Predictive characteristics to discriminate the longitudinal outcomes of childhood asthma: a retrospective program-based study.

BACKGROUND: Childhood asthma is an inflammatory disease with heterogeneous outcomes. We sought to determine the impact of total IgE, blood eosinophil, allergen sensitization, and inhaled corticosteroid (ICS) on longitudinal outcomes and to identify characteristics for discriminating different outcomes. METHODS: We conducted a retrospective study in 383 childhood asthma patients and another 313 patients with blood eosinophil data only receiving regular program-based visits from September 1, 2004, to December 31, 2018. Peak expiratory flow (PEF) variability, PEF predicted %, asthma severity, and asthma control at each visit were assessed as clinical outcomes. RESULTS: Our data show that the percentage of blood eosinophils was significantly associated with increased asthma severity (OR: 1.043, 95% CI: 1.002-1.086, P = 0.0392). Mold sensitization was significantly associated with asthma severity (OR: 2.2485, 95% CI: 1.3253-3.8150, P = 0.0027). Characteristics including sensitization status plus ICS dosage had the best area under the receiver operating characteristic curve (AUC) value for predicting longitudinal PEF predicted % (0.6609), PEF variability (0.6885), asthma severity (0.5918), and asthma control (0.6441), respectively. CONCLUSIONS: We showed that the risk for adverse clinical outcomes at follow-up differed between serum IgE, blood eosinophil, and allergen sensitization identified at baseline. Sensitization and ICS dosage were predictive characteristics of long-term clinical outcomes. IMPACT: The unique aspects of the study are its longitudinal assessment of patients receiving guideline-based asthma management program to help characterize the stability of the clinical outcomes over time. Characteristics including allergen sensitization and ICS dosage demonstrated an improved capability for distinguishing between better and worse clinical outcomes. Through longitudinal serial assessment, this study indicates the risk for adverse clinical outcomes differed between children with serum IgE/blood eosinophil/allergen sensitization characterized at baseline.

Post-Pandemic Patient Safety Culture: A Case from a Large Metropolitan Hospital Group in Taiwan.

Patient safety is the core goal of medical institutions. The present study focuses on the patient safety culture and staff well-being admit the COVID-19 pandemic. In a large metropolitan hospital group, 337 employees who had participated in the quality improvement interventions completed an anonymous questionnaire of patient safety culture and personal well-being. The multiple regression analyses indicated that managerial role, seniority, female gender and direct contact with a patient were significantly related to the positive attitude on overall or certain dimensions of safety culture. Multivariate analysis also found that dimensions of teamwork climate, safety climate, job satisfaction and stress recognition as patient safety culture predicted staff exhaustion. Finally, comparing with the available institutional historic data in 2018, the COVID group scored higher on the working condition dimension of patient safety culture, but lower on the stress recognition dimension. The COVID group also scored higher on exhaustion. In the post-pandemic era, there seems to be an improvement on certain aspect of the patient safety culture among hospital staff, and the improvement is more prevalent for managers. However, exhaustion is also a poignant problem for all employees. These findings can inform hospital decision-makers in planning and implementing future improvements of patient safety culture and promoting employee well-being and resilience. Our findings also reveal directions for future research.