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Background: Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care. Aim: To evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability). Methods: An effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the 'how' and 'why' of quantitative results. Results: HIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years. Conclusion: The behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts. Trial registration: ANZCTR, ACTRN12621001456842. Registered 25 October 2021. [ABSTRACT FROM AUTHOR]

Background: Organizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients' health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers. Methods: Between November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data. Results: Of 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials. Conclusions: Given their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals' organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training. [ABSTRACT FROM AUTHOR]

Background: A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. Methods: Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy's traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green 'healthy' items and 0% red 'unhealthy' items). Results: The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p < 0.001) overall and in serviced food outlets (p < 0.001) and vending machines (p < 0.001). In 2021, green items were a higher proportion of available items (20.7%, n = 815) compared to 2017 (14.0%, n = 371), as were amber items (49.8%, n = 1957) compared to 2017 (29.2%, n = 775). Fewer items were classified as red in 2021 (29.4%, n = 1156) than in 2017 (56.8%, n = 1506). Mixed dishes were the most prevalent green items in both years, representing 11.4% (n = 446) of all items in 2021 and 5.5% (n = 145) in 2017. Fewer red packaged snacks (11.6%, n = 457 vs 22.5%, n = 598) and red cold drinks (5.2%, n = 205 vs 12.5%, n = 331) were available in 2021 compared to 2017. However, at either time, no organisation or setting met the criteria for alignment with the Policy (≥ 55% green items, 0% red items). Conclusions: Introduction of the Policy improved the relative healthiness of food and drinks available, but the proportion of red items remained high. More dedicated support is required to fully implement the Policy. [ABSTRACT FROM AUTHOR]

Background: Various treatment approaches for individuals with ankle sprains can reduce treatment costs and enhance recovery. This study aimed to compare the efficacy of spring ankle braces with splints and casts in treating ankle sprains. Materials and methods: This cross-sectional study involved 60 patients diagnosed with ankle sprains at the orthopedic clinic of Imam Khomeini Hospital in Jiroft in 2022. Following diagnosis confirmation through additional examinations and imaging, patients with ankle sprains not requiring surgery were selected and placed in two groups: one treated with spring ankle braces and the other with splints or casts. Both groups underwent a 4-week treatment regimen, comprising 30 individuals each. Data were collected and analyzed using SPSS version 26. Results: The average age of patients was 32.5 ± 13.4 years. Of the ankle sprain patients, 56.7% were male. Patients reported the highest satisfaction levels with the plaster cast treatment method. A statistically significant relationship was found between patient satisfaction and the treatment methods of spring ankle braces and plaster casting (P < 0.05). Patients treated with plaster casts reported the lowest pain levels, with a significant relationship between pain levels and the two treatment methods (P < 0.05). Range of motion results were similar for both treatment methods, while the cast treatment showed the highest incidence of skin complications. A significant relationship was observed between spring ankle braces and plaster casts regarding skin complications (P < 0.05). Conclusion: Treating ankle sprains with plaster casts leads to higher satisfaction and lower pain levels compared to using spring ankle braces. [ABSTRACT FROM AUTHOR]

Background: Neonatal health is one of the targets for the sustainable development goals (SDGs) that aim to reduce neonatal mortality to at least as low as 12 per 1 000 live births in 2030. However, the world is not on track to achieve this target. The problem has worsened in many low-income countries, including Ethiopia, due to a fragile health system, as well as health crises such as the COVID-19 pandemic, conflict, food insecurity and climate change. According to the Mini Ethiopian Demographic Health Survey, neonatal mortality is unacceptably high in Ethiopia in general, and in Amhara region in particular. Despite these facts, there is a paucity of information on the quality of neonatal health service provision in comprehensive specialized hospitals in Amhara region. Therefore, this study is aimed at assessing the quality of neonatal health services in terms of outcome (neonatal mortality) and its causes in comprehensive specialized hospitals in Amhara region. Methods: A multi-center retrospective study was conducted (from September 1–30/2022) on 315 neonates in four comprehensive hospitals with chart review. Data were collected through death audit with standardized neonatal death audit tool. Data were entered into Epi-data 3.1 and exported to SPSS 20 for analysis. Descriptive analysis was used to describe and summarize the data in an informative manner. Results: From 315 neonatal deaths, about two-thirds, 205 (65.1%), were from rural areas. Nearly half, 151 (48%), of the mothers had complications and delivered outside a health facility. About 36 (11.4%), 45 (14.3%), and 21 (6.7%) neonates' mothers had 1st, 2nd, and 3rd delays, respectively. About 59 (19%) of mothers had membrane rupture before the onset of labor and 23 (7.3%) had meconium-stained liquor. Almost three-fourths, 226 (71.7%), of the deaths were low birth weight (< 2500 gram). About 25 (8%) of neonates had congenital anomalies, 65% of them had fast breathing and 54.6% were preterm. Conclusion: Higher proportions of neonatal deaths were observed among neonates with rural residence, low birth weight, mothers' complications and neonates admitted for fast breathing. Histories of abortion, complications, congenital anomalies, and the 3 delays contributed to neonatal deaths. [ABSTRACT FROM AUTHOR]

Introduction: Road traffic accident is the most common cause of death in adults worldwide. Road traffic accident-related deaths increased from time to time in low- and middle-income countries including Ethiopia; however, there is limited evidence about Survival status and its predictors among adult victims of road traffic accidents admitted to Hospitals in Ethiopia specifically in the study area. Thus, this study aimed to assess Survival status and its predictors among adult victims of road traffic accident admitted to Hospitals. Methods: An institutional-based retrospective follow-up study was conducted from July 01/2019 to June 30/2022. A total of 402 samples were chosen using simple random sampling. Data was collected by a prepared checklist from the victims' chart and entered into Epi-Data version 4.6 software and then exported to STATA version 14.1 for analysis. Kaplan-Meier failure function and log-rank test were computed. The assumption was checked by Schoenfeld residual test. All variables in bivariable analysis, p-value < 0.25 were entered into multivariable cox-regression model. Adjusted Hazard Ratio with 95% Confidence Interval was reported to declare the strength of association and statistical significance p-value of < 0.05. Model fitness was checked by using Cox-Snell residual. Data was presented by text, table, and graph. Result: The median survival time was 504 h. From all, 63(15.6%) deaths, 57% of deaths occurred between 24 and 168 h of follow-up with an overall incidence of 15.34deaths per10, 000 victims-hours observation. According to the Kaplan-Meier failure curve together with the log-rank test, the incidence density rate of death among victims who had a complication during admission was71.86per10,000victims-hour observation (95%, CI:53.66–96.25), which is different from those who did not have complication 5.17per10,000person-hour observation (95%, CI:3.26–8.21). The incidence density rate of death among victims who had low level of arterial oxygen saturation (SPO2 < 95%) during admission was 82.87per10, 000 victims-hour observation (95%, CI: 63.15-108.75), which is different from those who had arterial oxygen saturation ≥ 95% 3.16per10, 000victims -hour observation (95%, CI: 1.75–5.71) Develop complication (AHR = 3.1,95% CI:1.44–6.70), systolic blood pressure measurement value ≤ 89 mmHg (AHR = 2.4,95% CI:1.10–5.19), not admitted intensive care unit (AHR = 0.46,95% CI:0.022–0.97), Glasgow Coma Scale score ≤ 8 (AHR = 2.9,95% CI:1.07–7.75), Glasgow Coma Scale score 9–12(AHR = 3.8,95% CI:1.61–8.97) and, level of arterial oxygen saturation ≤ 95% (AHR = 6.5,95% CI:2.38–17.64) were predictors of outcome variable. Conclusion and recommendations: The median survival time was short. Complication, low systolic blood pressure measurement value, low Glasgow Coma Scale score, not admit to intensive care unit and low level of arterial oxygen saturation were significant predictors of the outcome variable. So that healthcare providers better give special attention and care to those victims admitted to Hospitals. A further prospective study is recommended. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 (COVID-19) pandemic, inpatient nurses faced various work stressors. Little is known about organizational interventions that can mitigate the negative consequences of pandemic-related stressors. Objective: The aim was to provide a synopsis of the literature concerning the types and outcomes of organizational interventions performed during the COVID-19 pandemic that directly (re)organized the work structures of inpatient nurses to address pandemic-related work stressors or to increase nurses' ability to cope. Methods: Within this preregistered systematic literature review, we searched four databases (PubMed, PsycINFO, PsycARTICLES, CINAHL) and two preprint databases (MedRxiv, PsyArXiv) for interventional studies of organizational interventions published between 01/2020 and 03/2023 (k = 990 records). We included 12 primary studies after title-abstract and full-text screening. A synthesis of results without meta-analysis was conducted. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials – version 2 (RoB-2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Results: All interventions were implemented in hospitals. The reasons given for implementation included pandemic-related work stressors such as a high workload, understaffing, and a lack of medical resources. To respond to the various work stressors, half of the studies took a multilevel approach combining organizational and person-oriented interventions (k = 6). Most studies (k = 8) took a secondary prevention approach, focusing on the organization of rest breaks (k = 5). With respect to outcomes, the studies examined nurse-related stress and resilience, turnover intention, job satisfaction, and other factors. Risk-of-bias analyses revealed that conclusions about the effectiveness of the interventions are limited due to confounding factors and self-selection. Conclusions: The identified interventions provide a basis for future research to draw conclusions on the effectiveness of organizational interventions during pandemics. The promotion of adequate work breaks could be useful if the work stressors associated with strain and negative consequences cannot be changed directly. However, the same stressors (e.g., high workload) can hinder nurses from participating in offered interventions. This emphasizes the importance of directly addressing inpatient nurses' work stressors. Registration: Prospero-ID CRD42023364807 (March 2023). [ABSTRACT FROM AUTHOR]

