Objective To analyze the nursing demands of stroke patients with aphasia during the rehabilitation period based on the KANO model. Methods A questionnaire was designed by combining the KANO model with the Delphi expert consultation method. A total of 200 stroke patients with aphasia who were in the rehabilitation period in the Department of Neurology of a municipal people's hospital from January 2023 to January 2024 were randomly selected as the research subjects. The attributes of patients' nursing demands were determined through KANO model demand attribute classification, better-worse coefficient analysis and two-dimensional matrix analysis. The most sensitive and need-to-improve elements were identified via demand element screening. Results After the classification of demand attributes by the KANO model, combined with better-worse coefficient analysis and two-dimensional matrix analysis, the index classification results showed that the expected demands accounted for 50.00% (8/16), attractive demands accounted for 18.75% (3/16), and must-be demands accounted for 31.25% (5/15). Through the KANO model factor selection line, the top 5 key factors affecting the nursing demands of stroke patients with aphasia during the rehabilitation period were screened out, which were post-discharge speech medical referral service, breaking the daily routine, relatives' companionship, adjustment of negative psychological state, and doctor-patient communication channels. Conclusion For the nursing service of stroke patients with aphasia during the rehabilitation period, on the basis of meeting the must-be attributes, efforts should be made to improve the expected attributes and strive to satisfy the attractive attributes. Hospitals can invest resources in these items to provide better medical services for patients.

Objective To evaluate the research status of chronic disease comorbidity trajectories, and systematically sort out the influence mechanisms of health behavioral factors on the development trajectories of chronic diseases and their comorbidities. Methods By retrieving relevant literatures published from 2000 to 2024 in databases such as CNKI, PubMed and Web of Science, we systematically sorted out the methodological progress of chronic disease comorbidity trajectory modeling at home and abroad, and focused on analyzing the impacts of health behavioral factors (smoking, physical activity, sleep quality, dietary patterns, and body weight management) on the accumulation of chronic diseases and the evolution of comorbidity trajectories. We comprehensively used evidence from cross-sectional studies and longitudinal cohort studies to explore the dynamic process of transition from single disease to multi-morbidity. Results Trajectory modeling studies showed that 4–6 types of comorbidity progression trajectories with significant heterogeneity could be identified based on advanced methods such as latent class growth models. Health behavior interventions had significant effects on the prevention and control of chronic disease comorbidities. Regular physical activity could serve as a primary prevention measure for 35 types of chronic diseases, significantly reducing the cumulative risk of chronic diseases; smoking cessation interventions effectively blocked the progression of cancers and cardiovascular diseases; adequate sleep (≥7 h/night) and high-quality dietary patterns were both significantly associated with a reduced risk of an increase in the number of chronic diseases. Longitudinal cohort studies further confirmed that individuals with low-level physical activity had a 2–3 times higher risk of being classified into the rapid progression trajectory group, and smoking combined with high-risk drinking significantly increased the probability of transitioning to a high-risk comorbidity state. Conclusion Health behaviors play a crucial regulatory role in the whole-course evolution of chronic diseases. Future prevention and control strategies should shift from single-behavior interventions to dynamic management of aggregated behavior patterns, so as to promote the construction of an individualized prevention and intervention system oriented by comorbidity trajectories.

Against the backdrop of smart hospital construction, medical data governance serves as a crucial underpinning for improving hospital management efficiency and advancing digital transformation. To address the challenges existing in data governance of public hospitals, including multi-source heterogeneous data, decentralized storage, insufficient standardization, inconsistent statistical calibers and low data utilization efficiency, a full-process governance system covering organizational, institutional and technical dimensions is established. A special leading group for data governance has been set up, relevant data management regulations and communication mechanisms improved. Combined with a multimodal big data platform, data cleansing and post-structural processing, construction of standardized coding systems as well as deployment of data security technologies are implemented. The system effectively eliminates information silos, improves data quality and sharing efficiency, and delivers high-quality data support for clinical decision-making, operational optimization and scientific research innovation.

Objective To understand the current status and charging models of internet medical service fees in China. Methods From September to October 2023, an online questionnaire survey was conducted on the medical service charging status of internet hospitals established based on physical medical institutions in 8 provinces (autonomous regions, municipalities directly under the Central Government) across China. Descriptive analysis was used to analyze the charging basis and standards of internet hospitals. Results Among the 54 surveyed hospitals, the charging of internet medical services was mainly based on the form of consultation, hospital grade and doctor's professional rank. The online follow-up consultation fee of 80.5% of the hospitals was 10 yuan or less per case. The fees for graphic, voice and video health consultations provided by doctors of different professional ranks in hospitals of different grades were mainly below 20 yuan. 44.4% of the hospitals supported online medical insurance payment. Conclusion It is necessary to establish a multi-level and composite pricing mechanism for internet medical services in China, improve the supervision of internet medical service charges, promote online medical insurance payment, and ensure the high-quality and sustainable development of internet medical services.

Objective To analyze the risk factors and protective factors for the reversal from mild cognitive impairment to normal cognition in patients with early Alzheimer's disease, and to construct a nomogram prediction model accordingly. Methods A total of 248 patients with early Alzheimer's disease admitted to Ganzhou Third People's Hospital from January 2018 to January 2020 were prospectively enrolled and followed up for 24 months. Baseline data and clinical diagnostic data were recorded. Patients who progressed from normal cognition to mild cognitive impairment or from mild cognitive impairment to Alzheimer's disease were divided into the non-reversal group; patients with reversal from mild cognitive impairment to normal cognition were divided into the reversal group. Univariate analysis and multivariate Logistic regression analysis were adopted to screen the risk factors and protective factors affecting cognitive function reversal. The nomogram model was constructed based on independent influencing factors. The area under ROC curve (AUC) was used to evaluate the predictive efficiency, calibration curve to assess calibration degree, and DCA decision curve to evaluate clinical benefit. ROC curve and calibration curve were used for internal validation. Meanwhile, 106 patients with early Alzheimer's disease admitted to the hospital from February 2020 to February 2021 were selected as the validation set for external validation. Results Among the 248 included patients, 182 cases were in the non-reversal group (39 cases progressed from normal cognition to mild cognitive impairment, 143 cases progressed from mild cognitive impairment to Alzheimer's disease), and 66 cases were in the reversal group, with a cognitive function reversal rate of 26.61%. Multivariate Logistic regression showed that marital status (single), BMI grade (obesity), APOE4 gene carriage, sleep disorders and low Tau protein level were independent risk factors for cognitive function reversal in patients with early Alzheimer's disease (P<0.05). Education level (junior high school, senior high school and above), cognitive intervention and high MMSE score were protective factors (P<0.05). The AUC of the model was 0.948 (95%CI:0.922~0.973), with sensitivity of 97.0%, specificity of 80.8%, maximum Youden index of 0.778 and optimal cut-off value of 0.166, which presented good discrimination. Internal validation showed that the trend of actual values was basically consistent with predicted values in the calibration curve, with good accuracy. The decision curve indicated that the model could provide significant clinical net benefit. External validation with the validation set proved that the corresponding calibration curve was close to the standard curve, suggesting favorable calibration consistency. Conclusion The established nomogram model can effectively identify the risk factors of cognitive function reversal in patients with early Alzheimer's disease. It can help clinicians formulate targeted intervention measures, promote the reversal of cognitive function, and reduce the risk of disease progression.

