Risk Management and Healthcare Policy最新文献

Central Line-Associated Bloodstream Infections (CLABSI) pose significant challenges in healthcare systems globally, contributing to increased morbidity, mortality, and healthcare costs. As healthcare organizations strive to improve patient safety and quality of care, Artificial Intelligence (AI) presents considerable promise in the prevention, detection, and management of CLABSI. This paper proposes a conceptual framework that integrates AI within healthcare systems, aligning technological innovations with human workflows, system design, and risk management strategies. By taking a systems approach, the framework supports the implementation of AI tools in ways that are compatible with the complexity of healthcare delivery. The paper explores the potential and significance of AI in enhancing healthcare through the prevention, early detection, and management of patient safety concerns, including CLABSI. It highlights how AI applications can predict infection risks, support timely interventions, and operate in tandem with standard infection control protocols to reduce the incidence of CLABSI. This integrated approach aims to promote safer, more efficient, and patient-centered care.

Background: Identifying risk factors associated with hematoma expansion following spontaneous intracerebral hemorrhage (ICH) is essential for improving early intervention strategies. We hope to use this predictive model in the future to comprehensively score the risk factors of hospitalized patients with cerebral hemorrhage and evaluate the possibility of hematoma enlargement. Being able to identify high-risk patients with hematoma enlargement early and take intervention measures to save their lives.

Methods: A retrospective analysis was conducted on clinical data from 226 individuals diagnosed with spontaneous ICH between December 29, 2023, and August 29, 2024. Multiple logistic regression analysis was performed to identify risk factors associated with hematoma expansion. Predictive performance of the model was assessed using ROC curve analysis and receiver operating characteristic curve analysis. Mortality rates were calculated for each group following a 7-day follow-up period.

Results: Hematoma expansion was associated with diabetes mellitus, a low Glasgow Coma Scale (GCS) score at admission, elevated systolic blood pressure at admission, coagulation abnormalities, and specific computed tomography (CT) imaging findings, such as heterogeneous density, black hole sign, swirl sign, lobulation sign, and blend sign. A prognostic model incorporating these factors demonstrated robust predictive performance, achieving an area under the curve of 0.771 (95% CI: 0.628-0.915, p = 0.002). The model yielded a maximum Youden index of 0.489, with an optimal cutoff score of 38, a sensitivity of 54.5%, and a specificity of 94.4%. Mortality among individuals with coagulation abnormalities was 53.3%.

Conclusion: Coagulation abnormalities, GCS score, systolic blood pressure at admission, CT imaging findings, and diabetes mellitus were identified as predictors of hematoma expansion in spontaneous ICH. Individuals with coagulopathy and elevated systolic blood pressure at admission exhibited the poorest prognoses.

Background and objective: Aspiration of gastric contents is the major cause of respiratory tract-related complications, which can lead to death. Despite its significance, nationwide research on the practice of managing gastric regurgitation and pulmonary aspiration remains inadequate. We aimed to conduct a national survey to gain an in-depth understanding of the management and clinical practices surrounding perioperative gastric regurgitation and pulmonary aspiration among anesthesiologists in China.

Methods: A 26-item questionnaire was sent to all registered anesthesiologist members via WeChat and the New Youth Anesthesia Forum website.

Results: A significant portion (70.77%) of respondents reported having encountered gastric regurgitation or pulmonary aspiration, with 50.15% experiencing cases where both regurgitation and aspiration occurred. While most patients had a favorable prognosis following aspiration, 20.63% and 20.72% of respondents indicated that their patients developed severe pneumonia or died as a result. Regurgitation and aspiration events mainly occurred during emergency surgery (86.39%), with abdominal operation (78.86%) being the most common. The induction of general anesthesia was identified as the most common phase for these events (75.33%). Rapid sequence induction (RSI) was employed by 61.98% of respondents. While 59.97% of respondents reported that their departments provided training on regurgitation and aspiration, only 20.34% had training specifically in gastric ultrasound technology. Additionally, 41.63% of the respondents' institutions were equipped with gastric ultrasound devices. A small fraction (14.93%) of respondents were proficient in gastric ultrasound examination techniques, while 20.99% were completely unfamiliar with the technology.

