Incorporating Exercise Efficiency to Evaluate the Accessibility and Capacity of Medical Resources in Tibet, China

Accessibility and capacity of medical resources are key for the health care and emergency response, while the efficiency of the medical resources is very much limited by hypoxia in Tibet, China.Through introducing exercise efficiency, this study explores the accessibility of township residence to county-ship medical resources in Tibet using weighted mean travel time(WMT), and evaluates the medical capacity accordingly.The results show that: 1) the average travel time of township residence to county-level hospital is around2 h by motor vehicle in Tibet.More than half of the population can not reach the county-ship hospital within 1 h, 33.24% of the population can not reach within 2 h, and 3.75% of the population can not reach within 6 h.2) When considering the catchment of the medical resources and the population size, the WMT of the county-ship medical resources ranges from 0.25 h to 10.92 h.3) After adjusted by travel time and exercise efficiency, the county-ship medical capacity became more unequal, with 38 out of 74 counties could not meet the national guideline of 1.8 medical beds per 1000.4) In total, there are 17 counties with good WMT and sufficient medical resources,while 13 counties having very high WMT and low capacity of medical resources in Tibet.In the end, suggestions on medical resources relocation and to improve the capacity are provided.This study provides a method to incorporate exercise efficiency to access the accessibility and evaluate medical capacity that can be applied in high altitude ranges.

一种基于血液检测的诊断和预测HBV相关疾病的弹性方法

Chronic hepatitis B virus(HBV)infection,which threatens global public health,is a major contributor to liver-related morbidity and mortality.Examinations for liver diseases related to chronic HBV infection-including laboratory tests,ultrasounds,computed tomography(CT),and liver biopsies-may take up medical resources,particularly since they overlap in most instances.Thus,there is an urgent need to establish an economical and effective diagnosis method in order to streamline the medical process for HBV-related disea ses.Using complex network models constructed based on clinical blood tests,we provide such a method by defining the novel measure of functional resilience to assess patients’liver conditions.By combining network models and dynamics,we discovered the pivotal items and their corresponding thresholds,which can guide further research on preventing disease deterioration in critical states of these diseases.The macro-averaged precision of our method,functional resilience,is84.74%,whereas the macro-averaged precision of physicians’experience without assistance from imaging or biopsy is 55.63%.From an economic perspective,our approach could save the equivalent of at least30 USD per visit for most Chinese patients and at least 400 USD per visit for most US patients,compared with general diagnostic methods.Globally,this will add to savings of at least 10.5 billion USD annually.Our method can comprehensively evaluate the condition of patients’livers and help avert the waste of medical resources during the diagnosis of liver disease by reducing excessive imaging exams.

The Increase in Total Knee Replacement Surgery in China: A 10-Year Real-World Study

Total knee arthroplasty (TKR) is the most common and costly surgical procedure performed, and it is considered one of the most successful clinical interventions for patients suffering from severe knee osteoarthritis (OA). The incidence of TKR, including demographics, incidence rates, lengths of hospital stay, and costs, was estimated from 2010 to 2019 by analyzing data extracted from the Joint Surgery Department in our hospital, which included a total of 6770 patients. We calculated the TKR risk ratios to compare the rate of TKR between different covariables such as gender, age group, and primary diagnoses. The annual volume of TKR increased by fivefold (5.14%), with a higher incidence observed in the 60 to 69 age group constituting approximately 36% of cases. There has also been an increase in incidence among young people (<50), which now stands at 6.2%. The rate ratio (RR) per female vs. male was found to be 3.0 and the RR of OA vs. RA was 0.09. The mean average length of stay (ALOS) in the hospital decreased from 15 to just 5 days during this period. Additionally, the adjusted mean cost per patient increased significantly from ¥ 38261 ± 3630.63 to ¥ 53115.17 ± 2831.35. The majority of TKR recipients were over 60 years old with osteoarthritis being identified as the main causative agent. It is worth noting that women are more susceptible to knee arthritis and there is a concerning shift toward younger individuals being affected by this disease. Our results indicate a rise in in-hospital costs alongside a significant decline in hospital ALOS for TKR procedures. We predict an unprecedented rise in TKR incidence in the coming years due to population aging and improving economic conditions in China.

