Objectives: To investigate factors associated with major adverse cardiovascular events (MACEs) in patients with rheumatoid arthritis (RA). Methods: We conducted a nationwide, population-based, case-control study using Taiwan’s National Health Insurance Research Database for 2003–2013. From 2004 to 2012, we identified 108,319 newly diagnosed RA patients without previous MACEs, of whom 7,580 patients (7.0%) developed MACEs during follow-up. From these incident RA patients, we included 5,994 MACE cases and 1:4 matched 23,976 non-MACE controls for analysis. The associations of MACEs with comorbidities and use of anti-rheumatic medications within 1 year before the index date were examined using conditional logistic regression analyses. Results: Using multivariable conditional logistic regression analysis, the risk of MACE in RA patients was associated with use of golimumab [odd’s ratio (OR), 0.09; 95% confidence interval (CI), 0.01-0.67], abatacept (OR, 0.13; 95% CI, 0.02–0.93), hydroxychloroquine (OR, 0.90; 95% CI, 0.82-0.99), methotrexate (OR, 0.72; 95% CI, 0.64–0.81), cyclosporin (OR, 1.43; 95% CI, 1.07–1.91), nonsteroidal anti-inflammation drugs (NSAIDs) (OR, 1.36; 95% CI, 1.27–1.46), antiplatelet agent (OR, 2.47; 95% CI, 2.31-2.63), hypertension (without anti-hypertensive agents: OR, 1.04; 95% CI, 0.96-1.12; with anti-hypertensive agents: OR, 1.47; 95% CI, 1.36-1.59), diabetes (OR, 1.27; 95% CI, 1.18-1.37), hyperlipidemia without lipid-lowering agents (OR, 1.09; 95% CI, 1.01-1.17), ischemic heart disease (OR, 1.20; 95% CI, 1.10-1.31), and chronic obstructive pulmonary disease (COPD) (OR, 1.12; 95% CI, 1.03-1.23) in the parsimonious model. The risk of MACE in RA patients also increased markedly in participants younger than 65 years with some comorbidities. Conclusions: This population-based case-control study revealed that the use of golimumab, abatacept, hydroxychloroquine, and methotrexate were associated with a decreased risk of MACE development in newly diagnosed RA patients, while the use of cyclosporin, NSAIDs, and antiplatelet agents, and comorbidities, including hypertension, diabetes, hyperlipidemia without lipid-lowering agent therapy, ischemic heart disease, and COPD, were associated with an increased risk of MACE development in RA patients.

Objective We aim to draw insights on how medical staff's perception of management leadership affects safety climate with key safety related dimensions—teamwork climate, job satisfaction and working conditions. Design/Setting A cross-sectional survey using Safety Attitude Questionnaire (SAQ) was performed in a medical center in Taichung City, Taiwan. The relationships among the dimensions in SAQ were then analyzed by structural equation modeling with a mediation analysis. Participants 2205 physicians and nurses of the medical center participated in the survey. Because not all questions in the survey are suitable for entire hospital staff, only the valid responses ( n = 1596, response rate of 72%) were extracted for analysis. Main Outcome Measure(s) Key measures are the direct and indirect effects of teamwork climate, job satisfaction, perception of management leadership, and working conditions on safety climate. Results Outcomes show that effect of perception of management leadership on safety climate is significant (standardized indirect effect of 0.892 with P -value 0.002) and fully mediated by other dimensions, where 66.9% is mediated through teamwork climate, 24.1% through working conditions and 9.0% through job satisfaction. Conclusions Our findings point to the importance of management leadership and the mechanism of its influence on safety climate. To improve safety climate, the implication is that commitment by management on leading safety improvement needs to be demonstrated when it implements daily supportive actions for other safety dimensions. For future improvement, development of a management system that can facilitate two-way trust between management and staff over the long term is recommended.

The provision of efficient healthcare services is essential, driven by the increasing demand for healthcare resources and the need to optimize hospital operations. In this context, the motivation to innovate and improve services while addressing urgent concerns is critical. Hospitals face challenges in managing internal dispatch services efficiently. Outsourcing such services can alleviate the burden on hospital staff, reduce costs, and introduce professional expertise. However, the pressing motivation lies in enhancing service quality, minimizing costs, and exploring innovative approaches. With the rising demand for healthcare services, there is an immediate need to streamline hospital operations. Delays in internal transportation services can have far-reaching implications for patient care, necessitating a prompt and effective solution. Drawing upon dispatch data from a healthcare center in Taiwan, this study constructed a decision-making model to optimize the allocation of hospital service resources. Employing simulation techniques, we closely examine how hospital services are currently organized and how they work. In our research, we utilized dispatch data gathered from a healthcare center in Taichung, Taiwan, spanning from January 2020 to December 2020. Our findings underscore the potential of an intelligent dispatch strategy combined with deployment restricted to the nearest available workers. Our study demonstrates that for cases requiring urgent attention, delay rates that previously ranged from 5% to 34% can be notably reduced to a much-improved 3% to 18%. However, it is important to recognize that the realm of worker dispatch remains subject to a multifaceted array of influencing factors. It becomes evident that a comprehensive dispatching mechanism must be established as part of a broader drive to enhance the efficiency of hospital service operations.

How to develop a better patient safety culture has been an important goal for healthcare organizations, but the effects of safety culture on psychosocial factors, such as emotional exhaustion and stress, have not been fully addressed. This study aimed to reconfigure important dimensions affecting safety culture and examine the associations between safety culture and psychosocial factors (emotional exhaustion and work-life balance). The partial least squaring technique was used to analyze the data, showing that job satisfaction (β = 0.320, P < 0.001), working conditions (β = 0.307, P < 0.001), and perception of management (β = 0.282, P < 0.001) positively affected the safety climate. The safety climate and work-life balance could reduce the occurrence of emotional exhaustion, whereas a high-stress environment would cause a higher level of emotional exhaustion. Given these findings, hospitals should endeavor to help employees feel safe and not threatened, reduce stress, and advise them to maintain a good work-life balance.

Study Objective: Overcrowding in emergency departments (ED) is an increasingly common problem in Taiwanese hospitals, and strategies to improve efficiency are in demand. We propose a bed resource allocation strategy to overcome the overcrowding problem. Method: We investigated ED occupancy using discrete-event simulation and evaluated the effects of suppressing day-to-day variations in ED occupancy by adjusting the number of empty beds per day. Administrative data recorded at the ED of Taichung Veterans General Hospital (TCVGH) in Taiwan with 1500 beds and an annual ED volume of 66,000 visits were analyzed. Key indices of ED quality in the analysis were the length of stay and the time in waiting for outward transfers to in-patient beds. The model is able to analyze and compare several scenarios for finding a feasible allocation strategy. Results: We compared several scenarios, and the results showed that by reducing the allocated beds for the ED by 20% on weekdays, the variance of daily ED occupancy was reduced by 36.25% (i.e., the percentage of reduction in standard deviation). Conclusions: This new allocation strategy was able to both reduce the average ED occupancy and maintain the ED quality indices.