Proceeding from the problems confronting hospitals, the paper first offers an analysis of the relationship between the coordination of the "three reforms" and the reform of the management system of public hospitals and then provides some views on the steps for the coordination of the "three reforms" including the reform of the management system of public hospitals, the breakthrough point of the issue in particular. The author holds that the breakthrough point of the coordination lies in reforming the mode of payment and the compensation mechanism of hospitals. The current method of payment by service items ought to be changed into the mode of total quantity control and payment by the amount of service so as to form a policy and operational environment wherein hospitals will seek substantial development on their own initiative. Under such an environment, hospitals can achieve maximum benefits only by minimizing the costs and the primary goals of the coordination of the "three reforms" can thus expect to be attained. On the basis of this, relevant models for the reform of the management system of public hospitals can be promoted. system; Public; Reform

The paper argues that if the policy of separating pharmacy from medicine is to be implemented in China in the current situation, medical institutions will appear to be the direct interest losers while the broad masses of drug consumers (or payers) will be the eventual interest losers. In other words, consumers (or payers) will have to cover the costs entailed in separating pharmacy from medicine whereas the channels for drug circulation(wholesalers and retailers) and the drug producers will benefit from the policy. The government will be faced not only with the pressure of either raising the level of charges for medical services or increasing compensations for medical institutions, but also the dilemma of whether to stunt the development of medical institutions or to allow the abnormal growth of medical expenses. Besides, it will be confronted with moral accusations of supporting the channels for drug circulation at the expense of the interests of medical institutions and consumers and increased government input. These problems have already emerged in an embryonic form in the cunent implementation of the policy of "progressive separation of pharmacy and medicine" by the drug administration agencies. The ideal state for adopting the policy of separating pharmacy from medicine would be the overall reduction of drug prices by 26% to 30%, the turnover of the drug gross profit valued at 46.9 to 54.7 billion yuan into the scope for readjusting the level of charges for medical services, and a yearly readjustment in future of the level of charges for medical services according to the price index.

In light of the scientific procedure of policy making and based on the logical deduction of direct and indirect factors related to the chaotic drug market, the authors found the root of the chaos, viz. The mechanism of reimbursement for medical institutions that formed a vicious circle. In view of the root, a policy model was developed and verified, viz. The optimal utilization of medical resources. The prerequisite condition to the implementation and success of the policy is the exertion of concerted efforts by various departments concerned under the centralized leadership of the government. And it has been proven by experience that to tackle the chaos of the drug market it is necessary to start with medical institutions and the logical order of the steps to be taken to carry out the policy is as follows: control of the total drug expenses, gradual control of the gross profit from drugs, extrication of medical institutions from their dependence on drugs, improvement of the management of the drug market, perfection of the “rules of game” of the market, and development of key techniques for each procedure. Evaluation of the results of the implementation of the policy indicates that the policy is scientific, rational and easy to operate and the steps are feasible.

In light of the scientific procedure of policy making and based on the logical deduction of direct and indirect factors related to the chaotic drug market, the authors found the root of the chaos, viz. The mechanism of reimbursement ofr medical institutions that formed a vicious circle. Inview of the root, a policy model was developed and verified, viz. The optimal utilization of medical resources. The prerequisite condition to the implementation and success of the policy is the exertion of concerted efforts by various departments concerned underthe centralized leadership of the government. And it has been proven by experience that to tackle the chaos of the drug market it is necessary to start with medical institutions and the logical order of the steps to be taken to carry out the policy is as follows: control of the total drug expenses, gradual control of the gross profit from drugs, extrication of medical institutions from their dependence on drugs, improvement of the management of the frug market,perfection of the "rules of game" of the market, and development of key techniques for each procedure. Evaluation of the results of the implementation of the policy indicates that the policy is scientific, rational and easy to operate and the steps are feasible.

