It is important and difficult to establish the market competition mechanism in the health care re-form. Medical voucher system in Hong Kong and Macao can provide policy guidelines for Mainland China to promote institutional innovation, force public hospital reform and the rational allocation of medical and health resources. This paper introduced the origin and development of medical voucher system. Based on the description of the implementa-tion background, similarities and differences and effects of medical voucher system in Hong Kong and Macao, the pa-per found that medical voucher system could help encourage the demander to make more frequent use of medical serv-ices, improve their consciousness of prevention and health care and promote family doctor system. Through analyzing the applicability of medical voucher system in mainland China, the paper pointed out it was consistent with the reform orientation and could be served as a useful supplement to the health care system to improve medical insurance, medi-cal assisstance system as well as an effective measure to develop private medical institutions.

Objective:To analyze and evaluate the usage and tendency of quinolones before and after the special rectification of antibacterial in one grade III level A hospital in üanjing to provide evidence for the special rectification of antibacterial and manage-ment. Methods:The usage records of quinolones in 2010( before the special rectification)and in 2011-2013( after the special rectifi-cation)were collected,and the sales revenue,DDDs,defined daily cost( DDC),drug resistance and adverse drug reactions( ADR) were analyzed retrospectively. Results:Both the amount and ratio of the sales revenue of quinolones were declined dramatically after the rectification(2011-2013). Among all kinds of quinolones,the sales revenue and DDDs of lomefloxacin aspartate injections was the highest before the rectification while moxifloxacin injections and levofloxacine hydrochloride injections ranked the first and the second respectively in sales revenue after the rectification(2012-2013). As for the DDDs,levofloxacin hydrochloride tablets and levofloxacine hydrochloride injections were the highest after the rectification. Besides,moxifloxacin injections had the highest DDC after the rectifica-tion. Moreover,the drug resistance of the main drug-resistant bacteria( namely staphylococcus,enterobacteriaceae and non fermenta-tion bacteria)to levofloxacin,norfloxacin and ciprofloxacin was declined after the rectification. The adverse drug reactions of levofloxa-cin,lomefloxacin,enoxacin and moxifloxacin were declined year by year after the rectification,and the ADR ratio of quinolones in all anti-bacterial agents was also declined. Conclusion:After the special rectification of antibacterials,the hospital exhibits obvious im-provement in all the application indices of antibacterials,reflecting a good result of the special rectification. However,the hospital still needs to strengthen the inspection over the clinical application of the fourth generation of quinolones.

Objective To analyze the clinical efficacy and toxic reaction of Tegafur,Gimeraciland Oteracil Potassium Capsule combined with Gemcitabine chemotherapy for patients with radical resection for advanced gallbladder carcinoma.Methods The clinical dataof 135 patients with advanced gallbladder cancer who were admitted to the 1 st Affiliated Hospital of Zhengzhou University and supported after the gastrectomy by the pathology from June 2007 to June 2012 were retrospectively analyzed.All patients were divided into three groups by different therapeutic regimens,operation groups (Radical resection or Extended radical resection of gallbladder carcinoma) with 47 cases,chemotherapy A group (Tegafur,Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine chemotherapy after Radical resection or Extended radical resection of gallbladder carcinoma) with 52 cases,and chemotherapy B group (5-Fluorouracil combined with Oxaliplatin chemotherapy after Radical resection or Extended radical resection of gallbladder carcinoma) with 36 cases.We collected the dates of all patients with the median survival time and the 1,3 and 5-year survival rate after operation,and counted the rate of major toxic reaction after chemotherapy.Results There were no significant differences in the general date of three groups (sex,age,tumor size,CA19-9,CA125,TNM stages,with or without cholecystolithiasis,operation methods,operation complication),The chemotherapy A group and chemotherapy B group had no differenceswiththe median survival time and 1,3 and 5-year survival rate after operation.There were significant differences in the median survival time and 3,5-year survival rate after operation between the operation group and chemotherapy A group (or between the operation group and chemotherapy B group).There were significant differences in the rate of whole toxic reaction and the rate of toxic reaction beyond Ⅲ degree between chemotherapy A group and chemotherapy B group.Conclusions The treatment of Tegafur,Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine chemotherapy for patients with radical resection of advanced gallbladder carcinoma has a lower rate of whole toxic reaction and rate of toxic reaction beyond Ⅲ degree than 5-Fluorouracil combined with Oxaliplatin chemotherapy,and for patients with advanced gallbladder carcinoma,the frontal treatment can obviously prolong the median survival time and effectively improve the 3 and 5-year survival rate after operation.

