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Objective:To compare the patient-centered doctor-patient communication skills in anesthesiologists with different working experience and genders.Methods:The second and third year residents who had been trained as residents in the Department of Anesthesiology in our hospital from September 2017 and September 2018 and senior physicians who had worked for 10-15 yr in our hospital, were recruited to perform a preoperative interview in a standardized patient counter.Consultation and Relational Empathy (CARE) measure was used to assess the communication skills among senior physicians, residents, and anesthesiologists of different genders.The residents also took the objective structured clinical examination (OSCE) and theory examination.Results:Thirty-six residents and 20 senior physicians were included.There was no significant difference in the CARE measure score between residents and senior physicians and in the total CARE measure score between residents who received doctor-patient communication training at the stage of medical students and those who did not ( P>0.05). Compared with the residents in the second year, the listening ability score and decision-making ability score were significantly decreased ( P<0.05), and no significant change was found in the scores for the other items in the residents in the third year ( P>0.05). Compared with residents, the listening ability scores were significantly increased, and the caring ability scores were decreased ( P<0.05), and no significant change was found in the scores for the other items in senior physicians ( P>0.05). There was no difference in CARE measure scores between the male and female anesthesiologists.The resident′s CARE measure score was positively correlated with the annual OSCE score ( r=0.486, P<0.05), and there was no correlation between the resident′s CARE measure score and annual theoretical examination grade ( r=0.308, P>0.05). Conclusion:Senior anesthesiologists with more clinical experience are not superior to the junior residents in patient-centered communication skills, and the doctor-patient communication skills of residents are not related to their medical theoretical grade.Moreover, there is no significant difference between male and female anesthesiologists in terms of doctor-patient communication skills before surgery.Therefore, training of patient-centered doctor-patient communication skills should be strengthened at all levels of anesthesiologists.
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Objectives To validate the reliability of the Chinese version of the Consultation and Relational Empathy (CARE) in physician-standardized patient (SP) encounter. We also tried to examine the agreement between video-based ratings and in-room ratings, as well as the agreement between the faculty ratings and SP ratings. Methods The CARE was translated into Chinese. Forty-eight anesthesia residents were recruited to make preoperative interview in SP-counter. Performance of each resident was graded by in-room raters, video raters and SP raters. Consistency between different raters was examined. Results The Chinese-CARE measure demonstrated high scale reliability with a Cronbach's alpha value of 0.95 and high consistency in the in-room ratings in intraclass correlation (coefficient=0.888,
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Objective To investigate the anesthesia residents' proficiency in the epidural puncture and training needs using questionnaire survey in China.Methods A questionnaire designed by ourselves was sent to anesthesia residents via the WeChat platform within 1 month.The data were recorded by the system automatically.Results A total of 795 anesthesia residents involved in the investigation,and the number of valid questionnaires was 753 (94.7％).There were 233 (30.9％) junior residents (0-2 yr of training),279 (37.1％) semi-senior residents (3-5 yr of training),and 241 (32.0％) senior residents (＞5yr of training).Compared with junior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in semi-senior and senior groups (P＜0.05).Compared with semi-senior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in senior group (P＜0.05).The self-evaluated difficulty of epidural puncture was lower as the number of prior epidural cases was more (r=-0.719,P＜0.01).There were 46.6％ of the residents who had received simulation-based training before performing epidural puncture on the patient,among which most residents considered the simulation-based training is effective in helping to familiarize with procedure (77.2％),familiarize with anatomy (70.4％),simulate the texture of different layers (47.9％),and enhance success rate of epidural puncture (56.7％).There were 75.0％ residents who considered visualization technology is helpful in enhancing the success rate and confidence of epidural puncture.Conclusion Currently,the proficiency of junior anesthesia residents in epidural puncture needs to be strengthened.The simulation-based training has not been widely applied in the epidural training,while residents think high of simulation-based training and are looking forward to visualization technique training.
