Obstacles and approaches for the implementation of external long-term prescription dispensing for chronic diseases / 中国药房

The policy of long-term prescription for chronic diseases in China is gradually being improved and implemented， and external long-term prescription dispensing is being encouraged. The long-term prescription policy runs through the links of drug supply， equipment， use and policy， involving government departments such as medical security and health， as well as stakeholders such as patients， medical institutions and designated detail pharmacies. There are still some problems in the external dispensing of long-term prescriptions， such as the disunity of drug catalogue and the need for coordination among regulatory parties in the policy link； the need to improve the participation enthusiasm and service ability in the equipment link； the increased difficulty of prescription management， the need to improve the circulation platform in the use link. The promotion of external long-term prescription policy requires health insurance， medical service， and the medicine industry co-development， multi-party participation， and policy coordination. Among them， the “dual channel” policy， the policy of centralized medicine procurement， and the pharmacy included in outpatient overall management policy have all played a positive role in promoting the implementation of external long-term prescription dispensing for chronic diseases. It is necessary to improve supporting policies and implement regulatory responsibilities in the policy link， promote drug classification and service capabilities in the equipment link， improve the electronic prescription circulation platform， and strengthen prescription management in use link， so as to promote the implementation of external long-term prescription dispensing.

Three cases of flagellate shiitake mushroom dermatitis caused by Pleurotus ostreatus, Auricularia auricula and Flammulina velutipes respectively / 中华皮肤科杂志

Three cases of flagellate shiitake mushroom dermatitis caused by Pleurotus ostreatus, Auricularia auricula, and Flammulina velutipes respectively were reported. Case 1, a 45-year-old male patient, developed multiple flagellate erythematous patches and papules on the trunk, axillae and abdomen without any subjective discomfort 8 hours after ingestion of a large amount of grilled Pleurotus ostreatus. Case 2, a 33-year-old female patient, developed multiple flagellate erythematous patches with mild swelling and itching on the back 1.5 days after consuming a fresh Auricularia auricula salad, and millet-sized papules were densely distributed on the erythematous patches. Case 3, a 54-year-old female patient, developed cord-like, flagellate edematous erythema and papules on the neck, trunk and proximal extremities 72 hours after consuming Flammulina velutipes. Histopathological examination of the dorsal lesions in case 3 showed epidermal spongiosis, intraepidermal blisters, papillary dermal edema, superficial dermal vasodilation, erythrocyte extravasation, inflammatory infiltration composed mainly of lymphocytes around dilated blood vessels, and a few scattered eosinophils. The 3 patients were all diagnosed with flagellate shiitake mushroom dermatitis. Case 1 received no treatment, while cases 2 and 3 were symptomatically treated with topical fluticasone propionate ointment, and achieved recovery of skin lesions after 1 week.

Discussion on policy of domestic and overseas high-level talents training and introduction / 中华医学科研管理杂志

Objective The drive for innovation is essentially a talent-driven,and comprehensive national strength competition is ultimately a competition for high-level talent.This paper aims to provide a reference for the formulation of high-level personnel training based on the introduction policies in various regions of China by combing the high-level talent training and introduction policies at home and abroad.Methods This study mainly used the literature review,policy analysis,comparative reference to analyze the history and current situation of high-level talent training policies in US,UK,Japan and China.Results High-level talents are the talents with high level of knowledge and strong innovation ability in a particular field,they are also the key training targets of the country.The cultivation and introduction of high-level talents has risen to the national strategy.Conclusions The study believes that there are some problems in the cultivation and introduction of high-level talents in China,such as low legislative level,concentrate on economic incentives while little attention was paid to the cultivation of scientific research environment,as well as the coordination of policy projects.It is recommended to improve the legal and regulatory system and form a high-level talent echelon policy,strengthen the implementation of supporting policies and evaluate the effectiveness of policy implementation.

