高学历青年医师规范化培训的探索

高学历青年医师是医院发展的未来,加强对他们临床能力的培养,是医院人才管理工作的重要任务。只有强化培训意识,建立规范化培训体系,严格规范化培训内容,实施系统的考核,才能使他们成长为合格的临床医学人才。     

医院人力资源管理现状与对策

随着我国医疗卫生事业的深入发展和医疗制度改革的逐步完善,现代医院人才资源管理模式已不能适应市场经济发展的需要。由于在管理机制、技能培训、绩效评估、激励机制、交流沟通机制等方面存在缺陷。制约了医院人才流动和医疗科技的发展。本文针对以上问题,提出坚持科学发展观,确立医院人才资源开发新理念．建立人才资源管理机制,增强医院综合实力;建立业务知识培训机制,强化对知识型员工的培训;建立医院文化建设机制．培植良好的团队精神;建立科学、公正、公开的绩效考核制度,创新人才资源激励机制,营造良好的人才发展环境：建立健全人才运作机制,积极培养具有本院特色,并与同行有竞争优势的人才,以增强自身发展潜力等对策和建议。     

创新医院培训理念促进医院人力资源整体水平

人才是医院可持续发展的命脉,卫生专业技术人才的培训至关重要,不仅能够增强医院的凝聚力,更能提高医院的服务水平,加强医院的执行力,使医院处于健康的发展中.从人力资源培训的内涵出发,对医院人力资源培训现状进行分析,提出如何对培训理念进行创新,从而促使医院人力资源的整体水平有效提升.     

建立符合专业特色的呼吸科住院医师规范化培训模式

住院医师规范化培训是住院医师成长的必经阶段.总结复旦大学附属中山医院呼吸科住院医师规范化培训模式的平台构建,通过建立长效的科学管理机制,制定严格的考核制度,注重实用型、创新型、自主型人才的培养;包括巩固基础知识、强化实践技能、强调沟通能力,培养科研创新思维,提升医德医风,形成自主学习能力等方面.在实践的基础上,探讨建立适合我国国情的内科（呼吸科部分）住院医师规范化培训模式的可行性.     

基于人文关怀的住院医师培训管理探讨

在住院医师培训工作中,医院管理者应注重住院医师的生存压力、职业发展、培训环境、心理状态等的培养,在培训管理中贯穿应有的人文关怀。培训规章制度的制定应兼顾科学与人文,以住院医师为主体,以保护和发展为前提,注重对住院医师的内在激励;培训大纲的落实、轮转计划的安排应在提升临床能力的同时注重医学人文素质的培养;还应不断改善培训条件,努力做好后勤支持,保障住院医师的正当权益,建立起人文关怀机制。     

医院全员培训的实践研究

医院员工培训是医学教育的重要组成部分,又是医院人力资源开发的重要途径和主要手段。医院的成长和发展,不仅在于合理的使用人才,更重要的是及时有效地开发和使用人才,对员工进行培训和再教育,这就需要医院树立全新的培训观念,并结合医院的实际制定科学的培训方案,打造完善的培训体系。     

医学研究生培养模式改革的理论思考与实践探索——以神经外科硕士研究生显微外科技能培训为例

在全国研究生培养机制改革的洪流引导下,医学研究生培养模式分为医学科学学位和医学专业学位两种模式。医学科学学位培养模式以培养和造就高水平、创新型医学研究人才为目标,而后者则以培养具备临床实践能力的高级应用型医学专业人才为目标。当前我校以科学发展观为指导,以国务院学位办公室研究生培养相关政策为理论基础,依据不同研究生培养目标,制定了规范的培养计划,开展了深入的理论研究和实践探索,取得了明显的成效。现以我校神经外科硕士研究生显微外科技能培训为例,探讨医学研究生培养模式改革的必要性、科学性和可行性,为培养高素质医学专业人才提供理论基础。     

综合性医院青年医师规范化培训的体会

住院医师规范化培训是培养临床医学人才的重要途径,是医院人才梯队建设中最基础的部分。青年医师是潜在的医学人才,他们的成长与发展关系到医院的整体素质,关系到医院的医疗质量、前途和命运。如何加强和提高医院青年医师规范化培训的水平和质量是医院管理人员必须高度重视的问题,领导重视是实施规范化培训的前提,强化机构管理是实施规范化培训的必然要求,制度完善是实施规范化培训的重点,创新管理使青年医师统一培训管理工作注入活力,严格考核,奖惩分明实施规范化培训的保证。在实施过程中,存在培训计划与医院实际工作需要存在矛盾;科室考核不到位,要求不严,流于形式;带教工作不规范,重使用轻培养,忽视对高素质专业人才的培养。针对此类问题提出了如下对策:计划和轮转相兼顾策略协同解决,对相关人员轮转科室进行微调制订个性化的培训方案;确立公平的考核审查体制,成立各级考核组,师生间交叉考核,背对背考核;建立符合中国国情的住院医师规范化培训模式。青年医师统一规范化培训管理是一个非常复杂的系统工程,它依赖于各个职能部门配合,也取决于培训全过程中各个关节的把关。搞好这项工作,将有助于人才队伍的健康成长,提高医院整体队伍素质和医院医疗技能水平。     

第一阶段住院医师培训在医学研究生培养中的实践性探索

培养高素质的医学人才是医学院校的重要使命。目前,进入硕士研究生教育的医学生大多为应届本科毕业生,其临床技能较为薄弱。为此,作为山东省卫生厅评审通过的住院医师规范化培训(专科医师规范化培训第一阶段)基地,青岛市市立医开展了硕士研究生第一阶段住院医师规范化培训工作,这是研究生培养机制改革的一项新的尝试。将硕士研究生培养与住院医师培训接轨,避免了医学教育资源的浪费,有利于医院的发展和医学人才的培养。     

对精神科护士进行分层次培训的体会

随着医学科学的发展,特别是今年2月份国务院学位委员会将护理学修订为一级学科,对护士进行有效培训,培养一支具有良好素质的护理队伍,已成为护理管理者们的共同目标[1]。我院从2010年开始对护士实施分层次培训与考核,收到较好效果。现将体会总结如下:1确立培训目标,制定培训计划1.1培训目标既然要对护士进行分层次培训,有一个明确的培训目标就显得极其重要,我院的培训总目标是:①完善和建全医院培训机制;②使各层次人员得到充分培养;③     

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.