临床带教中对实习医生医患沟通能力培养模式的探讨

针对传统临床带教模式忽视实习医生医患沟通能力培养的现状,实施了以增强医患沟通能力培养为目的的新教学模式。将2008年7月进入临床的84名实习医生分为改革组和对照组。改革组通过与病人进行面对面的交流,进行医患沟通技巧的训练,而对照组仍沿用传统的带教模式。采用问卷调查的方式对教学效果进行评估。问卷调查反馈结果表明,新教学模式深受实习医生的欢迎,能明显调动实习医生学习的积极性,提高医患沟通能力,并得到了病人及家属的高度认可。新教学模式对实习医生医患沟通能力的培养具有重要的意义。     

综合医院精神科门诊实习医生人文素质的培养

临床实习不仅是对实习医生专业技能的训练也是人文关怀能力的培养。精神医学是在医学各专科中最富有人文关怀的学科,在综合医院精神科门诊对实习医生的带教过程中,通过重视入科教育、在门诊和会诊医疗过程中指导学生建立良好医患沟通、举办典型病例和疑难病例讨论及学术讲座,利用网络互动和宣传开展人文阅读,采取角色互换扮演考试方式,加强临床带教教师自身修养的多种措施,将实习医生的精神病学专业技能的训练与人文关怀能力的培养紧密结合起来,不失时机进行医学人文教育,增强学生的人文关怀能力,从而更好的服务于社会。     

360度反馈评价法在实习医生临床沟通能力评价中的应用

目的：运用360度反馈评价法评价实习医生的临床沟通能力,为提高实习医生临床沟通能力和本科生临床沟通教学改革提供参考依据.方法：拟订评价的指标体系及相关考核标准,以实习医生的学生、带教老师、患者、护士以及其本人作为考评者,对其临床沟通能力进行综合评价.结果：5种类型的评分者所给分数有统计学差异.结论：360度反馈评价法能从多角度反映实习医生的临床沟通能力,有利于本科生临床沟通能力教学改革.     

实习医生书写血液科病历的常见问题与对策

为提高实习医生书写血液科病历的质量,考核评价100份实习医生书写的血液科病历后发现：现病史、既往史、个人史及血液科临床操作、输血、化疗病程记录书写存在的缺陷是影响血液科实习医生病历书写质量的主要原因;临床实习中不重视病历书写、教学管理相对滞后、血液科疾病的特殊性等因素也是导致病历书写质量不高的原因。因此加强教学管理,提高临床带教老师的综合素质,对医学实习生进行病历书写的岗前培训,培养实习医生问诊及医患沟通的能力,利用血液科的典型病历结合病历讨论法等多种途径以加强实习医生的临床病历书写技能,不断提高血液科实习医生的病历书写质量。     

加强神经内科实习医生医患沟通能力的培养

本文结合现代医学模式转变的需要,分析了目前实习医生在医患沟通中存在的问题,探讨了临床带教中提高实习医生医患沟通能力的方法.结合神经内科患者的特点,分析了神经内科常见的沟通障碍及解决办法.     

肛肠科临床实习带教思考

临床实习教学是培养合格医学人才的关键环节.重视入科教育,加强临床培养,严格出科考核,将实习医生培养为合格医生,是临床带教医师的职责.     

肝胆外科临床实习带教体会

临床实习是医学生迈向临床医师的重要阶段。如何提高医学生临床实习教学质量,使其成长为优秀的临床工作者是现代医学教育的重要环节,也是每一个临床带教教师面临的挑战。本文根据自身带教体会,从做一个有责任心的医生、注重"三基"的训练,提高临床能力、鼓励质疑,培养临床思维、带教个体化及医患沟通能力的培养五个方面入手,结合具体案例进行分析和总结,以提高实习医生综合素质,适应现代医学教育的发展要求。     

临床医学专业学生医患沟通能力培养探析

临床实习是培养医学生医患沟通能力的重要阶段。本文从医学教育角度出发，结合医学模式转变的需要，探讨了在临床实习带教中培养医学生医患沟通能力的意义及必要性，同时从带教教师和医学生两方面着重探讨了培养医学生医患沟通能力的方法和途径。     

关于培养实习医生医患沟通能力的实践与思考

传统医学教育的不重视和医患沟通能力不足导致近年来医疗纠纷等问题的不断出现,本文通过研究实习医生多掌握医患沟通的技巧,多注重理论与实践的结合,认真对待医学实习岗前培训,积极主动参加政府及医院等部门的人文活动,早期接触临床等实践活动,在临床实习阶段加强实习医生医患沟通能力的培养,提高医患沟通能力,为国家培养优秀的医学人才和构建良好的医疗环境。     

通过医患沟通促进临床实习

通过问卷调查了解临床教学中医患沟通面临的问题。结果表明有73．0％的实习医生主动与病人沟通，67．3％的实习医生要做沟通前的准备，62．0％的实习医生认为医惠沟通有助于临床实习，理论知识和病人信任的缺乏是医惠交流的主要问题。因此，医患沟通是临床教学中培养适应现代医学模式转变的合格医学人才的重要手段。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.