Influence of blood donation service on the autonomous motivation of blood donors / 中国输血杂志

【Objective】 To explore the influence of blood donors′ demographic characteristics and blood donation service experience on voluntary blood donation motivation. 【Methods】 Using self-made questionnaire, stratified sampling method was used to select blood donors from three urban areas in Zhejiang province for investigation. Independent sample t-test, variance analysis and chi-square test were used to compare the differences of blood donation motivation and blood donation service experience of different blood donors. Spearman correlation analysis and linear regression were used to analyze the correlation between blood donation motivation and blood donation service and the influencing factors of blood donation motivation. 【Results】 There were 705 valid samples. The motivation level of blood donation is higher in married people than that in unmarried people, in those over 27 years old than in those under 26 years old, and in those who donated for ≥3 times than those 1-2 times (P<0.05). The experience of blood donors in blood station staff service, blood donation process and blood donation environment was stronger than that of blood donation sites (P<0.05). Both voluntary motivation and controlled motivation were positively correlated with blood donation service experience (P<0.05). Good experience of blood donors on the distribution of blood donation sites, service of blood station staff and blood donation process was conducive to the improvement of blood donation motivation. 【Conclusion】 Blood donation service experience can influence the autonomous motivation and controlled motivation of blood donors to donate blood again. It is suggested that blood centers should take the test during conducting blood donation publicity and blood donation services.

Cluster analysis on the training needs of the aged care teachers of social volunteer teams in Jiangsu Province / 中华医学教育探索杂志

Objective:To analyze the level and latent categories of the training needs of the nursing staff of the social volunteer teams in Jiangsu Province, and to provide basis for the targeted training.Methods:From March to July in 2018, 224 elderly care teachers from 13 social volunteer teams of 100 Red Cross societies in Jiangsu Province were surveyed for the knowledge of the care for the aged and the needs of training by the self-designed questionnaires. A total of 207 valid questionnaires were collected, with an effective recovery rate of 92.4%. SPSS 21.0 and Latent GOLD 5.1 software were used for description analysis, hierarchical clustering and latent category analysis.Results:The number of answer of "very need" to knowledge and skills among the aged care teachers for the elderly, such as psychological care, elderly volunteer services and recreational activities for the elderly, was 196, 196 and 193, with a proportion of 94.7%, 94.7% and 93.2%, respectively. Cluster analysis showed that training needs could be divided into four aspects: life care knowledge and skills, health care knowledge and skills, psychological care knowledge and skills, and spiritual comfort knowledge and skills. The results of latent category analysis showed that the aged care teachers could be divided into three groups based on their different training needs: high demand group for overall knowledge and skills, partial demand group for overall knowledge and skills, and high demand group for medical care and psychological care knowledge and skills. The corresponding latent probability of the three groups were 80.2%, 13.0%, 6.8%, respectively.Conclusion:The training for the aged care of social volunteer teams should pay attention to the teaching of spiritual comfort knowledge and skills for the elderly. The training program should be oriented to the multi-level and individualized needs of the teachers, so as to meet the needs of the aged care teachers for their own development.

Quantitative assessment in the nursing of elderly patients with trachea after tracheotomy / 中国实用护理杂志

