This paper systematically analyzed the concept of patients'trust based on a study of the literatures and compared patients'trust with patients'satisfaction. The conclusion is that patients'trust plays a key role on the quality improvements of medical services.

ObjectiveTo analysis the current conditions of the main chronic disease,satisfaction,reactive and trust,then to make the control policy in community health management base in China.Method Using the questionnaire by oneself,which the contents include prevalence,understand rate,management rate,behavior correct rate,control rate,medicine obey and satisfaction,reactive and trust of 2009 the chronic disease in 2009.ResultsThe total investigate people was 1 189 456.The hypertension prevalence is 8.01％,the diabetes prevalence is 4.41％.To compare with Shanghai and Jilin in 6 aspects,the prevalence,understand rate,management rate,control rate,medicine obey rate is higher in Shanghai.But behavior correct rate is lower in Jilin.Survey of hypertension prevalence rate was decreased,awareness,management,rates,rates of behavior modification,medication compliance rates and control rates of growth from 2009 to 2010.Satisfaction,responsiveness and trust indicators investigated a total of 2268 people,the process of service satisfaction to 93.43％,93.78％ overall satisfaction; to have the privacy of reactivity to 94.41％ of the basic amenities and clean comfortable response of the 90.45％ ; of treatment services for the 92.59％confidence,the confidence of the cost for the 93.98％ of the overall trust in institutions is 92.76％.ConclusionsThe government must take main principle in chronic disease control.We must enhance base construct of community health management and increase management level of chronic disease.We must enhance practitioner's culture ang increase knowledge of chronic disease management.

Objective To study the effect of active ingredients(saikosaponin) of bupleurum chinensis D C.on GABA of hippocampus of chronic kindling induced by pentylenetetrazol(PTZ) in rats.Methods Forty-eight healthy Sprague-Dawley rats were randomly divided into six groups with eight in each group: normal control(Group A), normal saline(NS) group(Group B),sodium valproate(VPA) group(Group C),group of large-dose saikosaponin(Group D),group of medium-dose saikosaponin(Group E),and group of small-dose saikosaponin(Group F).Except Group A to be controlled,the other groups were given different treatments when chronically kindled by PTZ.The process of the test lasted for 4 weeks.After 4 weeks' administration the brain tissues were sampled,sliced and stained by enzyme immunohistochemistry(EIH).The results were analyzed according to the positive cell population and gray value.Results The positive cell population of CA1,CA2 and DG in group B was significantly different from that in the other groups(P

The patient-physician relationship can be understood from the two aspects of patients′ trust and patients′ satisfaction.Compared with patients′ satisfaction,dimensions and attributes of patients′ trust indicate to better match with the measuring capacity of patients.Thus,the evaluation of the quality of medical services based on patients′ trust is justified theoretically.The existing literatures assert that the research on patients′ trust could help understand patient-physician relationship and eventually improve the quality of medical services.The conceptual model in this paper entails the concept,dimensions and attributes of patients′ trust.Also,this paper points out its effect on the measurement of the quality of medical services through the comparison of patients′ trust and patients′ satisfaction.

From the aspects of advantages, barriers, opportunities and challenges, this paper analyzed the environmental factors of Shanghai medical resources serving people in the Pan-Yangtze River Delta. As envisaged by the author, such services will provide medical resources information to patients from outside Shanghai, probe into feasible ways to medical insurance based on experiences drawn from serving such patients, help with the resources integration of medical systems in Shanghai, and probe into the potentials of telemedicine and distant medical e-learning, as well as improve hospital management levels and service functionality.

Objective:To study e ects of Saikosaponin a(SSa) on tumour necrosis factor-alpha(TNF-?) release and its receptor expression in cultured hippocampal astrocytes induced by pentylenetetrazol(PTZ).Methods:The in vitro cultured primary hippocampal astrocytes were randomly divided into control group(group A),PTZ-induced group(group B)PTZ10mmol/L+SSa groups(group C and group D,the SSa concentrations were 1.25mg/L and 0.625mg/L respectively).The extracellular uid TNF-? level and the expression of tumour necrosis factor receptor type 1(TNFR1) in hippocampal astrocytes were respectively detected by ELISA and Western-blot after PTZ-induced 2 hours.Results:the TNF-? level and TNFR1 expression of group B were signi cantly higher than that of group A,group C and group D(P

Objective To observe the expression of SGK in decidua in patients with unexplained recurrent spontaneous abortion(URSA) and to investigate its role in the course of apoptosis.Methods The expression of SGK was detected by immunohistochemistry in decidua of URSA(abortion group,n =50) and normal first trimester pregnant women(control group,n =30).The apoptotic index was detected by TUNEL.Results Compared with the control group,the positive expression of SGK decreased significantly in the abortion group,and the difference was statistically significant(x2 =6.78,P ＜ 0.05).The average apoptotic index of the abortion group was (8.19 ± 3.58) ％,which was significantly higher than (2.87 ±1.07)％ of the control group(t =7.94,P＜0.05).Conclusion Intensive apoptosis,the decreasing positive expression rate of SGK in decidua cells may play critical roles in URSA.

