Objective To investigate current status of general practice service teams in urban Shanghai to provide practical evidence and lay theoretical basis for sustainable development of general practice service teams in the future. Methods A cross-sectional study was carried out for 40 staff members of eight general practice service teams in eight urban districts of Shanghai, as well as 110 local residents, by observation, interview and questionnaire methods during March to April 2008. Results Among 21 general practitioners, 86 percent of them ( 18/21 ) were graduated from medical colleges or universities with three-year curriculum or at levels above it and 52 percent ( 11/21 ) had intermediate professional titles or above.Among the eight general practice service teams, five had full coverage of supervision and management for tuberculosis therapy, six had full coverage of management for tumor patients, four had full coverage of management for cardiovascular and cerebrovascular diseases and four had full coverage of management for patients with mental disorders. In all staff members of eight general practice service teams, 38 percent of them (15/40) were satisfactory with their working environment, 40 percent (16/40) with their work activities, five percent (2/40) with their incomes, and 28 percent (11/40) with their professional future.In 110 local residents, 77 percent (85/110) were satisfactory with service environment, 85 percent (93/110) with quality of health-care service and 89 percent (98/110) with the attitude of service teams.Conclusions Implementation of management for chronic diseases and two-way referral, as well as satisfaction of staff members in general practice service teams should be improved further.

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 survey the current situation of teaching for general practitioners (GPs) in community health centers of Shanghai.Methods A questionnaire survey on the teaching situation was conducted among 742 GP mentors who attended a municipal training workshop during July to October 2012 in Shanghai.The items of the survey included general background,previous teaching experience and self-evaluation on teaching ability.Results Among 742 GP mentors receiving the survey,the average age was (37 ± 6) years old.49.8％ (366/734) of mentors expressed their willingness of teaching,and the main reason was that it may upgrade themselves,while learning from teaching (58.6％,419/715).Heavy work load,lack of teaching time (31.8％,378/1 187) and teaching experience (30.7％,364/1 187) were the main obstacles for teaching.Among 106 GP mentors who had teaching experience in community health center previously,79.2％ (80/101) made teaching plans,but only 8.9％ (9/102) often prepared syllabus.Teaching plans were made mainly according to the work needs in community health care (54.2％,52/96),the situation and demands students (29.1％,28/96) or requirement of syllabus (17.7％,17/96).The problems included lack of teaching experience (50.5 ％,50/99) and time (42.4％,42/99),monotonous instructional modality (24.1％,25/104),and weak operability of the syllabus (21.2％).The self-reported results showed that 14.4％ were not able to develop a teaching program and to execute,18.3％ were not able to use a variety of teaching methods,31.2％ were not able to engage in teaching for 1.5 days per week.Logistic regression analysis showed that mentors with higher education background (OR =2.027,P ＜ 0.05),community teaching experience (OR =3.069,P ＜ 0.05),higher self assessment of general personal quality and communication ability (OR =2.488,P ＜ 0.05),higher teaching ability (OR =2.399,P ＜ 0.05) and strong training wishes (OR =11.382,P ＜ 0.05) were more willing to engage in the teaching work.Conclusions Heavy work load,insufficiency of teaching capacity and experience are main problems for GP mentors in Shanghai community health centers.Educational theory and methods should be focus on teacher training so as to improve teaching abilities.

Objectives To investigate and analyze depressive state in patients with diabetes in a community so as to assess adverse impact of depression on diabetes and provide basis for health intervention.Methods A total of 115 patients with type 2 diabetes and healthy control group matched for demographic data and therapeutic compliance were selected from a community.All the subjects were evaluated with Beck Depression Inventory ( BDI),and their baseline data were collected by a short self-administered questionnaire,including diabetic history and medication compliance.Fasting blood glucose ( FBG),two hour post-prandial blood glucose (2hPBG) and HbAlc were measured for the diabetes mellitus (DM) group.Results BDI score was significantly higher in DM group than that in control group (P 0.05 ).There was significant difference in metabolic control,medication compliance and number of patients with complications between depression and non-depression groups in diabetics (P

Objective To study the changes in needs of standard training for general practice during the period of 2000 to 2006.Methods Sixty-two trainees participated in a municipal training program for general practitioners(GPs)in Zhongshan Hospital,Shanghai were interviewed by questionnaire to understand their recognition of general practice and needs in training for general practice,and compared to other 53 trainees who entered an another training program in 2000.Results Nineteen of 53 trainees(36percent)trained in 2000 could understand all the six aspects of general practice,including medical and health care,preventive care,rehabilitative care,health education and family planning techniques service,51(94 percent)were willing to accept such training,and 30(57 percent)did not satisfy with current conditions in community health care service.As compared,their recognition for general practice,acceptance of training,and satisfaction with their working condition improved obviously in trainees trained in 2006,with proportions of 100 percent,100 percent and 98 percent,respectively.But,main reason for dissatisfaction with community health care service could still attribute to less attention paid to general practice by relevant leadership.Conclusions Nowadays.the needs in general practice training by health care workers in communities increased greatly,but which still should be supported by governmental policies.

