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Objective:To explore the application effect of online and offline mixed teaching based on DingTalk platform in clinical practice teaching of respiratory department.Methods:The Batch 2016 ( n= 40) and Batch 2017 ( n=47) undergraduates of clinical medicine in Qiqihar Medical College were selected as the research objects, and they were divided into a control group and a research group. The control group adopted traditional offline theoretical teaching, while the research group adopted online-offline mixed teaching, focusing on teaching design and teaching objectives, teaching subjects, teaching resources, network platforms and teaching activities (classroom learning and evaluation). The theoretical and practical test scores of the two groups of interns were compared, and the evaluations of the students in the research group on the effect of online and offline mixed teaching were collected. Excel 2013 was used to sort out the data, and R software was used for data processing and statistical analysis. T-test was used for measurement data and Chi-square test was used for counting data. Results:The operational test scores [(28.16±1.70) points] and theoretical scores [(82.07±6.40) points] of the students in the study group were higher than those in the control group [(23.35±2.88) points and (76.20±5.67) points], with significant differences ( P<0.001). Compared with the students in the control group, the students in the research group were more satisfied with the mixed teaching method. Conclusion:The online and offline mixed teaching is conducive to improving students' comprehensive performance, learning effect, and promoting students' clinical diagnosis and treatment skills, self-study, innovation abilities and clinical competence.
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Objective:To observe the application effect of simulation medicine teaching in clinical practice teaching of respiratory department.Methods:A total of 96 five-year undergraduate students of clinical medicine specialty from Batch 2018 were randomized into in two groups in average. The traditional teaching group conducted bedside teaching according to traditional teaching outline, and the simulation medicine group used simulated medical teaching method. The performances of theoretical knowledge and skill operations and the teaching satisfaction with the department were evaluated between the two groups. SPSS 22.0 was used for t test and chi-square test. Results:There was no significant difference in theoretical knowledge between the two groups, but the results of skill operation test and satisfaction with the department of the simulation medicine group were significantly better than those of the traditional teaching group, and the difference was statistically significant [(80.92±5.99) vs. (87.71±4.95), P<0.050; χ2=26.14, P<0.05]. Conclusion:Simulation medicine teaching is better than traditional teaching in clinical practice teaching of respiratory department, which can improve students' clinical skills and operation level, cultivate good clinical thinking for students, and improve their learning interests.
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Objective:To investigate the effect of optimal time of intermittent pneumatic compression(IPC) on deep venous thrombosis (DVT) of critical patients in respiratory department.Methods:Totally, 105 critical patients in Department of Respiratory and Critical Care Medicine,Nanjing Drum Tower Hospital, Nanjing University Medical School from July 2018 to October 2019 were divided into experimental group 1, group 2 and group 3 by random digits table method, with 35 cases in each group. The experimental group 1 received IPC treatment with 30 min every time, twice a day; and group 2 received 40 min every time, twice a day; and group 3 received 1 hour every time, twice a day. The incidence of DVT and deep tissue injury was observed among three groups, meanwhile, the coagulation function index among three groups was compared before and after IPC treatment.Results:There was no significant difference in the incidence of DVT among the three groups ( P>0.05), however, the deep tissue injury rate were 22.9% (8/35) in the experimental group 3, significantly higher than 2.9% (1/35) in the experimental group 1 and 5.7% (2/35) in experimental group 2, the difference was statistically significant ( χ2 values were 6.248, 4.200, P<0.05). After 2 weeks of treatment, the levels of fbgrinogen and D-Dimer were (5.32±1.82) g/L, (0.71±0.38) mg/L and (4.15±1.82) g/L, (0.39±0.13) mg/L and (3.75±1.46), (0.33± 0.14) mg/L in the experimental group 1, experimental group 2, experimental group 3, respectively; the fbgrinogen and D-Dimer was significantly decreased in the experimental group 2 and experimental group 3 compared to the experimental group 1 ( t values were 2.131-3.977, P<0.05), however, there was no significant difference between experimental group 2 and experimental group 3 ( P>0.05). Conclusions:IPC can be extend to 40 min every time, twice a day, which can significantly improve coagulation function and do not increase the incidence of skin pressure injury of critical patients in respiratory department. It is worth being applied in clinic.
