The trend of tumor chronicity has put forward new requirements for tumor rehabilitation, but currently there is still a lack of systematic and integrated construction and demonstration in the field of tumor rehabilitation. Therefore, it is imperative to establish a standardized management system for integrated tumor rehabilitation. To this end, the Rehabilitation Management Special Committee of the Shanghai Anti-Cancer Association conducted a research on the rehabilitation needs of the real world, and led several domestic experts in oncology, rehabilitation medicine, nursing, health management and other related fields to hold multiple rounds of expert discussions and opinions collection, jointly formulating the “expert consensus on tumor integrated rehabilitation management (2024)”. This consensus proposes the definition and objectives of tumor integrated rehabilitation, elaborates on the staging, system and mode, evaluation and intervention of tumor integrated rehabilitation, and clarifies the specific practices of primary health service centers in the field of tumor integrated rehabilitation, in order to provide a basis for the development of tumor rehabilitation discipline and the formulation of integrated rehabilitation management strategies for tumor patients.

Objective To sort out typical cases of public hospitals applying artificial intelligence to improve patient experience, and analyse related strategies and practices. Methods In April 2024, practice cases of public hospitals applying artificial intelligence to improve patient experience were searched and screened on various databases, hospital portals, and public platforms. Based on Patient Journey Theory, the case content was analysed by thematic coding using text analytics, and 2 rounds of expert consultation were conducted to identify typical cases, and a narrative approach was adopted to summarise and distil their innovative experiences. Results Initially, 47 relevant cases were retrieved and coded according to the textual content of the cases to construct a thematic framework for the application of AI to improve patient experience. The thematic framework covers three main stages: pre-diagnostic service, diagnostic service and post-diagnostic service, and specifically includes 10 organisational practices to improve patient experience, such as intelligent diagnostic guidance, process optimisation, assisted self-examination and disease prediction. The 15 typical cases identified by the experts were further summarised and analysed to refine the specific ways and focuses of applying AI to improve patient experience at different stages of the medical journey. It was found that public hospitals focus on improving patient engagement and optimising the consultation process in the pre-consultation stage, improving the quality and efficiency of consultation services in the mid-consultation stage, and providing continuous health management and personalised follow-up visits in the post-consultation stage. Conclusion The application of artificial intelligence in the pre-diagnosis, diagnosis and post-diagnosis phases can significantly improve the patient's experience from different perspectives, and public hospitals around the world should actively apply advanced technology to help improve the patient experience.

Objective Based on the comparison of domestic and international literature, the study analyzes hotspots and development trends in the field of patient needs providing insights for future studies. Methods Literature from the CNKI database and Web of Science core database, spanning from January 1, 2003, to July 31, 2023, was searched. CiteSpace software was then used to visually compare and analyze the number of publications, authors, institutions, and keywords in both domestic and international research. Results A total of 1 480 Chinese literatures and 7 430 English ones were included. Both Chinese and English literature showed a significant increase in publication volume, but no stable core group of authors was identified. Compared to international institutions, domestic institutions have less inter-institutional collaboration. In addition to health education, research hotspots differ between a domestic and international studies: international research emphasizes machine learning, critical care, hospice care, pain management, quality of life, etc. Domestic research pays more attention to qualitative research, medical insurance, chronic disease management, and influencing factors. Conclusions Future research should focus on health education, chronic disease management, hospice care and explore innovate service models using mobile health technologies and artificial intelligence. Additionally, it should investigate demand-based medical insurance policies to improve medical services.

At present, the high-quality development of public hospitals in China benefits from institutional and systemic advantages, such as a high degree of organization within the government-led medical and health service system, a strong capacity to attract medical professionals and technical talents, high public trust and broad accessibility of medical services, and a strong ability to guarantee and regulate basic medical policies. However, it also faces challenges regarding operating costs due to the large number of existing beds. The article proposes, empowering public hospitals through information technology and digitization to enhance their capacity to reconstruct the value of new services, products, and efficiency, while strengthening the utilization value of existing beds through high-quality development value foundations and the creation of distinctive advantages. It also suggests utilizing digital transformation to promote the construction of a new production relationship based on the synergy between medical treatment, medical insurance, and medicines supply, and continuously enriching the new landscape of high-quality development of public hospitals through efficient mechanisms of this synergy.

Medical large language models (LLMs) are expected to improve the efficiency and quality of modern medical services by offering new tools. Robust and rational evaluation methodologies are essential to support scientific medical decision-making. Although the development of the domestic medical LLMs has closely follows the international advancements, research and practical experience in their evaluation method remains limited. This study reviews the current progress of the LLMs’ evaluation tools, summarizes the evaluation approaches, and analyzes key difficulties, aiming to provide a foundation for improving the evaluation framework.

Objective To investigate the Chinese physicians’ cognition and support attitude regarding the benefits and risks of artificial intelligence (AI)-assisted diagnostic technology for breast cancer pathological slides, and to provide decision-making basis for the development and clinical application of this technology in China. Methods A questionnaire survey was conducted among physicians responsible for clinical diagnosis and treatment of breast cancer, as well as medical technical support, in nine tertiary hospitals in Shanghai, Hubei and Gansu. The chi-square test was used to compare physicians’ cognition and support for AI-assisted diagnostic technology for breast cancer pathological slides. Results A total of 278 physicians were included. According to the physicians’ cognition, the top three benefits of AI-assisted diagnostic technology for breast cancer pathological slides were “reducing the workload of pathologists” (77.70%), “improving diagnostic efficiency” (76.26%), and “reduce the need for pathologists’ allocation” (48.20%). The top three risks were “increasing the risk of misdiagnosis” (66.55%), “increasing the risk of missed diagnosis” (56.47%), and “lack of standardized diagnostic criteria” (50.00%). Additionally, 68.71% of physicians supported or somewhat supported AI-assisted diagnostic technology for breast cancer pathological slides, with differences in support rate across regions and hospital types. Conclusion China sould establish a standardized medical imaging database and implement safety certification to promote the maturity and improvement of AI-assisted diagnostic technology for breast cancer pathological slides, thereby increasing physicians’ trust and support.

