对住院病人医疗服务评价及需求的调查分析

目的 考查医院现有服务结构的合理性和病人对医疗服务的需求。方法 对作者所在医院19个临床科室年龄15岁以上的130名病人进行问卷调查,医疗服务评价内容包括:(1)医院饮食、卫生状况;(2)收费合理性;(3)收费透明度;(4)病人总体满意度。医疗服务需求包括:(1)出院后服务;(2)药物类型;(4)病房类型(4)收费透明度;(5)知情选择。结果(1)医疗服务评价:87.4%病人对卫生状况满意,513%病人认为收费合理,6．7%病人认为收费不合理;37.2%病人认为收费透明度高,8.3%病人认为收费透明度低,大部分病人希望住院部每3~5 d给一次费用报告单;82．8%病人对医疗服务感到满意。表明医疗服务的综合质量虽然得到了病人的普遍赞同,但在饮食服务、收费透明度和收费合理性方面仍有待提高。(2)医疗服务需求:91.3%病人希望出院后一定时间内可免费看门诊或叶通过电话向主管医生咨询有关疾病防治、保健等问题;73．8%病人希望用合资企业生产的或国产药物,26．2%病人喜欢用进口药,仅11.3%病人认为药物越贵治疗效果越好;喜欢住50-70元双人间的病人占40．8%,愿意住30-50元多人间和90~120元单人间的病人比例分别为359%、23.3%;调查人群入住单人间、双人间与多人间的比例为2:39:59,病人需求的理想病房结构是36:41:23．矛盾突出在现在的人间设置得     

Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review

IntroductionTwo major techniques are used to repair complete quadriceps tendon ruptures, transosseous tunnel (TT) and the suture anchor (SA). There are multiple studies comparing the biomechanical outcomes of repairs performed with TT or SA. Our purpose was to compare the clinical outcomes following quadriceps tendon repair using SA and TT fixation techniques.MethodsThree major search engines were used with predetermined keyword searches to perform a systematic review of literature. These studies were independently scanned by two reviewers using PRISMA criterion. All included studies had to include at least one of the following outcome measures: range of motion (ROM), Lysholm score, complications, and/or re-ruptures.ResultsUsing three major search engines, 1039 articles were identified. After removing duplicates and screening for inclusion, 49 articles were reviewed. Two independent reviewers searched the studies to meet the inclusion criteria, and eight studies were selected. These eight studies included 156 knees in the TT group and 54 knees in the SA group. The TT group had a significantly better ROM after QT repair (132.5° versus 127.0°, p = 0.02). There was no significant difference in Lysholm scores between the TT group (92.6) and SA group (91.0, p = 0.11). There were significantly more complications in SA groups (9.3% versus 1.3%, p = 0.013), but not a significant difference in re-rupture rate between those undergoing SA vs. TT repair (3.7% versus 0%, p = 0.065). The SA group had a significantly higher age at time of surgery (63.62 vs. 54.32)ConclusionThe current study suggests that, following quadriceps tendon rupture, there are no significant differences in functional outcome between TT and SA techniques. Those undergoing TT repair attained a statistically significantly greater final ROM but this difference may not be clinically relevant. There was a statistically significantly higher rate of post-operative complications using SA technique.     

Efficacy and safety of a diode laser in second-stage implant surgery: a comparative study

For more than a decade, peri-implant tissues have been treated with soft tissue lasers to create a bloodless flap for implant placement and to uncover implants with minimal bleeding, trauma, and anaesthesia. This study was designed to assess if dental implant uncovering is possible with a diode laser without anaesthesia, and to compare its performance with traditional cold scalpel surgery. Thirty patients with a total of 45 completely osseointegrated implants participated in this study. Patients were divided into two groups. For the study group, second-stage implant surgery was done with a 970 nm diode laser. For the control group, the implants were exposed with a surgical blade. Certain parameters were used for evaluation of the two techniques. The use of the diode laser obviated the need for local anaesthesia; there was a significant difference between the two groups regarding the need for anaesthesia (P < 0.0001). However, there were no significant differences between the two techniques regarding duration of surgery, postoperative pain, time for healing, and success of the implants. The diode laser can be used effectively for second-stage implant surgery, providing both the dentist and the patient with additional advantages over the conventional methods used for implant exposure.     

Waist-to-thigh ratio is a predictor of internal organ cancers in humans: findings from a cohort study

ObjectiveStudies have shown that some specific body measures are associated with the occurrence of cancers. Few studies have demonstrated the relationship with more comprehensive approaches. This study aims to explore body measures and the combinations associated with internal organ cancers.MethodsThree-dimensional anthropometric body surface scanning data collected 10,215 participants from the health examination department in a medical center of Taiwan during 2000–2010. Follow-up was conducted for an average of 8 years, and 244 internal organ cancer cases were identified.ResultsAn increased risk of internal organ cancers was observed among the subjects with larger waist circumference/smaller thigh circumference, in which waist-to-thigh ratio (WTR) was constructed. Comparing the subjects in the fourth quartile for WTR to the subjects in the first quartile with multiple Cox regression analysis yielded a hazard ratio of 1.842 (95% confidence interval, 1.131～2.999). The association between WTR quartile and internal organ cancers was stronger among male participants, older participants, and participants with chronic conditions.ConclusionsThe study has revealed that WTR is the most significant predictor for the occurrence of cancer in Asian populations. Because it is easy to measure and open to modification, WTR may be more useful in clinical and preventive medicine in the future.     

