Health Care Analysis最新文献

There are numerous ways to improve the quality of healthcare services, and Quality Improvement (QI) tools play a central role in this. These tools are essential for identifying problems, reducing errors and costs, modifying practices, generating innovative ideas, acquiring and analysing data, visualising issues, and supporting decision-making. Using them effectively promotes healthcare quality, patient safety, and optimal resource utilisation. Despite the importance of QI tools, the lack of systematic and comprehensive data on the frequency and purpose of their use in healthcare facilities constitutes the main problem area of this study. This descriptive and cross-sectional study examines the frequency and purpose of QI tool usage among quality managers in hospitals across Türkiye. The study population comprised quality managers from 248 hospitals who fully completed the survey. It focused on the use of 18 widely recognised QI tools, including Brainstorming, Fishbone Diagram, Five Whys, Flowchart, Control Chart, PDCA Cycle, FMEA, Histogram, Scatter Diagram, Process Mapping, and others. The results indicated that the least known tools were the Swiss Cheese Model, Spaghetti Diagram, Six Thinking Hats, House of Quality, Mapping the Last Ten Patients, Tree Diagram, and Pareto Chart. Conversely, Brainstorming, Fishbone Diagram, Five Whys, and Flowcharts were the most frequently used. QI tools were primarily used for generating ideas, visualisation, identifying problems, and analysing them. Significant differences in tool usage were observed based on experience in healthcare and quality roles. The findings underscore the complementary nature of QI tools and the need for enhanced training and awareness.

Cost-effectiveness analysis (CEA) is a mainstay of contemporary health care priority setting. However, priority setting in reference to cost-effectiveness may discriminate against people with disabilities. The ethical literature on priority setting suggests that the permissibility of such discrimination varies with the reason why people with disabilities receive lower priority. In a vignette-based survey experiment (N = 1100) in the UK, we tested whether five justifications for prioritizing people without disabilities affect the views of the broader public on priority setting based on CEA. In our vignettes, a hospital denies a person with a disability treatment for a disease based on CEA, and respondents were asked to assess the moral permissibility of this. The vignettes varied in terms of the reason the hospital emphasized in the decision. We tested vignettes emphasizing lower expected lifespan, lower quality of life, higher costs of treatment due to disability, less efficient treatment due to disability, and lower productivity due to infrequent labor-market participation. Our study is an initial exploratory survey experiment, exploring participant's responses to CEA with respect to disability. Discrimination against the patient with a disability was deemed impermissible across all experimental conditions, and there were no significant differences between the various reasons. This suggests a discrepancy between folk intuitions and those of many ethicists.

Integrating artificial intelligence (AI) in healthcare has sparked innovation but exposed vulnerabilities in regulatory oversight. Unregulated "shadow" AI systems, operating outside formal frameworks, pose risks such as algorithmic drift, bias, and disparities. The Comprehensive Algorithmic Oversight and Stewardship (CAOS) Framework addresses these challenges, combining risk assessments, data protection, and equity-focused methodologies to ensure responsible AI implementation. This framework offers a solution to bridge oversight gaps while supporting responsible healthcare innovation. CAOS functions as both a normative governance model and a practical system design, offering a scalable framework for ethical oversight, policy development, and operational implementation of AI systems in healthcare.

'Positive Health' and 'recovery' seem to cover similar multidimensional health perspectives focussing on capabilities instead of incapabilities. The My Positive Health questionnaire and Individual Recovery Outcomes Counter were initially developed as dialogue tools, but nowadays also used as self-reported questionnaires. Structural validity of these dialogue tools was assessed in earlier research resulting in the 42-items Positive Health questionnaire (PH42) and 12-items Individual Recovery Outcomes Counter (I.ROC12). As a next step, we investigated their construct validity. An observational cross-sectional study was conducted in a representative general Dutch population (LISS-panel) determining (1) Coherence between the PH42 and I.ROC12 using correlation coefficients; (2) Convergent validity by testing hypotheses for PH42 and I.ROC12 with external health-related questions using correlation coefficients; (3) Discriminative validity for subgroups gender, age, educational level and healthcare use. (1) Nine out of twelve correlations between PH42 and I.ROC12 factors were substantial (> 0.5). (2) Hypotheses for PH42 and I.ROC12 factors with health-related questions were confirmed for 80% and 75%, respectively. (3) Scores on all factors increased (i.e., better health) from low to high educational level and decreased from no healthcare use to healthcare received from (medical) specialists. Only the factor physical health and functioning showed a continuous decrease in scores with increasing age. Women scored lower only on physical health and functioning. Convergent validity is adequate and discriminative validity is adequate for educational level and healthcare use supporting the conclusion that the PH42 and I.ROC12 are useful instruments to measure Positive Health in a general population.

Industry 4.0 represents the latest phase of industrial evolution, characterized by the seamless integration of cyber-physical systems, the Internet of Things, big data analytics, artificial intelligence, advanced robotics, and cloud computing, enabling smart, adaptive, and interconnected processes where physical, digital, and biological realms converge. In parallel, healthcare has progressed from the traditional, physician-centered model of Healthcare 1.0 by introducing medical devices and digitized records to Healthcare 4.0, which leverages Industry 4.0 technologies to create personalized, data-driven, and patient-centric systems. In this context, we hereby introduce Pediatrics 4.0 as a new paradigm that adapts these innovations to children's unique developmental, physiological, and ethical considerations and aims to improve diagnostic precision, treatment personalization, and continuous monitoring in pediatric populations. Key applications include AI-driven diagnostic and predictive analytics, IoT-enabled remote monitoring, big data-powered epidemiological insights, robotic assistance in surgery and rehabilitation, and 3D printing for patient-specific devices and pharmaceuticals. However, realizing Pediatrics 4.0 requires addressing significant challenges-data privacy and security, algorithmic bias, interoperability and standardization, equitable access, regulatory alignment, the ethical complexities of consent, and long-term technology exposure. Future research should focus on explainable AI, pediatric-specific device design, robust data governance frameworks, dynamic ethical and legal guidelines, interdisciplinary collaboration, and workforce training to ensure these transformative technologies translate into safer, more effective, and more equitable child healthcare.

