As the most critical part of post-graduate education,the Chinese government launched Standard Resident Training in 2013 to solve the regional inequality of medical quality and meet the increasing social requirement fo...As the most critical part of post-graduate education,the Chinese government launched Standard Resident Training in 2013 to solve the regional inequality of medical quality and meet the increasing social requirement for better medical service.We integrated problem-based learning(PBL)and case-based learning(CBL)in the Endodontics Standard Resident Training.By evaluating with objective parameters including theoretical knowledge and clinical practice skill,and subjective parameters including questionnaire,it was found that PBL+CBL played a positive role in endodontic resident training with a significant difference(P<0.05).This combined training model is instructive for China’s resident training,and this result can provide a rudimentary reference to current postgraduate teaching reform.展开更多
Objective: To explore the application effect of flipped classroom combined with problem-based learning teaching method in clinical skills teaching of standardized training for resident doctors of traditional Chinese M...Objective: To explore the application effect of flipped classroom combined with problem-based learning teaching method in clinical skills teaching of standardized training for resident doctors of traditional Chinese Medicine. Methods: The study used the experimental control method. The study lasted from September to November 2022. The subjects of this study were 49 students of standardized training for resident doctors of traditional Chinese Medicine from grades 2020, 2021 and 2022 of Dazhou integrated TCM & Western Medicine Hospital. They were randomly divided into experiment group (25) and control group (24). The experiment group adopted flipped classroom combined with problem-based learning teaching method, and the control group adopted traditional teaching method. The teaching content was 4 basic clinical skill projects, including four diagnoses of traditional Chinese Medicine, cardiopulmonary resuscitation, dressing change procedure, acupuncture and massage. The evaluation method was carried out by comparing the students’ performance and a self-designed questionnaire was used to investigate the students’ evaluation of the teaching method. Results: The test scores of total scores in the experimental group (90.12 ± 5.89) were all higher than those in the control group (81.47 ± 7.96) (t = 4.53, P P Conclusions: The teaching process of the flipped classroom combined with problem-based learning teaching method is conducive to improving the efficiency of classroom teaching, cultivating students’ self-learning ability, and enhancing students’ willingness to learn.展开更多
As an important part of postgraduate education,Standard Resident Training(STR)plays a crucial role in the process of culturing a competent dental care provider who can independently treat the common oral infectious di...As an important part of postgraduate education,Standard Resident Training(STR)plays a crucial role in the process of culturing a competent dental care provider who can independently treat the common oral infectious diseases.A systematic and comprehensive evaluation system is desiderating for realization of high-quality Endodontics resident training due to its discipline characteristics of highly specialized and strict operation.This paper analyzes the current status of resident training in our Endodontic Department and discusses how to improve the clinical skills and reasoning ability of residents,in order to construct a comprehensive resident training formative evaluation system in China.展开更多
AIM To investigate the use of a multidisciplinary,longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis.METHODS A multidisciplinary,multiple step simulation...AIM To investigate the use of a multidisciplinary,longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis.METHODS A multidisciplinary,multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department.Effectiveness of the simulation for the residents was measured with a pre-and post-test and a reference group not exposed to simulation.A follow up post-test was completed 3-6 mo after the simulation.Nurses completed a survey regarding the education activity.RESULTS Pediatric and medicine-pediatric residents(n=20)and pediatric nurses(n=25)completed the simulation course.Graduating residents(n=16)were used as reference group.Pretest results were similar in the control and intervention group(74%±10%vs 76%±15%,P=0.658).After completing the intervention,participants improved in the immediate post-test in comparison to themselves and the control group(84%±12%post study;P<0.05).The 3-6 mo follow up post-test results demonstrated knowledge decay when compared to their immediate post-test results(78%±14%,P=0.761).Residents and nurses felt the interdisciplinary and longitudinal nature of the simulation helped with learning.CONCLUSION Results suggest a multidisciplinary,longitudinal simulation improves immediate post-intervention knowledge but important knowledge decay occurs,future studies are needed to determine ways to decrease this decay.展开更多
