Search Results (4,175)

Background: Nursing regulation is a key component of health system governance; however, its role in structuring the development and deployment of professional competencies remains insufficiently examined, particularly in emerging health systems. Objective: To map and synthesize the evidence on nursing regulation and its relationship with professional competencies across the nursing profession, including the development of advanced nursing roles, and to analyze the Mexican regulatory framework within an international context. Methods: A scoping review was conducted using a structured and transparent approach. Searches in Scopus, Web of Science, and PubMed identified 194 records. After duplicate removal and screening, 17 studies met inclusion criteria based on relevance to regulation, scope of practice, and competency development. In parallel, 13 regulatory instruments in Mexico were identified through targeted searches of official sources; 9 key documents were selected based on specificity and relevance. Data were analyzed using a policy-oriented framework. Results: Regulatory frameworks consistently define scope of practice and enable the translation of competency-based education into recognized clinical roles. Regulatory coherence was associated with expanded professional autonomy, advanced role development, and improved workforce integration. Fragmented regulatory environments were linked to misalignment between education and practice and underutilization of competencies. In Mexico, a broad but fragmented regulatory architecture was identified, lacking a unified regulatory axis and an autonomous professional body. Conclusions: Nursing regulation functions as a structural determinant of professional competency deployment. Strengthening regulatory coherence is essential to align education, practice, and health system needs, with implications for workforce performance, patient safety, and system sustainability. Full article

Customer satisfaction offers economic benefits and competitive advantage to manufacturing enterprises. However, a gap exists in understanding how to achieve customer satisfaction due to the complexities involved in coordinating various subsystems of an enterprise in an efficient manner. In this paper, we identified four internal and external-to-the-firm customer satisfaction drivers which include: government policies, supply chain reliability, knowledge management, and manufacturing performance criteria such as on-time delivery, quality and cost. We then developed a conceptual framework to define the non-linear mathematical relationships between drivers using system dynamics modeling. We conducted “what-if “scenario analyses for a base case, optimistic case and pessimistic case using three intervention policies: “investing resources in knowledge management”, “inclusion of a safety stock”, and “decreasing cost of inventory” to study the impact of these policies on customer satisfaction. This work contributes to customer satisfaction research by presenting a decision-support tool that will enable the leadership of manufacturing enterprises to create a simplistic mental model of the complex interactions of an enterprise using easy-to-use mathematical relationships to capture system dynamics over time. Full article

The continued growth of e-commerce has changed the role of reverse logistics, turning it from a supporting activity into an important element of sustainable and resilient supply chain management. Handling product returns efficiently requires a clear understanding of how different logistics factors influence one another within the broader system. This study examines and models the causal links among six major factors through the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method. Using evaluations provided by a panel of domain experts, the analysis measures the strength of interactions between the selected variables and identifies those that act as driving forces as well as those that mainly respond to influences from other factors. The resulting model offers a practical basis for decision-making by showing which factors generate the strongest effects across the reverse logistics network. This perspective helps managers direct available resources toward the elements capable of producing the greatest influence on overall system performance. As a result, organizations can improve the use of resources while supporting both operational efficiency and environmental objectives throughout the supply chain. By applying a causal analysis framework, this research delivers a useful instrument for understanding return management processes in e-commerce. The findings support more informed strategic decisions and provide guidance for companies seeking to improve sustainability performance within a market environment shaped by circular economy principles and frequent change. Full article

