Hospital Type Research Articles

A comparative study on person-centered care practice between public and private General Hospitals in Addis Ababa, Ethiopia

BackgroundPerson-centered care practice has not yet been fully adopted in low- and middle-income nations such as Ethiopia. It focuses on improving several areas of patient-physician interaction. Despite Ethiopia's rapid growth in healthcare facilities, there is insufficient data available on care practices.MethodA facility-based comparative cross-sectional study was conducted in selected public and private general hospitals in Addis Ababa from May 26 to July 26, 2023. A multistage sampling technique was employed to select the study participants. The data were collected using an interviewer-administered structured questionnaire, entered into Epi Info-7, and exported to SPSS version 27 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify significant factors associated with care practices.ResultsA total of 848 patients were involved, with a response rate of 99.5%. The overall magnitude of good care practice was 52.8%, with 34.8% in public hospitals and 70.9% in private hospitals. Factors associated with good care practices in private hospitals included hospital attractiveness (AOR: 3.2; 95% CI: 1.6–6.5), ease of access to services (AOR: 12.1; 95% CI: 6.2–23.3), and privacy of access and care (AOR: 10.89; 95% CI: 5.60–21.19). In contrast, factors associated with good healthcare practices in public hospitals were perceived intimacy with the provider (AOR: 8.85; 95% CI: 4.50–17.43), privacy in accessing care (AOR: 12.1; 95% CI: 6.62–22.16), and the provision of medication information (AOR: 4.39; 95% CI: 2.40–8.03).ConclusionOverall, 52.8% of participants rated person-centered care practices as good, with private hospitals in Addis Ababa (70.9%) demonstrating a higher prevalence of person-centered care practices compared to public hospitals (34.8%). The factors associated with healthcare practices in both public and private hospitals include hospital type, hospital attractiveness, ease of access to services, privacy in accessing care, perceived intimacy with the provider, and the provision of medication information. We recommend targeted improvements in public hospitals to enhance the quality of PCC.

Hospitalizations in patients with systemic sclerosis: Differences between limited and diffuse cutaneous subtypes

Aim: Systemic sclerosis is associated with significant morbidity and mortality. It remains unclear from the literature if there are differences between the subtypes of systemic sclerosis and the rate of hospitalization. Our study investigates the rates of all types of hospitalizations between limited and diffuse cutaneous systemic sclerosis. Methods: Patients have been collected prospectively using the European Scleroderma Trials and Research Group database at the Waikato Hospital, and were screened for inclusion criteria. Data were collected retrospectively on hospitalizations (total, acute, elective and infusion-related) for all patients. Results: Overall, 140 patients were included in the analysis with 84 (60.0%) with limited cutaneous systemic sclerosis, 40 (28.6%) with diffuse systemic sclerosis, 3 (2.1%) with systemic sclerosis sine scleroderma and 13 (9.3%) with overlap syndrome. The mean number of total hospitalizations in 12 months was 0.9 (SD 3.0) for patients with limited disease versus 1.7 (SD 3.0) for diffuse disease (p = 0.062). The mean number of acute hospitalizations in 12 months was 0.6 (SD 1.3) for limited and 1.2 (SD 2.4) for diffuse (p = 0.061). Patients with diffuse systemic sclerosis were more likely to be admitted for reasons relating to systemic sclerosis than patients with limited disease (p < 0.001). Conclusion: Diffuse and limited systemic sclerosis subtypes appear to have similar rates of hospitalizations though there is a trend in favour of diffuse disease towards more total and acute hospitalizations. There are clear differences in causes of hospitalization between the two main subgroups.

Effects of factors influencing cesarean section rates between 2008 and 2018 in Taiwan: A population-based cross-sectional study.

