内科学是临床医学的基础学科.但在以往传统的内科学教学中长期存在重理论、轻育人的弊端,不利于学生德智的全面发展.如何在内科学课程教学过程中渗透课程思政内容,成为当前的一个迫切需要解决的问题,此文以消化系统疾病为例,具体介绍在胃食管反流、胃炎、消化性溃疡、肝硬化、肝癌、肝性脑病、急性胰腺炎、溃疡性结肠炎、上消化道出血中的教学内容中的课程思政的具体融入,使之有机结合,达到全面育人目的.

目的:探讨精准医学教学模式在内科学中的应用效果.方法:在2019届临床专业医学生中随机选取一个班(学生共166名)作为教改组,在精准医学教学模式指导下重构内科学课程,形成含精准系统的内科教学体系;在2018届临床专业医学生中随机选取一个班(学生共146名)作为对照组,应用传统内科学教学干预.比较两组医学生的内科学阶段考试成绩及学生对教学模式的满意度差异.结果:精准医学教学模式深受学生欢迎,99％的学生认为有利于提高学习兴趣,84.21％的学生认为有利于提高临床思维能力,97％的学生认为提高了学习效果.结果:①阶段测试成绩平均分数为(98.48±2.46分),高于往届学生的阶段平均成绩(93.86±10.89分).(t=5.311,P=0.000);②教改组学生的医学临床教学满意度是99％,高于对照组的88.65％.结论:精准医学教学模式下内科学体系的应用效果肯定,可进行精准诊疗,提高医学生的理论知识掌握程度,并有利扩展学生视野,并提高学生对医学临床教学的满意度,值得借鉴.

内科学是学习临床医学其他各科的基础,在整个临床医学中具有非常重要的地位.但在以往传统教学中广泛存在重理论知识的传授、轻育人的现象.如何在内科学课程教学中有机融入课程思政,以课堂为阵地,对学生适时进行思想政治教育,是当前医学教育中的一个难题.本文以呼吸系统疾病为例,大胆尝试在呼吸系统和循环系统各疾病的教学内容中融入课程思政教育,使之与教学内容有机结合,浑然一体,达到润物细无声,达到全面提高学生的综合素质的目的.

在健康中国建设背景下,全科医生仍不足,但医学院校临床医学专业专科毕业生却相对过剩,因此构建"2+1+2"卓越医生人才培养模式成为解决该问题的可行途径.我校在原来"3+2"助理全科医生培养模式基础上进一步创新与突破,探索新的"2+1+2"培养模式,通过建立完善的管理体系,制订"2+1+2"卓越医生人才培养方案,进行课程建设与改革、优化课程设置,修订课程标准、优化教学内容,产教融合、优化教学过程,校院合作、加强校内外实训基地建设,加强过程考核、施行"1+2+n"课程考核模式,编写融"三个习惯、三张处方"及思政教育于一体的校本教材,加强"双师"型师资队伍建设九大措施,使学生具备全科医生的综合素质和职业能力,对学生进行5年分阶段全程规范化的全科医生培训,弥补全科医生培养缺陷,促进专科医学生就业.

目的:探讨五星教学法在内科学教学中的应用效果.方法:以我校2019级三年制临床医学专业200名学生作为研究对象,分为对照组和实验组两组,对照组进行传统教学,实验组采取五星教学法为主的教学.学期结束后分别对两组学生进行期末测试及问卷调查,评估教学效果.结果:学生非常欢迎将五星教学法引入内科学教学,期末考试成绩实验组平均分数为(83.25±3.6),高于对照组学生的平均分数(70.32±2.9),且问卷调查结果显示95％的学生认为有利于激发学习兴趣,94％的学生认为有利于临床思维能力的提高,97％的学生认为有利于分析问题和解决问题的能力的提高,98％的学生认为有利于学习效果的提高.结论:将五星教学法引入内科学教学,能够激发学生的学习兴趣,切实提高学生临床思维能力及分析问题解决问题的能力,从而提高学习效果.

目的：观察葛根素与厄贝沙坦前列地尔联合治疗糖尿病肾病的临床治疗效果。方法：选取我院收治的70例糖尿病肾病患者，随机分为对照组与实验组，在综合治疗基础上对照组给于葛根素治疗，实验组给予葛根素联合厄贝沙坦前列地尔治疗，观察两组治疗前后白蛋白排泄率、尿素氮、肌酐变化情况。结果：两组治疗后白蛋白排泄率、尿素氮、肌酐均下降，与对照组相比，治疗组患者的各项指标下降更明显，差异有统计学意义（P<0.05）。结论：使用葛根素联合厄贝沙坦前列地尔治疗糖尿病肾病可延缓肾功能进展，提高临床疗效。

精准医学是根据个体基因差异、环境因素以及个人生活方式,在精准数据的指导下,对疾病开展预防和治疗的新方法.作为一种新的医学模式,精准医学的实施将会引起高职高专临床医学专业人才培养目标、培养模式、课程设置、教学内容、教学模式等方面的改革,必将引领精准医学教育时代的到来.

