Search

Objective: To analyze and understand the level of occupational external radiation personal dose of radiation workers in a hospital, and provide a reference for radiation protection. Methods: In May 2023, the personal dose monitoring data of all radiation workers in the hospital from 2018 to 2022 were collected, and their occupational external radiation exposure levels were analyzed and evaluated. All radiation workers were divided into radiation diagnosis, radiotherapy, interventional radiology, and nuclear medicine according to their occupational categories. Results: A total of 1626 person-times were monitored from 2018 to 2022, and the average annual effective dose per person (0.13-0.36 mSV) was lower than the national limit of 20 mSv. The average annual dose of nuclear medicine was the highest (0.36 mSv), and interventional radiology was lower (0.13 mSv). The average annual dose of individuals was the highest in 2020 (0.24 mSv) . Conclusion: The average annual effective dose per person of radiation workers in this hospital is lower than the national standard, and it is still necessary to strengthen the inspection of the wearing of personal dosimeters and the using of protective equipment for radiation workers.

The recent rise of active shootings calls for adequate preparation. Currently, the "Run, Hide, Fight" concept is widely accepted and adopted by many hospitals nationwide. Unfortunately, the appropriateness of this concept in hospitals is uncertain due to lack of data. To understand the "Run, Hide, Fight" concept application in hospitals, a review of currently available data is needed. A systematic review was done focusing on the "Run, Hide, Fight" concept using multiple databases from the past 12 years. The PRISMA flow diagram was used to systematically select the articles based on specific inclusion and exclusion criteria. The measurements were subjective evaluations and survival probabilities post-concept. One agent-based modeling study suggested a high survival probability in non-medical settings. However, there is a paucity of data supporting its effectiveness and applicability in hospitals. Literature suggests a better suitable concept, the "Secure, Preserve, Fight" concept, as a response protocol to active shootings in hospitals. The effectiveness of the "Run, Hide, Fight" concept in hospitals is questionable. The "Secure, Preserve, Fight" concept was found to be designed more specifically for hospitals and closes the gaps on the flaws in the "Run, Hide, Fight" concept.

Background and Objectives: Medication errors significantly impact patient safety, potentially causing adverse drug events (ADEs), increasing morbidity and mortality and prolonging hospital stays. This systematic review aimed to identify common medication errors in Saudi hospitals, their contributing factors, and effective prevention strategies. Materials and Methods: Following PRISMA-P guidelines, a comprehensive review of the literature published after 2019 was conducted. Inclusion criteria focused on peer-reviewed articles in English addressing medication errors in Saudi hospitals. Exclusion criteria eliminated reviews, opinion pieces, and non-peer-reviewed sources. A narrative synthesis identified common themes, and a descriptive analysis organized the data. Results: Searches yielded 22 articles from Embase (n = 4), PubMed (n = 10), and Web of Science (n = 8). After removing duplicates and one review article, twelve studies remained. Hand-searching references added 16 more, totaling 28 articles. Of the 28 included studies, 20 (71.4%) reported the types of medication errors observed. Wrong dose and improper dose errors are among the most frequently reported across multiple studies, while prescribing errors remain consistently high, indicating a critical area for intervention. Although less frequent, omission errors still hold significance. Conclusions: This review emphasizes the importance of comprehensive, proactive approaches to preventing medication errors. Integrating evidence-based strategies, fostering a safety culture, and continuously monitoring and evaluating interventions can significantly enhance medication safety and improve patient outcomes in Saudi Arabian hospitals.

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., (© 2024. The Author(s).)

Background: This study demonstrates that digital maturity contributes to strengthened quality and safety performance outcomes in US hospitals. Advanced digital maturity is associated with more digitally enabled work environments with automated flow of data across information systems to enable clinicians and leaders to track quality and safety outcomes. This research illustrates that an advanced digitally enabled workforce is associated with strong safety leadership and culture and better patient health and safety outcomes., Objective: This study aimed to examine the relationship between digital maturity and quality and safety outcomes in US hospitals., Methods: The data sources were hospital safety letter grades as well as quality and safety scores on a continuous scale published by The Leapfrog Group. We used the digital maturity level (measured using the Electronic Medical Record Assessment Model [EMRAM]) of 1026 US hospitals. This was a cross-sectional, observational study. Logistic, linear, and Tweedie regression analyses were used to explore the relationships among The Leapfrog Group's Hospital Safety Grades, individual Leapfrog safety scores, and digital maturity levels classified as advanced or fully developed digital maturity (EMRAM levels 6 and 7) or underdeveloped maturity (EMRAM level 0). Digital maturity was a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership as confounding variables. Hospitals were divided into the following 2 groups to compare safety and quality outcomes: hospitals that were digitally advanced and hospitals with underdeveloped digital maturity. Data from The Leapfrog Group's Hospital Safety Grades report published in spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospital beds were obtained from the CMS database., Results: The results revealed that the odds of achieving a higher Leapfrog Group Hospital Safety Grade was statistically significantly higher, by 3.25 times, for hospitals with advanced digital maturity (EMRAM maturity of 6 or 7; odds ratio 3.25, 95% CI 2.33-4.55)., Conclusions: Hospitals with advanced digital maturity had statistically significantly reduced infection rates, reduced adverse events, and improved surgical safety outcomes. The study findings suggest a significant difference in quality and safety outcomes among hospitals with advanced digital maturity compared with hospitals with underdeveloped digital maturity., (©Anne Snowdon, Abdulkadir Hussein, Melissa Danforth, Alexandra Wright, Reid Oakes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.08.2024.)

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 I 2 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., (© 2024. The Author(s).)

