目的:探讨心脏磁共振成像在评估心肌梗死心肌活性及其PCI术后心功能转归的相关性.方法:回顾性分析2016年7月～2018年12月30例行PCI术后的具有完整临床和影像资料的心肌梗死(MI)患者,并于术前及术后6个月行心脏磁共振及超声心动图检查,利用MRI工作站后处理软件测量左室功能相关参数;PCI术前CMR钆对比剂延迟强化(late gadolinium enhancement,LEG)的左室透壁程度与其术后6个月超声心动图像的左心室壁运动程度作为判断存活心肌的标准进行对比.结果:30例中共有193个左室节段异常,其中术前CMR-LEG有存活心肌121个,非存活心肌72个;PCI术后6个月超声心动图发现在其术前CMR-LEG发现的193个左室异常节段中有125个节段为存活心肌,68个节段为非存活心肌;二者相比较得出CMR-LEG测定存活心肌的灵敏度和特异度分别为92.0％和91.1％.左室壁非存活心肌范围越大,则其室壁运动能力恢复越差,二者呈负相关(r=0.416,P<0.05);CMR-LEG区域首过灌注时间较正常心肌区域明显延长,差异具有统计学意义(t=5.191,P<0.05).结论:心脏磁共振成像能评估心肌梗死心肌活性,反映存活心肌的范围,为临床选择治疗方案及判断预后提供影像学依据.

目的:探讨五年制临床医学生对OSCE考核过程采用SP模式进行病史采集考试改革的适应程度,以期加强病史采集能力.方法:通过考前强化培训,采用OSCE多站式考核方式,考核并统计海口地区2012级五年制临床医学本科182名学生的成绩.结果:通过S P模式强化培训,学生的临床技能掌握程度良好.结论:病史采集技能是医学生实习过程中需重点掌握技能之一,通过强化培训,有助于促进其技巧的掌握.

随着经济的发展,医疗设备越来越精良,医疗技术和水平明显提高,医疗事业快速发展.近几年来医疗纠纷事件却不断增多,且呈现上升趋势,医患关系也呈现出了前所未有的紧张局面.这一现象的出现说明我国现行医院的管理以及医患关系的处理存在众多不足之处.在层出不穷的医闹事件当中,不难发现不良医患关系诱发的纠纷事件不在少数.因此,改善当下紧张的医患关系,构建和谐的医患关系管理模式是现代社会医疗机构和社会各界关注的热点内容.

目的 探讨运用SP强化训练对医学生问诊条理性等技巧的影响.方法 将本校13级临床医学专业本科实习生随机分为实验组和对照组,在实习过程中,实验组接受SP下的强化问诊技巧训练,侧重于问诊的条理性,纠正沟通过程诱导性提问及连续性提问等问诊技巧.对照组未开展强化训练,仅由临床带教教师在临床教学过程,根据自己的经验指导学生和所管的真实患者进行问诊技巧训练.结果 实验组评价问诊技巧的6项内容的成绩明显高于对照组,且差异均有统计学意义(P<0.05).结论 SP模式下的病史采集强化训练,有助于实习生掌握问诊的条理性,纠正沟通过程中诱导性提问及连续性提问,学会感谢患者提供的信息,获得患者的认可,为进一步诊治提供帮助.

目的:基于健康信念模式,分析医学生的抑郁状况,期望为医学生心理卫生问题的干预提供新的思路.方法:采用分层整群抽样的方法选取海南省某高等医学院校1053名医学生,采用自编一般情况调查表、90项症状清单(SCL-90)、应付方式问卷(CSQ)、医学生健康信念调查问卷展开调查.结果:医学生抑郁症状阳性率为17.5％;多因素非条件Logistic回归分析结果表明,性别、应对方式、"知觉到障碍"、"知觉到严重性"、"知觉到易感性"、"自我效能"等6个因素是医学生抑郁的相关因素.结论:医学生抑郁的相关因素包括个人因素以及健康信念中的"知觉到障碍"、"知觉到严重性"、"知觉到易感性"、"自我效能"因素,医学生心理干预可尝试基于健康信念模式的干预方式.

