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The scientific construction and optimization of performance assessment of physicians,focusing on technical services reflecting the value of the medical staff,and paying attention to the connotation of medical services have important significance for effectively mobilizing the enthusiasm for work,and improving public hospital operation efficiency and management level.Through extensive literature research,the paper systematically analyzes the current situation and existing problems of the performance allocation model of public hospitals in China,and puts forward some corresponding suggestions and countermeasures according to the main existing problems.
RESUMO
<p><b>OBJECTIVE</b>The aim of this study was to compare the results of different combined chemotherapy regimens and to find the best regimen for metastatic nasopharyngeal carcinoma (NPC), and determine its prognostic factors.</p><p><b>METHODS</b>The clinical data of 171 patients with pathologically proven metastatic NPC were retrospectively analyzed. Of them, 26 were treated with best support care (BSC group), 92 with platinum-based regimen of two drugs (FP group: 5-Fu and cisplatin; TP group: paclitaxel and cisplatin; DP group: docetaxel and cisplatin), and 53 with platinum-based regimen of three-drugs (TFP group: FP plus paclitaxel, DFP group: FP plus doxtale).</p><p><b>RESULTS</b>The response rate (RR) in the three-drug regimens was significantly higher than that in the two-drug regimen (84.9% vs. 52.2%, P = 0.000), however, grade III approximately IV myelosuppression in the three-drug regimen group was also significantly higher than that in the two-drug regimen (58.5% vs. 27.2%, P = 0.000). Among the groups treated with platinum-based combination regimens of either two drugs or three drugs, no significant differences were observed in RR (P = 0.967, P = 0.400) or median survival time (MST) (P = 0.278, P = 0.413). The MST and one-year survival rate were 4.0 months, 13.2 months and 15.0 months, 24.0%, 64.1% and 70.3% in the BSC group, two-drug group and three-drug group, respectively. The MST in the chemotherapy group was significantly longer than that in BSC group (P = 0.000). Cox multivariate regression analysis showed that Karnovsky performance scores, time to progression or chemotherapy cycles were independent prognostic factors (P < 0.05).</p><p><b>CONCLUSION</b>Chemotherapy can improve the survival of metastatic NPC. Platinum-based combination regimen with two drugs is still the standard treatment. The combination regimens with three drugs can increase the RR, but no survival benefit can be achieved for its high toxicity.</p>