Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the ...Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the credibility of the evidence has not been quantified.Objective:This study was designed to evaluate the existing evidence and offer a comprehensive understanding of the associations between the use of RYR preparations and various adverse health outcomes.Search strategy:Seven literature databases were searched from inception to May 5,2023,using medical subject headings and free-text terms(e.g.,“red yeast rice,”“Xuezhikang,”and“Zhibitai”).Inclusion criteria:Meta-analyses that investigated and quantitatively estimated associations between the use of RYR preparations and adverse health outcomes were included in this study.Data extraction and analysis:Two researchers independently extracted data using a standardized data collection table;any disagreements were resolved by consulting a third researcher.Based on the participant,intervention,comparator and outcome(PICO)framework in each eligible meta-analysis,a series of unique associations between the use of RYR preparations and adverse health outcomes were determined.The associations’effect estimates were re-evaluated using random-effect models.Results:Fifteen meta-analyses,comprising 186(164 unique)randomized controlled trials,were identified.Based on A Mea Surement Tool to Assess Systematic Reviews version 2,3(20%)and 12(80%)of these meta-analyses had low and critically low confidence,respectively.A total of 61 unique associations between the use of RYR preparations and adverse health outcomes were extracted from eligible metaanalyses.Based on the random-effect models,10(16.4%)associations indicated a significant protective effect of RYR preparations against adverse health outcomes,while 5(8.2%)indicated an increased risk of adverse health outcomes related to uric acid,alanine transaminase and aspartate transaminase levels.The other 46(75.4%)associations showed no significant difference between the use of RYR preparations and control treatments.Regarding the credibility of the evidence,21(34.4%),34(55.7%)and 6(9.8%)associations showed moderate,low and very low credibility,respectively.Conclusion:The evidence examined in this study suggests that RYR preparations are safe;however,the credibility of the evidence was not high.Further high-quality evidence is required.展开更多
Purpose:Patients'complaints can be predictors of patient care quality and safety.Understanding patients'complaints could help healthcare organizations target the areas for improvements.The purpose of this stud...Purpose:Patients'complaints can be predictors of patient care quality and safety.Understanding patients'complaints could help healthcare organizations target the areas for improvements.The purpose of this study is to use a mixed method analysis to a)examine the characteristics and categories of patients'complaints,b)explore the relationships of patients'complaints with professions and units,and c)propose theory-based strategies to improve care quality.Methods:This is a descriptive mixed method study.Data examined are patients'complaints filed at a university-affiliated hospital in China from January 2016 to December 2017.A qualitative content analysis was conducted to categorize complaints.A TwoStep cluster analysis was performed to provide an overall profile of patients'complaints.Chi-Square tests were conducted to investigate the relationships among complaints,professions,and units.Results:838 complaints were filed,with 821 valid cases for analysis.Six categories surfaced from the qualitative analysis:uncaring attitudes,unsatisfactory quality of treatment or competence,communication problems,the process of care,fees and billing issues,and other miscellaneous causes.Physicians received most of the complaints(56.6%).The unit receiving the most complaints were outpatient clinics and medical support units(52.7%).The cluster analysis indicated four distinct clusters.Significant relationships existed between complaints and professions(x2(20)=178.82,P<0.01),and between complaints and units(x2(15)=42.72,P<0.01).Conclusions:Patients'complaints are valuable sources for quality improvements.Healthcare providers should be not only scientifically knowledgeable,but also humanistic caring.Caring-based theories may provide guidance in clinical practice.展开更多
This article discusses the causes of the contamination of rice with cadmium in China and considers what we know about the severity of the problem. It argues that it is misleading to extrapolate simply from levels of c...This article discusses the causes of the contamination of rice with cadmium in China and considers what we know about the severity of the problem. It argues that it is misleading to extrapolate simply from levels of cadmium in soil to health risks, because the uptake of cadmium by crops and the health impacts of the metal are affected by multiple factors. These include not only background levels of cadmium and pollution from mining and industry, but also soil quality, climatic conditions and the type and variety of crops grown. Social and cultural factors, including dietary habits, other exposure sources, nutritional quality and general health status will also affect the intake of cadmium and the severity of health impacts. For these reasons we argue that interdisciplinary analysis is crucial to a better understanding of patterns of risk to health from cadmium pollution, and to the design of effective responsive measures.展开更多
