中西医三环治疗IgA肾病蛋白尿的临床研究

目的：观察中西医三环治疗IgA肾病（IgAN）蛋白尿的临床疗效及其对肾功能的影响。方法：234例患者按病理Lee氏分级进行分组,Lee氏分级〈Ⅲ级为A组,随机分为治疗组（A1组32例）和对照组（A2组35例）;Lee氏分级〉Ⅲ级为B组,随机分为治疗组（B1组102例）和对照组（B2组65例）。A1组使用中医药三环＋中医新辨证方案,A2组使用ACEI/ARB＋中医原辨证方案;B1组使用中西医结合三环（中医药三环＋中医新辨证方案＋ACEI/ARB＋免疫抑制剂）,B2组使用激素＋中医原辨证方案。观察项目包括24h尿蛋白、肾功能、血白蛋白（Alb）、肝功能、血常规、尿常规及不良反应。观察时间6～8个月。结果：A1组蛋白尿、血肌酐（Scr）及血红蛋白（Alb）的改善好于A2组,A1组的总缓解率（完全缓解率＋基本缓解率）为75%,高于A2组的48.6%（P〈0.05）;B1组降蛋白尿的速度及幅度均强于B2组,B1组的总缓解率为80.4%,高于B2组的64.6%,两组比较（P〈0.05）。且B组在治疗前肾功能已下降（Scr〉133μmol/L）18例患者,其肾功能改善的程度B1组（12例）好于B2组（6例）。结论：中西医三环治疗能有效减少IgAN患者的蛋白尿,稳定并改善肾功能。     

血管外科结构化电子病历设计及应用前景研讨

基于国内外文献检索及既往病历书写、临床科研经验确定数据结构化节点,通过设计病历书写选择框、逻辑引用、信息系统互联影像、检验系统等方法建立结构化病历模板并在实际临床工作中应用评估,以此设计涵盖多种血管外科疾病的智能化、结构化病历系统,规范临床医师病历书写,提升病历质量,为后期临床科研提供结构化数据支持,并为血管外科专病数...     

Coalition for medical education—A call to action: A proposition to adapt clinical medical education to meet the needs of students and other healthcare learners during COVID-19

With the ongoing coronavirus, journals and the media have extensively covered the impacts on doctors, nurses, physician assistants, and other healthcare workers. However, one group that has rarely been mentioned despite being significantly impacted is medical students and medical education overall. This piece, prepared by both a medical student and a cardiothoracic surgeon with a long career in academic medicine, discusses the recent history of medical education and how it has led to issues now with distance-based learning due to COVID-19. It concludes with a call to action for the medical education system to adapt so it can meet the needs of healthcare learners during COVID-19 and even beyond.     

Response to COVID-19 pandemic: Beyond medical education in Brazil

We received a response to our Editorial from a group in Brazil that raised valuable concerns about the struggles in transforming medical education in low-income countries. Here, we address the concerns they raised that reinforce the global need for a "Coalition for Medical Education."     

实习医学生沟通技能评估及相关因素分析

目的 了解实习医学生沟通技能现状并探索其相关因素.方法 采用自行设计的一般资料问卷及沟通行为自我评价量表对260名医学生进行问卷调查.结果 医学生在与患者的沟通、对特定疾病或具体健康问题指导、与医务人员的沟通三方面的得分分别为3.26±0.55、3.00±0.69、3.43±0.64.医学生对受虐待/暴力及艾滋病患者的...     

The development of neurosurgical techniques: The postoperative notes and sketches of Dr. Harvey Cushing

Summary In the early development of American neurosurgical techniques, Harvey Cushing is often considered the founding father. As an accomplished artist and prolific writer his original operative sketches and detailed notes at the Peter Bent Brigham Hospital (1912–1932) are now being explored as early documentation of this pioneering surgeon's development of a field. We present four brain tumor cases with his unpublished sketches and direct quotations to illustrate both the trials and tribulations of those times and Cushing's innate surgical genius.     

