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Standardized training of specialists is an important part of medical education system. The training goal is to cultivate high-quality specialists with high clinical practice ability, teaching and scientific research ability. Based on the training practice of clinical, teaching and scientific research ability of the standardized training of cardiovascular specialists in Peking University Third Hospital, this paper discusses how to establish and improve the quality management system of cardiovascular specialist training, and introduces the training content, training methods, training organization and management, and training effect respectively, hoping to provide more practical basis for improving the quality of standardized training for cardiovascular specialists.
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Standardized training for specialist is recognized as the growth pathway to clinical medical experts worldwide. The United States has established a comprehensive specialist training system with a detailed assessment and evaluation system. This article introduces the evaluation tools of competency-oriented nephrology specialist training in the United States, including milestones evaluation system and EPAs (entrustable professional activities), which is of great significance for improving the evaluation tools of specialist training in China.
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The national outbreak of coronavirus disease 2019 (COVID-19) has brought a severe challenge to the management of standardized residency training (SRT). To protect SRT residents from being infected by 2019 novel coronavirus (2019-nCoV), to guarantee the training program well carried out, and to prevent psychological health problems are conundrums to the management of SRT. In this article, the specific countermeasures are introduced from the following aspects: perfecting the management system, implementing quarantine and life support, conducting epidemic prevention and control training, turning training patterns suitable to epidemic prevention, and maintaining the psychological health of the residents. And we expect to provide references for SRT management under the public health emergency in the future.
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Objective:To explore the difficulties and measures of clinical medical postgraduates management during the national prevention of COVID-19 pandemic.Methods:This study mainly used the document review, interview and questionnaire survey methodologies, to investigate the clinical medical postgraduates school situation, online teaching, training, scientific research, psychological state during prevention of COVID-19 emergency.Results:Up to February 14, 2020, the return rate of professional degree postgraduates was 92.8% (256/276). The average score of postgraduates participating in epidemic prevention and control training was 86.59. The effect of online learning was basically the same as that of face-to-face classroom teaching. Up to March 6, 2020, the in-hospital submission rate of postgraduates’ thesis was 50.0% (65/130). Facing the pressures of COVID-19 emergency, 62.6% professional degree postgraduates (124/198) and 35.4% (70/198) academic postgraduates suffered some anxiety or depression, the difference was statistically significant ( P<0.05). Conclusions:During the COVID-19 prevention and control period, it is important to innovate work style, found the linkage system of education department-clinical department-tutor-postgraduates, pay attention to physical and mental health of postgraduates, ensure the quality of teaching, adopt various measures to do well in the education and management of clinical medical postgraduates.
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Objective@#To determine the early recognizable factors related to patients with fulminant myocarditis.@*Methods@#Medical records from 60 adult patients who were diagnosed with acute viral myocarditis from January 2003 to September 2016 in our hospital were retrospectively reviewed, and divided into the fulminant group (n=9) and the non-fulminant group (n=51). Clinical presentations, biochemical markers, electrocardiography and echocardiography features on admission were analyzed.@*Results@#Prevalence of syncope (33.3%(3/9) vs. 2.0% (1/51), P=0.009) and fatigue (77.8% (7/9) vs. 21.6% (11/51) , P=0.002) was significantly higher, while the duration from flu-like syndromes to chest discomfort was shorter ((2.0±1.8) days vs. (4.5±3.5) days, P=0.041) in the fulminant group than that in the non-fulminant group. Systolic blood pressare (SBP) ((94±14) mmHg(1 mmHg=0.133 kPa) vs. (117±12)mmHg, P=0.001) and left ventricular ejection fraction((49±12)% vs. (60±13)%, P=0.016) were significantly lower, while heart rate ((99±20)bpm vs. (84±19)bpm, P=0.040) and NT-proBNP concentration ((7 962 (1 470, 23 849) ng/L vs. 1 771 (45, 2 380) ng/L, P=0.000) were significantly higher in the fulminant group than those in the non-fulminant group. PR interval was longer (199 (140, 416) ms vs. 156 (112, 204) ms, P=0.021), QRS complex was wider ((127±14)ms vs. (95±13)ms, t=-6.647, P<0.001) in the fulminant group than those in the non-fulminant group. Prolonged QRS duration≥120 ms was more often in fulminant group (77.8%(7/9) vs. 5.9%(3/51), P=0.000). Multivariate analysis revealed that PR interval (adjusted odd ratio 1.044, 95%CI 1.005-1.084, P=0.025) and QRS complex width (adjusted odd ratio 1.252, 95%CI 1.045-1.501, P=0.015) were the independent risk factors significantly associated with fulminant myocarditis.@*Conclusions@#The risk of a fulminant course of acute myocarditis is higher in patients with elevated NT-proBNP, reduced left ventricular ejection fraction, and conduction disturbances at admission. Prolonged PR interval and widened QRS complex on admission are independent risk factors for developing fulminant myocarditis in adult patients with acute viral myocarditis.
