医学生临床实习质量的影响因素与对策

临床实习是从医学生向临床医生过渡的关键时期。影响临床实习的因素很多,诸如医疗纠纷等社会因素;临床教师的功利主义倾向、教学水平和教学意识等影响;学生的功利化趋势及片面追求高学历而忽视了实习等。因此,深化医学教育教学改革,加强内涵建设是提高医学生临床实习质量的必然途径。概括而言,即加强管理建设,抓好环节质量控制;提高教师教学水平,强化教学意识,建设一支高素质的师资队伍是核心;大力开发利用现代化教学手段,充分利用教学资源是强劲推动力等,以提高医学生的临床实习质量。     

浅谈五年制医学生毕业实习质量的影响因素及对策

毕业实习是实现医学生培养目标的关键阶段。就目前形势来看 ,影响毕业实习的因素很多 ,诸如医疗纠纷等社会因素 ;临床教师的功利主义倾向、教学水平、教学意识等的影响 ;学生的功利化趋势及片面追求高学历而忽视了毕业实习等。因此 ,深化医学教育教学改革 ,加强内涵建设是提高五年制医学生毕业实习质量的必然途径 ,概括而言即加强管理建设 ,抓好环节质量控制 ;提高教师的教学水平 ,强化教学意识 ,建设一支高素质的师资队伍是核心 ;大力开发利用现代化教学手段 ,充分利用教学资源是强劲推动力     

浅谈影响毕业实习质量的因素及对策

毕业实习是实现医学生培养目标的关键阶段。就目前形势 ,影响毕业实习的因素很多 ,诸如医疗纠纷、双向选择、用人制度改革等社会因素对毕业实习的冲击 ,临床教师的功利主义倾向、教学水平、教学意识等的影响 ;学生就业的功利化趋势及片面追求高学历而忽视了毕业实习等。因此 ,深化医学教育教学改革 ,加强内涵建设是提高毕业实习质量的必然途径 ,概括而言即加强管理建设 ,抓好环节质量控制 ,做好医学生的思想教育是关键 ;提高教师的教学水平 ,强化教学意识 ,建设一支高素质的师资队伍是核心 ;大力开发利用现代化教学手段 ,充分利用教学资源是强劲推动力。     

加强医学生临床实践能力培养的探索与实践

医学是一门实践性特别强的学科，在临床实习阶段必须重点加强临床实践能力的培养。医学生临床实践能力水平的高低是评价医学教育质量的重要指标之一。近年来我们通过实行导师制，提高临床教师的实习教学带教水平；改革出科考核方法，确立科学的评估方案；调整教学计划，缓冲考研和就业对临床实习的冲击等途径来加强医学生临床实践能力的培养。实践征明，大大增强了学生临床实践技能训练的主动性和自觉性，全面提高了临床实习教学质量。     

医学生临床实习的影响因素与对策

目的总结医学生临床实习存在的不足,探讨全面提高实习质量的对策。方法对医学生临床实习过程中存在的问题和影响因素进行全面分析,结合临床实习的特点和规律,提出相应的对策。结果通过对影响医学生临床实习诸多因素的预防或克服,提高临床教师教学积极性,激发学生对临床实习的兴趣,加强对实习质量的监控,促使了临床实习的良性循环。结论形成有利于临床实习的环境,可提高临床实习质量。     

医学生毕业实习质量的影响因素分析及对策

高校的普遍扩招但医学教育资源并未同步增长，给医学生毕业实习质量带来严峻挑战。影响质量主要因素有：课间见习数量和质量下降影响日后的实习；实习条件较好的医院实习生、进修生人满为患，再加上因医疗风险和医疗管理制度的限制而导致学生技能操作机会明显减少；实习医院的管理和学校的监管不到位；带教老师的教学意识淡泊，学生考研和就业占用大量的时间和精力。主要对策：提高实习前实践教学的效果；加强实习纪律教育；配强实习组长，加强实习检查；创造有利于临床实习的政策环境；丰富教学活动，提高带教质量；加强实习成绩考核，开展评教、评学、评优。     

医学生生产实习管理模式改革的探讨及应用

近年来医学生生产实习阶段由于受考研、就业等因素的影响，质量逐年下滑。我们从管理方面制定一系列规章制度,严抓严管,从教师方面，改变教学模式、方法、并采取一系列激励措施，提高教师带教意识；从学生方面，通过调整实习时间，严格考勤制度等措施，确保实习质量，培养优秀合格的医学生。     

提高医学生肿瘤学临床实习质量的探讨

医学生临床实习是医学教育的最后阶段,是培养合格医学人才的重要环节,也是医学生在医学领域由感性认识过渡到理性认识的实践阶段。这一时期处理的好坏,尤其是医学生对临床实习质量的认识程度、带教教师的态度和教学医院的环境对提高医学生临床实习质量有着直接的影响。不可否认,近年来随着社会的发展,医学生毕业分配面临的就业压力、医院自身的管理体制改革、患者维权意识的增强、学生考研因素及教师的带教积极性等多方面影响,制约了医学生临床教学的发展,出现了临床实习质量令人担忧的现象。作为临床肿瘤学实习教学,由于时间短,加之目前肿…     

在临床教学过程中加强实习生管理的实践与思考

临床毕业实习是医学生向临床医生过渡最关键的时期,是培养学生具有良好医德医风,巩固专业基础理论知识和提高临床基本技能的重要环节。教学医院加强教学内涵建设的同时,实习生的管理是一个不容忽视的严峻课题。当前受多种因素的影响例如学生自身的懒惰、就业的迷茫等使临床实习质量呈现滑坡趋势。本文通过分析医学生实习的现状来谈谈如何加强实习生的管理内涵,提高医学生的临床实习质量。     

论提高医学生实习质量的对策与措施

针对医学生临床实习困难大、带教师资队伍薄弱、实习管理脱节、实习质量难以保证等问题，探讨加强医学生实习立法、加强实习基地建设、建立多元化实习模式、加强实习监督、强化实习考核与实习鉴定等是提高医学生临床实习质量的重要措施。     

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.     

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.     

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…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.