Background: Healthcare workers are a high-risk group for COVID-19 and protecting them is crucial for healthcare delivery. Limited studies have explored compliance with infection prevention and control (IPC) practices among Somali healthcare workers. This study aimed to determine compliance with IPC practices among healthcare workers in De Martino Public Hospital, Somalia. Methods: A cross-sectional study was conducted at the De Martino Public Hospital, Mogadishu, Somalia from August to October 2022, with the participation of 204 healthcare workers (response rate = 97%). Compliance was assessed using responses to 25 questions on a five-point Likert-type scale, and a median score of 20 was used to dichotomize compliance scores. A chi-square test and logistic regression analysis were performed to check the associations between healthcare workers' socio-demographic information, IPC-related factors, work conditions and practices on COVID-19, and IPC compliance during healthcare interventions using SPSS 23 version. Results: In total, 58.3% of the participants had good compliance with IPC. There were significant associations between IPC compliance and the type of healthcare worker (doctors and doctor assistants: 72.3%, nurses and paramedical staff: 67.3%, non-clinical staff: 5.7%, p < 0.01). After adjusting for potential confounding factors, compared to non-clinical staff, doctors and doctor assistants (OR: 12.11, 95% CI: 2.23–65.84) and nurses and paramedical staff (OR: 21.38, 95% CI: 4.23–108.01) had higher compliance with IPC measures. There were no significant associations between compliance and sex, marital status, vaccination status, or smoking (p > 0.05 for all). Conclusions: Low levels of compliance with COVID-19 IPC measures were observed among hospital workers. Prioritizing awareness campaigns and behavior change interventions, especially among non-clinical staff, is crucial for effective COVID-19 infection prevention and control within hospitals. [ABSTRACT FROM AUTHOR]

Background: By analysing the deaths of inpatients in a tertiary hospital in Hangzhou, this study aimed to understand the epidemiological distribution characteristics and the composition of the causes of death. Additionally, this study aimed to predict the changing trend in the number of deaths, providing valuable insights for hospitals to formulate relevant strategies and measures aimed at reducing mortality rates. Methods: In this study, data on inpatient mortality at a tertiary hospital in Hangzhou from 2015 to 2022 were obtained via the population information registration system of the Chinese Center for Disease Control and Prevention. The death data of inpatients were described and analysed through a retrospective study. Excel 2016 was utilized for data sorting, and SPSS 22.0 software was employed for data analysis. The statistical inference of single factor differences was conducted via χ2 tests. The SARIMA model was established via the forecast, aTSA, and tseries software packages (version 4.3.0) to forecast future changes in the number of deaths. Results: A total of 1938 inpatients died at the tertiary hospital in Hangzhou, with the greatest number of deaths occurring in 2022 (262, 13.52%). The sex ratio was 2.22:1, and there were significant differences between sexes in terms of age, marital status, educational level, and place of residence (P < 0.05). The percentage of males in the groups aged of 20 to 29 and 30 to 39 years was significantly greater than that of females (χ2 = 46.905, P < 0.001). More females than males died in the widowed group, and divorced and married males experienced a greater number of deaths than divorced and married females did (χ2 = 61.130, P < 0.001). The proportions of male students with a junior college and senior high school education were significantly greater than that of female students (χ2 = 12.310, P < 0.05). The primary causes of mortality within the hospital setting included circulatory system diseases, injury, poisoning, tumours, and respiratory system diseases. These leading factors accounted for 86.12% of all recorded deaths. Finally, the SARIMA (2, 1, 1) (1, 1, 1)12 model was determined to be the optimal model, with an AIC of 380.23, a BIC of 392.79, and an AICc of 381.81. The MAPE was 14.99%, indicating a satisfactory overall fit of this model. The relative error between the predicted and actual number of deaths in 2022 was 8.02%. Therefore, the SARIMA (2, 1, 1) (1, 1, 1)12 model demonstrates good predictive performance. Conclusions: Hospitals should enhance the management of sudden cardiac death, acute myocardial infarction, severe craniocerebral injury, lung cancer, and lung infection to reduce the mortality rate. The SARIMA model can be employed for predicting the number of deaths. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the status of performance indicators in hospitals affiliated with Qazvin University of Medical Sciences (QUMS) before and after the implementation of the Health Transformation Plan (HTP). Methods: This longitudinal descriptive-analytical study was conducted utilizing hospital data. The study collected data using a checklist that included both general characteristics of the participating hospitals and performance indicators such as "the number of outpatient visits," "the number of paraclinical patients," "the number of surgeries," and "the number of inpatients" on a monthly basis for 2012–2019. The intervention examined in this study was the implementation of the HTP in May 2014. The data collected was analyzed using interrupted time series and STATA statistical software version 15. Results: The study examined seven hospitals affiliated with QUMS, including general, trauma, pediatric, gynecology, and psychiatry hospitals. The findings indicated a significant increase in outpatient visits, paraclinical patients, and inpatients in the first month after the intervention. Specifically, there was an increase of 1739 in the number of outpatient visits, an increase of 513 in the number of paraclinical patients, and an increase of 135 in the number of inpatients (p < 0.001). Conclusion: The HTP has improved patients' access to medical services. It achieved this by reducing out-of-pocket payments for healthcare services and implementing programs such as developing clinics, improving the quality of visits, and retaining doctors in deprived areas. The reduction in out-of-pocket payments has been particularly beneficial for individuals who lack financial resources and previously faced barriers to accessing healthcare services. [ABSTRACT FROM AUTHOR]

Purpose: The European health data space promises an efficient environment for research and policy-making. However, this data space is dependent on high data quality. The implementation of electronic medical record systems has a positive impact on data quality, but improvements are not consistent across empirical studies. This study aims to analyze differences in the changes of data quality and to discuss these against distinct stages of the electronic medical record's adoption process. Methods: Paper-based and electronic medical records from three surgical departments were compared, assessing changes in data quality after the implementation of an electronic medical record system. Data quality was operationalized as completeness of documentation. Ten information that must be documented in both record types (e.g. vital signs) were coded as 1 if they were documented, otherwise as 0. Chi-Square-Tests were used to compare percentage completeness of these ten information and t-tests to compare mean completeness per record type. Results: A total of N = 659 records were analyzed. Overall, the average completeness improved in the electronic medical record, with a change from 6.02 (SD = 1.88) to 7.2 (SD = 1.77). At the information level, eight information improved, one deteriorated and one remained unchanged. At the level of departments, changes in data quality show expected differences. Conclusion: The study provides evidence that improvements in data quality could depend on the process how the electronic medical record is adopted in the affected department. Research is needed to further improve data quality through implementing new electronical medical record systems or updating existing ones. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence of polypharmacy, comorbidities and to investigate factors associated with polypharmacy among adult patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: This was a retrospective single-centre cross-sectional study. Patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 February 2020 and 1 March 2023 were included in this study. Patients were excluded if a pre-emptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Population characteristics were presented as frequency for categorical variable. Logistic regression analysis was used to identify predictors of polypharmacy. Results: The study sample included a total of 705 patients with COPD. Most of the study sample were males (60%). The mean age of the study population was 65 years old. The majority of the study population had comorbid diseases (68%), hypertension and diabetes were the most common co-existent diseases. Around 55% of the study sample had polypharmacy. Females were significantly less likely to be on polypharmacy compared to males (OR = 0.68, 95% CI = [0.50–0.92], P-value = 0.012)). On the other hand, older patients aged 65.4 or more (OR = 2.31, 95% CI = [1.71–3.14], P-value ≤ 0.001), those with high BMI (≥ 29.2) (OR = 1.42, 95% CI = [1.05–1.92], P-value = 0.024), current smokers (OR = 1.9, 95% CI = [1.39–2.62], P-value ≤ 0.001), those who are receiving home care (OR = 5.29, 95% CI = [2.46–11.37], P-value ≤ 0.001), those who have comorbidities (OR = 19.74, 95% CI = [12.70–30.68], P-value ≤ 0.001) were significantly more likely to be on polypharmacy (p ≤ 0.05). Conclusions: Polypharmacy is common among patients with COPD. Patients with high BMI, previous ICU hospitalization and older age are more likely to have polypharmacy. Future analytical studies are warranted to investigate outcomes in patients with COPD and polypharmacy. [ABSTRACT FROM AUTHOR]

