Risk Management and Healthcare Policy最新文献

{"title":"Constructing a Resilience Assessment Index System for Tuberculosis Healthcare Services Under Public Health Emergencies: A Modified Delphi Study.","authors":"Mingkuan Fan, Yushu Liu, Kui Liu, Canyou Zhang, Yuhong Li, Xiaoqiu Liu, Hui Zhang, Jun Cheng","doi":"10.2147/RMHP.S506867","DOIUrl":"10.2147/RMHP.S506867","url":null,"abstract":"<p><strong>Purpose: </strong>Understanding the resilience of tuberculosis healthcare services (TB-HSs) is crucial for the targeted reinforcement of weak links and mitigation of the impact of public health emergencies (PHEs). However, assessment systems in this domain are lacking. This study aims to construct a resilience assessment index system (RAIS) for TB-HSs in China.</p><p><strong>Methods: </strong>The following four-step design process was conducted: 1) establishing the RAIS index pool based on a literature review, 2) designing an initial RAIS for TB-HSs following Donabedian's \"structure-process-outcome\" framework through expert meetings; 3) employing a two-round Delphi survey to obtain a consensus on the RAIS; and 4) using the analytic hierarchy process to quantify the weight of each indicator included in the final RAIS.</p><p><strong>Results: </strong>The expert panel (n=26) had 100.0% and 96.2% response rates in the first and second Delphi rounds, respectively. The expert authority coefficients for the two rounds were 0.908 and 0.906. Both rounds showed high levels of expert coordination (<i>P</i><0.001). The final RAIS comprising three first-grade, nine second-grade, and 39 third-grade indicators. Our findings reveal that tuberculosis service provision/utilization tops the first-grade indicators, weighing 49.05%. Among the second-grade indicators, service outcomes (20.79%) and patient treatment (20.67%) were the top-weighted. Of the third-grade indicators, the treatment discontinuation proportion (10.29%) and the treatment coverage rate in confirmed TB patients (8.90%), were critical components in evaluating the resilience of TB-HSs.</p><p><strong>Conclusion: </strong>This study developed a unified hierarchical resilience assessment index system for TB-HSs in China. Further research is required to validate and improve our results. The study's findings could help develop strategies that benefit public health.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1057-1067"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756014","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":"Challenges in Results Robustness of Trials with Missing Data for the Primary Endpoint: Insights from Coronary Balloon/Stent Trials.","authors":"Xinyue Lang, Yanyan Zhao, Yingxuan Zhu, Lei Song, Chuangshi Wang, Duoer Wang, Chilie Danzeng, Yang Wang, Wei Li","doi":"10.2147/RMHP.S511449","DOIUrl":"10.2147/RMHP.S511449","url":null,"abstract":"<p><strong>Background: </strong>To assess the consequence of different degrees of missing primary endpoint data for randomized controlled trials and to find the influence factors.</p><p><strong>Methods: </strong>PubMed, Cochrane Library, EMBASE and ClinicalTrials.gov were searched up to Nov 30, 2023. We included trials of the drug-coated balloon/drug-eluted stent with angiographic outcomes as the primary endpoint. The tipping-point analysis was used to deal with the missing data for the primary endpoint. The inconsistency rate, tipping-point standardized effect size (SES) and tipping-point ratio were used to assess the result robustness.</p><p><strong>Results: </strong>A total of 101 trials were included, which had 109 trial comparisons. Among them, 89 (81.7%) comparisons had superior/non-inferior conclusions (H₀ rejected); 85 (78.0%) comparisons had a missing rate of ≥10%, and 30 (27.5%) comparisons had a missing rate of ≥20%. For H₀ rejected comparisons with a missing rate of ≥10%, the median of inconsistency rate, tipping-point SES and tipping-point ratio was 32.2% (IQR 19.7%, 45.4%), 0.90 (IQR 0.17, 1.79) and -1.53 (IQR -2.43, -0.39). A higher missing rate and a larger (worse) observed-target SES were associated with a more unreliable result.</p><p><strong>Conclusion: </strong>A high dropout rate and inflated target effect size could cause an unreliable result. We emphasize a robust evaluation of the results for clinical trials with missing data for the primary endpoint.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1045-1056"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756012","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":"Development and Validation of a Nomogram Prediction Model for Key Symptoms of Post-Intensive Care Syndrome-Family in Family Members of Critically-Ill Patients: Focusing on Sleep Disturbance, Fatigue, Anxiety, and Depression.","authors":"Haili Dong, Li Liu, Shasha Ma, Haixia Han, Jiadong Zhang, Jordan Tovera Salvador, Xiaoxiao Liu","doi":"10.2147/RMHP.S490487","DOIUrl":"10.2147/RMHP.S490487","url":null,"abstract":"<p><strong>Purpose: </strong>To construct and validate a nomogram model predicting the risk of post-intensive care syndrome-family (PICS-F) in family members of critically ill patients.