The unique concept,characteristics and service contents of general practice make its residency training to focus on outpatient teaching.General Practitioner Inquiry-Preceptor (GP-IP) is an outpatient teaching mode developed in the general practice residency training base of our hospital.The GP-IP teaching mode includes four modules:diagnosis and treatment package for medically unexplained physical symptoms,Pendleton and RICE inquiry model,video teaching and problem based learning.

Communication between doctors and patients is an important way to establish good doctorpatient relationship.It is crucial to master doctor-patient communication skills and arts for general practitioners who will extensively serve the people in community for life-long time after completion of residency training.To improve the communication skills and to enhance the clinical competency of general practitioners,we applied the Balint special group activities as core of doctor-patient communication course in residency training program.Through 3 years of practice,we found that the application of Balint group enriched the teaching contents and form of general practice residency training;improved doctor-patient communication skills,and enhanced the competency and professionalism of general practice trainees.

Communication skills are the basic requirement for general practitioners,the continuous improvement of communication skills is the guarantee of the service quality.It is crucial to establish an effective evaluation system in the training of communication skills for general practitioners.This article reviews the current status of evaluation scales of doctor-patient communication skill commonly used in China and other countries to provide reference for the establishment of the communication skill evaluation system for general practitioners which is suitable for China's condition.

Nine cases of colorectal lipoma who were admitted from January 2005 to December 2016 were reported.The pathological diagnosis was confirmed after surgery,and all 9 cases were cured and discharged.All patients were followed up and were alive by January 2017.

Forty four patients (84 eyes)with primary chronic angle closure glaucoma,including 14 cases(26 eyes)with mild visual field defect,22 cases(42 eyes)with moderate defect and 8 cases(16 eyes) with severe defect,treated in our hospital from January 2014 to January 2016 were enrolled in the study.The visual field defect (MD),corneal endothelial cell density (ECD) and central corneal thickness (CCT) were measured.The average CCT in mild,moderate and severe visual field defect groups was (531.4 ± 27.1) μm,(521.2 ± 31.4) μm and (513.3 ± 28.2) μm,respectively (F =-3.24,P =0.04).The mean endothelial cell density in three groups was (2 635.0 ± 320.3) cells/mm2,(2 619.2 ± 161.4) cells/mm2 and(2 589.7 ± 290.4) cells/mm2,respectively (F =0.22,P =0.80).The results indicate that with the aggravation of visual field defect in patients with chronic angle closure glaucoma,the central corneal thickness is significantly thinner,and the mean density of central corneal endothelial cells shows a downward trend.Close observation and active intervention are needed for chronic angle closure glaucoma with thin central corneal thickness.

The clinical manifestations,laboratory test results,treatments and prognoses of 5 adult patients with hyperimmunoglobulin E syndrome (HIES) were retrospectively analysed.All 5 patients experienced disease onset within 1 year of birth and had recurrent multiple infections,all had recurrent rash and 4 had skeletal abnormalities.Recurrent infections lasted for a mean of 19.6 years and predominantly affected the skin and respiratory tract.Other manifestations included chronic otitis media,renal abscess and osteomyelitis.Two cases had skin abscess (methicillin-susceptible Staphylococcus aureus infection),which was alleviated after antibiotic treatment and abscess drainage.Two cases had respiratory tract infection and one case had a foot skin ulcer,and all symptoms improved after antibiotic treatment.HIES should be suspected when an adult patient experiences repeated infection since birth,particularly when skeletal abnormalities and a history of neonatal rash is also present.Early diagnosis facilitates targeted anti-infection therapy,leading to earlier remission and an improved prognosis.

