Objective To explore and analyze the timing and postoperative effect of proximal femoral nail anti-rotation( PFNA) for the treatment of elderly femoral intertrochanteric fracture. Methods From September 2011 to March 2013, there were 36 elderly patients with femoral intertrochanteric fractures in our hospital, including 6 cases of type A1, 16 cases of type A2, and 14 cases of type A3. All the 36 pa-tients received PFNA and systematic rehabilitation exercise. Treat the underlying disease and strengthen the nursing to prevent thrombosis at the same time. Hip joint function was evaluated by the Harris score system. Results The average hospitalization of patients is 4 weeks. The wound healing was good in 30 cases and wound infection occured in 2 cases who recovered after subsequent treatment, and the other 4 pa-tients died due to complicated internal medicine diseases. 21 cases of patients were followed up,and their hip joint function recovered well according to the Harris score system, including 12 cases of excellent, 6 cases of good, and 3 cases of eligible, with an excellent and good rate of 85%. Conclusion The application of PFNA for the treatment of elderly femoral intertrochanteric fractures has the advantages of less damage to the local blood supply and better recovery of fracture healing and hip joint function, which is an ideal treatment for the elderly pa-tients with femoral intertrochanteric fractures.

Adult ; Bone Cysts ; diagnostic imaging ; Calcaneus ; Female ; Humans ; Tomography, X-Ray Computed

Adult ; Elbow ; Giant Cell Tumors ; diagnosis ; pathology ; physiopathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Tendons

Objective To analyze the clinical feature and prognostic predictors of disseminated herpes zoster.Methods A retrospective study was carried out on 76 patients with disseminated herpes zoster collected from 2005 to 2012 in the Department of Dermatology,Anhui Provincial Hospital.Statistical analysis and comparisons were done.Results The incidence rate of disseminated herpes zoster was highest in the three age groups:70-79 years,30-39 years,and 60-69 years.Of these patients,59.21％ suffered from complications,and 44.74％ from postherpetic neuralgia.Logistic regression analysis showed that the occurrence of complications was significantly associated with age and impaired cellular immune function,and the incidence of postherpetic neuralgia with age,impaired cellular immune function and presence of underlying diseases.Conclusions There is a high incidence of complications in patients with disseminated herpes zoster,and impaired cellular immune function may be an important factor affecting its prognosis.

Objective To analyze the value of fine needle aspiration for male breast cancer and to investigate the clinical characteristics of male breast cancer.Methods The cell morphological characteristics of fine needle aspi-ration and clinical data were analyzed retrospectively within a total of 35 cases with male breast cancer of Affiliated Hospital of Luzhou Medical College,from 2000 January to 2014 December.Results During the 35 patients of male breast cancer with fine needle aspiration,from 35 to 82 years old,the median age was 64 years old and mean age was 61.6 years old.There were 23 cases of male breast cancer from 60~82 years old,suggesting that the relatively high incidence was after the age of 60 years.The diameter of male breast tumor was 0.8~8cm,while the average diameter was 3.5cm.In the clinical stage of TNM,14 cases were with stageⅠ,13 cases were with stageⅡ,7 cases were with stage Ⅲand 1 case wasⅣstage;that was to say,the cases of male breast cancer in the late was relatively more.The invasive ductal cancers were 16 cases (45.7%) of male breast cancer.The sensitivity was 94.3% of fine needle aspiration cytology before the operation.Conclusion The accuracy of fine needle aspiration cytology has important significance for the diagnosis of male breast cancer,can be used as a mean of detecting male breast tumor as benign or malignant.

Objective To analyze the population distribution and clinical characteristics of esophageal cancer in Luzhou prefecture of Sichuan. Methods The data of 690 cases of resected specimens with esophageal cancer from October 2010 to September 2014 were analyzed retrospectively, including 659 cases of esophageal squamous cell carcinoma, 10 cases of adenocarcinoma, 7 cases of adenosquamous carcinoma, 5 cases of sarcomatoid carcinoma, 2 cases of carcinoma in situ, 3 cases of leiomyosarcoma, 2 cases of small cell carcinoma, 1 case of undifferentiated carcinoma and 1 case of mixed carcinoma. Results The constituent ratio of 51-60 years old population of 690 cases with esophageal cancer was the highest for 40.00%(276/690). In≤60 years patients, the rate of esophageal cancer in male was higher than that in female: 56.15%(338/602) vs. 34.09%(30/88), χ2 = 15.005, P =0.000. Clinical pathological factors of lymph node metastasis showed that there were statistically significant differences between male and female: 45.68%(275/602) vs. 34.09%(30/88), χ2 = 4.182, P =0.041;the lower the position, the higher the lymph nodes metastasis rate:the lymph nodes metastasis rate in superior segment, middle segment, inferior segment was 32.00%(8/25), 41.22%(216/524) and 57.45%(81/141),χ2=13.425, P=0.001;the lower the differentiation, the higher the lymph nodes metastasis rate:the lymph nodes metastasis rate in high, middle and lower differentiation was 40.84%(165/404), 47.60%(109/229) and 75.76%(25/33), χ2 = 16.065, P = 0.000. The lymph nodes metastasis rate in different general types and histology types had no significant differences(P>0.05). Conclusions The incidence rate of esophageal cancer in male is significantly higher than that in female, the higher the lymph node metastasis rate, the lower the position and the differentiation of esophageal cancer in Luzhou prefecture of Sichuan.

