Objective To understand the current situation of medical service and management in Xintian Central Township Health Center (XtC) through on-the-spot investigation, and to provide references for development of key techniques and products for township health centers in medicine allocation and delivery. Methods The questionnaire and the focus interview were carried out, which included the general information, human resources, medical service and management, as well as the practice of essential medicine list. Results a) The hardware conditions of XtC were not good enough, and the income of Lintao county and Gansu provincial government fell short of their needs; b) The General Practitioner (GP)/nurse ratio was higher than that of the national level, the GP/pharmacist ratio was a little bit lower, and the GP/laboratorian ratio reached the national level. There was only one medical technician. There was about 27.5% staff members having no college degree, and about 81% having at most primary profession titles. There were 26 medical workers allocated to XtC in recent two years and only one GP left; c) In 2009, the bed utilization ratio was a little bit higher than the national level (109% vs. 60.7%), while the average length of stay was longer than the national level (6 vs. 4.8); d) The outpatient service in 2010 increased by 17.6% compared to 2009 and the inpatient service in 2010 decreased by 17%; e) The average medical expense per outpatient and per inpatient increased by 23.5% and 14.9%, respectively, in 2010 compared to 2009; f) The essential medicine list (EML) was put into practice in June, 2010. The current count of medicine in hospital was 767, far beyond the EML demand. Conclusion XtC, as a basic rural Township Health Center in Western China, overtakes the burden of healthcare service for local population. The policy of “selecting graduates to work in Township Health Center” made by Gansu government ensures sufficient personnel reserve for rural Township Health Center. XtC needs to cope with challenges of insufficient hardware conditions, unreasonable personnel structure, low educational background and profession title of the staff, and low technical level of medical service. XtC has a big ratio of medicine income and the expense of outpatient is lower than that of the national level. The management of XtC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are needed to maintain its service quality. And it is necessary to carry out evidence-based selection of the essential medicine account and develop staff training and essential medicine usage guidance, so as to support the medicine used safely and rationally.
Objective To investigate financial burden of in-patients with hypothalamus-pituitary-adrenal gland/gonad diseases in the West China Hospital of Sichuan University, 2011, so as to provide baseline data for further research. Methods The data of in-patients (who had been discharged from the department of endocrinology and metabolism or discharged after being transferred to other departments for diagnosis and treatment in the West China Hospital in 2011) were collected from the Hospital Information System (HIS) of the West China Hospital, including basic information, initial diagnosis when the patients were discharged, hospital costs, the information about whether the patients had been registered the insurance in hospital, etc. We classified diseases according to ICD-10 based on the initial diagnosis when the patients were discharged on the first page of case reports. The data were input using Excel 2010 software, and statistical analysis was performed using SPSS 13.0 software. Results The results showed that: in 2011, 352 person-times of in-patients with hypothalamus-pituitary-adrenal gland/gonad disease as first diagnosis were hospitalized in the department of endocrinology and metabolism, of which, 139 were male and 213 were female, with mean age of 42.9±15.0 years; and b) median hospital stay was 11 days, the average cost of hospital stay for each patient was RMB 4 361.09 yuan, most of which was for lab tests, examination, and biomedicine cost. Conclusion Hypothalamus-pituitary-adrenal gland/gonad diseases are an important health problem in the department of endocrinology and metabolism in a Triple-A Hospital. Most of hospitalization costs are for lab tests, examination, and biomedicine cost.
Objective Through investigating and analyzing the training status quo of rural doctors in Liangshan Yi Autonomous Prefecture of Sichuan province, to find out problems existing in the training. Methods In October 2010, the on-site questionnaires were distributed to 300 rural doctors from 13 counties who were studying at medical schools of Liangshan Prefecture. The data of their training status were recorded with Epidata 3.0 software and then analyzed with SPSS 16.0 software. Results Among the total 300 questionnaires distributed, 279 were valid with the response rate of 93%. The results showed that: rural doctors in Liangshan Prefecture were generally low in education background and short of knowledge and skills, and took over the burden of the training tuition; and the training content was not fully correlated with theirs actual demands. Conclusion This paper suggests, the in-service training should be conducted on the following bases: the actual situation of Liangshan Prefecture, the adequate consideration of characters of minority region, the improvement of training quality, and the formulation of supporting policies and implementing methods.
