To investigate the microsurgical management of cranionasal tumors and the method of the reconstruction of the skull base. Methods From June 2005 to October 2007, 20 patients with cranionasal tumor were treated. There were 10 males and 10 females, aged between 13 and 77 years (median 49 years). The disease course was 2 months to 13 years.The cranionasal tumors, proved by MRI and CT scans, located in the anterior skull base, paranasal sinus, nasal and/or orbit cavity. And their cl inical presentations were l isted as follows: dysosphresia in 14 patients, headache in 11 patients, nasal obstruction in 9 patients, epistaxis in 8 patients, visual disorder in 4 patients, exophthalmos in 4 patients and conscious disturbance in 2 patients. All 20 patients underwent transbasal surgery combined with transnasal surgery, and tumors were resected by one-stage operation. The skull base was reconstructed by surgical technique “Pull Down Sandwich” with pedicle periosteum flap. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Pathological examination showed 8 cases of mal ignant tumors and 12 cases of benign tumors. The total surgical excision was complete in 16 patients, and 4 patients with subtotal excision. There was no operative death. Eighteen patients were followed up 3 months to 2 years and 6 months. Transient cerebrospinal fluid rhinorrhea was found in 2 cases which were cured by lumbar drainage. And recurrence of tumor was observed in 5 patients 3 months to 2 years after operation. Conclusion Microsurgical operation via subfrontal approach assisted bytransnasal endoscopy is an effective method in management of cranionasal tumors, with the advantages of econstruction of the skull base with pedicle periosteum flap or “Pull Down Sandwich” and low compl ication rate.
目的 分析当前医患沟通学课程教学中存在的问题，探索提高教学质量的有效途径。 方法 2011年12月－2012年1月通过收集相关文献及实际教学中有关医患沟通的事例，对医患沟通中存在的问题进行归类梳理，并针对各结症提出解决措施及建议。 结果 目前国内医患沟通学教学中存在以下问题：医学生对医患沟通学课程不够重视；缺乏系统的教学质量考评体系；医患沟通学课程的理论与实践课学时比例缺乏科学的设置标准；教学方式、课程开设对象等不统一。 结论 要提高医患沟通学教学质量，其提高医学生对沟通能力重要性的认识是前提，建立健全医患沟通学课程的教学模式和考核体系是关键，为学生构建早期接触临床实践的平台是保障。
Objective To seek the best evidence on communication between physicians and patients so as to improve the physician-patient relationship in China. Methods We used the key words ‘physician-patient relationship’ and ‘communication’ to identify related systematic reviews and meta-analyses, and then evaluated them with the Overview Quality Assessment Questionnaire (OQAQ) checklist. Results Seventeen studies were included for final evaluation. According to the OQAQ checklist, the score range of the study quality was 3 to 9. 41.29% (7/17) of the included studies scored 7 to 9, 23.5% (4/17) scored 6, and 35.3% (6/17) scored 3 to 5. Factors influencing physician-patient communication primarily included communication targets, time, contents, and approaches. Conclusion There are not enough studies on physician-patient communication in China. We need to identify the problems affecting communication behavior, encourage patients to express their preferences, choose appropriate training strategies, and make timely evaluation so as to better satisfy the needs of patients and physicians.
本文通过总结护士与老年患者进行一般性沟通和治疗性沟通的临床护理经验,提出改善临床护患沟通的重要性和意义,旨在增进老年病房护士的临床沟通技巧,适应不断增长的老年患者服务需求,提高老年病房护理质量。
ObjectiveVideo electroencephalography (VEEG) monitoring for health education of elderly patients based on a process-based communication model, and explore the impact of this model on the success rate, negative emotions, nursing satisfaction, and active cooperation rate of such patients.MethodsFrom September 2017 to September 2019, 118 patients with suspected epilepsy, encephalitis and other diseases who required VEEG monitoring in Suining Central Hospital were selected for this study (patients aged 61 to 73 years; 54 males and 64 females). Patients were divided into 2 groups using a random number table method, 59 patients in each group.A group received routine nursing, and B group received health education based on the process communication model. The monitoring success rate, negative emotion, active cooperation rate, and nursing satisfaction were compared between the two groups.ResultsThe total effective rate in the B group was 86.44%, which was significantly higher than 76.27% in the A group (P<0.05). After nursing intervention, the scores of anxiety and depression in the two groups were significantly decreased, but the decline was greater in the B group (P<0.05). The active cooperation rate and nursing satisfaction of the B group were significantly higher than those of the A group (P<0.05).ConclusionCompared with conventional nursing, health education based on process communication mode can significantly improve the success rate of VEEG monitoring in elderly patients, alleviate the negative emotions of patients, improve the active cooperation rate and nursing satisfaction.
ObjectiveTo discuss the present situation of emergency physicians' communicational ability and the intervention measures. MethodsWe investigated 66 students who participated in continuing medical education of "emergency physicians' communication skills training course" from 2010 to 2013. All students accepted systematic training. After the training, we did the investigation again, and then made a comparison before and after the training. ResultsA major 78.8% of the students in this training had never taken part in the training of communication skills before; 51.5% of the students thought that the improvement of communication ability could be achieved mainly through long-term accumulation of clinical experiences. Students' self-evaluation showed that communication problem occurred 2 times a year in 10.6% of them, 3 times in 22.7%, 4 times in 24.2%, and five or more times in 34.8%. Students' role playing score in the scenario training rose from 5.374±0.686 to 6.717±0.517 after the training, and the difference was statistically significant (P=0.024). ConclusionEmergency physicians lack knowledge of communication skills which needs to be improved. Through training, the skills can be improved significantly.