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Objective:To analyze the supervision mode and problems of intensive countywide medical communities and explore the methods and strategies to improve their supervision system.Methods:From March 2022 to May 2022, a stratified random sampling method was used and the intensive countywide medical communities in the province were selected for field study. In-depth interviews were made with the staff of the healthcare administration departments and health insurance agencies affiliated with intensive countywide medical communities, directors of general hospitals, directors of township hospitals, and heads of functional departments. These interviews mainly covered the principal entities of countywide medical community supervision, supervision measures and contents, supervision effects, supervision weaknesses, and how to improve internal and external supervision mechanisms. The interviews results were analyzed using thematic framework analysis and the data were subject to a descriptive analysis.Results:23 persons of five intensive countywide medical communities were selected for key person interview. The finalized framework of regulatory elements of intensive countywide medical communities consists of such five general themes as regulatory subjects, regulatory content, regulatory measures, regulatory effectiveness and existing problems, comprising 14 level-1 indicators and 52 level-2 indicators. The main regulatory bodies were mainly government departments (15 times), the regulatory content was focused on medical resources (10 times), the regulatory measures cover specific regulations (4 times), specific activities (4 times) and assessment and evaluation (4 times). And the regulatory effectiveness demonstrated a currently strong regulation strength of medical communities (5 times), and the existing problems were insufficient government supervision (12 times), difficulties encountered by social forces in their supervision (11 times) and internal governance (5 times).Conclusions:The supervision system of intensive countywide medical communities should be optimized by improving the governmental supervision mechanism, inviting supervision of social forces and building an effective internal governance.
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Objective:To analyze the evolution of China′s national-level healthcare sector regulatory policies between 2003 and 2021, and explore the characteristics and patterns of the use of policy instruments at different stages, for references in policy optimization.Methods:The policy documents related to the regulation of the healthcare sector released by the central government were searched from 2003 to 2021 from the policy document database of the State Council using the keywords " medical" " regulation" and " health" " regulation". Based on the analysis framework of " formulation subject-implementation subject-policy tools", such methods as content analysis, social network analysis, and policy tool analysis were used to analyze policy documents and conduct descriptive analysis of data.Results:A total of 236 policies were included in the study.From 2003 to 2008, according to the time progression, a total of 27 documents were issued, with the State Council as the main formulation subject (77.78%, 21/27), and the government as the main implementation subject (100.00%, 27/27). 191 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments were 21.46% (41/191), 30.37% (58/191), and 48.17% (92/191). From 2009 to 2017, a total of 48 policies were issued, the formulation subject was mostly the State Council (93.75%, 45/48), and the implementation subject was still mostly the government (100.00%, 48/48), but the proportion of institutions (25.00%, 12/48), industry organizations (43.75%, 21/48) and the society (37.50%, 18/48) has increased. 500 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments were 17.40% (87/500), 32.00% (160/500), and 50.60% (253/500), respectively.From 2018 to 2021, a total of 161 documents were issued, with the formulation subjects featuring multiple subjects (38.51%, 62/161), with a decrease in the percentage of the State Council′s issuance (22.36%, 36/161), and 157 (97.52%) policies were implemented by the government. 1 140 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments being 18.42% (210/1 140), 34.74% (396/1 140), and 46.84% (534/1 140), respectively.Conclusions:From 2003 to 2021, there was an upward trend in the number of policies issued in the field of healthcare sector regulation in China, and the subjects of formulation and implementation were diversified. But the use of different types of policy instruments was uneven.
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Objective To construct a scientific and rational post competency model of human organ donation coordinators. Methods Based on the onion model, the index pool was initially constructed by literature research and behavioral event interview. The index system was screened, modified and improved using Delphi method. The weight of indexes at all levels was determined by analytic hierarchy process. Results The effective response rates of two rounds of Delphi expert inquiries were both 100%, indicating that the expert opinions were highly dependable. The experts' judgment coefficient (Ca), familiarity (Cs) and authoritative coefficient (Cr) were all above 0.7, indicating that the experts' opinions were highly reliable. The expert coordination coefficients (W) were 0.294 and 0.342 (both P<0.001), indicating that experts delivered coordinated opinions and yielded slight difference in understanding the importance of indexes. Finally, according to the "onion model" theory and experts' opinions, a set of coordinator's post competency model including 6 first-level and 55 second-level indexes was established, which comprised an index surface layer, a middle layer and a core layer. Among them, the core layer represented core professional values, the middle layer was personal quality and professional ethics and quality, and the surface layer was interpersonal communication capability, organizational cooperation capability and professional knowledge and lifelong learning capability. Conclusions The post competency model of organ donation coordinators established in this study consists of 6 first-level and 55 second-level indexes, which is highly effective and reliable.
