ObjectiveTo elucidate the critical role of rehabilitation medical records (including electronic records) in rehabilitation medicine's clinical practice and management, comprehensively analyzed the structure, core content and data standards of rehabilitation medical records, to develop a standardized medical record data architecture and core dataset suitable for rehabilitation medicine and to explore the application of rehabilitation data in performance evaluation and payment. MethodsBased on the regulatory documents Basic Specifications for Medical Record Writing and Basic Specifications for Electronic Medical Records (Trial) issued by National Health Commission of China, and referencing the World Health Organization (WHO) Family of International Classifications (WHO-FICs) classifications, International Classification of Diseases (ICD-10/ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), this study constructed the data architecture, core content and data standards for rehabilitation medical records. Furthermore, it explored the application of rehabilitation record summary sheets (home page) data in rehabilitation medical statistics and payment methods, including Diagnosis-related Groups (DRG), Diagnosis-Intervention Packet (DIP) and Case Mix Index. ResultsThis study proposed a systematic standard framework for rehabilitation medical records, covering key components such as patient demographics, rehabilitation diagnosis, functional assessment, rehabilitation treatment prescriptions, progress evaluations and discharge summaries. The research analyzed the systematic application methods and data standards of ICD-10/ICD-11, ICF and ICHI Beta-3 in the fields of medical record terminology, coding and assessment. Constructing a standardized data structure and data standards for rehabilitation medical records can significantly improve the quality of data reporting based on the medical record summary sheet, thereby enhancing the quality control of rehabilitation services, effectively supporting the optimization of rehabilitation medical insurance payment mechanisms, and contributing to the establishment of rehabilitation medical performance evaluation and payment based on DRG and DIP. ConclusionStructured rehabilitation records and data standardization are crucial tools for quality control in rehabilitation. Systematically applying the three reference classifications of the WHO-FICs, and aligning with national medical record and electronic health record specifications, facilitate the development of a standardized rehabilitation record architecture and core dataset. Standardizing rehabilitation care pathways based on the ICF methodology, and developing ICF- and ICD-11-based rehabilitation assessment tools, auxiliary diagnostic and therapeutic systems, and supporting terminology and coding systems, can effectively enhance the quality of rehabilitation records and enable interoperability and sharing of rehabilitation data with other medical data, ultimately improving the quality and safety of rehabilitation services.

ObjectiveTo explore the data standard system of electronic medical records in the field of rehabilitation, focusing on the terminology and coding standards, data structure, and key content categories of rehabilitation electronic medical records. MethodsBased on the Administrative Norms for the Application of Electronic Medical Records issued by the National Health Commission of China, the electronic medical record standard architecture issued by the International Organization for Standardization and Health Level Seven (HL7), the framework of the World Health Organization Family of International Classifications (WHO-FICs), Basic Architecture and Data Standards of Electronic Medical Records, Basic Data Set of Electronic Medical Records, and Specifications for Sharing Documents of Electronic Medical Records, the study constructed and organized the data structure, content, and data standards of rehabilitation electronic medical records. ResultsThe data structure of rehabilitation electronic medical records should strictly follow the structure of electronic medical records, including four levels (clinical document, document section, data set and data element) and four major content areas (basic information, diagnostic information, intervention information and cost information). Rehabilitation electronic medical records further integrated information related to rehabilitation needs and characteristics, emphasizing rehabilitation treatment, into clinical information. By fully applying the WHO-FICs reference classifications, rehabilitation electronic medical records could establish a standardized framework, diagnostic criteria, functional description tools, coding tools and terminology index tools for the coding, indexing, functional description, and analysis and interpretation of diseases and health problems. The study elaborated on the data structure and content categories of rehabilitation electronic medical records in four major categories, refined the granularity of reporting rehabilitation content in electronic medical records, and provided detailed data reporting guidance for rehabilitation electronic medical records. ConclusionThe standardization of rehabilitation electronic medical records is significant for improving the quality of rehabilitation medical services and promoting the rehabilitation process of patients. The development of rehabilitation electronic medical records must be based on the national and international standards. Under the general electronic medical records data structure and standards, a rehabilitation electronic medical records data system should be constructed which incorporates core data such as disease diagnosis, functional description and assessment, and rehabilitation interventions. The standardized rehabilitation electronic medical records scheme constructed in this study can support the improvement of standardization of rehabilitation electronic medical records data information.

