案例背景: 数据显示,全国大型综合性医院医用耗材成本占医疗成本的20％左右,占患者就医总费用的40％～50％,医疗耗材管理已成为医院管理中不可缺失的重要环节.2017年4月,原国家卫生计生委发布《关于全面推开公立医院综合改革工作的通知》明确要求到2017年底试点城市公立医院百元医疗收入(不含药品收入)中消耗的卫生材料降到20元以下.

Objective: To investigate the dynamic changes of psychological distress in breast cancer patients after diagnosis, and determine the related factors of psychological distress. Methods: A longitudinal study design was used to evaluate the psychological distress, social support, and coping style at the time of diagnosis, and 1, 3, 6 months after diagnosis, to compared the difference and analyze the related factors of psychological distress. Results: The incidence of moderate or high psychological distress in patients with breast cancer was 63.9％ (T1), 78.2％ (T2), 69.4％ (T3), and 33.3％(T4), and the mean score was 4.08±1.59 (T1), 4.66±1.47 (T2), 4.40±1.99 (T3), 2.89±1.60 (T4), respectively. The related factors of psychological distress included time of diagnosis, age, education level, economic status, family history, social support and coping style. Conclusion: The psychological distress is popular in breast cancer patients, and the psychological distress level is dynamic. Psychological intervention should be strengthened to improve the patients' psychosocial status.

Objective:To investigate the occurrence of symptom group and their quality of life in patients with breast cancer,and to analyze the factors influencing the symptoms group.Methods:A total of 128 patients with breast cancer were selected as the subjects by using cross-sectional investigation and research methods,and investigation was conducted by using the General Information Questionnaire,Memorial Symptom Assessment Scale(MSAS),and the Function Assessment of Cancer Therapy-Breast (FACT-B).Results:There were four symptom groups in the patients with breast cancer in chemotherapy stage,including psychosomatic symptoms group,digestive tract symptom group,hormone-related symptom group and self-image disorder group.Quality of life scores were negatively correlated with symptom group scores.Age,marital status,educational level,family income,medical insurance,tumor stage,chemotherapy regimen,working condition,number of chemotherapy and other chronic diseases or not are factors affecting the symptom group.Conclusions:Breast cancer patients have a variety symptoms during chemotherapy,mutual coordination,strengthening.Medical staff should correctly understand the symptoms of groups,reduce the burden of patients with symptoms,improve the quality of life of patients.

It expounded the concept and assessment tools of symptom clus-ters;it expounded the symptoms clusters of breast cancer patients from two aspects of psychological and psychiatric symptoms clusters,physical symp-toms clusters;it expounded the influencing factors of symptoms clusters of breast cancer from demographic factors,disease and treatment related fac-tors and other relevant factors;it introduced the influence of symptoms clus-ters of breast cancer on prognosis and interventions.It put forward that in future researches symptom clusters should be clearly defined,symptom clus-ters in of symptom inclusion and exclusion criteria and the mechanism of symptom clusters should be defined.It suggested that clinical care workers should raise awareness of the symptom clusters,to give appropriate interven-tions during treatment and care,so as to mitigate the impact of the symp-toms clusters on the patients.