计算机辅助仿真模拟器对心血管专业研究生在冠状动脉造影技能培训中的作用

目的:明确计算机辅助仿真模拟器在心血管专业研究生培养中,是否有助于掌握冠状动脉造影技术。方法:选取我院14名无心血管放射介入经验的在读心血管专业硕士或博士研究生在接受相同课时的冠状动脉介入理论学习后,随机抽取7名研究生接受Angiomentor计算机辅助仿真模拟器培训课程,模拟冠状动脉造影操作;其余7名心血管专业在读硕士研究生未接受仿真模拟器培训,随后在有经验的冠状动脉介入医师指导下于真实临床环境中操作冠状动脉造影,评价操作错误的频数、平均造影时间、造影剂使用量、术中累计放射线剂量及单位面积X线累计曝光剂量。结果:培训组平均操作错误的频数减少50%、平均造影时间减少26·7%、造影剂使用量减少22·2%及术中放射线曝光总剂量明显减少45·7%,单位面积X线累计曝光剂量减少52·1%,少于非培训组。结论:仿真模拟器有助于心血管专业研究生熟练掌握冠状动脉造影技术。     

TBL联合情景模拟法在肺心病教学中的应用

目的 探讨团队基础式教学（TBL）联合情景模拟教学法在五年制临床医学生肺心病教学中的应用及效果。 方法 将本期临床医学生随机分成两个班，分别是采用传统的讲授式教学（LBL）班及TBL联合情景模拟教学班。通过问卷调查及随堂测试评价两种教学方法在能力培养、学习成绩等方面的差异。 结果 与传统的LBL教学班相比，TBL联合情景模拟教学班学生的个人单项学习能力和协作能力均显著提升，并且TBL联合情景模拟教学班的随堂测试成绩显著高于LBL班。 结论 TBL联合情景模拟教学法在肺心病疾病的教学效果优于传统讲授式教学法，值得在本科医学生教学中推广。     

结核性脓胸的电视胸腔镜外科治疗

目的：通过与开胸手术的对比，研究电视胸腔镜外科对结核性脓胸的治疗价值和优越性；方法：从１９９８年６月至１９９９年１２月，１８名结核性脓胸病人接受了电视胸腔镜手术治疗，术式包括脓胸清理、引流术（ｎ＝６）和纤维板剥脱术（ｎ＝１２），与同行开胸手术的１５例病人在手术时间、术后住院时间、拔管时间、术后麻醉药用量和疗效进行比较；结果：电视胸腔镜手术组在术后住院时间、术后麻醉药用量均优于开胸组，其余无显著差异     

基于深度学习的继发性肺结核CT辅助诊断模型构建及验证

目的:评价基于深度学习的继发性肺结核CT辅助诊断模型在临床应用中的价值。方法:回顾性收集2018年12月至2023年4月在重庆市公共卫生医疗救治中心接受胸部CT平扫的2004例患者的病例资料,分为肺部正常组(544例)、普通肺部感染组(526组)和继发性肺结核组(934例)。按照随机分组(通过R语言的sample函数实现训练集和测试集的完全随机分组)的方式,将数据集划分为训练集(1402例,70.0%)和测试集(602例,30.0%)。所有图像采用肺野自动分割算法,获得肺野区域。进一步采用BasicNet和DenseNet算法进行三组间的分类研究。采用曲线下面积(area under curve, AUC)、敏感度、特异度和准确率评价模型的分类性能。最后,在测试数据中,将最优模型与3位不同年资的放射科医生的诊断结果进行比较。结果:602例独立测试集中,DenseNet模型的性能优于BasicNet模型,两种模型的平均AUC、敏感度、特异度和准确率分别为92.1%和89.4%、79.7%和74.0%、89.4%和86.6%、86.2%和83.3%。其中,DenseNet模型的诊断性能优于...     