</p><p><strong>Methods: </strong>This study was conducted on family members (parents, spouses, or children) of critically ill patients in the three intensive care units of Binzhou Medical University Hospital from December 2023 to June 2024, responsible for medical decisions and primary care. The sleep disturbances, fatigue, anxiety, and depression were assessed using the Pittsburgh Sleep Quality Index, the Subscale of Fatigue Assessment Instrument, and the Hospital Anxiety and Depression Scale, respectively. Predictive factors were identified through univariate and multivariate logistic regression, and a nomogram was constructed using R4.2.3. Internal validation used the Bootstrap sampling method, and external validation employed the time-period method.</p><p><strong>Results: </strong>The study involved 567 participants divided into a modeling group (n = 432; median age = 46 years; 209 males, 223 females) and an external validation group (n = 135; median age = 45 years; 70 males, 65 females). The model included five predictive factors: family age, patient age, APACHE II score, average monthly income per family member, and PSSS score. The AUC of the modeling group was 0.894 (0.864 ~ 0.924), with a specificity of 85.4%, a sensitivity of 78.0%, and a maximum Youden index of 0.634. The H-L test revealed a good fit (<i>X</i> ² value = 9.528, <i>P</i> = 0.300). The internal validation results of the Bootstrap sampling method showed that the calibration curve of the model was close to the ideal curve, and the DCA curve results indicated high clinical practicality. Moreover, the external validation results showed that AUC was 0.847 (0.782 ~ 0.912), with sensitivity and specificity of 74.5% and 86.3%, respectively. The H-L test results indicated a good fit (<i>X</i> ² value = 9.625, <i>P</i> = 0.292).</p><p><strong>Conclusion: </strong>The nomogram demonstrated strong predictive performance for PICS-F risk in ICU patients' families, offering a valuable tool for clinical assessment.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1031-1043"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756018","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":"Early Detection of Malignant Cells in Gastric Lavage via Hexokinase 2 and Single-Cell Sequencing for Gastric Cancer Diagnosis.","authors":"Peiyu Qian, Jie Sun, Zhenya Zhao, Peihua Lu","doi":"10.2147/RMHP.S510123","DOIUrl":"10.2147/RMHP.S510123","url":null,"abstract":"<p><strong>Objective: </strong>Gastric cancer represents a significant global health challenge due to its high prevalence and mortality rates, largely attributed to the limitations of current screening methods, such as endoscopy, which impede early diagnosis. This study presents an innovative method for early detection by identifying exfoliated tumor cells in gastric lavage, aiming to overcome challenges related to patient compliance and the variability in endoscopist expertise.</p><p><strong>Methods: </strong>Hexokinase 2 (HK2), a metabolic marker, was utilized to identify exfoliated tumor cells with heightened glycolytic activity in gastric lavage fluid. The malignancy of these HK2-positive, high-glycolytic tumor cells was further validated using single-cell sequencing (SCS), specifically through genome-wide copy number variation analysis.</p><p><strong>Results: </strong>A total of 60 individuals were assessed, including 10 patients with gastric cancer (9 at stage IA and 1 at stage IIA), 26 patients with precancerous lesions, 15 patients with benign gastric conditions, and 9 healthy controls. The HK2 assay demonstrated an 80% diagnostic sensitivity for stages IA and IIA of gastric cancer and a 96% diagnostic specificity in distinguishing benign conditions from healthy controls. Importantly, the assay exhibited 57% sensitivity for cases of severe dysplasia, underscoring its potential for early gastric cancer detection and preventive diagnostics.</p><p><strong>Conclusion: </strong>The study highlights the feasibility of a novel gastric lavage-based HK2 assay, complemented by SCS for malignancy confirmation, as a highly accurate method for the early detection of gastric cancer. This approach offers a promising alternative to traditional gastroscopy, particularly for early-stage disease, potentially enhancing detection rates and improving patient outcomes.