北京市某区县疾病预防控制机构专业技术人员公共基础知识培训需求分析

目的 了解北京市某区县疾病预防控制中心专业技术人员在公共管理知识和公共基础知识上的需求,以提高培训的针对性和适用性.方法 采用自制问卷对北京市某区县疾病预防控制中心的专业技术人员共81人就公共基础知识培训需求进行调查,使用SPSS 16.0软件,运用率、x2检验等分析方法进行统计描述和分析.结果 接受调查的某区县疾病预防控制中心专业技术人员对公共基础知识的需求较高,尤其是在统计分析方法、卫生应急技能和人际交往语言表达方面,需求率分别为49.4％、64.2％、61.7％;对来自上级单位的培训、短期集中培训的需求率较高,分别为56.8％、70.4％;不同年龄、不同工作年限、不同学历、不同职称的人员对培训内容、培训方式和培训举办单位的需求不同,差异有统计学意义.结论 北京市某区县疾病预防控制机构应当进一步提高对专业技术人员公共基础知识的培训力度,并考虑不同特征人员的培训需求;增加上级单位和培训机构的培训,提高培训效果;以短期集中培训为主,不断拓展多种培训形式。     

城市社区人口与计划生育技术人员培训需求调查

目的通过调查两市社区人口与计划生育技术人员培训现状及对培训知识的需求,为计生委等有关部门进一步制定培训策略,做好人口与计划生育工作提出合理化建议。方法对所有接受培训的专业技术人员进行分阶段整群抽样,采用统一的问卷进行调查。培训前后分别进行闭卷考核,将培训前后的考试成绩进行评价分析。结果近3年内,有26.52%的专业技术人员参加过专科培训;65.6%参加过继续教育;21.15%参加过进修;有6.67%在三级医院参加培训;31.18%在二级医院参加培训;85%在社区卫生服务中心参加培训;12.75%在高校参加培训;从未参加过培训的护理人员占3.25%。培训时间最长6个月,最短1周。本次培训无论在内容选择,还是培训方式、时间上都受到了被培训者的积极响应,培训后专业技术人员考核成绩明显高于培训前的成绩,统计学分析四方面考核结果均有显著性差异(P0.01)。同时还有诸多原因和阻力造成满足不了被培训者的需求。结论针对被调查者现状及人口与计划生育技术服务工作需求,建议有关部门加大资金支持力度,并出台相关政策,有计划选派专业技术人员参加各类培训班;培训单位结合人口与计划生育技术人员自身素质及成人继续教育的特点,运用多形式、多渠道、人性化的培训方式,切实满足人口与计划生育工作技术人员对提高知识和技能水平的需求,从而从根本上改变计划生育专业技术人员的整体水平。     

长沙市社区卫生服务技术人员的培训现状与需求研究

目的了解长沙市社区卫生服务技术人员的培训现状和需求情况,为下阶段培训方案的制定提供参考。方法随机抽取长沙市17个社区卫生服务中心的316名技术人员,采用自填式问卷调查该人群接受培训的情况及对培训的需求。结果 48.1%的技术人员曾接受过社区卫生培训;不同培训类型的人员在培训模式、教学方式及对教学效果的评价间差异均有统计学意义(P<0.05)。57.6%的技术人员对接受社区卫生培训有较高意愿;不同岗位类型人员的培训意愿、培训时间需求间差异有统计学意义(P<0.05);既往是否培训和所在工作岗位是影响培训需求的因素(P<0.05)。结论社区卫生服务技术人员有较高的培训需求,培训工作有待调整和加强,应根据需求情况有针对性地制定培训方案。     

社区卫生技术人员继续教育现状与需求调查

本研究旨在通过问卷调查了解我区社区专业技术人员的学历层次,专业知识技能掌握情况,以及医务人员迫切需要接受继续教育和技能培训的内容和方式,分析我区以前在社区卫生技术人员医学继续教育和技能培训工作中存在的不足.对过去不适合人才培养的方法进行干预调整,建立起一整套培训机制,使我区的社区卫生专业技术人员都能够接受继续教育和培训的机会.我们于2009年2月份,对全区的"社区"卫生技术人员进行了抽样调查,结果如下.     

广东省全科医学教育培训中心

广东省全科医学教育培训中心是由广东省卫生厅批准成立的岗位培训机构。该中心设在广州医学院,由广州医学院院长陈敏生教授兼任中心主任。根据广东省卫生厅文件粤卫[2004]193号的要求,我省全科医学教育培训工作实行全行业管理,全省实行“五个统一”（统一培训大纲、统一培训计划、统一教材、统一考试、统一发证）和对社区卫生服务机构各类管理人员、专业技术人员实行“先培训、后上岗”制度。广东省全科医学教育培训中心承担全省全科医学教育培训的具体事务。《广东省全科医学教育培训管理暂行办法》（粤卫[2004]193号）规定：全科医学教育培训对象是从事或即将从事社区卫生服务工作的执业医师;社区卫生服务机构从事社区护理工作的执业护士;从事全科医学教育管理和社区卫生服务管理人员。全省全科医学教育培训的计划安排是：2004年底前基本建立和完善全省全科医学教育培训体系;完成试点地区社区卫生服务机构各类在职管理人员、执业医师、注册护士等有关专业技术人员全科医学岗位培训考核发证工作;2006年底前基本完成全省社区卫生服务机构各类在职管理人员、执业医师、注册护士等有关专业技术人员的全科医学岗位培训工作;AL2008年起对我省社区卫生服务机构工作执业医师实施“全科医师规范化培训”制度,高等医学院校非全科医学专业（或方向）毕业生拟从事社区卫生服务工作的医师均须参加全科医师规范化培训,培训合格后方可上岗。全科医学教育培训方式与教学形式是：培训主要采取脱产、半脱产和继续教育三种培训方式。采用理论授课、示教、案例讨论、教学研讨、社区调查与实践、科研等教学形式。     

