Objective: To explore the risk factors of atrial fibrillation (AF) in patients with coronary heart disease (CHD), and to construct a risk prediction model. Methods: The participants in this case-control study were from the cardiovascular Department of Changzhou Affiliated Hospital of Nanjing University of Chinese Medicine from June 2016 to June 2023, and they were divided into AF group and non-AF group according to whether AF occurred during hospitalization. The clinical data of the two groups were compared by retrospective analysis. Multivariate Logistic regression analysis was used to investigate the risk factors of AF occurrence in CHD patients. The nomogram model was constructed with R 4.2.6 language “rms” package, and the model’s differentiation, calibration and effectiveness were evaluated by drawing ROC curve, calibration curve and decision curve. Results: A total of 1258 patients with CHD were included, and they were divided into AF group (n=92) and non-AF group (n=1166) according to whether AF was complicated. Logistic regression analysis showed that age, coronary multiple branch lesion, history of heart failure, history of drinking, pulmonary hypertension, left atrial diameter, left ventricular end-diastolic diameter and diabetes mellitus were independent risk factors for the occurrence of AF in CHD patients (P < 0.05). The ROC curve showed that the AUC of this model was 0.956 (95% CI (0.916, 0.995)) and the consistency index was 0.966. The calibration curve of the model is close to the ideal curve. The analysis of decision curve shows that the prediction value of the model is better when the probability threshold of the model is 0.042~0.963. Conclusion: The nomogram model established in this study for predicting the risk of AF in patients with CHD has better predictive performance and has certain reference value for clinical identification of high-risk groups prone to AF in patients with CHD.
{"title":"Development of a Nomogram That Predicts the Risk of Atrial Fibrillation in Patients with Coronary Heart Disease","authors":"Xinfu Cao, Yi Sun, Yuqiao Chen, Chao Tang, Hongwen Yu, Xiaolong Li, Zhenhua Gu","doi":"10.2147/rmhp.s466205","DOIUrl":"https://doi.org/10.2147/rmhp.s466205","url":null,"abstract":"<strong>Objective:</strong> To explore the risk factors of atrial fibrillation (AF) in patients with coronary heart disease (CHD), and to construct a risk prediction model.<br/><strong>Methods:</strong> The participants in this case-control study were from the cardiovascular Department of Changzhou Affiliated Hospital of Nanjing University of Chinese Medicine from June 2016 to June 2023, and they were divided into AF group and non-AF group according to whether AF occurred during hospitalization. The clinical data of the two groups were compared by retrospective analysis. Multivariate Logistic regression analysis was used to investigate the risk factors of AF occurrence in CHD patients. The nomogram model was constructed with R 4.2.6 language “rms” package, and the model’s differentiation, calibration and effectiveness were evaluated by drawing ROC curve, calibration curve and decision curve.<br/><strong>Results:</strong> A total of 1258 patients with CHD were included, and they were divided into AF group (n=92) and non-AF group (n=1166) according to whether AF was complicated. Logistic regression analysis showed that age, coronary multiple branch lesion, history of heart failure, history of drinking, pulmonary hypertension, left atrial diameter, left ventricular end-diastolic diameter and diabetes mellitus were independent risk factors for the occurrence of AF in CHD patients (P < 0.05). The ROC curve showed that the AUC of this model was 0.956 (95% CI (0.916, 0.995)) and the consistency index was 0.966. The calibration curve of the model is close to the ideal curve. The analysis of decision curve shows that the prediction value of the model is better when the probability threshold of the model is 0.042~0.963.<br/><strong>Conclusion:</strong> The nomogram model established in this study for predicting the risk of AF in patients with CHD has better predictive performance and has certain reference value for clinical identification of high-risk groups prone to AF in patients with CHD.<br/><br/><strong>keywords:</strong> coronary heart disease, atrial fibrillation, risk factors, logistic regression analysis, nomogram model<br/>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"1 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141571784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study aims to explore the effects of eye exercises on the accommodative ability of Chinese school-aged children. Methods: This study used a convenience cluster sampling and selected 149 students from grades 2– 5 in a Wenzhou primary school to participate in the intervention in June 2022. This study involved a one-month intervention teaching eye exercises using a composite feedback model. Assessments were made at 3 and 9 months post-intervention. Data collection occurred thrice, including a baseline and two follow-ups, measuring monocular and binocular accommodative facility, monocular and binocular accommodative amplitude, CISS scale, spherical equivalent refraction, and uncorrected visual acuity. Analysis used chi-square tests and generalized estimating equations to evaluate the exercises’ effectiveness, with a significance threshold of P < 0.05. Results: 134 students completed the follow-up, including 61 females (45.52%). After teaching intervention, students showed significant improvements in the accuracy of manipulation, rhythm, acupoint location, strength effectiveness and rhythm of acupressure eye exercises (all P < 0.05), with increases of 10.37%, 13.03%, 16.96%, and 25.17%, respectively. Follow-up assessments revealed both monocular and binocular accommodative amplitude at T3 were significantly higher than at T1 and T2. Moreover, the binocular accommodative amplitude in the high-quality eye exercise group remained significantly higher than that in the low-quality group even(B=1.39,1.46, P < 0.01). Eye exercises could improve monocular and binocular accommodative amplitude in the short term(P < 0.05). High-quality eye exercises could alleviate visual fatigue (B=− 2.00--3.49, both P < 0.05). However, eye exercises did not demonstrate any advantages in affecting spherical equivalent refraction or uncorrected visual acuity (P > 0.05). Conclusion: Eye exercises can alleviate myopia-related symptoms in Chinese children aged 7 to 11 years. However, this study did not find that eye exercises effectively reduce the degree of myopia in children. Trial Registration: The original trial (Registration site: https://www.chictr.org.cn/ Registration number: ChiCTR2300070903) was retrospectively registered on 26/04/2023.