Many factors can affect delivery mode decisions. Therefore, this study aimed to explore the effects of maternal age, physician's sex, region, income, and hospital type on cesarean section (C/S) delivery rates between 2008 and 2018 in Taiwan. In this population-based cross-sectional study, data were extracted from the Taiwan National Health Insurance Research Database (2 million individuals). The logistic regression method was used to analyze the aforementioned risk factors, and data are expressed as odds ratios (ORs) and 95% confidence intervals. In total, 9826 and 9714 deliveries in 2008 and 2018, respectively, were included in the analysis. The C/S ratio increased from 16.5% (n = 1607) in 2008 to 19.7% (n = 1916) in 2018. A higher C/S risk for women aged >34 years (ORs: 2.835 and 2.225 in 2008 and 2018, respectively) than for those aged ≤34 years was noted in both years. Female physicians had a lower risk of performing C/S than male physicians in 2008 (OR: .762, 95% confidence interval: .625-.928), but this was not apparent in 2018. Higher income levels (>new Taiwan dollar 45,081) and central Taiwan were associated with a lower C/S risk in both years. Private, not-for-profit hospitals had a lower C/S risk in 2008, which was not apparent in 2018. In conclusion, this study revealed a significant increase in C/S rates over the past decade, which was influenced by multiple factors. Maternal age, physician's sex, income status, location, and type of hospital may influence C/S rates. Analyzing these relationships can inform the development of strategies aimed at reducing future C/S rates, and targeted interventions may reduce the C/S rates.

Point-of-care testing improves care timeliness in the emergency department. A multicenter randomized clinical trial (study POCTUR).

Emergency department (ED) crowding is a widespread problem that positions patients at risk. The desire to improve the ED throughput requires novel approaches. Point-of-care testing (POCT) has emerged as useful technology that could contribute to create more efficient patient flow and better timeliness in the ED. The main objective of our study is to demonstrate, in a multicenter study, that POCT benefits care timeliness in the ED. We conducted a multicenter and cluster randomized study. A total of 3,200 patients. We randomly assigned patients to a POCT group or Central Laboratory Group. The primary outcome was the ED time to clinical decision. The secondary outcome included the length of stay and the laboratory turnaround time. Readmission within the seven after discharge was also calculated. The primary finding of this study is a strategy based on POCT that aims to significantly improve care timeliness in the ED. We found significant reductions in all outcomes regardless of presentation reason, patient disposition or hospital type. Time to clinical decision decreased by 75.2 min (205-129.8), length of stay by 77.5 min (273.1-195.6) and laboratory turnaround time by 56.2 min (82.2-26) in the POCT group. No increase in readmission was found. Our strategy represents a good approach to optimize timeliness in the ED. It should be seen as a starting point for further operational research focusing on POCT for improving throughput and reducing crowding in the ED.

Study of factors leading to cancellation of elective surgeries in a tertiary care hospital

Background: The postponement of elective surgeries is a major problem that increases the time for patients on surgical waiting lists and can negatively affect psychologically and physically to patients and their families. Cancellation rates reported within the literature are highly variable with considerable differences depending on type of hospital, national health care systems or policies, geographical region, patient population, providers, and also the perioperative management practices present at specific institution. Aims and Objectives: The current study was to thoroughly understand the causes to minimize such cancellations in our institute. Materials and Methods: A prospective observational study was conducted in the Department of General Surgery in a tertiary care teaching hospital in North India. All the patients admitted for elective surgeries in the Department of General Surgery over a period of December 1st, 2022–May 30th, 2023 were noted and out of them, details of patients in whom surgery was cancelled were taken and they were followed for 2 months. Results: Out of a total 1065 patients, 92 patients got cancelled during the study period. Out of them, 67 patients (67.8%) were cancelled on the scheduled date of surgery or after reaching operation theatre whereas, 25 patients (27.2%) were cancelled on day before scheduled date of surgery. Maximum number of cancelled patients were of cholelithiasis planned for laparoscopic cholecystectomy followed by inguinoscrotal swellings. Maximum number of patients were deferred due to administrative-related factors, followed by medical related factors. Conclusion: This study will act as a quality improvement initiative by reducing the surgery cancellation rate thus improving utilization of limited resources and valuable time to provide better health care services in our institute. Such cancellations can be minimized by better planning and active inter-departmental communication regarding proposed plan of surgery.

Cross-sectional study evaluating the effectiveness of the Mozambique–Canada maternal health project abstraction tool for maternal near miss identification in Inhambane province, Mozambique

ObjectivesThe objectives of this study are to determine whether the additional clinical criteria of the Mozambique maternal near miss abstraction tool enhance the effectiveness of the original WHO abstraction tool...

