中药学硕士专业学位研究生培养模式初探——基于教育创新基地中药学研究生的培养模式

中药学硕士专业学位教育着力培养高层次应用型中药学专门人才,培养模式与学术学位中药学硕士生有明显区别。我校基于教育创新基地的中药学硕士学术学位研究生的培养模式,着重于提升研究生的专业水平、实践能力和行业适应性,符合中药学硕士专业学位研究生的培养目标,可应用于中药学硕士专业学位研究生的培养。     

药学硕士专业学位研究生药理学案例教学库的建设及应用探讨——以桂林医学院为例

药学硕士专业学位是我国2010年新增专业学位之一,具有职业性与学术性相统一、特定的职业指向性和教育的实践依赖性等特点。药理学课程是药学硕士专业学位研究生必修课——药学专业知识(一)的重要构成部分。从药理学课程案例教学库建设的角度探索药学硕士专业学位研究生的培养手段,以保障药学硕士专业学位研究生的培养质量。     

中药学硕士专业学位研究生培养模式和管理机制探讨

为适应我国中医药事业发展对中药学专门人才的迫切需求,完善中药学人才培养体系,创新中药学人才培养模式,提高中药学专业人才培养质量,实现从以培养学术型人才为主向以培养应用型人才为主转变。我校中药学硕士专业学位建设紧密结合我省和区域经济社会发展需求,从优化课程体系设置,完善校-企"两段式,双导师"培养模式,建立专业学位建设经费保障体系,加强师资队伍和实践教学基地建设,建立和完善中药学专业学位教育管理与评价体系,正确协调学术型与专业学位关系等方面来探讨,为中药学硕士专业学位培养模式的提供一些的借鉴。     

行业需求视角下护理硕士专业学位临床实践专科嵌入式培养模式的实施与建议

鉴于现阶段我国护理硕士专业学位临床实践培养尚处在初期,为加快适应临床护理行业发展需求,如何将护理硕士研究生培养成高层次、应用型、专科型高级实践护理人才仍是我们需继续探索的问题。本文将着重分析护理硕士专业学位研究生临床实践专科嵌入式培养模式的必要性以及国内外护理硕士研究生培养与职业资格衔接的现状,通过借鉴护理硕士研究生与临床专科护士的培养经验,探索行业需求视角下护理硕士专业学位临床实践专科嵌入式模式,以期为高校与行业共同培养高级护理实践人才提供新思路。     

浅议对中药学硕士专业学位培养目标与方式的认识

通过问卷调研形式深入分析导师、管理干部及研究生对中药学硕士专业学位培养目标与方式的认知及理解程度,初步提出构建中药学硕士专业学位研究生培养模式的主要思路与基本框架.     

医学全日制专业学位培养模式初探

国家从招收全日制硕士专业学位开始,正逐步推进研究生教育结构的调整。第四军医大学以此为契机,通过总结多年来对临床医学、口腔医学专业学位研究生培养实践,进一步深化专业学位培养模式改革,从优化课程设置、改革临床实践及考核模式等方面对构建医学全日制专业学位研究生培养模式进行了有益的尝试,保障医学全日制专业学位研究生培养质量,为缩短医学研究生培养现状与社会需求之间的差距提供可能的解决办法。     

工业药学领域药学硕士专业学位研究生实践体系探索——基于内蒙古大唐药业股份有限公司基地建设的研究

<正>1前言药学硕士专业学位研究生的培养,是药学人才培养的重要组成部分,是药学学术型研究生培养的有益补充。药学硕士专业学位研究生是要通过学习专业知识,经过实践培训,熟悉并能胜任药品生产、技术转化、产品流通、安全使用、规范监管以及用药服务等工作要求,最终成为高水平药学应用人才^[1]。     

全日制临床医学硕士专业学位研究生培养模式探讨

以国务院学位委员会《关于开展“服务国家特殊需求人才培养项目”试点工作的意见》为指导,结合学校实际,对全日制临床医学硕士专业学位研究生的培养目标、培养方案、临床能力培养、考核评价、师资队伍、联合培养等进行了深入思考与探索,旨在不断创新临床医学硕士专业学位研究生培养模式,提高人才培养质量.     

