Practical research on the application of PAD Class combined with micro class in the teaching of standardized training for cardiac surgery residents / 中华医学教育探索杂志

Objective:To study the effect of PAD Class (Presentation-Assimilation-Discussion) combined with micro class in the teaching of standardized training for cardiac surgery residents.Methods:From October 2019 to June 2020, 70 residents of cardiac surgery were randomized into group A and group B, with 35 cases in each group. Group A used conventional teaching method, while group B used PAD Class combined with micro class teaching. The scores of theoretical examination and practical operation examination before and after teaching, the evaluation of self-learning, clinical thinking and professional social ability before and after teaching, and the satisfaction with the teaching methods were compared between the two groups. SPSS 26.0 was used for chi-square test and rank sum test.Results:There was no significant difference in the scores of theoretical assessment, practical assessment, autonomous learning, clinical thinking and professional social ability between the two groups before teaching ( P>0.05). After teaching, the scores of theoretical assessment, practical assessment, autonomous learning, clinical thinking and professional social ability of the two groups increased, and the scores of group B were higher than those of group A. There was a significant difference in the distribution of satisfaction with teaching methods between the two groups ( P<0.05). The total satisfaction rate of group B[97.14%(34/35)] was higher than that of group A[77.14%(27/35)]. Conclusion:For the residents of cardiac surgery, the teaching method of PAD Class combined with micro class teaching can not only improve their examination results, enhance self-learning, clinical thinking and professional social ability, but also improve their satisfaction with teaching methods.

Observation on the effect of two-way evaluation combined with transposition learning in the teaching of standardized training of cardiac surgery / 中华医学教育探索杂志

Objective:To explore the application effect of two-way evaluation combined with transposition learning in the teaching of standardized training of cardiac surgery.Methods:A total of 67 trainees received by the Department of Cardiac Surgery of our hospital from January 2019 to October 2020 were divided into group A ( n = 32) and group B ( n = 35) according to the time of standardized training. Group A was trained by conventional method, while group B was trained by two-way evaluation combined with transposition learning. The examination scores, the post competency, and the teaching recognition of trainees between the two groups at the time of departure were respectively compared. SPSS 22.0 was used for the Chi-square test and t-test. Results:At the time of departure, the scores of theory examination and skill operation examination in group B were higher than those of group A [(92.08±11.50), (91.06±12.08) vs. (83.09±10.26), (82.23±10.09)]. There was no significant difference in the scores of clinical basic ability, professional spirit and quality, doctor-patient communication, mastery and application of medical knowledge, teamwork, basic public health services, information and management, and academic research between the two groups before teaching ( P > 0.05). The scores of the above-mentioned aspects were all increased after teaching, and the scores of group B were higher than those of group A ( P < 0.05). The recognition of the teacher's sense of responsibility, teaching awareness, expression ability, knowledge level, communication ability, and teaching method in group B were higher than those of group A ( P<0.05). Conclusion:The application of two-way evaluation combined with transposition learning in the teaching of standardized training of cardiac surgery can enhance the teaching effect, improve the post competency, and can be more recognized by the trainees.

Analysis of influencing factors of acute kidney injury in coronary artery bypass grafting patients treated with different statins / 中华急诊医学杂志

