Health economics analysis has become increasingly important in recent years. It is essential to master the use of relevant software to conduct research in health economics. TreeAge Pro software is widely used in the healthcare decision analysis. It can carry out decision analysis, cost-effectiveness analysis, and Monte Carlo simulation. With powerful functionlity and outstanding visualization, it can build Markov disease transition models to analyze Markov processes according to disease models and accomplish decision analysis with decision trees and influence diagrams. This paper introduces cost-effectiveness analysis based on Markov model with examples and explains the main graphs.
OBJECTIVE To summarize the clinical results of hollow compression screw in treatment of fracture of neck of femur in the aged. METHODS: From November 1993 to October, 1998, 52 aged patients with several types of fracture of neck of femur were treated; among them, there were 25 males and 27 females aged from 60 to 83 years (70 years on average). There were 48 cases of fresh fracture and 4 cases of old fracture. Forty-two cases were performed closed reduction internal fixation, 10 cases with open reduction internal fixation. RESULTS: All the patients could sit by themselves 4 to 6 days after operation, and could walk with a crutch 10 to 15 days after operation. The mobility of hip joint was nearly normal 4 weeks after operation. All the patients were followed 26 to 84 months, 48.5 months on average. Bone union was achieved in 50 cases, nonunion in 2 cases. The average healing time was 4.7 months. There were no other complications, such as ankylosis and muscular atrophy, but ischemic necrosis in 3 cases. CONCLUSION: This method has following advantages, convenient manipulation, less injury, stable fixation, and the short-term recovery, which avoid some common complications. It is a reliable method worthy of popularizing.
Objective To explore the accuracy and practicability of bone age assessment for the diagnosis of idiopathic precocious puberty (IPP). Methods According to the “Gold Standard”, we selected 55 girls with IPP for the study group, and 83 normal girls for the control group. We retrospectively analyzed the first left hand-wrist radiographs at the first visit. Bone ages were assessed by using a single-blind method according to the RUS (Radius Ulna and Short bones), carpale and 20 bones method (TW2). Each had 5 decision thresholds (gt;97th percentile, gt;90th percentile, gt;75th percentile, gt;50th percentile and ≤50th percentile). The diagnostic values from RUS, carpale and 20 bones methods assessing bone age were analyzed to identify the best decision threshold. Results ① Both sensitivity and specificity of the four decision thresholds were relatively higher, including gt;90th percentile of RUS (sensitivity 0.836, specificity 0.916), gt;90th percentile of carpale (sensitivity 0.746, specificity 0.916), gt;90th and gt;75th percentile of 20 bone (sensitivity 0.746, specificity 0.964 and sensitivity 0.982, specificity 0.783, respectively). ② Area under receiver operator characteristic curve (AUR): AUR of RUS 0.939 ± 0.019 (95%CI 0.902 to 0.977), AUR of carpale 0.899 ± 0.028 (95%CI 0.845 to 0.954), AUR of 20 bone 0.958 ± 0.014 (95%CI 0.930 to 0.986). No significant difference was found (F=2.03, P=0.13). ③ Agreement assessment within-observer reliability was 89.28%, and between-observer reliability was 80.3% (Kappa 0.68, u=6.87, P＜0.01). Conclusions RUS and 20 bones methods have high accuracy for the diagnosis of idiopathic precocious puberty. Considering sensitivity and specificity, we think that ＞90th percentile of RUS is the best decision threshold.
