运用Tanner临床判断模式设计仿真模拟情景学习

目的探讨以Tanner临床判断模式设计仿真模拟学习方法及效果。方法以Tanner临床判断模式为框架,对87名澳门护理本科生进行18学时仿真模拟临床技能训练,学习过程包括关注、诠释、应对、讨论与反思,按"澄清情景-首次表演-启发思考-小组讨论-小组演练-再次表演-小组反思"流程进行仿真模拟训练。训练结束以结构式开放性问题调查学生对仿真模拟学习的看法。结果学生认为仿真模拟学习加强了理论知识的运用、增强了处理突发情况的信心与能力;明确了解决临床问题的思路,增强了团队合作。为增加情景的逼真度,标准化病人需考虑运用于仿真模拟情景的设计。结论 Tanner临床判断模式可用于指导仿真模拟情景学习。学生通过对情景问题的观察、分析与处理,训练临床思维和临床判断力。仿真情景设计还需要进一步改进。     

数字化虚拟手术系统在胸腰椎骨折治疗中的应用价值

目的探讨数字化虚拟手术系统(digital virtual surgery system,DVSS)在治疗胸腰段骨折中的应用价值并验证其准确性。方法 2008年3月—2011年6月,对113例胸腰段单椎体爆裂型Denis B型骨折患者采用传统后路短节段经伤椎置钉行复位固定(A组)。2012年3月—2014年9月,对128例胸腰段单椎体爆裂型Denis B型骨折患者术前应用DVSS模拟骨折复位,制定最佳手术方案后行后路短节段经伤椎置钉(B组),手术方式与A组相同。比较2组病例手术时间、术中透视时间、术中出血量、椎弓根侧壁及椎体前方骨皮质穿破情况。结果 2组均无感染、血肿发生。B组在手术时间、术中透视时间、椎弓根钉穿破椎弓根侧壁与椎体前方骨皮质方面均优于A组,差异有统计学意义(P0.05)。2组出血量相比,差异无统计学意义(P0.05)。2组病例均未发生其他不良后果。结论应用DVSS辅助脊柱外科手术具有操作简便、安全性高、精确度可信的临床效果,而且便于推广。     

基于假体设计的成人股骨近端形态学研究

目的测量成人股骨近端解剖学参数,用以指导关节置换的术前计划和假体选择,同时为设计更符合国人解剖特点的人工髋关节假体提供数据支持。方法随机选取本院标准成人双髋正位X线片100例。选择对假体设计具有重要指导意义的股骨近端解剖参数进行测量,并对结果进行统计学分析。结果各参数均呈正态分布,股骨左右侧比较差异无统计学意义(P0.05),男性与女性在颈干角、大粗隆高点高于旋转中心的高度差、股骨距区域皮质弧度和CFI方面比较差异无统计学意义(P0.05),其余参数比较差异有统计学意义(P0.05)。峡部内径与年龄成显著正相关(r=0.381,P0.05)。与国内研究比较,大多数参数无明显差异,与国外研究比较,各参数均有明显差异。与现有假体资料比较,CFI、MCFI、峡部内径等参数差异无统计学意义,股骨距区域皮质弧度则差异有统计学意义(t=4.67,P0.001)。结论大粗隆高点与股骨头旋转中心并非等高,可用于指导术中下肢长度控制。本研究获得的解剖参数可以为设计符合国人股骨形态特点的假体提供参考。现有假体与国人股骨距区域皮质弧度不一致,需要在以后的设计中加以改进。     

翻转课堂教学模式在《护理研究》课程教学中的应用效果及评价

目的：探讨翻转课堂教学模式在《护理研究》课程教学中的应用效果。方法选取护理学专业2012级五年制本科生230人作为实验班,2011级本科生218人作为对照班。对照班采取讲授法和案例式教学,实验班开展翻转课堂教学模式,学期末比较两班学习成绩以及学习效果评价。结果实验班73.53％护生非常赞同翻转课堂教学模式和评价体系,66.21％护生认为翻转课堂教学模式有助于培养学生的学习能力和创新意识,75.34％护生认为翻转课堂教学模式有助于培养学生的团队合作精神和沟通交流能力;实验班护生考试成绩（86.21±3.67）分与对照班成绩（82.35±4.29）分比较有显著性差异（ P＜0.05）。结论护理学专业教师需转变教学观念,创新教学模式,尝试采用翻转课堂教学模式,不断提高护理研究教学质量。     

问题引导式教学法在医学史课程教学改革中的实践与思考

在医学史课程教学改革中应用问题引导式数学（Problem-Based Learning,PBL）,以专题重新组织教材内容,以问题引导教学,开展师生互换型教学和学生参与体验型教学,教考分离,旨在提高课程教学水平,使其从知识性课程提升为知识与思辨相结合的课程,使学生通过医学史课程知史、思史、明史。     