Objective To explore the influencing factors of rumination in patients with diabetic retinopathy (DR) using a structural equation model, and to examine the relationships between these factors.Impact pathway. Method  We selected 200 patients with DR who were treated at our hospital between January 2022 and June 2024. We collected general clinical information about these patients and used it for analysis.Event-related reflective thinking questionnaire (ERRI), social support rating scale (SSRS), and psychological resilience scale (CD-RISC-10). Conduct a survey of patients and analyze the various contributing factors.The pathways through which these factors influence one another. Results Show that social support, psychological resilience, sleep disorders, the progression of diabetes, household monthly total income, and educational attainment can all directly impact DR prevalence.
The levels of rumination differed among the groups, with the path coefficients being 0.502, 0.251, -0.181, -0.234, 0.326, and 0.275 (P < 0.05). Social support can influence mental well-being.Emotional resilience indirectly influences patients’ levels of rumination. Educational attainment can indirectly affect patients’ levels of rumination by influencing the total monthly household income. The path coefficient for this relationship is [insert value].
Results: 0.175, 0.492 (p < 0.05). Conclusion The level of rumination in DR patients is influenced by social support levels, psychological resilience levels, sleep disturbances, the duration of diabetes.Factors such as the total monthly household income and educational level can influence the situation. Healthcare professionals can develop corresponding intervention plans based on these factors to help patients improve their quality of life and address their psychological needs situation.

Objective To investigate the completion quality of the front page of inpatient medical records in township and community health centers, so as to lay a solid foundation for DRG-based payment. Methods A total of 437 copies of the front page of inpatient medical records of discharged patients from 15 township and community health centers between January and February 2025 were randomly selected from the regional medical and health information system. Quality inspection was conducted in accordance with the 《Specifications for Completing Data on the Front Page of Inpatient Medical Records (2016 Edition)》, and scoring was performed according to the corresponding quality scoring criteria. Results The average score of the front page quality among the 15 institutions was 91.7. The highest score was 94.6 in Hospital A, and the lowest was 86.2 in Hospital O. The top five items with the highest error rates were coma time in patients with craniocerebral injury (98.9%), contact person relationship (47.4%), other diagnoses and coding (34.1%), household registration address and postal code (33.6%), and readmission plan within 31 days (28.6%). Conclusion The regional medical and health information system needs improvement, medical record administrators lack professional competence, and clinicians do not complete the front page standardizedly. Relevant departments can formulate measures from three aspects: system construction, personnel training and institutional improvement to effectively improve the data quality of the front page of inpatient medical records.

Objective To explore the current situation, influencing factors, and intervention measures for the delayed initiation of the second stage of lactation in postpartum women. Methods We selected 197 women from the obstetrics department of Ganzhou Maternal and Child Health Hospital from December 2021 to December 2023 and investigated their second stage of lactation initiation time. We statistically analyzed the incidence of delayed second stage of lactation and performed logistic regression analysis to identify its influencing factors. We designed targeted intervention measures accordingly. Results The average time for the second stage of lactation initiation was 74.34 ± 5.78 minutes. Among the 197 women, 43 experienced delayed second stage of lactation, with an incidence rate of 21.83% (43/197). Results of the univariate analysis showed statistically significant differences between the two groups in terms of age, first childbirth, cesarean section, gestational diabetes, postpartum breastfeeding initiation time, anxiety, and depression (P < 0.05). Logistic regression analysis indicated that age ≥ 35 years, first childbirth, cesarean delivery, gestational diabetes, breastfeeding initiation time > 30 minutes, and anxiety and depression were risk factors for delayed second stage of lactation (P < 0.05) Conclusion Delayed second stage of lactation is closely related to various physiological, psychological, and obstetric factors. Special attention should be paid to high-risk groups such as older women and first-time mothers, and measures should be taken to optimize early postpartum maternal-infant contact, enhance gestational diabetes management, and provide psychological support to reduce the incidence of delayed lactation and promote successful breastfeeding.

Objective To explore the changes in the cost structure and influencing factors of inpatients with cerebral infarction, and to provide a reference for effectively controlling the growth of cerebral infarction costs and reducing the economic burden on patients. Methods The first-page medical record information of patients with a principal diagnosis of cerebral infarction from January 1, 2020 to October 31, 2024, collected from the medical record statistics management system of a hospital, was used to analyze the changes in the internal composition of hospitalization costs by the structural variation degree method, and the multiple linear regression analysis method was adopted to explore the influencing factors of hospitalization costs in patients with cerebral infarction. Results Among the components of hospitalization costs, drug expenses accounted for the highest proportion (33.10%), followed by examination expenses (19.98%) and laboratory test expenses (17.83%). The structural variation degree of hospitalization costs in patients with cerebral infarction from 2020 to 2024 was 13.61%, and the top three contributors to structural variation were consumable expenses (23.44%), drug expenses (17.63%), and treatment expenses (14.55%). The results of multiple linear regression analysis showed that length of hospital stay, admission route, and whether surgery was performed were the main influencing factors of hospitalization costs in patients with cerebral infarction (P＜0.05). Conclusion The overall hospitalization costs of patients with cerebral infarction showed a downward trend. Consumable expenses and drug expenses were the main internal factors affecting hospitalization costs. In addition, length of hospital stay, admission route, and whether surgery was performed also had a significant impact on hospitalization costs. It is necessary to further optimize the cost structure, standardize the diagnosis and treatment process, improve the level of medical technology, and reasonably shorten the length of hospital stay.

Focusing on the practical demand of medical refined management driven by data elements, based on multi-source data such as health statistics, traditional Chinese medicine statistics and front page of medical records, a refined management service platform for public hospitals based on data elements was explored and constructed by adopting a multi-level and distributed architecture design combined with the underlying architectures of J2EE and .NET Core. The platform is equipped with 7 major modules, integrates visual display and intelligent models, and supports data horizontal benchmarking and vertical trend analysis services, helping public hospitals achieve scientific management and precise improvement. The application verification in 43 cooperative pilot hospitals has further proved the effectiveness of the platform in breaking data barriers, improving management efficiency and service level, and provided a feasible path for exploring the empowerment of new productive forces by data elements. 

Objective To explore the risk factors of medical adhesive-related skin injury (MARSI) in elderly patients in the intensive care unit (ICU), and to construct and validate a risk nomogram model.Methods A total of 140 elderly patients admitted to the ICU of a hospital from January 2022 to September 2023 were selected as the training set. They were divided into the injury group and the non-injury group according to the occurrence of MARSI. Relevant data before and after treatment were collected for risk factor analysis, and a risk nomogram model was constructed. In addition, 60 elderly patients admitted to the ICU of the same hospital from October 2023 to June 2024 were selected as the validation set for external validation of the constructed risk nomogram model.Results In this study, there were 18 cases in the injury group (12.86%) and 122 cases in the non-injury group (87.14%). Multivariate analysis showed that body mass index, skin edema, complicated with diabetes mellitus, mechanical ventilation and Braden score were the influencing factors for the occurrence of MARSI in elderly ICU patients (P<0.05). A risk nomogram model was constructed based on these influencing factors. The area under the receiver operating characteristic (ROC) curve of the model was 0.935 (95% confidence interval [95% CI]: 0.877–0.992), with a sensitivity of 88.9% and a specificity of 86.9%. The maximum Youden index was 0.758. The overall trend of the model calibration curve was close to the ideal curve. The Hosmer-Lemeshow test showed that X²=8.945 and P=0.347. The AUC of external validation was 0.973, indicating good calibration consistency. The decision curve analysis (DCA) diagram suggested that the model had good clinical benefit.Conclusion The risk nomogram model constructed in this study can effectively identify the risk factors of MARSI in elderly ICU patients and help clinically prevent the occurrence of MARSI in elderly ICU patients.

