OBJECTIVE：To provide reference for improving medical insurance reimbursement for multi-indication drugs based on value-based pricing in China. METHODS：The theory and practice of value-based pricing for multi-indication drugs were sorted out，and the value standards and medical insurance reimbursement strategies based on value-based pricing in France，Germany，UK，Italy and Sweden were analyzed，so as to provide the suggestions for medical insurance reimbursement of multi-indication drugs in China. RESULTS & CONCLUSIONS：The realization of value-based pricing first needed to develop a value framework to define，measure and integrate value，and then established a model to convert the total value into price. The overall idea of value-based pricing for multi-indication drugs was consistent，but there were differences in the value standard. In the UK and Sweden， quality-adjusted life years （QALYs） and incremental cost-effectiveness ratios （ICERs） measured by pharmacoeconomicsare used as the value standard. France，Germany and Italy were more focused on the therapeutic value and clinical benefit improvement. As for medical insurance reimbursement strategies，France adopted single weighting method based on expected volume. Germany adopted combination weighting method based on value and volume. UK introduced the Patient Access Schemes and Italy introduced the Managed Entry reements，both based on the nominal reimbursement standard. Sweden adopted independent reimbursement for different indications by different brand names. It is suggested that China can explore the value-based pricing strategies of multi-indication drugs on the basis of the above international experiences，reference and use these variety of medical insurance reimbursement strategies comprehensively. Simultaneously，the information collection mechanism of patients and drug use should be improved to provide data support for the implementation of China’s value-based pricing and reimbursement strategies for multi-indication drugs.

Objective:To examine the relationship between conflict management model, perceived social support and psychological distress in psychiatric nurses, and to analyze the mediating effect of conflict management model in the relationship between perceived social support and psychological distress in psychiatric nurses.Methods:In November 2019, a total of 208 nurses in Shandong Mental Health Center were investigated with General Demography Questionnaire, Nurses' Interpersonal Conflict Handling Form Scale, Kessler Psychological Distress Scale and Perceived Social Support Scale.Results:The total score of psychological distress of psychiatric nurses was 22.74±7.71, and the level of psychological distress was negatively correlated with the integrated conflict management model and perceived social support ( r values were -0.329--0.266, P<0.001). The most commonly used conflict management model of psychiatric nurses was "integration". The integrated conflict management model had a partial mediating effect in perceived social support and psychological distress, and the mediating effect accounted for 20.2% of the total effect. Conclusions:Psychological distress of psychiatric nurses is at a moderate to severe level, and integrated conflict management model and perceived social support play an important role in reducing psychological distress of psychiatric nurses. Nursing administrators should carry out relevant intervention studies to improve nurse-patient conflict and guide nurses to adopt integrated conflict management model to reduce psychological distress and improve mental health level.

Objective:To investigate the situation of nursing handover among psychiatric nurses, and explore the association between perceived organizational support, self-efficacy and quality of nursing handover.Methods:A total of 186 clinical nurses in Shandong Mental Health Center were enrolled by convenience sampling method. They were assessed with handover evaluation scale, perceived organizational support scale and general self-efficacy scale for the evaluation of nursing handover, perceived organizational support and self-efficacy.Results:The average score of quality of nursing handover was 5.85±1.14, and bi-variate correlations were found between perceived organizational support, self-efficacy and quality of nursing handover. Self-efficacy could mediate the relationship between organizational support and nursing handover, and the value of mediating effect was 13.4%.Conclusions:Self-efficacy might mediate the relationship between perceived organizational support and nursing handover among psychiatric nurses.

Objective: To investigate the status quo and influencing factors of work burnout of psychiatric nurses, and to provide theoretical basis for formulating intervention strategies for work burnout of psychiatric nurses. Methods: A questionnaire was conducted on 812 nurses selected from 6 tertiary A psychiatric hospitals in Shandong province as the research object by stratified random sampling, and the questionnaire was conducted by using the Maslach Burnout Inventory (MBI), the Kessler Psychological Distress Scale (K10) and Emotion regulation questionnaire (ERQ). Results: There were significant differences in job burnout among psychiatric nurses with different educational background, age, nurse-patient conflict and income level. There were significant differences in the dimensions of job burnout among psychiatric nurses with different titles (P< 0.05), There were significant differences in emotional exhaustion (F=8.417, P=0.000) and depersonalization level (F=7.918, P=0.000) between psychiatric nurses with different frequency of nurse-patient conflict.There were significant differences in affective exhaustion (F=6.426, P=0.002) and personal accomplishment (F=3.444, P=0.032) between psychiatric nurses with different monthly income levels. Psychiatric nurses' age, working years, psychological distress, cognitive reappraisal, inhibition of expression were associated with job burnout (r=0.075~0.570) . Regression analysis revealed that the factors impacting emotion exhaustion (R²=0.374, F=81.627, P=0.000) and depersonalization (R²=0.240, F=65.014, P=0.000) were psychological distress, inhibition of expression, cognitive reappraisal, conflict between nurses and patients. The factors impacting diminished personal accomplishment (R²=0.199, F=68.332, P=0.000) were psychological distress, cognitive reappraisal and age. Conclusions The work fatigue of psychiatric nurses was at the moderate level. Emotional regulation and psychological distress were the influencing factors of job burnout.Nursing administrators in psychiatric department should pay attention to the improvement of nurses' sense of burnout, improve the ability of nurses' emotional management, cultivate positive mood and behavior pattern, reduce anxiety and depression and so on, so as to effectively improve the mental health level of nurses in psychiatric department.

