Zhiqiang Kevin Lu

Background: Bupropion is a common cause of drug-induced seizures, but evidence guiding prophylactic therapy is limited. No prospective head-to-head comparison of phenobarbital and benzodiazepines for symptomatic bupropion overdose has been reported. Methods: We performed a 6-month prospective observational cohort study of patients with symptomatic bupropion overdose. Patients were grouped by receipt of seizure prophylaxis versus no prophylaxis, with agent-specific exploratory analyses for phenobarbital and lorazepam. Baseline characteristics and clinical outcomes were summarized using descriptive statistics. Continuous variables were assessed for normality using Shapiro-Wilk testing and summarized as median and interquartile range (IQR) when non-normally distributed. Categorical outcomes were compared using two-tailed Fisher exact tests with statistical significance defined as p < 0.05. Exploratory logistic regression evaluated seizure odds by prophylaxis group with and without adjustment for initial heart rate. Results: Fifty-five patients were enrolled: 39 received prophylaxis and 16 who did not receive recommended prophylaxis and served as controls. The prophylaxis agents used were phenobarbital in 20 patients, lorazepam in 12, other benzodiazepines in 6, and combined phenobarbital plus lorazepam in 1. Initial heart rate was 114 bpm (IQR 97–133.5) in the prophylaxis group versus 109 bpm (IQR 103.5–117.8) in controls. Reported ingestion dose was 2.70 g (IQR 1.39–5.18) versus 1.80 g (IQR 0.98–7.13), respectively. Three patients had a documented seizure history and were in the prophylaxis group, none of which experienced a seizure. Overall seizure incidence was lower with prophylaxis but did not reach statistical significance (1/39 [2.6%] vs 3/16 [18.8%]; p = 0.069). Proconvulsant co-ingestions were similar between groups (12/39 [30.8%] vs 7/16 [43.8%]; p = 0.370). Among patients with known ingestion ≥3 g, seizures occurred in 0/10 phenobarbital-treated patients, 1/4 lorazepam-treated patients, and 3/5 controls; phenobarbital differed from control (p = 0.022), whereas lorazepam did not (p = 0.524), and phenobarbital did not differ significantly from lorazepam (p = 0.286). Among patients with initial heart rate ≥120 bpm, seizures occurred in 0/7 phenobarbital-treated patients, 1/6 lorazepam-treated patients, and 3/4 controls; phenobarbital differed from control (p = 0.024), whereas lorazepam did not (p = 0.190) and phenobarbital did not differ significantly from lorazepam (p = 0.462). Exploratory logistic regression adjusted for initial heart rate found higher seizure odds in controls than in prophylaxis patients (OR 26.86, 95% CI 1.21–598.08; p = 0.038); initial heart rate showed a nonsignificant trend (OR 1.08 per bpm; p = 0.070). Conclusions: In this interim cohort, phenobarbital was associated with fewer seizures than no prophylaxis in higher-risk subgroups. However, direct phenobarbital-lorazepam comparisons were not statistically different. Findings remain hypothesis-generating given the small sample, observational design, statistical fragility, sparse seizure events, wide regression confidence intervals, and potential reporting bias. Background: Bromadiolone is a long-acting anticoagulant rodenticide that can cause severe and prolonged coagulopathy in humans, while clinical data from low- and middle-income countries remain limited. This study aimed to describe the clinical characteristics, laboratory findings, management strategies, and outcomes of patients with bromadiolone poisoning treated at an emergency center in Vietnam, and to identify factors associated with severe outcomes. We conducted a retrospective observational study of adult patients with confirmed bromadiolone poisoning admitted to the Emergency Center of Thai Nguyen Medical University Hospital, Vietnam, between February 2021 and August 2024. Demographic data, exposure characteristics, clinical manifestations, laboratory parameters, treatment details, and outcomes were extracted from medical records. Severe outcome was defined as major bleeding, international normalized ratio (INR) ≥ 5, requirement for blood product transfusion, or death. A total of 33 patients were included, with a median age of 46 years; 60.6% were male, and suicidal ingestion accounted for 66.7% of cases. Severe outcomes occurred in 7 patients (21.2%). Patients with severe outcomes presented significantly later after exposure (median 48 vs. 5.5 h, p = 0.001) and had markedly