Risk Management and Healthcare Policy最新文献

Objective: The aim of this study is to assess the impact of educational interventions on knowledge and attitudes toward HIV/AIDS, with the goal of reducing stigma.

Methods: A cross-sectional epidemiological study was conducted. This intervention study assessed knowledge and attitudes about HIV/AIDS using a 5-point Likert scale. Participants, selected by convenience sampling method, included patients, their relatives, and healthcare providers at a University Hospital, excluding those with HIV/AIDS. After completing a pre-test questionnaire, participants received written information from an infectious disease specialist on HIV/AIDS, covering prevalence, transmission, prevention, and treatment per WHO guidelines. A post-test was then administered to evaluate changes in knowledge and attitudes. The study used a validated Turkish attitude scale. Statistical analysis was performed using SPSS 23.0. Continuous variables were presented as mean ± standard deviation or median and range. Correlation analysis examined the relationship between HIV/AIDS knowledge and stigmatizing attitudes.

Results: In the study conducted with 388 participants, the mean age was 34, with 48.7% male and 51.3% female. Education significantly increased HIV/AIDS knowledge and improved empathetic, accepting attitudes toward individuals living with HIV (p<0.05).

Conclusion: These results suggest that educational interventions should be implemented widely, especially in healthcare settings, to combat stigma. Future actions could include integrating similar programs into routine training for healthcare workers, patient education initiatives, and community outreach. Expanding the approach to other regions and monitoring long-term effects would further support stigma reduction.

Objective: To investigate the epidemiology, and hospitalization of tetanus in Suzhou, Jiangsu Province, China, focusing on the severity of the disease, treatment, outcomes and hospitalization costs, and to explore the risk factors for severe tetanus.

Methods: This retrospective, multicenter observational study analyzed tetanus patients admitted to various medical institutions between 2013 and 2023. Patients were classified into two groups as severe or non-severe, using the Ablett classification. Differences between the two groups were compared using the Chi-squared test, Fisher's exact test and Mann-Whitney U-test. Binary logistic regression analysis was used to evaluate potential risk factors for severe disease.

Results: A total of 63 patients with tetanus were included in this study. The median age of the patients was 57.0 (48.0-74.0) years, with a predominance of males (65.1%). There was an overall increasing trend in the rate of severe illness in tetanus patients from 2013-2023 (P<0.001). The proportion of patients admitted to the hospital was highest (39.7%) in summer (June-August) (P=0.001). The rate of severe tetanus was significantly higher in patients aged ≥65 years than in those aged 0-40 years and 41-64 years (P=0.019). The incubation period was 8.0(5.0-11.0) days for severe tetanus patients and 11.0 (8.0-18.0) days for non-severe patients (P=0.005). Compared to the non-severe group, the severe group shouldered a higher hospitalization cost, with total costs amounting to US $19062.8(4675.4-29,385.4) and US $4291.1(1356.6-19,635.4), respectively. Binary logistic regression analysis revealed that patients aged 65 years and above significantly increased the risk of developing severe disease (OR = 3.345, 95% CI: 1.039-10.770).

Conclusion: Tetanus occurs primarily in the summer in Suzhou City, Jiangsu Province, China. The incubation period is shorter in patients with severe tetanus. The elderly are the main affected population, with the risk of developing severe disease escalating with advancing age. Knowledge of tetanus immunoprophylaxis should be strengthened to further reduce morbidity and mortality.

Background: The emerging risk of personalized medicine is driving drug manufacturers to seek collaborations with advanced diagnostic firms, aiming to improve detection and treatment outcomes. However, the government's regulated pricing in personalized medicine affects manufacturers' strategic decisions, particularly regarding the selection of diagnostic partners. In this context, this study investigates whether the government should regulate the price of personalized medicine and how the government's regulated pricing decisions affect drug manufacturers' diagnostic test choices.

Methods: A stylized analytical model was developed, employing game-theoretic analysis. Numerical studies are also conducted to validate our results.

