基于SPOC的混合课程模式在预防医学教学中的应用效果评价

【摘要】 目的 探讨基于SPOC的混合课程教学模式在预防医学教学中的应用效果。方法 2013级影像专业92名学生共2个班,一班47名学生为对照组,采用LBL教学法,二班45名学生为实验组,采用基于SPOC的混合课程教学模式。通过课程考试和调查问卷对教学效果进行评估分析。结果 实验组学生总评成绩的平均成绩（80.69±7.663）高于对照组（71.96±8.795）（t=5.068, P=0.000）,实验组学生在80～89、90～100分数段的人数分布好于对照组（Z=3.713, P=0.000）。调查问卷的结果显示实验组72. 6％的学生认可基于SPOC的混合课程教学模式。结论 基于SPOC的混合课程教学模式可以提高学生的探索性思维能力和自主学习能力,提高教学效果。     

网络环境下病理学实验课团队学习教学实践

目的　探讨网络环境结合基于团队的学习（team-based learning,TBL）在病理学实验课教学的效果。方法　选取112名临床医学本科学生为研究对象,实验组（56名）在网络环境下利用数码显微互动教学平台,在病理学实验教学中,通过网络教学环境使用培训、教学计划说明、分组、布置教学任务或提出问题、团队学习交流、讨论等步骤实施TBL教学;对照组（56名）在无网络环境和数码显微互动教学平台,采用传统教学法（教师讲授为主）。通过成绩分析和问卷调查进行教学效果评价。数据行t检验,学生对TBL教学及网络环境学习资源的评价以百分比表示。结果　实验组平均成绩为（85.5±3.11）分,期末考试平均成绩为（83.8±2.53）分;对照组学生期末考试平均成绩为（76.4±11.89）分,2组间差异有统计学意义（t=7.018, P=0.000）。调查显示大部分学生认可网络学习资源结合TBL教学。结论　网络环境下TBL教学在病理学实验教学中具有可行性和有效性,学生的学习积极性普遍提高,TBL教学效果令人满意。     

临床医学专业核心课程考核模式探讨

目的　探讨以真实病例为中心的情境模拟考核模式在三年制临床医学专业核心课程中的应用价值。方法　随机选取2008级临床医学专业2个班的学生,分为实验组（158人）和对照组（156人）。实验组考核包括平时成绩、病例情境模拟考核、期末笔试,对照组沿用传统的考核模式。两组期末笔试采用同一试卷,利用期末笔试成绩和问卷调查来评价“病例情境模拟考核”的实施效果,数据使用SPSS 16.0软件作统计学分析,进行t检验和χ2检验,以P＜0.05为差异有统计学意义。结果　实验组学生期末笔试成绩高于对照组（P=0.000）;实验组学生独立完成病史采集、体格检查、病历书写次数明显高于对照组（P=0.002、0.017、0.048）。结论　病例情境模拟考核的内容与方法有利于医学生执业综合能力的培养。     

“微助教”平台在生理学教学中的应用

目的探讨“微助教”平台在生理学教学中的应用效果。方法选取湖北医药学院2016级康复专科1班（55人）和2班（57人）共计112名学生为研究对象。1班为对照组,2班为实验组,对照组采取传统讲授法进行教学,实验组用“微助教”平台来辅助生理学教学。课程结束时,通过期末考试和问卷调查来评价“微助教”平台在生理学教学中的应用效果,用SPSS17.0对数据进行分析和t检验。结果实验组和对照组期末考试成绩差异具有统计学意义[(81.46 ± 7.63) vs. (68.21 ± 10.27), t = -7.769 , P = 0.000],其中第四章内容得分[(15.76 ± 1.) vs. (289.34 ± 1.96), t = -20.595, P = 0.000],第八章内容得分[(8.31 ± 0.86) vs. (6.28 ± 1.22), t = -10.207, P = 0.000]及第十章内容得分[(15.99 ± 1.14) vs. (11.19 ± 1.81), t = -16.856, P = 0.000]差异具有统计学差异。实验班问卷调查回收率为100%,结果显示,56人（98.24%）认为“微助教”有助于互动交流,51人（89.47%）认为“微助教”有助于组织课堂纪律,43人（75.43%）认为“微助教”有助于提高学习兴趣,55人（95.26%）认为“微助教”有助于精准解决各重难点知识点。结论“微助教”平台在生理学教学中的应用有助于提高教学效果,值得推广。     