Background: Sepsis-associated encephalopathy (SAE) is a serious complication affecting septic patients and significantly increases mortality. Serum 25-hydroxyvitamin D (vitamin D) deficiency is prevalent in critical illness, but its relationship with SAE prognosis remains unclear. Methods: This retrospective cohort study enrolled SAE patients at Nanjing Drum Tower Hospital (January 2023–June 2024). Vitamin D levels were measured within 24 h of ICU admission with insufficiency and deficiency defined as ≤30 ng/mL and ≤20 ng/mL, respectively. Demographics, severity scores, laboratory parameters, organ support, and 90-day mortality were collected. Statistical analyses included Mann–Whitney U/t-tests, Spearman’s correlation, multivariate logistic regression, and ROC analysis. Results: Among 346 sepsis patients, 47 met SAE criteria. Vitamin D insufficiency affected 97.9% (46/47) of SAE patients, with 85.1% (40/47) being deficient. Ninety-day mortality was 25.5% (12/47). Non-survivors had significantly lower vitamin D levels than survivors (median 10.15 vs. 12.83 ng/mL, p = 0.010). Multivariate analysis identified higher APACHE II score (OR 1.164, 95% CI 1.042–1.300; p = 0.007) and lower vitamin D level (OR 0.758, 95% CI 0.603–0.954; p = 0.018) as independent predictors of 90-day mortality. Combining APACHE II score and vitamin D provided excellent predictive value (AUC 0.886). Vitamin D levels correlated negatively with IL-6 (rho = −0.293, p = 0.045) and vasopressor use (rho = −0.410, p = 0.004). Conclusions: Vitamin D insufficiency is nearly universal in SAE patients. Lower admission vitamin D levels independently predict 90-day mortality and enhance the predictive power of APACHE II. Vitamin D levels were negatively correlated with IL-6, suggesting a potential relationship with inflammation, but causality and clinical significance require further investigation. Full article

Objectives: To investigate the relationship between intrapartum cardiotocography (CTG) findings and neonatal outcomes by evaluating the association between CTG tracings, umbilical cord blood gas parameters, and APGAR scores, and to assess the diagnostic performance of CTG in identifying fetuses at risk of neonatal acidemia. Methods: This prospective study included women who delivered at a tertiary teaching hospital between January 2017 and January 2018. Of 1100 women initially screened, 596 met the inclusion criteria and were analyzed. Among them, 162 underwent operative delivery for non-reassuring fetal status (NRFS), while 434 served as controls. Demographic, obstetric, and neonatal characteristics were compared. Multivariable logistic regression was performed to explore factors associated with umbilical arterial pH < 7.20. Results: Mean umbilical arterial pH was significantly lower in the NRFS group than in controls (7.30 ± 0.08 vs. 7.32 ± 0.07, p < 0.05). Umbilical arterial pH differed significantly across NICHD fetal heart rate categories, with the highest values observed in Category I tracings. Twenty-eight neonates (4.7%) had an umbilical arterial pH < 7.20. CTG-based identification of NRFS predicted umbilical arterial pH < 7.20 with a sensitivity of 42.9%, specificity of 73.6%, positive predictive value of 7.4%, and negative predictive value of 96.3%. In multivariable analysis, pregestational diabetes mellitus and preeclampsia were independently associated with umbilical arterial pH < 7.20. Conclusions: Although CTG remains an essential tool for intrapartum fetal surveillance, its low positive predictive value indicates that many fetuses classified as having NRFS do not have biochemical evidence of acidemia. CTG findings should therefore be interpreted together with the overall clinical context, including maternal risk factors such as pregestational diabetes mellitus and preeclampsia, rather than being used in isolation to guide intrapartum management. Full article

The rehabilitation of aging educational buildings has become increasingly important in the context of sustainable campus development and adaptive reuse of existing infrastructure. This study proposes an integrated BIM-based framework for the rehabilitation of underutilized academic spaces through the combined application of Building Information Modeling (BIM), biophilic interior design principles, and Artificial Intelligence (AI) predictive modeling. The methodology was implemented in a case study involving non-functional areas within the Faculty of Aerospace Engineering at the National University of Science and Technology POLITEHNICA Bucharest. Autodesk Revit was employed to develop a parametric digital model of the existing structure, support spatial reconfiguration, and assess environmental and functional performance indicators throughout the rehabilitation process. To evaluate the effectiveness of the proposed framework, multiple performance criteria were considered, including spatial efficiency, daylight performance, material sustainability, acoustic quality, and user-perceived visual comfort. Furthermore, a synthetic dataset generated through parametric simulation was utilized to train and compare four machine learning algorithms (Multiple Linear Regression, Support Vector Regression, Random Forest, and Artificial Neural Networks) to predict user comfort based on spatial and environmental variables. The rehabilitation strategy resulted in an 18% increase in usable floor area, a 26% improvement in average daylight factor, a 25% increase in renewable material utilization, and a 38% reduction in estimated acoustic reverberation time. Simultaneously, the predictive modeling revealed that the Artificial Neural Network (ANN) provided the highest accuracy (R² = 0.91) in capturing the non-linear relationship between biophilic design elements and perceived interior quality. By integrating Gilbreth’s principles of cognitive ergonomics, the AI framework actively prevents the rigid, purely quantitative optimization associated with “Digital Taylorism, The findings demonstrate that the proposed BIM-integrated rehabilitation framework can support both technical optimization and user-centered environmental enhancement in educational facilities. The study contributes a transferable digital methodology for sustainable academic building transformation, combining geometric precision, predictive environmental performance assessment, and human-centered design principles within a unified rehabilitation workflow. Full article

