Health Care Science最新文献

{"title":"Impact of China's National Volume-Based Procurement Policy on Cost, Volume, and Market Structure: An Interrupted Time-Series Analysis of Montelukast Sodium","authors":"Yufei Cheng,&nbsp;Fanyu Liu,&nbsp;Yongyi Wu,&nbsp;Siyu Liu,&nbsp;Xiaohan Fan,&nbsp;Bin Jiang,&nbsp;Zhao Yang","doi":"10.1002/hcs2.70092","DOIUrl":"10.1002/hcs2.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To reduce drug prices and improve access to essential medicines, the Chinese government implemented the National Volume-Based Procurement (NVBP) policy, leveraging economies of scale. Montelukast sodium, widely prescribed for respiratory diseases, was included in the first round. This study evaluates the impact of the NVBP policy, offering insights for global pharmaceutical policy reform.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Utilizing national procurement data from the National Healthcare Security Administration (January 2019 to December 2020), we conducted an interrupted time-series analysis, employing autoregressive integrated moving average models to correct for autocorrelation. We evaluated changes in procurement volume (in defined daily doses), procurement expenditures, and defined daily dose costs of montelukast sodium before and after NVBP implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The NVBP policy triggered a substantial decline in total procurement expenditures and defined daily dose costs, significantly improving drug affordability. Unlike the volume surge observed in other NVBP-covered drugs, the total procurement volume of montelukast sodium remained stable, suggesting rational clinical demand. Structurally, the policy successfully drove a “generic substitution” effect, where bid-winning generics rapidly replaced high-priced originators. The market share of non-equivalent generics contracted significantly, marking a quality consolidation of the market.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The NVBP successfully achieved cost containment for chronic respiratory disease medications. By promoting high-quality generic substitution and reducing the market share of high-priced originators and low-quality generics, the policy effectively optimized the market structure. These findings provide a replicable China Model for low- and middle-income countries seeking to balance affordability and accessibility in chronic disease management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"5 5","pages":"424-435"},"PeriodicalIF":6.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Modular Resection Surgery Teaching Model Improves the Effect of Teaching Under Regional Anesthesia for Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Day Surgery","authors":"Ru Yao,&nbsp;Aocheng Wu,&nbsp;Jie Lian,&nbsp;Linjuan Tan,&nbsp;Lu Gao,&nbsp;Bo Pan,&nbsp;Qiang Sun,&nbsp;Yidong Zhou","doi":"10.1002/hcs2.70093","DOIUrl":"10.1002/hcs2.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Breast-conserving surgery (BCS) combined with sentinel lymph node biopsy (SLNB) is a standard treatment for early-stage breast cancer. However, surgical variability and patient discomfort under regional anesthesia present challenges for training programs and consistent clinical outcomes. To address this, we implemented a breast modular resection (BMR) surgical teaching course designed to deconstruct BCS + SLNB into standardized modules and evaluated its impact on training effectiveness and patient outcomes in the day surgery setting under regional anesthesia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 273 patients underwent BCS with SLNB between 2019 and 2022, performed by six attending breast surgeons. Patients were divided into a classical procedure resection group (<i>n</i> = 124) and a BMR group (<i>n</i> = 149). All surgeries were performed under regional anesthesia. Clinical and subjective outcome indicators, such as re-excision rate, pain scores, cosmetic satisfaction, and hospital stay, were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The BMR group showed significantly more favorable perioperative outcomes, including lower re-excision rates (3.85% vs. 11.88%, <i>p</i> = 0.038), reduced intraoperative pain (<i>p</i> &lt; 0.05), decreased seroma incidence (9.62% vs. 20.79%, <i>p</i> = 0.032), and enhanced breast symmetry satisfaction (<i>p</i> = 0.008). A substantially higher proportion of BMR patients were discharged on postoperative Day 1 (79.81% vs. 31.68%, <i>p</i> &lt; 0.001), confirming the feasibility of safe, same-day BCS + SLNB. There were no differences in long-term complications or recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The BMR-based teaching model improved surgical performance, standardized the technique, and enhanced the patient experience for BCS + SLNB under regional anesthesia. This structured modular approach provides a replaceable framework for surgical education and may facilitate broader adoption of day-case breast cancer surgery without compromising oncologic safety or patient comfort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"5 5","pages":"461-472"},"PeriodicalIF":6.