Objective This study aims to develop a Nemenyi test program for pairwise comparisons following the Kruskal-Wallis test of multiple independent samples using Python, and provide an efficient and reusable nonparametric test tool for medical researchers. Methods Based on Python, a directly callable function program named "kruskal_nemenyi_test" was designed and developed to realize the automated processing of the Kruskal-Wallis test and Nemenyi test. The correctness of the program was verified using the sample data from the textbook Medical Statistics. Results A complete program for the Kruskal-Wallis test and Nemenyi test was successfully developed. Verification tests showed that the test statistics and P-values output by the program were consistent with the standard sample results, and the program code has been open-sourced and shared on the GitHub platform. Conclusion The Python-based Nemenyi test program features high efficiency, accuracy and ease of invocation. It provides a practical tool for nonparametric statistical analysis in medical research and helps improve the scientificity and reliability of statistical results.

Objective To analyze the relevant risk factors for acute-on-chronic liver failure (ACLF) in patients with liver cirrhosis and construct an early warning model.Methods A total of 153 cirrhotic patients who were hospitalized and treated in a municipal hospital from May 2020 to July 2023 were retrospectively selected as the research subjects. They were randomly divided into a model set (102 cases) and a validation set (51 cases) at a ratio of 2:1. According to whether ACLF developed during the follow-up period, the model set was further divided into an ACLF group and a non-ACLF group. Multivariate logistic regression analysis was used to identify the influencing factors of ACLF occurrence, and a risk prediction model for ACLF in cirrhotic patients was constructed. The accuracy of the model was evaluated using the receiver operating characteristic (ROC) curve, and the goodness-of-fit of the model was assessed via the Hosmer-Lemeshow test.Results In the model set, there were 16 cases in the ACLF group (15.69%) and 86 cases in the non-ACLF group (84.31%). Multivariate analysis results showed that albumin (A_H) (OR=0.739, 95% CI: 0.576–0.949, P=0.018), prothrombin time (T_P) (OR=1.310, 95% CI: 1.015–1.691, P=0.038), and activated partial thromboplastin time (T_APT) (OR=1.177, 95% CI: 1.044–1.327, P=0.008) were all independent influencing factors for ACLF occurrence in the patients (P<0.05). On this basis, the risk prediction model was established with the equation: logitP＝-9.925-0.302×A_H+0.270×T_P+0.163×T_APT. The area under the ROC curve (AUC) of the model was 0.980 (95% CI: 0.958–1.000), with a sensitivity of 1.000, a specificity of 0.907, and a Youden index of 0.907. The Hosmer-Lemeshow test of the combined model showed that (X²=1.61)and P=0.991.Conclusion The risk prediction model for ACLF in cirrhotic patients has good predictive efficacy. Medical staff can use indicators such as A_H, T_P and T_APT to identify high-risk patients and take timely intervention measures.

Objective To analyze the distribution characteristics and influencing factors of patients with ultra-long hospital stay in a tertiary general hospital in Henan in 2023, and to explore measures to shorten the average length of hospital stay. Methods The first-page medical record information of 98,139 discharged patients from January 1 to December 31, 2023 was collected. The distribution characteristics of patients with hospital stay longer than 30 days were statistically analyzed. Chi-square test and multivariate logistic stepwise regression were used to analyze the influencing factors of ultra-long hospital stay. Results A total of 873 inpatients had a hospital stay longer than 30 days, accounting for 0.89% of all discharged patients. The male-to-female ratio was 1.28∶1, the average length of hospital stay was 44.32 days, and 75.49% of patients were aged 40-79 years. The top three departments were Rehabilitation Medicine (29.32%), Intensive Care Unit (15.23%), and Oncology (12.03%). The top three diseases were circulatory system diseases (22.45%), injuries, poisoning and certain other consequences of external causes (13.40%), and factors influencing health status and contact with health services (13.29%). Multivariate logistic stepwise regression showed that gender, age, surgery, ICD-10 disease category, critical illness status, admission condition, admission route, disease outcome, operation level, department transfer, discharge mode, and DRG relative weight (RW) were influencing factors for ultra-long hospital stay. Conclusion The actual situation and medical needs of patients should be fully considered. Measures such as preventive medicine, optimized medical processes, implementation of two-way referral, and strengthened hospital management should be comprehensively applied to shorten hospital stay on the premise of ensuring medical quality and patient safety.

Objective Based on domestic and international literature from 2000 to 2024, to systematically analyze the research status, hotspots and development trends in the field of mental health of visually impaired populations, so as to provide scientific evidence for mental health interventions for this group. Methods Relevant literature was retrieved from CNKI and Web of Science Core Collection from January 1, 2000 to December 31, 2024. CiteSpace 6.4.R1 was used for visual analysis of knowledge mapping, including countries, institutions, authors and keywords. Results A total of 367 Chinese articles and 1001 English articles were included, with an overall upward trend in publication volume. Among English literature, the United States ranked first in both publication volume and academic influence. The University of London was the core research institution, with collaborative teams represented by Lamoureux, Ecosse L and Van Nispen, Ruth M A. Among Chinese literature, He Kan was the most productive author, and the School of Special Education of Beijing Union University was the most productive institution. Keyword co-occurrence and cluster analysis showed that domestic studies mainly focused on visually impaired students under special education, with emphasis on their psychological adaptation and educational interventions. International studies tended to explore psychological problems such as depression and anxiety in elderly visually impaired individuals, analyze the mechanisms linking visual impairment and mental health, and develop targeted psychosocial interventions. Conclusion Research on mental health of visually impaired populations has shown an overall upward trend both in China and abroad, but the total number of studies and high-quality papers in China are insufficient. Future research should expand the scope of database retrieval, integrate quantitative and qualitative methods, further explore the mental health needs of visually impaired populations, and carry out precise interventions.

Objective To explore the association between childhood left-behind experience and mental health among college students. Methods A mixed research method combining quantitative survey and qualitative interview was adopted to carry out an empirical study in 3 universities of different types in a city of Shandong Province. In the quantitative survey, multistage cluster sampling was used to recruit 1605 college students (including 312 left-behind college students). Qualitative interviewees consisted of 40 left-behind college students and 1 psychological counselor. Results (1) The positive rate of mental health problems among left-behind college students (35.58%) was significantly higher than that of students without left-behind experience (19.95%). For the 312 left-behind college students, the positive rates of mental health problems across 10 dimensions ranked as follows: obsessive-compulsive symptoms > interpersonal sensitivity > hostility > depression > paranoia > others > phobic anxiety > anxiety > psychoticism > somatization. Multivariate logistic regression analysis showed that after adjusting for other covariates, the duration of parents' migrant work was a protective factor against phobic anxiety. Participants whose parents had been migrant workers for more than 3 years had a 63% lower risk of phobic anxiety compared with those whose parents worked away for 1 year (OR=0.37, 95%CI:0.16–0.83). In terms of living arrangement, students living alone had 5.65 times higher risk of somatization (OR=5.65, 95%CI:1.86–17.13), 3.05 times higher risk of obsessive-compulsive symptoms (OR=3.05, 95%CI:1.33–7.00), and 4.54 times higher risk of phobic anxiety (OR=4.54, 95%CI:1.67–12.33) than those living with one parent. Regarding campus interpersonal relationships, students with "average" relationships with teachers and classmates exhibited higher risks of somatization (OR=2.64, 95%CI:1.40–5.00), anxiety (OR=2.50, 95%CI:1.37–4.53) and phobic anxiety (OR=2.51, 95%CI:1.40–4.49), which were 2.64, 2.50 and 2.51 times those of students with "good" relationships, respectively. (2) Left-behind college students mainly suffered from anxiety, depression, obsessive-compulsive symptoms and interpersonal sensitivity. Psychological counseling experts also indicated that anxiety and obsessive-compulsive symptoms were the most prevalent psychological problems among left-behind college students. Conclusion Childhood left-behind experience is an important influencing factor for college students' mental health. It suggests that mental health education for college students should be implemented from a life-course perspective.