Objective:To compare the effects of rosuvastatin and atorvastatin on coronary artery bypass grafting (CABG) on the incidence of acute kidney injury (AKI), and assess the independent risk factors of AKI.Methods:We retrospectively collected 550 patients aged 18 years or older who underwent CABG from May 2014 to May 2020. They were divided into the rosuvastatin group ( n=322), atorvastatin group ( n=125) and non statins group ( n=103) according to whether rosuvastatin or atorvastatin was routinely used before operation. Demographic data, clinical data before and after CABG and laboratory results were collected. Blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr) and incidence of postoperative AKI were compared among the three groups. Univariate analysis and binary logistic regression analysis were used to investigate the effect of statins on AKI in patients undergoing CABG. Results:Compared with preoperation, BUN showed no significant change ( P>0.05), while Scr was increased and Ccr was decreased significantly (both P<0.01); BUN in the rosuvastatin group was decreased significantly ( P<0.01), whereas Scr and Ccr had no significant change ( P>0.05); Scr in the atorvastatin group was increased significantly ( P<0.01), but there was no significant difference in BUN and Ccr ( P>0.05). BUN and Scr in the non statins group were increased significantly (both P<0.01), while Ccr was decreased significantly ( P<0.01). After operation, BUN and Scr in the rosuvastatin group and atorvastatin group were significantly lower than those in the non statins group (all P<0.01); Ccr was significantly higher than that in the non statins group ( P<0.01). BUN and Scr were not significantly different between the rosuvastatin and atorvastatin groups ( P>0.05), but Ccr was significantly higher than that in the atorvastatin group ( P< 0.05). There were significant differences in BUN, Scr and Ccr among the three groups ( χ2=48.925, 22.677 and 34.426, all P<0.01). The incidence of AKI among 550 patients was 15.1% (83/550), of which 9.6% (31/322) in the rosuvastatin group, 16.0% (20/125) in the atorvastatin group and 31.1% (32/103) in the non statins group. The incidence of AKI in the rosuvastatin and atorvastatin groups was significantly lower than that in the non statins group ( χ2=28.412, 7.282, P<0.01). Multivariate regression analysis showed that hypertension ( OR=3.555, 95% CI: 1.959-6.451, P<0.01), NHYAⅢ/Ⅳ ( OR=2.438, 95% CI: 1.187-5.008, P=0.015), and increased serum creatinine level ( OR=1.018, 95% CI: 1.003-1.032, P=0.016), and intraoperative cardiopulmonary bypass ( OR=2.936, 95% CI: 1.454-5.927, P=0.003) were independent risk factors for AKI after CABG, while preoperative conventional statin therapy ( OR=0.490, 95% CI: 0.247-0.974, P=0.042) and increased serum albumin level ( OR=0.920, 95% CI: 0.856-0.990, P=0.026) were protective factors for AKI after CABG. Conclusions:The incidence of AKI after CABG is common. Rosuvastatin or atorvastatin and increased preoperative serum albumin level can protect renal function and reduce the incidence of AKI, which are the protective factors of AKI after CABG. The hypertension, NHYAⅢ/Ⅳ, increased preoperative serum creatinine level and cardiopulmonary bypass are the independent risk factors of AKI after CABG.

Risk factors of acute kidney injury in elderly patients undergoing coronary artery bypass grafting / 中华全科医师杂志

Objective:To analyze the risk factors of acute renal injury (AKI) after coronary artery bypass grafting (CABG) in the elderly patients.Methods:A total of 423 patients aged over 60 years who underwent CABG in Linyi People′s Hospital from May 2014 to May 2010 were retrospectively analyzed. Patients were divided into AKI group and control group according to whether AKI occurred. The risk factors of AKI were analyzed by multivariate logistic regression.Results:Among the 423 patients, 62 cases(14.7%)developed postoperative acute kidney injury. Compared with the patients without AKI ( n=361), the proportions of patients with hypertension, heart function (NYHA) ≥ Ⅲ, atrial fibrillation and cardiopulmonary bypass were higher in AKI group, the proportion of patients using statins before operation was lower [71.0%(44/62) vs. 50.7%(183/361),χ 2 =8.75, P<0.01;38.77%(24/62) vs. 7.5%(27/361),χ 2 =48.67, P<0.01;16.1%(10/62) vs. 4.4%(16/361),χ 2 =12.55, P<0.01;51.6%(32/62) vs. 21.3%(77/361),χ 2 =25.37, P<0.01;59.7%(37/62) vs. 85.6%(309/361),χ 2=23.87, P<0.01]. Patients in AKI group had higher level of blood uric acid, urea nitrogen and creatinine [353.8(275.5, 462.5)μmol/L vs. 314.5(262.9, 383.6)μmol/L, Z=2.75, P=0.01;5.5(4.3, 8.2)mmol/L vs. 5.1(4.3, 6.4)mmol/L, Z=2.44, P＝0.02; 74.9(58.5, 92.7)μmol/L vs. 67.0(57.1, 76.3)μmol/L, Z=2.90, P=0.01];and longer operation time, more blood loss and blood vessel bridge than those in control group [(403.2±124.1) vs. (350.6±110.2), t =3.41, P<0.01;(4.0±0.9) vs. (3.7±0.8), t=2.83, P=0.01;(3.8±0.7) vs. (3.5±0.8), t=3.58, P<0.01]. The multivariate logistic regression analysis showed that preoperative cardiac function (NYHA)≥Ⅲ( OR=8.528,95% CI:3.734-19.477, P<0.01),hypertension( OR=6.455,95% CI:2.605-15.997, P<0.01),extracorporeal circulation( OR＝3.046,95% CI:1.190-7.795, P=0.02),diabetes mellitus( OR=2.294,95% CI:1.047-5.026, P=0.04),elevated serum uric acid level( OR=1.004,95% CI:1.000-1.008, P=0.03)were the independent risk factors for AKI. Statins is a protective factor for postoperative AKI( OR=0.366,95% CI:0.154-0.873, P=0.02). Conclusions:AKI is a common complication after CABG in elderly patients. Cardiac function(NYHA) ≥ Ⅲ,hypertension,extracorporeal circulation,diabetes mellitus,elevated serum uric acid level are risk factors and administration of stating is protective factor for the incidence of acute kidney injury in elderly patients after coronary artery bypass grafting.