Objective To evaluate the necessity and practicability of optimizing the management of type 2 diabetes mellitus in community after acquiring the peer education and the music therapy to their physical and mental issues and sleep problems. Methods Totally 179 type 2 diabetes mellitus patients who were followed up in Ruijin 2nd community health service center, the random numbers table used to randomize the patients into 2 groups:control group ( 97 cases) and experiment group ( 96 cases), the conventional treatment was used in control group. Besides the conventional treatment measures, the peer support was used by patients in the experiment group. In the second step, 45 patients were met the inclusion and the exclusion criteria, the random numbers table used to randomize the patients into 2 groups:the multiple intervention group (22 cases) and the conventional treatment group (23 cases), the multiple intervention included the music therapy, the peer support and the sleep health education, the conventional treatment included the conventional treatment and the sleep health education. The t test was used to compare the patient's HbA1c and other quantitative data in two groups of patients after the intervention. Results In the first stage of research, compared with the control group patients, the patients 'HbA1c in intervention group was significantly improvement after 6 months(7.26%±1.37%vs.7.53%±1.63%,t=2.148, P<0.05),besides, the intervention group individuals achieved significant improvement in diabetic self-management behaviors and self-efficacy after 6 months, and the improvement in self-efficacy of peer support group was significant different compared with routinely educated patients(104.09±16.40 vs.110.96± 13.86,t=2.120,P<0.05), and the PHQ-9(5.95 ± 4.02 vs.2.55 ± 1.67,t=2.630,P<0.05)between the two group had significant difference, while no improvement was found in PSQI, BMI, and WHR between intervention group and control group. Conclusions Peer support could improve the blood glucose metabolism in patients with type 2 diabetes. With the effect of yoga music and physical exercises, peer support can improve the quality of sleep and decrease depression in T2DM patients, who also have sleep disorders and mild depression.

Objective To learn the present hospital medical quality management,to explore and improve the quality of care management system.Methods Literature review analysis theory of medical quality management system,questionnaires analysis the present medical quality management,case and influencing factors.Results The literature review showed that the trend of quality management study increased year by year in recent 20 years,and is gradually becoming a hot topic in China.The management practices survey found the quality of care management systems mostly established,yet with rooms of improvement for the management content and details.Thanks to the three-stage introduction,operation and indepth study of international standards,hospitals have effectively promoted their quality management.Conclusions Key influencing factors for hospital quality management are the design of such quality management system itself,and lack of quality tools and resources.To build a better quality of care management system,efforts should be paid from both internal and external aspects,thus elevating such quality to a new level.

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 discuss the treatment and clinical results of acetabular fracture. Method Clinical data of 78 cases of acetabular fracture was analyzed retrospectively on treatment methods and clinical effects from August 1988 to December 2007, 41 cases were performed operation and 37 cases were performed non-operative management. Result The treatment effects were excellent in 43 cases, good in 22 cases, fair in 10 cases, poor in 2 cases and dead in 1 cases, with a good rate of 83.3%, and 20 cases had complications: 1 posterior dislocations of hip, 13 posttraumatic arthritis, 1 incisional infection, 5 ectopic ossi-fication. Conclusions It is very important to choose appropriate treatment methods by judging the real state of acetabular fractureexactly. Acetabular reconstruction plate is convenient, safe, and reliable in treat-ment of posterior wall and superior wall fractures.

Objective To evaluate a model of management for chronic pain disease coordinated community health services and district hospital. Methods The epidemiology of chronic pain disease was surveyed in Haotao community of Zhongshan, before and after the establishment of the model of management. Results The prevalence rate of chronic pain disease was 51.83%, in which it was 47.06% in men, and 57.32% in women. After the establishment of the model, the efficacy of good to excellent improved from 30.22% to 67.08%, the cost for medicine reduced 36.16%, time for rest reduced from 32.42 d to 15.25 d (P<0.05). Conclusion The model of management that coordinated community health services and district hospital, including demonstration diagnosis and treatment through internet, tele-consultations and health education, is effective on chronic pain disease.

