对比OSCE与传统技能考核模式在医学生中的应用效果

目的 比较客观结构化临床考试(OSCE)与传统技能操作考核模式在临床医学专业毕业生技能操作考核中的应用效果.方法 比较某医学院临床医学专业2018届与2020届毕业生的技能操作考核成绩,其中2018届学生采用传统技能操作考核模式,2020届学生采用OSCE模式.结果 两届毕业生技能操作考核成绩差异有统计学意义(P<0....     

基于混合式教学的新护士规范化培训模式的构建及应用

为了增强新护士的技术水平和服务能力,提高新护士培训效果和效率,中山大学附属第三医院自2016年7月起建立了新护士规范化培训管理制度;制定了包含基础和专业培训、理论和实践培训的新护士规范化培训方案;建立了护士规范化培训移动管理系统。本文通过采用线上与线下相结合的培训方式,对289名新护士开展为期两年的规范化培训。2018年7月进行了包含理论考核和站点式综合技能考核的规范化培训结业考核。结果显示,培训基地和受训护士普遍对这一规范化培训模式持积极态度,各阶段培训计划完成率100%。这说明该培训模式效果良好,有利于保障培训方案的落实和提高培训效率。     

贵州省住院医师规范化培训中内科临床实践技能考核情况

目的:了解内科住院医师规范化培训临床技能考核的情况,探讨不同基地间考核结果的差异,为住培同质化发展提供参考依据.方法:统计2018年两个批次及2019年第一批次内科住培学员结业临床实践技能考核的相关资料,按照考核批次和基地类型进行分类分析,采用卡方检验比较不同基地技能考核结果的差异,分析七个考核站点中较为薄弱的站点.结...     

在轮科新护士护理操作技能培训考核中实施现场交叉点评方法的实践

目的 使用现场交叉点评方法 对轮科新护士进行护理操作技能培训考核,以提高其护理操作技能水平.方法 将2005年7月-2009年6月在我科轮科的新护士随机分为两组,以2005年7月-2007年6月的64名轮科新护士为对照组,2007年7月-2009年6月的72名轮科新护士为实验组.两组新护士均参与相同项目的 护理技能的培训考核,但采用不同技能考核评价方式: 对照组采用传统的"一考核一点评"的方法 ;实验组则采用"新护士现场交叉点评"的考核方法 .结果 两组护理技能考核成绩比较,差异有显著性意义(P＜0.05);实验组轮科新护士护理技能考核成绩明显优于对照组(P＜0.05).结论 将现场交叉点评方法 应用于轮科新护士的护理操作技能培训考核可使轮科新护士对教学满意度及护理技能操作考核成绩显著提高.     

综合病例站点式培训在临床护理教学中的应用

目的 分析综合病例站点式培训模式应用于临床护理教学的效果.方法 医院在2018年7月至2019年3月接收了57名护理实习生,作为研究对象,开展综合病例站点式培训模式教学.在培训前及培训后5个月末,以《Min-CEX迷你临床评量演练评估表》为主要评价工具,结合护理基础理论知识考核,对护理实习生的临床能力展开考核.结果 护...     

临床医学本科专业毕业生多站点综合性毕业考试的改革与实践

我校自2000级临床医学5年制本科起对毕业考试进行了改革,在毕业生返校时进行多站点综合性毕业考试,采用闭卷笔试考核临床理论知识,占45％;多站实践操作考核临床技能及相关知识,占40％;在实习期间书写1篇毕业论文,占15％.通过连续5年的实践证明,我校的此项改革促进了医学生端正实习态度,调动了实习的积极性和主动性,引导学生重视理论学习和实践相结合,让学生初步掌握医学论文的书写,在提高教学质量的同时为执业医师考试奠定了基础.     

患者抢救情景模拟演练在新护士能力考核中的应用

目的探讨患者突发病情变化的抢救情景模拟演练在新护士考核中的应用效果。方法对2016年入职(对照组)的101名病房护士采用传统技能考核,2017年入职(观察组)的93名病房护士应用患者突发病情变化的抢救案例、采取情景模拟的形式进行考核,考核结束1个月后,采用迷你临床演练评量(Mini-CEX)和批判性思维量表对194名护士进行临床能力和评批判性思维能力测评。结果 2016年入职护士Mini-CEX评分,未符合要求、基本符合要求、表现优秀人数分别为11人、70人、20人;2017年入职护士分别为2人、53人、38人,Z=-3.656,P=0.000,差异具有统计学意义;观察组评判性思维能力总得分高于对照组,t=-6.03,P=0.000,差异具有统计学意义。结论采用患者突发病情变化的抢救情景模拟演练对新护士进行考核可提高新护士的临床能力和批判性思维能力。     

妇产科护理考核模式的研究与实施

目的 适应国家培养高素质技能型紧缺护理人才的需求,探索学生综合能力考核与评价的新途径,逐步建立和完善妇产科护理多站点综合性考核系统.方法 对妇产科护理考核模式进行研究和改革,对某校559名高级护理专业学生施行理论笔试、实践技能操作和临床病例分析的多站点综合性考核方式,并与同步进行的传统考试比较.结果 2种考试结果经统计学处理有显著性差异.多站点综合性考核方式可有效激励学生学习的积极性和主动性,引导学生在学习中重视理论与实践的密切结合,强化护理程序的临床应用,显著提高学生临床整体护理的综合能力.结论 研究证明,多站点综合性考核方式可有效地提高学生的自主学习能力,全面提高学生的综合素质和学习成绩,可为学生的培养和综合评定开辟一条可行性道路.     

心肺复苏技能操作培训在临床医学实习生岗前培训中的开展及质控价值

目的　探讨心肺复苏操作技能培训在教学医院临床医学实习生岗前培训中的开展及其质控价值。方法　分别收集黔江中心医院2015年6月至2017年6月之间来自重庆医科大学、吉首大学、湖北民族学院等院校实习生数据136例,包括其在岗前培训3个月后心肺复苏技能考试成绩、合格率、补考合格率的数据,以未引入心肺复苏技能操作组（2015届）实习生为对照组,比较岗前培训引入心肺复苏操作技能培训考核组（2016届）与对照组（2015届）的差异,并分析心肺复苏操作技能再培训考核与岗前培训成绩的相关性以及对岗前培训效能的预测价值。结果　纳入研究136名实习生,2016届临床医学实习生65名,2015届临床医学实习生71名。岗前培训引入心肺复苏操作技能培训组与对照组3个月后心肺复苏操作技能考核成绩比较,再培训组评分显著高于对照组（t=15.594,P＝0.00０）。3个月后心肺复苏操作技能考核及格率,培训组显著高于对照组（χ2=22.859,P<0.01）;3个月后心肺复苏操作技能考核补考后及格率,再培训组显著高对照组（χ2=6.179,P=0.018）。结论　教学医院临床医学实习生岗前培训引入心肺复苏技能培训教学,可能提高岗前培训的效能和临床医学生的心肺复苏技能,有助于改进临床医学实习生岗前培训的质量,并可作为一种有效的临床实习教学质量控制策略。     

临床医学生毕业前多站式考核的一点感想

文章对临床医学毕业生毕业前采用的多站式技能考核进行了分析,将研究对象分为实验组和对照组,分别对每组学生各站考试成绩进行评分,并进行统计学分析,得出结论,多站式技能考核可对医学院校毕业生进行综合及客观评价,并且有助于提高学生的实践操作能力,提高教学效果。多站式技能考核是医学院校对临床毕业生毕业前实施考核的一种有积极意义的方法。     

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…     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.