lNTRODUCTlON

德國行政法院長久以來致力于縮短司法審判的周期，取得的成效卻并不盡如人意，尤其是行政訴訟類案件，時間更為冗長，這與我國當(dāng)下的司法實踐極為相似。但是在實施《調(diào)解法》所規(guī)定的調(diào)解措施之后，德國行政訴訟糾紛解決的效率有了大幅提升，同時確保了爭議雙方對調(diào)解結(jié)果的滿意程度。

Studies also show higher short-term rehospitalization and mortality rates in pneumonia patients,with 12% to 22% of the patients readmitted within 30 d after initial hospitalisation for pneumonia[3-5].Recent reports also show that rehospitalizations are associated with the increased risk of iatrogenic complications, resulting in additional financial burden on the health care system[6-8]. As a results of the general trend of having short hospital stays, the main responsibility of caring for older pneumonia patients after the discharge falls on the primary health care providers[9].

Yet, there is still a limited knowledge of how to identify the pneumonia patients who are at higher risk of having short-term rehospitalization following discharge[10-12]. Such knowledge is urgently required to ensure that the health care attention has been specifically given to the patients with the highest level of needs. Numerous studies attempted to investigate factors that are associated with the short-term rehospitalization[13-15]. However, the majority of these studies were inconclusive due to small sample sizes, differences in the definition of pneumonia, joint pooling of the in-hospital and postdischarge deaths and lower generalizability[16-18].

將處方量的枸櫞酸莫沙必利原料藥、助漂劑、黏合劑、泡騰劑混合均勻，過80目篩；將上述軟材擠出、滾圓制備丸芯，干燥后過篩，收集20～50目之間的丸芯，進行包衣，即得。

To the best of our knowledge, there has been no systematic effort to pool data on the risk factors for hospital readmissions in patients with pneumonia. The purpose of the present review is to pool data from individual studies to identify risk factors for hospital readmissions in patients with pneumonia.

MATERlALS AND METHODS

Design and registration

The protocol of the current systematic review and meta-analysis of observational studies was registered in PROSPERO under the registration number (CRD42021260284). “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement 2020” was utilized for reporting this systematic review incorporating the meta-analyses[19].

Eligibility criteria

Observational studies, irrespective of the study design (cross-sectional/case-control/cohort studies) reporting the relevant exposure and outcome were included. Only full-text publications were included while the studies published as conference abstracts/case reports/case series and unpublished data were excluded.

Two independent investigators assessed the risk of bias and quality of evidence for included studies using Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines[21]. GRADE approach consists of five components: (1) Risk of bias assessment: “Newcastle Ottawa Scale”; (2) Indirectness: Assessed in terms of population, exposure or outcomes; (3) Imprecision: To find how precise the estimate obtained–based on sample size and confidence interval; (4) Inconsistency:Evidence of heterogeneity using

statistic and chi square test of heterogeneity; and (5) Publication bias:Egger’s test and funnel plot.

We have included studies assessing the association of any sociodemographic risk factors or comorbidity with hospital readmissions. At least three studies should have reported the particular risk factor to be eligible for inclusion in the review.

The burden and incidence of acute infectious diseases, such as pneumonia, that have traditionally led to hospital admissions are expected to rise over the next few decades, mainly due to the increase in the population aged above 80 years[1,2]. Older patients with pneumonia often require hospital admissions[3]. The short-term rehospitalization and mortality rates are also found to be higher amongst those who survive the initial admission[3]. Most elderly patients require special attention from health care professionals after discharge to reduce short-term rehospitalization and mortality rates.

: A total of 4 studies evaluated the risk of readmissions in patients with and without ischaemic heart disease. The pooled OR was 1.15 (95%CI:0.94-1.40;

= 42%), indicating that there is no association between ischaemic heart disease and hospital readmissions (Figure 2I). The quality of evidence was found to be low as

GRADE approach.

Search strategy

Systematic search of the literature was performed in the electronic databases such as PubMed Central,EMBASE, MEDLINE, and Cochrane library and search engines such as ScienceDirect and Google Scholar. Both medical subject headings (MeSH) and free-text words were used to search all these databases & search engines. The final search was carried out by combining the individual search results using appropriate Boolean operators (“OR” and “AND”) and narrowed down using the available filters on time period (from January 2010 to July 2021), language (published in English language only) and study design (observational studies). The detailed search strategy with search terms and results has been reported in the Supplementary material.

