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Background The Nursing department within an acute general hospital wished to illuminate and build on positive local enhanced care practices. A collaborative research team was formed between academics in the linked higher education institution and nurses within the hospital to address this intent by building nurse-led research capacity, while addressing the practice derived research question. Methods A mixed methods approach was employed involving; site visits, audit of enhanced care staffing requirements, documentary and activity box analyses and use of appreciative inquiry (AI) methodology. AI is a collaborative and strengths-oriented approach supporting organisational development. It was implemented via three World Café events (www.theworldcafe.com 2021) bringing together hospital stakeholders (n = 17) with direct experience of delivering enhanced care, to consider pre-defined questions. Thematic analysis was used to analyse the resultant data. Ethical approval was obtained. Results Overall, the findings demonstrated a positive focus on implementing therapeutic enhanced care within the hospital in contrast to a more passive primarily observational orientation. The site visits facilitated shared learning. Thematic findings from the World Cafés identified positive care practices and enabled a multidisciplinary, inclusive approach, which facilitated pragmatic suggestions on how to plan for, and build on existing foundations of, enhanced care practice. Conclusion Both the study approach and outcome resulted in positive impacts. Working collaboratively supported research capacity building for hospital-based members of the research team. Using AI supported constructive and inclusive stakeholder participation in the World Cafés with a focus on good practices and ways in which they could be strengthened. One year post completion, study recommendations have led to

Introduction The ability to recognise and manage frailty and its associated presentations is variable among acute hospital staff. Patients living with frailty who are admitted to hospital are more likely to suffer adverse effects than those without. We created an inter-professional in-situ simulation programme designed to improve recognition and management of frailty and its common adverse events. The programme objectives align with recommendations from the British Geriatric Society’s ‘Frailty Hub’ and Royal College of Physicians’ ‘Acute Care Toolkit’ for frailty. Method Over a two month period, seven sessions were completed on the Older Persons Unit (OPU) at St Thomas’ Hospital. These comprised a simulated scenario followed by facilitated debrief—including technical skills and human factors highlighted by the scenario. Quantitative data was collected through pre and post session questionnaires using the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty based questions. Post session qualitative data was also collected. Results 30 participants attended the sessions (nursing, medical and allied health professional). All participants completing the post course questionnaire found the sessions useful. When comparing pre and post session data, participant confidence in 10/12 sections of the HuFSHI and 8/9 frailty based questions demonstrated improvement. The qualitative data showed common learning themes around improved communication, teamwork and escalation. Participants found that the sessions were a valuable ‘opportunity to reflect’ and ‘debrief’, and learn together as a multidisciplinary team. Conclusion In-situ simulation is an effective tool for improving knowledge and confidence in managing frail patients. It increases awareness and understanding of human factors, which are key to the multidisciplinary approach frail patients require. The course is being expanded across the OPU and now has funding for a departmental manikin. The programme can be disseminated to other units to help improve the care and safety of those with frailty in hospital.

The American Academy of Pediatrics recommends an emergency information form (EIF) for children with medical complexity (CMC) to facilitate emergency care. We sought to increase the EIF completion rate at our children's hospital's CMC clinic and to evaluate the effect on caregiver and emergency department (ED) provider opinion of preparation, comfort, and communication.We used a pre/post-quality improvement design. The main outcomes were (1) the proportion of completed EIFs and (2) caregiver and ED provider opinion of preparation, comfort, and communication, using a Likert scale survey (1, low; 5, high).Emergency information form completion increased from 3.1% (4/133) before the intervention to 47.0% (78/166) after (P0.001). Twenty-three providers completed presurveys, and 8 completed postsurveys. Seventy-two caregivers completed presurveys, and 38 completed postsurveys (25 with ED visit and 13 without). There were no changes in preparation, comfort, or communication for caregivers who had an ED visit after the intervention. For those without a postintervention ED visit, caregiver median scores rose for preparation (4 [interquartile range {IQR}, 3-5] vs 5 [IQR, 4-5], P = 0.02) and comfort (4 [IQR, 2.25-5] vs 5 [IQR, 4-5], P = 0.05). After the intervention, ED providers had increased median communication scores (3 [IQR, 2.75-4.25] vs 5 [IQR, 4-5], P = 0.02), whereas scores of preparation and comfort were unchanged.A quality improvement project at a CMC clinic increased EIF completion, caregiver preparation and comfort, and ED provider communication in emergencies.

