Objective:To survey the enablement level of elderly patients in the community and its influencing factors.Methods:A total of 460 patients aged ≥60 years visiting Changfeng and Fenglin Community Health Service Centers of Shanghai during September 3 to 15, 2018 were invited for a questionnaire survey. A self-made health status questionnaire, Patient Enablement Instrument (PEI), Chinese Health Questionnaire (CHQ-12), the Consultation and Relational Empathy Measure (CARE) were applied for survey.Results:All valid 460 questionnaires were retrieved. The positive rate of patient enablement was 73.91% (340/460). The median score for PEI was 3, Q1 was 0 and Q3 was 6. The univariate analysis showed that patient′s gender( Z=-2.32, P=0.02), age ( H=9.73, P<0.01), reason for visit ( H=42.06, P<0.01), health status in the past year ( H=8.28, P=0.02), consultation time ( H=22.92, P<0.01), sufficiency of communication with the doctor as patient thought ( H=41.83, P<0.01), detailed inquisition ( H=81.11, P<0.01), attending a contracted doctor ( Z=-3.42, P=0.04), the satisfaction of the visit ( H=38.64, P<0.01), total score of CHQ-12 ( Z=-2.01, P=0.04) and the score of CARE were significantly associated with the enablement level of the patient after the visit ( H=288.06, P<0.01). Multivariate linear regression showed that age 60-79( P=0.03), visit for acute disease( P<0.01), good or moderate health status in past year ( P<0.01), communication with the doctor<3 min or 3-<5 min ( P<0.01), sufficient or moderate time for communication with the doctor as patient thought ( P<0.01), detailed or moderate inquisition( P=0.03 or P=0.01), attending a contracted doctor ( P<0.01), CHQ-12 ≥4 ( P<0.01), middle or high CARE score ( P<0.01)were associated with the enablement of elderly patients after visit, with a cumulative contribution rate of 73.40%( F=50.08, P<0.01). Conclusion:The level of enablement of elderly patients after visiting the general outpatient clinic of the community health service center is relatively low. Patient′s age, types of disease, health status and the time of communication with the doctor, the sufficiency of communication time as patient thought, the detailed inquisition, attending a contracted doctor, the mental health status, and the empathy expression of the doctor are associated with the enablement of patients.

OBJECTIVETo study the expression difference in MicroRNA-21 (miRNA-21) levels of the plasma between the patients with coronary heart disease and the subjects without coronary artery lesions, and its clinical significance.

METHODSPlasma was obtained from the patients with coronary heart disease(trial group,56 cases) and the subjects without coronary artery lesions(control group, 10 cases), patients with coronary disease were divided into angina(AP, 39 cases) and acute myocardial infarction(AMI, 17 cases)subgroup, the contents of miRNA-21 were detected using qRT-PCR method, and the differential expression of miRNA-21 in each group was analyzed. The levels of creatine kinase isoenzyme (CK-MB), high sensitive troponin I(cTnI), B type natriuretic peptide urea (BNP), Gensini, left ventricular ejection fraction (LVEF), integral value of coronary left ventricular end diastole diameter (LV) and homocysteine (HCY) were determined and the correlation between miRNA-21 and these clinical indexes was analyzed.

RESULTSCompared with control group, there was a significant difference in expression of miRNA-21 in patients with angina and AMI (P < 0.05), and miRNA-21 expression in AMI group was much higher than that in AP group. There was statistical significance in CK, CK-MB, cTnI, Genisis integral comparison between AMI group and control group (P < 0.05). The correlation analysis showed that there was a positive correlation between expression of CK, CK-MB, cTnI and the level of circulating miRNA-21 in patients with acute myocardial infarction. And there was a negative correlation between BNP, Gensini integral, LVEF value of coronary artery, LV and circulating miRNA-21.

CONCLUSIONmiRNA-21 was significantly elevated in acute myocardial infarction subgroup than the control group. The level of miRNA-21 associates with the degree of coronary artery stenosis, and might be a potential marker for the diagnosis of acute myocardial infarction. miRNA-21 may play an important role in protecting myocardium from ischemia/reperfusion injury.

