatology consultants. PEs are a valuable development to augment musculoskeletal education in the face of expanding student numbers.     

急性肺血栓栓塞的诊治70例报告

目的对我院18年间住院急性肺血栓栓塞(PTE)病例进行临床分析,提高肺血栓栓塞的诊治水平。方法收集整理70例急性肺血栓栓塞的临床资料,并进行分析。结果 PTE的临床特征不典型,容易误诊,A组(1993～2002年)诊断18例,误诊10例,病死11例;B组(2003～2010年)诊断52例,误诊15例,病死13例,A组误诊数、病死数明显高于B组并有统计学意义。结论随着医师诊断意识的提高,医生掌握PTE正确的诊断程序及规范化治疗,肺栓塞的检出率逐年增多,而误诊率、病死率明显下降。     

Role of the observed long case in postgraduate medical training

Abstract
Background : The teaching of long case examination technique emphasizes case presentation, problem identification and discussion of management. It assumes that history taking and ability to perform a complete physical examination in a limited time are adequate. These can only be assessed by directly observing the long case examination.
Aims : To explore the usefulness of observing long case performance.
Methods : We used a structured assessment form to observe and evaluate the overall long case performance of 19 doctors in our physicians' training programme. Nine, group A, had received 6 months training, whereas the 10 in group B had only just commenced clinical examination training.
Results : Ten (53%) passed their long case, seven from group A and three from group B. Thirteen (68%) passed the history and examination section. Three failed the history component and five failed the examination component. The groups had similar scores for observed history taking. Common problems included poor time management, excessive time required to take the history and lack of organization of questions. Physical examination was usually poorly organized, requiring the use of short cuts, particularly in the respiratory, musculoskeletal and neurological systems. Group A were better at presentation and discussion, with eight (89%) passing compared with four (40%) passing in group B.
Conclusion : These results reflect the emphasis in our training programme on long case discussion and management, rather than examination technique. The observed case allowed for detection of defects in history-taking skills and time management. Therefore, it is valuable in preparing candidates for their Fellowship examinations. (Intern Med J 2001; 31: 523–528)     

强化模拟训练在急诊心肺复苏教学中的效果

目的 观察对学生进行强化模拟训练（即在第一次训练一个月后再强化一次）在急诊心肺复苏教学中的效果.方法 所有学生均通过模拟人进行心肺复苏训练一次,然后将62名学生随机分为实验组和对照组,实验组在一个月后再应用模拟人进行训练一次,而对照组采用传统培训模式（课堂基础理论回顾＋多媒体演示课件观看＋局部功能性训练模型练习）,统计分析两组考核成绩.结果 两组学生经过第一次模拟培训后单项技能考核及综合演练考核通过率差异无统计学意义（P＞0.05）.实习结束时,实验组学生单项技能考核中人工呼吸、气管插管、电除颤、综合演练考核指挥抢救、制定抢救措施通过率显著高于对照组,差异有统计学意义（P＜0.05）.两组心脏按压、判断现场情况及团队合作考核通过率无统计学差异（P＞0.05）.结论 通过采用强化模拟训练的教学模式可以提高心肺复苏的教学效果.     

两种不同方法对结核性胸腔积液的诊疗观察

目的研究胸腔镜联合胸腔闭式引流结合的方法与传统胸腔穿刺抽液联合胸膜活检对大量结核性胸腔积液的临床诊疗效果。方法抽取100例大量结核性胸腔积液病例,将其分为A、B两组,每组50例。分别采用反复胸腔穿刺抽液联合胸膜活检(A组)与胸腔镜联合胸腔闭式引流(B组)联合的方法进行处理。结果 B组患者的诊断率及临床好转率明显高于A组。经过治疗后的体温恢复正常和胸水控制所需的时间明显短于A组;治疗过程中的实际胸水抽放量明显多于A组;胸膜粘连包裹发生率及胸膜增厚发生率明显低于A组;结论胸腔镜与胸腔闭式引流结合的方法对胸腔积液的诊治是简单、快速、有效、安全。