Promoting the coordinated development and governance of medical services, medical insurance, and pharmaceuticals is a concrete practice in advancing the modernization of the national governance system and enhancing governance capacities. It is an inevitable requirement for implementing the strategy of prioritizing health development and an important part in deepening the healthcare system reforms. Currently, the coordinated development and governance of medical treatment, medical insurance, and pharmaceuticals still face numerous challenges. Healthy China Research Network, incorporating evidence-based scientific data, expert insights, and practical experience, has formulated the “Expert Consensus on the Coordinated Development and Governance of Medical Services, Medical Insurance, and Pharmaceuticals,” exploring the connotations, significance, and goals. The consensus proposed that, to promote the coordinated development and governance of medical treatment, medical insurance, and pharmaceuticals, it is essential to adhere to the comprehensive leadership of the Communist Party of China, and center the focus on people’s health. Upholding fundamental principles and breaking new ground, prioritizing institutional development, and following the systematic principle are critical as well. Accordingly, corresponding institutional mechanisms and supportive measures are proposed, aiming to provide references for policymakers, decision-makers, practitioners and researchers in the field of healthcare.

The clinical comprehensive evaluation of drugs based on real-world data is a vital approach for assessing the clinical value of drugs, including effectiveness, safety, and cost-effectiveness, in real-world healthcare settings. Currently, most real-world studies in China have yet to establish standardized quality control management protocols. The drug clinical comprehensive evaluation team should develop the Quality Control Standards for Real-World Research in Clinical Comprehensive Evaluation of Drugs (hereinafter referred to as the "Standards"), emphasizing scientific rigor, compliance, and reliability. These Standards provide operational guidelines for researchers, ensuring that studies are standardized, homogeneous, and possess a high degree of external validity. They systematically cover key aspects such as research objectives, study design, data sources and preprocessing, statistical analysis, and result interpretation. The Standards serve as a benchmark for quality control management of drug clinical evaluations based on real-world research, aiming to enhance the quality of such research and provide robust scientific support for drug supply security decisions and clinical treatment decision-making.

Objective To analyze the current status and trends of high-priced drugs covered by inclusive voluntary health insurance (IVHI) in China, and provide evidence for its high-quality development. Methods The benefit designs of IVHI in China and its high-priced drug lists from 2021 to 2023 were systematically collected. A comparative study was conducted to examine the provisions of coverage, the scope and level of coverage, and reimbursement trends for these drugs. Results Between 2021 and 2023, 112 (83.58%), 165 (86.84%), and 184 (85.58%) IVHI plans provided coverage for high-priced drugs. The average number of drugs listed in the high-priced drug catalog rose from 22.1 to 38.7, with oncology drugs being the most common. During this period, the median deductible and cap for high-priced drug coverage remained at 0 RMB and 1 million RMB, respectively, while the median reimbursement ratio declined slightly from 80% to 75%. The reimbursement ratio for individuals with pre-existing conditions was, on average, over 30% lower than that for the general population (P<0.001). As the number of high-priced drugs increased, so did the proportion of high-priced drug reimbursement relative to total reimbursement. Conclusions From 2021 to 2023, the number of drugs listed in the high-priced drug catalog increased annually, with oncology drugs being the primary focus of coverage. The scope and level of coverage for high-priced drug remained stable, but for individuals with pre-existing conditions, it was lower than for the general population. It is essential to maintain high-priced drug coverage as a core responsibility of IVHI and to further optimize the selection and payment mechanisms for these drugs to enhance coverage effectiveness.

In the context of global health, strengthening regulatory harmonization of pharmaceutics across countries and regions has become increasingly important and necessary. This study employs a literature review to analyze the key issues facing global health development, explores global practices in drug regulatory coordination and reliance, and examines the current status of China’s participation in international regulatory harmonization. It aims to propose recommendations for promoting international regulatory harmonization of pharmaceutics at both global and national levels. Currently, WHO has promoted the global drug regulatory coordination, and international organizations such as the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) and the Pharmaceutical Inspection Co-operation Scheme (PIC/S) have established international regulatory consensus. Mutual recognition of drug inspections has been largely established between regulatory agencies in developed countries, such as those in the United States, the European Union, the United Kingdom, Canada, and Australia. Regulatory agencies in Africa, Latin America, and the Caribbean, on the other hand, often rely unilaterally on the regulatory decisions made by the United States and Europe. China’s National Medical Products Administration (NMPA) has joined international regulatory coordination organizations, including ICH, PIC/S, and ICMRA (International Coalition of Medicines Regulatory Authorities), and has established bilateral cooperation with regulators in more than 50 countries and regions. In the future, agencies and organizations should work collaboratively to promote international regulatory coordination, facilitate the global sharing of regulatory resources from developed and high-income countries, and ensure that regulatory decisions are effectively shared worldwide. NMPA should advance the mutual recognition with counterpart agencies in countries with more well-established regulatory systems and encourage the creation of regional drug regulatory cooperation alliances. This will contribute China’s efforts toward addressing the imbalances in global health development.

Objective To provide insights for enhancing the dissemination capabilities of public health science popularization, this study analyzed the pathways of factors influencing users’ intention to adopt information from public health WeChat official accounts. Methods Utilizing the unified theory of acceptance and use of technology (UTAUT) as the theoretical framework, and incorporating methods such as expert consultations and literature reviews, the hypothetical theoretical model of factors influencing users’ intention to adopt information adoption from public health WeChat official accounts was constructed. Distribute online questionnaires to collect data, and the software Smart PLS 4 was employed to establish a structural equation model for path analysis of the influencing factors. Results 874 valid questionnaires were collected in total. The model explained 80.5% of the variance in users’ intention. Information usefulness (β = 0.154, P<0.001), information quality (β = 0.104, P= 0.030), facilitating conditions (β = 0.354, P<0.001), and source credibility (β = 0.352, P<0.001) had direct positive impacts on users’ intention. Additionally, source credibility (β = 0.018, P= 0.043), social influence (β = 0.020, P= 0.008), effort expectancy (β = 0.077, P<0.001), and facilitating conditions (β = 0.029, P= 0.020) also indirectly influenced users’ intention through the perceived usefulness of the information. Conclusions Information usefulness, quality, facilitating conditions, and source credibility can significantly and positively predict users’ intention to adopt information from public health WeChat official accounts. Moreover, source credibility, social influence, effort expectancy, and facilitating conditions can indirectly influence users’ intention through the mediating variable of information usefulness. This highlights the importance for operators of public health WeChat official accounts to focus on enhancing users’ adoption intention to promote the healthy development of the platform.

