目的 分析比较总额控制下的病种分值付费和单病种付费支付方式的应用效果。方法 回顾性分析2015年—2018年总额控制下病种分值付费和单病种付费模式下的平均住院费用、医保基金支出以及医保基金收入等基本情况,比对分析总额控制下单病种付费模式下与病种分值付费模式的总体运行效率。结果 2015年—2018年总额控制下病种分值付费情况存在轻微波动,但不出现明显上涨现象,稳定于9 000元左右的水平,并且总额控制下病种分值付费的医保基金结余率处于17%的水平,同时具有稳定的医保基金支出与医保基金收入水平。相比较总额控制下病种分值付费,单病种付费模式下的平均住院费用更高,且呈现出逐年增加的发展趋势;相比较2015年的平均住院费用,2018年平均住院费用高出500元。2015年—2018年总额控制下单病种付费的医保基金结余率具有较大波动,表示医保基金支出与医保基金收入水平不稳定。结论 总额控制下的病种分值付费模式具有明显的医疗费用以及医保基金费用支出控制效果,但同时也具有较大的基础投入水平以及较高管理成本等缺陷端,总额控制下的单病种付费模式具有方便管理的优势,但是在费用控制、病种涵盖等方面不如病种分值付费,总额控制下的单病种付费与病种分值付费各具优势和不足,需要依据区域情况,取长补短,因地制宜以及择优而用,确保健全医保支付方式。

Objective To analyze the application effect of the payment of disease type and the payment of single disease payment under the control of total amount. Methods A retrospective analysis of the basic hospitalization expenses, medical insurance fund expenditures and medical insurance fund income under the control of the total value of the disease and the single-income payment model under the total control from 2015 to 2018 were taken, and to have comparative analysis of the total control of the single disease overall operational efficiency of the payment model with the payment model. Results There was a slight fluctuation in the payment of disease value under the control of total amount from 2015 to 2018, but there was no obvious increase, which was stable at around 9 000 yuan, and the balance of medical insurance fund paid for the disease value under the total control was at 17% level and has both stable medical insurance fund expenditure and medical insurance fund income level. Compared with the total score control under the total amount control, the average hospitalization cost under the single disease payment mode was higher, and showed a trend of increasing year by year; compared with the average hospitalization cost in 2015, the average hospitalization cost in 2018 was higher, out of 500 yuan. From 2015 to 2018, the balance of the medical insurance fund paid for the control of the single disease had a large fluctuation, indicating that the medical insurance fund expenditure and the medical insurance fund income level were unstable. Conclusion The disease-based payment model under total control has obvious control effect of medical expenses and medical insurance fund expenses, but it also has a large basic input level and high management cost and other defects. The payment model has the advantage of convenient management, but it is not as good as the cost control and disease coverage, and the single disease payment and the disease value payment under the total control have their own advantages and disadvantages, which need to be based on the regional situation. We need to make use of the strengths and weaknesses, adapt to local conditions and choose the best, to ensure a sound medical insurance payment method.

目的 观察控制性减压术对重型颅脑损伤患者神经功能、颅内压及预后的影响。方法 将我院2016年3月—2017年2月治疗的94例重型颅脑损伤患者作为研究对象,入选者均依据随机数表法分为两组,各47例。对照组实施大骨瓣减压术,观察组实施控制性减压术。观察手术前后两组神经功能、颅内压及预后等。结果 术前2组神经行为认知状态检查表(NCSE)评分、颅内压对比,差异无统计学意义(P＞0.05);术后观察组NCSE评分高于对照组,颅内压低于对照组,差异有统计学意义(P＜0.05);2组预后等级相比,观察组优于对照组,差异有统计学意义(P＜0.05)。结论 将控制性减压术应用于重型颅脑损伤患者中降颅内压效果良好,可恢复受损神经功能,提升患者康复效果,改善预后。

目的 探讨糖尿病自我管理支持对社区2型糖尿病患者生化指标控制的影响。方法 2015年1月1日前已确诊为2型糖尿病患者,随机分为对照组和干预组,对照组303例按照广州市基本公共卫生服务包要求进行定期随访、体检及健康教育,干预组130例进行自我管理支持干预,观察两组生化指标的变化。结果 与对照组比较,自我管理支持组的空腹血糖、总胆固醇、甘油三酯、谷丙转氨酶、尿酸控制效果较好,差异有统计学意义(P<0.05)。结论 自我管理支持对社区2型糖尿病患者生化指标控制的效果良好,值得推广。

Objective To evaluate the control effect of biochemical criterion in patients with type 2 diabetes under diabetes self-management support in community. Methods 130 patients with type 2 diabetes in community from January 2015 to December 2015 accepting the diabetes self-management support were chosen as research group, another 303 diabetic patients without the diabetes self-management support were set as control group, the effect of management was analyzed. Results There was statistically significant difference (P<0.05) in biochemical criterion including blood sugar (BS), total cholesterol (TC), triglyceride (TG), alanine aminotransferase (ALT) and uric acid (UA). Conclusion Control effect of biochemical criterion was good in the diabetes self- management support for people with type 2 diabetes, which was worth to be popularized.

