Hospitals

Nurses working in the Neuro-Intensive Care Unit at Aarhus University Hospital lack the tools to prepare children for the alarming atmosphere they will enter when visiting a hospitalised relative. The complex soundscape dominated by alarms and sounds from equipment is mentioned as the main stressor. As a response to this situation, our design artefact, the interactive furniture Kidkit, invites children to become accustomed to the alarming sounds sampled from the ward while they are waiting in the waiting room. Our design acknowledges how atmospheres emerge as temporal negotiations between the rhythms of the body and the environment in conjunction with our internalised perception of the habituated background. By actively controlling the sounds built into Kidkit, the child can habituate them through a process of synchronising them with her own bodily rhythms. Hereby the child can establish, in advance, a familiar relationship with the alarming sounds in the ward, enabling her to focus later more on the visit with the relative. The article discusses the proposed design strategy behind this solution and the potentiality for its use in hospital environments in general.

To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care. A systematic review of the literature. A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15,447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles. The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive ...

Aims: To determine the prevalence and risk factors for painful diabetic peripheral neuropathy (PDPN) and evaluate sleep impairment and quality of life in patients with PDPN. Methods: Data from the Korean Diabetes Association Neuropathy Study Group were used to evaluate 3999 patients with type 2 diabetes. PDPN was diagnosed using visual analogue scales (VAS) and medical history. The patients were asked to answer the Brief Pain Inventory-Short Form (BPI-SF), Medical Outcomes Study Sleep (MOS-Sleep) Scale, EuroQol (EQ-5D), and VAS. Results: Among the patients with diabetic peripheral neuropathy (n = 1338), 577 (43.1%) were diagnosed with PDPN (14.4% of all patients with type 2 diabetes). PDPN was independently associated with age, female gender, fasting plasma glucose, hypertension, and previous cerebrovascular events. All pain severity and interference measures were higher in patients with PDPN than in non-PDPN patients, and patients with PDPN reported more impaired sleep and lower EQ-5D and VAS scores. Conclusions: The prevalence of PDPN in Koreans was comparable to that in Western populations. PDPN may impair sleep and quality of life compared with non-PDPN, and physicians should carefully consider pain symptoms in patients with diabetic peripheral neuropathy.

The insertion and the permanence of central venous catheters (CVC) represent potential sources of infection contracted in hospital. The evaluation of the risk of CVC-associated infections was evaluated in a retrospective study during the period 2007-2010 in a Hospital of Central Italy. A total of 514 CVC were collected and examined by microbiological techniques and, among the examined patients, 450 CVC blood cultures were collected. Cultures were performed collecting a portion of 5-6 cm of intravenous catheters in liquid medium and spread on selective media for Gram-positive and Gram-negative bacteria and yeasts; blood specimens were obtained through peripheral venous punctures and analyzed by a commercial automated system. 308/514 (59.90%) samples were positive to the microbiological culture. Staphylococcus aureus, S. epidermidis and other coagulase negative Staphylococci (CNS) were the prevalent Gram-positive bacteria. Among Gram-negative bacteria, Enterobacteriaceae and Pseudomon...

Objective: To assess the extent of and the reasons for unclaimed prescriptions, primary non-compliance, after automated transmittals to pharmacies. Methods: Cross-sectional study in 3 health care districts (population 240,000) in the southernmost of Sweden on unclaimed electronic prescriptions (e-prescriptions), transmitted to 21 pharmacies during the period of 3 months (2000) and semi-structured interview study with patients not claiming their e-prescriptions transmitted to 4 pharmacies during a period of 3 weeks (2001). Main outcome measure: Proportion of unclaimed e-prescriptions of total number of (dispensed and unclaimed) e-prescriptions and reasons for primary non-compliance. Results: In total, 2171 (2.4%) e-prescriptions remained unclaimed at the pharmacies. The peak non-redemption rate was observed for those 15-24 years old (5.5%). The lowest rate was observed for those 65-74 years old. Men had a higher non-redemption rate than women. The highest rate for men was observed 25-34 years old (6.6%). Drugs for the musculoskeletal system (ATC group M) had higher non-redemption rates than expected (3.9%), and antibiotics (ATC-group J) lower (1.7%). Adolescents and young adults, 15-24 years old, had high non-compliance rates for drugs for the musculoskeletal system (14%) and anti-asthmatic drugs (11%). Of 78 interviewed patients, not claiming their e-prescriptions, 61% reported no need to have the prescription dispensed. However, unintentional non-compliance was reported by 28%, most of them were not aware that a prescription had been transmitted to the pharmacy. Thirteen percent reported that non-redemption had given further medical problems or made obtaining a new prescription necessary. Conclusion: Primary non-compliance was generally low, but there were differences related to age, gender and type of drugs. The most common reason reported for non-redemption was that the prescription was not needed, but some patients were unaware that prescriptions were issued and transmitted to the pharmacy.

