Reasonable and effective compensation and incentive mechanism is key to maintaining and stimulating incentives of the staff.By means of defining the main problems and defects in the current hospital compensation system in China,performance management is used as the cornerstone for designing the public hospital compensation and incentive mechanism.Resource-based relative value scale(RBRVS) assessment system is called into play to build a compensation management system,which features workload as the basis,technical competency and risk assessment as the reference and balance scorecard as the means.This can build a fair,scientific and reasonable salary distribution system and performance evaluation system,which maximize incentives of the compensation system,and in the end maximize the economic and social benefits of the hospital.

Objective To provide insight into the clinical manifestation,histopathology characteristics,diagnostic and therapeutic methods of primary histiocytic sarcoma (HS) of central nervous system.Methods The clinical,auxiliary examination and pathological data of one patient with intracranial primary histiocytic sarcoma were presented,and relevant literature were reviewed.Results A 55-year-old female had an 2-month history of hypomnesia and unsteady gait.MRI scans showed multiple mass lesions in brain.Biopsies of the brain lesion showed the tumor cells had polymorphism,and abundant cytoplasm was eosinophilic or clear,with large,pleomorphic nuclei.Immunohistochemically,the tumor cells stained positively with CD45,CD68,CD163,Ki67 and Vimentin,but negatively with pan-cytokeratin,epithelial membrane antigen,CD3,CD20,CD79 a,estrogen receptor,progesterone receptor,Melan-A and glial fibrillary acidic protein.Though she had received radiotherapy,the disease progressed and her consciousness deteriorated within 2 months.Conclusions HS should be considered if multiple or single intracranial unexplained lumps are found and the earliest pathological biopsy is required for early diagnosis.There are no effective therapeutic methods for HS and the prognosis is very poor.

OBJECTIVE: To investigate the clinical effectiveness of Toubiao Qingfei (expelling exterior evil and clearing lung) Decoction (TBQFD) on wind-warm and pulmonary heat syndrome. METHODS: Forty-six subjects were randomized into treatment group and control group. Patients in the control group were treated with Western medicines, while patients in the treatment group were treated with Western medicines and TBQFD. The therapeutic effects and improvement of symptoms in both groups were observed. RESULTS: The durations of fever, cough and absorption of pulmonary inflammatory focus in the treatment group were 1.52, 3.52 and 6.25 days respectively, which were significantly shorter than those in the control group (P<0.05). CONCLUSION: TBQFD can improve the symptoms, such as fever and cough, and can promote the absorption of infection and shorten the clinical course of wind-warm and pulmonary heat syndrome.

OBJECTIVE: To investigate the guiding function of three-dimensional CT scan in the operation of eagle syndrome. METHOD: There were 48 cases of eagle syndrome hospitalized during July 2006 to June 2010 who underwent both three-dimensional reconstruction of CT scan and adem position and lateral X ray film. The images were measured by specialist of radiology department. RESULT: The detail of styloid process is showed more precisely by three-dimensional CT scan, which is able to determine the existence of interrupt, decline, ossification in styloid process. There was significant difference in the measured value (20.83%) between X ray and CT scan (4.16 ± 1.27)cm vs (3.11 ± 0.62)cm, P < 0.05, in 10 cases. We could not touch styloid process in oral approach in 6 cases (12. 5%), which also had diagnostic confliction between X ray and three-dimensional CT scan. Five patients whose styloid process could not be touched during surgery had longer operation time than the other 41 patients. CONCLUSION Three-dimensional CT has good repeatability, high detailed distinguishability, which is an important basis to diagnose eagle syndrome. When X ray shows prolonged styloid process which can not be palpable in oral, we suggest further three-dimensional CT to avoid unnecessary surgery.
Female ; Humans ; Imaging, Three-Dimensional ; Male ; Ossification, Heterotopic ; diagnostic imaging ; surgery ; Temporal Bone ; abnormalities ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVE: To explore the ways of quantitative and objective evaluation for analyzing the multiple influence factors on middle ear function in the patients with primarily diagnosed NPC, and to analyze the influence factors of middle ear function in the patients with primarily diagnosed nasopharyngeal carcinoma (NPC). METHOD: Three hundred and twenty cases (320 ears) of primarily diagnosed NPC patients were examinated with electric otoscope, acoustic immittance measurement, pure tone audiometry, nasopharynx and middle ear CT or MRI scanning, eustachian tube function examination, and electronic nasopharyngoscope. A series of quantitative methods, as the influence factors including T stage, clinical stage, location, diffusion type and form of tumor, eustachian tube function, pharynx mouth shape, imaging extension (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini and so on), were used to evaluate the middle ear function. SPSS 13.0 was used to anlyze the single and multiple factors in statistics. RESULT: T stage, clinical stage, location, diffusion type, and form of tumor, pharynx mouth shape, imaging extension (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini) were the single influence factors on the function of middle ear in primarily diagnosed NPC patients. The gender, age, pathological types, N staging and M staging of NPC patients primarily diagnosed had no effect on middle ear function. The multple factors analysis showed that T stage, tumor location, the function of eustachian tube, tensor veli palatini muscle invasion, and skull base invasion were independent factor of affecting the middle ear function on primarily diagnosed NPC patients. CONCLUSION In this study, the influence factors of middle ear function with primarily diagnosed NPC were related to T stage, location of tumor, the function of eustachian tube, tensor veli palatini muscle invasion, skull base invasion, otitis media and quantitative criteria. The way of quantitative analysis could be used to evaluate objectively the middle ear function in patients with primarily diagnosed NPC.
Adult ; Aged ; Aged, 80 and over ; Carcinoma ; Ear, Middle ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; diagnosis ; physiopathology ; Young Adult

