Overall Quality Of Care Research Articles

Quality indicators in respiratory therapy

Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance, effectiveness, and safety of healthcare services. These indicators provide a systematic way to evaluate the quality of care offered, and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices. Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives. Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care. By systematically tracking and analyzing indicators related to infection control, treatment effectiveness, and adherence to protocols, respiratory care practitioners can identify areas to improve and implement evidence-based changes. This article reviewed how to identify, implement, and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.

Predictive Value of Modified Frailty Index, Sarcopenia, Prognostic Nutritional Index, and Geriatric Nutritional Risk Index for Postoperative Complications in Oblique Lumbar Interbody Fusion Over 60 Years

ObjectiveElderly patients undergoing spinal surgery are at an increased risk of morbidity and mortality. Evaluating frailty and preoperative status is crucial for predicting postoperative outcomes. This study aimed to assess the predictive value of the modified Frailty Index (mFI), sarcopenia, Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI) in determining postoperative complications in patients undergoing oblique lumbar interbody fusion (OLIF) over 60 years. MethodsPreoperative risk factors were assessed using 11 variables, including mFI, PNI, GNRI. Complication rates were compared among nonfrail (mFI = 0; n = 50), prefrail (mFI = 0.09–0.18; n = 144), and frail (mFI ≥0.27; n = 80) patients. Demographic and perioperative variables were compared between the complication and noncomplication groups. The incidence of complications was the primary outcome measure. ResultsComplications occurred in 36 of 274 patients (13.1%). The frail group exhibited a significantly higher incidence of pneumonia than the nonfrail and prefrail groups. The complication group displayed significant differences in several variables, including age, fusion level, albumin level, lymphocyte count, platelet count, creatinine level, and estimated blood loss. Moreover, mFI, PNI, and GNRI differed significantly between the complication and noncomplication groups. ConclusionMFI, PNI, and GNRI can be useful for predicting postoperative morbidity and mortality in patients undergoing OLIF. These comprehensive assessment methods enable the identification of high-risk patients and the formulation of tailored strategies to enhance postoperative outcomes. Integrating mFI, PNI, and GNRI into the preoperative evaluation process can help healthcare providers proactively manage high-risk patients, thus improving the overall quality of care for elderly individuals undergoing OLIF.

Staff Resiliency in Long-Term Care during the COVID-19 Pandemic: A Qualitative Study

The COVID-19 pandemic has had a major impact on long-term care facilities (LTCFs). While much attention has been paid to the impact of the pandemic on residents, less attention has been given to the experiences of staff and factors impacting their resilience in facing challenges working in LTCF. This research describes the factors contributing to the resiliency of LTCF staff during the COVID-19 pandemic in northern British Columbia (BC). Transcripts from 53 participants who completed one-hour semi-structured interviews were included and thematic analysis was conducted. All participants had experience working in a LTCF facility in northern BC during the pandemic. The LTCF staff described resilience as the ability to adapt to changing circumstances and protocols, while also maintaining a positive attitude and uplifting spirits during times of adversity. The analysis revealed five key themes influencing staff resilience: (1) availability and provision of resources for staff, (2) leadership and management within LTCFs, (3) social support available to staff, (4) impact of residents’ morale on staff resilience, and (5) personal attributes and characteristics of the staff. Understanding and addressing the five themes can guide the development of targeted strategies and interventions aimed at enhancing staff resilience and well-being during challenging circumstances. By recognizing and addressing the specific needs of LTCF staff, it is possible to improve the overall quality of care provided in LTCF and promote the well-being of both residents and staff. The findings shed light on the interplay of these themes and their profound influence on LTCF staff. Identifying staff’s needs and factors that contribute to their resilience may lower staff turnover, leading to a stronger and more resilient healthcare system, capable of safeguarding vulnerable populations, particularly during times of crisis such as the COVID-19 pandemic.

Cancer Patients Satisfaction and Quality of Healthcare Services in Iraq: A Cross-Sectional Study to Evaluate the Quality of Care in Cancer Management.