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classified Comparison and Cause Analysis of the Characteristics of Co-Disabilities Among Older Adults With Physical Disability in China","authors":"Yiran Wang,&nbsp;Xiaodong Zhang,&nbsp;Lu Tan,&nbsp;Chenyu Yan,&nbsp;Xiaoqian Yan,&nbsp;Wenwen Liu,&nbsp;Tianran Wang,&nbsp;Sijiu Wang,&nbsp;Wannian Liang","doi":"10.1002/hcs2.70088","DOIUrl":"10.1002/hcs2.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The aim of the study is to investigate the characteristics of co-disabilities among older adults with physical disabilities (PDs) in China in 1987 and 2006, and the correlation between other co-occurring disabilities and the presence and severity of PD among the older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study is a cross-sectional comparative study. The data were derived from the first and second China National Sample Survey on Disability. Case counts and prevalence rates were used to compare the characteristics of PD and “co-disabilities comprising PD and other disabilities” (CdPDD) in these two surveys. The binary logistic regression was used to analyze the correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>(1) From 1987 to 2006, the age-standardized prevalence rates of PD, sole PD, and CdPDD among older adults in China all increased, and these increases were more pronounced in rural older adults. (2) In both years, co-disabilities involving PD and hearing-speech disability had the highest percentage distribution and age-standardized prevalence rate, accounting for more than 60%, and this pattern was consistent in both urban and rural older adults. (3) Speech and intellectual disabilities were consistently associated with higher odds of PD and moderate-to-severe PD in both the overall sample and the urban–rural subgroup analyses. (4) Co-disabilities involving PD and mental disability showed a marked increase over time in both urban and rural older adults, particularly for multiple-CdPDD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PD and CdPDD among older adults in China increased markedly from 1987 to 2006, especially in rural areas. Hearing-speech-related co-disabilities remained the dominant pattern, while mental-related co-disabilities increased most rapidly. The associations of different co-occurring disability types with PD and moderate-to-severe PD varied. In the short term, priority should be given to identifying high-risk co-disability combinations and strengthening screening, referral, rehabilitation follow-up, and continuity of care, particularly in rural areas. In the longer term, a more integrated co-disability management framework is needed to better connect rehabilitation, mental health, primary healthcare, and long-term care services. Greater use of the co-disability rate indicator may also help guide priority setting and service planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"5 5","pages":"448-460"},"PeriodicalIF":6.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Performance Under Different Conditions in Answering China's Standardized Training Examination for Resident Physician in Radiology: A Comparative Analysis","authors":"Zheng Zhu,&nbsp;Yanfeng Zhao,&nbsp;Lin Li,&nbsp;Xiaoyi Wang,&nbsp;Yongming Zhang,&nbsp;Xinming Zhao","doi":"10.1002/hcs2.70085","DOIUrl":"10.1002/hcs2.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The capabilities of general-purpose large language models (LLMs) on specialized medical examinations have not been systematically compared. To evaluate the performance differences among three LLMs—DeepSeek-R1, ChatGPT-o1, and Gemini-2.0—in answering questions from China's Standardized Training Examination for Resident Physicians in Radiology, and to assess the impact of different questioning conditions (with/without answer choices, and the introduction of doubt) on model accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 131 questions were analyzed at one time. The LLMs were subjected to two tasks (questions with/without answer choices). Each task included three conditions: no doubt, weak doubt, and strong doubt, with the latter two presented as follow-up questions after the models' initial responses. Subjective evaluation was conducted using the 5-point Likert scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In both tasks, Gemini-2.0 achieved the highest accuracy (0.763–0.809) and (0.595–0.679). In Task 2, all LLMs' accuracy was lower than in Task 1, but only DeepSeek-R1 showed statistical significance (<i>p</i> = 0.014). The introduction of doubt (weak or strong) did not significantly increase accuracy in Task 1 for any model. In Task 2, only DeepSeek-R1 showed a slight increase in accuracy under doubt conditions. All LLMs performed significantly better on single-choice questions than on multiple-choice questions (<i>p</i> &lt; 0.05) and showed superior performance in case-based questions vs. knowledge-based questions. The subjective evaluation scores were 4.46 for DeepSeek-R1, 3.92 for ChatGPT-o1, and 3.83 for Gemini-2.0. It was noted that ChatGPT-o1 negotiated not to answer all questions at once and had missing responses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LLMs exhibit variable proficiency in tackling radiology resident examination questions, with Gemini-2.0 showing the highest overall accuracy. However, repeated self-examination of LLMs through the introduction of doubt does not consistently or significantly enhance their performance on radiology-related questions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"5 5","pages":"436-447"},"PeriodicalIF":6.