Risk Management and Healthcare Policy最新文献

Objective: This study aimed to analyze the participation and results of the interlaboratory quality assessment for serological biomarkers of infectious diseases, including a five-panel test for hepatitis B, hepatitis C antibodies, and syphilis spirochete antibodies in Kaifeng City, China.

Methods: The assessment conducted by the Center for Clinical Laboratories in Kaifeng City from 2021 to 2022 was retrospectively analyzed. Laboratories participating in the interlaboratory quality assessment activities received two batches of independent clinical laboratory quality control material. These samples were tested in accordance with the provided test instruction manual. The reported results were statistically compared and assessed against those obtained by the clinical testing center.

Results: Data analysis revealed no significant differences in report rates and passing rates among medical institutions of varying levels. However, a significant statistical difference was observed between primary and tertiary hospitals (X ² = 341.1, P < 0.05). Additionally, a similar significant difference was noted in the results obtained using different methodologies (X ² = 0.997, P < 0.05).

Conclusion: The retrospective analysis of interlaboratory quality assessment activities, along with the statistical assessment of test results, assists clinical laboratories in identifying potential systematic and random errors, as well as other factors contributing to control loss. This process facilitates the timely development of effective improvement measures, enhancing test quality and ensuring the provision of accurate and reliable laboratory data for clinical use.

Purpose: To explore the application of Lean Six Sigma (LSS) combined with pre-prescription review system in reducing the irrational rate of emergency prescriptions.

Methods: The emergency prescriptions of our hospital in May 2022 to May 2023 and June 2023 to December 2024 were selected as the research objects. Based on the pre-prescription review system and LSS, a comparative analysis was carried out regarding the irrational rate of emergency prescriptions, the changing trend of the irrational rate, the types of irrational prescriptions and their departmental distribution, patients' satisfaction, and the proportion of doctors' returning and modifying irrational prescriptions before and after the implementation of intervention measures.

Results: After the adoption of LSS and Review system, the irrational rate of emergency prescriptions was significantly reduced (P<0.001); The irrational prescription rate decreased by 0.07% (P<0.001, 95% CI=[-0.06, 0.20]) month by month; The main types of irrational prescriptions remained unchanged, but except for combination medication, incompatibility and repeated medication, all types of irrational prescriptions were significantly lower than those before the intervention (P<0.05); Before and after the intervention, the irrational prescriptions were mainly issued by emergency internal medicine and urology emergency department, and the pediatric emergency department increased after the intervention; Patients' satisfaction was significantly improved after intervention (P<0.05); The proportion of physicians returning to correct irrational prescriptions increased significantly after the intervention (P<0.001).

Conclusion: LSS combined with pre-prescription review system can effectively reduce the irrational rate of emergency prescriptions, optimize emergency medication management, and ensure patient medication safety.

Background: Pressure injury (PI) is a major concern in ICUs, where multiple risk factors contribute to its development. ICU nurses are vital in PI prevention, a key element of patient safety and care quality.

Aim: Explore ICU nurses' perceptions of PI prevention in prone-positioned patients across nine major hospitals in Shanghai, China, and to evaluate their knowledge and attitudes toward PI prevention.

Design: A multicenter cross-sectional study.

Methods: Convenience sampling recruited 252 ICU nurses from nine hospitals in Shanghai between July 31 and August 25, 2024. Participants completed a questionnaire assessing their perceptions of PI prevention in prone-positioned patients. Their knowledge and attitudes were evaluated using the Pressure Ulcer Knowledge Assessment Tool version 2.0 (PUKAT 2.0) and the Attitudes toward Pressure Ulcer Prevention instrument (APuP). Statistical analyses included Pearson correlation, t-tests, ANOVA, and multivariate regression.

Results: ICU nurses showed a positive perception of PI prevention in prone-positioned patients. The mean knowledge score was 8.45 ± 2.55 (40.24%, ≥60% satisfactory), while the mean attitude score was 39.39 ± 4.88 (75.75%, ≥75% satisfactory). Knowledge and attitudes were significantly positively correlated (r = 0.215; p < 0.05). Demographic factors such as gender, age, and ICU experience significantly influenced knowledge and attitudes (all p < 0.05). Nurses with a master's degree and those who had been primary nurses for prone-ventilated patients had higher knowledge scores. Additionally, nurses with 6-15 years of experience showed more favorable attitudes toward PI prevention.

Conclusion: Although ICU nurses had a positive perception of PI prevention in prone-positioned patients, their knowledge was insufficient, and their attitudes were moderate. To address these gaps, healthcare administrators should implement targeted strategies and update evidence-based protocols for PI prevention in prone-ventilated patients. Improving nurses' knowledge and fostering a proactive attitude can enhance clinical practices and patient outcomes.

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.