Since its founding,the Management Center of Shenzhen Public Hospitals,on the basis of summarizing and inheriting reform outcomes in the past,has been working on to streamline the relationship between the government,public hospitals and the society in line with the general reform requirements of the stateupholding public welfare nature,motivating and ensuring sustainability.The center carries out a general reform covering the hospital management system,operating mechanism,supervision mode,and service mode.This way the center has built a set of contemporary hospital management system fitting Shenzhen' s conditions,encouraging hospital operations to better embody the interests of the government,medical workers and the society,and to better cover quality,equity and efficiency,thus effectively improving the management performance and services of the hospitals in question.

In the development of primary care system,Shenzhen has called into play the model of hospital-centering,and made it a link to build a new urban medical service system of clear-cut levels,rational division of responsibilities and mutual benefit.This design provides the primary care with a good credit,a reasonable medical insurance system,and appropriate technical support.Furthermore,it improved the efficiency of unban health resource allocation and utilization and alleviated residents' burden of medical costs.This study aims to introduce the measures and advantages in the implementation of the primary care system in Shenzhen,analyze the problems found in Shenzhen' s community health service system and make recommendations for the improvement.

Shenzhen implemented the health reform on the separation of drug prescribing and dispensing.This policy abolished the drug price addition system,which interrupted the interest chain between hospitals and pharmaceutical enterprises,and curbed the over-medication and use of expensive drugs.Such a reform has lowered the average cost of diagnose and treatment,the out-of-pocket payment by those covered by social insurance,outpatient infusion and the utilization of antibiotics.To further strengthen these outcomes and maintain the momentum of this policy,Shenzhen will further improve the compensation system for public hospitals,encourage the medical staffs' work enthusiasm and implement the reform measures actively.

As requested by both central government and Guangdong provincial government on the reform to separate drug prescribing and dispensing,Shenzhen has introduced its 1 + 6 comprehensive program.Breaking through from the drug price addition system,the program stages such six measures as the health service payment system reform,the compensation system reform among public hospitals,reform of the competition mechanism between pharmaceutical distribution enterprises and hospital pharmacies,reform of drug procurement methods,investigation and punishment of commercial briberies in drug purchase,and enhanced supervision of public hospitals.The paper detailed these measures and explained these innovative practices.

This articles introduced the development of the four systems and eight mechanisms in Shenzhen's health reform,and described the implementing measures of the public hospitals reform and major mechanisms reform.It also reviewed the major achievements and challenges met in the health reform and made an outlook of the future steps in the reform.

In order to reform the medical talent evaluation system, establish evaluation systems of physician competency, and implement physician resources management systems according to work position, and the compensa-tion system which reflects the value of medical services, The basic principles and standards of different physician tiers and grades are created in Shenzhen based on literature review, expert consultation and the methods from the American Centers for Medicare and Medicaid Services ( CMS) . Some results have achieved, including medical competency as-sessment of a certain number of physicians in the pilot project ( the coincidence rate of special hospitals is higher than general hospitals, respectively 78. 9% and 44. 8% ), comprehensive personnel systems reforms in public hospi-tals, and the trial selection of medical talents. The paper also provides some implications:The cognition of all sectors of society and physician themselves should be improved, Transitional policies for position recruitment and performance pay needs further improvement. Meanwhile, the grade evaluation system of non-physicians must also be given greater attention.

By analyzing the present development and reform experiments for public hospitals in Shenzhen,the author proposed the following directions for such a reform:1) Accelerating steps of the development strategy "One Large and One Small",to achieve a balanced deployment of local healthcare resources;2) Building a public hospitals group with reasonable resources deployment and information resources sharing;3) Advancing reforms of public hospitals,building an administrative system of public hospitals featuring separation between government functions and hospitals operations and that between hospital administration and hospital building;4) Improving the supervision mechanism for public hospitals featuring distinct rights and responsibilities and powerful regulatory practice;5) Building a scientific operation system of efficient incentives and self constraints;6) Building a service model for public hospitals featuring separation of medical service and pharmaceuticals sales and normalized system.