研究目的本研究旨在探讨眼保健操对中国学龄儿童适应能力的影响：本研究采用便利整群抽样法，于2022年6月在温州某小学选取了149名二至五年级的学生参与干预。本研究采用复合反馈模式进行为期一个月的眼保健操干预教学。干预后3个月和9个月进行评估。数据收集共进行了三次，包括一次基线和两次随访，分别测量单眼和双眼适应能力、单眼和双眼适应振幅、CISS量表、球面等效屈光度和未矫正视力。分析采用卡方检验和广义估计方程来评估练习效果，显著性临界值为 P < 0.05：134名学生完成了跟踪调查，其中包括61名女生（45.52%）。经过教学干预后，学生在穴位眼保健操的操作准确性、节奏、穴位位置、力度效果和节奏方面均有显著提高（均为 P < 0.05），分别提高了 10.37%、13.03%、16.96% 和 25.17%。随访评估显示，T3 期的单眼和双眼容纳振幅均明显高于 T1 和 T2 期。此外，高质量眼保健操组的双眼适应振幅仍明显高于低质量组（B=1.39,1.46, P <0.01）。眼保健操能在短期内改善单眼和双眼的容差振幅（P < 0.05）。高质量的眼保健操可以缓解视疲劳（B=- 2.00--3.49，均为 P <0.05）。然而，眼保健操在影响球面等效屈光度或未矫正视力方面并没有表现出任何优势（P > 0.05）：结论：眼保健操可以缓解 7-11 岁中国儿童的近视相关症状。结论：眼保健操可减轻 7-11 岁中国儿童近视相关症状，但本研究并未发现眼保健操可有效降低儿童近视度数：原始试验（注册网址：https://www.chictr.org.cn/ 注册号：ChiCTR2300070903）：ChiCTR2300070903）于 2023 年 4 月 26 日进行了回顾性注册：眼保健操、近视、适应能力、适应振幅、视疲劳
{"title":"Interventional Study on the Effectiveness of Eye Exercises Based on Composite Feedback Model in School-Age Children","authors":"Xiaojun Chen, Shushu Zuo, Chunhua Zhang, Bing Sun, Mengyue Zhang, Dandan Jiang, Yanyan Chen","doi":"10.2147/rmhp.s467570","DOIUrl":"https://doi.org/10.2147/rmhp.s467570","url":null,"abstract":"<strong>Objective:</strong> This study aims to explore the effects of eye exercises on the accommodative ability of Chinese school-aged children.<br/><strong>Methods:</strong> This study used a convenience cluster sampling and selected 149 students from grades 2– 5 in a Wenzhou primary school to participate in the intervention in June 2022. This study involved a one-month intervention teaching eye exercises using a composite feedback model. Assessments were made at 3 and 9 months post-intervention. Data collection occurred thrice, including a baseline and two follow-ups, measuring monocular and binocular accommodative facility, monocular and binocular accommodative amplitude, CISS scale, spherical equivalent refraction, and uncorrected visual acuity. Analysis used chi-square tests and generalized estimating equations to evaluate the exercises’ effectiveness, with a significance threshold of P < 0.05.<br/><strong>Results:</strong> 134 students completed the follow-up, including 61 females (45.52%). After teaching intervention, students showed significant improvements in the accuracy of manipulation, rhythm, acupoint location, strength effectiveness and rhythm of acupressure eye exercises (all <em>P</em> < 0.05), with increases of 10.37%, 13.03%, 16.96%, and 25.17%, respectively. Follow-up assessments revealed both monocular and binocular accommodative amplitude at T3 were significantly higher than at T1 and T2. Moreover, the binocular accommodative amplitude in the high-quality eye exercise group remained significantly higher than that in the low-quality group even(<em>B</em>=1.39,1.46, <em>P</em> < 0.01). Eye exercises could improve monocular and binocular accommodative amplitude in the short term(<em>P</em> < 0.05). High-quality eye exercises could alleviate visual fatigue (<em>B</em>=− 2.00--3.49, both <em>P</em> < 0.05). However, eye exercises did not demonstrate any advantages in affecting spherical equivalent refraction or uncorrected visual acuity (<em>P</em> > 0.05).<br/><strong>Conclusion:</strong> Eye exercises can alleviate myopia-related symptoms in Chinese children aged 7 to 11 years. However, this study did not find that eye exercises effectively reduce the degree of myopia in children.<br/><strong>Trial Registration:</strong> The original trial (Registration site: <u>https://www.chictr.org.cn/</u> Registration number: ChiCTR2300070903) was retrospectively registered on 26/04/2023.<br/><br/><strong>Keywords:</strong> Eye exercises, myopia, accommodative facility, accommodative amplitude, visual fatigue<br/>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"62 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141571806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The pandemic caused by COVID-19 has had a profound effect on global health. Due to its potential impact on the efficacy of pandemic control measures, vaccine hesitancy (VH) in relation to COVID-19 has emerged as a significant concern. The attainment of herd immunity is contingent on the rate of COVID-19 vaccine adoption. Despite this, there have been reports of reluctance toward the COVID-19 vaccine. This study seeks to investigate the effect of constructs that influence adults’ intentions to receive COVID-19 vaccination using the Health Belief Model (HBM). Methods: A cross-sectional study was conducted by recruiting Saudi Arabian adults as participants. Using Structural Equation Modeling (SEM), the proposed HBM model was evaluated. A total of 505 individuals replied to the survey. Results: The suggested HBM model explained 68% of the variation in intention to get COVID-19 immunization. I found all HBM variables namely perceived susceptibility, greater levels of perceived behavioral control, severity, benefits, and barriers to be significant predictors of vaccination intentions. Among demographic variables, only married status had a significant relationship with the intention to obtain COVID-19 immunization. Discussion: The findings of this study indicate that the HBM can be utilized effectively to obtain insight into the factors that influence COVID-19 prevention measure adherence. Understanding and recognizing individuals’ perceived health beliefs and practices is essential for the development of effective COVID-19 intervention strategies.
