This paper systematically compares the common integrated elderly care and medical services models and related elements in China, analyzes the six major elements of system dynamics order flow, capital flow, equipment flow, personnel flow, information flow and material flow under the health care integration service model, compares the current situation of the application of system dynamics in the operation mechanism of the integrated elderly care and medical services model, supporting policies, cooperation and collaboration model, effect evaluation and industrial prediction simulation of key elements, summarizes the shortcomings of the existing application research and proposes research outlook, and provides a theoretical basis for the optimization research of the integrated elderly care and medical services model.
With the rapid development of day surgery in China, ensuring continuous recovery services for patients after discharge has become an urgent issue. In response, this paper outlines the concept and development status of day surgery, emphasizes the importance of establishing an extended recovery system, summarizes relevant model innovation cases, discusses key elements for building an extended recovery system, including social resource engagement, multidisciplinary collaboration, institutional safeguards and technical support, and docking system platform to smooth the transmission of information, and proposes suggestions for future development. This paper provides theoretical and practical references for developing an extended recovery system for day surgery in China.
The aim of this article is to study how andrographolide-releasing collagen scaffolds influence rabbit articular chondrocytes in maintaining their specific phenotype under inflammatory environment. Physical blending combined with vacuum freeze-drying method was utilized to prepare the andrographolide-releasing collagen scaffold. The characteristics of scaffold including its surface morphology and porosity were detected with environmental scanning electron microscope (ESEM) and a density instrument. Then, the release of andrographolide from prepared scaffolds was measured by UV-visible spectroscopy. Rabbit chondrocytes were isolated and cultured in vitro and seeded on andrographolide-releasing collagen scaffolds. Following culture with normal medium for 3 d, seeded chondrocytes were cultured with medium containing interleukin-1 beta (IL-1β) to stimulate inflammation in vitro for 7 d. The proliferation, morphology and gene transcription of tested chondrocytes were detected with Alamar Blue assay, fluorescein diacetate (FDA) staining and reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR) test respectively. The results showed that the collagen scaffolds prepared by vacuum freeze-dry possess a high porosity close to 96%, and well-interconnected chambers around (120.7±17.8) μm. The andrographolide-releasing collagen scaffold continuously released andrographolide to the PBS solution within 15 d, and collagen scaffolds containing 2.22% andrographolide significantly inhibit the proliferation of chondrocytes. Compared with collagen scaffolds, 0.44% andrographolide-containing collagen scaffolds facilitate chondrocytes to keep specific normal morphologies following 7 d IL-1β induction. The results obtained by RT-qPCR confirmed this effect by enhancing the transcription of tissue inhibitor of metalloproteinase-1 (TIMP-1), collagen II (COL II), aggrecan (Aggrecan) and the ratio of COL II/ collagen I(COL I), meanwhile, reversing the promoted transcription of matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-13 (MMP-13). In conclusion, our research reveals that andrographolide-releasing (0.44%) collagen scaffolds enhance the ability of chondrocytes to maintain their specific morphologies by up-regulating the transcription of genes like COL II, Aggrecan and TIMP-1, while down-regulating the transcription of genes like MMP-1 and MMP-13 which are bad for phenotypic maintenance under IL-1β simulated inflammatory environment. These results implied the potential use of andrographolide-releasing collagen scaffold in osteoarthritic cartilage repair.
Objective To explore the matching relationship between the supply and demand of different types of integrated elderly care and medical service for the elderly population in the region, and achieve the simulation purpose of coordinated allocation and balanced development of supply and demand of integrated elderly care and medical service. Methods Combining literature, interviews, and expert consultation to sort out the main factors and system element relationships between the supply and demand of integrated elderly care and medical service in the region, the Vensim software was used to clarify the relationships and operation mechanisms between the subsystems of supply and demand of integrated elderly care and medical service. The data of the construction base for the integrated elderly care and medical service project in Suzhou city, Jiangsu province from January 1, 2010 to December 31, 2022 were selected. Results Combined with the accessibility and completeness of data, the main variables and indicators of the five subsystems were screened, and the causality diagram and flow diagram of the system dynamics were drawn to clarify the main variables and flow direction of the subsystems, and the constructed model was more stable in simulation operation. The simulation model results showed that the supply-demand ratio of home-based elderly care and community elderly care decreased relatively before 2012, and the institutional elderly care model gradually emerged and developed from 2013 to 2018. From 2019 to 2022, the supply-demand ratio of medical care with elderly care and elderly care with medical care decreased. Conclusions Based on the theoretical foundation of system dynamics, the supply and demand the integrated elderly care and medical service in the region are regarded as a complex system. Through the analysis of the system elements among the subsystems and the sorting out of the mechanisms, it can provide certain theoretical support for constructing and improving the system dynamics model for matching the supply and demand of integrated elderly care and medical service in the region.