Risk Management and Healthcare Policy最新文献

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.

Objective: To investigate the risk factors associated with dry eye disease (DED) development in cataract (CAT) patients following phacoemulsification surgery, with a focus on lens nucleus hardness grading, and to develop a predictive model for individualized clinical management.

Methods: This retrospective study included 150 cataract patients who underwent phacoemulsification from January 2023 to January 2025. Lens nucleus hardness was graded using the Emery system. Preoperative assessments included ocular surface status and systemic comorbidities. Logistic regression was used to identify independent risk factors, and a predictive model was developed and evaluated by receiver operating characteristic (ROC) analysis.

Results: Postoperative DED occurred in 38.7% of patients. Multivariate analysis revealed that diabetes mellitus, history of keratoconjunctivitis, conjunctivochalasis grade ≥III, lens nucleus hardness grade ≥IV, and 3.0 mm clear limbal incision were independent risk factors (all P<0.05). The prediction model showed good performance (AUC=0.836), with 84.5% sensitivity and 69.6% specificity.

Conclusion: Lens nucleus hardness, along with key clinical factors, independently predicts DED risk after cataract surgery. The developed model may assist in early risk identification and personalized perioperative management.

Healthcare is a constantly evolving field enriched by new technologies, medications, and treatment methods. However, these continuous innovations also introduce new complexities that can pave the way for medical errors to arise. As a result, quality of care and patient safety are always at stake, highlighting the imperative to set up processes to avoid errors in healthcare at any cost. This need for systematic approaches has led to the adoption of Quality Improvement Science (QIS), which deals with the early identification of problems and suggests ways to prevent them in a proactive manner. This study explores the principles of QIS as applied to patient safety, examining various approaches and proposing strategies to implement effective solutions. It further investigates methods for constant quality improvement, emphasizing the roles of technology and human resources in enhancing healthcare quality and patient safety. In particular, it studies how artificial intelligence (AI) strengthens information gathering and organization to provide practical insights. Furthermore, this study discusses the enablers and barriers to successful implementation of these quality improvement processes. Crucially, this paper provides a comprehensive and actionable framework for selecting appropriate QIS tools and indicators, developed through a structured synthesis of QIS literature and represented as decision flows that enable systematic care delivery problem identification and analysis.

Purpose: In Japan, the financial relationship between pharmaceutical companies and patient advocacy groups is considered to be weak; however, limited studies have examined this relationship. The financial relationship and issues surrounding the relationship between the two parties remain unclear.

Patients and methods: This study investigated the relationship between Japanese patient support groups and pharmaceutical companies by interviewing 10 pharmaceutical companies and examining the underlying challenges. Conducted from 2022 to 2023, this research employed a qualitative and quantitative interview survey using a prospective study design. Interview content was transcribed, coded, and categorized.

Results: In 70% of the pharmaceutical companies, the most common type of work with patient advocacy groups was listening to the patient's voice, and 90% of the pharmaceutical companies worked to understand patients' needs. Pharmaceutical companies viewed patient advocacy groups as partners in hearing the voices of patients. Regarding the relationship between the two parties, 60% of the pharmaceutical companies believed that the current guidelines were sufficient, despite some problems with the regulations, systems, and the number of group activities.

Conclusion: Compared with other countries, groups in Japan are unique in their relationships, size, history, and culture. These results indicate that in Japan, listening to the issues and voices of patients and their families is emphasized rather than financial support. Consequently, there was less concern about compromising the independence of patient advocacy groups, unlike those overseas. Regarding the problems in the relationship between patient advocacy groups and pharmaceutical companies, although the regulations make it difficult for these groups and companies to interact, immediate improvement of the regulations was deemed unnecessary. They prioritize collaboration to listen to the voices of patients. We considered that in Japan, unlike other countries, there is less risk that the independence of patient advocacy groups will be compromised by large amounts of financial support.

The rapid advancement of medical brain-computer interface (BCI) technology necessitates the transformation and upgrading of traditional governance paradigms urgently. China, the United States, and the European Union hold prominent positions in the global medical BCI landscape and have developed three highly representative governance models. Existing research on medical BCI primarily focuses on specific countries or regions, but it has failed to conduct a comprehensive comparison of governance frameworks across different jurisdictions from a horizontal perspective. In this study, a horizontal policy text analysis was employed to comprehensively compare the divergent approaches of China, the United States, and the European Union in regulating medical BCI, focusing on regulatory frameworks, approval procedures, neural data governance, and ethical governance. China's medical BCI governance is state-led, prioritizing safety; the United States features innovation-driven flexibility; the European Union uses an empowerment model to strictly mitigate risks. Yet these three models have inherent drawbacks. To ensure the healthy development of medical BCI, we suggest China, the United States, the European Union and other jurisdictions establish a lifecycle regulatory mechanism, introduce the regulatory sandbox, promote collaborative governance among multiple subjects, build hierarchical informed consent rules, endow users with neurorights and refine BCI ethical governance.

Purpose: This scoping review aims to summarize the landscape of web-based interventions for family caregivers of individuals with dementia, with a specific focus on their design, implementation approaches, and outcomes.

Methods: This scoping review followed Arksey and O'Malley's five-stage framework and conducted a comprehensive literature search of publications up to October 1, 2025. Six databases were systematically searched, with relevant studies collected and cataloged. The analysis focused on the theoretical foundations, development, content, and implementation of interventions, as well as intervention outcomes. Descriptive statistics were employed for data analysis.

