Objective To investigate the current policy of medical insurance expenditure control in Shanghai and put forward feasible advice. Methods Survey in 5 tertiary first-class hospitals in Shanghai involving 400 doctors and patients was conducted.The result of the questionnaire was tracked with Microsoft Excel 2000.The expense reports during 2001 to 2006 from the Office of Medical Insurance of Shanghai Renji Hospital was collected.All the data were statistically analysed. Results The global budget system was accepted by both the doctors and patients.Charging based on disease categories was proved a relatively satisfying method.Drug expenditure control was concerned by both the doctors and patients. Conclusion Ever since the global budget system of medical insurance is implemented in Shanghai,the medical insurance expenditure has been effectively controlled.The key point is the restraint of irrational consumption during the medical treatment.

Network management is very important for its effective operation in the hospital.From the aspects of fault management,configuration management,performance management,charging management,safety management,this paper proposes a high-efficiency and low-cost method for network management in the hospital.

OBJECTIVETo investigate the correlation between the pathogeneses of diarrhea-pre- dominant irritable bowel syndrome (D-IBS) complicated functional dyspepsia (FD) patients of Gan-stagnation Pi-deficiency Syndrome (GSPDS) and symptoms, psychological states, and gastrointestinal hormones.

METHODSA total of 111 patients with confirmed D-IBS complicated FD of GSPDS were recruited as the treated group by using Rome III standard and Chinese medical syndrome standard. And 30 healthy volunteers were recruited as the control group. The general condition, scoring for digestive symptoms, and the distribution of GSPDS subtype of all subjects were recorded by a questionnaire, and assessed by Symptom Checklist (SCL-90; a software for psychological test developed by Beijing Huicheng Adult Cor- poration). Meanwhile, plasma levels of 5-hydroxytryptamine (5-HT), somatostatin (SS), vasoactive intestinal peptide (VIP), endothelin (ET), interleukin 10 (IL-10), and interleukin 12 (IL-12) were measured in all subjects.

RESULTS(1) The subtype of D-IBS complicated FD of GSPDS was dominant in Pi-qi deficiency type (51/111,45.9%),Pi yang deficiency type (34/111,30.6%), and GSPDS. There was no statistical difference in the scoring of digestive symptoms among the 3 subtypes (P >0.05). (2) Compared with the control group, the anxiety factor score and the total score significantly increased in all three subtypes of D-IBS complicated FD of GSPDS, and the depression score of Pi yang deficiency type and Gan-depression type also significantly increased (P <0.05, P <0.01); the depression score of Gan-depression type was significantly higher than that of the Pi-qi deficiency type (P <0.01). Plasma 5-HT levels were obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities, and VIP and IL-10 levels were significantly lower than those in the control group (P <0.05). Plasma VIP levels were also obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities (P <0.01), and SS levels were significantly lower than those in the control group (P <0.05). There was no statistical difference in plasma ET or IL-12 levels in each patient group, when compared with the control group (P >0.05). (3) Compared with the.control group, plasma 5-HT levels significantly increased, plasma VIP and IL-10 levels significantly decreased in ach subtype of D-IBS complicated FD patients of GSPDS (P <0.05, P <0.01), and no significant change of SS, ET, or IL-12 occurred (P >0.05). Besides, plasma 5-HT levels were significantly higher in Gan-depression type than in Pi yang deficiency type, VIP levels were lower in Gan-depression type than in Pi-qi deficiency type (all P <0.05).

CONCLUSIONSGan stagnation and Pi deficiency were dominant in D-IBS complicated FD patients of GSPDS. Psychological abnormalities, increased plasma 5-HT levels, and decreased plasma VIP levels were closely correlated with Gan stagnation subtype, which provided some reference for looking for objective indicators of Chinese medical syndromes in treating D-IBS complicated FD patients of GSPDS.