Objective To compare the value of clinical application of the ratio of urine albumin to creatinine (ACR) in the community-dwelled middle-aged and elderly at high-risk for diabetes in screening for albuminuria with casual and morning urine specimens. Methods Totally, 443 middle-aged and elderly people (234 men and 209 women) at high-risk for diabetes, with an average age of (59±8) years, were recruited from Changfeng Community of Shanghai in screening for albuminuria with casual and morning urine specimens collected on the same day, as well as another two morning urine specimens collected at an interval of two weeks, for determination of urine ACR. Albuminuria was defined as ACR equal to or more than 30 mg (albumin)/g (creatinnine) in two or more of the three urine specimens collected. Results Overall prevalence of albuminuria was 6. 3% ( 28/443 ) in the middle-aged and elderly according to diagnostic standard mentioned above, significantly higher in casual urine specimens than in morning urine specimens (14. 9% vs. 5.9%, P <0. 05). Urine ACR of casual urine specimens was significantly higher than that of morning urine (7. 1 mg/g vs. 3. 2 mg/g, P<0. 001 ). There was no significant difference in sensitivity and positive predictive value (PPV) between casual and morning urine specimens in screening for albuminuria (96. 4% vs. 92. 9%, and 99.7% vs. 99. 5%, respectively, P >0. 05). Specificity and negative predictive value (NPV) of casual urine specimens was significantly lower than those of morning urine specimens (90.6% vs. 100.0%, and 40.9% vs. 100.0%, respectively, P<0.05). The optimal cut-off value of ACR by casual urine specimens was 40. 0 mg/g in screening for albuminuria, based on receiver operating characteristic (ROC) curve, with sensitivity of 96. 4%, specificity 95.2%, PPV 57.5% and NPV 99. 8%. The middle-aged and elderly with negative albuminuria in morning urine but positive in casual urine had more risk factors for cardiovascular and chronic kidney diseases than those with negative albuminuria in both morning and casual urine specimens. Conclusions Morning urine specimen is better than casual urine for albuminuria screening in the middle-aged and elderly people with risk factors for diabetes in urban community, but casual urine used in screening for albuminuria is very convenient for collection. It is suggested that urine ACR of 40. 0 mg/g be used as an optimal cut-off value for casual urine in albuminuria screening among them.

Objective To explore an optimal cut-off value of waist circumference(WC)for identifying metabolic syndrome(MS)in middle-aged and elder residents in an urban community.Methods Database of 1558 residents aged 40-79 years at high-risk in screening for diabetes from Changfeng community,Putuo District,Shanghai during 2005 to 2007 was used to analyze sensitivity and specificity of varied cut-off values of WC for identifying two or more components of MS in men and women,respectively.Receiver operating characteristics(ROC)curve was used to explore the optimal value.Results Optimal cut-off value of WC was 85.0 cm for men and 80.0 cm for women,respectively,for identifying two or more components of MS bv ROC curve,with sensitivity of 72.3%and 74.9%,and specificity of 50.2%and 62.2%,respectively.Based on that optimal cut-off value of WC and definition of International Diabetes Federation(IOF),prevalence of MS was 38.8%in this population,40.7%in men and 37.8%in women,respectively.Conclusion The optimal cut-off value of WC was 85.0 cm in men and 80.0 cm in women,respectively,for identifying MS in the middle-aged and eldedy in an urban community of Shanghai.

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 assess standardized patients (SP) in resident general practitioners training for their consultation skills to explore its role in clinical competence training. Methods SP are employed in standardized training for 52 resident general practitioners in Shanghai during May to July 2008 to assess trainees' clinical consultation skills, including medical history taking and physical examinations, as well as clinical competencies of trainers including medical history taking, physical examinations, clinical thinking (diagnosis, differential diagnosis and treatment plans), health education, medical record writing,and reception time management. Feedback and appraisal for their consultation skills were provided by SP later. Problems encountered in trainees' consultation were discussed in group manner with their trainers.And two mouths later, assessment with SPs was undergone again for their consultation skills to compare their scores in consultation skills and percentages of them passing the assessment before and after training. Results Trainees were enrolled in the training aged (28±1 ) years in average ( with a ratio of men to women of 19/33 ). Percentage of trainees passing the assessment by SP for consultation skills was significantly higher after training (88.5%) than that before it (46. 2% ) ( P < 0. 01 ). Percentage of trainees with scores passing assessment by trainers was also significantly higher after training than that before it (86.5% vs. 51.9%, P < 0.01 ), with a percentage of those qualified for clinical skills and health education after training of 80. 8% and 88.5%, respectively, as compared to those of 46. 2% and 67. 3%,respectively before it, ( P < 0. 01 ), and with a percentage of trainees qualified for clinical thinking, out-patient medical record writing and reception time management not changed after training (71.2%, 100. 0%,100. 0%, respectively) as compared to those before it (51.9%, 100. 0% and 100. 0%, respectively)(P > 0. 05 ). Conclusions Application of SP can effectively enhance consultation skills of the trainees,especially in their medical history taking and physical examinations. However, there is still rooms to improvein their clinical thinking.

The case design,standardized patients(SPs)training and training communication skills for medical students with SPs were illustrated in this paper.And our experiences of SPs using Were summarized.