Policy evaluation of human organ transplantation based on policy modeling consistency index model / 器官移植

Objective To evaluate the policy of human organ transplantation in China, aiming to provide theoretical basis for further optimizing the policy of human organ transplantation. Methods Based on text mining and statistical analysis, seven normative policies of human organ transplantation formulated by national government from 2000 to 2022 were quantitatively evaluated by constructing policy modeling consistency (PMC) with 10 first-level variables and 35 second-level variables. Results Among the seven policies, six were graded as excellent policies and one as perfect policy, with an average PMC index of 8.476. Except X8 policy audience, the scores of other second-level variables of P5 were higher than or equal to the mean. The scores of all second-level variables of P1 were lower than or equal to the mean. P1 and P5 significantly differed in X3 policy timeliness, X4 policy norms and X6 policy tools. P5 was more specific and relatively comprehensive in these aspects, and its score was significantly higher than that of P1. Conclusions Human organ transplantation policies in China are generally excellent, scientific and rational. Health administrative departments at all levels should pay attention to the grasp of policy timeliness, the combination of policy tools, and fully mobilize the initiative and enthusiasm of all policy audience to participate in organ transplantation management when formulating organ transplantation policies.

Policy analysis of high-quality development of traditional Chinese medicine based on PMC index model / 中国药房

OBJECTIVE To provide reference for the optimization of development policy of traditional Chinese medicine. METHODS ROSTCM text mining analysis software was adopted to screen the literature preliminarily ，the PMC policy index model was built ，and the results by PMC index and visual PMC surface were analyzed. RESULTS & CONCLUSIONS A total of 33 policies related to traditional Chinese medicine were included ，and 10 primary variables and 46 secondary variables were set. The average PMC index of 33 policies was 6.15，of which 2 were excellent policies and the rest were good policies. Among the primary variables ，the scores of policy openness ，policy evaluation and policy field were relatively high ，while the scores of release time ，policy level and policy type were low. The analysis of sink index and secondary variables showed that the macro planning of national policies was not specific enough in terms of policy objectives and contents ，with low score ，while the local policies were usually planned in detail. Generally speaking ，there is still much room for improvement in the policies related to the development of traditional Chinese medicine in terms of policy system construction ，government investment ，talent construction ， financing supporting policies ，market access rules ，responsible subjects and legal guarantee.

Quantitative evaluation for payment policy of diagnosis-related groups in China based on PMC index model / 中国药房

OBJECTIVE To quantitatively evaluate the existing payment policies of diagnosis-related groups （DRGs）in China ， so as to provide reference for the formulation and improvement of policies. METHODS Totally 58 documents related to DRGs payment issued by the national and provincial medical security bureaus from 2017 to 2022 were processed by text mining method. PMC index evaluation model of DRGs payment policy was established. Nine typical DRGs payment policies were quantitatively evaluated and analyzed by 10 primary variables and 40 secondary variables. RESULTS Among the 9 policies，5 were excellent and 4 were acceptable. The average score of PMC index was 6.882. Generally ，there was still room for improvement because of the acceptable level. By comparing the two representative policies ，it was found that the main reasons was a lack of consideration in terms of supervision and management ，incentives and constraints when facing policy changes ，reason of the lower level of urban development. CONCLUSIONS Although DRGs payment policy in China is basically perfect ，there is still a lot of room for improvement in terms of extending the time limit of the policy ，summarizing and spreading the successful experience of pilot cities.

Quantitative Evaluation of Chronic Disease Management Policy in China Based on PMC Index Model / 中国药房

OBJECTIVE：To su mmarize the achievements and shortcomings of chronic disease management policies in China ， and to provide reference for the formulation and improvement of the policy. METHODS ：Totally 109 documents related to chronic disease management issued by the State Council and various ministries and commissions from 2009 to 2020 were processed by text mining method. PMC index evaluation model of chronic disease management policy was established. Sixteen typical chronic disease management policies were quantitatively evaluated and analyzed by 10 first-level indicators and 40 second-level indicators. RESULTS：Among the 16 policies，10 were of excellent level and 6 were of acceptable level. The average PMC score was 7.243， which was generally acceptable level but still had large room for improvement. By comparing two representative policies ，it was found that the main reasons for the policies with low scores were the lack of long-term development planning ，the absence of “Internet + chronic disease management ”new model and other contents ，and the lack of talent incentive and legal guarantee measures. CONCLUSIONS ：Chronic disease management policy has been improved ，and it can be further improved from the aspects of policy prescription ，policy content and incentive mode.

