高仿真模拟支气管镜在支气管镜操作训练中的应用

目的:探讨高仿真模拟支气管镜模拟技术在呼吸科专科医师支气管镜操作训练中的作用.方法:对20名呼吸科医生(支气管镜检查术的初学者)作为观察对象,采用美国生产的Simbionix GI Mentor Simulator高仿真模拟支气管镜操作系统进行培训.由2名熟练进行支气管镜检查术的呼吸科医生进行指导,比较培训前后在高仿真模拟支气管镜操作的速度、灵活性和准确性方面差异.结果:20名初学者均完成了支气管镜的操作培训.在模拟训练后,操作的灵活性、准确性和速度都明显提高.与训练前相比视野清晰可见时间由(30.0±2.0)％增加到(75.0±5.0)％:段支气管检查到达由(74.0±5.1)％提高到(89.3±4.0)％;通过咽喉及声门时间由(00.01.28±00.00.54)h缩短到(00.00.36± 00.00.09)h,操作用时由(00.07.27± 00.01.23)h缩短到(00.06.24± 00.00.54)h.误入食道次数由(6.0±2.0)缩短到(2.0±0.5),培训前机器给予自动评分为(30.8±6.6)分,培训后(70.8±6.6)分.结论:高仿真模拟支气管镜在初学气管镜呼吸专科医师培训中起到重要的作用.     

虚拟支气管镜技术在临床技能培训中的作用

目的:多个指标评价观察虚拟支气管镜模拟技术在临床医师技能培训中发挥的作用.对象:初次接触支气管镜的呼吸科医生及纤维支气管镜相关科室医生(硕士以上学历,均已获取医师资格证).方法:随机选择36名临床医生,在培训前、培训2小时和培训5小时后对其进行虚拟支气管镜的理论与操作考核.采用训练前、训练后自身对照研究.结果:36名医师均完成了虚拟支气管镜的操作培训.培训结束后,受训者在操作用时(秒)、碰壁次数(次)、吸引器使用时间(秒)、出现红视时间(秒)、观察到的亚段支气管树比例等多个评价指标考核结果显示中与训练前考核结果显示比较,差异性显著.结论:初次接触支气管镜的呼吸科医生及纤维支气管镜相关科室医生经过培训后,无论在操作的准确性、灵活性,还是速度方面都比训练前有显著提高,并能独立完成临床检查操作.     

同伴教育在支气管内膜结核行支气管镜局部注药治疗患者中的应用

目的评价同伴教育在支气管内膜结核行支气管镜局部注药治疗患者中的应用效果。方法将80例支气管内膜结核行支气管镜局部注药治疗患者随机分为观察组和对照组各40例。对照组采用常规护理,观察组在常规护理基础上接受同伴教育。两组患者在干预3个月后均进行遵医行为问卷调查。结果观察组患者在服药依从、纤支镜注药依从、定期复查、合理饮食、劳逸结合、消毒隔离、情绪调节和纤支镜治疗配合8个方面依从性得分均高于对照组,差异具有统计学意义(P0.05)。结论同伴教育在支气管内膜结核行纤维支气管镜下注药治疗患者中的应用效果良好,值得临床推广。     

纤维支气管镜局部注药治疗耐药支气管内膜结核

目的:探讨和评价经纤维支气管镜局部注药对耐药肺结核合并支气管内膜结核患者的可行性和疗效.方法:对120例确诊为耐药肺结核合并支气管内膜结核患者,在进行全身抗结核治疗的同时依据患者志愿,随机分为两组,一组即单纯化疗者,另一组化疗+支气管镜注药组.比较两组病人在临床症状、痰菌阴转、影像学及纤维支气管镜下的疗效差异.结果:耐药肺结核合并支气管内膜结核经全身抗结核治疗辅以支气管镜局部给药,疗效显著优于单纯全身抗结核治疗.结论:使用支气管镜治疗耐药支气管内膜结核,可明显提高疗效、缩短病程,值得在临床上广泛应用.     

