构建“全程、分段式”临床技能培训与考核体系

为满足医学院校对医学生培养目标的要求,西安交通大学临床技能国家级实验教学示范中心建立了"临床基本技能""临床专科技能"和"临床综合技能"三个级别的训练平台.从医学生进入临床学习开始到毕业,构建了以临床课程教学为载体、以临床技能中心为主要培训基地、涵盖医学生"见习、实习和毕业前"三个阶段的"全程、分段式"临床技能培训体系,将临床技能的培训与考评融入医学生临床阶段教学的全过程.经过两年多的实践,该体系有效提升了医学生的临床实践能力,提升了医学教育质量,帮助学校顺利达到预期教学目标.     

对医学院校建立临床技能培训中心的几点思考

文章阐述了建立临床技能培训中心的必要性与重要性,认为临床技能培训中心应优化整合多学科实践教学内容,形成“临床基本技能训练”、“临床诊治思维能力训练”、“临床辅助检查教学”与“医患沟通技巧”四大临床技能教学模块,构建多角度、全方位、深层次、系统化的临床技能课程体系,架构多学科、综合性临床实践教学平台,应用标准化病人,加强医学生临床综合技能与临床诊治思维的培训,以满足从医学生到临床医生不同结构、不同层次和不同阶段的教学、培训、考核、学术研究与学术交流的需求。     

临床技能中心多层次医学训练平台构建与应用

临床技能中心可以整合多学科实践教学资源,建设阶梯式多层次医学训练平台,构建从临床专业医学本科生到硕士生、博士生的临床实践技能教学体系,并逐级建设医师资格实践技能考试、住院医师规范化培训和专科医师实践技能训练与考核平台,以满足从医学生到临床医生不同阶段的实践教学、技能培训、学术交流和研究的需要。     

医学生临床技能培训的探讨

临床医学是一门实践性很强的科学,临床技能教学是临床医学教学中的核心内容之一。由于传统教学模式的局限性,医学生临床技能培养尚存在很多不足。针对目前临床技能教学中存在的问题,只有建立科学的临床技能培训体系,才能培养出高素质医学专业人才。对医学生进行临床技能培训对毕业后从事临床工作有重要意义。     

临床生产实习操作技能训练手册的建立与管理

以医学生临床生产实习技能操作为重点,从训练手册的建立、技能培训、出科考核到管理等几个方面进行了阐述,以期对建立五年制医学生临床生产实习过程监控体系的实践进行探讨。     

临床技能教学平台的规划与建设

复旦大学上海医学院临床技能学习中心的建设，为临床医学各学科提供了教学平台，为医学生提供了临床技能实践操作机会。中心建立了临床技能教学平台，引入先进的临床教学模型和电子模拟人系统，对医学生进行各种临床技能培训，形成并完善了客观的评价体系，为改善临床教学和技能实践提供了可能的场所与硬件支持。目前，临床技能教学平台已经完成了初步建设并制定了进一步的发展规划。     

以临床技能中心建设为契机 加强临床实践教学改革

临床实践教学是医学教学过程中重要组成部分,是医学生理论联系实际、医学基础知识与临床实际工作衔接的重要时期,是由医学生到住院医师的必经之路。因此,在临床实践教学中,重视和加强医学生素质教育和创新能力、实践能力的培养尤为重要。以建设临床技能培训中心为契机,进行改革临床技能教学管理模式,建立科学、有效的教学方法,培养医学生正确的临床思维方式和创新意识具有重要意义。     

“5+3”背景下医学生感官系统技能培训体系建设

为探索以器官-系统为中心的整合课程的教学改革，本项目在“5＋3”医学生中进行了针对感官系统的临床技能培训新体系建设。根据当前医学教育改革发展的趋势和要求，结合目前临床技能教学的现状，项目整合了包括耳鼻咽喉科、眼科及皮肤科的基础与临床教学内容，设计了新的临床技能培训体系，其中包括编写新的教材，制定新的教学大纲，由专门的教学组负责实施，培训方式包括模拟训练和床旁实战训练，考核方法包括操作能力考核和临床病例考核，培训内容则涵盖各专业常规操作技能。经过实践运用，证实该培训体系能快速有效地提升学生的临床操作技能，取得了良好的教学效果。     

临床技能竞赛背景下医学生临床教学检视与反思

为创新医学生实践教学体系,提高临床教学质量,结合大学生临床技能竞赛检视和反思当前医学生临床教学现状及存在的问题,就技能竞赛背景下暴露的医学生重理论、轻实践的知识结构以及实习内容、质量等方面存在的问题,提出发挥以赛促教作导向作用,建立完整的临床技能教学体系、加强实习管理、建立临床技能训练中心等建议。     

发展医学模拟教学 提高临床技能水平

以临床技能综合培训中心为平台的模拟教学对医学生临床技能的培养具有重要意义,是培养医学生临床技能的重要形式.利用标准化病人、各种穿刺模型以及多功能综合模拟人等对医学生进行临床基本技能培训及临床思维能力、沟通能力和急救意识的培养,通过理论和技能考核方式进行教学评价、反馈,以调查问卷等多种形式评估探讨模拟教学在医学生技能培养中的作用。     

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…     

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.     

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.     

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.     

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.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.