Irrational drug use and prescription safety are pressing global concerns.The World Health Organization estimated that over half of all prescriptions worldwide contain errors,leading to substantial harm[1,2].In China,p...Irrational drug use and prescription safety are pressing global concerns.The World Health Organization estimated that over half of all prescriptions worldwide contain errors,leading to substantial harm[1,2].In China,prescription errors occur at a rate of 32%,and improper medication use is reported in over 70%of households[3,4].Vulnerable populations,including children(16.7%)and older adults(30.4%),are particularly affected[5].展开更多
In recent years,gratitude intervention,as an application method of positive psychology,has gradually attracted the attention of researchers.Gratitude intervention is considered to be an effective psychological interve...In recent years,gratitude intervention,as an application method of positive psychology,has gradually attracted the attention of researchers.Gratitude intervention is considered to be an effective psychological intervention,especially in patients with malignant tumors.This study reviews the research progress of gratitude intervention in patients with malignant tumors,focusing on the mechanism,implementation methods,effect evaluation and challenges in clinical application of gratitude intervention,in the hope of providing a theoretical support and practical guideline for future research and practice.展开更多
In Eastern medicine,an individual’s health and longevity is believed to depend on the balance of their metabolic energies,classified as body constitution.Traditional Mongolian Medicine categorizes the body into seven...In Eastern medicine,an individual’s health and longevity is believed to depend on the balance of their metabolic energies,classified as body constitution.Traditional Mongolian Medicine categorizes the body into seven constitution types based on metabolic dominance,influencing physical traits,behavioral tendencies,disease susceptibility,and adaptability to environmental factors.This study aims to analyze the principles of disease prevention based on body constitution in Eastern medicine,with a focus on Traditional Mongolian and Tibetan medical perspectives.It looks to clarify body constitution classifications,explore dietary management strategies,and highlight their significance in maintaining health and preventing diseases.This study adopts a literature review approach,incorporating source analysis,synthesis,and hermeneutic methodology to examine traditional medical theories related to body constitution.Classical texts from Traditional Tibetan medicine,including the rGyud-bZhi and Golden Subtitles,were analyzed alongside comparative research on Traditional Chinese and Korean constitutional medicine.The study integrates historical perspectives with modern biomedical insights to establish a comprehensive understanding of constitution-based health management.The findings indicate that the three principal metabolic energies—rLung,mKhris,and Bad-Kan—serve as symbolic codes representing physiological and metabolic states.By recognizing their body constitution,individuals can adopt constitutionally tailored dietary and lifestyle practices to maintain balance and prevent diseases.A comparative analysis reveals similarities and differences among different Eastern medical systems,while still demonstrating the potential for integrating constitutional medicine with modern healthcare approaches.展开更多
Amid the global wave of digital economy,China's medical artificial intelligence applications are rapidly advancing through technological innovation and policy support,while facing multifaceted evaluation and regul...Amid the global wave of digital economy,China's medical artificial intelligence applications are rapidly advancing through technological innovation and policy support,while facing multifaceted evaluation and regulatory challenges.The dynamic algorithm evolution undermines the consistency of assessment criteria,multimodal systems lack unified evaluation metrics,and conflicts persist between data sharing and privacy protection.To address these issues,the China National Health Development Research Center has established a value assessment framework for artificial intelligence medical technologies,formulated the country's first technical guideline for clinical evaluation,and validated their practicality through scenario-based pilot studies.Furthermore,this paper proposes introducing a"regulatory sandbox"model to test technical compliance in controlled environments,thereby balancing innovation incentives with risk governance.展开更多
Human cytomegalovirus(HCMV)poses a significant risk of neural damage during pregnancy.As the most prevalent intrauterine infectious agent in low-and middle-income countries,HCMV disrupts the development of neural stem...Human cytomegalovirus(HCMV)poses a significant risk of neural damage during pregnancy.As the most prevalent intrauterine infectious agent in low-and middle-income countries,HCMV disrupts the development of neural stem cells,leading to fetal malformations and abnormal structural and physiological functions in the fetal brain.This review summarizes the current understanding of how HCMV infection dysregulates the Wnt signaling pathway to induce fetal malformations and discusses current management strategies.展开更多
Climate is one of the environmental conditions on which people live.Climate conditions impact every aspect of people's daily life and production activities,even the survival of humankind.In recent years,human acti...Climate is one of the environmental conditions on which people live.Climate conditions impact every aspect of people's daily life and production activities,even the survival of humankind.In recent years,human activities have adversely changed the climate.The emergence of global warming and extreme weather has prompted people to pay attention to the impact of climate on life.The adverse climate issues include reduced quality of air and food,facilitated spread of diseases and increased mortality of the population.Being more orientated to climate changes in the past,research has been less alerted to the negative impacts that climate changes could bring to human health.This could be ascribed to that after living in a region for a long time,the human body has"adapted"to climate.And after adaptation,routine health outcomes such as disease incidence and hospitalization rate become less obvious,making the habitants blind from the undesirable impacts of climate on the health status.This review article summarizes the impacts of cold climate on human development,including maternal/fetal factors,lifestyle factors,etc.,and delineates the relationship between cold climate and human health.展开更多
