The division of specialists and general practitioners is the important of the establishment of a GP system. According to the theory of labor division, the study analyzes the evolution mechanism on the division of spe-cialists and general practitioners and discusses the main factors influencing the division in China. It is found that transaction costs of general practices are not much lower than that of specialist medical care, which encourages outpa-tients to visit specialists in hospitals. Additionally, transaction costs of referral are much higher than profits. There-fore, while there is no division of specialists and general practitioners, it has been difficult to address competition between them and the quality and the efficiency of general practice care in community health centers. Moreover, the income gap does not attract medical students to work in general practices, which has worsened the quality and effi-ciency of general practices. Finally, the transaction costs of general practices have continually increased. This vicious cycle has hindered the division of specialists and general practitioners in China.

Objective To learn the business operations of the pilot county-level public hospitals chosen for the 2014 experiment,which were subsidized at different levels in the financial subsidy mechanism reform.Methods County-level public hospitals from 109 counties were sampled as pilots from two provinces of the eastern,central and western regions of China.Descriptive analysis and correlation analysis were made to study their business operations at various subsidy levels.Results Proportional differences in the governmental financial subsidy level make a difference in the revenue and expenditure of county-level public hospitals.The higher the subsidy proportion,the lower the annual average of the total workload of the hospital(P <0.01),the less the inpatient expenditure per hospitalization(P =0.01),and the lower the drug proportion as well(P <0.01 ).Conclusions Financial subsidy plays a key role in the financial balance and business operation of such hospitals.Hence the government is proposed to guarantee its financial subsidy responsibility,to build a long-term financial subsidy mechanism.

International experiences can provide evidences for general practitioners ( GPs) system building in China. The paper reviews the development of GP systems from several typical countries of different insurance sys-tems, including national health care systems, commercial medical insurance systems, and social medical insurance systems, etc. The factors that influence GPs systems are analyzed. It is found that the control force of health security system on health system, the control force of specialists on health system, the incentive mechanism of general prac-tice, and the development of general medicine influence the establishment of GPs systems. Finally, this paper pro-vide several policy implications:First, in order to meet the needs of public health, a GPs system with Chinese char-acteristics should be established;Second, the core values of general medicine should be promoted to provide public support for the establishment of a GPs system;Third, a sound incentive mechanism should be established for the de-velopment of a GPs system to improve the status of general practitioners;Fourth, the division of general practitioners and specialists should be promoted to improve the development of general medicine.

Objective We sought to investigate the attitude to the evaluation of nursing undergraduate innovative talents quality by post audience and undergraduate nursing students and to provide reference for the cultivation of innovative talents and quality standard construction.Methods Using convenient sampling method,we selected the medical staff,patients and junior undergraduate nursing students as the research object.A questionnaire survey on the nursing undergraduate innovative talents quality evaluation was carried out.Results The attitude to nursing undergraduate innovative talents quality evaluation from high to low was physicians,nurses,hospital patients and junior undergraduate nursing students.Different populations had different expectations for nursing undergraduate innovative talents.Conclusions To cultivate the nursing undergraduate innovative talents,we should not only focus on the ability of nursing scientific research and innovation,but also should be based on the moral and occupation quality.Only giving full consideration to demands and expectations of the nursing undergraduate innovative talents by all post audience,can we evaluate the talent quality more professionally,scientifically and systematically.

Objective To understand the cognition of nursing undergraduate innovative talents of college nursing graduates,provide the basis for training and evaluation of nursing undergraduate innovative talents and establishing evaluation system.Methods Using the method of qualitative research,in-depth interviews were carried out in 13 nurses who had received full-time undergraduate nursing education from a comprehensive hospital.The acquired data were collected and analyzed,and the topics were put forward.Results The demands of clinical post for undergraduate nursing talents were many-sided.The explicit achievements such as specific topic submission,articles printed,patented invention,etc.were the most intuitionistic evaluation for innovative talents.Most of the nursing students during the learning period could not understand the importance of innovation ability in nursing work,and were lack of motivation to obtain related knowledge.Many undergraduate nurses chose self-development after work simply for professional title promotion,lacking the simplicity for innovation or for solving practical problems.Conclusions For cultivation of innovative talents,school should take students as the starting point,and the different competency as orientation,perfect cultivation mode of innovative talents.The hospital should provide learning,studying abroad opportunities for nurses,construct the innovation team of department.In addition to explicit results,internal innovation consciousness and innovation spirit should also be concerned in evaluation.