ObjectiveTo analyze the data structure and standards of rehabilitation outpatient medical records, to provide data support for improving the quality of rehabilitation outpatient care and developing medical insurance payment policies. MethodsBased on the normative documents issued by the National Health Commission, Basic Standards for Medical Record Writing and Standards for Electronic Medical Record Sharing Documents, in accordance with the Quality Management Regulations for Outpatient (Emergency) Diagnosis and Treatment Information Pages (Trial), reference to the framework of the World Health Organization Family of International Classifications (WHO-FICs), the data framework and content of rehabilitation outpatient medical records were determined, and the data standards were discussed. ResultsThis study constructed a data framework for rehabilitation outpatient medical records, including four main components: patient basic information, visit process information, diagnosis and treatment information, and cost information. Three major reference classifications of WHO-FICs, International Classification of Diseases, International Classification of Functioning, Disability and Health, and International Classification of Health Interventions,were used to establish diagnostic standards and standardized terminology, as well as coding disease diagnosis, functional description, functional assessment, and rehabilitation interventions, to improve the quality of data reporting, and level of quality control in rehabilitation. ConclusionThe structuring and standardization of rehabilitation outpatient medical records are the foundation for sharing of rehabilitation data. The using of the three major classifications of WHO-FICs is valuable for the terminology and coding of disease diagnosis, functional description and assessment, and intervention in rehabilitation outpatient medical records, which is significant for sharing and interconnectivity of rehabilitation outpatient data, as well as for optimizing the quality and safety of rehabilitation medical services.

ObjectiveTo explore the standardization of inpatient rehabilitation medical record summary sheet, encompassing its structure, content and data standards, to enhance the standardization level of inpatient rehabilitation medical record summary sheet, improve data reporting quality, and provide accurate data support for medical insurance payment, hospital performance evaluation, and rehabilitation discipline evaluation. MethodsBased on the relevant specifications of the National Health Commission's Basic Norms for Medical Record Writing, Specifications for Sharing Documents of Electronic Medical Records, and Quality Management and Control Indicators for Inpatient Medical Record Summary Sheet (2016 Edition), this study analyzed the structure and content of the inpatient rehabilitation medical record summary sheet. The study systematically applied the three major reference classifications of the World Health Organization Family of International Classifications, International Classification of Diseases (ICD-10/ICD-11, ICD-9-CM-3), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI Beta-3), for disease diagnosis, functional description and assessment, and rehabilitation intervention, forming a standardized terminology system and coding methods. ResultsThe inpatient rehabilitation medical record summary sheet covered four major sections: inpatient information, hospitalization information, diagnosis and treatment information, and cost information. ICD-10/ICD-11 were the standards and coding tools for admission and discharge diagnoses in the inpatient rehabilitation medical record summary sheet. The three functional assessment tools recommended by ICD-11, the 36-item version of World Health Organization Disability Assessment Schedule 2.0, Brief Model Disability Survey and Generic Functioning domains, as well as ICF, were used for rehabilitation functioning assessment and the coding of outcomes. ICHI Beta-3 and ICD-9-CM-3 were used for coding surgical procedures and operations in the medical record summary sheet, and also for coding rehabilitation intervention items. ConclusionThe inpatient rehabilitation medical record summary sheet is a summary of the relevant content of the rehabilitation medical record and a tool for reporting inpatient rehabilitation data. It needs to be refined and optimized according to the characteristics of rehabilitation, with necessary data supplemented. The application of ICD-11/ICD-10, ICF and ICHI Beta-3/ICD-9-CM-3 classification standards would comprehensively promote the accuracy of inpatient diagnosis of diseases and functions. Based on ICD-11 and ICF, relevant functional assessment result data would be added, and ICHI Beta-3/ICD-9-CM-3 should be used to code rehabilitation interventions. Improving the quality of rehabilitation medical records and inpatient rehabilitation medical record summary sheet is an important part of rehabilitation quality control, and also lays an evidence-based data foundation for the analysis and application of inpatient rehabilitation medical record summary sheet.

