Risk Management and Healthcare Policy最新文献

{"title":"Adenosine Triphosphate Bioluminescence Assay versus Microbiological Swab Culture in the Evaluation of Surface Sanitation in a Pediatric Hospital in Romania.","authors":"Alexandra Tudorica Sirmon, Luminița Mirela Bădițoiu, Mariana Anghel, Sorina Maria Denisa Laitin, Delia Muntean, Carmen Ana Kemper","doi":"10.2147/RMHP.S509274","DOIUrl":"10.2147/RMHP.S509274","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare two rapid testing methods - Adenosine Triphosphate (ATP) quantification and the total Aerobic Colony Count (ACC) by bioluminescence assay with the standard method - microbiological swab culture. The goal was to determine the advantages and limitations of these rapid alternative tests in assessing the sanitary condition of hospital surfaces.</p><p><strong>Methods: </strong>A total of 88 samples were collected from various surfaces (stainless steel, metal, plastic, Tarkett, ceramic, glass, textile) in medical and surgical wards of a pediatric hospital. For each tested area, one sample underwent standard microbiological culture (25 cm²), and two adjacent samples (each 100 cm²) were analyzed using the ENSURE^® TOUCH luminometer (Hygiena): one for ATP quantification (Ultrasnap) and one for ACC determination (Microsnap Total). Surfaces had been disinfected with commonly used agents-hydrogen peroxide, chlorinated products, or peracetic acid.</p><p><strong>Results: </strong>The Ultrasnap system identified 25 non-conforming samples; Microsnap Total found 13 non-conforming samples, while microbiological culture revealed one non-conforming sample and an additional 11 with low but detectable bacterial presence. The Ultrasnap method recorded a sensitivity of 100%, a specificity of 72.41% and an accuracy of 72.73%. In comparison, the Microsnap Total system showed higher specificity and accuracy (85.05% and 84.09%, respectively), but failed to identify the positive (non-conforming) test, resulting in a 0% positive predictive value.</p><p><strong>Conclusion: </strong>The study highlighted several advantages of rapid ATP tests, particularly their ease of use, their ability to provide results in just 10 seconds for Ultrasnap and approximately 7 hours for Microsnap Total, and their capacity to accurately identify well-sanitized surfaces. Additionally, Ultrasnap proved to be a sensitive indicator of residual organic matter, enhancing the capacity to distinguish between different sanitation levels and allowing cleaning and disinfection practices to be adjusted in real time, thereby reducing the risk of cross-transmission.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1669-1681"},"PeriodicalIF":2.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Training Strategies for Public Response to Out-of-Hospital Cardiac Arrest: A Scoping Review.","authors":"Heriyansyah Dalle, Yanny Trisyani, Aan Nur'aeni","doi":"10.2147/RMHP.S519931","DOIUrl":"10.2147/RMHP.S519931","url":null,"abstract":"<p><strong>Introduction: </strong>Out-of-hospital cardiac arrest (OHCA) is a critical medical emergency requiring immediate intervention to improve patient outcomes. Training the lay public in emergency intervention techniques has significantly enhanced survival rates. Easily accessible training programs are essential for equipping individuals with the necessary knowledge and skills. However, challenges such as standardized guidelines and cost-effective program delivery must be addressed. This study aimed to explore innovative practices in training and provide recommendations for enhancing emergency response capabilities in OHCA.</p><p><strong>Methods: </strong>The PRISMA Extension for Scoping Reviews (PRISMA-ScR) framework guided a comprehensive scoping review to identify relevant literature from PubMed, ScienceDirect, Scopus, EBSCOhost, and one search engine, Google Scholar. JBI tools were utilized to select high-quality articles, and thematic analysis was conducted to identify relevant innovations in OHCA training.</p><p><strong>Results: </strong>This review analyzed 13 articles discussing various methods of CPR training for the general public, considering cost, ease of use, and effectiveness. The findings highlight innovative approaches to improving the public's emergency response to OHCA. Smartphone apps significantly increase the likelihood of CPR and defibrillator use by laypersons. Low-cost DIY manikins are a viable alternative when resources are limited. Short CPR training videos and hands-only CPR training proved effective in training lay responders, while feedback devices and XR and VR-based training increased participants' confidence in CPR. Policy-based approaches, such as mandated CPR training, can broadly increase training coverage. Although advanced technologies offer high effectiveness, the cost and complexity of implementation remain significant challenges.