强化科研育人是深化本科生教育教学改革的重要内容之一[1].我国实行的医师资格考试制度中明确提出了执业医师应具备的基本科研素质[2] ,这对医学教育具有导向作用[3].医学科学研究设计是一门培养医学生科研能力的基础课程之一[4].该课程的绝大部分内容是医学生必修课医学(卫生)统计学的一部分,如:统计设计中的研究对象、因素、指标、设计类型和样本含量的选择等内容[5].为进一步完善医学科学研究设计课程,深化医学生教育教学改革,本文系统梳理相关文献,从《医师资格考试大纲》所涉及知识点、课程需求、参考书籍、课程情况和教学模式五个方面对国内医学科学研究设计课程现状进行介绍,并提出改进建议.

"医学科研设计"作为方法类课程是医学研究生重要的专业基础课.文章在简述医学科研设计教学目标的基础上,围绕医学科研设计慕课教学团队的建设、教学短视频资源和非视频资源建设、教学活动的组织与成绩评定分享"医学科研设计"的课程建设经验,并进一步结合"医学科研设计"慕课的应用从有利于满足不同学习者个性化学习需求、有利于促进研究生教育的课堂教学改革及有利于构建"互联网+"课程思政模式提出思考和建议.

新发感染病(EID)是指在人群中新出现或新认识的感染病,或是过去已认识、但发病率或发病地域范围已经或是将会迅速增加的感染病,通常是指20世纪70年代以来发现的感染病.因缺乏背景资料,难以及时预警和应对,EID给人类健康造成了巨大威胁.医院是应对EID的主战场,近年来医院在应对EID事件时暴露出预警能力低、准备不足、应对处置能力不强等问题.增强医院对EID的监测预警与应对处置能力,对提高中国疾病预防控制整体水平具有举足轻重的意义.本文就医院对EID症状监测、预警和应对处置能力的国内外进展作一综述.

文章首先论述了综合评价方法分类,其次分别分析了完全信息下和不完全信息下的静态综合评价方法,再次探讨了动态综合评价方法在教学质量评价领域的优势,最后指出了综合评价技术在该领域今后发展的新趋势.

目的 比较外科大骨瓣开颅血肿清除术和锥颅置管颅内血肿清除术(以下简称开颅手术和微创手术)的疗效影响.方法 选择2016年7月至2017年6月入院的120例典型的高血压脑出血患者,根据他们的治疗方式分为开颅手术组(开颅组60例)和微创手术组(微创组60例).评估指标为近期疗效判断标准:术后2周的GOS评分表进行疗效判断.通过对患者预后的分析,以期找出最有效的治疗方式.结果 开颅组患者的优良率为68.33%,微创组患者的优良率为85%,两组比较P<0.05,差异有统计学意义.开颅组并发症的发生率为43.33%,微创组并发症的发生率为18.33%,两组比较P<0.05,差异有统计学意义.结论 微创手术治疗高血压脑出血患者的疗效要优于开颅手术,且并发症少,值得在临床上广泛应用.

Pneumoconiosis is one of the most important and serious occupational diseases in China. In recent years,the number of notified pulmonary tuberculosis (PTB) ranks as the second place in the class A and B infectious diseases after viral hepatitis. PTB is a common complication among pneumoconiosis patients and is caused by a combination of various factors. This article introduced the incidence of PTB in patients with pneumoconiosis in recent years in different areas of China,and analyzed the researches on the susceptible factors for developing PTB. It is concluded that the incidence of PTB is still high in patients with pneumoconiosis. The results showed that the possible susceptible factors included: the stage of pneumoconiosis, age of onset, the years exposure to dust, type of work,the age of exposure to dust and other occupational susceptible factors, as well as other susceptible factors such as gene and preventive medication. In recent years, the related researches more aimed at the diagnosis and treatment of pneumoconiosis tuberculosis, but less on the cause of the disease and how to prevent and control the disease. The existing researches have various shortcomings and differences,and need to be further verified. Through our study, we suggest that the regular physical examinations to the workers exposed to dust and the patients with pneumoconiosis should be strengthened to timely detect the patients with pneumoconiosis and the pneumoconiosis patients complicated with PTB. Populations with the susceptible factors for developing PTB, such as the pneumoconiosis patients at higher pneumoconiosis stage, workers with longer time exposure to dust or earlier age exposure to dust and engaging in excavation work, etc., should be regarded as the key populations of prevention and give special attentions. So the incidence of pulmonary tuberculosis in patients with pneumoconiosis can be reduced and the pneumoconiosis tuberculosis can be effectively controlled.