Objective:To explore the application value of quantitative assessment in the pipeline nursing after tracheotomy in elderly critical patients.Methods:A total of 108 elderly critically ill patients admitted to our hospital from January 2018 to January 2020 were treated with tracheotomy and given plumbing care after surgery. According to the random number table method, it was divided into a control group (54 cases) and an observation group (54 cases).The control group received routine nursing, and the observation group received nursing according to the quantitative evaluation results. The tube placement time, ventilator use time, monitoring time, and total hospitalization time were compared between the two groups. The changes of blood oxygen saturation (SpO 2), diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) were compared on the 1st and 7th days after operation. The incidence of complications was recorded and the patients' satisfaction and quality of life were evaluated. Results:In the observation group, the catheter placement time, ventilator use time, monitoring time, and total hospital stay were (20.35±5.37) days, (9.65±3.53) days, (14.81±3.34) days and (31.29±4.87) days, respectively, compared with the control group (24.91±4.79) days, (11.81±4.02) days, (16.95±3.99) days, (35.97±6.51) days were significantly shortened ( t values were 3.153 to 4.657, P<0.05). SpO 2, DBP, and SBP of the control group were 0.975 2±0.018 3, (79.39±7.41) mmHg (1 mmHg=0.133 kPa) and (137.46±7.09) mmHg, respectively, at 1 week after operation, which were all higher than the preoperative 0.953 4±0.015 9 and (75.45± 8.01) mmHg, (134.66±6.61) mmHg ( t values were 6.608, 2.653, 2.123, P<0.05). SpO 2, DBP, and SBP in the observation group were 0.959 1±0.017 2, (76.13±6.94) mmHg, and (134.56±7.33) mmHg, respectively, in the observation group one week after operation, which were significantly lower than those in the control group ( t values were 4.711, 2.360, 2.090, P<0.05).The complication rate in the observation group was 11.11% (6/54), which was significantly lower than the 25.93% (14/54) in the control group ( χ2 value was 3.927, P<0.05). The total score of nursing satisfaction in the observation group was (61.52±8.03) points, which was higher than the (52.11±7.99) points in the control group ( t value was 6.104, P<0.05). Conclusion:Quantitative assessment can shorten the tube placement time, ventilator use time, monitoring time and total hospitalization time of elderly patients with critical tracheotomy, ensure stable postoperative vital signs. It can reduce the complication rate and improve the patients' satisfaction.

Online teaching application of Advanced Nursing Practice based on POGIL theory / 中华医学教育探索杂志

In view of the problems existing in the traditional class of Advanced Nursing Practice for nursing masters and the learning characteristics of students, under the guidance of process orientated guided inquiry learning (POGIL) theory, with the medium of information technology, centered on the cultivation of students' clinical practice with different specialties of nursing practice as the carrier, the autonomous online teaching mode of teaching and learning is fully integrated into the teaching process. That has been adopted in the teaching of Advanced Nursing Practice for nursing students in grade 2019 of Nanjing Medical University. As a result, autonomous teaching and learning guided by POGIL theory can improve students' clinical nursing practice ability, critical thinking ability, problem-solving ability, communication and cooperation ability, thus achieving the teaching goal of this course.

Reliability and validity analysis of Chinese version of rheumatoid arthritis self-efficacy scale / 中华风湿病学杂志

Objective To translate and revise the form of rheumatoid arthritis (RA) self-efficacy scale (RASE),and evaluate the revised scale.Methods Totally 101 patients with RA in one hospital were selected for investigation.Through the translation-back to the source scale and the cultural adjustment,the Chinese version of RASE (C-RASE) was formed.Exploratory factor analysis was conducted to acquire the construct validity while the Pearson correlation analysis was used to obtain the test-retest reliability.Results Factor analysis was carried out on 28 items,and the loading was 0.496,0.490,0.482 and 0.493 of item 5,and item 15 on two factors respectively.Exploratory factor analysis was conducted secondarily after deleting items of 5,15,and 17,considering the item contents,and 9 factors were extracted,respectively named for exercise,comprehensive treatment,relaxation,activity,sleep,social relationship,fatigue,cognition and active planning,which could explain 68.36％ of total variation;aud the correlation coefficient between each dimension and total table ranged 0.344 to 0.679 (P＜0.01);The Cronbach's alpha coefficient of the C-RASE was 0.751,and the retest reliability was 0.731.After deleting their own items,the Cronbach's alpha value range was 0.730 to 0.756.Conclusion C-RASE has sound reliability and validity and could provides a measurement of the self-efficacy among rheumatoid arthritis patients.

Analysis of the demographic and blood donation behavior of repeat blood donors and first-time donors——based on the data of blood donors in Zhejiang province from 2006 to 2015 / 中国输血杂志

Objective To compare with the characteristics of different demographic and blood donation behaviors of the first blood donors and the repeated blood donors,to analyze the related factors influencing the repeated blood donation behavior,to provide the evidence to develop the recall strategy for the retention of the first-time donors strategies.Methods Use methods such as the composition ratio of descriptive analysis,and logistic regression analysis,Retrospectively analyzed the data of 3 226 571 cases of the whole blood donors in Zhejiang province from 2006 to 2015.from BIS2.0 Results ZheJiang repeated blood donors in 2006-2015 is accounted for 30.8％,men (57.8％),the proportion of aged 25 above is higher than the first blood donors;71.7％ of men in the repeated blood donors are 60-79 kg,52.2％ of women repeated blood donors are 50 to 59 kg;40％ of the repeat donors blood for the first time donate 400 mL;71.6％ of the repeated blood donors to donate again in 0.5-2 years,and of these,40.8％ back in 0.5-1 year.Conclusion The main factors on the demographic aspects that influence the repeated blood donation is occupation,cultural degree,the quantity of blood donation for the first time.The characteristics of the precise recall people are as follows:Age 26 to 45 years old,stable career,donate 400 mL for the first-time,weight 70-89 kg of male,weight 55 kg above of women.The better recall intervention Interval is preferred to 0.5-2 years,and 0.5-1 year is the best.

