肿瘤专科医院肺癌住院费用及相关因素的回顾调查分析

目的 回顾调查了解影响肺癌住院费用的主要因素,为有效控制医疗费用的不合理增长提供政策依据。方法 抽样调查住院接受手术治疗的肺癌病例190例,对2家医院住院费用、患者年龄、性别、付费方式、住院次数、入院合并症、术后抗生素使用、抢救、转归、分期、手术时间、术前住院天数以及住院天数等可能影响住院费用的因素进行t检验、方差分析和多元逐步回归分析。 结果 2家医院间自费患者、住院次数、手术时间、术前住院天数和住院天数间存在显著性差异,而影响住院费用的因素主要有病例来源、术前住院天数、住院次数和住院天数。住院费用中西药费的比例偏大,而体现手术技术含量的项目收费偏低。结论 完善医疗保险制度,积极实施临床路径,健全早诊早治机制,是有效控制住院费用的重要措施。     

病种质量管理方式探讨 ——以剖宫产为例

目的 以剖宫产为例研究病种管理方式,探讨病种纳入标准。方法 采用统计学分析法,对不同指征剖宫产按照住院天数、住院费用进行分组,并对其住院费用的影响因素进行分析。结果 5组不同指征剖宫产数据根据住院费用指标可分为3组,按照住院天数指标分类则可归纳为2组,并且经分析发现,影响不同指征剖宫产术住院总费用的因素主要为药费、住院天数。结论 可以依据医疗资源消耗的相似性制定病种纳入标准,扩大病种质量控制体系范围;此外,通过控制关键影响因素来加强病种质量管理,降低患者医疗费用。     

住院择期手术取消的影响因素分析

目的 探索我国大型三甲医院住院择期手术取消的影响因素,为医院管理者提供科学参考依据。方法 前瞻性收集四川大学华西医院2014年11月1日—2015年1月31日住院择期手术取消原因,采用SPSS18.0软件进行统计分析,采用χ²检验、二分类logistic回归分析方法比较其影响因素。 结果 患者年龄、医疗组长职称、手术难度与住院择期手术取消有关,手术难度对手术取消的作用最大。结论 住院择期手术排程时,考虑手术取消的影响因素,合理排程以减少手术的取消。     

北京市某三甲医院31天内非计划性再入院研究

目的 了解北京市某三甲综合性医院住院患者出院31天内非计划再入院的现状及其影响因素。方法 对北京市某三甲综合性医院2008年1月1日—12月31日之间出院后31天内非计划性再入院的患者进行描述性分析，通过t 检验和χ²检验进行单因素分析，选择有统计学意义的危险因素用向后逐步回归法进行非条件Logistic分析。结果 患者性别、患者年龄、出院—再入院的间隔天数、前次入院时入院状况和前次入院疾病是否治愈是31天内非计划性再入院的主要影响因素。结论 患者特征和医院相关因素均与患者出院31天内非计划性再入院相关。     

重点疾病非计划重返住院的影响因素分析

目的 研究某三甲综合医院2012年18类重点疾病非计划重返住院的影响因素。方法 对样本院2012年18类重点疾病7 406例患者进行分析,研究其出院后15天、31天非计划重返住院的原因。 结果 9类疾病33名患者出现了非计划再次入院情况,慢性病和60岁以上老年人更有可能非计划重返住院,患者出院时疾病状态、出院主张、病情加重或病情复发、住院天数等是影响非计划重返住院的主要因素。 结论 要从熟练掌握相关疾病的临床治愈好转标准,加强医患沟通,加强健康宣教,加强出院随访等方面来提高医院的医疗质量。     

基于循证评价的现代化综合性中医院医疗质量评价指标体系的建立

目的 建立一套科学合理、量化可比、简便易行的现代化综合性中医院医疗质量评价指标体系。方法 对我国现有的医疗质量评价的文献进行循证分析,按循证医学的标准和引用频率提取综合性医院的共性指标和中医院特有的非共性指标,从而拟定指标体系草案。运用德尔菲法,进行3轮专家咨询,采用相乘模型的综合指数法筛选指标,用层次分析法和比例分配法确定指标权重。结果 指标体系由5个一级指标、23个二级指标构成,其中反映中医院特色的二级指标6个,占26%。结论 整套指标体系既有医院的共性指标,又强调了综合性中医院的特性指标,既能突出中医医疗质量管理与质量控制的特色,又能结合中医医院现代化发展的需要。     

