PPM Ir-f-phamidol-Catalyzed Asymmetric Hydrogenation of γ-Amino Ketones Followed by Stereoselective Cyclization for Construction of Chiral 2-Aryl-pyrrolidine Pharmacophores.

Transition metal catalysts with a million turnovers and excellent selectivity are rarely reported but are crucial for the industrial manufacture of optical pure pharmaceuticals, natural products, and fine chemicals. In this paper, we report an unprecedented aninoic Ir-f-phamidol catalyst for asymmetric hydrogenation of γ-amino ketones followed by stereoselective cyclization for construction of valuable chiral 2-aryl-pyrrolidine pharmacophores. The Ir-f-phamidol catalyst showed up to 1,000,000 TON and >99% ee, as well as excellent tolerance of substrates and protecting groups, providing various chiral amino alcohol intermediates. Upon optimization of the conditions, the stereoselective cyclization reaction was highly smooth and efficient (quantitative conversions, 92 to >99% ee). Finally, this solution was applied in the preparation of high-value chiral entities containing such chiral 2-aryl-pyrrolidine pharmacophores.

What drives the adoption of online health communities? An empirical study from patient-centric perspective.

BACKGROUND: Online health communities (OHCs) provide platforms for patients to seek advice from physicians and receive professional suggestions online. It can improve the efficiency of patients' diagnosis of simple diseases and alleviate hospital congestion. However, few empirical studies have comprehensively explored the factors influencing patients' intention to use OHCs through objective data. This study aims to fill this gap by identifying key factors that influence patients' acceptance of OHCs and proposing effective ways to promote the applications of OHCs in China. METHODS: Based on the Unified Theory of Acceptance and Usage of Technology (UTAUT), extended with additional constructs identified with patients' information demands in OHCs, this study developed a research model and proposed nine hypotheses. An online survey involving 783 valid responses was conducted in China to collect data to validate the proposed model. Confirmatory factor analysis and partial least squares (PLS) path model were conducted for instrument validation and hypothesis testing. RESULTS: Price value, eHealth literacy, and performance expectancy are the most prominent constructs in the study context. Interestingly, relation quality was also found to have a significant positive relationship with behavioral intention. CONCLUSIONS: Based on these findings, OHC operators need to create a user-friendly platform, improve information quality, set reasonable prices, and establish consummate security systems. Physicians and related organizations can raise awareness and assist patients in developing the skills to appropriately comprehend and utilize information in OHCs. This study contributes to both technology adoption theory and practice.

Fast Isomerization Before Isomerization-Hydroformylation: Probing the Neglected Period with A Novel Microfluidic Device.

By combining the concept of flash chemistry and radial synthesis, a novel microreactor (Flashstop reactor) was designed to study isomerization process of hydroformylation by a Rh/tetraphosphite catalyst in a time scale of seconds. It was found that in the initial 313 seconds, 60-99 % of 1-octene was isomerized to 2- and 3-octenes before the formation of aldehydes. Within this period, two different types of isomerization reactions were observed. It was proposed that a monohydride complex without CO ligand accounts for the ultrafast isomerization in the initial 30 seconds. The isomerization rate with such monohydride species was calculated much faster than that with the well-known H(CO)Rh(P-P) species. Both experimental and DFT computational studies were carried out to support this assumption. Fast transformations early on in catalytic cycles have been rarely studied due to the lack of proper tools. We believe that the Flashstop reactor is a powerful tool for analysis of kinetics in gas-liquid biphasic reactions within a time scale of seconds to minutes.

Integration of Milstein Ru-PNN and Rh-Tribi/Tetrabi for Isomerization Linear Selective Hydroformylation of Far Internal Alkenes.

Converting cheap and abundant internal alkenes to value-added linear aldehydes is of great importance but not an addressed issue. In this paper, an integration of a Milstein-type Ru-PNN catalyst and our Rh-Tribi/Tetrabi catalyst was first demonstrated in highly improved isomerization linear selective hydroformylation of 2-, 3-, and 4-alkenes, yielding excellent linear selectivities and activities (linear selectivity improvements of 2.2-58%, up to 94.2-98.6%, and turnover numbers improvements of 61-335 TON, up to 385-851) compared to the Ru-PNN/Rh-Bisbi system.

