This paper reviews outpatient security policy of typical developed countries .It provides reference for outpatient security system in China .Analysts believe that the experience for Chinese reference should be acquired in the following ways:The pooling of outpatient service is an inevitable trend in the development of health insurance , which is in principle an integral part of payment and financing system; the implementation of outpatient community first diagnosis system should be adapted to the local conditions; the community first diagnosis system is a necessary condition for capitation , so it is closely related to compensation methods and the elaborate degree of outpatient treat -ment catalog;Outpatient services should be supervised and payment policies should be developed respectively .There are two supervision models about outpatient service:external supervision and self supervision , but the key is to focus on the management of outpatient doctors .External regulation should be consistent with the current regulatory approach of the situation and patients have to bear some responsibilities for outpatient treatment expenses in some proportions , but the payment cap line should not to be low .The implementation of certain preferential policies for vulnerable groups can be considered under the harmonized system to partially reduce their medical expenses .

Extramural vascular invasion(EMVI)was defined as the presence of tumor cells within an endotheliumlined vessel beyond the muscularis propria.High-resolution MRI had 100％sensitivity and 89％specificity in identification of large(caliber greater than 3 mm)EMVI with histopathology as reference.EMVI detected by both histopathology and MRI was significantly associated with local recurrence,distance metastasis and tumor-related death in rectal cancer,which was also identified as an independent prognostic factor for 3-year tumor-free survival and overall survival.EMVI could be used as one of the risk factors,which would allow stratification of patients with rectal cancer to receive neoadjuvant chemoradiotherapy(neoCRT).Moreover,EMVI detected by high-resolution MRI was identified as an independent predictor for response to neoCRT.Tumor regression grading scale defined by high-resolution MRI could be used to evaluate EMVI regression after neoCRT.

In the paper, the training situation of clinical pharmacist of Chinese medicine was analyzed through the current work situation of clinical pharmacy of Chinese medicine in China. The lack of staff and low level are the undoubted facts. In order to promote clinical pharmacy of traditional Chinese medicine, clinical pharmacists with high quality should be trained. How to train clinical phar-macists of Chinese medicine with high quality, some suggestions were put forward from two aspects of the college education reform and clinical training:①The existing education system should be reformed to establish reasonable higher education for clinical pharmacy of Chinese medicines, including the reform of education system, the curriculum adjustment, practice direction change and so on;②With the attention of all the parties, practical talents of clinical pharmacy of Chinese medicine should be trained in clinics, including the na-tion should start the training for clinical pharmacist of Chinese medicine, hospitals should train practical clinical pharmacist of Chinese medicine and carry out the corresponding work of clinical pharmacy of Chinese medicine, staff should improve self quality and so on.

Objective To evaluate the incidence of retinal re-detachment and possible risk factors after removal of silicone oil.Methods The clinical data of 821 patients (858 eyes) who underwent removal of silicone oil in General Hospital of PLA during 2008-2012 were retrospectively analyzed.The patients included 518 males and 303 females.The age was ranged from 1 to 79 years old,with an average of 44.03 years.All patients underwent removal of silicone oil after vitrectomy combined with silicone oil tamponade (the tamponade period was ranged from 40 days to 13 years,with an average of 6.82 months).The incidence,time and causes of retinal re-detachment were analyzed.Results Retinal re-detachment occurred in43 patients (44 eyes,5.13％).Among these retinal re-detachment in 44 eyes,23 eyes (52.27％) occurred in 1 week,13 eyes (29.55％) in 1-4 weeks,4 eyes (9.08％) in 4-8 weeks,2 eyes (4.55％) in 8-12 weeks,and 2 eyes (4.55％) more than 12 weeks after silicone oil removal.Possible reasons of retinal re-detachment included activated original retinal holes (7 eyes),residual peripheral vitreous (3 eyes),traction of epiretinal proliferative membrane (18 eyes),new retinal hole (9 eyes),non-closure of original retinal holes (5 eyes) and traction of retinal incarceration in the scleral incision (2 eyes).Conclusions The incidence of retinal re-detachment after silicone oil removal is 5.13 ％.The incidence reduced gradually with the extension of time after removal silicone oil.

Objective To evaluate the efficacy of hysteroscopic adhesiolysis for intrauterine adhesion. Methods Thirty-two patients with intrauterine adhesions underwent hysteroscopic adhesiolysis between January 2001 and December 2003. Results In the 14 patients with stage Ⅰ or Ⅱ adhesions, the uterine cavity regained normal status after surgery. Among the 9 patients with stage Ⅲ adhesions, the oviductal orifice of the diseased side could be exposed in 6 patients. Of the 9 patients with stage Ⅳ or Ⅴ adhesions, the uterine cavity was dissected to normal configuration but the oviductal orifice was not exposed in 5 patients, and perforation of uterus occurred in 1 patient, who later received a laparoscopic repair and recovered uneventfully. No complications such as overhydration or postoperative infection took place. Out of 27 patients with abnormal menstruation, a regular menses was obtained in 25 patients (92.6%) postoperatively, and amenorrhea remained in 2 (7.4%). The periodic abdominal pain of 12 patients was relieved after operation. The postoperative pregnancy rate was 42.9% (6/14). Conclusions Hysteroscopic adhesiolysis is a safe and effective option for women with intrauterine adhesion.

