血吸虫病查治费用投入有效性评价模型

本文分析了普治、筛治和组合3种常用血防查治方案费用的效应部份和非效应部份的主要构成因素,并建立了以数学模型表达的评价指标.结果显示:普治方案费用效应的决定因素为人群感染率;筛治方案则以人群感染率和治查费用比为主,其次查病方法的敏感性和特异性亦能产生影响;组合方案的费用效应由分别符合前二者之基本规律的两部份构成.作者认为对查治方案的选择必须兼顾方案的防治效果、可供的查治能量大小和费用使用的合理性等诸个方面.     

浅谈医院成本核算管理的现状及建议

成本核算是医院经济管理的基础,核算工作的质量直接影响医院成本管理的成效.本文在分析医院成本核算现状的基础上,对医疗成本核算在医院管理中的重点问题及医院成本核算管理的改革思路进行了探讨.     

L''évaluation du coût des complications peut-elle contribuer à la poursuite du développement de la radiothérapie ?

At the present time, the current improvement of technical and dosimetric aspects of radiation oncology has to be evaluated in terms of potential benefit for the patient and the society. For this last point of view, specially designed economic analyses must be performed in order to justify the number of resources involved by these technical improvements. If the question is how the current technical procedures could reduce the risk of undesirable side-effects, the response cannot be immediately drawn from the literature. This paper emphasizes the possibility to evaluate the role of side-effects as endpoints of economic analyses when using special models in medical decision making such as Markov's. Only few oncologic situations are reliable to properly analyze the relationship between sophisticated radiation techniques and the incidence of post-radiation complications. These situations should be selected when prospective economic analyses are planned in the field of radiation therapy.     

妇幼卫生服务项目成本测算探讨

采用成本法，以福建省和黑龙江省为现场，测算2001年妇幼保健机构妇幼卫生服务项目实际消耗，并对测算结果进行分析讨论。得出重医疗、轻保健的现状导致了妇幼卫生服务工作数量和质量的下降，妇幼保健服务与人群健康水平提高的关系等，并提出保持妇幼保健机构的独立性，调整卫生资源配置方向等建议和意见。     

Daily durations of spontaneous activity in cat’s ankle muscles

 For an understanding of how various degrees of altered use (training, disuse) affect the properties of skeletal muscles, it is important to know how much they are used normally. The main aim of the present project was to produce such background knowledge for hindlimb muscles of the cat. In four adult female cats, each one being studied in several experimental sessions, ankle muscles were chronically implanted with electrodes for electromyographic (EMG) recording. The muscles recorded from were: extensor digitorum longus (EDL), peroneus longus (PL), tibialis anterior (TA), lateral gastrocnemius (LG) and soleus (SOL). For PL, TA and LG, there were anterior as well as posterior recording sites. During 24-h experimental sessions, the studied animal stayed, together with another cat, in a box large enough for playing and walking around. Using telemetric techniques, samples of EMG signals were recorded on tape for 4 min every 30 min. In an off-line analysis, measurements were made of the total accumulated duration of activity from each one of the studied muscle regions. These ”duty times” were expressed as a percentage of total sampling duration. When averaged over the whole 24-h experimental period, the mean duty times per muscle region varied from 1.9% for EDL up to about 13.9% for SOL. Also, among predominantly fast muscles of mixed-fibre composition (i.e. all studied muscles except SOL), marked and statistically significant differences in duty time were found, mean values varying fivefold from 1.9% (EDL) to 9.5% (PL, posterior site). For all three muscles with simultaneous recordings from different sites, consistent and statistically significant differences in daily duty time were found between anterior and posterior regions (anterior less than posterior for TA and PL; anterior more than posterior for LG). We also measured the extent to which each 4-min sampling period was filled with activity (if any). As compared to muscles with a low mean 24-h duty time, those with high duty times were not active during more sampling periods per day, but, whenever being used, their activity lasted relatively longer. Such results were consistent with the view that differences in mean 24-h duty time might largely reflect differences in the extent to which the various muscles and muscle regions were used for long-lasting stabilizing contractions. Received: 15 July 1996 / Accepted: 29 November 1996     

Deriving welfare measures from discrete choice experiments: a response to Ryan and Santos Silva

In this response we start by highlighting the key area of agreement between the commentaries and our original paper: if there is uncertainty regarding which alternative will be chosen, in a DCE or in the real world, then the compensating variation as modified for discrete data by Small and Rosen is the appropriate method of deriving welfare measures from DCEs. Both commentators point out circumstances in which the method traditionally used in the health economics arena may be consistent with the compensating variation. We show that these circumstances require a number of potentially unrealistic and ad hoc assumptions, and argue that using the traditional method could produce erroneous welfare estimates if these assumptions fail to hold in practice. We show that the compensating variation method can accommodate each of the special cases raised by the commentators and therefore is the more general and appropriate approach to deriving welfare measures from DCEs. We also respond to issues raised regarding the estimation of DCEs in general and our application to asthma medication in particular. Copyright © 2004 John Wiley & Sons, Ltd.     

Effects of reduction of carrier gas flow rate on sevoflurane and isoflurane consumption and costs

Purpose To evaluate whether sevoflurane and isoflurane consumption would be actually halved by halving the carrier gas flow rate, as predicted by a theoretical model, we measured the consumed volume of liquid sevoflurane and isoflurane and total costs of anesthetic gas at carrier gas flow rates of 3 and 61·min⁻¹. Methods Eighty patients of ASA physical status I or II were randomly assigned to one of four groups: sevoflurane at 3 or 61·min⁻¹ and isoflurane at 3 or 61·min⁻¹. Anesthesia was induced with thiamylal and maintained with sevoflurane or isoflurane, as well as with nitrous oxide in oxygen. The consumption of sevoflurane and isoflurane was measured by weighing the bottle of liquid agent, which was greater in the groups receiving 61·min⁻¹ gas than in those receiving 31·min⁻¹. Results Halving the carrier gas flow rate reduced the consumption of sevoflurane by 41.8% and that of isoflurane by 52.6%. It also reduced the total cost by 44.3% for sevoflurane and 49.2% for isoflurane. Conclusion Halving the carrier gas flow rates halved the consumption of isoflurane but not of sevoflurane, indicating that factors other than carrier gas flow rates are involved in determining consumption in the clinical setting.