The Health Insurance Portability and Accountability Act: Does It Live Up to the Promise?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed by Congress with two formidable tasks: (1) reform the insurance market; and (2) simplify healthcare administrative processes. From these ambitious beginnings, HIPAA has since taken on major healthcare issues including administrative simplification, security, privacy, and patient confidentiality. In November 1997, the Secretary of Health and Human Services (DHHS) introduced the proposed “standards” for what is referred to as “administrative simplification”. But, establishing the standards and guidelines necessary for administrative compliance was not an easy undertaking. DHHS estimated that 400 different formats were used in the US for healthcare claims processing. Three years later (August 2000), the Final Rule for Standards for Electronic Transactions and Code Sets was published by DHHS. The rule provided for national standardization of the most common healthcare transactions and several code sets. The compliance deadline for implementation of the new transactions and code sets was set for October, 2002. In January 2001, Congress enacted The Administrative Simplification Compliance Act to provide the industry with additional time to reach compliance. Yet, recent survey results by Phoenix Health Systems and the Health Information and Management Society (HIMSS) indicate many providers and payers are not fully compliant with the security and privacy regulations mandated by HIPAA. This issue threatens the effectiveness of administrative simplification and the integrity of healthcare information. Overall, HIPAA does offer the promise of a more efficient and effective means of sharing and disseminating vital healthcare information. But, many experts have concerns that the implementation and maintenance of HIPAA standards and policies will become a financial burden for many in the healthcare industry. Although DHHS has established mandates for the healthcare industry, many deadlines have been extended and the standards of administrative simplification continue to evolve over time. Others question whether the Department of Health and Human Services is capable of spearheading an information technology revolution in the healthcare industry. Unfortunately, it may take several years before the industry is able to realize any true cost savings from administrative simplification. Yet, few can question how HIPAA has revolutionized information technology in the healthcare industry.     

How do parents' child-feeding behaviours influence child weight? Implications for childhood obesity policy

BACKGROUND: Parents have some responsibility for children's dietary habits and they are often the focus of public health interventions designed to improve children's diets and thereby reduce the prevalence of childhood obesity. The current UK interventions promote awareness of healthy food choices, but offer little guidance for parents on child-feeding behaviours. METHODS: A review of recent literature regarding child-feeding behaviours and child weight. RESULTS: Parents report using a wide range of child-feeding behaviours, including monitoring, pressure to eat and restriction. Restriction of children's eating has most frequently and consistently been associated with child weight gain. Furthermore, there is substantial evidence for a causal relationship between parental restriction and childhood overweight. CONCLUSIONS: Parents may inadvertently promote excess weight gain in childhood by using inappropriate child-feeding behaviours. We recommend the development of interventions to increase awareness of the possible consequences of inappropriate child-feeding behaviours. Parents who are concerned about their child's weight will also require guidance and support in order to adopt more appropriate child-feeding behaviours.     

精氨酸对体外循环术后白细胞介素2变化的影响

目的：探讨精氨酸增强体外循环术后细胞免疫功能是否系促进术后白细胞介素２的产生所致。方法：６０例体外循环手术病人分为两组，每组３０例。精氨酸组术前３天至术后７天每日静脉滴注精氨酸。于术前及术后１、３、５、７、１４天等时点抽外周血按Ｓｔａｎｄｌｅｒ法测定白细胞介素２水平。结果以均数±标准差表示，采用ｔ检验分析差异显著性。结果：对照组术后白细胞介素２水平明显下降，从术前７２．０±３．５（Ｕ／Ｌ，下同）降至术后第５天２９．１±５．２，第７天３５．８±３．９，约２周恢复正常。用药组下降幅度较小，术后第５天４６．７±４．２，第７天７０．１±４．４（组间差异Ｐ＜０．０５），约１周已接近术前水平。结论：精氨酸对体外循环术后白细胞免疫功能恢复具有明显的促进作用，增加术后白细胞介素２的产生可能是其重要机制。     