Results: The study reveals that in the absence of the government's regulated pricing, drug manufacturers benefit from partnering with high-level diagnostic firms, enhancing consumer surplus and social welfare. However, when the government regulates pricing, the choice of partnering with a high-level diagnostic firm depends on specific conditions, such as low patient sensitivity to treatment failure and a low unit cost coefficient of diagnostic effort. The government's decision to regulate prices is influenced by three key parameters: patients' sensitivity to treatment failure, the unit cost coefficient of the diagnostic test effort, and the proportion of the price of specialized drugs in the regulated pricing.

Conclusions: The findings underscore the importance of legal frameworks in the personalized medicine industry. The absence of the government's regulated pricing incentivizes collaborations with high-level diagnostic firms, enhancing consumer surplus and social welfare. However, government intervention in pricing makes such decisions contingent on specific conditions, requiring nuanced regulatory policies that balance the interests of patients, manufacturers, and diagnostic firms.

Background: Bone mineral density (BMD) and monocyte-to-lymphocyte ratio (MLR) were recently identified as novel risk factors for patients with several malignancies. The objective of this study was to validate the role of preoperative BMD/MLR as a potential prognostic biomarker in patients with hepatocellular carcinoma (HCC) undergoing liver resection.

Methods: This investigation enrolled 442 adult patients diagnosed with HCC who underwent liver resection. The patients were classified into high- and low-BMD/MLR groups based on the median, and forward stepwise logistic regression was employed to identify independent predictors for early HCC recurrence. To mitigate the impact of confounding factors, a propensity score matching (PSM) analysis was conducted between patients in the high- and low-BMD/MLR groups. The Kaplan-Meier method was employed to assess and compare the disease-free survival (DFS) and overall survival (OS) between the two cohorts.

Results: The study categorized patients into high-BMD/MLR and low-BMD/MLR groups. Forward stepwise logistic regression analysis revealed that low BMD/MLR (P < 0.001), tumor size > 50 mm (P < 0.001), and AFP > 200 ug/L (P = 0.001) were significantly associated with the early recurrence of HCC. Moreover, the results suggested that DFS and OS were significantly shorter in the low-BMD/MLR group compared to the high-BMD/MLR group, both before and after PSM (P < 0.05).

Conclusion: Preoperative BMD/MLR held promise as a prognostic biomarker for early recurrence and prognosis in patients with HCC who underwent liver resection. Furthermore, the integration of tumor size, AFP level, and BMD/MLR demonstrated a robust predictive capacity for early recurrence within this patient population.

Background: Analyzing patients' nonattendance at medical appointments helps address an issue impacting the management and sustainability of health systems globally, providing valuable insights for healthcare managers. This study aims to identify factors at both patient and health system levels that contribute to understanding missed appointments.

Methods: The analysis was conducted using data from secondary care consultations within the Brazilian Unified Health System between April 2018 and March 2020. Primary care includes general medical consultations, while secondary care involves specialized services provided by doctors with advanced expertise. We examined demographic factors (age, sex, race/color, socioeconomic level) and health system practices (waiting time, hospitalization, distance to service, medical specialty, and severity of clinical condition) to assess their impact on patient attendance. A weighted analysis and receiver operating characteristic (ROC) analysis were applied to determine the relative risk of nonattendance.

Findings: Of 5,003,159 consultations, 435,523 (8.7%) were missed. Nonattendance was highest among patients facing long distances to the service (13.3%, [RRR] 1.227), younger age (16-30 years: 11.8%, [RRR] 1.041), and waiting times (>30: 10.9%, [RRR] 1.738). Socially vulnerable patients were more likely to miss appointments (9.6%, [RRR] 1.055) compared to less vulnerable groups (8.6%). Practice-level factors had a slightly greater impact on nonattendance (ROC: 0.621) than patient-level factors (ROC: 0.5674). The overall predictive model achieved a C statistic of 0.6228, resulting in a fair predictive ability. However, the model showed only modest prediction of no-shows, indicating the need for more detailed data to improve accuracy. Gauging which group suffers the highest risk of nonattendance was a secondary goal of this analysis.

Interpretation: Young, socially vulnerable patients with long commutes and extended waiting times are at higher risk of nonattendance. Effective management of these risk factors and targeted preventive actions are essential to reduce absenteeism and improve health system efficiency.

Introduction: The aim of this study is to evaluate the impact of face-to-face education on pressure ulcer prevention and care provided to caregivers of patients with pressure ulcers in home healthcare services, specifically on the progression of the ulcers and their effects on the patients.

