ObjectiveTo summary the standard treatment for early gastric cancer.
MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded.
ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences.
ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
ObjectiveTo analyze the relationship between maximum standardized uptake value (SUVmax) of primary tumor detected by 18F-FDG positron emission tomography/computed tomography (PET/CT) and clinicopathologic factors in stageⅠnon-small cell lung cancer (NSCLC), and investigate the prognostic value of PET/CT on pathological feature.
MethodsWe retrospectively analyzed clinical data of 182 patients with stageⅠNSCLC who underwent 18F-FDG PET/CT scan before lobectomy or segmentectomy in China-Japan Friendship Hospital from April 2013 to June 2014. There were 121 male and 61 female patients with their ages of 34-85 (68.1±9.8) years. Clinicopathologic factors including sex, age, smoking history, histology, TNM stage, T stage, tumor size, lymphatic vessel invasion, blood vessel invasion (BVI) and visceral pleural invasion were evaluated to identify the independent factors affecting SUVmax by univariate and multivariate regression analysis. The diagnostic efficiency and best cut-off point of SUVmax were calculated by the receiver operating characteristic curve.
ResultsThe univariate analysis identified that sex (P=0.015), smoking history (P=0.001), histology (P < 0.001), TNM stage (P=0.004), T stage (P=0.001), tumor size (P < 0.001), BVI (P=0.001) were factors affecting SUVmax. Only histology (P=0.001), tumor size (P=0.006), BVI (P=0.009) were found to be significant independent factors according to multivariate regression analysis. The SUVmax of primary tumor was a predictor for BVI with the highest diagnostic accuracy at a cut-off value of 4.85, the sensitivity and specificity were 65.5% and 71.7%.
ConclusionThe SUVmax is correlated with histology, tumor size and BVI in stageⅠNSCLC, higher in patients with non-adenocarcinoma, lager tumor and positive BVI. Furthermore, the probability of BVI could be predicted by SUVmax of the primary tumor.
ObjectiveTo analyze the value of structured electronic medical records for pulmonary nodules in increasing the ability of outpatient service and hospital management by resident physicians.MethodsWe included 40 trainees [94 males and 26 females aged 22-31 (26.45±2.81) years] who were trained in the standardized training base for surgical residents in our hospital from January 2018 to January 2021. The trainees were randomly divided into two groups including a structured group using the structured electronic medical record for pulmonary nodule and an unstructured group using unstructured electronic medical record designed by our department. The time of completing hospitalization records and first-time course records, the quality of course records, the accuracy of issuing admission orders, the quality of teaching rounds, and patient’s satisfaction between the two groups were analyzed and compared.Results(1) The average time in the structured group to complete inpatient medical records was significantly shorter than that of the unstructured group (53.61±8.12 min vs. 84.25±16.09 min, P<0.010); the average time in the structured group to complete the first-time course record was shorter than that of the unstructured group (13.20±5.43 min vs. 27.51±8.62 min, P<0.010), and there was a significant statistical difference between the two groups. (2) The overall teaching round quality score of the students in the structured group was significantly higher than that in the unstructured group (84.21±15.61 vs. 70.91±12.28, P<0.010). (3) The score of the medical record writing quality of the structured group was significantly higher than that of the unstructured group (80.25±9.22 vs. 74.22±5.40, P<0.010).ConclusionThe structured electronic medical record specific for pulmonary nodules can effectively improve the training efficiency in the standardized training of surgical residents, improve the clinical ability to deal with pulmonary nodules, improve the integrity and accuracy of key clinical data collected by students, and improve doctor-patient relationship.
The number of clinical practice guidelines for traditional Chinese patent medicine has been increasing recently. However, the quality of guidelines was still low compared to international guidelines. Considering the characteristics of traditional Chinese patent medicine, we suggested the following items should be taken into account when developing traditional Chinese patent medicine guidelines: ensuring the standardized guidelines of traditional Chinese patent medicine research problem is scientific based on reliable evidence; identifying the common questions according to these research problems; understanding the strength of evidence and how to recommend correctly; inviting some experts in other fields to take part in the development of guidelines; paying more attention on the changes of disease burden and the impact of new methods and technologies when developing the guideline; paying more attention to the non-consensus opinions and evidence supporting these opinions; insisting on quality is the priority, while speed is secondary.
Objective
To explore the application value of standardized patient (SP)-based teaching method in the teaching of medical history taking for international students.
Methods
During the autumn semester of 2017, 96 international medical students were randomly divided into two groups, with 48 students in the SP-based teaching group and 48 students in the conventional teaching group. The test scores of medical history taking in English in internal medical practice of the two groups were compared. The teaching feedback from the international students was collected and evaluated by online questionnaire survey.
Results
The scores of medical history taking examination in internal medical practice of the students using SP-based teaching method were higher than those of the students using conventional teaching method (86.5±9.7 vs.78.2±10.6), and the difference was statistically significant (t=3.983, P<0.001). According to the questionnaire analysis, in terms of whether the current teaching method could enhance learning interest, improve communication ability, promote clinical skills, train clinical thinking, and highlight humanistic care, students with positive views in the SP-based teaching group accounted for 92.86%, 97.62%, 85.71%, 90.48%, and 95.24%, respectively, while students with positive views in the conventional teaching group accounted for 90.00%, 87.50%, 82.50%, 77.50%, and 97.50%, respectively, and the differences were not statistically significant (P>0.05).
