Risk Management and Healthcare Policy最新文献

Background/objectives: Artificial intelligence (AI) is revolutionizing the healthcare industry, improving diagnoses, treatments, and clinical processes. However, its integration poses significant cybersecurity risks, including data breaches, algorithmic opacity, and vulnerabilities in AI-controlled medical devices. This narrative review analyzes these threats and evaluates blockchain technology as a potential mitigation strategy within a Clinical Risk Management framework.

Methods: The literature search was conducted on PubMed, Scopus, and Web of Science, considering peer-reviewed publications from 2000 to January 2025. 1,204 articles were identified. Inclusion criteria included studies on cybersecurity risks in healthcare, blockchain applications in the clinical setting, and regulatory references (eg, General Data Protection Regulation). Conference abstracts, non-English articles, and non-peer-reviewed contributions were excluded. To ensure methodological rigor, the Scale for the Assessment of Narrative Review Articles criteria were applied.

Results: The thematic analysis highlighted recurring critical issues: difficulties with informed consent, unauthorized access to sensitive data, and systemic vulnerabilities in hospital digital infrastructures. Blockchain presents a promising solution thanks to its decentralization, immutability, and transparency. Integration with smart contracts enables dynamic consent management, secure data sharing, and real-time monitoring of medical devices. Permissioned networks improve traceability and regulatory compliance, while Layer 2 solutions and optimized consent protocols address scalability challenges.

Conclusion: Despite its potential, blockchain adoption faces obstacles: high costs, regulatory rigidity, and poor acceptance among healthcare professionals. The review highlights the need for pilot projects, interdisciplinary collaboration, and regulatory updates for effective integration. Combining AI and blockchain in Clinical Risk Management can transform clinical risk management from reactive to proactive, improving patient safety, data governance, and accountability.

Introduction: Chronic kidney disease (CKD) treatment is often delayed in many countries, creating challenges for the health system. Therefore, it is necessary to strengthen its detection and management from the early stages. Local experiences that have been successful in managing CKD could transfer their policies and thus systematically expand the scope of their organizational learning.

Purpose: To characterize the elements of a success story of early detection and care of CKD in an adult population with social security, in order to transfer it to a similar organization.

Patients and methods: Qualitative study of organizational nature, exploratory, descriptive, and analytical. It consisted of a narrative review, documentation of the process in a primary care unit of a social security institution in Jalisco, Mexico, and a flowchart linking the primary components. The analysis followed the questions used in the design of integrated care pathways.

Results: The literature review highlighted that early detection should be targeted at groups at risk for developing CKD, defining the clinical tests necessary to monitor and stage CKD, as well as management by a multidisciplinary team and the use of nephroprotective drugs. The case characterization provided insight into the institutional context in which the care process for patients with risk factors for CKD takes place. By incorporating the results of the review into the clinical care process, an ideal process for early detection of CKD was developed.

Conclusion: This research allowed the incorporation of elements of the institutional context in the characterization of the process of early detection and care of CKD, systematically identifying organizational and clinical elements that can promote the transfer of this process to other contexts.

Purpose: FMEA (Failure Mode and Effects Analysis), a widely used tool in risk management, lacks systematic guidance on selecting the type of precaution. This study introduces a rule-based FMEA. Although the Risk Priority Number (RPN), widely used in the literature, expresses the risk level quantitatively, it is insufficient for guiding the appropriate type of precaution. The proposed rule-based model uses a multi-dimensional rule system that considers numerical parameters (probability, severity, detectability, and RPN) and contextual variables.

Material and methods: The model, structured according to the Occupational Health and Safety precaution hierarchy, defines six precaution classes: elimination, substitution, engineering measures, training, administrative measures, and personal protective equipment (PPE). The model's theoretical consistency, sensitivity, and practical applicability were tested in a neonatal intensive care unit (NICU).

Results: The FMEA method identified 24 failure modes related to infections. Scenario-based sensitivity analyses revealed that contextual variables significantly influenced the recommended precautions. Administrative and training measures were the most frequently recommended, while PPE was consistently recommended for exposure-related risks. Expert evaluation indicated 95.8% agreement with the model outputs.

Conclusion: These findings indicate that the development of a rule-based system can serve as a repeatable and explainable decision-support tool, especially in high-risk settings such as healthcare, which is the study's most distinctive contribution.

Objective: This study aimed to evaluate the distribution spectrum and epidemiological characteristics associated with post-traumatic sepsis and to identify associated risk factors.

