Three-dimensional imaging of spiral CT diagnosis of maxillofacial fractures in the clinical value
[Abstract] Objective To study the three-dimensional reconstruction of spiral CT diagnosis of maxillofacial fractures in the clinical value and significance. Methods Retrospective analysis of our hospital in January 2006 ~ January 2010 helical CT scanning and post-processing techniques MPR and SSD reconstruction of 50 patients with maxillofacial fractures in patients with imaging data. Results 50 patients were scanned by spiral CT axial images were found in 67 fractures, spiral CT scan images with the image post-processing can be found 80 fractures, 13 missing, missed diagnosis rate of 16.25%. Conclusion The three-dimensional reconstruction of multislice spiral CT technology can be solid, intuitive, a clear indication of maxillofacial bone fractures, to improve the diagnostic accuracy for clinical treatment provide strong guidance, has important clinical value.
[Key words] facial fractures; multi-slice spiral CT; MPR; SSD.
In recent years, the incidence of maxillofacial fracture increased, the anatomical structure of the maxillofacial complex, accurately determine the fracture site, type, shape and size, the shift in guiding the clinical treatment of such great value and significance. In recent years, spiral CT three-dimensional imaging technique (MPR and SSD reconstruction) has been widely used in the diagnosis of maxillofacial bone fractures for clinical treatment of a more convenient and intuitive imaging data [1]. This retrospective analysis of our hospital in January 2006 ~ January 2010 helical CT scanning and post-processing techniques MPR and SSD reconstruction of 50 patients with maxillofacial fractures in patients with CT imaging data, are reported below.
1 Materials and Methods.
1.1 General information.
Our hospital in January 2006 ~ January 2010 were treated 50 cases of patients with maxillofacial fractures, including 39 males and 11 females. Aged 9 to 65 years, mean 40.8 years old. Cause of his injuries: 24 cases of road accident, injured in 12 cases, 7 cases of fall injuries, bruises in 4 cases, 3 cases of other causes. The main clinical manifestations of pain, maxillofacial soft tissue swelling, trismus and so on.
1.2 Instruments and methods.
1.2.1 Instruments Toshiba Astioen4 using spiral CT scan machine.
Scan parameters: slice thickness 1mm, layer from the 1mm, the voltage 140kV, current 120mA, pitch (pitch) 1.35:1, non-continuous scanning interval.
1.2.2 check methods in patients with supine position, the first advanced scanning include 3cm from the superior orbital margin to the lower edge of the mandible 3cm, scanning multi-planar reconstruction after (MPR) and shaded surface display (SSD) technologies such as post-processing analysis. MPR soft tissue window and bone window were observed, and arbitrary orientation imaging, the world is the best imaging study The liver stores the image, reconstruction thickness of 3mm; shaded surface display threshold limit in the 150 ~ 250HU, select the features cutting removal of excess part of the organization, according to any of the lesions display rotation to select the best image storage.
2 results.
50 patients were scanned by spiral CT axial images were found in 67 fractures, spiral CT scan images with the image post-processing can be found 80 fractures, 13 missing, missed diagnosis rate of 16.25%. Three-dimensional reconstruction of spiral CT images clearly show the direct three-dimensional anatomy of mandibular fractures and its relationship with the surrounding structure, accurately show the fracture location, extent, direction of fracture fragment displacement, three-dimensional distance. 50 cases of single fractures in 11 cases, 39 cases of multiple fracture; on 21 cases of jaw fractures, mandible fractures in 29 cases. Cases of mandibular fracture, 4 cases were diagnosed 11 or associated with condylar fractures, of which 3 were the first by two-dimensional CT of mandibular lateral films and not diagnosed, after a rotation angle, confirmed to the hat lateral shift, and because no significant displacement of condyle, the surgeon took a conservative treatment.
3 discussions.
Maxillofacial complex anatomical structures, including nasal bone, lacrimal bone, maxilla, palatine bone, cheekbones and so on. In recent years, increased the rate of traffic accidents, the incidence of maxillofacial fractures is also increasing year by year [2].