Conclusions
Well-trained SP has a good application value in clinical practice of internal medicine and diagnostics teaching for international students. SP-based teaching method has been accepted and supported by the majority of international medical students who have experienced it.
Medication adherence will directly affect the validity of primary endpoint indicator. This article discussed how to improve the medication adherence of clomiphene citrate based on PCOSact. We found that 20 (3+15+2) cases were "protocol violation" and there were cases in which researchers made mistakes while distributing medicine and guiding patients how to take medicine. Focusing on these problems we sumed up experience and emphasized the importance of medication compliance through the following aspects:(1) Improvement of insite supervision and remote monitoring; (2) Standardization training for research assistants; (3) Health education for subjects.
Objective
To explore the application of the Handbook for the Training Nurses in the standardized training for nurses in pediatric surgery.
Methods
Twenty-four training nurses trained under the instruction of the Handbook for the Training Nurses in Department of Pediatric Surgery from July 2014 to December 2015 were included as the observation group. Their training effects were compared historically with those of twenty-four training nurses who were trained without the help of the handbook from January 2013 to June 2014 (the control group).
Results
After the completion of the half-year training, theoretical score of training nurses in the observation group was better than that in the control group, and the difference was significant (87.16±4.18 vs. 83.71±5.46; t=2.492, P=0.016). Meanwhile, the specialist practical skill examination of training nurses in the observation group, such as femoral vein blood collection, replacement of drainage bag and indwelling needle infusion in children, and emergency practical skill examination such as cardiopulmonary resuscitation and the use of simple respirator were higher than those in the control group; and the working performance scores of training nurses in the observation group, such as the ability to adapt to the environment, patient satisfaction, nursing document writing, work efficiency and morning questions were better than those in the control group; the differences were significant (P< 0.05).
Conclusion
The Handbook for the Training Nurses can help the training nurses to adjust their working environment, master the practical skills and nursing knowledge in pediatric surgery.
Objectives To investigate the personnel allocation and workloads of the medical residents across the subspecialties of the Department of Internal Medicine at a tertiary hospital. Methods A cross-sectional survey was performed to investigate personnel allocation and workload. The resulting data were compared with the ministerial standard that regulates the training of medical residents. Results Aside from the subspecialty of Rheumatology, medical residents accounted for 40% to 70% of the total staff physicians. The faculty physicians accounted for only 20% to 50% of the total. When the non-faculty residents were not taken into account, each individual faculty physician took charge of between 5.3 to 15.5 beds across all the subspecialties. When only the non-faculty residents were accounted for, each individual resident took charge of 1.7 to 9.4 beds, 1.3 to 5.7 bed-days per day, and 5.8 to 17.3 patients per month. When both were accounted for, each physician was responsible for 1.3 to 5.9 beds, 1 to 3.6 bed-days per day, and 4.2 to 10.7 patients per month. In comparison with the ministerial standards, medical residents have managed more patients per month in the subspecialties of Nephrology, Respiratory Diseases, Digestive Diseases, Neurology and Infection.Fewer patients were managed in the subspecialty of Endocrinology. Conclusion The medical resident allocation is balanced across the subspecialties of the Department of Internal Medicine, although it is less stable. The total number of physicians is smaller than required, and physicians generally bear an overload of work. The number of patients managed by each individual resident is more than the requirement set by the ministerial standards, and has significant variations across subspecialties. Medical residents need to be allocated in accordance with the corresponding workloads.
Standardized residents training is a necessary way to cultivate qualified clinical physicians, and the teaching ability of their mentors will be a key factor affecting the quality of standardized residents training. In view of the problems existing in the current teachers training of standardized residents training, West China Hospital of Sichuan University has innovatively built a “coordination of six priorities” teachers training system to conduct hierarchical training for different types of mentors, in order to improve the quality and achieve homogenization of training. This article mainly elaborates on the problems in the current residents teachers training, the “coordination of six priorities” teachers training system of West China Hospital of Sichuan University, and the effect of the teachers training.
ObjectiveTo briefly describe the specific contents of the “four-dimensional integration” standardized training model for neurology residents and analyze the implementation effects.MethodsSince September 2019, the Standard Training Center for Residents in Department of Neurology, Xuanwu Hospital of Capital Medical University trained residents under “four-dimensional integration” standardized training model, including primary knowledge teaching, basic skill training, clinical thinking training, and student group learning. The effect of the “four-dimensional integration” model was measured by comparing the midterm assessment results after four months of training of the resident trainees in Grade 2019 under the “four-dimensional integration” training mode (n=37) with those of the resident trainees in Grade 2018 under regular training mode (n=32). The midterm assessment was conducted through standardized and objective clinical examinations, including three evaluations (theory, skills, and clinical drills), and the pass rate of tests was evaluated through Fisher’s exact probability method for comparison between training groups.ResultsThere was no significant difference in the pass rate of theoretical assessment (100.0% vs. 96.9%, P=0.464) or the pass rate of Mini-Clinical Evaluation Exercise (100.0% vs. 90.6%, P=0.095) between the two groups. The pass rate of skill assessment in Grade 2019 was significantly higher than that of the students in Grade 2018 (94.6% vs. 71.9%, P=0.018).ConclusionThe “four-dimensional integration” standardized training model for neurology residents and it effect are worthy of recognition, which can provide a reference for medical teaching, especially for the standardized training of resident physicians.