Objective To summarize the application of real-world evidence(RWE)in the medical and healthcare field of various countries,including relevant policies,application scenarios and application methods.Methods Relevant pol...Objective To summarize the application of real-world evidence(RWE)in the medical and healthcare field of various countries,including relevant policies,application scenarios and application methods.Methods Relevant policies and application scenarios were obtained by consulting the official websites and public documents of various countries’healthcare institutions.Systematic literature retrieval was adopted to search PubMed,EMBASE,Cochrane Library,CNKI,CBM and Wanfang databases,and all papers related to real-world study and application were included.Then,these papers were classified and analyzed by country and application method.Results and Conclusion The RWE was mainly applied to supporting the preliminary approval of a new drug,expanding drug indications,accelerating approval or supporting conditional marketing authorizations and drug safety evaluation,etc.The United Kingdom,the United States,Germany,the Netherlands,Italy,Sweden,and France admitted RWE,but they treated the data obtained from RWE with caution.After systematic literature retrieval,a total of 701 articles were obtained,including relevant studies from 36 countries,among which the United States published 264 in total.The most common study was about using real-world data(RWD)to calculate treatment-related costs,which had a total of 259 studies.Secondly,158 articles were used for epidemiological analysis.Then,138 articles were about establishing risk models to analyze disease risk factors.A total of 70 articles were real-world efficacy evaluation of the drug treatment schemes,54 articles were about pharmacoeconomic evaluation with RWD as parameters.A total of 29 articles used RWD to build predictive models,and 15 articles used RWD to evaluate the health-related quality of life in patients.The application of RWE has been used widely in the medical and healthcare field of various countries.The application scenarios are gradually diversified,the application methods of RWD become mature,and the evidence quality of RWE is also improved greatly.展开更多
BACKGROUND Gastrointestinal neoplasm(GN)significantly impact the global cancer burden and mortality,necessitating early detection and treatment.Understanding the evolution and current state of research in this field i...BACKGROUND Gastrointestinal neoplasm(GN)significantly impact the global cancer burden and mortality,necessitating early detection and treatment.Understanding the evolution and current state of research in this field is vital.AIM To conducts a comprehensive bibliometric analysis of publications from 1984 to 2022 to elucidate the trends and hotspots in the GN risk assessment research,focusing on key contributors,institutions,and thematic evolution.METHODS This study conducted a bibliometric analysis of data from the Web of Science Core Collection database using the"bibliometrix"R package,VOSviewer,and CiteSpace.The analysis focused on the distribution of publications,contributions by institutions and countries,and trends in keywords.The methods included data synthesis,network analysis,and visualization of international collaboration networks.RESULTS This analysis of 1371 articles on GN risk assessment revealed a notable evolution in terms of research focus and collaboration.It highlights the United States'critical role in advancing this field,with significant contributions from institutions such as Brigham and Women's Hospital and the National Cancer Institute.The last five years,substantial advancements have been made,representing nearly 45%of the examined literature.Publication rates have dramatically increased,from 20 articles in 2002 to 112 in 2022,reflecting intensified research efforts.This study underscores a growing trend toward interdisciplinary and international collaboration,with the Journal of Clinical Oncology standing out as a key publication outlet.This shift toward more comprehensive and collaborative research methods marks a significant step in addressing GN risks.CONCLUSION This study underscores advancements in GN risk assessment through genetic analyses and machine learning and reveals significant geographical disparities in research emphasis.This calls for enhanced global collaboration and integration of artificial intelligence to improve cancer prevention and treatment accuracy,ultimately enhancing worldwide patient care.展开更多
Constraint-induced movement therapy is an effective rehabilitative training technique used to improve the restoration of impaired upper extremity movement after stroke. However, whether constraint-induced movement the...Constraint-induced movement therapy is an effective rehabilitative training technique used to improve the restoration of impaired upper extremity movement after stroke. However, whether constraint-induced movement therapy is more effective than conventional rehabilitation in acute or sub-acute stroke remains controversial. The aim of the present study was to identify the optimal time to start constraint-induced movement therapy after ischemic stroke and to explore the mechanisms by which constraint-induced movement therapy leads to post-stroke recovery. Sixty-four adult male Sprague-Dawley rats were randomly divided into four groups: sham-surgery group, cerebral ischemia/reperfusion group, early constraint-induced movement therapy group, and late constraint-induced movement therapy group. Rat models of left middle cerebral artery occlusion were established according to the Zea Longa line embolism method. Constraint-induced movement therapy was conducted starting on day 1 or day 14 in the early constraint-induced movement therapy and late constraint-induced movement therapy groups, respectively. To explore the effect of each intervention time on neuromotor function, behavioral function was assessed using a balance beam walking test before surgery and at 8 and 21 days after surgery. The expression levels of brain-derived neurotrophic factor, nerve growth factor and Nogo receptor were evaluated using real time-polymerase chain reaction and western blot assay to assess the effect of each intervention time. The results showed that the behavioral score was significantly lower in the early constraint-induced movement therapy group than in the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. At 21 days, the scores had significantly decreased in the early constraint-induced movement therapy and late constraint-induced movement therapy groups. At 8 days, only mild pyknosis appeared in neurons of the ischemic penumbra in the early constraint-induced movement therapy group, which was distinctly better than in the cerebral ischemia/reperfusion group. At 21 days, only a few vacuolated cells were observed and no obvious inflammatory cells were visible in late constraint-induced movement therapy group, which was much better than at 8 days. The mRNA and protein expression levels of brain-derived neurotrophic factor and nerve growth factor were significantly higher, but expression levels of Nogo receptor were significantly lower in the early constraint-induced movement therapy group compared with the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. The changes in expression levels at 21 days were larger but similar in both the early constraint-induced movement therapy and late constraint-induced movement therapy groups. Besides, the protein nerve growth factor level was higher in the late constraint-induced movement therapy group than in the early constraint-induced movement therapy group at 21 days. These results suggest that both early(1 day) and late(14 days) constraint-induced movement therapy induces molecular plasticity and facilitates functional recovery after ischemic stroke, as illustrated by the histology. The mechanism may be associated with downregulation of Nogo receptor expression and upregulation of brain-derived neurotrophic factor and nerve growth factor expression.展开更多
