Yeyao Hu,1,2 Min Tian,3 Yanyan Yu,1 Yongqin Qian,1 Hongli Deng,2 Dingying Wang,2 Yishuang Li,2 Rui Xia,2 Qiong He1,21Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563003, People’s Republic of China; 2School of Nursing, Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 3Department of Urology, Guizhou Maotai Hospital, Renhuai, Guizhou, 564500, People’s Republic of ChinaCorrespondence: Qiong He, Email byts75@126.com Min Tian, Email 1017771985@qq.comIntroduction: Disaster preparedness among physicians is critical for effective medical response during emergencies, especially in underdeveloped regions with limited healthcare resources. However, evidence from such contexts remains scarce. This study was conducted in Guizhou Province, a representative underdeveloped region in southwestern China, to assess physicians’ disaster response competencies and training needs, and to provide evidence for targeted healthcare policy and capacity-building strategies.Methods: A cross-sectional survey was conducted from June to August 2023 among physicians working in hospitals at various levels across Guizhou Province. The questionnaire included demographic and professional background information, a 46-item self-assessment of disaster response competencies, and a 51-item self-assessment of training needs related to disaster medicine education and training. All items were rated using a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). Data were analyzed using descriptive statistics, Mann–Whitney U-tests, Kruskal–Wallis tests, and multivariable linear regression.Results: A total of 760 physicians completed the survey. The disaster response competency total score ranged from 46 to 230, with a median of 141 (IQR 131– 181), indicating a low-to-moderate level of disaster preparedness. The training needs total score ranged from 51 to 255, with a median of 172 (IQR 153– 243), reflecting moderate-to-high training needs. Multivariable linear regression showed that location of practice, hospital type, clinical department, and institutional support (presence of an in-hospital disaster rescue team and existence of a comprehensive emergency plan) were associated with physicians’ disaster response competency scores (P < 0.05).Conclusion: Physicians in underdeveloped regions of southwestern China demonstrate notable gaps in disaster response competencies alongside substantial training needs. Tailored, context-specific disaster medicine education and training, supported by institutional support, should be integrated into healthcare policy and hospital management to strengthen system resilience and improve emergency medical response capacity in underdeveloped regions.Keywords: physicians, underdeveloped regions, disaster preparedness, disaster response competencies, training needs, institutional support, disaster medicine education and training, cross-sectional study
Background:Limited availability, high costs, and reliance on imported medicines challenge access to pediatric cancer treatment in Indonesia. For childhood acute lymphoblastic leukemia (ALL), the absence of reliable national quantification data complicates procurement, reimbursement, and budget planning. This study estimated hospital-level and national pharmaceutical requirements for pediatric ALL in Indonesia using a morbidity-based forecasting approach. Methods:A budget impact modeling approach using a morbidity-based pharmaceutical quantification framework was developed to estimate theoretical annual procurement requirements for pediatric ALL. Data were derived from three national cancer referral hospitals during the study reference period (January 2022-October 2023) and supplemented with registry data and national treatment guidelines. Drug quantities were calculated using standardized regimens for standard-risk and high-risk patients, assuming an average body weight of 24 kg and body surface area of 0.8 m2. National estimates were extrapolated using disease incidence and risk-group distribution rather than comprehensive national medicine-utilization data. Drug prices were obtained from the national electronic procurement catalogue. The model assumed full completion of standardized treatment regimens without treatment interruptions or dose modifications. Results:Pharmaceutical requirements and expenditure were highly concentrated in a limited number of medicines. The estimated annual national pharmaceutical expenditure was IDR 1.43 billion for standard-risk patients and IDR 4.48 billion for high-risk patients, with a combined budget of IDR 5.91 billion. L-asparaginase accounted for the largest share of expenditure, with annual national costs of IDR 993.3 million for standard-risk patients and IDR 2,885.2 million for high-risk patients. Vincristine and daunorubicin were additional major contributors. Across both risk groups, induction therapy represented the most resource-intensive treatment phase, and the ten highest-cost drug-risk group combinations accounted for approximately 97.8% of total pharmaceutical spending. Conclusion:This study provides the first national morbidity-based estimation of pediatric ALL pharmaceutical requirements and budget implications in Indonesia. The findings highlight key cost drivers and support regimen- and risk-specific forecasting for procurement planning and policy decision-making.
