医疗卫生服务价格改革方向初探

医疗卫生服务价格改革是要理顺价格构成成份之间量的关系，使每个构成成份的价格值都在供求关系的约束中，在政府的有效管制中，从而成为医疗卫生资源合理配置的有效工具。为此：①对生产要素分别定价；②对劳动定价；③对资本和自然资源定价；④确定医疗卫生机构内部管理时劳动价格；⑤价格中的所有构成成份价格都置于供给和需求关系约束下；⑥确定医疗卫生服务价格的理想传递方式。     

医院后勤服务社会化实践中的几点思考

就医院后勤服务社会化的实际操作中的几个问题进行了论述,指出实行后勤社会化服务,必须有相应的外部环境;后勤部门实行企业化管理,必须有相配套的政策作保障;实施商品化服务,必须有对等的经济意识;加大后勤服务化的力度,必须有果敢超前的决策意识。     

Efficacy of continuous subcutaneous insulin infusion in Type 1 diabetes: a 2-year perspective using the established criteria for funding from a National Health Service.

AIM: To determine the 2-year efficacy of continuous subcutaneous insulin infusion (CSII) following the current established criteria for funding of a National Health Service. METHODS: Longitudinal, prospective, observational unicentre study. Included in the study were 153 Type 1 diabetes (T1D) subjects, previously treated with multiple daily injections (MDI) of insulin, in whom CSII was started in accordance with the criteria for reimbursement of the Catalan National Health Service. At baseline, we recorded data on age, gender, duration of the disease, body mass index (BMI), insulin dose and indications for CSII. Glycated haemoglobin (HbA(1c)) and the frequency of hypoglycaemic events were used to assess glycaemic control. Quality of life was assessed using three different self-report questionnaires. After 24 months, these same items were remeasured in all subjects. Serious adverse events and injection-site complications were also recorded. RESULTS: In 96% of subjects, CSII indication included less than optimal glycaemic control using MDI. HbA(1c) fell from 7.9 +/- 1.3 to 7.3 +/- 1.1% (P < or = 0.001) after 24 months of CSII. Insulin requirements were significantly lower at the end of follow-up (0.55 +/- 0.21 U/kg body weight) in comparison with before use of CSII (0.70 +/- 0.20, P < or = 0.001). BMI increased from 24.0 +/- 3.1 to 24.4 +/- 3.2 kg/m(2) after 24 months (P < or = 0.025). The rate of episodes of diabetic ketoacidosis per year remained unchanged. Mild and severe hypoglycaemic episodes were significantly reduced. The scores in all subsets of the Diabetes Quality-of-Life (DQoL) questionnaire significantly improved after 24 months of CSII. CONCLUSIONS: CSII, commenced according to the criteria for a nationally funded clinical programme, improves glycaemic control and quality-of-life outcomes with fewer hypoglycaemic episodes in T1D subjects previously conventionally treated with MDI.     

再论医院后勤服务社会化的可行性

目前，经济高速发展，服务体系和水准相对滞后，加上管理者素质的提高，现代管理技术的应用，以及后勤管理体制的改革，为医院后勤工作向社会分离提供了条件，也为推进医院后勤服务社会化提供了机遇。但规范卫生服务市场体系是后勤服务社会化的保障，故要建立：卫生物质流通、后勤人才流动、经济信息市场及卫生建设筹资机构。在推进后勤服务社会化时尚需解决：①支持条件；②实施集团联盟；③注意经营定位等问题。     

现代化医院呼唤现代服务模式

当前我们正在向建设基本现代化医院迈进,在注意硬件建设的同时,不要忽略软件建设。硬件建设需要大量投入,较易见成果;而后者无需大量财力投入,只需转变医院人的思想观念,就能使医院明显改观。     

Cell-mediated immunity in leprosy and transfer of delayed hypersensitivity reactions

Eighty-nine patients with leprosy, 65 classified as lepromatous and 24 as tuberculoid, were examined in this study. Skin test responses to protein antigens and dinitrochlorobenzene (DNCB) were depressed in lepromatous patients compared to controls. Tuberculoid patients did not exhibit a significant depression to microbial antigens, but they showed a definite depression in the ability to be sensitized with DNCB. The transfer of delayed hypersensitivity reactions to tuberculin, trichophytin, and lepromin (Fernandez and Mitsuda reactions) was accomplished in lepromatous and indeterminate leprosy patients using viable lymphocytes from donors presenting positive reactions to these antigens. The lepromin reaction was also transferred to patients with South American blastomycosis and cutaneous leishmaniasis. The positive reactions of adoptive immunity were confirmed by histologic examination of skin biopsies.     

Psychological and neuropsychological aspects of COPD

A review of the literature dealing with the effects of chronic obstructive pulmonary disease (COPD) on psychological and neuropsychological functioning indicates that significant emotional and adaptive deficits characterize this patient population. Psychiatric consultation can provide valuable assistance to the primary care physician by reducing emotional distress and correcting dysfunctional attitudes and beliefs. Neuropsychological assessment can elucidate an individual's neurobehavioral resources and deficits.     

Glomerular matrix proteins in nodular glomerulosclerosis in association with light chain deposition disease and diabetes mellitus

The diagnosis of light chain deposition nephropathy is based on the immunohistochemical demonstration of monoclonal light chain deposits within connective tissue matrix and on the presence at the ultrastructural level of electron-dense granular deposits along glomerular and tubular basement membranes. A nodular glomerulopathy characterized by amorphous periodic acid-Schiff-positive and argyrophilic widened mesangium and nodules is described in three patients with light chain deposition nephropathy. Light microscopic examination did not allow discrimination between the glomerular changes found in these specimens and the nodular glomerulosclerosis described in four patients with well-documented diabetes mellitus. Electron microscopic examination revealed microtubular fibrils 10 to 12 nm thick in mesangial areas in both groups. Such microfibrils could be glycoproteins. Immunofluorescence localization of matrix proteins, by staining with affinity-purified antibodies to types I, III, IV, and V (A, B) collagens, fibronectin, laminin, and heparan sulfate-containing proteoglycans, showed similar distributions in the two conditions. The mechanism of this abnormal accumulation of mesangial and glomerular basement membrane matrix proteins in two different conditions remains unknown.     

Skin test suppression by antihistamines and the development of subsensitivity

The suppression of skin test reactivity by single doses of six antihistamines was measured before and after a period of daily antihistamine ingestion in 18 subjects. Single doses of hydroxyzine, 50 mg; chlorpheniramine, 16 mg; and promethazine, 50 mg; induced significant suppression of skin test reactivity at 2 hr, whereas the suppression produced by tripelennamine, 100 mg; diphenhydramine, 50 mg; and cyproheptadine, 16 mg; did not differ significantly from that produced by placebo. After 3 wk of treatment with hydroxyzine, 75 mg per day, the suppressive effect of hydroxyzine as well as the five clinically unrelated antihistamines was significantly reduced. Although the response to chlorpheniramine was also reduced after chronic treatment with chlorpheniramine, 24 mg per day, the difference was not statistically significant. We conclude that antihistamines in the doses used differ greatly in their suppressive effect on skin test reactivity. The antihistamine producing the most skin test suppression, hydroxyzine, when it was taken daily for 3 wk, caused the development of partial tolerance not only to its own effect but to those of clinically unrelated antihistamines.