电子信息专业学位硕士研究生培养模式探索

研究生教育肩负着高层次人才培养的重要使命,我国专业学位硕士研究生教育尚存在科研创新能力不足、体现学科交叉的课程少、产学研合作模式有待进一步深化等问题。文章依托高校、国家重点实验室、医疗设备企业、临床应用医院等产学研用平台,从电子信息专业学位硕士研究生培养专业方向设置、培养目标定位、交叉知识结构、专业实践平台、校企联合导师、培养质量保障6方面,探索在医疗设备领域构建医工融合、产学研用协同的电子信息专业学位硕士研究生培养模式,旨在培养具有创新实践能力的应用型、复合型医疗设备技术开发、临床应用和维护管理的专业人才。     

基于“贵州民族医药特色,服务地方经济”的药学研究生人才培养模式探讨

作为地方医药院校,如何充分利用区域医药卫生经济的特点,发挥人才培养优势,满足地方特色医药产业及经济发展的需求,成为当前地方院校研究生培养的焦点问题。贵州医科大学药学院作为贵州区域药学研究生培养的主要力量,在办学思路、培养方案、学科、研究平台及产学研合作基地建设,对外交流合作以及学位论文质量等方面进行了药学研究生人才培养的探索与实践。所构建的药学研究生培养模式能够与地方实际需求接轨,能更好地培养出满足贵州民族医药产业发展需求、服务地方经济的药学研究人才。     

Quality of reporting of randomized trials as a measure of methodologic quality

Context  The evaluation of the methodologic quality of randomized controlled trials (RCTs) is central to evidence-based health care. Important methodologic detail may, however, be omitted from published reports, and the quality of reporting is therefore often used as a proxy measure for methodologic quality. We examined the relationship between reporting quality and methodologic quality of published RCTs. Methods  Study of 60 reports of placebo-controlled trials published in English-language journals from 1985 to 1997. Reporting quality was measured using a 25-item scale based on the 1996 issue of the Consolidated Standards of Reporting Trials (CONSORT). Concealment of allocation, appropriate blinding, and analysis according to the intention-to-treat principle were indicators of methodologic quality. Methodologic quality was compared between groups of trials defined by reporting quality scores of low, intermediate, and high. Reporting quality scores were compared between groups defined by high and low methodologic quality. Results  Among 23 trials of low reporting quality (median score, 9 [range, 3.5-10.5]), allocation concealment was unclear for all but 1 trial, but there were 16 trials (70%) with adequate blinding and 9 trials (39%) that had been analyzed according to the intention-to-treat principle. Among 18 trials of high reporting quality (median score, 18 [range 16.5-22.0]), there were 8 trials (44%) with adequate allocation concealment, 16 trials (89%) with adequate blinding, and 13 trials (72%) analyzed according to the intention-to-treat principle. The median reporting score was 15.0 for the 33 trials that were analyzed according to intention-to-treat principle and 14.5 for the 14 trials with on-treatment analyses (P = .67). Conclusions  Similar quality of reporting may hide important differences in methodologic quality, and well-conducted trials may be reported badly. A clear distinction should be made between these 2 dimensions of the quality of RCTs.      

