In view of the two acute problems of excessive medical service and over-fast increase of medical expenditure as currently complained by the Chinese people, the author proposed that public hospitals take the 3 + 1 pattern in their reform. This pattern calls for reform in the payment mode,coordinated implementation of clinical pathways and standardization of outpatient prescriptions, as well as intensification of medical supervision and reform of hospital' s internal incentives and operation mechanism. All these measures should proceed in an interconnected and mutual-improvement manner,while internal incentives should ensure effective implementation of external obligatory reform measures,in an effort to control costs, ensure quality of care, mechanism change and a win-win outcome. The paper also proposed the key points and cautions for the reform.

Objective To understand the types and prices of drugs in outpatient pharmacies and retail pharmacies, study their differences and provide corresponding suggestions on policies. Methods The types and prices of drugs in 7 pharmacies and 8 hospital outpatient pharmacies in 4 provinces were studied and compared. Results Significant differences were found in the types and prices of drugs in these outpatient pharmacies and retail pharmacies. Retail pharmacies might fail to fill 60% of the physician prescriptions. The quality and price control of drugs in outpatient pharmacies was different from that in retail pharmacies. The types and prices of drugs in outpatient pharmacies were different from those in retail pharmacies. Many drugs independently-priced were extremely high. Pharmaceutical departments of hospitals had abundant senior and qualified pharmaceutical personnel whose pharmaceutical expertise was far superior to that of retail pharmacies. Conclusion There was a significant difference between outpatient pharmacies and retail pharmacies. Under the circumstances, it is not yet feasible to release policies and regulations that would separate pharmacies from hospitals or encourage outpatients to fill their prescriptions in retail pharmacies. Medical institutions should further standardize their purchases of drugs as well as prescriptions by physicians.

In light of the connotations of inadequate and overly expensive medical services,the paper analyzes solutions to the issue and their features under different circumstances.Then based on data about studies and establishment of medical security systems at home and abroad,it concludes that the establishment of a medical security system,with joint sharing of risks in bearing the burden of medical expenses,is the fundamental solution to the issue.It also puts forward suggestions for perfecting the medical security system in China.

Aiming at the confused situation of Stephania tetrandra and its adulterants in the production,supply and sale market,the author had overviewed information on Stephania tetrandra and its adulterants in source,character identification,microscopic identification,physical and chemical identification at home and abroad in recent years,so thus for scientific identify of species,distinguishing between the families and genera and correcting medication for clinical use.

Retrospective analysis of two cases of advanced carcinoma of the middle ear. Two patients underwent operation and radiotherapy. A case developed extensive necrosis in ear and neck, which finally led to lethal hemorrhage. Multiple relapse with cranial fossa invasion and extensive necrosis was found in the other case.
Aged ; Ear Neoplasms ; pathology ; radiotherapy ; surgery ; Ear, Middle ; Female ; Humans ; Middle Aged ; Necrosis ; Neoplasm Recurrence, Local ; Retrospective Studies

Objective To evaluated the surgical techniques and results of open reduction and internal fixation performed for ankle fracture. Methods Eighty-two patients with ankle fracture were treated with open reduction and internal fixation from March 1995 to June 1999. Fifty-eight patients with complete clinical data were analyzed. The patient group consisted of 36 males and 22 females. According to Weber-AO classification, the group was made up of 30 Weber B cases,28 Weber C cases. All patients were evaluated with modified Baird and Jackson scoring system. The relationship between final result and fracture pattern, fixation methods, the time of exercise initiation after operation were analyzed respectively. Results The followed-up period varied from 2 months to 52 months, with an average of 17 months. The number of patients whose results was excellent, good, fair and poor was respectively 31, 18, 6 and 3. The total percentage of good to excellent clinical results was 84.5%. Fifty-four ankles were completely pain free and the remainders had only slight pain after long time walking. Conclusion Operative treatment may provide satisfactory fracture reduction and clinical results for ankle fracture. Correct fracture pattern estimation and proper internal fixation is of importance to achieve and maitain reduction, and then, to gain better long term results.

Objective To evaluate the impact of sub-stage on the clinical prognosis of T 1 G3 and evaluate the feasibility of the T1me system in pT1G3 sub-staging.Methods The clinical data,pathological specimen and follow-up data were collected from 56 patients out of 87 patients diagnosed with initial high-grade T1 bladder urothelial carcinoma .The patients were divided into Group A [ T1-microinvasive (T1m),17 cases] and group B [T1-extensive-invasive (T1e),39 cases] according to pathological evaluation after transurethral resection.Clinical parameters were analyzed with Chi-square test,and recurrence-free and progression free survival were obtained by Kaplan-Meier analysis and Log-rank test.Results Age,tumor size,number and intravesical instilled medication showed no significant differences between the 2 groups ( P>0.05 ) .There were significant differences of 5-year recurrence-free rate ( P =0.037 ) and progression-free survival rate ( P =0.045 ) between the 2 groups, and the prognosis of group A was significantly better than that of group B .Conclusion The pathological sub-stage is an important predictor in initial high-grade T1 bladder urothelial carcinoma patients , and the T1me system is objective and feasible.

Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.

ObjectiveTo study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). MethodsTwenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years(range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.ResultsAll patients were followed up for average 4.5 years(range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy(7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . ConclusionPeriacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis.

OBJECTIVE: This article evaluates the auditory and speech perception outcomes of sensorneural hearing loss with cerebral white matter abnormalities after cochlear implantation. METHOD: A retrospective analysis was performed on the cochlear implantatees with cerebral white matter abnormalities by using the categories of auditory performance and speech intelligibility rating, and compared with the non-syndrome patients with sensorineural hearing loss. Paired t-test was used for statistical analysis. RESULT: There was statistical difference between normal group and white matter changes group with sensorineural hearing loss after 6 month. No statistical difference was found after 12 month and 24 month. CONCLUSION In the short term, the cochlear implant can be performed safely in patients with white matter changes. After a formal rehabilitation training,no significant difference in auditory or language ability was found between normal group and white matter changes group with sensorineural hearing loss.
Child, Preschool ; Cochlear Implantation ; rehabilitation ; Female ; Follow-Up Studies ; Hearing Loss, Sensorineural ; etiology ; surgery ; Humans ; Leukoencephalopathies ; complications ; Male