Sonography of suspected acute appendicitis in children: Evaluation of the progress in performance of senior residents

Purpose

The objective of this study was to evaluate the progress in performance of senior residents in diagnosing acute appendicitis.

某退役铀矿山周围居民淋巴细胞微核率分析

目的 调查某退役铀矿山周围居民外周血淋巴细胞微核情况,初步探讨环境因素对微核的影响,为综合治理退役铀矿周围环境提供科学依据。方法 采集100名退役铀矿山周围居民外周静脉血,用常规淋巴细胞微核培养法,检查淋巴细胞微核,进行统计分析。结果 在100名居民中,微核检出率为88.0%,细胞微核率（9.46±6.62）‰、微核细胞率为（8.77±5.92）‰;按性别和年龄分别分组分析得出,细胞微核率和微核细胞率整体随着年龄的增加而增加,但男性和女性增加的速度和幅度在各年龄段稍有不同,男性各组间无明显差异（P>0.05）,女性微核细胞率各组间无明显差异（P>0.05）,细胞微核率各组间差异具有统计学意义（P<0.05）。结论 该退役铀矿山周围居民外周血淋巴细胞微核检出率、淋巴细胞微核率和微核细胞率远超过国内外报道的本底范围,应对退役铀矿周围环境采取更具针对性的综合治理措施,以确保退役铀矿山周围居民的健康。     

城镇居民基本医疗保险与城镇贫困人群医疗救助制度衔接刍议

城镇居民基本医疗保险与城镇贫困人群医疗救助制度是社会保障体系的重要组成部分和社会保障领域改革的重要环节,两者衔接对缓解城镇贫困人员“看病难、看病贵”,提高卫生服务可及性、公平性有重要现实意义。结合两制度衔接现状,探讨两个制度衔接的必要性和可能性,以及当前两个制度衔接存在困难和问题,并提出相关的政策建议。     

徐州市居民糖尿病的脆弱性调查分析

目的掌握徐州市居民罹患糖尿病的脆弱性情况,为进一步的干预提供科学依据。方法采用多阶段分层随机抽样方法,抽取徐州市15～69岁居民共4980人,进行统一的问卷调查,分析应对糖尿病的脆弱性。结果被调查人群中不知道肥胖易患糖尿病者共2427例（48：73％）,不清楚糖尿病常见症状者2053例（41．22％）,不知道父母患糖尿病子女易患糖尿病者共2746例（55．14％）,不知道糖尿病会演变成其他疾病者2771例（55．64％）,从未测血糖者共3424例（68．76％）：1556例测过血糖中检出糖尿病116例,患病率为7．46％,其中未采取措施控制血糖者30例（25．86％）;文化程度、家庭每月人均收入低者应对糖尿病脆弱性较高。结论徐州市居民罹患糖尿病脆弱性偏高,不同居民罹患糖尿病脆弱性不同,针对不同年龄、文化程度、收入等不同层次的人群加大多样化的健康教育和干预措施,降低居民罹患糖尿病的脆弱性。     

Laparoscopic Appendectomy Performed by Residents and Experienced Surgeons

Background:

Laparoscopic appendectomy is widely performed by surgical residents, but its changing indications and outcomes have been poorly investigated. The aim of this study was to examine whether a difference exists in indications and outcomes between laparoscopic appendectomies performed by residents and those performed by experienced surgeons.

Methods:

Between 1999 and 2007, 218 laparoscopic appendectomies were performed and recorded. Data were analyzed to compare operations performed by residents with those by experienced surgeons in terms of indications for surgery and severity of disease. Moreover, laparoscopic appendectomies were thoroughly compared regarding outcomes and complications.

Results:

The residents had fewer conversions with laparoscopic appendectomy (8% vs 17%, P=0.04), and similar complication rates (12% vs 13%, P=0.16), compared with experienced surgeons. The median operating time was also comparable (67 minutes vs 60 minutes, P=0.23). However, patients operated on by residents had more emergencies (86% vs 70%, P=0.009), included more foreigners (27% vs 15%, P=0.03), and had intermediate to severe diseases, (81 vs 52%, P<0.001) than patients did operated on by experienced surgeons.

Conclusions:

Surgical residents performed more emergency laparoscopic appendectomies on foreign patients suffering from intermediate to severe diseases compared with experienced surgeons, with comparable surgical outcomes and lower conversion rates.     

