B超对急腹症的诊断与分析

目的 探讨B超对急腹症的超声诊断.方法 3.5～5.0MHz凸阵探头对186例急腹症患者进行图像分析.结果 B超诊断与临床诊断符合率达83.9％,误诊率达9.14％,未发现阳性结果占6.9％.结论 通过B超检查可使患者早诊断、早治疗、早康复.     

Real-world healthcare resource utilization related to migraine treatment failure: a panel-based chart review in France,Germany, Italy,and Spain

Abstract

Aims: This retrospective chart review examined the six-month migraine-related healthcare resource use (HRU) among European patients who had ≥4 migraine days per month and previously failed at least two prophylactic migraine treatments.

Methods: Neurologists, headache specialists, and pain specialists in France, Germany, Italy, and Spain who treated ≥10 patients with migraine in 2017 were recruited (April–June 2018) to extract anonymized patient-level data. Eligible physicians randomly selected charts of up to five adult patients with clinically-confirmed migraine, ≥4 migraine days in the month prior to the index date, and had previously failed at least two prophylactic migraine treatments. Treatment failure was defined as discontinuation due to lack of efficacy and/or tolerability. Demographic and disease characteristics as of the index date, and migraine-related HRU incurred during the 6-month study period, were recorded.

Results: A total of 104 physicians contributed 168 charts for patients (63% female). On average, patients were 38?years old and failed 2.3 prophylactic treatments as of the index date. During the study period, 83% of patients had ≥1 outpatient visit for migraine in the physician’s office, and 27% went to the ER/A&E. Approximately 5% of patients were hospitalized for migraine, with an average of one hospitalization and an average length of stay of 3 days. Approximately 39% of patients had ≥1 blood test, 22% had ≥1 magnetic resonance imaging, 17% had ≥1 electroencephalogram, and 13% had ≥1 computerized tomography scan. Visits to other healthcare providers were common.

Limitations: This study is subject to the limitations of chart review studies, such as errors in data entry.

Conclusions: Across four European countries, the HRU burden of migraine among patients who previously failed at least two prophylactic treatments was high, indicating a need for more effective prophylactic treatments to appropriately manage migraine and reduce the HRU burden attributable to this common disorder.     

沥青混凝土路面病害成因及防治

本文针对沥青混泥土路面各种病害成因进行了分析,并根据其成因提出有针对性的防治措施。     

Attainment of combined optimal lipid values and the impact of lipid medication on cardiovascular outcomes and costs in a commercially insured population in the US

Abstract

Objective: To determine factors associated with the achievement of optimal lipid values (OLVs) and subsequent impact on clinical and economic outcomes.

Methods: An observational managed care database analysis was conducted among treatment-naïve adults with elevated cardiovascular (CV) risk, ≥12 months follow-up and full lipid panel from the 1st January 2002 to the 28th February 2005. Achievement of guideline-based levels for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides was evaluated via laboratory data. Annual CV-attributable resource utilisation was assessed via medical and pharmacy claims data. Clinical and economic outcomes associated with the achievement of OLVs were assessed using multivariate regression.

Results: A total of 52,778 patients were followed for a mean (standard deviation) of 27 (10) months with 13% achieving combined OLVs at baseline and 23% after 4 years. Of patients, 69% did not initiate lipid-modifying medication. The achievement of combined OLVs reduced the risk of CV event (odds ratio = 0.86; 95% confidence interval 0.78–0.95), resource utilisation (inpatient visits: 3.36 vs. 4.41 per 100 patient years, p<0.0001; emergency department visits: 1.1 vs. 2.4 per 100 patient years, p<0.05) and costs: $703 vs. $903 per patient year, p<0.0001.

Conclusions: Simultaneous achievement of OLVs was rare in this patient population. Physicians should be encouraged to manage multiple risk factors aggressively to improve clinical and economic outcomes associated with CV disease.     