Cancer is a complex disease characterized by uncontrolled cell proliferation and the development of metastatic features. The aim of the study is to examine the patient's satisfaction with the quality of healthcare services provided at the Middle Euphrates Cancer Centre in Al-Najaf Al-Ashraf Governorate. Cancer patients who visited during 2021-2023 Middle Euphrates Cancer Center in Al-Najaf Al Ashraf Governorate in 2021-2023 were enrolled in the study. In the cross sectional study, enrolled cancer patients were screened based on inclusion and exclusion criteria. In this study, cancer patient satisfaction assessment was made based on responses from a 59 items questionnaire. In the study period, 400 cancer patients who visited the Middle Euphrates Cancer Center in Al-Najaf Al Ashraf Governorate enrolled in the study. Cancer patient's satisfaction was assessed based on the care provided by physicians, nurses, the infrastructure of the organization, and their socioeconomic status. Under the category of care provided by the physician, the level of assessment reported was low [L] =1-2.33; moderate [M] =2.34-3.66; 2.34-3.66, and high [H] =3.67-5). However, in the case of care provided by nurses, the level of assessment is low ([L] =1-2.33; moderate [M]=2.34-3.66; high [H]=3.67-5.0). The level of assessment (low [L] =1-2.33; moderate [M] = -3.66; high [H]=3.67-5) at the organization level for the services and facilities. Findings clearly demonstrate that the participants were dissatisfied with some services provided by doctors, nurses, or organizations. The findings also emphasize the critical need to tailor healthcare services, enhance accessibility, and elevate the overall quality of care to enhance patient satisfaction significantly.

Total triage model in general practice: a systematic review of the opportunities and challenges.

Total triage (TT) has the potential to achieve more equitable access to primary care, to improve the overall quality of care, and enhance health outcomes. TT has gained increasing attention from the public, policymakers, and academics. To examine relevant scientific literature regarding the implementation of TT, the reported opportunities and challenges for patients and staff, and implications for practice. Medline, Embase, CINAHL, and Scopus were searched for articles and grey literature between 2013 and February 2023. Included documents described the implementation of TT during in-hours general practice and provided perspectives from patients/staff. Patients and stakeholders were involved throughout each stage of the review process. Findings were synthesised using a framework approach. In total, 23 documents were included at full-text screening. Analysis highlights a range of TT approaches, sometimes conflating remote and TT systems. TT was seen to both increase and reduce workload. Consistently, patient and staff views worsened with TT use. TT can increase barriers to care access with potential to exacerbate inverse care laws across the UK. Critical knowledge gaps included patient co-production in TT systems and the role of reception teams to adapt systems to meet patients' needs. TT can influence patient access, safety, and equity. The approach may also generate profoundly different working styles for general practice. This review adds to current debates surrounding patient access and TT, and consequences for staff/patients. The findings can be used to aid practices when navigating the new GP contract and the implementation of new TT approaches.

Predictive Analysis for Personalized Machine: Leveraging Patient Data for Enhanced Healthcare

This research explores predictive analysis for personalized machine: leveraging patient data for enhanced healthcare. By leveraging the power of information and analytics, the healthcare industry can be driven towards a more patient-centric, proactive model that enhances outcomes and improve the overall quality of care. The objectives of the study are to: determine the significance and challenges of predictive analytics in healthcare, ascertain the data analytics techniques used in healthcare to enhance patient care, find out how predictive analytics can be applied for enhanced healthcare, and determine the ethical considerations associated with healthcare predictive analytics. This study employs the case study approach and experimental design. The study analyzes case studies of real-time deployment of predictive analytics models in healthcare centers, examines how these models enhance the healthcare delivery in those centers. Experiments were also conducted to understand how predictive analytics works. The C4.5 learning algorithm was employed to predict the presence of chronic kidney disease (CKD) in patients and differentiate between those not affected by the condition. The C4.5 classifier shows reasonable strength, evident in the large number of rightly classified occurrences (396) and a low misclassification of only 4 occurrences. This is further demonstrated by a low error rate of 0.37, as shown in table 5. The prevalence of this algorithm is emphasized by the large value of KS (0.97), indicating the classifier’s ground-breaking accuracy and performance. The performance of C4.5, featured by its minimal execution time and accuracy, puts it as a decent classifier. This characteristic makes it specifically well-suited for application in the healthcare sector, particularly for tasks involving prediction and classification. The application of data analytics methods for predictive analysis holds significant benefits in the health sector, as it gives us the power to predict and address potential threats to human health, covering different age groups, from the young ones to the elderly. This proactive method enables early disease detection, helping in timely interventions and contributing to better decision-making.

