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Objective:To assess the effect of intra-aortic balloon pump (IABP) on in-hospital mortality in patients with cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective study was performed on 696 patients with intra-hospital cardiac arrest undergoing ECPR from Samsung Medical Center in Korea between January 2004 and December 2013. According to whether IABP was used, the patients were divided into ECPR group and ECPR+IABP group. Cox regression and propensity score matching (PSM) were used to examine the correlation between IABP usage and in-hospital mortality, and standardized mean difference ( SMD) was used to check the degree of PSM. Survival analysis of in-hospital mortality was performed by the Kaplan-Meier method, and further analyzed by the Log-Rank test. Using the propensity score as weights, multiple regression model and inverse probability weighting (IPW) model were used for sensitivity analysis. In-hospital mortality, extracorporeal membrane oxygenation (ECMO) withdrawal success rate and neurological function prognosis were compared between the two groups. Results:A total of 199 patients with cardiac arrest undergoing ECPR were included, including 120 males and 79 females, and the average age was (60.0±16.8) years. Thirty-one patients (15.6%) were treated with ECPR and IABP, and 168 patients (84.4%) only received ECPR. The total hospitalized mortality was 68.8% (137/199). The 1 : 1 nearest neighbor matching algorithm was performed with the 0.2 caliper value. The following variables were selected to generate propensity scores, including age, gender, race, marital status, insurance, admission type, service unit, heart rate, mean arterial pressure, respiratory rate, pulse oxygen saturation, white blood cell count. After the propensity score matching, 24 pairs of patients were successfully matched, with the average age of (63.0±12.8) years, including 31 males and 17 females. The in-hospital mortality was 72.6% (122/168) and 48.4% (15/31) in the ECPR group and the ECPR+IABP group [hazard ratio ( HR) = 0.48, 95% confidence interval (95% CI) was 0.28-0.82, P = 0.007]. Multiple regression model, adjusted propensity score, PSM and IPW model showed that the in-hospital mortality in the ECPR+IABP group was significantly lower compared with the ECPR group ( HR = 0.44, 0.50, 0.16 and 0.49, respectively, 95% CI were 0.24-0.79, 0.28-0.91, 0.06-0.39 and 0.31-0.77, all P < 0.05). The combined application of IABP could improve the ECMO withdrawal success rate [odds ratio ( OR) = 8.95, 95% CI was 2.72-29.38, P < 0.001] and neurological prognosis ( OR = 4.06, 95% CI was 1.33-12.40, P = 0.014) in adult cardiac arrest patients. Conclusion:In patients with cardiac arrest using ECPR, the combination of IABP was independently associated with lower in-hospital mortality, higher ECMO withdrawal success rate and better neurological prognosis.
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Medical professionalism plays a critical role in training doctors with noble medical ethics and excellent medical skills. Clarifying the connotation of medical professionalism is the only way which must be passed to deepen the research and cultivation of medical professionalism. At present, there is a heated discussion on the medical professionalism in the world. This study will introduce the development history and latest research progress of medical professionalism and summarize the evolution track and characteristics of medical professionalism from three aspects: development period, international authorities' explanations and research framework. Furthermore, this study will also discuss the connotation and development of medical professionalism in the new era of China, in order to provide reference for the cultivation and evaluation of medical professionalism.
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Objective:To analyze the relationship between the clinical medical college students' time investment (including study, activities, entertainment and exercise) and general self-efficacy (GSE) in a medical university in Liaoning province, China.Methods:The first-year medical students were asked to participate the survey. Their GSE was measured by using general self-efficacy scale (GSES) in 2018. One year later, the independent variable table was used to investigate the extracurricular activity time, and 683 valid questionnaires were collected. Ordered logistic regression method was used to analyze the correlation between students' extracurricular activities and GSE.Results:Medical students' GSE was positively associated with their time in extracurricular study ( OR = 1.94, 95%CI = 1.49-2.54), volunteer activities ( OR=1.36, 95%CI = 1.01-1.83), and physical activities ( OR = 1.37, 95%CI = 1.01-1.85). However, there was no significant correlation with the time in activities organized by students ( OR = 1.09, 95%CI = 0.79-1.50) or activities organized by school ( OR = 1.15, 95%CI = 0.84-1.59). Furthermore, compared with clinical students of "5+3" year program, the 5-year program clinical students had a stronger correlation between medical students' GSE and the input of extracurricular study time. Conclusion:There is a positive correlation between medical students' GSE and their extracurricular time investment, which indicates that increasing medical students' GSE could be an effective method to improve their extracurricular time investment and eventually improve their comprehensive quality.
