Application research of PBL teaching based on POA theory in clinical practice teaching in the department of hand and foot surgery / 中华医学教育探索杂志

Objective:To explore the application value of problem-based learning (PBL) based on production-oriented approach (POA) theory in clinical practice teaching in department of hand and foot surgery.Methods:A total of 112 interns from the Department of Hand and Foot Surgery in Affiliated Hospital of Jining Medical University from January 2019 to October 2020 were randomly divided into control group and observation group, with 56 interns in each group. The control group was taught by PBL teaching, and the observation group was taught by PBL teaching based on POA theory. The two groups of interns were compared in terms of the evaluation of teaching effect, the statistics of errors in practice assessment, the assessment scale of independent learning ability, the career maturity inventory attitude scale, and the satisfaction of interns with their teachers. SPSS 25.0 was used for Chi-test and t-test. Results:The teaching effect and the satisfaction of interns with the teacher in the observation group were better than those of the control group ( P<0.05); the error rate of unskilled physical examination and the error rate of poor aseptic debridement concept in the observation group were all lower ( P<0.05); there was no significant difference in the error rate of irregular writing of medical records, the error rate of lack of medical history collection, and the error rate of communication errors between the two groups ( P>0.05). After teaching, the scores of independent learning ability and career maturity inventory attitude scale in the observation group were higher than those in the control group ( P<0.05). Conclusion:The PBL teaching based on POA theory has a good effect in the clinical practice teaching in the department of hand and foot surgery, and it is worthy of further promotion.

Hemangioma cavernoso del pie: a propósito de un caso / Cavernous hemangioma of the foot: a case report

RESUMEN Introducción: Los tumores de partes blandas son un grupo heterogéneo de lesiones tanto benignas como malignas. El origen histológico es diverso y entre ellos se encuentra el vascular como el hemangioma. Objetivo: Conocer un paciente con hemangioma cavernoso de partes blandas del pie derecho. Caso clínico: Paciente masculino de 21 años de edad, blanco sin antecedentes mórbidos de salud, acude a la consulta externa de Ortopedia y Traumatología por presentar una bola a nivel de la planta del pie derecho acompañada de dolor. Apareció hace dos años, pero ha incrementado su tamaño de forma rápida en los últimos tres meses. Mediante la exploración física se observó la tumoración en la cara plantar e interna del pie derecho, de consistencia dura, fija, mayor a 8 cm, de bordes irregulares y pobremente definidos con aumento de la temperatura local. Se realizaron exámenes complementarios imagenológicos y hematológicos. Al analizar el resultado de la exploración física y los complementarios se decidió la intervención quirúrgica consistente en la resección de la tumoración. Conclusiones: El hemangioma cavernoso es una enfermedad que afecta por lo general a niños y adolescentes sin predilección por el sexo, sus síntomas y signos más encontrados son el aumento de volumen y el dolor. El tratamiento consiste en la resección del tumor a través de un margen de seguridad y su principal complicación es la recidiva.

ABSTRACT Introduction: Soft tissue tumors are a heterogeneous group of both benign and malignant lesions. The histological origin is diverse and among them is the vascular one such as hemangioma. Objective: To present a patient with a soft tissue cavernous hemangioma of the right foot. Case report: A 21-year-old white male, without morbid antecedents, attended at the Orthopedics and Traumatology outpatient clinic for presenting a ball at the level of the sole of the right foot accompanied by pain. It appeared two years ago, but has grown rapidly in size in the last three months. The physical examination revealed that the tumor was on the plantar and inner side of the right foot, it was of a hard, fixed consistency, greater than eight centimeters, with irregular and poorly defined edges, with an increase in local temperature. Complementary imaging and hematological examinations were performed. Upon analyzing the results of the physical examination and the complementary ones, a surgical intervention consisting of resection of the tumor was decided. Conclusions: Cavernous hemangioma is an entity that generally affects children and adolescents without predilection for sex, its most common symptoms and signs are increased volume and pain. Treatment consists of resection of the tumor through a safety margin and its main complication is recurrence.

Comparison between caudal epidural block and popliteal nerve block for postoperative analgesia in children undergoing foot surgery: a randomized controlled trial

Background: Pain following surgery in children cause discomfort, restlessness and agitation in the postoperative period which may result in an increased incidence of nausea, vomiting and maladaptive behavioural changes. Regional anaesthesia is commonly used as an adjunct to general anaesthesia for perioperative analgesia in children as part of a multimodal approach of pain relief. This study is to compare between caudal epidural block and popliteal nerve block for postoperative analgesia in children undergoing foot surgery.Methods: A prospective randomized single blind study was carried out on 30 children aged 1-12 years of either sex undergoing foot surgery. Patients were randomly assigned into caudal epidural block group and Popliteal nerve block group, 15 children each. Both groups receive 1 ml/kg of 0.25% bupivacaine. Foot surgery was carried out under general anesthesia along with regional block for all children. After completion of surgery, children were shifted to PACU and HR, BP, SPO2 were monitored. Patient was discharged from PACU after CHEOPS (1-5 years) or VAS (6-12 years) <4. Parental satisfaction, sedation score, PONV, and any other side effects were recorded.Results: Demographic data and baseline vital signs were comparable between two groups. Statistically significant difference (p=0.025) in number of attempts in giving block in group A (1.20±0.41) than group B (1.80±0.86). The mean postoperative pain scores, CHEOPS and VAS were comparable in both groups.Conclusions: Both caudal epidural block and popliteal nerve block provides comparable and adequate analgesia in children undergoing elective foot surgery.

Comparative Analysis of Unilateral Subarachnoid block with Ankle block for elective foot surgery.

Background: There are many accepted anesthesia techniques for elective foot surgery ranging from general anesthesia to regional anesthesia, regional anesthesia being the preferred method. Regional anesthesia techniques employed for foot surgery includes subarachnoid block, epidural anesthesia and ankle block. Objective: The present study is aimed at providing comparative analysis of ankle block with unilateral subarachnoid block for elective foot surgeries in terms of hemodynamic safety profile and post operative analgesia. Material and Methods: Study includes prospective analysis of 80 ASA II and III patients who underwent elective foot surgery. Patients were randomly divided into two groups of 40 each, Ankle block group (AB) and Unilateral subarachnoid group (US). The parameters recorded for study includes systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale for pain severity, time of first analgesic need and the complications. Results: There were minimal blood pressure changes and heart rate variability in AB group as compared to US group when compared with basal values (p<0.05). The time for first analgesic requirement is prolonged in AB group as compared to US group. The visual analogue scale score was assessed at 2nd ,4th and 6th hours for group AB were lowered as compared to group US (p <0.05).