Hospital Environment Research Articles

Nurse perceptions of practice environment, quality of care and patient safety across four hospital levels within the public health sector of South Africa

Improving the practice environment, quality of care and patient safety are global health priorities. In South Africa, quality of care and patient safety are among the top goals of the National Department of Health; nevertheless, empirical data regarding the condition of the nursing practice environment, quality of care and patient safety in public hospitals is lacking.AimThis study examined nurses’ perceptions of the practice environment, quality of care and patient safety across four hospital levels (central, tertiary, provincial and district) within the public health sector of South Africa.MethodsThis was a cross-sectional survey design. We used multi-phase sampling to recruit all categories of nursing staff from central (n = 408), tertiary (n = 254), provincial (n = 401) and district (n = 244 [large n = 81; medium n = 83 and small n = 80]) public hospitals in all nine provinces of South Africa. After ethical approval, a self-reported questionnaire with subscales on the practice environment, quality of care and patient safety was administered. Data was collected from April 2021 to June 2022, with a response rate of 43.1%. ANOVA type Hierarchical Linear Modelling (HLM) was used to present the differences in nurses’ perceptions across four hospital levels.ResultsNurses rated the overall practice environment as poor (M = 2.46; SD = 0.65), especially with regard to the subscales of nurse participation in hospital affairs (M = 2.22; SD = 0.76), staffing and resource adequacy (M = 2.23; SD = 0.80), and nurse leadership, management, and support of nurses (M = 2.39; SD = 0.81). One-fifth (19.59%; n = 248) of nurses rated the overall grade of patient safety in their units as poor or failing, and more than one third (38.45%; n = 486) reported that the quality of care delivered to patient was fair or poor. Statistical and practical significant results indicated that central hospitals most often presented more positive perceptions of the practice environment, quality of care and patient safety, while small district hospitals often presented the most negative. The practice environment was most highly correlated with quality of care and patient safety outcomes.ConclusionThere is a need to strengthen compliance with existing policies that enhance quality of care and patient safety. This includes the need to create positive practice environments in all public hospitals, but with an increased focus on smaller hospital settings.

Radar in the darkness. The dreams and art of a psychotherapist in a forensic institution

Under the assault of disturbing experiences that seem sealed into a bodily discourse, there appears an increased permeability between the dream space and the psychotherapy space. It is in the forensic in-patient hospital environment that I have commonly sat with a calm and compliant patient to find myself grappling with an overwhelming pull toward sleep. Such tiredness in countertransference can be understood as a manifestation of the weight of buried or repressed disturbance which can only seemingly be registered at a bodily level. Forensic patients are usually the subject of vilification from the courtrooms to sensationalist media reports in a system that further bottlenecks their emotional lives. It seems to me that sometimes there can be a fine line between continuing the trend of condemnation and the taking up of clinical responsibility. It is perhaps one of the most helpful aspects of psychoanalytic work, that we consider the projective processes involved in the criminal justice system. That we look to ourselves and our own countertransference for greater clinical clarity, a radar in the darkness. It is with this in mind that I write an introspective paper focussing on the lens of my own dream life and artistic responses to the environment of a forensic institution.

Assessing the Relationship between Demographic Attributes and Patients' Views of Hospital Environment

The objective of this study was to examine the relationship between patient demographic factors (gender, age, marital status) and their perception of a patient-friendly hospital environment. A cross-sectional study was conducted using a questionnaire to collect data from 41 patients at a hospital in Kathmandu, Nepal. The questionnaire assessed perceptions of privacy, visitation, amenities, way finding, and other aspects that contribute to a patient-friendly environment. Correlation analysis was used to analyze the relationship between demographic variables and overall satisfaction. Most respondents were younger, female patients. Descriptive analysis found neutral to average satisfaction across different environment domains. Correlation analysis showed no significant relationships between gender, age, marital status and perception of a patient-friendly environment (p>0.05 for all). Patient demographics did not appear to influence perceptions of a patient-friendly environment in this study. While most domains scored neutrally, opportunities remain to enhance certain areas like bathroom accessibility and parking. Larger studies are needed to further understand how hospitals can optimize their physical environments to better support patients.

