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The outbreak of public health emergencies would bring an enormous impact on the order of medical treatment and the plan of medical education. In order to minimize the impact of such emergencies on the regular training of surgical residents, Beijing Professional Committee for Standardized Training of Surgical Residents has fully mobilized the enthusiasm of members and given full play to the advantages of special training base, and the committee has launched a series of twelve training courses with the help of an online platform, which provide experience for the training of surgical residents during special periods. This article elaborates on the design of the course, the requirements and selection of online platform, faculty selection and training, resident management, and reflections of future development.
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Objective:To determine the effect of prolonging the interval of flushing on ports′ function and catheter related complications for cancer patients after completing chemotherapy.Methods:A prospective randomized controlled trial was conducted in 190 patients who undergoing ports-maintenance in outpatient clinical, the First Affiliated Hospital of Sun Yat-sen University, after they finished the chemotherapy from April 2017 to February 2018. According to the random number table, the patients were divided into 4-week group, 8-week group and 12-week group after completing chemotherapy, then returned to the hospital to maintain the port every 4 weeks, every 8 weeks and every 12 weeks, respectively. Then evaluated the function and complications of catheter among different groups.Results:After completion of chemotherapy, the rate of catheters′ patency of tumor patients in 12-week group was 98.5% (66/67), while that in 4-week group was 98.1% (53/54) and in 8-week group was 98.6% (68/69), there was no statistically significant difference on catheters′ patency among different groups ( χ 2=0.48, P>0.05). The rate of catheters′ asymptomatic thrombosis in 12-week group was 18.9% (10/53), which was not significantly different from that of 4-week group 27.0% (10/37) and 8-week group 14.0% (7/50) ( χ 2=2.33, P>0.05). Conclusions:Tumor patients maintaining port every 12 weeks after completion of chemotherapy can ensure the safety of patients using the port. It is favorable for application and promotion of port in cancer patients.
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From September 2020 to August 2021, 34 general practice trainees in Xuanwu Hospital, Capital Medical University were were randomly divided into the control group and trial group with 17 in each group. The control group adopted the traditional clerkship method for outpatient clinical teaching; the trial group independently received patients with the supervision of clinical instructors, and the Leicester assessment package (LAP) was used for evaluation and training. The performance of two groups were assessed using the Beijing General Practitioner's Graduation Assessment and Admissions Patient Score Sheet. The LAP training was also given to control group at the late stage of the study, and the application of LAP was assessed with a questionnaire survey in two groups of trainees. The results showed that the performance of trial group was better than that of control group in terms of medical history collection [(23.12±1.05) vs. (21.18±0.88), t=-5.82, P<0.01 ], physical examination [(24.88±1.62) vs. (23.12±1.58), t=-3.22, P< 0.01 ], case analysis [(22.94±0.90) vs. (20.82±0.73), t=-7.55, P<0.01 ] and total score [(86.59±2.65) vs. (80.12±2.45) t=-7.40, P<0.01]. For assessment of LAP, all 34 trainees gave 5 points in items of improving patient care, knowledge and skills, communication skills, professional quality, reception skills, clinical thinking, clinical judgment, decision-making skills, and learning interest with the application of LAP in outpatient clinical teaching; the satisfaction of the trainees on the pertinence, teaching effect and LAP training method of the instructing physicians was 100% (34/34). It is suggested that the application of LAP for evaluation and implementation in general practice outpatient teaching will help to improve the teaching quality and the patient receiving ability of general practitioners.
