PBL教学模式在骨科教学中的实践

目的探索PBL教学模式在骨科教学中的实践与应用。方法针对80名南方医科大学南方医院（八年制）在南方医院骨科实习的学生采用PBL教学模式并进行问卷调查。结果共回收有效问卷76份,其中72名（94.7%）认为PBL教学模式是非常必要的,71名（93.4%）认为PBL教学模式吸引力强,69名（90.7%）认可其有效性。大多数学生认为PBL教学模式具有多方面的优势,包括培养学习兴趣和主动学习能力、提高临床思维和综合运用能力、提高表达沟通能力和团队合作能力、激发创新性思维等。结论PBL教学模式在骨科教学的应用取得良好的效果和显著的优势;但在国内目前的医学教学条件下,具有一定的局限性需要进一步完善。     

糖尿病患者物理检查与肌电图的相关性及早期护理干预

糖尿病并发周围神经病变无论是否出现临床症状,肌电图可见神经传导速度发生变化,因此,肌电图检查对糖尿病神经病变的诊断,特别是尚未出现症状的糖尿病神经病变的诊断,具有重要意义,但由于设备较昂贵,在我国大多数医院还没有配备。2002年10月起,我们就糖尿病患者痛觉、压力觉、温度觉、触觉改变与肌电图改变之间的相关性进行     

影响骨科临床实习教学的因素

临床实习是医学生过渡到医生的重要阶段，在医学教育中起到承前启后的作用。临床实习的主要任务是帮助医学生将理论知识应用于临床实践，培养分析问题、解决问题的能力，为以后的工作打下坚实的基础。本从教员、学员、教学条件、社会因素等多方面总结了可以影响骨科临床实习教学效果的原因,并对此提出了相应措施。     

糖尿病患者物理检查与肌电图的相关性及早期护理干预

糖尿病并发周围神经病变无论是否出现临床症状 ,肌电图可见神经传导速度发生变化[1] ,因此 ,肌电图检查对糖尿病神经病变的诊断 ,特别是尚未出现症状的糖尿病神经病变的诊断 ,具有重要意义 ,但由于设备较昂贵 ,在我国大多数医院还没有配备。2 0 0 2年 10月起 ,我们就糖尿病患者痛觉、压力觉、温度觉、触觉改变与肌电图改变之间的相关性进行了临床研究 ,发现感觉改变与肌电图改变之间确有一定的相关性 ,这对提高临床护理水准有重要意义。现将研究结果报告如下。1　资料与方法1.1　一般资料。随机选择住院的糖尿病患者作为测试对象 ,在做肌电…     

从误诊病例谈物理检查的重要性

1引言 众所周知,正确的临床诊断是制定治疗方案、判断预后和实施预防措施的重要依据.随着科学技术的迅速发展,临床医生越来越多地借助于各种科学仪器来提高诊断的准确率,但不应由此而忽视物理检查即体格检查的重要性.而且应强调,在进行体格检查时,既要突出重点,又要全面系统.医生只有经过全面细致的体格检查,结合详细的病史询问,才能得出初步诊断,在此基础上再借助科学仪器来证实,这样不但可以避免不必要的误诊,而且可以降低病人费用,减少医患纠纷.在急诊科处理危重病人时,体格检查显得尤为重要.因为危重病人起病突然,病情凶险,有的病人不能提供详细或全面的病史,有的病人来不及或不适宜搬动作各种辅助检查."中国误诊文献数据库"的统计资料表明,由于医生体格检查不仔细而导致的误诊占20%,专科特殊疾病占的比例则更高.以下几例是笔者在多年的急诊工作中所碰到的因忽视体格检查而造成误诊的典型病例,现分析如下,供同行参考.     

应用五常法规范骨科急救护理

对骨科急救护理程序中存在的问题进行评估、分析,运用五常法改善急救环境,改进急救工作流程,从而有效地规范了急救护理程序,提高了危重病人抢救成功率,降低了医疗风险。     

进一步推广和规范骨科损害控制技术

骨科损害控制(DCO)技术的应用使大量严重多发性骨关节损伤得到有效救治,并被逐渐应用到严重脊柱脊髓损伤、老年骨关节损伤等伤病的救治中。本文阐述了DCO的命名、定义、适应证和方法。     

快速成型技术在骨科临床中的应用

快速成型（Rapid Prototyping，简称RP）技术是20世纪80年代中后期发展起来的、观念全新的现代制造技术，是指在计算机的控制下，根据物体的CAD模型或CT等数据，不借助其他设备，通过材料的精确堆积，制造原型的一种基于离散、堆积成型原理的新的数字化成型技术，它是一种增加法（additive）制造方式，其构想突破了传统的“毛坯一切削加工-装配-成品”这一制造模式，而且符合绿色工程（Green Engineering）这一制造思想，集中体现了计算机辅助设计、激光加工、精密数控和新材料开发等多学科、多技术的综合应用。     

