BACKGROUND:Stroke is one of the most serious illnesses worldwide and is the primary cause of acquired disability among adults. Post-stroke cognitive impairment (PSCI) is a complication of stroke that significantly impacts patients' daily activities and social functions. Therefore, developing a risk prediction model for PSCI is essential for identifying and preventing disease progression. OBJECTIVES:This study systematically reviewed and analyzed PSCI prediction models, identifying the associated risk factors. METHODS:We systematically retrieved literature from PubMed, Cochrane Library, Embase, and other sources. Two researchers independently extracted the literature and assessed the risk of bias using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and The Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS:A total of 20 articles describe the PSCI prediction model, with an incidence rate ranging from 8% to 75%. The area under the receiver operating characteristic curve (AUC) value for the development models ranged from 0.66 to 0.969, while the validation models ranged from 0.763 to 0.893. Age, diabetes, hypersensitive C-reactive protein (hs-CRP), hypertension, and homocysteine (hcy) were identified as the strongest predictors. CONCLUSION:In this systematic review, several PSCI prediction models demonstrate promising prediction performance, although they often lack external validation and exhibit high heterogeneity in some predictive factors. Therefore, we recommend that medical practitioners utilize a comprehensive set of predictive factors to screen for high-risk PSCI patients. Furthermore, future research should prioritize refining and validating existing models by incorporating novel variables and methodologies.

Background and Purpose Intrinsic capacity (IC) has been shown to have the greatest impact on an individual's health status and health trajectory and can independently predict adverse outcomes such as mortality and care dependency in older adults. However, the current understanding of adverse outcomes associated with IC is incomplete. Methods A scoping review of the literature from PubMed, Web of Science (WOS), The Cochrane Library, CINAHL, and Embase databases was conducted from January 2015 to March 2023 to identify articles related to the adverse outcomes associated with IC in older adults. Results 711 studies met screening criteria, and 25 studies met inclusion criteria. These studies reported a total of 17 adverse outcomes related to IC across four domains. (1) Adverse outcomes in the physiological function domains included frailty, pneumonia onset, memory impairment, polypharmacy, incontinence, and poor/fair self-rated health. (2) Clinical outcomes domains included IADL disability, ADL disability, mortality, falls, autonomy decline, and incident dependence. (3) The resource utilization domains included hospitalization, nursing home stays, polypharmacy healthcare costs, and emergency department visits. (4) The other domains mainly included poor quality of life. Conclusion It is evident that IC decline in older adults is associated with a broad spectrum of adverse outcomes spanning cognitive function, activity ability, sensory perception, physical and mental health and living standards. Future studies should further deepen the exploration of IC.

BACKGROUND:Many studies have explored the impact of body mass index (BMI) on stroke prognosis, yet findings remain inconsistent. AIMS:The aims of this study were to conduct a systematic review and meta-analyses to summarize the existing evidence on BMI and stroke outcomes. METHODS:PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, Wanfang Database, and VIP Database were systematically searched from inception to 1 January 2023. Cohort studies were included if they reported on a population of patients with stroke, evaluated BMI on stroke outcomes (mortality/recurrence/score of modified Rankin scale (mRs)), and reported original data. Data extraction and quality assessment were independently undertaken by two reviewers. Stata 16.0 software was used for meta-analysis. RESULTS:Thirty-two studies involving 330,353 patients (5 Chinese language articles) were included in the analysis. The proportion of underweight, overweight, and obese patients was 1.85%, 18.2%, and 15.6%, respectively. Compared with normal weight, being underweight was associated with an increased risk of mortality (relative risk (RR) = 1.78, 95% confidence interval (CI) = 1.60-1.96), poor functional outcomes defined as modified Rankin scale ⩾ 3 (RR = 1.33, 95% CI = 1.22-1.45), and stroke recurrence (RR = 1.19, 95% CI = 1.04-1.37). Being overweight but not obese was associated with reduced mortality (RR = 0.81, 95% CI = 0.74-0.89) and better functional outcomes (RR = 0.92, 95% CI = 0.89-0.96), but did not alter the risk of stroke recurrence (RR = 1.03, 95% CI = 0.90-1.17). Obesity was associated with lower risk of mortality (RR = 0.76, 95% CI = 0.72-0.81) and better functional outcomes (RR = 0.89, 95% CI = 0.84-0.94). CONCLUSIONS:Our findings indicate that in patients with stroke, being underweight is associated with an increased risk of mortality, poor functional outcomes, and stroke recurrence. In contrast, being overweight but not obese, or being obese, was associated with a decreased risk of mortality and better functional outcomes. This is consistent with the obesity paradox in stroke, whereby obesity increases stroke risk in the general population but is associated with improved outcome in patients suffering stroke.