Background: In 2016, a voluntary National Healthy Food and Drink Policy was released to improve the healthiness of food and drinks for sale in New Zealand health sector organisations. The Policy aims to role model healthy eating and demonstrate commitment to health and well-being of hospital staff and visitors and the general public. This study aimed to understand the experiences of hospital food providers and public health dietitians/staff in implementing the Policy, and identify tools and resources needed to assist with the implementation. Methods: A maximum variation purposive sampling strategy (based on a health district's population size and food outlet type) was used to recruit participants by email. Video conference or email semi-structured interviews included 15 open-ended questions that focused on awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. Data was analysed using a reflexive thematic analysis approach. Results: Twelve participants (eight food providers and four public health dietitians/staff) were interviewed; three from small (< 100,000 people), four from medium (100,000-300,000 people) and five from large (> 300,000 people) health districts. There was agreement that hospitals should role model healthy eating for the wider community. Three themes were identified relating to the implementation of the Policy: (1) Complexities of operating food outlets under a healthy food and drink policy in public health sector settings; (2) Adoption, implementation, and monitoring of the Policy as a series of incoherent ad-hoc actions; and (3) Policy is (currently) not achieving the desired impact. Concerns about increased food waste, loss of profits and an uneven playing field between food providers were related to the voluntary nature of the unsupported Policy. Three tools could enable implementation: a digital monitoring tool, a web-based database of compliant products, and customer communication materials. Conclusions: Adopting a single, mandatory Policy, provision of funding for implementation actions and supportive tools, and good communication with customers could facilitate implementation. Despite the relatively small sample size and views from only two stakeholder groups, strategies identified are relevant to policy makers, healthcare providers and public health professionals. [ABSTRACT FROM AUTHOR]

Background: Oral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period. Methods: We included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient's age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%. Results: The mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42–97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns. Conclusions: The convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement. [ABSTRACT FROM AUTHOR]

Introduction: Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response. Methods: All nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the "Hospital Emergency Response Checklist" was used to measure hospital disaster preparedness and response before and after the intervention. Results: The overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including "command and control", "triage", "human resources", "communication", "surge capacity", "logistics and supply", "safety and security", and "recovery", but had not much impact on the "continuity of essential services" component. Conclusion: The research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is of great global public health concern. In order to address the paucity of antibiotic consumption data and antimicrobial resistance surveillance systems in hospitals in humanitarian settings, we estimated antibiotic consumption in six hospitals with the aim of developing recommendations for improvements in antimicrobial stewardship programs. Methods: Six hospitals supported by Médecins sans Frontières were included in the study: Boost-Afghanistan, Kutupalong-Bangladesh, Baraka and Mweso-Democratic Republic of Congo, Kule-Ethiopia, and Bentiu-South Sudan. Data for 36,984 inpatients and antibiotic consumption data were collected from 2018 to 2020. Antibiotics were categorized per World Health Organization Access Watch Reserve classification. Total antibiotic consumption was measured by Defined Daily Doses (DDDs)/1000 bed-days. Results: Average antibiotic consumption in all hospitals was 2745 DDDs/1000 bed-days. Boost hospital had the highest antibiotic consumption (4157 DDDs/1000 bed-days) and Bentiu the lowest (1598 DDDs/1000 bed-days). In all hospitals, Access antibiotics were mostly used (69.7%), followed by Watch antibiotics (30.1%). The most consumed antibiotics were amoxicillin (23.5%), amoxicillin and clavulanic acid (14%), and metronidazole (13.2%). Across all projects, mean annual antibiotic consumption reduced by 22.3% during the study period, mainly driven by the reduction in Boost hospital in Afghanistan. Conclusions: This was the first study to assess antibiotic consumption by DDD metric in hospitals in humanitarian settings. Antibiotic consumption in project hospitals was higher than those reported from non-humanitarian settings. Routine systematic antibiotic consumption monitoring systems should be implemented in hospitals, accompanied by prescribing audits and point-prevalence surveys, to inform about the volume and appropriateness of antibiotic use and to support antimicrobial stewardship efforts in humanitarian settings. [ABSTRACT FROM AUTHOR]

Background: In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, "the Policy") was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors' awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy. Methods: Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants. Results: Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that "Hospitals should be good role models." Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options. Conclusions: The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces. [ABSTRACT FROM AUTHOR]

Background: Cockroaches can pose a significant health risk in hospital environments because they may serve as reservoirs and vectors for nosocomial pathogens. Cockroaches harbor epidemiologically significant extended spectrum and metalo beta lactamase producing Gram negative bacterial pathogens, which complicate nosocomial infections. Objectives: The main aim of this study is to determine aetiology and phenotypic extended spectrum and metalo beta lactamase producing Gram negative bacteria pathogens from cockroaches collected in hospitals. Methods: A cross-sectional study was employed from February to May 2022 to determine the antibiotic resistance producing bacterial isolates from cockroaches by giving special emphasis to metalo beta lactamase and extended spectrum beta lactamase production from different wards of WSUCSH. Cockroaches were collected with hands wearing sterile gloves. External homogenate was prepared and incubated microbiologically by using different culture media and differentiated biochemically. Antimicrobial susceptibility testing was performed by disk diffusion method. ESBL production was conducted using double disc synergy method and double disk method was used to detect MBL enzyme detection. Descriptive statistics was used to determine prevalence and percentage. Result: Out of 245 cockroaches, 108 Gram negative bacteria were isolated. K. pneumoniae 29(26.9%) was the most predominant bacteria and Enetrobacter spp. 8(7.4%), was the least. All, K. pneumoniae, P. mirabilis, and Enterobacter isolates were pan-resistant to Ampicillin. P.aeruginosa and P.mirabilis antibiotics showed ≥ 80% resistant for amoxicillin/clavulanic acid antibiotics. Cefotaxime, ceftazidime, ceftriaxone and imipenem showed relative efficacy compared with other antibiotics. Out of 78 amoxicillin-clavulanic acid resistant isolates, 42(34.7%) were ESBL producers. ESBL production is more depicted by P. aeruginosa, A. baumannii, K. pneumoniae and E. coli. The overall prevalence of MBL production is 29(23.1%). K. pneumoniae P. aeruginosa, E.coli, A. baumannii, Enterobacter spp and K.oxytoca revealed MBL production. Conclusion: The overall prevalence of ESBL and MBL producing nosocomial agents from hospital cockroaches was 34.7% and 23.1% respectively. P.aeruginosa, A.baumannii, K.pneumoniae and E.coli showed pronounced ESBL production. All bacterial isolates except P. mirabilis and C. freundii showed MBL production. The needed to evaluate our antibiotic stewardship program and antibiotic resistance detection for treatment is mandatory. The impact of cockroach as a source of AMR should be sought. [ABSTRACT FROM AUTHOR]

