Risk Management and Healthcare Policy最新文献

Objective: This study aims to analyze the service supply challenges for Family Physicians during public health emergencies through the lens of street-level bureaucracy.

Methods: Guided by street-level bureaucracy theory within a three-tier analytical framework (micro-, meso-, and macro-levels), this qualitative study employed semi-structured interviews with 36 Family Physicians in Shanghai regarding their responses to a public health emergency. Interviews were recorded, transcribed verbatim using "iFlytek Hearing" software, manually reviewed, and analyzed thematically using NVivo 10.

Results: The analysis revealed multi-level challenges. At the micro-level, Family Physicians faced dual role pressures as "state agents" and "public agents", leading to reduced discretionary power and a tendency for prosocial deviant behavior; their understanding of policies and effectiveness of communication with the public directly impacted policy implementation outcomes. At the meso-level, resource scarcity created supply-demand contradictions, triggering adaptive policy implementation, where Family Physicians innovatively met service needs under constraints and participated in community collaborative governance. At the macro-level, policy ambiguity was prominent, essential medicine supply chains faced difficulties, and training and career development pathways in general practice remained underdeveloped.

Conclusion: This study provides a deep understanding of the service supply challenges faced by Family Physicians during public health emergencies, offering a scientific basis for optimizing service supply strategies, and this theoretical framework can be extended to the analysis of other street-level bureaucrats.

Purpose: To investigate the interaction between metabolic and behavioral factors in non-proliferative diabetic retinopathy (NPDR) among elderly patients with type 2 diabetes mellitus (T2DM).

Patients and methods: A cross-sectional study was conducted from October 2023 to May 2024 using cluster random sampling to recruit elderly patients with T2DM from two tertiary hospitals in Nantong. A self-designed questionnaire was utilized to collect lifestyle and behavioral data. Non-mydriatic fundus photography was used for DR screening, and biochemical indicators were extracted from electronic medical records. Descriptive statistics were applied to analyze demographic characteristics, while univariate and multivariable logistic regression analyses were performed to identify factors influencing NPDR. Interaction models evaluated multiplicative and additive effects between metabolic indicators (low-density lipoprotein cholesterol [LDL-C], urine albumin-to-creatinine ratio [UACR]) and weekly fish consumption frequency on NPDR. Receiver operating characteristic (ROC) curves assessed the diagnostic value of elevated UACR, low fish consumption, and their interaction for NPDR.

Results: Among 978 eligible elderly patients with T2DM, 794 were included, with 306 (38.5%) diagnosed with DR, including 246 (31.0%) with NPDR. Multivariable logistic regression identified diabetes duration, LDL-C, UACR, and weekly fish consumption as independent risk factors for NPDR. Interaction analysis demonstrated significant positive multiplicative (OR=8.89, 95% CI=2.87-9.52, P<0.001) and additive interactions (RERI=2.77, API=0.31, SI=1.54) were observed between low fish consumption (<2 times/week) and severe UACR (>33.9 mg/mmol). No interactions were found with moderate UACR (3.4-33.9 mg/mmol) or elevated LDL-C (>1.8 mmol/L). ROC analysis demonstrated AUC values of 0.840, 0.816, and 0.893 for severe UACR, low fish consumption, and their combined effect, respectively, indicating enhanced diagnostic utility for NPDR.

Conclusion: The synergistic interaction between severe UACR and infrequent fish consumption significantly elevates NPDR risk in elderly patients with T2DM, highlighting its potential as a predictive marker for early intervention.

Background: Nurses are pivotal to healthcare delivery, particularly in critical care settings where their performance directly affects patient outcomes. While job satisfaction and work engagement are established predictors of job performance, their interactive effects remain underexplored in low-resource and high-stress contexts such as Jordan.

Aim: This study examined the moderating role of work engagement in the relationship between job satisfaction and job performance among critical care nurses in Jordan.