目的 了解结核病患者医学应对方式及其影响因素,为制定结核病患者的临床护理策略提供依据.方法 采用一般情况问卷和中文版医学应对问卷(MCMQ)对长沙市某三甲综合医院结核病区402例住院结核病患者进行调查,并分析结核病患者医学应对方式现状及其影响因素.结果 结核病患者面对、回避、屈服维度得分分别为(18.91±3.05)、(15.49±2.62)、(10.00±3.01)分,与国内常模相比,结核病患者面对维度得分较低(P＜0.05),回避、屈服维度得分较高(P＜0.01).对结核病患者应对方式中面对维度有影响的因素有:居住地(城镇居住者得分较高,b=1.01,P=0.036)、是否参加结核病教育讲座(参加者得分较高,b=1.71,P=0.001)、对病情了解程度(对病情了解程度越高者得分越高,b=0.55,P＜0.001);对回避维度影响有统计学意义的因素是:居住方式(独居者得分较高,b=1.19,P=0.004);对屈服维度影响有统计学意义的因素有:结核病病程(病程长者得分高,b=0.53,P=0.008)、文化程度(文化程度高者得分较低,b=-0.35,P=0.047)、因结核病住院次数(住院次数多得分高,b=0.58,P=0.002)等.结论 结核病患者趋向于选择回避和屈服应对方式.结核病患者医学应对方式受居住地、文化程度等人口学因素和结核病病程、住院次数等疾病因素的影响.

Objective To understand the general self-efficacy level of patients with tuberculosis(TB patients) and its influencing factors, provide evidence for improving the general self-efficacy of TB patients.Methods All TB inpatients in a comprehensive pulmonary hospital were conducted face-to-face survey through a general questionnaire and general self-efficacy scale, self-efficacy level of TB patients and its influencing factors were analyzed.Results Mean scale of general self-efficacy of 402 TB patients was (20.4±4.2), of which only 14 cases(3.5%)showed a high level self-efficacy.163(40.5%), 225(56.0%), and 14(3.5%)patients were with low(10~),medium(20~), and high(30~) self-efficacy scale.The general self-efficacy level of TB patients was influenced by the course of disease(P<0.001), residence(P=0.012), whether or not attended the lecture on tuberculosis education(P=0.034), whether or not conducted physical exercise(P=0.053,stepwise multiple linear regression analysis: P=0.017), working status(P=0.027), No.of hospitalization due to TB(P=0.002), family economic situation(P=0.027), and education level(P=0.020).Conclusion TB patients' self-efficacy level is low, and the general self-efficacy level and its influencing factors should be assessed by health care workers during the follow-up for patients, individualized nursing intervention for improving the TB patients' self-efficacy level should be developed.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的建立湖南省手足口病发病趋势的SARIMA模型,为手足口病的预防和控制提供参考依据。方法收集中国疾病预防控制信息系统2008年5月—2013年12月湖南省手足口病月发病率数据建模,以2014年1—7月的月发病率数据进行验证,并对2014年8月—2015年7月发病情况进行预测;应用SPSS 18.0中的"Define Dates"模块和"Fore Casting"模块进行分析,建立季节性差分自回归移动平均模型（SARIM A）。结果湖南省手足口病月发病率发病趋势预测模型为SARIMA（1,0,0）（1,1,0）12,模型自回归参数AR1=0.765,（t=8.789,P&lt;0.001）,残差为白噪声（Ljung-Box Q=15.420,P=0.494）,预测值与实际值的相对误差范围为6.90%⁴6.31%,平均相对误差为20.37%;预测2014年发病率2次高峰分别在5月份和11月份,均高于2013年同月份的发病率;2015年上半年高峰期也在5月份,低于2014年同月份的发病率。结论 SARIM A（1,0,0）（1,1,0）12拟合效果较好,可用于湖南省手足口病月发病率的短期预测。</span>

