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IntroductionThe COVID-19 pandemic has placed additional burden on already strained healthcare systems worldwide, intensifying the responsibility and burden of healthcare workers. Although most hospital staff continued working during this stressful and challenging unprecedented pandemic, differences in the characteristics and attributes were noted between sectors and hospital departments. Israeli healthcare workers are trained and experienced in coping with national emergencies, but the pandemic has exposed variations in staff reactions. Understanding the intrinsic differences between sectors and departments is a key factor in staff and hospital preparedness for unexpected events, better resource utilization for timely interventions to mitigate risk and improve staff wellbeing.ObjectiveTo identify and compare the level of resilience, secondary traumatization and burnout among hospital workers, between different sectors and hospital departments, during the COVID-19 pandemic.MethodsCross-sectional research to assess the resiliency, secondary traumatization and burnout of healthcare workers at a large general public hospital in central Israel. The sample consisted of 655 participants across various hospital units exposed to COVID-19 patients.ResultsEmergency department physicians had higher rates of resilience and lower rates of burnout and secondary traumatization than staff in other hospital departments. In contrast, staff from internal medicine departments demonstrated the highest levels of burnout (4.29). Overall, physicians demonstrated higher levels of resilience (7.26) and lower levels of burnout compared to other workers.ConclusionIdentifying resilience characteristics across hospital staff, sectors and departments can guide hospital management in education, preparation and training of healthcare workers for future large-scale health emergencies such as pandemics, natural disasters, and war.

PURPOSE: To describe spermatozoa extraction rate by testicular sperm extraction (TESE) for posthumous sperm retrieval (PMSR) and examine harvest time impact on sperm motility; to compare long-term sperm usage between married vs. single deceased men. METHODS: This retrospective study included all PMSR cases in Shamir Medical Center during 2003–2021. We evaluated sperm cryopreservation according to latency time after death. Then, we assessed sperm usage according to Israeli PMSR regulations. RESULTS: The study included 69 (35 married and 34 singles) deceased men with average age of 30.3 ± 7.8 years. Sperm was cryopreserved in 65 cases (94.2%) after maximum and average harvest time of 40 and 16.5 ± 8.1 h, respectively. Motile sperm extraction was associated with significantly shorter harvest time compared with non-motile sperm (13.8 ± 7.3 vs. 18.7 ± 8.1 h, p = 0.046). Sperm usage among married deceased was significantly higher than single (15.6% vs. 0%, p = 0.05). Disposal requests were lower among single compared to married men relatives without reaching statistical difference. Eventually, single men had significantly higher rate of non-used cryopreserved samples (93.8% vs 69.6%, p = 0.01). CONCLUSION: This large long-term cohort study demonstrates high efficacy of PMSR. We found significant harvest latency time difference between motile and non-motile preserved sperm. Clinical sperm usage rate justifies the efforts for PMSR among married deceased. However, contradicting policy on the topic of single men (which implies liberal sperm preservation but rigid prevention of usage) results with high non-used sperm rate and relatives’ extremely sophisticated emotional burden.

The concentration of SARS-CoV-2-specific serum antibodies, elicited by vaccination or infection, is a primary determinant of anti-viral immunity, which correlates with protection against infection and COVID-19. Serum samples were obtained from 25 897 participants and assayed for anti-SARS-CoV-2 spike protein RBD IgG antibodies. The cohort was composed of newly vaccinated BNT162b2 recipients, in the first month or 6 months after vaccination, COVID-19 patients and a general sample of the Israeli population. Antibody levels of BNT162b2 vaccine recipients were negatively correlated with age, with a prominent decrease in recipients over 55 years old, which was most significant in males. This trend was observable within the first month and 6 months after vaccination, while younger participants were more likely to maintain stable levels of serum antibodies. The antibody concentration of participants previously infected with SARS-CoV-2 was lower than the vaccinated and had a more complex, non-linear relation to age, sex and COVID-19 symptoms. Taken together, our data supports age and sex as primary determining factors for both the magnitude and durability of humoral response to SARS-CoV-2 infection and the COVID-19 vaccine. Our results could inform vaccination policies, prioritizing the most susceptible populations for repeated vaccination.