The Los Angeles County (California) physician strike of January 1976 resulted in a partial withdrawal of physician services. Among recorded impacts were a $17.5 million loss in hospital revenues and an $8.5 million pay loss for hospital employees. Several surveys revealed no evidence of a significant impact on the general public in finding medical care. Analysis of emergency room visits and paramedical ambulance calls showed no significant increases during the strike. County mortality statistics for the strike were not affected. Eighty-eight fatalities among 2,171 patients transferred during the strike were analyzed; a

Background: This study compared the diversity of common diarrhoeal pathogens and antimicrobial susceptibility in four hospitals in Bangladesh. Methodology: A total of 13,959 diarrhoea patients, comprising rural Mirzapur [2,820), rural Matlab (2,865), urban Dhaka (5,287) and urban Mirpur (2,987) were included under the diarrhoeal disease surveillance system of icddr,b during 2010-2011; stool specimens were tested for Shigella spp., Vibrio cholerae, enterotoxigenic Escherichia coli and rotavirus. Results: Rotavirus was highest in Mirzapur (28%) followed by Dhaka (24%), Matlab (19%) and Mirpur (18%). Overall, Shigella was significantly more prevalent in rural sites (Mirzapur 13% and Matlab 7%), than in urban sites (Dhaka 3% and Mirpur 3%). Vibrio cholerae was more common in the urban sites of Dhaka (14%) and Mirpur (12%). 72% of Shigella isolates were susceptible to ciprofloxacin in Mirzapur, and 88% to mecillinam. In Dhaka, the figures for Shigella were 65% and 50%, in Matlab 65% and ...

Absiract. The compliance of practice to national guidelines on urethral catheter care has been examined. Questionnaires on the practices used with patients under their care were sent to 1350 nursing staff. Replies were received from 1153 individuals, 692 from hospitals, 345 from nursing homes and 116 from home care. While national guidelines stress the importance of maintaining a closed urine drainage system, the results revealed that 25.4% of respondents opened the drainage system to collect samples of urine for analysis, 57.9% to perform bladder washouts and 76% to change urine bags. 26% of respondents reported that they collected urine samples for routine bacteriological surveillance, a procedure considered unnecessary in the guidelines. 83% of staff reported that they washed their hands after emptying urine bags. Staff awareness of written guidelines for various aspects of catheter care ranged from 2 5 4 8 % in hospitals, 27-45% in nursing homes and 7-17% in home care. A marginal costs analysis was performed to estimate the economic consequences of non-compliance to the national guidelines.

A Sick Newborn Care Unit (SNCU), established in a district hospital in India, substantially reduced the neonatal mortality rate in the district; it, however, suffered from a dearth of trained nurses. Local girls with 10-12 years of school education underwent structured and hands-on training for six months, followed by a six-month internship at the SNCU and were assigned to it as stipendiary ‘Newborn Aides’. Based on the results of formal examinations, internal on-the-job assessment and interview of doctors, nurses, and parents and their technical skills and motivation were rated very high. Although the incremental cost of training is small, the cost of sustaining them, i.e. stipend and replacing attrition, needs to be addressed. Trained Newborn Aides may substantially alleviate human-resource constraint for SNCUs and Sick Newborn Stabilization units in smaller peripheral hospitals for care of sick newborns at an affordable cost.