Keywords: immunization, COVID-19, health belief model, vaccine hesitancy, structural equation modeling, Saudi Arabia
{"title":"Determinants of Intention to Uptake COVID-19 Vaccination Among Saudi Adults: Application of the Health Belief Model","authors":"Salah S Alshagrawi","doi":"10.2147/rmhp.s432153","DOIUrl":"https://doi.org/10.2147/rmhp.s432153","url":null,"abstract":"<strong>Introduction:</strong> The pandemic caused by COVID-19 has had a profound effect on global health. Due to its potential impact on the efficacy of pandemic control measures, vaccine hesitancy (VH) in relation to COVID-19 has emerged as a significant concern. The attainment of herd immunity is contingent on the rate of COVID-19 vaccine adoption. Despite this, there have been reports of reluctance toward the COVID-19 vaccine. This study seeks to investigate the effect of constructs that influence adults’ intentions to receive COVID-19 vaccination using the Health Belief Model (HBM).<br/><strong>Methods:</strong> A cross-sectional study was conducted by recruiting Saudi Arabian adults as participants. Using Structural Equation Modeling (SEM), the proposed HBM model was evaluated. A total of 505 individuals replied to the survey.<br/><strong>Results:</strong> The suggested HBM model explained 68% of the variation in intention to get COVID-19 immunization. I found all HBM variables namely perceived susceptibility, greater levels of perceived behavioral control, severity, benefits, and barriers to be significant predictors of vaccination intentions. Among demographic variables, only married status had a significant relationship with the intention to obtain COVID-19 immunization.<br/><strong>Discussion:</strong> The findings of this study indicate that the HBM can be utilized effectively to obtain insight into the factors that influence COVID-19 prevention measure adherence. Understanding and recognizing individuals’ perceived health beliefs and practices is essential for the development of effective COVID-19 intervention strategies.<br/><br/><strong>Keywords:</strong> immunization, COVID-19, health belief model, vaccine hesitancy, structural equation modeling, Saudi Arabia<br/>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"29 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141571612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Coronary artery disease (CAD) remains a significant global health challenge, with percutaneous coronary intervention (PCI) being a primary revascularization method. In-stent restenosis (ISR) post-PCI, although reduced, continues to impact patient outcomes. Inflammation and platelet activation play key roles in ISR development, emphasizing the need for accurate risk assessment tools. The systemic inflammation aggregation index (AISI) has shown promise in predicting adverse outcomes in various conditions but has not been studied in relation to ISR. Methods: A retrospective observational study included 1712 patients post-drug-eluting stent (DES) implantation. Data collected encompassed demographics, medical history, medication use, laboratory parameters, and angiographic details. AISI, calculated from specific blood cell counts, was evaluated alongside other variables using machine learning models, including random forest, Xgboost, elastic networks, logistic regression, and multilayer perceptron. The optimal model was selected based on performance metrics and further interpreted using variable importance analysis and the SHAP method. Results: Our study revealed that ISR occurred in 25.8% of patients, with a range of demographic and clinical factors influencing the risk of its development. The random forest model emerged as the most adept in predicting ISR, and AISI featured prominently among the top variables affecting ISR prediction. Notably, higher AISI values were positively correlated with an elevated probability of ISR occurrence. Comparative evaluation and visual analysis of model performance, the random forest model demonstrates high reliability in predicting ISR, with specific metrics including an AUC of 0.9569, accuracy of 0.911, sensitivity of 0.855, PPV of 0.81, and NPV of 0.948. Conclusion: AISI demonstrated itself as a significant independent risk factor for ISR following DES implantation, with an escalation in AISI levels indicating a heightened risk of ISR occurrence.