Since COVID-19 risk of reinfection is of great concern, the safety and efficacy of the mRNA-based vaccines in previously infected populations should be assessed. We studied 78 individuals previously infected with SARS-CoV-19, who received a single dose of BNT162b2 mRNA COVID-19 vaccine, and 1:2 ratio matched infection-naïve cohort who received two injections. The evaluation procedure included symptom monitoring, and serological tests. Among the post-infected population, the median IgG-S response after the first vaccine dose was 3.35 AU, compared to 2.38 AU after the second vaccine injection in the infection naive group. A strong correlation was demonstrated between IgG-S level before vaccination, and the corresponding responses after a single vaccine dose (r = 0.8, p

Since COVID-19 risk of reinfection is of great concern, the safety and efficacy of the mRNA-based vaccines in previously infected populations should be assessed. We studied 78 individuals previously infected with SARS-CoV-19, who received a single dose of BNT162b2 mRNA COVID-19 vaccine, and 1:2 ratio matched infection-naïve cohort who received two injections. The evaluation procedure included symptom monitoring, and serological tests. Among the post-infected population, the median IgG-S response after the first vaccine dose was 2260 AU/ml, compared to 238 AU/ml after the second vaccine injection in the infection naive group. A strong correlation was demonstrated between IgG-S level before vaccination, and the corresponding responses after a single vaccine dose (r = 0.8, p

The fourth industrial revolution has led to a paradigm shift in the world of data; this paper reviews the implications on the medical and health services. These changes include: -The transition to big data: New layers of information such as longitudinal data, OMICS, information from social networks and the internet will be added to the conventional sources of information: anamnesis, physical examination, lab results etc. and will assist in medical decisions. -The transition to medical prediction: The information will allow not only diagnosing the current medical situation, but will also enable predicting the patient's risk level for developing certain diseases in the future. -The transition to artificial intelligence systems: This will enable analysis and generate insights into the vast amount of available information. -The decline in data production and data analysis costs: Much of the information will be collected by the patient himself and derived from his wearable devices. Information that was previously costly and exclusively owned by health officials, will be owned by others including the patient himself. These changes pose risks alongside the opportunities. The pace and quality of incorporating all this data depends on two opposing forces: technological innovation on the one hand, and system barriers on the other. Barriers include objections from users, budgetary constraints, patient privacy and regulatory barriers. The healthcare system must prepare wisely, but quickly, for the dramatic changes.

Objective Needlestick and sharps injuries (NSIs) are known occupational risks among health-care workers. Reporting these injuries is important for early prevention and management of blood-borne infections. We investigated the prevalence and characteristics of NSIs and underreporting among hospital workers (HWs) from different sectors. Methods A single-center cross-sectional study, involving an anonymous survey delivered to 2205 HWs. The survey included demographic information about the worker and information about training, injuries and reporting. Results Of the 844 HWs respondents (40%), NSIs occurred in 443 of them (53%); the majority were from needles (68%) and at bedside (51%). Significantly higher prevalences of injuries (P Conclusions NSIs and underreporting are common among HWs from all sectors, including those who do not use needles. Improving preventive measures and reporting should be encouraged. We recommend reducing bedside procedures as possible and assigning two workers to procedures at risk for injuries, to increase the report rate.

Hospital patients are at risk of serious medication errors that may result in patient harm. Such errors commonly occur during the ordering of medication, drug administration, or the transcription and dispensing stages. Previous studies have shown that use of bar-code technology can prevent errors by providing automatic verification of a patient's identity and the medication to be administered. Bar-code technology is usually implemented in conjunction with an electronic medication administration system (eMAR). Bar-code eMAR records physician and pharmacy medication orders electronically; its implementation may reduce medication errors and protect patients from potential adverse events. Use of this technology has been increasing, but there is only limited and mixed evidence of its effectiveness. This prospective study evaluated the effectiveness of bar-code eMAR technology to reduce administration and transcription errors, as well as lower potential adverse drug events. Over a 9-month period in 2005 in a tertiary academic medical center, error rates in units that were using this technology were compared with the rates in units that were not. The 2 primary study outcomes were errors in timing, involving early and late administration of drugs, and errors unrelated to timing. Identified errors were reviewed by 2 members of a medical panel to confirm the presence of an error and the potential for adverse drug events and patient harm. A total of 7318 medication administrations were observed on patient units implementing bar-code eMAR and 6723 medication administrations on patient units that did not. Transcription orders were reviewed for 1283 units that used the bar-code eMAR and for 1799 that did not use this technology. On units not using the bar-code eMAR, there was an error rate of 11.5% (776/6723) for nontiming medication-administration errors, whereas on units with the bar-code eMAR, the error rate for nontiming-errors was 6.8% (495/7318). The difference represents a 41.4% relative reduction in the rate of nontiming errors (P < 0.001). Compared with units without bar-code eMAR, use of this technology reduced the rate of potential adverse drug events because of nontiming administration errors from 3.1% to 1.6%, representing a relative reduction of 50.8% (P < 0.001). The overall rate of timing errors decreased from 16.7% without the bar-code eMAR to 12.2% with its use, a reduction of 27.3% (P = 0.001), but there was no significant difference in the incidence of potential adverse drug events due to timing errors between the comparison groups. The rate of transcription errors was 6.1% on units that did not use the bar-code eMAR; no transcription errors were found in units using it.

