Objective: To understand the development and current status of pediatric digestive endoscopy over the past 40 years, so as to provide strategic recommendations for the discipline's future development. Methods: A cross-sectional survey was conducted between February and March 2025 across 504 hospitals practicing pediatric endoscopy in 31 provinces, autonomous regions or municipalities. The structured questionnaire encompassed institutional and endoscopy center profiles, workforce demographics, technical capabilities, and continuing education requirements. Results: All 504 distributed questionnaires were returned valid. Pediatric endoscopy was first established in 1985 in Zhejiang Province and Beijing, with the Xizang Autonomous Region commencing services in 2023. The 5 leading provinces by center volume were Shandong (65 hospitals), Zhejiang (47 hospitals), Jiangsu (36 hospitals), Sichuan (34 hospitals) and Guangdong (29 hospitals). Geographic distribution revealed significant disparities: East China dominated with 187 centers (37.1%), North China accounted for 51 (10.1%), Southwest China accounted for 84 (16.7%), South China accounted for 65 (12.9%), Central China accounted for 41 (8.1%), Northwest China accounted for 60 (11.9%), while Northeast China accounted for merely 16 (3.2%). The workforce comprised 2 089 physicians and 1 920 nurses (physician-to-nurse ratio 1∶0.92), with general hospitals demonstrating superior staffing ratios (1∶1.06) compared to pediatric specialized and maternal-child hospitals (1∶0.51). Training predominantly relied on external fellowships (49.4%, 249/504) or combined institutional-external programs (40.9%, 206/504), supervised mainly by pediatric endoscopists (75.2%, 342/455). Diagnostic and therapeutic capabilities achieved comprehensive gastrointestinal coverage, with the five most prevalent procedures being gastroscopy (100.0%,504/504), foreign body retrieval (89.7%,452/504), colonoscopy (74.6%,376/504), polypectomy (62.5%,315/504), and hemostasis (54.0%,272/504). Conversely, advanced interventions, including endoscopic retrograde cholangiopancreatography, endoscopic retrograde appendicitis therapy and peroral endoscopic myotomy remained limited in adoption. Between 1996 and 2025, 18 practice guidelines, consensus statements and standard operating protocols were published. Conclusions: Pediatric gastrointestinal endoscopy has developed rapidly, with progress in discipline development, technical standards, talent cultivation, and consensus guideline formulation. However, challenges remain in achieving regional balance, optimizing the doctor-nurse ratio, and advancing high-level endoscopic therapeutic technologies. Future efforts should focus on refining minimally invasive technologies, integrating intelligent technologies, and achieving integrated management across the entire service chain.

Prior disparity research has focused on evaluating patient outcomes in freestanding children's hospitals, rather than identifying potential drivers of these disparities. Our objective was to evaluate drivers of disparities in respiratory illness care quality and outcomes in a national sample of general hospitals. This retrospective study used pretrial data from hospitals in the SIP trial (Simultaneously Implementing Pathways for Improving Asthma, Pneumonia, and Bronchiolitis Care for Hospitalized Children, NCT05206695). Patients were eligible if they had a primary diagnosis of asthma, pneumonia, or bronchiolitis and were admitted during 3 winter periods (2019-2022). We evaluated quality measures/adherence to evidence-based practices and patient outcomes (length of stay, intensive care unit [ICU] transfer, and hospital readmission/emergency department [ED] revisit within 30days). Multilevel regression models were used to evaluate disparities by race and ethnicity, primary insurance, and preferred language. A total of 3188 admissions from 33 hospitals were analyzed. Quality measure adherence was 30% to 89%. Children with asthma on public insurance were more likely to receive recommended discharge prescriptions of inhaled corticosteroids than those on private insurance (77% vs 70%; odds ratio [OR], 1.87 [95% CI, 1. 12-3.12]). Children with public insurance admitted for asthma had higher risk of ICU transfer (adjusted OR [AOR], 1.93 [95% CI, 1.01-3.72]) and 30-day readmissions/ED revisits (AOR, 2.72 [95% CI, 1.37-5.39]). Hispanic children admitted for asthma had higher risk of 30-day readmissions/ED revisits compared with white children (AOR, 2.37 [95% CI, 1.08-5.22]). In this national analysis of children admitted to general hospitals, we found disparities in outcomes for children with asthma who were on public insurance or Hispanic.

