ABSTRACT
In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.
ABSTRACT
Objective:To compare the changing trends and differences of bed numbers,doctor numbers and medical service utilization in the US.and China so as to provide polity implication for the health care reform in China from the supply side.Methods:The data of beds,doctors,hospitalization and outpatient service utilization from the website of OECD and CDC of the United States as well as Chinese Statistical Yearbook of Health and Family Planning were used to describe the trends.Results:The beds per 1000 people in China had exceeded that of the US,while the doctors per 1 000 people in China was less than the US.Both the two countries had yearly increasing trend of outpatient visits.However,the hospitalization was decreasing in the US,while the growth rate of hospitalization was even higher than the outpatient visits in China.Conclusion:The decrease of bed amount and the increase of outpatient amount were the main changing trend of medical resources and service utilization in the US.The imbalanced structure of medical resource supply in China resulted the overuse of hospitalization services.In the supply side reform of medical reform in China,it suggested to promote the cooperation of medical insurance,drug and health care,adjusted the reform thought from resource amount into the promotion of service quality,changed the health management system from disease centered into health centered.
ABSTRACT
Summarized in the paper are the practices and experiences of hospitals across China,in their optimization of medical resources under the Healthcare Improvement Initiative to meet medical needs.Namely rationally allocating medical resources to strengthen emergency rescue,introducing new technologies to improve procedures and efficiency,introducing day surgery and day-care units,and innovating resource sharing among others.The author also recommended on further optimization of medical resources.
ABSTRACT
OBJECTIVE:To systematically review the efficacy and safety of Moxifloxacin(MFX)in the treatment of acute ex-acerbation of chronic bronchitis (AECB),and provide evidence-based reference for Tational use of MFX. METHODS:Retrieved from PubMed,EMBase,Cochrane Library,Medline,CBM,CJFD,VIP and Wanfang Database,the relevant conference proceed-ings and grey literature were also hand-searched,randomized controlled trials(RCT)about MFX(test group)versus other antibiot-ics (control group) in the treatment of AECB were collected. Meta-analysis was performed by using Rev Man 5.2 software with ITT analysis and PP analysis after literature selection,data extraction and quality evaluation. RESULTS:Totally 14 RCTs were in-cluded,involving 6 058 patients. Results of PP analysis showed,the clinical effective rate in test group was similar to that of con-trol group [RR=1.02,95%CI(1.00,1.04),P=0.06],while bacteria clearance rate was significantly higher than control group [RR=1.07,95%CI(1.04,1.11),P<0.001]. Results of ITT analysis showed,the clinical effective rate in test group was significantly high-er than control group [RR=1.03,95%CI(1.00,1.06),P=0.03],while there was no significant difference in the bacteria clearance rate [RR=1.02,95%CI(0.92,1.12),P=0.73] and the incidence of adverse reactions [RR=0.97,95%CI(0.87,1.08),P=0.52] be-tween 2 groups. CONCLUSIONS:The efficacy of MFX is not inferior to other antibiotics in the treatment of AECB,safety is simi-lar to other antibiotics.
ABSTRACT
OBJECTIVE:To explore the feasibility of using international index of rational drug use for the intervention and evaluation of rational use of antimicrobial agents during perioperative period in patients undergoing thyreoidectiomy.METHODS:The patients in the common surgical department were divided into intervention group and non-intervention group.An intervention control study was performed before intervention(from Mar.to Aug.in 2007)vs.after intervention(from Mar.to Aug.in 2008)on the synchronously discharged thyreoidectomy patients with the international index of rational drug use as references.RESULTS:After prophylactic use of antibiotics in the intervention group,the average antimicrobial application time was decreased from 6.83 days to 2.50 days,the average hospital stay of patients was decreased from 8.24 days to 7.15 days,the average hospitalization fee decreased from 1 895.99 yuan to 1 375.26 yuan,the cost of antibacterials decreased from 852.11 yuan to 538.53 yuan,and the proportion of the cost of antibacterials in the total hospitalization cost reduced slightly.However,all the indexes in the non-intervention group showed little change.CONCLUSION:It is effective and feasible to adopt the international index of rational drug use in the intervention and evaluation of rational use of antimicrobial agents during perioperative period.
ABSTRACT
Objective:To purify and characterize the major antigenic components of sand swimming crab,and provide theoretical evidences for the research of standardization of allergenic vaccine.Methods:The crude extract of Linnaeus was prepared using classical method, and electrophoresis of SDS-PAGE was used to separate the proteins of each group. The allergen proteins of 26 crab were identified using Western blot. To distinguish between the primary allergen proteins and secondary allergen proteins, FPLC(Gel Chromatography and ion exchange chromatography) was used to filtrate and identify the allergen protein.Results:SDS-PAGE analysis revealed that sand swimming crab proteins were composed of at lease 9 discrete protein bands, which molecular weight ranging from 13 000 to 90 000. Major bands were of 20 900, 24 200, 27 100, 29 200, 33 700, 38 900, 48 700, 74 700, 89 100 respectively. Western blot assay indicated that the crude extract reacted with sera obtained from 26 crab allergenic subjects and contained 5 allergen bands altogether, and the bands of 74 400 and 48 700 were the major allergenic components. The positive rates of the two major allergen proteins were both 100%, indicating the allergenic components maintained the immunocompetence after yielding from chromatography.Conclusion:The 74 400 and 48 700 bands are the major allergens of sand swimming crab. The major allergen proteins can be purified by chromatography.