Methods: This prospective, analytical intervention study assessed the training program implemented using the presentation teaching strategy for caregivers of patients with pressure ulcers, from the perspective of the patient and caregiver. The participants were 91 patients with pressure ulcers in the Home Health Care Unit and 91 caregivers. The data collection tool, consisted of questions regarding sociodemographic data prepared by researchers and questioning the knowledge of caregivers' knowledge about pressure ulcer. The Barthel Index, Pressure Ulcer Scale for Healing, Braden Risk Assessment Scale, and Care Assessment Inventory provided by family members were used to assess the level of dependence in patients' daily living activities.

Results: The patients' average age was 77.21±13.26 years and 58.2% of them were women. The caregivers' average age was 53.32±11.45 years and 83.5% of them were women. A statistically significant increase was observed between knowledge scores before and after training (p<0.001). Indicating that the training positively affects the caregivers' level of knowledge. Factors such as a private room, caregiver support, caregiver competence, and caregiving difficulties were significantly related to changes in knowledge scores.

Conclusion: Training programs for caregivers on pressure ulcer handling in home health care patients are effective and should be planned from a broader perspective to include caregivers within the family.

Purpose: Falls among older adults are a growing public health concern in Saudi Arabia. The Otago Exercise Program (OEP) is an evidence-based intervention aimed at reducing fall risk in this population. This study assessed the knowledge and attitudes of Saudi Arabian physical therapists toward the OEP and examined potential gender-based differences.

Patients and methods: A cross-sectional survey was conducted between November 2023 and April 2024, involving 120 licensed physical therapists from Saudi Arabia, recruited via Email and social media. The survey captured sociodemographic data, knowledge, and attitudes regarding the OEP. Responses were analyzed using descriptive statistics, chi-square tests, and Cramér's V to assess the strength of associations, with a significance level set at p < 0.05.

Results: Most physical therapists reported knowledge of the OEP's clinical effectiveness (36.7%), cultural compatibility (35.0%), and fall prevention benefits (28.3%). Gender was not significantly associated with knowledge of clinical effectiveness (χ² = 3.84, p = 0.57), contraindications (χ² = 4.44, p = 0.48), cost-effectiveness (χ² = 4.15, p = 0.52), or fall prevention in older adults (χ² = 2.44, p = 0.78), with moderate effect sizes observed (Cramer's V = 0.233 to 0.467). Attitudes toward the OEP were generally positive, with 51.7% supporting its use in regular aging care and 45.0% expressing confidence in delivering the program. There were no significant gender differences in understanding the OEP's recommendations (χ² = 7.45, p = 0.11) or confidence in program delivery (χ² = 7.62, p = 0.10), although strong association effects were noted (Cramer's V = 0.696 and 0.680, respectively).

Conclusion: This study highlights the strong knowledge and positive attitudes of Saudi physical therapists toward the OEP, underscoring its potential for integration into national healthcare strategies to improve geriatric care and reduce fall-related risks. The findings emphasize the importance of continuous professional development to address knowledge gaps and optimize the implementation of evidence-based fall prevention programs.

Purpose: To investigate the clinical characteristics and systemic risk factors of K. pneumoniae related endogenous endophthalmitis (KPREE) in China and explore the possible pathophysiological mechanisms.

Methods: This was a retrospective comparative study. All enrolled KPREE patients were followed up for at least 1 month to observe their clinical characteristics, unfavorable prognosis, and risk factors, and were compared with intraocular surgery-related postoperative endophthalmitis (ISRPE).

Results: Finally, a total of 15 eyes (3 both eyes) from 12 patients were enrolled in KPREE group, and 11 eyes (none both eyes) from 11 patients were enrolled in ISRPE group. Compared to the ISRPE group, the KPREE group had a higher percentage of fever (100% vs 9.09%, P = 0.000), liver abscess (91.67% vs 0%, P = 0.000), lung involvement (50.00% vs 0%, P = 0.024), and lower plasma albumin levels (24.1 [17.8, 31.7] vs 44.0 [37.7, 48.4], P = 0.001). Furthermore, Pearson's partial correlation analysis showed that fever (adjusted r = 0.592, adjusted P = 0.026) and plasma albumin (adjusted r = -0.658, adjusted P = 0.011) were independent factors associated with KPREE. In the KPREE group, ten eyes received 1-3 intravitreal antibiotic injections within one month. In the ten eyes that underwent injections, due to poor treatment reaction, four eyes experienced evisceration, and two eyes underwent vitrectomy with silicone oil tamponade at 1-month follow-up. And one eye developed sympathetic ophthalmia at 8-month visit.

