PBL与思维导图相结合教学模式在临床教学中的应用

目的探讨PBL与思维导图相结合教学模式在临床教学中的应用。方法本文研究对象为在我院见习的临床本科生,为大理大学2015级一个班级,共55名学生,数据收集时间为2019年1月;按照授课方式的差异将学生分为实验班与对照班,实验班27名学生,对照班28名学生;对照班实施常规教学法,实验班实施PBL与思维导图相结合教学法。结果实验班教学结束测试得分为(85.60±3.46)分,对照班教学结束测试得分为(77.48±3.12)分,差异具有统计学意义(P<0.05);实验班教学方式满意度评分为(90.35±4.12)分,对照班教学方式满意度评分为(80.25±4.05)分,差异具有统计学意义(P<0.05)。结论在临床教学中采用PBL与思维导图相结合教学模式,能够提高学生的专业知识掌握水平与对教学模式的认可度。     

用秩和比法对我院的10个公示病种医疗质量进行综合评价

目的对我院2005年度公示的10个病种进行医疗质量综合评价。方法采用秩和比法(RSR)进行统计分析。结果我院的10个公示病种被划分成4个医疗质量等级:老年性白内障、小儿支气管肺炎2个病种质量为优,急性阑尾炎、腹股沟疝(单侧)、子宫平滑肌瘤、剖宫产4个病种质量为良,胃大切、脑梗塞、急性心肌梗塞3个病种质量为中,脑出血1个病种质量为差。结论通过对综合指数秩和比(RSR)的计算并根据其值分级归档,反映出所研究病种之间存在着医疗质量高低的差异。控制和降低本院临床常见病种的医药费用,进行医疗全程连续性控制,为患者提供经济有效的医疗服务。     

Extraction of Potential Difficult-to-Manage Psychiatric Cases among Criminal Offenders: 5-Year Data from the Tokyo District Public Prosecutors Office

Abstract: In order to examine the characteristics of potential difficult-to-manage psychiatric cases, seven potential subgroups were extracted from the criminal offenders who were sent to the division of psychiatric diagnosis, Tokyo District Public Prosecutors Office for Pre-Prosecution Psychiatric Justice (PPPJ). The following criteria were used to select the potential subgroups: offenders who had experienced compulsory discharge from a mental hospital, those who had experienced Involuntary Admission to the mental hospital by the Prefectural Governor at least twice, those who had experienced admission to mental hospitals on more than 5 occasions, those who had been put on PPPJ previously for other criminal matters at least 3 times, those who had previously attempted suicide, and those who had committed homicide or arson. From the results of this study, it could be concluded that at least two types of "difficult-to-manage" psychiatric cases exist in the criminal offenders.     

Techniques for difficult cases of laparoscopic cholecystectomy

Our basic techniques for the management of difficult cases of laparoscopic cholecystectomy (LC) are presented in this article. If access to Calot's triangle cannot be gained safely, dissection should be started at the fundus or body of the gallbladder (GB), rather than the neck (fundus-first method). In cases with a short and wide cystic duct, a transfixing suture should be applied for ligation instead of clipping. EndoGIA is useful for ligating and transecting this case to avoid a subsequent stricture caused by normal method of ligation. Intraoperative cholangiography should be performed near the neck of the GB in cases in which orientation is lost during dissection. More dissection should be performed in the direction of the junction of the bile ducts after orientation is regained. In cases with GB filled with stones accompanied by severe fibrosis, part of the GB is incised to remove the stones and expose the lumen of the GB. Confluence stones can be removed by placing an incision on the GB side of the junction of the duct. The incised part is closed with suture. A cystic tube (C-tube) is placed in the common bile duct through the cystic duct for decompression. In more difficult cases in which dissection cannot be started safely at any location, the body and the fundus of the GB are excised, and a drain is placed at the neck of the GB. Dissection can be carried out from the main surgeon's or the assistant's side depending on the situation, and cooperation between the two surgeons is mandatory to achieve safe LC in difficult cases. When performing the LC, one must have a low threshold for converting to open surgery if injuries cannot be managed safely.     