Background The prevalence of orthostatic hypotension increases with age(1). The aim of this audit was to assess healthcare provider’s knowledge of identifying and measuring orthostatic hypotension (OH) in the acute setting. Early identification and management of OH is an important step to prevent adverse outcomes and improve patient’s overall functional performance. Methods Fifty-one questionnaires were distributed to a random selection of non-consultant doctors and nurses in our hospital. The questionnaires included questions regarding basic knowledge of OH and its measurement. Questions were based on international guidelines on the appropriate measurement and assessment of OH(1). An education session was then offered to junior doctors and nurses, and subsequently carried out by a senior nurse. Staff were educated on OH and how to correctly assess it. Doctors and nurses were subsequently reassessed using the same questionnaire. Results Initial results showed that many of the respondents were interns (37%) and nurses (35%). 94% of respondents had never received formal training in the evaluation of OH. 51% knew that a patient should lie supine for 5 minutes prior to initial BP assessment. 61% knew to take the BP at 1-minute post standing, and 45% knew that the BP should again be taken at 3 minutes. 71% knew to take the pulse alongside the BP checks. The education sessions and repeat audit are ongoing. Conclusion Many of the hospital staff who assess for OH have not received specific training on how to evaluate and diagnose OH. It is our aim to educate front line staff as to the importance of looking for OH and how to diagnose it.

Background For many people an admission to an acute hospital can be a stressful and overwhelming experience. During admission it can be difficult to process and understand the information provided by members of the multi-disciplinary team (MDT). Patient information leaflets (PILS) are important in educating and empowering patients in the management of their own health and wellbeing. PILs are frequently provided to patients by MDT members during their admission. These valuable resources are not always consulted by patients or their families and in many cases are not brought home from hospital. Methods Using Plan Do Study Act (PDSA) methodology patient information folders named “My healthcare information” were provided to in-patients by MDT members. Patients were encouraged to put all PILs provided by the MDT in these folders and bring them home for future reference. Questionnaires were administered to patients to ascertain if they found the folders useful and would be likely to use them going forward. Two PDSA cycles have been completed to date. Results ​The results were largely positive. A significant amount of those questioned found it difficult to understand and remember what was said to them by hospital staff (5 of 15 respondents or 33%) and felt they did not receive enough written information about their condition (6 of 15 respondents or 40%). A high proportion of those asked stated they found the folder useful and would be likely to use it at home going forward (22 of 23 respondents or 96%). Conclusion My healthcare information folders are a potentially useful tool in empowering patients and educating them about their own health and wellbeing. Further PDSA cycles and staff education is required to continue the project. The next PDSA cycle will focus on the MDT member’s experience of using the folders.

Background An acute hospital admission often means that patient’s mobility can decline if not maintained and encouraged throughout their inpatient stay. The “Buddy Walking Programme” is a joint initiative between the physiotherapy department, nursing department and hospital volunteers. The aim of this research was to implement a hospital “Buddy Walking Programme” within a teaching hospital in Cork to allow the provision of accompanied walking sessions by members of the hospital’s volunteer team. Methods Ward based physiotherapy staff and nursing staff identify suitable patients and add their bed number and mobility status to a list each morning. Patients are identified who are independently mobile or can safely mobilise with the supervision of one person, with or without a mobility aid and who are cognitively capable of simple commands. Physiotherapists and nursing staff are made aware of the programme at induction. Volunteers partake in an educational session and manual handling training prior to offering supervised walking sessions. Results A standard operating procedure has been developed for the “Buddy Walking Programme”. Training has been rolled out hospital wide amongst nursing staff, physiotherapy staff and hospital volunteers. Conclusion This programme will help encourage a culture of physical activity within the hospital in-patient setting and improve mobility levels. Further research is warranted to explore the beliefs and perceptions of hospital staff and volunteers regarding the initiative and to examine barriers and facilitators to the programme.