Study selection process

The selection of the relevant studies was performed by two independent investigators by screening the title, abstract and keywords of the manuscripts identified by the literature search. Full-text articles were retrieved for the studies shortlisted based on the eligibility criteria and screened by the same two investigators. Only studies that satisfy all the eligibility criteria with respect to design, participants, exposure and outcome were included. Disagreements between the investigators were resolved and final consensus on inclusion of studies was reached with the help of another investigator.

where andare the complex modal amplitudes and axial complex wavenumbers of the n-th decomposed mode,respectively,with superscript?representing forward and backward modes,respectively.The dispersion relation is described as follows:

Data extraction process

Manual extraction of data was done using a pre-defined structured data extraction form. Data extracted using the form were as follows: Author, year of publication, information related to methods section such as design, setting, sample size, sampling strategy, study participants, eligibility criteria, exposure and outcome assessment method, quality related information, number of participants in exposed and nonexposed group and number of exposed and non-exposed participants with hospital readmission. Data were entered by the primary investigator and it was double-checked by secondary investigators for correct entry.

Risk of bias assessment

The risk of bias assessment was performed by two independent investigators using the Newcastle Ottawa (NO) Quality Assessment Form for observational studies under the Selection (maximum 4 stars), Comparability (maximum 2 stars) and Outcome domains (maximum 2 stars) with the following criteria: Representativeness, Sample size justification, Non-response, Ascertainment of exposure,Control for confounding, Assessment of outcome and Statistical tests. The total score ranges from 0 to 8 stars. Studies having 7 to 8 stars were considered of “good” quality, 5 to 6 stars indicated “satisfactory”quality, and 0 to 4 stars indicated “unsatisfactory” quality[20].

Statistical analysis

Meta-analysis was executed using the software Review Manager 5.4 (The Cochrane Collaboration,2020). Since all the outcomes were dichotomous, number of events and participants in each group were entered to obtain the pooled effect estimate in terms of odds ratio (OR) and were graphically depicted by the forest plot. We used the random effects model with inverse variance method to calculate the weight of individual studies. Evidence of heterogeneity was assessed through chi square test and

statistics to quantify the inconsistencies[21]. We also performed sensitivity analysis to assess the robustness of results by removing the studies one by one and checking for any significant variation in the results. We have assessed publication bias through funnel plot for the outcomes with minimum of 10 included studies.

Quality of evidence

: We have included the studies conducted among the adult pneumonia patients aged ≥ 18 years. Studies conducted among specific diseased population were excluded from the analysis.

Finally, the quality of the included studies was classified as “Very Low”, “Low”, “Moderate” and“High” based on certainty of evidence.

前些天，我回老家，在街頭碰到他，讓我心中無比感慨。他幾乎已失去了昔日的光彩，很無所謂地說了一句：“沒考上?！?/p>

RESULTS

Study selection

In total, 2421 records were retrieved through the literature search. Of them, 110 studies were eligible for the full-text retrieval, including four studies identified through the hand-search of references in the 106 retrieved articles from the primary screening. During the final stage of the screening, 17 studies with nearly 3 million participants were included (Figure 1)[11,12,22-36].

Characteristics of the included studies

Almost all the studies (16 out of 17 studies) were retrospective in nature. Majority of the included studies were conducted in the United States of America followed by European countries such as Italy,Denmark, United Kingdom, and Spain. The sample sizes of the included studies ranged from 771 to 1472070. Mean age of the participants ranged from 60 to 79 (Table 1). All the included studies had good to satisfactory quality (Table 2).

Predictors of hospital readmissions among pneumonia patients

: Three studies have reported on the risk of readmissions among elderly pneumonia patients aged 65+ years. The pooled OR was 0.90 (95%CI: 0.58-1.39;

= 92%), indicating no difference in terms of hospital readmissions based on age group (Figure 2A). The quality of evidence was found to be very low as

GRADE approach.

辛娜說，好歹同學(xué)一場，他也不會太為難我，錢倒不必，大不了多吃幾次飯。今天同學(xué)小聚我也沒去，估計老陸去了。他們沒準(zhǔn)正在責(zé)備我缺席呢，沒聽我剛才打了幾個噴嚏嗎？

: Nine studies compared risk of readmissions between dementia and non-dementia pneumonia patients. The pooled OR was 1.11 (95%CI: 0.96-1.29;

= 99%), indicating that there was no between dementia and hospital readmissions among pneumonia patients (Figure 2C).The quality of evidence was found to be very low as

GRADE approach.

