Based on the practical dilemma that the moral relation model of traditional acquaintance society has already declined incurrent social development,it is urgent tocarry out the field observation and comparative study of two-level moral field in rural areas and to discuss appropriate strategies to reconstruct new ethical relations and moral behaviors among rural medical staff from the perspective of moral contract.Based on this,both the village acquaintance society in rural and the non-acquaintance society in towns need to adapt to the change of contractual service models to some extent because of different presentation of multidimensional moral connotation.Under the guidance of moral contract theory and practical application,moral relations and moral behaviors should be reconstructed to promote the formation of advocating moral and goodness and doctor-patient trust.

Medical students′ humanistic quality and ability are the key practice elements beyond professional skills. In the perspective of humanization, the cultivation of humanistic ability should guide medical students to es-tablish the human-centered service concept, and break through the narrow limitation of technological view with re-garding disease as the center, and. To integrate the humanism and medicine, the medical humane education should broaden the practical teaching channel and enrich the contents of teaching, based on clarifying the multi-demands.

Objective To explore a layered nursing intervention based on risk assessment strategies application effect in elderly patients with hip replacement. Methods Chosen during January 2013 to December 2014 rows of orthopaedic trauma treated 224 patients of senile hip replacement as the research objectto divide into observation group and control group 112 caseseach according to admission time.Observation group applied based on risk assessment strategy stratification nursing intervention, the control group used conventional care. Compared two groups of patients with postoperative pain degree, hip function, complications, and patient satisfaction. Results For 24 h, 48 h, 72 h after the operation, Visual Analog Scale (VAS) scores of observation groupwere 2.25 ± 0.35, 2.01 ± 0.31, 1.92 ± 0.23, which were significantly lower than 3.53 ± 0.51, 2.84±0.45, 2.70±0.35 of the control group (t=21.900, 16.075, 21.900, P<0.01);3 months and 12 months after the surgery, the index of the Harris hip score observation group was 71.32 ± 7.45, 93.44 ± 9.65, which were obviously higher than 60.47 ± 6.65, 83.75 ± 9.21 of control group (t=11.498, 7.688, P<0.01);8.04%(9/112) incidence of complications such as infection of incision, increase of observation group was obviously lower than 20.54%(23/112) of the control group(χ2=7.146, P<0.05);97.32%(109/112) satisfaction was significantly higher than 78.57% (88/112) of the control group (χ2= 18.572, P < 0.05). Conclusions Stratified nursing intervention based on risk assessment strategy can help to alleviate the degreeof pain, improve hip function, reduce postoperative complications and improve patient satisfaction.

Objective To determine in vitro susceptibility of itroconazole,voriconazole,caspofungi,and amphotericin B against 82 clinical strains of filamentous fungi.Methods Etest method was used to test the in vitro susceptibilities of itroconazole,voriconazole,caspofungi,and amphoteriin B against aspergillus fumigatus,A.flavus,A.niger,A.terreus,A.nidulans,et al.Results The MIC range of 4 antifungal agents were 0.03~2.00 mg/L and 0.01~32.00 mg/L against A.fumigatus and A.flavus,respectively.But amphotericin B had higher MIC90 value which was 16mg/L against A.flavus than A.terreus(MIC90 3.00 mg/L),A.fumigatus(MIC90 0.75 mg/L),and A.niger(MIC90 0.25 mg/L).Conclusion Itroconazole,voriconazole,caspofungi,and amphotericin B have different susceptibility patterns against various types of filamentous fungi.It's necessary to identify fungi to level of species and perform antifungal susceptibility test in serious patients.

The paper describes the basis, scope, and contents of the index system for assessing maternity and child care institutions in Beijing. The new system, based on the readjustment, recombination and redistribution of the original index system for assessment, has two newly added elements, viz. financial position analysis and leadership style and organization culture. In order to make a distinction between leaders' responsibilities and an institution's orientations and to reduce behavior abnormality and information bias in the process of assessment, the new system has been divided into two major parts: evaluation of the institution's conditions for survival and capabilities for development, which is jointly decided by internal and external factors, and appraisal of the institution's performance, which is decided mainly by internal factors.