Objective To understand the epidemiological characteristics and related risk factors on HIV,HBV infection of people from the southwest province of China and to provide basic data for the development of related strategies.Methods According to the information on current HIV epidemics,one township from the area was selected as the study field and all the adult population were surveyed using a questionnaire to collect social demographic data and information on infection-related factors.Results A total of 2 290 adults were investigated and data showed as follows:the average HIV infection rate as 7.9％,the average HBV infection rate as 3.1％,and the average HIV/HBV co-infection rate as 1.2％.As for HIV infection,people whose yearly family gross income between 1 000 and 3 000 Yuan (OR=0.28) or more than 5 000 Yuan (OR=0.14) were less likely to be infected with HIV than those people whose annual family gross income less than 1 000 Yuan.People with educational level of primary school and above were more likely to carry HIV than those who were illiterate (OR =3.28).People who had the history of migration were less likely to carry HIV than those who had not (OR=0.33).People who had the history of being drug abusers were more likely to infect HIV than those who had not (OR=46.32).People whose spouses had the history of using drugs were more likely to infect HIV than those who had not (OR=3.52).People whose spouses had been infected with HIV were more likely to infect HIV than those who had not (OR=9.56).As for HBV infection,people who had the history of migration were more likely to infect HBV (OR =2.48).As for HIV/HBV co-infection,people whose spouses had the history of HIV infection were more likely to infect HIV/HBV co-infection than others who did not have the history (OR=6.04).Conclusion There had been a serious HIV/AIDS epidemic in our study field.Other than taking measures as detection and vaccination on HBV,health education should be strengthened,together with measurements as needle exchange and methadone substitution therapy,to control the spread of AIDS.

OBJECTIVE: To investigate the correlation of hemoglobin (Hb) level with prognosis of elderly patients diagnosed as sepsis. METHODS: A retrospective cohort study was conducted. Information on the cases of elderly patients with sepsis in the Medical Information Mart for Intensive Care-IV (MIMIC-IV), including basic information, blood pressure, routine blood test results [the Hb level of a patient was defined as his/her maximum Hb level from 6 hours before admission to intensive care unit (ICU) and 24 hours after admission to ICU], blood biochemical indexes, coagulation function, vital signs, severity score and outcome indicators were extracted. The curves of Hb level vs. 28-day mortality risk were developed by using the restricted cubic spline model based on the Cox regression analysis. The patients were divided into four groups (Hb < 100 g/L, 100 g/L ≤ Hb < 130 g/L, 130 g/L ≤ Hb < 150 g/L, Hb ≥ 150 g/L groups) based on these curves. The outcome indicators of patients in each group were analyzed, and the 28-day Kaplan-Meier survival curve was drawn. Logistic regression model and Cox regression model were used to analyze the relationship between Hb level and 28-day mortality risk in different groups. RESULTS: A total of 7 473 elderly patients with sepsis were included. There was a "U" curve relationship between Hb levels within 24 hours after ICU admission and the risk of 28-day mortality in patients with sepsis. The patients with 100 g/L ≤ Hb < 130 g/L had a lower risk of 28-day mortality. When Hb level was less than 100 g/L, the risk of death decreased gradually with the increase of Hb level. When Hb level was ≥ 130 g/L, the risk of death gradually increased with the increase of Hb level. Multivariate Logistic regression analysis revealed that the mortality risks of patients with Hb < 100 g/L [odds ratio (OR) = 1.44, 95% confidence interval (95%CI) was 1.23-1.70, P < 0.001] and Hb ≥ 150 g/L (OR = 1.77, 95%CI was 1.26-2.49, P = 0.001) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (OR = 1.21, 95%CI was 0.99-1.48, P = 0.057). The multivariate Cox regression analysis suggested that the mortality risks of patients with Hb < 100 g/L [hazard ratio (HR) = 1.27, 95%CI was 1.12-1.44, P < 0.001] and Hb ≥ 150 g/L (HR = 1.49, 95%CI was 1.16-1.93, P = 0.002) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (HR = 1.17, 95%CI was 0.99-1.37, P = 0.053). Kaplan-Meier survival curve showed that the 28-day survival rate of elderly septic patients in 100 g/L ≤ Hb < 130 g/L group was significantly higher than that in Hb < 100 g/L, 130 g/L ≤ Hb < 150 g/L and Hb ≥ 150 g/L groups (85.26% vs. 77.33%, 79.81%, 74.33%; Log-Rank test: χ² = 71.850, P < 0.001). CONCLUSIONS Elderly patients with sepsis exhibited low mortality risk if their 100 g/L ≤ Hb < 130 g/L within 24 hours after admission to ICU, and both higher and lower Hb levels led to increased mortality risks.
Humans ; Male ; Female ; Aged ; Retrospective Studies ; Sepsis/diagnosis* ; Critical Care ; Intensive Care Units ; Prognosis ; Hemoglobins ; ROC Curve