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Objective@#To compare the clinical effects between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) assisted by Microendoscopic discectomy (MED) and Quadrant for the treatment of degenerative lumbar spinal stenosis (DLSS).@*Methods@#All of 59 patients suffered from DLSS treated surgically from May 2015 to October 2017 were reviewed. According to the surgery method, all cases were divided into MED group (27 cases) and Quadrant channel group (32 cases). All patients were followed up for an average of 18.5 months (11-29 months). Comparison was made on the operative time, intraoperative blood loss, postoperative drainage, postoperative time in bed, postoperative creatine kinase (CK), fusion rate and the degree of muscle fibrosis shown in MRI, as well as visual analogue scale (VAS)score and Oswestry dysfunction index (ODI) score in two groups.@*Results@#The duration of operation in MED group was significantly longer than that in Quadrant group (161.7±22.4 min vs. 145.6±19.4 min, t=4.541, P<0. 01), but less intraoperative blood loss (138.1±26.9 ml vs. 155.6±21.5 ml, t=-2.724, P< 0. 01) and shorter time in bed after surgery (2.3±0.7 d vs. 3.5±1.1 d, t=-4.564, P<0.01). Compared with Quadrant group, CK levels were risen slightly on the first and third postoperative day (P<0.01). CK on the fifth postoperative day in both groups returned to normal. VAS score of lower back pain in MED group was lower than that in Quadrant group on the third day and twelfth month after operation (P<0.05). After 3 months, there was no significant difference in VAS score and ODI between the two groups (P>0.05). ODI was lower in MED group than that in Quadrant group after 6 months and 12 months.The fusion rate was88.9%(24/27) in MED group and 93.8%(30/32) in Quadrant channel group. There was no statistical difference in fusion rate of two groups. 10 patients in MED group and 12 patients in Quadrant group underwent MRI examination of lumbar spine one year after operation. The ratio of postoperative and preoperative atrophy of multiplex muscle area was measured. Muscle atrophy of lower back muscle was lighter in MED group (0.12±0.05 vs. 0.22±0.04, t=-2.428, P<0.05). For intraoperative and postoperative complications, 1 case of dural sac rupture occurred in both groups. Gelatin sponge immediately with fibrin glue was used for plugging up, no postoperative cerebrospinal fluid leakage was found. In Quadrant channel group, 1 case had less blood supply of skin incision edges and epidermal necrosis while the other case had fat liquefaction.@*Conclusion@#Compared with the aid of Quadrant, MIS-TLIF assisted with MED had less blood loss, less trauma and faster recovery and could reduce the incidence of postoperative incision complication.
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Objective:To investigate the payment methods of 5 kinds of chronic diseases in public hospitals of Heze.Methods:8 383 cases of hypertension,diabetes,coronary heart disease,chronic bronchitis and hepatitis B were enrolled from the Municipal Hospital,the Second People's Hospital,the Third People's Hospital,the City Hospital of Traditional Chinese Medicine and the Infectious Disease Hospital in Heze from January 1,2012 to December 31,2015.The information of medical records and the cost of hospitalization were collected and analyzed.Results:The total hospitalization expense,examination fees and other costs of medicare patients were significantly higher than those of the non-medicare patients(P＜0.05),while the drug expenses were significantly lower than that those of non-medicare patients(P＜0.05).As to the medicare patients,hospitalized expense of male patients was significantly higher than that of female(P＜0.05),hospitalized expense and insurance expense of patients over 45 years old were significantly higher than those of patients under 45 years old(P＜0.05),hospitalized expense and insurance expense of retired patients were significantly higher than those of patients on-the-job(P＜0.05),total expense of urban patients were significantly higher than those of rural patients(P＜0.05).Conclusion:Payment of patients with chronic diseases was in relation with hospitalization expenses,which was also related to the social economic characteristics,but it was worth paying attention to avoiding excessive medical treatment and waste of resources,which needed to take comprehensive measures in combination with social situation.