Objective To investigate the prevalence of nutritional risk,undernutrition and nutritional support among elderly inpatients with coronary heart disease in 11 tertiary A hospitals in China.Methods Records of elderly patients under the age of 90 with coronary heart disease were collected between March 2012 and May 2012 from 11 tertiary A hospitals in China following the direction of diagnosis related group of Beijing government.Results A total of 1 279 consecutive cases were recruited with the average age 74 years old (65-89).The total nutritional risk prevalence was 28.14％ (360/1 279).The prevalence of nutritional risk and nutritional risk score ≥ 5 increased with age.The prevalence of nutritional risk (12.88％ vs.30.08％ vs.42.28％) and nutritional risk scored ≥5 (10.86％ vs.18.61％ vs.27.78％)increased with age.Judging from BMI,most patients were overweight or obese (BMI ≥ 24 kg/m2),accounting for 53.0％ of the total,and prevalence of nutritional risk in this subgroup was 15.12％ (96/635).The prevalence of nutritional risk in patients with normal BMI was 34.24％.The prevalence of undernutrition defined as BMI＜ 18.5 kg/m2 was 4.25％ (51/1 279),among which patients with score ≥ 5 account for 64.7％ (33/51).The prevalence of undernutrition defined as nutritional impairment score =3 was 7.58％ (97/1 279).In patients with nutritional risk,57 were administrated nutrition support (16.6％);in patients without nutritional risk,21 received nutrition support,mostly parenteral nutrition (16 cases,76.2％).In patients with nutritional risk [(79.46± 7.19) years vs.(76.40± 6.16) years],there were statistically significant difference between those who received nutrition support and those who did not in terms of age and the ratio of patients with nutritional risk scored≥5 (35.1％ vs.17.1％) (P =0.001,P=0.002).Conclusions The prevalence of nutritional risk in patients with coronary heart disease was high.The prevalence of undernutrition was low.Prevalence of overweight and obese was high,but there was still nutritional risk in this group of patients.The patients who received nutrition support were older and had high nutritional impairment score,but the indication is not rationale.

Objective: To discuss the relationship between lingual tonsil hypertrophy and laryngopharyngeal reflux. Methods: Ninety-two patients who received throat surgery in Nanfang Hospital between October 2015 and October 2016 were enrolled. Twenty-six healthy volunteers were recruited as normal controls. All participants were assessed with the reflux finding score(RFS) and the size of lingual tonsils were evaluated using a clinical grading system proposed by Friedman under electronic laryngoscope. The score of reflux symptom index(RSI), personal history and medical history were gathered. Biopsy specimens of lingual tonsils were taken from all participants for the immunohistochemical stain of pepsin.SPSS 19.0 software was used for statistical analysis. Results: There were 46.2% (12/26) pepsin-positive and 53.8% (14/26) pepsin-negative volunteers in normal controls. There were 87.0% (80/92) pepsin-positive and 13.0% (12/92) pepsin-negative patients in study group. The severity of lingual tonsil hypertrophy and expression intensity of pepsin in patients were significantly higher in volunteers (Z=-3.636, Z=-5.273, P<0.01). The severity of lingual tonsil hypertrophy was positively associated with the pepsin level in patients (r=0.556, P<0.01). The patients with pepsin-positive expression showed significant correlation between lingual tonsil hypertrophy and the positive rate of RSI and RFS (r=0.258, r=0.225, P<0.05). Analysis of correlated factors indicated that lingual tonsil hypertrophy was associated with smoking (χ²=8.502, P<0.05). Conclusions The expression of pepsin can be detected in lingual tonsil tissues. The lingual tonsil hypertrophy is closely related to laryngopharyngeal reflux.