某市社区卫生服务机构实施基本药物制度前后的经济运行情况比较

目的 了解基本药物制度实施前后某市试点三区社区卫生服务机构经济运行情况的变化及存在的主要问题.方法 采用整群抽样方法,抽取某市基本药物制度试点三区的41家城市社区卫生服务机构,对基本药物制度实施前后的财政补助、收支结构、结余情况、医疗服务提供量等指标进行分析.结果 样本机构经济运行的变化:(1)财政补助增加30.4%;(2)总收入增长5.0%,医疗总收入减少9.2%,药品收入增长6.6%,药占比例增至54.70%;(3)总支出增长14.4%;(4)总收支出现1 577万元的亏损,医疗总结余亏损增加,药品总结余降至753.9万元;(5)门急诊服务量下降8.7%,人均门诊费用增长12.5%.结论 社区卫生服务机构实施基本药物制度后,补偿机制尚不健全,虽然政府补偿明显增加,但仍补偿不足,存在亏损运营,部分机构仍存在"以药补医";社区卫生服务机构部分患者流失.建议加大政府财政投入,完善社区卫生服务机构经济补偿的机制和模式,优化基本药物目录,并加强基本药物制度的宣传教育.     

对药品价格改革的思考

1实行药品价格改革后医院的现状1.1长期以来,公立医院受计划经济影响,政府对医疗收费的定价相对偏低财政补助不足,药品收入成为医院收入的最主要部分。“以药养医”的实质就是以药品的差价收入来补偿医疗服务价格偏低和财政补助不足的部分,也是导致药品价格虚高的根本原因。如今医院已失去药品销售的优势,在医疗技术服务补偿不足的情况下,单方面大幅度降低药品价格,势必严重影响医院的经济运行和服务能力的提高。1.2药品价格降低后,在政府没有出台相应补偿机制的情况下,医院为了生存必然要采取一些应对方法有的医院为增加检查收入,提高大型…     

新医改背景下新疆公立医院财政补偿现状调查研究

目的：了解新疆医科大学6所附属公立医院收支及财政补偿的现状,为提出更加合理的财政补偿机制提供依据。方法采用回顾性调查的方法,收集新疆医科大学6所附属公立医院的2008－2012年财务报表数据,进行整理分析。结果2008－2012年新疆医科大学6所附属公立医院医疗收入占总收入的50．70％～52．15％,药品收入占40．17％～42．26％,财政补助收入仅占4．77％～7．89％。2008－2012年医院总收支差中药品收支差占44．42％～83．84％。结论政府对公立医院的财政投入比重严重偏低,“以药养医”是客观事实,增加政府财政对医疗卫生事业的补偿及建立合理的补偿机制是解决问题的关键。     

浙江省精神病医院收支状况调查分析

目的探讨浙江省精神病医院经济运行状况及其影响因素。方法以浙江省内所有独立设置的20所精神病医院为研究对象,从浙江省卫生统计信息中心提取样本医院2007年～2009年收入、支出、收支结余等数据。结果浙江省精神病医院总收入年均增加13．09％,药品收入占业务收入比例（平均52．40％）高于医疗收入（43．66％）,均次收费水平呈现出逐年上升,涨幅显著高于同期物价指数,在包括与不包括财政补助时,业务收支亏损率分别为10％、75％。结论浙江省精神病医院收入结构不合理,病人医疗负担加重,认为应建立政府财政长效保障机制,发挥财政补偿主渠道作用,建立医药费用控制的综合管理机制,加强收入结构调整,控制不合理费用增长,有效降低患者医药费用。     

陕西省公立医院成本补偿机制研究

目的 了解陕西省公立医院的总收支情况和三种成本补偿渠道的构成情况以及变化趋势.方法 结合焦点组访谈和现场调研的结果,根据医院收支的相关数据,分析2001、2004和2006年医院成本补偿方式的变化.结果 从2001年到2006年,政府财政投入对医院运行的影响日益显著,但仍不能全面满足医院的发展需要;医院收入依赖药品的局面短期内难以打破;医疗服务定价未能反映其实际成本.结论 当前的成本补偿机制给医院行为带来了不利的引导;完善财政投入和合理调整医疗服务价格是扭转这一现状的有效途径.     

陕西省公立医院成本补偿机制研究

目的 了解陕西省公立医院的总收支情况和三种成本补偿渠道的构成情况以及变化趋势.方法 结合焦点组访谈和现场调研的结果,根据医院收支的相关数据,分析2001、2004和2006年医院成本补偿方式的变化.结果 从2001年到2006年,政府财政投入对医院运行的影响日益显著,但仍不能全面满足医院的发展需要;医院收入依赖药品的局面短期内难以打破;医疗服务定价未能反映其实际成本.结论 当前的成本补偿机制给医院行为带来了不利的引导;完善财政投入和合理调整医疗服务价格是扭转这一现状的有效途径.     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系.由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线.从效果看降低了医疗和药品费用,提高r居民满意度.但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制.     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系.由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线.从效果看降低了医疗和药品费用,提高r居民满意度.但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制.     

医药费用控制及完善对策探析

以江苏省某大型医院的收支情况和医药费用情况为例,探索抑制医药费用的过快增长的各种手段,提出完善政府投入机制,控制医药费用上涨的建议,主要有:保持卫生投入总量适宜水平、优化政府卫生投入方向,完善政府卫生投入机制、完善医疗保障体系;改革收费方式,实现医院成本最小化的内涵发展模式;建立和完善社区医疗卫生服务体系;优化区域卫生规划统筹规划布局,引入社会资本;严格控制大型医疗设备的使用和加强药品及一次性医用耗材的价格及使用监管力度。     

厦门社区卫生服务模式效果初探

对原有社区卫生服务中心公共卫生与基本医疗功能进行合理划分,推进厦门市医疗资源的垂直整合,构建出具有厦门特色的新型社区卫生服务体系.由三级医院承办社区医疗服务中心;由区政府承办社区公共卫生服务中心;实行全额拨款、收支两条线.从效果看降低了医疗和药品费用,提高r居民满意度.但也存在三级医院对社区医疗服务理念理解偏误,财政补偿机制不完善等多种问题,需进一步探索一套与之相适应的运行管理机制.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.