Search Results (416)

Objectives: Burkholderia cepacia complex (Bcc), a Gram-negative organism, is a well-recognized cause of hospital outbreaks, often linked to a contaminated shared source, such as multidose medications. In this study, we report an outbreak of Bcc infections in a tertiary care hospital, associated with the intrinsic contamination of a prepared solution used in interventional radiology (IR) procedures. Additionally, we provide a detailed explanation of the interventions implemented to control and interrupt the outbreak. Methods: Records from the infection control committee from 1 January 2023 to 31 October 2024 were screened to identify cases with Bcc growth in cultured blood, urine, or respiratory samples. Clinical and laboratory data were collected in March 2025. Bacterial identification was performed using conventional methods and MALDI-TOF (Bruker Daltonics, Bremen, Germany). Controls were matched to cases by ward, date of initial growth, and duration of hospitalization. Demographic and clinical data of these patients were systematically collected and analyzed. Microbiological cultures were obtained from environmental objects of concern and certain medications. Results: A total of 82 Burkholderia species were identified. We enrolled 77 cases and 77 matched controls. The source of contamination was identified in ready-to-use intravenous medications (remifentanil and magnesium preparations) in the IR department. These preparations were compounded in advance by the team and were used repeatedly. Although the outbreak originated from contaminated IV medications used in IR, secondary transmission likely affected 28 non-IR patients via fomites, shared environments, and possible lapses in isolation precautions. The mortality rate among the cases was 16.9%. Infection with Bcc was associated with prolonged intensive care unit stays (p = 0.018) and an extended overall hospitalization duration (p < 0.001); however, it was not associated with increased mortality. The enforcement of contact precautions and comprehensive environmental decontamination successfully reduced the incidence of the Bcc outbreak. No pathogens were detected in cultures obtained after the disinfection. Conclusions: The hospital transmission of Bcc is likely driven by cross-contamination, invasive medical procedures, and the administration of contaminated medications. Implementing stringent infection control measures such as staff retraining, updated policies on medication use, enhanced environmental decontamination, and strict adherence to isolation precautions has proven effective in curbing the spread of virulent and transmissible Bcc. Full article

This study presents an algorithm developed by the Clinical Engineering department to automatically match surgical events recorded by robotic systems with corresponding entries in the hospital’s OR management software. At ASST Grande Ospedale Metropolitano Niguarda, robotic procedures were previously identified manually by surgical staff within the operating room management system, often leading to frequent inconsistencies and data quality issues. Two heterogeneous datasets—robot logs and hospital procedure records—were aligned using common features such as date, duration, and operating room, despite the absence of a unique identifier. The matching algorithm enables accurate identification of robotic procedures within the hospital system and facilitates integration of clinical and technical data into a unified framework. This integrated approach supports more effective data utilization for clinical engineering activities, operational monitoring, and Health Technology Assessment (HTA) analyses. The work provides a practical solution to a real-world data integration challenge and lays the foundation for future developments, including the application of machine learning to enhance matching precision. Full article

Background/Objectives: Pathology is often perceived as a technical medical specialty that lacks direct contact with the patient. However, oncological histopathological diagnosis requires a high degree of moral and emotional responsibility. The objective of this study was to investigate how empathy is manifested toward the “invisible” patient, the emotional impact on pathology staff, and potential repercussions in their personal lives. Method: We conducted a descriptive, cross-sectional study with a quantitative component, using an anonymous 22-item questionnaire among Romanian pathologists and medical personnel working in pathology services. The questionnaire was focused on three research directions: professional empathy in the absence of direct patient contact, the emotional impact of oncologic diagnosis on medical personnel in pathology departments, and the carryover of emotions from professional to personal life. A total of 165 respondents were included in the study (physicians, technicians, registrars). Results: Most of the respondents consider that the absence of the patient’s direct contact does not cancel the empathy, this being felt in a cognitive and more natural way. Over 60% of the respondents see oncologic histopathological diagnosis as an emphatic medical act. Over 80% of the respondents experience a sense of emotional responsibility and 70% consider that professional training does not include adequate emotional support. There is a high interest in empathy and psychological support. The professional activity of a pathologist may influence sleep, dreams, and the perception on their own health status. Diagnosing pediatric or young patients is perceived as particularly emotionally challenging. Collegial support is moderate and discussion about professional stress is rare. Conclusions: Empathy is present and relevant in pathology, despite the absence of direct patient interaction. Oncological diagnostics has a significant emotional impact on pathology department personnel, with the need to acknowledge the emotional dimension of the profession and to integrate psychological support mechanisms into pathology practice. Full article