Purpose:Laboratory data with outpatient prescriptions have expanded, and their usefulness has been reported. However, the effect of a modification in laboratory data provision on the content of tracing reports (TRs) submitted by community pharmacists to provide clinical feedback to physicians and on physician responses remains unclear. This study aimed to evaluate the impact of a system-level modification in laboratory data provision on the inclusion of laboratory data-related descriptions in TRs and to assess the association between TR characteristics and physician responses. Patients and Methods:We used TRs submitted by community pharmacies to a university hospital in Japan. An integrated prescription format (IPF), containing laboratory data automatically printed on prescriptions, was introduced in addition to the existing separate sheet format (SSF). Laboratory data-related descriptions in the TRs were compared pre- and post-implementation. Physician responses were evaluated, and associated factors were analyzed using logistic regression. Results:Laboratory data provision using SSF remained approximately 4% pre- and post-implementation, whereas IPF printed laboratory data fields on all prescriptions post-implementation. A total of 761 TRs were analyzed (pre-implementation, 389; post-implementation, 372). Laboratory data-related descriptions were identified in 16 TRs (2.1%), with a significant increase post-implementation (1.0% vs 3.2%; odds ratio [OR] 3.21, 95% confidence interval [CI] 1.03-10.04). Physician responses were recorded for 210 TRs (27.6%), with no significant difference pre- and post-implementation (27.8% vs 27.4%; OR 0.98, 95% CI 0.71-1.35). Multivariable analysis showed a strong association between pharmacists' proposals or concerns and physician responses (adjusted OR 10.39, 95% CI 5.39-20.03). Conclusion:The IPF-based laboratory data provision system increased inclusion of laboratory data-related descriptions in TRs but not physician responses. The findings suggest that providing information that includes clinically relevant proposals or concerns, rather than simply increasing the amount of information available, may be more important for promoting physician responses.
Yongbin Wang,1,* Ruiting Zhao,1,* Weihang Liu,1 Fei Lin,1 Chunjie Xu21Department of Epidemiology and Health Statistics, School of Public Health, The First Affiliated Hospital of Henan Medical University, Xinxiang, Henan, People’s Republic of China; 2Beijing Key Laboratory of Antimicrobial Agents/Laboratory of Pharmacology, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fei Lin, Email linfeixixi@aliyun.com Chunjie Xu, Email xuchunjie@imb.pumc.edu.cnBackground: Acute hemorrhagic conjunctivitis (AHC) is a highly contagious viral disease causing significant public health burden. Accurate forecasting is essential for timely intervention. The seasonal autoregressive integrated moving average (SARIMA) model is widely used, but the seasonal autoregressive fractionally integrated moving average (SARFIMA) model, which captures long-range dependence, may perform better for complex incidence series. This study compared the forecasting performance of SARFIMA and SARIMA models for AHC in Henan.Methods: Monthly AHC case data from January 2011 to June 2023 in Henan Province were analyzed. Data from January 2011 to June 2022 were used for model training, with the remaining 12 months reserved for testing. National-level data from mainland China were used for external validation. Model performance was assessed using mean absolute deviation (MAD), root mean square error (RMSE), mean absolute percentage error (MAPE), and mean error rate (MER).Results: AHC incidence showed a significant upward trend (average annual percentage change: 6.973%, 95% CI: 3.963%– 10.071%) and a pronounced seasonal peak from March to September. The optimal models were SARIMA(0,1,2)(0,1,1)12 and SARFIMA(0,0.410,2)(0,0.413,1)12. SARFIMA outperformed SARIMA on most metrics in both training (MAD: 23.392 vs 24.599; MAPE: 0.132 vs 0.134; RMSE: 31.218 vs 31.339; MER: 0.124 vs 0.131) and test sets (MAD: 39.375 vs 48.850; MAPE: 0.237 vs 0.280; RMSE: 50.390 vs 57.358; MER: 0.184 vs 0.229), with a substantially better fit (AIC: 987.59 vs 1231.50). National validation confirmed SARFIMA’s superiority for MAD, MAPE, and MER, although RMSE values were comparable between models.Conclusion: The SARFIMA model offers improved forecasting accuracy over SARIMA for AHC incidence in most metrics, suggesting its potential utility for public health surveillance. However, its application requires sufficient data length, and prospective validation is needed before operational deployment.Keywords: acute hemorrhagic conjunctivitis, SARFIMA model, SARIMA model, time series forecasting, incidence, long-range dependence
Mada A Al-Amoodi,1 Wadi B Alonazi,1 Shabana Tharkar,2 Khalid M Almutairi21Health Administration Department, College of Business Administration, King Saud University, Riyadh, Saudi Arabia; 2Department of Community Health Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Khalid M Almutairi, Department of Community Health Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia, Email kalmutairim@ksu.edu.saBackground: Direct access to physical therapy (DAPT) services has attracted global attention for its potential to promote healthcare coverage, access, and equity. This study investigated physical therapists’ opinions on DAPT practice, including awareness, perceived barriers, potential benefits, and implications for healthcare.Methods: A cross-sectional study was used to survey 137 physical therapists from governmental, semi-governmental, and private centers. The Bury and Stokes tool was used to evaluate the DAPT opinions that were originally assessed in the views of World Confederation for Physical Therapy (WCPT) members on DAPT policy. The link to the questionnaire and informed consent was emailed to the physiotherapists. Data was reported in percentages and means as appropriate. Mann‒Whitney U-test and the Kruskal‒Wallis test were employed to explore