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Physician Rostering in Emergency Departments: Managing Reentrant Patient Flows to Meet Excess Wait Time Targets","authors":"Xu Dai,&nbsp;Peng Gao,&nbsp;Xiaolei Xie","doi":"10.1002/hcs2.70100","DOIUrl":"10.1002/hcs2.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study optimizes physician rostering for emergency departments facing fluctuating patient volumes and complex flow dynamics. Specifically, we address the challenge of patient reentry, including those who leave without being seen and subsequently return (pre-service returns), as well as patients leaving subsequent to being seen requiring repeat evaluation or treatment for unresolved conditions (post-service revisits). These endogenous patient flows significantly disturb the clinical workload and complicate capacity planning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We develop a patient flow model that integrates these return loops and formulate a risk-aware physician rostering framework designed to strictly enforce excess wait time targets, for example, tail probability of delay service levels. We employ a simulation-based iterative staffing algorithm to efficiently compute the optimal physician rules required hour-by-hour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Discrete-event simulation experiments demonstrate that this approach effectively aligns workload with demand to maintain care standards without incurring unnecessary labor costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study develops a simulation-based, risk-aware physician rostering framework for emergency departments with reentrant patient flows to meet excess wait time targets such as tail probability of delay while reducing unnecessary workload pressure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"5 5","pages":"487-494"},"PeriodicalIF":6.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Computed Tomography Radiomics Approach for Assessing the T Cell-Inflamed Gene Expression Profile in Hepatocellular Carcinoma and Its Association With Immunotherapy Response.","authors":"Mimi Tang, Kaiyu Sun, Dasheng Wu, Yujian Zou, Jian Zhou, Bin Li, Huanjing Hu, Zhenpeng Peng, Jifei Wang, Bingsheng Huang, Shi-Ting Feng, Shuling Chen","doi":"10.1002/hcs2.70106","DOIUrl":"https://doi.org/10.1002/hcs2.70106","url":null,"abstract":"<p><strong>Background: </strong>The T cell-inflamed gene expression profile (GEP) provides a biomarker for immunotherapy response across various cancers. However, specific biomarkers for immunotherapy response in hepatocellular carcinoma (HCC) are lacking. In this study, we established a computed tomography (CT)-based radiomics model to predict the T cell-inflamed GEP and immunotherapy response in HCC.</p><p><strong>Methods: </strong>This retrospective, multicenter study included 270 patients with HCC, who were divided into training (<i>n</i> = 227) and test sets (<i>n</i> = 43). All included patients had available contrast-enhanced CT and RNA sequencing data. The T cell-inflamed GEP consisted of 18 genes derived from RNA sequencing data, and patients were classified into GEP-high and GEP-low groups. A support vector machine was used to establish the radiomics model. The immunotherapy dataset comprised patients who underwent contrast-enhanced CT and received anti-programmed cell death protein 1/programmed cell death ligand 1 immunotherapy at three hospitals (209 lesions). This immunotherapy dataset was used to evaluate the association between the predicted GEP status and immunotherapy response. Additionally, overall survival was compared between patients with and without predicted GEP-high lesions in the immunotherapy dataset.</p><p><strong>Results: </strong>The areas under the receiver operating characteristic curve of the radiomics model for predicting GEP in the training and test sets were 0.824 (95% confidence interval [CI] = 0.757-0.892) and 0.827 (95% CI: 0.674-0.980), respectively. In the immunotherapy dataset, the response rate of liver lesions at 6 months was significantly higher in the GEP-high group than in the GEP-low group (48.1% <i>vs</i>. 9.3%, <i>p</i> < 0.001). The areas under the receiver operating characteristic curve of the radiomics model for predicting immunotherapy response at 6 months was 0.750 (95% CI: 0.614-0.886). Median overall survival among patients with GEP-high lesions was 17.5 months, which notably exceeded the value of 8.3 months for patients without GEP-high lesions.</p><p><strong>Conclusions: </strong>This study provides the first CT-based radiomics model for predicting the T cell-inflamed GEP in HCC. This model highlights the potential of the T cell-inflamed GEP as a noninvasive biomarker to help guide immunotherapy selection.