Differences between doctors and patients in their possession of medical knowledge, surroundings and positions naturally lead to a gap in their understanding of diseases. Firstly, doctors and patients do not share an equal amount of medical knowledge and, moreover, patients do not attach much weight to the prevention of diseases. Secondly, current medical technologies are still unable to reveal the nature and laws of all the diseases confronting mankind, and yet many patients are unaware of the fact. Thirdly, many medical procedures run certain risks that ought to be assumed by both doctors and patients. Fourthly, due to the complexity, variousness and individual differences of the human body, there may be differences in the prognosis of disease and also there is usually a process before a disease can turn for the better. And yet patients often find it hard to see the point. Hence the gap between doctors and patients in their understanding of diseases.

The outbreak and spread of SARS warned us to be constantly on our guard against various contagious diseases in the years to come. The prevention and treatment of contagious diseases are not just the obligations of antiepidemic services in the public health field. General hospitals at various levels are not only an important member of the forces fighting against various contagious diseases but are also always at the forefront of the task. For this reason, it is imperative for general hospitals not only to set up and continuously better departments of contagious diseases but also to constantly enhance their staff's antiepidemic awareness and strengthen training with regard to relevant knowledge and skills. In addition, it is necessary to find a solution to the problem of referral of patients with contagious diseases.

It is difficult to interpret the infection after glucocorticosteroid treatment because glucocorticosteroid will lead to increased peripheral blood neutrophils.Procalcitonin (PCT) is a major biomarker,which can be used as the basis for early diagnosis of severe bacterial infections.The level of PCT is not inhibited by glucocorticosteroid.PCT can be used to interpret infection as systemic use of glucocorticosteroid

Objective To review the etiology of 10 201 adult patients with fever of unknown origin (FUO) in China from 1979 to 2012,and to compare the reasons between the South and the North of China,and to illustrate the change in different periods.Methods Literatures containing key wordfever of unknown origin were selected in China National Knowledge Infrastructure (CNKI) database from 1979 to 2012.Articles were excluded if patient population were less than 100.Diagnostic criteria of FUO were confirmed by the standard of Petersdorf and Beeson in 1961.Totally 43 literatures including 10 201 patients were enrolled in this study.The period of the literatures were divided into the early,middle and later period,and the regions were partitioned into the South and the North.Results A total of 42 articles (including 9787 patients) provided the gender information with 5063 men and 4724 women.The etiologies of 10 201 FUO patients included infectious diseases (53.5％),rheumatic diseases (20.1％) and tumor (12.0％).The positive diagnostic rate was 91.8％.Tuberculosis (23.8％) was the most common reason in infectious diseases.Adult Still's disease (7.0％) was the most common cause of FUO among rheumatic diseases.Lymphoma (3.4％) was the most common tumor in FUO patients.Besides,drug-induced fever (1.7％) should also be considered.In the recent 30 years,the proportion of FUO caused by infectious diseases had decreased,rheumatic diseases and other reason had increased (P ＜ 0.05).The proportion of tumor in middle period was significantly higher than that in the early and later period (P ＜ 0.05).The negative diagnostic rate had increased (all P ＜ 0.05).The proportion of infectious diseases in North China was significantly lower than that in the South (P ＜ 0.05).The proportion of other reason was significantly higher in the North (P ＜ 0.05).Conclusion In the recent 30 years,the most common cause of FUO was still infectious diseases,especially tuberculosis.

ObjectiveTo understand knowledge level about chronic obstructive pulmonary disease (COPD)of medical doctors practising at district hospitals and community health service and impact of different models of continuing medical education on their knowledge level.MethodsKnowledge of COPD was investigated with a close-book examination in 372 medical doctors working at the grassroots of 10 urban copies of finished examination papers were returned in this investigation.with an average score of 50.1 and pass rate of 42.5%.About 67.7%and 67.5%of medical doctors passed the examination of knowledge on definition,risk factors and non.pharmacological treatment for COPD.respectively,and 19.9%of them passed the examination on pharmacological treatment for COPD.Different modes of continuing medical education made varied impacts on their acquisition of COPD knowledge.with an average score of 67 and pass rate of 73.3%in the intensified education group,respectively,significantly higher than those in general education group and non-education group.ConclusionsClinical knowledge and skills of COPD for medical doctors working at the grassroots in Beijing Was not so satisfactory and education should be strengthened urgently to raise their knowledge on COPD prevention and control.