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Objective:To analyze the clinical features of patients with severe dengue (SD) in Guangdong Province, and to improve the understanding of the diagnosis and treatment of SD in China.Methods:The clinical data, laboratory examination and etiological test results of 257 SD cases from 29 dengue fever designated hospitals in Guangdong Province from January 1, 2013 to December 31, 2019 were respectively collected. The relevant indicators of the criteria for severe organ involvement were quantified. Logistic regression analysis was performed to analyze the risk factors for the development of multiple organ failure in SD patients.Results:Among the 257 SD patients, age was (64.1±20.1) years old, with 65.4%(168/257) of them ≥60 years old, 142 were male and 115 were female. One hundred and fifty-two (59.1%) patients had underlying conditions, including 115(44.7%) patients with hypertension. The clinical manifestations were mainly fever (98.4%(253/257)), fatigue (70.0%(180/257)), cough or expectoration (44.4%(114/257)), lethargy or irritability (39.3%(101/257)), vomiting (30.4%(78/257)), abdominal pain or tenderness (20.6%(53/257)), hepatomegaly (2.3%(6/257)), bleeding tendency (59.5%(153/257)), and pleural effusion or ascites (43.6%(112/257)). Platelet count levels were decreased in 90.9%(231/254) of the cases, and 97.1%(234/241) of patients had normal or decreased hematocrit. The most common of severe manifestations were severe organ involvement (61.1%(157/257)), followed by severe bleeding (37.0%(95/257)) and severe plasma leakage (30.0%(77/257)). Severe organ involvements were more common in the kidney (27.6%(71/257)) and heart (26.8%(69/257)). Multivariate logistic regression analysis showed that age (odds ratio ( OR)=1.051, 95% confidence interval ( CI) 1.004 to 1.100, P=0.035), hypertension ( OR=5.224, 95% CI 1.272 to 21.462, P=0.022), elevated aspartate aminotransferase (AST) level ( OR=1.002, 95% CI 1.001 to 1.003, P=0.001), blood urea nitrogen (BUN) ( OR=1.050, 95% CI 1.005 to 1.098, P=0.030), and international normalized ratio (INR) ( OR=4.604, 95% CI 1.601 to 13.238, P=0.005) were risk factors for the development of multiple organ failure in SD patients. The detection results of serum samples form 113 SD patients in acute phase showed that dengue virus (DENV)-1 accounted for 89.4%(101/113), DENV-2 accounted for 9.7%(11/113), and DENV-3 accounted for 0.9% (1/113). Conclusions:Elderly and those with co-existing conditions such as hypertension in SD patients in Guangdong Province are more common. Severe organ involvement such as kidney and heart is the main cause of SD. DENV-1 infection is predominant. Significant elevated levels of AST, BUN and INR may be related to a poor prognosis.
