BACKGROUND:Language dysfunction is a frequently reported symptom in Alzheimer's disease (AD). However, computer-assisted analysis of spontaneous speech in AD and mild cognitive impairment (MCI) is rarely used to date. OBJECTIVE:To characterize the language impairment in AD and amnestic MCI (aMCI) with computer-based automatic analysis via the "Automatic Speech Recognition (ASR) software for cognitive impairment V1.3". METHODS:A total of 64 subjects, including 20 AD patients, 20 aMCI patients, and 24 healthy controls were recruited. All subjects underwent neuropsychological tests, and spontaneous speech samples were recorded through the description of the "Cookie-Theft Picture" and then analyzed by the computerized software. Subsequently, we compared the speech parameters between the subjects and the controls. RESULTS:We identified seven spontaneous speech parameters (percentage of silence duration, average duration of phrasal segments, average duration of silence segments, number of speech segments, number of long pauses, ratio of hesitation/speech counts and ratio of short pause/speech counts) demonstrating significant differences between the three groups (p < 0.05). All seven speech parameters significantly correlated with cognitive performance, with average duration of silence segments demonstrating the best correlation to cognitive performance on stepwise multiple linear regression analysis. CONCLUSION:Computer-assisted automated analysis of speech/silence segments demonstrated the potential to reflect the intrinsic linguistic impairment associated with MCI and AD. It has a promising prospect in the early detection of AD and assessment of disease severity.

BACKGROUND:Repetitive transcranial magnetic stimulation (rTMS) is thought to be effective in alleviating cognitive symptoms in patients with amnestic mild cognitive impairment (aMCI), but the mechanisms related to network modification are poorly understood.OBJECTIVE:Here we tested rTMS efficacy and explored the effect of rTMS-induced changes in the default mode network (DMN) and their predictive value for treatment response.METHODS:Twenty-one subjects clinically diagnosed with aMCI were recruited to complete a 10-session randomized and sham-controlled rTMS treatment targeting the right dorsolateral prefrontal cortex. Resting-state functional magnetic resonance imaging in tandem with neuropsychological assessments were administered before and after the intervention. Changes in functional connectivity of the DMN and relevant brain regions, as well as the correlations between baseline functional connectivity and clinical rating scales were calculated in order to elucidate the mechanism of treatment response to rTMS therapy.RESULTS:Compared to the sham group, the rTMS group achieved improvement of neuropsychological performance and significant functional connectivity changes within the DMN. Group×Time interactions were found between posterior cingulate gyrus and right fusiform gyrus (F (1,19)  = 17.154, p = 0.001), and also left anterior cingulate gyrus (F (1,19)  = 3.908, p = 0.063), showing an rTMS-induced deactivation of functional connectivity within the DMN. Baseline functional connectivity analysis of seeds within the DMN in the rTMS group revealed negative correlation with AVLT-Recognition score changes.CONCLUSION:rTMS-induced hypoconnectivity within DMN is associated with clinical cognitive improvements in patients with aMCI. Further, pre-rTMS baseline activity of the DMN at rest may be a predictor for favorable rTMS treatment response.

目的:研究原发性帕金森病(Parkinson's disease,PD)与多系统萎缩(multiple system atrophy,MSA)患者间的运动诱发电位(Motor evoked potentials,MEP)差异,探索其在两者鉴别诊断中的价值.方法:对12例MSA患者和12例性别、年龄匹配的初诊未服药原发性PD患者进行单脉冲经颅磁刺激-MEP检查,比较2组患者的MEP指标,通过绘制受试者工作特征曲线选取适用于鉴别诊断的指标.结果:运动阈值、MEP波幅和中枢运动传导时间(central motor conduction time,CMCT)在MSA与初诊原发性PD患者间差异无统计学意义(P＞0.05),丽MEP波形在2组间的差异存在统计学意义(P＜0.05);MSA患者的MEP时长较初诊PD患者存在延长的趋势,但差异尚无统计学意义(P＞0.05).结论:对MEP波形评级和MEP时长的检测有助于MSA与原发性PD间的鉴别诊断.

To study the effect of real-time feedback teaching in the interviewer training for practical skills examination of doctor's qualification. The process of real-time feedback teaching included: prepara-tion; on-site teaching; on-site training; evaluation of the training effect. The manifestation of the trained in-terviewers was evaluated after the training of physical examination and practical operation, and the inter-viewers' accuracy was improved in both physical examination group and practical operation group. Therefore, it can be concluded that the application of real-time feedback teaching in the interviewer training for prac-tical skills examination of doctor's qualification is effective, and is worth popularizing.

