责任导师制下核医学规范化培训中PBL教学应用探讨

住院医师规范化培训以培养临床应用型专业人才为目标,以岗位胜任力作为基础,是医学人才成长过程中的重要阶段.近年来,我国医学教育模式不断改革、培养方式不断改善,尽管医学生的实践能力、临床素质提升明显,但仍与实际需求存在较大差距.核医学作为一门相对年轻的学科,传统灌输式的授课教学模式重理论轻实践,已无法适应新的发展形势.规范化培训医师责任导师制的实施能够进一步调动教师及学生的积极性,充分发挥导师优势,同时可以对学生因材施教,进行有针对性的个性化指导,能够有效促进教学相长.PBL(problem-based learning)教学法逐步被国内认可并广泛实施,以案例为基础的PBL教学法能更好地培养学生的临床素质、创造性思维.现对责任导师制下采用以案例为基础的PBL教学法在核医学教学中的实践应用进行探讨.     

“寓教于练”在肌肉骨骼超声影像教学中的应用探索

目的讨论在肌肉骨骼超声影像诊断培训中应用"寓教于练"方法的教学效果。方法通过对30名参加培训的进修医师进行一个月的"寓教于法"教学,其培养效果通过客观考题和问卷调查进行评估。结果 30名进修医师在培训后试卷的正确率较培训前显著提高(P0.05)。进修医生对于整个培训内容方面的综合评价,满意度为100%,其中非常满意为70%,满意为30%。对于自己在肌骨超声诊断水平提高方面的自我评价结果为非常满意45%,满意为40%,不满意为15%。结论通过"寓教于练"方法的实施,能够让进修医师尽快掌握肌肉骨骼的超声解剖理论知识,具备常见肌肉骨骼系统疾病的独立诊断能力。     

分层分级的进阶式培养模式在超声住院医师规范化培训中的应用

目的探索分层分级的进阶式超声住院医师规范化培训模式,以提高超声住院医师的培训质量。方法对不同教育背景的超声住院医师进行分层培养,按照年级和培训阶段设计制定进阶式的培训方案,建立分层分级的进阶式超声住培体系,并在2016级超声规培住院医师中尝试应用。将改革前2013级住院医师和改革后2016级住院医师的超声报告质量进行对比,评价教学改革效果。结果施行分层分级的进阶式培养方案后,2016级住院医师超声报告的病理符合率为97.2%,而改革前2013级超声报告的病理符合率为92.8%。教学改革后年级超声报告的病理符合率显著高于改革前(P0.05)。结论分层分级的进阶式培养模式有助于超声住院医师培训质量的提高,在超声住院医师规范化培训中具有一定的应用价值。     

全科住院医师内分泌代谢疾病临床规范化培训问题与对策

提高全科住院医师规范化培训内分泌代谢疾病专业临床教学质量是培养合格的全科医生的关键。本文通过分析全科住院医师规范化培训中内分泌代谢疾病专业教学要求及目标,结合临床教学实践,从教学内容方法、师资水平以及全科住院医师自身情况3方面总结全科住院医师规范化培训中内分泌专业教学中存在的问题,并结合本专业临床教学特点,提出提高全科住院医师规范化培训中内分泌专业教学质量的具体实施建议,包括如何优化教学内容、教学方法实施、提高全科医师自我认知以及全科师资培训建议。     

专科住院医师临床技能培训新模式-导师制的研究与实践

目的 为了提高专科住院医师的综合水平.方法 我院从 2006年开始实行专科住院医师临床技能培训新模式-导师制,通过导师制的实施,对专科住院医师从医德医风、实践能力、医疗质量、科研、教学、医院培训、院内考试等方面进行考核.结果 成绩明显高于未实行导师制之前已进行培训的专科住院医师.结论 专科住院医师导师制对提高专科住院医师的临床技能、综合素质、及其社会竞争力起着十分重要的作用.     