Background Approximately one in ten strokes occur in hospital whilst the patient is hospitalised for another reason. Existing research suggests that delays in recognition of in-hospital stroke (IHS) result in poorer outcomes compared to those with community-onset stroke. We aim to describe the characteristics of an IHS population and to phenotype the patient and/or environmental factors most likely to account for delays in recognition and response times. Methods Patients diagnosed with having an ischemic stroke while admitted to hospital for a non-stroke reason were identified through our hospital's stroke registry. We collected patient demographics along with the ward and service they were admitted under and if they underwent any invasive procedures prior to the stroke event. The patient cohort was dichotomised based on patient specific or environmental factors. We then calculated the likelihood of symptom recognition, medical review, and neuroimaging occurring within the 4.5 hour thrombolysis window between the two groups using the chi squared test. Results Fifty IHS occurred in the study time period. 52% were male, average age 74 (SD 12.7 years). 34 (68%) were admitted medically, and 16 (32%) surgically. 27 (54%) were assessed within the time frame for thrombolysis. Of these, seven received acute stroke treatment and the remaining 19 had contraindications to treatment. Patients presenting with collapse (67% vs 4%, p=0.011), limb weakness (85% vs 52%, p=0.011) or aphasia (63% vs 9%, p=0.019) were more likely to be recognised. Patients whose symptoms were recognised by a non-staff member (52% vs 78%, p=0.026) and those presenting out of hours (56% vs 70%, p=0.047) or with delirium (85% vs 39%, 0.051) were more likely to be missed. Conclusion In-hospital strokes are frequently missed due to the complexities of the patients involved. Education programs targeted at enhancing stroke pickup among hospital staff could potentially decrease delays and improve patient outcomes.

After 1 year, among 236 hospital staff members (HSMs) tested positive for SARS-CoV-2, we observed five cases of suspected reinfection in our teaching hospital in France. No probable reinfection was retained considering PCR Cycle Threshold and clinical context. Focus should concern COVID-free HSMs still not vaccinated rather than the ones previously infected.

To investigate the impact of promising a referral bonus and an autonomous referral request on nurses' referral likelihood and the quality of their referrals.We applied a 2 × 2 between-participants factorial design with referral bonus and autonomous referral request as experimental variables.In May 2019, 110 nurses working in Belgian hospitals were shown a fictitious e-mail with a request from their employer to look for potential new-hires and filled out an online survey measuring referral likelihood and quality.Promising a referral bonus did not affect nurses' referral likelihood and quality. Instead supporting self-determination theory, nurses exposed to the autonomous request were more likely to refer and assure referral quality than those exposed to the controlling request.Hospitals can increase nurses' referral likelihood and quality by framing their referral request in an autonomy-supportive way.Recruiting nurses are more important than ever in the current Covid-19 crisis. Our findings offer practical insights on how hospitals can engage their employees in the recruitment of nurses (i.e. through framing referral requests in an autonomy-supportive way).目标: 调查转荐奖金许诺和自主转荐要求对护士转荐可能性及转荐质量的影响。 设计: 我们采用2×2参与者间的因素设计,以转荐奖金和自主转荐请求作为实验变量。 方法: 2019年5月,110名在比利时医院工作的护士收到一封虚构的电子邮件,信中表明院方想要雇佣一些新员工,并让其填写一份线上调查,以衡量其转荐的可能性和质量。 结果: 转荐奖金许诺不影响护士转荐的可能性和质量。与自决权支持理论恰恰相反,自主转荐请求的护士比面对掌控请求的护士进行转荐的可能性更高,且转荐质量有保证。 结论: 医院可以通过自主支持方式确定转荐请求,藉此提高护士转荐的可能性和质量。 影响: 身处于当下新冠肺炎危机之中,招聘护士比以往任何时候都显得重要。我们的研究发现为医院如何让员工参与护士招聘工作提供了切实的见解(即以自主支持方式确定转荐请求)。.