Ordinary X-ray films can not accurately show the number of fractures, displacement as well as the location of fracture, clinical application has some limitations. Axial CT images of ordinary Although there is no duplication of facial structures, the lesions showed a significant increase, but the lack of three-dimensional, visual images, for some level of fracture parallel to the scan is still missing [3]. The group axial, MPR data, 50 patients with 80 fractures, axial display 67, missing 13, missed diagnosis rate of 16.25%, the direction of the horizontal line of multi-fracture line, and the case for many parts of complex fractures. MPR reconstruction, including coronal, sagittal, any slope and any surface reconstruction, axial images with the same two-dimensional spatial resolution and density resolution. Its technical parameters by adjusting the window width and window level to switch between the soft tissue window and bone window showed bone lesions in the same time, can clearly show the damage to surrounding soft tissue lesions, such as soft tissue thickening, swelling, product gas, hemorrhage, or open soft tissue injury (Cover Figure 1) [4]. However, only two-dimensional CT images show the plane of a level of bone damage, clinicians using two-dimensional CT diagnosis of plain film there will be errors, it is difficult to establish three-dimensional thinking, the lesion may have some deviations, which might affect the determination of treatment . MPR images show all the fracture group, diagnostic accuracy rate of 100%, no case of missed diagnosis. Studies have also confirmed that the orbital wall, orbital floor and the deep structures such as sieve plate, nasal septum, sphenoid greater wing of the fractures, CT is superior to CT two-dimensional image reconstruction [5].
SSD reconstruction stereoscopic imaging space (Cover Figure 2), can be an excellent show the structure of fractures, especially in three-dimensional structure of overlap between the location of the facial bone fractures, range and surrounding structures adjacent to the relations ( as shown from many angles condyle and glenoid fossa of the spatial relationship), degree of fracture displacement, direction, bone fragments film location, size, number, etc., especially to the whole paper format irregular fracture line clearly shows the abnormal Traveling to improve on the diagnostic accuracy of facial bone fractures [6]. Kreipke so that Lefortil fracture of two-dimensional X-ray and CT showed the fracture line is not well, and three-dimensional CT can directly display the fracture line of the fracture section of the situation and take the line shift for clinical treatment provides a reliable basis . CT three-dimensional reconstruction of another prominent advantage of condylar fractures in the display, can be observed from any point of the lesion, clearly shows the type of condylar fracture, fracture fragment displacement direction, distance and spatial location, the orientation of the articular surface, lower jaw Ramus bone ends move up the range, and the temporomandibular joint fossa relationship between space, representing two-dimensional CT images closer to the real anatomy of the human body structure, to avoid the subjective imagination of the process of understanding differences caused by the misdiagnosis. The group, 29 cases of mandibular fracture cases, 4 cases were diagnosed 11 or accompanied by condylar fractures, 3 cases of mandibular first by two-dimensional CT lateral films and not diagnosed, after a rotation angle, proved to be dislocation shift to the inside, and because no significant displacement of condyle, the surgeon took a conservative treatment.
In summary, the application of multi-slice spiral CT three-dimensional reconstruction technology, intuitive, a clear indication of maxillofacial bone fractures, to improve the diagnostic accuracy for clinical treatment provide strong guidance, has important clinical value.
Pharmacy undergraduate process of hospital pharmacy practice
Abstract: Objective To introduce undergraduate pharmacy practice in our hospital pharmacy process; Methods pharmacy undergraduate interns internship process, develop a detailed training specifications; has trained pharmacists to assume duties in the hospital pharmacy pharmacy graduates; Conclusion The established internship training process specification process and practical.
Keywords: Pharmacy education; practice; process; pharmacy
With the proposed concept of pharmaceutical care, pharmacy responsible for drug use patterns, that is, hospitals and community pharmacies the pharmacist has undergone major changes in work content. Pharmacists are no longer just a simple swap the functions of play, in fact, pharmacists in monitoring drug therapy is playing an increasing role, especially in adverse drug reaction monitoring and reporting of events to play a role [1]. This change to the teaching content and mode of Pharmacy created a new demand. Particular phase of the teaching practice before graduation related to the effectiveness of Pharmaceutical Education.
