The author earmarked institutional defects as the key to China's medical and health system reform during the economic reform.Main progress and fruits of this reform during the past three years are listed as follows:theory and system innovation,initial establishment of the primary healthcare security system of nationwide coverage,establishment and implementation of the essential drug system,establishment and perfection of the primary healthcare system,equity of primary public health service,and general startup of public hospitals reform.In addition,the author identified such reform roadblocks and challenges as growing conflicts between the demand and supply of healthcare services,resistance for furthering the system reform,conflicts in drug production and circulation,lack of top-tier design for public hospital reform,and lack of systematic planning for talent development.

Objective To observe indicators of hemorheology and blood gas analysis of COPD( chronic obstructive disease) patients complicated by CI(cerebral infarction) in acute exacerbation time and the relationship between them.Methods 46 patients with COPD complicated by CI in acute exacerbation time(complications group) and 44 patients with COPD in acute exacerbation time(COPD group) blood rheology indicators,fibrinogen(Fg) ,D-di-mer(DD) and blood gas analysis were detected.And 45 cases of health-related physical check (control group) were recruited for comparison.Results Compared with the control group,complication group,COPD group of whole blood viscosity,plasma viscosity,hematocrit,platelet adhesion rate,Fg,and DD levels were significantly increased,the difference was significant(P<0.05) ;The complications group of whole blood viscosity,Fg,and DD levels were significantly higher than COPD group;Fg and DD and blood PaCO2 correlated( r Fg =0.36,P<0.01 ,rDD =0.510,P<0.01).Conclusion Patients with chronic obstructive pulmonary disease and cerebral infarction in acute exacerbation time had abnormal coagulation status,and improving ventilation and early application of anticoagulant drug therapy,could reduce the chronic obstructive pulmonary disease,the occurrence of cerebral infarction.

Health -related quality of life is used as an outcome criterion to evaluate the quality and effect of different therapies. It's also frequently used in epidemiological studies, as well as health economic research.Instruments to assess health-related quality of life has been developed, mostly for adults. Inflammatory bowel disease is a chronic debilitating disorder. Assessing health-related quality of life of pediatric inflammatory bowel disease is useful. Present paper briefly describes four internationally most widely used available generic instruments and inflammatory bowel disease specific health-related quality of life. All of the generic instruments comply with psychometric standards concering the reliability, validity, and sensitivity of the scales. Diseasespecific instruments, conforming with psychometric criteria, have test-retest stability, constructive validity and could be widely used.

Objective:To research and evaluate community health service management,analyze the influencing factors,seek for related enlightenment and provide references for health decision making.Methods:In 2016,it organized the municipal community health service's management as a whole,reported by the research units.Results:Health center,65 held a total of 590 units,took part in the comprehensive assessment,60 held health centers were stratified randomly sampled and 42 units participated in the municipal review assessment.Conclusion:It needed to make better the construction and development of community health services,keep the maintain and upgrade for the policy environment and financial support,including community primary public health services and primary medical service fund support,personnel allocation standard and fund support,medical insurance policy support.Under the current community health management system,it needed to set up efficient community health operation mechanism,provide fast primary health care and primary public health service projects to solve the residents' primary health demands.

After defining chronergy for medical instruments maintenance,this paper generalizes the importance of maintenance chronergy,and puts forward some specific methods for its improvement.

Relapse of psychotic symptoms in Schizophrenia occurs in up to 40% of patients within a year of being hospitalised. A relapse may be secondary to any individual factor or several factors acting concomitantly. Risk factors that can precipitate a relapse in Schizophrenia are: significant residual psychopathology, poor compliance to medication, poor insight, substance misuse, interactions with other medication, poor social support, increased stress and caregivers with high expressed emotions. A thorough history and assessment should be conducted to elicit all contributory factors and appropriate interventions undertaken to address them in order to prevent the onset of a full blown relapse or to help the individual to achieve remission of symptoms. It is necessary to implement a proactive approach towards the prevention of relapses by using strategies such as psychoeducation and early identification of relapse signatures. More importantly, it should be emphasised that empowerment of the individuals in understanding and managing their illness is crucial.