Background: Many UK hospitals rely heavily on natural ventilation as their main source of airflow in patient wards. This method of ventilation can have cost and energy benefits, but it may lead to unpredictable flow patterns between indoor spaces, potentially leading to the unexpected transport of infectious material to other connecting zones. However, the effects of weather conditions on airborne transmission are often overlooked., Methods: A multi-zone CONTAM model of a naturally ventilated hospital respiratory ward, incorporating time-varying weather, was proposed. Coupling this with an airborne infection model, this study assessed the variable risk in interconnected spaces, focusing particularly on occupancy, disease and ventilation scenarios based on a UK respiratory ward., Results: The results suggest that natural ventilation with varying weather conditions can cause irregularities in the ventilation rates and interzonal flow rates of connected zones, leading to infrequent but high peaks in the concentration of airborne pathogens in particular rooms. This transient behaviour increases the risk of airborne infection, particularly through movement of pathogens between rooms, and highlights that large outbreaks may be more likely under certain conditions. This study demonstrated how ventilation rates achieved by natural ventilation are likely to fall below the recommended guidance, and that the implementation of supplemental mechanical ventilation can increase ventilation rates and reduce the variability in infection risks., Conclusion: This model emphasises the need for consideration of transient external conditions when assessing the risk of transmission of airborne infection in indoor environments., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Collaborative innovation between hospitals and biomedical enterprises is crucial for ensuring breakthroughs in their development. This study explores the structural characteristics and examines the main roles of associated key actors of collaborative innovation between hospitals and biomedical enterprises in China. Using the jointly owned patent data within the country's healthcare industry, a decade-long collaborative innovation network between hospitals and biomedical enterprises in China was established and analyzed through social network analysis. The results revealed that the overall levels of collaborative innovation network density, collaborative frequency, and network connectivity were significantly low, especially in less-developed regions. In terms of actors with higher degree centrality, hospitals accounted for the majority, whereas a biomedical enterprise in Shenzhen had the highest degree centrality. Organizations in underdeveloped and northwest regions and small players were more likely to implement collaborative innovation. In conclusion, a collaborative innovation network between hospitals and biomedical enterprises in China demonstrated high dispersion and poor development levels. Stimulating organizations' initiatives for collaborative innovation may enhance quality and quantity of such innovation. Policy support and economic investments, strategic collaborative help, and resource and partnership optimization, especially for small players and in less-developed and northwest regions, should be encouraged to enhance collaborative innovation between hospitals and the biomedical industry in China and other similar countries or regions., (© 2024. The Author(s).)

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., (© 2024. The Author(s).)

Background: Proper treatment of hospital wastewater (HWW) is crucial to minimize the long-term effects on human health and aquatic ecosystems. However, the majority of HWW generated in low and middle-income countries (LMICs), is discharged without adequate treatment. This systematic review aims to fill the knowledge gap in LMICs by examining the efficacy of HWW treatment and the types of technologies used., Methods: Studies included in the review offered valuable insights into the current state of HWW management in LMICs. Between 2000 and 2022, only 36 research studies focused on hospital-based wastewater treatment within LMICs. Data were extracted on wastewater treatment technologies in hospitals or healthcare settings in LMICs. Data on sampling techniques, effectiveness, microorganisms and risk of bias of included studies were recorded., Results: A total of 36 articles met the eligibility criteria: mentioned about 1) hospitals 2) wastewater treatment 3) LMICs and 4) treatment efficacy. Twenty-two studies were conducted in Asia (22/36), 17 were conducted in countries with high Human Development Index. Constructed wetland, and activated sludge process were the most common technologies used in LMICs. A few studies utilized membrane bioreactors and ozone/UV treatment. Fourteen studies reported the concentration reduction to assess the microbial efficacy of the treatment process, 29/36 studies did not meet the national standards for effluent discharge. Reporting on sampling methods, wastewater treatment processes and efficacy of HWW treatment were at high risk of bias. Extreme heterogeneity in study methods and outcomes reporting precluded meta-analysis., Conclusions: The existing evidence indicates inadequate microbial treatment in low- and middle-income country hospitals, with this systematic review emphasizing the need for improvement in healthcare waste management. It underscores the importance of long-term studies using innovative treatment methods to better understand waste removal in LMIC hospitals and calls for further research to develop context-specific healthcare waste treatment approaches in these regions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Meleis' theory: a tool for better understanding the hospital/town transitions. The purpose of this article is to provide a critique of the transition theory conceptualized by Afaf Meleis. A clinical vignette is used to highlight the strengths and limitations of the theory in the care of elderly people returning home after hospitalization for heart failure. The discussion is based on Peggy Chinn and Maeona Kramer's method of critical analysis., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative-interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and "positioner," and focus on talk-as a discursive leadership practice-to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes., (© 2023 The Authors. Nursing Inquiry published by John Wiley & Sons Ltd.)

Objective: To measure hospital quality based on routine data available in many health care systems including the United States, Germany, the United Kingdom, Scandinavia, and Switzerland., Data Sources and Study Setting: We use the Swiss Medical Statistics of Hospitals, an administrative hospital dataset of all inpatient stays in acute care hospitals in Switzerland for the years 2017-2019., Study Design: We study hospital quality based on quality indicators used by leading agencies in five countries (the United States, the United Kingdom, Germany, Austria, and Switzerland) for two high-volume elective procedures: inguinal hernia repair and hip replacement surgery. We assess how least absolute shrinkage and selection operator (LASSO), a supervised machine learning technique for variable selection, and Mundlak corrections that account for unobserved heterogeneity between hospitals can be used to improve risk adjustment and correct for imbalances in patient risks across hospitals., Data Collection/extraction Methods: The Swiss Federal Statistical Office collects annual data on all acute care inpatient stays including basic socio-demographic patient attributes and case-level diagnosis and procedure codes., Principal Findings: We find that LASSO-selected and Mundlak-corrected hospital random effects logit models outperform common practice logistic regression models used for risk adjustment. Besides the more favorable statistical properties, they have superior in- and out-of-sample explanatory power. Moreover, we find that Mundlak-corrected logits and the more complex LASSO-selected models identify the same hospitals as high or low-quality offering public health authorities a valuable alternative to standard logistic regression models. Our analysis shows that hospitals vary considerably in the quality they provide to patients., Conclusion: We find that routine hospital data can be used to measure clinically relevant quality indicators that help patients make informed hospital choices., (© 2024 Health Research and Educational Trust.)

Aim: To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies., Design: Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES)., Data Sources: PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022., Review Methods: Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group., Results: Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only., Conclusions: A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies., Impact: Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated., No Patient or Public Contribution: Prospero ID CRD42021292290., (© 2023 John Wiley & Sons Ltd.)