Geospatial analysis of first, second, and third level hospitals in a surgical network in the low and middle income countries

Introduction Distance from a healthcare facility is a barrier in access to surgery. Methodologies to evaluate the population covered by a hospital are time consuming and costly. The aim of this study was to analyse the population density around hospitals to pragmatically evaluate their access while comparing differences between hospital types. Methods This analysis was conducted in the hospitals that participated in an international cohort study on inguinal hernia patients (HIPPO study). Hospitals located in low and middle income countries were eligible for inclusion and were classified as first-referral, secondary, tertiary level hospitals. For each hospital, location and GPS coordinates were reported in maps. The population density within a 5km, 40km and 80km radius was calculated. The medians and interquartile range of the population densities were calculated in two stages: considering each hospital and considering the number of patients recruited. Results This analysis included 326 hospitals: 38 first-referral, 84 secondary and 204 tertiary level hospitals. For the 5km distance, the population density increased from first referral to tertiary hospitals (median of population density 1776, 3439 and 6979, respectively). In 40km and 80km radius, the same trend was observed (351, 300 and 888 for 40km and 294, 197 and 462 for 80km). When adjusting and weighting the patients recruited for the study, the differences became more evident. Discussion This analysis showed that in less densely populated areas first-referral hospitals predominate. The methods described can be used in other studies to evaluate the population that can be covered by different healthcare facilities.

Impact of COVID-19 pandemic on traumatic brain injury emergency department visits, interfacility transfer and mortality in the United States, 2016–2020: a cross-sectional study

ObjectiveThe aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in...

Medicare’s comprehensive care for joint replacement model increased public hospitals' inpatient length of stay

BackgroundThe Comprehensive Care for Joint Replacement (CJR) model is an alternative Medicare payment model for joint replacement that mandated participation by hospitals in randomly selected Metropolitan Statistical Areas (MSAs). On average, the program decreased inpatient length of stay and increased home discharge rates. It is unclear if these effects differed based on hospital ownership type, even though ownership may impact care redesign opportunities.MethodsWe used the 2014–2017 California Patient Discharge Datasets. The study included 113,590 hospitalizations for hip and knee joint replacement from 287 hospitals in the treated and control MSAs in California. The primary outcomes were inpatient length of stay and home discharge rates. Home discharge status included self-care, the use of home health, and hospice care at home. To determine whether the impact of the CJR model differed by hospital ownership type, we used event study, difference-in-differences (DID), and triple differences (DDD) models to estimate changes in health care services utilization in treated relative to control areas before versus after CJR implementation (April 2016) by hospital ownership type.ResultsOf the 113,590 hospitalizations, 51,708 (45.52%) were in treated MSAs and 61,882 (54.48%) were in control MSAs; 81,649 (71.88%) were from nonprofit hospitals, 20,247 (17.82%) were from for-profit hospitals, and 11,694 (10.29%) were from government-owned hospitals. DID analyses showed that after policy implementation, nonprofit and for-profit hospitals experienced a decrease in inpatient length of stay of 0.02 days (95% CI, -0.04 to -0.01) and 0.04 days (95% CI, -0.06 to -0.01), respectively, while government-owned hospitals experienced an increase by 0.11 days (95% CI, 0.04 to 0.18). For home discharge rates, nonprofit hospitals experienced an increase of 0.02 (95% CI, 0.01 to 0.03), while other hospitals did not show statistically significant changes. DDD analyses confirmed that inpatient length of stay increased in public compared to nonprofit hospitals in treated relative to control MSAs after policy implementation.ConclusionsThe impacts of the CJR program differed by hospital ownership type. Government-owned hospitals, with their unique financial circumstances, may have faced challenges that hindered the reductions in inpatient length of stay observed in other types of hospitals under the CJR Model.

