高等医学职业教育模式改革的实践与探索

目的 分析高等医学职业教育面临的形势,研究新型医学教育模式,为高职高专医学院校的改革与发展提供实践依据.方法 通过实施农村社区医疗卫生人才定向培养、加强人才实践技能培养、提高人才培养质量,开展高等医学职业教育模式改革实践.结果 浙江医学高等专科学校的农村社区医疗卫生人才培养模式深受本省各级卫生行政部门欢迎;实施模拟医院、校院(企)一体化培养,实现了学生与职业岗位的直接衔接;加强"双师型"教师培养等师资队伍建设,保证了人才培养的质量.结论 高职高专医学院校着力培养服务基层的专业技能人才,符合高等职业教育发展的方向,是一条切实可行的人才培养途径.     

坚持以服务“三农”为宗旨 促进医学教育体制机制创新

“因病致贫、因病返贫”的问题是困扰我国农村稳定发展一个主要因素.如何在深化医药卫生体制改革背景下,为农村培养“下得去、留得住、用得好”的高素质、实用型卫生人才队伍是当前医学教育面临的严峻挑战.本文就医学教育在服务“三农”方面存在的主要问题进行了详细的阐述,并建议从机制体制层面深化医学教育改革,包括坚持面向农村的医学教育优先发展战略;坚持和完善以农村生源为主的“三定”政策;坚持“面向基层、立足本地、服务三农”的办学定位;坚持以村级卫生服务人才为培养主体,发展临床医学专业专科教育;坚持“以人为本”理念,构建培养农村医学人才的“立交桥”.     

以创新农村卫生人才培养模式为基础促进农村卫生人才队伍的整体提升

为农村培养各级各类合格人才是高等医学院校的重要任务，如何培养出符合农村需要的各级各类合格的卫生人才，是我们医学教育工作者必须认真考虑的问题。本文从树立新的人才培养的理念、创新人才培养模式、建立人才培养基地等方面阐述如何进行农村卫生人才培养的认识和做法。同时通过建立农村卫生人才临床教育基地及通过其辐射作用，促进农村医疗卫生队伍的整体提高。     

浅谈高职医学人才与农村医疗卫生事业发展的需求

为适应21世纪我国高职医学教育发展的新形势，进一步满足社会和农村医疗卫生事业发展的需要，高职医学教育培养了大批的医学人才，充实到基层医疗卫生单位，但是还远远不能满足农村医疗卫生事业发展的需求。近年来，我国农村卫生工作在国家有关部门重视下，通过优化卫生资源，调整卫生结构，推进农村卫生改革，积极探索了多种形式的农民健康保障办法，不断地提高农民健康水平，促进了农村卫生事业与农村经济共同协调发展。下面就高职医学人才与农村医疗卫生事业发展需求谈谈自己的看法。     

中国与澳大利亚医学教育培养模式的比较研究

中国医疗卫生体制正面临重大改革,医学教育也随之进行了快速调整,以满足我国卫生服务和医药卫生事业发展的需要。然而,医学教育体制的调整以及全国不同地区的学制设置的差异,导致我国医学教育学制和与之相对应学位的定义很难进行国际的同步比较,也使我国医学学位和学制很难被国际上许多国家教育部门所理解。结合澳大利亚高等医学教育的理论和实践经验,从招生、学制建设、课程设置和教学模式等方面,与中国的医学教育培养模式进行系统性对比和分析,为完善我国高等医学教育体系提供参考,更为我国医学教育体制与国外成熟体制间的相互参照奠定基础。     

新中国成立初期苏联对我国高等医学教育的影响

建国初期,我国以苏联培养医疗卫生人才的方法为蓝本,改造了旧有的医学教育模式,建立起新中国高等教育的制度与体制。上世纪五十年代,我国全面学习了苏联高等医学教育的指导思想、教学方针以及教学计划、教学大纲、教学内容与教学方法。缘于当时特殊的历史背景,苏联对我国的高等医学教育的影响利弊同现,反思之,对我们今后的医学教育改革不无裨益。     

关于改革高等医学教育学制、建立七年制医学本科教育体制的建议

一、改革现行高等医学教育学制理顺教育层次明确培养规格社会对人才的需求是多层次、多规格的,教育要主动适应社会对各类人才的不同需求。高等医学教育必须适应国家医药卫生事业的发展和社会对不同层次和各种规格医学人才的需求,以合理的比例进行各类医学人才的教育和培养。根据我国医药卫生事业的发展和社会对高等医学专业人才的需要,在高等医学院校的毕业前在校教育之中,应该确立以下三个教育层次:(一)为农村和基层医疗卫生机构培养     

创新型医学教育浅析

如今,高等医学教育缺乏创新精神,亟待转变人才培养的模式以培养出创新型人才.为此,必须依据高等医学教育的人才培养要求,大力开展创新型医学教育,从而培养出更多更好的创新型医学人才.本文从强化创新价值观的引导、努力推进体制创新、调整高等医学教育课程结构、改革医学课程教学方法、增设人文类教育课程、大力加强实践教学等六个方面对创新型医学教育进行了探讨.     

河南省高等医学教育现状及其改革与发展策略

河南省高等医学教育为河南省医疗卫生事业的发展培养了大批合格的医药卫生人才,但也存在着一些问题与不足,其整体发展状况与社会的进步、科学技术的发展、卫生事业改革的需要仍然不相适应.本文就河南省高等医学教育现状、存在问题进行了调查研究,并提出了相应的改革与发展策略.     

中高制多层次办学模式的体会

随着医学教育的改革发展，中等医学教育出现了大的调整改进，原来一些基础条件较好的中专学校走上与高等医学教育单位联合办学，办卫生高职教育的路子，同时又保持中专教育层次，体现出一种多层次、多样化办学的新模式。如何适应这种新模式，把中专、大专两个层次的医学教育都作好，培养合格人才，满足医学教育和医疗卫生人才市场的需求，是办学单位领导工作面临的一个新课题、新任务。     

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.