简介：AbstractBackground:Coronavirus disease 2019 (COVID-19) is now a global public threat. Given the pandemic of COVID-19, the economic impact of COVID-19 is essential to add value to the policy-making process. We retrospectively conducted a cost and affordability analysis to determine the medical costs of COVID-19 patients in China, and also assess the factors affecting their costs.Methods:This analysis was retrospectively conducted in Shandong Provincial Chest Hospital between 24 January and 16 March 2020. The total direct medical expenditures were analyzed by cost factors. We also assessed affordability by comparing the simulated out-of-pocket expenditure of COVID-19 cases relative to the per capita disposable income. Differences between groups were tested by student t test and Mann-Whitney test when appropriate. A multiple logistic regression model was built to determine the risk factors associated with high cost.Results:A total of 70 COVID-19 patients were included in the analysis. The overall mean cost was USD 6827 per treated episode. The highest mean cost was observed in drug acquisition, accounting for 45.1% of the overall cost. Total mean cost was significantly higher in patients with pre-existing diseases compared to those without preexisting diseases. Pre-existing diseases and the advanced disease severity were strongly associated with higher cost. Around USD 0.49 billion were expected for clinical manage of COVID-19 in China. Among rural households, the proportions of health insurance coverage should be increased to 70% for severe cases, and 80% for critically ill cases to avoid catastrophic health expenditure.Conclusions:Our data demonstrate that clinical management of COVID-19 patients incurs a great financial burden to national health insurance. The cost for drug acquisition is the major contributor to the medical cost, whereas the risk factors for higher cost are pre-existing diseases and severity of COVID-19. Improvement of insurance coverage will need to address the barriers of rural patients to avoid the occurrence of catastrophic health expenditure.

简介：AbstractBackground:Nucleic acid test (NAT) could effectively control the spread of COVID-19 caused by large-scale sports competitions. However, quantitative analysis on the appropriate frequency of NAT is scarce, and the cost-effectiveness and necessity of high-frequency NAT remain to be fully explored and validated. This study aims to optimize the COVID-19 surveillance strategies through cost-effectiveness analysis for the Tokyo 2020 Olympic Games and the upcoming Beijing 2022 Olympic Winter Games.Methods:A total of 18 scenarios were designed regarding the NAT frequency, symptom monitoring, and strengthening close-contact control. An agent-based stochastic dynamic model was used to compare the cost-effectiveness of different NAT scenarios and optimize the surveillance strategies. The dynamics of the proposed model included the arrival and departure of agents, transmission of the disease according to Poisson processes, and quarantine of agents based on regular NATs and symptom onset. Accumulative infections, cost, and incremental cost-effectiveness ratio (ICER) were simulated in the frame of the model. ICER was used to compare the cost-effectiveness of different scenarios. Univariate sensitivity analysis was performed to test the robustness of the results.Results:In Scenario 16, where the competition-related personnel (CRP) received NAT daily and national sports delegation (NSD) with quarantined infections accepted an additional NAT daily, accumulative infection was 320.90 (90 initial infections), the total cost was (United States Dollar) USD 8 920 000, and the cost of detecting out each infection was USD 27 800. Scenario 16 would reduce the total cost by USD 22 570 000 (avoid 569.61 infections), USD 1 420 000 (avoid 47.2 infections) compared with Scenario 10 (weekly NAT, strengthened close contact control) and Scenario 7 (daily NAT, no strengthened close contact control), respectively. Sensitivity analysis showed that the result was most sensitive to the change in basic reproductive number.Conclusions:High-frequency NATs such as bidaily, daily, and twice a day were cost-effective. NAT daily for CRP with strengthening close-contact control could be prioritized in defense against COVID-19 at large-scale sports competitions. This study could assist policymakers by assessing the cost-effectiveness of NAT scenarios and provide the host country with an optimal COVID-19 surveillance strategy.