Acute Disease ; Biomarkers ; blood ; Coronary Disease ; blood ; Creatine Kinase, MB Form ; metabolism ; Humans ; MicroRNAs ; blood ; Myocardial Infarction ; blood ; Natriuretic Peptide, Brain ; metabolism ; Troponin I ; metabolism

Objective To analyze the clinical competency test results of general practitioners (GPs) in Shanghai Pudong New Area.Methods Total 1 160 GPs from Pudong New Area attended the clinical ability tests,all participated in theory test and 327 GPs attended practice skill tests.The results were reviewed by computer and the scores were automatically generated.Results The average score and pass rate of theory test were (64.24 ± 12.23) points and 64.2％ (745/1 155),respectively.The average scores of GPs with master or above degree were the highest (67.09 ± 13.38 points),however,the pass rate of GPs with undergradnate degree was the highest (69.7％,349/501).GPs with senior professional title got the highest average score and pass rate [68.26 ± 9.92 points and 82.7％ (43/52),respectively].Introduction to General Practice (69.7％),Internal Medicine (68.6％) and Cancer (66.9％) were the top 3 subjects with the highest correct rate.The pass rate of clinical skills was 39.1％ (128/327),GPs with master degree or above (192.87) and those with junior professional titles (171.08) had the highest scores.GPs with master degree or above (50.0％,8/16) and those with intermediate professional title (40.1％,97/242)had the highest pass rate.Conclusions The analysis shows that the average score and pass rate of both theory test and clinic practice skills test are not satisfactory among GPs in Shanghai Pudong New Area.The clinical ability of GPs need to be further improved,and the study of some specific disciplines need to be further strengthened.

A new flavonone, named as (2R, 3S)-pinobanksin-3-cinnamate(1), together with six known compounds, pinocem-brin (2), pinobanksin (3), 3-O-acetylpinobanksin (4), galangin (5), kumatakenin(6), and 3-methylkaempferol (7), were isolated from a 95% ethanol extract of seeds of Alpinia katsumadai through a combination of various chromatographic techniques, including silica gel and Sephadex LH-20. The structure of compound 1 was elucidated by spectroscopic data analysis. Compound 1 exhibits a potent neuroprotective effect against the corticosterone-damaged PC12 cells, which may be underlying the effect by scavenging intracellular ROS.
Alpinia ; chemistry ; Animals ; Cell Death ; drug effects ; Cholestenones ; chemistry ; isolation & purification ; pharmacology ; Cinnamates ; chemistry ; isolation & purification ; pharmacology ; DNA Fragmentation ; drug effects ; Neuroprotective Agents ; chemistry ; isolation & purification ; pharmacology ; Oxidative Stress ; drug effects ; PC12 Cells ; Rats ; Reactive Oxygen Species ; metabolism ; Seeds ; chemistry

Objective To establish a assessment system for comprehensive clinical competency of general practice residents.Methods An assessment system for comprehensive clinical competency of general practice residents was developed with modified Delphi expert consultation during November 2010 to October 2011.Thirty three experts in clinical practice,education and administration of general practice were invited for two-round Delphi questionnaire consultation.Results In two-round consultation,the expert activity coefficient was 100％,the authority coefficient was 0.852 and 0.855,and the coordination coefficient for the importance of the indicators was 0.228 and 0.245 respectively (P =0.000).The opinions among the experts became consistent from round 1 to round 2.An assessment system was established,which consisted of 5 first-level (professionalism,communicate skills,clinical competency and professional development ability) and 36 second-level indicators.Conclusion The index system established in this study may be used as references for evaluating comprehensive clinical abilities of general practitioners systematically and objectively.

