Objective  To understand the current status and mode of Internet medical service charge in China. Methods  An online questionnaire survey on Internet medical service charge was conducted in Internet hospitals established by physical medical institutions in 8 provinces in China from October to November 2023. Descriptive analysis methods were used to analyze data of charging basis and standards of Internet hospitals. Results  The charges for Internet medical services in the 54 hospitals investigated were primarily determined by the type of consultation, hospital classification, and doctors' professional levels. In 78.4% of the hospitals, the online subsequent visit cost was 10 yuan or less per case. The costs of graphic, voice, and video health consultation for doctors of different ranks in various levels of hospitals primarily were less than 20 yuan. Approximately 44.4% of hospitals supported online medical insurance payment. Conclusion  It is imperative to establish a multi-tiered and comprehensive pricing mechanism for Internet medical services in China, enhance supervision over Internet medical charges, and comprehensively promote online payment for medical insurance to ensure the provision of high-quality and sustainable development of Internet medical services.

Objective To explore the effects of muscle mass and muscle strength on frailty in patients with maintenance hemodialysis (MHD).Methods MHD patients at The First Affiliated Hospital of Xi’an Jiaotong University were investigated from January to May 2024. Their frailty was evaluated using the Frailty Assessment Scale, and muscle mass (SMI) and muscle strength (HGS) were assessed with a body composition analyzer and a grip strength meter. Relevant data including sociodemographic characteristics, clinical medical information, and personal lifestyle habits were collected. Logistic regression analysis was utilized to analyze the impacts of muscle mass and muscle strength on frailty, and the masking effect of muscle strength between muscle mass and frailty was explored based on the path analysis method.Results A total of 340 MHD patients were surveyed. The prevalence rates of frailty, low SMI, and low HGS were 43.5%, 41.8%, and 39.1%, respectively. Among the 148 frail MHD patients, 45.3% had both low HGS and low SMI. After adjusting for confounding factors, muscle strength was a protective factor against frailty. In the overall population, the masking effect between SMI→HGS→frailty was significant, with a masking effect value of −0.068 (95% CI: −0.102 to −0.041). Subgroup analysis showed a masking effect value of −0.069 (95% CI: −0.112 to −0.035) in males; in females, the effect of muscle mass on frailty was completely masked by muscle strength, with a masking effect value of −0.074 (95% CI: −0.149 to −0.007).Conclusion Increasing muscle strength is significantly associated with reduced frailty in MHD patients. Grip strength, as a marker of muscle strength, is more significant than muscle mass. Muscle strength plays a masking role between muscle mass and frailty.

Objective To understand the hospitalization situation of diabetic patients in Tianjin and the changing trends of the composition of their hospitalization expenses before and after the implementation of the DRG payment reform policy, and to analyze the effectiveness of the DRG policy reform and the possible existing problems. Methods Based on the medical insurance settlement data in Tianjin before and after the implementation of DRG from 2021 to 2023, the degree of structure variation (DSV), grey correlation analysis (GRA) and interrupted time series (ITS) analysis were used to study the impact of the DRG policy on the hospitalization situation and expenses of diabetic patients. Results Compared with before the reform, the emergency admission rate of hospitalized diabetic patients increased after the reform ($P < 0.001$), while the length of hospital stay, hospitalization expenses, comprehensive medical service fees, drug fees, health material fees and individual out-of-pocket expenses all decreased ($P < 0.001$). The results of DSV and GRA analysis showed that the main factors affecting the hospitalization expenses of diabetic patients were examination fees, laboratory test fees, comprehensive medical service fees and drug fees. The results of ITS analysis showed that after the DRG reform, the average inpatient expense per visit decreased by 281.50 yuan ($P < 0.001$), and the monthly growth rate reversed from 56.15 yuan before the reform to -42.51 yuan ($P < 0.001$), and the reduction rate of individual out-of-pocket expenses increased ($P < 0.001$). Except for the examination fees, the growth trends of the composition of various hospitalization expenses all reversed ($P < 0.001$). Among them, the comprehensive medical service fees had the largest reduction, and the monthly growth rate reversed from 21.68 yuan before the reform to -17.23 yuan ($P < 0.001$), followed by drug fees, laboratory test fees and health material fees. Conclusion The DRG payment method reform in Tianjin has achieved remarkable results, with obvious achievements in reducing costs and increasing efficiency, effectively reducing the economic burden on patients. However, the increase in the emergency admission rate and the still unreasonable expense structure suggest that the DRG reform still needs further optimization.

Objective To construct a medical mental damage compensation model based on Ordinary Least Squares (OLS) regression, so as to analyze the influencing factors of mental damage compensation in medical damage liability dispute cases. Methods Taking 830 medical damage dispute cases as the research objects, relevant factors were included in the OLS regression analysis through analysis of variance, and a linear regression model was constructed. Results The medical mental damage compensation model showed that the western and northeastern regions in the factor of "region" were negatively correlated with mental damage compensation (P < 0.05), while hospital liability, claimed compensation amount, and disability grade were positively correlated with mental damage compensation (P < 0.05). Conclusion The medical mental damage compensation model is simple with simplified indicators, which is convenient for judges to refer to the data. It is helpful for the pre-litigation settlement of medical disputes and further plays the role of people's mediation in doctor-patient disputes.

Objective  To analyze the changes in the structure of outpatient and inpatient costs in a public hospital in Binzhou under the background of new medical reform, and provide references and theoretical basis for further implementing healthcare reform policies in Binzhou. Methods  Outpatient and inpatient cost data from a public hospital in Binzhou City from 2013 to 2022 were collected, and grey correlation method and structural change degree were used to analyze the indicators. Results  Grey relational analysis revealed that, from 2013 to 2022, the top three correlated factors in outpatient expenses were medication expenses, examination fees, and laboratory fees; in inpatient expenses, medication expenses, health material fees, and examination fees were the top three expenses. The results of the structural correlation analysis showed that in both outpatient and inpatient expenses, the change in medication expenses was the largest contributor with a negative change. Conclusion  Under the background of the new medical reform, there have been initial achievements in controlling medication expenses. However, examination fees and health material fees have shown an upward trend and accounted for a relatively high proportion, which requires attention. Technical service fees have been increasing annually but still have a relatively low proportion.

