Objective: To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas. Methods: Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis. Results: This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms. Conclusions The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.

The fourth affiliated hospital of Zhejiang university is responsible for training general practitioners in view of the basics of local general practitioners and the characteristics of chronic and frequently-occurring diseases in Yiwu city. This program is carried out relying on the high-quality faculty of medical alliances within Zhejiang university, and funded by the municipal government of Yiwu. The "4+6"training program is designed to elevate the competence of primary general practitioners. Such training fit the overall medical level of general practitioners, enhances people′s trust of general practitioners and the rate of diagnosis at primary level.

Objective To evaluate the effect of " elite small class" training mode in capacity building for general practitioners in Yiwu city. Methods The Fourth Affiliated Hospital of Zhejiang University School of Medicine worked with Yiwu Health Bureau, and held the first training class for general practitioners from December 6th in 2018 to April 5th in 2019.The mode of " elite small-class" was adopted. Theoretical assessment was carried out for trainees before and after the training and discussion was conducted after the training. Descriptive analysis of quantitative data and thematic analysis of qualitative data were carried out. Results The trainees′theoretical performance had been significantly improved after 4 months of theoretical learning and clinical rotation.The average score of the theoretical performance was increased from 66.94 to 72.59. Conclusions It was preliminarily found that the " elite small-class" training mode was suitable for the training of general practitioners in rural areas.Government support and trainee selection are key to training outcomes.

One patient with chronic refractory wound in right lower leg was admitted to our department in June 2017, which experienced repeated ulceration for 4 years. On 4 days post admission, two bamboo sticks were taken out from the deep muscle of the right lower leg. The wound was repaired by perforator flap of posterior tibial artery in the right lower leg. The donor site was covered with split-thickness skin in the upper leg of the same side. On 7 days post operation, the flap and skin graft survived. During follow-up of 12 months, the flap had good appearance. This case suggests that the first thing for the treatment of chronic refractory wound is to find out the cause of wound.

This paper described the measures taken by Sir Run Run Shaw Hospital of Zhejiang University School of Medicine in development of general medicine,and differential care of acute and chronic diseases. Rational allocation of medical resources and leveraging of tertiary hospital′s advantages in medicine and education effectively improved the utilization ratio of medical resources for better health of the people.

In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.

Objective To explore the management of nursing adverse events based on JCI evaluation criteria, and to establish a voluntary, non-punitive nursing adverse event reporting system.Methods From January 2014 to December 2015, 680 hospital nurses implemented JCI standards, revision of nursing adverse events management system, created online of nursing adverse events reporting system, to all nursing staff of adverse event management knowledge training and improvement before the analysis of the implementation of the JCI standard, adverse event reporting process and treatment measures of awareness, took the initiative to report rate, nursing adverse events incidence, patient satisfaction rate.Results Before and after nursing staff of adverse event reporting procedure and disposal method of awareness to improve the rate of 39.43% implementation, nursing staff to take the initiative to report to enhance the rate of 7.54%,the incidence of nursing adverse events to reduce the rate of 0.07%,the patients' satisfaction rate increased by 6.15%,there were statistically significant differences(x2=13.50,10.15,12.09,231.51,all P<0.05).Conclusion Nursing adverse events management constructed based on JCI accreditation standards is helpful to avoid the occurrence of nursing adverse events, to improve the rate of patients' satisfaction to nursing, to create a secure hospital atmosphere.

