1.Analysis of DRG policy implementation dilemma and countermeasures of China based on Smith policy implementation process model
Manchen LYU ; Dian ZHOU ; Di TIAN ; Yuan ZHOU ; Yu ZHANG ; Tongbin XUE ; Xuezhen LIU ; Ye WU
Chinese Journal of Hospital Administration 2024;40(9):662-665
DRG payment reform is an important means to control the unreasonable growth of medical expenses, improve the quality of medical services and achieve a win-win situation among three sides of hospitals, medical insurance and patients. This study adopted the Smith policy implementation process model to analyze the difficulties in the DRG policy implementation process from four aspects(idealized policies, policy implementation institutions, target groups, and policy environment), including the deviation between policy connotations and actual needs; the interest objectives of all parties were not completely aligned, the target group lacked a sense of identity, and the social impact and technological support needed to be improved. It was suggested that optimization should be carried out from four dimensions: policy supply coordination and precision, performance evaluation and personnel literacy, target group cognitive level and participation willingness, and policy implementation environment and atmosphere, in order to synergistically promote the effective implementation of DRG policies.
2.Advances in biodegradation of polyolefin plastics.
Yingbo YUAN ; Wenkai ZHOU ; Quanfeng LIANG ; Longyang DIAN ; Tianyuan SU ; Qingsheng QI
Chinese Journal of Biotechnology 2023;39(5):1930-1948
Polyolefin plastics are a group of polymers with C-C backbone that have been widely used in various areas of daily life. Due to their stable chemical properties and poor biodegradability, polyolefin plastic waste continues to accumulate worldwide, causing serious environmental pollution and ecological crises. In recent years, biological degradation of polyolefin plastics has attracted considerable attention. The abundant microbial resources in the nature offer the possibility of biodegradation of polyolefin plastic waste, and microorganisms capable of degrading polyolefin have been reported. This review summarizes the research progress on the biodegradation microbial resources and the biodegradation mechanisms of polyolefin plastics, presents the current challenges in the biodegradation of polyolefin plastics, and provides an outlook on future research directions.
Plastics/metabolism*
;
Polymers/metabolism*
;
Polyenes
;
Biodegradation, Environmental
3.Effect analysis of day surgery cost control based on propensity value matching
Yuan ZHOU ; Dian ZHOU ; Di TIAN ; Xiubin FANG ; Ye WU ; Yifan WANG ; Chenhuan YAO ; Heng WANG ; Yan YANG ; Chunchun JIE
Chinese Journal of Hospital Administration 2022;38(2):110-114
Objective:To analyze the composition, the changes of expense structure and the influencing factors of hospitalization expenses, for reference in optimizing the cost control of day surgery.Methods:Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs, chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020. The confounding factors were eliminated through propensity matching. The structural change of hospitalization expenses was analyzed by structural change degree, and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results:After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery, 98 patients with lower extremity varicose veins, 356 patients with chronic cholecystitis and 38 patients with varicocele were finally included. Compared with non day hand, the total hospitalization cost of day surgical instruments decreased, and the cost structure changes of chronic cholecystitis, varicocele and varicose veins of lower limbs were 14.59%, 6.20% and 16.20% respectively. Among them, the general medical service fee, nursing fee and examination and laboratory fee showed a downward trend, and the fees of materials and drugs showed an upward trend. General medical service fee, nursing fee, examination and laboratory fee, clinical diagnosis fee, treatment fee, drug fee, material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90). The payment method, wound healing type and discharge diagnosis can influence the cost of day surgery( P<0.05). Conclusions:Compared with non daytime surgery, the total hospitalization cost of day surgery has a certain cost control effect, but it can not reduce the cost of all projects. The main influencing factors are the internal composition of the cost, payment method and so on. The hospitals should focus on tapping the internal cost control potential of day surgery and further expanding the coverage of day surgery diseases.
4.Mechanism of electroacupuncture for regulation of lipid production and improvement in obesity by mediating Wnt/ β-catenin pathway through activating SIRT1.
Ya-Yuan WANG ; Feng-Xia LIANG ; Wei LU ; Yu-Dian ZHOU ; Xiang-Xi HUANG ; Shu-Rui YANG
Chinese Acupuncture & Moxibustion 2021;41(7):774-780
OBJECTIVE:
To explore the mechanism of electroacupuncture (EA) for the regulation of lipid production and improvement in obesity by mediating Wnt/β-catenin pathway through activating silent information regulator 1 (SIRT1).