Objective  To explore the risk factors of 30-day survival after cardiac arrest (CA) and return of spontaneous circulation (ROSC) in the emergency department and to establish a nomogram prediction model. Methods  A dual center retrospectively observational study was conducted. The patients with CA admitted to the emergency departments of two hospitals were enrolled, including Affiliated Jinhua Hospital, Zhejiang University School of Medicine and Wucheng District of Jinhua Municipal Central Hospital. A modified Utstein template was applied to collect information about these patients, including general data, CA related data, arterial blood gas analysis after ROSC, and the 30-days survival rate. The influence factors of 30-days survival rate were screened with logistic regression analysis. A nomogram prediction model was established to evaluate the value in predicting 30 days survival after CA and ROSC.Results  A total of 150 patients with ROSC were enrolled, 40 cases survived within 30 days (26.7%), and only 22 cases survived to hospital discharge with good neurological prognosis (14.7%). The survival group patients were younger, with higher ratio of in-hospital cardiac arrest (IHCA), cardiogenic cardiac arrest, initial shockable rhythm and higher pH value than the death group (P < 0.025). The ROC curve showed that the cut-off value of age was 60.5 years old, and pH was 7.05. Multivariate logistic regression analysis showed that patients′ age < 60 years old (OR = 11.30, 95% CI 1.76-72.63, P = 0.011), cardiogenic cardiac arrest (OR = 10.78, 95% CI 1.55-75.16, P = 0.016) and pH > 7.05 (OR = 15.25, 95% CI 2.46-94.49, P = 0.003) were independent influencing factors of 30-day survival. The negative predictive value of pH > 7.05 for 30 day survival was 91.1%. The AUC of nomogram prediction model was 0.929 (95% CI 0.874-0.985), the sensitivity was 0.95, and the specificity was 0.75. The calibration curve showed that the predicted probability was basically consistent with the actual probability. The analysis of the decision curve confirmed that the nomogram prediction model had good clinical usability. Conclusion  The nomogram model based on age, cardiogenic cardiac arrest, location of CA, initial shockable rhythm and pH could predict the 30-day survival of patients after ROSC in the emergency department rapidly, and pH was the most significant prognostic factor.

Objective  To analyze the change trend on the number of radiological examinations with time-series in a children′s hospital in Hangzhou from 2021 to 2023, and to provide data support for strengthening the management level and service quality of the radiology department in the hospital. Methods  A retrospective study was conducted on 374303 radiological examinations in the radiology department of the hospital, from January 1, 2021 to December 31, 2023. The seasonal index analysis with time series was used to analyze the change trend of the number of radiological examinations in three years.Results  The total number of radiological examinations in the radiology department of the hospital was 374303 times from 2021 to 2023. The average highest peak on the number of radiological examinations was the fourth quarter (autumn, 37105 times), and the lowest was the first quarter (winter, 25166 times). The peak months of radiological examinations were July, August, October, November and December (total of 5 months), and the average highest peak month was October, with 13225 times, accounting for 10.6% of the radiological examinations during the year. The minimun number of the radiological examinations occurred from January to May (total of 5 months), and the number of the radiological examinations was the least in February, with 6487 times, accounting for 5.2% of the radiological examinations during the year. The peak periods in daytime on the number of radiological examinations were from 10∶00 to 12∶00 and from 13∶30 to 15∶30. The number of the radiological examinations in the night-time from 17∶30 to 1∶30 was 10.1 times that in the night-time from 1∶30 to 8∶00. Conclusion  The number of radiological examinations in the radiology department of the hospital varies seasonally. Analyzing the peak and low periods of the radiological examinations can provide a basis for allocating medical resources reasonably, which can effectively improve the diagnostic capabilities and the level of medical service in the radiology department of the hospital.

Objective To systematically evaluate the efficacy and safety of Chinese herbal decoctions containing Astragalus membranaceus and Poria cocos (HF-D) in the treatment of nephrotic syndrome (NS). 

Methods Databases including VIP, CNKI, WanFang, CBM, PubMed, Embase, and Cochrane were searched for clinical randomized controlled trials (RCTs) on HF-D for NS published between 2010 and 2023. Literature quality was assessed using the Cochrane Risk of Bias Tool, and data were analyzed with ReviewManager 5.3, Stata 12.0, and R software. 

Results Following PRISMA 2020 guidelines, 15 RCTs involving 1,538 patients were included. Meta-analysis showed: Efficacy outcomes: - The trial group had a significantly higher total response rate than the control group [RR=1.21, 95%CI: (1.13, 1.29), P<0.01].  The recurrence rate was significantly lower in the trial group [RR=0.38, 95%CI: (0.22, 0.66), P<0.01]. Laboratory indices: The trial group exhibited significantly lower levels of 24-hour urinary protein [MD=−1.20, 95%CI: (−1.43, −0.97), P<0.01], serum creatinine [MD=−7.13, 95%CI: (−13.15, −1.10), P<0.05], blood urea nitrogen [MD=−0.55, 95%CI: (−1.04, −0.06), P<0.05], total cholesterol [MD=−1.51, 95%CI: (−2.11, −0.91), *P*<0.01], and triglycerides [MD=−0.74, 95%CI: (−1.11, −0.36), P<0.01] compared to the control group. Serum albumin levels were significantly higher in the trial group [MD=5.65, 95%CI: (4.03, 7.27), P<0.01]. Safety outcomes: The incidence of adverse events was significantly lower in the trial group [RR=0.41, 95%CI: (0.28, 0.62), P<0.01]. Publication bias analysis: Egger’s test showed good symmetry in the funnel plot for 24-hour urinary protein (P>|t|=0.7), but trim-and-fill analysis for total response rate indicated potential unavoidable publication bias. 

Conclusion HF-D demonstrates promising efficacy and safety in treating NS, though further large-sample, high-quality RCTs are needed for validation.

Objective To retrospectively analyze the inpatient death cases in a tertiary general hospital, so as to understand and master the death situation and causes of inpatients in the hospital in recent years, and provide a scientific and reasonable management basis for the hospital. Methods The inpatient death cases in a tertiary general hospital from 2021 to 2023 were collected and retrospectively analyzed from the aspects of age, gender, department, and disease diagnosis at death. Results There were 819 death cases in this hospital from 2021 to 2023, with a total inpatient mortality rate of 0.58%. The male-female ratio was 1.96:1, and those aged 60 and above accounted for 82.42%. The departments with the most deaths were mainly ICU, Department of Cardiology, Department of Respiratory Medicine, and Department of Neurosurgery. The top three diseases were tumors, circulatory system diseases, and respiratory system diseases. Conclusion With the aggravation of population aging, tumors, circulatory system diseases, and respiratory system diseases have become the main causes of inpatient death in this hospital, and elderly patients are the key objects that need attention.