Factors affecting physicians using mobile health applications: an empirical study.

BACKGROUND: Mobile health applications (mHealth apps) have created innovative service channels for patients with chronic diseases. These innovative service channels require physicians to actively use mHealth apps. However, few studies investigate physicians' participation in mHealth apps. OBJECTIVE: This study aims to empirically explore factors affecting physicians' usage behaviors of mHealth apps. Based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) and mHealth apps features, we propose a research model including altruism, cognitive trust, and online ratings. METHODS: We collected data from physicians who have used mHealth apps and conducted a factor analysis to verify the convergence and discriminative effects. We used a hierarchical regression method to test the path coefficients and statistical significance of our research model. In addition, we adopted bootstrapping approach and further analyzed the mediating effects of behavioral intention between all antecedent variables and physicians' usage behavior. Finally, we conducted three robustness analyses to test the validity of results and tested the constructs to verify the common method bias. RESULTS: Our results support the effects of performance expectancy, effort expectancy, social influence, and altruism on the behavioral intentions of physicians using mHealth apps. Moreover, facilitating conditions and habits positively affect physicians using mHealth apps through the mediating effort of behavioral intention. Physicians' cognitive trust and online rating have significant effects on their usage behaviors through the mediating efforts of behavioral intention. CONCLUSIONS: This study contributes to the existing literature on UTAUT2 extension of physicians' acceptance of mHealth apps by adding altruism, cognitive trust, and online ratings. The results of this study provide a novel perspective in understanding the factors affecting physicians' usage behaviors on mHealth apps in China and provide such apps' managers with an insight into the promotion of physicians' active acceptance and usage behaviors.

Exploring the effects of health information seeking on e-satisfaction in online health communities: an empirical investigation.

BACKGROUND: Online health communities (OHCs) are becoming effective platforms for people to seek health information. Existing studies divide health information into general and specific information in OHCs. However, few studies discuss the effects of different types of information seeking in OHCs on users' electronic satisfaction (e-satisfaction). OBJECTIVE: This study explores the effects of general and specific information seeking on users' e-satisfaction with OHCs through the mediating roles of perceived benefits and costs drawing on the social information processing theory and the social exchange theory. METHODS: This study conducted an online survey to collected data from individuals who used OHCs to seek information. The structural equation model was used to analyze the collect data and the research model. Specifically, this study examined the common method bias and conducted a robustness check. RESULTS: Results show that general and specific information seeking affect e-satisfaction through the mediating roles of perceived benefits and costs. An interesting result is that general information seeking has a stronger effect on e-satisfaction than specific information seeking. CONCLUSIONS: This study suggests that e-satisfaction should be further enhanced by information seeking as online healthcare practices evolve and change. Managers of OHCs should focus on increasing users' perceived benefits, thereby increasing their e-satisfaction. Besides, this study discusses implications, limitations, and future research directions.

Rhodium-Catalyzed Chemo-, Regio- and Enantioselective Hydroformylation of Cyclopropyl-Functionalized Trisubstituted Alkenes.

The first rhodium-catalyzed highly chemo-, regio- and enantioselective hydroformylation of cyclopropyl-functionalized trisubstituted alkenes affording useful chiral cyclopropyl entities is reported. Compared to generally used diphosphine ligands for asymmetric catalysis, the modified hybrid phosphorus ligand, named (R,S)-DTBM-Yanphos, can convert a series of readily available cyclopropyl-functionalized trisubstituted alkenes into high-value chiral cyclopropyl-functionalized aldehydes with high selectivities (81-98 % ee). Gram-scale reactions (TON up to 1500) and follow-up transformations to the corresponding alcohol, acid, esters and nitrile are also presented. Finally, a possible hydroformylation mechanism involving ring-open-hydroformylation pathways is proposed based on control and deuteroformylation reactions.

Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study.

BACKGROUND: eHealth literacy is significantly associated with patients' online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients' eHealth literacy regarding health information-seeking behavior and physician-patient communication in OHCs. OBJECTIVE: This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory. METHODS: This was an empirical study, in which a research model consisting of 1 independent variable (patients' eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information-seeking behavior in OHCs, and patients' perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses. RESULTS: The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients' perceived quality of internet health information in OHCs. Patients' eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information-seeking behavior, and perceived quality of internet health information in OHCs. CONCLUSIONS: Results indicate that physician-patient communication, internet health information-seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients' eHealth literacy to improve treatment efficiency; OHCs' operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality.

