Effect of goal orientation combined with plan-do-check-act cycle improvement on the professional teaching of critical care medicine / 中华医学教育探索杂志

Objective@#To investigate the promotional effect of the new teaching method of goal orientation combined with plan-do-check-act (PDCA) cyclic improvement on specialized medical knowledge and operation skills among physicians in critical care medicine.@*Methods@#A total of 84 physicians who received critical care medicine training in Department of Critical Care Medicine in Foshan Hospital of Traditional Chinese Medicine from January 2013 to December 2015 were selected, and according to the time of admission, they were divided into control group with 41 physicians and experimental group with 43 physicians. The physicians in the experimental group received the new teaching method of goal orientation combined with PDCA cyclic improvement, i.e., the physicians started systematic learning according to the learning goals sent out by the teaching secretary, summarized problems during learning and looked for optimal solutions every week, and then continued learning in the next week through PDCA cyclic improvement. The physicians in the control group received traditional teaching combined with bedside teaching, but no learning goals were set for them. The two groups were compared in terms of theoretical examination scores, clinical operation skills, and results of the questionnaire survey. The t-test and Wilcoxon ranksum test were used for comparison of scores between the two groups by SPSS 18.0.@*Results@#Compared with the control group, the experimental group had significant increases in the scores of theoretical examination (91.50±4.18 vs. 87.80±3.63) and operation skills (88.80±3.34 vs. 85.40±2.88). The questionnaire survey showed that compared with the control group, the experimental group had a significantly higher degree of satisfaction, significantly greater learning interests, and significantly greater improvements in operation skills, clinical thinking ability, and self-confidence.@*Conclusion@#The new teaching method of goal orientation combined with PDCA cyclic improvement can stimulate learning interests, clarify learning goals, help physicians to master important and difficult issues, and thus improve their learning outcomes and scores in Department of Critical Care Medicine.

Effect of goal orientation combined with plan-do-check-act cycle improvement on the professional teaching of critical care medicine / 中华医学教育探索杂志

Objective To investigate the promotional effect of the new teaching method of goal orientation combined with plan-do-check-act (PDCA) cyclic improvement on specialized medical knowledge and operation skills among physicians in critical care medicine.Methods A total of 84 physicians who received critical care medicine training in Department of Critical Care Medicine in Foshan Hospital of Traditional Chinese Medicine from January 2013 to December 2015 were selected,and according to the time of admission,they were divided into control group with 41 physicians and experimental group with 43 physicians.The physicians in the experimental group received the new teaching method of goal orientation combined with PDCA cyclic improvement,i.e.,the physicians started systematic learning according to the learning goals sent out by the teaching secretary,summarized problems during learning and looked for optimal solutions every week,and then continued learning in the next week through PDCA cyclic improvement.The physicians in the control group received traditional teaching combined with bedside teaching,but no learning goals were set for them.The two groups were compared in terms of theoretical examination scores,clinical operation skills,and results of the questionnaire survey.The t-test and Wilcoxon ranksum test were used for comparison of scores between the two groups by SPSS 18.0.Results Compared with the control group,the experimental group had significant increases in the scores of theoretical examination (91.50 ± 4.18 vs.87.80 ± 3.63) and operation skills (88.80± 3.34 vs.85.40 ± 2.88).The questionnaire survey showed that compared with the control group,the experimental group had a significantly higher degree of satisfaction,significantly greater learning interests,and significantly greater improvements in operation skills,clinical thinking ability,and self-confidence.Conclusion The new teaching method of goal orientation combined with PDCA cyclic improvement can stimulate learning interests,clarify learning goals,help physicians to master important and difficult issues,and thus improve their learning outcomes and scores in Department of Critical Care Medicine.

The effect of Xuebijing injection on coagulation function and prevention of deep venous thrombosis in elderly fracture patients with mechanical ventilation / 中国基层医药

Objective To study effect of Xuebijing injection on coagulation function and prevention of deep venous thrombosis in elderly fracture patients with mechanical ventilation.Methods 60 patients were randomly divided into control group(30 cases) and Xuebijing group(30 cases).Xuebijing group received Xuebijing injection, besides physical therapy for prevention of deep venous thrombosis received by control group.Coagulation parameters and Lac at different time points,thrombosis incidence,hemorrhage incidence APACHE II score and 28 -day mortality were compared between the two groups.Results In Xuebijing group,PT,APTT,DD on d3 and Fg 48 on d5 had statistically significant differences compared with before treatment.PT,APTT on d3,d5 and DD on d5 were statistical-ly different compared with the control group(P <0.05).PLT,Lac,hemorrhage incidence and 28 -day mortality had no significant differences between the two groups.Thrombosis incidence in Xuebijing group was significantly lower than the control group(20.00% vs 3.33%) (χ2 =4.043,P =0.044,P <0.05).Both of APACHE II score were lower than before treatment,but the Xuebijing group was significantly decreased(t =5.48,P =0.000,P <0.05). Conclusion Xuebijing injection could improve coagulation function,and decrease thrombosis incidence in elderly fracture patients with mechanical ventilation.

Analysis of chitin-binding proteins from Manduca sexta provides new insights into evolution of peritrophin A-type chitin-binding domains in insects.

