High-throughput transcriptional profiling of perturbations by Panax ginseng saponins and Panax notoginseng saponins using TCM-seq / 药物分析学报

Panax ginseng(PG)and Panax notoginseng(PN)are highly valuable Chinese medicines(CM).Although both CMs have similar active constituents,their clinical applications are clearly different.Over the past decade,RNA sequencing(RNA-seq)analysis has been employed to investigate the molecular mechanisms of extracts or monomers.However,owing to the limited number of samples in standard RNA-seq,few studies have systematically compared the effects of PG and PN spanning multiple conditions at the transcriptomic level.Here,we developed an approach that simultaneously profiles transcriptome changes for multiplexed samples using RNA-seq(TCM-seq),a high-throughput,low-cost workflow to molecularly evaluate CM perturbations.A species-mixing experiment was conducted to illustrate the accuracy of sample multiplexing in TCM-seq.Transcriptomes from repeated samples were used to verify the robustness of TCM-seq.We then focused on the primary active components,Panax notoginseng sa-ponins(PNS)and Panax ginseng saponins(PGS)extracted from PN and PG,respectively.We also char-acterized the transcriptome changes of 10 cell lines,treated with four different doses of PNS and PGS,using TCM-seq to compare the differences in their perturbing effects on genes,functional pathways,gene modules,and molecular networks.The results of transcriptional data analysis showed that the tran-scriptional patterns of various cell lines were significantly distinct.PGS exhibited a stronger regulatory effect on genes involved in cardiovascular disease,whereas PNS resulted in a greater coagulation effect on vascular endothelial cells.This study proposes a paradigm to comprehensively explore the differences in mechanisms of action between CMs based on transcriptome readouts.

Primary care for atrial fibrillation patients with anticoagulation therapy in China: status quo and future perspective / 中华全科医师杂志

With the increasing prevalence of atrial fibrillation (AF), the incidence of its complications, such as ischemic stroke and thromboembolism is also increasing. According to the two-way referral system proposed by health authorities, AF management should be carried out mainly in primary care settings;and studies show that general practitioners play an indispensable role in AF management. At present,however,the inappropriate anticoagulation,AF complications and risk awareness are three major problems in the primary care of AF management in China. This article reviews the status quo and future prospect of AF management in primary care to provide suggestions for better management of AF in primary care level.

A survey on teaching ability of general practitioners in community health centers of Shanghai and its influencing factors / 中华全科医师杂志

Objective:To survey the teaching ability of general practitioners(GPs) in community health centers of Shanghai, and its influencing factors.Methods:A questionnaire survey on the teaching ability of general practice trainers was conducted from January to February 2017. The participants of the survey were GPs with teaching experiences from community health centers in Shanghai selected by a stratified and proportional cluster sampling method. The questionnaire included two aspects: the general information and teaching ability of the participants. The influencing factors of teaching ability were analyzed by univariate and multivariate regression analysis.Results:A total of 1 138 GPs from 116 selected community health centers participated in the questionnaire survey, among whom 63.6% (724/1 138) worked in community teaching bases and 78.5% (893/1 138) had received training for trainers. The total score of teaching ability was 38.00 (30.00, 40.00). The score of the item"interesting in teaching"was (3.46±0.80), 75%—80% of the other questions answered "yes". The score of"application of multi-teaching methods"was (3.78±0.72). Multivariate analyses showed that working for 5—9 and 10—19 years [ OR=7.14 (2.47—11.81), P=0.003; OR=5.32 (1.30—9.33), P=0.009], working in community teaching bases [ OR=13.23 (9.88—16.57), P<0.001] and receiving training for trainers [ OR=17.76 (13.80—21.71), P<0.001] were influencing factors of teaching ability. Conclusion:The main problems related to teaching ability in community GPs are lack of teaching interest and the poor application of multi-teaching methods, the relevant training is necessary for them in the future.

