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Objective:To analyze the evolution path and diffusion mechanism of the unified drug management system of countywide medical communities in China, and provide references for the deepening implementation of the system.Methods:The policy documents of the central and provincial governments were retrieved with the keywords of " medical community" " drug management" " county-township-village integration" and " central pharmacy". By means of the policy diffusion theory, the evolution path of the diffusion of the unified drug management system for the countywide medical communities was identified from such dimensions as time, space and hierarchy. On the other hand, the action mechanism of the diffusion of the system was summarized from such aspects as competition, administrative instruction, learning and imitation.Results:A total of 36 effective policy documents were collected. The time diffusion of the drug unified management system of countywide medical communities was characterized by an " S" curve. By the end of 2022, there were 30 provinces implementing the countywide medical community drug unified management system, and the policy diffusion has entered a saturation and stagnation stage; spatial diffusion showed " proximity effect" ; hierarchy diffusion embodied the " leader follower" mode. In the process of policy diffusion, competition mechanism, administrative instruction mechanism, learning mechanism, and imitation mechanism coexisted, but there were difference in the dominant mechanism at different stages of policy diffusion.Conclusions:The unified drug management system of the countywide medical communities has been widely disseminated. It is recommended to promote the introduction of supporting policies, optimize the system evaluation system, and comprehensively use various diffusion mechanisms to promote the optimization of the system, so as to promote the deepening and sustainable operation of the system.
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Objective:The study was planned to evaluate the clinical utility of microcytic anemia factor (MAF) and low hemoglobin density (LHD%) in the screening of iron deficiency in blood donors.Methods:A total of 400 blood donors, 200 male and 200 female, were randomly admitted to Fujian Blood Center from January1, 2022 to February 28, 2022 by the way of stratified sampling. According to the fourth edition of Diagnostic and therapeutic criteria for hematological diseases, the patients were divided into three groups: normal group (N=299), iron depletion group (ID, n=54) and iron deficient erythropoiesis group (IDE, n=47), Blood routine indexes including hemoglobin (HGB), mean corpuscular volume hemoglobin (MCV), mean corpuscular hemoglobin content (MCH), mean corpuscular hemoglobin concentration (MCHC) and iron metabolism indexes including serum ferritin (SF), serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TS) and unsaturated iron binding capacity (UIBC) were measured, MAF and LHD% were calculated by formula.One-way ANOVA or Kruskal-Wallis H tests were used to analyze the differences among three groups. Spearman correlation analysis was used to analyze the correlation between MAF and LHD% and iron metabolism indexes.The Receiver Operating Characteristic (ROC) curve was used to evaluated the diagnostic value of MCH, MCHC, MAF and LHD% for iron deficiency in blood donors. Results:MAF in ID group which was 11.81±0.81 were higher than the IDE group which was 10.69±0.95 and lower than the healthy group which was 13.17±1.24, the total difference among the three groups was statistically significant ( F=110.784, P<0.001), the difference between two groups was statistically significant ( P<0.01); LHD% in ID group which was 2.61 (1.87, 3.91)% were lower than the IDE group which was5.60(2.99, 8.02)% and higher than the healthy group which was1.74 (1.22, 2.73)%, the total difference among the three groups was statistically significant ( H=62.166, P<0.001), the difference between two groups was statistically significant ( P<0.01).In 101 iron deficiency blood donors, Spearman correlation analysis showed that MAF was positively correlated with SF, SI and TS ( r=0.426, P<0.01; r=0.547, P<0.01; r=0.566, P<0.01);contrarily, LHD% was negatively correlated with SF, SI and TS ( r=-0.397, P<0.01; r=-0.400, P<0.01; r=-0.479, P<0.01).The areas under the ROC curve of MCH, MCHC, MAF and LHD% diagnostic ID were 0.745, 0.646, 0.819 and 0.646, respectively;the cut-off value of MAF was 12.56, with a sensitivity of 67.90% and a specificity of 83.30%.While the areas under the ROC curve of MCH, MCHC, MAF and LHD% diagnostic IDE were 0.901, 0.834, 0.941 and 0.834, respectively; the cut-off value of MAF was 11.73, with a sensitivity of 87.60% and a specificity of 87.20%. Conclusions:MAF performed a high diagnostic value of iron deficiency, especially IDE, and can be used as a marker in the diagnosis of iron deficiency in blood donors.
