微信公众平台在外科住院医师规范化培训中的应用探索

微信公众平台作为近年来普及度非常广的流媒体共享平台,在教育方面拥有巨大的潜能。本文以“PUMC规培教学”公众号为例,探索微信公众平台在外科住院医师规范化培训中的应用。目前外科住院医师规范化培训缺乏针对性、系统性,在教学时间安排上也存在困难。微信公众平台通过与传统外科教学模式相结合,并对教学模式进行创新,提升教学的针对性和系统性,提高学生的学习效率。     

外科住院医师规范化培训需求的调查分析及对策

目的调查外科住院医师规范化培训中临床技能及科研技能的教学需求,指导教学改革方向。方法采取自填式问卷调查法,于2018年7月集中开会形式,召集在培第二年和第三年的北京协和医院外科住院医师,在阶梯教室隔位就座,统一讲解填写方法与注意事项,学员们“背靠背”式不记名自行填写。到场收取问卷85份,有效问卷83份。主要调查了培训的临床诊疗与操作技能学习需求、科研技能学习需求两方面共5道多项选择题。结果临床技能方面需求最多的为外科常见病的诊疗和手术教学,其中手术教学较多需求是有更多的动手机会。科研技能方面主要需求是数据资料收集、统计学方法(Meta分析)、科研设计与立项、标书的书写与投标,论文的写作与发表。结论外科住院医师对常见病诊疗、临床动手操作能力、科研能力的欠缺。对此外科教研室提出了“导师制”“动物模型”“全要素模拟手术”“增加科研培训课程”等改革方案。     

心血管外科住院医师规范化培训初探

随着学科的迅速发展、患者群体的不断扩大以及疾病谱的不断变化,我国对心血管外科医师的数量和素质的要求也不断递增。然而,心血管外科医师具有专业素质要求高、成长周期长的特点,目前很多单位呈现出＂供不应求＂的形势。针对这一现状,如何通过开展规范化培训,并在保证质量的同时尽可能缩短培训时间已成为亟待解决的问题。为此,作者根据所在单位多年住院医师培训的经验进行了初步的探讨。     

内科住院医师规范化培训中的模拟教学探索

目的在住院医师规范化培训广泛开展的大环境下,北京协和医院内科采取模拟教学模式进行新的探索。方法在内科规培住院医师中进行了问卷调查,并设计模拟教学针对部分学员进行了重症病例模拟培训。结果内科规培学员重症病例暴露较少,对提高值班能力的教学内容较为期待。目前已建立内科重症病例模拟教学机制,初步运行效果良好。结论在内科住院医师规培中应用模拟教学将有助于提高培训水平。     

基于网络的培训方式在北京市放射科住院医师规范化培训中的应用

目的探讨网络培训平台在北京市放射科住院医师规范化培训中的应用效果。方法在北京市住院医师规范化培训Ⅰ阶段考试前约1年的时间针对全体北京市放射科住院医师进行网络培训,对网络培训平台访问量、访问人数、观看时长及受众情况进行分析和整理,并对考生培训平台的使用情况调查问卷结果进行分析,问题包含考生是否喜欢网络培训方式及网络培训平台是否可补充日常工作的病例病种等。结果对视频课程及PPT课程,课程访问量明显多于访问人数(P<0.001),课程时长与平均实际观看时长相比,无差异。几乎所有的课程均可看到放射科以外的其他科室成员访问。学生普遍喜欢网络培训平台这一授课方式,认为培训平台提高了学习效率,对一阶段考试有所帮助。2018年北京市放射科住院医师规范化培训Ⅰ阶段考试成绩为平均分86分、通过率为87.8%,高于2017年考试成绩84.5分及通过率85.3%(p=0.380)。结论网络培训平台在放射科住院医师规范化培训中认可度较高,对考生通过Ⅰ阶段考试有所帮助,在今后的放射科住院医师规范化培训中可进行推广。     

线上PBL教学在儿科住院医师规范化培训中的应用

随着三孩政策的放开,我国出现儿科医师严重不足的情况,住院医师规范化培训是解决儿科医师短缺的重要途径。新型冠状病毒肺炎疫情常态化防控形势下,住院医师规范化培训面临新的挑战,线上课堂发挥其独特优势。在儿科住院医师规范化培训中采用线上PBL教学模式进行线上教学,突破集中授课的固定场地限制,PBL模式可培养学员主动思考、提出问题、分析问题、解决问题的能力,培养学员临床思维,也提高了学员学习的主动性和积极性。线上教学对教师也提出更高要求,教师在教学设计和实践过程中应做到时刻“以学生为中心”,包括课前准备、课堂教学中对课程的掌控以及课后学员反馈的再修正等。随着网络技术的发展,通过不断优化线上教学模式,根据教学需求和教学目的来综合运用各种表现手段,可达到培养合格医学人才的目的。     

