目的 通过对全国三级甲等医院神经介入医师进行调研,了解我国不同行政区域三级甲等医院急性缺血性脑卒中患者院前预警与院内绿色通道流程管理的现况及同质性.方法 采用便利抽样法,通过问卷星微信小程序、邮件等方式向我国脑血管病介入治疗领域的专家发放ALICE调查问卷(中文版脑血管病血管内治疗现状问卷调查-ALICE研究),调查内容包括医院基本信息、脑血管病(急性缺血性脑卒中、颅内动脉瘤、动静脉畸形、非狭窄性颈动脉斑块)治疗现况、患者转运制度等,并分析不同行政区域(华北、东北、华东、华中、华南、西南、西北七大行政区)的绿色道管流程通理现状及不同优化管理策略所能节省的入院至治疗时间.结果 共发放问卷142份,剔除内容不完整的问卷11份,回收有效问卷131份.131名神经介入医师来自126家医院,所有医院均为三级甲等医院.126家医院中,年机械取栓治疗例数>100例的医院占31.0％(39/126),救护车直接入院是急诊急性缺血性脑卒中患者的主要收治方式[53％(35％,70％)].不同行政区域医院的院前预警机制、急诊预检、CT机与导管室空间布局、常规麻醉方案、机械取栓准备均存在轻度差异,但差异均无统计学意义(P均>0.05).麻醉医师全天处于可呼叫状态、优化影像学检查流程、CT机位置优化或功能整合、提前预警机制分别可缩短入院至治疗时间21(19,30)、20(15,30)、20(12,25)、19(10,23)min.结论 我国不同行政区域三级甲等医院之间急性缺血性脑卒中院内绿色通道救治流程的同质性较高.避免非必要步骤、规划合理的卒中绿色通道及采用并联化管理可极大提高救治效率.

Objective:To investigate the propensity for mechanical thrombectomy for acute ischemic stroke with medium vessel occlusion (MeVO).Methods:From January 2019 to January 2020, doctors from 150 tertiary hospitals in China capable of performing mechanical thrombectomy were selected as the survey subjects. Questionnaires from 131 physicians in 126 hospitals were collected for the study. Referring to the Advanced Live Interventional Course of Essen (ALICE), the research questionnaire was designed, and the questionnaire was collected by Sojump. The contents of the questionnaire included: (1) Information about the hospitals and doctors was interviewed. (2) Six cases of mild MeVO were designed (3 cases in each group with and without contraindications to alteplase thrombolysis), and each group included 1 case with occlusion at the M3 segment of the middle cerebral artery, 1 cases with occlusion at the A2 segment of the anterior cerebral artery, and 1 case with occlusion at the P2 segment of the posterior cerebral artery. The treatment plan adopted by the interviewed doctors for 6 cases was investigated (immediate mechanical thrombectomy, refusal to perform mechanical thrombectomy, and mechanical thrombectomy after failure of thrombolysis). (3) Five typical MeVO cases with ages of 40-, 50-, 60-, 70-, and ≥80 years respectively were designed to investigate the treatment strategies for cases of different ages. (4) We investigated the difficulties of using mechanical thrombectomy for MeVO in clinical practice and relevant possible solutions.Results:Among the 131 physicians, the proportion of physicians refusing mechanical thrombectomy in 6 cases was 30.5% (40) to 47.3% (62). For M3 segment occlusion without contraindications to thrombolysis, the proportion of physicians choosing immediate mechanical thrombectomy was 11.5% (15), that was 33.6% (44) and 29.8% (39) for A2 and P2 occlusion respectively, and the differences were significant ( P<0.001). The proportion of physicians considering mechanical thrombectomy after failure of thrombolysis was 58.0% (76) for M3 segment occlusion, that was 22.1% (29) and 22.9% (30) for A2 and P2 occlusion respectively, and the differences were significant ( P<0.001). For M3 segment occlusion patients with contraindications to thrombolysis, the proportion of physicians choosing immediate mechanical thrombectomy was 55.7% (73), that was 68.7% (90) and 58.0% (76) for A2 and P2 occlusion respectively, and there was no significant difference ( P=0.720). For patients aged 40-, 50-, 60-, 70- and 80-, the proportion of doctors choosing mechanical thrombectomy were 86.3% (113), 84.8% (111) , 85.5% (112) , 77.9%(102) and 48.9%(64) respectively. the differences were significant ( P<0.001). The challenges of mechanical thrombectomy for MeVO mainly included the lack of thrombectomy instruments, assessment tools, and related technical experience. Conclusion:At present, there is a large heterogeneity in the endovascular treatment of MeVO, and the overall preferred ratio of mechanical thrombectomy is low.

