Overall progress of the Healthy China initiative highlights the importance of medical humanities in the connotation construction of health services, hence making standardized construction and effective governance of medical social workers a focus of the current healthcare reform. This study summarized the practices of medical social workers engaged in the cabin hospital in Wuchang district, Wuhan city, Hubei province during the outbreak of COVID-19. Their efforts aimed at reducing the stress faced by front-line medical workers, and assisting the patients to achieve body-mind balance for better treatment outcomes." Online+ offline" and" in-cabin+ out-of-cabin" service teams were organized to assist these medical staff, provide social support, and integrate resources. The study analyzed the problems and challenges in the process of practice, and provided a reference for further improving the management of public health emergency services.

Objective To study the quality of outpatient prescriptions for patients of different age groups at both township and village level,for the purpose of evaluating the outcomes and problems of the ongoing healthcare reform at primary levels.Methods 100 outpatient prescriptions of April 2015 were mechanically sampled randomly from two township hospitals and 8 village clinics in counties A and B in Hubei province.These prescriptions were analyzed for the drug count per prescription,percentage of intravenous prescriptions,that of antibiotics,that of hormones and average cost per prescription.Results At the township hospitals,the drug count per prescription(2.02)of county A was less than that of county B(3.26),while the percentage of intravenous prescriptions(30.30%),that of antibiotics(47.98%)and hormones(6.57%)of county A were significantly less than those of county B(50.65%,69.08% and 15.13% respectively).At village clinic level,the percentage of intravenous prescriptions(31.05%)of county A was higher than that of county B(20.34%),the average prescription costs(￥29.28)of county A was less than county B(￥31.45);while in terms of children′s prescriptions,average drug count of county A(2.50)was higher than county B(2.09),and its proportion of antibiotics(65.91%)was higher than county B(45.56%).Conclusions General primary care reform is faced with challenges of poor control of intravenous injection and use of antibiotics,particularly at village clinics and pediatric drug use in terms of prescription quality control.Both township and village levels should strengthen the supervision over the drug suppliers,guide the demand side to rationally use drugs and focus on the reasonableness of the medication of village clinics and children.

Xuzhou Cancer Hospital explored a development and reform of the hospital in the PPP framework,while adhering to the principles of Public nature as before,staff status as before,and government supervision as before. The reform features proactive attempts in operation and management,personnel management,and remuneration system,in an effort to build an operation system featuring board governance,total cost accounting,and dynamic total salary management in its reform toward building an innovative mixed ownership.

This study was designed to measure the performance of county health systems in central and western China utilizing routine healthcare data.Drawing on a literature review and expert consultation,the study established a theoretical framework and an indicator system for performance review.Questionnaires were designed and disseminated to collect empirical data on health system performance in four counties of two central and western provinces.Quantitative data were subjected to descriptive statistical analysis through SPSS12.0.Three dimensions were introduced in the performance review framework-health outcomes,financial risk protection and consumer and provider satisfaction.Health outcomes were assessed from four secondary indicators:infant mortality rate; maternal mortality rate;under-5 child mortality rate; and the incidence of Class A and Class B notifiable diseases.Financial risk was assessed using two secondary indicators:the proportion of the cost of inpatient care that was reimbursed under the New Cooperative Medical System (NCMS) insurance scheme,and the rate of NCMS funds utilization.The assessment of satisfaction was made using two secondary indicators:the overall satisfaction of local residents with healthcare services,and the satisfaction of health practitioners at the township and village level.The study indicated better health system performance in the two counties in Chongqing than those in Shanxi.It was concluded that outcome framework scores can fairly reveal performance differences among county health systems in central and western China,and can provide practical evidence for optimizing the operation and inputs of county health systems.Caution needs to be exercised in generalizing such performance outcomes as many factors such as spending and organization that contribute to county health system performance were not included in the study.

