X-ray examination of small intestine--conventional enteroclysis and CT enterography

We gave an outline while showing the image about conventional enteroclysis and CT enterography as X-ray examination of small intestine. Recently a double balloon enteroscopy and wireless capsule endoscopy have been used as new procedure for small intestinal examination. The former is high invasive examination for a patient and has a risk of perforation for the patients with intestinal adhesion and consequently it is unsuitable as screening examination. And for the latter, the stoppage to stenosis locus of a capsule becomes a problem for a patient having intestinal stenosis. Therefore, a conventional enteroclysis is still necessary at present. On the other hand, CT enterography which is new small intestinal examination procedure is attracting attention as the examination of low invasiveness except the exposure to radiation and equally taking very short time during examination. CT enterography will be it with more and more useful examination for the small intestine in a diagnosis of intestinal neoplasia, ileus and inflammatory bowel disease such as Crohn's disease in future.     

Quantifying learning in medical students during a critical care medicine elective: a comparison of three evaluation instruments

OBJECTIVE: To compare three different evaluative instruments and determine which is able to measure different aspects of medical student learning. DESIGN: Student learning was evaluated by using written examinations, objective structured clinical examination, and patient simulator that used two clinical scenarios before and after a structured critical care elective, by using a crossover design. PARTICIPATION: Twenty-four 4th-yr students enrolled in the critical care medicine elective. INTERVENTIONS: All students took a multiple-choice written examination; evaluated a live simulated critically ill patient, requested data from a nurse, and intervened as appropriate at different stations (objective structured clinical examination); and evaluated the computer-controlled patient simulator and intervened as appropriate. MEASUREMENTS AND MAIN RESULTS: Students' knowledge was assessed by using a multiple-choice examination containing the same data incorporated into the other examinations. Student performance on the objective structured clinical examination was evaluated at five stations. Both objective structured clinical examination and simulator tests were videotaped for subsequent scores of responses, quality of responses, and response time. The videotapes were reviewed for specific behaviors by faculty masked to time of examination. Students were expected to perform the following: a) assess airway, breathing, and circulation; b) prepare a mannequin for intubation; c) provide appropriate ventilator settings; d) manage hypotension; and e) request, interpret, and provide appropriate intervention for pulmonary artery catheter data. Students were expected to perform identical behaviors during the simulator examination; however, the entire examination was performed on the whole-body computer-controlled mannequin. The primary outcome measure was the difference in examination scores before and after the rotation. The mean preelective scores were 77 +/- 16%, 47 +/- 15%, and 41 +/- 14% for the written examination, objective structured clinical examination, and simulator, respectively, compared with 89 +/- 11%, 76 +/- 12%, and 62 +/- 15% after the elective (p <.0001). Prerotation scores for the written examination were significantly higher than the objective structured clinical examination or the simulator; postrotation scores were highest for the written examination and lowest for the simulator. CONCLUSION: Written examinations measure acquisition of knowledge but fail to predict if students can apply knowledge to problem solving, whereas both the objective structured clinical examination and the computer-controlled patient simulator can be used as effective performance evaluation tools.     

新型冠状病毒肺炎CT检查应急预案的建立与应用

目的建立新型冠状病毒肺炎CT检查应急预案,以期为提高医疗机构突发事件应急处置能力提供保障。方法从环境管理、CT检查前管理、CT检查中管理、CT检查后管理等方面构建了新型冠状病毒肺炎CT检查应急预案并试用1个月。结果2020年2月发热门诊专用CT检查共92例患者,每例CT检查时间大约需要5?10min,消毒时间大约1h,无一例医护人员感染。结论新型冠状病毒肺炎CT检査应急预案的应用,既避免了院内传染的发生,又可加快诊治过程,为明确诊断提供了可靠的线索,同时为按病情实施不同等级防护措施提供依据。     

