Tricuspid valve, also known as "forgotten valve" because of the high natural and surgical mortality. Transcatheter tricuspid valve replacement is an innovative surgical method to treat tricuspid regurgitation, which improves the prognosis of patients and is gradually being popularized in clinics. However, postoperative pulmonary complications are still the main causes affecting the rapid recovery and death. More and more medical experts begin to use preoperative inspiratory muscle training to reduce postoperative pulmonary complications and improve the quality of life of patients after cardiac surgery. However, there was no report on the effect of preoperative inspiratory muscle training on pulmonary complications after transcatheter tricuspid valve replacement. Therefore, for the first time, we boldly speculate that inspiratory muscle training can reduce pulmonary complications after transcatheter tricuspid valve replacement, and put forward suggestions for its treatment mechanism and strategy. But this rehabilitation intervention lacks practical clinical research. Unknown challenges may also be encountered, which may be a new research direction.
Objective To study the effect of preoperative urination training combined with restrictive fluid therapy with enhanced recovery after surgery (ERAS) on postoperative urination in total knee arthroplasty (TKA) patients. Methods A total of 150 patients who were conducted the unilateral TKA from March to May 2018 were divided into two groups, the trial group and the control group, with 75 patients in each group. The patients in the control group did not undergo urination training before surgery and were given liberal intravenous fluid therapy on the day of surgery; while the patients in the trial group received urination training before surgery and were given restrictive fluid therapy on the day of surgery. The pre-, intra-, and post-operative infusion volume and the total infusion volume on the day of surgery of the two groups were recorded; and the urination situation, urination time for the first time and the hospital days in the two groups were compared. Results The total infusion volume on the day of surgery in the trial group and the control group was (1 581.40±277.54) and (2 395.00±257.40) mL, respectively. After operation, in the trial group, there were 73 patients with smooth urinating, 2 with smooth urinating after inducing method, and none with urethral catheterization; in the control group, there were 66 patients with smooth urinating, 3 with smooth urinating after inducing method, and 6 with urethral catheterization. The urination time for the first time after operation in the trial group and the control group was (1.85±0.91) and (2.93±1.48) hours after back to the ward, respectively. These differences between the two groups were statistically significant (P<0.05). The hospital stay in the trial group and the control group was (5.86±2.48) and (6.28±1.60) days, respectively, and the difference between the two groups was not statistically significant (P>0.05). Conclusions Preoperative urination training combined with restrictive fluid therapy (the total infusion volume controls in about 1 500 mL on the day of surgery) in the TKA patients after ERAS is good for postoperation urination. It also can reduce the rate of postoperative urinary retention, and enhance rehabilitation.
Objective To provide scientific evidence for the establishment of medical specialist system in China by analyzing the current situation and problems, putting forward solution thoughts and countermeasures, from the angle of medical education system, residency training program and licensed physician management. Method Principle and method of evidence-based medicine were adopted. Retrospective investigation was conducted to gain information from 1996 to 2002 about enrollment and running form of medical education, current situation of residency and specialist training. Data was then extracted and analyzed for the benefit of corresponding countermeasures. Results By the end of 2001, there were totally 1 640 thousand physicians in China. The enrollment proportion of undergraduate and junior college student steadily increased from 1996 to 2002, while the situation quite the reverse as for medical secondary school. More than 300 thousand have taken part in the licensure exam, among whom less than 15% had university diploma. About 52 000 doctors have already completed the residency training program, and 65 700 are being trained. Standardized system of specialist training and admittance is not available in China. Conclusions It was three main tough problems that mainly account for the poor quality of doctor as a whole in China, which include diversity of educational system, insufficient software and hardware of residency training program, and absence of specialist training system. An allied funded program of "research on medical specialist training and admittance" has been on the way, and research outcomes will be published soon.
Abstract： Objective?To evaluate clinical experiences and long-term outcome of morphologic left ventricle （mLV） retraining for congenitally corrected transposition of the great arteries （cCTGA）. Methods From May 2005 to May 2011, 24 patients with cCTGA anomaly underwent left ventricle retraining by means of pulmonary artery banding in Fu Wai Hospital. There were 13 males and 11 females with their age of 0.17-22.00 （3.73±4.35） years and body weight of 5.10-61.00（15.71±10.95）kg. Major concomitant malformations included tricuspid valve insufficiency （TR）in 23 patients （mild in 11 patients, moderate in 7 patients, severe in 5 patients）, restrictive ventricular septal defect in 18 patients, atrial septal defect in 5 patients, patent foramen ovale in 5 patients, patent ductus arteriosus in 4 patients, mild pulmonary stenosis in 5 patients, and aortic coarctation in 1 patient. All the patients were preoperatively diagnosed by echocardiography, cardiovascular angiography or cardiac catheterization. The mLV end diastolic diameter （mLVEDD） was 8-32（21.56±6.60）mm, posterior wall thickness of mLV was 2-7 （4.29±1.52）mm , mLV to morphologic right ventricle （mRV） pressure ratio （mLV/mRV） was 0.12-0.65 （0.41±0.12）. Pulmonary artery banding operation was performed through upper partial sternotomy or median sternotomy without circulatory arrest. Results The mLV/mRV pressure ratio reached to 0.57-0.93 （0.76±0.10） under direct pressure monitoring after surgery. There was no in-hospital death in this group. Echocardiography before discharge showed that the structure and function of the two ventricles were good, the interventricular septum moved partially towards mRV, mLVEDD was increased slightly, and there was a tendency of reduced TR. Postoperative follows-up was from 1 to 35 months, and there was no late death during follow-up. All the patients were in good general condition with stable vital signs and New York Heart Association （NYHA） classⅠ-Ⅱ. The mLVEDD was 14-40 （26.17±7.11） mm, posterior wall thickness of mLV was 4-9 （4.95±1.44）mm, mLV/mRV pressure ratio was 0.52-0.98 （0.72±0.16） , and TR was significantly decreased. Fourteen patients successfully underwent staged complete double-switch procedure. Conclusion Left ventricle retraining is a safe and effective method to train mLV for cCTGA patients. Pressure load and posterior wall thickness of mLV are increased, mLV cavity is dilated, and TR is significantly reduced after the surgery.