The community serves as the fundamental unit for delivering healthcare services, and community healthcare is a crucial component of high-quality health development. This paper reviews the development history and current status of community health services in Shanghai. It outlines five practical pathways for enhancing community health service capacities: improving the "General Practice+Specialized Medical Service" model, expanding community pharmaceutical supplies, strengthening the family doctor contract service system, establishing the community health service brand "Three Centers and One Clinic," and effectively leveraging health insurance. The aim is to provide insights for the development of community health services in the new era.

Objective To analyze the patent development trends of key innovative enterprises in capsule endoscopy (CE) both domestically and internationally, providing insights for the patent layout and development direction in China's CE technology sector. Methods Medtronic, Olympus, Anhan Technology and Jinshan Science and Technology were selected as representatives of major CE innovators. Based on Derwent Innovation (DI) database and IncoPat global patent database, a patent literature dataset of key innovative enterprises in CE was constructed to analyze the characteristics and differences in patent development among the four enterprises. Results From the perspective of patent application trends, Olympus had the earliest global patent application (1978), with the highest annual application number (213). In terms of target markets, Medtronic primarily focuses on the United States (271 cases), Olympus on Japan (954 cases), and Anhan Technology and Jinshan Technology both on China (380 cases and 397 cases, respectively). Regarding the distribution of subdivided technological focuses, Medtronic, Olympus, Anhan Technology, and Jinshan Technology hold 125, 392, 78, and 77 patents respectively for image acquisition, and 47, 281, 106, and 102 patents respectively for magnetically controlled capsules. From the perspective of technological hotspot distribution, Medtronic and Olympus pay attention to digestive wall structure imaging, image processing, and capsule enteroscopy, while Anhan Technology and Jinshan Technology focus on targeted drug delivery and battery technology. Conclusions International innovators in capsule endoscopy started their R&D earlier, resulting in a large number of patents and a broader global layout. Although domestic capsule endoscopy innovation companies are in the growth stage of technological accumulation, they have a fast development momentum and show a certain trend of catching up in some sub-technical fields.

Objective To analyze and evaluate the current status of short video communication among grade 3A general hospitals in Shanghai, identify key issues and deficiencies, and provide strategic recommendations for improvement. Methods Collect data from the official Douyin and WeChat video accounts of five grade 3A hospitals in Shanghai from July to December 2023. Conduct statistical analysis on the total number of videos, number of followers, total number of likes, release date of the first video, and video collections. Evaluate the communication capacity of the official Douyin accounts of the five hospitals using the Douyin Communication Influence Index (DCI). Utilize Micro Word Cloud software to analyze word frequency statistics in Douyin video titles and key user comments. Results Five hospitals collectively released 1 631 short videos on WeChat Video Account, with eight video collections. On Douyin, they published 1 152 short videos, garnering 176 000 followers and 1.999 million likes. They also released 14 video collections with content primarily focused on medical health education (58.33%), hospital culture (16.67%), and medical supplies (16.32%). Overall, the communication capacity on the short video platform is relatively low (DCI approximately 250). The most frequently terms in short video titles and user comments on the official Douyin accounts include hospital abbreviations, disease names, medical-related terms, and expressions of gratitude. Conclusions Grade 3A general hospitals in Shanghai have relatively late starts in short video development, resulting in lower numbers of followers and likes. It is recommended to accelerate the integration of new media resources in hospitals. The Douyin accounts have low communication capacity, so it is suggested to enhance interactions with medical personnel who are highly ranked in science popularization influence on the Douyin platform. The published video collections lack personalization and differentiation; therefore, it is advisable to create science popularization short videos that highlight the hospital's specialized strengths.

The quality control guidelines for real-world studies in drug clinical comprehensive evaluation projects establish specific requirements for the complete, concise, standardized, and transparent reporting of research, from the formulation of research objectives to the presentation and interpretation of results. These guidelines encompass 5 domains and 36 specific criteria. They are applicable to the quality control and management of the real-world research component in drug clinical comprehensive evaluation projects, which are expected to play a crucial role in enhancing the quality of drug clinical comprehensive evaluation research. This paper introduces the development process and methodology of the quality control guidelines for real-world studies, describes the fundamental characteristics of the guidelines, provides a detailed interpretation of the regulatory items, and differentiates their applications based on the needs of various types of real-world studies, to facilitate better understanding and application by researchers.

Objective To analyze and compare the regulations for ethical review of chimeric antigen receptor (CAR) T cell therapy in China and the USA, aiming to provide recommendations for improving the ethical review system for this therapy. Method Using the search term “CAR-T cell therapy”, search for the relevant regulations, systems, and literature on governmental and medical association websites in China and the USA, as well as databases such as the CNKI, Wanfang, Weipu, SinoMed, PubMed, and Embase, and systematically summarized the findings. Results Key areas of focus in the ethical review of CAR-T cell therapy include the qualifications of research institutions, researchers, and third-party laboratories, informed consent, risk assessment and management, and vulnerable populations. Compared to the USA, China needs to enhance its ethics review system by establishing specific laws and regulations, developing comprehensive technical standards or guidelines covering the entire lifecycle of CAR-T cell therapy products, and refining ethical norms for these therapies. It is also crucial to support the development of cellular immunotherapy research at the national level to accelerate clinical investigation of these products. Conclusions Current regulations regarding the ethical review of CAR-T cell therapy in China are evolving rapidly. However, further refinement of ethical norms is needed to minimize risks and maximize benefits.