从1例延误诊断的库欣综合征看住院医师规范化培训的重要性

住院医师规范化培训是毕业后医学教育的基础。本文深入分析了一例被延误诊断的库欣综合征病例。患者一年内虽然反复就诊于省级三甲医院的多个专科,但各专科仅处理与各自专业相关的临床表现而未综合分析,导致诊断延误,丧失手术机会。由此说明规范化培训是临床整合分析的必备条件,也是专科医师培训无法替代的;住院医师需要通过规范化培训以增加对各相关科室的知识储备。此外,住院医师阶段的规范化培训可减小不同医学基础教育间的差距,将有助于提高国内住院医师和专科医师的整体水平。     

基于混合式教学法在影像科住院医师规范化培训中的初探

目的 探索一种能有效提高影像住培医师临床能力的混合式教学法.方法 将66名影像住培医师随机分为传统组、现代组和综合组.各组分别采用其相对应的教学法,分别记录规培教学前后客观结构化临床检查成绩,并使用问卷调查获得学生对教学工作和自我满意度的评价.结果 3组学生规培教学前、后组内考核成绩均有差异(P<0.05).3组学生的...     

中国精神科住院医师规范化培训的发展概述

1背景20年前,国内一些医学院校的附属医院的精神科相继开展住院医师规范化培训[1],但由于医院的专业水平存在差异,培训方案和执行情况也自然反映出明显差别,而且缺乏全国统一的评估和考试制度,所以,只能说是门派内的规范化。2004年,卫生部启动了建立我国专科医师     

独立值班考核制度在内科住院医师规范化培训中的应用

目的介绍北京协和医院内科创立的独立值班考核制度,分析该考核制度在住院医师独立值班能力评价和分层中的作用。方法对北京协和医院内科2017年和2018年内科住院医师独立值班考核的结果进行统计,分析不同来源的住院医师在考试次数、通过考试所需时间和通过率方面的分布。结果内科临床医学博士后、专业型临床硕士研究生和北京市基地规培住院医师在通过独立值班考核所需次数方面无差异;内科临床博士后通过考核用时最短,专业型临床硕士研究生次之,北京市规培住院医师用时最长(χ²=96.27,P<0.05),可以进行初步分层;通过临床带教,大部分住院医师都能在实习6个月内通过独立值班考核,承担独立值班工作。结论在内科住院医师规范化培训中,独立值班考核制度能够客观评价住院医师的值班能力,最大限度的保证临床安全。北京市基地规培住院医师通过考核时间较长,应注意加强临床教学、提高学员能力。     

An infant surgical table for laser photocoagulation: ergonomic improvement analysis

Current methods of treatment for retinopathy of prematurity, using laser photocoagulation, require surgeons to assume awkward standing positions, which can result in occupational injury. A new infant surgical table was designed for improving this surgical procedure. To quantify its benefits, an ergonomic comparison of the standard and modified procedures was carried out, using specialized checklists, Nordic Musculoskeletal Questionnaires, and analysis of videotaped procedures using an Ovako Working Posture Analysing System method. Analysis of the typical laser photocoagulation procedure revealed a high risk for cumulative trauma disorders. The majority of the risk factors were lowered considerably with use of the new table. Improvement was largely due to the new table allowing seated postures during surgery, relieving muscular stress on the back, shoulders and legs. This study demonstrates risk reduction through engineering design of new medical devices, and illustrates how combining different assessment approaches can help evaluate ergonomic impact of medical technologies.     

Multi-generational analysis and visualization of the vascular tree in 3D micro-CT images

Micro-CT scanners can generate large high-resolution three-dimensional (3D) digital images of small-animal organs, such as rat hearts. Such images enable studies of basic physiologic questions on coronary branching geometry and fluid transport. Performing such an analysis requires three steps: (1) extract the arterial tree from the image; (2) compute quantitative geometric data from the extracted tree; and (3) perform a numerical analysis of the computed data. Because a typical coronary arterial tree consists of hundreds of branches and many generations, it is impractical to perform such an integrated study manually. An automatic method exists for performing step (1), extracting the tree, but little effort has been made on the other two steps. We propose an environment for performing a complete study. Quantitative measures for arterial-lumen cross-sectional area, inter-branch segment length, branch surface area and others at the generation, inter-branch, and intra-branch levels are computed. A human user can then work with the quantitative data in an interactive visualization system. The system provides various forms of viewing and permits interactive tree editing for "on the fly" correction of the quantitative data. We illustrate the methodology for 3D micro-CT rat heart images.     