The following study describes the basic demography of colorectal cancer patients and characteristics of the disease seen at a regional tertiary care cancer hospital. The study highlights the influence of gender and age on the occurrence of this malignancy in patients in Pakistan. In general, this population shares many epidemiological features of developing countries for colorectal carcinoma. These include a younger age at presentation (mean age of patients was 46.5 years), subsite distribution (72.5% had left-sided tumors), and delayed presentation of the disease in an advanced stage. We stress the significance of public awareness regarding colorectal cancer to improve the outcome.

A historical review is presented of the link between Ludwig Wittgenstein, considered the most important philosopher of the 20 th century, and medicine, particularly neurology and psychiatry. Wittgenstein worked as a porter at Guy's Hospital in London, and then as a technician at the Royal Victoria Infirmary in Newcastle. He wrote about his important insights into language, and neuroscience. It has been suggested that he had Asperger syndrome and a possible movement disorder (mannerisms).

Formalin as a fixative has no practical substitutes, but is toxic and potentially carcinogenic, so caution of its use in hospitals and elsewhere is mandatory. In our hospital, preservation of surgical specimens into formalin to be transferred to pathology labs was replaced by under-vacuum sealing (UVS) tissues into plastic bags and preservation at 4°C until transfer. Data analysis showed UVS processing to be superior in terms of staff satisfaction and of gross anatomic preservation; no problems in terms of technical feasibility or histopathologic preservation were encountered. Formalin was confined to pathology labs while its use on hospital premises was vastly reduced.

Objectives: To explore contemporary antibiotic management of infections caused by carbapenemresistant Gram-negative bacteria in hospitals. Methods: Cross-sectional, internet-based questionnaire survey. We contacted representatives of all hospitals with more than 800 acute-care hospital beds in France,

Background— It is unknown whether the appropriate use of percutaneous coronary intervention (PCI) has improved over time and whether trends in PCI appropriateness have been accompanied by changes in the use of PCI. Methods and Results— We applied appropriate use criteria to determine the appropriateness of all 51 872 PCI performed in Washington State from 2010 through 2013. We evaluated the number of PCIs performed from 2006 through 2013 to provide a comparator period that preceded statewide appropriateness assessment beginning in 2010. Between 2010 and 2013, the overall number of PCI decreased by 6.8% (13 267 PCIs in 2010 to 12 193 in 2013) with a 43% decline in the number of PCIs for elective indications (3818 PCIs in 2010 to 2193 PCIs in 2013). The decline in the use of elective PCI was significantly larger after the onset of statewide PCI appropriateness assessment in 2010 ( P =0.03). The proportion of elective PCIs classified as appropriate increased from 26% in 2010 to 38% in ...

Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to Mulago National Referral Hospital (MNRH), Kampala, Uganda. We used a prospective neurosurgical registry based on Research Electronic Data Capture (REDCap) to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. 563 TBI patients were enrolled from 1 June- 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe T...

The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain. Seventy-nine women agreed to participate in the intervention study. After a medical examination, 65 individuals were assigned to one of three balanced groups: Endurance training (aerobic capacity promoting training: ET: n = 22), strength promotion exercise (SP: n = 24) or a control group (CON: n = 19). The active groups met twice a week for 60 minutes of exercise over 15 weeks. Aerobic capacity (VO 2m ax ) and musculoskeletal pain were measured immediately before (T1) and after the intervention period (T2). Aerobic capacity signi cantly increased in the ET group, whereas no change was observed in the SP group, and a signi cant reduction was found in the CON group from T1 to T2. Musculoskeletal pain was signi cantly reduced in both intervention groups, whereas minor changes were observed in the control group. Results from a 7-month follow-up (T3) survey con rmed the bene cial effects of interventions on musculoskeletal pain. In conclusion, improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction.