This study examines the successful medical and technological innovation model of the National Institutes of Health Clinical Center (NIH CC) in the United States, focusing on its strategies in functional positioning, funding allocation, talent cultivation, outcome translation, and organizational governance. As a specialized hospital dedicated to cutting-edge clinical research, NIH CC aims to develop innovative diagnostic and therapeutic solutions for patients with intractable diseases. It achieves a deep integration of medical research and clinical practice, embodying the concept of advancing healthcare through research. In contrast, high-level public hospitals in China face challenges in research orientation and investment, which hinder their transformation into research-focused institutions and create challenges in talent supply, outcome translation, and collaborative innovation. To facilitate this transformation, it is crucial for China to clarify the research functions of high-level public hospitals, scale up investment, and draw lessons from NIH CC’s successful approaches in research orientation, funding acquisition, talent cultivation, outcome translation, and network building.

Objective To understand the current situation of the construction of demonstration community rehabilitation centers in Shanghai and provide insights for the formulation of community rehabilitation policies in the city. Methods This study investigated the infrastructure, facilities, equipment, human resources, and service provision of 119 demonstration community rehabilitation centers in Shanghai, and compared relevant data before and after construction. Results The average treatment area of these in Shanghai was 587.4 m², with a total of 2671 beds. On average, each center is equipped with 10.8 rehabilitation physicians, 2.9 rehabilitation nurses, and 5.9 rehabilitation therapists. Among the 119 centers, 93.3% have outpatient rehabilitation information modules, 73.9% can automatically collect information data generated in rehabilitation services, 47.1% can link rehabilitation service data with residents’ health records, and 38.7% can connect rehabilitation service data with superior medical institutions in the integrated health care system. In 2023, these centers provided a total of 9.691 million rehabilitation visits, including outpatient rehabilitation (5.315 million), inpatient rehabilitation (2.704 million), and site-based rehabilitation (1.592 million). Conclusions Although significant progress has been made in the construction of demonstration community rehabilitation centers, traditional rehabilitation services still dominate, and there are notable regional disparities. It is recommended to further strengthen the community rehabilitation system, expand the workforce, enhance community service offerings, and advance informatization to improve the level of community rehabilitation services.

Objective To analyze the impact of the family doctor contract service policy in Shanghai on relevant contract indicators, providing decision-making references for the development of family doctor contract services. Methods Through the Shanghai Informationization Data Platform (Shanghai Community Health Comprehensive Management Platform), dynamic monitoring data of contract service management from August 2022 to April 2024 in 16 districts of Shanghai were collected. The data includes the number of contractees, contract coverage rate, community contract saturation, compliance of contracted communities, community visit rates, visit rates within contract groups, and coverage rates for key populations. With June 2023 as the policy intervention point, the interrupted time series model was utilized to analyze changes in contract indicators before and after the implementation of the family doctor contract target management policy. Results After the policy implementation, the number of contractees (10.884 9 million VS. 9.296 2 million), contract coverage rate (43.7% VS. 37.4%), and key population contract coverage rate (84.2% VS. 79.1%) all increased, when compared to those before the contract with statistically significant differences (all P<0.001). Regression analysis showed that after the policy implementation, the number of contractees, contract coverage rate, and contract coverage rate of key populations all presented an upward trend (all P<0.05). However, there was no significant change in the long-term trend of contract saturation (P = 0.441). The contract community visit rate indicated a downward trend (P<0.01), while compliance of contract community revealed an increasing trend (P<0.05), and there was no remarkable change in visit rates within the contract groups (P>0.05). Conclusions The policy intervention has a significant short-term effect on contract coverage and contract flow, but there is a decreasing trend over time. It is recommended that future policies address the slowing growth trends and optimize the quality and efficiency of contract services.

Objective To clarify the current situation and existing problems of the unified needs assessment service system for elderly care in Shanghai, to propose feasible recommendations for improvement, and to provide a reference for optimizing the system. Methods An institutional survey was conducted on assessment institutions at both the municipal and district levels in Shanghai, alongside key informant interviews with managers of Shanghai and district-level health commissions, medical insurance bureaus, civil affairs departments, and the heads of assessment institutions. The existing problems were analyzed using the WHO health system framework and thematic framework analysis. Results The unified needs assessment service system for elderly care in Shanghai has a large scale of service provision, a substantial number of assessors, and a generally well-established information platform, fund mechanism, and organizational structure. There are still some challenges such as the need to strengthen the top-level coordination, the small scale of assessment institutions, instability of the assessor workforce, low assessment costs, unreliable operation of the information platform, and underutilization of assessment results. Conclusion The future development of the unified demand assessment service system for elderly care in Shanghai should further strengthen the following aspects: clarifying the positioning and improving the top-level design, enhancing the overall departmental and industrial coordination, promoting the sustainable development of the industry, improving the professionalism of assessment institutions and personnel, refining operational mechanism, and increasing awareness of policy standards.

Objective To comb the policies regarding the outpatient chronic and catastrophic diseases (OCCDs) under the outpatient co-insurance of employee basic medical insurance in China, and to offer insights for further standardization of OCCDs support. Methods A comprehensive collection of policy documents of 31 provinces (including municipalities directly under the central government and autonomous regions) were assembled for a comparative study of the OCCDs support across regions. This analysis encompassed several key aspects, including the degree of policy unification, the scope of the OCCDs support, the reexamination period of diseases in the catalogue, the coverage of comorbidities, and the level of support. Results Significant discrepancies in OCCDs support in different regions were identified, including the disease entry standard, the scope of covered diseases, and the support level. Disorder and fragmentation are prominent features of China’s OCCDs support policy. Conclusion It is imperative to strengthen the top-level design, gradually consolidate the admission criteria for OCCDs via top-down approach, and formulate a catalogue of OCCDs, so as to lay the foundation for further equalization benefit and direct settlement of OCCDs in different insurance regions.

