Recomendaciones en el abordaje del hematoma intracerebral espontáneo durante la internación / Recommendations for the management of spontaneous intracerebral hemorrhage during hospitalization

Resumen El accidente cerebrovascular (ACV) constituye la principal causa de discapacidad de origen neuro- lógico en los adultos mayores a 40 años y la cuarta causa de muerte en Argentina. En los últimos diez años las publicaciones indexadas relacionadas al tratamiento del ACV isquémico fueron más numerosas que las de ACV hemorrágico. El objetivo de este material es proporcionar recomendaciones locales y actualiza- das del abordaje de pacientes con hematoma intraparenquimatoso espontáneo durante la internación. Para la redacción de este manuscrito se convocó a especialistas en esta enfermedad que conformaron grupos de trabajo. Se plantearon 10 tópicos centrales expresados como epidemiologia, atención inicial, imágenes, tratamiento de la presión arterial, reversión de antitrombóticos, indicación de cirugía, profilaxis anticonvulsivante, pronóstico, prevención de complicaciones y reinicio de antitrombóticos. De cada tópico se plantearon mediante preguntas PICO los interrogantes más frecuentes de la práctica diaria. Luego de una revisión sistemática de la literatura, se generaron recomendaciones evaluadas mediante sistema GRADE y consensuadas entre autores y pacientes.

Abstract Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracere- bral hemorrhage during hospitalization. For the writing of this manuscript, diferent specialists were convened to form working groups. Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.

Implementation of informatization construction and auxiliary decision-making of COVID-19 designated hospitals based on agile business intelligence system / 中华医院管理杂志

In order to complete the information statistics and submission work of designated hospitals with high quality, a hospital uses the agile business intelligence system to carry out information construction, and realize the statistics, analysis and auxiliary management decision-making of COVID-19 patients′ admission data. Based on the low-load and full-volume data capture mechanism, relevant basic data in the background of the hospital information system was extracted, and the admission information visualization and early warning analysis system was built by establishing data relations, data modeling and other methods. The hospital completed 634 batches of data statistics and reporting tasks of 2 943 patients in a timely and efficient manner, and assisted clinical diagnosis and treatment improvement and hospital leadership decision-making by using data analysis, early warning feedback and other functions.

Non-surgical diagnosis and management of chronic ectopic: A case report / The Health Sciences Journal

@#Chronic ectopic pregnancy is a rare form of ectopic gestation that contributes to the increased maternal morbidity and mortality in the frst trimester of pregnancy. Diagnosis is often challenging as it presents with subtle clinical signs and symptoms, imposing the need for surgical exploration and management. This is a case of a 27-year-old gravida 3 para 2 (2002) who presented with vaginal bleeding of three weeks duration, was hemodynamically stable with unremarkable physical examination fndings. The diagnosis of a chronic ectopic pregnancy was established with a conservative, non-surgical approach through the combination of clinical symptoms, transvaginal sonography, and b-hCG monitoring. Management was likewise conservative with multiple dose methotrexate chemotherapy, eventually yielding a decrease in b-hCG from 80.0 mIU/mL to 1.0 mIU/mL.

Review of ectopic pregnancy at tertiary care center: 2 years analysis

Background: Ectopic pregnancy is defined as any intra or extra-uterine pregnancy in which the fertilized ovum implants at an aberrant site which is inconducive to its growth and development. It is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergencies affecting approximately 2% of all pregnancies. The purpose of this study is to review cases of ectopic pregnancy and determine: incidence, high risk factors, types of clinical presentation, diagnostic methods, management, morbidity and mortality.Methods: The present study, conducted over a period of 2-year, total number of deliveries was 16,144 and total number of ectopic pregnancies was 116. More than half of the cases (56.04%) had one or the other identifiable risk factor. Results: Amongst the various risk factors studied, history of previous pelvic surgery (15.43%), history of Pelvic inflammatory disease (PID) (12.9%), use of Intrauterine contraceptive device (IUCD) (10.3%) and either spontaneous or induced abortion (7.76%) has been found. History of self-administered medical termination of pregnancy (MTP) pill was present in 3.45%. Repeat ectopic pregnancies were seen in 1.72%. There was no identifiable risk factor in 49.63% of cases.Conclusion: Ectopic pregnancy is a major challenge in obstetrical practice because of its varied clinical presentation. It can be diagnosed early by keeping a high index of suspicion. Undue delay in referral reduces significant morbidity and improves the chances of preserving future fertility. Mass education regarding safe abortion practices and post abortal care should be promoted. Unsupervised usage of MTP pill intake should be condemned.

