专科层次临床医学专业和临床医学专业(全科医学方向)学生的全科医师职业趋向调查

目的了解专科层次临床医学专业和临床医学专业(全科医学方向)学生的全科医师职业趋向,评价两个专业的课程和培养模式对学生职业选择的影响。方法采用结构式问卷调查2010级临床医学专业学生102人、临床医学专业(全科医学方向)学生76人。了解学生对所学课程的兴趣、对全科医师工作环境和就业前景的认知、毕业后的职业选择等。结果临床医学专业(全科医学方向)学生对全科医师的职业定位、工作认同优于临床医学专业学生。结论专科层次临床医学专业应采取全科医学方向进行培养,通过课程和培养模式改革来改变学生的职业趋向,引导学生树立服务基层、走向社区、扎根农村的全科医师职业理想。     

重庆市专科层次临床医学专业培养现状分析及对策研究

目的分析重庆市专科层次临床医学专业的培养现状,提出适应我市城乡社区卫生发展的人才培养新思路。方法分别对我市12个社区卫生服务机构、42名新进社区全科医师和50名应届专科层次临床医学专业毕业生进行问卷调查,小组访谈上述机构负责人。结果全科医师是社区医疗战线上的主要力量。近三年新进医师重医轻防,缺乏基本公共卫生相关知识和技能,临床基本诊疗水平和沟通能力也有待提高。54.55%的临床医学专业毕业生不愿意选择社区工作。结论社区卫生服务机构对全科医师的需求量较大,现有专科层次临床医学专业培养不适应我市社区卫生服务的发展,建立和推行以社区为基础的教育结合问题为基础的学习三年制临床医学专业(全科医学方向)的培养模式迫在眉睫。     

家庭健康调查对三年制临床医学专业(全科医学方向)学生职业倾向的影响分析

目的了解家庭健康调查对全科医学专科学生职业倾向的影响,寻找最佳培养方式。方法学生暑期家庭健康调查后,从对家庭卫生需求了解、对专业学习的影响、学生职业倾向三个维度,采取问卷调查和访谈的方式获取资料,并与未实施家庭健康调查前进行对比分析。结果来至农村的学生对家庭成员的生活习惯比较熟悉,经济基础较差、家庭人员较少的学生比较关注家庭成员的卫生需求;学生在对全科医师工作职责的认识方面,农村优于城镇、女性优于男性、家庭月收入低于5 000元优于5 000元及以上者;毕业后选择全科医生职业比例随年级增高而增加,56.0%的(42/75)学生重新选择专业会再次选择全科医学,选择全科医师职业的原因从"先就业后择业"转变为"前途好、服务方式人性化"(χ2=43.19,P<0.001),不愿选择全科医师职业的原因从"前途不明朗"转变为"待遇太低、只能在社区工作"(χ2=12.49,P=0.014)。结论家庭健康调查可以影响专科临床医学专业(全科医学方向)学生职业倾向。建议利用假期早期开展与专业相关社会实践活动,让学生早期接触社区、早期接触岗位、早期接触患者,积极开展以社区为基础的教育结合社区为问题的学习,十分有利于培养专科医学生的职业思想和职业能力。     

专科层次临床医学专业面向社区的教学改革效果评价

目的 评价专科层次临床医学专业面向社区的教学改革的效果,探索适合我省社区卫生服务需求的全科医学人才培养模式与课程体系.方法 将我院全科医学方向临床医学专业的2006级50名和2007级65名大专学生作为试验组1、试验组2,采用新课程体系及教学方法;同级55名、68名学生作为对照组1、对照组2,采用旧课程体系及教学方法,以统一的理论技能考核和问卷调查评价教学改革效果.结果 试验组与对照组的基础课程、临床课程、实习的成绩比较,差异均有统计学意义(P<0.05);试验组与对照组的临床理论与技能考核成绩比较,差异均有统计学意义(P<0.05).试验组学生对新课程体系及教学方法的评价较好,有98.3%的学生认为课程设置良好,94.8%认为讲授生动、启发引导.结论 专科层次临床医学专业应以社区卫生服务需求为导向改革其课程体系和教学方法.     

PBL教学法在全科医学儿科学教学中的实践及评价

陕西省教育厅陕西21世纪初高等教育教学改革工程立项"以社区为导向的全科医学人才培养模式与教学内容体系改革的实验研究"(06G17);西安医学院教育教学研究重点项目"以社区为导向的全科医学教学改革的实验研究"(2006JG3);本项目旨在进一步适应社区卫生事业发展的要求,改革临床医学专业(全科医学方向)的教学内容、课程体系和教学方法,强化学生的预防观念,使之具有预防和治疗疾病、增进健康与康复以及开展社区卫生服务的基本知识和技能,成为防治结合的复合型医学人才.在教学中不断进行教学方法的改革,把培养学生社区卫生服务观念和实践能力贯穿于医学教育的全过程.     

