Coordinated care delivery is faced with various challenges to carry out in China,which are major decisions to make for decision makers,including how to push forward,how to deliver resources, services and patients to primary institutions,and how to ease the difficulties and affordability of seeing doctors.Based on analysis of roadblocks in coordinated care delivery in China,the authors provided near-term and long-term policy recommendations on the system,including how to build a scientific and reasonable healthcare delivery system,coordinated care delivery by stages,building incentives and constraint mechanisms,and enhancing public awareness and patient-doctor education.

Concept of coordinated care delivery is clearly defined,before a comparative analysis is made between such a concept and the integrated care delivery concept which is popular overseas and similar.On such basis,a theory framework is established for building and implementing such care delivery in line with the integrated theory of care delivery systems.Coordinated care delivery system now in place in China aims at rationally delivering medical resources,services and patients to primary institutions,by means of efficiently distributing resources and service systems and integrating care delivery flows,thus offering patients with cost effective and appropriate services and optimizing the care delivery system.

OBJECTIVETo observe the prevention and clinical efficacy of combination of Liuwei Dihuang Pill (LDP) and Ginkgo Leaf Tablet (GLT) for early diabetic retinopathy (DR).

METHODSUsing randomized, double-blind, double simulation, parallel controlled clinical trial, 140 type 2 diabetes mellitus (T2DM) outpatients were recruited and assigned to the treatment group and the control group, 70 in each group. All patients received basic Western medicine treatment (such as blood glucose and pressure control). Patients in the treatment group took LDP (8 pills each time, 3 times per day) and GLT (19.2 mg each time, 3 times per day), while those in the control group took LDP placebos and GLT placebos. All treatment lasted for 24 consecutive months. All subjects were followed-up every month. The general clinical data as sex, age, and metabolic data such as blood glucose, blood pressure, blood lipid, and DR prevalence rate were collected and statistically analyzed.

RESULTSThere was no significant difference in levels of blood glucose, blood pressure, or blood lipid between the two groups (P > 0.05). After treatment the DR incidence rate was significantly lower in the treatment group than in the control group [3.1% (2/64) vs 18.6% (11/59), P < 0.05)]. Meanwhile, the DR prevalence rate of the treatment group was also significantly lower than that of the control group [6.3% (4/64) vs 20.0% (13/59), P < 0.05].

CONCLUSIONCombination of LDP and GLT could effectively prevent and treat the development of DR in T2DM patients.

Blood Glucose ; analysis ; Blood Pressure ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Retinopathy ; drug therapy ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Ginkgo biloba ; chemistry ; Humans ; Phytotherapy ; Tablets

Objective To investigate the effects of ephedrine on glial fibrillary acidic protein (GFAP) expression after cerebral ischemia-reperfusion injury in rats.Methods Altogether 60 male SD rats were randomly divided into sham-operation group,natural recovery group and ephedrine treatment group.The unilateral ischemia-reperfusion models were induced by clue-blocked method.The expression level of GFAP around ischemic area was examined by immunohistochemical technique at weeks 1,2,3 and 4 after operation.Results GFAP expression began to increase at 1 w and stabilized at 3 w in ephedrine treatment group and natural recovery group.There was a significant increase of GFAP expression in ephedrine treatment group compared with that in natural recovery group (P

Analyzed in the paper is the present development of medical rehabilitation service system in Beijing,Changsha,and Urumqi,in an effort to identify key measures,and discover problems found with the policy environment and system building.Based on such findings,the authors proposed such measures as developing policies and regulations, optimizing resource allocation, strengthening training of rehabilitation personnel and greater publicity.

Blood Coagulation Tests ; Coagulation Protein Disorders ; blood ; physiopathology ; Female ; Humans ; Young Adult

Objective To explore different socio-demographic and clinical characteristics for early onset patients (EOP) with psoriasis and late onset patients (LOP) with psoriasis in Chinese population and to provide scientific evidences for establishing comprehensive prevention and treatment strategy for psoriasis.Methods Cross-sectional study was performed.A total of 942 diagnosed psoriasis patients who paid a visit to outpatient clinic in a tertiary hospital in China from 12th September 2013 to 19th May 2015 was consecutively enrolled and investigated.Exploratory analysis was conducted to detect the association between disease onset age and patients features.Results Among 942 enrolled psoriasis outpatients,the average age was (40.6 ± 13.6) years with a range from 5 to 80 years.The sex ratio was 2.1 in favor of male.The most observed type of psoriasis in the present study was psoriasis vulgaris (98.3％).The average psoriasis area and severity index (PASI) for patients were 9.47 ±7.63.Comorbidity was combined in 20.2％ cases.Patients with EOP had a significantly higher likelihood of family history of disease.Compared EOP to LOP,LOP had a significantly higher likelihood of comorbidities involvement (P ＜ 0.05) and significant higher BMI index (P ＜ 0.05).Conclusions The present study supports the hypothesis that there are clinical differences between EOP and LOP in Chinese population.Both dermatologists and patients should pay more attention to psoriasis-associated features,such as family history and comorbidity diseases involvements.

Objective To explore the effects of wearing ankle-foot orthoses (AFOs) on motor function in children with spastic cerebral palsy (SCP). Methods Fifty-two children with SCP were randomly divided into a wearing-for-training group (n = 16, group 1 ), a day-wearing group (n = 19, group 2) and a day-night-wearing group (n = 17, group 3). In addition to the conventional rehabilitative treatment given to all participants, the children in group 1 wore AFOs during movement training, and children in group 2 wore AFOs in the daytime for 6-8 h per day, while AFOs were applied to the children in group 3 for 24 hours a day except for cleaning and during certain training routines. All the treatments were continued for 2 months. Clinical assessments included the range of passive ankle dorsi-and plantarflexion (APROM) , modified Ashworth scale (MAS) ratings, and the D and E dimensions of the Gross Motor Function Measure (GMFM). All were performed before and after treatment. Results Before treat-ment, no statistically significant differences were found among the three groups in terms of APROM, MAS, or GM-FM. There were significant subsequent improvements in groups 2 and 3 when compared with group 1 in terms of APROM, MAS and GMFM results. Group 2's improvements in APROM and MAS results were not significantly better than those of group 3, but their average GMFM score improvements were significantly better. Conclusion Wearing AFOs in the daytime 6-8 hours per day is more effective in reducing spasticity and improving functional performance in children with SCP.

Authors described the patterns,core measures and mechanisms of coordinated care delivery in the localities and analyzed initial outcomes of this practice.It is found that such practice has optimized distribution of regional healthcare resources,implemented first visit to primary institutions, and the care delivery to separate emergency from outpatient service.In addition,the paper analyzed problems found in localities in terms of policy,public hospitals and primary institutions,and proposed elements required for coordinated care delivery system to succeed,such as enhanced policy support, enhanced multi-departmental coordination,and public hospital reform to explore feasible approaches.

This paper summarized practices and experiences of other countries in coordinated care delivery system building,and described the care delivery systems used in various healthcare fundraising patterns.It is found that most countries have defined duties and service coverage of healthcare institutions at all the levels and measures to ensure rational patient flow.In the end,the paper concluded found experiences of these countries and inspirations for China.