健康查体人员年龄与查体费用、查体时间相关因素调查

目的 通过对健康查体人员的问卷调查,探讨现代人查体年龄与查体费用和查体间隔时间的关系并做出评价。方法 自行设计调查量表,自2003年3月至2003年6月对疗养院门诊查体人员进行调查,对收回的235份有效问卷进行统计分析。结果 显示健康查体人员年龄与查体时间密切相关,50岁以上两组人员中,1年次查体率分别达75％和88．89％,无3年次查体;而查体费用与年龄关系中,60岁以下各年龄组75％以上均为公费缴纳,大于60岁年龄组则个人支付超过公费缴纳。结论 查体的间隔时间与年龄相比除小于19岁组外差别不大;但查体费用有较大反差。提示应掌握正确的健康定义,加大对预防保健的投入。     

护理本科生攻读硕士意向及动机的调查

目的：了解目前护理专业本科生攻读硕士的意向、动机及其影响因素,为教育工作者正确引导学生端正考研态度提供科学依据。方法自行设计护理本科生攻读硕士意向及动机调查问卷,对502名护理本科生进行问卷调查。结果本组502名调查对象中有考研意向者93名,占18．5％;50．2％学生认可护理专业应发展研究生教育,54．0％学生认为攻读硕士可提高自身能力;93名有考研意向学生。调查显示,促使考研的因素中以“脱离临床护理工作”为第1位,准备报考护理专业的占52．7％,47.3％的学生准备报考非护理专业,且各科成绩越好,跨专业报考的现象越明显（ P＜0．01）;男性转专业现象高于女性（P＜0．01）;218名无考研意向学生中影响考研的因素主要是年龄因素,其次为家庭条件不允许和护理研究生用武之地。结论护理本科生有考研意向者比例相对较小,考研动机较消极,教育工作者和相关管理部门应给予重视并正确引导。     

Radiographers' Perceptions of Patients Care Needs During a Computed Tomography Examination

The aim of this study was to describe the radiographers' perceptions of the patient care that is needed by the latter undergoing a computed tomography (CT) examination. The study was conducted using phenomenography methodology. Eight female and four male radiographers were interviewed at three radiology departments in central Sweden. The radiographers highlighted that the patients' need for information regarding the whole examination was important for them to understand the procedure. The radiographers' perception was that the time required for a CT examination needs to be adjusted so that there is sufficient time for individualized patient care, while at the same time taking into account the patient's age and illness. There was also a need for the examination to be carried out by a knowledgeable professional radiographer. In conclusion, this study shows that patients are in need of good communication, information, physical/psychological care, and individualized adapted examination time. Radiographers' knowledge and ability to understand patients' needs have a significant impact if patients are involved in their examination.     

秦皇岛健康体检人群胸部X线检查7972例临床分析

目的研究秦皇岛健康体检人群胸部X检查的表现及临床应用价值,指导该项目在健康体检中的合理选择。方法对本体检中心2010-01—2011-12体检资料进行回顾性分析,统计胸部X线检查方式及阳性率。结果胸部X线检查仍以X线透视为主（81.92%）;阳性率极低,为2.07%,且与性别、年龄有关。结论健康体检胸部X线检查照射剂量大,阳性率低,应根据病史、职业、性别、年龄等进行个性化选择,不应作为体检普查项目。     

Predictive value of a senior comprehensive examination as to performance on a national certification examination.

