Thailand established the first medical care scheme in 1975 until set up 30 Baht Scheme in 2001,which achieved the universal coverage through 26 years,which China could learn some experiences from Thailand's universal coverage.Firstly,it needed to split health services purchaser from health services provider.Secondly,changing the fee for service to multi-way for payment mechanism.Thirdly,establishing the system of gatekeeper.Lastly,encouraging independent research institutions to provide technical support to health insurance system.

OBJECTIVE:To investigate the clinical efficacy and safety of amoxicillin sodium and clavulanate potassium com-bined with cranial mild-moderate hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) complicating with pulmonary infection. METHODS:80 children with HIE complicating with pulmonary infection were randomly divided into ob-servation group(42 cases)and control group(38 cases). Control group received routine treatment under normal body temperature as lowering intracranial pressure,correcting acid-base balance,giving nutritional support and anticonvulsive treatment,and then was given amoxicillin sodium and clavulanate potassium 30 mg/kg intravenously,tid,more than 30 min each time,for consecutive 3 d. On the basis of control group,observation group was additionally given cranial mild-moderate hypothermia therapy:wearing cooling cap,at 10 ℃;keeping pharynx nasalis temperature at 34 ℃;keeping rectal temperature at 33-37 ℃;decreasing at rate of 1 ℃/h. They continued treatment for 3 d till body temperature decreased to 34.5 ℃;and then cooling cap was taken off to recover normal body temperature. Therapeutic efficacy of HIE and pulmonary infection were observed in 2 groups. NBNA score of 2 groups were recorded 1st,2nd and 4th week after birth,and the occurrence of ADR was observed. RESULTS:Total effective rate of HIE therapy (95.24% vs. 78.95%),cure rate of pulmonary infection (52.38% vs. 26.32%) and total effective rate (85.71% vs. 65.79%) in observation group were significantly higher than control group,with statistical significance (P<0.05). There was no statistical significance in NBNA score between 2 groups 1st week after birth(P>0.05). Compared to 1st week after birth,NBNA score were significantly improved 2nd and 4th week after birth,and the observation group were significantly higher than the control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Amoxicillin sodium and clavulanate potassium combined with cranial mild-moderate hypothermia is effec-tive for HIE complicating with pulmonary infection,and can effectively improve the prognosis of children with good safety.

Objective To explore the clinical effect of dopamine,phentolamine,recombinant interferon α combined with nasal continuous positive airway pressure(CPAP) ventilation in treating severe infantile bronchiolitis.Methods Ninety-five cases of infantile severe bronchiolitis were divided into the observation group(55 cases) and control group (40 cases).The control group was given the combined treatment scheme of dopamine,phentolamine and recombinant interferon α,while on this basis the observation group was added with NCPAP.The curative effects were compared between the two groups.Results The total effective rate in the observation group was significantly higher than that in the control group(P<0.05);the temperature recovery time,wheezing disappearance time,cough stopping time,lung wheezing sound disappearance time and hospitalization time in the observation group were significantly lower than those in the control group(P<0.05);the breathing rate,heart rate and PaCO2 level after treatment in the two groups were significantly lower than those before treatment,the levels of PaO2,PaO2/FiO2 and pH were significantly higher than those before treatment in the same group,the differences were statistically significant(P<0.05);the breathing rate,heart rate and PaCO2 level after treatment in the observation group were significantly lower than those in the control group(P<0.05);the levels of PaO2,PaO2/FiO2 and PH after treatment in the observation group were significantly higher than those in the control group(P<0.05);the levels of IL-8,sVCAM-1and LTE4 after treatment in the two groups were significantly lower than those before treatment(P<0.05);there was no statistically significant difference in the levels of serum IL-8,sVCAM-1 and urine LTE4 between the two groups(P>0.05);the recurrence rate and death rate in the observation group were significantly lower than those in the control group with statistical difference(P<0.05);the occurrence rate of adverse situation during treatment period had no statistical difference between the two groups(P>0.05).Conclusion Dopamine,phentolamine,recombinant interferon α combined with NCPAP has obviously clinical effect for treating infantile severe bronchiolitis,can effectively improve the blood gas analytical indexes,reduces the signs and symptoms relief time,reduces the rates of relapse and death,and has higher clinical application value.

