ObjectiveTo explore the relationship of organizational factors with occupational burnout among doctors. Method740 doctors were assessed by CMBI, Job Demands and Decision Latitude scale, Distributive and Procedural Justice scale, Cross-Culture Role Conflict, Ambiguity, and Overload scale, Work Interference With Family and Family Interference With Work scale, Social Support scale. ResultsHierarchical multiple regression indicated that 27.8% variance of doctors' Emotional Exhaustion(EE), 36.8% variance of Depersonalization(Dp), 21.0% variance of Reduced Personal Accomplishment(RPA) were explained by Organizational factors. Work Interference with family, role conflict, work-family conflict, distributive justice and workload can significantly predict EE(Standardized β was 0.204, 0.102, 0.249,-0.109,0.093); Family interference with work, role ambiguity, family support, procedural justice and workload can significantly predict Dp(Standardized β was 0.506,0.192,-0.122,0.105,-0.068); Role ambiguity, family support, job control, work Interference with family and superior support can significantly predict RPA(Standardized β was 0.245,-0.179,-0.172,-0.106,-0.069). ConclusionOrganizational factors have significantly effect on doctor's burnout, especially work-family conflict and role character.

Objective:To investigate the characteristics of occupational burnout of psychiatrists,and explore its organi-zational factors.Methods:106 psychiatrists were assessed by CMBI,Job Demands and Decision Latitude scale,Distributive and Procedural Justice scale,Cross-Culture Role Conflict,Ambiguity,and Overload scale,Work Interference with Family and Family Interference with Work scale,Social Support scale.Results:Hierarchical multiple regression indicated that work interference with family,role conflict,workload and role ambiguity could significantly predict emotional exhaustion;family interference with work could significantly predict depersonalization;colleague support and role ambiguity could significantly predict reduced personal accomplishment.Conclusion:Status of reduced personal accomplishment of psychiatrists is serious.Occupational burnout has particular related factors.

Objective To explore the clinical effect of cognitive function training joint hydrochloride donepezil in the treatment of cerebral stroke cognitive dysfunction.Methods 60 cerebral stroke patients with cognitive dysfunction were divided into two groups randomly,each group 30 cases.The patients of the two groups were given corresponding improving circulation and other conventional treatment measures,including giving hydrochloride donepezil treatment to A group and cognitive function training on the based treatment of group A to group B.Before treatment and after treatment 1 month,3 months,clinical dementia rating scale(CDR),simple mental state scale of mini-mental state examination (MMSE) and daily life events scale (ADL) ability evaluation were compared between the two groups.Results Of the two groups,CDR scores [(2.3 ± 0.5) points,(1.9 ± 0.6) points] and ADL [(43.3 ± 12.5) points,(39.6 ± 12.2) points] were lower than those before treatment [(2.6 ± 0.6) points,(2.6 ± 0.5) points,(49.6 ± 11.2) points,(48.3 ± 12.5) points] (all P ＜ 0.05),and MMSE scores [(20.6 ± 3.2) points,(21.0 ±3.5) points] were no different to those before treatment [(19.3 ± 3.5) points,(19.6 ± 3.2) points] ;3 months after treatment,CDR scores [(1.6 ± 0.5) points,(1.3 ± 0.5) points],MMSE scores [(23.3 ± 3.5) points (25.6 ±3.2)points] and ADL scores[(39.6 ± 11.2)points (33.3 ± 12.5)points]were significandy improved,and which of B group improved obviously.Conclusion Cognitive function training joint hydrochloride donepezil in the treatment of cerebral stroke cognitive dysfunction is more effective than hydrochloride donepezil alone,and can more obviously improve the symptoms of patients,and promote the quality of life,and it is worth for clinical application.

Objective To investigate low frequency repetitive transcranial magnetic stimulation (rTMS) on acute cerebral infarction (ACI) patients movement function recovery,in order to provide certain reference basis about the further research on low frequency rTMS treatment ACI and clinical application.Methods Sixty patients of ACI with unilateral limb movement function disorder were divided into low frequency rTMS group and control group by table of random digit with 30 cases each.Two groups were given the conventional drug treatment and rehabilitation training,low frequency rTMS group added low frequencyrTMS treatment 10 d on the basis of the above.Before treatment and after treatment 10 d and 40 d in patientswith the U.S.national institutes of nerve function defect score (NIHSS),Fugl-Meyer motion scale (FMA)score and Barthel index (BI) score changes were observed.Results Before treatment the NIHSS,BI score,FMA score in low frequency rTMS group were (16.44 ± 3.29),(36.69 ± 5.97),(31.06 ± 7.43) scores,incontrol group were (16.38 ±4.01),(35.98 ±6.41),(30.87 ±8.56) scores,there was no significantdifference between the two groups (P ＞ 0.05).After treatment 10 d the NIHSS,BI score,FMA score in lowfrequency rTMS group were (8.13 ± 2.18),(56.04 ± 5.21),(48.42 ± 7.73) scores,in control group were(11.23 ± 1.97),(50.12 ±4.88),(42.12 ±8.61) scores.After treatment 40 d the NIHSS,BI score,FMAscore in low frequency rTMS group were (3.11 ± 0.53),(73.29 ± 5.34),(61.63 ± 8.36) scores,in controlgroup were (5.62 ±0.98),(63.96 ±4.46),(52.45 ±7.61) scores.The NIHSS in the two groups aftertreatment 10 d and 40 d was significantly lower than that before treatment (P ＜ 0.05),BI score and FMAscore was significantly higher than that before treatment (P ＜ 0.05).There were significant differences in theNIHSS,BI score,FMA score after treatment 10 d and 40 d of two groups (P ＜ 0.05).Conclusion Lowfrequency rTMS on ACI patients movement function recovery has obvious role in promotion.

