Objective To explore the effect of developed operating instrument set for cesarean section. Methods Toally 216 parturients to undergo cesarean section in our hospital during May to December 2014 , were divided into observation group and control group, 108 cases in each group:in the observation group the developed operating instrument set was used and in the control one, the routine operating instrument set was used. The two groups were compared in terms of contamination rate and the time for postoperative operating room preparation. Results The contamination rate of the observation group was significantly lower than that of the control group (P<0.01). The time for postoperative operating room preparation of the observation group was significantly shorter than that of the control group (P < 0.01). Conclusion The developed operating instrument set can reduce the rate of contamination at the operated area during cesarean section and shortned the time for postoperative operating room preparation , thus enhancing the work efficiency.

Based on the patient,bundled payment was known as episode-based payment,which pay the overall treatment cost on a or multiple medical service providers.In the current,there were 3 main bundled payment model in the United States,including confirm service,Prometheus and service improvement payment.The series of research showed that,bundled payment could decrease the cost of medical service based on keeping even improving medical service quality.Based on diagnosis related groups (DRGs),bundled payment increased total prepayment control and introduced the calculation method on cost prepayment ratio and potential avoidable allowance and reward for complication.The cost control based on the evidence and the incentive mechanism based on the encourage were all worth for references.

Objective:To analyze the pros and cons of the US strategic national stockpile ( SNS) from the per-spective of the supply chain and to put forward suitable recommendations for China’s national emergency medicine system. Methods:Literature review and a comprehensive analysis have been utilized to understand the SNS supply chain model and its differences from the Chinese model. Results:From the perspective of the supply chain, the Unit-ed State’s storage of emergency medicine consists of the forward placement of push packages, managed inventory and purchase contracts. The deployment of logistics for emergency medicine must gain approval from the federal government’s “local-state-nation” system, and be conducted at a different time. To transmit information, a large da-tabase, simulation software, and a technical advisory response unit have been established to manage information flow to distribute medicine accurately and promptly. Conclusion:Given the experiences of supply chain management in the US SNS system, it is critical for China to improve the supply chain system of emergency medicine, define the institu-tions and responsibilities within the supply chain, establish disaster relief reserve of emergency medicine and adopt fourth-party logistics for emergency medicine in order to make the China’s emergency preparedness more systemized, standardized, and information-based.

The theory of public goods was used to analyze the characteristics and status quo of emergency drug supply in China,holding such drugs as public goods.Based on the public-private partnership(PPP) model,the authors proposed to optimize the existing commanding mechanism,inventory system,information management system and supply system of emergency drugs.We recommended the establishment of an emergency drug supply assurance system,featuring leadership of local governments,and participation of pharmaceutical enterprises and hospitals,in which these entities are assigned with clear-cut emergency supply roles to ensure efficient supply of such drugs in the country.

Objective Analyzing the regional distribution discrepancy of medical and health resources in China,with the purpose of providing the government with policy making evidences for optimizing medical and health resource allocation.Results Dividing China into three regions based on regional economic development and geographic setting,and selecting 6 indicators for medical and health resources.On the basis of the statistics of 31 provinces released by the state in 2009,analyzing the interprovincial disparities of the distribution of these six resources,by means of the coefficient of variation,Gini coefficient and Theil index.Methods The largest inter-regional allocation disparity is found in the number of biopharmaceutical manufacturing companies per ten thousand population.And the smallest discrepancy is found in the number of hospital beds among these regions.The top two extreme differences of resource possession per ten thousand population between the maximum and the minmum region are the number of biopharmaceutical manufacturing companies and tertiary hospitals.The eastern region is the largest contributor to the discrepancy of allocation for the six resources within and between regions.The less developed regions contribute the most inter-regional discrepancy for the allocation of medical practitioners(their assistants included),hospital beds,tertiary hospitals and pharmaceutical companies.And the developed regions contribute the most inter-regional discrepancy of medical finance support from local governments and the most of the allocation of biopharmaceutical manufacturing companies.In general,regions of higher development enjoy greater possession of the SIX resources per population in such regions. But these two are not always in direct proportion. Condnsion Regional distribution disparity of the six resources is not yetreasonable in China.To better meet the health needs of the population in various regions,the government is expected to increase its financial support for building biopharmaceutical manufacturing companies and tertiary hospitals in the less developed western regions,to better use resources of developed regions,and to keep off investments at low level and repetition.The government is also recommended to pay attention to the proportion of government health finance output and the quality and quantity of medical practitioners.

