迷你临床演练(Mini-cex)评估量表在普外科的临床运用

目的　探讨分析基于迷你临床演练评估量表（mini-clinical evaluation exercise,Mini-CEX）的临床教学在普外科的应用效果。方法　选择2016年6月到2018年6月在普外科实习的护生共82名,其中2016年实习的本科生41名为对照组,2017年实习的本科生41名为干预组,对照组护生采用传统实习带教,实验组护生采用基于Mini-CEX构建的临床教学进行带教,比较分析两组护生实习出科考核成绩、Mini-CEX得分、临床护理带教质量评估表得分,采用SPSS 23.0进行卡方检验和t检验。结果　实验组护生出科考核成绩[（96.56±4.23）分]明显高于对照组[（90.42±5.12）分];Mini-CEX总得分,实验组[（5.22±0.45）分]高于对照组[（4.01±1.03）分],实验组护生优秀率高于对照组,差异具有统计学意义（P<0.05）;临床护理带教质量评估表,实验组[（98.34±6.12）分]高于对照组[（92.45±5.16）分]。结论　基于Mini-CEX的临床教学能够提高普外科带教质量,提高教师临床带教技能,进而提升护生的临床技能和综合素质。     

基于OBE理念的Mini-CEX评估模式在神经内科临床实习教学中的应用

目的 探讨基于OBE理念的Mini-CEX评估模式在神经内科临床实习教学中的应用实效。方法 选择2022年5月1日至2023年4月30日在神经内科实习的100名学生作为研究对象,将其分成实验组（n=50）和对照组（n=50）。实验组在OBE理念指导下,以学习成果为导向,细化教学目标,并应用Mini-CEX评估模式进行测评和反馈,对照组采用与实验组相同的评估方式,并按照传统教学流程进行。结合观察数据,分析对比2组学生实习开始时和实习结束时的各项指标数据。结果 实习结束时,实验组临床接诊、体格检查、人文医学、临床诊断、健康咨询、组织效果、整体评价等评分得到明显提升,且高于对照组P值;实习结束后,技能考试成绩方面,实验组得分高于对照组,差异有统计学意义（P<0.05）,而且实验组满意度评价得分也比对照组更高。结论 基于OBE理念的Mini-CEX评估教学模式应用于神经内科临床实习教学,可以增强学生临床实践技能培育效果。     

迷你临床演练评估在肾脏内科住院医师规范化培训中的应用研究

目的　观察迷你临床演练评估（Mini-CEX）在肾内科住院医师规范化培训中的应用效果。方法　对2017年3月至2018年3月在我院肾内科规范化培训的80名住院医师运用Mini-CEX进行考核;考核内容主要包括病史采集、体格检查、临床诊断、治疗方案、医患沟通、人文关怀、临床整体能力7方面。同时对肾内科9名教师和上述80名住院医师进行Mini-CEX反馈问卷调查,内容包括教师和住院医师对Mini-CEX的看法和满意度。应用SPSS 21.0对组间数据比较行独立样本t检验。结果　通过Mini-CEX考核,住院医师的各项临床能力在规培结束时明显高于规培初期,差异均有统计学意义（P<0.05）。住院医师最大的提高表现在治疗方案、整体临床能力和体格检查方面。治疗方案考核结果显示,规培结束时住院医师平均得分为（7.525±1.062）,明显优于规培初期平均得分（5.175±1.035）,差异有统计学意义（P=0.000）。其次是临床诊断和人文关怀,住院医师培训后平均得分均高于培训初期（P<0.05）。临床诊断考核结果显示,规培结束时平均得分为（6.925±1.071）,优于规培初期得分（5.425±1.238）,差异有统计学意义（P=0.000）。教师和住院医师的Mini-CEX反馈问卷调查显示,教师认为Mini-CEX是一种较好的评估方式（88.9%）,还可促进自身学习（77.8%）。住院医师认为Mini-CEX贴近临床实践,以病房和临床实践作为基础测评,考核内容较全面,可提高自身临床技能（85.0%）和综合素质（87.5%）,对Mini-CEX整体满意度达92.5%。结论　Mini-CEX运用于肾内科住院医师规范化培训中,能有效提高住院医师的临床综合能力,有助于提高规培教学质量。     

