OBJECTIVE:To provide reference for further promoting the implementation ofseparation of prescribing and dis-pensingpolicy which fit China's national conditions. METHODS:Based on literature review,informant interview,and filed in-vestigation the development ofseparation of prescribing and dispensingwere compared between typical eastern and western coun-tries. Constraints ofseparation of prescribing and dispensingin China were explored,international successful experiences were summarized to inspire appropriate implementation of this policy in China. RESULTS & CONCLUSIONS:There are four con-straints in the implementation ofseparation of prescribing and dispensingin China. Firstly,the legal foundation is yet established for the professional development of pharmacists. Secondly,the medicine pricing and hospital financing systems are unreasonable. Thirdly,patients'ownership of prescriptions and right of dispensing options are monopolized by hospitals. Fourthly,safety of medi-cines use is yet ensured.Separation of prescribing and dispensingshould follow the rules of social and economic development and should be adjusted to adapt local conditions.Separation of prescribing and dispensingpolicy itself may not help to achieve the objectives of cost containment and rational use of medicines. To achieve the intended objectives,legislation of Pharmacist Law should also be accelerated to clearly define the role of pharmacist and guide the behavior of prescribers with economic levers.

Objective To explore the influencing factors of inpatients′satisfaction in different types of hospitals from the perspective of demand and supply sides,and to generate evidence for further healthcare improvement in different types of hospitals.Methods Based on the inpatient satisfaction survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals, the discharged inpatients were divided in four groups according to the hospital types as general, traditional Chinese medicine(TCM), maternal and child(MCH)and specialty hospitals.SPSS 22.0 and SAS 9.4 softwares were used to conduct the Pearson chi-square test,variance analysis, Bonferroni test for univariate analysis,and binary multivariate logistic regression analysis,to explore the influencing factors of inpatients′satisfaction in different types of hospitals.Results The social and demographic characteristics were adjusted.Reasonable hospitalization expenditure was the most common influencing factor of inpatients ′satisfaction in general hospitals,TCM hospitals and MCH hospitals(P<0.01,OR=2.89,2.53,2.98). Quiet hospitalization environment was the most significant influencing factor of inpatients satisfaction in specialty hospitals(P <0.01, OR =2.32).Time-phased appointment for tests and examinations was another significant influencing factor of inpatients satisfaction of MCH hospitals(P<0.01, OR=2.25)and TCM hospitals(P<0.01, OR=1.91).Convenient admission was another influencing factor of inpatients satisfaction in specialty hospitals(P<0.01, OR=2.21).Conclusions In the next stage of healthcare improvement,different types of hospitals should take targeted actions.Specialty hospitals should control the visiting schedule and strengthen sound blocking facilities in the ward,in order to keep a quiet environment for inpatients, and further simplify the admission procedures.MCH and TCM hospitals should further promote the precise appointment system for tests and examinations.

Objective To analyze the differences and influencing factors of inpatient satisfaction on hospitals of different types in different regions two years following implementation of the National Healthcare Improvement Initiative.Methods Data of hospitals and inpatient satisfaction survey results were collected from the a third-party evaluation of the National Healthcare Improvement Initiative, and analyzed in a two-step clustering model.This effort aims at learning the subjective feelings of inpatients and impacts of the objective indicators of medical resources allocation on inpatient satisfaction.The analysis helps identify indicators to be included into the clustering model and their correlation with such satisfaction.Results The two-step clustering rounded hospitals into four categories based on the inpatient overall satisfaction.Gaps were found among different categories of hospitals in terms of types of hospitals, location, affiliation and healthcare resources allocation.The inpatient overall satisfaction varied with these indictors.Among the category with the highest inpatient overall satisfaction, 100% were general hospitals, most of which in eastern area(52.38%),and local hospitals(50.00%).Hospitals in this category feature larger scales and stronger medical techniques.The category with the lowest inpatient overall satisfaction were mostly hospitals located in western regions(65.52%), maternal and child hospitals(41.38%)and local hospitals (89.65%).Most of these hospitals were large in scale, but their medical techniques and resources fell behind their eastern counterparts.The strongest correlation with inpatient overall satisfaction was medical behavior(r=0.95), while the weakest was the medical resources allocation(r<0.30).Conclusions There are gaps of inpatient overall satisfactions among different types of hospitals located in different regions. Patients′subjective perceptions and medical resources allocation affected their overall satisfactions.The non-medical services were important factors towards patient satisfaction.

Gonorrhea, caused by Neisseria gonorrhoeae, is one of the most frequently reported infectious diseases. With the increasing antibiotic resistance in Neisseria gonorrhoeae, gonorrhea has become a major public health problem worldwide, making it imperative to develop a safe and effective vaccine. Lipooligosaccharides (LOS), which exist on the outer surface of gram-negative bacteria, contain many important antigenic determinants. In recent years, a large number of studies have shown that LOS may become the most potential target of Neisseria gonorrhoeae vaccine and immunotherapy. This article reviewed the structure of LOS, its role in Neisseria gonorrhoeae infection, research progress in LOS vaccine and the challenges faced in vaccine development, aiming to provide reference for further study.