Mammography is carried out in a special position, i.e. “an image is taken while the breast is compressed, stretched and kept in a fixed position”. The purpose of this study was to demonstrate quantitatively and qual...Mammography is carried out in a special position, i.e. “an image is taken while the breast is compressed, stretched and kept in a fixed position”. The purpose of this study was to demonstrate quantitatively and qualitatively the physical and psychological burden due to positioning and breast compression during mammography. Muscle activity of each part of the body during positioning for the standard imaging method, to obtain craniocaudal (CC) view images, was measured in 15 adult females using surface EMG. The associated pain was analyzed using visual analogue scale (VAS) scores. During positioning for the CC view, muscle activity was highest in the biceps (24.44 iEMG/s) followed by the trapezius (17.78 iEMG/s) on the imaging side. Muscle activity of the biceps and the sternocleidomastoid on the imaging side showed significant differences compared with pre-imaging activity (biceps P < 0.031, sternocleidomastoid P < 0.005). The pain during mammography was rated as moderate to severe pain (VAS = 3.3 - 6.7) for CC views. As a result, the activities of not only the muscles directly involved in mammography positioning but also those indirectly involved were high as compared with the normal state. Measurement of muscle activity during mammography is expected to be used effectively, such as in the care to reduce pain for the subjects.展开更多
[Objectives]Based on the related literature of benefit finding in China National Knowledge Infrastructure(CNKI),this paper analyzes the research status,hot spots and trends in this field.[Methods]To search for the rel...[Objectives]Based on the related literature of benefit finding in China National Knowledge Infrastructure(CNKI),this paper analyzes the research status,hot spots and trends in this field.[Methods]To search for the related literature on benefit finding in China National Knowledge Infrastructure(CNKI),and use Citespace software to visually analyze the number of papers,authors,institutions and keywords.[Results]A total of 204 related papers were obtained,and the annual number of published papers showed a gradual increasing trend.The authors of published papers were represented by Zhang Fenglan,Liu Zhunzhun and Zhang Ting,and the Nursing College of Anhui Medical University published the most papers.The research focus was on social support,coping method and other influencing factors,and qualitative research was the main research type.The key population was breast cancer,stroke patients and their caregivers,and the development trend focused on reliability and validity test and correlation analysis.[Conclusions]The field of benefit finding in China is in the initial exploration stage,and there is little cooperation and exchange between authors and institutions.In the future,academic exchanges and multidisciplinary assistance should be strengthened to promote the rapid development of this field.展开更多
Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adu...Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adults with multidrug-resistant tuberculosis(MDR-TB)in China.Methods A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years.The model parameter data were synthesized from the literature,the national TB surveillance information system,and consultation with experts.The incremental cost-effectiveness ratio(ICER)of BR vs.CR was determined.Results BR(vs.CR)had a higher sputum culture conversion rate and cure rate and prevented many premature deaths(decreased by 12.8%),thereby obtaining more quality-adjusted life years(QALYs)(increased by 2.31 years).The per capita cost in BR was as high as 138,000 yuan,roughly double that of CR.The ICER for BR was 33,700 yuan/QALY,which was lower than China's 1×per capita Gross Domestic Product(GDP)in 2020(72,400 yuan).Conclusion BR is shown to be cost effective.When the unit price of Bedaquiline reaches or falls below57.21 yuan per unit,BR is expected to be the dominant strategy in China over CR.展开更多
About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is asso...About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is associated with liver disease progression,cirrhosis,hepatocellular carcinoma,and liver-related mortality.The extrahepatic manifestations of CHC further add to the disease burden of patients.Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society.Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease.Traditionally,pegylatedinterferon plus ribavirin(PR)was the standard of care.However,a substantial number of patients are ineligible for PR treatment,and only 40%–75%achieved sustained virologic response.Furthermore,PR is associated with impairment of patient-reported outcomes(PROs),high rates of adverse events,and poor adherence.With the advent of direct acting antivirals(DAAs),the treatment of CHC patients has been revolutionized.DAAs have broader eligible patient populations,higher efficacy,better PRO profiles,fewer adverse events,and better adherence rates,thereby making it possible to cure a large proportion of all CHC patients.This article aims to provide a comprehensive evaluation on the value of effective,curative hepatitis C treatment from the clinical,economic,societal,and patient experience perspectives,with a focus on recent data from China,supplemented with other Asian and international experiences where China data are not available.展开更多
Objectives: To evaluate the impact of external-care-seeking, explore the framework to regulate patients’ seeking doctor behavior and to promote better medical resources allocation. Methods: Obtaining data from regula...Objectives: To evaluate the impact of external-care-seeking, explore the framework to regulate patients’ seeking doctor behavior and to promote better medical resources allocation. Methods: Obtaining data from regular reports from public medical institutions in Shanghai, comparing patients who seek doctors from out-of-Shanghai residence and local patients with insurance in terms of the quantity of service, types of diseases, medical expenses, etc. Results: External-care-seeking has a large quantity, especially in hospitalization. In 2012, the number of discharged population from out-of-Shanghai accounted for 22.74% of the total discharged number, the proportion even higher than 30% in tertiary hospitals. Tertiary hospitals have a significant attraction effect, concentrating 59.42% of the outpatient and emergency visits and 71.82% of the amount of hospitalization, with corresponding cost of 75.86% and 82.56%. The top three divisions in tertiary hospitals for external-care-seeking were surgical, obstetrics and gynecology, internal medicine. Based on the interview, admitting out-of-shanghai patients is conducive to the improvement of the technical level of hospitals, and to the enhancement of the utilization efficiency of health resource. However, the local residents may have less accessibility of high quality of medical service. The average expense of external-care-seeking is higher than that of local patients happened in the same level of hospitals. Conclusions: External-care-seeking will have a more far-reaching impact on the health care system in Shanghai;some interventions might be necessary, such as rationally allocating medical resources based on the estimates of external-care-seeking and establishing a medical service supervision mechanism.展开更多
