Risk Management and Healthcare Policy最新文献

Background and objective: To enhance healthcare service quality and foster harmonious doctor-patient relationships, it is necessary to explore the impact of physicians' overwork on patient satisfaction, with the mediating roles of physician-nurse collaboration and patients' medical risk perception in these relationships.

Methods: Using a stratified random sampling method, questionnaire surveys were conducted from June to September 2023 among 90 physicians and 550 inpatients in 13 Grade A tertiary public hospitals across five provinces in China. This survey collected data on physicians' overwork, physician-nurse collaboration, patient's medical risk perception, and patient satisfaction. The data were analyzed using the PROCESS macro (Model 6) in SPSS 23 to examine the chain mediation model.

Results: A total of 81 physicians and 512 inpatients were included. Physicians' overwork had a significant negative effect on patient satisfaction (β = -0.426, p < 0.001). Physician-nurse collaboration (β = 0.463, p < 0.001) and patients' medical risk perception (β = -0.260, p < 0.001) acted as partial mediators, accounting for 24.41% and 5.87% of the total effect, respectively. Furthermore, physicians' overwork indirectly affected patient satisfaction through a chain mediation pathway involving physician-nurse collaboration followed by patients' medical risk perception (β = -0.014, p < 0.001), accounting for 3.29% of the total effect.

Conclusion: Physicians' overwork demonstrates a significant negative predictive effect on patient satisfaction, encompassing both direct and indirect effects mediated by physician-nurse collaboration and patients' medical risk perception. To improve healthcare quality and satisfaction, governments should address physicians' overwork and patient risk perception. Future research could explore physician-patient trust as a mediator or analyze how different dimensions of risk perception influence chain-mediated pathways.

Purpose: The aim of this study was to examine how health-care professionals in assault centers in Norway navigate biomedical ethical principles, health-care legislation, and the mandatory reporting law when working with victims of intimate partner violence (IPV). The study was guided by the following research questions: How do health-care professionals in assault centers apply the law for mandatory reporting of IPV (MR-IPV)? How do they navigate various factors when they consider applying the MR-IPV law?.

Methods: This qualitative, explorative study is built on 12 individual, semi-structured interviews with nurses and medical doctors working at assault centers. The data were analyzed using Braun and Clarke's reflexive thematic analysis, with themes developed based on biomedical ethical principles, including relational autonomy.

Results: Two main themes were found. First, MR-IPV was perceived as subsequent but parallel to emergency medical treatment. Some participants used risk assessment tools, and they all emphasized the importance of making patients safe following medical treatment. However, only a few acknowledged that their duty to respect the MR-IPV law was a factor in prioritizing patient safety. Second, ethical principles and health-care legislation were recognized more than the MR-IPV law, which created dilemmas for nurses and medical doctors. These actors faced challenges in navigating patients' autonomy and beneficence in relation to the MR-IPV legislation. Conflicts between patient autonomy and beneficence can lead to paternalistic behavior, which creates ethical dilemmas.

Conclusion: The findings show tensions between medical practices and legal and ethical standards, which contributed to hesitation in reporting severe IPV cases to the police. Health-care professionals prioritized therapeutic relationships and patient confidentiality, sometimes at the expense of their responsibilities concerning the MR-IPV law. Addressing these challenges requires enhancing legal literacy and fostering a cultural shift in health care to align professional autonomy with legal requirements and institutional responsibilities.

Purpose: To conduct a cost-effectiveness analysis comparing zuberitamab combined with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone; Hi-CHOP) versus rituximab combined with CHOP (R-CHOP) as first-line therapy for previously untreated CD20-positive diffuse large B-cell lymphoma (DLBCL) patients in China.

Patients and methods: A partitioned survival model (PSM) was developed to conduct a cost-effectiveness analysis of Hi-CHOP versus R-CHOP regimens in newly diagnosed CD20-positive DLBCL patients. The study utilized a 20-year time frame. Evaluated outcomes included overall survival (OS), quality-adjusted life-years (QALYs), total treatment costs, and incremental cost-effectiveness ratios (ICERs). The willingness-to-pay (WTP) threshold was defined as $40,334.05 per QALY, equivalent to triple China's 2024 per capita GDP.

