目的:通过OSCE成绩评价临床医学五、八年制医学生临床能力.方法:选取中南大学湘雅医学院2008级五年制临床医学生,2006级八年制临床医学生为研究对象,分析两组学生OSCE成绩资料.结果:五、八年制学生在临床技能考核方面均较为合格,八年制学生在体格检查和文献检索方面表现突出.结论:五年制须更注重临床实践、文献检索能力培养;八年制则需寻求更多突破.

在卓越医生教育拔尖创新医学人才培养计划实施背景下,国内八年制院校陆续开展了八年制培养模式改革.本文以八年制临床教学改革为重点,从改革背景与目标、改革方案制定和改革主要举措等方面,探讨了八年制临床理论-见习-实习整合教学模式的创建与实践,并总结了该教学模式的主要特色和亮点.

Objective To discuss the education pattern of excellent and creative eight?year?school?system medical students.Methods Innovative reformations of class hour,class content,teaching method and skills training were included and a new teaching pattern of medical bridge curriculum was established in the experimental class covering two grades with 36 students. The teaching effects and the students′ test results were analyzed and compared with non?experimental students. Results The average score of diagnostics among experimental students was apparently higher than their counterparts in non?experimental classes in the same grade,the score of subjective questions among experimental students (37.82±5.30) was obviously bigger than that of the other group (30.82±6.54). The differences was statistical significance ( t =5.136, P<0.01) . The average scores of experimental classes ’ surgery ( 91. 63 ± 5. 37 ) and image diagnostics (89.95±3.24) were also better than those of the non?experimental classes ( surgery:73. 59 ± 6. 41;image diagnostics:82.51±7.07).The differences were also statistical significance ( t =13.13,6.14; P <0.01). Conclusion Students have a more active learning attitude under the new teaching pattern and they have a better understanding of the basic knowledge of diagnostics as well as a greater clinical skill. They also show some advantages in terms of clinical thinking of diagnosis and treatment.

Objective To evaluate the status of eight-year medical student's professionalism and provide reference for professionalism education.Methods An adaptation evaluation form on professionalism has been used to assess professionalism of 82 eight-year program students by their tutors,teachers and patients.Results Professionalism of eight-year program students overall is in a better scope,"honor & integrity" get highest score and "responsibility & accountability " get lowest score in seven evaluation elements of professionalism; Only eight indicators(total there are 29 indicators) difference was statistically significant between score of teachers and tutors,but difference with the patient score was statistically significant at the six indicators (P＜0.05),patients rated a lower score than teachers; The difference of professionalism ratings between different graders was statistically significant (P ＜ 0.05).Conclusions Responsibility & accountability and communication skills education of eight-year medical students should be strengthened.The students should be educated to help their fellow workers improve inadequate facets,intervene on behalf of patients when others behave unprofessionally,recognize and deal with medical uncertainty,and enhance emotional self-control and communication skills.We should take notice of the expected aspects of doctors' professional behavior from patients when implementing professionalism education.

The medical students' professionalism education has received more and more attentions.Medical students' professionalism education in USA developed very rapidly in recent years.It has already been half a century of history.This paper summarizes the medical students' the development history and status of professionalism education in USA,and refine the corresponding enlightenment for our medical students' professionalism education,mainly includes three aspects: to create integral course system about professionalism education and a good atmosphere of professionalism in the process of education and the implementation of the diversity of teaching methods.

随着社会环境的变化,影响医学生实习的不利因素越来越多,如就业压力、病人及家属的维权意识等等.在外部环境短期内很难改变的情况下,重点应该在内部管理上下功夫,为实习教学提供尽可能好的环境,我院通过多年的不断摸索,在继承优良传统的同时,大胆创新管理模式,为解决实习教学之难题不断努力,获得了一定经验,提高了我院医学生实习质量.

Dermatology curriculum reform has been constructed according to the training objectives of eight-year program medical education.The reform mainly includes optimizing the teaching contents and combing various teaching methods.The reform has been approved by most of students,and to a certain extent,the academic results have improved.

Objective To evaluate the efficacy and safety of XinZhiJun(Cefotaxime Sodium and Sulbactam Sodium for Injection) in treatment of urinary tract infections compared to Cefotaxime sodium for injection plus Sulbactam sodium for injection combination.Methods A randomized,double-blind,parallel controlled,multicenter trial was conducted,and the dose of XinZhiJun(experimental group)and Cefotaxime sodium for injection plus Sulbactam sodium for injection combination(control group)was 3.0 g,bid for 5-14 days.The total number of final evaluated subjects was 120.The bacterial evaluated subjects were 45 for experimental group and 53 for control group.Results Clinical efficacy rate and bacterial eradication rate for experimental group was 90.00% and 90.11%,for control group was 88.33% and 90.57%,respectively.The incidence of adverse reaction including whole clinicalreactions and laboratory abnormalities was 4.92% for experimental group and 1.54% for control group.Serious adverse drug reaction did not occur in two groups.Conclusion The XinZhiJun had an excellent clinical efficacy and good safety profile in treating patients with moderate to severe degree urinary tract bacterial infections.