BACKGROUND: Valvular heart disease (VHD) has become increasingly common with the aging in China. This study aimed to evaluate regional differences in the clinical features, management strategies, and outcomes of patients with VHD across different regions in China. METHODS: Data were collected from the China-VHD Study. From April 2018 to June 2018, 12,347 patients who presented with moderate or severe native VHD with a median of 2 years of follow-up from 46 centers at certified tertiary hospitals across 31 provinces, autonomous regions, and municipalities in Chinese mainland were included in this study. According to the locations of the research centers, patients were divided into five regional groups: eastern, southern, western, northern, and central China. The clinical features of VHD patients were compared among the five geographical regions. The primary outcome was all-cause mortality or rehospitalization for heart failure. Kaplan-Meier survival analysis was used to compare the cumulative incidence rate. RESULTS: Among the enrolled patients (mean age, 61.96 years; 6877 [55.70%] male), multiple VHD was the most frequent type (4042, 32.74%), which was mainly found in eastern China, followed by isolated mitral regurgitation (3044, 24.65%), which was mainly found in northern China. The etiology of VHD varied significantly across different regions of China. The overall rate of valve interventions was 32.67% (4008/12,268), with the highest rate in southern China at 48.46% (205/423). In terms of procedure, the proportion of transcatheter valve intervention was relatively low compared to that of surgical treatment. Patients with VHD in western China had the highest incidence of all-cause mortality or rehospitalization for heart failure. Valve intervention significantly improved the outcome of patients with VHD in all five regions (all P  <0.05). CONCLUSIONS: This study revealed that patients with VHD in China are characterized by significant geographic disparities in clinical features, treatment, and clinical outcomes. Targeted efforts are needed to improve the management and prognosis of patients with VHD in China according to differences in geographical characteristics. REGISTRATION ClinicalTrials.gov , NCT03484806.
Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Heart Valve Diseases/therapy* ; Kaplan-Meier Estimate ; Tertiary Care Centers ; Treatment Outcome

Objective:To explore the influence of artificial intelligence(AI)-assisted compressive sensing(ACS)technique with different acceleration factors on the image quality and scan time of three dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)for brain.Methods:Thirty participants who underwent brain magnetic resonance imaging(MRI)at Tongzhou Branch of Beijing Friendship Hospital were recruited.All subjects underwent imaging scans about four different parameters:a non-accelerated technique(control group),ACS technique integrated with acceleration factor of 4.03(ACS4 group),ACS technique integrated with acceleration factor of 5.02(ACS5 group),and ACS technique integrated with acceleration factor of 6.06(ACS6 group).The image clarity,ranking of imaging capabilities of distal branch blood vessels and the ratio of pseudo-stenosis were qualitatively analyzed.The signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR),edge sharpness,and scan time were quantitatively analyzed.Results:There was not difference in vessel clarity among three ACS groups at the proximal and middle intracranial segments.For distal segments of blood vessel,the ACS4 group[3.0(3.0,3.0)]and ACS5 group[3.0(3.0,3.0)]were better than ACS6[2.5(2.0,3.0)](q=29.800,27.500,P<0.05).The imaging capabilities of distal-branch vessel of ACS4 group and ACS5 group were better than ACS6 group.There was no stenosis in the proximal and middle segments of the images of the three ACS group,and there were no stenosis in the images of distal vessels of ACS4 group and ACS5 group.A total of 5 cases were pseudo-stenosis in the distal vessels of ACS6 group.Compared with the control group,the incidence of pseudo-stenosis in the distal vessels of ACS6 group was 16.7%.The SNR and CNR values of quantitative analysis for proximal vessels in ACS6 group were higher than them in ACS4 group(q=27.800,26.200,P<0.05),and there was not significant difference in them among ACS4 group,ACS6 group and ACS5 group(P>0.05).The differences of SNR and CNR values in the middle and distal segments of blood vessels among different groups were not significant(P>0.05).There was not significant difference in the edge sharpness of blood vessels among ACS4 group,ACS5 group,and ACS6 group(P>0.05),while all of them were higher than those of control group,and the differences were significant(q=48.150,53.367,44.883,P<0.001).Compared with control group,the scan-time of ACS4 group was reduced by 55.19%,and that of ACS5 group was reduced by 64.07%,and that of ACS6 group was reduced by 70%.Conclusion:ACS technique can accelerate the imaging speed of brain 3D-TOF-MRA and ensure image quality.It is clinically recommended to set the ACS acceleration factor as 5.02 to undergo brain 3D-TOF-MRA scans.