Educational facilities are the physical environment that supports the academic process for a better education. The quality of offices as workspaces is crucial in creating a supportive environment to enhance the staff and students’ experience. This paper aims to study the concept of space personalization and its impact on faculty members’ productivity, performance, and satisfaction in universities’ educational facilities. To achieve this aim, the research applied the qualitative research method of semi-structured interviews to gather comprehensive data about user experience. Approaching 39 faculty members within Al Yamamah University across three departments within the College of Engineering (Architecture, Industrial, and Computer). Data were analyzed using thematic analysis for qualitative insights, focusing on environmental aspects (such as: natural lighting, ventilation, noise control, etc.), psychological factors (such as: privacy, aesthetic appeal, etc.), and architectural settings (such as: area, space layout, materials, etc.). The research proposes a methodological framework for design considerations for office spaces in universities, fostering more flexible and personalized designs for enhancing sense of ownership and well-being. Findings indicate that personalized office spaces significantly enhance faculty satisfaction and productivity. Qualitative data highlighted that a lack of privacy in standardized offices adds stress and an overwhelming environment. These findings suggest that universities should consider flexible office designs to optimize academic work environments. Full article

Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study was to evaluate the impact of LUS, performed by a non-expert operator, in determining diagnosis and prognosis of patients with dyspnea. Methods: A total of 60 patients presenting with dyspnea at the ED were prospectively enrolled and underwent LUS examination by a medical student, after brief training, within 3 h of triage. LUS findings were classified into four patterns: N.1, absence of notable ultrasound findings, attributable to COPD/ASMA exacerbation; N.2, bilateral interstitial syndrome, suggestive of acute heart failure; N.3, subpleural changes/parenchymal consolidations, suggestive of pneumoniae; and N.4, isolate polygonal triangular consolidation, attributable to infarction in the context of pulmonary thromboembolism. Results: The diagnostic hypothesis formulated after LUS was compared with the final diagnosis after further investigations in the ED, showing agreement in 90% of cases. The mean LUS score value was higher in patterns N.2 (18.4 ± 8.5) and N.3 (17 ± 6.6), compared to patterns N.1 and N.4 (9.8± 6.7 and 11.5 ± 2.1). Given the high prevalence of pattern N.2, the diagnostic accuracy of LUS in this context was further evaluated, showing a sensitivity of 82% and specificity of 100%. In terms of the prognostic value of LUS, hospitalized patients had a higher LUS score compared to those discharged (17.3 ± 8.1 vs. 8.5 ± 6.8, p value 0.004). A similar trend was obtained in the subgroup of patients requiring non-invasive ventilation (NIV), who present a higher LUS score (21.1 ± 6.6 vs. 13.1 ± 8.1, p value 0.002). When considering a combined outcome (death and NIV), patients with worse outcomes more often had a LUS score > 15 (p value < 0.001). Conclusions: In conclusion, this study confirms that LUS is a very useful tool in the ED, assisting the clinical evaluation for diagnosis, treatment decision, and determination of the appropriate care setting for patients with acute dyspnea. Its short learning curve allows even non-expert staff to use it effectively. Full article