Methods: A descriptive cross-sectional design was employed with a convenience sample of 143 registered nurses from four public hospitals in Jordan. Data were collected using validated instruments: Demographic and Professional Characteristics Sheet, The Job Satisfaction Survey (JSS), the Utrecht Work Engagement Scale (UWES-9), and the Six-Dimension Scale of Nursing Performance (SDSNP). Descriptive statistics, Pearson's correlation, independent t-tests, and moderation analysis were conducted using SPSS v26.

Results: Participants reported moderate levels of job satisfaction (M = 2.90/4), work engagement (M = 3.58/6), and job performance in terms of both frequency (M = 3.31/4) and quality (M = 3.11/4). Job satisfaction positively correlated with work engagement (r = 0.28, p < 0.001) and job performance quality (r = 0.21, p < 0.05), but not frequency. Work engagement significantly moderated the relationship between job satisfaction and job performance frequency (β = 0.25, p = 0.027), but not quality.

Conclusion: Work engagement enhances the positive impact of job satisfaction on performance frequency, emphasizing its critical role in sustaining nurse productivity. Targeted strategies to improve both job satisfaction and engagement may enhance performance outcomes and healthcare quality in high-acuity environments.

Purpose: Chemotherapy remains the primary treatment for haematological malignancies (HMs). While recent therapeutic advances have improved patient survival, treatment-induced immunosuppression and prolonged neutropenia significantly elevate the risks of bloodstream infection (BSI), contributing to higher mortality. This study identifies risk factors for BSI in pediatric HM patients, aiming to establish evidence-based protocols for infection prevention and risk stratification, thereby informing targeted healthcare policies to reduce complications and improve treatment outcomes.

Patients and methods: We retrospectively analyzed 682 pediatric HM patients presenting with fever at our institution, including 98 BSI-confirmed cases.Results were statistically compared across multiple aspects.

Results: Pediatric HM patients with bloodstream infection showed significantly higher AML prevalence (47.96% vs 33.22%, P = 0.005) and Gram-negative bacteria predominance (66.33%), notably Escherichia coli (E. coli) (27.55%). Stenotrophomonas maltophilia infection rates were significantly higher in lymphoma patients than in other hematological malignancies (P < 0.05). Multivariable analysis identified four modifiable risk factors: peak body temperature (OR = 5.468, 95% CI 3.407-8.775, P < 0.001), duration of neutropenia (OR = 1.181, 95% CI 1.120-1.245, P < 0.001), febrile neutropenia (OR = 8.193, 95% CI 3.574-18.780, P < 0.001), and invasive procedures (OR = 4.265, 95% CI 1.920-9.474, P < 0.001).

Conclusion: To reduce BSI complications in pediatric HM patients, we recommend implementing risk-stratified temperature protocols and strict neutropenia control (≤7 days), emphasizing rigorous clinical criteria for invasive procedures (PICC). These findings provide an evidence base for healthcare policies aimed at reducing infection-related mortality through optimized treatment protocols and enhanced clinical care standards.

Purpose: To explore strategies for optimizing Automated External Defibrillator (AED) configuration in urban areas of China and improving the treatment conditions for out-of-hospital cardiac arrest (OHCA) patients.

Material and methods: Taking Dongcheng District, Beijing as the research object, spatial data such as administrative divisions, transportation road networks, AED configuration points, and points of interest in key public places, as well as non-spatial data such as population statistics, were collected. Service area analysis and location-allocation models were used to analyze the current status of AED configuration and explore optimization strategies for AED deployment.

Results: As of September 2024, a total of 86 AEDs had been configured in Dongcheng District, and their service area covered 13.74% of the district. The combined service area of AEDs and hospitals covered 82.62% of the district. After achieving the goal of full AED coverage in key public places in the future, AED service area will cover 34.80% of the district, and the combined service area of AEDs and hospitals will cover 85.92% of the district. According to the optimization plan proposed in this study, an additional 218 AEDs are needed in Dongcheng District, bringing the total number of AEDs to 519. At this point, AED service area will cover 50.62% of the district, and the combined service area of AEDs and hospitals will cover 97.28%.

Conclusion: The AED configuration optimization strategy proposed in this study is highly reasonable, and relevant government agencies can refer to this framework to optimize the AED deployment in urban areas. Additionally, technologies such as the Internet of Things and drones can be leveraged to establish urban AED search and delivery platforms, further enhancing the accessibility and utilization rate of AED to achieve optimal treatment outcomes for OHCA patients and save more lives.

