Objective:To evaluate the profile esthetics of children with skeletal class Ⅲ malocclusion treated with micro-implant.Methods:20 patients (12 boys and 8girls) aged 11-13 years were treated by micro-implant and maxillary protraction for 8 to 10 months.The profile esthetic indexes were measured on pre-and post-treatment cephalometric radiography.Results:The esthetic of the patients were remarkably improved after treatment.The factors that influence the esthetic index of children were the anteroposterior relationship of the maxilla,the mandible and the thickness of soft tissue.The results were stable 1 year after treatment.Conclusion:Maxillary protraction by micro-implant can improve the profile esthetic of children with Class Ⅲ malocclusion,correct over-bite and over-jet.

Objective To survey the training needs for key general practice (GP) trainers.Methods The survey was conducted among participants of the first training course for national key GP trainers hold on March 2014 in Shanghai.The contents of questionnaire used for the survey included training needs of GP relevant knowledge,teaching ability and modes of assessment.The differences in training needs between GP trainers from community teaching bases and hospital teaching bases were analyzed.Results Total 151 key trainers completed the questionnaire (male/female:48/103) with average age of (38 ± 6)years.Among them 67.5％ (102/151) were from community teaching bases and 29.8％ (45/151) from hospital teaching bases;60.9％ (92/151) participated in the General Practitioner Structured Vocational Training Program (GPSVTP).According to the survey,general practice clinical kills (72.2％,106/151) and general practice clinical thinking (70.2 ％,106/151) were most required relevant knowledge;while general practice basic concept was least required (25.8％,39/151).The rate with need of policy system related GP training in hospital trainers was higher than that in community teaching base trainers(66.7％ vs.44.1％,P ＜ 0.05).For teaching ability needs,85.4％ (129/151) selected teaching methods,75.5％ (114/151) chose teaching assessment and evaluation methods.The participants showed more interesting in new-type teaching and evaluation methods,such as PBL,OSCE,mini-CEX and DOPS,and would use them in future teaching work (P ＜ 0.01).Workshop (58.3％,88/151),demonstration(57.0％,86/151) and experience exchange (50.3％,76/151) were three most interested modes in current training;meanwhile theoretic teaching was lease interested (38.4％,58/151).Study tour was most interested training models for the future (71.5％,108/151),followed by short-term courses (49.0％,74/151),overseas study (39.1％,59/151) and distance learning (27.8％,42/151).Conclusion There are different needs for GP trainers from hospital and community teaching bases.To meet the different requirements,the focused training course and training method should be adapted.

Objective To investigate the clinical efficacy of Asian proximal femur intramedullary nail antirotation (PFNA-Ⅱ) in the treatment of intertrochanteric fractures in elderly people.Methods From July 2009 to December 2011,127 elderly patients with intertrochanteric fracture were treated by PFNA-Ⅱ.They were 49 cases of male and 78 cases of female,with a mean age of (74.3±15) years.127 elderly patients were classified by modified Evans:type Ⅰ (n=37),typeⅡ (n=42),type Ⅲ (n=26),type Ⅳ (n=15),type V (n=7).We made the statistics on the intraoperative bleeding volume,operation time,incision length,X-light exposure times,and made evaluation of the efficacy of postoperative follow-up and complications by the Harris hip score.Results The average operation time was 42.5 min (35-90) min,the average intraoperative bleeding volume was 107.5 ml (65-410)ml,X-light exposure times were (2.5±1.4) times (2-4) times and the average total incision length was (6.5± 1.8) cm (5.5-11.0) cm.No serious complications or original complications were found during perioperative period.All patients received a 6 to 24 month follow-up (mean 12.5 months in average).The X ray examination showed that the average neck shaft angle was (134±13)° (120°-150°).The average fracture healing time was (14.0±2.5) weeks (11 to 19 weeks).The average hip Harris score was (86.5± 19.5) points (65-100 points).Among them,29 cases (22.83％) were excellent,76 cases (59.8％) were good,20 cases (15.7％) were moderate,2 cases (1.6％) were poor.Totally,excellent and good rate was 82.7％.No complications including hip varus deformity,screw cut-out and femoral shaft fractures were found.There were 14 patients (11.0％) with thigh pain and 5 patients (3.9％) with inner thigh pain.The heavier pain in 4 patients were improved by physical therapy.Conclusions Asian PFNA-Ⅱ has advantages including simple operation,fewer complications,and better clinical efficacy for the treatment of intertrochanteric fractures,but its longterm efficacy and complications still need a large sample and multi-center observation.