Tracheal extubation (TE) is a commonplace procedure, but should not be trivialized; it remains a critical yet under-standardized step in anesthesia practice. Whether performed in the operating room (OR) or the post-anesthesia care unit (PACU), the TE location reflects a compromise between patient safety and operating room efficiency and remains a concern. This national survey aimed to describe TE practices among French anesthesia professionals and identify factors influencing the choice of routine TE site. We conducted a national mixed-methods survey, combining quantitative and qualitative analyses, to assess TE practices among care-providing anesthesia professionals. An online questionnaire endorsed by the French Society of Anesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) was distributed from June to September 2025. It included demographic data and three standardized clinical scenarios of increasing anesthetic complexity. Respondents specified their optimal TE site, operator characteristics, oxygenation methods, and rationale for decision-making. Quantitative data were analyzed descriptively; qualitative responses underwent thematic analysis. A total of 297 anesthesia professionals responded, including 194 (65.5 %) CRNAs and 102 (34.5 %) anesthesiologists. Most worked in university or general hospitals (72 %). The composition of PACU staff was heterogeneous, with nurses trained in the recovery room in 56.9 %, CRNAs in 47.5 %, and anesthesiologists in 10.8 %. TE location varied widely: 30% performed all routine TE in the OR, 23% mostly in the OR, 14% equally in both locations, 21% mostly in the PACU, and 12% exclusively in the PACU. Most operating room TE occurred after low-risk procedures (64%) and were performed by CRNAs under anesthesiologist supervision; anesthesiologist involvement increased with case severity. Most respondents reported to plan TE site before anesthesia induction. Determinants of TE site considered analgesia quality, staff competence, equipment reliability, and organizational constraints. Routine TE practices in France exhibit significant variability, shaped by clinical and institutional factors rather than standardized protocols. The predominance of nurse-based PACUs and limited anesthesiologist presence highlight the need for structured, evidence-based guidelines to optimize postoperative airway safety, even during non-difficult airway management.

Predominantly genetic, intrauterine, and lifestyle aetiologies of type 2 diabetes are associated with distinct clinical presentations and risk of complications: a Danish cross-sectional and follow-up study.

The operating room (OR) is the most resource-intensive setting in the hospital, making accurate OR financial metrics essential for value-based initiatives and cost-effectiveness analyses. However, prior estimates of OR time have been rendered likely obsolete by the COVID-19 pandemic, sustained inflation, and hospital consolidation, and conflation of 3 financial parameters-costs, charges, and revenue-has led to misapplication of these estimates. To estimate the cost of 1 minute of OR time in California hospitals, assess trends over time by hospital ownership and teaching status, and provide benchmarks for OR charges and revenue. This longitudinal cross-sectional study examined California Hospital Annual Disclosure Reports for fiscal years (FYs) 2014 to 2022 from short-term general and specialty care hospitals in California. Data were analyzed from January 24 to March 13, 2026. The primary outcome was mean costs, charges, and revenue per minute of OR time, stratified by hospital ownership and teaching status. Costs were further divided into direct and indirect components. Descriptive statistics summarized hospital characteristics and financial measures. The study included 278 hospitals that provided California Hospital Annual Disclosure Reports for FY 2022. Of these, 164 (59.0%) were not-for-profit hospitals, 75 (27.0%) were for-profit hospitals, and 39 (14.0%) were government owned hospitals; 34 (12.2%) were teaching hospitals. The mean (SD) cost of OR time across all hospitals was $57.71/min ($24.09/min), representing a 54% increase from FY 2014 with an annual increase of 5.24% (95% CI, 4.63%-5.82%). Direct costs accounted for 56.6% of total costs ($32.56 of $57.53), with wages and benefits comprising approximately two-thirds of direct costs. The mean (SD) charge was $295.09/min ($148.23/min) and the mean (SD) revenue was $66.31/min ($31.30/min). Government-owned hospitals had the lowest charges, highest costs, and intermediate revenues, illustrating that these 3 measures are not interchangeable. In this cross-sectional study, the mean cost of OR time in California hospitals was $57.71/min in FY 2022, establishing an updated benchmark for surgical cost analyses. Additionally, benchmarks were established for OR revenue ($66/min) and charges ($295/min). Appropriate use of the different financial metrics along with accurate values is essential for valid cost-effectiveness analyses and value-based surgical care initiatives.