Discontinuation of use and switching of antidepressants: influence of patient-physician communication

Context  Although current depression treatment guidelines recommend continuing antidepressant therapy for at least 4 to 9 months, many patients discontinue treatment prematurely, within 3 months. Objectives  To investigate the relationship between patient-physician communication and the continuation of treatment with antidepressants and to explore the demographics, adverse effects, therapeutic response, and frequency of follow-up visits. Design, Setting, and Patients  A total of 401 telephone interviews of depressed patients being treated with selective serotonin reuptake inhibitor (SSRI) therapy between December 15, 1999, and May 31, 2000, were conducted and 137 prescribing physicians completed written surveys from Northern California Kaiser Permanente health maintenance organization outpatient clinics. Main Outcome Measures  Patient-physician communication about therapy duration and about adverse effects; therapy discontinuation or medication switching within 3 months after start of SSRI therapy. Results  Ninety-nine physicians (72%) reported that they usually ask patients to continue using antidepressants for at least 6 months, but 137 patients (34%) reported that their physicians asked them to continue using antidepressants for this duration and 228 (56%) reported receiving no instructions. Patients who said they were told to take their medication for less than 6 months were 3 times more likely to discontinue therapy (odds ratio [OR], 3.12; 95% confidence interval [CI], 1.21-8.07) compared with patients who said they were told to continue therapy longer. Patients who discussed adverse effects with their physicians were less likely to discontinue therapy than patients who did not discuss them (OR, 0.49; 95% CI, 0.25-0.95). Patients who reported discussing adverse effects with their physicians were more likely to switch medications (OR, 5.60; 95% CI, 2.31-13.60). Fewer than 3 follow-up visits for depression, adverse effects, and lack of therapeutic response to medication were also associated with patients' discontinuing therapy. Conclusions  Discrepancies exist between instructions that physicians report they communicate to patients and what patients remember being told. Explicit instructions about expected duration of therapy and discussions about medication adverse effects throughout treatment may reduce discontinuation of SSRI use. Our finding that patients with 3 or more follow-up visits were more likely to continue using the initially prescribed antidepressant medication suggests that frequent patient-physician contact may increase the probability that patients will continue therapy.      

89SrCl2治疗恶性肿瘤骨转移的影响因素分析

目的 探讨89 SrCl2治疗恶性肿瘤骨转移的疗效影响因素.方法 选择南充市川北医学院附属医院2013年2月至2016年9月行89 SrCl2治疗的恶性肿瘤骨转移患者99例,分析患者的年龄、性别、肿瘤病理类型、89 SrCl2治疗次数、手术切除原发灶、放疗、化疗、肿瘤骨转移的病灶数量、联合止痛药状况以及碱性磷酸酶(ALP)是否会影响89 SrCl2的治疗效果.结果 89 SrCl2治疗的总有效率为63.6％.单因素分析结果显示不同肿瘤病理类型、不同治疗次数、是否联合放射治疗、是否手术切除原发灶、不同肿瘤骨转移病灶数量及是否联合止痛药患者的治疗效果进行比较,差异具有统计学意义(P<0.05).logistics回归分析显示,患者的肿瘤病理类型、89SrCl2治疗次数、手术切除原发灶、肿瘤骨转移的病灶数量及联合止痛药是影响89SrCl2疗效的独立因素(P<0.05).结论 肿瘤病理类型、89 SrCl2治疗次数、手术切除原发灶、肿瘤骨转移病灶数量以及联合止痛药能影响89 SrCl2治疗恶性肿瘤骨转移的疗效.     

Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence

Kaycee M. Sink, MD; Karen F. Holden, MD; Kristine Yaffe, MD

JAMA. 2005;293:596-608.

Context  Neuropsychiatric symptoms of dementia are common and associated with poor outcomes for patients and caregivers. Although nonpharmacological interventions should be the first line of treatment, a wide variety of pharmacological agents are used in the management of neuropsychiatric symptoms; therefore, concise, current, evidence-based recommendations are needed.

Objective  To evaluate the efficacy of pharmacological agents used in the treatment of neuropsychiatric symptoms of dementia.

Evidence Acquisition  A systematic review of English-language articles published from 1966 to July 2004 using MEDLINE, the Cochrane Database of Systematic Reviews, and a manual search of bibliographies was conducted. Inclusion criteria were double-blind, placebo-controlled, randomized controlled trials (RCTs) or meta-analyses of any drug therapy for patients with dementia that included neuropsychiatric outcomes. Trials reporting only depression outcomes were excluded. Data on the inclusion criteria, patients, methods, results, and quality of each study were independently abstracted. Twenty-nine articles met inclusion criteria.