OBJECTIVE: To determine what value a senior departmental comprehensive examination holds in predicting the future success of a student on the MT(ASCP) certification examination. DESIGN: Part 1: To evaluate the efficacy of the comprehensive examination, scores were obtained in the examination categories of hematology, clinical chemistry, immunohematology, and microbiology for all dinical laboratory science students who have graduated from the University of Mississippi Medical Center since 1993. The data were analyzed to determine if a correlation exists between student performance on the senior comprehensive, and their future performance on the MT(ASCP) national certification examination. Part 2: To determine the extent to which a senior comprehensive examination was required for graduation at other university-based clinical laboratory science programs, a simple survey was e-mailed to members of the clinical laboratory science educators forum. SETTING: 2+2 university-based dinical laboratory science program PARTICIPANTS: Part 1: Previous graduates of the Clinical Laboratory Science Program at the University of Mississippi Medical Center since 1993. Part 2: Program directors who are members of the Clinical Laboratory Sciences Educator's Forum. RESULTS: Part 1: Results indicated a distinct division between participants who scored higher than 74.36% (Group A) on the senior comprehensive examination, and those scoring below 74.36% (Group B). In Group A, 100% of participants passed the MT(ASCP) national certification examination on the first attempt. Results were mixed for Group B. Part 2: The survey indicated that of the 40 respondents, most were similar to the University of Mississippi Medical Center Clinical Laboratory Science Program in that they require a comprehensive to be taken, that the grade received is part of another course grade, and that the examination is prepared using questions submitted by the faculty. CONCLUSIONS: Part 1: The senior departmental comprehensive examination is of value in predicting the future success of a student on the MT(ASCP) national certification examination. Part 2: Unlike the University of Mississippi Medical Center, 16 of the 40 respondents stated that passage of the comprehensive examination was a requirement for graduation. In those programs, the comprehensive was a major part of a course grade.     

健康综合门诊部体检客户满意度的影响因素分析

目的探讨健康综合门诊部体检客户满意度的影响因素,并讨论体检者关系管理的相关方法。方法选取2017年1月—2019年10月期间于潮州第一健康综合门诊部200例体检者作为研究对象,采用体检满意度调查表对纳入体检者进行问卷调查。根据调查结果,将满意度评分≥70分的156例体检者作为满意组,将满意度评分<70分的44例体检者设为不满意组。采用单因素及多因素Logistic回归分析影响健康综合门诊部体检者满意度的相关因素。结果单因素分析显示,两组性别、年龄、文化程度、体检方式比较差异无统计学意义(P>0.05),引导体检、体检等待时间、体检人员技术水平、健康教育、报告讲解、体检环境、延续回访情况比较差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,体检等待时间、体检人员技术水平、健康教育及体检环境是影响体检者满意度的危险因素。结论健康综合门诊部体检者满意度的影响因素较多,应通过建立系统化管理团队和制度,优化体检护理服务,以提高体检者服务满意度。     

城乡居民健康体检前准备知识了解状况调查

目的了解城乡居民健康体检前准备知识了解状况,为实施针对性的健康教育提供依据,使每位体检者得到高质量的体检服务。方法对2006年3—8月在体检中心体检的1 600名城乡居民,用自行设计的调查问卷对其体检前准备知识了解情况、所掌握知识主要来源、喜欢接受的教育方式等问题进行调查。结果调查对象对健康体检前准备知识的了解情况总体水平比较低;所掌握的知识主要来源于单位体检前一天发放的简易的＂体检须知＂单;对体检知识的掌握程度,文化程度较高的体检者优于文化程度较低者,城镇居民优于农村居民;对知识需求率均为100%,喜欢的学习方式为录像结合医护人员讲解和示范。结论在体检前对体检者进行健康体检知识教育很重要,进行健康教育时应采取灵活多样的形式,加大对文化水平低及农村体检者的宣教力度。     

The frequency of digital and endoscopic examination of the rectum before radiological barium enema

Doctor's delay in patients with rectal carcinoma is common with a frequency between 30% and 60%. The reason for delay has been supposed to be the neglectance to perform digital examination and rigid proctosigmoidoscopy in patients with symptoms of anorectal disease. Especially general practitioners have been blamed for a high percentage of this kind of doctor's delay. In this study 300 consecutive patients referred for radiological examination of the large bowel have been questioned if digital examination and rigid proctosigmoidoscopy have been performed by their referral doctor. The results show that in 19% of the cases neither digital nor proctosigmoidoscopic examination had been performed. Rigid proctosigmoidoscopy had been omitted in 44%. No statistical difference was observed in the frequency of digital examination between general practitioners (79%) and hospital doctors (84%). The low figures, both for digital examination and rigid proctosigmoidoscopy are probably causing many patients a delay in the diagnosis of a rectal carcinoma. Thus, a more intense evaluation in this area should be applied in the medical faculties and also at post graduate courses.     

