Adult ; Bloodletting ; Combined Modality Therapy ; Female ; Herpes Zoster ; therapy ; Humans ; Male ; Manipulation, Chiropractic ; Middle Aged ; Young Adult

Acupuncture Therapy ; Acute Disease ; Adolescent ; Adult ; Child ; Combined Modality Therapy ; Conjunctivitis ; therapy ; Female ; Humans ; Male ; Middle Aged ; Needles ; Phlebotomy ; instrumentation

Objective　To evaluate the correlation between the sound pressure and intensity output by ultrasonic diagnostic apparatus and received by the embryo in the uterus.Methods　The transient sound parameter and sound field parameter inside the uterus in pregnant rats irradiated by transabdominal color Doppler we re measured with polyvinylidene fluoride (PVDF) piezoelectric sensor.Results　There was a significant difference in the maximal p+(pea k-positive acoustic pressure),p-(peak-negative acoustic pressure),Ispta(inten sity spatial peak temporal peak), Ispta(intensity peak temporal average),Im(int ensity maximum) measured between inside the uterus and in water free field by va rious kinds probes(2.5 MHz,3.5 MHz,7.0 MHz).Conclusions　The irradiation received by the embryo in uterus was smaller than the output of ultrasonic diagnostic apparatus.

Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Cold Temperature ; Female ; Humans ; Male ; Meridians ; Middle Aged ; Qi ; Yin Deficiency ; therapy

15 mm,10～15 mm,

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.

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 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 study the association between metabolic syndrome (MS) and prognosis of endometrioid carcinoma.Methods A total of 256 patients with endometrioid carcinoma at,Zhejiang Cancer Hospital between January,2001 and December,2008 were chosen.The deadline for follow up was December 2008.The general conditions(including age and body mass index),whether coupled with MS and it's risk factors(including waist circumference,fasting plasma glucose,triglycerides,high-densitylipoprotein,systolic and diastolic blood pressure) were analyzed.The outcome of 256 patients whether coupled with MS were analyzed using Kaplan-Meier curve.Relative risks were estimated using Cox proportional hazards regression model.Results A total of 256 cases were followed-up successfully.Sixtyfour (33.0％) cases coupled with MS among the 194 patients survived,while thirty-two (51.6％)coupled with MS from 62 cases died,there was significant difference between them (x2=6.953,P=0.008).The total fiveyear survival rate was 75.8％,the survival time was (78.0±3.4) months.The rate and the survival time of patients coupled with MS [66.7％,(67.0±2.4) months] were significatly lower than those coupled with no MS [81.3％,(85.0±4.0) months;P＜0.05].The Cox proportional hazards regression results showed that coupled with MS,body mass index ≥25 kg/m2,waist circumference＞80 cm,abnormol systolic and diastolic blood pressure,abnormal fasting plasma glucose and more than two components of definitions of MS were related to bad prognosis of endometrioid carcinoma(P＜0.05).Conclusion Metabolic syndrome may be lead to a bad prognosis of endometrioid carcinoma.

Objective To evaluate the simulation of standardized patients (SP) in objective structured clinical examination (OSCE) for general practice residency training.Methods The simulation levels of 15 SPs were evaluated by 37 examiners with a rating scale of OSCE Examiner Feedback on SP performance from Melbourne University School of Medicine.The evaluation was conducted in history-taking and doctor-patient communication stations of OSCE for general practice residency training.Results The overall scores of SP performance were high and most examiners considered that the performance of SP was realistic and consistent.Among 9 items of rating scale,more than 90％ of the examiners considered that SP performance met or completely met the requirements of OSCE,except the item of preparation for clothing and making up before role playing.Six items of performance in history-taking station and 4 items in doctorpatient communication station reached 100％ satisfaction from the examiners.T test was used to compare the difference of SP performance between the morning and afternoon,and there was no significant difference (P ＞ 0.05).Conclusion The study showed for this group of SPs,the realistic degree and consistency of performance meet the requirements of OSCE,and its stability is not affected by long time continuous performance.