Investigation on status quo and needs of pharmaceutical training among general practice faculty / 中华全科医师杂志

Objective:To investigate the current situation and needs of pharmaceutical training for general practice faculty.Methods:A self-designed questionnaire survey was conducted in April 2019. The participants were general practice faculty attending the national training course in Zhongshan Hospital and selected by convenience sampling method.Results:A total of 219 general practice teachers participated in the survey, 51.14% (112/219) of the participants thought that the current pharmaceutical knowledge did not meet the needs of pharmaceutical services in daily work, and 67.58% (148/219) attended pharmacy related training every year, and the frequency was mainly 1—2 times per year (56.62%, 124/219). The main reasons for attending the training were working needs (68.24%, 101/148) and willingness (55.41%, 82/148); 63.51% (94/148) of the participants thought that the training was moderate or less effective, mainly because of the weak strength of trainers (40.54%, 60/148), insufficient attention paid by trainers (37.16%, 55/148) and lack of depth (37.16%, 55/148). The survey showed that 76.26% (167/219) of general practice teachers had pharmaceutical training needs; and gender, working years and working experience in secondary and/or tertiary hospitals were influencing factors for pharmaceutical training needs. And female faculty, those working less than 10 years and with working experience in secondary hospitals had higher demand for pharmaceutical training. The expected pharmaceutical training focused primarily on the selection and optimization of medication schemes (72.60%, 159/219), interaction/incompatibility between medicines (62.10%, 136/219) and pharmaceutical care in medical treatment (57.08%, 125/219). The expected training methods were mainly interactive case analysis and discussion (69.41%, 152/219) through the internet or APP (such as WeChat) (54.34%, 119/219); the expected training frequency was no more than once in two months (36.07%, 79/219), better in working time (48.86%, 107/219) and each session was 30—45 minutes (38.36%, 84/219).Conclusion:General practice faculty has a high demand for pharmaceutical training. Targeted, individualized and systematic pharmaceutical training courses should be developed according to the pharmaceutical training needs of participants.

Influencing factors and weight analysis for medical graduates to choose general practice in China / 中华全科医师杂志

Objective:To explore the influencing factors and the weights for medical graduates to choose general practice and work in grassroots posts in China.Methods:On the basis of pre-investigation, the second interviews were conducted among medical students of grade two to established ahierarchical structure model. A survey was conducted with self-made questionnaire among 407 medical students of grade five from eight medical colleges selected by stratified random cluster sampling from January to June 2017. The influencing factors of choosing general practice choice as the future career were analyzed and the weights were calculated by analytic hierarchy process (AHP).Results:Total 395 valid questionnaires were received from 161 males and 234 females students. Under the general goal layer of influencing factors for medical graduates to choose general practice, the weights of the four first-level indicators were: career status and prospects for development (weight: 0.299), salary (weight: 0.294), family contribution (weight: 0.207) and professional interest (weight: 0.200). Among the secondary indicators of career status and prospects for development, job satisfaction had the highest weight (comprehensive weight: 0.073), followed by the work environment (comprehensive weight: 0.064), social status (comprehensive weight: 0.061), patterns of doctor-patient relationship in comprehensive care of general practice (comprehensive weight: 0.052), and work intensity had the lowest weight (comprehensive weight: 0.048). Among the five secondary indicators of professional interest, the weight of clinical practice was the highest(comprehensive weight: 0.066), followed by the guidance of theoretical teachers (comprehensive weight: 0.063). In the level 3 indicators in clinical practice, the attitude of general practice teachers to general practice had the higher weight than those teachers in other departments (the comprehensive weights were 0.037 and 0.030, respectively).Conclusion:Career status and development prospects and salary are the main influencing factors for medical students to choose general practice. Teachers′ guidance in clinical practice and theoretical study is the most critical factor for medical students to be interested in general practice.