Healthcare worker (HCW)-associated coronavirus disease 2019 (COVID-19) is of global concern due to the potential for nosocomial spread and depletion of staff numbers. However, the literature on transmission routes and risk factors for COVID-19 in HCWs is limited.To examine the characteristics and transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HCWs in a university teaching hospital in London, UK.Staff records and virology testing results were combined to identify staff sickness and COVID-19 rates from March to April 2020. Comparisons were made with staff professional groups, department of work, and ethnicity.COVID-19 rates in our HCWs largely rose and declined in parallel with the number of community cases. White and non-White ethnic groups among our HCWs had similar rates of infection. Clinical staff had a higher rate of laboratory-confirmed COVID-19 than non-clinical staff, but total sickness rates were similar. Doctors had the highest rate of infection, but took the fewest sickness days. Critical care had lower rates than the emergency department (ED), but rates in the ED declined when all staff were advised to use personal protective equipment (PPE).Sustained transmission of SARS-CoV-2 among our hospital staff did not occur, beyond the community outbreak, even in the absence of strict infection control measures in non-clinical areas. Current PPE appears to be effective when used appropriately. Our findings emphasize the importance of testing both clinical and non-clinical staff groups during a pandemic.

Background The German healthcare system is facing a serious shortage of healthcare professionals and is therefore dependent of foreign staff to ensure adequate healthcare. 14 % of the physicians and 17 % of the nurses working in Germany have foreign citizenship. The variety of cultural backgrounds and language skills raises the question for advantages and challenges when it comes to human resource policies in hospitals and outpatient care services. Methods The findings are based on 16 expert interviews with physicians, nurses, and managers in leading positions of two hospitals and two outpatient care services. These institutions differ in the extent to which they treat migrant patients and hire foreign healthcare workers. Results From the experts' perspective, the biggest advantage in foreign health workers are their language skills. Foreign language skills are a huge advantage provided that their knowledge matches the patients' languages and their German skills are adequate as well. Additionally, their knowledge about other medical cultures are very much appreciated. The experts see challenges in different qualifications that the professionals have gained in their home countries as well as diverse working cultures, which often leads to frustration among the teams. Therefore, too much ethnic diversity is difficult for everyday working life. Ethnic discrimination is the case in hospitals with less migrant staff and patients. Conclusions To ensure adequate healthcare, healthcare professionals should get a special training, which enables them to work in diverse teams with colleagues from other countries. Meanwhile, foreign staff need time to get used to new hospital structures and should feel strengthened to bring their skills in. This is a process, which the institutions must moderate and accompany constructively. Key messages Immigration of foreign healthcare professionals leads to multicultural teams in healthcare, which are characterized by differences in cultures and qualifications. Therefore, leading professionals should support and encourage multicultural teams to learn how to deal with this diversity in everyday working life.

