Application of staged modular theory and practice lectures in laparoscopic training / 中华医学教育探索杂志

Objective:To evaluate the effectiveness of staged modular theory and practice lectures in laparoscopic training.Methods:In this study, a large group of medical students and a large group of residents were selected, and each of the two groups was divided into an experimental group and a control group respectively. The experimental group received staged modular theory and practice lectures based on the conventional trainings, and the control group only underwent conventional laparoscopic skills training and instruction. Before and after the training, the completion time of 6 basic laparoscopic operations, laparoscopic suture time, suture quality and the number of accidental injuries were recorded and scored in each group according to the assessment criteria. SPSS 26.0 was used for statistical analysis of the assessment data. Independent samples t-test or Mann-Whitney U test was used for inter-group comparison between the two large groups, and paired samples t-test or Wilcoxon sign rank sum test was used for intra-group comparison before and after the training. Results:Compared with the control group, the experimental group of medical students that had undergone staged modular theory and practice lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=6.18, P<0.001) and higher quality of suturing ( t=4.17, P<0.001) and fewer accidental injuries ( Z=-2.03, P=0.043); the experimental group of residents that had undergone staged modular theoretical and practical lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=3.31, P=0.002) and higher quality of suturing ( t=3.68, P=0.001) and fewer accidental injuries ( Z=-2.44, P=0.015). Conclusion:The staged modular theory and practice lectures are able to further improve the quality of basic laparoscopic skills training.

Application and exploration of modular training using endoscopic simulator in the teaching of endoscopic skills in surgery / 中华医学教育探索杂志

Objective:To explore how to carry out endoscopic skill training in undergraduate medical education and evaluate the teaching effect of modular skill training using endoscopic simulator.Methods:After completing the basic teaching content of the surgical practice course, we added the learning course of the basic theory and basic operation of endoscopy to the students of Clinical Medicine Department from Nantong University. In the experimental group, 292 students were trained by the modular training using the endoscopic simulator. The control group consisted of 114 students, who were treated with ordinary video teaching and instrument operation exercises. After the same class hours of training, the two groups of students were evaluated with intermittent suture and knotting under endoscope as the skill assessment criteria. The chi-square test was performed using SPSS 19.0.Results:The excellent rate and qualified rate of the medical students after the modular training of the endoscopic simulator were 7.5% and 42.8% respectively, which were significantly higher than 0% and 11.4% of the control group, while the unqualified rate of the experimental group was 49.7%, which was also lower than 88.6% of the control group, with significant differences ( P<0.01). Conclusion:Modular training using endoscopic simulator helps the medical undergraduates to quickly increase the ability of endoscopic operation. And in the stage of undergraduate, medical education implementation of the training can shorten the learning curve of endoscopic skills for medical students after they enter clinical practice.

An Applied Research of Mobile Network PBL in Combination with the Micro-lesson Method in Surgical Practice Teaching / 昆明医科大学学报

Objective To research the application effect of mobile network PBL in combination with the micro-lesson teaching in surgical practice.Methods The research objects were the clinical medical interns of grade 2012. Students were divided into two groups: the experimental group using mobile network PBL in combination with the micro-lesson teaching method, and the control group using the traditional LBL teaching method. The examination scores, case analysis and discuss performance were compared between the two groups.Results The tests grades, clinical cases analysis, discuss performance of the experimental group were significantly higher than those of the control group (P＜0.05); Active classroom atmosphere, active learning, improve teamwork and interpersonal communication of the experimental group were significantly higher than those of control group, et cetera (P＜0.01).Conclusion The effect of mobile network PBL in combination with the micro-lesson teaching method in surgical practice teaching is very good.

Los equipos quirúrgicos avanzados en los escenarios contemporáneos de acciones combativas / Advanced surgical teams in contemporary scenarios of combat actions

