The new coming era has brought great challenge to present health service model, and the development of new science and technology had improved the reconstruction of medical system and model. With the guidance of evidence-based management and participation of model technology, this paper provides an explanation of the new health service model containing new health management, clinical medicine, chronic disease management and elder care which cover the whole life cycle, so as to implement the " Health China” strategy and develop a whole life cycle health service system for all residents with necessary, high quality, and affordable prevention, treatment, rehabilitation and health promotion.
目的:总结肝部分切除治疗肝胆管结石的临床经验。方法:回顾性分析91例肝胆管结石的定位诊断、手术方式、临床效果和手术并发症等情况。结果:术前行彩超检查91例（100％）、CT检查78例（85.7％）、MRI检查6例（5.5％）。术中发现合并胆管狭窄24例（26.4％），合并胆管癌2例（2.1％）。左外叶或左半肝切除71例（78.0％）、右叶各段切除18例（19.8％）、右半肝切除2例（2.2％）。术后并发症发生率19.8％，残石率18.7％。结论:彩超+CT对肝胆管结石的术前定位诊断基本能满足术前对手术方式的制定；以肝段叶切除为主的综合治疗方案是治疗肝胆管结石的有效手段；术中、术后彩超、纤维胆道镜的运用及术后针对患者具体情况的对症治疗措施可提高临床效果，减少并发症。
目的探讨低位直肠息肉恶变的合理的外科手术方式。方法对我院1997年1月至2001年12月收治的32例低位直肠息肉恶变患者的资料进行回顾性分析。 结果32例中经肛门局部切除20例，经腹前切除低位吻合（Dixon术）8例，经腹会阴联合切除（Miles’术）4例，其中27例术后给予放、化疗。28例获随访1~5年，2例死亡，余均无局部复发。 结论低位直肠息肉恶变手术方式的正确选择是达到“根除癌肿”、“改善患者生活质量”目的的关键，术中冰冻病理检查是手术方式选择的重要依据。
ObjectiveTo provide policy suggestions concerning the distribution of health resources between urban and rural areas and management and education of diabetes, this study depicted the current status of access to healthcare and analyzed its determinants among Chinese diabetic patients.MethodsMultivariate ordinal logistic regression and multivariate binary logistic regression were employed to analyze the effects of socioeconomic status and urban-rural disparities on health access.ResultsMultivariate results suggested that urban patients were more likely to conduct more blood glucose tests (P<0.000 1) and receive more self-care suggestions from physicians (P=0.02). After controlling all other covariates, patients graduated from secondary schools and those with vocational school degrees or above were 1.61 and 2.44 times more possible to take more blood glucose tests.Conclusions There exists significant urban-rural disparities of access to healthcare among Chinese diabetic patients. Education may be a key factor of access to healthcare among Chinese diabetic patients. It’s highly recommended to implement education programs on diabetes management in rural areas, where the education status and demographic factors should be considered. The distribution of health resource in rural areas requires more policy and governmental support.
The operation mode of scientific research incentive mechanism in West China Hospital of Sichuan University is closely connecting individual needs with organizational objectives, and coordinating and adjusting again through communication and feedback. It can play an incentive role continuously and actively promotes the development of hospital scientific research. But the incentive mode, research funding management, research output rate, strengthening of effective communication and other aspects need to be constantly optimized and improved. Based on Porter Lawler’s comprehensive incentive theory, this paper explores and summarizes the operation mode of scientific research incentive mechanism in West China Hospital of Sichuan University. Finally, the paper puts forward suggestions, which aims to provide reference for the construction of scientific research incentive mechanism in large general hospitals.
