ObjectiveTo identify and clarify the key issues faced by tertiary hospitals in responding to public health emergencies. MethodsA literature review index system was constructed， and key issues were identified using hierarchical analysis. ResultsAfter a systematic literature review， 20 types of problems faced by tertiary hospitals in responding to public health emergencies were identified. Three key issues were ultimately identified by prioritizing the issues that needed to be addressed. ConclusionThe key issues of tertiary hospitals in responding to public health emergencies are concentrated in the areas of emergency response capabilities and competencies of medical staff， the number of emergency response personnel， and the standardization and specificity of training and drills. Tertiary hospitals should focus on these issues in developing public health emergency response systems to improve the effectiveness of their emergency response.

Objective:To evaluate the test-retest reliability of MRI criteria in the 2019 Bosniak classification of cystic renal masses (CRMs) and to analyze the impact of lesions′ property, size and readers′ experience on the test-retest reliability.Methods:From January 2009 to June 2019, 207 patients with 207 CRMs were included in this retrospective study. All of them underwent renal MRI and surgical-pathologic examination. According to Bosniak classification, version 2019, all CRMs were independently classified twice by eight radiologists with different levels of experience. All radiologists were blinded to the pathology of the lesions. By using intraclass correlation coefficient (ICC), test-retest reliability was evaluated for all CRMs and for subgroups with different pathological properties (benign and malignant) and different sizes (≤40 mm and>40 mm). The test-retest reliability of 4 senior readers (≥10 years of experience) and 4 junior readers (<10 years of experience) were evaluated respectively. The comparison of ICC was performed using Z test. Results:The 207 CRMs included 111 benign lesions (83 benign cysts, 28 benign tumors) and 96 malignant tumors. There were 87 lesions with maximum diameter ≤40 mm and 120 with maximum diameter>40 mm. The test-retest reliability (ICC) of each reader for all lesions was 0.776-0.888, the overall ICC was 0.848 (95%CI 0.821-0.872). The ICCs of senior and junior readers were 0.853 (95%CI 0.824-0.880) and 0.843 (95%CI 0.811-0.871) respectively, without significant difference between the two groups ( Z=0.85, P=0.374). The ICC of all readers was 0.827 for benign lesions and 0.654 for malignant lesions, showing significant difference ( Z=2.80, P=0.005). The ICC was 0.770 for lesions ≤40 mm and 0.876 for lesions>40 mm, which was significantly different ( Z=-2.36, P=0.018). For CRM subgroups with different pathological properties and different sizes, there was no significant difference in test-retest reliability between senior and junior readers (all P>0.05). Conclusion:The test-retest reliability of MRI criteria in the 2019 Bosniak classification of CRMs is excellent and unaffected by readers′ experience. The reliabilities are not consistent among CRMs of different pathological properties and different sizes, but all reached the level of good and above.

Objective To make a comprehensive analysis of the satisfaction and preferences of rural doctors'incentive measures,and to identify the incentives that need to be optimized.Methods The method of multi-stage stratified random sampling was used to investigate the rural doctors in Shandong province in 2015.This survey called into play the sample mean and standard deviation for descriptive analysis.And according to Maslow's Hierarchy of Needs theory, the scoring and ranking of different levels and specific incentive measures were calculated.The important quadrant model which combined with motivational preference and satisfaction of incentive measures was used to analysis them.Results The top preference for rural doctors was survival demand,scoring 4 284.Among the specific incentives,the top wss lower medical practice risk,scoring 945.75.In combination with satisfaction analysis, 7 incentive measures, including improving welfare and policy assurance, were now in the state of low satisfaction and high preference. Conclusions In terms of demand level,the survival incentive factor tops the needs of rural doctors.In the specific incentive measures, the seven incentives, such as lower practice risk, deserve more attention. Relevant departments should actively improve and implement these seven measures in order to maximize their motivation for rural doctors.

Objective To identify the influencing factors for rural doctors′ training effect,and suggest on the improvement of such training.Methods On the basis of rural doctors′ survey,the theory of pre-intervention was used to probe into the influencing factors for such training in five dimensions of attention notice,mega-cognitive strategies,advance organizer,goal orientation,and preparatory information.Results 73.2% of the groups were found with satisfying effect.In the single factor analysis,comparison of training effect involving such factors as age,gender,length of work life and pre-intervention revealed statistical significance(P<0.05).As shown in the logistic regression analysis,High motivation in meta-cognitive strategies,Clear goals in goal orientation,Tiered and categorized training in advance organizers,and Practical learning in preparatory information,as well as variants like age would influence rural doctors′ training effect significantly.Conclusions The key to better training effect lies in better motivation of the trainee,setting correct training goals,emphasis on the practicability of training contents and,the pertinence of the training objects.

