Humanistic doctor-patient communication is an essential capability for medical workers and is as impor -tant as medical technology .Its education has been getting more and more attention in recent years .However , the training and evaluation of humanistic doctor-patient communication as a practical other than theoretical capability has been difficult .A new method , clinical scenery drama , based on psychodrama and role theory , is developed by Dept.of Psychological Medicine , Peking Union Medical College Hospital from recent 10 years of medical doctor and student training .In clinical scenery drama , medical students are thrown to different roles to empathize with their feelings and conflicts , try to resolve clinical dilemma with humanistic communication technique besides medi-cal technology .Then the sharing and comments from teachers and observers help students to understand the situa -tion from other perspectives and think about other possible solutions .

Objective To investigate the effect of HbA1c meeting the standard or not on microalbuminuria,blood lipids and liver enzymes in patients with type 2 diabetes.Methods A retrospective analysis was performed on 457 subjects who had type 2 diabetes.They were divided into substandard group and standard group according to HbA1c result.The general information and relevant laboratory indicators of patients were.collected and compared between two groups.Results The microalbuminuria,serum triglyceride and liver enzymes (glutamyl transpeptidase,alkaline phosphatase,aspertate aminotransferase) were significantly different between two groups [ (189.8 ± 235.3) mg/dl vs (38.9 ± 85.5) mg/dl,(2.64 ± 2.99) mmol/L vs (2.02 ± 1.50)mmol/L,(41.7 ±52.9)U/L vs (29.7 ±24.9)U/L,(83.6 ±28.6) U/L vs (74.3 ±25.8)U/L,(26.7 ±19.1)U/L vs (22.0 ±10.5) U/L,P ＜0.05].HbA1c level was positively correlated with microalbuminuria,glutamyl transpeptidase and alkaline phosphatase (r =0.209,0.115,0.11,P ＜0.01).The microalbuminuria was an independent risk factor of affecting HbA1c to reach the standard (OR = 1.009,P ＜0.05).Conclusions HbA1c meeting the standard or not can influence many factors except blood glucose.

As the survival across cancers continues to rise, the outcome indicators of rehabilitation at the social level of cancer survivors is worthy of attention, social participation is a good index to reflect the level of rehabilitation. Looking forward to providing references for descriptive and intervention researches in the future, this literature review expounds current situation of cancer survivors, and introduces the assessment tools and influencing factors of the cancer survivors' social participation.

Objective:To systematically evaluate the risk factors for oral mucositis (OM) in patients receiving hematopoietic stem cell transplantation (HSCT) , and provide a reference for the prevention and treatment of OM.Methods:Articles published up to June 2020 were systematically retrieved from PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, SinoMed, China National Knowledge Infrastructure (CNKI) , VIP, and Wanfang databases, and screened independently by two reviewers according to the inclusion and exclusion criteria. The research design, patient characteristics, follow-up time point, evaluation tools, statistical analysis results and other information of the included articles were extracted. After evaluating the risk of bias, RevMan 5.3 was used for statistical analysis.Results:A total of 17 studies and 3 659 HSCT patients were included. Meta-analysis was conducted on 9 factors related to OM, 2 factors related to moderate to severe OM, and 6 factors related to severe OM, and the results showed that the risk factors related to OM were female ( OR=1.40, 95% CI: 1.10-1.79, P=0.007) , bone marrow transplantation ( OR=1.86, 95% CI: 1.00-3.47, P=0.05) , oral busulfan ( OR=38.61, 95% CI: 11.04-134.97, P<0.001) , use of methotrexate ( OR=2.34, 95% CI: 1.38-3.98, P=0.002) , and allografting ( OR=2.21, 95% CI: 1.18-4.15, P=0.01) , and the risk factors associated with severe OM were a pretreatment program containing high-dose melphalan ( OR=2.00, 95% CI: 1.24-3.22, P=0.004) . Conclusions:Female, bone marrow transplantation, oral busulfan, use of methotrexate, and allografting are correlated with OM, and the pretreatment program containing high-dose melphalan is correlated with severe OM. The correlation between other factors and OM still needs further verification. Medical staff should pay attention to these risk factors and take targeted prevention and treatment strategies to further improve the quality of nursing work.

OBJECTIVELow or moderate consumption of red wine has a greater benefit than the consumption of other beverages in the prevention of atherosclerosis and coronary heart disease and this is increasingly attributed to the polyphenol compounds in red wine, such as resveratrol. In the present study, we investigated the effect of resveratrol on platelet aggregation in vitro and in vivo.