Introduction: Volunteering is an unpaid voluntary activity that provides some services to one or more other people or the community at large. Volunteer in the medical field is common. Physicians and medical students a...Introduction: Volunteering is an unpaid voluntary activity that provides some services to one or more other people or the community at large. Volunteer in the medical field is common. Physicians and medical students are participating in voluntary activities. This study assessed the motivations and barriers of Family Medicine (FM) Residents and Primary Health Care (PHC) Physicians in Qassim Region, Saudi Arabia. Methods: This is a descriptive cross-sectional study was carried out between 12th March 2021 to 31st September 2021 in Qassim Region, Saudi Arabia. 63 FM residents and 89 PHC physicians were involved. A self-administered questionnaire using Volunteer Functions Inventory (VFI) questions was distributed. A 30-item questionnaire is divided into 6 scales of 5 items each, which are scored using a 5-point Likert-type scale (where 1 strongly disagrees and 5 strongly agree). Results: Of 152 FM residents and PHC physicians, 91 (59.9%) were males, and Saudi 90 (59.2%). The mean age was 35 (±SD8.6) years. The majority of respondents 126 (85.7%) participated in different kinds of volunteer work. The highest rank of the benefits selected 137 (90.1%) was gained Allah’s pleasure. About 66 (43.4%) of respondents reported different reasons as barriers;lack of time was the dominant reason for 59 (38.8%). A strong statistical association was found between gender and facing barriers (P-value Conclusions: This study highlighted that the values motivation factor was the highest among the six motivation determinants. The main reason preventing respondents from doing voluntary work was the lack of time. Male gender and Saudi nationality physicians participated more in previous voluntary work P-value < 0.001. Further future research into studying human behaviour towards voluntary work is highly needed.展开更多
Training of emergency physicians through an emergency medicine residency program takes 5 years,that is,3 years in junior residency and 2 years in senior residency.Throughout this period,residents will be exposed to a ...Training of emergency physicians through an emergency medicine residency program takes 5 years,that is,3 years in junior residency and 2 years in senior residency.Throughout this period,residents will be exposed to a variety of educational methodologies and meet a spectrum of faculty,supervisors,and teachers,who will have different personalities,styles,and approaches to teaching and nurturing them.It is important to ensure the maintenance of psychological safety for these residents throughout their training journey and into the future years of practice s an emergency physician.Communications,interactions(which involve questioning),and presentations will be an important part of this training program.This article looks at two modes of questioning:advocacy inquiry and circular questioning,which can be applied as appropriate.These two methods are examples in which faculty may consider adopting in their many interactions,follow-up,feedback,tutorials,facilitation,partnerships,and counseling sessions with residents.These two techniques offer options to maintain psychological safety,which can facilitate learners sharing and opening up.It can be included in the faculty’s armamentarium of questioning techniques and applied where applicable.展开更多
BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation...BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.展开更多
In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous conditi...In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.展开更多
BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patie...BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes,with a newer trend of utilization of endoscopic band ligation(EBL).This study evaluates the outcomes of patients undergoing treatment for nodular GAVE.We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval.AIM To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE.METHODS A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study.The study population was divided between those treated initially with EBL(initial EBL)and initial endoscopic thermal therapy.Pretreatment and post-treatment hemoglobin values,the model for end-stage liver disease scores,hospitalization rates,and other outcomes.Additionally,endoscopic treatment modality type and frequency were recorded,including radiofrequency ablation,argon plasma coagulation,and EBL.Continuous variables were compared using a t-test,while categorical variables were compared using Fisher’s exact.RESULTS Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval(t=7.39,P<0.001),as well as between the number of endoscopic treatments(t=8.09,P<0.001).Hemoglobin levels increased in both the initial EBL group(8.7 vs 11.4,P<0.001)and the initial endoscopic thermal therapy group(8.6 vs 10.4,P=0.042).Clinical remission rates were higher in the initial EBL group(90%vs 69%P=0.041),with a non-significant trend of higher endoscopic remission rates(57.1%vs 37.5%,P=0.270).CONCLUSION The observed trend favoring EBL,combined with its association with improved clinical remission and reduced treatment burden,supports its consideration as a preferred initial treatment approach.展开更多
BACKGROUND There is increasing incidence of alcohol-associated liver disease in females.Despite this recent increased incidence,there is a paucity of research on the clinical course and outcomes of alcohol-associated ...BACKGROUND There is increasing incidence of alcohol-associated liver disease in females.Despite this recent increased incidence,there is a paucity of research on the clinical course and outcomes of alcohol-associated hepatitis(AH)in females compared to males.AIM To assess if there may be sex differences in severity,outcomes,and healthcare utilization for patients hospitalized for AH.METHODS This study used ICD-9-CM and ICD-10-CM codes to retrospectively identify inpatient encounters for AH at the University of Kentucky from 2012-2021 and obtained data on patient demographics and clinical outcomes.Encounters were cohorted by patient sex and differences in patient demographics and clinical outcomes were assessed.Multivariate logistic regression models were constructed to assess risk of mortality,sepsis,and mechanical ventilation during the encounter.RESULTS Of 1386 subjects,511(36.9%)were female and 875(63.1%)were male.Both sexes had similar baseline characteristics of race/ethnicity,discriminant function score,model of end-stage liver disease score,and length of hospital stay.However,the incidence of urinary tract infection,sepsis,and norepinephrine administration was significantly higher for females.Males had a significantly higher incidence of esophageal variceal bleed.On multivariate logistic regression analysis,females had higher odds of encounter sepsis(OR 1.41;95%CI:1.064-1.869)and mechanical ventilation(OR 1.352;95%CI:1.006-1.816).Odds of encounter mortality were significantly increased in encounters with sepsis(OR 2.309;95%CI:1.419-3.757)and mechanical ventilation(OR 9.301;95%CI:5.724-15.114).CONCLUSION This study shows sex-based differences in AH outcomes at the University of Kentucky.Future studies are warranted to assess whether tailoring treatments will improve clinical outcomes in females with AH.展开更多
BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and h...BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia.Despite increasing recognition,its clinical characteristics,risk factors,and outcomes remain poorly defined.The rationale of this review is to provide clinicians an upto-date overview of the most commonly encountered risk factors,triggers,clinical pictures,usual lab values,complications and outcomes,via the systemic analysis of currently published cases.METHODS:A systematic review was conducted using MEDLINE,Web of Science,and Cochrane Library databases through December 2024.Case reports,case series,and conference abstracts involving adult patients with BRASH syndrome were included.Data extraction focused on demographics,clinical presentations,laboratory findings,management strategies,and outcomes.RESULTS:Analysis included 131 patients from 111 published cases.Mean age was(71±13)years,with female predominance(58.1%).Hypertension(77.0%),chronic kidney disease(48.4%),and diabetes mellitus(46.7%)were the most common comorbidities.Beta-blockers were the predominant medication(76.5%).Most common presenting symptoms were syncope(17.9%),generalized weakness(16.2%),and altered mental status(11.9%).Mean potassium level was 6.6 mEq/L,with more than half of cases presenting with non-severe hyperkalemia(<6.5 mEq/L).Management often required multimodal therapy,with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis.CONCLUSION:This systematic review provides the most comprehensive analysis of BRASH syndrome to date,demonstrating that while potentially serious,outcomes are generally favorable with appropriate recognition and management.The syndrome can develop even with modest hyperkalemia,particularly in elderly patients with multiple comorbidities.Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial f...Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial fibrillation(AF),the most common cardiac arrhythmia,is frequently observed in patients with MASLD.While shared metabolic risk factors such as obesity,diabetes,dyslipidemia,and hypertension are implicated,underlying pathophysiological mechanisms that include systemic inflammation,oxidative stress,insulin resistance,endothelial dysfunction,and activation of the renin-angiotensin-aldosterone system(RAAS)are proposed to play significant part in the increased risk of AF in MASLD.The aim is to review the pathogenesis linking MASLD and AF.A comprehensive literature review was conducted,focusing on studies that explore the epidemiology,pathogenesis,and clinical implications of MASLD and AF.Databases searched included PubMed,Scopus,and Web of Science,with keywords such as"metabolic associated steatotic liver disease","non fibrotic metabolic associated steatohepatitis","Nonalcoholic fatty liver disease","metabolic syndrome","atrial fibrillation","antifibrotic therapies","pathogenesis",and"cardiovascular risk".Chronic low-grade inflammation and oxidative stress in MASLD contribute to atrial structural and electrical remodeling,fostering an arrhythmogenic substrate.Insulin resistance,a hallmark of MASLD,exacerbates metabolic dysfunction and promotes atrial fibrosis.Dysregulated lipid metabolism and gut microbiota alterations further compound cardiovascular risk.Aldosterone dysregulation and systemic inflammation stemming from RAAS activation contributes to the shared pathophysiology.The severity of MASLD does not seem to directly influence the risk of AF,suggesting that even early stages of liver disease can increase susceptibility to this arrhythmia.Effective management of MASLD requires targeted risk-factor modification strategies,including weight management,glycemic control,and pharmacological interventions.A multidisciplinary approach is essential for comprehensive assessment and management of MASLD patients,with a focus on cardiovascular risk assessment and arrhythmia prevention.Future research should explore the impact of emerging MASLD therapeutic agents on the incidence and recurrence of cardiac arrhythmias.Early detection and comprehensive management of MASLD and AF are crucial to mitigate the dual burden of these conditions.展开更多
BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imagi...BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imaging in detecting fibrosis and steatosis in this patient population remains unclear.AIM To investigate the correlation between steatosis and fibrosis and abnormal findings on liver imaging in patients with HCV.METHODS We conducted a retrospective cross-sectional analysis of patients with HCV at Grady Liver Clinic who had TE exams between 2018-2019.We analyzed the correlation of controlled attenuation parameter and liver stiffness measurement on TE and abnormal findings on liver imaging.Liver imaging findings(hepatic steatosis,increased echogenicity,cirrhosis,and chronic liver disease)were further evaluated for their diagnostic performance in detecting fibrosis(≥F2,≥F3,≥F4)and steatosis(≥S1,≥S2,≥S3).RESULTS Of 959 HCV patients who underwent TE,651 had liver imaging.Higher controlled attenuation parameter scores were observed in patients with abnormal liver findings(P=0.0050),hepatic steatosis(P<0.0001),and increased echogenicity(P<0.0001).Higher liver stiffness measurement values were also noted in those with abnormal liver(P<0.0001)and increased echogenicity(P=0.0026).Steatosis severity correlated with hepatic steatosis(r=0.195,P<0.001)and increased echogenicity(r=0.209,P<0.001).For fibrosis detection,abnormal liver imaging had moderate sensitivity(81.7%)and specificity(70.4%)for cirrhosis(≥F4),while cirrhosis on imaging had high specificity(99.2%)but low sensitivity(18.3%).Increased echogenicity showed high specificity(92.8%)but low sensitivity(20.9%)for steatosis detection.CONCLUSION Liver imaging detects advanced fibrosis and steatosis but lacks early-stage sensitivity.Integrating TE with imaging may improve evaluation in patients with HCV.展开更多
