Objective To investigate the current policy of medical insurance expenditure control in Shanghai and put forward feasible advice. Methods Survey in 5 tertiary first-class hospitals in Shanghai involving 400 doctors and patients was conducted.The result of the questionnaire was tracked with Microsoft Excel 2000.The expense reports during 2001 to 2006 from the Office of Medical Insurance of Shanghai Renji Hospital was collected.All the data were statistically analysed. Results The global budget system was accepted by both the doctors and patients.Charging based on disease categories was proved a relatively satisfying method.Drug expenditure control was concerned by both the doctors and patients. Conclusion Ever since the global budget system of medical insurance is implemented in Shanghai,the medical insurance expenditure has been effectively controlled.The key point is the restraint of irrational consumption during the medical treatment.

Network management is very important for its effective operation in the hospital.From the aspects of fault management,configuration management,performance management,charging management,safety management,this paper proposes a high-efficiency and low-cost method for network management in the hospital.

OBJECTIVETo investigate the correlation between the pathogeneses of diarrhea-pre- dominant irritable bowel syndrome (D-IBS) complicated functional dyspepsia (FD) patients of Gan-stagnation Pi-deficiency Syndrome (GSPDS) and symptoms, psychological states, and gastrointestinal hormones.

METHODSA total of 111 patients with confirmed D-IBS complicated FD of GSPDS were recruited as the treated group by using Rome III standard and Chinese medical syndrome standard. And 30 healthy volunteers were recruited as the control group. The general condition, scoring for digestive symptoms, and the distribution of GSPDS subtype of all subjects were recorded by a questionnaire, and assessed by Symptom Checklist (SCL-90; a software for psychological test developed by Beijing Huicheng Adult Cor- poration). Meanwhile, plasma levels of 5-hydroxytryptamine (5-HT), somatostatin (SS), vasoactive intestinal peptide (VIP), endothelin (ET), interleukin 10 (IL-10), and interleukin 12 (IL-12) were measured in all subjects.

RESULTS(1) The subtype of D-IBS complicated FD of GSPDS was dominant in Pi-qi deficiency type (51/111,45.9%),Pi yang deficiency type (34/111,30.6%), and GSPDS. There was no statistical difference in the scoring of digestive symptoms among the 3 subtypes (P >0.05). (2) Compared with the control group, the anxiety factor score and the total score significantly increased in all three subtypes of D-IBS complicated FD of GSPDS, and the depression score of Pi yang deficiency type and Gan-depression type also significantly increased (P <0.05, P <0.01); the depression score of Gan-depression type was significantly higher than that of the Pi-qi deficiency type (P <0.01). Plasma 5-HT levels were obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities, and VIP and IL-10 levels were significantly lower than those in the control group (P <0.05). Plasma VIP levels were also obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities (P <0.01), and SS levels were significantly lower than those in the control group (P <0.05). There was no statistical difference in plasma ET or IL-12 levels in each patient group, when compared with the control group (P >0.05). (3) Compared with the.control group, plasma 5-HT levels significantly increased, plasma VIP and IL-10 levels significantly decreased in ach subtype of D-IBS complicated FD patients of GSPDS (P <0.05, P <0.01), and no significant change of SS, ET, or IL-12 occurred (P >0.05). Besides, plasma 5-HT levels were significantly higher in Gan-depression type than in Pi yang deficiency type, VIP levels were lower in Gan-depression type than in Pi-qi deficiency type (all P <0.05).

CONCLUSIONSGan stagnation and Pi deficiency were dominant in D-IBS complicated FD patients of GSPDS. Psychological abnormalities, increased plasma 5-HT levels, and decreased plasma VIP levels were closely correlated with Gan stagnation subtype, which provided some reference for looking for objective indicators of Chinese medical syndromes in treating D-IBS complicated FD patients of GSPDS.