Post-ERCP pancreatitis (PEP) is a frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). The ability to predict which patients are at risk of developing PEP is essential for determining the suitability of same-day discharge. Therefore, the study was undertaken to validate the predictive value of the 2-hour post-ERCP serum amylase level and cannulation time in relation to the occurrence of PEP. An observational approach was adopted to conduct the study based on data collected from the BIRDEM General Hospital, Dhaka. The study duration was twelve months. All patients who underwent ERCP were included in this study. A total of 135 patients were enrolled after obtaining informed written consent. A structured questionnaire was used for data collection. Serum amylase levels at 2 hour and 24 hour post-procedure was measured along with cannulation time and procedure time among all patients. Risk factors were determined using univariate and multivariate logistic models. The collected data were analyzed by SPSS V-23. Ethical measures were taken in accordance with the current Declaration of Helsinki. A total of 135 cases (average age 55.32±13.16 years, 52.6% female) were analyzed. Of all, twenty-three developed Post-ERCP pancreatitis after the procedure. Both univariate and multivariate analyses revealed that a cannulation time of more than 6.3 min [AUC: 0.827, 95% CI: 0.736-0.919, p<0.0001] and 2 hours amylase levels greater than 128 IU/L cutoff value (AUC: 9.959, 95% CI: 0.917-1.000, p<0.0001) were significant predictive factors for PEP. A total of 21 patients out of 23 exhibited 2 hour amylase levels higher than the cutoff level and developed PEP. On the other hand, 19 of the 23 patients developed PEP and required cannulation times longer than the cutoff values. The combined result of both the 2-hour serum amylase level and cannulation time had a sensitivity of 95.65%, specificity of 72.32%, PPV of 41.50%, NPV of 98.78% and accuracy of 76.29%, with a significant (p<0.0001). The present findings imply that the grouping of serum amylase levels and cannulation timing at 2 hours post-ERCP is a suitable indicator for identifying patients at high risk for PEP.

This study investigates the degree of the perceived risk of intravenous thrombolysis in acute cerebral infarction among surrogate decision-makers and the factors influencing their propensity to make decisions about thrombolysis. An investigation was conducted on a cross-sectional basis. We recruited participants using a purposive sampling technique. All participants were recruited from the Advanced Stroke Centre in a tertiary care general hospital from January 2022 to December 2022. A total of 201 Surrogate Decision-Makers completed the survey. Using a self-designed questionnaire, the instrument of this survey contains three aspects of general information including risk perception level survey, propensity for thrombolysis, and consisting of 18 questions. Risk perception consists of three dimensions: economic risk perception, psychosocial risk perception, and physical functioning risk perception, and each dimension is scored in the range of 3-15 points. Higher scores indicate stronger risk perception. The mean risk perception score of acute ischemic stroke surrogate decision-makers was (11.26 ± 2.72). The average score of psychosocial risk perception was (10.71 ± 2.34); the score of physical function risk perception was (11.00 ± 2.37). The highest proportion of those choosing conservative treatment was 46.8%. The percentage of those willing to thrombolize was 27.4%, and those who were unsure about it was 25.9%. The degree of perceived economic risk, perceived psychosocial risk, and perceived physical function risk all had a significant negative effect on the propensity to make decisions about thrombolysis after excluding the confounding interference of different ages, education levels, and monthly per capita household income. This study found a significant effect of risk-perception of the surrogate decision-maker on treatment propensity. Healthcare professionals should pay attention to guiding surrogate decision-makers to establish correct disease perception and risk-perception through effective communication during thrombolysis communication in acute ischemic stroke to relieve their decision-making pressure, shorten decision-making time and reduce Door-to-Needle time to improve patient prognosis and increase the rate of thrombolytic therapy. This study is a questionnaire survey conducted by the investigator and no patient or public participation is required. The risk perception of surrogate decision-makers is likely to play an essential role in the decision-making process. However, increased risk perception and prolonged thrombolysis are due to a lack of knowledge about thrombolysis among surrogate decision-makers. Generalizing the need for intravenous thrombolysis may improve the rate of thrombolysis and thus provide clinical benefit to patients.

