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Objective To study the calculation of the cost consumption index adjusted with major diagnostic classification (MDC), for optimal use of DRGs index in hospital performance evaluation. Methods The adjustment method of CMI value in DRGs index system was used as reference, and we compared the different cost consumption indexes(both MDC adjusted and non-adjusted) of two hospitals(S and Y) in Guangdong province. Then we compared the different rankings of 82 tertiary general hospitals in the province before and after the adjustment. Results The cost consumption index of S hospital was higher than that of Y hospital by the non-adjusted method (1.30 >1.28). But as calculated by the adjusted method,the index of S hospital was significantly lower than Y hospital (1.31 <1.38). The rankings of these 82 hospitals also showed major changes,which prove that the cost consumption index, the same as CMI,will be affected by MDC cases makeup.Conclusions The MDC adjusted cost consumption index, when applied to hospital performance evaluation, renders more stable and reasonable results. This is an evidence that the adjusted cost consumption index is of great practical value in hospital performance evaluation.
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Objective To investigate effects and its mechanisms of hypertonic saline hydroxyethyl starch 200/0.5 solution on intracranial pressure and brain water content in rats with ischemic cerebral edema.Methods All experiments were conducted in the animal experimental center of Sun Yat-sen University.The 28 male Sprague-Dawle (SD) rats were randomly (random number) divided into hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group,control group and sham operation group,each n =7.Ischemic cerebral edema model was reproduced by middle cerebral artery occlusion (MCAO),followed by reperfusion after ischemia for 2 hours (If the moldel was not successful,other rats were operated to fill the missing models).Then reperfusion after ischemia 2 hours and received hypertonic saline hydroxyethyl starch and hydroxyethyl starch via tail vein at the beginning of reperfusion.The colloidal osmotic pressure (COP) and intracranial pressure (ICP) were evaluated on 0,2,6,12,18,24 hours after the surgery.The water content of the right hemisphere was measured on 24 h after the surgery.Results The ICP of hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group and control group were significantly higher than that of sham operation group on 2,6,12,18,24 h after the surgery.The ICP of hypertonic saline hydroxyethyl starch group was significantly lower than those of hydroxyethyl starch group and control group on 2,6,12,18 and 24 h.But there was no significant difference in ICP of the hydroxyethyl starch group compared with that of control group at all time points.The COP of hypertonic saline hydroxyethyl starch group and hydroxyethyl starch group were significantly higher than the control group and sham operation group at each time point; There was no significant difference in COP (mmHg) of the hydroxyethyl starch group compared with that of hypertonic saline hydroxyethyl starch group at all time points.The brain water content (BWC) of hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group and control group were significantly higher than that of sham operation group on 24 hours after the surgery [(81.24±0.36)％,(83.04±0.10)％,(83.14±0.41)％ vs.(78.37±0.37)％,all P=0.000],BWC of hypertonic saline hydroxyethyl starch group lower than these of hydroxyethyl starch group [(81.24±0.36)％ vs.(83.04 ±0.10) ％,P =0.000] and control group [(81.24 ±0.36)％ vs.(83.14 ±0.41) ％,P =0.000].There was no significant difference in BWC of the hydroxyethyl starch group compared with that of control group [(83.04 ± 0.10) ％ vs.(83.14 ± 0.41) ％,P =0.578].Conclusion Hypertonic saline hydroxyethyl starch solution could significantly ameliorate ischemic cerebral edema and reduce ICP,but the relationship between its elevated COP and reduced ICP has not been confirmed.
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Objective To study the manifestations and electroencephalography(EEG) features of benign childhood occipital epilepsy in order to improve clinical diagnosis.Methods The clinical and EEG characteristics of 26 patients diagnosed as benign childhood occipital epilepsy were retrospectively reviewed.Results The clinical characteristics were as follow:(1)Visual symptoms.(2)Motor symptoms:versive seizure tonic clonic seizures.(3)Automatism EEG features:discharge over one both occipital lobe.Conclusion Benign childhood occipital is a distinctive epilepsy syndrome.Understanding the clinical manifestations and EEG features can lead to obtain correct diagnosis.
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Objective To investigate the MRI characteristics of periventricular leukomalacia in children. Methods The clinical datas of 39 cases of PVL were retrospectively analyzed.Results MRI manifestation:(1) quantitative reduction of white matter:only in trigonal area 12 cases;at trigonal and semiovale center 7 cases.(2)Fo- ci form:patchy areas in 20 cases;punctate areas 13 cases;streake in 6 cases.(3)The signal of the focus:hyperin- tense/intense on T1 weighted and hyperintense on T2 weighted.(4)Ventricular enlarged:body of lateral ventricle 31 cases,triangular part 8 cases.(5)Ventricular appearance irregular 11 cases.(6)Others:corpus callosum dysplasia 2 cases.4 cases bilateral lateral fissure deepened and widened.Conclusion MRI is a way to diagnose PVL in early, level and scope of focus of PVL can be clearly displayed by MRI.
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Objective To evaluate the etiology and manifestation of computerized tomography(CT) with lacunar infarction in children. Methods Forty-three cases with lacunar infarction were studied.Results The casuses included minor head injury(21 cases),upper respiratory infection(8 cases),varicella(2 cases),mitochondrial encephalomyopathy(1 case),moyamoya diseses(1 case),systemic lupus erythematosus(1 case) and unknown causes(9 cases).The clinical manifestations included hemiparalysis(41 cases),aphasia(5 cases),epilepsy(10 cases),sudden deafness(2 cases).A total of 51 focal ischemic lesions were found with CT in 43 patients.CT scan in 15 cases showed punctuate calcification focus with circular infarcts of low density beside them in single or bilateral basal ganglia.The clinical symptoms in 40 cases disappeared within 12 weeks after therapy.Conclusions The review indicates that children with lacunar infarction have a favorable prognosis,which is probably a result of the difference in lacunar infarction etiology between children and adults.Basal ganglia calcification is somewhat association with acute hemiplegia in infants minor head trauma sustained.
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Objective To investigate the clinical value of serum cardiac troponin Ⅰ(cTNⅠ) in diagnosis of cardiac injury in neonatal hypoxic ischemic encephalopathy(HIE).Methods 20 healthy newborns were selected as the control group.58 patients with HIE were divided into mild group(n=20),medium group(n=19) and the severe group(n=19),respectively.The level of cTNⅠ was detected by immunofluorescence.Results Serum levels of cTNⅠ in experimental group were obviously higher than that of the control group;There were significant difference between any two groups(P