目的:评估我校专科层次临床医学专业施行内科学精准医学教学模式改革的应用成效.方法:随机选取我校2014级三年制临床医学专业的200名学生分别入选对照组和实验组(各100人).对照组按以前传统内科学教学模式进行教学,实验组则按照改革后的新内科学精准医学教学模式进行教学.教学结束后对两组学生进行理论、技能考核及问卷调查,分别比较两组的考核成绩及问卷调查结果,评估教学效果.结果:内科学精准医学教学模式的新改革深受学生欢迎,98％的学生认为有利于提高临床思维能力与实践动手操作能力,97％的学生认为极大地提高了学习效果,满意度达99％,且实验组考核成绩明显高于对照组,有显著差异(P＜0.05).结论:在我校三年制专科层次临床医学专业施行内科学精准医学教学模式改革,有利于提高教学质量,值得应用.

目的 观察西地那非在治疗原发性肺动脉高压的临床疗效.方法 选取我院收治的30例原发性肺动脉高压患者,在综合治疗基础上给予西地那非口服50mg/d,观察治疗前后临床症状缓解,肺动脉压下降情况.结果 与治疗前相比,治疗后患者的临床症状明显缓解,肺动脉压下降(P<0.05).结论 使用西地那非可明显提高原发性肺动脉高压的临床治疗效果,改善生活质量,且无明显副作用.

目的 观察英夫利昔单抗治疗克罗恩氏病的临床疗效.方法 将60例克罗恩氏病患者随机分为对照组和治疗组,各30例.对照组予综合治疗,治疗组在综合治疗基础上给予静脉输注英夫利昔单抗5 mg/kg,分别于患者用药0、2、6周及以后每隔8周予相同剂量维持,共8次,观察2组治疗前后临床症状缓解,生化指标恢复及内镜下病理改善情况.结果 与对照组相比,治疗组腹胀、腹痛等临床症状明显缓解(对照组治疗有效率为10.0%,治疗组为73.3%),生化指标ESR、CRP明显下降,内镜下病理明显改善(对照组内镜下缓解率为10.0%,内镜下改善率为6.7%,治疗组内镜下缓解率为66.7%,内镜下改善率为33.3%),差异均有统计学意义(P<0.05).结论 使用英夫利昔单抗可明显提高克罗恩氏病患者的临床治疗效果,改善生活质量,值得临床推广应用.

目的 通过与传统教学对比,探讨心肺模拟听诊系统的采用在诊断学教学中的作用及效果.方法 选取我校三年制临床专业学生200名,随机分为实验组和对照组,各100名.实验组采用心肺模拟听诊系统进行教学,对照组采用传统教学进行教学,而后进行心肺听诊测试和问卷调查,比较2组教学效果.结果 实验组学生测试成绩明显优于对照组(P＜0.05),且问卷调查反馈,该教学法的采用得到实验组学生的好评.结论 心肺听诊电子模拟的采用利于激发学生的学习兴趣,可显著提高教学效果,且可在一定程度上解决教学资源缺乏的问题.

《临床医学概要》考核过程中存在诸多问题,建议实行课程考核方案改革,真正达到以考促学,以学促考,提高执业助理医师考试通过率及适应将来职业岗位对临床专业知识的需求.

Objective To explore the prospective value of the dynamic change of C-reaction protein(CRP) in the Resistant Rheumatoid Arthritis(RRA).Methods Selected 142 patients with RA. Three groups (group A, group B and group C) were divided according to the change of CRP. The comparative analysis of the CRP dynamic change and RRA incidence were made among the three groups.Results At the end of follow-up, the overall incidence of RRA was 23.94%, with 48.00%, 11.11% and 10.00% in every group. A significant difference about RRA was found among the three groups(P<0.05). Further analysis of the dynamic changes of CRP from the follow-up of the 6th week, CRP levels was signiifcantly higher than non-RRA group (P<0.01).Conclusion The dynamic change of CRP can provide clues to a certain extent for the prognosis, prediction of refractory rheumatoid arthritis.

!Objective To investigate the clinical efficacy of low molecular weight heparin and acetylcysteine in the treatment of idiopathic interstitial pneumonia. Methods 80 patients with idiopathic interstitial pneumonia were randomly divided into observation group (n =80) and control group (n=80) from January to December 2015. And control group. 40 cases in the control group received convention-al therapy;the observation group 40 cases, on this basis, combined with low molecular weight heparin and acetylcysteine treatment for 3 months, analysis and comparison of the two groups of patients with clinical efficacy. Results ①Self-rating score of dyspnea: There was no significant difference in the distribution of dyspnea scores between the observation group and the control group before treat-ment (P>0.05). The improvement of the observation group after treatment was improved, but no significant improvement in the control group, between the groups P <0.05. ②The improvement of lung function index: Compared with the control group, the improvement of lung function in the observation group was significantly better than that in the control group (P <0.05). (P <0.05). ③Arterial blood analysis:Before treatment, the PO2 and PCO2 of the patients in the observation group were (53.39 ± 14.00) and (46.23 ± 12.93) re-spectively;the PO2 and PCO2 of the control group were (54.00 ± 13.23) (46.23 ± 11.23). After treatment, the PO2 and PCO2 of the ob-servation group were (71.98 ± 13.98) and (28.98 ± 11.02) respectively. The PO2 and PCO2 of the control group were (62.34 ± 11.23) and (38.83 ± 12.45) respectively, P<0.05. Conclusion Low-molecular-weight heparin and acetylcysteine combined therapy for idio-pathic interstitial pneumonia can significantly improve the patient's lung function indicators, improve the patient's respiratory status, balance the arterial blood Value, better control of the disease, improve the prognosis.

