Risk Management and Healthcare Policy最新文献

Background/objectives: Dispensing errors have the potential to cause significant and preventable patient harm, including adverse drug events, hospitalization, or even death. This study aims to analyze the characteristics of drug product dispensing errors in the outpatient pharmacy, identify risk factors, and develop a risk warning model for error prediction.

Methods: A retrospective study analyzed 930 prescriptions with product dispensing errors and 1860 control prescriptions without errors in an outpatient pharmacy of a tertiary hospital from April 2021 to March 2023. Univariate and multivariable logistic regression were used to identify risk factors. A risk warning model with a cutoff value was constructed and its reliability evaluated using Receiver Operating Characteristics(ROC) curve analysis. The cutoff value was then used to assess the model's test effectiveness with validation dataset.

Results: Logistic regression analysis identified six independent risk factors for product dispensing errors in outpatient pharmacies: work experience, professional title, education level, similar drug names, similar drug appearances, and multiple specifications. A risk warning model (p=e^x/(1+e^x), x=3.721-2.133×X1-0.424×X2-0.382×X3+0.736×X4+0.890×X5+0.701×X6) was established. ROC curve analysis showed an AUC of 0.921 (95% CI: 0.908, 0.933), cutoff value of 0.508, sensitivity of 86.0%, specificity of 91.7%, and Youden index of 0.777 for the training dataset. For the validation dataset, results revealed an AUC of 0.928 (95% CI: 0.901, 0.956), sensitivity of 85.90%, specificity of 83.10%, and Youden index of 0.69.

Conclusion: The risk warning model demonstrated high accuracy in predicting product dispensing errors in outpatient pharmacies. Validated externally, it provides a practical reference for preventing such errors.

Purpose: This study aimed to evaluate occupational health and safety risks among patient transport personnel at Vajira Hospital, Thailand, using the ISO 45001:2018 Occupational Health and Safety Management System (OHSMS). The goal was to identify hazards, quantify risk levels, and propose targeted corrective measures to enhance workplace safety.

Patients and methods: Data were collected from 60 patient transport personnel and their supervisors using in-person, semi-structured interviews. Task-related hazards were identified through standardized checklists aligned with ISO 45001:2018. Descriptive statistics (frequencies, percentages, mean values) were applied to summarize participant characteristics and risk levels.

Results: Among 21 assessed work activities: 2 activities were categorized as very high risk (ergonomic hazards). 12 activities as high risk. 6 activities as medium risk. 1 activity as low risk. Key hazards included repetitive lifting, awkward postures, and potential exposure to infectious agents. ISO 45001:2018 clauses 6.1.2 (Hazard Identification and Risk Assessment) and 8.1 (Operational Planning and Control) were most relevant for these high-risk activities.

Conclusion: The study identifies urgent needs for ergonomic interventions, staff training, and procedural adjustments to reduce high-risk activities. Implementing ISO 45001:2018 systematically can improve hazard control and promote a safer working environment for patient transport personnel in hospital settings.

Background: The increasing global burden of chronic conditions demands novel interventions that are both interactive and sustainable. Gamification has emerged as an innovative strategy to enhance patient engagement and self-management in chronic disease care. Although gamification is widely adopted in healthcare, a review of evidence on its effectiveness across various clinical settings remains inconsistent.

Purpose: This review aimed to identify the effectiveness of gamification-based interventions in improving outcomes among patients with chronic diseases.

Methods: A comprehensive systematic literature search was conducted using three major databases: EBSCOhost, PubMed, and Scopus, along with two search engines, including Google Scholar and Sage Journal, without year limitations, following PRISMA 2020 and Cochrane methodological guidelines. Eligible studies were RCTs involving adult patients with chronic illness that implemented gamification interventions. Data were extracted and analysed through qualitative thematic synthesis.