Objection: To evaluate the efficacy and safety of piperacillin-sulbactam(2︰1) in treatment of moderate to severe degree respiratory and urinary tract infections comparing with piperacillin-tazobactam(8︰ 1).Methods: A randomized,double-blind,parallel controlled,multicenter trial was conducted,and the doses of piperacillin-sulbactam and piperacillin-tazobactam were 6.0 g and 4.5 g,bid for 7-10 days,respectively.The total number of final evaluated subjects was 203 including 100 subjects in piperacillin-sulbactam group and 103 subjects in piperacillin-tazobactam group.The bacterial evaluated subjects were 93 for piperacillin-sulbactam group and 83 for piperacillin-tazobactam group.Results: Clinical efficacy rate,bacterial eradication rate,and incidence of adverse reaction for piperacillin-sulbactam group was 95.0%,90.0%,and 6.8%,for piperacillin-tazobactam group was 91.3%,95.1%,and 4.8%,respectively.Serious adverse drug reaction did not occur in the two groups.Conclusion: Piperacillin-sulbactam had an excellent clinical efficacy and good safety profile in treating patients with moderate to severe degree respiratory and urinary tract bacterial infections.

The 8-year Medical Doctoral education,an important reform initiative in the process of internationalization of China's medical education is elite-oriented and has tough requirements for students' clinical competence.The paper conducts a comparison of the way to develop medical students' clinical competence between China and the United States,in a bid to provide some references for the improvement of clinical education in Chinese medical schools.

目前原发性肾病综合征(NS)是临床上常见的病症之一,由于其发病机制复杂,病理类型不同,目前治疗方法诸多,疗效各异.为了让更多的原发性NS患者得到有效的治疗,我们采用黄葵胶囊加常规"四联"疗法治疗原发性NS,以观察其药物疗效,为原发性NS患者提供新的综合性治疗方法.

The 8-year Medical Doctoral education,an important reform initiative in the process of internationalization of China's medical education is elite-oriented and has tough requirements for students' clinical competence.The paper conducts a comparison of the way to develop medical students' clinical competence between China and the United States,in a bid to provide some references for the improvement of clinical education in Chinese medical schools.

MD education(8 years) is an important act in the reform of the internationalization of medical education in our country.Compared with developed countries such as the United States,the scale of development of eight-year medical education system in our country is small and its history of development is short.There are many aspects that should be improved.Our government should draw experiences from the developed countries in medical higher education and improve the training mode of MD education(8 years),and the researcher should study the present station of MD education(8 years) and adjust unreasonable cultivating model,as well as implement assesses regularly in order to guarantee educational quality of MD education(8 years) in our country.

Improving the quality of clinical teaching is an importent task of higher education. As a clinical school we took teaching as one of the central tasks, established teaching quality monitoring system, focused on the cultivation of students' clinical capability, implemented innovation in teaching materials, teaching methods and teaching means, thus the quality of clinical teaching was improved.

目的探讨不同预冲方法对维持性血液透析患者透析充分性的影响。方法将67例维持性血液透析患者先采用5次半开放式预冲方法(半开放式组),然后5次透析都采用密闭式预冲方法(密闭式组),通过在线尿素清除率的监测(Online Clearance Monitoring,OCM)测定每次透析的尿素清除指数(Kt/V)。观察透析器的凝血情况,进行自身对照比较。结果半开放式组透析3次后Kt/V有明显的降低,而密闭式组第1-5次都保持在比较稳定的数值,透析5次后两组之间Kt/V差异有统计学意义(P<0.05);半开放式组透析器在复用3-4次后,回血时透析器有凝血现象,与密闭式组比较,凝血分级有明显的区别(P<0.05)。结论采用密闭式预冲方法进行血液透析,操作程序简单,降低了交叉感染的风险,减少了透析器凝血的发生率,保持Kt/V值的稳定,能有效地提高血透患者的透析充分性。

Objective Structured Clinical Examination(OSCE) is a model of clinical skills examination.We have applied OSCE in the graduate examination of medical colleges for three years.There are different requests for training teachers and Standardized Patients(SP),setting exam place,examiners and students and so on.OSCE is worth spreading as clinical ability examination in other medical education.

