在县级医院中本科实习生实行导师制管理的思考及实践

本科生导师制是目前高等教育教学改革中正在积极探索的一种人才培养新模式,对于提高学生的专业素养和综合素质都起到了积极的作用.我院依托川北医学院丰富的教学资源优势,设计了对川北医学院临床医学系2007级实习学生实行导师制管理模式,医院首先制定了导师的任职要求,建立完善了师资队伍;制定了导师、实习生的工作职责;建立和完善了实习生导师制管理实施办法;建立了实习生导师工作考核办法,通过严格考评,培养学生在德、智、体、美、劳等方面得到全面、健康的发展.通过具体的实施过程和经验表明,把导师制落到实处,将对医学人才的培养产生积极的影响.     

本科实习生导师制模式的实践与探讨

实习是学生理论联系实际的重要阶段，在进行实践过程中，一对一的指导是非常必要的。我院自2003年开始实施本科实习生导师制，对学生的学习、工作、生活、就业、环境适应等问题给予帮助，对专业知识、学习方法、人生观、考研、论文写作等方面给予全面指导。通过导师制，学生的临床操作、病种完成率及病历书写规范率均明显高于往年（P〈0．05）。学生在导师身上不但可以学到诊治疾病的基本技能、临床思维能力，还可学习与病人的沟通技巧。导师制的实施，对实习生的发展更有益处，而且对整个教育教学改革具有重大意义。     

临床医学院本科生导师制现状调查分析

目的 分析在医学院校中实行本科生导师制的优势和存在的问题.方法 采用问卷调查方式对第二军医大学附属长征医院临床医学院实行本科生导师制的临床医学专业本科生进行调查,并对调查结果进行统计分析.结果 85.7%的被调查者认为本科生导师制对其自身的学业和未来的发展有所帮助.结论 在医学院校临床医学院中,本科生导师制的实行具有优势,本科生导师小组制是一种较好的选择,而且以在临床实习阶段开始实行较好.     

在临床教学中实行导师制的探索

临床实习作为高等医学教育的重要环节 ,其质量、效果一直倍受有关各方的关注。为提高临床实习的质量和水平 ,浙江大学医学院在临床医学专业本科生实习中推行导师制 :导师由具有主治医师以上职称、带教效果好的教师担任 ;其职责是熟悉和了解实习生的基本情况 ,关心实习生的学业、生活、身心健康 ,结合自身经历在学习方法、工作经验、就业、考研等问题上给予实习生全面指导 ,定期检查实习生的实习大纲完成情况 ,定期组织实习生的读书报告会 ,并在实习轮转结束时对自己所带的实习生作出考评。     

浅谈实习生导师制现状与改进措施

实习生导师制的实施。既有助于培养实习生的综合素质与能力,又可有效防止实习教学中可能引发的医患纠纷,同时还有助于培养中青年师资队伍。因此,应转变教育观念,建立和完善导师选拔制度,强化实习生入科教育,使实习生导师制发挥更大作用,从而提高临床实习教学质量。     

浅谈影像专业实习生临床实践能力的培养

带着临床实际问题、为解决问题来复习理论知识,初步完成理论教学与一临床实践培养的衔接;根据医学影像专业特点,采用“导师制”管理实习带教模式,通过训练思维能力、培养操作诊断技能、引导科研能力,并进行严格的考察和综合考评来培养并提高影像专业实习生临床实践能力,为成为合格的放射影像医生打下坚实基础。     

本科生导师制在医学生普外科临床实习中的应用

结合实践,围绕临床医学本科实习生导师的选取方法,以及本科生导师制在医学生普外科临床实习中应用后取得的成绩,总结本科生导师制在医学生普外科临床实习中的应用体会。     

如何做好五年制临床医学本科实习生导师的体会

结合实践,就如何做好五年制临床医学本科实习生导师,围绕学校和教学医院的支持以及导师自身心态、工作流程,介绍了本科生导师制的作用及其做法。     

五年制临床医学专业学生临床实践教学导师制满意度调查

目的 了解五年制临床医学专业学生对临床实践教学导师制的满意度,为将导师制落到实处提供参考.方法 自制调查问卷对中山大学附属第一医院2005级临床医学专业五年制本科实习生113人进行调查,并对调查结果进行分析.结果 85.8％的实习生对临床实践教学表示满意.92.9％的实习生认为临床实践教学实行导师制很有必要;86.7...     

影像专业实习生带教体会

医学影像学是一门形象思维学科,是医学领域中知识更新最快的学科之一,其实践性较强。如何提高影像专业实习生的教学质量,为临床培养医学影像专业人才是影像专业教育面临的重要问题。搞好医学影像专业实习教学是培养医学影像专业人才的重要环节。本文总结近年来我科医学影像专业放射诊断学实习教学与管理的经验。1加强组织领导与管理1.1指派专人负责管理影像专业实习生:该负责人必须具有讲师职称以上,且需要有丰富的临床教学经验、有扎实的放射诊断学基本理论知识、有强烈的责任心等。其职责就是负责与管理影像专业实习指导、学生的思想动态…     

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.