The students of clinical medicine professional (general medicine direction) in our three-year junior level were treated as the research object, a new model of practice teaching reform of internal medicine wasimplemented, mainly by the measures of increasing practice hours, stressing the cultivation of ability quality, integrating curriculum, standardizing training projects and the use of a variety of practical teaching methods and forms. It maked the students smoothly transition from training and trainee to practice, from the "simulation" to "actual combat". It could greatly improve one-time pass rate of the national assistant practicing doctors examination. It could mount guard after graduation, in turn, could make up for the current health demand gap, earnestly to output a large number of qualiifed practical talents in general medicine.

Higher vocational graduates of medical imaging technology colleges oriented medical institutions at the Grassroots Employment as the direction, but at present the problem of employment is facing the great challenge. The trend of employment through the research survey of graduates of the medical imaging technology, analysis of the employment direction, lack of demand, the level of post graduates in the professional and technical posts, to provide a reference for the reform of video technology professional curriculum system, increase employment capacity.

目的 探讨我校三年制专科层次临床医学专业(全科医学方向)施行内科学实践教学模式改革的应用价值及效果.方法 随机选取2013级三年制临床医学专业(全科医学方向)的400名学生分别入选对照组和实验组(各200人).对照组按以前传统内科学实践教学模式进行实践教学,实验组则按照改革后的新内科学实践教学模式进行实践教学.教学结束后对两组学生进行实践技能考核及问卷调查,分别比较两组的实践技能考核成绩及问卷调查结果,评估教学效果.结果 内科学实践教学模式的新改革深受99％的学生欢迎,98％的学生认为有利于提高实践动手操作能力,98％的学生认为极大提高了学习兴趣,且实践技能考核成绩实验组明显高于对照组,有显著差异(P＜0.05).结论 三年制专科层次临床医学专业(全科医学方向)施行内科学实践教学模式改革激发了学生的学习兴趣,有利于提高实践能力,同时也提高了教学质量.

Objective To determine if liver stiffness (LS) measurements by means of Fibroscan (FS)correlate with the presence of significant esophageal varices (EV) and if they can predict the occurrence of variceal bleeding. Methods We studied 100 cases of liver cirrhosis divided into 2 groups:patients without EV or with grade 1 varices (65 cases) and patients with significant varices (grade 2 and 3 EV) (35 cases). We divided the group of 54 cases with EV into another 2 subgroups:without variceal hemorrhage (37 patients) and patients with a history of variceal bleeding (17 cases). We compared the LS values between the groups using the unpaired t-test and we established cut-off LS values for the presence of significant EV and for the risk of bleeding by using the ROC curve. Results The mean LS values in the group 1 was statistically significantly lower than in the group 2. Using the ROC curve we established a cut-off value of 30 kPa for the presence of EV, with 83%sensitivity and 62%specificity, with 76.2%positive predictive value (PPV) and 71.3%negative predictive value (NPV).The mean LS values in the groupⅡ(17 patients) was statistically significantly higher than in the groupⅠ(37 patients):For a cut-off value of 51 kPa, LS had 53.33%sensitivityand 82.67%specificity, with 82.71%PPV and 53.66%NPV for the prediction of esophageal bleeding. Conclusion LS measurement by means of FS is a reliable noninvasive method for the detection of EV and for the prediction of variceal bleeding.

对于高职高专康复治疗技术人才培养，在康复实训基地开展实践教学，通过真实病例的学习，掌握肢体、言语、吞咽等功能障碍的临床特点，提高学生实践能力和职业能力，培养学生解决实际问题的能力。

目的 探讨智能化网络多媒体心电图模拟教学系统在诊断学心电图实训教学中的应用价值及效果.方法 将2011级三年制临床专业1班设为对照组(100人),用以往旧的心电图机及多媒体相结合进行教学;2011级三年制临床专业2班设为实验组(100人),用智能化网络多媒体心电图模拟教学系统教学,通过随堂测验及问卷调查比较两组教学效果.结果 智能化网络多媒体心电图模拟教学系统在诊断学实训教学中深受学生欢迎,94％的学生认为有助于正确与临床资料相结合,综合进行心电图的判读与分析;97％的学生认为有利于提高临床实践能力;98％的学生认为能激发学习兴趣,且课堂测试成绩实验组明显高于对照组,有显著性差异(P＜0.05).结论 在诊断学心电图实训教学中运用智能化网络多媒体心电图模拟教学系统能激发学生的学习兴趣,有利于提高学生的实践动手能力,同时也可提高教学质量.