The mistakes of ＂Old healthcare reform＂ lead to bad consequences： the contradiction between the reducing government investment and the rising costs of medical treatment, the contradiction between the nature of the...The mistakes of ＂Old healthcare reform＂ lead to bad consequences： the contradiction between the reducing government investment and the rising costs of medical treatment, the contradiction between the nature of the public welfare and the marketization of hospitals, and the contradiction between the unlimited demand growth for medical services and the scarcity of qualified medical resources. The causes of the failure of ＂old healthcare reform＂ are the loss of market-oriented reform and the decadence of medical tenet.展开更多
Background Amphotericin B （0.7 mg/kg） with flucytosine is the standard treatment for cryptococcal meningitis.However,the long treatment course can induce adverse reactions in patients; therefore,reducing the dose ma...Background Amphotericin B （0.7 mg/kg） with flucytosine is the standard treatment for cryptococcal meningitis.However,the long treatment course can induce adverse reactions in patients; therefore,reducing the dose may decrease such reactions.We performed a retrospective analysis of treatment effects and adverse reactions when amphotericin B （0.4 mg/kg or 0.7 mg/kg per day） and flucytosine were used together to treat HIV-negative patients with cryptococcal meningitis.Methods Retrospective analysis was conducted on inpatients at the First Affiliated Hospital,College of Medicine,Zhejiang University （January 2005 to December 2009）.Low- or high-dose amphotericin B （0.4 or 0.7 mg/kg per day,respectively） plus flucytosine was used.The negative conversion rate of Cryptococcus in the cerebrospinal fluid （CSF）,patient mortality,and the incidence of side effects for the two groups （low- vs.high-dose） were compared immediately after treatment and 2 and 10 weeks later.Data were analyzed by the Student＇s t test,chi-square tests using SPSS 12.0 statistical soitware.Results Two weeks post-treatment,Cryptococcus negative CSF rates were 78% （18/23） in the low-dose group and 87% （13/15） in the high-dose group （P=0.28）.Ten weeks post-treatment,both groups were negative.The mortality rate was 8% （2/25） in the low-dose group and 17% （3/18） in the high-dose group （P=-0.25）.There was a statistically significant difference in the incidence of adverse events between the groups,48% （12/25） and 78% （14/18） in the low- and high-dose groups,respectively （P=0.04）.Adverse events that required a change in treatment program in the low-dose group were 12% （3/25） compared to 39% （7/18） in the high-dose group （P=-0.04）.Conclusion Low-dose treatment regimens were better tolerated展开更多
Background The 2009 pandemic H1 N1 （pH1N1） influenza showed that relatively young adults accounted for the highest rates of hospital admission and death.In preparation for pH1N1,the aim of the study is to identify f...Background The 2009 pandemic H1 N1 （pH1N1） influenza showed that relatively young adults accounted for the highest rates of hospital admission and death.In preparation for pH1N1,the aim of the study is to identify factors associated with the mortality of patients with 2009 pH1N1 infection,especially for young patients without chronic medical conditions.Methods Retrospective observational study of 2151 severe or critical adult cases （-≥14 years old） admitted to a hospital with pH1N1 influenza from September 1,2009 to December 31,2009 from 426 hospitals of 27 Chinese provinces.A confirmed case was a person whose pH1N1 virus infection was verified by real-time reverse-transcriptase polymerase chain reaction （rRT-PCR）.Severe and critical cases were defined according to the H1N1 2009 Clinical guidelines （Third Edition,2009） released by the Ministry of Health of China.Results Among the 2151 patients,the mean age was 34.0 years.Two hundred and ninty-three （13.6%） died during hospital stay.One thousand four hundred and forty-two patients （67.0%） had no comorbidities and 189 （13.1%） of them died.Pregnancy （OR 8.03）,pneumonia （OR 8.91）,dyspnea （OR 3.95）,central nervous system （CNS） symptom （OR 1.55）,higher APACHE （Acute Physiology and Chronic Health Evaluation） Ⅱ score （OR 1.06）,Alanine aminotransferase （ALT） （OR 1.002）,and the lactate dehydrogenase （LDH） level （OR 1.001） were independent risk factors for death among adults without chronic medical conditions.Higher APACHE Ⅱ score （OR 1.08） and age （OR 1.06） were independent risk factors for death among adults with respiratory diseases.A multivariate analysis showed an association between mortality and CNS symptoms （OR 2.66）,higher APACHE Ⅱ score （OR 1.03）,ALT （OR 1.006）,and LDH level （OR 1.002） in patients with cardiovascular diseases.Dyspnea （OR 11.32） was an independent risk factor for patient death in patients with diabetes mellitus.Conclusion Clinical knowledge of identified prognostic factors for mortality may aid in the management of adult influenza infection.展开更多
文摘The mistakes of ＂Old healthcare reform＂ lead to bad consequences： the contradiction between the reducing government investment and the rising costs of medical treatment, the contradiction between the nature of the public welfare and the marketization of hospitals, and the contradiction between the unlimited demand growth for medical services and the scarcity of qualified medical resources. The causes of the failure of ＂old healthcare reform＂ are the loss of market-oriented reform and the decadence of medical tenet.