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Nonalcoholic fatty liver disease (NAFLD) refers to a chronic, obesity-related liver disease, which has become one of the most common liver diseases in children.NAFLD is also regarded as the liver symptom of metabolic syndrome in children, which is closely related with obesity, insulin resistance, abnormal lipid metabolism and even cardiovascular-related disease in children.Therefore, it is noteworthy to provide more concerns and efficiency strategies regarding prevention and treatment of NAFLD in children.Previous studies have shown that abnormal fructose metabolism could play an essential role in the physiopathological process of NAFLD.Here in, this study aims to perform the comparation of the similarities and differences regarding fructose metabolism in liver under physiological and pathological conditions, in addition, to clarify the problems and challenges that need to be overcome in clinical studies and bench work related to NAFLD.
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To investigate the quality value of medical education for supporting the strategy of Health China and cultivating the first-class medical talents. In this article, seven laws for the improvement of medical talents were put forward. Only by following these laws can truly put quality values of medical education into practice in the talent training, and can achieve the goal of improving the quality of medical talent training by medical education reform.
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To investigate the quality value of medical education for supporting the strategy of Health China and cultivating the first-class medical talents. In this article, seven laws for the improvement of medical talents were put forward. Only by following these laws can truly put quality values of medical education into practice in the talent training, and can achieve the goal of improving the quality of medical talent training by medical education reform.
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Objective To analyze the relationship between general gelf-efficacy and life-long learn-ing orientation in medical students of a university for providing scientific evidence for the improvement of their life-long learning orientation. Methods In March 2015, all the fifth grade medical students, altogether 822, were invited to participate in the survey and 748 questionnaires were collected effectively. The instru-ments employed were General Self-efficacy Scale (GSES) and Jefferson Scale of Physician Life-Long Learning Student Version in Chinese (JSPLL-S). The relationship was analyzed by using multiple linear regression. Results The general self-efficacy and life-long learning orientation in medical students had significantly positive correlation (β=0.53,P=0.00). Furthermore the general self-efficacy was significantly correlated with each sub-domain of life-long learning orientation, specifically attention to learning opportunity (β=0.53,P=0.00), technical skills in information seeking (β=0.47,P=0.00) and learning beliefs and motivation (β=0.31, P=0.00) respectively. The results also indicated that the magnitude and significance of these corre-lations were independent from the individual characteristics. Conclusion Medical students' general self-efficacy greatly affects their life-long learning orientation. Thus, the strategy aiming at improving students' general self-efficacy could be affective for the development of life-long learning orientation.
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With the development and changes of the modern medical system,the public is paying more and more attention to health,and the professionalism of the physicians becomes more and more important.In recent years,studies have found that doctors are often troubled by professionalism dilemmas in clinical practice.This article reviews the literature on the professionalism dilemmas.Firstly,it defines the concept of professionalism dilemmas and points out the hazards of professionalism dilemmas for individuals,teams and the entire medical industry.We can explore the factors that affect the professionalism dilemmas from the intemal and external aspects,and finally put forward some suggestions for effective prevention and improvement of the professionalism dilemmas.First,physicians themselves have to enhance self-reflection ability.Second,medical schools,through training,shouldenhance the ability of physicians to face occupations professionalism dilemmas,Third,medical institutions should give policy support to to protect physicians.Through the study of the professionalism dilemmas of physicians,we should strengthen the professionalism of physicians and enhance the sense of professional responsibility and mission of medical and health personnel so that they can better fulfill their obligations,serve the people's health better and promote the healthy development of the entire medical and health undertaking.
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In 1999,the author,as a visiting scholar,studied the curriculum reform of'New Path'in Harvard Medical School.In the past ten years,the author has concerned with and followed the track of the curriculum integration of Harvard Medical College.This paper discusses the psyc.hology theory foundation of the integration of Harvard Medical College,and involves the theory of cognitive psychology and the theory of humanism learning,which is an important reference for the integration of our medical curriculum.