Survey on employment intention of medical students in China / 中华全科医师杂志

Objective To survey the employment intention of medical students of five-year program in China.Methods A self-administered questionnaire survey on the employment intention was conducted among grade-5 medical students of 5-year program in 8 medical schools from January to June 2017,395 participants (161 males and 234 females) were selected by stratified random cluster sampling method.Results The survey showed that 57.65％ (226/392) respondents would return hometown after graduation as their first choice,20.66％ (81/392) preferred to work in large cities,only 0.76％ (3/292) chose the Western and rural areas;20.05％ (78/389) responders were willing to be a general practitioner working at the community health center,56.55％ (220/389) did not decide,while 23.40％ (91/389) did not want to be general practitioner.Students from rural areas vs.from urban areas (24.30％ vs.15.08％),whose parents with lower educational level vs.higher educational level (30.62％ vs.25.71％),from medical school in Western regions vs.in Eastern regions (28.65％ vs.11.68％) were more willing to choose general practice(P＜0.05).Students who had clerkship or rotation of general medicine vs.who had not more like the specialty of general practice (27.63％ vs.15.66％,P＜0.05),but there was no significant difference in the employment intention to be a general practitioner (19.93％ vs.20.45％,P＞0.05).Students who knew grassroots employment policies were more willing to be general practitioners (25.48％ vs.13.02％,P＜0.05).Conclusion The survey shows that the employment intention to be a general practitioner is stronger than before among medical students.But it is still need to take necessary measures to attract more medical graduates to work as general practitioners in grass-roots communities.

Requirement of objective structured teaching evaluation (OSTE) use for general practice trainers and station design / 中华全科医师杂志

Objective To survey the requirement of objective structured teaching evaluation (OSTE) use for general practice (GP) trainers and the station design.Methods A questionnaire survey on the requirement of OSTE use was conducted among 161 hospital trainers and 110 community trainers from a national key GP trainers training workship in April 2016.The survey included basic information,OSTE use requirements,frequency of clinical teaching scenarios,and frequency of teaching methods.Results The survey showed that 86.3％(234/271) of trainers were willing to use OSTE for assessing teaching competence and 92.3％ (250/271) for training teaching competence.The proportion of “having been observed and being given feedback from superior trainers for teaching process” was higher in hospital trainers than that in community trainers [68.3％(110/161)vs.40.9％(45/110),x2=20.060,P＜0.001].In the part of frequency of teaching scenarios,the proportion of “often” plus “always” was higher in “instructing students to write the medical records” [64.6％(175/271)],“teaching doctor-patient communication skills” [60.9％(165/271)] and “observing students' consultation and giving feedback” [57.9％(157/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).In the part of frequency of teaching methodS,the proportion of “often”plus “always”was higher in “clinical supervisor's report” [60.9％ (165/271)],“applied knowledge test” [52.4％(142/271)] and “problem-based learning” [38.0％(103/271)];there were no significant differences in above questions between the two types of trainers (all P＞0.01).Conclusion The requirements of assessment and training by using OSTE are strong in GP trainers.The OSTE stations should be designed based on the routine teaching scenarios and methods for both hospital trainers and community trainers without discriminations.

Comparison of awareness, training and assessment of teaching competence between hospital and community general practice trainers / 中华全科医师杂志

Objective To compare the awareness, training and assessment of teaching competence between hospital and community general practice (GP) trainers. Methods A questionnaire survey on teaching competence was conducted among 161 hospital GP trainers and 110 community GP trainers in 2016 April. Results There were 96 male and 175 female participants with an average age of (30.4 ± 8.0) years. On the the awareness of teaching competence,the propotion of"very important"of"creating a quality teaching environment for students","knowing how to teach students","ability to teach students medical knowledge and skills", " feedback ability ", "showing the virtue of being a teacher" in hospital and community trainers were 47.8％(77/161) and 40.0％(44/110), 66.5％(107/161) and 59.1％(65/110), 71.5％(115/161) and 62.8％(69/110), 54.7％(88/161) and 52.7％(58/110), 65.2％(105/161) and 60.9 (67/110), respectively;there were no significant differences of all importance ratings between the two groups (all P>0.05). Hospital trainers had higher proportions of "having received teaching method training" [70.2％(113/161)vs. 50.0％(55/110),χ2=11.302,P=0.001] and"having received teaching training before practice teaching for the first time" [(45.3％(73/161)vs. 21.8％(24/110),χ2=15.735,P<0.001] than those of community trainers. The proportion of "having received teaching comptence evaluation" was higher in hospital trainers than that in community trainers [(60.9％(98/161)vs. 43.6％(48/110),χ2=7.810,P=0.004], but there were no significant difference in teaching comptence evaluation methods between two types of trainers (P>0.01). Conclusion The awareness of teaching competence is similar between hospital and community GP trainers, but the community trainers are lack of teaching competence training, and their teaching competence evaluation methods need to be improved.