associations between variables.Results: The physiotherapists demonstrated good theoretical knowledge (65.7%) and understanding of DAPT concepts (73%). The overall awareness score was 2.46 ± 0.48 out of 3. Many supported (80.3%) and were willing to practice DAPT (77.7%). Out of a total mean score of 5, major concerns include physicians’ views score (3.32 ± 1.12), lack of evidence-based practices (3.07 ± 1.06), lack of professional competencies (3.01 ± 1.06), and payment models (3.2 ± 1.11). The documented advantages encompass enhanced patient satisfaction (4.19 ± 0.79), expedited services (4.32 ± 0.75), and elevated professional standing (4.33 ± 0.74). Senior practitioners demonstrated a higher level of awareness in comparison to their junior colleagues (score: 2.4 vs 2.6; p=0.004). Additionally, physiotherapists with over 25 years of clinical experience recognized the benefits of direct access over their counterparts with lesser experience (> 25 years’ experience median score 4.5; vs median scores < 4 for all lesser experience groups; p< 0.003).Conclusion: This study emphasizes physiotherapists’ opinions and positive attitudes regarding the DAPT policy implementation in Saudi Arabia. Nevertheless, addressing the challenges identified through education, advocacy, policy adjustments, and collaboration between stakeholders can enhance the accessibility, quality, and overall delivery of physiotherapy services.Keywords: direct access, perspectives, physical therapy, policy implementation, Saudi Arabia
Purpose:Under China's diagnosis-related group/diagnosis-intervention packet (DRG/DIP) payment reform, special case negotiation addresses clinically atypical cases that do not fit standard case-based payment rules but may also create payment misfit, fund leakage, discretionary review, delay, and accountability risks. This study examined whether policies translate these risks into enforceable governance rules. Methods:A structured policy-text analysis examined 20 documents within one provincial policy chain: one national document, one provincial document, and 18 municipal documents covering all prefecture-level jurisdictions in the province. The municipal documents constituted a complete census within the selected province rather than a nationwide sample of Chinese provinces. A 30-node, five-domain framework used a 0-1-2 scale. Two coders worked independently, and final analyses used adjudicated scores. Results:Inter-coder agreement was 95.0% (Cohen's kappa, 0.899). Domain scores were highest for payment misfit risk control (0.797), discretion and capture risk control (0.786), and administrative burden and delay risk control (0.767), and lowest for accountability and equity risk control (0.512). Applicable scope, volume or proportion cap, and submission or review cycle were universally enforceable. The weakest or least consistently enforceable nodes concerned cross-area or fund responsibility, appeal or reconsideration, processing time limits, and special diseases, infectious diseases, or rare diseases. Vertical attenuation was highest for cross-area or fund responsibility (72.2%) and for processing time limits and special diseases, infectious diseases, or rare diseases (both 55.6%). Municipal documents formed balanced, boundary-heavy, procedure-heavy, and low-formalisation configurations. Conclusion:Special case negotiation requires a minimum risk-governance package-a minimum set of enforceable procedural safeguards-combining eligibility boundaries, traceable review, appeal routes, and clear accountability. The analysis evaluates formal policy design rather than implementation outcomes. Functionally, the framework may inform risk audits of outlier, high-cost, new-technology, and other payment-exception mechanisms in DRG or other case-based payment systems internationally.
Background:Central sterile supply departments (CSSDs) play a critical role in surgical patient safety by ensuring the effective cleaning and correct packaging of reusable surgical instruments. However, process defects may still occur and lead to rework, delays, or safety risks. This study evaluated the effectiveness of a closed-loop defect management improvement program for surgical instrument reprocessing in a CSSD. Methods:We conducted a retrospective quasi-experimental before-after study comparing pre-intervention (January-June 2025, conventional management) and post-intervention (July-December 2025, closed-loop defect management improvement model) periods at West China Hospital. Data were collected through routine operational audits performed by trained human observers, including visual inspection, ATP testing, and protein residue testing, according to departmental standards. The intervention included standardized defect recording, structured analysis, corrective actions, feedback, and targeted training. Outcomes included qualified rates of cleaning and packaging, along with assembly errors, label errors, packaging integrity violations, and instrument damage. Results:In 2025, 54,412 cleaned instruments and 6,488 packages were randomly inspected. Packaging tracking covered 215,927 packages (107,943 pre-intervention; 107,984 post-intervention). Compared with the pre-intervention period, the qualified rate of regular sampling tests increased from 97.99% to 99.76% (P<0.05), and the packaging pass rate rose from 96.73% to 98.98% (P<0.05). Assembly errors dropped from 43 to 15 cases, packaging damages from 57 to 6, and incorrect label information from 15 to 5 (all P<0.05). Insufficient cleaning and instrument damage showed no significant difference. Conclusion:In the CSSD, implementing the closed-loop defect management improvement model was associated with improved reprocessing quality and reduced packaging-related defects. Given that our pre-intervention quality rates already exceeded many published figures, we sought to determine whether implementing a closed-loop defect management improvement program could further reduce defect events and enhance reprocessing reliability, rather than merely meeting minimum standards.
