影响体液失调章节教学质量因素剖析

目的 探讨影响体液失调章节教学质量的因素，以便改进教学方法，提高教学效果。方法 应用与不同层次学生座谈，系统复习、比较各科教材内容，分析学生试卷等方法，以了解此章节教与学的难点。结果 学生反映学习难点是内容难记、溶液标度难换算、补液公式难理解；前、后期教材编写中均存在某些不足之处；学生考试成绩不够理想，基本知识、基础理论掌握不牢。结论 应修订教材中某些不足之处；前、后期教学要相互兼顾、加强交流；溶液组成标度换算及补液公式是学习难点，应讲深、讲透；对实习医师、硕士研究生、住院医师可进行融汇前后期知识的专题讲座，强调如何将所学知识用于临床实际。     

加强临床教学管理提高教学质量

临床实习是医学院校学生走向临床工作不可逾越的阶段，是理论和实践相结合的必然环节，其重要性和必要性不言而喻。这一阶段的主要任务是促进实习生将理论知识应用于临床实践，培养分析问题、解决问题的能力。实习教学质量对学生毕业后能否成为有知识、有能力、重实践的高素质医学人才起着积极的作用。如何做好临床实习带教工作、提高教学质量是医院教学管理的一项重要内容。随着医疗体制改革，对临床教学工作提出了更高、更新的要求，这迫切地需要我们针对目前的医疗新形势，不断完善我们的临床教学管理制度、更新我们的教学方法。     

新生儿疾病命名和分类规范化管理的建议

疾病命名和疾病分类不仅与临床诊疗活动有关,还涉及医疗信息管理与交流、医疗费用支付、医疗保险赔付等领域。为规范临床医师的诊疗活动、病案记录和病案首页填报,本建议依据国际疾病命名法 （IND）和国际疾病分类 （ICD）,阐述了普通的疾病命名、疾病分类的基本原则和方法;并针对临床实际问题,提出了新生儿这一类特殊人群的分类和新生儿疾病诊断的基本程序、书写规则和死亡诊断原则。     

儿科临床护理教学的体会

临床毕业实习是实现理论知识向实际工作能力转化必不可少的过程，是护理教学的重要阶段，是培养护生临床思维、职业道德品质和综合能力的关键环节。儿科护士的专业角色与其他专业有所不同，儿科护士要提供“以家庭为中心”的服务，并对每一年龄段的患儿施以发展性的照顾，通过临床教学实习，培养具有较强专业操作技能的应用型高级护理人才是未来护理的需要，因此，我院采取了相应的教学计划，对儿科的临床教学进行了一些探索，现报告如下。     

英文版案例分析系列教材《儿科学》出版

为了配合全国医学院校开展双语教学的需要和以问题为中心的教学发展趋势，英文版案例分析系列教材《儿科学》已于2007年7月由人民卫生出版社和美国麦格劳-希尔（亚洲）出版公司合作出版发行。该教材的英文原版是由美国麦格劳．希尔公司推出的《Case File Pediatrics》，中文简体版由复旦大学上海医学院王卫平教授和上海交通大学医学院朱建幸教授共同担任中文编者，是全国高等学校临床医学专业卫生部规划教材。全书739千字，共分3个部分：如何解决临床问题、临床案例和案例列表。本书通过60个实际案例，对相关的临床或基础知识进行回顾和复习，涉及儿科学的各个方面，内容宽广。每个案例均包括讨论、重点概念、关键术语解释和临床提示，文后还有简短的自测题，编排上基本保留了英文原著的风貌，并根据我国国内医学教学情况对重要知识点和词汇进行了点评和加注，书后附有案例列表便于查询。本教材适用于全国医学院校开展双语教学和PBL教学，有助于医学生将医学基础知识和临床实践相结合，培养学生主动思考和自我学习的能力。     

Mini-CEX量表在北京市某三级甲等医院新护士入职评估中的应用

目的探讨Mini-CEX量表在新入职护士评估中的应用价值。方法选取2015年8月北京市某三级甲等医院新入职的护士共60名,通过Mini-CEX量表对新入职护士进行测评。结果经Mini-CEX测评反馈后,新护士了解到自身不足并在工作中加强练习,各项能力明显提高。初次和末次各项能力评分值比较,Mini-CEX量表中的护理面谈技巧、身体评估、人道关怀/专业素养、咨询建议沟通能力、总体临床能力各维度得分均有不同程度提高,差异有统计学意义(P0.05)。结论 MiniCEX量表是一种方便易行、成效显著的教学方法,有利于提高新护士的综合素质。     

护理学基础中小儿头皮静脉注射法在中专起点的高职教育教学中的改革与实践

为寻求适合中专起点的高职护理教育发展的道路,基础护理教研室对护理学基础中小儿头皮静脉注射法的教学方法进行了改革。改变传统的“教师先讲解示范,学生后练习操作”教学方法为“学生先动手操作,教师后解释示范”,因材施教、查漏补缺,避免重复教育,调动了学生学习的积极性,发挥了学习者主体作用,培养了学生的分析问题、解决问题的能力和创新能力。通过对2001级到2005级五届共500名学生的小儿头皮静脉注射技能考试成绩分析。结果表明:这次教学改革增强了学生独立思考问题的能力,提高了学生动手操作能力。同时本次教学改革符合高等职业教育的办学特点,是行之有效的改革方案。     

咳嗽、发热、音哑、呼吸困难

教学查房是我刊推出的一个新栏目，旨在利用刊物提高青年医生及基层医生的临床思维。一个病尤其是疑难或少见病．怎样正确地一步步思考．使诊断由模糊到清晰，由疑诊到确诊，尽快合理地治疗是医生的重要职责。查房既为患儿解决了问题、总结了经验教训．又锻炼了医生的临床工作能力、提高了医疗水平。欢迎教学医院的临床教师、一线医生都来关心和支持本栏目，使栏目逐渐成熟，受到同道欢迎。     

中国临床案例成果数据库CSCD

《中国临床案例成果数据库》(简称CMCR)是由中国科协资助、中华医学会杂志社承建的大型临床案例成果的发布平台。CMCR致力于推进基于病案成果的基层医疗工作者学术成果评价能力建设。所有经同行评议后收录CMCR数据库的病例报告,将获得正式收录证书。     

高职英护专业组织胚胎学双语课案例教学法探索

在组织胚胎学英-汉双语课教学中辅之以案例教学可以增加学生的学习兴趣和主动参与意识,使学生认识到组织胚胎学与临床医疗护理实践的密切关系,也为学生创造了听、说、读、写、译专业英语的教学环境。本文概述了组织胚胎学双语课案例教学的条件、步骤及意义。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.