浦东新区社区居民肿瘤知识与行为知晓率调查

目的了解浦东新区社区居民在肿瘤早发现方面的知识和行为现状,为有针对性地开展社区居民的肿瘤健康教育提供科学依据。方法采用分层整群抽样,对2035名浦东新区的社区居民进行问卷调查。结果浦东新区社区居民在"认同吸烟有害健康"、"支持全民戒烟"、"了解乙肝表面抗原"、"了解表抗阳性复查时间"、"日饮水1L以上"、"便后注意观察大便性状"等6项差异有统计学意义,女性高于男性;认同"吸烟有害健康"、"了解乙肝表面抗原"、"了解表抗阳性复查时间"、"有生活压力"、"日饮水量1L以上"、"便后注意观察大便性状"、"饮食规律"和"支持全民戒烟"等8个方面差异有统计学意义,文化程度高者较文化程度低者的肿瘤知识及生活行为方式更为合理;女性随着文化程度的增高,乳腺自查率呈上升趋势(P<0.05)。结论社区居民对肿瘤早发现的认知及重视不足,通过向居民进行有针对性的肿瘤早期发现防治知识的健康教育,提高居民的认知水平,帮助他们建立健康的生活方式。     

广东省城市居民吸烟与被动吸烟现状及控烟态度调查

目的了解城市居民吸烟状况与被动吸烟状况,了解居民对吸烟与被动吸烟危害的认知与态度状况,为开展针对性的控烟工作提供依据。方法采用随机偶遇抽样方法,在广州市、江门市、增城市医院、商场、车站等候室、政府对外办公大楼4类公共场所抽取18岁及以上人群进行面对面问卷调查,问卷采用中国控烟办公室统一设计的《成人被动吸烟调查问卷》。结果共调查城市居民599人,其中吸烟者190人,吸烟率为31．7％;男性吸烟率为56．6％,女性为3．2％;30-岁组吸烟率为最高,为42．6％;不同文化程度调查对象吸烟率的差异无统计学意义（P〉0．05）。392名不吸烟者中,162人处于被动吸烟状况,被动吸烟率为41．3％,男性被动吸烟率为37．6％,女性为43．1％。调查对象中,家里、室内娱乐场所和室内工作场所全部禁烟的比例分别为32．2％、12．3％和40．9％。非吸烟者对吸烟危害知识的知晓率高于吸烟者,支持公共场所禁烟的比例也高于吸烟者。结论广东省城市居民吸烟和被动吸烟状况严重,居民对公共场所禁烟的支持程度较高,吸烟者对吸烟危害认识不足,应加强吸烟危害健康教育,推动各类公共场所禁烟立法。     

Orion: A Web-Based Application Designed to Monitor Resident and Fellow Performance On-Call

Radiology residency and fellowship training provides a unique opportunity to evaluate trainee performance and determine the impact of various educational interventions. We have developed a simple software application (Orion) using open-source tools to facilitate the identification and monitoring of resident and fellow discrepancies in on-call preliminary reports. Over a 6-month period, 19,200 on-call studies were interpreted by 20 radiology residents, and 13,953 on-call studies were interpreted by 25 board-certified radiology fellows representing eight subspecialties. Using standard review macros during faculty interpretation, each of these reports was classified as “agreement”, “minor discrepancy”, and “major discrepancy” based on the potential to impact patient management or outcome. Major discrepancy rates were used to establish benchmarks for resident and fellow performance by year of training, modality, and subspecialty, and to identify residents and fellows demonstrating a significantly higher major discrepancy rate compared with their classmates. Trends in discrepancies were used to identify subspecialty-specific areas of increased major discrepancy rates in an effort to tailor the didactic and case-based curriculum. A series of missed-case conferences were developed based on trends in discrepancies, and the impact of these conferences is currently being evaluated. Orion is a powerful information technology tool that can be used by residency program directors, fellowship programs directors, residents, and fellows to improve radiology education and training.     

A suggested method for laparoscopic herniorrhaphy resident training

Summary The learning curve for laparoscopic herniorrhaphy (LH) is relatively long. Resident training is ideal for the acquisition of operative skills and yet intensive feedback is necessary for more complex procedures. A method whereby faculty provide objective and specific feedback for the technical details of operative LH is described. First a pretest focusing on important aspects of LH and relevant anatomy is given to the resident the day prior to the procedure. Immediately following the operation, the faculty and resident complete an evaluation form together to stimulate discussion and provide constructive feedback. This method of teaching is especially applicable at the resident training level but can be utilized by postgraduate surgeons willing to undergo the criticisms associated with objective operative feedback. Instant operative feedback is beneficial for all including the faculty member who by necessity is forced to communicate in specific terms the operative steps leading to the safe and effective conduct of LH.     

Teaching residents mental health care

Objective

We tested the hypothesis that trained medical faculty can train residents effectively in a mental health care model.