Pharmacy graduates of government for medicines management, production, circulation, use of links, with the development of society, other non-public medical institutions and pharmaceutical related industries such as health, health care, rehabilitation, counseling, insurance industry has become a pharmaceutical graduate jobs Health and employment areas. According to incomplete statistics [2], 1994 -1998 National Pharmacy professional graduates, only 10% of staying in school or further education, 8% in research institutes and Drug Control, up to 36% of the graduates to the hospital pharmacy, 19% of the pharmaceutical companies, 10% in the pharmaceutical distribution business. 1999 and 2000 and the proportion of hospital pharmacy graduates has declined about 24%, pharmaceutical companies increased to 28%, 14% of pharmaceutical distribution companies, staying in school or further education still 11%. Graduates can be seen in a larger proportion of the hospital pharmacy. How to regulate the pharmacy undergraduate students under the new situation in the hospital pharmacy internship process, cultivate a competent job drug use qualified people to work as top priority.
A comprehensive understanding of the workflow.
In our current evaluation system, job title, work after 1 year of graduation to take the examination, the examination may be granted by qualified pharmacists. Therefore, the undergraduate students in the attachment phase of the hospital should have a complete understanding of medicine and families familiar with the work flow. After 1 year of work to achieve the requirements and capabilities of pharmacists. Pharmacists at medical institutions should have the capacity requirements [3], the purpose should be achieved during the internship are the following: familiarity outpatient, emergency ward pharmacy, pharmaceutical information and consulting services to pharmaceutical and other departments of the duties, job content, work procedures and the job responsibilities. Initial grasp of drug procurement and supply management procedures and technical requirements; narcotic drugs, psychotropic substances, toxic drugs for medical use management; pharmaceutical information and drugs advisory services. Understanding of parenteral nutrition solution and deployment of intravenous drug use against drugs Room job responsibilities; commonly used name of the drug, pharmacological action, clinical application, usage, dosage and precautions; validity of the management of drugs commonly used; drug classification management principles and related policies and regulations; Hospital agents commonly used preparation, major equipment; rational drug use principles and safety monitoring methods, a preliminary knowledge of the prevention of medication errors; a preliminary understanding of clinical drug treatment program design and evaluation capacity; individualized regimens; clinical pharmacokinetics and bioavailability Degree; with the drug research and analysis, suggestions for improvement of knowledge.
2 reasonable arrangements for training time.
Our School of Pharmacy Practice times from the beginning in January, the end of May, except Spring Festival holiday, thesis defense, a total of 15 weeks internship. Some schools start from November to the end of the second year in March, except for Chinese New Year holiday, a total of 14 weeks, the remaining time to look for work. Pharmacy in the 80 to 90 years Undergraduates time is generally 1 year, and now the arrangements for each school is different. The authors found that the actual teaching for undergraduates practice time should be 1 year, in fact, the last one year under the semester most students find a job, find work in some of the units required by the employer to training, a considerable part of the students need Practice point turn, to stay a part-time students free reign. Therefore, effective training for about 24 weeks, all pharmacy students to understand.
3 to establish a standardized training process.
3.1 penetration Professional Ethics.
Day 1 vocational, professional ethics, the contents of this less contact in the classroom, there is no specific explanation. Found in the practice of teaching in the students for the future work of the whereabouts of the contents of the work is not covered by a general concept, for their love and the future direction of development is very vague and did not really understand the nature of the pharmacy, looking down on pharmacies and so on. Therefore, we arranged to work four hours to explain the direction.
Professional ethics should be involved in the attachment phase, these things do not study, students generally do not have the warning line, the work in the future staff relations and physician-patient relationship in the treatment will appear on bias. I Department of Pharmacy, the larger hospital, most of pharmacy are involved. We are prepared, including pharmaceutical research, pharmaceutical production, supply, pharmacy files of four parts of the code of ethics, to students focusing on the four hours.
3.2 a comprehensive understanding of training content.
1 to 5 weeks, 5 weeks lead time is to understand the work of the herbs Division. Respectively, to the clinic, ward pharmacy, medical supply store, drug testing, preparation room to rotate in various departments, each department is about 1 week. Familiar in all sectors relevant laws, regulations, industry standards, rules and regulations of various departments and so on. Understand the daily work and process. Arrangements with the teacher to teach in under the chores that help to know the contents of departments.
3.3 to strengthen the depth of practice.