Background: Healthcare-Acquired Infections have a major negative impact on the global healthcare delivery system, resulting in increased morbidity and mortality and excessive healthcare resource utilization. Infection prevention and control is the main healthcare agenda nationwide. However, it remains a challenge to achieving Sustainable Development Goals regarding healthcare issues. This study aims to assess nurses' knowledge and practice regarding infection prevention and associated factors at Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia., Methods: An institutional-based cross-sectional study was carried out from May 1 2021 to June 30 2021 at Debre Tabor Comprehensive Specialized Hospital, Ethiopia. A total of 219 nurses participated in this study. A stratified random sampling technique with a pre-tested structured self-administered questionnaire was used to collect data. A Multivariable logistic regression model was fitted to identify factors associated with the knowledge and practice of nurses regarding infection prevention., Result: The current study shows that the overall knowledge and practice of nurses regarding infection prevention are 59.4% (95% CI: 53.0-65.8) and 53% (95% CI: 46.6-59.4), respectively. Educational level of diploma [AOR: 0.8, 95% CI: 0.67-0.83], years of work experience ≤ 10 [AOR: 1.7, 95% CI: 1.3-9.28], and being trained in infection prevention [AOR: 2.5 (2.3-8.0)] were found to be factors that affect the knowledge of nurses about infection prevention. Moreover, ≤ 10 years of work experience [AOR = 1.5, 95% CI: 1.2-10.1] and being trained in infection prevention [AOR = 2.2, 95% CI: 1.94-13.5] were found to be factors that affect the practice of nurses regarding infection prevention., Conclusions and Recommendations: Most nurses were knowledgeable and had good practices. However, a substantial proportion of nurses had inadequate knowledge and practice regarding infection prevention. The nurses' knowledge and practice were associated with years of work experience and status of training on infection prevention. Moreover, the education level of nurses was another predictor variable of the knowledge of nurses. Therefore, healthcare workers in the hospital setting should adhere to the national infection prevention protocols. The policy designers should provide training for nurses on infection prevention to improve knowledge and practice in this area. Furthermore, to attain more detailed information, future research should involve a qualitative study., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tafere, Belachew, Feleke and Adal.)

Objective: To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48 h after hospital admission., Design and Setting: Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet., Participants: (i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period., Outcomes: (i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility., Results: 541 patients participated (median age 81 years); 270 control group and 271 experimental group. Allied health assistants (n = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24 h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention., Conclusions: It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

The Šibenik Foundling House was an institution that cared for abandoned children before their adoption. The paper analysed the accommodation capacities of the foundling house from 1886 to 1900, using registers of baptisms and deaths from the provincial hospital in Šibenik as the basis for the analysis. An analysis of the received children was conducted based on how they arrived at the site and the level of knowledge about their origin or identity. From 1886 to 1900, the Šibenik Foundling House received three hundred and seventy-eight abandoned children with a yearly average of 25.2 children. Two hundred and forty-three children were brought to the hospital by their mothers as newborns, and their identities were recorded in the baptism registers, constituting 60.15% of the total number of residents in the Foundling House. One hundred and six received infants were foundlings—children without known identity—comprising 26.24% of the total number of baptisms in the hospital. Twenty-nine children were born in the hospital and left by unmarried mothers in the care of the Foundling House, making up 7.18% of all entries in the register of baptisms. The monthly distribution of received children shows a balanced distribution. The mortality rate of these children in the Foundling House was 32.80%. Children who did not have names and surnames were given to them by the priest who baptised them.

This article on architecture, care and hospitality is part of a reflection shared by several researchers at the Chair of Philosophy in Hospitals. It follows on from previously published texts by Marie Tesson, Éric de Thoisy and Hugo Martin, which explore in different ways the spaces in which care can be deployed, and how the ethics of care are likely to guide our decisions about our cities and our architectures., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The prevalence of management concerns in hospitals and a highly normative conception of health care are converging today in a standardization of care. The latter is undoubtedly at the root of the current malaise among caregivers. Indeed, the New Public Management approach is encouraging them, despite themselves, to carry out their missions to the detriment of the values of care. A more appropriate form of management would, on the contrary, be based on a continuity to be sought between care values and management values, around the notion of support. This would mean reinstating concern for interpersonal relationships at the heart of care management missions., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objectives: Limited data exist regarding association between physical performance and in-hospital falls. This study was performed to investigate the association between physical performance and in-hospital falls in a high-risk population., Design: Retrospective cohort study., Setting and Participants: The study population consisted of 1200 consecutive patients with a median age of 74 years (50.8% men) admitted to a ward with high incidence rates of falls, primarily in the departments of geriatrics and neurology, in a university hospital between January 2019 and December 2021., Methods: Short Physical Performance Battery (SPPB) was measured after treatment in the acute phase. As the primary end point of the study, the incidence of in-hospital falls was examined prospectively based on data from mandatory standardized incident report forms and electronic patient records., Results: SPPB assessment was performed at a median of 3 days after admission, and the study population had a median SPPB score of 3 points. Falls occurred in 101 patients (8.4%) over a median hospital stay of 15 days. SPPB score showed a significant inverse association with the incidence of in-hospital falls after adjusting for possible confounders (adjusted odds ratio for each 1-point decrease in SPPB: 1.19, 95% CI 1.10-1.28; P < .001), and an SPPB score ≤6 was significantly associated with increased risk of in-hospital falls. Inclusion of SPPB with previously identified risk factors significantly increased the area under the curve for in-hospital falls (0.683 vs. 0.740, P = .003)., Conclusion and Implications: This study demonstrated an inverse association of SPPB score with risk of in-hospital falls in a high-risk population and showed that SPPB assessment is useful for accurate risk stratification in a hospital setting., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Public institutions have the opportunity to implement environmental sustainability policies through leveraging their buying potential. Given the role of hospitals within the food system, the implementation of sustainable initiatives into hospital foodservices is a priority. Compared to conventional agricultural methods, organic food production uses more sustainable practices and warrants consideration for utilisation in hospitals. This systematic review aimed to synthesise the published literature to identify benefits, limitations and implementation issues regarding the use of organic foods in hospital foodservice settings., Methods: The review protocol was prospectively published (PROSPERO registration CRD42022322245) and reported consistent with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of four databases was undertaken for papers published from January 2000 to March 2022; key outcome data were extracted and synthesised. Study quality was assessed using the Quality Criteria Checklist for Primary Research or the Critical Appraisal Skills Programme checklist., Results: After review of 4102 titles/abstracts and 113 full-text papers, the final library comprised 10 papers of moderate to high quality. The implementation of organic foods increased quality in addition to environmental sustainability improvements. The price premium, additional production requirements, change to kitchen routines and concerns with food quality and security of supply were reported as barriers. Government targets for increasing organic food, organisational support, and staff knowledge and training supported implementation., Conclusions: This review identified opportunities for the implementation of organic foods into hospital foodservices, but there are numerous barriers to be overcome through strategies including organisational support and staff training., (© 2022 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Aim: To review existing research on nonpharmacological tactile activity interventions for reducing behavioural and psychological symptoms of dementia in the acute hospital setting., Background: When people living with dementia are admitted to hospital, they often experience an exacerbation of behavioural and psychological symptoms of dementia. Pharmacological interventions are often used to manage behavioural and psychological symptoms of dementia despite the low success rate and the heightened risk of morbidity and mortality. Low-cost alternatives that are implementable at the bedside are nonpharmacological interventions such as tactile activity interventions., Design: An integrative review of the literature., Methods: Four databases were searched using the PRISMA framework to guide the search and screening. Eligible studies were identified and the quality of each was evaluated using the Mixed Method Appraisal Tool. Thematic analysis was conducted to identify and analyse key themes across all articles. The PRISMA checklist was used to evaluate the current study., Results: Seven studies examined the use of tactile activity interventions to reduce the behavioural and psychological symptoms of dementia and the barriers and facilitators to implementation., Conclusion: There is limited evidence exploring tactile activity interventions for reducing behavioural and psychological symptoms of dementia in acute hospital settings. Individualised approaches in combination with staffing expertise appear central to implementation., Relevance to Clinical Practice: Acute hospital settings can result in increased behavioural and psychological symptoms of dementia which can be distressing for patients and family and challenging for nursing staff. Tactile activity interventions may offer a low resource bedside option to support people with dementia in acute health settings., Patient or Public Contribution: No direct patient or public contribution to the review., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Measuring and monitoring safety (MMS) is critical to the success of safety improvement efforts in healthcare. However, a major challenge to improving safety is the lack of high quality information to support performance evaluation., Aims: The aim of this study was to use Vincent et al.'s MMS framework to evaluate the methods used to MMS in Irish hospitals and make recommendations for improvement., Methods: The first phase of this qualitative study used document analysis to review national guidance on MMS in Ireland. The second phase consisted of semi-structured interviews with key stakeholders on their understanding of MMS. The MMS framework was used to classify the methods identified., Results: Six documents were included for analysis, and 24 semi-structured interviews were conducted with key stakeholders working in the Irish healthcare system. A total of 162 methods of MMS were identified, with one method of MMS addressing two dimensions. Of these MMS methods, 30 (18.4%) were concerned with past harm, 40 (24.5%) were concerned with the reliability of safety critical processes, 16 (9.8%) were concerned with sensitivity to operations, 28 (17.2%) were concerned with anticipation and preparedness, and 49 (30%) were concerned with integration and learning., Conclusions: There are a wide range of methods of MMS in Irish hospitals. It is suggested that there is a need to identify those methods of MMS that are particularly useful in reducing harm and supporting action and improvement and do not place a large burden on healthcare staff to either use or interpret., (© 2023. The Author(s).)