纤维支气管镜活检组织的精细化制片

近年来,纤维支气管镜(纤支镜)的广泛运用,活检的组织病例越来越多,对于病理科技术制片的质量要求也越来越高,我们通过不断总结,分析和制定出专门针对支气管活检组织微小、组织重要、制片要求高的特点,制片过程中进行精细化操作,取得良好的效果,现介绍如下。     

支气管结石合并肺部盖尔森基兴奴卡菌感染1例

本文旨在通过对1例支气管结石伴盖尔森基兴奴卡菌肺炎患者的诊治过程进行回顾,并对相关文献进行复习,以提高临床医师对此类疾病的认识。该患者为结石性体质,胸部计算机断层扫描(computed tomography,CT)提示支气管内高密度影;无痛纤维支气管镜下确诊支气管内膜结石,给予患者支气管镜下碎石、取石,并送病理科行切片活检,同时行痰涂片、痰培养寻找病原体。结果成功在肺泡灌洗液中培养出盖尔森基兴奴卡菌,针对盖尔森基兴奴卡菌感染给予敏感药物治疗3个月后痊愈。支气管结石伴盖尔森基兴奴卡菌肺炎极其罕见,尤其局限于呼吸系统感染者更为少见。此类疾病需考虑支气管内膜结石所致支气管扩张等结构性疾病存在,导致局部抵抗力低下,从而引起条件致病菌盖尔森基兴奴卡菌感染。针对此类患者,建议及早行纤维支气管镜检查并完善灌洗液涂片、抗酸染色、灌洗液培养以获得病原学证据,为治疗赢得时间。控制盖尔森基兴奴卡菌感染后,需及早行纤维支气管镜下碎石等治疗,以纠正局部结构改变,减少再次感染机会。     

支气管镜操作带教体会及经验探讨

目的对支气管镜操作带教体会及经验进行总结。方法从支气管镜操作常规操作知识、清洗消毒保护、安全操作知识、模型教学、手把手教学等方面进行培训,教学结合。结果通过支气管镜的规范操作学习,培养了学员独立规范操作的能力。结论支气管镜教学需要教和学双方的共同努力。学习者必须具备扎实的基本功、较强的动手能力及立体定向思维,才能成为一个合格的内镜医生。     

经纤支镜治疗支气管结核的疗效观察及护理体会

目的探讨经纤支镜治疗支气管结核的疗效及护理配合措施。方法选择我院2012年10月~2013年12月确诊支气管结核患者72例,随机分为两组,对照组按常规方案进行抗结核治疗;治疗组在常规抗结核治疗的基础上,通过纤支镜灌洗并向病变部位注入药物。经纤支镜镜下治疗3个月、抗结核治疗1年以及随访1年,通过肺部CT,纤支镜刷检找抗酸杆菌,纤支镜直视下观察支气管黏膜改变,症状体征等方面比较临床疗效。结果经纤支镜灌洗及滴药治疗后,治疗组总有效率为97%,明显优于对照组的80%。结论经纤支镜局部治疗能促进病灶吸收,改善气道通气,提高患者生活质量。同时,充分的术前准备、术中密切观察及配合,是确保手术顺利完成的重要环节。     

支气管镜下冷冻联合镜下给药治疗溃疡型支气管结核的临床效果

目的 探讨支气管镜下冷冻联合局部镜下注药对溃疡型支气管结核的临床效果，为该病的治疗提供参考。方法 选取2019年1月至2021年1月大连市公共卫生临床中心结核科收治的溃疡坏死型支气管结核患者80例，根据治疗方案分为对照组（n=40，给予常规规范抗结核治疗）和研究组（n=40，在对照组基础上给予支气管镜下冷冻联合局部注药治疗）。观察两组患者治疗4周后疗效、痰菌转阴时间及治疗前和治疗4周后第1秒用力呼气量（FEV1）、白细胞介素-10(IL-10)、C反应蛋白（CRP）、血沉（ESR）水平及治疗期间不良反应情况。结果 研究组患者总有效率高于对照组，痰菌转阴时间短于对照组（均P<0.05），但两组患者不良反应发生率比较差异无统计学意义（15.0%vs 12.5%,P>0.05）。两组患者治疗后FEV1水平较治疗前上升，IL-10、CRP、ESR水平较治疗前下降，研究组患者上述指标水平治疗前后差值大于对照组（均P<0.05）。结论 支气管镜下冷冻联合局部镜下注药对溃疡型支气管结核的疗效较好，可抑制机体炎症介质的释放，缩短痰菌转阴时间，安全性较高。     

家鸽肺和气囊铸型标本制作方法

在实验中让学生较全面地观察和理解家鸽肺和气囊的形态构造比较困难,如用铸型方法制作成家鸽肺和气囊的标本,对理解其形态构造却非常有效。通过标本可以看到9个气囊、气囊的位置以及气囊和肺的连接、中级支气管和次级支气管以及三级支气管的分布,若取一小块肺的标本置解剖镜下观察,还可以见到三级支气管及其放射状发出的微细支气管。现将制作方法介绍如下:     

Disinfecting endoscopes: how not to transmit Mycobacterium tuberculosis by bronchoscopy.

