Effect analysis of day surgery cost control based on propensity value matching / 中华医院管理杂志

Objective:To analyze the composition, the changes of expense structure and the influencing factors of hospitalization expenses, for reference in optimizing the cost control of day surgery.Methods:Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs, chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020. The confounding factors were eliminated through propensity matching. The structural change of hospitalization expenses was analyzed by structural change degree, and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results:After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery, 98 patients with lower extremity varicose veins, 356 patients with chronic cholecystitis and 38 patients with varicocele were finally included. Compared with non day hand, the total hospitalization cost of day surgical instruments decreased, and the cost structure changes of chronic cholecystitis, varicocele and varicose veins of lower limbs were 14.59%, 6.20% and 16.20% respectively. Among them, the general medical service fee, nursing fee and examination and laboratory fee showed a downward trend, and the fees of materials and drugs showed an upward trend. General medical service fee, nursing fee, examination and laboratory fee, clinical diagnosis fee, treatment fee, drug fee, material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90). The payment method, wound healing type and discharge diagnosis can influence the cost of day surgery( P<0.05). Conclusions:Compared with non daytime surgery, the total hospitalization cost of day surgery has a certain cost control effect, but it can not reduce the cost of all projects. The main influencing factors are the internal composition of the cost, payment method and so on. The hospitals should focus on tapping the internal cost control potential of day surgery and further expanding the coverage of day surgery diseases.

Mechanism of electroacupuncture for regulation of lipid production and improvement in obesity by mediating Wnt/ β-catenin pathway through activating SIRT1 / 中国针灸

OBJECTIVE@#To explore the mechanism of electroacupuncture (EA) for the regulation of lipid production and improvement in obesity by mediating Wnt/β-catenin pathway through activating silent information regulator 1 (SIRT1).@*METHODS@#Of 75 Wistar male rats, 10 rats were selected randomly as the normal group and fed with standard diet. The rest rats were fed with high-fat diet for 8 weeks to establish the obesity model. Forty rats of successful modeling were randomized into a model group, an EA group, an EA plus inhibitor group (EA+I group) and an agonist group, 10 rats in each one. In the EA group, EA was applied at "Guanyuan" (CV 4), "Zhongwan" (CV 12), "Zusanli" (ST 36) and "Fenglong" (ST 40), with continuous wave, 2 Hz in frequency and around 1 mA in intensity. The needles were retained for 20 min. In the EA+I group, sirtinol solution was injected from caudal vein and EA was exerted simultaneously. In the agonist group, resveratrol solution was given by intragastric administration. The intervention of the above three groups was given once every two days, 3 times a week, consecutively for 8 weeks. Before and after intervention, body mass and Lee's index were recorded in the rats of each group. After intervention, the levels of serum total cholesterol (TC), triglyceride (TG) and free fatty acid (FFA) were detected in the rats of each group. After intervention, the mass of white adipose tissue (WAT) and the area of adipocytes were compared in the rats among the 5 groups. Using Western blot method, the protein expressions of SIRT1, glycogen synthase kinase-3β (GSK3β), β-catenin, cyclin D1 and peroxisome proliferators-activated receptor γ (PPARγ) were detected in WAT in the rats of each group.@*RESULTS@#After intervention, compared with the model group, the body mass and Lee's index were reduced in the rats of the EA group and the agonist group (@*CONCLUSION@#Electroacupuncture remarkably improves the body mass, Lee's index and blood lipid metabolism and reduces WAT mass and adipocyte size in obesity model rats, which is probably related to up-regulating the protein expression of SIRT1 in WAT, activating Wnt/β-catenin pathway and inhibiting the expression of PPARγ of downstream lipogenic gene so as to affect lipid production.

Research on the prevention and control of 2019 novel coronavirus pneumonia for Internet-based hospitals using UTAUT-DST model / 中华医院管理杂志

Thanks to the transmission characteristics of 2019 novel coronavirus pneumonia, Internet-based hospitals can effectively cut off the transmission route via online consulting service. The hospital, leveraging the UTAUT model and DST theory, and advantages of Internet-based hospitals, is deploying step by step such four modules, as "pre-hospital screening", "patient acceptance", "auxiliary diagnosis and treatment", and "prevention and control linkage". These efforts ultimately contribute to an innovative prevention and control pattern against the novel coronary pneumonia for Internet-based hospitals and based on the UTAUT-DST model. This practice proves an initial success, and offers useful references for prevention and control of the NCP and development of other Internet-based hospitals.