INTRODUCTION:In 2015, the term 'intrinsic capacity' (IC) was proposed by the World Health Organisation to promote healthy aging. However, the factors associated with IC are still discrepant and uncertain.AIM:We aim to synthesise the factors connected with IC.METHODS:This scoping review followed the five-stage framework of Arksey and O'Malley and was reported using PRISMA-ScR guidelines.RESULTS:In all, 29 articles were included. IC of older adults is associated with demographic characteristics, socioeconomic factors, disease conditions, behavioural factors, and biomarkers. Age, sex, marital status, occupation status, education, income/wealth, chronic diseases, hypertension, diabetes, disability, smoking status, alcohol consumption, and physical activity were emerged as important factors related to the IC of older adults.CONCLUSIONS:This review shows that IC is related to multiple factors. Understanding these factors can provide the healthcare personnel with the theoretical basis for intervening and managing IC in older adults.RELEVANCE TO CLINICAL PRACTICE:The influencing factors identified in the review help to guide older adults to maintain their own intrinsic capacity, thereby promoting their health and well-being. The modifiable factors also provide evidence for healthcare personnel to develop targeted intervention strategies to delay IC decline.NO PATIENT OR PUBLIC CONTRIBUTION:As this is a scoping review, no patient or public contributions are required.

目的 比较腹腔镜先天性胆总管囊肿根治术中2种胆肠吻合方式的优劣,为临床选择不同术式提供理论依据.方法 回顾性分析兰州大学第二医院2016年7月-2022年4月收治的117例先天性胆总管囊肿患者,按手术方式分为Roux-en-Y吻合组(63例)与改良Warren吻合组(54例).2组患者均行腹腔镜下胆总管囊肿根治性切除术,肠-肠吻合方式有Roux-en-Y式肠-肠吻合及改良Warren式肠-肠吻合.比较2组患者手术效果、术后效果及术后并发症等指标.结果 2组患者手术时间、吻合时间、术后恢复排气排便时间、术后并发肠梗阻及反流性胆管炎方面差异均有统计学意义(P<0.05),而其余指标没有显示明显差异(P>0.05).结论 改良Warren吻合术较Roux-en-Y吻合术,具有手术时间短、吻合快、术后肠功能恢复快、防反流效果好等优点,且操作简便,不切断肠管,保证肠管电生理活动的连续性,适合在基层医院推广.

Background In 2013, the Shanghai Hospital Development Center issued a policy to advocate public hospitals to report their information about costs on diseases. The objective was to evaluate the impact of interhospital disclosure of costs on diseases on medical costs and compare costs per case following information disclosure between hospitals of different rankings. Methods The study uses the hospital-level performance report issued by Shanghai Hospital Development Center in the fourth quarter of 2013, which covers quarterly aggregated hospital-level discharge data from 14 tertiary public hospitals participating in thyroid malignant tumors and colorectal malignant tumors information disclosure from the first quarter of 2012 to the third quarter of 2020. An interrupted time series model with segmented regression analysis is employed to examine changes in quarterly trends with respect to costs per case and length of stay before and after information disclosure. We identified high- and low-cost hospitals by ranking them on a costs per case basis per disease group. Results This research identified significant differences in cost changes for thyroid malignant tumors and colorectal malignant tumors between hospitals after disclosing information. A hospital’s discharge costs per case for thyroid malignant tumors increased significantly among top-cost hospitals (1629.251 RMB, P = 0.019), while decreased for thyroid and colorectal malignant tumors among low-cost hospitals (-1504.189 RMB, P = 0.003; -6511.650 RMB, P = 0.024, respectively). Conclusion Our findings indicate that information disclosure of costs on diseases results in changes in discharge costs per case. And low-cost hospitals continued to maintain their leading edge, whereas the high-cost hospitals changed their position in the industry by reducing discharge costs per case after information disclosure.

Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted. This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients’ outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.

BackgroundIn 2018, an innovative case-based payment scheme called Diagnosis-Intervention Packet (DIP) was piloted in a large developed city in southern China. This study aimed to investigate the impact of the new payment method on total medical expenditure per case, length of stay (LOS), and in-hospital mortality rate across different hospitals.MethodsWe used the de-identified patient-level discharge data of hospitalized patients from 2016 to 2019 in our study city. The interrupted time series model was used to examine the impact of the DIP payment reform on inflation-adjusted total expenditure per case, LOS, and in-hospital mortality rate across different hospitals, which were stratified into different hospital ownerships (public and private) and hospital levels (tertiary, secondary, and primary).ResultsWe included 2.08 million and 2.98 million discharge cases of insured patients before and after the DIP payment reform, respectively. The DIP payment reform resulted in a significant increase of the monthly trend of adjusted total expenditure per case in public (1.1%, P = 0.000), tertiary (0.6%, P = 0.000), secondary (0.4%, P = 0.047) and primary hospitals (0.9%, P = 0.039). The monthly trend of LOS increased significantly in public (0.022 days, P = 0.041) and primary (0.235 days, P = 0.032) hospitals. The monthly trend of in-hospital mortality rate decreased significantly in private (0.083 percentage points, P = 0.002) and secondary (0.037 percentage points, P = 0.002) hospitals.ConclusionsWe conclude that implementing the DIP payment reform yields inconsistent consequences across different hospitals. DIP reform encouraged public hospitals and high-level hospitals to treat patients with higher illness severities and requiring high treatment intensity, resulting in a significant increase in total expenditure per case. The inconsistencies between public and private hospitals may be attributed to their different baseline levels prior to the reform and their different responses to the incentives created by the reform.

目的:总结加拿大卫生技术评估(HTA)应用于医保决策的经验,分析HTA在医保决策应用中存在的主要问题,为我国在医保决策中更好地发挥HTA的作用提供参考和借鉴.方法:查阅国内外相关文献,系统梳理了加拿大卫生技术评估的相关文献,提取了加拿大药物和卫生技术局和国际卫生技术评估机构官方网站上的相关信息.结果:加拿大HTA在国家、省级、机构多个层面设立并同时开展,证据生产及时、透明、规范.我国尚存在缺乏公开透明的药品评审机制,评审过程的效率低下,以及缺乏规范的医用耗材评价指标等问题.结论:借鉴加拿大HTA评估过程的公开透明性、HTA指南的严谨、科学性以及HTA体系的统一性等经验,我国仍需在基本药物评审中,确保利益相关者的透明度,制定指南来保证HTA质量评价标准,并形成互联互通地HTA全国网络体系,实现信息资源共享.