Objective To investigate the therapeutic effect of Radish Seed Chengqi Decoction combined with glutamine for treatment of patients with sepsis complicated with paralytic ileus. Methods Sixty patients with septic ileus admitted to the Department of Emergency Intensive Care Unit (EICU) of Tianjin Medical University General Hospital from August 2017 to January 2019 were enrolled. The Western medicine treatment group (30 cases) received routine Western medical methods including intravenous drip of glutamine, etc. for symptomatic treatment, and the Radish Seed Chengqi Decoction group (30 cases), based on the treatment in the Western medicine group, were additionally given the decoction by nasal feeding and retention enema twice a day, once 100 mL with the course of 7 days in both groups. The herbal prescription of Radish Seed Chengqi Decoction contained rhubarb 24 g (decocted later), sodium sulfate 15 g (mixed with water to take), magnoliae cortex 15 g, orange frui 10 g, aucklandiae 10 g, henan achyranthes root 10 g and radish seed 15 g, constituting one dose, two doses one day given to a patient, making one dose of herbal medicine to 200 mL of decoction for nasal feeding and retention enema, once 100 mL respectively, twice a day for 7 days. After treatment, the changes of survival rate in ICU, the total effective rate and the level of procalcitonin (PCT) were observed in both groups. Results After treatment, the total effective rate in Radish Seed Chengqi Decoction group was significantly higher than that in the Western medicine treatment group [83.33% (25/30) vs. 66.67% (20/30), P < 0.05], and the ICU 7-day survival rate in Radish Seed Chengqi Decoction group was also significantly higher than that in Western medicine treatment group [90.00% (27/30) vs. 76.67% (23/30), P < 0.05]. After treatment, the levels of PCT (μg/L) in both groups were significantly decreased compared with those before the treatment (Western medicine treatment group: 3.38±1.72 vs. 6.43±3.29, and Radish Seed Chengqi Decoction group: 2.39±1.24 vs. 6.78±2.31, both P < 0.05), and the degree of decrease of PCT in radish seed chengqi decoction group was more obvious than that in Western medicine treatment group (μg/L: 2.39±1.24 vs. 3.38±1.72, P < 0.05). Conclusion Applying alanyl glutamine combined with Radish Seed Chengqi Decoction for treatment of patients with sepsis complicated with paralytic ileus can significantly improve the clinical symptoms, reduce the PCT level and elevate the survival rate of patients.

Objective? To explore the factors that affect the cognitive rehabilitation of aphasia after cerebral infarction, so as to provide reference for early diagnosis and rehabilitation. Methods? A total of 123 patients with post-infarct aphasia who were hospitalized in the Second Affiliated Hospital of Xi'an Jiaotong University from September 2016 to September 2017 were selected as the study subjects. Patients' cognitive status was assessed based on the increase in scores of the National Institute of Health Stroke Scale (NIHSS), Mini-Mental State Examination(MMSE),Aphasia Battery of Chinese(ABC), Non-Language-Based Congnitive Assessment (NLCA), and Stroke Aphasic Depression Questionnaire Hospital Version (SADQ-H) after 3 months. The level of rehabilitation was evaluated and divided into two groups: good group (n=92) and bad group (n=31). The clinical data of the two groups after 1 week of onset were compared and analyzed. Results? Univariate analysis revealed that differences in age, education level, disposable income, drinking history, smoking history, whether the lesions involved the cortex, and NIHSS score, ABC score, NLCA score, and SADQ-H score between the two groups were statistically significant (P＜0.05). Logistic regression analysis showed that age equal to or over 70 years, smoking history, drinking history, involvement of lesions in the cortex, and 1 week in hospital of NLCA score were all independent risk factors for cognitive impairment in patients with aphasia after cerebral infarction (P＜ 0.05). Conclusions? Elderly patients over 70 years of age, previous history of smoking and drinking, involvement of lesions in the cortex, and NLCA score are risk factors for cognitive rehabilitation in patients with aphasia after cerebral infarction. Based on this, we can formulate targeted interventions for patients with the above risk factors.