Pulmonary rehabilitation therapy is gaining more attention. The recent systematic review of domestic and foreign relevant literature indicates pre-operative pulmonary rehabilitation exercise training performs an important role in per-operative period. The rehabilitation therapy can efficiently improve exercise tolerance and quality of life of patients with lung cancer, reduce post-operative complications, shorten hospitalization time, and increase opportunity of operation. However, the evidence comes from small samples reported by present clinical study, and a standard treatment guideline of pulmonary rehabilitation has not been established until now. Further researches are expected to provide demonstration and promote pulmonary rehabilitation. It is an important part of comprehensive treatment of lung cancer. The therapy will benefit more patients suffering from lung cancer.
Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.
This study uses mind-control game training to intervene in patients with mild cognitive impairment to improve their cognitive function. In this study, electroencephalogram (EEG) data of 40 participants were collected before and after two training sessions. The continuous complexity of EEG signals was analyzed to assess the status of cognitive function and explore the effect of mind-control game training on the improvement of cognitive function. The results showed that after two training sessions, the continuous complexity of EEG signal of the subject increased (0.012 44 ± 0.000 29, P < 0.05) and amplitude of curve fluctuation decreased gradually, indicating that with increase of training times, the continuous complexity increased significantly, the cognitive function of brain improved significantly and state was stable. The results of this paper may show that mind-control game training can improve the status of the brain cognitive function, which may provide support and help for the future intervention of cognitive dysfunction.
ObjectiveTo analyze the status of scientific papers published by clinical medicine postgraduates during the "double-track integration" training period. MethodsData of publications of 634 clinical medicine postgraduate students who were been trained in the "double-track integration" system in West China School of Medicine, Sichuan University from 2015 to 2017 were collected. The data of the papers published during the concurrent training and residency were retrospectively analyzed. Results634 postgraduates with master degree in clinical medicine published 1 038 papers in total. Students from 3 grades published 1.606, 1.554 and 1.785 papers on average respectively, and the overall average number of publications was 1.637 per person. The composition ratios of the journal types of articles were: SCI, 37.96%; MEDLINE, 6.55%; Chinese core journals, 55.49%. Statistical differences were found in the types of journals published in the three grades. The composition ratios of article types were: case report, 24.56%; review, 34.01%; original study, 41.43%. There was no statistical difference in the composition of article types in 3 grades. All 634 graduate students met the requirements for thesis publication and succeeded in completing the training. ConclusionsIn the "double-track integration" training system, postgraduates with master degree in clinical medicine can meet the training requirements of publishing relevant articles prior to graduation.
ObjectiveTo explore a standardized model for cardiothoracic surgery resident training program based on a combined clinical and research oriented team approach. Methods We conducted this study in a nationally ranked Class AAA hospital among the eleven residents who were accepted into the program. Throughout their training periods, clinical surgical skills were taught by one-on-one mentoring by individually assigned doctoral degree advisors, other attending surgeons and doctoral degree candidates in the program. To foster their scientific curiosity and research skills, regular didactic lectures in basic science and statistical skills by the doctoral thesis advisors, supplemented by monthly journal clubs during which trainees were required to present and discuss a previously assigned topics based on recent clinical cases within the department, thus combining acquisition of clinical skills and theory/research at the same setting. ResultsEleven physicians were selected for this training path. With respect to clinical surgical skills, 4 residents were judged to be sufficient at the end of the first cycle. The other seven residents at the end of the second cycle. One trainee won the third prize in the Medical Skill Competition in the hospital. As for scientific research skills, the team produced 11 scientific articles, one of which was accepted by the annual national conference in cardiothoracic surgery and the first author was invited to present the article. The team submitted four research projects, one won funding at the provincial competition and three within the medical school. ConclusionOur proposed standardized model of cardiothoracic surgery resident training based on a combined clinical and research oriented approach appears to be practical with moderate success. Adaptation of this model by other cardiothoracic surgery training programs in the nation will further attest to its value and functionality.
In recent years, the system of standardized resident training has been set up and improved gradually in our country.However, the medical specialist training system for neurosurgeons is still at the stage of exploration.It is important to cultivate and select the best neurologic surgery specialists in China.Mayo Clinic is one of the best teaching hospitals in the United States, which has been ranking the second in the United States for the recent 20 years.Analyzing the neurologic surgery specialist training program of the world's top hospital and learning from its advanced experiences are beneficial for the establishment of medical specialist training system and the production of the highest caliber neurosurgeons in the Department of Neurosurgery in West China Hospital of Sichuan University.The Department of Neurosurgery in West China Hospital of Sichuan University is advantageous in its advanced technology and equipment, sufficient operations, rich teaching resources and independent laboratories.Our goal is to establish strict accessing, management and assessment system, perfecting security and feedback system, focusing on the cultivation of humanistic spirit, building neurosurgery specialist personnel, and establishing a unique brand of West China in the field of teaching.