Objective:To investigate the status of postoperative sore throat and hoarseness in patients undergoing general anesthesia with double-lumen endotracheal intubation and analyze its influencing factors.Methods:Using the convenient sampling method, a total of 129 patients with double-lumen endotracheal intubation who underwent elective surgery in a Class Ⅲ Grade A general hospital in Wuhan in Hubei Province from July to December 2020 were selected as the research objects. The general information questionnaire, Visual Analogue Scale (VAS), Labial and Tongue Mucosa Scale and Hoarse Voice Scale were used to investigate the patients.Results:The incidence of sore throat in 129 patients with double-lumen endotracheal intubation at 1, 6, 24, 48 and 72 hours after surgery were 68.22%, 44.96%, 76.74%, 64.34% and 48.84%, respectively. Among them, the incidences of sore throat in resting state were respectively 10.9%, 6.2%, 1.6%, 0 and 1.6%, incidences of sore throat in swallowing state were respectively 18.6%, 8.5%, 3.1%, 0 and 0, and the incidences of hoarseness were respectively 66.67%, 45.74%, 78.29%, 65.89% and 48.84%. There were statistically significant differences in the occurrence of hoarseness in patients of different ages and preoperative fasting time 1 hour after extubation ( t=2.499, 2.106; P<0.05). The VAS scores of patients with hoarseness in resting state and swallowing state were higher than those in patients without hoarseness, and the differences were statistically significant ( t=3.688, 2.818; P<0.01). Correlation analysis showed that hoarseness was negatively correlated with the condition of lip and tongue mucosa ( r=-0.309, P<0.01) . Conclusions:The incidence of postoperative throat pain in patients undergoing general anesthesia with double-lumen endotracheal intubation is high. With the extension of time, pain can be gradually relieved. The self-healing effect of hoarseness over time is not ideal. Advanced age, prolonged water fasting before operation and dry lip and tongue mucosa are the influencing factors of postoperative sore throat. Early identification and effective measures should be given in nursing evaluation to reduce the occurrence of postoperative sore throat.

Objective:To determine the incidence of adrenal incidentalomas(AIs) in patients with diabetes mellitus and the metabolism profiles.Methods:A total of 615 hospitalized patients with diabetes mellitus in the Department of Endocrinology and Metabolism of Peking University People′s Hospital from March 2020 to May 2021 were retrospectively included in this study. AIs were screened by unenhanced chest computed tomography(CT) retrospectively and subsequently confirmed by multiplanar reconstruction. Participants′ physical indicators, metabolic profiles, and adrenal function parameters were collected. Unpaired t test, Mann-Whitney U test, and Chi-Square test were adopted to compare the metabolism profiles between diabetes mellitus patients with or without AIs. Regression models were used to estimate the correlations between AIs and the metabolism profiles such as blood glucose, blood lipids, blood pressure, and the adrenal function parameters.Results:Twenty-seven out of 615 participants were detected with AIs(4.4%). Patients with AIs had higher body mass index, waist circumference, and hip circumference than patients without AIs [(29.4±5.1)kg/m 2vs(26.8±3.8)kg/m 2,P=0.018; (102.3±11.7)cm vs(95.8±10.3)cm, P=0.002; (107.3±10.1)cm vs(101.4±7.6)cm, P=0.008]. The levels of serum uric acid and urinary albumin/creatinine ratio were also significantly increased in patients with AIs [(409.6±118.1)μmol/L vs(357.4±100.6)μmol/L, P=0.009; 21.25(7.49, 180.24)mg/g vs 8.60(4.71, 34.56)mg/g, P=0.010]. Besides, individuals with AIs were also associated with a higher risk of co-existing hypertension( P=0.045). Conclusion:The incidence of AIs in patients with diabetes is 4.4%. The presence of AIs in patients with diabetes may associated with increased risk of obesity and hypertension.