CBI教学在呼吸内科医学英语教学中的应用

目的　探讨内容型（content-based instruction,CBI）教学在呼吸内科医学英语教学中的应用效果。方法　选择济宁医学院2009级本科临床医学专业120名学生为研究对象,分为对照组（60名）和实验组（60名）。实验组采用CBI教学;对照组采用传统教学。教学结束后,对2组学生进行医学英语水平测试及标准化病人测试;同时以不记名问卷调查方式,进行英语学习兴趣调查以及英语自主学习能力调查。采用SPSS 17.0软件进行统计学分析,用t检验和?字2检验评价两种方法教学效果,检验水准?琢=0.05。结果　实验组医学英语水平测试成绩、标准化病人测试成绩和英语自主学习能力总平均成绩分别为（81.97±4.91）、（80.33±5.85）、（3.88±0.38）分,均高于对照组成绩[（70.40±4.78）、（70.48±4.79）、（2.98±0.26）分],P值均等于0.000。实验组学生对CBI教学在提高学习动机、增加学习时间、改进学习方法、提高学习认真程度和提高学习困难应对方面的满意度明显高于对照组（?字2=13.084,8.000,13.297,11.627,13.374,P值均等于0.000）。结论　CBI教学优于传统教学,使英语学习转变为呼吸科专业知识和技能的学习,可激发学生学习兴趣、提高其自主学习能力与实际运用英语的能力。     

第二课堂实践教学对提升医学生医学笔译能力的效果评价

目的　探讨第二课堂实践教学在提高医学生医学笔译能力中的应用效果。方法　在2015级药学专业的两个平行班里,抽取一班58名学生作为对照组,采用传统的大学英语教学;另一班60名学生则为实验组,采用传统英语教学并开展为期一年的医学笔译第二课堂实践教学。实验结束后通过笔试测验和调查问卷等综合指标对教学效果进行评估分析。使用SPSS 19.0进行统计学分析,笔试成绩采用独立样本t检验,满意度调查采用卡方检验。结果　实验组成绩的平均成绩[（29.28±7.02）分]优于对照组[（22.08±9.49）分],差异有统计学意义（t=3.049,P=0.000）;对于教学方式、课程参与度和解决问题能力等方面,统计分析显示实验组明显优于对照组。结论　有计划、有目的进行第二课堂实践教学能促进医学生医学笔译能力的提高。     

“以器官系统为基础”的临床毕业实习整合教学效果分析

分析“以器官系统为基础”的临床毕业实习整合模式的教学效果。方法　选取沈阳医学院2009级临床医学专业本科生150人,随机分为实验组75人,对照组75人。实验组接受“以器官系统为基础”的整合模式实习,即按照人体器官系统实习;对照组按照“以学科为中心”的传统模式实习。实习结束对两组学生进行问卷调查和综合考试,对教学效果进行比较。数据统计利用SPSS 19.0 软件,采用卡方检验和t检验进行分析。结果　实验组学生在实习模式认可度（χ2=11.437,P=0.003）、知识体系的完整性（χ2=9.881,P=0.007）、提高自主学习能力（χ2=9.643,P=0.008）、教学方法和手段（χ2=11.006,P=0.004）、激发学习兴趣（χ2=13.550,P=0.001）、提高临床思维能力（χ2=13.309,P=0.001）六个方面满意度均高于对照组学生,差异均有统计学意义。综合考试成绩显示,实验组学生在理论知识考试（t=2.768,P=0.006）、技能操作考试（t=2.212,P=0.029）、临床能力考试（t=5.015,P=0.000）三部分成绩也明显高于对照组学生,差异有统计学意义。结论　“以器官系统为基础”的临床毕业实习整合模式受到学生的普遍认可,明显提高了学生的临床思维能力以及毕业实习教学质量。     