Objective:To investigate the diagnosis and treatment for incarceration of retroverted uterus in pregnant women.Methods:This study retrospectively recruited four gravidas with incarcerated retroverted uterus indicated by prenatal ultrasonography in Hunan Provincial Maternal and Child Health Care Hospital from August 2016 to February 2020. Clinical features, diagnosis, and treatment of these cases were described.Results:Vaginal bleeding or discharge were the main symptoms of the four cases and prenatal ultrasound suggested incarcerated retroverted uterus. Obstetric examination was performed for all cases, except one due to small gestational age, and bulging posterior fornix was found in one case. Three cases were diagnosed in the third trimester and one at 14 gestational weeks. In light of gestations, symptoms, and anterior uterine muscle thickness, three patients underwent planned cesarean sections with a median abdominal incision and a superior transverse uterine incision after fetal lung maturation acceleration. Uterus involution was good, and the incisions healed well in these three cases, with all neonates in good condition. Following a two-week knee-chest position treatment, the position of her uterus and bladder turned normal in case 4.Conclusions:Considering the atypical clinical presentations, clinicians should be aware of incarceration of retroverted uterus when related symptoms or signs were presented. Placenta previa might be the comorbidity and should be differentially diagnosed. The timing of a cesarean section is supposed to be determined based on multiple factors. Moreover, a median abdominal incision and a superior transverse uterine incision are recommended, and an anatomic landmark is often required for the latter's accurate position.

Objective To probe into the current services and outcomes of township hospitals following their transformation, and their future positioning of functionality. Methods Pinpointing townships A, B and C as samples from a district in Beijing, in which field surveys were made in the township hospitals to learn their services, service provision methods and outcomes. Results Among the current services provided by these three hospitals, those of public health and primary healthcare nature in hospital A account for 50% each; those in hospital B account for 70% and 30% respectively; those in hospital C account for 60% and 40% respectively. Recommendable services provided in these hospitals include universal coverage of medical files, management of infectious diseases, public health emergency management, and immunization. Conclusion Township hospitals as the center of the 3-tier rural health service network, deserve a repositioning of their functionality to fit the health needs of residents at large.

A brief description of performance appraisal as used in the healthcare sector, and an analysis of problems existing in performance appraisal for posts in community heahhcare organizations in the country. The paper proposes a job-analysis based performance appraisal for such posts, featuring the appraisal model of "performance + skills + attitude+ work intensity". On the basis of work analysis, a job description should be worked out for such healthcare workers as doctors, nurses and prevention workers in community healthcare organizations, aided by a targeted job-based performance appraisal system. These efforts can effectively enhance the job performance in such organizations, catering to the healthcare needs of community residents.

Objective To explore the effects of dexmedetomidine on analgesia of general anesthesia in elderly patients with lumbar vertebra surgery.Methods From August 2013 to for August 2014, 80 cases elderly patients with fracture of lumbar vertebra and prepared to have an surgery of pedicle screw internal fixation in Department of Anesthesiology in Beijing Jishuitan Hospital were admitted , and divided into control group and observation group.The control group were continuously-pumped with sufentanil and the observation group with dexmedetomidine for anesthesia.The anesthetic effect were compared between two groups.Results The rate of sedative satisfaction in observation group post-anesthesia was higher than that in control group (100.0%vs.75.0%;χ2 =11.429,P<0.05).The Ramesay score, awaking and extubation time perioperational period in observation group were lower than those in control group(P<0.05).The analgesic effect in observation group was higher than that in control group(100.0%vs. 90.0%;χ2 =4.211,P<0.05).Conclusion Dexmedetomidine has the obvious sedative and analgesic effect on elderly patients with lumbar vertebra surgery.

An analysis of the existing incentives mechanism of performance appraisal for community health service centers, and insight into the challenges for linking the post performance appraisal in community health service centers with incentive measures. It is pointed out the administrators should take a variety of measures including material incentive, target incentive, knowledge incentive, and emotional incentive among others. In addition, such measures should be used sophistically, flexibly and reasonably, while timing of incentives should meet the human resource needs of the institution, notably a combination of positive incentive with negative ones,, mostly the former incentive.