优化医学人文课程体系提高医学生人文素质

课程教学是医学人文教育的主要形式.针对当前医学人文课程中存在的问题,本文提出了医学人文课程体系设置应当遵循全面发展原则、价值导向原则、实际性原则和系统性原则,并就医学人文课程体系的构建,提出了包括人文社会科学基础课程、医学人文综合课程、医学人文应用课程、医学人文隐性课程等4类课程的“递进式、全维化”课程群.     

新形势下地方高校医学人文教育现状分析与对策研究

加强医学人文教育是改善医患关系、促进医学教育全面发展的重要方式。本文通过分析目前地方高校普遍存在的对医学人文教育重视不够、医学人文教育师资严重不足和医学人文课程设置不合理等现象,提出相应对策,如普及医学人文教育、拓宽医学人文教育途径、丰富医学人文教师资源、开展医学人文学科研究、构建科学的医学人文教育体系等。     

基础医学教育阶段实施医学人文教育的探索与实践

本文分析了基础医学教育阶段实施医学人文教育的意义和受到冷落的原因;指出通过整合医学人文教育课程,注重在生物医学课程中融入医学人文素质教育,结合医学生特点开展多种人文教育活动,并落实各种保证性措施,以确保基础医学生医学人文素质的提高.     

医学人文学科课程面临的问题及对策

随着医学人文教育改革的深入,医学人文教育暴露出越来越多的问题,医学人文课程设置的随意性,教学评价方式的单一,教材内容的贫乏,医学人文教师的整体素质缺乏以及医学人文教育的实效性差等问题都影响着我国医学人文教育的发展.通过对国内外医学人文教育的对比分析,发现课程改革和评价方式的改变是解决这些问题的关键.     

加强医学留学生人文教育的途径探索

通过对当下医学留学生的人文教育现状的分析,引出了其在适应医学模式转变、完善知识结构、健全品格三方面的重要性.并在此基础上提出了加强医学留学生人文教育的途径：医学专业教学应渗透人文教育;优化针对医学留学生的人文课程设置;积极开展人文教育隐性课程;融人文教育于医学实践.     

上海市某医学院校课程思政体系构建研究

通过辨析“医学人文”与医学专业“课程思政”的逻辑关系，分析上海市某医学院校结合自身办学特色和办学理念，将医学人文教育和思想政治教育有机融合的课程思政体系建设情况。该校以医学人文教育为载体，通过医学人文课程先行示范，着力推动课程思政的体制机制、课程设计、教学方法改革、教材和案例编写、师资培训、实践基地建设和校园文化建设等。     

医学本科人文教育潜在课程构成及其内涵探讨

通过潜在课程对医学本科学生进行人文教育是众多医学院校面临的共同课题。在此探讨医学本科人文教育潜在课程的构成及其内涵,目的在于提高医学人文教育的针对性和有效性。     

人文医学课程的发展空间:基于右江民族医学院的个案研究

医学院校以学科为基础的人文社会科学课程与医学课程表述了科学与人文、科学精神与人文精神的分离与对立。拓展人文医学课程的发展空间,一是要将人文社会科学通识教育课程转化为人文医学课程,二是对医学课程进行整合并渗透人文精神。人文医学课程的建设与发展,重在教师队伍建设。     

慕课在医学人文教学实践中相关问题探析* ——以哈尔滨医科大学医学人文慕课为例

21世纪初,大规模在线开放课程在全球兴起,因其开放性、互动性、大规模及社会性等特点受到了学习者的青睐,各大平台、各大高校都相继推出了种类繁多的特色课程。为满足医学人文教育的需求,自2015年始,哈尔滨医科大学创建了医学人文系列慕课,并积极地投入到医学人文教育的实践当中。哈尔滨医科大学人文慕课团队以“课程设计-课程应用-课程管理”为轴心,坚守“医学人文慕课彰显医学人文教育本质”的核心理念,以高胜任力的慕课教师团队保证课程的质量,最大限度地促动以在校学生和临床医生为主的医学人文慕课学习者学习的积极性和主动性,在获取新知识的同时领略医学人文教育的重要意义。     

整合叙事医学素材的医学人文教育多环节联动研究

以当前医学人文教育现状及问题为背景,运用叙事医学理念来梳理并整合医学人文各课程素材,探讨医学人文教育多环节联动模式,将分散在医学教育活动中的医学人文课程如医学伦理学、卫生法学、医患沟通、卫生政策学等与教学阶段、教学资源及教学方式进行有机整合,形成生动形象的叙事医学素材贯穿医学人文教育全程,通过共享资源、优化资源提升教学效率。通过问卷分析,发现医学人文教育有诸多不尽如人意之处;进而对问题进行分析,重点围绕学习意愿与时间分配矛盾、教学与社会发展没有同频、课程之间缺乏融合、教学方法创新不足等问题。在此基础上提出整合医学人文课程的叙事医学素材、搭建叙事医学素材应用与交流平台等对策。     

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.