Objective To construct a nomogram model to predict the risk of delirium during ICU admission in alcohol withdrawal patients.Methods Data were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV version 2.2) on patients admitted to the ICU for alcohol withdrawal and were randomly divided into training and validation sets based on a 7:3 ratio. Lasso regression analysis combined with logistic regression analysis was used to select the best variables to construct the model for visualization in the form of the nomogram.Results Five optimal variables were screened as independent risk factors for delirium during ICU admission in alcohol withdrawal patients in this study, which were mean heart rate (OR=0.967, 95%CI: 0.953-0.982), SOFA score (OR=1.151, 95%CI: 1.054-1.257), OASIS score (OR=1.131, 95%CI: 1.089-1.174), use of propofol (OR=2.453, 95%CI: 1.187-5.071) and LMR (OR=0.876, 95%CI: 0.774-0.991). The area under the ROC curve (AUC) of the column-line graphical model constructed on the basis of these five optimal variables was 0.852 (95%CI: 0.820-0.885); the accuracy of the model was 0.706, the precision was 0.743, the recall was 0.690, the F1 score was 0.716, and the Brier score was 0.157; the mean absolute error of the calibration curve was 0.014; clinical decision curve analysis (DCA) showed a large net benefit at threshold probabilities of 0.07-0.95.Conclusion The nomogram model developed in this study can accurately predict the risk of delirium during ICU admission in patients with alcohol withdrawal and can be useful for early clinical prevention, intervention, and graded care.

Objective To understand the construction and operation of Internet hospitals in China and provide a reference for improving relevant policies and developing Internet hospitals.Methods A questionnaire survey was conducted on 136 medical institutions in 8 provinces in China to collect operational data in 2022 of Internet hospitals and entity hospitals they were based on. SPSS 26.0 software was used to analyze the data, and the Mann-Whitney U test was used to compare Internet hospitals of different grades.Results Among the 136 medical institutions, 54 have established Internet hospitals, accounting for 39.7%. Among the 54 Internet hospitals, 27.8% have received government investment, 40.7% have set up independent management departments, and 85.2% have reached effective operation. In 2022, the median number of Internet hospitals in effective operation was 20000, which had a large gap compared with the median number of entity hospitals, which was 1.37 million. The top three business systems with the highest construction ratio in Internet hospitals were online diagnosis and treatment system, e-prescription and online medical order system, prescription review and drug distribution system, accounting for 83.3%, 75.9% and 75.9%, respectively.Conclusion In China, Internet hospitals have not established a relatively mature management and operation system, and the financial support is insufficient. Compared with the scale of offline hospitals, the promotion and application of Internet hospitals in China need to be further strengthened. It is necessary to strengthen policy guidance, give full play to the subjective initiative of hospitals, ensure capital investment, standardize the Internet operation and management system, and optimize the construction of information platforms, so as to enhance patients’ experience and satisfaction of Internet hospitals.

Objective To linearly weight the results of inverse distance weighted interpolation (IDW), ordinary Kriging interpolation (OK) and thin plate spline interpolation (TPS), and fit a comprehensive model of ensemble interpolation to objectively and comprehensively reveal the spatial pattern of diseases. Methods Taking the mortality rate of liver cancer at county level in Guangxi for example, we revealed the death risk via IDW, OK and TPS interpolation models, and compared the mean prediction error (MPE), root - mean - square prediction error (RMSE), R - square (R2) value and the fitting smoothness of spatial interpolation maps between the IDW model, the OK model and the TPS model. Then, we used the RMSE of above specific models to generate weights to linearly weight single interpolation models, and estimated the death risk of liver cancer across Guangxi by a comprehensive model of ensemble interpolation.
Results The fitting indicators of IDW, OK and TPS models were somewhat inconsistent, and each model had its advantages and disadvantages. Specifically, from small to large, the MPE was TPS (0.002), OK (0.004) and IDW (0.020), respectively, and the accuracy of TPS was better than that of OK. From small to large, RMSE was OK (0.349), TPS (0.362) and IDW (0.390), respectively, and the variability of OK was better than that of TPS. From small to large, R2 was OK (0.47), TPS (0.44) and IDW (0.37), respectively, and OK was better than TPS in fitting accuracy. The comprehensive model of ensemble interpolation integrated the advantages of above three models and overcame the instability of specific models, with MPE, RMSE and R2 being 0.005, 0.352 and 0.43, respectively. Conclusion IDW, OK and TPS interpolation models have their own advantages in estimating the spatial patterns of diseases, but findings of different models are inconsistent to some extent. The comprehensive model of ensemble interpolation reduces the uncertainty of each single model, balances the advantages and disadvantages of each single model and generated a comprehensive evidence to reveal the spatial pattern of diseases, via weighting above three single models.

Objective To analyze the changes in the disease spectrum of discharged patients in a psychiatric specialized hospital from 2013 to 2022, with a focus on exploring the impact of the COVID-19 pandemic on a specific mental disorder, F98, which usually onset during childhood and adolescence, so as to provide a reference for the prevention and treatment of mental diseases and the management of the hospital. Methods The information on the front pages of inpatient medical records of discharged patients from the psychiatry department of a psychiatric specialized hospital from January 1, 2013 to December 31, 2022 was exported through the medical record statistical management system of medical institutions in Guangdong Province. The constituent ratios, changing trends of the main discharge diagnoses of patients in each year, and the differential changes related to the pandemic were analyzed. Results Schizophrenia (F20) ranked first in the disease spectrum for 10 consecutive years. The number of male patients with schizophrenia reached its peak in the age group of 26-35 years old. It is particularly noteworthy that since the pandemic, the number of cases of F98, which usually onset during childhood and adolescence, has significantly increased, especially among female patients, and this increase is statistically significant. Conclusion The hospital should adjust its specialty settings according to the changes in the disease spectrum and the growth of the number of inpatients, and focus on strengthening the construction of the departments of mental disorders, affective disorders, clinical psychology, and the adolescent sub-specialty. At the same time, targeted mental health support should be provided for female adolescents, and public health policies and the education system should be promoted to strengthen mental health education and early intervention to alleviate the long-term impact of the pandemic.

Objective  To systematically evaluate the effect of dapagliflozin on glucose and lipid metabolism in patients with stage Ⅲ of diabetic nephropathy (DN-Ⅲ). Methods  Randomized controlled studies (RCTs) on the effect of dapagliflozin on glucose and lipid metabolism in patients with DN-Ⅲ were retrieved. Literature was screened, the data were extracted, and RevMan 5.4.1. was used for quality evaluation. Results  A total of 2107 patients were included in 23 studies. Meta results showed that compared with the control group, dapagliflozin significantly reduced HbA1c, FBG, PBG, HOME-IR and significantly increased HOME-β in patients with DN-Ⅲ, but it had little impact on ΔFIns; compared with the control group, dapagliflozin significantly reduced TC, TG, LDL-c and significantly increased HDL-c in patients with DN-Ⅲ; compared with the control group, dapagliflozin significantly reduced SBP and DBP in patients with DN-Ⅲ. In addition, compared with the control group, dapagliflozin could significantly reduce BMI, but there was no significant difference in the incidence of ADR. Conclusion  Dapagliflozin can improve the glucose and lipid metabolism in patients with DN-Ⅲ, and it is safe and effective. However, in view of the limitations of the inclusion study, it still needs to be verified by a well-designed large-scale clinical randomized controlled study.

