Through an analysis of the establishment of a medical quality and cost reporting system,the paper argues that quality management in the hospital is an eternal theme and that full awareness and high regard of quality management-related costs together with an effective control of them is an important guarantee for gaining advantages amidst quality competition.

In recent years constant improvements have been made regarding medical and health laws and reg-ulations in China while at the same time clinical teaching, a closely related field, has been conducted in accordance with old rules and regulations. Such a mechanism of clinical teaching, which finds itself hard to operate under the new medical and health laws and regulations, will restrict or even hinder patient care and clinical teaching. For this rea-son, it is imperative for us to find by legal means solutions to such problems as the status, work extent and legal re-sponsibility of those engaged in clinical teaching and set up a mechanism and mode of legal guarantees for clinical teaching, wherein there are laws to abide by.

Objective To improve the hospital's capability for controlling the quality and expenses of disease categories so as to reduce unnecessary consumption of medical resources while ensuring medical quality. Methods All inpatient cases in the hospital were classified according to disease categories,reference criteria for the quality and expenses of all disease categories were formulated,feedback and analysis systems and assessment systems for the quality of disease categories were improved,and evaluation of the care quality and work performance by departments or physicians was conducted.Results The departments' awareness of the quality and expenses of disease categories was enhanced,the rate of good-quality cases rose from 80.01% to 86.22%,and the proportion of drug expenses dropped to 40.32%.Conclusion Classified management of cases of disease categories plays a key role in improving a hospital's managerial level,enhancing its medical efficiency,reducing its medical costs,and standardizing its medical behavior.

Objective To explore the clinical application of GlideScope video laryngoscope combined with fiberoptic bronchoscope for double-lumen endobronchial tube intubation in patients with difficult glottis exposure.Methods Forty patients undergoing scheduled for thoracic surgery (24 males,1 6 females,aged 24-78 years,falling into ASA Ⅰ or Ⅱ,Mallampati classification Ⅲ or Ⅳ, were randomly divided into two groups (n=20 each):GlideScope video laryngoscope combined with fiberoptic bronchoscope group (group GF)and Macintosh laryngoscope group (group M).In group GF,GlideScope video laryngoscopy combined with fiberoptic bronchoscope was used to guide the double-lumen tube bronchial intubation and then bronchoscope was used to check the placement of the tube.In group M,the double-lumen endobronchial tube was intubated with conventional macintosh laryngoscope,and then the placement of the tube was checked by bronchoscope.The results of the Cormack and Lehane grade measuring the degree of glottic opening during laryngoscopy,the intuba-tion time consumed,one-time intubation success rate,patients manoeuvre needed to aid tracheal intu-bation and endotracheal intubation related complications within 48 hours after operation were recorded and compared between the two groups.Results Compared with group M,the Cormack and Lehane grade was significantly better (P < 0.01 ), intubation time consumed was significantly shorter [(104.3±1 1.1)s vs.(138.6 ± 33.0)s](P < 0.01 ),one-time intubation success rate was higher (90% vs.55%)(P <0.05 ),fewer patients needed manoeuvre to aid tracheal intubation (20% vs. 90%)(P < 0.01 )and postoperative complications of hoarseness and pharyngalgia within 48 hours were significantly fewer (5% vs.35%,25% vs.75%)in group GF(P <0.05 ).Conclusion Com-pared with conventional method, GlideScope video laryngoscope combined with fiberoptic bronchoscope used to guide double-lumen endobronchial tube intubation in patients with difficult glottis exposure may improve the success rate of intubation,reduce the stress response of intubation and postoperative complications of hoarseness and pharyngalgia.

Objective To establish the evaluation index system on maternal health seeking behavior with Delphi method.Methods Based on Andersen health service utilization models,literature analysis was used to establish evaluation index system on maternal health seeking behavior,then Delphi method was carried out to revise index system through two rounds questionnaire consulting from 24 experts.Results The confirmed index system of maternal health seeking behavior included 4 first-level index,12 second-level index and 57 third-level index.The average authority degree of experts were 0.869,and the coordination coefficients of expert in the total index were 0.195 and 0.166(P＜0.01).The weight coefficients of the indicators at first level were 0.1529,0.3403,0.2786 and 0.2281,respectively.Condusion The representativeness,authority degree and coordination of expert are good,and the tentatively established evaluation index system on maternal health seeking behavior is scientific and reasonable.