Understanding Youth Justice Professionals’ Motivations For Their Work

Youth Justice (YJ) professionals experience work-related stress, challenges and trauma in their work (Sibisi & Warria, 2020) yet they continue to enter the field. Research regarding motivations of YJ professionals for their work is limited, but necessary to improve overall quality of care and to ensure the most suitable candidates are hired. Semi-structured interviews aimed to explore YJ workers’ motivations for their work and how they experience and cope with challenges on the job. Thematic analyses indicates that YJ professionals are motivated by the opportunity to contribute to the lives of youth through prevention and intervention, progress and learning, and advocacy and resource provision. Challenges in YJ work are often related to feeling unsupported owing to low salaries, staff shortages, and system constraints. Motivating factors which contribute to their ability to stay in the field despite the challenges include a passion for their work and seeing change in their clients. Healthy coping strategies appear necessary to manage challenges and may contribute to the longevity in the field. Findings provide insight into YJ professionals' motivations, coping, and reasons for remaining in the field. These results can help to inform hiring, training and policy in Ontario YJ work.

BREAST CANCER ASSISTANCE JOURNEY FROM THE PERSPECTIVE OF THE PUBLIC HEALTHCARE SERVICE OF RIO GRANDE DO SUL

Objective: This study aims to characterize the breast cancer (BC) patient journey in Rio Grande do Sul (RS), Brazil, through the perspectives of the High Complexity Oncology Assistance Centers (CACONs) and High Complexity Oncology Assistance Units (UNACONs). Methods: Conducted between March and May 2023 across 17 RS Oncology public healthcare services, the cross-sectional study utilized a 54-question questionnaire administered to healthcare professionals. The survey covered various aspects, including diagnosis, treatment, funding, and multidisciplinary teamwork. Results: Descriptive analysis revealed that BC patients undergo screening tests upon treatment entry (88.2%), with immunohistochemistry commonly performed externally (64.7%) and PCR often requested (82.4%) for adjuvant therapy initiation, taking an average of 90 to 250 days for all procedures. Patients encounter challenges such as lengthy hospital stays, extensive travel to treatment centers, treatment side effects, and high transportation expenses, often leading to treatment discontinuation. The most time-consuming stage is treatment, with subcutaneous infusion proving more time-efficient than intravenous administration. Physical limitations, mobility issues, late diagnosis (90-day average), and limited access to care significantly impact patients' quality of life. Healthcare teams face difficulties with outdated guidelines, lack of intravenous treatment facilities, and extended administration durations. Institutions confront barriers like drug shortages, guideline disparities, and logistical challenges. Conclusion: The study concludes by emphasizing the identified hurdles in BC patients' public healthcare journey, underscoring the need to address delays in screening, resource constraints, and disparities in access to care based on geographical, socioeconomic, and racial/ethnic factors to enhance overall quality of care and equity within the system.

IJCM_417A: Internet health information seeking and its effect on patient-doctor relationship and satisfaction among patients attending a tertiary care hospital in Mangalore

Background: The doctor-patient relationship is a fundamental and essential component of healthcare that plays a critical role in patient outcomes, trust, and overall quality of care. Internet-based health information has been found to have both positive and negative effects on patients. Objectives: To assess the internet health-seeking behaviour among patients, and its effect on the doctor-patient relationship Methodology: In this facility-based cross-sectional study, 110 patients were assessed regarding their internet health-seeking behaviour and its effect on the doctor-patient relationship. Patient-Doctor Depth-of-Relationship Scale and Patient Satisfaction Questionnaire – Short form (PSQ-18) was used to assess the relationship. A comparison of patient satisfaction scores and doctor-patient relationship scores among those who use the internet for seeking health-related information with those who do not was done by independent t-test and P < 0.05 will be considered to be a statistically significant difference. Results: Sixty-seven-point three per cent use the internet for health-related information. Most of the patients felt satisfied with their medical care but there was still some scope of improvement in the domains of communication and the time devoted by the doctor to the patient. The overall level of patient satisfaction was above average. Our study also showed that 77.2% of the study participants had a good relationship with their doctor. Conclusion: In our study, we found that the internet using study participants were found to have an above average satisfaction with their doctors.