Context: Medical errors are the third leading cause of death after heart disease and cancer, but in contrast to these conditions, progress in reducing mistakes has been minimal.

Personal experience and learning: I learned firsthand about barriers to improvement during events surrounding the death of my grandson, who had a complex heart defect missed on a pregnancy ultrasound. Following his tragedy, universal pulse oximetry screening was implemented at a national level, probably saving dozens of children from a similar fate every year in our country.

Barriers to improvement: On the other hand, I also found a refusal to link failure with correction. Lawyers working for the HMO where ultrasound had missed the heart defect claimed that the practice was reasonable, rejecting responsibility for the failure and quest for improvement, such as considering adoption of AI for enhanced diagnostic accuracy. Pulse oximetry universal screening could have been implemented a decade ago (thereby preventing our tragedy). Still, the people in charge at a National Council then did not listen to the committee of experts they had appointed and who recommended the screening.

Insights: Linking errors with improvement brings meaning to suffering: the tragedy would not have been in vain if it had motivated corrective actions. Communication failure is responsible for most errors, and a significant barrier is the fear of speaking up. The lesson was tragically learned at NASA and other organizations, emphasizing the importance of listening to everyone to prevent disasters. Respectful listening is an essential key to cooperation and success.

Conclusion: Healthcare needs a paradigm shift to a culture of transparency, responsibility and collaboration, building growth from past failures, learning from mistakes to improve patient safety.

Purpose: Health organizations play a critical role in society, but they also contribute significantly to global carbon emissions. This study examines the adoption of reusable surgical gowns to reduce operating room waste and emissions.

Methods: Two surveys (n_A = 146 and n_B = 55) and a pilot test in two Belgian university hospitals (Antwerp and Ghent) are conducted to assess operating room healthcare professionals' (HCP) willingness to reuse (adoption intention), and how expectations and evaluation can influence the adoption of reusable gowns. A between-subject design compared perceptions of HCP without recent experience with reusable gowns (HCP A) and participants in a wearing test (HCP B).

Results: It was found that participants of the pilot test had greater adoption intention than HCP without recent experience. Moreover, HCP with higher expectations about reusable gowns were also more willing to adopt. Misconceptions about reusable gowns being old-fashioned or inferior were common among those unwilling to adopt. Currently, HCP have lower expectations about reusable gowns compared to the disposables in use, in terms of trust in protection, comfort and usability. However, participants of the pilot test evaluated their trust in protective properties higher than what HCP without wearing the gown had initially expected.

Conclusion: Information campaigns on reusables in healthcare and educational insights on their safe use can improve perceptions about reusable gowns as a safe and high-quality alternative. This study's findings may guide legislative efforts and hospital managers to promote sustainable healthcare practices. Fostering bottom-up readiness among HCPs may influence the hospital's procurement process. Additionally, further improving the design of reusable products can optimize the user satisfaction.

Background: Due to the specific nature of uncomplicated urinary tract infections (uUTIs), female patients are often labelled with stigma. The presence of stigma has a serious impact on their mental health, social functioning and healthcare-seeking behavior, which in turn affects disease recovery.

Purpose: To identify the sense of stigma and its associated influencing factors in female patients with uUTIs.

Patients and methods: A cross-sectional study was conducted between December 2022 and December 2023, during which samples were collected from 240 adult women with uUTIs from various healthcare facilities in Wuxi, China. General information questionnaires, the Chinese Version of the Social Impact Scale (range 24 to 96), the Multidimensional Perceived Social Support Scale, the Self-Rated Anxiety Scale and the Self-Rated Depression Scale were used. SPSS 27.0 was used to create the database and statistical analysis was performed after data entry by two people.

Results: A total of 240 validated questionnaires were collected in this study, and the patients' stigma score was 2.71 ± 0.37 (at a moderate level of stigma). Internalized stigma was the highest and social isolation the lowest of the four dimensions of stigma. Multiple linear regression analyses showed that the level of stigma was higher in patients with symptoms of urinary frequency, urgency, and hematuria uUTIs. uUTIs with longer duration of symptoms, more frequent episodes, less knowledge about the disease, higher anxiety and depression, and lower levels of perceived social support for the disease had higher levels of stigma.