Objective To compare the change of management time for patients with acute cerebrovascular disease before and after re-accreditation of Grade Ⅲ Class A in a general hospital.Methods Electronic medical records of 490 patients diagnosed as acute cerebrovascular disease(215 cases of cerebral infarction,275 cases of cerebral hemorrhage) managed in Zhongnan Hospital of Wuhan University from June 2015 to July 2016 were collected,including 262 patients managed before re-accreditation (group A,June 2015 to December 2015) and 228 patients admitted after re-accreditation (group B,January 2016 to July 2016).In group A,there were 109 cases of cerebral infarction and 153 cases of cerebral hemorrhage(68 caused by trauma);in group B there were 106 cases of cerebral infarction and 122 cases of cerebral hemorrhage(54 caused by trauma).The time in emergency department (ED time),time waiting for admission (admission time) and the total management time (total time) were analyzed and compared between two groups.Results The ED time in group A and group B was 44.5 (30.0,71.5) and 39.0 (20.3,69.0) min (Z =-2.103,P =0.036) respectively;the admission time was 35.0 (25.8,50.0) and 39.0 (27.3,55.8) min(Z =-2.211,P=0.027);and total time was 85.0(62.8,120.0)and 82.5(61.0,119.0) min(Z =-0.356,P =0.722) in two groups respectively.For patients of cerebral infarction in group A and B the ED time was 49.0 (33.5,81.5) and 41.0 (29.8,74.3) min(Z =-1.872,P =0.061);the admission time was 37.0(27.0,52.0) and 36.0(25.0,52.3) min(Z =-0.516,P =0.606);and total timewas97.0(69.5,131.0)and 83.5(62.0,118.3) min(Z=-1.914,P=0.056).For patients of cerebral hemorrhage in group A and B,the ED time was 42.0 (28.0,64.0) and 35.0 (17.8,65.0) min (Z=-1.426,P =0.154);the admission time was 34.0(24.5,49.0)and 41.0(31.0,61.0) min (Z=-3.353,P =0.001);and total time was 79.0(58.0,108.0) and 82.0(60.0,120.8) min (Z =-1.052,P =0.293).Conclusions After re-accreditation of Grade Ⅲ Class A Hospital the total waiting time for patients of cerebral infarction is decreased significantly in emergency department,however,for patients of cerebral hemorrhage the waiting time for admission is longer.

Objective To analyze the infection features,risk factors,and the relationship with the efficacy in patients with acute leukemia during initial induction chemotherapy.Methods The clinical data of 200 patients with newly diagnosed acute leukemia from January 2015 to February 2016 in the Second Hospital of Shanxi Medical University were retrospectively analyzed.Results The infection rate of patients with acute leukemia under induction chemotherapy was 84.0％ (168/200).Among 168 patients with infection,159 cases (94.6％) had known infection sites,the top three infection sites were the lungs,gastrointestinal tract and the oral cavity.Total 213 strains of pathogens were identified,Gram-negative bacilli accounted for 39.0％ (n =83),Gram-positive cocci for 34.3％ (n =73),fungi for 23.5％ (n =50) and the virus for 3.3％ (n =7).Multivariate regression analysis showed that agranulocytosis was the independent risk factor for acute leukemia patients during induction chemotherapy (OR =14.370,95％ CI:2.576-116.518,P ＜ 0.01).The rate of complete remission (CR) and CR with incomplete hematologic recovery (CRi) in infection group was 74.4％ (125/168),and the rate of CR + CRi in non-infected group was 87.5％ (28/32),and there was no significant difference between the two groups.(χ2 =2.564,P =0.109).Conclusion During the induction therapy for acute leukemia patients,the rate of infection and the rate of fungal infection are high;lung is the most common site,Gram-negative bacteria is more common;agranulocytosis increases the chance of infection;and the infection may not affect the disease remission rate.

