医学院校非直属型教学医院教学现状分析与对策研究——以我校邵东临床教学医院为例

近年来,医学院校招生规模不断扩大,但医学院校直属的附属医院教学规模有限,已无法承担日益繁重的临床教学任务.在新形势下,医学院校通过与综合实力较强的医院共同建立非直属型教学医院来改善临床教学基地不足的情况.临床教学医院在完成繁重医疗工作的同时又承担着临床教学任务,使临床教学医院建设无论在教学管理上,还是在保证教学质量方面都面临着巨大的挑战[1].     

非直属附属医院10年建设的实践与思考

高等医学教育大规模扩招带来了临床教学资源不足的问题,而临床教学基地是完成临床教学的主要场所,其数目的 多少和质量的高低直接影响着医学生的培养质量,建立非直属附属医院是保证临床教学质量、实现医学教育可持续发展的重要举措之一.本文对新乡医学院10年非直属附属医院建设过程、建设成效进行了思考和总结,为"大众化教育"阶段的高等医学教育提供了可资借鉴的经验.     

临床教学基地建设的研究与实践

长期以来医院已成为医学院校的有机组成部分 ,医院具有教育教学职能 ,既是医学教育的客观规律 ,也是国家赋予的重要社会职责。为了实现高等医学教育的全新培养目标 ,必须加强临床教学基地 (附属医院、教学医院、实习医院等 )的教育职能建设 ,使之积极地适应医学教育改革和发展的需要。一、我校临床教学基地的状况我校现有直属附属医院 3家、非直属附属医院 9家 ,教学医院和实习医院 38家。附属医院承担了临床理论课和实习带教两部分的教学任务 ;教学医院和实习医院仅承担实习带教任务。目前 ,我校四年级临床医学专业 80 %的学生已进入 6家异…     

医学院校非直属附属医院的建立和运作体会

目的探讨扩招后解决临床教学基地面临困难的可行方法。方法对近十年来学院非直属附属医院的建立和运作情况进行回顾性分析。结果非直属附属医院的建立和临床教学质量控制体系的实施缓解了扩招与临床教学基地紧张的矛盾,保障了临床教学质量。结论高质量的非直属附属医院的建立和运作,是医学院校解决扩招与临床教学基地紧张的矛盾有效方法。     

我院教学工作的实践与思考

非直属附属医院是现代医院与医学院校建立的新型合作关系,为解决高等医学教育扩大规模后临床教学资源不足的问题发挥了非常重要的作用,但与附属医院相比,在建设过程中也存在一些问题和不足,如何深入推进非直属附属医院与学校之间的密切合作,真正助推非直属附属医院提升科研水平、提高临床教学质量,实现"双赢互惠",需进一步深入探究.文章结合我院作为非直属临床医学院建设的经验,客观地分析了加强临床教学工作的做法、成效及体会,提出非直属临床医学院是高等医学教育发展的必然趋势,院校合作是培养医学人才的必要途径,医院要坚持"科教兴院"的战略,进一步强化医院临床教学职能,完善相关教学管理规章制度,培养出更多高素质医学人才.     

非直属附属医院临床教学质量影响因素的调查分析

为研究非直属附属医院临床教学质量的影响因素,采用德尔菲法对在非直属附属医院学习的学生、临床教师、医院教学管理人员和学校教学管理人员进行了调查分析,指出要提高临床教学质量,应着重于临床师资队伍建设、教学管理、学生教育和管理等方面的努力。     

借力非直属附属医院平台 探索校院教学合作新途径

为了解决当前我国高等医学教育规模快速扩大与附属医院临床教学资源不足的突出矛盾,充分发挥社会医院的巨大潜能,非直属附属医院模式应运而生。郑州人民医院医疗集团作为南方医科大学、新乡医学院的非直属附属医院,通过院校合作的探索与实践,医院变被动为主动,充分借力非直属附属医院平台,创新医学教育模式,实现了社会医院医学教育的立体化,促进了医院的快速发展,实现了院校共赢,以及社会大型公立医院从单纯医疗型向医教研复合型的转变。     

加强非直属附属医院教学质量监控的实践与成效

医院是高等医学院校临床教学的重要基地，南京医科大学按照“校、院合作，双方共赢”的指导思想，充分利用江苏省及周边发达省、市的优质临床教学资源，先后建立11所非直属附属医院，并探索了一系列行之有效的管理办法，加强对附属医院教学质量的监控，调动非直属附属医院从事临床教育教学工作的积极性，保证了医学人才的培养质量。     

加强临床教学基地建设 构建强大教学基地网络

临床实习是临床医学专业人才培养的重要教学阶段 ,教学基地是进行临床实习的重要场所 ,其水平的高与低、好与坏直接影响到人才的培养质量。长期以来 ,我院按照“学校总体部署 ,二级学院具体联系和实施”的临床教学管理思路 ,与有关医院建立了相对固定的关系 ,保持直接联系 ,利用第一临床医学院与第一附属医院“院系合一”的优势 ,充分发挥临床医学院在临床实践教学工作中的优势 ,在基地内涵建设方面发挥直接的实质性的作用 ,协助加强教学基地的规范化、科学化、制度化建设 ,构建强大的教学基地网络。1　我院负责联系的临床教学基地的状况我院除第一附属医院外 ,现有负责联系的教学基地 2 4间 ,其中非直属附属医院 3间 ,教学医院 9间 ,实习医院 12间。病床数 5 0 0 0余张 ,总建筑面积 5 5万m2 。第一附属医院承担了临床理论课和实习带教内容两部分的教学任务 ,教学医院和实习医院仅承担实习带教任务。目前 ,我院学生毕业实习 10 0 %安排在非直属附属医院、教学医院实习 ,其中大部分在三甲医院实习 ,其他实习医院暂只安排三年级学生三个月的教学实习。各基地普遍认识到教学对医院综合水平提高和可持续发展的重要性 ,医院教育...     

高等医学院校直管附属医院建设模式探讨

临床教学基地是临床教学的主要场所,是医学院校的重要组成部分。随着高校的扩招,临床教学基地面临巨大的压力和困境,文章结合川北医学院创建直管附属医院的实践与经验,就如何构建医学院校直管附属医院的建设模式进行探讨,以期在附属医院的建设过程中,形成具有西部特色的建设模式。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.