Objective To evaluate the pelvic floor function in post-hysterectomy patients. Methods Transperineal pelvic ultrasound was used to observe the pelvic organs in post- hysterectomy patients, and parameters of pelvic floor were measured. Taking the inferior margin of public symphysis as the reference plane,the shape and motion of the proximal urethra and bladder neck were observed at rest and on maximum Valsalva maneuver. Bladder neck-symphyseal distance(BSD) and retrovesical angle were measured. And the bladder neck descent(BND),urethral rotation angle and the rotation angle of the bladder neck were also calculated. Interclass correlation coefficients were calculated to evaluate the consistency of data. Results At rest,the BSD and retrovesical angle were (-2.73±0.37)cm and (119.00±22.40)°, while on maximum Valsalva maneuver was (-0.25±0.67)cm and (114.74±21.50)°,respectively. BND was (2.46±0.59)cm,the urethral rotation angle and the rotation angle of the bladder neck was (70.68±19.91)° and (60.81±17.34) °,respectively. Combined with pelvic ultrasound and clinical manifestations,29 cases of pelvic floor dysfunction after hysterectomy were diagnosed (58.00%, 5 cases of stress urinary incontinence, 8 cases of proctoptoma and 16 cases of bladder prolapse). The consistency was very high in measuring BNS, retrovesical angle at rest and on maximum Valsalva maneuver and BND by different observers. The interclass coefficient was 0.90,0.89,0.91,0.88,0.92,respectively. And the interclass coefficient of urethral rotation angle and the rotation angle of the bladder neck was 0.79, 0.88,respectively. These results showed a good interobserver agreement. Conclusion Transperineal pelvic ultrasound is a simple,reproducible and noninvasive imaging method, which can reveal the position and function of female pelvic organ dynamically and evaluate postoperative pelvic floor function.

Objective To evaluate the effects of modified method of fixation and withdrawal of needles in intravenous infusion.Methods The modified method of two-step fixation and withdrawal of needles was adopted in emergency transfusion room of our hospital from September 2013.In January 2015,during every day's low peak period 12:00-14:00,246 emergency transfusion patients were chosen and divided into the traditional group (122 cases,using three-step fixation and withdrawal of needles) and the modified group (124 cases,using two-step fixation and withdrawal of needles) according to transfusion order.The pain degree caused by withdrawal of needles using Numeric Rating Scale (NRS),time consumption of fixation and withdrawal of needles and rate of adhesive pastes abscission was assessed by nurses and compared between two groups.Results The incidence of pain in the modified group was lower than that of the traditional group [48.39％ (60/124) vs.81.97％ (100/122)],x2=30.49,P＜0.05.The time consumption of fixation and withdrawal of needles in the modified group was shorter than that of the control group [(7.55 ±2.01) seconds vs.(10.88 ±2.72) seconds;(2.44 ±0.84) seconds vs.(11.55 ± 4.62) seconds],Z=8.70,13.55,P＜0.05.Therate of adhesive pastes abscission in the modified group was lower than that of the control group [4.0％(5/124) vs.18.9％ (23/122)],x2 =13.39,P＜0.05.All the difference between two groups was statistically significant.Conclusions The modified method of fixation and withdrawal of needles can relieve the pain caused by withdrawal of needles.Nurses can operate easily,adhesive pastes is fixed sturdily,which is popular among nurses and patients.

Objective:To comprehend the main characteristics and historical evolution of health finan-cing transition in China.Methods:Data were collected from various sources,including the Global Health Expenditure Database(GHED),China Health Statistics Yearbook,National Health Finance Annual Report,China's Total Health Expenditure Research Report,et al.Descriptive statistics and liter-ature study was conducted.Results:Since the beginning of the 21st century,most countries in the world had witnessed a transition of health financing,characterized by the expansion of health financing scale and the strengthening of public financing responsibility.Notably,China's health financing transition exhibited distinctive features.Firstly,there had been a more rapid expansion in health financing scale compared with global averages.Between 2000 and 2019,total health expenditure per capita experienced a remarkable increase of 816.6％at comparable prices,significantly surpassing average growth rates observed among other countries worldwide(102.1％).Secondly,greater efforts had been made to strengthen the responsibilities of public financing.From 2000 to 2019,there was a substantial decrease of 30.6 percentage points in the proportion of out-of-pocket health expenditure as a share of total health expenditure.This decline was significantly larger than the average reduction observed among other coun-tries worldwide(5.6 percentage points).Thirdly,there had been a significant shift in government health expenditure allocation patterns,with an increased emphasis on"demand-side subsidies"surpassing"supply-side subsidies".Within the realm of"supply-side subsidies",funding directed towards hospitals had notably increased and surpassed that allocated to primary healthcare institutions and public health institutions.Based on these distinctive characteristics,this paper expanded China's health financing tran-sition into three dimensions:Scale dimension,structure dimension and flow dimension.Using a compre-hensive analytical framework,the history of China's health financing transition was roughly divided into four stages:The planned economy stage,the economic transition stage,the post-SARS stage and the new health system reform stage.The main features and evolutionary logic associated with each stage were ana-lyzed.Conclusion:Above all,the health financing system should be enhanced in terms of vertical"em-beddedness"and horizontal"complementarity".Moreover,the significance of health financing transition in preserving hidden value and mitigating public risk should be emphasized,and there is a need for an improved two-way trade-off mechanism that balances value and risk.Additionally,the ethical principles associated with health financing transition should be considered comprehensively,while optimizing budget decision-making within the government's actual governance model.Lastly,it is crucial to recognize the overall and profound impact of modern medicine development and explore long-term strategies and path-ways for health financing transition in China.

