Evaluation of teaching-in-English reform in five-year clinical tropical medicine program–Case analysis of curriculum reform of clinical medicine in Hainan Medical University

Objective: To investigate the model, quality as well as effect of teaching-in-English in five-year clinical medicine program of Hainan Medical University.Methods: The questionnaire was carried out among clinical medicine undergraduates of2012–2015 grades in Hainan Medical University, to investigate studying time, studying habits and the impact of teaching in English. Additionally results of CET-4, CET-6 and overseas internship from undergraduates of 2012–2015 grade, as well as the result of phased medical licensing examination and post-graduate entrance examination from undergraduates of 2012 were accordingly collected from the Teaching Management Department.Results: For the Chinese students in international classes, the average time of self-study was 161.49 min, 58.3% had preview before classes, and 90.7% had habit of review after classes. Thus the first time pass rate, total pass rate, first time excellent rate and total excellent rate of CET-4 and CET-6 of international classes were significantly higher than those of regular classes. The result of post-graduate entrance examination in 2016 showed that the score, pass rate and acceptance rate of international classes of 2012 grade were significantly higher those of regular classes(P < 0.01).Conclusions: Teaching-in-English reform in Hainan Medical University has achieved initial success. Chinese students from international classes are superior to those from regular classes in many aspects. However, there are still many problems, and effective measures should be implemented to promote teaching quality continuously.

Implementing and Popularizing Health Clinics and Educational Programs in NJ School Areas for Supporting NJ Pregnant Teenagers

This proposal focuses on the prevalence of teenage pregnancy issue in NJ and illustrates the benefits of school-based health clinics and educational programs which should be implemented for teenage pregnancy and childbearing.Without the early intervention of educational programs and preventive medical services which should be implemented in school areas,teen pregnancy and childbearing can have physical and emotional health influences on teen mothers,their babies and other family members,and the worst consequence should be abortion.What’s more,teenage pregnancy and childbearing have substantial economic consequence for state.The annual estimated cost associated with teen childbearing (teens 19 and younger) in NJ to taxpayers is at least $167 million in 2004 (24% federal costs and 76% state and local costs).Studies demonstrated that a much larger amount of money is spent on the consequences of teenage pregnancy than on prevention.NJ has an opportunity to invest in prevention and reduce not only the monetary but also the societal costs to our youth burdened by the often overwhelming responsibilities of teenage pregnancy and parenting.According to the 15 years follow-up research and data analyzing,two models of success which specifically implemented in South Carolina high schools and Chicago public schools have been proved to effectively reduce incidence of repeat pregnancy and emergency room visits,reduce incidence of teen mothers smoking during pregnancy,improve emotional outcomes among teen mothers,decrease incidence of teen mothers drug impairment,arrest,conviction,or jail time and reduce use of food stamps and other public assistances,which can consequently increase the state public health costs.In order to support teen mothers’ academic,physical,emotional and social needs in a stable and consistent school environment,the plan which titled "Physical and Mental Health Promotion for NJ Teen Mothers" is effective and practical enough to arouse the attention of some relevant departments.It’s worth patron to fund the plan because supporting teenage pregnancy at early stage can subsequently benefit the national and state economy and teen mothers.

A review of obstacles and facilitating factors of implementing Clinical Ladder Programs in nursing

Clinical Ladder Programs is to develop different training programs according to different levels of nurses’management.The purpose is to improve nurses’sense of professional identity,professional and technical capabilities,and determine salary levels,so as to fully mobilize nurses’enthusiasm.This article reviews the current status of the application of Clinical Ladder Programs in clinical nursing around the world,and understands the obstacles and facilitating factors that affect the implementation of Clinical Ladder Programs,in order to provide a reference for establishing a perfect hierarchical nurse training model in China.

