Objective:It aims to explore the spatial heterogeneity,dynamic evolution patterns,and driving mechanisms of medical insurance fund sustainability across Chinese provinces,providing decision-making support for addressing regional development imbalances and improving collaborative governance of healthcare systems.Methods:Based on data from 31 provinces in China(2010-2023)on the accumulated balance of medical insurance funds available for payment months,the Dagum Gini coefficient decomposition method is employed to analyze regional disparity sources,combined with spatial autocorrelation analysis and the Spatial Durbin Model(SDM)to reveal spatial dependency pathways and multidimensional driving mechanisms.Results:The findings indicate a gradient disparity characterized by"high stability in the east and high heterogeneity in the west with some high-risk zone".Tibet and Gansu represent the extremes of this distribution.The regional disparity mechanism has shifted from inter-group dominance to super-variable density dominance,with the latter contributing 48.59％by 2023.Significant spatial agglomeration effects were observed(Moran's I≥0.249,P＜0.01),where economic development(total effect of regional average GDP=0.278),aging populations(total effect of the dependency ratio for the elderly=-0.324),and cross-regional healthcare utilization(total effect of cross-regional healthcare utilization=-0.223)exerted asymmetric impacts through spatial spillovers.Conclusion:The sustainability of medical insurance funds is shaped by the interplay of geographical and institutional spaces.A categorized governance framework and regional collaborative mechanisms are essential,prioritizing policy integration for economic empowerment,population regulation,and resource optimization to transition healthcare governance from"localized administration"to"regional coordination".

Objective:It aims to explore the spatial heterogeneity,dynamic evolution patterns,and driving mechanisms of medical insurance fund sustainability across Chinese provinces,providing decision-making support for addressing regional development imbalances and improving collaborative governance of healthcare systems.Methods:Based on data from 31 provinces in China(2010-2023)on the accumulated balance of medical insurance funds available for payment months,the Dagum Gini coefficient decomposition method is employed to analyze regional disparity sources,combined with spatial autocorrelation analysis and the Spatial Durbin Model(SDM)to reveal spatial dependency pathways and multidimensional driving mechanisms.Results:The findings indicate a gradient disparity characterized by"high stability in the east and high heterogeneity in the west with some high-risk zone".Tibet and Gansu represent the extremes of this distribution.The regional disparity mechanism has shifted from inter-group dominance to super-variable density dominance,with the latter contributing 48.59％by 2023.Significant spatial agglomeration effects were observed(Moran's I≥0.249,P＜0.01),where economic development(total effect of regional average GDP=0.278),aging populations(total effect of the dependency ratio for the elderly=-0.324),and cross-regional healthcare utilization(total effect of cross-regional healthcare utilization=-0.223)exerted asymmetric impacts through spatial spillovers.Conclusion:The sustainability of medical insurance funds is shaped by the interplay of geographical and institutional spaces.A categorized governance framework and regional collaborative mechanisms are essential,prioritizing policy integration for economic empowerment,population regulation,and resource optimization to transition healthcare governance from"localized administration"to"regional coordination".

Objective:To investigate the current situation of intravenous infusions of outpatients in our hospital to obtain the infor-mation and data of infusion characteristics in order to provide the basis for the safe and reasonable application of infusions. Methods:Totally 346 cases of outpatients with infusions were selected from the infusion room during May and June in 2017. The rationality of in-fusions was analyzed according to the guidelines of clinical application of antibiotics(2015 edition) and the diagnosis and treatment of related diseases. Results:In the 346 cases of infusion patients,men accounted for 36.13% and women accounted for 63.87%. The order of department ranked top was department of reproductive medicine, dermatology, respiratory medicine and urology respectively accounting for 18.79%,16.47%,13.29% and 10.12%. The order of intravenous infusions ranked top was phloroglucinol,levoflox-acin,moxifloxacin and human serum albumin respectively accounting for 11.46%,8.05%,6.83% and 5.85%. Antimicrobial drugs accounted for 42.77% and the unreasonable prescription accounted for 29.76%. The main unreasonable reasons were without indica-tions,appropriate usage and unsuitable solvent respectively accounting for 51.46%,40.78% and 5.83%. The lack of infusion neces-sity accounted for 10.98%. Conclusion: The irrational proportion in the hospital outpatient intravenous infusion room is high (29.76%),and antibiotics use accounts for higher proportion(42.77%). Most patients still have the necessity of infusion,so outpa-tient infusion can not be canceled,however,management should be strengthened.