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Objective To study the effect of electronic daily assessment on the application of standardized training for residents of anesthesiology department. Methods Compared the feedback rate of the previous paper evaluation form and the electronic daily evaluation submission,and summarized the results of the daily evaluation of residents of different grades and different sources through the electronic system. Results The feedback rate of the paper form and the electronic for was 59.5% and 96.7% separately. Comparing the scores of different grads, the total score and sub option scores gradually increased from grade one to grade three. The lowest score of sub options in all grades were anesthetic plan/crisis management scores. The worst overall rating(performance worse than expected)happened in the second-year residents. The best overall rating(performance better than expected) happened in the third-year resident. The residents form other hospitals had higher scores than PUMCH(Peking Union Medical Col-lege Hospital)'s residents and graduate students except for the score of theoretical knowledge. The PUMCH's resi-dents got lower score in overall rating.The teaching staff rescheduled and modified the training program according to the educational defect,so as to individualize resident training. Conclusions The daily electronic assessment helps to monitor daily performance of residents in a timely and comprehensive manner, so to adjust teaching methods, and contributes to conduct formative evaluation,which has a positive impact on improving teaching effectiveness.
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Objective To investigate the efficacy of intravitreal injection of monoclonal antibody in the treatment of patients with exudative age-related macular degeneration (AMD).Methods Together 33 patients (33 eyes) with exudative AMD from February 2010 to May 2015 selected in this study were treated with intravitreal injection of ranibizumab,followed by examination of the best corrected visual acuity before and after surgery by international standard logarithmic visual acuity chart.The differences in ophthalmic artery (OA),central retinal artery (CRA) and ciliary artery hemodynamic parameters before and after operation were compared,and fundus fluorescein angiography (FFA) was used to measure and calculate the changes in choroidal neovascularization (CNV) fluorescein leakage area before and after operation.Results The best corrected visual acuity was significantly improved 1 week after operation when compared with preoperative data [(0.29 ± 0.18) vs.(0.16 ± 0.15)],with significant difference (P =0.002).And 7 days after operation,the area of CNV fluorescein leakage was less than that of postoperative data [(8.48 ± 6.13)mm2 vs.(11.39 ± 6.12)mm2],and the difference was statistically significant (P =0.029).However,there was no difference in OA,CRA,the peak systolic velocity (PSV),end diastolic blood flow velocity (EDV)and resistance index (RI),pulsatility index (PI) in the treatment eyes between before operation and 1,4 weeks after operation (all P ＞ 0.05).Conelusion Intravitreal injection of ranibizumab in the treatment of exudative AMD is safe and effective and can effectively improve the visual acuity and alleviate CNV leakage,without adveme effects on patients' hemodynamics.
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Objective To compare simulated training of "45° tilting insertion" and the "dynamic scan" needling under B ultrasound.Methods Fifty volunteer residents and visiting physicians worked in the anesthesiology department in Peking Union Medical College Hospital were recruited to attend the simulated needling training.The insertion time,insertion attempts until success,numbers of success while advancing the needle and numbers of needle tip visible upon success were re corded.The degree of difficulty and safety of the techniques,the confidence of performing the techniques,the clinical usefulness of the techniques and the training effect were evaluated among the volunteers.Results There were no differences in the insertion time,numbers of successful insertion while advancing the needle and numbers of needle tip visible upon success between the two techniques.Compared with "45° tilting insertion" technique,"dynamic scan" resulted in less needle redirection times and a higher first-attempt successful rate,and got higher scores in terms of difficulty and safety (P＜0.05 or P＜0.01).The confidence scores of performing the two technique were similar.20 (40％) volunteers chose to use "dynamic scan",8 (16％) chose to use "45° tilting insertion" and 22 (440％) chose to use both technique in their clinical work.100％ of them considered the training was greatly helpful or helpful.Conclusion The technique of "dynamic scan" produced a higher first-attempt successful rate and was easier and safer than "45° angle insertion".The combination of the two techniques might be a new technique that is worth trying.