Objective To investigate the current state of fear regarding the progression of systemic lupus erythematosus (SLE) among patients, and to analyze the associated risk factors using a random forest model.Method A convenience sampling method was used to select 200 patients with systemic lupus erythematosus (SLE) admitted to a hospital in Jiujiang from October 2021 to January 2024 as the study subjects. The patients were divided into a fear of disease progression group and a non-fear of disease progression group based on whether they experienced fear about the progression of their disease. General information about the patients, scores from the SLEDAI (Systemic Lupus Erythematosus Disease Activity Index), Brief-IPQ (Brief Illness Perception Questionnaire), SSRS (Social Support Scale) were collected. The impact of potential variables on fear of disease progression was assessed using a random forest algorithm model, with an analysis of the importance ranking and out-of-bag error data classification errors for the variables with the lowest out-of-bag error rates. A binary logistic regression model was used to analyze the variables with the lowest out- of-bag error rates.Results showed that the incidence of fear of disease progression among patients with systemic lupus erythematosus was 62.50%. The random forest analysis indicated that the out-of-bag error rate was lowest when the number of variables was 10. The multivariate analysis revealed that occupation status (OR = 5.351), number of hospitalizations (OR = 6.493), SLEDAI score (OR = 1.558), positive coping (OR = 0.820), complete surrender (OR = 1.449), negative avoidance (OR = 1.484), Brief-IPQ score (OR = 1.429), and SSRS score (OR = 0.896) were independent factors associated with fear of disease progression in patients with systemic lupus erythemathosus (P < 0.05).Conclusion Patients with systemic lupus erythematosus are more likely to experience fear of disease progression. Those who are employed, have experienced their first hospitalization, have a high SLEDAI score, employ negative coping mechanisms, have a high Brief-IPQ score, and lack social support are at greater risk of experiencing fear of disease progression. Clinicians are advised to focus on high-risk individuals, promptly implement interventions, and reduce the incidence of fear of disease progression to improve patients’ quality of life.

Objective To analyze the effect of implementing performance appraisal for coders on improving the data quality of inpatient medical record front pages, and explore the mode for the continuous improvement of inpatient medical record front page quality. Methods Since June 2023, the Medical Record Department has set up a coding group, appointed specialized coders, and implemented performance appraisal for coders. Targeted supporting schemes were formulated and implemented for the difficulties encountered in coding work. A total of 1000 inpatient medical record front pages before and after the implementation of performance appraisal (March–May 2023 and March–May 2024) were randomly selected. Quality control of the medical record front pages was conducted in accordance with the Specifications for Completing the Data of Inpatient Medical Record Front Pages (2016 Edition). The changes in the data quality management and control indicators of inpatient medical record front pages and the filling status of major error items before and after the implementation of performance appraisal were compared and analyzed. Results After the implementation of performance appraisal, the average quality control score of inpatient medical record front pages was significantly increased, the excellent rate was raised, and the error rate was lower than that before the implementation, with statistically significant differences (P<0.05). Conclusion Implementing performance appraisal for coders can effectively improve the data quality of inpatient medical record front pages, which is worthy of popularization and application.

Objective To analyze the efficiency of health resource allocation under the regional development pattern of "One Cluster, Two Cores, Three Circles" in Shandong Province from 2019 to 2023, so as to provide a reference for optimizing health resource allocation. Methods The BCC model of data envelopment analysis was used for horizontal analysis of health resource allocation efficiency in Shandong Province in 2023; the Malmquist index model was adopted for vertical analysis of the efficiency from 2019 to 2023. Results The input and output of health resources in Shandong Province generally showed an upward trend from 2019 to 2023. In 2023, within the Shandong Peninsula Urban Agglomeration, Jinan, Dongying, Dezhou, Qingdao, Rizhao, Linyi and Heze achieved DEA efficiency with both pure technical efficiency and scale efficiency equal to 1; Zaozhuang and Jining showed weak DEA efficiency with one of the two efficiencies equal to 1; Zibo, Tai'an, Liaocheng, Binzhou, Yantai, Weifang and Weihai presented DEA inefficiency with both values less than 1. The average total factor productivity of health resource allocation in Shandong Province was 1.007 from 2019 to 2023, with an annual average increase of 0.70%, and the order was Jiaodong Economic Circle > Provincial Capital Economic Circle > Lunan Economic Circle. Conclusion In 2023, the total amount of health resources in the Shandong Peninsula Urban Agglomeration is large, but the overall allocation efficiency is not optimal, with inter‑regional and intra‑regional differences. From 2019 to 2023, the overall efficiency is basically stable with a slight increase, but problems such as urban efficiency differentiation, uneven technological progress and unbalanced regional development exist. These problems can be solved by optimizing regional layout, strengthening regional coordination and implementing differentiated regional strategies.

Objective To explore the potential categories and influencing factors of the development trajectory of medication beliefs among individuals with schizophrenia during the recovery phase, and to analyze its impact on medication adherence.Method A prospective study was conducted on 200 patients with schizophrenia in the recovery phase who were treated at a hospital in Shaoxing City from January 2022 to January 2024. The use of medication beliefs was assessed using the Beliefs About Medication Questionnaire (BMQ) at the time of admission, 1 week after treatment, 1 month after treatment, and 3 months after treatment. Growth mixture modeling was used to analyze the optimal number of categories for the trajectory of medication belief development. Single-factor analysis and multivariate logistic regression were employed to examine the independent factors between potential categories and their impact on medication adherence.Results The development trajectories of medication beliefs for 200 patients can be categorized into three potential groups: high-stable (15.0%), medium-decreasing (13.5%), and low-decreasing (71.5%). There were statistically significant differences in medication adherence among patients within each group. Patients in the high-stable group had higher medication adherence compared to those in the other two groups (P < 0.05). Single-factor analysis and multivariable logistic regression analysis revealed that marital status, educational level, history of suicide, living situation, medication use, and Treatment Emergence Symptoms Scale (TESS) scores were all independent factors influencing the development of medication beliefs in patients with schizophrenia during the recovery phase (P < 0.05).Conclusion There are individual differences in the development trajectory of medication beliefs among individuals with schizophrenia during the recovery phase, which affects medication adherence. The development trajectory is influenced by factors such as marital status, educational level, history of suicide attempts, living arrangements, medication usage, and TESS scores. Personalized intervention measures should be developed to improve the development of medication beliefs.

Objective To explore the influencing factors of intraoperative hypothermia in elderly patients undergoing total knee arthroplasty, construct and validate a nomogram model, and provide a basis for the intervention of intraoperative hypothermia in elderly patients undergoing total knee arthroplasty. Methods A total of 196 elderly patients who underwent total knee arthroplasty in a municipal hospital of traditional Chinese medicine from November 2021 to November 2023 were selected as the modeling group. According to the occurrence of intraoperative hypothermia, they were divided into the hypothermia group (93 cases) and the non-hypothermia group (103 cases). In addition, 84 elderly patients who underwent total knee arthroplasty in the same hospital from December 2023 to June 2024 were selected as the validation group at a ratio of 7:3, and divided into the hypothermia group (40 cases) and the non-hypothermia group (44 cases) based on the presence of intraoperative hypothermia. Multivariate logistic regression analysis was performed on the potential influencing factors of intraoperative hypothermia in elderly patients undergoing total knee arthroplasty. A nomogram model for risk prediction was constructed and externally validated. Results Logistic regression analysis showed that age, body mass index (BMI), intraoperative blood loss, operation duration, total volume of fluid infusion, and intraoperative admission temperature were the influencing factors of hypothermia. The area under the curve (AUC) of the prediction model was 0.824 (95% confidence interval [95% CI]: 0.767–0.881), with a sensitivity of 0.720 and a specificity of 0.796, indicating good discriminative ability. The AUC of external validation was 0.735, showing favorable validation efficacy. The overall trend of the calibration curves of the prediction model and external validation was close to the ideal curve. Conclusion The early warning model for intraoperative hypothermia in elderly patients undergoing total knee arthroplasty has good predictive value. Targeted intervention measures can be formulated according to the actual conditions of patients.