目的:探讨运用SP强化OSCE考试后医学生自我介绍和问诊内容中的一般项目问诊技能的效果.方法:将214名临床医学专业本科实习生随机分为实验组和对照组,实验组(105人)除接受临床带教教师教学外,还要接受2次SP问诊模式的强化培训,对照组(109人)只接受传统的临床教师带教.结果:实习1年后再次进行OSCE考试发现,对照组和实验组的自我介绍和问诊内容中的一般项目成绩均有显著差异(P＜0.05).结论:运用SP模式下的病史采集强化训练,有助于提高实习生医患沟通过程,培养其与患者首次见面时的自我介绍及一般项目问诊的临床能力.

Objective: Based on the health belief model, the depression status of medical students was analyzed in order to provide new ideas for the intervention of mental health problems of medical students. Methods: By using the method of stratified cluster sampling, 1053 medical students in a medical college in Hainan province were investigated with self-designed general situation questionnaire, SCL-90, CSQ and emotional management health belief questionnaire. Results: The positive rate of depressive symptoms in medical students was 17.5％. Multivariate unconditional Logistic regression analysis showed that gender, coping style, "perceived obstacles", "perceived severity", "perceived susceptibility" and "self-efficacy" were related factors of depression in medical studengts. Conclusion: The related factors of depression in medical students include personal factors and the health belief factors such as "perceived obstacles", "perceived severity", "perceived susceptibility" and "self-efficacy". Psychological intervention based on Health belief model can be used for intervention of medical students .

人类历史上暴发的每一次传染病危机都对人民生命安全与身体健康产生重大影响.预防传染病采取的各种措施也伴随着一系列伦理问题.所有传染病的防控措施都会在保证公共健康的重要性与个体的自由与福祉之间形成张力,这些个体的自由可能会以维护公共健康的名义受到伤害.仅凭某种形式的强制干预可以预防伤害这一事实,但不足以认为这些干预措施在伦理上是可接受的.在公共卫生领域采取强制性干预措施的伦理正当性及其影响因素应当加以充分考虑.

目的 探讨心理健康教育新模式,了解基于健康信念模式的医学生情绪管理状况,为进一步开展医学生情绪管理及心理健康教育提供基础数据.方法 采用分层整群抽样的方法抽取本校学生1050名,采用自编一般情况调查表和医学生情绪管理能力调查问卷进行调查.结果 城市学生在“知觉到益处”“知觉到严重性”“自我效能”“外部回报”4个维度上的得分及总分均低于乡村学生(P均＜0.05);独生子女学生在“知觉到益处”“知觉到严重性”2个维度上的得分及总分均低于非独生子女学生(P均＜ 0.05);单亲家庭和非单亲家庭学生情绪管理能力各维度得分及总分差异无统计学意义(P均＞ 0.05);在“知觉到障碍”“自我效能”及总分上,直系亲属未患过心理疾病的学生得分均低于其他学生(P均＜0.05);母亲文化程度为大学及以上的学生在“知觉到益处”“知觉到严重性”“自我效能”3个维度及总分均低于母亲文化程度较低的学生(P均＜ 0.05).结论 医学生的情绪管理能力在健康信念模式的某些维度上存在差异.

目的 了解海南省三甲医院住院患者就医期望,及时发现医疗服务中的缺陷,为加强医院管理提供参考.方法 采用问卷调查法对海南某医学院第一附属医院的422名住院患者进行调查.结果 住院患者的期望按其就医需求的重要程度由高到低依次为:医疗质量(44.3%)、服务态度(21.1%)、医院环境(11.8%)、医疗信息(11.6%)和合理收费(11.1%).结论 医院应根据患者的需求提高医疗质量,从给患者提供人性化的服务入手,改善住院环境,及时与患者沟通,告知相关信息;同时合理收费,将有利于构建和谐的医患关系.

