Although the Shanghai's basic health insurance always takes the leading position nationwide in the aspects of coverage, funding level, security level, etc, it still cannot avoid the contradictory problems brought by the rapidly rising demand for health care, poor results of funds management, etc. Commercial health insurance has its u-nique advantages in terms of funds and personnel management. Therefore, they can play their complementary role to the basic medical insurance in order to improve the basic health insurance system. Based on the perspective of com-mercial health insurances, this paper explores the basic health insurance system in Shanghai from the aspects of man-agement patterns, governing body, insurance objects, funding modalities and insurance programs.

PurposeTo investigate whole-body magnetic resonance imaging in diagnosis of idiopathic inflammatory myopathy (IIM), and to guide clinical treatment.Materials and Methods Twenty-six patients clinically diagnosed IIM including 19 dermatomyositis and 7 polymyositis were analyzed retrospectively. Whole-body MRI was performed in all patients including whole-body coronal scan and axial scan of both sides of thigh. Short tau inversion recovery (STIR) sequences were used in the coronal scan and T1WI and fat-suppressed T2WI were performed in the axial scan. Ten healthy volunteers were recruited as control group. MRI findings were compared between the two groups.Results Whole body MRI showed that muscles were homogeneously low signal intensity in the control group. Imaging findings of the patients with IIM included muscle inflammation, fascitis, subcutaneous tissue edema, muscle atrophy and fatty infiltration. The most common distribution site of muscle inflammation of dermatomyositis patients was thigh (n=18), followed by gluteus (n=14), great psoas muscle (n=13), shoulder muscles (n=11), leg muscle (n=11), erector spinae (n=10) and neck muscles (n=9). Findings out of muscles included cavities in the both lungs, infarction in femurs and tibias, avascular necrosis of femoral head, adrenal mass and thyroid nodules. The most common distribution site of muscle inflammation of polymyositis was thigh (n=5), followed by gluteus (n=3), great psoas muscle (n=3), shoulder muscles (n=2), leg muscles (n=2), erector spinae (n=1) and neck muscles (n=1). Findings out of muscles included 1 case of infarction in femurs and tibias.Conclusion Whole-body MRI can not only comprehensively evaluate the activity of IIM but also detect complications such as bone infarction. It's a powerful tool for diagnosis, guiding treatment and monitoring of IIM.

Objective To evaluate the quality of life(QOL)of postpartum women within six months after delivery in Pudong New Area in Shanghai.Methods From January 1st to June 30th in 2011,435 postpartum women,discharged from Children and Women's Health Care Hospital in Pudong New Area,Gaoqiao Community Health Service Center and Lujiazui Community Health Service Center in Pudong New Area,were investigated by SF 36 questionaire including eight items [physical functioning (PF),role limitations due to physical problems (RP),bodily pain (BP),general health (GH),vitality (VT),social functioning (SF),role limitations due to emotional problems (RE) and mental health (MH)] and divided into three subgroups according to the duration after delivery (8-42,43-119 and 120 180 d).The SF-36 scores were compared with the control (baseline data of 25 to 36-year-old young women in Pudong New Area) or within the three groups.Statistical methods,such as t-test and analysis of variance,were applied.Results (1) The tota lscore and the scores of the seven items in SF-36 were lower than those of control (total score:74.2±11.7 vs 80.5,PF:79.0±19.0 vs 94.6,RP:47.5±12.2 vs 85.7,BP:74.0±18.7 vs 78.4,GH:73.9±13.1 vs 71.0,VT:69.8±16.2 vs 75.0,SF:78.3±20.1 vs 86.9,RE:63.4±21.7 vs 83.5,t=-11.225,-17.105,-18.914,-4.893,3.688,-6.642,-8.881 and-10.076,all P＜0.05) and no significant difference was found in MH score between the postpartum women and the control (78.3±15.0 vs 77.8,t=0.629,P＞0.05).Compared the SF-36 scores in three subgroups (8 42,43-119 and 120 180 d postpartum),the differences on PF score(73.0±19.1,86.3± 17.1,89.1±12.9),RP score(32.4±18.6,57.7±19.1,79.9±12.0),BP score(70.7±18.0,75.6±19.0,81.6±17.3),SF score(76.3±19.6,78.2±21.7,83.9±19.3),RE score(58.5±12.9,71.4± 18.3,70.1± 19.5) and SF-36 total score (72.2± 11.1,76.1± 12.8,78.0± 11.1) were all significant (F=37.744,60.640,13.137,5.185,4.577 and 10.548,allP＜0.05).The PF,VT,RE and total score of postpartum women at 120-180 days after delivery were still lower than those of the control group(t=-4.174,-2.353,-3.341 and-2.166,all P＜0.05).Conclusions The QOL of postpartum women within six months after delivery is not good enough.Up to 120-180 days after delivery,the QOL remains.More efforts should be made to improve the QOL of postpartum women by the whole society.

