论临床医学专业学位和专科医师准入制度的相互作用

本文论述了临床医学专业学位和专科医师准入制度的相互作用:临床医学专业学位为本科学历背景的临床医师以同等学力在职申请学位创造了条件,促进了住院医师规范化培训制度的健全和发展;同时,随着专科医师“3+X”培训模式的实施,临床医学专业学位研究生的培养方案必须进行重新修订。     

附属医院眼科专科医师与专业学位研究生培养中实行门诊分诊负责制的构想

本文分析了我国医疗服务一线工作中门诊分诊的现状,结合我国逐步启动的专科医师培训与临床医学专业学位研究生培养制度的实践情况,提出了在高校附属医院中把门诊分诊工作与专科医师和专业学位研究生培养相结合,率先在眼科学进行试点并逐步探索推广分诊负责制这一培训思路,同时借鉴美国成熟的专科医师培训制度,结合国情对我国医学教育体系中临床实践能力的培养方案提出设想.     

浅谈口腔医学专业学位研究生的培养模式

自1993年原卫生部颁发《临床住院医师规范化培训试行办法》以来,我国住院医师规范化培训制度逐步完善,目前基本成为医学生走向临床医生必备的一个训练阶段。同时,在住院医师规范化培训制度基础上,专科医师培训制度也被提上日程并将逐步推广。这些变化对临床医学专业学位,特别是口腔医学专业学位研究生的培育模式将产生一定影响。基于此,本文以现口腔医学研究生培养模式为基点,探索在住院医师规范化及专科医师培训发展趋势下的口腔医学专业学位研究生培养的新模式。     

广州中医药大学一附院中医专科医师培训制度实施成效分析

从培训学员的基本情况、就业去向、结业考核等角度,对全国首家中医专科医师培训基地广州中医药大学第一附属医院六批209名专科培训医师的调查与分析,为在医教协同新理念指导下中医专科医师培训制度的建设提供参考。结果显示,培训学员临床能力显著提升,得到医院与行业认可,成为医院选留人才的重要途径。考核内容与办法随着培训工作的不断深入趋于完善规范。结合博士/硕士是该院专科医师培训主要对象的结果分析,以及新的政策要求,指出临床医学博士专业学位研究生培养与专科医师规范化培训制度紧密衔接是未来专科医师培训制度发展的重要方向。     

临床医学专业学位博士研究生教育与专科医师规范化培训 并轨改革初探

探索临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革方案。采用文献分析法、专家访谈法初步构建并轨培养方案初步框架，通过两轮函询后确定指标体系及指标权重，最终构建了包含6个一级指标，26个二级指标，72个三级指标的并轨培养方案指标体系。 通过科学地制定系统的培养方案，建立以岗位胜任力为核心培养内容和全方位考评体系，使用弹性学制，为开展临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革提供依据。     

临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革方案指标体系构建研究

目的　探索临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革方案。方法　采用文献分析法、专家访谈法初步构建并轨培养方案初步框架,通过专家咨询法确定最终指标体系。通过Excel 2010录入数据资料,利用SPSS 19.0软件进行统计分析。结果　经过两轮专家咨询,从招生方式、培养资源、培养内容、培养方式、培养考核、质量监控这6个方面最终确定了临床医学专业学位博士与专科规范化培训医师并轨培养的框架,建立了包含6个一级指标、26个二级指标、72个三级指标的并轨培养方案指标体系。结论　通过科学地制定系统的培养方案,建立以岗位胜任力为核心培养内容和全方位考评体系,使用弹性学制,为开展临床医学专业学位博士研究生教育与专科医师规范化培训并轨改革提供了依据。     

住院医师规范化培训与在职申请临床医学专业学位

临床医学专业学位的建立,将住院医师规范化培训与研究生教育有机地结合在一起,促进了住院医师规范化培训制度的健全和发展,开辟了一条培养高层次临床适用型医学人才的新途径。北京大学医学部充分发挥高校优势,经过不断地实践和探索,形成了一套比较完善的临床医师在职申请临床医学专业学位制度。     

浅议法医本科生以同等学力参加临床病理医师培养的可行性

病理学在临床医疗活动中发挥着重要作用，但我国却面临病理医师稀缺的困境。法医学本科生的医学课程结构基本和临床医学本科等同，但法医病理专业课程的学习使其病理学基础起点高于临床医学专业本科和专科。借鉴发达医学国家的法医学病理医师及临床病理医师互融互通的培养经验，建议法医学本科生以同等学力参加医师资格考试，作为可选生源参加病理住院医师规范化培训及报考临床病理专业学位研究生，缓解临床病理医师医荒现象。     

卫生部关于开展专科医师培训试点工作的指导意见(征求意见稿)

临床医学是知识性、实践性、技能性很强的学科。临床医师的成长不仅要有系统、广博的专业知识,更要有扎实、熟练的临床能力。专科医师培训(住院医师培训)是临床医师提高实际诊断和治疗能力的必要阶段,也是临床医学人才成长特有的阶段。推行专科医师培训制度是医学科学发展和医学人才成长规律的必然要求,     

医学专业型研究生临床培养模式的研究

近年来我国研究生教育制度进行了较大的改革,其中的一个重要方面是逐步加大了专业型研究生招生比例,减少了以前占据主体地位的科学型研究生规模,这种变化在医学研究生中尤为突出。临床医学科学学位以培养从事基础理论或应用基础理论研究人员为目标,注重学术理论水平和实验研究能力。临床医学专业学位以培养高级临床医师等应用型人才为目标,注重实际工作能力,其科研要求相应较低,但要求临床技能水平达到住院医师规范化培训第一阶段的临床工作水平。住院医师规范化培训对象为本科以上学历毕业生,其第一阶段为普通专科培训。2013年教育部、国家卫生和计划生育委员会开始试行专业学位硕士研究生与住院医师规范化培训相结合的联合培养改革模式。     

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.