PBL教学模式在康复科进修医生培训中的应用效果分析

目的分析PBL教学模式在康复科进修医生培训中的应用可行性,并研究其应用效果。方法我院于2012年开始全面推行进修医生的PBL教学模式,以2012年1-12月间参与康复科进修学习的32名医生作为对照组,行传统LBL教学模式（授课中心教学模式）,以2013年1-12月间参与康复科进修学习的35名医生作为研究组,行PBL教学模式（问题中心教学模式）。以问卷调查的方式统计进修医生对该教学模式的主观认可度,同时由带教医生设置试卷,考核进修医生对康复科医疗技术的掌握程度。结果 1观察组对培训模式的总主观认可率97.1%,对照组为75.0%,组间差异具备统计学意义（P〈0.05）;2两组进修医生入科成绩均值相近,差异不具备统计学意义（P〉0.05）,但观察组出科成绩平均（88.4±3.6）分,显著性优于对照组（78.6±2.9）分,组间差异具备统计学意义（P〈0.05）。结论应用PBL教学模式能够有效激发康复科医生的学习积极性,可促进其综合能力的提升,具备推广价值,值得临床采用。     

实验教学管理软件的研究方案

目的：开发研制实验室管理软件,形成理论教学与实验教学并重的模式。方法：应用css/div标准化结构进行登录界面的设计,建立浏览器登录界面,设置用户登录及身份验证。结果：该实验教学管理软件不仅可在网上预约实验,还能够随时查询实验课程的安排及内容,查询实验室的使用情况、实验室仪器的管理、使用情况。结论：实验教学管理软件在实现实验室的信息化管理的同时,可提高已有教学资源的利用率,促进教育教学改革的发展,对于学生科研意识及动手能力的培养起到很大作用。     

医学模拟教学基地的建设及意义

目的：探讨医学模拟教学基地建设的意义。方法：介绍我院由医学救援培训中心和临床技能培训中心两部分组成的医学模拟教学基地的基本情况。结果：医学模拟教学基地建设的意义在于理论与实践相结合,教学考核直观化;教学与服务相结合,使社会效益最大化;教学与需要相结合,突出了武警救援医学教学特色。结论：医学模拟教学基地是一种更高效、更理性化和人性化的医学教育、培训以及考核手段。     

改良喙突入路与经典喙突入路定位对锁骨下臂丛神经阻滞的影响对比

目的探讨改良喙突入路和经典喙突入路定位对锁骨下臂丛神经阻滞的影响。方法对60例择期行臂丛神经阻滞手术的患者,按随机数字表法分为观察组（采用神经刺激器定位臂丛神经）和对照组,每组30例。对照组以喙突内下2cm为穿刺点,观察组穿刺点参考喙突内下2cm,并用臂丛神经体表的投影对该穿刺点进行改良。记录两组操作时间、穿刺次数、阻滞成功率、并发症及患者的24h麻醉满意度。结果观察组操作时间明显少于对照组[（3．2±1．1）min比（4．3±1．4）min]（P〈0．05）,且观察组一次穿刺定位到神经的比率明显高于对照组[73．3％（22／30）比50．0％（15／30）]（P〈0．05）。两组阻滞成功率、并发症及患者的24h麻醉满意度比较差异无统计学意义（P〉0．05）。结论改良喙突入路可以明显提高单次穿刺定位到神经的概率,且可减少操作时间,提高了穿刺点体表定位的准确性。     

A novel individualized substrate modification approach for the treatment of long-standing persistent atrial fibrillation: Preliminary results

Background

The most effective approach for long-standing persistent atrial fibrillation (LPAF) ablation remained undetermined. Our goal was to explore the heterogeneous left atrial substrate in patients with LPAF and to evaluate the effectiveness of a novel individualized substrate modification (ISM) approach in LPAF ablation.

Methods

One hundred and twenty-four patients with LPAF were randomized to ISM group (n = 64) or stepwise ablation (SA) group (n = 60). After pulmonary vein isolation, ISM was performed in the ISM group and SA was applied in the SA group. The clinical effectiveness after a single and a repeated procedure was compared.