Physical examination: a revered skill under scrutiny

Clinicians in the 1980s rely on the physical examination to a lesser degree than their predecessors in making diagnostic and therapeutic decisions. The major criticisms are that the physical examination lacks sensitivity for many common diseases and has not been subjected to the same scientific scrutiny afforded laboratory testing. On the positive side, the physical examination is a series of diagnostic maneuvers that permit physicians to test hypotheses generated during history taking, to determine disease severity, and to lessen clinical uncertainty. Furthermore, the physical examination fosters the development of personalized medical care and a bond of mutual trust between patient and doctor. The challenge for tomorrow is to determine the operating characteristics of physical examination techniques and the clinical utility of physical findings. For preclinical students, emphasis should be directed at basic examination principles and sequencing. Many model programs have used patient instructors and other innovative techniques. Clinical students and postgraduate trainees need emphasis on interpretation of physical findings and their integration into the clinical context. There is no substitute for bedside teaching at this level.     

重视骨科基本功训练-规范临床物理检查

骨科临床物理检查是骨科医师必须掌握的基础技能之一,是骨科教学的重点内容。临床物理检查在骨科疾病的诊断过程中发挥非常重要的作用,骨科医生在进行临床工作时需要而且必须首先对患者进行系统全面的物理检查以获得诊断的重要信息。规范并加强骨科临床教学中物理检查技能的训练,提高物理检查结果准确性具有重要的科学和临床意义。      

Endoscopic examination for pancreatic fistula

We have conducted endoscopic examination in 5 cases of postoperative pancreatic fistula, and discuss its clinical significance. The examination provided not only an observation of the fistula but also opportunity to irrigate the fistula for removal of foreign substances. The biopsy permitted histological examination for necrotic substances and the fistulous wall. Endoscopy made it easy to introduce a drain into the affected site and to judge when to remove the drain. Closure of the fistula was also attainable using fibrin glue. Consequently, the fistulas were closed within 1 month from the examination in all cases but one, in which death resulted due to carcinoma. The examination is an easy and safe technique.     

An analysis of Michigan EMT licensure examination results as a predictor of paramedic licensure examination success

INTRODUCTION: Predicting paramedic candidate performance on the written licensure examination is of considerable importance to educators, students, employers, and state regulators. There has been little investigation of the available statistical data regarding examinee pass rate and examination score. No studies have measured an examinee's sequential success pattern on the basic emergency medical technician (EMT) or paramedic examinations. There has been no analysis of the relationship between the number of examinations required for successful paramedic licensure and examination score. OBJECTIVE: The purpose of this study was to determine the frequency with which paramedic licensure examinees successfully pass the State of Michigan written examination on the first or subsequent attempts; to determine the frequency with which the paramedic examinees pass the prerequisite basic EMT licensure examination; to determine whether the frequency of paramedic examination attempts is related to examination score; and to determine whether there is a relationship between successfully passing the basic EMT examination and successfully passing the paramedic examination. METHODS: A retrospective study of Michigan paramedic licensure examination results for 1994 was done on the basis of a review of reports prepared for Michigan Department of Public Health Emergency Medical Services (MDPH-EMS) by Professional Examination Services. Analysis of paramedic examination score and the number of examination attempts is correlated to EMT score and number of attempts required to pass. Success in the first or subsequent paramedic examinations is correlated to paramedic score, and success in passing the first or subsequent EMT examination is then related to success in passing the paramedic examination. RESULTS: Paramedic examinees (n = 869) generated a 72.1% pass rate in 1994 (mean score = 82.2%). The minimum passing score is 80%. The average score for examinees who passed (n = 627) was 86.2% (95% confidence interval [CI] = 85.8-86.6%); those who failed (n = 242) averaged 71.9% (95% CI = 71.1-72.6%). Paramedic examinees successful on the first attempt (n = 500) had higher average scores (mean = 87.1%; 95% CI = 86.7-87.5%) than did those who required multiple attempts (mean = 82.8%; 95% CI = 82.3-83.3%; n = 127). A total of 702 (90.5%) paramedic examinees passed the EMT examination on the first attempt. Examinees who passed the EMT examination the first time averaged fewer attempts on the paramedic examination (mean 1.5; 95% CI = 1.4-1.6) than did those who required multiple EMT examinations (mean 2.3; 95% CI = 2.0-2.6). Paramedic examinees passing the EMT examination in one attempt had higher average paramedic scores (82.6%; 95% CI = 82.1-83.2%) than those needing multiple EMT attempts (75.5%; 95% CI = 73.4-77.5%). CONCLUSION: Paramedic examinees who pass their EMT licensure examination on the first attempt have a significantly better chance of passing the paramedic licensure examination. Paramedic licensure examinees who pass the paramedic examination on the first attempt score significantly higher than do examinees who require additional attempts. Paramedic programs should incorporate EMT examination performance into their student selection criteria. Further study of variables predictive of success is needed.     