Dacryocystorhinostomy ; Endoscopy ; Humans ; Nose

Objective To compare the effects between epidural and general anesthesia for laparoscopic cholecystectomy. Methods A total of 500 cases scheduled for laparoscopic cholecystectomy (LC) were randomly divided into the epidural anesthesia group (Group E, n=250) and the general anesthesia group (Group G, n=250). Results (1) Hemodynamic parameters: in both groups the cardiac output (CO) decreased significantly after CO 2 pneumoperitoneum ( P 0 05), without significant differences between the two groups; the central venous pressure (CVP) was transiently elevated after pneumoperitoneum ( P 0 05), with significant differences between the two groups ( P 0 05), without significant differences between the two groups. (2) Ventilative parameters: the mean airway pressure (P AWM ) and the peak airway pressure (P peak ) were remarkably elevated during the course of pneumoperitoneum in the Group G ( P

Objective To investigate the effect of multidisciplinary intervenient on survival of patients with malignant tumor. Methods Six hundred and thirty-nine malignant tumor patients were randomly assigned to the intervenient and the control group. A total of 584 completed the follow-up study. The intervenient group received comprehensive treatment for 2 years,while the control group was in a process of self-rehabilitation. The 2-year survival rate was compared between the groups by using Cox proportional hazard model. Results The 2-year survival rate was 94. 74% (108/114) or 80. 67% (121/150) in II stage patients of the intervenient or control group, respectively ( P < 0. 01 ) . The 2-year survival rate was 88. 03% (163/177) or 82. 8% (184/222) in early and medium stage patients of the intervenient or control group,respectively(P <0. 01). Conclusion The multidisciplinary intervenient may help to improve the 2 year survival of early or moderate stage malignant tumors.

Objective To assess clinical competencies of trainees with standardized patients(SPs)and explore reform in methods of assessment for trainees at their completion in standardized training for general practice.Methods Totally,52 trainees in clinical training bases for general practice in Shanghai attended the examinations.Their skills in commanication skills,information and data gathering,comprehensive consultation,clinical thinking and decision-making in diagnosis and treatment were examined by rotation of three serial assessment stations in a specified time to perform standardized tasks,including medical history-taking,physical examinations(PE),medial record writing and oral tests.Results Scoresof history-taking,PE and skills of communication with SPs were higher than those agsessed by examiners themselves.but they both correlated each other with a P-value less than 0.01,with the highest coefficient of correlation of 0.774 between score of PE and that assessed by examiners.There was significant difference in average score among all clinical skills(F=9.867,P＜0.01),with the lowest one of comprehensive consultation skills of 64±22(P＜0.01).Skills of communication with patients had the highest correlation with data gathering ability(r=0.582,P＜0.01).Results of analysis for influential factors showed no significant difference in average score for all skills between men and women trainees(P＜0.05).Average score of comprehensive consultation ability in those with work experience was lower than that in thoge without it(P＜0.05)and no significant difference in scores of all the other skills wag found between those with varied length of working(P＞0.05).There was significant difiefence in average scores of communication skills,medical record writing,and case analysis between various trainees(P＜0.01).In addition,average scores of information collecting and medical record writing also differed among trainees from varied bases for general practice training(P＜0.05).Conclusions Clinical skills,ability to direct teaching work,and improvement of teaching model can be assessed in a comprehensive and objectively way using standardized patients in general practice training.