Research on the Status Quo and Optimization of Centralized Procurement of Coronary Stents

Objective To study the impact of the first national centralized procurement of coronary stents on patients’psychology,the economy of medical institutions,and the survival and development of the coronary stents industry,and to provide suggestions on perfecting procedures to better carry out the centralized procurement of coronary stents.Methods Literature analysis was used to investigate the results of the procurement of coronary stent in a province and a hospital.Results and Conclusion The centralized procurement of coronary stents has alleviated the economic pressure of patients,but it has many problems.Therefore,this paper proposes some suggestions,such as promoting the orderly development of the coronary stent industry,improving the evaluation link of the centralized procurement of coronary stents,adopting the accurate reporting model to ensure the quality of coronary stents and improving the standardization of clinical services.

Association between medical resources and the proportion of oldest-old in the Chinese population

The potential association between medical resources and the proportion of oldest-old(90 years of age and above)in the Chinese population was examined,and we found that the higher proportion of oldest-old was associated with the higher number of beds in hospitals and health centers.

北京市大型医院空间优化与再配置的计算实验研究

医疗资源的合理布局是构建高质量医疗体系的重要基础。随着北京疏解工作的全面启动,以往高度集中布局的北京医疗资源需要重新配置。如何实现优质医疗资源空间布局的优化,既要解决“看病难、看病贵”,还不能加剧北京的“大城市病”,这是疏解面临的新课题。研究以计算社会科学的方法为基础,北京医疗资源疏解为背景,开发基于agent的城市医疗资源空间配置和布局的计算实验平台,讨论“点轴放射”模式和“组团”模式等不同布局情景下居民的居住选择和就医行为,“动态”观察和评估不同模式在平常和应急两种状态下资源配置的合理性和有效性。计算实验结果表明,“点轴放射”模式的医院布局在空间分布上更加均匀,能够随着人口的迁移互动逐渐形成自己的服务半径,效果略好于“组团”模式。然而,在灾情疫情等应急情形下,“组团”模式的医疗资源配置表现要显著好于“点轴放射”模式。研究表明,基于agent的建模和计算实验方法能够为利用真实数据建立现实模型展开这类布局事前研究和规划提供坚实的基础。

Spatial Distribution Characteristics of Medical Resources for Epidemic Prevention in the Main Urban Area of Handan City Based on GIS

The spatial distribution of medical resources for epidemic prevention (including a total of 79 facilities in designated hospitals,fever clinics,and primary medical institutions) in the main urban area of Handan City was studied by using three algorithms (average nearest neighbor algorithm,kernel density estimation method and standard deviation ellipse method).The results show that the medical resources for epidemic prevention in the main urban area of Handan City are all in a state of agglomeration,but due to the different functions of different types of medical resources,their distribution range and distribution direction also show different characteristics.Therefore,the spatial balance of comprehensive medical resources in the main urban area of Handan City needs to be further improved.

Resources for Medical Editors in World Association of Medical Editors

Introduction Established in 1995, WAME （pronounced ＂whammy＂） is a nonprofit voluntary association of editors of peer-reviewed medical journals from countries around the world who seek to foster international cooperation among and education of medical journal editors.

The Development Opportunities and Dilemmas of Telemedicine - Base on the Perspective of Medical Resource Distribution

Objective To discuss issues related to telemedicine in the context of the“Internet plus”and the prevention of novel coronavirus in early 2020,so as to provide some reference for the rapid development of Internet plus telemedicine.Methods Literature analysis method was used to summarize the current status of telemedicine at home and abroad.Descriptive statistical analysis and comparative analysis were also conducted to analyze the data of population and health in the“China Health Statistical Yearbook”and“China Statistical Yearbook”from 2009 to 2018.Results and Conclusion The distribution of medical demand and medical resources is uneven in 31 provinces,municipalities and autonomous regions,such problems are more serious between urban and rural areas in different regions.The population’s demand for medical care and the allocation of medical resources have the characteristics of positive correlation,large urban-rural differences and regional imbalance.Confronted with the situation that the uneven distribution of medical resources provides potential development opportunities for telemedicine and the difficulties in the further development of telemedicine,the government should formulate policies to improve the publicity of telemedicine,setting up a full coverage of telemedicine service system.Besides,hospitals should ensure the information security monitoring.