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<p><b>BACKGROUND</b>Many studies have shown that the serum uric acid (SUA) level is one of the cardiovascular risk factors. The aim of the study is to evaluate the relationship between SUA levels and the severity of coronary artery disease (CAD) assessed by angiography and the Syntax score in patients with obstructive CAD.</p><p><b>METHODS</b>Participants who visited our hospital for a coronary angiography, from December 2007 to September 2012, were eligible for this analysis. SUA and other blood parameters after at least 12-hour fast were determined. First, the patients were divided into tertiles according to their Syntax scores (low Syntax score group: Syntax score ≤ 10.0; moderate Syntax score group: 10.0 <Syntax score ≤ 18.0; high Syntax score group: Syntax score >18.0). Second, to clarify the association between SUA levels and major adverse cardiovascular events (MACEs), all patients were divided into two subgroups on the basis of SUA levels. The cutoff value of SUA was defined by diagnostic criteria of hyperuricemia. Patients were separated into normal SUA group (n = 251, with SUA <416 µmol/L for men and SUA <357 µmol/L for women) and high SUA group (n = 96, with SUA ≥ 416 µmol/L for men and SUA ≥ 357 µmol/L for women). All participants were followed for a mean of 22.0 months (1-75 months, interquartile range: 28 months) for major adverse cardiovascular events (MACEs), including all-cause death, recurrent nonfatal myocardial infarction (re-MI) and recurrent percutaneous coronary intervention (re-PCI).</p><p><b>RESULTS</b>A total of 347 patients were registered for the study. The SUA levels in the high Syntax score group were significantly higher than that of the moderate Syntax score group and the low Syntax score group ((392.3 ± 81.6) µmol/L vs. (329.9 ± 71.0) µmol/L, P < 0.001; (392.3 ± 81.6) µmol/L vs. (311.4 ± 64.7) µmol/L, P < 0.001). The SUA level was positively correlated not only with the Syntax score (r = 0.421, P < 0.001; 95% CI: 0.333-0.512), but also with the number of diseased vessels (r = 0.298, P < 0.001; 95% CI: 0.194-0.396). After multiple linear regression analysis, SUA levels were identified to be independently correlated with a high Syntax score (B = 0.033, 95% CI 0.023-0.042, P < 0.001). Compared with the normal SUA subgroup, the high SUA subgroup tended to have a higher Syntax score (19.9 ± 8.7 vs. 13.6 ± 7.5, P < 0.001) and more multi-vessel disease (70.8% vs. 46.6%, P < 0.001). Follow-up data showed a higher incidence of MACE in the high SUA subgroup (20.8% vs. 6.0%, P < 0.001). Binary Logistic regression analysis indicated that the elevated SUA can predict the long-term prognosis of patients with obstructive CAD (OR = 2.968, 95% CI 1.256-7.011, P = 0.013). Kaplan-Meier analysis showed a significantly lower event-free survival rate in patients with high SUA levels than in the normal SUA subgroup (79.2% vs. 94.0%, Log rank = 17.645, P < 0.001).</p><p><b>CONCLUSIONS</b>SUA levels were independently associated with the severity of CAD in patients with obstructive CAD. An elevated SUA is associated with cardiovascular events and may be useful as a biomarker of the severity of CAD.</p>
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Aged , Female , Humans , Male , Middle Aged , Arterial Occlusive Diseases , Blood , Mortality , Coronary Artery Disease , Blood , Mortality , Kaplan-Meier Estimate , Uric Acid , BloodABSTRACT
Objectives To evaluate the prognostic value of the coronary artery calcium (CAC) score in patients with stable angina pectoris (SAP) who underwent percutaneous coronary intervention (PCI). Methods A total of 334 consecutive patients with SAP who underwent first PCI following multi-slice computer tomography (MSCT) were enrolled from our institution between January 2007 and June 2012. The CAC score was calculated according to the standard Agatston calcium scoring algorithm. Complex PCI was defined as use of high pressure bal-loon, kissing balloon and/or rotablator. Procedure-related complications included dissection, occlusion, perforation, no/slow flow and emer-gency coronary artery bypass grafting. Main adverse cardiac events (MACE) were defined as a combined end point of death, non-fatal myo-cardial infarction, target lesion revascularization and rehospitalization for cardiac ischemic events. Results Patients with a CAC score>300 (n=145) had significantly higher PCI complexity (13.1%vs. 5.8%, P=0.017) and rate of procedure-related complications (17.2%vs. 7.4%, P=0.005) than patients with a CAC score≤300 (n=189). After a median follow-up of 22.5 months (4-72 months), patients with a CAC score≤300 differ greatly than those patients with CAC score>300 in cumulative non-events survival rates (88.9 vs. 79.0%, Log rank 4.577, P=0.032). After adjusted for other factors, the risk of MACE was significantly higher [hazard ratio (HR):4.3, 95%confidence inter-val (95%CI):2.4-8.2, P=0.038] in patients with a CAC score>300 compared to patients with a lower CAC score. Conclusions The CAC score is an independent predictor for MACE in SAP patients who underwent PCI and indicates complexity of PCI and proce-dure-related complications.