Objective To examine the policy design of long-term care insurance in China and optimize its practical implementation path. Method The PMC index model was used to quantify the policy texts from 12 cities in China’s first and second pilot projects, followed by a differential analysis of the policy content. Results The policy level in each pilot city is at or above the “good” level, with an overall positive outcome. However, improvements are needed in areas such as incentives and constraints, policy timeliness, and institutional indicators. Moreover, remarkable differences and fragmentation exist among pilot cities in terms of insurance payment, service models, and standards for benefits and payment. Conclusions The pilot phase of China’s long-term care insurance system has yielded initial results, but substantial room for improvement remains. There are notable differences in long-term care insurance among pilot cities, and there is a pressing need for coordinated planning. A sound financing mechanism is the key to the sustainable development of the system.

Shanghai is advancing the construction of high-level talent highland. However, as a leading industry, biomedicine industry is inseparable from the construction of medical talent highland. This paper defines the connotation of building medical talents highland in Shanghai in the new era. It also examines the overall scale of medical talents, including the status quo of three types of talents, namely, outstanding, high-level and general ones, as well as the “Attracting and Nurturing” policy in Shanghai for talents. Currently, Shanghai has established a comprehensive medical talent highland policy system, which has facilitated the initial aggregation of high-level talents. However, to establish a competitive advantage in the field of life and health on the Asian and global stages, there still exists a wide gap to bridge. Deficiencies are apparent in the scale of outstanding talents represented by academicians of the two academies in China, high-level talents represented by physician scientists, and general talents represented by intensivists and registered nurses. Shanghai should further strengthen the introduction of overseas talents and cultivation of local medical talents in shortage disciplines, and continuously improve the innovation ecology and talent evaluation system.

The development of digital health is of great significance in enhancing population health and promoting the high-quality development of healthcare sector. Many countries have prioritized digital health by incorporating it into their national strategic plans. Summarizing international experience of digital health development can provide valuable insights for China's digital health policy formulation and the advancement of Healthy China initiative. The study applies the ROCCIPI framework to analyze the policies and practices of the EU, the US, the UK and Japan in promoting digital health across seven dimensions, and systematically sums up their characteristics, key achievements and experiences. Based on the challenges in China’s digital health development, the paper proposes corresponding recommendations including improving the top-level strategy, consolidating digital infrastructure, establishing a digital health standard system, ensuring data security and privacy, and strengthening the pilot application of cutting-edge technologies such as medical artificial intelligence and blockchain.

The objective of achieving carbon neutrality is a significant strategic goal for China. Failure to effectively control carbon emission will lead to global warming, directly impacting the ecological environment and the health of the population. It is inevitable that the pharmaceutical and healthcare industries will contribute to a certain amount of carbon emissions as a consequence of the provision of healthcare services. This phenomenon has attracted widespread attention. This paper briefly analyzes the necessity of decarbonization in the healthcare sector, along with the current status of carbon emissions of health system and pharmaceutical industry. It aims to explore the strategies for enhancing the measurement of carbon emissions and facilitating collaborative efforts for carbon reduction through joint efforts.

Objective This study aims to explore the factors influencing health information avoidance behavior in the elderly, providing theoretical support and practical guidance for constructing a comprehensive, multi-dimensional health management system for them and improving age-friendly health information services. Methods A systematic review was conducted across 11 databases, including CNKI, Wanfang, Embase, EBSCO, PubMed, and WOS, to identify empirical studies related to health information avoidance behaviors in the elderly. The search period was set to end on September 30, 2024. Eligible empirical studies were selected for meta-analysis. Publication bias was assessed using funnel plots, Egger’s regression test, and fail-safe N. Heterogeneity was examined through Q-tests and I-squared statistics, followed by an analysis of the overall effect size and moderator variables. Results The factors influencing health information avoidance behavior among older adults can be categorized into two types: individual factors and situational factors. Among the individual factors, health information avoidance behavior is positively correlated with perceived risk (r = 0.265), negative emotions (r = 0.389), and fatalism (r = 0.146), while they are negatively correlated with self-efficacy (r = −0.309). The situational factors related to health information avoidance behavior include technological barriers (r = 0.405), information overload (r = 0.247), information credibility (r = −0.268), intergenerational support (r = −0.326), and stigma (r = 0.101). Gender, region, educational level, and negative emotions also play a moderating role. Conclusion The findings suggest that the optimization of health information services for older adults can be achieved by establishing fine-grained intergenerational support networks to enhance the self-efficacy of the elderly; raising the entry threshold for health service channels to improve the quality of health information content; and developing age-friendly health information services to eliminate barriers related to digital technology.

This article delves into the core functional positioning and optimal construction pathways of regional large-scale population cohort data platforms, aiming to provide theoretical foundations and practical guidance for the planning, construction, and operation of data platforms within the field. Through literature review, comparative analysis, and other research methods, the current status and bottleneck issues in the construction of regional large-scale population cohorts are comprehensively examined, and a tailored framework system, functional positioning, and construction path for data platforms suitable for regional large-scale population cohort research are proposed. This framework system closely aligns with the scientific rigor of cohort design, the efficiency of data collection, the rigor of data management, the convenience of service sharing, and the depth of analytical applications, offering guidance on full-process digitization capabilities for the construction and management of large-scale population cohorts. This article contributes to enhancing the effectiveness of cohort construction through digital means, improving the standardized construction level of population cohorts in China, and promoting research based on population cohorts and their applied transformation.