</p><p><strong>Conclusion: </strong>The study provides valuable insights for developing innovative and effective training strategies to improve community emergency response to OHCA. However, further research should focus on long-term evaluation and integrating innovative technologies with low-cost training methods to develop more standardized and contextually appropriate training guidelines.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1635-1650"},"PeriodicalIF":2.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram Prediction Model of Thyroid Nodule in Healthcare Professionals: Based on Physical and Psychological Risk Factors.","authors":"Yuanling Tao, Chunyu Hu, Laixi Zhang, Zhen Cheng, Bing Zou, Mi Yan, Li Sun, Zongtao Chen","doi":"10.2147/RMHP.S517992","DOIUrl":"10.2147/RMHP.S517992","url":null,"abstract":"<p><strong>Background: </strong>Thyroid nodules are a common condition with a 7-15% likelihood of developing thyroid cancer. The prevalence of thyroid nodules in healthcare professionals is poorly understood, and how psychosomatic factors affect the occurrence of thyroid nodules is an interesting question. Therefore, the aims of this study are to explore the physiological and psychological aspects associated of thyroid nodules in healthcare professionals and establish a prediction model to provide a supportive basis for the primary prevention of thyroid nodules.</p><p><strong>Methods: </strong>A total of 738 healthcare professionals in a tertiary general hospital were selected by convenience sampling to complete an online psychological questionnaire and physical examination (biochemical indicators, ultrasound, etc.) from February to May 2023. Logistic regression was used to analyze risk factors, and the prediction model was established by nomogram.</p><p><strong>Results: </strong>A total of 406 of 738 healthcare professionals had thyroid nodules, the detection rate was 55.0%, among those detected, 24.1% were male and 75.9% were female. Multivariate logistic regression analysis showed: compared with ≤40 years old, aged 41-50 years old, or >50 years old were risk factors for thyroid nodules (OR=2.071/8.034); female (OR=1.873) was also risk factor for thyroid nodules relative to male; in addition, anxiety (OR=1.105), perceived stress (OR=1.045), fatty liver (OR=2.716), TSH abnormality (OR=1.944), and ALT abnormality (OR=2.252) were also risk factors. Based on the above seven influencing factors, a nomogram was drawn and verified internally. The results showed that the area AUC under the ROC curve of the model was 0.713, and the calibration curve indicated that the model consistency was acceptable.</p><p><strong>Conclusion: </strong>The detection rate of thyroid nodules is higher in healthcare professionals. A combination of psychological and physiological factors in TNs has a significant impact on thyroid nodules. Identifying risk factors for thyroid nodules and managing them promptly is important for the complete health of healthcare professionals.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1621-1633"},"PeriodicalIF":2.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triaging Clients at Risk of Disengagement from HIV Care: Application of a Predictive Model to Clinical Trial Data in South Africa.","authors":"Mhairi Maskew, Shantelle Parrott, Lucien De Voux, Kieran Sharpey-Schafer, Thomas Crompton, Ashley Christopher Govender, Pedro Terrence Pisa, Sydney Rosen","doi":"10.2147/RMHP.S510666","DOIUrl":"10.2147/RMHP.S510666","url":null,"abstract":"<p><strong>Purpose: </strong>To reach South Africa's targets for HIV treatment and viral suppression, retention on antiretroviral therapy (ART) must increase. Here, we aim to successfully identify ART clients at risk of loss from care prior to disengagement.</p><p><strong>Patients and methods: </strong>We applied a previously developed machine learning and predictive modelling algorithm (PREDICT) to ART client data from SLATE I and II trials. The primary outcome was interruption in treatment (IIT), defined as missing the next scheduled clinic visit by >28 days. We tested two risk triaging approaches: 1) threshold approach classifying individuals into low, moderate, or high risk of IIT; and 2) archetype approach identifying subgroups with characteristics associated with risk of ITT. We report associations between risk category groups and subsequent IIT at the next scheduled visit using crude risk differences and relative risks with 95% confidence intervals.</p><p><strong>Results: </strong>SLATE datasets included 7199 client visits for 1193 clients over ≤14 months of follow-up. The threshold approach consistently and accurately assigned levels of IIT risk for multiple stages of the care cascade. The archetype approach identified several subgroups at increased risk of IIT, including those late to previous appointments, returning after a period of disengagement, living alone or without a treatment supporter. Behavioural elements of the archetypes tended to drive the risk of treatment interruption more consistently than demographics; eg adolescent boys/young men who attended visits on time experienced the lowest rates of treatment interruption (10% PREDICT datasets; 7% SLATE datasets), while adolescent boys/young men returning after previously disengaging had the highest rates of subsequent treatment interruption (31% PREDICT datasets; 40% SLATE datasets).