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。     

临床医学专业学位在读硕士研究生满意度调查

目的　调查临床医学专业学位在读硕士研究生对课程培养、实践培养、科研培养、导师培养、管理服务方面的满意度,发现问题并提出对策建议。方法　采用问卷对广西某高等医学院校1 585名临床专硕进行满意度调查。使用SPSS 20.0软件对相关数据进行统计分析。定量资料统一采用（均数±标准差）进行统计描述,组间比较采用方差分析。结果　临床医学专业学位在读研究生在导师培养方面满意度最高,均值超过4分;在课程培养、管理服务方面总体为满意,但在实践培养、科研培养两方面的满意度评价呈现两极分化;其中补助津贴、科研工作的参与度、科研工作的强度均为不满意。结论　对于临床医学专业学位硕士研究生的培养,应该提高补助津贴待遇,提升学校管理服务能力;开拓科研培养平台,提升科研工作参与度;协同制订培养标准,适度提升科研强度。     

口腔医学硕士专业学位研究生生源质量的实证研究:基于指导医师对专业学位研究生综合评价的统计数据

目的　基于指导医师对专业学位研究生综合评价的统计数据对口腔医学硕士专业学位研究生生源质量进行实证研究。方法　对上海交通大学医学院附属第九人民医院67名口腔医学硕士专业学位研究生，在其出科时由其指导医师进行综合评价。使用SPSS 25.0进行t检验和方差分析。结果　67名学员综合评价平均得分为（91.39±3.55）分。综合评价指标具有较好的信度和效度。推免、统考、本校7年制转"5+3"和港澳台地区学生招录方式中，7年制转"5+3"培养学员的综合评价总分最高。初始成绩高分段学员的综合评价得分略高于低分段学员得分。学员本科就读高校为双一流高校和第四轮学科评估A、B档的学员得分较高。结论　应当重视生源质量，多渠道吸引优质生源，积极探索提高研究生生源质量的途径，同时努力夯实培训质量，并科学构建专业学位研究生综合考核评价体系，进一步深化"医教协同"内涵，促进口腔医学应用型高层次医学人才的培养与发展。     

《药物分析》课程本科教学改革和思考

目的　分析《药物分析》课程在当今药学本科教育培养过程中的现状，探索《药物分析》课程在新时代药学教育背景下的教学改革与创新，构建符合药学培养要求、满足社会市场需要的复合型药学人才培养模式。方法　第一阶段，开展教学改革的建议和需求调查；第二阶段，开展《药物分析》课程改革探索与实践；第三阶段，教学效果评价。结果　需求调查显示《药物分析》课程的教学内容、课程设计、教学手段亟须进一步优化和拓展。结论　该课程通过调整教学内容、拓展教学手段、创新多元化实践教学、融入"课程思政"建设等，激发了学生的学习兴趣和创新精神，强化了学生理论素养和实践能力，培养了其国际化视野和崇高的职业道德。     

医学统计学课程教学中课前预习指导方式的应用效果

目的　调查"医学统计学"课程教学中运用知识要点型和知识提纲型课前预习指导方式时学生的反馈情况。方法　将2018级临床医学五年制学生共126人，按宿舍号随机分配进两组。课前通过"雨课堂"分别给两组学生分发知识要点型和知识提纲型预习指导资料辅助其课前预习。采集预习指导材料利用情况，问卷调查学生对所接受预习指导方式的评价。本研究采用SAS9.4统计软件进行Wilcoxon秩和检验和卡方检验。结果　知识要点型组的课前预习材料总体完成率低于知识提纲型组（62.78% vs. 80.30%，P<0.001）。知识要点型和知识提纲型两组学生满意度评分中位数分别为89.50和90.00，组间差异无统计学意义（P=0.252）。总体上，61.90%（78/126）的学生非常喜欢或喜欢接受课前预习指导，75.40%（95/126）的学生认为指导对课堂学习有帮助或很有帮助，62.70%（79/126）的学生认为指导对课前预习效率的提升效果很高或较高，两组学生在此3方面的等级评价结果相近。结论　两种课前预习指导方式均可行、有效，知识提纲型组学生的预习完成率优于知识要点型组，教学中可考虑优先使用知识提纲型预习指导方式。     