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Dietary surveyis a method to evaluate whether dietary intake meets body requirements by recording food consumed during a certain period.Widely-used dietary survey methods include:24 h dietary recall,dietary record,food frequency questionnaire and dietary history questionnaire.Since each method has its own advantages and limitations,researchers need to choose appropriate methods according to research purposes,accuracy requirements,availability of resources,etc.Obese children who are the focus and the major difficulty in dietary survey,it is important to choose an appropriate survey method.This article reviews widely-used dietary survey methods and evaluates them in the study of obese children related dietary surveys.
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The growing trend of childhood obesity has attracted much attention globally.Overweight and obesity are not only popular in developed countries,but have spread to developing countries.China has entered an overall epidemic stage of childhood obesity.Studies have shown that obesity does not only impairs children's health,but also leads to health hazards in adult stage.Diabetes,coronary heart disease and other cardiovascular diseases may take place sooner or the incidence may become higher.The causes of obesity include genetic,early life events,physical activity patterns,diet and social psychological factors.This article reviews the current epi-demic status and the influencing factors of childhood obesity worldwide.
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Objective To observe the effects of Ulinastatin on pulmonary vascular endothelium permeability and respiratory function in patients with extrapulmonary acute respiratory distress syndrome(ARDS exp). Methods The data of 39 patients with ARDS exp were retrospectively analyzed.According to whether treated with Ulinastatin or not, all patients were divided into Ulinastatin group(n = 21)and control group(n = 18); The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index(PVPI) and respiratory function were measured before and after the treatment. Results The mortality rate of Ulinastatin group was lower than that of control group (28.6% vs 38.9%). The time of decreasing EVLWI, PVPI and improving PaO2/FiO and respiratory function in Ulinastatin group was shorter than that of control group, and the effect was superior. Conclusion Ulinastatin could reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with extrapulmonary acute respiratory distress.
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Ojective To determine the risk factors and the clinical distribution of multiple drug resistant bacteria in stroke- associated pneumonia (SAP) patients with multiple drug-resistant bacterial infections from in-tensive care unit, providing guidance for clinical treatment of SAP. Methods A retrospective study was de-signed to analyze the clinical data of the SAP patients from January 2012 to December 2015. Univariate analysis and multivariable regression analysis were taken for risk factors of MDR infections , and investigated the distribu-tion and drug resistance of MDR. Results There were 183 SAP patients, of which 131patients (71.6%) had MDR infection. There are 193 MDR strains in the 131 patients , the first 5 MDR strains were Acinetobacter bau-mannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Escherichia coli. MDR in-fection is highly associated with sever unconsciousness , time of stay in ICU longer than 7 days , ventilator time longer than 7 days and late-onset pneumonia and the difference was significant (P < 0.05). Conclusion SAP patients with MDR bacterial infections are in association with the following risk factors: sever unconsciousness , time of stay in ICU longer than 7 days, ventilator time longer than 7 days and late-onset pneumonia. The rate of MDR bacterial infections was high , and these MDR strains were widely different degrees of resistance to many antibiotics.