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Background: Ebola Hemorrhagic Fever (EHF) has become well known all over the world; especially following the West African outbreak in Guinea; Sierra Leone and Liberia (December 2013). The Ebola virus was first discovered in the Democratic Republic of Congo (DRC); an African country that has continued to register Ebola outbreaks. This study aims to summarize old and new experiences of Ebola in the DRC; in order to propose strategies for better prevention.Materials and Methods: Information was taken from databases such as PubMed and Cochrane library. A total of eleven full text and three abstracts were identified for the data extraction. Results: Since its discovery in the DRC; there have been seven Ebola outbreaks; accounting for a total of 1032 cases and 795 deaths. The presence of Non-Human Primates; also considered as the natural reservoir and susceptible host of Ebola virus; can be one major factor that has contributed to the increased number of Ebola outbreaks and cases in the Equatorial region. The existence of rumors and legends related to Ebola in DRC obscure the the viral nature of the disease; and lead to difficulty for health workers; to easily accomplish their tasks.Conclusion :It is important ;to scale up community education campaigns designed to give more details on the viral nature of the EHF; establish national agencies and institutions specialized in controlling hunting in the Equatorial region; for better prevention; since there is not yet a specific drug or vaccine to the Ebola Virus
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Disease Outbreaks , Hemorrhagic Fever, Ebola/prevention & control , ReviewABSTRACT
Objective:To study the public health Emergency Operations Centers (EOCs)in the US, the European Union, the UK and Australia, and summarize the good practice for the improvement of National Health Emergency Response Command Center in Chinese National Health and Family Planning Commission.Methods:Literature review was conducted to explore the EOCs of selected countries.Results:The study focused on EOC function, organizational structure, human resources and information management. The selected EOCs had the basic EOC functions of coordinating and commanding as well as the public health related functions such as monitoring the situation, risk assessment, and epidemiological briefings. The organizational structures of the EOCs were standardized, scalable and flexible. Incident Command System was the widely applied organizational structure with a strong preference. The EOCs were managed by a unit of emergency management during routine time and surge staff were engaged upon emergencies. The selected EOCs had clear information management framework including information collection, assessment and dissemination.Conclusions:The performance of National Health Emergency Response Command Center can be improved by learning from the good practice of the selected EOCs, including setting clear functions, standardizing the organizational structure, enhancing the human resource capacity and strengthening information management.
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Objective:To understand the status of two -week prevalence and the influencing factors in rural preschool leftover children of Shandong , so as to provide evidence for putting forward effective health intervention means .Methods:Using the method of stratified -cluster-random sampling and elect 646 cases of preschool lefto-ver children from 2 counties of Shandong .We surveyed with self -made questionnaire .Results:The two-week prevalence of the rural preschool leftover children is high;the influencing factors of the two -week prevalence with the rural preschool leftover children including whether children are only -child, the type of children guardianship , whether children piddle and whether left -behind children can avoid dangerous .Conclusion: The two -week prevalence present situation of rural preschool left -behind children is low , and its problems of health and ethics are clear.Therefore, effective measures should be carried out to improve the health level of rural leftover children .
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Objective To analyze the principal components and trends of total health expenditure from 1995 to 2011 in Xinjiang,in order to put forward policy recommendations to improve health financing.Methods Calculating the total health expenditure in Xinjiang using the financing source method,and analyzing the calculation results.Results Total health expenditure increase in Xinjiang averaged 14.75％ from 1995 to 2011.The total health expenditure in Xinjiang and per capita health expenses maintained a growing trend,and the level of financing was higher than regional economic development,but the health consumption elasticity coefficient was unstable; Residents' individual health burden was gradually decreasing,the health expenses of financing structure were relatively reasonable; Urban and rural residents health care spending grew faster than the per capita income,and the proportion in people's living consumption was found rising.Conclusion It is recommended to continue with the health reform,make full use the policy of strategic health support to Xinjiang,promote primary health service equity,develop economy and improve the urban and rural income,strengthen social health care security systems,tighten macro-control and curb the fast rising trend of health expenses.
