目的 了解下肢PICC置管穿刺鞘断裂不良事件的根本原因并进行系统改进.方法 成立专家团队,根据RCA2实施步骤进行事件调查,识别近端原因,采用质量检测、资料比对和问题树分析法等寻找根本原因,从建立风险评估管理体系、完善标准操作程序、建立床旁超声急会诊分级管理机制三方面进行改进.结果 PICC导管选择符合率由75.51％提升至100.00％,穿刺鞘使用规范率由82.65％提升至96.26％,一次性置管成功率由95.92％提升至100.00％;紧急床旁超声到位时间从平均26 min缩短至14 min,床旁超声急会诊到位时间达标率由33.33％提升至100.00％.未再出现断鞘事件.结论 应用RCA2寻找不良事件系统根因并进行改进,有利于强化事前风险管理,增强团队合作,建立组织质量安全文化,从而保障患者安全.

目的 调查家庭医生服务现状、脑卒中预防和康复胜任力及其影响因素.方法 于2021年5月,采用整群抽样法对重庆市某区125名家庭医生进行问卷调查,了解家庭医生签约服务开展情况、脑卒中知识培训效果及预防和康复胜任力.结果 家庭医生脑卒中预防和康复工作胜任力自评得分为(3.32±0.84)分.家庭医生的性别、年龄、学历、职称、平均月收入、每日门诊服务人数、到上级医院进修、掌握脑卒中快速识别方法、曾帮助辖区居民转诊和接收过脑卒中康复患者经验者,对脑卒中预防和康复胜任力自评得分的差异有统计学意义(P<0.05).logistic回归分析提示,家庭医生职称、每日门诊服务人数、到上级医院进修、快速识别脑卒中是胜任力的影响因素(P<0.05).结论 进修学习、教育培训和实践训练是提高家庭医生工作胜任力的关键.上级医疗机构可构建医疗联合体单病种全链式MDT管理模式,设置系列应用型课程,建立组合式签约服务模式,采用"团队帮扶社区、科室结对互助、专业研讨合作"的管理方法进行全面帮扶.

在理论研究的基础上,开展大学创新教育实践研究,获得可供借鉴的实践经验,即“以能力为中心”设计人才培养目标,依据目标关联度设置课程体系,着眼创新人才培养推进教学方法改革,基于能力培养创新实践训练体系,建立发展性综合考核评价体系,发展“教研一体、科教融合”的师资成长体系,健全综合多元的质量管理体系等.

实践成效是检验教育研究价值和成败的重要标准.通过12年大学创新教育研究及实践,取得了系列重要理论和实践成果:深化了创新教育教学理念,建立了创新教育教学体系,提升了办学能力水平,提高了人才培养质量.

教育理论创新是教育改革实践的先导.在对现代大学教育理论发展及职能拓展作纵向历史分析、对国内外高等教育改革发展现状作横向剖析,对大学教育本质进行重新认识和界定的基础上,从概念解析、理论架构、目标定位及主要特征等方面,进行了大学创新教育理论的研究构建.

In order to meet the new medical talents demand generated by social development and the advancement of medical science, this article has made a thorough analysis about the current education, putting forward an innovative education system which consists of educational concept, training objectives, training models and condition construction. Besides, the article summarized the educational reform experience at Third Military Medical University which has showed the preliminary effectiveness for the quality of talent training.

The current article summarized the elective courses reform experience at Third Military Medical University,which included the following two aspects:the construction of general education curriculum system,and the implementation of self-motivated learning model.Besides,the article discussed the obstacles in the process of curriculum reform with suggestions on how to deal with the situation.

With the differentiation of medical science and the progress of technology,improving the humanistic quality of medical students has become one of the focuses of medical education reform.This article analyzed the current insufficient situation of medical humanity in China,proposing some countermeasures to strengthen the humanistic quality of medical students involving modem concepts of medical education,curriculum assignments,combine of humanity education with professional education,and emphasizing the campus culture.

Aiming at the existing problems of medical humanity curriculum system,this article analyzed that the medical humanity curriculum system should follow the principle of overall development,the value oriented principle,the practical principle and the system principle.Finally,this article proposed a "progressive and full dimension" curriculum cluster including foundation courses,integrated courses,application courses and invisible courses of medical humanities education.

