Health insurance subsidies and deductible choice: Evidence from regional variation in subsidy schemes

The extent to which premium subsidies can influence health insurance choices is an open question. In this paper, we explore the regional variation in subsidy schemes in Switzerland, designed as either in-kind or cash transfers, to study their impact on the choice of health insurance deductibles. Using health survey data and a difference-in-differences methodology, we find that in-kind transfers increase the likelihood of choosing a low deductible plan by approximately 4 percentage points (or 7%). Our results indicate that the response to in-kind transfers is strongest among women, middle-aged and unmarried individuals, which we explain by differences in risk-taking behavior, health status, financial constraints, health insurance and financial literacy. We discuss our results in the light of potential extra-marginal effects on the demand for health care services, which are however not supported by our data.     

常熟市卫生资源现状调查与分析

目的：通过对常热市2003年卫生人力资源、卫生物力资源、卫生财力资源及医疗机构卫生服务供给情况等方面卫生资源情况的分析，为制定常熟市区域卫生规划提供基础性的数据，促进卫生体制改革的进程。方法：采用普查方法，对常熟市卫生资源各项指标的绝对数、均数及其构成比等进行描述性统计分析，并与苏州市、全省总体水平进行比较。结果：2003年全市共有各类医疗卫生机构473个，共有床位3318张，卫生工作人员6224名。每千人口拥有卫技人员4．14人，全市医护比为1：0．62；每千人口拥有3．20张床位；医疗机构业务收入主要以药品收入为主；人均卫生事业经费迭81．44元；住院人数及手术人次数均以市属医院为高，分别占全市的52．97％和73．41％。结论：卫生资源存量丰富，各类医疗卫生机构配备齐全；卫生资源结构配置不合理；医疗机构基本能收支平衡，业务收入结构不舍理；卫生技术人员中严重缺乏护理人员。     

新型冠状病毒肺炎国家第三到七版诊疗方案中医诊治对比分析

新型冠状病毒肺炎（简称新冠肺炎，COVID-19）属中医"疫病""湿毒疫"范畴，在国内外广泛传播。疫情发生以来，国家卫生与健康委员会先后发布了7版《新型冠状病毒感染的肺炎诊疗方案》（简称《诊疗方案》），对该病的认识及诊治具有重要的指导意义。通过对比分析第三到七版《诊疗方案》中医诊治的内容，进一步分析探讨中医学对新冠肺炎的认识、辨证分型及临床治疗的变化特点，归纳总结中医对本病认识过程的规律可见从已知到未知的逐步深入，为完善、优化中医药应对传染性疾病的防治体系提供参考。     

生物电阻抗法用于重大手术患者手术期间输液方案的评估

目的 通过多频生物阻抗分析仪测定观察肺叶切除术手术期间不同输液方案下体液的分布,特别是临床上难以测定的有效循环血量之外的细胞外液的变化,为重大手术期间制定更合理、安全的输液方案,保证手术患者术中、术后有更稳定的内环境及良好的器官功能.方法 63例行胸外科手术患者随机分为A组（常规输液组,28例）,B组（限制输液组,35例）.A组：手术期间输注复方乳酸钠林格氏液12～14 ml·kg-1·h-1B组：手术期间输注LR液 6～8 ml·kg-1·h-1.用多频生物阻抗分析仪监测手术期间患者的总体液量（TBW）、细胞内液（ICW）、细胞外液（ECW）.结果 2组术前后水含量：手术结束时,常规输液组细胞内、外液和全身水量均增加,其中细胞外液和全身水量增加更为明显,限制输液组细胞内、外液和总体液量在术前、术后变化不明显.Hct、pH值、K＋、Na＋2组差异无统计学意义（P〉0.05）.结论 在择期胸外科手术中使用两种输液方案均能维持较为正常的生命体征和内环境,但传统输液组细胞外液量有增多趋势.     

Long term physical sequelae after adult-onset cancer

Introduction With two thirds of cancer patients living for at least 5 years, clinical research has increasingly focused on the long-term health of cancer survivors. Contrary to the amount of knowledge on long-term consequences observations on late effects after childhood cancer in adult-onset cancer are sparse. Only limited literature is available recommending guidelines for long-term follow-up of cancer patients and their implementation in the delivery of health care. Methods In this review we summarize updated knowledge on the most frequent physical long-term effects after adult-onset cancer, and we discuss how these findings can be implemented in life-long follow-up programs of cancer survivors. Results Second cancer, cardiovascular disorders and gonadal dysfunction are the most common physical late effects along with fatigue. Common age-related co-morbidity reduces physical function in long-term cancer survivors. Conclusions Cancer survivors have to be informed about their risk of late effects, and how to prevent them by life style adjustments and, if indicated, regular health care visits. Studies on late effects after cancer treatment should be combined with translational research in order to improve our understanding of pathophysiological mechanisms of long-term effects. The effectiveness of therapeutic interventions for reduction of these treatment sequelae in long-term survivors need to be investigated in randomized trials. Guidelines for life-long follow-up of cancer survivors should be established and will form the first step is the design of an individual life-long cancer survivor care plan.     