BACKGROUND Giant cell tumor of bone(GCTB)is a rare,locally aggressive neoplasm that should be treated surgically,whenever possible.This treatment approach may be linked with greater morbidity besides functional impair...BACKGROUND Giant cell tumor of bone(GCTB)is a rare,locally aggressive neoplasm that should be treated surgically,whenever possible.This treatment approach may be linked with greater morbidity besides functional impairment.Denosumab is a human monoclonal antibody.Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB,as it allows local control with a view to downstaging for a more conservative surgical procedure.However,there is no consensus in the literature regarding the optimal denosumab regimen for GCTB.Therefore,a wide discussion of denosumab regimen is necessary.AIM To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB.METHODS A broad and systematic literature search was carried out using the PRISMA guidelines.We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab.Articles with fewer than five patients and in languages except Spanish,Portuguese and English were excluded.Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data.RESULTS 1005 articles were screened,of which 26 articles met the inclusion criteria and were selected,totaling 1742 patients,51.8%women and 48.2%men,with an average of 35 years of age.Treatment with denosumab was associated with high rates of clinical benefit(CB)and imaging response(IR),without changing local recurrence rates when compared to patients treated without denosumab,regardless of the therapeutic regimen adopted and the number of doses applied.The adverse events(AE)presented were mostly mild,with the exception of a malignant transformation to osteosarcoma.CONCLUSION Treatment of GCTB with denosumab is effective,showing high rates of CB and IR.The AE that occurred were mostly mild.We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.展开更多
Current scientific endeavours in the field of geroscience have begun to reveal how factors such as exercise could modulate the brain aging process.In this review,we ask how exercise could potentially modulate aging,an...Current scientific endeavours in the field of geroscience have begun to reveal how factors such as exercise could modulate the brain aging process.In this review,we ask how exercise could potentially modulate aging,and by extension,the development of Alzheimer’s Disease(AD).Furthermore,we discuss how exercise could mitigate the cascade of debilitating manifestations in AD.Mechanistically,we discuss how biomolecules such as brain-derived neurotrophic factor(BDNF)and its cognate receptor,tropomyosin receptor kinase B(TrkB)could change during the life course and how its signalling pathways could be altered with exercise(acute sessions or chronic training).Tackling these questions could help the scientific and medical community mitigate age-related decline in terms of neurological functions.展开更多
Hepatocellular carcinoma(HCC) makes up 75%-85% of all primary liver cancers and is the fourth most common cause of cancer related death worldwide. Chronic liver disease is the most significant risk factor for HCC with...Hepatocellular carcinoma(HCC) makes up 75%-85% of all primary liver cancers and is the fourth most common cause of cancer related death worldwide. Chronic liver disease is the most significant risk factor for HCC with 80%-90% of new cases occurring in the background of cirrhosis. Studies have shown that early diagnosis of HCC through surveillance programs improve prognosis and availability of curative therapies. All patients with cirrhosis and high-risk hepatitis B patients are at risk for HCC and should undergo surveillance. The recommended surveillance modality is abdominal ultrasound(US) given that it is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with non-alcoholic fatty liver disease(NAFLD). With the current obesity epidemic and rise in the prevalence of NAFLD, abdominal computed tomography or magnetic resonance imaging may be indicated as the primary screening modality in these patients. The addition of alpha-fetoprotein to a surveillance regimen is thought to improve the sensitivity of HCC detection.Further investigation of serum biomarkers is needed. Semiannual screening is the suggested surveillance interval. Surveillance for HCC is underutilized and low adherence disproportionately affects certain demographics such as nonCaucasian race and low socioeconomic status.展开更多
Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, ...Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, much emphasis has been placed on studying risk factors for both esophageal and gastric cancers. However, with increasing understanding of these diseases, low survival rates persist and continued intensive studies are necessary to optimize treatment plans. This review article discusses updates in the evolving epidemiology, clinical presentation, risk factors, and diagnostic and treatment modalities of esophageal and gastric cancers.展开更多
基金supported by the Teaching Reform Project of Stomatology College of Chongqing Medical University(KQJ202215,KQJ202204)the Teaching Reform Project of Chongqing Medical University(JY20220317).
