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Objective:To analyze the effect of the implementation of diagnosis-intervention packet (DIP) on the doctors′ diagnosis and treatment behavior of chronic diseases, so as to provide reference for further improving medical insurance payment related policies.Methods:The first page information of chronic disease patients admitted to hospitals with diabetes, hypertension and coronary atherosclerotic heart disease as the main conditions in 103 hospitals at all levels and township health centers in a city from 2016 to 2020 was collected, and the patients were divided into non-DIP group and DIP group according to the implementation time of DIP. After 1∶1 propensity score matching to balance the general conditions of the 2 groups, the diagnosis and treatment behaviors were analyzed from two dimensions: diagnostic behavior and treatment behavior. The grade A rate of medical record writing, admission and discharge diagnosis coincidence rate, and the average length of stay were used to evaluate the diagnostic behavior; the proportion of drugs and the degree of change in the cost structure were used as the evaluation indicators of treatment behavior.Results:After matching, 41 050 patients were included in both the non-DIP group and the DIP group.From the perspective of diagnostic behavior, the grade A rate of medical record writing in the non-DIP group and the DIP group was 99.40% and 99.83%, the coincidence rate of admission and discharge diagnosis was 58.42% and 61.79%, the average hospital stay was 8.03 days and 7.04 days respectively, and the difference between the groups was significant ( P<0.05). From the view of treatment behavior, the proportion of drugs decreased from 33.00% in the non-DIP group to 27.59% in the DIP group, with a significant difference ( P<0.05); the drug cost represented by Western medicine changed negatively, while the diagnostic cost showed a positive change. Conclusions:DIP has played a certain role in regulating doctors′ diagnosis and treatment behavior for chronic diseases. Among them, doctors have significantly improved their diagnostic behavior for chronic diseases, and the proportion of drugs in treatment behavior has been well controlled.
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Objective:To build a performance evaluation index system of family doctor contracting service for urban communities, so as to evaluate the effects of such service.Methods:Based on the conceptual framework of performance appraisal of family doctor contracting service, such means as Delphi method and analytic hierarchy process were employed to evaluate the performance appraisal system of such service. A measured simulation test was made in Guangzhou.Results:A library of performance appraisal candidate indexes for such service was established, based on the performance appraisal concept framework of " structure, input, output, result" of such service. A questionnaire made based on such a library was developed for correspondence inquiry of 20 experts from December 2018 to June 2019. Based on results of such inquiry, a performance appraisal system for family doctor contracting service in Guangzhou was developed, consisting of 4 level-1 indexes, 10 level-2 indexes and 34 level-3 indexes. In the system, level indexes include organizational structure and management(weight 0.21), resource input(weight 0.24), contracting service process(weight 0.19), and contracting service effect(weight 0.36). A community health center in Guangzhou was used as the measurement site, for adjustment and improvement of data acquisition methods of individual indexes or scoring criteria.Conclusions:The index system is developed scientifically; appraisal tools are designed focusing on results and outputs, ensuring the appraisal of contracting service quality from multiple perspectives of supply-demand sides and health management patterns; the system can provide appraisal tools for policy appraisal authorities to evaluate the performance of contracting service reform.
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Background/Aims@#Crohn’s disease (CD) primarily affects young female adults of reproductive age. Few studies have been conducted on this population’s ovarian reserve status. The aim of study was to investigate potential risk factors associated with low ovarian reserve, as reflected by serum anti-Müllerian hormone (AMH) in women of reproductive age with CD. @*Methods@#This was a case-control study. Cases included 87 patients with established CD, and healthy controls were matched by age, height and weight in a 1:1 ratio. Serum AMH levels were measured by enzyme-linked immunosorbent assay. @*Results@#The average serum AMH level was significantly lower in CD patients than in control group (2.47±2.08 ng/mL vs. 3.87±1.96 ng/mL, respectively, P<0.001). Serum AMH levels were comparable between CD patients and control group under 25 years of age (4.41±1.52 ng/mL vs. 3.49±2.10 ng/mL, P=0.06), however, serum AMH levels were significantly lower in CD patients over 25 years of age compared to control group (P<0.05). Multivariable analysis showed that an age greater than 25 (odds ratio [OR], 10.03; 95% confidence interval [CI], 1.90–52.93, P=0.007), active disease state (OR, 27.99; 95% CI, 6.13–127.95, P<0.001) and thalidomide use (OR, 15.66; 95% CI, 2.22–110.65, P=0.006) were independent risk factors associated with low ovarian reserve (serum AMH levels <2 ng/mL) in CD patients. @*Conclusions@#Ovarian reserve is impaired in young women of reproductive age with CD. Age over 25 and an active disease state were both independently associated with low ovarian reserve. Thalidomide use could result in impaired ovarian reserve.