Impact of the COVID-19 pandemic on direct medical costs of acute coronary syndrome admissions in Yogyakarta, Indonesia

The number of admissions, therapeutic management, and clinical results of acute coronary syndrome (ACS) have been extensively reported. However, the economic impact of ACS therapy has been ignored. This study examined the effect of the COVID-19 pandemic on direct medical costs for ACS hospitalizations in Yogyakarta, Indonesia. A retrospective study of patients with ACS admitted to one of three hospitals during March to August in 2019, 2020, and 2021 was conducted. Direct medical costs from a provider’s perspective were estimated using the charges. All costs were reported in Indonesian Rupiah (IDR) at a 2021 value. Multiple linear regression analysis was used to evaluate the impact of the pandemic on total direct medical costs. The total direct medical costs associated with ACS admission per patient during the pandemic period was approximately 40% higher than that during the pre-COVID period (28.41 vs. 20.33 million IDR or 1976.90 vs. 1414.65 USD). A substantial impact of the COVID-19 pandemic on total direct medical costs still remained after adjusting the ACS types, hospital types, length of stay, percutaneous coronary intervention, in-hospital mortality, and delay time of onset to first medical contact. Given the limited health budget, reallocation of health care resources must be prioritized to maintain the provision of essential health care for those who timely treatment is crucial.

Patterns and outcomes of individuals admitted at emergency units following intentional self-harm in Northern Uganda

We retrospectively reviewed charts of 253 self-harming patients admitted to emergency units in Northern Uganda in 2021. Twenty-two (8.7%) died by suicide, especially due to organophosphate poisoning (n = 14, 63.6%). Regarding self-harm management, observed differences were noted in the type of hospital and the use of antidotes between public and private facilities. There is a need for more studies and a multisector approach to prevent and treat self-harm in Uganda.

Characteristics of patients hospitalized for falls: electronic health records analysis

Abstract Aim Falls are common adverse events, often leading to hospitalization with adverse effects on the physiological and psychological health of patients. Although risk factors for falls are well examined, it is difficult to identify fallers through their electronical health records (EHR). This study investigates whether EHR contain characteristics that indicate a fall before hospitalization. Subject and methods We evaluated 500 EHR of patients hospitalized through the Department of Emergency Medicine of Jena University Hospital. We considered electronically available characteristics including free texts and ICD-10-GM codes. Inpatients with and without a fall event previous to their hospitalization were compared for significant differences in EHR characteristics. Therefore, we applied the Mann–Whitney U test and the exact Fisher test, respectively, with a two-sided significance level of 0.05 and without correction for multiple testing. Results It was possible to identify significant differences between fallers and non-fallers by gender (66.3% women), age (median: 84 years), living situation prior to hospital admission (20.5% from nursing home, 41.1% living alone) and type of discharge. Besides other risk factors, ICD-10-GM codes included injuries, especially fractures and superficial injuries, but also cognitive deficits, incontinence, and physical limitations were more prevalent with fallers than non-fallers. Conclusion This study identified characteristics that can support identification of fall patients through EHR. Such information should be tested in other hospitals and is expected to enhance patient safety and utilization of healthcare resources.

Provision of inguinal hernia surgery in first-referral hospitals across low- and middle-income countries: Secondary analysis of an international cohort study.

Surgical care in first-referral hospitals (FRHs) in low- and middle-income countries (LMICs) is poorly characterized. Inguinal hernia repair can act as a good tracer condition. This study aimed to evaluate the variation in hernia repair across different hospital types in LMICs. We conducted a secondary analysis of an international prospective cohort study of hernia surgery. Data was collected from consecutive patients undergoing primary inguinal hernia repair between 30 January and May 21, 2023. We characterized patients from LMICs, comparing first-referral, secondary, and tertiary hospitals. Emergency surgery, financing methods, mesh use, and complications were defined as key performance measures relevant for FRHs. A multilevel logistic regression model was used to test associations between complications and hospital type. This analysis included 8155 patients undergoing hernia repair across 328 hospitals in 55 LMICs. Most patients were male (89.8%, 7324/8155), of working age (mean age 41.6, SD 25.3). Emergency surgery rates were similar across first-referral, secondary and tertiary hospitals (11.1%, 10.9%, and 9.6%, respectively). Patients in FRHs were most likely to experience out-of-pocket payments (31.4%, 9.4%, and 17.4%). They also had lower rates of mesh use (71.9%, 82.1%, and 84.1%) and higher postoperative complication rates (19.1%, 12.5%, and 14.0%), although complications were similar after adjustment (adjusted odds ratio 1.71, 95% CI 0.83-3.54, p=0.148). This sample of FRHs is capable of delivering simple elective surgery, reducing the burden on subsequent referral hospitals. To scale these surgical pathways, FRHs need support to increase the use of mesh and ensure cost protection for patients.

