Objective To explore the key factors of public hospital regulation and the impact factors for such regulation,and to provide reference for improvement.Methods Multi-input precedence chart was used to identify the key factors,and decision making trial and evaluation laboratory was used to analyze impact factors on the regulation.Results Such preference charts as medical behavior,quality and patient safety,and admittance scored over 60 points,thus ranking key factors of regulation on public hospitals.Those factors affecting the outcomes of regulation,namelydefective legal system,poor management system, and diversification and fragmentation of supervision entities, as well asincapable supervisors scored greater than 0,ranking as the cause factors.Conclusions The key content and factors related to effect of regulation could be used to improve regulation.In the course of reform of the regulation mechanism,the regulation outcomes could be improved with focus on key regulation factors and main cause factors.

Objective To study the correlation between anatomical measurement and CT measurement of adult occipital thickness so as to provide anatomic evidence for the selection of screw length in occipital-cervical fusion. Methods The occipital thickness was measured on the occipital specimens of 10 normal adults in two ways: direct anatomic measurement and CT measurement. Measurements were made on the basis of the McRac' s line and according to a matrix of 66 points following a grid with one cm spacing. The results of both measurements were statistically analyzed using SPSS 10.0. Results The results of both measurements were highly correlated. The external occipital protuberance was the thickest while the region of cerebellar fossa was the thinnest. The regions two cm lateral to the midline between plane Five and plane Six, one cm lateral to the midline between plane Four and at plane Five, and median between plane Three and plane Four were found to have a thickness of more than eight mm. Conclusions The occipital thickness varies with individuals. CT measurement and direct anatomic measurement are highly correlated. Preoperative CT measurements can be reliable evidence for optimal screw placement before performing occipital-cervical fusions.

OBJECTIVE:To evaluate the economics of caspofungin vs. voriconazole in initial empirical antifungal therapy of fe-brile neutropenia(FN). METHODS:Based on two international multiple center clinical trials about caspofungin vs. voriconazole in initial empirical antifungal therapy of FN,combined with domestic clinical experts'opinions about drug selection,a decision tree model was developed. TreeAge Pro 2011 software was used to analyze the cost and effectiveness of 10-day therapy of caspofungin or voriconazole as initial empirical antifungal therapy. RESULTS:The direct medical cost of caspofungin group was lower than that of voriconazole group(52826.71 yuan vs. 58246.70 yuan). The success rate and survival rate were higher than voriconazole group(33.95% vs. 25.63%、92.36% vs. 91.87%). Whether the success rate or the survival rate of patients as the effect indicators, cost-effectiveness ratio of caspofungin group was lower than that of voriconazole group. Moreover,incremental cost effectiveness ra-tio and sensitivity analysis confirmed this conclusion. CONCLUSIONS:Caspofungin has more advantages than voriconazole in cost and effectiveness as initial empirical antifungal therapy in patients with FN.

Thalassemia is a genetic disease with a high-incidence rate which has influenced the health condi-tions of newborns in south China. In this paper, we analyze the policy process of thalassemia prevention strategy in Guangxi based on John Kingdon’s policy stream theory, discussing the problem, policy and political flows of the strat-egy and analyzing how does the policy window open. We found that the thalassemia prevention policy was based on the deep understanding of the women and children’s health conditions, and the policy entrepreneur had made a pro-gram for alleviating to and eradicating the problem. In the condition of deepening health system reform, the thalasse-mia prevention policy in Guangxi had attracted the attention of policy makers. At a right political time for policy-mak-ing, the three above mentioned flows came in bond pushing the policy window open. As long as the thalassemia pre-vention policy process is analyzed based on the policy stream theory, it could be a good theoretical and practical ex-ample for other public health policy analysis in China.

Objective The study was to provide evidence for the development of local community health services through the analysis of patiems' expectations for community health services. Methods The expectations were indirectly evaluated by investigating the patients in the willingness-to-pay. Results The patients had a generally high expectation for health community services and they would be highly disappointed once their expectations fall short. Conclusions Those expectations that could be realized with short-term efforts ought to attract high attention of community health service providers and made important goals to achieve in the near future.

