Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
目的：探讨彩色多普勒超声在心脏手术中的应用价值。方法：在14例心脏病手术中，于心脏修复完成后经心外膜超声检查。结果：一例先天性心脏病室间隔缺损修补片周少量残余漏；一例风湿性心脏病二尖瓣、主动脉瓣置换术后，主动脉瓣下少量返流；因不构成血流动力学的改变，未行二次修复。结论：可即时、准确地为外科医生提供相关信息，评价手术效果。
目的 提高对囊性纤维化的认识。 方法 2011年11月收治1例自幼有临床表现的囊性纤维化患者，回顾其诊断及治疗经过，复习相关文献总结其临床特征、诊疗进展及预后评价。 结果 囊性纤维化起病年龄较早，患者自幼年起即反复出现肺、消化道、肝脏等多系统病变，最终导致多器官功能衰竭。 结论 应提高对囊性纤维化的识别度，对于发病年龄过早、反复发作的严重支气管扩张，伴随生长发育延迟、肝硬化等临床征象应注意对囊性纤维化的筛查。
ObjectivesTo analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China.MethodsPubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed.ResultsForeign integrated care was dominated at government level. The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on. At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation.ConclusionThere is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.
Objective To analyze the dynamic efficiency of township hospitals. Methods Based on the DEA-Malmquist index, this research analyzed the change of the total factor productivity indices and the decomposition items of 281 township hospitals in Hunan province with panel data from 2000 to 2008. Results Among 281 township hospitals, less than half increased their scale efficiency, while more than half increased their total factor productivity, technology, whole efficiency and technical efficiency. Increasing technology and whole efficiency was the best way to improve total factor productivity. Besides, increasing technical efficiency and scale efficiency was the best way to improve whole efficiency. Conclusions The improvement of scale efficiency is key to developing the central township hospitals, while the improvement of technology is the key to developing general township hospitals.
ObjectivesTo systematically review the concept, definition, development, operation mechanism, function, efficacy, advantages and challenges of pharmacy benefit management (PBM), in order to provide evidence for its introduction and application in China.MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and CBM databases were searched to collect literatures on researches, policies, and applications related to PBM from January 1st, 2000 to January 1st, 2017. Two researchers independently screened literatures, extracted data and used the AHRQ evaluation list to evaluate the quality of the observational studies, then qualitative method was used to review literature.ResultsA total of 12 researches were included. The results showed that PBMs had played an important role in negotiation discounts with drug manufacturers, supervising drug circulation and doctors' prescription behaviors, delivering health management services for patients, prescription payments with highly information-oriented systems, etc., which, as a result, could reduce the medication burden of patients with superior diseases management.ConclusionsChina's attempt to adopt a PBM model must take full account of practical conditions, which involves health management system, pharmaceutical market environment and social culture. It cannot merely emulate the PBM model of the United States. With consideration of local conditions, China can explore a suitable path for its own PBM model.
【摘要】 目的 探讨胰腺癌早期诊断的要点及误诊因素。 方法 回顾性分析2009年7月8日收治的1例以腹胀、呕吐为主要表现的胰腺癌患者。 结果 患者经及时剖腹探查确诊为胰腺癌并行手术切除。 结论 胰腺癌起病隐匿，其早期误诊率高，进行胰腺癌的早期诊断、避免误诊是提高预后的重点和难点。【Abstract】 Objective To explore the main points of early diagnosis of pancreatic cancer and its misdiagnosis factors. Methods The clinical data of one patient with pancreatic cancer on the 8th July, 2009 was retrospectively analyzed. The chief complaints included abdominal distension and vomiting. Results By exploratory surgery in time,the patient was diagnosed as pancreatic cancer and underwent the resection. Conclusion The onset of pancreatic cancer is very insidious,usually with a high misdiagnosis rate. How to make the right early diagnosis and to avoid misdiagnosis are the focal points of improving the prognosis.
【摘要】 目的 观察低温等离子射频治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome，OSAHS）合并变应性鼻炎的疗效。 方法 对2010年1－5月收治的42例OSAHS合并变应性鼻炎患者，采用低温等离子射频双下鼻甲减容、鼻腔内蝶腭神经及筛前神经末梢阻滞，并配合鼻中隔成形等手术。使用Epworth嗜睡评分量表（epworth sleepiness scale， ESS）和视觉模拟评分法（visual analogue scale，VAS）对治疗前及治疗3个月后的总体感受评分。 结果 ESS评分与VAS评分均符合正态分布，手术前、后ESS评分[（14.22±4.21）分，（6.78±4.12）分]与VAS评分[（8.34±2.72）分，（3.96±1.02）分]差异有统计学意义（Plt;0.05）。 结论 低温等离子射频治疗OSAHS合并变应性鼻炎疗效较好。【Abstract】 Objective To observe the clinical effect of treatment by low-temperature plasma radio frequency on obstructive sleep apnea-hypopnea syndrome (OSAHS) complicated with allergic rhinitis. Methods A total of 42 patients with OSAHS complicated with allergic rhinitis between January 2010 and May 2010 were chosen. All of the patients were treated by low-temperature plasma radio frequency nerve block, concha nasalis inferior ablation and other operations such as nasal septal construction. The nerve terminals of sphenopalatine nerve and anterior ethmoid nerve were blocked by ablation. Epworth sleepiness scale (ESS) and visual analogue scale (VAS) were used to estimate the curative effects. Results The results of ESS and VAS were consistent with gaussian distribution. There were statistical significant difference between the scores of pre-and post-operation (Plt;0.05). Conclusion The low-temperature plasma radio frequency treatment for OSAHS complicated with allergic rhinitis is easy，safe and efficient.
Interventional radiology is an emerging discipline based on image-guided minimally invasive diagnosis and treatment. The number of interventional procedures performed is increasing year by year, resulting in a dramatic increase in the demand for interventional radiologists. Procedure training systems based on virtual reality (VR) technology simulate real interventional procedure through real-time interaction between hand manipulators and virtual environments, allowing physicians to experience real interventional procedures during training and reducing training time and costs. A growing number of medical schools are now adopting VR simulated training systems for interventional procedure training. This article reviews the relevant research progress of VR simulation interventional procedure training system in recent years and discusses the development prospects of VR technology in interventional procedure training.
Bone tissue engineering is considered as one of the most promising way to treat large segmental bone defect. When constructing bone tissue engineering graft in vitro, suitable bioreactor is usually used to incubate cell-scaffold complex under perfusion to obtain bone tissue engineering graft with good repair efficiency. However, the theoretical model for growth rate of single cell (especially for stem cell) during this process still has many defects. The difference between stem cells and terminally differentiated cells is always ignored. Based on our previous studies, this study used self-made perfusion apparatus to apply different modes and strengths of fluid shear stress (FSS) to the cells seeded on scaffolds. The effects of FSS on the proliferation and osteogenic differentiation of mesenchymal stem cells (MSCs) were investigated. The regression analysis model of the effect of FSS on the single-cell growth rate of MSCs was further established. The results showed that 0.022 5 Pa oscillatory shear stress had stronger ability to promote proliferation and osteogenic differentiation of MSCs, and the growth rate of a single MSC cell under FSS was modified. This study is expected to provide theoretical guidance for optimizing the perfusion culture condition of bone tissue engineering grafts in vitro.