Objective To construct a structural equation model and analyze the influence path of various factors on the recovery level of patients with schizophrenia. Methods Using the convenience sampling method, patients with schizophrenia treated in a hospital in Shaoxing from February 2022 to February 2024 were selected as the research objects. A general information questionnaire, the Recovery Assessment Scale (RAS), the Perceived Social Support Scale (PSSS), the Link Stigma Scale, and the General Self-Efficacy Scale (GSES) were used for the survey. Pearson correlation analysis was used to analyze the correlation between each influencing factor and the recovery level of patients with schizophrenia. SPSS Amos 28.0 software was applied to construct a structural equation model for path analysis of each influencing factor. Results The scores of RAS, PSSS, GSES and Link Stigma Scale of 275 patients with schizophrenia were (87.52±12.46), (61.26±5.54), (23.25±4.38) and (127.43±8.24), respectively. Pearson correlation analysis showed that the RAS score of patients with schizophrenia was positively correlated with the PSSS score and GSES score (r=0.810, 0.811, P<0.05), and negatively correlated with the Link Stigma Scale score (r=-0.771, P<0.05). Structural equation model analysis showed that social support had a negative effect on stigma (path coefficient=-0.973, P<0.001), and positive effects on self-efficacy and recovery level (path coefficients=0.656, 0.649, P<0.05); stigma had a negative effect on recovery level (-0.243, P<0.05), and self-efficacy had a positive effect on recovery level (0.117, P<0.05); stigma had a negative effect on self-efficacy (-0.292, P<0.05). Conclusion The recovery level of patients with schizophrenia is affected by multi-path interactions. Social support can directly affect the recovery level, and also indirectly affect it through self-efficacy and stigma, which play partial mediating roles in this process.

Objective To explore the effect of palliative care under the medical community model on quality of life and negative emotions in patients with advanced liver cancer.Methods A total of 94 patients with advanced liver cancer admitted to a hospital from August 2022 to November 2023 were selected and divided into the routine group (n=47, routine nursing) and the medical community group (n=47, palliative care under the medical community model) by the random number table method. The emotional status [assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS)], cancer-related fatigue (CRF) [assessed by Cancer Fatigue Scale (CFS)] and quality of life [assessed by Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep)] were compared between the two groups on the day of discharge and 3 months after discharge.Results At 3 months after discharge, the SAS, SDS and CFS scores of the two groups were lower than those on the day of discharge (P<0.05), and the above scores in the medical community group were lower than those in the routine group (P<0.05). The 5 dimension scores of FACT-Hep in both groups were higher than those on the day of discharge (P<0.05), and were higher in the medical community group (P<0.05).Conclusion The application of palliative care under the medical community model for patients with advanced liver cancer can significantly relieve negative emotions, and effectively improve cancer-related fatigue and quality of life.

Objective To understand the composition and influencing factors of hospitalization costs for diabetes patients, providing a reference for reducing the burden of diabetes on patients. Method Retrospective analysis.Collect information on diabetic patients discharged from a top-tier hospital in Zhejiang Province between January 2018 and December 2023. The composition of hospital expenses is analyzed using descriptive statistics, employing multiple methods.Linear regression and path analysis were used to examine the direct and indirect factors influencing hospital costs. Results: A total of 4,020 diabetic patients were included, with an average hospital cost.
RMB 11,967.47, average hospital stay of 13.01 days. The proportion of diagnostic costs in diabetes-related hospital expenses increased slightly from 2018 to 2023, while the trend of declining pharmaceutical costs was evident.
The top 5 factors influencing the total cost of hospitalization for diabetic patients are: the number of days spent in the hospital (0.696), the number of discharge diagnoses (0.283), and age.(0.215), DRGs reform (−0.213), surgical treatment (0.120). Length of hospital stay, surgical treatment, severity of illness (critical), mode of admission (emergency), first-time admission.Admission to the hospital can directly impact the cost of hospitalization. Other factors influence hospitalization costs indirectly through the number of days spent in the hospital. Conclusion: The number of days in the hospital, the number of discharge diagnoses, and age are factors that influence hospitalization costs.
An important factor in the cost of hospitalization for diabetic patients. While hospitalization costs for diabetes have been well-controlled and are showing a downward trend, it is still essential to minimize hospital stays as much as possible in clinical practice.Standardize treatment and care procedures, optimize the internal structure of inpatient costs, and thereby reduce the financial burden of diabetes on patients.

Objective Based on the analysis of DRGs combined with the workload of physicians in hospital settings, to examine the efficiency of bed utilization and the configuration status of different departments, in order to promote the refinement of public hospitals.This study provides theoretical support and decision-making assistance for managing hospital beds and optimizing the allocation of bed resources. Methodology A tertiary general hospital set up surgical beds in 2023.
Take the ward as an example. A Boston Matrix diagram is used to describe the types of bed utilization. The efficiency of departmental bed utilization is calculated based on the weights assigned to each bed, and it is also assessed in terms of the workload borne by each physician during their stay.Adjustments were made, and a comprehensive analysis was conducted of the status of bed allocation. Results Of the 27 surgical departments analyzed, there were 8 departments categorized as efficient, congested, idle, and cyclical.1, 5, 8, 6; the weight of each bed in 15 departments is higher than the average for surgical departments; the workload of each physician in 10 departments is greater than the average for surgical departments; beds.The departments with appropriate, insufficient, and excessive bed capacity numbers were 10, 8, and 9, respectively. Conclusion The calculation of theoretical bed capacity is influenced by the range of departments selected.The results derived from the departmental scope vary. By conducting a comprehensive analysis of bed utilization types, bed weighting, the workload of individual physicians during hospitalization, and the state of bed allocation, it is possible to effectively evaluate the situation.Evaluate the efficiency of hospital bed utilization while providing reference for continuous improvement of departments. Strengthen the coordination of management across the entire hospital, optimize bed allocation rules, regularly assess bed utilization efficiency, and establish a system for managing beds.Implement a dynamic adjustment mechanism to promote the optimal allocation of hospital beds. Accelerate the establishment and improvement of a hospital bed management information system to accurately reflect the operational efficiency of each available bed, thereby facilitating precision management.Refine the management of bed resources by providing the necessary data support.

Objective The assumption of randomness for missing data in clinical studies is difficult to verify. Sensitivity analysis can be adopted to test the reliability and robustness of results obtained from missing data handling. Methods A practical example was used to analyze the effect of albumin administration on C-reactive protein levels in patients with sepsis. Complete case analysis and multiple imputation were performed to handle binary outcome variables with missing values, and threshold analysis was applied for sensitivity analysis of missing data. Results The results of threshold analysis indicated that a critical point emerged when 3 cases in the control group were converted to positive outcomes. The conclusion was consistent with those from complete case analysis (P=0.78) and multiple imputation (P=0.89), which verified the robustness and reliability of the analytical results. Conclusion Threshold analysis serves as an available sensitivity analysis method for missing data. It can verify the robustness and reliability of findings and provide visualized evidence for judgment. This study offers a new strategy for clinical researchers dealing with missing binary outcome data. The SAS code can be accessed by scanning the OSID QR code.