全科医学教育的现状与展望

全科医学是一门以初级卫生保健和社区医疗服务为目的的医学专科,经过多年的发展,全科医学逐渐形成了整体的医学观,现代的医学服务模式,独特的医疗方法、服务内容与艺术,为社区居民提供连续性、综合性和个体化的医疗服务．全科医生是全科医疗服务的提供者,全科医疗是以解决社区常见健康问题为主要目的的基础医疗服务．我国自2000年开始启动全科医师规范化培训和岗位培训,至今已形成以高等医学院校的全科医学知识教育,全科医师规范化培训为重点的临床医学专业毕业后医学教育,以及全科医师岗位培训所构成的我国全科医学的培养模式．     

构建广东省全科医学教育体系的探索与实践

为满足当前我省社区卫生服务工作对高层次防治结合型实用型全科医学人才的急需,在深化医学教学改革过程中,率先在我省开办了临床医学专业全科医学方向。初步探索出在地方性高等医学院校医学生总数70%以上的临床医学专业本科生(全日制普通生和业余成人生)中加强预防医学、全科医学知识和技能培养,为社区卫生服务机构培养急需的,具有社区综合卫生服务能力的,不仅精通于疾病治疗而且能够指导社区居民防病、防治合一的实用型全科医学人才的途径从新生入学讲座、理论课、实验课、第二课堂到毕业实习,以及采取“前期打基础、后期向全科医学专业方向分流”等措施。加强预防与临床医学的结合,对临床医学专业本科生提前有机地增加和融入社区预防保健以及全科医学知识,进行扎根于基层为社区居民服务的思想教育,逐步深化社区卫生服务能力及综合素质的培养,为其毕业后从事基层社区卫生服务工作奠定了基础。学生的就业取向和社区卫生服务观念发生了较大变化,自愿申请参加全科医学方向学习并到基层社区卫生服务机构工作的人数逐年增多,已有3届本科毕业生充实到我省基层社区卫生服务机构工作,初步建立了适合我省现阶段省情的全科医学教育体系。同时,积极对全省社区卫生服务机构在职人员开展全科医学岗位培训和全科医学成人学历教育,为我省社区卫生服务机构的建设和可持续发展培养了4000余名具有一定的全科医学知识与技能的在职专业技术人才,取得了良好的社会效益和经济效益。     

临床医学专业本、硕生社区实践效果评价及对策研究

目的 探讨临床医学专业本、硕生参加社区实践的效果并对存在的问题进行分析,提出相应对策.方法 选择2007年9月-2009年12月在德胜社区卫生服务中心"全科医师规范化培训社区教学基地"参加社区实践的北京大学医学部临床医学专业本硕生98名为研究对象,分别于实践前后采用自行设计的"临床医学专业本硕生对全科医学知识技能了解程度"统一调查问卷进行调查,对其实践前后社区卫生服务和全科医学知识技能了解程度(11个条目)的变化情况、对社区医院主要功能和社区全科医生与大医院专科医生工作不同点的知晓率进行比较.结果 临床医学专业本、硕生实践后对社区卫生服务和全科医学知识技能了解掌握程度(11个条目)较实践前均有明显的提高,差异均有统计学意义(P<0.05);实践后对社区医院功能和社区全科医生与大医院专科医生工作不同点的知晓率较实践前有明显的提高,差异亦均有统计学意义(P<0.05).临床医学生普遍对社区医院、全科医学的认知度低,不感兴趣,硕士生更为严重.港、澳、台学生对社区实践的重视和积极参与的程度高于内地的医学生.结论 临床医学专业本硕生参加社区实践对了解和掌握全科医学知识技能会起到明显的作用,是非常必要的.社区教学基地根据临床医学生的需求和对全科医学的实际了解程度,科学合理地设计课程和安排实践,是保证社区实践效果的前提.     

探索全科医师社会价值感与自信心的培养

随着医学不断发展,居民对健康教育、健康咨询、疾病预防及人文关怀等医疗服务的要求越来越高,全科医学服务成为健康促进目标的体现,由此应运而生的是全科医学理念和全科医师(general practitioner,GP)。为了履行基本医疗保健服务,健康与疾病咨询服务的职责,要求全科医师不仅要具备扎实的专业技能,更需要广博的人文知识及管理能力。上海市全科医师规范化培养包括全科医学理论,临床科室轮转,社区轮转,毕业考核及科研能力等。一名技能合格的全科医师完全可以承担常见病、多发病等疾病的诊疗工作,发挥以问题为目标,以人为中心,家庭为单位,社区为范围的健康守门人角色。但全科医师自身社会价值感与自信心的培养依赖于全科医师良好沟通能力的培养,社区居民积极的精神鼓励,政府的大力支持等。因此,全科医师社会价值感和自信心的培养,成为全科医学不断完善的重要任务之一。     

专科层次的全科医学教育与国情

我国农村社区卫生人才短缺,总体素质不高,特别是全科医学人才严重匮乏.利用专科层次全科医学教育"短、平、快"的特点,推行全科医学教育普及和充实农村社区基层医疗人才队伍,能够满足基层民众健康医疗的需求,符合现阶段的我国国情.专科层次的全科医学教育人才培养模式对创建中国特色的全科人才培养之路具有积极与深远的意义.     

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.