Risk Management and Healthcare Policy最新文献

Background: Hypertension, a major cardiovascular disease risk factor, is a global public health challenge. Self-management is key, and with information and communication technology prevalence, online health information seeking behavior (OHISB) has become a common trend to boost patients' self-management.

Purpose: This study aims to explore hypertensive patients' OHISB and their impact on self-management practices, providing a basis for further improving patients' OHISB and self-management behaviors.

Patients and methods: This study selected 312 hypertensive patients from the Cardiology Department of a Wuhan tertiary hospital (March-April 2025), using a general information questionnaire, revised version of the Online Health seeking behavior Scale (OHB-S) and the Hypertension Patients Self-Management Behavior Rating Scale (HPSMBRS) for surveys. SPSS 26.0 did descriptive analysis of enumeration/measurement data; t-tests/ANOVA analyzed group differences; multiple linear regression examined OHISB-influencing factors; Pearson correlation and hierarchical regression explored relationships between OHISB and self-management.

Results: The total scores of OHISB and self-management were (55.20±14.29) and (96.54±16.62) respectively in the patients. The total scores of OHISB and self-management were significantly positively correlated (r=0.634, P<0.05). The results of hierarchical regression analysis show that OHISB is an important influencing factor of self-management and can independently explain 21.2% of the variation in patients' self-management.

Conclusion: Both the OHISB and self-management behaviors of hypertensive patients are at a relatively low level. OHISB is an important influencing factor of self-management. Hypertensive patients with a higher level of OHISB have a higher level of self-management. In the future, information sources should be carefully controlled, and a variety of online health information channels should be combined to provide targeted online hypertension health education, thereby enhancing the self-management capabilities of hypertension patients.

Objective: To evaluate the effectiveness of integrating Orem self-care mode with early rehabilitation training in mechanically ventilated ICU patients.

Methods: This retrospective cohort study included 142 patients who underwent mechanical ventilation at the Department of Intensive Care Medicine from January to December 2023. Patients were divided into two groups based on documented nursing interventions: the control group (n=62) received standard care, while the experimental group (n=62) received Orem-based nursing combined with structured early rehabilitation training. Respiratory function, psychological status, and adverse event incidence were compared between groups.

Results: The experimental group showed significantly improved respiratory parameters including respiratory rate, partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), and PaO₂/FiO₂ ratio (P < 0.05). Mechanical ventilation duration and ICU length of stay were significantly shorter in the experimental group (P < 0.001). Psychological assessments revealed significantly lower scores for delirium, anxiety (HAMA), and depression (HAMD) in the experimental group post-intervention (P < 0.001). Additionally, the incidence of adverse events such as pressure ulcers and delirium was markedly reduced (P < 0.001).

Conclusion: Integrating Orem self-care model with early rehabilitation training demonstrates significant benefits in improving respiratory outcomes, mental health, and clinical safety for mechanically ventilated ICU patients, offering a promising approach for critical care nursing.

Objective: The implementation of comprehensive microinvasive cervical cancer (MIC) risk assessment in high-grade squamous intraepithelial lesion (HSIL) patients undergoing loop electrosurgical excision procedure (LEEP) is critical to optimize treatment strategies and improve patient outcomes.

Methods: From March 2017 to January 2024, a total of 3066 eligible patients with HSIL were retrospectively enrolled from two hospitals and assigned into one training cohort (n = 2084), one internal validation cohort (579) and one external testing cohort (n = 403). Four feature selection methods (Random Forest, Lasso regression, Boruta algorithm, and Extreme Gradient Boosting) were employed to identify key predictive factors from the training cohort. Then, four machine learning models were developed and evaluated using comprehensive metrics. The optimal model was visualized through interpretable techniques and operationalized as a web-based clinical decision support system for real-world implementation.

Results: Six clinical predictive variables were identified, including surgical margins, endocervical curettage (ECC), TCT status, HPV status, Transformation Zone (TZ) type and Age. The optimal model demonstrated good predictive performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.822 (95% CI: 0.793-0.852) in the internal validation cohort and 0.802 (95% CI: 0.730-0.874) in the external validation cohort.

Conclusion: The machine learning-based model can accurately assess the risk of MIC during the treatment of HSIL with LEEP, potentially aiding in the selection of appropriate treatment and surveillance strategies in clinical practice.