Objective To analyze the effect of group narrative psychological intervention on non-suicidal self-injury behavior (NSSI) in adolescent depression patients.Method A total of 118 adolescent depression patients treated in a certain hospital from January 2022 to June 2023 were randomly divided into two groups: the control group of 59 patients and the observation group of 59 patients. The control group received routine nursing care, while the observation group received group narrative psychological intervention besides routine nursing care. The occurrence of NSSI in two groups of patients was statistically analyzed to compare their levels of depression, psychological resilience, and self-esteem before and after the intervention.Results Three months after the intervention, the frequency of NSSI and the degree of injury in the observation group patients were significantly reduced and lower than those in the control group patients (P<0.05). Before and after the intervention, the differences in SDS score, HAMD score, CD-RISC score, and SES score in the control group were 10.01±2.15, 6.91±1.78, 9.45±2.54, and 7.08±1.53, respectively, while the differences in the observation group were 16.14±3.02, 10.08±2.06, 15.10±2.86, and 11.75±2.12, respectively. The differences of the observation group were higher than those of the control group (P<0.05).Conclusion Group narrative psychological intervention can improve the depression situation of adolescent depression patients, reduce NSSI, and is worthy of clinical application.

This paper analyzes the filling and coding quality of the main diagnosis and main surgery in the medical records of intestinal polyps in the Gastroenterology Department, and explores its impact on DRG grouping. Combining with the DRG grouping results, it analyzes the possible problems in coding and explores the changes in DRG grouping before and after code correction. The study finds that the main reasons for coding errors include that clinical doctors do not pay attention to the selection and filling of the main diagnosis, coders lack clinical knowledge and coding skills, and the return time of pathological reports lags. Therefore, it is recommended to strengthen the standardized training of clinical doctors on filling the front page of medical records, improve the professional level of coders, strengthen the hospital quality control process, and establish a supervision and feedback mechanism, etc., so as to improve the accuracy of coding and the correct rate of DRGs grouping, and provide accurate data information for DRGs payment and the hospital.

Objective Through a systematic analysis of the current situation of the professional identity of integrated medical and elderly care talents and its influencing factors, to provide social support for enhancing the professional identity of relevant talents in integrated medical and elderly care and promoting their professional development. Methods Based on the social interaction theory, a self-designed questionnaire was combined with relevant literature. The survey was carried out around three dimensions of the research objects, namely professional cognitive evaluation, interaction influence, and future choices. Results Currently, the overall professional identity of integrated medical and elderly care talents is not high. There are statistically significant differences in the dimensions of professional cognitive evaluation and future choices in terms of age, the possession of old-age care worker certificates, and educational attainment. Conclusion It is necessary to improve the professional identity of integrated medical and elderly care talents by further strengthening social interaction, improving the professional development mechanism for integrated medical and elderly care talents, and providing personalized guidance and services.

Objective To compare the clinical characteristics, skin care habits in the half year before the first visit, and emotional states in the half year before the first visit of adolescent acne patients of different genders, so as to seek clinical evidence and new ideas for the individualized prevention and treatment of acne. Methods A questionnaire survey was conducted on adolescent acne patients in the dermatology outpatient departments of two Class III Grade A general hospitals in Shandong from December 2023 to March 2024. The questionnaire content included general information, clinical data, skin care habits in the half year before the first visit, emotional states in the half year before the first visit, etc., and the differences among adolescent acne patients of different genders were compared. Results There were statistically significant differences in the age of initial onset and skin care habits in the half year before the first visit among adolescent acne patients of different genders (P < 0.05), while there were no statistically significant differences in the acne affected areas, family history of inheritance, and emotional states in the half year before the first visit (P > 0.05). Conclusion The age of the first visit and the age of initial onset of adolescent acne patients are younger in males than in females. In terms of skin care habits in the half year before the first visit, there are significant differences in skin care methods between males and females. There are no obvious gender differences in the emotions of stress, anxiety, and depression in adolescent acne patients in the half year before the first visit.

Objective To study the fairness of health resource allocation in China's maternal and child health hospitals and provide a reference for further optimizing resource allocation, as maternal and child health hospitals have gradually become an influential part of the medical institutions in China and play a significant role in comprehensively improving the health level of women and children.Methods The Lorenz curve, Gini coefficient, and agglomeration degree were used to analyze the fairness of health resource allocation in China's maternal and child health hospitals from three dimensions: population, economy, and geography.Results (1) The total amount of health resources in China's maternal and child health hospitals is showing an increasing trend; (2) the fairness of resource allocation based on population is better than that based on economy and geographic area; (3) there is a significant regional gap in the health resources of maternal and child health hospitals in China. In terms of geographical distribution fairness, densely populated areas are superior to areas with average or sparse populations; in terms of population distribution fairness, areas with an average population are better than areas with dense or sparse populations.
Conclusion The gap between the supply and demand of health resources in China's maternal and child health hospitals still needs to be filled; it is necessary to focus on improving the fairness of health resource allocation in China's maternal and child health hospitals in terms of geographic dimensions and narrowing the gap in regional health resource allocation.

Objective To investigate the impact of medication adherence on blood pressure control in community-dwelling hypertensive patients. 

Methods A follow-up study was conducted on hypertensive patients managed by the Community Health Service Center of Sanxiang Town, Zhongshan City, Guangdong Province, from January 2022 to December 2023. Participants were provided with home blood pressure monitors to collect self-measured blood pressure data, and antihypertensive prescription information was obtained from local community clinics. Two time periods were set: T₁ (2022) and T₂ (2023). Annual medication adherence indicators and blood pressure control effect indices were extracted for each participant. A cross-lagged model was used to analyze the longitudinal associations and predictive relationships between medication adherence and blood pressure control. 

Results A total of 305 patients were included. In the autoregressive path, the associations between medication adherence and blood pressure control at T₁ and T₂ were statistically significant (P < 0.01), both showing positive correlations. In the cross-lagged path, medication adherence at T₁ predicted blood pressure control at T₂ (β₁ = -0.068, P < 0.05), indicating that better medication adherence was associated with reduced severity of blood pressure exceeding the target level. 

Conclusion Both medication adherence and blood pressure control exhibited certain stability, and medication adherence had a definite predictive significance for subsequent good blood pressure control.

Objective To analyze the effect of tobacco control interventions among rural residents in Tongxiang City, Zhejiang Province, and provide a basis for formulating tobacco control strategies in Tongxiang City. Methods A stratified multi-stage random sampling method was used to select 640 rural permanent residents aged 15–69 years from 4 towns in Tongxiang City as the survey subjects. Tobacco control health interventions were implemented, and the intervention effects were analyzed. 