Objective:To evaluate the effect of the comprehensive reforms of clinic-pharmacy separation and medical-consumables expenditure linkage in Beijing.Methods:Monitoring data of the comprehensive reforms were collected from 363 public medical institutions in Beijing between January 2016 and December 2019, while descriptive analysis and interrupted times series analysis using segmented regression models were adopted to analyze the influence of the two reforms on medical expense and its structure. We also studied the impact mechanism of service utilization and service price factors on medical expense control.Results:During the period from 2016 to 2019, the medical expenditure of public medical institutions in Beijing increased steadily at an annual growth rate of 4.4%-7.2%. The proportion of drug expense decreased from 44.6% in 2016 to 34.6% in 2019, while the proportion of medical service expense rose from 15.6% in 2016 to 24.3% in 2019, the proportion of examination and laboratory test expenses respectively showed a significant decline in April 2017 and June 2019. These two months witnessed respectively the launch of the two comprehensive reforms. Service utilization played an important role in controlling outpatient and emergency expenses, and service price was the key factor for controlling inpatient expenditure.Conclusions:The implementation of the two reforms in Beijing has effectively curbed the unreasonable growth of medical expenditure, and the expense structure has been constantly optimized and labor value of medical staff gradually improved.

Objective:To understand the loss to follow-up of children born to pregnant women with HIV infection (HIV-exposed children) and analyze its influencing factors in China in 2019.Methods:The data were collected from the follow-up records of pregnant women with HIV infection and their children reported by the national "Management Information System for the Prevention of HIV, syphilis and Hepatitis B Mother-to-Child Transmission" in 2019. HIV-exposed children were defined as those who were not followed up after birth or who were not followed up at 18 months of age and who were not followed up at 21 months of age. The univariate and multivariate influencing factors of loss to follow-up of children born to HIV-infected pregnant women were analyzed by χ2 test and logistic regression model. SPSS 25.0 software was used for statistical analysis. Results:The number of HIV-infected pregnant women was 5 039, the number of live-born children was 5 035, the number of loss to follow-up children within 18 months of age was 283, and the loss to follow-up rate children was 5.62%(283/5 035). The results of multivariate logistic regression analysis showed that the rate of loss to follow-up of exposed children born to pregnant women who worked as farmers (animal husbandry and fishery) (a OR=0.34, 95% CI: 0.22-0.53), unmarried (a OR=0.47, 95% CI: 0.24-0.93), first marriage (a OR=0.38, 95% CI: 0.22-0.67), remarriage (a OR=0.36, 95% CI: 0.20-0.67) and cohabiting (a OR=0.47, 95% CI: 0.23-0.97), and knew they had HIV infection before this pregnancy (a OR=0.53, 95% CI: 0.40-0.70) was lower. Han nationality (a OR=1.52, 95% CI: 1.09-2.13), primary school (a OR=2.06, 95% CI: 1.10-3.89) and junior middle school (a OR=1.81, 95% CI: 1.03-3.17) educational level, non-use of antiviral drugs (a OR=6.21, 95% CI: 4.32-8.93) and delivery in township (street) level midwifery institutions (a OR=5.72, 95% CI: 1.61-20.27) had higher rates of loss to follow-up among infants born to HIV-infected pregnant women. Conclusions:HIV-exposed children still have a specific rate of loss to follow-up in China in 2019. In order to further reduce the rate of loss to follow-up, it is of great significance to improve the detection rate of HIV before pregnancy and the rate of antiviral drugs used in pregnant women with HIV infection, which is of great significance for the effective implementation of comprehensive intervention measures of prevention of mother-to-child transmission of HIV.