Background: Smoke-free zone policies in school settings have been widely implemented; however, evidence regarding their impact on smoking-related attitudes and secondhand smoke (SHS) exposure remains limited. This study aimed to examine the association between a smoke-free zone policy implemented along school commuting routes and attitudes toward smoking and SHS exposure among elementary school students, their parents, and school staff in Seoul, South Korea.

Methods: A cross-sectional study was conducted. Participants were 210 students, 272 parents, and 137 school staff from the five schools randomly selected according to the criteria of regional deprivation index and prevalence of designated smoke-free zones from all the 25 districts of Seoul, South Korea. "Attitudes toward smoking" and "exposure to SHS" were the outcome variables, and the "presence of a smoke-free zone along the school commuting route" was the predictor variable. All variables were assessed using self-reported questionnaires. Data were collected between November 2020 and December 2020. The multiple logistic regression analysis was performed to test main hypotheses.

Results: Students and school staff in schools with designated smoke-free zones along school commuting routes were significantly less likely to be exposed to SHS along those routes, compared to their counterparts without such zones (odds ratio [OR] = 0.29; 95% confidence interval [CI], 0.098-0.853; p =0.025 for students; OR = 0.09; 95% CI, 0.008-0.939; p =0.044 for school staff). However, the presence of smoke-free zones along school commuting routes was not significantly associated with attitudes toward smoking among students, parents, or school staff.

Conclusion: Designation of smoke-free zones along school commuting routes may be effective in reducing exposure to SHS among students and school staff. The active and consistent enforcement of smoke-free policies within school settings may play a critical role in further reducing SHS exposure among children and related stakeholders.

Background: Older adults in rural China bear a significant proportion of their healthcare expenses through out-of-pocket payments, resulting in a considerable financial burden on their families.

Objective: This study aimed to explore the key factors influencing adult children's involvement in financing healthcare expenses for their elderly parents in rural China.

Methods: Data were collected by in-depth interviews using a semi-structured interview guide approved by all researchers. Inductive content analysis was employed to analyze data. A total of 15 participants were involved in the study.

Results: Adult children primarily assume responsibility for their elderly parents' healthcare expenses in rural China, with occasional support from government subsidies. The principles guiding cost-sharing among adult children include filial piety, fairness, capability, and traditional gender roles. When adult children decline to take on the financial responsibilities, they may face pressure from the family members, the community, and local authorities, in some cases, elderly individuals may even resort to legal recourse. The state covers the healthcare expenses for older individuals without children through the "Five Guarantees" program and elder care institutions.

Conclusion: This study highlights the financial dynamics within families in rural China, emphasizing the need for improved support systems to alleviate the burden on adult children and their elderly parents.

Objective: This study aimed to investigate the status of negative information attentional bias, self-management, and health-promoting behaviors among patients with chronic refractory wounds receiving orthopedic care. Additionally, the study sought to construct a structural equation model (SEM) to evaluate the influence of negative attentional bias on self-management and health-promoting behaviors, with the intent of informing the clinical implementation of evidence-based health behavior education programs.

Methods: A total of 226 patients with chronic refractory wounds under orthopedic treatment at a single institution between January 2020 and December 2022 were enrolled in this study. Data were collected using a general information questionnaire, the Negative Cognitive Processing Bias Questionnaire, the Chronic Disease Self-Management Scale (CDSMS), and the Health-Promoting Lifestyle Profile II (HPLP-II). Pearson's correlation analysis was conducted to assess associations among negative attentional bias, self-management, and health-promoting behaviors. SEM using Amos 21.0 was conducted to examine potential mediating effects.

Results: Health-promoting behaviors demonstrated a positive correlation with self-management and a negative correlation with negative attentional bias. Furthermore, self-management was negatively correlated with negative attentional bias (all p < 0.05). SEM indicated that negative attentional bias partially mediated the relationship between self-management and health-promoting behaviors, accounting for 31.65% of the total effect.

Conclusion: Negative attentional bias mediates the association between self-management and health-promoting behaviors among patients with chronic refractory wounds receiving orthopedic care. These findings suggest that enhancing self-management may improve engagement in health-promoting behaviors by reducing the influence of negative attentional bias.