Evidence Synthesis  For typical antipsychotics, 2 meta-analyses and 2 RCTs were included. Generally, no difference among specific agents was found, efficacy was small at best, and adverse effects were common. Six RCTs with atypical antipsychotics were included; results showed modest, statistically significant efficacy of olanzapine and risperidone, with minimal adverse effects at lower doses. Atypical antipsychotics are associated with an increased risk of stroke. There have been no RCTs designed to directly compare the efficacy of typical and atypical antipsychotics. Five trials of antidepressants were included; results showed no efficacy for treating neuropsychiatric symptoms other than depression, with the exception of 1 study of citalopram. For mood stabilizers, 3 RCTs investigating valproate showed no efficacy. Two small RCTs of carbamazepine had conflicting results. Two meta-analyses and 6 RCTs of cholinesterase inhibitors generally showed small, although statistically significant, efficacy. Two RCTs of memantine also had conflicting results for treatment of neuropsychiatric symptoms.

Conclusions  Pharmacological therapies are not particularly effective for management of neuropsychiatric symptoms of dementia. Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy. However, the effects are modest and further complicated by an increased risk of stroke. Additional trials of cholinesterase inhibitors enrolling patients with high levels of neuropsychiatric symptoms may be warranted.

     

两种抗凝剂对实验用小型猪血液生理指标的影响

目的比较分析两种抗凝剂对实验用小型猪血液生理指标的影响。方法将22只成年的实验用小型猪,分别用EDTA三钾和肝素锂抗凝采血后,用日本光电MEK-7222K血球分析仪测定血液生理指标。结果使用不同的抗凝剂,同一批样本的血液生理指标中单核细胞绝对值(MON)有差异(P0.05),平均红细胞体积(MCV)、平均红细胞血红蛋白浓度(MCHC)、血小板比积(PLT)、血小板平均体积(PCT)、血小板平均体积(MPV)、淋巴细胞绝对值(LYM)、嗜酸性粒细胞绝对值(EOS)、嗜碱性粒细胞绝对值(BAS)、淋巴细胞绝对值(LYM)%、单核细胞绝对值(MON)%、嗜酸性粒细胞百分率(EOS)%和嗜碱性粒细胞百分率(BAS)%这12个指标有显著差异(P0.01);EDTA三钾抗凝的血液生理指标中血小板比积(PLT)、中性粒细胞绝对值(NEUT)和中性粒细胞百分率(NEUT)%有性别差异(P0.05),MON、EOS、MON%和EOS%性别差异有显著性(P0.01);肝素锂抗凝的血液生理指标中血小板体积分布宽度(PDW)、中性粒细胞绝对值(NEUT)和LYM%有性别差异(P0.05),MON、EOS、MON%、NEUT%和EOS%性别差异有显著性(P0.01)。结论不同的抗凝剂对实验用小型猪血小板和白细胞分类计数参数影响显著,进行相关实验时应妥善选择血液抗凝方式。     