A comparison of efficacy between 0.2% of topical glyceryl trinitrate and lateral anal sphincterotomy

Background: Anal fissure is a linear tear in the lining of the anal canal below the dentate line. Among the conservative modalities glyceryl trinitrate (GTN) is emerging as first line of treatment since it breaks the vicious cycle and relaxes the sphincter. Surgery was considered as the first line of treatment if conservative measures such as bulk laxatives, stool softeners and local anaesthetics fail. Aim of this study was to study the aetiology and predisposing factors, age and sex distribution, clinical presentation, position of fissure, complications associated with medical and surgical management and comparison of efficacy of topical GTN (0.2%) and lateral anal sphincterotomy.Methods: The study was based on analysis of 60 patients who were treated for chronic fissure in ano at Malla Reddy Institute of Medical Sciences, Hyderabad from January 2018 to February 2020. Patients were divided into 2 groups. One group was managed by topical application of the ointment and other group was managed by surgery (lateral anal sphincterotomy). Statistical tool (software) used to analyse the data was SPSS 13.0 software.Results: Around 33.33% patients who were managed medically by 0.2% glyceryl trinitrate did not have relief of symptoms. Patients under surgical management had more relief of symptoms (86.6%). Almost all patients treated with glyceryl trinitrate had some form of headache. During the immediate post-operative period 13.3% patients treated with surgery had pain.Conclusions: It can be concluded that open lateral anal sphincterotomy is superior to topical 0.2% GTN with high rate of healing and very low rate of complications.

A comparative clinical evaluation of outcome of medical and surgical management of symptoms due to benign prostatic hyperplasia

Background: Benign hypertrophy of prostate is common disorder and benign neoplasm of man above 50 years of age. Around 30% patients with benign hypertrophy of prostate lower urinary tract symptoms (LUTS) but all symptoms may not be due to benign hypertrophy of prostate (BHP). Present study has been designed for comparative evaluation of the outcome of medical and surgical management of symptoms, due to benign prostatic hyperplasia by using IPSS (international prostate score) and quality of life score as tool.Methods: In present study patients with LUTS, clinically diagnosed by per rectal digital examination and transrectal ultrasonographically confirmed cases of enlargement of prostate are enrolled for this study. Patients enrolled were divided equally in three groups.Results: After six month the mean IPSS score in silodosin (Sd) group was 6.55±0.86 and in Sd+Dutasteride (Dt) group it was 5.09±1.12. After six months mean IPSS score in Sd+Dt group was 5.09±1.12 and in TURP group it was 2.44±0.59.Conclusions:  Single drug treatment with silodosin is associated with slow and less improvement in IPSS score in comparison with silodosin and dutasteride. But the response to TURP was better and faster than medical management.

Medical management after subthalamic stimulation in Parkinson's disease: a phenotype perspective / Manejo medicamentoso após estimulação subtalâmica na doença de Parkinson: uma perspectiva fenotípica

Abstract Subthalamic nucleus deep brain stimulation (STN DBS) is an established treatment that improves motor fluctuations, dyskinesia, and tremor in Parkinson's disease (PD). After the surgery, a careful electrode programming strategy and medical management are crucial, because an imbalance between them can compromise the quality of life over time. Clinical management is not straightforward and depends on several perioperative motor and non-motor symptoms. In this study, we review the literature data on acute medical management after STN DBS in PD and propose a clinical algorithm on medical management focused on the patient's phenotypic profile at the perioperative period. Overall, across the trials, the levodopa equivalent daily dose is reduced by 30 to 50% one year after surgery. In patients taking high doses of dopaminergic drugs or with high risk of impulse control disorders, an initial reduction in dopamine agonists after STN DBS is recommended to avoid the hyperdopaminergic syndrome, particularly hypomania. On the other hand, a rapid reduction of dopaminergic agonists of more than 70% during the first months can lead to dopaminergic agonist withdrawal syndrome, characterized by apathy, pain, and autonomic features. In a subset of patients with severe dyskinesia before surgery, an initial reduction in levodopa seems to be a more reasonable approach. Finally, when the patient's phenotype before the surgery is the severe parkinsonism (wearing-off) with or without tremor, reduction of the medication after surgery can be more conservative. Individualized medical management following DBS contributes to the ultimate therapy success.

