PBL与LBL教学模式在临床专业系统解剖学教学中的比较研究

目的：比较PBL与LBL两种教学模式在临床医学专业系统解剖学教学中对教学效果的影响。方法：随机抽取临床医学本科生80人,将其分为实验组（40人）和对照组（40人）,实验组采用PBL教学模式,对照组采用LBL教学模式教学,比较两组教学效果。结果：理论考核成绩表明,实验组与对照组学生比较,在记忆型题目中得分差异无统计学意义（ P ＞0．05）,而在理解型题目、应用型题目得分和考试总分方面,实验组学生得分更高（ P ＜0．05）;问卷调查结果表明,两组学生之间在问卷的5个方面差异均有统计学意义（ P ＜0．05）。结论：PBL教学法在临床医学专业系统解剖学教学中表现出明显的优势,在今后的系统解剖学教学中可以广泛推广PBL教学法。     

浅析PBL为基础的多元化教学模式在临床实习中的应用

目前PBL教学模式风靡全球,成为医学院校最流行的教学手段之一,但在其临床教学开展过程中也暴露出一些弊端。以PBL教学为基础有机结合其他教学方法的多元化教学模式可能是现阶段临床实习生教学的有益尝试。     

中医药治疗食管癌的研究进展

为了总结中医药治疗食管癌的相关研究及发展状况,为食管癌的治疗寻求新的研究方法与治疗思路,查阅近10 a相关文献,并从理论认识、临床和实验研究等方面进行综述。发现近年来中医药在食管癌病因病机、证候、治则治法等理论认识方面都取得了一定进展;临床上中医药在食管癌围手术期可进行辅助治疗,与化疗药或放疗联合治疗可以起到增效减毒、提高患者生存质量、提高机体免疫力的作用;在实验方面,中医药对食管癌细胞有抑制增殖、诱导凋亡及降低其侵袭能力、调节机体免疫能力等作用,涉及多个分子和细胞信号传导通路。     

Effectiveness of near-peer simulation for managing the acutely deteriorating patient among residents of an internal medicine junior residency programme

INTRODUCTIONNear-peer teaching is gaining popularity as a teaching modality, as it improves the learner’s understanding, is targeted at an appropriate level and promotes familiarisation. This study was initiated to evaluate the effectiveness of incorporating near-peer instruction into simulation-based training within a junior residency programme.METHODS42 first-year residents from an internal medicine junior residency programme were recruited. Participants underwent a simulation-based training programme conducted over five weeks. Each week involved either an emergency or acute clinical scenario. A structured questionnaire was administered prior to and after the course to compare participants’ perceived knowledge, experience and confidence in managing the clinical scenarios.RESULTSIn our study, 83% of participants agreed/strongly agreed that the scenarios were realistic. There were improvements in perceived knowledge, experience and confidence after the course. The greatest improvement was seen for experience (post-simulation: median 7.00 [interquartile range (IQR) 6.00‒8.00] vs. pre-simulation: median 5.00 [IQR 3.00–6.25]). 65% of participants were keen to help with future training.CONCLUSIONNear-peer simulation training was found to be a viable and valuable method of instruction for first-year residents for increasing experience, instilling confidence and improving perceived knowledge. Integration of such programmes within medical education curricula shows good promise of continuity, with many first-year residents inspired to organise subsequent sessions.     

Alpha‐melanocyte stimulating hormone ameliorates disease activity in an induced murine lupus‐like model

Alpha‐melanocyte stimulating hormone (α‐MSH) is a neuropeptide exhibiting anti‐inflammatory activity in experimental models of autoimmune diseases. However, no studies thus far have examined the effects of α‐MSH on systemic lupus erythematosus (SLE). This study aimed to determine the effects of an α‐MSH agonist in induced murine lupus. Here we employed female Balb/cAn mice in which lupus was induced by pristane. Groups of lupus animals were treated daily with the α‐MSH analogue [Nle4, DPhe7]‐α‐MSH (NDP–MSH) (1·25 mg/kg) injected intraperitoneally or saline for 180 days. Normal animals comprised the control group. Arthritis incidence, plasma immunoglobulin (Ig)G isotypes, anti‐nuclear antibodies (ANA) and plasma cytokines were evaluated. Renal function was assessed by proteinuria and histopathological lesion. Glomerular levels of IgG, α‐smooth muscle actin (α‐SMA), inducible nitric oxide synthase (iNOS), C3, CD3, melanocortin receptors (MCR)1, corticotrophin‐releasing factor (CRF) and α‐MSH was estimated by immunohistochemistry. When compared with normal controls, lupus animals exhibited increased arthritis, IgG levels, ANA, interleukin (IL)‐6, IL‐10, proteinuria and mesangial cell proliferation together with glomerular expression of α‐SMA and iNOS. Glomerular expression of MCR1 was reduced in lupus animals. NDP‐MSH treatment reduced arthritis scores by 70% and also diminished IgG1 and IgG2a levels and ANA incidence. In the glomerulus, NDP–MSH treatment reduced cellularity by 50% together with reducing IgG deposits, and expression levels of α‐SMA, iNOS and CRF were also all decreased. Taken together, our results suggest for the first time that α‐MSH treatment improves several parameters of SLE disease activity in mice, and indicate that this hormone is an interesting potential future treatment option.     