Objective To investigate current status of diagnosis, treatment and referral of pulmonary tuberculosis in general hospital. Methods Statistical reports of hospital work, notification forms of tuberculosis (TB) cases on the internet, registration book of laboratory sputum mgcobacteria examinations, statistical reports of X-ray examinations for outpatient department, referral forms for mycobacteria patients, medical records for hospitalized patients at the respiratory ward of the People's Hospital, Peking University during August 2005 to July 2006 were reviewed and analyzed. Results In outpatient pulmonary department, there were 45 055 visitors during the period of August 2005 to July 2006,and 4960 of them (11.0%) had their chest X-ray examined, 1 512 (3.4%) had sputum mycobacteria examined with smear-positive in 24 cases, 189 (0.4%) were referred to specialized TB dispensaries for further diagnosis and 183 with notification forms with a notification rate of 96.8%, and 30 (0.1%) were finally diagnosed as TB after hospitalization with an interval less than 14 days between onset of symptoms and diagnosis in 27 of the 30 (90.0%) and 26 were referred to a specialized TB dispensary (86.7%) for treatment. Conclusions On general, detection, diagnosis and referral of TB in People's Hospital of Peking University are in a good situation.However,more aUenfion should be paid to the following aspects：① quantity and quality of sputum myeobacteria examinations for outpatients should be improved further,②chest radiograph reading by radiologists and clinicians need to be improved,and ③consciousness of early detection for TB need to be enforced in physicians by bronchoscopy and pathological diagnosis,especially in those with complicated and difficultly diagnosed smear-negative TB.

Objective To analyse the cause for delaying diagnosis of WG and improve the diagnosis level.Methods A retrospective study was done on patients who were admitted to the People's Hospital of Peking University and were diagnosed with WG from 1997 to 2007,by searching the computer system of the hospital for patients with WG,who were misdiagnosed and reported in Chinese Journal of Rheumatology and Clinical Misdiagnosis ﹠ Mistherapy from 2003 to 2007.Results WG included multiple systems and organs ivolvement.The lung,kidney and upper airway were the most commonly involved organs,and ear,eye,external salivary gland and oral cavity were also involved.Most initial symptom and clinical manifestation were not typical manifestation of WG trilogy,which led to misdiagnosis and mistreatment.Anti-neurophil cytoplasmic antibody(ANCN)positive rate was high.The most common pathologic features were necrotizing granulomatous inflammation and vasculitis.Conclusion Clinical manifestation of WG is complicated and it injures multiple system or organs.When the symptoms are atypical,it is easy to lead to misdiagnosis,especially in early stage.We suggest running requisite revision for diagnostic criteria of WG,in order to make early diagnosis and treatment of WG.

Objective To discover the knowledge level about the COPD of doctors in District and Community Hospitals. Methods The knowledge level of COPD was investigated with questionnaire in 400 physicians in 10 districts of Beijing in December 2007. Content included: COPD definition, diagnosis, epidemiology, risk factor, COPD common symptoms, exacerbation manifestation, COPD non-pharmacological treatment (pulmonary rehabilitation, smoking quitting, influenza and pneumococcal vaccination), and COPD pharmacological treatment (bronchodilator therapy, antibiotic therapy, inhaled and systemic corticosteroids therapy). Results There were 372 answered copies of questionnaire collected, the total average score was 50.1?20.6 points, pass rate was 42.5%, while was 55.2?20.6 points and 57.6% in 30~year old group and 55.6?14.2 points & 51.9% in 40~year old group, which were higher than those in 20~year old group and ≥50 year old group (P