Introducción: con el uso de la plataforma de Servicios de Información Ebsco Host, se accedió a las bases de datos a texto completo Academic Search Premier y Medline Complete. Objetivo: revisar la información contenida en los Descriptores MeSH 2014 acerca de Forward Surgical Teams, Iraq and Afghanistan. De dicha búsqueda surgieron evidencias bibliográficas de la utilización, empleo y desarrollo de los Forward Surgical Teams de los Servicios Médicos de las Fuerzas Armadas Norteamericanas (Ejército de Tierra), Francia, Reino Unido y Finlandia. Métodos: se expone el modo de empleo y la sucesiva tendencia a su perfeccionamiento operacional y tecnológico durante las últimas guerras en Medio Oriente a propósito del despliegue de tropas norteamericanas y de la coalición de la ONU en la cruzada contra el terror liderada por los Estados Unidos de Norteamérica. Los aspectos reportados en el artículo se refieren a la composición, despliegue y utilización táctica de los Forward Surgical Teams, a la aplicación de diversos protocolos de diagnóstico y tratamiento para la recepción y manejo de las bajas sanitarias debido a las acciones combativas y el afrontamiento de la preparación del personal médico y de enfermería antes, durante y después del despliegue de la institución médica(AU)

Introduction: Using Ebsco Host Information Services platform, the full-text Academic Search Premier and Medline complete databases were accessed. Objective: Review the information contained in 2014 MeSH Descriptors about Forward Surgical Teams, Iraq and Afghanistan. From this search bibliographical evidences emerged of the use, employment and development of the Forward Surgical Teams of the Medical Services of the Armed Forces in United States of America (Army), France, United Kingdom, and Finland. Method: It is presented here the way of employment and the successive trend towards its operational and technological improvement during the last wars in the Middle East on the deployment of US troops and the UN coalition in the United States-led crusade against terror of North America. The aspects reported in the article refer to the composition, deployment and tactical use of the Forward Surgical Teams, to the application of various diagnostic and treatment protocols for the reception and management of health casualties due to combat actions and the coping of the preparation of medical and nursing personnel before, during, and after deployment of the medical institution(AU)

The application and research on medical college of dynamic network training in surgical ;practice teaching / 中国医学装备

Objective: To research the application of dynamic-network probation in combination with traditional clinic probation in surgical practice teaching. Methods:Sixty four people in the undergraduate 2012(1, 2 session) set as the experimental group. 40 people in the undergraduate 2012(biochemical class) set as the control group. The traditional clinic probation was applied to the control group. The traditional clinic probation was applied to the control group. The dynamic-network probation in combination with traditional clinic probation was applied to experimental group. The teaching effects were evaluated and compared roundly. Results:The teaching effects of experimental group was significantly better than control group in all respects (x2=7.512, x2=6.797, x2=7.778, x2=4.768, x2=8.541;P<0.05). Satisfaction ratio of experimental group was significantly higher than that of control group in all respects of surgery teaching (x2=4.475, x2=5.900, x2=5.005, x2=5.904, x2=4.502; P<0.05). The examination performance of experimental group was significantly better than control group in theoretical knowledge and clinical skills testing (t=25.840, t=19.319;P<0.05). Conclusion:Dynamic-network probation in combination with traditional clinical probation has a great effect on surgical practice teaching and worth to be applied.

El ambiente quirúrgico seguro: paradigma emergente en la práctica profesional de la cirugía / The safe surgical environment: emergent paradigm in the surgical professional practice

Desde que las Guerras Mundiales que se escenificaron en el siglo XX, en los teatros operacionales del conflicto en Europa, Norte de Africa, medio oriente, Asia, I y II Guerras Mundiales, Corea, Viet Nam, Afganistán Guerra Arabe- Israelí obligó a los países involucrados a atender a los millones de víctimas resultantes, planificando, organizando y rediseñando a pasos acelerados las estructuras de asistencia médica, capaces de suministrar recursos de atención masivo del trauma y estrategias para tratar a sus soldados y a la población civil. La consecuencia positiva para el avance de la medicina y especialmente de la cirugía de estos tragicos sucesos, fue la aparición y el desarrollo de la "cirugía compleja" y la conquista del abordaje quirúrgico de regiones del cuerpo humano, hasta ese momento vedados a la actividad del tratamiento quirúrgico: cavidad craneal, cirugía torácica, trauma cardiovascular, cirugía intestinal de urgencia, anestesia y manejo respiratorio, antibióticos, derivados sanguíneos, resucitación cardio-respiratoria y evacuación y trasporte de heridos. Varias décadas después el desarrollo de esta cirugía compleja, produjo un aumento desmesurado de la morbi-mortalidad ocasionado principalmente por los efectos de la anestesia inadecuada, hemorragias masivas, infección-sepsis y factores de error humano. Surgen entonces nuevas líneas de investigación clínica para identificar y disminuir estos factores. Esos esfuerzos logran al final del siglo XX y comienzos del XXI, resultados tangibles y eficaces mejorando los resultados finales de la cirugía. Por estos logros surge un nuevo paradigma en el mundo de la cirugía, conocido como "el ambiente quirúrgico seguro"; que comprende estrategias operativas y organizacionales, tales como: reingeniería de quirófanos, innovaciones tecnológicas, digitalización de aparatos de registro y la protección integral de los equipos humanos interactuantes en los servicios quirúrgicos. En este ensayo se describen...