Results: The base-case analysis indicated that Hi-CHOP provided an additional 1.49 life-years and 1.57 QALYs compared to R-CHOP. The total treatment cost of Hi-CHOP was $238,164.77 higher than that of R-CHOP over 20 years, resulting in ICERs of $151,373.19 per QALY and $160,273.99 per life-year. One-way sensitivity analysis (OSA) identified progression-free survival (PFS) utility as the most significant parameter impacting model outcomes. Probabilistic sensitivity analysis (PSA) demonstrated that almost all simulated outcomes surpassed the WTP threshold. The cost-effectiveness acceptability curve (CEAC) demonstrated R-CHOP's superior cost-effectiveness probability relative to Hi-CHOP across a WTP range from $0 to $150,000.

Conclusion: Given that Hi-CHOP is not cost-effective at conventional WTP thresholds, a substantial price reduction or unnecessary procedures, and optimizing clinical workflows for Hi-CHOP would be necessary to make it an economically viable first-line option for DLBCL compared to R-CHOP.

Background: The Acute Physiology and Chronic Health Evaluation II (APACHE II) is a widely used intensive care unit (ICU) severity score; however, it provides only an admission snapshot. Therefore, we introduced a novel metric, APACHE/m (average daily decrease in APACHE II score during ICU stay), to examine whether faster physiological improvement was correlated with better outcomes in ICU trauma patients.

Methods: This retrospective cohort study was conducted at a level I trauma center. Participants comprised 1784 adult trauma patients admitted to the ICU (2016-2023) who survived ICU discharge were included in this study. The APACHE II scores at ICU admission and discharge were recorded. APACHE/m was calculated as the decrease in APACHE II divided by the length of stay in the ICU. We analyzed the ability of APACHE/m to predict post-ICU in-hospital mortality and compared outcomes between the high and low APACHE/m groups. Propensity score matching (1:1) was used to adjust for initial injury severity and comorbidities.

Results: Hospital mortality after ICU discharge was 2.3% (41/1784). APACHE/m alone showed poor discrimination for mortality (AUC = 0.57). In the unmatched cohort, mortality was 2.6% in high APACHE/m patients (>1.03 points/day) vs 2.0% in low APACHE/m patients (≤1.03), P = 0.523. After matching (199 pairs), high APACHE/m patients had longer hospital stays (median, 14 vs 12 days, P = 0.005) and higher mortality (3.5% vs 0%, P = 0.022) than matched low APACHE/m patients.

Conclusion: A rapid APACHE II score decline (high APACHE/m) did not predict improved survival in ICU trauma patients. Paradoxically, the patients with the fastest APACHE II improvements had similar or worse late outcomes, likely because they were initially more critically ill. Thus, initial severity remains an important predictor of outcomes than the ICU recovery rate.

Background: Catheter-associated urinary tract infection (CAUTI) is the most frequent hospital-acquired infection and remains a major challenge for nursing quality and infection control. Existing studies are fragmented, and high-quality evidence syntheses are lacking.

Objective: This study aimed to systematically search for relevant evidence on the prevention and care of catheter-associated urinary tract infections. The evidence was evaluated and integrated to provide reference for clinical practice.

Design: This study was conducted as a systematic evidence summary, following a systematic review methodology to identify, appraise, and synthesize best available evidence on the prevention and care of catheter-associated urinary tract infections.

Methods: Identify the evidence-based questions, based on the "6S" evidence pyramid model, evidence related to the prevention and care of urinary tract infections in patients with indwelling urinary catheters were systematically searched from relevant databases and relevant websites for clinical decisions, guidelines, evidence summaries, systematic reviews and expert consensuses. The study was initiated in December 2024, and the search period covered from database inception to January 2025. Three researchers who had completed their professional training and assessment at the Evidence-based Nursing Center conducted literature screening, quality evaluation, and evidence synthesis. The study population was global, not restricted to a specific region.