Results: A total of 17 RCTs met the inclusion criteria. Three categories of interventions were identified: (1) active video games for rehabilitation, (2) virtual reality (VR)-based intervention, and (3) digital gamification for education and behaviour change. Across these studies, four consistent outcome domains were identified: physical function improvement, psychological well-being, adherence and self-management, and motivation and engagement. Most studies reported significant improvements in physical function.

Conclusion: Gamification demonstrates multidimensional benefits, integrating physical, psychological, and behavioural improvements within patient-centred digital health frameworks. The success of these interventions depends on aligning game design mechanics with clinical objectives. Future studies should emphasise hybrid, long-term models combining VR, mobile platforms, and clinician feedback systems to enhance sustainability and scalability in chronic disease management.

Objective: To explore the risk factors of urinary tract infection after transurethral bipolar plasmakinetic prostatectomy (TUPKP) in patients with prostatic hyperplasia (BPH), to construct a nomogram model for predicting postoperative urinary tract infection, and evaluate the differentiation and consistency of the model.

Methods: A total of 580 BPH patients who underwent TUPKP between October 2016 and October 2022 were included as the modeling group, and 115 patients treated from November 2022 to November 2024 formed the validation group. Patients were classified into UTI and non-UTI groups based on the occurrence of UTI within 1 month postoperatively. Clinical data were analyzed using univariate and multivariate logistic regression to identify risk factors. A nomogram was constructed using R software, and its performance was assessed with ROC and calibration curves.

Results: The incidence of postoperative UTI in the modeling group was 14.83%. Compared with the non-UTI group, the UTI group had significantly higher age, diabetes prevalence, preoperative catheterization, and routine nursing ratio, along with longer operation and catheterization times, and shorter antibiotic use duration (P<0.05). Multivariate analysis revealed that age (OR=1.061), diabetes (OR=1.889), operation time (OR=1.063), and indwelling catheter time (OR=1.912) were independent risk factors (P<0.05). The nomogram demonstrated good discrimination (AUC=0.825, 95% CI: 0.780-0.869) and calibration (Hosmer-Lemeshow test P=0.390). External validation showed similar performance (AUC=0.818, 95% CI: 0.711-0.925) with good consistency.

Conclusion: Age, diabetes, duration of surgery, and postoperative indwelling catheter time are risk factors for urinary tract infection in patients with benign prostatic hyperplasia undergoing TUPKP. The constructed nomogram model demonstrates good discrimination and consistency.

Purpose: Screening for HIV and Hepatitis C (HCV) is critical in caring for individuals with substance use disorders (SUD). This is particularly relevant in identifying prescribing habits for Pre-Exposure Prophylaxis (PrEP). The objectives were to examine HIV and HCV screening rates, and PrEP prescription among managed care beneficiaries with SUD and without an HIV diagnosis and determine the factors associated with the screenings and PrEP prescriptions.

Methods: We conducted a retrospective cross-sectional analysis (January-December 2021) of managed care claims for beneficiaries who visited either urban primary care clinics or emergency departments affiliated with an academic medical center. Sample included 2381 Medicaid and dually eligible for Medicare and Medicaid managed care beneficiaries with SUD, continuously enrolled for 12 months, 21 years or older, and without an HIV diagnosis. Substances included in the analysis were alcohol, opioid, cocaine, cannabis, and other psychoactive drugs. Univariate descriptive statistics and multivariable logistic models were used to address the objectives. Rates of HIV and HCV screening, and PrEP prescriptions were examined. Outcome variables for multivariable logistic regression were whether beneficiaries had HIV screening, HCV screening, and PrEP prescription. The predictors were age, gender, race, primary language, area of residence, insurance type, chronic conditions, tobacco use, polysubstance use, number of providers seen, primary care physician seen, emergency department visits, hospitalizations, and annual cost of care.

Results: About 22% of beneficiaries had HIV or HCV screening; PrEP prescriptions were non-existent in this sample. About 83% visited their primary care physician (PCP). The predictors of HIV and HCV screenings include gender, area of residence, polysubstance use disorder, PCP visits, and hospitalizations.