: Seven studies have reported on the risk of readmissions between diabetes and non-diabetes pneumonia patients. The pooled OR was 1.18 (95%CI: 1.08-1.28;

=34%), indicating that the diabetes patients have 1.18 times higher odds of having hospital readmissions when compared to non-diabetes pneumonia patients (Figure 2D). The quality of evidence was found to be low as

GRADE approach.

隨著全面深化改革不斷走向深入，國家不再全額供養(yǎng)地方科研院所，大量單位轉(zhuǎn)制為國有科技型企業(yè)，這就不可避免的要直面市場競爭。難以融資、體制機制僵化、人才隊伍更迭嚴(yán)重等問題更是加劇了地方科研院所的困難。具體到改革過程中，需要進行法人治理結(jié)構(gòu)的單位正面臨著理事會對單位的實際把控問題。行業(yè)性質(zhì)的研究單位隨著產(chǎn)業(yè)轉(zhuǎn)移和更新轉(zhuǎn)型壓力更大，有一定規(guī)模的科研單位因二級法人單位業(yè)務(wù)、財務(wù)獨立而難以有效集聚資源，完全按照政府部門的模式管理又導(dǎo)致科研單位體制機制僵化，致使盈收無法合法分配，這些問題有的是現(xiàn)實發(fā)展所致，有的是歷史遺留問題。

: Ten studies showed the risk of readmissions in patients with and without chronic respiratory disease. The pooled OR was 1.37 (95%CI: 1.19-1.58;

=93%), indicating that the patients with chronic respiratory disease have significantly (1.37 times) higher odds of having hospital readmissions when compared to patients without chronic respiratory disease (

＜ 0.001) (Figure 2E). The quality of evidence was found to be low as

GRADE approach.

: A total of 13 studies looked at the risk of readmissions in male and female pneumonia patients. The pooled OR was 1.22 (95%CI: 1.16-1.27;

= 79%), indicating that the males have 1.19 times higher odds of having hospital readmissions when compared to female pneumonia patients and this association was statistically significant (

＜ 0.001) (Figure 2B). The quality of evidence was found to be low as

GRADE approach.

: Seven studies have reported on the risk of readmissions between patients with and without chronic kidney disease. The pooled OR was 1.38(95%CI: 1.23-1.54;

= 47%), indicating that the patients with chronic kidney disease have 1.38 times higher odds of having hospital readmissions when compared to patients without chronic kidney disease(

＜ 0.001) (Figure 2F). The quality of evidence was found to be low as

GRADE approach.

: Five studies evaluated the risk of readmissions in patients with and without chronic liver disease and showed the pooled OR of 1.39 (95%CI: 0.98-1.98;

=75%), indicative of no significant association between chronic liver disease and readmission risk(Figure 2G). The quality of evidence was found to be very low as

GRADE approach.

: Nine studies have reported on the risk of readmissions between patients with and without heart failure. The pooled OR was 1.28 (95%CI: 1.20-1.37;

= 19%),indicating that the patients with heart failure have 1.28 times higher odds of having hospital readmissions when compared to patients without heart failure (Figure 2H). The quality of evidence was found to be low as

GRADE approach.

: Studies reporting the rate of hospital readmission across the different sociodemographic and comorbidity factors were included.

: Five studies have reported on the risk of readmissions between patients with and without cerebrovascular disease. The pooled OR was 1.08(95%CI: 0.85-1.38;

= 71%), indicating there is no association between cerebrovascular disease and hospital readmissions (Figure 2J). The quality of evidence was found to be low as

GRADE approach.

: Risk of readmissions in patients with and without cancer was discussed in 10 studies. The pooled OR was 1.94 (95%CI: 1.61-2.34;

= 96%), indicating that the patients with cancer have significantly higher (1.94 times) odds of having hospital readmissions when compared to patients without cancer (

＜ 0.001) (Figure 2K). The quality of evidence was found to be very low as

GRADE approach.

: Three studies have reported on the risk of readmissions between patients with and without intensive care units (ICU) admission during their hospital stay for primary diagnosis. The pooled OR was 1.21 (95%CI: 0.69-2.13;

= 46%), indicating there is no association between ICU admission and hospital readmissions (Figure 2L). The quality of evidence was found to be low as

GRADE approach.