Despite the rapid expansion of unmanned aerial vehicle (UAV) applications across precision agriculture, logistics, infrastructure inspection, disaster response, and aerial surveying, objective and quantitative hardware evaluation criteria for UAV components remain insufficiently developed. This paper proposes quantitative key performance indicators (KPIs) for thirteen core hardware subsystems, including airframe and propulsion, battery and power supply, flight control, wireless communication, imaging (camera), Global Positioning System (GPS)/Global Navigation Satellite System (GNSS) positioning, thermal management, acoustic and vibration characteristics, AI-based autonomous flight, electromagnetic compatibility (EMC), cybersecurity, and reliability and environmental qualification, together with LiDAR payload evaluation criteria. International standardization activities by 3GPP (Release 15/17), IEEE (1936–1958 series), American society for photogrammetry and remote sensing (ASPRS), and national regulatory frameworks are synthesized to define measurable performance metrics and recommended test methods for each subsystem. An integrated KPI matrix maps application-domain-specific performance targets—encompassing surveying (real-time kinematic (RTK) horizontal accuracy ≤ 2 cm root-mean-square error (RMSE), ground sample distance (GSD) ≤ 2 cm/px), infrastructure inspection (LiDAR payload up to 8 kg, beyond visual line-of-sight (BVLOS) latency ≤ 140 ms), and logistics delivery (payload ≥ 2 kg, precision landing ≤ 50 cm)—demonstrating that no universal platform can simultaneously satisfy all domain requirements. A fuzzy-AHP weighting procedure and inter-subsystem coupling analysis are introduced to address size, weight, and power (SWaP) trade-off relationships that purely additive scoring models cannot capture. The proposed evaluation framework is intended to contribute practically to UAV standardization, certification, and quality management across the full design–procurement–operation lifecycle. Full article

Reliable precipitation forecasts are critical for hydrological modelling and flood early warning in West African river basins, where rainfall is dominated by highly variable monsoon-driven convection. This study evaluates and improves the precipitation forecasting skill of six numerical weather prediction (NWP) models over the Ouémé River basin in Benin, with particular emphasis on lead-time dependence, basin-scale effects, and the added value of statistical bias correction. Daily precipitation forecasts, over the period 1985–2015 across lead times of one to seven days, are assessed across six sub-basins using complementary continuous and event-based verification metrics. The results indicate that precipitation forecast skill varies with model choice, forecast horizon, and spatial scale. Among the raw forecasts, the ECMWF and UK Met Office models consistently outperform the other systems with KGE values reaching 0.5. ECMWF exhibits the highest overall skill at short to medium lead times, while the UK Met Office model shows relatively low volumetric bias across most sub-basins (Pbias less than 25%). For some models, forecast performance improves with increasing basin size, reflecting the smoothing effect of spatial aggregation, although this relationship remains model-specific. Distribution-based methods outperform regression-based approaches, with empirical quantile mapping providing the most robust and consistent improvements across lead times and sub-basins. Following bias correction, Empirical quantile mapping achieved median Likelihood Ratio values of approximately 6 during validation, with upper-range values reaching 15–18 across sub-basins for both ECMWF and UK Met Office forecasts. This represents a substantial improvement over raw predictions whose distributions remained consistently bounded below 10 throughout the calibration and validation phases (more than 50% improvement). Overall, the combination of ECMWF or UK Met Office precipitation forecasts with empirical quantile mapping offers a reliable framework for improving precipitation inputs to hydrological models and flood early warning systems in the Ouémé basin. The findings highlight the importance of multi-criteria evaluation and appropriate bias correction when applying NWP precipitation forecasts in monsoon-influenced hydrological environments and flood forecasting. Full article