Objective:Development of health resources is extremely uneven in China. It is need to consider the situation of each region for China 's health regional planning, so area classification should be in progress. Methods Considering the economic, social, population and health factors, the study conducted principal component analysis and factor analysis by statistical yearbook data to calculate the composite score for each region. Then cluster analysis was conducted. Results Principal components and factor analysis were both divided the country in to six categories. Conclusions:The study divided the country into six regions, the first class area:Shanghai, Beijing;the second class area:Tianjin; the third class area: Jiangsu, Zhejiang, Guangdong; the fifth class area: Guangxi, Ningxia, Xin-jiang, Gansu, Guizhou, Yunnan, Qinghai;the sixth class area:Tibet. The rest is the forth class area.

The way to develop the seven-year program studnts'ability mainly includes:paying great attention to study the basic theory for developing students'comprehensive abilities;laying stress on clinical teachers'important role in training students'ability on scientific research and their participation in clinical scientific research activities in order to develop their ideology and ability of clinical oncology scientific research.

BACKGROUND:Liushen Pil is a traditional Chinese herbal formula, has the effects of heat-clearing and detoxicating, eliminating stagnation, detumescence and al eviating pain. Modern pharmacology verifies that Liushen Pil has anti-inflammatory, analgesic, cardiac, anti-viral, anti-tumor effects, and has been extensively used in the treatment of various infectious diseases and malignant cancer. OBJECTIVE:To investigate the inhibitory effects of Liushen Pil on esophageal cancer xenografts, and effects on microvessel density and vascular endothelial growth factor expression. METHODS:After reproducing nude mouse models of human esophageal cancer, 48 nude mice were randomly divided into high-dose Liushen Pil group, moderate-dose Liushen Pil group, low-dose Liushen Pil group, cisplatin group, model group and blank group. According to medication regimen, drugs were given. The growth of transplanted tumor of nude mice was dynamical y observed in each group. The nude mice were sacrificed after 20 days of treatment. Neoplasm weight was taken and the tumor-suppressing rate was calculated. Immunohistochemistry was used to detect microvessel density and the expression of vascular endothelial growth factor. RESULTS AND CONCLUSION:The weight of transplanted tumor was significantly lower in the high-dose Liushen Pil group, moderate-dose Liushen Pil group, low-dose Liushen Pil group, and cisplatin group than in the model group (P<0.05). Microvessel density and the expression of vascular endothelial growth factor were obviously lower in the each Liushen Pil group than in the model group, but not as apparent as that in the cisplatin group. Results suggested that Liushen Pil can inhibit the growth of the esophageal cancer xenografts. Liushen Pil can down-regulate the expression of vascular endothelial growth factor and reduce microvessel density, which is one of the tumor-inhibiting mechanism of Liushen Pil .

Dislocation of both ends of a clavicle in a 49-yesr-old man during an auto-accident is presented. The medial end of the right clavicle was severely displaced antero-inferiorly while the 1ateral end displaced posteriorly. And the clavicle was rotated along its long axis. Sever al attempts of manual and a surgical reduction through separate incision on both ends of the clavicle failed to have anatomical reduction. It was presumed that the cause of failure in reduction were delayed reduction due to combined chest injury, blockade by first rib that was broken and was anteriorly displaced as well as the complexity of the dislocation. It is speculsted that anatomic reduction in this rare injury require wider surgical exposure. Though authors failed to have anatomic reduction in present case, stabilization of the medial end of the clavicle with a strip of fascia lata after medial clavicular resection and ligament repair at the lateral end resulted in satisfactory regain of shoulder motion and cosmetic improvement.
Clavicle ; Dislocations ; Fascia Lata ; Ligaments ; Ribs ; Shoulder ; Thoracic Injuries

Objective To observe the effect of circadian rhythm on hypnotic median effective dose( ED50) of ketamine. Methods Sixty mice were randomly divided into 4 groups which had 15 mice in each group. They were intraperitoneally injected with ketamine at different times of 2 Am,8 Am,2 Pm and 8 Pm, respectively. Righting reflex was recorded and the value of ED50 was measured with sequential experimental method. Results The hypnotic ED50 of ketamine at 2 Am was(54.57?0.82) mg/kg, with 95% confidence limit of ED50 38.06-78.22 mg/kg;ED50 was(49. 27?0. 12) mg/kg at 8 Am, with 95% confidence limit of ED50 40. 21-60. 37 mg/kg;ED50 at 2 Pm was (42.28?0.21) mg/kg, with 95% confidence limit 37.35 - 47 83 mg/kg;and ED50 at 8 Pm was(57.42?0.14) mg/kg, with 95% confidence limit 37.51-73 72 mg/kg,respectively. The ED50 were significant different at 2 Pm and 8 Pm. However, there were no significant difference in ED50 value among other groups. Conclusion The hypnotic effect of ketamine has circadian rhythm - dependent.