Background: Unplanned admission after surgery at an ambulatory surgery center (ASC) is an established measure of the quality of care and can affect the patient's experience. Previous studies on this topic are generally dated, focused on a single specialty, or studied 30-day admissions after ambulatory surgery. Few studies have reported admission within 24 h after surgery at an ASC which is a different but important measure of the quality of anesthetic and surgical care. Understanding admissions within 24 h of surgery can identify opportunities for improvement immediately after surgery. Therefore, our study was designed to assess the incidence and risk factors for unplanned hospital admissions within 24 h after surgery performed at a hospital ASC. Methods: After Institutional Review Board approval, a retrospective analysis was performed on all adult patients who underwent surgery at a US ASC between January 1, 2016, and December 31, 2022. Data were obtained from the hospital's electronic medical record. The study sample was divided into two groups: those with an unplanned hospital admission within 24 h after surgery and those without an unplanned hospital admission. To evaluate risk factors for unplanned hospital admissions, univariate analyses with p value < 0.05 were utilized to identify significant patient variables related to hospital admissions. These variables were further adjusted using a multivariable Firth logistic regression. Descriptive statistics were used to explore the number of patients in different variable categories. Results: Overall, 53,185 cases were identified for the 7-year period. The incidence of unplanned hospital admission over this period was 0.09% (95% CI 0.07–0.1122%; ranging from 0.05 to 0.12% per year. In the multivariable model, surgery duration (OR 1.010, 95% CI 1.007–1.012, p value < 0.0001), peripheral vascular disease (OR 14.489, 95% CI 4.862–43.174, p value < 0.0001), and deep venous thrombosis (OR 5.527, 95% CI 1.909–16.001, p value = 0.0016) were significantly associated with unplanned hospital admission. Conclusion: The overall incidence of unplanned hospital admission after surgery at a large tertiary care ambulatory surgery center is very low. This admission rate can also serve as a reference point for future studies and quality improvement initiatives. [ABSTRACT FROM AUTHOR]

Background: Measures of patient safety culture and patient experience are both commonly utilised to evaluate the quality of healthcare services, including hospitals, but the relationship between these two domains remains uncertain. In this study, we aimed to explore and synthesise published literature regarding the relationships between these topics in hospital settings. Methods: This study was performed using the five stages of Arksey and O'Malley's Framework, refined by the Joanna Briggs Institute. Searches were conducted in the CINAHL, Cochrane Library, ProQuest, MEDLINE, PsycINFO, SciELO and Scopus databases. Further online search on the websites of pertinent organisations in Australia and globally was conducted. Data were extracted against predetermined criteria. Results: 4512 studies were initially identified; 15 studies met the inclusion criteria. Several positive statistical relationships between patient safety culture and patient experience domains were identified. Communication and teamwork were the most influential factors in the relationship between patient safety culture and patient experience. Managers and clinicians had a positive view of safety and a positive relationship with patient experience, but this was not the case when managers alone held such views. Qualitative methods offered further insights into patient safety culture from patients' and families' perspectives. Conclusion: The findings indicate that the patient can recognise safety-related issues that the hospital team may miss. However, studies mostly measured staff perspectives on patient safety culture and did not always include patient experiences of patient safety culture. Further, the relationship between patient safety culture and patient experience is generally identified as a statistical relationship, using quantitative methods. Further research assessing patient safety culture alongside patient experience is essential for providing a more comprehensive picture of safety. This will help to uncover issues and other factors that may have an indirect effect on patient safety culture and patient experience. [ABSTRACT FROM AUTHOR]

Background: Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR). Methods: We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals' PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively. Results: Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time. Conclusion: Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance. Plain English summary: In humanitarian contexts, abortion complications are a leading cause of maternal mortality. Providing quality post-abortion care (PAC) is therefore an important part of needed services. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic). We measured quality indicators in four components: 1) an assessment of the equipment and human resources available in hospitals, 2) a survey of the knowledge, attitudes, practices, and behavior of clinicians providing PAC, 3) an assessment of the medical care provided by clinicians to women presenting with abortion complications and, 4) a survey of a subgroup of these women who were hospitalized. Both hospitals had almost all the equipment and human resources necessary to provide post-abortion care. Less than 2.5% of women received a non-recommended method to evacuate their uterus in both hospitals. More than 80% of women received a blood transfusion or antibiotics when they needed them. However, 30% of women received antibiotics without written justification and only 15% of women reported being able to ask questions about their treatment. Overall, only 65% of Nigerian women and 34% of Central African women said that the staff provided them with the best care all the time. The fact that less than 2% of women experienced a very severe complication 24 hours or more after their arrival at the two hospitals suggests that the care provided was lifesaving. But they urgently need to adopt a better patient-centered approach as well as to improve the rational management of antibiotics. [ABSTRACT FROM AUTHOR]

Background: While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012–2023) change towards VBHC in a pioneering Dutch university hospital. Method: Through retrospective, complexity-informed process research, we study how a Dutch university hospital's strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital's internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20). Results: The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a "hybrid" strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients' responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians' use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it. Conclusions: VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial. [ABSTRACT FROM AUTHOR]

Pediatric asthma management is a compelling challenge for every pediatrician. Different aspects require attention and definition. The present Intersocietal Survey aimed to collect real-world experiences from a sample of Italian pediatricians. A web platform was used to collect anonymous answers to the survey questions. Four hundred four pediatricians participated in this initiative promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Society of Preventive and Social Pediatrics (SIPPS), and the Federation of Italian Pediatricians (FIMP). The results showed an extensive participation of primary care pediatricians (72%). There was a large consensus about diagnostic criteria and medication choice. However, treatment duration and device choice were various. Adherence to guidelines on general aspects of practical clinical management was high. In conclusion, the present Intersocietal Survey confirmed that pediatric asthma management is rather satisfactory, even if further improvement should concern a more widespread use of ICS for acute asthma/wheezing attacks, a better definition of the duration of ICS and bronchodilator use, and hospital-primary care integration. [ABSTRACT FROM AUTHOR]

Background: Hospitals, as one of the core elements of healthcare service delivery, should pave the way for more efficient compliance with the Patient Rights Charter (PRC). The COVID-19 pandemic affected the interactions between healthcare providers and patients. The present study aimed to investigate the importance and practice of PRC from the perspective of hospitalized patients in surgical wards during the COVID-19 pandemic. Methods: The participants in this cross-sectional study were 355 patients who underwent surgery at Imam Khomeini Hospital in southern Kerman, Iran, in 2021. Data was collected by convenience sampling. The data in this study were collected using Justification and Practice of Patient Rights (JPPR). Data analysis was performed with SPSS-16 software using the Kruskal-Wallis, Wilcoxon, and Spearman correlation tests. Results: The total mean score for the justification of patient rights (PR) was 69.12 ± 58.44, which was significantly higher than the total mean score of PR practice (61.02 ± 1.32) (p < 0.001). In addition, the mean scores for all PR justification dimensions were significantly higher than the mean scores for PR practice (p < 0.05). A comparison of the dimensions of the PR justification showed service facilitation had the highest score and handling patient complaints had the lowest score. Furthermore, an analysis of the dimensions of PR practice indicated that handling patient complaints had the lowest score and other dimensions had the same score. Conclusion: The results of this study showed that despite the great importance of PR from the patients' perspective, PR is not still practiced optimally. The findings from this study can have some clinical implications and help hospital managers to take measures to better adapt to the PRC with staff training and developing a strong policy to comply with the PRC, especially by paving the way for handling patient complaints. [ABSTRACT FROM AUTHOR]

Introduction: Possessing ethical intelligence and cognitive flexibility can play a significant role in the acceptable performance of nurses. Furthermore, respecting the privacy of patients should always be a primary ethical principle that nurses focus on. This study aimed to investigate the ethical intelligence and cognitive flexibility of nurses and their role in predicting the level of patients' privacy observance. Also, determining the overall status of patient privacy protection and its two domains, namely human dignity domain and maintaining personal privacy, were specific objectives of this study. Methods: This cross-sectional descriptive-analytical study was conducted in 2022. A sample of 340 nurses and 1067 patients from teaching hospitals affiliated with Shiraz University of Medical Sciences in southern Iran were selected. Standard questionnaires of ethical intelligence and cognitive flexibility were used for nurses, and a privacy observance questionnaire was used for patients. Data were analyzed using t-tests, ANOVA, Pearson correlation coefficient, and multiple linear regression with the SPSS23 software. Results: The mean score of ethical intelligence and cognitive flexibility for nurses was 98.33 ± 18.06 (out of 200) and 74.56 ± 16.76 (out of 140), respectively. The mean score of patients' privacy observance was 79.74 ± 14.53 (out of 150). The results of multiple linear regression showed that the dimensions of perseverance and assertiveness towards rights (β = 0.540, p < 0.001), action based on principles, values, and beliefs (β = 0.454, p < 0.001), responsibility towards personal decisions (β = 0.410, p < 0.001), accepting responsibility for serving others (β = 0.393, p < 0.001), ability to forgive one's mistakes (β = 0.301, p = 0.001), ability to forgive others' mistakes (β = 0.287, p = 0.002), honesty (β = 0.275, p = 0.004), acknowledgment of mistakes and failures (β = 0.263, p = 0.005), commitment to promises (β = 0.242, p = 0.005), and interest in others (β = 0.237, p = 0.01) from the dimensions of ethical intelligence, as well as the dimensions of perceived control (β = 0.580, p < 0.001), perception of multiple solutions (β = 0.511, p < 0.001), and perception of justifications (β = 0.373, p < 0.001) from the dimensions of cognitive flexibility had a positive and significant effect on the level of patients' privacy observance. Conclusion: Ethical intelligence and cognitive flexibility of nurses and the level of patient privacy protection were estimated to be at a moderate level. Also, the level of ethical intelligence and cognitive flexibility of nurses played a predictive role in the level of patients' privacy observance. It is suggested that hospital managers and policymakers enhance nurses' ethical intelligence and cognitive flexibility through educational, welfare, managerial, motivational, and job-related programs, thereby improving the status of patient privacy protection. [ABSTRACT FROM AUTHOR]

