试论医学生的通识教育

本文介绍了大学通识教育的历史与现状,就我国高校通识教育的问题,医学生的通识教育的重要性以及复旦大学构建医学生通识教育的原则与设想构架等问题进行了探讨。提出要培养适应全球化需要的人才,必须大力加强大学通识教育,以通识教育去矫正过去高等教育偏重专业知识和技术的弊端,培养全面发展、有创新能力、有价值的人,并特别强调通过通识教育促进医学生的人格培养。     

构建以提升医学生人文素质为目标的通识教育体系

通识教育(General Education)以培养理科学生的人文社会素养和文科学生的科学素养为重要内容,旨在给予学生一个合理的知识结构和能力结构,使学生成为一个积极参与社会生活,具有社会责任感、创新意识、全面发展、负责任的公民.在医患关系日益紧张的今天,培养医学生的人文素质显得极其迫切,而通识教育是医学院校提升医学生人文素质的重要途径.为了深化医学生的通识教育、人文教育课程与教学改革,构建合理的人文素质通识教育课程体系,培养高素质的现代化实用型医学人才,从整体上提高医学生人才培养的质量,笔者组织课题组设计了"广东地区医学生人文素质与医学院校通识教育课程体系现状"调查问卷,经过调查研究,深入分析广东地区医学生人文素质与医学院校通识教育课程体系现状和特点,并以广州医学院为例,有针对性地提出提升医学生人文素质、构建和完善通识教育体系的对策.     

论通识教育对长学制医学生培养的重要性

探讨通识教育对长学制医学生培养的重要性。通过对南京大学长学制医学生本科教育的深入分析,结合国家对长学制医学生的培养要求,以南京大学为长学制医学生开设的通识课程为例,说明通识教育在学生拓宽人文视野、发展专业兴趣、提升个人修养、强化创新意识等方面起到的积极意义。通识教育在长学制医学生的本科教学中有着重要的作用,是长学制医学生本科教育必不可少的一环。     

论医学高等院校通识教育途径

随着高等教育的不断发展,通识教育也越来越受到重视。与美国、日本等发达国家相比,我国通识教育起步较晚;与国内综合性大学相比,医学高等院校通识教育更为薄弱。医学是最应体现人文关怀的学科,加强医学生通识教育,提升医学生人文素养,对改善医疗人文环境、促进医学和医疗卫生事业健康发展具有重要意义。     

双院制下医学生培养模式的探索与实践

转变教育理念,创新教育模式;推进书院制建设,探索育人新方法。西安交通大学启德书院努力探索双院制下医学生素质能力培养的新思路,通过不断的尝试与努力,逐步形成"以通识教育为导向,以书院活动为载体,以基地建设为依托"的医学生培养新模式,有力推动了我校师生大学教育理念的更新与转变。     

通识教育对医学生医德医风培养的影响

医学生的医德医风培养正面临人文素质缺失、理想信念弱化以及市场经济冲击等诸多不利因素的影响。通识教育的引入对于重构医学生的人文素质,强化医学生的理想信念以及使医学生学会正确看待市场经济具有直接作用。因此。通过深化通识教育从而加强医学生医德医风的培养势在必行。     

新医科视域下大数据技术通识教育实践探索

新医科背景下医学院校开展大数据技术通识教育,但需充分协调解决医学生跨学科学习难度大等诸多问题。本研究针对医学院校在大数据通识教育中存在的问题与需求进行深入研究,采取灵活多样的教学内容与教学时间机制,设计多元化教学微单元模式,制定完善合理的教学机制,采取混合式教学模式开展大数据技术通识教育、教学实践,注重培养学生的实践能力,激发医学生对大数据技术通识课程的学习主动性,有效提升医学生的大数据技术素养。在教学实践中改革探索行之有效的教学模式,达到预期教学效果。     

医学院校通识课程设置研究

通识教育在医学生培养中的作用越来越被医学院校所重视,本文对医学院校通识课程设置的现状及存在的问题进行了调研分析,并对医学院校通识课程建设提出了一些参考性建议。     

新时代医学院校通识教育路径探析

通识教育是培育医学生人文素养的重要环节。文章分析了医学院校通识教育的现状，结果显示，通识教育存在课程设置不科学、师资队伍结构不合理和医学院校特色不鲜明等问题。因此，通过优化通识教育课程设置、完善通识教育师资队伍结构、有效融入医学院校特色等举措，达到推动通识教育规范化、有序化发展、不断提升医学人才教育的整体质量的目标。     

论医学生的通识教育

高等医学教育应培养全面发展的、具有较高人文素质和创新精神的高级医学人才，鉴此，通识教育是高等医学教育必不可少的组成部分。目前，加强医学生的通识教育，重点在于培养学生的传承理念、创新思维、科学精神、公民意识、人文素养。     

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.