Oxaliplatin-based chemotherapy is the standard adjuvant treatment for stage III colon cancer, but oral fluoropyrimidines remain widely used for patients unsuitable for combination therapy. Real-world data comparing these strategies are limited. We conducted a retrospective cohort study of patients with stage III colon cancer who received adjuvant chemotherapy at Kaohsiung Veterans General Hospital (2017-2021). Using a 12-month landmark design, we compared disease-free survival (DFS) between patients receiving FOLFOX (IV-Only) versus oral fluoropyrimidines (PO-Only). The primary analysis used overlap-weighted restricted mean survival time (RMST) differences to quantify absolute treatment effects. Cox proportional hazards regression provided complementary hazard ratio estimates. Of 157 patients included, 58 (36.9%) received FOLFOX and 99 (63.1%) received oral fluoropyrimidines. During median follow-up of 36 months, 22 DFS events occurred. The 3-year DFS was 93.1% versus 76.5% for IV-Only and PO-Only groups, respectively. The primary analysis showed that patients receiving FOLFOX had 4.0 additional months of disease-free time over 48 months (RMST difference: 4.0 months; 95% CI, 0.6-7.9; p = 0.014) and 2.4 months over 36 months (RMST difference: 2.4 months; 95% CI, 0.2-4.7; p = 0.024). The hazard ratio from overlap-weighted Cox regression with covariate adjustment was 0.37 (95% CI 0.09-1.45; p = 0.154), directionally consistent with the RMST findings but not reaching statistical significance. Hazard ratio estimates were directionally consistent across sensitivity analyses but varied in statistical significance, likely reflecting limited power: unadjusted (HR 0.23; p = 0.019), stabilized weighting with covariates (HR 0.19; p = 0.046), and multivariable adjustment (HR 0.44; p = 0.249). In this real-world cohort, oral fluoropyrimidines were associated with 4.0 fewer months of disease-free time compared with FOLFOX at 48 months among patients for whom both treatment options were appropriate. As a single-center study with limited events, these findings should be confirmed in larger multicenter cohorts. The combination of RMST with overlap weighting provides an interpretable framework for comparative effectiveness questions where treatment selection is strong.

BackgroundCeftriaxone is currently the most frequently recommended first-line therapy for gonorrhoea globally. The emergence of ceftriaxone-resistant Neisseria gonorrhoeae threatens effective control, yet longitudinal surveillance data remain limited in many settings. Sentinel gonococcal antimicrobial resistance surveillance has been conducted at the Department of STI Control (DSC), Singapore, since 2014. We report findings on the emergence of ceftriaxone-resistant Neisseria gonorrhoeae detected between 2018 and 2025.MethodsWe conducted an analysis of longitudinal sentinel laboratory surveillance data from January 2018 to October 2025. Neisseria gonorrhoeae isolates underwent culture and antimicrobial susceptibility testing using gradient diffusion method (Etest) at the Department of Microbiology, Singapore General Hospital. Isolates with ceftriaxone minimum inhibitory concentrations ≥0.25mg/L were identified using European Committee on Antimicrobial Susceptibility Testing criteria. Clinical, behavioural and treatment outcome data were extracted from electronic medical records.ResultsAmong 2695 Neisseria gonorrhoeae isolates tested, 23 (0.85%) ceftriaxone-resistant isolates were identified. No ceftriaxone-resistant isolates were detected prior to 2018, and annual detection varied without a consistent upward trend. Median patient age was 35years (IQR 24-48). The earliest case was a female patient involved in transactional sex work with pharyngeal infection; subsequent cases occurred exclusively among heterosexual individuals, predominantly men with urethral infection. Exposure through encounters involving paid sex as well as the absence of condom use during oral sex, were common. Most infections resolved following treatment with ceftriaxone 500mg intramuscularly, although persistent pharyngeal infection was observed in one case.ConclusionCeftriaxone-resistant Neisseria gonorrhoeae has been detected in Singapore since 2018 through sentinel surveillance. Continued culture-based antimicrobial resistance surveillance, incorporation of extragenital testing, and prioritisation of test-of-cure for pharyngeal infection are essential to support early detection, guide empirical therapy and inform clinical and public health responses.

Hierarchical associations with care-seeking delay in patients with heart failure: A network analysis.

Moments That Matter: A Prospective Mixed-Methods Study Integrating Emotional Intelligence Opportunistically Into Everyday Surgery Education.

Nursing dying people in an acute hospital: A focused ethnography.

