Risk Management and Healthcare Policy最新文献

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.

Objective: To analyze risk factors for PICC-related thrombosis in cancer patients and assess the preventive efficacy of a risk-stratified nursing intervention based on these factors.

Methods: This prospective observational cohort study evaluated the preventive effect of risk-stratified nursing on PICC-related thrombosis in cancer patients. Chemotherapy patients undergoing PICC placement in the oncology department of our hospital from January 2023 to December 2024 were enrolled. Participants were allocated into two cohorts based on the implementation timeline of the nursing protocol: Control group (n=117) received routine PICC care (January 2023-December 2023), while intervention group (n=119) received risk-stratified nursing interventions (January 2024-December 2024) guided by a logistic regression model identifying key thrombosis risk factors (eg, tumor staging, comorbid diabetes, D-dimer levels).

Results: The intervention group (2024) exhibited a significantly lower PICC-related thrombosis incidence compared to the control group (2023) (4.20% vs 29.91%, χ²=28.436, P<0.001). Multivariate analysis identified tumor stage III/IV (OR=2.556, 95% CI 1.798-5.564), history of thrombosis (OR=19.273, 95% CI 10.674-37.561), diabetes (OR=2.572, 95% CI 1.027-5.712), catheter tip malposition (OR=14.339, 95% CI 8.916-29.795), and elevated D-Dimer (OR=9.528, 95% CI 6.703-15.597) as independent risk factors, while anticoagulant use (OR=0.449, 95% CI 0.089-0.874) was protective. In the intervention cohort, protocol-guided anticoagulation showed enhanced protection (OR=0.332, 95% CI 0.121-0.898, P=0.028). The intervention group also demonstrated improved quality of life across all SF-36 domains (eg, physical functioning: 58.94±1.97 vs 45.93±3.02, P<0.05) and significantly higher nursing satisfaction (96.64% vs 86.32%, χ²=8.091, P=0.004).

Conclusion: Risk-stratified nursing interventions, guided by logistic regression analysis of thrombosis risk factors, significantly reduce PICC-related thrombosis incidence and improve patient quality of life and nursing satisfaction. This protocol offers a practical framework for oncology nursing to enhance patient outcomes.

Purpose: To date, no comprehensive studies have examined the relationship between various thyroid function statuses and thyroid hormone levels with uric acid levels. This study aims to analyze the correlation between thyroid disease and hyperuricemia.

Patients and methods: Data from individuals undergoing health screenings in the Taiyuan area were collected. The data were categorized by thyroid disease type, thyroid function indices (FT4, FT3, and TSH), and serum uric acid (SUA) levels, followed by statistical analysis.

Results: The analysis indicated that the prevalence rates were as follows: clinical hyperthyroidism (CHyper) at 0.9%, subclinical hyperthyroidism (SCHyper) at 0.7%, clinical hypothyroidism (CHypo) at 0.8%, subclinical hypothyroidism (SCHypo) at 13.7%, and hyperuricemia at 16.9%. Further analysis revealed that the prevalence of hyperuricemia increased with higher FT4 and FT3 levels but decreased with lower TSH levels. However, logistic regression analysis showed that after adjusting for covariates, thyroid disease status, including CHyper, SCHyper, CHypo, and SCHypo, was not significantly correlated with hyperuricemia. Among the thyroid function indices, only FT4 had a statistically significant effect on the risk of hyperuricemia (OR 1.028, 95% CI 1.011-1.045). Additionally, the restricted cubic spline (RCS) was employed to assess the dose-response relationship between thyroid function indicators (FT4, FT3, and TSH) within the normal reference range and the risk of hyperuricemia. The FT4 level exhibited a positive relationship with the risk of hyperuricemia (nonlinear test χ² was 0.26, P > 0.05). When FT4 exceeded 16.85 pmol/L, higher levels of FT4 became a risk factor for hyperuricemia.

Conclusion: Thyroid disease status does not significantly affect hyperuricemia. However, within the normal range, the FT4 level demonstrates a positive dose-response relationship with the risk of hyperuricemia.