Background/Objectives: Coercive measures remain a common practice in mental health, despite ethical concerns, potential risks, and uncertain efficacy. Mental healthcare workers’ (MHCWs) attitudes toward coercion can influence their use. However, research in Italy is limited. This study aimed to investigate Italian MHCWs’ attitudes toward coercion and their associations with sociodemographic and professional characteristics. Methods: A cross-sectional study was conducted on 356 MHCWs from a mental health department in Southern Italy. Participants completed the Staff Attitude to Coercion Scale (SACS), which assesses negative, pragmatic, and positive attitudes toward coercion. Descriptive statistics (i.e., frequencies, percentages, means) and bivariate analyses (i.e., one-way ANOVA) were used to explore the associations between variables. Results: The majority of participants were male (56.7%), nurses (50.3%), and worked in acute psychiatric settings (52%), with a mean age of 51.08 years (±10.59) and 13.74 years (±12.14) of experience in mental health. Attitudes differed significantly according to age, sex, professional role, and work setting. More negative attitudes were found among staff in residential settings and non-caring roles (p < 0.001). Pragmatic attitudes were lower among older staff (p = 0.012) and among those in residential settings and non-caring roles (p < 0.001). Positive attitudes were higher among males (p = 0.001), nursing staff (p < 0.001), and staff in acute settings (p = 0.049). Conclusions: Italian MHCWs reported different attitudes toward coercion, which was influenced by personal and professional factors. These findings highlight the need for targeted interventions and policy strategies to promote attitudinal change, particularly in settings where positive attitudes are prevalent. Full article

Background/Objectives: Pain remains as a prevailing cause, prompting patients to seek medical attention, comprising approximately 40% of all emergency department (ED) visits annually. Timely and effective pain management is crucial for patient comfort, satisfaction, and optimal recovery. However, there is increasing evidence highlighting the concern that patients often receive inadequate pain management in both emergency departments and prehospital settings. Despite the simplicity and potential for the repetitive use of pain scales throughout a patient’s stay, it appears that a greater emphasis is often placed on monitoring hypotension or low saturation values rather than addressing pain levels above 7 on the numeric rating pain scale. Methods: This article represents an ambitious attempt to implement process improvement methodologies such as Lean Management and SixSigma, both which have been well established in service and industrial fields, within the hospital environment to improve the process of pain management in the emergency department. Results: The implementation of pain management improvement processes in the emergency department led to a statistically significant but clinically modest increase in the administration of analgesics and improved pain reporting practices. The percentage of patients receiving no analgesia decreased from 96.6% to 94.8% (p = 0.008), and the documentation of pain characteristics during triage improved. However, the escalation of pain therapy remained limited, and strong analgesics were still underutilized. Conclusions: Despite partial improvements, the lean management-based interventions did not sufficiently address the problem of oligoanalgesia in the emergency setting. Sustainable change requires enhanced clinical engagement, ongoing staff training, and the broader adoption of structured analgesia protocols across prehospital and hospital care. Full article

The room for reducing carbon emissions and improving low-carbon practices in the building industry is significant. In this study, a bibliometric analysis shows that technology is the primary mechanism adopted for driving carbon reduction in the existing practices building industry, which is conducted by using the CiteSpace 6.2.R4 tool. It is considered that there is a limitation in promoting further low-carbon practices by technological dominance without a proper management paradigm. This paper, therefore, aims to search for a new management paradigm in order to help further reduce emissions in the building industry. This study adopts an innovative synergy theory to explain the mechanism by which the efforts of all management dimensions can be synergized to promote low-carbon practices in the building sector. Consequently, the outcome of this paper is the introduction of a total low-carbon management (TLCM) paradigm. Synergy theory supports our assertion that a joint force can be formed within the building industry system to drive TLCM practice, as all building-related elements (government departments, building organizations, building personnel, building activities, and building processes) in the system will have to follow the government’s actions towards low-carbon practices. The TLCM paradigm is integrated by five components: whole regulation, whole industry, whole enterprise, whole staff, and whole process. The new paradigm should be promoted to replace the existing technology-dominated paradigm in order to achieve low-carbon practices in the building industry. The TLCM paradigm will guide low-carbon management decisions and practices across all phases of the building project’s lifecycle, together with integrating quality and risk management. Full article

Osteoporosis therapy is a crucial component of fragility fracture patients’ care. A Quality Improvement Project (QIP) was undertaken to review and improve such bone protection practice within a busy UK hospital orthopaedic department. Full-loop audit cycles, totalling 216 patients, were conducted before and after the implementation of a single-page checklist. This intervention significantly increased consultant-led osteoporosis plans by 37%, enhanced bone-sparing treatment administration by 20%, and eliminated unsafe prescriptions. Provision timeliness was not affected, but the communication of correct discharge information was significantly improved by 27%, and staff surveys showed the checklist was well-received, easy-to-use, and educational. Hopefully this will encourage other orthogeriatric teams to utilise a similarly effective and simple QI strategy. Full article