To identify body temperature dynamic patterns and develop a machine learning model for the early detection of nosocomial infections. A retrospective and observational study of patients hospitalised in the haematology department of the Chinese People's Liberation Army General Hospital between January 2014 and December 2023. A latent class trajectory model was used to discover patterns in patients' body temperatures over time. Machine learning models were then built to predict nosocomial infections and evaluated using standard metrics (AUROC, sensitivity, specificity). SHAP (SHapley Additive exPlanations) values were used to interpret the final model. Among 6989 patients, we identified four distinct body temperature trajectories. Bloodstream infections were most common in patients exhibiting either a slow rise followed by a gradual decrease or a rapid rise followed by a quick decrease in body temperature. The XGBoost model showed excellent predictive performance (AUROC = 0.801), with balanced sensitivity (0.718) and specificity (0.701). The top five predictors of nosocomial infections were elevated procalcitonin, neutropenia, prolonged central venous catheter use and two specific temperature trajectories: 'stable and relatively high' and 'a rapid rise followed by a quick decrease'. The XGBoost model effectively predicted nosocomial infections. Dynamic body temperature trajectories provided early, objective warning signs of infection. This predictive tool empowered nursing staff to proactively monitor nosocomial infection, allowing for timely, data-driven interventions in vulnerable hematologic patients. The developed machine learning predictive tool can help clinical medical staff identify nosocomial infections as early as possible, facilitate personalised rehabilitation and health management plans, aligning with the philosophy of patient-centred precision nursing. Further, the four body temperature trajectory patterns identified provide nurses with objective, dynamic indicators for recognising potential infection subphenotypes, supporting a shift from experience-driven reactive care towards data-driven proactive nursing. Previous studies suggested that body temperature could indicate the severity and prognosis of infections, but the pattern was unknown. In this study, we found that body temperature trajectories could signal infection subphenotypes, such as bloodstream infections being most common in patients with a slow rise followed by a gradual decrease in body temperature or with a rapid rise followed by a quick decrease. By integrating body temperature trajectories with key clinical biomarkers, the developed prediction model enables early and accurate identification of nosocomial infections in hematologic patients. The application of this tool may significantly shorten the time window between infection onset and intervention, potentially reducing infection-related complications, mortality and healthcare costs, thereby improving overall care quality and patient outcomes. The study adhered to the relevant EQUATOR reporting guidelines, the TRIPOD Checklist for Prediction Model Development and Validation. The research team included nursing staff and clinicians responsible for infection surveillance and control in the hospital, who contributed real-world insights into the definition of predictors, interpretation of temperature trajectories, clinical implications of the prediction model and preparation of the manuscript. Their expertise helped ensure that the study addressed relevant clinical questions and that the findings are interpretable and actionable in practice.

This study aimed to develop and internally validate a neonatal mortality risk prediction model for low birthweight (LBW) neonates in public hospitals of North-West Ethiopia. An institution-based prospective follow-up study. The study was conducted in seven hospitals, comprising three general hospitals and four primary hospitals, between 14 February and 31 October 2025. The general hospitals, Injibara, Finote Selam and Pawi, provide level II neonatal intensive care services, whereas the primary hospitals, Dangila, Chagni, Jawi and Gimja Bet, provide level I newborn care services. These hospitals are situated in the Awi, West Gojjam and Metekel zones of the Amhara and Benishangul Gumuz regions in north-western Ethiopia. 955 LBW neonates were enrolled in the study. Neonates born outside health facilities were excluded if their birth weight was unknown, particularly those delivered by traditional birth attendants, as were neonates whose first recorded weight was obtained more than 24 hours after birth. Participants were selected using consecutive sampling and data were collected electronically using the KoboCollect mobile application. Data were analysed using R software V.4.4.3. Least Absolute Shrinkage and Selection Operator regression and multivariable logistic regression were used to identify predictors and develop a simplified risk score and nomogram. Model performance was evaluated in terms of discrimination and calibration, while internal validation was performed using bootstrapping. The clinical utility of the model was assessed using decision curve analysis (DCA). The final model included nine predictors: sepsis, perinatal asphyxia, respiratory distress syndrome, absence of exclusive breastfeeding, absence of Kangaroo Mother Care, gestational ages of 28 weeks to <32 weeks and 32 weeks to <37 weeks, and birth weights of <1000 g and 1000-1499 g. The original model demonstrated good discrimination, with an area under the curve of 84.2% (95% CI 81.5% to 86.9%). After internal validation, the simplified risk score and nomogram achieved areas under the curve of 83.85% and 83.5%, respectively. The model showed excellent calibration before and after validation. DCA indicated that the model provides meaningful clinical benefit. The nomogram and simplified risk score demonstrated excellent calibration and good discriminatory performance. Their application in clinical settings may improve early intervention and potentially reduce neonatal mortality in Ethiopia by enabling rapid, individualised mortality-risk prediction among LBW neonates. However, external validation in different settings is required.