创伤骨科修复中采用伤害控制骨科学原则治疗的临床体会

选取2009年1月~2011年12月我院收治的72例骨科创伤患者,随机分为观察组和对照组各36例。分别采用伤害控制骨科学原则和常规治疗措施治疗,比较两组患者临床效果。结果治疗组患者中,优14例,良11例,可7例,差3例,治疗有效率为91.67%;对照组中,优8例,良10例,可5例,差13例,治疗有效率为63.89%,两组比较,差异显著(P0.05)。伤害控制骨科学原则对患者进行创伤骨科修复治疗具有显著的效果,能大幅度降低患者手术的治疗风险,值得临床推广和应用。     

老年骨科100例临床护理

目的:探讨老年骨科患者的临床护理方法.方法:对100例老年骨科患者实施有效护理干预,做好基础护理、并发症预防及康复锻炼指导.结果:本组护理质量优良,除1例由于原发病加重自动放弃治疗外,其余均痊愈出院,无一例并发症发生.结论:有效的护理措施是老年骨科患者康复的关键.     

Physical Diagnosis Skills of Physicians in Training: A Focused Assessment

Objective: To assess the proficiency of emergency medicine (EM) trainees in the recognition of physical findings pertinent to the care of the critically ill patient.
Methods: Fourteen medical students, 63 internal medicine (IM) residents, and 47 EM residents from three university-affiliated programs in Philadelphia were tested. Proficiency in physical diagnosis was assessed by a multimedia questionnaire targeting findings useful in emergencies or related to diseases frequently encountered in the ED. Attitudes toward diagnosis not based on technology, teaching practices of physical examination during EM training, and self-motivated learning of physical diagnosis also were assessed for all the EM trainees.
Results: With the exception of ophthalmology, the EM trainees were never significantly better than the senior students or the IM residents. They were less proficient than the IM residents in cardiology, and not significantly different from the IM residents in all other areas. For no organ system tested, however, did they achieve less than a 42.9% error rate (range: 42.9–72.3%, median = 54.8%). There was no significant improvement in proficiency over the three years of customary EM training. The EM residents who had received supervised teaching in physical diagnosis during training achieved a significantly higher cumulative score. The EM residents attributed great clinical importance to physical diagnosis and wished for more time devoted to its teaching.
Conclusions: These data confirm the recently reported deficiencies of physical diagnosis skills among physicians in training. The results are particularly disturbing because they relate to EM trainees and concern skills useful in the ED. Physical diagnosis should gain more attention in both medical schools and residency programs.     

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。     

医联体内清单式教学在骨科临床护理实习生 带教中的应用研究

目的:探讨医联体内清单式教学在骨科临床护理实习生带教中的应用效果。方法:选取2018年—2020年在德阳市人民医院医联体内实习的46名骨科护理实习生,将2018年7月—2019年5月的护理实习生23人作为对照组,选取2019年7月—2020年1月的护理实习生23人作为观察组。对照组采用传统教学方法,观察组采用清单式教学进行培训,培训结束后对实习生360°评价,对带教老师进行满意度评分。综合统计护理实习生理论考试成绩、操作考试成绩,对其进行比较。结果:观察组护理实习生对带教老师的满意率明显高于对照组,两组差异有统计学意义(P<0.05),观察组护理实习生出科理论、操作考核成绩以及综合能力考核优良率均高于对照组,两组差异有统计学意义(P<0.05)。结论:清单式教学应用于医联体内护理实习生,不仅提高了护理实习生的综合能力,同时也提高了带教水平。     

Observation of Emergency Medicine Residents at the Bedside: How Often Does It Happen?

Objective: To determine how often trainees in emergency medicine (EM) are observed while performing a history, a physical examination, or specific procedures. Methods: The 26 members of the National Consensus Group on Clinical Skills in Emergency Medicine affiliated with an EM residency program were asked to circulate a survey to their residents during February and March 1994. Twenty-one programs participated. surveying a total of 514 residents. The residents were asked how many times they had been observed by an attending physician while they performed a history, a physical examination. endotracheal intubation. or central vein catheterization during training. The residents also were asked about observation of specific components of the physical examination. such as the heart. lung, and genitourinary systems. Results: Three hundred nineteen residents (62%) responded to the survey. Thirteen percent of the residents reported that they had never been observed taking a history during training. During their PGYI training, 19% of the residents reported that they had never been observed taking a history, 42% had been observed one to three times, 255% had been observed four to 12 times. and 13% had been observed >12 times. Six percent of the residents reported that they had never been observed doing a physical examination during training. During their PGYI training, 10% of the residents had never been observed performing a physical examination, 38% had been observed one to three times. 34% had been observed four to 12 times, and 18% had been observed >12 times. Conclusions: Many residents report that they are infrequently observed performing histories and physical examinations during their EM training. with a significant number of residents reporting that they were never observed performing basic bedside clinical skills. More direct observation with trained faculty observers may provide an opportunity for better evaluation and remediation of bedside clinical skills.