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Objective:To analyze the long-term efficacy and safety of thalidomide on refractory Crohn′s disease (CD).Methods:A total of 79 patients with refractory CD in the First Affiliated Hospital of Sun Yat-sen University treated with thalidomide were enrolled in this retrospective study from September 2005 to July 2018. Clinical effects and adverse drug reactions were recorded and assessed.Results:In this cohort,69 patients were treated with thalidomide for ≥6 months. Sixty-eight patients among the 69 patients achieved complete clinical remission and were followed up for a median 33.5 months (range, 7-110 months). Seventeen cases relapsed during follow-up. The cumulative probabilities of remaining in remission at 12, 24, 60 months were 88.6% (95% CI 80.6%-96.6%), 80.7% (95% CI 70.3%-91.1%), 53.7% (95% CI 32.1%-75.3%) respectively. Disease activity was the only variable associated with relapse risk, with a hazard ratio ( HR) of 3.559 for Crohn′s disease activity index (CDAI) ≥220(95% CI 1.213-10.449, P<0.05). Adverse reactions were recorded in 42 (53.2%) patients including12 (15.2%) leading to discontinuation of thalidomide. No serious side effects were observed in all subjects. Conclusions:This study suggests a long-term benefit of maintenance treatment with thalidomide in refractory CD.Moderate to severe patients have an increased risk of relapse. The high incidence of drug adverse reactions may restrain the clinical application of thalidomide.
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OBJECTIVE@#To design systematic review to summarize high quality evidence for the effectiveness of mobile learning on medical and nursing education.@*METHODS@#PubMed, Embase, ERIC, SCI and SSCI and Cochrane Library were searched since 2000 to December 2014 to identify articles that discussed the effectiveness of mobile learning on medical and nursing education for medical or nursing students or healthcare professionals. After assessed quality using the Cochrane Risk of Bias tool, the heterogeneity allowed for only narrative synthesis.@*RESULTS@#A total of 208 articles were searched and 11randomized controlled trials were included for final analysis. In the 11 studies, 7 studies show that when applying mobile devices for learning, their clinical knowledge and performance improved effectively. While 4 studies were not significantly different with who used traditional teaching method or no intervention group.@*CONCLUSIONS@#With the rapid advances in technology, it suggests that mlearning can play a very important role on medical and nursing education for improving clinical knowledge and performance, providing a new learning method, encouraging 'anywhere, anytime' learning and promote the popularization and fairness of medical education. Though it enables a personalized learning experience for the learners, some studies argue that mobile learning is still equivalent to traditional didactic lectures.
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Humans , Clinical Competence , Education, Medical , Methods , Education, Nursing , Methods , Learning , Mobile Applications , Randomized Controlled Trials as TopicABSTRACT
AIM:To investigate radiosensitization effect of apatinib, a vascular endothelial growth factor (VEGF) receptor2 tyrosine kinase inhibitor, on human gastric carcinoma cell line SGC-7901 and its mechanism.METHODS:SGC-7901 cells were divided into control group, apatinib group, radiotherapy group and combination group.The cell viability was measured by CCK-8 assay.The changes of cell apoptosis and cell cycle were analyzed by flow cytometry.The protein levels of cell apoptosis biomarkers, such as PARP, cleaved caspase-9, cleaved caspase-3 and Bcl-2, and cell proliferation biomarkers, p-PLCγ1 and p-ERK1/2, were detected by Western blot.γ-H2AX expression was detected by immunofluorescence.RESULTS:Compared with apatinib group and radiation group, the cell viability was inhibited after treatment with both apatinib and X-ray (P<0.01).The protein levels of cell proliferation markers p-PLCγ1 and p-ERK1/2 were down-regulated.The cell apoptosis was enhanced (P<0.01).The protein levels of cell apoptosis makers such as PARP, cleaved caspase-9 and cleaved caspase-3 were up-regulated, while Bcl-2 was down-regulated.The disappearance of γ-H2AX foci in the nucleus was delayed, indicating that apatinib impaired the repair of radiation-induced DNA double-strand breaks.The proportion of G2 phase was significantly increased (P<0.01).The combination treatment had more significant effect on SGC-7901 cells than treating with apatinib or radiotherapy alone.CONCLUSION:Apatinib increases the radiosensitivity of gastric cancer cells via blocking VEGF pathway.
