儿科学标准化病人培训与应用初探

标准化病人(standardized patient,SP)的应用在我国尚属起步阶段,在儿科学的教学经验有限。本文总结了SP在儿科学教学中的应用特点,并从撰写培训素材、制定评分标准、确定培训步骤、考核和监督手段等几个方面,较为详细地描述了儿科学SP志愿者的培训方法。文章认为SP的应用具有不可替代的优点,同时对比了国内外SP应用情况,提出了对今后的展望。     

标准化病人在儿科教学中的应用

标准化病人（Standardized patient,SP）的应用在我国尚属起步阶段,在此总结了SP在儿科学教学中应用的几点体会,包括儿科学SP志愿者的选择和培训、SP剧本的产生与完善、SP评分及在OSCE的应用等几个方面。提出SP的应用具有不可替代的优点。     

外科临床教学中标准化病人的培训

标准化病人(SP)的应用在我国处于起步阶段,在外科临床的教学中应用有限。分析SP在外科学教学中的优势,并从实际教学条件出发,从招募、纳入标准及训练目标、具体培训方案等几个方面,较为详细地描述泌尿外科学SP的培训方法,逐步运用SP开展教学活动。     

CBL+SP与LBL教学模式在儿科住院医师培训效果的比较研究

探讨CBL+SP教学模式在儿科住院医师培训中教学效果。用教学实验和问卷调查的方法,将CBL+SP与LBL教学模式的儿科住院医师教学效果进行分析,评价其优劣性,得出结论,为CBL+SP教学模式在住院医师培训中的应用提供经验。     

应用标准化病人技术辅助儿科临床教学的研究

目的探讨标准化病人(SP)与多媒体相结合的组合SP技术辅助儿科临床见习的有效性及可行性。培训模拟患儿家长的SP,配套以相应病例多媒体患儿影像用于临床技能、临床思维及交流能力的培训。方法实验组以1名SP对3名学生的方式进行病例分析教学,其余内容与对照组相同。比较两组成绩,分析问卷。结果结果示实验组平时、理论及总成绩高于对照组,病历成绩无显著性差异。问卷调查结果示学生对此教学法持肯定态度。结论SP自我评价认为规范培训及丰富的幼儿知识利于工作。故组合SP教学有利于提高学生成绩及综合素质,可加强教学薄弱环节,有效辅助儿科临床技能的培训。     

内科标准化病人的选择及培训

使用标准化病人（Standardized patients,SP）是临床医学教育改革的趋势,如何规范、有效地培训SP是保障教学效果的基础。通过介绍内科标准化病人的选择及培训经验,探讨内科标准化病人在临床医学教育中的意义,以期对后续进一步深化SP在内科学教学及其他临床学科的应用提供一定借鉴。     

标准化家属在儿科临床教学中的应用

标准化病人（standardized patient,SP）是目前国内外医学院校广泛采用的一种教学和考核方法。儿科问诊对象多为家长,在儿科相关的医学教育中,一般采用标准化家属（standardized family,Sfam）扮演患儿家属,故儿科SP通常指Sfam。现阶段,我国Sfam用于儿科教学的发展较为缓慢。本文从儿科教学的特点出发,综述Sfam在儿科教学中的必要性、不同类型Sfam在儿科教学中的应用、Sfam与其他临床教学方式在儿科教学中的融合应用、Sfam在儿科教学中的价值,并探讨未来人工智能Sfam在儿科教学中的应用方向及前景。Sfam经过多年发展,是一项经过验证的行之有效的教学形式,希望通过本文的介绍,让更多的儿科临床教育者深入了解Sfam教学法,进一步推广Sfam教学法在儿科教学中的应用,使其发挥最大效用,促进儿科教育事业发展。     

模拟诊疗结合标准化病人在儿科见习教学中的应用

目的：探讨医学生模拟标准化病人（SP）用于儿科临床见习教学的效果。方法：选取典型病例作为诊疗对象,课前指定1-2位学生做好扮演SP的准备,其他学生扮演医生,逐步运用SP开展教学活动。结果：医学生模拟SP提高了学生学习兴趣,有助于培养学生的临床综合能力,提高见习带教的质量。结论：在标准化病人资源短缺的情况下,医学生模拟标准化病人为儿科学见习教学提供了新思路。     

标准化病人在临床医学教学中的应用

目的：对标准化病人（SP）应用于临床医学教学过程的相关文献进行回顾,探讨其对临床医学教学效果的实际影响。方法：通过检索国内各大数据库中公开发表的相关中文文献,制定有效的纳入和排除标准,由2名独立研究人员对其进行质量评价和数据提取,并对纳入文献进行系统性评价。结果：共纳入12篇中文文献,涉及外科学、传染病学、儿科、妇产科以及诊断学等课程中SP的应用。临床医学教学过程中SP的应用不同程度提高了学生成绩、实践操作能力以及教学满意度和学习积极性。结论：标准化病人在临床医学专业课程教学中的应用可提高其教学效果与学生的学习积极性。     

浅谈多媒体与儿科学教学

随着近年来电子信息技术的飞速发展，多媒体教学在包括儿科学在内的医学教育中得到了迅速的推广和应用。多媒体教学一方面很好地克服了传统教学的呆板，提高了儿科学教学效果；另一方面，如果应用得不得当，也会给教学带来诸多问题，我们结合本教研室近年来应用多媒体教学的一些经验，就如何科学合理地将多媒体应用于儿科学教学作一简单探讨。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.