Purpose:Hysterectomy and adnexectomy for carcinoma in situ and nonmalignant lesions (HAC) is a subgroup of the diagnosis-related groups (DRG). A comprehensive set of reforms in Beijing, referred to as the medicine-consumables linkage (MCL) reforms, is intended to improve the quality of medical services. This study aims to analyze the impact of the MCL reforms on the changes in hospitalization expenditures, out-of-pocket (OOP) expenditures, and length of stay (LOS) for patients underwent HAC. Methods:We used an interrupted time series (ITS) model along with relevant data on HAC from January 2017 to December 2020 to analyze changes in hospitalization expenditures, OOP expenditures, and LOS for patients before and after the MCL reforms were implemented. Results:The results showed that after the reforms average surgical expenditures per hospitalization increased by 75.34%, whereas average examination and medical consumable expenditures per hospitalization decreased by 17.51% and 12.63%, respectively. The proportion of OOP expenditures decreased by 14.26%, and the average LOS per hospitalization decreased by 21.86%. The ITS analysis showed that the average total, laboratory test, drug, and OOP expenditures per hospitalization decreased monthly after the reforms. The impact of the reforms on the subgroup without comorbidity and complications was even more significant and reached the expected goals of the reforms. Conclusion:The hospitalization expenditure structure was optimized after the reforms, and the price of surgical services increased after the MCL reforms. The patients' cost burden was reduced, and the LOS for patients declined after the reforms. This study provides evidence and reference points for comparing hospitalization expenditures and the LOS for patients in optimizing DRG programs in China and other countries with similar hospitalization systems.
Background:International guidelines lack standardized quantitative criteria for surgical evacuation in incomplete abortion, leading to heterogeneous clinical practice, which may result in unnecessary interventions and increased clinical and economic burdens on women and healthcare resources. Methods:This retrospective study included clinical data from 411 patients with medical abortion at Hangzhou Women's Hospital (2023-2025). A stacking ensemble model with 5-fold cross-validation was constructed, and its performance was evaluated using AUC, with 95% CI, accuracy, sensitivity, and specificity, followed by internal hold-out validation. Feature importance was determined using a weighted average of Information Gain (IG) and SHapley Additive exPlanations (SHAP) values. SHAP analyses were further used to quantify the effects of key features on surgical intervention risk and identify critical risk thresholds. Results:The stacking model exhibited the optimal performance, with an internal validation AUC of 0.821 (95% CI: 0.795-0.846), accuracy 0.794, sensitivity 0.757 and specificity 0.806, and a hold‑out validation AUC of 0.801 (95% CI: 0.700-0.892), outperforming traditional and single ensemble models. Blood β-human chorionic gonadotropin (β-hCG), body mass index (BMI), uterine residual tissue blood flow resistance index (RI), and residual tissue size at first post-medical abortion review (RTS‑FPAR) were identified as core predictive factors. SHAP analysis confirmed that β-hCG ≥ 824.90 mIU/mL, BMI ≤ 18.91 or ≥ 23.42, RI ≤ 0.51, RTS‑FPAR ≥ 3.30 cm significantly elevated surgical intervention risk. Conclusion:The stacking model showed promising moderate performance in predicting the need for surgical evacuation in our study. Our findings suggest that existing criteria for surgical intervention may cover an overly broad range of cases, and more selective thresholds may support improved risk stratification to potentially reduce unnecessary interventions. These findings offer preliminary research insights for auxiliary risk assessment of incomplete abortion, and multi-centre external validation is required before clinical use.
Dita N S Argadiredja,1– 3 Mohammed Alfaqeeh,2 Yasmin Fatinah,1,2 Vesara Ardhe Gatera,4 Lucia R Andalusia,2,3 Rano K Sinuraya,2,5,6 Dina Abushanab,7 Rizky Abdulah,2,5 Auliya A Suwantika2,5,61Doctoral Program of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia; 3Directorate of Pharmaceuticals Production and Distribution, Ministry of Health, Jakarta, Indonesia; 4Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia; 5Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia; 6Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia; 7Office of Vice President for Medical and Health Sciences, QU Health, Qatar University, Doha, QatarCorrespondence: Auliya A Suwantika, Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia, Tel/Fax +62-878-2267-1010, Email auliya@unpad.ac.idBackground: Limited availability, high costs, and reliance on imported medicines challenge access to pediatric cancer treatment in Indonesia. For childhood acute lymphoblastic leukemia (ALL), the absence of reliable national quantification data complicates procurement, reimbursement, and budget planning. This study estimated hospital-level and national pharmaceutical requirements for pediatric ALL in Indonesia using a morbidity-based forecasting approach.Methods: A budget impact modeling approach using a morbidity-based pharmaceutical quantification framework was developed to estimate theoretical annual procurement requirements for pediatric ALL. Data were derived from three national cancer referral hospitals during the study reference period (January 2022–October 2023) and supplemented with registry data and national treatment guidelines. Drug quantities were calculated using standardized regimens for standard-risk and high-risk patients, assuming an average body weight of 24 kg and body surface area of 0.8 m2. National estimates were extrapolated using disease incidence and risk-group distribution rather than comprehensive national medicine-utilization data. Drug prices were obtained from the national electronic procurement catalogue. The model assumed full completion of standardized treatment regimens without treatment interruptions or dose modifications.Results: Pharmaceutical requirements and expenditure were highly concentrated in a limited number of medicines. The estimated annual national pharmaceutical expenditure was IDR 1.43 billion for