Background: Antinuclear antibodies (ANA) can be detected in patients with rheumatoid arthritis (RA) and pose many diagnostic challenges, especially when RA presents an atypical course and requires differentiation from other systemic connective tissue diseases (sCTDs). This study assessed ANA fluorescence patterns and immunoblot profiles, as well as the relationships between ANA titers, antibody expression intensity, and markers of disease activity in patients with RA. Methods: This single-center, cross-sectional, observational study included 81 RA patients (53 ANA-positive) meeting the 2010 ACR/EULAR classification criteria. ANA titers and fluorescence patterns were assessed using indirect immunofluorescence. Anti-extractable nuclear antigen (ENA) autoantibody profiles and expression intensity were assessed using immunoblot analysis. Demographic, clinical, and laboratory data were obtained. Spearman’s rank correlation coefficient was used to analyze the relationship between ANA titers and selected variables. Univariate and multivariate logistic regression analyses were performed to identify factors associated with ANA positivity. Results: The cohort consisted primarily of women (86.4%) with moderate disease activity. ANA fluorescence patterns were heterogeneous, with nucleolar and homogeneous patterns most frequently observed. Immunoblot analysis also revealed diverse autoantibody profiles without a clearly dominant specificity. Ro-52, SS-A, and Sm antibodies were detected more frequently, although their prevalence remained relatively low. No statistically significant correlations were found between ANA titers and inflammatory markers, serological parameters, or disease activity indices. Conclusions: RA patients with positive ANA demonstrated marked immunological heterogeneity, without concomitant symptoms of sCTD. A positive result in RA may reflect generalized immune dysregulation rather than a distinct clinical subtype. Further studies with larger cohorts are needed to clarify the clinical significance of ANAs in rheumatoid arthritis. Full article

Background: Malnutrition is common among patients with cancer and has been associated with unfavorable postoperative outcomes, including higher rates of complications. This study aimed to synthesize current evidence on the relationship between malnutrition, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria, and postoperative outcomes after curative surgery for upper gastrointestinal (GI) cancers. Methods: We systematically searched the literature from database inception to 28 March 2026. Studies were eligible if they included adult patients with upper GI cancer who underwent surgical resection and had their nutritional status evaluated according to the GLIM criteria. We conducted a systematic review and random-effects meta-analysis. The primary outcomes were overall survival and overall postoperative complications, defined as events with a Clavien–Dindo grade ≥ II occurring within 30 days after surgery. Hazard ratios with 95% confidence intervals for overall survival and risk ratios with 95% CIs for postoperative complications were pooled. Results: Fourteen studies (17 reports) including a total of 7876 patients were eligible for both qualitative and quantitative synthesis. Compared with patients without malnutrition, those with GLIM-defined malnutrition showed poorer overall survival (hazard ratio: 1.96, 95% confidence interval: 1.57–2.45) and a higher risk of postoperative complications (risk ratio: 1.43, 95% confidence interval: 1.14–1.79). Conclusions: GLIM-defined malnutrition was associated with shorter overall survival and a higher incidence of postoperative complications in patients with upper GI cancer after surgery. However, because most included studies were observational and at low-to-moderate certainty of evidence, these associations should be interpreted with appropriate caution. Full article

Sepsis-induced coagulopathy (SIC) represents an early, predominantly prothrombotic disturbance that is difficult to detect using conventional coagulation tests. This review aims to evaluate whether rotational thromboelastometry (ROTEM) provides added value in the diagnosis and phenotyping of SIC compared with standard laboratory parameters. We summarize current evidence on SIC pathophysiology and its relationship to disseminated intravascular coagulation (DIC), with particular focus on mechanisms driving hypercoagulability and fibrinolytic shutdown. The limitations of routine tests, platelet count, PT/INR, fibrinogen, and fibrin-related markers are examined, especially their inability to capture early dynamic changes in coagulation. We then outline the principles of ROTEM and review clinical studies assessing its application in sepsis. Available data consistently demonstrate increased clot firmness, frequently driven by elevated fibrinogen, along with impaired fibrinolysis. These patterns often precede overt SIC or DIC and are associated with worse clinical outcomes, including organ dysfunction and mortality. Finally, we discuss the implications of these findings for clinical management. While routine anticoagulation in unselected septic patients remains unsupported, integrating SIC criteria with ROTEM profiles may improve risk stratification and help identify prothrombotic phenotypes that could benefit from targeted therapies. Overall, ROTEM appears to be a valuable adjunct to conventional testing, with potential to refine diagnostic accuracy and guide future interventional strategies in septic coagulopathy. Full article