The study investigates the impact of the COVID-19 pandemic on health services with and without specific health care of COVID-19 patients through the eyes of leading physicians at the University Medical Center Hamburg-Eppendorf (UKE).From April 30 to May 12, 2020, four interviewers conducted 38 expert interviews via telephone, video or face-to-face by using a semi-standardized questionnaire. The standardized answers were analysed descriptively. The free text-answers were subject to a qualitative content analysis. The categories were analysed via quantitative frequency distributions.All chief physicians with responsibility for inpatient and outpatient health care at the UKE took part in this study (N=38). The leading physicians reported numerous changes regarding occupancy in the hospital, patient composition, work flows and diagnostic as well as therapeutic measures. Additionally, various arrangements were necessary to cover the needs of prevention, treatment and follow-up care as well as protection of staff. Measures showed, on the one hand, a strong reduction in occupancy and workload in most inpatient and outpatient clinics. On the other hand, the amount of work also increased by fundamental transitions of work flows, communication, staff structure and hygiene measures. Many respondents commented positively on the rapid and efficient setup of a digital communication structure. Partially, staff was strained by the pandemic itself and by the associated measures.The results of the study help to understand and assess the effects of the pandemic on health care, work flows and staff. The findings may support the specification and adaptation of prospective measures and processes for pandemic crisis situations. Future studies should investigate how staff beneath the highest executive level experienced and evaluated this crisis and consequences.Die Studie beschreibt die Auswirkungen der COVID-19-Pandemie mit Blick auf Bereiche mit und ohne spezifische Versorgung von COVID-19-Patientinnen und -Patienten aus Sicht der Klinikdirektorinnen und -direktoren am Universitätsklinikum Hamburg-Eppendorf (UKE).Im Zeitraum vom 30. April bis 12. Mai 2020 wurden mit den im UKE verantwortlichen Klinikdirektorinnen und -direktoren Interviews per Telefon, Video bzw. face-to-face mithilfe eines teilstandardisierten Fragebogens durchgeführt. Die standardisierten Antworten wurden deskriptiv analysiert. Freitextantworten wurden einer qualitativen Inhaltsanalyse unterzogen. Die entwickelten Kategorien wurden quantitativ nach Häufigkeiten analysiert.Alle leitenden Ärztinnen und Ärzte mit einer Verantwortung für die stationäre und ambulante Versorgung am UKE konnten für die Interviewstudie gewonnen werden (N=38). Diese berichten von gravierenden Veränderungen in der medizinischen Versorgung, v. a. im Bereich der Bettenbelegung, der Patientenzusammensetzung, den klinischen und Arbeitsprozessen sowie den diagnostischen und Behandlungsprozessen. Zusätzlich mussten viele neue Regelungen getroffen werden, um den Präventions-, Behandlungs- und Nachsorgebedarf von Patientinnen und Patienten sowie den Schutz der Mitarbeitenden zu gewährleisten. In den meisten klinischen Bereichen zeigte sich stationär wie ambulant phasenweise eine starke Reduktion in den Belegungszahlen und der Arbeitsauslastung. Teilweise stiegen aber auch Arbeitsaufwände, z. B. durch die Anpassung von Arbeitsabläufen, veränderte Kommunikations- und Personalstrukturen sowie zusätzliche Hygienemaßnahmen. Viele Befragte äußerten sich positiv über den effizienten Aufbau einer digitalen Kommunikationsstruktur. Das Personal war durch die Pandemie an sich, aber auch durch die damit verbundenen Maßnahmen vielseitig gefordert.Die Ergebnisse helfen, die Auswirkungen der aktuellen COVID-19-Pandemie auf die Versorgung und Arbeitsprozesse besser zu verstehen. Zudem können sie dabei unterstützen, zukünftig Maßnahmen für pandemische Krisensituationen noch besser anzupassen. Weitere Studien könnten untersuchen, wie die Mitarbeitenden unterhalb der Leitungsebene diese Krise und ihre Auswirkungen erlebt haben.

