By means of global budget,the disease-specific scoring method was put in place for both settlement and payment in Huaian,Jiangsu province,for the purpose of cost control by the hospitals.This reform consists of total cost accounting,rational performance-based distribution system,multi-approached regulation of medical behaviors,and individual disease management to regulate medical behavior.These efforts aim at aligning with medical insurance payment reform,so as to improve hospital management,operation quality and socio-economic outcomes.Problems found in practice were also reviewed.

OBJECTIVE To study the relation between the occurrence of nosocomial infection(NI) and white blood cell(WBC) count in malignant tumor patients after chemotherapy.METHODS The occurrence of NI and leukopenia and application of granulocyte colony stimulating factor(G-CSF) in patients after chemotherapy from Jan 2003 to Jun 2004 was investigated and analyzed retrospectively.RESULTS Among 2 040 patients,8.87% developed NI,and case rate was 11.67%;among patients with WBC count

Objective To discuss the clinical application of percutaneous transhepatic cholangiopancreatic drainage (PTCD) combined with CT-guided microwave ablation in treating hepatic hilar cholangiocarcinoma. Methods The clinical data of 29 patients with inoperable Ⅲ and Ⅳ type hilar cholangiocarcinoma complicated by obstructive jaundice, who were admitted to authors’ hospital during the period from December 2012 to August 2014, were retrospectively analyzed. The diagnosis of bile duct adenocarcinoma was confirmed by pathology in all patients. Of the 29 patients, both internal and external biliary tract drainage was employed in 19, external biliary tract drainage in 4, and bilateral (both left and right side) bile duct drainage in 6. CT-guided microwave ablation was carried out when the liver function became improved. A total of 46 procedures of microwave ablation were completed in the 29 patients with a mean of 1.5 times per patient. Hepatic function tests, enhanced CT or MR scan were performed 4-8 weeks after treatment. According to mRECIST criteria the therapeutic results were evaluated; the serum bilirubin levels were recorded; the disease progress and the patient’s survival time were followed up. Results One month after the treatment, complete response (CR) was obtained in 15 patients (15/29, 51.7%), and partial remission (PR) in 17 patients (17/29, 58.6%), with the overall efficacy (CR﹢PR) being 82%. After the treatment, one patient developed hepatic metastasis and another one had pulmonary metastasis. Postoperative serum bilirubin levels showed an obvious decrease in all 29 patients. The 6-month, one-year and two-year survival rates were 68.9% (20/29), 31.0% (9/29) and 6.8% (2/29) respectively; the median survival time was 8.9 months and the overall survival time was 11.7 months. Conclusion For the treatment of hepatic hilar cholangiocarcinoma, PTCD combined with CT-guided microwave ablation is minimally invasive, clinically safe and effective.

ObjectiveTo study the advanced training status for emergency department nurses in Chongqing,and to improve the training program.MethodsThe basic and professional information of 208 emergency department nurses who obtained advanced training for emergency nursing in the previous 5 years was analyzed and the self-designed Satisfaction Survey on Teaching and Self-evaluation on Training Outcome were applied to learn about the feedback of trainees.ResultsThe average age of trainees was ( 29.24 ± 5.44 ),among whom 65.86％ with junior college education experience,49.51％ with 2-5 years of working experience,50.48％ at primary professional rank,61.53％ from second level hospitals.Their average score ( 77.91 ± 7.69 ),and teaching satisfaction score was ( 87.01 ± 7.63 ).The survey indicated that self-evaluation on training outcome was significant to enhance emergency nursing knowledge and skills,while weak to improve research and managing capability.ConclusionNurses attending advanced training for emergency nursing are characterized with short working time,low professional ranks,jagged education experiences and various levels of hospital. It is suggested to adopt leveled training in accordance with education experience and working hospital of trainees,and to strengthen nursing research and team managing competencies.