Clinical microbiology should participate the infectious diseases consult.There is no guideline about this topic in the professional field so far.The professional recommendations are given to the different items including definition,professional,prerequisite,pre-consult phase,consult phase,post-consult phase,and etc.It is hoped that our recommendations are conducive to the consult task and can promote the development of clinical microbiology and infectious diseases.

Objective To compare effects between laparoscopy and laparotomy for the treament of ovarian endometriosis cysts and to investigate the value of laparoscopy in the treatment of ovarian endometriosis cysts. Methods We retrospectively analyzed 144 cases of ovarian endometriosis cysts,92 of which underwent laparoscopic operations(Laparoscopic Group) and 52 of which received open operations(Open Group).All the cases were followed for 4 months ~ 5 years.Results The operation time,postoperative hospital stay,and intraoperative blood loss were 69?41.8 min,3.5?1.0 d,and 55?12.0 ml in the Laparoscopic Group,respectively,and 137?54.3 min,8.7?3.5 d,and 178?105.9 ml in the Open Group,respectively,with significant differences between the two groups(t=-8.402,-11.048,and-13.350;P=0.000).There was no significant difference in the rate of abdominal pain relief between the Laparoscopic Group(66.0%,35/53) and the Open Group(52.8%,19/36)(?~2=1.580,(P=0.209)).The recurrent rate was 19.6%(18/92) in the Laparoscopic Group and 19.2%(10/52) in the Open Group,without significant difference between the two groups(?~2=0.002,P=0.961). Conclusions Laparoscopic surgery gives similar efficacy to open surgery in the treatment of ovarian endometriosis cysts.Laparoscopic surgery can be used as the first choice in treating ovarian endometriosis cysts because of its minimally invasive characteristics.

Ovarian cancer is sex hormone-Dependent.Gonadotropin releasing hormone (GnRH) analogues inhibit ovarian cancer not only through the hypothalamus-pituitary-gonadal axis, but also through directly inhibiting the proliferation and inducing the apoptosis via GnRH receptors on the ovarian carcinoma cells.In addition, GnRH analogues target GnRH receptors on the cancer cells and can serve as a carrier for cytotoxic agents, improving the efficiency of cytotoxic agents and lowering the side effect.In a word, treatment with GnRH analogues may be a valuable alternative for advanced and recurrent ovarian cancer.

Teaching method is important to carry through the content of the course and guarantee the teaching quality.We have proceeded some reforms and research in the Obstetrics and Gynecology teaching and have obtained the good result by intergroting teaching conteut and teaching resoures,selecting high-level teaching team,case teaching,PBL teaching and multi-media teaching.

Tsutsugamushi disease is an acute infectious rickettsial disease caused by the intracellular parasite Orientia tsutsugamushi. Due to its variety of clinical signs, this disease is often misdiagnosed. This article examines a total of 4 patients who visited our clinics with fever and sore throat. 3 of them had body temperature of 39.5 Celsius degrees when admitted. The characteristic black eschar occurred on 4 of them. Lymphadenopathy occurred on 2 of them. Cough occurred on 1 of them. Lab tests showed that 3 of them had Leukocytosis, 1 of them had increased bronchovascular markings, and 3 of them had Weil-Felix test positive. After admission, all patients, who were confirmed of diagnosis of tsutsugamushi disease instead of tonsillitis, received the comprehensive treatment and cured afterwards.
Diagnostic Errors ; Humans ; Orientia tsutsugamushi ; Pharyngitis ; etiology ; Scrub Typhus ; complications ; diagnosis ; Tonsillitis ; diagnosis

Objective: To evaluate the effect and safety of low-dose naloxone combined with sufentanil and ropivacaine for postoperative patient-controlled epidural analgesia (PCEA) in elderly patients undergoing total hip replacement. Methods: A total of 60 elderly patients (ASA I-II) undergoing total hip replacement were randomly assigned to two equal groups: Group C was given 0.5 μg/ml sufentanil in 0.15% ropivacaine; Group N was given the same solution with 0.09 μg/(kg·ml) naloxone. The 2 groups were followed up in a double-blinded manner: the visual analogue scale (VAS) for pain score was recorded at 2, 6, 12, and 24 h to evaluate the analgesia effect. Meanwhile, the incidences of postoperative nausea and vomiting (PONV), pruritus, sedation, respiratory depression, and hypotension were also recorded. Results: The VAS pain score in Group N was significantly lower than that in Group C at 6, 12 and 24 h (P<0.01). The incidence of PONV in Group N was significantly lower than that in Group C (P<0.05); the incidences of other opioid-induced side-effects were not significantly different between the 2 groups. During the course of analgesia, the vital signs of 2 groups were stable; no patients had respiratory depression or hypotension. Conclusion: Low-dose epidural naloxone can enhance the analgesic effect of sufentanil. With timely postoperative monitoring, low-dose naloxone combined with sufentanil and ropivacaine is safe and effective for postoperative patient-controtled epidural analgesia in elderly patients undergoing total hip replacement.