Relevant factors for policy concerning comprehensive genomic profiling in oncology: stakeholder perspectives

BackgroundComprehensive genomic profiling (CGP) can identify targets beyond standard of care, potentially revolutionizing personalized cancer management. However, conducting well designed studies in this rapidly evolving field is complex and demands time and investments. Consequently, the total added value of CGP remains uncertain. Clinical benefit and costs often are driving factors in coverage decisions. Recently, five additional factors were identified in the literature that can influence the choice for targeted profiling vs. CGP, specifically: “feasibility”, “test journey patient/physician”, “wider implications of diagnostic results”, “organization of laboratories”, and “scientific spillover”. The objective of the current study is to examine the role and importance assigned to these five additional factors for a comprehensive technology assessment by different stakeholders.MethodsPurposive sampling was used to identify respondents from 4 stakeholder groups (i.e., medical specialists, molecular specialists, patient representatives, and policymakers) from different regions and hospital types (academic vs. non-academic) in the Netherlands. In semi-structured interviews, respondents scored the importance to decision-making of the five factors on a 0 (not important) to 5 (essential) scale. Reasoning behind the scores were elicited using open-ended follow-up questions. Transcripts were independently double-coded by two researchers using thematic analysis.ResultsNineteen stakeholders (100% response rate; medical specialists (n = 7), molecular specialists (n = 7), patient representatives (n = 2), and policymakers (n = 3)) were interviewed. We observed differences between stakeholders in the relative importance assigned to the factors (range of median importance scores: 2–5). Overall, “wider implications of diagnostic results”, primarily CGP’s potential to identify additional treatment options, was deemed the most important factor alongside clinical benefit and costs in decision-making about CGP (median range: 3–5). While the “organization of laboratories” was considered less important (median range: 3–4), opposing arguments and preferences regarding the organization of laboratories were identified, with participants from academic centers preferring a centralized approach whilst non-academics preferred a decentralized approach.ConclusionsStakeholders deemed “wider implications of diagnostic results”, “feasibility”, and “test journey” the most important considerations for decision-making about targeted profiling vs. CGP alongside clinical benefit and costs. For policy decision-making, it is important to understand the arguments behind the heterogeneous opinions, often related to the setting they originate from.

Contribution of Product, Price, Place, Promotion, and People (5P) Marketing Mix Strategy on Patients’ Interest To Revisit

In the National Health Insurance (JKN) era, hospitals in Indonesia rapidly grew in number and also developed. In order to stand out amongst the competition, hospitals often rely on marketing strategies through attractive advertisements, offering unique services, and also introducing their services to the public. One method often utilized in the 5P marketing mix consists of product, price, place, promotion, and people. This study aims to identify the impact of 5P marketing mix strategies on the patients’ interest in visiting Bandung Hospital in the city of Medan. Bandung Hospital in Medan conducted this quantitative study using a cross-sectional approach. This study involved 150 patients of Bandung Hospital’s inpatient unit, which is the whole outpatient clinic patient (total sampling) during the May 2023 period. Analysis was carried out using frequency distribution, chi-square, and binomial logistic regression analysis. This study found that the majority of patients visiting Bandung Hospital belong to the 30-39 years age group (62.0%), are female (58.7%), hold a bachelor's degree (48.0%), and are visiting Bandung Hospital for the first time (62.7%). Most of the patients in this study have a good perception toward all aspects of 5P marketing strategies in Bandung Hospital and are interested in visiting the hospital again in the future (p<0.05), with place playing the biggest role in influencing patients’ interest (OR = 4.082). According to all findings in this study, it can be concluded that marketing strategies such as the 5P marketing mix strategy positively influence patients’ interest in visiting Bandung Hospital. It can also be inferred that this strategy would work in similar types of hospitals, not only in Bandung Hospital. Keywords: Marketing mix, Hospital, Product-Price-Place-Promotion-People (5P), Patients

Toward stakeholders' understanding of media reporting on doctor-patient relationship issues: trust, unfamiliarity and uncertainty in the Chinese context.