Molecular characterization of enterovirus 71 sibling strains for thermal adaption in Vero cells with adaptive laboratory evolution

Enterovirus 71 is the main pathogen that causes severe and fatal hand-foot-mouth-disease (HFMD) cases. As the enterovirus virus mutation has implications for pathogenesis, vaccine development, antiviral therapy, and epidemiological disease management of the virus. In this study, we investigated the variations of enterovirus 71 in thermal adaption, using the method of adaptive laboratory evolution. The sibling virus strains were isolated from a 2-year-old severe case of HFMD (#100) and her symptomless close contact (#101). Both strains were cultured in Vero cells by serial passage of 36 generations at the temperatures of 28.0 °C, 33.0 °C and 39.5 °C to construct adaptive lineages. According to the comparative analysis of phenotypes between adapted strains and parental strains, differences in growth rate were observed in the sibling lineages and a larger plaque was found mainly in the hot adapted strains for lineage #101. Two sets of adaptive strains from six time points (parental, 12th 17th, 31st, 35th passage and endpoint) were sequenced and analyzed by both Sanger sequencing and Next Generation Sequencing. Several variations in most coding genes and one reverse mutation in 5′UTR was observed, along with the identity of 99.8% for complete genome for both lineages. Notably, thermal specific non-synonymous mutations were found in the gene of VP1\VP3\3A\2C\3C. Moreover, the concurrent mutations A292G, A434G and A355C/T of sibling lineages in VP1 showed quantificational trace with distinguishing patterns for different temperatures, which were suspected to be the thermo-sensitive mutation hotspots. These results highlight the possible rules of thermal adaption in enterovirus 71, produce a novel picture of genome evolution of the virus, and shed light on viral variation and evolution.     

Association between single limb standing test results and healthcare costs among community-dwelling older adults

Background and objectiveIdentifying risks for older adults who will require healthcare resources is critical for the government, healthcare providers, and consumers. The objective of this study was to examine the relationship between the results of the single limb standing (SLS) test and healthcare costs among community-dwelling older adults.MethodsWe used data obtained from a population-based prospective cohort study of the residents of Tadami town in Fukushima Prefecture, Japan. The participants were above 60 years of age and had undergone annual health check-ups, and data on their healthcare costs over the two-year study period were available. A censored regression model adjusted for potential confounders was used to estimate the mean difference in total healthcare costs between participants who could remain standing on a single limb for at least 30 s and those who could not.ResultsHealthcare costs of participants who passed the SLS test were significantly lower than those who did not. The mean difference between the two groups’ healthcare costs was 4064 USD (95 % confidence interval: 2661–5467 USD, p < 0.05). After adjusting for potential confounders, the mean difference between the two groups was smaller (1686 USD) but remained statistically significant (95 % confidence interval: 125–3246 USD, p < 0.05).ConclusionsAmong community-dwelling older adults, limited static balance (SLS time <30 s) was found to be associated with high healthcare costs in the two years after the SLS test. The SLS test may help identify individuals at high risk of becoming frequent users of healthcare services in the future.     

Impact of the HITECH financial incentives on EHR adoption in small,physician-owned practices

BackgroundPhysicians in small physician-owned practices in the United States have been slower to adopt EHRs than physicians in large practices or practices owned by large organizations. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 included provisions intended to address many of the potential barriers to EHR adoption cited in the literature, including a financial incentives program that has paid physicians and other professionals $13 billion through December 2015.ObjectiveGiven the range of factors that may be influencing physicians’ decisions on whether to adopt an EHR, and given the level of HITECH expenditures to date, there is significant policy value in assessing whether the HITECH incentives have actually had an impact on EHR adoption decisions among U.S. physicians in small, physician-owned practices. This study addresses this question by analyzing physicians’ own views on the influence of the HITECH incentives as well as other potential considerations in their decision-making on whether to adopt an EHR.MethodsUsing data from a national survey of physicians, five composite scales were created from groups of survey items to reflect physician views on different potential facilitators and barriers for EHR adoption as of 2011, after the launch of the HITECH incentives program. Multinomial and binary logistic regression models were specified to test which of these physician-reported considerations have a significant relationship with EHR adoption status among 1043 physicians working in physician-owned practices with no more than 10 physicians.ResultsPhysicians’ views on the importance of the HITECH financial incentives are strongly associated with EHR adoption during the first three years of the HITECH period (2010–2012). In the study’s primary model, a one-point increase on a three-point scale for physician-reported influence of the HITECH financial incentives increases the relative risk of being in the process of adoption in 2011, compared to the risk of remaining a non-adopter, by a factor of 4.02 (p < 0.001, 95% CI of 2.06–7.85). In a second model which excludes pre-HITECH adopters from the data, a one-point increase on the incentives scale increases the relative risk of having become a new EHR user in 2010 or 2011, compared to the risk of remaining a non-adopter, by a factor of 3.98 (p < 0.01, 95% CI of 1.48–10.68) and also increases the relative risk of being in the process of adoption in 2011 by a factor of 5.73 (p < 0.001, 95% CI of 2.57–12.76), compared to the risk of remaining a non-adopter in 2011. In contrast, a composite scale that reflects whether physicians viewed choosing a specific EHR vendor as challenging is not associated with adoption status.ConclusionsThis study’s principal finding is that the HITECH financial incentives were influential in accelerating EHR adoption among small, physician-owned practices in the United States. A second finding is that physician decision-making on EHR adoption in the United States has not matched what would be predicted by the literature on network effects. The market’s failure to converge on a dominant design in the absence of interoperability means it will be difficult to achieve widespread exchange of patients’ clinical information among different health care provider organizations.