Adult ; Case-Control Studies ; Diarrhea ; etiology ; Dyspepsia ; blood ; complications ; psychology ; Gastrointestinal Hormones ; blood ; Humans ; Irritable Bowel Syndrome ; blood ; complications ; psychology ; Psychological Tests ; Qi ; Serotonin ; Surveys and Questionnaires ; Yang Deficiency

Objective To investigate the role of depression and C-reaction protein (CRP)in the early development of vascular disease in the elderly patients with type 2 diabetes. Methods Totally 396 patients with type 2 diabetes were recruited in the study,including 196 cases with depression and 200 cases without depression.Depression was evaluated by Hamilton depression scale (HAMD),and CRP was measured using rate nephelometry.The related parameters of wave intensity (WI) such as accelerating wave intensity (W1),decelerating wave intensity (W2),arterial stiffness β,pressure-strain elasticity modulus (Ep),arterial compliance (AC),pulse wave velocity -wave intensity(PWVWI),pulse wave velocity (PWV) and argumentation index (AI) were detected and compared between the groups. Results The levels of CRP [(8.1±2.8)mg/L vs. (3.9±3.2) mg/L,t=6.411,P=0.000],W2 [(4.82±1.33) mm Hg· m-1 · s-3 vs.(2.27±1.28)mm Hg · m-1 · s-3,t=4.256,P=0.021],arterial stiffness β(12.58±3.23 vs.8.96±2.24,t=4.634,P=0.019),Ep (157.90±52.64 vs.118.24±53.08,t=5.512,P=0.007),PWVβ(7.53± 1.41 vs.6.68±1.56,t=3.982,P=0.024),AI(19.26± 13.21 vs.15.34±10.23,t=3.213,P=0.037)and PWV-WI (7.59±1.67vs.6.63± 1.45,t =2.613,P =0.046) in cases with depression were higher than the cases without depression,while the AC value was reduced (0.70±0.19 vs.0.78±0.21,t=4.676,P =0.017).There was no difference in W1 value between the groups.The CRP level and HAMD score were positively associated with W2 (r=0.470,P=0.000),stiffness β (r=0.582,P=0.000),Ep (r=0.352,P=0.004),PWV-WI (r=0.233,P=0.019),PWVβ (r=0.340,P=0.007) and AI (r=0.265,P=0.015),but negatively related with AC(r=-0.457,P=0.000).HAMD score was positively correlated with CRP level(r=0.328,P=0.003). Conclusions The carotid artery wave intensity W2,blood vessel elasticity parameter β,Ep,AC,PWV-WI,PWVβ and AI determination can evaluate the risk of cardiovascular diseases in elderly diabetes,and higher CRP level and HAMD score may deteriorate its process.

Objective To investigate the effect of sodium ozagrel injection on hemorheology, endothelin (ET) and nitrogen monoxidum (NO) of patients with non-ST segment elevation myocardial infarction (NSEMI). Methods A total of 81 NSEMI patients were divided randomly into two groups: control group and experimental group. Isosorbide mononitrate, low molecular heparin and simvastatin were administered in the control group while sodium ozagrel was added to the experimental group apart from the above-mentioned drugs. The clinical effect of sodium ozagrel was observed. The changes in the indexes of hemorheology, ET and NO were analyzed. Results The clinical effect was significantly better in the experimental group than in the control group (P<0.05). The level of ET was obviously lower after treatment than that in the experimental group and the control group before treatment (P<0.05). The level of NO was obviously higher after treatment than that in the experimental group and the control group before treatment (P<0.05). The changes of ET and NO in the experimental group post-treatment were more significant than those in the control group after-treatment (P<0.05). The level of hemorheology index after treatment was lower than that before treatment in the experimental group (P<0.05). High-shear rate of whole blood viscosity, platelet adherence rate, and fibrin as hemorheology indexes were lower after-treatment than those pretherapy in the control group (P<0.05). Conclusion Sodium ozagrel injection could affect hemorheology,ET and NO of patients with non-ST segment elevation myocardial infarction. Thefore, the therapeutic efficacy can be better if sodium ozagrel is added to the conventional therapy.

