Volume and yield of screening colonoscopy at a tertiary medical center after change in medicare reimbursement

OBJECTIVE: Starting July 1, 2001, Medicare began to reimburse for screening colonoscopy in asymptomatic adults older than 50 yr with no risk factors for colorectal cancer. We sought to determine the short-term impact of the change in Medicare reimbursement on the demand for and yield of screening colonoscopy at our tertiary institution. METHODS: Asymptomatic patients older than 50 referred for first screening colonoscopy after the change in Medicare reimbursement from July 1, 2001 to December 31, 2001 were compared with a similar cohort screened before Medicare coverage for a family history of cancer or polyps during the same months the previous year (July 1, 2000 to December 31, 2000). Patient demographics, number, size, location, and histology of polyps/cancers for these screening colonoscopies were collected. RESULTS: A total of 1282 colonoscopies were performed in our institution from July 1, 2001 to December 31, 2001, 257 (20%) for screening. During the same months in the previous year, 121 of 938 colonoscopies (12.9%) were for screening (p < 0.01). This was a 55% increase in the percentage of colonoscopies performed for screening, and a 112% increase in the number of screening colonoscopies. Patients screened after the change in Medicare reimbursement were on average 5 yr older compared with patients of the previous year (62 +/- 10 [mean +/- SD] vs 56 +/- 9 yr; p < 0.01). A total of 61 screening colonoscopies (24%) performed after the change in Medicare reimbursement had adenomatous lesions, compared with 25 (21%) screened for family history (p = ns). The number of adenomas 10 mm or larger or cancers did not differ significantly between the two groups (17 in 2001 vs 12 in 2000; p = ns). Age of 65 or older was associated with detection of adenomatous lesions (OR = 1.7; 95% CI = 1.01-2.9013). CONCLUSIONS: Since the change in Medicare reimbursement, there has been a significant increase in the number and proportion of colonoscopies performed for screening at our institution. Patients screened since this change are older, and the detection rate of neoplastic lesions is similar to those previously screened for a family history of colorectal cancer or polyps.     

亲脂性修饰对小檗碱体内调脂活性的影响

目的：观察亲脂性修饰后小檗碱体内调脂活性的变化．方法：以8-烷基小檗碱同系物（Ber—n）为模型化合物,以实验性高脂血症大鼠为实验动物模型,实验分为正常对照组（NC组）,高脂对照组（FC组）和小檗碱组（Ber-0组）,8-丁基小檗碱组（Ber-4组）,8-辛基小檗碱组（Ber-8组）,8-月桂基小檗碱组（Ber-12组）,8-十六烷基小檗碱组（Ber-16组）5个药物组．实验期间NC组给予普通饲料,FC组和5个药物组均给予高脂饲料．用7g/L羧甲基纤维素钠水溶液作为药物溶剂,5个药物组大鼠每日按125mg／kg分别给予灌胃相应药物,NC组和FC组给予同体积药物溶剂．于给药后10d和25d时测定各组实验大鼠血清总胆同醇（TC）、总三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）含量;实验结束时记录计算各组大鼠肝脏指数,肾脏指数,脾脏指数和胸腺指数．结果：在给药10d后与FC组相比较,各药物组血清TC,TG,HDL—C均有一定程度的修复．HDL—CBer-16组（1．22±0．19）mmol／L与FC组（0．95±0．19）mmol／L相比较差异显著（P〈0．05）,但各Ber—n组间的差异不明显．当给药25d后,TC值FC组（11．38±3．41）mmol／L与Ber-8组（6．77±3．26）mmol／L相比较差异显著（P〈0．05）,与Ber-12组（5．24±2．45）mmol／L,Ber-16组（4．78±2．67）mmol／L相比较差异更为显著（P〈0．01）．TG值FC组（1．05±0．37）mmol／L与Ber-12组（0．64±0．25）mmol／L,Ber-16组（0．66±0．23）mmol／L相比较差异显著（P〈0．05）．HDL—C值FC组（1．11±0．21）mmol／L与Bet-8组（1．34±0．20）mmol／L差异显著（P〈0．05）;与Ber-12组（1．49±0．21）mmol／L,Ber-16组（1．48±0．28）mmol／L相比较差异更为显著（P〈0．01）．各药物组的肝脏指数与FC组相比较明显降低且均有显著差异（P〈0．05）．结论：随着烷基链长度的增加,Ber—n     

8-烷基小檗碱同系物对蛋白荧光的淬灭作用与其抗菌活性的关系

目的：了解8-烷基小檗碱同系物（Ber-C8-n）对蛋白荧光的淬灭作用与其抗菌活性的关系,探讨Ber-C8-n抗菌活性变化的机制.方法：以牛血清白蛋白（BSA）为实验材料,等渗磷酸缓冲液（PBS）为溶剂,分别将每种Ber-C8-n用PBS溶液配制不同浓度的梯度溶液,测定BSA与不同浓度Ber-C8-n在PBS体系中反应后苯丙氨酸（Phe）,色氨酸（Trp）和酪氨酸（Tyr）残基的荧光强度,观察Ber-C8-n对BSA残基荧光的淬灭情况.结果：Ber-C8-n对BSA中3种氨基酸残基的荧光均有不同程度的淬灭作用,并均有明显的剂量效应.比较后发现,Ber-C8-n对BSA中Phe,Trp和Tyr残基荧光的淬灭作用表现出相似规律,即Ber-C8-8同样表现了最强的荧光淬灭作用,其次为烷基链较长或较短的Ber-C8-n,基本上呈现以Ber-C8-8顶点的抛物线.3种残基之间比较,Ber-C8-8对Trp残基荧光的淬灭作用明显强于对Tyr和Phe残基的作用.结论：抗菌活性越强的Ber-C8-n对BSA荧光的淬灭作用也越强,Ber-C8-n抗菌活性的差异可能是不同Ber-C8-n与目标蛋白的富Trp残基区的结合能力差异导致的．     

孕妇孕期保健知识现状及需求的调查与分析

目的：发现目前孕期保健存在的问题。方法：对孕妇一般情况现状及与妊娠有关知识获得来源进行调查与分析。结果：孕妇一般情况显示出具备接受各种知识的能力与心理准备；各种护理小儿的技术准备明显不足；孕妇有关知识获得来源为书籍。结论：对孕妇的孕期保健内容与形式需要进行调整，应对孕妇进行新生儿保健知识和护理技术的培训。     

补偿式体内压力换能器的研制

目的:探讨临床医疗上胆囊和胃肠道内压力检测的有效方法。方法:采用自制的换能器,利用导管内泵入气体测量胆囊和胃肠道内的压力。结果:自制的换能器能简便、直现、准确地测量出胆囊和胃肠道中的静态压强,精确度可达0.1cm水柱。结论:补偿式体内压力换能器能够用于测定消化系统内部不同器官、不同部位的静态压强。操作简便、灵敏度高、准确性好、安全可靠。     

湿润烧伤膏治疗溃疡性褥疮48例临床体会

目的：观察应用湿润烧伤膏治疗溃疡性褥疮的临床效果。方法：通过对48例不同原因所致的溃疡性褥疮的治疗，观察湿润烧伤膏治疗溃疡性褥疮的疗效。结果：47例病人创面愈合，死亡l例。结论：湿润烧伤膏治疗溃疡性褥疮方法简便、实用性强，疗效显著。