The paper presented a reform program jointly launched by China National Health Development Research Center(CNHDRC) and the UK National Institutes of Health and Care Excellence (NICE) for integrated care pathway and payment reform in China,and its theory basis and framework as well.Intervention measures of the program in Shanxi,Chongqing,Shandong and Henan proved the program theory design as reasonable and implementation outcomes as successful.These two measures,though proven,fall far short of a total solution to overcome roadblocks in the ongoing healthcare reform,and further reforms are expected in the future.

Objective To investigate the influence of the post stroke depression (PSD) on cognitive function in patients with stroke and their correlation, and to evaluate the diagnosis value of P300 cognitive function in patients with PSD. Methods One hundred and seventeen cases of inpatient with acute stroke in neurology medicine were continuously observed and scored using HAMD rating scale at the onset of 2 weeks. And 53 cases of PSD and 64 cases of non-post-stroke depression (NPSD) were scored using MMSE score and P300 determination respectively,and the results were compared. Results The incidence of PSD was 45.29%(53/117) at the 2 weeks after stroke,including 35 cases (29.91%) of mild depression,11 cases (9.40%) of medium degree depression and 7 cases (5.98%) of major depression. Compared with NPSD group, the P300 latency period of PSD group was significantly prolonged ( < 0.01), and the amplitude significantly reduced ( < 0.01) . The MMSE score difference was statistically significant ( <0.05) in the two groups. Conclusion The PSD is given priority to with mild-to-moderate depression, and the cognitive function damage in patients with PSD is more obvious than that in NPSD group. P300 determination can be used as the evaluation indicator of diagnosis cognitive function in patients with PSD.

Purpose To explore the value of high frequency convex ultrasound probe in the diagnosis of ovarian tumor in infants and young children. Materials and Methods Sixty-nine infants and young children with ovarian tumor were examined with high frequency convex ultrasound probe, and the ultrasound findings were analyzed. Results Out of 69 cases, 45 had tumors on the right side of ovary and the rest 24 on the left side;27 cases of simple cyst, 24 cases of benign teratoma, 9 cases of borderline teratoma, 3 cases of serous cystadenoma, 3 cases of mucous cystadenoma, 3 cases of yolk sac tumor;24 accompanied with torsion or necrosis. The ultrasound of ovarian tumor presented the following features:polycystic structures were common;the strong echo posterior acoustic shadow was not obvious; no specific manifestation was shown to distinguish benign from malignant tumors. Doppler ultrasound of tissues around the tumor was significant in detecting ovarian tumor torsion and necrosis. Conclusion High frequency convex ultrasound probe can provide clear images and distinct dissection information, which is beneficial in diagnosis and differential diagnosis of ovarian tumor in infants and young children.

Objective From the perspective of health economics, to evaluate 23 pneumococcal polysaccharide vaccination programme among chronic obstructive pulmonary disease (COPD) patient. Methods In the pilot counties of the project of integrated care pathway for COPD patient (Hanbin district of Hanzhong city in Shanxi Province, Qianjian district of Qingqing city, Huandao district of Qindao city in Shangdong Province, Wen county of Jiaozuo city in Henan Province), information of insurance participants of New Rural Cooperative Medical System (NRCS) was collected by local NRCM information system, which included general information as well as records of medical care and medical fee. Nonprobability sampling method was applied to select a total of 860 objects, who were over 60 years old with local household registration, hospitalized within one recent year due to COPD acute exacerbation, and without vaccination of 23 voluntary pneumococcal polysaccharide vaccine within 3 years. A quasi-experimental design without control group was adopted. Objects were vaccinated with 23-valent pneumococcal polysaccharide vaccine from January to December in 2013, then were followed up from January in 2014 for one year. Data of effectiveness and medical cost was collected by self-designed questionnaire and (Chinese version). Paired rank sum test applied to test the difference of quality of life, number and direct medical cost of treatment (including outpatient treatment and hospitalization) due to COPD acute exacerbation, one year before and after intervention. The incremental cost-effectiveness ratio (ICER) and cost-benefit ratio (CBR) of the programme were calculated. Results By January 2014, eight hundred sixty objects were vaccinated. By January 2015, seven hundred eighty eight objects were followed up, with 72 cases withdrawed (8.4%). On average, COPD patients reduced 1.12±2.51 treatments due to acute exacerbation, including 0.28±2.09 outpatient treatments and 0.85±1.15 hospitalizations. Total medical cost was saved by 3 610.21 per capita yuan, including outpatient cost of 241.41 yuan and hospitalization cost of 269.82 yuan; Quality of life was gained by 0.03 QALY gain per capita. The ICER was dominant and CBR was 12.00. Conclusion COPD patients vaccinated with 23-valent pneumococcal polysaccharide vaccine within one year reduced treatments due to acute exacerbation. The vaccination was cost effective and cost saving , and we suggest the vaccine should be covered in the public health program or health insurance scheme in conditional region.

