建构主义视角下的早期接触临床教学设计与实践

目的运用建构主义理论,探索八年制医学生合理的“早期接触临床”的教学内容与教学形式。方法“早期接触临床”活动分为两个阶段：第一阶段按照北京大学医学部课程内容安排,为学生提供多种临床场景和医疗工作。第二阶段依据第一阶段后的学生自我设想,教师设定备选教学内容,由学生进行自由选择,自己参与设计见习内容、完成相关知识准备及小组之间的分工合作。分别在2008级八年制临床医学专业63名学生两个阶段早期接触临床教学活动后,对其进行问卷调查,分析和比较学生对“早期接触临床”活动目的的认识,学习态度、学习能力和学习收获等方面的情况,评价“早期接触临床”教学活动的效果。结果学生对早期接触临床教学活动的目的更为明确,学习兴趣和积极性更高,与医护人员以及患者的沟通能力明显增强。学生小组合作式学习的主动性有了明显提高。此外,学生在第二阶段的早期接触临床教学活动中的收获也比以前明显增加,反映在对临床医学的感性认识和兴趣、临床医疗流程、医院管理等多个方面。绝大多数学生对医德医风和爱伤观念感受更深,对将来进入临床课程学习有了更充分的心理准备。结论将建构主义理论融于“早期接触临床”教学活动中,能够培养学生“自主学习”和“合作式学习”的能力,不仅有利于增加学生的感性认识和激发学生的学习兴趣,贯彻全程医学职业精神教育理念,同时也为今后临床医学课程体系的教学改革做好了准备。     

本科医学生对《临床医学导论》课程早期接触临床见习的效果评价

目前,我国医学教育主要采用分段教学模式,即基础课-临床课-实习,在一定程度上造成了实践与理论知识的脱节.学生在理论学习的过程中不接触临床,造成学生学习目的不明确、热情较低,对未来所从事的职业缺少感性认识和职业认同感[1].为了使学生增强感性认识、学会与病患交流、提升学习兴趣,以及解决和改善医学教育中理论与实践脱节的情况,我校《临床医学导论》课程专门增加了早期接触临床见习的内容.     

"早期接触临床"见习实践教学的思考

世界各国高等医学教育的课程改革趋势之一就是“早期接触临床”。“早期接触临床”可以改善医学教育理论和实践脱节的情况，实现理论联系实际，让医学生在实践中增加感性认识，增强责任感，训练与病人交流的能力，激发学习兴趣，培养学生主动获取临床技能。国内外医学院校都在积极研究和探索此项课题，组织低年级医学生不同形式和内容的“早期接触临床”，取得了一定成果。     

早期接触临床对医学生综合能力及职业认知提升效果评价

目的　探讨早期接触临床对提高医学生综合能力及强化职业认知的作用。方法　选择本校2014级儿科专业五年制学生，其中在大二结束的暑假开展早期接触临床教学活动的学生为实验组（７８名），未参加的学生为对照组（８１名）。在活动结束后，对参加教学活动的学生进行问卷调查。同时对该年级学生小儿外科学理论课成绩及临床实习表现进行统计分析。结果　超过90%的学生对早期接触临床教学活动满意，认为该活动有助于提高医学生的临床思维、强化职业认知、增强学习兴趣、提高沟通技能、促进基础与临床知识相结合。同时，后期追踪分析发现，早期接触临床活动可以提高学生理论课考试成绩，实验组学生临床工作熟练度、临床思维、动手能力及医患沟通能力均优于对照组。结论　在医学生中开展早期接触临床活动，能够提高学生的综合能力，有利于培养医学生的临床思维能力及医患沟通能力，强化职业认知，为医学教育培养高素质人才奠定良好基础。     

护理专业学生假期分散自主见习方式的尝试与成效

目的 探索大规模招生情况下护理专业学生临床见习的有效方法.方法 第一步,随机抽取南阳医学高等专科学校护理专业学生96名,在假期实施分散自主见习并对学生和带教教师进行问卷调查,分析该见习方式的可行性.第二步,在学校全体护理专业学生中推广应用,通过对学生及教师的问卷调查,分析该见习方式的效果.结果 问卷调查结果显示,98.0％的学生对分散自主见习持肯定态度,90.0％以上的学生认为增强了人际沟通能力、有利于对知识的学习、增强了自主学习能力;98.0％以上的学生和校内教师认为加深了对已经学习的理论知识的掌握、有利于熟悉医院环境及临床工作.结论 分散自主见习方式可行、有效.可以解决班级大、集中见习困难的问题,并达到了充分利用社会资源、学生早期接触护理岗位的目的.     