This study was designed to measure the performance of county health systems in central and western China utilizing routine healthcare data. Drawing on a literature review and expert consultation, the study established a theoretical framework and an indicator system for performance review. Questionnaires were designed and disseminated to collect empirical data on health system performance in four counties of two central and western provinces. Quantitative data were subjected to descriptive statistical analysis through SPSS12.0. Three dimensions were introduced in the performance review framework-health outcomes, financial risk protection and consumer and provider satisfaction. Health outcomes were assessed from four secondary indicators: infant mortality rate; maternal mortality rate; under-5 child mortality rate; and the incidence of Class A and Class B notifiable diseases. Financial risk was assessed using two secondary indicators: the proportion of the cost of inpatient care that was reimbursed under the New Cooperative Medical System (NCMS) insurance scheme, and the rate of NCMS funds utilization. The assessment of satisfaction was made using two secondary indicators: the overall satisfaction of local residents with healthcare services, and the satisfaction of health practitioners at the township and village level. The study indicated better health system performance in the two counties in Chongqing than those in Shanxi. It was concluded that outcome framework scores can fairly reveal performance differences among county health systems in central and western China, and can provide practical evidence for optimizing the operation and inputs of county health systems. Caution needs to be exercised in generalizing such performance outcomes as many factors such as spending and organization that contribute to county health system performance were not included in the study.

Objective To compare two common techniques for motor unit number estimation (MUNE), multiple point stimulation(MPS) and incremental stimulation, and determine which is preferable in the follow-up study of patients with amyotrophic lateral sclerosis (ALS).Methods MPS or incremental stimulation MUNE was recorded respectively in 120 ALS patients at baseline and month 3, 6, 9 ,and 12 after study entry.The maximal baseline to negative peak compound muscle action potential (CMAP) amplitude was recorded.For multiple point stimulation, the stimuli sites included the skin of the wrist, 6 cm above the wrist, elbow and 6 cm above the elbow.Individual motor unit responses were obtained by moving thestimulating electrode and isolating threshold responses.Then, with finely graded stimulus intensity at one point, 3 steps in a CMAP were investigated.For incremental stimulation, stimulus intensity was slowlyincreased from subthreshold levels until a small, all-or-none response was evoked.The intensity was slowly increased until the response increased in a quantal fashion.This process was repeated for a total of 10 increments.Single motor unit potential were obtained by subtracting amplitudes of each response from that of the prior response.The values obtained from two methods were compared.Results The value of MUNE declined in the follow-up period.MUNE obtained from MPS was the same as that gained from incremental stimulation at the baseline and the 3rd, 9th, 12th month after study entry, while MUNE obtained in MPS was more than that obtained from incremental stimulation at the 6th month after study entry ( 88 ± 6 and 47 ± 5;t = 1.72, P = 0.04).Conclusions Both MPS and incremental stimulation are certain in the follow-up study of patients with amyotrophic lateral sclerosis.The value of MUNE obtained from two methods might be different in some period.

Objective To examine the technique of multiple point stimulation for motor unit number estimation (MUNE) and to establish the normative value range in Chinese.Methods Surface-recorded motor unit action potentials were measured in 80 healthy subjects.The compound muscle action potential (CMAP) amplitude measured by maximum baseline to negative peak was recorded.The stimuli sites included the wrist, 6 cm above the wrist, elbow and 6 cm above the elbow along median nerve and ulnar nerve.Individual motor unit responses were obtained by adjusting location of the stimulate electrode and isolating threshold responses with distinct morphologies.Then, stimulus intensity was increased gradually to detect single motor unit action potentials (SMUPs).SMUPs were recorded three times.Stimulating was increase again to record another SMUPs set.Total of 12 SMUPs were recorded.Repeat the whole procedure for two times.Results MUNE was 230.0±35.7 in abductor pollieis brevis muscle, and 242.5±30.2 in aductor digiti minimi muscle for multiple point stimulation.Test-retest correlation coefficients and coefficients of variation for mean of two MUNE were 0.88-0.91 and 13.20%-15.24%.Conclusions The multiple point stimulation is a useful and replicable method to asses the MUNE.