Mycobacterium tuberculosis was cultured from the bronchial washings of two patients who underwent bronchoscopy consecutively with the same bronchoscope. Active pulmonary tuberculosis was later confirmed in the first patient, whereas the second patient had clinical and serologic evidence of infection with respiratory syncytial virus. The bronchoscope had been cleaned with an iodophor disinfectant, which had not destroyed the tubercle bacilli. The agent recommended for chemical disinfection of fibreoptic bronchoscopes is 2% glutaraldehyde solution; the instrument should be immersed in it for 10 to 30 minutes. Five hours'' exposure to ethylene oxide is recommended for sterilization of instruments. These procedures must be preceded by adequate mechanical cleaning. Then transmission of pathogenic organisms during endoscopy, which can result in nosocomial disease, misdiagnosis or inappropriate treatment, will be avoided.     

Fine needle aspiration of pulmonary lesions via fiberoptic bronchoscopy

Mediastinal and hilar masses not associated with an endoscopically visible lesion and processes involving only the bronchial submucosa are often difficult to diagnose despite the ability to obtain cytologic and histologic samples via the flexible fiberoptic bronchoscope; necrotic endobronchial lesions are often suspected to be tumorous but may not be biopsied for fear of creating further and uncontrollable bleeding. Diagnostic material from such lesions can be obtained by aspiration with a thin needle localized via the bronchoscope at the site of the lesion and then inserted through the bronchial wall into the mediastinum, hilum or bronchial submucosal area. Not only can the question of neoplasia be answered by this technique, but staging in an inexpensive and non-morbid way can be accomplished. Indications for transbronchial fine needle aspiration, the excellence of cytologic samples thus obtained and the problems encountered using existing disposable equipment are discussed. Four cases are reported briefly as examples of the use of the technique.     

Morphological evaluation of reconstructive operations on the bronchi using a microsurgical technic in an experiment

Morphological study of bronchial anastomoses repair made with or without microsurgical techniques has been performed in 30 mongrel dogs. Comparative analysis of bronchoscopy, microscopy and scanning electronic microscopy data shows earlier epithelialization, more regular conjunction of bronchial tube and less marked inflammation in anastomosis made with microsurgical techniques. The fact may be explained by a less pronounced traumatization of bronchial tissues with microinstruments and also by tight suture of mucosal layer which creates favourable conditions for repair of anastomosis per primam.     

新形势下神经内科研究生专业特色培养的模式探索

：新形势下我国医学教育提出了培养高素质创新人才的要求,医学研究生的培养是医学生培养的最高层次。随着神经病学及其亚专业的迅猛发展,不仅对研究生的临床和科研水平提出了严峻的挑战,而且要求研究生在某一专业领域有较高的造诣。因此,对研究生进行专业特色培养是值得探索的新课题。本研究对我校神经内科研究生专业特色培养的系列探索与实践进行了总结。实践表明,我校神经内科研究生专业特色培养教学改革已取得明显成效：探索出一套行之有效的研究生专业特色培养的新模式,建立并完善了研究生培养中高素质专业人才的质量保障体系,强化了研究生的专业特色。为国内高等医学院校研究生培养模式提供了有价值的参考。     

EvoS: A Prescription for What Ails Pre-Medical Education?

Pre-medical students are certainly a widely varied group, with different motivations and experiences, different skills sets and interests. However, they often tend to approach their undergraduate education as a necessary evil that they must endure in order to achieve their ultimate goals. This article summarizes recent literature addressing some of the questions that have been raised regarding pre-medical education programs. Are students prepared for the intellectual, emotional, and even physical challenges of medical training? What deficiencies are commonly seen in entering medical students? What are students’ perceptions of how well their pre-medical studies helped them? Many of these studies have resulted in a call for more science training, while some have advocated for less, but with an enhanced focus on humanistic studies. We supply a brief outline of our Evolutionary Studies (EvoS) program and reflect upon how participation in this program can enhance pre-medical students’ education. Importantly, we argue that EvoS can expand students’ depth of understanding of science, as well as nurture their ability to think about the needs of their patients and the context of their medical practice.     

Improving the preregistration experience: the New Zealand approach.