简介：AbstractAspirin-exacerbated respiratory disease (AERD) patients with CRSwNP suffer from reduced quality of life, reduced economic productivity, and higher risk of depression and sleep dysfunction. These patients often require frequent medical and surgical therapy, including functional endoscopic sinus surgery for recalcitrant disease. Given this severity, anti-type 2 biologic treatments are being investigated for use in this subgroup of patients with CRSwNP, including Omalizumab and Dupilumab. Preliminary data suggests that SNOT-22 related quality of life improvements following treatment with biologics are comparable to the current standard of care in the short term, but there is a lack of long-term data and standardized regimen that makes direct comparison difficult. Biologic therapies additionally require continuous use to avoid recurrence, and currently cost many times more than existing medical or surgical therapies. Aspirin-Exacerbated Respiratory Disease (AERD) is a type 2 (Th2)-mediated inflammatory disease characterized by chronic rhinosinusitis (CRS), nasal polyposis, rhinorrhea and asthma exacerbated by nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (aspirin/ASA).1 From a rhinologic standpoint, AERD patients are recognized as a subset of patients CRS with nasal polyps (CRSwNP), with AERD affecting approximately 1% of the United States population.2 Broadly, CRSwNP patients demonstrate derangements of several Th2 pathways, including dysregulation of the interleukin (IL)-4, IL-5, and IL-13. Cytokine levels are altered systemically, in the nasal mucosa, and in polyp tissue itself, while mast cells and eosinophils are also increased locally.3,4,5,6 From a rhinologic standpoint, patients with AERD are often considered to be among the most difficult to treat CRS patients, due to severity and disease recalcitrance.6 This is reflected at the cellular and molecular level; nasal polyps from patients with AERD have over 3 times as many eosinophils and higher IL-5 concentrations when compared to polyps taken from subjects with non-AERD CRS.7,8

简介：AbstractBackground:Continuing progress in the global pediatric human immunodeficiency virus (HIV) response depends on timely identification and care of infants with HIV. As countries scale-out improvements to HIV early infant diagnosis (EID), economic evaluations are needed to inform program design and implementation. This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases (Embase, MEDLINE and EconLit) and grey literature for economic analyses of HIV EID in low- and middle-income countries published between January 2008 and June 2021. We extracted data on unit costs, cost savings, and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats. We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records, we included 29 studies: 17 cost analyses and 12 model-based cost-effectiveness analyses. Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests. All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective. Most studies reported costs of EID testing strategies; however, few studies assessed the same intervention or reported costs in the same way, making comparison of costs across studies challenging. Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV, while not directly comparable across studies, covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving. Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.

简介：摘要目的测量公立三级综合医院成本效率及其构成要素，分析其成本效率的影响因素。方法采用数据包络分析法的COST、CCR、BCC模型，分别测量我国3个省份141所样本医院的成本效率、配置效率、技术效率、纯技术效率和规模效率值。对数据进行描述性分析和多元线性回归分析。结果2018年样本医院成本效率值为0.632，配置效率值为0.929，技术效率值为0.675，纯技术效率值为0.732，规模效率值为0.917。10所(7.09%)样本医院处于规模报酬不变状态，41所(29.08%)样本医院处于规模报酬递减状态，90所(63.83%)样本医院处于规模报酬递增状态。地区人均GDP以及医院的床位使用率、平均住院日、每门急诊人次平均收费水平等，对样本医院成本效率值的影响具有显著性。结论技术效率是影响成本效率的主要原因，纯技术效率是提升技术效率的关键因素，不断提升医院内部管理水平是提高技术效率的主要和必要途径。内部因素对成本效率影响较大。降低平均住院日、提高床位使用率、降低每门急诊人次平均收费水平等，有利于提高医院成本效率。

简介：AbstractBackground:When utilizing the retrosigmoid approach (RA), accurately identifying the transverse and sigmoid sinus transition (TSST) is a key procedure for neurosurgeons, especially in developing countries restricted by the lack of expensive devices, such as the neural navigation system and the three-dimensional volumetric image-rendered system. Before operations, a computed tomography scan is a common and cost-effective method of checking patients who suffer lesions located at the cerebellopontine angle. Therefore, we present a technique using only high-resolution computed tomography to identify the transverse and sigmoid sinus transition.Methods:This retrospective study included 35 patients who underwent retrosigmoid approach operations to resect an acoustic neurinoma with the assistance of our technique. In brief, our technique contains 4 steps: (1) All patients’ 1-mm, consecutive, high-resolution computed tomographic images that clearly displayed landmarks, such as the inion, lambdoid suture, occipitomastoid suture, and the mastoid emissary foramen, were investigated initially. (2) We selected two particular slices (A and B) among all of these high-resolution computed tomographic images in which scanning planes were parallel with the line drawn from the root of the zygoma to the inion (LZI). Slice A contained both the root of the zygoma and the inion simultaneously, and slice B displayed the mastoid emissary foramen. (3) Four points (α, β, γ, δ) were arranged on slices A and B, and point α was located at the inner surface of the skull, which represents the posterior part of the sulci of the sigmoid sinus. Point β was located at the outer surface of the skull, and the line connecting them was perpendicular to the bone. Similarly, on slice B, we labeled point γ as the point that represents the posterior part of the sulci of the sigmoid sinus at the inner surface and point δ as the point located at the outer surface of the skull, and the line connecting them was also perpendicular to the bone. The distances between point β and the lambdoid suture/occipitomastoid suture and between point δ and the mastoid emissary foramen were calculated for slices A and B, respectively. (4) During the operation, a line indicating the LZI was drawn on the bone with ink when the superficial soft tissue was pushed away, and this line would cross the lambdoid suture/occipitomastoid suture. With both the crosspoint and the distance obtained from the high-resolution CT images, we could locate point β. We also used the same method to locate point δ after revealing the mastoid emissary foramen. The line connecting point β and point δ indicated the posterior border of the sigmoid sinus, and the intersection between the line and LZI indicated the inferior knee of the transverse and sigmoid sinus transition (TSST).Results:All 35 patients underwent the RA craniectomies that were safely assisted by our technique, and neither the sigmoid sinus nor the transverse sinus was lacerated during the operations.Conclusion:Our cost-effective technique is reliable and convenient for identifying the transverse and sigmoid sinus transition (TSST) which could be widely performed to guarantee the safety of RA craniectomy.

