高专临床实践技能教学应对医师资格考试的研究

为了提高医学生的综合素质和实际工作能力,我系参照国家执业助理医师考试大纲(实践技能部分),以改革临床技能训练和考核模式为切入点,并对临床专业2004级学生实习前进行了考核,以考促教,以考促学。通过考核情况的反馈,找出教学工作中的薄弱环节,以便在今后的教学过程中得到改进。     

临床技能竞赛背景下医学生临床教学检视与反思

为创新医学生实践教学体系,提高临床教学质量,结合大学生临床技能竞赛检视和反思当前医学生临床教学现状及存在的问题,就技能竞赛背景下暴露的医学生重理论、轻实践的知识结构以及实习内容、质量等方面存在的问题,提出发挥以赛促教作导向作用,建立完整的临床技能教学体系、加强实习管理、建立临床技能训练中心等建议。     

创伤救护情境教学法的实践与探索

对传统创伤救护教学实施情境教育改革,即结合现代医学特点,通过场景布置、电教直观、语言渲染、急救道具等形式,创设一种接近真实场景的野外实地训练环境,使学生亲自参与到教学过程中,演练创伤救护技术。通过角色扮演,强化主体意识,调动学生的非智力因素;通过拓宽教育空间,优化教学环境;通过开展第二课堂,超前训练、分级辅导,以比赛促训练等强化技能训练,以达到把学生的认知活动与实践活动结合起来,有效地提高教学质量,促进学生综合能力的发展。     

实习前对医学生实施"训练-考核-总结"三段式考评的实践与思考

为使医学生顺利进入临床实习,实习前,以提高学生动手能力、强化临床基本技能、增强理论与实践衔接为目标,以校本教材为指导和依据,遵循教为主导、练为主线、考为手段、以考促练的宗旨,实施"训练-考核-总结"三段式考评模式,对即将实习的医学生进行为期3周的临床基本技能强化训练与考核.经过5年的实践与探索,取得良好效果.     

创伤救护情境教学模式的开发和实施

在外科学创伤救护教学中引入和实施情境教学法的教学模式。通过精简教学内容 ,创设典型情境 ,开发以典型场景为基础的情境教学模式 ,实施倒金字塔式分级辅导 ,突出重点难点训练 ,解决传统教学分组大、示教效果差的问题 ;实行野外训练 ,扩展教学空间 ,优化了教学环境 ;实施角色扮演 ,强化了学生主体感受 ;实行以赛促训 ,增强了学生的实践综合应用能力。实践表明 ,采用情境教学法 ,其技术考核成绩较传统教学法显著提高 (P <0 .0 5 ) ,学生对知识的内在联系和整体认识与体验明显增强 ,提高了他们的实践能力和对知识的综合运用能力。     

物理治疗因子在脑卒中偏瘫康复训练中的应用

促通技术为现代脑卒中偏瘫康复治疗的孩心技术,遵循其训练的基本原则,在训练程序中我们引入了物理疗因子进行综合训练治疗,并进行了临床的疗效观察,将结果报告如下。     

以赛促学 提高临床基本技能

探讨开展比赛对医学生的临床技能培养的效果。汕头大学医学院引入＂以赛促学＂临床技能训练新模式,对医学生的临床技能培养进行改革实践。对比实验组与对照组的期末临床技能考核成绩,两组考核方式和内容相同。实验组学生的考核成绩均高于对照组学生。开展技能竞赛对医学生临床技能的教与学均有促进作用,值得推广运用。     

老年脑卒中失语症患者的康复治疗

目的 观察言语功能训练对老年脑卒中失语症患者的疗效.方法 20例老年脑卒中失语症患者在接受言语功能训练后,采用中国康复研究中心失语症检查法(CRRCAE)进行评定.结果 老年脑卒中失语症患者在接受言语功能训练后言语功能明显改善,治疗前、后比较差异有统计学意义(P＜0.01).结论 老年脑卒中失语症患者经言语功能训练能促...     

重型颅脑外伤后持续性植物状态患者的促醒与康复

目的探讨重型颅脑外伤后持续性植物状态患者的促醒与康复。方法对２９例重型颅脑外伤后持续性植物状态患者（Ｇｌａｔｇｏｗ昏迷量表评分３－８分）进行中西医结合促醒治疗,醒后进行认知训练和语言治疗及精心护理。结果２９例患者中２６例被促醒（８９.７％）,醒后能参加简单工作的５例（１７．２％）、生活能基本自理的１４例（４８．３％）、需要他人协助生活的５例（１７．２％）、生活完全依靠他人的２例（６．９％）、未醒３例 （ １０．３％）。结论重型颅脑外伤后持续性植物状态患者经过早期积极的中西医结合促醒治疗及醒后的认知训练和语言治疗可以得到最大限度的的康复。植物状态持续时间越长,促醒越困难,醒后留有残疾越重。     

药物化学/有机化学实践教学现状分析及改革思路

普通高等学校本科教学工作水平评估以《中华人民共和国高等教育法》为依据，贯彻“以评促改，以评促建，以评促管，评建结合，重在建设”的原则。通过教学水平评估进一步加强国家对高等学校教学工作的宏观管理与指导，促进学校自觉地按照教育规律不断加强教学基本建设，强化教学管理，深化教学改革，全面提高教学质量和办学效益。药学学科是实践性很强的学科。实践教学既是理论联系实际的重要环节，又是训练学生基本技能、发展智力、培养工作能力和良好作风、全面提升素质的重要途径，也是学生将来适应社会需求和进行技术创新的基础。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.