Background: Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings., Objectives: To identify patients' experiences of PCC in hospital settings., Methodological Design: This systematic review followed the Joanna Briggs Institute's (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis., Setting and Participants: Studies were included if they had explored adult patient experiences of PCC in hospital settings., Results: A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient-professional relationship and being seen as a person., Conclusions and Implications: This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients' involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient-professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient-professional communication should be provided to health care professionals., (© 2023 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

People who use drugs often continue to use drugs while in hospital. However, health-care systems often expect abstinence from drugs as a condition of engagement in various services. This commentary piece proposes that this approach is inconsistent with the principles of person-centred care. A harm reduction-based approach in conjunction with collaboration of people who use drugs is proposed as a model for providing person-centred care to people who use drugs during hospital-based treatment., (© 2023 Australasian Professional Society on Alcohol and other Drugs.)

The increasing prevalence of infections caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae strains (CR-hvKP) prompts the question of whether these strains also circulate outside of clinical settings. However, the environmental occurrence and dissemination of CR-hvKP are poorly studied. In the current study, we investigated the epidemiological characteristics, and dissemination dynamics of carbapenem-resistant K. pneumoniae (CRKP) isolated from a hospital, an urban wastewater treatment plant (WWTP), and adjacent rivers in Eastern China during one year of monitoring. A total of 101 CRKP were isolated, 54 were determined to be CR-hvKP harboring pLVPK-like virulence plasmids, which were isolated from the hospital (29 out of 51), WWTP (23 out of 46), and rivers (2 out of 4), respectively. The period with lowest detection rate of CR-hvKP in the WWTP, August, corresponded with the lowest detection rate at the hospital. Comparing the inlet and outlet of the WWTP, no significant reduction of the detection of CR-hvKP and relative abundance of carbapenem resistance genes was observed. The detection rate of CR-hvKP and the relative abundance of carbapenemase genes were significantly higher in the WWTP in colder months compared to warmer months. Clonal dissemination of CR-hvKP clones of ST11-KL64 between the hospital and the aquatic environment, as well as the horizontal spread of IncFII-IncR and IncC plasmids carrying carbapenemase genes, was observed. Furthermore, phylogenetic analysis showed that the ST11-KL64 CR-hvKP strain has spread nationally by interregional transmission. These results indicated transmission of CR-hvKP clones between hospital and urban aquatic environments, prompting the need for improved wastewater disinfection and epidemiological models to predict the public health hazard from prevalence data of CR-hvKP., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions., Methods: This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software., Results: In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts' opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental., Conclusions: Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers., (© 2023. The Author(s).)

Introduction: Pharmaceutical systems are frequently characterized by fragmentation, and competences for outpatient and inpatient sectors sit with different authorities, payers, and purchasers. This fragmentation of responsibilities can incentivize shifting expensive therapies and thus patients from one sector to the other., Areas Covered: Reimbursement and procurement policies in Europe addressing unwanted consequences of this fragmentation were identified through literature reviews and surveys with policy-makers. Good practice examples include cross-sectorial reimbursement lists managed by committees with representatives from the outpatient and hospital sectors, specific funding mechanisms, joint procurement involving purchasers from both sectors, actions against procurement contracts prohibiting generic competition, and an extension of Health Technology Assessment to the hospital sector., Expert Opinion: Recognizing fragmentation as a major challenge for pharmaceutical systems, policy-makers in some countries reacted by implementing policies to support cross-sectorial collaboration. However, only a handful of good practice examples exist for reimbursement and procurement policies in Europe. Though robust evaluations are lacking, there are indications that pharmaceutical policies which ensure collaboration at the interface of the outpatient and inpatient sectors would likely result in efficiency gains and better use of public budgets and may serve as lever to improve access to medicines.

