Objective The rising medical expenditure is an international problem. By comparing theories and methods of medical expenditure control between China and the US, this paper aims to find out the medical expenditure strategies fitting for our country and to help with the new round of medical and health system reform. Methods This evidence-based research searched for literatures using the search strategy and screened literatures according to inclusion and excluding criteria. Useful information in the literatures was extracted through quantitative analysis of literature tables and descriptive statistical analysis. Results We found that the US academia showed a sustainable and steady trend of increased concern on the medical expenditure control, while the Chinese academia showed a larger volatility on it. There were some obvious differences such as reasons for expenditure increase, the reasonableness of the medical expenditure increase, and the specific methods and strategies of the medical expenditure control between Chinese and American authors. Conclusion On the one hand, the purpose of medical expenditure control is based on the different stages of development. On the other hand, the main interest group determines the main body who is responsible for the medical expenditure control. According to our national context, China should develop effective strategies and methods for medical expenditure control.
In order to understand the influence of the free tendon graft and the tendon transfer on their blood supply, histological and biochemical changes during healing following repair of the damaged tendon after the alteration of the nourishing environment, an experiment was carried on 36 New Zealand white rabbits. In the front paws of the rabbits, the free tendon graft was sutured in the tendon defect of flexor of the fourth toe and the flexor tendon of the third toe was transferred to the second toe to reconstr...
Purpose
To evaluate differences in the pattern of optic disc and retinal nerve fiber layer (RNFL) damage in normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) patients.
Methods
We enrolled 49 eyes of 49 patients:30 NTG (IOP≤21 mm Hg,1 mm Hg=0.133 kPa), 19 HTG(IOP≥25 mm Hg). Mean age was 59.2±12.3 (range, 36-75) for HTG patients, and 59.6±8.6(range, 39-71) for NTG patients. All patients underwent complete ophthalmic examination, achromatic automated perimetry (AAP), scanning laser ophthalmoscopy (SLO), scanning laser polarimetry (SLP), optical coherence tomography (OCT) and Heidelberg retinal tomography (HRT). All patients had glaucomatous optic nerve damage and abnormal AAP.
Results
There were no differences in mean deviation on AAP between NTG and HTG eyes (P=0.37), while the corrected pattern standard deviation was larger in NTG than in HTG eyes (P=0.014). Cup∶disc area ratios in global (P=0.03) and three sectors (Plt;0.05) except nasal sector were significantly larger in the NTG group, whereas rim area in global (P=0.03) and three sectors (Plt;0.05) except nasal quadrant obtained by SLO were smaller in NTG than in HTG eyes. The other numerical parameters obtained by three imaging technologies could not detect differences in the optic disc or RNFL anatomy between the two groups.
Conclusions
Cup∶disc area ratio was larger in patients with NTG than in those with HTG, whereas significant thinning of rim was associated with NTG eyes. The measurement of retinal nerve layer thickness in global and each quadrant was similar between two groups. More focal or segmental analysis of the data contained within SLO, SLP and OCT images are needed to detect localized differences in eyes with varying levels of IOP.
(Chin J Ocul Fundus Dis, 2002, 18: 109-112)
ObjectiveTo compare the effect of problem-based learning (PBL) and traditional teaching method (lecture-based learning) on clinical practical teaching of orthopedic surgery.
MethodsBetween May 2012 and December 2013, 55 orthopedic interns were chosen to be divided into two groups: PBL group (n=29) and traditional lecture group (control group, n=26). Case report and examination on a completion of orthopedic surgery were used to assess the teaching outcomes.
ResultsPerformance differences in content of presentation and capability of answers to questions were significant between PBL group and the traditional group in the report test (P<0.05). The test scores of case analysis examination in PBL group were significantly higher than those in the traditional lecture group (P<0.05). There was no significant difference between the two groups in other types of questions (P>0.05).
ConclusionThe participants in PBL group have performed significantly better in culturing clinical thinking and comprehensive analysis, competence and in no circumstance did they perform worse than traditional lecture method.
Objective To compare effects, advantages and disadvantages of simple internal fixation to that of l imited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group (n=39) and the external fixator group (n=27). The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The external fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups (P gt; 0.05). Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the princi ple of internalfixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases inthe internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture heal ing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture heal ing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups (P gt; 0.05). Conclusion The therapeutic effects of simple internal fixation and l imited internal fixation with external supporting frame fixation were similar in the treatment of complex fractures of tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.