Medical artificial intelligence (AI) in China is now on the eve of a massive surge. Despite great promise from this emerging field, there remain formidable pitfalls and obstacles, especially the challenges to current ...Medical artificial intelligence (AI) in China is now on the eve of a massive surge. Despite great promise from this emerging field, there remain formidable pitfalls and obstacles, especially the challenges to current legal rules. We review the development of legal rules concerning medical AI in China, discuss risks of liability of commercial organizations and health care providers and whether current rules should be amended, and if so, what are the key issues to be addressed. Finally, we close by sketching possible ways forward for the legal and regulatory system.展开更多
Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedic...Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.展开更多
Objective To systematically review the published clinical and economic research on liposomal irinotecan in combination with 5-FU/LV for metastatic pancreatic ductal adenocarcinoma(mPDAC)at home and abroad.Methods PubM...Objective To systematically review the published clinical and economic research on liposomal irinotecan in combination with 5-FU/LV for metastatic pancreatic ductal adenocarcinoma(mPDAC)at home and abroad.Methods PubMed,Cochrane Library,Embase,CBM,CNKI,Wan Fang data,CRD database and health technology assessment official websites were searched to collect clinical and economic studies on liposomal irinotecan for mPDAC.Results and Conclusion Nine clinical studies and four economic studies were included.The result of clinical studies showed that liposomal irinotecan in combination with 5-FU/LV could extend survival with good drug compliance in patients with mPDAC who progressed on prior gemcitabine-based therapy.This agent represented a new treatment option for second-line chemotherapy in these patients.The results of the economic evaluations failed to reach a consistent conclusion due to different economic levels in various countries.展开更多
Objective To review the domestic and foreign economic studies on CDK4/6 inhibitors in first-line or second-line treatment of HR+/HER2-advanced breast cancer,and to analyze the main methodologies and research results.M...Objective To review the domestic and foreign economic studies on CDK4/6 inhibitors in first-line or second-line treatment of HR+/HER2-advanced breast cancer,and to analyze the main methodologies and research results.Methods Systematic literature review was used to search PubMed,EMBASE,Cochrane Library,CNKI,CBM,and Wanfang database.The incremental cost-effectiveness ratio was taken as the main outcome index,and all pharmacoeconomic evaluations with CDK4/6 inhibitors as intervention measures were included,such as Palbociclib,Ribociclib,and Abemaciclib.According to the Quality of Health Economic Studies Instrument,the quality of the included articles was evaluated,and then the included literature was analyzed.Results and Conclusion A total of 16 pharmacoeconomic evaluation studies were included,mainly from the perspective of national healthcare systems or third-party payers.Only 2 studies focused on second-line treatment,and the remaining treatment levels were first-line treatment.In terms of model structure,7 studies adopted the Markov model,6 studies adopted the PSM model,and 3 studies adopted the DES model.The basic analysis results showed that CDK4/6 inhibitor combined with endocrine regimen was not economical compared with endocrine alone regimen when the threshold was the conventional willingness to pay(WTP)value of each country.The uncertainty analysis included deterministic sensitivity analysis and probability sensitivity analysis.The included studies are all Cost-Utility Analysis with high-quality evaluation,which can provide evidence support for health-related decision-makers in decision-making.It can also provide methodological reference for the economic evaluation of other targeted drugs.展开更多
This paper explores the expansion from fintech-based regulatory sandboxes to those that include medical artificial intelligence(AI)by examining their potential to foster innovation and accelerate market access while e...This paper explores the expansion from fintech-based regulatory sandboxes to those that include medical artificial intelligence(AI)by examining their potential to foster innovation and accelerate market access while ensuring safety and compliance,especially considering how they provide a flexible framework for medical AI companies to develop and test new technologies.This work also highlights the key risks involved,including data privacy,ethical concerns,real-world validation,and regulatory consistency,and proposes strategies for mitigation.Using case studies from the United States,the United Kingdom,the European Union,Indonesia,Japan,and China,this paper illustrates how regulatory sandboxes can support AI-driven healthcare innovation.Overall,although regulatory sandboxes present several risks,they are valuable for advancing medical AI,granted that they balance innovation with robust oversight to ensure patient safety and long-term benefits.展开更多
Objectives:To analyze the satisfaction of patients with community health service(CHS)and the changes of the CHS delivered before and after the new health reform in different regions of China,and to put forward relevan...Objectives:To analyze the satisfaction of patients with community health service(CHS)and the changes of the CHS delivered before and after the new health reform in different regions of China,and to put forward relevant policy recommendations for CHS development.Methods:Twelve community health centers were selected by random sampling in each of the eight typical cities in the east,middle and west regions of China.Questionnaire survey was conducted among patients visiting these institutions during daily work hours.Results:The proportions of the participants who stated that the medical environment,service attitude and medical skills of the doctors were improved were higher in the west region than those of the east and middle regions;but the percentage of patients who held that the drug price had lowered was higher in the east region than those of the middle and west region,the differences were of statistical significance(P<0.0125).The patients’satisfaction rates with medical environment,service attitude,and technical skills of the medical staff in the west region were 88.9%,91.5%and 81.6%respectively,which were higher than those in the east and middle regions.In the east region,the satisfaction rate with the reimbursement for this visit was 58.5%,which was highest among the three regions;in the west region,patients’satisfaction rates with drug types and preventive care were 51.5%and 65.9%,respectively,which was significantly higher than those in the east and middle regions(P<0.0125).As recommended by the participants,the top three aspects of health services that need to be improved were drug type and quality(25.3%),drug prices(21.8%)and technical skills(18.2%)in the east region;infrastructure(28.2%),drug prices(21.8%)and drug types and quality(21.2%)in the middle region;infrastructure(30.8%),drug types and quality(28.1%)and reimbursement(27.9%)in the west region.Conclusions:The comprehensive CHS reform should take the opinions of patients into account;essential drug system should be consolidated continually;and the reform of the payment system should be promoted by actively cooperating with the health insurance organizations.展开更多
基金supported by the Ministry of Science and Technology of the People’s Republic of China under the“New Generation Artificial Intelligence”Major Project of Science and Technology Innovation 2030(2020AAA0105002).