Mirizzi综合征的微创外科治疗

目的 总结应用腹腔镜和内镜联合治疗Mirizzi综合征的初步经验，探讨微创外科对Mirizzi综合征的治疗效果。方法 对21例CsendesⅡ型，Ⅲ型Mirizzi综合征患者，采用内镜鼻胆管引流术（ENBD）配合实施腹腔镜胆囊切除，胆总管探查，胆囊胆管瘘I期缝合修补术（内衬ENBD导管）。结果 19例手术成功，2例中转开腹。术中结石清除率100％，无胆漏，胆道出血等术后并发症。手术时间平均93.6min，术后平均住院9．4d。术后随访18－41个月，未有结石复发。结论 应用腹腔镜和内镜手段，综合治疗Mirizzi综合征在技术上是切实可行的。但腹腔镜下缝合修复胆管壁缺损较困难，适宜在腹腔镜技术较成熟的单位开展。     

冠状动脉外科发展史

冠状动脉搭桥手术（CABG）是当今冠心病治疗的重要手段之一。因其疗效好，再手术率低，已越来越多地被冠心病患者所接受。冠状动脉外科的发展是一个具有创造性思维的故事，期间有极大期望，亦有极大失望，但最终它产生了令人满意的结果。本文分5个阶段简述。     

犬左心房心肌细胞动作电位的计算机建模仿真研究

目的构建犬左心房心肌细胞动作电位的计算机仿真模型。方法在Ramirez-Nattel-Courtemanche心房肌细胞模型的基础上,根据离子流数据构建左心房心肌细胞的计算机仿真模型。结果计算机仿真的电流与实验得到的离子流相似,最后得到的动作电位与我们在单个左心房肌细胞记录到的动作电位基本一致。结论我们根据犬左心房肌细胞离子流数据构建的细胞模型较现有模型更符合左心房细胞的特性,为进一步仿真研究心房颤动的机制打下了良好的基础。     

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。     

医学细胞生物学虚拟仿真实验教学的效果评价研究

目的 利用虚拟仿真系统开展医学细胞生物学实验教学,探讨虚拟仿真教学平台的应用效果。方法 选取本校临床专业2022级118名本科生作为研究对象,随机分为两组,传统教学方式组(未使用虚拟仿真软件辅助教学),虚拟仿真教学组(在传统教学方式上增加虚拟仿真实验环节)。连续观察一个章节学习效果,分析使用虚拟仿真软件辅助教学前后学生成绩、和教学评价的差异。结果 虚拟仿真教学组学生理论测试成绩(91.24±1.26)高于传统教学组成绩(85.17±3.65)分,差异有统计学意义(P<0.01)。在课堂参与度评分方面,实验组课堂讨论参与度、合作与协作能力,以及提问能力评分均高于对照组,两组比较差异有统计学意义(分别为t=-4.06,-4.91,-6.86,均P<0.01)。在对两组学生不同能力的评价方面,实验组学生在学习能力、理论知识掌握能力、团队协作能力、自主学习能力和自我展示能力均高于对照组,差异均有统计学意义(均P<0.01)。实验组对教学的总体满意度也高于对照组,差异有统计学意义(Z=-2.74,P=0.004)。结论 虚拟仿真实验教学平台的应用,可以有效地提升教学效果。该平台...     

经皮冠状动脉介入治疗后股动脉假性动脉瘤行外科治疗的特点

目的:探讨经皮冠状动脉介入治疗(PCI)后发生股动脉假性动脉瘤并接受外科治疗的患者特点及相关护理对策。方法:回顾性纳入2016年1月至2019年1月,就诊于北京安贞医院的66例行PCI治疗术发生股动脉假性动脉瘤的患者,根据接受的治疗策略分为保守治疗组(n=44)和外科治疗组(n=22)。比较两组患者基线资料、用药情况、PCI治疗情况和下肢动脉超声检测结果。结果:与保守治疗组相比,外科治疗组患者术后低分子肝素使用率明显较高(81.8%vs.40.9%,P=0.034);两组患者的基线资料、其他用药情况、PCI治疗情况和下肢动脉超声检测结果差异无统计学意义(P>0.05)。使用Logistic回归校正年龄、性别、BMI、高血压病史、血小板数量、动脉瘤位置、缝合器使用情况、压迫时间、肢体制动时间后,术后使用低分子肝素仍然是需要外科处理假性动脉瘤的预测因素(OR=1.62,95%CI:1.13~2.63,P=0.038)。结论:在PCI治疗后发生股动脉假性动脉瘤的患者中,使用低分子肝素的患者可能更易因保守治疗效果不佳而接受外科治疗。对于病情需要术后使用低分子肝素的患者,应提前给予多方面、针对性、个体化护理,以提高保守治疗的成功率,减轻患者负担。     