Background and purpose:Since the number and tumor size of localized liver metastases can be controlled, local minimally invasive treatment can improve the survival of patients. Hence, microwave ablation has become an important treatment method for liver metastases. This study was to investigate the value of percutaneous microwave ablation in the treatment of tumor metastases. Methods: From Sep. 2011 to Oct. 2014, 26 advanced nasopharyngeal carcinoma patients with post-chemotherapy consolidation, liver metastases were collected. All the patients with the number of tumor lesions less than 3, diameter less than 5 cm, no other distant metastases was excluded. The ultrasound-guided percutaneous microwave ablation was used for 26 patients. Finally, 43 ablations were completed followed by liver function test, enhanced CT and MRI diagnosis 1 month later. mRECIST criteria was used to evaluate the effcacy of cancer treatment. Progression-free survival (PFS) and overall survival (OS) were calculated. Results:Twenty-six cases of a total of 53 lesions, including complete ablation (CA) 20 patients (20/26, 77.0%), partial ablation (PA) 3 patients (3/26,11.5%). The overall effciency was 88.5%(CA+PA) with no serious complications. 6 months, 1-, 2-year survival rates of 26 patients were 96.1%, 65.3%and 23.0%. PFS was 11.4 months. The median survival time (MST) was 11.9 months, while OS was 23.7 months. Conclusion:Percutaneous microwave ablation for limited liver metastases of nasopharyngeal carcinoma is a minimally invasive, safe and effective treatment method.

Objective To discuss the clinical application of preoperative tumor-feeding artery emboli -zation in treating hypervascular giant meningiomas.Methods A total of 71 patients with giant meningioma (maximum diameter ＞5 cm),who were admitted to authors' hospital during the period from April 2013 to August 2014,were selected for this study.Preoperative MRI demonstrated that the lesions showed obvious enhancement with rich blood supply.The patients were divided into the study group (using preoperative embolization,n =38) and the control group (not using preoperative embolization,n =33).Based on preoperative DSA findings,the lesions were classified into type Ⅰ and type Ⅱ.Tumor-feeding artery embolization with PAV particles (200-300 μm) was employed in the patients of the study group,while only cerebral angiography was adopted in the patients of the control group.The amount of intraoperative blood loss,tumor resection time and embolization complications in both groups were recorded.Postoperative MRI scan was performed to observe the degree of tumor resection.Results The amount of intraoperative blood loss and the tumor resection time in the study group were (562±178) ml and (5.45±2.13) h respectively,which in the control group were (833±234) ml and (7.23±2.45) h respectively;the differences between the two groups were statistically significant (both P＜0.05).The tumor resection degree of Simpson classification Ⅲ and ＜ Ⅲ was obtained in 27 patients of the study group (27/38,71.0％) and in 19 patients of the control group (19/33,57.6％),the difference between the two groups was statistically significant (P＜0.05).After embolization,cerebral edema became aggravated in 7 patients,ischemic necrosis of the scalp was observed in 2 patients,and one patient developed epileptic seizure during the operation.After symptomatic treatment,all the above complications were relieved.Conclusion For the treatment of hypervascular giant meningiomas,preoperative tumor-feeding artery embolization can strikingly reduce the amount of intraoperative blood loss,shorten the operation time,and improve the tumor resection degree,therefore,this therapy is worthy of clinical promotion and application.

Objective To investigate the effect of atorvastatin on blood lipid and carotid atherosclerosis in patients with hyperlipidemia and cerebral infarction.Methods 98 patients with hyperlipidemia and cerebral in-farction in our hospital from September 2014 to February 2017 were selected and divided into observation group(49 cases)and control group(49 cases)according to the random number table method.The control group was treated with conventional treatment,the observation group was treated with atorvastatin on the ba-sis of the control group.The two groups were treated for 4 weeks.The ADL score,NIHSS score,blood lipid index,carotid IM T and carotid plaque area were compared between the two groups before and after treatment. Results ADL score of the patients in the observation group after treatment higher was than the control group (t=12.7783,P<0.05),NIHSS score was lower than the control group(t=10.941,P<0.05);LDL-C,TC and TG levels after treatment in the observation group were than in the control group(t= 17.239,9.216, 9.800,P<0.05),while the HDL-C level was higher than the control group(t=7.683.P<0.05);the patients in the observation group were treated by carotid artery IM T and carotid plaque area was higher than that of the control group(t=8.919,6.344,P<0.05).Conclusion Atorvastatin can improve hyperlipidemia in pa-tients with cerebral infarction and carotid atherosclerosis,dyslipidemia,has the important research signifi-cance.