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【Objective】 To investigate the variation of hematological parameters in male plateletpheresis donors. 【Methods】 A total of 194 male plateletpheresis donors from Fujian Blood Center were divided into two groups according to the frequency of blood donation: Group 1 (n=107), with the number of plateletpheresis donation less than or equal to 12 per year; Group 2 (n=87), with the number of plateletpheresis donation more than 12 per year. Serum ferritin (SF) and related iron metabolism indexes, red blood cell count (RBC), hemoglobin (Hb), hematocrit(Hct), platelet count (Plt) and other blood routine indexes, as well as percentage of reticulocyte counts (RET%), immature reticulocyte fraction(IRF) and other reticulocyte indexes were measured before blood donation and analyzed by statistical methods. 【Results】 Compared with Group 2, the RBC, Hb, Hct, SF in Group 1 were significantly higher, while Plt, RET%and IRF were significantly lower(P<0.05), and the probability of ferritin decrease in Group 1 was lower, with significant difference(P<0.05). 【Conclusion】 As the number of donation increased, male plateletpheresis donors were prone to iron deficiency, and the bone marrow hematopoiesis were obviously enhanced. We should be more concerned about male plateletpheresis donors who donated more than 12 times per year, further more, SF monitoring should be conducted and the blood donation interval should be appropriately extended.
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The in-depth advancement of the new era reforms such as new urbanization and rural revitalization strategies has transformed the characteristics and resource structure of rural villages. The traditional village health resources allocation models based on administrative divisions needed to evolve and achieve fair allocation and higher efficiency, and better meet the needs of rural primary health services. The authors sorted out the current status of village health resources allocation models. Based on such concepts as regional integration, and such key elements as demographics, population, health needs and information technology, the authors proposed the village-level health resources allocation model and selection strategy, under the three regional integration theories of township-village integration, village-area integration, and village leadership assistance. Their efforts aim at providing new perspectives for better protection and promotion of health of rural residents.
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Objective:To explore the application value of ultrasonic layer-specific strain technology in evaluating left ventricular systolic function in young male strength athletes.Methods:In October 2018, 30 professional young male wrestlers from Henan Provincial Heavy Sports Management Center (athlete group) and 30 healthy young males matched with age (control group) were randomly selected.Using traditional echocardiography combined with stratified strain technique, heart rate (HR), left ventricular end-diastolic diameter(LVDd), interventricular septal thickness on diastole(IVSTd), postwall thickness on diastole (PWTd), relative wall thickness (RWT), end diastolic volume index(EDVI), end systolic volume index (ESVI), ejection fraction (LVEF), stroke volume index (SVI), cardiac index (CI), spherical index (SPI), endocardial myocardial global longitudinal strain(GLSendo), mid-myocardial global longitudinal strain(GLSmid), epicardial myocardial global longitudinal strain(GLSepi), peak strain dispersion(PSD) and whole myocardial longitudinal strain cross-wall difference (ΔLS) were measured respectively. The differences between the two sets of data were analyzed.ROC curves were plotted to analyze and compare the stratified strain parameters performance to predict left ventricular systolic function or synchrony in athletes.Results:The values of LVDd, PWTd, IVSTd, RWT, SPI, EDVI, ESVI and SVI in athelete group were higher than those of the control group. And the values of HR, GLSendo, GLSmid, GLSepi and ΔLS were lower than those of the control group.The differences were statistically significant (all P<0.05). There was no significant difference in LVEF, CI and PSD between the two groups (all P>0.05). The areas under the ROC curve of GLSendo, GLSmid and GLSepi for athletes′ left ventricular systolic function were 0.753, 0.747 and 0.726, respectively, and the optimal cut-off values were -22.34%, -19.95%, -17.35%, respectively. Conclusions:Long-term high-intensity exercise can lead to subclinical changes in left ventricular systolic function, and ultrasonic layer-specific strain technology can more accurately and specifically evaluate left ventricular systolic dysfunction. Among the GLS parameters, GLSendo is the optimal parameter for testing the left ventricular systolic function of athletes.
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The current rural family doctor contracted services are plagued by such problems as discontinuity and inefficient supply, making the improvement of the family doctor′s non-technical service capabilities a key to promoting the development of rural family contract services. With the help of situationist theory, the authors classified the non-technical service capabilities of rural family doctors as service empathy, information management, relationship management, service management, and external contact. They on which built a framework of non-technical service capabilities of rural family doctors along with analysis, to empower their non-technical service capabilities.
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In recent years, the contradiction between the construction of backward first aid system and the demand for emergency services in rural areas in China is increasingly serious. In order to further improve the quality and efficiency of first aid, the state has vigorously promoted the construction of the " Five Centers" , namely chest pain centers, stroke centers, trauma centers, critical maternal treatment centers, and critically ill children and neonatal treatment centers in rural areas, in an effort to develop an efficient rural emergency service network. The authors collected relevant policy documents and summarized practices of the " Five Centers" construction. On such basis, they referred to experiences of overseas emergency systems and medical rescue centers, and made focused analysis for on the functionality and mechanism of the " Five Centers" in building an innovative first-aid system, in terms of internal and external environment, institutional function positioning, resource integration, and operation mechanism. In view of the integration among " Five Centers" , pre-hospital emergency and in-hospital first aid in rural areas, information construction, personnel first aid capacity building and interest allocation, policy recommendations are proposed.