This study explores doctors' and patients' understandings of citizen journalism on doctor-patient relationship issues. It also examines the communication effect of citizen journalism as a communication platform on doctors and patients who are taking part in the doctor-patient relationship in contemporary China. This study draws on the analysis of 24 semi-structured interviews with doctors from both publicly funded and privately operated hospital, and nine focus groups which included 36 patients with different socio-economic backgrounds. The empirical research present the following results: (1) authority and witness are the two key factors to construct the stakeholders'(doctors' and patients') awareness and trust of citizen journalist reporting on the doctor-patient relationship issues. (2) stakeholders' perception on citizen journalism will construct them concern on the uncertain and unfamiliar knowledge during the hospital activities. The interpretation of doctor-patient relationship reports by doctors and patients affects their mutual trust. Authority and witnessing are two key factors that citizen journalists should consider when reporting on doctor-patient relationship news. Doctors from different types of hospitals and patients with different income levels have different understandings of the authority and witnessing of the reported content. Reading the content of doctor-patient conflicts reflected in citizen journalist reports can exacerbate the emotional fluctuations of doctors and patients. After reading these reports, doctors and patients may experience increased anxiety about uncertainty and unfamiliarity in doctor-patient communication. This study provides a framework for public health research from the relationship between communication content and audience. It also provides answers from the perspectives of media and stakeholders to investigate the tension in doctor-patient relationships in China.

The impact of corporate governance on the cancer waiting time target of the English National Health Service hospitals

Purpose This paper aims to examine the impact of a board-level governance bundle (i.e. size, independence, expertise, meetings, gender diversity and multiple directorships) on the non-financial performance of National Health Service (NHS) hospitals – and, separately, by hospital type (i.e. trusts hospitals and foundation trusts hospitals). Design/methodology/approach A logit regression for panel data is used for a sample of 128 NHS trusts and foundation trusts across England from 2014 to 2018. The data was hand-collected from NHS hospitals’ annual reports and Care Quality Commission reports. The cancer waiting time target (i.e. 62-day cancer referral and treatment target) is used to measure non-financial performance. Findings The main findings for NHS hospitals indicate that multiple directorships positively and significantly affect non-financial performance. However, board expertise and gender diversity have a negative and significant influence. When the sample is partitioned, the results remain the same for the NHS foundation trusts hospitals. For NHS trust hospitals, except for multiple directorships having a positive and significant effect, all remaining governance attributes have an insignificant impact. Practical implications The findings have implications for policymakers and practitioners as they move to implement measures to improve hospital performance against the cancer waiting time targets in the English NHS. Originality/value To the best of the authors’ knowledge, this is the first study to examine the impact of corporate governance on cancer waiting time targets in public hospitals. Overall, this paper contributes to the corporate governance literature, especially in the context of public hospitals, and has significant practical and theoretical implications.

Analysis of medico-legal claims related to deliveries: Caesarean section vs. vaginal delivery.

The Iranian National Health Service (NHS) suggested that gynecologists face a higher risk of medicolegal claims, with a significant number of claims being related to delivery events. This study aimed to investigate the factors associated with delivery related claims. In this cross-sectional study, we conducted an analysis of medico-legal documents which related to complications during delivery events and presented to Iranian Medical Legal Organization spanning from March 2018 to February 2020. A total of 227 legal prosecutions that were initiated by patients or, in cases where that wasn't possible, by their families, were included in the study and all of them were evaluated in commission with experienced professionals. The data collection phase occurred between February 2023 and May 2023. The collected data encompassed various aspects, including patient characteristics mode of delivery, reasons for claims, hospital type, accused party, the occurrence of instrumental delivery and the final disposition of the claims (paid claims or closed claims). Paid claims represent successful lawsuits where the healthcare provider or their insurer made a financial settlement to the patient. Closed claims encompass those that were either denied or dismissed. Chi-square or t-tests were employed to compare factors between paid claims and closed claims. In this study, it was observed that vaginal delivery was performed in 51.1% of the claims, whereas 48.9% underwent a caesarean section.. Approximately half of the claims were against obstetrician-gynecologists, and 33% of the claims against other providers were against midwives.. The majority of complaints were related to perinatal mortality (34.8%) and neonatal asphyxia (18.5%). In 58.1% of cases, no malpractice was identified, while 41.9% resulted in paid claims. Also, there were no significant differences between the paid claims and closed claims groups in several factors, such as the type of hospital (P = 0.904), maternal age (P = 0.157), type of delivery (P = 0.080), and accused party (P = 0.168). However, the number of instrumental deliveries (13.8% of vaginal deliveries) and the reasons for claims, exhibited significant differences between the two claims (P = 0.021, P<0.001 respectively). This study found that maternal complications were more common in caesarean sections, while neonatal claims were more prevalent in vaginal deliveries. The study recommended public health interventions to reduce the overall prevalence of delivery-related claims.