实施快速手术住院制度 降低平均住院日

目的 　探讨腹腔镜胆囊切除快速手术住院制度的可行性。方法　120例腹腔镜胆囊切除术患者被随机分为2组：对照组,按传统住院途径管理,60例;实验组,按快速手术住院制度管理,60例。分析2组平均住院日、住院费用、并发症及患者满意率的差异。结果　2组平均住院日与住院费用有显著性差异,而并发症及满意率无显著性差异。结论 实施快速手术住院制度,规范了医疗工作流程,有效降低了平均住院日,节约了住院费用,体现了病房的精细化管理。     

专家门诊亚专科化及专病门诊优化的效果分析

目的 探讨专家门诊亚专科化及专病门诊优化对学科发展及患者就诊的影响。方法 2011年及2014年分别对老年医学科及普通外科专家门诊实行亚专科化并在2013年至2014年对专病门诊进行优化,比较调整前后门诊相关指标的变化。结果 亚专科化后,两个专科的专家门诊量分别增长了63.0%和5.6%,均高于医院同期平均水平（经χ²检验,P=0.000）。普通外科4级手术率达34.9%,高于2013年同期（经χ²检验,P=0.000）,挂号错误率也明显下降（经χ²检验, P=0.000）。2014年底专病门诊增至38个,其中联合专病门诊7个,门诊量增长了36.5%,高于同期专病门诊数量及医院门诊量的增长率（经χ²检验,P=0.000）。结论 专家门诊的亚专科化及充分发挥专病门诊的作用是促进学科建设、提升医院影响力、方便患者就诊的有效措施之一。     

DRGs方法在临床亚专科医疗服务绩效评价中的应用

目的 运用疾病诊断相关组指标对研究医院“消化系统大手术”亚专科住院医疗服务绩效进行评价,为医院加强精细化医院管理和学科建设提供数据支持。方法 以“国家版诊断相关组”作为风险调整工具,从能力、效率和安全3个维度对样本医院“消化系统大手术”亚专科住院医疗服务绩效进行评价。结果 2008—2015年,样本医院亚专科总权重逐年增加,2015年亚专科病例数占到了市属医院的50.27%;时间消耗指数0.91,但费用消耗较市属医院平均水平高24%;2015年GB15、GB25疾病组死亡率均为0,GB11、GB23疾病组死亡率低于市属医院平均水平。结论 2008—2015年,样本医院“消化系统大手术”亚专科医疗服务能力稳步提升,在市属医院范围内具有明显优势;但须注意在保持服务效率和安全优势的同时,增加GB11、GB23疾病组病例的收治,并应注意严格控制患者住院费用。     

Risk and the evolution of human exchange

Compared with other species, exchange among non-kin is a hallmark of human sociality in both the breadth of individuals and total resources involved. One hypothesis is that extensive exchange evolved to buffer the risks associated with hominid dietary specialization on calorie dense, large packages, especially from hunting. 'Lucky' individuals share food with 'unlucky' individuals with the expectation of reciprocity when roles are reversed. Cross-cultural data provide prima facie evidence of pair-wise reciprocity and an almost universal association of high-variance (HV) resources with greater exchange. However, such evidence is not definitive; an alternative hypothesis is that food sharing is really 'tolerated theft', in which individuals possessing more food allow others to steal from them, owing to the threat of violence from hungry individuals. Pair-wise correlations may reflect proximity providing greater opportunities for mutual theft of food. We report a laboratory experiment of foraging and food consumption in a virtual world, designed to test the risk-reduction hypothesis by determining whether people form reciprocal relationships in response to variance of resource acquisition, even when there is no external enforcement of any transfer agreements that might emerge. Individuals can forage in a high-mean, HV patch or a low-mean, low-variance (LV) patch. The key feature of the experimental design is that individuals can transfer resources to others. We find that sharing hardly occurs after LV foraging, but among HV foragers sharing increases dramatically over time. The results provide strong support for the hypothesis that people are pre-disposed to evaluate gains from exchange and respond to unsynchronized variance in resource availability through endogenous reciprocal trading relationships.     

To kill a kangaroo: understanding the decision to pursue high-risk/high-gain resources

In this paper, we attempt to understand hunter–gatherer foraging decisions about prey that vary in both the mean and variance of energy return using an expected utility framework. We show that for skewed distributions of energetic returns, the standard linear variance discounting (LVD) model for risk-sensitive foraging can produce quite misleading results. In addition to creating difficulties for the LVD model, the skewed distributions characteristic of hunting returns create challenges for estimating probability distribution functions required for expected utility. We present a solution using a two-component finite mixture model for foraging returns. We then use detailed foraging returns data based on focal follows of individual hunters in Western Australia hunting for high-risk/high-gain (hill kangaroo) and relatively low-risk/low-gain (sand monitor) prey. Using probability densities for the two resources estimated from the mixture models, combined with theoretically sensible utility curves characterized by diminishing marginal utility for the highest returns, we find that the expected utility of the sand monitors greatly exceeds that of kangaroos despite the fact that the mean energy return for kangaroos is nearly twice as large as that for sand monitors. We conclude that the decision to hunt hill kangaroos does not arise simply as part of an energetic utility-maximization strategy and that additional social, political or symbolic benefits must accrue to hunters of this highly variable prey.     

