Research on the doctors′ willingness of working at primary institutions and the economic incentive effect from the perspective of mental account / 中华医院管理杂志

Objective:To understand the incentive effect and influencing factors of the current economic incentive policy for medical alliances in Longhua District of Shenzhen(the alliance for short) on doctors′ willingness to work at primary medical institutions(the primary for short) from the perspective of mental account, and to explore the economic incentive effect of different economic incentive distribution methods on doctors′ willingness to work at the primary.Methods:The questionnaire was designed based on mental account theory. Random sampling was made in November 2019 for a questionnaire survey among doctors in two district-level medical institutions of the alliance in Longhua District of Shenzhen. The purpose was to analyze their inclination to work at the primary and their selection preferences for economic incentive distribution methods under the current economic incentive policy. The data were analyzed by descriptive analysis, and the influencing factors of doctors′ willingness to work at the primary were analyzed by χ2 test and binary logistic regression. Results:A total of 254 valid questionnaires were collected with an effective recovery rate of 90.7%. Among the respondents, 189(74.4%) were willing to work at the primary, 168(66.1%) chose to receive the economic incentives specifically for working at the primary, and 148 people(58.3%) hoped to receive such economic incentives immediately. Education background, self-rated economic income level of doctors and different payment methods of economic incentive for working at the primary had significant effects on their willingness to work at the primary( P<0.05). Conclusions:The current economic incentive policy of the alliance can meet the demands for economic incentives in terms of doctors′ material accounts, and doctors′ overall inclination to work at the primary was strong. If the amount of economic incentives is constant, doctors preferred to receive the economic incentives specifically, mainly affected by income accounts and additional income accounts. In addition, education and self-assessment of economic income level were important factors affecting the willingness of doctors to work at the primary, which may be affected by mental accounts other than material accounts.

Clinical effect of subcutaneous negative pressure suction with anti L incision in liver surgery / 局解手术学杂志

Objective To explore the clinical effect of subcutaneous negative pressure suction cosmetic suture with anti L incision in liver surgery.Methods A total of 140 patients who received liver surgery in general surgery department of our hospital from March 2015 to April 2016 were randomly selected,of which 70 cases received cosmetic suture with negative pressure drainage (observation group),the other 70 cases treated with conventional suture(control group).The repair times,the healing of the incision of two groups were observed and analyzed.Results Compared with the control group,the repair time and hospital stays of patients in observation group were significantly shorter than those of the control group,and the differences were statistically significant (P ＜ 0.01).Conclusion Cosmetic suture with negative pressure drainage is effective to shorten the repair time,reduce the incidence of incision fat liquefaction and infection,while ensuring the aesthetic level of the incision.

Co-transplantation of acellular allogeneic dermis and autologous split-thickness skin for burn repair at functional parts / 中国组织工程研究

BACKGROUND:Autologous split-thickness skin grafting is the main therapy for burn repair at functional sites, which has achieved certain effects, but there are stil some deficiencies, such as poor texture, stiffness and poor toughness, as wel as severer hyperplasia that is easy to result in contracture deformity and poor functional recovery. OBJECTIVE: To analyze the clinical efficacy of skin co-transplantation on burn repair at functional sites. METHODS:Sixty patients with burns at functional sites (n=84) were randomized into two groups: co-transplantation of acelular dermis and autologous split-thickness skin in experimental group and autologous split-thickness skin graft in control group. Survival rate of skin flap and rate of secondary operation were compared between two groups. At 1 month after transplantation, Vancouver Scar Scale was used to assess skin color, thickness, blood vessel distribution and flexibility, and meanwhile, the severity of scar was determined. RESULTS AND CONCLUSION:The survival rate of skin flap was significantly higher in the experimental group than the control group (93%vs. 70%,P < 0.05), and the rate of secondary operation was significantly lower in the experimental group compared with the control group (0vs. 13%,P < 0.05). At 1 month after transplantation, scores on the skin color, thickness, blood vessel distribution and flexibility were al lower in the experimental group than the control group (P < 0.05), but the incidence of mild hyperplasia in the experimental group was significantly higher than that in the control group (52% vs. 29%,P < 0.05). These findings indicate that co-transplantation of acelular alogeneic dermis and autologous split-thickness skin for burn repair at functional sites can effectively enhance the survival rate of skin flap, reduce the rate of secondary operation, contribute to wound healing and reduce the severity of hyperplasia.