OBJECTIVE:To evaluate the application of cost-utility analysis in health area of China in recent year. METH-ODS:From CNKI,Wanfang and VIP database,settingcost utilityorcost-utilityastitleorkeyword,related literatures were retrieved during Jan. 2011-Dec. 2015,with subject field ofmedical science and technologyin CNKI,medical sciencein Wanfang database,clinical medicineChinese medicinepreclinical medicinepreventive medicine hygieneorpharmacyin VIP. The comprehensive evaluation involved research design,research perspective,cost measurement,utility index and measure-ment method,cost-utility analysis index,discount and sensitivity analysis. RESULTS:A total of 31 literatures meeting inclusion cri-teria were selected,including 12 prospective studies,9 retrospective studies,9 Markov model studies,1 mixed study. Thirteen lit-eratures worked in medical institutions. Seven literatures explicitly mentioned research perspective;most literatures only measured direct cost(19 literatures)and adopted QALY as utility index(27 literatures). Twenty eight literatures described measurement meth-od of utility index(direct measurement,indirect measurement or literature method)in detail. More than half(16 literatures)analyzed cost-utility by using cost-utility ratio(CUR);7 literatures adopted incremental cost-utility ratio(ICUR)and 6 literatures adopted both CUR and ICUR. Five literatures used the threshold of ICUR. Eleven literatures described discount,and the majority was Markov mod-el study. Sensitivity analysis was conducted in 16 literatures,among which 11 literatures adopted single factor analysis. The most com-monly involved influential factor was cost,followed by utility value and discount rate. CONCLUSIONS:Cost-utility analysis has been widely used in China,but the quality and normalization of studies have much room for improvement. Learning more experiences from international researches can help to promote the quality of domestic studies,guide the practice of clinical rational use of drugs and sup-port the government decision-making process and medical insurance payment in the future.

Objective To explore effective methods of nursing quality evaluation. Methods Guided by human-centered thinking,the new DRG quality indicators were formulated based on clinical investigation,literature review and expert consulta-tion. Then,the standards of the new indicators for radical masteetomy were identified by Delphi method and the reliability and validity were tested in 30 patients with radical mastectomy. Results The two new quality indicators were illness observation and health education. The Cronbach'α was 0.82 and 0.88 respectively. The results of expert consultation showed high content validity. Moreover,the new quality indicators got high commend by involved nurses. Conclusion The new quality indicators will lead nursing work to illness observation and health education,which will more benefit to reflect the true work of nurses and improve the internal quality of nursing.

Adult ; Aged ; Aged, 80 and over ; Buruli Ulcer ; pathology ; surgery ; DNA, Bacterial ; analysis ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Mycobacterium ulcerans ; genetics ; isolation & purification ; Tuberculosis, Cutaneous ; pathology

Objective To investigate the dosimetric difference of organ at risk (OAR) for planning and actual estimated during intensity-modulated radiotherapy (IMRT) for patients with nasopharyngeal carcinoma.Methods Thirteen patients were enrolled to accept full course of IMRT.CT scans were acquired in the 10th,20th,and 30th fractions during radiotherapy,respectively.OAR,including brain stem,spinal cord,parotid gland and submandibular gland,were delineated on repeated CT scans.The volume change of OAR were investigated.After that,the plans were copied to the new CT image to calculate the escalated average dose of OAR during radiotherapy (Actual estimated receiving dose minus planning dose).Results The change trend of volume was decreasing gradually for parotid gland and submandibular gland during the 10th,20th,and 30th times radiotherapy (all P =0.000).The maximum dose (Dmax) of brain stem and spinal cord and the 50％ volume receiving dose (D50) of parotid gland increased significantly in the 10th,20th,and 30th times during radiotherapy,respectively.The escalated average dose were 3.76 and 3.68 Gy for Dmax of brain stem and spinal cord (P =0.000,0.000),5.11 and 3.54 Gy for D50 of left and right parotid (P =0.001,0.023),and 0.49 and 0.75 Gy for D50 of left and right submandibular gland (P =0.220,0.230),respectively.Conclusions The volume of parotid gland and submandibular gland significantly decreased after radiotherapy The actual receiving dose of brain stem,spinal cord,and parotid gland increased significantly during radiotherapy.However,there was no significant change for the actual receiving dose of submandibular gland.

