Following an analysis of the problems and challenges of public hospitals in Shanghai,the paper presented the approach of Shanghai Shenkang Hospital Development Center in its problem-based reform of such hospitals.The measures include promotion of capital construction,enhanced discipline human resources,and accelerated informationization,as well as overall budget management and hospital director performance appraisal,which enhanced their service capacity and operational efficiency.

In order to improve the teaching competence of clinical teachers in standardized nursing training and ensure the teaching quality of the training, since 2014, Chongqing Municipal Health and Family Planning Commission has held a unified training course for teachers in a standardized training base for new nurses in the city annually, and formulated a teacher training system; on the basis of fully considering the study needs of clinical teachers, the course of "taking teaching competence as the direction and improving clinical teaching ability as the core" has been set up, and the training teachers are evaluated by various ways. At the end of the training, the satisfaction survey on the training effect has been carried out, and the participants are satisfied with the contents and methods of the teaching. Higher satisfaction can improve the teaching competence of teachers.

Objective The study was to provide evidence for the development of local community health services through the analysis of patiems' expectations for community health services. Methods The expectations were indirectly evaluated by investigating the patients in the willingness-to-pay. Results The patients had a generally high expectation for health community services and they would be highly disappointed once their expectations fall short. Conclusions Those expectations that could be realized with short-term efforts ought to attract high attention of community health service providers and made important goals to achieve in the near future.

[ ABSTRACT] AIM:To investigate the protective effect of 1, 3-dicyclopentyl-1, 2, 3, 6-tetrahydropyrimidine-4, 5-dicarboxylic acid diethyl ester (ZL-5015) on lethal endotoxin-challenged mice and to explore the underlying mechanism. METHODS:Mouse model of lethal endotoxin challenge and endotoxemia were established by intraperitoneal administration of lipopolysaccharide (LPS) at a dose of 70 mg/kg to the C57BL/6J mice.Mouse peritoneal macrophages stimulated with LPS (10 mg/L) were used as an in vitro inflammatory model.The levels of interleukin-1β( IL-1β) , interleukin-10 ( IL-10) and tumor necrosis factor-α(TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA).Real-time PCR was used to evaluate the mRNA expression of the cytokines.RESULTS:Prophylactic treatment of the mice with ZL-5015 (100 and 200 mg/kg, ig) slightly increased the survival rate, extended the survival time, decreased the serum levels of IL-1βand TNF-α, and increased the serum level of IL-10 in the early stage of endotoxemia as compared with model group.The results of in vitro study demonstrated that treatment of the endotoxin-stimulated mouse peritoneal macrophages with ZL-5015 (10, 20 and 40μmol/L) inhibited the expression of IL-1βand TNF-αat both mRNA and protein levels but promoted the expression of IL-10 at both mRNA and protein levels.CONCLUSION: The tetrahydropyrimidine derivative ZL-5015 shows a moderate anti-endotoxin effect by increasing the survival rate and extending the survival time of the mice challenged by endotoxin, which may result from inhibition of the expression of pro-inflammatory cytokines such as IL-1βand TNF-α, and promotion of the expression of anti-inflammatory cytokine IL-10.

Objective To evaluate the clinical outcomes of cemented bipolar femoral head arthroplasty in treatment of intertrochanteric fractures in elderly patients combined with heart,lung,brain and other diseases.Methods The study comprised 23 cases,aged 75-86 years old,treated with cemented bipolar artificial femoral head arthroplasty between January 2005 and October 2013 (replacement group).Evans' classification of the fracture was type Ⅰ in 3 cases,type Ⅱ in 9,type Ⅲ a in 5,type Ⅲ b in 2,type Ⅳ in 3 and reverse intertrochanteric fracture in 1.Additionally,23 cases with the similar physical condition treated with anatomical locking plates were chosen as controls.For comparisons between groups,operation time,amount of bleeding,drainage volume,mean time to extract drainage tub,antibiotics dosage,perioperative complications,complications of lying in bed,fracture complications and Harris score were measured.Results There were no significant differences between replacement and control groups with respect to operation time (52.7 minutes vs 52.0 minutes),amount of bleeding (160.9 ml vs 156.5 ml),drainage volume (162.2 ml vs 158.3 ml),Harris score (73.7 points vs 74.2 points),time to extract drainage tub (69.9 hours vs 68.9 hours) (P ＞ 0.05).Both groups had 5 days of preventive antibiotic usage.Better results were observed in replacement group than in control group concerning mean time of ambulation (8.1 days vs 109.3 days),rate of perioperative complications (19％ vs 59％),rate of bed rest complications (0 vs 36％) and rate of internal fixation complications (0 vs 18％) (P ＜ 0.05).Conclusion Cemented bipolar femoral head arthroplasty is effective to prevent the complications of internal fixation,bed rest as well as perioperation and improve the quality of life during the treatment of intertrochanteric fracture in elder patients with heart,lung,brain and other diseases.

