以问题为基础教学法在急性缺血性脑血管病临床教学中的应用研究

目的 探讨以问题为基础教学法（problem-based learning，PBL）在缺血性脑血管病临床教学中的应 用效果。 方法 选取首都医科大学附属北京天坛医院2016-2017年新入血管神经病学科轮转的神经病学专 业学位研究生30名，随机分为PBL组（15名）和传统授课式教学的对照组（15名）。在血管神经病学科 临床轮转阶段对2组分别采用PBL教学与传统授课式教学培养，比较2组出科考核时对缺血性脑血管 病的临床诊疗能力。 结果 接受PBL培养的研究生在急性缺血性脑血管的影像判读能力、疾病定位和定性诊断能力、病 例鉴别诊断能力、病例治疗方案的制定能力、患者预后预测能力等方面均优于传统授课式教学培养 的研究生，差异有统计学意义；2组的年龄和基线学习成绩并无显著差异。 结论 相比传统授课式教学法，PBL有助于调动临床神经病学专业研究生学习的积极能动性及提 高其对急性缺血性脑血管病的临床诊疗能力。     

以问题为基础联合以病例为基础教学模式在神经内科进修医师教学中的应用

目的探讨以问题为基础(problem-based learning,PBL)教学法结合以病例为基础(case-based learning,CBL)教学法在神经内科进修医师教学中的应用效果。方法选取首都医科大学附属北京天坛医院神经内科的进修医师40例,随机分为实验组(20例)和对照组(20例),分别应用PBL结合CBL教学法和传统的授课式教学法完成神经病学教学任务,采用调查问卷和理论考试评估教学效果。结果实验组在对学习兴趣、理论知识掌握、语言表达能力、分析解决问题能力,创新思维能力等方面的培养均显著优于对照组。前者的考试成绩亦显著高于后者。结论 PBL结合CBL教学法可激发进修医师的学习兴趣和自主学习能力,提高考试成绩,提升了临床神经病学的教学效果。     

PBL教学法在神经病学临床实习中的应用

目的 探讨基于问题的学习(PBL)教学模式在神经病学临床实习教学中的应用效果.方法 根据PBL教学理论,选取首都医科大学2008级五年制学生共76人作为研究对象,按班级分为实验组(n=38)和对照组(n=38),实验组采用PBL教学法,对照组采用传统教学法,采用比较两组学生的出科考试成绩以及问卷调查评价教学效果.结果 实验组的出科考试成绩(87.58±4.77)分明显优于对照组(82.08±4.24)分,差异有统计学意义(P＜0.01);实验组肯定“有利于激发你的学习兴趣”“有助于只是的理解和记忆”“提高自学能力”和“有助于培养分析解决问题的能力”4个方面人数明显高于对照组,差异均有统计学意义(P＜0.05).结论 在神经病学临床实习教学中应用PBL教学模式,不影响学生对基础知识、知识要点难点的掌握,有助于提高学生学习的积极性和主动性,促进其对知识的理解与掌握,有利于培养其临床思维能力,促进学生自我认识和成长综合素质水平的提高.     

以问题为基础教学法在鉴别帕金森病与血管性帕金森综合征教学中的运用

目的对比以问题为基础教学法(problem-based learning,PBL)与传统教学法在帕金森综合征鉴别诊断教学中的效果。方法将首都医科大学附属北京天坛医院神经病学中心神经变性疾病科轮转学员随机分成传统教学组和PBL组。所有学员教学前先接受对帕金森病及血管性帕金森综合征的熟悉度调查。传统教学组采用授课教学;PBL组以PBL教学法进行教学。教学结束后比较两组客观及主观教学指标成绩。结果教学前两组学员对帕金森病及血管性帕金森综合征熟悉度无差异。教学后PBL组教学主观和客观考核成绩均显著优于传统教学组,对教学过程的体验也显著优于传统教学组(均P0.05)。结论引入PBL教学法能显著提高学员在学习帕金森病及血管性帕金森综合征鉴别中的获益。     