Objective To explore the design and construction of a visual analysis system for disease-related costs. Methods Power BI was selected as the visual analysis tool. Data related to disease costs were collected, imported into Power BI to establish a data model and write measures. The visual interface was designed using Power BI Desktop to visually display the analysis results, and a complete visual analysis system for disease costs was constructed. Results The visual analysis system performed analysis and display from five perspectives: general overview, department cost analysis, DRG cost analysis, DIP cost analysis, and disease cost analysis. The system provided rich content and achieved excellent insight and analysis effects. Conclusion This study rapidly realized the construction of a visual analysis system for disease costs using Power BI. The system can effectively support refined management and decision-making.

Objective To analyze the influencing factors of lower extremity venous thrombosis (LEVT) in patients after knee joint cruciate ligament reconstruction, and to construct a prediction model. Methods A total of 200 patients with knee cruciate ligament injury who underwent cruciate ligament reconstruction in a hospital from August 2022 to February 2024 were selected as the research objects. According to the occurrence of LEVT, they were divided into the thrombosis group (n=42) and the non-thrombosis group (n=158). The data of the two groups were collected to analyze the related influencing factors of LEVT after knee cruciate ligament reconstruction. R language was used to construct a nomogram prediction model. Calibration curves and decision curves were used to evaluate the model, and the related nursing intervention measures were analyzed. Results Compared with the non-thrombosis group, the patients in the thrombosis group had higher body mass index (BMI), tourniquet time and D-dimer level, and a higher proportion of combined reconstruction (P<0.05). BMI, tourniquet time and D-dimer had certain predictive value for postoperative LEVT, with their area under the curve (AUC) being 0.763, 0.790 and 0.734 respectively (P<0.05). BMI, surgical type, tourniquet time and D-dimer were the influencing factors of postoperative LEVT (P<0.05). The nomogram model showed good performance in predicting the risk of postoperative LEVT, with a concordance index (C-index) of 0.942 (0.912-0.973). When the risk threshold was greater than 0.16, the model could bring benefits to patients by influencing clinical decisions. Conclusion BMI, surgical type, tourniquet time and D-dimer are the influencing factors of postoperative LEVT in patients after knee cruciate ligament reconstruction, and the constructed nomogram model has good predictive ability. 

Objective To explore the application effect of risk intervention based on binary logistic regression analysis in the preventive management of defective loaner instrument packages in the Central Sterile Supply Department (CSSD). Methods A total of 298 loaner instruments registered from April 2023 to December 2023 were retrospectively selected as the modeling group through the CSSD information traceability system of a hospital. According to the defect status of loaner instruments, they were divided into the defect group (n=52) and the qualified group (n=246). Univariate analysis and binary logistic regression were used to identify independent risk factors, construct a risk prediction model, and analyze the application of risk intervention in the preventive management of defective loaner instrument packages in CSSD. Another 128 loaner instruments registered in the hospital from January 2024 to April 2024 were selected as the verification group for external verification of the predictive performance of the model. Furthermore, 141 loaner instruments registered from May 2024 to August 2024 were managed with risk intervention based on the risk prediction model. Results The incidence of defective loaner instrument packages in CSSD was 17.45% (52/298). Univariate analysis showed that unused contaminants on instruments with service life limits, compliance of supplier qualification and training, standardized loading, standardized pretreatment, standardized operation of cleaning equipment, correct concentration of cleaning agent, standardized cleaning procedures, qualified disinfection and sterilization, post duty performance, and sound systems/procedures/plans were influencing factors for defective loaner instrument packages in CSSD (P＜0.05). Binary logistic regression analysis indicated that using contaminated instruments with service life limits, non-compliance of supplier qualification and training, non-standard loading, non-standard pretreatment, non-standard operation of cleaning equipment, incorrect concentration of cleaning agent, non-standard cleaning procedures, failure of disinfection and sterilization, failure to perform post duties, and imperfect systems/procedures/plans were independent risk factors for defective loaner instrument packages in CSSD (P＜0.05). The area under the receiver operating characteristic (ROC) curve of the risk prediction model was 0.866 (95%CI:0.810–0.923), the maximum Youden index was 0.605, the sensitivity was 0.731, and the specificity was 0.874, indicating good discrimination. The Hosmer-Lemeshow test for the nomogram fitting effect yielded χ²=8.082, P=0.325, showing good fitting degree (P＞0.05). The overall trend of the model calibration curve was close to the ideal curve, with favorable calibration performance (P＜0.05). When the threshold probability of the decision curve analysis (DCA) for defective loaner instrument packages in CSSD ranged from 0.07 to 0.83, the net benefit of applying the prediction model was relatively high. The external verification confirmed favorable predictive efficiency of the model. After risk intervention targeting the above independent risk factors of defective loaner instrument packages in CSSD identified by binary logistic regression analysis, the theoretical and operational assessment scores of CSSD staff were higher than those before intervention, and the incidence rate of defective packages (2.13%) was lower than before intervention, with statistically significant differences (P＜0.05). Conclusion The risk prediction model constructed based on independent risk factors for defective loaner instrument packages in CSSD has good predictive performance. The application of risk intervention based on binary logistic regression analysis to the preventive management of loaner instrument packages in CSSD can improve staff awareness of preventive management and reduce the risk of defective packages.

Objective To analyze the risk of pulmonary thromboembolism (PTE) after radical resection of lung cancer based on a nomogram prediction model. Methods A total of 180 patients who underwent radical resection of lung cancer in the Fifth People's Hospital of Ganzhou from June 2023 to January 2024 were retrospectively selected as the modeling cohort. According to the presence or absence of postoperative PTE, they were divided into non-PTE group (n=142) and PTE group (n=38). Another 54 patients with radical resection of lung cancer from February 2024 to June 2024 were enrolled as the validation cohort. The baseline data of patients were collected, and clinical data were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors of PTE after radical resection of lung cancer, and a nomogram risk prediction model for pulmonary thromboembolism after radical resection of lung cancer was constructed. Results Univariate analysis showed that pathological type, TNM clinical stage, smoking and serum D-dimer (D-D) were influencing factors of postoperative PTE (P<0.05). Multivariate logistic regression indicated that adenocarcinoma, TNM clinical stage 2–3, smoking and serum D-D≥500 mmol/L were independent risk factors for postoperative PTE (P<0.05). The area under the ROC curve was AUC=0.840 (95%CI:0.869–0.911), with good discrimination, the sensitivity was 0.711 and the specificity was 0.852. The theoretical value and actual value of the calibration curve were 0.037, with good consistency. Conclusion Pathological type of adenocarcinoma, TNM clinical stage 2–3, smoking and serum D-D≥500 mmol/L are independent risk factors for pulmonary thromboembolism after radical resection of lung cancer. The prediction model constructed based on the above factors has high predictive value.

Objective To explore the mediating effect of personal sense of control on self-efficacy and diabetes distress in patients with type 2 diabetes. Methods A total of 180 patients with type 2 diabetes who were treated from June 2022 to June 2023 were enrolled as the research subjects. General data of the patients were collected. Scales were used to evaluate the levels of personal sense of control, diabetes distress and self-efficacy. Pearson correlation analysis was adopted for correlation analysis, and the Process macro plug-in was applied for mediating effect analysis. Results The total scores of personal sense of control, diabetes distress and self-efficacy of the patients were 25.00 (22.00, 29.00) points, (38.42±11.54) points and (29.03±6.50) points, respectively, with the average item scores of 3.57 (3.14, 4.14) points, (2.26±0.68) points and (3.23±0.72) points, respectively. Diabetes distress was negatively correlated with self-efficacy and personal sense of control at different levels (P＜0.05). Personal sense of control played a partial mediating role between self-efficacy and diabetes distress. According to the personal sense of control from low to high, the mediating effect values were -0.010, -0.017 and -0.001, respectively, with the mediating effect being the strongest when the personal sense of control was at the moderate level. Conclusion Personal sense of control has a mediating effect between self-efficacy and diabetes distress in patients with type 2 diabetes, and the mediating effect is the strongest when the level of personal sense of control is moderate.