The Impact of Treatment-Related Internet Health Information Seeking on Patient Compliance.

Background: Patients are increasingly using technology to seek health information, particularly on treatments. Treatment-related internet health information-seeking behavior may have impact on patients' trust in their physicians and the patient-physician relationship. Therefore, understanding the impacts of treatment-related internet health information-seeking behavior on patient-physician relationship, especially patient compliance, from the perspective of trust is important. Methods: The established research model has two independent variables (emerging and mature treatment-related internet health information seeking), two mediators (cognition- and affect-based trust), and one dependent variable (patient compliance). All variables were measured using previously validated multiple-item scales. We collected data through a web-based questionnaire survey in China and obtained 336 valid responses. The questionnaire validity rate was 89.6% (336/375), and reliability and validity were acceptable. Finally, we used confirmatory factor analysis and structural equation modeling to test the hypotheses and develop the research model. Results: Cognition- and affect-based trust had a direct positive impact on patient compliance. Cognition-based trust had a direct positive impact on affect-based trust. Mature treatment-related internet health information seeking had a significant positive impact on patient compliance through patients' cognition- and affect-based trust in their physicians. However, the emerging treatment-related internet health information seeking indicated a nonsignificant impact on patients' cognition- and affect-based trust in their physicians. Conclusions: Providing patients with access to treatment-related internet health information will not have a negative impact on the patient-physician relationship. Instead, encouraging patients to seek treatment-related health information online can improve patient compliance. Physicians can also learn much about health information related to emerging treatments to enhance their professionalism and reliability.

Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance.

Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.

Impact of Personal Trust Tendency on Patient Compliance Based on Internet Health Information Seeking.

Background: Personal trust tendency is an individual characteristic that can affect one's evaluation of others, behavior and its related outcomes. It may significantly affect one's health information seeking behavior and compliance. Therefore, this article aims at figuring out how personal trust tendency influences patient compliance through the internet health information seeking and patient satisfaction with it. Methods: Data were collected from 336 valid participants through an online survey in China. There are two independent variables: (1) cognition-based trust tendency and (2) affect-based trust tendency, three intervening variables (emerging internet health information seeking, conservative internet health information seeking, and satisfaction with internet health information), one dependent variable (patient compliance), and control variables. We performed confirmative factor analysis and structural equation modeling to test the hypotheses. Results: The cognition- and affect-based trust tendency positively affects patient compliance through the mediation of emerging and conservative internet health information seeking and satisfaction with internet health information. Surprisingly, strong positive relationships between affect-based trust tendency and emerging and conservative internet health information seeking were found, which are contrary to our initial hypothesis. Conclusions: Health information is considerably important when regarding health-related issues for individuals with cognition- and affect-based trust tendency. Physicians should encourage patients to seek health information on the internet and guide them to use internet health information that suits them. Information exchange and correlations should be involved in doctor-patient interactions. By following the suggestions just cited, better patient compliance can likely be obtained.

Is the Internet Different from Traditional Mass Media in Promoting Patient Compliance with Mature Treatments?

Background: Through mass media, some patients tend to seek mature treatment-related health information whereas some prefer information related to emerging treatments, which may influence patient compliance, specifically, following the medical diagnoses and treatment regimens. Given that traditional mass media (TMM) and the internet (INT) may promote the publication of different treatment-related information, this study aims to identify the difference between TMM and the INT in influencing patient compliance with mature treatments (PCMTs). Materials and Methods: Our subjects were Chinese who had received therapies within a month and had experience of seeking health information through mass media. An online survey involving 384 valid responses was conducted to collect data. The confirmatory factor analysis and structural equation modeling were adopted to test hypotheses. Results: Both TMM and the INT significantly affect PCMTs, through the mediation of mature treatment-related health information. Conclusions: A provision of mature treatment-related information via TMM can effectively help patients gain awareness and knowledge about treatments. In addition, physicians can update patients' knowledge by making cutting-edge treatments continuously available to patients through the mass media and analyzing patient's access patterns for different treatment-related information.