0.05).Myocardial perfusion defect scores were decreased significantly from 14.8?3.0 to 10.5?1.8(P

Objective To investigate the effect of home diabetes care platform based on internet and family fixed partner on the continuous care of diabetes patients outside the hospital.Methods A total of 150 out-patients with diabetes were collected from June 2016 to November 2016,divided into family fixed partner group(group A),smart phone APP home diabetes care platform group(group B),family fixed partner combination with smart phone APP home diabetes care platform group(group C)with 50 cases each by random digits table method.The three groups received the same health education during their stay in hospital,patients in group A and group C were required to have family fixed partners,patients in group B and group C were required to receive the home diabetes care platform for smart phones APP after they left the hospital,the intervention time was six months,and the indexes of blood glucose metabolism,self-management ability of diabetes were assessed at the end of six months after intervention and before intervention.Results Fasting blood glucose and postprandial blood glucose and glycosylated hemoglobin values of the three groups after intervention were lower than those before intervention.The postprandial blood glucose and glycosylated hemoglobin values was(9.96±4.23)mmol/L,(7.16±1.47)%in group C,(13.78±3.34),(11.46±4.85)mmol/L and(8.46±2.21)%,(8.07±2.45)%in group A and B,the difference was significant(F=10.57,3.92,P＜0.05).The scores of self-management ability of diabetes of the three groups after intervention were all higher than those before intervention.The score of self-management ability of diabetes of item 1-6 was(6.45±1.65),(4.87±2.23),(6.17±2.12),(5.24±1.65),(4.67±2.13),(6.27±2.02)points in group C,(5.78±1.96),(3.63±2.14),(5.25±2.34),(4.12±1.97),(3.65±1.34),(5.26±2.21)points in group B,(5.04±1.78),(3.37±1.64),(4.63±1.87),(4.03±2.17),(3.32±1.74),(5.30±1.97)points in group A,the difference was statistically significant(F=3.82-7.94,P＜0.05).Conclusions Home diabetes care platform based on internet,combined with family fixed partner education,are more conductive to patient blood sugar control,and enhance self-management ability and account ability.

The policy of long-term prescription for chronic diseases in China is gradually being improved and implemented， and external long-term prescription dispensing is being encouraged. The long-term prescription policy runs through the links of drug supply， equipment， use and policy， involving government departments such as medical security and health， as well as stakeholders such as patients， medical institutions and designated detail pharmacies. There are still some problems in the external dispensing of long-term prescriptions， such as the disunity of drug catalogue and the need for coordination among regulatory parties in the policy link； the need to improve the participation enthusiasm and service ability in the equipment link； the increased difficulty of prescription management， the need to improve the circulation platform in the use link. The promotion of external long-term prescription policy requires health insurance， medical service， and the medicine industry co-development， multi-party participation， and policy coordination. Among them， the “dual channel” policy， the policy of centralized medicine procurement， and the pharmacy included in outpatient overall management policy have all played a positive role in promoting the implementation of external long-term prescription dispensing for chronic diseases. It is necessary to improve supporting policies and implement regulatory responsibilities in the policy link， promote drug classification and service capabilities in the equipment link， improve the electronic prescription circulation platform， and strengthen prescription management in use link， so as to promote the implementation of external long-term prescription dispensing.

OBJECTIVE: To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. METHODS: A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. RESULTS: The wound area was 21.0-180.0 cm ² (mean, 57.82 cm ²) before operation, and it was 1.2-27.0 cm ² (mean, 6.57 cm ²) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). CONCLUSION Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Cicatrix ; Retrospective Studies ; Treatment Outcome ; Tibial Fractures/surgery* ; Wound Healing ; Fracture Fixation, Internal/methods* ; Fractures, Open/surgery*