Background: Lung cancer carries a high psychosocial burden. Tobacco use, the stigma attached to the disease, and coping strategies are thought to interact and shape psychological outcomes, yet they have rarely been examined together. This review aimed to synthesise the evidence on the relationship between tobacco use, lung cancer stigma, and coping, and how these factors interact and influence patients’ psychological outcomes. Methods: Following the PRISMA 2020 guideline, PubMed/MEDLINE and Dialnet were searched (window 2014–April 2026) for empirical studies conducted in adults with lung cancer that addressed stigma, coping, or relevant psychological outcomes (e.g., anxiety, depression, distress, or quality of life). Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved by consensus and, where needed, by a third reviewer. Methodological quality was appraised with design-specific tools (JBI for cross-sectional and cohort studies, CASP for qualitative studies, and COSMIN-oriented criteria for the psychometric study). Given the clinical and methodological heterogeneity, a structured narrative synthesis was conducted following the SWiM guideline. The protocol was registered in the Open Science Framework. Results: Twenty-four studies were included. Stigma was prevalent and consistently associated with depression, anxiety, distress, and poorer quality of life, with longitudinal evidence indicating that stigma precedes and predicts distress. Internalised stigma (guilt, shame, self-blame) was the facet most strongly linked to depression and anxiety. Smoking history graded stigma intensity (current > former > never smokers) but did not determine it, since clinically significant stigma also affected never-smokers. Adaptive coping (e.g., fighting spirit, positive reappraisal) and social support were consistently associated with better psychological adjustment and quality of life, while maladaptive coping (e.g., helplessness, avoidance, anxious preoccupation) was associated with worse outcomes; cross-sectional evidence further indicated that coping modes mediated the relationship between stigma and quality of life and that social support and self-compassion attenuated the impact of stigma on distress. Conclusions: Internalised stigma is a central, modifiable psychosocial stressor in lung cancer that affects smokers and never-smokers alike. Systematic screening for stigma, coping, and social support, together with non-stigmatising care, is warranted. Full article

Background/Objectives: Lower gastrointestinal bleeding (LGIB) is a common and potentially life-threatening emergency that disproportionately affects elderly, comorbid patients, yet evidence-based risk stratification tools remain underused. The Oakland Score was developed to identify patients who can be safely discharged. This study aimed to determine prognostic factors in patients presenting with LGIB and to evaluate the relationship between the Oakland Score and adverse clinical outcomes. Methods: In this single-centre, retrospective, descriptive study, patients aged 18 years and older who presented to the emergency department with LGIB between 2015 and 2024, and who were evaluated, treated and followed up by the Department of Gastroenterology at Dokuz Eylül University, and who underwent endoscopic evaluation were reviewed. A total of 890 patients who met the inclusion criteria and had complete medical records, defined as full availability of all Oakland Score variables and primary outcome data, were included in the final analysis. The Oakland Score was calculated for every patient, and its association with mortality, intensive care unit (ICU) admission, blood-product transfusion, early and late rebleeding, and the need for emergency surgery was analysed. Receiver operating characteristic (ROC) analysis was used to assess discriminative performance. Results: The mean age was 69.8 ± 15.6 years, and 50.4% of patients were female. The most frequent comorbidities were hypertension (56.2%), coronary artery disease (28.9%) and diabetes mellitus (25.1%). Diverticular bleeding was the most common aetiology (25.1%). Red blood cell transfusion was required in 52.8% of patients, and the in-hospital mortality rate was 6.1%. The Oakland Score was significantly associated with mortality, ICU admission, blood-product transfusion, early and late rebleeding, and emergency surgery (all p < 0.05). On ROC analysis the score performed best for ICU admission (AUC 0.754) and mortality (AUC 0.706), and was significantly associated with red blood cell, platelet and fresh frozen plasma transfusion requirements (p < 0.001). On multivariable logistic regression, the Oakland Score was an independent predictor of one-month rebleeding (OR 1.082; 95% CI 1.032–1.133; p = 0.001) but did not retain independent significance for mortality or ICU admission after adjustment for malignancy, serum albumin and BUN. Conclusions: The Oakland Score is significantly associated with major adverse outcomes in LGIB and is particularly sensitive for predicting mortality and ICU admission. It is a useful adjunct to clinical judgement for risk stratification, although it should be interpreted alongside the patient’s overall clinical status. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that commonly begins in early childhood and substantially impairs quality of life. Patient-Oriented Eczema Measure (POEM) is a validated patient-reported outcome, whereas SCORing Atopic Dermatitis (SCORAD) is a widely used clinician-assessed severity index for AD. Methods: In this single-center observational analytical pilot study, 90 pediatric patients (1 month–15 years) diagnosed with AD, according to Hanifin and Rajka criteria, were recruited at Saint Constantin Hospital, Brașov, Romania (September 2025–February 2026). During one visit, caregivers and/or children completed the Romanian version of the POEM, and a dermatologist assessed disease severity using SCORAD. Demographic and clinical data were recorded. Descriptive statistics, group comparisons, linear regression, and correlation analyses (Pearson/Spearman) were performed (significance p < 0.05). The main objectives of the study were to translate and adapt the POEM questionnaire into Romanian for use in children with AD and to assess the relationship between POEM and SCORAD scores. Secondary objectives were to explore the influence of clinical and perinatal factors (sex, prematurity, mode of delivery, in vitro fertilization, breastfeeding) and the presence of other atopic diseases on AD severity. Results: POEM and SCORAD scores showed a strong positive correlation (rho = 0.841, p < 0.001), indicating that patient-reported symptom burden closely paralleled clinician-assessed disease severity. The presence of another atopic condition was independently associated with higher POEM (B = 4.31, p < 0.001) and SCORAD scores (B = 15.34, p < 0.001). No other demographic or perinatal factor showed a consistent independent association with disease severity. No significant independent associations were found for sex, age, prematurity, in vitro fertilization, or breastfeeding. Conclusions: This first Romanian pilot study in pediatric AD demonstrates a strong correlation between POEM and SCORAD and supports the concurrent use of POEM as a practical patient-reported tool alongside SCORAD in clinical practice, while recognizing the limitations of a relatively small cohort and single-visit design. Full article