Dynamics and data fitting of a time-delayed SIRS hepatitis B model with psychological inhibition factor and limited medical resources

Hepatitis B is an infectious disease worthy of attention.Considering the incubation period,psychological inhibition factor,vaccine,limited medical resources and horizontal transmission,an SIRS model is proposed to describe hepatitis B transmission dynamics.In order to describe the behavior changes caused by people's psychological changes,the non-monotonic incidence rate is adopted in the model.We use the saturated treatment rate to describe the limited medical resources.Mathematical analysis shows the existence conditions of the equilibria,forward or backward bifurcation,Hopf bifurcation and the Bogdanov-Takens bifurcation.During the observation of the case data of hepatitis B in China,it is found that there are mainly three features,periodic outbreaks,aperiodic outbreaks,and periodic outbreaks turns to aperiodic outbreaks.According to the above features,we select three different representative regions,Jiangxi,Zhejiang province and Beijing,and then use our model to fit the actual monthly hepatitis B case data.The basic reproduction numbers that we estimated are 1.7712,1.4805 and 1.4132,respectively.The results of data fitting are consistent with those of theoretical analysis.According to the sensitivity analysis of Ro,we conclude that reducing contact,increasing treatment rate,strengthening vaccination and revaccinating can effectively prevent and control the prevalence of hepatitis B.

“十四五”时期我国卫生健康事业发展展望

“十四五”时期,我国卫生健康事业步入新的历史阶段。在这一时期,公共卫生能力建设应成为发展重点,通过优化医疗卫生资源配置,实现大健康观下的医防结合。推动以医疗为中心的医疗联合体转变为以预防和健康管理为中心的健康联合体,使医疗保险为公众的健康结果而非医疗卫生服务买单。完善健康服务体系,实现健康联合体内部上下联动。建立以健康结果为导向的医疗保险支付方式,倒逼服务供给侧改革,推动医疗保险基金形成战略性购买机制。充分发挥信息时代互联互通的优势,深化健康大数据的治理与应用,助力公众健康管理。

医疗资源配置的规划约束困境与改善

目的 总结国内外规划约束资源配置的相关经验,梳理国内医疗资源规划约束的困境症结所在,为提高规划对医疗资源配置的约束力,推进规划工作落实提供政策建议。方法 综合运用政策梳理、文献分析及专家咨询等方法。结果 由于医疗资源配置是一个动态调整的过程,加之其屡屡突破卫生规划的现实情况,对医疗资源的规划约束有其必要性,然而当前规划本身存在刚性约束力不足的问题。通过对典型国家经验梳理发现,这些国家规划约束的开展具有长期性和经常性、规范性和科学性及重反馈和强监管的特点。相比之下,我国医疗资源规划约束主要面临法律法规滞后、内容方法不完善、缺乏动态监督和有效反馈等问题。结论 我国应推进医疗资源规划约束的常态化、规范化和制度化,纵向开展从编制到实施的“全过程”监督,横向开展基于目标导向的“分条块”评估,在立体化监督评估的基础上进行动态反馈,同时完善保障措施,推动医疗资源规划约束开展。

The Usage of Triage Systems in Mass Casualty Incident of Developed Countries

Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victims. In peacetime, the triage systems are applied to allocate constrained medical resources for the victims in MCI. There are several kinds of triage systems in different countries, such as Simple Triage and Rapid Treatment (START), Sort, Assess, Life-saving interventions, Treatment and/or Transport (SALT), Sacco Triage Method (STM), Careflight triage and Triage Sieve (TS). The START system is widely used in developed countries, especially in USA. The SALT is formulated by a work group of the Centers for Disease Control and Prevention (CDC) based on scientific data. STM is a triage algorithm designed for resource-constrained condition. Besides, the other triage systems show their power in managing the victims in MCI. However, the data of theses popular triage tools are mainly based on simulated tests, lacking of validity and reliability of triage systems. Therefore, the application, reliability, sensitivity and specificity of existing triage tools require to be validated in the real condition of MCI. Furthermore, due to the difference among triage tools used in different countries, international cooperation is demanded for a more highly organized mass-casualty medical response.