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Objective To explore the method of the major hospital indexes examination using clinical pathway as an opportunity.Methods Based on the material of our hospital from 2008 to 2010,reference the data of the same level hospital in Xinjiang Uygur Autonomous Region,we set the benchmark and formulated the examination standard of three examination indexes:average length of stay (ALOS),average hospitalization expense and drug proportion.Meanwhile,we took the subentry incentives to give the corresponding reward to clinical departments according to the decreases rate compared with the benchmark monthly.Results ALOS,average hospitalization expense and drug proportion of department and the whole hospital were obviously decreased compared with the same period last year,and the differences were statistically significant (Medical system:t =27.479,14.462,11.362,all P ＜ 0.01 ; Surgical system:t =18.944,16.029,12.071,all P ＜ 0.01).Conclusion After using the examination methods and combining clinical pathway,the effects are obvious,which can effectively shorten ALOS,reduce average hospitalization expense and drug proportion,so as to relieve the patients' economic burden.
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There is an insufficient supply in essential medicines, so the nation intends to reconsider the designated medicine production. But this will raise certain risks such as negative distribution, monopolies and weakening price signal. Thus the supporting methods should be proposed as below: improving the incentive of enterprises, the efficiency of designated products, and the government administration level to promote the development of the pharmaceutical market and improve the level of public health.
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A detection system for rational drug use is vital for promoting rational drug use clinically, implementing the primary drugs policy of the state, and encouraging constant improvement of both quality of care and medical safety. This paper presented a summary of international experiences on rational drug use, introduced the initial progress to build a detection system for drug use in China, and came up with analysis on measures to further improve existing defects.
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Objective To analyze the prevention and control condition of infectious diseases of national health cities of prefecture and county level and non-national health cities in Shandong province according to the requirement to create national health cities.Methods To select 15 cities in Shandong province as the research object,including the 5 prefecture-level national health cities,5 county-level national health cities and 5 non-national health city closer to the national health situation.The survey status of infectious diseases,infectious morbidity and children′s vaccination status were analyzed,respectively.Results From 2005 to 2008,registration reporting rate,timeliness rate,accuracy rate and integrity rate of legal infectious diseases increased to 99％ or more.Direct reporting network coverage rate of 1infectious diseases and public health emergencies reached 100％.No type A and B infectious diseases outbreak occurred.The incidences of hepatitis B,dysentery and tuberculosis of national health city were all lower than the rates of non-state health cities and the national average level.The care rate of mobile children living more than 3 months and the immunization rate reached 100％ at county-level cities.Immunization rates of child 4 vaccines and hepatitis B vaccination were more than 99％ annually in the year 2007 and 2008.Conclusions The status of prevention and treatment of infectious diseases is effective.The national health city had a more powerful emergency response ability in Shandong province.
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Objective To explore the diagnostic value of NAP activity detection in SLE.Methods Technique of AS-BI was used to NAP staining of peripheral blood smear in patients with newly-diagnosed SLE(30 cases)and normal healthy women(30 cases),to observe positive rate and positive score of NAP.Results The positive rate was(22.1±8.8)% in group SLE,(56.8±9.4)% in group normal;The positive score was(22.2±8.9)in group SLE,(58.2±9.8)in group normal.The positive rate and positive score were much lower in patients with SLE comparing with those in group normal.Differences were statistically significant(P＜0.01).Conclusions The detection of NAP is useful in the patients with newly-diagnosed SLE,but we must go on researching the pathogenesis of NAP activity decreased in SLE.
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The authors first of all make it clear that the establishment of regional medical centers in rural areas was based on the role displayed by the People's Hospital of Jinxiang County in meeting the needs of rural residents for medical services, the great importance attached to rural residents by the central government and the local governments at various levels, and the changes in the needs of rural residents for medical services. Then they argue in greater detail that the establishment of regional medical centers in rural areas is beneficial to more efficiently allocating the limited resources in rural areas, thus reducing the economic burden of and benefiting rural residents; it is also beneficial to more efficiently using the health resources technically and to enhancing the awareness of administration, quality and service delivery within the hospital.