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Objective:To explore the application of Bloom target teaching theory combined with PBL teaching mode in standardized residency training of respiratory.Methods:A total of 44 residents of Batch 2019 who had been in respiratory department of our hospital for 2 months on rotation were selected as the control group, and traditional teaching training was adopted in the group. In addition, 41 residents of Batch 2020 who were enrolled in the respiratory department of our hospital for a 2-month residency training rotation were selected as the research group, and Bloom target teaching theory combined with PBL teaching mode was applied in the group. After the residency training, the teaching effect of the two groups of training residents was evaluated by theoretical examination, practical skill operation examination and questionnaire survey. SPSS 22.0 was used to conduct t test. Results:The results of theoretical assessment and practical skills operation assessment of students in the study group were better than those in the control group, and the difference was statistically significant ( P<0.05). The subjective satisfaction of the training residents and the tutors were scored respectively. The results showed that the scores of residents in the study group were higher than those in the control group, the difference was statistically significant ( P<0.05). The subjective satisfaction score of residents on the assessment results of this stage showed that residents in the study group had higher scores than the control group, with statistical significance ( P<0.05). The tutor's subjective satisfaction score of the assessment results at this stage showed that the scores of the residents in the study group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Conclusion:The combination of Bloom target teaching theory and PBL teaching mode can improve the theoretical and practical operation ability of students in respiratory department, improve their learning initiative, enthusiasm and teaching satisfaction, and then improve the teaching quality.
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Objective: To compare the application of Sofren injection in respiratory department before and after the intervention to provide reference for clinical application and pharmacy management.Methods: A retrospective study was conducted on the medical records of inpatients treated with Sofren injection, and then intervene the found problems.Comparative study of Sofren injection in respiratory department before and after the intervention was performed.Results: Among the 584 cases in the retrospective study, those with off-indications were 438 ones (75%), those with inappropriate solvents were 555 ones (95.03%), and those with improper course were 196 ones (33.56%).After the intervention in the clinical practice, the improvement rate of improper solvents was 98.70%, that of off-indications was 29.85%, and that of unsuitable course was 77.71%.Conclusion: Through comparative study on the main problems before the intervention and the effective performance of specific solutions, the application of Sofren injection in respiratory department is greatly improved, which provides reference for the special management of other drugs.
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OBJECTIVE:To evaluate the effects of interventions on the use of human serum albumin in respiratory department of our hospital,and to promote rational clinical drug use.METHODS:According to package inserts,related guideline and literatures of human serum albumin,the evaluation standard of human serum albumin use in respiratory department of our hospital was established with evidence-based medicine method.The comprehensive intervention of human serum albumin use was carried out by means of medical order review,prescription comment,permission setting of information system and performance evaluation.The prescriptions of patients receiving human serum albumin were collected during Jan.-Jul.2015 (pre-intervention group,226 cases)and Jan.-Jul.2016 (post-intervention group,148 cases).Those prescriptions were analyzed statistically in respects of total amount of human serum albumin,per capita amount,average duration,indications,contraindications and rationality,etc.The utilization of human serum albumin was compared between 2 groups before and after intervention.RESULTS:The total amount of human serum albumin,per capita amount and average duration decreased from 18 350 g,(81.2±71.3)g,(7.8±7.2)d before intervention to 7 584 g,(51.2±48.3)g,(4.7±2.1)d after intervention,respectively.The proportion of not in line with the indication stated in Guidelines for Use of Human Serum Albumin,Non-protein Colloidal Solution and Srystalline Solution,the proportion of being contrary to contraindication decreased from 80.1％,50.0％ before intervention to 39.9％,16.9％ after intervention,respectively.The number of patients with serum albumin concentration ≥35 g/L,ranged ≥30-＜35 g/L or ranged ≥20～＜25 g/L before medication in pre-intervention group was more than post-intervention group;the number of patients with serum albumin concentration＜ 20 g/L or ranged 20-25g/L in post-intervention group was more than pre-intervention group.The proportion of patient who took human serum albumin rationally increased from 16.8％ before intervention to 52.7％ after intervention (P＜0.05),there were statistical significances in above-mentioned indexes between before and after intervention.CONCLUSIONS:The comprehensive intervention can effectively reduce the indication,medication course and proportion of unreasonable use of human serum albumin,and improves rational use of human serum albumin.