Survey on status and demands of advanced clinical training among community general practitioners in two districts of Shanghai / 中华全科医师杂志

Objective To survey the status and related demands of advanced clinical training among community general practitioners (GPs) in Shanghai.Methods A survey on the status and demands of advanced clinical training was conducted with a self-designed questionnaire among GPs in Minhang District and Jiading District of Shanghai from January to May 2016.The questionnaire included basic information , experience of advanced clinical training , satisfaction with training and training demands .Results Total 526 questionnaire were distributed and 478 valid questionnaires were returned with a response rate of 90.9%. Among the participants 202 (42.3%) had experience of advanced clinical study ; the training units were mainly secondary hospitals in Shanghai (69.3%, 140/202); 67.2%(131/195) participants considered that the previous training did not fully meet the needs of the community .There was significant difference in the training demands among participants with different ages , professional titles, and working years ( χ2＝12.754, 7.912, 4.501, all P＜0.01); those with younger age, higher education and shorter working years had higher training demands .Survey showed that 57.3%( 274/478 ) of participants demanded further studies in the future; 58.3%( 239/410) of them chose tertiary hospitals in Shanghai as training unit , 79.0%(321/406) chose internal medicine and geriatrics as training specialties , particularly in outpatient clinic (73.2%, 298/407); the length of study should be 3 months (32.8%, 132/402) or 6 months (27.6%, 111/402), and completed in segments (61.5%, 253/411).The purpose of training was mainly to upgrade clinical competence (94.2%, 258/272); busy working schedule (53.4%, 66/116) was the main reason for not intending the advanced clinical studies .Conclusions The community general practitioners in Shanghai have high demands for advanced clinical training .The training should meet the needs of clinical practice in community and the mode of study should be more flexible .

Influencing factors for medical school graduates to choice general practice in Shanghai / 中华全科医师杂志

Objective To investigate the influencing factors and their weights of professional choice among medical school graduates in Shanghai.Methods Base on literature review and interviews with medicine students in a university of Shanghai,a questionnaire of"employment intention for general practice in medical graduates"was developed.A questionnaire survey on influencing factors of general practice among five year medical students was conducted in the medical college of a university in Shanghai during May to June 2016.The weights of each factor were calculated with analytic hierarchy process(AHP). Results The valid questionnaires were retrieved from 14 male and 26 female students.The results showed that 53.8%(21/40)preferred Beijing, Shanghai, Guangzhou and other economically developed cities as future working place,and 38.5%(15/40)chose to go home town; for general practice 22.5%(9/40) chose"very like",70%(28/40)chose"like"and 7.5%(3/40)chose"not like"; only 10%(4/40) were willing to be a general practitioner, 55.0%(22/40)were depended on the working conditions of community health center,and 35%(14/40)were not ready to be a GP.AHP analysis showed that the weights of influencing factors were: the salary(0.380 2), the doctor-patient relationship(0.262 3),professional interest and occupation development prospects(0.220 4),social status and family contribution (0.137 1).Weight analysis for the affecting factors on professional interest and occupation development showed that the guidance of mentors in theoretical study and clinical practice were the major factors (comprehensive weight was 0.067 3 and 0.062 1,respectively),and the attitude GPs to general practice in community learning was more important(comprehensive weight was 0.042 5 and 0.019 6).Conclusion The willingness to be a general practitioner is not strong in the medical school graduates in Shanghai.It is important to improve the status and working conditions of general practitioners, and to strengthen education and guidance of the general practice in theoretical study and clinical practice for medical students.

Implementation of community rotation in residency training of general practice / 中华全科医师杂志

The community rotation is an important stage of standardized residency training for general practitioners (GPs).However, the community rotation is also considered as a most difficult part of the GP residency training because of the problems in training management and evaluation .Based on our experiences of 7-months community training , we expanded the duration of community training to 1 year, and implemented a new segmentation and multipoint practice plan in Zhongshan hospital .This is a new attempt for GP residency training , which would hopefully meet the international standards of GP residency training .