BACKGROUND: As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches. METHODS: In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months' management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months. RESULTS: A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96. CONCLUSIONS: The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management. TRIAL REGISTRATION ClinicalTrials.gov, NCT03264638.
Biomarkers ; Female ; Humans ; Metabolomics ; Polycystic Ovary Syndrome/diagnosis* ; Prospective Studies ; ROC Curve

The 2nd round of the third-party evaluation of the National Healthcare Improvement Initiative was made during Dec 2016 and Jan 2017.The methods, organization and implementation of the survey and the technical roadmap were the same as those of the 1st round of evaluation.The total number of respondents was 94 218,including 19 773 doctors,24 315 nurses,29 105 outpatients and 21 025 inpatients. 142 typical cases were collected from sample hospitals.The key findings showed that, the National Healthcare Improvement Initiative has been implemented quite well in the 2nd year, achievements and challenges exist side by side.The overall satisfaction rate of both outpatients and inpatients was good, both were about 90%.Further improvement is expected.Hospital staff have been actively involved in this Initiative,but they are not satisfied with their working environments and compensations.

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system.Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment(2016-2017),the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred.Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower(P<0.01,95%CI=-0.17, -0.06).The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03,95%CI=-0.11,-0.01).Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction.To further improve the referral system and to raise patient satisfaction,there is a need to take following actions,to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system,to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system.In addition, it is critical to further regulate and optimize the referral procedures,so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy.Finally,it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.

Objective To understand the current situation of inpatients′perceptions of doctor-patient relationship and its influencing factors, and to make policy recommendations for further targeted healthcare improvement.Methods Based on the survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we analyzed the inpatients′perceptions of doctor-patient relationship.SPSS 22.0 software was used to conduct Kruskal-Wallis test and Dunn-Bonferroni test,and SAS 9.4 was used to conduct multivariate logistic regression to analyze the influencing factors of inpatients′perceptions of doctor-patient relationship.Results The mean perception score of the inpatients pertaining to doctor-patient relationship was 4.34 ±0.84,and the median was 5.00.The perception score of the male inpatients pertaining to doctor-patient relationship was significantly higher than that of the female respondents(P<0.05),that of the inpatients who had fixed physicians or general practitioners before visiting was higher than that of the inpatients who did not have(P <0.05).The overall satisfaction of inpatients during hospitalization(P <0.01, OR =2.73)and doctors′satisfaction to have enough communication time with patients(P <0.01, OR =1.84)were the most significant protection factors to inpatients′perceptions of doctor-patient relationship.The process and structure evaluation results of hospitals in harmonization of doctor-patient relationship was a significant risk factor.Inpatients who had fixed physicians or general practitioners before visiting(P<0.01, OR=1.31)was another statistically significant positive influencing factor of inpatients′perceptions of doctor-patient relationship.Conclusions It is imperative to strengthen communications between doctors and patients and to improve healthcare service, in order to raise patients′satisfactions for a harmonized doctor-patient relationship.In addition to establish a working mechanism for medical disputes as a post-incident strategy, hospitals are recommended to take proactive and preventive measures.In addition,measures like integration of family doctor system and medical alliance system,as well as encouraging patients to contract their family doctors will help to harmonize the doctor-patient relationship.

Objective To learn the current situation and influencing factors of outpatients′perceptions of doctor-patient relationship,and to generate evidence for effective improvement of outpatients′perceptions of doctor-patient relationship.Methods Based on the results of the third party evaluation of the National Healthcare Improvement Initiative(2016-2017)in 136 hospitals, we analyzed the outpatients′perceptions of doctor-patient relationship and its influencing factors.Univariate analysis of the outpatients′perceptions of doctor-patient relationship(Chi-square test and Wilcoxon rank sum test),and binary logistic regression were conducted to analyze the influencing factors of the outpatients′perceptions of doctor-patient relationship.Results A total of 29 105 out-patients were included in this study.The average outpatient perception score of doctor-patient relationship was 3.88 ±0.99, and the median was 4.00.The perception score of outpatients pertaining to doctor-patient relationship was the highest in the eastern regions and lowest in the western regions.That of outpatients from general hospitals was highest than that of those in maternal and child hospitals and traditional Chinese medicine hospitals.Patients′waiting time for consultation,having a fixed physician or general practitioner before visiting, contracting with a community doctor or not, the overall satisfaction,and the household income and insurance coverage were all the influencing factors of the outpatients′perceptions of doctor-patient relationship(P<0.05).Conclusions There is still a long way to go before the patients can agree with the perception of a better doctor-patient relationship.The critical points for improvement include reducing waiting time for consultation, allocation of more medical resources to the western regions,improving humane care to patients and raising outpatients′overall satisfactions, especially in the departments of obstetrics and gynecology,and pediatrics.

The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.