总额预付下定点医院加强医保管理实践探索

定点医院不仅是参保人员获取基本医疗服务和实现基本医疗消费的主体,又是直接控制医疗费用的载体,还是具体与参保人员接触、沟通、落实医保政策的场所。定点医院成为基本医疗保险管理体系中极为重要的组成部分,总额预付下如何加强医保管理与政策落实是否到位,直接关系到控制医保费用的关键所在。     

失效模式与效应分析在麻醉复苏期风险管理中的应用

目的识别麻醉复苏期患者医疗处置过程中的潜在风险,改进复苏流程。方法运用失效模式与效应分析(FMEA)工具,对患者麻醉复苏期医疗处置流程进行分析,查找每个医疗环节中可能存在的风险;针对管理制度不完善、具体流程不明确、人员职责不清楚及技能培训不到位等关键环节,实施改进措施1年。结果麻醉复苏期患者医疗风险危机值(RPN)由改进前的1 721降至357,不良事件发生率由改进前的2.40%降至0.97%(P0.01)。结论运用FMEA对麻醉复苏期患者实施医疗风险管理,有助于规范患者麻醉复苏工作流程,保障了患者复苏期全过程的安全,有利于麻醉复苏工作质量的持续改进。     

African Americans with cancer: the relationships among self-esteem,locus of control,and health perception

The purpose of this study was to describe and examine the relationships among self-esteem, locus of control, and perceived health status in African Americans with cancer and to identify predictors of perceived health status. A convenience sample of 95 oncology outpatients at two large medical facilities completed the Tennessee Self-Concept Scale, the Multidimensional Health Locus of Control Scale, and the Cantril Ladder, a measurement of perceived health. In an audiotaped interview two open-ended questions were used to clarify participants' Cantril Ladder scores. A significant positive relationship was discovered between self-esteem and powerful others health locus of control (p <.05). Participants tended to view God as the Powerful Other capable of influencing their health and well-being. Self-esteem and an internal health locus of control were found to account for 23% of the perceived variance in health status. In addition, interview data indicated that participants with normal to high levels of self-esteem and an internal health locus of control perceived their state of health and well-being positively.     

U.S. Experience with the AddVent VDD(R) Pacing System

The AddVent pacemaker generator and model 1328C AV single-pass lead is a new pacemaker system capable of VDD or VDDR modes. The purpose of this study was to present the initial experience with AddVent in the United States and Canada. Between May 10, 1995 and May 3, 1996, 53 devices were implanted in 52 patients and followed for a mean of 217 (±39) days. At the predischarge, 1-, 3-, and 6-month follow-up evaluations, atrial sensing thresholds and ventricular sensing and capture thresholds were measured in the supine, sitting, and standing positions to evaluate stability of atrial sensing with respect to body posture at rest. At the 1-month follow-up, a treadmill exercise test was performed to evaluate atrial sensing during exercise and to evaluate two new features of the AddVent called "sensor-mediated rate smoothing" and "preferential P wave sensing." Atrial sensing thresholds were not significantly different (P > 0.05) among body postures for any follow-up period or among follow-up periods for each posture. At rest, the percentage of appropriately tracked P waves observed was > 99% at each follow-up period. During treadmill exercise, the percentage of appropriately tracked P waves was > 98.7%. Appropriate preferential P wave sensing and sensor-mediated rate smoothing (VDDR mode) was observed. The AddVent pacing system provides safe and effective pacing therapy. Several features of VDDR pacing offer advantages over standard VDD pacing.     

Association between antibiotic usage and subsequent colonization or infection of extensive drug-resistant Acinetobacter baumannii: a matched case-control study in intensive care units

Nosocomial spreading of extensive drug-resistant Acinetobacter baumannii (EDRAB) is an emerging problem. To clarify the association between prior antibiotic usage and subsequent EDRAB acquisition, we conducted a one-to-one matched case-control study among patients in all intensive care units (ICUs) at the National Taiwan University Hospital, Taipei, Taiwan, during a 1-year period. A total of 113 pairs of patients were identified. We measured prior antibiotics exposure in 4 perspectives: usage, overall treatment duration, accumulated dosage, and treatment potency. We found positive associations between EDRAB acquisition and prior usage of imipenem and meropenem across 4 measures, especially in usage and average treatment potency (usage, odds ratio [OR](imipenem) = 3.7 with 95% confidence interval [CI] = 1.2-11.0, OR(meropenem) = 5.4 with 95% CI = 1.2-20.0; average treatment potency, OR(imipenem) = 5.3 with 95% CI = 1.3-22.0, OR(meropenem) = 3.4 with 95% CI = 1.0-12.0). Ceftazidime use with stronger treatment potency was also strongly associated with subsequent nosocomial EDRAB acquisition (OR = 5.5, 95% CI = 1.5-21.0). The OR of EDRAB acquisition greatly increased in patients who had previously been exposed to any 1 (OR = 5.5, 95% CI = 2.3-13.2) or to any 2 or 3 (OR = 11.1, 95% CI = 2.7-46.4) of the abovementioned antibiotics. Based on these findings, we conclude that usage of imipenem, meropenem, and/or ceftazidime is associated with subsequent acquisition of EDRAB in critically ill patients in ICUs.     

