基于德尔菲法构建我国临床药师知识体系标准

目的：建立临床药师知识体系标准，为临床药师的培养和评估提供依据。方法：通过文献查阅，梳理出若干一级指标和二级指标；依据按Likert5级评分法设计咨询问卷；运用德尔菲法对35名专家进行两轮问卷咨询。结果：建立了包含5个一级指标，33个二级指标的临床药师知识体系标准。两轮咨询中，专家咨询积极系数分别为100%和92.9%，专家权威系数分别为0.904 3和0.907 7，专家协调系数分别为0.268和0.565。结论：专业核心知识是临床药师最应具备的知识，是临床药师培养的重中之重；临床药师的知识结构要由"以化学知识为主"转变为"以医学知识为主"；临床药师自身需要注重知识的再生，并树立终身学习的理念。本研究专家积极性和权威程度高，意见协调程度好，建立的知识体系标准能够对临床药师的培养与评估提供依据。     

温针灸联合放血疗法对痤疮患者皮损程度、DLQI评分及复发率的影响

目的观察温针灸联合放血疗法对痤疮患者皮损程度、皮肤病生活质量指数(dermatology life quality index,DLQI)评分及复发率的影响。方法 120例湿热型痤疮患者随机分为观察组和对照组,每组60例。对照组采用放血疗法,观察组在对照组基础上联合温针灸治疗。观察两组患者治疗前后皮损程度、DLQI评分、中医症候评分变化,比较两组的临床疗效、不良反应发生率及复发率。结果观察组总有效率显著高于对照组(P<0.05)。两组治疗后皮损个数显著减少(P<0.05),且观察组皮损个数少于对照组(P<0.05),皮损减少率大于对照组(P<0.05)。治疗后两组DLQI评分、中医症候评分均显著降低(P<0.05),且观察组低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。治疗组复发率显著低于对照组(P<0.05)。结论温针灸联合放血疗法治疗湿热型痤疮疗效佳,不良反应率低,复发率低,疗效稳定。     

基于子宫内膜异位症与恶性肿瘤的相关性探析补肾化瘀法作用机制及中医理论依据

子宫内膜异位症其异位内膜组织虽然在形态学上呈良性表现，却具有类似恶性肿瘤的生物学特性。中医学一般认为，“正虚伏邪”为恶性肿瘤的病机特点；那么，肾虚血瘀既属于“正虚伏邪”的范畴，又体现了EMs发病学和疾病发生、发展过程中的主要特点。在“病证相应”的中医治则之下，补肾化瘀法的临床疗效主要表现为：缓解痛经症状、提高受孕率，以及调整月经周期。本文基于EMs与恶性肿瘤的相关性，通过分析补肾化瘀法治疗EMs的理论依据及其抑制异位内膜侵袭的调控机制，主要包括解除免疫抑制、阻断局部微血管新生等，旨在阐明其疗效显著的原因，为临床推广提供可靠的基础研究证据。     

儿科临床教学中EBM+PBL教学法的应用分析

目的分析儿科临床教学中EBM+PBL教学法的应用效果。方法选取2018年2月—2018年12月在医院儿科实习的医学专业学生50名,随机将其分为参照组(常规教学法)和观察组(EBM+PML教学法)。比较两组的教学效果。结果相对比参照组,观察组学生的理论掌握得分(94.28±3.15)分更高、临床实践得分(90.69±3.55)分明显提高,学生对自主学习、语言表达、问题解决、文献检索及团队合作能力的认可度更高,而学生对教学满意度达到96%,两组数据差异经过比较P<0.05。结论在儿科临床教学期间采用EBM+PBL教学法,学生的综合能力增强,确保教学质量。     

基于三维实践平台的《经络腧穴学》教学新模式探讨

探讨基于实践平台的《经络腧穴学》教学新模式,以促进教学相长。《经络腧穴学》作为针灸推拿专业的基础课程,也是核心理论与实践课程。通过建立多个校内实践平台,如大学生针灸推拿技能协会、针灸推拿理疗室,推进校外医疗服务实践平台等,根据"理论-实践-再理论-再实践"的教学模式,优化课堂理论教学和技能实训教学,构建"课堂教学-校内实践-社会服务"的《经络腧穴学》三维教学实践平台。可有效调动教与学的积极性,提高《经络腧穴学》的教学质量,提高学生的专业理论水平和临床实践能力,对针灸推拿专业人才的培养起到积极作用。     