The Development of Undergraduate curricula in surgery: II. Generic Surgery

The present paper focuses upon the issues in curricular reform that have specific relevance for surgeons. A central theme is that, taking into account the dual diminution of general surgery and large central teaching hospitals, there is a need to have a clear vision of what should be included in surgical curricula and how we can adjust to new methods of teaching and learning.     

The development of undergraduate curricula in surgery: I. General issues

Undergraduate surgical education is evolving in line with societal changes, the growth of information technology, developments in educational processes, and shifts in the health-care industry. The underlying principles include the establishment of a strong linkage between the objectives and content of curricula, the identification of core knowledge and appropriate attitudes, achieving competence in basic skills, the creation of greater integration, and the promotion of study in depth. The aim of the present paper was to provide surgeons with an overview of these developments.     

The continued decline of formal urological education of medical students in the United States: does it matter?

PURPOSE: Survey analyses of 50 years document a substantial decline in the formal urological education of United States medical students, resulting in repeated calls by urologists to reverse this trend. Has this trend continued during the last decade? If so, should we be concerned? We performed a national survey to provide an updated assessment of urological education at United States medical schools. MATERIALS AND METHODS: All 321 applicants to the 2003 to 2004 United States urology residency match and 527 applicants to a Boston area emergency medicine residency program in 2003 to 2004 from accredited United States medical schools were invited to participate in the study. On a validated, anonymous online survey, these students were asked 1) did their school offer a required and/or elective clinical rotation in urology, and 2) if so, what was its duration and in which year was it usually completed. RESULTS: Curricular data were obtained on 110 of 125 (88%) accredited United States medical schools. Of United States schools 17% (17.3%, SE 1.2%, 19 of 110) have required clinical rotations in urology; these required rotations are 1 to 2 weeks in duration and, in 79% of cases, conducted in year 3 of medical school. Those medical schools that require a clinical rotation in urology do not have a greater percentage of their students entering the urology match (Mann-Whitney U test p = 0.540). CONCLUSIONS: Formal urological education of United States medical students has continued to erode during the last decade, but the impact of this trend on student learning and career choice is not clear. Further research is required to determine whether these changes are of concern for the quality of applicants to urological training and for the future of urological care in the United States.     

不同医务人员对医疗设备应用知识需求程度分析

目的分析不同医务人员对医疗设备应用知识需求程度。方法选取2011年10月～2013年5月本院的75名医务人员为研究对象,采用问卷调查对所有医务人员进行医疗设备应用知识需求程度评估,然后将其中不同岗位、职称、工作年限及文化程度者的评估结果进行比较。结果护理人员、职称较低、工作年限较短及文化程度较低的医务人员对于医疗设备应用知识需求程度明显高于其他医务人员,差异有统计学意义（P〈0．05）。结论不同医务人员对医疗设备应用知识需求程度存在明显的差异,故在干预的过程中应注意对不同岗位、职称、工作年限及文化程度者的需求进行针对性干预。     

Medical student attitudes toward kidney physiology and nephrology: a qualitative study

Interest in nephrology among trainees is waning in the USA. Early perceptions and attitudes to subject matter can be linked to the quality of pre-clinical curricula. We wanted to explore these attitudes in the setting of modern curriculum redesign. We utilized Q methodology to understand first-year medical student attitudes after an innovative kidney physiology curriculum redesign that focuses on blending multiple learning methods. First-year medical students were invited to take a Q sort survey at the conclusion of a kidney physiology course. Students prioritized statements related to their understanding of kidney physiology, learning preferences, preferred course characteristics, perceived clinical relevance of kidney physiology, and interest in nephrology as a career. Factor analysis was performed to identify different student viewpoints. At the conclusion of our modified course, all students (n?=?108) were invited to take the survey and 44 (41%) Q sorts were returned. Two dominant viewpoints were defined according to interest in nephrology. The Potentials are students who understand kidney physiology, perceive kidney physiology as clinically relevant, attend class sessions, utilize videos, and are willing to shadow a nephrologist. The Uninterested are students who are less satisfied with their kidney physiology knowledge, prefer to study alone with a textbook, avoid lectures, and are not interested in learning about nephrology. In an updated renal physiology course, students that use multiple learning methods also have favorable attitudes toward learning kidney physiology. Thus, modern curriculum changes that accommodate a variety of learning styles may promote positive attitudes toward nephrology.     

