北京协和医学院八年制临床医学专业学生科研经历及认知现状调查

目的调查八年制临床医学专业学生对科研的认知、科研训练经历以及对自身科研能力的评价,了解医学生的科研训练需求,评估目前科研训练的效果,探索更高效的科研训练模式。方法对北京协和医学院2012级、2013级八年制临床医学专业64名学生进行相关内容的问卷调查,对问题结果进行描述性分析,进一步对两个年级间的调查结果进行统计分析。结果北京协和医学院八年制医学生普遍认为在临床学习阶段临床知识和技能比科研能力培养更为重要;提高科研能力和做出科研成果是学生现阶段参加科研训练的主要动机;68.8%学生对科研训练感兴趣,希望通过科研训练提升的能力包括论文撰写、实验设计、数据分析、文献检索与阅读和实验技术等;84.5%学生认为科研训练有难度,开展科研训练时的最大阻碍是学业或临床学习任务繁重;82.8%被调查的学生有科研经历,但学生科研成果产出不多;学生对自己的科研素养自我评价普遍较低。结论北京协和医学院八年制临床医学生对科研兴趣浓厚,但面临诸多困难,通过教学制度的改革,因材施教,将有助于临床医学生的科研能力、科研素养的提高。     

PBL联合多种教学法在儿科学医患沟通课程中的临床应用

目的探讨PBL联合CBL和情景模拟教学法在儿科学医患沟通课程中的临床应用效果。方法选取北京协和医学院临床医学生53名,其中26名学生接受常规PBL教学,为对照组;另27名学生接受PBL联合CBL和情景模拟教学法,为观察组。比较两组成绩考核分数、相关知识掌握情况、课堂教学效果和学习促进情况。结果观察组医学生成绩考核分数高于对照组(P0.001)。观察组医学生儿科学相关知识掌握评分高于对照组(P0.001)。观察组课堂教学效果评分高于对照组(P0.001)。观察组医学生学习促进情况评分显著高于对照组。结论 PBL联合CBL和情景模拟教学法能优化儿科学课堂学习氛围,提高医学生与患儿、家属交流技巧,促进学习,可在临床推广应用。     

如何提高临床医学生实习质量

临床实习阶段是临床医学生学习和实践的重要环节,是医学生迈向社会的重要转折点,但在此过程中往往会出现很多问题直接影响实践工作的质量,而使这一项学习的效果大打折扣,如何合理的解决这些问题,提高医学生的实习质量,使其真正成为巩固和拓展理论学习,提高医学生医学素养的课程将成为医学类院校提高教学质量的重要议题。     

解剖学“大爱无疆、无语体师”医学人文教育创新课程体系的设计与实施

自2010年起,深圳大学医学院解剖学科结合自身优势和特色,连续3年系统地在临床医学本科专业中开展了"大爱无疆,无语体师"医学人文教育创新课程体系建设,获得良好的效果。高等医学教育肩负着为社会培养医学人才的重任,医学生的人文素质将直接影响未来社会的医疗服务水平和医患关系。"大爱无疆,无语体师"医学人文教育创新课程体系的成功实施,对促进医学生的自主学习、培育职业素养和医德医风建设方面产生了积极的影响,充分地体现了国家关于实施科学发展观和构建"和谐社会"的精神,有力地促进了医疗教育和卫生事业健康发展。     

医学生对精神障碍患者歧视态度调查

为了解医学生对精神障碍患者歧视状况。采用歧视精神疾病患者评估量表对784名临床医学专业大学生施测。结果显示,大二医学生在量表总分、危险维度和能力维度评分高于其它年级医学生,差异有统计学意义(F=4.639,4.074,5.443,P<0.05);有精神障碍亲友医学生在能力维度评分高于无精神障碍亲友医学生,差异有统计学意义(t=-1.974,P<0.05)。当前医学生存在对精神障碍患者歧视现象,人文医学教育及社会精神心理卫生知识宣传能够降低歧视水平。     

从遗体捐献到医学生人文素质教育的思考

前我国医患关系的日益恶化显现出医学生人文素质教育的不足,传统的医学人文教学方式已不再适用,迫切需要找到相应的解决方法,遗体捐献体现的精神对医学生学习医学人文知识有很强的促进作用,而医学生人文素质的提高又能够有效的带动遗体捐献率,两者的相辅相成为医学教育发展开辟了一条新的路径。     

香港医学生的解剖学双语能力调查

目的 了解香港中文大学医学院临床医学专业本科生的解剖学双语能力.方法 问卷调查,调查对象为122名临床医学专业一年级的本科生.问卷共列出了22个英文解剖学名词和19个中文解剖学名词,要求学生进行英汉或汉英互译,并就每个名词听到过的程度进行评级.结果 1.常听到的英语名词的中文翻译为所有名词的14%;中文名词的英文翻译为8%;2.英译汉的正确率为总人数的18%;汉译英的正确率亦是18%.两者的水平大致相同;3.常听到的名词虽然较容易译对,但有不少是惯用错词,经常译错;4.中学时期的授课语言(纯中文或纯英文教学)似乎与医学生的双语能力无关;授课时如果兼用另一种语言,則学生的双语能力较好.结论 香港医学生解剖学双语能力存在如下问题:1.对中文名词认识不足,英译汉或汉译英都存在困难;2.强记英文和拉丁名词,不求甚解;3.人错我错.双语能力亦是医学生面对社会、与人沟通的问题.提升双语能力对社会和学生而言都是十分重要的.     

临床情景剧在医患沟通培训及考核中的应用

临床人文医患沟通是医务工作者的一项基本能力,与医疗技术同样重要。近年来针对医学生临床沟通技能的教学也愈发受到重视。然而作为一项实践技能,其教学和考核有不同于理论课的特殊性,难度较大。北京协和医学院心理医学科,基于心理剧和角色理论,发展出一种新的沟通教学和评价方法——临床情景剧考试方法。该方法将医学生投入不同角色去共情其内心感受与冲突,主动运用医疗技术以外的人文沟通技术解决临床难题,并从旁观者的分享与点评进一步理解情境和思考其他可能的解决方法。     

浅谈长学制医学教育中的人文素质教育

随着医学模式的转换和卫生需求的不断增长,社会对医务工作者的人文素养要求越来越高。本文就加强医学生人文素质教育的重要性进行了探讨,总结了北京协和医学院90年办学历史中在医学生人文素质培养中进行的探索,同时对未来长学制医学教育中人文素质教育存在的问题提出了思考。     

医学人文教育的缺失与回归

医学研究和医疗实践渗透着大量的人文知识和人文精神.不过,长期以来我国医学人文研究力量有待加强,教学内容及方法需要更新,医学生人文素养有待提高.作者建议:加强师资队伍建设,借助“以问题为导向”的教学方法,培养医学生的批判思维能力,弘扬科学精神,重塑医学职业理想.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.