目的 了解"订单式"医学本科生的社会责任感现状,为其职业素质的培养提供理论依据和建议.方法 采用问卷调查法对海南医学院2010~2012级239名临床医学专业免费订单培养的本科生进行调查,并对调查结果进行分析.结果 订单式医学生对自我、他人、家庭、集体、民族、人类及自然都有一定的责任感;对自己和家庭的责任感较强,对民族、人类及自然的责任感行为相对较弱.结论 从社会责任感的认知、情感和行为三方面进行全方位的培养,将有利于提升"订单式"医学本科生的社会责任感及在基层服务的信心和决心.

Objective To discuss effects of practical teaching of general practice theory under different medical models. Methods In September 2013,80 undergraduates majoring in clinical medicine of year 2011 in Hainan Medical University were randomly divided into control group and experiment group (n = 40). According to the school syllabus and teaching plan,the course of general introduction to general practice was developed in two groups routinely,first theory teaching, and then practical teaching. The control group practiced under the general medical model (community health service center), and the experiment group under the specialist medical model (specialist of general hospital). The two groups had the same practical contents. After the practice,the evaluation of the teaching effects was made by students through questionnaire survey. A total of 78 questionnaires were collected and 39 in each group. The effective response rate was 97. 5% . Results There was no significant difference in evaluating the humanistic medical care presented in practical contents the between the two groups (P >0. 05). The evaluation of accessible medical care,coordinating medical care,continuous medical care,comprehensive medical care,basic medical care presented in practical contents by students in the control group was significantly better than that in the experiment group (P < 0. 05). The evaluation of biological - psychological - social medical model,individual - group combined medical care,prevention - oriented medical care,community - based health care presented in practical contents by students inthe control group was significantly better than that in the experiment group (P < 0. 05). There was no significant difference in the evaluation of chronic disease management presented in practical contents by the students between the two groups (P > 0. 05). There was no significant difference in the evaluation of teaching quality (cultivation of the doctor - patient communication and archives writing ability,understanding the differences between general and specialist medicine,help to learn and apply the general practice theory and practice,practice places,satisfaction of teachers)between two groups (P > 0. 05). Conclusion The practical teaching of general practice theory under specialist and general practice models can make students understand and apply the basic theory characteristics and principles of general practice objectively,and thus achieve a good practical teaching purpose.

目的 探讨"品管圈"活动在提高门诊患者满意度中的应用效果.方法 2016年1~6月,九龙坡区人民医院门诊成立优质服务"品管圈",应用"品管圈"管理办法对门诊患者就诊过程中存在的问题讨论分析,制定相应措施及实施方案,并将活动前(2015年7~12月)400例和活动后(2016年7~12月)400例门诊患者的满意度、投诉率等进行比较.结果 实施"品管圈"管理活动后,门诊患者的满意度由93.50%提高到96.75%,投诉率由42.50‰下降到15.00‰,差异均有统计学意义(P<0.05);而且门诊护理人员的沟通协调能力、解决问题的能力等综合素质均得到明显提升.结论 通过"品管圈"管理模式可以改善门诊工作中存在的问题,不断深化优质服务,提高患者满意度和护理人员的综合能力.

基于当前医患矛盾不断加剧,患者对医生的期望愈来愈高;如何扮演好患者期望的角色,为患者提供更好的服务,本文从不同角度了解到患者就医时希望医生有整洁的仪表姿态、大方得体的举止、温和耐心的言谈、高尚的职业道德及精湛的医疗技术,提出医生应从职业形象、职业道德和专业技能三个方面构建自己的良好形象,建立和谐医患关系.了解患者的期望,有助于医生在不断完善医疗知识的基础上,注重职业形象、优化职业素养,从而更好胜任时代赋予医生的新使命.