Objective To investigate the association between gut microbiota metabolite,trimethy-lamine-N-oxide(TMAO),and total imaging burden in diabetic patients with cerebral small vessel disease(CSVD).Methods A prospective study was conducted on 112 elderly diabetic patients with CSVD admitted in our hospital from June 2022 to May 2024.According to the total imaging burden score,they were divided into a high burden group(burden score≥2,57 cases)and a low burden group(burden score＜2,55 cases).High-performance liquid chromatography with online electrospray ionization tandem mass spectrometry was applied to detect the plasma level of TMAO.Then based on the tertile of plasma TMAO level,the patients were also assigned into low(＜2.44 μmol/L,38 cases),median(2.44 μmol/L≤TMAO＜5.18 μmol/L,37 cases)and high TMAO(≥5.18 μmol/L,37 cases)groups.ROC curve analysis was used to assess the predictive value of plasma TMAO level for high imaging burden in diabetic patients with CSVD.Binary logistic regression analysis was employed to analyze the correlation between plasma TMAO level and high imaging burden.Results The high burden group exhibited significantly higher plasma TMAO level than the low burden group(P=0.002).The AUC value of plasma TMAO level in predicting high imaging burden was 0.669(95％CI:0.569-0.769,P=0.002).The percentage of high imaging burden was 34.2％,54.1％and 64.9％,respectively among the low,median and high TMAO groups,with significant differences among them(Chi-square=7.270,P=0.026).Binary logistic regression analysis indicated the correlation between TMAO and high imaging burden(OR=1.178,95％CI:1.019-1.364,P=0.027).Conclusion In elderly diabetic patients with CSVD,plasma TMAO level is closely associated with high imaging burden,with higher TMAO level,higher risk for high imaging burden.

Objective: To explore the correlation between small intestinal bacterial overgrowth(SIBO) and cognitive impairment in patients undergoing peritoneal dialysis(PD). Methods: 60 PD patients and 46 non-dialysis patients with end-stage renal disease(ESRD) were included in this study. SIBO was detected by lactulose hydrogen methane breath test(LHMBT). The cognitive function levels of the subjects were evaluated using the Montreal cognitive assessment(MoCA) and mini-mental state examination(MMSE). The emotional states of the patients were assessed by self-rating anxiety scale(SAS) and self-rating depression scale(SDS). The gastrointestinal symptoms were evaluated using gastrointestinal symptom rating scale(GSRS). According to the results of LHMBT, the PD patients were further divided into two subgroups: SIBO-positive and SIBO-negative. The general conditions, laboratory data, and scores of each scale were compared between the two groups. Furthermore, according to the MoCA scores, the PD patients were divided into two groups: those with normal cognitive function and those with cognitive dysfunction. The positive rates of SIBO between the two groups were compared. Binary Logistic stepwise regression was used to explore whether SIBO was an independent risk factor for cognitive impairment in PD patients. At the same time, other independent influencing factors for cognitive impairment in PD patients were analyzed. Results: The positive rate of SIBO in PD patients was 40.00%. Among them, the positive rate of SIBO in the group with normal cognitive function during peritoneal dialysis was 27.27%, and the positive rate of SIBO in the group with cognitive dysfunction during peritoneal dialysis was 55.56%. There was a statistically significant difference in the positive rate of SIBO between the two groups(P=0.026). Further analysis by multivariate Logistic stepwise regression showed that in addition to age(OR=1.118, 95%CI 1.007-1.242, P=0.037), educational attainment(OR=0.655,95%CI 0.442-0.972,P=0.036), and hemoglobin(OR=0.946,95% CI 0.895-0.998,P=0.044), SIBO(OR=7.613,95% CI 1.160-49.979,P=0.034)was also an independent risk factor for cognitive impairment in PD patients. Conclusion The incidence of SIBO in PD patients is relatively high and is associated with multiple factors, among which SIBO may be closely related to cognitive dysfunction in PD patients.

Objective:To study the consistency between post-processing bone mineral density(BMD)values of multi-slice spiral computed tomography(MSCT)scan and the BMD value of quantitative computed tomography(QCT)for lumbar vertebra,so as to explore the feasibility of utilizing MSCT scan-based post-processing BMD values for lumbar vertebra in clinical practice.Methods:The MSCT equipment and QCT equipment were respectively adopted to conduct imaging scan for the L2-L4 of lumber vertebra of QRM-ESP145 European Spine Phantom(ESP),and L2-L4 of lumbar vertebra of adult sheep,and L2-L4 of lumbar vertebra of adult volunteer.The L2-L4 of ESP lumber vertebra and L2-L4 of lumbar vertebra of adult sheep were scanned respectively MSCT and QCT for three times,so as to measure BMD values.The L2-L4 of lumbar vertebrae of volunteers were scanned respectively by the two methods for one time according to the standard of clinical examination,which were reconstructed by three times so as to obtain mean of them.The BMD values of QCT scan were set as control group,and the BMD values of MSCT scan were set as experiment group.The experiment group was further divided into experiment 1 group[two dimension(2D)regional volumetric BMD values of the lumbar vertebra]and experiment 2 group[three dimension(3D)global volumetric BMD post-processing of the lumbar vertebra]according to the reliability of experiment.Then,the consistency between the MSCT 3D post-processing BMD values of three groups and QCT-measured BMD values was compared and analyzed.Results:The MSCT 3D post-processing BMD values of L2-L4 of ESP lumbar vertebra of three groups were respectively(120.83±0.97),(199.57±0.54)and(119.19±1.04)mg/cm3,and that of L2-L4 of lumbar vertebra of adult sheep of three groups were respectively(414.89±1.72),(410.50±0.77)and(420.25±2.71)mg/cm3,and that of L2-L4 of lumbar vertebra of volunteer were respectively(141.22±0.09),(137.38±0.37)and(152.03±1.03)mg/cm3.There were not statistically significant differences in BMD values between MSCT examination and QCT examination(P＞0.05).Conclusion:MSCT 3D post-processing BMD values on lumbar vertebra has high consistency with that of QCT measurements,which post-processing technique can replace QCT to conduct BMD examination,and reduce unnecessary radiation exposure and examination costs for patients.