Objective To investigate the capacity and training needs of the community general practice mentors in different areas of Shanghai.Methods General practice mentors from community health centers,who attended a municipal training program in Shanghai during July 2012 to October 2012,were participated in the survey with a self-designed questionnaire.The general condition,basic ability (clinical skill,teaching ability and professional development),motivation and needs of training were investigated.The factors affecting the willingness of training were analyzed.Results Among 742 mentors receiving the survey,259 were from the urban area,174 from rural-urban continuum and 309 from rural area.The academic degree in urban group was relatively higher:17 out of 257 (6.6％) holding master degree.The ratio of participants who had received standardized training in urban,rural-urban and rural areas was 33.2％,25.3％,37.4％,respectively.The personal quality and communication skills in urban group were significantly higher than those in rural-urban continuum and rural group (18.58 ± 2.49,17.89 ± 2.69,17.85 ±2.34,P ＜0.05).The clinical skill (12.31 ± 1.98,11.95 ±2.02,11.52 ± 1.81),teaching ability (11.99 ± 2.62,11.63 ± 2.86,11.12 ± 2.77) and professional development (6.42 ± 1.61,6.36 ± 1.55,5.61 ± 1.38) in urban group were all significantly poorer than those in other two groups.The main purpose of participation in training was to improve medical knowledge and clinical skills in three groups (70.8％,74.0％,80.4％,respectively),followed by the need for community teaching.The rural group has higher training requirements in improving clinical diagnosis and treatment ability (75.3％,80.1％,85.5％,respectively in three groups),doctor-patient communication ability (38.0％,44.0％,50.7％,respectively) and community preventive care ability (29.4％,30.7％,42.8％,respectively).The urban group had much more requirements in scientific research training (38.8％,34.9％,14.1％,respectively).Logistic regression analysis showed that doctors with supports from the leadership (OR =2.688,P ＜ 0.05) and with less working stress (OR =2.241,P ＜ 0.05) were more willing to participate in mentor training.Conclusion There are discrepancies in basic ability and training needs of community general practice mentors in different areas of Shanghai,so we should develop specific or targeted training program in the future.

Objective To develop an index system for evaluation index system for community general practice teaching base.Methods A draft of evaluation index system for community general practice teaching base was preliminarily developed on the basis of literature research.Two rounds Delphi consultations with 32 experts of general practice were conducted between July 2014 and May 2015.The results of consultation were analyzed and the evaluation index system for community teaching base was established.Results In two rounds of Delphi consultation,the positive coefficients were both 100％,the authority coefficient of experts were 0.879 and 0.897,respectively,and the coordination coefficient were 0.165 and 0.204 (P ＜0.01).The established evaluation index system consisted of 4 first-class indexes,8 second-class indexes and 27 third-class indexes.Four first-class indexes were basic conditions,teaching conditions,teaching staff and teaching practice.Conclusion The established evaluation index system may be used to accredit community general practice teaching base and to improve the quality of general practitioner training.

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 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.

Objective To survey the current situation of teaching for general practitioners (GPs) in community health centers of Shanghai.Methods A questionnaire survey on the teaching situation was conducted among 742 GP mentors who attended a municipal training workshop during July to October 2012 in Shanghai.The items of the survey included general background,previous teaching experience and self-evaluation on teaching ability.Results Among 742 GP mentors receiving the survey,the average age was (37 ± 6) years old.49.8％ (366/734) of mentors expressed their willingness of teaching,and the main reason was that it may upgrade themselves,while learning from teaching (58.6％,419/715).Heavy work load,lack of teaching time (31.8％,378/1 187) and teaching experience (30.7％,364/1 187) were the main obstacles for teaching.Among 106 GP mentors who had teaching experience in community health center previously,79.2％ (80/101) made teaching plans,but only 8.9％ (9/102) often prepared syllabus.Teaching plans were made mainly according to the work needs in community health care (54.2％,52/96),the situation and demands students (29.1％,28/96) or requirement of syllabus (17.7％,17/96).The problems included lack of teaching experience (50.5 ％,50/99) and time (42.4％,42/99),monotonous instructional modality (24.1％,25/104),and weak operability of the syllabus (21.2％).The self-reported results showed that 14.4％ were not able to develop a teaching program and to execute,18.3％ were not able to use a variety of teaching methods,31.2％ were not able to engage in teaching for 1.5 days per week.Logistic regression analysis showed that mentors with higher education background (OR =2.027,P ＜ 0.05),community teaching experience (OR =3.069,P ＜ 0.05),higher self assessment of general personal quality and communication ability (OR =2.488,P ＜ 0.05),higher teaching ability (OR =2.399,P ＜ 0.05) and strong training wishes (OR =11.382,P ＜ 0.05) were more willing to engage in the teaching work.Conclusions Heavy work load,insufficiency of teaching capacity and experience are main problems for GP mentors in Shanghai community health centers.Educational theory and methods should be focus on teacher training so as to improve teaching abilities.