“智教”+“慧学”混合式教学在中西医结合内科实习带教中的应用研究

目的 探究“智教”+“慧学”混合式教学在中西医结合内科实习教学中的应用效果。方法 按照随机原则,将2019级中西医临床医学专业一班的54名实习生纳入对照组,给予传统教学;另将2019级中西医临床医学专业二班的56名实习生纳入观察组,给予“智教”+“慧学”混合式教学。实习6个月后,比较两组实习生理论考核成绩（基础理论知识、专业理论知识）、临床实践能力[列斯特评估量表（Leichester assessment package,LAP）]、教学满意度。采用SPSS 17.0进行t检验和卡方检验。结果 实习结束时,观察组实习生基础理论知识[（41.53±3.42）vs.（38.71±3.38）]、专业理论知识[（39.49±3.14）vs.（37.85±3.07）],LAP评分总分[（84.32±6.65）vs.（78.46±6.17）]及各分项评分,以及教学满意度均高于对照组（P均<0.05）。结论 “智教”+“慧学”混合式教学能够加强中西医结合学科实习生掌握理论知识,提高实习生临床实践能力和教学满意度。     

Survival Analysis Using Albumin-Bilirubin (ALBI) Grade for Patients Treated with Drug-Eluting Embolic Transarterial Chemoembolization for Hepatocellular Carcinoma

PurposeThe albumin-bilirubin (ALBI) grade has been established as an improved predictor of survival in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization and yttrium-90 radioembolization. The purpose of the study was to investigate the utility of ALBI grade in prognosticating outcomes in patients with HCC treated with drug-eluting embolic (DEE) transarterial chemoembolization (TACE).Materials and MethodsA single-center retrospective review was performed to compare the efficacy of ALBI grade and Child-Pugh (CP) classification in predicting the survival of patients with HCC receiving DEE-TACE. A total of 303 patients with HCC were identified who had received DEE-TACE without concomitant locoregional therapy within 30 days. Survival analysis was performed using Kaplan-Meier methods and censored for curative therapy. Survival curves were stratified based on the ALBI grade, CP class, Barcelona Clinic Liver Cancer (BCLC) stage, Eastern Cooperative Oncology Group performance status, and presence of ascites. The discriminatory ability of survival curves was calculated by C-Index.ResultsKaplan-Meier survival curves stratified by the ALBI grade produced distinct, nonoverlapping curves (P < .001), showing greater discriminatory ability than the CP classification (C-index = 0.568 and 0.545, respectively). The substratification of the BCLC stage by the ALBI grade yielded greater discriminatory ability than the substratification by the CP classification (C-index = 0.573 and 0.565, respectively). For patients with BCLC stage B, the substratification by the ALBI grade yielded distinct curves, whereas the substratification by the CP classification did not (P = .011 and P = .379, respectively).ConclusionsALBI grade showed improved discriminatory ability compared with CP classification in differentiating overall survival among patients with HCC receiving DEE-TACE. Furthermore, ALBI grade was effective in substratifying survival among patients categorized as CP class A and patients with BCLC stage B, whereas CP classification was not effective.     

中西医结合内科治疗中晚期胃癌临床体会

目的:对中西医结合治疗中晚期胃癌的治疗情况进行分析,从而改善患者的症状、生活质量以及治疗生存率等方面.方法:选取在医院就诊的70名中晚期的胃癌患者,随机将他们分成两组,一组为治疗组另一组为对照组.其中治疗组为40名患者采用化疗和中药的方案进行治疗,对照组为30名只是进行化疗.结果:结果治疗组的客观效率有50.5％,对照组的客观效率为28.5％,两者具有明显的差别.患者症状的改善方面治疗组比对照组有明显的好转,同时患者的生存质量治疗组比对照组有巨大的提高.结论:中西医结合内科治疗中晚期胃癌对患者的治疗具有积极的作用,同时改善患者的生存质量和延长患者的生存时间,提高综合胃癌的疗效.     

中西医结合治疗老年人肾病综合征98例疗效观察

目的 :比较中西医结合和单纯西医治疗老年人原发性肾病综合征 (PNS)的临床疗效。方法 :98例老年人PNS随机分为治疗组和对照组。治疗组 (4 9例 )用强的松、环磷酰胺 (CTX)并分阶段辨证配合中药治疗。对照组(4 9例 )单用西药治疗。观察临床缓解率、不良反应率、复发率及缓解时间。结果 :治疗组完全缓解率 (5 9.2 % )和总缓解率 (85 .7% )均显著高于对照组 (38.7%、6 3.2 % ,P <0 .0 5 )。治疗组不良反应率 (36 .7% )明显低于对照组 (80 .1% ,P <0 .0 1)。随防 (4 2± 11.6 4 )月后 ,治疗组复发率 (10 .3% )与对照组 (2 1% )比较无统计学差异 (P >0 .0 5 )。但治疗组平均缓解期为 (36 .7± 4 .6 )月 ,较对照组 (15 .2± 4 .4 )月显著延长 (P <0 .0 1)。结论 :中西医结合治疗老年人肾病综合征优于单纯西医治疗。     