Access编制数据库在白内障病例管理中的应用

目的 应用微机对白内障病例进行管理，实现病例管理自动化。方法 根据患者姓名、晶状体等各项临床信息，在Windows98及以上版本的操作平台上，应用Access2000建立患者信息病例库。结果 建立Access病例库管理白内障病例，病例存储量大，查询方便快捷，数据处理方便。结论 Access2000编写的数据库在临床病例的管理中值得广泛应用及推广。     

四川省绵阳市2019—2021年流行性感冒流行病学特征分析

目的 了解绵阳市2019—2021年流行性感冒流行病学特征,为绵阳市流感防控工作提供重要依据。方法 收集绵阳市2019—2021年流感监测相关数据,采用描述性流行病学方法进行统计学分析。结果 绵阳市2019—2021年流感共报告发病55 970例,年均报告发病率388.08/10万。报告流感样病例（influenza-like illness cases, ILI） 103 723例,年平均ILI%为3.58%。2019年流感报告发病率、ILI%、阳性检出率均远超过历年同期水平。人群分类构成以15岁以下学生为主。报告发病数居前三位的地区分别为涪城区20 118例（占35.94%）、游仙区6 394例（占11.42%）、江油市5 800例（占10.36%）。2019—2021年共收到并检测ILI标本10 126份,阳性率19.53%;标本阳性检出率以15岁以下学生为主。历年流感病毒优势毒株呈现出交替流行的趋势,2019年以A（H3）型为主,2020年受新冠疫情影响,全年阳性检出率均较低,2021年除检出2份A（H9）型外,其余均为BV型。2019—2021年共报告ILI暴发疫情43起,发生时间主要集中在冬季,场所以小学居多。结论 2019—2021年绵阳市流感病例、ILI、病原学监测、暴发疫情的特征基本一致,15岁以下的学生及学校仍为重点关注人群及场所。而新型冠状病毒肺炎疫情大流行下,流感的低发水平进一步印证非药物干预措施对流感防控工作的重要性。     

2016年4月—2022年3月深圳市和济南市流感病原学监测及流行特征

目的 分析在新型冠状病毒肺炎流行背景下,2016年4月—2022年3月国内深圳市和济南市流感流行特点,了解我国南北方地区流感流行差异。 方法 使用深圳市和济南市国家级哨点医院2016—2022监测年度流感样病例(ILI)和流感病原学监测资料,分析流感流行特征和趋势。 结果 2016—2022监测年度深圳市和济南市国家级哨点医院的门急诊病例中流感样病例百分比(ILI%)分别为2.25%、3.45%。两地区ILI%最高的年份均为2021—2022监测年度。ILl年龄构成均以0~4岁为主(分别占40%、46%)。按月分析两地区流感病毒分离阳性率与ILI%变化的相关性,两者趋势均存在正相关(r=0.238,P<0.05;r=0.425,P<0.001)。两地区不同监测年度流感优势毒株型别均不相同,呈交替变化,但每年流行的型别及高峰期的优势毒株型别基本一致。 结论 2020—2021监测年度即新型冠状病毒肺炎流行初期,深圳市和济南市流感活跃程度明显低于往年平均水平且流行毒株型别单一,其余监测年度基本符合我国南、北方地区流感流行特征。     

小儿重症哮喘多因素回归分析

应用电脑对111例儿童哮喘50项指标进行多因素逐步回归分析,把发作时喘憋严重,平时也有不同程度的喘息症状患儿列入小儿重症哮喘,与非重症哮喘比较,结果显示夜间喘、急性发作持续天数、非特异性刺激诱发、间歇期症状、发绀、呼吸困难、入院后激素治疗、中性粒细胞、IgA、pH、哮喘持续状态等11个因素入选重症哮喘回归方程,表明这些因素与小儿重症哮喘相关,提出儿童哮喘危险信号的临床指标。     

Imported paracoccidioidomycosis : A public health problem in non-endemic areas

Diagnosis of paracoccidioidomycosis in an immigrant who had returned to Italy following a long sojourn in Venezuela prompted a review of imported cases of this Latin American disease in nonendemic countries. Forty-two such instances of well documented paracoccidioidomycosis were compiled. Among these, eleven individuals had arrived in nonendemic countries with active symptomatic infections, fifteen others were first suspected of having tuberculosis, and four each were considered to have blastomycosis caused by Blastomyces dermatidis and carcinomas. Three, individuals were considered to have Wegner's granulomatosis or blastomycosis. Two other patients were treated for syphilis before being diagnosed as having paracocidioidomycosis. A striking feature of most of these cases was the long asymptomatic period following initial infection. The dormant periods ranged form four months to 60 years with an average duration of 14 years. The need to question patients about travel to or residency in foreign countries is emphasized, along with the necessity to include the mycoses in differential diagnoses. Three reported cases, all from Africa with no history of travel to the endemic areas of the New World, were considered to be doubtful. In one of these, Russell bodies apparently had been mistaken for the tissue-form cells of Paracoccidioides brasiliensis. A Japanese case, upon restudy of available histologic slides, revealed that the fungal cells present in various organs were those of Cryptococcus neoformans and not of P. brasiliensis.Corresponding author