Objective: To analyze the current status of village health worker practice and their remuneration in six provinces. Methods: After 18 counties (cities/districts) from 6 provinces are selected based on their levels of economic and social development, this paper uses self-designed questionnaires to survey all village clinics under the jurisdiction of these 18 counties. Results: The average numbers of village health workers range from 6. 79 to 19. 05 per 10,000 rural populations and 1. 36 to 3. 24 per village. In some provinces, more than 20% of the village health workers are 60 years old, and the educational level of more than 50% is technical secondary school and they have village health worker prac-ticing certificates only. The coverage ratio of medical malpractice liability insurance among village health workers in two western provinces is less than 11%. Except Jiangsu province, village health workers in the other five provinces have mainly joined the New Rural Pension Scheme ( NRPS) . Jiangsu province ranks the highest in subsidies for the services of public health and essential medicines per village health workers, and Fujian province ranked the lowest. Village health workers who are included in the administrative staffing management of township health centers account for less than 20%. Except Jiangsu province, more than 70% village health workers provide 24-hour service. The number of the outflow personnel is higher than the number of the inflow. Conclusions and Suggestions:The problem of village health worker aging is getting worse. Their education level, practicing quality and remuneration are low. This paper suggests the government not only improve the practicing quality and define the legal status of village health workers, but also in-crease the remuneration, incentives and job satisfaction of village health workers Further studies should be conducted in order to put forward a more practical advice about how to attract more health workers in rural areas.

Objective:To analyze the status quo and problems of the health human resources of township health center.Methods:296 township health centers in 18 counties of 6 provinces were selected with typical sampling and workers in the centers as target population.Relative administrative officials and directors of township health centers were interviewed.Descriptive analysis and thematic analysis were conducted with quantitative data and qualitative da-ta.Results:The volume and distribution of human resources in township health centers are not balanced and the allo-cation standard of the middle area is low.The null establishment and the employees out of establishment coexist.The allocation of health human resources inside township health centers is not reasonable and the ratio of health profes-sionals is lower than national standard.The rate of senior professionals is low.That health workers are out of stock is a potential problem in some counties.Medical education is not matched with the demand of township health centers.The recruitment policy is inappropriate and the remuneration of health professionals is low.It is difficult for the worker in township health centers to get professional promotion.Recommendations:The structure of workers in township health centers and the recruitment policy should be adjusted.The path of professional promotion should be clear in order to ex-pand the space of career development of workers in township health centers.Improving the remuneration of workers in township health centers should be considered to increase the attractiveness of the post in township health centers.

Objective:To Compare the operational status of the New Rural Cooperative Medical Scheme( NCMS) in 14 Counties of 6 provinces. Methods:Two provinces were selected from eastern, central and western areas respec-tively and then two counties were chosen randomly from each province, but each of Jiangsu and Guangxi Provinces pro-vided 3 to reach the sample number of 14 counties. Excel 2007 was used for descriptive and comparative analysis of fund and in-patient service for NCMS. Results:The average funding standard was about 300 and 350 Yuan for 2012 and 2013. Hospitals outside county were frequently used and the ratio was over 40% in county I. Except Jiangsu and An-hui, the rate of enrollees who get compensation for inpatient service was over 10% and the actual compensation rate more than 50%, Fujian being an exception. Average hospitalization costs per time were different among counties and significantly rose in 2013. The ratio of out of pocket inpatient service expenses to the net rural household income was diverse among counties and it declines in some of them in 2013. The rate of fund for hospitals outside county was high and that of G counties was more than50%. The fund surplus rate was negative in that same year and was accumulatively ranging between 1 and 2%. Conclusions:The NCMS financing level was low and the personal financing responsibility was lighter;the enrollees didn’t contribute enough. In-patient service utilization structure was not rational in different level hospitals. The actual compensation rate for inpatient service didn’t increase a lot and the medical expenses burden didn’t alleviate apparently. The funds supervision was weak and it probably leaded to a high risk fund deficit.

OBJECTIVE:To provide reference for perioperative rational prophylactic application of antibacterials in type Ⅰ in-cision operation. METHODS:4 201 patients underwent type Ⅰ incision operation were collected from a class A grade three hospi-tal during Mar. 2013-Feb. 2015. The perioperative prophylactic application of antibacterials in type Ⅰ incision operation were ana-lyzed statistically. RESULTS:Of 4 201 patients underwent type Ⅰ incision operation,there were 2 399 cases of prophylactic appli-cation of antibiotics(accounting for 57.10%). Cephalosporins andβ-lactam/β-lactamase inhibitor were the main classes of antibacte-rials for preventive use,accounting for 45.60%and 19.76%,respectively. The frequency of using cefazolin,ceftriaxone and amoxi-cillin-clavulanic acid ranked the top 3 places, among which there was 823 cases of unsuitable prophylactic medication time (34.31%),and 855 cases of prophylactic medication time >48 h(accounting for 35.64%). CONCLUSIONS:There still is unrea-sonable perioperative prophylactic application of antibacterials in type Ⅰ incision operation in this hospital. It is necessary to strengthen the supervision of antibacterials and conduct regular rational antibacterials use seminars in order to promote rational use of antibacterials.