Resumo A estimulação cerebral profunda do núcleo subtalâmico (ECP NST) é um tratamento estabelecido para doença de Parkinson (DP), que leva à melhora das flutuações motoras, da discinesia e do tremor. Após a cirurgia, deve haver uma estratégia cuidadosa de programação da estimulação e do manejo medicamentoso, pois um desequilíbrio entre eles pode comprometer a qualidade de vida. O gerenciamento clínico não é simples e depende de vários sintomas motores e não motores perioperatórios. Nesta revisão, discutimos os dados da literatura sobre o tratamento clínico agudo após a ECP NST na DP e propomos um algoritmo clínico baseado no perfil fenotípico do paciente no período perioperatório. Em geral, nos estudos clínicos, a dose diária equivalente de levodopa é reduzida em 30 a 50% um ano após a cirurgia. Em pacientes que recebem altas doses de medicações dopaminérgicas ou com alto risco de impulsividade, recomenda-se redução inicial do agonista dopaminérgico após a ECP NST, para evitar síndrome hiperdopaminérgica, particularmente a hipomania. Por outro lado, uma rápida redução de agonistas dopaminérgicos em mais de 70% durante os primeiros meses pode levar à síndrome de abstinência do agonista dopaminérgico, com apatia, dor e disautonomia. Em pacientes com discinesia grave antes da cirurgia, é recomendada redução inicial na dose de levodopa. Finalmente, quando o fenótipo do paciente antes da cirurgia é o parkinsonismo grave (flutuação motora) com ou sem tremor, a redução da medicação após a cirurgia deve ser mais conservadora. O tratamento médico individualizado após a ECP contribui para o sucesso final da terapia.

Primary ovarian ectopic pregnancy: early diagnosis is the key

Ectopic pregnancy means implantation of the embryo outside the uterine cavity. It may occur in the fallopian tubes, ovaries or the cervix. Primary ovarian ectopic is a very rare condition. In such cases preservation of ovary is extremely important, particularly in patients with infertility. We report a case of primary ovarian ectopic which was managed conservatively in a patient of primary infertility. Preservation of ovary is extremely important, particularly in patients with infertility.

Neurocognitive outcome in young child with Isovaleric Acidemia

Isovaleric Acidemia (IVA) is inherited as an autosomal recessive trait, caused by the deficiency of the enzyme isovaleryl CoA dehydrogenase. It has the prevalence of 1 in 62,500 (in parts of Germany) to 1 in 250,000 live births (in the United States). Acute episodes of metabolic decompensations may occur, which may mimic sepsis, ketosis or shock. Early diagnosis & early initiation of treatment has been reported to correlate with a good neurocognitive outcome. This is case of child presenting in Paediatric emergency department with fever, vomiting, increased respiratory activity and lethargy. Child had GCS score of 8/15, acidotic breathing, hypotonia with hyporeflexia. Sepsis screen, metabolic work up and neuroimaging were all normal except for high anion Gap acidosis with ketosis. So further neurometabolic screening work up was done in view of persistent metabolic acidosis, developmental delay, and bad obstetric history in mother. It revealed increased excretion of isovalerylglycine 1(IVG 1), Isovalerylglycine 2 (IVG2) Lactate, 3-Hydroxypropionate (3HP) and 3-Hydroxybutyrate (3 HB).Serum lactate 358.54 (control 1.1-208.1) confirming the diagnosis of Isovaleric Acidemia. After recovery from the acute attack, the patient was advised low-protein diet (1.0-1.5 g/kg/24 hrs.) and carnitine (100 mg/kg/24 hrs. orally) supplements. On follow up child is asymptomatic & showing neurological improvement as he started achieving further developmental milestones during 6 months follow up.Early diagnosis and early treatment of IVA cases definitely results in favorable outcome and better prognosis. But chronic intermittent cases presenting late should not be neglected, proper medical management can reverse neuromotor consequences in them also.