目的 探讨术中控制性减压对儿童重型颅脑损伤的治疗作用。方法 122例儿童重型颅脑损伤需要开颅手术减压患者,术中随机分成控制性减压手术研究组(60例)和常规手术治疗对照组(62例)进行治疗,观察两组患者术后脑梗死的发生率及预后。结果 研究组术后脑梗塞发生率为6.7％(4例),低于对照组的17.7％(11例)(P<0.05);术后6个月采用GOS标准进行预后判定,治疗组不良预后(重残、植物状态、死亡)有9例占15.0%,低于对照组的23例(37.1%)(P<0.05)。结论 术中采用控制性减压能减少儿童重型颅脑损伤患者术后脑梗塞的发生率及明显改善患者的预后。

Objective To investigate the clinical efficacy of intraoperative controlling decompression in treating of severe craniocerebral injuries in children. Methods 122 cases of severe craniocerebral injuries in children who needed surgical decompression by craniotomy were randomly divided into control decompression surgical group(60 cases)and conventional surgical group(62 cases).The incidence of postoperative cerebral infarction and the outcome according to GOS scores after 6 months were observed in two groups. Results The incidence of postoperative cerebral infarction was 6.7% in controlling decompression surgical group and 17.7% in conventional surgical group. The differences between two groups were statistical significant(P<0.05); The all poor prognosis patients(severely disabled, vegetative state and death) were 9 cases in controlling decompression surgical group and 23 cases in conventional surgical group. The differences between two groups were statistical significant(P<0.05). Conclusion Intraoperative controlling decompression can significantly reduced the incidence of postoperative cerebral infarction and improved the poor prognosis patients of severe craniocerebral injuries in children.

        当前公立医院面临的内外部环境十分复杂，各种不确定因素影响公立医院健康运营。引入内部控制理念，建立健全采购与付款环节是必要的。文章对目前公立医院采购与付款业务管理中存在的问题进行分析，从改善内部环境建设、建立起有效的风险评估体系、加强采购与付款业务控制活动、巩固监督检查体系、加强信息沟通建设五个方面提出相应策略，优化公立医院采购与付款环节内部控制，从而减少风险带来的不确定性，保障医院运行的效率效益，助力医院高质量持续发展。

      Public hospitals are currently navigating a complex internal and external environment，where  various uncertainties can impact their effective operation．The introduction of internal control concepts and the establishment of  robust procurement and payment processes are essential．This paper analyzes the issues present in the management of procurement and payment operations within public hospitals．It proposes strategies across five key areas：enhancing the internal environment，establishing an effective risk assessment framework，strengthening control activities in procurement and payment processes，reinforcing the supervision and inspection system，and improving information communication．These  strategies aim to optimize internal controls，reduce uncertainty associated with risks，ensure operational efficiency，and support the sustainable，high-quality development of public hospitals．

       传统的结肠镜检查质量评估方式具有主观性强、费时费力等缺点。近年来，人工智能（AI）技术在结肠镜检查质量控制方面展现出客观性、即时性、全面性等优势，具有广阔的应用前景。文章全面探讨了AI在结肠镜检查质量控制中的多个应用场景，包括评估肠道准备质量、记录退镜时间、息肉识别和分类、预测早期结直肠癌浸润深度等方面，并通过具体的研究案例和数据分析了AI技术的有效性和优势。AI技术有望在提升结肠镜检查质量、促进结直肠癌的早诊早治方面发挥更加重要的作用，但面对技术、伦理及法规等多方面的挑战，未来需要持续努力，不断优化算法，加强跨学科合作，推动AI技术在医疗领域的健康、快速发展。

     Traditional colonoscopy quality assessment methods have strong subjectivity and are time-consuming．In recent years，artificial intelligence technology has shown objectivity，timeliness，and comprehensiveness in colonoscopy quality control，with broad application prospects．This article comprehensively explores multiple application scenarios of AI in colonoscopy quality control，encompassing assessments of bowel preparation quality，recording of withdrawal times，polyp identification and classification，and prediction of early colorectal cancer invasion depth．Through specific research cases and data analysis，the effectiveness and advantages of AI technology are elucidated．AI technology is expected to play an increasingly significant  role in enhancing the quality of colonoscopy and promoting early diagnosis and treatment of colorectal cancer．However，facing challenges from technology，ethics，regulations，and other aspects，continued efforts are  needed in the future to continuously optimize algorithms，strengthen interdisciplinary collaboration，and promote the healthy and rapid development of AI technology in the medical field．