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A total of 207 general practitioners who participated in the "Beijing-Hong Kong Community Health Service Training Demonstration Center Project" training from 2013 to 2017 were selected for this questionnaire survey. A self-designed questionnaire was used, which contained the basic information of the trainees, the training purpose, the shortcomings of training, the satisfaction and suggestions for training. Total 192 valid questionnaires were retrieved with a recovery rate of 92.8%. The in-depth personal interviews were conducted among 8 trainees who served as key trainers in community health service centers and 4 managers from their institutions, to investigate the subsequent application of the learning results after they returning to work. The survey showed that the reasons of participating in training were knowledge updates (165, 85.94%), competence requirements (128, 66.67%), and due to administration decision (127, 66.15%). The highest comprehensive scores of training needs were improvement of general practice thinking ability (4.63), followed by clinical diagnosis and treatment ability (4.44), and general practice skills (3.97). For teaching contents, participants were most interested in diagnosis ability (4.03) and clinical operative techniques (3.20). For the training form, the participants more favored the case discussion method (80.73%, 155/192), clinical practice (52.08%, 100/192) and community practice (38.02%,73/192). The trainees were highly satisfied with the overall training organization, training time, training form, and training teachers of the Beijing-Hong Kong training project, and had a good grasp of the training content. Half of trainees (97, 50.52%) thought that the main shortcomings of training was the discrepancy between training content and practical work. Interviewees showed that after the training, the team management, communication skills and disease management ability for some minor specialties had been significantly improved; the enthusiasm for scientific research had been stimulated; they had a certain managerial thinking; and were able to apply what they leant in community health service. In summary, the training project has reached the initial training goals to promote the comprehensive ability of trainees.
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Resident standardized training is the indispensable way to develop the medical and health services in China, and the construction of resident standardized training base is the basis of this work. Under the current situation of the supply and demand of the resident standardized training base and the resident who need to participate in the standardized training, the cooperative base development plays a very good auxiliary role in the work of the national standardized training base for residents. In the process of coordination, the hospital leaders should attach great importance to the development, and we also should promote effective communication among base managers, integrate the training base management system, improve the teaching quality, establish the mechanism of training and supervision, and build a systematic construction bridge between the bases. The most important part of the base coordination is to integrate the advantageous residential training base, professional base, department and professional group, explore the new management model, actively learn from the excellent experience of other bases, as well as increase the training quality and the number of residents.
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In the original publication, the author name was incorrectly published as "Lifeng Chen".
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Objective To develop the social support system for family caregivers of schizophrenic patients in community. Methods Based on the previous field investigation and the principle of comprehensiveness,feasibility,pertinence,suitability,generality and classification,the social support service item pool was established. Fifteen experts with intermediate or higher professional titles and working in the mental health fields were selected from government departments,specialized hospitals and community health service centers. The experts were consulted by Delphi and the results were analyzed. Results The average age of the consultation specialists was (40.7 ± 8.0) years, and the duration of working in mental illness rehabilitation was (14.9±7.6) years. The positive coefficients of the two rounds of consultation were 100％,the authoritative coefficients of experts were 0.795,and the coordination coefficients of opinions were from 0.252 to 0.344, respectively. The 67 items of social support service for family caregivers of schizophrenic patients in Beijing were obtained after two rounds of expert consultation, but fewer of the services were for schizophrenic caregivers only. Conclusion The authority and society should take measures to establish a social support system for family caregivers of patients with schizophrenia, in order to reduce their family burden and improve the quality of rehabilitation for mental patients in the community.
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Objective To investigate the effect of exercise diary on arm exercise compliance ofpatients with peripherally inserted centralcatheter (PICC). Methods Thirty patients with PICC hospitalized in our hospital from June to August in 2017 were selected as the control group, where the patients received guidance on functional exercises through arm exercise videos and routine methods. Another thirty-two patients hospitalized in our hospital from September to November of 2017 were selected as the observation group, where in addition to the same treatment as in the control group and these patients received interventions using their self-designed exercise diary for a total of 31 days. Their compliance with functional exercises before and after intervention and the incidences of venous thrombosis after intervention were compared between the two groups. Results After interventions, the compliance rate of arm exercises in the observation group was significantly higher than that of the control group (90.6% vs. 26.7%, P＜0.05). The incidence of venous thrombosis in the observation group was significantly lower than that of the control group (3.1% vs. 30.0% , P＜0.05). Conclusions Exercise diary can improve the arm exercise compliance of PICC patients and prevent the occurrence of venous thrombosis. It is worthy of clinical application and promotion.