中美老年专科临床药师培训项目比较分析

目的 比较中美两国老年专科临床药师培训项目的基本情况,为我国老年专科临床药师培训项目的进一步优化提供参考。方法 查询美国卫生系统药师协会(ASHP)和中国医院协会官方网站,检索并收集中美两国老年专科临床药师培训项目的培训大纲、机构类型/规模、招生人数、培训内容、申请条件、考核标准等资料和数据,采用Excel软件进行统计分析。结果与结论 截至2024年1月12日,美国ASHP共开展毕业后第2年老年专科临床药师培训项目24个,可招收25人,并提供相应薪酬;培训基地涉及医院、药学院,规模不一;申请人需获得药学博士学位、完成毕业后第1年培训。ASHP就基础患者照护、高级患者照护、领导力和管理能力、知识的教育教学传播能力四大必备技能设计了详细的培训目标,各培训基地可结合自身特点,适当增设学术技能、长期照护技能等可选技能,制订学员轮转计划,并在培训过程的多个时间节点进行考核、评估。我国共开展老年专科临床药师培训项目5个,可招收15人,不提供薪酬;培训基地均为三级甲等医院,规模较大;申请人需要获得本科及以上学位,并根据所学专业和学位的不同,对其有不同的工作年限要求。中国医院协会药事专业委员会设置了详细的培训大纲,就理论知识、实践技能、科研思维等提出了具体的培训目标,在入组时、规定内容培训完成时和结业时由培训基地组织考核、评估。参考美国的项目开展经验,建议带教老师针对不同层次的学员开展差异化的知识和技能培训,灵活安排轮转科室,要求学员尽可能独立开展工作并深入参与临床教学、科研工作,安排多次、多种形式的考核、考察,及时调整学习方案,全面提升学员能力。

Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease

Background: There are many programs which focus on late-stage chronic kidney disease (CKD), and it is considered that further evidence needs to be generated regarding the effectiveness of the programs used before renal replacement therapy. Study Design: A cohort study. Settings & Participants: Patients over 15 years of age who had been diagnosed with CKD according to the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines and who had undergone conventional treatment (CT) or a renal protection program (RPP). These were patients of two Colombian health insurance companies. Predictors: Age, sex, marital status, comorbidities, CKD stage, and clinical indicators. Outcomes: First CKD progression, and need for renal replacement therapy (RRT). Measures: Clinical marker. Results: The RPP is structurally and functionally different from the CT. It offers the interdisciplinary management of patients, a greater number of medical appointments, and patients start to receive treatment at younger ages and at earlier stages of their condition. The clinical markers of the patients following the RPP are within adequate ranges, and their renal function is less impaired, despite the differences in basal conditions. Upon finishing the study, we found that patients who received CT had a higher risk of receiving nephrotoxic drugs and not receiving nephroprotective drugs. The explanatory variables for the first progression were age, stage, history of dyslipidemia, and hemoglobin, potassium, and albumin levels. These variables, together with glycemia levels were also valid for RRT, except for history of dyslipidemia, as it was not significant. Upon adjusting for the explanatory variables, it was found that belonging to the RPP and attending more appointments had a protective effect in the process of controlling renal damage. Limitations: A possible selection bias. Conclusions: Belonging to a structured renal protection program is an effective way to keeping the clinical markers associated with renal impairment within normal ranges.

Transversal Competencies of a Clinical Mentor in Nursing Graduate Studies

Introduction: The focus of clinical mentoring in nursing specialists is to develop both generic or transversal skills, as well as specific skills needed to assess their profile and become a graduate student under the guidance of experts. Objective: The objective of this study is to diagnose the transversal competencies of clinical mentors from the Unique Program of Nursery Specialties (UPNS) in student body training. Method: This study utilized a descriptive and phenomenological interpretative approach. Twelve informants from UPNS participated, and the variables were clinical mentoring and transversal competencies from novice and senior mentors. Two focus groups were conducted for data collection, and data analysis was performed according to Strauss and Corbin. All participants provided signed informed consent. Results: Post-analysis of qualitative data revealed three categories with subcategories. Category 1: Strengths of clinical mentors in three dimensions. Sub-categories: 1.1) PD: Academic and personal companionship;1.2) PD: Guidance with humanist focus and feedback from mentor to student in real scenarios;1.3) PD: Guidance in the teaching-learning process;1.4) DD: Integration of theoretical-practical knowledge and development of advanced abilities in nursing for clinical practice;1.5) CD: Responsibility and commitment from student’s characteristics to group’s general statements. Category 2: Competencies that lead the clinical mentor in pedagogy, discipline and generic dimensions, reported 9 subcategories six of them focused on the didactics of clinical mentors, and three on the interpersonal communication between mentors. Category 3: Opportunity areas to develop by the clinical mentor. From a mentor’s perspective, eight subcategories revealed transversal competencies that define a clinical mentor for UPNS. In this state, competencies are oriented toward the pedagogical and interpersonal communication dimensions, but central aspects are recognized between disciplines, namely, precise theoretical-practical knowledge, clinical experience in the field of specialty, certification as a specialist, and updated knowledge. Conclusions: The profile of clinical mentors from UPNS clearly identifies transversal competencies in clinical teaching and interpersonal communication, both of which are important. In terms of professional competencies, there are leaders in nursing specialty, meaning that these competencies are specific in such cases.