Objective To study the therapeutic effects and mechanism of Sodium Fendate(SF) on rats with severe acute pancreatitis(SAP) induced by L-arginine. Method A total of 60 adult SD rats were randomly and e-qually divided into control group, SAP group and SF group, with 20 rats in each group. The rat model of SAP wes established by injecting 2.5 g/kg L-arginine at a dose of intraperitoneally twice at an interval of 1 hour, and rats in SAP group and SF groups were administrated intraperitoneally with 20% L-arginine solution(2.5 g/kg×2) twice at an interval of 1 hour; rats in control group were injected intraperitoneally with the same volume of physiological saline twice alone.At 5 minutes after L-arginine administration,rats in SF group were injected with SF solution (100 mg/kg, qd×3 d) via the tail vein, and rats in the other two groups received a sham injection of the same volume of physiological saline alone. The characteristics of ascites, the pathological changes of pancreatic tissue and the serum levels of amylase(AMY), endothelin-l(ET-1), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and the contents of malonaldehyde (MDA), suede dismutase (SOD), reduced glutathioue (GSH) of pan-creatic tissue of rats and prognosis were compared at 72 hours after L-arginine administration. Measurement data were evaluated by oue-way ANOVA, and numeration data were assessed by Fisher' s exact test. P<0.05 was considered statistically significant. Results Compared with control group,at 72 hours after L-arginine administra-tion,rats in SAP group presented characteristically histopathological changes of SAP with significantly higher serum levels of AMY, ET-1, TNF-α, IL-6 and MDA of pancreatic tissue[(9715.5±301.3) IU/L vs. (729.2±134.2) IU/L;(25.32±3.67) ng/L vs. (14.32±2.69) ng/L;(102.95±11.24) ng/L vs. (38.62±3.87) ng/L; (538.63±9.53) ng/L vs. (186.35±1.19) ng/L;(34.8±3.9) mol/kg vs. (8.1±2.1) mol/kg, all P< 0.01], and lower GSH and SOD in the pancreatic tissue[(7.1±0.6) mg/kg vs. (16.9±1.9) mg/kg; (6423± 1978) kU/kg vs. (29905+2945) kU/kg,both P<0.01].Compared with SAPmodel group,at 72 hours after ad-ministration of L-arginiue, the pathological lesions of SAP in rats of SF group were significantly alleviated with lower pathological scores (P<0.05), lower serum levels of AMY, ET-1 ,TNF-α,IL-6 and MDA in the pancreatic tissue [(8104.6±149.9) IU/L vs. (9715.5±301.3) IU/L; (20.26±5.86) ng/L vs. (25.32±3.67) ng/L; (84.19±15.14) ng/L vs. (102.95±11.24) ng/L;(458±5.37) mol/kg vs. (538.63±9.53) rig/L;(28.3±2.5) moL/kg vs. (34.8±3.9) mol/kg,all P<0.05], and higher SOD and GSH in the pancreatic tissue[(8.5 ±1.4) mg/kg vs. (7.1±0.6) mg/kg;(10 316±2810) kU/kg vs. (6423±1978) kU/kg, both P<0.05].At 72 hours the death rate in SF group was lower than that in SAP group,but the difference had no significance (P= 0.2.5). Conclusions SF can scavenge oxygen-derived free radicals, upgrade the contents of SOD and GSH of pancreatic tissue,decrease the levels of serum proinflammatory cytokines and ET-1, ameliorate the pathological le-sions of pancreatic tissue in rats,and has the capability of decreasing death rate, so it possesses a distinct advantage for the treatment of SAP.