Application of fever clinic online consultation for Internet-based hospitals in epidemic prevention and control / 中华医院管理杂志

Based on the transmission characteristics of COVID-19, Internet-based hospitals can effectively cut off its transmission route via online consulting service. The hospital, leveraging the UTAUT model and DST theory, and advantages of Internet-based hospitals, is deploying step by step such four modules, as " pre-hospital screening" , " patient acceptance" , " auxiliary diagnosis and treatment" , and " prevention and control linkage" . These efforts ultimately contribute to an innovative prevention and control pattern against COVID-19 for Internet-based hospitals and based on the UTAUT-DST model. This practice proves an initial success, and provides references for other Internet-based hospitals in epidemic control.

Relationship between Thrombotic Events and Peripheral Neutrophil-to-lymphocyte Ratio in Patients with Newly Diagnosed Essential Thrombocythemia / 中国实验血液学杂志

OBJECTIVE@#To explore the role of neutrophil-to-lymphocyte ratio（NLR) in patients with newly diagnosed essential thrombocythemia（ET) and its relationship with thrombotic events.@*METHODS@#The clinical and follow-up data of 150 ET patients were retrospectively analyzed. The risk factors of thrombotic events and role of NLR by statistical methods.@*RESULTS@#Age (P<0.01) and JAK2V617F mutation (P<0.01) were the independent risk factors for thrombotic events at diagnosis; WBC count (P<0.05), NLR (P<0.01), age (P<0.05) and thrombosis history at diagnosis (P<0.05) were independent risk factors for future thrombotic events. The ROC curve showed that NLR for prediction of future thrombotic events was suprior to other risk factors. The Kaplan-Meier analysis showed that the progress-free survival time in thrombotic events patients with higher NLR (median survival 22.3 months, 95% CI:17.8-26.8) was significantly shorter than that of patients with lower NLR (median survival 55.5 months, 95% CI:53.4-57.5) . After follow-up 60 months, the thrombosis progress-free survival in lower NLR patients reached 97.4%, while that in the patients with higher NLR was rate 46.7%.@*CONCLUSION@#NLR at diagnosis is a better predictive parameter for future thrombotic events than other clinical parameters in ET patients, but without corralations with thrombosis at diagnosis.

Research on the coupling and coordination of scale, efficiency and quality of public hospitals in Anhui / 中华医院管理杂志

Objective@#To evaluate the scale, efficiency and quality of secondary and tertiary public hospitals in Anhui province, and analyze the degree of coupling and coordination among the three dimensions.@*Methods@#Thirty-two hospitals′ data were extracted from the direct reporting system of Anhui Health Commission. Hospital efficiency was evaluated by DEA model, hospital quality was evaluated by TOPSIS model, and coupling coordination degree was analyzed by coupling function.@*Results@#In the single-dimension evaluation, there were significant differences in the distribution of the three dimensions among different levels of hospitals, and the efficiency and quality of secondary hospitals were better than those of tertiary hospitals. In the coupling evaluation, the average degree of coupling coordination in Anhui was 0.637, which was in the " primary coordination" level. The overall coupling and coordination degree of the tertiary hospitals were better than that of the secondary hospitals, and the highest score was in central Anhui.@*Conclusions@#Single-dimensional evaluation method cannot objectively represent a general picture of the hospitals. On the other hand, coupling coordination degree evaluation can provide a more comprehensive and objective result. The development strategy of hospitals should be made to fit local conditions and to coordinate the development of scale, efficiency and quality.

Research on target management of 21 medical institutions in Anhui province / 中华医院管理杂志

Objective To understand the status quo of the target management assessment of medical institutions in Anhui province, and provide a basis for further improving the performance appraisal mechanism and strategy of medical institutions. Methods In June 2017, 21 medical institutions in Anhui province conducted a questionnaire survey on the setup and implementation of target management indicators. Results Among the 21 medical institutions, there were 2, 16 and 3 hospitals in the first, second and third grades respectively. The average number of available beds was 681.35, and the average time for conducting target assessment was 4.42 years. The coverage rates of the clinical departments, medical technology departments, efficiency and efficiency, scientific research teaching, and department management of 21 medical institutions were 80% (316/397), 84% (52/63), 71% ( 120/168), 38% (48/126 ) and 60% (61/102) respectively. There were significant differences in coverage rates between clinical departments, medical technology departments, efficiency and efficiency, and research and teaching in different levels of medical institutions( P <0.05 ). Judging from the effectiveness of the current target assessment, it was considered that 64% ( 37/78 ) of the overall assessment results of the departments were in line with expectations, and the ratio of target management to hospital development management, department quality management, and functional department execution was 75% (42/64). Conclusions The status quo of performance assessment of medical institutions in Anhui province is running well, but the target management indicators and models of different medical institutions are different. It is necessary for the health administrators to establish a unified, authoritative and standard target performance assessment system.

