Neural control of cerebral blood flow: scientific basis of scalp acupuncture in treating brain diseases.

Scalp acupuncture (SA), as a modern acupuncture therapy in the treatment of brain diseases, especially for acute ischemic strokes, has accumulated a wealth of experience and tons of success cases, but the current hypothesized mechanisms of SA therapy still seem to lack significant scientific validity, which may not be conducive to its ultimate integration into mainstream medicine. This review explores a novel perspective about the mechanisms of SA in treating brain diseases based on its effects on cerebral blood flow (CBF). To date, abundant evidence has shown that CBF is significantly increased by stimulating specific SA points, areas or nerves innervating the scalp, which parallels the instant or long-term improvement of symptoms of brain diseases. Over time, the neural pathways that improve CBF by stimulating the trigeminal, the facial, and the cervical nerves have also been gradually revealed. In addition, the presence of the core SA points or areas frequently used for brain diseases can be rationally explained by the characteristics of nerve distribution, including nerve overlap or convergence in certain parts of the scalp. But such characteristics also suggest that the role of these SA points or areas is relatively specific and not due to a direct correspondence between the current hypothesized SA points, areas and the functional zones of the cerebral cortex. The above evidence chain indicates that the efficacy of SA in treating brain diseases, especially ischemic strokes, is mostly achieved by stimulating the scalp nerves, especially the trigeminal nerve to improve CBF. Of course, the mechanisms of SA in treating various brain diseases might be multifaceted. However, the authors believe that understanding the neural regulation of SA on CBF not only captures the main aspects of the mechanisms of SA therapy, but also facilitates the elucidation of other mechanisms, which may be of greater significance to further its clinical applications.

Examination of Differences in Nonmedical Supplemental Benefit Coverage for Dual-Eligible Enrollees in Medicare Advantage Plans in 2021.

This cross-sectional study uses Medicare Advantage benefit package data for 2021 to examine differences in the coverage of nonmedical supplemental benefits­such as transportation services and food and meal assistance­for dual-eligible enrollees with health-related social needs.

Effects of affiliation network membership on hospital quality and financial performance.

OBJECTIVE: To examine the effects of hospital membership in affiliation networks-franchise-like networks sponsored by high-quality health systems in which affiliate hospitals pay an annual fee for access to sponsor's operational and clinical resources-on clinical quality, patient experience ratings, and financial performance of affiliates and their competitors. DATA SOURCES: Network membership data from press releases and websites of four sponsors (Mayo Clinic, Cleveland Clinic, MD Anderson, Memorial Sloan Kettering), American Hospital Association's Annual Survey, Centers for Medicare & Medicaid Services' Hospital Compare, and Healthcare Cost Report Information System, all for 2005-2016. STUDY DESIGN: We used a quasi-experimental design and estimated hospital-level regressions with hospital-fixed effects. Dependent variables were measures of clinical quality, patient experience, and financial performance. Independent variables included an indicator for affiliate versus nonaffiliate and fixed effects for hospital characteristics and year. To analyze effects on competitors, we repeated analyses by comparing hospitals in the same county as an affiliate to nonaffiliated, noncompetitor hospitals. DATA COLLECTION: Membership was obtained through press releases and network websites then linked across datasets by name and Medicare's identification number. PRINCIPAL FINDINGS: Across networks, affiliates (N = 199) experienced insignificant clinical quality changes but increased net income by $38,500 and operating margin by 6.6% (p values = 0.01-0.08) compared to nonaffiliates. Multispecialty affiliates improved on no measures. Cancer-specific affiliates improved their net income ($96,900) and operating margin (3.6%; p-values < 0.05). Affiliates' competitors experienced mixed changes in clinical measures relative to hospitals without affiliates in market (p-value < 0.05) but no financial effects. Affiliation was not associated with patient experience ratings for affiliates nor competitors. CONCLUSIONS: Despite quality-focused missions, affiliation networks are not guaranteed to improve public measures of quality in affiliated hospitals, although hospitals in these communities improve financially. Future research should assess the conditions and mechanisms by which affiliation improves quality consistently and which forms of quality.

The rationale behind the four major anti-coronavirus principles of Chinese herbal based on systems medicine.

As the novel coronavirus disease 2019 (COVID-19) and its multi variants continue to rage into the second year of a global pandemic, many success stories of applying Chinese herbal medicine (CHM) to COVID-19 patients continue to emerge from China and other parts of the world. Herewith, the authors summarized those experiences from a systems medicine perspective and categorize the four major treatment principles: (1) focusing on eliminating toxins in the early stage of the disease, (2) tonifying the body against deficiency throughout the entire disease course, (3) treating affected lung and intestine simultaneously based on visceral interactions, and (4) and cooling the blood and removing blood stasis at the later stage. The rationale behind these principles is shown via a scientific interpretation. This is not only helpful in reducing the complexity of promoting the CHM applications to enhance anti-pandemic efficacy but also to ramp up the process of integrating traditional Chinese medicine with modern medical practices.

Who Joins the Franchise, Affiliation Model of Hospital Networks? An Analysis of Hospital and Market Characteristics of Members.

Joining nonownership based, organization-driven networks and alliances is a common strategy for hospitals to pursue yet little is known about what types of hospitals join these collaborations, due in part to challenges in identifying members. One novel network form that has recently emerged, and made identification feasible, is franchise-like "affiliation networks" in which affiliate hospitals pay an annual membership fee that allows access to the clinical expertise and resources of high-status, nationally ranked sponsor hospitals. Affiliation networks and their members publicize affiliation. Using 2006-2015 data on United States' hospitals, we find hospitals with higher patient acuity, teaching hospitals, and hospitals located in areas of higher utilization intensity were more likely to join an affiliation network. Joining affiliation networks does not appear to be in response to highly competitive markets because hospitals in less competitive environments are more likely to join and hospitals with higher net incomes are more likely to join.

Voluntary Hospital Reporting of Performance in Cancer Care: Does Volume Make a Difference?

Little is known about which hospitals participate in voluntary public reporting of quality processes and what influences their performance, particularly in cancer care. We hypothesize that patient volume is positively associated with both reporting and performance. In 2014, when Pennsylvania became the first and only state to have public reporting for cancer care, it became possible to test these hypotheses, which we did in cross-sectional study of the 72 Pennsylvania hospitals accredited by the Commission on Cancer. Hospitals that publicly reported their performance (57 of 72) had higher patient volumes than hospitals that did not release performance. Among reporting hospitals, no association was found between patient volume and performance on process of care metrics. These findings suggest the importance of attending to volume effects in public reporting of cancer care and recognizing that volume is not a predictor of performance for reporting hospitals, which indicates the need for research to identify other factors that differentiate performance within and across reporting and nonreporting hospitals.