Objective:To explore the model of first aid skills training based on competition.Method:The second-year residents who participated in the competition in 2021 ( n = 142) were selected. According to whether they attended BLS training in the first year, they were divided into group A ( n = 88) who attended BLS training and group B ( n = 54) who did not. Chi-square test, T test, Wilcoxon rank sum test and Logistic regression were used in our study. Results:There was no significant difference in gender and specialty between both groups (female, 62.5% vs. 68.5%, P= 0.466; TCM, 50% vs. 53.7%, P= 0.668), but the real resuscitation experience of group A was more than that of group B (40.9% vs. 9.3%, P= 0.000). The qualified rate of CPR and the compression score in group A was higher than that in group B [(81.8% vs. 61.1%, P = 0.006; (30±5) vs. (25 ±10), P= 0.001], including compression frequency, depth, rebound and compression/respiration rate (73.9% vs. 55.6%, P= 0.024; 88.6% vs. 70.4%, P= 0.006; 96.6% vs. 87%, P= 0.031). In the theoretical examination, the correct rates of electrocardiogram [(53.63±2.9)% vs. (50.44±2.57)%] and first aid medication [(57.38±3.55)%, P = 0.001] in the two groups were significantly lower than the qualified rate. After adjusting other factors, Logistic regression analysis showed that the CPR qualification rate in group A was 2.769 times higher than that in group B ( P= 0.015, 95% CI 1.215~6.311) Conclusions:The first aid skills training mode based on competition can objectively reflect first aid skills level of residents. We found that the quality of CPR skills was not related to gender, specialty and real CPR experiences but experience of BLS training was an independent influencing factor. And how to identify and manage arrhythmias and how to choose different emergency drugs are urgent emergency skills for residents to improve.

目的 通过住院医师问卷调查,查找住院医师规范化培训(简称住培)招收工作存在的问题并提出对策,为进一步完善我国住培制度提供决策参考.方法 依托国家级住培基地,对全国28个省市的部分2020年住院医师进行线上问卷调查,调查内容涵盖住院医师基本情况、招收信息获取、培训基地和专业填报、招收考试情况、对招收工作的评价以及期望.结果 59.48％的住院医师未专门了解过培训基地的相关信息;69.23％和83.98％ 的住院医师分别填报了1家培训基地、1个专业,90.37％和84.71％的住院医师希望可以填报2家及以上培训基地、专业;14.72％的住院医师表示没有参加笔试,没有参加技能考试和面试的比例分别为33.13％和23.92％;94.27％的住院医师认为目前的住培招收工作是公平的;52.79％的住院医师希望有机会可以去外省心仪的培训基地学习;86.98％的住院医师支持建设全国统一的招收信息平台.结论 为进一步完善住培招收工作,建议设立全国统一的住培招收信息平台、允许住院医师填报多个平行志愿、开展全国统一的住培招收笔试考试.

目的 从住院医师和临床医学硕士专业学位研究生两类培训对象角度,以岗位胜任力为导向,调查医教协同政策实施后北京市住院医师规范化培训的效果.方法 对已完成2016—2019年住院医师规范化培训并参与结业考试的培训对象的基本情况、培训完成情况和培训能力提高情况等进行问卷调查.结果 2019年参与北京市住院医师规范化培训效果调查的3084名对象中66.67％为住院医师,33.33％为临床医学专业硕士学位研究生.经过住院医师规范化培训,两类培训对象的各项能力都有所改善,其中职业素养改善效果最显著,培训效果呈现显著差异,住院医师的整体培训效果优于临床医学硕士专业学位研究生;影响两类培训对象培训效果的因素无显著差异.结论 医教协同政策实施后,建议进一步探索更加满足两类培训对象不同需求的住院医师规范化培训模式,进一步提高住院医师规范化培训同质化.

目的 探讨临床医学硕士专业学位研究生培养与住院医师规范化培训双轨合一的培养模式中存在的问题及解决思路.方法 对204名学员、26名导师进行问卷调查,提出现存问题及解决思路.结果 学员对带教培训、能力考核、行政管理、培训效果的满意度均大于80％,对薪资待遇的满意度为63.72％.硕士专业学位研究生满意度普遍低于住培学员.50％的学员认为超负荷工作或经常加班.导师认为培养方案、专硕生源等方面存在问题.结论 建议完善专硕培养的相关政策及制度、优化培养方案;进一步提高生源质量;充分发挥导师指导作用;完善医院教学质量评价体系;建立完整的教学奖惩体系.

了解美国联邦医疗保险对毕业后医学教育的投入机制,为我国下一步建立稳定的住院医师规范化培训投入机制提供参考.通过文献综述,对美国毕业后医学教育经费来源和美国联邦医疗保险资助毕业后医学教育的政策演变、经费补助方式、成本分析、面临的挑战等进行了详细分析.美国联邦政府是毕业后医学教育最主要的资金提供者,其中大部分资金来自联邦医疗保险.联邦医疗保险通过复杂的公式计算,从两个方面对住院医师规范化培训进行经费补助:直接和间接医疗费用,每年补助近100亿美元.我国应完善住院医师规范化培训补助机制,在保持目前的投入基础上,探索由医疗保险向培训医院支付更高比例的医疗费,以间接弥补医院对住培工作的投入,确保培训工作健康、可持续发展.