6 to 13 weeks, after the last phase of the internship, the students of pharmaceutical preparations, testing, supply and drug use have to understand the process. We love the student's future direction with the students choose an internship at this stage sector. Outpatient ward progress of pharmacy practice: the first 6 weeks, understanding prescriptions, prescription management program to continue and read the familiar name of the drug package insert. Section 7-8 weeks, following the deployment of teachers by prescription, dispensing. Week 9, following the emergency window with mentor to learn daily routines and the management of toxic psychotropic drugs anesthesia 10 weeks, following pharmacists for prescriptions, study reviewed prescription. 11 weeks, following the pharmacists dispensing the window, studying the patient's medication guide. No. 12,13 weeks, and the daily work of collecting pharmacy records of problems and related data, the summary for the next stage of preparation. Pharmacy-related topics, including a lot of content, such as: adverse drug reaction to the collection, analysis; drug inventory management; Analysis and drug withdrawal; prescription common error analysis.
The progress of preparation room practice: the first 6 weeks, management procedures and familiar with pharmaceutical GMP requirements. Section 7-8 weeks, followed with a teacher in the preparation of topical formulations. 9,10 weeks, followed with a teacher in the preparation of oral preparations. No. 11,12 weeks, following the preparation of traditional Chinese medicine preparation of teaching in the teacher. The first 13 weeks, familiar with common technical operation, job responsibilities, fill out all registration forms, understand the hospital preparation works of major equipment, operation and maintenance. Progress in doping control room practice: the first 6 weeks of various formulations are familiar with USP General requirements. Week 7, followed by preparation with a General Education teacher test preparation materials.
The first 8,9 weeks, following the teacher in learning traditional Chinese medicine with TLC method. 10 weeks, learning to follow the teacher in pharmaceutical content with UV method. 11 weeks, learning to follow the teacher in pharmaceutical content with high performance liquid method. No. 12,13 weeks, following the study drugs with a teacher in High Performance Liquid Method for Determination.
Laboratory Practice schedule: in the laboratory is engaged in scientific research departments, research projects generally have teachers to guide students with the education part of the research topic. Teachers should select the topic of teaching in the basic part, together with the students start from the experimental design, experimental materials, preparation, start the experiment, experimental writing records, data sorting, data statistics, summary of thesis. Test content should be as simple as possible to complete within the stipulated time so that students have the whole system to understand the process of scientific research.
3.4 Summary internship.
14 ~ 15 weeks, summarize the content of practice, writing the corresponding papers.
4 Summary.
4.1 undergraduate internship in the basic work of inculcating the idea.
With the development of higher education, undergraduate education, the increasing popularity, more and more graduates, 80,90 some of the graduates should be the basis of the work in the absence of adequate staff can not meet demand. Although education has not been educated to posts after training in this part of the work, but found problems in the basic work, with the idea of the problem and take action inadequate, and in compliance with norms, if not understand the meaning of norms , compliance will be relatively worse, these capabilities can only practice in the training, identify problems from the grass roots work to find solutions to problems, and gradually self-development.
4.2 with the teaching methods should be diversified.
Practice with teaching must have a certain form, or become an intern working odd jobs, learn the basics of stage is not used in practice, practice, he also did not learn new knowledge. Practical forms of learning can be varied, such as: problem-oriented approach based on [4], a common problem in the design, to guide students to find solutions. Group discussion format scenarios, simulated the case of drug treatment [5], the design cases, choose to use drugs [6].
The training process in accordance with Section 3 I graduate, in the training process of the process was continually revised. Since the development of society, industry norms, changes in consumer demand, the ability to work on the needs of employees changing undergraduate education have also changed, especially the attachment phase is the basic quality in the industry and ability, should be given adequate attention, should be standardized.
References:
[1] Patel J. Using game format in small groupclasses for pharmacotherapeutics case studies [J]. Am J Pharm Educ. 2008,15; 72 (1): 21.
[2] Nykamp D, Marshall LL, Ashworth L. An active-learning assignment using nonprescriptionmedicines [J]. Am J Pharm Educ. 2008, 15; 72 (1): 20.
Keywords: Pharmacy education; practice; process; pharmacy
With the proposed concept of pharmaceutical care, pharmacy responsible for drug use patterns, that is, hospitals and community pharmacies the pharmacist has undergone major changes in work content. Pharmacists are no longer just a simple swap the functions of play, in fact, pharmacists in monitoring drug therapy is playing an increasing role, especially in adverse drug reaction monitoring and reporting of events to play a role [1]. This change to the teaching content and mode of Pharmacy created a new demand. Particular phase of the teaching practice before graduation related to the effectiveness of Pharmaceutical Education.
