以临床胜任力为导向的CBL教学在急危重症护理教学中的实践

目的 探讨基于病例教学（case based learning,CBL）在急危重症护理学本科临床教学中的可行性和有效性。方法 急危重症护理本科生120人随机分为CBL教学组和传统教学组,两组分别采取不同的临床教学方法,并采用理论考试、技能考试以及问卷调查等多种考核方式评价教学效果。结果 与传统教学组相比,CBL教学组在理论考试和技能考试方面均更好,且差异有统计学意义;教学满意度调查方面, CBL教学组也优于传统教学组。结论 以学生临床胜任力为导向的CBL教学应用于急危重症护理本科临床教学是可行的,能有效培养学生的临床思维和提高实际的临床胜任力。     

3D打印骨骼模型在基层医院骨科实习教学中的应用初探

目的 探索3D打印骨骼模型在基层医院骨科临床实习教学中的作用。方法 将2015年10月－2016年10月轮转我科的30名临床医学本科实习学生采用电脑随机数法随机分为3D打印模型教学组（n=15）和传统教学组（n=15），分别以每位学生为主要教学对象选择1例典型骨折病例进行教学查房，其中传统教学组按照常规流程进行，3D打印模型教学组利用患者的3D打印骨骼模型辅助进行教学查房，并进行模拟手术。轮转结束对两组学生进行理论和实践操作考试，并采用问卷调查的形式进行教学评价，采用SPSS19.0对结果进行独立样本t检验。结果3D打印模型教学组学生的理论成绩（92.27±4.56 vs 86.87±5.30）及实践操作考试成绩（90.07±4.61 vs 82.53±5.03）明显优于传统教学组（P<0.01）；3D打印模型教学组学生对其所接受的教学在促进理论知识理解、增强手术参与度、动手能力锻炼、教学吸引力、总体满意度等方面评分均高于传统教学组（P<0.01）。结论 3D打印骨骼模型是一种有效的教学工具，其在基层医院骨科临床实习教学中的应用可明显提升教学效果和满意度，值得进一步探索和推广。     

示教与反示教系统在住院医师规范化培训临床技能教学中的应用

目的　探讨示教与反示教系统在住院医师规范化培训临床技能教学中的应用及效果。方法　将湖南省儿童医院2018级40名儿科住院医师分成传统教学组、示教与反示教教学组,每组20人。对其进行执医技能培训,并对教师现场单项技能教学时间、两组学员掌握单项技能的时间、技能操作能力、综合能力进行比较分析;另外通过问卷星调查师生对示教与反示教系统教学的满意度。采用SPSS 17.0软件进行t检验和卡方检验。结果　示教与反示教教学组教师现场单项技能教学时间[（21.75±3.24）min vs.（48.65±2.91）min]、住院医师单项技能掌握时间[（20.46±3.57）min vs. （30.24±4.73）min]均短于传统教学组（P<0.05）。示教与反示教教学组住院医师临床技能成绩[（92.96±5.21）vs.（84.13±3.28）]及综合能力评分[（91.23±5.06）vs.（85.23±5.72）]均高于传统教学组（P<0.05）。调查问卷显示住院医师对示教与反示教教学持肯定积极的态度：认为其具有便于全维度观看、提高学习兴趣、学习效果好等优势。结论　示教与反示教系统在儿童专科医院住院医师规范化培训中的运用,能弥补在儿童专科医院少见的成人临床操作学习机会,迅速提高住院医师的专业技能,提高执业医师考试通过率,有助于提高住院医师岗位胜任力。     