Status survey of informatization infrastructure development of 155 hospitals in Anhui province / 中华医院管理杂志

Objective To learn the informatization infrastructure of Anhui provincial hospitals. Methods Questionnaire data of 155 public hospitals in Anhui province in the year 2017 by CHIMA were analyzed and compared with the national level.Based on the questionnaire survey, hospitals were randomly selected to interview their IT support staff.Descriptive statistics was used to analyze the data.Results Only 5.30% (43/804) of the IT staff had master′s degree or above as found in their IT department.Network trunk bandwidth of 31 hospitals(20.00% , 31/155)reached 10 G; A total of 44 hospitals(28.39% , 44/155)had formulated comprehensive IT development plans. Conclusions Hospitals in Anhui province should strengthen their IT infrastructure construction and IT talent team building.On the other hand, the province should improve the informatization level of primary hospitals, and further hospital informationization by means of innovation in interconnections.

Advances in Pathogenesis of Essential Thrombocythemia - Review / 中国实验血液学杂志

Essential thrombocythemia(ET) is one of the Ph chromosome-negative myeloproliferative neoplasms. Some studies discovered that the mutation of JAK2 V617F existed in 50%-70% patients with ET. Recently, many significant advances in researches about pathogenesis of ET, such as mutations of JAK2V617F, MPL, CALR and other related mutation; the epigenetic abnomalities in incidence of ET; the changes of bone marrow microenvironment of ET and the regulation of related cytokines were obtained. In this article, the advances of above mentioned aspects of ET are summarized.

Descriptive Evaluation of the Research on Influencing Factors of Patients' Selection of Institutions / 中国医院管理

Through screening of the literature,published time,published journals,research sites,research objects,research perspectives,influencing factors and countermeasures were listed by multi angle analysis of the bibliometrics method.The results show that the research on influencing factors of patients' selection of institutions in China has reached a certain level,but there are still some deficiencies.Follow-up studies need to define the following points which include the research heat is strongly related with the policy,the research of the patient's referral influencing factors should be strengthened,the depth of research needs to be improved,and the patients is the foundation of the countermeasures.

Immunomodulation of mesenchymal stem cells in inflammatory microenvironment / 中国组织工程研究

BACKGROUND: Mesenchymal stem cells are a kind of adult stem cells with self-renewal and multi-directional differentiation potential. These cells have the functions of immunoregulation, regulation of cell growth and repair of injury. In recent years, it has been found that when inflammatory injury occurs, mesenchymal stem cells can regulate the secretion of inflammatory factors, and function on the damaged region, thereby repairing and improving tissue damage caused by inflammation. OBJECTIVE: To review the immunoregulatory effects of mesenchymal stem cells on T lymphocytes, B lymphocytes, dendritic cells and natural killer cells when the body is in an inflammatory state. METHODS: A computer-based search of PubMed and CNKI was performed for articles published from 2000 to 2018 using the keywords of"inflammatory microenvironment, mesenchymal stem cell, immune response, T cell, B cell, DC, NK cell" in English and Chinese, respectively. Seventy-six articles related to the topic and with reliable arguments were finally included in result analysis. RESULTS AND CONCLUSION: The interaction between mesenchymal stem cells and inflammatory cells determines the result of tissue damage repair. In an inflammatory state, the biological characteristics of mesenchymal stem cells will undergo certain changes, but mesenchymal stem cells can still exert immunomodulatory effects by secretion of various soluble cytokines or via cell contact. There are still many problems to be further explored to facilitate better clinical application of mesenchymal stem cells.