{"title":"Machine Learning-Based Prediction of In-Stent Restenosis Risk Using Systemic Inflammation Aggregation Index Following Coronary Stent Placement","authors":"Ling Hou, Jinbo Zhao, Ting He, Ke Su, Yuanhong Li","doi":"10.2147/rmhp.s468235","DOIUrl":"https://doi.org/10.2147/rmhp.s468235","url":null,"abstract":"<strong>Introduction:</strong> Coronary artery disease (CAD) remains a significant global health challenge, with percutaneous coronary intervention (PCI) being a primary revascularization method. In-stent restenosis (ISR) post-PCI, although reduced, continues to impact patient outcomes. Inflammation and platelet activation play key roles in ISR development, emphasizing the need for accurate risk assessment tools. The systemic inflammation aggregation index (AISI) has shown promise in predicting adverse outcomes in various conditions but has not been studied in relation to ISR.<br/><strong>Methods:</strong> A retrospective observational study included 1712 patients post-drug-eluting stent (DES) implantation. Data collected encompassed demographics, medical history, medication use, laboratory parameters, and angiographic details. AISI, calculated from specific blood cell counts, was evaluated alongside other variables using machine learning models, including random forest, Xgboost, elastic networks, logistic regression, and multilayer perceptron. The optimal model was selected based on performance metrics and further interpreted using variable importance analysis and the SHAP method.<br/><strong>Results:</strong> Our study revealed that ISR occurred in 25.8% of patients, with a range of demographic and clinical factors influencing the risk of its development. The random forest model emerged as the most adept in predicting ISR, and AISI featured prominently among the top variables affecting ISR prediction. Notably, higher AISI values were positively correlated with an elevated probability of ISR occurrence. Comparative evaluation and visual analysis of model performance, the random forest model demonstrates high reliability in predicting ISR, with specific metrics including an AUC of 0.9569, accuracy of 0.911, sensitivity of 0.855, PPV of 0.81, and NPV of 0.948.<br/><strong>Conclusion:</strong> AISI demonstrated itself as a significant independent risk factor for ISR following DES implantation, with an escalation in AISI levels indicating a heightened risk of ISR occurrence.<br/><br/><strong>Keywords:</strong> coronary artery disease, percutaneous coronary intervention, Systemic inflammation aggregation index, machine learning models, In-stent restenosis<br/>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"10 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141551265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Al-Shammari, Ahmed M Al-Wathinani, Mohammed A Abahussain, Nawaf A Albaqami, Mohammad A Alhallaf, Hassan Farhat, Krzysztof Goniewicz
Introduction: This study aimed to evaluate disaster preparedness and management among an inter-professional team at the Royal Commission Hospital (RCH) in Jubail, Saudi Arabia. Methods: Conducted between May and July 2023, this cross-sectional study involved healthcare providers in both patient-facing and non-patient-facing roles. Participants responded to a comprehensive online questionnaire comprising 22 questions across seven sections covering aspects of emergency response, disaster management, and infection control. The study targeted a minimum sample size of 500 participants, successfully garnering responses from 512 individuals. Results: Of the 512 participants, 59.9% (n=312) were healthcare providers in patient-facing roles, and 40.1% (n=209) were in non-patient-facing roles. The results revealed notable disparities in awareness and preparedness between these two groups. Healthcare providers demonstrated higher awareness levels compared to their non-patient-facing counterparts. For instance, 76.9% of healthcare providers were aware of the hospital’s emergency response plan compared to 56.2% of non-healthcare providers (χ² = 52.165, p < 0.001). Similar disparities were observed in understanding the term “disaster” (86.5% vs 54.1%, χ² = 27.931, p < 0.001), and awareness of a command center (73.4% vs 45.2%, χ² = 42.934, p < 0.001). Discussion: These findings underscore the critical need for enhancing awareness, education, and preparedness within healthcare facilities, emphasizing an integrated approach that includes both healthcare and non-healthcare staff. By addressing these gaps, healthcare facilities can significantly improve their emergency response efficiency, disaster management capabilities, and infection control measures, thereby enhancing the overall safety and quality of patient care.
