胃癌术后患者的不同营养治疗费用比较及其影响因素分析

目的:了解肠外营养(Parenteral Nutrition,PN)与肠内营养(Enteral Nutrition,EN)治疗临床应用和费用的现状及费用影响因素。方法:通过对87份胃癌手术患者的病例回顾性调查(PN EN 28份和PN59份),利用SPSS10．0进行临床疗效和费用的单因素比较,以及影响住院总费用的多因素分析。结果:2004年全部胃癌手术病例的营养治疗率为100％(单纯PN治疗率为69％,EN加PN的治疗率为31．0％);两组临床疗效无明显差异,但两组出院和入院自身状况比较,PN EN组略优于PN组;从住院日和各类人均费用指标来看,PN EN组明显高于PN组(有统计学差异);但其人日均EN药费为113．81元,明显低于本组或PN组的人日均PN药费(P=0．034);PN EN组和PN组病例进行了多因素分析,结果提示PN EN组和PN组影响住院总费用的首位因素均是PN药费。结论:胃癌患者术后EN的治疗率不足30％,多数适合EN治疗的患者并没有进行EN治疗;并且无论PN还是有限的EN治疗,均存在着相当程度的不规范治疗。目前影响临床营养合理用药的主要原因并不是医疗技术水平因素,更多的是非医疗技术水平以外的因素。要推动营养治疗的健康发展,单单依靠临床技术的教育和培养是远远不够的,如何制定合乎营养治疗实际情况的经济激励及医保支付和报销政策,以及实施临床营养治疗的监管措施,对于实现临床营养治疗的真正意义来说是至关重要的。     

我院2003～2004年抗微生物药物使用频度分析

目的:了解我院抗微生物药物的应用情况及趋势,为临床医护人员及产、供、用单位有关人员提供参考。方法:以限定日剂量(DDD)、用药人次(DDDs)、消耗金额(元)、每日药费(元)为统计指标,对我院2003 -2004年抗微生物药物的应用情况进行初步统计、分析结果:2003年DDDs排序前20位的品种有14个进入2004年的前20位,2003年消耗金额排序前20位的品种有16个进入2004年的前20位:与2003年比较:2004年抗微生物药物的品种增加了14种、消耗金额增加了311%、人均日药费增加了19.84%,口服制剂所占的DDDs和消耗金额比率略有下降,而注射制剂的情况正好相反。结论:我院抗微生物药物应用广泛, 使用基本合理。     

糖尿病及其并发症患者的住院费用分析

目的:了解糖尿病及其并发症相关的住院费用和疾病负担情况.方法:将广州市7家三甲医院2002年度2 465例糖尿病患者按国际疾病分类分组,采用方差分析方法,研究不同组别患者的住院费用及其构成.结果:糖尿病住院患者中,无并发症的比例为42.6%,而57.4%的患者发生一种以上并发症;不同并发症之间的平均住院费用存在统计学差异,以糖尿病足病的平均费用为最大;糖尿病的药费占医疗费用的比例平均为40%.结论:糖尿病及其并发症带给患者家庭和社会沉重的经济负担,在加强糖尿病及其并发症防治研究的同时,必须加强对糖尿病的卫生经济学研究.     

Differences in energy expenditure during high-speed versus standard-speed yoga: A randomized sequence crossover trial

ObjectivesTo compare energy expenditure and volume of oxygen consumption and carbon dioxide production during a high-speed yoga and a standard-speed yoga program.DesignRandomized repeated measures controlled trial.SettingA laboratory of neuromuscular research and active aging.InterventionsSun-Salutation B was performed, for eight minutes, at a high speed versus and a standard-speed separately while oxygen consumption was recorded. Caloric expenditure was calculated using volume of oxygen consumption and carbon dioxide production.Main outcome measuresDifference in energy expenditure (kcal) of HSY and SSY.ResultsSignificant differences were observed in energy expenditure between yoga speeds with high-speed yoga producing significantly higher energy expenditure than standard-speed yoga (MD = 18.55, SE = 1.86, p < 0.01). Significant differences were also seen between high-speed and standard-speed yoga for volume of oxygen consumed and carbon dioxide produced.ConclusionsHigh-speed yoga results in a significantly greater caloric expenditure than standard-speed yoga. High-speed yoga may be an effective alternative program for those targeting cardiometabolic markers.     

