专业承诺、核心自我评价与医学生沟通技能态度的关系

目的探讨专业承诺与医学生沟通技能态度的关系及核心自我评价在二者间的中介效应。方法采用医学生沟通技能态度量表、大学生专业承诺量表和核心自我评价量表对随机抽取的485名临床医学专业的大学生进行调查分析。结果医学生沟通技能积极态度总分为51.3±7.3、消极态度总分为33.0±7.3。女生、父母非医务人员、未参加见习实习、大二年级的医学生在积极态度和沟通技能态度得分上更高(P<0.05)。医学生沟通技能态度与专业承诺及其各维度、核心自我评价得分呈正相关(P<0.01)。专业承诺对医学生沟通技能态度具有正向预测作用(P<0.001),核心自我评价在专业承诺与医学生沟通技能态度间存在部分中介效应,占总效应比例为21.7%。结论专业承诺、核心自我评价对医学生沟通技能态度具有正向预测作用,核心自我评价在专业承诺和医学生沟通技能态度间具有部分中介作用。     

医学院校大学生沟通能力现状调查及其影响因素分析

目的 了解目前医学生的沟通能力现状及其影响因素,为提升医护人员沟通技能奠定基础.方法 利用分层抽样法调查山东省某医学院校1558名在校大学生,调查内容包括一般情况调查表和医学生沟通技能态度量表(CSAS).结果 医学生积极态度量表(PAS)得分为(50.72±7.45)分,消极态度分量表(NAS)得分为(31.25±6...     

军队院校医学生坚韧性水平及其影响因素

目的 调查军队院校医学生坚韧性水平,探索医学生坚韧性的影响因素。方法 采用中国成年人坚韧人格量表、一般自我效能感量表、领悟社会支持量表对543名某军队院校医学生进行调查。结果 回收有效问卷504份,有效回收率92.8%。军校院校医学生坚韧性平均得分为72.91±13.03,其中韧性维度均分最高,其次依次是控制、投入和挑战;预测军队医学生坚韧性的因素有：参加课外活动频率（β=0.121,P<0.001）、自我效能（β=0.432,P<0.001）、朋友支持（β=0.170,P<0.001）,以上因素可解释军校医学生坚韧性27.5%的变异量。结论 军队院校医学生坚韧性水平有待提升;可通过鼓励参加课外活动、提升自我效能、增加朋友支持等途径提升军校医学生坚韧性水平。     

医学本科生对于医患沟通技能学习态度之探索性研究

目的了解医学本科生对于医患沟通技能学习的态度,为改进医患沟通课程教学提供科学依据。方法对某高等医学院校医学本科生采用中译版医患沟通态度量表进行横断面调查研究。结果回收有效问卷272份(有效率为90.7%),积极态度PAS和消极态度NAS分数均值是51.90和34.41。不同性别医学生间NAS及不同班级医学生的PAS和NAS分值有统计学差异。结论代课教师需利用医学生医患沟通技能学习的积极态度,采取有效措施将消极态度最小化,以提高医患沟通教学的实效性。     

医学生的医患沟通技能教育现状调查

目的：了解综合性大学医学生医患沟通教育中,学生的学习态度及医患沟通技能的自我评价现状。方法利用国内外已发表的《医学生沟通技能态度量表》（CSAS）及《医学生医患沟通行为量表（自评）》对某综合性大学的127名医学生进行问卷调查。结果127名学生完成CSAS后其积极态度分量表平均得分为51．43分,消极态度分量表平均得分为32．94分。调查前、后比较,差异有统计学意义（ P＝0．000）,而男女、不同学制之间比较差异无统计学意义（ P＞0．05）。95．28％学生同意或完全同意“学习医患沟通技能与学习临床技能同样重要”。127名学生完成《医学生医患沟通行为量表（自评）》,总分150分,127名学生的平均自评得分为104．93分,男生得分高于女生（ P＝0．008）。五年制及八年制学生各项得分比较差异均无统计学意义（ P＞0．05）。结论医学生对医患沟通学习持积极态度,绝大多数学生认为“学习医患沟通技能与学习临床技能同样重要”,且对沟通技能自评不高,医患沟通技能教育亟待加强。     