Objective To study three contouring approaches of the bowel and evaluate the bowel dose volume with cervical cancer patient.Methods Twelve patients were selected,prescribed dose 45 Gy/ 25f.For each patient we contoured the bowel according to three different definitions:bowel loops,bowel bag and peritoneal space.Then we generated three rival plans each considering a different bowel definition and to evaluate dose differences of the HI,CI of PTV and D D V5-V45 of bowel loops with paired t-test.Results Comparison between BL and BB plan,Dmax,HI and CI of PTV,V5-V45 of bowel loops were not significantly different (P =0.171,0.076,0.192,P =0.315-0.855),D of PTV and Dmax of bowel loops had difference (P=0.017,0.038).Comparison between BL and PS plan,Dmax,D HI and CI of PTV and Dmax of bowel loops had differences (P=0.033,0.044,0.046,0.041,0.013),V5-V45 of bowel loops were not significantly different (P=0.416-0.977).If the bowel loops V40 ≤ 15％,and bowel bag and peritoneal space V40≤20％.Conclusions All definitions provided a very similar dose volume of bowel loops.Taking into account HI and CI of PTV and max dose of bowel loops,BB seems better than PS.

Objective To investigate the difference in normal tissue complication probability (NTCP) of lower cranial nerves (LCNs) between target volumes recommended by Radiation Therapy Oncology Group (RTOG) and China in intensity-modulated radiotherapy (IMRT) for T1-2 nasopharyngeal carcinoma (NPC),and to provide the evidence of dose-volume effect for the protection of LCNs in IMRT for NPC.Methods A total of 20 patients with T1-2 NPC who were treated from 2013 to 2015 were enrolled,and LCNs were delineated on CT images.Target volume delineation and treatment plan designing were performed according to the method recommended by RTOG0225 (RTOG target volume delineation method) or the Chinese Working Committee for Clinical Staging of NPC in 2010 (Chinese target volume delineation method),and the differences in the dose to LCNs and NTCP were calculated.Results In the RTOG and Chinese methods for target volume delineation,Dmax to the left and right LCNs was 7 450±273 cGy/7294±309 cGy and 7 361± 160 cGy/7 190±395 cGy,respectively (P=0.018 and 0.042),Dmean was 6735±285 cGy/6 660±333 cGy and 6 446±429 cGy/6 299±467 cGy,respectively (both P=0.000),and the NTCP was 60％±10％/57％±13％ and 51％±15％/45％±17％,respectively (both P=0.000).Conclusions It is feasible to precisely delineate target volume with the LCNs as a routine OAR and predict NTCP in IMRT for T1-2 NPC.The NTCP of the LCNs is closely associated with target volume dose and irradiated volume.The dose to the LCNs and NTCP determined by the Chinese target volume delineation method are significantly lower than those determined by the RTOG method.

Objective To design nursing occupational safety and health curriculum reasonably.Methods With a semi-structured interview outline,focus group interviews among eight clinical nursing and nursing education specialists were conducted to develop the occupational safety and health curriculum design.Results It was important to set up nursing occupational safety and health curriculum.The main object,contents,teaching and evaluation methods were identified.Conclusions Occupational safety and health curriculum can be involved in nursing curriculum system to reduce occupational hazards and maintain physical and mental health of nursing students.