中美注册护士考试的比较与启示

通过中美注册护士考试的比较总结两国该方面的差异，为完善我国护士执业资格考试提供借鉴。美国注册护士考试体系形成了较成熟的技术操作方案，能较好地满足执业准人考试的要求。我国护士执业资格考试在考试形式、考试内容、考试题型及合格标准等方面还存在不足。美国注册护士考试体系为我国护士执业考试的改革提供了经验。我国应该完善考试的组织管理系统和相关制度规定，实现计算机化考试形式，改革考试设计和合格标准，探索操作技能考查办法。     

Predictive Validity of the Global Assessment Form Used in a Final-year Undergraduate Rotation in Emergency Medicine

OBJECTIVES: To determine whether the predictive validity of Global Assessment Form (GAF) knowledge subdomain marks exceeds that of the overall GAF marks with respect to written examination marks for an undergraduate rotation in emergency medicine, and to determine the interdependence between subdomain marks on the GAF. METHODS: Final-year clinical clerks completing a four-week rotation through the emergency departments of a university teaching center were evaluated using both a ten-subdomain GAF for clinical performance and an independent written examination. The GAF and examination marks were prospectively obtained for clinical clerks over a two-year period. Pearson correlations were calculated between examination marks and both the GAF knowledge subdomain and the GAF overall mark. Olkin's Z score was calculated to determine the significance of the difference between correlations. Interdependencies between subdomains of the GAF were calculated using an alpha coefficient and inter-item correlations. RESULTS: Data sets were reviewed for 347 clinical clerks. Nine sets of data were excluded (incomplete evaluations); 338 sets were analyzed. Means for overall clinical mark and examination mark were 80.11% (SD = 4.375) and 81 (SD = 7.66). Among subdomains, knowledge had the highest correlation with the examination mark (0.19). Overall clinical marks had lower correlation with the examination marks (0.169); the difference was not significant (Olkin's Z = 0.40). The correlation of the examination marks with the average marks of all subdomains excluding knowledge was even lower (0.12). The tenitem alpha for the GAF was 0.92. CONCLUSIONS: Clinical GAF assessments of knowledge, as measured by written examination, do not appear to be any more predictive than overall clinical impression. There is substantial consistency between subdomain scores, suggesting that assessors are not effectively discriminating between them when assigning marks.     

伙伴互助教育联合实景观摩学习法对CTA检查患者的配合度及造影剂不良反应的影响

目的探讨伙伴互助教育联合实景观摩学习法对CT血管造影(CTA)检查患者检查配合度及造影剂不良反应的影响。方法选取我院2017年1月至2019年1月收治的CTA检查患者98例为研究对象,随机将其等分成对照组与观察组,对照组予以常规护理,观察组在对照组基础上采用伙伴互助教育联合实景观摩学习法,比较两组患者的检查配合度及造影剂不良反应。结果观察组患者检查教育、检查准备、检查操作及检查护理配合情况高于对照组(P<0.05);观察组造影剂不良反应发生情况低于对照组(P<0.05)。结论将伙伴互助教育联合实景观摩学习法应用于CTA检查患者中,能提升患者的检查配合度,减少造影剂不良反应,值得推广应用。