Patient education in rheumatology

In Switzerland, patient education in rheumatology faces challenges, despite national advances following the development of the concept of self-management support by the Federal Office of Health. Yet it is a fundamental pillar of rheumatic disease management, meeting the needs of both patients and healthcare professionals. It helps to improve the overall quality of care and is recommended by the European Alliance of Associations for Rheumatology (EULAR). Training in PE needs to be strengthened, as does the evaluation of programmes, which must take account of the specific nature of rheumatic diseases. An integrated, patient-centered approach is essential to overcome these obstacles and promote PE in rheumatology.

Nurses Knowledge regarding Blood transfusion in Hayatabad Medical Complex, Peshawar

Background: Blood transfusion is a critical and life-saving procedure in medical practice, necessitating high levels of knowledge and competency among healthcare providers, particularly nurses, to ensure patient safety and minimize risks associated with transfusion. Despite its importance, gaps in knowledge and training among nursing professionals can significantly impact the quality of care and patient outcomes. Objective: This study aimed to assess the knowledge of nurses regarding blood transfusion practices at a tertiary care hospital in Peshawar and to identify educational gaps that could be addressed to improve the safety and efficacy of transfusion services. Methods: A cross-sectional descriptive study was conducted among Registered Nurses working at Hayatabad Medical Complex, Peshawar. A total of 206 nurses were recruited using convenience sampling. The blood transfusion knowledge questionnaire, adapted from previous studies with modifications to include demographic questions and specific queries related to blood transfusion, was used for data collection. Statistical analysis was performed using SPSS version 25, focusing on calculating means, standard deviations, frequencies, and percentages. Results: The study found that 63.60% of the participants were female, and the majority (52.4%) were aged between 31 to 40 years. Regarding blood transfusion practices, 89.3% correctly identified the use of a blood transport box for transporting blood from the blood bank to the ward. Furthermore, 90.77% acknowledged checking the details on the bag label and blood request form as the first step in collecting a blood bag. However, the study highlighted a moderate level of overall knowledge about blood transfusion among nurses, with significant gaps in training and education noted. Conclusion: The findings suggest that while nurses at the tertiary care hospital in Peshawar have a reasonable understanding of some aspects of blood transfusion practices, there is a clear need for enhanced training programs and the inclusion of comprehensive transfusion medicine education in nursing curricula. Addressing these gaps is essential for improving patient safety and the overall quality of care in transfusion services.

The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors.

This research aims to investigate the role of management leadership in promoting a culture of patient safety within healthcare organizations. Through a comprehensive mediation analysis of the Chinese version of the safety attitudes questionnaire (CSAQ) and patient safety culture, the study examines the interplay between these critical factors and their combined influence on healthcare outcomes. In a medical center located in Taiwan, a cross-sectional survey was carried out utilizing the CSAQ. Among the 1500 distributed surveys, 1037 were returned and deemed valid, resulting in a return rate of 69.13%. To investigate the main measures, Structural Equation Modeling with mediation analysis was employed to scrutinize the direct and indirect effects of factors including teamwork climate, job satisfaction, stress recognition, perceptions of management, working conditions, and emotional exhaustion on safety climate. The findings reveal that effective management leadership plays a pivotal role in shaping safety attitudes and fostering a robust patient safety culture. The study identifies three critical facets of patient safety that are entirely mediated by management perceptions: teamwork climate, working conditions, and stress recognition. The results highlight the importance of enhancing these dimensions to advance the patient safety culture within healthcare organizations. Moreover, stress recognition is identified as a critical factor influencing the organizational culture of patient safety. This research offers valuable insights for healthcare organizations seeking to prioritize patient safety and improve overall quality of care. By enhancing our understanding of the critical factors that shape safety attitudes and patient safety culture, this study provides a roadmap for effective management leadership and a culture of patient safety within healthcare organizations. The study underscores the significance of management leadership in promoting patient safety culture and highlights the importance of enhancing teamwork climate, working conditions, and stress recognition to advance patient safety culture.

Post-surgical readmission risk factors in otolaryngology/head and neck surgery.