Results Correct rate of knowledge about tobacco hazards: The correct rate increased from 43.29% before intervention to 68.32% after intervention, with a statistically significant difference (χ²=81.297, P<0.001).Correct rate of knowledge about smoking cessation skills: The correct rate increased from 55.98% before intervention to 72.39% after intervention, with a statistically significant difference (χ²=37.469, P<0.001). Correct rate of knowledge about secondhand smoke handling: The correct rate increased from 29.69% before intervention to 54.69% after intervention, with a statistically significant difference (χ²=82.002, P<0.001). Smoking rate: The smoking rate decreased from 22.97% before intervention to 17.34% after intervention, with a statistically significant difference (χ²=6.291, P=0.012). 

Conclusion After health interventions, the awareness rate of tobacco control knowledge among rural residents significantly increased, and the smoking rate significantly decreased, indicating that the intervention measures are effective and worthy of further promotion.

Objective To explore the potential profile classification of cognitive function in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and analyze the influencing factors of different cognitive function classifications.Methods A convenient sampling of 210 OSAHS patients treated in the First People’s Hospital of Yongkang City from April 2021 to April 2024 was conducted to score cognitive function by using the Montreal Cognitive Assessment Scale (MoCA), and the optimal number of cognitive function categories were analyzed and named by potential profile. Clinical data of patients were collected by using hospital electronic medical record system, and the influencing factors of cognitive function classification were analyzed with univariate analysis and multifactor logistic regression.Results The cognitive function of 210 active OSAHS patients could be classified into three potential categories: 54 cases (25.71%) of low cognitive function, 86 cases (40.95%) of middle cognitive function-low memory, 70 cases (33.33%) of high cognitive function. Multivariate logistic regression analysis showed that age (OR=1.043, 95%CI=1.001-1.088), OSAHS severity (OR=1.694, 95%CI=1.069-2.685), and HSP70 (OR=1.589, 95%CI=1.006-2.509) were independent factors of middle cognitive function-low memory type in OSAHS patients with high cognitive function as reference. Age (OR=1.117, 95%CI=1.055-1.183), smoking history (OR=6.893, 95%CI=2.518-18.867), drinking history (OR=4.972, 95%CI=1.893-13.064), OSAHS severity (OR=2.668, 95%CI=1.441-4.942), HSP70 (OR=2.769, 95%CI=1.484-5.168), GABA (OR=0.940, 95%CI=0.910-0.970) were independent factors of low cognitive function type in OSAHS patients (P<0.05).Conclusion There is a certain heterogeneity in the classification of potential profiles of cognitive function in OSAHS patients. Medical staff can focus on OSAHS patients’ age, lifestyle, condition, HSP70 and GABA levels to classify patients and take appropriate measures to reduce cognitive function impairment.

Objective To investigate the association between the triglyceride-glucose index (TyG) and renal function with the incidence of depression. 

Methods The study population comprised middle-aged and older adults without baseline depression from the UK Biobank database. Exposure variables were the TyG index and renal function. Traditional and additive Cox proportional hazards models were used to estimate the associations between the TyG index, renal function, and depression incidence. 

Results A total of 383,860 eligible participants were included, among whom 20,711 (5.40%) were diagnosed with depression during follow-up. The results showed: - Compared with the lowest TyG quartile (Q1), higher TyG quartiles were associated with a significantly increased risk of depression (HR_Q4 = 1.42, 95%CI: 1.36–1.47; HR_Q3 = 1.27, 95%CI: 1.22–1.32; HR_Q2 = 1.13, 95%CI: 1.09–1.18). - Compared with the normal renal function group, the renal dysfunction group had a significantly higher risk of incident depression (HR_{moderate-severe dysfunction} = 2.14, 95%CI: 1.96–2.33; HR_{mild dysfunction} = 1.32, 95%CI: 1.28–1.36). - No additive (RERI = 0.01, 95%CI: –0.05–0.07) or multiplicative (HR = 0.99, 95%CI: 0.95–1.04) interaction was observed between the TyG index and renal function in relation to depression incidence. 

Conclusion Middle-aged and older adults with a high baseline TyG index or renal dysfunction have a higher risk of depression. Monitoring the TyG index and estimated glomerular filtration rate (eGFR) is recommended for early prevention of depression in this population.

Objective  To analyze the influencing factors of type 2 diabetes mellitus complicated with nephropathy based on biochemical indexes and construct Nomogram prediction model. Methods The data of patients in the complication group and non-complication group were observed to analyze the relevant factors affecting type 2 diabetes mellitus complicating nephropathy; Nomogram prediction model was constructed and validated. Results Compared with patients in the non-complicated group, the patients in the complicated group had higher levels of BMI, disease duration, CysC, HbA1c, BUN, Cr, hs-CRP, UA, lower levels of FCP, HDL-C, UA, and a higher percentage of the presence of insulin resistance (P < 0.05); the AUC of BMI, disease duration, FCPCysC, HDL-C, HbA1c, BUN, Cr, and hs-CRP were 0.702, 0.696, 0.609, 0.690, 0.626, 0.806, 0.647, 0.607, 0.689, 0.655, respectively (P < 0.05); BMI, disease duration, HbA1c, UA, and insulin resistance were the patients with co-morbid nephropathy (P < 0.05); Nomogram model was constructed based on risk variables to predict the risk of comorbid ne-phropathy in patients with type 2 diabetes mellitus with a C-index of 0.753 (95% CI: 0.712-0.769), and the risk threshold of this model was > 0.15; Analysis of the ROC curve based on the validation set showed an AUC of 0.902 (0.844-0.960); H-L goodness-of-fit test showed: χ² = 14.918, P = 0.061 (P > 0.05). Conclusion BMI, disease duration, HbA1c, UA, insulin re-sistance are the influencing factors of type 2 diabetes mellitus patients with comorbid nephropathy, and the constructed Nomogram model has good predictive ability and clinical practical value. It helps to individualize and quantify the assessment of patients with comorbid nephropathy.

Objective：To explore methods for accurately describing the transition state of disease patterns, facilitating the analysis of related impacts caused by disease pattern transitions. 

Methods：Based on the theory of multidimensional vector similarity and distance metrics, a Disease Pattern Distance Index (DPI) was constructed. Using the disease structure data of inpatients in Shenzhen from 2007 to 2022, the study analyzed the changes in disease patterns and their relationship with the average cost per hospitalization. 

Results：Taking 2007 as the baseline, the in-hospital disease pattern distance index in Shenzhen gradually increased, reaching 20.93 by 2022, indicating a gradual change in disease patterns. Among them, the proportions of trauma/toxicity, pregnancy/delivery, and infectious diseases decreased, while the proportions of tumors, urogenital diseases, and musculoskeletal and connective tissue diseases significantly increased. A positive correlation was found between the Disease Pattern Distance Index and the average cost per hospitalization (r = 0.9929, P < 0.01). 

