Objective To explore the application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians, and compare it with traditional rotational training. Methods Continuing physicians who received training in the Department of Neurology of Xuanwu Hospital, Capital Medical University between March 2021 and February 2023 were selected. The continuing physicians who received traditional rotational training between March 2021 and February 2022 would serve as the control group, and the continuing physicians who received four-dimensional teaching library model training between March 2022 and February 2023 would serve as the experimental group. The Mini-CEX scale was used to evaluate the clinical comprehensive abilities of two groups of continuing physicians. At the same time, self-made questionnaires were used to evaluate the evaluation of two groups of continuing physicians on different teaching modes. Results A total of 55 continuing physicians were included. Among them, there were 27 people in the control group and 28 people in the experimental group. There was no statistically significant difference in the comparison of general information between the two groups (P＞0.05). At the time of graduation, all items on the Mini-CEX scale in the experimental group were higher than those in the control group (P<0.05). The survey questionnaire results showed that the experimental group scored higher than the control group in terms of improving learning interest, improving self-learning ability, improving clinical thinking, improving analysis and problem-solving ability, improving doctor-patient communication ability, and increasing teamwork (P<0.05). Conclusion The application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians is better than that of traditional rotational training, which can significantly improve the clinical comprehensive ability of continuing physicians and is worth promoting.
目的 了解醫院內血源性職業暴露高風險人群，有針對性采取防護措施，降低血源性職業暴露的發生率。 方法 對2008年1月－2011年12月四川省婦幼保健院52例血源性職業暴露醫務人員，按照暴露人群、暴露方式、暴露病種、暴露地點的不同進行調查分析。 結果 52例職業暴露人群中護士27例（占51.9%）；產房和手術室為高發職業暴露場所，共32例，分別為17例（占32.7%）和15例（占28.8%）；職業暴露病種主要為乙型肝炎，共27例（占51.9%）；暴露方式主要為針刺傷，共37例（占71.2%）。 結論 提高醫務人員職業防護意識，規范操作流程，加強自身防護是減少職業暴露的根本所在。
在過去二十年間，麻醉技術和手術技術的改進使肺部惡性腫瘤患者的手術死亡率大大降低，但術后并發癥仍是主要問題。肺切除術后的常見并發癥是肺部并發癥[1]，主要表現是低氧血癥，尤其在肺功能減退的肺切除患者中發病率更高[2]。目前國內對低氧血癥的診斷缺乏統一的診斷標準，一些作者采用Russell等[3]提出的標準，吸空氣氧的情況下，患者動脈血氧飽和度（SpO2）≤92%，大于30 s就可診斷為術后低氧血癥。也有作者建議[4]將一次或以上血氣檢查PaO2lt;8 kPa或PaO2/FiO2lt;300 mm Hg（1 mm Hg=0.133 kPa）作為診斷低氧血癥的標準。30%~50%的術后患者可發生低氧血癥，一般認為這樣的低氧血癥是一過性的，對大多數患者是無害的[5]。但如果合并心腦或其他器官動脈硬化或其他原因的血管阻塞，這種低氧血癥就是很危險的[6]。常見低氧血癥的原因是肺萎陷不張和誤吸、心源性肺水腫、靜脈輸入液體過量、通氣血流比例失調和急性肺損傷/急性呼吸窘迫綜合征（ALI/ARDS）[7]，其中ALI/ARDS是肺切除術后患者死亡的主要原因[8-10]。
【摘要】 目的 探討并分析導致肺曲霉病患者誤診的原因，為早期診斷并及時正確治療提供科學的依據。 方法 回顧性分析2010年1-4月間確診為肺曲霉病的3例患者在診治過程中被誤診的原因。 結果 3例患者均缺乏明顯的特異性臨床表現和影像學表現，最后確診均依據病理學活檢證實。 結論 肺部的曲霉菌感染缺乏特異性的臨床和影像學表現，及早行纖維支氣管鏡檢查或肺組織活檢可提高早期診斷率。【Abstract】 Objective To analyze the misdiagnostic causes of pulmonary aspergillosis. Methods The clinical data of three patients with pulmonary aspergillosis from January to April 2010 were retrospectively analyzed, and the misdiagnostic causes were analyzed. Result No specific clinical and imaging findings were found in the three patients, and pulmonary aspergillosis was finally diagnosed according to the pathological biopsy. Conclusion Pulmonary aspergillus lacks specific clinical and imaging manifestations; early fiberoptic bronchoscopy or pulmonary biopsy may improve the rate of accurate diagnosis.
Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia, including clinical diagnostic criteria, evaluation of biomarkers, ventilator associated events, clinical pulmonary infection score, ventilator-associated tracheobronchitis, microbiological diagnosis and duration of therapy were discussed. The viewpoints in the guidelines of America, Europe and Japan were also reviewed.
Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.