3D可视化联合3D打印在肝癌大部分肝切除术中的应用

目的:探讨基于3D重建系统软件的肝体积评估和3D可视化、3D打印辅助肝癌大部分肝切除术的应用价值。方法:将符合要求的肝癌行大部分肝切除术患者46例,随机分为观察组和对照组,每组23例。观察组（3D组）患者采用3D可视化技术和3D打印模型进行围手术期规划和指导,主要基于肝体积评估等术前规划和3D可视化分析、3D打印指导肝切除术手术;对照组（CT组）患者采用传统CT资料进行肝体积评估等术前规划、CT二维影像资料指导肝切除术。观察指标:虚拟切除肝体积、实际切除肝体积、残肝体积、标准残肝体积比、手术时间、术中出血量、术后并发症、患者满意度等。结果:3D组与CT组虚拟切除肝体积与实际切除肝体积、虚拟（术前）残肝体积与实际（术后）残肝体积比较,差异均无统计学意义（P>0.05）,相关性分析显示虚拟切除肝体积与实际切除肝体积呈正相关性（3D组r=0.990, P<0.001;CT组r=0.943, P<0.001）。3D组与CT组虚拟残肝体积比、实际残肝体积比比较,差异均无统计学意义（P>0.05）,且相关性分析显示呈正相关性（3D组r=0.931, P<0.001;CT组r=0.902, P<0.001)。3D组术中出血量少于CT组（P<0.05）,3D组患者满意度优于CT组（P<0.05）。两组患者手术时间、术后并发症等比较,差异无统计学意义（P>0.05）。结论:3D重建系统软件和CT软件在评估肝癌大部分肝切除术的肝体积均可行、准确,具有很好的临床应用价值,有助于肝切除术的安全实施。3D可视化联合3D打印在围手术规划可减少手术出血,提高患者满意度,在临床应用中具有潜在优势。     

3D visualization as a communicative aid in pharmaceutical advice-giving over distance

Background

Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information.

Objective

To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker.

Methods

We created a Web-based communication service called AssistancePlus that allows an advisor to demonstrate the physical handling of a complex pharmaceutical product to an advice seeker with the aid of 3D visualization and audio/video conferencing. AssistancePlus was tested in 2 separate user studies performed in a usability lab, under realistic settings and emulating a real usage situation. In the first study, 10 pharmacy students were assisted by 2 advisors from the Swedish National Co-operation of Pharmacies’ call centre on the use of an asthma inhaler. The student-advisor interview sessions were filmed on video to qualitatively explore their experience of giving and receiving advice with the aid of 3D visualization. In the second study, 3 advisors from the same call centre instructed 23 participants recruited from the general public on the use of 2 products: (1) an insulin injection pen, and (2) a growth hormone injection syringe. First, participants received advice on one product in an audio-recorded telephone call and for the other product in a video-recorded AssistancePlus session (product order balanced). In conjunction with the AssistancePlus session, participants answered a questionnaire regarding accessibility, perceived expressiveness, and general usefulness of 3D visualization for advice-giving over distance compared with the telephone and were given a short interview focusing on their experience of the 3D features.

Results

In both studies, participants found the AssistancePlus service helpful in providing clear and exact instructions. In the second study, directly comparing AssistancePlus and the telephone, AssistancePlus was judged positively for ease of communication (P = .001), personal contact (P = .001), explanatory power (P < .001), and efficiency (P < .001). Participants in both studies said that they would welcome this type of service as an alternative to the telephone and to face-to-face interaction when a physical meeting is not possible or not convenient. However, although AssistancePlus was considered as easy to use as the telephone, they would choose AssistancePlus over the telephone only when the complexity of the question demanded the higher level of expressiveness it offers. For simpler questions, a simpler service was preferred.

Conclusions

3D visualization paired with video conferencing can be useful for advice-giving over distance, specifically for issues that require a higher level of communicative expressiveness than the telephone can offer. 3D-supported advice-giving can increase the range of issues that can be handled over distance and thus improve access to product information.     