Recent years witnessed the surge of chimeric antigen receptor (CAR) T cell therapy in China to meet the great market demand. As of May 2024, there are 11 CAR-T cell products available globally, with five approved by the National Medical Products Administration（NMPA） of China. China has emerged as a global leader in CAR-T cell therapy research and development, particularly in terms of the number of patent applications and clinical trials. With the ongoing accumulation of experience and deeper exploration, the authorities in China have established a three-tier regulatory system of laws, regulations and guidelines that cover the entire life cycle of CAR-T cell products, from research and development to registration, production, and post-marketing surveillance. Nevertheless, there remain gaps when compared to the regulatory systems in countries and regions such as the United States, the European Union, and Japan. This paper examines the development of the CAR-T cell therapy industry in China, and introduces the regulatory practices of the United States, the European Union, and Japan, in order to provide recommendations for the regulatory system improvement for CAR-T cell products in China.

Objective To compare the nursing service capacity of community health service centers before and after the establishment of nursing centers, and to provide insights for evidence-based decision-making. Methods A survey was conducted on 36 community nursing centers in Shanghai that passed municipal acceptance in 2023. Data were collected and compared regarding the basic situation, site setup, personnel allocation, specialty service capacity, discipline construction, medical network integration, and information technology development before and after construction. Results The average service area of 36 community nursing centers was (213.90 ±170.15) m², including 14 in urban areas (38.89%), 12 in suburban areas (33.33%) and 10 in outer suburbs (27.78%). The proportion of centers with relatively independent comprehensive care service areas increased from 22.22% in 2022 to 100.00% in 2023, showing a statistically significant difference (χ² = 45.818, P<0.001). Although the number of specialist nursing service visits increased to 1,509,831 from 1,274,176 in 2022, the difference was not statistically (χ² =72.000, P = 0.445). The top three nursing services were Chinese medicine nursing, diabetes nursing and rehabilitation nursing. By 2023, all community nursing centers had full-time nurses, and the proportion of nurses with middle or high professional titles increased to 1:0.047 compared to 1:0.040 before construction. The number of academic achievements reached 541, significantly higher than 269 in 2022. Additionally, there was an increase in the number of “Internet+” nursing services, and the number of nursing linkages between communities and higher-level hospitals also grew. Conclusions After one year of development, the 36 community nursing centers in Shanghai that passed municipal acceptance showed significant improvements in site setup, specialized nursing service capacity, and discipline construction. However, further improvements are needed in nursing personnel allocation and homogenization-induced nursing services across this communities should be avoided.

Objective To investigate the current status of self-media management among healthcare professionals in tertiary hospitals in Shanghai, identify existing challenges, and propose optimization strategies to support future standardized management efforts. Methods A questionnaire survey and expert interviews were conducted in 20 tertiary hospitals in Shanghai to assess current status of the self-media account operations among healthcare professionals. The findings were summarized to identify problems in self-media management. Results Among the 539 respondents from tertiary hospitals participated in the survey, 130 (24.1%) reported having registered and operated self-media accounts. The most commonly used platforms included WeChat (73.1%), Douyin (51.5%), and Xiaohongshu (36.2%). Ninety-eight accounts (75.4%) had 10,000 to 50,000 followers, and one account had over 3 million followers. Survey and interview data showed that posted content primarily consisted of health education, lifestyle advice, and personal clinical insights. The major challenges faced were lack of time and energy, inadequate regulatory guidelines from self-media platforms, and constraints from medical institutions. Although basic systems and guidelines had been established for account regulation, deficiencies remained in platform supervision, content control, privacy protection, and other areas. Health related self-media accounts were associated with four potential risks: ideological concerns, public opinion sensitivity, inadequate content professionalism, and reputational damage to institutions. Conclusions Although the proportion of healthcare professionals operating self-media accounts in tertiary hospitals in Shanghai is relatively low, notable risks persist in the areas of ideology, public perception, content credibility, and institutional image. It is recommended to enhance management standardization by providing regulatory guidance, integrating expert resources, innovating management models, and optimizing internal processes.

Objective This study aims to explore the influence of product design factors of Huimin insurance on people’s purchase willingness from the perspective of demand side. Method Sample data were collected through a questionnaire survey, and a multi-factor logistic regression model was used to examine the impact of various factors on purchase intention. Results Among the design factors of Huimin insurances, coinsurance (P<0.05), health management service (P<0.01), deductible (P<0.05) and insurance price (P<0.05) are significant factors affecting residents’ purchase intention. Among the factors related to insurance literacy, the depth of comprehension regarding Huimin insurance (P<0.01) and the intention to buy other commercial insurance (P<0.01) are vital factors affecting purchase intention. Conclusions The findings indicate that people’s demand for Huimin insurance encompasses more than just cost compensation. There is a notable need for both cost compensation and health promotion. Insurance literacy also plays a crucial role in purchase intention. It is recommended that the government guide insurance companies to reorient the value proposition of Huimin insurance product, make full use of Huimin insurance promotion activities as a means to enhance health insurance literacy of the public, and foster the orderly and healthy development of the health insurance market.

Objective To identify key pathways for optimizing the operation and management of public hospitals based on the Input-Process-Output (IPO) theoretical model, providing a reference for enhancing the operation and management level of public hospitals in China and promoting their high-quality development. Methods Semi-structured interviews were conducted with 8 key informants from relevant government departments and hospitals using the key informant interview method to understand the current situation and existing issues in public hospital operations management. The Colaizzi 7-step analysis method was employed for summarization and analysis. An example of operational management in a public hospital was analyzed based on IPO theory. Results Current practices in public hospital operation and management lack systematic theoretical guidance, with issues including insufficient integration of business and finance and incomplete operational management systems. The IPO model can enhance the systematization and standardization of hospital operations management. In the input stage, organizational structure and staff development are key focuses; resource conversion, especially financial and performance management, is central to hospital operations management. Dynamic evaluation of management effectiveness is crucial in the output stage. Conclusions The IPO model has practical value for public hospital operations management. It is recommended to improve departmental operational guidance by clarifying the organizational and work systems, strengthening employees’ operational management thinking, and enhancing performance management. Additionally, improving the integration of business and finance and reinforcing budget and cost management in the conversion process is advised. Finally, establishing a comprehensive evaluation system for hospital operations management is a potential mechanism in dynamically monitoring and optimizing the entire management process.