Background: An essential condition to improve patient safety is considered to ensure a supportive patient safety culture. Measuring the culture of patient safety in all health care institutions may be a first step to ...Background: An essential condition to improve patient safety is considered to ensure a supportive patient safety culture. Measuring the culture of patient safety in all health care institutions may be a first step to target improvements. Creating a culture of safety requires eliminating the culture of blame. In order to formulate actions for improvement, it is important for hospitals to assess their baseline scores for the existing safety culture and to determine the areas of priority. Aim: The aim of this study was first to measure the use, translation in Albanian and adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) assessment as a tool for improving patient safety in Kosovo Hospitals. The second aim was to measure the level of patient safety culture in Kosovo, in seven hospitals and one University Clinical Center (hospitals with over 50 beds, including psychiatric hospitals). Method: The questionnaire (HSOPSC) was translated into Albanian for use in the Kosovo. It was used forward-backward translation: the questions were translated into Albanian by one translator and then translated back into English by an independent translator who was blinded to the original questionnaire. Results: In the eight-factor model, the internal consistency of the factors and the construct validity of the HSOPSC questionnaire were mostly satisfactory. The construct validity was sufficient for all subscales, except for the 4 other subscale regarding intention to report incidents which correlated poorly with other subscales. In total, HSOPSC has 12 dimensions. Cronbach’s α showed that in Kosovarian society, we could use only 8 dimensions model. Conclusion: The hypothesis that HSOPSC would be a suitable instrument to provide important indicators for the improvement of patient safety culture was tested and it was confirmed, that HSOPSC could be used as 8 dimension model. HSOPSC is suitable to improve patient safety culture and provide each hospital with a basic profile on patient safety culture and recommendations for an oriented intervention plan.展开更多
Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The nu...Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The number of practicing nurses' density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL),postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement,postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods.The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period.The statistical technique of panel data analysis including unit root test,co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series.Results: There were significant relationships from nurse-staffing level to reducing FBL,PPE,DVT,PSA and PWD with long-run magnitudes of-2.91,-1.30,-1.69,-2.81 and-1.12 based on surgical admission method as well as-6.12,-14.57,-7.29,-1.41 and-0.88 based on all admission method,respectively.Conclusions: A higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.Hence,we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.展开更多
Traditionally the global management system of an organization is frequently split into a number of individual management systems that are defined and implemented according to specific management systems standards (MSS...Traditionally the global management system of an organization is frequently split into a number of individual management systems that are defined and implemented according to specific management systems standards (MSSs) as well as managed independently. The individual implementation of MSSs is an option that leads to several inefficiencies and sub-optimization of the global management system of an organization. As referred by ISO [1] the interested parties’ requirements increase. A more effective and efficient option for an organization is to integrate, into an integrated management system (IMS), the implementation and management of requirements of multiple MSSs. Certain difficulties are associated to the structuring process, implementation, verification, evaluation, improvement and progressive development of an IMS in the organizations. Several scholars have proposed various theoretical approaches regarding the integration of individual management systems (MSs) leading to the conclusion that there is not a common practice for all organizations as they encompass different characteristics. This paper aims to present and justify a designed methodology to be used by organizations to support the integration of various MSs. Among them are highlighted: the Environmental Management System (EMS) according ISO 14001 [2], the Quality Management System (QMS) according ISO 9001 [3], and the Occupational Health and Safety Management System (OH & SMS) according OHSAS 18001 [4]. The methodology was designed in the context of a Portuguese company, on sequence of an organizational diagnosis and a research that was performed through a questionnaire. The strategy and the research methods took into consideration the case study.展开更多