Objective To analyze rural doctors′ social mentality with the theory of relative deprivation.Methods 642 rural doctors from 225 villages of 1 5 counties in Shandong were selected for a questionnaire survey.The factor analysis method was used to reduce the scale dimension and simplify the scale.Analysis of rural doctors′vertical and horizontal relative deprivation was made based on different reference groups.Results Rural doctors tend to identify themselves with rural teachers and doctors in township hospitals,and 60.0% identify themselves as the low income group.39.9% of them found a higher income,while 33.5% of them found a higher social status.76.3% of them found their social contributions are higher.91.4% of them hold that villagers benefit from the new healthcare reform policies,while 65.9% of them hold themselves as benefiting from such policies.This indicates a low sense of achievement.Conclusions Compared with the reference groups,rural doctors feel an obvious sense of relative deprivation comparing both horizontally and vertically.They hold themselves as underpaid and have little sense of achievement for the policies.In this consideration,the government should increase subsidies to lift pay for rural doctors,and to identify their legitimacy,in order to stabilize these medical workers.

To study performance problems found in China's essential medicine system.The SmithModel of system implementation was called into play in a systematic collation and analysis for the ideal policies,system implementation agencies,target groups and policy environment in its performance,along with relationships among the four factors.The system is found with a number of loopholes as the system itself is highly idealized,its system objectives set inappropriately,problems found with the four factors,and tension and conflicts among these factors.Given these problems found in its performance,it is inappropriate to make drastic changes to avoid instability of the system at its early stage.Government departments in question are advised to comprehensively analyze the four factors and their relationships then taking effective measures to deal with them and the tension,conflict among them.This can ensure effectively implementation of the essential medicine system.

Objective To comprehensively evaluate prevention and health care services of community health centers in Shandong province since the ongoing health reform and provide policy basis for development of community health services.Methods To study with rank sum ratio method and important quadrant models.Results Seventy-eight percent of community health centers were appraised as“average”.Overall satisfaction of residents for preventive and health services was 2.66 points.Preventive and health services of community health centers are expected to improve.Conclusion Overall prevention and health services of CHS centers were found less than satisfactory.Prevention and health services of CHS centers in regions a and B were poor,which deserves attention of the government health authorities.The government is expected to take actions to promote development of CHS centers for prevention and health care service.

Grounded theory was used to summarize and analyze influencing factors and their mechanism on availability of essential medicine.Four factors which influenced the availability of essential medicine were singled out:defective top design in the essential medicine system,interactions among its policies,deviations in the policy implementation by government agencies,and deficiency of supporting policies for the system.The availability of essential medicine in rural areas was influenced by a variety of factors.The ideas and methods of the grounded theory prove helpful for this study.In the future studies,both qualitative and quantitative study should be made to perfect this model formed by the grounded theory,to identify roadblocks and underlying causes in order to provide evidence for improving availability of essential medicine in rural areas.

Objective To evaluate the township hospitals'medical service efficiency in Shandong province,and to provide references for the development in township hospitals under the background of the essential medicine system.Methods The method of data envelopment analysis(DEA)was used to analyze the township hospitals' medical service efficiency in Shandong province before and since the implementation of the essential medicine system.Results For the township hospitals in Shandong province in general,their relative efficiency ratio of the medical service efficiency dropped from 66.67% to 53.33% since the implementation of the essential medicine system.In terms of the input and output,the non-DEA effective township hospitals are found with insufficient output as measured by the output indicator,while some input indicators input were found as excessive.Conclusion The low scale efficiency has become the main factor for the low service efficiency of such hospitals since the implementation of the essential medicine system in Shandong province.In order to improve the medical service efficiency,it is important to continue to improve the essential medicine system,increase the medical staff's incentives, improve the fiscal compensation policy,and keep the policy continuity.

Objective To study the different types of medication guidance for community doctors in the context of essential medicine system,and analyze its influencing factors.Methods SPSS 1 9.0 was called into play for statistical analysis of data gathered,and the medication guidance behavior of the doctors were graded on the two dimensions of personal willingness and practical action.With important quadrant method,the medication guidance behavior of such doctors was classified,while the multiple linear regression was used to study the influencing factors.Results Most of the community doctors of the fourteen counties fall into the area of “high willingness and less action”,with only a few falling into the area of the “high willingness and more action”. Major influencing factors of their willingness on medication guide were found to include impacts on job autonomy,attention to essential medicine system, and the forms to improve income.Major factors of the doctors'actions on medication guide include awareness of essential medicines,awareness of essential medicines catalog,and training outcomes. Conclusion The community doctors have high personal willingness for medication guidance related to essential medicines,but only a number of them carried it in their work.Therefore,it is necessary to take actions to strengthen awareness of the doctors for medication guidance and encourage them to carry it out.