医学生一般自我效能感与社交焦虑的相关研究

目的：考察医学生一般自我效能感与社交焦虑的关系,为医学生心理健康教育提供依据。方法：采用分层整群抽样方法,运用一般自我效能感（GSES）和社交焦虑量表（IAS）对1600名医学生进行心理测评。结果：男生一般自我效能感显著高于女生;社交焦虑的发生率为24.0%;女生社交焦虑发生率高于男生;一般自我效能感与社交焦虑显著负相关;社交焦虑、女性、家住农村和矿区、年级是预测一般自我效能感的主要因子,联合解释一般自我效能感总变异的13.8%。结论：通过提高自我效能感等干预措施,对医学生的社交焦虑问题实施针对性的心理健康教育。     

医学生沟通技能态度及相关因素分析

目的调查医学生对沟通技能的态度,了解其相关因素。方法采用方便抽样的方法抽取306名医学生,应用一般资料问卷及Donald[4]等研制的医学沟通技能态度中文版进行调查。结果医学生正性态度均分为(3.94±0.45),负性态度均分为(2.45±0.73),中性态度均分(3.28±0.63).不同性别的医学生之间沟通技能态度各维度之间无统计学差异(P>0.05);护理专业的学生在正性态度得分高于其他专业(P<0.01),而负性态度得分低于其他专业(P<0.05),而中性态度各专业间无统计学差异;医学生的实践经历与正性态度成正相关(P<0.01),而与负性态度成负相关(P<0.01),与中性态度未发现相关性(P>0.05)。结论医学生对沟通技能的态度是积极的。不同专业及实践经历的多少与沟通技能的正性态度及负性态度有关,而与中性态度无关,性别与沟通技能态度之间不存在相关性。     

实习医学生的自我效能及其作用的相关研究

目的研究实习医学生的自我效能感水平及其相关因素,探讨自我效能感在医学教育中的作用。方法采用＂人脸量表＂、＂一般自我效能感量表＂、＂特质应付方式量表＂、自编职业压力量表,来进行测量评定。结果实习医学生的自我效能感与主观幸福感、应付方式、职业压力之间存在显著相关性。结论自我效能感与实习医学生的职业满意度下降、离职率升高有关。     

护生对老年人态度、自我效能感与老年知识水平相关性研究

目的了解护生对老年人态度、自我效能感与老年知识水平的相关性。方法采用一般情况调查表、对老年人态度量表(KAOP)、老年知识量表1(FAQ1)、一般自我效能感量表(GSES)对641名护生进行问卷调查,调查护生对老年人态度、自我效能感及掌握老年知识水平,分析护生老年知识水平的影响因素。结果 641名护生KAOP得分为(158.09±20.32)分,FAQ1得分(9.72±2.85)分,GSES得分(2.29±0.51)分;护生FAQ1得分与KAOP总得分、欣赏维度得分、偏见维度得分、GSES总分均呈正相关(P<0.05);自我效能感、对老年人态度、是否曾照顾老人、是否喜欢护理老年人是护生老年知识水平的影响因素(P<0.05)。结论护生对老年人态度趋于正向,老年知识水平偏低,自我效能感处于中等水平,对老人态度、自我效能感是影响护生掌握老年人知识的因素。     

Wilson病患者自我效能与生存质量状况及其相关性分析

目的探讨Wilson病（WD）患者自我效能与生存质量状况及其相关性。方法采用一般自我效能感量表（GSES）和世界卫生组织生存质量测定量表简表（ WHOQOL－BREF）对2013年1月至2014年1月安徽中医药大学神经病研究所附属医院215例WD患者和相匹配的190例健康人群（对照组）进行问卷调查,了解WD患者自我效能与生存质量状况及其相关性。结果WD组患者自我效能得分低于对照组[（2.344±0.4978）分 vs （2.611±0.4912）分],差异有统计学意义（t＝5.407,P＜0.05）;WD组患者生存质量总分低于对照组[（76.46±13.20）分vs （91.26±16.95）分],差异有统计学意义（t＝9.835,P＜0.05）,各维度得分均低于对照组（ P＜0.05）;WD 患者自我效能得分与生存质量总分及各维度得分呈正相关（ P均＜0.05）。结论 WD患者一般自我效能及生存质量低于健康人群,其自我效能与生存质量呈正相关,即一般自我效能感越好其生存质量越好。     

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.