standard-risk patients and IDR 4.48 billion for high-risk patients, with a combined budget of IDR 5.91 billion. L-asparaginase accounted for the largest share of expenditure, with annual national costs of IDR 993.3 million for standard-risk patients and IDR 2,885.2 million for high-risk patients. Vincristine and daunorubicin were additional major contributors. Across both risk groups, induction therapy represented the most resource-intensive treatment phase, and the ten highest-cost drug–risk group combinations accounted for approximately 97.8% of total pharmaceutical spending.Conclusion: This study provides the first national morbidity-based estimation of pediatric ALL pharmaceutical requirements and budget implications in Indonesia. The findings highlight key cost drivers and support regimen- and risk-specific forecasting for procurement planning and policy decision-making.Keywords: pediatric acute lymphoblastic leukemia, morbidity-based forecasting, pharmaceutical procurement, budget impact analysis, Indonesia
Takahiro Motoki,1 Hiroaki Tanaka,1 Tatsuya Tai,1,2 Kazunori Yamaguchi,1,3 Shinji Kosaka,4 Yasuaki Mino11Department of Pharmacy, Kagawa University Hospital, Miki, Kagawa, Japan; 2Department of Infection Control Service Office, Kagawa University Hospital, Miki, Kagawa, Japan; 3Department of Safety Management, Kagawa University Hospital, Miki, Kagawa, Japan; 4Drug Information Center, Kagawa Pharmaceutical Association, Takamatsu, Kagawa, JapanCorrespondence: Takahiro Motoki, Department of Pharmacy, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan, Tel +8187-898-5111, Fax +8187-891-2318, Email motoki.takahiro@kagawa-u.ac.jpPurpose: Laboratory data with outpatient prescriptions have expanded, and their usefulness has been reported. However, the effect of a modification in laboratory data provision on the content of tracing reports (TRs) submitted by community pharmacists to provide clinical feedback to physicians and on physician responses remains unclear. This study aimed to evaluate the impact of a system-level modification in laboratory data provision on the inclusion of laboratory data-related descriptions in TRs and to assess the association between TR characteristics and physician responses.Patients and Methods: We used TRs submitted by community pharmacies to a university hospital in Japan. An integrated prescription format (IPF), containing laboratory data automatically printed on prescriptions, was introduced in addition to the existing separate sheet format (SSF). Laboratory data-related descriptions in the TRs were compared pre- and post-implementation. Physician responses were evaluated, and associated factors were analyzed using logistic regression.Results: Laboratory data provision using SSF remained approximately 4% pre- and post-implementation, whereas IPF printed laboratory data fields on all prescriptions post-implementation. A total of 761 TRs were analyzed (pre-implementation, 389; post-implementation, 372). Laboratory data-related descriptions were identified in 16 TRs (2.1%), with a significant increase post-implementation (1.0% vs 3.2%; odds ratio [OR] 3.21, 95% confidence interval [CI] 1.03– 10.04). Physician responses were recorded for 210 TRs (27.6%), with no significant difference pre- and post-implementation (27.8% vs 27.4%; OR 0.98, 95% CI 0.71– 1.35). Multivariable analysis showed a strong association between pharmacists’ proposals or concerns and physician responses (adjusted OR 10.39, 95% CI 5.39– 20.03).Conclusion: The IPF-based laboratory data provision system increased inclusion of laboratory data-related descriptions in TRs but not physician responses. The findings suggest that providing information that includes clinically relevant proposals or concerns, rather than simply increasing the amount of information available, may be more important for promoting physician responses.Keywords: tracing reports, laboratory data provision, interprofessional collaboration, patient safety, drug-related problems, clinical information sharing
Tingting Zheng, Aiying Zeng, Yingfeng ChenCentral Sterile Supply Department, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of ChinaCorrespondence: Tingting Zheng, Email ztt1161725288@wchscu.edu.cnBackground: Central sterile supply departments (CSSDs) play a critical role in surgical patient safety by ensuring the effective cleaning and correct packaging of reusable surgical instruments. However, process defects may still occur and lead to rework, delays, or safety risks. This study evaluated the effectiveness of a closed-loop defect management improvement program for surgical instrument reprocessing in a CSSD.Methods: We conducted a retrospective quasi-experimental before–after study comparing pre-intervention (January–June 2025, conventional management) and post-intervention (July–December 2025, closed-loop defect management improvement model) periods at West China Hospital. Data were collected through routine operational audits performed by trained human observers, including visual inspection, ATP testing, and protein residue testing, according to departmental standards. The intervention included standardized defect recording, structured analysis, corrective actions, feedback, and targeted training. Outcomes included qualified rates of cleaning and packaging, along with assembly errors, label errors, packaging integrity violations, and instrument damage.Results: In 2025, 54,412 cleaned instruments and 6,488 packages were randomly inspected. Packaging tracking covered 215,927 packages (107,943 pre-intervention; 107,984 post-intervention). Compared with the pre-intervention period, the qualified rate of regular sampling tests increased from 97.99% to 99.76% (P< 0.05), and the packaging pass rate rose from 96.73% to 98.98% (P< 0.05). Assembly errors dropped from 43 to 15 cases, packaging damages from 57 to 6, and incorrect label information from 15 to 5 (all P< 0.05). Insufficient cleaning and instrument damage showed no significant difference.Conclusion: In the CSSD, implementing the closed-loop defect management improvement model was associated with improved reprocessing quality and reduced packaging-related defects. Given that our pre-intervention quality rates already exceeded many published figures, we sought to determine whether implementing a closed-loop defect management improvement program could further reduce defect events and enhance reprocessing reliability, rather than merely meeting minimum standards.Keywords: central sterile supply department, surgical instrument reprocessing, packaging, defect management