Inter-professional education (IPE)is an education process in which two or more than two professions learn from each other to improve collaboration and medical service quality.In the process of advancing the National Resident Standardized Training in China,professional technology and clinical decision making are the key to the training. Our affiliated hospital integrated IPE into resident standardized training,which has effectively improved the residents'comprehensive competency and at the same time raised some thinking on the future training mode.

Objective To investigate the application of simulation in the training and assessment of North American specialists,and to discuss the problems and development of simulation used in specialist training and assessment in China.Methods Literature investigation and expert discussion.Results Simulation technology has been widely used in the training and certification of various specialties.In general,it used as a requirement for certification,maintenance of certification or in training process.The application of simulation in the training of specialists in China is just in the initial stage,and the main problems are lack of attention,inadequate investment,non-standard curriculum development and lack of teachers.Conclusions The application of simulation in North America specialist training and assessment is relatively deep,but in China it is still in its infancy.There is still much to do to get a better result.

Objective To investigate the status quo of psychological capital and core competence of medical students so as to figure out their correlation.Methods Luthas psychological capital questionnaire and CanMEDS core competence self-evaluation questionnaire were used to investigate 168 medical students.The data were analyzed by SPSS 17 software.Results The average score of psychological capital of medical students was 102.20 ± 15.31,and the score of psychological capital of undergraduate medical students was lower than that of residents (P =0.048).The score of CanMEDS core competence of medical students was 4.41 ±0.63,and the scores of undergraduates were lower than those of residents (P ＜0.001).There was a positive correlation between psychological capital and CanMEDS core competence of medical students (R =0.752,P ＜0.001).Conclusion Mental health of medical students should be paid more attention to.Improvement of psychological capital is a way to improve the core competence.Multi-dimensional education is critical to train doctors who meet the requirements of the times.

目的 从医学生在生活中利用自媒体查看医学类新闻的习惯入手,调查自媒体对医患关系的影响.方法 随机抽取在上海交通大学第六人民医院就读或实习的182名医学生,于2016年3～6月期间,对其进行问卷调查并现场回收.共回收问卷182份,回收率100％;有效问卷182份,有效率100％.研究内容包括:(1)医学生的个人基本情况:性别、年级、专业等;(2)医学生使用自媒体查看医学类新闻的习惯:每日查看的时间、频率、对医学类新闻的关注度、查看新闻的渠道等;(3)医学生对自媒体报道的信任度;(4)医学生对医患关系的评价等.结果 98.4％的医学生表示通过自媒体关注医疗报道,并主要关注医疗技术、医患沟通和医院环境的报道;医学生对自媒体报道的信任度较低;年级越高的医学生,认为医患关系越紧张对立(P＜0.001)且对医患关系现状的看法,更倾向于自身的体会(P＜0.001);医学生期望自媒体对医患纠纷可以进行后续处理的报道.结论 医学生使用自媒体的频率较高;医学生对医患关系的评价较低,但评价并不依赖于自媒体的报道;利用自媒体,建立长期有效的正向宣传机制.

目的 在可教授、可学习、可测评的职业精神研究框架内,将职业精神的概念进行本土化解读,同时通过对医学生的职业精神概况的测评以及PBSG-ED模式(Practice Based Small Group-EducationModule)的应用,开展职业精神培养师生协同培育机制的构建研究.方法 通过对临床教师和医学生有关医学职业精神概念的理解的访谈,结合文献,归纳相关维度和特征,设计问卷展开调查;通过典型案例的实践研究将PBSG-ED模式进行本土化实践,并构建实践模型.结果 责任与义务、同情与同理心、诚信和正直、沟通与团队协作、奉献与自我完善、利他主义和尊重是本次研究所归纳的与职业精神相关的六个维度;构建案例库,以典型案例和基于PBSG-ED模式进行的实践研究取得了良好效果.结论 六个维度的医学职业精神的问卷具有很好的信度;基于PBSG-ED模式的师生协同培育机制的构建和技术路线设计是职业精神教育的有效途径;与此相关的研究将在继续扩大样本量和更加科学严谨的设计框架内进行深入探索.

Objective To investigate the current status of medical students ’ critical thinking ability and its influencing factors. Methods We selected 135 clinical medicine students from the Sixth Clinical Medical School Affiliated to Shanghai Jiaotong University. Thinking Disposition InventoryChinese Version( CTDI-CV) was adopted for the survey. Results The average total score of critical thinking ability of the medical students was 242. 94 ± 20. 65,and only 4. 44% of the students showed positive critical thinking ability. Among the seven dispositions,only cognitive maturity( 43. 23 ± 6. 98)was positive. Self-confidence( 28. 61 ± 6. 21) was negative. Analysis capability( 30. 01 ± 4. 53) and desire for further knowledge( 30. 01 ± 4. 91) were in the negative state threshold. Male and female medical students differed significantly in critical thinking ability( 239. 52 ± 22. 09 vs. 247. 53 ± 18. 23,P = 0. 025). Conclusion The critical thinking ability of medical students is weak. To improve their critical thinking,we should attach importance to the cultivation of critical thinking ability,adopt new teaching techniques and change evaluation methods,which are the effective ways to improve medical students’ critical thinking ability.