METHODSPlatelet aggregation in rabbits and normal subjects was measured using Born's method.

RESULTSResveratrol, at 10 - 1000 micromol/L, significantly inhibited platelet aggregation in vitro induced by collagen, thrombin, and ADP in healthy subjects. The inhibitory effect was concentration-dependent. Hypercholesterolemia induced by high-cholesterol diet enhanced ADP-induced platelet aggregation. Resveratrol 4 mg x kg(-1) x d(-1) inhibited ADP-induced platelet aggregation in vivo despite no changes in serum lipid levels.

CONCLUSIONSResveratrol inhibits platelet aggregation both in vitro and in vivo. This may be one of the mechanisms by which resveratrol prevents atherosclerosis.

Animals ; Arteriosclerosis ; prevention & control ; Cholesterol, LDL ; blood ; Humans ; Lipids ; blood ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; pharmacology ; Rabbits ; Stilbenes ; pharmacology

Objective To objectively study the current progress of China Healthcare Improvement Initiative, and its effectiveness and shortcomings for further improvement. Methods Questionnaires were customized by expert consultation and pre-investigation, and distributed by the National Health Commission in April 2018 to the hospitals.Data of 5 469 hospitals were recovered and analyzed with a statistics software for descriptive analysis.Results Implementation progress of the five working systems varied with regions, and rooms of improvement were found in such aspects as outpatient appointment, clinical pathway management and social work system.In 2017, the proportion of outpatient appointments of 5 469 hospitals averaged 19.1%.Progress of the ten major service models also varied, as defects were found in such service models as continuous medical service, intelligent service, and interconnection service.In 2017, only 6.7% of the 5 469 hospitals had put in place hierarchical integrated clinical pathways within their medical alliances.Conclusions Improvement of the medical services calls for not only the efforts of medical institutions themselves, but also top-level design by the local health authorities. In particular, an online information platform should be established for the whole region, to unify the information standards and processes, and corresponding mechanisms and system support are needed.

Autoimmune hepatitis (AIH) is a progressive chronic inflammatory liver disease with unknown etiology. At present, genetic susceptibility and environmental factors are universally recognized as the etiological factors for AIH. With the deepening of research in recent years, other etiological factors, such as immune cells, immune factors, liver transplantation, and drugs, have attracted more and more attention. This article briefly describes related research findings in the past five years.

Objective:To establish a nomogram prediction model for the risk of postoperative delirium in elderly patients with chronic subdural hematoma.Methods:A total of 450 elderly patients with chronic subdural hematoma who were admitted into Shengjing Hospital of China Medical University from January 2017 to January 2020 were selected as the research objects. The patients were divided into the delirium group ( n=135) and the non-delirium group ( n=315) according to whether they had delirium. The indexes of patients in two groups were compared and analyzed. Univariate analysis and multivariate Logistic regression analysis were used to investigate the independent risk factors for postoperative delirium in elderly patients with chronic subdural hematoma, and a prediction model for the risk of delirium was establish based on independent risk factors. ROC curve and calibration curve were used to evaluate the discriminant ability and predictive effectiveness of the model. Results:In 450 elderly patients with chronic subdural hematoma after surgery, 135 cases of delirium occurred postoperatively, and the incidence of delirium was 30.0%. Univariate analysis showed that there were statistically significant differences in delirium incidence among patients with different ages, alcoholism history, Markwalder grade and postoperative pain grade (χ 2=23.069, 27.325, 36.081, 44.834; P<0.05) . Logistic regression analysis showed that advanced age, preoperative Markwalder grade Ⅳ, history of alcoholism and severe postoperative pain were independent risk factors for postoperative delirium ( P<0.05) . A nomogram prediction model for postoperative delirium risk in elderly patients with chronic subdural hematoma was established based on independent risk factors. The Bootstrap internal verification method proved that the prediction accuracy of the model was good ( C- index was 0.904) , and the area under the ROC curve calculated by the Nomogram model was 0.904. Conclusions:The delirium risk nomogram prediction model constructed in this study has good accuracy, discrimination and good predictive ability. It can improve the screening efficiency for elderly patients with chronic subdural hematoma who are at high risk of developing delirium after surgery.

