ObjectivesTo analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China.MethodsPubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed.ResultsForeign integrated care was dominated at government level. The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on. At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation.ConclusionThere is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.
目的 研究人喉表皮癌细胞系Hep-2中乳腺癌易感基因1（BRCAl）、P53结合蛋白1（53BP1）和DNA损伤检测点介质1（MDC1）的表达及临床意义。 方法 采用逆转录聚合酶链式反应检测BRCA1、53BP1、MDC1在喉癌细胞系Hep-2中mRNA的表达，同时用免疫印迹法检测蛋白的表达。 结果 在所检测的人喉癌细胞系Hep-2中BACR1、53BP1、MDC1在基因与蛋白两个水平均有表达。 结论 BRCA1、53BP1、MDC1可能在喉癌的发生发展中有一定作用。
ObjectivesTo systematically review the concept, definition, development, operation mechanism, function, efficacy, advantages and challenges of pharmacy benefit management (PBM), in order to provide evidence for its introduction and application in China.MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and CBM databases were searched to collect literatures on researches, policies, and applications related to PBM from January 1st, 2000 to January 1st, 2017. Two researchers independently screened literatures, extracted data and used the AHRQ evaluation list to evaluate the quality of the observational studies, then qualitative method was used to review literature.ResultsA total of 12 researches were included. The results showed that PBMs had played an important role in negotiation discounts with drug manufacturers, supervising drug circulation and doctors' prescription behaviors, delivering health management services for patients, prescription payments with highly information-oriented systems, etc., which, as a result, could reduce the medication burden of patients with superior diseases management.ConclusionsChina's attempt to adopt a PBM model must take full account of practical conditions, which involves health management system, pharmaceutical market environment and social culture. It cannot merely emulate the PBM model of the United States. With consideration of local conditions, China can explore a suitable path for its own PBM model.
Objective To investigate the preventive effect of simvastatin，a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor，on hypoxic pulmonary hypertension and the relation between it and the angiotensin Ⅱ receptor-1（AT1R） expression in pulmonary arteriole.Methods Thirty male Sprague-Drawley rats were randomly allocated into three groups：a control group，a hypoxic group and a simvastatin preventive group.The animal model of hypoxic pulmonary hypertension was established by exposing the rats to normobaric hypoxic condition（8 h×6 d×3 w），and the preventive group were treated with simvastatin 10 mg/kg before hypoxic processing while the control and hypoxic groups were treated with sodium chloride.The mean pulmonary pressure（mPAP），serum cholesterol concentration，right ventricular hypertrophy index [RV/（LV+S）]，percentage of the wall thickness in the external diameter（WT%），percentage of the wall area in the total vascular area（WA%），and the AT1R expression in pulmonary arterioles were measured.Results When compared with the hypoxic group，in the preventive group，the mPAP and RV/（LV+S）obviously reduced [（22.6±3.86）mm Hg vs （29.3±2.27）mm Hg，（25.13±0.75）% vs （33.18±1.58）%，Plt;0.01 respectively]，the indices of wall thickness of rat pulmonary arteriole and area also decreased significantly [WT%：（15.98±1.96）% vs （25.14±1.85）%；WA%：（54.60±3.94）% vs 74.77±4.52）%；Plt;0.01 respectively]，and the positive degree of AT1R still lessened noticeably（1.23±0.09 vs 1.57±0.13，Plt;0.01）.All of the indices above in the hypoxic group increased markedly compared with the control group（Plt;0.01 respectively）.However，the differences of serum cholesterol among three groups were not significant（Pgt;0.05）.Conclusions Simvastatin can suppress the expression of AT1R in pulmonary vessel and prevent hypoxic pulmonary hypertension.
ObjectiveTo evaluate the diagnostic value of endobronchial ultrasound technology in combination with LungPoint virtual navigation system for pulmonary peripheral nodules. MethodsRetrospective analysis of 317 patients with peripheral pulmonary nodules who underwent endobronchial ultrasound at the endoscopy center of Shanghai Pulmonary Hospital from January 2021 to March 2022 was used as the study population. They were divided into the endobronchial ultrasound group (EBUS-GS group) and the virtual navigation combined with endobronchial ultrasound group (VBN+EBUS-GS group) according to whether the path was planned with the LungPoint virtual navigation system preoperatively or not. The diagnostic rate, bronchoscopic arrival rate, arrival time, operation time and complications were compared between the EBUS-GS group and the VBN+EBUS-GS group, and the factors associated with the diagnostic rate of endobronchial ultrasound were analyzed. ResultsThere were 101 malignant nodules and 216 benign nodules. The mean size of lung nodules was (1.9±0.7) cm and (1.8±0.6) cm in the EBUS-GS and VBN+EUBS-GS groups, respectively (P>0.05); The time to reach the lesions was 7 (5 - 9) and 4 (3 - 5) min, and the total operation time was 18 (16 - 20) and 16 (14 - 18) min, respectively (P<0.05). The arrival rates of endobronchial ultrasound in the two groups was 82.6% and 98.1% (P<0.05), respectively. The overall diagnostic rate, malignant nodule diagnostic rate and benign nodule diagnostic rate of the two groups were 61.3% vs. 64.8%, 67.9% vs. 68.6% and 57.6% vs. 63.1% respectively (P>0.05). There was one pneumothorax in the EBUS-GS group after examination (0.6%, 1/155). No complications such as hemoptysis or infection occurred in all patients. ConclusionsLungPoint virtual navigation can significantly improve the arrival rate of lesions under endobronchial ultrasound, significantly reduce the arrival time of endobronchial ultrasound to the lesions and the total operation time, which is beneficial to improve the efficiency of clinical examination.
Objectives To describe background, measures and impacts of building essential healthcare system in the developed and developing countries aboard. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. The resources we searched included electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develop an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result 166 studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objectives, many studies (160 articles) aimed to describe strategies, while few studies(6 articles) were to evaluate effectiveness of strategies. Most of studies evaluating effectiveness were cross-sectionnary data, Except one time cohort study with intervention. Conclusions Strategies to implement essential healthcare system varies in the different country because of diversity of political, culture and economic background and different goals. The experience in transition countries gives us more high lights.
Objective To describe the criteria and procedure for defining an essential healthcare package in the developed and developing countries. Method Search words were chosen by both health policy experts and search coordinators after discussion and pilot. We searched electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develope an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result One hundred and sixty-six studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objective,160 articles aimed to describe strategies, 6 articles aimed to evaluate effectiveness of strategies.Five studies evaluating effectiveness were cross-sectionnary data, and one study was time series. Conclusion An appropriate package should be defined according to both technique criteria and social welfare criteria, considering each country’s healthcare system and market structure, characteristics of the demander and provider, capacity of government’s regulation. The experience in transition countries gives us more high lights.