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with increased length of hospital stay. Early detection of renal dysfunction by measuring the renal resistive index (RRI) using &lt;/em&gt;&lt;em&gt;D&lt;/em&gt;&lt;em&gt;oppler ultrasound is a non-invasive parameter that reflects intrarenal vascular resistance and has the potential to predict AKI occurrence in critically ill patients. This study aims to &lt;/em&gt;&lt;em&gt;compare RRI values between patients with and without AKI&lt;/em&gt;&lt;em&gt; based on severity levels&lt;/em&gt;&lt;em&gt; classification from AKIN criteria&lt;/em&gt;&lt;em&gt;, and to establish the RRI value as a predictor of AKI occurrence in critically ill patients.&lt;/em&gt;&lt;em&gt; T&lt;/em&gt;&lt;em&gt;his study was an analytical observational study with a prospective cohort design conducted on critically ill patients treated in the ICU of dr. Zainal Abidin Banda Aceh&lt;/em&gt;&lt;em&gt; General Hospital&lt;/em&gt;&lt;em&gt; from June to August 2025. Data were obtained through Doppler ultrasound RRI examination performed within the first 24 hours and medical record data during treatment. Data were analyzed using ANOVA and ROC curve analysis to determine the cut-off value of RRI as an AKI predictor&lt;/em&gt;&lt;em&gt;. Out of&lt;/em&gt;&lt;em&gt; the 60 critically ill patients who met inclusion criteria, 30 patients (50%) developed AKI during treatment. There were significant differences (p&amp;lt;0.0001) between RRI and AKI occurrence as well as AKI severity, for both the right and left kidneys. &lt;/em&gt;&lt;em&gt;ROC curve analysis identified an RRI cut-off value of 0.7 for predicting AKI, with a Receiver Operating Characteristic Area Under the Curve (AUC) of 0.9628&lt;/em&gt;&lt;em&gt; and CI 95% : 0.9155 – 1.000&lt;/em&gt;&lt;em&gt;­&lt;/em&gt;, yielding a sensitivity and specificity of 90%&lt;em&gt;.&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;There are significant differences in RRI values between non-AKI patients and AKI patients at stages 1, 2, and 3. RRI value can be used as a predictor for AKI occurrence in critically ill patients. &lt;/em&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords: Acute Kidney Injury, Critically Ill, Doppler Ultrasonography, Renal Resistive Index.&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

While stroke management has evolved rapidly, comprehensive nationwide evidence covering all stroke subtypes remains limited. We evaluated 10-year secular trends in acute stroke care and outcomes in South Korea using a mandatory national quality audit dataset. Data from the Acute Stroke Quality Assessment Program, covering nearly all general and tertiary hospitals in Korea, were linked with national insurance claims and mortality records. We analyzed 136,191 episodes of ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) from 2013 to 2023. Over the decade, mean patient age increased (67.1 to 69.6 years), with the ≥85-year population doubling (7.2% to 13.4%). An unexplained discrepancy between ambulance use and arrival time emerged: ambulance use rose (55.4% to 61.8%), but median onset-to-arrival time remained stagnant (4.0 hours), with only 36.6% of IS patients arriving within 3 hours. While intravenous thrombolysis utilization remained stable at approximately 6.0% after 2014, endovascular thrombectomy rates more than doubled (5.3% to 11.6%), reaching 41.1% in severe cases. Statin (92.1%), non-vitamin K antagonist oral anticoagulant (78.4%), and dual antiplatelet therapy (67.2%) use increased markedly. In SAH, treatment shifted from clipping (36.7% to 12.2%) to coiling (36.0% to 63.4%). Notably, adjusted mortality exhibited a non-linear U-shaped trend, reaching a nadir in 2018 followed by an uptick after 2020. Despite substantial improvements in inpatient stroke care, the discrepancy between ambulance use and arrival time highlights structural challenges. Furthermore, the U-shaped mortality reversal underscores the vulnerability of healthcare resilience in a super-aging society, particularly under the strain of the COVID-19 pandemic.