Objectives To study the relationship between the prevalence of depressive symptoms in newly admitted nursing home residents and their previous place of residence. Methods In 65 nursing homes in the Netherlands trained physicians assessed 562 residents (mean age 78.5, range 28-101, 64.6% female) within 10 days after admission. Depressive symptoms were assessed with the Minimum Data Set (MDS) Depression Rating Scale (DRS), and the MDS items: 'diagnosis of major or minor depression', 'change in depression' and 'indicators of persistent depressed, sad or anxious mood disorder present'. Previous place of residence was categorized as 'own home', 'hospital' or 'sheltered living facility'. Adjustments were performed for demographic and health related factors measured with the MDS. Results The prevalence of depressive symptoms (DRS ! 3) for all 562 residents was 26.9%; it was higher in residents admitted from their own home (34.3%) than in residents admitted from the hospital (19.7%) (p ¼ 0.002). Residents who were admitted from the hospital have an adjusted Odds Ratio for having many depressive symptoms of 0.54 (95% CI 0.31-0.94) compared to residents admitted from their own home. There is, after adjustment, no statistical significant difference between residents admitted from their own home, or residents admitted from a sheltered living facility. Conclusions Depressive symptoms are very prevalent in nursing homes. Residents who are admitted from their own home, or from a residential facility, have more depressive symptoms than residents admitted from the hospital. This may reflect different conceptualizations or different adjustment patterns for those groups. For a better understanding of the factors associated with nursing home depression, future studies in detection, prevention and management of depressive symptoms should start prior to or directly after admission, especially for those who have no prior institutional history.

We examined 3 negative outcomes for 58 351 hip and knee arthroplasty patients: rehospitalization, revision and infection, and their impact on resource use in the year after surgery. In the year before surgery, 12.9% of elective hip and 10.2% of knee patients were hospitalized. In the year after, 14.8% of elective hip and 15.5% of knee patients were hospitalized, representing a 15% and 52% increase, respectively. Twenty-eight percent of emergent hip patients were hospitalized at least once preoperatively; this did not change after surgery. Revision occurred in 2.0% of emergent hip, 1.7% of elective hip, and 0.9% of knee patients. Joint infection was diagnosed in 1.3% of patients. The increased hospitalization after the elective hip and knee procedures represents an incremental cost of 10% over the index hospital stay.

Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. We found that ...

Developmental delay (DD) in infants and children is one of the chief complaints of parents. It has been established that the concerns of parents are as accurate as quality screening tests. Some kinds of concerns are particularly useful in the early detection of associated developmental problems. The purpose of this study was to investigate the relationship between the main parental concerns and the final diagnosis based on professional assessment of children who are suspected to have DD. One-hundred and 1 infants or children were recruited into this study. The major concerns of parents were elicited and categorized by various developmental domains: speech, motor, behavioral, cognitive, global, and non-specific developmental problems. All children underwent comprehensive combined assessments by professionals in the hospital, and were classified into 6 subtypes: speech, motor, behavioral, cognitive, and global DD, and normal development. Our results revealed that parental concerns abo...

The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33)...

Nosocomial infections bring a high risk to the health of hospital patients and employees. Ants are common organisms in Brazilian hospitals, where they can act as dispersers of opportunistic microorganisms in places they forage. The occurrence of multi-resistant bacteria carried by ants was analyzed in two public hospitals (HA and HB) in southeastern Bahia, Brazil. In these two hospitals 132 workers belonging to three ant species were collected. The bacteria associated to these ants were identified and their susceptibility to antibiotics was evaluated. More than half (57.3%) of ants collected in HA were associated with some kind of bacteria, with 26.7% of them being opportunist bacteria, while 84,2% of the ants from HB presented associated bacteria growth, with 61.4% of them being opportunist bacteria. Twenty four species of bacteria were isolated. The Gram-positive bacilli of the genus Bacillus were the most frequent, followed by the Gram-positive cocci, Gram-negative bacilli (family Enterobacteriaceae) and Gram-negative non-fermenters bacilli. The profile of sensitivity of the bacterial isolates to drugs pointed out the existence of multi-resistant isolates carried by ants. For the first time, are reported cases of the same bacterial resistant isolates taken form homospecific ant workers that point out the importance of ants to bacteria dissemination and proliferation in a hospital. Our results suggest that the risk of contamination presented by these ants is similar to the one of any other mechanical vector of bacterial dissemination.

