复旦大学医学生学分制管理实践研究

复旦大学于2002年正式推出了"以通才教育为目标,文理教育为特色"的完全学分制建设方案,从2001级学生开始,复旦大学所有一年级本科医学生在管理体制上全部纳入复旦大学教务处学分制选课系统,现已实施5年。本文主要从教学管理角度,结合对医学生实行学分制管理以来的实践,探讨医学教育特殊规律对实施学分制管理的影响及医学生学分制教学管理中需要解决的问题。在既要规范学分制教学管理制度、又要适应医学教育特点的条件下,正确处理好教学管理工作中"严谨"与"灵活"、"稳妥"与"变化"的关系,不断发现和解决问题,为继续探索、完善和推广医学生的学分制管理模式提供思路。     

完善高等医学教育学分制教学管理的探索和思考

根据高等医学教育实施学分制教学管理中出现的问题,探索学分制的特点和高等医学院校学分制管理模式的应用,并通过对高等医学教育实施学分制现状的分析,对完善学分制管理的策略进行探讨。旨在正确认识学分制,探索完善学分制管理的教育教学改革途径。     

医学教育实行学分制改革的进一步探索

医学教育实行学分制管理存在着较多的争议。同济医学院自1994年实行学分制以来，经过几年的探索和实践，逐步形成了以学分制教学管理为基础的医学人才培养模式，为医学生个性发展、能力培养和综合素质的提高作出了有益的尝试。     

高职高专医学教育学分制管理的研究与实践

学分制是以选课制为基础,以发展学生的个性为核心,以学分为计量单位来衡量学生学业完成情况的一项教学管理制度,已被我国高校广泛采用,但高职高专医学教育如何实行学分制管理值得探讨。本文从高职高专医学教育的特点出发,分析了高职高专医学教育实施学分制的必要性、实施过程中存在的主要问题与对策,为构建高职高专医学教育学分制教学管理体制奠定基础。     

中职教育学分制管理存在的问题与对策——以中等医学教育为例

分析中等医学教育实施学分制的意义和教学管理过程中存在的问题,提出解决中职教育学分制教学管理存在问题的对策.     

普通高等医学院校有限学分制教学管理的研究与实践

为了使传统的医学教育注入生机和活力 ,保证高等医学教育质量 ,保持和增强在同类高等医学院校中的竞争力 ,建立一种既适合社会需要又适合自身发展的办学模式 ,我们本着“以质量求生存 ,以改革促发展”的原则 ,立足校情 ,从医学学科特点出发 ,积极探索现阶段普通高等医学院校行之有效的教学管理模式 ,在大量调研和反复论证的基础上 ,出台了以弹性学制为核心的有限学分制管理办法。一、医学院校实施学分制的必要性1.医学生未来职业拒绝“伪劣产品”。治病救人是医生的神圣天职和责任所在 ,人民健康所系、性命相托 ,这就要求医学院校要培养医疗…     

医学生素质教育与学分制管理的改革与探索

随着教育事业的不断发展和国际化进程的推进,加强素质教育势在必行。素质教育是一项系统工程,如何有效地开展素质教育是一大难题。医学科学的特征更加需要强化素质教育。实行学分制管理是推进素质教育的有效手段。学分制是一种教学管理制度,其核心机制是“选择”,遵循“以学生为本”的原则,突出学生的教学主体地位,调动学生自主学习的积极性,坚持因材施教,提供选修课程,促进个性化教学,提高学生的综合素质,确保医学教育质量。本文总结了我院实行学分制管理、推进医学生素质教育的实践及其相关经验。     

医学专业本科85级教学管理制度改革两年总结

在《中共中央关于教育体制改革的决定》精神指导下。我院自1985年9月起,对医学专业本科85级的教学管理制度实行了改革,试行“学年制”与“学分制”相结合的教学管理制度——“学年学分制”。经过两年多的实施,取得了一定的成绩;初步达到了顶期的目的;但是,也存在一定的问题和不足,有待改进和完善,现总结如下: 一、改革的起因和动机在学习贯彻中央关于教育体制改革决定中,结合我院的实际情况,我们体会到:在当前,医学教育如何适应时代和社会发展的需要,是医学教育界面临的巨大挑战,随善医学科学技术的发展,社会和卫生服务需要的变革以及医学模式的转变,医学教育不仅要在内容上,而且要在形式上进行相应的改革,作为医学院校,教学管理制度的改革,是达到以上目的的不容忽视的重要环节。     

加强教务管理信息化建设 深化医学学分制改革

随着学分制改革的实施,对教务管理工作提出了更高的要求,如何利用现代化的管理手段提高教学管理工作效率,推进学分制改革,探索医学教育的新机制成为大家关注的问题。文章从工作中总结了经验,通过对学分制的理解,教务管理工作的认识等方面阐述了教务管理信息化建设对学分制改革的作用。     

《中华医学教育杂志》稿约

《中华医学教育朵志》是我国第一份正式出版的医学教育期刊,创办于1981年,2010年被收录为“中国科技论文统计源期刊”（中国科技核心期刊）。《中华医学教育杂志》是反映我国高中等医学教育与继续医学教育研究进展、国际医学教育发展动态,开展医学教育交流的学术性刊物,供高中等医药院校（包括附属医院和教学医院）的教师、医师、教育研究人员、教学管理人员和医学生,以及教育卫生行政主管部门管理人员阅读。     

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.     

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.     

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.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.