Effect of Lentiviral Vector-Mediated CXCR4 Gene Overexpression on Mesenchymal Stem Cell Homing Capacity / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To explore the effects of lentiviral-mediated CXC chemokine receptor-4（CXCR-4）gene over-expression on the homing capacity of mesenchymal stem cells（MSC）in vivo.</p><p><b>METHODS</b>The MSC overexpressing CXCR-4 were constructed by using the lentiviral vector-mediated mouse MSC overexpressing the CXCR-4 gene. The BALB/c mice were divided into 3 group: simple radiation group（TBI）in which mice exposed to total body irradiation, then were infused with normal saline; EGFP-MSC group in which mice were infused with MSC（5×10）transducted by EGFP via tail vein after TBI; and CXCR-4-MSC group in which mice were infused with MSC (5×10) simultaneously carraying EGFP and CXCR-4 gene via tail vein after TBI. The mice were sacrified at 24 hours after infusion, the frozen sections were prepared to detect the distribution of infused MSC. Furthermore, the numbers of MSC homing into spleen and bone marrow was detected by flow cytometry, and the level of stromal cell-derived factor-1(SDF-1) was detected by ELISA.</p><p><b>RESULTS</b>The frozen section showed that the CXCR-4 over-expression could significantly enhance the efficacy of MSC homing into lung, liver and spleen; the flow cytonetry detection slowed that the number of over-expressed CXCR-4 MSC homing into spleen and bone matrow was sigmificantly higher than that in EGFP-MSC group（P<0.05）, the ELISA showed that the SDF-1 level in peripheral blood and bone marrow after 24 hours of irradiation significantly incrtaoed （P<0.05）, moreover, the SDF-1 level increase was associcted with horming efficacy of MSC with CXCR-4 overexpression.</p><p><b>CONCLUSION</b>overexpression CXCR-4 gene mediated by lentiviral vector can prmote the efficacy of MSC homing into spleen and bone marrow.</p>

Comparative Analysis of the Hospitalization Expenses Before and After the City-level Public Hospital Reform: Taking a Third-level Grade-A Hospital in Anhui Province as an Example / 中国医院管理

Objective To understand the present situation of city-level public hospital reform and to analyze the impacts on different clinical departments by analyzing the changes of hospitalization expenses of a third-level grade-A hospital from Anhui Province.Methods The inpatient data from April to September,2014 and 2015 of the third-level grade-A hospital were collected.Three typical diseases in Department of Internal Medicine,Surgery,Gynecology and Pediatrics respectively,were chosen to compare the changes of expenses and the structure before and after the reform.Results Overall,hospitalization expenses saw a declining trend after city-level public hospital reform.But,it was different in each department.The structure of hospitalization expenses became more reasonable after reform,however,the medical material expense remained a question.Conclusion The city-level public hospital reform reduces drug costs and inspection fees for inpatients effectively,thereby abating the overall cost of hospitalization,and the structure of hospitalization expenses becomes more reasonable.But the changes of hospitalization expenses in different departments reflect some problems.

Research progress in immunomodulatory properties of mesenchymal stem cells / 中国组织工程研究

BACKGROUND:Mesenchymal stem cel s are multipotent progenitor cel s that can be isolated from the bone marrow, adipose tissue, umbilical cord blood and so on. Mesenchymal stem cel s possess strong immunosuppressive effects on both innate and adaptive immunity. OBJECTIVE:To summarize the immunomodulatory properties of mesenchymal stem cel s for T lymphocytes, B lymphocytes, natural kil er cel s and dentritic cel s and prospect its therapeutic implication. METHODS:PubMed and CNKI databases were searched for relevant literatures published from 2000 to 2015. The key words were“mesenchymal stem cel s, immunomodulator, T cel s, B cel s, NK cel s, dendriticc cel s”in Chinese and English, respectively. Then, 61 papers were included and further analyzed. RESULTS AND CONCLUSION:The immunomodulatory effects of MSCs on lymphocytes, B lymphocytes, natural kil er cel s and dentritic cel s were elicited by cel-cel contact and soluble cytokines. But mesenchymal stem cel s from different sources hold different immunomodulatory effect on immune cel s. When we use mesenchymal stem cel s in clinic, some important factors, such as isolation methods, cel sources, colonization sites, should be taken into account. In order to ensure the clinical safety and effectiveness, there are stil many problems to be further studied before mesenchymal stem cel s can be widely used in clinic.

Study on the information management system of medical equipment / 中国医学装备

Objective: To explore how to implement the medical equipment management reasonably, normatively, scientifically. Methods:The digital management of medical equipment of the hospital is implemented in our hospital by the method of system analysis. Results:There are a great number of data and material needs to be integrated, collected and recycled in each link of medical equipment management in the process. All data after reasonable integration can improve the quality and of medical equipment effectively. Conclusion: It can provides a favorable basis for the hospital management decision by analysis the management data of a certain type medical equipment, using dynamic regulation process of medical equipment in the life cycle, through the information management system of medical equipment.

Exploring the compensation mechanism for public hospitals of county-level during the ongoing health reform / 中华医院管理杂志

The drug zero-profit reform in place has changed the compensation channels for China's public hospitals at the county level.In view of this situation,the paper probed into the present landscape of the compensation mechanism at such hospitals.The authors analyzed five compensation channels,i.e.,the special government budget subsidy,adjustment of medical service charges and rates,health insurance payment,social financing,and income/expenditure management.The study aimed at providing policy proposals and references for sustainable reform at such hospitals.