Objective:With Diagnosis related groups(DRG)indicator introduced into the hospital efficiency evaluation, to analyze the adjustment effect of DRG on the efficiency value, and to compare the similarities and differences between the DEA efficiency value and the DRG efficiency indicator.Methods:The DRG pilot data in 2017 and 2018 of tertiary hospitals in Hubei province and related data from other reports were collected. Indicators including the actual number of beds, the number of employees, the actual total bed days occupied, and medical income were used as input indicators, and total admissions, number of discharges, weight of DRG and number of DRG groups were used as output indicators. 7 models were constructed using different indicator combinations. The efficiency of the hospital was calculated by the Bootstrap-DEA efficiency evaluation method. The relationship between hospital attributes and efficiency was analyzed by a generalized linear model.Results:There was an abnormal phenomenon that the higher the hospital level, the lower the efficiency in the efficiency value calculated by the traditional method. The efficiency values of county hospitals, city hospitals and provincial hospitals were 0.83, 0.74 and 0.71, respectively( P<0.01). DRG weight and group number were used as output for DEA analysis, and the efficiency values of county hospitals, city hospitals, and provincial hospitals were 0.95, 0.95 and 0.96( P=0.20)respectively. The DRG efficiency indications of county hospitals, city hospitals and provincial hospitals were 1.42, 1.11, 1.00 respectively( P<0.01). The higher the level, the lower the efficiency, while the efficiency values calculated by DEA were 0.84, 0.82, 0.86, respectively( P=0.58). Conclusions:The efficiency value calculated by the traditional method presents a systematic bias, which could be corrected effectively when DEA analysis using DRG weights is used as output indicator. The results developed new ideas of efficiency analysis for hospitals practicing DRG management.

Objective:To quantitatively measure the level of hospital human resources management of public hospitals in China with D-CHMS.Methods:From January through December of 2019, the Development Chinese Hospital Management Survey(D-CHMS)was used in field survey of relevant personnel of 36 tertiary general hospitals and 27 secondary general hospitals, with 10 persons chosen from each hospital. Survey data were subject to descriptive analysis and t test, for quantitative measurement of the human resources management level of these sample hospitals. Results:The level of human resources management in Chinese public hospitals was on the low side, as seven secondary dimensions scored 2.94 in average. To name a few, talents retention and talents recruitment scored the lowest, being (2.13±0.29) and (2.90±0.63) respectively. Tertiary hospitals presented an obviously better performance than secondary hospitals in incentives for best performers, talents retention and recruitment. Human resources management level of hospitals in China′s west regions scored the highest, followed by those in the east regions.Conclusions:Public hospitals in China, especially secondary hospitals were expected to enhance their human resources management. Approaches recommended include building a talent pool, developing a series of preferential policies, building development platforms, optimizing performance appraisal, motivating remuneration schemes, and offering unique employee value propositions, which serve to recruit and retain talents.

Objective:To measure the cost efficiency and its components of 141 public tertiary hospitals of China and measure the influencing factors.Methods:COST, CCR and BCC model of DEA were used to measure the cost efficiency, allocative efficiency, technical efficiency, pure technical efficiency and scale efficiency.Results:In 2018, the values of cost efficiency, allocative efficiency, technical efficiency, pure technical efficiency, scale efficiency of the sample hospitals were 0.632, 0.929, 0.675, 0.732 and 0.917 respectively. 10(7.09%)sample hospitals were in the state of constant returns to scale, 41(29.08%)sample hospitals were in a state of decreasing returns to scale, while 90(63.83%)sample hospitals were in a state of increasing returns to scale. The regional GDP per capita and the bed utilization rate, average hospitalization days, average charge per output of hospital had significant impacts on the cost efficiency.Conclusions:Technical efficiency is the main factor affecting cost efficiency, and pure technical efficiency is the key factor for technical efficiency. Continuously improving the internal management level of the hospital is the main and necessary approach to enhance the technical efficiency of public tertiary hospitals. Internal factors have greater impacts on the efficiency of the sample hospitals. Reducing the average length of stay, increasing the utilization rate of beds and reducing the average charge level per outpatient can improve the cost efficiency of the hospitals.

Objective:To develop a new kind of efficiency-based hospital ranking based on existing major hospital rankings with reference to hospital input data.Methods:DEA method was called into play and built five models for hospital ranking according to the efficiency value so calculated. The hospital beds available and the number of employees of 59 general hospitals in 2018 were used as the input indicators, and China′s Best Hospitals ranking by Fudan University′s Hospital Management Institute(Fudan ranking)and the total scoring and individual items evaluation from China Hospital STEM ranking by the Medical Information Institute of the Chinese Academy of Medical Sciences were used as the output indicators.Results:The correlation coefficients between hospital beds and the scores from Fudan-rankings and STEM-ranking were 0.08 and 0.09 respectively( P>0.05), and the correlation coefficients between personnel and scores from the two rankings were 0.34 and 0.39 respectively( P<0.01). The correlation coefficients of the efficiency values of the five super-efficiency DEA models and the beds were 0.37, -0.61, -0.71, -0.61 and-0.61 respectively( P<0.01), and the correlation coefficients of personnel were-0.17, -0.37, -0.60, -0.39 and -0.39( P<0.01)respectively. Compared with the original ranking, the ranking of the efficiency value of the super-efficiency DEA model found the average ranking of hospitals in Beijing and Shanghai rose by 6.38 places, and the ranking of hospitals in non-Beijing and Shanghai areas dropped by 4.37 places on average. The difference was statistically significant( P=0.02), and other differences in the ranking of different types hospitals were not statistically significant. Conclusions:Thanks to the super-efficiency DEA efficiency value which is added with such input indicators as hospital beds and personnel, the ranking becomes more scientific and comprehensive. The research results can provide references for more rational patient flow and encourage hospitals onto a more healthy development pathway.