Emergence of multidrug-resistant Staphylococcus haemolyticus in Neonatal Intensive Care Unit in Southern France, a Genomic Study

An emergence of multidrug-resistant (MDR) Staphylococcus haemolyticus has been observed in the neonatal intensive care unit (NICU) of Nîmes University Hospital in southern France. A case-control analysis was conducted on 96 neonates, to identify risk factors associated with S. haemolyticus infection, focusing on clinical outcomes. Forty-eight MDR S. haemolyticus strains, isolated from neonates between October 2019 and July 2022, were investigated using routine in vitro procedures and whole-genome sequencing. Additionally, five S. haemolyticus isolates from adult patients were sequenced to identify clusters circulating within the hospital environment. The incidence of neonatal S. haemolyticus was significantly associated with low birth weight, lower gestational age, and central catheter use (p<0.001). Sepsis was the most frequent clinical manifestation in this series (20/46, 43.5%) and was associated with five deaths. Based on whole-genome analysis, three S. haemolyticus genotypes were predicted: ST1 (6/53, 11%), ST25 (3/53, 5.7%), and ST29 (44/53, 83%), which included the subcluster II-A, predominantly emerging in the neonatal department. All strains were profiled in silico to be resistant to methicillin, erythromycin, aminoglycosides, and fluoroquinolones, consistent with in vitro antibiotic susceptibility tests. Moreover, in silico prediction of biofilm formation and virulence-encoding genes supported the association of ST29 with severe clinical outcomes, while the persistence in the NICU could be explained by the presence of antiseptic and heavy metal resistance-encoding genes. The clonality of S. haemolyticus ST29 subcluster II-A isolates confirms healthcare transmission causing severe infections. Based on these results, reinforced hygiene measures are necessary to eradicate the nosocomial transmission of MDR strains.

Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study.

To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). A patient representative has been involved in planning this study.

Organizational culture and climate among hospitals in Jolo: Nurses’ perspective

This study assessed the l extent of organizational culture among hospitals in Jolo as perceived by nurses; extent of organizational climate among hospitals in Jolo as perceived by nurses Fiscal Year 2023. With 100 samples taken through non-probability sampling method via purposive sampling, and with the use of weighted mean, standard deviation, t-test for independent samples, One-way ANOVA, and Pearson’s r, this study reveals the following findings: 1) Of the 100 nurse-respondents, mostly are female within the age range of 30 years old &amp; below, mostly are staff nurse, with 5 years &amp; below of work experience, and mostly with contractual employment status; 2) On the average, positive organizational culture is provided by hospitals in Jolo; 3) On the average, positive organizational climate is afforded by hospitals in Jolo; 4) Generally, profile variables like age, gender, position, years of experience, and employment status do not significantly mediate in ways how nurse-respondents assessed the extent of organizational culture in hospitals in Jolo; 5) Generally, profile variables like age, gender, position, years of experience, and employment status do not significantly mediate in ways how nurse-respondents assessed the extent of organizational climate in hospitals in Jolo; 6) Generally, the group of nurse-respondents who assessed the extent of organizational Culture as Agree or with High Extent is mostly probably the same group of nurse-respondents who assessed the extent of knowledge Organizational Climate as Agree or with High Extent, respectively; 7) This study seems to support Edgar Schein’s (2010) Organizational Culture Model which posits that organizational culture consists of three levels: artifacts and behaviors, espoused values, and underlying assumptions. In the hospital environment, artifacts and behaviors refer to observable elements such as rituals, communication styles, and physical spaces found within the healthcare facility. The collaboration of nursing staff during patient handovers and the communication channels used can reflect the underlying organizational culture.

Assessing child satisfaction and expectations for developing a child-friendly environment at the pediatric department in a general hospital in Qatar