Applicability of 360-degree evaluation in teaching ability assessment of community general practice trainers / 中华全科医师杂志

Objective To investigate the feasibility of 360-degree evaluation in teaching ability assessment of community general practice trainers.Methods The 360-degree evaluation questionnaire was used to assess the teaching ability of 39 general practice trainers in 3 community teaching bases in Xuhui District of Shanghai during January to March 2014.Five dimensions were included in the questionnaire:ability of primary care, ability of common disease management, clinical skills and appropriate community technology, teaching ability and personal overall ability.Each trainer was evaluated by 2 managers, 2 colleagues, 2 nurses, and 2 trainees, beside trainer him(her)self.Results Total 343 questionnaires were rechieved with a response rate of 97.7%.The average overall scores of assessments from trainers themselves, managers, colleagues, nurses, and trainees were 6.66 ±0.85, 6.91 ±1.28, 8.06 ±0.58, 8.36 ±1.68, and 8.12 ±0.81, respectively.The scores from nurses were the highest in all dimensions of the questionnair.The overall scores and scores of each dimention assessed by colleagues, nurses and trainees were significantly higher than those from trainers themselves ( P 0.05 for all).The overall cronbach′s alpha was greater than 0.9 in every aspect of assessors.The cronbach′s alpha of all dimension was greater than 0.8, except that of primary care ability assessed by trainers themself ( 0.694 ).Conclusion The 360-degree evaluation combines the assessments of community service ability, clinical ability, comprehensive quality and teaching ability, so it is practicable for teaching ability assessment of general practice trainers in community.

The practice of standardized training of general practitioners in Zhongshan Hospital / 中华全科医师杂志

Objective To review the standardized training of General practitioners (GPs) in Zhongshan Hospital since 2010.Methods Sixty seven GP trainees were recruited by Zhongshan Hospital since 2010.A retrospective analysis was carried out about the training methods,training content,assessment methods and training management.Results The pass rate of hospital examination was 100.0％.Sixteen out of nineteen GP residents of grade 2010 passed both the final examination and medical licensing examination,and completed the training plan; the remaining 3 trainees did not pass the licensing examination,among whom 2 extended the training and passed the exam eventually,and 1 dropped off.Sixteen out of seventeen in grade 2011 passed the medical licensing examination and were preparing for 2014 graduation examination.The training mode of human-centered and competency-based assessment system was established.Conclusion Zhongshan Hospital has accumulated rich experience in standardized training of GPs,established a system of training and assessment,and it will be continuously improved in the future.

Survey on the application of Chinese Hypertension Prevention and Treatment Guideline by general practitioners in Shanghai / 中华全科医师杂志

To investigate the status of application of Chinese Hypertension Prevention and Treatment Guideline (Guideline) by general practitioners (GPs) in Shanghai.A questionnaire survey was conducted among 260 GPs from 8 communities in Xuhui District of Shanghai during March 2011 to December 2012.Among all participants,94.2％ knew the Guideline.The overall correct rate was 56.2％; that of epidemiology,diagnosis,treatment,two-way referral and community management of hypertension was 49.2％,54.5％,60.6％,56.9％ and 32.3％,respectively.There were significant differences in correct rates of the questionnaire between GPs with different age,gender,education and community (P =0.000,0.035,0.000,0.000).The correct rates of epidemiology and treatment in GP teaching bases (58.5％ and 62.6％) were higher than those in non-teaching bases (39.2％ and 58.4％) (P =0.002,0.040).But there was no difference in overall correct rate between these two groups (P =0.095).The results indicate that the understanding and application of Hypertension Guideline by General practitioners in community is insufficient.Teaching hospitals should carry out systematic,comprehensive,sustained,targeted training course in order to improve the diagnosis and treatment levels of hypertension for general practitioners in community.