Results: Fourteen studies were included: two clinical decision-making articles, eight guideline articles, two systematic review articles and two expert consensus articles. A total of 32 pieces of evidence were formed in five aspects: pre-catheterization criteria, catheterization techniques and requirements, daily care and maintenance of urinary catheters, catheter removal, and diagnosis and treatment of CAUTI.

Conclusion: This study summarizes the best available evidence on the prevention and care of urinary tract infections in patients with indwelling urinary catheters. The findings provide an evidence base for clinical nursing practice, enhance nurses' awareness of CAUTI prevention and care, and support the development of evidence-informed protocols for clinical settings.

Trial registration: This study was registered at the Center for Evidence-Based Nursing of Fudan University (registration number ES20257362).

Objective: This study aimed to construct and evaluate an AI-assisted mobile nursing information closed-loop management model.

Methods: This study adopted a prospective before-after control design to compare nursing indicators before and after model implementation, conducted in the Pediatric Surgery Department of Anqing Municipal Hospital Affiliated with China Pharmaceutical University, where an information management system was implemented. A statistical analysis was conducted on the quality control data of 3891 cases (from 438 hospitalized patients) before model implementation (March to May 2024) and 3697 cases (from 417 patients) after implementation (July to September 2024) to evaluate its effectiveness. Existing quality control indicators were reviewed, and new/updated metrics generated from the implementation of new nursing closed-loop management measures were evaluated. AI-driven tools were leveraged to enhance the early warning capabilities of mobile nursing information systems through data acquisition, collection, and interpretation, and establishing a closed-loop management model for mobile nursing information.

Results: Following the model implementation, significant improvements were observed in all evaluated indicators. The bedside settlement completion rate rose from 66.16% to 83.3% (χ²=61.63, *p*<0.001), and the critical value reception rate increased from 51.72% to 93.55% (χ²=21.78, *p*<0.001). The nursing plan and workflow completion rates improved to 98.17% and 94.89% (both *p*<0.001), respectively. Nursing work efficiency surged from 3.03 to 25 tasks per hour, and overall patient satisfaction increased from 83.3% to 97.65%, confirming the model's effectiveness in enhancing nursing quality and patient experience.

Conclusion: The AI-assisted mobile nursing information closed-loop management model presented here was found to enhance nursing work efficiency, improve patient experience, and optimize workflow processes, contributing to a more effective and structured nursing management system.

Purpose: This study examines the intersectoral interdependencies of nurse employment, conceptualized as nurse employment spillovers, and their effects on inpatient care quality in Taiwan. It particularly addresses the critical issue that over 40% of Taiwanese nurses report unwillingness to enter or remain in the nursing profession.

Methods: The research design follows a quantitative and observational time-series methodology. A time-series dynamic connectedness network analysis was employed to assess interdependencies in nurse employment across various practice settings. Additionally, a general-to-specific modeling approach was used to examine the relationship between the transmission of nurse employment spillovers and inpatient care quality. The analysis utilized annual data from 1997 to 2023, comprising 27 observations, sourced from publicly available Taiwanese government databases that contain information on nurse employment, inpatient care quality indicator, and relevant control variables.

Results: The analysis reveals that nurse employment in other healthcare facilities and the non-nursing labor market (hospitals, clinics, and long-term care facilities) serves as a net transmitter (receiver) of nurse employment spillovers. Notably, nurse employment inflows from non-nursing to nursing labor markets are linked to enhancements in inpatient care quality. Five distinct spillover pathways originating from clinics, other medical institutions, and non-nursing sectors into hospitals were identified as having positive effects on inpatient care quality. Furthermore, increases in nurses' regular wages are associated with a shift in employment toward hospital settings.

Conclusion: These findings underscore the importance of strengthening hospital nurse employment to improve inpatient care quality. Policymakers should consider salary increases as a means to attract and retain nurses in the healthcare sector, thereby mitigating shortages of nurses and enhancing care outcomes.