Grounded in motivation theory, this study examines the direct relationship between a supportive workplace environment (SWE) and employee performance (EP). The SWE has been identified into three dimensions, i.e., work recognition (WR), work motivation (WM), and career development (CD). Moreover, we focused on the mediating effect of employee engagement (EE) on the relationship between SWE and EP. A quantitative research method was used, and data were collected through a questionnaire survey. Data were collected from 349 respondents. The target population were the senior managers, middle managers, and administrative staff working in the semi-government organizations based in Riyadh, Saudi Arabia. The data were analyzed using partial least squares structural equation modeling (PLS-SEM) software version 4.0. The results indicate that in the direct relationship, workplace recognition, workplace motivation, and career development are positively connected with EP. Similarly, the findings show that employee engagement positively mediates between an SWE (work recognition, work motivation, and career development) and EP. This study suggests that managers can establish practices acknowledging and appreciating employee contributions, leading to increased motivation and improved performance. Creating a work environment that fosters work motivation by addressing employees’ physical and safety, social, and egoistic needs can further enhance employee engagement and performance. The study highlights the significant role of work recognition, work motivation, career development, and employee engagement in influencing employee performance. This study also recommends some practical implications for the semi-governmental organizations. First, it was suggested that organizations create a workplace environment in which employees feel appreciated, valued, and happy. Second, the organizations introduce the employee engagement culture at the department level as well as at the organizational level. Third, the organizations also introduce flexible work schedules for middle-level and administrative staff. Finally, Saudi organizations recognize the output of their employees and provide them with monetary incentives. Full article

In the world of academia, there is a great mobility of talented university professors with a high level of movement among different entities. This could be a major problem, as universities must retain a minimum level of talent to support their various academic programmes. In this sense, finding out what factors could increase the loyalty of such staff can be of great interest to human resource (HR) departments and the overall administrative management of an organisation. Thus, this area, also known as People Analytics (PA), has become very powerful in human resource management to strategically address challenges in talent management. This paper examines talent commitment within the university environment, focusing on identifying key factors that influence the loyalty of professors and researchers. To achieve this, machine learning (ML) techniques are employed, as Principal Component Analysis (PCA) for dimensionality reduction and clustering techniques for individual segmentation have been employed in such tasks. This methodological approach allowed us to identify such critical factors, which we have termed Quantitative Emotional Salary (QES), enabling us to identify those factors beyond those merely related to compensation. The findings offer a novel data-driven perspective to enhance talent management strategies in academia, promoting long-term engagement and loyalty. Full article

Background/Objectives: Nursing staff face mentally and physically demanding work environments in the obstetrics and gynecology departments in hospitals. This study elucidated the working hours of midwives and nurses in these departments and the background factors influencing them. Methods: This study employed a quantitative, descriptive, and correlational cross-sectional design. A questionnaire-based survey targeting nursing personnel working in the obstetrics and gynecology departments in hospitals across Japan was conducted. The respondents’ attributes, working hours, number of night shifts, and other employment conditions were described. To identify the background factors of long working hours, multivariate logistic regression analysis was performed using working hours ≥50 h per week as dependent variables and respondents’ attributes and employment conditions as explanatory variables. Results: Questionnaires were sent to 1170 hospitals, and valid responses were obtained from 2043 nursing personnel in 474 hospitals. Working ≥50 and ≥60 h per week were observed in 15.5% and 3.6% of the respondents, respectively, and 54.2% reported working night shifts ≥5 times monthly. Background factors strongly correlated with working ≥50 h per week among nursing staff included being in their 40s, licensed practical nurses, or a head nurse; having 5–8 night shifts per month; and working in hospitals with a total bed count of 200–400, 400–600, or 600–800, as well as ≥10 full-time physicians, ≥10 or an unknown number of advanced practice midwives, and >400 inpatient midwifery delivery cases annually. Conclusions: Urgent interventions are needed to reduce the workload of nursing staff in the obstetrics and gynecology departments of Japanese hospitals. Full article