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Holistic education is an important philosophy of medical education.Medical graduate students can show their skills of medical specialties,improve their abilities of communication and cooperation,and promote their sense of social responsibility through social practice.Through conducting questionnaire among medical graduate students of Peking University Third Hospital who major in internal medicine,we have got to know the effect of social practice on holistic education philosophy.Meanwhile,social practice is a crucial approach to implementing holistic education.
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Objective To analyze the relationship between fasting plasma glucose (FPG) level and complexity of coronary artery lesions in patients with coronary stenosis by angiography. Methods The data of clinic and coronary angiogram (CAG) were retrospectively collected in 929 patients with established coronary stenosis by coronary angiography at Peking University Third Hospital from January 2009 to January 2011. The patients were grouped according to SYNTAX score, and the relationship between FPG level and SYNTAX score were analyzed using bivariate, Multivariate stepwise regression and logistic regression analysis. Results ①929 patients were devided into three groups:47 cases into low risk group (score<22), 189 into moderate risk group (score≥22 and<33) and 639 into high risk group (score≥33). Intergroup analysis showed that age (P=0.000), FPG level [5.20 (4.70,6.30) mmol/L, 5.70 (4.90,7.15) mmol/L, 5.80 (5.30,7.60) mmol/L, P=0.000], proportions of FPG abnormality [283 (40.8%), 100(52.9%), 28(59.6%), P=0.001] and patients with diabetes history (P=0.003) were increased along with SYNTAX score elevated.②Correlation analysis showed correlativity (r=0.167, P=0.000) between SYNTAX score and FPG. In non-diabetes history subgroup, correlation between SYNTAX score and FPG remained signiifcant (r=0.149, P=0.000). However, in diabetes history subgroup, the correlation was not significant. ③ Multivariate stepwise regression analysis showed an independent correlation between FPG and SYNTAX score (β=0.452, P=0.002). In non-diabetes history subgroup, the correlation remained significant (β=1.039, P=0.000).④ When moderate-high risk group serve as dependent variable, and age, gender, CAD risk factors and FPG serve as independent variables, logistic regression analysis screened out two variables:age (whole group:OR 1.033, 95%CI 1.017 ~ 1.049, P=0.000;non-diabetes history subgroup:OR 1.039, 95%CI 1.020 ~ 1.059, P=0.000) and FPG (whole group: OR 1.114, 95% CI 1.038 ~ 1.195, P=0.003; non-diabetes history subgroup:OR 1.299, 95%CI 1.088 ~ 1.387, P=0.001). Conclusions FPG is likely to relfect complexity of coronary artery lesions and predict SYNTAX score in patients with coronary stenosis, especially in patients without diabetes history.
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Objective To examine the association between serum resistin levels and the severity of coronary artery lesions and cardiovascular risk factors in postmenopausal women.Methods The study population consisted of 117 postmenopausal women who underwent diagnostic coronary angiography for evaluation for suspected myocardial ischemia.Fasting serum resistin,insulin,blood glucose(BG),high-sensitive C-reactive protein(hs-CRP),fibrinogen(Fib)and lipid profile,including total cholesterol(TC),triglycerides(TG),HDL-cholesterol(HDL-C),LDL-cholesterol(LDL-C),apolipoprotein A1(Apo A1),apolipoprotein B(Apo B)and lipoprotein(a)(Lp(a))were measured in all the patients.Patients were divided into four groups according to the score of their coronary artery lesions:group Ⅰ included patients with coronary artery lesion score 0(no evidence of CAD),while group Ⅱ with score 1(mild lesion),group Ⅲ with score 2(moderate lesion),and group Ⅳ with score 3(severe lesion).Only patients with moderate to severe coronary lesions were diagnosed as coronary artery disease(CAD).Results Among the 117 patients,74 were diagnosed as CAD patients.Patients with CAD had significantly higher levels of resistin compared with controls:[4(1-10)?g/L vs 2(0-4)?g/L,median(interquartile range),P=0.002].In multiple logistic regression analysis,resistin levels were associated with CAD independent of age,BMI,metabolic syndrome,history of hypertension(HTN),diabetes(DM),dyslipidemia,smoking,SBP,DBP,hs-CRP,lipids [TC,TG,HDL-C,Apo A1,Apo B,Lp(a)],Fib,BG and insulin(OR 1.131,95%CI 1.012-1.263,P=0.030).Resistin levels correlated positively with CAD lesion severity in postmenopausal women(r=0.231,P