精神心理方向护理硕士专业学位研究生临床实践培养方案的构建

目的 构建精神心理方向护理硕士专业学位研究生临床实践培养方案。方法 基于文献回顾和专家讨论,形成精神心理方向护理硕士专业学位研究生临床实践培养方案初稿。选取来自北京、长沙、武汉、南京、上海、广州、成都、合肥、南昌的13名专家作为函询对象,于2022年10月—12月采用专家函询法对其进行2轮函询。结果 2轮专家函询的专家积极系数均为100%;专家权威系数分别为0.94、0.96;肯德尔协调系数分别为0.251和0.418(P<0.001)。最终构建的精神心理方向护理硕士专业学位研究生临床实践培养方案由7个模块(培养目标、培养内容、培养方式、培养时间、考核内容及占比、带教师资、实践基地)、36个一级条目、67个二级条目、103个三级条目构成。结论 本研究构建的精神心理方向护理硕士专业学位研究生临床实践培养方案科学、可信,可为我国精神心理方向护理硕士专业学位研究生临床实践能力的培养提供参考。

Practice on Capability Accreditation Program(CAP)of Ethics Review System for Chinese Medicine Research

Capability Accreditation Program(CAP) of Ethics Review System for Chinese Medicine Research of World Federation of Chinese Medicine Societies(WFCMS) is the first certification project in the field of Chinese medicine research on ethics review. Based on the Requirements for Ethical Review of Biomedical Research Involving Human, ethical review system for Chinese medicine research was established and standardized from 4 aspects, such as organization, ethics committee, office of the ethics committee, and researchers. The period of CAP certification is three years, which include certification application and acceptance, initial certification(document review, on-site audit), certification decision, and supervision audit. The implementation of the CAP certification is of great importance for upgrading the research on ethics review system of Chinese medicine, which promotes the development of the research on ethics review system in China and the continuous improvement of the ability of the Chinese medicine research on ethics review.

微信小程序在护理本科实习生母乳喂养临床教学中的应用

探讨微信小程序在护理本科实习生母乳喂养临床教学中应用的效果。采用便利抽样法,以某三级甲等医院产科2022年3—9月入科的72名护理本科实习生为对照组,采用常规临床教学方法;2022年10月—2023年3月入科的74名护理本科实习生为试验组,在对照组的基础上应用微信小程序打卡学习母乳喂养知识。应用实践表明,在产科母乳喂养临床教学中应用微信小程序进行打卡学习,有助于提升学生母乳喂养的知识水平和指导产妇进行母乳喂养的自我效能,提升教学满意度。

临床医学"5+3"一体化医学生对班导师教育引导需求的调查研究

自主设计网络调查问卷,对大连医科大学第一临床学院145名临床医学"5+3"一体化学生的学习现状及学习需求进行分析.结果显示:46.90%的学生有很大或比较大的学习压力,且高年级比低年级更明显(P<0.01);学生们课余时间主要用于安排专业学习、看课外书籍、参加社团活动、参加体育运动,但也有54.48%的学生花时间在手机游戏上;学生们最希望班导师在专业学习和职业规划方面提供指导,男女生存在一定差异(P<0.01);学生们在大学期间的目标规划排前三位的分别是掌握好医学基础知识、通过国家英语四六级考试和掌握基本的临床技能.深入了解学习现状及需求,有利于制定更符合"5+3"医学生特点和需要的班导师教育引导形式.