目的:分析细胞形态学检查在鉴别诊断难治性贫血与巨幼细胞性贫血方面的临床价值.方法:将我院收治的67例难治性贫血患者及巨幼细胞性贫血患者根据病情的不同分为难治性贫血组与巨幼细胞性贫血组,对两组患者进行骨髓各系细胞形态学检查、外周血细胞形态检验及有核红细胞糖原高碘酸-无色品红染色(PAS)检查,然后对比分析其检查结果.结果:与巨幼细胞性贫血组患者相比,难治性贫血组患者在进行骨髓各系细胞形态学检查时发现淋巴样小巨核细胞、粒系病态造血、红系病态造血及PAS呈阳性的几率较高.与巨幼细胞性贫血组患者相比,难治性贫血组患者巨幼变原始红细胞的体积、巨幼变早幼红细胞的体积均较小,差异显著,有统计学意义(P<0.05).结论:在对难治性贫血患者与巨幼细胞性贫血患者的病情进行鉴别诊断时应综合分析其进行骨髓各系细胞形态学检查、外周血细胞形态检验及有核红细胞PAS检查的结果,以提高其病情诊断的准确率.

目的 调查长沙市结核病患者的自我感受负担(self-perceived burden,SPB)水平,分析其影响因素. 方法 运用自设调查表和自我感受负担量表对长沙市某结核病医院的200例结核病患者进行调查;并运用有序Logistic回归分析SPB的影响因素. 结果 结核病患者SPB得分为(29.25±8.82)分,处于中等水平;单因素分析结果显示:不同职业、婚姻状况、主要照顾者、参加结核病教育讲座等7个因素是结核病患者SPB的影响因素.有序Logistic回归分析结果显示,增加结核病患者SPB的因素有:参加结核病教育讲座(OR =3.452,95％CI:2.116～78.257)、结核病患者住院次数(与住院次数1比较,均OR＞1)和经济状况很差(OR =2.918,95％CI:1.113～7.653)三个因素. 结论 结核病患者具有中等水平的SPB.结核病患者自我感受负担的主要影响因素有是否参加结核病教育讲座、因结核病住院的次数和经济状况等.

手足口病是影响学龄前儿童的主要传染病之一,早期的预测预警可以为疫情防控措施提供重要的参考,意义重大.本文介绍了国内用于手足口病疫情预测预警的主要模型,包括动力学模型、差分自回归移动平均模型、空间统计学、灰色预测模型及其他模型,指出了主要模型的优缺点,为手足口病疫情预测预警模型的选择和发展方向提供参考依据.

目的 分析某高校医学类研究生医学统计学考试成绩的影响因素,为改进教学方法和提高教学质量提供理论依据.方法 采用有序Logistic回归方法综合分析医学统计学成绩的影响因素.结果 预防医学专业的学生成绩较高;没有分析过科研数据的学生成绩较差;对课堂气氛评价为优的学生成绩最好;学生自我评价统计学思维能力的优劣与成绩高低一致.结论 医学统计学成绩的影响因素主要有就读专业、入校前科研数据分析经历、课堂教学气氛等.建议根据学生专业情况安排教学;教师注意活跃课堂教学气氛;布置实际科研数据分析作为学生的课后练习,注重学生实际能力的培养.

Objective To evaluate the associations between inguinal hernia and testicular cancer.Methods A computerized search on literature was carried out in Wanfang,CNKI,VIP databases and CBM,PubMed,EMBASE databases to collect articles published between 1979 and 2012 concerning the associations between inguinal hernia and testicular cancer.There are total 49 articles,in which six articles were written in Chinese and other articles were written in English.Odds ratio (OR) and standard incidence ratio (SIR) were used to assess the strength of the association,and 95％ Confidence Interval (CI) to present the precision of the estimates.Meta-analysis was performed using the STATA (11.0) statistical software.Results We identified 16 case-control studies and one cohort studies by the uniform inclusion and exclusion criteria.Among the 16 case-control studies,six reported statistically significant positive association between inguinal hernia and testicular cancer,the others reported none statistically significant association between inguinal hernia and testicular cancer.Analysis of the 16 case-control studies that included 4695 testicular cancer patients and 6328 controls revealed an overall statistically significant association between inguinal hernia and testicular cancer (summary OR=1.33,95％CI 1.06 to 1.67).Of the one cohort study that included 30 199 inguinal hernia patients and reported SIR (1.1,0.4-2.2),there was not a statistically significant association between inguinal hernia and testicular cancer.Conclusions Our findings support a relationship between inguinal hernia and increased risk of testicular cancer.