Conclusion：Disease patterns can be characterized by multidimensional vectors, and the method of measuring vector distances can describe the relative relationships between disease patterns.

Objectives To explore the long-term trends in demographic characteristics and survival rates of lung cancer patients in a Grade A tertiary oncology hospital in Guangdong Province from 2000 to 2015, so as to provide epidemiological evidence for lung cancer prevention and control strategies. Methods Information of patients first diagnosed with lung cancer in a large Grade A tertiary oncology hospital from 2000 to 2015 was extracted from the hospital's medical record information system, including demographic data, diagnosis and treatment information, and follow-up data up to December 31, 2020. Stratified analysis was conducted according to diagnosis year (2000-2003, 2004-2006, 2007-2009, 2010-2012, and 2013-2015), gender, and age (<45 years, 45-54 years, 55-64 years, 65-74 years, and ≥75 years). Trend chi-square test was used to analyze the changing trends of the composition ratio of patients in different groups during the observation period; life table method was adopted for survival analysis to evaluate the 5-year survival rate and median survival time of patients; weighted least squares regression model was used to analyze the changing trends of survival rate and median survival time. Results A total of 20,685 patients were included in the final analysis, with 71.0% being male and 29.0% being female. The composition ratio of female patients gradually increased from 24.9% in 2000-2003 to 31.5% in 2013-2015 (χ²=49.449, P<0.001). The overall 5-year survival rate of lung cancer patients increased from 20.3% (95%CI: 18.7%-21.9%) in 2000-2003 to 47.6% (95%CI: 46.0%-49.2%) in 2013-2015, with an average increase of 6.8% every 3 years (95%CI: 4.1%-9.4%). The 5-year survival rate of female patients increased more significantly, from 21.4% (95%CI: 18.1%-24.7%) to 56.3% (95%CI: 53.7%-59.0%), with an average increase of 8.8% every 3 years (95%CI: 6.1%-11.6%); the survival rate of male patients increased from 19.9% (95%CI: 18.1%-21.7%) to 43.3% (95%CI: 41.4%-45.2%), with an average increase of 5.5% every 3 years. Age-stratified analysis showed that the 5-year survival rate of young patients increased more significantly; the median survival time of lung cancer patients in different gender and age groups showed an upward trend, with the median survival time increasing from 1.58 years (2000-2003) to 4.90 years (2013-2015) (P<0.05). Conclusions From 2000 to 2015, the 5-year survival rate and median survival time of lung cancer patients in a Grade A tertiary oncology hospital in Guangdong Province increased significantly. Among them, female and young lung cancer patients had higher 5-year survival rates and a greater annual increase, which was attributed to the continuous improvement of lung cancer diagnosis and treatment quality in Guangdong Province. However, the gradual increase in the composition ratio of female lung cancer patients suggests that further research on the pathogenesis of lung cancer and related influencing factors is needed to provide a basis for the formulation of lung cancer prevention and control strategies.

Objective To scientifically formulate budget targets, integrate the Diagnosis-Related Groups (DRG) tool into budget management, develop a budget preparation method that matches the medical insurance payment method, and improve the level of budget management. Methods Based on 282,701 DRG-related cases from 2022 to 2023, SPSS 25.0 software was used for statistical analysis. An income budget prediction model was established through analysis of variance and regression analysis. Results According to the model prediction, the Case Mix Index (CMI) in 2024 could reach 1.31, the total weight increased by 9.8%, the unit price per weight decreased from 24,662 yuan to 21,570 yuan, the total budgeted income increased by 6.90%, and the average cost increased by 4.67%. Conclusion Integrating medical services into comprehensive budget management in the form of DRG data realizes the refinement of budget management, promotes the transformation of public hospitals' operation mode to value-based healthcare, and contributes to the achievement of strategic goals. 

Objective To analyze the early warning value of glycated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) in the differential diagnosis of type 2 diabetic proliferative retinopathy (PDR). Methods A total of 338 patients with diabetic retinopathy (DR) discharged from hospital between 2019 and 2023 were selected as research subjects. According to the coding rules of the International Classification of Diseases, 10th Revision (ICD-10), they were divided into two groups: the type 2 diabetic non-proliferative retinopathy (NPDR) group (230 cases) and the type 2 diabetic proliferative retinopathy (PDR) group (108 cases).A PDR prediction model was established using logistic regression. The receiver operating characteristic (ROC) curve was adopted to analyze the cut-off points and early warning values of HbA1c and hs-CRP for PDR screening, respectively. Additionally, the decision curve analysis (DCA) was used to compare the fitting effect differences between the initial model and the final model after adding HbA1c and hs-CRP. Results Independent samples t-test results showed that the levels of HbA1c and hs-CRP in the PDR group were significantly higher than those in the type 2 diabetic non-proliferative retinopathy group (P<0.01). ROC curve analysis indicated that the cut-off points of HbA1c and hs-CRP for PDR diagnosis were 9.510% and 1.675 mg/L, respectively, with the areas under the ROC curve (AUC) reaching 0.826 and 0.929 (P<0.01). DCA results revealed that the net benefit of the final model established after including HbA1c and hs-CRP was higher than that of the initial model. The clinical impact curve (CIC) showed that when the threshold probability (Pt) > 0.4, the actual distribution of the final model was close to its predicted distribution, and the fitting degree was significantly improved. Logistic regression results of the final model demonstrated that both HbA1c (OR=6.052, 95% CI: 2.745–13.346) and hs-CRP (OR=1.835, 95% CI: 1.001–3.367) were risk factors for PDR (P<0.05). Conclusion HbA1c and hs-CRP have high early warning value for PDR and are expected to become auxiliary indicators for clinical early warning of DR lesions and differential diagnosis of PDR.

Objective To evaluate the operational efficiency of surgical departments in a tertiary specialized public hospital, establish an Autoregressive Integrated Moving Average (ARIMA) multiplicative seasonal model to predict surgical volume, and provide references for the hospital's operational decision-making. Methods Data Envelopment Analysis (DEA) and Malmquist index method were used for static and dynamic analysis of 13 surgical departments in the target hospital from 2020 to 2023. The ARIMA combined with multiplicative seasonal model was applied to predict the short-term future surgical volume. Results From 2020 to 2023, the proportions of non-DEA efficient surgical departments in the hospital were 30.8%, 46.2%, 23.1% and 46.2% respectively, with accurate recommended values for adjusting input and output quantities. The average values of total factor productivity change index for each year and the four-year period were 0.957, 0.937, 1.051 and 0.980 respectively. The ARIMA multiplicative seasonal model predicted that the hospital's short-term future surgical volume would continue to increase, and the hospital should adjust resource allocation reasonably in advance. Conclusion There are differences in operational efficiency among the surgical departments of the hospital, so differentiated management should be well implemented. It is recommended to flexibly adjust health resource allocation by combining scientific analysis tools such as DEA and ARIMA multiplicative seasonal model. 