Objective To observe the clinical efficacy of L-carnitine combined with trimetazidine in the treatment of chronic heart failure.Methods The clinical data of 700 patients with chronic heart failure were retrospectively analyzed.According to different treatment methods,they were divided into four groups:A,B,C,D.181 cases of A group used L-camitine combined with trimetazidine treatment on the basis of routine treatment.177 cases of B group received L-carnitine treatment on the basis of routine treatment.175 cases of C group received trimetazidine treatment on the basis of routine treatment.167 cases of D group received conventional treatment.Then,the clinical efficacy of the four groups was compared.Results The total effective rates of A,B,C,D groups were 83.43％,76.84％,73.71％,62.28％,respectively.The total effective rate of A group was obviously higher than the other groups,the difference was statistically significant(x2 =22.40,P ＜0.05).There was no significant difference in total effective rate between B group and C group (x2 =0.46,P ＞ 0.05),but both B and C groups were obviously better than group D (x2=4.37,5.13,all P ＜ 0.05).The data before and after treatment in four groups were significantly improved,such as 6MWT,NT-proBNP,LVEF and FS(A group:t =33.856,37.474,17.722,31.250,B group:t =27.328,31.559,6.863,25.581,C group:t =23.430,32.640,9.524,16.923,D group:t =15.863,9.602,3.061,10.169,all P ＜ 0.01).In the above four indicators,those in A group were obviously better than B group,C group and D group (F =5.884,38.621,4.357,13.770,all P ＜ 0.01).Conclusion L-carnitine combined with trimetazidine can improve the abnormal metabolism of myocardium,optimize the energy metabolism pathway of myocardium,improve the short-term cardiac function of patients markedly.L-carnitine combined with trimetazidine is worthy of promoting joint use.

This study summarized the experiences of disease-specific performance appraisal at tertiary hospitals in Shanghai,which was launched since year 2013 by Shanghai Hospital Development Center (SHDC). 38 tertiary hospitals in Shanghai were included in the study. A disease-specific performance appraisal system centering on quality and performance, by means of case-mix model, classified surgery management and typical disease screening, and leveraging disease and surgery difficulties analysis, and inter-hospital performance appraisal of typical diseases. This reform has established appraisal criteria of disease difficulty management,coding criteria and data norms,guiding such hospitals to consolidate their functional positioning of focusing on difficult,urgent and complicated cases in the medical service delivery system.All these efforts have paved the way for the reforms to build a hierarchical medical service system, pricing per disease, payment per disease, and consolidate performance appraisal of medical workers.

Objective To reflect the main influencing factors of career development for Chinese nurses. Methods Databases including PubMed, Embase, Cochrane Library, CNKI, VIP, CBM and Wanfang Data were searched to collect literature on the main influencing factors of career development for Chinese nurses. The literatures were screened according to the inclusion and exclusion criteria. After extracting data and appraising the quality of the included studies,Meta-analysis was conducted by Revman 5.0 and Stata 12.0 software. Results Of the 494 identified studies, 8 studies were included. The summary effect size and 95％CI were found for psychological capital 0.44(0.16-0.73), self-efficacy0.35 (0.22- 0.48), positional titles 0.20(0.14- 0.27), hospital scale- 0.19(- 0.26-- 0.13), years of work experience 0.17(0.09-0.25), stress-0.17(-0.24--0.09) respectively. Conclusions Psychological capital, self-efficacy, positional titles, hospital scale, years of work experience and stress are the main influencing factors related to nurses′ career development. Nursing managers should pay attention to and actively develop nurses' psychological capital, use of different professional titles and seniority nurses reasonably, and reduce the work pressure to promote the nurse career development.

OBJECTIVETo optimize the experimental model of nitric oxide (NO) production in mouse peritoneal macrophages in response to lipopolysaccharides (LPS) stimulation.

METHODSMouse resident peritoneal macrophages were collected by lavaging the peritoneal cavity of mice with Hank's solution and stimulated with Pseudomonas aeruginosa LPS for NO production. NO concentration in the culture supernatants was measured with Griess Reagent. The influences of cell density, LPS concentration, LPS stimulation duration and culture medium volume on NO production were investigated. Finally, the feasibility of the model was confirmed with specific anti-inflammatory drugs.

RESULTSThe density of macrophages produced the most significant effect on NO production (P<0.001), and optimal results were obtained at the macrophage density of 6×10(6) cells/ml with a volume of 100 µl in each well in 96-well plate. At a LPS concentration below 1 µg/ml, NO production increased proportionally with the increment of LPS concentration (P<0.001), but the increment of NO production declined obviously at LPS concentrations beyond 1 µg/ml, and the peak NO production occurred at a LPS concentration of 10 µg/ml. NO production also increased significantly with the prolongation of LPS stimulation (P<0.05), and the increments were greater within 24-48 h than those in 48-72 h. NO content in the culture supernatant was associated with the medium volume, and the highest level occurred in a system volume of 100 µl. Aspirin (1 mmol/L), dexamethasone (10 µmol/L), and cyclosporin A (10 µmol/L) all significantly inhibited LPS-stimulated production of NO in mouse resident peritoneal macrophages (P<0.001).

CONCLUSIONSMacrophage density, LPS concentration, and the duration of LPS stimulation are the main factors affecting LPS-stimulated NO production in mouse resident peritoneal macrophages. The optimal results can be obtained with a macrophage density of 5×10(6) cells/ml (100 µl per well), LPS concentration of 10 µg/ml, LPS stimulation duration of 24 h or 48 h, and a culture medium volume of 100 to 200 µl.

Animals ; Cells, Cultured ; Female ; Lipopolysaccharides ; pharmacology ; Macrophages, Peritoneal ; drug effects ; secretion ; Male ; Mice ; Mice, Inbred Strains ; Nitric Oxide ; biosynthesis

To sum up the reform of internal performance appraisal system and income allocation system of Shanghai municipal hospitals.The internal performance appraisal index system,evaluation methods and corresponding income allocation system,featuring two breaks,one change and eight elements.The reforms highlight public welfare nature of public hospitals,which is expected to create profound impacts on hospital operation and medical staff behavior.