Background: Radiation to the adjacent parts of the tumor and radiation to the larynx may lead to voice changes and the development of dysarthria, however, dysarthria is often overlooked compared to other complications. It is necessary to understand the experience of nasopharyngeal cancer (NPC) patients with symptoms related to dysarthria after radiotherapy.

Methods: This qualitative descriptive study enrolled 33 patients NPC radiotherapy patients who experienced dysarthria were recruited from May to August 2024. Data were collected using semi-structured interviews. The interviews were audio-recorded and converted verbatim into standard text, and the data were iteratively thematically analyzed.

Results: Changes in speech and language quality after radiotherapy for NPC are common, but there are differences in the degree of symptoms perceived by patients. At the same time, dysarthria is often accompanied by other diverse oropharyngeal symptoms, and the trajectory-varying nature of these symptom experiences imposes a dual physical and psychological burden on patients. Lack of awareness of dysarthria and inadequate emotional support may lead to very different coping styles and a desire for professional ongoing voice management.

Conclusion: This study helps to elucidate the current status of dysarthria faced by patients undergoing radiotherapy for NPC and provides multiple dimensions of dysarthria assessment and management goals for quantitative research. We call attention to the need for healthcare professionals to pay attention to patients' perspectives and related needs and to develop targeted management strategies that match patients' needs, and we emphasize the importance of continuity of care to effectively improve dysarthria-related symptoms.

Objective: To compare the application of the SaCo visual laryngeal mask and the WORK laryngeal mask in adult laparoscopic surgeries under general anesthesia, and to assess their effects on postoperative pharyngolaryngeal discomfort.

Methods: A retrospective analysis was conducted on 90 adult patients who underwent elective laparoscopic surgery under general anesthesia between June 2022 and April 2024. Based on the airway device used, patients were divided into the control group (n=45, WORK laryngeal mask) and the observation group (n=45, SaCo visual laryngeal mask). The two groups were compared in terms of laryngeal mask insertion parameters (seal pressure, insertion time, first-attempt success rate, number of adjustments >2 times, peak airway pressure, endoscopic visibility grading, positioning accuracy, removal time), vital signs (heart rate, mean arterial pressure), perioperative outcomes (post-extubation time, time to regular diet, postoperative hospital stay), VAS-based pharyngolaryngeal discomfort scores, and complication rates.

Results: The observation group demonstrated significantly higher airway seal pressure at insertion, 1 hour, and 2 hours post-insertion (P<0.05). Adjustment rate >2 times was significantly lower, while positioning accuracy was significantly higher (P<0.05). No significant differences were found in heart rate or mean arterial pressure between groups. The observation group had significantly shorter post-extubation time, earlier diet resumption, and shorter hospital stays (P<0.05). Pharyngolaryngeal discomfort scores at 1, 3, and 7 days post-surgery were significantly lower in the observation group (P<0.05). The complication rate was also lower in the observation group (4.44%) than in the control group (20.00%) (P<0.05).

Conclusion: Compared to the WORK laryngeal mask, the SaCo visual laryngeal mask offers better sealing and placement accuracy, reduces pharyngolaryngeal discomfort, and promotes faster postoperative recovery with fewer complications.

Purpose: Since 2020, COVID-19 severely affected the world population, generating numerous deaths and a great socioeconomic impact that affected the healthcare system. This investigation aimed to analyze a prediction model for COVID-19 mortality on the basis of different risk factors.

Patients and methods: Retrospective, cross-sectional study in a sample of 2000 hospitalized patients. Biological and clinical factors (signs and symptoms), laboratory/diagnostic results and comorbidities were taken into account. The SPSS version 29 statistical package was used to process the information, performing a bivariate and multivariate analysis with binary logistic regression using the intro methods.

Results: Most of the deceased were male, older than 60 years, blood type O positive, hypertensive, type 2 diabetic, obese. The most common symptoms were fever, malaise, shortness of breath and fatigue, the most common tomography findings were bilateral ground glass with BiRad 5 scale in more seriously impaired patients.

Conclusion: An adequate model was obtained with a 76% prognostic rate. The variables included in the predictive model for COVID-19 mortality were age, fever, productive cough, sore throat, fatigue, shortness of breath, unilateral consolidation on CT scan, hemoglobin level, leucocyte count, lymphocytes, platelets, urea, and ferritin.

