Objective To understand the comments for the essential drug system by doctors at township health centers in Nantong's six counties and to discuss the effect of implementing the essential drug system to different ownership systems.Methods The survey was made with stratified clusters random sampling method to select township health centers.Questionnaires were filled out by doctors,and leaders of the health bureau and township health centers were interviewed.Results After the implementation of the essential drug system,94.6％of the doctors found that the number of laboratory examinations increased in Rugao,Rudong and Haian.23.2％of the doctors in Tongzhou,Qidong and Haimen found that enthusiasm for work increased.Conclusion The compensation mechanism should be perfected and the financial subsidies should be paid in time.Supervision and management should be strengthened and the grassroots need for medicine be ensured.The skills training should be enhanced and the medical service ability be improved.

With the support of World Bank ( WB ) and UK Department for International Development ( DFID) , China Rural Health Project ( hereinafter referred as Health XI Project) began to introduce the idea of performance management to 40 counties in 8 provinces in 2008 . The project implemented cyclic performance manage-ment strategies, including performance planning, performance communication, performance evaluation and perform-ance improvement. With the continuous improvement of performance as the goal, the project attempted to establish incentive mechanisms based on the performance of health care services. After five years of pilots in 40 counties, it has achieved good results in the aspects of improving the quality and efficiency of health care services, motivating the enthusiasm of health care managers and workers, etc. Moreover, it has successfully built several advanced counties with exemplary performance management and accumulated some experience, which provides reference and demonstra-tion for implementing performance management in other areas. The key experiences of implementing performance management of rural primary health care include taking health care quality as the core of performance, appropriately combining economic and non-economic incentives, encouraging personnel participation in performance management in order to ensure the sustainability of performance improvement, and effectively applying the ideology of systematic per-formance management in order to effectively enhance the management level of hospitals. The paper also puts forward some policy suggestions based on emerging issues during implementation of performance management.

Objective:To analyze the pay for performance related costs and provide suggestions for further stud-y. Methods:Empirical literatures from inside the country and overseas were collected with a systematic review. Costs were summarized on the basis of three drivers ( performance appraisal, performance improvement and incentive per-formance) . Results:A total of 141 papers, 47 in Chinese and 94 in English were enrolled. Most papers in Chinese were subjected on healthcare facilities while the English ones emphasized on hospitals. Pay for performance may lead to the healthcare service costs, regulation costs and the resources allocation related costs reduction. In addition to these visible costs, a large amount of others hidden from different hospital management levels were also due to pay for performance. Conclusions:(1) Differences in costs could be found from home and overseas experience which per-haps resulted from the pay for performance, the supporting measures and the policy development. (2) More attention should be paid to the quantification researches on the health facilities’ hidden costs. (3) Most available researches fo-cus on pay for performance cost-effectiveness from the society and service purchase but not the providers’ perspective and the hidden costs were also ignored.

Objective · To explore family medical intervention model of senile dementia with behavioral and psychological symptoms. Methods · Four streets of Changning District in Shanghai were randomly selected and subjects were enrolled according to the inclusion criteria, who were randomly divided into the intervention group (n=71) and control group (n=70). The intervention group received door-to-door service from psychiatric doctors, given drug treatment and psychological intervention. Subjects were evaluated by several scales, including Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Mini-Mental State of Examination (MMSE), Activity of Daily Living Scale (ADL), Quality of Life-Alzheimer's Disease (QOL-AD), and Generic Quality of Life Inventory-74 (GQOLI-74), at baseline and by the end of 6 months and 12 months. Results · ① There was no significant difference in the total scores and all factor scores of BEHAVE-AD between the two groups before intervention (P>0.05). Repeated measures analysis of variance revealed a significant main effect of time (P<0.001). The between-group effect was significant in the total scores of BEHAVE-AD and the factor scores of affective disorder, anxiety and terror (P<0.001). The interactive effect of time×group was significant in the total scores of BEHAVE-AD and the factor scores of delusion and affective disorder (P<0.05). ② Intergroup comparison of the BEHAVE-AD scores indicated that by the end of 6 months, factor scores of hallucination, circadian rhythm disorder, affective disorder, anxiety and terror of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.01). By the end of 12 months, total scores of BEHAVE-AD, and factor scores of delusion, conduct disorder, affective disorder, anxiety and terror of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.01). ③ There was no significant difference in the scores of MMSE, ADL, QOL-AD and GQOLI-74 between the two groups before intervention (P>0.05). Repeated measures analysis of variance revealed a significant main effect of time (P<0.001). The between-group effect was significant in the scores of MMSE and QOL-AD (P<0.001). The interactive effect of time×group was significant in the scores of MMSE, ADL, QOL-AD, and GQOLI-74 (P<0.05). ④ Inter-group comparison of MMSE, ADL, QOL-AD, and GQOLI-74 scores indicated that by the end of 6 months, scores of MMSE of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). By the end of 12 months, scores of MMSE, ADL, QOL-AD, and GQOLI-74 of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). Conclusion · The family medical intervention model of door-to-door services from psychiatrists integrating multidisciplinary team is effective to attenuate the mental and behavioral symptoms of senile dementia patients, and can improve the quality of life of patients and caregivers. The effect of persistent implementation will be more remarkable.