文摘As the most critical part of post-graduate education,the Chinese government launched Standard Resident Training in 2013 to solve the regional inequality of medical quality and meet the increasing social requirement for better medical service.We integrated problem-based learning(PBL)and case-based learning(CBL)in the Endodontics Standard Resident Training.By evaluating with objective parameters including theoretical knowledge and clinical practice skill,and subjective parameters including questionnaire,it was found that PBL+CBL played a positive role in endodontic resident training with a significant difference(P<0.05).This combined training model is instructive for China’s resident training,and this result can provide a rudimentary reference to current postgraduate teaching reform.
文摘Objective: To explore the application effect of flipped classroom combined with problem-based learning teaching method in clinical skills teaching of standardized training for resident doctors of traditional Chinese Medicine. Methods: The study used the experimental control method. The study lasted from September to November 2022. The subjects of this study were 49 students of standardized training for resident doctors of traditional Chinese Medicine from grades 2020, 2021 and 2022 of Dazhou integrated TCM & Western Medicine Hospital. They were randomly divided into experiment group (25) and control group (24). The experiment group adopted flipped classroom combined with problem-based learning teaching method, and the control group adopted traditional teaching method. The teaching content was 4 basic clinical skill projects, including four diagnoses of traditional Chinese Medicine, cardiopulmonary resuscitation, dressing change procedure, acupuncture and massage. The evaluation method was carried out by comparing the students’ performance and a self-designed questionnaire was used to investigate the students’ evaluation of the teaching method. Results: The test scores of total scores in the experimental group (90.12 ± 5.89) were all higher than those in the control group (81.47 ± 7.96) (t = 4.53, P P Conclusions: The teaching process of the flipped classroom combined with problem-based learning teaching method is conducive to improving the efficiency of classroom teaching, cultivating students’ self-learning ability, and enhancing students’ willingness to learn.
基金supported by Teaching Reform Project of Stomatology College of Chongqing Medical University(No.KQJ201813).
文摘As an important part of postgraduate education,Standard Resident Training(STR)plays a crucial role in the process of culturing a competent dental care provider who can independently treat the common oral infectious diseases.A systematic and comprehensive evaluation system is desiderating for realization of high-quality Endodontics resident training due to its discipline characteristics of highly specialized and strict operation.This paper analyzes the current status of resident training in our Endodontic Department and discusses how to improve the clinical skills and reasoning ability of residents,in order to construct a comprehensive resident training formative evaluation system in China.
基金Supported by A University of Alabama at Birmingham Department of Pediatrics Founders Fund Grant
文摘AIM To investigate the use of a multidisciplinary,longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis.METHODS A multidisciplinary,multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department.Effectiveness of the simulation for the residents was measured with a pre-and post-test and a reference group not exposed to simulation.A follow up post-test was completed 3-6 mo after the simulation.Nurses completed a survey regarding the education activity.RESULTS Pediatric and medicine-pediatric residents(n=20)and pediatric nurses(n=25)completed the simulation course.Graduating residents(n=16)were used as reference group.Pretest results were similar in the control and intervention group(74%±10%vs 76%±15%,P=0.658).After completing the intervention,participants improved in the immediate post-test in comparison to themselves and the control group(84%±12%post study;P<0.05).The 3-6 mo follow up post-test results demonstrated knowledge decay when compared to their immediate post-test results(78%±14%,P=0.761).Residents and nurses felt the interdisciplinary and longitudinal nature of the simulation helped with learning.CONCLUSION Results suggest a multidisciplinary,longitudinal simulation improves immediate post-intervention knowledge but important knowledge decay occurs,future studies are needed to determine ways to decrease this decay.
文摘Introduction: Volunteering is an unpaid voluntary activity that provides some services to one or more other people or the community at large. Volunteer in the medical field is common. Physicians and medical students are participating in voluntary activities. This study assessed the motivations and barriers of Family Medicine (FM) Residents and Primary Health Care (PHC) Physicians in Qassim Region, Saudi Arabia. Methods: This is a descriptive cross-sectional study was carried out between 12th March 2021 to 31st September 2021 in Qassim Region, Saudi Arabia. 63 FM residents and 89 PHC physicians were involved. A self-administered questionnaire using Volunteer Functions Inventory (VFI) questions was distributed. A 30-item questionnaire is divided into 6 scales of 5 items each, which are scored using a 5-point Likert-type scale (where 1 strongly disagrees and 5 strongly agree). Results: Of 152 FM residents and PHC physicians, 91 (59.9%) were males, and Saudi 90 (59.2%). The mean age was 35 (±SD8.6) years. The majority of respondents 126 (85.7%) participated in different kinds of volunteer work. The highest rank of the benefits selected 137 (90.1%) was gained Allah’s pleasure. About 66 (43.4%) of respondents reported different reasons as barriers;lack of time was the dominant reason for 59 (38.8%). A strong statistical association was found between gender and facing barriers (P-value Conclusions: This study highlighted that the values motivation factor was the highest among the six motivation determinants. The main reason preventing respondents from doing voluntary work was the lack of time. Male gender and Saudi nationality physicians participated more in previous voluntary work P-value < 0.001. Further future research into studying human behaviour towards voluntary work is highly needed.