住院医师规范化培训中引入Mini-CEX的实践

目的　观察对住院医师规范化培训部分学员使用Mini-CEX进行临床教学的效果。方法选取我院2015级住培学员40名，随机分为对照组和实验组，每组20人。2015年10月至2018年4月，对照组采用传统教学；实验组在传统教学基础上结合Mini-CEX活动，实验组每人在每个轮转科室至少进行2次Mini-CEX。毕业时应用改良的Mini-CEX评分量表、病例答辩和OSCE三种考核方法对两组学员进行测评。针对实施过Mini-CEX的教师和学员分别发放问卷，进行满意度调查。采用SPSS 18.0对数据进行统计分析，组间比较采用独立样本t检验，组内前后比较采用配对样本t检验。结果 Mini-CEX测评显示，两组学员各项临床能力毕业成绩均高于入学成绩，实验组学员毕业成绩优于对照组，实验组学员成绩提高分数大于对照组提高分数，差异均有统计学意义（P＜0.05）。病例答辩显示，实验组学员平均成绩为（81.16±3.75）分，优于对照组的（70.13±3.88）分，差异有统计学意义（t= -9.140，P=0.000）。OSCE考核显示，实验组平均总分为（96.300±4.681），优于对照组的（91.775±3.227）分，差异有统计学意义（t=-3.559，P=0.001）。共发放调查问卷80份，其中教师40份、学员40份，结果显示教师满意率达95.0%、学员满意率达92.5%。结论　Mini-CEX应用于住院医师规范化培训临床带教中，有利于提高学员的临床思维、医患沟通和人文关怀能力。     

迷你临床演练评估联合情景模拟教学在肝胆外科实习护士临床思维训练中的应用效果

目的 探讨迷你临床演练评估(Mini-CEX)联合情景模拟教学在肝胆外科实习护士临床思维训练中的应用效果。方法 选取2021年6月至2022年1月河南省人民医院80名肝胆外科实习护士为研究对象,以随机数字表法分为两组,各40例。对照组接受情景模拟教学进行临床思维训练,观察组接受Mini-CEX联合情景模拟教学进行临床思维训练,均培训1个月。培训1个月结束时,采用Mini-CEX评估两组临床思维训练效果,评估结束后进行问卷调查,统计两组实习护士对本次教学的满意度。结果 培训1个月时,与对照组比较,观察组Mini-CEX中问诊技巧、人文关怀、临床判断、健康宣教、组织效能、整体评价的达标率均高(P<0.05);培训1个月时,观察组对本次教学的满意度评分高于对照组(U=7.145,P<0.001)。结论 与单独行情景模拟教学相比,Mini-CEX联合情景模拟教学可有效提升肝胆外科实习护士临床思维训练成效及Mini-CEX中问诊技巧、健康宣教、人文关怀、临床判断、组织效能、整体评价的达标率,实习护士对二者联合教学满意度高。     

导师制模式下医学本科生培养及评价体系探索

目的　通过观察导师制模式下的本科医学生临床执业能力培养过程，探索新的临床培养模式及评估方法。方法　将进入临床实习阶段的40名本科医学生随机分为导师制组和对照组，每组20名，运用多元化评估体系，在不同阶段联合应用专业理论考试、迷你临床演练评估（Mini-Clinical Evaluation Exercise，Mini-CEX）、临床步骤的直接观察（Direct Observation of Procedural Skills，DOPS）、临床病例汇报等多种方法，对本科医学生的临床执业能力进行多方位评估。采用SPSS 23.0行t检验。结果　实习结束后导师制组学生的临床专业理论（86.24±2.93）、临床实践能力（7.53±0.48）、临床操作技能（4.35±0.47）和临床思维能力（6.31±0.52）得分高于对照组，差异具有统计学意义（P＜0.05）。结论　将导师制培养模式应用在本科医学生实习阶段，能提高实习医生职业素养、医学理论与实践技能水平等多方面的综合素质；多元化评估体系可以更好地评价教学效果，反映学生综合素质的养成情况。     

微信视频教学在消化内镜护生临床带教中的应用

目的　研究微信视频教学法在消化内镜护生临床带教中的应用价值。方法　选取2018年1月至2020年6月在北京中医药大学附属重庆市中医院消化内镜科实习的126例护生为本研究教学对象;并将其随机分为对照组和实验组,每组63例;对照组采用传统教学,实验组采用传统教学结合微信视频教学。两组实习时间均为4 周。比较两组实习结束后综合能力考核成绩,并采用批判性思维能力测量表、护生临床实习满意度量表评价两组教学前后实习护生评判性思维能力及满意度。采用SPSS 19.0统计软件对研究数据进行统计分析。连续变量以（均数±标准差）表示,采用t检验;分类变量以百分比表示,采用四格表法检验。检验水准α=0.05。结果　实验组实习护生综合能力得分、理论知识及技能操作得分均显著高于对照组（P＜0.05）。两组教学后实习护生寻找真相、开放思想、系统化能力、分析能力、求知欲、认知成熟度得分及总量表得分显著高于教学前（P＜0.05）,思维自信心得分与教学前比较,差异无统计学意义（P＞0.05）。实验组教学后实习护生寻找真相、开放思想、系统化能力、分析能力、求知欲、认知成熟度得分及总量表得分显著高于对照组（P＜0.05）,思维自信心得分与对照组比较差异无统计学意义（P＞0.05）。实验组实习管理、实习环境、教学内容、实习效果得分及总量表得分显著高于对照组（P＜0.05）,带教素质得分与对照组比较差异无统计学意义（P＞0.05）。结论　消化内镜护生临床带教中应用微信视频教学法,能提高实习护生综合能力考核成绩及满意度,增强评判性思维能力。     