三勒浆口服液HPLC指纹图谱的建立及多成分定量测定

目的建立三勒浆口服液(SOL)的HPLC指纹图谱,测定其中主要成分量,为SOL的质量控制提供参考。方法采用Welchrom C18色谱柱(250 mm×4.6 mm,5μm),以0.1%磷酸水溶液-甲醇为流动相进行梯度洗脱,体积流量为1.0 m L/min,检测波长270 nm,柱温25℃,建立SOL的HPLC指纹图谱,并对没食子酸、没食子儿茶素、表儿茶素、柯里拉京和鞣花酸指标成分的定量测定进行方法学考察。结果在SOL特征指纹图谱研究中,共确定22个共有峰,同时利用相似度软件对10批SOL指纹图谱进行分析,各批次样品相似度在0.95以上;通过对比特征峰的保留时间,指认出5种主要成分,分别为没食子酸(3号峰)、没食子儿茶素(8号峰)、表儿茶素(15号峰)、柯里拉京(16号峰)和鞣花酸(21号峰);并且10批样品中没食子酸的量在5.743 2~7.538 0 mg/m L,没食子儿茶素的量在0.492 9~0.847 1 mg/m L,表儿茶素的量在0.529 7~0.8048 mg/m L,柯里拉京的量在0.937 5~1.756 5 mg/m L,鞣花酸的量在0.352 7~0.554 5 mg/m L。结论所建立的SOL HPLC指纹图谱和定量测定方法简单,分离效果较好,重复性好,实现了对SOL定性和定量的双重研究,可为其质量控制提供参考。     

Optimal zeroing dynamics with applications to control of serial and parallel manipulators

The appearance of robot manipulators has dramatically improved the productivity in manufacturing. Serial and parallel manipulators are 2 classes of most popularly investigated manipulators, which have been playing an important role in robotic domain for a long time. Optimal control theory is a widely employed method that can achieve the objective constrained by some equations as subtasks, whereas zeroing dynamics is another powerful method to solve time‐varying problems with an exponential rate of error convergence. Intuitively, the cross‐fertilization of optimal control theory and zeroing dynamics may reach the capability to deal with time‐varying problem in a cost‐optimal manner. In this paper, we make progress along this direction by combining the optimal control theory and zeroing dynamics to propose a novel method called optimal zeroing dynamics for motion control of manipulators. The proposed method is applied to the control of serial and parallel manipulators, and the corresponding results have illustrated high accuracy and low sensitivity of the proposed optimal zeroing dynamics to disturbances.     

Optimal control for the spread of infectious disease: The role of awareness programs by media and antiviral treatment

This paper presents a detailed mathematical analysis of the role of awareness programs by media and antiviral treatment on the control of infectious diseases. A nonlinear model is proposed in order to control the infectious diseases, and the model is examined under various scenarios of control measures using variety of mathematical techniques including stability, sensitivity, optimal control, and cost‐effectiveness analysis. Considering the constant control parameters, the basic reproduction number is derived and investigated by the existence and stability of equilibria, then the relative impact of each of the constant control parameters are assessed by calculating the sensitivity index of the basic reproduction number. Under the time‐dependent controls, the necessary conditions for the optimal control of the disease are derived using the Pontryagin's maximum principle in order to determine optimal strategies for controlling the spread of the disease. In order to investigate the most cost‐effective control strategy among all the possible strategies, cost‐effectiveness analysis is carried out using numerical simulations and the result reveals that the strategy combination of 3 control measures (the successful campaign of awareness programs by media, controlling effort that alters infectious cases receiving treatment, and strengthening effort made on awareness campaign programs) is the most cost‐effective control strategy and this indicates that implementation of all the 3 control measures is necessary in order to control the disease outbreak.     

Prevention and management of recurrent postoperative Hirschsprung's disease obstructive symptoms and enterocolitis: Systematic review and meta-analysis

Background/Purpose

The purpose of this study was to review the management of obstructive symptoms and enterocolitis (HAEC) following pull-through for Hirschsprung's disease.