Conclusion: Our survey revealed that gastric regurgitation and pulmonary aspiration, as major threats to the safety of perioperative patients, still pose significant challenges in the practice of anesthesia in China. There are still many deficiencies in management. Strengthening training and improving resource allocation, especially in the adoption and widespread use of gastric ultrasound technology, are the directions that need to be improved in the future.

Objective: This study aims to investigate the associations between future, present-hedonistic, and present-fatalistic time perspectives (TP) and body mass index (BMI) among college students, and to examine whether self-control and sugar-sweetened beverage (SSB) consumption mediate these relationships.

Methods: A cross-sectional survey was conducted in Jiangsu Province, China, involving 920 college students. The survey collected data on participants' height, weight, future TP, present-hedonistic TP, present-fatalistic TP, self-control, and SSB consumption. Multiple hierarchical regression analysis was employed to identify potential covariates, and three chain mediation models were analyzed using the PROCESS macro (Model 6) in SPSS version 26.

Results: The results indicated that future TP was negatively associated with BMI (β = -0.23, 95% CI = [-3.81, -2.24]), and present-hedonistic TP showed a positive association (β = 0.18, 95% CI = [1.47, 2.73]). Present-fatalistic TP was not significantly related to BMI. Furthermore, self-control and SSB consumption mediated the relationships between future TP, present-hedonistic TP, present-fatalistic TP, and BMI (β = -0.02, 95% CI [-0.04, -0.01]; β = 0.02, 95% CI [0.01, 0.02]); β = 0.02, 95% CI = [0.01, 0.02]).

Conclusion: TP, self-control, and SSB consumption are important factors associated with BMI among college students. Promoting a future-oriented TP and self-control, while reducing present-oriented TP and SSB intake, may support more effective BMI management. These findings offer theoretical implications for designing targeted health interventions.

Introduction: Nurses are the cornerstone of the healthcare system, playing a vital role in delivering consistent, high-quality patient care. However, working in high-stress environments such as hospitals and health clusters exposes them to ongoing well-being, emotional, and psychological challenges. If unaddressed, these factors can significantly compromise their mental health, subjective well-being, and self-efficacy, ultimately affecting workforce sustainability and patient outcomes.

Aim: To assess the mental health, subjective well-being, and self-efficacy of the nursing workforce within the Qassim Health Cluster and identify individuals or groups at elevated risk.

Methods: A cross-sectional correlational study was conducted with 306 nursing staff, recruited through convenience sampling. Data were collected via a standardized electronic survey administered between January to March 2025 across three hospitals in Buraydah city. The survey included the Mental Health Continuum-Short Form (MHC-SF) to assess mental health, the WHO-5 Well-Being Index to measure subjective well-being, and the General Self-Efficacy Scale (GSE) to evaluate perceived self-efficacy.

Results: The majority of participants were female, middle-aged, and holding a bachelor's degree and varying levels of work experience. Overall, nurses demonstrated moderate to high levels of mental health (65.26%), self-efficacy (58.64%), and subjective well-being (69.95%). Mean scores were 45.68 (±17.26) for mental health (MHC-SF), 30.98 (±5.70) for self-efficacy (GSE), and 14.66 (±6.17) for well-being (WHO-5). Significant positive correlations were observed among all variables: mental health was strongly correlated with self-efficacy (r = 0.671) and moderately with well-being (r = 0.510); well-being was also moderately correlated with self-efficacy (r = 0.427).

Conclusion: Nurses' mental health, self-efficacy, and well-being are interrelated and critically impact the quality of patient care. Healthcare organizations should implement targeted interventions, particularly training and stress management programs to support the psychological and subjective health of nurses, with a focus on less experienced staff.

Background: Patient safety involves proactive and systematic efforts within healthcare settings to prevent harm to patients during medical care. Globally, healthcare organisations prioritise patient safety as a key factor in quality and safety initiatives.