Burnett Order Stress and Spatially-Dependent Boundary Conditions for the Lattice Boltzmann Method

Stress boundary conditions for the lattice Boltzmann equation that are consistent to Burnett order are proposed and imposed using a moment-based method. The accuracy of the method with complicated spatially-dependent boundary conditions for stress and velocity is investigated using the regularized lid-driven cavity flow. The complete set of boundary conditions, which involve gradients evaluated at the boundaries, are implemented locally. A recently-derived collision operator with modified equilibria and velocity-dependent collision rates to reduce the defect in Galilean invariance is also investigated. Numerical results are in excellent agreement with existing benchmark data and exhibit second-order convergence. The lattice Boltzmann stress field is studied and shown to depart significantly from the Newtonian viscous stress when the ratio of Mach to Reynolds numbers is not negligibly small.     

临床路径教学法在ICU新进护士前3个月护理带教中的应用效果观察

目的探讨在ICU新进护士的前3个月护理带教中,采取临床路径教学法的效果。方法选取该院2016年1月—2018年1月ICU新进的60名护士为研究对象,将护士分成两组,即研究组与对照组,每组30名,对照组采取一对一的护理带教模式,研究组则采取临床路径教学法的护理带教模式,观察两组带教效果。结果护理带教后,研究组护士在理论与操作考核成绩上均要显著高于对照组(P<0.05);研究组新进护士对临床实践能力、应急能力、工作能力及学习兴趣的认可率均显著高于对照组(P<0.05)。结论针对ICU新进护士,在前3个月的护理带教中,实施临床路径教学法的带教模式,可显著提高护士理论与操作能力,且护士对护理带教模式的认可度也高。     

Bioinformatic identification of key candidate genes and pathways in axon regeneration after spinal cord injury in zebrafish

Zebrafish and human genomes are highly homologous;however,despite this genomic similarity,adult zebrafish can achieve neuronal proliferation,regeneration and functional restoration within 6–8 weeks after spinal cord injury,whereas humans cannot.To analyze differentially expressed zebrafish genes between axon-regenerated neurons and axon-non-regenerated neurons after spinal cord injury,and to explore the key genes and pathways of axonal regeneration after spinal cord injury,microarray GSE56842 was analyzed using the online tool,GEO2R,in the Gene Expression Omnibus database.Gene ontology and protein-protein interaction networks were used to analyze the identified differentially expressed genes.Finally,we screened for genes and pathways that may play a role in spinal cord injury repair in zebrafish and mammals.A total of 636 differentially expressed genes were obtained,including 255 up-regulated and 381 down-regulated differentially expressed genes in axon-regenerated neurons.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment results were also obtained.A protein-protein interaction network contained 480 node genes and 1976 node connections.We also obtained the 10 hub genes with the highest correlation and the two modules with the highest score.The results showed that spectrin may promote axonal regeneration after spinal cord injury in zebrafish.Transforming growth factor beta signaling may inhibit repair after spinal cord injury in zebrafish.Focal adhesion or tight junctions may play an important role in the migration and proliferation of some cells,such as Schwann cells or neural progenitor cells,after spinal cord injury in zebrafish.Bioinformatic analysis identified key candidate genes and pathways in axonal regeneration after spinal cord injury in zebrafish,providing targets for treatment of spinal cord injury in mammals.     

高职院校中医诊断学教学方法探讨与思考

中医诊断学是中医学及相关专业学生必修的一门专业基础课,因其理论内容丰富,知识点多,实践性强,在实际教学中讲授本课程具有一定的难度,对于高职学生更加要侧重技能的培养。本文从课前准备、课堂教学、技能实训、课后总结等方面结合教学实践探讨中医诊断学教学方法,让学生能够真正掌握所学知识和技能,以提高教学质量和效果。