Objective To survey the awareness and knowledge of Helicobacter pylori (Hp) infection among medical staff in Shanghai.Methods A questionnaire survey was conducted among 316 medical staff in Shanghai,including 74 gastroenterologists (GI),158 general practitioners (GP),and 68 gastroenterology nurses(GN),from October 2014 to September 2015.The questionnaire was designed according to the Fourth Helicobacter Pylori Infection Treatment Consensus Report of China (the Consensus).There were 4 parts and 29 questions in the questionnaire,including the knowledge and performance of the Consensus (8 questions),the indications of Hp eradication (8 questions),detection methods of Hp infection (7 questions)and the therapy of Hp eradication (6 questions).Results Total 300 valid questionnaires were received with a response rate of 94.9％ (300/316).The awareness rate of the Consensus in GI,GP and GN groups was 81.1％ (60/74),57.6％ (91/158) and 26.4％ (18/68),respectively (χ2 =43.67,P=0.001).GI had higher awareness rate than GP and GN in indications of Hp eradications (for peptic ulcer,mucosa-associated lymphoid malignancies,post-resection patients of early gastric cancer,and family history of gastric cancer,the χ2 values were 16.68,35.60,33.46 and 39.22,respectively;all P ＜0.05).In part of Hp infection detection methods,the responses of GI,GP and GN groups in C14 or C13 urea breathing test were 97.3％ (72/74),47.5％ (75/158) and 82.1％ (55/68),respectively (χ2 =72.38,P =0.001);in gastric mucosa tissue rapid urease test were 70.3％ (52/74),13.9％ (22/158) and 25.4％ (17/68),respectively (χ2 =78.22,P =0.001);in serological test were 58.1％ (43/74),20.9％ (33/158)and 44.8％ (30/68),respectively (χ2 =40.30,P =0.001);in gastric mucosa tissue section staining were 56.8％ (42/74),13.3％ (21/158) and 22.4％ (15/68),respectively (χ2 =50.35,P =0.00).In part of Hp eradication therapy the responses of GI,GP and GN groups in recommended bismuth quadruple therapy were 71.6％ (53/74),47.5％ (75/158) and 40.3％ (25/62),respectively (χ2 =15.93,P =0.001);in triple therapy were 27.0％ (20/74),51.6％ (81/158) and 42.0％ (26/62),respectively (χ2 =12.42,P =0.002);in 10 or 14 d for treatment duration were 78.4％ (58/74),78.5％ (124/158)and 67.6％ (46/68),respectively (χ2 =3.36,P =0.186).Conclusion Gastroenterologists are more likely to adhere with the Consensus than general practitioners and gastroenterological nurses in the management of Hp infection.The survey suggests that more attention should be paid for popularization and implementation of Hp infection guidelines and consensus among Shanghai medical staff,especially for GP and nurses.

Objective To analyze the allocation and utilization of health resources for the elderly in Xicheng district of Beijing.Methods A questionnaire survey on the allocation and utilization for elderly was conducted during March 2016 to December 2016 in Xicheng district of Beijing.The participants were selected from 4 community health service centers (CHS) in the district by stratified cluster random sampling method.The main contents of the questionnaire included chronic diseases prevalence among the elderly residents,health resources utilization,satisfaction and suggestion of the health service system.Two hundred questionnaires were distributed and equal number of questionnaire was received with a retrieval rate of 100.0％.Results At the end of 2014,there were 632 medical and health institutions in Xicheng district.The residents aged 60 and over were increased from 292 416 in 2010 to 354 696 in 2014;those aged 65 and over increased from 218 891 to 246 560;those aged over 80 increased from 61 620 to 81 011;and those aged over 100 increased from 74 to 384.Among 200 participants 78.0％ (156/200) suffered with chronic diseases,and 29.5％ (59/200) had more than 2 kind of chronic diseases;65.0％ (130/200) preferred the first visit in the secondary or tertiary hospitals,while 33.5 ％ (67/200) chose community health service center for their first visit;and 54.0％ (108/200) visited tertiary hospitals more than 4 times per year.For the health service,11.5 ％ (12/200) were "very satisfied",26.5 ％ (53/200) were "satisfied",59.5 ％ (119/200) were "not satisfied",and 2.5％ (5/200) were "very dissatisfied".Among all participants 81％ (162/200) felt too long waiting time;63.0％ (126/200) were dissatisfied with service attitude of medical staff in the secondary or tertiary hospitals,while 6.5％ (13/200) were dissatisfied with service attitude of medical staff in community health service centers.Conclusion The population of Xicheng district is progressively aging in recent years,the health service demand of elderly is large,the residents prefer to large hospitals for their first visit,and the elderly residents in Xicheng district are less satisfied with the current status of health and medical resources.