Objectives: The paper aims to analyze the practice and outcome for the rural doctors’ contracted service in Dafeng and Shengzhou counties. Methods:The methods used were typical sampling which played in selec-ting Dafeng and Shengzhou counties and interviews conducted with the director of the bureau of health in Dafeng and Shengzhou counties, the dean of the township health centers ( two for each county) and the rural doctors ( four for each county) . We adopted descriptive statistics to analyze the quantitative data and incentives. Results: The rural clinic and/or township health centers were the main contracted service providers and services were supplied to all in-habitants, especially to the target patients such as those suffering from NCDs. The individual benefit packages were designed to coordinate with local demands and the security and incentive mechanisms were established. Conclusions:Contracted service brought several benefits such as meeting the individual demands of inhabitants, rural doctors were inspired and the basic rural health system consolidated, the basic public health service quality was improved, and the function was intensified for the primary health institutions. The rural doctors’ contracted service is helpful to advance rural health care reforms, and provides more evidence in setting up the local rural health policies. It still needs fur-ther perfections. Suggestions:The rural doctors’ team construction should be strengthened and the incentive mecha-nism, summary and evaluation of their contracted service should be improved timely.

Voriconazole is a broad spectrum triazole antifungal agent, widely used in the prevention and treatment of invasive fungal diseases.Long-term use of voriconazole can induce periostitis and cutaneous squamous cell carcinoma, accounting for serious adverse effects on patients, which has been reported in increasing clinical cases.This review is to characterize the epidemiological and clinical manifestations of periostitis and squamous cell carcinoma induced by voriconazole, and to analyze the mechanisms of triggering periostitis and squamous cell carcinoma, so as to promote the rational use of voriconazole in clinics.

ObjectiveTo observe the clinical effects of mirabilite external application and neostigmine injection at Zusanli acupoint combined with Xuebijing intravenous injection on patients with severe sepsis.Methods A history-prospective controlled study was conducted. Patients with severe sepsis admitted to the Fourth People's Hospital of Jiangsu University from January 2012 to November 2015 were enrolled. Twenty-one cases admitted from January 2014 to November 2015 were assigned as a research group and treated with application of mirabilite external application, Zusanli acupoint injection of neostigmine combined with intravenous Xuebijing injection; 22 patients with Xubijing treatment from January 2012 to November 2015 were included in a Xubijing group; 21 patients with routine therapy from January 2012 to November 2013 were included in a control group. The changes of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), mean arterial pressure (MAP), oxygenation index (OI), serum creatinine (SCr), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, sequential organ failure assessment (SOFA), gastrointestinal function score, blood platelet count (PLT), plasma prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimmer in three groups before and after treatment were observed; the length of stay in ICU and the 28-day mortality were compared among the three groups. Results Compared with those before treatment, WBC, PCT, CRP, SCr, APACHE Ⅱ score, SOFA score, gastrointestinal function score, APTT, PT, and D-dimer were all obviously lower after treatment for 7 days in various groups; OI, MAP, PLT were significantly higher, and the improvement degree of WBC, PCT, CRP, SCr, APACHE Ⅱ score, SOFA score, gastrointestinal function score, OI in research group was more significant than those of control group and Xubijing group [WBC (×109/L): 7.52±0.75 vs. 12.87±4.13, 10.88±0.66, PCT (μg/L): 1.14±0.55 vs. 6.32±1.39, 3.47±1.94, CRP (mg/L): 21.0±9.2 vs. 65.0±13.6, 35.0±13.9, OI (mmHg, 1 mmHg = 0.133 kPa): 357.0±20.4 vs. 295.0±20.4, 309.0±21.4, SCr (μmol/L): 7.89±2.35 vs. 14.33±9.17, 11.27±4.65, APACHE Ⅱ score: 10.38±0.75 vs. 18.27±2.57, 13.09±4.10, SOFA score: 1.05±0.66 vs. 6.01±2.33, 3.26±1.03, gastrointestinal function score: 0.31±0.11 vs. 2.01±0.46, 1.85±0.29, all P < 0.05], the improvement of PLT, APTT, PT, D-dimer indicators in the research group was more significant than those in control group, but the above improvement compared with that in Xubijing group, no statistically significant difference was found [PLT (×109/L): 220.32±32.44 vs. 105.56±44.03, 170.56±54.03, APTT (s): 30.16±5.23 vs. 39.09±10.11, 29.56±6.85, PT (s): 10.74±1.25 vs. 13.56±4.65, 10.05±1.44, D-dimer (mg/L): 1.13±1.98 vs. 4.03±2.65, 1.13±0.54]. The length of stay in ICU was shortened in research group than that in control group and Xubijing group (days: 13.23±9.45 vs. 25.22±15.46, 18.56±10.33, P < 0.05); the 28-day mortality was significantly lower in the research group than that in the control group [28.6% (6/21) vs. 47.6% (10/21), P < 0.05], but there was no statistically significant difference compared with that in Xubijing group [28.6% (6/21) vs. 31.8% (7/22), P > 0.05]. Conclusions The treatment of mirabilite external application and neostigmine injection at Zusanli acupoint combined with Xuebijing intravenous injection can obviously improve the clinical symptoms, blood coagulation indexes and organ functions, reduce the levels of inflammatory indexes, shorten the time of the length of stay in ICU and elevate the survival rate of patients with severe sepsis.

