临床医学研究生导师能力评价指标体系的构建及信度和效度分析

目的　构建临床医学研究生导师能力评价指标体系。方法　在"文献优选法"基础上，采用"德尔菲法"由14名专家初步构建指标体系。在109人的调查研究中，采用Cronbach’s α系数和探索性因子分析进行信度和效度评价，采用层次分析法计算各指标权重。分别使用SPSS 26.0和AMOS 26.0软件完成统计分析。结果　临床医学研究生导师能力评价指标体系包含2个一级指标、5个二级指标、27个三级指标。总指标体系、一级指标和二级指标内部Cronbach’s α系数为0.833~0.931。探索性因子分析共萃取5个公因子，因子内涵与理论结构基本相符。以5个二级指标为一阶因子建立验证性因子模型，理论模型与实际数据拟合良好。三级指标"导师治学态度""导师医德医风""导师主持承担的科研课题""研究生学位论文质量""研究生科研培养质量""研究生临床培养质量""导师可支配的科研经费"为组合权重值的前7位。结论　构建的临床医学研究生导师能力评价指标体系内涵比较合理，具有良好的信度和效度，可作为导师评价的参考依据。     

基于绩效激励机制、着重于临床能力培养的实习生评价指标体系研究

目的　构建以临床能力培养为中心的实习生评价指标体系,根据指标体系建立绩效激励机制,以提高实习生临床能力水平。方法　采用主观赋值法、专家咨询法构建5个一级指标、15个二级指标,并通过问卷和深入访谈的形式对评价指标体系指标、分值设置进行专家咨询。结果　专家咨询的反馈结果指出,指标体系里教学查房、小讲座的分值需要进行调整,同时设置最低毕业标准,以此标准确定是否能参加结业考核。结论　教学查房、小讲座分值提高,病例讨论分值降低,结业考核分数不纳入最低标准。在建立初步的指标体系后,还将通过一系列配套措施（包括导师双选、研究生复试等政策导向进行绩效激励）,同时采用新的教学方法,通过开展学生为主导的教学活动,注重形成性评价等方面,积极提升实习生临床能力。     

影像专科护士核心能力评价指标的构建、信效度检验分析

目的　探讨影像专科护士核心能力评价指标的构建、信效度检验分析。方法　首先成立研究小组查阅相关文献资料,经过研究小组成员反复讨论并邀请影像专科护士讨论、修改、完善评价指标体系框架,形成影像专科护士核心能力评价指标体系专家咨询问卷。通过两轮专家咨询构建影像专科护士核心能力评价指标体系,并以构建的指标体系为依据编制问卷调查表。采用问卷调查的方法验证本研究所构建的影像专科护士核心能力评价指标体系的合理性和科学性。结果　构建的影像专科护士核心能力评价指标体系包括3个一级指标、20个二级指标和48个三级指标。评价指标体系总体Cronbach’s α系数为0.972,一级指标影像专科护理理论知识、影像专科护士护理实践技能、相关能力的Cronbach’s α系数分别为0.915、0.934、0.924。指标体系总体内容效度（content validity index,CVI）指数（S-CVI）为0.977,各条目的内容效度指数（I-CVI）为0.812~1.000。一级指标与指标体系总体相关系数为0.800~0.936（P<0.05）,二级指标与相应一级指标相关系数为0.562~0.972（P<0.05）,三级指标与相应一级指标的相关系数为0.362~0.914（P<0.05）。结论　构建的影像专科护士核心能力评价指标问卷信度良好,内部结构一致,具有较好的可行性、可靠性、合理性和科学性,为影像专科护士核心能力培养考核和评价提供了理论依据和实践指南。     

临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革方案指标体系构建研究

目的　探索临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革方案。方法　采用文献分析法、专家访谈法初步构建并轨培养方案初步框架,通过专家咨询法确定最终指标体系。通过Excel 2010录入数据资料,利用SPSS 19.0软件进行统计分析。结果　经过两轮专家咨询,从招生方式、培养资源、培养内容、培养方式、培养考核、质量监控这6个方面最终确定了临床医学专业学位博士与专科规范化培训医师并轨培养的框架,建立了包含6个一级指标、26个二级指标、72个三级指标的并轨培养方案指标体系。结论　通过科学地制定系统的培养方案,建立以岗位胜任力为核心培养内容和全方位考评体系,使用弹性学制,为开展临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革提供了依据。     

以胜任力为导向的"特殊环境医学"课程内容体系的构建

目的　以学员岗位胜任力为导向构建新开课程"特殊环境医学"的课程内容体系。方法　结合军校学员特点，分析中国医师岗位胜任力需求，利用科学的方法进行课程内容体系构建。本研究采用德尔菲法和层次分析法构建特殊环境医学课程内容体系。遴选的专家意见用Kendall’s W协调系数表示，用卡方检验进行统计分析。各级条目层级和权重采用层次分析法，一致性比率（CR）作统计检验。通过检验（CR<0.1）方可纳入体系内。结果　遴选的专家权威性、积极性高，专家意见一致性好，并形成了5条Ⅰ级条目、15条Ⅱ级条目、54条Ⅲ级条目的教材内容体系和13个知识模块用于实际授课，以及1种综合研讨课。结论　以中国医师岗位胜任力的需求为指导，通过定性和定量相结合的研究方法，构建了特殊环境医学教学课程内容体系。     