Miscarriage is a common complication of pregnancy, and it is defined as spontaneous pregnancy loss before the fetus reaches viability. However, there are no clear pathological factors identified as causes of recurrent miscarriage in some cases. Preimplantation genetic testing for aneuploidy (PGT-A) has been shown to have some advantages in the live birth rate in limited populations with a favorable prognosis. Hence, we investigated whether PGT-A improves pregnancy outcomes in patients with recurrent pregnancy loss. We conducted a retrospective study including patients with a history of recurrent pregnancy loss from December 2021 to June 2022 receiving assisted reproduction therapy in the first medical center of the Chinese PLA General Hospital. The patients were divided into PGT-A and non-PGT-A groups, and we compared the pregnancy outcomes between the PGT-A and non-PGT-A groups. PGT-A significantly increased the clinical pregnancy rate per embryo transfer (ET) (58.7 vs. 32.3%, p = 0.023) and live birth rate per ET (50.0 vs. 25.8%, p = 0.034). However, there were no differences in biochemical pregnancy rates per ET (69.6 vs. 51.6%, P = 0.111), biochemical pregnancy loss rates (15.6 vs. 37.5%, p = 0.089), and miscarriage rate per clinical pregnancy (11.5 vs. 20.0%, p = 0.511) between the PGT-A and non-PGT-A groups. PGT-A was associated with significant improvements in clinical pregnancy and live birth rates in patients with recurrent pregnancy loss. This study was registered at the Chinese Clinical Trial Registry (ChiCTR2200056991 http//www.chictr.org.cn/). Registration Date 20,220,225.

Diagnosis-Related Group (DRG)-based payment reform aims to improve efficiency and restrain unnecessary expenditure, yet routine hospital indicators often report case mix, cost deviation, and profitability separately. This separation may obscure whether an unfavorable departmental profile reflects low cost-adjusted weighted output, reimbursement-cost misalignment, or an adverse position within the complexity-profitability distribution. This study develops and applies a DRG-Based Profitability-Efficiency Mapping (DRG-PEM) framework to evaluate departmental performance and identify reimbursement-cost pricing distortions within a DRG-based payment system. A retrospective analysis was conducted using discharge and cost data from 29 clinical departments in a large tertiary general hospital in China between January and June 2022. The analytical workbook contained 25,379 discharges, 1,962 department-DRG group records, and 595 unique DRG codes. DRG-PEM integrates three sequential modules: the Structural Efficiency Score (SES), the Weight-Cost Deviation Index (WCDI), and a DRG profitability-complexity quadrant map. Scenario simulation was performed for high-deviation DRG groups meeting predefined criteria: baseline WCDI > 40%, theoretical reimbursement below observed cost, complete cost data, and stable department-level case volume. SES values ranged from 23.86 in Pulmonary Medicine to 71.38 in Stomatology, demonstrating substantial interdepartmental heterogeneity. WCDI values ranged from 31.77% in Urology to 84.56% in Stomatology; similarly high values were observed in Pediatrics (83.72%), Pain Medicine (76.51%), and Anorectal Traditional Chinese Medicine (63.75%). Directional financial indicators showed that high WCDI did not uniformly indicate under-reimbursement: Stomatology had high WCDI but positive average profit per case, whereas ICU combined high CMI (1.81), negative average profit per case (-¥11,286.44), and severe WCDI (46.07%). Scenario simulations showed that reimbursement-to-cost ratios improved after hypothetical weight increases but remained below 1.0 for several high-deviation groups. DRG-PEM provides an implementable department-level framework for distinguishing cost-adjusted weighted output, reimbursement deviation, and structural financial risk under DRG payment. The framework supports integrated assessment of departmental performance and can inform targeted DRG weight adjustment, cost control, and internal resource allocation and institutional operational governance.