Chest compressions quality during sudden cardiac arrest scenario performed in virtual reality: A crossover study in a training environment

Potential attributes of virtual reality (VR) can be a breakthrough in the improvement of sudden cardiac arrest (SCA) training. However, interference with the virtual world is associated with the need of placing additional equipment on the trainee''s body. The primary aim of the study was to evaluate if it does not affect the quality of chest compressions (CCs).91 voluntarily included in the study medical students participated twice in the scenario of SCA – Traditional Scenario (TS) and Virtual Reality Scenario (VRS). In both cases two minutes of resuscitation was performed.If VRS was the first scenario there were significant differences in CCs depth (VRS - Me = 47 mm [IQR 43 – 52] vs TS - Me = 48 mm [IQR 43 – 55]; P = .02) and chest relaxation (VRS - Me = 37% [IQR 5 – 91] vs TS - Me = 97% [IQR 87 – 100]; P < .001). 97.8% of respondents believe that training with the use of VR is more effective than a traditional method (P < .01). Most of the study group (91%, P < .01) denied any negative symptoms during the VR scenario.Virtual reality can be a safe and highly valued by medical students, method of hands-on CPR training. However additional VR equipment placed on the trainee''s body may cause chest compressions harder to provide. If it is not preceded by traditional training, the use of VR may have an adverse impact on depth and full chest relaxation during the training. To make the best use of all the potential that virtual reality offers, future studies should focus on finding the most effective way to combine VR with traditional skill training in CPR courses curriculum.     

Progress in laparoscopic anatomy research: A review of the Chinese literature

The development of laparoscopic surgery has generated the new field of study, laparoscopic anatomy. This article reviews the reported literature on laparoscopic anatomy and explores how it has evolved along with advances in abdominal surgery. In addition, the principal concerns in current laparoscopic anatomy research are discussed, including: (1) types of special adjacent anatomical structures; and (2) special surgical planes and anatomical landmarks. Understanding of systematic laparoscopic anatomy can pr...     

Use of laparoscopic techniques in colorectal surgery

PURPOSE: This study evaluated the feasibility and safety of laparoscopic bowel surgery performed by colorectal surgeons not previously experienced in laparoscopic biliary or appendiceal surgery. METHODS: Thirty-two patients underwent ileocolic resection/anastomosis (n=12), loop ileostomy (n=7), colostomy (n=4), ileostomy takedown/ileorectal anastomosis (n=3), subtotal colectomy/ileorectal anastomosis (n=2), sigmoid resection (n=2), or other procedures (n=2). No curative cancer surgery was undertaken. RESULTS: Time to first bowel movement was one to eight (median, four) days. Length of stay ranged from 4 to 11 (median, 6) days. There were no major complications seen in follow-up from 6 to 15 (median, 7) months after surgery. CONCLUSIONS: Large intestinal and distal ileal surgery using laparoscopic techniques, performed by surgeons with training only in laparoscopic intestinal surgery, is feasible and safe. Faster recovery and need for less postoperative analgesia in laparoscopic surgery compared with conventional surgery cannot be surmised from this study. A randomized study design is needed to evaluate many of the differences between conventional and laparoscopic intestinal surgery.     

Laparoscopic left lateral sectionectomy as a training procedure for surgeons learning laparoscopic hepatectomy

Background

Laparoscopic liver resection remains limited to a relatively small number of institutions because of insufficient hepatic and laparoscopic surgical experience and few training opportunities. The aim of this study was to assess the feasibility and safety of an improved laparoscopic left lateral sectionectomy technique as a training procedure for new surgeons.

Methods

Twenty-four laparoscopic left lateral sectionectomies (LLLSs) were retrospectively reviewed. Patients were divided into 3 groups with 8 patients in each: those undergoing surgery by expert surgeons prior to 2008 (Group A); those undergoing surgery by expert surgeons after 2008, when a standardized LLLS technique was adopted (Group B); and those undergoing LLLS by junior surgeons being trained (Group C).

Results

The median operative time was significantly shorter for Group B (103 min; range, 99–109 min) and C (107 min; range, 85–135 min) patients than for Group A (153 min; range, 95–210 min) patients. There were no significant differences in blood loss or hospital stay. In Groups B and C, no conversions to open laparotomy or complications occurred.