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Objective To investigate the application value of the human B cell-confinement receptor P2RY8 in the diagnosis and prognosis of hepatocellular carcinoma (HCC) and its association with tumor immunity. Methods The Cancer Genome Atlas database was used to compare the expression of P2RY8. R software package was used to analyze the correlation between P2RY8 and tumor staging, and the receiver operating characteristic (ROC) curve and a nomogram model were established for diagnosis and survival. Tumor Immune Evaluation Resource was used to analyze immune cell infiltration, immune cell biomarkers, and immune checkpoints. STRING database was used to analyze protein-protein interaction network information. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were used to analyze the function of P2RY8 and its interacting genes. For the purpose of validation, HCC tissue samples were collected from 64 patients who underwent radical surgery for HCC from June 2007 to November 2008, and the corresponding adjacent tissue samples were collected from 35 patients out of these patients (tissue chips were purchased from Shanghai Outdo Biotech Co., Ltd.); related clinical data and follow-up data were analyzed, and immunohistochemistry was used to measure the expression of P2RY8 in HCC and adjacent tissue samples. The t -test was used for comparison of normally distributed continuous data between two groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate the correlation between two variables. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to calculate survival rates. Results P2RY8 was overexpressed in HCC, and the expression level of P2RY8 could accurately differentiate tumor from normal tissue, with an area under the ROC curve of 0.794. The patients with a higher expression level of P2RY8 tended to have a better prognosis ( P =0.005). The data from 64 clinical samples also confirmed that compared with the patients with a low expression level of P2RY8, the patients with a high expression level of P2RY8 had significantly higher 3-year survival rate (78.9% vs 46.2%, P =0.007), 5-year survival rate (76.3% vs 38.5%, P =0.002), and overall survival time [92.5 (48.8-102.0) months vs 33.0 (25.0-95.5) months, P =0.022], and the Kaplan-Meier survival curve further indicated that the expression level of P2RY8 was associated with the prognosis of HCC patients. In addition, P2RY8 was positively correlated with immune cell infiltration and immune checkpoint in HCC. The GO/KEGG pathway enrichment analyses showed that P2RY8 was enriched in the signal transduction pathways such as humoral immunity and cellular immunity. Conclusion P2RY8 participates in the development, progression, and immune regulation of HCC, and therefore, P2RY8 can serves as a potential biomarker and a therapeutic target for the diagnosis and prognosis of HCC.
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Objective:To study the willingness of county-level hospital physicians within a county medical alliance(alliance)to participate in county-township human resource integration for medical institutions, for furthering the development of such integration.Methods:Based on a discrete selection experiment, a questionnaire was designed for the selection of the work attributes that affect the participation of county-level hospital physicians in such an integration. On-the-job physicians from four county-level hospitals in a prefecture level city were selected by multi-stage stratified random sampling method as the survey objects, and a field questionnaire survey was conducted from November to December 2021. The mixed logit model was used to analyze the preference of physicians in county-level hospitals for five types of work attributes(work unit, monthly income, seniority required for professional title promotion, training opportunities, serving as middle-level and above administrators), the relative importance of each work attribute, and marginal willingness to pay with regard to their participation in the integration.Results:A total of 172 valid questionnaires were collected. When county-level hospital physicians participate in county-township human resource integration for medical institutions, their statistically significant job attributes and level preferences included monthly income, working unit of county-level hospitals, 7 years for professional title promotion, and more training opportunities ( P<0.001). The relative importance of monthly income ranked the highest among the five categories of work attributes, up to 55.55%. Conclusions:When physicians in county-level hospitals participate in the integration of county-township human resources, the most important was their monthly income, and economic incentives could enhance their willingness to participate.
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Objective:To provide reference for the sustainable development of county medical communities through analyzing key issues in the construction of such communities in China.Methods:Such Database websites as CNKI, Wanfang Data and VIP Information were selected to retrieve journal papers and dissertations with the keywords of " county medical community" " county medical alliance" " county medical and health community" and " medical alliance" . The time period ranged from the establishment of the database to December 2021. Content analysis and social network analysis were used to classify and sort key issues of county medical community construction in the included literature, and the descriptive analysis was used for all the data.Results:274 literatures were obtained in this study, 82 high-frequency issues were extracted for the construction process of county medical communities. It was divided into 3 dimensions of service system, operation mechanism and fund guarantee, including 14 items of integration of resources, integrated management, resource intensification, information construction, medical services, medical quality, family doctors, public health, management system, personnel system, salary system, supervision mechanism, medical insurance fund and financial input. The results of social network analysis showed that the top three high-frequency issues of point centrality and intermediary centrality were lack of highly unified information exchange platform (107.00, 514.48), insufficient service capacity of primary medical institutions (61.00, 238.48) and lack of sustainable benefit distribution mechanism (45.00, 192.38).Conclusions:The construction of county medical community covered three aspects: medical service system, operation mechanism and fund guarantee.The shortage of primary medical service capacity, the lack of coordination of an information platform, the general shortage of essential drugs, the imperfect internal assessment and incentive system, the imperfect supervision system and the imperfect medical insurance supporting policy becomed the main roadblocks in building county medical communities in China. In order to promote the sustainable development of county medical community, the authors recommend to further upgrade the county integrated medical service system, perfect the operation mechanism, and strengthen the input into county health care.