Factors Influencing Person-Centered Care Among Psychiatric Nurses in Hospitals.

This study aimed to examine the association between psychiatric nurses' empathy, teamwork, nursing work environment, and the degree of person-centered care, as well as to identify factors influencing person-centered care (PCC). An online cross-sectional survey was conducted from 11 January to 19 January 2024, using four validated questionnaires. Participants included 167 psychiatric nurses with more than one year of clinical experience working in South Korea. Person-centered care was positively correlated (p < 0.001) with empathy, teamwork, and the nursing work environment. Hierarchical regression analysis was used to identify factors influencing person-centered care among psychiatric nurses. The analysis revealed that the nursing work environment (p < 0.001), teamwork (p < 0.001), empathy (p < 0.001), type of hospital (general hospital) (p = 0.002), and age (p = 0.037) significantly influenced person-centered care, explaining 78.7%. Enhancing PCC among psychiatric nurses requires the development of training and educational programs that bolster empathy and teamwork. Additionally, improvements and strategic enhancements to the nursing work environment are essential.

Antimicrobial Resistance of Escherichia coli for Uncomplicated Cystitis: Korean Antimicrobial Resistance Monitoring System.

Objectives: Uncomplicated cystitis is a leading form of bacterial UTI; the most common causative bacterium worldwide is Escherichia coli. This internet-based, prospective, multicenter, and national observational study aimed to report the antimicrobial resistance of E. coli in patients with uncomplicated cystitis through the use of the Korean Antimicrobial Resistance Monitoring System (KARMS) in 2023. Results: Data for a total of 654 patients were retrieved from the KARMS database. The mean (standard deviation) patient age was 55.9 (18.3) years. The numbers of postmenopausal women and patients with recurrent cystitis were 381 (59.4%) and 78 (11.9%), respectively. Regarding antimicrobial susceptibility, 96.8% were susceptible to fosfomycin, 98.9% to nitrofurantoin, 50.9% to ciprofloxacin, and 82.4% to cefotaxime. Extended-spectrum beta-lactamase positivity was 14.4% (89/616), and was significantly higher in tertiary hospitals (24.6%, p < 0.001) and recurrent cystitis (27.6%, p < 0.001). Fluoroquinolone resistance was significantly higher in tertiary hospitals (57.8%, p < 0.001), postmenopausal women (54.2%, p < 0.001), and recurrent cystitis (70.3%, p < 0.001). In addition, postmenopausal status (95% confidence interval [CI]: 1.44-3.17, odds ratio [OR] 2.13, p < 0.001), recurrent cystitis (95% CI: 1.40-4.66, OR 2.56, p = 0.002) and tertiary hospitals (95% CI: 1.00-2.93, OR 1.71, p = 0.049) were associated with significantly increased fluoroquinolone resistance. Methods: Any female patient diagnosed with clinical uncomplicated cystitis and microbiologically proven E. coli infection in 2023 was eligible for this study. Patient data were obtained from the web-based KARMS database. The antimicrobial susceptibility of E. coli was analyzed according to clinical factors, including hospital region, hospital type, menopause status, and recurrence status. Conclusions: The antimicrobial resistance of E. coli in patients with uncomplicated cystitis in the Republic of Korea has reached a serious level, especially in fluoroquinolone resistance. Therefore, major efforts should be made to reduce antimicrobial resistance.