Otolaryngology patients are a high-readmission-risk group due to the complexity of surgeries, significant alterations to speech and swallowing functions, and high postoperative complications risk. A retrospective review was performed on patients who underwent otolaryngologic surgery at a single-academic-institution between March 2019 and February 2020. Among 365 discharges, 21 patients had unplanned readmissions within 30 days. On univariable analysis, acute myocardial infarction, number of total comorbidities, prior chemotherapy/radiation, active smoking, airway surgery, and enteral feeding, and on multivariable analysis, prior chemotherapy/radiation and active smoking were identified as significant readmission risk factors. Readmission risk increased from 2.43% to 7.48% and 41.67% with the addition of each risk factor. Nearly 75% of the readmissions were due to potentially preventable reasons. By identifying and proactively intervening on "at risk" patients during the perioperative timeframe, complications and readmission can be reduced, thereby improving the overall quality of care delivered.

The challenges of voluntary care provision for hospitalized patients with COVID-19: A qualitative study of the public volunteers' experiences.

During the COVID-19 pandemic, there was a remarkable increase in public volunteering for the care of hospitalized patients. They faced challenges during their voluntary care provision. This study aimed at exploring public volunteers' experiences of the challenges of the voluntary care provision to hospitalized patients with COVID-19. A descriptive qualitative study with an inductive content analysis method was conducted, 2022-2023. Eighteen public volunteers providing care to hospitalized patients with COVID-19 were purposefully selected among 10 hospitals, specialized in COVID-19 care in Tehran and Shiraz, Iran. Data were collected over 7 months through in-depth semistructured interviews and concurrently analyzed using conventional content analysis methods. The challenges of voluntary care provision to hospitalized patients with COVID-19 were illustrated in five main categories, each with two subcategories. The categories included structural challenges, interpersonal conflicts, financial constraints, covert participationand the deteriorating condition of care provision. The subcategories comprised lack of volunteer recruitment bases, ineffective organization of voluntary activities, pervasive distrust, heightened risk of clinical errors, conflicts between volunteer commitments and primary occupation, lack of financial support, lack of family support, isolation by friends, mental traumaand physical exhaustion. Public volunteers encounter diverse challenges while providing care to hospitalized patients with COVID-19, which negatively impacts their motivation to serve. By addressing these challenges, we can create a more supportive environment for volunteers and enhance the quality of care provided to patients during public health emergencies. Identifying such challenges can assist healthcare managers and policymakers develop effective strategies to mitigate mounting difficulties and enhance volunteer services, thereby improving the overall quality of care provided to patients during public health crises. Participants were identified and recruited after the study objectives were explained in person to the managers. The participants were approached and interviewed by one author. Participation was voluntary and the participants did not receive any financial compensation for their time.

Methadone Maintenance Therapy (MMT) and Alternatives in Opioid Use Disorder: Reviewing the latest advancements, outcomes, and challenges in substitutional therapy for opioid addiction - literature review

Introduction and Purpose: Opioid addiction is a serious challenge for public health worldwide, and methadone maintenance therapy (MMT) is a key therapeutic approach. This review intends to provide an up-to-date summary of the pathophysiology, clinical manifestation, diagnostic techniques, and treatment options for Opioid Use Disorder. Materials and methods: The literature available in PubMed, Scopus, and Google Scholar databases was reviewed using the following keywords: "MMT," "methadone maintenance therapy", “maintenance therapy”, "opioid use disorder", "opioid addiction," "methadone”, ”naloxone” “naltrexone”, and “buprenorphine”. State of Knowledge: This review examines current approaches in maintenance therapy for Opioid Use Disorder (OUD). In the study, we focus on treatments using methadone, buprenorphine, naloxone, and naltrexone. It focuses on recent advancements, comparing the effectiveness, safety, and patient outcomes of these therapies. Key challenges in treatment accessibility and implementation are also discussed, providing an updated overview of the field and identifying areas for future research in opioid addiction therapy. Conclusion: There is a series of studies researching the psychological and behavioral problems associated with opioid addiction. This research has given medical practitioners valuable guidance on effective management techniques. According to the authors, compared to other alternative treatment methods, methadone maintenance therapy (MMT) is still considered the most effective pharmacotherapeutic method in the treatment of opioid addiction. Nevertheless, ongoing research is essential to improve diagnostic processes, develop innovative therapies, and enhance the overall quality of care for those affected by these challenges.

Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends.