文摘Training of emergency physicians through an emergency medicine residency program takes 5 years,that is,3 years in junior residency and 2 years in senior residency.Throughout this period,residents will be exposed to a variety of educational methodologies and meet a spectrum of faculty,supervisors,and teachers,who will have different personalities,styles,and approaches to teaching and nurturing them.It is important to ensure the maintenance of psychological safety for these residents throughout their training journey and into the future years of practice s an emergency physician.Communications,interactions(which involve questioning),and presentations will be an important part of this training program.This article looks at two modes of questioning:advocacy inquiry and circular questioning,which can be applied as appropriate.These two methods are examples in which faculty may consider adopting in their many interactions,follow-up,feedback,tutorials,facilitation,partnerships,and counseling sessions with residents.These two techniques offer options to maintain psychological safety,which can facilitate learners sharing and opening up.It can be included in the faculty’s armamentarium of questioning techniques and applied where applicable.
文摘BACKGROUND:Maxillofacial trauma represents a significant challenge in emergency medicine,requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics.The complex anatomy of this region,with its proximity to critical structures,demands a thorough understanding of assessment and management principles.This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma,with particular emphasis on early recognition of critical injuries,airway management strategies,and special population considerations.METHODS:A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases,which focused on maxillofacial trauma management in emergency settings.Articles were selected based on relevance to clinical practice,methodological quality,and current management guidelines.The review synthesized evidence from multiple study types,including original research,systematic reviews,and clinical practice guidelines,to provide practical guidance for emergency physicians.RESULTS:Initial assessment following Advanced Trauma Life Support(ATLS)principles is crucial,with airway management being a primary concern due to the risk of dynamic obstruction.Critical time-sensitive emergencies include orbital compartment syndrome,trapdoor fractures(in pediatric patients),and facial nerve injuries.Computed tomography(CT)imaging remains the gold standard for diagnosis.Special considerations are required for pediatric patients,who present unique anatomical challenges and injury patterns,and for elderly patients,who often have complex medical comorbidities and increased complication risks.Management strategies range from conservative treatment to urgent surgical intervention,with decisions based on the injury pattern and associated complications.CONCLUSION:Emergency physicians must maintain a structured yet fl exible approach to maxillofacial trauma,focusing on early recognition of critical injuries,appropriate airway management,and timely specialist consultation.Understanding injury patterns and their potential complications allows for eff ective risk stratifi cation and treatment planning,ultimately improving patient outcomes.
文摘In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.
文摘BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes,with a newer trend of utilization of endoscopic band ligation(EBL).This study evaluates the outcomes of patients undergoing treatment for nodular GAVE.We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval.AIM To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE.METHODS A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study.The study population was divided between those treated initially with EBL(initial EBL)and initial endoscopic thermal therapy.Pretreatment and post-treatment hemoglobin values,the model for end-stage liver disease scores,hospitalization rates,and other outcomes.Additionally,endoscopic treatment modality type and frequency were recorded,including radiofrequency ablation,argon plasma coagulation,and EBL.Continuous variables were compared using a t-test,while categorical variables were compared using Fisher’s exact.RESULTS Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval(t=7.39,P<0.001),as well as between the number of endoscopic treatments(t=8.09,P<0.001).Hemoglobin levels increased in both the initial EBL group(8.7 vs 11.4,P<0.001)and the initial endoscopic thermal therapy group(8.6 vs 10.4,P=0.042).Clinical remission rates were higher in the initial EBL group(90%vs 69%P=0.041),with a non-significant trend of higher endoscopic remission rates(57.1%vs 37.5%,P=0.270).CONCLUSION The observed trend favoring EBL,combined with its association with improved clinical remission and reduced treatment burden,supports its consideration as a preferred initial treatment approach.
