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The clinical medical post-doctoral project is an elite post-graduation national project supported by Min-istry of Human Resources and Social Security and Health and Family Planning Commission .It is a new investiga-tion for elite medical education in new era.During the first academic year of launching this project in Peking Union Medical College Hospital ( PUMCH) , the department of internal medicine has continuously modified and developed the implementation of this project, including the setting of courses, teaching process, evaluation and feedback, basing on the feedback collecting from multiple dimensions during the process .These actions have boosted this project to be outstanding on the basis of the regular training program of residents , which has been es-tablished in the internal medicine department of PUMCH , and made it as an elite post-graduation medical educa-tion project.The process and experience of this project could provide reference for the implementation of similar projects in other teaching hospitals .
ABSTRACT
Objective To establish a new competency based evaluation and feedback system, which can evaluate real-time how the residents perform and get feedbacks for improvement .Methods Based on the situation and re-quirements of standard resident training in China , and learn from experiences of other countries, we designed a new progressive evaluation and feedback system, and use the system to evaluation 6 clinic post-doctors in internal medicine department who graduate in 2016.Results This evaluation and feedback system not only reflect a total score of each resident evaluated, but also show advantages and weakness in each competency.Conclusions To implement this progressive evaluation and feedback system into the process of standard resident training can provide a feasible way to formatively and progressively evaluation residents and help them to improve , which is of critical importance.
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Objective To observe the clinical effect of digital subtraction angiography (DSA) combined with double-chamber Fogarty catheter in venous crisis after replantation of severed extremities. Methods A total of 12 cases with venous crisis after replantation of severed extremities treated by DSA combined with double-chamber Fogarty catheter from June 2011 to January 2016 were included in this study. Results Eleven cases survived after operation. Healing status of surgical incisions was stageⅠfor all patients. Of which osteofascial compartment syndrome was found in 1 case, and it was cured by surgical incision treatment; liver damage was found in another case, and acute liver damage was treated by comprehensive treatment of internal medicine. The postoperative venous thrombosis was found again in one case. The patient underwent exploratory surgery, and venous thrombosis was found again, limb partial necrosis was found, amputation was perform, and the incision was healed in Ⅰ stage. Complications including vascular rupture, air embolism, infection and sepsis were not found in all patients. Thrombosis was presented in the vein, the length of 0.6-4.2 cm. A total of 11 patients were treated with Fogarty catheters and followed up for 11 months (7 months to 29 months). The limb shape of the patient was satisfactory, blood supply of limb was improved, and capillary filling time was 1.5-3.3 s, swelling degree was improved, skin temperature was normal or lower than the limb 0.6-1.5℃, the skin color was normal, the activity improved, the feeling of recovery S0-S4 levels, the average in the S3 + level, two-point discrimination was 3-8 mm with an average of 4.5 mm. According to the evaluation criteria of the replantation function of the limb replantation of the Chinese Medical Association, 5 cases were excellent, 4 cases were good and 2 cases were poor. Conclusion The application of DSA combined with double-chamber Fogarty balloon catheter for the treatment of venous crisis shows precise localization of thrombosis, increased targeting venous branch in blood vessels, minimally invasion, quick, and satisfactory clinical results.
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Objective To observe the clinical effect of digital subtraction angiography (DSA) combined with double-chamber Fogarty catheter in venous crisis after replantation of severed extremities. Methods A total of 12 cases with venous crisis after replantation of severed extremities treated by DSA combined with double-chamber Fogarty catheter from June 2011 to January 2016 were included in this study. Results Eleven cases survived after operation. Healing status of surgical incisions was stageⅠfor all patients. Of which osteofascial compartment syndrome was found in 1 case, and it was cured by surgical incision treatment; liver damage was found in another case, and acute liver damage was treated by comprehensive treatment of internal medicine. The postoperative venous thrombosis was found again in one case. The patient underwent exploratory surgery, and venous thrombosis was found again, limb partial necrosis was found, amputation was perform, and the incision was healed in Ⅰ stage. Complications including vascular rupture, air embolism, infection and sepsis were not found in all patients. Thrombosis was presented in the vein, the length of 0.6-4.2 cm. A total of 11 patients were treated with Fogarty catheters and followed up for 11 months (7 months to 29 months). The limb shape of the patient was satisfactory, blood supply of limb was improved, and capillary filling time was 1.5-3.3 s, swelling degree was improved, skin temperature was normal or lower than the limb 0.6-1.5℃, the skin color was normal, the activity improved, the feeling of recovery S0-S4 levels, the average in the S3 + level, two-point discrimination was 3-8 mm with an average of 4.5 mm. According to the evaluation criteria of the replantation function of the limb replantation of the Chinese Medical Association, 5 cases were excellent, 4 cases were good and 2 cases were poor. Conclusion The application of DSA combined with double-chamber Fogarty balloon catheter for the treatment of venous crisis shows precise localization of thrombosis, increased targeting venous branch in blood vessels, minimally invasion, quick, and satisfactory clinical results.
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<p><b>OBJECTIVE</b>To observe the clinical efficacy and safety of sildenafil in the treatment of high altitude heart disease associated with severe pulmonary arterial hypertension (PAH) in children.</p><p><b>METHODS</b>Fifty children (aged 2 months to 2 years) with high altitude heart disease associated with severe PAH, who were continuously transferred to the Intensive Care Unit between January 2011 and October 2013, were randomly assigned to observation and control groups. The control group was given conventional treatment, while the observation group received oral sildenafil [1 mg/(kg . d)] three times daily for 7-10 days in addition to the conventional treatment. Before and after treatment, hemodynamics, blood gas, routine blood parameters, and blood biochemical parameters were recorded.</p><p><b>RESULTS</b>After treatment, the observation group had a significantly higher decrease in mean pulmonary artery pressure and significantly higher increases in arterial partial pressure of oxygen, cardiac output, cardiac index, and oxygenation index compared with the control group (P<0.05). In the observation group, there were no significant changes in mean arterial pressure, routine blood parameters and blood biochemical parameters (P>0.05), and no obvious adverse reactions were found.</p><p><b>CONCLUSIONS</b>For children with high altitude heart disease associated with severe PAH, sildenafil can effectively reduce pulmonary artery pressure and improve cardiac function and does not cause adverse reactions. This therapy has good safety according to the preliminary evaluation.</p>