研究生科研能力培养的探索与实践

硕士研究生科研能力的培养是一个复杂的培养过程，笔者结合研究生教育的实践活动，提出要抓，科研道德素质、科研创新思维、科研实践能力、科研合作能力、科研表达能力共五个方面的培养。     

心血管外科临床专业学位研究生培养的几点思考

临床专业学位研究生是高素质临床医生的重要来源。心血管外科临床专业学位研究生培养过程中，应以综合能力培养为中心，侧重临床工作能力的培养，同时不能忽略科研能力的培养。临床工作要加强临床技能的培养，利用循证医学培养医学生的思维能力。科研能力的培养应注重研究生独立科研能力的培养，并掌握一定的科研方法。道德教育是成为合格医生的关键和保证。[第一段]     

提高中医药研究生科研能力的探讨

科学技术是第一生产力,教育是基础,人才是关键。中医药学要发展,要创新,关键是我们培养的中医药人员的科研素质,尤其是将成为我国跨世纪中医药人才研究生的科研能力的提高。而研究生科研能力的提高在很大程度上取决于学科水平,包括师资的素质、学科的学术水平、实验条件等。目前由于受中医传统教育思想的影响,中医药研究生的科研能力发展受到了一定限制。为了使培养出来的中医药研究生更多地成为未来中医药的学科带头人,能担负起继承和发展中医药的重任,笔者就目前中医药研究生科研能力的培养作如下探讨。     

专业型医学研究生科研创新能力培养面临的问题及思考

在“四证合一”的专业型医学研究生培养新模式下,研究生科研能力的培养面临新的机遇与挑战。学校、医院、导师和学生尚存在不同程度的忽视研究生科研能力培养的现象;多学科协作诊疗（MDT）是现代医学发展的重要方向。本文探讨将临床MDT理念引入临床科研团队建设,将临床问题与基础研究结合,以临床病种为中心、以基础研究为平台,整合临床科室和基础研究人员,构建临床科研MDT团队,对适应专业型医学研究生培养要求,提高研究生的主观能动性和科研素质以及科研效率和质量具有积极意义。     

护生临床实践中的“带”与“教”

护生临床实习是护理教育的重要组成部分，是在校护生实现理论知识向实践能力转化．护生向护士角色转变的重要阶段。而临床带教是医疗教学工作的重要内容。是培养护生成为合格护理人员的关键，是要达到使受教育者能够成为从事护理实践、护理教育、护理管理、护理科研高级人才的目标。为此，在教学工作中，作为带教人员，要明确教育的任务是传授知识．培养护生创新能力、合作能力、动手能力和解决问题的能力。本文总结我院多年临床带教经验（我院是一所集医疗、保健、预防、科研、教学为一体的综合性二级甲等医院）．在带教过程中就如何选择带教老师、如何安排护生使之理论与实践相结合，培养高素质护理人员的问题，与同行们共同探讨。     

试谈青年医学科研人员思想品德的培养

作者在长期的医学科研管理工作实践中,深感当代青年医学科研人员,不仅要有才智和科研能力,更重要的是要具有良好的道德品质修养。在今后的医学科研工作中,对青年医学科研人员来说,除了在学术水平、研究能力等业务素质方面的培养提高外,更重要的是要注重科研道德品质的培养。     

中西医结合临床专业研究生科研协作能力的培养

科研协作能力是衡量科研机构研究水平的重要标准，也是研究生培养的重要内容。跨单位协同培养、跨导师培养和研究生之间的科研协作是提升中西医结合专业研究生科研协作能力的有效培养模式。     

关于医学本科教育中加强科研能力培养的探讨

关于医学本科教育中加强科研能力培养的探讨泸州医学院附属医院陈良海，李刚，彭永权高等医学本科教育既要培养有专业理论知识及实际工作能力的实用型人才，又要培养有一定科研能力的高级人才，以适应当今突飞猛进的医学发展需要。但目前医学本科教育中，对医学生科研能力...     

