In light of the unfulfilled docking of the previous curriculum system of clinical medicine science specialty in higher vocational colleges and with the requirement of being a first-line physician,we put forward our reform sketch for Clinical Medicine Transboundary Curriculum System targeting at fostering technical and skilled genius that will be qualified for the post of clinical physician in primary heahh-care institution,following the principle of quality-first,capability-centered and knowledge-based and attempting to establish a unified system combining quality,capability and knowledge,and analyze the difficulty during the implementation of the reform ideas and measures that could be taken.In this way,it will be possible for us to comprehensively dock curriculum initiatives with the capability of the post,curriculum content with professional criteria,professional teaching with clinical applications,vocational education and lifelong study,and hence,it will be helpful for us to foster qualified genius for first-line medical institution.

Objective To detect the renal reserve in senility and deduce the clinic significance.Methods The glomerular filtration rate and filtration fraction were measured in 43 healthy citizens before and after infusion 18-amino acid to investigate the renal functional reserve.Results Before infusion the amino acid,the range of GFR basal value of senile persons was(58～101)ml/min 1.73m 2 mean value was(76?8.5)ml/min 1.73m 2.And after the amino acid infusion,the GFR value was (65～128)ml/min 1.73m 2,mean value was (103?8.1)ml/min 1.73m 2,there was obviously elevation (P

Objective To study the effects on tissue CT number caused by scan protocols.Methods The phantom was repeatedly scanned in different protocols by changing only one of parameters,such as X-ray tube voltage,mAs and recon kernel,while other parameters were ketp unchanged.The CT number of different materials in phantom were measured and analyzed.Results The CT numbers of tissues changed remarkably with the tube voltage and had different relativity for different tissues.The CT numbers had positive correlation with kV for such maierials as polyethyle,lexan,perspex,but for teflon the correlation was negative.The mAs and recon kernel had no effects on CT number.Conclusions The CT number of tissue changes with scanning X-ray tube voltage,so the setting of scan parameters should be taken into account in image diagnosis and radiotherapy.

Objective:To investigate the workload of extracorporeal membrane oxygen(ECMO) patients, estimate the number of hours of care based on the amount of nursing work, and to analyze the status of human resources, improve the quality of care and the effect of nursing.Methods:The Nursing Activity Assessment Scale was used to evaluate the daily workload of ECMO patients in the Intensive Care Unit of Zhejiang Province People′s Hospital, and the relevant factors affecting the workload were analyzed.Results:The average daily workload of ECMO patients was (76.06 ± 7.23) points, the daily nurse care ECMO patients time was 10.31 h, and the number of ideal nurses who needed to participate directly in the daily patients was 2.28. The workload was related to age, whether heparin and vasoactive drugs were used, and prognosis( t values were -3.184-7.291, P<0.05 or 0.01). Conclusions:The workload of ECMO patients is relatively large. At this stage, the ratio of nurse to patient is reasonable in our hospital. The patients′ age, use the heparin, vasoactive drugs and prognosis affect the level of nursing workload of ECMO patients.

Objective:To explore the effect and nursing experience of vein-artery extracorporeal membrane oxygenation (V-A-ECMO) combined with continuous renal replacement therapy(CRRT) in the treatment of fulminant myocarditis.Methods:From January 2014 to October 2019, 15 cases of fulminant myocarditis were treated by V-A-ECMO combined with CRRT in the department of critical care medicine of Zhejiang People′s Hospital. During the operation of V-A-ECMO combined with CRRT, heart rate, blood pressure, coagulation function, troponin, creatinine and other indicators were closely monitored, strict liquid management and extracorporeal circulation pipeline management were implemented, and various complications such as arrhythmia, hypotension, bleeding and acral circulation disorder were timely observed and treated.Results:After 48 hours of treatment with V-A-ECMO and CRRT, the troponin value, lactic acid and creatinine of the patients were (21.53 ± 3.19) μg/L, (2.24 ± 0.37) mmol/L, and (58.13 ± 2.41) μmol/L, which were significantly lower than the start of the machine (79.65 ± 6.08) μg/L, (7.65 ± 1.28) mmol/L, (185.24 ± 5.63) μmol/L, the difference were statistically significant ( t values were -32.784, -15.726, -80.386, P<0.01), except for one dead patient, the left ventricular ejection fraction was significantly increased, reaching 45%-55% within 72 hours, and the left ventricular systolic and diastolic function was normal. Among the 13 patients who successfully withdrew the machine, 11 were cured, 3 were discharged automatically and 1 died. The success rate of withdrawing the machine was 86.67% and the cure rate was 73.33%. Conclusions:V-A-ECMO combined with CRRT can effectively improve cardiac renal function, maintain the stability of internal environment and improve the survival rate of patients. High-quality nursing can effectively improve the healing of patients, clinical need to continue to summarize the relevant nursing experience, improve the level of nursing, prevent various complications, improve the success rate of treatment, promote the recovery of patients.

