Objective To explore the clinical application of vascular augmentation of an extra-long latissimus dorsi flap through an intercostal artery in limb wound repair. Methods Between January 2016 and December 2017, 5 patients with limb wounds were treated with the extra-long latissimus dorsi flaps. The vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery was applied during the operation. There were 4 males and 1 female, with an average age of 45.8 years (range, 43-59 years). The time from post-traumatic admission to flap repair was 7-25 days (mean, 12.3 days). The causes of injury included machine injury in 2 cases, traffic accident in 2 cases, and roller crush injury in 1 case. The wounds were located at the anterior of upper limb in 3 cases, the posterior of upper limb in 1 case, and the posterior of leg in 1 case. The size of wounds ranged from 26 cm×8 cm to 38 cm×10 cm. The size of the latissimus dorsi flap ranged from 36 cm×6 cm to 43 cm×7 cm. The size of the muscle flap ranged from 36 cm×10 cm to 43 cm×15 cm. The donor sites were closed directly. Results The distal flap necrosis occurred in 1 case and healed after symptomatically treatment. The other flaps survived completely. The wounds and incisions at donor sites healed by first intention. All patients were followed up 8-18 months with an average of 14.9 months. At last follow-up, the flaps had satisfactory appearances, soft textures, and function of sweating. Conclusion Application of vascular augmentation of the extra-long latissimus dorsi flap through the intercostal artery in repair of limb wound can reduce the incidence of distal flap necrosis and achieve satisfactory effectiveness.
Malignant tumors are the major diseases which threat human beings. Anti-cancer medicines play important roles in the treatment of malignant tumors, especially for the new targeted therapies. They bring the life hope for cancer patients who were sentenced to death, and improve quality of life, and some patients may achieve normal lifetime. However, the new anti-cancer medicines are usually too expensive to afford, and most of them have not yet been included in Chinese public health security system, the accessibility of the new anti-cancer medicines is seriously limited. This paper introduces the accessibility of high-cost anti-cancer medicines in China, analyzes the influence factors, and proposes policy recommendations to improve the accessibility of high-cost anti-cancer medicines in China.
Objective
To evaluate the methodological and reporting quality of systematic reviews/meta-analyses related to the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia.
Methods
PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data and VIP databases were searched by computer, and the systematic reviews/meta-analyses of corticosteroid hormone as an auxiliary means for the treatment of severe pneumonia which were published from establishment of the databases to October 25th, 2018 were searched. A Measurement Tool to Assess Systematic Review-2 (AMSTAR-2) was used to assess the methodological quality of the included studies, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to evaluate the quality of literature reports.
Results
A total of 16 systematic reviews/meta-analyses were included, all of which were non-Cochrane systematic reviews. In terms of methodological quality assessed by AMSTAR-2, there was no plan in all studies; only one study explained the reasons for inclusion in the study type; eight studies did not describe the dose and follow-up time of the intervention/control measures in detail; three studies did not indicate the evaluation tools and did not describe the risk bias; six studies did not explicitly examine publication bias. In terms of reporting quality assessed by PRISMA, all studies had no pre-registered study protocol or registration number; thirteen studies did not describe the specific amount of articles retrieved from each database; three studies did not present their retrieval strategies or excluded reasons in detail; no funding sources were identified in included studies; eight studies reported both whether the study was funded and whether there was a conflict of interest.
Conclusions
At present, there are many systematic review/meta-analysis studies on the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia, and the overall quality of the study has been gradually improved. However, the common problems in the study are relatively prominent. The follow-up period and dose of intervention in the study of severe pneumonia are different, so the baseline is difficult to be unified. Suggestions: strengthening the training of researchers, standardize the research process, and report articles in strict accordance with the PRISMA statement; subgroup analysis being conducted according to the dose and duration of the hormone.
Objective To investigate the financial burden of in-patients with thyroid diseases in the West China Hospital in Chengdu, Sichuan province, from January 2011 to December 2012, so as to provide baseline data for further research. Methods The data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital in 2011) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, initial diagnosis when the patients were discharged, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on the initial diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Results The results showed that: a) in 2011, 205 person-times were hospitalized in the department of endocrinology and metabolism, of which, 84 were male and 121 were female, with mean age of 45.3±15.7 years; b) for patients with thyroid diseases, median hospital stay was 10 days, the average cost of hospital stay for each patient was RMB 2 881.43 yuan, most of which was for lab tests and examination; c) the person-times of patients with hyperthyroidism was 162, accounting for 79.5% of the total of thyroid diseases, median hospital stay was 10 days, and the average cost of hospital stay was RMB 2 958.36 yuan; and d) there was no association between the number of hyperthyroidism complications and hospital stay and costs. Conclusion Thyroid diseases are a commonly-seen disease in the department of endocrinology and metabolism, of which, hyperthyroidism accounts for the most. There is no association between the number of hyperthyroidism complications and hospital stay/costs.