METHODS:
Of 75 Wistar male rats, 10 rats were selected randomly as the normal group and fed with standard diet. The rest rats were fed with high-fat diet for 8 weeks to establish the obesity model. Forty rats of successful modeling were randomized into a model group, an EA group, an EA plus inhibitor group (EA+I group) and an agonist group, 10 rats in each one. In the EA group, EA was applied at "Guanyuan" (CV 4), "Zhongwan" (CV 12), "Zusanli" (ST 36) and "Fenglong" (ST 40), with continuous wave, 2 Hz in frequency and around 1 mA in intensity. The needles were retained for 20 min. In the EA+I group, sirtinol solution was injected from caudal vein and EA was exerted simultaneously. In the agonist group, resveratrol solution was given by intragastric administration. The intervention of the above three groups was given once every two days, 3 times a week, consecutively for 8 weeks. Before and after intervention, body mass and Lee's index were recorded in the rats of each group. After intervention, the levels of serum total cholesterol (TC), triglyceride (TG) and free fatty acid (FFA) were detected in the rats of each group. After intervention, the mass of white adipose tissue (WAT) and the area of adipocytes were compared in the rats among the 5 groups. Using Western blot method, the protein expressions of SIRT1, glycogen synthase kinase-3β (GSK3β), β-catenin, cyclin D1 and peroxisome proliferators-activated receptor γ (PPARγ) were detected in WAT in the rats of each group.
RESULTS:
After intervention, compared with the model group, the body mass and Lee's index were reduced in the rats of the EA group and the agonist group (
CONCLUSION
Electroacupuncture remarkably improves the body mass, Lee's index and blood lipid metabolism and reduces WAT mass and adipocyte size in obesity model rats, which is probably related to up-regulating the protein expression of SIRT1 in WAT, activating Wnt/β-catenin pathway and inhibiting the expression of PPARγ of downstream lipogenic gene so as to affect lipid production.
Acupuncture Points
;
Animals
;
Electroacupuncture
;
Male
;
Obesity/therapy*
;
Rats
;
Rats, Wistar
;
Sirtuin 1/genetics*
;
Triglycerides
;
beta Catenin/genetics*
5.Analysis of Effect of Realgar with Different Compatibility Proportions on Transitional Constituents of Indigo Naturalis in Rat Serum Based on UPLC-Q-TOF-MS/MS
Min ZHANG ; Qing-qing WU ; Chen-hui LI ; Ling-ling XU ; Yuan-yuan ZHOU ; Peng HUANG ; He-ping HUANG ; Juan YU ; Dian-lei WANG
Chinese Journal of Experimental Traditional Medical Formulae 2020;26(13):79-86
Objective:To investigate the effect of different dose of Realgar compatible with Indigo Naturalis on the transitional constituents of Indigo Naturalis in rat serum based on the compatibility of Qinghuangsan.Method:Indigo Naturalis test solution, the drug-containing serum of three different proportions of Qinghuangsan (10 g of Indigo Naturalis compatible with 52.5, 105, 210 mg of Realgar for group A, B and C, respectively) and blank serum were detected by UPLC-Q-TOF-MS/MS, in combination with the chemical components identified in Indigo Naturalis test solution, the differences of transitional constituents of Indigo Naturalis in rat serum from the group A, B and C were analyzed. HL-60 cells (human leukemia cells) were treated with the three groups of Qinghuangsan drug-containing serum and the effect of drug-containing serum on the activity of HL-60 cells was detected by cell counting kit-8 (CCK-8) assay.Result:A total of 19, 22, 25 of transitional constituents were detected in Qinghuangsan drug-containing serum from group A, B and C, respectively. The three groups of drug-containing serum all contained 5 prototype components from Indigo Naturalis test solution, including tryptanthrin, indigo, indirubin, 2-aminobenzoic acid and
6. Research on the prevention and control of 2019 novel coronavirus pneumonia for Internet-based hospitals using UTAUT-DST model
Yuan ZHOU ; Di TIAN ; Dian ZHOU
Chinese Journal of Hospital Administration 2020;36(0):E006-E006
Thanks to the transmission characteristics of 2019 novel coronavirus pneumonia, Internet-based hospitals can effectively cut off the transmission route via online consulting service. The hospital, leveraging the UTAUT model and DST theory, and advantages of Internet-based hospitals, is deploying step by step such four modules, as "pre-hospital screening", "patient acceptance", "auxiliary diagnosis and treatment", and "prevention and control linkage". These efforts ultimately contribute to an innovative prevention and control pattern against the novel coronary pneumonia for Internet-based hospitals and based on the UTAUT-DST model. This practice proves an initial success, and offers useful references for prevention and control of the NCP and development of other Internet-based hospitals.
