Objective:To identify and analyze the key factors affecting online medical patient satisfaction, providing references for improving online patient satisfaction.Methods:Matched " user satisfaction, patient satisfaction" with keywords such as " internet medical, online medical", and searched for literature published from 2013 to 2023 in databases like CNKI and the Full-text Database of Chinese Medical Journals.Based on the critical appraisal skills programme for quality assessment, screened the literature. Employed the meta-ethnography method to synthesize the factors affecting online medical patient satisfaction in the included studies. Identified key influencing factors through the decision making trial and evaluation laboratory (DEMATEL) method, and then constructed a multi-level cascading structure model using the interpretative structural modelling (ISM) method to analyze the logical connections and hierarchical structure among the influencing factors, and obtained the key influencing paths.Results:20 articles were included, and through the meta-ethnography method, obtained a set of influencing factors for three thematic dimensions: personal, social, and technological, including eight influencing factors: perceived risk, perceived quality, information support, social support, environmental support, emotional support, medical technology, and platform design. By employing the DEMATEL-ISM method, information support and perceived quality were identified as key outcome factors, with centrality values of 15.713 and 15.417, respectively, and reason degrees of -0.957 and -1.095, respectively. Medical technology was identified as a key cause factor, with a centrality value of 15.476 and a reason degree of 0.956; the key influence path was platform design-medical technology-social support-information support, with a sum of centrality values totaling 59.305.Conclusions:This study identified key outcome factors, key cause factors, and key influence paths for online medical patient satisfaction. Based on these findings, it is suggested to enhance information support by improving the quality of health information on the online medical platform, improve the quality of patient perception by optimizing the doctor-patient interaction mode, improving the efficiency and response speed of doctor-patient communication, strengthening the supervision of the diagnosis and treatment process, etc., improve the level of online medical technology by establishing an Internet doctor ability evaluation index system and strengthening training, and jointly promote the improvement of online medical patient satisfaction by collaborating with multiple stakeholders.

In order to understand the potential target and related mechanism of action of Termina-lia Chebula treatment,network pharmacology and molecular docking methods were used in this experiment,and the challenge test of Salmonella from yak was performed.The active ingredients and potential targets of Terminalia Chebula were screened through HERB cluster identification database,TCMSP database and SwissTargetPrediction web page tool,and"gastroenteritis"was searched through OMIM and GeneCards database.Cytoscape and STRING databases were used to construct the Terminalia Chebula PPI network to screen out key targets,the intersection targets between Terminalia Chebula and enteritis were obtained through Venny platform,and gene ontol-ogy(GO)and Kyoto encyclopedia database of genes and genomics(KEGG)were enriched through DAVID database.The core target of screening was verified by molecular docking.After that,the gastrointestinal inflammation model of mice was established,the pathological changes of gastroin-testinal tract were observed,and the effect of Terminalia Chebula on the target protein was veri-fied by Western blot test.The results showed that:after analyzing and sorting out 8 main active in-gredients of Terminalia Chebula,118 targets of Terminalia Chebula were screened,11 161 targets of gastroenteritis and 100 targets of intersection were obtained;the core targets of PTGS2,CASP3,SLC3A2,Bax,Bcl-2 and TP53 of Terminalia Chebula and enteritis were obtained through PPI network.GO and KEGG enrichment analysis collected 337 items and 138 items,respectively,mainly related to chemokine pathway,PI3K-Akt signaling pathway,apoptosis related pathway,i-ron ion transport related pathway,NF-κB signaling pathway,etc.The results of molecular docking showed that chebulidic acid,the first active component of chebulidic acid,can bind to Bax,Bcl-2,PTGS2 and SLC3A2 through hydrogen bonding,hydrophobic action,π-π packing force and other intermolecular forces.The pathological tissue sections showed that Terminalia Chebula could sig-nificantly recover gastrointestinal tissue injury.Western blot test results showed that Terminalia Chebula can regulate the process of apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways to achieve the effect of treating intestinal inflammatory damage.The results showed that Terminalia Chebula can regulate the occurrence and development of enteritis by regu-lating apoptosis and iron death through Bax/Bcl-2 and PTGS2/SLC3A2 pathways.Terminalia Chebula has the characteristics of multi-target and multi-pathway in the treatment of enteritis.