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Integration of healthcare and prevention is key path to achieving the pattern of " macro healthcare, macro health". However, it is hard at present to fully integrate healthcare and prevention in China, mostly due to the lack of effective incentive compatibility strategies. Based on the incentive compatibility theory, this study proposed a multi-level principal-agent chain of healthcare and prevention integration. Taking the incentive transmission among stakeholders in the principal-agent chain as the analysis framework, the dilemma and causes of incentive incompatibility of healthcare and prevention integration were studied.Combined with the proctice of healthcare and prevention integration in Sanming city, the incentive compatibility strategies of healthcare and prevention integration were proposed at the level of government, medical institutions, medical staff, public health staff and residents. These strategies refer to coordinating the use of medical insurance funds and public health funds, strengthening organization management as well as assessment and incentive, rewarding health promotion management points, and setting up health science popularization teams.
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Based on a research on judicial cases concerning the authenticity of electronic medical records in the past three years, the authors encountered judicial dilemmas in judicial practice. The challenges arise due to the special manifestations of electronic medical records, unclear and disputable criteria for the authenticity of electronic medical records, low application level of electronic medical records identification, and inconsistent responsibility attribution. In order to effectively apply the electronic medical record system, it is recommend to promote pre-litigation prevention by unifying the construction standards of the computerized patient record system, strengthening hospital electronic medical record management and entrusting third-party storage to ensure the evidential weight. In addition, it is necessary to establish standards for authenticity of medical records, improve the electronic medical record forensic identification system and clarify the attribution of the responsibility for untrue medical records, so as to improve the handling of such medical damage cases during litigation.
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Objective:To analyze the relationship between the structure of health resource supply and the growth structure of medical expenditure in Fuzhou.Methods:In accordance with hospital scale category standards, health resources provided for medium and large hospitals were categorized as high quality resources, while those provided for urban community health centers and township hospitals, and those for hospitals with less than 200 beds were categorized as primary health resources. The descriptive statistical method was used to analyze the health resource allocation and supply in Fuzhou; The structure decomposition method was used to decompose 2016—2019 hospitalization expenditure, and the principal component analysis was used to discuss the influencing factors of differences in the growth structure of hospitalization expenses.Results:In accordance with such factors as the economic development level, health service needs and geographical locations of districts and counties of Fuzhou city, 12 districts/counties were divided into three levels. The number of high-quality health resource medical institutions deployed in the first and second-level regions accounted for 78.95% of all. Among them, GL and TJ districts were equipped with hospital beds accounting for 44.29% of the total high-quality beds of all, while those resources of third-level regions were mostly primary health resources.From 2016 to 2019, medical expenditure of public hospitals kept rising. As found in structural decomposition, scale effect was the fundamental driver, followed by the structural effect, and then the inflation effect. This study identified increased inpatient service demand as the main driver for increased costs. Principal component regression results found that increased supply of high quality health resources as having a positive pull effect on the increase of hospitalization expenditure.For example, expansion of hospital beds at large hospitals contributes positive effect on the cost inflation( β1=0.421, P<0.001). On the other hand, investment in primary health resources could play a constraint role on excessive growth of medical expenditure, while the overall deployment level of their health resources affected negatively the patient flow(beds/per thousand population β2=-0.303, P<0.001). Conclusions:The structure of health resource supply is strongly related to the structure of medical expenditure growth. It is suggested to differentiate the allocation of high-quality and basic-quality health resources and optimize the supply structure of resources. It is also imperative to strengthen the investment in basic health resources and enhance the medical and health service capabilities of related institutions, in order to optimize the flow of residents′ medical visit flow and guide medical expenditure growth in a reasonable manner.