The paper describes the short and medium term (within 2 to 5 years) priorities that any region in China right now faces in working out and implementing its regional health planning, viz. the coordinated development strategy of medicine and health, medical security and social economy. The authors hold that to achieve the coordinated growth of the health cause and society, it is imperative to overcome in the short run logically related obstacles in four aspects: ineffective solution to the apparent problems followed with interest by both the social and health sectors and lack of effective operating conditions accompanying medical insurance reform, both resulting in the lack of a driving force in the reform within hospitals; difficulty in achieving breakthroughts in the development of the health cause; and the probability of a regional health planning becoming a mere formality because of the above factors. In addition, the fact that reform of medical and health institutions in their setup and ownership of property rights lags behind macroscopic social economic reform obscures the explanation of and solution to the above problems. Based on the research results, the paper sets forth the priorities in short and medium term planning.

Exercise Test ; methods ; Heart ; physiology ; Heart Rate ; physiology ; Humans ; Lung ; physiology ; Male ; Oxygen Consumption ; physiology ; Physical Endurance ; physiology ; Predictive Value of Tests ; Students ; Universities ; Young Adult

Objective To evaluate the appropriateness of hospitalization days at a tertiary hospital in 2014 by means of the Appropriateness Evaluation Protocol ( AEP ) , and to analyze the causes of inappropriate stays. Methods Medical records of inpatients admitted at a tertiary hospital in 2014 were randomly selected. AEP( US version) was used to evaluate the appropriateness of every hospitalization day, while the causes of inappropriate hospitalization day were also analyzed. Results A total of 1 641 days of stay from 148 medical records were reviewed, and 129 days of stay (7. 9%) were seen as inappropriate. Two major factors for inappropriate stays were waiting for surgery and waiting for test, roughly 89. 1% of the inappropriate hospitalization days. The proportion of inappropriate hospital stays reduced to 4. 8% after adjustment of two-day weekend. Inappropriate hospital stays mostly appeared during the second day to the eighth day after admission(93. 8%). Logistic analysis results showed that with concomitant symptoms, preoperative waiting days > 5 days, high level surgery, non-emergency admission were significantly associated with appropriateness of hospital stays (P<0. 05). Conclusions The rate of inappropriate stays will be reduced and the quality of medical services will be improved if comprehensive measures could be carried out according to the causes of inappropriate stays.

Objective To evaluate the effect of inhaling Ipratropium bromide to patients with chronic obstructive pulmo- nary disease(COPD)on resting pulmonary function,ventilation and exercise capacity during exercise.Methods All 12 stable patients were diagnosed as COPD.Before and after inhaling single-dose lpratropium bromideis,resting pul- monary function and Symptom-limited progressive cycle ergometer exercise tests were proceed.Results No obvious change in resting pulmouary function after inhaling Ipratropium bromide solution of four times the standard dose,but the maximal rate of work,maximal oxygen uptake,the maximal volume of ventilation per minute and the maximal ratio of tidal volume to inspiratory capacity increase significantly.The maximal dead space/tidal volume ratio and the maximal ventilatory equivalent for CO_2 have no change.There is a significant correlation between the amount of the maximal ratio of tidal volume to inspiratory capacity improved and amount of maximal oxygen uptake improved(r=0.598,P