闊葉樹種，在京城及周邊木材市場上進入4季度銷路仍然暢通。與針葉原木市場相同的是，在京城以及周邊木材市場上經(jīng)營東北原木的商家普遍認(rèn)同的仍是俄產(chǎn)木材。這一塊闊葉原木由于需求不減，資源品質(zhì)有保證，價格水平下行機會幾乎全無。另外，從俄方進口的北洋闊葉樹種原木像榆木、楸木、樺木、楊木、柞木、椴木和水曲柳，不僅需求仍然保持著前兩個月的強勁勢頭，其銷售價位也繼續(xù)堅挺上揚，例如北方市場最認(rèn)可的水曲柳大徑級優(yōu)質(zhì)新材售價最強能夠沖高到5 000元/m3以上，一般材也就能賣到4 500元/m3左右。

人口老齡化問題的研究重點在于人口老齡化系數(shù)，根據(jù)前人的研究，主要采用以下幾類方法對河南省人口老齡化進行研究。一是如郭敬（2015）建立向量自回歸模型預(yù)測未來幾年的人口總數(shù)與老年人數(shù)，并在此基礎(chǔ)上計算相應(yīng)的人口老齡化系數(shù)。二是喬谷陽、喬家君（2016）從空間上對河南省人口老齡化進行分析，以把握其空間分布特征并分析其未來的發(fā)展趨勢。

: Four studies have reported on the risk of readmissions between patients with and without mechanical ventilation requirement during their hospital stay for primary diagnosis. The pooled OR was 1.36 (95%CI: 0.96-1.93;

= 74%), indicating there is no association between mechanical ventilation and hospital readmissions (Figure 2M). The quality of evidence was found to be low as

GRADE approach.

Additional analysis

Sensitivity analysis has revealed that the estimates obtained for all the outcomes were robust to small study effects in terms of magnitude or direction of the outcomes. Funnel plot for the risk factors such as gender, cancer and chronic respiratory disease showed asymmetrical plot indicating the possibility of publication bias (Supplementary Figures 1-3).

1209 Prognostic value of preoperative serum pre-albumin in patients with bladder urothelial carcinoma

DlSCUSSlON

Almost one in five pneumonia patients have to be readmitted to the hospital[37]. Hospital readmissions following an episode of pneumonia are becoming a relatively frequent event, specifically among the older adults and patients with various co-morbidities[38]. It is important, therefore, to identify the patients at high-risk of getting readmitted as early as possible and prevent the development of future complications. Despite its importance, the role of various risk factors on the hospital readmission rate among pneumonia patients remains unclear. The goal of this review was to study the association of various risk factors on hospital readmission rate among pneumonia patients.

We have found a total of 17 studies matching the eligibility criteria of the review. Most of these studies were conducted in American and European region. Though, almost all the studies were retrospective in nature, all of them were of good to satisfactory quality. We found that males had significantly higher odds of having hospital readmissions when compared to female pneumonia patients. Co-morbidities, such as diabetes mellitus, cancer, heart failure, chronic respiratory disease and chronic kidney disease were also significantly associated with the risk of readmissions among pneumonia patients. Sensitivity analysis revealed that there was no significant single-study effect on the magnitude or direction of association.

Although, there was no previous reviews to compare our study findings, the possible impact of various risk factors on hospital readmission rate among pneumonia patients has been explored using the previous literature. Studies show that in one in six patients pneumonia might fail to resolve completely in spite of appropriate treatment[39]. Such patients might end up developing serious complications that require hospital readmissions[39]. Our study showed that several host factors like gender, immunocompromising conditions (cancer, diabetes mellitus), heart failure, and chronic respiratory and kidney diseases are associated with the failure to resolve completely and increased risk of readmission.

(5)《緇衣》簡1：“好美如好緇衣，惡惡如惡巷伯，則民咸力而型不屯(蠢)?！?屯，定母文部；蠢，昌母文部。)

Since the most frequent reason for the 30-d hospital readmission amongst pneumonia patients is the decompensation of the associated comorbid conditions[29,34], it is important to develop interventions that are aimed at reducing the all-cause readmission rates. This, in turn, would have a significant impact on the pneumonia readmission rate. Almost all the top five diagnoses of the potentially avoidable readmissions for each comorbidity were either a direct or an indirect complication of that comorbidity.For example, in patients with diabetes mellitus, atrial fibrillation, heart failure, ischemic heart disease, or chronic kidney disease, the most common cause and diagnosis of the potentially avoidable hospital readmission was the acute heart failure. Therefore, ensuring stability of comorbidities at the time of discharge in high risk patients with heart failure, kidney failure, cancer,

, would impact not only the all-cause readmission rate but also the pneumonia readmission rate. Further research is required to explore potential interventions to evaluate and ensure clinical stability at the level of discharge, particularly in patients with the multiple and interrelated comorbidities.