Nursing leaders are currently faced with opportunities to advance nursing’s role in the use of electronic health records (EHRs). Nurse leaders can advance the design of EHRs with nurse informaticists to improve healt...Nursing leaders are currently faced with opportunities to advance nursing’s role in the use of electronic health records (EHRs). Nurse leaders can advance the design of EHRs with nurse informaticists to improve health outcomes of individual and populations of patients.展开更多
The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in a...The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in acute care hospitals in the United States. This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented IT functionalities in their general medical and surgical inpatient units. It used publicly available 2007 datasets, the hospital was the unit of analysis, and teaching and non-teaching hospitals were analyzed separately. Hospital-acquired injurious falls were identified based on fall-related primary and secondary diagnoses and were flagged by the hospitals as not “present on admission” in the 2007 California, Florida, and New York State Inpatient Database data. The 4 health IT functionalities in general medical and surgical inpatient units were 1) electronic clinical documentation, 2) results viewing, 3) computerized provider order entry, and 4) decision support. The research question was What are the effective health IT functionalities in the general medical and surgical units for reducing fall risk among adult patients aged 65 years or older at their hospitals? Independent t tests were used. The results showed that no significant difference was found in the hospital-acquired injurious fall rates between hospitals with and without each of the 4 functionalities and between the teaching hospitals with and without each of the 4 functionalities. Significant differences were found in the injurious fall rates between non-teaching hospitals with and without electronic clinical documentation and result viewing. Future research may focus on assessing the clinicians’ use of the IT functionalities of electronic clinical documentation and results viewing, as well as the effect of the clinicians’ use patterns on patient outcomes.展开更多
目的模拟训练(simulation-based training,SBT)是一种有效的教育方法,广泛应用于包括肿瘤学在内的多种临床环境中。该文对肿瘤学中与SBT相关的研究进行了范围综述,全面了解SBT在提高医护人员技能方面的作用,从而提高护理质量和患者安全...目的模拟训练(simulation-based training,SBT)是一种有效的教育方法,广泛应用于包括肿瘤学在内的多种临床环境中。该文对肿瘤学中与SBT相关的研究进行了范围综述,全面了解SBT在提高医护人员技能方面的作用,从而提高护理质量和患者安全。方法根据Arksey和O’Malley提出的范围综述方法框架,在Medline、Scopus和Web of Science数据库中检索于2012年至2022年发表的,与SBT在提高肿瘤科医护人员技能方面的相关研究文献,仅纳入经过同行评审的英文或法语文献。由2名研究员独立进行文献的筛选、提取和分析。结果检索出1013篇文章,共纳入29篇文献。其中25篇文献侧重于非技术技能,如决策技能、沟通和团队合作技能以及认知能力;13篇文献侧重于技术技能。纳入文献研究结果表明,通过SBT项目,肿瘤科医护人员的技能得到了显著提高。其中14篇文献对SBT的应用进行了主观评估,9篇文献对其进行了客观评估,6篇文献采用了主观和客观相结合的评估方法。结论SBT是提高肿瘤科医护人员技能的有效方法,支持和推广SBT对提供高质量的医疗服务和确保患者安全至关重要。展开更多
基金supported by the Natural Science Foundation of Fujian Province(Grant No.2022J05062)the Natural Science Foundation of Xiamen(Grant No.3502Z20227041)+3 种基金the Science and Technology Planning Project of Quanzhou(Grant No.2021N142S)the Scientific Research Funds of Huaqiao University(Grant No.21BS126)the Huaqiao University Young and Middleaged Teachers Science and Technology Innovation Funding Program(Grant No.ZQN-PY319)the Huaqiao University Research and Development Project(Grant No.20221HH273)。
文摘Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the credibility of the evidence has not been quantified.Objective:This study was designed to evaluate the existing evidence and offer a comprehensive understanding of the associations between the use of RYR preparations and various adverse health outcomes.Search strategy:Seven literature databases were searched from inception to May 5,2023,using medical subject headings and free-text terms(e.g.,“red yeast rice,”“Xuezhikang,”and“Zhibitai”).Inclusion criteria:Meta-analyses that investigated and quantitatively estimated associations between the use of RYR preparations and adverse health outcomes were included in this study.Data extraction and analysis:Two researchers independently extracted data using a standardized data collection table;any disagreements were resolved by consulting a third researcher.Based on the participant,intervention,comparator and outcome(PICO)framework in each eligible meta-analysis,a series of unique associations between the use of RYR preparations and adverse health outcomes were determined.The associations’effect estimates were re-evaluated using random-effect models.Results:Fifteen meta-analyses,comprising 186(164 unique)randomized controlled trials,were identified.Based on A Mea Surement Tool to Assess Systematic Reviews version 2,3(20%)and 12(80%)of these meta-analyses had low and critically low confidence,respectively.A total of 61 unique associations between the use of RYR preparations and adverse health outcomes were extracted from eligible metaanalyses.Based on the random-effect models,10(16.4%)associations indicated a significant protective effect of RYR preparations against adverse health outcomes,while 5(8.2%)indicated an increased risk of adverse health outcomes related to uric acid,alanine transaminase and aspartate transaminase levels.The other 46(75.4%)associations showed no significant difference between the use of RYR preparations and control treatments.Regarding the credibility of the evidence,21(34.4%),34(55.7%)and 6(9.8%)associations showed moderate,low and very low credibility,respectively.Conclusion:The evidence examined in this study suggests that RYR preparations are safe;however,the credibility of the evidence was not high.Further high-quality evidence is required.