Objective:To evaluate the teaching effect of online clinical nursing practice in Psychiatry Department for undergraduate nursing students by using Web standardized patients (Web-SP) .Methods:In June 2021, 219 undergraduate nursing students from a university in Beijing were selected as research subjects by convenient sampling. We organized a week of online nursing practice in Psychiatry Department, set up an online practice teaching and research group, recruited and trained 15 standardized patients (SP) among hospital nurses, and designed 12 roles including schizophrenia patients, depression patients, and bipolar disorder patients with typical symptoms according to the actual clinical cases. According to the practice plan, an online practice class was opened on Tencent conference platform. The clinical teachers broadcastedand interviewed SP and SP's family members on the spot. Studentsinteracted with the online teachers and SP through video, voice or text. After the practice, 219 undergraduate nursing students were issued SP Simulated Quality of Standardized Patient Scale (SQSPS) and self-made Web-SP Use Effect Evaluation Questionnaire in Psychiatry Department online. A total of 219 questionnaires were distributed online, and 219 valid questionnaires were recovered, with a valid recovery rate of 100%.Results:The total score of SQSPS of 219 nursing students was (92.08±10.89) . The overall evaluation score of nursing students on the application of Web-SP in online practice was (46.52±4.60) , and the highest score was "deepened empathy for patients", which was (4.79±0.47) . The second was "deepened the understanding of psychiatric nursing", which was (4.75±0.68) . The third was "understanding the impact of symptoms on patients", which was (4.73±0.52) .Conclusions:Applying Web-SP to online clinical nursing practice in Psychiatry Department can meet the practice needs of nursing students for Psychiatric Department and nursing courses, and Web-SP after systematic training can replace real patients to achieve teaching goals.

Objective:To explore the current status of protective restraint during hospitalization in patients with affective disorders.Methods:A self-made questionnaire was used to investigate 400 patients with convalescent affective disorder in a psychiatric hospital in Beijing from November 2018 to April 2019.Results:Among 400 patients with affective disorders, 158 cases had restraint experience, and the incidence of protective restraint was 39.50%. Among the physical influences caused by protective restraint, 147 cases (93.03%) of limb movement were restricted, 133 cases (84.17%) were unable to defecate on their own, and 88 cases (55.69%) had limb pain. Among the psychological influences caused by protective restraint, 83 cases (52.53%) were helpless, 82 cases (51.89%) were aggrieved, 78 cases (49.37%) were powerless and 68 cases (43.04%) were fearful. There were statistically significant differences in age, gender, marital status, number of hospitalizations, and hospitalization diagnosis among patients with protective restraint experience, witnessed protective restraint and never exposed to protective restraint ( P<0.05) . Conclusions:Patients with affective disorders have a high rate of protective restraint. The physical influence and negative psychological experience of patients during and after the protective restraint is a potential threat to the establishment of the doctor-patient treatment alliance. Health education of protective restraint knowledge should be strengthened for inpatients, and comprehensive health education, nursing measures, and psychological interventions should be provided for protective restraint patients, so as to improve the misunderstanding of protective restraint in patients with affective disorders and reduce the negative experience and psychological influences of protective restraint in patients.

Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.

As a complex autoimmune disease， rheumatoid arthritis （RA） involves immune microenvironment dysregulation resulting from excessive activation of pyroptosis， which is a crucial factor in disease progression. Based on the theory of ying-wei in traditional Chinese medicine， "ying decline and wei attack" is considered the fundamental pathogenesis of RA. Pyroptosis serves as a microscopic manifestation of this concept， suggesting a potential correlation between "ying decline and wei attack" and pyroptosis nd immune microenvironment dysregulation in RA. Accordingly， treatment principles based on this theory are proposed： in the early stage of the disease， boosting wei to consolidate the exterior， and regulating ying to dispel pathogens； in the middle and late stages， harmonizing ying to remove stagnation， and nourishing its transformational source.