Internet-based assessment technology for age-related cognitive impairment / 中华全科医师杂志

With the population aging,the number of elderly with Alzheimer's disease or other types of dementia is increasing,which seriously threatens the health and quality of life in elderly.The early screening and detection of dementia among high-risk population and appropriate interventional measures would delay the disease course,and maintain patients' self-care abilities and dignity.Computerized neuropsychological assessment devices are economic and efficient,and suitable for screening in large population.This article reviews the theory,characteristics and application of internet-based neuropsychological assessment for age-related cognitive impairment,as well as the prospect in the future studies.

Influential factors for hospitalization costs regarding the final phase of malignant tumor patients in Shanghai / 中南大学学报(医学版)

Objective:To explore the influential factors for hospitalization costs regarding the final phase of malignant tumor patients in Shanghai,and to explore the relevant policy for reasonable control of hospitalization costs.Methods:A total of 10 065 patients with malignant tumors were enrolled in this study.The multiple linear regression analysis was used to seek the determinants for hospitalization cost of malignant tumor patients during the final phase.Results:The median length of hospital stay was 43 days for the patients,with an average age of (70.73±12.87) years.Among them 61.66％ of hospitalized patients were male and the median hospitalization cost of malignancy was 55 447.84 yuan.Hospitalization cost showed the linear regression relationship with type of health care,hospital level,hospital types,tumor types,length of hospital stay,surgery,age,gender,and time from hospital admission to death.Conclusion:Proximity to death in malignant tumor patients is an important factor for the hospitalization cost.Medical resources should be allocated rationally,and the comprehensive measures should be taken to control the cost reasonably.

Co-words analysis of technological hot pots in Shanghai health system / 中华医学科研管理杂志

Objective To investigate the patent technological domain distribution of shanghai health system,and comparative analysis of patent technological hotspots between shanghai health system and enterprises.Methods The study used IPC classification method to conduct quantitative analysis of the distribution of patent technology,co-words analysis and visualization of social network establishment method were adopted to analyze patent technological hot spots.Results Within the A61 category,numbers of authorized patents of shanghai health system in orders are A61B、A61K、A61M and A61F.Further analysis of the highest authorized A61B17 group patent in the highest class A61B found that,compare to enterprises,the degree of coincidence with the high-frequency keywords of the technology hotspots is small,the technical hotspots are scattered,and lack of overall technical arrangement.Conclusions Shanghai health system mainly focused on medical device development.It is lower than that of enterprises regarding to the patent technology market demand matching,technical arrangement of the enterprise is relatively better than the health system,thus,the study suggested enhancing market demand survey,adjusting patent distribution,and broadening the scope of market promotion.

Efficacy of 308-nm excimer laser versus high-intensity ultraviolet radiation for the treatment of active localized vitiligo / 中华皮肤科杂志

Objective To investigate the efficacy and safety of 308-nm excimer laser compared to high-intensity ultraviolet radiation for the treatment of active localized vitiligo,and to observe changes in skin lesions before and after the treatment by confocal laser scanning microscopy.Methods Sixty patients with 203 skin lesions of active localized vitiligo and were enrolled into this study,and the vitiligo disease activity (VIDA) score of these patients ranged from 2 to 3.We selected more than 3 skin lesions from a same anatomical site of each patient,one of lesions served as a control and the other skin lesions (≥ 2) were randomly treated with 308-nm excimer laser (laser group) or high-intensity ultraviolet radiation (ultraviolet group).The treatment was conducted twice a week for 25 sessions,and a 3-month follow-up was performed.Results A total of 48 patients with 169 skin lesions completed the trial.The marked response rate was significantly higher in the laser group [66.15％ (43/65)] than in the ultraviolet group [44.64％ (25/56),x2 =8.28,P ＜ 0.01].The patients with a VIDA score of 2 showed a significantly higher marked response rate [67.69％(44/65)] compared with those with a VIDA score of 3 [44.64％(25/56),x2 =6.80,P ＜ 0.01].During the 3-month follow-up,no relapse was observed.Confocal laser scanning microscopy showed that the number of inflammatory cells increased at the dermal-epidermal junction of the intra-and extra-marginal lesional skin.After treatment,the number of inflammatory cells markedly decreased and returned to normal level in lesions.Conclusion Both 308-nm excimer laser and high-intensity ultraviolet radiation are effective in the treatment of active localized vitiligo,but the 308-nm excimer laser shows a more rapid onset of action and a better therapeutic effect.

