ABSTRACT
Objective:To observe the effect of simulation combined with problem-based learning (PBL) in the clinical practice teaching of internal medicine.Methods:A total of 41 internal medicine interns accepted from January 2019 to August 2019 in The Third Hospital of Hubei Medical University were selected as the control group, and the traditional clinical teaching was adopted. Another 43 internal medicine interns received from September 2019 to August 2020 were selected as the experimental group, and the simulation combined with PBL teaching was adopted. The clinical skill knowledge and practical operation skills were compared between the two groups in the examination results, the changes in clinical ability before and after the internship, and the recognition of the teaching. SPSS 25.0 was used for t-test, Chi-square test, and rank sum test. Results:The clinical skill knowledge and practical operation skills of interns in the experimental group [(94.51±4.49), (91.05±7.66)] were higher than those in the control group [(89.20±9.23), (85.63±11.57)] ( P<0.05). There was no significant difference in various scores and total scores of clinical competences (including medical interview skills, physical examination skills, humanistic care skills, clinical judgment skills, communication skills, organizational effectiveness, and overall clinical competence) between the two groups before internship. After the internship, the above scores and total scores of the two groups were higher than those before the internship, and the experimental group was higher than the control group ( P < 0.05). The total recognition of the teaching by interns in the experimental group was 95.35% (41/43), which was significantly higher than 78.05% (32/41) in the control group. Conclusion:Simulation combined with PBL teaching can significantly improve the clinical skill knowledge, practical operation level, clinical ability, and recognition of teaching of medical interns.
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Objective:To identify the risk factors of heart failure in elderly patients with hip fracture by Meta-analysis.Methods:The clinical studies on perioperative heart failure in elderly patients with hip fracture were searched by computer in Pubmed, EMbase, Cochrane Library, Medline, Web of Science, CNKI, CBM, Wanfang and VIP database. The retrieval period was from the establishment of the databases to October 2021. The literature screening, data extraction and quality evaluation were completed by two researchers, and the selected literature were statistically analyzed by RevMan5.3 software.Results:A total of 17 articles were included in this study, involving 1 76 611 patients and 24 related risk factors. Cardiac history ( OR= 4.47, 95% CI 3.56-5.62), positive balance of perioperative inflow and outflow ( OR=5.99, 95% CI 3.30-10.87), anemia ( OR= 3.78, 95% CI 2.50-5.69), and the number of complications >4 ( OR=6.21, 95% CI 3.71-10.38), electrolyte disorder ( OR=7.40, 95% CI 3.77-14.54), preoperative cognitive impairment ( OR=3.60, 95% CI 1.39-9.31) and American Society of Anesthesiologists (ASA) grade ≥ 3 ( OR= 4.73, 95% CI 2.73-8.12) were statistically significant risk factors ( P<0.05). Conclusions:Cardiac history, positive balance of perioperative inflow and outflow, anemia, number of complications >4, electrolyte disorder, preoperative cognitive impairment and ASA grade ≥3 were the risk factors of perioperative heart failure in elderly patients with hip fracture.
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This study was aimed to investigate the effects of hesperidin on the macrophage foam cell formation in RAW264.7 cells and the expression of ICAM-1.RAW264.7 cells were culture in vitro and induced by oxLDL (50 μg· mL-1).Furthermore,cells were separated into the control group,oxLDL model group and hesperidin treatment group.The effect of hesperidin on cell viability in RAW264.7 was assessed by MTF assay.Oil Red O staining was examined by foam cells formation.Effect of hesperidin on protein expression of ICAM-1 was analyzed by western blot.In addition,the effect of hesperidin on mRNA expression of ICAM-1 was assessed by RT-PCR.The results showed that the viability should been over 80％ after less than or equal to 5 μM hesperidin treatment.Hesperidin decreased the protein expression of ICAM-1 in RAW264.7 cells.Additionally,hesperidin suppressed the mRNA expression of ICAM-1 in RAW264.7 cells.It was concluded that hesperidin can inhibit foam cell formation and the expression of ICAM-1 in RAW264.7 cells.It suggested that hesperidin protect against atherosclerosis.