Objective: To investigate the occurrence trends, distribution characteristics, and contributing factors of medical damage liability disputes in Chongqing from 2012 to 2024, thereby providing data support for risk prevention and control in regional medical institutions and for health policy formulation. Methods: A retrospective study design was employed. Adjudication documents pertaining to medical damage liability disputes in Chongqing, spanning from January 2012 to December 2024, were retrieved from the China Judgments Online database. A total of 1761 eligible cases were selected based on standardized criteria. Statistical analysis was conducted on core case variables. Results: The number of cases exhibited a fluctuating upward trend from 2012 to 2024, peaking in 2019 (276 cases) before subsequently declining. The average actual compensation amount demonstrated a steady increase, reaching its highest level in 2023 (259,200 ± 53,900 CNY). Deficiencies in diagnostic and therapeutic procedures constituted the predominant cause of disputes (50.37%). Surgical departments (46.05%) and orthopedics departments (22.60%) were identified as high-risk specialties. Tertiary public hospitals accounted for the highest proportion of disputes (48.89%) and the highest average actual compensation (216,100 ± 10,600 CNY). Regarding the apportionment of liability, secondary liability attributed to the medical provider was the most frequent (29.59%). Patient death was the most common adverse outcome (37.14%). The highest average compensation amount was associated with persistent vegetative state outcomes (777,500 ± 157,200 CNY). Statistically significant differences in actual compensation amounts were observed across all outcome categories (all p < 0.05). Conclusions: The situation concerning medical damage disputes in Chongqing remains severe. The etiologies of disputes are predominantly attributable to medical technical factors—particularly deficiencies in diagnostic and therapeutic procedures—and failure to fulfill a duty of care, both of which are associated with elevated compensation amounts. Given that this study employed a retrospective descriptive design, the aforementioned findings reflect associations among variables rather than causal relationships. Based on the identified risk hierarchy, it is recommended that priority be given to strengthening perioperative safety verification and re-certification of critical procedural skills in high-incidence departments, such as surgery and obstetrics and gynecology, enhancing informed consent and medical record quality management, and advancing the tiered healthcare delivery system, with a view to reducing medical risks and mitigating doctor–patient conflicts. Full article