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Objective To investigate current status of knowledge-attitude-behavior about unplanned extubation (UEX) of central venous catheter among infusion nurses in Guangdong Province.Methods The nurses who attended the 2015 intravenous therapy nursing training provided by Guangdong Nursing Association were selected as participants.A self-designed questionnaire about nurses' knowledge-attitude-behavior about UEX of central venous catheter was used to investigate 450 nurses.Results The proportion of nurses who reached good level in knowledge were 41.1％,nurses who had positive attitude were 71.0％,nurses who had positive behaviors were 30.0％.There were significant differences among nurses with different educational background,different titles and different hospital ranks(P＜0.05).Conclusion The knowledge-attitude-behavior of nurses are not satisfactory,especially those who are junior or have lower education or work in non-tertiary hospital.
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Objective To explore the effect of central venous pressure waveforms on the location of power PICC tip. Methods From January 2015 to December 2015, we placed power PICC for 47 patients in our intensive care unit. The CVP waveforms were applied to detect any displacement into small thoracic veins after a four-step localization method. The position of the catheter tip was finally confirmed by X-ray inspection. Results Among the 47 cases undergoing PICC implantation, 45(95.75%) displayed a typical CVP waveform, with the catheter tip positions were located in the superior vena cava inferior segment, 1 (2.13%) displayed a typical CVP waveform, with the catheter tip was misplaced into axillary vein and retraced and 1(2.13%) did not display typical CVP waveforms and CVP value was negative, with the catheter tip was in left internal jugular vein. To locate the catheter tip position with CVP waveform and chest X-rang were 100.00%the same. Conclusions The central venous pressure waveform can be used to determine whether the catheter tip is located in the inferior segment of the superior vena cava or not immediately after the placement of a power PICC. However, chest X-ray inspection conformation is still needed.
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Objective To explore the effect of central venous pressure waveforms on the location of power PICC tip. Methods From January 2015 to December 2015, we placed power PICC for 47 patients in our intensive care unit. The CVP waveforms were applied to detect any displacement into small thoracic veins after a four-step localization method. The position of the catheter tip was finally confirmed by X-ray inspection. Results Among the 47 cases undergoing PICC implantation, 45(95.75%) displayed a typical CVP waveform, with the catheter tip positions were located in the superior vena cava inferior segment, 1 (2.13%) displayed a typical CVP waveform, with the catheter tip was misplaced into axillary vein and retraced and 1(2.13%) did not display typical CVP waveforms and CVP value was negative, with the catheter tip was in left internal jugular vein. To locate the catheter tip position with CVP waveform and chest X-rang were 100.00%the same. Conclusions The central venous pressure waveform can be used to determine whether the catheter tip is located in the inferior segment of the superior vena cava or not immediately after the placement of a power PICC. However, chest X-ray inspection conformation is still needed.
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Objective To explore the effects of different time spans for off-bed activities on postoperative rehabiliatioin of patients with liver transplantation. Methods The clinical data of 42 patients having undergone allogeneic liver transplantation during Jan. 2014 to Oct. 2015 were assigned as the observation group. Another 44 patitents during the same period , matched to those in the observation group in terms of general data , were assigned as the control group . The clinical data of two groupos were reviewed to make comparisons in terms of the time for anus exhaust , the time spans for gastric tube and urinary catheter indwelling , abdominal cavity effusion and hemorrhage and pulmonary infection 3 days after operation. Result The time for anus exhaust and the time spans for gastric tube and urinary catheter indwelling in the observation group were all significantly shorter than the control gorup (P<0.05), but there were insignifiant differences between the groups in abdominal cavity effusion and hemorrhage and pulmonary infection. Conclusion Off-bed activities 3 days after operation is safe and feasible for the patients having undergone allogeneic liver transplantation. It can promote their process of rehabilitation.