TBL联合CBL在军人积极心理学教学中的应用

目的　探讨以团队为基础的教学（team-based learning，TBL）联合以案例为基础的教学（case-based learning，CBL）在军人积极心理学教学中的应用效果。方法　选取陆军军医大学校2017级临床医学专业100名本科生作为教学对象，随机分为TBL联合CBL教学组（n=50）和传统教学组（n=50）。通过基础理论知识及案例分析考核、问卷调查和心理测评等方式评估两种教学方法的教学效果。运用SPSS 19.0 对结果进行t检验。结果　TBL联合CBL教学组在理论知识得分（54.87±4.98）高于传统教学组（48.65±3.51）；案例分析考核得分（36.84±2.73）也高于传统教学组（32.37±2.34）；在心理测评结果中，TBL联合CBL教学组在SCL-90后测得分（143.31±43.62）低于传统教学组（149.89±46.96）；ERC、GWB后测得分（48.76±5.37）、（107.87±15.56）均高于传统教学组（43.58±5.79）、（102.32±12.13）。此外，TBL联合CBL教学组学生对该教学满意率达95.83%（46/50）。结论　TBL联合CBL教学在军人积极心理学教学中能取得良好的教学效果，提高学员的知识应用水平和心理调适能力，具有较好的可行性和适用性。     

CBL教学病例库在心内科五年制本科教学中的应用

目的:探讨CBL教学病例库在心内科五年制本科教学中应用的可行性和有效性。方法:将100名五年制本科学员随机分为传统阶段教学组和CBL病例库教学组;以理论考试、病例分析和临床技能考核作为评价方法。结果:临床实习成绩CBL病例库教学组优于传统阶段教学组(P<0.05)。结论:CBL教学病例库的应用更适合于学员灵活运用心内科专业知识,可进一步推广。     

CBL联合临床路径在胸外科实习教学中的应用

目的 探讨以案例为基础的学习（case-based learning,CBL）联合临床路径在胸外科实习带教中的可行性和应用价值。方法 筛选2018年1月至2018年8月实习的临床专业本科学生30名,按照随机数字表法分为传统组和研究组。传统组以传统教学模式带教,研究组以CBL联合临床路径教学。对比两组学生的出科理论成绩、实践技能成绩和病例分析能力等。另外通过匿名调查问卷的方式观察两组教师和学生对教学效果的评价。采用 SPSS 21.0 进行t 检验和卡方检验。结果 研究组学生出科各项成绩均优于传统组,其中理论成绩[（88.20±4.02） vs. （80.76±4.62）,P<0.001]、实践技能成绩[（90.80±2.16） vs. （84.80±3.07）,P<0.001]和病例分析能力成绩[（89.80±3.34） vs. （81.86±4.31）,P<0.001],差异均有统计学意义。同时调查问卷显示,研究组在提高学生的学习兴趣、临床技能、病例分析能力、临床沟通能力,加深对理论知识的理解及培养临床思维能力方面均优于传统组,差异有统计学意义（P<0.05）;而在学生对带教教师的满意度方面,两组差异无统计学意义（P=0.083）。结论 CBL联合临床路径教学法可提高胸外科实习带教效果,值得推广使用。     

以能力培养为导向的高职护生实习带教模式效果评价

目的 探讨以能力培养为导向的高职护生实习带教模式与效果。方法 以某高等医学院校2014年7月至2015年5月进入感染科实习的高职护生96名设为对照组，给予常规的师徒带教模式；2015年7月至2016年5月进入感染科实习的高职护生99名设为实验组，在常规师徒带教模式基础上，同时给予以能力培养为导向的带教模式。两组护生在出科前均进行专科理论知识与技能测试，同时进行关怀能力与延续护理能力自我评价，比较两组护生专科理论知识与技能测试成绩、关怀能力与延续护理能力的变化。计量资料以均数±标准差表示，两组间比较采用独立样本t检验。结果 实验组护生专科理论成绩[（93.70±4.27） vs.（88.00±4.83）]及技能考试成绩[（95.70±2.49）vs.（91.40±2.87）]均高于对照组；关怀能力总分[（189.3±13.5）vs.（179.4±10.4）]，认知维度均分[（51.6±9.8）vs.（50.2±10.3）]、勇气维度均分[（70.2±6.5）vs.（65.7±8.4）]、耐心维度均分[（67.5±4.8）vs.（63.4±5.4）]；延续护理能力总分[（124.95±24.06）vs.（118.18±20.41）]，知识维度均分[（38.43±8.22）vs.（36.08±7.23）]、态度维度均分[（54.08±10.66）vs.（51.02±9.16）]、行为维度均分[（32.43±6.25）vs.（32.43±6.25）]，较对照组均有所提高，差异有统计学意义（P＜0.05）。结论 以能力培养为导向的带教模式优于传统带教模式，值得临床推广。     