</p><p><strong>Conclusion: </strong>Routinely collected medical record data can be combined with basic demographic and socioeconomic data to assess individual risk of future treatment disengagement. This approach offers an opportunity to prevent disengagement from HIV care, rather than responding only after it has occurred.</p><p><strong>Trial registration: </strong>SLATE I trial: Clinicaltrials.gov NCT02891135, registered September 1, 2016. First participant enrolled March 6, 2017, in South Africa and July 13, 2017, in Kenya. SLATE II trial: Clinicaltrials.gov NCT03315013, registered 19 October 2017. First participant enrolled 14 March 2018.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1601-1619"},"PeriodicalIF":2.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12091061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effectiveness of the WHO 6-Step Hand Hygiene Technique: Impact of Step Omission and Duration on Microbial Reduction.","authors":"Arkadii Vodianyk, Volodymyr Shyrobokov, Vadym Poniatovskyi","doi":"10.2147/RMHP.S506993","DOIUrl":"10.2147/RMHP.S506993","url":null,"abstract":"<p><strong>Introduction: </strong>The World Health Organization has proposed practical recommendations for hand hygiene, which include a six-step technique for hand washing and hand rubbing with antiseptic agents. Hand hygiene has become one of the five key elements of the patient safety program. However, adherence to all six steps of hygienic handrub among medical staff is quite low. In our study, we evaluated the effectiveness of reducing microbial load on the skin of hands depending on the number of steps performed and the duration of handrub.</p><p><strong>Methods: </strong>The preparation of the contamination fluid and the contamination of the volunteers' hand skin were carried out according to the European standard EN 1500. Subsequently handrub was performed using an alcohol-based antiseptic with various modifications of the six-step technique, either excluding certain elements or reducing the time spent on each step. After the handrub, swabs were performed, and the number of viable microorganisms in the obtained samples was determined.</p><p><strong>Results: </strong>Adherence to all stages of the WHO-recommended 6-step hand hygiene technique provided effective decontamination of hand skin. Using all six steps for 30 seconds resulted in a log reduction of microorganisms up to 2.82 (mean value of colony-forming unit (CFU) = 2.024×10³ (95% confidence interval (CI) ±0.545×10³). Reducing the duration of antiseptic use from 30 to 15 seconds did not decrease the effectiveness of the antiseptic action.</p><p><strong>Conclusion: </strong>Based on the conducted experimental studies, it can be concluded that following the WHO-recommended algorithm for hand hygiene significantly reduces the contamination of the skin surface with test cultures.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1591-1600"},"PeriodicalIF":2.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Obesity on Readmission and Healthcare Costs in Patients with Skin and Subcutaneous Tissue Infections.","authors":"David Suh, Seung-Mi Lee","doi":"10.2147/RMHP.S516684","DOIUrl":"10.2147/RMHP.S516684","url":null,"abstract":"<p><strong>Purpose: </strong>Obesity is a global public health issue linked to worsened skin and subcutaneous tissue infections (SSTIs), complicating clinical management and increasing healthcare costs. This study aimed to evaluate obesity's influence on hospitalization duration, readmission rates, and healthcare costs among patients with SSTIs, with an emphasis on sex-specific patterns.</p><p><strong>Patients and methods: </strong>This retrospective cohort study analyzed data from South Korea's national healthcare database. The study population comprised adults hospitalized with SSTIs between 2015 and 2020. Obesity measures included body mass index (BMI) and waist circumference (WC), categorized by standard thresholds. Statistical analyses included Cox proportional hazards models for hospitalization duration, while multivariable logistic regression evaluated readmission risks. Healthcare costs were analyzed using generalized linear models, with sex-stratified analysis to examine clinical and economic outcome disparities.</p><p><strong>Results: </strong>Male patients demonstrated an inverse relationship between BMI and hospitalization duration and costs, with minimal WC influence. Conversely, female patients exhibited positive associations between both obesity measures and hospitalization outcomes. SSTI-related readmissions within two years increased with rising BMI and WC across both sexes (<i>p</i> < 0.001). Estimated readmission costs showed significant sex-specific variations, increasing 55% among males with WC ≥ 100 cm versus < 80 cm and 132% among females with WC ≥ 95 cm versus < 75 cm.