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Objective To investigate clinical competence assessment in the graduation examination for surgical professional degree postgraduates and surgical residents in Beijing. Methods Data of clinical competence assessment of graduation examination for surgical postgraduates from Capital Medical University (CMU) and residents from Beijing surgical residency training programs in 2013 were summarized and ana-lyzed. SPSS 11.5 software was used to do t test and chi square test to the corresponding data line. Results There were 118 surgical postgraduates in clinical medicine from CMU and 274 residents from Beijing surgi-cal residency training programs, who attended final clinical competence assessment. There were significant differences between the postgraduate and resident clinical competence assessment system. The differences included their organization in charge of examination and the contents of assessment system. The assessment system of clinical competence for the surgical postgraduates did not involved communication skills, reading and analysis of laboratory tests and imaging investigation. The score of case analysis in the postgraduate group was higher than that in the resident group [(84.6±1.1) vs. (82.2±10.2), P=0.039], however the score of surgical skill assessment in postgraduate group was significantly lower than that of the resident group [(78.2 ±14.0) vs. (90.5 ±6.3), P=0.000]. In addition, the rate in the score being higher or equal to 70 of case note, case analysis and surgical skill assessment between postgraduates and residents was significantly different (P<0.05). Conclusion Clinical competence assessment system for the surgical postgraduates should be adapted to their training goal. In addition to the process assessment, the objective structured clinical skills examination (OSCE) can be as a reasonable postgraduate graduation examination mode.
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Objective To provide a reference for local best practice information sheet by way of analyzing the status quo of adult peripheral venous catheters nursing and maintenance.Methods Systematically analyzing the related 487 documents met the inclusion criteria in CBMdisc,CNKI Database and WanFang Database from the year of 1990 to 2013 by biliometric analysis methods.Results The number of documents,rising year after year,stood mainly in nursing journals,of which the majority authors are from Guangdong [10.3％(50/487)],Anhui [9.0％(44/487)] and Hubei [7.6％(37/487)].50.3％ (245/487)of the documents did not refer in particular to the object.The three major research concerns are the prevention and treatment of complications[80.9％(394/487)],cannulation [23.6％(115/487)] and maintenance [19.9％ (97/487)].Conclusions Peripheral venous catheter cannulation and maintenance has gained widespread attention among the domestic clinical staffs,but the overall quality of articles concerning these aspects is not high.High-quality research papers are expected to provide better evidence for local best practice information sheet.
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Objective To review the publication of general practice education in China mainland in 20 years from 1993 to 2012.Methods The research articles of general practice education published between January 1,1993 and December 31,2012 were searched from CNKI and Wanfang databases, and analyzed with bibliometric and literature management software NoteExpress 2, Epidata 3.1 and SPSS 13.0.Results Total 4 281 articles were retrieved and 241 education relevant articles were selected.29.9％ (72/241) of the 241 articles were on on-campus education, 67.6％ (163/241) were on continuing medical education and 4.5％ (11/241) were on post-graduation education.As to the published institutions, 58.5％ (141/241) were from the medical colleges and research institutions, 25.7％ (62/241 were from the tertiary hospitals, 3.7％ (9/241) were from primary care institutions, 1.7％ (4/241 were from the secondary hospitals and 5.8％ (14/241) were from the government departments.The general practice education grants increased from 1 in 2001 to 46 in 2012;20 of which were supported by provincial and ministerial level funds.Conclusion The contents of general medical education literature in China is mainly on on-campus education and continuing medical education;most of which were from the tertiary hospitals and the medical colleges and research institutions.The amount of research grants of general practice education were increasing year by year during 1993-2012, indicating that more attention had been paid to general practice education in mainland China in the last two decades.
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Disorder of sexual development(DSD) refers to a group of diseases with various causes and phenotypes.It has attracted great worldwide as the incidence is rising and the life-long consequences accompanying.Environmental endocrine disruptors(EED) are thought to have an impact of the sex differentiation process and induce disorder of sexual development.This review summarizes the mechanism of DSD that associated with EED and focus on the relationship between DSD and EED.
