UNASSIGNED: Epidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital\'s ability to respond to sudden epidemics.
UNASSIGNED: Based on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved.
UNASSIGNED: The stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t0, early epidemic stage t1, and outbreak stage t2 are P ^ t 0 ( S n ) = { 0 . 142 , 0 . 546 , 0 . 220 , 0 . 093 } , P ^ t 1 ( S n ) = { 0 . 025 , 0 . 364 , 0 . 254 , 0 . 357 } , and P ^ t 2 ( S n ) = { 0 . 020 , 0 . 241 , 0 . 191 , 0 . 548 } , respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness.
UNASSIGNED: This paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state.

Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: -0.67 [-0.98, -0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.

Maternal, neonatal, and child health play crucial roles in achieving the objectives of Sustainable Development Goal (SDG) 2030, particularly in promoting health and wellbeing. However, maternal, neonatal, and child services in Moroccan public hospitals face challenges, particularly concerning mortality rates and inefficient resource allocation, which hinder optimal outcomes. This study aimed to evaluate the operational effectiveness of 76 neonatal and child health services networks (MNCSN) within Moroccan public hospitals. Using Data Envelopment Analysis (DEA), we assessed technical efficiency (TE) employing both Variable Returns to Scale for inputs (VRS-I) and outputs (VRS-O) orientation. Additionally, the Tobit method (TM) was utilized to explore factors influencing inefficiency, with hospital, doctor, and paramedical staff considered as inputs, and admissions, cesarean interventions, functional capacity, and hospitalization days as outputs. Our findings revealed that VRS-I exhibited a higher average TE score of 0.76 compared to VRS-O (0.23). Notably, the Casablanca-Anfa MNCSN received the highest referrals (30) under VRS-I, followed by the Khemisset MNCSN (24). In contrast, under VRS-O, Ben Msick, Rabat, and Mediouna MNCSN each had three peers, with 71, 22, and 17 references, respectively. Moreover, the average Malmquist Index under VRS-I indicated a 7.7% increase in productivity over the 9-year study period, while under VRS-O, the average Malmquist Index decreased by 8.7%. Furthermore, doctors and functional bed capacity received the highest Tobit model score of 0.01, followed by hospitalization days and cesarean sections. This study underscores the imperative for policymakers to strategically prioritize input factors to enhance efficiency and ensure optimal maternal, neonatal, and child healthcare outcomes.

In 2009, China initiated a new round of health reform to establish a well-functioning health system. The 2009 health reform did make some significant achievements in improving affordability and accessibility. In particular, social health insurance has been expanded significantly and various social health insurance plans have covered over 95% of total population in China by 2011. The Chinese government also has significantly increased fiscal input for health financing. However, affordability remains a serious concern as the social health insurers, as purchasers, were not very effective in containing the growth of health expenditure. Accessibility to primary care and public health is another concern. In this context, health governance reforms are necessary to address affordability and accessibility issues. Health governance set rules for key actors of the health system (including service providers, health insurers and government departments) by taking into account the strategies and incentives of these actors in their interactions. In recent years, a series of reforms in health governance have been initiated. Some progresses have been achieved. For the next stage of health reform, issues including how to further reform the governance structure of medical institutions and how to improve resource allocation in the health system are critical.

BACKGROUND: Antimicrobial stewardship programmes are a critical tool for addressing the rising threat of antimicrobial resistance.
OBJECTIVE: To determine changes in patterns of antimicrobial use in Queensland public hospitals following introduction of the National Safety and Quality Health Service antimicrobial stewardship standard.
METHODS: A retrospective pre/post intervention study was conducted across Queensland public hospitals at the ecological level using Queensland Health\'s MedTRx database. An interrupted time-series analysis was performed using linear regression models to determine rates of antimicrobial use by quarterly aggregated defined daily dose per 1000 patient-days, for groups of hospitals stratified by peer group classification. Pre-defined time-periods for antimicrobial stewardship programme implementation in response to the introduction of the standard were analysed.
RESULTS: In the post-intervention period, there was a decrease in overall use of systemic antimicrobials, glycopeptides, carbapenems and fluoroquinolones in principal referral and public acute group A hospitals. A decrease in overall use was also observed for smaller regional and remote public acute group C and D hospitals; however, increases in glycopeptide and fluoroquinolone use were observed. Third-generation cephalosporin use was unchanged for all hospital peer groups. The proportion of overall use that was accounted for by narrow-spectrum penicillin was low for all facilities, with modest improvements in the post-intervention period observed in principal referral facilities only.
CONCLUSIONS: These findings add to current knowledge on the effectiveness of legislative quality standards on antimicrobial stewardship at the macro level and highlight gaps to target for future programmes.

BACKGROUND:  Clinical supervision is pivotal in supporting nurses in rendering quality, safe patient care. Therefore, it is essential to understand clinical supervision from operational nursing managers\' context to define existing challenges and propose suitable recommendations.
OBJECTIVE:  This study aimed to explore and describe operational nursing managers\' experiences of clinical supervision within the context of an academic hospital in Gauteng province and propose evidence-based practice recommendations to improve patient safety and the quality of clinical supervision.
METHODS:  An exploratory, sequential, mixed-method design was used and implemented over two phases to take advantage of the strengths of both the qualitative and quantitative research designs. Unstructured individual interviews were conducted to collect data in phase one, and an adapted Manchester Clinical Supervision Scale (MCSS) questionnaire was used to collect data in phase two.
RESULTS:  Operational nursing managers work in stressful conditions and environments with a gross shortage of staff and tools of the trade while being expected to deliver high-quality and safe nursing care. Of the sampled respondents, 36% (n = 17) were dissatisfied with the supervision they received, while 64% (n = 30) were indifferent in the sense that they did not think it was adequate or inadequate.
CONCLUSIONS:  Clinical supervisors should be trained and supported in clinical supervision, with regular workshops on interpersonal relations.Contribution: A clearer understanding of clinical supervision within the hospital context and evidence-based practice recommendations to improve patient safety and the quality of clinical supervision.