A Case of Vancomycin Resistant Enterococcal Urinary Tract Infection and Pseudomembranous Colitis Co-Infection / 대한신장학회지

Infections are the second leading cause of mortality among patients with end-stage renal disease (ESRD). Recently, colonization or infection with vancomycin-resistant enterococci (VRE) is increasing in prevalence at many institutions and is often reported in dialysis patients. Enterococci are generally considered to be of low pathogenicity but may cause urinary tract infection, bacteremia, endocarditis or meningitis in debilitated patients. Three cases of VRE peritonitis in patients on CAPD were reported, but there was no report of VRE urinary tract infection (UTI) in hemodialysis patients in Korea. We present a case of VRE UTI with pseudomembranous colitis (PMC) in an ESRD patient with anal VRE colonization. The VRE UTI was treated successfully with linezolid.

Esosinophilic Gastroenteritis with Clostridium difficile-associated Colitis: A Case Report / 대한소화기내시경학회지

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration in the bowel wall and presents various symptoms depending on the affected site and bowel layer. Pseudomembranous colitis is an antibiotic-associated infection caused by abnormal overgrowth of the toxin-producing Clostridium difficile in the large bowel. A 16-year-old boy was admitted with abdominal pain for 6 days. On admission, we performed an endoscopy and diagnosed gastroduodenitis. Then, we prescribed gastritis medication but he still presented with diffuse abdominal pain and fever above 38.0degrees C after admission. We considered infectious enterocolitis, so we prescribed an antibiotic. The next day, he presented with bloody diarrhea. A diagnosis of pseudomembranous colitis was confirmed by a colonoscopic examination with a biopsy. We also obtained a diagnosis of eosinophilic gastroenteritis through a histological diagnosis. This is the first case of the simultaneous occurrence of eosinophilic gastroenteritis and pseudomembranous colitis in the Korean medical literature. We report this case with a brief review of the literature.

Anti-Tuberculosis Agents Induced Pseudomembranous Colitis Treated with Maintaining Anti-Tuberculosis Drugs / 대한소화기내시경학회지

Tuberculosis is one of the main infectious health problems in Korea, and a combination of antibiotics is required to treat this illness. The combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide has many adverse reactions and there have been several case reports about pseudomembranous colitis (PMC) after anti- tuberculosis treatment. Rifampicin is regarded as a main cause of anti-tuberculosis induced PMC because of its bacteriocidal effect, and interruption of the offending drug, such as rifampicin, is usually necessary to treat the PMC. However, in patents with uncompensated tuberculosis, the discontinuance of anti-tuberculosis medication accentuates the disease severity, and continuance of the anti-tuberculosis medication is necessary to overcome the tuberculosis. We report here on a case in which the anti- tuberculosis agents induced PMC in 32 year old female who was diagnosed with active pulmonary tuberculosis. She was treated with maintenance of the anti-tuberculosis medication and also the addition of both oral metronidazole and probiotics.

Changes of Plasma Endothelin-1 Concentration after Percutaneous Mitral Commissurotomy

BACKGROUND: Endothelin, a very potent vasoconstricting substance released from the endothelium, has been known to be elevated in various cardiovascular disorders, however, the sites of endothelin porduction as well as the influence of acute hemodynamic changes upon plasma endothelin-1 concentration remains elucidated. METHODS: In order to evaluate the probable site of endothelin production and relationship between levels of plasma endothelin and hemodynamic variables, six patients with moderate to severe mitral stenosis underwent percutaneous mitral commissurotomy(PMC) were included. Measurement of mean pulmonary arterial pressure, cardiac output as well as plasma endothelin-1 concentration of renal vein, main pulmonary artery, and ascending aorta were performed before and 20 minutes after PMC. RESULTS: After PMC, cardiac output increased significantly, whereas mean pulmonary artery pressure and transvalvular pressure gradient were reduced significantly(both p<0.05). Before PMC, plasma endothelin-1 concentration tended to be higher in renal vein(6.12+/-3.7pg/ml) and pulmonary artery(5.07+/-1.7) than that in aorta(3.05+/-1.2pg/ml). After hemodynamic improvement with PMC, plasma endothelin-1 concentration decreased at all the site, however the change at pulmonary artery was statistically significant. CONCLUSION: These results suggest that endothelin-1 may be produced mainly somewhere in systemic venous circulation such as kidney rather than pulmonary circulation, and plasma endothelin-1 concentration tends to decrease in response to the acute hemodydnamic im provement.