护理干预预防川崎病患儿发生静脉血栓的临床价值

目的探究综合护理干预预防川崎病患儿发生静脉血栓的临床价值。方法回顾性分析我院于2012年3月~2016年3月期间的川崎病患儿的临床资料,共计302例。以2014年5月开展综合护理干预为界点,2014年5月前,采用常规护理干预的150例崎病患儿作为参照组,2014年5月后实施综合护理干预的152例患儿为研究组。观察并比较两组患儿护理后的热程、退热时间、手足肿胀时间等治疗相关指标、治疗依从性、静脉血栓发生率、死亡率以及对护理的满意度。结果经过护理后,研究组患儿的热程、退热时间、手足肿胀时间、淋巴结肿大消退时间、黏膜充血时间均少于参照组,依从性及满意度高于参照组,静脉血栓发生率、死亡率均低于参照组,组间比较具有差异性,存在统计学意义(P0.05)。结论两组患者经过护理后都有一定成效,但研究组疗效更显著,川崎病患儿采用综合护理干预,能改善临床症状,有效预防静脉血栓形成,降低死亡率,具有较高的临床价值。     

Inserción de la simulación clínica en el currículum de Anestesiología en un hospital universitario. Evaluación de la aceptabilidad de los participantes

IntroductionClinical simulation is currently an integral part of the curriculum of the Anesthesiology residency programs in other countries. We aimed to describe and evaluate the insertion of simulation in an anesthesia residency training program.MethodsActivities feasible to be used for training in a simulated environment were classified into 2 modules: workshops for technical skills conducted with first year residents, and high fidelity simulation scenarios performed with second and third year residents. After each activity, and using an anonymous questionnaire, residents assessed their satisfaction and objectives accomplished.ResultsA total of 18 activities: 6 skills workshops and 12 high fidelity scenarios were assessed. A total of 206 questionnaires were analyzed, corresponding to 41 residents. Almost all (96%) of respondents agreed or strongly agreed that workshops met the objectives and should be mandatory in the anesthesia curriculum; however, 11% agreed that the activity caused anxiety and/or nervousness. The high fidelity scenarios were considered realistic and consistent with the objectives by 97% of residents, and 42% felt that workshops caused anxiety and/or nervousness.ConclusionsThe inclusion of simulation has been well accepted by the residents. The activities have been described as realistic, and limited to the objectives, essential points in adult education, as according to Kolb's learning model this is associated with profound, useful and long lasting knowledge.     

CT诊断甲状腺癌价值分析及临床意义

目的:探究、总结CT影像技术对于甲状腺癌的诊断价值和意义。方法:通过CT对62例病理证实甲状腺癌患者进行分析,均进行平扫和增强扫描自舌骨水平至主动脉弓上缘,评价CT强化方式及特点。结果:通过不同强化密度的甲状腺癌各型CT影像技术,能有助于对病变良恶性诊断。结论:甲状腺癌CT扫描可较为准确地提示病变良恶性质及强化特征,对临床医生诊断及制定手术等治疗方案有显著意义。     

Randomized Trial of Zileuton for Treatment of COPD Exacerbations Requiring Hospitalization

Rationale: Leukotrienes have been implicated in the pathogenesis of acute exacerbations of COPD, but leukotriene modifiers have not been studied as a possible therapy for exacerbations. Objective: We sought to test the safety and efficacy of adding oral zileuton (a 5-lipoxygenase inhibitor) to usual treatment for acute exacerbations of COPD requiring hospitalization. Methods: Randomized double-blind, placebo-controlled, parallel group study of zileuton 600 mg orally, 4 times daily versus placebo for 14 days starting within 12 hours of hospital admission for COPD exacerbation. Primary outcome measure was hospital length of stay; secondary outcomes included treatment failure and biomarkers of leukotriene production. Main Findings: Sixty subjects were randomized to zileuton and 59 to placebo (the study was stopped short of enrollment goals because of slow recruitment). There was no difference in hospital length of stay (3.75 ± 2.19 vs. 3.86 ± 3.06 days for zileuton vs. placebo, p = 0.39) or treatment failure (23% vs. 27% for zileuton vs. placebo, p = 0.63) despite a decline in urinary LTE₄ levels in the zileuton-treated group as compared to placebo at 24 hours (change in natural log-transformed ng/mg creatinine ?1.38 ± 1.19 vs. 0.14 ± 1.51, p < 0.0001) and 72 hours (?1.32 ± 2.08 vs. 0.26 ± 1.93, p<0.006). Adverse events were similar in both groups. Principal Conclusions: While oral zileuton during COPD exacerbations that require hospital admission is safe and reduces urinary LTE₄ levels, we found no evidence suggesting that this intervention shortened hospital stay, with the limitation that our sample size may have been insufficient to detect a modest but potentially meaningful clinical improvement.     

地方综合性大学临床医学教育体制改革探索实践

医学教育体制的探索和创新根本出发点是为了整合临床资源,提高教学质量,特别在地方综合性高校任务尤为艰巨。研究探索实施最大限度发挥以地方高校的唯一性,高效整合医疗资源,并实现优势医疗资源向教学资源的转化,有效弥补地方教学资源相对缺乏为特色的临床教育体制改革。