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AIM:To explore efficacy of the different kinds of artificial tears treatment in patients with xerophthalmia after phacoemulsification combined with intraocular lens implantation.METHODS:Totally 280 patients (280 eyes) with xerophthalmia after operation in our hospital from January 2015 to June 2016 were selected.According to the different treatment methods, they were divided into control group (n=70;treated with tobramycin and dexamethasone eye ointment 3 times per day for 1wk, levofloxacin eye drops 3 times per day for 1wk, pranoprofen eye drops 4 times per day for 1mo), polyacrylic acid group (n=70;besides the treatment of control group, polyacrylic acid was used 4 times per for 1mo), polyethylene glycol group(n=70;besides the treatment of control group, polyethylene glycol was used 4 times per for 1mo) and sodium hyaluronate group (n=70;besides the treatment of control group, sodium hyaluronate was used 4 times per for 1mo).The tear film break up time (BUT), Schirmer Ⅰ test (SⅠt), symptoms of dry eye and corneal staining in four groups were observed.RESULTS:(1) BUT:The BUT of the four groups significantly increased after treatment(P0.05);sodium hyaluronate group was significant lower than other groups in corneal staining score at 3wk and 1mo after treatment(P<0.05).CONCLUSION:Artificial tears in the treatment of xerophthalmia after cataract phacoemulsification combined with intraocular lens implantation has better clinical efficacy, which contains sodium hyaluronate may be the better than others.
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Objective To compare the effectiveness of training with a digital video disc ( DVD)-based instruction ver-sus intubation model simulator in placement of endotracheal tube by video -laryngoscope .Methods Sixty patients un-dergoing elective gynecology surgeries and twenty residents of Dept .of anesthesiology were randomized to place a en-dotracheal tube by video-laryngoscope .Results Compared with intubation model simulator , intubation time [ (68 ± 14)s vs (69 ±7)s], score of performance (8.24 ±0.64 vs 8.31 ±0.58), failure rate (3 times/11 vs 1time/9 resi-dents), and instruction rate (5times/11 vs 4times/9 residents) were no statistic difference .Conclusions Digital video disc ( DVD)-based instruction is an alternative way to intubation model simulator in training .
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<p><b>OBJECTIVE</b>To observe the hemodynamic changes in patients undergoing pericardiectomy at different operational stages.</p><p><b>METHODS</b>Totally 16 consecutive patients receiving radical pericardiectomy were enrolled in this observational study. Hemodynamic variables were monitored continuously by pulse-indicated continuous cardiac output(PiCCO)system. Totally,three sets of intraoperative hemodynamic parameters were obtained at three different stages of pericardiectomy.</p><p><b>RESULTS</b>During the pericardiectomy,the cardiac index[CI,(1.9±0.6),(2.7±0.6),(3.0±0.5)L·min(-1)·m(-2);P<0.05]and stroke volume index[SI,(22.5±8.7),(29.9±8.5),(30.1±8.5)dyn·s·cm(-5)·m(2);P<0.05]showed significant improvement,whereas central venous pressure[CVP,(17.1±5.0),(13.3±3.9),(12.3±3.0)mmHg;P<0.05]decreased significantly. Global end-diastolic volume index[GEDVi,(533±156),(580±153),(559±144)ml·m(-2);P<0.05]increased and stroke volume variation[SVV,(15.6±6.1)%,(10.8±4.2)%,(9.4±5.4)%;P<0.05]decreased intra-operatively. The majority of the above-mentioned hemodynamic improvements occurred after the resection of pericardium over the left ventricular outflow tract(LVOT).</p><p><b>CONCLUSIONS</b>PiCCO system can serve as a reliable,less invasive hemodynamic monitoring method during pericardiectomy. Resection of the pericardium over the LVOT is the most important step of the pericardiectomy.</p>
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Humans , Cardiac Output , Heart , Heart Rate , Hemodynamics , Pericardiectomy , Stroke VolumeABSTRACT
