Direct medical costs unequivocally related to diabetes in Italian specialized centers

This study estimated the resource utilization and direct medical costs in Italian diabetes centers (DCs). Hospital admissions for major chronic complications were not considered since DCs deliver primary care and follow up only complications unequivocally related to diabetes-acute complications and diabetic foot. The multicenter, prospective, observational study involving 31 Italian DCs included a total of 1,910 patients classified into eight prognostic groups by type of diabetes (types 1 and 2), metabolic control (HbA1c >7.5%, HbA1c 7.5%) and age (60, >60). The average total cost of type 1 diabetes per patient per year ranged from € 762 in group 2 (age 60, HbA1c >7.5%) to € 1,060 in group 4 (age >60, HbA1c >7.5%), and that the cost of type 2 diabetes from € 423 in group 5 (age 60, HbA1c 7.5%) to € 613 in group 8 (age >60, HbA1c >7.5%). The study brought to light the wide variability in the single cost components across clinically defined groups of patients. The cost of diabetes management in the strict sense was significantly affected by the type of diabetes and metabolic control.Data monitoring: E. Negri.E. Ansaldi, Alessandria; C. Baggiore, Florence; M. Balsanelli, Ostia; C. Bertoni, La Spezia; V. Borzì, Catania; A. Boscolo Bariga, Chioggia; A. Bruno, Turin; S. Caronna, Parma; F. Chiaromonte, Rome; S. Ciaccio, Pisa; G. Cicioni, Terni; M. Di Mauro, Catania; S. Gamba, Turin; L. Gentile, Asti; S. Giannini, Florence; D. Giorgi Pierfranceschi, Piacenza; T. Lavagnini, Padua; M. Lunetta, Catania; M. Marchesi, Bolzano; I. Meloncelli, San Benedetto del Tronto (Ascoli Piceno); G. Micali, Messina; M. Orrasch, Treviso; C. Pacchioni, Modena; M. Parillo, Caserta; G. Perriello, Perugia; S. Pistone, Potenza; G. Rinaldi, Naples; G. Sessa, Naples; M. Tagliaferri, Larino; P. Tatti, Marino (Rome); P. Ubaldi, Genua; M. Velussi, Monfalcone (Triest); E. Vitacolonna, Pescara; G. Zoppini, Verona; P. Zucchi, Asola (Mantua).     

Hospital resources used for ectopic pregnancy treatment by laparoscopy and methotrexate.

OBJECTIVE: To compare resources used in the medical and laparoscopic treatment of unruptured ectopic pregnancy. METHODS: We prospectively recorded all the medical resources required in the treatment of unruptured ectopic pregnancy. The study period ranged from January 1, 1995 to June 30, 1998. Single-dose intramuscular methotrexate injections were administered in 55 women (group I). This therapeutic option was provided on an outpatient basis in small EP (beta-HCG level < 5000 IU/L and hematosalpinx diameter < 3 cm). Serial clinical controls and biologic tests were performed until bHCG became negative. Forty women underwent a laparoscopic salpingostomy because they refused the methotrexate regimen or had "social" contra-indications (ie, predictable difficulties in the follow-up) (group II). Twenty-one patients underwent conservative laparoscopic treatment because of "medical" contraindications to methotrexate (group III). We recorded the resources used with the outpatient and inpatient treatment in each group (methotrexate consumption, operating room acts, length of hospital stay, clinical examinations, biological tests, and sonograms during the follow-up). RESULTS: We observed similar cure rates in each group, but it took significantly longer for beta-HCG to become negative in group 1. However, hospitalization was significantly less often required, and the length of hospital stay was shorter in this group. But length of follow-up, number of office visits, biological tests, sonograms, and subsequent readmissions were significantly more frequent after methotrexate. Despite more severe clinical presentations for patients in group III, we didn't find any significant differences in the hospital resources used in this group in comparison with those used in group II. CONCLUSIONS: The outpatient methotrexate option may result in low consumption of resources for a hospital because most of the follow-up can be performed by city practitioners and laboratories. For the laparoscopic option, efforts should be made to reduce the postoperative hospital stay.     

关于实现卫生资源优化配置的思考

分析了当前卫生资源配置存在的主要问题进行，提出了实现卫生资源优化配置应遵循可及性、可得性、有效性和有序性的原则，以指导建立符合我国国情的卫生资源优化配置模式。     

新疆地区中等护理教育资源分布现况调查

目的 调查新疆中等护理教育资源在全疆的配置及分布现况,为新疆护理教育资源进行合理配置提供参考依据.方法 采用自设问卷对新疆地区所有开设中等护理教育的12所院校进行教育资源状况调查.结果 新疆开设全日制中等护理学专业院校数量由高到低依次为北疆、南疆、东疆地区;学校教育资源配置的17项指标中,护理教师职称结构比例和学生人均图书册数在东疆地区、北疆地区、南疆地区配置差异有统计学意义(P＜0.05);其余各项资源配置差异均无统计学意义(P＞0.05).结论根据此次研究结果,建议通过与地区高等院校进行合作,共享教育资源;以及加强教师队伍建设的措施来解决新疆中等护理教育资源中存在的问题.     