Objective To analyze the correlation between psychological resilience and job burnout of nursing staff in the rehabilitation department. Methods From February 26 to May 31, 2024, 102 nursing staff engaged in nursing work in the rehabilitation department were selected as the research subjects. A general information questionnaire, Connor-Davidson Resilience Scale (CD-RISC), and Maslach Burnout Inventory-General Survey (MBI-GS) were used for the survey. Spearman correlation analysis (rs value) was applied to explore the correlation between psychological resilience and job burnout of the nursing staff. Results Among the 102 nursing staff in the rehabilitation department, the total score of CD-RISC (psychological resilience) was 69 (64, 81) [median (interquartile range)], and the total score of MBI-GS (job burnout) was 3 (3, 4) [median (interquartile range)]. The total score of CD-RISC and its dimensions were negatively correlated with the total score of MBI-GS and its dimensions (P < 0.05). Conclusion Psychological resilience of nursing staff in the rehabilitation department is negatively correlated with their job burnout.

Objective To explore the impact of pharmaceutical care under the physician-pharmacist collaboration model on disease control and health behaviors in elderly patients with chronic diseases in the community. Methods A total of 110 elderly patients with chronic diseases in the community were selected and randomly divided into two groups. Patients in the control group were provided with routine medication consultation and guidance, while those in the observation group received pharmaceutical care intervention under the physician-pharmacist collaboration model. The disease control status and health behaviors of patients in the two groups were compared. Results After the intervention, the compliance rates of blood glucose, blood lipid, and blood pressure reaching the standard in the observation group were higher than those in the control group (P<0.05); the rate of good medication adherence in the observation group was higher than that in the control group (P<0.05); and the completion rates of health behaviors such as abiding by the doctor's advice for medication, regular reexamination, healthy diet, and regular work and rest in the observation group were higher than those in the control group (P<0.05). Conclusions For elderly patients with chronic diseases in the community, the application of pharmaceutical care under the physician-pharmacist collaboration model for nursing intervention can effectively control the disease, improve health behaviors, and enhance medication adherence.

Objective To explore the nomogram prediction model for lung cancer patients complicated with lower respiratory tract infection.Methods The data of lung cancer patients admitted to a cancer hospital in Jiangxi Province from July 2020 to July 2023 were analyzed retrospectively. Logistic regression was used to analyze the risk factors for lower respiratory tract infection in lung cancer patients, and R software was applied to construct a nomogram prediction model for the risk factors of lower respiratory tract infection in lung cancer patients.Results Among 200 lung cancer patients, 118 were complicated with lower respiratory tract infection. Multivariate logistic regression analysis showed that ≥3 underlying diseases, combined chemotherapeutic drugs, clinical stage (Stage III-IV), length of hospital stay ≥20 days, invasive procedures, and abuse of antibacterial drugs were independent risk factors for lower respiratory tract infection in lung cancer patients (P < 0.05). The calibration curve of the nomogram prediction model was close to the original curve and the ideal curve, with a C-index of 0.895 (95% CI: 0.851-0.938), indicating a high degree of model fit. When the threshold of the nomogram prediction model was > 0.17, it could provide clinical net benefits.Conclusion The occurrence of lower respiratory tract infection in lung cancer patients is related to factors such as the number of underlying diseases, combined use of chemotherapeutic drugs, and clinical stage (Stage III-IV). Constructing a personalized nomogram prediction model with these factors as predictors is helpful for the predictive assessment of lower respiratory tract infection in lung cancer patients.

Objective To study the influencing factors of in-hospital hemorrhagic transformation in elderly patients with acute ischemic stroke undergoing intravenous thrombolysis, construct a risk prediction model, and explore related countermeasures for early warning and prevention.Methods A total of 195 elderly patients with acute ischemic stroke undergoing intravenous thrombolysis from May 2018 to May 2023 were selected retrospectively as research subjects. They were divided into non-hemorrhagic transformation group (140 cases) and hemorrhagic transformation group (55 cases) according to whether hemorrhagic transformation occurred. General data of patients were collected for comparison; a hemorrhagic transformation prediction model was constructed via multivariate logistic regression analysis, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive efficacy of the model.Results There were statistically significant differences between the two groups in age, presence of hyperlipidemia, presence of atrial fibrillation, time from onset to intravenous thrombolysis, admission NIHSS score, NLR, FPG level, and family history of stroke (P < 0.05). Multivariate logistic regression analysis identified 7 independent risk factors (P < 0.05). For the prediction model, the Hosmer-Lemeshow test showed χ² = 6.536 and P = 0.587. Nomogram validation indicated that the model had an AUC of 0.909 (good discrimination), with a maximum Youden index of 0.659, sensitivity of 0.909, and specificity of 0.750. The theoretical and actual values of the calibration curve showed good consistency.Conclusion The Nomogram model for in-hospital hemorrhagic transformation in elderly patients with acute ischemic stroke undergoing intravenous thrombolysis has good predictive value. It can provide a reference for early screening of high-risk groups and further help formulate more accurate prevention and treatment plans. 

Objective To explore the patterns and context of research in the field of patients' medical care choice, and provide reference for future studies. Methods Using the visual analysis tool CiteSpace, a visual analysis was conducted on domestic literature related to patients' offline medical care choice, which was published between 2013 and 2023 and included in databases such as CNKI, SinoMed, Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform. Results A total of 80 literatures were included. The number of literatures on patients' offline medical care choice showed an overall upward trend, but the total quantity was relatively small. Jiang Jinxing, Zhuo Lang, Zhang Yan, Miao Chunxia, etc., were high-yield authors; Sichuan University, Xuzhou Medical University, and Capital Medical University published a relatively large number of papers. The keyword co-occurrence map showed that keywords such as "medical care choice", "influencing factors", and "hierarchical medical system" had high frequencies; the keyword timeline map was mainly clustered into 9 major thematic clusters, including "primary care first consultation", "medical care choice", "medical care preference", "medical-seeking behavior", "hierarchical medical system", "patients", "health education", "rural patients", and "dermatology". Conclusions It is suggested to strengthen and promote cooperation among scholars, institutions, and regions, continuously supplement and revise existing conclusions based on dynamic changes, provide theoretical support for the formulation of national health policies, and promote the construction of a more reasonable medical system.