Methods: This retrospective study analyzed data from 722 patients with traumatic injuries admitted to the Emergency Department of the Hebei Medical University Third Hospital between January 1, 2021, and November 30, 2023. Participants were categorized into two groups: those who developed sepsis and those who did not. Patients diagnosed with sepsis were further categorized into survival and non-survival subgroups. Patient demographics, injury characteristics, and clinical variables were collected. Sepsis occurrence was assessed within the first week post-injury. Multivariate logistic regression analysis was performed to identify independent risk factors for post-traumatic sepsis.

Results: Among 722 trauma patients, 189 developed sepsis. In the sepsis cohort, injuries were mainly from traffic accidents (54.5%), falls from heights (17.46%), crush injuries (13.76%), and falls/collisions (11.64%). In contrast, non-sepsis cases (n=533) were predominantly due to falls/collisions (43.15%) and traffic accidents (36.02%). Pulmonary infection was the leading site in both survivors (95.62%) and non-survivors (100%), with some patients presenting multiple infection sites. A predictive model for post-traumatic sepsis, incorporating 10 variables such as hospitalization length and injury site number, achieved excellent performance (AUROC 0.998). A sepsis mortality model, based on five variables including age and injury sites, also showed high accuracy (AUROC 0.969).

Conclusion: Traffic accidents were the primary cause of post-traumatic sepsis. Key risk factors included injury severity, CRP level, and hospitalization duration. Independent predictors of 28-day mortality included age, organ failure score, and vasoactive drug use.

Background: To better understand the temporal evolution of healthcare utilization in Shanghai, this study examines changes in Shanghai's ecology of medical care from 2018 to 2023 and compares them with other countries to contextualize global trends.

Methods: Using data from the 7th Shanghai Health Service Survey (2023), this study estimated monthly health-related symptoms and healthcare-seeking behaviors per 1,000 residents, examined subgroup differences via logistic regression, and contextualized findings through a scoping review of international studies applying the ecology of medical care framework.

Results: In 2023, per 1,000 Shanghai residents per month, 503 reported illness, 495 sought treatments (including healthcare visits or self-medication), 228 visited healthcare facilities, 144 visited primary care, 98 self-medicated, 31 used TCM, 6 were hospitalized, and 3 underwent surgery. Compared to 2018, self-reported illness (+59), treatment seeking (+62), and self-medication (+6) increased, while outpatient visits, primary care, TCM use, and hospitalizations declined. Internationally, Shanghai shows relatively low illness reporting, primary care use, TCM use, and hospitalization rates, but relatively high treatment-seeking and self-medication.

Conclusion: These findings suggest a shift in Shanghai's healthcare utilization from formal services toward individual-led actions, with increased treatment-seeking, higher self-medication, and decreased outpatient, primary care, TCM, and hospitalization use. Internationally, Shanghai shows a distinctive pattern of high treatment-seeking and self-care despite low formal service use, indicating greater reliance on informal health strategies.

Objective: Myxofibrosarcoma (MFS) is a rare malignant fibrogenic soft tissue tumor with high propensity for recurrence. This study retrospectively analyzed the surgical treatment outcomes of patients with myxofibrosarcoma (MFS) at a single center to evaluate the impact of recurrence on survival prognosis.

Methods: Clinical data from 80 patients who underwent surgical treatment for MFS between January 2015 and January 2023 were reviewed retrospectively. Postoperative follow-up was conducted to assess recurrence and overall survival. Kaplan-Meier survival analysis was used to estimate overall survival (OS) and compare survival curves. Patients were stratified into recurrence and recurrence-free groups based on recurrence status. Oncological prognosis, prognostic factors influencing survival and recurrence, and the association between recurrence and survival prognosis were examined.

Results: Over a median follow-up period of 40.6 months, recurrence was observed in 38 patients (47.5%), including 16 patients with multiple recurrences. A total of 17 patients (21.3%) died, and the 5-year OS rate was 70.1%. Independent prognostic factors for OS included age, tumor size, and chemotherapy. The presence of a tumor adjacent to a major vessel or nerve, as well as involvement of the upper extremity, were identified as independent risk factors for recurrence. No statistically significant differences in survival prognosis were observed between patients with and without recurrence. Additionally, survival outcomes did not differ significantly between patients with a single recurrence and those with multiple recurrences.

Conclusion: MFS exhibits a high recurrence rate, with multiple recurrences frequently occurring within three years postoperatively. However, both single and multiple recurrences, when managed with aggressive surgical intervention, may not had an adverse effect on overall survival. For tumors located near major vessels or nerves, achieving complete surgical resection and maintaining vigilant postoperative surveillance are essential to mitigate the risk of recurrence.

Background: The physical activity level of Maintenance Hemodialysis (MHD) patients is closely associated with prognosis and quality of life. This study aimed to investigate the exercise status and influencing factors among MHD patients in the Nantong region.