1992～2004年常州市医疗卫生人力状况分析

[目的]了解常州市卫生人力资源的动态变化,发现存在问题,为政府部门制定卫生人力规划提供参考。[方法]对1992-2004年常州市卫生人力资源的数量、结构及其利用状况进行分析。[结果]卫技人员数1992-2001年、2002-2004年平均增长2.20%、1.45%,2004年每千人口卫技人员为4.5人;2004年医护比为1∶0.85;2004年与1992年比较,乡镇卫生院的医生日均诊疗人次下降21.09%,医生日均担负床数下降46.96%。[结论]常州市卫生人力资源数量趋于饱和,但医护比倒置,农村卫生人力利用不足。     

加强医院图书馆资源建设 搞好网络资源重组与整合

简要论述了医院图书馆文献资源向学科专业化整合的方式和对网资源进行重组与整合以及信息资源的采集与整合的方法。     

唐山地区药用植物资源及其可持续开发利用研究

目的:调查唐山地区药用植物资源的种类与分布,为药用植物资源的开发利用提供依据。方法:深入各代表性地域进行药用植物资源调查,采集标本,鉴定标本,考证文献资料,调查在民间的应用等。结果:唐山地区有药用植物113科、301属、382种,其中蕨类植物7科8属11种;裸子植物5科6属8种;单子叶植物9科36属42种。双子叶植物92科251属321种。结论:唐山地区药用植物资源丰富,具有较好的开发利用前景。     

RBRVS-KPI模式下公立医院绩效考核体系构建及应用

目的探讨如何将以资源为基础的相对价值比率（RBRVS）与关键绩效指标法（KPI）相结合,运用于公立医院绩效考核体系实践中。方法分析样本医院绩效考核体系的应用效果,根据医院总体目标,经过点值测算、指标选择,建立了一套具有医院特色的改良型RBRVS-KPI模式绩效考核体系。结果经实践,医疗质量和运行效率大幅度提高,在一定程度上促进了医院管理的精细化。结论RBRVS-KPI模式下的绩效考核体系较唯财务导向的绩效模式更能体现医护人员劳动价值,值得探索与推广。     

Clinical course and outcomes of critically ill patients with COVID-19 infection: a systematic review

ObjectivesCoronavirus disease 19 (COVID-19) is a major cause of hospital admission and represents a challenge for patient management during intensive care unit (ICU) stay. We aimed to describe the clinical course and outcomes of COVID-19 pneumonia in critically ill patients.MethodsWe performed a systematic search of peer-reviewed publications in MEDLINE, EMBASE and the Cochrane Library up to 15th August 2020. Preprints and reports were also included if they met the inclusion criteria. Study eligibility criteria were full-text prospective, retrospective or registry-based publications describing outcomes in patients admitted to the ICU for COVID-19, using a validated test. Participants were critically ill patients admitted in the ICU with COVID-19 infection.ResultsFrom 32 articles included, a total of 69 093 patients were admitted to the ICU and were evaluated. Most patients included in the studies were male (76 165/128 168, 59%, 26 studies) and the mean patient age was 56 (95%CI 48.5–59.8) years. Studies described high ICU mortality (21 145/65 383, 32.3%, 15 studies). The median length of ICU stay was 9.0 (95%CI 6.5–11.2) days, described in five studies. More than half the patients admitted to the ICU required mechanical ventilation (31 213/53 465, 58%, 23 studies) and among them mortality was very high (27 972/47 632, 59%, six studies). The duration of mechanical ventilation was 8.4 (95%CI 1.6–13.7) days. The main interventions described were the use of non-invasive ventilation, extracorporeal membrane oxygenation, renal replacement therapy and vasopressors.ConclusionsThis systematic review, including approximately 69 000 ICU patients, demonstrates that COVID-19 infection in critically ill patients is associated with great need for life-sustaining interventions, high mortality, and prolonged length of ICU stay.     

Health-related quality of life (HRQoL) domains most valued by urban isiXhosa-speaking people

Purpose The aim of the study was to investigate and identify aspects of health-related quality of life (HRQoL) that are most valued by isiXhosa-speaking people resident in under-resourced areas of Cape Town. Methodology Fifty-seven domains of HRQoL were identified as important through group discussions with isiXhosa-speaking people. Participants randomly selected from the community (n = 601) and from individuals seeking medical attention at a local clinic (n = 102) graded the domains on a visual analogue scale (VAS) ranging from 0 as “not at all important” to 10 as “ very important”. The domains were then mapped to the categories of the International Classification of Functioning, Disability, and Health. Results The domains regarded as being most important were food availability (9.5, SD = 1.52), owning a brick house (9.4, SD = 1.57), access to medical services (9.4, SD = 1.55), and family safety (9.4, SD = 1.7). Having no bodily pain was ranked 40th. Environmental factors were valued significantly more than the other two categories and those related to body functions were valued more highly than domains in the category of activity/participation. Discussion and conclusion Despite being asked specifically to answer the questions in relation to their health status, the participants apparently did not differentiate between general quality of life (QoL) and specific HRQoL. It appears that members of an under-resourced community regard socioeconomic and service delivery aspects of their lives as integral to their perceived state of health. It may be that it is not possible to separate factors relating to general quality of life from those specifically related to HRQoL in an under-resourced population and such populations might not be suitable for inclusion in certain clinical trials where improvement in HRQoL is the required outcome. Alternatively, if a HRQoL instrument is to be used to monitor the impact of medical intervention, the inclusion of environmental factors should be considered.