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Public hospitals stand in need of strengthening cost control and improving operational efficiency to balance public welfare and economic benefits.Taking practice and exploration of ultrasound department as an exam-ple,it integrates the advantages of TDABC with cost management.Take the merits of time driver and activity driver,realizes direct cost accounting under the clinical pathway,strengthen capacity management capabilities un-der the integration of industry and finance,with a view to providing a powerful cost control tool for public hospitals to sensibly respond to pricing reform and reasonably make operational decisions.
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Objective:To analyze the clinical characteristics and management strategy of carotid web (CW)-related stroke and improve the understanding of CW.Methods:The clinical data of 6 patients with CW-related stroke treated at Xuanwu Hospital, Capital Medical University, from January 2018 to September 2022 were retrospectively analyzed. Relevant data included clinical manifestations, bronchial magnetic resonance imaging (MRI), CT angiography (CTA)/digital subtraction angiography (DSA), carotid ultrasonography, and transcranial color-coded Doppler sonography (TCCD). Treatments and follow-ups were also reported.Results:All 6 patients were middle-aged or young, without traditional risk factors for cerebrovascular disease. The male-to-female ratio was 2∶4. All patients had recurrent strokes, with a score of 2-4 on the National Institutes of Health Stroke Scale at the time of onset. Head MRI showed 5 patients with cerebral infarction in the middle cerebral artery supply area; 1 patient had no intracranial infarction. No significant stenosis of the vessels at the site of the CW was observed in any of the 6 patients. Four patients had ipsilateral stenosis or occlusion of the middle cerebral artery, 1 patient had microembolic signals in the middle cerebral artery, and 1 patient had no significant abnormalities in the intracranial artery. All 6 patients were initially diagnosed by ultrasound. Diagnoses were confirmed by CTA/DSA in 5 cases; the other patient did not show any significant abnormalities. All 6 patients underwent a carotid endarterectomy after a pathological examination to confirm the diagnosis. Postoperatively, regular antiplatelet aggregation and statin lipid-lowering therapies were administered. A follow-up of 0.5 to 5.2 years showed no stroke recurrence in any patient.Conclusions:CW-related stroke is a rare cause of cryptogenic stroke and has a high recurrence rate. For stroke patients who do not have traditional risk factors for cerebrovascular disease while repeatedly experiencing embolic events of the internal carotid artery system, attention should be paid to the combination of the carotid and cerebral arteries, and comprehensive hemodynamic characteristics should be checked for the presence of a CW. Carotid artery ultrasound and TCCD combined with other imaging methods can improve the detection rate of a CW. Simple antiplatelet aggregation therapy cannot effectively prevent stroke recurrence. For patients with confirmed CW-related cerebral infarction, surgical resection can be performed, and the treatment effect can be evaluated using ultrasonography.
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Health benefits of physical activity are well known, yet available physical activity data is limited from children living in African and Asian countries. The purpose of the cross-sectional study was to evaluate and compare physical activity and sedentary behavior patterns, particularly hourly variations, among children in Kenya and Japan. Participants included 298 primary school students (122 Kenyan, 176 Japanese) aged 9-12 years. Physical activity and sedentary behavior were measured with accelerometers. Domain-specific physical activity, screen time, and proportion of children using active transport to school were measured by questionnaire. A two-way ANOVA (countries × time) was used to examine the differences in the activity patterns between Kenyan and Japanese children. The results from the present study demonstrated that Kenyan children spent more time in moderate-to-vigorous physical activity compared to Japanese children (p < 0.05) with the greatest differences found for weekday evenings (for boys and girls) and weekend afternoons (for girls). This suggests that these were 'critical periods' to differentiate the physical activity levels between Kenyan and Japanese children. However, a higher proportion of the children from Japan used active transport to school and spent less time in television viewing and computer gaming. The results suggest that both countries have successes and challenges that can aid in developing effective and country-specific intervention strategies for promoting physical activity.