ObjectiveTo evaluate the diagnostic performance of different screening tools for sarcopenia in the community for the elderly with sarcopenia, and to provide evidence-based support for the accurate screening of elderly patients with sarcopenia. MethodsThe PubMed, Web of Science, Cochrane Library, Embase, CINAHL, VIP, CBM, and WanFang Data databases were searched by computer, and the relevant research on the diagnosis of sarcopenia in the elderly by publicly published risk screening tools was found. The retrieval time was from inception to June 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies, and then data analysis was performed by using Stata 15.1 and Meta Disc 1.4 software. ResultsA total of 24 studies were included, including 10 961 patients, involving 8 risk screening tools for sarcopenia in the elderly: leg circumference, MSRA-5, MSRA-7, upper arm circumference, ring test, Ishii score, SARC-CalF and SARC-F. Meta-analysis showed that the combined sensitivities of eight screening tools were 0.84 (95% CI 0.61 to 1.15), 0.82 (95% CI 0.48 to 1.38), 0.80 (95% CI 0.47 to 1.36) and 0.72 (95%CI 0.33 to 1.55), 0.67 (95%CI 0.37 to 1.21), 0.63 (95%CI 0.33 to 1.19), 0.49 (95%CI 0.38 to 0.63), 0.24 (95%CI 0.18 to 0.30), and the combined specificities were 0.39 (95%CI 0.18 to 0.82)、0.52 (95%CI 0.29 to 0.93)、0.54 (95%CI 0.29 to 1.03)、0.62 (95%CI 0.49 to 0.79)、0.63 (95%CI 0.50 to 0.78).The results of reticular meta-analysis showed that the surface under the cumulative ranking curve (SUCRA) of the eight screening tools ranked from high to low according to the cumulative sensitivity: calf circumference (67.4%) > MSRA-5 (65.3%) > MSRA-7 (64.1%) > upper arm circumference (54.5%) > ring test (46.5%) > Ishii score. The values of specificity SUCRA from highest to lowest were as follows: SARC-F (72.2%) > SARC-CALF (71.3%) > Ishii score (60.2%) > ring test (57.1%) > upper arm circumference (40.1%) > lower leg circumference (36.2%) > MSRA-5. ConclusionThe simple screening tool for common sarcopenia has high sensitivity and high specificity, so medical staff can give priority to the combination of the two screening tools, namely SARC-CalF. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Purpose
To investigate the histopathologic changes of macula lutea retinae in the elderly Chinese population,and to provide information for the cause of visiual disturbance in an autopsy study.
Methods
Two hundred and twelve eyes from 108 consecutive cases of postmortem (mean age of 78.4 years old) sections of the area of macula lutea retinae were studied by histopathology.
Results
Among the 212 eyes,hard drusen were found in 36.3% of eyes and soft drusen in 19.3% of eyes.The eyes with both of the above mentioned 2 types of drusens were found to be combined with RPE atrophy and RPE detachment;and subretinal neovascularization were found in 5.7% of these eyes and they were associated with obvious RPE atrophy and photoreceptor loss;3.2% eyes had posterior scleral staphyloma showing thinning of the sclera and choroid,RPE atrophy and apparent photoreceptor loss;2.4%eyes showed CME with the history of cataract surgery.
Conclusion
The macular affections,age-related macular degeneration,myopic macular degeneration and post-perative cystoid macular edema are varying in number in the above mentioned order successively,in elderly Chinese at an autopsy study.
(Chin J Ocul Fundus Dis,2000,16:233-235)
ObjectiveThis study aims to analyze the trends in Parkinson’s disease incidence rates among the elderly population in China from 1990 to 2021 and to forecast incidence growth over the next 20 years, providing. MethodsJoinpoint regression and age-period-cohort models were employed to analyze temporal trends in Parkinson’s disease incidence, and the Nordpred model was used to predict case numbers and incidence rates among the elderly in China from 2022 to 2044. ResultsFindings indicated a significant increase in Parkinson’s disease incidence among China’s elderly population from 1990 to 2021, with crude and age-standardized incidence rates rising from 95.37 per 100 000 and 111.05 per 100 000 to 170.52 per 100 000 and 183.91 per 100 000, respectively. Predictions suggested that by 2044, the number of cases will rise to approximately 878 264, with the age-standardized incidence rate reaching 223.4 per 100 000, and men showing significantly higher incidence rates than women. The rapid increase in both cases and incidence rates indicated that Parkinson’s disease will continue to impose a heavy disease burden on China’s elderly population. ConclusionThe burden of Parkinson’s disease in China’s elderly population has grown significantly and is expected to worsen. To address the rising incidence rates effectively, it is recommended to enhance early screening and health education for high-risk groups, improve diagnostic and treatment protocols, and prioritize resource allocation to Parkinson’s disease prevention and care services to reduce future public health burdens.
ObjectiveTo explore the influence factors of gallstone.
MethodsClinical data of 511 patients who were admitted to our hospital from Apr. 2015 to Apr. 2016 were retrospectively analyzed.
ResultsOf 511 patients, there were 274 patients with gallstone (gallstone group) and 237 patients without gallstone (control group). Univariate analysis results showed that, no significant difference of age, gender, and diabetes was found between gallstone group and control group (P > 0.050), but the levels of serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), and fasting blood glucose (FBG) were significantly higher in patients of gallstone group (P < 0.050), but the level of serum high density lipoprotein (HDL-C) was significantly lower in patients of gallstone group (P=0.001). Logistic regression results showed that four factors including diabetes〔OR=4.491; 95% CI is (2.021, 9.976); P < 0.001〕, the serum TC〔OR=2.548; 95% CI is (1.944, 3.338); P < 0.001〕, HDL-C〔OR=0.115; 95% CI is (0.056, 0.237); P < 0.001〕, and FBG〔OR=1.277; 95% CI is (1.086, 1.502); P=0.003〕 entered the final regression model after controlling confounding factors. The results showed that patients who combined with diabetes, high levels of serum TC and FBG, and low level of serum HDL-C, had higher ratio of galls-tone.