Background: Mobility in hospital is important to maintain independence and prevent complications. Our multi-centre study aimed to measure mobility and identify barriers and enablers to mobility participation from the older patient's perspective., Methods: Mixed methods study including direct observation of adult inpatients on 20 acute care wards in 12 hospitals and semi-structured interviews with adults aged 65 years or older on each of these wards. Interviews were undertaken by trained staff during the inpatient stay. Quantitative data were analysed descriptively. Qualitative data were initially coded deductively using the theoretical domains framework (TDF), with an inductive approach then used to frame belief statements., Results: Of 10,178 daytime observations of 503 adult inpatients only 7% of time was spent walking or standing. Two hundred older patient interviews were analysed. Most (85%) patients agreed that mobilising in hospital was very important. Twenty-three belief statements were created across the eight most common TDF domains. Older inpatients recognised mobility benefits and were self-motivated to mobilise in hospital, driven by goals of maintaining or recovering strength and health and returning home. However, they struggled with managing pain, other symptoms and new or pre-existing disability in a rushed, cluttered environment where they did not wish to trouble busy staff. Mobility equipment, meaningful walking destinations and individualised programmes and goals made mobilising easier, but patients also needed permission, encouragement and timely assistance., Conclusion: Inpatient mobility was low. Older acute care inpatients frequently faced a physical and/or social environment which did not support their individual capabilities., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Trustful relationships play a vital role in successful organisations and well-functioning hospitals. While the trust relationship between patients and providers has been widely studied, trust relations between healthcare professionals and their supervisors have not been emphasised. A systematic literature review was conducted to map and provide an overview of the characteristics of trustworthy management in a hospital setting., Methods: We searched Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link from database inception up until Aug 9, 2021. Empirical studies written in English undertaken in a hospital or similar setting and addressed trust relationships between healthcare professionals and their supervisors were included, without date restrictions. Records were independently screened for eligibility by two researchers. One researcher extracted the data and another one checked the correctness. A narrative approach, which involves textual and tabular summaries of findings, was undertaken in synthesising and analysing the data. Risk of bias was assessed independently by two researchers using two critical appraisal tools. Most of the included studies were assessed as acceptable, with some associated risk of bias., Results: Of 7414 records identified, 18 were included. 12 were quantitative papers and 6 were qualitative. The findings were conceptualised in two categories that were associated with trust in management, namely leadership behaviours and organisational factors. Most studies (n = 15) explored the former, while the rest (n = 3) additionally explored the latter. Leadership behaviours most commonly associated with employee's trust in their supervisors include (a) different facets of ethical leadership, such as integrity, moral leadership and fairness; (b) caring for employee's well-being conceptualised as benevolence, supportiveness and showing concern and (c) the manager's availability measured as being accessible and approachable. Additionally, four studies found that leaders' competence were related to perceptions of trust. Empowering work environments were most commonly associated with trust in management., Conclusions: Ethical leadership, caring for employees' well-being, manager's availability, competence and an empowering work environment are characteristics associated with trustworthy management. Future research could explore the interplay between leadership behaviours and organisational factors in eliciting trust in management., (© 2023. The Author(s).)

Introduction: Living with a neuromuscular disease often leads to a need for specialized rehabilitation due to the complexity and progression of the diseases. Aim: To investigate cross-sectoral collaboration on rehabilitation for patients with neuromuscular diseases among hospital professionals to inform future targeted rehabilitation services. Patients & methods: The design was qualitative using the interpretive description methodology and the theoretical lens of symbolic interactionism. Ethnographic fieldwork was conducted, and 50 hospital professionals included, 19 of whom were interviewed. Results & conclusion: The results emphasize the importance of relations when collaborating across sectors. The professionals acted and made choices in relation to dilemmas and influences of diagnosis and progression, professional demarcations in multiprofessional teams, and cross-sectoral collaboration toward a mutual goal.

Complementing theoretical courses, hospital internships are intended to encourage learners to apply their acquired knowledge while experiencing the field. In fact, this is becoming more and more complicated, and students are direct witnesses of the crisis affecting the hospital. The degraded working conditions of professionals do not allow them to properly supervise trainees, and even allow reprehensible behavior to flourish. Suffering on the job, the students desert the hospital after graduation., (Copyright © 2023. Published by Elsevier Masson SAS.)

Background: The evidence shows that the need for emergency evacuation in hospitals has arisen. Designing an emergency evacuation decision making tool increases the confidence of hospital managers in the decision made. Therefore, this study was aimed at the development, and the psychometric properties, of the decision-making scale for emergency hospital evacuation in disasters., Methods: This study was done in 2 phases of qualitative study and literature review and designing and psychometric properties of the instrument. After development of the primary item pool, the psychometric properties of the questionnaire were evaluated. In this regard, face and content validity, internal consistency (Alpha's Cronbach), reliability (ICC), and stability were assessed., Results: In the validity stage of the instrument, 4 items were removed. Also, 4 items were modified and 2 items were merged. The number of items was thus decreased to 64. After CVI calculation, 5 items were removed, 4 items were modified, and 2 items were merged. As a result of this, the number of items decreased to 58 items. The scale has good reliability and stability., Conclusion: It seems that the instrument could be useful in decision-making for emergency hospital evacuation in disasters.

Aims: To identify the origin of fresh and minimally processed foods served to hospital patients, and explore the challenges and enablers to local food procurement in hospitals., Methods: A mixed methods study was conducted in a healthcare network in Victoria, Australia. Packaging labels and product information were used to audit fresh and minimally processed foods purchased in 1 week. Processed food items and meals made offsite were not audited. Interviews were conducted with patients, staff and suppliers to explore their perspectives towards local food in hospitals. Framework analysis was used to identify themes., Results: Of 105 food products audited, 32% were imported, 25% were 'local' from Victoria and the remaining 43% were from within Australia (excluding Victoria). Qualitative interviews revealed several challenges including: increased cost of local food items, inconsistent supply and variable quality of local produce, difficulty accessing origin information, and lack of autonomy for hospitals to make food procurement choices. Enablers included: conducting a food origin audit to increase awareness, group purchasing organisation prioritising local food suppliers, and suppliers valuing local produce., Conclusion: A food origin audit and interviews with stakeholders provided a rich understanding of current practices and how to increase local food procurement., (© 2023 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Australia.)