Background: Radiation Personal Protective Equipment (RPPE) is crucial for shielding against radiation exposure in medical settings, particularly in orthopedics. Typically stored on open racks outside operating rooms, these items are shared among users without designated ownership.

Objective: This study aims to evaluate contamination rates and levels in lead aprons used in orthopedic surgery, as well as assess the efficacy of cleaning procedures in reducing microbial growth.

Methods: A cross-sectional study was conducted at major tertiary hospital in Eastern Saudi Arabia. Twenty aprons out of thirty in the hospital's orthopedic operating rooms were sampled over two months, both before and after cleaning. Microbiological analysis was performed at Imam Abdulrahman bin Faisal University's microbiology laboratory.

Results: Out of 120 swabs, 62 tested positive for microorganisms including micrococcus, Coagulase-negative staphylococci, Methicillin-sensitive Staphylococcus aureus, Pseudomonas Stutzeri, yeast, Haemophilus spp, Corynebacterium diphtheriae, and Klebsiella. Pre-cleaning contamination was significantly reduced from 37% to 25% post-cleaning (P = 0.023). Highest contamination levels were found inside the aprons (P < 0.001).

Conclusion: While cleaning processes reduced contamination levels, detection of concerning organisms post-cleaning highlights the need for enhanced cleaning protocols in orthopedic surgery settings to mitigate contamination risks effectively.

Purpose: Early identification of pathological changes in high myopia (HM) with tessellated fundus (TF) remains challenging. To address this, a diagnostic nomogram was developed and validated to aid clinical screening of pathologic myopia (PM) in HM patients with TF.

Patients and methods: A cross-sectional study was performed at The First Affiliated Hospital of Guangxi Medical University between May 10, 2023, and March 31, 2024. Patients with HM, defined as a spherical refractive error of ≤ -6.0 D or an axial length of ≥ 26.5 mm, who presented with TF were enrolled. The collected clinical data were randomly divided into training and validation sets at a 7:3 ratio. A diagnostic nomogram was constructed from independent predictive factors. Its discrimination, calibration, and clinical utility were assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results: Data from 418 eyes with TF were included in this study. Independent predictors for PM, in descending order of association, were axial length, optic disc tilt ratio, spherical equivalent, education level, and extent of peripapillary atrophy. The nomogram demonstrated robust performance in both sets. In the training set, the area under the ROC curve (AUC) was 0.851 (95% CI: 0.808-0.895), with a sensitivity of 0.775 and a specificity of 0.736. In the validation set, the AUC was 0.827 (95% CI: 0.755-0.900), with a sensitivity of 0.773 and a specificity of 0.700.

Conclusion: This simple predictive model, developed and validated using common interpretable clinical and fundus imaging features, serves as a valuable tool for screening PM in HM patients with TF.

This protocol's objective is to offer evidence-based suggestions for the identification, treatment, and management of epidermolysis bullosa (EB) in Saudi Arabia. EB is a rare genetic condition that results in blistering and skin fragility. Depending on the subtype, it can produce a variety of consequences. The four primary kinds of EB are EB Simplex, Junctional EB, Dystrophic EB, and Kindler EB. This guideline provides a thorough understanding of EB and describes diagnostic techniques including genetic testing and immunofluorescence mapping. The significance of an interdisciplinary team (IDT) approach in treating severe instances is also covered, guaranteeing integrated treatment across wound care, nutrition, dermatology, genetics, and psychosocial support. In addition, the guideline discusses the role of new treatments for EB, such as Beremagene geperpavec (B-VEC), and stresses the necessity of creating a National Saudi EB Registry to maximize patient care and guarantee fair access to treatment. The guideline also emphasizes the importance of genetic counseling for prenatal diagnosis, family planning, and parental screening, as well as the need to address the psychological difficulties that people living with EB and their families face. In summary, this guideline offers a structured framework for physicians and healthcare providers to guarantee the best possible care for people living with EB in Saudi Arabia, with the goal of improving clinical outcomes, quality of life, and long-term management of the disease.