</p>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Primary-Care-Centered Integrated Care Intervention for Stratified Cardiovascular Risk Control in China: Study Protocol for a Pragmatic Cluster Randomized Controlled Trial.","authors":"Weijia Lu, Xinxin Xia, Ziming Wang, Yaoyun Zhang, Yiting Lin, Wuxiang Xie, Jin Xu","doi":"10.1002/hcs2.70105","DOIUrl":"10.1002/hcs2.70105","url":null,"abstract":"<p><strong>Introduction: </strong>Gaps in primary care (PC) restrict its potential as a core foundation of the health system in its response to the growing burden of cardiovascular disease (CVD). China has been promoting County-wide Tight Medical Alliances to strengthen PC by integrating services from hospitals and PC providers. However, a practical model of care for effective CVD risk management is still lacking. We developed a multifaceted intervention, namely the Cardiovascular-Risk-Stratified Integrated Management model, to strengthen PC for CVD risk management by leveraging both PC providers and hospital-based specialists in the County-wide Tight Medical Alliances. The purpose of this study is to evaluate the effectiveness of the Cardiovascular-Risk-Stratified Integrated Management model.</p><p><strong>Methods: </strong>This study is a multicenter, cluster-randomized controlled trial conducted with a total of 2560 patients with diagnosed hypertension and/or diabetes, aged 41-70 years, served by 64 family doctor teams in three county-wide tight medical alliances. The primary outcome is the change in 10-year CVD risk score from baseline to 12 months after intervention, using the World Health Organization CVD risk laboratory-based chart for East Asians. Secondary outcomes include 12-month and 6-month changes in CVD risk factors, and incidence rate of major adverse cardiovascular events, and so forth. All participants will receive outcome measurements at baseline, 6, and 12 months.</p><p><strong>Discussion: </strong>This study pioneers a PC-based integration of individualized CVD risk management with economic incentives, evaluating its effects on resource allocation and preventive outcomes to inform scalable models in low- and middle-income countries. The study findings will be disseminated through multiple channels, including a final report, publications in peer-reviewed journals, and evidence-based recommendations tailored to healthcare providers, health service commissioners, and policymakers.</p><p><strong>Trial registration: </strong>Clinical Trials ID: NCT06302127. Date of registration: March 8, 2025. Prospectively registered. URL of Trial Registry Record: https://clinicaltrials.gov/study/NCT06302127.</p>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Avoidable Emergency Department Visits and the Potential Role of Community Health Centers in Northern Italy: A Retrospective Observational Study.","authors":"Silvia Caristia, Isabella Santomauro, Erika Bassi, Laura Ferraris, Alberto Dal Molin, Fabrizio Faggiano","doi":"10.1002/hcs2.70103","DOIUrl":"10.1002/hcs2.70103","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) are experiencing a growing burden of non-urgent presentations, which frequently signal deficiencies in access to primary and community-based healthcare. Evidence suggests that a substantial proportion of ED visits could be safely and effectively managed within community care settings. The general aim of the study was to identify which ED visits could have been managed within primary and community care services in a scenario of full implementation of community health centers.</p><p><strong>Methods: </strong>A retrospective observational study was conducted. This study examined data from the first-level ED at S.S. Trinità Hospital, Borgomanero in Northern Italy. It involved analyzing all access data from the ED in 2022. Avoidable ED visits were identified using triage assessments, multidisciplinary team, double-blinding nursing assessments, and data validation.</p><p><strong>Results: </strong>Of the 43,437 ED visits in 2022, 91.8% were nonurgent (<i>n</i> = 39,864). We identified 46.3% (<i>n</i> = 20,104) of the ED visits as avoidable, with the most common characteristics of presentation being trauma or burns, fever, eye issues, urological symptoms, ear nose and throat problems, lower back pain, and swelling.</p><p><strong>Conclusions: </strong>Our findings highlight the need to strengthen primary care services through cohesive, accessible, and timely interprofessional networks to effectively address non-urgent healthcare needs and reduce the burden on ED settings.</p>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing Technology and Ethics in Corneal Xenotransplantation: A Scoping Review of Standards and Safety in Ophthalmology.","authors":"Sankhajyoti Saha, Moubani Dutta, Agnihiya Bosu","doi":"10.1002/hcs2.70102","DOIUrl":"10.1002/hcs2.70102","url":null,"abstract":"<p><p>Xenotransplantation offers a potential solution to the critical global organ shortage by allowing the transplantation of organs from non-primate animals to humans. To address the critical barriers of biological safety, zoonotic infections, and immunological rejection, this review evaluates current innovations in genetically engineered donor species strategies and assesses existing ophthalmological standards, employing specific expression of human regulatory proteins (hCD46/hCD55) and genetically modified triple knockout (<i>GGTA1</i>/<i>B4GalNT2</i>/<i>CMAH</i>), biophysical