Objective To investigate the image quality,radiation dose and contrast medium(CM)intake in coronary computed tomography angiography(CCTA)of overweight patients based on wide-detector using different tube voltages and CM of different concentrations.Methods A total of 150 overweight patients[body mass index(BMI)≥ 25 kg/m2]who underwent CCTA were divided into three groups according to scan protocols:group A(120 kVp,370 mg I/mL CM),group B(100 kVp,350 mg I/mL CM),and group C(80 kVp,320 mg I/mL CM),with each group had 50 patients.The mean CT value,mean signal-to-noise ratio(SNR),mean contrast-to-noise ratio(CNR),figure of merit(FOM)of all images were measured and calculated.Images were assessed using a 5-point scale by two radiologists.The volume CT dose index(CTDIvol)and dose length product(DLP)of each patient were recorded and the effective dose(ED)was calculated.The total iodine intake values of patients in three groups were calculated.The above data were statistically analyzed by one-way ANOVA.Results The mean CT value,mean SNR,mean CNR,and mean subjective score of groups B and C were significantly higher than those of group A(P＜0.001),but there was no significant difference between groups B and C(P＞0.05).The FOM value of groups B and C was significantly higher than that of group A(P＜0.001),and the FOM value of group B was significantly lower than that of group C(P＜0.001).The total iodine intake values of groups B and C was significantly lower than that of group A(P＜0.001).The ED and total iodine intake values in groups B and C were 30.34％,68.53％and 10.22％,16.85％lower than those in group A,respectively(P＜0.001).Conclusion Under the premise of ensuring image quality,the lower tube voltage and lower concentration of CM based on wide-detector allows for significant reduction in radiation dose and total iodine intake in CCTA for overweight patients compared to routine scan protocols.

Objective From the perspective of health economics, to evaluate 23 pneumococcal polysaccharide vaccination programme among chronic obstructive pulmonary disease (COPD) patient. Methods In the pilot counties of the project of integrated care pathway for COPD patient (Hanbin district of Hanzhong city in Shanxi Province, Qianjian district of Qingqing city, Huandao district of Qindao city in Shangdong Province, Wen county of Jiaozuo city in Henan Province), information of insurance participants of New Rural Cooperative Medical System (NRCS) was collected by local NRCM information system, which included general information as well as records of medical care and medical fee. Nonprobability sampling method was applied to select a total of 860 objects, who were over 60 years old with local household registration, hospitalized within one recent year due to COPD acute exacerbation, and without vaccination of 23 voluntary pneumococcal polysaccharide vaccine within 3 years. A quasi-experimental design without control group was adopted. Objects were vaccinated with 23-valent pneumococcal polysaccharide vaccine from January to December in 2013, then were followed up from January in 2014 for one year. Data of effectiveness and medical cost was collected by self-designed questionnaire and (Chinese version). Paired rank sum test applied to test the difference of quality of life, number and direct medical cost of treatment (including outpatient treatment and hospitalization) due to COPD acute exacerbation, one year before and after intervention. The incremental cost-effectiveness ratio (ICER) and cost-benefit ratio (CBR) of the programme were calculated. Results By January 2014, eight hundred sixty objects were vaccinated. By January 2015, seven hundred eighty eight objects were followed up, with 72 cases withdrawed (8.4%). On average, COPD patients reduced 1.12±2.51 treatments due to acute exacerbation, including 0.28±2.09 outpatient treatments and 0.85±1.15 hospitalizations. Total medical cost was saved by 3 610.21 per capita yuan, including outpatient cost of 241.41 yuan and hospitalization cost of 269.82 yuan; Quality of life was gained by 0.03 QALY gain per capita. The ICER was dominant and CBR was 12.00. Conclusion COPD patients vaccinated with 23-valent pneumococcal polysaccharide vaccine within one year reduced treatments due to acute exacerbation. The vaccination was cost effective and cost saving , and we suggest the vaccine should be covered in the public health program or health insurance scheme in conditional region.