Cost of postoperative complications: How to avoid calculation errors

Postoperative complications(PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients' clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC,improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.     

基于生物活性与效应基准的中药质量 评价技术发展现状与展望

中药质量的评控问题是制约中药现代化发展的瓶颈,因此有必要在现有检测方法的基础上结合生物评价,继而更为全面地保证中药质量。生物评价是完善中药质量标准、保证临床功效和安全性评价的重要方法,已成为中药质量标准化发展趋势之一。在此处主要论述了近年来基于生物活性与效应基准的中药质量评价技术和已取得的部分研究进展,同时对目前中药质量生物评价研究与应用中存在的主要问题进行探讨,进一步对其未来应用做出展望,从而更好的对中药质量进行控制。     

手术室细节护理管理在医院感染控制中的应用评价

目的探讨手术室细节护理管理在医院感染控制中的应用效果。方法选定2017年1月-2018年3月该院收诊的160例手术室患者,按照管理方法的不同分为观察组(细节护理管理)80例与对照组(传统护理管理)80例,比较两组手术室患者的护理质量、并发症发生率、感染发生率、护理满意度、收缩压。结果观察组护理管理后的护理安全(82.23±6.14)分、体征监测(93.46±6.23)分、体位协助(87.32±4.65)分、器械准备(91.57±6.21)分、文书记录(90.24±4.92)分、护理满意率(98.75%)均高于对照组(P<0.05);观察组护理管理后的并发症发生率(2.50%)、感染发生率(1.25%)、收缩压(121.37±6.26)mmHg均低于对照组(P<0.05)。结论细节护理管理方法可有效提高手术室患者的护理满意度,减少其感染情况,值得推广使用。     

Economic Evaluation of Factorial Trials: Cost-Utility Analysis of the Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes 2 × 2 × 2 Factorial Trial of Atorvastatin,Omega-3 Fish Oil,and Action Planning

ObjectivesWe applied principles for conducting economic evaluations of factorial trials to a trial-based economic evaluation of a cluster-randomized 2 × 2 × 2 factorial trial. We assessed the cost-effectiveness of atorvastatin, omega-3 fish oil, and an action-planning leaflet, alone and in combination, from a UK National Health Service perspective.MethodsThe Atorvastatin in Factorial With Omega EE90 Risk Reduction in Diabetes (AFORRD) Trial randomized 800 patients with type 2 diabetes to atorvastatin, omega-3, or their respective placebos and randomized general practices to receive a leaflet-based action-planning intervention designed to improve compliance or standard care. The trial was conducted at 59 UK general practices. Sixteen-week outcomes for each trial participant were extrapolated for 70 years using the United Kingdom Prospective Diabetes Study Outcomes Model v2.01. We analyzed the trial as a 2 × 2 factorial trial (ignoring interactions between action-planning leaflet and medication), as a 2 × 2 × 2 factorial trial (considering all interactions), and ignoring all interactions.ResultsWe observed several qualitative interactions for costs and quality-adjusted life-years (QALYs) that changed treatment rankings. However, different approaches to analyzing the factorial design did not change the conclusions. There was a ≥99% chance that atorvastatin is cost-effective and omega-3 is not, at a £20 000/QALY threshold.ConclusionsAtorvastatin monotherapy was the most cost-effective combination of the 3 trial interventions at a £20 000/QALY threshold. Omega-3 fish oil was not cost-effective, while there was insufficient evidence to draw firm conclusions about action planning. Recently-developed methods for analyzing factorial trials and combining parameter and sampling uncertainty were extended to estimate cost-effectiveness acceptability curves within a 2x2x2 factorial design with model-based extrapolation.     

认知行为干预在冠心病患者护理中的应用效果

目的观察认知行为干预在冠心病患者护理中的应用效果。方法选取本院2016年12月～2018年2月期间收治的53例冠心病患者,根据住院号奇偶性情况将其随机分为观察组(n=27)和对照组(n=26),对照组予以常规护理,观察组予以认知行为干预。比较两组患者控制态度评分、心理状况评分、生活质量改善情况及依从性。结果观察组控制态度评分、心理状况评分、生活质量改善情况及依从性与对照组比较,差异有统计学意义(P0.05)。结论在冠心病患者护理中给予认知行为干预应用效果极佳,可作为临床干预首选措施。     

循经冥想训练干预大学生抑郁情绪的效果分析

背景　现有研究表明，抑郁是影响大学生心理健康的重要原因之一。因此，有必要采取有效的方法干预大学生抑郁情绪。目的　探究循经冥想训练干预大学生抑郁情绪的效果。方法　2018年4月，在以循经冥想课题组的名义招募的某大学本科生中，发放抑郁自评量表（SDS），筛选出自愿接受循经冥想训练的60人。根据受试者性别比例，采用随机数字表法随机分为循冥组和静息组。其中循冥组30人进行4周循经冥想训练，在开始循经冥想训练前和循经冥想训练结束后填写SDS并进行E-prime情绪图片评价任务。静息组30人进行静息训练，其余与循经冥想组相同。比较两组前测、后测及前后测差值有无差异。结果　两组前测积极、中性、消极情绪图片评分比较，差异均无统计学意义（P>0.05）；两组后测积极、中性、消极情绪图片评分比较，差异均无统计学意义（P>0.05）；两组积极、中性、消极情绪图片评分前测与后测差值比较，差异均无统计学意义（P>0.05）。静息组前测与后测积极、中性、消极情绪图片评分比较，差异均无统计学意义（P>0.05）。循冥组后测积极情绪图片评分低于前测、消极情绪图片评分高于前测（P<0.05）。两组前测SDS评分比较，差异无统计学意义（P>0.05）。循冥组后测SDS评分低于静息组，SDS评分前测与后测差值高于静息组（P<0.05）。循冥组和静息组后测SDS评分均低于前测（P<0.05）。结论　循经冥想能降低大学生抑郁水平，可能是由于其能够改变人的情绪认知评价和睡眠质量，使人变得平和。     

Changes in the SF-12 among Depressed Elders Six Months after Discharge from an Inpatient Geropsychiatric Unit

Using the SF-12 to measure physical and mental functioning, the authors examine the intra-individual changes in health-related quality of life (HRQOL) 6 months post-discharge for depressed older adults. In addition, they examine three sets of predictors that might influence these changes. The sample of depressed older adults was recruited from an inpatient geropsychiatry unit. Although their physical and mental health scores on the SF-12 were lower than comparable norms, the sample showed an average increase in their mental functioning but a decrease in the physical functioning over the 6 months. Negative life-events were significant predictors of people who reported no change in their mental health functioning and decreases in their physical health functioning. Interestingly, those who experienced positive life events were more likely to report declines and younger participants were more likely to report no change in their physical functioning. The findings indicate that the effects of depression on HRQOL can have enduring effects on a sample of previously hospitalized older adults. The significance of life event changes might signify the importance of taking into account non-traditional areas of medical interventions. Further, the findings indicate the usefulness of the SF-12 quantifying HRQOL outcomes.