higher admission INR values. Bleeding manifestations and blood product transfusion were observed exclusively in the severe outcome group, and no in-hospital deaths occurred. In conclusion, bromadiolone poisoning is associated with substantial morbidity due to prolonged coagulopathy. Delayed hospital presentation and severe coagulopathy at admission are strongly associated with adverse outcomes, highlighting the importance of early recognition and appropriate vitamin K therapy in resource-limited settings. Methods: This retrospective observational study was conducted at the Emergency Center of Thai Nguyen Medical University Hospital, Thai Nguyen, Vietnam. Study population: All consecutive adult patients diagnosed with bromadiolone poisoning and admitted between February 2021 and August 2024 were eligible. Inclusion criteria: Exclusion criteria: Data collection Data extracted from medical records included: Results: Baseline characteristics: Thirty-three patients with bromadiolone poisoning were included. The median age was 46 years (IQR 27), and 20 patients (60.6%) were male. Suicidal ingestion was the most common exposure intent, accounting for 22 cases (66.7%). The median time from exposure to hospital presentation was 7 h (IQR 20), and the median estimated ingestion dose was 1 mg (IQR 4). Conclusions: Bromadiolone poisoning is a serious clinical condition associated with prolonged coagulopathy and a substantial risk of severe bleeding. Delayed hospital presentation and severe coagulopathy at admission are strongly associated with adverse outcomes. Early diagnosis, close monitoring of coagulation parameters, and appropriate vitamin K therapy are essential to improve outcomes, particularly in low- and middle-income countries. Background: Amiodarone is an antiarrhythmic drug used to treat life-threatening cardiac dysrhythmias, but its use is limited by multiorgan toxicity. Large-scale age-stratified data on clinical outcomes remain limited. The National Poison Data System (NPDS) is a national database of over 81 million de-identified case records from all 53 U.S. poison centers. The objective of this study was to describe amiodarone exposures reported to U.S. poison centers.

Related Group (DRG) payment data: high-margin cases were more likely to be low-value hospitalizations, suggesting that bundled payment may move waste rather than remove it. Zheng et al. 10 find that clinical pathway-based single disease payment for hysterectomy reduced expenses, shortened stays, increased minimally invasive surgery, and lowered complications.Yang et al. 11 complete the implementation picture by showing that clinicians' attitudes, not knowledge alone, shape diagnosis-based payment practice. These studies favor payment models with equity guardrails, case-mix surveillance, and clinician engagement. They also show why average savings should never be interpreted without distributional and behavioral evidence.A second group addresses access to medicines and innovation. Xie et al. 12 find that provincial pooling of basic medical insurance increased inpatient use and spending without eliminating prorich inequality, so financial integration must be linked to resource redistribution. Xu et al. 13 and Zhu et al. 14 examine National Drug Price Negotiation from the firm side. Their findings suggest that negotiation access can stimulate research and development investment and patenting, particularly when market signals, subsidies, firm size, and market power support innovation. This challenges the simple claim that price negotiation necessarily discourages industry investment. Yet patient access remains unfinished. Yao et al. 15 show that innovative anticancer medicines were less available and less affordable than essential or generic medicines. Jiang et al. 16 report that lecanemab provides better value than aducanumab but is not cost-effective against standard care at current prices. Liu et al. 17 and Sun et al. 18 further show that multidimensional assessment methods can help compare devices and TCM products when evidence, safety, patient value, and budget impact must be balanced.Delivery capacity is another value determinant. Huang et al. 19 estimate generally high primary healthcare efficiency in China, but regional imbalance and projected outpatient demand growth suggest continued pressure on grassroots services. Lyu 20 reaches a similar conclusion by showing spatial dependence, path dependence, and club formation in resource allocation efficiency; weaker regions