Objective: To examine the potential mediating effect of perceived social support on job insecurity and psychological distress among clinical nurses. Methods: A total of 462 clinical nurses in Shandong Province were selected by convenience sampling method. They were assessed with job insecurity scale, perceived social support and 10-item Kessler Psychological Distress Scale (K10) for the evaluation of job insecurity, self-esteem and psychological distress. Results: The mean score of K10 was (23.72±7.22) points among clinical nurses, and 85.9% (397/462) of them had psychological distress problems. The K10 scores were positively correlated with the scores of job insecurity (r=-0.282, P<0.01), and the K10 scores were negatively correlated with perceived social support scores (r = -0.282, P<0.01). Job insecurity was negatively correlated with perceived social support (r = -0.365, P<0.01). The confidence interval from Bootstrap method indicated perceived social support played a partial mediating role between job insecurity and psychological distress, and the value of mediating effect was 13.7%. Conclusion The relation of perceived social support to job insecurity and psychological distress among clinical nurses are intimate. Perceived social support might mediate the relationship between job insecurity and psychological distress.

Objective To investigate the present status and influencing factors of psychological distress among psychiatric nurses, and provide theoretical basis for intervention measures. Methods Totally, 812 psychiatric nurses in six psychiatric hospitals of Shandong province were selected to complete the Kessler Psychological Distress Scale (K10), Perceived Organizational Support(POS), Simplified Coping Style Questionnaire(SCSQ) and Emotion regulation questionnaire(ERQ). Results The mean scores of psychological distress among psychiatric nurse was (21.29±8.11) points,70.3%of psychiatric nurses had psychological distress. There were significant differences in psychological distress among psychiatric nurses with different age (F=6.886,P=0.001), working years (F=4.403,P=0.004), professional title (F=6.597,P=0.000) and experience of nurse-patient conflict (F=7.228,P=0.000).Psychological distress was negatively related to cognitive reappraisal(r =- 0.093), positive coping style (r =- 0.163) and perceived organizational support(r =- 0.379), while psychological distress was positively related to expressive suppression(r=0.160) and negative coping style(r=0.258)(all P<0.01). Regression analysis revealed that the factors impacting psychological distress were positive coping style, perceived organizational support, expressive suppression, negative coping style and nurse-patient conflict (R2=0.224,F=46.611,P=0.000). Conclusions Psychiatric nursing managers should pay attention to the cultivation of emotional management ability of nurses and the ability to deal with conflict,encouraging them apply positive thinking cognition and positive coping style to deal with negative events in the work,creating a supportive work environment in order to improve the level of mental health.

BACKGROUND:Maxil ofacial malformation limits the function of the mandible, produces the overload of the temporalmandibular joint leading to oral diseases. OBJECTIVE:To measure the characteristics of mandibular movement in populations with various types of dental occlusion. METHODS:Thirty-three volunteers (1 male and 32 females, mean age 21.71 years) meeting the inclusion criteria were enrol ed from Dalian Medical University, China and divided into four groups:normal control (n=10), Angle’s class I, II, III malocclusion (n=10, 8, 5). The protrusion, lateral, opening motion trace of mandibular central incisor and the right mandibular first molar, and the trace from mandibular postural position to intercuspal position were measured using the mandibular kinesiograph. The features of different occlusal patterns were analyzed using SPSS 17.0 software. RESULTS AND CONCLUSION:In the trace of protrusion, lateral, opening and closing motion, there were significant differences in the trace of the right mandibular first molar’s Max.Slant between Angle’s class II malocclusion group and the other three groups (P<0.05). In the trace of open wide and close fast, there were significant differences in the trace of mandibular central incisor in vertical distances between normal control group and Angle’s class I, III malocclusion groups (P<0.05);there were significant differences in the trace of mandibular central incisor in Max.Slant between normal control group and Angle’s class I malocclusion group (P<0.05);there were significant differences in the trace of the right mandibular first molar in vertical distances between Angle’s class II malocclusion group and the other three groups (P<0.05);there were significant differences in the trace of the right mandibular first molar in Max.Opening velocity between normal control group and Angle’s class II, III malocclusion groups (P<0.05). There were no significant differences in free space between the four groups (P>0.05). These results indicate that there are differences in the trace of mandibular central incisor and the trace of the right mandibular first molar in range and speed between different occlusal patterns. We can draw a conclusion that malocclusion has effects on the direction, range and speed of mandibular movement.