Clinical and reflectance confocal microscopy features of 11 cases of extragenital lichen sclerosus et atrophicus / 中华皮肤科杂志

Objective To investigate clinical and reflectance confocal microscopy(RCM)features of extragenital lichen sclerosus et atrophicus.Methods Clinical data and RCM images were collected from 11 patients with extragenital lichen sclerosus et atrophicus in Department of Dermatology of Shenyang No.7 People's Hospital and the First Hospital of China Medical University between October 2010 and October 2016,and retrospectively analyzed.Results Of the 11 patients,9 were female,and 6 had lesions on the neck.RCM imaging showed atrophy of the epidermis,disappearance of high reflectivity and circular structures in the basal layer,blurred dermo-epidermal junction,highly reflective quasi-circular big cells and a few mononuclear cells scattering in the superficial dermis,and homogenization and increased density of collagen.Conclusion Extragenital lichen sclerosus et atrophicus has characteristic RCM presentation.

Experience of Antibiotics Management in Norway and Its Enlightenment for China / 中国药房

OBJECTIVE:To provide reference for antibiotics management in China. METHODS:The current situation of antibiotics use in Norway was reviewed and the experiences of antibiotics management in Norway and relevant industrial organization were analyzed;thinking and suggestions for improving antibiotics management in China were put forward. RESULTS& CONCLUSIONS:To deal with potential drug resistance and strengthen antibiotics management,the government of Norway formulated national action plan for antibiotics resistance, established comprehensive management and monitoring system for antibiotis (including veterinary antibiots),research and cooperative platform,formulated guidance scientifically,and standardized prescribing behavior to obtain good management and control effect. China needs to learn from Norway and other countries to continuously strengthen the top-level design of antibiotics management, speed up the comprehensive coverage of antibiotics monitoring,improve the construction of monitoring and evaluation indicator system,evaluate the structure of antibiotics use again, promote the consciousness of all social parties to rational drug use,and use antibiotics rationally and cautiously on the basis of scientific evidence,so as to deal with the threat of drug resistance.

Influential factors of inpatient care among residents in Shanghai / 中南大学学报(医学版)

Objective:To analyze the influential factors for inpatient care among residents in Shanghai and to provide evidence for health policy.Methods:Data were obtained from the Fifth National Health Services Survey,the independent variables were selected based on the framework of Andersen Model,and the two models were used to analyze the determinants-relevant hospitalization probability and the cost among residents in Shanghai.Results:The hospitalization rate among permanent residents over 18 years old was 6.1％ in 2013 in Shanghai.For the hospitalized population,its average expenses (median) were 10 000.00 yuan.Gender,age,education,marriage,smoking,drinking,exercise,the travel time,family annual income,Engel coefficient and the number of chronic diseases were the determinants of hospitalization probability.Gender,age,smoking,drinking,exercise,Engel coefficient,medicaid and level of medical institution were the influential factors for the hospitalization costs.Conclusion:The utilization of inpatient care among residents in Shanghai is determined by many factors.Thus,the corresponding health policies should be formulated for different populations.

The dynamic adjustment mechanism of medical service price in the United States and its implications for China / 中国卫生政策研究

The establishment of a scientific and reasonable medical service price dynamic adjustment mechanism is the focus of the current reform of public hospitals in China.This paper analyzed the medical service price reform history in the United States, the price dynamic adjustment of the main body and its process, as well as the development trend of medical service price reform.At the same time, the existing problems of medical service price adjustment in China were briefly analyzed, and put forward 1) the establishment of multi-participant dynamic adjustment model;2) the establishment of the medical service standard value system, strengthening Medicare payment standard construction;3) and gradually changing the current fee-for-service payment system and establishing DRGs and performance based payment mechanism and other policy recommendations.