浅谈医学生科研能力的培养

如何培养合格的新型医学生是当今医学教育所面临的重要课题。现代医学教育要求医学生毕业后应具备医疗、教学、科研等多方面的能力。为了适应当今快速变化的医学模式需要．应大力提倡素质教育，积极培养医学生的思维能力、分析能力及创造能力，培养学生的科研意识，均衡发展学生的综合能力．为我国医学事业的发展培养高素质、复合型的医学人才。现就医学生科研能力的培养谈几点认识和体会。     

高等中医药院校教务人员素质调查分析

高等中医药院校要提高办学水平，就要拥有一支高素质的教学管理队伍。通过全国20所中医药院校教务人员的问卷信函调查，结果表明：目前，高等中医药院校教学管理队伍虽然政治素质比较高，基本实现了年轻化、知识化，但依然存在着队伍不稳定、教务人员知识结构不合理、缺乏自我提高意识、科研能力较弱等现象。要改变这种现状，需要转变观念，认识到提高教务人员素质的重要性，并有计划地逐步优化教学管理队伍的结构，对目前的教务人员采取提供多形式、多渠道的培养，鼓励教务人员开展科研等方式对其素质加以提高，并要形成一套行之有效的考核制度和激励机制。     

Fieldwork and social science research ethics

Fieldwork as a part of social science research brings the researcher closest to the subject of research. It is a dynamic process where there is an exchange between the researcher, participants, stakeholders, gatekeepers, the community and the larger sociopolitical context in which the research problem is located. Ethical dilemmas that surface during fieldwork often pose a unique challenge to the researcher. This paper is based on field experiences during an action research study conducted with a human rights perspective. It discusses the role conflict that researchers face during fieldwork in a situation of humanitarian crisis. It raises issues pertaining to the need to extend the ethical decision-making paradigm to address ethical dilemmas arising during the course of fieldwork.     

Ethics in a scientific approach: the importance of the biostatistician in research ethics committees

In medical practice and research it is necessary to consider the rights of the researcher or physician and of the subject or patient, to conform to scientific standards and to examine the appropriateness with respect to laws and moral values. Research ethics committees have an important role to play in ensuring the ethical standards and scientific merit of research on human subjects. Research of no scientific value is also against ethical principles. To obtain valid and reliable results from biomedical research, it is a scientific and ethical obligation to make use of the science of statistics. Therefore, for research to be evaluated using biostatistics intensively from ethical and scientific points of view, a biostatistics expert is necessary on research ethics committees. Developments in Turkey are used as examples.     

Trust based obligations of the state and physician-researchers to patient-subjects

