Objective To assess the effect of problem-based learning (PBL) versus traditional methods in nursing students. Methods Computer retrieval was conducted to search for controlled studies comparing PBL and traditional methods. The quality of included studies was critically evaluated and data were analyzed by using The Cochrane Collaboration’s RevMan 5.0 software. Results A tota1 of 321 articles were retrieved, but only l1 were included. Metaanalyses showed that there was no significant difference between PBL and traditional methods in the objective knowledge of nursing students (SMD 0.12, 95%CI -0.32 to 0.56, P=0.6gt;0.05); but PBL was superior to traditional methods in the training of critical thinking (WMD 11.52, 95%CI 6.29 to 16.74), conflict resolution skills (WMD 8.09, 95%CI 5.02 to 11.16), clinical problem-solving skills (WMD 0.43, 95%CI 0.22 to 0.64), and communication skills (WMD 1.56, 95%CI 0.17 to 2.95). Although no significant difference was identified in the training of clinical decision-making skills, collaborative skills, and self-directed learning skills, PBL tended to be superior to traditional methods. Conclusion PBL tends are associated with better learning results among nursing students compared with traditional methods. However, most trials included in the review were of low quality, so large-scale randomized controlled trials of higher quality are needed to confirm this.
ObjectiveTo evaluate the efficacy and safety of bronchoscope in the treatment of transbronchial broncholiths.MethodsThe clinical data, treatment methods, clinical efficacy and complications of 18 patients who were diagnosed with transbronchial broncholiths were etrospectively reviewed in the Respiratory Department of the Second Hospital of Lanzhou University during January 2010 to December 2017.ResultsEighteen patients were diagnosed by bronchoscopy with a total of 22 pieces of stone for transbronchial broncholiths. An elective surgical procedure was performed in 2 cases. Six cases were treated with removing broncholiths once by foreign body forceps under bronchoscope. Repeated treatments were performed in 10 patients. Two cases underwent massive hemorrhage in the process of one-time broncholiths removal by foreign body forceps under bronchoscope, and one case suffered from bronchial fistula after the broncholiths removal, all of the above 3 patients underwent surgical treatment. All patients were followed up for 5 months without any long-term complications.ConclusionsRemoval of broncholithiasis by bronchoscopic forceps can effectively treat transbronchial broncholiths with low complication and high safety. If the broncholiths cause severe distal lung tissue injury, massive hemoptysis, bronchial fistula, or the diagnosis is unclear, surgical treatment is required. When the transbronchial broncholith is difficult to remove completely at once, batch could be chosen. First, to remove one portion which causes the obstruction of airway; and then, to remove the left part of the transbronchial broncholith by stages.
ObjectiveTo explore a new method of treating serious tibiofibula comminuted fracture by using three-dimensional (3-D) printing personalized external fixator. MethodsIn April 2015, a male patient (aged 18 years with a height of 171 cm and a weight of 67 kg) with left tibiofibula comminuted fracture was included in the study. Computer-assisted reduction technique combined with 3-D printing was used to develop a customised personalized external fixator for fracture reduction. The effectiveness was observed. ResultsThe operation time was about 10 minutes without fluoroscopy, and successful reduction was obtained. The patient had equal limb length after operation. X-ray films showed that the posterior angulation of distal fracture was corrected 37°, and the eversion angle was corrected 4°. The tibial fractures had good paraposition or alignment, and the lower limb force line was corrected completely. No new fracture displacement occurred. The clinical healing time of fracture was 3.5 months and the bone union was achieved after 8 months. The function of affected limb recovered well after operation. ConclusionA personalized external fixator for serious tibiofibula comminuted fracture reduction made by 3-D printing technique has the merits of easy manipulation, high individuation, accurate reduction, stable fixation, and no need of fluoroscopy.
