Logistical and Economic Advantages of Sterile-Packed,Single-Use Instruments for Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is well established as a clinically successful and cost-effective procedure. The transition of the US healthcare system from a fee-for-service model to a value-based care model requires careful examination of patient care to ensure both quality and efficiency. Sterile-packed, single-use instruments have been introduced as a tool to help streamline the operating room (OR) logistics while reducing sterilization requirements. The aim of this study was to examine the potential logistic and economic benefits of single-use instruments compared to traditional, reusable instruments for TKA.MethodsFour variables related to TKA costs and logistics were modeled in this study: OR turnover time tray sterilization, tray management time, and 90-day infection rates. Model input data for traditional instruments and single-use instruments were based on peer-reviewed literature. A total of 200 sites and 500 cases per site were simulated using the Monte-Carlo-Technique.ResultsThe median total cost savings with single-use instruments was $994 per case. The largest driver for cost savings was tray sterilization. Sites with higher staff wages and sterilization costs had a larger probability of realizing greater cost savings with adoption of single-use instruments. In cases using single-use instruments, up to 51% of operating days could have accommodated an additional procedure due to the time savings in OR turnover.ConclusionThis cost modeling study observed significant potential for logistical and economic improvements in TKA with single-use vs reusable instruments. Although few studies have been conducted to measure the impact of single-use instruments in practice, the results of these simulations motivate further investigation.     

慢性阻塞性肺疾病住院患者医院感染的卫生经济学评价

目的 研究医院感染(NI)对慢性阻塞性肺疾病患者住院费用的影响。方法 选取某三级甲等医院呼吸内科病区118例发生NI的慢性阻塞性肺疾病住院患者作为病例组,采用1∶1条件配比非感染病例作为对照组,比较两组患者的一般情况,慢性阻塞性肺疾病对两组患者的住院天数及住院费用的影响。结果 慢性阻塞性肺疾病发生NI患者住院天数延长,住院费用增加,P<0.01;各分项费用中除其他费用外,两组患者花费差异均具有统计学意义P<0.01。结论 慢性阻塞性肺疾病患者NI延长住院时间,增加住院费用。采取有效措施控制NI将会产生良好的经济效益和社会效益。     

穴位敏化规律及相关机制的系统科学解析

穴位敏化规律包括基于过程的穴位敏化规律和基于空间的敏化穴位的分布规律,应当从动态过程去认识穴位敏化。试举例说明关于穴位"静息态"与"敏化态"的分界标准,以及穴位敏化的演化过程与对应器官功能变化的演化过程之间的响应关系,但仍需深入研究。穴位敏化是开放的人体自组织系统的一个主动过程,这一主动性使敏化穴位成为了实现"小刺激大效应"的一个基础性的本能环节。以针灸为代表的穴位刺激疗法所具备的双向良性调节、饱和调节、多靶点调节的特征是由人体自组织系统的一系列内在特性所决定的。     

基于文献数据挖掘中药复方治疗支气管扩张伴感染的用药规律*

目的基于文献数据挖掘的方式,收集近20年文献中治疗支气管扩张伴感染的中药复方,探讨支气管扩张伴感染的中医用药规律。方法 将收集所得83个处方,运用频数分析、聚类分析、关联规则进行数据挖掘,探讨其潜在的用药规律。结果 频数分析显示共涉及药物140味,使用频次≥10次的中药有29味;聚类分析反映了清肺祛痰消痈、祛瘀止血、益气养阴的治疗方法;关联规则体现清热补虚为本病的基本方法,重视消痈排脓。结论 支气管扩张的基本病机为本虚标实,在清热祛痰排脓的同时,要兼顾益气养阴、活血化瘀。     