文章主要以哈佛医学院为例,介绍了美国医学院校通过人文社科课程教学、专业教育中的人文渗透、隐性教育等方面对医学生进行良好的人文教育,对我国的医学人文教育具有重要的借鉴价值。

医学整合课程教学自20世纪50年代在欧美发达国家兴起,已发展成为医学教育的主要课程教学模式。通过对整合课程的起源和发展历程的回顾以及对国内外部分院校开展整合课程教学的介绍,结合国家教育政策导向、医学科技发展和医学教育发展规律,对国内医学教育推行系统整合课程教学模式进行展望。

高等医学教育教学内容与生命科学的发展应该保持同步更新.研究了生命科学前沿学科群在临床医学本科专业人才培养中的重要性、课程方式及课程深度.提出前沿课程设置应处理好基础与新进展、宏观与微观、时间与内客三个关系,现代医学本科教育应培养学生成为宽口径、厚基础、多分化能力的"干细胞型人才".

The paper analyzed the characteristic of general education in medical university, advising on the design of medical humanities curriculum, better choice of organization for general education curriculum , and the generalization of medical professional education, with exploration on better enlightenment of general education in medical university.

This article analyzes the actuality and influence factors of general education in military medical university and puts forward some suggestions for the development of general education which include advancing the conception,construction of curriculum system,strict teaching management,and reinforce the teaching staff.

In this article,we analyzed seven necessary aspects of ability for military medical students under new military transformation condition,and all these abilities should be implemented through general education.By the situation analysis of the general education in military medical university,we found the gap between the demand and actuality.So we think that a proper pattern of general education should be constructed in military medical university in order to adapt the military medical students to the new requirements of the new era.

Objective:To construct a fused H.pylori DNA vaccine consisting of UreB,HpaA gene fragments,and observe its immunogenicity.Methods:The fragment of UreB and HspA genes was obtained by PCR amplification from H.pylori genome DNA,then the fusing gene UH was obtained by SOE PCR(splicing by overlap extension).UH was subcloned into an eukaryotic expression vector pcDNA3.1.Then the fusion protein was identified by Western blot after plasmid pcDNA3.1-UH was transfected into COS-7 cells and ELISA was used to detect the specific antibody after immunization in mice.Results:The eukaryotic expression plasmid of the fusing gene two fragments was constructed,and a novel fusion protein was expressed after transfection into COS-7 cell.Specific antibody was found in mouse serum after immunization with the DNA vaccine.Conclusion:A fused DNA vaccine of from H.pylori with good immunogenicity has been successfully constructed,which lay a foundation for further investigation on H.pylori DNA vaccine.

To establish an effective method for purification of Helicobacter pylori UreB fragment and conduct functional analysis of the purified protein.The protein fragment expression was induced by IPTG and the expressed protein was purified through affinity chromatography and ion-exchange chromatography. The purity of the fragment was determined by high-performance liquid chromatography (HPLC), and the specific biological activity of the purified fragment was assayed by urease activity inhibition test.The protein fragment was highly expressed in E. coli with a purity over 91%. The protein fragment showed highly specific biological activity and the specific antibody induced by this fragment in rabbits could inhibit the activity of urease in a dose-dependent manner.The UreB fragment with high purity and biological activity can be applied for further studies.

医学基础课程为临床等多种医学专业课程奠定了坚实的基础[1],是医学生专业教育的真正起步阶段;在这一阶段,学生要能系统掌握和综合运用医学基础学科的基本理论、基础知识和基本技能,才能在随后的临床教学和见习中更有效、系统的学习和掌握临床专业课程的知识和实践技能,有利于教务部门正确评估基础教学阶段的成效和更好的组织实施临床教学,有利于医学生毕业后参加国家执业医(护)师考试奠定良好的基础,有利于学生分析问题、解决问题和实践技能的提高[2].

目的观察并比较携带Hp不同抗原基因的质粒pTCAE-ureB(pT-ureB)和pTCAE-hpaA(pT-hpaA)肌注小鼠后诱导的体液免疫应答.方法构建真核表达质粒pT-ureB;与已成功构建的质粒pT-hpaA分别作为疫苗方案,肌肉注射免疫BALB/c小鼠并设置空质粒对照,末次免疫后第2、4、6周分别用间接ELISA法检测小鼠血清特异性IgG抗体滴度.结果两免疫组在末次免疫后第2周均可出现特异性IgG,抗体滴度随时间逐渐增高;末次免疫后第6周,两免疫组的抗体滴度与对照组相比较,差异极显著(P＜0.01);且pT-ureB免疫组抗体滴度显著高于pT-hpaA(P＜0.01).结论pT-ureB具有良好的免疫原性,诱导体液免疫应答的能力优于pT-hpaA.