There were 461939 outpatient visits in Shanghai Tianping Primary Health Center from January to December 2010,the data were retrospectively analyzed based on the electronic outpatient record.The 20 most common illnesses accounted for 73.67％ of total outpatient consultations (340310/461 939),hypertension ranked the first position of all illnesses ( 21.06％ ) and followed by coronary heart disease (8.36％).Patients aged over 65y accounted for 72.35％ of all patients,the frequency of consultations was positively correlated with age of patients(P ＜0.01 ).The frequency of consultations varies according to the gender,age of the patients as well as the organ system involved (P ＜ 0.01 ).It can be concluded that the most frequently encountered illnesses in primary health center are common illnesses and chronic diseases.There are different needs for primary health service between genders and different age groups.

Objective To explore the size of access channel that may influence the intrarenal pelvic pressure during percutaneous nephrolithotomy.Methods From April 2014 to July 2015,83 patiens with unilateral renal calculus,ranged from 20 to 40mam were divided into 2 group randomly.40 cases underwent F24 channel PCNL and 43 cases underwent F16 channel PCNL.There was no statistically significant difference between the groups in preoperative variables,such as age,gender,preoperative status of infection,status of hydrpnephrosis,size and location of stone (P ＞ 0.05).We used a 6Fr ureteral catheter positioned into the renal pelvic,and the intrarenal pelvic pressure was measured by anesthesia monitor IBP channel during PCNL in different stages (entrance into the collecting system,calculi fragmentation,and termination)for all patients.Removing calculus time,postoperative hemoglobin changing,fever rate,procalcitonin abnormal rate,white blood cell counts and calculi clearance rate were recorded and compared.Results The intrarenal pelvic pressure in different stages on F24 channel and F16 channel were (7.5 ± 1.3)、(22.5± 4.3)、(14.0 ± 2.7) mmHg and (10.3 ± 1.1)、(34.6 ± 4.1)、(23.0 ± 3.6) mmHg,respectively.There was statistically significant difference between 2 groups (P ＜ 0.05).Compared with F16 channel,F24 channel had significant differences in removing calculus time [(12.8 ± 3.7) min vs.(23.3 ± 3.6) min],fever rate [17.5％ (7/40) vs.39.5％ (17/43)],procalcitonin abnormal rate [15.0％ (6/40) vs.34.9％(15/43)] and white blood cell counts abnormal rate [10.0％ (4/40) vs.27.9％ (12/43)] (P ＜ 0.05).However,no significant difference in postoperative hemoglobin changing [(11.8 ± 4.4)g/L vs.(13.7 ±4.7)g/L] and calculi clearance rate [87.5％ (35/40) vs.81.4％ (35/43)] (P ＞0.05).Conclusions Compared with F16 channel,the F24 channel PCNL maintains lower renal pelvic pressure,which is less than reflux limit,during calculi fragmentation,It might be contributed to reduce the postoperative fever rate.It can short time for removing calculi and achieve the better effect.

The objective structured teaching evaluation (OSTE) is a new method for training and objective assessment of the teaching ability of clinical faculty by using standardized students and teaching scenario.It is mainly used to evaluate training programs,train teaching skills and assess teaching ability of clinical faculty.The differences and association between teaching ability,teaching skills and teaching scenario should be clarified before designing OSTE.Although there are some differences in various studies,OSTE can be summarized into two aspects:teaching administration knowledge and special teaching skills.Given the great potential of OSTE in training and assessing faculty,medical educators in general should actively explore its concept and application.

The community rotation is an important stage of standardized residency training for general practitioners (GPs).However, the community rotation is also considered as a most difficult part of the GP residency training because of the problems in training management and evaluation .Based on our experiences of 7-months community training , we expanded the duration of community training to 1 year, and implemented a new segmentation and multipoint practice plan in Zhongshan hospital .This is a new attempt for GP residency training , which would hopefully meet the international standards of GP residency training .

Objective To understand the status quo of work satisfaction of the graduates of GP vocational training program by Zhongshan hospital Fudan university,to provide bases for making best GP career development strategy by health authorities.Methods Using short form of the career orientation inventory to conduct career investigation of the 152 graduates of GP vocational training program by Zhongshan hospital,Fudan university.152 questionnaires were issued and the effective response rate was 100％.Results The top of GPs' career anchor is job security orientation (106,69.7％),followed by technical competence (28,18.4％),service (8,5.3 ％),managerial (5,3.3 ％),autonomy (3,1.9％),lifestyle (1,0.7 ％),entrepreneurship (1,0.7 ％),pure challenge (0,0) and geographic security orientation (0,0).We found that for male GPs,they displayed higher score for entrepreneurship orientation than female GPs (t =2.775,P =0.006).Those older than 35 displayed higher score for geographic security orientation than those younger than 35 (t =-2.154,P =0.033).GPs with at least 10 years' work experience displayed higher score for geographic security orientation than those with less than 10 years' work experience (t =-2.414,P =0.017).The distribution of all types of career orientations of GPs was the same no matter how different their degrees and professional titles were.Conclusions Job security orientation and technical competence are the major job orientations of GP vocational training program by Zhongshan hospital,some career anchor orientations are related to age,gender and duration of work experience.Effective career management should be conducted based on these characters of the graduates' career orientation.