Addressing patient expectations is necessary to achieve high satisfaction. However, few data are available on nurses' perceptions and performance with respect to patient expectations and satisfaction.This international multicenter study aimed to: (a) evaluate nurses' attitudes and performance with respect to patient satisfaction and expectations, and (b) identify predictors of nurses' inquiry of patients' satisfaction at the point of discharge.A questionnaire examining attitudes and performance toward patient satisfaction and expectations was developed and validated. Nurses at four academic hospitals in the United States, the United Kingdom, Israel, and Denmark were surveyed.A total of 536 nurses participated in the study (response rate 85.3%). Nurses expressed positive attitudes toward activities related to patient satisfaction and expectations, endorsing the importance of talking with patients about their satisfaction status (91.6%) and their expectations (93.2%). More than half of the responders (51.8%) claimed to have responded to the status of patient satisfaction or dissatisfaction (Israel: 25%; United States: 54.9%; United Kingdom: 61.7%; Denmark: 69.9%; p.001). However, only 12.1% stated that they routinely ask patients about their level of satisfaction, with nurses in the United States (18.3%) and Denmark (17.5%) more likely to ask compared to nurses in the United Kingdom (7.4%) and Israel (6.3%; p = .001). Adjusted logistic regression identified four significant predictors (p.05) of nurses' inquiry about patients' satisfaction: "Responding to patient's satisfaction status" (OR: 3.1; 95% CI: 1.7-5.8); "Documenting patient's satisfaction status" (OR: 2.8; 95% CI: 1.6-5.1); "Asking routinely about expectations" (OR: 5.4; 95% CI: 3-9.7); and "Responded to expectations during the past month" (OR: 4.3; 95% CI: 1.9-9.4).These findings warrant further investigation, potentially into the nurses' work environments or educational programs, to better understand why nurses' positive attitudes toward patient satisfaction and expectations do not result in actively asking patients about their satisfaction level and what should be done to improve nurses' performance. Healthcare organizations and policy makers should develop and support structured programs to address patient expectations and improve patient satisfaction during hospitalization.

Objective. Genital neonatal herpes simplex virus type 1 (HSV-1) infection was observed in a series of neonates after traditional Jewish ritual circumcision. The objective of this study was to describe neonate genital HSV-1 infection after ritual circumcision and investigate the association between genital HSV-1 after circumcision and the practice of the traditional circumcision. Methods. Eight neonates with genital HSV-1 infection after ritual circumcision were identified. Results. The average interval from circumcision to clinical manifestations was 7.25 ± 2.5 days. In all cases, the traditional circumciser (the mohel) had performed the ancient custom of orally suctioning the blood after cutting the foreskin (oral metzitzah), which is currently practiced by only a minority of mohels. Six infants received intravenous acyclovir therapy. Four infants had recurrent episodes of genital HSV infection, and 1 developed HSV encephalitis with neurologic sequelae. All four mohels tested for HSV antibodies were seropositive. Conclusion. Ritual Jewish circumcision that includes metzitzah with direct oral–genital contact carries a serious risk for transmission of HSV from mohels to neonates, which can be complicated by protracted or severe infection. Oral metzitzah after ritual circumcision may be hazardous to the neonate.

Background Achieving high levels of patient satisfaction requires hospital management to be proactive in patient-centred care improvement initiatives and to engage frontline clinicians in this process. Method We developed a survey to assess the attitudes of clinicians towards hospital management activities with respect to improving patient satisfaction and surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA. Results We collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries on three continents. Overall, 90.4% of clinicians believed that improving patient satisfaction during hospitalisation was achievable, but only 9.2% of clinicians thought their department had a structured plan to do so, with significant differences between the countries (p