The crystal structural data of TACE, MMP-1, MMP-2, MMP-3 and MMP-9 were obtained from PDB database, and then their catalytic domains' properties including conformation, molecular surface hydrophobicity and electrostatic potential were analyzed and compared by using Insight II molecular modeling software. It was found that the conformation and molecular surface hydrophobicity of catalytic domains of TACE and MMPs were not obviously different, but the molecular surface electrostatic potential of catalytic domain of TACE and MMPs had obvious differences. The findings are helpful in the Rational Drug Design of TACE selective inhibitor.

ObjectiveTo explore the influencing factors of health seeking behavior of delivery women in Guangdong province.MethodsStratified random sampling method was used,and 1491 delivery women from primary,secondary and tertiary hospitals were investigated with self-made maternal health seeking behavior questionnaire.Logistic regression analysis was used to analyze the impact of environmental factors and population characteristics on health seeking behavior.ResultsDelivery women with qualified health seeking behavior account for 83.4%.Present pregnancy was planned (OR=2.114),prenatal examination was needed when self-feeling good (OR=2.323),social medical insurance system was socialized medicine (OR=2.755) or medical insurance (OR=1.697),hospital level of secondary hospital (OR=1.568) or tertiary hospital (OR=1.800) were independent positive influencing factors of health seeking behavior.ConclusionThe qualified rate of health seeking behavior of delivery women in Guangdong province is low.Delivery women with the following characteristics of low educational level,low family income,uninsured,coming from rural area and delivery in primary hospital need to be guided scientifically at seeking for health.

Objective To build the method of computerized case classification,for the purpose of perfecting the diseases typing and classification,and supporting the management based on the quality and expenses of the disease.Methods 875 cases were defined into two types.Eight parameters were selected for non-surgery cases,namely the disease diagnosis,severity at admission,and age.For surgery cases,five parameters were defined,namely the disease diagnosis,operative quantity,and severity at admission.Then Fisher function was called into play to obtain the function descriminant equation,realizing computerized classification.Results The rate of matching was 86.2％ between computerized classification and manual classification.The high accuracy of function descriminant equation proves the satisfactory outcomes of the classification.Collusion The computerized classification is satisfactory in its outcomes,and therefore it can better quality of care and cost management of diseases in clinical practice.

ObjectiveTo study the effects and mechanisms of hypoxia-ischemia (HI) on long-term learning and memory abilities and astrocytes in hippocampal formation and the efficacy of nimotop in treating hypoxic-ischemic brain damage. MethodsThe rats were subjected to right common carotid artery ligation followed by exposure to 8% oxygen at 37℃ for 2 h and then 13 rat pups received an introperitoneal injection of nimotop per day immediately following cerebral hypoxia-ischemia for 5 days. When the rats were 80-day-old, they were given test of Y-maze to determine their learning and memory abilities, and then their brain tissues were studied by immunohistochemistry for glial fibrillary acidic protein (GFAP) that marked astrocytes. ResultsThe learning and memory abilities of the HI group were lower than those of the normal control and nimotop treated group (P<0.01), nimotop significantly increased Y-maze learning abilities (P<0.05) of rats received HI, but did not affect their memory abilities. The numerical density of GFAP-positive cells in CA1 radiatum stratum of hippocampal formation were markedly higher in the HI group than those in the other two groups (P<0.01), but the others strata showed no difference. ConclusionHypoxic-ischemic brain damage cause rats to disorders of learning and memory that may be correlated with increase astrocyte in hippocampal formation which became easy to be damaged of declining regulation abilities of neurons microenvironment. Nimotop may be effective to counteract hypoxic-ischemic brain damages.

Objective To compare the efficacy and safety of the non-invasive high frequency ventilation (NHFV) and non-invasive intermittent positive pressure ventilation (NIPPV)in neonates with respiratory distress syndrome (RDS) after extubation.Method Neonates with RDS from January 2015 to January 2016,who required high frequency ventilation after birth and were extubated after treatment were retrospectively studied.The enrolled patients were divided into NHFV group and NIPPV group to compare the rate of successful extubation within 7 days,non-invasive respiratory ventilation support time and complication incidence.Result In total 42 neonates were included,NHFV group were 21 cases and NIPPV group were 21 cases.The rates of successful extubation were not statistically different (71.4％ vs.80.9％,P ＞ 0.05);Compared with NIPPV group,NHFV group had shorter ventilation time [3.5 (2.2,4.1) d vs.4.6 (2.8,5.3)];the incidence of bronchopulmonary dysplasia,pneumothorax,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature and necrotizing enterocolitis between groups were not statistically different (P ＞ 0.05).Conclusion NHFV is a new safe and efficient ventilation support method for extubated neonates,and needs further research.