PBL教学法在神经病学教学中的应用初探

PBL教学法即"以问题为基础的学习"(problem based learning,PBL)方法,该教学模式为1969年由美国的神经病学教授Barrows在加拿大麦克马斯特大学首创,最初主要用于医学教育,目前已成为国际上较流行的教学方法,在西方发达国家已被广泛地应用于临床医学教学中,并取得了良好的教学效果。目前国内外有关PBL的研究已从相关课程的     

角色扮演教学法在血管神经病学进修医师带教中的应用

目的 探索角色扮演教学法在血管神经病学进修医师教学查房中的效果评价。 方法 以首都医科大学附属北京天坛医院神经内科20名进修医师作为病房带教的教学对象,随机分入 角色扮演法教学组或传统教学组。在血管神经病学中最常见的急性缺血性卒中的诊断和治疗方案的教 学过程中分别对2组采用角色扮演法和传统教学法,以问卷调查方法对2组的教学效果进行评价。 结果 角色扮演法与传统教学相比,进修医师在自主学习能力,知识储备能力,知识拓展能力,临床 分析能力,系统诊治能力,解决问题能力,医患沟通能力等方面均显著提升。 结论 角色扮演教学法可以提高进修医师在血管神经病学科中管理患者的能力。     

基于团队的学习模式在血管神经病学实习医师带教中的应用

目的 探索基于团队的学习模式在血管神经病学实习医师教学查房中的效果。 方法 以首都医科大学附属北京天坛医院神经内科20例实习医师作为教学对象,随机分入基于团队 的学习模式和传统教学组。在血管神经病学中最常见的急性脑梗死的诊断和治疗方案的教学过程中 分别对两组采用基于团队的学习模式和传统教学法,以问卷调查方法对两组的教学效果进行评价。 结果 基于团队的学习模式与传统教学相比,实习医师在学习主动能力、分析问题能力、解决问题能 力、表达交流能力、知识拓展能力、临床分析能力及团队合作能力等方面均显著提升。 结论 基于团队的学习模式可以提高实习医师在血管神经病学科中掌握知识的能力。     

神经病学临床教学和命题工作中建议教师采用美国“基本问题的提出及其学习的方法”

简要介绍了在神经病学临床教学和命题工作中教师采用"基本问题的提出及其学习的方法"(Problem Based Learning,PBL)教学方法的基本思想;PBL教学的特点和优点及其应用方法;在PBL教学中考试命题的主要方法病例串试题的命制原则.     

病案导学式教学法在血管神经病学临床教学中的应用

在血管神经病学临床教学中,设计了以病例为引导的教学法——病案导学式教学法（casebased study,CBS）。CBS包括展示病案、提出问题、自学思考、讨论置疑、评价精讲等步骤。通过病例的引导和深入,学生巩固了理论课知识,培养了临床思维,活跃了课堂气氛,提高了教学效率。CBS是血管神经病学临床教学中一种有效的教学法,值得进一步推广和完善。     

以问题为基础教学法在卒中后癫痫教学中的应用

目的 探讨卒中后癫痫教学过程中应用以问题为基础学习（problem-based learning,PBL）教学法的效果。 方法 以7年制临床医学专业30名学生作为教学对象,随机分入PBL教学组或以授课为基础学习 （lecture-based learning,LBL）的传统教学组。在卒中后癫痫的诊断和治疗过程中分别对两组采用PBL 教学法和LBL教学法,以问卷调查方法对两组的教学效果进行评价。 结果 PBL教学法与LBL教学法相比,学生在自主学习能力、提出问题能力、解决问题能力、临床思维 能力、临床实践能力、医学知识扩展、医患沟通能力、团队合作能力各方面均显著提升。 结论 PBL教学法可以提高学生在卒中后癫痫诊断和治疗过程中的临床思维及实践工作能力。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.