某医科高校大学生公共选修课现状调查及分析

目的　了解某医科高校大学生对公共选修课（以下简称"公选课"）的重视程度、满意度及其影响因素，为学校公选课教学改革提供参考。方法　本研究采取定量问卷调查方式，随机抽取南方医科大学2018级在校大学生进行问卷调查。共计发放691份问卷，收回有效问卷674份。使用SPSS 20.0对数据进行描述性分析、单因素方差分析、多元线性回归分析。结果　学生的选课目的、对教师的评价、对课程的评价以及课程收获等与学生对公选课的重视程度和满意度得分差异有统计学意义（P<0.05）。在选课目的中，因提高综合素质选课的学生对公选课重视程度（4.30±0.73）分和满意度（4.34±0.69）分高于其他选项；在教师评价中，对教师教学评价良好的学生对公选课的重视程度（4.32±0.71）分和满意度（4.45±0.62）分高于其他选项；在课程评价中，对课程评价优良的学生的重视程度（4.35±0.71）分和满意度（4.47±0.63）分最高；在课程收获中，学生对课程收获较多的公选课的重视程度（4.75±0.53）分和满意度（4.85±0.36）分最高。对不同特征对象公选课满意度进行多元线性回归分析，发现性别、教学形式、教师评价、课程质量及课程收获5个变量对公选课满意度得分差异均有统计学意义（P<0.05）。结论　男性、探究式教学形式、对教师评价越高、对课程质量评价越高、课程收获越多，具有这些特征的学生公选课满意度较高。     

师生双角度评估临床及转化医学导师胜任力现况和导师培训需求

目的　通过师生双角度评估临床及转化医学导师胜任力现状的调查,为导师胜任力的师资培训提供依据。方法　选取北京协和医院临床及转化医学导师121人,以及临床医学博士后170人作为研究对象。采用中文版导师胜任力评估量表,从保持有效沟通、建立一致的预期和目标、评估学生、培养独立性、尊重多样性、促进学生职业发展6个维度26项条目,由临床及转化医学导师和临床医学博士后通过李克特量表（Likert scale）双角度评估导师胜任力。同时,调查临床及转化医学导师的构成和导师培训需求。应用SPSS 25.0软件进行t检验。结果　70.0%（119/170）的临床医学博士后认为导师指导非常有帮助,78.5%（95/121）的导师认为有必要开展导师培训。导师胜任力方面,临床博士后对导师的评价明显高于导师自我评价[各条目总分（162.35±23.59） vs. （154.80±19.81）,P<0.01]。临床博士后和导师对26项胜任力条目评价的优秀率分别为100.0%（170/170）和46.3%（56/121）。师生共同认为在建立基于信任的关系、激励学生方面做得较好,但在考虑可能带入到导师/学生关系中的偏见等方面存在不足。结论　前临床及转化医学导师具备良好胜任力,但仍存在较高的导师培训需求,需结合导师胜任力开展有针对性的导师培训和建立导师评价体系,以完善和提高医学人才培养体系建设。     

科研院所全日制卫生管理硕士研究生就业去向分析

目的　对北京市某科研院所近5年全日制卫生管理硕士研究生就业去向进行分析，提出相关建议。方法　以2015至2019年全日制卫生管理硕士毕业生为研究对象，对于毕业生就业去向分布采用描述性分析，不同培养类型和不同性别间的比较采用卡方检验。结果　就业率100.0%，维持较高水平；从事工作与专业对口，学术型硕士和专业型硕士就业去向差异并无统计学意义，都以医院和医疗卫生事业单位为主要选择，且近年来呈上升趋势；不同性别研究生的就业去向由于受收入和稳定性影响，差异存在统计学意义。结论　完善专业培养方案，体现专业特色和优势，加强研究生职业规划教育，引导帮助研究生就业、择业。     