Conclusion: Results indicate low HIV and HCV screening rates and no PrEP prescriptions among the managed care population with SUD. Specifically, beneficiaries with rural residence, females, and Medicaid beneficiaries need targeted interventions and missed opportunities exist at PCP offices.

Background: Digital literacy is increasingly recognized as a key determinant of health, yet the mechanisms linking it to self-rated health in transitional economies like China remain underexplored. This study examines how digital literacy influences self-rated health, directly and indirectly through mental health, while exploring heterogeneity across age and gender groups.

Methods: Using data from the 2023 Chinese General Social Survey (n=8,039 adults aged 18 and above), we constructed a multidimensional digital literacy index via entropy weighting and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), integrating dimensions of digital access, usage, and entertainment. Structural equation modeling (SEM) and multi-group analyses were employed to test relationships, controlling for gender, age, and education. Model fit was assessed using RMSEA, CFI, and other indices; robustness was verified through alternative specifications, sensitivity checks, and outlier trimming.

Results: Digital literacy had a significant positive effect on self-rated health (β=0.115, p<0.001), comprising a direct effect (β=0.076, p<0.001) and an indirect effect via mental health (β=0.039, p<0.001; mediation proportion=33.9%). Multi-group SEM revealed heterogeneity: effects were strongest in young and middle-aged females (β=0.141-0.143, p<0.001) and weaker in older adults (eg, β=0.050 for females >60, p<0.01). Mental health mediated more strongly in older groups (β=0.500, p<0.001). The model explained 38.5% of variance in self-rated health.

Conclusion: Digital literacy positively influences self-rated health by enhancing resource access and mental well-being, with pronounced benefits for younger and female populations. Policymakers should prioritize age-appropriate digital literacy initiatives with psychological support to reduce disparities, aligning with China's "Healthy China 2030" and "Digital China" strategies.

Introduction: The well-being of healthcare workers (HW) affects both their psycho-physical state, and the quality of care provided. In Emergency Department (ED), overcrowding, long work shifts and the criticality of patients can affect the professionals' quality of life and empathy.This empirical study aims to evaluate the HWs' professional quality life and empathy in an ED.

Methods: With a cross-sectional design, we administered the "Jefferson Scale of Empathy" (JSE) and the "Perception of the quality of professional life" (ProQOL) to 70 HWs in a General Hospital ED and collected demographic and work variables of participants. We statistically analyzed data.

Results: We collected responses from 16 doctors, 39 nurses, and 15 healthcare assistants, with a response rate of 70%. The JSE score (111.13 ± 11.75) showed high empathy levels in all professions. The PROQOL burnout (23.73 ± 5.53; chi-squared = 8.80; p = 0.012) and compassion fatigue (43.73 ± 9.49; chi-squared = 10.48; p = 0.005) scores showed statistically significant differences between the three HWs. Doctors were the profession most affected by stress (23.12 ± 6.47; chi-squared = 5.70; p = 0.058), burnout (27.62 ± 5.97; chi-squared = 8.80; p = 0.012) and compassion fatigue (50.75 ± 10.6; chi-squared = 10.48; p = 0.005) compared to other HWs. At multiple linear regressions, JSE score, as dependent variable, was associated with ProQOL burnout (Coeff: -0.88; p = 0.021) and stress (Coeff: 0.76; p = 0.048), whereas secondary traumatic stress score, as dependent variable, was positively associated with HWs' years of employment (Coeff: 0.38; p = 0.040).

Discussion: Stress and burnout were higher among physicians than among other HWs, but empathy was high among all HWs, with no sex difference. These findings may inform future training programs and organizational policies aimed at improving the HWs professional quality of life, suggesting that support for HWs are essential for quality of care.

Background: While the concept of active aging has been extensively studied in high-income countries, China faces distinct demographic challenges, including a rapidly growing elderly population, accelerated aging, and aging prior to widespread economic prosperity. These trends highlight the urgent need for a context-specific conceptual and evaluative framework to measure active aging, tailored to China's socio-cultural and economic realities.

