我院8年疑难危重病人住院趋势的调查

目的 了解近8年我院疑难危重病种住院构成和趋势,为领导者提供决策依据。方法采用回顾性方法和ICD国际疾病分类微机汇总库调研。结果危重病种前5位为恶性肿瘤49. 5%、心脏病14. 0%、脑血管病12. 2%、神经系病6. 1%、糖尿病4. 4%;前5种疾病也是死亡构成最高的前5种疾病:恶性肿瘤、脑血管病、心脏病、颅内损伤、慢肝肝硬变。结论适当地调整和增加对疑难危重病种的学科建设和投入,以满足社会患病人群逐年增长的保健和医疗需求。

高血压急症住院趋势和终末器官损害与住院死亡率的关系

迄今为止还没有针对高血压急症（hypertensive emergency，HTNE）和并发症管理的全面性指南。尽管在治疗高血压上有所发展，但是HTNE仍有显著的发病率和死亡率。方法：查询2002—2012年全国住院样本数据库以确定HTNE患者。

Analysis of the effect of medical insurance on cancer inpatients: A 10-year retrospective study on a large hospital in Northeast China

Objective The aim of the study was to analyze hospital costs for cancer inpatients availing different methods of payment and the influencing factors, to provide inputs to improve the medical insurance payment policy. Methods We analyzed the information related to length of hospital stay, hospitalization cost, and self-pay cost, collected from one large-scale, Grade A, Class Three hospital in Shenyang, China, during 2004–2013.Results The number of cancer inpatients with different payment types(medical insurance group and non-medical insurance group) presented a rising trend. Further, the ratio of medical insurance inpatients increased rapidly(from 22.2% to 48.7%); however, this group was still a minority. The length of hospital stay became shorter(21 d vs. 17 d; P = 0.000) while the gap got narrower; the hospitalized expense showed an upward trend and the difference was remarkable($24048.6 ± $4376.28 vs. $20544.36 ± $4057.01; P = 0.000). Conclusion Along with normalization of cancer therapy, the influence of payment on treatment has been getting weak, the policy has impact on controlling hospitalization cost, lightening burden of cancer patient, as well as allocating medical resources in a reasonable way, becoming an important defray pattern of hospitalization cost.

TEMPORAL TRENDS IN ETIOLOGY AND IN-HOSPITAL OUTCOME IN CHINESE PATIENTS WITH PERICARDIAL EFFUSION:10-YEAR EXPERIENCE OF A SINGLE CENTER

Objective To evaluate the evolution of etiology, clinical characteristics, and in-hospital outcomes of pericardial effusions in the recent decade. Methods All patients with a diagnosis of pericardial effusion during hospitalization were recruited from the Hospital Inpatient System between January 1996 and December 2005. Demographic and clinical characteristics, laboratory measurements, echocardiographic and treatment features, and in-hospital outcomes were retrospectively reviewed by using a standardized data collection form. Results One hundred and fifry-three consecutive patients were recruited. Mild, moderate and large pericardial effusion occurred in 61 （40%）, 52 （34%） and 40 （26%） patients, respectively. The most frequent etiologic diagnoses were tuberculous pericarditis （ n = 50, 33% ） , malignancy （ n = 36, 24% ） and idiopathic pericarditis （n = 35, 23% ）. Large effusions were more likely＇ associated with malignancy （P 〈 0. 01 ）. Compared to the initial 5 years （from 1996 to 2000） , the incidence of tuberculous effusion was decreased but neoplastic effusion increased significantly in the recent 5 ）,ears （from 2001 to 2005 ）. Forty-four patients underwent percardiocentesis （tuberculous in 23, neoplastic in 16, and others in 5） and 28 patients required pericardectomy （tuberculous in 11 and neoplastic in 17）. One patient with tuberculous and 3 patients with neoplastic pericardial effusion died during hospitalization. Conclusion Tuberculosis remains the major cause of pericardial effusion, but neoplastic pericardial effusions are on the rise. Pericardial drainage or pericardectomy are often required for symptomatic relief in those with malignancy-caused pericardial effusion.

Nationwide trends of hospital admissions for acute cholecystitis in the United States

Background and aims:Acute cholecystitis is a fairly common inpatient diagnosis among the gastrointestinal disorders.The aim of this study was to use a national database of US hospitals to evaluate the incidence and costs of hospital admissions associated with acute cholecystitis.Method:We analyzed the National Inpatient Sample Database(NIS)for all patients in which acute cholecystitis(ICD-9 codes:574.00,574.01,574.30,574.31,574.60,574.61 or 575.0)was the principal discharge diagnosis from 1997 to 2012.The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year.The statistical significance of the difference in the number of hospital discharges,lengths of stay and associated hospital costs over the study period was determined by using the Chi-square test for trends.Results:In 1997,there were 149661 hospital admissions with a principal discharge diagnosis of acute cholecystitis,which increased to 215995 in 2012(P<0.001).The mean length of stay for acute cholecystitis decreased by 17% between 1997 and 2012(i.e.from 4.7 days to 3.9 days);(P<0.05).During the same time period,however,mean hospital charges have increased by 195.4% from US$14608 per patient in 1997 to US$43152 per patient in 2012(P<0.001).Conclusion:The number of inpatient discharges related to acute cholecystitis has increased significantly in the United States over the last 16 years,along with a great increase in the associated hospital charges.However,there has been a gradual decline in the mean length of stay.Inpatient costs associated with acute cholecystitis contribute significantly to the total healthcare bill.Further research on cost-effective evaluation and management of acute cholecystitis is required.