thresholds, porcine cytomegalovirus screening, bacterial/mycotic cultures, and DNA sequencing for unidentified organisms. Employing a snowball strategy across PubMed Central, ResearchGate, and Wiley Online Library, 47 articles were selected and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The feasibility of xenotransplantation relies heavily on advancements in donor technology and genotype transparency, animal husbandry and biosafety, infectious testing and surveillance, recipient monitoring and lifetime surveillance, biosafety incident and response plan, data governance, sharing and oversight, and animal welfare and social license, necessitating pathogen observation, biosecure storage, bioexclusion monitoring, and good manufacturing practice-style manual, quantitative polymerase chain reaction for porcine cytomegalovirus, porcine reproductive and respiratory syndrome virus, hepatitis E virus, alongside porcine endogenous retrovirus-A/B/C; metagenomic sequencing initially, followed by 1, 3, 6, and 12 months, and subsequently once every year, systematic and preliminary persistent sampling evaluations, independent data safety monitoring board, collaborative guidelines, encrypted databases, and data retention. The integration of endothelium-protective human genes, including <i>hA20</i> or <i>hHO-1</i>, into genetically altered donor corneas in non-human primate xenografts, is expected to minimize initial post-transplant endothelial cell density loss by ≥ 20% compared to existing models. While clustered regularly interspaced short palindromic repeats-based modifications offer transformative potential for xenotransplantation, their reliability currently depends on establishing stringent biosafety standards.</p>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility Assessment of Extracting Social Determinants of Health From Electronic Medical Records: A Multicenter Study Across Chinese Healthcare Institutions.","authors":"Mengchun Gong, Zihao Ouyang, Dandan Ma, Qilin Wang, Endi Cai, Chao Liu, Yue Yu, Jingdong Yan, Sheng Nie, Lin Lin","doi":"10.1002/hcs2.70094","DOIUrl":"10.1002/hcs2.70094","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Social determinants of health (SDoH) are pivotal in influencing health outcomes and disparities across various populations. Real-world data rich in SDoH information, such as electronic medical records (EMRs), can considerably enhance public health interventions. However, in Chinese medical practice, these non-clinical factors are often neglected, with many healthcare providers failing to recognize the importance of SDoH information in the improvement of patient care. The objective of this study is to explore the feasibility and effectiveness of extracting SDoH information from Chinese EMRs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We developed a China-specific SDoH classification framework by integrating findings from relevant research using real-world data. This framework was applied to over three million patient records from Chinese EMRs to examine the completeness and availability of SDoH-related attributes within relevant fields. We also developed a quantitative assessment framework for evaluating SDoH information in EMR fields. This two-dimensional evaluation system measures data completeness and availability using a three-level hierarchical scoring approach, progressing from basic to advanced criteria. Additionally, we analyzed variations in SDoH information extraction across different healthcare institutions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Drawing on the literature and 2000 manually annotated EMRs, we established a standardized framework of SDoH factors, comprising 50 features tailored to the Chinese medical diagnostic and treatment environment. We analyzed over 5.6 million EMRs from 40 hospitals within the National Clinical Research Data Center and found that tables and fields in Chinese EMRs cover all six primary SDoH categories, encompassing 25 out of 50 specific attributes. However, data extraction feasibility was relatively poor, with only seven features being fully extractable, with most \"social and community context\" data missing. Our evaluation of 43 electronic health record fields containing SDoH data revealed significant disparities between completeness and availability metrics. The composite completeness score averaged 1.47 (95% confidence interval: 1.20-1.73) out of a maximum score of 3. Availability assessments demonstrated notably higher performance with a mean score of 2.14 (95% confidence interval: 1.83-2.44) out of a maximum score of 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This research established a culturally adapted SDoH framework for China and demonstrated the feasibility of extracting SDoH attributes from Chinese EMRs. Although some SDoH information in EMRs still cannot be captured or requires more advanced data processing to be usable, Chinese EMRs contain a wealth of SDoH data, allowing us to use large existing EMR databases to support ongoing SDoH research. Natural language processing technology has a critical role in this process, underscoring the importance of medical informatics and curren","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}