Maternity careproviders often have strong views concerning a woman's choice of where to give birth.These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should "counts' instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.

Background: We conducted a retrospective analysis on the identification and antibiogram of all bacteria isolated from urine samples with microbiological confirmation of urinary tract infection (UTI) in a Spanish reference hospital over a 7-year period. Methods: A retrospective analysis was performed of the identification and antibiogram data. Results: A total of 31,758 uropathogens were isolated. Escherichia coli accounted for the majority (55.2%) of these, followed by Enterococcus faecalis (18.0%) and Klebsiella spp (10.3%). The highest E coli susceptibility rates were to imipenem (93.0%-99.8%), amikacin (97.3%-99.5%), nitrofurantoin (96.7%-98.9%), and fosfomycin (95.3%-100%), and the lowest were to cefuroxime (67.8%-86.4%), ciprofloxacin (61.2%-69.8%), and co-trimoxazole (55.0%-65.5%). We highlight the overall high activity of imipenem, piperacillintazobactam, nitrofurantoin, and fosfomycin on isolates versus the low activity of fluoroquinolones, co-trimoxazole, or cephalosporins. The activity of amoxicillin-clavulanic acid and fosfomycin decreased significantly over the 7-year study period. Conclusions: Imipenem and piperacillin-tazobactam appear to be good options for the empiric treatment of UTI acquired in hospital or requiring hospitalization, whereas nitrofurantoin and fosfomycin can be first-choice antibiotics for the treatment of uncomplicated community-acquired cystitis. However, surveillance studies are required to detect resistance to these antibiotics, given that an increase in uropathogen resistance rates may contraindicate its future use in empiric UTI therapy.

Aims: to investigate the prevalence of and interrelationship between cognitive impairment and behavioural problems in older people in residential care. Subjects: all those aged 65 years and over resident on one night in any type of residential care within the Leicestershire District Health Authority. Methods: an assessment form for each resident was completed by care staff. The assessment included demographic information and functioning (both mental and physical) during the previous week. Cognitive impairment was measured by the confusion sub-scale of the Crichton Royal Behavioural Rating Scale. Results: 6079 people were enumerated in 241 establishments, including hospitals, homes and hostels provided by the National Health Service (NHS), local authority social services and private and voluntary agencies. Thirty-eight percent (2219) were moderately or severely cognitively impaired and behavioural problems were present in 11.5%, most being associated with the presence of cognitive impairment. Compared •with elderly people in private residential homes, residents in local authority (part HI) homes had significantly higher odds of demonstrating offensive behaviour of 1.40 (95% confidence interval 1.11-1.78) after adjustment for age, sex and cognitive impairment. No significant association between number of patients in the home and the proportion exhibiting offensive behaviour was found in any of the non-NHS facilities. Conclusions: this survey of old people in institutional care found that most of those with behavioural problems were cognitively impaired. This has implications for staff training in the management of behavioural problems in demented people

... were equally scattered in Northern Ireland (Allison & Millar 1954) and too few for definitive assessment in Iceland (Gudmundsson 1962) ; in northern Scotland (Sutherland 1956) , Norway (Swank 1952), Sweden (Sallstrom 1942), Denmark (Gram 1934, Hyllested 1956), and ...

Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services.

Objective. To examine whether participating in a pressure ulcer prevalence survey and receiving feedback results in an improvement in quality of care. Design. Cross-sectional studies from 1998 to 2002 were compared over time. Setting. Sixty-two acute care hospitals in the Netherlands. Study participants. Patients hospitalized at the moment of the surveys. Interventions. Each hospital was given hospital-specific performance data and national aggregate data, and peer comparisons to improve the quality of care. Main outcome measures. The case-mix-adjusted prevalence of pressure ulcers of grade ≥2, the percentage of high-risk patients receiving adequate prevention, and the total number of enabling conditions present were compared between successive surveys using multi-level analysis, in order to estimate a linear trend model and trend differences for each hospital. Results. The case-mix-adjusted prevalence of pressure ulcers decreased over the 5-year period, while the percentage of patients receiving adequate prevention and the total number of enabling conditions present increased. The total number of enabling conditions had a significant effect on the decrease in case-mix-adjusted prevalence: more enabling conditions led to a lower case-mix-adjusted prevalence (χ 2 = 125; degrees of freedom = 1; P < 0.00). The percentage of patients receiving adequate prevention also had an effect on the change in case-mix-adjusted prevalence, with a higher percentage leading to a lower casemix-adjusted prevalence. This effect, however, was not significant. Conclusions. Monitoring prevalence and giving feedback results in an improvement in quality of care in terms of pressure ulcer prevention. It is very important to continue conducting surveys to avoid attention moving away from this topic, which may in turn lead to a deterioration in the quality of pressure ulcer care. Further research to find the most effective feedback approach is needed.