思维导图结合持续质量改进在消化内科实习带教中的效果研究

目的　探讨思维导图结合持续质量改进在消化内科实习医师带教中的效果。方法　将2019年9月至2020年1月在消化内科实习的55名学生设为对照组,采取传统教学方法;2020年2月至2020年6月实习的54名学生设为思维导图组,采取思维导图教学;2020年7月至2020年11月实习的55名学生设为结合组,采取思维导图结合持续质量改进教学。比较3组实习生培训前和出科时消化内科知识理论考核成绩、实践技能操作考核成绩,以及学习主动性、自学能力、综合思维能力、团队协作能力、分析与处理问题能力、归纳总结能力等教学效果,另比较出科时的教学满意率。采用SPSS 20.0进行t检验和卡方检验。结果　培训前,3组理论考核成绩、实践技能操作考核成绩及各方面能力得分比较差异均无统计学意义。出科时,结合组和思维导图组的理论考核成绩分别为（89.74±4.18）分和（86.52±3.72）分,实践技能操作考核成绩分别为（90.04±4.86）分和（87.46±4.52）分,均高于对照组;结合组高于思维导图组,差异有统计学意义（P＜0.05）。结合组和思维导图组各项能力得分均高于对照组,结合组各指标得分均高于思维导图组,差异有统计学意义（P＜0.05）。结合组和思维导图组教学总满意度均高于对照组,结合组教学总满意度高于思维导图组。结论　思维导图结合持续质量改进在消化内科实习医师带教中效果显著,能提高实习生各项能力和教学满意度。     

团队式自主学习在《医学伦理学》教中的应用

目的 论证在医学伦理学教学中采用团队式自主学习的实用性。 方法 将临床医学五年制本科大三学生186人随机分成A组/实验组（96人）和B组/对照组（90人），分别采用团队式自主学习和传统学习方式学习，并从批判性思维能力、课终评价等方面对教学效果进行比较。数据均采用SPSS15.0进行统计分析，采用t检验。结果 批判性思维能力方面，两组学生课题开始前CCTDI量表得分：实验组（271.10±19.77）、对照组（272.54±23.44）；课程结束后测试得分：实验组（285.93±21.37）、对照组（280.87±19.24）。课终评价方面，期末成绩得分[（79.86±12.37）vs.（77.24±9.17）分];临床案例分析得分[（81.07±7.43）vs.（75.23±10.74）];自主实践得分[（7.598±1.231）vs.（7.019±0.997）],实验组均高于对照组。结论 团队式自主学习对提高学生创新思维能力、激发学习主动性、提高学习效果具有积极作用。     

以执业医师资格考试为导向构建Mini-CEX联合DOPS模式教学在急诊医学应用的探索研究

目的：探究以执业医师资格考试为导向构建迷你临床演练评估（Mini-CEX）联合操作技能直接观察评估（DOPS）模式教学在急诊医学教学中的应用效果。方法：以2021年广西中医药大学附属瑞康医院急诊科医师规范化培训实施以执业医师资格考试为导向构建Mini-CEX联合DOPS模式教学为分界线,将2020年7月～2020年9月间急诊科参加传统模式教学的32名实习医师纳为对照组,将2021年7月～2021年9月间急诊科参加以执业医师资格考试为导向构建Mini-CEX联合DOPS模式教学的32名实习医师纳为观察组,两组均进行12周培训,比较两组Mini-CEX评分、DOPS评分、综合急救技能测评得分、执业医师资格考试通过率及综合教学质量。结果：培训3个月后,观察组Mini-CEX、DOPS、综合急救技能测评各项评分均显著高于对照组（P<0.05）;两组执业医师资格考试理论和实践通过率比较差异均无统计学意义（P>0.05）,观察组总通过率显著高于对照组（P<0.05）;观察组综合教学质量各项评分均显著高于对照组（P<0.05）。结论：以执业医师资格考试为导向构建Mini-CEX联合DOPS模式教学有助于提高急诊医学规范化培训效果,在提升实习医师综合技能、急诊专业技能方面效果显著,执业医师资格考试通过率较高,有利于提高实习医师的岗位胜任能力,值得推荐。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.