Objective To set up methods for objective structured clinial examination(OSCE)for its application in assessment for clinical competencies of trainees in standardized training for general practice at its completion in Shanghai.Methods Trainees in standardized training for general practice in Shanghai were assessed at its completion in July 2009 at Zhongshan Hospital of Fudan University,which was organized and implemented by establishment of OSCE management framework and design of assessment stations,including writing-up medical records for cases,training standardized patients,selecting assessment itemsfrom checklists of clinical skills.as well as working-out a form for assessment scoring.Results Six assessment stations were set up for OSCE,including clinical data collection,medical record writing,case analysis,clinical skills,diagnostic decision-making based on electrocardiograms(ECGs)and x-ray films.Totally,32 trainees took part in OSCE and all passed examination.Score of medical record writing Was higher than that of clinical data collection [86(IQR 74-91)vs.79(IQR 67-85),P＜0.05].There was no significant difference in scores between medical reeord writing and case analysis [86(IQR 74-91)vs.80(IQR 73-86),P＞0.05].Score of X-ray film diagnosis Was higher than that of ECG diagnosis and clinical skills[99(IQR 96-100) vs.95(IQR 91-98),and 99(IQR 96-100)vs.90(IQR 83-94),all P＜0.01].Conclusions Clinical competeneies of trainees of general practice Can be assessed by OSCE in multiple aspects,which provides a new examination method for GP training.

Objective To study current status of health education and explore its pattern in community health-care service(CHS)in Shanghai.Methods A total of 200 health-care workers(HCWs)from five CHS centers in Shanghai were investigated by questionnaire of health education knowledge.Results Among 200 HCWs investigated,96.5%(193/200)of them have recognized importance of health education,98.0%(196/200)could undertake health education in their clinical work,only 60.5%(121/200)had receired regular training on it,and 85.5%(171/200)thought they should be further trained regularly.Correct awareness of knowledge was 94.O%.47.0%and 33.6%for health education perception,healthy life-style and health education knowledge for chronic disease.respectively in them.There was very significant difference in correct awareness of knowledge between HCWs with varied ages and districts(χ2=17.663 and 82.376,P=0.001 and 0.000,respectively),but no significant difierence was found between men and women and those with varied professional titles(χ2=0.015 and 2.406,P=0.903 and 0.300.respectively).Short of time(48.5%),lack of relevant knowledge(15.0%)in HCWs and poor compliance of patients(33.0%)were main factors influencing their implementation of health education.Conclusions HCWs in CHS have already recognized importance of health education.but have not known enough its theoretical knowledge and skills.It is necessary to set guidelines of health education intervention for HCWs in CHS,and perfect monitoring and evaluation.as well as mechanism for rewards and penalties to promote development of health education in CHS.

Objective To explore application of standardized patients (SPs) in intensive training of clinical competency for general practice trainees. Methods Fifty-three general practice trainees in Shanghai Zhongshan Hospital were enrolled in the study, randomly assigned to intervention and control groups. Control group proceeded in routine clinical rotation, while intervention group accepted intensive training course with SPs as trainers. Three months after intervention, clinical skills of the two groups were compared in a simulated medical environment. Results There was no statistically significant difference in their baseline characteristics between the two groups (P ＞0.05). Competency in history taking, physical examinations,communication with patients, comprehensive consultation, medical record writing as well as case-analysis,improved significantly in intervention group after intervention, as compared to those before it ( P ＜ 0. 01 ),with the highest score of communication skill of 82 ± 10. Although competency of history taking, physical examinations, comprehensive consultation, medical record writing also improved significantly three months later in control group as compared to their baselines (P ＜ 0. 01 ), while no statistically significant difference in their communication skills was found ( P ＞ 0. 05 ). Scores of skills in physician-patient communication,comprehensive consultation as well as medical record analysis were significantly higher in intervention group than those in control one after intervention ( P ＜ 0. 01 ), but no significant difference in physical examinations was found between the two groups ( P ＞ 0. 05 ). Conclusions Application of SP in intensive training course for clinical competency can remarkably improve their competency in interpersonal communication and comprehensive consultation for general practice trainees.