Objective To probe into the strategies for improving the accessibility to orphan drugs for patients of rare diseases in China. Methods Analysis of typical cases of orphan drug use in recent years in China, interviews of hospital administrators and clinical doctors, and analysis of the present health insurance policies in China for orphan drugs, definition of the concept of drug accessibility, clarification of the factors hindering orphan drug accessibility. Results Four factors are found to hinder orphan drug accessibility in such aspects of science and technology, supply, information transfer and medical assurance in China's medicine and healthcare system. These subjective and objective factors affect drug accessibility of the patients of rare diseases, denying them of drug accessibility, of drug use in time, and of affordability of such drugs. Conclusion To raise the orphan drug accessibility in China, it is necessary to define basic concepts and incentive mechanism of rare diseases and orphan drug, design and raise the response mechanism of the medicine and health system in orphan drug supply, build a three dimensional cooperation model between such parties as the government, enterprise and patient, and reduce patients' economic burdern.

Objective:To systematically evaluate the influence of the implementation of essential drug policy ( EDP) on prescrip-tion use rate of antibiotics in primary hospitals. Methods:Based on CNKI, Wanfang and VIP of China journal databases, all litera-tures were adopted including the data of the prescription use rate of antibiotics in primary hospitals. RevMan5. 3 and Stata 12. 0 soft-ware were used to conduct the Meta analysis. Results:Totally 43 literatures were included in the study according to the evaluation se-lection criteria. After the implementation of EDP, the prescription use rate of antibiotics in primary hospitals was decreased, and com-pared with that before the implementation of EDP, the risk difference value was significant [RD= -0. 03,95%CI( -0. 04,-0. 03), P<0. 000 01], while the use rate was still high (46. 16%). The result of Egger’s test indicated the publication bias of the 43 litera-tures was not significant (P=0. 571). However, there was high heterogeneity(I2 =94%,P<0. 000 01)among the different studies. Based on the classification of hospital type and different areas, the results of sub-group analysis showed the differences of study methods in the literatures and regional implementation measures of EDP contributed to the high heterogeneity among the different studies. Con-clusion:In order to reduce the heterogeneity of studies, a unified evaluation criteria for the research quality of the cross-section survey should be established. And special policies related to EDP should be taken to effectively decrease the use rate of antibiotics in primary hospitals.

Objective To explore a medical insurance model for rare diseases and orphan drugs applicable in China.Methods Eleven rare diseases from six disease systems and thirty-five orphan drugs covered were pinpointed for comparative analysis of their present coverage in various medical insurance systems in China.Results The coverage of 35 orphan drugs in the national essential drug list(2009)and the national essential drug list(2012)is 0 and 37.1％ respectively; the coverage in the national essential insurance medicine list is 54.3％ (19 types),and the average coverage in the medicine list for the New Rural Cooperative Medical Insurance Scheme is 33.6％.The study found insufficient rare diseases included in the Basic Medical Insurance Schemes in general.Conclusion The coverage of basic medical insurance for rare disease patients is low in China.In this regard,such measures should be taken to mitigate the economic burden for these patients,namely expanding the coverage of reimbursement list of orphan drugs,building the special reimbursement system of rare diseases and orphan drugs and improving the medical rescue system for rare diseases in China and their medical care level.

OBJECTIVE:To ensure drug use safety and lower drug-induced risks.METHODS:Based on risk management theory and USA-EU drug risk management system,we analyzed the contents of drug risk management,the relationship between drug safety and drug risk,and the classification of drug-risk factors etc.And some suggestions were put forward.RESULT & CONCLUSION:The introduction of drug-risk management system can help facilitate the normalization and standardization of drug safety control,maximize drug benefit and minimize drug risk.

Objective To explore the activation of the primary somatosensory cortex (S_Ⅰ) and secondary somatosensory cortex (S_Ⅱ) undermild and moderate pain. Methods 7 healthy right-handed volunteers accepted electrostimulation of 1 and 2 times pain threshold respectively.The severity of pain was determined with the Visual Analogue Score (VAS), and they received functional magnetic resonance imaging(fMRI) simultaneously. Results 1 and 2 times pain threshold electrical stimulation caused mild and moderate pain respectively. Bothmild and moderate pain activated contralateral S_Ⅰ similarly, and bilateral S_Ⅱ with pain intensity. Conclusion S_Ⅰ and S_Ⅱ respond to the mildand moderate pain in different ways.