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Ejercicio Físico , Conducta Sedentaria , Niño , Estudios Transversales , Femenino , Humanos , Japón , Kenia , MasculinoRESUMEN
Objective To investigate the feasibility of Doppler ultrasonography in evaluating the vulnerability of carotid atherosclerotic plaque prospectively. Method A total of 44patients (46plaques) who performed carotid endarterectomy were continuously enrolled in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University from March 2019 to October 2019. Several examinations such as carotid Doppler ultrasonography (CDU) , CT angiography, CT perfusion imaging, and/or digital subtraction angiography were scheduled conventionally before surgery. Pathologic examination, including the plaque morphology, histopathologic hematoxylin eosin(HE) staining, and immunohistochemical CD31 staining, were evaluated after surgery. The plaque vulnerable score was calculated based on the parameters of CDU consisting of plaque morphology, characteristic of echo, fiber cap integrity, presence of ulcer, degree of vascular stenosis, assigned with 0 to 3 points, respectively. The plaque was defined as the vulnerable plaque if vulnerable score was more than 4, otherwise, the plaque was the stable plaque. Then the plaques were divided into vulnerable group ( n =36) and stable group ( n = 10) according to the pathological results. The patients were divided into the stroke group ( n = 33) and the non-stroke group (n = 11) based on the incidence of ischemic stroke within the last 6 months. The evaluation of neovascularization in the plaque was referring to the immunohistochemical CD31 staining. The independent-sample t test, Wilcoxon rank-sum test, and χ2test were used to compare the differences between the two groups in general data, laboratory tests, clinical symptoms, vulnerable scores, and the rates of vulnerable plaques. Kappa value was used to evaluate the consistency between CDU and histopathological HE staining in the evaluation of plaque vulnerability. Results ( 1) The differences in the National Institute of Health stroke scale score and neurological symptoms between the vulnerable group and stable group were statistically significant (all P < 0. 05). (2) The vulnerable score was significantly different between the vulnerable group and stable group (6.00 [5.00,7.00] scores vs. 4.00 [4.00,4.25] scores, P<0.01), and between the stroke group and non-stroke group (6.00 [5.00,7.00] scores vs. 4.00 [4.00,5.00] scores, P = 0.002). (3) Diagnostic efficacy: compared with histopathologic results, the sensitivity and specificity of CDU were respectively 88.9% and 8/10, positive predictive value was 94. 1% .negative predictive value was 8/12, and the Youden index was 68. 9%. The consistency between CDU and histopathological HE staining was strong ( Kappa = 0. 642, P < 0. 01). (4) Neovascularization; immunohistochemical CD31 staining showed neovascularization in vulnerable plaque; the microvessel density in vulnerable group was higher than that in stable group([2. 84 ± 1. 56] mm3vs. [ 1. 38 ±0. 61 ] mm3). (5) The relationship between plaque vulnerability score and ischemic stroke: the rates of vulnerable plaques in the stroke group was higher than that in the non-stroke group (88. 6% [31/35 ] vs. 3/11 ;χ2= 13. 286, P < 0. 01 ). Conclusion The plaque vulnerable score evaluating by vascular ultrasound can accurately and quantitatively assess the vulnerability of carotid plaques, and angiogenesis can be observed in the vulnerable plaque, which provides a theoretical basis for clinical diagnosis and accurate treatment.
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Objective To understand current reality of institutional elderly care services in 11 districts in Shanghai and discuss solutions to the planning and enhancement of such institutions. Methods Surveys were conducted in 20 elderly care institutions in Shanghai from August to October 2017 and questionnaires were distributed to the staff and residents in these facilities. Data were analyzed using Stata 12. 0. Results All the 20 institutions offer medical and nursing care, 19 of which providing insurance settlement and 10 were in deficit. Public facilities boost larger scale than private ones. A survey of 186 staff indicated that only 59. 67% of them felt satisfied with their academic title and professional career promotion opportunities; of 450 of the residents surveyed, 61. 47% of them expressed high acceptance of institutional elderly care, and the coverage of such insurances as critical illness and long-term care insurance was below 7%. Conclusions Half of the sample institutions experienced financial difficulties, roadblocks for staff professional promotion mechanism, unaffordable economic burden for residents, and insufficient supplementary insurance coverage. Policies should be implemented to ensure infrastructure and talent cultivation at elderly care facilities. Combination of elderly care with medical services should be promoted. Supplementary insurance is recommended for citizens to relieve disease and elderly care burden.
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Objective To analyze the flow tendency of elderly patients,create a better mechanism to help guide elderly patients to form a good order in seeking medical care,and consequently improve the resource operational efficiency in medical service.Methods Analyzing the data by the descriptive,χ2 test and logistic regression of SPSS 20.0.Results Elderly patients prefer community health service centers and tertiary hospitals;of those visiting tertiary hospitals,nearly 30% seek medical advice for common chronic diseases.Main influencing factors for patient flow are medical insurance coverage and education. They tend not to embrace the two-way referral service,due to such factors of inconvenient process and defective mechanisms.Conclusion Transition from medical demand management to medical supply management.Such factors as quality cost,expense cost,time cost,and public opinion cost should be used to replace and weaken their mindset of the medical hierarchy,and embrace the concept of “seeking medical advice by grades”,thus improving the utilization of medical resources,and optimizing medical service accesibility.
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An analysis is made on major issues and difficulties in the application of the performance appraisal system structure,appraisal model and appraisal outcomes.It was discovered that the performance appraisal system,if used in clinical medical technology departments in the hospital,should focus on the system itself,the appraisal process and re-improvement of the system.These three factors are key to determining whether the system is effective and efficient,and key to transforming the system into departmental and hospital performance,even into overall enhancement of hospital performance in general.
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d infrastructure quality.Conclusions Raising responsiveness for special medical services will be conducive for improving the quality of non-medical services for these inpatients when they are in the hospital.