Coordinated care delivery is faced with various challenges to carry out in China,which are major decisions to make for decision makers,including how to push forward,how to deliver resources, services and patients to primary institutions,and how to ease the difficulties and affordability of seeing doctors.Based on analysis of roadblocks in coordinated care delivery in China,the authors provided near-term and long-term policy recommendations on the system,including how to build a scientific and reasonable healthcare delivery system,coordinated care delivery by stages,building incentives and constraint mechanisms,and enhancing public awareness and patient-doctor education.

Concept of coordinated care delivery is clearly defined,before a comparative analysis is made between such a concept and the integrated care delivery concept which is popular overseas and similar.On such basis,a theory framework is established for building and implementing such care delivery in line with the integrated theory of care delivery systems.Coordinated care delivery system now in place in China aims at rationally delivering medical resources,services and patients to primary institutions,by means of efficiently distributing resources and service systems and integrating care delivery flows,thus offering patients with cost effective and appropriate services and optimizing the care delivery system.

Objective To investigate the cognition of falling from doctors,nurses and patients in eight Chongqing local hospitals,and develop targeted health education to prevent the occurrence of falling events.Methods Based on data analysis of 368 falling cases from eight Chongqing local hospitals,a selfdesigned questionnaire was developed and used to investigate doctors,nurses and patients from these eight hospitals.1 393 questionnaires were returned,with a recovery rate of 97.69％.The method of t test,analysis of variance and Chi Square （x2) test were used for analysis.Results Nurses had highest recognition for falling features,doctor followed,patients with the lowest,the differences had statistical significance; Nurses' cognitive degree from Third-Grade A-Level hospital was above that of nurses from Second-Grade A-Level hospital,the differences had statistical significance; Doctors' cognition of hospitalization days when falling and susceptible population of falling was lower than that of nurses.Nurses thought falling tended to occur from nightfall to midnight.Conclusions Survey found that,the cognitions of falling from doctors,nurses and patients were different from actual results.Cognition were also different among three sides of them,according to the survey results,health education for different objects should be provided,raise everyone's awareness,thus using targeted falling prevention measures to reduce the incidence of falling.

Objective To understand the psychological needs of old people in nursing homes,so that more humanistic services will be supplied to old people,and hopefully to facilitate the management of the nursing home facilities.Methods Field research method was used in this paper in four nursing homes in Chongqing City.Data were collected by observation and interview.Results Data were coded and translated into three themes:wishing to be listened,especially the new resident; eager to be more respected and the feeling of being at home; the most important thing was happiness.Conclusions To concern the psychological needs of old people in nursing homes and supply corresponding service have a significant meaning for improving the survival state and their life quality,as well as increase service level.

BACKGROUND:Cannulated screw tension band combined with wire fixation is most commonly used for treatment of patel a fractures.
OBJECTIVE:To evaluate the clinical outcomes of combination of cannulated screw tension band and wire fixation in the treatment of patel a fractures.
METHODS:A literature search method was employed to retrieve relevant articles addressing cannulated screw tension band and wire fixation of patel a fractures. In-depth analysis of literatures meeting the study criteria was carried out. Patients with patel a fractures who received cannulated screw tension band and wire fixation were fol owed up to evaluate the postoperative fracture healing, complications and functional recovery of the knee joint at the injury side. Then, the clinical efficacy of cannulated screw tension band combined with wire fixation was analyzed.
RESULTS AND CONCLUSION:After treatment with cannulated screw tension band and wire fixation, patients with patel a fractures exhibited good fracture healing and low probability of complications, including screw or wire loosening, broken, and shedding. Functional recovery of the affected knee was up to 90%. Clinical case analysis showed that cannulated screw tension band combined with wire fixation achieved good outcomes in the treatment of patel a fracture, with over 90%functional recovery of the affected knee, which is consistent with the reported results. It indicates that the cannulated screw tension band combined with wire fixation is one of the ideal and reliable methods in use for internal fixation of patel a fractures.

Technology and technique of coronary artery stent have been developed to a certain degree, restenosis rate of metal stent reduces to 15%, but coronary artery stent is still difficult for long-term effect of interventional therapy on coronary atherosclerotic heart disease. Drug-eluting stent is newly discovered during recent years, while it is prospect for preventing restenosis postoperatively. Although clinical efficacy of drug-eluting stent is encouraged, indication is still simple. In addition, some events related to drug-eluting stent remain poorly unknown. This study was designed to compare security between drug-eluting stent and metal bared stent, analyze major factors correlated with security of drug-eluting stent, and investigate the development of drug-eluting stent.