may not converge without targeted support. Patient-centered implementation is equally important. Chin et al. 21 describe a Singapore General Hospital framework that operationalizes value-based care for outpatient conditions through scoping, outcome selection, baseline assessment, and improvement planning. Wei et al. 22 develop a patient-centered outpatient satisfaction tool and identify the physician-patient relationship, waiting-order management, and service quality as major drivers. These papers remind us that VBM cannot be implemented only through reimbursement rules. It also requires data systems, workflow redesign, institutional learning, and patient-reported measures that capture what care actually feels like. In hospital-centered health systems, this delivery perspective is essential for avoiding narrow, payer-only definitions of value.The post-acute and environmental studies extend the boundaries of value. Zuo et al. 23 Part 1 that home infusion therapy and home health services could address aging, antimicrobial resistance, long infusion needs, and hospital crowding in China. Zuo et al. 24 in Part 2 move from demand to execution, emphasizing accreditation, sterile compounding, technology integration, workforce training, and value-aligned reimbursement. Together, these reviews shift the discussion from hospital episodes to longitudinal care delivered where patients live. Tang et al. 25 broaden the frame further by estimating health-economic burdens from fine particulate matter (PM2.5) and ozone (O3) across Chinese regions from 2013 to 2023. The simultaneous decline in PM2.5-related burden and rise in O3-related mortality shows that value is also created through prevention outside clinical encounters. For VBM, the denominator should include avoidable hospital days, delayed institutionalization, exposure risk, and population-level prevention rather than hospital throughput alone.Taken together, these studies offer several important implications. First, cost containment should not be conflated with value; savings matter only when quality, equity, and outcomes are preserved. Second, price and payment reforms require transparent assessment methods and postimplementation surveillance. Third, VBM in China and the Asia-Pacific region should remain pluralistic: TCM-dominant services, oncology and dementia medicines, medical devices, outpatient pathways, home-based care, and environmental health require distinct evidence standards and operational tools. Fourth, implementation capacity is itself part of value. Policies that appear efficient nationally may fail locally when clinicians are unconvinced, data systems are fragmented, or disadvantaged regions lack resources. These constraints are central, not peripheral, to whether evidence-based reform becomes durable practice. Volume II advances the field by presenting VBM as an iterative cycle of measurement, incentive design, learning, and correction. Its practical agenda is clear: define outcomes that matter to patients and society, pay for appropriate care, assess technologies transparently, protect equity, and revise policies when real-world consequences emerge. Reduced hospitalization costs and length of stay but increased out-of-pocket burden for some vulnerable groups.Payment reform needs explicit equity monitoring, not only spending targets.Wu et al. 9 Diagnosis-Related Group payment and low-value admissions Claims analysis of 251,811 payment records using multilevel regression.Low-value hospitalizations rose and were more common among high-margin admissions.Bundled payment requires safeguards against profitable low-complexity admissions.Zheng et al. Attitudes...

Using 2016–2023 data from the Behavioral Risk Factor Surveillance System (BRFSS), this study examined trends in self-reported past-month poor mental health (≥ 1 day) among individuals using cannabis and disparities in subgroups. From 2016 to 2023, the prevalence of self-reported past-month poor mental health (≥ 1 day) among those using cannabis increased from 54.54% to 67.88%. Women reported higher rates than men (77.08% vs. 60.14%). Young adults (25–34) showed the largest increase (from 51.42% to 77.67%). Hispanics (69.17%) exhibited the highest prevalence in 2023. Findings underscore the need for mental health screening and targeted counseling as cannabis legalization expands.

Older patients with Alzheimer’s disease and related dementias (ADRD) face high rates of unplanned hospital readmissions, many of which may be avoidab