Objective To study teaching cases of health economics in the context of health reform and development in China.Method Preparing for lessons in groups,information collection,experiences summary,and field research.Result Three productions:a teaching plan,a case collection,and a guideline of case teaching.Discuss It is useful to improving students’ ability to contact theory with practices and enhance teacher’s teaching and researching ability,but it also needs further improvement.

Objective To explore the appropriate frequency of ventilator tube replacement by researching the influence of different ventilator circuit change frequency on ventilator-associated pneumonia (VAP).Methods A prospective randomized sampling study was conducted.The patients undergoing invasive mechanical ventilation over or equal to 3 days admitted to emergency intensive care unit (EICU) of the First Affiliated Hospital of Kunming Medical University from December 2012 to December 2015 were enrolled.The patients were divided into 3,7 and 10 days group according to the frequency of ventilator tube replacement.Bacteriology of ventilator tube and the incidence of VAP were compared among the groups.Results Ninety-eight patients were enrolled,mainly with the artificial airway of endotracheal intubation or tracheotomy,with 56 male and 42 female,aging 8 to 86 years with mean of (51.97 ± 17.56) years.There were no statistical differences in gender,age,Glasgow coma scale (GCS) score,cough function and application of glucocorticoid,enteral nutrition,atomization and sedative therapy among three groups,indicating that the risk factors among three groups were consistent.The bacteria detection rates of extension tube,breathe out tube,breathe in tube,and hydrops collection cup were 36.7％,36.7％,33.3％,and 33.3％ respectively in 3 days group,and they were 73.0％,67.6％,62.2％,and 62.2％ in 7 days group respectively,and were all 90.3％ in 10 days group.It was showed that the bacteria detection rate in different pipe parts was almost the same with the same change frequency,and the rate was higher with the longer usage of ventilator tube (x2 values were 20.599,19.879,21.975,21.975,all P =0.000).The longer of the tube used time,the higher incidence of VAP.The incidence of VAP in 3,7,10 days groups were 26.7％,59.5％ and 77.4％,respectively,but there was statistically significant difference among all groups (x2 =30.486,P ＜ 0.001).Based on the value of 3 days group,the incidence of VAP in the 7 days group was 15.950 folds of 3 days group,and the incidence of VAP in the 10 days group was 18.333 folds of the 3 days group (both P ＜ 0.001).Conclusion This study suggests that the longer of pipeline using time,the more serious degree of bacterial contamination of pipeline,the higher incidence of VAP.

Objective To investigate the effectiveness of training at morning shift meeting in improving healthcare-associated infection(HAI) prevention and control among health care workers(HCWs) in newly established hospital departments.Methods On July 11-22, 2016, HAI management full-time personnel performed training for HCWs about HAI prevention and control at morning shift meeting of 8 newly established clinical departments and 1 laboratory, the questionnaire survey was conducted before, immediately after, and 3 months after training, training effectiveness was evaluated.Results A total of 239 HCWs were required to receive training, including 85 doctors (35.6％), 150 nurses (62.8％), and 4 technicians (1.7％).The knowledge of HAI prevention and control that most HCWs wanted to know was occupational exposure and occupational precaution(85.6％);most HCWs wanted to obtain knowledge of HAI through training in their respective department by HAI management full-time personnel(87.1％).Total awareness rates of HAI knowledge before, immediately after, and 3 months after training were 45.1％, 96.7％, and 83.9％ respectively, difference was significant(P<0.001);comparison among groups showed that HCWs'' awareness in influencing factors of HAI, hand hygiene opportunity, isolation measures, and medical waste classification 3 months after training was significantly lower than immediately after training(all P<0.001);the average scores of HAI prevention and control knowledge among HCWs immediately after and 3 months after training were both higher than before training(P<0.001);average score of HAI prevention and control knowledge among HCWs 3 months after training was lower than that of immediately after training(P<0.001).Conclusion The training at morning shift meeting of clinical departments can improve the awareness of HAI prevention and control knowledge among HCWs.

Objective To compare the dosimetric difference between RapidArc and fixed gantry angle dynamic IMRT (dIMRT) for central-type lung cancer radiotherapy. Methods Therapy for 10 patients previously treated with dIMRT was replanned with RapidArc. Dose prescription was 66 Gy/33 fraction. Comparative endpoints were planning target volume (PTV) dose, doses to surrounding structures,number of monitor units, and treatment delivery time. Results There was no significant dosimetric difference between RapidArc and dIMRT. Compared with dIMRT, RapidArc slightly elevated target volume dose, lung V5, V10. The average values of lung V20, V30 and heart V30 were larger in dIMRT than those in RapidArc. The number of monitor units was reduced by 32% and the treatment time by 66% in RapidArc.Conclusions Both RapidArc and dIMRT plans could meet the clinical therapy needs. RapidArc could achieve similar target coverage and sparing of organs at risk, with fewer monitor units and shorter delivery time than dIMRT.

Objective To analyze the difference in constituent and antimicrobial resistance of pathogens in commu-nity-associated urinary tract infection(CA-UTI)and healthcare-associated UTI(HA-UTI).Methods Clinical data and microbial detection of urine specimens of 960 patients with UTI in a hospital between January 2013 and June 2014 were investigated retrospectively,difference in constituent and antimicrobial resistance of pathogens were ana-lyzed.Results 403 cases were CA-UTI,and 557 were HA-UTI;pathogens in both CA-UTI and HA-UTI were gram-negative bacteria,accounting for 78.16% and 66.97% respectively.Constituent of pathogens in CA-UTI and HA-UTI were significantly different(χ2 =21 .68,P <0.001 ).Resistant rates of Escherichia coli to piperacillin /tazobactam,cefazolin,cefoperazone / sulbactam,aztreonam,meropenem,ertapenem,gentamicin,and compound sulfamethoxazole were all significantly different between CA-UTI and HA-UTI (all P <0.05);Except aztreonam, resistant rates of Escherichia coli in HA-UTI to the other antimicrobial agents were all higher than CA-UTI.Re-sistant rates of Enterococcus faecium in HA-UTI to penicillin,ampicillin,gentamicin,levofloxacin,ciprofloxacin, and moxifloxacin were all higher than CA-UTI(all P <0.05).Conclusion Constituent and antimicrobial resistance of pathogens in CA-UTI and HA-UTI are different,proper antimicrobial agents should be chosen according to con-stituent features of pathogens and change in antimicrobial resistance,so as to prevent and reduce the emergence of drug-resistant strains,and improve therapeutic effectiveness.