Fulfilling information needs of patients in online health communities.

BACKGROUND: Online health communities (OHCs) experience difficulties in utilising patient reported posts to fulfil the information needs of online patients concerning health related issues. OBJECTIVES: We aim to propose a comprehensive method that leverages medical domain knowledge to extract useful information from posts to fulfil information needs of online patients. METHODS: A knowledge representation framework based on authoritative knowledge sources in the medical field for the OHC is proposed. On the basis of the framework, a health related information extraction process for analysing the posts in the OHC is proposed. Then, knowledge support rate (KSR) and effective information rate (EIR) are introduced as metrics to evaluate changes in knowledge extracted from the knowledge sources in terms of fulfilling the information needs of patients in the OHC. RESULTS: On the basis of a data set with 372 343 posts in an OHC, experimental results indicate that our method effectively extracts relevant knowledge for online patients. Moreover, KSR and EIR are feasible metrics of changes in knowledge in terms of fulfilling the information needs. CONCLUSIONS: The OHCs effectively fulfil the information needs of patients by utilising authoritative domain knowledge in the medical field. Knowledge based services for online patients facilitate an intelligent OHC in the future.

A meta-analysis of ABCG2 gene polymorphism and non-small cell lung cancer outcomes.

We aimed to analyze the correlation between ABCG2 gene polymorphisms of 34 GG/(GA + AA) loci, 421 CC/(AC + AA) loci, and non-small cell lung cancer (NSCLC) therapeutic effects via meta-analysis. With key words, the databases PubMed and EMBASE were searched for clinical studies on ABCG2 polymorphism and NSCLC. RR and 95% CIs were used to compute combined effects, followed by heterogeneity testing. Publication bias was examined using the funnel plot method. Review Manager 5.3 software was used for the meta-analysis. Ten studies were included. No evidence of heterogeneity exists in these studies. The results indicate that two polymorphic loci of ABCG2 gene (34 G>A, and 421 C>A) had no relationship with the curative effect of chemotherapy for NSCLC, except ABCG2 34G>A, which had a significant relationship with the skin toxicity complication. There was no significant relationship between these polymorphisms and complications (skin toxicity, diarrhea, interstitial pneumonia, liver dysfunction, and neutropenia). Begg's test and Egger's test indicated that there was no obvious publication bias. The meta-analysis indicated that there was no significant correlation between ABCG2 gene polymorphism and NSCLC outcomes.

Why do patients follow physicians' advice? The influence of patients' regulatory focus on adherence: an empirical study in China.

BACKGROUND: In general, medical regimens and treatments are more likely to be effective if patients follow their physicians' advice. However, limited studies have focused on the relationship between regulatory focus and patient adherence. This study explores the antecedents of patient adherence employing regulatory focus theory. METHODS: This study established a research model consisting of two independent variables, two mediators, one dependent variable, two moderators, three control variables, and six hypotheses. An online survey involving 336 valid responses was conducted to collect data in China. We used structural equation modelling and confirmatory factor analysis to test the hypotheses and to develop the research model. RESULTS: The reliability and validity of the measures were accepted. In terms of control variables, age had a positive effect on conservative treatment-related health information seeking behaviour, and patients with different resident statuses held different attitudes towards seeking conservative treatment-related health information. However, educational level did not have any effect on the variables of the research model. The hypothesis testing results corroborate that promotion focus had a positive impact on patients' emerging treatment-related health information seeking behaviour; prevention focus had a positive impact on patients' conservative treatment-related health information seeking behaviour, which had a positive impact on patient adherence. In addition, media campaigns had a positive impact on the relationship between promotion focus and emerging treatment-related health information seeking behaviour, and website reputation had a positive impact on the relationship between prevention focus and conservative treatment-related health information seeking behaviour. CONCLUSIONS: Individuals can be encouraged to seek health information and share health-related knowledge through mass media, such as the Internet, when the quality of information, especially information from online sources, is guaranteed. In addition, physicians need to improve their professionalism and expand their knowledge of conservative healthcare. As a further application of our work, an Internet information recommendation system can be designed to recommend different types of health information for users according to their regulatory focus.

Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study.