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Pilot areas have achieved initial success in capitation reform. On the other hand, challenges remain unsolved in terms of practical pathways, change of national medical insurance management system, related measures, incentives and allocative mechanism for implement of the reform. With the concerning on progress, practice, effects and challenges of typical areas, this article established an institutional framework. On such basis, we propose to design and refine a scheme in terms of 5 aspects, namely strengthening the basic medical care packages′financing, setting contents and standard of the basic medical care packages rationally, establishing effective evaluation system and formulating supporting measures.
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Objective To analyze the main practices of capitation payment system reform in the case areas and put forward enlightenments and suggestions in this regard. Methods The implementation practices of the case areas were summarized, and descriptive statistical analysis was carried out on the implementation effects. Results By analyzing the effectiveness of the case areas′reform, it was found that the case areas are curbing the excessive growth of medical expenses (for example, outpatient fees per visit of Dingyuan county-level hospitals decreased from 245.11 yuan in 2015 to 218.40 yuan in 2017), increasing the actual compensation ratio of residents ( for example, the actual compensation ratio of Funan increased from 59.80% in 2015 to 63.28% in 2017), forming a medical treatment pattern within the county (for example, out-of-county compensation ratio in Dingyuan decreased from 37.38% in 2015 to 31.13% in 2017), achieving double-way referrals (for example, the number of referrals to superior hospitals of Jimo increased from 98 in 2015 to 328 in 2017), improving the subsidence of quality services, and controlling the risks of medical insurance funds. Conclusions At present, the reform of the case areas has been implemented steadily and achieved results. It is recommended to further improve such aspects as reform coordination, insurance standard setting, incentive mechanism establishment, and leadership to ensure the reform progress.
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Taking Dafeng county of Jiangsu province as a pilot, this paper analyzed the mechanism of the family physicians′contracted service for achieving the hierarchical medical system. Such a system is designed to promote the contracted service of family physicians, comprising health management, convenient medical treatment, opinion leader, IT-based power, and capability enhancement. Authors of the paper rounded up data of the sample township from 2015 to 2017, and the practical effect of the family physicians′contracted service in promoting the hierarchical medical system. Their recommendations include:currently focusing on targeted groups and population of chronic diseases; elevating the contracting rate of pregnant women and children; motivating countywide medical communities in the promotion of the family physicians′contracted service, for joint efforts in developing the hierarchical medical system; leveraging the showcase of Dafeng for achieving the hierarchical medical system fitting local needs.
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Objective To analyze the current situation and influencing factors for the inflow and outflow of village doctors. Methods The stratified random sampling method was used to collect data on the flow of village doctors from 2010 to 2015. Thirty-six townships were sampled, which were located in 12 counties from 6 provinces in the eastern, central and western China respectively. Results The average age of sampled village doctors was 31. 25 ± 8. 75 years, and most of them graduated from technical secondary school(57. 21% ). The outflows were greater than the inflows, and the net inflow in the eastern region was highly negative. Among the outflows, those under 60 years old accounted for 44. 78%, and most of them went to medical institutions of higher level. 22. 26% of the outflows were under 40 years old, while 85. 42% of them had college degree or above, and 71. 72% were practicing(assistant) physicians. Conclusions The main force of village doctors is draining, with replenishment difficult to attract. Income and career prospects are the main causes for the loss. A model of rural doctors is thus recommended, combining such major elements as capabilities, motivations and opportunities for reinforcement of the teambuilding.
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This paper analyzed and concluded successful experience and mechanisms of regional global per capita budget implemented since 2015 in Anhui province,including the formation of mutual incentive and restraint mechanism, the mechanism of controlling expenses spontaneously and resource allocation efficiently.After the reform, flow of hospitalized patients was more rational, and the financial burden of patients was alleviated, while the capacity of medical institutions was improved notably in pilot counties.The successful experience of Anhui province can put forward corresponding suggestions to guide the future work in other areas.
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The countywide healthcare reform in Anhui province since 2015 was analyzed in the paper.The reform is based on the integration of healthcare management system and health service system of the new rural cooperative medical system (NCMS).The core of reform is regional global per capita budget of NCMS.The reform promotes the county′s healthcare institutions to shift from profit oriented to costs control, improves their quality of care, emphasizes disease prevention and control, and maintains residents health.Next, we should pay attention to the rationality of funds balance and benefits distribution, and the training of county healthcare personnel.