我国临床药学专业本科教育药学服务能力培养现状分析

目的探索适合我国药学服务人才培养的本科教育模式。方法分类收集我国10所高等学校(山东大学、上海交通大学、四川大学,安徽医科大学、哈尔滨医科大学、南方医科大学、天津医科大学、南京医科大学,中国药科大学、沈阳药科大学)2018年至2021年临床药学专业本科学生的培养方案,包括课程设置、学时和学分方案等,并对药学服务能力培养相关课程体系进行比较与分析。采用问卷调查法,调研四川大学华西药学院2018级至2022级在校临床药学专业本科学生对现行培养方案的认识、评价与需求。结果10所高等学校中,临床药学培养方案总学分和总学时、必修课程学分和学时设置最多的均为南京医科大学(290学分和3886学时,209学分和3562学时)。选修课程设置学分最多的为四川大学(35学分)。各医科大学理论课程设置学时较多,四川大学、中国药科大学、山东大学的实践课程设置学时较多,理论课程、实践课程学时最多的分别为南方医科大学(2910学时)和四川大学(1332学时)。各高等学校(除上海交通大学无法统计外)毕业实习时长均达到42周。中国药科大学和四川大学开设的药学服务类课程相对较多(14门、494学时和14门、424学时),且兼顾了理论和实践教学。共发放问卷149份,回收有效问卷141份,四川大学临床药学专业学生对培养方案和药学服务相关课程总体满意度高(均超过70%),但仍有24.11%的学生认为理论课程过多,实践课程过少。结论调研的10所高等学校临床药学专业本科学生的培养方案存在较大差异,且均缺乏系统的药学服务能力培养课程体系。建议以药学服务胜任力为目标,完善临床药学专业本科实践课程体系建设,增设跨学科、跨专业实践课程,建设药学服务课程群,将药学服务能力培养贯穿本科教育始终,构建适合我国药学服务人才培养的本科教育模式。

铜绿假单胞菌脓毒症患者程序性细胞死亡受体1/程序性细胞死亡配体1信号通路相关蛋白与短期临床预后的相关性分析

目的探讨程序性细胞死亡受体1/程序性细胞死亡配体1(PD-1/PD-L1)信号通路相关蛋白对铜绿假单胞菌(PA)脓毒症患者短期临床预后的影响。方法选择2021年1月—2023年6月宁夏医科大学总医院收治的122例PA脓毒症患者为研究对象,均根据脓毒症治疗指南和实际病情开展治疗。收集患者临床资料、治疗前慢性健康状况评分系统Ⅱ(APACHEⅡ)评分;治疗前抽取外周静脉血测定T淋巴细胞水平(CD3^(+)、CD4^(+)、CD8^(+))以及血清PD-1和PD-L1水平。结果122例PA脓毒症患者入住急诊重症监护室及其他科室后28 d存活101例(82.79%,存活组),死亡21例(17.21%,死亡组)。存活组与死亡组患者高血压比率、慢性阻塞性肺病比率、慢性肝病比率、APACHEⅡ评分、CD4^(+)、CD4^(+)/CD8^(+)、PD-1和PDL-1比较,差异有统计学意义(P<0.05)。单因素Logistic回归分析结果显示,基础疾病(高血压、慢性阻塞性肺病、慢性肝病)、APACHEⅡ评分、CD4^(+)/CD8^(+)、PD-1和PD-L1均是PA脓毒症患者短期生存的影响因素(P<0.01)。多因素Logistic回归分析结果显示,基础疾病(高血压、慢性阻塞性肺病、慢性肝病)、APACHEⅡ评分、PD-1和PD-L1均是PA脓毒症患者短期生存的影响因素(P<0.01)。结论PD-1/PD-L1信号通路对PA脓毒症患者的临床预后有影响,该通路相关蛋白表达上调可增加PA脓毒症患者短期临床预后不良的风险。

