提高骨科临床教学质量的实践探讨

临床教学是医学生培养的重要环节,是医学理论教学与临床实践教学的桥梁。临床教学的主要任务是把医学生基础阶段所学习的理论知识应用于临床实践,培养学生分析和解决临床问题的能力。根据骨科临床教学的特点,通过加强学生医患沟通能力建立良好的医患关系、及时正确采集病史、规范化骨科体格检查、病历书写能力、正确的选择影像学检查、准确地阅读影像学资料和临床思维能力等方面培训。提高学生综合素质和临床分析和解决问题的能力,达到提高骨科临床教学质量的目的 。     

以医患沟通为导向强化医疗纠纷防范意识提高《神经病学》临床实践教学质量

当前,随着生物医学模式逐渐向生物-心理-社会医学模式转变,并随着患者自我维权意识逐渐增强和相关法制的健全,体现构建"以患者为中心"的新型医患关系的确立,医患纠纷事件频繁发生,医患矛盾呈逐年上升的趋势。其中,医务人员沟通能力缺乏是一个重要原因,医患沟通越来越成为医疗服务中必不可少的重要工作环节。因此,医学生作为医学界的未来,在临床实习教学中,医学生医疗纠纷风险显著增加并备受关注,如何培养其减少和防止医患纠纷发生,如何培养其提高医疗纠纷防范意识,越来越成为现今临床教学的重要组成部分。医患沟通是实习医生综合能力培养中的一项基本技能,实习医生掌握良好的医患沟通能力是实现和谐医患关系的基础,也是提高医学生临床医疗技能的前提。本文以医患沟通为导向,探讨神经病学临床实践教学中加强实习医生医患沟通能力培养的策略和技巧,以期找出加强医患沟通能力培养的最佳解决方案。在临床工作中的各个环节上学会真诚有效地与患者沟通,不断提高专业技术水平,构建和谐医患关系,最大限度地防范医患纠纷发生,努力提高神经病学临床实践教学质量,保证神经病学临床实践教学中医学生医疗安全,促进神经病学学科健康发展。      

临床教学中加强实习医生医患沟通能力培养的体会!

医患沟通是实习医生综合能力培养中的一项基本技能,临床教师在医学生医患沟通能力培养过程中起到至关重要的作用.本文阐述了临床教学中加强实习医生医患沟通能力培养的重要性,并提出提高实习医生医患沟通能力的主要对策.     

医学生医患沟通能力的现状与培养模式研究

医患沟通是影响医患关系的重要因素,医患沟通教育可以提高医学生沟通能力,改善医患关系。本文探讨医学生医患沟通能力现状与医学生医患沟通教育培养模式中的医患沟通课程设置、医患沟通培养教学方法、医患沟通临床实践和医患沟通教育评价体系,对医患沟通能力培养方法进行分析总结。最后,提出对医学生医患沟通能力培养模式的展望。     

提高医学生医患沟通能力的途径和方法

医患沟通不良是目前医患矛盾的重要原因。临床教学是医学生走向工作岗位的重要环节,培养其沟通能力是现代医学发展模式及医学教育的要求,也是缓解医患矛盾,构建和谐医患关系的基本技能。文章分析了当前医患沟通不良的原因以及加强医患沟通的重要性与必要性,提出了实现医学生沟通能力培养的措施,以探讨加强医患沟通能力培养在临床教学中的作用。     

肝胆外科临床教学中医学生临床综合能力的培养

医学生临床综合能力的培养,是外科临床教学的核心和主要目的之一。根据肝胆外科临床教学特点,将基础理论与临床实践相结合,从临床基本技能培训、转化医学理念教育等多方面,就如何提高学生的临床操作能力、逻辑思维能力、科研创新能力、医患沟通能力,培养其良好医德医风等进行探讨。     

加强儿科医学生临床实习期医患沟通能力培养的体会

临床交流和沟通技术培养是医学生教育的重要内容,临床教学中应该加强医患交流与沟通技能的教育。本文通过阐述儿科医学生医患沟通能力培养的重要性,总结目前医学生医患沟通能力存在的问题及原因,提出提高儿科医学生医患沟通能力的途径。     

临床教学中如何培养医学生构建和谐医患关系的探索和思考

和谐的医患关系是构建和谐社会的重要组成部分,在临床教学中为实习医学生树立医患关系的正确理念,培养医学生职业道德素养和良好的沟通技巧、提高在解决问题过程中的沟通能力,有助于医学生尽早适应临床工作环境,减少医患纠纷。     

在临床教学中培养医学生医患沟通能力的探讨

做为未来一线医务人员的医学生,具备良好的医患沟通能力,既是医学模式发展的需要,也是其学好专业知识,减少医患纠纷,创建和谐医疗环境所必须具备的基本技能。临床教学是医学生学习和成长的关键阶段,在临床教学过程中培养医学生医患沟通能力是临床教学的基本内容。只有充分重视在临床教学过程中培养医学生医患沟通能力,通过加强岗前培训、注重带教老师的言传身教、采用多种形式的培养方式、建立监督评价与考核制度,才能更有效地培养医学生医患沟通能力,从而全面提高医学生的自身素质,为他们顺利完成学业,成为一名合格的医务工作者打下坚实的基础。     

医患沟通教育在胸外科临床教学中的实践和体会

临床教学中医患沟通能力培养非常重要。良好的医患沟通是医学生获得更多实践机会的前提。胸外科疾病特点决定其诊疗过程与其他疾病不同,医学生往往难以掌握要点,在与患者交流中也常常存在沟通欠佳的情况。胸外科临床教学中加强医患沟通教育,可以提高医学生综合素质及诊疗能力,提高患者满意度。     

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.