Journal of the American College of Surgeons, The - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le lundi 20 avril 2020

Objective The objective of the research was to explore attitudes of hospital nurses toward integrative medicine (IM). Design A special training program was developed in the Bnai-Zion medical center, a public hospital in Israel, where an innovative IM program was launched. Methods 65 nurses from 22 wards were asked at the beginning and the end of the program to complete an open-ended questionnaire concerning three major aspects: 1) their attitudes toward complementary medicine and its integration, 2) the importance and impact of the training program and 3) how they perceive their potential role in promoting IM in the wards. Results Nurses perceive themselves as boundary actors, who can play an important role in promoting IM within the wards. IM training programs for hospital nurses are recommended. This empowers nurses while restoring to clinical practice the essence of nursing as an integrative healing discipline.

Zusammenfassung Hintergrund und Ziel Es besteht ein Bedarf an zugewanderten Ärzten in der Versorgungsstruktur der Bundesrepublik Deutschland. Die Situation der betreffenden Ärzte ist bisher weitestgehend unerforscht. Im Rahmen einer explorativen Pilotstudie wurden Stressoren und Ressourcen von zugewanderten Ärzten im Hinblick auf ihre migrationsbedingten Erfahrungen an deutschen Kliniken und im medizinischen Team erforscht. Methodik Im Rahmen einer qualitativen Untersuchung wurden im Zeitraum von Juli bis September 2014 acht problemzentrierte Interviews mit zugewanderten Ärztinnen und Ärzten durchgeführt und analysiert. Die Befragten stammten aus dem EU-In- und Ausland und waren seit 1,0–4,5 Jahren in verschiedenen Kliniken in Deutschland tätig. Ergebnisse Stressoren und Herausforderungen ergaben sich im Bereich der deutschen Sprachkenntnisse, der medizinischen Kompetenzen, der Zusammenarbeit im Team sowie in Bezug auf die Arbeit im neuen Gesundheitssystem. Diskriminierung durch Kollegen und Patienten stellte eine besondere Belastung dar. Währenddessen verfügten die zugewanderten Ärzte über Ressourcen sprachlich-kommunikativer, medizinischer, sozialer und organisationaler Art. Diskussion Die Ergebnisse verdeutlichen die besondere Beanspruchung von zugewanderten Ärzten. Künftige Forschung sollte migrationsbedingte Belastungs- und Entlastungspotenziale von zugewanderten Ärzten mittels quantitativer Methodik auf eine breitere Basis stellen und im Sinne eines Mehrperspektiven-Ansatzes deutsche Kollegen und Patienten einbeziehen.

Effect of SARS-CoV-2 Vaccine at a Medical Center With the rollout of mRNA SARS-CoV-2 vaccines under emergency use authorization, dramatic decreases in the incidence of SARS-CoV-2 infections were se...

Background Survival of children with cancer goes hand-on-hand with cancer treatment and improvement of infection care and prevention (ICP). The Hispaniola Island project aims to improve the quality of care and survival for children with cancer in 3 pediatric cancer units by implementing ICP programs in these units with the long-term plan of absorbing such programs into the structure of the hospital care delivery process. We report the 1-year outcomes of establishing ICP standards in pediatric oncology units. Methods We followed the general steps for health promotion when engaging with the new sites, which are: (1) planning the process; (2) conducting a situational assessment; (3) identifying objectives; (4) identifying strategies; (5) developing indicators; and (6) tracking progress. Results The planning process included discussions with local leadership, timeline plans for ICP interventions, data gathering, and decision-making. Three healthcare providers were identified and trained through the St. Jude Global educational programs as local ICP champions and institutional contacts. Through site visits and focus group discussions, each unit developed a team consisting of the local ICP champion and an infection preventionist to lead the local unit ICP improvement. Situational analysis revealed no surveillance in infections, suboptimal practices hand hygiene, central-line management, and mechanical ventilation. To guide improvement, the local ICP team begun collecting surveillance of ICP indicators, such as infection rates, with monthly reporting to and mentoring by the St. Jude team. Since February 2019, the 3 sites ICP teams prospectively captured 17,532 patient-days (median: 365 patient-days per month; range: 209–573), 384 central-line days (median: 15 central-line days per month; range: 0–33), identified 278 healthcare-associated infections in 159 patients; monitored hand hygiene through direct (observations) and indirect (alcohol gel consumption) methodologies and provided monthly education sessions in ICP to hospital staff, patients and their families. Early results demonstrate the utility of a dedicated ICP team using a standardized ICP reporting system to guide focused improvement of care delivery. Conclusions Improving ICP standards is essential for any intervention which aims to improve the survival of children with cancer. A step-wise procedure in building local teams, engaging hospital leaders, evaluating on-site resources, and introducing methods to collect infection rates and other quality indicators for healthcare delivery will provide evidence-based guidance to improve the safety of cancer care delivery. We hope that the improvement could be sustained in the longer run by incorporating the created structure and processes to the hospital system.