Central Line-Associated Bloodstream Infections (CLABSI) pose significant challenges in healthcare systems globally, contributing to increased morbidity, mortality, and healthcare costs. As healthcare organizations strive to improve patient safety and quality of care, Artificial Intelligence (AI) presents considerable promise in the prevention, detection, and management of CLABSI. This paper proposes a conceptual framework that integrates AI within healthcare systems, aligning technological innovations with human workflows, system design, and risk management strategies. By taking a systems approach, the framework supports the implementation of AI tools in ways that are compatible with the complexity of healthcare delivery. The paper explores the potential and significance of AI in enhancing healthcare through the prevention, early detection, and management of patient safety concerns, including CLABSI. It highlights how AI applications can predict infection risks, support timely interventions, and operate in tandem with standard infection control protocols to reduce the incidence of CLABSI. This integrated approach aims to promote safer, more efficient, and patient-centered care.

Background: Identifying risk factors associated with hematoma expansion following spontaneous intracerebral hemorrhage (ICH) is essential for improving early intervention strategies. We hope to use this predictive model in the future to comprehensively score the risk factors of hospitalized patients with cerebral hemorrhage and evaluate the possibility of hematoma enlargement. Being able to identify high-risk patients with hematoma enlargement early and take intervention measures to save their lives.

Methods: A retrospective analysis was conducted on clinical data from 226 individuals diagnosed with spontaneous ICH between December 29, 2023, and August 29, 2024. Multiple logistic regression analysis was performed to identify risk factors associated with hematoma expansion. Predictive performance of the model was assessed using ROC curve analysis and receiver operating characteristic curve analysis. Mortality rates were calculated for each group following a 7-day follow-up period.

Results: Hematoma expansion was associated with diabetes mellitus, a low Glasgow Coma Scale (GCS) score at admission, elevated systolic blood pressure at admission, coagulation abnormalities, and specific computed tomography (CT) imaging findings, such as heterogeneous density, black hole sign, swirl sign, lobulation sign, and blend sign. A prognostic model incorporating these factors demonstrated robust predictive performance, achieving an area under the curve of 0.771 (95% CI: 0.628-0.915, p = 0.002). The model yielded a maximum Youden index of 0.489, with an optimal cutoff score of 38, a sensitivity of 54.5%, and a specificity of 94.4%. Mortality among individuals with coagulation abnormalities was 53.3%.

Conclusion: Coagulation abnormalities, GCS score, systolic blood pressure at admission, CT imaging findings, and diabetes mellitus were identified as predictors of hematoma expansion in spontaneous ICH. Individuals with coagulopathy and elevated systolic blood pressure at admission exhibited the poorest prognoses.

Background and objective: Aspiration of gastric contents is the major cause of respiratory tract-related complications, which can lead to death. Despite its significance, nationwide research on the practice of managing gastric regurgitation and pulmonary aspiration remains inadequate. We aimed to conduct a national survey to gain an in-depth understanding of the management and clinical practices surrounding perioperative gastric regurgitation and pulmonary aspiration among anesthesiologists in China.

Methods: A 26-item questionnaire was sent to all registered anesthesiologist members via WeChat and the New Youth Anesthesia Forum website.

Results: A significant portion (70.77%) of respondents reported having encountered gastric regurgitation or pulmonary aspiration, with 50.15% experiencing cases where both regurgitation and aspiration occurred. While most patients had a favorable prognosis following aspiration, 20.63% and 20.72% of respondents indicated that their patients developed severe pneumonia or died as a result. Regurgitation and aspiration events mainly occurred during emergency surgery (86.39%), with abdominal operation (78.86%) being the most common. The induction of general anesthesia was identified as the most common phase for these events (75.33%). Rapid sequence induction (RSI) was employed by 61.98% of respondents. While 59.97% of respondents reported that their departments provided training on regurgitation and aspiration, only 20.34% had training specifically in gastric ultrasound technology. Additionally, 41.63% of the respondents' institutions were equipped with gastric ultrasound devices. A small fraction (14.93%) of respondents were proficient in gastric ultrasound examination techniques, while 20.99% were completely unfamiliar with the technology.

Conclusion: Our survey revealed that gastric regurgitation and pulmonary aspiration, as major threats to the safety of perioperative patients, still pose significant challenges in the practice of anesthesia in China. There are still many deficiencies in management. Strengthening training and improving resource allocation, especially in the adoption and widespread use of gastric ultrasound technology, are the directions that need to be improved in the future.