The quality control of medical links runs through the whole process of medical service. Through the identification, management and quality control of key medical links, such as the system of making ward rounds by three levels of doctors, perioperational control, emergency treatment, writing of medical records, medical safety control, and management of critically ill patients, the entire staff's awareness of medical quality has been enhanced, the overall medical quality has been improved and sound social and economic benefits have been attained.

Objective To explore the feasibility and efficiency of laparoscopic surgery for the treatment of acute biliary pancreatitis (ABP) at early stage. Methods From January 2003 to June 2006, 18 patients with ABP received laparoscopic surgeries, including laparoscopic cholecystectomy (LC) in 3, LC combined with laparoscopic common bile duct exploration (LCBDE) in 9, LC combined with opening of the pancreatic capsule for drainage in 5, and LC combined with LCBDE and opening of the pancreatic capsule for drainage in 1. Results In all the patients, the laparoscopic operations were completed successfully without conversion to open surgery. The operation time was 100-150 min with a mean of (115.3?15.2) min. The stones in the bile duct were removed completely by LCBDE in 10 patients. No subcutaneous emphysema, hemorrhage, abdominal abscess or stenosis of the bile duct occurred in this series. The 18 patients were followed up for 4-40 months (mean, 28.5 months), during which 2 patients developed pancreatic pseudocyst. One of the patients was cured by internal drainage. In the other patient, the pseudocyst was absorbed spontaneously. No recurrence of pancreatitis or common bile duct stones was found. Conclusions Laparoscopic surgery is minimally invasive and effective for the treatment of ABP at early stage.

Total 118 patients with pyogenic liver abscess admitted to Zhongshan Hospital were classified into pypgenic liver abscesses of cryptogenic origin (PLAC,n =54),pyogenic liver abscesses of biliary origin (PLAB,n =48) and pyogenic liver abscesses of hemagenous origin (PLAH,n =16)according to the causes.The clinical features of three groups were compared and analyzed.The results showed that no statistically significant difference existed among three groups in clinical manifestation and signs.Compared to PLAB,the abscesses in right lobe of liver were more common in PLAC,diabetes mellitus was more prevalent in PLAC,but the co-existing diseases including chronic liver disease,non biliary malignant tumor and ALP elevation were less in PLAC.Klebsiella pneumoniae was frequently detected in PLAC,but there was no significant difference comparing to other two groups.No significant difference was found among three groups in the choice of therapeutic methods,the course of antibiotics,length of hospital stay and the days from admission to diagnosis.

The clinical data of 118 patients with bacterial liver abscess admitted to a tertiary hospital from January 2007 to December 2009 were analyzed retrospectively.Etiology study showed that 45.8％(54/118) cases of bacterial liver abscess were cryptogenic,40.7％ (48/118) were biliary source and 13.5％ (16/118) were hematogenous.The positive rate of pus culture was 57.1％ (36/63),among which klebsiella pneumoniae accounted for 72.2％ (26/36).The positive rate of blood culture was 31.2％(20/64) and klebsiella pneumoniae accounted for 95％ (19/20).One hundred and sixteen patients (98.3％) underwent color ultrasound examination with an accuracy rate of 93.2％.84 patients (71.2％)underwent the CT scan with an accuracy rate of 95.3％ and 20 patients underwent MRI with an accuracy rate of 85％.Seventy five patients (63.6％)accepted ultrasound-guided percutaneous aspiration and catheter drainage combined with antibiotic therapy; 40 patients(33.9％)were treated with antibiotics alone.On the discharge 27 patients(22.9％) achieved clinical cure,87 patients (73.7％) were classified as effective,4 patients (3.4％) had no effect and no death in this group of patients.The average length of hospital stay was 16 days.Cryptogenic was the most common cause of bacterial liver abscess,biliary source took the second place.Kleibsiella pneumoniae was the predominant organism.Detailed medical history inquiry,physical examination and assistant examination may increase the accuracy rate of diagnosis.Needle biopsy should be performed if necessary.Ultrasound-guided percutaneous aspiration and catheter drainage combined with antibiotics should be the first-line treatment.

Purpose:To study the pathological and clinical characteristics of different subtypes of cyst-associated renal cell carcinoma and summarize the experience in diagnosis and therapy. Methods:39 cases with cyst-associated renal cell carcinoma underwent urological operations in our hospital from 1991 to 2000. Their medical data were analyzed and then divided into different subtype according to pathological characteristics. Results:The data included 2 patients with renal cell carcinoma on the background of polycystic kidney, 20 cases with renal cell carcinoma originating in a cyst and 17 cases with cystic renal cell carcinoma.3 patients underwent partial nephrectomy and 36 cases unilateral radical nephrectomy.16 patients were Robson stage Ⅰ and 23 were RobsonⅡstage.The pathological diagnosis was 38 cases of clear cell carcinoma and one of chromophobe cell carcinoma. The survival rates at 1,3,5 years are 100%、100%、94.8%(37/39) respectively after follow-up. Conclusions:The cases with renal cyst need periodical health check-up.Most of cyst-associated renal cell carcinomas belong to low stages. Contrast-enhanced computed tomography and selective digital subtraction angiography of renal artery are the main methods for preoperative clinical diagnosis. The long-term effect of operations of cyst-associated renal cell carcinoma is better.