摘要：为了解医疗决策中医务人员的价值期望,研究影响其价值期望的相关因素,为医务人员的医疗决策提供参考,通过自行设计调查问卷,按照从业年限与性别进行分组,抽取广东省内部分医院中具有执业资格并从事临床一线工作的338位医护人员进行调查,并运用SPSS19.0统计软件及Excel表格进行描述性分析、Cochran Q检验、卡方检验等。在回收的338份有效问卷中,医患间内在影响因素与社会中外在影响因素的各个因素响应频率差异有统计学意义(P<0.01),“患方缺乏背景知识”“患方不信赖医护人员”及“医患间沟通障碍”是主要的医患内在影响因素;“患者参与决策的诊疗后果还需医护人员承担”为主要的外在影响因素。因此,加强健康教育,提高公众的医学素质,强化医患沟通,公平分担医疗决策责任等,对于医疗决策的改善具有积极意义。

摘要：目的:利用两样本,多变量及双向孟德尔随机化(MR)研究设计,探究程序细胞死亡蛋白1 (programmeddeath-1, PD-1)及其配体(PD-1 ligand, PD-L1)与心肌炎风险的因果关联。方法:从公开全基因组关联研究(GWAS)中提取PD-1/PD-L1与心肌炎的工具变量。采用逆方差加权法(IVW)作为主要的MR分析方法,辅以加权中位数(WM)、Robust adjusted profile score (RAPS)、MR-Egger、孟德尔随机化多效性残差和异常值(MR-PRESSO)、Cochran’s Q检验、留一法、水平多效性分析作为敏感性分析。结果:两样本MR的IVW结果提示,PD-L1与心肌炎具有负向因果关联[比值比(OR),0.619;95%置信区间(CI),0.434~0.884;P,0.008],敏感性分析结果表明因果关系稳健。在多变量MR中,PD-L1与心肌炎的负向因果关系依然存在(OR, 0.658;95% CI, 0.47~0.92, P, 0.015)。PD-1与心肌炎,心肌炎与PD-1/PD-L1的因果关联没有统计学意义。结论:该研究为PD-L1与心肌炎之间的负向因果关联提供了新的证据,而PD-1与心肌炎,心肌炎与PD-1/PD-L1没有直接因果关系。Objective: To investigate the causal association between programmed death-1 (PD-1) and its ligand (PD-1 ligand, PD-L1) and the risk of myocarditis using a two-sample, multivariate and bidirectional Mendelian randomization (MR) study design. Methods: Instrumental variables for PD-1/PD-L1 and myocarditis were extracted from public genome-wide association studies (GWAS). Inverse variance weighting (IVW) was used as the main MR analysis method, supplemented by weighted median (WM), Robusta adjusted profile score (RAPS), MR-Egger, Mendelian randomization pleiotropic residuals and outliers (MR-PRESSO), Cochran’s Q test, leave-one-out method, and horizontal pleiotropy analysis as sensitivity analyses. Results: The IVW results of the two-sample MR suggested that PD-L1 had a negative causal association with myocarditis [odds ratio (OR), 0.619;95% confidence interval (CI), 0.434~0.884;P, 0.008], and the sensitivity analysis results showed that the causal relationship was robust. In multivariate MR, the negative causal relationship between PD-L1 and myocarditis still existed (OR, 0.658;95% CI, 0.47-0.92;P, 0.015). The causal association between PD-1 and myocarditis, and between myocarditis and PD-1/PD-L1 was not statistically significant. Conclusion: This study provides new evidence for the negative causal association between PD-L1 and myocarditis, while there is no direct causal relationship between PD-1 and myocarditis, and betw

摘要：目的探讨科研反哺教学法对五年制临床医学专业本科生提高沟通能力的应用效果,并从中获得启示。方法以广州医科大学五年制临床医学本科生为研究对象,入选学生72人,随机分成2组:传统教学组(1组)和科研反哺教学组(2组)。1组采用传统教学方法授课。2组除了传统教学授课外,定期组织科研实践学习。采用自行设计的问卷从个人基本信息、沟通技能态度认知以及个人沟通能力评价教学效果,采用SPSS 24.0软件对数据进行分析。结果在医学生的沟通技能态度方面科研反哺教学组与传统教学组差异无统计学意义(P=0.05)。在个人沟通能力评估方面科研反哺教学组优于传统教学组(P<0.05)。结论科研反哺教学法有助于提高五年制临床医学专业本科生的沟通能力。