Objective:To analyze the clinico-pathological features of intestinal neuroendocrine tumors (NET), as well as the treat-ment protocols and survival of intestinal NET patients. Methods:Clinico-pathological features of 82 intestinal NET patients were retro-spectively reviewed. Results:The male to female ratio was 1.41:1 in the group of patients, and the mean age was 48.72 ± 13.26. Up to 72 cases were NET, 7 were neuroendocrine cancer, and 3 were mixed adeno-neuroendocrine carcinoma. The most commonly observed organ exhibiting primary lesion of the tumors was the rectum. The overall five-year survival rates were 78%and 80%among all the pa-tients and among the NET patients, respectively. Tumors of different histological types demonstrated statistically significant differences in terms of primary site, pT stage, and metastasis (P<0.05). The pT stage, histological classification, age, and primary site of the tumors were associated with the metastasis of the intestinal NETs (P<0.05). Age was the main risk factor of metastasis in the tumors. Conclu-sions:Intestinal neuroendocrine neoplasms usually occur in males, and the most commonly involved organ is the rectum. Age is an im-portant factor of neuroendocrine tumor metastasis.

Objective: To analyze relevant ethical issues in safeguarding the right of informed consent among patients with cancer in the course of medical treatment and convalescence,so as to protect their legal right of informed consent and provide a more rational and humanistic medical treatment and nursing.Methods: Phenomenological method was adopted in this research and 13 subjects who met our criteria were interviewed randomly.Results: After reading,analyzing,introspecting,and classifying the data,8 themes of relevant ethical issues are concluded for the right of informed consent among patients with cancer in the course of medical treatment and convalescence,including the informed consent right of independent hospitalization,the informed consent right on one's own illness state,the informed consent right on medical insurance,the informed consent right on medical risks,the informed consent right on therapeutic schedule,the informed consent right on medical documents,the informed consent right on inspection,and family member's rights of informed consent.Conclusion: In order to provide a more rational and humanistic medical treatment and nursing for patients with cancer,relevant ethical issues of patients' informed consent right must be stressed and well settled,so as to better preserve patients' rights of informed consent.

Objective: To analyze the equity of benefit for inpatient services under the three basic medical insurance programs in China.Methods: Using the baseline survey data collected by China Family Panel Studies (CFPS) in 2010, and the two-part model was applied to explore whether the insured groups with different income levels had different aspects on inpatient rate and the compensation of hospitalization expenses in health insurance coverage.Results: There was no significant difference in the inpatient service utilization rate for different income groups, but the highest and second highest income groups reimburse more expenses than the lowest income group, that is 36.5% and 26.3%, respectively.Specifically, the income level and the compensation amount are not significantly correlated in the Urban Employer Medical Insurance (UEMI) program;the compensation amounts to be paid by urban residents are basically increasing with the increase of the income level;and there is a moderate discrepancy between the highest and the lowest income groups in the New Rural Cooperative Medical System (NCMS).Conclusion: The benefit equity is obviously fair in terms of inpatient service utilization rate, but the benefit degree increases for higher income groups, which shows that there are unfair inequalities related to the income at the level of reimbursement.In terms of program comparison, the benefit degree equity is higher for the UEMI program, followed by the URMI program and the NCMS program is the worst.Besides, the impatient rate and reimbursement amounts are significantly lower for NCMS program participants.The government should merge URMI and NCMS programs, actively promote the integration of basic medical insurance system by strengthening the construction of the medical assistance system and improving the system of catastrophic disease medical expenditure insurance in order to achieve better benefit equity.

The reform for medical insurance payment was the important method for standardizing medical service provider behavior,controlling costs and improving efficiency,which was also the important measurement for further improve and implement the reform of drug and health system.Since the new medical reform in 2009,the central and local government had paid more attention on the role of medical insurance payment reform.Local medical departments of different places implemented reform pilots.Through summarizing the foreign and domestic researches around capitation,bundle payment and global payment,the experiences and effectiveness of these pilots were evaluated so as to provide corresponding policy implications.

Doing a good job of guarding against medical risks can effectively improve medical safety and reduce waste of medical resources. In recent years, marked results have been attained in the US in studies on the use of FMEA, a prospective quality analysis tool, to minimize medical risks. Similar studies, though not many, have been made in some other countries, such as Italy and Australia. No reports, however, have been published at home on studies in this field. The paper gives an account of the use and theoretical studies of FMEA in medical risk management in the US, illustrates cases wherein it was used to lower risks in prescribing drugs to patients and ensure the safe use of hospital software and hardware, and puts forward issues that shouldn't be ignored in using FMEA so as to arouse the attention of domestic hospital management departments.