胸主动脉阻断后脊髓各段血供状况的动物实验研究

目的：了解胸主动脉阻断后转流术或部分体外循环改善脊髓血供的程度。方法：６只家兔分别在左锁骨下动脉远侧和膈肌上方阻断胸主动脉建立脊髓缺血模型，阻断段远、近端灌注印度墨汁。结果：阻断段相应脊髓组织内墨汁分布明显少于远、近侧。结论：胸主动脉阻断后转流术或部分体外循环法，不能完全改善阻断段脊髓血供。     

弱氦氖激光血管内照射治疗缺血性脑卒中临床试验文献评价

目的:了解中国弱氦氖激光血管内照射(intravascularlowleverHe-Nelaserirradiationonblood,ILIB)治疗缺血性脑卒中(cerebralischemicstroke,CIS)随机对照试验和临床对照试验(RCTs/CCTs)的现状,为其系统评价提供线索。方法:通过机检和手检获得发表的RCTs/CCTs共64篇,对文献的随机化分配方法、盲法采用、样本含量、患者纳入标准和排除标准、疗效判定标准、不良反应报告、治疗依从性、随访、失访报告等进行分析。结果:具有明确随机方法仅1篇占2%(1/64),有明确半随机方法3篇占5%(3/64),仅有1篇采用盲法,只有1篇运用空白对照,纳入/排除标准明确占6%,诊断标准明确占94%,疗效判定标准明确占100%,提及不良反应占12%,失访报告占3%,无一篇涉及随访和意向性分析。结论:按Jadad(Jadad1996)和Schulz(Schulz1995)提出的评价文献的质量标准,所调查的文献均存在高度偏倚,仅只有两个研究Jadad评分为2分。中国ILIB治疗CIS的RCTs/CCTs的质量有待进一步提高。     

心脏直视手术后心包及纵隔引流血的分析（附18例报告）

目的：为心脏直视手术后回输未经洗涤的心包及纵隔引流血提供可靠依据。方法：对１８例心脏直视手术后心包及纵隔引流血和１１例库血进行检测，并对各项结果进行Ｆ检验。结果：术后４小时及６小时心包及纵隔引流血分别占术后２４小时引流血量的５０．７％（３６０±９５ｍｌ）及５７．７％（４３０±１００ｍｌ）。心脏手术后病人血及其引流血经需氧菌及厌氧菌培养均阴性。引流血红细胞压积０．３１，库血０．３４（Ｐ＞０．０５）。引流血纤维蛋白降解产物（ＦＤＰ）２３１μｇ／ｍｌ，库血１２５０μｇ／ｍｌ（Ｐ＜０．０５），说明引流血的纤溶活性明显低于库血。ＶＩＩ因子测定，引流血虽较正常值低，但较库血略高。引流血中游离血红蛋白明显高于库血，分别为１３３８±４０６ｍｇ／Ｌ及２１８±８７ｍｇ／Ｌ（Ｐ＜０．０５）。结论：心脏直视手术后的纵隔及心包引流血回输是安全的。     

血管紧张素转换酶抑制剂对缺氧心肌细胞的保护机制

目的：探讨血管紧张素转换酶抑制剂对缺氧心肌细胞的保护机制。方法：培养Ｗｉｓｔａｒ大鼠心肌细胞，７２小时后分为对照组、卡托普利组、依那普利拉组、缺氧组、缺氧加卡托普利组、缺氧加依那普利拉组。药物终浓度为１０－５ｍｏｌ／Ｌ。前３组采用有氧培养，后３组应用低糖无氧培养３０分钟。在ＭＰＶ３型显微分光光度计下测定心肌细胞内乳酸脱氢酶、琥珀酸脱氢酶相对含量，并取细胞上清液应用生化分析仪测定细胞内酶漏出情况。实验结果采用ｔ检验。结果：卡托普利和依那普利拉均可提高心肌细胞内乳酸脱氢酶含量（与对照组、缺氧组相比Ｐ＜０．０１）；减少缺氧心肌细胞内酶的漏出（与缺氧组相比Ｐ＜０．０１）。结论：血管紧张素转换酶抑制剂可明显改善缺氧心肌细胞糖代谢，加速糖酵解，减轻缺氧性损伤，对缺氧心肌细胞具有一定的保护作用。