Objective: This study aims to investigate the patient safety culture at Sarawak General Hospital (SGH), a tertiary referral hospital in Malaysia.

Methods: A cross-sectional study was conducted at SGH from May 2022 to August 2022 using the Safety Attitude Questionnaire (SAQ). The survey included 767 hospital staff members, such as doctors, nurses, pharmacists, and other clinical personnel, achieving a response rate of 84.2% (646 respondents). Statistical analysis was performed using Jamovi 2.3.28.

Results: The overall mean SAQ score was 65.8±15.0, with a positive response rate of 31.3%. Most domain scores were higher than benchmark scores (65.7% to 72.2%), except for the stress recognition domain. Among the domains, job satisfaction recorded the highest mean score (71.7±23.3) and the highest positive response rate (53.4%), indicating high levels of contentment among healthcare workers. Conversely, the working condition domain demonstrates significant room for improvement.

Conclusion: Generally, the patient safety culture at SGH is satisfactory, with most domain scores exceeding benchmark levels.

Purpose: This study evaluates the effectiveness of motorcycle ambulances (motorlances) in delivering emergency medical response at the Khon Kaen International Marathon (KKIM), Thailand, over a three-year period (2023-2025).

Patients and methods: We conducted a retrospective analysis of emergency medical service (EMS) data from three consecutive annual Khon Kaen International Marathons held on January 28-29, 2023; January 13-14, 2024; and January 11-12, 2025. Data including EMS operation intervals, clinical interventions carried out, and patient outcomes were collected from EMS patient care documents, organized by Srinagarind Hospital, Khon Kaen University, Thailand during the marathon events. A comparative analysis was carried out to evaluate year-over-year operational improvements utilizing IBM SPSS version 27.0, with continuous data expressed as means ± standard deviations, categorical data as frequencies and percentages, chi-square tests employed for associations among categorical variables, and p<0.05 considered statistically significant.

Results: Among 20,681 marathon participants, 132 cases (6.38%) required emergency intervention with motorlance support. The use of motorlances significantly increased from 25 cases in 2023 to 65 in 2025 (p=0.011), with consistently rapid mean response times (5.3-5.6 minutes each year). Clinical capabilities improved over the study period, evidenced by a rise in advanced interventions such as intravenous glucose administration and pain management (from 0% to 23.1%, p=0.010). Scene time increased in parallel with this expanded clinical scope (from 8.2 to 18.6 minutes, p<0.001). Importantly, over 90% of patients treated by motorlance were able to continue the race following on-scene care.

Conclusion: Motorcycle ambulances significantly enhance the efficiency of emergency medical responses during large marathon events. Notable results indicate a constant increase in motorlance utilization, consistently rapid response times, and enhanced clinical competencies with advanced interventions. Extended scene duration indicated enhanced on-site treatment delivery. Significantly, over 90% of patients treated by motorlance resumed to racing after treatment, indicating the efficacy of prehospital intervention.

Purpose: Colorectal cancer (CRC) affects older adults disproportionately and presents considerable challenges to surgical management owing to age-related physiological vulnerabilities. Frailty, characterized by a reduced physiological reserve, is a recognized predictor of adverse postoperative outcomes. However, data on the impact of preoperative frailty in Taiwanese older adults with CRC are limited.

Patients and methods: A retrospective cohort study was conducted using prospectively collected data from a Taiwanese medical center between 2016 and 2018. A comprehensive geriatric assessment (CGA) encompassing eight domains was performed to preoperatively assess patients aged ≥65 years undergoing curative CRC surgery for frailty. Patients were classified as fit (≤1 deficit) or frail (>1 deficit). Postoperative complications and overall survival (OS) were compared between the groups.

Results: Among 179 patients (median age, 74, range 65‒99), 46.9% were identified as frail. Malnutrition was the most common deficiency (47%). Frail patients had significantly higher rates of intensive care unit admission (13.1% vs 3.2%, p = 0.023), major postoperative complications (50% vs 26.3%, p = 0.001), and longer hospital stay (median 11 vs 9 days, p = 0.002). All three in-hospital deaths occurred in frail patients. Frailty independently predicted worse OS (adjusted hazard ratio 1.88, 95% confidence interval 1.02-3.73, p = 0.040), with a dose-dependent increase in complication risk corresponding to the number of frailty deficits.