微课在中医诊断学教学中的运用和评价

中医学是源于我国的传统医学,中医诊断学是中医学专业课程体系中的主干课程,它不仅涵盖了中医诊断的基本理论和知识,而且还涉及到基本的临床操作技能。中医诊断学是我校的国家级精品课程,我校所有本科专业均开设了该课程。该课程知识点多、信息量大、内容零散、包含许多中医术语,传统灌输式授课法容易给学生带来枯燥乏味、抽象繁杂的感觉,从而降低学生的学习兴趣和效率,制约教学质量的提升。为增强学生的应用实践能力,提高学生的中医临床分析思维能力,本教研团队一直致力于改革和探索新型的中医诊断学教学方法,已经实践过的教学方法有PBL 教学法[1]、慕课、网络资源共享课[2-3]、数字化实验实训课程等[4]。     

Ascertainment Through Family History of Disease Often Decreases the Power of Family-based Association Studies

Selection of cases with additional affected relatives has been shown to increase the power of the case-control association design. We investigated whether this strategy can also improve the power of family-based association studies that use the transmission disequilibrium test (TDT), while accounting for the effects of residual polygenic and environmental factors on disease liability. Ascertainment of parent-offspring trios conditional on the proband having affected first-degree relatives almost always reduced the power of the TDT. For many disease models, this reduction was quite considerable. In contrast, for the same sample size, designs that analyzed more than one affected offspring per family often improved power when compared to the standard parent-offspring trio design. Together, our results suggest that (1) residual polygenic and environmental influences should be considered when estimating the power of the TDT for studies that ascertain families with multiple affected relatives; (2) if trios are selected conditional on having additional affected offspring, then it is important to genotype and include in the analysis the additional siblings; (3) the ascertainment strategy should be considered when interpreting results from TDT analyses. Our analytic approach to estimate the asymptotic power of the TDT is implemented online at http://pngu.mgh.harvard.edu/∼purcell/gpc/. Edited by David Allison     

Computer-aided analysis of the influence of digitizing and surfacing on the accuracy in dental CAD/CAM technology

In dentistry, ceramic materials with high fracture resistance are needed for all-ceramic fixed partial dentures (FPDs). The sophisticated processing of advanced ceramics that can be used for such dental restorations demands the application of CAD/CAM technologies. These techniques necessitate digitizing of the prepared teeth or the planned restoration itself and surfacing of the acquired digital data before milling paths can be generated. As precision in fit is crucial for dental restorations, a computer-aided method for the quantitative and qualitative 3D analysis has been developed and applied. Factors influencing the obtainable precision in the application of CAD/CAM techniques were taken into consideration.     

Adaptation of Quality by Design-Based Development of Isradipine Nanostructured–Lipid Carrier and Its Evaluation for In Vitro Gut Permeation and In Vivo Solubilization Fate

The present study demonstrated the systematic adaptation of quality by design-integrated approach for the development of novel nanostructured lipid carrier (NLC) of an anti-hypertensive drug isradipine (ISD) to address the inherent challenges such as low solubility and low oral bioavailability. Plackett-Burman design was used for preliminary screening of significant process and formulation variables (p <0.05), which were further processed using Box-Behnken design for the attainment of optimization goal that is, mean particle size (85.7 ± 7.3 nm), drug entrapment efficiency (87.4 ± 3.29%), and in vitro drug release characteristics (92.89 ± 5.47%). The optimized ISD-NLC formulation also demonstrated well-dispersed uniform-shaped particles (polydispersity index 0.207 ± 0.029), high gastrointestinal fluid stability (zeta potential ?10.17 ± 0.59 mV), and higher in vitro gut permeation (21.69 ± 2.38 μg/cm² of ISD-NLC as compared to 11.23 ± 1.74 μg/cm² in ISD suspension). Furthermore, lipolysis studies were performed for the purpose of in vivo fate, and significantly higher drug content of ISD from ISD-NLC in aqueous phase was found (72.34 ± 4.62%) as compared to drug suspension (3.01 ± 0.91%). Relative bioavailability of ISD-NLC and ISD suspension was increased by 4.2-fold and 1.78-fold in the absence and presence of cycloheximide which is a lymphatic uptake inhibitor revealing lymphatic uptake of ISD-NLC in bioavailability improvement. Hence, systematic adaptation of quality by design integrated approach improved gut permeation and potential solubilizaton fate (dynamic lipolysis) of ISD-NLC, which further improved the lymphatic uptake and biodistribution of drug thereby promisingits in vivo prospect and clinical efficacy.