Objective The purpose of this study was to compare the self-evaluation and doctor-patient orientation between medical students and residents before the courses in different communication sections,and gave guide to different objects for their targeted teaching.Methods We set a sample made of 331 medical students and 308 residents who were trained in Clinical communication skills course in Peking Union Medical College from Oct.2009 to Oct.2013.Before the course,they were investigated by two self-assessment questionnaires.One is communication skills and occupation practice confidence;the other is doctor-patient orientation.Their result data were analyzed and handled by SPSS 17.0 software,adopting an independent samples t test.Results The order of the different aspects of doctor patient communication skills was same in two groups,gathering complete history [(4.340 ± 0.756) vs.(4.050 ± 0.707)] first,and establishing good doctor patient relationship [(4.310 ±0.740) vs.(4.030 ±0.790)],discussing a therapeutic plan with patient [(4.050 ± 0.812) vs.(3.600 ± 0.823)],informing bad news [(3.850 ± 0.897) vs.(3.260 ± 0.907)] followed.According to the self-assessment,residents were more confident than medical students in all these aspects above mentioned and establishing good doctor patient relationship.The doctorpatient orientation scale indicated that the residents group is more inclined to doctor-centric mode than the medical students group.Conclusion This study suggested that the residents is more confident in doctorpatient communication skills than medical students,while is less inclined to patient-centric mode than them.The focus of the communication teaching is similarity in the distribution of the two groups.Medical students' communication curriculum needs to take into account the limited clinical experiences,and training for residents needs to emphasize the capacity of empathy and perspective-taking.

Objective:To compare the antiplatelet effects of vicagrel and clopidogrel in patients with different cytochrome P450 (CYP) 2C19 genotypes.Methods:This is a post-hoc analysis of a phase Ⅱ clinical trial of vicagrel, which included patients with coronary heart disease who underwent percutaneous coronary intervention from August 2018 to June 2019 in 18 centers. Patients were categorized based on the presence of CYP 2C19 *2 or *3 loss-of-function (LOF) alleles into LOF carrier group ( n=111) and non-LOF carrier group ( n=90). Each group included patients received vicagrel 5 mg, 6 mg, 7.5 mg, or clopidogrel 75 mg for 28 days per study protocol. P2Y 12 reaction units (PRU) were measured using VerifyNow at baseline, 6 to 8 hours after loading dose, 7 to 10 days after randomization, and 28 days after randomization and the percentage inhibition of platelet aggregation (%IPA) was calculated. The primary endpoint was %IPA on day 28. Within the patients from the General Hospital of Northern Theater Command, 8 to 12 patients in each study arms were enrolled in a prespecified pharmacokinetic sub-study, measuring the time to reach maximum plasma concentration (T max), peak plasma concentration (C max), and area under the plasma concentration-time curve (AUC). Results:Among 201 patients, the age was (58.8±8.5) years, and 139 (69.2%) were male. In non-LOF carriers, there was no significant differences in PRU values and %IPA between the vicagrel 5 mg, 6 mg, 7 mg, and clopidogrel groups at all time points (all P>0.05). In LOF carriers, %IPA was significantly higher in the vicagrel-treated groups than in the clopidogrel group at 6-8 hours after loading dose (22.9 (14.2, 31.5)% vs. 19.8 (11.0, 28.6)% vs. 29.5 (20.9, 38.0)% vs. 12.9 (3.9, 21.9)%, P=0.038) and 7-10 days after randomization (22.4 (14.2, 30.5)% vs. 34.4 (26.1, 42.6)% vs. 39.8 (31.8, 47.9)% vs. 24.7 (16.3, 33.2)%, P=0.001), with a trend towards higher %IPA in the vicagrel-treated groups at day 28 (30.4 (21.3, 39.6)% vs. 36.5 (27.2, 45.7)% vs. 40.8 (31.8, 49.8)% vs. 30.7(21.2, 40.2)%, P=0.056). Pharmacokinetic results of 35 patients showed that the C max and AUC of the active metabolite M15-2 of vicagrel was similar to that of clopidogrel in non-LOF carriers, but AUC between vicagrel 5 mg, 6 mg, 7 mg and clopidogrel were significantly different in LOF carriers ((5.6±0.6) h·μg -1·L -1 vs. (6.8±2.7) h·μg -1·L -1 vs. (9.2±3.3) h·μg -1·L -1 vs. (4.2±1.9) h·μg -1·ml -1, P=0.020). Conclusion:Vicagrel and clopidogrel have similar antiplatelet effects in non-LOF carriers, but vicagrel exhibits superior antiplatelet effects in LOF carriers.