Impacts of attentional training on attention bias of sub-clinical depressed undergraduates / 中华行为医学与脑科学杂志

Objective To explore the attention bias characteristics and impacts of attention training on negative attention bias of undergraduates with sub-clinical depression.Methods The undergraduates whose BDI scores being at the top of 5％ were recruited as participations and assigned to early attention training group and late attention training group using random number table.The dot probe paradigm was used to compare the difference of depressive symptoms and ingredients of attention bias made by different processing phases of attention training.Results (1)The BDI score after the training(87.91± 12.47) was significantly lower than that the former test (97.23±17.72) (F~,32)=4.78,P＜0.05),and the attention bias score in late attention training group (-5.97±2.92) was lower than that in the early attention training group(2.77±2.75) (P＜0.05).The interaction of the stimulus materials presenting time and the measuring time was significant(F(2,64) =4.76,P＜0.05).Simple effect analysis showed that when the time of stimulus material presenting was 1 000 ms,the score of negative attention bias after the test (-4.89 ± 23.66) was significantly lower than pre-test (7.73±26.14) (F(1,33) =5.11,P＜ 0.05).In the pre-test,the negative attention bias scores of the stimulus materials presenting time for 100 ms and 1 000 ms (8.62 ± 27.60,7.73 ± 26.14) were significantly higher than that for 500 ms (-12.80±29.09)(P＜0.05).(2)When the negative disengaged score as a dependent variable,the repetitive measure analysis of variance showed that the interaction effect of the stimulus materials' presenting time and training group type was significant (F(1,32) =4.41,P＜0.05).Simple effect analysis results indicated the negative disengaged score of the late attention training group at post-test (-5.84±7.79) was significantly lower than that at pre-test (24.16±7.35) (P＜0.05).Conclusion The attention training during the late stage of the attention process can efficiently intervene the negative attention bias of undergraduates with sub-clinical depression.

Effects of aging-expectation on leisure-time physical activity among the old adults / 中华行为医学与脑科学杂志

Objective To investigate the relationship between aging-expectation and leisure-time physical activity among the old adults.Methods Structural interviews were administered to 550 old adults using the Godin Leisure-Time Exercise Questionnaire, Expectation Regarding Aging-12 (WHO-DAS 2.0), Activity of Daily Life-8, and the Geriatric Depression Scale-5.Results There was only 16％ of the old adults whose leisure-time physical activities met the WHO global recommendations.The level of cognitive function expectation was still significant in the regression models statistically even after adjusting the social characteristics,mental health status, and physical function successively (OR=1.024,95％ CI=1.005-1.043;OR=1.024,95％ CI=1.005-1.043;OR=1.029,95％ CI =1.009-1.050, respectively), and both of physical health expectation and mental health expectation were not significant in the three models.Conclusion The leisure-time physical activity of the majority old adults doesn't achieve the WHO global recommendations.Improving the cognitive function expectation of the old adults would be one of the valuable approaches to promote the leisure-time physical activity engagement.

Research on the ability level of institutionalized elderly people and its influence to pension service demand / 中国实用护理杂志

Objective To investigate the ability level of institutionalized elderly people and its correlation with pension service demand.Methods Ability assessment for older adults and a self-designed questionnaire about pension service demand were used to survey the ability level and service demand of 332elderly people in 7 institutions of Yancheng city in Jiangsu province in July 2014.The influence factors of pension service demand were analyzed by the binary classification Logistic regression.Results 67.8％ (225/332),14.8％(48/332) and 15.7％(52/332) institutionalized elderly's ability level were mild,moderate and severe impairment.The impairment of ability levels of the elderly had positive impact on helping eating,bath,cleaning,medical service and other services agency and negative impact on culture and entertainment.Conclusions The ability of institutionalized elderly were poor in Yancheng city in Jiangsu Province.We should provide service according to their abilities and demand,in order to ensure the rational use of the limited resources.

