Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations

Quality of primary diabetes care is a key health policy concern in many OECD countries with an aging population. This cross-national, population-based study examined the extent and attributes of diabetes-related avoidable hospitalizations (DRAHs) in South Korea and Taiwan, both of which have social health insurance-based health systems with limited gate-keeping for hospitalizations. We analyzed comparable, nationally representative health insurance beneficiary datasets for the two countries (2002–2013), linked with community health resource data. The age- and sex-standardized DRAH rates were calculated, and multivariate, multi-level longitudinal modeling approaches were adopted. The DRAH rate decreased in Taiwan consistently during 2002–2013 and in Korea after 2011 only. Under the universal health coverage, people enjoyed high accessibility to care. A higher number of physician visits reduced DRAHs in Korea but not in Taiwan. Socio-economic disparities in DRAHs still existed in both countries, especially in Taiwan. We found a different trajectory in two similar health systems for the selected health system performance indicator for primary diabetes care. This can be partly explained by different policy approaches to diabetes management in the two countries over the years. Necessary are policy efforts to improve the quality and equality of primary diabetes care and better control of hospital admissions in these two health systems that provide generous access to care at a low cost in East Asia.     

新加二仙汤治疗老年高血压伴焦虑状态临床研究

目的:观察新加二仙汤治疗老年高血压伴焦虑状态的疗效及安全性。方法:95例确诊为老年高血压伴焦虑状态的患者按随机数字表法分为新加二仙汤组49例和拜新同组46例。拜新同组单纯使用拜新同片治疗,新加二仙汤组在服用拜新同片的基础上加用新加二仙汤,两组均连续治疗4周。治疗前后测量患者血压,统计患者中医临床证候评价量表、焦虑自评量表(SAS)评分,评价中医证候及降压疗效。结果:新加二仙汤组降压总有效率83.67%,高于拜新同组的65.22%,但差异无统计学意义(P0.05);与拜新同组比较,新加二仙汤组舒张压降低更明显。新加二仙汤组的中医证候评分较治疗前明显降低,差异有统计学意义(P0.01);新加二仙汤组中医证候疗效明显优于拜新同组,差异有统计学意义(P0.05)。与治疗前比较,新加二仙汤组治疗后的SAS评分明显降低,差异有统计学意义(P0.01);拜新同组无明显变化,差异无统计学意义(P0.05)。两组治疗期间均未出现明显不良反应。结论:新加二仙汤合用拜新同片能有效降低患者血压,且降低舒张压的效果更明显,可改善患者临床症状,缓解其焦虑情绪,有助于从多方面提高患者的生活质量。     

腹腔镜胆囊切除术与微创保胆手术治疗胆囊结石比较分析

目的对照观察腹腔镜胆囊切除术与微创下保胆手术治疗胆囊结石临床疗效、患者手术感受、术后并发症和治疗费用以及术后结石复发情况的差别。方法临床选用20例微创下保胆手术患者作为观察组,随机选取相同时间段20例使用腹腔镜胆囊切除术患者作为对照组,观察两组患者临床疗效、患者手术感受、术后并发症和治疗费用以及术后结石复发情况。结果微创保胆手术组患者临床疗效和手术感受与腹腔镜胆囊切除术对照组患者基本一致,两组患者在手术时间、费用、术后结石复发比例上有明显差异。结论腹腔镜胆囊切除术与微创保胆手术治疗胆囊结石患者均可达到很好的治疗效果,在有条件的医院可以逐步开展,但是目前不适宜最基层的外科临床。     

Sample Size Estimation of Multiregional Clinical Trials with Heterogeneous Variability Across Regions

In recent years, global collaboration has become a conventional strategy for new drug development. To accelerate the development process and shorten approval time, the design of multiregional clinical trials (MRCTs) incorporates subjects from many countries around the world under the same protocol. After showing the overall efficacy of a drug in all global regions, one can also simultaneously evaluate the possibility of applying the overall trial results to all regions and subsequently support drug registration in each of them. Several statistical methods have been proposed for the design and evaluation of MRCTs. Most of these approaches, however, assume a common variability of the primary endpoint across regions. In practice, this assumption may not be true, due to differences across regions (e.g., differences in ethnic factors and/or medical culture/practice). In this article, we use a random-effect model for modeling heterogeneous variability across regions for the design and evaluation of MRCTs. We also address consideration on the determination of the number of subjects in a specific region to establish the consistency of treatment effects between the specific region and the entire group.