"订单式"医学生作为未来基层医疗执业的后备军,能否扎根基层,具备高度的社会责任感,是社会和学校共同关注的焦点.通过对海南医学院"订单式"医学生社会责任感的调查,了解他们社会责任感缺失根源,从社会、学校、家庭、个体四个方面剖析其社会责任感缺失的原因,从而多方努力,培养其社会责任感.

通过论述知行一体概念,提出医学伦理学教学模式改革,引入案例教学、模拟实践等多种教学方法;以第二课堂为依托,引人体验式学习机制;改革评价方式,将过程性评价和终结性考核合理结合,全方位培养医学生的人文素养.

Objective To observe the anatomy status of the anterior clinoid process (ACP)and the anterior clinoid segment of in-ternal carotid artery (ICA)respectively by multisliced computed tomography (MSCT),and to provide useful imaging information for ACP removal surgery.Methods A total of 100 patients (200 sides)had volume rendering reconstruction of skull.Cranium was removed along cranio-orbital bone in simulation.Then the anatomical structures of the ACP and its surrounding were observed in cephalad direction.The total length,medium length,basic width,medium width of the ACP and the sagittal view curve length of anterior clinoid segment of the ICA from both sides were measured.Results Total length of left ACP was (9.82±2.48)mm,basal width was (9.47±1.88)mm,medium length was (5.03±1.55)mm,medium width was (6.1 9 ±1.75)mm;for right side total length was (10.41±2.1 6)mm,basal width was (9.66 ±2.21)mm,medium length was (5.86 ±2.48)mm,medium width was (6.66±1.5 1)mm.Left anterior clinoid segment of ICA curve length was (6.74±2.25)mm;right was (8.54±3.00)mm.Paired sample t test showed no significant difference in total length,basal width and medium width of ACP in both sides (P >0.05);while the difference in medium length and curve length of the anterior clinoid segment of ICA were statistically significant respectively (P <0.05).Conclusion MSCT can clearly display the vivisection and variation status of the ACP and the anterior clinoid segment of the ICA and can provide useful imaging information for removal of ACP in operation.

目的 利用多层螺旋CT(multi-slice spiral computed tomography,MSCT)三维重建在活体个性化观察颈内动脉(internal carotid artery,ICA)床突段与眼动脉(ophthalmic artery,OA)分支的关系.方法 观察100例(200侧)受检者薄层轴位和容积再现(volume rendering,VR)融合图像上OA的起始位置,并将轴位ICA前半部分分成前内、中、外各1/3等分,分别记录OA起始点所在的位置;常规进行VR重建颅骨,沿眶截骨平面模拟切除颅盖骨,同时分别距前床突左或右外侧缘1 cm处模拟矢状位切除左或右外侧颅骨,并以正中矢状面将其分成左右两部分,于左或右侧分别观察OA与ICA的上下关系.结果 100例(200侧)受检者中,轴位上OA起始于ICA前、中、外1/3各占52.00％(左29.00％,右23.00％)、45.00％(左19.50％,右25.50％)和3.0％(左右各1.50％).侧位上OA起始于OA段、床突段及其交界处者分别为76.50％(左39.00％,右37.50％)、6.00％(左、右侧各3.00％)、17.50％(左9.00％,右8.50％).结论 MSCT能清楚地显示前床突、ICA床突段与OA起始部的关系,能为显微外科手术入路的选择和术中磨除前床突提供有用的影像学信息.

注重医学生人文素质的培养，为基层输送高素质的全科医学人才，是当前医学教育的根本任务之一。在分析医学生人文素质不足的基础上，探讨了“订单式”医学本科生人文素质教育的有效途径：根据社会实情，有针对性培养；在专业课中注重人文知识渗透，激发学生关爱生命的伦理思想；在社会实践中，培养学生社会责任感和奉献精神。