Establishing a balanced scorecard measurement system for integrated care organizations in China.

To address, among other issues, the regional and international challenges of the heavy health care burden caused by an aging population, integrated care organizations (ICOs) were proposed at the end of the 20th century for health care delivery. However, the implementation of ICOs has not progressed smoothly, and the current results have not eliminated the imbalance of medical service capabilities among hospitals of different levels. To make up for the deficiency in the current evaluation system at ICOs and offer suggestions for improved sustainable health planning and management, this study establishes a balanced scorecard based on a comprehensive measurement system valid for a Chinese ICO by surveying the staff at the West China Hospital ICO. This study collected valid responses from 216 professional staff members at the ICO via questionnaires. K-means clustering and the coefficient of variation method were used to evaluate the weights of the first- and second-level indicators. The results show the importance ranking of the core perspectives of the ICO balanced scorecard in the following order: patient, internal process, learning and growth, and financial. The weight-based analysis identified the importance ranking of all indicators and pointed to the areas that require close attention in future ICO planning and management.

Efficacy and safety of Sancai powder in patients with type 2 diabetes mellitus: a randomized controlled trial.

OBJECTIVE: To assess the efficacy and safety of Sancai powder in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with single oral metformin in a randomized controlled trial (RCT). METHODS: A total of 132 patients with T2DM were enrolled in the study, who only took metformin (500-1000 mg/day) for at least three months and with inadequate glycemic control (7.0% ≤ hemoglobin A1c ≤ 9.0% ) in the past three months. The patients stopped taking metformin with lifestyle interventions for three weeks, and 105 patients qualified for the program. They were randomly divided into the Sancai powder group and the metformin group (1500 mg/day). The follow-up period was for 12 weeks. Comparisons of several variables were analyzed. RESULTS: No significant differences were found between the two groups in hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and 2 h post-meal glucose (2hPG), although they had decreased significantly (P < 0.01). Homeostasis model assessment of beta cell function index was significantly improved in Sancai powder group (P < 0.01), and there were significant differences in the changes of homeostasis model assessment of insulin resistance and insulin sensitivity index in the two groups (P < 0.05). Sancai powder significantly reduced triglyceride level (P < 0.05), although there was no significant difference in the body weight and body mass index in the two groups. CONCLUSION: In this 12-week study, Sancai powder could significantly reduce hemoglobin A1c, FPG and 2hPG levels, improved beta-cell function and insulin resistance of the T2DM inadequately controlled with metformin.

NELL-1 in the treatment of osteoporotic bone loss.

NELL-1 is a secreted, osteoinductive protein whose expression rheostatically controls skeletal ossification. Overexpression of NELL-1 results in craniosynostosis in humans and mice, whereas lack of Nell-1 expression is associated with skeletal undermineralization. Here we show that Nell-1-haploinsufficient mice have normal skeletal development but undergo age-related osteoporosis, characterized by a reduction in osteoblast:osteoclast (OB:OC) ratio and increased bone fragility. Recombinant NELL-1 binds to integrin ß1 and consequently induces Wnt/ß-catenin signalling, associated with increased OB differentiation and inhibition of OC-directed bone resorption. Systemic delivery of NELL-1 to mice with gonadectomy-induced osteoporosis results in improved bone mineral density. When extended to a large animal model, local delivery of NELL-1 to osteoporotic sheep spine leads to significant increase in bone formation. Altogether, these findings suggest that NELL-1 deficiency plays a role in osteoporosis and demonstrate the potential utility of NELL-1 as a combination anabolic/antiosteoclastic therapeutic for bone loss.

Preparation and characterization of trace elements-multidoped injectable biomimetic materials for minimally invasive treatment of osteoporotic bone trauma.