OBJECTIVE:To analyze intervention effect of Drug Rational Usage Guidelines System(DRUGS)on antibacterial agents use in department of obstetrics and gynecology in our hospital. METHODS:The application of antibacterial agents in depart-ment of obstetrics and gynecology in our hospital during Jan.-May(before intervention)and Jun.-Nov. 2012(after intervention)were extracted in respects of drug name,preoperative medication duration,perioperative additional condition,postoperative drug with-drawal time,drug combination,usage and dosage,average hospitalization stay,hospitalization cost. The intervention effects were analyzed. RESULTS:After intervention,the type of antibacterial agents were more in line with national regulations;the proportion of type Ⅰ incision surgery without antibacterial agents increased from 57.8% to 75.2%;the prophylactic application of antibacteri-al agents in type Ⅱ incision surgery within 0.5-2 h increased from 80.2% to 97.0%. The rate of reasonable antibacterial selection, drug combination,usage and dosage increased from 76.9%,64.9%,71.3% to 89.3%,84.6%,90.2%,respectively. The average hospitalization stay and antibacterial cost per capita decreased significantly. There was statistical significance among above indica-tors before and after intervention(P<0.05 or P<0.01). CONCLUSIONS:DRUGS effectively change irrational use of antibacterial agents in department of obstetrics and gynecology,which provide a new method for the management of antibacterial agents.

Objective To optimize primary cultures techniques of isolating neonatal rat cardiomyocytes and to com?pare three different methods of extractingβ3-adrenergic receptor(β3-AR)membrane protein from cultured neonatal rat car?diomyocytes. Methods TypeⅡcollagen and differential velocity adhesion were used to collect primary cardiomyocytes. To?tal protein method, ultracentrifugation method, extract kit method were used to isolate cardiomyocytesβ3-AR membrane pro?teins. The BCA method was applied for protein quantification. Relative content ofβ3-AR membrane protein and GADPH in the sample were examined by western blot. Results Optimizing culture and isolation skills can produce a great quantity of cardiomyocytes in high concentration.The kit method acquired a higher level of protein concentration(8.26±0.29)g/L than to?tal protein method(5.12±0.47)g/L does than ultracentrifugation method(3.20±0.37)g/L does all of which were with signifi?cant difference(P < 0.05). The concentration of β3-AR membrane protein was higher if obtained by kit method(0.22 ± 0.05)than ultracentrifugation method(0.09 ± 0.03)than total protein method (0.01 ± 0.01) with significant difference(P <0.05). Conclusion optimizing methodology can obtain abundant myocardial cells in high concentraion. The kit method of isolating primary culturedβ3-AR membrane proteins result in improved concentration and specificity of membrane protein.

Objective: To analyze the current situation and effect of vertical integrated of rural health services in Dafeng County. Method: Policy documents and data are collected and interviews are implemented for studying the integrated situation. Results: The vertical integration in Dafeng County is virtual joint form with forming 6 city-level medical volunteer service teams and 52 health management teams. With the imple-mentation of fully integrated management, signing service with rural doctor mode is carried out, which pro-mote the establishment of rural unified service standards and regulations. Using health card of residents which promote the regional shared of treatment information. Conclusions: Vertically integrated mode had connection in health management teams, supported by fully integration, developed by signing service with rural doctor and carried by residents’ health card, which could provide reference for implementing vertical integration of rural health service. But strategies needed to be strengthened in improving health services’ ability of township hospitals, clarifying interest relationship as well as integrating health service regulations and strengthen the health information system for sharing and docking.