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On the basis of principal-agent theory,this paper analyzed the reasons of doctor-patient problems from the perspective of patients and hospitals,hospitals and physicians,and patients and physicians.It included asymmetric medical information,ethical risks of physicians,incomplete contracts between physicians and patients,and uncertainty of medical results.Aimed at these problems,this paper put forward relevant suggestions.In the view of recognition,patients are supposed to get a rational idea in the process of selecting hospitals and try making a contract with general practitioners.In the view of improvement,the pattern of performance assessment to physicians should be developed.In the view of system,the corresponding management measures of health service should be improved so as to better serve patients.
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The family doctor service is an important measure to transform primary health care mode,makes the community health service institutions to take on the gatekeeper role of residents' health and health care costs,and promotes the achievements of hierarchical diagnosis and treatment.At present,there are some difficulties in the process of family doctor service.For example,the construction of the general practitioner team is lagging behind and the residents don't understand the specific contents of the family doctor service well.Medical social workers have both the social work professional skills and medical literacy,which makes them become the effective strength of community health service.Introducing medical social workers by the purchase of the governments,volunteer training,and job settings mode can meet the needs of the development of family doctor service to some extent,and bring in new ideas to the implementation of the family doctor service.
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Objective To analyze the clinical features,clinical prognosis and predictive factors of ulcerative colitis (UC) complicated with cytomegalovirus (CMV) infection.Methods From May 2004 to November 2014,120 hospitalized patients diagnosed as UC and screened for CMV infection were enrolled.A total of 31 patients with moderate to severe UC accompanied by CMV infection were screened out.Demographics,clinical features,endoscopic appearance and treatment of patients with UC complicated with CMV infection were analyzed,and compared with 60 moderate to severe UC patients without CMV infection at the same period of hospitalization.Mann Whitney U test was performed for statistical analysis.Logistic regression analysis was used to analyze risk factors of UC complicated with CMV infection.Results Among 120 patients with UC,29 were mild or in remission period,whose CMV screening tests were all negative.Ninety-one were moderate to severe,31 patients (34.1 ％) of them had CMV infection,and 20 of 31 patients were steroid-refractory.Among the 31 patients with UC complicated with CMV infection,median age was 39 years (22 years,51 years),median disease duration was 24.0 months (6.0 months,42.0 months) which was shorter than that of patients without CMV infection (36.0 months (13.5 months,84.0 months)),and the difference was statistically significant (U=639.5,P=0.015).A total of 23 patients (74.2％) had extensive colitis and 26 patients (83.9％) had history of severe colitis.A total of 29 patients (93.5％) had history of corticosteroids treatment,12 patients (38.7％) had history of immunosuppressive agents treatment,and six patients (19.4 ％) had history of infliximab treatment.Compared with UC patients without CMV infection,fever,abdominal pain and weight loss were more common in UC patients with CMV infection.Five CMV-infected patients had mild liver dysfunction.Endoscopic appearance was longitudinal ulceration,irregular ulceration,large deep ulceration,punchedout ulceration and worm-like ulceration.Among the 25 CMV-infected patients who were treated with corticosteroids,11 patients (44.0％) had no response.Among the 39 CMV-negative patients who were treated with corticosteroids,eight patients (20.5％) had no response.The rate of patients who needed rescue therapy of the former was higher than that of the latter,and the difference was statistically significant (x2 =4.026,P=0.045).The results of multivariate Logistic regression analysis showed that hemoglobin over 100 g/L(OR=0.144,95％ confidence interval (CI) 0.040 to 0.516,P=0.003) was a protective factor of CMV infection,however corticosteroids use within a month before the onset (OR=8.946,95％oCI 2.459 to 32.541,P=0.001) was a risk factor.Conclusions UC patients treated with corticosteroids and immunomodulator therapy may predispose UC patients to CMV infection,on the other hand,CMV infection can exacerbate the severity of UC.CMV infection should be screened and monitored in UC patients,and anti viral therapy should be taken in time in case of CMV infection.