Biomechanical,metabolic and cardiopulmonary responses of masters recreational runners during running at different speeds

This study tested interactions between age and running speed on biomechanics, metabolic responses and cardiopulmonary responses. Three-hundred participants ran at preferred and standardized speeds. Age group (younger, masters [≥40 years]) by speed (self-selected 8.8 km/h, 11.2 km/h and 13.6 km/h) interactions were tested on main outcomes of sagittal kinematic, temporal spatial, metabolic and cardiopulmonary parameters. At all speeds, angular displacements of the ankle, pelvis and knee were less in masters than younger runners (Hedges g effect size range = 0.30–1.04; all p < 0.05). A significant age group by speed interaction existed for hip angular displacement (Wald χ² = 10.753; p = 0.013). Masters runners ran at higher relative heart rates (p < 0.05) but at similar rates of oxygen use and energy expenditure. Masters runners used hip-dominant motion and step lengthening as running speed increased, but did not change centre of mass vertical displacement. This may increase mechanical stresses on tissues of the lower extremity in masters runners, especially hamstrings, hip joint and Achilles.     

Day-to-Day Variation in Food Intake and Energy Expenditure in Healthy Women: The Dietitian II Study

Because day-to-day food intake varies, we tested the hypothesis that ad libitum food intake and energy expenditure show corrective responses over periods of 1 to 10 days in healthy young women. Food intake and accelerometry measurements were collected daily for 17 days in 15 young women. Total daily energy expenditure (TDEE) using doubly labeled water was also measured. The daily deviations in macronutrient and energy intake and energy expenditure from the average values were compared with the deviations observed over succeeding intervals to estimate the corrective responses. The intraindividual coefficients of variation for energy intake averaged ±25%, ranging from 16% to 34%. TDEE had a coefficient of variation of 8.3%, and accelerometry had a coefficient of variation of 8.4% (range=4.6% to 16.4%). Energy expenditure by accelerometry (2,087±191 kcal/day) was not significantly different from TDEE (2,128±177 kcal/day), but reported daily energy intake was 20.4% lower (1,693±276 kcal/day). There were significant corrective responses in energy from fat and total energy intake. This occurred from Days 3 to 6, with a peak at Day 5 that disappeared when data were randomized within each subject. Human beings show corrective responses to deviations from average energy and macronutrient intakes with a lag time of 3 to 6 days, but not 1 to 2 days. These corrective responses are likely to play a role in bringing about weight stability.     

Predicting healthcare expenditure by multimorbidity groups

Objectives

This article has two main purposes. Firstly, to model the integrated healthcare expenditure for the entire population of a health district in Spain, according to multimorbidity, using Clinical Risk Groups (CRG). Secondly, to show how the predictive model is applied to the allocation of health budgets.

新疆心脑血管疾病治疗费用核算与住院费用影响因素分析

目的 综合分析新疆心脑血管疾病总治疗费用现状，为医疗资源的合理配置提供理论依据。方法 通过多阶段分层随机抽样，收集2017年新疆心脑血管疾病患者样本信息。在SHA 2011框架下，采用自上而下的分摊方法，核算心脑血管疾病的治疗费用。建立线性回归模型，用以分析住院费用的影响因素。结果 心脑血管疾病总治疗费用达105.74亿元；占比67.22%的治疗费用发生在综合医院；排名前三位的疾病分别为冠心病、高血压和脑梗塞，占比达74.20%；65岁及以上老年人群花费占比为43.51%；县（区）级机构（t = - 218.362，P＜0.001）、市级机构（t = - 103.65，P＜0.001）、住院天数（t = 233.297,P＜0.001）、65岁以上人群（t = 58.422，P＜0.001）、手术情况（t = 101.514，P＜0.001）均是影响住院费用的主要因素。结论 新疆心脑血管疾病消耗大量医疗资源；防控工作重点关注老年人群；治疗费用机构流向有待优化，应强化基层医疗机构在防治慢病工作中的主导作用；缩短住院时间是有效控制治疗费用的直接途径。