Objective:To build a performance evaluation index system of family doctor contracting service for urban communities, so as to evaluate the effects of such service.Methods:Based on the conceptual framework of performance appraisal of family doctor contracting service, such means as Delphi method and analytic hierarchy process were employed to evaluate the performance appraisal system of such service. A measured simulation test was made in Guangzhou.Results:A library of performance appraisal candidate indexes for such service was established, based on the performance appraisal concept framework of " structure, input, output, result" of such service. A questionnaire made based on such a library was developed for correspondence inquiry of 20 experts from December 2018 to June 2019. Based on results of such inquiry, a performance appraisal system for family doctor contracting service in Guangzhou was developed, consisting of 4 level-1 indexes, 10 level-2 indexes and 34 level-3 indexes. In the system, level indexes include organizational structure and management(weight 0.21), resource input(weight 0.24), contracting service process(weight 0.19), and contracting service effect(weight 0.36). A community health center in Guangzhou was used as the measurement site, for adjustment and improvement of data acquisition methods of individual indexes or scoring criteria.Conclusions:The index system is developed scientifically; appraisal tools are designed focusing on results and outputs, ensuring the appraisal of contracting service quality from multiple perspectives of supply-demand sides and health management patterns; the system can provide appraisal tools for policy appraisal authorities to evaluate the performance of contracting service reform.

On the basis of principal-agent theory,this paper analyzed the reasons of doctor-patient problems from the perspective of patients and hospitals,hospitals and physicians,and patients and physicians.It included asymmetric medical information,ethical risks of physicians,incomplete contracts between physicians and patients,and uncertainty of medical results.Aimed at these problems,this paper put forward relevant suggestions.In the view of recognition,patients are supposed to get a rational idea in the process of selecting hospitals and try making a contract with general practitioners.In the view of improvement,the pattern of performance assessment to physicians should be developed.In the view of system,the corresponding management measures of health service should be improved so as to better serve patients.

Objective To examine the chemo-preventive effect of cyclooxygenase-2(COX-2) inhibitor (celecoxib) in an animal model of stomach carcinogenesis. Methods Eighty-six male Wistar rats were divided into six groups. The rats were given water alone (group A, n=5), N-methyl-N′-nitro-N-nitrosoguanidine (MNNG) (group B, n=16), 3 mg/kg of indomethacin daily (group C, n=16), 5 mg/kg of celecoxib daily (group D, n=17), 10 mg/kg of celecoxib daily (group E, n=16) or 20 mg/kg of celecoxib daily (group F, n=16). The animals in group B to F were given 10% sodium chloride (in the initial 6 weeks) and drinking water containing MNNG (100 ?g/ml) to induce gastric adenocacinoma. All animals received treatment for 40 weeks, and were sacrificed after death or at week 48. Gastric tumor was evaluated histologically. Results Among 86 rats, 26 rats died, and 60 rats completed the experiment. The incidences of gastric cancer were found 0 (0%) in group A, 12 (75.0%) in group B, 11 (68.8%) in group C, 12 (70.6%) in group D, 3(18.8%) in group E, and 5(31.3%) in group F. There were significant differences in tumor incidence (P=0.002), multiplicity (P=0.001) and volume (P=0.009) among different groups. When compared with group B, the group E had the greatest reduction in tumor incidence (P=0.004), tumor multiplicity ( P=0.006) and mean tumor volume (P=0.02). Treatment with indomethacin had no significant effect on tumor development. Conclusion While treatment with indomethacin had no significant effect on tumor development, treatment with celecoxib reduced gastric cancer incidence and growth in rats.

Objective To investigate the relationship of Helicobacter pylori(Hp) and gastric cancer in animal.Methods Ninety of two-grade Wistar male rats were randomly divided into experimental group and control group.In 12 weeks after the rats of experimental group were infected with SS1 Hp strain,animal in two groups were then randomly subdivided into blank ,MNNG subgroup and MNNG+NaCl subgroup,15 rats in each subgroup.Animals in the MNNG and MNNG+NaCl subgroups received 100?g/ml of MNNG in the drinking water,and in the MNNG+NaCl still received 10% NaCl 1 5ml,two times a week for ten months.The blank received water plus libitum.All animals were sacrificed in two months after the above treatment.Histopathological features of the glandular stomach were assessed by HE stainning.Results By the end of the study ,87 rats were survival,3 rats died from the mistakes of perfusion of NaCl.Hp was detected in all infected rats.Adenocarcinoma had developed in the antrum of one experimental rat in the MNNG+NaCl subgroup. Adenomatous hyperplasia were observed in two groups,but its incidence in the MNNG and MNNG+NaCl subgroups of the experiment were 40% and 57 14% respectively,higher than that of the control(6 67% and 15 38%)(P0 05).Conclusions We demonstrated that long-term Hp infection could induce the chronic active and atrophic gastritis in animal model,increase the sensitivity of glandular gastric mucosa to carcinogen,and promote the incidence of pre-carcinomatous lesion.