Conclusion

The standardized LLLS procedure was both safe and feasible as a technique for training surgeons in laparoscopic hepatectomy.     

Augmented reality (AR) and virtual reality (VR) applied in dentistry

The OSCE is a reliable evaluation method to estimate the preclinical examination of dental students. The most ideal assessment for OSCE is used the augmented reality simulator to evaluate. This literature review investigated a recently developed in virtual reality (VR) and augmented reality (AR) starting of the dental history to the progress of the dental skill. As result of the lacking of technology, it needs to depend on other device increasing the success rate and decreasing the risk of the surgery. The development of tracking unit changed the surgical and educational way. Clinical surgery is based on mature education. VR and AR simultaneously affected the skill of the training lesson and navigation system. Widely, the VR and AR not only applied in the dental training lesson and surgery, but also improved all field in our life.     

What Impact Might General Surgery Practice Patterns of Colon and Rectal Surgeons Have on Future Training?

Currently, surgeons specialize in colon and rectal surgery after a complete residency and certification in general surgery. The American Board of Surgery is proposing reorganization of surgical training; only two to four years of general surgery would be required followed by two to three years of specialization. The general surgery practice patterns of colon and rectal surgeons are unknown. The purposes of this study were to evaluate the current practice patterns of colon and rectal surgeons and to quantify the frequency and type of general surgical procedures performed. Active candidates, members, and fellows of The American Society of Colon and Rectal Surgeons were asked to complete an online survey. Results collected from November 18 to 26, 2004 were included. Data were self-reported. A total of 772 surgeons were included in the analysis; 7 percent were candidates, 29 percent were members, and 64 percent were fellows. Sixty-three percent had been practicing for 20 years or less and 64 percent were younger 50 years of age. Colon and rectal practice consisted of 28 percent abdominal surgery, 14 percent laparoscopic surgery, 28 percent anorectal surgery, and 30 percent endoscopy. Fifty-six percent of colon and rectal surgeons reported performing general surgery procedures with an average of 25 percent of their practice being general surgery. The most common procedures were herniorrhaphy (87 percent), cholecystectomy (76 percent), and appendectomy (33 percent). The most common reasons for general surgery practice were practice (52 percent) and emergency room requirements (43 percent). Currently, colon and rectal surgeons perform general surgery procedures in clinical practice. If general surgery residency of future trainees is shortened, the types of procedures colon and rectal surgeons will be competent to perform may need to be redefined. This will have profound implications on training programs, certification requirements, and future practice patterns. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006.     

Virtual reality as a learning tool for improving infection control procedures

BackgroundHand hygiene and donning personal protective equipment (PPE) are essential techniques for infection control; however, low compliance is an issue. The effectiveness of virtual reality (VR) in learning infection control procedures is unknown.MethodsTo verify the effectiveness of VR, medical students were categorized into VR or lecture groups (n=21 each). Each group was given the same curricular content; one group received the training through VR learning using a fully-immersive 360-degree video and the other was conventional lecture-style learning. Before and after the training, they were evaluated for the implementation of hand hygiene and PPE using an Objective Structured Clinical Examination method. Post-test questionnaires were administered.ResultsThe scores for hand hygiene, donning PPE, and the total score increased after learning in both groups. There was no difference between the pre-test total scores of the two groups (7 [5-9] vs 6 [5-7.5], P=.352); however, the VR group had significantly higher post-test total scores than the lecture group (12 [9.5-12] vs 9 [8-12], P=.024). More students in the VR group responded that they enjoyed the training and would like to use the same learning method next time.ConclusionsVR can be a useful tool for learning and practicing appropriate infection control procedures.     

Musculoskeletal examination—an ignored aspect. Why are we still failing the patients?

