Risk Management and Healthcare Policy最新文献

Background: The factors influencing nurses' knowledge of delirium in acute care settings have not been fully investigated in Saudi Arabia. Therefore, this study aimed to investigate these factors among nurses in acute care settings in the northern region of Saudi Arabia.

Methodology: A cross-sectional study was conducted using a convenience sample of 234 acute care nurses at the main public hospitals in the Hail region of Saudi Arabia. Data were collected using a structured, self-administered questionnaire, from November 2023 to February 2024. Multiple linear regression was used to identify factors of knowledge about delirium.

Results: Of the acute care nurses, 7.3% had a good level of overall knowledge about delirium, while 66.1% and 26.6% showed poor and moderate levels, respectively. Most nurses (78.2%) had poor knowledge of delirium assessment. Significantly higher scores on delirium assessment were observed for nurses who reported receiving in-service training on delirium (P = 0.006) and when a clear job description was applied (P = 0.031), whereas significantly higher scores on knowledge about risk factors were observed for those who had previous experience in caring for delirious patients (P <0.001), received educational sessions on delirium (P = 0.001), and participated in training on delirium care (P <0.001). Lack of previous experience in caring for delirious patients and participation in delirium care training were significant factors for lower knowledge about delirium scores (CI=-5.750 --1.200, P <0.001).

Conclusion: In-service training, daily clinical discussion, availability of instructional materials, and specific training on delirium significantly influence nurses' knowledge about delirium, particularly regarding delirium assessment and early recognition. Enhancing these factors could improve nurses' knowledge and the care and management of patients complaining of delirium in acute care settings.

Background: The aging global population presents challenges in medication management, particularly among diabetic elderly patients vulnerable to potentially inappropriate medications (PIM). PIM can lead to adverse outcomes like hypoglycemia, falls, cognitive decline, and hospitalizations, affecting quality of life and survival. This study aimed to assess PIM prevalence among diabetic elderly patients in a tertiary care hospital in Saudi Arabia, using the American Geriatrics Society 2023 Updated Beers Criteria.

Methods: A cross-sectional retrospective study was conducted among 480 diabetic adults aged 60 years or older at a tertiary care hospital over 3 months. Data, including demographics, comorbidities, and medication use, were extracted from Electronic Health Records. 2023 AGS Updated Beers Criteria® was followed.

Results: The median age was 66 years with a male predominance (62.7%). Peripheral vascular disease (42.7%) and prior myocardial infarction (22.7%) were prevalent comorbidities. Inappropriate insulin use was observed in 17.7% of insulin users, mainly short-acting insulin without basal/long-acting insulin. Approximately 39.2% of patients were prescribed antidiabetic drugs deemed inappropriate by Beers Criteria, with Gliclazide being the most common (35.6%). Despite potential drug-disease interactions, such as urogenital infections, half of the patients received cautioned drugs, while only 4.2% experienced such infections.

Conclusion: The study highlights the prevalence of PIMs among diabetic elderly patients in Madinah, Saudi Arabia. Adherence to Beers Criteria guidelines is crucial to optimize therapy for this population. Age and congestive heart failure were significant predictors of PIM use.

The Israel military occupation, ongoing for over 75 years, has profoundly impacted the health and well-being of Palestinians. Despite longstanding calls for Universal Health Coverage (UHC) and sustainable development, the response of global health systems and organizations to crises such as the recent large-scale military assault on Gaza in October 2023 has been inadequate. There is a critical need to examine why these global health approaches have failed and how they can be restructured to address the unique challenges in Gaza effectively. This analysis aims to analyze the shortcomings of global health strategies in the context of the Gaza crisis during 2023-2024, evaluate their alignment with UHC and the Sustainable Development Goals (SDGs), and propose actionable solutions to enhance their relevance and effectiveness in conflict-affected settings. The ongoing military assault has rendered Gaza uninhabitable, exacerbating mass human loss, destruction, health insecurity, and widespread social inequities. The crisis has highlighted the erosion of health systems and the inability to meet basic population needs. Global health strategies, as currently implemented, fail to address the specific challenges of Gaza, including ensuring human rights for health, achieving UHC, and advancing SDGs. These failures are rooted in a lack of context-specific adaptation, inadequate accountability, and unresponsive global health diplomacy. The analysis concludes that global health entities and organizations have been largely ineffective in responding to the Gaza crisis, resulting in significant inequities and failures in life-saving actions. To address these challenges, there is an urgent need to tackle the factors behind the ineffective role of these organizations and suboptimal attainment of global goals. This role of global health should be redefined. Reforming the existing global health architecture and shaping well-representative alliances by involving influential actors from the Global South is a priority. These alliances should prioritize accountability, advocacy, and diplomacy while developing innovative and context-specific approaches to safeguard human rights, achieve UHC, and promote sustainable development in Palestine.