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This article aims to summarize the significance of the establishment of human milk banks, the status of human milk banks in mainland China, analyze the relevant factors that affect the development of human milk banks, and propose corresponding countermeasures to provide a reference for improving the status of human milk banks in mainland China and promoting sustainable development.
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Objective:To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled. According to the clinical classification, the patients were divided into severe group and critical group. The myocardial injury markers, such as lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK), cardiac troponin I (cTnI), myoglobin (MYO), MB isoenzyme of creatine kinase (CK-MB), B-type natriuretic peptide (BNP) and electrocardiogram (ECG) changes were compared between the two groups.Results:A total of 55 COVID-19 patients were selected, including 15 critical cases and 40 severe cases. The patients with severe and critical COVID-19 were male-dominated (61.8%), the average age was (61.2±13.0) years old, 83.6% (46 cases) of them had contact history of Hubei, 38.2% (21 cases) of them were complicated with hypertension. There was no significant difference in baseline data between the critical group and the severe group. Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion, LDH increased in most patients (20 severe cases and 7 critical cases), followed by AST (16 severe cases and 5 critical cases). There was significant difference in the number of patients with elevated CK between severe group and critical group (cases: 1 vs. 4, P = 0.027). Abnormal ECG was found in 39 of 42 patients with ECG examination. Nonspecific change of T wave was the most common. Before and after treatment, 9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg (1 mmHg = 0.133 kPa), and the prominent changes of ECG were heart rate increasing and ST-T change. Conclusions:The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients. At the same time, the dynamic changes of myocardial injury markers and ECG could reflect the situation of myocardial damage.
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Objective:To analyze the research hotspots and change trends of Sanming medical reform theory in China from 2013 to 2019, so as to provide reference for the relevant research of medical reform in China.Methods:The theoretical and empirical studies on Sanming medical reform from 2013 to 2019 in relevant databases at home and abroad were screened. The literature metrology method was used to analyze the overall trend of domestic literature. The keyword cloud method was used to analyze the research hotspots and main problems.Results:After screening, a total of 59 literatures were obtained. It was found that the reform of public hospitals was the hotspot of current research. Three medical linkage, governance system, annual salary system and medical insurance integration were the core contents of researches.Conclusions:The research of Sanming medical reform is in the initial stage of development. In the future, the research on medical reform can be further deepened around the relevant basic theories, normative and specific research, and so on.
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Objective:To evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) and arbidol in treating patients with coronavirus disease 2019 (COVID-19) in the real world.Methods:The clinical data of 178 patients diagnosed with COVID-19 admitted to Guangzhou Eighth People′s Hospital from January 20 to February 10, 2020 were retrospectively analyzed. According to patient′s antiviral treatment regimens, 178 patients were divided into 4 groups including LPV/r group (59 patients), arbidol group (36 patients), LPV/r plus arbidol combination group (25 patients) and the supportive care group without any antiviral treatment (58 patients). The primary end point was the negative conversion time of nucleic acid of 2019 novel coronavirus (2019-nCoV) by pharyngeal swab.Results:The baseline parameters of 4 groups before treatment was comparable. The negative conversion time of viral nucleic acid was (10.20±3.49), (10.11±4.68), (10.86±4.74), (8.44±3.51) days in LPV/r group, arbidol group, combination group, and supportive care group respectively ( F=2.556, P=0.058). There was also no significant difference in negative conversion rate of 2019-nCoV nucleic acid, the improvement of clinical symptoms, and the improvement of pulmonary infections by CT scan ( P>0.05). However, a statistically significant difference was found in the changing rates from mild/moderate to severe/critical type at day 7 (χ 2=9.311, P=0.017), which were 24%(6/25) in combination group, 16.7%(6/36) in arbidol group, 5.4%(3/56) in LPV/r group and 5.2%(3/58) in supportive care group. Moreover, the incidence of adverse reactions in three antiviral groups was significantly higher than that in supportive care group (χ 2=14.875, P=0.002). Conclusions:Antiviral treatment including LPV/r or arbidol or combination does not shorten the negative conversion time of 2019-nCoV nucleic acid nor improve clinical symptoms. Moreover, these antiviral drugs cause more adverse reactions which should be paid careful attention during the treatment.
