Under the background of resident standardization training pilot in Zhejiang province , this paper put forward the scheme of resident doctors standardization training and teacher training for the first time .This paper an-alyzed the necessity of medical ethics education in teacher training and standardization training and the requirements of teacher training in ethical education and ways for ethical education .Carrying out medical ethics education not only improves teachers'medical ethics knowledge , but also let them master the medical ethics teaching methods and skills.

Objective:To explore the application value of case-based learning (CBL) and problem-based learning (PBL) dual-track teaching mode in the standardized resident training in laboratory medicine.Methods:The students of Grade 2017 and Grade 2018, who underwent standardized resident training of laboratory medicine in the Second Affiliated Hospital of Wenzhou Medical University from September 2017 to June 2021, were selected in this study. Seven students of Grade 2017 were served as the traditional lecture teaching group (traditional teaching group), and 12 students of Grade 2018 were assigned to the CBL-PBL dual-track teaching mode group (CBL-PBL group). Students of the two groups received 22 months of laboratory specialty training, and underwent one admission theory assessment,two mid-term theory assessments, annual professional level test, final theory assessment, final practical skills assessment as well as questionnaire survey. The questionnaire was distributed and finished anonymously after the final assessment. Survey indicators included ability assessment on solving clinical problem, assessment on the theoretical knowledge, computer operation skill, preparation time before teaching, teaching method satisfaction degree and clinical recognition. The results were divided into 5 categories: extremely agree, agree, general, disagree and extremely disagree, respectively (ranked as 5, 4, 3, 2, and 1). The Cronbach′s α coefficient was used to analyze the reliability of the questionnaire.Results:The mid-term theory assessment, annual professional level test and assessment results of clinical outcome interpretation were significantly higher in CBL-PBL dual-track teaching mode group than those in traditional lecture teaching group (all P<0.05). The performance after standardized resident training was significantly higher in the CBL-PBL group than in the traditional teaching group ( P<0.05). The Cronbach′s α coefficient of questionnaire reliability analysis was 0.938. Parameters assessment results including improved clinical problem-solving skills, computer operation skill, the ability to analyze and solve problems, the ability of innovation and adaptation, the learning interest, the ability of autonomous learning, teaching method satisfaction and conventional application to clinical recognition scores were all significantly better in the CBL-PBL group than those in the traditional teaching group (all P<0.05). Conclusion:The application of CBL-PBL dual-track teaching mode for the standardized resident training in laboratory medicine can effectively improve the assessment results and performance of students undergoing standardized resident training, and help to cultivate high quality medical laboratory professionals.

Objective:To investigate the impact of overweight/obesity on postoperative complications in breast reduction surgery.Methods:A retrospective study was conducted on patients who underwent breast reduction surgery in our hospital from 2016 to 2022. Basic patient information and postoperative complications, such as poor wound healing, infection, hematoma, nipple necrosis, etc., were collected. Patients were categorized into normal/low weight group and overweight/obese group according to their body mass index (BMI). The differences in postoperative complications between the two groups were compared and statistically analyzed.Results:The study included 82 patients, 48 in the normal/low weight group and 34 in the overweight/obese group. The gender, age, and surgical methods of the two groups of patients were relatively balanced, and there was no statistical difference. However, the incidence of postoperative complications was 50.0% (17/34) in overweight/obeseitg group, higher than 18.8% (9/48) in normal/low weight group. Common complications included delayed healing such as infection or dehiscence in 8 cases (9.8%), skin necrosis in 5 cases (6.1%), and hypertrophic scars in 5 cases (6.1%). The incidence of skin necrosis and delayed healing in the overweight/obese group was higher than that in the normal/low weight group, but the difference was not statistically significant ( P>0.05). Postoperative hematoma and hypertrophic scars occurred in both groups, while fat liquefaction and thrombosis only occurred in the overweight/obese group. Conclusions:Overweight/obesity is an important risk factor for postoperative complications in breast reduction surgery. Patients should be evaluated before surgery, and necessary measures should be taken to reduce the risk of complications.