[Objective] To evaluate the life quality (QoL) of peritoneal dialysis (PD) patients,and investigate the factors affect it. [Methods] By using the FM 36-item short form heath survey,inquring investigate in 105 peritoneal dialysis patients was conducted,and comparative analysis was made. [Results] No difference in SF-36 between male and female in PD patients was observed; QoL in the young patient group was higher than that in the middle age group and elder group,but no difference in QoL between the middle age group and elder group was found; The trend of QoL was stable in the first two years of initial dialysis,but SF-36 was lower and lower in two years; The QoL of PD patients with complications was lower than others. [Conclusion] The SF-36 can evaluate synthetically the QoL of PD patients; PD is suitable not only in the elder patients but also in the young patients and female patients; PD may be the first initial therapy of integrated therapentic model of ESRD patients in early term; Age,dialysis term and complications may impact QoL in different ways.

Teaching quality in clinical medical school exerts a critical impact on medical teaching quality.Having experienced clinical education for many years,Xiangya Hospital has established a guarantee system of teaching quality for teaching administration which includes the stable and sound teaching administration organization system,strict and standardized teaching rules and regulations,high degree of the teachers' quality,effective monitoring system for teaching quality,and the scientific and reasonable teaching administration for clinical skills and the humanity-oriented policy for enhancing teachers' teaching initiative.

在社会和科技发展综合化程度日益明显的今天,发展交叉学科对于社会的发展和科技的进步具有举足轻重的作用。加强交叉学科建设是发展交叉学科的核心手段。本文在学科建设的基础上结合交叉学科的特点,对交叉学科建设作出了一个明确的定义,分析了一流大学在交叉学科建设中的优势,并且总结了世界一流大学交叉学科建设的一些方法和手段,以期为我们正确认识、了解交叉学科建设打开一扇窗口。

[Objective] To investigate the correlation of ICI, plasma lipid, and renal function in patients with idiopathic nephropathy syndrome (NS), and to elucidate the clinical effect of receiving therapy by anti-hyperlipidemea and anti-coagulation in early stage of idiopathic NS. [Methods] ①35 patients, definitely diagnosed as idiopathic NS firstly, were divided into two groups according to intraglomerular coagulation index (ICI), and those whose ICI less than 0.5 were contributed to low ICI group (22 patients ); Those whose ICI more than 1, belonged to high ICI group (13 patients). 24 hours urine of all the cases was collected for examining urinary protein (Upro), FDP, NAGase and RBP by ELISA; Parameters of plasma lipid and renal function were detected by automatic biochemical analyze machine. Pearson′s analysis was applied for analyzing the relationship between ICI, parameters plasma lipid, and renal function. ②35 patients were divided into 4 groups according to with or without therapy of anti-hyperlipidemia or/and anti-coagulation: 9 cases as control for routine treatment, 7 cases as receiving anti-hyperlipidemia therapy, 12 cases as receiving anti-coagulation therapy, 7 cases as receiving both anti-hyperlipidemia and anti-coagulation therapy, and the parameters of plasma lipid and renal function before and after therapy were detected as mentioned before. [Results] ①Linear correlation analysis revealed that ICI and TC, TG, LDL, ApoB, Lp-a, SCr, β2-MG, 24 hours Upro, FDP, NAGase, RBP were positively correlated, whereas, negatively correlated with CCr , respectively (all P 0.05). ②The levels of plasma TC, TG, LDL, ApoB, Lp-a, SCr, β2-MG, 24 hours Upro, FDP, NAGase, RBP were significantly higher in high ICI group compared to low ICI group (all P 0.05), and lower levels of CCr were detected in high ICI group (all P0.05). ③There was no significant improvement on the levels of plasma lipid in routine therapy group (all P 0.05), but the levels of SCr, β2-MG, 24 hours Upro, FDP, NAGase and RBP were decreased after routine therapy; in receiving anti-hyperlipidemia therapy group, plasma lipid and renal function were improved significantly, and the extent of increase CCr (△CCr(%)) was greater than routine therapy group; the clinical effect of anti-coagulation therapy was as same as anti-hyperlipidemia treatment except for decreasing plasma lipid levels; those receiving both anti-hyperlipidemia and anti-coagulation treatment benefited from a larger extent of significant improvement CCr compared to the other three groups (all P 0.05), although the rest clinical effect did not show many advantage for the patients. [Conclusions] Intraglomerular coagulation is closely correlated with the levels of plasma lipid, which maybe as an important factor of renal dysfunction; combining anti-hyperlipidemia and anti-coagulation treatment in early stage of idiopathic nephropathy syndrome can obviously improve CCr and delay the processing of renal failure.