In insects, chitin is a major structural component of the cuticle and the peritrophic membrane (PM). In nature, chitin is always associated with proteins among which chitin-binding proteins (CBPs) are the most important for forming, maintaining and regulating the functions of these extracellular structures. In this study, a genome-wide search for genes encoding proteins with ChtBD2-type (peritrophin A-type) chitin-binding domains (CBDs) was conducted. A total of 53 genes encoding 56 CBPs were identified, including 15 CPAP1s (cuticular proteins analogous to peritrophins with 1 CBD), 11 CPAP3s (CPAPs with 3 CBDs) and 17 PMPs (PM proteins) with a variable number of CBDs, which are structural components of cuticle or of the PM. CBDs were also identified in enzymes of chitin metabolism including 6 chitinases and 7 chitin deacetylases encoded by 6 and 5 genes, respectively. RNA-seq analysis confirmed that PMP and CPAP genes have differential spatial expression patterns. The expression of PMP genes is midgut-specific, while CPAP genes are widely expressed in different cuticle forming tissues. Phylogenetic analysis of CBDs of proteins in insects belonging to different orders revealed that CPAP1s from different species constitute a separate family with 16 different groups, including 6 new groups identified in this study. The CPAP3s are clustered into a separate family of 7 groups present in all insect orders. Altogether, they reveal that duplication events of CBDs in CPAP1s and CPAP3s occurred prior to the evolutionary radiation of insect species. In contrast to the CPAPs, all CBDs from individual PMPs are generally clustered and distinct from other PMPs in the same species in phylogenetic analyses, indicating that the duplication of CBDs in each of these PMPs occurred after divergence of insect species. Phylogenetic analysis of these three CBP families showed that the CBDs in CPAP1s form a clearly separate family, while those found in PMPs and CPAP3s were clustered together in the phylogenetic tree. For chitinases and chitin deacetylases, most of phylogenetic analysis performed with the CBD sequences resulted in similar clustering to the one obtained by using catalytic domain sequences alone, suggesting that CBDs were incorporated into these enzymes and evolved in tandem with the catalytic domains before the diversification of different insect orders. Based on these results, the evolution of CBDs in insect CBPs is discussed to provide a new insight into the CBD sequence structure and diversity, and their evolution and expression in insects.

The effect of Xuebijing injection on transfusion and inflammatory factors in patients with traumatic coagulopathy / 实用医学杂志

Objective To study the effect of Xuebijing injection on transfusion and systemic inflammation in traumatic coagulopathy patients. Methods Seventy-nine patients were randomly divided into Xuebijing Group (36 cases) and Control Group (43 cases). Xuebijing group received Xuebijing injection in addition to the regular treatment received by control group. Levels of TNF-α, IL-6, IL-8 and transfusion amount between two groups were compared. Results Coagulation abnormality was almost corrected in all patients after treatment. In Xuebijing Group, transfusion of RBC, FFP and cryoprecipitate were significantly less than that in control group (P<0.05). At 72 h after admission, TNFα, IL-6 and IL-8 were significantly lower in Xuebijing Group (P < 0.05). Conclusion Xuebijing injection could reduce transfusion in traumatic coagulopathy patients , possibly resulting from its antagonism against systemic inflammation.

Research on the relationship between C reactive protein and postoperative delirium of elderly patients after hip fracture / 中国基层医药

Objective To study the relationship between C reactive protein ( CRP) and postoperative deliri-um of elderly patients after hip fracture , and to explore the possible mechanism of delirium .Methods A total of 186 elderly patients with hip fracture who received operation were included in the study .24h after operation,according to the patients'awareness of ICU fuzzy evaluation method ,the patients were divided into the delirium group and non delirium group .The levels of CRP and procalcitonin were detected and compared .Results The CRP levels in the de-lirium group and non delirium group were (207 ±86)mg/L,(87 ±42)mg/L,there was significant difference between two groups (t =2.427,P 0.05).Conclusion CRP may be related with delirium.Inflammatory response without systemic infection may be one of the mechanisms of delirium .

The clinical application of homemade airway exchange catheter on extubation of patients with difficult tracheal intubation in intensive care unit / 中国中西医结合急救杂志

Objective To discuss the clinical application of homemade airway exchange catheter on the extubation of patients with difficult tracheal intubation in intensive care unit(ICU). Methods Sixty-two patients with difficult tracheal intubation who failed their initial extubation trial were randomly divided into conventional group (31 cases)and observation group(31 cases). The patients in the conventional group received routine extubation process,while the patients in the observation group were extubated under the guidance over a homemade airway exchange catheter. The changes in heart rate(HR),blood pressure,respiratory rate(RR)and pulse blood oxygen saturation(SpO2)were compared at 12 hours after extubation,so as the re-intubation rate,intubation success rate at first attempt and re-intubation time in two groups,and the tolerance and complications after extubation were observed. Results After extubation,the HR,blood pressure and RR were increased significantly(all P<0.05), and the SpO2 was much lower in conventional group(P<0.05),while those parameters were changed little and basically in the normal ranges in the observation group. At 12 hours after extubation,the re-intubation rate was much lower(6.45%vs. 25.81%,P<0.05)in the observation group,with shorter re-intubation time(seconds:27±14 vs. 49±28,P<0.01),higher intubation success rate at first attempt(90.32%vs. 54.84%,P<0.01)and better tolerance (77.4% vs. 61.3%,P<0.05)compared with those in the conventional group. There was no severe complication in the observation group,and there were 1 cases of glottic edema with cricothyroid membrane puncture,2 cases of broncheal mucous membrane bleeding and 2 cases of bucking in the conventional group. Conclusion Compared with conventional extubation process,the extubation over homemade airway exchange catheter can increase the rate of extubation,reduce re-intubation rate and the re-intubation time,with favorable tolerance and no occurrence of serious complications,and is one of the safe and effective extubation strategies in patients with difficult tracheal intubation in ICU.