Objective:To identify and analyze the key factors affecting online medical patient satisfaction, providing references for improving online patient satisfaction.Methods:Matched " user satisfaction, patient satisfaction" with keywords such as " internet medical, online medical", and searched for literature published from 2013 to 2023 in databases like CNKI and the Full-text Database of Chinese Medical Journals.Based on the critical appraisal skills programme for quality assessment, screened the literature. Employed the meta-ethnography method to synthesize the factors affecting online medical patient satisfaction in the included studies. Identified key influencing factors through the decision making trial and evaluation laboratory (DEMATEL) method, and then constructed a multi-level cascading structure model using the interpretative structural modelling (ISM) method to analyze the logical connections and hierarchical structure among the influencing factors, and obtained the key influencing paths.Results:20 articles were included, and through the meta-ethnography method, obtained a set of influencing factors for three thematic dimensions: personal, social, and technological, including eight influencing factors: perceived risk, perceived quality, information support, social support, environmental support, emotional support, medical technology, and platform design. By employing the DEMATEL-ISM method, information support and perceived quality were identified as key outcome factors, with centrality values of 15.713 and 15.417, respectively, and reason degrees of -0.957 and -1.095, respectively. Medical technology was identified as a key cause factor, with a centrality value of 15.476 and a reason degree of 0.956; the key influence path was platform design-medical technology-social support-information support, with a sum of centrality values totaling 59.305.Conclusions:This study identified key outcome factors, key cause factors, and key influence paths for online medical patient satisfaction. Based on these findings, it is suggested to enhance information support by improving the quality of health information on the online medical platform, improve the quality of patient perception by optimizing the doctor-patient interaction mode, improving the efficiency and response speed of doctor-patient communication, strengthening the supervision of the diagnosis and treatment process, etc., improve the level of online medical technology by establishing an Internet doctor ability evaluation index system and strengthening training, and jointly promote the improvement of online medical patient satisfaction by collaborating with multiple stakeholders.

For advanced pulmonary metastases or melanoma, radiotherapy combined with immune checkpoint inhibitor can block the immunosuppression pathway, enhance the antitumor immune response, and significantly improve survival. Stereotactic body radiation therapy ( SBRT ) delivers a large dose of radiation to the tumor target with high precision while sparing irradiation of the surrounding normal tissues. It is suggested that SBRT could be the most appropriate radiotherapy modality to be combined with immunotherapy since it induces the expression of a series of cytokines and immune molecules and is more likely to cause intense immune response and exert an abscopal effect than conventional radiotherapy. Previous studies have explored that total dose and fractionation seem to be important parameters for determining the immune response;the timing of radiation with immunotherapy significantly influences the outcome, and tumor infiltrating lymphocytes, the expression level of programmed death-ligand 1, and mismatch repair defect may be important predicators of the outcome. With appropriate radiotherapy dose and fractionation, the optimal timing of radiation with immunotherapy, and effective predictive markers, a combination of SBRT and immunotherapy may eliminate advanced malignancies while activating the systemic immune response to exert an abscopal effect.

Objective To study the quality of outpatient prescriptions for patients of different age groups at both township and village level,for the purpose of evaluating the outcomes and problems of the ongoing healthcare reform at primary levels.Methods 100 outpatient prescriptions of April 2015 were mechanically sampled randomly from two township hospitals and 8 village clinics in counties A and B in Hubei province.These prescriptions were analyzed for the drug count per prescription,percentage of intravenous prescriptions,that of antibiotics,that of hormones and average cost per prescription.Results At the township hospitals,the drug count per prescription(2.02)of county A was less than that of county B(3.26),while the percentage of intravenous prescriptions(30.30%),that of antibiotics(47.98%)and hormones(6.57%)of county A were significantly less than those of county B(50.65%,69.08% and 15.13% respectively).At village clinic level,the percentage of intravenous prescriptions(31.05%)of county A was higher than that of county B(20.34%),the average prescription costs(￥29.28)of county A was less than county B(￥31.45);while in terms of children′s prescriptions,average drug count of county A(2.50)was higher than county B(2.09),and its proportion of antibiotics(65.91%)was higher than county B(45.56%).Conclusions General primary care reform is faced with challenges of poor control of intravenous injection and use of antibiotics,particularly at village clinics and pediatric drug use in terms of prescription quality control.Both township and village levels should strengthen the supervision over the drug suppliers,guide the demand side to rationally use drugs and focus on the reasonableness of the medication of village clinics and children.