{"title":"Integrating Inter-Professional Insights for Enhanced Disaster Response: A Cross-Sectional Analysis in Jubail’s Royal Commission Hospital, Saudi Arabia","authors":"Sarah Al-Shammari, Ahmed M Al-Wathinani, Mohammed A Abahussain, Nawaf A Albaqami, Mohammad A Alhallaf, Hassan Farhat, Krzysztof Goniewicz","doi":"10.2147/rmhp.s458606","DOIUrl":"https://doi.org/10.2147/rmhp.s458606","url":null,"abstract":"<strong>Introduction:</strong> This study aimed to evaluate disaster preparedness and management among an inter-professional team at the Royal Commission Hospital (RCH) in Jubail, Saudi Arabia.<br/><strong>Methods:</strong> Conducted between May and July 2023, this cross-sectional study involved healthcare providers in both patient-facing and non-patient-facing roles. Participants responded to a comprehensive online questionnaire comprising 22 questions across seven sections covering aspects of emergency response, disaster management, and infection control. The study targeted a minimum sample size of 500 participants, successfully garnering responses from 512 individuals.<br/><strong>Results:</strong> Of the 512 participants, 59.9% (n=312) were healthcare providers in patient-facing roles, and 40.1% (n=209) were in non-patient-facing roles. The results revealed notable disparities in awareness and preparedness between these two groups. Healthcare providers demonstrated higher awareness levels compared to their non-patient-facing counterparts. For instance, 76.9% of healthcare providers were aware of the hospital’s emergency response plan compared to 56.2% of non-healthcare providers (χ² = 52.165, p < 0.001). Similar disparities were observed in understanding the term “disaster” (86.5% vs 54.1%, χ² = 27.931, p < 0.001), and awareness of a command center (73.4% vs 45.2%, χ² = 42.934, p < 0.001).<br/><strong>Discussion:</strong> These findings underscore the critical need for enhancing awareness, education, and preparedness within healthcare facilities, emphasizing an integrated approach that includes both healthcare and non-healthcare staff. By addressing these gaps, healthcare facilities can significantly improve their emergency response efficiency, disaster management capabilities, and infection control measures, thereby enhancing the overall safety and quality of patient care.<br/><br/><strong>Keywords:</strong> disaster preparedness, emergency response, inter-professional collaboration, healthcare management, infection control, emergency medicine training, patient safety, cross-sectional analysis<br/>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141503014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yang Zhang, Chenggen Xiao, Guoqing Huang, Minxue Shen
Objective: This study aims to evaluate the impact of COVID-19 prevention and control policies on the frequency of emergency department (ED) visits in a large tertiary hospital in central China, from January 2018 to September 2023. Methods: We conducted a multi-stage interrupted time series analysis to investigate the impact of various epidemic control policies on weekly ED visits at a tertiary hospital in Hunan Province, China. The study period ranged from January 1, 2018, to September 30, 2023, and was divided into four distinct periods: pre-epidemic, pandemic, normalized control, and end of control. Using a quasi-Poisson regression model, we examined the specific effects of these policies on emergency visits, with a particular focus on stratifying patients based on respiratory versus non-respiratory diseases. Results: Compared to the pre-pandemic period, the number of ED visits in a tertiary hospital decreased by 38.5% (95% CI: 25.1% to 49.8%) during the COVID-19 pandemic, of which the number of ED visits for respiratory diseases increased by 79.4% (95% CI: 13.2% to 177.2%) and the number of ED visits for non-respiratory diseases decreased by 45.9% (95% CI: − 55.7% to − 34.2%). After the end of the epidemic control, the total number of ED visits increased by 31.5% (95% CI: 19.1% to 45.0%), with the number of ED visits for respiratory diseases rising by 379.2% (95% CI: 275.9% to 511.8%), but with no significant change in the number of ED visits for non-respiratory emergencies. Conclusion: Control policies were associated with people avoiding emergency care for non-respiratory related reasons during the pandemic, while the end of control policies was associated with a sharp rise in emergency care for respiratory diseases. This study provides a scientific basis for the different changes in ED visits under the implementation of varying epidemic prevention and control policies.
