Business process cost management is key to hospital business process management It mostly consists of process cost accumulation and cost analysis. The paper probed into theories of Activity Based Costing (ABC), and built a model for hospital process costing based on the hospital organizational structure Discussed herein include the items of hospital medical services and their activity costs, followed by a case study to prove ABC as practical in the analysis and calculation of hospital business process costs.

Objective To explore the changes and comparisons of the four biochemical indicator detection for the early renal im‐pairment in multiple myeloma patients .Methods The 54 patients with multiple myeloma of early onset(MM group) and 54 healthy peoples(control group) were retrospectively analyzed .The levels of serum Cystatin C(Cys C) ,creatinine(Cr) ,β2‐microglobulin(β2‐MG) ,and lactate dehydrogenase(LDH) were detected .And the results for statistical analysis .Results The levels of serum Cys C , Cr ,β2‐MG and LDH were higher significantly in the MM group than in the control group ,the difference was statistically significant (P<0 .05) .In the MM group ,the positive rate of Cys C ,Cr ,β2‐MG ,LDH ,combined detection of Cys C and Cr ,combined detection of β2‐MG and LDH ,combined detection of Cys C ,Cr ,β2‐MG and LDH was 63 .0% ,42 .6% ,74 .1% ,61 .1% ,66 .7% ,85 .2% and 96 .3% respectively .The positive rate of Cys C was higher than Cr ,the difference was statistically significant(P<0 .05) .Between the positive rate of combined detection of β2‐MG ,LDH and Cys C ,Cr ,the difference was statistically significant(P<0 .05) .The positive rate of combined detection of the four biochemical tests was the most highest .Conclusion In the early stage of the renal in‐jury in the patients with MM ,the combined detection of the four biochemical tests is most sensitive to discovery the early stage of the renal glomerular function injury .

An analysis of the development and present status of overseas hospital cost management pinpoints the setbacks found in China's hospital cost management, and brings forth the proposal to learn from advanced ideas and methods in overseas hospital industrial engineering and cost management. The goals are to build a nationwide total cost control system, explore new fields in cost management and introduce strategic cost management, in an effort to realize scientific cost management in China.

Objective To investigate the risk factors of postoperative complications in spinal tuberculosis surgery,and try to find a way to improve the results of perioperative management and reduce or avoid the postoperative complications.Methods All of 172 cases of spinal tuberculosis who were treated by surgery from February 2005 to January 2013 in orthopedic department of Zhongshan hospital,Fudan University were retrospectively analyzed.There were 88 males and 84 females,whose average age was 50.9± 18.7y (18-84y).Among them 98 cases got cold abscess,and 56 cases had tuberculosis poisoning symptoms.The lesions located mostly in thoracic spine (112/172,65.1％) and lumbar spine (40/172,23.3％),while rarely in cervical or sacral spine.2 intervertebral spaces were involved in 116 cases (67.4％),more than 2 intervertebral spaces were involved in 32 cases (18.6％),and single intervertebral space were involved in the rest cases (14.0％).38 cases were treated through single anterior approach,54 cases were treated by anterior-posterior surgical approach,and single posterior approach was performed in 80 cases.58 cases were suffered from neurological dysfunction.All the postoperative complications and related clinical parameters during hospitalization period were collected and analyzed with SPSS software.Each clinical parameter was analyzed with univariate analysis to find the factors related to postoperative complications,and then the related factors were analyzed by multivariate regression analysis.Results All of 172 patients were included and 41.9％ (72/172) of the patients suffered from postoperative complications.System complications were the most common (33.7％,58/172).The rates of local complications were 10.5％ (18/172).Univariate analysis showed that the lesion site,value of hemoglobin,electrolyte disturbances,postoperative ASIA score and blood loss were related with postoperative complications.Posterior approach related with local complications.Multivariate regression analysis showed that preoperative hemoglobin ＜100 g/L,poor postoperative ASIA scores and long period of preoperative anti-TB treatment (＞28 days) were related with the system or local postoperative complications.Conclusion Patients with anemia (hemoglobin ＜ 100g/L),poor postoperative neurological function and long period of preoperative anti-TB treatment could take more risks of the postoperative complications.

This study was aimed to optimize the extraction process of resveratrol by central composite design (CCD) and response surface method (RSM), based on the result of single factor experiment. Resveratrol was extracted from Polygonum cuspidatum by water bath extraction of organic solvent. And content of resveratrol was taken as index in the investigation of solvent concentration effect, extraction time and solvent content on extraction process. The results showed that the optimum condition was 12.7 times amount of 72.0% ethanol and extract for 2 times under the temperature of 50℃, 1.1 h for each time; the average deviation between the maximum theoretical value and measured value was 0.83%. It was concluded that this extraction process was highly predictive, which provided experimental evidence for the industrial production of P. cuspidatum extraction.