Modern medical education is characterized by innovative education,but the specialty of medical education determines the complexity of its innovative education.The paper elaborates the construction of cultivation mode of talents of creative pattern in medical universities by infiltrating and implementing the ideas and practice of innovative education into the full process of higher medical education proceeding with such innovative thoughts and quality training links as education concept,teaching mode,knowledge structure,training of methods and ability.

The fashion of innovative medical education prompted the teaching mode and teaching aims in medical colleges into fundamental innovation.In this paper,the authors have analyzed the advantages and disadvantages of talent training mode from medical colleges at home and abroad in the past few decades.The training mode for the innovative talents in the new period has been discussed.It includes the flowing aspects:the teaching aims,curriculum setup,teaching methods and education evaluation system.

The article discusses the main problems existing in training medical students’ creativity and practice ability. By re-realizing the connotations of creativity and practice ability, this paper explore the paths for improving medical students’creativity and practice ability from students,teachers,teaching supervisors,and the college itself.

The forecast of health human resources demand is the most important and one of the most complex aspects of health manpower planning projections. There are many methods in forecasting human resources demand,and each method has its own advantages and disadvantages. Five kinds of commonly used basic methods are comparatively analysised in this paper.

Objective To analyze the clinical features,clinical prognosis and predictive factors of ulcerative colitis (UC) complicated with cytomegalovirus (CMV) infection.Methods From May 2004 to November 2014,120 hospitalized patients diagnosed as UC and screened for CMV infection were enrolled.A total of 31 patients with moderate to severe UC accompanied by CMV infection were screened out.Demographics,clinical features,endoscopic appearance and treatment of patients with UC complicated with CMV infection were analyzed,and compared with 60 moderate to severe UC patients without CMV infection at the same period of hospitalization.Mann Whitney U test was performed for statistical analysis.Logistic regression analysis was used to analyze risk factors of UC complicated with CMV infection.Results Among 120 patients with UC,29 were mild or in remission period,whose CMV screening tests were all negative.Ninety-one were moderate to severe,31 patients (34.1 ％) of them had CMV infection,and 20 of 31 patients were steroid-refractory.Among the 31 patients with UC complicated with CMV infection,median age was 39 years (22 years,51 years),median disease duration was 24.0 months (6.0 months,42.0 months) which was shorter than that of patients without CMV infection (36.0 months (13.5 months,84.0 months)),and the difference was statistically significant (U=639.5,P=0.015).A total of 23 patients (74.2％) had extensive colitis and 26 patients (83.9％) had history of severe colitis.A total of 29 patients (93.5％) had history of corticosteroids treatment,12 patients (38.7％) had history of immunosuppressive agents treatment,and six patients (19.4 ％) had history of infliximab treatment.Compared with UC patients without CMV infection,fever,abdominal pain and weight loss were more common in UC patients with CMV infection.Five CMV-infected patients had mild liver dysfunction.Endoscopic appearance was longitudinal ulceration,irregular ulceration,large deep ulceration,punchedout ulceration and worm-like ulceration.Among the 25 CMV-infected patients who were treated with corticosteroids,11 patients (44.0％) had no response.Among the 39 CMV-negative patients who were treated with corticosteroids,eight patients (20.5％) had no response.The rate of patients who needed rescue therapy of the former was higher than that of the latter,and the difference was statistically significant (x2 =4.026,P=0.045).The results of multivariate Logistic regression analysis showed that hemoglobin over 100 g/L(OR=0.144,95％ confidence interval (CI) 0.040 to 0.516,P=0.003) was a protective factor of CMV infection,however corticosteroids use within a month before the onset (OR=8.946,95％oCI 2.459 to 32.541,P=0.001) was a risk factor.Conclusions UC patients treated with corticosteroids and immunomodulator therapy may predispose UC patients to CMV infection,on the other hand,CMV infection can exacerbate the severity of UC.CMV infection should be screened and monitored in UC patients,and anti viral therapy should be taken in time in case of CMV infection.

The family doctor service is an important measure to transform primary health care mode,makes the community health service institutions to take on the gatekeeper role of residents' health and health care costs,and promotes the achievements of hierarchical diagnosis and treatment.At present,there are some difficulties in the process of family doctor service.For example,the construction of the general practitioner team is lagging behind and the residents don't understand the specific contents of the family doctor service well.Medical social workers have both the social work professional skills and medical literacy,which makes them become the effective strength of community health service.Introducing medical social workers by the purchase of the governments,volunteer training,and job settings mode can meet the needs of the development of family doctor service to some extent,and bring in new ideas to the implementation of the family doctor service.