Objective To explore the influence of nursing intervention on the social support and compliance of parents of severe β-Mediterranean anemia children. Methods A total of 100 cases of Mediterranean anemia children’s parents were surveyed with the Social Support Rating Scale (SSRS) and self-made compliance questionnaires, the investigation was performed before the intervention,6 months, 1 year after the intervention. Results The scores of objective support, subjective support and supporting availability after the intervention were all higher than those before intervention (F=269.04, 125.12, 243.04, all P<0.01). In the pairwise comparison tests, the ranks of objective support score and subjective support score were:1 year after intervention>6 months after intervention>before intervention (P<0.01);the score of supporting availability was lower than the scores of 6 months and 1 year after intervention (P<0.01). The compliance of blood transfusion on time and taking deferoxamine on time before and after the interventions had statistical meanings (Hc=100.40,70.53, all P<0.01). In the pairwise comparison tests, the compliance score before intervention was lower than the score after intervention (P < 0.01). Conclusions Nursing intervention can improve the social support and compliance of the parents with severe Mediterranean anemia children.

OBJECTIVE: To analyze the clinical characteristics of primary gastric lymphoma (PGL) and to improve its diagnosis and treatment. METHODS: The clinical manifestations, diagnosis, treatments and history of 50 PGL patients, who were hospitalized from September 2005 to September 2009, were reviewed and analyzed. RESULTS: The main manifestation of PGL was epigastric pain with infrequent systemic symptoms, such as stomach ache, abdominal discomfort, vomit, black stool, loss of appetite, fever, feeble, and skinny. Pathological examination indicated that only 1 patient had T cell lymphoma while the rest 49 had B cell lymphoma. Fourteen had mucosa-associated lymphoid tissue lymphoma (MALT), 35 had diffuse large B cell lymphoma (DLBCL), and 2 had both DLBCL and MALT (DLBCML). All the 50 patients received chemotherapy, and 12 underwent surgical treatment besides chemotherapy. Fourteen out of the 49 patients with B cell lymphoma received rituximab together with chemotherapy, and 35 received chemotherapy alone. The 2-year survival rate in the patients receiving rituximab together with chemotherapy was higher than that in the patients receiving chemotherapy alone (85.7% vs 77.1%, P< 0.05). The 2-year survival rate in patients of clinical stage I-II was higher than that in patients of clinical stage III-IV (90.9% vs 71.4%, P< 0.05). CONCLUSION The main clinical manifestation of PGL patients is non-specific gastrointestinal symptoms, among which abdominal pain is most common. The clinical examination mainly relies on pathological examinations, and the most common pathological type of primary gastric lymphoma is DLBCL. The main treatment is chemotherapy, and the prognosis is related to the clinical stage and the use of rituximab. After the treatment, the 2-year survival rate in the 50 patients reaches 80.0%.
Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Humans ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin ; diagnosis ; drug therapy ; pathology ; Prognosis ; Retrospective Studies ; Rituximab ; Stomach Neoplasms ; diagnosis ; drug therapy ; pathology ; Survival Rate

Objective To determine the maintenance and loss of Epstein-Barr virus (EBV) genome during the clonal expansion of the EBV-infected epithelial cells. Methods The epithelial tumor cell line, 293-EBV, in which the EBV genome was observed with green fluorescent protein (GFP) readout. After a dozen of passages, it contained cells with strong or weak GFP expression, and some with complete loss of EBV genome. The cell growth was then continuously observed under a confocal microscope. The cell dividing and GFP expression were also observed during the clonal expansion by being made into very low density. Results The cells moved around due to adherence and mobility, while the GFP expression remained unchanged in the undivided cells. The cells could form compact or loosen clones. The EBV genome easily persisted in those clones when cells were growing compactly. As the cell number increased, the GFP expression became weak or even died away at the sites of low density in the loosen clones. Conclusion EBV-positive epithelial cells are able to sustain the EBV genome during its clonal expansion. The cells maintain EBV genomes by passing them to the daughter cells after replication. When the cells unsuccessfully inherit the EBV genome, the daughter cells may lose them which is related to the low cell density as well as the epithelial environment.