Background To ensure the rapid and correct triage of patients in potential need of specialized treatment, Norwegian hospitals are expected to establish trauma teams with predefined criteria for their activation. The objective of this study was to map and describe the criteria currently in use. Methods We undertook a cross-sectional survey in the summer of 2008, using structured telephone interviews to all Norwegian hospitals that might admit severely injured patients. Results Forty-nine hospitals were included, of which 48 (98%) had a trauma team and 20 had a hospital-based trauma registry. Criteria for trauma team activation were found at 46 (94%) hospitals. No single criterion was common to all hospitals. The median number of criteria per hospital was 23 (range 8-40), with a total number of 156 and wide variation with respect to physiological &quot;cut-off&quot; values. The mechanism of injury was commonly in use despite a well-known, large over-triage rate. Conclusions In recent ...

In contrast, HTLV-2 is found predominantly in native intravenous drug users (IDUs). Spain has experienced a large wave of immigration, which could have influenced the current prevalence and distribution of HTLV-1 and HTLV-2 infection. A 1-day cross-sectional survey was carried out in May 2005 in 13 hospitals distributed across Spain. A total of 2873 outpatient subjects were screened for HTLV-1/2 antibodies. Although the majority of the study population consisted of native Spaniards, 206 (7.2%) were immigrants. Two cases of HTLV-1 and one of HTLV-2 infection were found (overall prevalence, 0.1%). The two individuals with HTLV-1 were immigrants from endemic areas and the single case of HTLV-2 infection was a former Spaniard IDU coinfected with HIV-1. In summary, the current prevalence of HTLV-1/2 infection in Spain is low, with no evidence of spread beyond the classical risk groups. However, a rapidly growing population of immigrants from HTLV-1-endemic areas in Spain could modify this pattern and periodic surveillance studies including both natives and immigrants are warranted.

Enterococci, no more regarded as GRAS (Generally Recognized As Safe) organism, are emerging as an important source of nosocomial infections worldwide. The main contributors in pathogenesis of enterococci are the presence of various virulent factors and antibiotic resistance genes. We aimed to examine the prevalence, dissemination, antibiotic resistance and virulent factors associated with enterococci from bulk soil (BS). A total of 372 enterococci were isolated from 500 soil samples. PCR was used to identify the isolates up to species level and for carriage of 16 virulence genes including hospital associated marker (i.e. IS16). E. faecium (77%), E. faecalis (10%), E. hirae (4%) and E. casseliflavus (1%) were the major species isolated. The efaAfs was the most dominant gene (100%), followed by gelE (78.9%), sprE (76.3%) and esp (13%) in E. faecalis isolates. The E. faecium carried largely efaAfm (86.8%) and acm (50.3%) genes. Presence of entP (10%), entA (8.3%) and entB (6.9%) genes ...

Twenty-six community-associated methicillin-resistant Staphylococcus aureus (CAMSRA) isolates were characterized by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and screened for accessory gene regulator (agr), capsular polysaccharide (cap), and Panton-Valentine leucocidin (PVL) genes. They exhibited five PFGE patterns (types A to E). The majority were PFGE type A (12 isolates) or type B (8 isolates). MLST showed that PFGE type A isolates belonged to sequence type 80 (ST80), while the PFGE type B isolates were ST30. The ST80 and ST30 clones contained agr allotype 3, cap type 8, and PVL. The results showed that two internationally recognized CAMRSA clones are dominant in Kuwait hospitals.