To Compare the Efficacy of Ulipristal acetate and Mifepristone in Management of Uterine Fibroids in Symptomatic Patients of Reproductive Age Group

Introduction: Uterine myomas incidence is variable asmost of the patients are asymptomatic but most commonclinical feature which makes women seek their treatment aremenorrhagia and iron deficiency anaemia leading to chronicfatigue. Study aimed to compare the efficacy of UPA andmifepristone in medical management of uterine fibroids insymptomatic patients of reproductive age group.Material and methods: A prospective randomizedobservational study was carried out, in women with single ormultiple uterine leiomyoma. Exclusion criteria: severe anemia,using any hormonal therapy, with suspected carcinomas orwith adnexal masses. 100 patients were randomly allocatedto two subgroups; group A receiving 5 mg UPA and groupB receiving 25 mg Mifepristone daily, for 13 weeks. PBACwas used to assess menstrual blood loss and Likert scorefor other symptoms. Baseline variables: uterine size andvolume, Myoma size and volume, number, hemoglobin, liverfunction tests were noted and reassessed at 1, 3 and 6 months.Endometrial sampling was done initially and at the end tostudy.Results: Mean fibroid volume reduction was 35.23% in groupA and 33.45% after 13 weeks’ treatment in group B. Meanreduction in menorrhagia: 84% in group A and 52.5% in groupB. 91% cases experienced amenorrhoea in group A and 72%in group B.Conclusion: UPA 5mg was better at achieving significantreduction in menorrhagia and achieving amenorrhoeic state ascompared to Mifepristone.

Clinical study of ectopic pregnancy at tertiary care center in Haryana, India

Background: Ectopic pregnancy is a life threatening condition in the first trimester of pregnancy. Diagnosis can be done by clinical examination, serum β-HCG and ultrasonography. This retrospective study was done to know the incidence, risk factors, and management of ectopic pregnancy.Methods: It was a retrospective study conducted on 75 patients of ectopic pregnancy admitted at tertiary care hospital in Haryana from February-2017 to January-2019. Data collected from record room and analysis done.Results: Total deliveries were conducted were 5064. The incidence of ectopic pregnancy was 1.48%, majority of the women were in the age group of 21-30 (68%), multi-parous (77.32%). The most common risk factor was abortion 33.33%, f/b tubal ligation was 13.13%, medical management of ectopic pregnancy done in 30.66%, 8% were managed by laproscopically and 58.66% by laparotomy.Conclusions: Safe sexual practices can reduce pelvic infections and ectopic pregnancy incidences. Early diagnosis before tubal rupture can reduce morbidity and mortality in ectopic pregnancy.

Difteria: Experiencia en el servicio de enfermedades infecciosas del Hospital Universitario de Caracas

Difteria es una enfermedad infecciosa bacteriana producida por Corynebacterium diphtheriae, es altamente contagiosa, prevenible por vacunas, con importantes complicaciones agudas y alta mortalidad. Objetivo: Describir las características clínicoepidemiológicas y el manejo médico de los pacientes con diagnóstico de Difteria ingresados en el Servicio de Enfermedades Infecciosas del Adulto del Hospital Universitario de Caracas (HUC) en los años 2017 y 2018. Metodología: Estudio de casos, analítico, retrospectivo, de revisión de historias clínicas. Resultados: Ingresaron 27 pacientes de los cuales se encontraron 22 historias clínicas y se excluyeron 2. De los 20 pacientes 13 (65 %) ingresaron en el año 2017 y 7 (35 %) hasta mayo del 2018. Predominó el género masculino 11 (55 %). La mayoría eran procedentes del Distrito Capital 9 (45 %), seguido del estado Miranda 8 (40 %). El promedio de edad fue de 26 años. La mayoría 8 (40 %) no tenían reportes de datos epidemiológicos en la historia clínica, 7 (35 %) negaron viajes recientes, 3 (15 %) estaban vacunados. La mayoría de los pacientes consultaron por fiebre, odinia y odinofagia 13 (65 %), seguido de fiebre y odinia 6 (30 %), el 100 % tuvo membrana blanco grisácea como clínica primaria, seguido de edema de cuello 10 (50 %). La ubicación de las membranas fue más frecuente en amígdalas palatinas 15 (75 %), con 9 casos (45 %) de formas extensivas a úvula, paladar blando y paredes de orofaringe. Las complicaciones al ingreso fueron respiratorias 9 (45 %) y neurológicas 1 (5 %). El tratamiento fue penicilina cristalina en 12 casos (60 %) y antitoxina diftérica (ATD) en el 100 %, la mayoría administrada en las primeras 24 hrs 9 (45 %). Un paciente presentó polineuropatía y 1 falleció por insuficiencia respiratoria. Conclusiones: El HUC es un centro de referencia y es pertinente determinar las características clínico-epidemiológicas y el manejo médico de los pacientes hospitalizados con diagnóstico de difteria, en el contexto de la actual epidemia.