For the purpose of resolving such current problems as low inclusion ratio and high exit ratio in the single-disease clinical pathway management,the paper proposed an idea of clinical pathways grouping management,in line with DRG management and based on traditional clinical pathway management practice and China' s conditions.Proposed in the paper are such measures for government service procurement,as quality control mechanism,price negotiation mechanism,performance-based payment mechanism,and supervision mechanism.These measures are designed to provide incentives for medical institutions and medical workers,control irrational rise of medical expense,optimize expense makeup,and improve both quality of care and patient satisfaction.Thanks to the China Rural Health Development Project in place in Henan province where DRG-based clinical pathway grouping management and government service procurement are in trials,the following outcomes are achieved.Namely,significant expansion of diseases coverage and population coverage,efficient control of per-patient/per-visit expenses,and a steady rise of surgery and treatment expenses which embody value of service of medical workers.Other benefits include 50％ to less than 30％drop of drugs proportion,gradual optimization of medical expenses makeup,obvious improvement of quality of care.These measures have made hospitals,insurance providers and patients satisfactory.

An analysis of the fundamental concepts for public hospital reform further defined public hospitals and other hospitals,business and non-business in nature,public benefits and welfare,as well as public benefits and profit-oriented hospitals.These distinctions can help reformers of public hospitals clarify their concepts,make clear the purpose and direction of the public hospitals reform,so as to speed up the reform with theory support.

This paper studied the development stages in terms of the public nature of public hospitals in China and analyzed the causes for their weakened public benefits.It proposed the principle of government guidance,achieving government purchasing of healthcare services as the roadmap,as well as building and improving the service purchasing system,performance appraisal system,and payment review system along with supervision system.These measures are designed to make public hospitals in their public benefit nature with scientific system design,powerful institutional guarantee,and efficient execution strategies.

Object Through performing the service satisfaction survey,to learn their interest claim and discover the service defects ,so as to provide advice and countermeasures.Method Using field survey methods and statistics analysis to study.Result The satisfaction of relatives of pediatric patients at the level of "relatively good" and "good" is about 60% both in medical treatment environment and equipment ,over 70% in medical treatment effect,doctor capacity,nursing capacity and overall assessment,but only 5.1% in medical expenses.Conclusion Relatives of pediatric patients have high satisfaction in treatment capability of medical staff,medical treatment effect as well as overall assessment ,normal satisfaction in medical environment and equipment,but lowest satisfaction in medical expenses,and the satisfaction in tertiary hospital is not high.Relatives in some districts demand much in some aspects,such as improving hospital environment,attaching importance to ward hygiene ,improving service attitude,and providing single ward ect.

The massive water and steam are consumed in the production of cellulose ethanol, which correspondingly results in the significant increase of energy cost, waster water discharge and production cost as well. In this study, the process strategy under extremely low water usage and high solids loading of corn stover was investigated experimentally and computationally. The novel pretreatment technology with zero waste water discharge was developed; in which a unique biodetoxification method using a kerosene fungus strain Amorphotheca resinae ZN1 to degrade the lignocellulose derived inhibitors was applied. With high solids loading of pretreated corn stover, high ethanol titer was achieved in the simultaneous saccharification and fermentation process, and the scale-up principles were studied. Furthermore, the flowsheet simulation of the whole process was carried out with the Aspen plus based physical database, and the integrated process developed was tested in the biorefinery mini-plant. Finally, the core technologies were applied in the cellulose ethanol demonstration plant, which paved a way for the establishment of an energy saving and environment friendly technology of lignocellulose biotransformation with industry application potential.
Bioelectric Energy Sources ; economics ; Biofuels ; analysis ; Biotransformation ; Ethanol ; analysis ; metabolism ; Fungi ; metabolism ; Industrial Microbiology ; methods ; Lignin ; metabolism ; Steam ; Water ; analysis