文摘Purpose:Patients'complaints can be predictors of patient care quality and safety.Understanding patients'complaints could help healthcare organizations target the areas for improvements.The purpose of this study is to use a mixed method analysis to a)examine the characteristics and categories of patients'complaints,b)explore the relationships of patients'complaints with professions and units,and c)propose theory-based strategies to improve care quality.Methods:This is a descriptive mixed method study.Data examined are patients'complaints filed at a university-affiliated hospital in China from January 2016 to December 2017.A qualitative content analysis was conducted to categorize complaints.A TwoStep cluster analysis was performed to provide an overall profile of patients'complaints.Chi-Square tests were conducted to investigate the relationships among complaints,professions,and units.Results:838 complaints were filed,with 821 valid cases for analysis.Six categories surfaced from the qualitative analysis:uncaring attitudes,unsatisfactory quality of treatment or competence,communication problems,the process of care,fees and billing issues,and other miscellaneous causes.Physicians received most of the complaints(56.6%).The unit receiving the most complaints were outpatient clinics and medical support units(52.7%).The cluster analysis indicated four distinct clusters.Significant relationships existed between complaints and professions(x2(20)=178.82,P<0.01),and between complaints and units(x2(15)=42.72,P<0.01).Conclusions:Patients'complaints are valuable sources for quality improvements.Healthcare providers should be not only scientifically knowledgeable,but also humanistic caring.Caring-based theories may provide guidance in clinical practice.
基金FORHEAD with funding from the Rockefeller Brothers Fund(RBF)
文摘This article discusses the causes of the contamination of rice with cadmium in China and considers what we know about the severity of the problem. It argues that it is misleading to extrapolate simply from levels of cadmium in soil to health risks, because the uptake of cadmium by crops and the health impacts of the metal are affected by multiple factors. These include not only background levels of cadmium and pollution from mining and industry, but also soil quality, climatic conditions and the type and variety of crops grown. Social and cultural factors, including dietary habits, other exposure sources, nutritional quality and general health status will also affect the intake of cadmium and the severity of health impacts. For these reasons we argue that interdisciplinary analysis is crucial to a better understanding of patterns of risk to health from cadmium pollution, and to the design of effective responsive measures.
文摘Background: An essential condition to improve patient safety is considered to ensure a supportive patient safety culture. Measuring the culture of patient safety in all health care institutions may be a first step to target improvements. Creating a culture of safety requires eliminating the culture of blame. In order to formulate actions for improvement, it is important for hospitals to assess their baseline scores for the existing safety culture and to determine the areas of priority. Aim: The aim of this study was first to measure the use, translation in Albanian and adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) assessment as a tool for improving patient safety in Kosovo Hospitals. The second aim was to measure the level of patient safety culture in Kosovo, in seven hospitals and one University Clinical Center (hospitals with over 50 beds, including psychiatric hospitals). Method: The questionnaire (HSOPSC) was translated into Albanian for use in the Kosovo. It was used forward-backward translation: the questions were translated into Albanian by one translator and then translated back into English by an independent translator who was blinded to the original questionnaire. Results: In the eight-factor model, the internal consistency of the factors and the construct validity of the HSOPSC questionnaire were mostly satisfactory. The construct validity was sufficient for all subscales, except for the 4 other subscale regarding intention to report incidents which correlated poorly with other subscales. In total, HSOPSC has 12 dimensions. Cronbach’s α showed that in Kosovarian society, we could use only 8 dimensions model. Conclusion: The hypothesis that HSOPSC would be a suitable instrument to provide important indicators for the improvement of patient safety culture was tested and it was confirmed, that HSOPSC could be used as 8 dimension model. HSOPSC is suitable to improve patient safety culture and provide each hospital with a basic profile on patient safety culture and recommendations for an oriented intervention plan.
