TBL联合CBL在军人积极心理学教学中的应用

目的探讨以团队为基础的教学(team-based learning,TBL)联合以案例为基础的教学(case-based learning,CBL)在军人积极心理学教学中的应用效果。方法选取陆军军医大学校2017级临床医学专业100名本科生作为教学对象,随机分为TBL联合CBL教学组(n=50)和传统教学组(n=50)。通过基础理论知识及案例分析考核、问卷调查和心理测评等方式评估两种教学方法的教学效果。运用SPSS 19.0对结果进行t检验。结果TBL联合CBL教学组在理论知识得分(54.87±4.98)高于传统教学组(48.65±3.51);案例分析考核得分(36.84±2.73)也高于传统教学组(32.37±2.34);在心理测评结果中,TBL联合CBL教学组在SCL-90后测得分(143.31±43.62)低于传统教学组(149.89±46.96);ERC、GWB后测得分(48.76±5.37)、(107.87±15.56)均高于传统教学组(43.58±5.79)、(102.32±12.13)。此外,TBL联合CBL教学组学生对该教学满意率达95.83%(46/50)。结论TBL联合CBL教学在军人积极心理学教学中能取得良好的教学效果,提高学员的知识应用水平和心理调适能力,具有较好的可行性和适用性。     

影响护生实习后期护理安全的因素分析及对策

目的探讨护生实习后期护理安全影响因素及防范对策。方法对我院2001年至2005年护生实习后期发生的12起护理差错进行分析。结果法律意识淡薄,执行操作规程不认真、未严格执行“三查八对”、未能较好执行带教老师放手不放眼的制度是影响护理安全的主要因素。结论加强护生实习后期管理,严格执行各项查对制度,健全和完善临床教学监督机制是预防差错发生的关键。     

影响学生接受PBL教学法的个体因素分析

目的　分析影响学生接受PBL教学法的个体因素。方法　选取天津医科大学临床医学院药学专业的医药市场营销学课程应用PBL教学法,使用李克特量表对学生接受PBL教学的程度进行问卷调查。令研究对象对“接受并喜欢PBL教学方法”和“新教学方法很好,希望其他课程也能使用”这两条语句的认同程度进行打分,设置1~5分,分值越大认同程度越高。随后,使用二元logistic回归对问卷数据进一步分析,找出影响学生接受PBL教学法的个体因素。采用SPSS 19.0软件进行统计分析。结果　两条语句得分的平均分分别是4.14和3.11,说明研究对象对PBL教学法普遍接受;而标准差分别是1.07和0.97,说明研究对象对PBL教学法的接受程度差异较大。使用二元logistic回归进一步分析,假设显著性水平为0.05;对模型起显著影响（P<0.05）的有5个变量,分别是学习时间、学习动机、性格、学习能力、风格。说明这5个变量对学生是否接受PBL教学法有显著影响。其中,性格因素的估计的系数绝对值最大（为2.190）,是影响学生是否接受PBL教学法的关键因素。结论　在独立学院药学专业医药市场营销学课程中应用PBL教学,应充分发挥小组的力量,提高学生团队协作能力。教师要注意鼓励、引导学生适应讨论式学习;并且优化教学安排,完善教学内容,完善PBL教学法的评分方式。     

病理生理学教学中学生创新思维的培养

三峡大学医学院病理生理学教研室在教学中,用病理生理学发展规律激发学生创新思维潜力,用临床实例帮助学生清除思维定势,用医学创新事例介绍探讨学生创新思维培养方法;通过总结相关经验,以期为医学本科创新教育提供参考。     

Roles of clinical supervisors in the clinical training of radiography students in Zambia: a qualitative study

IntroductionClinical supervisors are responsible for the facilitation of practice-based learning for radiography students. However, literature is scarce on the roles of clinical supervisors in the clinical training of students in Zambia.ObjectiveThis study was aimed at identifying and exploring the roles of clinical supervisors in the clinical training of radiography students in Zambia.MethodsA qualitative design with unstructured interviews was used in this study. Ten individual interviews were conducted in July 2018 with clinical supervisors of radiography students working at the main clinical training and placement sites of the Lusaka and Copperbelt provinces of Zambia, respectively. All digital interview recordings were transcribed verbatim and analysed thematically.ResultsThree main roles of a clinical supervisor emerged: managerial, educational, and supportive. The managerial role deals with organising and managing clinical training resources. The educational role involves imparting knowledge and skills to students. The supportive role involves supporting students with social and learning problems. Findings show the inter-relationship of these roles to each other.ConclusionClinical supervisors need to understand their roles in order to develop and maintain their competences in the facilitation of practice-based learning. This could also help stakeholders to provide appropriate support to clinical supervisors.     

