ABSTRACT
Objective To evaluate the clinical applications of rigid dilatation using double catheter method for ureteric stenosis.Methods The clinical data of 51 ureteric stenosis patients who had underwent rigid dilatation using double catheters method were retrospectively analyzed. Results Among the 51 patients,the ureteroscopy successfully went through the stricture in 46 cases(90.2%),and all patients had no ureteral perforation or laceration.Among the 5 patients in whom ureteroscopy did not go successfully through the stricture,2 cases were placed double J tube,2 cases underwent percutaneous nephrolithotomy,and 1 case underwent two stage ureteral stricture resection and religation.All patients were examined by ultrasound examination 3 months after the treatment,and the degree of hydronephrosis was partial remission. Conclusions The double catheters method is a safe and effective way for rigid dilatation for ureteric stenosis,and it is worth popularizing.
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As a mode of pay for performance,hospital value-based purchasing has been become widespread the US.Medicare managed to encourage the service providers to provide medical services with more value and quality.The implementation background,financing,payment mode and performance evaluation of hospital value-based purchasing were briefly introduced.In the payment reform of China,it also needed to focus on the medical service quality,learn from the performance evaluation system,incentive mechanism and multiple measurement,reasonably design the implementation scheme.
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Objective: The main objective of the present study is to develop the risk-adjusted capitation pay-ment standards to compensate health service providers. Methods:Descriptive statistical analysis was conducted to an-alyze the insured's enrollment and visit conditions, and the two-part model was conducted to obtain the appropriate compensation standard using data retrieved from information system of social health insurance for the period of 2014 to 2015 in Shenzhen City. Results:The estimated value of total expenditure per insured person per month is 6. 17 yuan. Age,sex,insurance level and with or without chronic disease or catastrophic disease were elicited as risk adjustors. The whole number insured people were divided into 52 groups by this four risk-adjustment factors whereby the rele-vant payment standards for each group was calculated. Conclusions:By adjusting capitation fee on the grounds of risk of disease and expected expense of medical services of the insured, the capitation payment standards can be calculat-ed virtually. This method will promote the process of capitation payment system reform and also lay a solid foundation for further research.
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An analysis is made according to policy documents of localities on capitation payment, and by means of literature review and the analysis framework of the World Bank,this paper reviewed studied the following:definition of service package,per capita rate,designated institutions,design of financial regulations,and service supervision.Given the attempts made at localities,most of the schemes are incomplete in design,and defective in capitation measurement methods and dynamic adjustment mechanisms.The authors recommend a systematic design of the capitation payment scheme for better outcomes.
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Objective To assess the safety and the curative effect of the combination of minipercutaneous nephrolithotomy (mini-PCNL) and ureteroscopic lithotripsy (URL) in the treatment of nonhydronephrotic staghorn calculi. Methods The clinical data of 53 eases with non-hydronephrotic staghom calculi treated by mini-PCNL combined with URL were retrospectively analyzed. Results Fifty-three cases (64 renal units) were performed first-stsge operation, 9 renal units were stone free in first-stage operation, 33 renal units were stone free in second-stage operation, other 13 renal units were stone free in third-stage operation. A complete stone clearance rate of 85.9%(55/64) was achieved, and after one to three sessions of mini-PCNL and extracorpereal shock wave lithotripsy afterwards that increased to 95.3% (61/64). Blood transfusion was performed in 3 cases, no major complication was noted in the patients. Conclusions The combination of mini-PCNL and URL has more advantages, less invasions, easier recovery and less complications. It provides a new minimally invasive way for non-hydronephrotic staghorn calculi.
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Objective To explore emergency treatment methods for acute renal failure caused by negative imaging ureterolith. Methods There were 36 cases of acute renal failure caused by negative imaging ureterolith, which were finally diagnosed by ureteroscope examination. The negative imaging ureterolith were broken by air pressure ballistic curve shock wave,and taken out of ureter by ureteroscope. All cases were put double-J in ureter. Results Thirty-six cases were got success relieves of ureter obstruction in 24 hours. The urine volume of them were increased, symptoms of urinemia were disappeared, BUN and creatinine were normal after operations. Conclusions The treatment and diagnosis methods by ureteroscope for acute renal failure caused by negative imaging ureterolith are quick and safety, which can treat both side ureterolith at the same time and get reliable and safe effect with less trauma. It should be the first choice to treat acute renal failure caused by negative imaging ureterolith.