Objective To understand the clinical features of drug-induced kidney injury(DIKI)in inpatients. Methods The medical records data of inpatients diagnosed as DIKI from January 31,2010 to January 31,2017 were retrospectively analyzed. The main analytic indicators included general conditions of patients,degree of renal damage,outcomes,and suspected drugs causing acute kidney injury(AKI),and so on. Results A total of 20 patients were entered into this study,including 16 males(80.0%)at age 8 to 80 years and the average age of(44 ± 20)years,4 females(20.0%)at age 27 to 71 years and the average age of(49 ± 22)years. Eleven patients(55.0%)were≤44 years old(young people),4 patients (20.0%)were 45-59 years old(middle-aged people),5 patients(25.0%)were ≥60 years old(old people). The kinds of diseases were 2 to 6 in each patient in the 20 patients. Of them,3 patients(15.0%) had 2 kinds of diseases at the same time,7 patients(35. 0%)had 3 kinds of diseases,5 patients (25.0%)had 4 kinds of diseases,4 patients(20.0%)had 5 kinds of diseases,1 patient(5.0%)had 6 kinds of diseases. The serum creatinine(Scr)and blood urea nitrogen(BUN)values in the 20 patients were 56.0-132.5(89.1 ± 22.1)μmol/L and 2.9-8.5(4.9 ± 1.6)mmol/L before medication,respectively and significantly increased to 128.0-506.0(241.8 ± 112.8)μmol/L and 4.3-28.0(13.0 ± 5.9)mmol/L after medication,respectively. After treatments with hemodialysis or renal protective drugs,the Scr and BUN values were significantly reduced to 52.0-439.0(174.8 ± 97.5)μmol/L and 1.0-27.6(9.3 ± 7.1)mmol/L, respectively. The differences of Scr and BUN levels between before medication and after medication,before treatment and after treatment were statistically significant(all P<0.05). All DIKI during hospita-lization were AKI. Six patients(30.0%)were in AKI stage 1,10 patients(50.0%)in AKI stage 2,and 4 patients(20.0%)in AKI stage 3(acute renal failure). By the time of discharge,5 patients were cured,in 12 patients the condition was improved,1 patient had no change,in 1 patient the condition was deteriorated, and 1 patient died. The effective rate of treatments was 85.0%. A total of 29 kinds of drugs were used in combination in the 20 inpatients,and 6-24(14 ± 5)kinds of drugs were used in each patient. Five categories and 12 drugs were found to induce kidney injury in this study,involving antibacterial drugs (15 patients),chemotherapeutic drugs(2 patients),antiviral drugs(2 patients),immunosupp-ressants (3 patients),and anti-gout drugs(1 patient). Kidney damage was clearly documented in the instructions of all above-mentioned drugs. The time from medication to onset of DIKI was 1-56 days and the median time was 9 days. Conclusions Antibacterial drugs,especially antifungal drugs such as amphotericin B,were the main drugs causing kidney injury in hospital. The DIKI was AKI during hospitalization,and the treatment effect for AKI was good.

Objective To understand the clinical features of drug-induced kidney injury(DIKI)in inpatients. Methods The medical records data of inpatients diagnosed as DIKI from January 31,2010 to January 31,2017 were retrospectively analyzed. The main analytic indicators included general conditions of patients,degree of renal damage,outcomes,and suspected drugs causing acute kidney injury(AKI),and so on. Results A total of 20 patients were entered into this study,including 16 males(80.0%)at age 8 to 80 years and the average age of(44 ± 20)years,4 females(20.0%)at age 27 to 71 years and the average age of(49 ± 22)years. Eleven patients(55.0%)were≤44 years old(young people),4 patients (20.0%)were 45-59 years old(middle-aged people),5 patients(25.0%)were ≥60 years old(old people). The kinds of diseases were 2 to 6 in each patient in the 20 patients. Of them,3 patients(15.0%) had 2 kinds of diseases at the same time,7 patients(35. 0%)had 3 kinds of diseases,5 patients (25.0%)had 4 kinds of diseases,4 patients(20.0%)had 5 kinds of diseases,1 patient(5.0%)had 6 kinds of diseases. The serum creatinine(Scr)and blood urea nitrogen(BUN)values in the 20 patients were 56.0-132.5(89.1 ± 22.1)μmol/L and 2.9-8.5(4.9 ± 1.6)mmol/L before medication,respectively and significantly increased to 128.0-506.0(241.8 ± 112.8)μmol/L and 4.3-28.0(13.0 ± 5.9)mmol/L after medication,respectively. After treatments with hemodialysis or renal protective drugs,the Scr and BUN values were significantly reduced to 52.0-439.0(174.8 ± 97.5)μmol/L and 1.0-27.6(9.3 ± 7.1)mmol/L, respectively. The differences of Scr and BUN levels between before medication and after medication,before treatment and after treatment were statistically significant(all P<0.05). All DIKI during hospita-lization were AKI. Six patients(30.0%)were in AKI stage 1,10 patients(50.0%)in AKI stage 2,and 4 patients(20.0%)in AKI stage 3(acute renal failure). By the time of discharge,5 patients were cured,in 12 patients the condition was improved,1 patient had no change,in 1 patient the condition was deteriorated, and 1 patient died. The effective rate of treatments was 85.0%. A total of 29 kinds of drugs were used in combination in the 20 inpatients,and 6-24(14 ± 5)kinds of drugs were used in each patient. Five categories and 12 drugs were found to induce kidney injury in this study,involving antibacterial drugs (15 patients),chemotherapeutic drugs(2 patients),antiviral drugs(2 patients),immunosupp-ressants (3 patients),and anti-gout drugs(1 patient). Kidney damage was clearly documented in the instructions of all above-mentioned drugs. The time from medication to onset of DIKI was 1-56 days and the median time was 9 days. Conclusions Antibacterial drugs,especially antifungal drugs such as amphotericin B,were the main drugs causing kidney injury in hospital. The DIKI was AKI during hospitalization,and the treatment effect for AKI was good.