Application of generalizability theory in the examination of introduction of nursing / 中国实用护理杂志

Objective To analysis the reliability of the examination of Introduction of Nursing by using the methods of generalizability theory and to give advice on how to modify examination paper.Methods Estimation value of variance component from different variations and precision indexes were calculated by applying the principle of generalizability theory.Results The generalizability coefficient and index of dependability were greater than 0.4 in choice question and terminology explanation,the generalizability coefficient of short-answer question was also greater than 0.4.Short-answer question's index of dependability and generalizability coefficient and index of dependability of comprehensive problem were less than 0.4.Conclusions Generalizability theory can be used in analysis the reliability of the examination of Introduction of Nursing.Its result is helpful to improve the framework of examination papers and the reliability of examination.

The comparison adiponectin, glycosylated hemoglobin, blood lipid and body mass index in individuals with impaired glucose regulation and type 2 diabetes mellitus / 重庆医学

Objective To investigate the difference of adiponectin ,glycosylated hemoglobin (HbA1c) ,blood lipid and body mass index(BMI)in individuals with impaired glucose regulation(IGR) and type 2 diabetes mellitus (T2DM ) ,and to predict their effect in development of IGR 、T2DM .Methods Medical examination objects were selected and divided into three groups :145 patients with newly diagnosed T2DM group ,128 patients with impaired glucose regulation(IGR group) ,160 individuals with normal glucose tol‐erance (NGT group ,as control) .Fasting adiponectin ,HbA1c ,total cholesterol (TC ) ,triglyceride (TG ) ,low density lipoprotein (LDL‐C) ,high density lipoprotein cholesterol(HDL‐C) were determined .We measured body height ,body weight to compute body mass index(BMI) .Results The levels of HbA1c ,TC ,TG ,LDL‐C ,BMI were significantly higher in T2DM group than those in NGT group(P< 0 .05) ,the levels of HDL‐C and adiponectin were more declined in T2DM group than those in NGT group (P<0 .05) .The levels of HbA1c ,TC ,TG ,LDL‐C ,BMI were significantly higher in IGR group than those in NGT group(P< 0 .05) ,the levels of HDL‐C and adiponectin were more declined in IGR group than those in NGT group (P < 0 .05) .The levels of HbA1c , TC ,TG ,LDL‐C ,BMI were significantly higher in T2DM group than those in IGR group(P < 0 .05) ,the levels of HDL‐C and adi‐ponectin were more declined in T2DM group than those in IGR group (P < 0 .05) .Conclusion During the course of disease from NGT to IGR to T2DM ,plasma adiponectin levels are decreasing ,however HbA1c ,TC ,TG ,LDL‐C are increasing gradually while BMI were increasing .Therefore it has very important effect and significance in controlling BMI and plasma adiponectin levels to pre‐vent and cure IGR ,T2DM and plasma lipid disorder .

Initial investigation on effect of breviscapine on triglyceride in HepG2 cells in different time points and its mechanism / 重庆医学

Objective To initially investigate the time - dependent relation between breviscapine with peroxisome proliferator‐ac‐tivated receptor‐alpha(PPAR‐α) ,apolipoprotein A5 (apoA5) and triglyceride(TG) in HepG2 cells in different time points by ob‐serving the effect of breviscapine on the expression and contents of PPAR‐α ,apoA5 and TG in order to lay a certain foundation for further exploring the concrete mechanism for its regulating TG metabolism .Methods On the basis of earlier stage experiment ,100 mmol/L breviscapine was selected to treat the HepG2 cells at different time points (0 ,6 ,12 ,24 ,36 ,48 h) .The levels of PPAR‐αand apoA5 gene and protein ,and the TG content in HepG2 cells were detected .Results Breviscapine could increase the levels of PPAR‐α and apoA5 gene and protein and decrease the TG content in HepG2 cells (P< 0 .05) ,moreover which showed the time -dependence .Conclusion Breviscapine may decrease the TG level in HepG2 cells ,its mechanism may be realized by increasing the expression of PPAR‐α ,thus increacing the expression of apoA5 in HepG2 cell .