Incident Reporting Systems (IRS) continue to be an important influence
on improving patient safety. IRS can provide valuable insights
into how to prevent patients from being harmed at the
organizational level. But inadequate expectations and misuse, for
performance assessment, patient safety measurement or research,
have hindered the full IRS potential. Health care organizations
need to develop effective strategies built on trust and truth telling
to improve the impact of IRS. This requires strategies to address
the limited resources to analyse the near-misses or adverse events;
avoid the punitive drift through maintaining the anonymity and
protective legislation; integrating IRS and avoiding its confusion
with mandatory adverse event response systems; training data
analysts to focus on the system instead of the individual through a
balanced simple taxonomy; combine the analyses at the local level,
to reinforce effective and personalized feedback, with the potential
of a national or supranational learning platform.

The effectiveness of the long-term monitoring of errors detected by frozen section-permanent section correlation is unknown. To determine factors important in laboratory improvement in frozen section-permanent section discordant and deferral rates by participation in a multi-institutional continuous quality improvement program. Participants in the College of American Pathologists Q-Tracks program self-reported the number of anatomic pathology frozen-permanent section discordant and deferred cases in their laboratories by prospectively performing secondary review of intraoperative consultations. Laboratories participated in the program for 1 to 5 years and reported their data every quarter. We calculated mean and median discordant and deferred case frequencies and used mixed linear modeling to determine if length of participation in the program was associated with improved performance. One hundred seventy-four laboratories self-reported data. Mean frozen-permanent section discordant ...

Background: Studying safety attitudes of front-line workers can help hospital managers take initiatives to improve patient safety. The Safety Attitudes Questionnaire, a psychometric tool that measures safety attitudes in health facilities, has been used and validated in several languages worldwide but there is no Italian version available. Hence, the study is aimed at cross-culturally validating the questionnaire (short form 2006) in Italian at two hospitals in the Veneto region (northeastern Italy). Methods: The translation and linguistic adaptation process of the questionnaire followed the World Health Organization guidelines. The questionnaire was delivered to staff working in four departments in two hospitals. Confirmatory factor analysis was used to assess the content validity of a pre-specified factor model that recognizes seven safety factors of the SAQ. Retest was performed to assess reliability. Internal consistency of items and safety factors was evaluated via Cronbach's alpha. Results: Response rate was 60 % (n = 261/433). Test-retest correlation between items and factors showed a high degree of agreement. Goodness-of-fit indices demonstrated an acceptable hypothesis model with seven safety factors. Cronbach's alpha of a whole questionnaire was 0.85, demonstrating a good internal consistency. Polychoric correlations showed that the factors are well correlated with each other. Stress recognition was found to have negative correlation with other safety factors. Conclusions: The Safety Attitudes Questionnaire in Italian language has satisfactory psychometric characteristics and is a valid instrument to measure safety culture in Italian hospitals.

Objective: The aim of this study is to investigate to which extent diversity is part of current healthcare practices and to explore opportunities and barriers in the implementation of diversity dimensions in healthcare practices. Methods: Nine in-depth, semi-structured interviews and three focus groups were conducted in three healthcare settings (mental health, hospital, nursing home care). Results: Results demonstrate that (the potential of) diversity is an ambiguous issue; diversity is said to be important, but this has not led to adjustments of the neutral, disease-oriented approach of patients. If recognized at all, diversity is reduced to one dimension (sex). Barriers in the implementation of diversity relate to: (a) lacking awareness and knowledge of diversity, (b) poor information and communication, and (c) organizational constraints. Opportunities to implement diversity in healthcare include: (d) an emerging sense of urgency to attend to diversity, (e) the development of good practices, and (f) the political climate. Conclusion: Various barriers and some opportunities for the implementation of diversity in healthcare practices have been identified. There is an ambiguity in how professionals deal with diversity. As a result, the neutral approach remains dominant in practice and policy. Practice implications: In order to raise the awareness and enhance the competence of professionals, educational programmes and learning networks are required.