从执业医师资格考试探讨医学生临床实践教学改革

目的 通过调查2011年重庆市某考试基地国家医师资格考试西医临床医学类考生实践技能考试结果,探讨在不同级别医院工作的临床医生的实践技能状况,为改进医学生临床实践教学提供依据.方法 收集2011年重庆市某考试基地国家医师资格考试考生的实践技能考试资料,从考生所属单位及其级别、考试成绩等方面对考试结果进行统计学分析.结果 2011年,重庆市某考试基地参加国家医师资格考试西医临床医学类的考生共1 906人,其中,执业医师考生1 047人,执业助理医师考生859人;执业医师考生实践技能考试通过率为83.5％,执业助理医师考生实践技能考试通过率为64.7％,实践技能考试结果的构成有较大的不均衡性,主要表现在3站考试成绩分布不均,考生类别、所在单位分布存在差别;执业助理医师考生总体通过率较低.结论 国家执业医师资格考试实践技能考试统计结果显示,考生的临床基本技能有待于进一步提高,建议加强医学教育临床实践技能教学环节和毕业后教育,切实提高医学生的实践能力.     

从近10年我院的医师资格考试结果探讨临床教学工作改革

文章通过对我院10年来医师资格考试情况分析,研究其对临床医学教育的影响,思考临床医学教学改革,阐释了临床教学改革以执业医师资格考试为导向的重要性和必然性,并提出了以执业医师考试为导向的临床教学改革的几点措施,以期为新形势下临床教学改革起到积极作用。     

以执业医师资格考试为导向的临床医学本科教学改革初探

临床医学本科专业教学活动如何应对执业医师资格考试通过率逐年下降的挑战,是当前各医学院校面临的重要改革课题。本文通过透视我国执业医师资格考试的现状和临床医学本科专业教学面临的问题,阐释了临床医学本科教学改革以执业医师资格考试为导向的重要性和必然性,并提出了以执业医师考试为导向的临床医学本科教学改革的措施,以期为新形势下临床医学本科教学改革起到指导作用。     

器官系统课程在三年制临床医学专业教学中的效果评价

三年制临床医学专业学生毕业工作一年后参加国家临床执业助理医生考试,考核通过后具有执业资格。医师资格考试标志着医师资格的“准入”制度,其通过率将是检验和衡量各医学院校教学质量的重要标准[1]。这就决定了专科层次临床医学专业的教学改革必然是以执业医师资格考试为导向[2]。因此本校从2012年围绕医师资格考试大纲,开始在临床医学专业实施以器官系统为中心的课程体系,通过对2012级临床医学专业教改班与平行班模拟执业助理医师考试成绩比较,器官系统课程显示出了较为明显的优势,现将结果报道如下。     

以执业(助理)医师考试为导向的病理学翻转课堂教学探讨

《执业医师法》的施行和确立,对促进医学院校不断改进教学方法,提高教学质量起到了积极的作用,同时也对我国医学教育水平提出新的要求[1].执业(助理)医师资格考试中,其医学综合笔试是对考生基本理论知识、技能、临床综合能力和思辨能力及实际工作能力的综合测评[2].《病理学》是高职高专临床医学专业的核心课程,既属于执业(助理)医师资格考试的考核内容,也是学生接触疾病学习的第一门学科,在基础医学和临床医学之间起着重要的桥梁作用,具有特殊的学科特色和重要的学科地位.为了使临床医学专业的学生毕业后能够更顺利通过执业(助理)医师考试,培养方式就必须紧密结合国家执业(助理)医师考试[3].     

改革教学模式提高实习生临床技能操作水平

执业医师考试是所有临床医学生从医的必经之路。执业医师考试分两个阶段进行,其中之一就是医师资格实践技能考试,为了提高考试通过率,从医学院校教学,到临床实习,以及毕业后见习培训等各个环节都得到空前重视。本人在多年本科实习教学管理工作中,对本科实习生临床技能培训工作进行改进,探索新的教学模式,以适应新形势变化。     

以执业医师技能考试为导向的临床医学本科专业《诊断学》教学改革

诊断学是基础与临床医学之间的桥梁课程,是阐述疾病基本理论、基本技能和临床思维的学科,是诊断和解释疾病规律最基本的理论和方法,是临床执业医师实践技能考试的重点内容.如何使学生掌握该课程的基本理论和技能,且能顺利通过临床执业医师技能考试,方便他们在城乡基层就业,这是诊断学教师要经常思考的问题.     

实习生试行执业医师模拟考试的初步实践

在临床专业的实习生中开展执业医师模拟考试对于提高毕业生的执业医师考试通过率具有重要意义。通过三年来对国内及军内若干所三级甲等医院的执业医师考试通过率的跟踪考察与现场调研,结合我院在历年的执业医师考试过程中总结的实践经验,我院在临床五年制及七年制学员中试行了执业医师模拟考试的制度,取得了一些初步成果。     

浅谈临床执业医师综合笔试之复习经验

执业医师资格考试是行业准入考试,是评价申请医师资格者是否具备从事医师工作所必需的专业知识和技能的考试。执业医师资格考试分实践技能考试和医学综合笔试2部分。考试分为2级4类,即执业医师和执业助理医师2级,每级分为临床、中医、口腔、公共卫生4类。笔者现就临床执业医师综合笔试谈谈考试前的复习经验。     

2006年某省公共卫生执业医师资格考试结果分析

目的了解2006年某省公共卫生执业医师资格考试的考生构成及考试结果,探讨目前该省公共卫生人才队伍状况,为改进医师资格考试和医学教育提供科学依据。方法收集2006年某省公共卫生执业医师资格考试考生的资料,从总量、类别、学历、所属单位和所属级别、成绩等几个方面对符合考试资格的考生进行统计学分析。结果参加考试的考生共470人,实践技能考试通过率为63.62%,医学综合笔试通过率为39.13%,总通过率为24.89%。2006年某省公共卫生执业医师资格考试考生构成有较大的不均衡性,主要表现在学历构成,考生所在单位分布;学历水平是影响考试成绩的最主要因素;总体通过率较低。结论统计结果显示某省公共卫生执业医师考生学历总体过低,主要以大中专学历为主,基层公共卫生人才的数量和素质有待提高,中国医师考试制度及医学教育需进一步完善;该省公共卫生医师后备人才存在学历结构缺陷及其分布的差异,建议要把住公共卫生执业医师的入门教育关,为公共卫生执业医师整体素质的提高创造条件。     

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.