Conclusions: Patients with K. pneumoniae infection with hypoproteinemia or fever should be highly vigilant about the occurrence of KPREE, and more attention should be paid to the contralateral risk of KPREE or sympathetic ophthalmia.

Aim: To evaluate the prevalence and trend of inventory waste in a tertiary hospital over the last 7 years. This included the type and average monetary value (MV) of inventory waste, as well as the outcome of using the Always-Better-Control (ABC)-Vital-Essential-Non-essential (VEN) matrix as part of a Zero-Waste Strategy.

Methods: This was a retrospective observational study conducted at King Abdulaziz Medical City (KAMC) over 7 years.

Results: The prevalence of waste was 0.21%, which equates to (SAR) 15 million out of SAR 7 billion. The pharmaceutical inventory had significantly higher waste in terms of MV and the number of items (89.8%, and 80.3%, respectively) (P<0.001). The expired pharmaceutical inventory had a significantly higher waste of MV than non-moving and obsolete inventory (79.8%, 14.3%, and 5.9%, respectively) (P<0.001). The ABC-VEN matrix categorized the inventory into Category I, which has the highest MV waste at 82.3%, followed by Category II with 16.8%, and then Category III with 0.9%. However, category II had a significantly higher number of wasted items at (58.2%), followed by Category I (24%) and Category III (17.8%) (P<0.01). The majority of MV waste consisted of a small number of pharmaceutical items that had a high clinical impact, representing 66% and 18%, respectively. After implementing a zero-waste strategy for landfills using the ABC-VEN matrix, the prevalence of waste declined from 0.9% to 0.21%. The waste sent to the landfill was zero from 2018 through 2020, saving 73.64% of the total money.

Conclusion: The use of the ABC-VEN matrix positively impacted the reduction of MV waste. The prevalence and trend rate of inventory waste were lower than the benchmarks of global companies, saving more than two-thirds of the inventory value that would have been wasted. The majority of the wasted MV consisted of a small number of pharmaceutical items that had a significant clinical impact.

Objective: To determine the prevalence of Cardiovascular-Kidney-Metabolic (CKM) Syndrome and identify risk factors, including occupational factors, lifestyle factors and clinical measurements, and female-specific risk enhancers among healthcare workers in China.

Methods: A cross-sectional study was conducted among healthcare workers at Taizhou People's Hospital between April and May 2024. We collected data through surveys and laboratory results. Univariate and multivariate logistic regression analyses were performed to identify predictors of CKM syndrome and female-specific risk enhancers.

Results: A total of 1110 participants were recruited (197 male; 913 female; mean age 34.8±7.9). Almost 90% of male healthcare workers and 60% of female healthcare workers met the criteria for CKM syndrome (stage 1 or higher). Additionally, most male CKM syndrome patients were in stages 2-3 (53.81%), while most female CKM syndrome patients were in stage 1 (35.82%). Multivariate logistic regression analysis revealed that, compared to those with over 20 years of work duration, a work duration of less than 10 years was a protective factor for CKM Syndrome. Additionally, more than 8 hours of sedentary time was identified as a risk factor compared to less than 2 hours (OR = 1.376, 95% CI 1.027-1.844, P < 0.05). Receiver operating characteristic analysis showed that body mass index (BMI) was superior to fasting plasma glucose, glycated hemoglobin, triglycerides, and the triglyceride glucose product index in predicting CKM Syndrome, with area under the curve values of 0.884 vs 0.638, 0.708, 0.745, and 0.761, respectively (P < 0.05 for all). BMI was identified as an independent risk factor for female-specific risk enhancers.

Conclusion: CKM syndrome is prevalent among healthcare workers in Chinese tertiary hospitals, with males generally presenting at more advanced stages than females. BMI is a key predictor of CKM syndrome and female-specific risk enhancers.