Since the occurrence of the World Wars in the 20th. Century, at the military operational theatres in Europe, North Africa, Meddle East, Korea, Viet nam, Afghanistan and Israel the countries involved in these conflicts were forced to render medical care to the million of casualities in thousands of battlefields, specially organizing massive trauma care to military personnel also to civilian populations. The positive result of this tragic scenarios was that medicine as a whole and surgery, was the development of the so called "complex surgical care", and the conquest of the surgical approach of different regions of the human body, until then impossible to reach with therapeutic efficacy: intracranial structures, thoracic surgery, cardio-vascular injuries, acute intestinal trauma anesthesia and respiratory ventilation, antibiotics, blood replacement, cardio pulmonary resuscitation; and triage and the planning of transport of wounded soldiers. Some decades later, the development of the complex surgery reachers alarming levels of morbidity and mortality, mainly due to inadequate delivered anasthesia, massive hemorrhage, uncontrolled bacterial infections-sepsis and lethal consequences of human errors. New lines of clinical investigations and research conducted in the late XX century and early XXI century gave the answers to obtain strategies to diminish and fight this adverse factors; improving better outcomes for surgical therapies. This achievement gave birth to a new paradigm into the surgical world which is identified nowadays as the "safe surgical environment", compromising new strategies to redesing surgical operating rooms, application of technological discoveries, digitalization of patient's surveillance and bio protection of the surgical personnel avoiding events as accidents, thermal injuries, and infections with transmissible diseases in this scenario. In this paper will be described fundamental definitions of novel paradigm, reviewing concepts...

Physical diagnosis-ground work in surgical practice / 中华肝胆外科杂志

For clinical surgeons,physical diagnosis is the stepping stone or open sesame in clinical practice such as inquiry of medical history,physical examination,medical investigation,and disease comprehension.It is the starting point and complementation of clinical diagnosis in surgical practice.It helps and leads young practitioners to acquire basic,true,and useful scientific information and evidence of clinical diagnosis in each patient.It is the essential technique and procedure,which is applicable for lifelong time in young or elder surgeons.

Application of standardized patient in clinical surgical practice teaching for eight-year-program medical students / 中华医学教育探索杂志

Objective Discussed the efficacy of applying standardized patient in clinical surgical practice teaching.Method Twenty eight-year-medical students in our college were enrolled and students' theoretical knowledge mastering ability,students' evaluation on the teaching and students'clinical ability were surveyed.Result Students' score significantly increased compared to last year scores (P ＜0.01).100％ of the participants found the SP teaching methods can increase the interest in learning; 90％ of students found the SP as a guide to better grasp the teaching content; 95％ of students found the SP teaching methods can improve the ability to communicate with patients.Conclusions The class atmosphere was improved,students' enthusiasm was activated,students' clinical ability was promoted and satisfactory teaching effect was obtained after applying standardized patient.

Tres médicos mexicanos y su referencia al ejercicio ético moral de la medicina: segunda mitad del siglo XIX / Three Mexican physicians and their moral and ethical reference to the practice of medicine: second half of the 19 century

En la actualidad se habla cada vez más de la suficiencia tecnológica, del aislamiento humano y de la evasión por parte del personal de salud hacia las necesidades afectivas de los pacientes; este enfoque no es reciente. A través de múltiples fuentes, los médicos del siglo XIX mexicano externaron sus inquietudes respecto a la manera como se llevaba a cabo la atención del enfermo; aseguraban que el progreso científico estaba originando la deshumanización de la medicina, haciendo olvidar que el médico trabaja con seres sensibles e inteligentes y que, por tanto, debía ajustar su proceder de acuerdo con la personalidad de sus pacientes. Ante tal situación, los médicos decimonónicos invitaban a la reflexión, a cumplir una serie de deberes frente al enfermo, ante sus colegas y ante las autoridades gubernamentales, lo que nos lleva a concluir que los principios éticos siempre han estado vigentes. Este artículo analiza en particular la postura de tres profesionales de la salud: Francisco Flores (1855-1931), Porfirio Parra (1854-1912) y Adrián de Garay (1860-192?), respecto a cómo debía ser el ejercicio de su profesión; externan que los principios éticos debían estar presentes en todo momento.