浅谈沥青路面施工

在经济不断发展的背景下,公路的发展取得了举世瞩目的成就。随着国家石油沥青产量的急剧增加,沥青路面已经成为我国路面的一种主要形式。沥青路面的施工工艺已经日趋成熟,其质量也越来越易于控制。本文就沥青路面的施工工艺、病害原因分析及控制进行简单的讨论。     

试论2011年全国传染病医院效益分析

2011年全国传染病医院资产规模扩张速度快,有持续发展能力。应加强成本核算,控制成本支出,加强资产管理,提高资产利用率,提升服务质量,增加业务收入,提高工作效率,加快转型发展。     

自然地质环境与人类健康研究

本文对自然地质环境和人类健康的关系进行了初步探讨，揭示人类的身体健康与自然地质环境密切相关。正如《黄帝内经 》中所说“人与天地相应”，指出了人体与自然地质环境相互依存又相互制约的关系。当周围环境中缺少了人体必须的物质成份，人就会罹患生物地球化学性疾病。有利于人类健康的自然地质环境可使人健康长寿，不利于人类健康的自然地质环境则导致各种传染和非传染性疾病。     

欠发达地区疾病预防控制文化的建设思路与营销策略

文章分析了我国疾病预防控制体系建设的历程,提出了疾病预防控制文化的内涵,分析了疾病预防控制的意义,研究了欠发达地区疾病预防控制文化建设存在的不足和问题,并提出了加强欠发达地区疾病预防控制文化建设的思路和营销策略。     

Livestock Disease Indemnity Design When Moral Hazard Is Followed by Adverse Selection

Averting or limiting the outbreak of infectious disease in domestic livestock herds is an economic and potential human health issue that involves the government and individual livestock producers. Producers have private information about preventive biosecurity measures they adopt on their farms prior to outbreak ( ex ante moral hazard), and following outbreak they possess private information about whether or not their herd is infected ( ex post adverse selection). We investigate how indemnity payments can be designed to provide incentives to producers to invest in biosecurity and report infection to the government in the presence of asymmetric information. We compare the relative magnitude of the first- and second-best levels of biosecurity investment and indemnity payments to demonstrate the tradeoff between risk sharing and efficiency, and we discuss the implications for status quo U.S. policy.     

Costs of inpatient and emergency department care for chronic obstructive pulmonary disease in an elderly Medicare population

Objective:

Treatment in the hospital setting accounts for the largest portion of healthcare costs for COPD, but there is little information about components of hospital care that contribute most to these costs. The authors determined the costs and characteristics of COPD-related hospital-based healthcare in a Medicare population.

Methods

Using administrative data from 602 hospitals, 2008 costs of COPD-related care among Medicare beneficiaries age ≥65 years were calculated for emergency department (ED) visits, simple inpatient admissions and complex admissions (categorized as intubation/no intensive care, intensive care/no intubation, and intensive care/intubation) in a cross-sectional study. Rates of death at discharge and trends in costs, length of stay and readmission rates from 2005 to 2008 also were examined.

Main results:

There were 45,421 eligible healthcare encounters in 2008. Mean costs were $679 (SD, $399) for ED visits (n = 10,322), $7,544 ($8,049) for simple inpatient admissions (n = 25,560), and $21,098 ($46,160) for complex admissions (n = 2,441). Intensive care/intubation admissions (n = 460) had the highest costs ($45,607, SD $94,794) and greatest length of stay (16.3 days, SD 13.7); intubation/no ICU admissions had the highest inpatient mortality (42.1%). In 2008, 15.4% of patients with a COPD-related ED visit had a repeat ED visit and 15.5–16.5% of those with a COPD-related admission had a readmission within 60 days. From 2005 to 2008, costs of admissions involving intubation increased 10.4–23.5%. Study limitations include the absence of objective clinical data, including spirometry and smoking history, to validate administrative data and permit identification of disease severity.

Conclusions:

In this Medicare population, COPD exacerbations and related inpatient and emergency department care represented a substantial cost burden. Admissions involving intubation were associated with the highest costs, lengths of stay and inpatient mortality. This population needs to be managed and treated adequately in order to prevent these severe events.