Pharmacy graduates of government for medicines management, production, circulation, use of links, with the development of society, other non-public medical institutions and pharmaceutical related industries such as health, health care, rehabilitation, counseling, insurance industry has become a pharmaceutical graduate jobs Health and employment areas. According to incomplete statistics [2], 1994 -1998 National Pharmacy professional graduates, only 10% of staying in school or further education, 8% in research institutes and Drug Control, up to 36% of the graduates to the hospital pharmacy, 19% of the pharmaceutical companies, 10% in the pharmaceutical distribution business. 1999 and 2000 and the proportion of hospital pharmacy graduates has declined about 24%, pharmaceutical companies increased to 28%, 14% of pharmaceutical distribution companies, staying in school or further education still 11%. Graduates can be seen in a larger proportion of the hospital pharmacy. How to regulate the pharmacy undergraduate students under the new situation in the hospital pharmacy internship process, cultivate a competent job drug use qualified people to work as top priority.
A comprehensive understanding of the workflow.
In our current evaluation system, job title, work after 1 year of graduation to take the examination, the examination may be granted by qualified pharmacists. Therefore, the undergraduate students in the attachment phase of the hospital should have a complete understanding of medicine and families familiar with the work flow. After 1 year of work to achieve the requirements and capabilities of pharmacists. Pharmacists at medical institutions should have the capacity requirements [3], the purpose should be achieved during the internship are the following: familiarity outpatient, emergency ward pharmacy, pharmaceutical information and consulting services to pharmaceutical and other departments of the duties, job content, work procedures and the job responsibilities. Initial grasp of drug procurement and supply management procedures and technical requirements; narcotic drugs, psychotropic substances, toxic drugs for medical use management; pharmaceutical information and drugs advisory services. Understanding of parenteral nutrition solution and deployment of intravenous drug use against drugs Room job responsibilities; commonly used name of the drug, pharmacological action, clinical application, usage, dosage and precautions; validity of the management of drugs commonly used; drug classification management principles and related policies and regulations; Hospital agents commonly used preparation, major equipment; rational drug use principles and safety monitoring methods, a preliminary knowledge of the prevention of medication errors; a preliminary understanding of clinical drug treatment program design and evaluation capacity; individualized regimens; clinical pharmacokinetics and bioavailability Degree; with the drug research and analysis, suggestions for improvement of knowledge.
2 reasonable arrangements for training time.
Our School of Pharmacy Practice times from the beginning in January, the end of May, except Spring Festival holiday, thesis defense, a total of 15 weeks internship. Some schools start from November to the end of the second year in March, except for Chinese New Year holiday, a total of 14 weeks, the remaining time to look for work. Pharmacy in the 80 to 90 years Undergraduates time is generally 1 year, and now the arrangements for each school is different. The authors found that the actual teaching for undergraduates practice time should be 1 year, in fact, the last one year under the semester most students find a job, find work in some of the units required by the employer to training, a considerable part of the students need Practice point turn, to stay a part-time students free reign. Therefore, effective training for about 24 weeks, all pharmacy students to understand.
3 to establish a standardized training process.
3.1 penetration Professional Ethics.
Day 1 vocational, professional ethics, the contents of this less contact in the classroom, there is no specific explanation. Found in the practice of teaching in the students for the future work of the whereabouts of the contents of the work is not covered by a general concept, for their love and the future direction of development is very vague and did not really understand the nature of the pharmacy, looking down on pharmacies and so on. Therefore, we arranged to work four hours to explain the direction.
Professional ethics should be involved in the attachment phase, these things do not study, students generally do not have the warning line, the work in the future staff relations and physician-patient relationship in the treatment will appear on bias. I Department of Pharmacy, the larger hospital, most of pharmacy are involved. We are prepared, including pharmaceutical research, pharmaceutical production, supply, pharmacy files of four parts of the code of ethics, to students focusing on the four hours.
3.2 a comprehensive understanding of training content.
1 to 5 weeks, 5 weeks lead time is to understand the work of the herbs Division. Respectively, to the clinic, ward pharmacy, medical supply store, drug testing, preparation room to rotate in various departments, each department is about 1 week. Familiar in all sectors relevant laws, regulations, industry standards, rules and regulations of various departments and so on. Understand the daily work and process. Arrangements with the teacher to teach in under the chores that help to know the contents of departments.
