Objective To assess clinical competencies of trainees with standardized patients(SPs)and explore reform in methods of assessment for trainees at their completion in standardized training for general practice.Methods Totally,52 trainees in clinical training bases for general practice in Shanghai attended the examinations.Their skills in commanication skills,information and data gathering,comprehensive consultation,clinical thinking and decision-making in diagnosis and treatment were examined by rotation of three serial assessment stations in a specified time to perform standardized tasks,including medical history-taking,physical examinations(PE),medial record writing and oral tests.Results Scoresof history-taking,PE and skills of communication with SPs were higher than those agsessed by examiners themselves.but they both correlated each other with a P-value less than 0.01,with the highest coefficient of correlation of 0.774 between score of PE and that assessed by examiners.There was significant difference in average score among all clinical skills(F=9.867,P＜0.01),with the lowest one of comprehensive consultation skills of 64±22(P＜0.01).Skills of communication with patients had the highest correlation with data gathering ability(r=0.582,P＜0.01).Results of analysis for influential factors showed no significant difference in average score for all skills between men and women trainees(P＜0.05).Average score of comprehensive consultation ability in those with work experience was lower than that in thoge without it(P＜0.05)and no significant difference in scores of all the other skills wag found between those with varied length of working(P＞0.05).There was significant difiefence in average scores of communication skills,medical record writing,and case analysis between various trainees(P＜0.01).In addition,average scores of information collecting and medical record writing also differed among trainees from varied bases for general practice training(P＜0.05).Conclusions Clinical skills,ability to direct teaching work,and improvement of teaching model can be assessed in a comprehensive and objectively way using standardized patients in general practice 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 explore application of standardized patients (SPs) in intensive training of clinical competency for general practice trainees. Methods Fifty-three general practice trainees in Shanghai Zhongshan Hospital were enrolled in the study, randomly assigned to intervention and control groups. Control group proceeded in routine clinical rotation, while intervention group accepted intensive training course with SPs as trainers. Three months after intervention, clinical skills of the two groups were compared in a simulated medical environment. Results There was no statistically significant difference in their baseline characteristics between the two groups (P ＞0.05). Competency in history taking, physical examinations,communication with patients, comprehensive consultation, medical record writing as well as case-analysis,improved significantly in intervention group after intervention, as compared to those before it ( P ＜ 0. 01 ),with the highest score of communication skill of 82 ± 10. Although competency of history taking, physical examinations, comprehensive consultation, medical record writing also improved significantly three months later in control group as compared to their baselines (P ＜ 0. 01 ), while no statistically significant difference in their communication skills was found ( P ＞ 0. 05 ). Scores of skills in physician-patient communication,comprehensive consultation as well as medical record analysis were significantly higher in intervention group than those in control one after intervention ( P ＜ 0. 01 ), but no significant difference in physical examinations was found between the two groups ( P ＞ 0. 05 ). Conclusions Application of SP in intensive training course for clinical competency can remarkably improve their competency in interpersonal communication and comprehensive consultation for general practice trainees.

Objective Paraquat(PQ) is an effective herbicide which is widely used in agricultural production .PQ poisoning is frequently seen in humans with the lung as the target organ ,but the poisoning mechanisms is not very clear .Studies show that endoplasmic reticulum stress(ERS) is closely associated with poisoning , but there are few reports on the relationship between ER stress and PQ poi-soning.This article was to investigate the effects of ERS-induced apoptosis and total flavonoids from astragalus complanatus (FAC) in a-cute lung injury(ALI) following paraquat poisoning in rats . Methods A total of 30 adult healthy Sprague-Dawley (SD) rats were ran-domly divided into 3 groups:control group, ALI group, ALI+FAC group and ALI+saline group.Biochemical method was applied to de-tect superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) in lung tisssue,TdT-mediated dUTP nick end labeling (TUNEL) assay in observing lung apoptosis, Western blotting and real-time PCR(RT-PCR) in detecting the changes in expressions of C/EBP homologous peotein (CHOP), activating transcription factor 4 (ATF4) and X-box binding protein 1 (XBP) following ALI, and HE staining in observing the pathological changes of lung tissue . Results Compared with control group , the expression of MDA content was enhanced in ALI group ([3.26 ±0.24] vs [5.04 ±0.36],P<0.01), along with significantly decreased activity of SOD and CAT ([300.26 ±35.69] vs [187.21 ±25.66]), ([5.78 ±1.28] vs [2.15 ±1.12],P<0.01), increased cell apoptosis , upregulated pro-tain level of CHOP ([0.74 ±0.20] vs [0.23 ±0.07],P<0.01) and mRNA expression of ATF4, XBP1 and CHOP.However, FAC sig-nificantly attenuated ALI following PQ , as showed by reduced MDA content , enhanced activity of SOD and CAT , decreased cell apopto-sis, inhibited protain level of CHOP and mRNA expression of ATF 4, XBP1 and CHOP ([5.04 ±0.36] vs [3.99 ±0.27],P<0.01). Furthermore, the activity of SOD and CAT were higher in FAC pretreatment group than those in ALI group ([ 0.74 ±0.20 ] vs [0.42 ±0.11],P<0.01). Conclusion From the research, ERS-induced cell apoptosis is involved in ALI following PQ , and the protec-tive role of FAC in lung tissue following PQ is due to its effect in atten-uating ERS-induced apoptosis .