医护一体化护理改善颅脑外伤术后颅骨修补术后切口美观度的成效

目的 探讨医护一体化护理对颅脑外伤术后颅骨修补术后切口美观度的影响。方法 选取2021年1月-2022年12月于安徽医科大学第一附属医院神经外科接受颅脑外伤术后颅骨修补术的120例患者,随机分为对照组和试验组,每组60例。对照组采用常规护理,试验组采用医护一体化护理,比较两组切口愈合时间、美观度、满意度和并发症发生率。结果 试验组切口愈合时间短于对照组（P ＜0.05）;试验组美观度、满意度评分均优于对照组（P ＜0.05）;试验组并发症发生率为3.33%,低于对照组的13.33%（P ＜0.05）。结论 医护一体化护理可以改善颅脑外伤术后颅骨修补术后切口的愈合和美观度,提高患者的满意度,降低并发症的发生率,值得临床应用。     

Integrated vascular surgery applicants' perspectives of virtual residency interviews during the coronavirus disease 2019 application cycle

BackgroundIn agreement with Association of American Medical Colleges guidelines, the 2020 to 2021 integrated vascular surgery (I-VS) residency interviews were conducted virtually. In the present study, we collected data about the virtual interview process from the applicant's perspective, including preferences for interview format and the virtual resources they found most helpful.MethodsAn anonymous, online survey study of medical students who had been accepted into I-VS residencies during the 2020 to 2021 application cycle was performed. The survey contained questions about applicant behavior during the virtual application cycle, their perception of the virtual interviews, the utility of the virtual format, their preferences, and the virtual resources they found the most helpful for determining their rank list.ResultsOf 72 applicants, 38 (18 women, 19 men, and 1 declined to answer) had completed the survey for a 57.2% response rate. The average number of programs interviewed was 25 to 30 (31%). More than one-half (55%) of the respondents had responded that they had interviewed at more programs than they would have had the interviews been in person. More than one-half of the applicants (55%) reported that they preferred remote interviews with the option to visit in-person at their top choice programs compared with the use of all remote interviews (21%) or all in-person interviews (18%). Most had somewhat or strongly agreed (79%) that virtual interviews allowed them to properly gauge a residency program and provided adequate opportunities to interact with the residents (65%). The online resources the applicants found the most helpful in determining their rank lists were attending educational conferences, prerecorded videos from faculty and residents, and the program’s social media platforms.ConclusionsThe results from the present study have illuminated the current trends and attitudes of I-VS applicants for virtual interviews, including the virtual resources they found the most useful. Virtual interviews were a preferred method of interviewing and allowed applicants to assess a residency program and interact with the current residents. These variables should be considered by the program leadership when developing protocols for upcoming application cycles.     

婴儿湿疹治疗方法研究进展

湿疹是皮肤科常见病,在任何年龄均可发病,但其中又以儿童最为常见。中医与西医对湿疹均有广泛研究,二者在其病因解释上存在相似之处,中西医均认为饮食不当是湿疹诱因之一;中医上痰浊瘀血和西医的血液循环障碍也有相似之处。为此,针对湿疹开展中西医研究,能为临床诊治提供更多依据。中医认为湿疹主要是外感六淫、饮食不当、外感风邪、气血两虚、情志内伤等所致,建议从调理出发,经中药治疗,促进经络畅通,提高抗过敏能力。基于此,为了进一步探讨婴儿湿疹的相关情况,本文对湿疹的发病机制以及中西医治法进行综述,以期临床治疗提供一定参考。     

桡骨远端骨折中西医论治的思考

正桡骨远端骨折是创伤骨科最为常见的骨折之一,从中西医论治的角度,手术治疗与保守治疗谁占优势?骨折复位是手法闭合复位,还是手术切开复位?骨折固定是采用夹板外固定,还是钢板内固定?疗效的评价,影像学与腕关节功能孰重孰轻?诸如还有下尺桡关节     

背向散射积分定量技术分析腹主动脉瘤腔内血栓

目的应用背向散射积分（IBS）技术研究腹主动脉瘤（AAA）腔内血栓的性质,探讨腔内血栓形成时间以及与AAA破裂的关系。方法对29例AAA腔内血栓进行IBS参数测定,对均质型、非均质型血栓（按照回声性质分为近管腔和近管壁两层血栓）的IBS参数（AII：平均值,SDI：离散度）进行统计学分析,并采集血栓标本行病理组织观察比较。结果①均质型组中AII个体间差异较大,而SDI值均低。均质型与近管腔层面SDI值均低,两组间差异无统计学意义（P〉0.05）。非均质型组中近管壁层面血栓AII值与SDI值均高,与其他组比较有差异有统计学意义（P〈0.01）。②在非均质型近管壁血栓中纤维素含量高,均质及非均质型近管腔组血栓中纤维素含量低。结论IBS参数可对AAA腔内血栓的组织学特征进行客观的定量依据,为研究AAA发展规律和破裂风险提供重要信息。