Objective To detect the mutations of RET proto-oncogene in patients with medullary thyroid carcinoma (MTC). Methods Twelve patients with MTC confirmed by pathology and two clinically suspected patients were recruited. Total genomic DNA was extracted from peripheral blood for PCR. PCR products of exon 10, exon 11 and exon 16 of the RET proto-oncogene were purified and direct gene sequencing was performed. Results The genomic mutations were detected in 8 patients, in which direct gene sequencing analysis detected a mutation of TGC to CGC at codon 618 in exon 10 in 1 patient, a mutation of TGC to TAC at codon 634 in exon 11 in 2 cases, a mutation of TGC to CGC at codon 634 in exon 11 in 3 patients and a mutation of ATG to ACG at codon 918 in exon 16 in the remaiming 2 cases. Conclusion MTC can be diagnosed at gene level by direct gene sequencing analysis. It is possible to diagnose MTC before operation by means of molecular genetic analysis.

With DQOL (diabetes quality of life) scale, quality of life was evaluated before and after diabetic education in 136 type 2 diabetic patients. The Cronbach′s ? of DQOL scale was from 0.809 to 0.849, suggesting that the DQOL scale did effectively reflect the life quality of type 2 diabetic patients.

Objective To learn the present hospital management conditions in Shanghai for upgrading quality of care.Methods The stratified sampling method was used for a questionnaire survey of the quality of care at 20 hospitals in Shanghai (10 tertiary hospitals and 10 secondary hospitals).The survey covered such six dimensions as organizational framework,management functions,management tools,professional training,regulations and norms,and supervision over operations.Results Medical quality management system is established at such hospitals and all of them have established medical quality management committees.Rooms of improvement remain in such details as departmental quality management,regulations standardization,IT support,and management tools popularity.Conclusion Management regulations and standards of medical quality management should be improved and implemented from both external and internal aspects,to improve medical quality and patient safety.

Objective An attempt to develop a patient survey questionnaire on the public benefit nature of medical institutions as seen by patients,along with an evaluation of its reliability and validity.Methods A field survey was conducted among the patients visiting these institutions.The Cronbach's α coefficient was calculated to test the reliability.Factor analysis and spearman correlation analysis were applied to test the validity.The validity was also tested by analyzing the demographic factors and comparing the results between different kinds of medical institutions.Results The Cronbach's α coefficient of the questionnaire was 0.853,meanwhile the Cronbach's α coefficient of the three items was 0.845(quality of care),0.845 (suitability of services) and 0.752 (professional ethics).Three common factors were extracted,which coincided with the three items-quality of care,suitability of services and professional ethics.And the results are hardly affected by common demographic characteristics.Condusion The reliability of the questionnaire was acceptable,and the items were reasonably divided in the questionnaire with good structural validity.The questionnaire can be widely applied to evaluate the public benefit nature of medical institutions.

Objective To investigate the effects of control status scale for diabetes (CSSD70), designed by diabetes center of Ruijin Hospital, in type 2 diabetes patients. Methods The correlations between CSSD70 and age, gender, duration of diabetes, educational backgrounds, insulin use, instruments for diabetes control, diabetes family history, symptoms at the onset of diabetes, complications, random plasma glucose and HbA_(1c) were analysed in 136 type 2 diabetes patients. The correlation between CSSD70 and another national questionnaires DQOL was analysed, and in order to determine the validity and stability of CSSD70, 30 patients were asked to complete the scales twice within one week. Results The coherent results in CSSD70 and DQOL were obtained, but CSSD70 was more comprehensive and sensitive. Almost all factors included in this study were related to CSSD70 total score and sub-scale score. The stability of CSSD70 was fine, and a close relationship between total score and sub-scale score was found. Conclusion The CSSD70 appears to be a good scale in evaluating the functional health status in type 2 diabetes, and is suitable for Chinese patients in evaluating diabetes control.