<p><b>OBJECTIVE</b>To detect the expression of phosphorylated-signal transducer and activator of transcription 3 (p-Stat3) and myeloid leukemia-1 (Mcl-1) as well as their correlation, and to investigate the functional role of Stat3 and Mcl-1 in the pathogenesis of esophageal squamous cell carcinoma (ESCC).</p><p><b>METHODS</b>Stat3 activity in ESCC cells was inhibited with JAK/Stat3 inhibitors (AG490 or JSI-124). Specific siRNA was used to inhibit the Stat3 expression. Cell apoptosis was detected by flow cytometry. Expression of Mcl-1 protein was determined by Western blotting. Expression of phospho-Stat3 (Tyr705) and myeloid leukemia-1 (Mcl-1) proteins in ESCC tissues was detected by tissue microarray and immunohistochemistry. The relationship between p-Stat3 or Mcl-1 aberrant expression and clinicopatholohical features of ESCC was analyzed. The correlation of their expression was also analyzed.</p><p><b>RESULTS</b>Suppression of the Stat3 signaling activation in ESCC cells led to marked apoptosis, and dramatic reduction of Mcl-1 protein. The positive rate of phospho-Stat3 (Tyr705) expression was 45.0% in 50/111 of the ESCC tissue samples. The lower the degree of tumor differentiation, the higher the positive rate of phospho-Stat3 (Tyr705), showing a significant difference (P = 0.018). The positive rate of Mcl-1 protein expression was 72.1% (80/111), and the lower the degree of tumor differentiation was, the higher there was the positive rate of Mcl-1, with a significant difference (P = 0.026). There was a positive correlation between the expressions of p-Stat3 and Mcl-1 proteins (P = 0.012).</p><p><b>CONCLUSIONS</b>In a subset of ESCC tissues, p-Stat3 (Tyr705) and Mcl-1 are overexpressed and positively correlated with each other, and both are correlated with tumor differentiation. Persistent activation of Stat3 contributes to apoptotic resistance in ESCC cells, and may be at least partly mediated through upregulation of Mcl-1.</p>
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Humans , Antineoplastic Agents , Pharmacology , Apoptosis , Carcinoma, Squamous Cell , Metabolism , Pathology , Cell Differentiation , Cell Line, Tumor , Cell Survival , Esophageal Neoplasms , Metabolism , Pathology , Myeloid Cell Leukemia Sequence 1 Protein , Metabolism , Neoplasm Grading , Neoplasm Staging , Phosphorylation , RNA, Small Interfering , Genetics , STAT3 Transcription Factor , Genetics , Metabolism , Tyrphostins , PharmacologyABSTRACT
This study was purposed to investigate the change of Th cell subsets in the patients with acute graft-versus host disease (aGVHD) and to explore its role in the pathogenesis of aGVHD after allogeneic hematopoietic stem cell transplantation (allo-HSCT). 23 patients underwent allo-HSCT were selected for analysis. The aGVHD in patients was diagnosed according to clinical features, and was confirmed by skin biopsy in some patients. The peripheral blood from 23 patients was collected before and after allo-HSCT. The quantitative chenges of Th1 and Th2 cells in peripheral blood samples were detected by using flow cytometry. The results showed that out of 23 patieats the aGVHD occured in 8 patients including 1 case of grade I, 2 case of grade II, 3 cases of grade III; no aGVHD occured in 15 patients. The flow cytometry analysis revealed that the amount of Th1 cells in patients with aGVHD was much higher than that in patients without aGVHD (p < 0.01), the IFN-gamma expression of Th1 cells in patients with aGVHD of grad II - III significantly was higher than that in patients without aGVHD (p < 0.01), meanwhie the IL-4 expression of Th2 cells in patients with aGVHD of grade II - III was significantly lower than that in patients without aGVHD (p < 0.05). Dynamical detection indicated that the Th1 obviously increased before occurrence of aGVHD and before treatment of aGVHD, while the Th1 cells obviously decreased after treatment of aGVHD. The Th1 cells not changed significantly in patients without aGVHD before and after allo-HSCT. It is concluded that Th1 cells obviously increase in patients with aGVHD, this increase is related to aGVHD pathogenesis. Detecting the changes of Th cell subsets in the early stage after allo-HSCT may be contributed to early diagnosis and therapy of aGVHD.
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Humans , Graft vs Host Disease , Blood , Allergy and Immunology , Hematologic Neoplasms , Allergy and Immunology , Therapeutics , Hematopoietic Stem Cell Transplantation , Th1 Cells , Allergy and Immunology , PathologyABSTRACT
B cell activated co-receptor plays important roles in linkage of innate and acquired humoral immune responses. CD21 molecule in the co-receptor complex is a receptor for C3dg and CD19 molecule enhances BCR signal transduction. CD21 also expresses on the surface of follicular dendritic cells, which mediates the long-term maintenance of antigens and is indispensable for maintaining the memory of B cells. B cell activated co-receptor also has an effect on the negative selection of B cells reactive to autoantigens.