</p><p><strong>Conclusion: </strong>Obesity substantially impacts SSTI clinical severity and economic costs, with distinct sex-specific disparities. Implementing tailored antimicrobial regimens, weight management strategies, and sex-specific treatment protocols is essential for outcome optimization and cost reduction. Future research should prioritize sex-specific interventions and resource allocation strategies in SSTI management.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1579-1590"},"PeriodicalIF":2.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seasonal Factors Associated with Surgical Site Infections Following Gynecologic and Obstetric Surgeries and Pathogen Identification: A Retrospective Study in A Single Center in China.","authors":"Dong Wang, Yan Zhang, Jinlin Wu","doi":"10.2147/RMHP.S514951","DOIUrl":"10.2147/RMHP.S514951","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) are one of the commonly reported nosocomial infections. Previous studies of SSI prevention have focused on patient characteristics. Relevant studies that consider both patient characteristics and seasonality are rare. This study investigated the independent risk factors associated with surgical site infections in patients undergoing gynecologic and obstetric surgeries in different seasons to determine whether the results showing increases in SSIs by season could be reproduced.</p><p><strong>Methods: </strong>Medical records of 185 patients with SSIs among 201,912 patients who underwent gynecologic and obstetric surgeries at a hospital in southwestern China from September 2013 to June 2021 were analyzed. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SSIs in patients undergoing gynecologic and obstetric surgeries in different seasons.</p><p><strong>Results: </strong>Heart disease and the amount of intraoperative blood loss were the suspicious seasonal factors associated with SSIs. SSIs were more likely to occur in the patients with intraoperative blood loss ≥500 mL in spring and winter but were more likely to occur in the patients with intraoperative blood loss <500 mL in autumn.</p><p><strong>Conclusion: </strong>More attention should be paid to maintaining patient temperature during surgery, improving surgical skills, and standardizing aseptic techniques to prevent SSIs.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1569-1577"},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influencing Factors (History of Alcohol Consumption) and Construction of a Nomogram Prediction Model for In-Hospital Gastrointestinal Bleeding Secondary to Acute Cerebral Hemorrhage in a Certain Hospital.","authors":"Peng Ye, Yeting Luo","doi":"10.2147/RMHP.S511692","DOIUrl":"https://doi.org/10.2147/RMHP.S511692","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the factors influencing acute cerebral hemorrhage (ACH) secondary to nosocomial gastrointestinal hemorrhage (GIH) and construct a nomogram prediction model.</p><p><strong>Methods: </strong>A total of 500 ACH patients admitted to our hospital from August 2022 to August 2024 were retrospectively analyzed and divided into a modeling group (350 cases) and a validation group (150 cases) in a 7:3 ratio. Patients in the modeling group were further divided into the GIH and non-GIH groups. Clinical data were collected, and multivariate logistic regression was used to analyze risk factors. A nomogram model was constructed using R software. The predictive performance was evaluated using the ROC curve, calibration curve, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Among 500 patients, 78 (15.6%) developed GIH. In the modeling group (350 cases), 56 (16.0%) had GIH. There were significant differences in age, history of coronary heart disease, history of alcohol consumption, NIHSS score, systolic blood pressure, and hemorrhage volume between groups (P<0.05). Logistic regression analysis identified these factors as independent risk factors for secondary GIH (P<0.05). The Area Under Curve(AUC) was 0.798 in the modeling group and 0.978 in the validation group, with calibration curves showing good agreement between predicted and observed values (Hosmer-Lemeshow(H-L) test: modeling group, χ²=7.156, P=0.732; validation group, χ²=7.015, P=0.703). DCA indicated a high clinical application value when the probability ranged from 0.06 to 0.95.</p><p><strong>Conclusion: </strong>Age, history of coronary heart disease, history of alcohol consumption, NIHSS score, systolic blood pressure, and hemorrhage volume are key risk factors for secondary GIH in ACH patients. The nomogram model constructed based on these factors demonstrates good predictive performance and clinical application value. It can help clinicians prevent early onset and reduce the risk of bleeding in patients.