7.Comparative study on serum transitional components of Huatan Jiangqi Capsules in rats under pathological and physiological status.
Chen-Hui LI ; Wei FANG ; Min ZHANG ; Yuan-Yuan ZHOU ; Ling-Ling XU ; He-Ping HUANG ; Dian-Lei WANG ; Ze-Geng LI
China Journal of Chinese Materia Medica 2020;45(6):1440-1451
The differences of transitional components and metabolic processes of Huatan Jiangqi Capsules(HTJQ) in rats under normal physiological and pathological conditions of COPD were analyzed by UPLC-Q-TOF-MS. The rat COPD model was established by passive smoking and intratracheal instillation of lipopolysaccharide. After the normal and COPD model rats were douched with HTJQ, the blood was collected from hepatic portal vein and the drug-containing serum samples were prepared by methanol precipitation of protein. Then, 10 batches of drug-containing serum samples of HTJQ were prepared and analyzed by UPLC serum fingerprint to evaluate the quality and stability of drug-containing serum samples. UPLC-Q-TOF-MS was used to collect the mass spectrometric information of the transitional components. Twenty-eight transitional components of HTJQ in normal rats and 25 transitional components of HTJQ in COPD model rats were identified by UPLC-Q-TOF-MS. Under pathological and physiological conditions, there were not only the same transitional components in rat serum, but also corresponding differences. Further studies showed that there were also differences in the metabolic process of transitional components between the two conditions. In normal rats, most of the metabolic types of transitional components were phase I reactions. In COPD model rats, phase Ⅰ reactions decreased and phase Ⅱ reactions increased correspondingly. With UPLC-Q-TOF-MS technology, the differences of transitional components and the metabolism process of HTJQ in rats under normal physiological and pathological conditions were analyzed. The results showed that types of transitional components and the activity of some metabolic enzymes would be changed in COPD pathological state, which would affect the metabolic process of bioactive components in vivo. It laid a foundation for further elucidating the metabolic process and pharmacodynamic substance basis of HTJQ.
Animals
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Capsules
;
Chromatography, High Pressure Liquid
;
Drugs, Chinese Herbal/pharmacokinetics*
;
Mass Spectrometry
;
Pulmonary Disease, Chronic Obstructive/drug therapy*
;
Rats
;
Serum/chemistry*
8.A clinical epidemiological investigation of neonatal acute respiratory distress syndrome in southwest Hubei, China.
Yong-Fang ZHANG ; Xin-Qiao YU ; Jian-Hua LIAO ; Feng YANG ; Cong-Rong TAN ; Su-Ying WU ; Shi-Qing DENG ; Jun-Yuan FENG ; Jia-Yan HUANG ; Zuo-Fen YUAN ; Kai-Dian LIU ; Zhen-Ju HUANG ; Li-Fang ZHANG ; Zheng-Guo CHEN ; Hong XIA ; Lin-Lin LUO ; Yan HU ; Hua-Sheng WU ; Hong-Ling XIE ; Bao-Min FEI ; Qing-Wei PANG ; Song-Hua ZHANG ; Bi-Xia CHENG ; Lang JIANG ; Chang-Tao SHEN ; Qiong YI ; Xiao-Guang ZHOU
Chinese Journal of Contemporary Pediatrics 2020;22(9):942-947
OBJECTIVE:
To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China.
METHODS:
According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017.
RESULTS:
A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66).
CONCLUSIONS
Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.
China
;
Female
;
Humans
;
Infant, Newborn
;
Meconium Aspiration Syndrome
;
Pregnancy
;
Respiratory Distress Syndrome, Newborn
;
Retrospective Studies
9.Artificial intelligence system of faster region-based convolutional neural network surpassing senior radiologists in evaluation of metastatic lymph nodes of rectal cancer.