We developed a patient satisfaction (PS) scale to measure PS and determined associated factors with PS in several hospitals in Vietnam. In this cross-sectional survey, study on 108 patients in three hospitals in Hanoi, Vietnam was conducted. A PS instrument covering four domains: 1) Transparency of information and procedure; 2) Facilities and equipment; 3) Attitude and capacities of health professionals, and 4) Outcomes of service was used. Multivariate linear regression was performed to detect factors associated with patient satisfaction scores. The internal consistency reliability was excellent at 0.9400. The highest percentage of people having complete satisfaction was 64.8% in the item "Doctors have good attitudes and communication with patients," while the lowest percentage was in "the level of satisfaction with the price of medical services of the hospital" (13.0%). Overall, 23.2% of patients rated complete satisfaction with health services. There were 54.6%, 44.4%, 40.7%, and 26.9% patients having satisfaction/complete satisfaction with Outcomes of service, Facilities and Equipment, Attitude and capacities of health professionals and Transparency of information and procedure, respectively. Patients who were outpatients, living in other provinces, using on-demand services, and unable to pay service fees had lower levels of satisfaction compared to others. To conclude, the satisfaction with health service in our sample was moderately low, particularly transparency in information and procedure. Improving the quality of administrative procedures and the application of information technology are priority issues in improving the quality of hospitals and assure equality in health care delivery among different patient groups.

Background: The constraining prison culture is not, for the most part, conducive to the provision of palliative care for people in prison., Aim: This study aimed to explore patterns of palliative and end-of-life care provision for hospitalised prison patients., Design: A retrospective qualitative review of hospital medical records to explore the quality of end-of-life care provision for patients experiencing incarceration who died within hospital. Qualitative inductive analysis of record extracts of each patients final 3-months of life was undertaken., Setting/participants: An Australian metropolitan hospital responsible for providing secondary and tertiary health services for people experiencing incarceration. This study included a systematic sample of male patients experiencing incarceration who died in hospital between 2009 and 2019., Results: Medical record extracts of 15 male patients revealed two broad themes: (1) barriers to equitable access to palliative care for incarcerated hospitalised patients; and (2) factors that facilitated quality end-of-life care for patients and families. Barriers included: tensions between balancing risk and humanity; and limited agency over place and death. Conversely, early recognition of deterioration and anticipated dying provided patients and families opportunity to focus on end-of-life goals., Conclusions: Institutional influences of security and control challenged the provision of equitable end-of-life care for people experiencing incarceration. Further research is required to inform, and incorporate, best approaches to identifying patient wishes and advance planning into care within, or despite, the constrains of incarceration. Policy reform and a coordinated, best practice approach to the management of end-of-life care for people experiencing incarceration is needed.

Objectives: Clinicians and policy makers are increasingly exploring strategies to reduce unwarranted variation in outcomes and costs. Adequately accounting for case mix and better insight into the levels at which variation exists is crucial for such strategies. This nationwide study investigates variation in surgical outcomes and costs at the level of hospitals and individual physicians and evaluates whether these can be reliably compared on performance., Methods: Variation was analyzed using 92 330 patient records collected from 62 Dutch hospitals who underwent surgery for colorectal cancer (n = 6640), urinary bladder cancer (n = 14 030), myocardial infarction (n = 31 870), or knee osteoarthritis (n = 39 790) in the period 2018 to 2019. Multilevel regression modeling with and without case-mix adjustment was used to partition variation in between-hospital and between-physician components for in-hospital mortality, intensive care unit admission, length of stay, 30-day readmission, 30-day reintervention, and in-hospital costs. Reliability was calculated for each treatment-outcome combination at both levels., Results: Across outcomes, hospital-level variation relative to total variation ranged between ≤ 1% and 15%, and given the high caseloads, this typically yielded high reliability (> 0.9). In contrast, physician-level variation components were typically ≤ 1%, with limited opportunities to make reliable comparisons. The impact of case-mix adjustment was limited, but nonnegligible., Conclusions: It is not typically possible to make reliable comparisons among physicians due to limited partitioned variation and low caseloads. Nevertheless, for hospitals, the opposite often holds. Although variation-reduction efforts directed at hospitals are thus more likely to be successful, this should be approached cautiously, partly because level-specific variation and the impact of case mix vary considerably across treatments and outcomes., (Copyright © 2023. Published by Elsevier Inc.)

Objective: To explore how a tertiary metropolitan public healthcare provider supported children who presented with 'no fixed address' (NFA)., Methods: A retrospective data mining of the electronic medical records of patients with an NFA classification, over 12 months period., Results: Data mining identified 475 NFA patients, 6% were children. Of the children with NFA, 96% attended the ED only; 10% were referred internally for psychosocial support; 34% had existing psychosocial services; 69% had no recorded discharge location; and 48% self-discharged prior to assessment., Conclusion: The hospital system did not effectively identify or respond to the psychosocial needs of children with NFA., (© 2022 Australasian College for Emergency Medicine.)

Background: In Italy, the State Regions Conference on 1 st August 2019 approved the Guidelines for Short-Stay Observation (SSO). At the beginning of 2022, the main Scientific Societies of the pediatric hospital emergency-urgency area launched a national survey to identify the extent to which these national guidelines had been adopted in the emergency rooms and pediatric wards of the Italian Regions., Methods: A survey has been widespread, among Pediatric Wards and Pediatric Emergency Departments (EDs), using both a paper questionnaire and a link to a database on Google Drive, for those who preferred to fill it directly online. Those who did not spontaneously answer, where directly contacted, via email and/or through a phone call and invited to participate. The data collected have been: age of managed children, presence of triage, presence of Sub-intensive Care Unit and Intensive Care Unit and special questions about Pediatric SSO, availability of training courses for workers, number of ED access in the last 4 years., Results: This survey is still ongoing, without a definite deadline, so we presented the preliminary data. Currently, 8/20 Regions have not yet adopted the Guidelines. Till 02 January 2023, data from 253 hospitals were collected. There are currently 180/253 active Pediatric SSO (71.03% of the Hospitals). There are not active SSO in 33.27% of first level ED, in 19.35% of second level ED and in 33.66% of General Hospitals with Pediatric Wards. Active SSO are located mainly (75.97%) within Pediatric Wards. At the moment, the survey has been completed in 16 Regions: in the 8 Regions which are using guidelines, pediatric SSOs are active in all the second level ED (compared to 60.87% of the other 8 regions), in the 91.66% of first level ED (compared to the 33.3%), and in the 97.1% of General Hospitals (compared to 33.3%), with a statistically significance (p < 0.0001). The territorial analysis of these 16 regions highlighted geographical differences in the percentage of SSOs active: 35.22% are active in hospitals in Southern Italy, 88.64% in Central Italy and 91.67% in those of the North., Conclusions: The delay in adopting specific guidelines negatively influences activation of pediatric SSOs in hospital system and prevents the adjustment of welfare level to new needs. To facilitate the activation of SSOs in hospitals, it is also necessary to guarantee adequate economic recognition. It is essential to implement public interventions to overcome the current inequalities in the interest of children and their families: the current delay seriously penalizes emergency pediatric hospital care, especially in the southern Italian Regions., (© 2023. The Author(s).)