3.3 to strengthen the depth of practice.
6 to 13 weeks, after the last phase of the internship, the students of pharmaceutical preparations, testing, supply and drug use have to understand the process. We love the student's future direction with the students choose an internship at this stage sector. Outpatient ward progress of pharmacy practice: the first 6 weeks, understanding prescriptions, prescription management program to continue and read the familiar name of the drug package insert. Section 7-8 weeks, following the deployment of teachers by prescription, dispensing. Week 9, following the emergency window with mentor to learn daily routines and the management of toxic psychotropic drugs anesthesia 10 weeks, following pharmacists for prescriptions, study reviewed prescription. 11 weeks, following the pharmacists dispensing the window, studying the patient's medication guide. No. 12,13 weeks, and the daily work of collecting pharmacy records of problems and related data, the summary for the next stage of preparation. Pharmacy-related topics, including a lot of content, such as: adverse drug reaction to the collection, analysis; drug inventory management; Analysis and drug withdrawal; prescription common error analysis.
The progress of preparation room practice: the first 6 weeks, management procedures and familiar with pharmaceutical GMP requirements. Section 7-8 weeks, followed with a teacher in the preparation of topical formulations. 9,10 weeks, followed with a teacher in the preparation of oral preparations. No. 11,12 weeks, following the preparation of traditional Chinese medicine preparation of teaching in the teacher. The first 13 weeks, familiar with common technical operation, job responsibilities, fill out all registration forms, understand the hospital preparation works of major equipment, operation and maintenance. Progress in doping control room practice: the first 6 weeks of various formulations are familiar with USP General requirements. Week 7, followed by preparation with a General Education teacher test preparation materials.
The first 8,9 weeks, following the teacher in learning traditional Chinese medicine with TLC method. 10 weeks, learning to follow the teacher in pharmaceutical content with UV method. 11 weeks, learning to follow the teacher in pharmaceutical content with high performance liquid method. No. 12,13 weeks, following the study drugs with a teacher in High Performance Liquid Method for Determination.
Laboratory Practice schedule: in the laboratory is engaged in scientific research departments, research projects generally have teachers to guide students with the education part of the research topic. Teachers should select the topic of teaching in the basic part, together with the students start from the experimental design, experimental materials, preparation, start the experiment, experimental writing records, data sorting, data statistics, summary of thesis. Test content should be as simple as possible to complete within the stipulated time so that students have the whole system to understand the process of scientific research.
3.4 Summary internship.
14 ~ 15 weeks, summarize the content of practice, writing the corresponding papers.
4 Summary.
4.1 undergraduate internship in the basic work of inculcating the idea.
With the development of higher education, undergraduate education, the increasing popularity, more and more graduates, 80,90 some of the graduates should be the basis of the work in the absence of adequate staff can not meet demand. Although education has not been educated to posts after training in this part of the work, but found problems in the basic work, with the idea of the problem and take action inadequate, and in compliance with norms, if not understand the meaning of norms , compliance will be relatively worse, these capabilities can only practice in the training, identify problems from the grass roots work to find solutions to problems, and gradually self-development.
4.2 with the teaching methods should be diversified.
Practice with teaching must have a certain form, or become an intern working odd jobs, learn the basics of stage is not used in practice, practice, he also did not learn new knowledge. Practical forms of learning can be varied, such as: problem-oriented approach based on [4], a common problem in the design, to guide students to find solutions. Group discussion format scenarios, simulated the case of drug treatment [5], the design cases, choose to use drugs [6].
The training process in accordance with Section 3 I graduate, in the training process of the process was continually revised. Since the development of society, industry norms, changes in consumer demand, the ability to work on the needs of employees changing undergraduate education have also changed, especially the attachment phase is the basic quality in the industry and ability, should be given adequate attention, should be standardized.
References:
[1] Patel J. Using game format in small groupclasses for pharmacotherapeutics case studies [J]. Am J Pharm Educ. 2008,15; 72 (1): 21.
[2] Nykamp D, Marshall LL, Ashworth L. An active-learning assignment using nonprescriptionmedicines [J]. Am J Pharm Educ. 2008, 15; 72 (1): 20.
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