浅谈21世纪新型医学人才的培养

随着医学科学技术的发展和医学模式的转变,为21世纪医学生制定培养目标并付诸于实施已是医学教育工作的当务之急。我国医学教育应顺应历史潮流,深化医学教育改革,全面推进素质教育,培养21世纪新型医学人才。     

医学生临床实习前集中强化培训模式探索与实践

医学生临床实习是医学人才培养必经之路、医学教育的关键时期，是实现高等医学教育培养目标的重要环节。我院多年来不断采取一系列切实有效的措施加强临床实践教学，其中在实习前一直探索集中培训模式，每年由临床实习督查组根据学生病房实习参加医疗、教学活动情况，结合实习大纲、医师资格考试，制定理论和基本临床技能培训课程，遴选教学经验丰富的老师进行授课，并实施考核评价，提高医学生理论知识、技能水平、职业道德、人文素养、医德医风、临床思维等，每次培训的评价结果显示培训对医学生综合素质起到了积极促进作用，学生的评价反馈良好。     

新时期医学生临床阶段素质教育的实践和思考

参考全球医学教育最基本要求,以教育部本科教学评估为契机,在医学生临床阶段教学中,从职业价值与态度、科学基础与临床技能、信息管理与沟通技能、批判性思维等多个方面制定新的培养目标,改革培养方法。     

医学文献检索课的课程建设

作为培养医学生获取和利用文献信息能力的方法学课程，医学文献检索课是整个医学教育的重要组成部分，是为实现医学生的培养目标，着眼于医学生基本科学素养训练的重要课程。医学文献检索课从初创之日起就遵循教育学基本原则，强化课程基本建设。     

血尿查因在八年制医学生泌尿系统整合教学中的探索

我国部分医学院校八年制医学教育教学中,采用器官系统整合教学面临一些挑战。根据泌尿系统疾病特点、八年制医学生培养目标及湘雅医学院教学经验,探索以血尿查因参与构建八年制医学生泌尿系统三阶段立体整合教学。在八年制医学教育的不同阶段设计相应的教学目标、教学方案及考核方案,以优化八年制医学教育系统整合教学质量,为器官系统整合教学提供新思路。     

注重提高医学生的创新能力培养创新型医学人才

世界医学高峰会议提出“为21世纪重新设计医生”的战略决策，它不仅是对未来医生标准的重新定位，更是对医学教育培养目标的重新确立。医学教育必须把素质教育放在重要位置，而素质教育的核心是培养医学生的创新能力。     

对新形势下医学生医德教育的思考

对新形势下医学生医德教育的思考王照华，黄占辉（宣传部）高等医学院校的培养目标，是培养一大批为社会主义建设事业服务的工作者。我们培养的学生，既要有真才实学，又要有高尚的医德。对医学生进行医德教育，是整个医学教育的重要环节。本文试对新形势下加强医学生的医...     

试论医科学生的智能培养

<正> 对大学生的智能培养,是当今世界各国非常注重的问题,也是我国高校教学改革的核心问题。现代科技及经济竞争,主要是人才竞争。医学教育的目的就是为了发展医学生的智能,培养大批具有创新精神、开拓能力及竞争能力的高质量医学人才,以适应医疗卫生事业发展需要及世界新技术革命挑战。培养医学生的智能主要应从四个方面来考虑。一、对医学教育的培养目标进行再认识根据我国国情及世界医学教育发展趋势,我国医学教育的培养目标应包括:坚持“三个面向”,立足本国,建设具有中国特     

医学生人文素质教育探研

医学院校的人文教育的核心目标应当是增强医学生对人、对生命、对病人的尊重与关爱，遵循和维护医学增进人民健康的内在精髓和神圣宗旨。所以，在高等医学教育中充分重视医学人文教育十分重要。医学院校的人文素质教育应适应医学教育培养目标和医学生综合素质的提升，在学科建设、课程设置、内容更新上进行改革创新。     

医学生职业接触感染认知情况的调查与分析

对在校高年级医学生预防职业接触感染认知情况进行调查，以了解医学生接受职业防护教育的现状，为有关部门制定预防教育规划提供依据。结果表明，现阶段医学生预防职业接触感染教育还存在严重不足，应在今后的医学教育中开设相关的课程或讲座。以减少职业暴露对医务人员的危害。     

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.