Objectives: Because of the inherent risks facing pharmacy technicians, and consequently also patients, initial and continuing education on hospital pharmaceutical technologies is essential. Simulation is a pedagogical tool now widely used in healthcare education. This study's objectives are to provide an overview of simulation's current place in the field of hospital pharmaceutical technology education, to classify these uses, and to discuss how simulation technologies could be better used in the future., Data Sources: Two pharmacists independently searched PubMed, Embase, and Web of Science on 21 July 2020 and included studies in English or French that used simulation as an educational tool in the field of hospital pharmaceutical technologies, whether in academic teaching or professional practice., Data Summary: Our search criteria resulted in 6248 articles, of which 24 were assessed for eligibility and 13 included in the qualitative synthesis. Simulation in hospital pharmaceutical technology education is used in three different ways: first, as a playful pedagogical tool, with error-based simulations (cleanrooms and preparation sheets with errors), or game-based simulations (escape games, role-plays, and board games); second, as an electronic tool with virtual reality (virtual cleanrooms and serious games), or augmented reality (3D glasses); finally, to evaluate chemical contamination (fluorescein and quinine tests) and microbiological contamination (media-fill tests) during compounding to periodically requalify pharmacy technicians., Conclusion: Further studies, including non-technical skills evaluations, are needed to confirm the usefulness of this innovative technique in training as efficiently as possible actual and future pharmacy professionals., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2023. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

This article presents the findings of a service evaluation on the role of the youth worker offered to young people in the hospital setting across the United Kingdom and what differentiates the role of the youth worker from other health-care professionals, as described by young people, parents, and members of the existing multidisciplinary team. Young people, parents, and members of multidisciplinary teams were approached by a youth worker in the hospital regarding the purpose of the evaluation and the online survey relating to their views and experiences of working with a youth worker in the hospital setting. Data were analyzed descriptively. The n value represents the total number of responses: Young people 11-25 years ( n = 47), mothers/fathers ( n = 16), and members of the multidisciplinary team ( n = 76). The findings suggested that the youth worker was highly valued by all, with a consensus that they had a positive impact on the experiences of young people, their parents, and members of the multidisciplinary teams. Youth workers were reported as offering a more relatable style of engagement that connected with young people on a different and more informal level than other members of the multidisciplinary team. Their approach to the support provided was also different as their focus was guided by what young people valued. Youth workers acted as the bridge between young people, their parents, and the multidisciplinary team and were considered by the multidisciplinary teams to be a fundamental ingredient when working with young people in the hospital setting. The findings from this evaluation provide unique insights into the role the youth worker offers to young people in hospital settings that is different from what other health-care professionals provide, as reported by young people, parents, and the multidisciplinary team. However, further evaluation of the service should include objective outcome measures of the role and in-depth qualitative research to gain a greater and more detailed understanding of young peoples', parents', and members of the multidisciplinary team's views and experiences of what makes this role different.

Objective: To investigate the knowledge of the rational use of antibiotics among pharmacists in medical institutions in Shanxi Province, People's Republic of China, in order to determine the problems and provide support for the correct management of antibiotics., Methods: A questionnaire survey was conducted, which included the basic information of the respondents, the basic knowledge of antimicrobial management, and the related knowledge of antimicrobial drugs., Results: 462 pharmacists were investigated. The average score of the knowledge related to the rational use of antibiotics was 10.49±4.05. It showed that the hospital type, grade, pharmacist's education, professional title and working years all had an effect on the pharmacist's mastery of antimicrobial-related knowledge (p<0.05). Multivariate logistic regression analysis showed that hospital grade and pharmacist's education were the main influencing factors (p<0.05)., Conclusion: Pharmacists have insufficient knowledge about the rational application of antibacterial drugs. It is essential to strengthen the training of management regulations and the application of antibacterial drugs., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

The recent discovery of a manuscript has allowed historians to understand the medical routine in a hospital known as the Schneidhaus in Augsburg between the sixteenth and nineteenth century. The context of the manuscript shows that at this institution, non-academic specialists, generally members of the guild of barber-surgeons and barbers, routinely performed surgical cures of intestinal hernia, scrotal swellings, and vesical calculus. The Schneidhaus exclusively admitted patients applying for such specialised treatments and offered no other services. Such a degree of specialisation within medical establishments seems to have only existed in the Holy Roman Empire at this institution founded by the Fugger family in Augsburg. We propose that the Schneidhaus was either itself a model hospital or adopted a model from another site in Europe. In this paper, we investigate the connections of the Schneidhaus to the practice of surgeons in both Italy and Spain. In Italy, a momentous new technique for identifying and removing vesical calculi was first published in 1522. Although surgical treatment was established in Italian hospitals, they tended not to specialise in such surgical treatment exclusively. Moreover, at the time of the hospital's foundation, the Fugger shifted their economic and social focus from Venice to the Iberian Peninsula. In Spain, research in the history of medicine is complicated by outdated notions about specialised surgery, not unlike those that were recently still current regarding the Holy Roman Empire. We attempt to disprove these notions and use the exemplary textbook of one academic physician, Francisco Díaz, to approach specialized surgical practice in sixteenth-century Spain. In his work, Díaz describes the new Italian surgical method in detail and recognizes the importance of craftsman surgeons to both its development and application. However, he also argues for an expanded role for academic physicians as supervisors of craftsman surgeons' work. All this is suggestive of a greater network of surgical professionals within which both the methods of the craft and its organisational structures were transported. As such, the Schneidhaus can be seen as a node that embodied the institutionalization of surgical practice as a European phenomenon. Further research is necessary, and we propose how this might be carried out to reveal these historical phenomena in their full complexity., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: The importance of accurately costing implementation strategies is increasingly recognised within the field of implementation science. However, there is a lack of methodological guidance for costing implementation, particularly within digital health settings. This study reports on a systematic review of costing analyses conducted alongside implementation of hospital-based computerised decision support systems., Methods: PubMed, Embase, Scopus and CINAHL databases were searched between January 2010 and August 2021. Two reviewers independently screened and selected original research studies that were conducted in a hospital setting, examined the implementation of a computerised decision support systems and reported implementation costs. The Expert Recommendations for Implementing Change Framework was used to identify and categorise implementation strategies into clusters. A previously published costing framework was applied to describe the methods used to measure and value implementation costs. The reporting quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist., Results: Titles and abstracts of 1836 articles were screened, with nine articles eligible for inclusion in the review. Implementation costs were most frequently reported under the 'evaluative and iterative strategies' cluster, followed by 'provide interactive assistance'. Labour was the largest implementation-related cost in the included papers, irrespective of implementation strategy. Other reported costs included consumables, durable assets and physical space, which was mostly associated with stakeholder training. The methods used to cost implementation were often unclear. There was variation across studies in the overall quality of reporting., Conclusions: A relatively small number of papers have described computerised decision support systems implementation costs, and the methods used to measure and value these costs were not well reported. Priorities for future research should include establishing consistent terminology and appropriate methods for estimating and reporting on implementation costs., Trial Registration: The review protocol is registered with PROSPERO (ID: CRD42021272948)., (© 2023. The Author(s).)

