From the aspects of strengths,weaknesses,opportunities and threats,this paper analyzed external factors of the reorganizations and group building reform of public hospitals in Shanghai.Points made are as follows:Characteristics of individual hospitals should he respected instead of a generalized pattern for all;the role of the government to play in this regard should he guidance of an orderly competition,Strengthen Supervision,and promotion of the reform in property rights,These efforts will create a desirable environment for hospital groups;mid- and long-term goals for the reform should consolidate the independent legal entity status of such groups.

Objective:To compare the hotspots and frontiers related to polypharmacy research at home and abroad, understand the current research status of polypharmacy and provide reference for improving the current situation of polypharmacy.Methods:Taking "polypharmacy" and "polymedication" as search terms in both Chinese and English, CiteSpace 5.8.R3 software was used to analyze the publication volume, national and institutional cooperation network analysis, and publication journal analysis of the relevant literature included in the CNKI and the core collection database of Web of Science from September 1st, 2006 to September 1st, 2022. The keywords were conducted co-occurrence, clustering and burst analysis.Results:A total of 412 valid Chinese literatures and 1 447 English literatures were retrieved, and the literature focused on the field of geriatrics. The overall number of publications at home and abroad increased, showing a trend of multi-disciplinary cooperation, but the cooperation among domestic organizations was weaker than that of foreign countries. Foreign research focused on the health outcomes and control strategies of polypharmacy, and the influence of polypharmacy on social psychology and quality of life was a trend. Domestic research focused on the influencing factors of polypharmacy and medication compliance.Conclusions:Domestic scholars should pay more attention to the hotspots and trends in the field of polypharmacy and carry out deeper scientific research.

Objective:To explore the current status of medication adherence among the elderly with polypharmacy in the community, analyze its influencing factors, so as to provide a reference for improving the medication adherence of the elderly on polypharmacy in the community.Methods:From July to September 2021, 600 elderly people with polypharmacy in the community were selected by convenience sampling in Hangzhou as the research object. The General Information Questionnaire, the Medication Knowledge and Medication Belief Questionnaire, and the Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8) were used to investigate the elderly. A total of 600 questionnaires were distributed, 510 valid questionnaires were recovered, and the valid recovery rate was 85.0%.Results:Among the 510 elderly patients with polypharmacy in the community, 191 elderly patients (37.5%) had good adherence, 187 elderly patients (36.7%) had moderate adherence, and 132 elderly patients (25.9%) had poor adherence. The results of univariate analysis showed that there were statistical differences in age, gender, educational level, family monthly income, type of medication, medication belief and medication knowledge ( P<0.05) . Logistic regression analysis showed that educational level, medication knowledge, and medication belief were the independent influencing factors of medication adherence among the elderly with polypharmacy, and the difference was statistical difference ( P<0.05) . Conclusions:Medication adherence among the elderly with polypharmacy in the community of Hangzhou is poor, and medication knowledge and medication belief need to be improved. Medical and nursing staff should strengthen medication guidance, and use comprehensive interventions to conduct regular follow-up and health guidance, so as to improve medication adherence of elderly patients with polypharmacy.

To analyze and evaluate the knowledge of Chinese Guidelines of Diabetes Prevention and Treatment in Shanghai medical staff. 175 medical staff working in endocrinology or community health were enrolled and evaluated by a questionnaire of guidelines about the state of professional, training, and related knowledge. Only 16. 6% medical staffwere trained about the guidelines( 46. 67% from the general hospitals, 14. 75% from secod-level hospital and 7. 14% persons from the community hospitals, P＜0. 01 ). The total correct answer rate of the guidelines was 37. 36%. The correct rate of community hospitals was lower than others( P＜0. 05 ). The rate of doctors' was higher than nurses'( P＜0. 05 ). There were difference between doctors and nurses with the key point of diabetes care knowledge in different level hospitals. The effective method of clinical training in diabetes care should be explored. We still have to work hard to promote the effect of diabetes control and prevention. Effective training about the guidelines should be enhanced. The cooperation between general hospitals and community health institutions in diabetes prevention and treatment should be enhanced.

Objective To investigate the diagnostic value of CT thin-section target reconstruction technique in patients with pulmonary small size groud glass nodules (sGGN).Methods A total of 109 patients with pulmonary sGGN certified post-operation and/or follow up were analyzed retrospectively,and the clinical and CT images of all patients were completely collected.There were 23 cases of benign group,21 cases of adenocarcinoma in situ group,29 cases of minimally invasive adenocarcinoma group and 36 cases of invasive adenocarcinoma group,respectively.The differential diagnostic value using CT thin-section target reconstruction technique was analyzed between the benign and malignant pulmonary sGGN groups,and the CT feature detection rates were compared between CT thin section target and common reconstruction techniques.Results The CT thin-section target reconstruction technique had improved the diagnostic efficiency of pulmonary sGGN.The diagnostic accuracy,area under curve(AUC),sensitivity and specificity were 85.32 ％,0.679,90.80 ％,63.64 ％ in malignant group and 77.06％,0.764,83.72％,52.17％ in benign pulmonary sGGN group,respectively.The CT features as solid component in whole nodule,"halo sign",speculation sign,pleural retraction sign,lobulation sign were more detected by using the thin-section target reconstruction technique than that by using the common reconstruction among adenocarcinoma in situ group,minimally invasive adenocarcinoma group and invasive adenocarcinoma group (P＜0.05) but not speculation sign in the invasive adenocarcinoma group(P=0.126).Conclusion The CT thin section target reconstruction technique can improve the diagnostic value of pulmonary sGGN.