Objective To explore the effects of self-management intervention on the self-management ability and health service utilization of patients with chronic obstructive pulmonary disease (COPD). Methods A total of 84 COPD patients in stable condition with permission of being discharged in respiratory department of a tertiary comprehensive hospital in Wenzhou city,were selected as research objects from May to November 2014 by convenience sampling method,and were randomly divided into the intervention group (n=42) and the control group (n=42). Patients in the control group received routine care,while patients in the intervention group received self-management intervention and all patients were followed up. The self-management scale of chronic obstructive pulmonary disease was used investigate the self-management status of patients three months,six months and 12 months after intervention. The times of emergency services and the times of re-hospitalization were also recorded.Results The self-management ability of patients at the third month,sixth month and 12th month after intervention in the intervention group was significantly improved compared with the control group (P<0.05). There was no significant difference in the aspect of health service utilization at the third month after intervention between two groups (P>0.05);the times of health service utilization in the intervention group at the sixth month and 12th month after intervention were less than the control group (P<0.05).Conclusions Self-management intervention can improve the self-management ability of patients with COPD in stable period,and reduce the times of emergency visits and re-hospitalizations. It is an effective method for the management of chronic diseases.

OBJECTIVETo investigate the role of NLRP3 inflammasome in imiquimod-induced psoriasis-like inflammation in mice and the therapeutic effects of mustard seed (Sinapis Alba Linn).

METHODSThirty BALB/c mice were randomized equally into blank control group (fed with normal forage and treated with vehicle), model group (fed with normal forage and treated with 5% imiquimod cream), and experimental group (fed with 5% mustard seed forage and treated with 5% imiquimod cream). RT-PCR was used to detect the mRNA expression of NLRP3, ASC, caspase-1, and caspase-11. Immunohistochemistry was performed to determine the expression and distribution of ASC and caspase-1. ELISA was used to test the serum levels of interleukin-1β (IL-1β) and IL-18.

RESULTSCompared with the blank control group, the mice with imiquimod-induced psoriasis-like inflammation showed significantly increased NLRP3, ASC, caspase-1, and caspase-11 mRNA expressions, ASC and caspase-1 protein expressions , and serum levels of IL-1β and IL-18 (P<0.05). These changes were obviously attenuated by feeding the mice with mustard seed.

CONCLUSIONNLRP3 inflammasome is involved in imiquimod-induced psoriasis-like inflammation in mice, and mustard seed may suppress the inflammation induced by IL-1β and IL-18 through down-regulating the expression of NLRP3 inflammasome.

Aminoquinolines ; adverse effects ; Animals ; Carrier Proteins ; metabolism ; Caspase 1 ; metabolism ; Female ; Inflammasomes ; metabolism ; Inflammation ; drug therapy ; pathology ; Interleukin-18 ; metabolism ; Interleukin-1beta ; metabolism ; Mice ; Mice, Inbred BALB C ; Mustard Plant ; chemistry ; NLR Family, Pyrin Domain-Containing 3 Protein ; Phytotherapy ; Psoriasis ; chemically induced ; drug therapy ; metabolism ; Seeds ; chemistry

Objective To investigate the role of NLRP3 inflammasome in imiquimod-induced psoriasis-like inflammation in mice and the therapeutic effects of mustard seed (Sinapis Alba Linn). Methods Thirty BALB/c mice were randomized equally into blank control group (fed with normal forage and treated with vehicle), model group (fed with normal forage and treated with 5% imiquimod cream), and experimental group (fed with 5% mustard seed forage and treated with 5% imiquimod cream). RT-PCR was used to detect the mRNA expression of NLRP3, ASC, caspase-1, and caspase-11. Immunohistochemistry was performed to determine the expression and distribution of ASC and caspase-1. ELISA was used to test the serum levels of interleukin-1β (IL-1β) and IL-18. Results Compared with the blank control group, the mice with imiquimod-induced psoriasis-like inflammation showed significantly increased NLRP3, ASC, caspase-1, and caspase-11 mRNA expressions, ASC and caspase-1 protein expressions , and serum levels of IL-1βand IL-18 (P<0.05). These changes were obviously attenuated by feeding the mice with mustard seed. Conclusion NLRP3 inflammasome is involved in imiquimod-induced psoriasis-like inflammation in mice, and mustard seed may suppress the inflammation induced by IL-1βand IL-18 through down-regulating the expression of NLRP3 inflammasome.