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Objective To study the quality of outpatient prescriptions for patients of different age groups at both township and village level,for the purpose of evaluating the outcomes and problems of the ongoing healthcare reform at primary levels.Methods 100 outpatient prescriptions of April 2015 were mechanically sampled randomly from two township hospitals and 8 village clinics in counties A and B in Hubei province.These prescriptions were analyzed for the drug count per prescription,percentage of intravenous prescriptions,that of antibiotics,that of hormones and average cost per prescription.Results At the township hospitals,the drug count per prescription(2.02)of county A was less than that of county B(3.26),while the percentage of intravenous prescriptions(30.30%),that of antibiotics(47.98%)and hormones(6.57%)of county A were significantly less than those of county B(50.65%,69.08% and 15.13% respectively).At village clinic level,the percentage of intravenous prescriptions(31.05%)of county A was higher than that of county B(20.34%),the average prescription costs(￥29.28)of county A was less than county B(￥31.45);while in terms of children′s prescriptions,average drug count of county A(2.50)was higher than county B(2.09),and its proportion of antibiotics(65.91%)was higher than county B(45.56%).Conclusions General primary care reform is faced with challenges of poor control of intravenous injection and use of antibiotics,particularly at village clinics and pediatric drug use in terms of prescription quality control.Both township and village levels should strengthen the supervision over the drug suppliers,guide the demand side to rationally use drugs and focus on the reasonableness of the medication of village clinics and children.
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Tripartite-sector reform (a synergistic reform in public health services,medical insurance and medicine production-circulation) in Sanming city was described in the paper which centers on medical insurance.Tapping full potentials of the medical insurance,the city achieved efficient synergy among healthcare,medical insurance and medication systems.This reform has trimmed out inflated drug pricing to some extent for rooms of maneuver of medical service pricing changes,thus curbing excessive growth of medical costs successfully.The authors proposed areas of further improvements including the relationship between achieving such objective as curbing medical expenditure,and advancement of technical/medical service capacity;that between integrative control of medical insurance expenditure and protection of people's health;the equilibrium of interests between medical insurance,healthcare and medication.All these will contribute to the goal of healthy patients flow and a hierarchical medical system.
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Objective To evaluate the outcomes of the payment reform at public hospitals in Sanming city.Methods Interrupted time series analysis was used to compare changes of the average days of stay,per capita hospitalization expense,outpatient expense per visit,proportion of medical expense and that of drugs during hospitalization at 21 public hospitals at or above county level before and after the DRGs reform.Results Comparisons before and after the reform found the average days of stay at the original momentum,poor control in curbing the proportion of medical expense and that of drugs during hospitalization,adropping followed by rising trend in the outpatient expense per visit,and minimal drop of the abovementioned proportions.Conclusions The rapid growth of outpatient and hospitalization costs at tertiary hospitals may be incurred by unreasonable cost transfer,structural trend of hospitalization expense makeup,and rationality pending scrutiny.
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Covered in the paper are the significance of rural doctors′professional development and their professional characteristics,as well as systematic insights on such key factors of professionalism of these doctors,as their professional qualifications,functional positioning,practicing approach,professional guarantee,professional development,social identity,professional stability,and professionalism.Based on such thoughts,the authors recommend on reforms of professional development for rural doctors by stages and levels.
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Objective:To study the preparation technology of ambroxol hydrochloride double-layer tablets and evaluate the drug re-lease in vitro. Methods:The best technology was screened by orthogonal design, and the drug release in vitro was evaluated by UV spectrophotometry. Results:The drug release in vitro was in accordance with the corresponding standard. Conclusion:The preparation technology is simple and the quality is stable for industrial production.
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@#Objective To explore the effect of functional electrical stimulation (FES) on hemiplegic gait of acute stroke patients. Methods 41 stroke patients were randomly divided into treatment group (n=21) and control group (n=20). All the patients received conventional rehabilitation and body weight supported treadmill training, and the treatment group received FES in addition. The patients were evaluated with the Composite Spasticity Scale (CSS), the Berg Balance Scale (BBS) and the Functional Ambulation Category (FAC) before and 8 weeks after intervention. Results There was no significant difference in all the assessment between two groups before intervention (P>0.05). The scores of CSS, FAC and BBS improved in both groups 8 weeks after intervention (P<0.001), and improved more in the treatment group than in the control group (P<0.05). Conclusion FES could further improve ambulation of stroke patients.
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Objective:To evaluate the clinical effects of warm needling for scapulohumeral periarthritis (SP). Methods:Eighty-six patients with SP due to wind, cold and dampness in conformity with the research criteria were randomly divided into an observation group and a control group. The control group was given the routine acupuncture treatment and the observation group was treated by warm needling. The treatment was given once every day and ten sessions made one course. After two courses, the therapeutic effects and the changes in the scores of visual analogue scale (VAS) were observed. Results:After treatment, VAS scores were statistically different from those before treatment in the two groups (P0.05). Conclusion:The warm needling has the dual effect of acupuncture and moxibustion in the treatment of SP due to wind, cold and dampness, and its clinical effect is better than routine acupuncture treatment.