Background:Patients undergoing pulmonary anesthesia face dignity and privacy threats due to intraoperative positioning, unconsciousness, and postoperative discomfort. Existing studies focus mainly on technical safety, lacking systematic investigation from the patient's perspective. This neglect may lead to patient dissatisfaction and ethical concerns. Objective:To identify patients' dignity and privacy needs, evaluate service quality gaps, and prioritize improvement targets in pulmonary anesthesia nursing using an integrated Kano-SERVQUAL framework. Methods:A cross-sectional survey was conducted between March and September 2025 among patients undergoing pulmonary resection under general anesthesia in five tertiary hospitals in China. A 25-item questionnaire based on the Kano and SERVQUAL models was developed to assess dignity- and privacy-related service needs. Kano attribute classification, Better-Worse coefficient analysis, SERVQUAL gap analysis, and integrated quadrant analysis were performed. Results:A total of 423 valid questionnaires were analyzed. Patients' dignity- and privacy-related needs showed a clear hierarchical structure, with informed consent, confidentiality protection, professional competence, and body privacy identified as fundamental requirements. Significant gaps were observed between patients' expectations and perceived service experiences, particularly in the domains of assurance and empathy. The integrated Kano-SERVQUAL analysis identified informed consent, privacy protection, responsiveness to patient concerns, professional competence, and respectful communication as the highest-priority areas for improvement. Conclusion:Patients undergoing pulmonary anesthesia place substantial importance on dignity and privacy protection, yet important service gaps remain. This study is among the first to integrate Kano-based need hierarchy analysis with SERVQUAL service quality assessment in pulmonary anesthesia nursing, enabling simultaneous evaluation of patient priorities and service deficiencies. The proposed framework offers a practical and evidence-based strategy for prioritizing patient-centered quality improvement and resource allocation in perioperative anesthesia care.
Purpose:The community two committees play a pivotal role in urban grassroots public health emergency governance. Situated within China's distinctive grassroots governance context, this study examines the associations among the perceived performance of community two committees, government trust, public participation, and satisfaction with urban infectious disease governance. Patients and Methods:Using 2023 China Social Governance Survey data, 3182 participants were selected for cross-sectional analysis. We estimated stepwise regression models and tested mediation using the weighted least squares mean and variance adjusted estimator and bootstrap procedures. We conducted robustness tests using alternative variable specifications and propensity score matching, and assessed potential endogeneity using the Oster test, Rosenbaum bounds, and the Lewbel approach. Results:Perceived performance of community two committees was positively associated with satisfaction with urban infectious disease governance (β = 0.158, 95% CI: 0.118-0.197). Government trust (β = 0.086, 95% CI: 0.068-0.104) and public participation (β = 0.031, 95% CI: 0.020-0.043) partially mediated this association, accounting for 29.20% and 10.40% of the total effect, respectively. In addition, a sequential indirect association through government trust and public participation was observed (β = 0.020, 95% CI: 0.013-0.027), accounting for 6.70% of the total effect. The robustness tests indicated that both the direct and indirect associations remained significant, while the sensitivity and supplementary endogeneity analyses suggested that the findings were not highly sensitive to omitted-variable bias or unobserved confounding. Conclusion:The study revealed that the perceived performance of community two committees was positively associated with satisfaction with urban infectious disease governance, with government trust and public participation sequentially mediating this association. Governments should strengthen the governance capacity of community two committees, improve transparency and responsiveness to foster public trust, and establish institutionalized channels for public participation in urban infectious disease governance.
Background:To explore the effectiveness of Failure Mode and Effects Analysis (FMEA) combined with Root Cause Analysis (RCA) in deep vein thrombosis (DVT) risk management for patients undergoing total knee arthroplasty (TKA). Methods:In this prospective, non-randomized, quasi-experimental before-after design study, consecutive patients undergoing primary unilateral TKA were allocated according to admission period to receive either routine DVT risk management or an integrated FMEA-RCA program. Sample size calculation indicated that at least 64 patients per group were required, and 68 were enrolled in each group. Outcomes included RPN values, DVT incidence, length of stay, and HSS knee scores assessed preoperatively and at 6 weeks postoperatively. Results:The RPN values for all eight high-risk failure modes in the DVT prevention process were lower in the intervention group than in the control group (all Bonferroni-adjusted P values < 0.00625). The incidence of DVT was significantly lower in the intervention group than in the control group (5.88% vs 23.53%; χ2 = 8.442, P = 0.004), and this association remained significant after adjustment for age, BMI, and baseline Caprini score (aOR = 0.24, 95% CI: 0.08-0.72; P = 0.011). The length of stay was shorter in the intervention group than in the control group (7.99 ± 2.06 vs 11.20 ± 4.21 days; mean difference = -3.21 days, 95% CI: -4.33 to -2.09; t = 5.647, P < 0.001). At 6 weeks postoperatively, HSS knee scores were higher in the intervention group than in the control group (82.30 ± 5.60 vs 76.80 ± 6.90; t = 4.327, P < 0.001). Conclusion:Combining FMEA with RCA could help identify key nursing control points in DVT prevention for patients undergoing TKA.