早期临床结合社区实践在口腔本科教学中的探索

【摘要】目前中国的医学教育模式存在的最大问题是基础与临床严重脱节。为了改变这一状况,重庆医科大学口腔医学院自2009年,通过社会实践志愿者活动引入早期临床教学模式。分别对2009级、2010级和2011-2015级施行“早期进入科室”、“早期进入科室 早期接触病人”和“早期进入科室 早期接触病人 社区医疗实践”的早期临床教学模式。通过对口腔医学系2009级-2015级本科参与学生（共525人）及带教老师（共120人）进行问卷调查,带教老师和学生的问卷应答率分别达到了96.7%和96.2%。调查结果显示：超过70%的带教教师认为2011-2015级学生较2009级、2010级学生在医患沟通、临床动手能力及团队合作意识方面的提高都更为明显。大部分教师和学生都认为“早期进入科室 早期接触病人 社区医疗实践”三种方式相结合的培养模式优于单纯的“早期进入科室”和“早期进入科室 早期接触病人”,特别是加强了学生的医患沟通、职业规划及团队合作能力,值得推广。     

口腔医学生早期接触临床教育模式的应用与体会

口腔医学生早期接触临床教育模式的构建和实施是当今口腔医学教育教改的核心内容之一.学校、医院密切配合,做好课程内容的设计和教学过程的组织协调工作.将"早临床、多临床、反复临床"的教育理念贯穿于口腔医学人才培养的全过程.实施口腔医学生早期接触临床教育模式,极大地促进了口腔医学生学习专业知识的热情和决心,提高了学习的兴趣;同时带教教师更加注重言传身教,努力提升自身业务水平.早期接触临床教育模式体现了基础课程和临床课程之间的双向渗透和重组,做到基础教学中有临床,临床阶段有基础,学生早期接触口腔临床.     

农村定向专科医学生临床实践教学模式的探讨

目的通过课外实践教学,让学生提早接触临床,提高学习效果。方法学生利用晚上时间去临床科室见习,教师、实习生、理论学习学生形成"一带二、一帮一"的学习模式。结果此种课外实践教学模式有助于学生自主学习能力的提升,发挥其学习积极性、主动性,91.0%教师对"互助"教学活动持肯定态度,96%理论学习的学生认为此模式适合临床实践学习。结论实施课外实践教学,对医学生初步接触临床是一种比较适合的形式,同时对教师的教学能力和意识的培养也起到了积极的促进作用。     

关于在校及毕业医学生对“服务-学习”型医德教育模式效果的主观评价调查

目的 了解在校及毕业医学生对“服务-学习”型医德教育效果的主观评价,为探索适合我国医学生有效的医德教育模式提供基础资料和依据.方法 利用自编调查问卷对831名在校医学生和近5年来从汕头大学医学院毕业的302名医学生（现为医生）进行调查,并随机抽取参加服务学习活动的27名在校学生和9名毕业学生进行个人深入访谈,采用SPSS19.0软件对调查数据进行卡方检验（α=0.05）分析,用Nvivo8软件对深入访谈材料编码后进行定性分析.结果 调查对象参与服务学习型医德教育的比例高,77.6％的在校医学生及74.8％的医生认为服务学习对医德教育起到很大或较大作用,其收获主要体现在“了解病人疾苦,鞭策自己做一个好医生”“更好地理解和同情患者”及“激励自己努力学习”等.结论 “服务学习”模式是一种创新的医德教学方法,为医德教育搭建理论联系实践平台提供了科学可行的手段,提高了医德课程的教育效果,是一种值得借鉴和推广的医德教育模式.     

早期接触临床课程教学目标与形式的探讨

早期接触临床课程为医学生提供了一个早期直接接触临床的机会,同时也是医学生了解整个医疗体系的窗口.在“增进对宏观医疗体系认识,建立医疗全局观”的目标下,北京协和医学院对早期接触临床课程进行了改革,包括对教学理念上的重新定位,扩展教学内容,并将课堂教学、以问题为基础学习教学、小组学习等教学形式应用于早期接触临床课程教学中.本文通过对北京协和医学院2008级八年制临床医学专业82名学生早期接触临床课程教学后进行的问卷调查,评价了课程改革的效果,并对该课程的教学目标、内容和形式进行了讨论.     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.