Objective To explore the difference of cardiovascular risk factors and coronary artery lesion between Hui nationality and Han nationality patients with premature coronary heart disease. Methods A total of 316 patients with premature coronary heart disease were divided into two groups, including the Hui group (78 cases) and the Han group (238 cases). Eight risk factors for premature coronary heart disease (including age, gender, body mass index, familial heredity, diabetes, hypertension, dyslipidemia and smoking history) and coronary artery lesion characteristics were compared between the two groups. Results Compared with the Han group, the Hui group had a higher prevalence of smoking history and myocardial infarction, but a lower prevalence of angina (Plt;0.05). Type A disease was the major type in both Hui and Han groups. Compared with the Han group, the rate of type C were higher. Single-vessel lesion was the major lesion in both Hui and Han groups. The incidence of three-vessel lesion in the Han group was significantly lower than that in the Hui group. Gensini score in the Hui group was higher than that in the Han group, with a significant difference (Plt;0.05). Conclusion Hui patients with premature coronary artery disease are more than Han patients with premature coronary artery disease in proportions of smoking, diabetes, and the lesions of the left anterior descending artery, the right coronary artery disease, three-vessel disease rate, and C-type lesions. The coronary artery disease of the Hui group is more serious.
Objective To compare the outcomes of 23G and 20G vitrectomy in treatment of proliferative diabetic retinopathy (PDR). Methods This was a prospective randomized study. One hundred twenty six patients (142 eyes) suffering from PDR with symptoms requiring vitrectomy were randomly divided into 20G vitrectomy group (66 patients, 74 eyes) and 23G vitrectomy group (60patients,68eyes). Visual acuity, intraocular pressures,indirect ophthalmoscopy, B-scan ultrasound, tear film break up time (BUT), Schirmer Ⅰ test (S Ⅰ T), astigmatic power and the astigmatic axial at 6 mm area of anterior and posterior corneal surface were observed and measured before surgery. The follow-up period was 15.0 and 12.5 months separately in 20G and 23G groups. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications, reoperation, and postoperative ocular conditions including changes of astigmatic power and the astigmatic axial measurements were analyzed. Results At last follow-up, there was 49 eyes (66.2%) and 47 eyes (69.1%) with visual acuity ge;0.05 in 20G and 23G groups. Comparing visual acuity ge;0.05, there was no statistical difference between the groups (chi;2=0.14, P＞0.05). The eyes suffering from iatrogenic injuries were 18 (24.3%) and seven (10.3%). There was obvious difference in iatrogenic injury between the two groups (chi;2=4.81, P＜0.05). The mean surgical times were (69.0plusmn;8.2) and (51.0plusmn;6.3) minutes in 20G and 23G group, which was significantly different (t=3.65, P＜0.05). The postoperative third day, hypotony was detected in three (4.1%) and 11 eyes (14.7%) in 20G and 23G group, which was a significantly different (chi;2=5.85, P＜0.05). Postoperatively high intraocular pressures were not significantly different between the two groups (chi;2=2.54,P＞0.05). There were 24 (32.4%) and 14 eyes (20.6%) in 20G and 23G group. There were significant differences in BUT, SⅠT, astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first month after operation (t=3.35, 4.12, -3.12, -3.22; P＜0.05), but no significant differences in them at the third and sixth month after operation (third month: t=0.45, 0.98, -2.12, -1.02; P＞0.05, and the sixth month: t=0.95, 1.48, -1.02, -2.11; P＞0.05). In 23G group, there were no significant differences in BUT, SⅠT, astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first, third and sixth month after operation (first month: t=1.21, 1.46, -2.32, -1.61; P＞0.05, third month: t=1.45, 2.21, -2.19, -1.89; P＞0.05, and sixth month: t=1.92, 1.25, -1.76, -2.35; P＞0.05). Conclusion 23G vitrectomy is a safe and effective treatment for PDR with shorter surgery time, fewer surgical complications and postoperative ocular surface changes.
Objective
To summarize and compare the functional characteristics and technical parameters of the comprehensive global clinical practice guideline (CPG) databases, so as to provide references for the construction of CPG database of China.