Objective To systematically evaluate the effectiveness of the Bispectral Index (BIS) in monitoring anesthesia depth. Methods CNKI, Wanfang, VIP, SinoMed, Ovid-MEDLINE, Cochrane Library, PubMed, Web of Science and Embase databases were searched, and all relevant randomized controlled trials were collected according to inclusion and exclusion criteria. Literature screening, data extraction, and methodological quality were assessed independently by two evaluators. R 4.0 software was used for analysis. Results A total of 92 studies were included. Compared to traditional depth monitoring of anesthesia, BIS monitoring significantly reduced the incidence of postoperative delirium (RR = 0.56, 95% CI: 0.42 ~ 0.75, P<0.01), intraoperative awareness (RR = 0.51, 95% CI: 0.36 ~ 0.74, P<0.01), and postoperative cognitive impairment (RR = 0.77, 95% CI: 0.67 ~ 0.89, P<0.01). Additionally, it substantially shortened the time to eye opening (MD = −2.55, 95% CI: −3.75 ~ −1.35, P<0.01), recovery time to orientation (MD = −5.38, 95% CI: −8.94 ~ −1.82, P<0.01), extubation time (MD = −5.65, 95% CI: −7.13 ~ −4.17, P<0.01), and post-anesthesia care unit stay time (MD = −9.47, 95% CI: −13.50 ~ −5.43, P<0.01), while also reducing the amount of anesthesia drugs used (SMD = −1.02, 95% CI: −1.37 ~ −0.67, P<0.01). There were no significant differences between the use of BIS monitoring and traditional depth monitoring of anesthesia in postoperative nausea and vomiting, the incidence of abnormal blood pressure, mortality, operation time, and predicted recovery of consciousness. Conclusion The use of BIS monitoring in anesthesia can significantly improve the effectiveness of clinical anesthesia management, contributing positively to ensuring both the safety of patients undergoing anesthesia and he safety of surgeries.

Objective To explore the use of Best-Worst Scaling (BWS-1, object case) in the attribute selection process of stated preference research, providing methodological guidance for researchers. Methods A BWS-1 questionnaire was created using a balanced incomplete block design. The study surveyed depressed and depression-prone individuals online to assess their preferences for antidepressant selection. Data were analyzed using counting methods and a conditional logit model. The preference heterogeneity was also examined. Results The BWS-1 results obtained from the counting method and modelling approach showed high consistency. Liver or kidney injury (both ranked first in importance), headache or dizziness (ranked second and third, respectively) and relapse rates (ranked fourth and second, respectively) were highly prioritized by both depressed patients and depression-prone respondents. Monthly out-of-pocket costs exhibited substantial preference heterogeneity in both groups. Based on qualitative research and BWS-1 quantitative findings, six attributes were ultimately included in the subsequent stated preference study: the risk of liver or kidney injury, the risk of headache or dizziness, the risk of gastrointestinal adverse effects, sleep disturbances, remission rate, and monthly out-of-pocket costs. Most of these attributes were highly ranked in the BWS-1 results. Conclusions BWS-1 can provide valid and reliable evidence for attribute selection in stated preference research. However, it should be complemented by qualitative research that considers research questions, decision-making contexts, and stakeholder opinions to address attributes not covered by BWS-1, thereby enhancing the study’s rigor.

Objective To compare the economic aspects and accessibility of three innovative brain cytoprotective drugs (Urinary Kallidinogenase Injection, Edaravone dexborneol Injection, and dl-3-n-butylphthalide Injection) in acute ischemic stroke, providing a basis for the rational allocation of healthcare resources. Methods For economic evaluation, a decision-tree model was constructed and a cost-utility analysis was performed from the perspective of China’s healthcare system. For accessibility, data were collected through hospital surveys and literature reviews to describe the availability and affordability of the three drugs in Jiangsu, Zhejiang and Shanghai. Results In terms of cost-effectiveness, the total direct medical costs within 90 days for Urinary Kallidinogenase Injection, Edaravone dexborneol Injection, and dl-3-n-butylphthalide Injection were ¥19 514.68, ¥19 575.47, and ¥20 264.07, respectively, with corresponding utilities of 0.174 6 QALYs, 0.182 2 QALYs, and 0.179 9 QALYs. The use of Edaravone dexborneol Injection compared to Urinary Kallidinogenase Injection resulted in an incremental cost-effectiveness ratio of ¥8 010.15 /QALY, which is less than the average GDP per capita, indicating better cost-effectiveness. Compared to dl-3-n-butylphthalide Injection, Edaravone dexborneol Injection was more cost-effective and had higher utility. Sensitivity analysis showed that results are robust. The average hospital availability rates for Urinary Kallidinogenase Injection, Edaravone dexborneol Injection, and dl-3-n-butylphthalide Injection were 59.8%, 84.4%, and 95.9% in Shanghai, Zhejiang and Jiangsu, respectively, with no statistically significant differences between regions. The total treatment costs of the three drugs over 90 days accounted for 10.6% to 15.6% of the average family annual income, not resulting in catastrophic health expenditure. Among these, Urinary Kallidinogenase Injection had the lowest cost. Conclusions Among the three innovative brain cytoprotective therapies, Urinary Kallidinogenase Injection has the lowest cost, while Edaravone dexborneol Injection is the most cost-effective. Dl-3-n-butylphthalide Injection has the highest availability in Shanghai, Zhejiang and Jiangsu.