Objective The mechanism of acute rejection after tracheal transplantation remains unclear.Orthotopic tracheal transplantation model is technically challenging,and difficult to be widely adopted.In this study,a heterotopic tracheal transplantation model in rat was used to simulate acute rejection after transplantation,establishing a simple but effective animal model.Methods This work was performed from May 2017 to July 2017.SD and Wistar rats were selected for both syngeneic and allogeneic heterotopic tracheal transplantations.The average time and success rate of tracheal transplantation were calculated.Trachea was enclosed with omentum through an abdominal incision.The implants were harvested on postoperative day 1,3,7 and 14,hematoxylin and eosin (HE) staining was used to compare the infiltration of inflammatory cells at each time point,descriptive statistics were done afterwards.Results Thirty-one heterotopic tracheal transplantations were performed successfully,and one died of accidental anesthesia.All tracheal grafts from the 8 donors were obtained within 10 min,the procedure of heterotopic tracheal transplantation spent an average of (6.0 ± 1.8) min.There was no graft infection or other failure.The overall success rate was 96.9％.There was much more omentum wrapping the allograft than the isograft.HE staining indicated that infiltration of inflammatory cells in allograft gradually aggravated over time,and the tracheal wall was damaged progressively.Conclusion The heterotopic tracheal transplantation model in rat is simple but effective,has been verified to present typical pathological changes of acute rejection and would be suitable for the study of immune response after transplantation.

目的 肿瘤的局部复发和远处转移是非小细胞肺癌(non-small cell lung cancer,NSCLC)治疗失败和死亡的最主要原因.本研究评价与NSCLC患者复发/转移后生存时间(postrecurrence survival,PRS)和总生存率(overall survival,OS)相关的临床病理因素.方法 回顾性分析2005-01-01-2011-12-31于中日友好医院胸外科行肺叶切除+纵隔淋巴结清除的160例NSCLC患者临床资料及随访资料,病理分期为p I A～ⅢA期且经过随访均发生局部复发或者远处转移,应用SPSS 20.0对资料进行统计分析.应用Kaplan-Meier曲线及Cox回归对根治性切除术后OS和PRS相关风险因素进行分析.结果 160例患者平均年龄62岁,其中鳞癌41例,腺癌101例,其他类型NSCLC 18例(腺鳞癌11例,大细胞癌7例).随访终点43例发生局部复发,93例发生远处转移,24例同时发生局部复发和远处转.入组患者中位生存时间45个月;复发/转移后中位生存时间20个月.单因素分析结果显示,性别、TNM分期和复发/转移与OS有相关性,P＜0.05;年龄、吸烟指数、吸烟史、病理类型、淋巴血管浸润、复发/转移时间≤12个月、复发转移时间≤24个月、术后有无(放)化疗以及复发后有无治疗亦与OS具有相关性,P＜0.01.多因素分析结果显示,年龄(HR=0.23,95％CI:0.14～0.38,P＜0.01)、吸烟指数(HR=11.28,95％CI:2.53～50.26,P＜0.01)、TNM分期(HR=1.50,95％CI:1.08～2.07,P＜0.05)、复发时间≤24个月(HR=0.31,95％CI:0.16～0.60,P＜0.01)、术后有无放化疗(HR=0.82,95％CI:0.68～0.99,P＜0.05)、复发后有无治疗(HR=1.40,95％CI:1.24～1.58,P＜0.01)为影响OS的独立危险因素.单因素分析结果显示,年龄、吸烟指数、病理类型、TNM分期、术后有无(放)化疗和复发后有无治疗与PRS有相关性,P＜0.01;复发/转移亦与PRS有相关性,P＜0.05.多因素分析结果显示,年龄(HR=0.26,95％CI:0.18～0.45,P＜0.01)、吸烟指数(HR=1.73,95％CI:1.12～2.68,P＜0.05)、术后有无(放)化疗(HR=0.77,95％CI:0.66～0.91,P＜0.01)、复发后有无治疗(HR=1.36,95％CI:1.22～1.52,P＜0.01)为影响PRS的独立危险因素.结论 NSCLC患者OS和PRS与多个因素密切相关,其中术后早期(≤24个月)发生复发/转移的患者预后较差;复发/转移后治疗可以显著改善患者的OS与PRS.

目的:评估不同纵隔淋巴结清扫方式对早期非小细胞肺癌预后的影响.方法:回顾性分析563例临床Ⅰ期非小细胞肺癌患者临床数据.结果:入组患者200例患者行叶特异性淋巴结清扫;363例患者行系统性淋巴结清扫.与系统性淋巴结清扫相比,叶特异性淋巴结清扫组清扫纵隔淋巴结个数较少(9.84±8.55 vs 13.09±9.31,P＜0.01);发生多站N2淋巴结转移较少(15.8％ vs 55.7％,P＜0.01);局部复发率(12.0％ vs 6.6％,P＜0.05)和远处转移率(28％ Vs 18.2％,P＜0.01)较高;但多因素分析显示淋巴结清扫方式并不是局部复发率和远处转移率的独立风险因素(P＞0.05);2组比较所有入组患者生存率和不同肿瘤大小生存率均无统计学差异.结论:叶特异性淋巴结清扫具有与系统性淋巴结清扫相一致的肿瘤治疗效果,可以在早期非小细胞肺癌范围内进行推广.