Objective To explore the competency of community health administrators in a survey of such administrators at large in Shanghai. Methods McClelland's Competency Dictionary was used to set two benchmark positions, while the behavioral event interviewing and questionnaires were made to survey 19 community health service centers in Shanghai. Results The competency model benchmarking on the head of a medical branch consists of 6 character clusters, 11 characteristic items, 27 evaluation dimensions and 27 typical behavior descriptions. The model benchmarking on the community team leader consists of 5 character clusters, 8 characteristic items, 21 evaluation dimensions and 21 typical behavior descriptions. Conclusion Findings of the survey provide objective criteria for competence appraisal of community health administrators, and serve as reference for formulating their development plans as well.

Objective To discuss the risk factors for coagulopathy in acute isolated traumatic brain injury (TBI).Methods A retrospective study was performed on 191 patients with acute isolated TBI hospitalized from July 2012 to June 2015.There were 70 patients with coagulopathy (coagulopathy group) and 121 patients without coagulopathy (control group).Age,gender,injury type,midline shift on CT and injury severity (Glasgow Coma Scale,GCS) were analyzed to identify the independent risk factors for coagulopathy using the logistic regression analysis.Correlation between the independent risk factors and coagulation indices was analyzed.Results Injury severity,acute subdural hematoma,intraventricular bleeding and midline shift on CT were identified as the independent risk factors for coagulopathy(P ＜ 0.05,OR ＞ 1).Furthermore,injury severity and acute subdural hematoma were respectively associated with abnormalities of international normalized ratio (INR) and fibrinogen (Fg) (P ＜0.05 or P ＜ 0.01),intraventricular bleeding with abnormalities of prothrombin time (PT) and platelet count (PC) (P ＜ 0.01),and midline shift on CT with abnormalities of Fg and PC (P ＜ 0.05).Conclusions Injury severity,acute subdural hematoma,intraventricular bleeding and midline shift on CT are independent risk factors for coagulopathy in patients with acute isolated TBI,and correlate with abnormalities of several coagulation indices.Changes in coagulation indices should be monitored accurately after TBI,and timely treatment of coagulopathy can improve the prognosis.

Objective To assess the incidence,risk factors and mortality of acute kidney injury(AKI)in patients with chronic myelogeneous leukemia(CML)after myeloablative allogenetic hematopoietic stem cell transplantation(HSCT). Methods Renal function in 93 CML patients undergone myeloablative allo-HSCT was retrospectively analyzed by the RIFLE criteria. Results Thirty-nine patients (41.9%) developed AKI at a median of 40 days after allo-HSCT, including 24 AKI-R patients(25.8%), 10 AKI-I patients(10.8%) and 5 AKI-F patients (5.4%). The morbidity of AKI in patients with ≥Ⅲ acute graft-versus-host disease (aGVHD) and without ＜Ⅲ GVHD was (81.82±11.63)% and (36.59±5.32)% (P=0.0037)rospectively. The morbidity of AKI in patients with increased total bilirubin and without increased total bilirubin was (72.73±13.43)% and (37.04±5.37)%(P=0.0192) respectively. ≥Ⅲ aGVHD was peor-prognostic factor of AKI and RR was 2.773 [95%CI (1.073-7.167), P=0.035]. RR of AKI-I and AKI-F in patients with ≥Ⅲ aGVHD was 6.320195%CI (1.464-27.291), P=0.013]. The mortality within 100 days after allo-HSCT of patients with AKI was significantly different as compared to patients without AKI (P=0.001). Six-mouth survival rates of different class AKI patients after myeloablative allo-HSCT were (86.96±7.02)% (AKI-R), (70.00±14.49)% (AKI-I), 0 (AKI-F) (P=0.000)respectively. Conclusions AKI is one of the main complications in CML patients after myeloablative allo-HSCT. ≥Ⅲ aGVHD and increased total bilimbin are poor-prognostic factors of AKI, and higher morbidity of AKI-I and AKI-F can be found in patients with ≥Ⅲ aGVHD. With the deteriorated AKI, 6-month survival is decreased. RIFLE criteria is sensitive to the early diagnosis of renal function. Moreover RIFLE can monitor the progression of AKI and predict the clinical outcome.