Results

The total procedural time was significantly shorter in ISM than that in SA. In the ISM group, mild left atrial substrate was observed in 17 (27.4%), moderate in 26 (41.9%) and severe in 19 (30.6%) patients after successful cardioversion of the 62 patients. The intention-to-treat analysis showed that sinus rhythm was maintained in 65.5% of patients in the ISM group and in 45.0% of patients in the SA group after a single procedure, P = 0.04. Atrial tachycardia (AT) recurred in 5 of 22 in the ISM group and in 20 of 33 in the SA group, P = 0.01. After a repeated procedure, 75% of patients in the ISM group and 63.3% of patients in the SA group were free of further recurrence, P = 0.16.

Conclusions

Left atrial substrate varied noticeably in patients with LPAF. The ISM approach was superior to SA approach in terms of procedural time, recurrence rate of AT and clinical effectiveness after a single procedure. However, they yielded comparable outcomes after a repeated procedure.     

The safety and efficacy of endoscopic endonasal approach in the treatment of recurrent craniopharyngioma: A protocol for systematic review and meta-analysis

Background:Craniopharyngioma is the most challenging brain tumor with a high recurrence rate. Some scholars have shown that endoscopic endonasal approach (EEA) can achieve a higher total tumor resection rate and significantly reduce the incidence of complications and mortality. However, there is still no consensus on the surgical approach for recurrent craniopharyngioma. The purpose of this study is to evaluate the safety and efficacy of EEA in the treatment of recurrent craniopharyngioma.Methods:We will search 7 electronic databases (PubMed, EMBASE, Web of Science, the Cochrane Library, PsycINFO, AMED, Scopus) to collect related randomized controlled trials (RCTs). The resection rate, recurrence rate and progression-free survival rate will be regarded as the primary outcome, and the incidence of complications will be regarded as the secondary outcome. Endnote Software X9.0 will be used to filter articles, Review Manager Software 5.2 and STATA software 16.0 will be used for analysis and synthesis.Results:We will integrate existing studies to assess the safety and efficacy of EEA in the treatment of recurrent craniopharyngioma.Conclusion:Our study will provide EEA as an effective and safe treatment for recurrent craniopharyngioma.Registration number:International Prospective Register of Systematic Reviews (PROSPERO): CRD42020199860     

经Wiltse 肌间隙入路置入椎弓根螺钉固定治疗多节段非连续性胸腰椎骨折的疗效观察

目的观察经Wiltse肌间隙入路置入椎弓根螺钉治疗多节段非连续性胸腰椎骨折的临床疗效。方法回顾性分析陆军军医大学大坪医院脊柱外科2016年9月-2019年5月收治的24例多节段非连续性胸腰椎骨折的病例资料,男性17例,女性7例;年龄29~63岁,平均44.7岁。致伤原因:高处坠落伤17例,道路交通伤7例。术中采用后路经Wiltse入路置入椎弓根螺钉固定多节段非连续性胸腰椎骨折,统计患者的手术时间、术中出血量、术后引流量、VAS评分、ODI评分情况以及术前、术后、末次随访时关键骨折椎体Cobb角等临床资料。结果患者均顺利完成手术。手术时间90~150min,平均120.8min;失血量100~240mL,平均150.6mL;术后第1天引流量为70~120mL,平均为100.5mL;术前VAS评分平均为7.6分,术后为2.3分,疼痛明显缓解;术前ODI指数平均为26.7分,术后为8.2分;术前关键骨折椎体Cobb角平均为27.8°,术后1周为9.1°,末次随访时为9.9°。术后随访3~32个月,患者症状均明显缓解,术后无医源性脊髓损伤发生,脊柱活动度正常。结论经Wiltse肌间隙入路置入椎弓根螺钉固定治疗多节段非连续性胸腰椎骨折能有效减少手术创伤,加速患者恢复,临床疗效明确。