Nurses carry out holistic assessments of patients during hospital admission. This assessment includes the need for leisure and recreation. Different intervention programmes have been developed to meet this need. The aim of this study was to investigate hospital leisure intervention programmes described in the literature in order to determine their effects on patient health and highlight the strengths and weaknesses of the programmes as reported by health professionals. A systematic review of articles in English or Spanish published between 2016 and 2022 was carried out. A search was performed in the following databases: CINAHL COMPLETE, PubMed, Cochrane Library and Dialnet and the Virtual Health Library and Web of Science resources. A total of 327 articles were obtained, of which 18 were included in the review. The methodological quality of the articles was assessed using the PRISMA, CASPe and STROBE scales. A total of six hospital-based leisure programmes were identified, including a total of 14 leisure interventions. The activities developed in most of the interventions effectively reduced the levels of anxiety, stress, fear and pain in patients. They also improved factors such as mood, humour, communication, wellbeing, satisfaction and hospital adaptation. Among the main barriers to implementing hospital leisure activities is the need for more training, time and adequate spaces for them develop. Health professionals consider it beneficial for the patient to develop leisure interventions in the hospital.

In-hospital falls are a serious threat to patient security and fall risk assessment (FRA) is important to identify high-risk patients. Although sensor-based FRA (SFRA) can provide objective FRA, its clinical use is very limited and research to identify meaningful SFRA methods is required. This study aimed to investigate whether examples of SFRA methods might be relevant for FRA at an orthopedic clinic. Situations where SFRA might assist FRA were identified in a focus group interview with clinical staff. Thereafter, SFRA methods were identified in a literature review of SFRA methods developed for older adults. These were screened for potential relevance in the previously identified situations. Ten SFRA methods were considered potentially relevant in the identified FRA situations. The ten SFRA methods were presented to staff at the orthopedic clinic, and they provided their views on the SFRA methods by filling out a questionnaire. Clinical staff saw that several SFRA tasks could be clinically relevant and feasible, but also identified time constraints as a major barrier for clinical use of SFRA. The study indicates that SFRA methods developed for community-dwelling older adults may be relevant also for hospital inpatients and that effectiveness and efficiency are important for clinical use of SFRA.

Background: Recent rising costs and shortages of healthcare resources make it necessary to address the issue of hospital efficiency. Increasing the efficiency of hospitals can result in the better and more sustainable achievement of their organizational goals., Objective: The purpose of this research is to examine hospital efficiency in the Eastern Mediterranean Region (EMR) using data envelopment analysis (DEA)., Methods: This study is a systematic review and meta-analysis of all articles published on hospital efficiency in Eastern Mediterranean countries between January 1999 and September 2020, identified by searching PubMed through MEDLINE, Web of Science, Scopus, Science Direct, and Google Scholar. The reference lists of these articles were checked for additional relevant studies. Finally, 37 articles were selected, and data were analyzed through Comprehensive Meta-Analysis Software (v.2.2.064)., Results: Using the random-effects model, the mean hospital efficiency in Eastern Mediterranean hospitals was 0.882 ± 0.01 at 95% CI. Technical efficiency (TE) was higher in some countries such as Iraq (0.976 ± 0.035), Oman (0.926 ± 0.032), and Iran (0.921 ±0.012). A significant statistical correlation was observed between the hospital efficiency and the year of publication and sample size ( p < 0.05)., Conclusion: Efficiency plays a significant role in hospital growth and development. Therefore, it is important for healthcare managers and policymakers in the EMR to identify the causes of inefficiency, improve TE, and develop cost-effective strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ravaghi, Afshari, Isfahani, Mahboub-Ahari and Bélorgeot.)

Recently, technological transformation has led to critical innovations in the health sector. Hospitals can provide much better services via digital transformation. However, the desired result cannot be achieved due to the lack of organizational preparation for digital transformation. This article has introduced criteria to measure the readiness for digital transformation, and the analysis of these criteria was performed using Explanatory and Confirmatory Factor analysis. The proposed structure includes 21 items under five factors: Management Support, Current Status Tracking, Corporate Culture, Resource Reservation and Service Management. Exploring the factors for Digital readiness will be a guide for researchers, hospitals and practitioners.

We define the magnet hospital and its organizational and managerial characteristics, present its virtuous effects as reported in the scientific literature, and consider the conditions for its transposition to the French hospital context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

As health systems transition to value-based care delivery models, reducing costs and improving quality of care without sacrificing either remains a challenge for many healthcare organizations. There is extensive research on hospital costs, however, works addressing the complex relationship between hospital costs and the quality of care have been limited. In this commentary, I expound on the scoping review on integrated hospital strategies by Wackers et al that aim to improve quality while lowering costs. Specifically, I reiterate the complexity of the relationship between cost and quality and delve into major interdependent themes identified by the authors as relevant for the implementation of hospitals' integrated strategy., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)