Autoimmune Diseases ; Child ; Humans

This paper analyzed the current scientific research situation of medical postgraduates in Xi'an Jiaotong university,stated briefly the existing main problems and relevant influence factors including poor scientific research ability due to low quality enrollment,unreasonable construction of experimental platform,patchy quality of tutor teams et al.To solve the problems above,several policies were proposed,mainly including strengthening basic experimental skills of medical undergraduates,reforming the postgraduate curriculum system,optimizing the building of experimental platform and reinforcing the development of tutor teams.

Objective To explore the influence of fluid management and prognosis guided by goal direction on patients undergoing gastrointestinal surgery.Methods Eighty ASA grade Ⅰ-Ⅲ,consecutive consenting patients undergoing gastrointestinal surgery were divided into observation group (40 patients)and control group (40 patients) by random digits table method.The intraoperative fluid management in control group was based on central venous pressure(CVP),and kept CVP at 8-10 mmHg(1 mmHg =0.133 kPa).The intraoperative fluid management in observation group was based on stroke volume variation (SVV),and kept SVV at 10 ％-12％.The operation time,intraoperative and postoperative 3 d fluid management,time of defecation and exhaust,time of full or semi-liquid diet,length of stay in hospital,rate of complications after operation for 48 h between two groups were compared.Results The volume of total fluid,colloid solution and crystalloid solution received during operation in observation group were significantly lower than those in control group[(2 686.0 ± 977.5) ml vs.(4 837.5 ± 1 566.0) ml,(792.4 ± 197.6) ml vs.(1 284.6 ± 356.7)ml,(1 894.9 ± 460.4) ml vs.(3 569.9 ± 1 318.7) ml] (P ＜ 0.05).The time of semi-liquid diet,length of stay in hospital in observation group were significantly lower than those in control group [(171.1 ± 45.3) h vs.(235.8 ±89.5) h,(11.4 ±1.8) d vs.(14.7 ±4.9) d] (P＜0.05).The time of full liquid diet,time of defecation and exhaust between two groups had no significant difference(P ＞ 0.05).The rate of complications between two groups had no significant difference(P ＞ 0.05).Conclusion Compared with monitoring CVP,the fluid management based on SVV can decrease the fluid volume during operation and shorten the length of stay in hospital.

OBJECTIVE To investigate the antibacterial resistance of clinical isolates from inpatients of non-ICU departments in China in 2006-2007.METHODS Clinical isolates were collected by member hospitals of Mohnarin according to unified protocol.Bacterial susceptibility testing was carried out using Kirby-Bauer(KB),MIC or E-test methods according to CLSI 2006.The data were analyzed by WHONET 5.4 software.RESULTS A total of 77253 clinical isolates from inpatients of non-ICU departments in Mohnarin member hospitals were collected from Jun 2006 to May 2007,of which Gram-negative bacteria accounted for 53549(69.3%),and Gram-positive cocci for 23704(30.7%).Meticillin-resistant Staphylococcus aureus(MRSA) and coagulase-negative Staphylococcus(MRCNS) strains accounted for 57.6% and 83.3%,respectively.There was no glycopeptide-resistant Staphylococcus to be found,but small part of coagulase-negative Staphylococcus was teicoplanin intermediate or resistant.50.9% Of Enterococcus faecalis and 69.9% of E.faecium strains were resistant to high concentration gentamicin.1.1% And 2.7% of E.faecalis and E.faecium isolates were resistant to vancomycin,0.8% and 2.7% resistant to teicoplanin.There were 9.9% isolates of Streptococcus pneumoniae were penicillin-nonsusceptible.About 34.5% Escherichia coli and 23.5% Klebsiella pneumoniae isolates were ESBLs-producing strains.Isolates of Enterobacteriaceae were still highly sensitive to imipenem and meropenem,the average resistant rate was less than 2%.There were about 70% E.coli isolates resistant to quinolones,and 20-60% of non-fermentative Gram-negative bacilli were resistant to antibacterials.CONCLUSIONS Bacterial resistance is severe in inpatients in our country,and the resistant rates are increasing.More effective measures should be taken