Effects of serum from the obesity patients with diabetic mellitus on TLR4/NF-κB pathway in human THP-1 monocytes / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effects of serum from the obesity patients and obesity patients with Diabetic mellitus on toll-like receptor 4/Nuclear factor -κB p65 (TLR/NF-κB) pathway in human THP-1 monocytes and to explore the inflammatory immune response in obesity.@*METHODS@#Peripheral serum was isolated from healthy volunteers (the control group), the obesity patients (Ob group) and the obesity patients with diabetic mellitus (the Ob with DM group), respectively, 20 in each group. THP-1 monocytes were incubated with the serum for 48 h. The monocytes and culture supernatant were collected. The phosphorylation level of NF-κB p65 protein in THP-1 monocytes was evaluated by Western blot as well as immunofluorescence assay. The TLR4 mRNA expression was evaluated by RT-PCR. ELISA was used to measure the monocyte chemotactic protein-1 (MCP-1) levels in the culture supernatant.@*RESULTS@#In the presence of serum, the obesity group and the obesity with diabetic mellitus group showed the up-regulated phosphorylation level of NF-κB p65 protein and TLR4 mRNA expression in THP-1 monocytes compared with the healthy control group (both P<0.05), and the MCP-1 levels in the obesity patients were up-regulated significantly compared with the healthy control group [healthy control group (26.4 ± 3.9) pg/mL, Ob group (45.8 ± 10.0) pg/mL, Ob with DM group (58.0 ± 15.3) pg/mL; P<0.05]. These parameters were further up-regulated in the obesity patients with diabetic mellitus patients.@*CONCLUSION@#The serum from the obesity patients or the obesity patients with diabetes can induce monocyte dysfunction, which might be related to the activation of TLR4/NF-κB signaling pathway.

Effectiveness of group counseling in the social anxiety among college students: a meta-analysis / 中华行为医学与脑科学杂志

Objective To systematic evaluate the effectiveness of group counseling in the social anxiety among college students.Methods Relevant literature between January 1990 and December 2013 was searched by computer and relevant group intervention study about social anxiety among college students was collected,and then meta analysis was used in statistical analysis.Results In terms of each factor score of SCL-90,they showed significant differences not only between pre-treatment and post-treatment of the intervention group,but also between pretreatment and follow-up.The results indicated that the combined effect size of comparison of the data in these reports with pre-treatment vs.post-treatment varied between 0.27 and 0.66,pre-treatment vs.follow-up varied between 0.24 and 0.67.Conclusion Group counseling can effectively increase the level of mental health of the social anxiety among college students.

Effect of siRNA targeting Livin gene on biological characteristics of human prostate cancer PC3 cells / 中华泌尿外科杂志

Objective To observe the effect of RNAi targeting Livin gene on biology characteristics such as apoptosis and proliferation in human prostate cancer cells.Methods siRNA expression vector targeting Livin gene was constructed and transfected into human prostate cancer cell line PC3.The expressions of Livin mRNA and protein were detected by real-time PCR and Western-blot,cell apoptosis and cell cycle were assayed by flow cytometry,proliferation and colony formation were detected by MTT and colony formation assay,and the tumor growth in vivo was observed in nude mice.Results After transfection,downregulation of Livin mRNA and protein expression in PC3 cells was observed (P＜0.01).Compared with the control group,the proliferation of cancer cells was inhibited significantly (P＜0.01) and the apoptotic ratio was (26.5±3.3) ％ (P＜0.01).The Caspase3 activity increased obviously (P＜0.05),and the experimental group showed a decreased colony formation rate (P＜0.01).The tumor volume of xenografts in nude mouse in experimental and control group was (1.79± 0.07) and (4.40 ± 0.06) cm3 respectively (P ＜ 0.01).Conclusions The siRNA recombinant expression vector targeting Livin gene was constructed and can knockdown the expression of Livin mRNA and protein.It can inhibit PC3 cell proliferation,induce apoptosis and inhibit tumor growth in vivo.

