General practitioners need not only to have comprehensive knowledge and clinical competency, and also to have the soft skill that are social and personal management skills.In the residency training of general practice, it is necessary to pay attention to the soft skill development.The training institutions should adopt various measures: including soft skills cultivation in training contents, emphasizing soft skills training in the traditional teaching practice, establishing a variety of practice platforms and introducing soft skills in the evaluation and examination system.

Objective To define the assessment dimensions of community-based elderly care service.Methods Firstly 11 assessment dimensions of elderly care service needs were teased out through literature review and group discussion, these were illness, self-care ability, vision, risk of falls, willingness/information self-expression ability, the comprehension in others' willingness/information, depression, anxiety, family care ability, self-desires for old-age support, family-desires for old-age support.Then 37 experts were invited to reconfirm and empower theose assessment dimensions with two rounds of Delphi method.Results Results showed that the enthusiasm and authority degree of experts were favorable in two rounds, and the results from the second round showed strong opinion coordination.Finally, 12 assessment dimensions were confirmed, in which financial situation of the aged added and used for reference.After weight calculation, illness was weighted the highest (0.11), while vision and the degree of anxiety were weighted lowest in 11 dimensions (0.07).Conclusion The reliability of the assessment dimensions of the aged service needs is high.This study had positive significance on the solution of the dilemma in elderly care at the present stage.

Thrombotic thrombocytopenic purpura (TTP) is a kind of thrombotic microangiopathies which has low incidence but highly mortality.The outcome of TTP has been improved significantly since last decade due to the application of plasma exchange,however,early relapse occurs in some patients,and for relapsed/refractory patients the prognosis is still poor.This article reviews the recent progress in treatment and relevant influencing factors of TTP.

Rheumatoid arthritis is a autoimmune diseases characterized as joint chronic synovitis, and is accompanied with systemic damage.Osteoporotic fracture is one of the common complications of rheumatoid arthritis, which may decrease quality of life, and even increase the mortality of patients.Variety of factors may be associated with the occurrence of osteoporotic fractures in rheumatoid arthritis patients.In this article, through the literature review we discuss the risk factors of osteoporotic fracture, including vitamin D deficiency, lower limb muscle strength and balance ability in rheumatoid arthritis patients.

Forty nine patients with vesicovaginal fistula underwent transvaginal repair by the use of Foley catheter in our hospital.The clinical data were retrospectively analyzed.The success rate of primary operation was 98% (2/49), the mean operation time was (85±8)min, the mean postoperative hospital stay was( 13±2) d, the rate of postoperative urine leakage was 2%(1/49), the mean bladder capacity was (378±53)ml.Transvaginal repair of vesicovaginal fistula by the use of Foley catheter is an effective surgical modality with satisfactory results.

The antihypertensive treatment protocols of 4102 patients from the database of Changbai Community Health Service Center of Shanghai Yangpu District were analyzed.Patients with irregular drug treatment were excluded in the study.In 4102 hypertensive patients,45.6% took calcium channel blockers (CCB),16.0% took angiotensin converting enzyme inhibitors ( ACEI),3.6% took AT1-receptor blocker (ARB),9.0% took β-adrenergic receptor blockers,4.7% took diuretics and 21.1% took compound preparation.68% patients were in single-drug protocol,29.3% in two-drug,2.6% in three-drug and 0.1% in four-drug.In patients with two-drug protocol,75.8% was based on CCB; three-drug or four-drug protocols were also based on the combination of CCB.The results indicate that the treatment protocol for hypertensive patients in our community health service center basically meets the requirements of International Society of Hypertension Treatment Guidelines,but the proportion of the single drug use seems to be high,more combination of antihypertensive drug use should by proposed.

The dada of 987 out-patients aged 60 or over,who visited Bajiao Community Health Center of Beijing Shijingshan District from January 2006 to December 2009,were retrospectively analyzed.The results revealed that there was no gender difference in the prevalence of low vision and blindness ( χ2 =2.719,P = 0.606); the severity of low vision and blindness was correlated with the age of patients ( χ2 =138.389,P = 0.000); cataract was the main cause of low vision and blindness,accounting for 49.6%(62/125) of low vision and 64.3% (36/56) of blindness.

To compare the performances of community family physicians in different patterns of chronic disease management.From June 2011 to April 2012,3 different models (A,B,C) of chronic disease management were employed for a total of 4972 patients.Statistics analyses were performed.The number of participants,session and average effective working time were different.In terms of standard management of hypertension,diabetic management rate and non on-site management rate,model C was superior to models A and B (P ＜ 0.01).And model A had the lowest rate of non on-site management (P ＜0.05).Though with each own advantage,three models are complementary.But model C reflects the residents' self-management concept of chronic disease.

The medical records of all 12 patients diagnosed as chronic active Epstein-Barr virus (CAEBV) infection at our hospital were analyzed retrospectively.There were 7 males and 5 females with a median onset age of 28 years.CAEBV was characterized by fever,splenomegaly,hepatomegaly and lymphadenopathy,etc.The abnormalities of laboratory examination included liver dysfunction,thrombocytopenia,anemia and leucopenia.EBV-DNA detected by real-time polymerase chain reaction was (1.7 × 103-3.5 × 107) copies/μg DNA in peripheral blood mononuclear cell.Among them,the outcomes were death (n =5),lost to follow-up (n =2) and T cell lymphoma (n =1).It is necessary to improve our awareness of CAEBV infection because of its poor prognosis and high mortality.

A total of 258 cases of elderly patients with herpes zoster were divided into treatment group (n =128) and control group (n =130).The treatment group received a once daily dose of narrowband ultraviolet irradiation plus oral acyclovir 0.8 g,5 times a day.However,the control group received a once daily dose of infrared therapy plus the same oral acyclovir.At Day 9,the effective rates of treatment and control groups were 91.7％ (117/128) vs.74.6％ (97/130) (P＜0.05).Also,in terms of pain relief time (2.56 ± 1.51) vs.(5.44 ±4.06) days,crusting time (4.51 ±0.48) vs.(6.11 ± 1.81) days and healing time (5.65 ±0.56) vs.(9.28 ±0.21) days,the treatment group was better than those of the control group (P ＜0.01).