BACKGROUND: In China, the utilization of medical resources is tense, and most hospitals are highly congested because of the large population and uneven distribution of medical resources. Online health communities (OHCs) play an important role in alleviating hospital congestions, thereby improving the utilization of medical resources and relieving medical resource shortages. OHCs have positive effects on physician-patient relationships and health outcomes. Moreover, as one of the main ways for patients to seek health-related information in OHCs, physician-patient communication may affect patient compliance in various ways. In consideration of the inevitable development of OHCs, although they have several shortcomings, identifying how physician-patient communication can impact patient compliance is important to improve patients' health outcomes through OHCs. OBJECTIVE: This study aimed to investigate the impact of physician-patient communication on patient compliance in OHCs through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance, using an empirical study based on the self-determination theory. METHODS: A research model was established, including 1 independent variable (physician-patient communication), 3 mediators (perceived quality of internet health information, decision-making preference, and physician-patient concordance), 1 dependent variable (patient compliance), and 4 control variables (age, gender, living area, and education level). Furthermore, a Web-based survey involving 423 valid responses was conducted in China to collect data, and structural equation modeling and partial least squares were adopted to analyze data and test the hypotheses. RESULTS: The questionnaire response rate was 79.2% (487/615) and the validity rate was 86.9% (423/487); reliability and validity are acceptable. The communication between physicians and patients in OHCs positively affects patient compliance through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Moreover, physician-patient communication exhibits similar impacts on the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Patients' decision-making preference shows the weakest impact on patient compliance compared with the other 2 mediators. Ultimately, all 3 mediators play a partially mediating role between physician-patient communication and patient compliance. CONCLUSIONS: We conclude that physician-patient communication in OHCs exhibits a positive impact on patient compliance; thus, patient compliance can be improved by guiding physician-patient communication in OHCs. Furthermore, our findings suggest that physicians can share high-quality health information with patients, discuss benefits, risks, and costs of treatment options with patients, encourage patients to express their attitudes and participate in health-related decision making, and strengthen the emotional connection with patients in OHCs, thereby decreasing patients' misunderstanding of information and increasing concordance between physicians and patients. OHCs are required to not only strengthen the management of their published health information quality but also understand users' actual attitudes toward information quality and then try to reduce the gap between the perceived and actual quality of information.

The Impact of Individuals' Attitudes Toward Health Websites on Their Perceived Quality of Health Information: An Empirical Study.

Background: A growing number of patients have increasingly used health websites to search and gather health information. Nevertheless, few studies have focused on the driving factors of internet health information quality from the perspective of psychology. Accordingly, this study explores how the attitudes of individuals toward health websites affect their perceived quality of internet health information through the mediation of seeking behavior on treatment information by employing regulatory focus theory. Materials and Methods: We defined six hypotheses that both trust in health websites and expectancy of health websites have a positive impact on emerging and conservative treatment-related online health information seeking; emerging treatment seeking has a negative impact on internet health information quality; and conservative treatment seeking has a positive impact on internet health information quality. Emerging treatment refers to some therapies based on new technologies or research, which is barely used, whereas conservative treatment is more common among the medical field. An online survey involving 336 valid participants was conducted in China. In the research model, all variables were measured using multiple-item scales, and structural equation modeling was employed for testing the hypotheses. Results: The expectancy of health websites significantly affects conservative and emerging treatment-related online health information seeking, but trust in health websites does not. Moreover, trust in health websites strongly affects the expectancy of health websites, and attitudes toward health websites have a strong effect on conservative treatment-related online information seeking. The effect of conservative treatment-related online health information seeking was considerably larger than that of emerging treatment-related online health information seeking on perceived quality of internet health information. Conclusions: From the perspective of health websites operators and public hospitals, conservative treatment and online service might be worth providing and improving. Cooperation between health websites and hospitals might be a good choice.

Relationship Between Internet Health Information and Patient Compliance Based on Trust: Empirical Study.