Purpose: Examine the epidemiology and burden of illness of patients with Lennox-Gastaut syndrome (LGS) in Taiwan.

Methods: The National Health Insurance Database (NHID) was used, complemented by the Chang Gung Research Database (CGRD). Confirmed LGS was defined by International Classification of Diseases-10 (ICD-10) LGS codes or ≥1 rufinamide prescription; probable LGS was defined as patients aged ≤10 years when receiving ≥3 antiseizure medications (ASMs), with ICD-9/10 codes for developmental delay. Independent clinical review/validation of all LGS cases in the CGRD was conducted. Prevalence, incidence, time to treatment/LGS diagnosis, hospitalizations, costs (US dollars), ASM usage, and mortality were assessed. For the NHID, a positive predicted value (PPV) was calculated from the CGRD validation step to adjust prevalence/incidence estimates.

Results: In the NHID, 190 patients with confirmed LGS were identified. In 2018, PPV-adjusted prevalence was 2.4, 0.6, and 10.2 per 100,000 people and PPV-adjusted incidence was 0.6, 0.2, and 2.4 per 100,000 person-years in the total, adult, and pediatric populations, respectively. Of 92 (48%) hospitalized patients, 22 (24%) had ≥3 hospitalizations/year. Mean (standard deviation [SD]) time to treatment and LGS diagnosis were 12.3 (26.5) and 110.1 (54.7) months. Mean length of stay was around 12 days. Most hospitalizations (96%) were epilepsy related. Mean (SD) hospitalization cost was $237 ($216) per day. Mean (SD) total inpatient and outpatient costs were $5800 ($817) and $2667 ($132), respectively, per patient per year (PPPY); medication in hospital and ASM costs were $1910 ($108) and $1614 ($93) PPPY. Most prescribed ASMs were valproate (89%), levetiracetam (83%), clonazepam (69%), clobazam (68%), and topiramate (65%). Mortality was 0.01 deaths per 100,000 people in 2018.

Conclusion: Although prevalence and incidence of LGS in Taiwan were lower than in other countries, the multifaceted burden of illness in LGS is highlighted herein. Reduced hospitalizations through better epilepsy control may reduce LGS expenditure.

Background and objectives: Medication abuse is a major global issue due to its health risks. In Thailand, regulation of drug sales is overseen by the Thai Food and Drug Administration (FDA). This study aimed to examine pharmacists' opinions on policies regarding the control and monitoring of the sales of drug that have been abused in Thailand.

Methods: A mixed-method design was employed, combining a survey of 440 pharmacy pharmacists and 77 regulatory enforcement pharmacists selected through accidental sampling with in-depth interviews of 17 pharmacists recruited via purposive and snowball sampling until data saturation. Survey data were analyzed descriptively, while interview data were examined using content analysis. Data were collected nationwide in Thailand between April and October 2023.

Results: Over 80% of respondents understood the policy measures, yet most reported limited effectiveness and unintended consequences. Nearly 90% indicated that maintaining drug sales records drives high-risk buyers to underground markets while increasing workloads and leading some pharmacies to discontinue sales. Respondents favored eliminating or digitalizing records. The FDA Reporter system was viewed as useful, but incomplete and retrospective data limited its effectiveness. Participants recommended real-time integration across the supply chain. Restrictions on retail and wholesale quantities were considered only partially effective, often burdening patients requiring continuous treatment. By contrast, requiring pharmacists to comply with Good Pharmacy Practice (GPP) and personally dispense dangerous drugs was regarded as the most effective measure. Interviews also align with the survey and highlighted persistent issues such as "hanging-license pharmacies" and emphasized stricter enforcement, intersectoral collaboration, and education for at-risk groups.

Conclusion: Current measures to control drug sales remain ineffective, leading to diversion, increased workloads, and discontinued sales. Enforcing Good Pharmacy Practice (GPP) has proven more effective. Policy strengthening should focus on modernizing electronic reporting, eliminating rigid quantity limits, and enforcing pharmacist presence during operating hours for safe, responsible drug distribution.