Diphtheria is a bacterial infectious disease caused by Corynebacterium diphtheriae, it is highly contagious, preventable by vaccines, with important acute complications and high mortality. Objective: To describe the clinical-epidemiological characteristics and medical management of patients diagnosed with Diphtheria admitted to the Adult Infectious Diseases Service of the Hospital Universitario de Caracas (HUC) in the years 2017 and 2018. Methodology: Case study, analytical , retrospective, review of medical records. Results: 27 patients were admitted, of which 22 clinical records were found and 2 were excluded. Of the 20 patients, 13 (65%) entered in 2017 and 7 (35%) up to May 2018. The male gender predominated 11 (55 %). Most were from Distrito Capital 9 (45%), followed by Miranda 8 (40%). The average age was 26 years. The majority 8 (40%) had no reports of epidemiological data in the clinical history, 7 (35%) denied recent trips, 3 (15%) were vaccinated. The majority of patients consulted for fever, odinia and odynophagia 13 (65%), followed by fever and odinia 6 (30%), 100% had grayish white membrane as primary clinic, followed by neck edema 10 (50%) . The location of the membranes was more frequent in palatine tonsils 15 (75%), with 9 cases (45%) of extensive forms to the uvula, soft palate and walls of the oropharynx. Complications at admission were respiratory 9 (45%) and neurological 1 (5%). The treatment was crystalline penicillin in 12 cases (60%) and diphtheria antitoxin (DAT) in 100%, the majority administered in the first 24 h 9 (45%). One patient presented polyneuropathy and 1 died due to respiratory failure. Conclusions: The HUC is a reference center and it is pertinent to determine the clinical-epidemiological characteristics and medical management of hospitalized patients diagnosed with diphtheria, in the context of the current epidemic.

Non-surgical treatment of ectopic pregnancy

In the past few decades, ectopic pregnancy has been termed by medical practitioners has a global epidemic. With the questions lingering on everbody minds how this menace can be tamed. In a bid to reduce the mortality and financial burden brought by this evolving growing health concern, the medic has developed non-surgical alteratives to deal with ectopic pregnancy, i.e., treatment using methotrexate. In a bid to explore this topic further, these study goals were to share the experience of treating mothers who have un-ruptured ectopic pregnancies traditionally. Mothers who were found to have an ectopic pregnancy and fit the medical care were encompassed in the program, a total of 37 women. For instance, those with serum beta HCG in the range of 1000 mIU per liter were treatment expectantly whereas those with a level more than a thousand were given an injection of methotrexate. To monitor the response of experiment, beta HCG levels were monitored for each mother. The results of the current study established that 88.0% of women who underwent the study, only 12.0% of them exhibited full rsolution while the remaining lot resolved only after a sole dose of methotrexate. From the results of this study, it is evidently clear that a lot of pregnant mothers would be greatly helped if they are enrolled in such therapy at early days

An empirical study on patients′risk of access to online medical information / 中华医院管理杂志

Objective To explore the critical risk points and major current threats for patients to access online medical information. Methods The patient perception value questionnaire was used, to sample survey 1 164 patients with online medical experiences from hospitals in Zhejiang province in January 2018.Their risks in accessing online medical information was evaluated.The evaluation results were ranked according to their importance and satisfaction, and a cross comparison was made between the two, to identify the top ranking factors and the highest difference factor.Descriptive statistics and related analysis methods were used for the data so obtained.Results Health risks and privacy risks were the highest concerns for patients in accessing online medical information.Among the risk factors, information content credibility and transmission channel credibility rank top two.A cross-comparison found that factors of good risk control for online medical information were information author credibility, transmission mode reliability and service risk in turn. The factor of the worst risk control was privacy, while the most problematic risk points were information type credibility and transmission channel credibility.Conclusions The present focus should be placed on the factors of privacy risks and the credibility of information delivery channels, and the main cause of risks is the regulatory awareness.In this consideration, it is suggested that the relevant risk indicators be hierarchically managed according to the current perception characteristics in patients′ online medical access risks, with measures taken accordingly to minimize their risk in such information access.