Background: Electronic medical record (EMR) systems provide timely access to clinical information and have been shown to improve medication safety. However, EMRs can also create opportunities for error, including system-related errors or errors that were unlikely or not possible with the use of paper medication charts. This study aimed to determine the detection and mitigation strategies adopted by a health district in Australia to target system-related errors and to explore stakeholder views on strategies needed to curb future system-related errors from emerging. Methods: A qualitative descriptive study design was used comprising semi-structured interviews. Data were collected from three hospitals within a health district in Sydney, Australia, between September 2020 and May 2021. Interviews were conducted with EMR users and other key stakeholders (e.g. clinical informatics team members). Participants were asked to reflect on how system-related errors changed over time, and to describe approaches taken by their organisation to detect and mitigate these errors. Thematic analysis was conducted iteratively using a general inductive approach, where codes were assigned as themes emerged from the data. Results: Interviews were conducted with 25 stakeholders. Participants reported that most system-related errors were detected by front-line clinicians. Following error detection, clinicians either reported system-related errors directly to the clinical informatics team or submitted reports to the incident information management system. System-related errors were also reported to be detected via reports run within the EMR, or during organisational processes such as incident investigations or system enhancement projects. EMR redesign was the main approach described by participants for mitigating system-related errors, however other strategies, like regular user education and minimising the use of hybrid systems, were also reported. Conclusions: Initial detection of system-related errors relies heavily on front-line clinicians, however other organisational strategies that are proactive and layered can improve the systemic detection, investigation, and management of errors. Together with EMR design changes, complementary error mitigation strategies, including targeted staff education, can support safe EMR use and development. [ABSTRACT FROM AUTHOR]

Background: German hospitals are legally obliged to implement digital patient portals within the next years. Systematic reviews show that the use of patient portals may be associated with improved patient-centeredness and workflows. However, mandatory digital healthcare innovations are sometimes not used by the target group as planned or even completely rejected. Based on Roger's theory of innovation diffusion, it can be assumed that the time factor is of particular importance for the adoption of the patient portal. The aim of the project is to assess determinants of patient portal adoption and to examine whether Roger's theory can be confirmed. Methods: The project investigates the use of the patient portal in three different clinics of a large academic teaching hospital in Germany using a longitudinal study design with three cross-sectional time points (pre, post, post). Doctors and patients are surveyed about factors that predict the use of the patient portal and whether the strength of these factors changes over time. They are also interviewed about possible barriers they experience when using the patient portal or about the reasons why the patient portal is not used. Regression models and content analyses are used to answer the research questions. Discussion: Determinants of patient portal use will be discussed under the light of the temporal component of Roger's theory. At the same time, it is expected that some determinants will remain unchanged over time. Identifying determinants independent of time allows targeting the groups, enabling specific communication strategies to empower these groups to use the patient portal, contributing to an equal health care system. Trial registration: The study was prospectively registered in the German register of clinical trials (DRKS00033125) in May 2024. [ABSTRACT FROM AUTHOR]

Background: Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence. Methods: A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals. Results: A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills. Conclusions: This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system. [ABSTRACT FROM AUTHOR]

Background: The demand for urgent psychiatric care is increasing, but in Spain there are no clear recommendations for emergency departments (ED) on how to optimize care for patients with psychiatric emergencies. We aimed to provide expert consensus recommendations on the requirements for general hospitals´ emergency departments to treat patients with urgent psychiatric symptoms. Methods: We used a modified Delphi technique. A scientific committee compiled 36 statements based on literature search and clinical experience. The statements covered the organizational model, facilities, staffing, safety, patient interventions, and staff training. A panel of 38 psychiatry specialists with expertise in psychiatric emergencies evaluated the questionnaire in two rounds. Results: After two rounds of voting, 30 out of 36 proposed items (83%) were agreed upon. The panel agreed that psychiatric emergencies should be managed in a general hospital, with dedicated facilities for patient assessment, direct supervision of patients at risk, and an observation unit run by the psychiatric service. In addition to the psychiatrist, the ED should have specialist nurses and security staff available 24/7. Social workers should also be readily available. ED and consulting rooms should be designed to ensure patient and staff safety. A triage system should be established for patients with psychiatric symptoms, with medical evaluation preceding psychiatric evaluation. Guidance on supplies, equipment, and staff training is also provided. Conclusion: All ED in general hospitals should have adequate resources to handle any psychiatric emergency. This paper provides recommendations on the minimum requirements to achieve this goal. [ABSTRACT FROM AUTHOR]

Objective: Describe the screening, referral, and treatment delivery associated with an opt-out tobacco treatment program (TTP) implemented in six hospitals varying in size, rurality and patient populations. Methods: Between March 6, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to six hospitals affiliated with the Medical University of South Carolina were screened for smoking status. The hospitals ranged in size from 82 to 715 beds. Those currently smoking were automatically referred to one of two tobacco treatment options: 1) Enhanced care (EC) where patients could receive a bedside consult by a trained tobacco treatment specialist plus an automated post-discharge follow-up call designed to connect those smoking to the South Carolina Quitline (SCQL); or 2) Basic care (BC) consisting of the post-discharge follow-up call only. An attempt was made to survey patients at 6-weeks after hospitalization to assess smoking status. Results: Smoking prevalence ranged from 14 to 49% across the six hospitals; 6,000 patients were referred to the TTP.The delivery of the bedside consult varied across the hospitals with the lowest in the Charleston hospitals which had the highest caseload of referred patients per specialist. Among patients who received a consult visit during their hospitalization, 50% accepted the consult, 8% opted out, 3% claimed not to be current smokers, and 38% were unavailable at the time of the consult visit. Most of those enrolled in the TTP were long-term daily smokers.Forty-three percent of patients eligible for the automated post-discharge follow-up call answered the call, of those, 61% reported smoking in the past seven days, and of those, 34% accepted the referral to theSCQL. Among the 986 of patients surveyed at 6-weeks after hospitalization quit rates ranged from 20%-30% based on duration of reported cessation and were similar between hospitals and for patients assigned to EC versus BC intervention groups. Conclusion: Findings demonstrate the broad reach of an opt-out TTP. Elements of treatment delivery can be improved by addressing patient-to-staffing ratios, improving systems to prescribe stop smoking medications for patients at discharge and linking patients to stop smoking services after hospital discharge. [ABSTRACT FROM AUTHOR]

Background and aim: Medication errors (MEs) in hospitals decrease patient satisfaction, increase hospital mortality, lower hospital productivity, and increase in the costs of the health system. This study was conducted to determine the rate of MEs in Iranian hospitals. Method: In this meta-analysis, all published articles on ME rates in Iranian hospitals were identified from five databases and Google Scholar and assessed for quality. The heterogeneity of the studies was examined using the I2 index and a meta-regression model was used to evaluate the variables suspected of heterogeneity at the 0.05 significance level. Finally, 17 articles were eligible to be included in this study and were analyzed using the Comprehensive Meta‐Analysis (CMA) software. Findings: Based on the estimation of the random-effects model, the ME rate in Iranian hospitals was 10.9% (5.1%-21.7%; 95% CI). The highest rate was observed in Sanandaj in 2006 at 99.5% (92.6%-100.0%; 95% CI) and the lowest rate was observed in Kashan in 2019 at 0.2% (0.1%-0.3%; 95% CI). In addition, sample size and publication year were significantly correlated with ME rate (P < 0.05). Conclusion: According to the results of this study; ME rate in Iran is relatvively high based on the synthesis of the research conducted in Iranian hospitals. In addition to being costly, MEs have negative consequences for patients. Thereofore, it is necessary to emphasize the voluntary nature of medication error reporting in health sytem of Iran. [ABSTRACT FROM AUTHOR]