文摘BACKGROUND There is increasing incidence of alcohol-associated liver disease in females.Despite this recent increased incidence,there is a paucity of research on the clinical course and outcomes of alcohol-associated hepatitis(AH)in females compared to males.AIM To assess if there may be sex differences in severity,outcomes,and healthcare utilization for patients hospitalized for AH.METHODS This study used ICD-9-CM and ICD-10-CM codes to retrospectively identify inpatient encounters for AH at the University of Kentucky from 2012-2021 and obtained data on patient demographics and clinical outcomes.Encounters were cohorted by patient sex and differences in patient demographics and clinical outcomes were assessed.Multivariate logistic regression models were constructed to assess risk of mortality,sepsis,and mechanical ventilation during the encounter.RESULTS Of 1386 subjects,511(36.9%)were female and 875(63.1%)were male.Both sexes had similar baseline characteristics of race/ethnicity,discriminant function score,model of end-stage liver disease score,and length of hospital stay.However,the incidence of urinary tract infection,sepsis,and norepinephrine administration was significantly higher for females.Males had a significantly higher incidence of esophageal variceal bleed.On multivariate logistic regression analysis,females had higher odds of encounter sepsis(OR 1.41;95%CI:1.064-1.869)and mechanical ventilation(OR 1.352;95%CI:1.006-1.816).Odds of encounter mortality were significantly increased in encounters with sepsis(OR 2.309;95%CI:1.419-3.757)and mechanical ventilation(OR 9.301;95%CI:5.724-15.114).CONCLUSION This study shows sex-based differences in AH outcomes at the University of Kentucky.Future studies are warranted to assess whether tailoring treatments will improve clinical outcomes in females with AH.
文摘BACKGROUND:BRASH syndrome(Bradycardia,Renal failure,AV nodal blockade,Shock,and Hyperkalemia)is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia.Despite increasing recognition,its clinical characteristics,risk factors,and outcomes remain poorly defined.The rationale of this review is to provide clinicians an upto-date overview of the most commonly encountered risk factors,triggers,clinical pictures,usual lab values,complications and outcomes,via the systemic analysis of currently published cases.METHODS:A systematic review was conducted using MEDLINE,Web of Science,and Cochrane Library databases through December 2024.Case reports,case series,and conference abstracts involving adult patients with BRASH syndrome were included.Data extraction focused on demographics,clinical presentations,laboratory findings,management strategies,and outcomes.RESULTS:Analysis included 131 patients from 111 published cases.Mean age was(71±13)years,with female predominance(58.1%).Hypertension(77.0%),chronic kidney disease(48.4%),and diabetes mellitus(46.7%)were the most common comorbidities.Beta-blockers were the predominant medication(76.5%).Most common presenting symptoms were syncope(17.9%),generalized weakness(16.2%),and altered mental status(11.9%).Mean potassium level was 6.6 mEq/L,with more than half of cases presenting with non-severe hyperkalemia(<6.5 mEq/L).Management often required multimodal therapy,with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis.CONCLUSION:This systematic review provides the most comprehensive analysis of BRASH syndrome to date,demonstrating that while potentially serious,outcomes are generally favorable with appropriate recognition and management.The syndrome can develop even with modest hyperkalemia,particularly in elderly patients with multiple comorbidities.Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial fibrillation(AF),the most common cardiac arrhythmia,is frequently observed in patients with MASLD.While shared metabolic risk factors such as obesity,diabetes,dyslipidemia,and hypertension are implicated,underlying pathophysiological mechanisms that include systemic inflammation,oxidative stress,insulin resistance,endothelial dysfunction,and activation of the renin-angiotensin-aldosterone system(RAAS)are proposed to play significant part in the increased risk of AF in MASLD.The aim is to review the pathogenesis linking MASLD and AF.A comprehensive literature review was conducted,focusing on studies that explore the epidemiology,pathogenesis,and clinical implications of MASLD and AF.Databases searched included PubMed,Scopus,and Web of Science,with keywords such as"metabolic associated steatotic liver disease","non fibrotic metabolic associated steatohepatitis","Nonalcoholic fatty liver disease","metabolic syndrome","atrial fibrillation","antifibrotic therapies","pathogenesis",and"cardiovascular risk".Chronic low-grade inflammation and oxidative stress in MASLD contribute to atrial structural and electrical remodeling,fostering an arrhythmogenic substrate.Insulin resistance,a hallmark of MASLD,exacerbates metabolic dysfunction and promotes atrial fibrosis.Dysregulated lipid metabolism and gut microbiota alterations further compound cardiovascular risk.Aldosterone dysregulation and systemic inflammation stemming from RAAS activation contributes to the shared pathophysiology.The severity of MASLD does not seem to directly influence the risk of AF,suggesting that even early stages of liver disease can increase susceptibility to this arrhythmia.Effective management of MASLD requires targeted risk-factor modification strategies,including weight management,glycemic control,and pharmacological interventions.A multidisciplinary approach is essential for comprehensive assessment and management of MASLD patients,with a focus on cardiovascular risk assessment and arrhythmia prevention.Future research should explore the impact of emerging MASLD therapeutic agents on the incidence and recurrence of cardiac arrhythmias.Early detection and comprehensive management of MASLD and AF are crucial to mitigate the dual burden of these conditions.