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BACKGROUND/AIMS: The past decades have seen increasing incidence and prevalence of inflammatory bowel disease (IBD) in China. This article aimed to summarize the current status and characteristics of surgical management for IBD in China. METHODS: We searched PubMed, Embase, and Chinese databases from January 1, 1990 to July 1, 2014 for all relevant studies on the surgical treatment IBD in China. Eligible studies with sufficient defined variables were further reviewed for primary and secondary outcome measures. RESULTS: A total of 74 studies comprising 2,007 subjects with Crohn's disease (CD) and 1,085 subjects with ulcerative colitis (UC) were included. The percentage of CD patients misdiagnosed before surgery, including misdiagnosis as appendicitis or UC, was 50.8%±30.9% (578/1,268). The overall postoperative complication rate was 22.3%±13.0% (267/1,501). For studies of UC, the overall postoperative complication rate was 22.2%±27.9% (176/725). In large research centers (n>50 surgical cases), the rates of emergency operations for CD (P=0.032) and in-hospital mortalities resulting from both CD and UC were much lower than those in smaller research centers (n≤50 surgical cases) (P=0.026 and P <0.001, respectively). Regarding the changes in CD and UC surgery over time, postoperative complications (P=0.045 for CD; P=0.020 for UC) and postoperative in-hospital mortality (P=0.0002 for CD; P=0.0160 for UC) both significantly improved after the year 2010. CONCLUSIONS: The surgical management of IBD in China has improved over time. However, the rates of misdiagnosis and postoperative complications over the past two decades have remained high. Large research centers were found to have relatively better capacity for surgical management than the smaller ones. Higher quality prospective studies are needed in China.
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Humans , Appendicitis , Asian People , China , Colitis, Ulcerative , Crohn Disease , Diagnostic Errors , Emergencies , Hospital Mortality , Incidence , Inflammatory Bowel Diseases , Outcome Assessment, Health Care , Postoperative Complications , Prevalence , Prospective StudiesABSTRACT
BACKGROUND/AIMS: The past decades have seen increasing incidence and prevalence of inflammatory bowel disease (IBD) in China. This article aimed to summarize the current status and characteristics of surgical management for IBD in China. METHODS: We searched PubMed, Embase, and Chinese databases from January 1, 1990 to July 1, 2014 for all relevant studies on the surgical treatment IBD in China. Eligible studies with sufficient defined variables were further reviewed for primary and secondary outcome measures. RESULTS: A total of 74 studies comprising 2,007 subjects with Crohn's disease (CD) and 1,085 subjects with ulcerative colitis (UC) were included. The percentage of CD patients misdiagnosed before surgery, including misdiagnosis as appendicitis or UC, was 50.8%±30.9% (578/1,268). The overall postoperative complication rate was 22.3%±13.0% (267/1,501). For studies of UC, the overall postoperative complication rate was 22.2%±27.9% (176/725). In large research centers (n>50 surgical cases), the rates of emergency operations for CD (P=0.032) and in-hospital mortalities resulting from both CD and UC were much lower than those in smaller research centers (n≤50 surgical cases) (P=0.026 and P <0.001, respectively). Regarding the changes in CD and UC surgery over time, postoperative complications (P=0.045 for CD; P=0.020 for UC) and postoperative in-hospital mortality (P=0.0002 for CD; P=0.0160 for UC) both significantly improved after the year 2010. CONCLUSIONS: The surgical management of IBD in China has improved over time. However, the rates of misdiagnosis and postoperative complications over the past two decades have remained high. Large research centers were found to have relatively better capacity for surgical management than the smaller ones. Higher quality prospective studies are needed in China.