Worldwide, the technological revolution is taking place, but the human aspect of health care demonstrates that medical personnel often avoid the responsibility for the emotional care of their patients. This is not a recent point of view. In many ways, during the 19th century, Mexican physicians were outspoken about the problems in regard to the manner in which care of sick persons was carried out. They were certain that scientific progress was the origin of medical dehumanization, frequently forgetting that physicians were treating sensitive and intelligent persons and, therefore, must adjust their behavior in accordance with their patients. Because of this situation, 19th century physicians were invited to share a list of responsibilities and duties to patients, among their professional colleagues as well as among government authorities. In particular, the philosophies of three health professionals were analyzed, Francisco Flores (1855-1931), Porfirio Parra (1854-1912) and Adrián de Garay (1860-192?), in regard to how the practice of medicine should be exercised and that the underlying ethical and moral principles must always be present.

Características clínicas y terapéuticas de los pacientes que ingresaron con diagnóstico de hemorragia digestiva superior, en el hospital central de Maracay, Edo. Aragua-Venezuela. 2001-2005

La Hemorragia Digestiva Superior (HDS) es la emergencia más importante y seria en gastroenterología. A pesar de los avances en el manejo médico-quirúrgico y endoscópico la mortalidad ha permanecido invariable. La causa más frecuente son las úlceras gastroduodenales. El abordaje inicial es médico. La utilidad de la Endoscopia Digestiva Superior es ilimitada, diagnostica la lesión, la ubica, permite efectuar tratamiento y orienta el pronóstico, resangrado y la mortalidad. Objetivo: analizar manifestaciones clínica, etiología y manejo terapéutico de los pacientes con HDS que ingresaron en el HCM 2001-2005. Métodos: estudio descriptivo-retrospectivo para caracterizar clínicamente a los pacientes con diagnóstico de HDS en HCM 2001-2005. Resultados: se revisaron 223 casos, encontrando predominio del grupo etario de 61-80 años (38%), del sexo masculino (63%), úlceras gastroduodenales (37%) como causa más frecuente, la melena (49%) como manifestación clínica, el 64% tuvieron antecedentes patológicos personales, 15% consume Antinflamatorios no Esteroideos (AINES), con un promedio de estancia hospitalaria de 4 días y de 1 transfusión sanguínea por evento de sangrado. Conclusión: la HDS se caracterizó por ocurrir más frecuentemente entre la quinta y sexta década de la vida, en el sexo masculino, asociada a patologías de base, donde se aplicó un manejo terapéutico conservador.

Upper Gastrointestinal Bleeding (UGB) is the most important and serious emergency in the area of Gastroenterology. In spite of the great advances in endoscopic and surgical techniques, the mortality rate has remained invariable. Gastro-duodenal ulcers are the most frequent cause. The preliminary approach is medical. The value of Upper Digestive Endoscopy is unlimited, it diagnoses and locates the lesion, allowing treatment procedures and permitting a prognosis assessment (re - bleeding and mortality). Objective: To analyze clinical manifestations, etiology and therapeutic handling of patients with UGB admitted to the HCM during 2001-2005. Methods: Retrospective- Descriptive Study to clinically characterize the patients with a diagnosis of UGB at the HCM during 20001-2005. Results: 223 cases were considered, finding predominance in the 61-80 age group (38%), males (63%), gastroduodenal ulcers (37%) as the most frequent cause, melena (49%) as clinical manifestation, and 64% had a personal pathological background, 15% used non-steroidal anti-inflammatory drugs (NSAID), with an average hospital stay of 4 days and 1 blood transfusion per bleeding event. Conclusion: UGB occurred more frequently between the fifth and the sixth decade, in males, associated with base pathologies. They were handled through a conservative therapeutic approach.