An empirical test of the bet‐hedging polyandry hypothesis: Female red flour beetles avoid extinction via multiple mating

Bet‐hedging via polyandry (spreading the extinction risk of the female''s lineage over multiple males) may explain the evolution of female multiple mating, which is found in a wide range of animal and plant taxa. This hypothesis posits that females can increase their fitness via polyandrous mating when “unsuitable” males (i.e., males causing reproductive failure for various reasons) are frequent in the population and females cannot discriminate such unsuitable mates. Although recent theoretical studies have shown that polyandry can operate as a bet‐hedging strategy, empirical tests are scarce. In the present study, we tested the bet‐hedging polyandry hypothesis by using the red flour beetle Tribolium castaneum. We compared female reproductive success between monandry and polyandry treatments when females mated with males randomly collected from an experimental population, including 20% irradiated (infertile) males. In addition, we evaluated geometric mean fitness across multiple generations as the index of adaptability of bet‐hedging traits. Polyandrous females showed a significantly higher egg hatching rate and higher geometric mean fitness than monandrous females. These results strongly support the bet‐hedging polyandry hypothesis.     

The benefits of stealing from a predator: foraging rates, predation risk, and intraspecific aggression in the kleptoparasitic spider Argyrodes antipodiana

In the trade-off between food and safety, the role of aggressiveintraspecific interactions has not been extensively examined.Here I present information on this system using a kleptoparasiticspider, Argyrodts antipodiana, and its host spider and potentialpredator, Eriophora pustulosa. A. antipodiana can feed eitherat a potentially dangerous site (the hub of its host's web withthe host), or at a relatively safe site (on food bundles aroundthe edge of the host's web). I found that A. antipodiana cangain food very quickly when feeding with the host, apparentlyby exploiting the host's ability to digest the prey. Thus A.antipodiana follows predictions based on foraging models inthat it accepts a higher predation risk at the hub because ofthe higher food payoff. A. antipodiana also aggressively competesfor access to more food. However, aggressive competition increasesthe predation risk from the host, especially at tile hub wherethe host is very close. Consequently, A. antipodiana modifiesits level of intraspecific aggressiveness in accordance withits position on the web: at the hub, where the cost of aggressionis high (due to predation risk), A. antipodiana reduces itsaggressiveness, but it is aggressive away from the hub whencompeting for food bundles. The ability of A. antipodiana tochange interaction intensity as a function of its position onthe web enables it to exploit a rich, but risky, food sourceand provides a new angle for examining food and safety tradeoffs in light of intraspecific competition for food     

Quantitative genetic studies of antisocial behaviour

This paper will broadly review the currently available twin and adoption data on antisocial behaviour (AB). It is argued that quantitative genetic research can make a significant contribution to further the understanding of how AB develops. Genetically informative study designs are particularly useful for investigating several important questions such as whether: the heritability estimates vary as a function of assessment method or gender; the relative importance of genetic and environmental influences varies for different types of AB; the environmental risk factors are truly environmental; and genetic vulnerability influences susceptibility to environmental risk. While the current data are not yet directly translatable for prevention and treatment programmes, quantitative genetic research has concrete translational potential. Quantitative genetic research can supplement neuroscience research in informing about different subtypes of AB, such as AB coupled with callous-unemotional traits. Quantitative genetic research is also important in advancing the understanding of the mechanisms by which environmental risk operates.     

大型综合性医院风险矩阵量化评估与分析

任何风险最后都需要用数字或精确的文字描述来表述，才能被大多数人正确认识。运用矩阵的方法和原理，采用专家咨询法对大型综合性医院的风险进行量化评估，并提出对应的对策分析。     

Integrating species traits with extrinsic threats: closing the gap between predicting and preventing species declines

In studies of extinction risk, it is often insufficient to conclude that species with narrow ranges or small clutch sizes require prioritized protection. To improve conservation outcomes, we also need to know which threats interact with these traits to endanger some species but not others. In this study, we integrated the spatial patterns of key threats to Australian amphibians with species' ecological/life-history traits to both predict declining species and identify their likely threats. In addition to confirming the importance of previously identified traits (e.g. narrow range size), we find that extrinsic threats (primarily the disease chytridiomycosis and invasive mosquitofish) are equally important and interact with intrinsic traits (primarily ecological group) to create guild-specific pathways to decline in our model system. Integrating the spatial patterns of extrinsic threats in extinction risk analyses will improve our ability to detect and manage endangered species in the future, particularly where data deficiency is a problem.     