Cognition and attitude analysis of medical workers toward public hospitals reform in Anhui / 中华医院管理杂志

A total of 1140 medical workers from 8 public hospitals of secondary and tertiary levels in Anhui were surveyed with questionnaire. Their knowledge of the reform, acknowledgement of key points of the reform, desire of participating in the reform and other factors that may influence the reform were investigated as categorized by their hospital, position, title and age. This study comes up with such recommendations as reinforcing communications on public hospital reform, reforming the compensation mechanism to clarify government responsibilities, probing into a better model for multi-institution practice of certified physicians, and encouraging private capital to participate in medical service while ensuring its non-profit nature, and improving the performance appraisal mechanism to ensure incentives of medical workers. These recommendations aim to enable the health administrators in their decision making.

Case study on the pay by segmentation and quota in NRCMS / 中华医院管理杂志

Objective To refrain the medical costs from out-of-control increase, and identify a per-disease payment mode suitable for New-CMS.Methods Case studies were conducted on all the data of five diseases in the course of three years, in a field study of the pilot counties for NRCMS in Anhui Province.Results This system of per-disease "pay by segmentation and quota" is composed of five parts: choice of diseases, measurement of payment criteria, method of settlement, method of compensation, and methods of supervision.Conclusion This system is an effective way to keep the medical costs in the NRCMS under control, given an effective play of the five supportive measures including the clinical pathways for individual diseases.

Preparation of ondansetron hydrochloride osmotic pump tablets and their in vitro drug release / 药学学报

<p><b>AIM</b>To prepare ondansetron hydrochloride osmotic pump tablets (OND-OPT) and investigate their in vitro drug release behavior.</p><p><b>METHODS</b>OND-OPT were prepared with a single punch press and pan coating technique. Osmotic active agents and plasticizer of coating film were chosen by drug release tests. The effects of the number, position and direction of drug release orifice on release behavior were investigated. The relation between drug release duration and thickness of coating film, PEG content of coating film and size of drug release orifice was established by uniform design experiment. The surface morphological change of coating film before and after drug release test was observed by scanning electron microscopy. The osmotic pumping release mechanism of OND-OPT was confirmed by drug release test with high osmotic pressure medium.</p><p><b>RESULTS</b>Lactose-mannitol (1:2) was chosen as osmotic active agents and PEG400 as plasticizer of coating film. The direction of drug release orifice had great effect on the drug release of OND-OPT without HPMC, and had no effect on the drug release of OND-OPT with HPMC. The OND-OPT with one drug release orifice at the centre of the coating film on one surface of tablet released their drug with little fluctuation. The drug release duration of OND-OPT correlated with thickness of coating film and PEG content of coating film, and didn't correlate significantly with the size of drug release orifice. OND-OPT released their drug with osmotic pumping mechanism predominantly.</p><p><b>CONCLUSION</b>OND-OPT are able to realize ideal controlled drug release.</p>

Anxiety state and its related factors in Shanghai high school students / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the anxiety state in high school students and related factors in order to get reasonable suggestions for prevention.</p><p><b>METHODS</b>The mental health test (MHT) for high school students, and the living environmental and parental style were used in this study.</p><p><b>RESULTS</b>MHT served as an assessment scale of anxiety. The efficiency sample was 3,050, aged 11 to 18 years old. The level of total anxiety and its each contents was low to moderate (0.24 to 0.54). The percentage of moderate to high of total anxiety was 16.7%, the percentage of moderate to high of each anxiety aspects were 8.8%-21.8%. The mostly high aspects were self-blame, schooling anxiety, social anxiety and over sensitiveness. In general, the girls' anxiety level was higher than boys', but the boys' lonely feeling was higher than the girls'. The total score of anxiety was decreased with age. Except of the over sensitiveness, the decrease tendency of each anxiety contents was significant in boys. For girls, the lonely feeling was deceased and the over sensitiveness increased with age. The age of fifteen seems as a significant changing age. The related disadvantage factors of students' anxiety were: the low education level, the parents' anxiety and depression characters, the authoritarian or neglecting parental style, the often contradiction parental styles between mother and father, parents often quarrel, the experience of often being scalded and physical punishment, lacking in care of others when in difficulties.</p><p><b>CONCLUSIONS</b>The schooling pressure should be decreased to an appropriate level. The students' self-confidence and social ability should be emphasized. Good family environments and the support outside the family should be quite important for adolescents' mental health, these factors might decrease the adolescents' anxiety.</p>