高职医学生校外实践教学改革的成效调查分析

目的：了解由学校、实践教学医院、带教医护人员组成的“三位一体”的具有双向反馈机制的医学生校外实践教学管理模式的改革成效。方法选取2所地市级三级综合性甲等医院的带教医护人员和实习生为研究对象,以1所采取传统教学管理模式医院为对照组,1所采用“三位一体”的具有双向反馈机制管理模式的医院为教改组。学生校外实践结束后,对医院带教医护人员和学生进行满意度问卷调查。结果带教医护人员对教改组学生的满意度和实习学生对教改组带教医护人员的满意度均优于对照组,差异均有统计学意义(P <0.05)。结论“三位一体”具有双向反馈机制的校外实践教学管理模式全面提升了校外实践教学的质量,更适合高职医学类人才的培养。     

Roles and competencies in the nutritional domain for the management of the metabolic diseases and in the hospital setting: A position paper of the Italian College of Academic Nutritionists,MED-49 (ICAN-49)

Epidemiological evidence has confirmed the potential causal relationship between specific dietary factors and non-communicable diseases. However, currently nutrition was shown to be insufficiently integrated into medical education, regardless of the country. Without an adequate nutrition education, it is reasonable to assume that future physicians, as well as other health care professionals, will be not able to provide the highest quality care to patients in preventing and treating non-communicable diseases. Furthermore, the insufficient availability of physicians with specializations in nutrition has posed the basis for the development of non-medical careers in the field of nutrition. The present document was drafting by the Italian College of Academic Nutritionists, MED-49 (ICAN-49), with the aim to provide an overview on the nutritional competency standards covered by several health care professionals (Physicians Clinical Nutrition Specialists, Clinical Dietitians, Professional Clinical Nutrition Specialists, etc) for the prevention of diseases and/or support of pharmacological therapies. The aim of the ICAN 49 is to suggest a major shift in practice opportunities and roles for many nutritionists, especially for the management of the metabolic diseases, and promote a paradigm change: a clinical and educational leadership role for Physician Clinical Nutrition Specialists in the hospital setting.     

从用药分析的视角看临床药学的发展

通过分别从医生和临床药师的角度对同一张处方进行用药分析,探讨临床药师应具备的素质,并对此进行展望。     

1例心脏病术后患者华法林抗凝治疗的用药分析

1例46岁男性患者,既往有房颤及脑梗塞病史,二尖瓣机械瓣膜置换术后予以华法林抗凝治疗。根据药物基因检测及合并用药情况,初始给予华法林2.5 mg po qd,监测INR值偏低,华法林调整至3.75 mg po qd后出院,一月后复查INR 1.64。在随访过程中,临床药师发现该患者出院后自2014年10月至2015年1月,华法林剂量上调,但抗凝效果不佳,有栓塞风险。经详细了解后,考虑与患者服药依从性差相关,建议家属严格监督患者每日按时按量服用华法林,在饮食上避免长期摄入大量含有维生素K的食物并戒酒,一周后复查INR为1.46,接近合适范围。     

广州市某高校医学生批判性思维能力现状及其影响因素

目的 了解广州市高校医学生批判性思维能力现状及其影响因素,为改善医学生批判性思维能力提供依据.方法 采用中文版批判性思维测量表,分层整群抽取广州医科大学医学生335名进行问卷调查.结果 医学生总体具有正性批判性思维(285.75±33.74分),多因素logistic回归结果显示:参加科研学习(OR =0.651,95％ CI:0.441～0.960)、了解批判性思维(OR =0.460,95％ CI:0.277～0.765)、热爱本专业(OR=0.559,95％ CI:0.330～0.946)、参加过医院临床实习(OR=3.327,95％CI:2.053～5.392)是医学生批判性思维能力的主要影响因素.结论 广州市高校医学生批判性思维平均得分低于欧美国家,注重培养医学生的科研能力、开展批判性思维能力相关知识的教育、增强专业的热爱感以及合理的医院临床实习教学是高等医学教育提高医学生批判性思维能力的有效途径.     

2009-2013年无锡地区医疗机构中华核心期刊论文发表情况排名分析

按照文献检索的方法,通过万方数据知识服务平台搜集相关文献,提取符合标准的相关基本信息,按照年度变化、医疗机构、期刊分布、作者情况等进行统计分析,从而了解无锡地区医疗机构2009-2013年间在中华系列核心期刊上发表论文数量动态变化,为医院科研管理部门提供决策参考。     

Rationale of therapy in the patient with acute myocardial infarction and life-threatening arrhythmias: a focus on bretylium

Experimental evidence suggests a number of pathologic and electrophysiologic mechanisms that may help initiate ventricular arrhythmias accompanying myocardial ischemia and infarction. Early and late phase events are associated with reentry or an enhancement of focal mechanisms, or both. These can initiate ventricular tachycardia (VT) or ventricular fibrillation (VF), or both. The presence of distinct mechanisms that may initiate and maintain life-threatening dysrhythmias early in myocardial ischemia suggest different pharmacologic approaches for their prevention or suppression. Another consideration concerns patients subjected to coronary artery angioplasty or thrombolytic therapy and the development of arrhythmias associated with reperfusion of the once ischemic myocardium. The electrophysiologic mechanisms associated with reperfusion arrhythmias are unknown, and little is known about appropriate therapy for each episode of cardiac dysrhythmia. Ventricular extrasystoles or VT usually precedes VF. These premonitory arrhythmias are poor criteria for the institution of antiarrhythmic drug therapy, because VF develops within 1 to 10 minutes after the appearance of the rhythmic disturbances. Some authorities suggest that all patients with acute myocardial infarction should receive prophylactic antiarrhythmic therapy, because warning arrhythmias either do not occur at all or provide insufficient time to intervene pharmacologically. Many of the new class I antiarrhythmic agents effectively reduce the frequency of premature ventricular depolarizations, but lack specific antifibrillatory activity. However, the recent introduction of bretylium into clinical cardiology opens a new approach to preventing life-threatening ventricular dysrhythmias. Along with other members of class III, bretylium exerts different cardiac electrophysiologic effects than do the other 3 classes of drugs.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative plasma catecholamine and hemodynamic responses to handgrip, cold pressor and supine bicycle exercise testing in normal subjects

Serial hemodynamic and plasma catecholamine responses were compared among 10 healthy men (27 +/- 3 years) (+/- 1 standard deviation) during symptom-limited handgrip (33% maximal voluntary contraction for 4.4 +/- 1.8 minutes), cold pressor testing (6 minutes) and symptom-limited supine bicycle exercise (22 +/- 5 minutes). Plasma catecholamine concentrations were measured by radioenzymatic assays: ejection fraction and changes in cardiac volumes were assessed by equilibrium radionuclide angiography. During maximal supine exercise, plasma norepinephrine and epinephrine concentrations increased three to six times more than during either symptom-limited handgrip or cold pressor testing. Additionally, increases in heart rate, systolic blood pressure, rate-pressure product, stroke volume, ejection fraction and cardiac output were significantly greater during bicycle exercise than during the other two tests. A decrease in ejection fraction of 0.05 units or more was common in young normal subjects during the first 2 minutes of cold pressor testing (6 of 10 subjects) or at symptom-limited handgrip (3 of 10), but never occurred during maximal supine bicycle exercise. The magnitude of hemodynamic changes with maximal supine bicycle exercise was greater, more consistent and associated with much higher sympathetic nervous system activation, making this a potentially more useful diagnostic stress than either handgrip exercise or cold pressor testing.