虚实结合的实践教学在《医学影像设备学》中的研究

目的　探讨"虚实结合"的实践教学在《医学影像设备学》中的应用效果。方法　以齐齐哈尔医学院2018级医学影像技术专业学生为观察组，在《医学影像设备学》实践教学采用"虚实结合"的教学方法，实物参观教学（8学时）、实验箱电路测量教学（20学时）、虚拟仿真教学（16学时）。2017级医学影像专业（对照组）没有采用虚拟仿真教学。比较两个年级学生授课效果和学生成绩。采用SPSS 17.0行t检验和卡方检验。结果　2018级观察组学生实践成绩提高，与2017级对照组比较差异有统计学意义（t=6.44，P=0.007）；观察组授课满意度为100%，两组授课满意度比较差异有统计学意义（χ²=5.25，P=0.022）。结论　"虚实结合"的教学方式，能够有效提高学生的动手操作能力，加强了对抽象性原理的认知，并且解决了实物教学中无法完成的设备故障分析、大型设备拆解与安装等的教学难题。     

混合式TBL教学在产科危重症实习教学中的应用

目的　探讨混合式以团队为基础的学习（team-based learning，TBL）教学法在产科危重症实习教学中的应用。方法　选取2019年4月至6月在重庆医科大学附属第一医院产科实习的72名临床医学"5+3"专业的本科学生作为研究对象。选择产科危重症典型病例，采用TBL教学联合翻转课堂的混合式方法开展教学。课后进行问卷调查，评价教学效果。结果　收回72份调查问卷，所有学生认为这种混合式TBL教学有助于发展临床思维能力，并且认为"小组成员讨论"及"课外准备"过程均十分有助于学习。93%（67/72）的学生喜欢这种教学，28%（20/72）的学生认为这种教学方法使其学习压力很大。结论　将混合式TBL教学运用于产科危重症实习教学中具有较好的教学效果。     

The pathophysiological and molecular basis of Bartter's and Gitelman's syndromes

Molecular defects affecting the transport of sodium, potassium and chloride in the nephron through the ROMK K⁺ channel, Na⁺/K⁺/2Cl^- cotransporter, the Na⁺/Cl^- cotransporter and chloride channel have been identified in patients with Bartter''s and Gitelman''s syndromes. Defects of the angiotensin II type I receptor and CFTR have also being described. These defects are simple (ie, most are single amino acid substitutions) but affect key elements in tubular transport. The simplicity of the genetic defects may explain why the inheritance of these conditions remains unclear in most kindreds (ie, not just recessive or dominant) and emphasises the crucial importance of the conformational structure of these channels. Application of this molecular information will allow the early genetic identification of patients with these syndromes and enable us to differentiate between the various disorders at a functional level. It may also identify a sub-group in which the heterozygous form may make patients potentially exquisitely sensitive to diuretics.


     

抗菌肽PR39真核表达载体的构建及其在巨噬细胞中的表达和抗菌作用

目的 构建抗菌肽PR39的真核表达载体,转染后观察PR39在小鼠巨噬细胞RAW264.7中的表达及抗菌作用.方法 采用拼接PCR法合成抗菌肽PR39基因,克隆到真核表达载体pIRES2-GFP中,经鉴定后用阳离子脂质体转染小鼠巨噬细胞RAW264.7,通过RT-PCR和免疫荧光法检测目的 基因的表达,并对其抗菌活性进行初步检测.结果 成功构建了抗菌肽PR39的真核表达载体pIRES2-GFP/PR39,并能在小鼠巨噬细胞RAW264.7中表达抗菌肽PR39.表达抗菌肽PR39的巨噬细胞杀灭和清除胞内菌的能力明显增强.结论 抗菌肽PR39基因能够在小鼠巨噬细胞RAW264.7中表达并发挥抗菌作用.     