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Humans , Appendicitis , Asian People , China , Colitis, Ulcerative , Crohn Disease , Diagnostic Errors , Emergencies , Hospital Mortality , Incidence , Inflammatory Bowel Diseases , Outcome Assessment, Health Care , Postoperative Complications , Prevalence , Prospective StudiesABSTRACT
AIM:To identify the serum proteins that might serve as biomarkers for predicting mucosal healing ( MH) in the patients with Crohn’ s disease ( CD) treated with infliximab ( IFX) .METHODS:We collected serum sam-ples before treatment (0 week, group A) and 14 weeks after treatment (group B) from 7 CD patients with IFX treatment who had achieved MH, as well as the serum samples from 7 CD patients who had not achieved MH (0 week, group C;14 weeks, group D) .Two-dimensional fluorescence difference gel electrophoresis was applied to analyze and compare the re-sults of serum profiles between groups A and B, C and D, A and C, B and D.Matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry and bioinformatics tools were utilized to preliminarily identify and figure out the dif-ferentially expressed proteins.RESULTS:(1) In total, there were 44 differentially expressed spots, 36, 3, 10 and 31 differentially expressed spots were detected while comparing A with B, C with D, A with C and B with D, respectively. (2) Among those spots, 17, 2, 2 and 15 proteins were identified, respectively.In total, there were 19 differentially ex-pressed proteins, including apolipoprotein E, apolipoprotein A-I, complement factor H, and so on.(3) Protein functional association networks were carried out based on STRING database.CONCLUSION: The serum protein profiles obviously change after IFX treatment in MH CD patients, and the serum protein profiles of MH patients are different from that of non-MH patients after IFX treatment.The 19 proteins we identified may serve as potential biomarkers for predicting MH in CD patients with IFX treatment.
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Objective To analyze clinical features and prognosis of primary intestinal T cell lymphoma (ITCL)which was misdiagnosed as Crohn′s disease (CD),and summarized the key points of differentiation between ITCL and CD.Methods From January 2003 to January 2014,clinical data of patients with ITCL once misdiagnosed as CD were retrospectively analyzed,which included demographic,clinical,pathological and prognostic data.The data of 177 patients diagnosed as CD from January 2012 to January 2014 were collected. The demographic,clinical,pathological and prognostic data of these two groups were analyzed and compared. The continuous variables were compared with t test or Mann-WhitneyU test,and the differences of classification variables between two groups were analyzed by Chi-square test or Fisher exact probability method.Results A total of 18 patients (17 males and one female)with ITCL misdiagnosed as CD were enrolled in the study,and the median age at diagnosis was 38.5 (28.8 to 42.5)years and the median duration of diagnosis was 6.00 (3.75 to 13.25)months.The common primary symptoms were abdominal pain (12/18),diarrhea (13/18)and anemia (13/18).Intestinal perforation was primary symptom in two cases (2/18).However,B symptoms of lymphoma was observed in 16 patients,which included fever in 13 patients,weight loss in 16 patients and night sweat in one patient.One or more serious complications appeared in 12 patients,which included intestinal perforation in nine patients,severe gastrointestinal bleeding in seven patients and intestinal obstruction in two patients.In 177 patients with CD,104 patients were male (58.8%),and the median age at diagnosis was 22.0 (18.0 to 29.0) years.The primary symptoms were abdominal pain (88.7%,157/177),diarrhea (55.9%,99/177),anemia (63.8%,113/177),fever (33.3%,59/177)and weight loss (59.9%,106/177).During the disease course,30 patients (16.9%)had intestinal perforation (mainly chronic),12 patients (6.8%)had intestinal obstruction and seven patients (4.0%)had severe gastrointestinal bleeding.Compared to CD patients,male patients were more common in ITCL (χ2 =8.837,P <0.01),age at diagnosis was older (χ2 =314.5,P <0.01),the disease course was shorter (U=385.0,P <0.01),weight loss (χ2 =5.867,P <0.05)and fever (χ2 =10.609,P <0.01)were more common in clinical symptoms and intestinal perforation and severe gastrointestinal bleeding were more common in complications (χ2 =9.185,24.908,both P <0.01).The lesions of ITCL were multiple lesions, small bowel involved in eight cases,colon involved in 14 cases and one case with esophagus involved.Under endoscopy examination,most lesions appeared as ulcerations and were segmentally distributed.Compared to CD, lymphocyte proliferation was more common in the intestinal histopathological findings of ITCL (17/18 vs 19.7%(35/177);χ2 =42.844,P <0.01)and granuloma was rare (0 vs 42.8%(76/177),χ2 =12.665,P <0.01). Among 18 patients with ITCL,nine received chemotherapy and the median survival time was two months. Conclusions Primary ITCL had non-specific symptoms and was easily misdiagnosed as CD.More attention should be paid to the differential diagnosis of the two disease.