Application of 360 degree evaluation in competency assessment of community general practice trainers / 中华全科医师杂志

Objective To apply 360 degree evaluation in competence assessment of community general practice trainers.Methods The 360 degree evaluation questionnaire was designed by authors and the evaluation was applied to assess the personal comprehensive quality,competence in general practice and teaching of 16 general practice trainers in Fenglin Community Health Service Center of Shanghai Xuhui District.Results The scores of personal comprehensive quality,competency in general practice and teaching were 7.73 ± 0.73,6.91 ± 0.91 and 6.44 ± 1.38,respectively.The total scores from different evaluators were 6.93 ± 0.12 for peers,6.68 ± 0.74 for hospital executives,8.17 ± 0.12 for nurses and 6.43 ± 0.89 from self evaluation (F =27.91,P =0.000).Conclusion The variance between different evaluators in 360 degree evaluation can avoid bias of single one.The results of 360 degree evaluation show that the teaching ability of community general practice trainer is relatively low,suggesting the training of teaching ability should be strengthened for these trainers.

Survey on mental health status of rural-to-urban migrant workers in Shanghai / 中华全科医师杂志

Objective To survey the mental health status of rural-to-urban migrant workers in Shanghai.Methods The survey subjects were selected from migrant workers in Shanghai with a multi-stage stratified cluster sampling method.The Symptom Check List ( SCL-90 ) scores were used for evaluation of metal health status.Results The prevalence of mental health problem of 5 626 rural-to-urban migrant workers in Shanghai was 18.8% ( 1 058/5 626 ).The mean total score of SCL-90 was 114.86 ±31.21.Compulsive-obsessive, interpersonal sensitivity, hostility ranked the top three among 9 factors, with scores of 1.37 ±0.43, 1.31 ±0.43 and 1.30 ±0.41 respectively.The mean total scores and scores of 9 factors of rural-to-urban migrant workers in Shanghai were lower than those of Chinese adults norm the mean total scores(129.96 ±38.76) ( t =-15.34, -3.84 --24.08 respectively, all P <0.01) .There were significant differences in mental health among migrant workers with different age , education , marital status , living conditions and occupation (all P<0.05).Conclusion The prevalence of mental health problems in Shanghai rural-to-urban migrant workers is high, with are related to their age, education, marital status, living conditions and occupation.

Nicotine dependence among rural-to-urban migrant workers in Shanghai / 中华全科医师杂志

Objective To explore the nicotine dependence levels and the influencing factors of dependence among rural-to-urban migrant workers in Shanghai so as to provide scientific rationales for an effective implementation of tobacco control.Methods Multi-stage randomized sampling was used to select a total of 5 856 rural-to-urban migrant workers from 7 districts in Shanghai.Fagerstrom Test for Nicotine Dependence ( FTND) and logistic regression model were used to analyze the association between nicotine dependence and relevant risk factors.Results The current smoking prevalence was 23.7%.The average FTND score for current smokers , high dependence and low dependence were 3.38 ±2.49, 7.00 ±1.07 and 2.23 ±1.71 respectively.The high and low dependence rates were 21.7% and 78.3%.The results of logistic regression showed that education , duration of smoking and length of migration were associated with nicotine dependence.Lower level of education was more prone to high nicotine dependence.Those with a lower education had a higher risk of nicotine dependence ( junior high school: OR=1.742, primary school or lower: OR =1.994 vs.senior high school or higher ).High nicotine dependence increased with the duration of smoking (smoking 6-10 years:OR=3.007, 11-15 years:OR=4.076, 16-20 years:OR=5.451, 20 years or more:OR=5.726 vs.5 years or less).Length of migration over 3 years was less likely to have a high nicotine dependence (3-5 years: OR=0.602, more than 5 years: OR=0.407 vs.<1 year) .Conclusion The rate of high nicotine dependence is high among rural-to-urban migrant workers in Shanghai.Level of education , duration of smoking and length of migration are significant influencing factors of nicotine dependence.