Background:Dental and periodontal diseases share common social determinants and oral health-risk behaviours, yet these factors have not been thoroughly investigated across different contexts. Aim:This study aimed to examine the association between aggregated common oral health-risk behaviours and their determinants with self-rated dental and gingival health in Jazan, Saudi Arabia (SA). Methods:A cross-sectional study was conducted among a non-probability convenience sample of 687 school students in Jazan, SA. Participants completed an online questionnaire assessing behaviours related to oral hygiene, dental visits, dietary habits (sugar and fruit consumption), tobacco use, and sociodemographic and socioeconomic factors. Logistic regression modelling was performed to assess the determinants and aggregated behaviours associated with self-rated poor dental and gingival health. Results:The median age of participating students was 15 (interquartile range: 2) years, and 67% were female. The aggregate of oral health-risk behaviours score was significantly associated with self-rated poor dental and gingival health, with each additional risk behavior associated with higher odds of poor dental health (OR = 1.29, 95% CI: 1.17-1.42) and poor gingival health (OR = 1.34, 95% CI: 1.23-1.47). Rural residence was also significantly associated with both outcomes, including poor dental health (OR = 2.44, 95% CI: 1.56-3.83) and poor gingival health (OR = 2.02, 95% CI: 1.37-2.99). Conclusion:This study found a significant association between aggregated oral health-related risk behaviours and poor self-rated dental and gingival health among schoolchildren in Jazan region, SA. Notably, area of residence emerged as a key shared social determinant, with students living in rural areas disproportionately impacted. These findings support the shared role of oral health-risk behaviours and social factors in the development of both dental and gingival diseases.
Aim:To develop a risk prediction model for unplanned extubation (UE) in invasively ventilated patients in the respiratory intensive care unit (RICU) using nursing-related and ventilation characteristics, and to perform risk stratification. Methods:This single-center retrospective study included adult patients receiving invasive mechanical ventilation in the RICU. Nursing-related variables (RASS score, delirium, physical restraint use, nurse-to-patient ratio) along with baseline and treatment data were collected. Univariate and multivariate logistic regression was employed to identify UE-associated factors and build a nomogram. Model performance was evaluated using ROC curve, Hosmer-Lemeshow test, calibration curve, decision curve analysis, and bootstrap internal validation. Risk stratification was performed based on predicted probability. Results:Among 1120 patients, 102 (9.11%) experienced UE. Multivariate analysis identified RASS category, nurse-to-patient ratio, and FiO2 as independent factors. Compared with agitation, awake/mild sedation (OR = 0.262, P = 0.002) and deep sedation (OR = 0.071, P < 0.001) were protective. A nurse-to-patient ratio ≥ 1:4 was an independent risk factor (OR = 3.257, P = 0.001). FiO2 was protective (OR = 0.037, P = 0.009). The model achieved an AUC of 0.781 (95% CI: 0.738-0.824), sensitivity 0.760, specificity 0.700, Brier score 0.076, Hosmer-Lemeshow P 0.301, and calibration slope 1.000. UE incidence in low-, medium-, and high-risk groups was 2.80%, 15.60%, and 25.00%, respectively. Conclusion:The UE risk prediction model based on nursing-related characteristics has good discrimination and calibration. RASS category, nurse-to-patient ratio, and FiO2 are key independent factors. This model enables effective risk stratification and supports early identification of high-risk patients and optimized nursing management; however, its generalizability should be interpreted cautiously because of the single-center retrospective design and lack of external validation.
Objective:To examine and analyze the barrier factors influencing prescription circulation in Xiangyang City under the outpatient coordination policy and to provide reference evidence for promoting prescription circulation. Methods:To assess the practical implementation of prescription circulation under the outpatient coordination policy in retail pharmacy, a targeted questionnaire survey was administered to clinicians from medical institutions at all levels in Xiangyang City. Chi-square tests and structural equation modeling were employed to systematically identify key implementation challenges and to explore the underlying causes within the current electronic prescription circulation process. Results:The findings indicated that clinicians in Xiangyang City possessed a high level of awareness regarding electronic prescription circulation policies. However, the actual circulation rate remained low, and circulation willingness was generally neutral to conservative. Professional title and degree of policy understanding were identified as significant factors influencing circulation willingness. Structural equation modeling further demonstrated that policy incentives and regulatory constraints indirectly affected clinicians' willingness through multiple mediating pathways, including system functional deficiencies and patient cognitive biases. Conclusion:Clinicians in Xiangyang City exhibited high awareness of electronic prescription circulation policies, yet actual circulation rates remained limited, accompanied by neutral to conservative willingness. Complicated system procedures, ambiguous delineation of authority and responsibilities, and insufficient incentive mechanisms constituted the primary barriers to implementation. Policy familiarity and patient misperceptions were confirmed as critical factors influencing clinicians' willingness to participate in prescription circulation.