When may a physician enroll a patient in clinical research? An adequate answer to this question requires clarification of trust‐based obligations of the state and the physician‐researcher respectively to the patient‐subject. The state relies on the voluntarism of patient‐subjects to advance the public interest in science. Accordingly, it is obligated to protect the agent‐neutral interests of patient‐subjects through promulgating standards that secure these interests. Component analysis is the only comprehensive and systematic specification of regulatory standards for benefit‐harm evaluation by research ethics committees (RECs). Clinical equipoise, a standard in component analysis, ensures the treatment arms of a randomised control trial are consistent with competent medical care. It thus serves to protect agent‐neutral welfare interests of the patient‐subject. But REC review occurs prior to enrolment, highlighting the independent responsibility of the physician‐researcher to protect the agent‐relative welfare interests of the patient‐subject. In a novel interpretation of the duty of care, we argue for a “clinical judgment principle” which requires the physician‐researcher to exercise judgment in the interests of the patient‐subject taking into account evidence on treatments and the patient‐subject‘s circumstances.With increasing demand for contemporary medicine to be placed on a firmer scientific foundation, clinical research is enjoying unprecedented expansion. Accordingly, doctors in increasing numbers are participating in clinical trials, as are greater numbers of patients. Hence, it is surprising that the central moral dilemma of the randomised controlled trial (RCT) remains so vexing: when may physicians, consistent with their duty of care to patients, offer the them enrolment in an RCT?¹ If reasonable public trust in the ethical integrity of clinical research is to be maintained, a convincing answer to this question must be given. Presently, we explore the dilemma, examine solutions that have failed to galvanise support, and offer a new one.The dilemma arises because offering patients enrolment in RCTs imperils the doctors'' duty to act in their interests. This is because, in seeming contrast to clinical practice, an activity structured to protect and advance the medical interests of the patient, clinical research necessarily calls for the pursuit of other interests, including the public interest in the production of generalisable knowledge, and the variable private interests of industry, institutions and researchers. The pursuit of these interests inevitably influences the conduct of clinical research materially. To ensure scientifically valid results, treatment in a clinical trial is restricted by design features of the study protocol (eg, randomisation to treatment, blinding of treatment allocation and fixed schedules for treatment provision). Further, patient‐subjects typically undergo non‐therapeutic procedures to answer the scientific question. In these ways, the demands of science place the conduct of clinical trials in tension with the doctor‐researcher''s positive duty of care (hereinafter referred to as duty of care) to the patient‐subject.Hellman and Hellman² have argued that an unmanageable conflict exists between the interests of the patient‐subject and those of others in clinical research. Conducting RCTs, in their view, necessarily violates the rights of patient‐subjects to have their interests protected. They view the rights violation as being of such magnitude that RCTs on patients must be abandoned and replaced by non‐randomised forms of clinical research. We believe that their position is untenable. RCTs have a pivotal role in the generation and scrutiny of the evidentiary foundation of clinical practice. The results of clinical research are not merely of private and academic interest; they further the public good of high quality medical care. Without clinical research, much of the practice of medicine would remain untested, and medical progress would be stymied. Furthermore, we question whether the tension between the demands of science and the rights of patients results in an insoluble conflict of interest, requiring an either/or solution.A recent proposal from the US purports to solve the dilemma by denying its existence. Miller and colleagues deny that doctor‐researchers operate under a duty of care to patient‐subjects. They argue as follows. Clinical practice and clinical research have differing goals. The goal of clinical practice is to provide the patient with optimal care. The goal of research is to produce generalisable knowledge that may benefit future patients and society. They assert that because the goals of clinical practice and clinical research differ, the norms governing each must not overlap.³ Implicit is the suggestion that the physician‐researcher ceases to be a physician when conducting research by virtue of the nature of research as an activity. They explicitly deny that the physician‐researcher has a positive obligation to act in the interests of the patient‐subject when conducting research.^4,5 The only duties of the physician‐researcher to the patient‐subject are to obtain informed consent and avoid exploitation.The solution given by Miller and colleagues is unsatisfactory. It has already been noted that an implausible form of moral dissociation is required, whereby doctors engaging in research must wilfully ignore the professional obligations they have as doctors.⁶ Further, the assertion that activities themselves generate norms is counterintuitive and requires argument. Finally, the additional assertion that the norms governing activities with differing ends are non‐overlapping is obviously false. Norms prohibiting fraud and murder are universal and thus apply across diverse activities. Worse still, Miller et al''s view is internally inconsistent on this very point. They recognise a duty to obtain informed consent applicable to clinical practice and clinical research. Thus, at least one norm in their schema is overlapping, refuting a central premise of their argument.Given this, we think physician‐researchers will rightly continue to wonder about the implications of their duty of care to patient‐subjects when conducting clinical research. When, consistent with this obligation, can a doctor offer a patient enrolment in an RCT? Is approval by the research ethics committee (REC) sufficient? Is there a role for clinical judgement when doctors act as physician‐researchers? To consider these questions and the broader dilemma satisfactorily, in our view, requires recognition and elucidation of the independent obligations of the state and the doctor‐researcher to protect the interests of patient‐subjects. These obligations are understood to be derived from the trust‐based relationship between the patient‐subject and the state and the doctor‐researcher, respectively.     

Local Research Ethics Committees can audit ethical standards in research.

OBJECTIVES: To show that a Local Research Ethics Committee (LREC) can carry out an audit of ethical standards in research. To find out if a researcher met certain ethical standards in recruiting subjects for clinical trials and in obtaining their consent. DESIGN: Postal questionnaire. SETTING: Clinical research by one doctor during one year. SUBJECTS: Eleven patients entered in clinical trials. MAIN OUTCOME MEASURES: Success in ethics committee obtaining data. Achievement of ethical standards in recruitment of subjects and in obtaining consent. RESULTS: The audit was successfully carried out and standards were partly met. CONCLUSIONS: Local Research Ethics Committees can carry out audits of the conduct of research projects which they have approved. Provision for possible audits can be made at the time of application to the committee. Our committee thought the ethical standards in the research which we audited were acceptable.     