Objective Reengineering of existing facility capacity of the hospital operating department to tap the potential of the capacity, and development of scientific and quantitative basis for hospital decision-making. Methods Existing data of the hospital's operating department was called into play for a fit test of probability distribution, followed by an analysis of such capacity in the queuing theory, ending with a redesign based on the present service demand.Results The operating department in question was found with a low utilization, and with surplus capacity. When the utilization lies between 70% and 80% (7 operating rooms), the queuing system indexes are optimal.Conclusion It is rational and feasible to analyze and optimize operating department facility capacity in the queuing theory. This is conductive to increasing operating room utilization and enhancing hospital competitiveness.

Objective To evaluate the effect of obesity on the potency of propofol for sedation.Methods Sixty patients of both sexes, aged 35-55 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective operation under general anesthesia, were enrolled in the study.The patients were divided into 2 groups (n=30 each) according to the body mass index (BMI) : normal body weight (BMI ＜ 25 kg/m2) group (group C) and obesity (BMI 30-40 kg/m2) group (group O).No patients received premedication.Propofol was given by target-controlled infusion.The initial target plasma concentration of propofol was set at 1.2 μg/ml.After the target concentration was steadily maintained for 30 s, it was increased in 0.3 μg/ml increment until the patients lost consciousness (OAA/S score =1).The target plasma concentration of propofol was recorded during each period.The median effective concentration (EC50) and 95％ confidence interval of propofol for loss of consciousness was calculated using probit analysis.Results The EC50 and 95％ confidence interval of propofol for loss of consciousness were 3.82 (3.73-3.90) and 3.29 (3.20-3.37) μg/ml in group C and group O, respectively.Compared with group C, the EC50 was significantly decreased in group O (P＜0.05).Conclusion Obesity can enhance the potency of propofol for sedation.

Objective To explore the effectiveness of Liberman mental rehabilitation training on social function of the patients with chronic schizophrenia. Methods Sixty-two in-patients with stable chronic schizophrenia were trained for 12 weeks with Liberman mental rehabilitation technique. The social disability screening schedule (SDSS) was used to assess the social function before and after training. Result After training, the scores by SDSS were lower those than before training with statistical significance (P < 0.001). Conclusion Liberman mental rehabilitation training can improve the social function of patients with chronic schizophrenia.

Objective To evaluate the accuracy of stroke volume variation (SVV) in monitoring the changes in blood volume during laparoscopic surgery.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,with body mass index ranged from 20 to 25 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were studied.After induction of general anesthesia,baseline registrations of variables were obtained.After establishing pneumoperitoneum,6％ hydroxyethyl starch (HES 130/0.4) 500 ml was infused over 30 min.Before pneumoperitoneum (T1),at 5 min after pneumoperitoneum (T2),immediately before volume expansion (T3) and at 3 min after volume expansion (T4),cardiac output (CO),cardiac index (CI),SV,stroke volume index (SVI) and SVV were monitored and recorded.The changing rate of CI (△CI) was calculated.The criterion for effective volume expansion was △CI ≥ 15％.The ROC curve for SVV in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under the curve and 95％ confidence interval were calculated.Results SVV was significantly lower at T2 than at T1.CO,CI,SV and SVI were significantly higher,and SVV was lower at T4 than at T3.The results of ROC curve analysis showed that a 9.2％ SVV threshold discriminated between responders and non-responders with a sensitivity of 61％ and a specificity of 50％,and the area under the curve (95％ confidence interval) was 0.567 (0.378-0.757).Conclusion SVV is not a suitable index in monitoring the changes in blood volume during laparoscopic surgery.

Objective To investigate the effect of carbon dioxide ( CO2 ) pneumoperitoneum on the neuromuscular block of cisatracurium in patients undergoing laparoscopic operation.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 35-60 yr,with body mass index of 18-24 kg/m2,scheduled for elective hysterectomy,were randomly divided into 2 groups ( n =30 each ):pneumoperitoneum group ( group P) and control group ( group C ).Each group was further divided into 2 subgroups according to the use of the antagonist of neuromuscular block ( n =15 each):no neostigmine group ( group P0 or C0 ) and neostigmine group (group P1 or C1 ).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with target-controlled infusion of propofol and remifentanil.Tracheal intubation was performed and the patients were mechanically ventilated.Neuromuscular function was monitored by TOF-Watch SX accelerography (Organon Co.,Organon).A train of four (TOF) stimulation of the ulnar nerve was used.When T,returned to 5％ of control height after CO2 pneumoperitoneum was established,cisatracurium 0.05 mg/kg was injected intravenously in group P.When T1 returned to 25％ of control height after the end of operation,neostigmine was injected intravenously in groups P1 andC1.The clinical duration and recovery index were recorded after CO2 pneumoperitoneum was established.Arterial blood samples were obtained immediately before induction,at 30 and 60 min of pneumoperitoneum,and at the end of operation for blood gas analysis.Results The clinical duration and recovery index were significantly longer in group P0 than in group C0,and in group P1 than in group C1 ( P ＜ 0.05).Compared with group C0,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P0 ( P ＜ 0.05).Compared with group C1,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P1 ( P ＜ 0.05).Conclusion CO2 pneumoperitoneum can strengthen the neuromuscular block induced by cisatracurium and prolong the recovery time following antangonism by neostigmine administration in patients undergoing laparoscopic operation.