OBJECTIVE: To analyze the coupling and coordination level of medical education and health resource allocation in China, and to provide scientific basis for promoting the high-quality development of medical education and the efficient allocation of health resources.
METHODS: Based on the panel data from 2011 to 2021, the coupling coordination degree model was used to measure the coupling coordination index of medical education and health resources in China. The spatial auto-correlation model was used to analyze the development status and distribution characteristics of the coupling coordination degree of the two systems. The kernel density estimation method was used to analyze the dynamic evolution trend of the coupling coordination of the two systems. The QR quantile regression model was used to explore the key factors affecting the coupling coordination degree of the two systems.
RESULTS: During the observation period, the coupling coordination degree of the two systems increased from 0.393 to 0.465, with a growth rate of 18.3%. The coupling coordination degree between regions gradually decreased in the eastern-central and eastern-western regions, and there were still large differences between the central and western regions. The coupling coordination degree of the two systems in the region was significantly different in the eastern and western regions, and the central region was relatively similar. There is a positive spatial correlation between the provinces, and 25.81% of the provinces have transitions. Finally, the number of points in the first and third quadrants is higher than that in the second and fourth quadrants. In the process of dynamic distribution, the degree of polarization of the coupling coordination degree curve of the two systems is gradually weakened. Per capita GDP, residents \' income difference and population size are the positive and significant factors driving the coupling and coordinated development of the two systems.
CONCLUSIONS: The coupling and coordination degree of the two systems of medical education and health resource allocation showed a stable upward trend during the observation period, and the global spatial positive correlation also gradually increased, showing the spatial agglomeration characteristics of \' high-high agglomeration \' and \' low-low agglomeration \'. The spatial difference of coupling coordination degree shows a shrinking trend and develops towards equalization. The coupling coordination degree of the two systems is affected by social, economic and demographic factors to varying degrees. Therefore, it is necessary to innovate the coordinated development mechanism of the two systems, promote the two-way flow of medical education and health resource allocation in talents, technology and other elements, and then promote the coupling and coordinated development of the two systems.

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UNASSIGNED: To evaluate the current status and equity of older adult resource allocation in the 31 provinces (autonomous regions and municipalities) of mainland China, and to offer recommendations for the optimization of these allocations.
UNASSIGNED: Four key indicators, namely, the number of older adult institutions, employees, professionals, and beds in mainland China in the year 2020, were used and analyzed using various methods and tools, including agglomeration analysis, the Gini coefficient, and the Lorenz Curve. These methods were applied to evaluate the equity of older adult resource allocation across the different provinces (autonomous regions and municipalities) and regions of China, using two dimensions, namely, the geographical area and the older adult population.
UNASSIGNED: Overall, the number of older adult resource allocations was found to be increasing in China, while the number of employees with educational levels of junior college or above was relatively low and the population structure was aging. In terms of the equity of older adult resource allocation, the results showed that this was good according to the dimensions of the older adult population but was on the low side based on the dimension of geographical area, and the Gini coefficient of the western region, in particular, was in an alarming state. Different provinces (autonomous regions and municipalities) were found to have an uneven allocation of resources for older adults, with large differences, with some areas having a serious under-allocation of resources, while others showed resource over-allocation.
UNASSIGNED: While China\'s allocation of older adult resources is relatively equitable, there is nevertheless a need to take into account recent changes in the older adult population and strengthen the construction of a reasonably structured, high-quality team of professionals and technicians, as well as consider factors such as geographical area and the older adult population, and rationally allocate older adult resources in the eastern, middle, and western regions, to achieve a balanced allocation in terms of equity and efficiency and enhance social capital, to better satisfy the demands for older adult services in older adults at multiple levels.

Drug shortages remain a serious and widespread problem affecting all health systems and patients. Anesthesiology practice is strongly impacted by shortages of sterile injectable drugs, resulting in a negative impact on the quality of care. Understanding the root causes of drug shortages guides the anesthesiologist toward an ethical response. While rationing is a common consideration in secular ethics, and indeed rationing strategies are utilized, the use of rationing alone risks normalizing and perpetuating the drug shortage problem. Drug shortages are the direct result of a market failure brought on by lack of oversight of drug production standards in some cases as well as by the impact of intermediary purchasing groups on costs and availability of drugs. Legislation needs to reestablish a responsible, competitive, and robust manufacturing drug market.