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Objective:To analyze key issues in the implementation process of the " Eight-integrations system" for close-type countywide medical alliances in Fujian province, and provide references for improving such a mechanism.Methods:Sixteen counties in the province were selected from October to December 2019 and materials were collected by means of interview, questionnaires and field survey. On such basis, the Meter-horn model was used to systematically analyze and evaluate the implementation status, and completion rate was used to describe the implementation of the " Eight-integration system" .Results:The average completion rate of the regions surveyed was 60.15%, of which the mountainous counties being 65.90%, and coastal counties being 47.50%. Of the eight regulations to be integrated, the aspects of better completion include institutions′ names(16 institutions, 100.00%), quality of care(13 institutions, 81.25%), promotions(12 institutions, 75.00%)、staff deployment(11 institutions, 68.75%) and financial management(10 institutions, 62.50%). Those of poor completion rates were drug supply(7 institutions, 43.75%), labor performance(6 institutions, 37.50%)and informationization development(3 institutions, 18.75%). Some of the counties staged localized measures to promote the " Eight-integration system" . Such factors as vague policy objectives, inadequate policy resources, lack of means, biased value orientations of the implementation entities, and complex socio-economic environments influence negatively effective implementation of the system.Conclusions:This system has not yet achieved the expected effects in the implementation process. We should improve the system implementation and its sustained operation by such means as clarifying policy objectives, broadening policy resources, enriching implementation means, enhancing experience exchange and optimizing policy environments.
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Objective To analyze the clinical features of death cases of dengue fever and the causes of their deaths.Methods The clinical data and death reports of nine death cases of dengue fever in Guangdong Province from June 23,2014 to September 10,2019 were retrospectively analyzed.All of nine cases were positive for serum dengue virus RNA as confirmed by reverse transcription polymerase chain reaction,and some of the virus strains were serotyped.Results The median age of the nine patients was 57.5(range: 18-80)years.Among them,six patients were females; eight patients were local cases and one was imported case; all of nine cases occurred in September and October.The median time from onset to visit hospital and diagnosis was three and four days,respectively.Three of the nine patients had underlying diseases.All of nine cases had fever,including three with double-peak fever.Eight of the cases had three or more severe dengue fever warning indexes before admission.Three cases had severe bleeding upon admission,one case had shock,and six cases had organ failure.Three cases underwent invasive examination,including arterial puncture catheterization,endoscopic titanium clip hemostasis,and percutaneous transluminal coronary angiography.Two cases developed malignant arrhythmia and one had massive hemorrhage of subcutaneous soft tissue after operation.The death cases included four cases of cardiogenic shock and fatal arrhythmia,three cases of encephalitis and encephalopathy,one case of refractory shock,and one case of acute liver failure.Among the six cases that underwent serological typing,four were identified as dengue virus type 1(DEN-1)and two were DEN-2.Conclusions Severe organ failure is the major cause of dengue fever-related death,especially fulminant myocarditis,and DEN-1 is most common.Early diagnosis and treatment,and avoidance of invasive procedures can effectively reduce the mortality rate of the severe dengue fever patients.
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With the rapid development of " Internet+ healthcare" , medical data has gained an ever important role. How to determine the reasonable use boundary of medical data and leverage its supporting role, has grown an urgent problem to be solved. The authors analyzed the characteristics of medical data, and held that medical data is not equivalent to information, as it does not have the characteristics of legal objects in nature. In addition, it lacks originality. Therefore it is difficult to protect through the existing rights system. However, due to its property interest and personality, the authors tried to establish a new right for protection. In the construction of such medical data right, the authors claimed that patients should be the subject of the right, and medical institutions can appropriately restrict the freedom of patients′ through reasonable use rules and legal licensing system. In this way, we can not only promote medical data sharing and the development of social health, but also fully protect the legitimate rights and interests of patients.