Objective To evaluate the application of upper trapezins muscle electromyography (EMG) in the diagnosis of lower motor neuron damage in bulbar region in amyotrophic lateral sclerosis (ALS). Methods Standard EMG was recorded over upper trapezius muscle in 100 patients with ALS, 80 patients with cervical spondylotic myelopathy (CSM) and 100 normal controls. In groups of ALS and CSM,EMG was also recorded over sternocleidomastoid, rectus abdominis, first dorsal intercostals muscle and tibialis anterior muscles. Among those CSM patients, 43 patients had operations and the EMG on their trapezius muscle was examined at pre-operation and at 3 months post-operation. The parameters of EMG were analyzed between the groups. Results In ALS patients, spontaneous activity in upper trapezius EMG was detected more frequently in patients with disease duration equal to or less than 8 months than the others (21/30(70%) vs 28/70(40%), X~2=7.56, P=0.004). There was no difference in neurogenic EMG changes including abnormal spontaneous potentials and motor unit action petentials (MUAP) between trapezius and sternocleidomastoid in patients with ALS. Significant differences in MUAP were noted between ALS patients((1086.9±152.6)μV, (17.2±6.5) ms,23.6%±3.4%) and controls ((606.7± 82.7)μV,(11.6±1.8) ms,12. 8%±2.2%;q=9.27, 4.57, 4.12, all P<0.01), and between patients with ALS and patients with CSM ((615.7±90.3) μV,(12.1±2.0) ms,13.5%±2.4%,q=8.32,4. 25, 4. 23, all P < 0. 01). Few spontaneous activities in trapezius EMG were detected in post-operation CSM patients. Conclusion EMG in upper trapezius can assist in assessment of clinical and subclinical involvement of bulbar lower motor neurons in patients with ALS, especially at earlier stage.

Objective: To establish normative value of multiple segments motor nerve conduction of bilateral median nerve and ulnar nerve, including motor nerve conduction velocity (MCV)、latency (LAT)and amplitude (AMP). Method: Two hundred normal volunteers were divided into 5 groups according to different ages. Median nerve was examined at multiple points: palm, wrist, elbow, axilla and Erb's. Ulnar nerve was examined at multiple points: wrist, below elbow, above elbow, axilla and Erb's. The values of segmental MCV, LAT and AMP were recorded. Result: Gender and sidedness had no effect on MCV, LAT and AMP of median nerve and ulnar nerve. However, age had significant effects on MCV, LAT and AMP of median nerve and AMP of ulnar nerve. Conclusion: The examination of multiple segments motor nerve conduction of bilateral median nerve and ulnar nerve possess important value in diagnosis.

Objective To assess the value of electromyography (EMG) of rectus abdominis muscle in the diagnosis of polyneuropathy. Methods 109 patients with polyneuropathy were studied. The routine nerve conduction study was done and standard EMG was recorded from rectus abdominis muscle, first dorsal interosseous muscle and tibialis anterior muscle. The parameters studied included spontaneous activity fibrillation potentials (fib) and positive sharp waves (psw); duration, amplitude and percentage of polyphasic wave of motor unit action potential (MUAP) and pattern of recruitment. A group of controls and patients with amyotrophic lateral sclerosis (ALS) were studied at the same time. EMG parameters of rectus abdominis muscles were compared among patients with polyneuropathy, patients with ALS and the controls.Results EMG of rectus abdominis muscle in the patients with polyneuropathy showed neurogenic change.The amplitude of motor unit potential in patients with polyneuropathy(451.67±75.01)μV was higher than that of the controls (373.78±56.46)μV (t=2. 01, P < 0. 04) and lower than that of patients with ALS (537.19±159. 04)μV (t=2. 32, P<0.03). Conclusion EMG of rectus abdominis muscle might be used to find the lesion of intercostal nerve in polyneuropathy.