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OBJECTIVE:To evaluate the effect of clinical pharmacist intervention on the application of antibiotics in patients with respiratory infection from our hospital. METHODS:Each 500 patients were selected from respiratory department of our hospi-tal during Jan. to Jun. in 2016 and Jul. to Dec. in 2016. The patients were divided into pre-intervention group and post-intervention group. The application of antibiotics,the occurrence of ADR and anti-infective effects were compared before and after clinical phar-macist intervention,and the rationality of antibiotics use was evaluated. RESULTS:After intervention,the utilization rate of antibi-otics decreased from 92.60％ to 74.20％;the proportion of single drug therapy and triple and more drugs therapy were decreased significantly,with statistical significance(P0.05). CONCLUSIONS:The intervention implemented by clinical pharmacists effectively reduce the utiliza-tion rate of antibiotics and the incidence of ADR,improve the rate of infection control,reduce antibiotics cost and the occurrence of irrational drug use. However,there are still some problems in respiratory department of our hospital,such as irrational drug use, nonstandard dosage,irrational drug combination and no etiological support,etc. Continuous follow-up intervention is needed.
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OBJECTIVE:To provide reference for rational drug use in respiratory department. METHODS:ADR/ADE report-ed by respiratory department of a class three grade A hospital during Jan. 2011 to Dec. 2015 from national ADR monitoring system were collected. 2011-2015 ADR/ADE database of respiratory department in a hospital was established and analyzed statistically. RE-SULTS:202 records were gotten,among which 89 cases were male(44.06%)and 113 cases were female(55.94%);the patients’ age approximated normal distribution,the incidence of ADR/ADE was the highest in 61-80 age group (55.94%);the occurrence time of ADR/ADE was mostly lower than 1 h (47.21%);the main route of administration was intravenous drip (71.29%);22 kinds of drugs were involved,and antibiotics took up the lead(43.11%);84 patients(41.58%)used 2 and more kinds of drugs before the occarrence of ADR/ADE;organs/systems involved in ADR/ADE were skin and its appendants (32.86%) and digestive system(26.19%). Most of the ADR/ADE could be cured or recovered after related treatment. CONCLUSIONS:The occurrence of ADR/ADE in respiratory department is related to various factors,of which advanced age,intravenous administration and antibiotics use are important ones. Great importance should be attached to rational clinical drug use as well as ADR/ADE monitoring and re-porting. Clinical also should pay attention to the safety of drug use in elderly patients.