Hand hygiene reduces healthcare-associated infections. The World Health Organization (WHO) recommends the multimodal hand hygiene strategy to improve hand hygiene. To compare hand hygiene knowledge and compliance of healthcare practitioners (HCPs) before and after the implementation of the WHO multimodal strategy, a before-and-after cross-sectional study was conducted in two Tunisian University Hospitals (2019–2023). Hand hygiene knowledge and compliance were assessed using the WHO questionnaire and observation tool. In 2019, 42 of 246 HCPs (17%) correctly answered ≥80% of 25 questions on hand hygiene knowledge. By 2023, this increased to 47 HCPs (19%). Knowledge on hand hygiene significantly improved for 10 out of 25 questions (12–38% increases) but declined for eight questions (5–40% decreases). Seven questions showed no significant changes in knowledge. Overall hand hygiene compliance increased from 21% in 2019 to 40% in 2023 (p < 0.001). Improvements were observed across the hospital departments (p < 0.001) and staff categories (p < 0.001). In 2023, the lowest hand hygiene compliance was for/before touching a patient (29%), and before clean/aseptic procedures (37%). Hand hygiene compliance was improved, but progress fell short of the WHO’s desired 80% target. Sustained efforts and complementary interventions are needed to accelerate progress and achieve the desired outcomes. Full article

To reduce the risk of COVID-19 infection, transmission and illness during the pandemic, the Department for Education (DfE) issued guidance to schools. However, research on how the school community perceives the impact of the COVID-19 mitigation measures outlined remains limited. This qualitative study aims to explore the effects of school closures and in-school mitigation measures on daily school life, as well as their impact on mental health and wellbeing from the perspective of English secondary school staff and students. Participants were purposively sampled from English secondary schools serving diverse communities participating in the COVID-19 Mapping and Mitigation in Schools study (CoMMinS). Selection ensured representation of staff roles and student demographics. Semi-structured interviews were conducted remotely, and data analysed thematically. Interviews took place between January and August 2021 with participants from five secondary schools (20 staff and 25 students). Both staff and students reported significant disruption to school life, with four themes identified: (1) teaching and learning impact, (2) social impact, (3) safeguarding impact, and (4) and mental health and wellbeing impact. Findings highlight widespread negative effects across every aspect of school life, for both staff and students. This study suggests that COVID-19 mitigation measures in UK secondary schools led to a sense of loss and uncertainty as well as increased self-reported stress among both staff and students. Full article

Background/Objective: Early mobilization (EM) of critically ill patients is a feasible and safe intervention that limits the implications of bed rest and improves lung function. However, its limited implementation suggests a gap between the research evidence and clinical practice. It is widely accepted that early mobilization faces a variety of barriers. This study aimed to investigate the perceptions of Greek physiotherapists on EM barriers and record their knowledge and practices. Methods: We conducted an electronic survey using the online platform “Microsoft Forms”, among critical care physiotherapists in 66 hospitals that had an Intensive Care Unit (ICU) department in Greece in 2024. We administered a questionnaire, developed based on valid and reliable international questionnaires, with the following domains: education and knowledge on early mobilization, practices, perception regarding EM, and perceived barriers to early mobilization. Results: A total of 126 Greek physical therapists participated. The majority of them worked in urban area hospitals and in a rotation schedule around all departments. Most physical therapists stated that early mobilization is a priority for the patient’s rehabilitation and an important factor in preventing the complications of bed rest. Yet, they do not use specific protocols. Most had knowledge of what EM involved and the international guidelines. The most common barriers reported were the hemodynamic instability and the incoherence with the ventilator. Dedicated physiotherapists singled out certain barriers like the presence of delirium and the lack of communication among ICU staff. Additionally, physiotherapists with more years of experience did not acknowledge tubes, connections, femoral lines and Body Mass Index (BMI) as barriers. Conclusions: Most Greek physiotherapists believe that early mobilization is crucial for the rehabilitation of critically ill patients. A significant percentage know the guidelines, yet they do not follow a specific protocol. Various barriers prevent its implementation, which depends on the patients, healthcare providers, and the overall process. Yet, It is recognized that practices and perceived barriers are influenced by experience and work schedule. Establishing clinical protocols is essential to facilitate the implementation of early mobilization and support patient rehabilitation. Future efforts should focus on designing strategies and EM protocols for physiotherapy in Greek ICUs. Also, we need to monitor changes in perceived barriers across other countries as focus on the matter via published studies and clinical seminars could lead to significant changes. Full article