医学院校非直属型教学医院教学现状分析与对策研究——以我校邵东临床教学医院为例

近年来,医学院校招生规模不断扩大,但医学院校直属的附属医院教学规模有限,已无法承担日益繁重的临床教学任务.在新形势下,医学院校通过与综合实力较强的医院共同建立非直属型教学医院来改善临床教学基地不足的情况.临床教学医院在完成繁重医疗工作的同时又承担着临床教学任务,使临床教学医院建设无论在教学管理上,还是在保证教学质量方面都面临着巨大的挑战[1].     

临床教学基地建设的研究与实践

长期以来医院已成为医学院校的有机组成部分 ,医院具有教育教学职能 ,既是医学教育的客观规律 ,也是国家赋予的重要社会职责。为了实现高等医学教育的全新培养目标 ,必须加强临床教学基地 (附属医院、教学医院、实习医院等 )的教育职能建设 ,使之积极地适应医学教育改革和发展的需要。一、我校临床教学基地的状况我校现有直属附属医院 3家、非直属附属医院 9家 ,教学医院和实习医院 38家。附属医院承担了临床理论课和实习带教两部分的教学任务 ;教学医院和实习医院仅承担实习带教任务。目前 ,我校四年级临床医学专业 80 %的学生已进入 6家异…     

非直属附属医院10年建设的实践与思考

高等医学教育大规模扩招带来了临床教学资源不足的问题,而临床教学基地是完成临床教学的主要场所,其数目的 多少和质量的高低直接影响着医学生的培养质量,建立非直属附属医院是保证临床教学质量、实现医学教育可持续发展的重要举措之一.本文对新乡医学院10年非直属附属医院建设过程、建设成效进行了思考和总结,为"大众化教育"阶段的高等医学教育提供了可资借鉴的经验.     

医学院校非直属附属医院的建立和运作体会

目的探讨扩招后解决临床教学基地面临困难的可行方法。方法对近十年来学院非直属附属医院的建立和运作情况进行回顾性分析。结果非直属附属医院的建立和临床教学质量控制体系的实施缓解了扩招与临床教学基地紧张的矛盾,保障了临床教学质量。结论高质量的非直属附属医院的建立和运作,是医学院校解决扩招与临床教学基地紧张的矛盾有效方法。     

我院教学工作的实践与思考

非直属附属医院是现代医院与医学院校建立的新型合作关系,为解决高等医学教育扩大规模后临床教学资源不足的问题发挥了非常重要的作用,但与附属医院相比,在建设过程中也存在一些问题和不足,如何深入推进非直属附属医院与学校之间的密切合作,真正助推非直属附属医院提升科研水平、提高临床教学质量,实现"双赢互惠",需进一步深入探究.文章结合我院作为非直属临床医学院建设的经验,客观地分析了加强临床教学工作的做法、成效及体会,提出非直属临床医学院是高等医学教育发展的必然趋势,院校合作是培养医学人才的必要途径,医院要坚持"科教兴院"的战略,进一步强化医院临床教学职能,完善相关教学管理规章制度,培养出更多高素质医学人才.     

非直属附属医院临床教学质量影响因素的调查分析

为研究非直属附属医院临床教学质量的影响因素,采用德尔菲法对在非直属附属医院学习的学生、临床教师、医院教学管理人员和学校教学管理人员进行了调查分析,指出要提高临床教学质量,应着重于临床师资队伍建设、教学管理、学生教育和管理等方面的努力。     

借力非直属附属医院平台 探索校院教学合作新途径

为了解决当前我国高等医学教育规模快速扩大与附属医院临床教学资源不足的突出矛盾,充分发挥社会医院的巨大潜能,非直属附属医院模式应运而生。郑州人民医院医疗集团作为南方医科大学、新乡医学院的非直属附属医院,通过院校合作的探索与实践,医院变被动为主动,充分借力非直属附属医院平台,创新医学教育模式,实现了社会医院医学教育的立体化,促进了医院的快速发展,实现了院校共赢,以及社会大型公立医院从单纯医疗型向医教研复合型的转变。     

加强非直属附属医院教学质量监控的实践与成效

医院是高等医学院校临床教学的重要基地，南京医科大学按照“校、院合作，双方共赢”的指导思想，充分利用江苏省及周边发达省、市的优质临床教学资源，先后建立11所非直属附属医院，并探索了一系列行之有效的管理办法，加强对附属医院教学质量的监控，调动非直属附属医院从事临床教育教学工作的积极性，保证了医学人才的培养质量。     

高等医学院校直管附属医院建设模式探讨

临床教学基地是临床教学的主要场所,是医学院校的重要组成部分。随着高校的扩招,临床教学基地面临巨大的压力和困境,文章结合川北医学院创建直管附属医院的实践与经验,就如何构建医学院校直管附属医院的建设模式进行探讨,以期在附属医院的建设过程中,形成具有西部特色的建设模式。     

加强临床教学基地建设 构建强大教学基地网络

临床实习是临床医学专业人才培养的重要教学阶段 ,教学基地是进行临床实习的重要场所 ,其水平的高与低、好与坏直接影响到人才的培养质量。长期以来 ,我院按照“学校总体部署 ,二级学院具体联系和实施”的临床教学管理思路 ,与有关医院建立了相对固定的关系 ,保持直接联系 ,利用第一临床医学院与第一附属医院“院系合一”的优势 ,充分发挥临床医学院在临床实践教学工作中的优势 ,在基地内涵建设方面发挥直接的实质性的作用 ,协助加强教学基地的规范化、科学化、制度化建设 ,构建强大的教学基地网络。1　我院负责联系的临床教学基地的状况我院除第一附属医院外 ,现有负责联系的教学基地 2 4间 ,其中非直属附属医院 3间 ,教学医院 9间 ,实习医院 12间。病床数 5 0 0 0余张 ,总建筑面积 5 5万m2 。第一附属医院承担了临床理论课和实习带教内容两部分的教学任务 ,教学医院和实习医院仅承担实习带教任务。目前 ,我院学生毕业实习 10 0 %安排在非直属附属医院、教学医院实习 ,其中大部分在三甲医院实习 ,其他实习医院暂只安排三年级学生三个月的教学实习。各基地普遍认识到教学对医院综合水平提高和可持续发展的重要性 ,医院教育...     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.