ObjectiveTo evaluate the effectiveness of three-dimensional (3D) printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis to treat maliganant bone tumors around the knee. MethodsBetween March 2007 and September 2014, 43 patients with malignant tumor around the knee were divided into 2 groups: 3D printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis were used in 21 cases (trial group), and conventional tumor resection and reconstruction with hinged total knee prosthesis were used in 22 cases (control group). There was no significant difference in age, gender, tumor location, pathological diagnosis, tumor stage, diameter of tumor, disease duration, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05), which were comparable. Intraoperative length of tumor resection and blood loss were recorded and compared, and the postoperative complications and tumor recurrence were observed. The Musculoskeletal Tumor Society (MSTS) score was used to evaluate knee joint function. ResultsThe operations were completed successfully in the patients of 2 groups and postoperative pathological results were negative in tumor resection margin. All the patients were followed up 12-77 months (mean, 36.7 months). There was no significant difference in the length of tumor resection and blood loss between trial group and control group (t=1.01, P=0.32; t=-0.76, P=0.45). In trial group, the resection range and reconstruction results were consistent with preoperative computer simulation; postoperative complications happened in 2 cases (9.52%); 1 case of immunological rejection and 1 case of infection); 2 cases (9.52%) had recurrence of osteosarcoma and pulmonary metastasis at 1 year after operation. In the control group, complication occurred in 6 cases (27.27%; 2 cases of periprosthetic fractures, 2 cases of infection, 1 case of incision nonunion, and 1 case of common peroneal nerve injury); 4 cases (18.18%) had recurrence of osteosarcoma and metastasis at 1 year after operation. There was no significant difference in postoperative complication and recurrence rate between 2 groups (χ2=2.24, P=0.14;χ2=0.67, P=0.41). At last follow-up, distal femur score of tumor and proximal tibial score of tumor in trial group were significantly better than those in control group (t=4.89, P=0.00; t=3.94, P=0.00). The mean flexion and extension range of motion of the knee joint was (115.45±12.25)° in trial group and was (101.49±11.96)° in control group, showing significant difference (t=3.78, P=0.00). ConclusionThe effectiveness using 3D printing navigation templates assisting reconstruction with personalized unrestricted prosthesis for maliganant bone tumors around the knee is better than conventional tumor resection and reconstruction with hinged total knee prosthesis. It can improve the joint function better and the patients' quality of life.
0bjective To evaluate the efficacy of FEV6 and FEV1／FEV6 as surrogates for FVC and FEV1／FVC in the spirometric diagnosis of airway obstruction，and to determine the fixed cut-off point of FEV1／FEV6 which can be used as an alternative for FEV1／FVC lt; 70％.Methods Spirometry measurements were perform ed in 128 participants．FEV1，FEV6，FVC，FEV1％pred，FVC％pred，FEV1／FVC and FEV1／FEV6 were measured and analyzed.FEV1／FVClt;70％ was used as the“gold standard”。Severity of obstruction was based on FEV ％ pred．From ROC curve analysis，the FEV1／FEV6 ratio，which corresponded to optimal combination of sensitivity and specificity，was determined．Correlation between FEV1／FVC and FEV1／FEV6 was studied．Results Of 128 participants，there were 65(51％)with FEV1／FVC ≥70％ ．Of the 63 participants with FEV1／FVC lt;70％ ，there were 5 with FEV1／FEV6 between 70.09％ to 71％。There was no significant difference between the mean value of FVC and that of FEV ．Lifear correlation was revealed between FEV1／FVC and FEV1／FEV6 with the value close to 1(r=0.9979，Plt;0.0001)．From ROC curve analysis，the FEV1／FEV6lt;71.14％ was the best cut-off point coresponding to FEV1／FVC lt;70％ ．Conclusion These results suggest that FEV1／FEV6 is a valid alternative to FEV1／FVC for spirometric diagnosis of airw ay obstruction．There is a b corelation between FEV1／FEV6 and FEV1／FVC．
Objective To evaluate the effectiveness of precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with external fixator. Methods Twenty-six cases of tibial angulation deformity combined with shortening deformity were treated between June 2012 and August 2016, including 12 males and 14 females aged from 1 to 19 years with an average age of 16.5 years. There were 6 cases of congenital patella pseudoarthrosis, 1 case of fibrous dysplasia of femur and tibia, 3 cases of limb shortening deformity caused by infantile paralysis, 16 cases of fracture malunion. Limb shortening was 1.5-9.5 cm (mean, 6.2 cm) before operation. The deformity from three-dimensional perspective was analysed by digital technology, the surgical procedures of lengthening and osteotomy was simulated, the navigation templates were completed with computer aided design (CAD) and three-dimensional printing, and the external fixator was used to assist the lengthening of the tibia. X-ray films were regularly reviewed after operation to observe the new bone remolding, limb lengthening, load bearing line of lower limb, and recurrences of angulation. Results All the patients were followed up 14-48 months (mean, 18.8 months). There was only 1 case of superficial pin site infection which was cured with oral antibiotics and pin site care with mild disinfectants, and no complication such as bone nonunion, equines deformity, or vascular nerve injury occurred. The deformity of tibia and load bearing line of lower limb had been completely recovered according to postoperative X-ray films at 1 week. All the cases achieved perfect limb length as with preoperative design. The bone mineralization time was 12-20 weeks (mean, 11.6 weeks), the external fixator removal time was 18-26 weeks (mean, 14.9 weeks), and the healing index was 21-78 d/cm (mean, 63.4 d/cm). The postoperative flexion range of the injured limb was 15° less than the unaffected extremity in 1 case, and the situation was improved significantly after some physical manipulation and exercise, who completed the limb lengthening and achieved the expected effectiveness finally. Conclusion Precise orthormorphia of tibial deformity by using digital technology, and limb lengthening with the aid of external fixator can achieve good effectiveness with good reliability, invasiveness, and precision.
