目的 探讨急性重症胰腺炎不同时期的治疗方式，观察治疗效果以及治疗前后的临床表现。 方法 回顾性分析2006年1月-2009年1月收治的34例急性重症胰腺炎患者的临床资料，患者给予内科规范化治疗，并对比治疗前、后的APACHEⅡ评分、主要的实验室检查指标以及CT检查表现。 结果 31例治愈，2例中途转外科治疗，1例死亡。所有患者治疗后APACHEⅡ评分较治疗前减小（Plt;0.01），治疗后血清淀粉酶和白细胞计数较治疗前明显降低（Plt;0.05），而治疗后短期内CT检查表现无明显变化。 结论 内科规范化治疗能有效地治疗急性重症胰腺炎，适当的肠内外营养和预防性使用抗生素可有效地减少急性重症胰腺炎并发症的发生。APACHE-Ⅱ评分可作为判断急性重症胰腺炎患者预后的指标。
Objective To improve the satisfaction of standardized remote consultation of epilepsy center in patients with refractory epilepsy, and initially establish a standardized remote consultation model of three-level comprehensive epilepsy center. Methods Based on the characteristics of our epilepsy center, we designed a set of standardized remote consultation process of epilepsy center in tertiary hospitals, including sorting out patient data before consultation, improving examination, application of multi-modal technology during consultation, notification of results after consultation, and decision of operation time and method. A total of 209 patients who received remote consultation in our epilepsy center from January 2022 to June 2023 were selected as the observation group, and 150 patients who received offline consultation in our epilepsy center during the same period were randomly selected as the control group. The satisfaction of patients in the two groups on the service of doctors and nurses in consultation and the consultation results were compared. Results Through the application of the new multi-modal remote consultation mode, the number of consultations gradually increased, Compared with the offline consultation mode, there was no significant difference in patients' satisfaction with the service of doctors and nurses in remote consultation mode (P<0.05). Conclusion The establishment of standardized remote consultation mode in epilepsy center has effectively reduced the economic burden of patients, simplified the medical treatment process and improved the service quality, but the consultation quality has not been affected.
ObjectiveTo standardize the techniques for laparoscopic radical rectal resection and discuss its application prospect. MethodsThe clinical data of 433 patients who underwent laparoscopic radical rectal resections from July 2003 to December 2010 in our hospital were reviewed retrospectively, and the different surgery procedures and the development prospect were explored. ResultsFive cases (1.2%) underwent handassistant laparoscopic procedures, 412 cases (95.2%) were done by laparoscopic-assisted operation, and the specimens were taken out with transanal pull-through technique in 16 cases (3.7%). In all of them, conversion to open procedures occurred in 11 patients (2.5%), and 290 (67.0%) patients were followed-up in 1 to 6 years, average in 2.7 years. Local recurrence occurred in 7 (2.4%) patients, while distant metastasis were diagnosed in 22 （7.6%） cases, and the overall mortality was 15.9% (46/290). There was no port-site metastasis occurred. ConclusionsFour-port laparoscopic rectal resection technique is also the clinical mainstream. Standardized laparoscopic procedure for rectal resections enhances the transformation of laparoscopic skills, and makes the operation predictable. Single incision procedure and natural orifice transluminal endoscopic surgery are future direction to explore.
目的 研究自体动静脉内瘘全程规范化护理的可实施性及优势。 方法 制定自体动静脉内瘘全程规范化护理工作流程及标准，将2011年6月－8月经自体动静脉内瘘行维持性血液透析患者随机分为观察组（125例）和对照组（115例），分别予以全程规范化护理和普通护理，对比分析两组之间内瘘不良事件发生率、患者满意度、护士认同度等指标的差异。 结果 两组内瘘不良事件发生率分别为8.0%和21.0%，患者满意度分别为98.4%和84.3%，差异均有统计学意义（P＜0.05）；两组护士对本组护理模式认同度均为90.0%，差异无统计学意义（P＞0.05）。 结论 自体动静脉内瘘全程规范化护理模式能有效降低内瘘不良事件发生率并显著提高患者满意度，值得临床推广。
ObjectiveTo analyze the status of scientific papers published by clinical medicine postgraduates during the "double-track integration" training period. MethodsData of publications of 634 clinical medicine postgraduate students who were been trained in the "double-track integration" system in West China School of Medicine, Sichuan University from 2015 to 2017 were collected. The data of the papers published during the concurrent training and residency were retrospectively analyzed. Results634 postgraduates with master degree in clinical medicine published 1 038 papers in total. Students from 3 grades published 1.606, 1.554 and 1.785 papers on average respectively, and the overall average number of publications was 1.637 per person. The composition ratios of the journal types of articles were: SCI, 37.96%; MEDLINE, 6.55%; Chinese core journals, 55.49%. Statistical differences were found in the types of journals published in the three grades. The composition ratios of article types were: case report, 24.56%; review, 34.01%; original study, 41.43%. There was no statistical difference in the composition of article types in 3 grades. All 634 graduate students met the requirements for thesis publication and succeeded in completing the training. ConclusionsIn the "double-track integration" training system, postgraduates with master degree in clinical medicine can meet the training requirements of publishing relevant articles prior to graduation.