A literature review of perishable medical resource management

In recent decades,healthcare providers have faced mounting pressure to effectively manage highly perishable and limited medical resources.This article offers a comprehensive review of supply chain management pertaining to such resources,which include transplantable organs and healthcare products.The review encompasses 93 publications from 1990 to 2022,illustrating a discernible upward trajectory in annual publications.The surveyed literature is categorized into three levels:Strategic,tactical,and operational.Key problem attributes and methodologies are analyzed through the assessment of pertinent publications for each problem level.Furthermore,research on service innovation,decision analytics,and supply chain resilience elucidates potential areas for future research.

A DYNAMIC ALLOCATION MODEL FOR MEDICAL RESOURCES IN THE CONTROL OF INFLUENZA DIFFUSION

In this paper, we develop a unique time-varying forecasting model for dynamic demand of medical resources based on a susceptible-exposed-infected-recovered （SEIR） influenza diffusion model. In this forecasting mechanism, medical resources allocated in the early period will take effect in subduing the spread of influenza and thus impact the demand in the later period. We adopt a discrete time-space network to describe the medical resources allocation process following a hypothetical influenza outbreak in a region. The entire medical resources allocation process is constructed as a multi-stage integer programming problem. At each stage, we solve a cost minimization sub-problem subject to the time-varying demand. The corresponding optimal allocation result is then used as an input to the control process of influenza spread, which in turn determines the demand for the next stage. In addition, we present a comparison between the proposed model and an empirical model. Our results could help decision makers prepare for a pandemic, including how to allocate limited resources dynamically.

China’s Government Information Capacity,Medical Resource Allocation and COVID−19 Prevention and Control

The fight against the COVID−19 epidemic is a war against an“invisible enemy”.Access to accurate information and appropriate allocation of medical resources are key to containing the spread of the virus as soon as possible.The Chinese government has great power to collect information from individuals and basic-level organizations.It also has strong ability to pool and allocate medical resources.The fight against COVID−19 can be deemed as a quasi-natural experiment and based on this,we examine how government information capacity and medical resource allocation influence epidemic prevention and control in 286 Chinese cities(prefecture level and above).The fi ndings are as follows:(1)Government information capacities improve the effectiveness of prevention and control policies.At city level,for every 0.1 point of increase in government information capacity score,the number of confi rmed cases will reduce by 66.5,and the number of deaths per 10000 people will be down by 0.008.(2)The quantity of medical resources available has no direct influence on the effectiveness of epidemic prevention and control,but higher allocation efficiency does bring higher effectiveness.(3)The government can,on the one hand,allocate public resources based on information,and on the other hand guide the flow of social resources by releasing relevant information.Both can improve the allocation efficiency of medical resources.These fi ndings have some policy implications for improving global emergency management.

Coordination and Cooperation are Essential: A Call for a Global Network to Enhance Integrated Human Health Risk Resilience Based on China’s COVID-19 Pandemic Coping Practice

More than a year after its appearance and still rampant around the world,the COVID-19 pandemic has highlighted tragically how poorly the world is prepared to handle systemic risks in an increasingly hyper-connected global social-ecological system.The absence or clear inadequacy of global governance arrangements and mechanisms is painfully distinct and obvious.In this short article,we summarize a set of COVID-19 pandemic-related analyses and lessons that are inspired by Chinese practice.First,strong government response is one of the most important methods to control a pandemic.Second,countries should be concerned about human-to-frozen goods-to-human transmission.Third,sharing resources and experiences through cooperation is crucial to ensure an adequate health response.Based on these insights,we stress the critical importance of coordination and cooperation,and call for a global network to enhance integrated human health risk resilience.

Mathematical modeling and analysis of meningococcal meningitis transmission dynamics

Meningococcal meningitis(MCM)is one of the serious public health threats in the tropical and sub-tropical regions.In this paper,we propose an epidemic model to study the transmission dynamics of MCM with high-and low-risk susceptible populations.The model considers two different groups of susceptible individuals depending on the availability of medical resources(MR,including hospitals,health workers,etc.),which varies the infection risk.We find that the model exhibits the phenomenon of backward bifurcation(BB),which increases the difficulty of MCM control since the dynamics are not merely relying on the basic reproduction number,TZo.This study explores the effects of MR on the MCM epidemics by mathematical analysis and shows the existence of BB on MCM disease.Our findings suggest that providing adequate MR in a community is crucial in mitigating MCM incidences and deaths,especially,in the MCM endemic regions.