Objective To investigate the impacts on inpatient costs of a hospital in Beijing as incurred by the reform of clinic-pharmacy-separation by means of DRGs. Methods As required by BJ-DRGs, we selected DRGs grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Beijing from January to March in 2017 ( pre-reform group ) and that from May to July in 2017 ( the post-reform group ) . Then we compared the differences of inpatient costs before and after the reform, and the inpatient cost changes of the DRGs groups. Results The median of inpatient costs before the reform was 8751. 21 yuan, and that after the reform was 8522. 07 yuan, a difference without statistical significance (P>0. 05). Of the 104 DRGs studied, cost changes were found in 28 DRGs (P<0. 05), with increases in 19 DRGs and drops in 9 DRGs groups. Conclusions The reform, though without impact on the inpatient costs, changed the makeup of costs on the other hand, especially on HJ13 and BB25 DRGs groups, worthy of attention. A dynamic tuning mechanism is thus suggested for pricing of medical services, and a fine management suggested for the hospitals to curb unreasonable growth of costs.

Objective:To analyze the cost difference between bilateral surgery and unilateral surgery in the same diagnosis-related group(DRG), and to explore the necessity of coefficient adjustment in DRG payment for bilateral surgery.Methods:The medical record frontpage information of all discharged patients who were divided into FJ25(complicated operation of venous system, without complications and accompanying diseases)by DRG in a tertiary hospital from 2017 to 2019 was selected, and the cost difference between unilateral operation and bilateral operation was compared.Results:A total of 359 patients were included, including 230 patients(64.07%) in unilateral operation group and 129 patients(35.93%) in bilateral operation group. There was no significant difference in gender, age and length of hospital stay between unilateral operation group and bilateral operation group( P>0.05). The hospitalization expenses of the bilateral operation group were higher than those of the unilateral operation group( P<0.05), and the differences mainly came from the expenses of consumables, operation, anesthesia and drugs. There was no significant difference in the expenses of diagnosis and treatment, and the cost of inspection between the two groups( P>0.05). The individual burden of patients with medical insurance in bilateral operation group was higher than that in unilateral operation group. Conclusions:In the same DRG group, the adjustment coefficient can be used to adjust the medical insurance payment for bilateral surgery, so as to avoid the occurrence of clinical decomposition hospitalization behavior.

Objective:To retrieve, evaluate, integrate the evidence of Traditional Chinese Medicine (TCM) nursing appropriate technology for chemotherapy-induced nausea and vomiting at home and abroad, and summarized the relevant best evidence to provide evidence-based basis practice for the clinical standard management of chemotherapy-induced nausea and vomiting and improved the treatment efficiency of patients' symptoms.Methods:The study evidence on TCM nursing appropriate technology for chemotherapy-induced nausea and vomiting systemically retrieved in the websites and databases,included13 guidelines and evidence summary websites, namely National Guideline Clearinghouse, New Zealand Guidelines Group, Medlive, etc; 6 Oncology Professional Association Websites, namely British Columbia Cancer Agency, Cancer Care Ontario, National Comprehensive Cancer Network, Oncology Nursing Society, European Society for Medical Oncology, American Society of Clinical Oncology;11 electronic databases, namely CNKI, VIP, WanFang, CBM, PubMed, Web of Science, Embase, etc; supplementary searched expert consensus and practice guidelines for cancer diagnosis and treatment including evidence-based decision-making, guidelines, evidence summaries, best/recommended practices, systematic reviews, expert consensus, and government documents. The literature retrieval period was from the database construction to January, 2023. The guidelines individually evaluated by 3 researchers, and the remaining literature independently evaluated by 2 researchers. The literature that met the criteria extracted and graded. Finally, the expert group integrated the evidence and summarized the evidence topics.Results:A total of 12 articles were involved, included 2guidelines,2 evidence summaries,3 expert consensuses, and 5 systematic reviews. Finally,4 evidence topics and 20 pieces of best evidence were formed, included applicable population, efficacy, safety and intervention measure .Conclusions:The best evidence of TCM nursing appropriate technology treatment of chemotherapy-induced nausea and vomiting provided evidence resources for clinical transformation, for traditional Chinese medicine and integrated Chinese and western medicine nursing group to provide clinical decision-making basis, and according to the principle of syndrome differentiation to form personalized practice scheme, effectively improved patients' symptoms, promote the recovery of patients.

Objective    To study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time. Methods    From March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery. Results    There was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single- vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention. Conclusion    The learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.

Objective: Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA. Methods: Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA < 200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 (n = 153) or 96 weeks (n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281. Results: At the end of 48 and 96 weeks' treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks' treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg < 1 500 IU/mL and week 24 HBsAg < 200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss. Conclusion Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.