Objective:To evaluate the analgesic effects of lidocaine cream and ice application during botulinum toxin type A treatment on bilateral gastrocnemius hypertrophy.Methods:A retrospective study was conducted, including 60 patients who underwent botulinum toxin type A treatment for bilateral gastrocnemius hypertrophy at Peking University Shenzhen Hospital from January 2020 to January 2022. Patients were divided into two groups based on the analgesic methods: lidocaine surface anesthesia group (lidocaine group, 30 cases) and ice application analgesia group (ice group, 30 cases). The lidocaine group consisted of 2 males and 28 females, with a mean age of (27.0±5.0) years, while the ice group consisted of 30 females, with a mean age of (26.2±4.4) years. Depending on individual needs, 100-200 U of botulinum toxin type A was injected into the calf muscle of each patient. In the lidocaine group, nurses applied lidocaine cream to the injection area and covered it with a film before injection. In the ice group, nurses used custom-made ice packs to surround the injection site for 10 minutes. Pain levels were assessed using the visual analog scale (VAS) during injection, including pain scores for needle puncture and drug injection. The incidence of postoperative adverse reactions and patient satisfaction rates were also recorded.Results:The VAS score for needle puncture pain was (2.60±1.25) in the lidocaine group and (2.30±1.12) in the ice group, with no statistically significant difference ( P=0.331). However, the VAS score for drug injection pain was significantly higher in the lidocaine group (3.47±1.25) than that in the ice group (2.77±1.28, P=0.036). The overall analgesic VAS score was (3.37±1.16) in the lidocaine group, also significantly higher than that (2.60±1.25) in the ice group ( P=0.017). Two patients in the lidocaine group experienced localized swelling, and one reported localized itching with a rash, while no adverse reactions were observed in the ice group. Patient satisfaction rates were 86.7% (26/30) in the lidocaine group and 93.3% (28/30) in the ice group. Conclusions:Ice application provides superior analgesic effects compared to lidocaine cream surface anesthesia during botulinum toxin type A treatment for bilateral gastrocnemius hypertrophy.

Objective:To observe the effects of early energy intake and early enteral nutrition on prognosis of patients during extracorporeal membrane oxygenation (ECMO).Methods:Patients who received ECMO treatment in the emergency intensive care unit (EICU) of the Jiangsu Provincial Hospital (First Affiliated Hospital of Nanjing Medical University) from January 2021 to June 2022 were selected as subjects to summarize the early energy intake of ECMO patients. Logistic regression analysis and restricted cubic spline (RCS) analysis were used to determine the relationship between early energy intake and prognosis of ECMO patients. According to the results of RCS analysis, the patients were divided into energy-deficient group and energy-sufficient group. And according to whether early enteral nutrition (EEN) was initiated, the patients were divided into EEN group and non-EEN group. The differences of clinical outcomes between energy-deficient group and energy-sufficient group, EEN group and non-EEN group were compared.Results:There was no significant difference in age, sex, BMI, primary disease and ECMO pattern between energy-deficient group and energy-sufficient group, EEN group and non-EEN group. The ECMO conversion time (days) and hospitalization time (days) in the energy-deficient group were significantly lower than those in the energy-sufficient group, and the survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group [43.2% (19/44) vs. 66.0% (31/47), P=0.029]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group, and the risk of death was 2.595 times higher than that in the energy-sufficient group. The conversion time (days), hospital stay (days) and average daily energy intake [kcal/(kg·d)] in the EEN group were higher than those in the non-EEN group ( P<0.05), and the survival rate in the non-EEN group was significantly higher than that in the non-EEN group [66.1% (41/62) vs. 31.0% (9/29), P<0.002]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the non-EEN group was significantly lower than that in the EEN group, and the risk of death was 2.981 times higher than that in the EEN group ( P<0.001). Conclusions:The energy intake of patients with ECMO above 16.94 kcal/ (kg·d) is a protective factor for prognosis. EEN helps to increase early energy intake and improve prognosis in patients during ECMO.