Objective To investigate the value of computer-aided design (CAD) in defining the resection boundary, reconstructing the pelvis and hip in patients with pelvis tumors. Methods Between November 2006 and April 2009, 5 cases of pelvis tumors were treated surgically using CAD technology. There were 3 males and 2 females with an average age of 36.4 years (range, 24-62 years). The cause was osteosarcoma, giant cell tumor of bone, and angiosarcoma in 1 case, respectively,and chondrosarcoma in 2 cases. According to the Enneking system for staging benign and mal ignant musculoskeletal tumors, regions I, I + II, III, IV, and I + IV is in 1 case, respectively. According to the principle of reverse engineering, 5 patients with pelvis tumors were checked with lamellar CT/MRI scanning, whose two-dimensional data were obtained in disease area. The three-dimensional reconstruction of pelvic anatomical model, precise resection boundary of tumor, individual surgical template, individual prosthesis, and surgical simulation were precisely made by computer with CAD software. Based on the proposal of CAD, the bone tumor was resected accurately, and allograft il ium with internal fixation instrument or allogeneic il ium with personal ized prosthetic replacement were used to reconstruct the bone defect after tumor was resected. Results The operation was successfully performed in 5 cases. The average operation time was 7.9 hours, and the average blood loss was 3 125 mL. Hemorrhage and cerebrospinal fluid leakage occurred in 1 case, respectively, and were cured after debridement. Five patients were followed up from 24 to 50 months (mean, 34.5 months). All patients began non-weight bearing walk with double crutches at 4-6 weeks after operation, and began walk at 3-6 months after operation. Local recurrence developed in 2 patients at 18 months after operation, and resection and radiotherapy were performed. According to International Society of Limb Salvage criteria for curative effectiveness of bone tumor l imb salvage, the results were excellent in 2 and good in 3. Conclusion The individual surgical template, individual prosthesis, and surgical simulation by CAD ensure the precision and rel iabil ity of pelvis tumors resection. The CAD technology promotes pelvis tumor resection and the reconstruction of pelvis to individual treatment stage, and good curative effectiveness can be obtained.
Objective To investigate the prevalence of depression in patients with chronic obstructive pulmonary disease ( COPD) and risk factors. Methods 215 patients with stable COPD were recruited in the study. The Patient Health Questionnaire-9 ( PHQ-9) standardized scale were performed for the depression survey. Meanwhile CAT, pulmonary function test and the history taking ( sex, age, height, weigh, smoking status, education level) were applied to evaluate all the COPD patients. The COPD patients were classified into A, B, C, and D groups according to 2011 GOLD new COPD classification system. Pearson chi-square test and multivariate logistic modeling were used to estimate the prevalence of depression and the risk factors. Results The prevalence of depression in COPD patients whose PHQ-9 scores ≥7 was 37.7% with 18.5% , 35.8% , 46.5% , and 62.5% respectively in A, B, C, and D groups. There was significant difference in prevalence between each groups ( Plt;0.05) . Compared with the COPD patients without depression, the COPD patients with depression had younger age, more female, higher education level, higher CAT scores and smaller means of body mass index ( BMI) . Logistic analysis revealed that depression in COPD was associated with age, sex, education level, BMI, FEV1% pred and CAT scores. The patients who with younger age, female sex, higher education level, lower FEV1% pred, lower BMI and higher CAT scores were had higher rsik to be complicated with depression. However no significant difference was observed between different FEV1 /FVC or smoking status. Conclusions This study confirms the high prevalence of depression in patients with stable COPD, and the prevalence in A, B, C, and D groups of COPD are different. Sex, age, education level, FEV1% pred, BMI, and CAT scores are the risk factors of depression in COPD.