Objective To investigate the rural residents’ payment will for disease control and its influencing factors, so as to provide evidence for the government to make policy of combing disease control and New Rural Co-operative Medical system (NRCMS). Methods The self-designed questionnaire was adopted to investigate 1 117 rural residents from 156 villages, 44 towns, 19 counties (cities, districts) in Henan province. The frequency analysis and the multiple logistic regression analysis were conducted by using SPSS 11.5 software. Results On the basis of NRCMS payment, 68.3% of the rural residents were willing to pay extra for disease control, 62.3% of whom were willing to pay RMB 1.00 or more, and the average willing payment were RMB 3.01±7.66. The multiple logistic regression analysis revealed that the people willing to pay extra were as follows: self-employed, graduates from a secondary technical school, dink family, and the respondents who believed NRCMS had relieved their medical financial burden. Conclusion In practicing the rural public health policy of combining disease control and NRCMS, it is suggested to ask rural residents to pay a little extra money on the basis of current NRCMS payment. The foundation of bringing this policy into force is to keep practicing NRCMS well so as to relieve more financial burdens for rural residents. During the implementation, low income families should be taken into consideration according to their occupation, educational level and family structure.
Objective To retrospectively analyze the clinical information of a series of patients with cryptococcal neoformans meningitis in order to improve the diagnosis and treatment level. Methods Fifteen patients with etiological diagnosis as cryptococcal neoformans meningitis from January 2004 to December 2009 in the Affiliated Shengjing Hospital of China Medical University were included in the study. The clinical manifestations, treatment and prognosis of those patients were retrospectively analyzed. Results Seven of the total 15 patients were misdiagnosed with misdiagnosis rate of 46.7%. Twelve patients were treated by combination of amphotericin B/Lipo-AMB and fluconazole intravenously infusion, and then followed by the maintenance therapy of fluconazole orally administration, of which 7 were cured, 3 were improved, and 2 died. Five patients undergoing lumbar cisterna drainage were all cured. The follow-up study showed that 4 cases were accompanied by auditory or/and visual dysfunction within 1 to 5 years after hospital discharge. Three cases died that were not treated with anti-fungal drugs. Conclusion The misdiagnosis rate of cryptococcal neoformans meningitis is high. The keys to reduce mortality are raising vigilance, early diagnosis, rational use of antifungal drugs, and effectively lowering the intracranial pressure. The integrated therapy of amphotericin B/Lipo-AMB and fluconazole is effective and safe. Lumbar cisterna drainage can effectively lower the intracranial hypertension, quickly relieve symptoms and improve prognosis.
Objective To investigate the satisfaction of participants in Wenjiang District of Chengdu regarding the New-style Rural Cooperative Medical Care (NRCMC), and to analyse its factors in order to help the decision makers optimize and improve the scheme in the future.Methods Three towns of Wenjiang District were selected for study by computer simple random sampling. Five percent of NRCMC participants were randomly selected in Wenjiang for a face-to-face interview using a questionnaire. Data entry and statistical analysis were completed by Epidata 3.0 and SPSS 11.5 respectively. Results A total of 2500 questionnaires were conducted for face-to-face interviews, and 2438 questionnaires were returned (response rate 97.6%); 58% participants were satisfied with NRCMC, and the results of stepwise multiple logistic regression analysis indicated that their desire to participation (partial regression coefficient B=-3.54, P=0.014) and the satisfaction with the present compensation proportion (partial regression coefficient B=-4.62, P=0.018) were the most important factors that influenced the total satisfaction with NRCMC.Conclusion It is of great significance to strengthen the promotion of NRCMC; reasonably establish the compensation mode and proportion; encourge voluntary participation for the sake of their benefits to improve the quality and performance of NRCMC.
Objective To investigate the effect of new type ultrafiltration technique in preventing and relieving the main organ injury that may follow open heart surgery with cardiopulmonary bypass (CPB),and improve the operative effects and decrease the postoperative complications. Methods Thirty patients with congenital heart diseases were randomly divided into two groups. Modified ultrafiltration group: modified ultrafiltration was used after CPB; new type ultrafiltration group: new type ultrafiltration technique was used throughout CPB. The serum concentrations of nflammatory mediators,hematocrit,serum albumin concentrations, pulmonary function, operative duration time and main organ function parameters were measured in both groups. Results Ultrafiltration time after CPB in new type ultrafiltration group was significantly shorted as compared with modified ultrafiltration group（6.35±1.28 min vs. 12.45±4.52 min，P=0.000）; serum concentrations of interleukin6(IL-6)and tumor necrosis factor α(TNF-α) after CPB were significantly decreased as compared with modified ultrafiltration group（292.84±58.23 μg/L vs. 383.79±66.24 μg/L,P=0.000; 13.32±2.31 μg/L vs. 16.41±2.65 μg/L,P=0.000）; the hematocrit and serum albumin concentrations at the ten minutes after CPB were increased as compared with modified ultrafiltration group (0.39±0.04 vs. 0.35±0.03,P=0.003; 38.32±4.26 g/L vs. 34.04±2.83 g/L, P=0.003); the mechanical ventilation support time and ICU time after operation was shorted as compared with modified ultrafiltration group (Plt;0.05); main organ function was improved as compared with the modified ultrafiltration group. Conclusion The clinical application of new type ultrafiltration throughout CPB can effectively exclude some harmful inflammatory mediators, concentrate blood,short operation time,attenuate the main organ edema and injury.