Background:Pre-anesthesia blood pressure (BP) elevation frequently occurs in normotensive elective surgical patients and may disrupt perioperative safety. This study adopted two mainstream diagnostic criteria (absolute and relative thresholds) to define BP elevation, and integrated physical, laboratory and psychological indicators to systematically explore relevant associated factors. Methods:This case-control study enrolling a total of 528 non-cardiac surgical patients. Patients were divided into case (elevated pre-anesthesia BP) and control (normal pre-anesthesia BP) groups. Pre-anesthesia BP elevation was defined as absolute threshold (systolic BP [SBP] ≥140 mmHg and/or diastolic BP [DBP] ≥90 mmHg), and relative threshold (≥20% increase from baseline). Multivariable logistic regression was used to screen associated factors. Results:The incidence of pre-anesthesia BP elevation was 35.6% (n=188) under the absolute threshold and 28.2% (n=149) under the relative threshold. Multivariable analysis revealed that increasing age (absolute threshold: odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10, relative threshold: OR 1.03, 95% CI 1.01-1.04), hyperlipemia (absolute threshold: OR 2.66, 95% CI 1.84-3.86, relative threshold: OR 1.49, 95% CI 1.18-1.88) and anxiety (absolute threshold: OR 1.17, 95% CI 1.10-1.25, relative threshold: OR 1.07, 95% CI 1.02-1.13) were correlated with BP elevation under both definitions (all p < 0.01). Under the absolute threshold, body mass index (BMI) (OR 1.12, 95% CI 1.03-1.21) and alcohol drinking (OR 2.74, 95% CI 1.55-4.84) were positively correlated (both p < 0.01), whereas prolonged sleep duration (2-4 hours: OR 0.37, 95% CI 0.15-0.95, 4-6 hours: OR 0.14, 95% CI 0.06-0.35, 6-8 hours: OR 0.12, 95% CI 0.04-0.34) was negatively correlated (all p < 0.05). Conclusion:Increasing age, hyperlipemia and preoperative anxiety are consistently associated with transient pre-anesthesia BP elevation under both criteria. Further studies are required to confirm causal links and verify whether intervening on these correlates can reduce perioperative BP fluctuations.
Objective:To assess whether the Life Hope Program, when added to routine nursing care, improves self-care ability (primary outcome) and hope levels (co-primary outcome), as well as psychological well-being, nutritional status, quality of life, and complication rates in uremic patients receiving hemodialysis. Methods:In this randomized controlled trial, 120 uremic hemodialysis patients were assigned to either routine care (control, n=60) or routine care plus a 3-month Life Hope Program (study, n=60). The program integrated goal-setting, psychological support, behavioral and nutritional guidance, cognitive restructuring, and social support. The co-primary endpoints were the Exercise of Self-Care Agency Scale (ESCA) and the Herth Hope Index (HHI). Secondary outcomes included depression (SDS), anxiety (SAS), fatigue (PFS), quality of life (WHOQOL-BREF), nutritional biomarkers (hemoglobin, prealbumin, albumin, transferrin), and complications. Baseline-adjusted analysis of covariance (ANCOVA) was used as the primary analytical method, with adjusted mean differences, 95% confidence intervals (CIs) and Cohen's d effect sizes reported. Bonferroni correction was applied for the two co-primary endpoints to control family-wise Type I error; secondary endpoints are reported with nominal P values and interpreted as exploratory. Results:All 120 participants completed the study with no dropouts or missing data. At 3 months, the study group showed significantly greater improvement in ESCA (adjusted mean difference 16.4, 95% CI 11.3-21.5, Cohen's d = 1.16, large effect) and HHI (adjusted mean difference 5.7, 95% CI 3.8-7.6, Cohen's d = 1.09, large effect) compared to controls (both P<0.001, below the Bonferroni-corrected threshold of α = 0.025). Significant between-group differences favoring the study group were also observed for SDS (d=1.13), SAS (d=1.28), PFS (d=0.92), and all WHOQOL-BREF domains (all nominal P<0.001; all remained significant after FDR correction). Nutritional biomarkers improved more in the study group (all nominal P<0.01; all remained significant after FDR correction), and risks of vascular access infection (RR 0.12, 95% CI 0.02-0.96), constipation (RR 0.44, 95% CI 0.21-0.94), and dyspepsia (RR 0.45, 95% CI 0.24-0.87) were lower, while urinary tract infection rates did not differ significantly. Conclusion:The Life Hope Program was associated with significant improvements in self-care ability, hope, psychological well-being, and nutritional status in hemodialysis patients, alongside reductions in fatigue and certain complications. Given the multi-component nature of the intervention, the single-blind design, and the 3-month follow-up period, these promising findings warrant confirmation in attention-controlled trials with longer-term assessment.