Objective To compare the agreement among Chinese 1992, 2008 and UICC 2010 staging systems of nasopharyngeal carcinoma (NPC) and evaluate their predictive value of radiotherapeutic prognosis.Methods 347 NPC patients without distant metastasis treated in our hospital from 2000 to 2005 were retrospectively analyzed.Every patient was categorized into T, N, and clinical stage by Chinese 1992, 2008 and UICC 2010 staging systems, respectively.Kappa value was used to evaluate the agreement among three systems.Kaplan-Meier method was used to analyze the 5-year overall survival (OS), local-free survival (LFS) and distant metastasis-free survival (DMFS), the difference between subgroup was tested by Logrank.Results The agreement of clinical stage, T and N stage between Chinese 2008 and UICC 2010 staging system was better than that of them compared to 1992 staging system, Kappa value were 0.700、0.881 and 0.722.The agreement of T stage was better than N and clinical stage among these three staging system.The difference of OS between stageⅢ and stage Ⅳ was significant in Chinese 2008 and UICC 2010 staging system (χ2=4.48,P=0.034;χ2=8.88,P=0.003), and with no different in 1992 staging system (χ2=0.40,P=0.526).There was no significant difference of LFS between T1 and T2,T2 and T3,T3 and T4 in all staging systems (χ2=1.85,0.53,0.50,P=0.174,0.467,0.479;χ2=1.25,2.10,1.99,P=0.264,0.148,0.159;χ2=0.77,0.60,0.87, P=0.381,0.441,0.350).There were no significant differencesin 1992 staging system, while there was significant differences of DMFS between N1 and N2, N2 and N3 in 2008 stage system, N1 and N2 in UICC 2010 stage system.Conclusions The predictive value of Chinese 2008 and UICC 2010 staging system for prognosis were similar, and were better than that of 1992 staging system in NPC.

Objective To investigate the relationship between genetic polymorphisms of ERCC1 and survival rate in advanced non-small cell lung cancer (NSCLC) patients treated with platinum based chemotherapy.Methods A total of 204 patients with advanced NSCLC were routinely treated by platinbased chemotherapy.The polymorphic genotypes were analyzed by MALDI-TOF-MS nethod using DNA samples isolated from peripheral blood before treatment.Besides,5 ％ samples werc extracted randomly for sequencing to test the accuracy of this method.To explored the association between SNP of ERCC1 (118) and prognosis to platinum-based chemotherapy in advanced NSCLC patients.Results Among 204 patients,61 achieved partial response,116 achieved stable response,and 27 achieved progressive disease.The overall response rate was 29.9 ％ (61/204).The effective rates of patients with the ERCC1 (118) C/C genotype,C/T + T/T genotype were 24.0 ％ (29/121) and 38.6 ％ (32/83),respectively,with significant difference (P ＜ 0.05).The response rate of ERCC1 (118) C/T allele carriers was 1.992-fold than that of C/C allele carriers (95 ％ confidence interval:1.083-3.650,P =0.025).MST,1-year survival and 2-year survival rates of patients with the ERCC1 (118) C/C genotype,C/T + T/T genotype were 9.0 months,34.7 ％ (42/121) and 4.1％ (5/121) vs 12.0 months,60.2 ％ (50/83) and 12.0 ％ (10/83),respectively,with significant difference (P ＜ 0.05).Conclusions Polymorphisms of ERCC1 might be associated with overall survival period in patients with advanced NSCLC after treatment with platin-based chemotherapy,which might be the predictive markers for overall survival.

Objective To compare the anesthetic effect of sufentanil combined with propofol and remifentanil combined with propofol in hysteroscopic surgery, and to provide a scientific basis for the selection of clinical anesthesia methods. Methods From November 2016 to March 2017, 94 patients in Lishui central hospital underwent hysteroscopic surgery were divided into the observation group and the control group according the anesthesia way, 47 cases in each group. The control group were given remifentanil(1 μg/kg) combined with propofol(2 mg/kg) by intravenous injection, the observation group were given sufentanil(0.2 μg/kg) combined with propofol(2 mg/kg). The mean arterial pressure(MAP), respiration (RR), pulse oxygen saturation (SpO2), heart rate (HR), the onset time of anesthesia, the postoperative recovery time, the recovery time of orientation and Ramsay sedation score in the two groups were recorded and compared before anesthesia, 2 min after anesthesia, 10 min after operation, 10min after operation finished. Results Compared with before anesthesia, MAP, RR, SpO2, HR index decreased significantly after anesthesia, the differences have statistical significance (P<0.05), the control group compared to the index value, the observation group and the control group of convergence and the decline of difference, group showed no statistically significant difference the observation group was more stable; comparison between the 10min group and MAP HR index after surgery, there was significant difference between two groups (P<0.05). The onset time of anesthesia, postoperative recovery time, orientation recovery time, Ramsay score difference between the groups was not statistically significant sedation score difference was statistically significant between group VAS, observation group than in the control group (P<0.05). Conclusion Sufentanil combined with propofol anesthesia were used in hysteroscopic surgery, which can better maintain the vital signs of patients, effectively reduce postoperative pain.