基于CiteSpace知识图谱软件分析中医住院医师规范化培训的热点和趋势

目的　通过CiteSpace知识图谱软件分析1998年至今中医住院医师规范化培训研究的进展、热点和未来趋势。方法　检索中国知网中关于中医住院医师规范化培训的相关文献。经Refworks格式转换后,利用CiteSpace 5.6 R3软件进行知识图谱的构建。分别绘制中医住院医师规范化培训研究相关文献的作者合作、机构合作、关键词共现,以及分时区研究热点视图。结果　共获得259篇相关文献,作者253名,发表文章最多的是任献青和崔瑾（各4篇）,发表文献最多的机构为北京中医药大学（23篇）。共有259个关键词,得到频次大于5且中心度大于0.1的关键词16个,关键词聚类标签14个。共探测到15个突现词,并据此展开趋势讨论。结论　中医住院医师规范化培训的研究趋势主要跟随政府职能部门出台的相关政策而定,研究热点则取决于各规培基地在实际应用中所遇到的阻碍和困境。     

116项继续医学教育项目评估结果及影响指标分析

目的　分析116项继续医学教育项目评估结果并探讨影响评估结果的指标,为明确项目质量评估重点提供参考。方法　采用卡方检验、Fisher精确检验对28个指标的评估结果进行单因素分析,采用logistic回归进行多因素分析。结果　logistic回归显示：项目基本信息一致性[OR=6.712,95%CI（1.314~34.275）]、主办单位是否提供教材[OR=109.386,95%CI（2.577~4 642.659）]、现场学员与签到人数是否符合[OR=13.296,95%CI（2.440~72.456）]、学员考核材料反馈[OR=19.069,95%CI（3.713~97.929）]、教师评估材料反馈[OR=13.497,95%CI（2.672~68.181）]和主办单位是否按要求送审学分[OR=51.326,95%CI（4.999~526.996）]为继续医学教育项目评估结果合格与否的影响指标。结论　继续医学教育管理部门应健全项目评估制度,根据研究结果改进并完善评估指标,重视影响评估结果的指标,发挥评估指标的导向作用。     

医学院校青年教师规范化培训考核指标体系构建

目的 构建医学院校青年教师规范化培训考核指标体系,用于培训实践,提高培训质量。方法 通过文献分析和小样本专家访谈初步确立考核指标体系,而后采用德尔菲法对40名熟悉医学院校青年教师规范化培训的专家进行咨询,并根据专家意见对考核指标体系修改后再咨询,直到所咨询专家意见基本一致。用层次分析法对各指标赋权。使用SPSS 17.0软件对数据进行分析处理。结果 经过两轮专家咨询,35名专家对各指标的认同率达到90%以上,意见基本一致;各指标权重变异系数（W值）为0.00~0.15,集中程度较高。最终构建了一套青年教师规范化培训考核指标体系,包括4个一级指标、11个二级指标和35个三级指标。结论 该考核指标体系为科学评价医学院校青年教师规范化培训效果提供了保障,通过发挥“以评促建、以评促导”作用,提高了医学院校青年教师规范化培训质效。     

基于Delphi法的全科医师岗位胜任力评价体系研究

目的　创建一套用于全科医师岗位胜任力评价的体系。方法　2020年4至10月,采用专家咨询法对全科医师岗位胜任力评价的4项一级指标和48项二级指标的重要性进行咨询。采用Excel 2016和SPSS 22.0软件进行数据录入和统计分析。结果　咨询专家16名,两轮积极系数分别为100%和75%;专家总体权威系数Cr为0.85;两轮专家咨询一级指标的重要性赋值均数分别为8.07~9.00、8.67~9.00,变异系数分别为0~0.16、0~0.09;二级指标的重要性赋值均数分别为6.79~9.00、8.17~9.00,变异系数为0~0.38、0~0.16;协调系数检验均具有统计学意义（P<0.001）。最终形成包含4项一级指标和32项二级指标的全科医师岗位胜任力评价体系。结论　构建的全科医师岗位胜任力评价体系专家积极度和协调度比较高,专家意见协调性好,可信度高,可为全科医师培养的岗位胜任力评估提供参考。     

基于德尔菲法构建临床护理带教教师遴选指标体系

目的 构建临床护理带教教师遴选指标体系，为提高临床带教教师综合素质及本科护生临床综合实践能力提供理论依据。方法 采用文献回顾法、头脑风暴法、半结构访谈法，初步构建临床带教教师遴选指标体系；应用德尔菲法对25名专家进行两轮咨询；应用SPSS 20.0统计软件分析咨询数据，通过计算专家积极系数、权威系数、意见集中程度及协调程度等指标，根据专家意见对指标内容进行修改、完善；最终确立临床护理带教教师遴选指标体系。结果 两轮咨询专家积极系数均为96%，专家权威系数分别为0.857、0.848，专家协调系数为0.277~0.442（P<0.001），确定了4个一级指标、12个二级指标及45个三级指标。结论 临床护理带教教师遴选指标体系具有较高的科学性和可靠性，可为临床带教教师的筛选提供理论依据。     

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…     

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.     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.