Background: Aggression and violence by patient (and their relatives/friends) is widely acknowledged as a serious occupational hazard, with physicians being particularly susceptible to witnessing and experiencing such incidents within hospitals. Research has shown that the negative consequences of such aggression and violence are not only felt at the individual level, but also at the team and organizational levels. Understanding how to prevent and manage this behavior towards physicians in hospitals is urgent and not fully researched. While there are many potentially effective interventions, it is unclear which ones would be valuable and feasible for Chinese hospitals. Because patient aggression and violence may occur more frequently in Chinese hospitals than in other countries, this suggests that cultural differences play a role and that tailored interventions may be needed. Method: We conducted a Delphi study to reach a consensus on the importance and feasibility of hospital interventions to prevent and manage patient (and their relatives/friends) aggression and violence against physicians in Chinese hospitals. Seventeen experts in China were invited to complete online questionnaires over three rounds. Results: After three rounds, consensus was achieved concerning 44 interventions, five other interventions were rejected, and no consensus was reached on another two. These interventions were clustered into eight categories: environment design, access and entrance, staffing and working practices, leadership and culture, training and education, support, during/after-the-event actions, and hospital policy. Each category is considered important in preventing and managing patient (and their relatives/friends) aggression and violence towards physicians in Chinese hospitals. This study also investigated the feasibility of the suggested interventions and found that 36 of the 44 interventions were considered not only relevant, but also feasible for implementation in Chinese hospitals. Conclusions: This study provides an overview of interventions that can be implemented in Chinese hospitals to prevent and manage patient (and their relatives/friends) aggression and violence before, during, and after a violent incident occurs. [ABSTRACT FROM AUTHOR]

Background: In-hospital mortality from acute myocardial infarction (AMI) is widely used in international comparisons as an indicator of health system performance. Because of the high risk of early death after AMI, international comparisons may be biased by differences in the recording of early death cases in hospital inpatient data. This study examined whether differences in the recording of early deaths affect international comparisons of AMI in-hospital mortality by using the example of Germany and the United States, and explored approaches to address this issue. Methods: The German Diagnosis-Related Groups Statistics (DRG Statistics), the U.S. National Inpatient Sample (NIS) and the U.S. Nationwide Emergency Department Sample (NEDS) were analysed from 2014 to 2019. Cases with treatment for AMI were identified in German and U.S. inpatient data. AMI deaths occurring in the emergency department (ED) without inpatient admission were extracted from NEDS data. 30-day in-hospital mortality figures were calculated according to the OECD indicator definition (unlinked data) and modified by including ED deaths, or excluding all same-day cases. Results: German age-and-sex standardized 30-day in-hospital mortality was substantially higher compared to the U.S. (in 2019, 7.3% vs. 4.6%). The ratio of German vs. U.S. mortality was 1.6. After inclusion of ED deaths in U.S. data this ratio declined to 1.4. Exclusion of same-day cases in German and U.S. data led to a similar ratio. Conclusions: While short-duration treatments due to early death are generally recorded in German inpatient data, in U.S. inpatient data those cases are partially missing. Excluding cases with short-duration treatment from the calculation of mortality indicators could be a feasible approach to account for differences in the recording of early deaths, that might be existent in other countries as well. [ABSTRACT FROM AUTHOR]

Background: Several studies have been conducted with the 1.0 version of the Hospital Survey on Patient Safety Culture (HSOPSC) in Norway and globally. The 2.0 version has not been translated and tested in Norwegian hospital settings. This study aims to 1) assess the psychometrics of the Norwegian version (N-HSOPSC 2.0), and 2) assess the criterion validity of the N-HSOPSC 2.0, adding two more outcomes, namely 'pleasure of work' and 'turnover intention'. Methods: The HSOPSC 2.0 was translated using a sequential translation process. A convenience sample was used, inviting hospital staff from two hospitals (N = 1002) to participate in a cross-sectional questionnaire study. Data were analyzed using Mplus. The construct validity was tested with confirmatory factor analysis (CFA). Convergent validity was tested using Average Variance Explained (AVE), and internal consistency was tested with composite reliability (CR) and Cronbach's alpha. Criterion related validity was tested with multiple linear regression. Results: The overall statistical results using the N-HSOPSC 2.0 indicate that the model fit based on CFA was acceptable. Five of the N-HSOPSC 2.0 dimensions had AVE scores below the 0.5 criterium. The CR criterium was meet on all dimensions except Teamwork (0.61). However, Teamwork was one of the most important and significant predictors of the outcomes. Regression models explained most variance related to patient safety rating (adjusted R2 = 0.38), followed by 'turnover intention' (adjusted R2 = 0.22), 'pleasure at work' (adjusted R2 = 0.14), and lastly, 'number of reported events' (adjusted R2=0.06). Conclusion: The N-HSOPSC 2.0 had acceptable construct validity and internal consistency when translated to Norwegian and tested among Norwegian staff in two hospitals. Hence, the instrument is appropriate for use in Norwegian hospital settings. The ten dimensions predicted most variance related to 'overall patient safety', and less related to 'number of reported events'. In addition, the safety culture dimensions predicted 'pleasure at work' and 'turnover intention', which is not part of the original instrument. [ABSTRACT FROM AUTHOR]

Background: Prioritizing prevention over treatment has been a longstanding principle in the world health system. This study aims to compare the demographic changes, mortality, clinical, and paraclinical findings of patients hospitalized in the Corona ward before and after the start of general vaccination. Methods: This cross-sectional study utilized the simple random sampling method in 2022, analyzing 300 medical records of patients admitted to the Corona ward at 22 Bahman Khaf Hospital. Data were collected using a checklist with the help of the Medical Care Monitoring System and analyzed using SPSS-22 statistical software and Chi-square statistical test at a significance level of p < 0.05. Results: Before the start of general vaccination for COVID-19, the majority of patients were hospitalized in the Corona Intensive Care Unit (59.3%), aged between 51 and 65 years (47.3%), hospitalized for more than 3 days (54%), required intubation (49.3%), had SPO2 < 93% (60.7%), and exhibited common symptoms such as cough, shortness of breath, and loss of consciousness. Paraclinical findings included positive CRP, decreased lymphocytes, and ground glass opacity (GGO). After the start of general vaccination for COVID-19, most patients were hospitalized in the general care department of Corona (68%), aged between 36 and 50 years (47.3%), hospitalized for less than three days (66%), required intubation (20%), had SPO2 ≥ 93% (77.3%), and exhibited common symptoms such as weakness, headache, and body pain. Paraclinical findings were within the normal range. Conclusions: General vaccination for COVID-19 has significantly reduced patient mortality and morbidity. Health policymakers should prioritize general vaccination to achieve herd immunity and improve public health. [ABSTRACT FROM AUTHOR]

Background: Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. Methods: Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. Results: Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. Discussion: While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures. [ABSTRACT FROM AUTHOR]

Background: Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. Methods: We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. Results: We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. Conclusion: The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings. [ABSTRACT FROM AUTHOR]