Resumen: Objetivo: Validar un instrumento para medir la calidad de vida laboral en hospitales publicos (CVL-HP) de Tlaxcala, Mexico. Material y metodos: El instrumento fue validado en 669 trabajadores de seis hospitales de la Secretaria de Salud de Tlaxcala, Mexico. Se evaluo validez de contenido por consulta a expertos, de constructo mediante analisis factorial, de criterio por comparacion con otras escalas y la confiabilidad con Alpha de Cronbach. Resultados: El analisis factorial descubrio cuatro dimensiones: “bienestar individual”, “condiciones y medio ambiente de trabajo”, “organizacion” y “bienestar logrado a traves del trabajo”. La confiabilidad fue de 0.921. Los trabajadores con mejor CVL-HP fueron menores de 50 anos, de contrato, con menor antiguedad laboral, personal de jornada acumulada diurna y aquellos con licenciatura. Conclusiones: La escala CVL-HP mostro ser psicometricamente valida y confiable. Se recomienda probar esta escala en otras instituciones publicas y privadas, y relacionarla con indicadores de desempeno y gestion de los servicios de salud.

Powered drives designed to assist with moving hospital beds are commercially available but no studies have evaluated whether they reduce the push and pull forces likely contributing to injury in caregivers. This study measured hand forces of 10 caregivers maneuvering a manual and powered bariatric bed through simulated hospital environments (hallway, elevator, and ramp). Peak push and pull forces exceeded previously established psychophysical limits for all activities with the manual bed. For the powered bed, peak forces were significantly (p

Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. In our teaching hospital, flu vaccination rate among HCWs has been growing during last 3 years. The aim of this study was therefore to describe the flu vaccination coverage across the past 3 years and to analyze which factors lead to such increase. We performed a cross-sectional study on all HCWs of Fondazione Policlinico Universitario “A. Gemelli” (FPG) hospital of Rome (Italy) to determine the flu vaccination coverage. Socio-demographic and occupational data were collected from hospital personnel records and included age, gender, previous flu vaccination, profession and workplace unit. On site vaccination plus academic detailing involving leaders have been the main strategies adopted in this last 3 years that have already proved to be effective in increasing vaccination coverage among HCWs. During the 2018-2019 season, we analyzed how the flu vaccination coverage among leaders (nurse coordinators and head physicians) could affect all HCWs coverage rate. Flu vaccination rate increased from 9.57% in the 2016-17 to 14.24% in the 2017-18 and to 22.38% in 2018-2019. A total of 4035 HCWs employed in the FPG were included in 2018-19. Concerning the role played by vaccination of leaders in increasing general vaccination coverage during the 2018-2019, the group of HCWs with a vaccinated leader showed a higher coverage rate (28.65%) than the group with a non-vaccinated leader (16.22%) (p < 0.0001). The results are preliminary. Flu vaccination coverage of HCWs in our hospital during the last 3 years has been increasingly higher. Vaccination of the leaders, in addition to previously implemented effective strategies, resulted to be a key factor in increasing flu vaccination coverage among all HCWs. Socio-demographic and occupational variables can significantly influence the coverage rate as well. Key messages Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. This study shows the growing flu vaccination coverage rate in our teaching hospital and the effectiveness of the example given by the vaccinated leaders in increasing the coverage among all HCWs.

