15MV医用直线加速器光中子蒙特卡罗模拟

目的 研究高能医用直线加速器运行过程中因光核反应所形成的光中子辐射场。方法 利用蒙特卡罗(MC)程序模拟Clinic 2300CD型医用电子加速器15 MV X射线模式下光中子污染,掌握机头内不同位置光中子能谱和不同照射野下等中心处中子周围剂量当量变化,分析光中子在等中心平面内剂量分布和水模体中剂量衰减。结果 准直器关闭时,加速器机头内靶、主准直器、均整器和多叶准直器下表面的光中子平均能量分别为1.08、1.20、0.35、0.30MeV;等中心处中子周围剂量当量随着照射野的增大先增大后减少,在30 cm × 30 cm照射野下达到最大;随着测点在水模体中的深度增加,中子通量先增加后减小,而中子剂量却在逐渐减小;不同照射野下,光中子剂量率在水模体深度20 cm处,基本都接近本底。结论 探究高能医用直线加速器机头光中子谱和剂量分布特点,以及光中子在水模体内剂量沉积规律,能为进一步研究高能医用直线加速器光中子污染对患者产生的附加剂量提供支持。     

A time–motion study of digital radiography at implementation

With increasing budgetary restraints on the health system, it is apparent that the main contribution that radiology departments can make to significant cost reduction in hospitals is to decrease the length of time between requesting an X-ray examination and receiving the report (and images). Digital radiography (DR) was introduced into the Radiology Department at the Royal Adelaide Hospital as a pilot project to research the cost–benefits and efficiency of the system, and to determine future directions for planning a digital department. The business plan developed prior to implementation of this pilot project predicted a saving of one bed-day per inpatient when a fully digital department with a picture archiving and communication system (PACS) is installed. This initial study comparing DR and conventional radiography (convR) provides baseline data and shows encouraging results for more rapid transmission of reports to clinicians.     

Selective high dose gamma-globulin treatment in Kawasaki disease: Assessment of clinical aspects and cost effectiveness

BACKGROUND: High-dose intravenous gamma-globulin (IVGG) plus aspirin (ASA) treatment is effective in preventing coronary artery complications in acute Kawasaki disease (KD). However, gamma-globulin is very expensive, especially in Japan. Furthermore the indication for IVGG treatment and the optimal dose of gamma-globulin remain controversial. OBJECTIVES: To examine these two issues, we used Harada's scoring system to investigate whether a single 2 g/kg dose therapy has any advantage over the 5 day 400 mg/kg per day therapy. METHODS: We studied 203 patients with KD who had no coronary artery complications on admission. Of these, 145 patients scored 4 or more on Harada score within the first 9 days of illness and were treated with IVGG treatment. Using a random number table, 72 patients were selected to receive a single 2 g/kg dose (2 g group), while the remaining 73 patients were treated with 400 mg/kg per day for 5 consecutive days (400 mg group). Those who had a Harada score of three or less received no IVGG (non-IVGG group) treatment (58 patients). RESULTS: The incidence rate of coronary artery complications in the 2 g group was significantly lower than in the 400 mg group. The duration of high fever, positive duration of C-reactive protein and the number of hospital days in the 2 g group were each significantly shorter than in the 400 mg group. The total medical expense in the 2 g group was significantly lower than in the 400 mg group. There were no coronary artery complications in the non-IVGG group. CONCLUSIONS: It was found to be clinically more effective and more cost effective to select a patient by Harada's scoring system and, where a score of four or more was obtained, to administer a single 2 g/kg intravenous dose of gamma-globulin for acute KD.     

上海市45家医院供给的技术效率评价

医院供给的技术效率对医院运行成本和医疗服务项目的定价具有重要指导作用，通过运用随机前沿成本模型，对上海市45家医院供给的技术效率进行分析，显示不同级别医院存在着不同的低效率现象；采用多元回归统计方法，显示医疗收入占医院总收入的比例、医院总人数及卫技人员所占医院总人数的比例、医院所在区域、床位使用率、上级拨款等因素造成医院的低效率。在此基础上提出了相应的对策建议。     

抗菌药物使用的调查与管理

目的 了解某院抗菌药物使用情况及管理效果。方法 根据药剂科及检验科的原始登记数据进行汇总、统计，并从1998年1月1日～12月31日及2000年1月1日～12月31日的出院病历中，抽取住院号尾数为0的病历，各科均抽满40份为止，进行回顾性调查。结果 1998年1～12月耐药率比较高；抗菌药物总使用率为96．25％，耗资比率为52．38％；以治疗用药及二联用药为主。2000年1～12月抗菌药物总使用率为93．54％，耗资比率为50．47％，以治疗用药及单用一种药为主。2次调查的抗菌药物总使用率经过u检验，有显性差异。结论 应对抗菌药物进行目标性管理，以减少抗菌药物滥用现象，控制细菌耐药性增长。     

功能性肠病住院情况分析

目的　探讨功能性肠病 (FBD)住院发病情况、临床特点及住院耗资。方法　复习我院消化科 1999～ 2 0 0 2年期间住院的FBD和器质性肠病 ,比较两大类疾病临床特征、辅助检查及住院费用情况。结果　FBD 65例 ,器质性肠病167例。两组患者腹痛、腹泻、腹胀、便秘、厌食、乏力、体重下降均无显著性差异 (P >0 .0 5 ) ,FBD多伴随焦虑、抑郁和失眠 ,而便血、发热、潮热、盗汗、贫血、腹水征、腹部包块多提示器质性肠病。FBD多数检查异常发现率及平均每日住院费用较器质性肠病低 (P <0 .0 5 )。检查费用两组无显著性差异 ,而检查费用占住院费用比例FBD较器质性肠病高 (P <0 .0 5 )。结论　临床医师应提高对FBD认识 ,熟悉诊断标准 ,并合理安排检查     

Screening for latent malformations: cost effectiveness in neonates with correctable anomalies

A screening program for latent malformations in infants born with surgically correctable anomalies was reviewed to determine its cost effectiveness. Two hundred and seventy six infants with esophageal atresia, imperforate anus, omphalocele, gastroschisis, or diaphragmatic hernia were screened for latent congenital anomalies not detected by the routine history, physical examination, and roentgenograms. While additional malformations were detected, many congenital defects were missed only to become evident later in the infant's course. Routine screening for latent malformations is not cost effective in all infants with surgically correctable anomalies, but directed screening is indicated in selected neonates. Screening IVP's are indicated in patients with esophageal atresia, high pouch imperforate anus and possibly diaphragmatic hernia. Screening IVP's are not indicated in infants with gastroschisis, omphalocele, or females with low pouch imperforate anus who have normal sacral spine films.     

Dental care expenditures in the Netherlands and the USA: a design for historical and international comparison

Policymakers face the problem that virtually no standards are available to judge whether the amount of dental care provided is satisfactory or to weight the interests of dental care against other health and economic interests. It is suggested that international comparison of a number of standardized indicators and analyses of their development over time constitutes a practical approach to the partial solution of these problems. A specific set of basic data and seven indicators are suggested. Of the indicators, two serve as measures for the total volume of dental care available to the individual, two could help to assess the productivity of dental care workers, and three are intended to put the expenditures for dental care in the perspective of health care expenditures in general and the national economy at large. The practicality of the approach is subsequently demonstrated by the comparison of the basic data and the indicators for the Netherlands and the USA over the period 1972 through 1979.