BACKGROUND: The internet has become a major mean for acquiring health information; however, Web-based health information is of mixed quality and may markedly affect patients' health-related behavior and decisions. According to the social information processing theory, patients' trust in their physicians may potentially change due to patients' health-information-seeking behavior. Therefore, it is important to identify the relationship between internet health information and patient compliance from the perspective of trust. OBJECTIVE: The objective of our study was to investigate the effects of the quality and source of internet health information on patient compliance using an empirical study based on the social information processing theory and social exchange theory. METHODS: A Web-based survey involving 336 valid participants was conducted in China. The study included independent variables (internet health information quality and source of information), 2 mediators (cognition-based trust [CBT] and affect-based trust [ABT]), 1 dependent variable (patient compliance), and 3 control variables (gender, age, and job). All variables were measured using multiple-item scales from previously validated instruments, and confirmative factor analysis as well as structural equation modeling was used to test hypotheses. RESULTS: The questionnaire response rate was 77.16% (375/486), validity rate was 89.6% (336/375), and reliability and validity were acceptable. We found that the quality and source of internet health information affect patient compliance through the mediation of CBT and ABT. In addition, internet health information quality has a stronger influence on patient compliance than the source of information. However, CBT does not have any direct effect on patient compliance, but it directly affects ABT and then indirectly impacts patient compliance. Therefore, the effect of ABT seems stronger than that of CBT. We found an unexpected, nonsignificant relationship between the source of internet health information and ABT. CONCLUSIONS: From patients' perspective, internet health information quality plays a stronger role than its source in impacting their trust in physicians and the consequent compliance with physicians. Therefore, patient compliance can be improved by strengthening the management of internet health information quality. The study findings also suggest that physicians should focus on obtaining health information from health websites, thereby expanding their understanding of patients' Web-based health-information-seeking preferences, and enriching their knowledge structure to show their specialization and reliability in the communication with patients. In addition, the mutual demonstration of care and respect in the communication between physicians and patients is important in promoting patients' ABT in their physicians.

Leveraging Shannon Entropy to Validate the Transition between ICD-10 and ICD-11.

This study aimed to propose a mapping framework with entropy-based metrics for validating the effectiveness of the transition between International Classification of Diseases 10th revision (ICD-10)-coded datasets and a new context of ICD-11. Firstly, we used tabular lists and mapping tables of ICD-11 to establish the framework. Then, we leveraged Shannon entropy to propose validation methods to evaluate information changes during the transition from the perspectives of single-code, single-disease, and multiple-disease datasets. Novel metrics, namely, standardizing rate (SR), uncertainty rate (UR), and information gain (IG), were proposed for the validation. Finally, validation results from an ICD-10-coded dataset with 377,589 records indicated that the proposed metrics reduced the complexity of transition evaluation. The results with the SR in the transition indicated that approximately 60% of the ICD-10 codes in the dataset were unable to map the codes to standard ICD-10 codes released by WHO. The validation results with the UR provided 86.21% of the precise mapping. Validation results of the IG in the dataset, before and after the transition, indicated that approximately 57% of the records tended to increase uncertainty when mapped from ICD-10 to ICD-11. The new features of ICD-11 involved in the transition can promote a reliable and effective mapping between two coding systems.

Medical service unity: an effective approach for medical care in rural areas in China.

CONTEXT: Medical care in rural China has long suffered because of a concentration of medical resources in major hospitals in cities. The patients in rural areas thus do not have affordable access to quality medical services. To tackle such issues, a tiered medical scheme (TMS) was promoted by the Chinese State Council in 2015. It divides hospitals into three tiers and encourages collaborations among different tiers within a region in order to provide better accessibility to medical care for patients in rural areas. ISSUES: The implementation of the TMS policy has not been successful, because the previous funding model, which allocated funding to each hospital according to the number of patients treated, did not facilitate close collaborations between different hospitals. In this report, the medical service unity (MSU) approach, which has been piloted in Funan county, is reported. The MSU organises the tiered hospitals as a unity in terms of medical capabilities and financial abilities. With the radical reform of financial decentralisation, three flows are thereby enabled: the funding flow binds together the hospitals into a unity, the patient flow shares the load across the providers and eases barriers to access, and the resource flow ensures accessibility and affordability for patients. LESSONS LEARNED: The MSU approach has been shown by the pilot project in Funan to be effective for the realisation of the TMS policy, benefiting hospitals, doctors and patients. The successful experience of the Funan MSU could be introduced to other regions across China and other countries. In particular, future finance reform policies for the health system would largely benefit the health reforms and especially the decentralisation of medical resources to rural areas.