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1011-1021"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756020","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":"Pattern and Neonatal Outcome of the Neonatal Intensive Care Unit in Qassim, Saudi Arabia.","authors":"Abdullah Al-Nafeesah, Ashwaq Al Eed, Abdullrahman Alsalamah, Osama Al-Wutayd, Abdulrahman A Alshoshan, Lamees Abdulaziz Algubllan, Mohammad Alhasoon, Ishag Adam","doi":"10.2147/RMHP.S490593","DOIUrl":"10.2147/RMHP.S490593","url":null,"abstract":"<p><strong>Purpose: </strong>Neonatal mortality is one of the main public health problems, especially in developing countries. Limited studies on neonatal mortality exist in Saudi Arabia, particularly in central Saudi Arabia. Therefore, this study aimed to determine the incidence, causes, and associated factors for mortality among neonates admitted to the neonatal intensive care unit (NICU) in a single center in Al-Qassim, Saudi Arabia.</p><p><strong>Patients and methods: </strong>This retrospective study included 988 neonates admitted to the NICU in Saudi Arabia, between January and December 2023. Data were obtained from the hospital records using a questionnaire composed of sociodemographic data, neonatal and maternal information, and neonatal outcomes. Logistic regression analyses were performed, and the adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated.</p><p><strong>Results: </strong>Data from 970 neonates (46.6% female) were collected and included in the analysis. Of the 970 neonates, 291 (30.0%) were preterm births, and 317 (32.7%) were low-birth-weight (LBW) babies. Overall, 417 (43.0%) neonates were delivered via cesarean section. Prematurity (51.7%), hypothermia/hypoglycemia (17.6%), neonatal jaundice (11.4%), congenital malformations (5.4%), respiratory distress syndrome (3.9%) and neonatal sepsis/infection (3.1%) were the main diagnoses at admission. Nineteen (2.0%) neonates died during the time of admission to discharge in the NICU. Univariate analysis showed that preterm birth (OR = 4.12, 95% CI = 1.60‒10.5) and LBW (OR = 5.9, 95% CI = 2.13‒16.77) were associated with increased odds of neonatal mortality. Maternal age, number of children, duration of admission, mode of delivery, and sex of the neonate were not associated with neonatal mortality. In the multivariable logistic regression analysis, LBW (AOR 4.2, 95% CI = 1.24‒14.39) was associated with neonatal mortality.</p><p><strong>Conclusion: </strong>The current study showed that prematurity, neonatal jaundice, and congenital malformations were the main causes of admission to the NICU. Neonatal mortality is lower than in other regions and is associated with LBW.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"1023-1030"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755838","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":"Correlations Between Leadership, Self-Efficacy, and Evidence-Based Practice Competency in Nursing in a Chinese Tertiary Hospital.","authors":"Jing Li, Ya-Qi Liu, Jia Song, Xu-Fang Huang, Mei-Fen Chen","doi":"10.2147/RMHP.S500221","DOIUrl":"10.2147/RMHP.S500221","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the interplay between nursing leadership, innovative self-efficacy, and evidence-based practice competencies, aiming to identify predictive factors for enhancing nursing performance in evidence-based care.</p><p><strong>Methods: </strong>A convenience sampling strategy was employed to enlist 1104 clinical nurses from a tertiary A-level general hospital in Lishui city. Data collection involved the utilization of a general information survey, an implementation leadership scale, the Innovative Self-Efficacy Questionnaire (IS-EQ), and a simplified scale designed to assess evidence-based practice.</p><p><strong>Results: </strong>The mean total scores observed were 37.34±9.77 for nursing supervisor implementation leadership, 29.04±5.39 for nurses' innovation self-efficacy, and 28.80±4.98 for evidence-based practice competency. Through correlation analysis, it was found that in the actual nursing work scenarios, when head nurses effectively exert their leadership and nurses have a relatively high level of innovative self-efficacy, the nurses' evidence-based practice ability will subsequently improve, and the two show a highly significant positive correlation (p < 0.01). The multiple stepwise regression analysis further reveals in depth that the leadership implemented by head nurses, nurses' innovative self-efficacy, as well as nurses' educational level and the degree of participation in academic conferences are all key factors for accurately predicting nurses' evidence-based practice ability. These factors work together and account for 52.8% of the variance in evidence-based practice ability (P < 0.05).</p><p><strong>Conclusion: </strong>Strengthening the leadership training for head nurses, improving nurses' professional quality, and providing more academic exchange opportunities could effectively improve nurses' evidence-based practice ability to practically optimize the quality and professional level of nursing services.