Conclusion: Our findings revealed that preoperative frailty is prevalent and independently associated with poor surgical and survival outcomes in older Taiwanese patients with colorectal cancer. Incorporating a CGA-based frailty assessment into preoperative planning may enhance risk stratification and guide tailored perioperative care in this vulnerable population.

Purpose: This study aims to analyze the regional and hierarchical disparities in the distribution of pharmacist human resources in China from 2012 to 2022, with the goal of identifying underlying trends and challenges. The findings are intended to serve as a basis for optimizing the equitable and efficient allocation of pharmacist resources to better support healthcare system development.

Patients and methods: Data were collected from the China Health Statistics Yearbook and China Statistics Yearbook. The number of pharmacists per 1,000 population was selected as a measure of equity in pharmacist allocation, and Dagum's Gini coefficient, kernel density estimation method and spatial β-convergence model were utilized to analyze the regional differences and convergence trends of pharmacist resource allocation in Chinese hospitals and primary health care organizations.

Results: The findings reveal that while the overall allocation of pharmacist resources has improved, significant discrepancies remain. The mean number of hospital pharmacists was approximately twice that of primary care centers, with the most pronounced disparity observed in the central region. Regional disparities show declining trends in hospitals but widening gaps in PHCs, particularly in the eastern region. Kernel density results highlight improvements in pharmacist distribution but also reinforce advantages for High-resource provinces, especially at the hospital tier. Spatial analysis indicates significant clustering effects in pharmacist allocation, though these effects have weakened over time. Notably, absolute and conditional β-convergence trends are observed, with faster convergence rates in hospitals compared to PHCs and distinct regional variations in convergence speed.

Conclusion: Since 2012, the allocation of pharmacists' human resources in China has improved, with regional disparities showing signs of reduction. However, hierarchical disparities remain a significant issue that requires further attention, particularly in the central region. To address these challenges, it is essential to increase investment in primary healthcare institutions, with a focus on strengthening pharmacist staffing, improving infrastructure, and enhancing the capacity of pharmacy services at the grassroots level.

Objective: This study aimed to identify the characteristics and risk factors associated with stroke recurrence in a Chinese patient population and to assess the effectiveness of targeted interventions addressing common stroke risk factors to inform stroke health management strategies.

Methods: A total of 1072 stroke patients who were hospitalized in Huai'an First People's Hospital from January 2018 to November 2020 were included in this study. Patients with recurrent stroke were assigned to the observation group (815 cases), while those experiencing a first-ever stroke were assigned to the control group (257 cases). The observation group received health intervention measures targeting the risk factors of stroke in the Chinese population. A one-year follow-up was conducted to compare the recurrence rates of stroke between the two groups. From November 2020 to February 2021, targeted health intervention measures were implemented for the patients who were hospitalized (ie, the intervention group). These intervention measures aimed to address modifiable risk factors and involved a one-year follow-up for the participants to assess the impact of the health intervention on stroke patients.

Results: The mean age of patients in the observation group was significantly higher than that of the control group. An increased recurrence rate was observed among those with a family history of diabetes. A significantly higher proportion of patients in the observation group engaged in regular physical exercise and adhered to a low-salt, low-fat diet compared to the control group. However, the prevalence of sleep-related snoring and sleep-disordered breathing was also significantly higher in the observation group. Additionally, the observation group had a significantly higher proportion of patients with a history of hypertension, diabetes, and heart disease. After one year of follow-up, stroke recurrence was lower among those who had undergone targeted risk factor management, although the difference did not reach statistical significance.

Conclusion: Comprehensive and targeted management of sleep-disordered breathing, diabetes, hypertension, and heart disease may contribute to a reduction in stroke recurrence among individuals in China. However, further validation through multi-center studies with larger sample sizes is necessary to establish definitive conclusions.