Cortisol levels and psychosocial factors in preadolescent children

Regarding the relationship between psychosocial factors and health, one model of explanation states that psychosocial stress constitutes a principal mediator connecting psychosocial factors to health outcome, affecting the body through psychobiological mechanisms. This relationship has scarcely been studied in children. In the present study the relation between diurnal cortisol secretion and psychosocial factors [socio‐economic status (SES), immigrant status and impact of psychiatric symptoms] was investigated in a normal population of 6–12 year old children (n = 273). Salivary cortisol levels were measured in the early morning, late morning and in the evening during three consecutive days. Parents answered demographic questionnaires and teachers answered psychiatric questionnaires concerning the children. Children exposed to one or more of the factors of psychosocial load (n = 117) had significantly higher morning (p < 0.001) and evening (p = 0.029) cortisol levels as well as total daily cortisol secretion [measured by the area under the curve (AUC), p = 0.003] compared to the group of children with none of the factors (n = 156). Different psychosocial stressors seemed to influence different parts of the diurnal cortisol curve. In conclusion, this study indicates that even children exposed to a moderate degree of psychosocial load differ in their cortisol levels compared to non‐exposed children. Copyright © 2006 John Wiley & Sons, Ltd.     

衡阳市护士权益维护感知调查

目的了解衡阳市临床对护士权益维护的感知,为提高护士权益维护能力提供参考。方法采用一般资料问卷、护士权益维护调查问卷对衡阳市10所二级或三级医院的690名护士进行调查。结果护士感知医院对护士权益维护均分、护士感知自身对护士权益维护均分及护士权益维护总均分分别为(3.54±0.71)分、(3.37±0.74)分、(3.47±0.67)分,护士权益维护水平受籍贯、年龄、工龄、用工形式、月收入等因素影响(P0.05,P0.01)。结论衡阳市护士权益维护水平偏低,医院应当提高护士对权益维护重要性的认识,根据影响因素积极开展维权工作,维护护士权益。     

Economic Stressors and Psychological Distress: Exploring Age Cohort Variation in the Wake of the Great Recession

This study examined processes linking age cohort, economic stressors, coping strategies and two indicators of psychological distress (i.e. depressive symptoms and anxiety symptoms). Structural equation models were conducted utilizing data from a national survey that was undertaken in order to understand life change consequences of the period of economic downturn from 2007 to 2009 known as the Great Recession. Findings revealed that the associations between economic stressors and symptoms of both depression and anxiety were significantly greater for members of the millennial cohort compared with baby boomers. These effects are partly explained by the greater tendency of members of the baby boomer cohort to use active coping strategies. These findings clarify the circumstances in which age matters most for the associations among economy‐related stressors, coping strategies and psychological well‐being. They highlight how difficult economic circumstances influence the availability of coping strategies and, in turn, psychological well‐being—and differently for younger and older age cohorts. Copyright © 2016 John Wiley & Sons, Ltd.     

医养一体化护理模式对老年卒中后遗症期患者康复的影响

目的探讨医养一体化护理模式对老年卒中后遗症期患者康复的影响。方法将140例老年卒中后遗症期患者随机分为观察组和对照组各70例,对照组采用家庭照护模式,观察组采用医养一体化护理模式(集医疗、养生、养老为一体的模式)。分别在入组时、入组12个月时对患者日常生活活动能力、抑郁状态、卒中复发率及经济学指标进行比较。结果入组12个月时,观察组日常生活活动能力评分显著高于对照组,抑郁评分、卒中复发率、脑卒中相关费用显著低于对照组(P0.05,P0.01)。结论医养一体化护理模式可提高老年卒中后遗症期患者的日常生活活动能力,减少负性情绪,降低成本,有利于康复。     

The burden of costs on health services from patients with venous leg ulcers in Singapore

Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.     

现代畜牧产业经济联合体集聚效度分析

农牧民增收一直是"三农"问题的核心内容之一,如何提升农牧民收入也是党和国家非常关心的重点问题。本文基于新疆伊吾县"现代畜牧产业经济联合体(以下全文简称现代畜牧联合体)"的调查发现,该组织形式和经营模式在提升农牧民一次收入的同时,可以二次增加农牧民收入,有利于降低产品交易费用、产生规模效益、稳固范围经济效能、减少对农牧民生产积极性的挫伤,同时有利于形成品牌、便于产品质量安全追溯体系的构建,实现经济效益、社会效益和生态效益的综合协调发展。