Keywords: COVID-19, health policy, emergency visit, respiratory disease, interrupted time series analysis
{"title":"Impacts of Major Changes in China’s COVID-19 Prevention and Control Policies on Emergency Department Visits: A Quasi-Experiment","authors":"Yang Zhang, Chenggen Xiao, Guoqing Huang, Minxue Shen","doi":"10.2147/rmhp.s463062","DOIUrl":"https://doi.org/10.2147/rmhp.s463062","url":null,"abstract":"<strong>Objective:</strong> This study aims to evaluate the impact of COVID-19 prevention and control policies on the frequency of emergency department (ED) visits in a large tertiary hospital in central China, from January 2018 to September 2023.<br/><strong>Methods:</strong> We conducted a multi-stage interrupted time series analysis to investigate the impact of various epidemic control policies on weekly ED visits at a tertiary hospital in Hunan Province, China. The study period ranged from January 1, 2018, to September 30, 2023, and was divided into four distinct periods: pre-epidemic, pandemic, normalized control, and end of control. Using a quasi-Poisson regression model, we examined the specific effects of these policies on emergency visits, with a particular focus on stratifying patients based on respiratory versus non-respiratory diseases.<br/><strong>Results:</strong> Compared to the pre-pandemic period, the number of ED visits in a tertiary hospital decreased by 38.5% (95% CI: 25.1% to 49.8%) during the COVID-19 pandemic, of which the number of ED visits for respiratory diseases increased by 79.4% (95% CI: 13.2% to 177.2%) and the number of ED visits for non-respiratory diseases decreased by 45.9% (95% CI: − 55.7% to − 34.2%). After the end of the epidemic control, the total number of ED visits increased by 31.5% (95% CI: 19.1% to 45.0%), with the number of ED visits for respiratory diseases rising by 379.2% (95% CI: 275.9% to 511.8%), but with no significant change in the number of ED visits for non-respiratory emergencies.<br/><strong>Conclusion:</strong> Control policies were associated with people avoiding emergency care for non-respiratory related reasons during the pandemic, while the end of control policies was associated with a sharp rise in emergency care for respiratory diseases. This study provides a scientific basis for the different changes in ED visits under the implementation of varying epidemic prevention and control policies.<br/><br/><strong>Keywords:</strong> COVID-19, health policy, emergency visit, respiratory disease, interrupted time series analysis<br/>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"204 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Putu Ayu Indrayathi, Luh Putu Sinthya Ulandari, Putu Erma Pradnyani, Inge Dhamanti, Marilynne N Kirshbaum, Csongor Istvan Szepesi, Nora Horvath, Laszlo Robert Kolozsvari
Purpose: Understanding patient’s preferences is important to delivering good quality services. Patients’ feedback provides healthcare providers with valuable information about the services provided. The increasing number of international students enrolling in Hungarian Universities raises the need to ensure the quality of services meets international students’ requirements, which includes healthcare. This study aimed to assess service quality in the University Health Center (UHC) from the international student’s point of view to be used to improve the quality of services. Methods: This cross-sectional study was conducted at the university health center. We used a mixed methods approach to collect both quantitative and qualitative data. We used the importance-performance analysis (IPA) for quantitative analysis to understand expectations and perceptions in service research. The qualitative analysis was conducted from responses to reflection questions. The qualitative data were then analyzed using thematic analysis. Results: 437 international students participated in the study, but only 402 (91.99%) were analysed. The gaps between the importance and performance of service quality were negative in all dimensions (P-value < 0.001). This suggests that there is an unmet need for student expectations and university health center performance. From the Importance factor, the highest and lowest were related to safety (4.54 ± 0.56) and efficiency (4.31 ± 0.66) dimensions. The Performance factor’s highest and lowest mean scores were also related to safety (4.22 ± 0.72) and efficiency (3.91 ± 0.87), respectively. From qualitative analysis, there are two major themes several secondary themes from the thematic analysis of free-text responses were identified. Conclusion: The importance and performance analysis could provide useful information to university policymakers about university health center service quality. There is a need for improvement and obviating the importance-performance gaps, especially in the efficiency dimension. Decision-makers can use the IPA analysis results to allocate limited resources more effectively, giving special attention to possible organizational weaknesses for further direction.