Fournier's gangrene and its emergency management

Fournier's gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.     

叶进教授从乙癸同源辨治女童青春期疾病经验撷要

乙癸同源又称"肝肾同源"，作为中医五行学说的重要组成部分，历来受到医家重视，在发展完善的过程中被用来治疗诸多病证。叶进教授作为江苏省中医院儿科生长发育专科创始人，在诊治儿童青春期内分泌疾病方面有着丰富的临床经验，临证发现小儿青春期相关疾病从"乙癸同源"角度进行辨治可以取得满意疗效。     

986例新安王氏内科含茯苓处方用药规律及数据挖掘研究

[目的]挖掘新安王氏内科医案中含茯苓方剂的临床用药特色。[方法]以《王任之医案》《王仲奇医案》作为方剂资料来源,筛选包含茯苓的处方,基于新安医学数据信息应用平台构建数据库,应用IBM SPSS Modeler 14.2,进行频数统计及关联规则分析,以Apriori算法为主要数据挖掘方法,分析并获得含茯苓处方中单味药物频次、治疗疾病频次、药物组合频次、关联规则等。[结果]共筛选含茯苓方剂986首,含茯苓的高频次组合的药物包括佩兰、半夏、苦杏仁、白术、枳壳,常用于治疗脾胃系统的泄泻、痢疾,以及肺系的咳嗽等病证。与茯苓配伍的高频次药物的组合中,支持度≥10%、置信度≥60%的关联规则包括“佩兰→枳壳”“佩兰→半夏”“半夏→枳壳”“佩兰→白豆蔻”等。[结论]新安王氏内科医案中含茯苓处方所治疾病多有痰湿要素,王氏临床论治多从脾、胃、肺三脏入手,喜用芳香药物,多用温药,治痰治气并举,寓燥湿化痰于健脾降肺之中。     

A rare case report of appendix and cecum in the sac of left inguinal hernia (left Amyand's hernia)

This case is a rare aspect of left inguinal hernia. The patient was a 60-years old man with left scrotal mass since childhood. In the operating room, the hernia sac was opened which included cecum and appendix that is called left Amyand‘s hernia. The patient underwent herniorrhaphy with Lichtenstein repair.     

A comparative study of the different diagnostic criteria of gestational diabetes mellitus and its incidence

Background

High prevalence of diabetes and genetic predisposition to metabolic syndrome among Indians places Indian women at risk to develop gestational diabetes mellitus (GDM) and its complications. Literature defines multiple criteria for GDM. This prospective study compares available diagnostic criteria for GDM in Indian women and their correlation with perinatal morbidity.

Method

Nine hundred and forty-eight consecutive voluntary nondiabetic pregnant women were recruited for the study. Seven hundred and twenty-three of these (mean age 23.45 years; 75.7% < 25 years) who reported for the follow-up were screened for GDM at 24–28 weeks gestation by American College of Obstetrics and Gynaecology (ACOG) guidelines and World Health Organization (WHO) criteria. Glycated haemoglobin (HbA_1c) and fasting and two-hours postglucose plasma insulin levels were also analysed. Pregnancy outcome was known for 291 of these. Concordance of risk factors and perinatal complications was analysed with respect to GDM.

Results

Prevalence of GDM at 24–28 weeks gestation was found to be 4.8% by WHO criteria, 6.36% by Carpenter and Coustan's criteria, and 3.5% by O'Sullivan's criteria. Prevalence was marginally higher in women of higher age, having past history of abortion or family history of diabetes mellitus (DM) (P > 0.05). None of these women had HbA_1c > 6%. Relative risk of abnormal delivery (pregnancy outcome) was 1.93, 1.39, and 1.17 in women with GDM by O'Sullivan's, WHO, and Carpenter's criteria, respectively (P > 0.05). Abnormal deliveries were marginally higher in women with high postglucose load insulin levels. Mean weight of the newborns was essentially the same in GDM and nonGDM women by any of the criteria. One-hour and two-hours postglucose values were more sensitive in diagnosing GDM by O'Sullivan's criteria while fasting plasma glucose value had the poorest specificity with 2.5% of nonGDM women having values above the cut-off. Modifications of these criteria did not im-prove their predictive value for abnormal delivery over that of O'Sullivan's criteria.