Lei DING ; Guang-Wei LIU ; Bao-Chun ZHAO ; Yun-Peng ZHOU ; Shuai LI ; Zheng-Dong ZHANG ; Yu-Ting GUO ; Ai-Qin LI ; Yun LU ; Hong-Wei YAO ; Wei-Tang YUAN ; Gui-Ying WANG ; Dian-Liang ZHANG ; Lei WANG
Chinese Medical Journal 2019;132(4):379-387
BACKGROUND:
An artificial intelligence system of Faster Region-based Convolutional Neural Network (Faster R-CNN) is newly developed for the diagnosis of metastatic lymph node (LN) in rectal cancer patients. The primary objective of this study was to comprehensively verify its accuracy in clinical use.
METHODS:
Four hundred fourteen patients with rectal cancer discharged between January 2013 and March 2015 were collected from 6 clinical centers, and the magnetic resonance imaging data for pelvic metastatic LNs of each patient was identified by Faster R-CNN. Faster R-CNN based diagnoses were compared with radiologist based diagnoses and pathologist based diagnoses for methodological verification, using correlation analyses and consistency check. For clinical verification, the patients were retrospectively followed up by telephone for 36 months, with post-operative recurrence of rectal cancer as a clinical outcome; recurrence-free survivals of the patients were compared among different diagnostic groups, by methods of Kaplan-Meier and Cox hazards regression model.
RESULTS:
Significant correlations were observed between any 2 factors among the numbers of metastatic LNs separately diagnosed by radiologists, Faster R-CNN and pathologists, as evidenced by rradiologist-Faster R-CNN of 0.912, rPathologist-radiologist of 0.134, and rPathologist-Faster R-CNN of 0.448 respectively. The value of kappa coefficient in N staging between Faster R-CNN and pathologists was 0.573, and this value between radiologists and pathologists was 0.473. The 3 groups of Faster R-CNN, radiologists and pathologists showed no significant differences in the recurrence-free survival time for stage N0 and N1 patients, but significant differences were found for stage N2 patients.
CONCLUSION:
Faster R-CNN surpasses radiologists in the evaluation of pelvic metastatic LNs of rectal cancer, but is not on par with pathologists.
TRIAL REGISTRATION
www.chictr.org.cn (No. ChiCTR-DDD-17013842).
Adult
;
Aged
;
Aged, 80 and over
;
Artificial Intelligence
;
Female
;
Humans
;
Lymphatic Metastasis
;
Male
;
Middle Aged
;
Neoplasm Recurrence, Local
;
Neoplasm Staging
;
Neural Networks (Computer)
;
Pathologists
;
Radiologists
;
Rectal Neoplasms
;
diagnostic imaging
;
mortality
;
pathology
10. Research on the coupling and coordination of scale, efficiency and quality of public hospitals in Anhui
Di TIAN ; Hongbing XU ; Bowen WANG ; Yuan ZHOU ; Dian ZHOU
Chinese Journal of Hospital Administration 2019;35(11):961-965
Objective:
To evaluate the scale, efficiency and quality of secondary and tertiary public hospitals in Anhui province, and analyze the degree of coupling and coordination among the three dimensions.
Methods:
Thirty-two hospitals′ data were extracted from the direct reporting system of Anhui Health Commission. Hospital efficiency was evaluated by DEA model, hospital quality was evaluated by TOPSIS model, and coupling coordination degree was analyzed by coupling function.
Results:
In the single-dimension evaluation, there were significant differences in the distribution of the three dimensions among different levels of hospitals, and the efficiency and quality of secondary hospitals were better than those of tertiary hospitals. In the coupling evaluation, the average degree of coupling coordination in Anhui was 0.637, which was in the " primary coordination" level. The overall coupling and coordination degree of the tertiary hospitals were better than that of the secondary hospitals, and the highest score was in central Anhui.
Conclusions
Single-dimensional evaluation method cannot objectively represent a general picture of the hospitals. On the other hand, coupling coordination degree evaluation can provide a more comprehensive and objective result. The development strategy of hospitals should be made to fit local conditions and to coordinate the development of scale, efficiency and quality.

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