Objective To explore a new rotation training mode suitable for residency standardized non-professional radiological trainees in radiology department, so as to improve the training quality. Methods The residency standardized non-professional radiological trainees who rotated in the Department of Radiology, West China Hospital, Sichuan University between June 2021 and January 2022 were retrospectively included as the research objects. According to the training mode, they were divided into traditional training mode group and innovative training mode group. The training results of the two groups were compared by taking process assessment, final examination and final score as evaluation indicators. Results Finally, 122 residents were included, including 45 in the traditional training model group and 77 in the innovative training model group. There was no significant difference in gender, major, identity and grade between the two groups (P>0.05). There was no significant difference between the two groups in the first film reading skill examination and their usual homework performance (P>0.05). The score of the second film reading skill examination [15 (14, 16) vs. 12 (11, 13)], the score of the final examination [34 (31, 36) vs. 29 (25, 31)] and the final score [80 (76, 83) vs. 71 (67, 74)] in the innovative training mode group were better than those in the traditional training mode group (P<0.05). Conclusion The innovative training mode of online teaching platform combined with offline teaching can improve the training effect of residency standardized non-professional radiological trainees in radiology department.
Objective To explore the mental health status and influencing factors of clinical medical students pursuing a professional master’s degree under the “dual-track integration” training systems. Methods Clinical medical students pursuing a professional master’s degree who underwent residency standardized training in 123 hospitals from different areas of China were selected as the research objects from May 28th to June 4th, 2024, and the mental health and stress were investigated by questionnaire. Results A total of 1195 clinical medical students pursuing a professional master’s degree were included. Symptom Checklist-90 analysis showed that 582 (48.7%) master students had mental health problems. The two-group students (with and without psychological problems) had statistical differences in exercise frequency, sleep quality, extent of staying up late, interpersonal communication, and average number of night shifts per month (P<0.001). The subjective scores of interpersonal pressure, economic pressure, love and marriage pressure, schoolwork pressure, scientific research pressure, clinical work pressure, entering higher education pressure and employment pressure, and the proportion of graduating from 985/211 university of the master students with psychological problems were significantly higher than those of the master students without psychological problems (P<0.001). Logistic regression analysis showed that poor sleep quality [odds ratio (OR)=1.626, 95% confidence interval (CI) (1.085, 2.438), P=0.019], 985/211 university degree [OR=1.448, 95%CI (1.097, 1.910), P=0.009], interpersonal pressure [OR=1.194, 95%CI (1.121, 1.272), P<0.001], love and marriage pressure [OR=1.067, 95%CI (1.014, 1.122), P=0.012] and entering higher education pressure [OR=1.110, 95%CI (1.055, 1.167), P<0.001] were independent risk factors, while the male sex [OR=0.621, 95%CI (0.472, 0.817), P=0.001] were protective factor for psychological problems of these medical students. Conclusions Under the “dual-track integration” training systems, the clinical medical students pursuing a professional master’s degree have a higher prevalence of psychological problems, especially the females and the 985/211 bachelor’s degree scholars. It is important to improve sleep quality, strengthen interpersonal interaction and reduce pressure load to improve the mental health level of these clinical medical students.
Objective To explore the mental health status and the relevant influencing factors of the resident standardized trainees, and to provide reference for the psychological intervention. Methods All the resident standardized trainees in a first class of the third grade hospital in Sichuan from July 2012 to August 2015 were investigated by the questionnaire including symptom checklist 90, demographic characteristics and work condition. Results The detection rate of psychological problem among resident standardized trainees was 24.7% which was higher than the general population. The analysis of logistic regression showed that the training grade, identity, work time and working achievement were the main factors related to psychological problems. Conclusions The psychological problems of resident standardized trainees were prominent because they are in a transformation stage from medical students to clinical doctors. The related department should pay more attention and take measures to improve the resident standardized trainees’ mental health.
ObjectiveTo explore medical waste management method in a large hospital and strengthen the standardized management of medical waste. MethodsBetween July 2012 and December 2014, according to the PDCA cycle working procedures, existing problems were found in medical waste management through survey, the cause of which was analyzed to formulate and implement a new system of medical waste management, to help carry out employee training and cross examination, and give feedback to clinical departments to make improvements. Then, we analyzed the awareness rate of medical waste-related knowledge among medical staff, accuracy rate of medical waste disposal, average daily medical waste amount before and after the application of PDCA cycle to evaluate the effect of the measures taken. ResultsAwareness rate of medical waste-related knowledge among medical staff (2012:55.59%, 2013:62.89%, 2014:94.43%) increased with statistical significance (χ2=410.871, P<0.001). Accuracy rate of medical waste disposal (2012:69.83%, 2013:87.29%, 2014:94.91%) increased with statistical significance (χ2=197.449, P<0.001). Rank correlation analysis showed that average daily medical waste amount declined as average daily inpatients number increased (rs=?0.590, P<0.001). ConclusionUsing PDCA cycle can improve the awareness rate of medical waste-related knowledge and accuracy among medical staff to achieve continuous quality improvement of medical waste management.