Objective To group patients with gastric malignant tumors into Diagnosis-Related Groups (DRGs) using the Exhaustive CHAID (ECHAID) decision tree model, and empirically analyze the influencing factors of inpatient expenses.Methods Retrospectively extract the first-page data of medical records of inpatients with gastric malignant tumors who received treatment in our hospital from June 2022 to August 2024. Taking inpatient expenses as the dependent variable, 16 clinical and expense-related variables including age, gender, main diagnosis, surgical method, and Comorbidity and Complication Index (CCI) were selected as independent variables to construct the ECHAID decision tree model. The model parameters were set as follows: maximum tree depth of 5 layers, minimum sample size of 100 for parent nodes, minimum sample size of 50 for child nodes, and significance level α = 0.05. The average expense and Case Mix Index (CMI) of the terminal DRGs nodes were calculated to form the final DRGs grouping scheme. The 10-fold cross-validation method was used to evaluate the stability of the model.Results The binary logistic multivariate regression model showed that the tolerance and Variance Inflation Factor (VIF) of each index had good discrimination, and there was no multicollinearity. Surgical method, chemotherapy regimen, and Charlson Comorbidity Index were the main factors affecting the median inpatient expenses (P < 0.001). By incorporating surgical method, chemotherapy regimen, and Charlson Comorbidity Index as independent variables into the ECHAID decision model and establishing tree-like nodes, a total of 4 layers with 27 nodes were generated, including 15 DRGs grouping nodes. The range of Coefficient of Variation (CV) was 0.17-0.31, and the range of Relative Weight (RW) was 1.05-3.26, indicating good discrimination between groups. The median of average inpatient expenses among the 15 DRGs groups ranged from 40,321.46 yuan to 128,565.90 yuan, and the over-limit range between groups was 2.27%-3.76%.Conclusion The DRGs grouping scheme for gastric malignant tumors based on the ECHAID decision tree model has good homogeneity and heterogeneity, which can provide a reference for the formulation of relevant payment policies.

Objective To conduct a retrospective analysis of 2,789 death cases in a tertiary grade A hospital in a certain prefecture-level city from 2019 to 2023, explore the factors related to deceased patients, and provide a reference basis for continuously improving the level of treatment and reducing the mortality rate. Methods The first-page information of inpatient medical records from 2019 to 2023 was collected using the medical record statistics system. Combined with the International Classification of Diseases (ICD) rules, Excel 2007 and SPSS 19.0 software were used to conduct statistical analysis on the data of 2,789 deceased patients. Statistical charts were used to describe the distribution differences in mortality rates across different years, genders, age groups, emergency/critical care patients, and low-risk groups. The composition and ranking of the main causes of death (by disease category) and the composition and ranking of specific disease types of the main causes of death among inpatient deceased patients were analyzed, and the chi-square test (χ² test) was used for inter-group comparison.Results Over the 5-year period from 2019 to 2023, the mortality rate of the hospital was 0.61%, and the male-to-female ratio of inpatients was 1:1.07. The mortality rate was 0.80% for male patients and 0.43% for female patients. The age group with the highest mortality rate among deceased patients was those aged 81 years and above (3.2%), followed by the 71-80 years group (1.11%). In terms of the proportion of deaths by age group, the 71-80 years group accounted for the highest proportion (24.60%), followed by the 61-70 years group (22.30%). The top 3 disease categories in terms of the proportion of causes of death were tumors (29.94%), circulatory system diseases (28.11%), and respiratory system diseases (11.98%). The top 3 specific disease types causing death were acute myocardial infarction, lung cancer, and intracranial injury. Patients admitted with acute conditions had the highest mortality rate (5.51%), followed by those admitted with critical conditions (0.67%). A total of 88 patients died in the low-risk group over the 5 years, with a low-risk group mortality rate of 0.36‰. The highest low-risk group mortality rate in the 5 years was in 2022 (0.64‰), and the lowest was in 2023 (0.11‰).Conclusion To improve the comprehensive service capacity of disease diagnosis and treatment in tertiary public hospitals, it is necessary to optimize the allocation of hospital resources, strengthen the discipline construction and specialized service capacity of departments such as oncology, cardiovascular medicine, and critical care medicine, continuously enhance the ability and level of diagnosis and treatment of difficult and critical diseases, and promote the high-quality development of the hospital.

The concept of Outcome-Based Education (OBE) is an advanced educational philosophy. In the design of the teaching syllabus for Medical Statistics based on the OBE concept, students should be the main focus of teaching objectives, and teaching activities should be centered on students. Attention should be paid not only to "cultivating professional talents" but also to "fostering moral integrity". On one hand, it is necessary to add competence objectives, deepen affective objectives, and strengthen the integration of ideological and political education into the curriculum within the connotation of course objectives. On the other hand, it is essential to incorporate higher-order thinking skill objectives to enhance students' ability to solve practical problems using statistical thinking and methods. In the design of teaching activities, the amount of assignments should be increased—requiring students to complete relevant research designs and the writing of papers/reports—so that students can "stay engaged" in "doing assignments" during their spare time.

Objective: To construct a WeChat-based remote rehabilitation nursing program for patients with Alzheimer's disease and evaluate its effect, so as to provide a reference for the rehabilitation nursing of Alzheimer's disease. Method: From June 2022 to June 2024, based on literature analysis, two rounds of expert letter consultations were conducted to revise the items and construct the WeChat-based remote rehabilitation nursing program; the program was initially applied in 300 patients with Alzheimer's disease, and its effect was evaluated. Result: The effective recovery rate of the two rounds of expert letter consultation questionnaires was 100%. The expert authority coefficient was 0.88, the coefficient of variation was 0.05-0.21, and the Kendall's coordination coefficients were 0.211 and 0.095 respectively. After the application of the program, the patients' depression level, quality of life and language function were all improved compared with those before the application, and the differences were statistically significant (P < 0.05). Conclusion: The WeChat-based remote rehabilitation nursing program for patients with Alzheimer's disease constructed in this study has good scientificity and practicability, and can provide a reference for the implementation of rehabilitation nursing for patients with Alzheimer's disease.

Objective To analyze the influencing factors of depression risk among the urban and rural elderly in China, and conduct a comparison between urban and rural areas.Methods Based on the 2018 China Health and Retirement Longitudinal Study (CHARLS) data, a total of 7,690 elderly individuals aged 60 years and above were included as the research subjects. Binary logistic regression model and decision tree model were used to conduct multivariate analysis on the depression risk of the urban and rural elderly. Additionally, the prediction accuracy of the two models and the screened influencing factors were compared. Results (1) The detection rate of high depression risk among the 7,690 elderly individuals was 30.73%, with 21.5% in urban areas and 43.0% in rural areas.
(2) Gender, educational level, self-rated health, and chronic diseases were common influencing factors for depression risk among both urban and rural elderly. High depression risk in the urban elderly was associated with social activities, while depression risk in the rural elderly was associated with wage income and sleep.(3) The correct prediction rates of the logistic regression model for the influencing factors of depression in the urban and rural elderly were 82.5% and 74.3% respectively, and those of the decision tree model were 81.5% and 73.4% respectively. The prediction effect of the logistic regression model was better than that of the decision tree model.Conclusion There are significant urban-rural differences in the proportion of high depression risk and its influencing factors among the elderly in China.