Purpose: In order to obtain sustainable healthcare, engagement of patients in patient safety improvement is vital. Drawing upon a multi-perspective approach, this study aimed to investigate perspectives of patients and healthcare professionals on key implementation factors (ie, barriers and facilitators) for effective patient engagement (PE) in healthcare organizations to improve patient safety.

Patients and methods: A two-round Delphi technique comprising semi-structured interviews and an online survey was applied to consolidate the individual perspectives of stakeholders and establish consensus on factors (expected, potential or experienced) that facilitate or mitigate successful implementation of PE in healthcare organizations (ie, all types, including hospital and outpatient medical practices). Adult, German-speaking experts in patient safety or PE (ie, with professional background or personal experience) were eligible to participate. Purposive and convenience sampling for inclusion of different healthcare professionals and patient representatives was established. Thirty-four panelists participated in data collection.

Results: We identified eight key barriers and seven facilitators for effective patient engagement in healthcare organizations. Time constraints and perceived low effectiveness of patient engagement activities were deemed as most critical barriers. Supportive organizational culture, education and training opportunities, and clearly nominated responsibilities for patient feedback and engagement were rated as the most important facilitators. There were no statistically significant differences in the ratings between patient representatives and healthcare professionals.

Conclusion: Our findings contribute to a deeper understanding of real-world implementation factors for effective patient engagement in healthcare organizations in Germany to improve patient safety. Our insights may further inform recommendations for future development and implementation of effective patient involvement in healthcare organizations, especially for similar countries with low levels of PE.

Trial registration: German Clinical Trials Register (ID: DRKS00031837).

Vertigo, including central and peripheral causes, is one of the common symptoms in patients who are admitted to neurological outpatient and emergency rooms. Despite the advancements in imaging techniques in recent years, central vertigo is difficult to identify and is often misdiagnosed in clinical practice. In this study, 4 patients were admitted to the hospital with complaints of dizziness or vertigo. Information about their symptoms, physical examinations and imaging were collected. Two patients were accurately diagnosed using diffusion-weighted imaging (DWI), a specific type of brain MRI. They received targeted treatments, which led to significant improvement, and were discharged nearly cured within a week. One patient with dorsolateral medullary infarction was misdiagnosed due to atypical symptoms, such as vertigo without the typical lateral medullary syndrome signs, and was discharged with a mild swallowing disorder after 2 weeks of treatment. One patient was diagnosed with both central and peripheral vertigo. It was observed that the symptoms of isolated vertigo caused by an acute lacunar infarction resolved more quickly than the accompanying physical symptoms. In summary, more attention should be paid to the diagnosis of isolated central vertigo, as early identification and intervention can improve a patient's prognosis and reduce medical expenses.

Background: Deep venous thrombosis (DVT), known to be a major factor in poor outcomes and death rates, is common after polytrauma with traumatic brain injury (TBI). In this study, a nomogram will be developed to predict the risk of DVT in polytrauma patients with TBI, since there is currently no specific and convenient diagnostic method.

Methods: A retrospective and observational trial was conducted between November 2021 and May 2023. The predictive model was created using a group of 349 polytrauma patients with TBI in a training set, with data collected between November 2021 and August 2022. A nomogram was presented after using multivariable logistic regression analysis to create the predictive model. Validation of the model was conducted internally. A separate group for validation included 298 patients seen consecutively between August 2022 and May 2023.