ObjectiveTo investigate the etiology of patients with convulsive status epilepticus (CSE).MethodsBy taking epilepsy, seizure, status epilepticus, and epileptic seizure as keywords, the clinical data of epilepsy patients hospitalized in the First People’s Hospital of Longquanyi District of Chengdu and the People’s Hospital of Leshan from January, 2012 to December, 2017 were retrospectively collected from a retrieval system for electronic patient records. The collected CSE cases were screened by trained epilepsy specialists in strict accordance with inclusion criteria and exclusion criteria. The etiology of CSE, and the pathogenetic distinctions among patients with different ages, sexes, educational levels, places of residence, and histories of epilepsy were analyzed based on medical histories and accessory examinations. The prognostic factors for epilepsy were determined using logistic regression analysis.ResultsIn this study, a total of 852 hospitalized epilepsy cases were retrieved, among which 104 cases were CSE cases aged between 18 and 86, including 75 males and 29 females. There were 13 CSE deaths (12.5%). There were significant differences in the pathogeneses among CSE patients with different ages and histories of epilepsy (χ2=52.396, 18.354; P<0.05). However, no significant difference in CSE pathogeneses was observed among patients with different sexes, educational levels, or places of residence (P>0.05). Drug withdrawal or dose reduction was the leading cause of CSE in patients with a history of epilepsy (n=28, 57.1%), while cerebrovascular diseases (n=19, 34.5%) were common causes among those without a history. Among patients aged over 65, cerebrovascular diseases (n=17, 43.6%) were determined as the major causes of CSE, while for those aged under 65, drug withdrawal or dose reduction was the main pathogeny (n=20, 30.8%). Results obtained from multivariate logistic regression analysis on the prognostic factors for epilepsy showed that the duration of epileptic seizure significantly influenced the prognosis of patients [odds ratio=1.299, 95% confidence interval (1.074, 1.571), P=0.007], while there were no significant correlations between other factors and epilepsy prognosis (P>0.05).ConclusionsCerebrovascular diseases are the leading causes of geriatric CSE. Irregular medication of epilepsy patients is a prominent avoidable trigger for CSE.
Objective To investigate the diagnosis and treatment of status epilepticus in hospitals of different levels and the knowledge of status epilepticus in clinical physicians, in order to better guide clinical education in the future. Methods From August 2014 to August 2015, a questionnaire was designed and used to investigate the general situation of the hospital, the diagnosis of status epilepticus and the clinical practice among trainee doctors and students in the epilepsy training class in the Neurological Intensive Care Unit and the Department of Neurology of West China Hospital, Sichuan University. The results of the investigation were statistically analyzed. Results Ninety questionnaires were distributed, and all the questionnaires were retrieved with validity. The number of investigated physicians was 42 (46.7%) from the Department of Neurology, 6 (6.7%) from the Department of Neurosurgery, 30 (33.3%) from the Intensive Care Unit and 12 (13.3%) from other departments. Twenty-seven (30.0%) physicians were from class Ⅲ grade A hospitals, 31 (34.4%) from class Ⅲ grade B hospitals, and 32 (35.6%) from class Ⅱ grade A hospitals. All the class Ⅲ hospitals and 53.1% of class Ⅱ hospitals had electroencephalograph monitoring facilities. The proportion of status epilepticus patients ranged from 0.5% to 10.0% in different hospitals. There were great differences in the identification and treatment of convulsive status epilepticus among different hospitals. Conclusions Status epilepticus is a common emergency. Questionnaire survey is an effective means to reflect the difference in identifying and treating the emergency among different departments and hospitals. It can guide clinical education and promote the identification and treatment of the emergency more accurately in doctors of all levels.