Objective:To study the features and regularity of the diseases occurred among the officers and sailors of a certain large surface ship during a long oceangoing mission, and to provide some targeted preventive measures for improving the medical support in long oceangoing mission in future.Methods:A retrospective survey was conducted on the medical records of outpatient, emergence, and onboard medical inspection by classifying all the cases into different medical disciplines, to analyze the features of disease distribution and regularity among the crew members during a long oceangoing mission.Results:There were 673 case/times were included into this analysis from the 81-day-long 549-people-participation oceangoing mission. The top 3 disorders involved in the respiratory system, the motor system (trauma), and the digestive system, accounting for 70.58% of the total cases. Among them, the upper respiratory tract infection, hand injury, and oral ulcer accounted for 21.86%, 5.65%, and 5.28% of the disease spectrum respectively. The incidence of diseases requiring surgery and further medical care was relatively higher (24.59%), especially trauma and infectious diseases as the prevalent disorders, concentrating on the motor system and digestive system.Conclusion:The disease spectrum during the long oceangoing was related with the onboard living environment, individual body constitution, individual history of long oceangoing deployment, and gender difference. With regard to disease control, the efforts should be devoted to health education and disinfection of onboard environment, especially preventing infectious diseases. Personal health records and pre-warning of disease outbreak system should also be established if necessary. Meanwhile, the manning of medical team and the preparation of medical supplies should conform to the features and distribution regularity of diseases spectrum during a long oceangoing mission.

The United States attaches importance to teachers' teaching ability development in higher medical colleges and universities. The measures include integrating the promotion of teacher development into the certification standards of colleges and universities, establishing a specialized service organization, updating the training content and form , and evaluating the effectiveness of the training programs . The enlightenment for medical colleges and universities in China is to improve the status of teaching in colleges and universities, strengthen the construction of teaching service organization, scientifically plan the teachers' career development, enrich the teacher training content, and diversify the training model.

采用大学生羞耻量表进行问卷调查,并采集该学期学业成绩.结果表明羞耻量表内部一致性信度、分半信度良好,适合在军校医学生中使用.个性、行为分量表高于常模(边缘显著),总量表得分显著高于常模分,个性羞耻感得分与学业成绩呈正相关(边缘显著),高个性羞耻感学生学业成绩更好.提示管理部门应关注学生个性羞耻感的教育.

Concerning the first navigational practice for the military medical university students, a"united-separated"integrated training mode was carried out in the ocean-going navigation of a large-scale surface fleet of Chinese Navy, and achieved favorable effects. With the navigational practice as its premise, medical practice as its foundation and overall qualities promotion as its goal, this training mode proved to be an effective practical exploration on cultivating medical service talents for a powerful navy.

医学院校教育是我国传统医学教育模式下的基础阶段,主要指医学生在医学院校内本科或研究生学历之内的时期. 医学院校通过开设全科医学相关课程,使医学生能够对学科产生初步认识,掌握基本临床技能,是全科医学人才培养的基础. 本次研究回顾和梳理了近年来国内医学院校在课程体系、 教学模式与教学评价等方面做出的改革尝试,讨论了医学院校教育在全科医学人才培养体系全局中的现状, 同时立足于学科特性与社会需求,为医学院校教育提供改良思路.