Background: Optimizing transitional care by practicing family-centered care might reduce unplanned events for patients who undergo major abdominal cancer surgery. However, it remains unknown whether involving family caregivers in patients' healthcare also has negative consequences for patient safety. This study assessed the safety of family involvement in patients' healthcare by examining the cause of unplanned events in patients who participated in a family involvement program (FIP) after major abdominal cancer surgery. Methods: This is a secondary analysis focusing on the intervention group of a prospective cohort study conducted in the Netherlands. Data were collected from April 2019 to May 2022. Participants in the intervention group were patients who engaged in a FIP. Unplanned events were analyzed, and root causes were identified using the medical version of a prevention- and recovery-information system for monitoring and analysis (PRISMA) that analyses unintended events in healthcare. Unplanned events were compared between patients who received care from family caregivers and patients who received professional at-home care after discharge. A Mann-Whitney U test was used to analyze data. Results: Of the 152 FIP participants, 68 experienced an unplanned event and were included. 112 unplanned events occurred with 145 root causes since some unplanned events had several root causes. Most root causes of unplanned events were patient-related factors (n = 109, 75%), such as patient characteristics and disease-related factors. No root causes due to inadequate healthcare from the family caregiver were identified. Unplanned events did not differ statistically (interquartile range 1–2) (p = 0.35) between patients who received care from trained family caregivers and those who received professional at-home care after discharge. Conclusion: Based on the insights from the root-cause analysis in this prospective multicenter study, it appears that unplanned emergency room visits and hospital readmissions are not related to the active involvement of family caregivers in surgical follow-up care. Moreover, surgical follow-up care by trained family caregivers during hospitalization was not associated with increased rates of unplanned adverse events. Hence, the concept of active family involvement by proficiently trained family caregivers in postoperative care appears safe and feasible for patients undergoing major abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents (RTAs) are predicted to become the world's seventh leading cause of death by 2030. Given the significant impact of RTAs on public health, effective hospital preparedness plays a pivotal role in managing and mitigating associated health and life-threatening issues. This study aims to meticulously evaluate the preparedness of selected hospitals in western Iran to handle road traffic accidents with mass casualties (RTAs-MC). Methods: The study employed a descriptive-analytical approach, utilizing a reliable and valid questionnaire to measure hospitals' preparedness levels. Descriptive statistics (frequency distribution and mean) were utilized to provide an overview of the data, followed by analytical statistics (Spearman correlation test) to examine the relationship between hospital preparedness and its dimensions with the hospital profile. Data analysis, performed using SPSS software, categorized preparedness levels as weak, moderate, or high. Results: The study found that hospitals in Kurdistan province had a favorable preparedness level (70.30) to respond to RTAs-MC. The cooperation and coordination domain had the highest preparedness level (98.75), while the human resource management (59.44) and training and exercise (54.00) domains had the lowest preparedness levels. The analysis revealed a significant relationship between hospital preparedness and hospital profile, including factors such as hospital specialty, number of beds, ambulances, staff, and specialized personnel, such as emergency medicine specialists. Conclusion: Enhancing preparedness for RTAs-MC necessitates developing response plans to improve hospital profile, considering the region's geographic and topographic features, utilizing past experiences and lessons learned, implementing of Hospital Incident Command System (HICS), providing medical infrastructure and equipment, establishing communication channels, promoting cooperation and coordination, and creating training and exercise programs. [ABSTRACT FROM AUTHOR]

Background: Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. Methods: This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. Results: Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. Conclusions: The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Inappropriate antimicrobial use, such as antibiotic intake in viral infections, incorrect dosing and incorrect dosing cycles, has been shown to be an important determinant of the emergence of antimicrobial resistance. Artificial intelligence-based decision support systems represent a potential solution for improving antimicrobial prescribing and containing antimicrobial resistance by supporting clinical decision-making thus optimizing antibiotic use and improving patient outcomes. Objective: The aim of this research was to examine implementation factors of artificial intelligence-based decision support systems for antibiotic prescription in hospitals from the perspective of the hospital managers, who have decision-making authority for the organization. Methods: An online survey was conducted between December 2022 and May 2023 with managers of German hospitals on factors for decision support system implementation. Survey responses were analyzed from 118 respondents through descriptive statistics. Results: Survey participants reported openness towards the use of artificial intelligence-based decision support systems for antibiotic prescription in hospitals but little self-perceived knowledge in this field. Artificial intelligence-based decision support systems appear to be a promising opportunity to improve quality of care and increase treatment safety. Along with the Human-Organization-Technology-fit model attitudes were presented. In particular, user-friendliness of the system and compatibility with existing technical structures are considered to be important for implementation. The uptake of decision support systems also depends on the ability of an organization to create a facilitating environment that helps to address the lack of user knowledge as well as trust in and skepticism towards these systems. This includes the training of user groups and support of the management level. Besides, it has been assessed to be important that potential users are open towards change and perceive an added value of the use of artificial intelligence-based decision support systems. Conclusion: The survey has revealed the perspective of hospital managers on different factors that may help to address implementation challenges for artificial intelligence-based decision support systems in antibiotic prescribing. By combining factors of user perceptions about the systems´ perceived benefits with external factors of system design requirements and contextual conditions, the findings highlight the need for a holistic implementation framework of artificial intelligence-based decision support systems. [ABSTRACT FROM AUTHOR]

Background: The National Health Service in England aims to implement tobacco dependency treatment services in all hospitals by 2024. We aimed to assess the uptake of a new service, adapted from the Ottawa Model of Smoking Cessation, and its impact on 6-month quit rates and readmission or death at 1-year follow-up. Methods: We conducted a pragmatic service evaluation of a tobacco dependency service implemented among 2067 patients who smoked who were admitted to 2 acute hospitals in London, England, over a 12-month period from July 2020. The intervention consisted of the systematic identification of smoking status, automatic referral to tobacco dependence specialists, provision of pharmacotherapy and behavioural support throughout the hospital stay, and telephone support for 6 months after discharge. The outcomes were (i) patient acceptance of the intervention during admission, (ii) quit success at 6 months after discharge, (iii) death, or (iv) readmission up to 1 year following discharge. Multivariable logistic regression was used to estimate the impact of a range of clinical and demographic variables on these outcomes. Results: The majority (79.4%) of patients accepted support at the first assessment. Six months after discharge, 35.1% of successfully contacted patients reported having quit smoking. After adjustment, odds of accepting support were 51-61% higher among patients of all non-White ethnicity groups, relative to White patients, but patients of Mixed, Asian, or Other ethnicities had decreased odds of quit success (adjusted odds ratio (AOR) = 0.32, 95%CI = 0.15-0.66). Decreased odds of accepting support were associated with a diagnosis of cardiovascular disease or diabetes; however, diabetes was associated with increased odds of quit success (AOR = 1.88, 95%CI = 1.17-3.04). Intention to make a quit attempt was associated with a threefold increase in odds of quit success, and 60% lower odds of death, compared to patients who did not intend to quit. A mental health diagnosis was associated with an 84% increase in the odds of dying within 12 months. Conclusions: The overall quit rates were similar to results from Ottawa models implemented elsewhere, although outcomes varied by site. Outcomes also varied according to patient demographics and diagnoses, suggesting personalised and culturally tailored interventions may be needed to optimise quit success. [ABSTRACT FROM AUTHOR]

Background: Intravenous cannula-related infections are one of the leading causes of healthcare-associated infections. It leads to morbidity and mortality in hospitalized patients. Nurses play a significant role in the prevention of these infections. Whereas in Ethiopia, there is limited information and published studies done on nurses' knowledge, practice, and associated factors and also most of other available studies done only the magnitude it lack associated factors. The purpose of this study was to assess nurses' knowledge, practice, and associated factors toward intravenous cannula-related infection prevention. Methods: An institution-based cross-sectional study was conducted at Northwest Amhara Regional State Comprehensive Specialized Hospitals on May 1-30/2022. By using single population proportion formula the sample size was determined; we used a 50% proportion value (0.05), and 95% Confidence Interval 5% margin of error. A simple random sampling method was used to select 423 nurses. The data were collected by using structured pretested self-administered questionnaires. Then coded, and enter into epi-data version 4.6 and exported into the statistical package for social science version 23 for cleaning and analyzing the data. Data were presented by texts, tables, and figures. A binary logistic regression model was used to assess the association between variables. Based on the adjusted odds ratio, variables having a p-value less than 0.05 with a 95% confidence interval were used to state associated with the outcome variables. Results: A total of 412 nurses participated in this study with 97.4% response rate. The participants had good knowledge and practice in proportions of (54. 9%) and (53. 4%) respectively. Being male, working wards/units, having training, and a higher educational level were factors that were significantly associated to having good knowledge. Working wards/units, having good knowledge, training, and access to guidelines were significantly associated with performing good practice. Conclusion: The finding of this study revealed that nearly half of the nurses had poor knowledge and practice in intravenous cannula-related infection prevention. As a result, hospital administrators and other concerned stakeholders better to prepare and ensure that guidelines are available, provide training, and develop the educational levels of nurses. [ABSTRACT FROM AUTHOR]

Background Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the “Patients with Surgical Indication” (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. Methods Retrospective observational study of elective surgical requests (2016–2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. Results We enrolled 82,844 indications in the PSI (2016–2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p<0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p<001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019- March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. Conclusion Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil. [ABSTRACT FROM AUTHOR]