罕见病医学科临床医学博士后教学模式探索

临床医学博士后培养项目是中国探索新时代医学精英教育的崭新形式。北京协和医院罕见病医学科是2023年成立的国内首个开展罕见病诊疗的临床科室,基于《中国住院医师培训精英教学医院联盟住院医师核心胜任力框架共识》,罕见病医学科探索了独特的临床博士后教学模式。该模式强调在三基三严的基础上全面提升学员核心胜任力,优化教学评价和反馈体系,有望成为中国复合型罕见病医学精英人才的教育样板,为我国罕见病领域培养具备优秀临床思维和综合能力的复合型人才奠定基础。

在地国际化临床医学人才培养实施路径

党的十九届五中全会提出,要加快构建以国内大循环为主体、国内国际双循环相互促进的新发展格局。以国内大循环为主体双循环战略的提出,对新时代国际化复合型医学精英人才培养提出新要求。重庆医科大学以中外合作办学为契机,以培养具有国际视野的复合创新型临床医学精英人才为目标,以临床岗位胜任力为导向,以学生发展为中心,充分利用国际国内资源,通过培养体系、管理体制、教学资源、师资队伍、评价体系、多元文化等“六大融合”,构建以“一体两翼”课程体系、增强虚拟混合学习模式、数字化资源赋能为主要特征的在地国际化临床医学人才培养模式,开启“以我为主”的临床医学人才培养在地国际化高质量发展新格局,在国内自主培养具有家国情怀、国际视野的创新型未来卓越医学人才。

我国本科临床医学类专业招生规模的时空布局分析

1998—2019年,我国普通高校本科临床医学类专业招生规模显著增长,院校由90所增至181所;招生人数由2.9万人增至9.6万人。不同地区的招生规模差异较大,具有显著的空间正相关性,即招生规模相似的省份在空间上趋于聚集。高-高聚类主要位于经济发达、高等教育发展历史悠久、地理位置优越的地区,如华东地区;而低-低聚类则多位于经济社会发展水平较低、基础设施建设滞后的地区,如西北地区。因此,应进一步优化招生规模在地区间的分布,通过制定实施倾斜性的政策、进行资源支持、发挥地区带动效应等促进招生规模的区域均衡布局。

临床实践前课程线上教学效果及影响因素分析

探究北京协和医学院八年制临床实践前课程线上与线下教学效果的差异及影响因素。妇产科学、皮肤性病学和口腔科学的线上教学成绩显著低于线下,儿科学、神经病学、眼科学、耳鼻咽喉学和中医学线上教学成绩显著高于线下。互动可显著提高线上教学效果。线上教学可以作为临床实践前部分课程的有效教学方式。

临床营养助手程序的研发与应用

目的提高临床肠外营养(PN)治疗的安全性。方法临床药师根据PN处方的常见问题,基于Java语言设计研发临床营养助手程序,并参考肠内肠外营养专著、相关指南、专家共识、药品说明书等资料设置系统参数。随机抽取20例需进行PN治疗的患者,由5名医师均分别以人工和使用程序为其开具PN处方(各开具4例),比较开具处方的速率(以人均单张处方开具用时计)和准确率。回顾性分析医院外科2021年1月至5月(程序使用前)和2021年7月至11月(程序使用后)接受PN治疗住院患者的病历各100份,分析PN处方的合理性。结果医师使用程序开具处方的速率为(4.53±0.57)min,准确率为(99.00±0.14)%,显著优于人工开具处方的(16.15±1.54)min和(80.00±0.42)%(P<0.01)。该程序使用后,不合理处方数显著减少(P<0.05),处方改善率为8.70%~44.78%。结论临床营养助手程序的研发和应用提高了医师开具PN处方的效率,保障了PN处方的安全、合理使用。