ObjectiveTo investigate the guidance centers for promoting equalization of basic public health services in Sichuan province, in order to provide evidence for construction and development. MethodsBy questionnaire survey, we collected relevant information and data about the guidance centers at all levels in Sichuan province. The EpiData 3.0 was used to establish a database and the SPSS 16.0 was used to analyze data. ResultsA total of 202 guidance centers had been set up in Sichuan province. All disciplines of the basic public health services were covered by these centers. There were 2 020 technicians, whose average age was 41.37, more had college degree, and intermediate professional title. 54.5% of the guidance centers didn't work together, and there were 92.7% part-time technicians. Only 40% city and 20% county guidance centers got working funds. The average working funds of province, city and county were 890 000 yuan per year, 101 000 yuan per year and 89 000 yuan per year, respectively. ConclusionThe guidance centers of Sichuan province at all levels have effectively promoted the basic public health services project, but we should improve and perfect the management mechanism and guarantee mechanism.
ObjectiveTo investigate the effect of electroacupuncture on the apoptosis of hippocampal neurons in C57BL/6J mice with status epilepticus by observing the changes of hippocampal subtle neuron pathology and apoptosis.MethodsMale C57BL/6J mice were used to prepare epileptic status models of lithium-pilocarpine mice, and then 7-day electroacupuncture stimulation (Baihui, Fengfu) were given to the mice model. Open field experiment and new object recognition experiment were performed to observe the changes of cognitive abilities. The pathological changes of hippocampal neurons were detected by HE staining. Hippocampal apoptosis protein (Caspase-3) and microtubule-associated protein (MAP-2) were detected by immunohistochemistry. Effect of electroacupuncture on apoptosis of hippocampal neurons in C57BL/6J mice with status epilepticus were recorded.Results① Compared with the control group, the vertical movement, modification times, and number of crossings of the model group all decreased significantly (P<0.000 1,P<0.000 1,P<0.000 1), and their cognitive ability decreased significantly (P<0.01). Compared with the model group, vertical movements, modification times, and number of crossings were increased in the electroacupuncture (EA) group (P<0.01,P<0.05,P<0.05), and the cognitive ability of new objects was increased (P<0.01). ② HE staining showed that the model group had significant damage to the hippocampal neurons of mice, and the cells swelled, nuclear collapsed and vacuoles appeared. In the EA group, the injury of hippocampal neurons was alleviated, and cell edema and vacuolization were alleviated. ③ Immunohistochemistry showed that compared with the control group, the IOD of the Caspase-3 positive cells in the hippocampus of the model group increased significantly (P<0.000 1), and the IOD of the MAP-2 positive cells decreased significantly (P<0.01); Compared with the electroacupuncture, the IOD of the Caspase-3 positive cells in the hippocampus of the mice decreased (P<0.05), and the IOD of the MAP-2 positive cells increased (P<0.05).ConclusionsElectroacupuncture can improve the pathological changes of hippocampal neurons in C57BL/6J mice with status epilepticus, promote cytoskeletal repair, reduce neuronal apoptosis in hippocampus, and antagonize the damage of hippocampal neurons induced by status epilepticus.
Objective To provide a reference for the exploration to the characteristic specialized subjects in well-off township hospital construction principle, thought and standard through investigating the basic medical units in Shuangliu County. Methods Self-designed questionnaires were made to survey the current situation of characteristic professional subjects in 24 county township medical units comprehensively (i.e. 3 central township hospitals, 3 community health centers, and 18 general township hospitals). Epidate 3.1 was used for data input, SPSS 17.0 was used for descriptive statistics and stratified analysis. Results Fifteen among 24 township hospitals in Shuangliu County set up 21 characteristic specialized subjects, accounted for 62.5%; Traditional Chinese Medicine Orthopedics Subjects were set up in 9 hospitals, accounted for 42.9% ranked as the top; Chinese Medicine Rehabilitation Physiotherapy Subjects were set up in 6 hospitals, accounted for 28.6% ranked as the second. Conclusion The characteristic specialized subjects in township hospitals should be established with reasonable planning and construction according to diagnosis and therapy demand for local disease and hospital’s condition, so as to promote characteristic medical services in market competition by subject construction. Traditional Chinese Medicine Orthopedics Subject and Chinese Medicine Rehabilitation Physiotherapy Subject are worth to be established and spread as characteristic specialized subject.