基于相位衬度成像的小鼠肺肿瘤三维可视化研究

目的肿瘤的早期发现对患者意义重大。鉴于相位衬度成像对于如肺部这样的软组织成像效果显著,本文提出利用相位衬度成像技术,以微米尺度的空间分辨对肿瘤进行成像,并定量分析,早期发现肿瘤。方法在KM小鼠肺部原位接种人肺癌细胞,培育10d后取出肺组织,利用上海同步辐射光源进行相位衬度成像获取投影图像,拍摄结束后对样本进行切片、HE染色,并光学显微镜观察病理切片。然后利用滤波反投影对获取的投影图进行CT断层重建,并通过病理切片对比验证肿瘤位置,最后通过Amira软件进行三维模型的建立。结果重建出了清晰的三维模型,在模型上可以发现小肿瘤结节的存在,并测量得出该肿瘤体积为0．655mm3。结论相位衬度成像对软组织分辨率高,能发现体积较小的肿瘤．对肿瘤的早期发现有一定意义。     

数字化原位子宫动脉血管3D可视化模型的构建及意义

目的探讨构建女性原位子宫动脉血管3D可视化模型和研究子宫动脉血管的结构特征。方法采用聚乙烯醇-氧化铈血管造影术进行2例女尸盆腔动脉血管灌注,X线平位摄影、64排螺旋CT扫描后采集数据,导入计算机Mimics10.01重建软件进行子宫动脉血管3D可视化模型构建,观察子宫动脉血管的形态及血供分布情况。结果①构建的子宫动脉血管三维模型图像清晰,管道饱满,立体空间感强,均能清晰地显示子宫动脉的4级以上血管,各级分支血管的形态、走行、分布及各血管间的吻合显影清晰,效果满意。2例子宫及附件无实质性病变,为正常子宫。②清晰显示子宫动脉血管网的构建特点:子宫动脉自主干依次发出膀胱支、输尿管支、上行支、下行支等分支动脉;上行支较粗呈弓状沿子宫体侧缘迂曲上行,至宫角处分为宫底支、输卵管支和卵巢支,主要向子宫体和子宫附件供血;下行支较细分布于宫颈及阴道上段,但分布于阴道的血管较少;子宫动脉通过其卵巢支与卵巢动脉相交通;同时子宫动脉的供血还存有着明显的同侧倾向,双侧子宫动脉在子宫的中轴线处有少量细小的交通支。结论采用聚乙烯醇-氧化铈血管造影术盆腔动脉血管灌注可构建理想的子宫动脉血管网3D可视化模型,为系统研究人子宫动脉血管网的形态结构和血供分布提供了血管解剖学基础。     

A novel segmentation method using multiresolution analysis with 3D visualization for X-ray coronary angiogram images

Coronary angiography is a widely used tool in the diagnosis and treatment of cardiac diseases. The main cause of coronary artery disease is atherosclerosis, which leads to the narrowing of artery lumen, resulting in decreased blood supply to heart muscles. Determination of narrowing of the lumens mainly depends upon the quality of the segmented image; with improved segmentation technique there is better accuracy in identification of blocks. The main purpose of the paper is to develop an automatic, accurate segmentation technique with 3D visualization for the segmented images. 3D visualization provides clearer information regarding the shape and severity of the lesion. The thresholding technique is one of the oldest and simplest techniques used for segmentation. This paper proposes a multithresholding approach using the entropy measure and multiresolution analysis to ensure automatic and accurate segmentation by overcoming some of the problems encountered in other techniques. Also, segmentation performance analysis was conducted for various segmentation methods. This method is tested with different real coronary angiographic images and was found to perform better than the other techniques.     

胰十二指肠区动脉血管3D可视化模型的构建及意义

目的探讨构建胰十二指肠区动脉血管3D可视化模型和研究胰十二指肠区动脉血管的结构特征。方法采用128排螺旋CT对5例新鲜肝标本进行扫描,并进行三维重建。记录螺旋CT影像下胰十二指肠区血管的空间位置关系。结果构建的胰十二指肠区动脉血管三维模型图像清晰,管道饱满,立体空间感强,均能清晰地显示胰十二指肠区动脉的4级以上血管,各级分支血管的形态、走行、分布及各血管间的吻合显影清晰,效果满意。清晰显示胰十二指肠区动脉血管网的构建特点。结论采用聚乙烯醇-氧化铈血管造影术胰十二指肠区动脉血管灌注可构建理想的胰十二指肠区动脉血管网3D可视化模型,为系统研究人胰十二指肠区动脉血管网的形态结构和血供分布提供了血管解剖学基础。     

System for the analysis and visualization of large 3D anatomical trees

Modern micro-CT and multi-detector helical CT scanners can produce high-resolution 3D digital images of various anatomical trees. The large size and complexity of these trees make it essentially impossible to define them interactively. Automatic approaches have been proposed for a few specific problems, but none of these approaches guarantee extracting geometrically accurate multi-generational tree structures. This paper proposes an interactive system for defining and visualizing large anatomical trees and for subsequent quantitative data mining. The system consists of a large number of tools for automatic image analysis, semi-automatic and interactive tree editing, and an assortment of visualization tools. Results are presented for a variety of 3D high-resolution images.