Adult ; Case-Control Studies ; Diarrhea ; etiology ; Dyspepsia ; blood ; complications ; psychology ; Gastrointestinal Hormones ; blood ; Humans ; Irritable Bowel Syndrome ; blood ; complications ; psychology ; Psychological Tests ; Qi ; Serotonin ; Surveys and Questionnaires ; Yang Deficiency

Objective To investigate the feasibility and efficacy of combined preoperative chemora- diation program followed by radical surgery in bulky early or moderate uterine cervical cancer.To determine the incidence and predictive value of rasidual disease in the radical hysterectomy specimens after CCR. Methods Thirty-five patients with uterine cervix carcinoma from January 2001 to September 2003 were treated with preoperative external beam radiotherapy to 3060 cGy in 4 weeks.Patients received concurrent continuous infusion cisplatin(20 mg/m~2)on day 1,8,15,22 of four weeks and 5-Fu(4 g)chemotherapy during the first four days and the last four days of the radiation course.Radical surgery was not performed until 4 weeks after the completion of the preoperative treatment.Results Clinical response was 85.71%,complete response,54.29 %;partial response,31.43 %.The analysis of the surgical specimens showed 19 patients had revealed residual disease and 16 patients had revealed no residual disease,the complete pathological response hed been 45.71%.Three-year survival rate was 87.14 % in 35 patients.Three-year survival rate of residual disease patients(76.32 %)was significantly lower than that of no residual disease(100.0 %)(P=0.0358). Three-year survival of cervical stromal invasion less than 1/2 and invasion extra stromal was 100.0 %, 41.67 % respectively(P=0.0109);three-year survival of lymph-vascular space involvement and no lymph- vascula space involvement was 0,85.29 %,respectively(P=0.0148).Conclusion Combined preoperative chemoradiation program followed by radical surgery in bulky early or moderate cervical cancer could reveal an effective efficacy with a tolerant complication.Residual disease is an independent and strong predictive factor.

Objective To investigate the role of depression and C-reaction protein (CRP)in the early development of vascular disease in the elderly patients with type 2 diabetes. Methods Totally 396 patients with type 2 diabetes were recruited in the study,including 196 cases with depression and 200 cases without depression.Depression was evaluated by Hamilton depression scale (HAMD),and CRP was measured using rate nephelometry.The related parameters of wave intensity (WI) such as accelerating wave intensity (W1),decelerating wave intensity (W2),arterial stiffness β,pressure-strain elasticity modulus (Ep),arterial compliance (AC),pulse wave velocity -wave intensity(PWVWI),pulse wave velocity (PWV) and argumentation index (AI) were detected and compared between the groups. Results The levels of CRP [(8.1±2.8)mg/L vs. (3.9±3.2) mg/L,t=6.411,P=0.000],W2 [(4.82±1.33) mm Hg· m-1 · s-3 vs.(2.27±1.28)mm Hg · m-1 · s-3,t=4.256,P=0.021],arterial stiffness β(12.58±3.23 vs.8.96±2.24,t=4.634,P=0.019),Ep (157.90±52.64 vs.118.24±53.08,t=5.512,P=0.007),PWVβ(7.53± 1.41 vs.6.68±1.56,t=3.982,P=0.024),AI(19.26± 13.21 vs.15.34±10.23,t=3.213,P=0.037)and PWV-WI (7.59±1.67vs.6.63± 1.45,t =2.613,P =0.046) in cases with depression were higher than the cases without depression,while the AC value was reduced (0.70±0.19 vs.0.78±0.21,t=4.676,P =0.017).There was no difference in W1 value between the groups.The CRP level and HAMD score were positively associated with W2 (r=0.470,P=0.000),stiffness β (r=0.582,P=0.000),Ep (r=0.352,P=0.004),PWV-WI (r=0.233,P=0.019),PWVβ (r=0.340,P=0.007) and AI (r=0.265,P=0.015),but negatively related with AC(r=-0.457,P=0.000).HAMD score was positively correlated with CRP level(r=0.328,P=0.003). Conclusions The carotid artery wave intensity W2,blood vessel elasticity parameter β,Ep,AC,PWV-WI,PWVβ and AI determination can evaluate the risk of cardiovascular diseases in elderly diabetes,and higher CRP level and HAMD score may deteriorate its process.