Background Pathways into care-homes have been under-researched. Individuals who move-in to a care-home from hospital are clinically distinct from those moving-in from the community. However, it remains unclear whether the source of care-home admission has any implications in term of costs. Our aim was to quantify hospital and care-home costs for individuals newly moving-in to care homes to compare those moving-in from hospital to those moving-in from the community. Methods Using routinely-collected national social care and health data we constructed a cohort including people moving into care-homes from hospital and community settings between 01/04/2013-31/03/2015 based on records from the Scottish Care-Home Census (SCHC). Individual-level data were obtained from Scottish Morbidity Records (SMR01/04/50) and death records from National Records of Scotland (NRS). Unit costs were identified from NHS Scotland costs data and care-home costs from the SCHC. We used a two-part model to estimate costs conditional on having incurred positive costs. Additional analyses estimated differences in costs for the one-year period preceding and following care-home admission. Results We included 14,877 individuals moving-in to a care-home, 8,472 (57%) from hospital, and 6,405 (43%) from the community. Individuals moving-in to care-homes from the community incurred higher costs at £27,117 (95% CI £ 26,641 to £ 27,594) than those moving-in from hospital with £24,426 (95% CI £ 24,037 to £ 24,814). Hospital costs incurred during the year preceding care-home admission were substantially higher (£8,323 (95% CI£8,168 to £8,477) compared to those incurred after moving-in to care-home (£1,670 (95% CI£1,591 to £1,750). Conclusion Individuals moving-in from hospital and community have different needs, and this is reflected in the difference in costs incurred. The reduction in hospital costs in the year after moving-in to a care-home indicates the positive contribution of care-home residency in supporting those with complex needs. These data provide an important contribution to inform capacity planning on care provision for adults with complex needs and the costs of care provision. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify (1) the extent of work-related stress and (2) stressors associated with cognitive and behavioral stress reactions, burnout symptoms, health status, quality of sleep, job satisfaction, and intention to leave the organization and the profession among health professionals working in acute care /rehabilitation hospitals, psychiatric hospitals, nursing homes, and home care organizations. Background: Health professionals are faced with various stressors at work and as a consequence are leaving their profession prematurely. This study aimed to identify the extent of work-related stress and stressors associated with stress reactions, job satisfaction, and intention to leave and health-related outcomes among health professionals working in different healthcare sectors (acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organizations). Methods: This study is based on a repeated cross-sectional design, which includes three data measures between 2017 and 2020 and 19,340 participating health professionals from 26 acute care / rehabilitation hospitals, 12 psychiatric hospitals, 86 nursing homes and 41 home care organizations in Switzerland. For data analysis, hierarchical multilevel models (using AIC) were calculated separately for hospitals, nursing homes, and home care organizations, regarding health professionals' stress symptoms, job satisfaction, intention to leave the organization / profession, general health status, burnout symptoms, and quality of sleep. Results: The main findings reveal that the incompatibility of health professionals' work and private life was significantly associated (p < 0.05) with their stress reactions, job satisfaction, intention to leave, and health-related outcomes in all the included work areas. The direct supervisor's good leadership qualities were also associated with health professionals' job satisfaction regarding all work areas (B ≥ 0.22, p = 0.000). In addition, a positive perceived bond with the organization (B ≥ 0.13, p < 0.01) and better development opportunities (B ≥ 0.05, p < 0.05) were associated with higher job satisfaction and a lower intention to leave the organization and profession among health professionals. Also, a younger age of health professionals was associated with a higher intention to leave the organization and the profession prematurely in all the included work areas. High physical (B ≥ 0.04, p < 0.05) and quantitative demands (B ≥ 0.05, p = 0.000) at work were also associated with negative health-related outcomes. [ABSTRACT FROM AUTHOR]

Background: Non-beneficial treatment affects a considerable proportion of older people in hospital, and some will choose to decline invasive treatments when they are approaching the end of their life. The Intervention for Appropriate Care and Treatment (InterACT) intervention was a 12-month stepped wedge randomised controlled trial with an embedded process evaluation in three hospitals in Brisbane, Australia. The aim was to increase appropriate care and treatment decisions for older people at the end-of-life, through implementing a nudge intervention in the form of a prospective feedback loop. However, the trial results indicated that the expected practice change did not occur. The process evaluation aimed to assess implementation using the Consolidated Framework for Implementation Research, identify barriers and enablers to implementation and provide insights into the lack of effect of the InterACT intervention. Methods: Qualitative data collection involved 38 semi-structured interviews with participating clinicians, members of the executive advisory groups overseeing the intervention at a site level, clinical auditors, and project leads. Online interviews were conducted at two times: implementation onset and completion. Data were coded to the Consolidated Framework for Implementation Research and deductively analysed. Results: Overall, clinicians felt the premise and clinical reasoning behind InterACT were strong and could improve patient management. However, several prominent barriers affected implementation. These related to the potency of the nudge intervention and its integration into routine clinical practice, clinician beliefs and perceived self-efficacy, and wider contextual factors at the health system level. Conclusions: An intervention designed to change clinical practice for patients at or near to end-of-life did not have the intended effect. Future interventions targeting this area of care should consider using multi-component strategies that address the identified barriers to implementation and clinician change of practice. Trial registration: Australia New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619000675123p (approved 06/05/2019). [ABSTRACT FROM AUTHOR]

Background: Medical services are among the most urgent needs of the disaster-affected population. Consequently, hospital preparedness -as the main health services provider- is one of the vital factors in effective response to disasters. The present study aims to explore the perspectives of study participants about the influential factors of hospital functional preparedness in a lower middle-income country. Methods: In this qualitative study, data were collected through 17 semi-structured interviews with disaster management authorities selected by purposive sampling. Content-Analysis was used to analyze the data. Results: 138 codes were developed and categorized into ten categories and 34 subcategories. The main categories were: 1- leadership, command, and coordination (4 subcategories); 2- risk assessment (3 subcategories); 3- legislating and developing protocols, guidelines, and programs (3 subcategories); 4- estimating and storing the necessary supplies and equipment (3 subcategories); 5- human resource management (4 subcategories); 6- education, training, and development of staff (6 subcategories); 7- vital routes and facilities (3 subcategories); 8- communication (3 subcategories); 9- security, safety and locating of safe zones (3 subcategories); 10- underlying disaster risk factors (2 subcategories). Conclusion: According to the participants of this study, ten categories of factors can affect hospitals' functional preparedness; hospital managers and decision-makers can consider these factors to ensure the proper provision of medical services during disasters. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. As AMR colonization among newborns can predispose to infection with these bacteria, we aimed to characterize the frequency of and risk factors for colonization of mothers and newborns during hospitalization for delivery. Methods: We enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization. Results: We enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10–1.40; CRB 2.46, 95% CI 1.39–4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08–1.59; newborn ESBL-PB 1.34, 95% CI 1.09–1.64; newborn CRB 1.73, 95% CI 1.20–2.47). Conclusions: In this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms. [ABSTRACT FROM AUTHOR]

Background: Youth experiencing homelessness (YEH) suffer from poorer physical and mental health outcomes than stably housed youth. Additionally, YEH are forced to navigate fragmented health and social service systems on their own, where they often get lost between systems when transitioning or post-discharge. Inevitably, YEH require support with health system navigation and healthcare coordination. The aim of this study is to understand interactions within and between the emergency youth shelter (EYS) and health systems that affect healthcare coordination for YEH in Toronto, Canada, and how these interactions can be targeted to improve healthcare coordination for YEH. Methods: This study is part of a larger qualitative case study informed by the framework for transformative systems change. To understand interactions in healthcare coordination for YEH within and between the EYS and health systems, we developed a causal loop diagram (CLD) using in-depth interview data from 24 key informants at various levels of both systems. Open and focused codes developed during analysis using Charmaz's constructivist grounded theory methodology were re-analysed to identify key variables, and links between them to create the CLD. The CLD was then validated by six stakeholders through a stakeholder forum. Results: The CLD illustrates six balancing and one reinforcing feedback loop in current healthcare coordination efforts within the EYS and health systems, respectively. Increasing EYS funding, building human resource capacity, strengthening inter and intra-systemic communication channels, and establishing strategic partnerships and formal referral pathways were identified among several other variables to be targeted to spiral positive change in healthcare coordination for YEH both within and between the EYS and health systems. Conclusions: The CLD provides a conceptual overview of the independent and integrated systems through which decision-makers can prioritize and guide interventions to strengthen healthcare coordination within and between the EYS and health systems. Overall, our research findings suggest that key variables such as streamlining communication and improving staff–youth relationships be prioritized, as each of these acts interdependently and influences YEH's access, quality and coordination of healthcare. [ABSTRACT FROM AUTHOR]