Results: A total of 647 trauma patients were included in the study. Out of these, 349 individuals were part of the training group, while 298 were part of the validation group. Training cohorts reported 32.1% and validation cohorts reported 31.9% DVT. Age, Smoking, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), D-dimer, Mechanical ventilation (MV) and Application of Vasoactive Drugs (AVD) comprised the individualized prediction nomogram. The model exhibited strong discrimination, achieving a C-index of 0.783 and a statistically insignificant result (P=0.216) following the Hosmer-Lemeshow test. Nomogram calibration plots and decision curve analysis showed the nomogram's utility in predicting DVT.

Conclusion: Our study characterized the incidence of DVT in polytrauma patients with TBI and further emphasized that it represented a substantial health concern, as evidenced by its frequency. Using this nomogram, it is possible to predict DVT in polytrauma patients with TBI based on demographics and clinical risk factors.

Background: There is lack of predictive models for the risk of severe complications during hospitalization in patients with acute myocardial infarction (AMI). In this study, we aimed to create a nomogram to forecast the likelihood of in-hospital severe complications in AMI.

Methods: From August 2020 to January 2023, 1024 patients with AMI including the modeling group (n=717) and the validation group (n=307) admitted in Changsha Central Hospital's emergency department. Conduct logistic regression analysis, both univariate and multivariate, on the pertinent patient data from the modeling cohort at admission, identify independent risk factors, create a nomogram to forecast the likelihood of severe complications in patients with AMI, and assess the accuracy of the graph's predictions in the validation cohort.

Results: Age, heart rate, mean arterial pressure, diabetes, hypertension, triglycerides and white blood cells were seven independent risk factors for serious complications in AMI patients. Based on these seven variables, the nomogram model was constructed. The nomogram has high predictive accuracy (AUC=0.793 for the modeling group and AUC=0.732 for the validation group). The calibration curve demonstrates strong consistency between the anticipated and observed values of the nomogram in the modeling and validation cohorts. Moreover, the DCA curve results show that the model has a wide threshold range (0.01-0.73) and has good practicality in clinical practice.

Conclusion: This study developed and validated an intuitive nomogram to assist clinicians in evaluating the probability of severe complications in AMI patients using readily available clinical data and laboratory parameters.

The interrelationality of health and peace is complex, multifactorial, and imbued with political and economic challenges. Peace and health outcomes reflect shared fundamental values related to the achievement of a balanced holistic condition on the individual and collective level. This causal relationship between social inequity and health requires special attention be paid to the impact of political instability and structural violence on undermining health systems in conflict zones. The mutual dependency between peace and health means that peace cannot be achieved without the existence of physical, mental, social, and spiritual health, and holistic health cannot be sustained under violent conditions. The interrelationality of peace and health as mutual conditions shapes our understanding of global solidarity and advocacy in relation to health diplomacy and peace promotion if addressed equally across all conflict zones. This commentary analyzes the unique interdisciplinary contextual factors that contribute to, or undermine the realization of global health and peace in three active conflict zones: Palestine, Ukraine, and Venezuela. Contextual analysis, review of the evidence, and synthesis of the authors' perspectives were used. The health-peace nexus remains a theoretical approach and lacks real application in most settings under crisis. Peace is a multifaceted phenomenon that necessitates the participation, dedication, and action of all sectors and stakeholders in global societies, including health policymakers, scientists, professionals, and people. Both the "right to health" and the "right to peace" even at the minimum remains unfulfilled, particularly in Palestine, and can be realized through two trajectories: (1) honest, responsible, and fair accountability, transparency, and political commitment empowered by reliable global health diplomacy for maintaining peace, eliminating the roots of injustice, and protecting health systems, and (2) equitable and real implementation of peace-health approaches, policies and actions driven by monitoring mechanisms that promote health, well-being, health security and equity for all nations under conflicts.

Objective: To describe the prevalence of self-reported coronary heart disease (CHD) and assess the influence of varied risk factors on it in Tianjin.