Keywords: healthcare, service quality, international students
{"title":"Understanding International Students’ Perspective of Health Service Quality: A Cross-Sectional Study in a Hungarian University","authors":"Putu Ayu Indrayathi, Luh Putu Sinthya Ulandari, Putu Erma Pradnyani, Inge Dhamanti, Marilynne N Kirshbaum, Csongor Istvan Szepesi, Nora Horvath, Laszlo Robert Kolozsvari","doi":"10.2147/rmhp.s460534","DOIUrl":"https://doi.org/10.2147/rmhp.s460534","url":null,"abstract":"<strong>Purpose:</strong> Understanding patient’s preferences is important to delivering good quality services. Patients’ feedback provides healthcare providers with valuable information about the services provided. The increasing number of international students enrolling in Hungarian Universities raises the need to ensure the quality of services meets international students’ requirements, which includes healthcare. This study aimed to assess service quality in the University Health Center (UHC) from the international student’s point of view to be used to improve the quality of services.<br/><strong>Methods:</strong> This cross-sectional study was conducted at the university health center. We used a mixed methods approach to collect both quantitative and qualitative data. We used the importance-performance analysis (IPA) for quantitative analysis to understand expectations and perceptions in service research. The qualitative analysis was conducted from responses to reflection questions. The qualitative data were then analyzed using thematic analysis.<br/><strong>Results:</strong> 437 international students participated in the study, but only 402 (91.99%) were analysed. The gaps between the importance and performance of service quality were negative in all dimensions (P-value < 0.001). This suggests that there is an unmet need for student expectations and university health center performance. From the Importance factor, the highest and lowest were related to safety (4.54 ± 0.56) and efficiency (4.31 ± 0.66) dimensions. The Performance factor’s highest and lowest mean scores were also related to safety (4.22 ± 0.72) and efficiency (3.91 ± 0.87), respectively. From qualitative analysis, there are two major themes several secondary themes from the thematic analysis of free-text responses were identified.<br/><strong>Conclusion:</strong> The importance and performance analysis could provide useful information to university policymakers about university health center service quality. There is a need for improvement and obviating the importance-performance gaps, especially in the efficiency dimension. Decision-makers can use the IPA analysis results to allocate limited resources more effectively, giving special attention to possible organizational weaknesses for further direction.<br/><br/><strong>Keywords:</strong> healthcare, service quality, international students<br/>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"26 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To ensure best possible patient outcomes, patient safety is a major component of healthcare delivery system that needs to be prioritized. Safety practices among nurses are essential to maintain patient safety, especially the practices of medication administration, handover, patient falls and unplanned extubations prevention.
Purpose: To investigate the mediating effect of patient safety culture between the relationship of transformational leadership and safety practices among nurses.
Methods: The data in this cross-sectional study were gathered from a survey targeted clinical nurses using a random sampling technique. The study was conducted in a medical city in Saudi Arabia, and two hundred nurses were surveyed. The Multifactor Leadership, Hospital Survey on Patient Safety Culture, and Nursing Safety Practice questionnaires were used in the study.
Results: The results revealed significant positive associations between transformational leadership, patient safety culture, and nursing safety practices. Moreover, patient safety culture mediates the association between transformational leadership and safety practices among nurses.
Conclusion: Enhancing transformational leadership capabilities among nurse managers should be considered in order to improve nursing safety practices. Additionally, patient safety culture should be measured and improved periodically to ensure better nursing safety practices.
{"title":"The Association of Transformational Leadership on Safety Practices Among Nurses: The Mediating Role of Patient Safety Culture.","authors":"Mahmoud Hamdan, Amar Hisham Jaaffar, Omar Khraisat, Marwan Rasmi Issa, Mu'taman Jarrar","doi":"10.2147/RMHP.S458505","DOIUrl":"10.2147/RMHP.S458505","url":null,"abstract":"<p><strong>Background: </strong>To ensure best possible patient outcomes, patient safety is a major component of healthcare delivery system that needs to be prioritized. Safety practices among nurses are essential to maintain patient safety, especially the practices of medication administration, handover, patient falls and unplanned extubations prevention.</p><p><strong>Purpose: </strong>To investigate the mediating effect of patient safety culture between the relationship of transformational leadership and safety practices among nurses.</p><p><strong>Methods: </strong>The data in this cross-sectional study were gathered from a survey targeted clinical nurses using a random sampling technique. The study was conducted in a medical city in Saudi Arabia, and two hundred nurses were surveyed. The Multifactor Leadership, Hospital Survey on Patient Safety Culture, and Nursing Safety Practice questionnaires were used in the study.</p><p><strong>Results: </strong>The results revealed significant positive associations between transformational leadership, patient safety culture, and nursing safety practices. Moreover, patient safety culture mediates the association between transformational leadership and safety practices among nurses.</p><p><strong>Conclusion: </strong>Enhancing transformational leadership capabilities among nurse managers should be considered in order to improve nursing safety practices. Additionally, patient safety culture should be measured and improved periodically to ensure better nursing safety practices.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"1687-1700"},"PeriodicalIF":2.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11214760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25eCollection Date: 2024-01-01DOI: 10.2147/RMHP.S459307
Dilson Palhares Ferreira, Claudia Vicari Bolognani, Levy Aniceto Santana, Sergio Eduardo Soares Fernandes, Matheus Serwy Fiuza de Moraes, Luana Argollo Souza Fernandes, Daniella Queiroz de Oliveira, Rosália Bezerra de Santana, Leila Bernarda Donato Gottems, Fabio Ferreira Amorim
Purpose: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic.
Patients and methods: Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality.