Objective To explore the effect of focused nursing model on negative emotions and subjective well-being of lung cancer patients. Methods Eighty-six lung cancer patients hospitalized from November 2014 to November 2016 in our hospital were divided into two groups according to the order of admission in equal number. The control group was treated with routine care, and the observation group was with focused nursing model. The two groups were compared in terms of anxiety by SAS, depression by SDS, subjective well-being. Results The scores by SAS and SDS in the observation group were lower than those in the control group (P<0.05). The levels of objective support, subjective support, self-evaluation and subjective well-being index of the observation group were higher than the control group (P <0.05). Conclusion Focused nursing model can effectively relieve negative emotions, improve subjective well-being of lung cancer patients, worthy of clinical promotion.

Objective To learn the professional ability of rural doctors in our country ,to provide scientific reference for educa-tional reform of junior-college clinical medicine .Methods A self-made questionnaire was performed in 1 245 rural doctors from 86 rural grassroots health institutions in 7 provinces(municipalities) of our country .Results The rural doctors were familiar with working environment ,coordinated and communicated well with colleagues ,basic competence at work .But their clinical diagnosis-treatment technology and operational capability of medical equipments were not strong .The doctor-patient relationship was not so good .Conclusion Not the proper use of medical equipment and treatment technology of weak seriously affected the quality of serv-ice .Not ideal doctor-patient relationship influenced the service effect .It was suggested that college of clinical medical professional education should enhance the cultivation of students′clinical diagnosis technology ,basic operational skills and communication skills between doctors and patients .

Objective To investigate the feasibility and efficacy of combined preoperative chemora- diation program followed by radical surgery in bulky early or moderate uterine cervical cancer.To determine the incidence and predictive value of rasidual disease in the radical hysterectomy specimens after CCR. Methods Thirty-five patients with uterine cervix carcinoma from January 2001 to September 2003 were treated with preoperative external beam radiotherapy to 3060 cGy in 4 weeks.Patients received concurrent continuous infusion cisplatin(20 mg/m~2)on day 1,8,15,22 of four weeks and 5-Fu(4 g)chemotherapy during the first four days and the last four days of the radiation course.Radical surgery was not performed until 4 weeks after the completion of the preoperative treatment.Results Clinical response was 85.71%,complete response,54.29 %;partial response,31.43 %.The analysis of the surgical specimens showed 19 patients had revealed residual disease and 16 patients had revealed no residual disease,the complete pathological response hed been 45.71%.Three-year survival rate was 87.14 % in 35 patients.Three-year survival rate of residual disease patients(76.32 %)was significantly lower than that of no residual disease(100.0 %)(P=0.0358). Three-year survival of cervical stromal invasion less than 1/2 and invasion extra stromal was 100.0 %, 41.67 % respectively(P=0.0109);three-year survival of lymph-vascular space involvement and no lymph- vascula space involvement was 0,85.29 %,respectively(P=0.0148).Conclusion Combined preoperative chemoradiation program followed by radical surgery in bulky early or moderate cervical cancer could reveal an effective efficacy with a tolerant complication.Residual disease is an independent and strong predictive factor.

Objective To understand the work tasks of rural doctors in our country and to provide bases for the reforms of clini‐cal medical education of junior colleges .Methods A self‐made questionnaire was performed in 1 245 rural doctors from 86 rural grassroots health institutions in 7 provinces/municipalies of our country .Results The academic levels of rural doctors were low (65 .54% )and the rates of their medical certification holding were low in western district(7 .79% ) .The work load including basic medical care and basic public health services they committed were approximately matching .The top 5 items of basic medical care were ,in proper sequence ,diagnoses and treatments of common diseases ,common symptoms ,chronic disease management ,communi‐ty rehabilitation ,community first aid .The top 5 items of basic public health services were establishment of residents′health files , maternal and child health ,health care of the aged ,immunization ,health education .Conclusion The technological levels of diagnosis and treatment and theoretical knowledge of rural doctors should be further improved .The clinical medical education of junior medi‐cal colleges must strengthen the training and cultivation of the students′abilities of basic public health services ,besides consolida‐ting the training of the abilities of practical diagnosis and treatment .