Li Zhang

Interdepartmental consultations are essential for managing complex inpatient care but are often inefficient. Hospital-wide, data-driven analyses are needed to guide process improvements; yet, most existing studies have focused on single departments or specific diseases, leaving a gap in understanding hospital-level collaboration networks. Understanding these patterns is crucial for optimizing clinical workflows, reducing delays, and improving patient outcomes in large tertiary hospitals. This study aimed to analyze the distribution and network characteristics of interdepartmental consultations across a large tertiary hospital, focusing on high-frequency collaboration pairs and their disease associations. This retrospective cohort study included all interdepartmental consultations for inpatients and emergency patients at Peking Union Medical College Hospital (Beijing, China) from January 1 to December 31, 2024. Secondary data were extracted from the Hospital Information System. In total, 102,858 valid consultations involving 42 clinical departments were analyzed. Outcome measures included consultation requests and receptions per department, per capita request intensity, and pairwise collaboration volume. High-frequency collaboration pairs were defined as those with an annual consultation volume of 300 or more. Descriptive statistics (medians and IQRs) and proportions with 95% CIs were used. Consultation activity exhibited marked concentration. The Emergency Department issued the most consultation requests (19,698/102,858, 19.15%), far exceeding the median departmental request volume of 1899.5 (IQR 1359.5-3759.25). Meanwhile, the Internal Medicine Consultation Service received the highest number of consultations (10,428/102,858, 10.14%), substantially above the median reception volume of 1886.0 (IQR 521.25-4056.75) across departments. The per capita request intensity varied widely, with Critical Care Medicine highest value (21.64) vs a hospital-wide average of 0.32. Collaboration demonstrated a strong Pareto distribution: the top 5.37% (65/1210) of department pairs (65 pairs) accounted for 42.02% (43,221/102,858) of all consultations. These high-volume pairs were predominantly disease-specific. Examples include: Endocrinology-Ophthalmology primarily for diabetic and thyroid eye disease (1287/102,858, 1.25%); General Surgery-Otolaryngology mainly for preoperative thyroid airway assessment (1225/102,858, 1.19%); General Surgery-Clinical Nutrition for perioperative support (1032/102,858, 1.00%); Endocrinology-Clinical Nutrition for metabolic disease management (703/102,858, 0.68%); Orthopedics-Rehabilitation Medicine for postoperative rehabilitation (686/102,858, 0.67%); Oncology Medical Center-Clinical Nutrition for nutrition support in patients with cancer (681/102,858, 0.66%). Recurring clinical scenarios generated these stable, predictable consultation pathways. This study provides a novel, hospital-wide, network-based mapping of interdepartmental consultations using real-world data. Unlike prior work limited to single departments or diseases, it reveals that collaboration is concentrated, Pareto-like, and disease-driven. The identification of stable, disease-specific consultation pairs offers a data-driven framework for understanding multidisciplinary collaboration. These findings offer a data-driven framework for understanding multidisciplinary collaboration as a networked system. In practice, administrators and clinicians can use this evidence to prioritize resources, design standardized multidisciplinary team pathways, and implement spatial or digital interventions to reduce delays and improve patient flow and outcomes.

Serous surface papillary borderline ovarian tumor (SSPBOT) is a distinct subtype of serous borderline ovarian tumor characterized by solid tissue deposition confined to the ovarian surface. Because SSPBOT is rare, there are few published reports on the ultrasonographic features of this condition. In this retrospective study, we investigated 12 cases of SSPBOT. Ultrasound imaging of SSPBOT showed grossly normal ovaries that were encased partially or wholly by tumor deposits that were confined to the surface, with clear demarcation between normal ovarian tissue and surrounding tumors. Color Doppler imaging demonstrated the ‘fireworks sign’ in all cases of SSPBOT, corresponding to an intratumoral vascular bundle originating from the ovarian vessels and supplying hierarchical branching blood flow to the surrounding tumor. No patient with ovarian high‐grade serous carcinoma showed these morphological and Doppler features. In our series, the fireworks sign appeared to be a characteristic feature of SSPBOT that could facilitate correct identification of this tumor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

探讨遗传性凝血因子Ⅹ（FⅩ）缺乏症的临床特征、实验室检查、诊断、治疗及转归。 回顾性分析2009年7月至2021年2月期间就诊于中国医学科学院血液病医院的11例遗传性FⅩ缺乏症患者的临床资料。 11例患者中，男3例，女8例，中位初诊年龄39（5～55）岁。1例有家族史。10例（90.9％）存在出血事件，包括皮肤磕碰后瘀斑或出血（7例）、鼻出血（7例）、齿龈出血（6例）和肌肉血肿（1例）。8例女性患者中，6例有月经增多，1例正常分娩后发生出血。8例患者有手术史，4例发生术后出血。实验室检查见活化部分凝血活酶时间（APTT）延长、凝血酶原时间（PT）延长、FⅩ促凝活性（FⅩ∶C）减低。4例患者接受F10基因检测，发现5个新突变位点。11例患者中，4例输注凝血酶原复合物浓缩物（PCC），7例输注新鲜冰冻血浆（FFP），1例女性患者应用PCC预防性治疗后月经量明显减少，另有1例患者手术前预防性输注FFP后未发生术中、术后出血。 多数遗传性FⅩ缺乏症患者有出血倾向，F10基因突变检测对疾病的诊断和预后判断具有一定意义。

Background: Cardiovascular diseases (CVD) is the leading cause of death in China. Secondary prevention medications can improve the prognosis of CVD, yet little is known about the current use, variation and associated factors of these therapies in China. Purpose: The aim of this study was to describe the current use of secondary prevention medications among patients with established CVD in the community setting in China, assess variations across population subgroups, and identify the individual characteristics associated with these therapies. Methods: We studied 2.6 million participants aged 35–75 years from all 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project, a government-funded public health program conducted from 2014 to 2018. Participants self-reported their history of ischemic heart disease (IHD) or ischemic stroke (IS) and medication use in an interview. Among participants with IHD and/or IS, we assessed the reported use of secondary prevention medications (anti-platelet drugs and statins) in the overall population and in 1,530,408 population subgroups, defined by all possible combinations of 16 factors (age, sex, urbanity, geographic region, ethnicity, occupation, annual household income, education, marital status, medical insurance, current smoker, current drinker, history of hypertension, history of diabetes, body mass index and years since diagnosis). Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of demographic, socioeconomic and health behavior factors with the reported use of secondary prevention mediations. Results: Among 2,613,035 screened participants, 2.9% (74,830) had history of IHD and/or IS (1.2% for IHD, 2.4% for IS). Overall, the reported use rate either anti-platelet drugs or statins was 21.9% (18.3% anti-platelet drugs, 11.0% statins, and 7.4% both). Among the 1,530,408 population subgroups, the use of secondary prevention medications varied substantially (3.4% to 52.0%). Multivariable analyses found that that younger people, women, those living in rural areas, current smokers, current drinkers, people without hypertension or diabetes, and those with established CVD for more than 2 years were less likely to take anti-platelet drugs or statins (Figure). Forest plot of multivariable mixed model Conclusions: The current use of secondary prevention drugs is suboptimal and varies substantially across population subgroups in China. Our study identifies target populations for interventions to improve secondary prevention of CVD. Acknowledgement/Funding: This study was supported by the Ministry of Finance of China and National Health Commission of China