BackgroundIn recent years in China, the tense physician-patient relationship has been an outstanding problem. Empathy is one of the fundamental factors enhancing the therapeutic effects of physician-patient relationships and is significantly associated with clinical and academic performance among students.MethodsThis cross-sectional study used the JSPE-S (The Student Version of the Jefferson Scale of Physician Empathy) to assess 902 medical students from 1st year to 4th year at China Medical University. The reliability of the questionnaire was assessed by Cronbach’s alpha coefficient. We performed an exploratory factor analysis to evaluate the construct validity of the JSPE-S. Group comparisons of empathy scores were conducted via the t-test and one-way ANOVA. Statistic analysis was performed by SPSS 13.0.ResultsThe Cronbach’s alpha coefficient was 0.83. The three factors emerging in the factor analysis of the JSPE-S are “perspective taking”, “compassionate care” and “ability to stand in patients’ shoes”, which accounted for 48.00%. The mean empathy score was 109.60. The empathy score of medical students had significant differences between different genders (p < 0.05) and academic year level (p < 0.05).ConclusionsThis study provided support for the validity and reliability of the Chinese translated version of the JSPE-S for medical students. Early exposure to clinical training and a curriculum for professional competencies help to enhance the empathy of medical students. We suggest that the curriculum within Chinese medical schools include more teaching on empathy and communicational skills.

The first enantioselective Satoh-Miura-type reaction is reported. Av ariety of CÀNa xially chiral N-aryloxindoles have been enantioselectively synthesized by an asymmetric rhodium-catalyzed dual C À Hactivation reaction of N-aryloxindoles and alkynes.H igh yields and enantioselectivities were obtained (up to 99 %yield and up to 99 %ee). To date,itisalso the first example of the asymmetric synthesis of CÀNa xially chiral compounds by such aC ÀHactivation strategy.

BackgroundOver the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments’ measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations.MethodsA systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990–2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument’s usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee’s criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments.ResultsAfter screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar’s instrument for nursing students, Nurse Practitioners’ Roles and Competencies Scale, and Perceived Faculty Competency Inventory.ConclusionAlthough instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.

Background Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context. Methods We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students. Results Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood. Conclusion In our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

The first enantioselective Satoh-Miura-type reaction is reported. Av ariety of CÀNa xially chiral N-aryloxindoles have been enantioselectively synthesized by an asymmetric rhodium-catalyzed dual C À Hactivation reaction of N-aryloxindoles and alkynes.H igh yields and enantioselectivities were obtained (up to 99 %yield and up to 99 %ee). To date,itisalso the first example of the asymmetric synthesis of CÀNa xially chiral compounds by such aC ÀHactivation strategy.

Ubiquitin-specific protease 11 (USP11) is a deubiquitinating enzyme that exerts its biological functions by regulating multiple signaling pathways such as p53, NF-κB, TGF-β, and Hippo. A large body of evidence supports a link between UPS11 and tumorigenesis. However, the clinical significance and biological function of USP11 in hepatocellular carcinoma (HCC) remains unclear. Here, USP11 expression was assessed by immunohistochemistry in a pilot series of 71 HCC clinical samples, and the association between USP11 expression and clinicopathological features and overall survival time was analyzed. The cytoplasmic expression rate of USP11 was higher in non-cancerous tissue than that in cancer tissue (36.6 vs. 12.7%, P = 0.001), whereas the nuclear expression rate of USP11 was lower in non-cancerous tissue (5.6 vs. 69.0%, P < 0.001). USP11 expression level was higher in tumor than that in non-tumor tissue (P < 0.001). Chi-square analysis of variances suggested that USP11 expression was associated with vascular invasion (P = 0.033), differentiation (P = 0.027), tumor number (P = 0.009), and recurrence (P = 0.036). USP11 expression was also associated with shorter overall survival time (P = 0.001) by log-rank test. Unconditional logistic regression analysis with multiple covariates indicated that high USP11 expression was associated with a 2.96-fold increase in the risk of death compared with low USP11 levels (P = 0.041) and acted as an independent predictor of overall survival. HCC patients with simultaneously high USP11 and alpha-fetoprotein expression had an adjusted 5-fold higher risk of all-cause-related death (P = 0.006). Moreover, in vitro and in vivo experiments confirmed that USP11 could promote the migration and invasion of HCC cell. Overall, we suggest that USP11 promotes HCC cell metastasis, and we provide the first evidence of the prognostic significance of USP11 expression in HCC, which suggests that USP11 is a promising therapeutic target for the treatment of HCC.

Background: Medical residents usually suffer from work overload and experience both personal and professional distress, which affects their level of the empathy to patients. Psychological capital (PsyCap) is a psychological resource that is negatively associated with indicators of distress. Objective: This study explored the potential mediating effect of PsyCap on the relationship between distress and empathy, which may help healthcare professionals in their defense of empathy erosion due to distress. Design: A total of 620 first-year residents were recruited for this cross-sectional survey. Empathy and PsyCap of residents were assessed by the Chinese version of the Jefferson Scale of Physician Empathy and the Psychological Capital Questionnaire, respectively. In this study, both personal and professional aspects contributing to resident distress were investigated by the Satisfaction with Life Scale and an occupational distress scale. T-tests and oneway ANOVA were used to test differences in empathy of residents. Pearson's correlation was used to examine correlations between distress, PsyCap, and empathy. Structured equation modeling was used to conduct the pathway analysis to test the mediating effect of PsyCap on the association between distress and empathy. Results: 537 residents (86.6%) completed the survey. Distress, empathy, and PsyCap were significantly correlated (P < .01) and in the expected directions. The first step analysis showed that as distress increased, the empathy of residents significantly decreased (P < .01), with the direct effect coefficient being 0.265. When PsyCap was included, the direct effect coefficient decreased to 0.033. This indirect effect was significant (P < .01). The variance accounted for was 81.14%, which indicated a partial mediating effect of PsyCap. Conclusions: PsyCap may serve a significant protective role against the impact of distress on the level of empathy of medical residents. In addition to reducing distress, PsyCap development could be considered in empathy decline prevention and empathy cultivating strategies.

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