文摘Background Amphotericin B （0.7 mg/kg） with flucytosine is the standard treatment for cryptococcal meningitis.However,the long treatment course can induce adverse reactions in patients; therefore,reducing the dose may decrease such reactions.We performed a retrospective analysis of treatment effects and adverse reactions when amphotericin B （0.4 mg/kg or 0.7 mg/kg per day） and flucytosine were used together to treat HIV-negative patients with cryptococcal meningitis.Methods Retrospective analysis was conducted on inpatients at the First Affiliated Hospital,College of Medicine,Zhejiang University （January 2005 to December 2009）.Low- or high-dose amphotericin B （0.4 or 0.7 mg/kg per day,respectively） plus flucytosine was used.The negative conversion rate of Cryptococcus in the cerebrospinal fluid （CSF）,patient mortality,and the incidence of side effects for the two groups （low- vs.high-dose） were compared immediately after treatment and 2 and 10 weeks later.Data were analyzed by the Student＇s t test,chi-square tests using SPSS 12.0 statistical soitware.Results Two weeks post-treatment,Cryptococcus negative CSF rates were 78% （18/23） in the low-dose group and 87% （13/15） in the high-dose group （P=0.28）.Ten weeks post-treatment,both groups were negative.The mortality rate was 8% （2/25） in the low-dose group and 17% （3/18） in the high-dose group （P=-0.25）.There was a statistically significant difference in the incidence of adverse events between the groups,48% （12/25） and 78% （14/18） in the low- and high-dose groups,respectively （P=0.04）.Adverse events that required a change in treatment program in the low-dose group were 12% （3/25） compared to 39% （7/18） in the high-dose group （P=-0.04）.Conclusion Low-dose treatment regimens were better tolerated
基金This work wassupported by grants from the Ministry of Health of the People＇s Republic of China, the World Health Organization for the clinical study of the influenza A pandemic A （H1N1） 2009 and the National Natural Science Foundation of China （No. 81030032 and No. 81070005）.Acknowledgements： The authors gratefully acknowledge the following individuals who helped identifying cases and collated clinical data： SONG Shu-fan, LI Ran, YANG Ting, YIN Yu-dong, MA Chen, and BAI Lu who participated in the collection of clinical data Hui David Shu-Cheong （Hong Kong, China）, Colin James McArthur （New Zealand）, Dale Andrew Fisher （Singapore）, OH Myoung Don （Korea）, Dong Jie （World Health Organization） who provided technical support XIAO Fei and WU Si-nan who help reviewing the manuscript.
文摘Background The 2009 pandemic H1 N1 （pH1N1） influenza showed that relatively young adults accounted for the highest rates of hospital admission and death.In preparation for pH1N1,the aim of the study is to identify factors associated with the mortality of patients with 2009 pH1N1 infection,especially for young patients without chronic medical conditions.Methods Retrospective observational study of 2151 severe or critical adult cases （-≥14 years old） admitted to a hospital with pH1N1 influenza from September 1,2009 to December 31,2009 from 426 hospitals of 27 Chinese provinces.A confirmed case was a person whose pH1N1 virus infection was verified by real-time reverse-transcriptase polymerase chain reaction （rRT-PCR）.Severe and critical cases were defined according to the H1N1 2009 Clinical guidelines （Third Edition,2009） released by the Ministry of Health of China.Results Among the 2151 patients,the mean age was 34.0 years.Two hundred and ninty-three （13.6%） died during hospital stay.One thousand four hundred and forty-two patients （67.0%） had no comorbidities and 189 （13.1%） of them died.Pregnancy （OR 8.03）,pneumonia （OR 8.91）,dyspnea （OR 3.95）,central nervous system （CNS） symptom （OR 1.55）,higher APACHE （Acute Physiology and Chronic Health Evaluation） Ⅱ score （OR 1.06）,Alanine aminotransferase （ALT） （OR 1.002）,and the lactate dehydrogenase （LDH） level （OR 1.001） were independent risk factors for death among adults without chronic medical conditions.Higher APACHE Ⅱ score （OR 1.08） and age （OR 1.06） were independent risk factors for death among adults with respiratory diseases.A multivariate analysis showed an association between mortality and CNS symptoms （OR 2.66）,higher APACHE Ⅱ score （OR 1.03）,ALT （OR 1.006）,and LDH level （OR 1.002） in patients with cardiovascular diseases.Dyspnea （OR 11.32） was an independent risk factor for patient death in patients with diabetes mellitus.Conclusion Clinical knowledge of identified prognostic factors for mortality may aid in the management of adult influenza infection.