Methods: This study employs the Latent Dirichlet Allocation (LDA) topic model to construct a multidimensional indicator system for measuring active aging among older adults in China. Drawing on five waves of nationally representative panel data from the China Health and Retirement Longitudinal Study (CHARLS), spanning 2011 to 2020, we evaluate individual-level active aging scores using a quantitatively derived framework.

Results: The measurement system consists of six core dimensions and 21 indicators: (1) physical health and functional capacity, (2) psychological well-being and life satisfaction, (3) family caregiving and social security, (4) economic security and intergenerational support, (5) social participation and enabling environments, and (6) lifelong learning and self-management. All scale-based measures demonstrated acceptable internal consistency (Cronbach's alpha ≥ 0.70). The average active aging score among the full sample was 0.4912±0.0907.

Conclusion: Active aging levels in China have shown consistent improvements over the observation period, with the most pronounced gains in the eastern region. The central region has seen a narrowing of differences, while the eastern, northeastern, and western parts of the country have seen a widening of differences. Key positive correlates of active aging include educational attainment, urban residence, male gender, alcohol consumption, and being married. Negative associations were found for older age, geographic region, presence of chronic conditions, number of surviving children, and smoking. Among these, education attainment, urban-rural status, age and gender emerged as the most influential factors.

Background: The Barthel Index (BI) is a standardized tool used to evaluate patients' ability to perform daily activities. Lower scores on the index indicate greater dependency. The distribution of nursing workload is often uneven and rarely assessed using validated measures, particularly on busy days, such as those following patient admission days when care demands are higher.

Purpose: This study aims to quantify nursing workload in two hospital wards using the Barthel Index.

Methods: This cross-sectional comparative study collected patient data through direct observation and interviews with all patients in two hospital wards in northern Greece on a busy working day. The 10-item BI was employed to determine each patient's level of dependency.

Results: A total of 62 patients (31 females; mean age 74.5 years, range 20-94) participated in this study. Ward A had 12 nurses, while ward B had 13. On a heavy workday, the mean BI score was 45 in ward A and 20 in ward B, indicating higher patient dependency in Ward B.

Conclusion: The BI provides a quick and objective assessment of patient dependency, which reflects nursing workload. Integrating BI assessments into routine practice could support evidence-based staffing decisions and allow for better alignment of nurse allocation with the specific needs of each ward, especially during high-demand periods.

Introduction: Hospital-acquired pneumonia (HAP) remains a major challenge in clinical practice, particularly due to polymicrobial infections and antimicrobial resistance. Traditional diagnostic methods, such as culture and PCR, are limited by low sensitivity, slow turnaround time, and inability to detect fastidious or novel pathogens. Metagenomic next-generation sequencing (mNGS) offers an unbiased approach to pathogen detection and may improve diagnostic accuracy and clinical decision-making.

Methods: We conducted a retrospective study of 300 adult HAP patients admitted to Beijing Rehabilitation Hospital, China. Bronchoalveolar lavage fluid samples were analyzed using the Illumina sequencing platform for mNGS. Detection rates, pathogen spectrum, resistance gene identification, and treatment modifications were compared with conventional culture methods.

Results: mNGS achieved a pathogen detection rate of 92%, significantly higher than the 72% achieved by culture. It identified a broader spectrum of bacteria, fungi, and viruses, including Pseudomonas, Klebsiella, and Aspergillus, which were often missed by culture. Polymicrobial infections were detected in 28% of cases, and antibiotic resistance genes were identified in 30% of samples. The median turnaround time for mNGS results was 48 hours after BAL sampling. Based on mNGS findings, treatment regimens were adjusted in 26% of patients.

Conclusion: mNGS demonstrated superior diagnostic performance compared with culture by increasing pathogen detection rates, identifying resistance genes, and guiding treatment adjustments in HAP patients. Despite its promise for precision medicine, further studies are needed to assess cost-effectiveness and generalizability, given the retrospective and single-center design of this study.