Results: There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: -227.5; 95% CI: -307.0 to -149.0), elective (absolute effect per week: -170.9; 95% CI: -232.8 to -112.0), and emergency (absolute effect per week: -57.7; 95% CI: -87.5 to -27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: -0.01 to 4.2).
Conclusion: Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.
{"title":"Impact of the COVID-19 Pandemic on Elective and Emergency Surgeries, and Postoperative Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study.","authors":"Dilson Palhares Ferreira, Claudia Vicari Bolognani, Levy Aniceto Santana, Sergio Eduardo Soares Fernandes, Matheus Serwy Fiuza de Moraes, Luana Argollo Souza Fernandes, Daniella Queiroz de Oliveira, Rosália Bezerra de Santana, Leila Bernarda Donato Gottems, Fabio Ferreira Amorim","doi":"10.2147/RMHP.S459307","DOIUrl":"10.2147/RMHP.S459307","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic.</p><p><strong>Patients and methods: </strong>Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality.</p><p><strong>Results: </strong>There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: -227.5; 95% CI: -307.0 to -149.0), elective (absolute effect per week: -170.9; 95% CI: -232.8 to -112.0), and emergency (absolute effect per week: -57.7; 95% CI: -87.5 to -27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: -0.01 to 4.2).</p><p><strong>Conclusion: </strong>Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"1701-1712"},"PeriodicalIF":2.7,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11214554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25eCollection Date: 2024-01-01DOI: 10.2147/RMHP.S465858
Rosaria Di Lorenzo, Matteo Reami, Diego Dragone, Martina Morgante, Giulia Panini, Paola Ferri, Sergio Rovesti
Background: The Sars-CoV-2 pandemic imposed unprecedented and drastic changes in health care organizations all over the world.
Purpose: To evaluate the impact of the pandemic on hospitalizations in an acute psychiatric ward.
Patients and methods: We retrospectively identified and compared acute psychiatric hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena during the pre-pandemic (n = 1858) and pandemic period (n = 1095), from 01/01/2017 to 31/12/2022. Data were statistically analyzed using STATA12.
Results: We collected 1858 hospitalizations in the pre-pandemic and 1095 in the pandemic. During the pandemic, we observed a progressively sharp reduction in voluntary hospitalizations, whereas involuntary ones remained stable with an increase in 2022 (p < 0.001), longer hospital stays (12.32 mean days vs 10.03; p < 0.001), longer periods of involuntary hospitalizations (8.45 mean days vs 5.72; p < 0.001), more frequent aggressive behaviour (16.10% vs 9.12%; p < 0.001) and referral to psychiatric communities at discharge (11.04% vs 6.13%; p < 0.001); non-Italians (p = 0.001), people with disability pension (p < 0.001) and Support Administrator (p < 0.001) were more frequently hospitalized.
Conclusion: During the pandemic, voluntary psychiatric hospitalizations decreased, but not involuntary ones, and the most vulnerable people in serious clinical conditions were hospitalized.
{"title":"Impact of the SARS-CoV-2 Pandemic on Hospitalizations in an Acute Psychiatric Ward.","authors":"Rosaria Di Lorenzo, Matteo Reami, Diego Dragone, Martina Morgante, Giulia Panini, Paola Ferri, Sergio Rovesti","doi":"10.2147/RMHP.S465858","DOIUrl":"10.2147/RMHP.S465858","url":null,"abstract":"<p><strong>Background: </strong>The Sars-CoV-2 pandemic imposed unprecedented and drastic changes in health care organizations all over the world.</p><p><strong>Purpose: </strong>To evaluate the impact of the pandemic on hospitalizations in an acute psychiatric ward.</p><p><strong>Patients and methods: </strong>We retrospectively identified and compared acute psychiatric hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena during the pre-pandemic (n = 1858) and pandemic period (n = 1095), from 01/01/2017 to 31/12/2022. Data were statistically analyzed using STATA12.</p><p><strong>Results: </strong>We collected 1858 hospitalizations in the pre-pandemic and 1095 in the pandemic. During the pandemic, we observed a progressively sharp reduction in voluntary hospitalizations, whereas involuntary ones remained stable with an increase in 2022 (p < 0.001), longer hospital stays (12.32 mean days vs 10.03; p < 0.001), longer periods of involuntary hospitalizations (8.45 mean days vs 5.72; p < 0.001), more frequent aggressive behaviour (16.10% vs 9.12%; p < 0.001) and referral to psychiatric communities at discharge (11.04% vs 6.13%; p < 0.001); non-Italians (p = 0.001), people with disability pension (p < 0.001) and Support Administrator (p < 0.001) were more frequently hospitalized.</p><p><strong>Conclusion: </strong>During the pandemic, voluntary psychiatric hospitalizations decreased, but not involuntary ones, and the most vulnerable people in serious clinical conditions were hospitalized.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"1713-1723"},"PeriodicalIF":2.7,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11215659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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