TACE联合瑞戈非尼及PD-1二线序贯治疗中晚期肝细胞癌的临床研究

目的 探讨TACE联合瑞戈非尼及程序性死亡受体(PD-1)二线序贯治疗中晚期肝细胞癌(HCC)的有效性和安全性。方法 纳入南通大学附属医院及南通市第三人民医院2020年10月至2022年5月所有接受TACE联合瑞戈非尼及PD-1(TACE-RP,三联组)和接受TACE联合瑞戈非尼治疗(TACE-R,二联组)的患者进行回顾性研究,共83例。收集、评估患者的临床资料,采用改良的实体瘤反应评估标准(mRECIST方法)评估治疗效果,比较两组患者无进展生存期(PFS)、总生存期(OS)以及治疗相关不良事件(TRAEs)。以Kaplan-Meier法绘制PFS及OS曲线,采用Log-rank检验进行组间比较,绘制COX回归模型确定PFS和OS的影响因素。结果 两组患者基线数据差异无统计学意义(P≥0.05);三联组患者客观缓解率(ORR,31.1%vs 18.4%,P=0.024)和疾病控制率(DCR,77.8%vs 57.8%,P=0.038)均高于二联组。三联组患者的mOS、mPFS均高于二联组(分别为16.80个月vs13.20个月,9.10个月vs 7.40个月)。两组间用药不良反应差异无统计学意义(P≥0.05)。结论 TACE联合瑞戈非尼及PD-1二线序贯治疗中晚期HCC较TACE联合瑞戈非尼治疗效果更佳,可优先作为HCC的二线治疗。

Clinical outcome in patients with hepatocellular carcinoma after living-donor liver transplantation

AIM: To investigate risk factors for hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT) and efficacy of various criteria. METHODS: From October 2000 to November 2011, 233 adult patients underwent LDLT for HCC at our institution. After excluding nine postoperative mortality cases, we analyzed retrospectively 224 patients. To identify risk factors for recurrence, we evaluated recurrence, disease-free survival (DFS) rate, survival rate, and various other factors which are based on the characteristics of both the patient and tumor. Additionally, we developed our own criteria based on our data. Next, we compared our selection criteria with various tumor-grading scales, such as the Milan criteria, University of California, San Francisco (UCSF) criteria, TNM stage, Barcelona Clinic Liver Cancer (BCLC) stage and Cancer of the Liver Italian Program (CLIP) scoring system. The median follow up was 68 (6-139) mo.RESULTS: In 224 patients who received LDLT for HCC, 37 (16.5%) experienced tumor recurrence during the follow-up period. The 5-year DFS and overall survival rates after LDLT in all patients with HCC were 80.9% and 76.4%, respectively. On multivariate analysis, the tumor diameter {5 cm; P < 0.001; exponentiation of the B coefficient [Exp(B)], 11.89; 95%CI: 3.784-37.368} and alpha fetoprotein level [AFP, 100 ng/mL; P = 0.021; Exp(B), 2.892; 95%CI: 1.172-7.132] had significant influences on HCC recurrence after LDLT. Therefore, these two factors were included in our criteria. Based on these data, we set our selection criteria as a tumor diameter ≤ 5 cm and AFP ≤ 100 ng/mL. Within our new criteria (140/214, 65.4%), the 5-year DFS and overall survival rates were 88.6% and 81.8%, respectively. Our criteria (P = 0.001), Milan criteria (P = 0.009), and UCSF criteria (P = 0.001) showed a significant difference in DFS rate. And our criteria (P = 0.006) and UCSF criteria (P = 0.009) showed a significant difference in overall survival rate. But Milan criteria did not show significant difference in overall survival rate (P = 0.137). Among stages 0, A, B and C of BCLC, stage C had a significantly higher recurrence rate (P = 0.001), lower DFS (P = 0.001), and overall survival rate (P = 0.005) compared with the other stages. Using the CLIP scoring system, the group with a score of 4 to 5 showed a high recurrence rate (P = 0.023) and lower DFS (P = 0.011); however, the overall survival rate did not differ from that of the lower scoring group. The TNM system showed a trend of increased recurrence rate, decreased DFS, or survival rate according to T stage, albeit without statistical significance. CONCLUSION: LDLT is considered the preferred therapeutic option in patients with an AFP level less than 100 ng/mL and a tumor diameter of less than 5 cm.