RESUMEN
Objective To objectively study the current progress of China Healthcare Improvement Initiative, and its effectiveness and shortcomings for further improvement. Methods Questionnaires were customized by expert consultation and pre-investigation, and distributed by the National Health Commission in April 2018 to the hospitals.Data of 5 469 hospitals were recovered and analyzed with a statistics software for descriptive analysis.Results Implementation progress of the five working systems varied with regions, and rooms of improvement were found in such aspects as outpatient appointment, clinical pathway management and social work system.In 2017, the proportion of outpatient appointments of 5 469 hospitals averaged 19.1%.Progress of the ten major service models also varied, as defects were found in such service models as continuous medical service, intelligent service, and interconnection service.In 2017, only 6.7% of the 5 469 hospitals had put in place hierarchical integrated clinical pathways within their medical alliances.Conclusions Improvement of the medical services calls for not only the efforts of medical institutions themselves, but also top-level design by the local health authorities. In particular, an online information platform should be established for the whole region, to unify the information standards and processes, and corresponding mechanisms and system support are needed.
RESUMEN
OBJECTIVE:To explore losses and gains (L&G) and L&G ratio induced by Essential Medicine System in a county. METHODS:By choosing a county in western China as sample area,field investigation was used to collect outpatient and inpatient visits,outpatient and inpatient income,drug income,total length of stay and medical insurance reimbursement criteria in primary medical institutions (township health centers,village health rooms) of the county during 2009-2015. By setting the year 2009 as the baseline year,the drug cost reimbursed by medical insurance was simulated and calculated when Essential Medicine System were not implemented;L&G and L&G ratio of medical insurance were calculated by comparing with actual drug cost reimbursed by medical insurance. RESULTS:The year 2012,in which the sample county fully implemented the Essential Medicine System was the turning year. Medical insurance funds lost in primary medical institutions of the county during 2010-2011(lost 437000,915000 yuan,respectively),but gained during 2012 to 2015(gained 199000,494000,858000,1290000 yuan, respectively);the L&G ratio increased from -0.67％ to 1.21％. For reimbursed outpatient drug cost and inpatient cost,L&G of medical insurance were different. For reimbursed drug cost of village health room and township health center,L&G of medical insurance were also different. CONCLUSIONS:The implementation of Essential Medicine System benefits to medical insurance within the county and Medical insurance funds can be saved.
RESUMEN
OBJECTIVE To compare two administration methods of triamcinolone acetonide cream for the treatment of ear mycosis with pevison. METHODS Eighty-six cases diagnosed as the external auditory canal fungal infections with tympanic membrane perforation were randomly divided into observation group and control group, with 43 cases in each group. All the selected patients were positive in the external auditory meatal secretions fungus detection test, fungi and secretions of the external auditory canal are thoroughly cleaned under the endoscope. After ear canal cleaning, the obervation group was treated with Pevisone smeared on gelatin sponge which was evenly placed on the external auditory canal with fungal infection. The control group was treated with Pevisone smearing on external auditory canal by the patients themselves, twice a day. Two groups of patients come to the hospital every 3 days for review. After 2 weeks of treatment, the patients were followed up for 3 months, and the clinical efficacy of each group was compared. RESULTS The observation group was cured in 39 cases(90.7％), effective in 2 cases(4.7％), and ineffective in 2 cases(4.7％), The total efficiency rate is 95.3％.1 case recurred at 3 months of follow-up(2.4％). While in the control group, it was cured in 26 cases(60.5％), effective in 1 cases(2.3％), and ineffective in 16 cases(37.2％), the total efficiency rate is 62.8％.9 cases recurred at 3 months of follow-up(31.0％). The effect of the observation group was significantly higher than that of the control group(x2=14.508, P<0.05). CONCLUSION The ear endoscope can be used to remove the external auditory canal fungus thoroughly and has good visibility. Treating external auditory canal fungi disease with tympanic membrane perforation with gelatin sponge coated with triamcinolone acetonide cream has better clinical efficacy.
