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Objective To explore the application effect of the Mini-CEX evaluation model based on the OBE concept in the clinical Practice teaching of neurology.Methods We Selected 100 students who will Practice in the Department of Neurology from 2022 to 2023 as the research objects,and divided them into the experimental group(n=50)and the control group(n=50).Under the guidance of the OBE concept,the experimental group was guided by learning outcomes,refined the teaching objectives,and applied the Mini-CEX evaluation mode for evaluation and feedback.In contrast,the control group adopted the traditional teaching mode.Combined with the observation data,we analyzed and compared the data of various indicators of the two groups of students at the beginning and end of the internship.Results At the end of the internship,the scores of clinical consultation,Physical examination,humanistic medicine,clinical diagnosis,health consultation,organizational effect,and overall evaluation of the experimental group were significantly improved and were higher than those of the control group.After the Practice,in terms of skill test scores,the experimental group scored higher than the control group,the difference was statistically significant(P<0.05),and the experimental group also scored higher in satisfaction evaluation than the control group.Conclusion The Mini-CEX evaluation teaching model based on the concept of OBE is applied to the clinical practice teaching of the neurology department,which can enhance the training effect of students'clinical practice skills.
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Objective@#To investigate the influencing factors of nosocomial infections among patients undergoing radiotherapy, so as to provide insights into nosocomial infection control among radiotherapy patients. @*Methods@#The malignant tumor patients receiving radiotherapy in Yiwu Central Hospital from 2019 to 2020 were selected. Their demographic features, radiotherapy and nosocomial infections were collected through the eletronic medical records. The factors affecting nosocomial infections were identified among radiotherapy patients using a multivariable logistic regression model.@*Results@#Totally 553 malignant tumor patients receiving radiotherapy were enrolled, including 268 men ( 48.46% ) and with a mean age of ( 60.31±13.66 ) years. The mean duration of hospital stay was ( 28.67±14.32 ) days, and the mean radiotherapy cycle was ( 3.63±1.89 ) weeks. A total of 46 patients were detected with nosocomial infections, with prevalence of 8.32%. The top three sites with the highest prevalence of nosocomial infections included the lower respiratory tract ( 14 cases, 30.43% ), oral cavity ( 10 cases, 21.74 ) and urinary tract ( 8 cases, 17.39% ), and 42 bacterial strains were isolated, with Gram-negative bacteria as the predominant strains ( 25 strains, 59.52% ). Multivariable logistic regression analysis showed that radiotherapy cycle of 4 weeks and longer ( OR=3.857, 95%CI: 1.896-7.846 ), radiotherapy exposure ( OR=3.254, 95%CI: 1.561-6.783 ), arteriovenous catheterization ( OR=2.165, 95%CI: 1.144-4.098 ), urinary tract intubation ( OR=6.028, 95%CI: 1.841-19.734 ) and poor nutritional status ( OR=3.933, 95%CI: 1.493-10.360 ) were associated with nosocomial infections among radiotherapy patients.@*Conclusion@# Radiotherapy cycle, exposure to radiotherapy, arteriovenous catheterization, urinary tract intubation and poor nutritional status are factors affecting nosocomial infections among radiotherapy patients.
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Objective To explore how to effectively prevent and detect cancer early postoperative intestinal obstruction and treatment methods and means.Methods This retrospective analysis of 13 years occurred in 57 patients with rectal cancer diagnosis and treatment of cases of early postoperative intestinal obstruction process, including fasting,gastrointestinal decompression,fluid therapy,liquid paraffin,diatrizoate and surgical treatment of oral contrast.Results In 57 cases,paralytic intestinal obstruction in 7 cases,conservative treatment was relieved,the success rate was 100.0%;early inflammatory intestinal obstruction in 37 cases after conservative treatment of 36 cases of remission,the success rate was 97.3%;mechanical intestinal obstruction in 13 cases after conservative treatment could not be alleviated,conservative success rate was 0.0% and was cured by reoperation.The first two groups of patients compared with mechanical intestinal obstruction patients,conservative success rate had statistical differences (χ2 =40.08,11.08,all P<0.01).Conclusion Cancer treatment lies in early postoperative intestinal obstruction effective prevention,early detection,close observation and timely and effective treatment,a good grasp of timing of surgery and surgical indications.