Association of dietary intake of fat and fatty acids with risk of breast cancer

Context  High intakes of fat and specific fatty acids, including total, animal, saturated, polyunsaturated, and trans-unsaturated fats, have been postulated to increase breast cancer risk. Objective  To determine whether intakes of fat and fatty acids are associated with breast cancer. Design and Setting  Cohort study (Nurses' Health Study) conducted in the United States beginning in 1976. Participants  A total of 88,795 women free of cancer in 1980 and followed up for 14 years. Main Outcome Measure  Relative risk (RR) of invasive breast cancer for an incremental increase of fat intake, ascertained by food frequency questionnaire in 1980, 1984, 1986, and 1990. Results  A total of 2956 women were diagnosed as having breast cancer. Compared with women obtaining 30.1% to 35% of energy from fat, women consuming 20% or less had a multivariate RR of breast cancer of 1.15 (95% confidence interval [CI], 0.73-1.80). In multivariate models, the RR (95% CI) for a 5%-of-energy increase was 0.97 (0.94-1.00) for total fat, 0.98 (0.96-1.01) for animal fat, 0.97 (0.93-1.02) for vegetable fat, 0.94 (0.88-1.01) for saturated fat, 0.91 (0.79-1.04) for polyunsaturated fat, and 0.94 (0.88-1.00) for monounsaturated fat. For a 1% increase in energy from trans-unsaturated fat, the values were 0.92 (0.86-0.98), and for a 0.1% increase in energy from omega-3 fat from fish, the values were 1.09 (1.03-1.16). In a model including fat, protein, and energy, the RR for a 5% increase in total fat, which can be interpreted as the risk of substituting this amount of fat for an equal amount of energy from carbohydrate, was 0.96 (95% CI, 0.93-0.99). In similar models, no significant association of risk was evident with any major types of fat. Conclusion  We found no evidence that lower intake of total fat or specific major types of fat was associated with a decreased risk of breast cancer.      

Evaluation of berries of Phytolacca dodecandra for growth inhibition of Histoplasma capsulatum var. farciminosum and treatment of cases of epizootic lymphangitis in Ethiopia

Objective:To evaluate the berries of Phytolacca dodecundra(P.dodecandra) for its effect on Histoplasma cupsulatum var.farciminosum(HCF) and for the treatment of cases of epizootic lymphangitis(ELi.Methods:Samples were collected from un-ruptured nodules of cases of EL at Debre Zeit and Akaki(central Ethiopia).Mycologieal culture and isolation of HCF were performed at the Akliln Lemma Institute of Pathobiology.Phytochemical screening was done for n-butanol extract of P.dodecandra to delect alkaloids,saponins,phenolic compounds and flavonoids.The minimum inhibitory concentrations(MICs) and minimum fungicidal concentrations(MFCs) ol aqueous and n-butanol extracts of P.dodecandra against FICF were determined by agar dilution assay.For the in vivo trial.5%simple ointment was prepared from n-butanol extract and applied topically to 24(twelve early and twelve moderate) cases of F.L.Results:Phytochemical screening showed that n-butanol extract ol P.dodecandra was positive lor alkaloids.saponins and phenolic compounds but negative for flavonoids.The MFCs of n-butanol and aqueous extracts of P.dodecandra were(0.039%-0.078%) and(0.625%-1.250%),respectively.The MFCs of n-butanol and aqueous extracts of P.dodecandra were(0.078%t-0.156%)and(1.250%-2.500%),respectively.The MIC and MFC of ketoconazole(positive control) was(1.200×10~(-5)%-2.500×10~(-5)%) and(5.000× 10~(-5)%-1.000×10~(-4)%),respectively while growth was observed on free medium(negative control).From the total of 24 treated cases of EL,14(58.3%) responded lo treatment;however,10(41.7%) did not respond to treatment.There was no significant difference in the degree of response to treatment between early and moderate cases(χ~2=0.086:P=0.408.Conclusions:It can be concluded that n-butanol extract of P.dodecandra demonstrates antifungal effects while the aqueous extract shows no antifungal activity.     