Objective This study aims to analyze income-related inequality in outpatient service utilization among elderly patients with multimorbidity in China and identify the contributing factors. Methods The study utilized the 2018 follow-up data from the China Health and Retirement Longitudinal Study (CHARLS) database for analysis. The Concentration Index (CI) and Horizontal Inequity Index (HI) were calculated to measure the inequality in outpatient service utilization among elderly patients with multimorbidity in China. A logit regression model was employed to decompose the CI, analyzing the contributions of various factors, including per capita consumption expenditure, education level (uneducated, primary school or below, middle school, high school or above), health insurance coverage (uninsured, urban employee health insurance, urban and rural resident health insurance, other), and the number of chronic diseases. Results The overall outpatient service utilization rate among elderly patients with multimorbidity was 19.71%, with a CI of 0.055. The CIs for elderly patients with multimorbidity in urban and rural areas were 0.098 and 0.044, respectively. Patients with three chronic conditions had a negative CI (-0.015), while those with two, four, five, and six or more chronic conditions had CIs of 0.063, 0.095, 0.076 and 0.032, respectively. The HI was 0.218 overall, with urban and rural areas showing 0.325 and 0.185, respectively. The decomposition of the CI indicated that self-rated health status, health insurance coverage, the number of chronic diseases, and per capita consumption expenditure contributed 35.24%, 19.77%, 13.67% and 9.28% to the inequality, respectively. Conclusions The outpatient service utilization rate among elderly patients with multimorbidity in China increases with the number of chronic diseases and is higher for urban patients compared to rural patients. Utilization tends to be concentrated among more affluent groups, with this inequality persisting even when health service needs are identical. Self-rated health status, the number of chronic diseases, health insurance and per capita consumption expenditure are the main factors contributing to inequality in outpatient service utilization.

Objective To explore the intrinsic relationship between digital use and physical activity of the elderly, and analyze the mechanism of the influence of digital use on physical activity of the elderly, so as to provide theoretical basis for promoting the participation of the elderly in physical activity. Method Based on CGSS2021 data, this study used ordinal logistic regression to analyze the impact of digital use on daily physical activity and exercise physical activity of the elderly, and used structural equation model to test the mediating effect of vitality in the relationship between digital use and physical activity. Results The study found that digital use has a promoting effect on the daily physical activity and exercise physical activity of the elderly. At the same time, digital use can increase the frequency of elderly people’s participation in daily physical activities and exercise physical activities by enhancing vitality. Conclusions Digital use has a positive effect on physical activity in the elderly, and vitality plays a positive role in promoting this relationship. It is necessary to further improve the digital use ability of the elderly, use digital technology to cultivate the awareness of the elderly to participate in physical activities, maintain the emotional health of the elderly, and help them embrace a healthy life.

The increasing demand for healthcare services, coupled with the constraints of limited medical resources, presents an ongoing challenge for modern healthcare systems. Addressing these challenges is crucial for the transformation and sustainability of healthcare delivery. In response, Singapore has actively explored innovative out-of-hospital care models, most notably through the progressive piloting and expansion of the Mobile Inpatient Care at Home program. This article examines the background, operational framework, pilot implementation, and progress of Singapore’s home-based hospitalization initiative. It synthesizes key success factors, explores future directions for care redesign and development opportunities, and elucidates the roles and benefits of out-of-hospital care across the pre-hospital, in-hospital, and post-hospital continuum. Additionally, the article highlights critical elements and strategic considerations essential for healthcare system transformation, offering insights that may inform the global development of patient-centered and sustainable healthcare models.

Objective This study aims to identify antecedents of dynamic capabilities in primary care facilities and their impacts on these capabilities, thereby constructing a model for their formation. This provides insights for cultivating and enhancing the dynamic capabilities of primary care facilities. Methods Using purpose-driven, theoretical, and snowball sampling methods combined with grounded theory, semi-structured interviews were conducted with 37 directors of township health centers. Through open, axial, and selective coding, a model for the formation of dynamic capabilities in these centers was constructed. Results The interviews lasted a total of 1 991 minutes, and the textual data amounted to 428 935 words. Open coding yielded 61 original interview statements and their corresponding initial concepts, which were integrated and refined into 26 concepts and 12 categories. Axial and selective coding identified the core category of this study as “antecedents of and impacts on dynamic capabilities in township health centers,” from which five main categories emerged: environmental changes, organizational resources, organizational systems, management traits of directors, and policy support. Conclusions Environmental changes could trigger the formation of dynamic capabilities; organizational resources and systems are crucial organizational-level antecedents for this formation, while the management traits of directors are individual-level antecedents. Policy support plays an important role in influencing how organizational resources, organizational systems, director management traits affect dynamic capabilities. The government should ensure the autonomy of primary care facilities and promote the professional development of their leaders. Primary care facilities should enhance their sensitivity to environmental changes through improved organizational system.

Objective To analyze the intention of female college students to receive human papilloma virus (HPV) vaccination and its influencing factors based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. Methods We conducted a cross-sectional survey from May 13 to June 27, 2023, at seven full-time universities in Taiyuan, Shanxi Province (Northern China) and Hangzhou, Zhejiang Province (Eastern China). Female college students aged 18 to 26 years were selected through convenience sampling. We distributed 596 questionnaires and analyzed demographic data along with COM-B model variables using descriptive statistics. Independent sample t-tests, pearson correlation analysis, and multiple linear regression were applied to examine the relationships between demographic variables, COM-B variables, and HPV vaccination intention. Results A total of 565 returned questionnaires were valid. The mean score for HPV vaccination intention among female college students was 3.72 ± 0.88. Multiple linear regression analysis showed that knowledge level (β = 0.08, P = 0.02), prescriptive social norms (β = 0.13, P<0.01), feasibility of vaccination timing (β = 0.13, P<0.01), affordability of vaccine costs (β = 0.11, P = 0.02), perceived severity (β = −0.13, P<0.01), opportunity cost (β = −0.08, P = 0.03), self-efficacy (β = 0.21, P < 0.001), risk perception (β = 0.09, P = 0.019), and educational level (β = 0.14, P<0.01) significantly influenced HPV vaccination intention. Conclusions The vaccination intention is moderate, with potential for improvement. Social norms and risk perception are crucial factors in stimulating vaccination intention. However, overemphasizing the severity of disease may provoke fear or anxiety, deterring vaccination. Individuals often prioritize immediate benefits over long-term cost-effectiveness when considering vaccination.