文摘BACKGROUND Liver imaging and transient elastography(TE)are both tools used to assess liver fibrosis and steatosis among people with hepatitis C virus(HCV)infection.However,the diagnostic accuracy of conventional imaging in detecting fibrosis and steatosis in this patient population remains unclear.AIM To investigate the correlation between steatosis and fibrosis and abnormal findings on liver imaging in patients with HCV.METHODS We conducted a retrospective cross-sectional analysis of patients with HCV at Grady Liver Clinic who had TE exams between 2018-2019.We analyzed the correlation of controlled attenuation parameter and liver stiffness measurement on TE and abnormal findings on liver imaging.Liver imaging findings(hepatic steatosis,increased echogenicity,cirrhosis,and chronic liver disease)were further evaluated for their diagnostic performance in detecting fibrosis(≥F2,≥F3,≥F4)and steatosis(≥S1,≥S2,≥S3).RESULTS Of 959 HCV patients who underwent TE,651 had liver imaging.Higher controlled attenuation parameter scores were observed in patients with abnormal liver findings(P=0.0050),hepatic steatosis(P<0.0001),and increased echogenicity(P<0.0001).Higher liver stiffness measurement values were also noted in those with abnormal liver(P<0.0001)and increased echogenicity(P=0.0026).Steatosis severity correlated with hepatic steatosis(r=0.195,P<0.001)and increased echogenicity(r=0.209,P<0.001).For fibrosis detection,abnormal liver imaging had moderate sensitivity(81.7%)and specificity(70.4%)for cirrhosis(≥F4),while cirrhosis on imaging had high specificity(99.2%)but low sensitivity(18.3%).Increased echogenicity showed high specificity(92.8%)but low sensitivity(20.9%)for steatosis detection.CONCLUSION Liver imaging detects advanced fibrosis and steatosis but lacks early-stage sensitivity.Integrating TE with imaging may improve evaluation in patients with HCV.
文摘BACKGROUND Giant cell tumor of bone(GCTB)is a rare,locally aggressive neoplasm that should be treated surgically,whenever possible.This treatment approach may be linked with greater morbidity besides functional impairment.Denosumab is a human monoclonal antibody.Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB,as it allows local control with a view to downstaging for a more conservative surgical procedure.However,there is no consensus in the literature regarding the optimal denosumab regimen for GCTB.Therefore,a wide discussion of denosumab regimen is necessary.AIM To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB.METHODS A broad and systematic literature search was carried out using the PRISMA guidelines.We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab.Articles with fewer than five patients and in languages except Spanish,Portuguese and English were excluded.Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data.RESULTS 1005 articles were screened,of which 26 articles met the inclusion criteria and were selected,totaling 1742 patients,51.8%women and 48.2%men,with an average of 35 years of age.Treatment with denosumab was associated with high rates of clinical benefit(CB)and imaging response(IR),without changing local recurrence rates when compared to patients treated without denosumab,regardless of the therapeutic regimen adopted and the number of doses applied.The adverse events(AE)presented were mostly mild,with the exception of a malignant transformation to osteosarcoma.CONCLUSION Treatment of GCTB with denosumab is effective,showing high rates of CB and IR.The AE that occurred were mostly mild.We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.
文摘Current scientific endeavours in the field of geroscience have begun to reveal how factors such as exercise could modulate the brain aging process.In this review,we ask how exercise could potentially modulate aging,and by extension,the development of Alzheimer’s Disease(AD).Furthermore,we discuss how exercise could mitigate the cascade of debilitating manifestations in AD.Mechanistically,we discuss how biomolecules such as brain-derived neurotrophic factor(BDNF)and its cognate receptor,tropomyosin receptor kinase B(TrkB)could change during the life course and how its signalling pathways could be altered with exercise(acute sessions or chronic training).Tackling these questions could help the scientific and medical community mitigate age-related decline in terms of neurological functions.
文摘Hepatocellular carcinoma(HCC) makes up 75%-85% of all primary liver cancers and is the fourth most common cause of cancer related death worldwide. Chronic liver disease is the most significant risk factor for HCC with 80%-90% of new cases occurring in the background of cirrhosis. Studies have shown that early diagnosis of HCC through surveillance programs improve prognosis and availability of curative therapies. All patients with cirrhosis and high-risk hepatitis B patients are at risk for HCC and should undergo surveillance. The recommended surveillance modality is abdominal ultrasound(US) given that it is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with non-alcoholic fatty liver disease(NAFLD). With the current obesity epidemic and rise in the prevalence of NAFLD, abdominal computed tomography or magnetic resonance imaging may be indicated as the primary screening modality in these patients. The addition of alpha-fetoprotein to a surveillance regimen is thought to improve the sensitivity of HCC detection.Further investigation of serum biomarkers is needed. Semiannual screening is the suggested surveillance interval. Surveillance for HCC is underutilized and low adherence disproportionately affects certain demographics such as nonCaucasian race and low socioeconomic status.
文摘Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, much emphasis has been placed on studying risk factors for both esophageal and gastric cancers. However, with increasing understanding of these diseases, low survival rates persist and continued intensive studies are necessary to optimize treatment plans. This review article discusses updates in the evolving epidemiology, clinical presentation, risk factors, and diagnostic and treatment modalities of esophageal and gastric cancers.