      目的   探讨在冠状动脉造影术后患者中应用风险防范护理干预对血管并发症的控制效果。方法   选择2022年1月—2023年6月于我院接受治疗的85例冠状动脉造影术后患者。按照随机数字表法分组，其中对照组42例给予常规护理干预，观察组43例给予风险防范护理干预，比较两组干预前后的心理状态、治疗依从性、血管并发症。结果   干预后，观察组正性情绪（PA）评分高于对照组PA评分（t=3.821，P＜0.001），观察组负性情绪（NA）评分低于对照组NA评分（t=5.380，P＜0.001）。与对照组比，观察组治疗依从性更好（Z=2.268，P=0.023）。观察组血管并发症总发生率低于对照组（9.30% vs 30.95%，χ ² =6.224，P=0.013）。结论   采用风险防范护理干预，能够改善冠状动脉造影术后患者的心理状态，提高治疗依从性，并降低血管并发症总发生率。

       Objective  To explore the effect of  risk prevention nursing intervention on controlling vascular complications in patients after coronary angiography．Methods  Eighty-five patients after coronary angiography in our hospital were selected from January 2022 to June 2023．They were grouped according to the random number table．And 42 cases were divided into the control group for routine nursing intervention，and 43 cases in the observation group were given risk prevention nursing intervention．Psychological status，treatment compliance and vascular complications of the two groups were observed．Results  After the intervention，the postive affect score of the observation group was higher than that of the control group（t=3.821，P＜0.001），and the negative affect score of the observation group（21.25±3.31）was lower than the score of the control group（25.35±3.70）（t=5.380，P＜0.001）．Compared with the control group the compliance of observation group was higher（Z=2.268，P=0.023）．The overall incidence of vascular complications in the observation group was lower than that in the control group（9.30% vs 30.95%，χ2=6.224，P=0.013）．Conclusions  Risk prevention nursing intervention can improve the psychological status of patients after coronary angiography，improve treatment compliance，and reduce the overall incidence of vascular complications．

       目的   分析共同照护模式联合回授法健康教育在2型糖尿病患者中的应用效果。方法   将2023年1月—2023年12月广州市第一人民医院收治 的114例2型糖尿病患者作为此次研究对象，分为研究组（n=57）和对照组（n=57），对照组患者给予常规护理结合健康教育，研究组患者给予共同照护模式联合回授法健康教育，评估两组在培训前及培训后1、3个月的血糖控制情况及糖尿病患者自我管理行为量表（SDSCA）等指标。结果   培训1、3个月后，两组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白均低于培训前，且研究组空腹血糖、餐后2 h血糖、糖化血红蛋白水平均低于对照组（P＜0.05）。培训1、3个月后，两组患者的糖尿病患者SDSCA评分高于培训前，且研究组各项评分高于对照组（P＜0.05）。重复测量方差分析表明随着时间的推移，患者的血糖控制状况随着不同护理培训策略而得到改善。结论   使用共同照护模式联合回授法健康教育对2型糖尿病患者可以更显著改善血糖控制水平、提高自我管理效能。

       Objective  To analyze the effect of co-care mode and feedback  health education on  patients with type  2 diabetes．Methods  From January 2023 to December 2023，114 patients with type 2 diabetes admitted to Guangzhou First People’s Hospital were divided into two groups：experimental group（n=57）and control group（n=57）．Patients in control group were given routine nursing combined with health education．Patients in study group were given co-care and feedback health education．Before intervention and 1，3 months after intervention，patients’ blood glucose control and diabetic self-management behavior scale（SDSCA）were evaluated．Results  After 1 and 3 months of intervention，the fasting blood glucose，2-hour blood glucose and HbA1c of the two groups were significantly lower than those before intervention，and the fasting blood glucose，2-hour blood glucose and HbA1c of the experimental group were significantly lower than those of the control group（P＜0.05）．After 1 month and 3 months of intervention，the SDSCA scores of diabetic patients in both groups were higher than those before intervention，and the scores of study group were higher than those of control group（P＜0.05）．Repeated measures analysis of variance indicating that glycemic control improved significantly over time with different nursing training strategies．Conclusions  Co-care mode and feedback health education can significantly improve blood glucose control and self-management efficiency in patients with type 2 diabetes．