Detection of anti-tyrosinase IgG antibody and anti-tyrosinase-related protein-1 IgG antibody in sera of patients with vitiligo / 中华皮肤科杂志

Objective To investigate relationships between serum levels of anti?tyrosinase IgG antibody(TYR IgG)as well as anti?tyrosinase?related protein?1 IgG antibody(TRP?1 IgG)and vitiligo. Methods Enzyme linked immunosorbent assay(ELISA)was performed to detect serum levels of TYR IgG and TRP?1 IgG in 260 patients with vitiligo and 50 health controls. The threshold for defining a positive test result was set at 3 standard deviations above the mean serum level of TYR IgG or TRP?1 IgG in the healthy controls. Results The positive rate of TYR IgG and/or TRP?1 IgG in the vitiligo group was 57.31%(149/260). The positive rates of TYR IgG and TRP?1 IgG were both significantly higher in the vitiligo group than in the control group(TYR IgG:37.3%[97/260]vs. 0,χ2=25.441, P0.05). Among patients with vitiligo, the positive rate of TRP?1 IgG was significantly higher in females than in males(χ2=5.811, P20 years(χ2=6.498, P 20 years (both P >0.05). Conclusion Detection of TYR IgG and TRP?1 IgG may provide some evidence for the diagnosis and treatment of vitiligo.

Comparative study on satisfaction of young medical workers in Shanghai / 中华医院管理杂志

Objective To find out the satisfaction changes among young medical workers and explore the influence of the healthcare reform on such people.Methods A survey was conducted by means of random sampling among 716 medical workers under 45 years old from 6 hospitals,and combined with the survey data in 2009,young medical workers′satisfaction changes and the influencing factors were analyzed.Results Young medical workers′satisfaction is generally low,with declining satisfaction of social respect as well;satisfaction of medical workers in community medical institutions and secondary medical institutions was found declining dramatically.Conclusions Healthcare reform should pay more attention to these young people in terms of their own satisfaction,especially for those working at primary healthcare institutions.

Development and Current Situation Analysis of Patents from First Class Hospitals in Shanghai / 中华医学科研管理杂志

Objective This paper analyzed the development and current situation of patents from first class hospitals in Shanghai,reflecting the development of scientific researches,providing medical science research management with data support as the basis of decision making.Methods Based on patent search and analysis of State Intellectual Property Office of The P.R.C and Incopat,a technology innovation intelligence platform with global patent information,patents from first class hospitals in Shanghai published before the year of 2015 are analyzed from aspects including patent category,legal status,time trend,applicants of invention patent,proprietor and inventors of authorized invention patents,transfer of invention patents,etc.Results First class hospitals in Shanghai had 1979 invention patents,which accounted to 56.38％ of the total.71.21％ of invalid invention patents fell into abeyance because of withdraw,rejection,and abandon,which was 2.47 times of those due to termination.Eight hospitals including Shanghai Ninth People's Hospital and Huashan Hospital were at the top of both the invention patent application list and the authorized invention patent list,both accounting to more than sixty percent.Conclusions The number of invention patents has gone through germination stage,developing rapidly in recent years,the ratio of authorized inventions appears to decline slightly after rise.The reasons of patent invalidation are worthy of attention,the information about legal status of patents can be reasonably used,applicants and inventors shows uneven distribution,patent quality should be emphasized with quantity rise,cross regional and cross border cooperation can bring about complementary advantages.

Exploration and enlightenment of the compensation mechanism reform featuring drug sale with zero makeup / 中华医院管理杂志

The paper summarized the explorations of public hospital pilots in the compensation mechanism and identified the following findings.For example,by means of fiscal support of public hospital infrastructure and development spending,cancellation of drug markup,higher service prices, and reformed payment mode of medical insurance,these hospitals have made initial changes at their business operating mechanism, motivation-guidance of compensation, and their makeup of medical revenue.In addition,such hospitals are found with lower cost of medical care per visit,and higher income of medical workers.The authors also pointed out such problems as inflated drug pricing and expenses,lack of scientific pricing mechanism for medical services,vague definition of policy-related losses,and old-fashioned practice of government investment and health insurance payment.Based on such findings,the paper advised to adjust health care prices by stages and to improve the management of health insurance and the coherence of compensation mechanism.