What drives the evolution of hunter–gatherer subsistence technology? A reanalysis of the risk hypothesis with data from the Pacific Northwest

Recent studies have suggested that the decisions that hunter-gatherers make about the diversity and complexity of their subsistence toolkits are strongly affected by risk of resource failure. However, the risk proxies and samples employed in these studies are potentially problematic. With this in mind, we retested the risk hypothesis with data from hunter-gatherer populations who lived in the northwest coast and plateau regions of the Pacific Northwest during the early contact period. We focused on these populations partly because the northwest coast and plateau differ in ways that can be expected to lead to differences in risk, and partly because of the availability of data for a wide range of risk-relevant variables. Our analyses suggest that the plateau was a more risky environment than the northwest coast. However, the predicted differences in the number and complexity of the populations' subsistence tools were not observed. The discrepancy between our results and those of previous tests of the risk hypothesis is not due to methodological differences. Rather, it seems to reflect an important but hitherto unappreciated feature of the relationship between risk and toolkit structure, namely that the impact of risk is dependent on the scale of the risk differences among populations.     

BH3-mimetic drugs prevent tumour onset in an orthotopic mouse model of hepatoblastoma

Drug resistance and metastasis remain major challenges in the treatment of high-risk hepatoblastoma (HB) and require the development of alternative therapeutic strategies. Modulation of apoptosis in HB cells enhances the sensitivity of these cells towards various drugs and has been discussed to enforce treatment. We investigated the impact of apoptosis sensitisers, BH3-mimetics, on the interaction between the host and HB to reduce tumour growth and dissemination while enhancing immunity. BH3-mimetics, such as obatoclax and ABT-737, enhanced the apoptosis-inducing effect of TRAIL and TNF-α resistant HB cells (HepT1 and HUH6). Tumour cell migration was inhibited by ABT-737 and more markedly by obatoclax. In an orthotopic model of HB, tumour uptake was reduced when the cells were pretreated with low concentrations of obatoclax. Only 1 of 7 mice developed HB in the liver, compared with an incidence of 0.8 in the control group. In summary, our study showed that apoptosis sensitisers had broader effects on HB cells than expected including migration and susceptibility to cytokines in addition to the known effects on drug sensitization. Sensitising HB to apoptosis may also allow resistant HB to be targeted by immune cells and prevent tumour cell dissemination.     

Prevalence,Associated Risk Factors,and Phylogenetic Analysis of Toxocara vitulorum Infection in Yaks on the Qinghai Tibetan Plateau,China

Toxocara vitulorum has been rarely reported in yaks at high altitudes and remote areas of Sichuan Province of Tibetan Plateau of China. The current study was designed to investigate the prevalence, associated risk factors, and phylogenetic characteristics of T. vitulorum in yak calves on the Qinghai Tibetan plateau. Fecal samples were collected from 891 yak calves and were examined for the presence of T. vitulorum eggs by the McMaster technique. A multivariable logistic regression model was employed to explore variables potentially associated with exposure to T. vitulorum infection. T. vitulorum specimens were collected from the feces of yaks in Hongyuan of Sichuan Province, China. DNA was extracted from ascaris. After PCR amplification, the sequencing of ND1 gene was carried out and phylogenetic analyses was performed by MEGA 6.0 software. The results showed that 64 (20.1%; 95% CI 15.8–24.9%), 75 (17.2; 13.8–21.1), 29 (40.9; 29.3–53.2), and 5 (7.6; 2.5–16.8) yak calves were detected out to excrete T. vitulorum eggs in yak calve feces in Qinghai, Tibet, Sichuan, and Gansu, respectively. The present study revealed that high infection and mortality by T. vitulorum is wildly spread on the Qinghai Tibetan plateau, China by fecal examination. Geographical origin, ages, and fecal consistencies are the risk factors associated with T. vitulorum prevalence by logistic regression analysis. Molecular detection and phylogenetic analysis of ND1 gene of T. vitulorum indicated that T. vitulorum in the yak calves on the Qinghai Tibetan plateau are homologous to preveiously studies reported.