实行教学督导的几点体会

教学是学校的中心工作,我校为适应社会的发展及教学改革的不断深入,为维护正常的教学秩序,提高教师教学能力和教学水平,提高教学质量,实行了教学督导制,笔者认为教学督导工作应着重抓好以下几方面。1确立督导内容,明确督导任务督导工作的主要内容是:对影响教学质量的诸多因素如     

教学督导在提高教学质量中的作用

教学督导工作是对高等教育教学活动全过程进行检查、监督、评价与指导.通过对教师教学活动的检查、指导,以及教学文件和考试等方面的监督、管理,加强教学建设,规范课堂教学,推动教学改革,有效地提高了教学水平,为学校决策部门提供改进教学及其管理的依据和参谋意见.因此,加强教学督导,对于保证和提高教学质量具有重要意义.     

高等医学院校关键教学环节常规性教学督导体系的研究与实践

与流行的"全程监控、全员参与"的教学督导体系不同,我们根据高等医学院校的课程特点建立并实践了"以教学督导专家为教学督导主体,以教师课堂教学、临床见习和实习、考试等为关键教学环节,以系列教学督导规章制度和评价标准为准则,对教师课堂教学和临床教学及考试进行常规性的教学检查、评价、评估、认证和督导"的督导体系,符合实际,易于操作,为保证和提高医学教学质量提供了保障。     

以提高教学质量为核心的教学督导模式探索

教育事业步入了以提高教学质量为重点的新阶段,无论是高等职业教育还是中等职业教育,都要把提高教学质量作为核心任务。教育教学督导作为保证教学质量的重要组成部分,应把提高质量作为重点,以服务为宗旨,以就业为导向,推进教育教学改革。在教育教学督导中,我们对教学质量、教学过程及教学管理进行多方位检查、研究和督导,取得了良好效果,现汇报如下。     

加强教学管理,完善教学督导机制

随着教学改革不断深入发展,教学督导工作越来越显示出它重要的作用,而督导工作要持之以恒地进行并取得实效,督导机制的完善是十分重要的。二年来,我们在完善督导机制方面进行了探索与研究,我们认为,完善的督导机制必须有一支稳定的督导专家队伍,必须明确督导工作宗旨,必须做好督导工作的各项计划、安排,更重要的是督导意见必须及时反馈,并与教学激励机制挂钩,使督导工作充满生机与活力。     

以医学专业认证为导向加强二级教学督导体系的研究

实施医学专业认证,重在深化医学教育教学改革,加强内涵建设,完善医学教育质量保障体系,规范医学教育管理,提高医学教育质量.二级教学督导是教学和管理工作的重要环节,通过加强二级督导制度保障系统、健全二级督导组织机构系统、强化二级督导目标任务系统、完善二级督导信息反馈系统,建立二级督导组、同行教师、学生信息员构成的督教、督管、督学三位一体的二级督导体系,形成检查—反馈—改进—检查的闭合循环的长效督导运行机制,实行全方位、实时、立体化、多层次的教学质量监控,推进以岗位胜任力培养为基础的医学教育,逐步实现转化式学习,不断优化教学过程、提高教学管理水平和教学质量.     

非直属临床医学院实践教学督导结果分析研究

目的分析某高校非直属临床医学院实践教学督导现状及教学评价结果。方法收集2015年9月~2017年1月非直属临床医学院实践教学督导结果,汇总建立数据库,分析教学督导现状,对不同专业技术职称临床教师教学评价进行差异性分析。结果共收集3家非直属临床医学院教师实践教学督导评价表40份,分布于5门临床课程,其中内科学督导11次,外科学督导10次,妇产科学和儿科学各督导7次,神经病学督导5次。按专业技术职称分类,中级、副高级、正高级临床教师人数分别为15、19、6人,副高职称临床教师数最多,占47.5%。中级、副高级、正高级专业技术职称的临床教师教学评价得分分别为(85.5±2.4)分、(89.6±3.2)分、(92.5±2.1)分,三组专业技术职称临床教师教学评分差异有统计学意义(P0.05)。结论实践教学督导覆盖率有待提高,医院根据教学需求,做好临床教师的教学能力提升工作,充分发挥教学督导作用,实现实践教学质量的持续改进。     

“以生为本”实践教学评价方法的实践与应用

目的:比较分析学生、教师、督导三方对教师实践教学质量的评价结果,从中发现问题,为完善教学评价提供借鉴。方法:采用自设评价标准对10名教师实践教学设计讲授进行三方评价,对得分进行比较。结果:对10名教师中7名教师的评价基本一致,对3名教师的评价存在较大差距。结论:学生和教师参与教学质量评价,有利于调动学生和教师广泛参与教学、关心教学的积极性,有利于促进各项教学改革的顺利开展,有利于提高学生的主体意识和评判性思维能力。     

某军医大学教师人格特质、角色压力与督导效能关系的研究

以某军医大学教师为研究对象,采取问卷调查的方式,研究分析教师人格特质、角色压力以及教学督导行为与教学督导效能的关系.结果 显示,教学督导效能受到教师人格特质、角色压力和督导行为的影响,不同人格特质和角色压力的教师,其督导效能会有所不同.     

非直属临床医学院教学督导工作存在的问题及对策

教学督导工作是非直属临床医学院教学质量监控重要组成部分,是稳定教学秩序、强化管理职能、深化教学改革的重要保证.非直属临床医学院教学督导在实施过程中存在督导组织不够健全、督导队伍不够合理、督导范围不够广泛、信息反馈不够通畅、评价体系不够科学等问题.并提出了通过健全督导组织、加强督导队伍建设、拓展督导范围、疏通反馈通道、构建评价体系等途径,构建非直属临床医学院有效教学督导机制.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.