文摘Irrational drug use and prescription safety are pressing global concerns.The World Health Organization estimated that over half of all prescriptions worldwide contain errors,leading to substantial harm[1,2].In China,prescription errors occur at a rate of 32%,and improper medication use is reported in over 70%of households[3,4].Vulnerable populations,including children(16.7%)and older adults(30.4%),are particularly affected[5].
基金Supported by the National Natural Science Foundation of China(71774049).
文摘In recent years,gratitude intervention,as an application method of positive psychology,has gradually attracted the attention of researchers.Gratitude intervention is considered to be an effective psychological intervention,especially in patients with malignant tumors.This study reviews the research progress of gratitude intervention in patients with malignant tumors,focusing on the mechanism,implementation methods,effect evaluation and challenges in clinical application of gratitude intervention,in the hope of providing a theoretical support and practical guideline for future research and practice.
文摘In Eastern medicine,an individual’s health and longevity is believed to depend on the balance of their metabolic energies,classified as body constitution.Traditional Mongolian Medicine categorizes the body into seven constitution types based on metabolic dominance,influencing physical traits,behavioral tendencies,disease susceptibility,and adaptability to environmental factors.This study aims to analyze the principles of disease prevention based on body constitution in Eastern medicine,with a focus on Traditional Mongolian and Tibetan medical perspectives.It looks to clarify body constitution classifications,explore dietary management strategies,and highlight their significance in maintaining health and preventing diseases.This study adopts a literature review approach,incorporating source analysis,synthesis,and hermeneutic methodology to examine traditional medical theories related to body constitution.Classical texts from Traditional Tibetan medicine,including the rGyud-bZhi and Golden Subtitles,were analyzed alongside comparative research on Traditional Chinese and Korean constitutional medicine.The study integrates historical perspectives with modern biomedical insights to establish a comprehensive understanding of constitution-based health management.The findings indicate that the three principal metabolic energies—rLung,mKhris,and Bad-Kan—serve as symbolic codes representing physiological and metabolic states.By recognizing their body constitution,individuals can adopt constitutionally tailored dietary and lifestyle practices to maintain balance and prevent diseases.A comparative analysis reveals similarities and differences among different Eastern medical systems,while still demonstrating the potential for integrating constitutional medicine with modern healthcare approaches.
文摘Amid the global wave of digital economy,China's medical artificial intelligence applications are rapidly advancing through technological innovation and policy support,while facing multifaceted evaluation and regulatory challenges.The dynamic algorithm evolution undermines the consistency of assessment criteria,multimodal systems lack unified evaluation metrics,and conflicts persist between data sharing and privacy protection.To address these issues,the China National Health Development Research Center has established a value assessment framework for artificial intelligence medical technologies,formulated the country's first technical guideline for clinical evaluation,and validated their practicality through scenario-based pilot studies.Furthermore,this paper proposes introducing a"regulatory sandbox"model to test technical compliance in controlled environments,thereby balancing innovation incentives with risk governance.
基金supported by the Natural Science Foundation of Shandong Province(ZR2019MC059)the Traditional Chinese Medicine Science Project of Shandong Province(M-2023093)the Weifang Municipal Science and Technology Development Program(2025YX037).
文摘Human cytomegalovirus(HCMV)poses a significant risk of neural damage during pregnancy.As the most prevalent intrauterine infectious agent in low-and middle-income countries,HCMV disrupts the development of neural stem cells,leading to fetal malformations and abnormal structural and physiological functions in the fetal brain.This review summarizes the current understanding of how HCMV infection dysregulates the Wnt signaling pathway to induce fetal malformations and discusses current management strategies.
文摘Climate is one of the environmental conditions on which people live.Climate conditions impact every aspect of people's daily life and production activities,even the survival of humankind.In recent years,human activities have adversely changed the climate.The emergence of global warming and extreme weather has prompted people to pay attention to the impact of climate on life.The adverse climate issues include reduced quality of air and food,facilitated spread of diseases and increased mortality of the population.Being more orientated to climate changes in the past,research has been less alerted to the negative impacts that climate changes could bring to human health.This could be ascribed to that after living in a region for a long time,the human body has"adapted"to climate.And after adaptation,routine health outcomes such as disease incidence and hospitalization rate become less obvious,making the habitants blind from the undesirable impacts of climate on the health status.This review article summarizes the impacts of cold climate on human development,including maternal/fetal factors,lifestyle factors,etc.,and delineates the relationship between cold climate and human health.
文摘Objective To summarize the application of real-world evidence(RWE)in the medical and healthcare field of various countries,including relevant policies,application scenarios and application methods.Methods Relevant policies and application scenarios were obtained by consulting the official websites and public documents of various countries’healthcare institutions.Systematic literature retrieval was adopted to search PubMed,EMBASE,Cochrane Library,CNKI,CBM and Wanfang databases,and all papers related to real-world study and application were included.Then,these papers were classified and analyzed by country and application method.Results and Conclusion The RWE was mainly applied to supporting the preliminary approval of a new drug,expanding drug indications,accelerating approval or supporting conditional marketing authorizations and drug safety evaluation,etc.The United Kingdom,the United States,Germany,the Netherlands,Italy,Sweden,and France admitted RWE,but they treated the data obtained from RWE with caution.After systematic literature retrieval,a total of 701 articles were obtained,including relevant studies from 36 countries,among which the United States published 264 in total.The most common study was about using real-world data(RWD)to calculate treatment-related costs,which had a total of 259 studies.Secondly,158 articles were used for epidemiological analysis.Then,138 articles were about establishing risk models to analyze disease risk factors.A total of 70 articles were real-world efficacy evaluation of the drug treatment schemes,54 articles were about pharmacoeconomic evaluation with RWD as parameters.A total of 29 articles used RWD to build predictive models,and 15 articles used RWD to evaluate the health-related quality of life in patients.The application of RWE has been used widely in the medical and healthcare field of various countries.The application scenarios are gradually diversified,the application methods of RWD become mature,and the evidence quality of RWE is also improved greatly.