Over the past two decades, rheumatologists from around the world have not only championed the musculoskeletal system examination but also modified the undergraduate teaching curriculum. This has led to the development and adoption of the gait, arms, legs and spine (GALS) screening along with regional examination techniques. The purpose of this study is to review current practice, determining the frequency of patient exposure to appropriate examination and confidence of junior doctors when dealing with MSK conditions. Two district-general hospitals (non-teaching) and one teaching hospital in North-East London were chosen. At each site, 50 patient notes were reviewed from the acute admission wards for medicine and surgery and the medical assessment unit. Factors considered included whether GALS screenings had taken place, documentation of MSK examinations and assessment of confidence of junior doctors in assessing MSK conditions. GALS screenings were performed for 4% of patients on the medical assessment unit, 7% of acute medical and 0% of acute surgical patients on admission. Examination of the MSK system yielded better results with 16%, 22% and 10% on each of the respective wards. Interviews with junior doctors found 10% routinely screening for MSK conditions, despite 87% feeling confident in taking MSK histories. This prospective audit of clinical practice highlights that patients failed to have a minimal assessment of the MSK system through GALS screenings. When examining the MSK system, results were somewhat better, although still fewer than expected. It is curious that the majority of junior doctors in training felt confident in dealing with MSK disease but few did it in practice. This begs the question of whether current teaching curricula and strategies are adequate. At a time where there is ever-increasing national momentum to address issues on obesity and cardiovascular health, our patients are still deprived of a standard MSK examination by the medical faculty.     

Virtual reality bronchoscopy simulation: a revolution in procedural training

BACKGROUND: In the airline industry, training is costly and operator error must be avoided. Therefore, virtual reality (VR) is routinely used to learn manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills must also be acquired to competently perform invasive procedures such as flexible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and other endoscopic procedures has occurred on the job in real patients. We hypothesized that novice trainees using a VR skill center could rapidly acquire basic skills, and that results would compare favorably with those of senior trainees trained in the conventional manner. METHODS: We prospectively studied five novice bronchoscopists entering a pulmonary and critical care medicine training program. They were taught to perform inspection flexible bronchoscopy using a VR bronchoscopy skill center; dexterity, speed, and accuracy were tested using the skill center and an inanimate airway model before and after 4 h of group instruction and 4 h of individual unsupervised practice. Results were compared to those of a control group of four skilled physicians who had performed at least 200 bronchoscopies during 2 years of training. Student's t tests were used to compare mean scores of study and control groups for the inanimate model and VR bronchoscopy simulator. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired two-sample t tests were used. RESULTS: Novices significantly improved their dexterity and accuracy in both models. They missed fewer segments after training than before training, and had fewer contacts with the bronchial wall. There was no statistically significant improvement in speed or total time spent not visualizing airway anatomy. After training, novice performance equaled or surpassed that of the skilled physicians. Novices performed more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models. CONCLUSION: A short, focused course of instruction and unsupervised practice using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopic inspection similar to those of colleagues with several years of experience. These skills were readily reproducible in a conventional inanimate airway-training model, suggesting they would also be translatable to direct patient care.     

Exploring the Role of Virtual Reality to Support Clinical Diabetes Training—A Pilot Study

Background:It is estimated that 16 to 25% of patients in hospital have diabetes and 1 in 25 inpatients with Type 1 Diabetes develop diabetic ketoacidosis (DKA). It is vital that non-specialist doctors recognize and appropriately manage diabetes emergencies. Simulation training is increasingly being used in healthcare and virtual reality (VR) based educational resources is transforming medical education. This study aimed to evaluate the use of virtual reality to help non-specialist clinicians manage clinical scenarios related to diabetes.Methods:This pilot project, titled ‘DEVICE’ (Diabetes Emergencies: Virtual Interactive Clinical Education) was developed in collaboration with Oxford Medical Simulation. Fully interactive immersive VR scenarios were created to stimulate real life diabetes emergencies. Users then received personalized feedback and performance metrics. Feedback surveys were provided before and after the participation in the VR scenario. Kirkpatrick’s training evaluation model was used.Results:Thirty-nine participants from 2 hospitals in UK provided feedback up to 3 months after attending the VR education sessions. Overall feedback was extremely positive, and participants found this immersive teaching experience very helpful. After use of virtual reality scenarios, the mean trainee confidence in managing DKA (on an 8-point Likert scale) increased from 3.92 (3.38-4.47) 95% CI to 5.41 (4.79-6.03) 95% CI (statistically significant). The VR study demonstrates Kirkpatrick level 3 in the follow up survey.Conclusion:VR based training scenarios in this pilot project increased confidence in managing diabetes emergencies and demonstrated positive changes in their behavior. VR education is a safe, useful and a well-liked training tool for diabetes emergencies.