Objective:The current work aims to evaluate the importance of combined detection of the tumor markers CA125, CA19-9,and CEA in the diagnosis of ovarian cancer.Methods:A computerized literature search was carried out in the databases of Pubmed,CBMdisc,CNKI,and VIP,among others,to collect articles regarding the diagnostic value of combined detection of the cancer markers CA125,CA19-9,and CEA in the diagnosis of ovarian cancer.Meta DiSc14.0 and Stata10.0 software were used to conduct the meta-analysis.Results:A total of 12 literatures were obtained in the current study with the unified inclusion and exclusion criteria.The results showed that the sensitivity(SE ),specificity(SP ),diagnostic odds ratio(DOR ),area under curve of SROC curve(AUC ), and Q* index of the tumor markers CA125,CA19-9,and CEA were 0.90(0.88-0.93 ),0.83(0.80-0.86 ),39.75(22.58-69.97 ),0.95 and 0.89,respectively,in the diagnosis of ovarian cancer.In contrast,the indices of SE,SP,DOR,AUC,and Q~* of the marker CA125 that was detected alone were 0.73(0.69-0.77 ),0.88(0.86-0.91 ),17.45(9.95-30.48),0.804,and 0.739 respectively.The result of the Z test has proven that significant differences exist between the two methods in diagnosing ovarian cancer(Z=4.859,P < 0.05 ).Conclusion: The combined detection of CA19-9,CA125,and CEA in the clinically auxiliary diagnosis of ovarian cancer may provide more competent and valuable laboratory proof compared with solitary detection of CA125.

This paper researches and analyzes the problems about teaching quality evaluation of undergraduate medical curriculum,which contain the vagueness evaluation objects,the single evaluation subject,simplex evaluation method,static assessment method,etc.This study proposes to build targeted evaluation indicators,to set up diversification evaluation of the main subjects and to carry out combination of comprehensive evaluation in dynamic style.The aim of this research is to improve the effectiveness,feasibility and scientificalness of teaching quality evaluation,provide the scientific approach to promoting education reforms,and subsequently improve the quality of teaching.

This paper discusses the application and effect of the Medical Statistics module teaching reformation on content and method based on first hand teaching experience.The author not only focuses on timely updating and optimization on teaching content,but also implements teaching method transformation.Comprehensively adopting teaching styles,including PBL-style,elicitation style,visualization style and feeding style,is helpful in mobilizing the students' enthusiasm and initiative,enhancing the students' ability in?analyzing and solving problems,and promoting the teaching quality.

Objective To evaluate the associations between polymorphisms of LEPR Gln223Arg,LEPR Pro 1019Pro and the risk on obesity.Methods A computerized search on literature was carried out in Wanfang,CNKI,VIP databases and CBM,PubMed,EMBASE databases to collect articles published between 1979 and 2010 concerning the associations between polymorphisms of LEPR Gln223Arg and/or LEPR Pro 1019Pro and risk of obesity in the Chinese population.Odds ratios (ORs) were used to assess the strength of the association,and 95％ confidence intervals (CIs) to present the precision of the estimates.Meta-analysis was performed using the STATA statistical software.Results Fifteen literature were collected for Meta-analysis by the uniform inclusion and exclusion criteria.There were 1096 obese patients and 949 controls for polymorphisms of LEPR Gln223Arg in 9 papers,together with 961 obese patients and 818 controls for polymorphisms of LEPR Prol019Pro in 8 papers.Overall,there were significant associations between decreased risk of obesity and LEPR Gln223Arg polymorphisms (-668 A→G) (G versus A,OR=0.66,95％CI:0.49-0.89; AG and GG versus AA,OR=0.50,95％CI:0.32-0.77; respectively).There were significant associations between increased risk of obesity and LEPR Prol019Pro polymorphisms (-3057 G→A) (A versus G,OR=1.61,95％CI:1.15-2.26; AG and AA versus GG,OR=1.50,95％CI:1.08-2.08; respectively).Conclusion Variant alleles at both LEPR-668 and LEPR-3057 were associated with obesity in the Chinese Han-dominated population.

对某大学2006级814份医学硕士研究生《医学统计学》期末考试试卷分析,结果如下:本次试题设计合理、覆盖面宽、符合教学大纲精神,关注学生统计思维的形成过程、各知识点之间的联系,基础知识与科研实际之间的联系;成绩呈负偏态分布;学生独立思考、发现并解决问题的能力尚有欠缺,统计思维还未成定势。应更多的采用PBL教学,加强统计思维的培养,继续采用研究式教学,提高教学质量.