临床医学专业开设《实用护理技术》课教学效果分析

目的 探讨医学生学习《实用护理技术》(简称《护技》)课的必要性。方法 将本校96、97级专科医学生分为两组,对照组不开设《护技》课;实验组第4学期开设《护技》课,每周2个学时,15周授完全部课程。然后对实验组学生学习《护技》课前后护理操作技术掌握情况、两组学生实习期间及毕业后工作的综合能力、两组学生就业情况进行跟踪调查。结果 实验组学生学习《护技》课前后护理操作技术掌握程度差异有显著性意义(P相似文献   

医改形势下病人需求情况的调查分析

目的：探讨医改形势下病人的医疗,服务需求情况。方法：采用分层抽样方法对240例病人需求情况进行问卷调查,内容包括病人一般资料。病人选择就医的依据,对“病人选医生”的看法以及服务需求,结果：病人选择就医的依据权重依次为医疗水平,服务态度,收费,就医环境,就医耗时,所有病人对“病人选医生”这项举措表示赞同;79．66％的病人认为应开设全日门诊,收费透明度要求高,门诊病人选择通过电脑自查费用为主,住院病人则要求每日提供一日清单;52．08％的病人对实行医疗保险制度的具体内容不清楚,“优质优价”的服务方式仅被16．25％的病人接受,结论：疗效高,服务好,费用低是病人对医院的永恒要求。     

Creating an Academy of Medical Educators: How and Where to Start

Background

While most faculty members want to improve as teachers, they neither know where their educational strengths and weaknesses lie nor where or how to begin to effect a change in their teaching abilities. The lack of actionable, directed and specific feedback, and sensible and sensitive metrics to assess performance and improvement complicates the attainment of educational excellence.

Purpose

The purpose of this article was to outline a series of specific steps that medical education programs can take to enhance the quality of teaching, promote teaching excellence, elevate the status and value of medical educators, and stimulate the creation of innovative teaching programs and curricula.

Methods

To achieve these goals at the Hospital for Special Surgery, the Academy of Rheumatology Medical Educators was formed. The academy had the following goals: (1) create within our institution a mission which advances and supports educators, (2) establish a membership composed of distinguished educators, (3) create a formal organizational structure with designated leadership, (4) dedicate resources that fund mission-related initiatives and research, and (5) establish a plan for promoting teachers as well as enhancing and advancing educational scholarship.

Results

The Hospital for Special Surgery Academy of Rheumatology Medical Educators was recently formed to address these goals by promoting teaching and learning of musculoskeletal skills in an environment that is supportive to educators and trainees and provides much needed resources for teachers.

Summary

The development of a pilot academy of medical educators represents one of the high-priority goals of those institutions that wish to elevate and enrich their teaching through a structured, proven approach.     

The development of undergraduate curricula in surgery: III. Assessment

The present review is aimed at providing an overview of the assessment process. The mode of assessment has a powerful influence on the learning behaviour of students. It is therefore important to ensure that there is congruity between the objective, the task and the test. In other words: define it, teach it, examine it. It is difficult to evaluate many of the attributes that we desire in a doctor; and examples of this include empathy, ethical behaviour, problem-solving skills, ability to self-educate and teamwork. Nevertheless, it is generally agreed that it is better to measure uncertainly the significant than to measure reliably and validly the trivial. Furthermore different methods of assessment suit different educational objectives (fitness for purpose) and this supports the use of multiple assessment techniques.