Conclusion: Studies have shown that female patients with uUTIs have a moderate level of stigma. Nursing administrators should pay attention to the sense of shame in this population and enhance health promotion to reduce their sense of stigma.

Background: Thrombospondin-1 (TSP-1) and vascular endothelial growth factor (VEGF) are placental glycoproteins involved in angiogenesis and vascular regulation during pregnancy. Dysregulation of these markers has been linked to complications such as preeclampsia and intrauterine growth restriction. In this cross-sectional study, we evaluated maternal and fetal serum levels of TSP-1 and VEGF and their associations with clinical characteristics.

Methods: We studied 438 pregnant women with singleton live pregnancies between 28-40 weeks of gestation. Women with fetal anomalies were excluded. Serum levels of TSP-1 and VEGF were measured using enzyme immunoassay. Group comparisons were performed using the Mann-Whitney U and Kruskal-Wallis tests, and correlations were analyzed using Spearman's test.

Results: Median maternal and fetal TSP-1 levels were 5.1 [2.6-7.4] ng/mL and 4.7 [2.3-8.9] ng/mL, respectively. Fetal TSP-1 levels positively correlated with maternal TSP-1 (r = 0.27, p < 0.000) and fetal VEGF (r = 0.21, p < 0.000). Lower fetal TSP-1 was observed in women with diabetes mellitus (1.9 vs 4.7 ng/mL, p = 0.042) and higher levels in those with small-for-gestational-age fetuses (8.5 vs 4.7 ng/mL, p = 0.036). Median maternal and fetal VEGF levels were 37.2 [33.3-42.5] pg/mL and 148 [62.9-247.8] pg/mL. A positive correlation was found between maternal and fetal VEGF (r = 0.24, p < 0.000). Lower maternal VEGF was associated with chronic hypertension, gestational diabetes, preterm premature rupture of membranes, and use of methyldopa or metformin. Fetal VEGF was higher in mothers taking thyroxine (220 vs 142.7 pg/mL, p = 0.018) and lower during established labor (114.1 vs 165.5 pg/mL, p = 0.038).

Conclusion: Maternal and fetal levels of TSP-1 and VEGF were significantly correlated and influenced by clinical and pharmacologic factors, supporting their potential utility as early biomarkers of pregnancy complications and maternal-fetal health.

Registration: Research Registry (UIN: researchregistry6781), April 30, 2021.

Background: Delirium is a prevalent and severe neuropsychiatric syndrome commonly observed among critically ill patients in the intensive care unit (ICU). Despite its substantial clinical impact, effective tools for predicting delirium risk remain limited. This study aimed to develop and validate a nomogram to predict the risk of delirium in ICU patients, integrating clinical, demographic and laboratory parameters for individualized risk assessment.

Methods: A retrospective cohort study was conducted involving 964 ICU patients admitted between January 2020 and December 2023. Comprehensive clinical data were collected, and delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Predictive variables were identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by multivariate logistic regression analysis. A nomogram was constructed based on significant predictors and validated using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

Results: Among the 964 ICU patients, 186 (19.3%) developed delirium. Eight predictors were identified as independent risk factors for delirium, including drug abuse, alcohol abuse, male sex, maximum potassium (potassium_max), minimum chloride (chloride_min), length of hospital stay, maximum blood urea nitrogen (BUN_max), and minimum hematocrit (hematocrit_min). The nomogram demonstrated good discrimination with an area under the ROC curve (AUC) of 0.732 (95% CI: 0.690-0.773) and satisfactory calibration. DCA confirmed the clinical utility of the model, showing a net benefit across a wide range of risk thresholds.

Conclusion: This study developed a robust and clinically applicable nomogram for predicting ICU delirium risk, integrating key clinical and laboratory variables. The nomogram can aid ICU clinicians in implementing timely preventive interventions to improve patient outcomes.