生理学是医学教育基础课程中的核心内容之一.随着医学教学改革的不断深入和现代化科技的迅速发展,教学方法和手段日趋完善,传统的生理学教学模式受到了前所未有的冲击.文章通过微信在传统的LBL+PBL+CBL教学模式中激活式应用的体会,说明了传统教育在保留其优势的前提下,如何更好地融入及跟上现代科技的脚步,跟随新时代学生的思维模式及其全新生活方式,全方位、立体地进行生理学知识的传授,激发学生的学习兴趣,有效地调动其主动寻求知识的积极性,从而达到良好的生理学教学效果,为学习其他医学课程打好坚实的基础.

社会职业引导作为全科医学人才培养重要的组成部分,是指因行业服务发展需要而对全科医学人才的业务能力提供引导性提升支持的培养方式.本文从我国的初级医疗服务发展的现状出发,提出以医疗卫生事业发展的行业需求和医疗服务发展的社会需求为导向的社会职业引导的全科医学人才培养概念,意在为全面提升全科医学人才的培养质量探寻出路,推动全科医疗服务创新发展.

全科医学是一个服务于社区与家庭,整合临床医学、预防医学、康复医学以及人文社会学科等多专业内容于一体的综合性医学专业学科[1],它既包含了其他学科在医学专业知识和技能上的共性,更具有自身学科专业体系和服务模式的特性.因此,在着眼于全科医学的学科发展,特别是学科发展的核心——全科医学人才的培养时,应当注意兼顾学科的两大特性.全科医学人才培养的“三位一体”模式旨在突破我国当前全科医学事业发展的瓶颈期,为推动全科医疗服务创新思路.

目前,随着社会快速发展和人民生活水平的提高,居民对于医疗和健康的要求逐渐增加,全科医学人才承担了基层常见病诊治、慢性病管理、健康宣教等大量工作,在完善分级诊疗制度、推动医药卫生事业改革中发挥不可或缺的作用. 本次研究分析当前全科医学人才临床岗位培训现状,探讨改良途径,旨在探索培养新思路,完善全科医学人才培养模式.

Objective To analyze the epidemiological characteristics of 2 859 patients with hip fractures,so as to provide reference for the prevention and treatment of elderly patients with hip fractures.Methods The clinical data of 2 859 patients with hip fractures in Changhai Hospital,Second Military Medical University from Jan.2004 to Dec.2016 were collected,including age,gender,injury mechanism,fracture type,injury-operation time,hospital stays,bleeding volume and operation method.SPSS 16.0 software was used to analyze the epidemiological characteristics of elderly patients with hip fractures.Results (1) The total number of in-patients with hip fractures in our hospital increased annually,with the proportion of femoral neck fractures being the highest (1 602/2 859,56.03％),followed by intertrochanteric fractures.(2) The age of the patients with hip fractures was 52-104 years old,and there was a significant difference in the age distribution (P＜0.05),with the patients aged 71-80 years being the most majority,accounting for 37.39％ (1 069/2 859).(3) The proportion of female patients with hip fractures (1 916/2 859,67.02％) was higher than that of male patients (943/2 859,32.98％).(4) The distribution of injury mechanism was significantly different (P＜0.05).The number of fractures caused by walking falls was the highest,accounting for 87.65％ (2 506/2 859).(5) The distribution of fracture types was significantly different in different genders (P＜0.05).The proportion of femoral neck fractures was higher in female patients,while the proportion of intertrochanteric fractures was higher in male patients.(6) The incidences of hip fractures were the highest in patients with diabetes or cardiovascular disease,accounting for 26.76％ (765/2 859) and 25.85％ (739/2 859),respectively.Conclusion Femoral neck fractures and intertrochanteric fractures are the most common types in elderly patients with hip fractures.The distributions of age,gender,injury mechanism and complications of elderly patients have certain epidemiological characteristics,which provides clue to further improve the prevention and treatment of hip fractures.