Effect of calcium carbonate on the absorption of levothyroxine

Context  The effect of calcium carbonate on the absorption of levothyroxine has not been studied systematically. Such a potential drug interaction merits investigation because concurrent treatment with both drugs is common, particularly in postmenopausal women. Objective  To investigate the potential interference of calcium carbonate in the absorption of levothyroxine. Design  Prospective cohort study conducted from November 1998 to June 1999, supplemented with an in vitro study of thyroxine (T₄) binding to calcium carbonate. Setting  Veterans Affairs Medical Center in West Los Angeles, Calif. Patients  Twenty patients (age range, 27-78 years; n=11 men) with hypothyroidism who were taking a stable long-term regimen of levothyroxine were included in the study. All patients had serum free T₄ and thyrotropin values in the normal range before beginning the study. Intervention  Subjects were instructed to take 1200 mg/d of elemental calcium as calcium carbonate, ingested with their levothyroxine, for 3 months. Main Outcome Measures  Levels of free T₄, total T₄, total triiodothyronine (T₃), and thyrotropin, measured in all subjects at baseline (while taking levothyroxine alone), at 2 and 3 months (while taking calcium carbonate and levothyroxine), and 2 months after calcium carbonate discontinuation (while continuing to take levothyroxine). Results  Mean free T₄ and total T₄ levels were significantly reduced during the calcium period and increased after calcium discontinuation. Mean free T₄ levels were 17 pmol/L (1.3 ng/dL) at baseline, 15 pmol/L (1.2 ng/dL) during the calcium period, and 18 pmol/L (1.4 ng/dL) after calcium discontinuation (overall P<.001); mean total T₄ levels were 118 nmol/L (9.2 µg/dL) at baseline, 111 nmol/L (8.6 µg/dL) during the calcium period, and 120 nmol/L (9.3 µg/dL) after calcium discontinuation (overall P=.03). Mean thyrotropin levels increased significantly, from 1.6 mIU/L at baseline to 2.7 mIU/L during the calcium period, and decreased to 1.4 mIU/L after calcium discontinuation (P=.008). Twenty percent of patients had serum thyrotropin levels higher than the normal range during the calcium period; the highest observed level was 7.8 mIU/L. Mean T₃ levels did not change during the calcium period. The in vitro study of T₄ binding to calcium showed that adsorption of T₄ to calcium carbonate occurs at acidic pH levels. Conclusions  This study of 20 patients receiving long-term levothyroxine replacement therapy indicates that calcium carbonate reduces T₄ absorption and increases serum thyrotropin levels. Levothyroxine adsorbs to calcium carbonate in an acidic environment, which may reduce its bioavailability.      

Effect of awareness of a randomized controlled trial on use of experimental therapy

Context  Use of experimental therapies during but outside of randomized controlled trials (RCTs) has not been studied. Objective  To determine whether initiation of an RCT leads to increased use of the experimental therapy outside the trial. Design and Setting  Data on national apheresis use during 3 Canadian RCTs for multiple sclerosis (1986-1988), thrombotic thrombocytopenic purpura (1982-1988), and myeloma cast nephropathy (1998-2000) were obtained from 19 major medical centers in Canada. The multiple sclerosis and myeloma cast nephropathy trials had data on apheresis use for 3 years prior to and during the trials, which permitted a time-series analysis to determine the impact of the RCTs on the use of apheresis. The ongoing myeloma cast nephropathy trial provided data on the number of patients inside and outside of the RCTs in trial and nontrial centers. Initial and follow-up questionnaires were sent to 24 Canadian physicians in trial and nontrial centers to determine if they had noted an increase in apheresis activity during the trials and, if so, their explanation for it. Main Outcome Measure  Change in number of patients undergoing apheresis for thrombotic thrombocytopenic purpura, multiple sclerosis, and myeloma cast nephropathy prior to and during the respective RCTs compared with all patients undergoing apheresis during the same periods. Results  During all 3 RCTs, there were large increases in use of apheresis. The majority of the increased use of apheresis was outside of the trials: for multiple sclerosis, 30 of 49 patients per year (61% of increase); thrombotic thrombocytopenic purpura, 49 of 56 patients per year (72% of increase); and myeloma cast nephropathy, 60 of 72 patients per year (57% of increase). The myeloma cast nephropathy study noted that this increase occurred in both nontrial and trial centers. Among questionnaire respondents (n = 22; 92% response rate), most physicians noted an increase in apheresis activity during the trials and attributed it to a "jumping-the-gun" phenomenon. Conclusions  During 3 Canadian RCTs, apheresis increased, but most of the increase occurred outside the trials. This behavior during an RCT, in the absence of clear efficacy, can be termed jumping the gun.