Objective To investigate the status of vascular calcification and analyze its influencing factors in uremic patients undergoing maintenance hemodialysis. Methods A total of 130 uremic patients who received maintenance hemodialysis in a hospital from January 2023 to January 2024 were enrolled. Vascular calcification was evaluated by echocardiography, and the patients were divided into a calcification group (n=52) and a non-calcification group (n=78). Clinical indicators were compared between the two groups. Factors with statistical differences in univariate analysis were included in binary logistic regression analysis to screen for risk factors. Receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of continuous variables for vascular calcification. Results Compared with the non-calcification group, the calcification group had significantly higher levels of age, dialysis duration, serum phosphorus, serum calcium, high-sensitivity C-reactive protein (hs-CRP) and parathyroid hormone (all P<0.05). Binary logistic regression analysis showed that age, dialysis duration, serum phosphorus, serum calcium, hs-CRP and parathyroid hormone were independent influencing factors for vascular calcification in uremic patients undergoing hemodialysis (all P<0.05). Conclusion Age, dialysis duration, serum phosphorus, serum calcium, hs-CRP and parathyroid hormone are the main influencing factors for vascular calcification in uremic patients undergoing hemodialysis. Clinical attention should be paid to these factors, and early prevention and treatment measures should be taken when necessary to improve the quality of life of uremic patients undergoing hemodialysis.

Objective To revise an evaluation index system for college students based on the national 《Guidelines for the Evaluation of Citizens’ Environmental and Health Literacy (for Trial Implementation)》, so as to better understand the level of environmental health literacy and its influencing factors among college students in Shandong Province, and put forward targeted countermeasures and suggestions. Methods Undergraduates from several universities in Shandong Province were selected by stratified multistage random sampling and investigated with a self-designed questionnaire. Descriptive statistics were used to analyze the data, expressed as mean ± standard deviation or frequency percentage. Differences between groups were tested by analysis of variance or chi-square test. Spearman rank correlation was used for correlation analysis, and regression analysis was conducted with environmental health literacy and its dimensions as dependent variables. All tests were two-sided, and P < 0.05 was considered statistically significant. Results A total of 1692 valid questionnaires were collected. The overall level of environmental health literacy among college students was above average but with several deficiencies. The performance of the five dimensions ranked from high to low as follows: attitude > awareness > knowledge > skills > behavior. Medical students scored significantly higher in knowledge than students of other majors (4.69 ± 0.57 vs 4.44 ± 0.68, P < 0.05). Conclusion The revised evaluation index system is applicable to the assessment of environmental health literacy among college students. Although the level of environmental health literacy of college students in Shandong Province is above average, it still needs to be improved. It is necessary to strengthen the cultivation of practical transformation ability for students majoring in hygiene-related fields.

Objective To analyze the factors related to susceptibility to incision infection after surgery in elderly diabetic gallbladder removal patients and construct a suitable lineage model. Methods Retrospectively, 495 patients who underwent gallbladder removal at the hospital from April 2022 to March 2024 were divided into model samples (346 cases) and validation samples (149 cases) by a ratio of 7: 3. The samples were divided into infected and uninfected groups according to whether postoperative incision infection had occurred. Collect relevant data before and after their surgery, analyze their risk factors and build a risk matrix model. Results There were 48 cases (13.87 per cent) in the infected group and 298 cases (86.13 per cent) among the uninfected group. Multivariate analysis showed that smoking, preoperative endoscopic retrograde cholangiopancreatography (ERCP),Surgery time, gallbladder rupture during surgery, gallbarrow stones, fluid around the gallbladder, white blood cell count, blood transfusion during surgical, steroid drugs, surgical incision, and ASA were ranked as independent influences of postoperative incision infection in patients (P < 0.05) to construct a risk matrix model.The area under the receiver characteristic curve was 0.930 (95% CI: 0.894-0.967), the sensitivity was 0.813, the specificity was 0.909, and the Youden index was 0.722.Hosemer-Lemeshow test showed χ 2 = 5.146, P = 0.742.Conclusion The line chart model predicted postoperative incision infection in patients with diabetic gallbladder removal in elderly patients was good. Healthcare professionals could determine the risk of postoperative incisions infection and take targeted interventions through indicators such as smoking status, ERCP, surgical incision and ASA grading.

Objective To investigate the longitudinal changes in binary coping levels of patients with prostate cancer undergoing castration therapy at different time points, and to analyze the associated factors. Methods A prospective study was conducted, selecting 75 patients with prostate cancer who had undergone castration therapy at the Urology Department of a hospital in Wenzhou from October 2022 to October 2024. Binary coping levels were assessed using the Binary Coping Inventory (CDCI), the Locke-Wallace Marital Adjustment Test (MAT), and a general situation survey. The changes in binary coping levels over time were compared at 1 month, 3 months, 6 months, and 12 months after castration therapy, and the relevant factors influencing the changes in binary coping levels of prostate cancer patients undergoing castration therapy were analyzed using multiple linear regression analysis. Results A total of 70 patients completed the survey at the end of the follow-up period. The CDCI scores at 1 month, 3 month, 6 month, and 12 months were 108.93 ± 14.92, 111.39 ± 15.37, 104.77 ± 14.30, and 104.46 ± 13.99, respectively. Multiple linear analysis showed that occupation (b = -7.78, 95% CI = -15.12 to -0.45) and marital age (b = -4.41, 95%CI = -8.35 to -0.47) were significant factors influencing the binary coping levels of prostate cancer patients who had undergone long-term castration therapy. Conclusion The binary coping abilities of prostate cancer patients undergoing long-term castration therapy are generally low and show an initial increase followed by a decline over time. Occupation and marital age are important risk factors for changes in binary coping abilities. By assessing both the patients and their spouses, measures can be taken to promote collaboration between the couple, enhance their knowledge about the disease, and thereby improve the patients’ binary coping abilities.

Objective To explore the risk factors of venous catheter-associated bloodstream infection (CRBSI) in patients with acute pancreatitis (AP) by parenteral nutrition (PN), and to construct and validate the predictive model of Durian tree.  Methods A retrospective analysis of 140 patients with AP extraintestinal nutrition admitted to a hospital in Jijiang from January 2021 to August 2023 was a model group. The patients were divided into 20 CRBSI patients and 120 non-CRBSI patients according to whether or not they had CRBSI.  Univariate and binary logistic regression were used to analyze the influencing factors of CRBSI in patients with AP parenteral nutrition, and to construct a decision tree predictive model.  According to the distribution ratio of 7: 3, 60 patients with AP parenteral nutrition from September 2023 to April 2024 were selected as the verification group.  ROC curves were used to evaluate the predictive effectiveness of the model.  Results The incidence of CRBSI in 140 AP parenteral nutrition patients was 14.29%. The multifactorial analysis showed that age ≥ 60 years, duration of extraintestinal nutrition > 10 days, duration intubation > 14 days, and combined diabetes were independent influencing factors for CRBSI in patients with extraintestinal nutrition (P < 0.05). According to the proportion of nodes in CRBSI that represents the risk of CRBSI in AP parenteral nutrition patients, four high-risk groups were screened out: (1) parenteral nutrition time > 10 days, combined with diabetes, accounting for 62.50% of this node; The duration of parenteral nutrition was more than 10 days, without glycouria and catheterization was more than14days, accounting for 38.50% of the nodes.  The duration of parenteral nutrition was less than 10 days, the age was more than 60 years and the duration of intubation was more than 14 days, accounting for 40.00% of the nodes.  The duration of parenteral nutrition was less than10days, the age was more than60years, the duration of intubation was less than 14 days, and the incidence of glycouria was 20.00%.  In theROC curve, the area under the curve (AUC) of the training set was 0.929 (95% CI: 0.877-0.980), the sensitivity was 80.00%, and the specificity was 87.50%.  The AUC of the validation set was 0.926 (95% CI: 0.840-1.000), sensitivity 85.00% and specificity 83.00%.  Conclusion The decision tree predictive model based on the factors related to the occurrence of CRBSI in patients with extraintestinal nutrition has a good predictive effect, and clinicians may use this model to screen high-risk patients with extrauterine nutrition who are prone to CRBSI and intervene in a timely manner.