Preliminary evaluation of reliability and validity of Chinese version of Nursing Student Self-Efficacy Scale / 中国实用护理杂志

Objective To translate and evaluate the reliability and validity of Chinese version of Nursing Student Self-Efficacy Scale.Methods A total of 212 nursing students in practice were recruited and completed the questionnaire survey including Chinese version of Nursing Student Self-Efficacy Scale and General Self-Efficacy Scale.Results The fitness of confirmatory factor analysis neither in intersectant model nor in orthogonal model were not good.Chinese revised version of Nursing Student Self-Efficacy Scale was formed based on the exploratory factor analysis.The three factors could explain 67.7％ variance of self-efficacy and the loading of all items was above 0.6.The correlation coefficient between the total score and three factors of revised NSSES and GSES was 0.570,0.427,0.582,and 0.480 respectively.The fitness of revised NSSES confirmatory factor of intersectant model,orthogonal model,and modified intersectant model were also not satisfying.Conclusions Although the reliability and the criterion-related validity of revised Chinese version of Nursing Student Self-Efficacy Scale were satisfying,the construct validity was not good and the further revision concerning on the task description and item response grade was required before applying for the internal measurement.

Insights of drug zero-profit reform at county-level public hospitals in Zhejiang Province / 中华医院管理杂志

This paper presented the practice of Zhejiang in introducing the drug zero-profit reform.A comparative analysis was made to the pilot county hospitals regarding their business performance,patients' burden,financial subsidy and medical insurance expenditure.The reform has scored a success as expected with the following outcomes:sharp rise in medical services volume,medical income and financial aid on one hand; drop of the proportion of drug income and changes in the medical income makeup; controlled increase of average cost of outpatient and inpatient care,and significant drop of pharmaceutical costs; increased expenditure yet stable operation of medical insurance funds;proportional increase of medical insurance compensation,with drops of the proportion of both out-ofpocket expenses and visits to doctors out of their county.This reform,however,has such shortcomings as follows:insufficient adjustment toward true costs of medical services,lack of a clear and sustainable financial compensation mechanism,and that of supporting measures.Based on these,the authors call for accelerated payment system reform,dynamic and scientific adjustment of medical service prices,exploration of clear financial compensation methods,optimization of internal management of hospitals,and acceleration of the formation of a medical staff income distribution mechanism.

Assessment of validity and reliability of Chinese version of tools in measuring yangsheng / 中华行为医学与脑科学杂志

ObjectiveTo assess the reliability and validity of Chinese version of tools in measuring yangsheng.MethodsChinese version of tools in measuring yangsheng was administered to 706 elderly citizens and evaluated for the reliability and validity.ResultsThe fittingness of the both exiting model were unidentified.A model of six factors and twenty-six items was determined using exploratory factor analysis.The fitness of such model was perfect ( RMSEA =0.050,AGFI =0.871,GFI =0.902,NFI =0.903,CFI =0.953 ) and all the construct reliability were more than 0.6 while the average variance extracted were higher than 0.5 except the diet yangsheng factor.The Cronbach's α of Chinese version of tools in measuring yangsheng was 0.918 and Cronbach's α of factors were all above 0.7.ConclusionThe Chinese version of tools in measuring yangsheng appears to have good validity and reliability to estimate the Yangsheng of elderly citizens in China.

Analysis of the status and related factors of health literacy of Korean- Chinese elderly patients with hypertension / 中国实用护理杂志

ObjectiveTo investigate the status and related factors of health literacy of Korean-Chinese elderly patients with hypertension. MethodsStructural interview were conducted among 334 Korean-Chinese elderly patients with hypertension using general condition questionnaire,hypertension-related health literacy evaluation scale,and physiological and biochemical parameter of the subjects including SBp,DBp,height,waist and fasting blood glucose were measured. ResultsThe average score of health literacy was (85.0±71.6),while about two thirds (65.0％) had inadequate health literacy and about one quarter (25.4％)had adequate health literacy.Age and SES entered multiple regression equation of health literacy(Cum.R2=0.347). ConclusionsHealth literacy of Korean-Chinese elderly patients with hypertension was serious;age and SES were the important factors about health literacy.

Attainment of the economies of scale in medical service and the application / 中华医院管理杂志

The paper analyzed the economies of scale of medical service and its characteristics according to the concepts and original of such a theory. It holds that hospital operations demands an appropriate size; for medical services in need of procuring large equipments, specialized service units of an appropriate size are more cost effective than service provision in individual hospitals; web release of medical service information and price information can help expand the market size; hospital alliances can integrate medical services horizontally and vertically. The above measures can attain the economies of scale for medical service.