Study on real-time wearable monitoring system for human heat and cold stresses / 生物医学工程学杂志

In order to study the way of evaluating human performance under heat and cold stresses, we developed a wearable physiological monitoring system-intelligent belt system, capable of providing real-time, continuous and dynamic monitoring of multiple physiological parameters. The system has following features: multiuser communication, high integration, strong environment adaptability, dynamic features and real time physiological monitoring ability. The system uses sensing belts and elastic belts to acquire physiological parameters, uses WIFI to build wireless network monitoring for multiuser, and uses Delphi to develop data processing software capable of real-time viewing, storagng, processing, and alerting. With four different intensity-activity trials on six subjects and compared with standard laboratory human physiological acquisition instruments, the system was proved to be able to acquire accu-rate physiological parameters such as ECG, respiration, multi-point body temperatures, and body movement. The system worked steadily and reliably. This wearable real-time monitoring system for human heat and cold stresses can solve the problem facing our country that human heat stress and cold stress monitoring technology is insufficient, provide new methods and new ways for monitoring and evaluation of human heat and cold stresses under real task or stress environment, and provide technical platform for the study on human ergonomics.

The model of training the trainers in community general practice / 中华全科医师杂志

Objective To evaluate a normative and systematic training mode for teachers of community general practice.Methods A total of 16 general practice teachers,who came from Fenglin community health service centre in Shanghai,participated three-stage training mode during March 2011 to February 2012.The clinical competence evaluation and questionnaire survey were conducted before and after training.Fifty trainees trained by the teachers also received clinical competence evaluation.Results After the three-stage training,the test score in medical knowledge,physical examination and clinical skills of the teachers did not change significantly (P =0.794,0.674 and 0.326).The self assessment questionnaire survey of general practice teachers indicated a significant increase,especially in practice capability (t =-2.840,P =0.015) and overall quality (t =-3.017,P =0.011).After training by the teachers,the medical knowledge (t =-9.200,P =0.000),physical examination (t =-9.947,P =0.000) and clinical skills (t =-14.828,P =0.000) of 50 trainees increased markedly.Conclusions Differed from conventional training courses,the three-stage training enhances teaching ability and overall quality of community general practice teachers,and provides a effective training model.

Clinical value of non-invasive positive pressure ventilation in the therapy of acute pulmonary edema / 中国综合临床

Objective To investigate the change of HR,RR and arterial blood gas in the treatment of BiPAP ventilation in patients with acute pulmonary.Methods Fifty eight patients with acute pulmonary edema were randomized into two groups.The control group(n =29)were given conventional general treatment only,but treatment group(n =29)were given BiPAP ventilation besides conventional treatment.4 h later,heart rate (HR),respiratory rate(RR),SaO2,pH,PaO2 and PaCO2 were compared between the two groups.Hospitalization duration and incidence of invasive mechanical ventilation were recorded after discharge.Results Compared with pre-treatment,HR,RR,SaO2 and PaO2 in treatment group were improved significantly(HR 124 ± 12 beat/min vs 83 ±6 beat/min,t =5.372,P ＜0.01)(RR 37 ±5 beat/min vs 19 ± 8 beat/min,t =4.285,P ＜0.01)(SaO2 81.4％ ±5.4％ vs94.1％ ±4.2％,t=2.731,P＜0.05)(PaO2 53.2±5.4 mm Hg vs 89.1 ±8.5 mm Hg,t=5.763,P ＜0.O1).And these four indicators were also improved in control group after treatment,(HR 123 ± 10 beat/min vs 95 ± 8 beat/min,t =t =3.459,P ＜ 0.01)(RR 36 ± 7 beat/min vs 24 ± 6 beat/min,t =3.127,P ＜0.01)(SaO2 81.8％ ±5.7％ vs 88.3 ±4.5％％,t =2.314,P ＜0.05)(PaO2 53.5 ±4.6 mm Hg vs 72.8 ±9.5 mm Hg,t =3.756,P ＜0.01).HR,RR,SaO2 and PaO2 in treatment group were more significantly improved than that of control group(P ＜ 0.01 or P ＜ 0.05).Hospitalization duration in treatment group was significantly shorter than that of control group(9 d vs 15 d,t =3.763,P ＜ 0.01).The incidence of invasive ventilation were lower than that of control group too(but P ＞ 0.05.Conclusion These results suggested that BiPAP ventilation can regulate HR RR and blood gas value to accetable levels,shorten hoptipitalization duration and reduce the incidence of invasive ventilation.It is proved to be an effective therapeutic technique in the treatment of acute pulmonary edema patients.