This study examines the incidence of acute allergic reactions to mRNA COVID-19 vaccine administrations in health care employees in Massachusetts.

Although state surrogate laws are the most common way surrogate decision makers are identified, no studies have been conducted to determine physician understanding of these laws or how these laws are utilized during clinical practice. The purpose of this study is to better understand how surrogate decision-making laws function in practice.A cross-sectional survey of 412 physicians working in Indiana hospitals was conducted between November 2014 and January 2015 to determine physicians' knowledge of Indiana's surrogate decision-making law and physicians' approaches to hypothetical cases using the law in clinical practice.Fewer than half of physicians (48%) were able to correctly identify all legally allowable surrogate decision makers. Of those physicians who knew the law, nearly all of them (98%) indicated that they would violate the law during clinical practice by allowing nonlegal surrogates such as grandchildren to make medical decisions.A majority of physicians endorse relying on surrogates who have strong ties to the patient but are not legally allowable in Indiana. It is possible that these decisions reflect sound ethical reasoning even though they are illegal. Due to the narrow construction of some state surrogate decision laws, physicians may be placed in the position where they must either choose to follow medical ethical principles or the law. To alleviate these issues, state surrogate decision laws need to be amended to include a broader list of surrogates, such as extended family and close friends.

Introduction. This study measures the exposure of occupational therapists from a 1.5-T magnetic resonance imaging (MRI) machine. Method. A total of 14 time-series on each of the chest, head and hand were taken before and after different MRI procedures. The peak values were noted in each case together with an average of all data recorded in the time-series. Results. The highest exposure recorded was observed on the hand, followed by the head and the chest. The overall maximum exposure (1479.40 mT) recorded was observed on the hand during a change of coil. It was also observed that the recorded exposure of experienced radiographers working in the MRI environment was less than that of junior staff due to different practices. Conclusion. This study is of significant importance in Malta since it is the first conducted in a MRI environment, especially because the results were compared with limits imposed by EU Directive 2013/35/EU which has to be implemented by July 2016.

Resume Objectifs Evaluer les pratiques de gestion du traitement personnel des patients hospitalises au sein des unites de soins (US) deux ans apres la diffusion d’une procedure institutionnelle. Evaluer le niveau d’information et de satisfaction des patients hospitalises quant a cette thematique. Methode Realisation d’un audit des pratiques aupres des soignants de 23 US de notre groupement hospitalier universitaire (medecine, chirurgie et urgences) par le biais de questionnaires valides par un groupe de travail institutionnel et composes de trois themes : gestion du traitement personnel a l’entree, connaissance des outils et transmission des informations. Dans chaque US, deux medecins (un senior et un interne), un infirmier diplome d’Etat, un cadre infirmier, ainsi qu’un patient etaient interroges. Resultats Quatre-vingt-un membres des equipes medicales et paramedicales et 21 patients ont ete interroges. La procedure institutionnelle etait meconnue pour 100 % des chirurgiens et 69 % des medecins. D’apres les declarations obtenues, les pratiques des soignants des US de medecine etaient davantage en adequation avec les recommandations diffusees par rapport a celles des professionnels des US de chirurgie. Parmi les patients interroges 19 (86 %) etaient satisfaits du niveau d’information recu au cours de l’hospitalisation et 4 (19 %) geraient eux-memes leur traitement avec un controle de l’administration par l’equipe paramedicale dans seulement 36 % des cas selon leurs declarations. Conclusions La gestion du traitement personnel du patient est emblematique de la difficulte de maitriser la continuite de la prise en charge medicamenteuse du patient aux differents points de transition. Les coordinations et la collaboration entre les differents acteurs intervenant autour du patient sont des elements cles garantissant un parcours de soins optimise.