江苏省儿童专科夜间门诊诊察费定价政策成效分析

2019年5月20日,江苏省医保局推出调整了儿童专科夜间门诊诊察费收费标准举措。文章以江苏省某三甲综合医院为样本,围绕上述政策实施后儿科诊疗工作量、病人满意度、医院收入影响等方面进行了调查,结果表明,上述政策可满足儿科病人就诊差异化需求,合理分流病人,保障急诊优先的诊疗秩序。     

Can Participants’ Characteristics Predict Benefit from a Multimodal Burnout Prevention Program? Secondary Analysis of a Randomized Controlled Trial Conducted in Germany

Abstract

Chronic psychological distress appears to be increasing markedly among the working population. A recent randomized controlled trial (RCT) supported the effectiveness of a three-week outpatient burnout prevention program—comprised of stress management interventions, relaxation, physical exercise, and moor baths followed by massage—in reducing perceived stress and emotional exhaustion. However, the effectiveness of treatments in the real world that were shown to be efficacious in RCTs is related to the appropriate selection of individuals who are most likely to yield sustainable gains. Therefore, factors predicting the intensity of response and nonresponse of individuals to treatment are of interest. This secondary data analysis aims to explore predictors of response to the outpatient burnout prevention program in a sample of eighty employed persons at high risk of burnout. Hierarchical linear regression was performed to identify predictors of successful response—defined by lower perceived stress at last follow up. Nutritional behavior, symptoms of eating disorder syndrome, and well-being were significant predictors of perceived stress at last follow up, when adjusted for age, sex, education level, baseline stress values, and timing of intervention. Persons with low levels of well-being, poor nutritional behavior, and higher symptoms of eating disorders should be given special care and attention to ensure that they respond well to the outpatient burnout prevention program.     

全腹腔镜、腹腔镜辅助与开腹胃癌根治术治疗Ⅱ、Ⅲ期胃癌的疗效对比

目的探讨全腹腔镜胃癌根治术（TLG）、腹腔镜辅助胃癌根治术（LAG）与传统开腹术（TOS）对Ⅱ、Ⅲ期胃癌的近期及远期疗效。 方法回顾性分析2013年1月至2016年6月陕西中医药大学附属医院行胃癌根治术的患者共136例，根据患者手术方式的不同分为TLG组（45例），LAG组（40例），TOS组（51例）。观察和比较3组患者手术时间、出血量、淋巴结清扫数、术后排气时间、住院时间、术后并发症发生情况，采用Kaplan-Meier法对患者术后5年远期疗效进行生存分析。 结果TLG组患者出血量、排气时间及住院时间低于TOS组及LAG组，LAG组患者手术时间高于TLG组及TOS组，差异均有统计学意义（P<0.05）；3组患者术后并发症发生率比较，差异无统计学意义。共129例获得随访，其中TLG组失访2例，LAG组2例，TOS组3例。TLG、LAG、TOS组平均无瘤生存时间为（53.4±2.1）个月（95%CI=50.45~58.22个月）、（54.3±2.0）个月（95%CI= 47.99~56.18个月）、（52.3±2.1）个月（95%CI=50.98~55.65个月），3组患者无瘤生存时间比较，差异无统计学意义（F=0.519，P=0.772）。 结论TLG术能够在保证患者术后疗效的同时，降低患者术中出血量、排气时间及术后住院时间，TLG术治疗Ⅱ、Ⅲ期胃癌安全可行，疗效显著，值得推广。     

优质护理干预对肺结核患者用药依从性的作用

目的对优质护理干预对肺结核患者用药依从性的作用进行观察。方法选择本院收治的120例肺结核患者作为本次研究的纳入对象,选取时间段为2017年1月-2018年1月,随机将这些患者划分为两组,甲组60例,乙组60例,采用常规护理方式护理甲组患者,在此基础上,应用优质护理干预的方式护理乙组患者,对两组患者的治疗依从性进行分析和比较。结果在经过精心的护理之后,甲组中23例完全依从,23例部分依从,14例不依从,总依从率达到了76.7%,乙组中37例完全依从,21例部分依从,2例不依从,总依从率达到了96.7%。乙组在总依从率方面相对于甲组而言更高(P <0.05)。结论采用优质护理干预的方式护理肺结核患者具有很好的效果,能够使患者的用药依从性得以显著提升,从而进一步保障患者的治疗效果。     

Comparative Effectiveness of Computed Tomography- Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma

Background

For patients with hepatocellular carcinoma (HCC) not eligible for surgical resection, radiofrequency ablation (RFA) is a promising technique that reduces the risk of disease progression.

Hospitalization costs and resource allocation in cholecystectomy with use of intravenous versus oral acetaminophen

Objective: To evaluate intravenous (IV) acetaminophen (APAP) vs oral APAP use as adjunctive analgesics in cholecystectomy patients by comparing associated hospital length of stay (LOS), hospital costs, opioid use, and rates of nausea/vomiting, respiratory depression, and bowel obstruction.

Methods: We conducted a retrospective analysis of the Premier Database (January 2012 to September 2015) including cholecystectomy patients who received either IV APAP or oral APAP. Differences in LOS, hospitalization costs, mean daily morphine equivalent dose (MED), and potential opioid-related adverse events were estimated. Multivariable logistic regression was performed for the binary outcomes and instrumental variable regressions, using the quarterly rate of IV APAP use for all hospitalizations by hospital as the instrument in two-stage least squares regressions for continuous outcomes. Models were adjusted for patient demographics, clinical risk factors, and hospital characteristics.

Results: Among 61,017 cholecystectomy patients, 31,133 (51%) received IV APAP. Subjects averaged 51 and 57 years of age, respectively, in the IV and oral APAP cohorts. In the adjusted models, IV APAP was associated with 0.42 days shorter LOS (95% CI?=?–0.58 to –0.27; p?p?p?=?.0005), and lower rates of respiratory depression (odds ratio [OR]?=?0.89, 95% CI?=?0.82–0.97; p?=?.006), and nausea and vomiting (OR?=?0.86, 95% CI?=?0.86–0.86; p?Conclusions: In patients having cholecystectomy, the addition of IV APAP to perioperative pain management is associated with shorter LOS, lower costs, reduced opioid use, and less frequent nausea/vomiting and respiratory depression compared to oral APAP. These findings should be confirmed in a prospective study comparing IV and oral APAP.