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OBJECTIVE To understan d the c urrent situation and feasibility of payment reform for TCM dominant diseases from the perspective of clinicians ，so as to provide reference for optimizing and improving the reform scheme. METHODS A questionnaire was designed by ourselves ，and a simple random sampling method was used to select clinicians from the pilot hospitals of payment reform for TCM dominant diseases in Guizhou province to conduct a face-to-face questionnaire survey. SPSS 20.0 software was used for statistical analysis. The single-factor analysis and ordered Logistic regression analysis of multi-factor were used to analyze the influential factors of reform feasibility. RESULTS A total of 420 questionnaires were distributed in this survey，and 413 valid questionnaires were recovered ，with an effective rate of 98.3％. Totally 86.0％ of the clinicians thought that it was feasible for the reform to be carried out in their hospitals ，and 81.8％ thought that the selected TCM dominant diseases in the pilot hospitals were reasonable. After the reform was carried out ，61.0％ and 58.8％ of clinicians indicated that the daily number of patients treated in their departments and their willingness to communicate with patients increased ，respectively；60.3％ indicated that the difficulties and obstacles encountered in the reform were the complexity and diversity of TCM diseases ，for the treatment of patients with integrated traditional Chinese and Western medicine ，which was difficult to use a unified disease and surgery code to correctly code ；76.3％ indicated that the greatest advantage of the reform implementation was the improvement of medical quality ，while 54.2％ indicated that the greatest disadvantage was the excessive restriction of doctors ’autonomy. The results of multi-factor ordered Logistic regression analysis showed that changes in treatment services （changes in readmission rate of patient），the reasonableness of the selection of TCM dominant diseases ，and whether to reduce medical costs ，improve doctor-patient relationship ， and promote hierarchical treatment were the influential factors of reform feasibility after the implementation of reform （P＜0.05）. CONCLUSIONS It is feasible to carry out payment reform for TCM dominant diseases in Guizhou province ，but it is still in the exploratery stage ，and there are many factors affecting the feasibility of the reform. It is suggested that in the future ，when promoting in the whole pr ovince and even the whole c ountry，we should pay attention to selecting more and more reasonable dominant diseases for payment reform ， further standardize the diagnosis and treatment behavior of clinicians ， control the unreasonablegrowth of medical expenses ， strengthen communication between clinicians and patients， improve the accurate diagnosis rate of traditional Chinese medicine diseases ，implement hierarchical calculation of dominant diseases ，and promote hierarchical diagnosis and treatment of medical institutions.
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Objective To evaluate a new platelet function analyzer PL-11 with three major platelet function methods.Methods A randomized controlled trial was adopted.Totally 20 healthy young students from People's Liberation Army Medical School were enrolled in the study during July and August in 2013.Subjects were treated with aspirin or clopidogrel and the platelet function was measured by using of PL-11,as well as light transmittance aggregometry (LTA),VerifyNow and thromboelastography (TEG).Results When monitor aspirin response,correlations between arachidonic acid (AA) induced PL-11 and other methods were:LTA,0.614; VerifyNow,0.829; TEG,0.697,respectively.Biases between AA induced PL-1 1 and LTA were 1.94％ at baseline and 24.02％ during aspirin treatment.Cut-off value of aspirin response tested with AA induced PL-11 was 33.3％.When monitor clopidogrel response,correlations between adenosine piphosphate (ADP) induced PL-11 and other methods were:LTA,0.767; VerifyNow,0.851; TEG,0.608.Biases between ADP induced PL-11 and LTA were 3.01％ at baseline and 6.56％ during clopidogrel therapy.Cut-off value of clopidogrel response tested with ADP induced PL-1 1 was 66％.Conclusion Results of different platelet function testing methods were not equally effective.PL-11 has a high capability when monitoring short aspirin or clopidogrel response.
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Objective To evaluate performance of PlateletMapping(R) and RapidTEGTM based on thrombelastography by blocking platelet function with Reopro.Methods PlateletMapping was carried out with whole blood from healthy volunteers mixed with Reopro in vitro in a serial of titration.TEG(R) ACT of heparinized blood was tested with Rapid TEG kits.Linearity, repeatability and validity were calculated for two methods.Results MA activated by Kaolin, AA and ADP decreased with the increase of the concentration of Reopro. Inhibition rates (%)for AA and ADP induced aggregation were repeatable in channels and systems.At the Reopro levels of (1-4) × 10-2 mg, inhibition rate increased statistically( AA:27.99% ± 2.8% vs 63.37% ± 0.0% ,t = 21.9, P ＜ 0.01;ADP: 35.9% ± 0.56% vs 91.42% ± 1.14%,t=58.9,P ＜ 0.01 ) after addition of Reopro.Dose-dependent effect relationship could be seen between TEG(R) ACT and heparin;In Rapid TEG assay, measurement repeatability of K, α angle, MA and TEG(R)ACT were all good ( CV ＜ 5% ) except for R.Conclusions PlateletMapping(R) is sensitive to the inhibition of platelet function with good precision with dose-dependent effect.Moreover, Rapid TEG provides analysis of the overall coagulation function besides monitoring heparin therapy.