简介：摘要目的探讨加强院前急救护理管理在院前救护中的应用效果。方法选取深圳市急救中心2020年10月至2021年5月304例院前急救患者资料进行回顾性研究，随机数字表法分为观察组和对照组，每组152例。观察组男80例、女72例，年龄（38.49±2.47）岁；对照组男78例、女74例，年龄（39.28±2.64）岁。对照组采取常规院前急救护理管理，观察组采取加强院前急救护理管理。对比两组急救所需时间、病死率以及护理满意度。统计学方法采用独立样本t检验、χ2检验。结果观察组转移回院时间、达到患者处时间、出车反应时间均低于对照组［（6.28±2.12）min比（12.26±2.84）min、（7.64±2.18）min比（13.51±3.51）min、（2.12±0.57）min比（3.20±0.68）min］，两组比较差异均有统计学意义（t=5.201、4.632、5.102，P=0.016、0.013、0.024）；观察组病死率显著低于对照组［5.92%（9/152）比27.63%（42/152）］（χ2=25.657，P<0.001）；观察组护理满意度高于对照组［98.68%（150/152）比75.66%（115/152）］（χ2=36.033，P<0.001）。结论通过加强院前急救护理管理可有效缩短急救所需时间，降低病死率，提升家属的护理满意度。

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简介：摘要目的探讨出院前培训结合出院后居家发音功能训练对喉癌患者术后喉功能重建的影响。方法选取2016年10月至2019年9月在无锡市第二人民医院进行喉癌术后喉功能重建患者80例，依照入院时间将患者分为研究组和对照组各40例。研究组患者采用出院前培训结合出院后居家发音功能训练，对照组患者采用常规喉癌术后喉功能重建护理。比较两组患者的临床效果。结果研究组术后并发症发生率为5.00%，显著低于对照组的25.00%，差异有统计学意义(P<0.05)；两组患者干预前基频(Fo)，基频微扰(Jitter)、振幅微扰(Shimmer)比较差异均无统计学意义(均P>0.05)；干预后1个月、3个月研究组患者Fo、Jitter、Shimmer指标显著低于对照组，差异均有统计学意义(均P<0.05)；研究组患者在干预后改良华盛顿大学生活质量量表(UWQOL)各项评分显著高于对照组，差异均有统计学意义(均P<0.05)。结论出院前培训结合出院后居家发音功能训练对喉癌患者术后喉功能重建具有良好的应用价值，可显著降低患者的并发症发生率，提升患者喉部发音功能，显著提高患者的生活质量。

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简介：摘要目的探讨基于项目合作的院-所融合模式。方法围绕临床和基础科研协作模式创新的管理，探讨基于项目合作的院-所融合模式的方式及实践中应注意的关键点，以加深对该建设与发展模式的理解。结果创建基于项目合作的院-所融合模式要将科研与临床有机融合，全面开展管理理念、科研能力、教学组织和服务理念等方面的综合建设，培养研究型高水平人才，组织创建研究型科室，形成医院主体架构与中坚力量；同时，在医疗改革及行业竞争的形势下找准定位，及时转换发展模式，促进医院的健康发展。结论基于项目合作的院-所融合模式是临床和基础科研协作模式创新的发展方向，是在新医疗改革形势下，促进诊疗水平提高的有效保障。