ConclusionDiabetes, high-level of serum TC and FBG, low-level of serum HDL-C were risk factors of gallstone.
PURPOSE:Toinvestigate the classification and the age incidence of Coats disease.
METHODS:75 cases(79 eyes)of Coats disease were analysed,which were diagnosed by fundus fluorescein angiograpy(FFA)between Jan.1981 and Dec.1994.
RESULTS:The patients included 59 males and 16 famales.Average age of the first presentation was 26 years old,and there were 45(60%)cases aged from 19 to 60 years old.In 5 eyes,the ophthalmoscopic examination revealed no obviously abnormal retinal blood vessel,but a number of dilated retinal vessels and microaneuryms were demonstrated by FFA.
CONCLUSIONS:The autors consider that there is no essential distinction between type Ⅰand type ⅡCoats disease and it is no longer suitable to apply the traditional classification.Coats disease affects not only juvenile patients but also persons of all ages.
（Chin J Ocul Fundus Dis,1996,12: 77-79）
Abstract： Objective To summarize the clinical characteristics of young patients with Stanford type A aortic dissection. Methods We retrospectively analyzed 54 patients with Stanford type A aortic dissection who received surgical treatment in General Hospital of PLA between March 2004 and June 2011. All the patients were divided into two groups: a young patient group with patients’ age less than 40 years and a control group with patients’ age more than or equal to 40 years. There were 23 patients including 17 males and 6 females with an average age of 34.2±6.3 years in the young patient group and 31 patients including 27 males and 4 females with an average age of 51.5±6.8 years in the control group. The clinical characteristics and surgical treatment outcomes of the two groups were compared. Results There was no statistical difference in cardiopulmonary bypass（CBP）time（224.4±83.1 min vs. 215.0±88.0 min, t=0.39, P=0.69） and aortic cross-clamping time（152.3±60.8 min vs. 130.9±51.2 min, t=1.34, P=0.18）between the two groups. Compared with the patients in the control group, young patients were more likely to have congenital malformations with rate at 34.7%（8/23） vs. 6.4%（2/31） with χ2=5.27, P=0.02, such as Marfan syndrome and bicuspid aortic valve. The mortality of the young patients was similar to patients in the control group at rate of 13.0%（3/23）vs.12.9%（4/31） with χ2=0.15 and P=0.69, but postoperative mental and neurological complications rate in the young patient group were less frequent than those in the control group at 4.3%（1/23）vs. 32.2%（10/31） with χ2=5.32 and P=0.02. Conclusion Young patients with Stanford type A aortic dissection have fewer cardiovascular risk factors for aortic dissection but are more likely to have congenital malformations. The surgical methods are more active for young patients with less frequency of postoperative mental and neurological complications.
Objective To analyze the risk factors for postoperative cognitive confusion in a surgical intensive care unit. Methods A total of 388 consecutive patients in Surgical Intensive Care Unit of General Hospital of PLA were retrospectively studied. We posed clinical questions according to the patients with older age and large dosage corticosteroid. Using “Postoperative cognitive confusion” and“Intensive Care” as key words, we searched for evidence from MEDLINE (1968-2004). Results We found 3.1% (10/388) of the patients developed postoperative cognitive confusion. Of the 10 postoperative cognitive confusion patients, 9 were over 65 years old. 6.6% (9/136) of the patients (≥ 65 years old) developed postoperative cognitive confusion. While 0.4%(1/252) of the patients (＜65 years old) developed postoperative cognitive confusion. Older age (≥ 65 years old) may induce more postoperative cognitive confusion (P＜0.05). While 7.0% (5/71) of the patients treated by large dose corticosteroids (≥1 000 mg) developed postoperative cognitive confusion. And 1.65% (5/317) of the patients received corticosteroid with large dosage (＜1 000 mg) developed postoperative cognitive confusion. Large dosage corticosteroid (≥1 000 mg) may induce more postoperative cognitive confusion (P＜0.05). Conclusion Older age (≥ 65 years old) and high dose corticosteroid (≥1 000 mg) may be the two main risk factors for postoperative cognitive confusion.