Objective:To explore the effects of multifunctional butterfly-shaped chassis ostomy bag for faeces drainage in incontinence-associated dermatitis (IAD) .Methods:From January to September 2019, this study selected 84 fecal incontinence patients with IAD of Intensive Care Unit in Zhejiang Provincial People's Hospital by convenient sampling. All of patients were divided into observation group ( n=42) and control group ( n=42) with the method of random number table. Control group carried out the IAD skin management trilogy combined with the common ostomy bag, while observation group implemented the IAD skin management trilogy combined with the multifunctional butterfly-shaped chassis ostomy bag. We compared the overall effective rate of treatment for IAD, nursing time of nurses for IAD, average retention time, average use time and replacement frequency of ostomy bag, family members satisfaction of patients between two groups. Results:The overall effective rate of treatment for IAD in observation group was 95.24% (40/42) higher than that 73.81% (31/42) in control group with a statistical difference ( P<0.05) . The nursing time and retention time of observation group was (1.89±0.32) h/d and (5.2±0.4) days per person respectively shorter than those [ (5.73±1.64) h/d and (9.4±1.2) days per person] of control group with statistical differences ( P<0.05) . The use time of observation group was (98.27±12.18) hours per bag longer than that (72.18±4.63) hours per bag of control group with a statistical difference ( P<0.05) . The replacement frequency of observation group was (1.20±0.10) times per person also statistically less than that [ (3.10±0.70) times per person] of control group ( P<0.05) . Family members satisfaction of observation group was significantly higher than that of control group ( P<0.05) . Conclusions:Compared with traditional ostomy bag, the multifunctional butterfly-shaped chassis ostomy bag has effective treatments for IAD can shorten the nursing time for IAD, lengthen the use time of ostomy bag, reduce the average retention time and replacement frequency and improve family members satisfaction which can be widely used in clinical application.

Objective:To explore the effects of early goal-directed mobilization (EGDM) in rehabilitation of patients after cardiac surgery.Methods:Totally 200 patients admitted into ICU after cardiac surgery in Zhejiang Provincial People's Hospital were selected. A total of 100 patients admitted between January and April 2019 were included into the control group who received routine care, while 100 patients admitted from May to August 2019 were included into the observation group received EGDM on this basis. The postoperative rehabilitation indicators (indwelling time of tracheal intubation, time of first exhaust, time of admission to ICU, complication cases) and satisfaction before transferring to ICU were compared between the two groups of patients.Results:The indwelling time of tracheal intubation, time of first exhaust and time of admission to ICU was (25.93±2.42) h, (28.44±1.62) h and (38.63±4.91) h in the observation group, which were shorter than that in the control group, and the difference was statistically significant ( t=45.932, 78.464, 32.702; P<0.01) ; the incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant ( P<0.05) ; before transferring to ICU, the patient satisfaction of the observation group was (57.58±1.15) , while that of the control group was (49.32±1.26) , and the difference was statistically significant ( t=-48.420, P< 0.01) . Conclusions:EGDM is conducive to the early recovery of patients after cardiac surgery and can improve patient satisfaction.

OBJECTIVETo study the relationship between compliance with anti-hypertension therapy and assessment of quality of health care in hypertensive patients in community.

METHODSAccording to multi-stage cluster random sampling, we selected two communities from 36 streets in certain areas of Shanghai respectively using random number method on May, 2013, 72 communities in total, then we randomly selected 25 patients who were archived in the community health center from each community of the street.We conducted 1 800 questionnaires in total in which 1 172 patients were under medication study. The Morisky Medication Adherence Scale was used to evaluate medication compliance while the Patient Assessment of Chronic Illness Care Scale was applied to measuring the quality of patient's self-reported health service. The Spearman rank correlation analysis was used to evaluate the relationship between assessment of quality of health care for chronic illness and compliance with anti-hypertension therapy. Binary logistic analysis was applied to evaluate the factors which influenced patient's medicine compliance.