Aims Glucose-dependent insulinotropic polypeptide (GIP) confers a variety of metabolic benefits in type 2 diabetes mellitus (T2DM). This meta-analysis was conducted to investigate the impact of dipeptidyl peptidase 4 (DPP4) inhibitors on GIP levels in T2DM patients. Methods Medline (PubMed), CENTER (Cochrane Library), and Embase (Ovid) were searched and randomized controlled trials (RCTs) evaluating the impact of DPP4 inhibitors on fasting and postprandial GIP levels were obtained. For postprandial GIP, only studies with the data of GIP changes reported as the total area under the curve (AUC GIP ) using a meal or oral glucose tolerance test were included. A random-effects model was used for data pooling after incorporating heterogeneity. Results Overall, 14 RCTs with 541 T2DM patients were included. Compared to placebo/no treatment, the use of DPP4 inhibitors significantly increased the fasting GIP level (standard mean difference [SMD]: 0.77, 95% confidence interval [CI]: 0.48–1.05, P <0.001; I 2 = 52%) and postprandial AUC GIP (SMD: 1.33, 95% CI: 1.02–1.64, P <0.001; I 2 = 65%). Influence analysis by excluding one dataset at a time showed consistent results. Sensitivity analyses only including studies with radioimmunoassay showed also consistent results (fasting GIP: SMD: 0.75, 95% CI: 0.51–1.00, P<0.001; I 2 = 0%; and postprandial AUC GIP : SMD: 1.48, 95% CI: 1.18–1.78, P <0.001; I 2 = 54%). Further subgroup analyses demonstrated that the influence of DPP4 inhibitors on fasting and postprandial GIP levels in T2DM patients was not significantly changed by study characteristics such as study design, patient mean age, baseline glycated hemoglobin (HbA1c) concentration, body mass index (BMI), background treatment, treatment duration, or method for postprandial GIP measurement (all P for subgroup effects <0.05). Conclusion The use of DPP4 inhibitors effectively increases the fasting and postprandial GIP concentrations in T2DM patients. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42022356716.

The aim of this meta-analysis was to comprehensively evaluate the effectiveness of Diagnosis-related group (DRG) based payment on inpatient quality of care. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science from their inception to December 30, 2022. Included studies reported associations between DRGs-based payment and length of stay (LOS), re-admission within 30 days and mortality. Two reviewers screened the studies independently, extracted data of interest and assessed the risk of bias of eligible studies. Stata 13.0 was used in the meta-analysis. A total of 29 studies with 36 214 219 enrolled patients were analyzed. Meta-analysis showed that DRG-based payment was effective in LOS decrease (pooled effect: SMD = −0.25, 95% CI = −0.37 to −0.12, Z = 3.81, P < .001), but showed no significant overall effect in re-admission within 30 days (RR = 0.79, 95% CI = 0.62-1.01, Z = 1.89, P = .058) and mortality (RR = 0.91, 95% CI = 0.72-1.15, Z = 0.82, P = .411). DRG-based payment demonstrated statistically significant superiority over cost-based payment in terms of LOS reduction. However, owing to limitations in the quantity and quality of the included studies, an adequately powered study is necessary to consolidate these findings.

Abstract Context A patient classification-based payment system called diagnosis-intervention packet (DIP) was piloted in a large city in southeast China in 2018. Objective This study evaluates the impact of DIP payment reform on total costs, out-of-pocket (OOP) payments, length of stay (LOS), and quality of care in hospitalised patients of different age. Methods An interrupted time series model was employed to examine the monthly trend changes of outcome variables before and after the DIP reform in adult patients, who were stratified into a younger (18–64 years) and an older group (≥ 65 years), further stratified into young-old (65–79 years) and oldest-old (≥ 80 years) groups. Results The adjusted monthly trend of costs per case significantly increased in the older adults (0.5%, P = 0.002) and oldest-old group (0.6%, P = 0.015). The adjusted monthly trend of average LOS decreased in the younger and young-old groups (monthly slope change: -0.058 days, P = 0.035; -0.025 days, P = 0.024, respectively), and increased in the oldest-old group (monthly slope change: 0.107 days, P = 0.030) significantly. The changes of adjusted monthly trends of in-hospital mortality rate were not significant in all age groups. Conclusion Implementation of the DIP payment reform associated with increase in total costs per case in the older and oldest-old groups, and reduction in LOS in the younger and young-old groups without deteriorating quality of care.