Objective Through the analysis of hospital costs of 16 866 cases of patients with lung cancer in Sichuan Province, in oder to find the main influencing factors of hospital costs of patients with lung cancer, and to provide references for reducing the hospital costs of patients with lung cancer. Methods We selected information of in-patients with lung cancer in 6 hospitals in Sichuan province from January 2008 to December 2011 based on full consideration into the local economic levels geographics distribution of different regions in Sichuan province. Then we extracted baseline data, hospitalization data and costs, and then analysis on relevant influencing factors was performed using single factor analysis of variance and multiple stepwise regression analysis. Results A total of 16 918 cases are chosen, of which, 16 866 were effective for further analysis. The results of statistical analysis showed that, the cost of western medicine accounted for the most of the average of the total hospital costs (50.79%) , followed by the cost of diagnosis and treatment (40.79%). The reuslts of multiple stepwise regression analysis showed that, the top three factors influencing hospital costs most included hospital stay, operation, and regions. Conclusion Facing daily increasing costs of hospital costs of lung cancer, effectively reducing drug expenses of patients could be a breakthrough. We could ultimately reduce the hospital costs of patients with lung cancer as well as the the economic burden of patients and society, by strengthening hospital management, shortening hospital stay, and rationally regulating drug use.
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.
ObjectiveTo investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer.MethodsBetween January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly.ResultsAll the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites.ConclusionThe latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.
ObjectivesTo analyze the economic burden caused by delay in the diagnosis and treatment of diabetes.MethodsThe employee/non-employee health insurance and medical examination data from Japan Medical Data Center (JMDC) and Milliman Inc. were used to analyze the health economic burden of the situation in case the diabetic population receives timelydiagnosis and treatment with real world data.ResultsThe overall population delaying the diabetes diagnosis and treatment in Japan was estimated to be 916 000, and the average time of delay was 39.6 months. The increase in time of delay was related with the increase in monthly medical costs after diabetes diagnosis. If the whole delayed population could receive timely diagnosis and treatment, it can totally save about 38.24 billion yuan (1.5% of the annual Japanese national medical expenditure.ConclusionsThe current study suggests a huge potential health economic burden that can be improved by promoting the diagnosis and treatment of diabetes, which provides reference for the economic evaluation of similar health policies and also the application of real world data in China in future.
ObjectivesThis study aimed to study the economic effect of five kinds of detection systems for nucleic acid, which were based on five kinds of working electrodes: gold electrode, glassy carbon electrode, carbon paste electrode, screen printing electrode, and indium-tin-oxide (ITO) glass electrode.MethodsThe cost of completing a single test was taken as the cost of economic analysis. The Youden index was used to represent the effect of cost-effectiveness analysis (CEA). Meanwhile, the cost-utility analysis (CUA) and incremental cost-effectiveness ratio (ICER) were used for the economic analysis of the corresponding system.ResultsThe cost of five detection systems based on gold electrode, glass carbon electrode, carbon paste electrode, screen printing electrode, and ITO glass electrode was 3.70 yuan/unit, 4.20 yuan/unit, 5.25 yuan/unit, 33.98 yuan/unit and 5.01 yuan/unit, respectively. The Youden indexes of all five systems were 1. The cost effectiveness (C/E) were 3.70, 4.20, 5.25, 33.98, and 5.01, respectively. The cost utility (C/U) were 6.61, 6.89, 9.91, 62.93, and 9.45, respectively. The C'/E and C'/U of the gold electrode detection system were the minimum (2.96 and 5.29). Compared with the system applying the gold electrode, the system using the glassy carbon electrode had ΔC >0 and ?E0 >0; When carbon paste electrode, screen printing electrode, and ITO glass electrode system were used, ?C was >0 and ?E0 was <0.ConclusionsFrom the perspective of CEA and CUA, the system using the gold electrode has the best economic effect. The sensitivity analysis proved the reliability of CEA and CUA results. According to the ICER, gold electrode or glassy carbon electrode can be used in clinical practice with the choice depending on the user.