RESUMEN
Objective To compare the clinical results of anterior cruciate ligament(ACL)reconstruction using anterior tibial muscle tendons allograft and hamstring tendons autograft.Methods According to the graft used for ACL reconstruction,60 patients with chronic ruptures of ACL were divided into group A(30 patients,using anterior tibial muscle tendons allograft)and group B(30 patients,using semitendinosus and gracilis tendons autograft).The average follow-up periods after surgery were 29.4 and 31.6 months respectively.Lysholm,Tegner,IKDC clinical rating scales and KT2000 were used for evaluation pre-and post-operation.The muscle strength of the extension,flexion,internal rotation and external rotation of knees was evaluated by the isokinetic tester.Results There were statistically significant differences in Lysholm,Tegner,IKDC clinical rating scales and KT2000 results between pre-and postoperation(P0.05).The Isokinetic muscle strength tester showed that the knee muscle strength of the internal rotation and flexion were decreased post-operative in group B,rather than group A,which showed no significant differences between pre-and post.operation(P<0.05).Conclusion For ACL reconstruction under arthroscopy,anterior tibial muscle tendons allograft was a favorable substitute for autograft materials for its convenience,satisfactory clinical effect and less complications.
RESUMEN
BACKGROUND:With the rapid development and wide application of proteomics techniques,effective tools are available for exploring specific biomarkers for early detection and diagnosis of liver diseases.Recent years,many novel and promising biomarkers have been discovered and evaluated.OBJECTIVE:To review the advances and applications of proteomics in liver development,regeneration and diseases.RETRIEVAL STRATEGY:A computer-based online search of Medline database was undertaken for the English literatures about liver diseases and proteomics published from January 1995 to July 2007 with the keywords "proteomics,liver".Meanwhile,Chinese articles published from January 1995 to July 2007 were searched in CNKI database,with the same keywords in Chinese.The retrieved articles were screened firstly,and those about proteomics and liver diseases were selected and searched for full texts.Repetitive studies and Meta analysis were excluded.156 articles about the proteomics and liver diseases were collected,and finally 32 articles were included.LITERATURE EVALUATION:Of the 32 articles,3 were about the research background of proteomics,6 about proteomics under healthy status,and 23 about proteomics research in liver diseases.DATA SYNTHESIS:Proteomics is a novel science to study protecome using various techniques.The study of the proteome,called proteomics,now evokes all the proteins coded by gene in any given organism,tissue,cell,and even organelle.The researches of proteomics help us to find and understand the life as a whole.Nowadays,there lacks of effective strategy in diagnosis,stages,and treatment in liver diseases.Proteomics is promising in alertness,diagnosis,treatment and prognosis in liver diseases.CONCLUSION:With the deepened study of proteomics in liver diseases,there will be a revolution in the diagnosis and treatment of liver diseases.
RESUMEN
Objective To study the correlation between expression of vascular endothelial growth factor(VEGF)and tissue inhibitor of metalloproteinase 2(TIMP-2)and prognosis of patients with laryngeal squamous cell carcinoma.Methods The expression of VEGF and TIMP-2 were measured in 38 specimen of LSCC and 19 specimens of normal laryngeal tissue adjacent to the tumors with EnVision immunohistochemical technique,follow-up for 3~5 years after operation local relapse occurred in four cases,cervical nodular metastasized occurred in fwo cases and pneumonic metastasis occurred one case.Results The expression level of two marks in primary tumors was significantly higher than that in pericancerous tissues(P
RESUMEN
Objective To investigate the incidence,original location and clinical features of olfactory sulcus polyp in patients with chronic sinusitis.Methods Two hundred and seventeen cases(351 sides) with chronic sinusitis were reviewed,their olfactory sulcus was carefully examined with nasal endoscope during operation.The incidence and original location of olfactory sulcus polyp were observed,and the relationship between olfactory sulcus polyps and prognosis of chronic sinusitis or olfaction of the patients with olfactory sulcus polyps were also statistically analyzed with Chi-square test and Spearman rank correlation.Results The incidence of olfactory sulcus polyp in the cases with chronic sinusitis was 18.52%.Among these cases with olfactory sulcus polyps,the rate of olfactory disorder was 81.82%,which was higher than that in the cases without olfactory sulcus polyps(25.63%,P