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Objective@#To analyze the clinical features of death cases of dengue fever and the causes of their deaths.@*Methods@#The clinical data and death reports of nine death cases of dengue fever in Guangdong Province from June 23, 2014 to September 10, 2019 were retrospectively analyzed. All of nine cases were positive for serum dengue virus RNA as confirmed by reverse transcription polymerase chain reaction, and some of the virus strains were serotyped.@*Results@#The median age of the nine patients was 57.5 (range: 18-80) years. Among them, six patients were females; eight patients were local cases and one was imported case; all of nine cases occurred in September and October. The median time from onset to visit hospital and diagnosis was three and four days, respectively. Three of the nine patients had underlying diseases. All of nine cases had fever, including three with double-peak fever. Eight of the cases had three or more severe dengue fever warning indexes before admission. Three cases had severe bleeding upon admission, one case had shock, and six cases had organ failure. Three cases underwent invasive examination, including arterial puncture catheterization, endoscopic titanium clip hemostasis, and percutaneous transluminal coronary angiography. Two cases developed malignant arrhythmia and one had massive hemorrhage of subcutaneous soft tissue after operation. The death cases included four cases of cardiogenic shock and fatal arrhythmia, three cases of encephalitis and encephalopathy, one case of refractory shock, and one case of acute liver failure. Among the six cases that underwent serological typing, four were identified as dengue virus type 1 (DEN-1) and two were DEN-2.@*Conclusions@#Severe organ failure is the major cause of dengue fever-related death, especially fulminant myocarditis, and DEN-1 is most common. Early diagnosis and treatment, and avoidance of invasive procedures can effectively reduce the mortality rate of the severe dengue fever patients.
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Objective@#To design the self-rating scale on basic ability in graduates of preventive medicine major, and test its reliability and validity, providing a reliable tool for evaluating the basic ability of graduates.@*Methods@#On the basis of constructing the Evaluation Index System on Basic Ability in Graduates of Preventive Medicine Major, the three-level indexes were converted to specific questions. Self-evaluation scale including 58 items, 22 sub-dimensions and 8 main dimensions were finally designed after pre-survey and expert argumentation. A total of 205 graduates of preventive medicine major from a medical college and 9 experts in the field of public health were selected to completed the questionnaire. Scale's reliability was tested by applying internal consistency reliability and composite reliability; it's validity was tested by applying content validity and confirmatory factor analysis.@*Results@#Scale's α coefficient of internal consistency reliability was 0.976; α coefficient and combination reliability of eight main dimensions were both higher than 0.8; the content validity index S-CVI of the scale was 0.94, the content validity index I-CVI of the item level was 0.78 to 1.00; the average variance extraction amount (AVE) of the eight main dimensions was higher than 0.50. Fitting of the structural model with the item used as observation indexes was reasonable (χ2/df=1.749, RMR=0.036, RMSEA=0.061, NFI=0.801, IFI=0.904, TLI=0.904, CFI=0.903), and the sub-dimension as used observation indexes was good(χ2/df=1.876, RMR=0.032, RMSEA=0.066, NFI=0.913, IFI=0.958, TLI=0.945, CFI=0.957).@*Conclusion@#This scale is the first self-rating scale on the basic ability in graduates of preventive medicine major on the basis of the National Standards of Teaching Quality on Public Health and Preventive Medicine, with good reliability and validityl. It is able to achieve quantitative evaluation on graduates' basic abilities.
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Objective@#To compare such supply structure differences of health resources as number of beds and manpower at medical institutions of different types, and to analyze the extent and direction of the health resources supply in affecting the growth of medical expenses.@*Methods@#Clustering analysis was used to cluster health resources indicators in Fujian province. The hierarchical regression model was used to estimate the impact of such factors as population, social economy and health resource supply structure on medical cost growth. All the sample data were logarithmically processed to eliminate the influence of different index measurement units on the analysis results.@*Results@#The clustering indicators of health resources were classified into two categories: basic and quality health resources indicators. The per capita GDP had a positive impact on the per capita total hospital expenses(β=0.228, P<0.05), and the number of basic beds had a negative impact on the per capita total hospital expenses(β=-0.719, P<0.001). The increase in basic bed allocation had a significant effect on reducing the total cost of hospitalization per capita, but the regression results of quality health resources were generally not significant.@*Conclusions@#From the perspective of supply-side reform policy, the supply structure of health resources should be in line with the growth level of medical expenses, and the control of medical expenses should be strengthened. The government should strengthen the pertinence in the selection and target of health resource investment to ensure the sustainable and healthy development of health care.