对医学生人文教育的几点思考

人文教育是指进行人文学科、人文素质和人文精神的教育。医学人文教育则是指在对医学生进行专业知识教育的同时，进行人文教育，使医学生同时拥有医学知识与人文知识，达到科学精神与人文精神双修。这种医学人文教育是当今世界医学教育发展的趋势，医学教育只有顺应这种大趋势才能有效地培养学生的素质。为此，笔者对医学人文教育进行科学地反思和教育框架的构建，以期推进医学人文教育的发展。……     

医学生人文医学实践性教育浅论

目前我国人文医学实践性教育存在着不足.人文医学教育必须以社会需求为导向,所学知识和技能必须与实践相关联.多种形式的实践性教育活动,如参加义工、开展患者需求调研、采取角色扮演方式进行医患沟通技能培训、床边人文关怀教育以及结合临床实际问题的医学伦理和医疗法规教育等,能有助于提升医学生的人文精神和提高医学生的人文医学服务技能.     

重视医学生职业道德和人文精神培养

在医学生中进行职业道德和人文精神培养是医学教育永久的需要。目前我国医学院校中道德培养和人文精神培养相对落后,职业道德和人文医学的教育亟待加强。职业道德和人文精神的培养对医生具有重要的价值。培养现代职业道德,并对教师进行相关培训,进一步培训医学生的职业道德。通过教医学生建立医患关系,正确有效的采集病史,制定双方同意的治疗方案及学会进行病情告知来培养医学生在实践中的人文精神。医疗模式的迅速转变和医学教育模式的相对滞后使得在医学生中开展正规的、与实践紧密结合的职业道德和人文精神培养十分必要。     

浅析医学人文教育

医学教育长期以来过分注重医学生的专业知识教育而忽视人文素质教育,医学院校应该转变教育观念,把医学人文教育纳入学校重点建设内容,形成医学与人文并重的办学氛围,切实加强医学生人文精神的培养,一要提高医学生对人文教育的思想认识;二要加强社会实践,对于人文素养的养成至关重要;三要科学构建人文教育课程体系;四要营造浓厚的校园医学人文氛围。     

新时期加强对医学生人文素质培养的思考

医学生人文素质教育是医学教育的重要内容，医学和生命科学都面临着范围与结构的调整。现代医学要求医学生不仅要懂得生物、医学知识，也必须掌握更多的人文社会科学知识。高等医学教育要跟上时代的要求，必须加强人文素质教育，根据自身教育的特点和教育目标，注重全程对医学生进行人文素质教育，与时俱进，将人文精神融入于整个医学教育之中，以科学发展观推动我国高等医学院校的人文素质教育健康发展。     

湖北省某高等医学院校人文素质培养体系探讨

高等医学院校对医学生进行人文素质培养是适应新的医学模式转变的需要,也是为了适应医学教育工作可持续发展的要求和适应医学实践的内在要求。本文针对目前高等医学院校的医学生在人文素质教育培养过程中存在的人文教育理念缺乏、课程设置不合理等问题,并结合湖北某高等医学院校医学生人文素质教育的现状,对建立科学有效的人文素质培养体系进行了探索,旨在推进医学生人文素质与医学教育的进一步融合,从而为我国高等医学院校更加有效的培养优秀医学人才提供理论依据。     

医学生沟通能力培养的初探

随着医学模式的转变,新的医学模式核心是"以人的健康为中心"。对高等医学院校提出了新的挑战,这就要求医学教育在医学科学教育的基础上进行人文素质教育;在传授医学知识和培养临床技能的同时更重要的是培养医学生的沟通能力。本文就怎样培养医学生良好的医患沟通能力进行了探讨。     

中西方医学人文教育的比较研究

与西方发达国家相比,我国医学院校在医学人文教育的培养系统、医学人文教育的课程设置和医学生人文素质的基本状态方面明显处于滞后状态.因此,我们应当认真学习和借鉴西方发达国家的先进经验,树立医学教育的新理念,贯彻《本科医学教育标准》,建设高水平师资队伍,调整人文教育课程设置,发挥校园文化育人作用,采取切实有效措施,提高医学生人文素质,为培养既有医学知识、又有人文精神的医学人才而努力.     

基于 GMER 的临床本科毕业生人文素质现况分析

医学是自然科学与人文科学相互交融的综合学科,作为医生理应体现仁心、仁术。然而,近年来医患间信任缺失,因沟通不畅等原因致关系十分紧张,医学领域急切呼唤人文精神回归,加强医学人文教育迫在眉睫[1-2]。2001年,全球医学教育委员会推出了医学本科教育“全球最低基本要求”(GMER),其中涉及职业价值、态度、行为与伦理、沟通技能、信息收集与管理、群体健康与卫生系统、批判研究思维等人文素质方面的要求,特定于对临床医学毕业生的基本能力评价[3-5]。近几年,为保证医学教育质量和医学人才培养的国际化,成都医学院非常重视该标准,采取了增设人文课程、举办人文讲座、书画展、征文活动及大学生艺术节等多种措施加强医学生人文素质培养。特别是新近成立了医学人文研究中心,选派青年教师到香港中文大学等机构培训学习,提升人文教师自身素质,邀请国内外知名教授作人文讲座,开展师生共同参与的人文论坛等,很大程度提升了校园人文氛围,激起医学生重视人文素质培养的热情。     

医学生人文素质教育的思考与探索

我国现行的医学教育过分注重医学生的专业知识教育而忽视人文素质教育、人文精神的培养。加强和提高医学生的人文素质教育，使他们成为高素质医学人才，是现代医学发展的必然要求，更是现代高等医学教育的必由之路。为此要从更新教育观念、改革课程体系、树立教师榜样作用及通过多种渠道开展人文素质教育活动等方面探讨加强医学生人文素质教育的途径。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.