This study aimed to assess the degree of adherence to key recommendations of the 2023 HerniaSurge International Guidelines for Groin Hernia Management among surgeons performing adult groin hernia repair at a high-volume tertiary government training hospital in the Philippines. International guidelines for groin hernia management provide evidence-based recommendations to standardize the care of groin hernia cases. Despite dissemination, adherence varies across institutions. Evaluating real-world compliance is essential to identify gaps in implementation. A retrospective audit of adult patients who underwent groin hernia repair at the Philippine General Hospital over one year was performed. The primary outcome was guideline adherence rate which was defined as the proportion of cases fulfilling predefined, audit-appropriate operational definitions based solely on ten selected guideline recommendations assessable through routine institutional documentation. A total of 355 patients underwent groin hernia repair during the study period, accounting for 373 hernia units after separating bilateral cases. Use of clinical examination alone for diagnosis of primary inguinal hernias was documented in 203 cases (60.4%), while EHS classification was recorded in 251 cases (70.7%). Appropriate anesthesia was administered in 84.5% of patients, while antibiotic prophylaxis was given in 93.0%. All patients (100%) received recommended postoperative oral analgesics. In contrast, documentation-dependent technical steps such as nerve identification and intraoperative anesthesia infiltration were not recorded in any case, resulting in 0% documented compliance by audit criteria. Among female patients (n = 4), round ligament preservation was documented in one case (25.0%). Compliance patterns varied across training levels and surgical divisions, with higher adherence observed in mesh utilization and prophylaxis than in technical documentation elements. Adherence to guidelines was high for broadly established practices such as mesh-based repair, antibiotic prophylaxis, and post-operative analgesia, but inconsistent for documentation-sensitive technical recommendations. Findings for intraoperative parameters with 0% documented compliance should be interpreted with caution, as these most likely reflect documentation gaps rather than confirmed non-performance. Gaps in adherence may reflect documentation practices as much as technical deviations. This establishes a baseline for institutional quality improvement and future outcome-linked evaluations.

Objective: To construct a machine learning diagnostic model for hereditary hearing loss based on GJB2 and SLC26A4 genes and perform interpretability analysis using SHapley Additive explanations (SHAP). Methods: The data of genetic variants and hearing status were collected from 1 539 individuals at the Deafness Molecular Diagnosis Center of the Chinese PLA General Hospital from June 2015 to August 2024. Participants were categorized by expert diagnosis as hereditary hearing loss patients or non-hereditary hearing loss individuals, and were randomly assigned to a training set (n=1 077) and a test set (n=462) in a 7∶3 ratio using a computer-generated random sequence. Using non-zero coefficient variants of GJB2 and SLC26A4 genes screened by least absolute shrinkage and selection operator (LASSO) regression, six machine learning models including logistic regression, decision tree, random forest, gradient boosting (GB), eXtreme Gradient Boosting and k-nearest neighbors were constructed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) with the DeLong test, and accuracy, precision, sensitivity, F1 score and specificity were calculated. The best model was compared against intermediate-level physicians to assess its clinical value, and SHAP was applied for interpretation. Results: A total of 748 hereditary hearing loss patients (391 males and 357 females) aged 29 (13, 36) years and 791 non-hereditary hearing loss individuals (405 males and 386 females) aged 27 (12, 36) years were included. LASSO regression yielded 121 non-zero coefficient variants: 34 in the GJB2 gene and 87 in the SLC26A4 gene. The GB model produced an AUC of 0.975 (95%CI: 0.967-0.983), outperforming each of the other five models (all P<0.05). Moreover, the GB model also showed higher precision [98.5% (95%CI: 97.8%-99.2%) vs 92.6% (95%CI: 90.4%-94.4%)] and specificity [98.7% (95%CI: 98.1%-99.3%) vs 93.2% (95%CI: 91.2%-94.8%)] than intermediate-level physicians (both P<0.001). SHAP identified the top 10 impactful variants in the GB model: nine pathogenic variants (GJB2: p.Leu79CysfsTer3, p.His100ArgfsTer14, p.Val37Ile, p.Gly59AlafsTer18; SLC26A4: c.919-2A>G, p.His723Arg, p.Asn392Tyr, p.Thr410Met, p.Val659Leu) and one benign variant (GJB2: p.Val27Ile). The model tends to diagnose individuals carrying pathogenic homozygous or compound heterozygous variants as hereditary hearing loss patients. Conclusion: The machine learning models incorporating the GJB2 and SLC26A4 genes are of referential value for the auxiliary diagnosis of hereditary hearing loss, with the GB model demonstrating the best diagnostic performance.