Methods: A cross-sectional study was conducted among 227 MHD patients from three hospitals in Nantong, China, between June 2024 and February 2025. The Physical Activity Stage of Change Scale was used to assess exercise behavior stage; the Dialysis Patient Exercise Benefits/Barriers Scale was used to evaluate exercise cognition; and the Perceived Social Support Scale was used to assess perceived social support. Patients were divided into regular exercise and non-regular exercise groups based on behavior stage. Influencing factors were analyzed using univariate and multivariate methods.

Results: Among 227 patients, 83 (36.56%) engaged in regular exercise, while 144 (63.44%) did not. Univariate analysis showed that age, marital status, education level, exercise cognition, and social support differed significantly between the two groups (P<0.05). Multivariate logistic regression revealed that marital status, exercise cognition, and social support were independent influencing factors of regular exercise behavior.

Conclusion: Exercise participation among MHD patients in Nantong remains insufficient. Targeted interventions addressing exercise cognition and social support should be adopted to promote regular physical activity in this population.

Keywords: Maintenance Hemodialysis; Physical Activity; Cross-sectional Study; Social Support; Exercise Cognition.

The evolution of digital media over recent decades has fundamentally reshaped how health crises are communicated and managed, significantly influencing medical policy reforms. The increasing prominence of social media platforms has created new opportunities and challenges in health crisis management. This review examines how online discourse surrounding health crises, including both accurate information and misinformation, has shaped public health policy by influencing public trust and complicating policy implementation. Through an analysis of case studies and crisis communication literature, this review identifies the key factors driving policy changes in response to digital public opinion. The role of misinformation, viral content, and digital activism in driving or hindering health policy reforms is discussed, with a focus on how governments and health agencies have adapted their communication strategies to maintain public trust and ensure effective policy implementation. Notable examples include South Korea's digital health initiatives during the COVID-19 pandemic and the United States responses to vaccine eligibility confusion, which illustrate the dynamic relationship between digital mobilisation and policy shifts. The review advocates for the integration of digital engagement strategies into health policy development, emphasising transparency, real-time feedback, and active stakeholder participation. Best practices in digital crisis management, such as social media monitoring, data-informed decision-making, and transparent communication, are highlighted. As digital media continues to shape public opinion, agile, transparent, and responsive communication has become critical. Policymakers must now consider digital engagement not only as a tool for crisis management but as an essential component of the policymaking process.

Purpose: Studying abroad represents a significant risk factor for diminished health and well-being due to cultural, environmental, and psychosocial challenges. This study aimed to explore international students' perceptions of well-being and examine the factors contributing to their well-being while living and studying abroad.

Methods: We used an exploratory sequential mixed-methods study design. The first part of the research involved a qualitative study conducted through in-depth interviews and focus group discussions. We analyzed the data using thematic analysis. We used the results from the first stage to develop the quantitative part of the study. Multiple regression was used to analyze the factors contributing to international students' perceived well-being.

Results: The qualitative study identified four main factors: academic life, health, social connectedness, and environmental factors. The quantitative study found that faculty and student status significantly affected well-being.

Conclusion: Universities and those managing international student affairs should develop pre-arrival plans for incoming students, considering their diverse backgrounds and perspectives on well-being. Student well-being positively influences academic results by enhancing cognitive function, motivation, social engagement, and resilience while reducing risks of stress, burnout, and dropout rates.

Background: The COVID-19 pandemic has brought about substantial changes in lifestyles, highlighting the importance of online nutritional counseling as a viable strategy to enhance knowledge and promote healthier lifestyles. This approach serves as an alternative means to prevent non-communicable diseases and strengthen immune function. This study aimed to assess the impact of nutritional tele-counseling on knowledge levels and lifestyle habits related to immunity among university staff members in Lima, Peru.

Methods: A quasi-experimental analytical study was conducted, using a non-probabilistic convenience sampling method to select a sample of 35 participants aged between 30 and 59 years. The study was conducted via the Zoom platform. A pre-test was administered, followed by a two-month counseling program that included sessions on nutrition and lifestyle-related topics. A post-test was administered at the conclusion of the intervention. Data analysis was conducted using the McNemar test for categorical variables and the Wilcoxon signed-rank test for quantitative variables, with a statistical significance level set at p < 0.05. All analyses were performed using SPSS version 17.

Results: The knowledge score related to immunity-enhancing foods and nutrients showed a significant increase, with the mean score rising from 3.3 ± 1.9 to 7.1 ± 1.5 (p < 0.001). Similarly, following the intervention, a significant improvement in lifestyle scores was observed, with the mean score increasing from 4.3 ± 1.8 to 11.3 ± 1.6 (p < 0.001).

Conclusion: These results demonstrate the effectiveness of the nutritional tele-counseling program in significantly enhancing both nutritional knowledge and lifestyle practices.