The result of neuropsychological tests is crucial to confirm a diagnosis of dementia or cognitive impairment. It might be improper judging individuals with different basic cognitive function using the same standard. The evaluation of premorbid intelligence is an effective way for error correction, but not enough attention has been paid during clinical practice. Here we present a review of the existing methods of premorbid intelligence evaluation and their application in cognitive impairment. DOI: 10.3969/j.issn.1672-6731.2016.09.016

目的:采用经颅磁刺激(transcranial magnetic stimulation,TMS)法评估长病程随访和初诊原发性帕金森病(Parkinson's disease,PD)患者的运动诱发电位(motor-evoked potentials,MEP),探究长期PD病理改变对大脑皮层兴奋性和中枢神经传导的影响.方法:选择病程＞8年的PD患者和初诊未服药的PD患者各7例,采用统一帕金森病评定量表运动部分(Unified Parkinson's Disease Rating ScaleⅢ,UPDRS-Ⅲ)评估其运动功能,并用简易精神状态量表评估其认知功能,通过TMS检测其双侧静息运动阈值(resting motor threshold,RMT)、活动运动阈值(active motor threshold,AMT)、MEP波幅和中枢传导时间(central motor conduction time,CMCT),根据每位患者症状重侧和轻侧进行双侧对比和组间比较.结果:RMT、AMT、MEP波幅及CMCT在长病程PD患者与初诊PD患者间,以及在每位患者症状重侧与症状轻侧之间的差异均无统计学意义(D0.05).全体PD患者症状轻侧的CMCT与其UPDRS-Ⅲ总分及症状轻侧得分呈正相关(P＜0.05);而在长病程组中,患者症状重侧的CMCT与症状重侧的UPDRS-Ⅲ得分间呈正相关(P＜0.05).结论:长病程PD并不改变患者的皮层兴奋性,但其中枢传导速度可能随疾病发展而降低.

Objective To investigate the value of virtual reality thoracentesis applied in clinical teaching .Methods We made a retrospective analysis of the thoracentesis training data of 57 students at No.6 Clinical Medical School Affiliated to Shanghai Jiaotong University between April 2013 and March 2014 .We divided the students into two groups . Combination training group received the teaching approach of mold thoracentesis after finishing virtual thoracentesis , while model training group received a single model teaching approach .Students'self-assessment and thoracentesis operation examination were arranged after training .Results There was no significant difference in sex , scores in internal medicine , surgery, gynecology and obstetrics or pediatrics before and after model training between the two groups (P>0.05).As for self-assessment, the combination training group outperformed the model training group in smooth operation and self-confidence (9.27 ±0.87 vs.8.30 ±0.87,P<0.001;8.90 ±0.84 vs.8.30 ±0.99, P=0.016).As far as examination results are concerned , the combination training group was superior to the model training group in local anesthesia and familiarity with operation procedures (8.90 ±0.99 vs. 8.15 ±1.35, P=0.019;7.40 ±1.16 vs.6.26 ±1.32, P=0.001).However, there was no significant difference in overall performance between the two groups (86.80 ±6.06 vs.84.93 ±3.65, P=0.169). Conclusion The combination training group is superior to the model training group in teaching effects . Virtual reality training system helps to improve students'operation skills of thoracentesis .

目的:评价临床思维训练软件——DxR的教学效果.方法:将58位医学生分为DxR组和对照组.比较两组学生的自我评价和出科考试成绩.结果:自我评价:DxR组在“自信程度”和“主动学习”方面优于对照组.出科考试:DxR组在“问诊思路”“现病史书写”“诊断及鉴别诊断”“治疗计划制定”和“总体评价”方面优于对照组.结论:DxR教学能增加医学生的自信程度,促进主动学习,并能训练医学生临床思维能力.

目的:从医学生基本能力培养出发,探讨临床实践教学模式构建的必要性.方法:回顾10年来临床技能实验室的若干实践,分析各自在医学生能力培养中的作用.结果:“标准化病人”项目、医学在线考试与辅助教学系统、医学人文教学、客观结构化临床考试、反馈式教学、团队与职业化精神培养、教师培训等手段,是医学生能力培养的重要方法.结论:序贯化人才培养模式是医学生能力培养的有效形式.