TBL教学对护理本科学生自主学习能力的影响

目的　探讨以团队为基础的学习（team-based learning, TBL）对护理专业本科学生自主学习能力的影响。方法　将某学院2010级护理专业本科生160人作为研究对象,按照学生自愿原则,随机分成实验组（n=80）及对照组（n=80）。实验组学生部分教学中应用TBL,对照组学生全程采用传统教学（lecture-based learning,LBL）。用护理人员自主学习能力评价量表测量两组学生的自主学习能力,组间结果比较行t检验。结果　实施TBL教学后,实验组学生自主学习能力总分为（120.33±16.09）,高于实施前的测量总分（100.35±11.15）（P=0.000）,高于教学完成后对照组学生的总分（110.87±11.89）（P=0.000）,差异均有统计学意义。结论　TBL有助于提高护理专业本科学生的自主学习能力。     

病例教学为主导的交叉学科整合课在医学检验专业的构建与实施

目的　通过病例教学为主导的交叉学科整合课在医学检验专业的构建与实施,探讨对医学检验专业学生岗位胜任力培养的影响。方法　将医学检验技术专业本科生2015级作为实验组（57人）,2014级作为对照组（59人）,实验组接受交叉学科整合课的学习,实验组1班采用CBL教学、实验组2班采用TBL教学进行病例讨论课。对照组未接受交叉学科整合课的学习,按照传统检验专业课程设置学习。第四学期课程结束后,进行病理生理学课程期末成绩比较;实验组在学期初与学期末通过调查问卷评价教学效果,结果录入SPSS 19.0软件进行两独立样本t检验。结果　实验组病理生理学课程期末成绩（75.65±7.13）明显高于对照组（69.94±9.77）,差异有统计学意义（P=0.000）。实验组学期末调查问卷结果中交叉学科学习兴趣、基础课间联系、基础临床融合、分析问题能力、解决问题能力、自主学习能力、表达沟通、团队合作以及批判性思维的评分分别为（7.59±1.48）、（8.19±1.22）、（8.33±1.19）、（8.10±1.17）、（7.71±1.14）、（8.07±1.55）、（8.02±1.15）、（7.55±1.17）和（7.41±1.23）,明显高于学期初（3.81±1.80）、（4.07±1.57）、（3.36±1.42）、（3.64±1.44）、（4.12±1.51）、（3.52±1.54）、（3.59±1.34）、（3.19±1.38）和（3.72±1.36）,差异有统计学意义（P＜0.01）。结论　病例教学为主导的交叉学科整合课对基础医学阶段医学检验专业学生岗位胜任力的培养具有促进作用。     

小规模限制性在线课程在医学本科生淋巴瘤临床教学中的应用研究

目的　探究设计基于小规模限制性在线课程（small private online course,SPOC）的整合教学应用于医学本科生淋巴瘤临床教学的可行性和实践效果。方法　将60名在血液内科进行临床学习的医学生,按入科前基础医学理论考试成绩,随机分入SPOC教学组（n=30）和以问题为基础的学习（problem-based learning,PBL）组（n=30）,进行淋巴瘤相关知识点的临床教学和指导。教学活动结束后,采用匿名问卷调查师生对SPOC和PBL教学的主观体验及评价;并通过两组学生出科考试成绩的比较,分析不同方法下教学质量的差异。采用SPSS 19.0对两组学生考试成绩行t检验。结果　调查结果显示,与PBL教学组相比,SPOC教学组师生的教学反馈评价更高、教学体验更好,SPOC得到师生的普遍认可。SPOC教学组学生的出科考试三项成绩均优于PBL教学组,且差异有统计学意义：出科理论成绩[（84.03±7.66） vs.（77.60±8.22）,P=0.005],实践技能成绩[（87.83±8.17） vs. （81.97±6.13）,P=0.001],病例分析成绩[（88.17±6.53） vs. （80.10±6.91）,P=0.000]。结论　基于SPOC的整合教学适宜医学本科生淋巴瘤临床教学,且有助于提升学生的学习兴趣、学习能力、基础理论水平和临床实践能力,为专科疾病临床教学提供了新思路。     

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.