Outcomes of first-line endoscopic management for patients with sigmoid volvulus

Background

Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery.

保护性通气策略对老年人术中肺顺应性及氧合的影响

目的研究保护性通气策略[低潮气量(LV)加机械通气(PEEP)]对老年人术中肺顺应性(CL)及氧合的影响。方法选在气管插管全身麻醉下实施择期开腹手术的老年患者60例(ASAⅠ～Ⅱ级,年龄60～81岁),随机分为(1)LV组:VT(潮气量)为7 ml/kg PBW(预测体重);(2)LV+PEEP组:VT为7ml/kgPBW,PEEP为5 cmH_2O;(3)C组(常规通气量组):VT为12 ml/kg PBW。分别于插管后5 min(TO)、30 min(T1)、1 h(T2)、3 h(T3)4个时点记录心搏率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)、呼气末二氧化碳分压(P_(ET)CO_2)、气道峰压(Ppeak)、气道平台压(Pplat)及CL变化,并于各时点桡动脉处抽血测血气指标。结果三组患者各时点HR、MAP、SpO_2、P_(ET)CO_2及手术种类比较差异无统计学意义(P0.05);C组在机械通气期间Pplat、Ppeak明显高于LV组(P=0.001;P=0.012)及LV+PEEP组(P=0.006;P=0.011);LV组、LV+PEEP组、C组CL均随着时间延长呈下降趋势(P=0.003;P=0.001;P=0.000),C组明显低于LV组与LV+PEEP组(P=0.004;P=0.001);LV组与LV+PEEP组差异无统计学意义(P=0.340)。动脉血氧分压(PaO_2)在LV组、LV+PEEP组、C组均随着时间延长呈下降趋势((P=0.002;P=0.002;P=0.000),C组较LV组与ILV+PEEP组降低明显(P=0.001;P=0.001),LV组与LV+PEEP组差异无统计学意义(P=0.231)。结论与常规大潮气量相比,小潮气量通气(7 m/kg PBW)能改善老年人术中的氧合及肺顺应性;小PEEP未显示出进一步的肺保护作用。     

对我国老年医学专科医师培养途径与模式的粗浅认识

随着我国进入老龄化社会,建立一支为之服务的老年医学医师队伍是保证老年人医疗健康服务的基础.但如何培养并建立起这支既能满足老年社会的基本医疗需求又能兼顾老年医学学科发展的队伍是摆在我们面前的重要任务.从内科高年住院医师中选拔高素质人才,进行现代老年医学相关专科培训,同时建立一支多学科老年医学临床工作团队,从临床上培养老年医学专科医师是一种可行的培养模式;另外建立导师制,从科研与个人职业发展方向两方面给予指导是培养高层次老年医学领军人才的可借鉴模式;将这些培养模式与社区医师培养相结合,使老年医学专科人才资源延伸到社区是快速培养我国老年医学医师队伍的可能方式.     

美国老年医学专科医生的培训和资格认证

美国老年医学专科医生必须经过一整套正规和系统的培训,包括4年大学本科和4年医学院的医学教育及3年内科(或家庭医学科)住院医生培训和1～3年老年医学专科培训.老年医学专科医生的资格认证和水平考核也很严格,除了全美统一的医师执照考试(3步)和各州政府医师执照的审批外,还有非政府性的老年医学专科医生的资格认证和水平考核.后者是一个很专业化的过程,包括自学、书面考试和患者调查等,其证书需要每10年更新1次.这一整套正规和系统的培训和专科资格认证考核确保了老年医学专科医生的高专业水平,同时,也避免各地老年医学专科医生专业水平参差不齐.希望通过我们的介绍能促进我国老年医学专科医生培训以及资格认证和水平考核正规化、系统化.     

A Geriatric Summer Research Fellowship Program with Preceptors and Undergraduate Medical Students

Abstract

This article describes the incorporation of aging-related research into a medical school curriculum through a summer fellowship program. The geriatric office at a medical school designed the program to increase the research orientation and skills of undergraduate medical students and provide them with a mentoring experience in the field of geriatrics. A survey of students and preceptors participating in the program over an eleven-year period indicated a high level of acceptance of the program by both students and faculty. Students perceived applications from their fellowship experience for both their practice with the elderly and their critical thinking about issues related to older patients. The program served to stimulate interest in research and introduced undergraduate medical students to the research/scholar role of the physician.