This paper retrospectively reviewed the program of soliciting reflective notes on clinical internship among medical students of a military medical university for consecutively 4 years, aiming to find out the positive effects on their clinical practice.It is concluded that writing reflective notes is of great significance for the department of teaching and administration to know more about interns teaching management, to stimulate medical students'' enthusiasm in clinical internship and to preserve and promote clinical records.Therefore, it is an effective teaching management method worthy of popularization.

本文通过分析当前医学生成长过程中普遍面临的“两个问题”，提出当下卫生法教育应在案例教学法基础上充分利用有限的教学资源，调动学生思考与讨论积极性，增进师生互动，把唤醒医学生的法律和责任意识，培养其职业精神和道德素质作为主要目标，着力打造好几堂具有启发意义的精品课。

通过对军队医学院校援外培训教学中授课形式、教学方法和教学评价等方面的调查，提出医学援外培训教育应注意合理安排授课形式、采取灵活的教学方法、提高教师的授课技能、采取适当的学习评价方式，以提高教学质量。

军队医学本科留学生教育在我国刚刚起步，第二军医大学经过两年的探索，通过科学的顶层设计，建立了留学生教学、管理和质量保证体系，有力促进了军队医学本科留学生教育的质量。

有机化学是医学专业公共基础课程，在医学专业中的作用和地位非常重要。有机化学课测重于介绍有机化合物的结构和性质，是后续生物化学、药理学、临床药理学等的重要支撑课程之一。人体内与生命相关的生物大分子物质的结构、性质，以及生命机体活动中的变化都与有机化学有着密切关系。本文在分析留学生有机化学教学特点的基础上，开展了一些具体优化教学效果的方法，为医学专业留学生有机化学教学方法及改革提供了一些意见和建议。

实践教学是生物技术专业人才培养的关键一环，本文从改革生物技术实践教学体系、建立本科导师制、拓宽校外实践教学交流平台、优化毕业考评机制等方面对加强和完善实践教学体系进行了研究和探讨。

Objective To explore suitable anatomy for teaching methods for international medical students from multiple sources. Methods Thirteen international medical students of 6-year-programme （grade 2011） and 19 Chinese medical students of five-year-programme were taught with Chinese system anatomy（module） textbooks and Chinese-English bilingual textbook（as reference） by three-step bilingual anatomy teaching method , which includes previewing anatomical vocabulary , teaching Chinese and foreign students in the same class. Teaching effect was international tested by scale separating teaching and examing and questionnaire survey. SPSS 10.0 was used to do statistical analysis and t test was used to compare the score of Chinese medical students and international med-ical students. P〈0.05 students for statistic difference. Results Average test scores of international and Chinese students in the same class were 86.2 and 88.1 respectively, with no significant difference （P﹥0.05）. 92.3%（12/13） international students were satisfied with this teaching method and the same class teaching for Chinese and international students . Conclusions Three-step bilingual anatomy teaching method in the same class may be more suitable for international students from multiple sources and this teaching method is worthy of further study and practice.

To understand the status of critical thinking skills and constraints of eight -year medical students in military medical university and provide the basis for higher medical education reform .Critical thinking skills meter ( CTDI-CV) was used to investigate 81 eight-year medical students from 2009 to 2012 grade.Of 81 students the average total score of critical thinking skills was 231 .10 ±26 .68 , indicating that the critical thinking tendencies were in contradiction .There was no significant difference between all grades .Among seven dispositions , only their cognitive maturity had positive quality (>40 ) , and the rest dispositions were weak (<40 ) .Their self-confidence was the weakest disposition (28.62 ±6.12).Traditional teaching methods and lack of critical thinking training may be the major restricting factors .