The author earmarked institutional defects as the key to China's medical and health system reform during the economic reform.Main progress and fruits of this reform during the past three years are listed as follows:theory and system innovation,initial establishment of the primary healthcare security system of nationwide coverage,establishment and implementation of the essential drug system,establishment and perfection of the primary healthcare system,equity of primary public health service,and general startup of public hospitals reform.In addition,the author identified such reform roadblocks and challenges as growing conflicts between the demand and supply of healthcare services,resistance for furthering the system reform,conflicts in drug production and circulation,lack of top-tier design for public hospital reform,and lack of systematic planning for talent development.

Health -related quality of life is used as an outcome criterion to evaluate the quality and effect of different therapies. It's also frequently used in epidemiological studies, as well as health economic research.Instruments to assess health-related quality of life has been developed, mostly for adults. Inflammatory bowel disease is a chronic debilitating disorder. Assessing health-related quality of life of pediatric inflammatory bowel disease is useful. Present paper briefly describes four internationally most widely used available generic instruments and inflammatory bowel disease specific health-related quality of life. All of the generic instruments comply with psychometric standards concering the reliability, validity, and sensitivity of the scales. Diseasespecific instruments, conforming with psychometric criteria, have test-retest stability, constructive validity and could be widely used.

OBJECTIVE: To probe into the characteristics and regularity of the adverse drug reaction(ADR) occurred in our hospital.METHODS: 221 ADR cases collected in our hospital from Jan.2007 to Dec.2008 were analyzed statistically in respect of patients' age and sex,route of administration,drug categories,organs and systems involved in ADR and the clinical manifestations etc.RESULTS: 14 major drug categories were involved in the 221 ADR cases,with antiinfective drugs showing the highest proportion in terms of incidence of ADR,followed by traditional patent drugs and drugs for cardiovascular system.The ADR occurred chiefly via intravenous route.CONCLUSION: Great importance should be attached to ADR monitoring.

OBJECTIVE:To provide reference for establishment of delivery way of essential drugs in China.METHODS:Related information and literatures were reviewed in order to analysis the characteristics of 3 kinds of delivery ways,i.e.Songjiang Shanghai delivery way,Beijing community medicine delivery way,Zhejiang community delivery way from background,the difficulty of actualization,pros and cons of the delivery way.RESULTS & CONCLUSION:3 kinds of delivery ways which have their own advantage and disadvantage should be adopted according to actual situation.The government of provinces may summarize the experience and innovate to establish a delivery way of essentical drugs.

Objective To explore the clinical significance of combined detection of serum procalcitonin (PCT)and interleukin 6 (IL-6 )in patients with lower limbs long bone open fractures before and after emergency debridement fixation and postoperative reg-ular antibiotics treatment.Methods Patients with lower limbs long bone open fractures within 8-24 h after injury were divided in-to wounds fester group,wounds contamination group and wounds non-contamination group.Serum PCT and IL-6 levels were detec-ted and compared between patients group and control group.Results Before treatment,PCT and IL-6 levels in wounds contamina-tion group and wounds fester group were higher than control group (P<0.05 or P<0.01),but those in wounds non-contamination group were not different with control group (P>0.05).After treatment,PCT and IL-6 levels in wounds fester group and wounds contamination group were decreased,but those in non-contamination group were with a trend of fluctuation.In the first day of treatment,PCT and IL-6 levels in contamination and fester group were higher than control group (P<0.05 or P<0.01),but there was no significant differences,compared with the levels before treatment(P>0.05).PCT and IL-6 levels in non-contamination group,compared with control group and levels before treatment,were not significantly different (P>0.05).In the third day of treatment,PCT and IL-6 levels in the three patient groups were higher than control group (P<0.05 or P<0.01).PCT and IL-6 levels in fester and contamination group were not significantly different with the levels before treatment (P>0.05).PCT and IL-6 levels in non-contamination group were significantly higher than the levels before treatment (P<0.05).In the fifth day of treat-ment,with the improvement of disease condition,PCT and IL-6 levels decreased significantly.PCT and IL-6 levels in fester and contamination group were significantly higher than control group (P<0.05),but lower than the levels before treatment (P<0.05).PCT and IL-6 levels in non-contamination group were higher than control group and the levels before treatment (P>0.05). Conclusion Wounds infection could onset in patients combined with lower limbs long bone open fractures and soft tissue open inj u-ry.Dynamic monitoring of PCT and IL-6 levels might be significant for early prediction of bacteria infection,rational use of antibi-otics and promote healing of wounds and fractures.

Relapse of psychotic symptoms in Schizophrenia occurs in up to 40% of patients within a year of being hospitalised. A relapse may be secondary to any individual factor or several factors acting concomitantly. Risk factors that can precipitate a relapse in Schizophrenia are: significant residual psychopathology, poor compliance to medication, poor insight, substance misuse, interactions with other medication, poor social support, increased stress and caregivers with high expressed emotions. A thorough history and assessment should be conducted to elicit all contributory factors and appropriate interventions undertaken to address them in order to prevent the onset of a full blown relapse or to help the individual to achieve remission of symptoms. It is necessary to implement a proactive approach towards the prevention of relapses by using strategies such as psychoeducation and early identification of relapse signatures. More importantly, it should be emphasised that empowerment of the individuals in understanding and managing their illness is crucial.

Objective To observe the clinical efficacy of Tongxinluo Capsule on hypertension with interaction of phlegm and blood stasis, context stagnation or Qi deficiency and blood stasis, and its impact on blood rheology. Methods One hundred and forty-seven cases of hypertension were randomly divided into treatment group (74 cases) and control group (73 cases). Both groups were given conventional antihypertensive and lipid-lowering treatment, and the treatment group was given Tongxinluo Capsule additionally. Symptom score, blood pressure, lipid and rheology of two groups were observed before and after treatment. Results There was no significant difference between before and after treatment in hemorheology and blood lipid of two groups (P

29 aged patients of transvenous endocardial pacemaker implantation have been performed during 1981-1988. Elderly group consisted of 29 cases with 19 males and 10 females with age ranging from 60-86 years. The indications for permanent pacing in this series included. (1) Sinus bradycardia (2 cases), (2) Sinus bradycardia, sinus arrest and/or sinoatrial block (2. cases), (3) Brady-tachyarrhythmia (It cases), (4) Bifaseicular block (2 cases), (5) Trifascicu lar block (3 cases), and (6) Complete AV block (9 cases). All 29 cases were symptomatic (syncopal attacks). They required permanent pacing. They have been followed up for 2 to 90 (average 39) months. The incidence of complications has been relatively low. A pacing mortality during the follow-up period was not seen in this series.A clinical assessment was made with emphasis on some special features in elderly individuals. In the elderly bradyarrbythmia was usually due to fibrosis and sclerosis of the conduc-tion system rather than to ischaemic heart disease. In the elderly the implantation of a pacemaker was indicated for any symptomatic bradycardia. Age was not a contraindication for permanent pacing

After defining chronergy for medical instruments maintenance,this paper generalizes the importance of maintenance chronergy,and puts forward some specific methods for its improvement.