Risk Management and Healthcare Policy最新文献

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.

Background: Cardiopulmonary resuscitation (CPR) is a critical life-saving procedure in managing cardiac arrest, with its success largely dependent on the knowledge, attitudes, and practices (KAP) of healthcare providers. This study aimed to evaluate CPR-related KAP among anesthesia providers in public hospitals in Sana'a City, Yemen, and to explore the associations between demographic characteristics and KAP levels.

Methods: A cross-sectional study was conducted among 226 anesthesia providers using a standardized, structured questionnaire consisting of 12 knowledge items, 7 attitude items, and 12 practice items. Data were analyzed with descriptive statistics and correlation analysis to examine associations between demographic factors and KAP levels.

Results: Among participants, 60% demonstrated adequate knowledge, 30% had moderate knowledge, and 10% had inadequate knowledge of CPR. Positive attitudes toward CPR were reported by 85% of providers, while 15% exhibited negative attitudes. Good CPR practices were observed by 75% of respondents, with 25% showing poor practices. Significant positive correlations were found between knowledge and attitudes (r = 0.312, p < 0.01), knowledge and practices (r = 0.365, p < 0.01), and attitudes and practices (r = 0.289, p < 0.01). Better KAP scores were significantly associated with younger age, recent training, and higher educational attainment.

Conclusion: This study highlights the current levels of knowledge, attitudes, and practices (KAP) regarding CPR among anesthesia providers in public hospitals in Sana'a as one of the first studies. While most participants demonstrated adequate knowledge, positive attitudes, and good practices, notable gaps persist-particularly among older providers and those without recent training. The positive correlations among the KAP components emphasize the need for regular, targeted educational interventions to enhance CPR competence and improve patient outcomes. Ensuring that anesthesia providers and healthcare workers maintain up-to-date CPR knowledge and practical skills is critical for increasing survival rates during cardiac arrest. Implementing mandatory CPR certification or re-certification every 2-3 years could systematically sustain and improve knowledge, attitudes, and practices.

Aim: To systematically analyze and compare studies on risk prediction models for diabetic foot ulcers progressing to amputation, facilitate clinical decision-making, and provide recommendations for improving modeling strategies in future research.

Methods: We searched Medline, Embase, Cochrane Library, and Clinicaltrials.gov from inception to January 29, 2025, to identify studies on risk prediction models for diabetic foot ulcers progressing to amputation. After study screening and data extraction, we evaluated bias and applicability using the Prediction Model Risk of Bias Assessment Tool.

Results: We included 18 papers comprising 15 development studies and 3 external validation studies. The development studies reported 17 models, while the validation studies externally validated 12 models. The area under the curve of all models ranged from 0.557 to 0.957. The most commonly used predictors were peripheral arterial disease, glycated hemoglobin, infection, Wagner classification, and ulcer depth. All included studies had low concerns regarding applicability but exhibited high risk of bias, primarily due to insufficient events per variable, missing data, inadequate consideration of data complexity, lack of model performance assessment, and absence of internal validation.

Conclusion: Risk prediction model research for diabetic foot ulcer progression to amputation remains in its early stages. Future efforts should prioritize prospectively developing and externally validating models with robust performance and low bias, accompanied by rigorous internal validation and transparent reporting. (Funding: Natural Science Foundation of Hubei Province (2022CFB145) and Research Fund of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (2023D36)).

Background: Laboratories are a critical part of epidemiological surveillance implementation through their participation in cases' detection and investigation. The Integrated Disease Surveillance and Response (IDSR) strategy is implemented in Cameroon since 2003 although weaknesses in terms of low detection, timeliness and reporting rates are reported. The present study was conducted to assess the implication of health facilities' laboratories in epidemiological surveillance by evaluating the activities conducted, the availability of resources and communication pathways.

Methods: A cross-sectional descriptive study was conducted in laboratories of health facilities in the Littoral region of Cameroon selected from health districts by stratified random sampling from April to May 2024. Data were collected using a face-to-face structured questionnaire administered to head of each laboratory. Collected data included health facilities' characteristics, epidemiological surveillance activities conducted in the laboratories, availability of supplies and equipment, data reporting and availability of energy supply.

Results: Out of the 302 laboratories reached, 273 (90.4%) consented to participate in the survey. Most (198 [72.53%]) of the laboratories declared being involved in samples' collection while only 61 (22.34%), 18 (6.59%) and 93 (34.07%) declared to be involved in screening of suspected cases during outbreaks, case confirmations during outbreaks and notification of suspected cases respectively. Regarding the availability of transport supplies/equipment, out of the 273 laboratories, 43 (15.8%), 105 (38.5%) and 123 (45.1%) laboratories had Cary Blair medium, isothermal carrying cases and safety bags respectively. It is noted that 26 (9.5%) laboratories reported not communicating their results with surveillance units. A total of 263 (96.3%) laboratories declared to have the national distribution electricity service as their main source of energy and 78 (29.7%) laboratories had an alternative energy source.

Conclusion: The present study revealed gaps in terms of participation of health facilities' laboratories in key epidemiological surveillance such as case confirmation and results' reporting. Weakness in terms of supply chain are also noted. Efforts to strengthen laboratory surveillance capacities must prioritize investments in reliable supply chains and sustainable infrastructure.