临床医学七年制学生专业理论考试质量分析

目的了解和分析我校七年制学生专业理论考试质量.方法采用标准化试题库编制试卷,考试对象为该校临床医学七年制英文班和法文班六年级学生,对五次考试结果进行质量分析.结果两班学生共85人,法文班平均成绩为(124.89±7.52)分,英文班平均成绩为(134.39±8.47)分.平均区分度为0.16±0.01,平均难度值为0.66±0.04,试卷信度系数为0.83±0.03.结论临床医学七年制英文班学生考试成绩整体略高于法文班;要在教学管理过程中加强考试质量分析,以提高考试的可靠性和有效性.     

病理学考试试卷分析与评价

目的通过分析南华大学2004级临床医学专业专升本学生病理学期末考试试卷,对教学质量进行评估。方法随机抽查2004级临床医学专升本学生的200份考试试卷进行统计分析。结果考试成绩呈负偏态分布,平均成绩为(78.88±8.02)分,难度为0.79,区分度为0.19。结论这份试卷能较全面地评价学生对课程的掌握程度,试题难度适中,区分度尚可,为今后提高试卷的命题水平及调整教学安排提供了经验。     

肾脏内科出科考试试卷分析暨临床教学评估

目的通过分析我校 1999级 5年制临床医学专业肾内科出科考试试卷 ,对临床教学质量进行评估。方法选择全部 1999级 5年制临床医学专业学生的出科考试试卷进行统计分析。结果考试成绩基本呈正态分布 ,平均为 73 0 9分 ,标准差为 12 0 3分 ,难度为 0 70 ,区分度为 0 3 0。结论本试卷难度适中 ,区分度尚可 ,较全面、客观地反映了学生对本门课程的掌握程度 ;不同知识点成绩的高低反映出医学生在实习阶段存在的问题 ,表明了临床教学中有待加强的环节 ,为今后的教学改革提供了依据     

《临床诊断学》试卷分析及教学策略反思

目的 评估《临床诊断学》理论考试试卷的质量,探讨、反思教学方法。方法 使用统计软件SPSS 20.0对40名临床医学专业七年制学生《临床诊断学》理论考试成绩进行统计分析。结果 40名学生的考试成绩为61分～96分（平均83.64 8.07分）;试卷总体难度为0.84,区分度为0.16～0.30,学生总失分率为16.36%。 结论 本次考试试卷难度适中,区分度良好;学生整体对《临床诊断学》理论知识掌握良好,但仍需调整教学策略以加强学生灵活应用基础知识的能力。     

先天性心脏病多媒体教学和传统教学效果比较分析

目的:探讨多媒体在先天性心脏病(简称先心病)教学中的应用效果。方法:先心病教学中,2008级临床医学专科1班采用多媒体教学,2班采用传统教学。结果:1班学生的测试成绩为(17±1.865)分,2班学生的成绩为(12±3.647)分,两班学生的测试成绩差异有统计学意义(P<0.01)。结论:多媒体和传统教学扬长避短,可明显提高先心病的教学效果。     

PBL教学模式联合微课在妇产科临床见习中的应用研究

目的:探讨PBL教学模式联合微课在妇产科临床见习中的应用价值。方法:选取2020年3－12月120名广东医科大学附属医院妇产科见习的四个本科班临床医学专业学生,随机将四个班分为A组(试验组,n=60)与B组(对照组,n=60)。对照组应用传统的多媒体课件进行教学,试验组应用PBL联合微课教学模式带教,全部见习任务完成后通过试卷考试及问卷调查形式对两组学生进行学习效果测评。结果:试验组试卷平均理论成绩(78.49±6.69)分,明显高于对照组(75.46±6.73)分,操作实践成绩试验组(81.54±3.99)分,高于对照组(71.18±5.23)分,差异有统计学意义(P<0.05);试验组学生各方面调查满意度均高于对照组,差异有统计学意义(P<0.05)。结论:PBL教学模式联合微课在提高临床思维能力、促进所学知识点的掌握程度、激发学习兴趣和学习效率、调动进一步学习主动性和积极性方面取得很好的临床教学效果,值得进一步完善并推广。     

临床专业学生医患沟通技能考核分析与改进建议

目的　了解临床专业学生对医患沟通技能掌握情况,评估医患沟通教学效果,提出改进设想。方法　以南京医科大学2009级临床专业学生５４９名为研究对象,于实习结束后组织客观结构化临床技能考试（objective structured clinical examination,OSCE）,其中包括医患沟通技能毕业考核。分析不同学制医学生的医患沟通技能及相关成绩。数据用ＳＰＳＳ 11.0进行统计处理,采用t检验及Pearson分布。结果　549人医患沟通技能平均成绩为（82.72±4.23）分,其中五年制329人均分（81.88±4.23）,七年制220人均分（83.96±3.91）,七年制临床专业学生医患沟通平均成绩比五年制要好（P<0.001）。五年制和七年制学生OSCE考核总成绩与医患沟通成绩均呈正相关（五年制：相关系数0.520,P=0.000;七年制：相关系数 0.416,P=0.000）。结论　医患沟通教学效果总体较好,经过改进必然对临床专业学生医患沟通技能的提高有更积极的意义。医患沟通考核成绩不仅体现沟通能力培养成效,实质是综合能力培养成效的表现。     

外科学总论不同教学模式的教学效果比较及存在问题分析

探讨外科学总论不同教学模式对教学效果的影响,从而提高教学质量。因此,对交大医学院2005级法文班、英文班和教改班的126名学生进行比较,通过接受不同教学模式的学生外科学总论考试的成绩。教改班学生的平均成绩显著好于英文班和法文班,而英文班和法文班的成绩没有显著差异。故不同的教学方法对教学效果存在一定的影响。     

神经病学试卷质量分析与评价

目的评估我院 2 0 0 0级 ( 3)班临床医学专业神经病学期末考试试卷的质量。方法选择 2 0 0 0级( 3)班临床医学专业学生的神经病学期末考试试卷进行统计分析。结果考试成绩呈正态分布 ,平均成绩73.0 6分 ,标准差 10 .14 ,难度 0 .6 97,区分度 0 .2 2 5。结论考试成绩理想 ,本套试卷试题质量良好     

五年制和八年制临床医学专业培养效果与人才培养模式改革思考

目的 阐述华中科技大学同济医学院八年制、五年制临床医学专业培养成效，分析医学人才培养新模式。方法：汇总华中科技大学同济医学院2008级临床医学八年制学生96名、2011级临床医学五年制学生200名的毕业阶段考核成绩，包括毕业理论考核成绩及毕业客观结构化临床考试（OSCE）成绩。另外，对2008级八年制学生和2011级五年制学生毕业前进行教学满意度调查。结果用SPSS17.0统计软件，采用两组独立样本卡方检验进行统计学分析。结果 两组学生毕业理论考核平均分差异无统计学意义(63.80±1.36 vs 61.37±6.95, P=0.175)。八年制及格率更高(63.5% vs 54.0%, P=0.039)；八年制与五年制OSCE考核成绩平均分分别为76.11±2.13 vs73.21±2.12前者优于后者(P=0.03)。共回收满意度调查表186份（八年制85份，五年制101份），从时间分配、教学方式及教师态度三方面进行分析，一半以上八年制学生对基础理论教学和自学能力教学满意，而五年制学生只对基础理论教学三方面满意度超过50%。结论 华中科技大学同济医学院八年制医学教育与五年制医学教育培养成效显著。今后仍要继续改进和完善培养机制，从而培养优秀医学人才。     

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.     

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.     

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…     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.