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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 investigate correlation of serum acute amyloid A (A-SAA) level and activity of Behcet's disease (BD).Methods·Blood samples from patients with active BD (n=40),remission BD (n=15),Takayasu disease (TA,n=12),rheumatoid arthritis (RA,n=25),systemic lupus erythematosus (SLE,n=25) and healthy donor (HD,n=25) were collected.Serum A-SAA,ESR,and CRP levels were detected and compared among groups.The correlation between A-SAA and its downstream IL-8 or International Society for Behcet's disease (ISBD) disease activity scores was analyzed as well.Results·Serum A-SAA level was significantly increased in the patients with active BD [(115.70±87.78) mg/L],as well as patients with RA and TA,which levels were (68.72±61.50) mg/L and (96.25±87.41) mg/L respectively,but remained unchanged in SLE patients.Moreover,serum A-SAA level was found correlated with ISBD score as well as IL-8 level.Conclusion·A-SAA can work as a detection index for evaluating BD activity.
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Objective To investigate the trend of cardiac reserve function during the normal labor.Methods Sixty-three cases were chosen randomly from hospitalized maternal women in the First Affiliated Hospital of Chongqing Medical University from 2010 June to December ( six months).The digital technique of heart sound signal processing was used to analysize cardiac reserve function parameters including the heart rate ( HR),the ratio of the amplitude of the first heart sound to the second heart sound and the ratio of diastolic to systolic duration (D/S) of pregnant women.Results ( 1 ) Comparisons of cardiac reserve function between uterine contractions and relaxations during labor:①Latent phase of labor ( cervix dilation ＜ 3 cm ):HR was ( 87.3 ± 14.0 ) beats/min in uterine contractions and ( 82.8 ± 12.5 )beats/min in uterine relaxations,the ratio of D/S was 1.14 ±0.27 in uterine contractions and 1.21 ±0.22 in uterine relaxations,the comparisons of the above two were statistically significant,P ＜0.05 ; But the ratio of S1/S2 was 2.19 ±0.82 in uterine contractions and 2.28 ±0.81 in ueterine relaxations,the comparison was not statistically significant,P ＞ 0.05.② During early active stage of labor ( cervix dilation 3-6 cm):HR was (89.3 ± 15.4) beats/min in uterine contractions and (83.1 ± 13.5) beats/min in uterine relaxations,the ratio of D/S was 1.09 ± 0.30 in uterine contractions and 1.20 ± 0.27 in uterine relaxations,the comparisons of the above two were statistically significant,( P ＜0.05 ) ;But the ratio of S1/S2 was 2.42 ± 1.08 in uterine contractions and 2.29 ±0.83 in ueterine relaxations,the comparison was not statistically significant ( P ＞0.05 ); ③During late active stage of labor (cervix dilation 6-10 cm),HR was (95.4 ± 18.7 ) beats/min in uterine contractions and (86.2 ± 15.6) beats/min in uterine relaxations,the ratio of D/S was 1.01 ±0.25 in uterine contractions and 1.18 ± 0.25 in uterine relaxations,the comparisons of the above two were statistically significant,( P ＜ 0.05 ) ; But the ratio of S1/S2 was 2.61 ± 1.26 in uterine contractions and 2.67 ± 1.19 in ueterine relaxations,the comparison was not statistically significant ( P ＞ 0.05 ).④ The second stage of labor (cervical dilation ≥ 10 cm ):HR was (109.4 ± 19.7 ) beats/min in uterine contractions and (93.5 ± 16.7 ) beats/min in uterine relaxations,the ratio of D/S was 0.89 ± 0.23 in uterine contractions and 1.14 ±0.26 in uterine relaxations,the ratio of S1/S2 was 3.66 ± 1.37 in uterine contractions and (2.81 ± 1.07 ) in uterine relaxations,the comparisons of all were statistically significant (P＜0.05).(2)Comparison of cardiac reserve function in uterine relaxations of each stage of labor:①Maternal heart rate gradually increased from latent stage of labor to the second stage of labor,and decreased postpartum,the comparison was statistically significant ( P ＜ 0.05 ) ;② The ratio of S1/S2 of maternal gradually increased from latent stage of labor to the second stage of labor,and decreased postpartum,the comparison was statistically significant( P ＜0.05 ) ;③ The ratio of D/S gradually decreased from latency to the second stage of labor,and increased postpartum,the comparison was statistically significant( P ＜0.05 ).(3) Comparison of cardiac reserve function in uterine contractions of each stage of labor:① Maternal heart rate gradually decreased from latent stage of labor to the second stage of labor,the comparison was statistically significant( P ＜ 0.05 ) ;② The ratio of S1/S2 of maternal gradually increased from latent stage of labor to the second stage of labor,the comparison was statistically significant( P ＜ 0.05 ) ; ③ The ratio of D/S gradually decreased from latency to the second stage of labor,the comparison was statistically significant (P ＜0.05).Conclusions The maternal cardiac reserve function decreased in uterine contractions than relaxation during labor; With the progress of labor,the maternal cardiac reserve function declined,especially in the second stage of labor,and recovered in postpartum stage.