The return of individual research findings in paediatric genetic research

The combination of the issue of return of individual genetic results/incidental findings and paediatric biobanks is not much discussed in ethical literature. The traditional arguments pro and con return of such findings focus on principles such as respect for persons, autonomy and solidarity. Two dimensions have been distilled from the discussion on return of individual results in a genetic research context: the respect for a participant's autonomy and the duty of the researcher. Concepts such as autonomy and solidarity do not fit easily in the discussion when paediatric biobanks are concerned. Although parents may be allowed to enrol children in minimal risk genetic research on stored tissue samples, they should not be given the option to opt out of receiving important health information. Also, children have a right to an open future: parents do not have the right to access any genetic data that a biobank holds on their children. In this respect, the guidelines on genetic testing of minors are applicable. With regard to the duty of the researcher the question of whether researchers have a more stringent duty to return important health information when their research subjects are children is more difficult to answer. A researcher's primary duty is to perform useful research, a policy to return individual results must not hamper this task. The fact that vulnerable children are concerned, is an additional factor that should be considered when a policy of returning results is laid down for a specific collection or research project.     

Children, Gillick competency and consent for involvement in research

This paper looks at the issue of consent from children and whether the test of Gillick competency, applied in medical and healthcare practice, ought to extend to participation in research. It is argued that the relatively broad usage of the test of Gillick competency in the medical context should not be considered applicable for use in research. The question of who would and could determine Gillick competency in research raises further concerns relating to the training of the researcher to make such a decision as well as to the obvious issue of the researcher's personal interest in the project and possibility of benefiting from the outcome. These could affect the judgment of Gillick competency if the researcher is charged with making this decision. The above notwithstanding, there are two exceptional research situations in which Gillick competency might be legitimately applied: (1) when the research is likely to generate significant advantages for the participants while exposing them to relatively minor risks, and (2) when it is likely to generate great societal benefit, pose minimal risks for the participants and yet raise parental objection. In both cases, to ensure that autonomy is genuinely respected and to protect against personal interest, Gillick competency should be assessed by an individual who has no interest or involvement in the research.     

葛仙米水溶性多糖的抗菌性实验研究

目的:葛仙米是一种富含多糖的藻类,本文旨在研究葛仙米水溶性多糖的抗菌作用。方法:本实验采用滤纸贴片法对从葛仙米中提取的水溶性多糖进行抗菌性研究,所用受试菌种为金黄色葡萄球菌、大肠杆菌、绿脓杆菌和霉菌。结果:葛仙米水溶性多糖对以上4种菌均有抑制作用,而其对绿脓杆菌的抑制作用最为明显。结论:葛仙米水溶性多糖具有显著的抗菌和防腐作用,表明葛仙米可作为新型(绿色植物)医药开发的研究对象。     

树结构法及其在医学研究中的应用

目的：介绍树结构法的基本原理与方法,并用分类树法对医学研究中的实例进行分析。方法：采用单变量分裂,以Ｇｉｎｉ相异性指标为分裂原则,１０层互相证实法及１－ＳＥ准则估计错分率,用最小复杂性指标的向上删剪法产生最终树。结果：分类树共引入５个费用影响因素,并最终分为６个终节点。结论：该分类树结果简单、直观,易于理解与解释,与实际的疾病费用分布不矛盾,可以作为该疾病费用分类系统的建立方式     

潜艇长航应激ABC理论模型概述及对我军的启示

本文主要介绍美国海军潜艇医学研究实验室的资深潜艇心理学研究员Benjamin B.Weybrew提出的潜艇长航应激ABC理论模型,总结基于此理论模型的美军潜艇心理学研究与实践工作情况,并分析该模型在实际应用中存在的缺陷,为我军未来开展潜艇医学与心理学研究提供参考.