RESULTSThere were 567(48.4%) respondents with good compliance. Age less than or equal to 65 accounted for 43.3% (245 people) while age greater than 65 accounted for 56.7% (321 people). The average scores of total and difference dimensions remained at a low level, ranging from 1.97 to 2.67 out of 5. The Assessment of quality of health care score was (2.67 ± 1.33)scores, in which the highest score of the dimensions was patient activation which was (2.56 ± 1.41)scores and the lowest was follow-up / collaboration which was (1.97 ± 1.49)scores. The Spearman rank correlation analysis showed that negative association between accumulate points of patient medicine compliance and patient activation was found (rs = -0.09, P < 0.01). The result of binary logistic analysis indicated that medication adherence of age greater than 65 was 1.49 times (95%CI: 1.11-2.00) higher than age less than or equal to 65. The patient activation was a protective factors of good medicine adherence (OR = 1.35, 95%CI:1.14-1.59).

CONCLUSIONSThe medicine adherence of hypertension patients in community medication compliance is not very good at the moment. The self-rated quality of health care is still relative poor. Positive activation from interaction of physicians and patients can help enhancing patient's medicine compliance.

Objective: To study clinical and pathologic characteristics of leiomyomas of the gastrointestinal tract, and to investigate the distribution characteristics of interstitial cells of Cajal ( ICCs ) in gastrointestinal leiomyomas. Methods: One hundred and forty-seven cases of leiomyomas of gastrointestinal tract were collected at the Second Affiliated Hospital of Zhengzhou University from June 2012 to June 2017. Clinical and pathologic findings were analyzed, combined with immunohistochemistry, Alcian blue-osafranin staining and molecular study. Results: The age of patients ranged from 13-82 years with mean age of 52 years. Male to female ratio was about 1∶2. Histologically, all tumors were composed of ovoid to spindle cells arranged in short intersecting fascicles. All tumors were diffusely and strongly positive for smooth muscle antibodies, desmin and h-caldesmon by immunohistochemical staining. A prominent interspersed subpopulation of elongated/dendritic-like cells with CD117 and DOG1 positivity (accounting for 1% to 30% of all tumor cells) and negative for Alcian blue-osafranin staining was identified in all esophageal leiomyomas, 16 of 20 (80%) gastric leiomyomas and 3 of 12 small bowel leiomyomas, but none in colonic/rectal leiomyomas. Mutational analysis in 16 cases showed absence of mutation in exons 9, 11, 13 or 17 of C-KIT and exons 12 or 18 of PDGFRA. Conclusions ICCs are identified in esophageal and gastric leiomyomas, as well as in small percentage of intestinal leiomyomas. Such findings may bring significant diagnostic pitfalls for misdiagnosis as gastrointestinal stromal tumor. Careful attention to the distribution of CD117 and DOG1 positive cells and molecular mutation analysis of C-KIT and PDGFRA may be necessary to establish the correct diagnosis.

Objective To explore the situation and question of standardized training of residents/graduate students in cardiac surgery by questionnaire survey. Methods From September 2010 to May 2012, 61 resident physicians/graduate students were chosen as research objects in Department of Cardiac Surgery, Peking University Third Hospital. A total of 61 questionnaires were sent out, with a recovery rate of 100%,and an effective rate of 95.1%.The contents of investigation included standardized training content design, standardized training management, the time and"environment" pressure, compliance training effect analysis,student opinion and others,a total of 14 options.EpiData 2.1a software was used to sort and record the data. SPSS 17.0 software was used for statistical analysis. The enumeration data were compared by chi square test.Results During the period of training,the most expected teaching method was"small lecture", accounting for 63.8%; The most difficult part of the process of cardiac surgery training was "postoperative care", accounting for 69%; 100% of the trainees thought that it would be helpful for future work through cardiac training;8.3% of the trainees thought the teachers of cardiac surgery teaching consciousness was not strong; resident weekend "in the hospital" was higher than the proportion of graduate students, and most graduate students chose weekend "in the experiment and research work", the difference was statistically significant (P<0.05). Conclusion Appropriate standardized training program should be combined with the students' background; Teaching team construction and clinical reasonable and effective clinical skills train-ing system is an important link to ensure the quality of teaching.The combination of residents' standardized training and postgraduate education of professional degree remains to be tracked and evaluated in a long time.The feedback from all aspects of the training should be paid more attention to,and the training details should be improved.