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Objective To explore the influence of oral administration of glucose before surgery on insulin resistance and oxidative stress in castric cancer patients undergoing surgery.Methods 63 cases of castric cancer patients undergoing surgery were divided into observation group (n=32) and the control group (n=31) according to random number table method.Patients were given fasting after ten o'clock the day before surgery.Patients in the observation group were dealed with 500 ml 100 g/L glucose solution orally,while patients in the control group were dealed with the same amount of distilled water 3 hours before surgery.The general information and operation indicators were recorded.Blood glucose (GLU),insulin,malondialdehyde (MDA) and superoxide dismutase (SOD) levels were detected before surgery and 4 hours after surgery.Insulin resistance index(HOMAIR) was recorded also.Results The general data between the two groups before the test started had no statistically significant difference (P＞0.05).All patients completed test successfully,and the complications such as choking cough,aspiration did not happen during the treatment.The operation time,Intraoperative fluid infusion,intraoperative blood loss and postoperative pathological stage between the two groups had no statistical difference (P＞0.05).GLU,insulin and HOMA-IR in the two groups after surgery increased significantly than those before surgery,and the difference had statistical significance (P＜0.05).GLU,insulin and HOMA-IR were significantly lower in the observation group than in the control group,and the difference had statistical significance (P＜0.05).SOD and MDA in the two groups after surgery increased significantly than those before surgery,and the difference had statistical significance (P＜0.05).SOD in the observation group was significantly higher,while MDA was significantly lower than those in the control group,and the difference had statistically significance(P＜0.05).Conclusion Oral administration of glucose before surgery in castric cancer patients undergoing surgery can reduce insulin resistance and oxidative stress,and it is safe.
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Objective To analyze the influence of different digestive tract reconstruction methods on blood sugar in T2DM patients after subtotal gastrectomy,and to explore the possible mechanism.Methods The clinical data of 64 cases of T2DM patients undergoing subtotal gastrectomy because of gastric ulcer or cancer were retrospectively analyzed.They were divided into Roux-en-Y group (34 cases) and Billroth Ⅱ group (30 cases) according to the different reconstruction methods of digestive tract,and they were treated by Roux-en-Y anasto-mosis and Billroth Ⅱ anastomosis respectively after subtotal gastrectomy.They were followed up for 6 months.BMI,fasting blood sugar,2 h postprandial blood glucose,glycosylated hemoglobin,fasting insulin,insulin resistance index (HOMA-IR),glucagon peptide 1 (GLP-1),gastric inhibitory peptides (GIP),and GIP/GLP-1 before surgery and one week,one month,3 months,and 6 months after surgery were compared between the two groups.Results BMI of the two groups 3 months,and 6 months after surgery was significantly lower than those before surgery (P＜0.05),and it had no statistical significance between the two groups at the same time point (P＞0.05).Compared with preoperative,the fasting blood sugar,2 h postprandial blood glucose,glycosylated hemoglobin,fasting insulin,HOMA-IR one week,one month,3 months,and 6 months after surgery in the two groups were significantly lower than those before surgery (P＜0.05).The fasting blood sugar,and 2 h postprandial blood glucose were lower in Roux-en-Y group than in Billroth Ⅱ group (P＜0.05).The glycosylated hemoglobin in Roux-en-Y group was lower than those in Billroth Ⅱ group at 3 months,and 6 months after surgery (P＜0.05).Compared with those before surgery,GIP and GIP/GLP-1 in the two groups at one week,one month,3 months,and 6 months were significantly decreased after operation (P＜0.05).Also,they were significantly lower in Roux-en-Y group compared with Billroth Ⅱ group at the same time point.Conclusion Roux-en-Y anastomosis after subtotal gastrectomy may be more beneficial?for reducing blood glucose in T2DM patients,which may be more beneficial for keeping the balance of entero-insular axis.
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Objective: To compare the efficacy and safety of early nasogastric enteral nutrition [EN] with total parenteral nutrition [TPN] in patients with severe acute pancreatitis [SAP]
Methods: From July 2008 to July 2014,185 patients with SAP admitted to our centre were enrolled in this retrospective study. They were divided into EN group [n=89] and TPN group [n=96] based on the nutrition support modes. Patients in EN group received nasogastric EN support, while patients in TPN group received TPN support within 72 hours of disease onset. The medical records were reviewed and clinical factors were retrospectively analyzed
Results: There were no significant differences in baseline characteristics between two groups. EN group had significantly lower incidence of pancreatic infections [P=0.0333] and extrapancreatic infections [P=0.0431]. Significantly shorter hospital stay [P=0.0355] and intensive-care stay [P=0.0313] were found in EN group. TPN group was found to have significantly greater incidence of multiple organ dysfunction syndrome [MODS] [P=0.0338] and mortality [P=0.0382]. Moreover, the incidence of hyperglycemia was significantly higher in TPN group [P=0.0454]
Conclusions: Early nasogastric EN was feasible and significantly decreased the incidence of infectious complications as well as the frequency of MODS and mortality caused by SAP
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ObjectiveTo investigate the efficacy of mountain-burning fire acupunctureat point Yongquan(KI1)in treating spinal cord injury.MethodThirty patients with spinal cord injury were randomly allocated to observation and control groups, 15 cases each. The control group received modern rehabilitation therapy and the observationgroup, mountain-burning fire acupuncture at point Yongquan plus exercise rehabilitation therapy.ResultThe total efficacy rate was 93.3% in the observation group and 73.3% in the control group. The total efficacy rate increased significantly in the observation group and was significantly higher than in the control group(P<0.05).ConclusionMountain-burning fire acupuncture at point Yongquan has a marked therapeutic effect on spinal cord injury and effectively improves urinary and fecal voiding, sexual and limb motor functions in the patients.