多元化教学模式在超声医学科教学中的应用

为改进教学质量,进一步提升参加规范化培训的住院医师、研究生、临床博士后、进修医生的临床综合素质,超声医学科设计了以基础级别课程、高级级别课程、上机操作带教、住院医师晨课等内容为主的7个分级培养教学模块。教师在教学过程大胆尝试新方法,教学模式不断更新;学生在教学过程中,主动参与,强化体验互动,课堂生成丰富精彩。多元化教学模式的使用可以提高超声医学科受培训医师的实践能力和理论水平,促进其专业技能的提升。     

就业见习护士初级肿瘤专科能力规范化培养

目的：根据对处于就业空白期的高校毕业生进行专业规范化培养,提升专业能力,提高就业竞争力。方法对就业见习护士及带教导师按照设置标准进行遴选,对入选见习护士在见习前后发放问卷调查表进行自我评价、导师评价、科室评价;按照创新实习计划,每批30人,通过为期6个月理论、实践学习后对每位轮转见习护士进行最终评价。结果就业见习护士培训前后在问卷调查显示自身能力及理论考核成绩上具有统计学意义,<0.05,就业率达到100%。结论就业见习护士通过《就业见习护士肿瘤专科能力规范化培养模式》方式培养,对自身综合素质、专业医学基础知识、初级肿瘤专科知识及技能的能力得到很大提升,提高就业率。     

超声医学教学体系构建的实践

超声医学科住院医师规范化培训在医学生毕业后和专科医师的继续教育中起着承上启下的关键作用。近年来随着各类医学生纳入超声医学科住院医师规范化培训，遇到了被培训医师素质参差不齐、培训目标定位缺乏个性化、实施管理手段不足等一些问题。本文探讨了中日友好医院超声医学科规范化培训体系建设的具体内容，包括文化建设、课程体系建设、过程考核建设、师资建设等实践。可通过自身优势整合课程等资源并优化利用、健全并严格执行培训考核制度、重视师资建设、科室文化建设和人文关怀并举等措施，在超声医学科住院医师规范化培训工作上创出自己的特色，以期为未来构建规范化的超声医学医师培训管理体系奠定基础和提供经验。     

日常病例报告评价及反馈系统在超声住院医师培训中的应用

目的探讨日常病例报告评价及反馈系统在超声住院医师规范化培训中的应用价值。方法按照规范化操作、规范留图、体表标记、彩色血流、语言表达及报告书写等方面制定住院医师考核评分评估的方法;按照评分方法对培训后的住院医师的日常病例报告进行评分,并对病例进行定期点评反馈;以往届未经过培训的住院医师同时期的诊断报告为对照,在以上方面及常规定期考核成绩进行配对t检验,判断同期水平住院医师报告诊断水平有无差别。结果经过日常病例报告评价及反馈系统培训后的住院医师临床报告各方面的评分(总分46.70)水平均较对照组的评分(总分40.70)有提高(P0.05);住院医师在超声诊断及报告水平提高方面的自我评价结果满意率为90%。结论日常病例报告评价与反馈系统在临床教学实践中具有较高的可行性,可以有效地提高医师培训的质量。     

基于需求分析的超声医学科住院医师晨课建设及优化

为深化超声医学科住院医师规范化培训,进一步提高住院医师综合素质和核心能力。针对目前教学培训中的盲点,以问卷调查的形式对超声医学科住院医师的教学培训需求进行梳理,开展有针对性的“点菜式”早间课程。根据学员反馈,早间课程主要设置了临床技能、科研专题、医患沟通及人文素养和执业医师考试4个主题。此外根据住陪学员的不同学历背景,采用分层级课程安排和培养计划。早间课程利用早上的碎片时间,有助于协调带教老师和住院医师的工作、学习时间安排,有利于缓解住院医师规范化培训中存在的工学矛盾,有利于提高住院医师的综合素质,提升教学质量。     

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.