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[Objective] To investigate the change of liver histology, proliferation of BDEC, and expression of TGF-β in different stages of liver chelestusis. [Methods] ①Rat cholestatic livers were induced by common bile duct ligation (BDL) and separated into 3 groups, namely control group (DO), 7 days after BDL group (DT), and 18 days after BDL group (D18). ② Histological changes of livers in different groups were evaluated based on Knodell HAI score. ③ Real-time PCR was used to detect the expression of TGF-β in liver tissue and isolated BDEC in different groups. ④ Statistically analyzing the correlation between Knedell HAl score and the levels of TGF-β_1 mRNA. ⑤ In vitro study was performed to investigate the effect of TGF-β_1 on an immortalized mouse intrahepatic bililary epithelial cell line (mIBEC). [Results] (I) Knedell HAI score and the proliferation of intrahepatic bile ducts increased as the liver cholestasis aggravated. ② The levels of TGF-β_1, TGF-β_2, and TGF-β_3 mRNA were significantly up-regulated in liver tissues and BDEC as the liver cholestasis aggravated. ③ Positive correlation was found between Knedell fibrotic score and the levels of TGF-β_1 mRNA in liver tissues and BDEC(r=0.9376, P<0.05 and r=0.9682, P < 0.01). ④ In vitro study showed that TGF-β_1 inhibited the proliferation of mIBEC. [Conclusion] ① Liver injury, biliary proliferation, and the levels of TGF-β mRNA expression increased as liver cholestasis aggravated. ② The interaction of TGF-β_1 and BDEC plays an important role in the pathogenesis of BDL induced cholestatic liver disease. ④ Up-regulated expression of TGF-β_1 mRNA in the proliferated BDEC participates in the formation of BDL induced cholestatic liver fibrosis.
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Objective To elucidate the association of interleukin (IL)-17F A7488G (p.His161Arg) polymorphism with gastric cancer susceptibility,clinicopathological features and survival.Methods DNA from 927 unrelated patients with gastric cancer and 777 age and gendermatched healthy controls was typed for IL-17F A7488G polymorphism by polymerase chain reactionrestriction fragment length polymorphism.Logistic regression analyses and Cox proportional hazards analyses were used to evaluate the associations between polymorphisms and gastric cancer susceptibility,clinicopathological features and survival.Results There was significant difference between healthy controls and patients with gastric cancer with respect to frequencies of IL-17FA7488G genotypes (X2= 16.55,P<0.01).After adjusted for age and gender,IL-17F A7488G GA and GG genotypes were associated with an increased risk of gastric cancer compared with the AA genotype (OR=1.51;95% CI:1.22-1.87 for GA;OR=1.61,95% CI:1.03-2.51 for GG).In comparison with AA genotype carriers,the risk of gastric cancer increased in those with GA or GG genotypes (OR= 1.53,95 % CI:1.25- 1.87,P<0.01 ).Further stratification analyses indicated that the effect of IL-17F A7488G GA genotype was especially noteworthy in gastric cancer patients of noncardia,intestinal type,poorly and moderately differentiated,and lymph node metastasis.Whereas there was no significant difference in survival among subjects with different polymorphisms of IL-17F A7488G gene (P= 0.534).Conclusions Genetic polymorphism of IL-17F A7488G involves in susceptibility to gastric cancer,which also influences certain subtypes of gastric cancer according to clinicopathological features,however,it is not the independent risk factor for prognosis of gastric cancer patients.
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Modern medical education is characterized by innovative education,but the specialty of medical education determines the complexity of its innovative education.The paper elaborates the construction of cultivation mode of talents of creative pattern in medical universities by infiltrating and implementing the ideas and practice of innovative education into the full process of higher medical education proceeding with such innovative thoughts and quality training links as education concept,teaching mode,knowledge structure,training of methods and ability.
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This paper performs some explorations of the objective of talent-cultivation in 8-year-system medical education,and gives some advices of the objective of talent-cultivation in 8-year-system of Southern Medical University.
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The reflective behaviors of teachers are a primary factor affecting teaching quality.However,the reflective behaviors of teachers can be propelled only by enhancing stimulus to teaching work,completing training system of continuing education on teaching theory and techniques to increase the teaching theory of teachers and performing teaching summarization of courses and assessment system.Only in this way can the teaching level and teaching quality of teachers be enhanced.
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The forecast of health human resources demand is the most important and one of the most complex aspects of health manpower planning projections. There are many methods in forecasting human resources demand,and each method has its own advantages and disadvantages. Five kinds of commonly used basic methods are comparatively analysised in this paper.
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The article discusses the main problems existing in training medical students’ creativity and practice ability. By re-realizing the connotations of creativity and practice ability, this paper explore the paths for improving medical students’creativity and practice ability from students,teachers,teaching supervisors,and the college itself.