儿科学见习中的主要问题及教改措施初探

本文对目前儿科学临床见习阶段学生对见习学习重视不够,学生从理论走向实践的过渡困难以及示教病人数量有限且患儿家长依从性差等主要问题进行了归纳和分析,并提出了相应的教学改革措施,包括教师岗前培训,创造教师与学生的交流机会,采用灵活多样的教学方式,增加临床见习机会、病例讨论式教学、病房查房与教学查房,创建新的教学基地等,以期提高儿科学见习阶段的教学质量。     

儿科学见习中的主要问题及教改措施初探

本文对目前儿科学临床见习阶段学生对见习学习重视不够,学生从理论走向实践的过渡困难以及示教病人数量有限且患儿家长依从性差等主要问题进行了归纳和分析,并提出了相应的教学改革措施,包括教师岗前培训,创造教师与学生的交流机会,采用灵活多样的教学方式,增加临床见习机会、病例讨论式教学、病房查房与教学查房,创建新的教学基地等,以期提高儿科学见习阶段的教学质量.     

面试在儿科学见习教学中的应用及其意义

目的探讨面试在儿科学见习教学中的应用及其意义。方法教师提供病例,学生对病例进行分析,并提出进一步的检查和治疗计划;教师针对病例提问,学生回答问题。面试的病例来源于临床的真实病例,教师可以随时更换。面试病例与教材及教学大纲所要求的内容相呼应,且与学生见习的疾病相关联。面试成绩占儿科学见习总成绩的40％。结果 面试能够较好地反映学生对儿科学基础知识掌握的程度和临床思维能力,有利于考查学生的人际交往能力,调动学生主动学习的积极性,检验教师的教学效果。结论面试是评估学生儿科学见习效果的重要考查方法之一,且有利于提高儿科学见习教学质量。     

应用模拟诊疗提高儿科见习带教的质量

临床见习是医学生在掌握了一定医学基本理论、基本知识后,把所学的理论与临床结合起来,培养临床综合能力的关键阶段。由于受儿科见习病种,病例数的制约,加上医疗与教学的矛盾,家长常常不愿配合教学,儿科临床见习的教学质量也因此明显受到影响。为了更好地培养学生的临床综合能力,提高儿科见习的带教质量,可应用“模拟诊疗”作为儿科见习带教的辅助手段。模拟诊疗与启发式教学相结合,大大地提高了学生的学习兴趣和积极性,是提高儿科见习带教质量的有效方法。     

模拟教学在儿科学见习中的应用

目的 研究模拟教学应用于儿科学见习的效果.方法 以哈尔滨医科大学五年制2007级临床医学专业参加儿科学见习的180名学生为研究对象.随机将其分为实验组和对照组,每组90名学生.比较两组学生在性别、年龄和前期学习成绩,其差异无统计学意义(P＞0.05).实验组学生先在儿科病房熟悉患儿、病历,然后教师实施模拟教学;对照组学生只在儿科病房熟悉患儿、病历并讲解相关知识.教学结束后,比较两组学生理论考试、操作技能考核结果,并对实验组学生进行问卷调查以评价教学效果.结果 实验组学生经过模拟训练,其临床技能操作考核及理论考试成绩明显高于对照组学生(P＜0.05).实验组学生的问卷调查结果表明,100.0％的学生认为儿科学见习中采用模拟教学是必要的.结论 将模拟教学应用于儿科学见习有利于提高医学生的临床思维和实践能力,有利于提高教学效果.     

浅谈儿科学见习教学的实践性和教学相长

临床教学是医学人才培养的关键环节，如何提高临床教学质量是当前医学教育面临的重要课题。见习学生带教活动是临床医学教育的重要组成部分，学生从中可以吸取教师多年的临床思维方法和实践经验，教师也能够提高自身素质和理论水平。见习阶段是师生互动的教学过程，相互促进、相互督促、相互协调。一些教学方法如何应用到儿科学教学中来，我们在见习教学实践中进行了一些探索，如实施基于问题学习（problem—based learning，PBL）的教学方法、模拟教学方法等，注重从多方面提高医学生的临床诊断能力和各项临床操作能力，培养敏捷、正确的临床思维，以减少医疗事故和纠纷的发生，提高学生的临床综合技能。     

儿科结构化见习模式的实践

目的：探讨结构化教学模式在儿科见习教学中的运用。方法：在3年内对我院临床医学专业对5、7年制5个班进行儿科结构化见习教学,包括常规见习、以学生为主的病例讨论式教学见习、模拟教学查房、临床技能见习等。结果：结构化见习教学法得到了学生们的普遍好评。结论：结构化见习教学法适用于儿科学见习教学;     

医学生儿科见习面临的困难及对策

采用问卷调查法了解234名医学生在儿科见习中面临的困难、对儿科见习的期望及对带教方式的评价,评估其对儿科学基础知识和基本技能的掌握情况.调查发现,教学资源相对不足、学生缺乏儿科诊疗技巧和医患沟通方法,这给儿科见习带来困难.应充分发挥教师的指导作用、培养学生的自学能力和临床工作技能、加强人文教育、充分运用各种教学手段,以保证和提高儿科见习质量.     

PBL与LBL教学法在儿科学临床见习教学中的比较研究

为了提高儿科学临床见习教学质量,改革传统教学方法,文章对135名2003级学生分别予以问题为基础的（PBL）教学法和以授课为基础的（LBL）教学法进行儿科学临床见习教学,并比较评价两种教学法的教学效果。研究结果表明,PBL教学法组学生考核平均成绩及学生对教学效果评价指标的优良率均明显高于LBL教学法组,提示PBL教学法提高了临床见习教学质量,其教学效果明显优于LBL教学法,值得在儿科临床见习教学中推广应用。     

病例导入式教学作为一种PBL教学形式应用于八年制医学生儿科见习

为提高八年制医学生的临床思维能力,提高教学质量,在儿科学见习教学中采用病例导入式教学方法。研究结果显示学生对于病例导入式教学法评价高,对儿科见习评价较好。在儿科临床见习中采用病例导入式教学形式,作为一种PBL的教学形式,取得良好效果,是我国现阶段医学教育中授课式教学和PBL教学相结合的教学形式。     

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.