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In response to the increasing burden of chronic diseases, many countries have launched the reform of the health system. Based on the Diagnoses Treatment Combination (DTC) and Healthy Kinzig-tal Gesundes Kinzigtal (GK), this paper elaborates on the experience of chronic diseases management during different populations in Germany and the Netherlands. Based on the scientific decision-making and system integration, the DTC builds a multidisciplinary team to achieve individualized and continuous integrated disease management. The GK model focuses on health promotion, extensively integrated social resources, to achieve the goal of reducing the incidence of chronic diseases and controlling the cost. This provides a useful reference for the building of Healthy China: integrating resources from the supply side and the demand side, strengthening the integration of the health service system, promoting citizen engagement and improving individual health literacy, so as to achieve universal health.
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Objective To compare the control effect on postoperative GER disease between tubular EC stomach esophagus anastomosis and the traditional full stomach esophagus anastomosis.Methods From September 2010 to October 2015 in Bozhou People's Hospital,85 patients diagnosed with esophageal cancer undergoing elective resection were randomly divided into a tubular stomach EC group (45 cases) and total gastrectomy group (40 cases),two patients underwent esophageal resection,wherein the tubular stomach set of rows of tubular esophagus stomach anastomosis,total gastrectomy group underwent conventional full stomach esophagus anastomosis.After the surgery until the patient to return to normal gastrointestinal function uses dynamic monitor its pH 24h esophageal pH monitoring chamber,the other respectively after 1 March using RDQ Scale GER-related symptoms in patients with score,at the same time Statistics after 1 March of the occurrence of GER.Results There were no deaths occurred,and no occurrence of postoperative anastomotic fistula and thoracic gastric emptying dysfunction,etc;the two groups were almost reached full monitoring 24 h,and between groups while monitoring the total time,Li position monitoring time,there was no significant supine monitoring time (P＞0.05);24 h reflux episodes long tubular gastric reflux group and significantly less than the number of total gastrectomy group,the longest duration of reflux and pH value ＜4.00 The cumulative time was significantly shorter in total gastrectomy group,DeMeester scores were significantly lower than the total gastrectomy group,between groups were statistically significant (P＜0.01);postoperative gastric tube 1,March RDQ score and incidence of GER significantly lower than the total gastrectomy group,between groups were statistically significant (P＜0.01 or P＜0.05).Conclusion Tubular stomach esophagus anastomosis compared with conventional full stomach esophagus anastomosis resection of esophageal cancer has a more ideal GER disease control effect,and can provide a reference for the choice of nastomosis ways for patients with esophageal cancer surgery.
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Introdu��o: O tratamento do refluxo gastroesof�gico (RGE) com f�rmulas espessadas com goma jata� tem se mostrado eficaz na redu��o dos epis�dios de refluxo e regurgita��o. Neste estudo, n�s comparamos o tratamento cl�nico, evolu��o p�ndero-estatural e padr�o das fezes, de lactentes com RGE em aleitamento materno ou recebendo f�rmula infantil antirregurgita��o com goma jata�. Material e m�todos: Analisamos um total de 42 prontu�rios m�dicos de lactentes menores de 1 ano com RGE atendidos em uma cl�nica de gastroenterologia pedi�trica. Os pacientes foram divididos em Grupo AME- aleitamento materno (n=17); e Grupo FAR- f�rmula antirregurgita��o com goma jata� (n=17). Dados antropom�tricos, uso de medica��o antirrefluxo, padr�o evacuat�rio e evolu��o do ganho p�ndero-estatural foram avaliados em 4 consultas consecutivas. Resultados: Observamos maior prescri��o de medicamentos antirrefluxo no grupo AME quando comparado ao FAR (p=0.08). N�o houve diferen�a entre os grupos no c�lculo do z-escore P/E e E/I, nem nos epis�dios de diarreia e/ou constipa��o intestinal ao longo dos 4 tempos de acompanhamento (p>0.05). Conclus�o: O uso da f�rmula espessada com goma jata� foi eficaz e segura para garantir crescimento adequado, com bom ganho p�ndero-estatural, n�o ocasionando sobrepeso, al�m de n�o interferir no padr�o das evacua��es.
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PURPOSE: Many diagnostic modalities have been used for diagnosis of gastroesophageal reflux disease (GERD). Feeding materials during esophageal pH monitoring may interfere the result of examination and esophageal pH monitoring can not diagnose GER in case of alkaline reflux. The purpose of our study is to evaluate whether scintigraphy can substitiute 24 hr pH monitoring in children with GERD. METHODS: From March 2002 to June 2003, 23 patients (12 boys and 11 girls, mean age 27 months) who have been admitted to Hanyang University Hospital presented with GER symptoms (recurrent vomiting, cough, chest pain, irritability) were included in the study. Scintigraphy and 24 hr pH monitoring were performed in all patients. RESULTS: Six out of the 23 patients (26.1%) had evidence of GER on 24 hr pH monitoring, whereas nine of 23 patients (39.2%) exhibited GER by scintigraphy. Two out of the 23 patients could not be tested because of irritability. Three (14.3%) patients had evidence of GER on both 24 hr pH monitoring and scintigraphy, three (14.3%) patients on only 24 hr pH monitoring, six (28.6%) patients on only scintigraphy, and nine (42.9%) patients had no evidence of GER on both methods. No correlation was observed between 24 hr pH monitoring and scintigraphic results by Fisher's exact test (p=0.523) or Kendal's tau (t=0.678). CONCLUSION: The results of this study demonstrated that there was no correlation between 24 hr pH monitoring and scintigraphy. Therefore these modalities could be used as complementary tests to diagnose GERD.
Subject(s)
Child , Female , Humans , Chest Pain , Cough , Diagnosis , Esophageal pH Monitoring , Gastroesophageal Reflux , Hydrogen-Ion Concentration , Radionuclide Imaging , VomitingABSTRACT
Prokinetic drugs and H2-receptor blocking agents are being used for suspected GER in ELBW (<1,000 grams) infants with apnea and bradycardia (unresponsive to methylxanthines) or feeding intolerance. Purpose: To evaluate whether anti-reflux therapy is effective in ELBW infants in improving the clinical signs for which the therapy was instituted. Methods: Clinical data of all ELBW infants admitted to NICU at Georgetown University Hospital in 1996, who received prokinetic drugs (cisapride or metoclopramide) and/or an H2 receptor blocking agent (ranitidine) were reviewed. The number of episodes and the frequency of intervention for apnea/bradycardia (As&Bs), and the number of trancutaneous oxygen desaturation episodes (O2 desats) were recorded for 72 hours before and after the institution of anti-GER therapy. Feeding intolerance was assessed by the ability to tolerate enteral feeding without significant gastric residue. The data (mean ฑ SD) were analyzed by paired t-test. Results: Twenty out of 68 infants received prokinetic drugs and/or ranitidine. Eighteen infants received anti-reflux therapy for apnea and/or bradycardia unresponsive to methylxanthines, and two infants for slow gastric emptying noted during a milk scan. The mean postnatal age and body weight at the time of therapy were 63 ฑ 37 days and 1,365 ฑ 486 grams respectively. Feeding tolerance did not change after anti-reflux therapy. There was no significant improvement in the number of apnea/bradycardia, desaturation episodes or the need for intervention after the medications was given. Conclusion: Pharmacological therapy for clinically suspected GER is prescribed frequently and appears to be of questionable efficacy in ELBW infants. As anti-reflux therapy may have serious side effects, its routine use in ELBW infants needs to be reassessed.