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<p><b>OBJECTIVE</b>To assess the effects of continuous blood purification (CBP) on extravascular lung water and respiratory function in patients with extrapulmonary acute respiratory distress syndrome (ARDSexp).</p><p><b>METHODS</b>The data of 31 patients with ARDSexp admitted in our department were retrospectively analyzed.Sixteen of the patients received CBP, and the other 15 patients did not (control group). The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and respiratory function were measured before and after CPB.</p><p><b>RESULTS</b>The mortality rate was significantly lower in CBP group than in the control group (12.5% vs 33.3%, P<0.05). The patients in CPB group showed markedly earlier and significantly greater improvements in EVLWI, PVPI, PaO2/FiO, and respiratory function than the control patients (P<0.05).</p><p><b>CONCLUSION</b>CBP can reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with ARDSexp.</p>
Subject(s)
Humans , Capillary Permeability , Extravascular Lung Water , Hemofiltration , Lung , Monitoring, Physiologic , Respiration , Respiratory Distress Syndrome , Retrospective StudiesABSTRACT
Objective To investigate the demands and problems of the sharing and construc-tion of teaching resources in medical universities. Method A self-designed questionnaire named The questionnaire of the present situation and demand of teaching resources sharing platforms in medical universities in China was used to conducted in all the attainders during a national teaching resources meeting, and SPSS 17.0 was used to analyze the data. Results Among 125 valid questionnaires, 117 people (93.6%) think it's necessary to establish the resources sharing platform, what's more 108 people (86.4%) believe that education resources sharing platform is very helpful for teaching, and multimedia materials, online courses, course wares, teaching cases, website of subject resources and other educa-tion resources should be widely shared. Our investigation has involved 48 medical universities from all over the country, in which 33 medical universities have teaching resources sharing platform. However, 20 (60.6%) of the universities have still not updated the content on time. There are 10 main factors which influence the using of the education resource sharing platform, in which 105 (84%) of them have con-sidered the factor as backward concepts, 91 (72.8%) think that there exist problems in resource con-struction mechanism, 76 (60.8%) think to be the standardized and universal problems. Conclusion It is necessary to build the education resource sharing platform. In all, we should change the traditional education concept and consciousness, strengthen mechanism of management, and exploit high quality education resource to improve the sharing level of education resource in medical universities.
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With the growth of people's living standard,the prevalence of childhood obesity is increasing year by year.Meanwhile,the adverse effect caused by obesity occurred more frequently as well.Therefore,obesity in childhood has become a critical issue in public health area.Complications of obesity may lead to enormous implications on children,including their endocrine,cardiovascular,digestive system,etc.,which will have an impact on the body growth in the adolescence.Obesity not only has a huge threat to children's physical and psychological health,but also has a long-term effect on body health condition in the future.Consequently,it is significant to diagnose the occurrences of complications of children,and implement the guiding and curing at an early stage.
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The medical curriculum which is designed reasonable, plays a decisive role in the training specifications and quality of medical talents. The medical education in England is always in the world first column, and its medical curriculum is distinctive. The courses are mostly offered by the form of integration. They pay more attention to the setup of selective courses, humanities and social sciences courses, and they also put emphasis on the early clinical contact and early scientific research training. In addition, they are also outstanding in practice and internship. There is much beneficial enlightenment for our country's course reform from the British medical curriculum design, namely to establish integration courses which is interdisciplinary, to strengthen the humanistic quality's cultiva-tion, to advocate early clinical contact and early scientific research, and to strengthen cooperation and coordination between medical colleges and social organizations in all aspects.
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Education reform and innovative education are the strong requirements of the times and social development.We developed immunological paper free examination system based on the optimized question bank,characteristics of immunological examination and information technology.This system can randomly develop electronic examination paper and can integrate the processes of exam registration,examination paper development,online examination,paper inspection,scores generation and printing into one system,which can save human resources,enhance the accuracy and fairness of the examination,making it conform to international standards.
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Due to the restriction of the specific situation in China and the concrete conditions of universities,Problem-based learning teaching method failed to gain its popularity in medical education in China.In the era of information globalization,the web-based teaching method relying on the network and taking the PBL as the dominant has many advantages and there is nothing comparable to this.To establish a network of PBL platform in the area of medical education will provide medical education with a new chapter.
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Objective To analyze the relation between calcium and phosphate metabolism and the death for cardiovascular disease in continuous peritoneal dialysis patients.Methods60 peritoneal dialysis patients from our hospital were collected from July,1999 to December,2007 were divided into two groups by the death causes:the death cause for CVD group and the death cause for non-CVD group,and then compare their gender、age、time for dialysis、difference for pulse pressure(PP)、the content of Ca、P、Ca?P and PTH in serum.Results There are 28 cases in CVD group(47%);there are 32 cases in non-CVD group(53%).There are not differences for age、gender、time for dialysis and serum calcium between two groups;there are significant differences for PP、serum phosphorus、Ca?P、PTH between two groups.ConclusionThe high value for phosphorus、Ca?P and PTH in serum are closely related to the death cause for CVD in continuous peritoneal dialysis patients,which are the main dangerous factors in the death cause for CVD.