UNASSIGNED: Given the preventable nature of most healthcare-associated infections (HAIs), it is crucial to understand their characteristics and temporal patterns to reduce their occurrence.
UNASSIGNED: A retrospective analysis of medical record cover pages from a Chinese hospital information system was conducted for surgery inpatients from 2010 to 2019. Association rules mining (ARM) was employed to explore the association between disease, procedure, and HAIs. Joinpoint models were used to estimate the annual HAI trend. The time series of each type of HAI was decomposed to analyze the temporal patterns of HAIs.
UNASSIGNED: The study included data from 623,290 surgery inpatients over 10 years, and a significant decline in the HAI rate was observed. Compared with patients without HAIs, those with HAIs had a longer length of stay (29 days vs. 9 days), higher medical costs (96226.57 CNY vs. 22351.98 CNY), and an increased risk of death (6.42% vs. 0.18%). The most common diseases for each type of HAI differed, although bone marrow and spleen operations were the most frequent procedures for most HAI types. ARM detected that some uncommon diagnoses could strongly associate with HAIs. The time series pattern varied for each type of HAI, with the peak occurring in January for respiratory system infections, and in August and July for surgical site and bloodstream infections, respectively.
UNASSIGNED: Our findings demonstrate that HAIs impose a significant burden on surgery patients. The differing time series patterns for each type of HAI highlight the importance of tailored surveillance strategies for specific types of HAI.

UNASSIGNED: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout.
UNASSIGNED: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic.
UNASSIGNED: Three public sector hospitals in Gqeberha, South Africa.
UNASSIGNED: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout.
UNASSIGNED: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71-26.40), being in the lowest income band (AOR = 10.78, 2.55-45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12-8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92-13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98-10.18). Low support at work (AOR = 9.99, 3.66-27.23), medium job satisfaction (AOR = 5.38, 2.65-10.93) and medium support at work (AOR = 3.39, 1.71-6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10-0.80) and high levels of resilience (AOR = 0.08, 0.03-0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout.
UNASSIGNED: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors.
UNASSIGNED: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

Following the marketization of China\'s health system in the 1980\'s, the government allowed public hospitals to markup the price of certain medications by 15% to compensate for reduced revenue from government subsidies. This incentivized clinicians to induce patient demand for drugs which resulted in higher patient out-of-pocket payments, higher overall medical expenditure, and poor health outcomes. In 2009, China introduced the Zero Markup Drug Policy (ZMDP) which eliminated the 15% markup. Using Shanghai as a case study, this paper analyzes emerging and existing evidence about the impact of ZMDP on hospital expenditure and revenue across secondary and tertiary public hospitals. We use data from 150 public hospitals across Shanghai to examine changes in hospital expenditure and revenue for various health services following the implementation of ZMDP. Our analysis suggests that, across both secondary and tertiary hospitals, the implementation of ZMDP reduced expenditure on drugs but increased expenditure on medical services, exams, and tests thereby increasing hospital revenue and keeping inpatient and outpatient costs unchanged. Moreover, our analysis suggests that tertiary facilities increased their revenue at a faster rate than secondary facilities, likely due to their ability to prescribe more advanced and, therefore, more costly procedures. While rigorous experimental designs are needed to confirm these findings, it appears that ZMDP has not reduced instances of medical expenditure provoked by provider-induced demand (PID) but rather shifted the effect of PID from one revenue source to another with differential effects in secondary vs. tertiary hospitals. Supplemental policies are likely needed to address PID and reduce patient costs.

UNASSIGNED: Maternal near miss refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of pregnancy termination. While there has been considerable progress in reducing maternal mortality rates, maternal near miss cases can provide valuable insights into the quality of maternal healthcare and help identify areas for improvement. However, there is limited evidence on the factors contributing to maternal near miss cases, including health system failures, delays in care, and provider-related factors. Therefore, this study aimed to assess the incidence, causes, and factors associated with maternal near misses in public Hospitals of Borena Zone.
UNASSIGNED: A facility-based longitudinal cross-sectional study design was employed at four Public Hospitals in Borena Zone from August 15, 2022, to November 15, 2022, using the WHO criteria for maternal near miss event. In total, 117 participants were included in the study. Eligibility was determined using key clinical, organ dysfunction, laboratory, and management criteria, as per the WHO guidelines for near-miss events. Underlying and contributing causes of maternal near misses were documented from each participant\'s records.
UNASSIGNED: There were 1421 deliveries during the study period and 117 eligible women developed potentially life-threatening conditions. Only 61 women experienced severe maternal outcomes (55 near misses and six maternal deaths). The maternal near miss incidence ratio was 38.7 per 1000 live births, with a mortality index of 9.8%. Hypertensive disorders and obstetric hemorrhage are the leading underlying causes of maternal near misses.
UNASSIGNED: The incidence of maternal near miss was remarkably high when compared to previous studies. Giving special emphasis to life-saving interventions, critical care, reducing delays and improving the referral system are critical to improve quality of care.