Methods
CPG databases were collected worldwide by discussing with experts in the guideline and database fields. Studies on guideline databases were searched in PubMed and CNKI to additionally collect CPG databases mentioned in these studies. Representative comprehensive CPG databases were finally selected by consulting relevant guideline experts. The basic information, functional characteristics (including column settings, service contents, and related file types) and technical parameter data were extracted and summarized. A descriptive analysis was conducted to compare different CPG databases.
Results
Nine guideline databases which are distributed in eight countries of the Americas, Europe, Oceania and Asia were included. The number of included guidelines of the nine databases ranged from 31 to 15 410. The earliest database was established in 1993. Except that the MINDS database didn’t provide search function, eight databases provided basic search function, and six provided further advanced search function. PDF and HTML formats of guidelines were available in most databases, but the XML format was only available in National Guideline Clearinghouse (NGC). Responsive Web design was an important feature for most websites of databases and four databases developed mobile applications. Local mainstream social media sharing function was provided by six databases. All databases’ construction was professional in technical parameters including network transmission, Web server, programming language and the selection of server room.
Conclusion
This study compares the functional features and technical parameters of the comprehensive global CPG databases, which provides important information that should be considered in establishing a guideline database, to strengthen the top-level design or to help optimize the functionality of a guideline database. It also helps guideline databases users to find more proper resources.
Objective To evaluate short-term effects of percutaneous microwave coagulation therapy（PMCT） combined with chemotherapy in patients with advanced non-small cell lung cancer（NSCLC）.Methods Eighty cases with advanced NSCLC were randomly assigned to underwent chemotherapy plus PMCT(PMCT group，n=40) or single chemotherapy(chemotherapy group，n=40).The chemotherapeutics regimen was Taxotere plus Cisplatin.The preliminary results and quality of life score of two groups were compared.Results In PMCT group and chemotherapy group，the 3-month relieve rate was 52.5% and 32.5%，and the half-year survival rate was 87.5% and 62.5%，respectively.The differences between the two groups were both significant(Plt;0.05).The quality of life score in PMCT group was significantly higher than that in chemotherapy group (Plt;0.05).Conclusion PMCT combined with chemotherapy is effective and safe in the treatment of advanced NSCLC.
ObjectiveTo discuss the relationship between antinuclear antibody (ANA) fluorescence pattern detected by indirect immunity fluorescence (IIF) and antinuclear antibody profiles (including anti-dsDNA, RNP, Sm, SSa, SSb, Scl-70, Jo-1 and rib-P) in human serum.
MethodsA total of 7385 cases of ANA pattern and ANA profiles were retrospectively analyzed from January 2010 to December 2013. ANA was detected by IIF substrated as HEp-2 cells, anti-dsDNA by IIF substrated as crithidia, and the other 7 antibodies by enzyme immunoblot with purified antigen.
ResultsGranular pattern mostly presented as anti-RNP, anti-Sm, anti-SSa and anti-SSb (P < 0.001); homogeneous pattern was anti-dsDNA and anti-SSa (P < 0.001); nucleolus, centromere, and mixed pattern was anti-SSa (P < 0.05); cytoplasm pattern was anti-rib-P and anti-SSa (P < 0.05). But few above antibodies could be detected in Golgi, dots, rim, actin, actotropomyosin, prolifevating cell nuclear antigen (PCNA) and vementin pattern. Homogeneous pattern was shown up to 77.91% in only anti-dsDNA positive serum; granular was 96.84%, 52.01%, and 82.35% respectively in only anti-RNP or anti-SSa or anti-Sm positive. Homogeneous and nucleolus mix pattern was up to 30.53% in only anti-Scl-70 positive. Cytoplasm pattern was 50.00% and 61.54% respectively in only anti-rib-P or anti-Jo-1 positive. But no fixed relationship was found between ANA pattern and anti-SSb.
ConclusionsThere is a certain relationship between ANA and antinuclear antibody profiles. Granular, homogeneous and cytoplasm pattern often can be detected more than one autoantibodies. Eight kinds of specific autoantibodies often are negative when ANA patterns are centromere, Golgi, dots, rim, actin, tropomyosin, PCNA, and vimentin. Anti-dsDNA is mainly corresponding to homogeneous, anti-RNP, anti-SSa and anti-Sm to granular, anti-Scl-70 to homogeneous and nucleoli, anti-rib-P and anti-Jo-1 to cytoplasm. The study can give suggestions for further tests application and lab result checking.