文摘Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The number of practicing nurses' density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL),postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement,postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods.The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period.The statistical technique of panel data analysis including unit root test,co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series.Results: There were significant relationships from nurse-staffing level to reducing FBL,PPE,DVT,PSA and PWD with long-run magnitudes of-2.91,-1.30,-1.69,-2.81 and-1.12 based on surgical admission method as well as-6.12,-14.57,-7.29,-1.41 and-0.88 based on all admission method,respectively.Conclusions: A higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.Hence,we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.
文摘Traditionally the global management system of an organization is frequently split into a number of individual management systems that are defined and implemented according to specific management systems standards (MSSs) as well as managed independently. The individual implementation of MSSs is an option that leads to several inefficiencies and sub-optimization of the global management system of an organization. As referred by ISO [1] the interested parties’ requirements increase. A more effective and efficient option for an organization is to integrate, into an integrated management system (IMS), the implementation and management of requirements of multiple MSSs. Certain difficulties are associated to the structuring process, implementation, verification, evaluation, improvement and progressive development of an IMS in the organizations. Several scholars have proposed various theoretical approaches regarding the integration of individual management systems (MSs) leading to the conclusion that there is not a common practice for all organizations as they encompass different characteristics. This paper aims to present and justify a designed methodology to be used by organizations to support the integration of various MSs. Among them are highlighted: the Environmental Management System (EMS) according ISO 14001 [2], the Quality Management System (QMS) according ISO 9001 [3], and the Occupational Health and Safety Management System (OH & SMS) according OHSAS 18001 [4]. The methodology was designed in the context of a Portuguese company, on sequence of an organizational diagnosis and a research that was performed through a questionnaire. The strategy and the research methods took into consideration the case study.
文摘Nursing leaders are currently faced with opportunities to advance nursing’s role in the use of electronic health records (EHRs). Nurse leaders can advance the design of EHRs with nurse informaticists to improve health outcomes of individual and populations of patients.
文摘The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in acute care hospitals in the United States. This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented IT functionalities in their general medical and surgical inpatient units. It used publicly available 2007 datasets, the hospital was the unit of analysis, and teaching and non-teaching hospitals were analyzed separately. Hospital-acquired injurious falls were identified based on fall-related primary and secondary diagnoses and were flagged by the hospitals as not “present on admission” in the 2007 California, Florida, and New York State Inpatient Database data. The 4 health IT functionalities in general medical and surgical inpatient units were 1) electronic clinical documentation, 2) results viewing, 3) computerized provider order entry, and 4) decision support. The research question was What are the effective health IT functionalities in the general medical and surgical units for reducing fall risk among adult patients aged 65 years or older at their hospitals? Independent t tests were used. The results showed that no significant difference was found in the hospital-acquired injurious fall rates between hospitals with and without each of the 4 functionalities and between the teaching hospitals with and without each of the 4 functionalities. Significant differences were found in the injurious fall rates between non-teaching hospitals with and without electronic clinical documentation and result viewing. Future research may focus on assessing the clinicians’ use of the IT functionalities of electronic clinical documentation and results viewing, as well as the effect of the clinicians’ use patterns on patient outcomes.
文摘目的模拟训练(simulation-based training,SBT)是一种有效的教育方法,广泛应用于包括肿瘤学在内的多种临床环境中。该文对肿瘤学中与SBT相关的研究进行了范围综述,全面了解SBT在提高医护人员技能方面的作用,从而提高护理质量和患者安全。方法根据Arksey和O’Malley提出的范围综述方法框架,在Medline、Scopus和Web of Science数据库中检索于2012年至2022年发表的,与SBT在提高肿瘤科医护人员技能方面的相关研究文献,仅纳入经过同行评审的英文或法语文献。由2名研究员独立进行文献的筛选、提取和分析。结果检索出1013篇文章,共纳入29篇文献。其中25篇文献侧重于非技术技能,如决策技能、沟通和团队合作技能以及认知能力;13篇文献侧重于技术技能。纳入文献研究结果表明,通过SBT项目,肿瘤科医护人员的技能得到了显著提高。其中14篇文献对SBT的应用进行了主观评估,9篇文献对其进行了客观评估,6篇文献采用了主观和客观相结合的评估方法。结论SBT是提高肿瘤科医护人员技能的有效方法,支持和推广SBT对提供高质量的医疗服务和确保患者安全至关重要。