Results: A total of 41 studies met the inclusion criteria, representing 37 unique web-based interventions. Half of the studies were conducted in the United States and the Netherlands. Over 80% (80.5%) of the interventions were delivered via websites, with a smaller proportion (19.5%) provided through applications. The interventions typically featured components including providing information and care skills guidance (85.4%), peer support (41.5%), contact with professionals (43.9%), decision support (39.0%), psychological support (90.2%), and self-care guidance (90.2%). Although a substantial portion of interventions demonstrated notable improvements in caregiver burden and stress within the intervention groups, differences between the intervention and control groups were often not substantial. Additionally, approximately two-thirds (68.3%) of the interventions lacked theoretical guidance in their development and implementation.

Conclusion: The scoping review indicates that existing web-based interventions have potential benefits in supporting family caregivers of individuals with dementia, but there are notable gaps in personalization, theoretical guidance, and strategies to enhance adherence. Future studies should focus on strengthening the theoretical frameworks that guide intervention design and implementation, improving adherence strategies, and exploring more flexible and personalized online tools to reduce caregiver burden and stress, thereby enhancing the effectiveness and scalability of these interventions.

Background: The Western Pacific Region is experiencing accelerated population aging, and diseases related to Low Bone Mineral Density (LBMD) have become a major public health challenge for the elderly population. Therefore, this study aims to assess the trends in the diseases burden of LBMD among the population aged 60 and above in the Western Pacific Region from 1990 to 2021, as well as its relationship with the human resources for health (HRH).

Methods: Disability-Adjusted Life Years (DALYs) and deaths data from Global Burden of Disease Study (GBD) 2021 and HRH data from GBD 2019 were used. The trends in the burden were evaluated through percentage changes and the Estimated Annual Percentage Change. Decomposition analysis was employed to assess the contributing factors of the burden. The Spearman rank correlation coefficient was used to quantify the correlations between the burden indicators, the Socio-demographic Index (SDI), and HRH.

Results: From 1990 to 2021, the diseases burden of LBMD increased in most countries and regions in the Western Pacific Region. From the perspective of gender stratification, the disease burden of females is generally higher than that of males. From the perspective of age stratification, the age-standardized rates of DALYs and deaths both increase with increasing age. There is a statistically significant negative correlation between deaths and SDI (p<0.05). More importantly, there has been a statistically significant negative correlation between deaths and Nursing and Midwifery from 1990 to 2021 (p<0.05).

Conclusion: The disease burden of LBMD in the Western Pacific Region remains a major public health issue. Strengthening the construction of HRH is conducive to reducing the burden related to LBMD.

Background: Interdialytic hyperkalemia is linked to a heightened risk of adverse clinical outcomes among patients undergoing maintenance hemodialysis (MHD). This study aimed to develop and validate a nomogram to assess the risk of interdialytic hyperkalemia in this patient population.

Methods: A total of 312 patients undergoing MHD were retrospectively enrolled from two hemodialysis centers between January 2024 and December 2024. The group was randomly divided into a training set and a validation set in a 7:3 ratio. Least absolute shrinkage and selection operator regression was applied to identify independent predictors of hyperkalemia, which were subsequently incorporated into a multivariate logistic regression model. Model performance was assessed using receiver operating characteristic curve analysis, area under the curve (AUC), calibration plots, and decision curve analysis (DCA) to assess both discrimination and clinical utility.

Results: The overall incidence of interdialytic hyperkalemia was 28.2%. The final nomogram included seven predictors: dietary potassium intake, dietary phosphorus intake, serum albumin concentration, pre-dialysis blood glucose level, interdialytic weight gain rate, time interval since the last dialysis session, and a history of hyperkalemia within the preceding three months. The model demonstrated strong discriminatory ability with an AUC of 0.905 (95% Confidence Interval (CI): 0.883-0.931) in the training set and 0.782 (95% CI: 0.756-0.819) in the validation set. Calibration plots indicated good agreement between predicted and observed outcomes. DCA confirmed the clinical applicability of the model by demonstrating a net benefit across a range of threshold probabilities.

Conclusion: A nomogram-based risk prediction model for interdialytic hyperkalemia in patients undergoing MHD was developed and externally validated. The model demonstrated robust predictive performance and may assist clinicians in early identification of patients who are at high-risk, thereby supporting timely interventions.

Introduction: Stroke is the second leading cause of death worldwide and ranks third as a cause of disability. The American Heart Association/American Stroke Association (AHA/ASA) recommends that treatment begin within three hours of onset with intravenous thrombolysis therapy. This scoping review aimed to identify the factors that influence the delay in intravenous thrombolysis (IVT) management in patients with ischemic stroke.

Methods: We searched relevant studies in PubMed, ScienceDirect, and EBSCO and this review includes studies on ischemic stroke patients that analyze the factors contributing to delays in intravenous thrombolysis therapy, and it demonstrates that such delays are present in the management of IVT.

Results: A total of 48 studies were included in this study. Among pre-hospital factors, the most frequently reported contributors to delays in IVT for acute ischemic stroke (AIS) patients were the use of Emergency Medical Services (EMS) (12 studies), mode of hospital presentation (12 studies), comorbidities (6 studies), symptom recognition (5 studies), and timing of event (5 studies), with several studies reporting statistically significant associations (p<0.05). Emergency department use shortened hospital admission time by an average of 30 minutes, p<0.05Regarding in-hospital delay factors, the main contributors to delays included long scan times (5 studies), low NIHSS scores (5 studies), and limited implementation of stroke programs (5 studies). Other in-hospital delay variables included delayed activation of stroke codes (3 studies), inefficiency of human resources (3 studies), suboptimal triage processes (2 studies), diagnostic process (1 study), and logistics (1 study).

Conclusion: Delayed thrombolysis in ischemic stroke patients is caused by various factors, both pre-hospital and in-hospital. Community education and telemedicine can reduce delays by 30%. Collaboration between the community, stroke units, medical personnel, and the government through comprehensive programs is key in accelerating stroke treatment and improving patient clinical outcomes.