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"999-1009"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756016","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":"Examining the Impact of Availability and Accessibility of Community Benefit Provisions on County Health Outcomes.","authors":"Jinyoung Cha, Ahreum Han, Keon-Hyung Lee","doi":"10.2147/RMHP.S492160","DOIUrl":"10.2147/RMHP.S492160","url":null,"abstract":"<p><strong>Background: </strong>The recent rise of accountability in healthcare providers has spurred a keen interest in improving community benefit provisions and how these are associated with community health development. However, prior studies predominantly focus on the adequate amount of community benefit provisions (availability), disregarding the potential influence of distributional provisions (accessibility). To fill this gap, this study explores how the total amount (availability) and Blau's Index (accessibility) of community benefits are positively associated with county health outcomes.</p><p><strong>Methods: </strong>This study adopts a cross-sectional time series two-way fixed effect analysis from 2014 to 2019 for the county level. Independent variables are calculated as the total amount and Blau's Index of community benefit provisions in hospital referral regions (HRRs). Dependent variables are county health outcomes, measured by physical and mental unhealthy days and distress days.</p><p><strong>Results: </strong>The results demonstrated that both the availability and accessibility of community benefit provisions are correlated with lower physical and mental healthy days and distress. Remarkably, the accessibility of community benefit provisions by hospitals became pivotal to improving county health outcomes.</p><p><strong>Conclusion: </strong>From the theoretical aspects, it provides empirical evidence between community benefit provisions and community health outcomes and extends the theory of access into community benefit provisions. From the practical aspects, it offers invaluable insights for hospital managers and policymakers for their strategic decision-making to contribute to community health outcomes.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"963-974"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756022","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":"Prevalence and Associated Factors of Poor Sleep Quality Among Nurses in a Tertiary Care Hospital: A Cross-Sectional Study.","authors":"Rahma Yusuf Haji Mohamud, Nur Adam Mohamed, Ali Abdullahi Abdi, Iftin Mohamed Osman, Amal Nor Ali, Serpil Doğan, Said Mohamed Mohamud, Zerife Orhan","doi":"10.2147/RMHP.S511543","DOIUrl":"10.2147/RMHP.S511543","url":null,"abstract":"<p><strong>Background: </strong>Poor sleep quality among nurses negatively impacts job performance, patient care, and mental well-being, leading to compromised cognitive ability, decision-making, and increased errors, which ultimately jeopardize patient care and safety. This study aimed to determine the prevalence of poor sleep quality and its associated factors among nurses at a tertiary care hospital in Mogadishu, Somalia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among nurses working at a tertiary care hospital between May and August 2024. Data were collected using a standardized questionnaire, which included socio-demographic information, the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety, and Stress Scale (DASS-21), and the Oslo Social Support Scale (OSSS-3). Bivariate and multivariate logistic regression analyses were used to identify risk factors for poor sleep quality. A p-value of 0.05 was considered the threshold for statistical significance.</p><p><strong>Results: </strong>A total of 280 nurses participated in the study, with 45.7% (95% CI: 39.8-51.7) reporting poor sleep quality. The odds of reporting poor sleep quality were higher among female nurses (AOR = 2.68; 95% CI: 1.35-5.32), those working night shifts (AOR = 4.76; 95% CI: 2.06-11.02), those with poor social support (AOR = 2.82; 95% CI: 1.09-7.27), and those experiencing depression (AOR = 5.35; 95% CI: 2.22-12.88), anxiety (AOR = 5.58; 95% CI: 2.61-11.92), and stress (AOR = 3.92; 95% CI: 1.11-13.90).</p><p><strong>Conclusion: </strong>This study revealed a significantly high prevalence of poor sleep quality among nurses. These findings underscore the importance of addressing sleep quality as a key component of nursing well-being. It is recommended that nursing managers assess both the mental and physical health of their staff, implement targeted interventions such as stress management and counseling, and develop workplace strategies to improve sleep, including flexible scheduling and education on sleep hygiene.