BACKGROUND: Rationing nursing care is a term that applies to various aspects of the required patient care that are omitted or their performance is delayed.
OBJECTIVE: This study aimed to identify the extent of rationing of nursing care in intensive care units (ICUs) in different types of hospitals and determine the relationship between rationing of nursing care and hospital and staff characteristics.
METHODS: This quantitative, cross-sectional, multicenter study was performed. The sample comprised 226 nurses working in ICUs in a North-East part of Poland. The Polish version of the PRINCA questionnaire methods was applied. The survey was conducted between 15 January and 31 May 2023.
RESULTS: There were statistically significant differences between rationing of nursing care in university/provincial hospitals and district hospitals t = 6.92 p<0.001. In provincial and university hospitals, nursing care is often omitted, leading to a lower perceived quality of nursing care (t = -3.0 p = 0.003). This is further compounded by the fact that nursing care is more likely to be rationed in units with a larger number of beds. The level of rationing of nursing care was significantly correlated with the perceived work quality and job satisfaction in both types of hospitals. The most frequently omitted aspects of nursing care included providing emotional support (university/provincial 1.27 vs. district 0.89), patient and family education (1.11 vs. 0.74), communication with external entities (1.11 vs. 0.84), and observing safe patient-handling practices (1.01 vs. 0.99).
CONCLUSIONS: The type of hospital and organizational factors influence the rationing of nursing care. Improvements in working conditions can improve nursing care quality in ICUs.

The application of personalized medicine in developing countries is a major challenge, especially for those with poor economic status. A critical factor in improving the application of personalized medicine is the efficient allocation of resources. In healthcare systems, optimizing resource allocation without compromising patient care is paramount. This tutorial employs a simulation-based approach to evaluate the efficiency of bed allocation within a hospital setting. Utilizing a patient arrival model with an exponential distribution, we simulated patient trajectories to examine system bottlenecks, particularly focusing on waiting times. Initial simulations painted a scenario of an \'unstable\' system, where waiting times and queue lengths surged due to the limited number of available beds. This research offers insights for hospital management on resource optimization leading to improved patient care.
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BACKGROUND: The Health and Medical Assistance Program for Poverty Alleviation is part of China\'s targeted poverty elimination strategy, which aims to protect poor people\'s right to health and prevent them from becoming trapped in or returning to poverty because of illness. Many tasks have been defined in this program, including raising the medical insurance level, providing a triage system, improving medical and health services, and enhancing people\'s health. One pivotal aspect of this initiative involves equitable health resource allocation, a key measure aimed at bolstering medical and health services. This study aimed to analyze and compare health resource allocations in different counties in Northwest China after the implementation of the program.
METHODS: The Gini coefficient quantifies the level of distributional equality, the Theil index assesses the sources of inequality, and the Health Resource Agglomeration Degree gauges the accessibility of health resources.
RESULTS: 1) The health resource allocation distributed based on population(Gini Coefficient < 0.45) was more equitable than that distributed based on area(Gini Coefficient > 0.35) among counties in Northwest China. 2) The contribution rate within non-impoverished counties is higher than that of impoverished counties, which means the inequality within non-impoverished counties. 3) The allocation of beds in medical institutions by area in non-impoverished counties was better than that in impoverished counties, and accessibility to health services for residents in non-impoverished counties was better than that in impoverished counties.
CONCLUSIONS: The analysis of health resource allocation among the five provinces in Northwest China revealed significant differences in equality among the five provinces in Northwest China, and the differences were mainly derived from the non-impoverished counties. Although the equality is gradually improving, the number of health resources in impoverished counties remain lower than that in non-impoverished counties.Subsequently, it is essential to ensure equitable distribution of healthcare resources while also taking into account their utilization and quality.

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Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, \"Liver Units\" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care.
UNASSIGNED: Lebererkrankungen sind global eine bedeutende Ursache für Morbidität und Mortalität. Leberzirrhose kann zu schwerwiegenden Komplikationen wie Blutungen, hepatischer Enzephalopathie (HE) und Infektionen führen. Eine klare Strategie zum Aufnahmemanagement auf die Intensivstation (ITS) verbessert die Patientenversorgung. Hämodynamisch relevante Ösophagus‑/Magenvarizenblutungen (ÖVB/MVB) und eine HE Grad 4, begleitet von der Notwendigkeit einer Nierenersatztherapie (NET), sind definitive Indikationen für eine Aufnahme auf die ITS. ÖVB/MVB, spontane bakterielle Peritonitis (SBP) und Infektionen mit multiresistenten Erregern (MRE) erfordern eine hochkritische Bewertung. Patienten mit schwerem hepatorenalen Syndrom (HRS) oder respiratorischem Versagen weisen eine erhöhte Basismortalität auf und profitieren mit hoher Wahrscheinlichkeit von einer frühzeitigen Behandlung auf der ITS. Die rasche Identifizierung von Sepsis bei Patienten mit Leberzirrhose ist ein entscheidendes Kriterium für die Aufnahme auf die ITS. Eine Fallpriorisierung basierend auf dem Mortalitätsrisiko und der klinischen Dringlichkeit ermöglicht eine effiziente Ressourcennutzung und optimiert das Patientenmanagement. Zusätzlich bieten „Liver Units“ eine Versorgungsebene mit Intermediate-Care(IMC)-Standard für Patienten mit Lebererkrankungen, die eine engmaschige Überwachung, aber keine unmittelbare intensivmedizinische Behandlung benötigen.