Methods: This study included a total of 102,576 individuals aged 35 to 75 from 13 community health centers and grassroots hospitals in Tianjin. Basic information, questionnaire responses, physical examinations, and laboratory tests of each participant were researched, and documented. Participants were categorized into CHD group and non-CHD group. Multivariate logistic regression was utilized to evaluated the relationships between associated factors and CHD.

Results: The prevalence of self-reported CHD was 2.56%, 3.97% among men and 1.69% among women. In multivariate logistic regression analysis, older age (41-65 years: OR: 7.37, 95% CI: 4.56-11.94; >65 years: OR:17.88, 95% CI: 11.02-29.01), female sex (OR: 0.40, 95% CI: 0.36-0.44), education (sedentary level: OR: 0.88, 95% CI: 0.79-0.97; high level: OR: 0.74, 95% CI: 0.63-0.87), family annual income (10,000-50,000 yuan: OR: 0.68, 95% CI: 0.60-0.77; >50,000 yuan: OR: 0.71, 95% CI: 0.62-0.82), recently drinking habits (2-4 times /month: OR: 0.75, 95% CI: 0.63-0.90; 2-3 times/week: OR: 0.69, 95% CI: 0.56-0.86; >4 times/week: OR: 0.72, 95% CI: 0.63-0.83), obesity (OR: 1.17, 95% CI: 1.07-1.28), central obesity (OR: 1.51, 95% CI: 1.33-1.71), hypertension (OR: 1.60, 95% CI: 1.43-1.80), dyslipidemia (OR: 0.90, 95% CI: 0.83-0.98), diabetes mellitus (OR: 2.02, 95% CI: 1.85-2.19), stroke (OR: 1.42, 95% CI: 1.24-1.63), family history (CVD: OR: 4.48, 95% CI: 4.00-5.01; stroke: OR: 1.83, 95% CI: 1.58-2.12) were associated with CHD (P < 0.05).

Conclusion: These findings highlight growing concerns regarding the escalating rates of CHD. Implementing multifaceted, population-based interventions is crucial to mitigate the burden of cardiovascular conditions.

Clinical trial registry number: The study received approval from the Ethics Committee of Tianjin Chest Hospital (approval number: 2018KY-003-01). Written informed consent was obtained from all survey participants.

Objective: This study aimed to develop a measurement scale with good reliability and validity to assess the reasonableness of resident healthcare-seeking culture.

Methods: This investigation utilized a cross-sectional research design, employing a multi-stage random sampling technique to select adult inhabitants aged eighteen and above who possess fundamental literacy abilities. An online survey was conducted from March to April 2021 across 27 provinces in China, encompassing 911 questionnaires for scale development. This study primarily applied discriminant coefficients and exploratory factor analysis to refine the scale items. Scale reliability was assessed using Cronbach's alpha, and split-half reliability. Scale validity was determined through content validity and structural validity. Data analysis was performed using SPSS 21.0, and structural equation modeling was executed with AMOS 23.0 software. Statistical significance was defined at P<0.05.

Results: The Resident Healthcare-seeking Culture Scale (RHCS) ultimately comprised 5 dimensions and 20 items. The cumulative explained variance of the five common factors within this scale amounts to 55.24%, satisfactorily adhering to the established criterion of social science research that the extracted factors should explain between 50% and 60% of the total variance. The Cronbach's alpha coefficient for the total scale was 0.83. Split-half reliability was 0.87. The Pearson correlation coefficients associating the scores from the five dimensions with the overall scale score were 0.78, 0.65, 0.65, 0.64, and 0.42, respectively, all statistically significant with P-values less than 0.001. The results of confirmatory factor analysis suggested that RMR=0.045, GFI=0.952, AGFI=0.936, PGFI=0.712, NFI=0.917, IFI=0.944, TLI=0.931, CFI = 0.943, and RMSEA = 0.046.

Conclusion: The measurement scale for healthcare-seeking culture among Chinese residents exhibits superior reliability and validity, serving as an effective instrument for hospital administrators to evaluate the reasonableness of demand-side healthcare culture.