Conclusion

Prevalence of GDM and abnormal delivery in women < 35 years of age is low. Therefore, global screening for GDM may not be very useful in women < 25 years of age unless family history of DM or past history of abortion is present. Existing evidence is inadequate to justify the switchover from O'Sullivan's criteria for diagnosis of GDM.     

A new variant of Carney's triad: phaeochromocytoma and chondrosarcoma

A 61 year old hypertensive woman presented in 1986 with a right scapular chondrosarcoma. She developed type 1 diabetes mellitus in 1991 and suffered a stroke in 1991. Chest radiography showed pulmonary metastases in 1997. Further radiological staging detected a right sided phaeochromocytoma, which was subsequently removed in 1998. Before this, repeated urine estimations of vanillylmandelic acid had been normal. Her diabetes was cured by adrenalectomy. It is believed that the combination of phaeochromocytoma and extrapulmonary chondrosarcoma represents a new variant of Carney's triad.     

Oral care of elderly patients: nurses' knowledge and views

It is important that healthcare professionals caring for the elderly in hospitals have a core knowledge of the orodental care requirements of their patients. The aim of this study was to determine the knowledge and views of nurses working on acute and rehabilitation care of the elderly wards about orodental care. One hundred nurses and healthcare assistants took part in this questionnaire study of which 58 were qualified nurses and 70 had been employed on care of the elderly wards for two or more years. Although the majority of the respondents were registered with a dentist and attended regularly, 40 did have 'some anxiety' about visiting their dentist. Approximately half of the study population regularly gave advice to their patients about dental care but their knowledge of and reasons for providing oral care and advice was often incorrect. The group's understanding of the availability of dental treatment provided by the National Health Service was also often inaccurate. It was concluded that a better core knowledge of the orodental care of older patients is required by all healthcare professionals who care for this group. It is also important that individuals in whom anxiety is associated with their own dental experience do not neglect to give orodental health advice to their patients.     

Marjolin's ulcer: clinical and pathologic features of 83 cases and review of literature

Background

Marjolin''s ulcer is a rare, aggressive condition that arises on chronic skin lesions and diseases. Inthis article, we will report 83 cases of this disease.

Methods

Retrospectively, we retrieved 83 records of patients with cancer arising from chronic skin conditions.Data concerning demography, type of original skin insult, time interval between original lesion and cancer,cancer histology, and lymph node involvement were recorded.

Results

The mean age was 55.30 years (range: 21-90). There were 51 males (61.5%) and 32 females (38.5%).Foot was the most prevalent site of primary skin lesion (49.4%) followed by scalp (15.6%). Original skin insultswere burn (87.9%), osteomyelitis (2.4%), radiation (2.4%), electrical burn (1.2%), surgical scar (2.4%),pemphigus (1.2%), bite (1.2%), and bed sore (1.2%). Histologic diagnosis were well differentiated SCC(38.6%), SCC, differentiation not reported (24.1%), moderately differentiated SCC (13.2%), BCC (9.6%), poorlydifferentiated SCC (6.0%), melanoma (2.4%), verrucous carcinoma (2.4%), MFH (1.2%), mucoepidermoidcarcinoma (1.2%), and leiomyosarcoma (1.2%). Most of the cases occurred more than 20 years after the initialskin insult. There were 6 (7.2%) cases that developed within 1 year (acute Marjolin''s Ulcer). Forty three patients(69.3%) had palpable regional lymph nodes.

Conclusion

Data in this series were in confirmation with many other reports. Marjoln''s ulcer should be consideredas a significant post-skin injury complication.