Third-party consent, while common in medical practice, presents complex ethical dimensions and intricate legal connotations. In Malaysia, the absence of comprehensive legislation governing third-party consent for adults lacking decision-making capacity due to temporary conditions creates profound dilemmas for healthcare professionals. This article critically examines these challenges through a compelling case study of an 18-year-old female with respiratory failure who required immediate invasive intervention but did not receive consent from her mother. Despite medical urgings and a favourable prognosis, the mother's refusal highlights the difficulties healthcare providers face when navigating between their ethical obligations to act in the patient's best interests and the patient's family's wishes. Employing a dual analysis from ethical and Malaysian legal perspectives, the study explores the tensions between universal medical ethics-particularly the principles of autonomy, beneficence, and non-maleficence-and the existing Malaysian legal framework. It reveals contradictions between the Malaysian Medical Council's guidelines, which appear to grant decision-making authority to family members, and English common law principles that emphasise acting in the patient's best interests, especially in emergency situations. This inconsistency generates significant uncertainty for healthcare professionals, potentially compromising patient care and exposing physicians to litigation when acting without explicit consent. Through systematic examination of both emergency and non-emergency scenarios, the article underscores the urgent need for comprehensive legislation in Malaysia to address third-party consent, particularly for patients not covered by the Mental Health Act 2001. It advocates for laws that clearly differentiate between emergency and non-emergency situations, delineate the authority of relatives and legal guardians, and align with international practices and fundamental medical ethics principles. By harmonising legal statutes with ethical imperatives, Malaysia can resolve the contradictions that currently jeopardise patient welfare and physician security. These findings have important implications for healthcare policy development and clinical practice, emphasising the necessity for ethical and legal coherence in medical care in Malaysia.

Hospital-based research plays a crucial role in advancing medical knowledge, but it also presents significant ethical challenges, particularly when involving hospitalized patients. Ethical concerns such as informed consent, patient autonomy, and the power dynamics between healthcare providers and patients are critical to maintaining the integrity of such research. The aim of this research was to explore and analyze the ethical considerations in conducting research involving hospitalized patients. A qualitative phenomenological approach was used to investigate the experiences and perceptions of healthcare professionals involved in clinical or public health research in hospital settings. Semi-structured interviews were conducted with 33 participants from both public and private hospitals in Dhaka, Bangladesh. The data were analyzed using thematic analysis to identify recurring ethical themes. This study identified five key themes: (1) Ethical challenges in hospital-based research, (2) Informed consent and patient vulnerability, (3) Patient autonomy and decision-making in research, (4) Institutional Review Boards (IRBs) and ethical oversight, and (5) Strategies to improve ethical research practices in hospitals. Participants reported concerns about coercion, difficulties in obtaining consent from critically ill patients, conflicts in surrogate decision-making, and delays in IRB approval. The findings also emphasized the importance of ethical training, continuous consent practices, and patient-centered approaches. Ethical research practices in hospital settings require a balance between scientific progress and patient protection. The study emphasizes the need for improved ethical guidelines, better informed consent processes, and ongoing training for healthcare professionals to ensure patient autonomy is respected. The findings also call for streamlined Institutional Review Board (IRB) processes to support timely and ethical research execution.

Culturally diverse societies often struggle with providing appropriate dementia care. Cultural sensitivity is considered an important prerequisite for meeting the needs of persons with dementia. This article discusses culture specific aspects of dementia care by referring to the Turkish community in Germany as an example. Factors are discussed that specifically infringe on the quality of dementia care for migrants. The article defends the claim that good dementia care for migrants can be provided through a person-centered approach which is again based on culturally sensitive approach. We show how culture shapes health phenomena but also argue that a focus on culture may stereotype individuals as belonging to a particular culture, grouping people together irrespective of their heterogeneity. Person-centered care is ideal for recognizing diverse needs and values. It is often seen as being at odds with culturally sensitive care, but this paper suggests a way of reconciling them. We argue that culture does indeed provide a framework to create the necessary foundation for person-centered care. Finally, some criticisms and plausible replies are discussed and practical implications arising from the analysis are presented.

The opioid epidemic continues to be a prevalent crisis in North America. How best to address this challenge has long been debated. Abstinence is currently the preferred policy within the inpatient hospital setting, however, this is fraught with difficulties such as withdrawal and using substances in secrecy. It can also result in stigma and a lack of knowledge on substance use among health care providers. The concept of harm reduction could provide an ethical approach to supporting people with substance use disorder. Through Principlism and the principles of Autonomy, Beneficence, Justice and Non-Maleficence, this paper suggests that harm reduction practices represent a viable and more ethically sound approach to health care compared to abstinence-based approaches. Harm reduction practices could result in a more equitable health care system that reduces stigma and increases help-seeking behaviour. More empirical research in other jurisdictions or other settings such as long-term care is needed. Future research should address additional theoretical frameworks such as dialogical bioethics, care ethics and the capabilities approach.