Objective To observe the clinical effect , blood glucose time , clearance time of ketone body , correction time of acidosis and influence on average daily dosage of insulin of supplementing Qi and nourishing Yin combined with insulin treatment of patients with diabetic ketoacidosis (DKA).Methods 67 cases of DKA were divided into 2 groups.Control group (n=32) was giv-en micro injection of pump continuous infusion of insulin and aggressive fluid resuscitation for potassium supplement , water and elec-trolyte maintaining and acid -base balance;the observation group ( n=35 ) was given oral Chinese medicine for supplementing Qi and nourishing Yin on the basis of control group .The clinical effect after treatment , blood glucose time , clearance time of ketone body, correction time of acidosis , average daily dosage of insulin and the average number of hypoglycemia per capita were compared and analyzed .Results Blood sugar could be controlled faster in observation group .Clearance time of urine ketone and correction time of acidosis were significantly shortened .The dosage of insulin and number of hypoglycemia per capita were greatly reduced .There were significant differences compared with the control group (p<0.01);in terms of clinical effect, 19 cases of observation group were markedly effective , 14 cases effective , and 2 cases ineffective with the efficiency rate of 94.29%; 13 cases of control group were markedly effective , 10 cases effective , and 9 cases ineffective with the efficiency rate of 71.88%.There were differences between the two groups (p<0.05).Conclusion Supplementing Qi and nourishing Yin can significantly improve the curative effect in the treat -ment of DKA .

0.05). The length and the angle of the proximal tibial slope were (2.34?0.2) cm and (20.1?4.3)?, respectively. Conclusion The specification of entry point of intramedullary nailing must be individual because the shape of proximal tibia varies in different persons.

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 survey the double-preceptor system in standardized residency training of general practitioners (GPs).Methods A questionnaire survey was conducted among 48 residents,53 clinical and community preceptors during May and June 2013.Results The preceptors mostly agree with the necessity to carry out double-preceptor system.82.8％ (24/29) clinical preceptors,95.8％ (23/24) community preceptors and 89.6％ (43/48) residents considered that it was very effective.Less than half of the clinical(13/29) and community (11/24) preceptors knew very clearly about their responsibilities and obligations ; 93.1％ (27/29) clinical preceptors and 95.8 ％ (23/24) community preceptors hoped to receive corresponding training courses.72.4％ (21/29) clinical preceptors and 75.0％ (18/24) community preceptors communicated with residents frequently,75.9％ (22/29) clinical preceptors thought residents were not actively involved was the main obstacle in the implementation of double-preceptor system.The guide contents were focused on clinical skills,scientific research and how to pass assessments.The main approaches were interviews,checking the quality of medical instruments and small lecture.Only 6.9％ (2/29) clinical preceptors conducted outpatient teaching,83.3％ (40/48)residents thought tutors did not knew clearly about their responsibilities and obligations was the main obstacle in the practice of doublepreceptor system.Regarding how to evaluate the double-preceptor system,clinical and community preceptors tended to use examination results and feedback of residents.Clinical preceptors,community preceptors and residents all gave low comments about the preceptor-resident contact handbook.87.5％ (21/24) community preceptors thought lack of corresponding incentive mechanisms was the main obstacle in the practice of double-preceptor system.Conclusions Double-preceptor system has been widely recognized by both preceptors and students.In order to improve the system,we should conduct tutor training courses regularly and establish an effective mechanism to assess and evaluate tutors.

To investigate the status of application of Chinese Hypertension Prevention and Treatment Guideline (Guideline) by general practitioners (GPs) in Shanghai.A questionnaire survey was conducted among 260 GPs from 8 communities in Xuhui District of Shanghai during March 2011 to December 2012.Among all participants,94.2％ knew the Guideline.The overall correct rate was 56.2％; that of epidemiology,diagnosis,treatment,two-way referral and community management of hypertension was 49.2％,54.5％,60.6％,56.9％ and 32.3％,respectively.There were significant differences in correct rates of the questionnaire between GPs with different age,gender,education and community (P =0.000,0.035,0.000,0.000).The correct rates of epidemiology and treatment in GP teaching bases (58.5％ and 62.6％) were higher than those in non-teaching bases (39.2％ and 58.4％) (P =0.002,0.040).But there was no difference in overall correct rate between these two groups (P =0.095).The results indicate that the understanding and application of Hypertension Guideline by General practitioners in community is insufficient.Teaching hospitals should carry out systematic,comprehensive,sustained,targeted training course in order to improve the diagnosis and treatment levels of hypertension for general practitioners in community.