目的 分析上海市定点医疗机构病案首页数据收集和质量控制(以下简称"质控")情况,提出持续改进措施,为提高病案首页数据质量提供参考,为推进医疗保险支付方式改革提供保证.方法 梳理国家与上海市相关政策文件、查阅国内外相关文献、访谈病案质控专家,并对2016—2020年上海市医疗保险事务管理中心平台所获取的三级定点医疗机构病案首页大数据基于完整性、规范性、合理性进行对比分析.结果 病案首页122个单项指标中错误问题逐步下降,其中入院和出院时间的填写逐渐趋于规范,离院方式缺失问题显著下降,但次要诊断缺失现象严重.结论 上海市定点医疗机构病案首页数据总体质量较好,提升编码员水平、确保信息导入的准确性、规范编码规则、完善病案质控奖惩机制是改进首页数据质量的有效措施.

目的 对新疫苗纳入国家免疫规划涉及的决策要素相关的文献进行系统梳理.方法 通过8个中英文文献数据库检索国内外相关文献,归纳各国进行免疫决策时的评价维度及核心指标等.结果 纳入41篇文献,内容以案例研究为主,实证研究较少.各文献基本遵循疾病、疫苗、卫生系统的评价框架,但有不同程度的延伸.疾病死亡率、疫苗安全性及有效性、成本效果评价等为高频评价指标.本研究梳理出基于"疾病-疫苗-能力-效益评价"的4维度13个要素43个指标的评价体系.结论 国内外关于疫苗决策的研究处于发展阶段,我国应增强疫苗纳入免疫规划的评价框架的可操作性及广度,注重本土的流行病学、卫生经济学数据收集,进一步发挥国家免疫规划技术工作组在疫苗循证决策中的作用.

目的 梳理上海市医疗保险(以下简称"医保")支付方式的演变过程及改革背景,理解其决策逻辑.方法 结合多源流分析与实施背景分析框架,分析上海医保支付改革形成的原因及特点.结果 各级政府均高度重视医保支付方式改革,为上海医保支付改革提供了政治支持.上海医保改革始终以政策问题为导向,早期面临基金失衡后采取总额预算管理,医院积极性不高便采取结余留用,基金效率低下而进行按疾病诊断相关分组/病种分值付费改革.上海"海派文化"中的"包容性"表现为"小步走、不停留"的改革理念,"精致性"表现为循证决策和数字化赋能的改革策略;上海较高的经济水平、较低的医保基金失衡风险,使其更多关注医院和患者利益,注重医疗服务质量,强调改革的连续性与一致性.结论 上海医保支付改革的演变是外部政策、当前问题、文化与经济环境等因素的综合产物.

Objective:To explore the influence of driving pressure-guided individualized positive end-expiratory pressure (PEEP) titration on lung protection and postoperative atelectasis in children undergoing laparoscopic surgery.Methods:From June 2021 to October 2021, a total of 46 children undergoing laparoscopy at Second Hospital of Lanzhou University were selected as research subjects.They were divided randomly into two groups of fixed PEEP and driving pressure-guided individualized PEEP ( n=23 each). Fixed PEEP group: 5 cmH 2O (1 cmH 2O=0.098 kPa) PEEP was set until end of operation.Driving pressure-guided individualized PEEP group: PEEP started from 2 cmH 2O with an increment of 1 cmH 2O and each PEEP level was maintained for 10 breathing cycles until the lowest driving pressure.There was a hourly repetition.Plateau pressure (Pplat), PEEP, driving pressure, lung dynamic compliance, mean arterial pressure (MAP) and heart rate (HR) were recorded at 5 min after tracheal intubation (T 1), 5 min after pneumoperitoneum (T 2), 4 min after PEEP (T 3) and end of operation (T 4); Lung Ultrasound Score (LUS) at T 1, /T 4/T 5 (out of PACU) and intraoperative pneumoperitoneum time, pneumoperitoneum pressure, mechanical ventilation duration and operative duration were analyzed. Results:As compared with T 1, pulmonary dynamic compliance of two groups declined and driving pressure spiked obviously at T 2.And the difference was statistically significant ( P<0.05). As compared with T 2, lung dynamic compliance and driving pressure of two groups improved markedly at T 3 and T 4 ( P<0.05). As compared with fixed PEEP group, driving pressure-guided individualized PEEP group offered more advantages of improving lung dynamic compliance and reducing driving pressure and lung ultrasound score ( P<0.05); no inter-group statistical difference existed in HR/MAP changes at different timepoints. Conclusion:For ASA Ⅰ-Ⅱ children aged 1-6 years undergoing laparoscopy, driving pressure-guided individualized PEEP ventilation strategy can significantly improve lung dynamic compliance and reduce driving pressure and postoperative lung ultrasound scores.