Suggestions to improve the compensation mechanism of public hospitals / 中华医院管理杂志

According to the target-model of the health care system and characteristics of the health financing system,it is proposed in the paper that the charges of medical services should be the main revenue of public hospital compensation.Efforts should be made to adjust health care service prices and strengthen pharmaceutical management simultaneously so as to rebuild the structure of medical service charge.Medical insurance should make the majority in the compensation to cover most the medical expenses,with government subsidies supporting development.Both government financial investment and medical insurance should join their efforts for planning-guidance and performance-guidance.The authors also suggested to improve a graded and normative diagnoses and treatment system,regulate medical behaviors of public hospitals and their cost standards,justifying the total compensation and standard verification of such hospitals.

Analysis of the reliability and validity about scientific research competence indicators system of hospitals in Shanghai / 中华医学科研管理杂志

Objective To analyze the reliability and validity of an established Research Hospital Competitiveness Evaluation System.Methods To evaluate the research competitiveness of 34 tertiary hospitals and their departments in Shanghai using above system.The reliability and validity of the indicator system were analyzed with the Cronbach's alpha coefficient, and confirmatory factor analysis based on the structural equation model.Results After adjusting for structure of the index system via item parceling, the CFI, MFI, RMSEA AND IFI were 1.000, 1.009, 0.000 and 1.028, the Cronbach's alpha of whole set indicators system was 0.768.Conclusions The results suggested that the measured reliability and validity are both in good degree, survey results can reflect the actual competence of evaluated hospitals.

Establishment of research competitiveness evaluation index system for the hospitals in Shanghai / 中华医学科研管理杂志

Objective Establishing the scientific research competitiveness evaluation index system of Shanghai hospitals.Methods Delphi method and Analytic Hierarchy Process were applied.Results Thirty-four experts were invited to provide evaluation index and weighted scores.The positive coefficient from two rounds of expert's consultation were 88.24％ and 94％.The expert's opinion of authority coefficient of each indicator's was greater than 0.7.The degrees of coordinative consistency was high.Kendall concordance coefficient was increasing with the increasing of consulting times.After two rounds of Delphi expert consultation,2 level-one indictors,10 level-two indictors and 47 level-three indictors were confirmed.Conclusions After two rounds of Delphi expert consultation,using all objective indicators,an Index System for research competitiveness evaluation in the hospitals in Shanghai has been created and could be used with scientific,objectivity and feasibility.

Concept, connotation and priorities of premium healthcare:A case study of Shanghai / 中国卫生政策研究

Premium healthcare is one of the major components of private healthcare, a key part of the health service industry, and one of the significant areas of the Thirteenth Five-Year Plan of health. However, there is no clear definition of premium healthcare that is widely accepted based on a Chinese literature review, and to define the concept of premium healthcare is the basis and premise for research. This paper adopted the methods of systematic re-view, field investigation and key person interviews to clarify the definition of premium healthcare and the results sug-gested that areas of health management, medical care for the elderly, mobile medical care, and so on should be the priorities of premium healthcare development.

Development of premium healthcare industry:International experience and implications / 中国卫生政策研究

Premium healthcare is the key area of healthcare industry and private medical institutions. Howev-er, with the expansion of VIP services in public hospitals and policy barriers to private medical institutions, the de-velopment of premium healthcare in China is still in its early stage. The premium healthcare industry has in fact be-gun to take shape in some developed countries, accumulating rich experience in the aspects of developing bases, op-erating modes and security systems. Therefore, this paper introduces the experiences of premium healthcare develop-ment in several countries:the United Kingdom, the United States, Germany, Singapore, Australia, and India: the building of safety net hospitals;the setting of hierarchical pricing and differential financial assistance;the use of pub-lic-private partnership based on commercial health insurance to determine prioritization. Based on the actual situation in China, this paper provides some implications to develop premium healthcare, including the implementation of dif-ferential payment policies built on the provision of basic healthcare services, the promotion of commercial health in-surance and public-private partnerships, and the determination of preferential areas.