Aim To study the effects of amitriptyline(Ami)on focal cerebral ischemia-reperfusion injury in rats.Methods An animal model of focal cerebral ischemia-reperfusion injury was induced by the middle cerebral artery occlusion(MCAO) by reversibly inserting a nylon thread method.The rats were decapitated after ischemia for 1 hour and reperfusion for 2 hours.The infarct volumes were determined using a 2,3,5-tri-phenyl tetrazolium chloride(TTC) staining and assessed by image analysis system.The neurologic deficit status were evaluated on 0~5 grade scale.The levels of dopamine(DA),norepinephrine(NE),serotonin(5-HT) and its metabolic product~hydroxyindole acetic acid(5-HIAA) in cortex and striatum were measured by fluoro-spectrophotometry.Results Ami treatment exhibited a remarkable reduction in infarct volume and neurologic deficit scores.The monoamines content of cortex and striatum had a significant increase compared with ischemia-reperfusion group.Conclusion Amitriptyline has protective effect on cerebral ischemia-reperfusion injury in rats.The mechanism might be related to reducing the release of NE,DA and 5-HT during cerebral ischemia-reperfusion,attenuating or inhibiting of the neurotoxic effects of monoamine neurotransmitters.

Objective To develop criteria for trainers of general practitioners in clinical training bases.Methods A primary version of criteria was established through literature review and expert interview.Thirty-two experts with middle-level professional title or above,who had 10 years of working experience or more in general practice,teaching and administration,were invited for 3 rounds of Delphi consultation during March and October 2013.Results The criteria consisted of 3 first-grade indicators and 12 second-grade indicators were established.The first-grade indicators included professional quality,clinical competence and teaching capability.The weight coefficient of first-grade indicators were 0.332 0,0.336 0 and 0.332 0,respectively.For 3 rounds of consultation the activity coefficient of experts was all 100％ ; the authority coefficients of experts were 0.881,0.897 and 0.883,respectively; and the harmonious coefficient of importance of the evaluation were 0.136,0.127 and 0.204,respectively (P ＜ 0.01).Conclusion The established criteria are credible and important for the selection of trainers of general practitioners in clinical bases,which would improve the quality of standardized training for general practitioners.

Objective To establish a set of accreditation standards for trainers of general practitioner (GP) in community health service centers.Methods A modified Delphi expert consultation was conducted during December 2012 and September 2013.Thirty two experts of general practice from different teaching hospitals and community health service centers were invited for three rounds Delphi questionnaires.A set of accreditation standards for GP trainers in primary care was established through data analysis,synthesis and process.Results Expert activity coefficients were 100.0％ for three rounds consultation,the authority coefficients were 0.894,0.882 and 0.893,respectively.The opinion coordination coefficients of experts were 0.156,0.166 and 0.215,respectively (P =0.000).The developed accreditation standards system comprised of three first-grade indicators and 14 second-grade indicators.The weight coefficients of three first-grade indicators,namely professional profiles,clinical competences in primary care and teaching abilities,were 0.339 8,0.335 6 and 0.324 6,respectively.Conclusions The established accreditation standard system is credible,which would appropriately guide the selection of GP trainers in primary care from three dimensions and enhance the quality of standardized training of general practitioners.

The manifestations of current poor doctor -patient communication are: doctors have insufficient communication beforehand , randomness is big , communication is not detailed or in -depth , the patients also have certain shortcomings .The causes of this situation are: interests driven factors , lack of education supervision and management , service responsibility consciousness weakening .Therefore , should strengthen the propaganda and ed-ucation, raise awareness, constantly enhance the consciousness of doctor -patient communication; to strengthen the construction of medical ethics , to reconstruct the doctor -patient integrity , play up the solid foundation of doc-tor-patient communication;Strengthen supervision and management , establish and improve the system , to insure the good doctor-patient communication , orderly and transparent;reinforcement learning training , pay attention to the accumulation of human skills to develop and enhance the effectiveness of doctor -patient communication .

Objective: To explore the relationship between left coronary plaque character with the bifurcation angle and diameter by 256-slice CT angiography (CTA). Methods: A total of 387 consecutive patients who received CTA in our hospital were retrospectively studied. There were 102 patients with normal image including 60 male and 42 female at the mean age of (52.10 ± 9.65) years and 285 patients with left coronary plaque including 166 male and 119 female at the mean age of (55.65 ± 10.40) years. All patients were divided into 4 groups according to the plaque condition, Normal group,n=102 patients without plaque, Non-calciifcation group,n=137, Calciifcation group,n=79 and Mixed group,n=69. The patients with non-calciifcation plaque included 73 of mild stenosis and 57 of moderate to severe stenosis in proximal LDA. Left coronary bifurcation angle, proximal diameter and area were measured by multi-planar reconstruction (MPR) and the maximum density projection (MIP) techniques to analyze the relationship between the above indexes and plaque position, character, degree of local stenosis. Results: Left coronary bifurcation angle, the proximal diameter, area in LDA and LCX in 3 plaque groups were all larger than those in Normal group,P<0.05. In Non-calciifcation group, the above indexes were similar between the patients with mild stenosis and moderate to severe stenosis,P>0.05, while in patients with moderate to severe stenosis, the bifurcation angle and diameter were larger in male than those in female patients,P<0.05. Conclusion: 256-slice CTA could objectively evaluate left coronary bifurcation angle, stenosis degree and plaque character, which are valuable for coronary artery disease prevention, diagnosis and treatment in clinical practice.