Experiment of the "super-ministry" system at hospital's medical management department / 中华医院管理杂志

The medical management department of individual hospitals varies with their organizational structure and operational mechanism, instead of following a general pattern. Inspired by the"super-ministry" system of government,the hospital has integrated successively the Medical Affairs Office, Patient Safety Office,Medical Quality Control Office,Hospital-acquired Infection Control Office and Medical insurance office. Through integration and innovation of duties, regulations, culture, decision-making progress,coordination and talent training mechanism, the " Five-in-One" super-ministry model of medical management came into being,achieving collaborative and efficient medical management as a result.

Establishment of a Quantitative Medical Technology Evaluation System and Indicators within Medical Institutions / 中华医学杂志(英文版)

<p><b>Background</b>The development and application of medical technologies reflect the medical quality and clinical capacity of a hospital. It is also an effective approach in upgrading medical service and core competitiveness among medical institutions. This study aimed to build a quantitative medical technology evaluation system through questionnaire survey within medical institutions to perform an assessment to medical technologies more objectively and accurately, and promote the management of medical quality technologies and ensure the medical safety of various operations among the hospitals.</p><p><b>Methods</b>A two-leveled quantitative medical technology evaluation system was built through a two-round questionnaire survey of chosen experts. The Delphi method was applied in identifying the structure of evaluation system and indicators. The judgment of the experts on the indicators was adopted in building the matrix so that the weight coefficient and maximum eigenvalue (λ max), consistency index (CI), and random consistency ratio (CR) could be obtained and collected. The results were verified through consistency tests, and the index weight coefficient of each indicator was conducted and calculated through analytical hierarchy process.</p><p><b>Results</b>Twenty-six experts of different medical fields were involved in the questionnaire survey, 25 of whom successfully responded to the two-round research. Altogether, 4 primary indicators (safety, effectiveness, innovativeness, and benefits), as well as 13 secondary indicators, were included in the evaluation system. The matrix is built to conduct the λ max, CI, and CR of each expert in the survey, and the index weight coefficients of primary indicators were 0.33, 0.28, 0.27, and 0.12, respectively, and the index weight coefficients of secondary indicators were conducted and calculated accordingly.</p><p><b>Conclusions</b>As the two-round questionnaire survey of experts and statistical analysis were performed and credibility of the results was verified through consistency evaluation test, the study established a quantitative medical technology evaluation system model and assessment indicators within medical institutions based on the Delphi method and analytical hierarchy process. Moreover, further verifications, adjustments, and optimizations of the system and indicators will be performed in follow-up studies.</p>

Cost Analysis of Cervical Cancer Patients with Different Medical Payment Modes Based on Gamma Model within a Grade A Tertiary Hospital / 中华医学杂志(英文版)

<p><b>Background</b>Cervical cancer shows a growing incidence and medical cost in recent years that has increased severe financial pressure on patients and medical insurance institutions. This study aimed to investigate the medical economic characteristics of cervical cancer patients with different payment modes within a Grade A tertiary hospital to provide evidence and suggestions for inpatient cost control and to verify the application of Gamma model in medical cost analysis.</p><p><b>Methods</b>The basic and cost information of cervical cancer cases within a Grade A tertiary hospital in the year 2011-2016 were collected. The Gamma model was adopted to analyze the differences in each cost item between medical insured patient and uninsured patients. Meanwhile, the marginal means of different cost items were calculated to estimate the influence of payment modes toward different medical cost items among cervical cancer patients in the study.</p><p><b>Results:</b>A total of 1321 inpatients with cervical cancer between the 2011 and 2016 were collected through the medical records system. Of the 1321 cases, 65.9% accounted for medical insured patients and 34.1% were uninsured patients. The total inpatient medical expenditure of insured patients was RMB 29,509.1 Yuan and uninsured patients was RMB 22,114.3 Yuan, respectively. Payment modes, therapeutic options as well as the recurrence and metastasis of tumor toward the inpatient medical expenditures between the two groups were statistically significant. To the specifics, drug costs accounted for 37.7% and 33.8% of the total, surgery costs accounted for 21.5% and 25.5%, treatment costs accounted for 18.7% and 16.4%, whereas the costs of imaging and laboratory examinations accounted for 16.4% and 15.2% for the insured patient and uninsured patients, respectively. As the effects of covariates were controlled, the total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs showed statistical significance. The total hospitalization costs, drug costs, treatment costs as well as imaging and laboratory examination costs of insured patient were 1.33, 1.42, 1.52, and 1.44 times of uninsured patients.</p><p><b>Conclusions</b>The analysis of different payment modes toward the medical economic characteristics based on Gamma model is basically rational. Medical payment modes are having certain influence toward the hospitalization expenses of cervical cancer patients in an extent, as drug costs, treatment costs, and examination costs appear to be the main causes.</p>