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1557-1568"},"PeriodicalIF":2.7,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of Diaphragmatic Ultrasonography and Intra-Abdominal Pressure Measurement for Optimizing Weaning from Mechanical Ventilation.","authors":"Dan Su, Ruixin Li, Zhi Chen, Na Cui, Zhanbiao Yu, Xiaoxu Ding, Jiaqian Wu","doi":"10.2147/RMHP.S502810","DOIUrl":"https://doi.org/10.2147/RMHP.S502810","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the effectiveness of diaphragmatic ultrasonography in conjunction with intra-abdominal pressure (IAP) measurement for assessing diaphragm function and determining the optimal timing for weaning from mechanical ventilation (MV).</p><p><strong>Methods: </strong>A cohort of 100 patients undergoing MV at the intensive care department of the Affiliated Hospital of Hebei University between January 2023 and July 2023 was enrolled. Spontaneous breathing trials (SBTs) were performed once patients met the weaning criteria. At the 30-minute mark of the SBT, diaphragmatic ultrasonography and IAP measurements were conducted. Based on weaning outcomes, patients were categorized into successful and failed weaning groups. Diaphragmatic excursion (DE), diaphragm thickening fraction (TFdi), diaphragmatic rapid shallow breathing index (D-RSBI), and IAP were compared between groups. The predictive value of these parameters in determining optimal weaning timing was analyzed using receiver operator characteristic (ROC) curves.</p><p><strong>Results: </strong>Compared to the failed weaning group, the successful weaning group exhibited significantly lower values of D-RSBI and IAP values along with higher values of DE, TFdi, diaphragm thickness at end-inhalation (DTei), and diaphragm thickness at end-exhalation (DTee) (<i>p</i> < 0.05). In the single-parameter analysis, the area under the curve (AUC) values for D-RSBI, DE, TFdi, and IAP were 0.880 (95% CI: 0.811-0.948), 0.981 (95% CI: 0.960-1.000), 0.907 (95% CI: 0.872-0.972), and 0.838 (95% CI: 0.748-0.929), respectively. The optimal cut-off values were 13.5 breaths /(min*cm), 1.2 cm, 29.3%, and 5.6 mmHg, respectively. In combined parameter analysis, the combination of IAP and DE demonstrated the highest predictive accuracy.</p><p><strong>Conclusion: </strong>The integration of diaphragmatic ultrasonography with IAP measurement is an effective approach for predicting weaning outcomes in patients undergoing MV. This combined assessment may assist clinicians in optimizing weaning strategies and improving patient outcomes.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1547-1556"},"PeriodicalIF":2.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Prepaid Consumption Policies in China's Fitness Industry.","authors":"Zhizhuang Duan, Rui Zheng","doi":"10.2147/RMHP.S517722","DOIUrl":"https://doi.org/10.2147/RMHP.S517722","url":null,"abstract":"<p><p>The implementation of the \"Fit for Life\" concept is not only related to individual physical and mental well-being and the stable development of society but also represents a critical issue for the welfare of all humanity. The Chinese government is committed to realizing this ambitious vision through the \"Healthy China\" initiative, with national fitness serving as a key component of this plan. In the context of expanding demand within the fitness consumption market, the Chinese fitness industry is in urgent need of high-standard development. However, despite strong national policy support, consumer disputes remains common, such as difficulties with prepaid card refunds, unfulfilled sessions due to frequent changes in personal trainers, and challenges in obtaining refunds after gym or business closures, which may be linked to the widespread use of prepaid consumption as the primary payment method. This paper examines the regulatory framework governing prepaid consumption in China's fitness industry, employing a policy review and comparative analysis to explore local legislation across four representative regions selected for their economic significance, policy orientation, and geographical diversity. The study examines both preventive and remedial measures, revealing that while there are regional variations in the stringency of regulations, local legislation generally provides clear and comprehensive guidelines on the definition of prepaid consumption, their scope, card issuance procedures, and liability for compensation. To address common challenges such as standard-form contracts, some regions have introduced region-specific measures, including model contract templates, which have positively influenced the regulation of prepaid consumption in the fitness industry. By systematically reviewing relevant policy frameworks, this study compares their varying impacts on the fitness consumption industry. It further aims to strengthen regulatory support by improving risk prevention and enforcement efficiency for policymakers, while helping business stakeholders enhance operational stability and manage compliance costs more effectively.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1535-1545"},"PeriodicalIF":2.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}