Objective To analyze the feasibility and practicality of the navigational template for antegrade lag screw fixation of the fractures in the posterior column of acetabulum.Methods Spiral CT scan data of 40 normal adult pelvis was collected.3D CT scans of pelvics were performed.Virtual 3D pelvic models were reconstructed with software Mimics 10.01.Virtual cylindrical implants were placed along the longitudinal axis of the acetabular posterior column via the ischial tuberosity among the ipsilateral hemipelvis and some anatomical parameters were measured.To adjust cylinder position to determine the best projection point,the shortest distance of the point to the linea terminalis and the anterior border of the auricular surface,the angle between the cylindrical and the coronal plane (α),and the angle between the quadrilateral district and iliac fossa plane (β) were measured respectively.The 3D models were imported into software UG 6.0.The models of navigational templates were designed according to the anatomic features of the acetabulums and the measured parameters.16 cases of dry left side of pelvis specimens were collected.Simulate acetabular posterior column screw fixation from different screw holes and verify the accuracy of navigation template assisted in the nail.Results The navigational templates was designed and manufactured successfully which was more consistent with the anatomical features of the quadrilateral plane.Placement of lag screw from the first hole:6.3％ achieved accurate positioning,75％ well positioning,and 18.7％ loose.From the second hole:81.3％ had accurate positioning,18.7％ well positioning.From the third hole:37.5％ had accurate positioning,62.5％ loose.Conclusion The navigational template designed according to the anatomic features of acetabulum and the measured parameters can accurately assist lag screw placement.

Background: Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other nonmechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. Methods: We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. Results: A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. Conclusions Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.

Background: Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other nonmechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. Methods: We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. Results: A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. Conclusions Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.

The paper described the development stages of a hospital performance evaluation scale based on patient experience.An empirical application on 7 856 patients of 26 hospitals in four provinces in the country identified the challenges encountered in the course of its application.These include limits of patients experience,variations on the experience reports incurred by different services experienced by patients,and setting of the patient-inpatient ratio among others.Solutions proposed based on these studies aim at creating a patient experience scale tailored to Chinese patients.

Objective:To clarify the characteristics and differences between obsessive-compulsive disorder (OCD)and attention-deficit/hyperactivity disorder (ADHD)in male children.Methods:Forty boys with OCD and 40 boys with ADHD were selected from out-patient department,and 40 normal boys matched with age,gender and IQ were recruited as the controls.Patients'diagnosis was made according to the International Statistical Classifica-tion of Diseases and Related Health Problems,Tenth Revision (ICD-10).The choice delay tasks (CDT1 /2)were assessed respectively for the measurements of normal or high ecological validity of delay aversion.In CDT1 /2, waiting time and scores of the tasks were indicators reflecting the delay aversion.Results:The scores of CDTs were higher in children with OCD than in the controls [CDT1,(30.9 ±3.2)vs.(27.6 ±3.8);CDT2,(31.3 ±4.4)vs. (28.5 ±4.9);P <0.01].The scores of CDTs were lower in children with ADHD than in the controls [CDT1, [(25.0 ±4.3)vs.(27.6 ±3.8)];CDT2,[(26.2 ±4.6)vs.(28.5 ±4.9);P <0.001].Conclusion:The results in-dicate that the children with OCD have a trend to choose the task with longer waiting time and higher score,and the children with ADHD trend to choose the task with shorter waiting time and lower score.The results suggest that the pathogenesis of hyperactivity/impulse control may be different between OCD and ADHD in delay aversion.

Objective:To explore the impact of mentors' behaviors on the professional identity of medical students during the internship.Methods:Based on the data of the China Medical Students Survey in 2020, a research was conducted on 25 557 medical graduates from 104 universities in China. The Wilcoxon rank-sum test and multiple linear regression were used to analyze the impact of mentors' behaviors on the professional identity of medical students during the internship.Results:More than 70% of medical students believed that the clinical mentors they met during their internship had positive medical and teaching behaviors. If students believed that clinical mentors were enthusiastic, responsible for their work, highlighted role modeling and paid attention to their behaviors in teaching, the scores of professional identity would be 3.027, 0.445, 0.840 and 1.234 points greater than if they did not respectively (all P<0.001). Conclusion:The students have generally good evaluation on mentors' behavior during the internship. The positive medical and teaching behaviors of mentors have a positive impact on the professional identity of medical students and the impact of enthusiasm is the greatest. Medical institutions should provide complete institutional support and standardize the behavior of clinical teachers in order to enhance the professional identity of medical students.