Can the patient pinpoint where the ingested fish bone is impacted?: A single-center,retrospective study

Among the plethora of foreign body impactions, fish bones are common examples that patients may struggle to properly disclose in clinical situations. This study investigated whether patients could pinpoint where the ingested fish bone was lodged. In addition, we investigated the differences between fish bone and other foreign bodies, the usefulness of computed tomography (CT), and the related risk factors for hospitalization. The cases of patients who underwent an endoscopic removal of fish bone between April 2008 and April 2020 were retrospectively reviewed. The clinical outcomes, X-ray scan, CT, and complications of each patient were investigated. A total of 96 patients were included in this study. The mean size of the impacted fish bone was 23.78 mm, and most were found in the upper esophagus (n = 38). There was a weak correlation between pain location and the actual lesion location (r = 0.419, P < .001). Compared to those of other foreign bodies, the location of impacted fish bones was different (P < .001), the X-ray detection rate of fish bones was lower (P < .001), and the complication incidence was higher (P = .030). CT (95.89%) showed higher sensitivity than X-ray scanning (11.24%) (P < .001). Foreign body size (P = .004) and door-to-endoscopy time (P = .029) were related to admission. Patients only managed to point out the approximate location of the ingested fish bone. CT detected fish bones well, but scans should include at least the entire esophagus instead of solely the area where pain is felt. Fish bone impaction has different clinical characteristics from other foreign bodies. Endoscopic removal without delay can reduce the admission rates.     

“5·12”地震陇南灾区学生受伤情况调查与分析

目的:调查分析"5·12"地震甘肃陇南学生受伤情况,进一步讨论如何采取措施应对突发灾害,保护弱势群体。方法:采用问卷调查、访谈等方法,对甘肃陇南地震受灾人口进行抽样调查,重点对伤员伤情、致伤原因、救治方法进行统计学分析。结果:在此次共调查地震伤患者1652人,死亡16人,其中学生受伤361人,占总人数的21.9%,死亡1人,占受伤学生人数的0.3%,四肢骨折156人,占学生受伤人数的43.2%。结论:总结出了弱势群体救治的经验,为突发灾难的救治提供理论依据和方法。     

诊断学教学中不同情境下的问诊训练要点

问诊是病史采集的主要手段,教学时不应局限于内科住院病人,需要对学生进行多情境的问诊训练。门诊问诊训练时,需要设计好问诊场景及时间限制,主要为重点病史采集,同时训练病历书写;急诊问诊训练时,可介绍些常用问诊准则,如SAMPLE准则;还可针对老年人群、儿童、外科患者、海洛因依赖患者等不同人群介绍问诊的侧重点。通过理论教学和见习相结合的模式,理论中穿插小组讨论和角色扮演,见习中设计多情景教学,加强标准化病人的应用,合理设计课堂学时、内容分配并及时反馈,以获得最优化教学效果。     

治疗自身免疫性疾病的抗细胞因子疫苗

抗细胞因子疫苗是针对疾病相关细胞因子而设计与构建的一类能激发体液免疫应答的主动免疫治疗性疫苗,是用于自身免疫性疾病的一种极具潜力的新型疗法。目前研究与开发的抗细胞因子疫苗主要有2种类型,一种是通过偶联载体或直接修饰为细胞因子引入外源表位而构建的蛋白疫苗,另一种则是可表达细胞因子免疫原的核酸疫苗。这两类疫苗在临床前及临床研究中,对各种自身免疫性疾病均显现出治疗活性。简介各类抗细胞因子疫苗及其作用机制,综述用于治疗类风湿性关节炎、多发性硬化症、系统性红斑狼疮等各种自身免疫性疾病的抗细胞因子疫苗研究进展。     

咽异物感伴有咽喉反流患者抗反流治疗的临床观察

目的 观察抗反流治疗对咽异物感伴有咽喉反流的临床疗效。 方法 将门诊以咽异物感自评超过3分,患病1个月以上的患者,进行反流症状指数量表(RSI)及反流临床表现量表(RFS)评分,对RSI超过13分及RFS超过7分的患者进行抗反流治疗,以能持续治疗8周以上为有效观察对象,共104例。分析入组患者反流各症状发生率、反流临床表现各体征发生率,并进行疗效评定。 结果 104例咽异物感患者多有反流症状清嗓动作(92/104,88.46%),主要反流体征为后连合肥厚(97/104,93.27%),红斑/充血(89/104,85.57%),喉内黏稠分泌物(87/104,83.65%),喉室阻塞(73/104,70.19%)等,经抗反流治疗,有效61例,有效率为58.65%;RSI治疗前后比较,差异有统计学意义(t=1.975,P<0.05);RFS治疗前后比较,差异无统计学意义(t=1.258,P>0.05)。 结论 咽异物感伴反流症状的患者,通过反流治疗是有效的。对于有咽异物感的患者,经过长期治疗效果不明显,应考虑是否有咽喉反流的可能。