Objective To investigate the feasibility and safety of transradial approach(TRA)for carotid artery stenting(CAS)using single-layer braided carotid stents with a microporous dense mesh design.Methods A retrospective consecutive series of patients with carotid artery stenosis who underwent CAS via TRA using single-layer braided microporous dense mesh stents admitted to the Department of Neurology,Linyi People's Hospital,Shandong Second Medical University were included from December 2022 to April 2023.General and clinical data,lesion characteristics,procedural metrics,periprocedural conditions,and follow-up outcomes were collected from the patients.General and clinical data including sex,age,medical history(hypertension,diabetes,coronary artery disease),and preoperative modified Rankin scale(mRS)score.Lesion characteristics included stenosis location,normal lumen diameters distal and proximal to the stenosis,stenosis rate,lesion length,and aortic arch type.Procedural metrics included successfully guided catheter placement,stent deployment,retrieval of the embolic protection device and residual stenosis rate.Periprocedural conditions included periprocedural complications(within 72 hours included puncture site bleeding,symptomatic radial artery occlusion,new cerebral infarctions on diffusion-weighted imaging,and cardio-cerebrovascular events[angina,acute myocardial infarction,cerebral infarction,cerebral hemorrhage])and length of hospital stay.The mRS scores at 1 and 6 months after surgery were recorded via telephone follow-ups.At 12 months after surgery,outpatient carotid color Doppler ultrasound was performed to evaluate in-stent restenosis.Results(1)Ten patients(9 male,1 female)aged 57-72 years,with a median age of 70(62,71)years were included.Among them,9 had hypertension,2 had diabetes,and 1 had coronary artery disease.Four patients had symptomatic carotid stenosis:2 presented with hemiparesis,1 with mild dysarthria,and 1 with transient ischemic attack.Preoperative mRS scores among symptomatic patients were 0(1 patient),1(2 patients),and 2(1 patient).The remaining 6 patients had asymptomatic stenosis,all with preoperative mRS scores of 0.(2)Two patients had left internal carotid artery(ICA)stenosis,and 8 had right ICA stenosis.The mean stenosis degree was(79.9±7.1)％,and the mean lesion length was(16.8±5.7)mm.The mean normal distal and proximal lumen diameter of the stenosed blood vessel were(5.1±0.5)mm and(8.1±0.8)mm,respectively.One patient had a type Ⅰ aortic arch,8 patients had type Ⅱ,and 1 patient had type Ⅲ.Among the 8 patients with right ICA stenosis,4 underwent direct catheterization of the right common carotid artery using a glidewire,while the other 4 required exchange technique for guide catheter placement.Both left-sided lesions were treated using exchange technique.Guide catheter placement and stent deployment were successful in all cases.No difficulties were encountered in embolic protection device retrieval.The mean residual stenosis rate was(21.6±6.7)％.(3)The mean postoperative hospital stay was(1.8±0.9)days.No puncture site bleeding or symptomatic radial artery occlusion occurred.One patient experienced a cerebrovascular event due to a pontine perforator artery infarction,presenting with diplopia and impaired left eye adduction,likely caused by postoperative hypotension and hypoperfusion.This patient had an immediate postoperative mRS score of 2 at discharge,which improved to 0 at 6 months.The other 9 patients showed no change in mRS scores compared to preoperative assessments,and no new cerebral infarctions were detected within 72 hours after surgery.At 12-month follow-up,carotid color Doppler ultrasound revealed no in-stent restenosis in any patient.Conclusions CAS performed via TRA using single-layer braided microporous dense mesh stents appears to be feasible and safe.However,this study is a single-center,retrospective analysis with a small sample size.Larger prospective randomized controlled trials are needed to validate these findings.