北京市口腔医疗质量控制和改进中心工作方式和效果初探

北京市口腔医疗质量控制和改进中心成立以来,开展了对全市有口腔科业务的医疗机构进行设备设施配置、人员结构、开展医疗项目等方面情况调查,以此确定工作重点,制定质量控制和改进文件,并且有针对性地分阶段开展集中和分散方式的专业技术人员和管理人员培训,专家深入医疗机构做现场评估和指导,探索更加有效的工作方式。     

医学实验技术人员应加强能力培养

本医学实验技术人员的工作性质和工作职责,提出医学实验技术人员应具备的１０种能力,并从４方面阐述了医学实验技术人员在提高思想认为、强化岚位培训和优化知识结构的基础上,更应学以致主用,在实际工作中全方位加强能力培养,加强综合素质的锻炼,方能适应二十一世纪社会医学模式下的医学实验技术工作。     

浙江省计划生育技术人员专业知识技能现况调查及培训思考

目的　了解卫生和计划生育工作合并后现阶段浙江省计划生育技术队伍的专业知识结构,更好地掌握培训需求,为提升相关培训的针对性和实效性提供参考依据。方法　本研究采用多阶段分层整群抽样方法,在2016年4至6月,对浙江省杭州、嘉兴、台州、温州四个市不同级别计划生育服务机构的计划生育技术人员,进行匿名自填式问卷调查,回收有效问卷365份。所用问卷经文献回顾结合实际情况编制设计完成,调查内容包括一般情况、培训情况、专业技能结构情况。通过Epidata 3.0录入数据,选用SPSS 20.0分析数据;采用t检验和单因素方差分析,探讨专业技术掌握情况与被调查者人口学特征之间的关系。结果　不同地区计生技术人员的学历、专业、职称结构参差不齐;现阶段计生技术人员的培训意愿比较强烈,97.53%（356/365）的人希望通过培训获得专业知识。298人对专业技能知识掌握情况调查项作答,总体结果不尽理想,掌握盆底康复训练者3.66%（9/246）、遗传咨询者7.42%（19/256）、产前筛查者4.9%（12/245）、乳腺常见病筛查防治者5.26%（13/247）、不孕症诊治者6.22%（15/241）;不同级别的计生服务站,不同学历、专业、岗位类型及职称的人员,对整体业务知识掌握程度的差异有统计学意义（P=0.000）。结论　目前计生技术人员知识结构和技能状态不能契合新时期生殖健康服务需求,需加快完善培训设计,进行分类分层次培训。     

广东省全科医学教育培训中心

广东省全科医学教育培训中心是由广东省卫生厅批准成立的岗位培训机构。该中心设在广州医学院,由广州医学院院长陈敏生教授兼任中心主任。根据广东省卫生厅文件粤卫[2004]193号的要求,我省全科医学教育培训工作实行全行业管理,全省实行“五个统一”(统一培训大纲、统一培训计划、统一教材、统一考试、统一发证)和对社区卫生服务机构各类管理人员、专业技术人员实行“先培训、后上岗”制度。广东省全科医学教育培训中心承担全省全科医学教育培训的具体事务。《广东省全科医学教育培训管理暂行办法》(粤卫[2004]193号)规定：全科医学教育培训对象是从事或即将从事社区卫生服务工作的执业医师；社区卫生服务机构从事社区护理工作的执业护士；从事全科医学教育管理和社区卫生服务管理人员。全省全科医学教育培训的计划安排是：2004年底前基本建立和完善全省全科医学教育培训体系；完成试点地区社区卫生服务机构各类在职管理人员、执业医师、注册护士等有关专业技术人员全科医学岗位培训考核发证工作；2006年底前基本完成全省社区卫生服务机构各类在职管理人员、执业医师、注册护士等有关专业技术人员的全科医学岗位培训工作；从2008年起对我省社区卫生服务机构工作执业医师实施“全科医师规范化培训”制度,高等医学院校非全科医学专业(或方向)毕业生拟从事社区卫生服务工作的医师均须参加全科医师规范化培训,培训合格后方可上岗。全科医学教育培训方式与教学形式是：培训主要采取脱产、半脱产和继续教育三种培训方式。采用理论授课、示教、案例讨论、教学研讨、社区调查与实践、科研等教学形式。考证程序：学员参加省全科医学教育培训中心主办的培训班,经分科结业考试合格发给培训结业证后,参加全省医学岗位培训统考(理论综合与技能综合)合格,获得《广东省全科医学岗位培训证书》。     

地方直招护理士官培训质量的评价模式

本文分析了地方直招护理士官培训特点,研究有效的培训评价方式、方法,以确保培训质量。以三期地方直招护理士官培训为模型,分别就学员学习、教员教学和培训机构工作质量评价的内容、方式和方法进行研究。学员学习评价采用理论知识综合笔试、技能操作考试和态度问卷测评方式进行。教员教学质量评价包括专家听课、学员问卷和教员自评。培训工作质量评价采用问卷方式进行。学员学习质量评价应当侧重知识、技能的综合与应用;教员教学质量评价应当侧重教员对军事医学领域新知识、新技术掌握情况的评价,并加大学员评价的权重;培训工作质量评价重在培训工作设计和培训计划落实效果方面,强调学员、专家、培训管理人员的综合评价。实践证明,这种评价模式是有效的,能够全面反映培训的质量     

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.