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"975-986"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756034","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":"Financial Toxicity for Pembrolizumab and Atezolizumab for Metastatic Non-Small Cell Lung Cancer: A Pooled Analysis of Cost-Effectiveness Analyses.","authors":"Weijia Huang, Xianglin Zhu, Jia-Hui Weng, Kai Xu, Yi-Feng Wang, Zi-Jia Chen, Qinghua Zhou, Jiewei Liu","doi":"10.2147/RMHP.S504442","DOIUrl":"10.2147/RMHP.S504442","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) were promising medical treatments for advanced or metastatic non-small cell lung cancer (NSCLC), while the financial toxicity could not be neglected due to the high cost which might impair the prognosis and quality of life. Thus, we compared the cost-effectiveness analyses to identify the potential financial toxicity of metastatic NSCLC received ICIs.</p><p><strong>Methods: </strong>A systematic literature search was performed for the published economic evaluation of ICIs in the Medline and Web of Science databases between January 2015 and September 2021. Only the studies conducting the cost-effectiveness analysis, including total cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), were included in our research. We compared the economic outcomes between the immunotherapy group and chemotherapy group and stratified by the programmed death receptor-1 ligand (PD-L1) expression. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist would be employed to check the quality of included papers.</p><p><strong>Results: </strong>A total of 25 studies and 30 cost-effectiveness analyses were included, in which 22 (73.3%) were on Pembrolizumab, eight (26.7%) on Atezolizumab, and 17 (56.7%) on the American payer perspective. In total, the ICER was lower than the willingness to pay (WTP) in 43% of the included analyses. The ICER of Pembrolizumab was lower than that of Atezolizumab (P = 0.049), and it was comparable between ICER and WTP either for Pembrolizumab (P = 0.533) or Atezolizumab (P = 0.056). The economic outcomes were all comparable as stratified by the PD-L1 expression.</p><p><strong>Conclusion: </strong>Immunotherapy could bring financial toxicity, and financial toxicity assessment during clinical decision would weaken the potential impact in the whole course of immunotherapy.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"987-998"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755725","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":"Reducing Nurses' Barriers to Reporting Adverse Events Using a WeChat-Based Cognitive Load Training Platform: An Open-Label, Randomized Controlled Trial.","authors":"Xiaoying Zhao, Lihua Zhao, Guangyao Li, Wenfeng Yang, Huili Wang, Yanmeng Yang","doi":"10.2147/RMHP.S482233","DOIUrl":"10.2147/RMHP.S482233","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of a cognitive load theory (CLT)-based WeChat training platform on reducing the barriers to reporting adverse events among clinical nurses.</p><p><strong>Methods: </strong>In total, 400 clinical nurses from a tertiary general hospital were randomized into experimental and control groups (200 each). The experimental group used the CLT-based WeChat training platform, whereas the control group received conventional training for nursing adverse events. Both interventions lasted 12 weeks. Barriers to reporting, reporting awareness, intention, and habit scores were compared between the groups.</p><p><strong>Results: </strong>After the dropouts, 197 experimental and 196 control participants completed the study. In the experimental group, the total scores for barriers to reporting adverse events and in the dimensions of punitive culture, reporting process, and reporting significance scores were 93.87 ± 6.85, 48.88 ± 4.68, 21.53 ± 4.15, and 23.40 ± 2.11, respectively, whereas the control group corresponding scores were 72.07 ± 6.67, 34.20 ± 6.02, 20.06 ± 3.25, and 17.36 ± 2.92, respectively. The experimental group demonstrated significantly higher scores and reporting significance (P all < 0.01). Additionally, the experimental group had significantly higher scores for safety event reporting awareness, intention, and habits than those in the control group (P < 0.01). When responding to nursing adverse events of various severity, the only exception to statistically significant differences between the groups was in \"reporting to the head nurse\" for medium-severity incidents (P = 0.302). However, the experimental group demonstrated significantly higher rates of \"submitting an adverse event report\", \"reporting to the head nurse\", and \"discussing with colleagues\" than those in the control group regardless of the severity of the adverse event (P < 0.01).</p><p><strong>Conclusion: </strong>This study confirmed that the CLT-based WeChat training platform model can effectively reduce the level of barriers to adverse event reporting by nurses, enhance nurses' adverse event reporting awareness, intention, and promote improvement in nurses' adverse event reporting behaviors, thereby improving the quality of nursing care and patient safety.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"947-961"},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712276","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}