Abstract： Objective To compare minimally invasive technique with multiple short incisions and traditional open technique for great saphenous vein (GSV) harvesting in coronary artery bypass grafting (CABG). Methods Fortyseven patients underwent first time CABG between November 2007 to January 2009. These patients included 37 males and 10 females with their age ranged from 43 to 78 years and their average age was 61.3±84 years old. The patients were prospectively randomized into the minimally invasive harvesting group (group A,n=21) and the traditional open harvesting group (group B, n=26). For group A, we adopted the method of minimally invasive technique with multiple short incisions, while for group B, the traditional long incisions were adopted. The incision length, GSV harvesting time, lower limbs suture time and incision complications were compared between the two groups. Results During harvesting, no injury to the saphenous vein trunk or complications related to the quality of venous grafts occurred in both groups. There were no significantly differences in the number of venous grafts and the GSV length between the two groups. Group A had significantly longer GSV harvesting time than group B (51.9±11.5 min vs. 40.3±7.6 min,P=0.000). However, incision length (16.1±4.1 cm vs. 49.2±7.2 cm, P=0.000), incision suture time (11.0±3.0 min vs. 33.6±4.8 min,P=0.000) and lower limbs total operation time (62.6±14.9 min vs.73.8±11.6 min,P=0.006) in group A were much shorter than those in group B. Fortyseven patients were followed up (100%) and the followup time ranged from 3 to 26 months. The rate of leg wound complications such as serous exudates, hematomas and wound infection was 4.8% (1/21) in Group A and 34.6% (9/26) in Group B. These complications were all cured with additional treatments. Group A had lower leg wound complication rate than Group B (Plt;0.05). Conclusion Our study demonstrates that minimally invasive technique for GSV harvesting can be performed at a satisfactory speed and helpful in decreasing the lower limb incision complication rate.
ObjectiveTo briefly describe the specific contents of the “four-dimensional integration” standardized training model for neurology residents and analyze the implementation effects.MethodsSince September 2019, the Standard Training Center for Residents in Department of Neurology, Xuanwu Hospital of Capital Medical University trained residents under “four-dimensional integration” standardized training model, including primary knowledge teaching, basic skill training, clinical thinking training, and student group learning. The effect of the “four-dimensional integration” model was measured by comparing the midterm assessment results after four months of training of the resident trainees in Grade 2019 under the “four-dimensional integration” training mode (n=37) with those of the resident trainees in Grade 2018 under regular training mode (n=32). The midterm assessment was conducted through standardized and objective clinical examinations, including three evaluations (theory, skills, and clinical drills), and the pass rate of tests was evaluated through Fisher’s exact probability method for comparison between training groups.ResultsThere was no significant difference in the pass rate of theoretical assessment (100.0% vs. 96.9%, P=0.464) or the pass rate of Mini-Clinical Evaluation Exercise (100.0% vs. 90.6%, P=0.095) between the two groups. The pass rate of skill assessment in Grade 2019 was significantly higher than that of the students in Grade 2018 (94.6% vs. 71.9%, P=0.018).ConclusionThe “four-dimensional integration” standardized training model for neurology residents and it effect are worthy of recognition, which can provide a reference for medical teaching, especially for the standardized training of resident physicians.
目的 調查四川省婦幼保健院醫院感染發生情況及影響因素，以改進醫院感染發病率監測方法與醫院感染預防和控制措施。 方法 對2011年9月19日0：00～24：00所有住院患者進行調查，包括當日出院、轉院、死亡的患者，但不包括新入院患者，使用全國醫院感染監控網統一設計的調查表，采用床旁調查和查閱病歷相結合，對調查結果進行統計分析。 結果 應調查住院患者112例，實際調查109例，實查率為97.3%；發生醫院感染4例，現患率為3.7%。醫院感染部位以呼吸道為主，抗菌藥物使用率為64.2%。 結論 通過醫院感染現患率調查，可以在短期內全面了解醫院感染的現狀，針對性的制定醫院感染監控措施，預防和控制醫院感染的發生。
Objective To analyze symptoms, associated anomalies, diagnostic approach, and surgical procedures in patients with unroofed coronary sinus syndrome (UCSS), a rare congenital disorder. Methods The clinical, echocardiographic, operative, and followup data on 44 patients with unroofed coronary sinus syndrome (typeⅠin 15，typeⅡin 9，type Ⅲ in 5 and type Ⅳ in 15) between May 1998 and January 2008 were reviewed retrospectively. The initial diagnosis of unroofed coronary sinus syndrome was made by echocardiography in 12 patients, by the surgeon at repair of other congenital cardiac anomalies in 32 patients. The patients underwent cardiovascular surgery at Fu Wai hospital. Left superior vena cava(LSVC) directly drains into the left atrium (LA) were found in 15 cases, LSVC was ligated in 1 case, the intracardiac tunnel to drain LSVC to right atrium (RA) were reconstructed in 14 cases. The associated cardiac lesions were corrected concomitantly. Results There were 3 hospital deaths. One patient died of low cardiac output syndrome and 2 patients died of pulmonary infection. One case was applied diaphragm plication because of right diaphragm paralysis after the heart operation and the hospital stay was 70 days.The other 40 cases had good surgical result. The average time of extubation was 11.7±12.1 h and hospital stay was 8.1±2.8 d. In the 32 cases, who have been followed up from 4 months to 10 years, there was no death and severe complications. Conclusion Unroofed coronary sinus syndromes are often missed in the preoperative evaluation of congenitally malformed hearts. When associated with LSVC, unroofed coronary sinus syndrome should be considered as a possible additional finding.We performed different surgical approaches to deal with the different kinds of LSVC with a good result.