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Objective To explore the causes of ambiguous genitalia.Methods Clinical data of 106 cases with ambiguous genitalia from Ruijin Hospital of Shanghai Jiaotong University School of Medicine were retrospectively analyzed.DNA fragments of related genes from parts of patients were amplified by means of polymerase chain reaction (PCR) and were directly sequenced to detect gene mutations.Results (1)The 106 ambiguous genitalia patients presented a variety of clinical phenotypes.Karyotype of 42 cases(39.6％)were 46,XX,while 62 cases(58.5％)were 46,XY and 2 cases(1.9％)were abnormal.(2)Forty(95.2％)patients with 46,XX were diagnosed with congenital adrenal hyperplasia(CAH) ;one case(2.4％) was adrenal cortical tumor and one case (2.4％) was 46,XX [sex determining region of Y choromosome (SRY) positive] male syndrome.(3) Fifty-three cases (85.5 ％) out of 46,XY karyotype were directly sequenced with steroid-5-alpha-reductase,alpha polypeptide 2 gene (SRD5A2),androgen receptor gene (AR) and steroidogenic factor-1 gene(SF-1).Sequencing analysis of SRD5A2 revealed 8 patients with compound heterozygous or homozygous mutations.A patient carried a novel missense mutation of SF-1 and another patient had a mutation of AR.(4) One abnormal karyotype was 46,XX/46,XY and the other was 46,XX/46,XY/46,X.+ may.ish (DYZ3 +) (DXZ1-).Conclusions (1) CAH is the most common cause of genital ambiguity in 46,XX patients but some rare causes such as adrenal cortical tumors or SRY positive should not be ignored.(2) To find the causes of 46,XY genital ambiguity,direct DNA sequencing analysis of candidate genes would be the better choice because of the complicate pathogenesis.(3)Abnormal karyotype also can lead to ambiguous genitalia.
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Objective To compare the effects of peripherally inserted central catheter(PICC)and venous port access (VPA)on the complication incidence of breast cancer.Methods A total of 191 breast cancer patients with VPA and 218 ones with PICC for chemotherapy from January 2012 to January 2014 were involved.The two groups were compared in respect of incidence of complications during intubation.Result The complication incidence in the VPA group was lower than the PICC group(P<0.05). Conclusion VPA is an ideal pathway for intravenous infusion in breast cancer patients undergoing chemotherapy.
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Objective To investigate the nutritional risks in hospitalized patients with liver diseases and work out nursing countermeasures.Methods Forty patients with liver cirrhosis, 40 patients with primary liver cancer and another 40 revisiting after liver transplantation involved in the investigation with a self-designed general information questionnaire and the nutritional risk screening 2002. The three groups were compared in terms of nutritional risks.Results Among the total 120 patients,38.3%(46/120)of them took the nutritional risk and even 12.5%(15/120)had the risk of undernourishment.The risk in the patients with liver cirrhosis was higher than that in the other two groups(χ2=9.899 and 11.4299 and P=0.002 and 0.001,respectively).Conclusions The nursing staffs should pay attention to the nutritional status of patients with liver diseases, especially the patients with liver cirrhosis.It is necessary to take effective measures in order to improve the nutritional status of the patients to reduce the nutritional risks.
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With the improvement of people's living standards, the degree of aging is increasing, so the health demands is increasing greatly. In China, General Medicine attracts more and more attention, and the training of general practitioner is important and urgent. First of all ,“providing good service for the patients” should be the central concept in the GP training. Secondly, based on the national conditions, we should learn the modern medicine theories and absorb the essence of“Preventive Treatment of Dis-ease”in traditional Chinese medicine. In the actual implementation process we should pay attention to the integration of western philosophy and modern technology. Finally , we shoulduse the example of Xuanwu Hospital's general practitioner standardization training to conduct empirical research tothe above prelimi-nary understanding of the situation.