It has always been a clinical challenge to use the proper implants or biomaterials to restore function to traumatized bone defects in patients with osteoporosis. In this study, we prepared the alginate-chitosan/trace elements-multidoped octacalcium phosphate-bioglass (AT-CS/teOCP-BG) hydrogel composite as an injectable biomaterial and evaluated its physicochemical properties and biological performance. Trace amount of silicon, strontium, and zinc was first doped into the structure of OCP porous microspheres via a wet chemical reaction. The AT-CS complex was mechanically mixed with teOCP and then neutralized by the ionic products of bioglass 58S particles dissolution. Formulations of this novel composite presented in wet state have teOCP-BG contents ranging from 7.8 to 25.4% and AT-CS content of below 3.2%. The composite retained gel in culture medium at 37°C, and the ratio of storage modulus and loss modulus (G'/G″) exhibited a marked increase with decreasing the amount of BG, signifying a pH-dependent enhancement of rheological properties and gel stability. After injection into rat femoral bone marrow cavity with minimal tissue invasion, new bone ingrowth was observed from radiologic images in the ovariectomized (OVXed) rats, which was significantly greater than that found in sham-operated animals within 8 weeks postoperatively. The fast bone regeneration phenomenon was observed in the OVXed rats by radiographic and microcomputerized tomography examination and histological analysis. These findings suggest that the AT-CS/teOCP-BG system might be used as an injectable biomaterial for minimally invasive treatment of osteoporosis-related (micro-)trauma.

[Survey on vitamin A deficiency in children under-6-years in China].

OBJECTIVE: To understand the prevalence and spatial distribution of vitamin A deficiency (VAD) in China among children at ages under six years. METHODS: About 8,600 children under 6 years of age in 14 cities and 28 counties of 14 provinces were selected with stratified cluster sampling for survey, including interview with questionnaire for their family information and nutritional status. Blood specimens were collected for measuring serum level of VA with fluorescent spectrophotometry in laboratory. RESULTS: Totally, 8,669 children under 6 (2,877 in urban area and 5,792 in rural area) were surveyed in 14 provinces, with 4,629 males and 4,040 females. Eight cases of night blindness and seven cases of xerophthalmia were found among the children at ages of two to five years. Sixty-one mothers of the children in this group were also found suffering from night blindness. All the cases of night blindness and xerophthalmia both in children and mothers were living in rural areas. Based on their serum levels of VA, 11.7% of the all 1 018 children were diagnosed as VAD, with serum VA concentrations below or equal to 0.70 micro mol/L. Prevalence of VAD was 15.0% and 5.8% in rural (23.3% in the poverty-stricken counties) and urban areas, respectively, and 5.8%, 11.5% and 16.8% in the coastal, inland and remote areas, respectively. The average serum level of VA was 1.20 micro mol/L and 0.99 micro mol/L for urban and rural areas, respectively, with a national average of 1.06 micro mol/L. And, babies under six months of age with an average serum levels of VA < or = 0.70 micro mol/L accounted for 33.4%, and those at ages of four to five years with the same level of VA accounted for 8%. There was significant difference in serum levels of VA between ages, but no significant difference between genders. CONCLUSION: VAD did exist in children of China, especially in the remote and poverty-stricken rural areas and VA supplementation is urgently needed for the children in these regions.

[Cohort study on relationship between hepatitis B and gallstones using stratified sampling].

OBJECTIVE: To investigate the relationship between hepatitis B and gallstones using epidemiological methods. METHODS: The analysed data from 510 patients with hepatitis B and 359 patients with other diseases treated in our hospital from the period January 1998 to June 2001 were retrospectively analysed. The patients with hepatitis B were classified into groups. The incidence of gallstones was determined in each group. Queue study method was used to calculate RR in each group and statistical analysis was conducted to determine difference among different groups. RESULTS: As compared the patients gallstone with the patients with other diseases RR in those with hepatitis B (including those with chronic hepatitis or liver cirrhosis) was significantly higher (P<0.01). The value of RR was not markedly increased in patients with acute hepatitis or cholestatic hepatitis. After long-term administration of Chinese herbal medicine, the incidence of gallstones in patients with hepatitis B was decreased. CONCLUSIONS: Chronic pathological changes in patients with hepatitis B may be one of the causes for gallstones. This may provide epidemiological basis for prevention and treatment of gallstones.