肝部肿瘤三维立体定向适形放疗计划设计探讨

 目的 探讨肝部肿瘤的三维适形放射治疗计划设计。方法 对50例肝部原发及转移性肿瘤患者，根据医师要求的CTV和周围正常的敏感器官限制受量设计三维适形放射治疗计划，结合剂量-体积直方图选择最佳方案。结果 以ICRU剂量参考点（肿瘤中心点剂量）剂量归一，80 % ~ 90 %剂量线均能包绕90 %以上的PTV。90 %剂量线包绕PTV的程度和靶区的大小及所在部位有关。结论 肝部肿瘤的治疗计划设计时，对位于不同部位的病灶采用不同的设计；正常肝组织的受照体积的大小和受照剂量直接影响着患者的放射治疗反应，同时对处方剂量、剂量分割方式的选择有重要影响。     

基于PQM脚本进行直肠癌放疗计划定量评价的研究与应用

目的:建立一个计划质量评估脚本,用于量化评估放疗计划,并验证该程序的临床可行性。方法:建立直肠癌计划质量测度标准（plan quality metrics,PQM）,其中包含18个子测度（submetrics）,使用C#语言在Visual Studio编辑器中构建脚本评估程序,对20例采用不同辐照技术的治疗计划分别通过脚本程序和Plan IQ软件（参照对象）进行评价打分,首先分析两种评估方法所得评分的差异然后进行两种辐照技术的得分对比,从而验证脚本程序的临床可行性。结果:使用脚本程序、Plan IQ这两种评估方法得出VMAT组和IMRT组靶区得分为（73.2±16.6）分和（56.8±14.9）分、（70.7±19.3）分和（63.1±11.5）分,差异具有统计学意义（P＜0.05）;危及器官(organ at risk,OAR)得分为（91.9±3.2）分和（80.4±8.5）分、（89.9±5.1）分和（75.1±11.0）分,差异具有统计学意义（P＜0.05）;总分得分为（84.1±8.1）分和（70.2±10.0）分、（84.6±5.9）分和（71.8±10.0）分,差异具有统计学意义（P＜0.05）。对数据使用Bland-Altman分析,处于特定区间外的数据在数据总量中占比小于5%。结论:脚本评估程序可以针对计划质量进行客观的评估,可作为计划系统的评估应用程序。     

等中心位置的选择对肺癌SBRT验证计划Gamma通过率的影响

目的:研究肺癌立体定向放射治疗(stereotactic body radiotherapy,SBRT)计划设计过程中,等中心位置的选择对验证计划Gamma通过率的影响.方法:选取2018年11月至2019年3月间的13例肺部SBRT病例,分别通过Pinnacle 9.10计划系统设计两个对应不同等中心的SBRT计划,...     

Restructuring Skin Cancer Care in Ontario: A Provincial Plan

There is a global rise in skin cancer incidence, resulting in an increase in patient care needs and healthcare costs. To optimize health care planning, costs, and patient care, Ontario Health developed a provincial skin cancer plan to streamline the quality of care. We conducted a systematic review and a grey literature search to evaluate the definitions and management of skin cancer within other jurisdictions, as well as a provincial survey of skin cancer care practices, to identify care gaps. The systematic review did not identify any published comprehensive skin cancer management plans. The grey literature search revealed skin cancer plans in isolated regions of the United Kingdom (U.K.), National Institute for Health and Care Excellence (NICE) guidelines for skin cancer quality indicators and regional skin cancer biopsy clinics, and wait time guidelines in Australia and the U.K. With the input of the Ontario Cancer Advisory Committee (CAC), unique definitions for complex and non-complex skin cancers and the appropriate cancer services were created. A provincial survey of skin cancer care yielded 44 responses and demonstrated gaps in biopsy access. A skin cancer pathway map was created and a recommendation was made for regional skin cancer biopsy clinics. We have created unique definitions for complex and non-complex skin cancer and a skin cancer pathways map, which will allow for the implementation of both process and performance metrics to address identified gaps in care.