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Objective To find out about the demands of health education in the border defense army .Methods A self-made questionaire was used to investigate both the demand of health education in the border defense army and the knowledge-attitude-practice of health .Comprehensive evaluation was conducted on the spectrum of disease in hospitals of border defense army in the previous year .Results Mental health (63.605%), lifestyle (53.829%) and knowledge on occupational protection (41.375%) were the most needed knowledge in the border defense army .Videos and lectures were the means of health education , accounting for respectively 69 .368%and 42 .936%.The total rate of awareness of knowl-edge about health education reached 64.156%.The total rates of holding health attitude and health behavior were 80.765%and 49.113%, respectively.Recently, intervertebral disc disorders,arthritis and other injuries (dislocation, sprain and strain ) were atop the disease spectrum at border defense hospitals .Conclusion Knowledge of mental health , lifestyle and occupational protection along with videos and lectures are the most urgent demand of the border defense army . What needs to be done right away is to improve the awareness of military occupation protection and develop healthy behaviors .
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Objective To investigate the prognostic value of HbA1c and hs-CRP in patients with acute coronary syndrome . Methods A total of 141 patients diagnosed as acute coronary syndrome from August 2009 to August 2011 in this hospital were col-lected .According to the levels of HbA1c and hs-CRP ,patients were divided into the following four groups :the high HbA1c and hs-CRP group ,the high HbA1c group ,the high hs-CRP group ,the low HbA1c and hs-CRP group(control group) .After receiving standard treatment and being discharged from hospital ,all patients were followed up every two month until death or the end of the study .Clinical data from all patients were statistically analyzed .Results Compared with the control group ,the cumulative survival of the high HbA1c group was much lower in 2 years(P0 .05) .However ,the cumulative survival in high HbA1c and high hs-CRP group and the high hs-CRP group were significantly lower than the control group through the whole follow-up time .A Cox regression modal with HbA1c and hs-CRP as the covariates established and the formula was :h(t ,x)=h0(t) exp(0 .092 × HbA1c+ 0 .610 × hs-CRP)(χ2 =10 .326 ,P<0 .01) . The value of HbA1c and hs-CRP were associated with increased risk of mortality [RR 1 .971 ,95% CI(1 .245 -2 .539) ,P<0 .05 and RR 3 .398 ,95% CI(2 .879-3 .917) ,P<0 .05 ,respectively] .The specificity and sensitivity of that modal was 75% and 83 .6% , respectively .The Kappa value was 0 .446 .Conclusion The combined detection of HbA1c and hs-CRP level can predict the progno-sis of patients with acute coronary syndromes .
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Objective To explore the clinical epidemiological characteristics of gastrointestinal stromal tumor (GIST). Methods By using the clinical epidemiological study methods, the clinical epidemiological characteristics of GIST in Shanxi province from 2000 to 2005 were investigated and analyzed. Results A total of 181 cases of GIST was found from January 2000 to December 2005. The new cases increased every year, and all of them belonged to the Han nationality. There was no statistical significance between the two sexes. The ages were between 18 to 80 years, and the median age was 57 years. The disease incidence increased along with the increase of age. More cases were found in Taiyuan, Changzhi and Jinzhong city, and most of them lived in the downtown area. GIST may occur in any part of the digestive tract, and the predilection sites were stomach, small intestine, colon, rectum and esophagus. 76.83 % of them were in the gastrointestinal tract, the other 23.17 % were not. The commonest symptoms and physical signs were dysphagia, nausea, vomiting, abdominalgia, abdominal distension, abdominal mass and magersucht. As to the histological types, 70.30 % were spindle cell type, 12.10 % were epithelial cell type, and 17.60 % were mixed cell type. As to the karyokinesis, 49.50 %≤5, 36.30 % was 6~10, and 14.30 %≥10. The immunological expression was as follows: CD117 was 80.20 %, CD34 was 67 %, and no positive expression was found on MCK. Conclusions GIST is a rare tumor, and was sporadic in the populations. The clinical incidence of GIST showed a tendency of gradual increase.
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The examinations of blood and bone marrow in 125 patients with visceral leishmaniasis revealed that seven routine parameters of the blood samples were below the lower limit of normal in most cases and 64.8% of the cases showed complications with iron deficiency anemia(IDA) and cell maturation disorders.Therefore, iron deficiency anemia and significant reduction of blood components can be used as indicators on the severity of Leishmania infection.