In other cases, pneumonia readmissions may not be related to the initial pneumonia episode or the comorbidity decompensation, but rather to other causes, such as hospital-acquired infections, acute conditions, or trauma. With enhanced care, numbers of readmission due to hospital-acquired infections decreases. However, a significant number of these cases may remain as potentially unavoidable readmissions. Further studies are needed to assess how these factors may impact readmission rates in pneumonia patients, and to develop appropriate intervention plans.

The major strength of our review is the rigorous literature search and methodology used to provide reliable estimates. Additionally, this was the first review providing the association between sociodemographic and comorbid risk factors and hospital readmissions among pneumonia patients. Most studies included in our review were of higher quality and had a standard-criteria for defining hospital readmission (30-d hospital readmission), which might further enhance the generalisability of our study findings. Moreover, sensitivity analysis did not show any significant changes in magnitude and direction of association with respect to any of the exposure-outcome relationships.

However, our study has some limitations. There was a significant between-study variability that may limit the extrapolation of the study results. Most of the included studies were retrospective in nature,which makes it difficult to establish causation between the exposure and the disease. Hence, more longitudinal studies are needed to identify accurate and reliable effect estimates and make evidencebased recommendation for developing potential interventions in hospital setting.

CONCLUSlON

Male gender and specific chronic comorbid conditions were found to be significant risk factors for hospital readmission among pneumonia patients. These results may allow clinicians and policymakers to develop better intervention strategies for the patients.

ARTlCLE HlGHLlGHTS

Research motivation

To the best of our knowledge, there has been no systematic effort to pool data on the risk factors for hospital readmissions in patients with pneumonia.

Research objectives

To pool data from individual studies to identify risk factors for hospital readmissions in patients with pneumonia.

Research methods

Systematic search was conducted in PubMed Central, EMBASE, MEDLINE, Cochrane library, Science-Direct and Google Scholar databases, and search engines from inception until July 2021.

Research results

In total, 17 studies with over 3 million participants were included. Majority of the studies had good to satisfactory quality as

Newcastle Ottawa scale. Male gender, cancer, heart failure, chronic respiratory disease, chronic kidney disease and diabetes mellitus had statistically significant association with the hospital readmission rate among pneumonia patients.

Research conclusions

Male gender and specific chronic comorbid conditions were found to be significant risk factors for hospital readmission among pneumonia patients. These results may allow clinicians and policymakers to develop better intervention strategies for the patients.

Research perspectives

More longitudinal studies are needed to identify accurate and reliable effect estimates and make evidence-based recommendation for developing potential interventions in hospital setting.

FOOTNOTES

Fang YY and Ni JC conceived and designed the study; Wang Y and Yu JH were involved in literature search and data collection; Yu JH and Fu LL analyzed the data; Fang YY and Ni JC wrote the paper; Wang Y and Yu JH reviewed and edited the manuscript; all authors read and approved the final manuscript.

The authors deny any conflict of interest.

The authors have read the PRISMA 2020 Checklist, and manuscript was prepared and revised according to the PRISMA 2020 Checklist.

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

China

Yuan-Yuan Fang 0000-0003-2104-6932; Jian-Chao Ni 0000-0003-1723-1182; Yin Wang 0000-0003-0493-3150; Jian-Hong Yu 0000-0002-2096-0506; Ling-Ling Fu 0000-0002-6613-2271.

Fan JR

A

委內(nèi)瑞拉工程由于空預(yù)器入口設(shè)有空氣旁路，在每臺送風(fēng)機出口、空預(yù)器入口、聯(lián)絡(luò)風(fēng)道及旁路風(fēng)道至煙氣再循環(huán)風(fēng)機處均設(shè)有風(fēng)門，綜合考慮空預(yù)器入口彎頭、風(fēng)門、變徑管等布置，暖風(fēng)器只能布置在送風(fēng)機出口水平段上，暖風(fēng)器疏水口標(biāo)高約為0.275 m，暖風(fēng)器疏水箱和疏水泵布置在鍋爐房區(qū)域0 m，疏水箱疏水入口標(biāo)高為5.966 m，暖風(fēng)器疏水至疏水箱之間存在高差近6 m的垂直U型布置，疏水不能自流到疏水箱內(nèi)，不能滿足疏水泵的汽蝕余量的要求，導(dǎo)致疏水管道振動、疏水不暢等。

Fan JR

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