基金Supported by National Natural Science Foundation of China,No.72104183Shanghai Municipal Health Commission Project,No.20234Y0057+4 种基金Shanghai Sailing Program,No.20YF1444900Shanghai Hospital Association Project,No.X2022142Projects of the Committee of Shanghai Science and Technology,No.20Y11913700Guangdong Association of Clinical Trials(GACT)/Chinese Thoracic Oncology Group(CTONG)and Guangdong Provincial Key Lab of Translational Medicine in Lung Cancer,No.2017B030314120Beijing CSCO(Sisco)Clinical Oncology Research Grant,No.Y-HS202101-0205.
文摘BACKGROUND Gastrointestinal neoplasm(GN)significantly impact the global cancer burden and mortality,necessitating early detection and treatment.Understanding the evolution and current state of research in this field is vital.AIM To conducts a comprehensive bibliometric analysis of publications from 1984 to 2022 to elucidate the trends and hotspots in the GN risk assessment research,focusing on key contributors,institutions,and thematic evolution.METHODS This study conducted a bibliometric analysis of data from the Web of Science Core Collection database using the"bibliometrix"R package,VOSviewer,and CiteSpace.The analysis focused on the distribution of publications,contributions by institutions and countries,and trends in keywords.The methods included data synthesis,network analysis,and visualization of international collaboration networks.RESULTS This analysis of 1371 articles on GN risk assessment revealed a notable evolution in terms of research focus and collaboration.It highlights the United States'critical role in advancing this field,with significant contributions from institutions such as Brigham and Women's Hospital and the National Cancer Institute.The last five years,substantial advancements have been made,representing nearly 45%of the examined literature.Publication rates have dramatically increased,from 20 articles in 2002 to 112 in 2022,reflecting intensified research efforts.This study underscores a growing trend toward interdisciplinary and international collaboration,with the Journal of Clinical Oncology standing out as a key publication outlet.This shift toward more comprehensive and collaborative research methods marks a significant step in addressing GN risks.CONCLUSION This study underscores advancements in GN risk assessment through genetic analyses and machine learning and reveals significant geographical disparities in research emphasis.This calls for enhanced global collaboration and integration of artificial intelligence to improve cancer prevention and treatment accuracy,ultimately enhancing worldwide patient care.
基金supported by the Natural Science Foundation of Shandong Province of China,No.2014ZRB14502(to XHL)
文摘Constraint-induced movement therapy is an effective rehabilitative training technique used to improve the restoration of impaired upper extremity movement after stroke. However, whether constraint-induced movement therapy is more effective than conventional rehabilitation in acute or sub-acute stroke remains controversial. The aim of the present study was to identify the optimal time to start constraint-induced movement therapy after ischemic stroke and to explore the mechanisms by which constraint-induced movement therapy leads to post-stroke recovery. Sixty-four adult male Sprague-Dawley rats were randomly divided into four groups: sham-surgery group, cerebral ischemia/reperfusion group, early constraint-induced movement therapy group, and late constraint-induced movement therapy group. Rat models of left middle cerebral artery occlusion were established according to the Zea Longa line embolism method. Constraint-induced movement therapy was conducted starting on day 1 or day 14 in the early constraint-induced movement therapy and late constraint-induced movement therapy groups, respectively. To explore the effect of each intervention time on neuromotor function, behavioral function was assessed using a balance beam walking test before surgery and at 8 and 21 days after surgery. The expression levels of brain-derived neurotrophic factor, nerve growth factor and Nogo receptor were evaluated using real time-polymerase chain reaction and western blot assay to assess the effect of each intervention time. The results showed that the behavioral score was significantly lower in the early constraint-induced movement therapy group than in the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. At 21 days, the scores had significantly decreased in the early constraint-induced movement therapy and late constraint-induced movement therapy groups. At 8 days, only mild pyknosis appeared in neurons of the ischemic penumbra in the early constraint-induced movement therapy group, which was distinctly better than in the cerebral ischemia/reperfusion group. At 21 days, only a few vacuolated cells were observed and no obvious inflammatory cells were visible in late constraint-induced movement therapy group, which was much better than at 8 days. The mRNA and protein expression levels of brain-derived neurotrophic factor and nerve growth factor were significantly higher, but expression levels of Nogo receptor were significantly lower in the early constraint-induced movement therapy group compared with the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. The changes in expression levels at 21 days were larger but similar in both the early constraint-induced movement therapy and late constraint-induced movement therapy groups. Besides, the protein nerve growth factor level was higher in the late constraint-induced movement therapy group than in the early constraint-induced movement therapy group at 21 days. These results suggest that both early(1 day) and late(14 days) constraint-induced movement therapy induces molecular plasticity and facilitates functional recovery after ischemic stroke, as illustrated by the histology. The mechanism may be associated with downregulation of Nogo receptor expression and upregulation of brain-derived neurotrophic factor and nerve growth factor expression.
文摘Mammography is carried out in a special position, i.e. “an image is taken while the breast is compressed, stretched and kept in a fixed position”. The purpose of this study was to demonstrate quantitatively and qualitatively the physical and psychological burden due to positioning and breast compression during mammography. Muscle activity of each part of the body during positioning for the standard imaging method, to obtain craniocaudal (CC) view images, was measured in 15 adult females using surface EMG. The associated pain was analyzed using visual analogue scale (VAS) scores. During positioning for the CC view, muscle activity was highest in the biceps (24.44 iEMG/s) followed by the trapezius (17.78 iEMG/s) on the imaging side. Muscle activity of the biceps and the sternocleidomastoid on the imaging side showed significant differences compared with pre-imaging activity (biceps P < 0.031, sternocleidomastoid P < 0.005). The pain during mammography was rated as moderate to severe pain (VAS = 3.3 - 6.7) for CC views. As a result, the activities of not only the muscles directly involved in mammography positioning but also those indirectly involved were high as compared with the normal state. Measurement of muscle activity during mammography is expected to be used effectively, such as in the care to reduce pain for the subjects.