Objective:To analyze and compare the demographic and clinical characteristics of patients with different types of hyperglycemic crisis, so as to provide clinical basis for the prevention and treatment of hyperglycemic crisis.Methods:The data of patients with hyperglycemic crisis in six First-level general hospitals in Chongqing from Jan. 2015 to Dec. 2020 were retrospectively collected and divided into diabetic ketoacidosis (DKA) , hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis with hyperglycemic hyperosmotic state (DKA-HHS) . The demographic and clinical characteristics of each group were analyzed by descriptive method.Results:A total of 1668 patients were collected, among whom1388 were DKA, 113 were HHS and 167 were DKA-HHS. The proportion of T2DM in DKA was 90.1%, the proportion of urban residents’ medical insurance, farmers and retirees was higher in the three groups, and the incidence of hyperglycemic crisis in patients above 60 years old was the highest in all age groups. The incidence of DKA and HHS changed little during the six years, but increased significantly in the DKA-HHS group. Shock, disturbance of consciousness, hospitalization expenses and mortality in the DKA-HHS group were higher than those in the other two groups.Conclusions:There are differences in demographic and clinical characteristics among different types of hyperglycemic crisis. Clinically, more attention should be paid to patients above 60 years old and patients with hyperglycemic crisis such as DKA-HHS. Health education and guidance for diabetic patients in high-risk groups should be strengthened in order to reduce the occurrence of diabetic hyperglycemic crisis.

Platinum-based nanoplatforms can enhance the absorption of X-ray due to the presence of high atomic number element of platinum and are applied to computed tomography imaging.Meanwhile,platinum-based nanomaterials have good near-infrared light absorption properties and photothermal conversion efficiency,which make them capable of photothermal imaging and photoacoustic imaging.In addition,by reducing transverse and longitudinal relaxation time,platinum-based nanoplatforms can mediate MRI imaging.In this paper,we report a multimodal imaging system based on platinum-based nanoplatforms for guiding the development of cancer treatment and diagnosis platform and medical application research,and also summarize the prospects of multimodal imaging technology in cancer diagnosis and treatment,report the research progress of platinum-based nanoplatforms in improving the contrast of medical images and enhancing cancer treatment.

Objective To investigate the prevalence rate of healthcare-associated infection(HAI)in Xiangya Hospital,and provide reference for preventing and controlling HAI.Methods The cross sectional surveys on preva-lence rates of HAI,cross-sectional antimicrobial use,and bacterial detection among all hospitalized patients on the given days in 2000-2014 (except 2006)were carried out by combination of bedside investigation and medical record reviewing.Results The prevalence rates of HAI in 2000-2014 decreased from 6.30% to 3.91%,difference was statistically significant (χ2 = 35.14,P < 0.001 );prevalence rates of community-associated infection(CAI)were 15.61%-15.76%,there was no significant difference among each year.General intensive care unit (ICU)had the highest prevalence rate;respiratory tract was the most common site of both HAI and CAI;urinary catheterization rate showed a decreased tendency,arteriovenous catheterization rate showed a increased tendency,difference were both significant(χ2 = 5.21,96.24,respectively,both P <0.001).In 2008 - 2014,pathogenic detection rates for specimens from patients receiving therapeutic antimicrobial agents were 36.37%-44.51%,from patients with HAI were 34.00%-44.99%,detection rate of pathogens causing HAI were 41.57%-68.48%,all showed a increased tendency,difference was significant (χ2 = 22.78,10.03,26.49,respectively,all P < 0.001 ).Gram-negative bacteria were the main pathogens causing infection;both cross sectional and combination antimicrobial usage rates declined (P < 0.05 ).Conclusion Prevention and control of HAI,and antimicrobial management has achieved preliminary success,prevalence rate of HAI and cross sectional antimicrobial usage rate declined obviously,the main pathogen is gram-negative bacteria,and the major infection site is lower respiratory tract.