Experiencia en la Elaboración de un Inventario Funcional de Equipo de Imagenología / Experience in the Development of a Functional Inventory of Imaging Medical Equipment

RESUMEN: En nuestro México las Instituciones de salud han ganado experiencia en la administración de sus procesos; para muchos la clave del éxito está en la gestión de los recursos existentes, a medida que estos sean los adecuados, su eficacia será mayor. El presente documento pretende brindar un procedimiento que apoye las funciones de planeación y toma de decisiones de equipos de imagenología, bajo el criterio de contar con un inventario funcional de equipo de Rayos X en las unidades de atención médica de la Delegación Sur del Instituto Mexicano del Seguro Social (IMSS) de la Ciudad de México. Los resultados obtenidos permiten conocer las necesidades de modernización de la infraestructura tecnológica instalada y su distribución; así como planear su renovación y conservación para contribuir en el proceso de mejora de la calidad de los servicios de salud. Se analiza su distribución geográfica, edad media de funcionamiento y su productividad. En el inventario se detectaron 198 equipos relevantes, de los cuales los equipos de Rayos X de 500 y 300 mA son los más abundantes (43.94%) seguidos de los de Ultrasonógrafia (29.80%) y las unidades de radiología y fluoroscopia (21.21%). Los datos presentados deben ayudar a una mejor planeación en la adquisición de los equipos médicos dentro de la Delegación.

ABSTRACT: Healthcare institutions in Mexico have gained experience in the administration of their processes. The key to success lies in the management of existing resources, as long as these are adequate, their effectiveness will be greater. This document is aims to provide a procedure that supports the planning and decision-making functions of imaging equipments, under the criterion of having a functional inventory of X Ray equipment in medical care units of South Delegation of the Mexican Institute of Social Security (IMSS) of Mexico City. In this report it is described the type of equipment used in radiology and other imaging services. Its geographical distribution, average functional age and its productivity are analyzed. The Inventory reported 198 pieces of radiology equipment, equipments of 300 mA or 500 mA the most common type (43.94%) followed by ultrasound (29.80%) and fluoroscopy units (21.21%). Follow-up in the inventory should help in planning the acquisition and maintenance of medical equipment within the Delegation.

Analysis on the characteristics and risk exposure of online medical information transmission / 中华医院管理杂志

By means of literature review, theoretical analysis and analogy analysis, the authors analyzed the characteristics and risk exposure of online medical information transmission. According to whether the sender has a clear intention or target and whether the receiver intends to search,the transmission models of such information fall into four types: "clear-active", "unclear-active", "unclear-passive", and"clear-passive". The characteristics of online medical information transmission include the complexity of multiple dimensions and multiple levels, multiple sources of information, multiple directions and media of transmission, and the rapid development of mobile internet medical information technology. The risk exposure of online medical information transmission can be classified into three categories: the risk of information dissemination source, that of transmission process and that of receiver′s individual behavior. Transmission risks mostly come from quality gaps of information dissemination sources, uncontrollable transmission paths, numerous influencing factors, difficulties in information screening and poor regulating systems.

Prevention of urolithiasis: what should we do? / 中华泌尿外科杂志

Urolithiasis is a common chronic disease with high recurrence rate,which has world widely impacted on the human health.Comprehensive metabolic evaluation followed by appropriate dietary and pharmacological management is of paramount importance for preventing recurrence.This article reviewed the progress in the prevention of urolithiasis based on the latest guidelines of urolithiasis.