Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
ObjectiveTo evaluate the effect of basic life support (BLS) intensive training for medical students who have received BLS training within one year. MethodsWe enrolled 865 medical students between January to December 2015 who had received BLS training within one year. These students were divided into three groups [undergraduate upcoming doctor (group A, n=436), postgraduate upcoming doctor (group B, n=197), and undergraduate upcoming medical technician (group C, n=232)] based on their major and educational background. In the study, they received on-the-spot BLS intensive training, and took BLS basic knowledge examination, skill examination and comprehensive capacity test before and after training. During the study, comprehensive capacity was evaluated by training scale including such items as emergency awareness, psychological diathesis, disposal ability, cooperation ability, and operation accuracy. ResultsBLS basic knowledge scores for the above three groups before and after training were respectively 58.9±9.5 vs 93.5±7.6, 52.5±4.5 vs 90.3±3.5, 54.8±5.3 vs 88.5±4.5, and the skill scores were 58.8±3.2 vs 95.3±1.7, 57.6±4.2 vs 90.5±2.3, 50.9±3.8 vs 93.5±1.8, respectively. The scores after training were significantly better than those before training (P＜0.05). Comprehensive capacity was also improved significantly after intensive training (P＜0.05). ConclusionsEstablishing a BLS intensive training program has important clinical significances for updating and consolidating the emergency knowledge, improving teaching quality and emergency training effect. So it is worth popularizing.
Objective To explore the short term and long term effectiveness of the problem-based learning (PBL) in clinical skill training. Methods A total of 162 clinical medicine undergraduates in Grade 2003 (7-years study) and 2004 (5-year study) who were supposed to intern in the internal medicine departments were randomly divided into the PBL group (n=75) and the control group with traditional training (n=87) for having their clinical skills training. Then t test was applied to compare the two groups about the scores of intern rotation examination and graduate OSCE as well. Results About the baseline: the students in the two groups got similar scores in their internal medicine exam before clinical intern rotation (84.04±7.40 vs. 82.63±8.77, P=0.287). About the short term effectiveness: compared to the control group, the students in the PBL group got higher subjective evaluation from their supervised clinicians (P=0.006). In writing examination, the students of those two group got similar scores in knowledge part (54.17±9.26 vs. 51.67±9.56, P=0.92), while the PBL group won in case reasoning question (20.39±5.27 vs. 16.51±4.90, Plt;0.001). About the long term effectiveness: in the graduate OSCE, the two groups got similar scores in skills operation such as punctures and lab results analyses (P=0.567 and P=0.741), while the students in the PBL group had better performance at the case reasoning and standard patients treating (75.59±9.85 vs. 71.11±12.01, P=0.027). Conclusion With the great short term and long term effectiveness, the PBL applied in the clinical skill training improves the students’ ability of both synthesized analyses and the integrated clinical skills such as clinical thinking and interpersonal communication, but doesn’t aim at the basic knowledge and operation skills.
ObjectiveTo explore the teaching effects of scene simulation of medical disputes in clinical skills training. MethodsBetween September 2012 and June 2013, 93 clinical medicine undergraduates in Grade 2010 (8-year study) were randomly divided into the scene simulation teaching of medical disputes group (n=47) and the control group with traditional training (n=46) for clinical skills training. Teaching effects were assessed by clinical skills operation tests. ResultsThrough scene simulation teaching of medical disputes, the trainees' clinical disposal ability, operating skills, communication skills, cultural knowledge, and legal knowledge dimension scores were all significantly better than previous tests (P<0.05). ConclusionScene simulation of medical disputes has an obvious advantage in clinical skills training.
ObjectiveTo investigate the effects of medical simulation (MST) combined with case-based learning (CBL) in training of trainee doctors in emergency department. MethodA total of 120 trainee doctors practicing in the emergency department between March 2008 and December 2014 were randomly divided into two groups:MST combined with CBL group and CBL group, who accepted MST combined with CBL training and merely CBL training, respectively. The training effects were evaluated in terms of theoretical knowledge, practical operation, comprehensive abilities of case analysis and questionnaire survey. The results were compared and analyzed with the t test. The P value less than 0.05 was a significant difference. ResultsTrainee doctors in MST combined with CBL group acquired higher scores in all of the indicators (P<0.05). ConclusionsMST combined with CBL is a feasible method and has a better effect in training of trainee doctors in Emergency Department.
ObjectiveTo analyze the influencing factors on clinical response to conbercept for diabetic macular edema (DME).MethodsA total of 51 patients (51 eyes) with DME who underwent intravitreal injection of conbercept were included in this retrospective study. The general information (age, sex, body mass index, smoking history, drinking history), blood glucose indicators (duration of diabetes, fasting blood glucose, HbA1c), blood pressure indicators (history of hypertension, systolic blood pressure, diastolic blood pressure), lipid indicators [total cholesterol (TC), high-density lipoprotein (HDL), apolipoprotein A (APOA)], biochemical indicators [neutrophil concentration, hemoglobin (HB), serum creatinine (Scr)] were collected. The best corrected visual acuity (BCVA) and macular central macular thickness (CMT) before and after treatment were comparatively analyzed. CMT reduced not less than 20% and BCVA increased by 2 lines as effective standards. Univariate analysis and multivariate logistic regression analysis were used to determine the factors affecting the efficacy of intravitreal injection of conbercept in patients with DME.ResultsUnivariate analysis showed that diastolic blood pressure, HDL, serum neutrophil concentration, baseline CMT and baseline BCVA were associated with edema regression (P＜0.05); HbA1c was associated with vision improvement (P＜0.05). Multivariate logistic regression analysis showed that there was a history of smoking (OR=0.122, 95% CI 0.017 − 0.887), low diastolic blood pressure (OR=0.850, 95%CI0.748 − 0.966), low HDL (OR=0.007, 95%CI 0.000 1 − 0.440), thin baseline CMT (OR=0.986, 95%CI0.977 − 0.995) were independent risk factors for failure outcome of edema regression (P＜0.05); long duration of diabetes (OR=1.191, 95%CI 1.011 − 1.404), high APOA (OR=1.007, 95% CI 1.000 − 1.013) were independent risk factors for failure outcome of vision improvement. Age, fasting blood glucose, systolic blood pressure, TC, HB, Scr and other indicators had no effect on the efficacy of edema regression and vision improvement after treatment (P＞0.05).ConclusionsSmoking history, long duration of diabetes, low diastolic blood pressure, low HDL level, high APOA level and thin baseline CMT are independent risk factors for the treatment of DME with intravitreal injection of conbercept.
ObjectiveTo explore the standardized index system of quality control for single disease of day surgery in Shanghai municipal hospitals.MethodsFrom April to November 2020, through literature research and comprehensive analysis of research results, the framework of quality control index system for single disease of day surgery focusing on obstructive sleep apnea hypopnea syndrome surgery and laparoscopic cholecystectomy was constructed; Delphi method was used to evaluate the quality of day surgery in terms of results, objectivity, statistics, sensitivity, accessibility, quantifiability, importance, and guidance. Finally, the final indicators were screened out.ResultsAfter three rounds of Delphi investigation, 18 experts finally formed 14 general indexes and 14 personalized indexes (6 for obstructive sleep apnea hypopnea syndrome and 8 for laparoscopic cholecystectomy) in the single disease of day surgery quality control index system.ConclusionsThe general indexes and personalized indexes quantifying the quality control index for single disease of day surgery are conducive to the standardization and standardized management of day surgery, and can provide a reference for improving the medical quality and safety, and sustainable development of day surgery.