Recent advancements in orthopedic surgery have greatly improved the management of musculoskeletal disorders and injuries. This review discusses the latest therapeutic approaches that have emerged in orthopedics. We examine the use of regenerative medicine, including stem cell therapy and platelet-rich plasma (PRP) injections, to accelerate healing and promote tissue regeneration. Additionally, we explore the application of robotic-assisted surgery, which provides greater precision and accuracy during surgical procedures. We also delve into the emergence of personalized medicine, which tailors treatments to individual patients based on their unique genetic and environmental factors. Furthermore, we discuss telemedicine and remote patient monitoring as methods for improving patient outcomes and reducing healthcare costs. Finally, we examine the growing interest in using artificial intelligence and machine learning in orthopedics, particularly in diagnosis and treatment planning. Overall, these advancements in therapeutic approaches have significantly improved patient outcomes, reduced recovery times, and enhanced the overall quality of care in orthopedic surgery.

International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty

BackgroundThis modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures. MethodsAn international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were 3 rounds of anonymous voting per topic using a modified 5-point Likert scale with a predetermined consensus threshold of ≥ 75% agreement necessary for a statement to be accepted. ResultsAfter 3 rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included (1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); (2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); (3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); (4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and (5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures. ConclusionsThrough a structured modified Delphi approach, a panel of 20 orthopedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.

Effective coverage of curative child health services in Ethiopia: analysis of the Demographic and Health Survey and Service Provision Assessment survey

ObjectivesDespite a remarkable decline, childhood morbidity and mortality in Ethiopia remain high and inequitable. Thus, we estimated the effective coverage of curative child health services in Ethiopia.DesignWe conducted a cross-sectional...

Prevention of Catheter-Associated Bloodstream Infections in Hemodialysis Patients

This study aimed to assess the efficacy of preventive measures against catheter-associated bloodstream infections in hemodialysis patients. Seventy patients undergoing hemodialysis treatment at our hospital from January 2020 to January 2023 were recruited and randomly assigned in a 1:1 ratio to receive either conventional nursing (control group) or targeted preventive nursing (observation group), with 35 cases in each group. Outcome measures for nursing effects assessment included nursing outcomes, the incidence of catheter-related bloodstream infections, patient stress, and quality of life. Targeted preventive nursing demonstrated a significantly lower incidence of catheter-related bloodstream infection and adverse catheter events compared to conventional care (P <0.05). Moreover, targeted preventive nursing significantly reduced catheter retention duration in comparison to conventional care (P <0.05). The higher quality of nursing associated with targeted preventive nursing was evident in the elevated nursing quality scores (P <0.05). Patients who underwent targeted preventive nursing exhibited milder stress compared to those receiving routine care, as indicated by lower hemodialysis stress scale (HSS) scores (P <0.05). Furthermore, the observation group, receiving targeted preventive nursing, reported higherWorld Health Organization quality of life (WHOQOL-BREF) scores than the control group, suggesting an improved quality of life (P <0.05). Targeted preventive care for catheter-associated bloodstream infections in hemodialysis patients not only fortifies the rigor and standard of care but also effectively reduces the infection rate, shortens catheter retention time, alleviates patient stress, and enhances their overall quality of care and survival.

Disparities and Underutilization of Surgery for Early Stage Small Cell Lung Cancer

BackgroundThe National Comprehensive Cancer Network recommends surgical resection for stage I small cell lung cancer (SCLC). Despite these recommendations and the curative potential of such surgery, many continue to underutilize surgery. Our aim is to investigate factors that contribute to underutilization of surgery for stage I SCLC. MethodsThe National Cancer Database was queried to identify patients with SCLC stage I-IV from 2004 to 2018. Staging was defined by the American Joint Committee on Cancer guidelines. Cochran-Armitage analysis was performed to analyze trends in surgical treatment for patients diagnosed with stage I SCLC. Multivariable logistic regression assessed relationships between patient factors and surgical treatment. ResultsA total of 296,583 patients were diagnosed with SCLC. Of the stage I patients (n = 13,003), only 29.4.% (n = 3823) underwent surgery. Trend analysis demonstrated increased frequency of surgical treatment for stage I SCLC over years 2004 to 2017, from 14.9% to 39.6% (P < .0001). Factors that were associated with underutilization of surgery for stage I SCLC include African American race, lower median income, nonprivate insurance or Medicare, community facility, and geographic regions other than the Northeast. ConclusionsSurgical treatment for stage I SCLC remains underutilized and our study identifies notable associated factors. The recognition of these factors may help patients overcome barriers to receiving recommended treatments, improve guideline adherence, and overall quality of care for stage I SCLC patients.