Objective To explore the current status and influencing factors of social support network in pregnant women with pregnancy-induced hypertension (PIH). Methods Pregnant women with PIH admitted to a hospital from October 2022 to March 2024 were selected by convenience sampling method, and the current status and influencing factors of their social support network were analyzed. Results Among the 230 pregnant women with PIH, the functional network dimension of social support network was (8.94±2.47) person-times, and the structural network dimension was (12.03±2.72) person-times. Univariate analysis showed that age, participation in economic/public welfare activities, educational level, self-management ability and place of residence were all influencing factors of the functional network dimension of PIH pregnant women, with statistically significant differences (P<0.05). Multiple linear regression analysis showed that age, participation in economic/public welfare activities, educational level and self-management ability were all influencing factors of the structural network dimension of PIH pregnant women, with statistically significant differences (P<0.05). Conclusion There are many influencing factors of functional and structural network dimensions in PIH pregnant women. It is necessary to strengthen the construction of social support network and improve the level of social support network of PIH pregnant women, which is helpful to improve their health status. 

Objective To explore the risk factors for catheter-related bloodstream infections (CRBSI) in children with acute lymphoblastic leukemia (ALL) and construct a nomogram prediction model.Methods A retrospective analysis was performed on the clinical data of 230 children with ALL admitted to a hospital from July 2021 to June 2024. According to the occurrence of CRBSI during treatment, the children were divided into an infection group (n=58) and a non-infection group (n=172). The clinical data of the two groups were compared. LASSO regression analysis was used to initially screen the potential early warning indicators for CRBSI in children with ALL. Multivariate binary logistic regression analysis was adopted to identify the risk factors for CRBSI in the children. The R software 4.3.3 package was used to construct a nomogram prediction model. The Hosmer-Lemeshow test, calibration curve, and decision curve were applied to evaluate the goodness-of-fit, calibration degree, and clinical applicability of the nomogram prediction model. The receiver operating characteristic (ROC) curve of the model was plotted.Results There were statistically significant differences between the two groups in white blood cell count, duration of neutropenia, number of chemotherapy cycles, number of punctures, and catheter indwelling time (P<0.05). White blood cell count, duration of neutropenia, number of chemotherapy cycles, number of punctures, and catheter indwelling time were potential early warning indicators for CRBSI in children with ALL. Duration of neutropenia, number of chemotherapy cycles, number of punctures, and catheter indwelling time were identified as the risk factors for CRBSI in children with ALL. The results of the Hosmer-Lemeshow test (X²=9.138, P=0.331) indicated that the nomogram prediction model had a high goodness-of-fit. The prediction results of the nomogram model for CRBSI in children with ALL were highly consistent with the actual outcomes. When the risk threshold was between 0.10 and 0.97, the nomogram model yielded a higher clinical net benefit in predicting CRBSI in children with ALL compared with any single predictor. The area under the ROC curve (AUC) was 0.967 (95% confidence interval [95% CI]: 0.935–0.986), with a sensitivity of 89.66% and a specificity of 93.60%, suggesting that the nomogram model had high predictive efficacy.Conclusion The nomogram prediction model constructed based on the duration of neutropenia, number of chemotherapy cycles, number of punctures, and catheter indwelling time can help clinicians better identify high-risk children during treatment, take corresponding preventive measures, and improve the prognosis.

Objective To investigate the grouping effects and factors influencing hospital costs among patients undergoing breast cancer surgery under the DGR grouping system. Method Analysis conducted on January 1, 2021.As of December 31, 2023, the distribution of 1,812 breast cancer surgery patients at a tertiary public hospital in Jiangmen City according to the DRG system, using the coefficient of variation and the overall variance reduction method.Evaluate the effectiveness of the grouping method. Analyze the changes in the structure of hospitalization costs for different DRG groups using structural variation values and structural variation degrees. Employ logistic regression analysis to examine hospitalization patterns.Factors Affecting Costs. Results Patients undergoing breast cancer surgery showed better outcomes in the DRG group. Hospital expenses accounted for a higher proportion, including diagnostic fees, treatment costs, consumables, and medications.Fee. JA13Total mastectomy for malignant breast tumors, with complications and associated conditions group vs. JA15.The comprehensive medical service costs for the group undergoing a total mastectomy for malignant breast tumors, compared to the average length of stay.The correlation with hospital costs was the strongest. The results of the univariate analysis showed that comorbidities, payment methods, age, and length of hospital stay were factors that influenced hospital costs. The results of the t-test regression analysis indicate that JA13. The factors influencing hospital costs for the group undergoing a total mastectomy for malignant breast tumors were hospital stay duration ≥ 15 days and age 55–64 years; JA15. The factors influencing the costs of hospitalization for patients undergoing a total mastectomy for malignant breast tumors were the length of hospital stay and age: 55-64 years vs. ≥65 years; JA25.Partial mastectomy for malignant breast tumor.Regarding the group without complications or comorbidities, the influencing factors for hospital costs were the length of hospital stay and age: 45–54 years, 55–64 years, and ≥65 years. Each factor had an impact on JA23.  breastThe impact of subtotal resection surgery for malignant tumors, including complications and associated conditions, on hospital costs was not statistically significant (P > 0.05). Conclusion Healthcare management departments should take appropriate measures.Develop localized and refined DRG cost-control tools that are in line with the local disease profile and actual economic levels. Optimize the structure of disease categories, reduce the length of hospital stays, and decrease consumables and medication costs.This will help reduce the costs associated with hospitalization for patients undergoing breast cancer surgery.

Objective To construct a system of indicators for job competency evaluation for standardized training of graduate interns with specialized degrees in clinical medicine and to determine the weight of indicators at each level.Methods Adopting an improved Delphi law organization of two rounds of expert consultations (round 1 n = 35, Round 2 n = 21, assessing the importance and feasibility of the indicators based on the Likert scale at level 5, calculating mean and coefficient of variance (CV), and examining the coordination of expert opinions with Kendall's W; Calculate the authority factor (Cr) based on expert familiarity (Cs) and the basis of judgment (Ca). On this basis, layer analysis (AHP) is applied to build a judgment matrix and empower it, while a consistency test (CI, CR) is performed. The confidence was assessed by Cronbach's alpha and the structural effectiveness was evaluated by KMO and Bartlett spherical tests. An exploratory factor analysis (EFA) was conducted. Results The evaluation system for seven levels, 14 levels and 38 levels of indicators was established.Two rounds of the Kendall ′ s W Level 3 indicator increased from 0.621 to 0.857, respectively;0.632 rose to 0.765;0.545 rose to 0.810 (P < 0.01), and the expert authority coefficients Cr were 0.875 and 0.885. Coherence within the scale Cronbach ′ s α = 0.9902; KMO = 0.871, the Bartlett test P < 0.001, and the EFA's common factor load is > 0.50. AHP consistency ratio CR = 0.0142 < 0.10, passed the consistency test. Conclusion The resulting system of job competency indicators, covering the seven dimensions of knowledge, clinical, learning, scientific innovation, teamwork, communication and professional literacy, was well weighted and could be used for process and final evaluation of graduate standardized training and as a basis for quality improvement.