Objective To investigate and analyze the characteristics of stressor that the undergraduate nursing students have to face at the clinical work in grade A hospitals , then to provide the scientific basis for clinical teaching management and reduce the pressures of undergraduate nursing students. Methods Questionnaires werehanded outto 80 undergraduate nursing students and datawere collected in the condition of their consents. Results The undergraduate nursing students had the higher scores on the dimensions of Patient Care and Nursing Work and stayed the pressure above average. Male and female undergraduate nursing students had the different top 5 stressors, the difference was statistical significance (t=2.434-3.644, P < 0.05). Conclusions The clinical teaching should care for the different stressors of male and female to reduce work and psychological pressure by taking effective measures, and give more attention to strengthen capacity-building of professional practice.

Optimizing the allocation and configuration of type two large-scale medical equipment,promoting the using efficiency of large-scale medical equipment and the level of medical services,which had important significance on protecting the health of residents.It analyzed and summarized the guiding ideology,main principles,allocation standard,basic and specific requirements,and the total number of the allocated type two large-scale medical equipments in Nanchang during the Twelfth Five-Year Plan period,which had certain significance of references on the configuration and planning of type two large-scale medical equipments.

Objective To explore the clinical significance of combined detection of serum procalcitonin (PCT)and interleukin 6 (IL-6 )in patients with lower limbs long bone open fractures before and after emergency debridement fixation and postoperative reg-ular antibiotics treatment.Methods Patients with lower limbs long bone open fractures within 8-24 h after injury were divided in-to wounds fester group,wounds contamination group and wounds non-contamination group.Serum PCT and IL-6 levels were detec-ted and compared between patients group and control group.Results Before treatment,PCT and IL-6 levels in wounds contamina-tion group and wounds fester group were higher than control group (P<0.05 or P<0.01),but those in wounds non-contamination group were not different with control group (P>0.05).After treatment,PCT and IL-6 levels in wounds fester group and wounds contamination group were decreased,but those in non-contamination group were with a trend of fluctuation.In the first day of treatment,PCT and IL-6 levels in contamination and fester group were higher than control group (P<0.05 or P<0.01),but there was no significant differences,compared with the levels before treatment(P>0.05).PCT and IL-6 levels in non-contamination group,compared with control group and levels before treatment,were not significantly different (P>0.05).In the third day of treatment,PCT and IL-6 levels in the three patient groups were higher than control group (P<0.05 or P<0.01).PCT and IL-6 levels in fester and contamination group were not significantly different with the levels before treatment (P>0.05).PCT and IL-6 levels in non-contamination group were significantly higher than the levels before treatment (P<0.05).In the fifth day of treat-ment,with the improvement of disease condition,PCT and IL-6 levels decreased significantly.PCT and IL-6 levels in fester and contamination group were significantly higher than control group (P<0.05),but lower than the levels before treatment (P<0.05).PCT and IL-6 levels in non-contamination group were higher than control group and the levels before treatment (P>0.05). Conclusion Wounds infection could onset in patients combined with lower limbs long bone open fractures and soft tissue open inj u-ry.Dynamic monitoring of PCT and IL-6 levels might be significant for early prediction of bacteria infection,rational use of antibi-otics and promote healing of wounds and fractures.

OBJECTIVE: To probe into the characteristics and regularity of the adverse drug reaction(ADR) occurred in our hospital.METHODS: 221 ADR cases collected in our hospital from Jan.2007 to Dec.2008 were analyzed statistically in respect of patients' age and sex,route of administration,drug categories,organs and systems involved in ADR and the clinical manifestations etc.RESULTS: 14 major drug categories were involved in the 221 ADR cases,with antiinfective drugs showing the highest proportion in terms of incidence of ADR,followed by traditional patent drugs and drugs for cardiovascular system.The ADR occurred chiefly via intravenous route.CONCLUSION: Great importance should be attached to ADR monitoring.