Article-at-a-Glance Background A study was conducted to examine and compare information gleaned from five different reporting systems within one institution: incident reporting, patient complaints, risk management, medical malpractice claims, and executive walk rounds. These data sources vary in the timing of the reporting (retrospective or prospective), severity of the events, and profession of the reporters. Methods A common methodology was developed for classifying incidents. Data specific to each incident were abstracted from each system and then categorized using the same framework into one of 23 categories. Results Overall, there was little overlap, although each reporting system identified important safety issues. Communication problems were common among patient complaints and malpractice claims; malpractice claims' leading category was clinical judgement. Walk rounds identified issues with equipment and supplies. Adverse event reporting systems highlighted identification issues, especially mislabelled specimens. The frequency of contributions of reports by provider group varied substantially by system. Physicians accounted for 50% of risk management reports, but in adverse event reporting, where nurses were the main reporters, physicians accounted for only 2.5% of reports. Complaints and malpractice claims come primarily from patients. Conclusions The five reporting systems each identified different yet complementary patient safety issues. To obtain a comprehensive picture of their patient safety problems and to develop priorities for improving safety, hospitals should use a broad portfolio of approaches and then synthesize the messages from all individual approaches into a collated and cohesive whole.

Incident reporting represents a key tool in safety improvement. Electronic voluntary reporting systems have been perceived as advantageous compared to paper approaches and are increasingly being implemented.To evaluate the rate, content, ease of use, reporters' profile, and the follow-up and actions resulting from reports submitted to a Web-based electronic reporting system.Analysis of the submitted reports to a commercial Web-based reporting system at a tertiary care academic hospital for 31 months between May 2004 and November 2006.During the study period, 14,179 reports were submitted. The leading incident categories were labs (30%), followed by medication issues (17%), falls (11%), and blood bank (10%). Of the reported incidents, 24% were near misses, 61% were adverse events that caused no harm, 14% caused temporary harm, 0.4% caused permanent harm, and 0.1% caused death. Of the eligible staff, 29% submitted a report during the study period. Physicians submitted only 2.9% of the reports; most reports were submitted by nurses, pharmacists, and technicians. Physicians tended to report on more severe cases and focused on different topics than other professionals. Overall, 84% of the reports came from the inpatient setting. On average, it took 14 minutes to submit a report. In following up on reports, first manager review was completed within a median of 22 hours, and a mean of 4 people reviewed each report. A large array of actions followed the reports.This application effectively captured incidents, actions, and follow-up. Ease of data manipulation facilitated descriptive statistical analysis, and the ability to use branching algorithms may have helped in decision making about actions and follow-up.

Key steps that led to Kennestone Hospital's success in improving patient flow in the cath lab included: Developing an urgency classification system for patients. Creating a more accurate scheduling system to increase throughput and efficiency. Establishing a project team. Developing a time line. Recognizing ongoing challenges

The British NHS system is undergoing a process of reform and renewal. In addition to allocating resources, the NHS developed the star rating system, a system developed to evaluate and increase performances of the medical institutes. The rating of zero to three stars of the general hospitals (acute trusts) is based on the level of achievements of the 9 key targets and 36 indicators composing 3 focus areas: clinical, patient and logistic aspects. The key targets and performance indicators are determined every year based on the accomplishments of the previous year and actual problems. The 2004 key targets included shortening waiting times in the emergency room and waiting lists for elective admission and ambulatory clinics, hospital finance management and hospital cleanliness. We examined the evaluation system in relation to the goals set, after a three-year period. There is impressive progress in the quality and level of medical care given in the areas examined. Besides the improvement, criticism arose in respect of different aspects: the hospital rating does not necessarily reflect the quality of care given in the individual departments, the publicity of the hospital ratings had a deleterious effect on the patient trust in the medical staff and their relationship, the hospitals requested to be involved in the process of choosing the indicators etc. The method for evaluating hospitals is one of the top issues on the agenda of the leaders of the Israeli health system. It is known that the evaluation process itself leads to improvement but it might also have a harmful effect. The application of the British Star system to the Israeli system requires core adjustments: defining relevant indicators based upon current problems, securing the quality of the data, defining the correct case-mix of patients and working in full cooperation with the hospital managers and the professional authorities. The publicity aspect is a delicate issue considering the current restrictions on patient's freedom of choice.

The paper examines whether work process standardisation as perceived by resident physicians can reduce their number of medical treatment errors, in particular when their level of fatigue increases. The perceptions of work standardisation and level of fatigue among 126 residents at two teaching hospitals were surveyed. A senior nurse, who had been working closely with each resident, tallied the number of errors made by the resident over a three-month period. The results demonstrated a significant, positive main effect of the residents' level of fatigue, and a significant negative main effect of perceived level of standardisation on the number of residents' errors. In addition, a significant interaction suggested that the number of resident treatment errors increased as the level of fatigue increased, depending on the level of perceived standardisation; when the residents were highly fatigued, they made fewer errors when they perceived that they had more work standardisation.