我国农村长期护理保险制度的构建研究

农村作为我国经济社会发展的薄弱地区,理应在社会保障制度上给予更高的关注。长期护理保险制度能从生活照料和医疗护理方面保障老年人的晚年生活质量,化解我国农村老年人因失能、失智带来的社会风险。本文从分析农村长期护理保险制度开展的必要性出发,结合农村长期护理保险制度实施的困境,对长期护理保险制度在农村筹资、服务给付等几方面提出具体建议,旨在加快农村地区长期护理保险制度建设的征程。     

家庭医生团队下家庭医生助理的服务模式研究

背景　在加速推进家庭医生责任制服务进程中,为家庭医生配置类似助手的角色,可有效提升家庭医生的服务效率,该助手角色通常被称为家庭医生助理。上海、北京等社区卫生服务中心已经构建了以家庭医生为核心和责任主体的、护士作为主要助理人员的服务模式。但对于家庭医生团队的核心人员结构、家庭医生助理的人员特征、工作范围和薪酬体制等还缺少统一的标准。目的　了解国内外家庭医生助理的服务模式运行现况,为我国家庭医生助理的服务模式建设提供借鉴。方法　于2019年11月5-20日,选择PubMed、ScienceDirect、中国知网（CNKI）和万方数据知识服务平台为文献搜索引擎,在数据库中检索与家庭医生助理模式（包括家庭医生助理的人员配置及人员特征、主要职责及服务内容、绩效考核方式及分配方式等）相关的文献,检索时间范围为2009-2019年,检索词（主题词或关键词）为“family physician assistant”OR“general practitioner assistant”OR“全科医生助理”OR“家庭医生助理”OR“家庭医生”AND“助理”OR“全科医生”AND“助理”。通过评阅文献内容,总结国内外家庭医生助理模式开展现状。结果　阅读全文后最终获得符合要求的文献47篇,其中英文文献31篇,中文文献16篇。家庭医生助理主要由专职医生助理、护士、公共卫生医生、乡村医生、“3+2”助理全科医生担任;人员特征方面,国外的医生助理通常为接受过“医生助理”项目培训并取得相应资格或学历的专业人员;中国承担家庭医生助理的专职医生助理主要由非医学专业人员经过岗位培训后担任,担任家庭医生助理的护士、公共卫生医生和乡村医生都是由社区卫生服务中心在岗的卫生专业人员兼任。家庭医生助理的职责范围在不同国家有不同的规定,主要包括患者治疗方案的实施、健康管理、健康宣教、患者分诊、健康初步评估、慢性病随访等。在绩效考核方式方面,国外家庭医生助理一般由机构根据统一的考核指标体系进行考核,或由家庭医生直接对助理进行考核;中国家庭医生助理的绩效考核方式包括二级考核,机构质控部门统一考核,涉及全中心的工作内容由机构统一考核、与家庭医生工作相关内容由家庭医生考核。结论　国内外家庭医生助理在人员特征、主要职责和绩效考核分配方式上存在较大差异,建议构建以“全科医生+护士/乡村医生”或“全科医生+专职助理”为核心人员的家庭医生服务团队,分类设立家庭医生助理的岗位职责和服务内容,建立以“医疗技术的复杂程度”“服务质量”“工作数量”作为主要绩效考核指标的薪酬分配制度。     

基层医疗卫生机构医防“五融合”健康管理服务模式研究

推进基层医防深度融合,做实家庭医生签约服务,是深化医药卫生体制改革的重要任务。本文以高血压、糖尿病健康管理为突破口,以家庭医生签约服务为载体,探索基层医防融合健康管理服务模式。通过基层医疗卫生机构内部的“管理融、队伍融、服务融、绩效融、信息融”,实现由全科医生团队统揽医疗和公共卫生服务,做到一次门诊既满足患者诊疗需求,同时也完成必需的基本公共卫生服务。医防“五融合”提供“防、治、管”一体的健康管理,既有利于提升服务质量,增强居民获得感,又有利于推动机构内部横向的基本医疗和基本公共卫生的融合及机构外部纵向的医疗资源整合。