ObjectiveTo analyze the changing trend of cancer burden in China from 2005 to 2020, so as to provide reference for the formulation of cancer prevention and control strategies. MethodBased on the report “National and subnational trends in cancer burden in China, 2005–20”, the overall changes in cancer deaths in China by gender, age, urban and rural areas, and different regions of the country were analyzed. Results① Among the whole population, the number of cancer-related deaths and years of life lost (YLLs) in China increased by 21.6% and 5.0% respectively, and the top third leading cause of cancer-related deaths ranked by mortality rate were tracheal, bronchus, and lung cancer, liver cancer, and stomach cancer. ② In different gender groups, for the males, the top five leading cause of cancer-related deaths by mortality rate remained unchanged from 2005 to 2020, they were tracheal, bronchus, and lung cancer, liver cancer, stomach cancer, oesophageal cancer, and colon and rectum cancer. The average annual percent change (AAPC) of the age-standardized mortality rate (ASMR) increased in 4 of the leading 10 cancers, followed by prostate cancer (1.70 per 100 000), pancreatic cancer (0.95 per 100 000), lymphoma (0.33 per 100 000), and colon and rectum cancer (0.31 per 100 000). For the females, the tracheal, bronchus, and lung cancer remained the first leading cancer from 2005 to 2020, the second to the fifth leading cancers by mortality rate showed evident changes, with the liver cancer moving from the third to the second position, the stomach cancer moving from the second to the third position, the colon and rectum cancers moving from the fifth to the fourth position, and the breast cancer moving from the sixth to the fifth position, the pancreatic cancer moving from the ninth to the eighth position. Among the top 10 cancers, only the pancreatic cancer had an increase in AAPC of ASMR (0.67 per 100 000). ③ Among different age groups, the cancer-related mortality in young people (18–44 years old) and middle-aged people (45–59 years old) was much lower than that of the elderly (over 60 years old). ④ The mortality and YLL rates due to cancer in rural areas were higher than those in urban areas for both sexes. The cancer mortality rates of 11 provinces or regions such as Anhui were higher than those the national average value. The mortality, ASMR, YLL rates, and age-standardized YLL rates of all cancer types in Guangxi Zhuang Autonomous Region, Hebei, Xinjiang Uygur Autonomous Region, Henan, and Qinghai decreased in the males and which in Jiangsu, Henan, Guangxi Zhuang Autonomous Region, Xinjiang Uygur Autonomous Region, and Shanghai in the females also decreased. The ASMR of the colon and rectum cancer and pancreatic cancer increased significantly in some provinces or regions.ConclusionsFrom 2005 to 2020, there are rising trends in the number of cancer-related deaths and YLLs in China, and there are differences in the gender, age, urban and rural, and regional distribution of cancer burden. The prevention and control situation is grim, there is an urgent need for a comprehensive cancer prevention and control strategy to deal with the changing cancer burden in China.
【摘要】 目的 了解成都市社区居民脑卒中的流行病学特征，为脑卒中预防、干预提供科学依据。 方法 采用整群随机抽样方法抽取成都市2个社区。对132 303人采用前瞻性的热追踪，搜集社区中脑卒中发病及死亡人群。 结果 2008年脑卒中发病率、死亡率分别为217.68/10万、49.13/10万，2009年发病率、死亡率分别为239.60/10万、41.57/10万，2008年—2009年标化发病率216.01/10万，标化死亡率43.61/10万。缺血性脑卒中患者构成比最高，占半数以上。发病率随年龄增长而增高（χ2=1 095.11，Plt;0.001），男女发病率差异无统计学意义（χ2=2.367，P=0.124）。 结论 成都市社区居民发病率与我国平均水平相当，死亡率略低于我国平均水平。【Abstract】 Objective To explore the epidemiologic features of cerebral apoplexy in community of Chengdu, and to provide references for intervention and prevention of cerebral apoplexy. Methods Two communitis in Chengdu were selected by randomized cluster sampling method. The morbidity and mortality in 132 303 people were calculated by prospective tracing. Results The annual incidence was 217.68 per 100 000, and the annual mortality was 49.13 per 100 000 in 2008. The annual incidence was 239.60 per 100 000, and the annual mortality was 41.57 per 100 000 in 2009. The age-standardized incidence was 216.01 per 100 000, and the age-standardized mortality was 43.61 per 100 000 in the two years. Ischemic cerebral apoplexy exceeded half of all and had a highest constituent ratio. The incidence Increased with the age (χ2=1 095.11, Plt;0.001), while there was no significant difference between the male and female (χ2=2.367, P=0.124). Conclusion The incidence of cerebral apoplexy in Chengdu City is similar to the average incidence of our country, and the mortality is lower than that of the average mortality.