ObjectiveTo explore the scientific method of hospital disease cost management under the disease payment system.MethodsThe data of " breast mass” disease in the case hospital of 2018 were collected, and the cost accounting of the disease was calculated by the income and expenditure ratio method, cost-to-charge ratio method, project-adding method, clinical path method, and activity cost method, respectively. Comprehensive evaluation was conducted for the five methods.ResultsThe direct costs of the disease calculated by income and expenditure ratio method, cost-to-charge ratio method, project-adding method, clinical path method, and activity-based cost method were 3 021.14, 3 387.79, 3 744.45, 3 997.44, and 4 297.18 yuan, respectively, and accounting for 63%, 67%, 70%, 74%, and 80% of total cost, respectively. The standard deviations of direct cost were 514.37, 495.23, 231.22, 317.33, and 197.47, respectively, of which the standard deviation of direct cost of the activity-based costing method was the smallest. The comprehensive scores of key performance indicator of the income and expenditure ratio method, cost-to-charge ratio method, project-adding method, clinical path method, and activity-based cost method were 4.15, 5.40, 7.85, 7.10, and 8.55, respectively.ConclusionsIn terms of the cost results and index evaluation of the disease, the activity-based costing method is the optimal method. The accounting process is close to the real path, which can track the cost drivers, enhance the cost controllability, and is conducive to the management of disease resource consumption.
The injuries caused by earthquake were characterized as complicated injuries, multiple injuries, crush injury, commonly accompanied by the impairment of the organs, open wound with susceptibility to contamination, difficulties in the implementation of in-time treatment, and resource-limited settings. Considering the specialty of early treatment of earthquake victims and existing misconduct, we propose recommendations according to general principles of early rationale use of antibiotics, in order to treat the earthquake victims safely, effectively and feasibly, and to decrease wound infection rates after surgery.
ObjectiveTo systematically review the incidence of social isolation in Chinese elderly population. MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and CENTRAL databases were electronically searched to collect studies on the incidence of social isolation in China from inception to May 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, meta-analysis was performed by using Stata 15.1 software. ResultsA total of 20 studies involving 86 111 subjects were included. Meta-analysis results showed that the incidence of social isolation among the elderly in China was 27.54% (95%CI 22.15% to 57.74%). The results of subgroup analysis showed that gender, age, educational level, marital status, self-assessment of health, living style, year of publication, and region surveyed were all influential factors of the incidence of social isolation among the elderly in China. ConclusionCurrent evidence shows that the incidence of social isolation among the elderly in China is relatively high. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
【摘要】 目的 探討2型糖尿病（T2DM）胰島素抵抗導致糖尿病性心功能不全的臨床表現特點及相關激素的改變。 方法 2008年1-4月對T2DM患者35例（胰島素抵抗指數HOMA-IRlt;2.69者19例為A1組，HOMA-IR≥2.69者16例為A2組）及健康體檢者20人B組測體重指數（BMI）、空腹血糖（FPG）、胰島素、心鈉素（ANP）、腦鈉素（BNP）水平；心臟彩色多普勒超聲分別測E/A、e/a、S/D、LVEF、DT期。 結果 A2組BMI較A1、B組均明顯增加（Plt;0.05），A1、B組間差異無統計學意義（Pgt;0.05）。ANP、BNP及DT值在A1、A2組均較B組增高（Plt;0.05），BNP在A2組高于A1組（Plt;0.05），ANP、DT值在A1、A2組間差異均無統計學意義（Pgt;0.05）。E/A、e/a和S/D在A1、A2組均較B組降低（Plt;0.05），A1、A2組間差異均無統計學意義（Pgt;0.05）。A2組患者LVEF較A1、B組均明顯降低（Plt;0.05），A1、B組間差異無統計學意義（Pgt;0.05）。 結論 隨著胰島素抵抗加重，心肌舒張順應性較差和收縮力下降，伴隨相關激素（心臟利鈉肽）分泌增加，最終產生心功能不全的臨床表現、體征及多普勒超聲心動圖表現。【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.
“Valve-in-valve” technique is an effective method to treat the bioprosthesis structural valve degeneration. In this paper, an 82-year-old male patient with severe aortic valve regurgitation had underwent surgical aortic valve replacement. He had a bioprosthesis structural valve degeneration which caused severe aortic stenosis more than 3 years after surgery. His symptoms of chest distress and short breath were aggravated progressively, and not relieved by conventional treatment. As the deterioration in his unstabled circulation system, an emergency transcatheter aortic valve replacement was conducted for him. The operation was finally successful, the symptoms were relived significantly after operation, and then the follow-up indicated that he had a good recovery.