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Objective To analyze the distribution and drug resistance situation of pathogens in the respiratory department during the recent 9 years to provide the basis for rational use of antibacterial drugs in clinic .Methods All pathogens isolated from the respiratory depeartment from January 2003 to December 2011 and the drug susceptibility test results were retrospectively and statistically analyzed .Results A total of 5 714 strains of pathogenic bacteria were isolated ,which mainly distributed in the sputum (90 .1% ) ,excrement (4 .2% ) and urine (3 .6% );among them ,2 943 strains (51 .5% ) were Gram‐negative bacteria ,596 strains (10 .4% ) were Gram‐positive bacteria and 2 175 strains (38 .1% ) were fungi .The top six of isolated bacteria were Candida albi‐cans ,Pseudomonas aeruginosa ,Acinetobacter baumannii ,Klebsiella pneumoniae ,Candida tropicalis and Escherichia coli .The isola‐tion rates of A .baumannii and C .albicans were increased year by year ,while the isolation rate of E .coli was decreased .A .baumannii and P .aeruginosa had a high resistant to all antibacterial drugs ,whereas the resistant rate of A .baumannii was increased year by year and that of P .aeruginosa showed some fluctuation .K .pneumoniae had a high susceptibility to imipenem and meropenem ,and the sensitivity to other antimicrobial agents had a gradually increasing tendency .The sensitive rate of C .albicans to amphotericin B was almost 100% ,and they had a high susceptible to other antifungal agents .Conclusion Drug resistance of the pathogens is com‐mon in the respiratory department .It is of importance to emphasize the pathologic examination ,carry out the surveillance of drug re‐sistance of pathogenic bacteria ,and use the antibacterial drugs rationally in clinical anti‐infective therapy .
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Objective To investigate the utility of antibiotics in elderly patients of respiratory department in No. 210 Hospital of PLA, and to understand the rational use of antibiotics in respiratory department. Methods A total of 534 patients >60 in respiratory department of our hospital from September to December in 2011 were randomly selected. The usage rate of antibiotics, the types that used, dosing routes and so on were recorded and analyzed. Some rational suggestions were dis‐cussed put forward. Results ① The usage rate of antibiotics was 97%. ② A total of 21 kinds of antibiotics had been used. The types of drugs are Amp C, levofloxacin, β‐lactamase inhibitors, nitromidazoles, aminoglycoside, antifungals, MALS, lincomycin. The percentage rate of the top three antibiotics were 59. 97%, 17. 30% and 7. 58%. ③ There were some problems in the usage of antibiotics, such as no indication of medicine, high use rate of antibiotics, improper variety selection, dosing routes and drug intervals, irrational use of drugs combinations. Conclusion The application rate of antibiotics was 97%, there was some illegiti‐mate phenomenon in the use of antibiotics. Some attentions should be paid to the rational use of antibiotics in elderly patients, and to raise the rational use rate of antibiotics.
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OBJECTIVE To investigate the drug-resistance of AmpC enzyme derepressing Enterobacter cloacae isolated from patients of respiratory department.METHODS Totally 364 strains of E.cloacae(162 strains from respiration department) collected from Jan 2001 to Dec 2006 were investigated to know their ward distribution,infection site and susceptibility test results.Three-dimensional tests were adopted to test AmpC lactamase.RESULTS Among the total 162 strains from respiration department,AmpC producers were 76 strains,accounting for 46.91%. Among the 202 strains from the other departments,however,AmpC producers were 36 strains,accounting for 17.82%.And drug-resistance of E.cloacae from respiration department was distinctly higher than that from the other departments.CONCLUSIONS E.cloacae from respiratory department has the higher isolating rate and drug-resistance rate.We should take effective measurement to contain nosocomial infections with E.cloacae.
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OBJECTIVE To find out the actual situations of antibiotics utilization in Respiratory Department of our hospital and provide feedback of improper applications to the clinic,so as to promote proper utilization of antibiotics.METHODS To take samples from clinical cases of 141 samples in Oct to Nov 2006 and fill the forms of the basic information and investigation items of General Hospital of Chinese People′s Armed Police Forces,the cases were finally sorted and summarized with Excel.RESULTS The antibiotics utilization ratio was 96.5%,their combination usage accounted for 70.2%,the etiology detection rate was 61.7%,the improper usage accounted for 34.8%.CONCLUSIONS The situation of antibiotics utilization in our hospital has changed a lot.Hospitals should define regulations and reinforce the management according to The Principle Guidelines of Antibiotics Utilization and actual situations.
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Problem-based and student-centered learning patten brings new challenges to the both sides of teaching and learning.Clinical probation is the first step of medical students.The problem-based learning patten is used to clinical probation and achieves good results.It helps to improve medical students' quality and should be applied in China medical education.