Objective By drawing the learning curve of virtual reality thoracentesis,to find out how easy it is to grasp the technology,design the reasonable teaching plan and provide reference to carrying out this kind of new teaching method.Methods Thirty clinical medical students finished eight times practices of virtual reality thoracentesis within 20 day period.We divided the eight times practices into four.phases(A,B,C,D)according to the time sequence,and compared the procedure time,performance scores and performance confidence among the four phases.Results The procedure time was shortened gradually with the increase of operation times,and the curve reached a plateau at trial 4.As for four phases,there was no significant difference in procedure time between C phase and D phase(P =0.133),and the significant differences were observed among the other phases(P＜0.001).The procedure time of C,D phases was significantly less than A,B phases (218.1 ±24.78) seconds vs (310.9 ± 53.63) seconds,P＜ 0.001.The performance scores and the performance confidence of C,D phases were significantly higher than A,B phases (P＜0.001).Conclusions Students without experience can grasp the technique of virtual reality thoracentesis after four times practices.The technique is relatively easy to grasp.

目的 验证汉化版的杰弗逊医师同理心量表(JSPE)的有效性,并利用该量表对临床实习医师和住院医师同理心状况进行调查,为同理心教育和测量方法的建立提供依据.方法 对JSPE进行汉化,并利用该量表对上海交通大学医学院1 043位临床实习医师及住院医师的同理心状况进行测量,以了解其同理心的一般水平及其在不同性别、年级及学历等人群中的差异.结果 住院医师平均分高于临床实习医师,女性平均得分高于男性,且差异具有统计学意义(P＜0.05);同理心测量结果并未呈现出“随着年资增高,同理心水平下降”的趋势.参与调查的临床实习医师和住院医师的同理心平均得分与其他一些国家测量结果相比,处于中间水平.结论 汉化版的JSPE具有较好的信度;单纯采用量表对同理心水平进行测量尚存在一定的局限性;在今后继续开展同理心教育的同时,可结合多种研究方法,以发现其他要素与同理心测量的相关性.

目的：观察PBL教学模式在五年制外科学教学中的应用效果。方法选择上海交通大学医学院2007～2009级五年制临床医学3系为研究组，2004～2006级五年制临床医学3系作为对照组。研究组在传统教学模式基础上增加PBL教学模式，对照组仅采用传统教学法。观察比较两组学生理论考试成绩并分析不同试题类型的得分情况，采用问卷调查以评估学生反馈。结果研究组理论考试平均成绩明显优于对照组（P＜0.05），研究组的优良率及及格率亦高于对照组，但两组间差异无统计学差异。研究组应用类试题及PBL授课章节试题的得分率高于对照组，研究组内普通外科考试中PBL授课章节试题的得分率高于其他章节试题的得分率。问卷调查显示学生对PBL教学更感兴趣。对其评价亦明显优于传统教学模式。结论 PBL教学法激发了五年制医学生的学习兴趣，提高了学习主动性和参与性，有助于加强知识的掌握和应用，提高理论考试成绩，是外科临床教学中理想的教学方法。

Objective To know the status of work engagement and specialty identity of medical students. Methods Based on Utrecht work engagement scale (UWES) and vocational identity scale, 195 medical students and 99 non-medical students from Shanghai Jiao Tong University were investigated. Results Scores of work engagement and specialty identity of students from clinical medicine and stomatology were higher than that of students from preventive and laboratory medicine and nursing, with statistical significance. Students from clinical medicine had the highest score of specialty identity, while students from preventive and medicine had the lowest. Undergraduate students from clinical medicine had higher scores of work engagement and specialty identity than graduate students. There was a positive correlation between work engagement and specialty identity. There was no statistical significance in work engagement and specialty identity between medical and non-medical students. But medical students had higher sense of dedication, certainty, significance, self-efficacy and self-decision, with statistical significance. Conclusions The more specialty identity, the more work engagement. Work engagement and specialty identity of students in our study is not very much, but medical students had higher sense than non-medical students.

目的 对上海交通大学医学院八年一贯制学生的教学效果进行评价.方法 基于美国医学研究生教育认证委员会(ACGME)能力模型的6个方面制定量表,对上海交通大学医学院2005-2012级145名八年一贯制学生、86名临床医学专业的本科生和研究生及拥有八年制教学经验的10名教师进行调研.结果 八年制男生在总分和“问题解决和临床技能”方面评分高于女生,差异有统计学意义(P＜0.05).八年制学生随着年级升高,“问题解决和临床技能”和“系统实践能力”的自评分数增高(P＜ 0.05).八年制学生自评总分均高于相应阶段的本科生和研究生(P＜0.05).教师对八年制的评价与学生自评结果基本一致,对“问题解决和临床技能”评分较高(P＜0.05).结论 上海交通大学医学院八年一贯制学生的临床能力得到证实,但临床经验仍有不足.