Aged ; Antineoplastic Agents ; therapeutic use ; B7-2 Antigen ; analysis ; Diagnosis, Differential ; Follow-Up Studies ; Histiocytic Disorders, Malignant ; drug therapy ; metabolism ; pathology ; Humans ; Male ; Sarcoma ; chemistry ; drug therapy ; pathology ; Skin Neoplasms ; chemistry ; drug therapy ; pathology

General practice (GP) training program in Shanghai has been carried out in Zhongshan Hospital of Fudan University,which consists of theoretical study,clinical rotation and community practice.The contents of assessment include clinical competences,theoretical knowledge,and research capability; the methods of assessment include objective structured clinical examination,multiple choice tests,and assay writing.During the program implementation Zhongshan Hospital exert great efforts to set up the teaching management framework,quality control system,and to improve teaching methods in order to upgrade the clinical capability training for the residents.

Objective:To observe the therapeutic effect of warm needling moxibustion for erectile dysfunction (ED).
Methods:A total of 46 eligible ED patients were randomized into a treatment group (n=24) and a control group (n=22). The treatment group was intervened by warm needling moxibustion while the control group by conventional acupuncture treatment, for a total of 4 courses. The therapeutic effect was evaluated by the international index of erectile function 5 (IIEF-5).
Results:After 4 courses of treatment, the overall effective rate was 91.3% in the treatment group (23 completed), versus 75.0% in the control group (20 completed), with a significant difference (P<0.05). After the treatment, the change of IIEF-5 score in the treatment group was significantly different from that in the control group (P<0.05).
Conclusion:Warm needling moxibustion can produce a more significant efficacy than conventional acupuncture in the treatment of ED.

Objective: To summarize and critically assess the evidence from randomized controlled trials (RCTs) of acupuncture in treating dry eye syndrome (DES) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Cochrane Collaboration recommendations. Methods: A search of PubMed, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Embase was made from their inception to August 2016, as well as Chinese, Japanese, and Korean databases. Two reviewers independently selected RCTs and assessed the methodological quality. Meta-analysis and the level of evidence were processed by RevMan 5.3 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: After selection, 8 trials were subjected to our systematic review. The methodological quality was low generally. The 3-10 weeks follow-up showed that acupuncture improved the tear film break-up time (BUT) (MD=1.33, 95%CI=1.01-1.66, 619 participants). The mean difference of Schirmer's test was 1.73 mm (95%CI=1.28-2.18, 618 participants) between the acupuncture group and the control group. The subjective variables exhibited no significant differences. Conclusion: The low methodological quality of the trials does not suggest drawing firm conclusions on the value of acupuncture therapy for DES. Acupuncture treatment may have some effects on the tear film BUT and Schirmer's test, but not on the subjective symptoms. Well-planned large-scale high-quality RCTs are needed to make it clear whether acupuncture is effective in treating DES.

Objective To assess consultation competence of resident general practitioners in Shanghai. Methods Standardized patients (SPs) were employed as an assessment tool in exploring consultation competence of resident general practitioners ( GPs) , including clinical and communication skills. Clinical skills included information collection, clinical thinking, health education, out-patient history taking and recording and reception time management, and patient-physician communication skills included building a good relationship, information collection and feedback, understanding issues from patient's perspective, sharing information and obtaining informed consent and close of consultation. Score rate defined as actual score of each item divided by total score of the domain was employed to assess competence of GPs in varied aspects. Results There were 157 resident GPs, 52 men and 105 women, with an average age of (28 ±2) years. Overall score rate of clinical skills averaged (76 ±10) percent, and score rate of each item ranking from the highest to the lowest was reception time management (91 ±4) percent, out-patient history taking and recording (80 ±14) percent, information collection (76 ±12) percent, clinical thinking (74 ±17) percent, health education (68 ±1) percent. Overall score rate of communication skills averaged (74 ±12) percent, and score rate of each item ranking from the highest to the lowest was building a good patient-physician relationship (86 ±3) percent, information collection and feedback (80 ±5) percent, sharing information and obtaining informed consent (74 ±15 ) percent, close of consultation (62 ±27 ) percent and understanding issues from patient's perspective (43 ±0) percent. Conclusions Resident GPs have improved their consultation competence to certain extent after standardized training, but there still exist some weakness to be improved in them.

Objective To analyze nucleic acid sequence homology of the 6 kb(pYC) plasmid of Yersina. pestis (Y. pestis) isolated from Yurman by searching GenBank. Method The search of sequence similarity was accomplished with BLAST. Results The pYC plasmid sequence had high homology with some genes in nueleotide sequence, such as: 97.1% homology with Shigella sonnei pKYM, 92.1% homology with Haemophilus influenzae(H. influenzae) gene, Salmonella typhi (S. typhi) gene LT2 and plMVSI with 88.2% and 87.2% of homology respectively, Escherichia coli(E, coli) O157:H7 and K-12, ECOR31 with 81.4%, 81.4% and 84.7% of homology respectively. This plasmid ORFs could code for some proteins which were similar with others in GenBank, such as: ORFi and H. paragallinarum replication protein B(47.2%), ORF4 and E. coli hypothetical protein(52.7%), ORF5 and Y. pseudotuberculosis Tile (48.3%), ORF6 and E. coil Pilx5/VirB5-1ike protein (42.3%), Y. enterocolitica TriD protein(38.5%), ORFIO and S. typhimurium LT2, E. coli O157:H7 hypothetical protein(83.1% and 81.9%, respectively), ORF11 and E. coli, damage-inducible protein J(81.4%). Conclusions The pYC plasmid sequence has high homology with a few bacterial genes of Enterobacteriaceac. This plasmid may code for some proteins that are similar with hypothetical protein, damnge-indncible protein, TriD and TilE protein, Pilx5/VirB5-hke protein of Escherichia or Yersinia.