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Objective: This study aimed to analyze the effect of coronary stent policies implemented in Shanghai on the risk of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) inpatients based on real-world data. Methods: Two retrospective cohorts of inpatients with a first diagnosis of ACS who had undergone PCI for the first time in the previous year in Shanghai hospitals were examined (one for the postpolicy period and the other for the prepolicy period). χ2 tests were used to compare categorical variables between the two cohorts. Single- and multivariate Cox proportional hazards models were used to compare the risk of major adverse cardiovascular events (MACEs) between the two cohorts. Results: A total of 31,760 ACS patients were included in this study. The proportion of ACS inpatients who had at least one bid-winning stent and 3 or more coronary stents implanted for first-time PCI in the postpolicy cohort was higher than that in the prepolicy cohort (86.52% vs. 55.67% and 6.27% vs. 4.39%, respectively; all p values < 0.0001). The single- and multivariate Cox proportional hazards models revealed that the unadjusted and adjusted hazard ratios for MACEs at 1 year after PCI for the postpolicy cohort relative to the prepolicy cohort were 0.869 (P<0.0001) and 0.814 (P = 0.0007), respectively. Conclusions: The implementation of coronary stent policies changed coronary stent utilization but had no significant adverse effects on the risk of PCI among ACS patients in Shanghai in the short term. However, the reasons for changes in the number of coronary stents implanted should be analyzed and addressed in the future. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the association between diabetes mellitus and health-related quality of life (HRQoL) of older people in Shanghai, China, especially regarding the differences in each aspect of the EQ-5D and how large the score gaps are between older people with and without diabetes.Methods: A total of 11,103 people of either sex older than 60 years were enrolled from 17 districts of Shanghai. The EQ-5D-3L was used to assess the HRQoL of older people. The Wilcoxon rank sum test and t-test were used to compare the difference in HRQoL between people with or without diabetes. After univariate regression, multiple linear regression and ordinal logistic regression were conducted to evaluate the influence of diabetes mellitus and other confounding variables on the EQ VAS scores and on the five dimensions of the EQ-5D.Results: Twelve percent of all participants had diabetes mellitus, and the proportion was almost the same between men and women. The EQ VAS scores of people with diabetes mellitus were approximately 3.70 points lower than those of people without diabetes (95% CI = -4.40,  -2.99, p < 0.001) after adjusting for confounding variables. People with diabetes mellitus had increased problems with mobility (OR = 1.57, 95% CI = 1.33, 1.85), self-care (OR = 1.65, 95% CI = 1.35, 2.01), usual activities (OR = 1.78, 95% CI = 1.51, 2.11), pain/discomfort (OR = 1.42, 95% CI = 1.24, 1.64), and anxiety/depression (OR = 1.33, 95% CI = 1.07, 1.64).Conclusions: This study showed that diabetes mellitus was associated with the HRQoL of older people and that older people with diabetes had poorer performance in every aspect of EQ-5D measurements. [ABSTRACT FROM AUTHOR]

Objectives: Using the person-environment (PE) fit theory, this study aims to explore factors affecting medical professionals' job satisfaction, turnover intention, and professional efficacy, and to examine individual characters associated with PE fit. Design and methods: This study used data from the sixth National Health Service Survey conducted in 2018, with a focus on job outcomes among medical professionals in Shanghai. The reliability and validity of the tools for measuring PE and job outcomes were calculated. A structural equation model was used to examine the relationship among person-job (PJ) fit and person-group (PG) fit, job satisfaction, turnover intention, and professional efficacy. Finally, a hierarchical regression model was used to analyze the association between demographic variables and the PJ and PG fit. Results: PG fit was directly and positively associated with job satisfaction and professional efficacy. PJ fit had a direct and positive association with job satisfaction but had a direct and negative association with turnover intention. The indirect association of PJ fit with turnover intention was statistically significant. The results from the hierarchical regression analysis showed that younger physicians generally had a lower level of PJ fit and older physicians with higher education tended to have a lower level of PG fit. Conclusions: Medical professionals with higher PJ or PG fit have higher job satisfaction, and those with higher PG fit have higher professional efficacy. The impact of PJ fit on turnover intention was mediated by job satisfaction. Healthcare managers should take actions to effectively promote medical professionals' PJ and PG fit to improve their retention and efficiency. [ABSTRACT FROM AUTHOR]

MitraClip edge-to-edge (E2E) repair system is the only transcatheter device recommended in the current guidelines for treating mitral regurgitation (MR). The percutaneous femoral venous transseptal access of MitraClip requires a complex steerable delivery system and may thus be technically complex to optimally position and deploy the clip onto the mitral valve. A transapical approach for E2E repair has been devised to treat MR for the ease of operation (ValveClamp system, Hanyu Medical Technology, Shanghai). The first-in-human study of ValveClamp has demonstrated its early feasibility and effectiveness for the treatment of patients with degenerative MR. Transesophageal echocardiography (TEE) is the only imaging modality required for intraoperative guidance of ValveClamp implantation. Successful implantation depends on accurate localization and orientation of the clamp and efficient intraoperative communication between the echocardiographer and the intervention team. Thus, the focus of this review is on elaborating how two-dimensional (2D) and three-dimensional (3D) TEE are used in clinical practice to guide ValveClamp implantation and it may facilitate the understanding of simplicity and safety of this novel procedure. We also describe the implementation of several novel advancements in 3D TEE imaging, which improve the confidence of image interpretation for intraoperative guidance and expedite implantation times. [ABSTRACT FROM AUTHOR]