There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students'' undergraduate training, and the model could have much to offer the United Kingdom. Students take their final examinations at the end of the second clinical year; they spend their final year in a series of eight clinical attachments, during each of which they shadow a preregistration house officer or senior house officer. As trainee interns they are paid 60% of a house officer''s salary for their clinical work, which is supervised by the firm''s registrars and consultants under the overall responsibility of the head of the academic department. The order of the attachments is determined on educational, not service, grounds, and trainees have to attend educational sessions and pass assessments on each attachment. The trainee internship, funded jointly by the education and health departments, offers a more seamless transition from student to house officer and aims at improving both general medical education and clinical training.     

The 10-year experience of an academically affiliated occupational and environmental medicine clinic.

Occupational and environmental diseases are underrecognized. Among the barriers to the successful diagnosis, treatment, and prevention of these conditions are inadequate consultative and information resources. We describe the 10-year clinical and training experiences of an academically affiliated referral center that has as its primary goal the identification of work-related and other environmental diseases. The University of Washington Occupational and Environmental Medicine Program has evaluated 6,048 patients in its diagnostic and screening clinics. Among the 2,841 seen in the diagnostic clinics, 1,553 (55%) had a work-related condition. The most prevalent diagnoses included asbestos-related lung disease (n = 603), toxic encephalopathy (n = 160), asthma (n = 119), other specific respiratory conditions (n = 197), carpal tunnel syndrome (n = 86), and dermatitis (n = 82). The clinics serve as a training site for fellows in the specialty training program, primary care internal medicine residents, residents from other medical specialties, and students in industrial hygiene, toxicology, and occupational health nursing. The program serves two additional important functions: providing consultative services to community physicians and training specialists and other physicians in this underserved area of medicine.     

微生物学课程创新实践教学模式探索

为激发本科生对微生物学的学习兴趣、训练实验技能、拓展创新思维、促进素质教育,我们探索了"课堂讲授—实验课程—课题研究"三位一体、"理论—技能—创新实践"同步训练的微生物学教学模式,首次将研究生引入本科生素质教育中,并在教学方法、手段、考核等方面进行了改革试验,实践证明这一教学模式对主动掌握理论知识、激发创新精神、提高学生素质都有积极的推动作用。     

Undergraduate cancer education in Spain: The debate,the opportunities and the initiatives of the University Forum of the Spanish Society of Radiation Oncology (SEOR)

Most medical schools in Spain (80%) offer undergraduate training in oncology. This education is highly variable in terms of content (theory and practical training), number of credits, and the medical specialty and departmental affiliation of the professors. Much of this variability is due to university traditions in the configuration of credits and programmes, and also to the structure of the hospital-based practical training. Undergraduate medical students deserve a more coherent and modern approach to education with a strong emphasis on clinical practice. Oncology is an interdisciplinary science that requires the input of professors from multiple specialties to provide the primary body of knowledge and skills needed to obtain both a theoretical and clinical understanding of cancer. Clinical skills should be a key focus due to their importance in the current model of integrated medical management and care.Clinical radiation oncology is a traditional and comprehensive hospital-based platform for undergraduate education in oncology. In Spain, a significant number (n = 80) of radiation oncology specialists have a contractual relationship to teach university courses. Most Spanish universities (80%) have a radiation oncologist on staff, some of whom are department chairs and many others are full professors who have been hired and promoted under competitive conditions of evaluation as established by the National Agency for Quality Evaluation.The Spanish Society of Radiation Oncology (SEOR) has identified new opportunities to improve undergraduate education in oncology. In this article, we discuss proposals related to theoretical (20 items) and practical clinical training (9 items). We also describe the SEOR University Forum, which is an initiative to develop a strategic plan to implement and organize cancer education at the undergraduate level in an interdisciplinary teaching spirit and with a strong contribution from radiation oncologists.     

Sleep as a teaching tool for integrating respiratory physiology and motor control

Sleep exerts major effects on most fundamental homeostatic mechanisms. Current data suggest, however, that students of physiology and medicine typically receive little or no formal teaching in sleep. Because sleep takes up a significant component of our life span, it is proposed that current teaching in systems and integrative physiology is not representative if it is confined to functions describing wakefulness only. We propose that sleep can be readily integrated into various components of physiology and medical curricula simply by emphasizing how commonly taught physiological processes are importantly affected by sleep mechanisms. In our experience, this approach can be used to reinforce basic physiological principles while simultaneously introducing sleep physiology into the students' training. We find that students have a general and inherent interest in sleep and related clinical disorders, and this proves useful as an effective means to teach the material. In this paper, examples of how sleep influences motor control and the respiratory system will illustrate these points. These considerations also highlight some important gaps in traditional teaching of respiratory physiology.