蓝色橡皮疱痣综合征为一种罕见综合征,是发生在皮肤和胃肠道,以及肝脏、肺、肾、骨骼肌、关节等器官的多发性血管畸形,常伴有消化道出血、隐性失血、贫血等,多见于婴幼儿和青壮年,血管瘤的数目和大小随着年龄的增长而增大、增多.蓝色橡皮疱痣综合征发病率较低,容易被误诊、漏诊.本研究通过1例小儿蓝色橡皮疱痣综合征的诊治并复习相关文献,以提高临床医师对蓝色橡皮疱痣综合征的进一步认识.

In clinical practice, intestinal autologous diseases, ailments and organ transplants can cause severe congestive damage to the intestinal tract. However, after the etiological factor is gotten rid of and blood flow is free without any hinderance, further damage to the intestinal wall often occurs, causing other related organ dysfunctions. This ultimately results in intestinal congestion reperfusion injury (ICRI). When the structure and function of the intestine are destroyed, bacteria, metabolites and endotoxins in the intestinal tract perfuse and enter the portal vein through the already compromised intestinal mucosa, to the other organs via the liver. Nevertheless, this gives rise to further aggravation of the injury, and reperfusion injury syndrome occurs. ICRI is a very common complication encountered by clinicians, and its harm is more severe and serious as compared with that caused by ischemia-reperfusion. Quite a few number of studies on ICRI have been reported to date. The exact mechanism of the injury is still idiopathic, and effective treatment strategies are still limited. Based on recent studies, this article is aimed at reviewing the destruction, damage mechanisms resulting from ICRI to the intestinal anatomical sites and distant organs. It is geared towards providing new ideas for the prevention and therapeutic approaches of ICRI.

With the urgent need to regulate provider behaviors, China developed a novel patient classification with global budget payment system, expecting to achieve both easy implementation and cost containment. The new system, called "diagnosis-intervention packet (DIP)" payment, is based on a deterministic patient classification approach, which groups patients according to the combination of principal diagnosis ICD-10 (International Classification of Diseases, 10th Revision) codes and procedure ICD-9-CM3 (International Classification of Diseases, 9th Revision, Clinical Modification) codes and links each group to relative historical costs market-wide. This study investigated the impact of the DIP-based payment on inpatient costs, length of stay, and quality of care in the largest DIP pilot city of China. In 2018, the city changed from the "fixed rate per admission with a cap on annual total compensation" policy to DIP with global budget for all insured inpatients. A difference-in-differences approach was employed to identify changes in outcome variables before and after the DIP policy among insured relative to uninsured patients. We found an average of 8.5% (p = 0.000) increase in inpatient costs per case (as intended), trivial changes in length of stay, and a 3.6% (p = 0.046) reduction in postoperative complication rate in response to DIP adoption among patients with high severity. Our findings suggested that the DIP-based payment helped regulate provider behaviors when treating high-risk patients. And the new payment has the potential for rapid rollout in resource-limited areas where lack a uniform coding practice or high-quality historical data.