Objective To investigate the expression and correlation of cell cycle protein-D1 and Ki-67 in laryngeal cancer tis-sues.Methods Immunohistochemical streptavidin-perosidase ( SP) staining method was used to detect the expression of Cyclin D 1 and Ki-67 proteins in laryngeal squamous cell carcinoma tissues and their correlation between Cyclin D 1 and Ki-67 was analyzed .Re-sults Among 56 cases of Cyclin D1 positive over-expressed laryngeal squamous cell carcinoma tissues , 41 cases of Ki-67 had positive over-expression.Among 51 cases of Ki-67 low-expressed tissues, 35 cases of Cyclin D1 had low-expression.Spearman rank correlation test showed that expressions of Cyclin D 1 and Ki-67 in laryngeal squamous cell carcinoma tissues had a significant positive correlation ( rs =0.620, P <0.01).Conclusions Cyclin D1 and Ki-67 expressions in laryngeal squamous cell carcinoma have a significantly positive correlation .

The paper briefly introduced the outpatient and inpatient medical services and medical insurance system in Germany.It also covered the regulatory model and its structure and role of the German medical service,which are characterized ofSociety-led self-governance.Based on the observation and inspiration of this model,the authors came up with.recommendations to improve China' s medical service,medical insurance and regulatory model.

Objective To investigate the correlation between subacromial space and acromial shoulder impingement syndrome (SIS).Methods The clinical and imaging data of 40 patients with SIS were collected and retrospectively reviewed.The shape of acromion and tears of rotator cuff of all patients were classified.A cromion-Humerus (A-H) distance was measured.Results Among 40 patients,there were 9 cases of type Ⅰ,12 cases of type Ⅱ,19 cases of type Ⅲ.32 patients had subacromial space narrowing.7 cases had calcification in the supraspinatus tendon and 10 patients had acromioclavicular joint ostcoarthritis.There were 17 cases of type Ⅰ,15 cases of type Ⅱ,18 cases of type Ⅲ of tears of rotator cuff.6 patients had subacromial bursa thickening,5 patients had subacromial-deltoid sac fluid and 10 patients had the joint capsule fluid.2 patients had jointlabrum avulsion,3 patients had the supraspinatus muscle atrophy and 4 patients had Bankart Lesion.There was no significant difference was found in A-H distance measured with X-ray and MRI(P =0.137 0).There was positive correlation between the A-H distance and class of rotator cuff(r =0.545,P =0.000 1).Conclusion There exists some correlation between subacromial space and SIS.The diagnosis and class of SIS can be assessed according to narrowing range of subacromial space.

Objective To analyze the management of clinical pathways ( CP) in China. Methods Cross-sectional questionnaire surveys of 51 public hospitals with CPs in place in Shanghai, Hubei province and Gansu province were conducted from March to May of 2015. Results Among the 51 public hospitals with CPs, 48 ( 94. 1%) of them organized training on CPs, 48 ( 94. 1%) of them monitored CPs′implementation, and 40 (78. 4%) applied incentives for CPs′ implementation. But there were some issues and difficulties encountered in CPs′ implementation. Conclusions Comprehensive measures are necessary to improve the management of CPs at public hospitals of China.

Objective To analyze the implementation of clinical pathways ( CP) at public hospitals at different levels and in different regions in China. Methods The status of CPs′ implementation at 54 public hospitals in Shanghai, Hubei province and Gansu province was surveyed by questionnaires from March to May of 2015. Results 51 (94. 4%) of the surveyed public hospitals put in place clinical pathway(s), where the average CPs implemented were 45 and the average percentage of the cases using CPs was 52. 7%. There were great variations among these hospitals. In addition, the common diseases with definite diagnostic and treatment options were found with the highest implementation rates of CPs at such hospitals. Conclusions CPs are implemented widely at public hospitals of China, yet enhanced implementation strategies are expected to further CPs′adoption.