BACKGROUND:Different embolic materials can be used for bronchial artery embolization in patients with pulmonary tuberculosis hemoptysis. Sodium alginate microspheres and gelatin sponge are two commonly used materials; however, there are relatively few related reports about the comparative analysis on the application effect of these two materials. OBJECTIVE:To investigate the clinical efficacy of sodium alginate microspheres for bronchial artery embolization on pulmonary tuberculosis hemoptysis. METHODS:Totaly 157 patients with pulmonary tuberculosis hemoptysis, including 98 male and 59 female patients, aged 22-75 years, were enroled and subjected to bronchial artery embolization using different embolic materials: sodium alginate microspheres group (n=74) and gelatin sponge group (n=83). During the 12 months of folow-up, the clinical curative effect, recurrence and complications condition of these two groups were observed. RESULTS AND CONCLUSION:The total effective rates of sodium alginate microspheres and gelatin sponge groups were respectively 91.19% and 81.93%, and there was a significant difference between groups (P < 0.05). The recurrence rates of sodium alginate microspheres and gelatin sponge groups were respectively 6.8% and 26.5%, and there was a significant difference between groups (P < 0.05). Additionaly, there was no significant difference in the complications between groups (P > 0.05). These results demonstrate that sodium alginate microspheres for bronchial artery embolization has a better result in the clinical treatment of pulmonary tuberculosis hemoptysis with a high clinicaly effective rate and low recurrence rate.

Objective To understand the work tasks of rural doctors in our country and to provide bases for the reforms of clini‐cal medical education of junior colleges .Methods A self‐made questionnaire was performed in 1 245 rural doctors from 86 rural grassroots health institutions in 7 provinces/municipalies of our country .Results The academic levels of rural doctors were low (65 .54% )and the rates of their medical certification holding were low in western district(7 .79% ) .The work load including basic medical care and basic public health services they committed were approximately matching .The top 5 items of basic medical care were ,in proper sequence ,diagnoses and treatments of common diseases ,common symptoms ,chronic disease management ,communi‐ty rehabilitation ,community first aid .The top 5 items of basic public health services were establishment of residents′health files , maternal and child health ,health care of the aged ,immunization ,health education .Conclusion The technological levels of diagnosis and treatment and theoretical knowledge of rural doctors should be further improved .The clinical medical education of junior medi‐cal colleges must strengthen the training and cultivation of the students′abilities of basic public health services ,besides consolida‐ting the training of the abilities of practical diagnosis and treatment .

Objective To review the experience of the bone traction treatment for displaced fracture of femur shaft in children.Methods All of the cases were treated with femur supercondylar traction,and they were fixed in a stable position with hip joint in 90? flexion and 30?~45? abduction and with knee in 90? flexion.Result The effects of 86 cases were satisfactory.Conclution This method is simple and effective.It reduces complications of skin traction and operation to patients.

Objective To explore the effect of focused nursing model on negative emotions and subjective well-being of lung cancer patients. Methods Eighty-six lung cancer patients hospitalized from November 2014 to November 2016 in our hospital were divided into two groups according to the order of admission in equal number. The control group was treated with routine care, and the observation group was with focused nursing model. The two groups were compared in terms of anxiety by SAS, depression by SDS, subjective well-being. Results The scores by SAS and SDS in the observation group were lower than those in the control group (P<0.05). The levels of objective support, subjective support, self-evaluation and subjective well-being index of the observation group were higher than the control group (P <0.05). Conclusion Focused nursing model can effectively relieve negative emotions, improve subjective well-being of lung cancer patients, worthy of clinical promotion.