Objective To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Methods Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P gt; 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Results Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P lt; 0.05). But the intraoperative blood loss and the hospitalization days showed no significant difference between 2 groups (P gt; 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 ± 2.34) weeks in the new approach group and was (13.78 ± 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 ± 4.2 in the new approach group, and was 89.2 ± 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). Conclusion New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.
Objective To investigate the cl inical appl ication effect of the new bone harvester. Methods Between August 2006 and October 2009, 112 patients underwent autogenous il iac bone graft and were followed up. There were 71 males and 41 females with a median age of 42 years (range, 11-71 years), including 45 cases of comminuted fracture of the l imbs, 47cases of bone nonunion, and 20 cases of benign bone tumor. According to different methods of bone harvesting, the patients were divided into 5 groups: group A (n=32, with new bone harvester), group B (n=29, with tricortical bone harvester), group C (n=15, with internal lamina harvester), group D (n=23, with external lamina harvester), and group E (n=13, with bicortical il iac bone by saw). There was no significant difference in general data of 5 groups (P gt; 0.05). The incision length, operation time, and peri-operative bleeding volume were compared. At 4 days, 7 days, 60 days, and 1 year postoperatively, the pain degree was assessed using visual analogue scale (VAS), and the incidence rates of peri pheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain were observed. Results The incision length and the operation time in group A was shorter than those in other groups, the peri-operative bleeding volume in group A was less than in other groups, the VAS in group A was the lowest among 5 groups, showing significant differences (P lt; 0.05). The occurrence rates of chronic pain and il iac crest sag in group A were lower than those in group B, showing significant differences at 1 year after operation (P lt; 0.01). There was no significant difference in the incidence rates of peripheral nerve injury, fracture, haematoma, ventral hernia, il iac crest sag, and chronic pain between group A and groups C, D, E (P gt; 0.05), and in the incidence rates of peri pheral nerve injury, fracture, haematoma, and ventral hernia between group A and group B (P gt; 0.05). The total compl ication in group A was the lowest among 5 groups, showing significant difference (P lt; 0.05). Conclusion The new bone harvester is minimally invasive bone harvester,which has the advantages of short operation time and incision length, less bleeding volume, low VAS and complications.
Objective To investigate the attitude and its influencing factors of Henan provincial rural residents towards the partial usage of funds from the New Rural Co-operative Medical System (NRCMS) for the disease control and prevention, in order to provide evidence for policy making. Methods In Henan province, 1 117 rural residents were randomly sampled with questionnaire from the 156 villages distributing in 44 townships of 19 counties (cities, districts). The frequency analyses, the multiple linear regression analysis and the one-way analysis of variance were conducted. Results Among all the respondents, only 3.4% of the rural residents absolutely disagreed (Zero agreement degree score), 34.4% fully agreed (10 agreement degree scores), and 90.6% had agreement degree scores equal to or more than five. The agreement degree was direct proportional to NRCMS satisfaction degree. The agreement degrees from residents who were relieved from medical financial burdens by NRCMS were higher than the others. 13.2% of rural residents believed that NRCMS did not alleviate their medical financial burden. For the men and women who believed that their village general practitioner was timely at vaccination, their agreement degree was higher than the others who considered vaccination time was late or common. The “timely group” was alone a subset. The “late group” and the “common group” were homogeneous subsets. The proportion of those who answered that the vaccination timeliness at late or common reached 40.6%. Conclusion The proposition to pay funds from the existing NRCMS for disease control and prevention is in line with the will of the majority of rural residents. The combination of disease control and prevention and NRCMS is a strategy in rural healthcare management. A bettering NRCMS and disease control and prevention are the basis of this policy in the future. More attention should be paid to the timeliness of the village general practitioners’ disease control work. It is necessary to perfect the NRCMS policy focusing on residents who hasn’t been relieved from medical financial burdens, so that more population will be benefited.