ObjectivesTo survey the domestic research situation of evidence-based education through visual studies. To summarize the utilization of education evidence in China and promote the process of evidence-based practice concepts and methods application in social science fields, so as to facilitate the domestic evidence-based research towards more scientific and practical. Methods WanFang Data and CNKI databases were searched to collect evidence-based education literatures from inception to December, 2017. Tableau and UCINET software were used to conduct visual and co-word analysis of study types, regions, staff, time, foundation/government support and key words. The social evidence based research situation was sketched. Results A total of 54 literatures were included. Beijing and Guangdong province published the most literatures, followed by Zhejiang province and Tianjin municipality. The quantity of literatures published in 2014 reached the peak of 11 articles, followed by 2016 and 2017, and relatively few in remaining years. We found that " evidence-based pedagogy” owned the highest frequency through building core keywords matrix. Conclusions Evidence-based education in China is still at an early stage. Introduction and promotion is currently the main content. There exists problems remaining in the development of evidence-based education, for instance disjointedness of theory and practice, regional unbalance, and deficiency of original-research. It is still a long way to go.
Objective To investigate the disease constitution and hospitalization cost in Yong’an Central Township Health Center (YaC) in Shuangliu County of Sichuan Province from 2008 to 2010, so as to provide baseline data for further research. Methods Questionnaire and focus interview were carried out; case records and cost information of YaC inpatients in 2008, 2009 and 2010 were collected. The diseases were classified according to ICD-10 based on the first diagnose and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of inpatients were 4 236, 4 335 and 4 844 in 2008, 2009 and 2010, respectively. Females were more than males (56.99% vs. 42.96%, 55.59% vs. 44.1%, 54.36% vs. 45.62%), and their disease spectrum included 20 categories, which accounted for 95% of disease classes of ICD-10; b) The inpatients suffering from top three systematic diseases accounted for 62.74% to 72.31%, which included the respiratory, digestive, urinary tract and urogenital systematic disease; c) The top 15 single diseases were upper respiratory infection, acute bronchitis, pulmonary infection, acute gastroenteritis, fracture, acute appendicitis, chronic bronchitis, calculi in urinary system, cerebral vascular insufficiency, lumbar vertebra disease, acute gastritis, superficial injury, chronic gastritis, hypertension, and cholecytolithiasis or cholecystitis; d) The number of inpatients in the group of over 15-24 ages with chronic diseases increased with age and females were more than males. The acute disease burden of inpatients in 0-4 age group was the heaviest, who only suffered from acute diseases and males were more than females. The inpatients in 25-54 age group suffered from more acute diseases than chronic diseases and females were more than males; and e) The inpatients’ average costs of chronic diseases were higher than those of acute diseases in 2010 (1 564.45 yuan vs. 1 104.11 yuan) and those of either Xintian Central Township Health Center (1 311.81 yuan) or Gaozha Central Township Health Center (1 002.99 yuan). Conclusion a) In recent three years, the main systematic diseases that inpatients suffer are digestive, respiratory, and urinary tract and urogenital system diseases; the acute diseases are more than the chronic; the acute diseases mainly include infection and injury; b) During the past three years, the top 15 diseases have been stable and the same diseases include upper respiratory infection, pulmonary infection, acute bronchitis, acute appendicitis, acute gastritis, acute gastroenteritis, fracture, chronic gastritis, chronic bronchitis, and calculi in urinary system; c) It should be paid attention to the inpatients with chronic diseases in over 15-24 age group and the inpatients with acute diseases in 0-4 age group; and d) The inpatients’ average costs of top 15 diseases in 2010 were higher than those of either XtC or GzC, and consideration on rationality of the hospitalization cost should be paid attention to.