基金Supported by National Natural Science Foundation of China(71774049)。
文摘[Objectives]Based on the related literature of benefit finding in China National Knowledge Infrastructure(CNKI),this paper analyzes the research status,hot spots and trends in this field.[Methods]To search for the related literature on benefit finding in China National Knowledge Infrastructure(CNKI),and use Citespace software to visually analyze the number of papers,authors,institutions and keywords.[Results]A total of 204 related papers were obtained,and the annual number of published papers showed a gradual increasing trend.The authors of published papers were represented by Zhang Fenglan,Liu Zhunzhun and Zhang Ting,and the Nursing College of Anhui Medical University published the most papers.The research focus was on social support,coping method and other influencing factors,and qualitative research was the main research type.The key population was breast cancer,stroke patients and their caregivers,and the development trend focused on reliability and validity test and correlation analysis.[Conclusions]The field of benefit finding in China is in the initial exploration stage,and there is little cooperation and exchange between authors and institutions.In the future,academic exchanges and multidisciplinary assistance should be strengthened to promote the rapid development of this field.
基金supported by The National 13th Five-year Mega-Scientific Projects of Infectious Diseases in China[Grant Number:2017ZX10201302001004]。
文摘Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adults with multidrug-resistant tuberculosis(MDR-TB)in China.Methods A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years.The model parameter data were synthesized from the literature,the national TB surveillance information system,and consultation with experts.The incremental cost-effectiveness ratio(ICER)of BR vs.CR was determined.Results BR(vs.CR)had a higher sputum culture conversion rate and cure rate and prevented many premature deaths(decreased by 12.8%),thereby obtaining more quality-adjusted life years(QALYs)(increased by 2.31 years).The per capita cost in BR was as high as 138,000 yuan,roughly double that of CR.The ICER for BR was 33,700 yuan/QALY,which was lower than China's 1×per capita Gross Domestic Product(GDP)in 2020(72,400 yuan).Conclusion BR is shown to be cost effective.When the unit price of Bedaquiline reaches or falls below57.21 yuan per unit,BR is expected to be the dominant strategy in China over CR.
文摘About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is associated with liver disease progression,cirrhosis,hepatocellular carcinoma,and liver-related mortality.The extrahepatic manifestations of CHC further add to the disease burden of patients.Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society.Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease.Traditionally,pegylatedinterferon plus ribavirin(PR)was the standard of care.However,a substantial number of patients are ineligible for PR treatment,and only 40%–75%achieved sustained virologic response.Furthermore,PR is associated with impairment of patient-reported outcomes(PROs),high rates of adverse events,and poor adherence.With the advent of direct acting antivirals(DAAs),the treatment of CHC patients has been revolutionized.DAAs have broader eligible patient populations,higher efficacy,better PRO profiles,fewer adverse events,and better adherence rates,thereby making it possible to cure a large proportion of all CHC patients.This article aims to provide a comprehensive evaluation on the value of effective,curative hepatitis C treatment from the clinical,economic,societal,and patient experience perspectives,with a focus on recent data from China,supplemented with other Asian and international experiences where China data are not available.
文摘Objectives: To evaluate the impact of external-care-seeking, explore the framework to regulate patients’ seeking doctor behavior and to promote better medical resources allocation. Methods: Obtaining data from regular reports from public medical institutions in Shanghai, comparing patients who seek doctors from out-of-Shanghai residence and local patients with insurance in terms of the quantity of service, types of diseases, medical expenses, etc. Results: External-care-seeking has a large quantity, especially in hospitalization. In 2012, the number of discharged population from out-of-Shanghai accounted for 22.74% of the total discharged number, the proportion even higher than 30% in tertiary hospitals. Tertiary hospitals have a significant attraction effect, concentrating 59.42% of the outpatient and emergency visits and 71.82% of the amount of hospitalization, with corresponding cost of 75.86% and 82.56%. The top three divisions in tertiary hospitals for external-care-seeking were surgical, obstetrics and gynecology, internal medicine. Based on the interview, admitting out-of-shanghai patients is conducive to the improvement of the technical level of hospitals, and to the enhancement of the utilization efficiency of health resource. However, the local residents may have less accessibility of high quality of medical service. The average expense of external-care-seeking is higher than that of local patients happened in the same level of hospitals. Conclusions: External-care-seeking will have a more far-reaching impact on the health care system in Shanghai;some interventions might be necessary, such as rationally allocating medical resources based on the estimates of external-care-seeking and establishing a medical service supervision mechanism.
文摘Medical artificial intelligence (AI) in China is now on the eve of a massive surge. Despite great promise from this emerging field, there remain formidable pitfalls and obstacles, especially the challenges to current legal rules. We review the development of legal rules concerning medical AI in China, discuss risks of liability of commercial organizations and health care providers and whether current rules should be amended, and if so, what are the key issues to be addressed. Finally, we close by sketching possible ways forward for the legal and regulatory system.