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简介：目的：对于精神专科医院长期住院患者，医院感染管理是一项临床需要重点关注的问题。通过研究分析专科医院院感危险因素可以更好地保障广大住院患者的生命健康，提高医疗质量，评估检测医院医疗水平。方法：通过目前基层医院现有检测手段，分析在院患者医院院感危险因素，可以更好辅助临床诊断治疗，以及对预后评估。回顾2019年12月至2022年9月我院精神一科三、四、五病区在院患者医院感染病例，及其可能危险因素分析总结。采取多因分析方法，对相关病例进行回顾分析。结果：精神专科医院院感主要危险因素为上呼吸道感染。其次包括皮肤软组织感染，口腔感染，胃肠道及泌尿系统感染。结论：基层专科医院院感危险因素主要与患者基础自理能力差，医务人员专业人手不足以及检验手段单一等因素有关。

简介：摘要浙江武康疗养院由始建于1887年的杭州广济麻风医院演变而来，是中华人民共和国成立后浙江省麻风病防治中心。现居疗养院的麻风病患(休养员)大多于20世纪60年代陆续进院。由于氨苯砜单疗法的局限和生活条件艰苦，休养员需要长期接受隔离治疗，从事集体生产。改革开放后，疗养院的医疗和生活水准得到显著改善，社会治疗取代隔离治疗，休养员逐渐融入社会；联合化疗的推广缩短了疗程，也大大降低了麻风畸残率；政府持续加大对麻风病人的财政补助，他们的生活来源基本得到保障；广泛普及的麻风防治知识也使麻风病人逐渐摆脱了被"污名化"的困境。在"后麻风时代"，武康疗养院由注重疾病治疗转向加强病人的心理建设，其职能从隔离防疫转向休憩养老，麻风病人的身份也从"病人"转变为"休养员"。这一系列的变迁反映了麻风防疫事业由防治向养老转变过程中的人文关怀与"去污名化"的价值引导。

简介：摘要作者介绍了某院将医院信息系统与医院微信公众号无缝对接，构建离院患者的用药管理平台(以下简称"智慧药师"平台)，向离院患者自动定时推送个性化的用药提醒；同时通过移动互联网建立用药咨询等服务窗口，拓宽药学服务范围。建立了涵盖用药提醒、用药打卡记录、语音播报、用药咨询、处方查询、药品说明书查询6项功能的"智慧药师"平台，实现了离院配药患者居家用药有提醒，并提供了触手可及的"药师-患者互动"服务窗口，保障了离院患者的用药安全有效。

简介：摘要目的分析院际转运在危重症儿童中的应用现状，探讨如何进一步优化危重症儿童院际转运系统建设。方法回顾性分析2018年2月至2020年12月深圳市儿童医院儿童疾病转运中心通过院际转运收治PICU的296例危重症患儿的临床资料。结果296例院际转运危重症患儿主要来自深圳地区及深圳周边地区共74家医院，辐射半径2.5~365 km，其中164例(55.4%)转运半径为50~200 km，117例(39.5%)转运半径为50 km以内，15例(5.1%)转运半径>200 km。转运患儿中男186例(62.8%)，女110例(37.2%)。年龄范围1月龄~16岁(中位数1岁10个月)。所有转运危重症患儿中需要呼吸机辅助通气152例(51.4%)，转运途中发生不良事件4例(1.4%)。需紧急处理的：需吸痰18例(6.1%)，球囊通气1例(0.3%)，镇静药止痉4例(1.4%)，无一例患儿在转运途中死亡。转运病种呈多样化，其中意外伤害103例(34.8%)，呼吸系统疾病60例(20.3%)，神经系统疾病52例(17.6%)，心血管系统疾病24例(8.1%)，感染致多脏器功能障碍20例(6.8%)，消化系统疾病(含外科疾病)15例(5.1%)，传染性疾病11例(3.7%)，血液系统疾病5例(1.7%)，内分泌及免疫系统疾病各3例(1.0%)。296例危重症患儿均经过我院急诊科绿色通道收入PICU住院治疗，住院后经手术治疗39例(13.2%)，主要为颅脑手术29例(9.8%)，2例(0.7%)接受体外膜肺氧合治疗。住院天数1~246 d(中位数12 d)，243例(82.1%)治愈或好转出院，27例(9.1%)放弃治疗或转院，26例(8.8%)死亡。结论危重症儿童院际转运系统在三甲医院尤其是儿科专科三甲医院的建立，有助于解决周边大部分综合性医院儿科医疗设备不齐全和医疗水平受限的问题，有利于更迅速、更积极有效地救治危重症患儿，而持续推广和优化院际转运系统对实现三级诊疗阶梯建设、保障儿童健康和生存质量极其重要。

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