Objective Measure the variation trend and the problems of bed allocation and its equity at primary medical institutions and provide theoretical basis for optimizing the policy of health resources allocation for the government.Methods Analysis of the distribution and equity of the inpatient beds at primary medical institutions in terms of geographical area by means of the survey of regular overall statistics forms and the methods of Gini coefficient and Theil index.Results From 2009 to 2012,the number increase of beds at such institutions geographically was 7.72%,while that in eastern,central and western regions of China were respectively 5.35%, 3.97% and 27.88%.The number increase at community healthcare centers was 46.58%,while that in eastern,central and western regions of the country were respectively 18.09%,29.57%和 81.53%.The number increase at township hospitals was 2.33%,while that in eastern,central and western regions were respectively - 3.83%,- 0.43% and 22%.The Gini coefficient of bed allocation at such institutions was beyond 0.6,while that in eastern, central and western regions were respectively under 0.3,0.3-0.4 and 0.6 above.The Gini coefficient of bed allocation at community healthcare centers fell from above 0.4 to under 0.4.The Gini coefficient in the western regions increased from 0.3-0.4 to over 0.4.The variation trend of township hospitals was similar with the overall conditions at such institutions.The intra-regional Theil indexes and their contribution rates of bed allocation at such institutions were higher than those of inter-regional. Conclusions The overall variation trend of bed allocation at such institutions was on the rise,yet its variation trend of equity remains unchanged.The bed allocation and its equity at such institutions were higher than those at township hospitals.The growth rate in western regions was the highest,but the absolute number was the lowest.Moreover,the equity of bed allocation in such regions was not only the lowest,but also was found rising.The influence of bed allocation in intra-region terms was large,while its equity was not only lower but falling as well.

Objective To assess the clinical efficacy of vitrectomy with intravitreal ranibizumab (IVR) at different injection time for proliferative diabeticretinopathy (PDR).Methods This was a prospective,comparative,and randomized study.Ninety-seven eyes of 97 patients were enrolled and randomly assigned to three different treatment groups:30 eyes (30 patients) in the preoperative IVR group,32 eyes (32 patients) in the intraoperative IVR group and 35 eyes (35 patients) in the no IVR injection group.The best corrected visual acuity (BCVA) (F=0.18) and the grading of vitreous hemorrhage (x2 =1.39) before surgery did not differ significantly among the 3 groups,respectively (P ＞ 0.05).All eyes enrolled underwent conventional 23-gauge pars plana vitrectomy (PPV).The preoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection 3 to 7 days before PPV,intraoperative IVR group received intravitreal 0.5 mg/0.05 ml ranibizumab injection at the end of PPV and non-drug injection group received PPV only.Postoperative BCVA,fundus color photography,optical coherence tomography examination was performed in all eyes at 1 week and 1,3,6,9,12 months after surgery.Early RVH was defined as RVH occurred within 1 week to 1 month postoperatively;while late RVH was defined as RVH occurred 1 month later after the operation.Results The mean BCVA were all improved among the 3 groups compared with the preoperative vision at 1 month after operation.At the beginning of 3 months after surgery,the average BCVA of the preoperative injection group and the intraoperative injection group tended to stable;while 3 eyes in the non-drug injection group began to decreased.There was no significant difference in average BCVA at 1,3 and 12 months of follow-up periods among the 3 groups (F=1.42,1.17,0.26;P＞0.05).The incidences of early RVH were 16.7％,9.4％,28.6％ in the preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =5.12,P＜0.05).The incidence of early RVH in the intraoperative injection group reduced compared to preoperative injection group and non-drug injection group (x2 =4.04,4.93;P＜0.05).The incidences of late RVH were 13.3％,9.4％,14.3％ in preoperative injection group,intraoperative injection group,and non-drug injection group,respectively (x2 =0.47,P＞0.05).The average centeral foveal thickness (CFT) decreased among the 3 groups in different degrees at 1 month when compared with that of 1 week after operation and the decreasing was statistically significant (F=59.50,P＜0.05).A subgroup pairwise analysis showed no significant difference of decreasing CFT in preoperative injection group compared with that of intraoperative injection group (t=0.23,P＞0.05).The average CFT of the 3 groups had different degrees of thickening at 3,6,9,12 months after surgery,and the increasingof CFT among the 3 groups were not differ significantly (F=2.92,2.86,3.07,3.12;P＞0.05).Conclusions The adjunctive use of IVR can reduce the incidence of early postoperative RVH in vitrectomy for PDR,decrease in macular thickness and obtain favorable visual recovery.The effect of preoperative IVR injection was slightly better than that of the intraoperative IVR injection.