文摘Objective To re-evaluate the systematic review of the safety and effectiveness of epidural analgesia(EA)for labor analgesia.Methods The Cochrane database,PubMed,EMBASE,EBSCO,Web of Science,ScienceDirect,China Biomedical Literature database,CNKI,Wanfang and VIP databases were searched,and the search time was limited to August 2020.Two researchers screened the literature and extracted data according to the inclusion criteria.AMSTAR was used to evaluate the methodological quality of the included studies.Pain intensity and pain relief satisfaction were used as the main indicators for re-evaluation of the effectiveness.Midwifery rate,cesarean section rate,back pain,fever,nausea and vomiting,umbilical artery pH value,and newborn Apgar score were used as the main indicators to re-evaluate the safety.Results and Conclusion A total of 9 meta-analyses were included.The safety and effectiveness of EA and opioid intravenous analgesia,acupuncture stimulation,inhalation analgesia,no analgesia,and continuous delivery were evaluated separately.The included systematic reviews showed that EA could increase the rate of device-assisted delivery,causing maternal fever,and prolonging the first and second stages of labor.But the incidence of back pain,nausea,and vomiting was lower.Therefore,analgesia had a good effect with better satisfactory degree.Current evidence shows that EA is safe and effective for labor analgesia,but the quality of the reports of current studies is not high.
文摘Objective To systematically review the published clinical and economic research on liposomal irinotecan in combination with 5-FU/LV for metastatic pancreatic ductal adenocarcinoma(mPDAC)at home and abroad.Methods PubMed,Cochrane Library,Embase,CBM,CNKI,Wan Fang data,CRD database and health technology assessment official websites were searched to collect clinical and economic studies on liposomal irinotecan for mPDAC.Results and Conclusion Nine clinical studies and four economic studies were included.The result of clinical studies showed that liposomal irinotecan in combination with 5-FU/LV could extend survival with good drug compliance in patients with mPDAC who progressed on prior gemcitabine-based therapy.This agent represented a new treatment option for second-line chemotherapy in these patients.The results of the economic evaluations failed to reach a consistent conclusion due to different economic levels in various countries.
基金The cooperative project of Shenyang Pharmaceutical University and Zhonglian Medicine-“Research on the Marketing Strategy of Imported Drugs in China”(2020-0-4-048).
文摘Objective To review the domestic and foreign economic studies on CDK4/6 inhibitors in first-line or second-line treatment of HR+/HER2-advanced breast cancer,and to analyze the main methodologies and research results.Methods Systematic literature review was used to search PubMed,EMBASE,Cochrane Library,CNKI,CBM,and Wanfang database.The incremental cost-effectiveness ratio was taken as the main outcome index,and all pharmacoeconomic evaluations with CDK4/6 inhibitors as intervention measures were included,such as Palbociclib,Ribociclib,and Abemaciclib.According to the Quality of Health Economic Studies Instrument,the quality of the included articles was evaluated,and then the included literature was analyzed.Results and Conclusion A total of 16 pharmacoeconomic evaluation studies were included,mainly from the perspective of national healthcare systems or third-party payers.Only 2 studies focused on second-line treatment,and the remaining treatment levels were first-line treatment.In terms of model structure,7 studies adopted the Markov model,6 studies adopted the PSM model,and 3 studies adopted the DES model.The basic analysis results showed that CDK4/6 inhibitor combined with endocrine regimen was not economical compared with endocrine alone regimen when the threshold was the conventional willingness to pay(WTP)value of each country.The uncertainty analysis included deterministic sensitivity analysis and probability sensitivity analysis.The included studies are all Cost-Utility Analysis with high-quality evaluation,which can provide evidence support for health-related decision-makers in decision-making.It can also provide methodological reference for the economic evaluation of other targeted drugs.
基金National Science and Technology Major Project(2020AAA0105000)Beijing Science and Technology Plan(Z241100007724003).
文摘This paper explores the expansion from fintech-based regulatory sandboxes to those that include medical artificial intelligence(AI)by examining their potential to foster innovation and accelerate market access while ensuring safety and compliance,especially considering how they provide a flexible framework for medical AI companies to develop and test new technologies.This work also highlights the key risks involved,including data privacy,ethical concerns,real-world validation,and regulatory consistency,and proposes strategies for mitigation.Using case studies from the United States,the United Kingdom,the European Union,Indonesia,Japan,and China,this paper illustrates how regulatory sandboxes can support AI-driven healthcare innovation.Overall,although regulatory sandboxes present several risks,they are valuable for advancing medical AI,granted that they balance innovation with robust oversight to ensure patient safety and long-term benefits.
基金Supported by the CAHHF project(AuSAID):FA55 HSS409。
文摘Objectives:To analyze the satisfaction of patients with community health service(CHS)and the changes of the CHS delivered before and after the new health reform in different regions of China,and to put forward relevant policy recommendations for CHS development.Methods:Twelve community health centers were selected by random sampling in each of the eight typical cities in the east,middle and west regions of China.Questionnaire survey was conducted among patients visiting these institutions during daily work hours.Results:The proportions of the participants who stated that the medical environment,service attitude and medical skills of the doctors were improved were higher in the west region than those of the east and middle regions;but the percentage of patients who held that the drug price had lowered was higher in the east region than those of the middle and west region,the differences were of statistical significance(P<0.0125).The patients’satisfaction rates with medical environment,service attitude,and technical skills of the medical staff in the west region were 88.9%,91.5%and 81.6%respectively,which were higher than those in the east and middle regions.In the east region,the satisfaction rate with the reimbursement for this visit was 58.5%,which was highest among the three regions;in the west region,patients’satisfaction rates with drug types and preventive care were 51.5%and 65.9%,respectively,which was significantly higher than those in the east and middle regions(P<0.0125).As recommended by the participants,the top three aspects of health services that need to be improved were drug type and quality(25.3%),drug prices(21.8%)and technical skills(18.2%)in the east region;infrastructure(28.2%),drug prices(21.8%)and drug types and quality(21.2%)in the middle region;infrastructure(30.8%),drug types and quality(28.1%)and reimbursement(27.9%)in the west region.Conclusions:The comprehensive CHS reform should take the opinions of patients into account;essential drug system should be consolidated continually;and the reform of the payment system should be promoted by actively cooperating with the health insurance organizations.