在医用化学教学中运用CBL对培养医学生岗位胜任力的研究

目的　探究以案例为基础的学习（case-based learning,CBL）运用到医用化学教学中对医学生岗位胜任力的培养效果。 方法　选择中国医科大学护理专业两个班为实验组,两个班为对照组,分别采用CBL教学和传统教学,授课教师和教材均相同。通过问卷调查和期末考试来评估CBL教学对培养医学生岗位胜任力的现状。应用SPSS 20.0统计软件进行t检验。结果　问卷调查结果显示,实验组学生对CBL教学持肯定态度。期末考试成绩显示,实验组学生医用化学考试平均分为（73.5±10.3）,明显高于对照组学生平均分为（６８.1±9.1）,差异有统计学意义（P=0.003）。结论　在医用化学教学中运用CBL教学,能够有效地改善学生的学习效果,培养医学生的岗位胜任力,在基础医学教学领域具有推广价值。     

危重病教学CBL评估体系的探索

目的探索危重病教学中以病例为基础的学习（Case—basedlearning,CBL）评估方法。方法将53名2010年至2012年在我院实习的上海交通大学医学院临床医学系本科学生分为传统教学组和CBL教学组,CBL教学组采用传统教学结合CBL教学,选择重症急性胰腺炎及多发伤2种重症监护病房（Intesivecareunit,ICU）常见危重病病例为CBL案例。2组学生均在教学实习结束后进行理论知识、迷你临床评估训练（Mini—clinicalevaluationexercise,Mini-CEX）及直接观察操作技能（Directobservationofproceduralskills,DOPS）评估。结果2组在理论知识考核中差异无统计学意义;在Mini-CEX评估中,CBL教学组在医疗面谈能力（P=0．000）、人文关怀（P=0．013）、临床诊断（P=0．035）、咨商卫教（P=0．009）、整体临床能力方面（P=0．008）明显优于传统教学组;CBL案例中所讨论到的气管插管（P=0．016）及中心静脉穿刺（P=0．001）的DOPS评分,CBL教学组明显高于传统教学组。结论传统理论知识考核在CBL教学评估中意义不大;针对临床综合能力及技能操作能力的Mini—CEX及DOPS评估更能体现CBL教学的优势。     

PBL联合CBL教学结合自媒体平台在消化内科临床见习教学中的应用

目的 观察以问题为基础的学习（problem-based learning,PBL）联合以案例为基础的学习（case-based learning,CBL）结合自媒体平台在消化内科临床见习教学的应用效果。方法 选取2019年7月至2020年 6月在陆军特色医学中心消化内科临床见习的学员60人,其中传统教学组30人,PBL联合CBL结合自媒体平台教学组30人;教学结束后通过理论考试、实际操作考核和调查问卷作为评价方法,评估两种教学方式的教学效果。采用SPSS 23.0软件进行t检验。结果 研究组学生课程综合得分[包括理论考试（86.60±1.17）和实际操作考试（86.40±0.83）]高于对照组的（81.70±0.98）和（82.00±1.18）;调查问卷中PBL联合CBL结合自媒体平台教学组自学和查阅资料能力、学生自身的自信度及对教学的满意度调查方面均优于传统教学组（P<0.001）。结论 PBL联合CBL结合自媒体平台利用实际病案引导学生进行临床问题的讨论分析与归纳总结,结合自媒体的灵活学习,突破了传统教学模式限制,提高了教学水平及学习满意度,值得在消化内科临见习教学中推广应用。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.