Background“Patient-centered” care positions the patient at the core and emphasizes fulfilling their unique needs, preferences, and values. This approach is particularly significant in the context of children. Although widely recognized as necessary, this approach is not universally implemented. The children find themselves in hospital wards where they are required to follow protocols and systems designed primarily for adults. In the appropriate atmosphere, children often express themselves more effectively through words, body language, and play, leading to a richer understanding of their needs. There is growing recognition of the importance of addressing children's concerns regarding hospital environments.AimThis study investigates children's satisfaction with the physical aspect of the hospital environment. Insights from this exploration could provide valuable input for creating hospital environments centered around children's needs and preferences.MethodsThis mixed-methods study involves children aged 6–14 years with parental consent from a premiere healthcare provider in the state of Qatar. The survey used nine items to gauge satisfaction with the existing hospital environment as a “child-friendly hospital” and another nine items to explore their expectations for such environments. The Mann–Whitney U and Kruskal–Wallis tests as well as thematic analyses were employed to assess the statistical significance of differences in satisfaction levels and children's expectations of the hospital's physical environment.ResultsA total of 398 children participated in the study. Of them, 40.3% were aged 6–8 years; 60.3% had experienced two to five hospital visits; 55.8% of children participated during their outpatient service visit; and 31.7% were Asian. Children's satisfaction levels with various aspects of the hospital environment—including its physical appearance, signage, lounge, consultant rooms, corridors, bedrooms, TV content, toys, and staff uniforms—were in the range of 42.9%–59%. The children expressed a desire for a hospital environment that is spacious, colorful, attractive, and filled with cartoon characters and toys in the children's hospital from the front lounge to the inpatient units.ConclusionThe findings underline the importance of considering the perspectives of children in evidence-based healthcare design. The study reveals that children's satisfaction with the hospital environment is generally average or below average. Ultimately, a “child-friendly hospital environment” integrates children's rights into healthcare to significantly improve outcomes.

ENVIRONMENTAL IMPACTS OF COVID-19 HOSPITALS AND ARCHITECTURAL REMEDIES

Pandemics, with their potential for widespread devastation and global impact, have historically been a critical concern for public health and society. the historical impact of pandemics on the environment underscores the interconnectedness of human lives and health, societal systems, and the environment, highlighting the need for holistic approaches to public health and environmental management. The COVID-19 pandemic has brought about significant changes in healthcare facilities worldwide, particularly in hospitals designated for COVID-19 patients to counter and serve the impact on humans which universally led to the rapid establishment of specialized hospitals to manage the surge in patients. However, such hospitals not only posed significant challenges to healthcare systems worldwide but also highlighted the need for sustainable practices in designing and operating healthcare facilities along with their significant environmental impacts. In response to these challenges, architects, designers, and healthcare professionals have explored innovative architectural and other remedies to mitigate the environmental impacts of COVID-19 hospitals. This paper explores these potential environmental impacts and proposes architectural planning strategies that include sustainable practices and green design principles through which, by implementing, COVID-19 hospitals or similar hospitals can minimize their environmental footprint and contribute not only to a more sustainable healthcare system but also create healthier and more sustainable environments for patients, healthcare workers, and the community at large. KEYWORDS: Hospital Environmental Impact, Hospital Environment Relation, COVID-19 Hospital Impact on Environment, COVID-19 Hospital Impact, Environmental Impact of Pandemics, Pandemic Hospital Impact on Environment

Analysing Pre-Operative Gait Patterns Using Inertial Wearable Sensors: An Observational Study of Participants Undergoing Total Hip and Knee Replacement

Background. Knee and hip arthroplasty are two of the most frequently performed procedures in orthopaedic surgery. They are associated with positive patient-reported outcomes and significant improvements in quality of life for patients. Despite this, there may be room for further progress by quantifying functional improvements with gait analysis. Our study therefore aims to characterise the disease-specific gait pattern of participants with knee and hip osteoarthritis undergoing total joint replacement using a single chest-based wearable sensor. Methods. Twenty-nine participants awaiting total hip replacement and 28 participants awaiting total knee replacement underwent three-dimensional motion analysis with inertial wearable sensors. These gait metrics were then compared with 28 healthy controls of similar ages. Differences in gait metrics were evaluated using a T-test. The participants were recruited through a single centre to participate in this cross-sectional observational study. Participants with osteoarthritis severity sufficient to warrant surgical intervention were considered for inclusion in our study. The participants were instructed to walk 15–120 m in a hospital environment while fitted with a chest-based wearable sensor. Results. In total, three domains were evaluated, including spatiotemporal, variability and asymmetry parameters. There were marked variations in the gait asymmetry parameters and step length variation in both the hip and knee osteoarthritis patients compared with the healthy controls. The magnitude of gait deterioration in terms of step length asymmetry was greater on average in the hip osteoarthritis group than the knee group. The hip osteoarthritis (+180%, p &lt; 0.001) and knee osteoarthritis (+129%, p = 0.001) groups demonstrated marked differences in step length asymmetry. Discussion. A single chest-based sensor was found to be capable of detecting pathological gait signatures in osteoarthritis patients when compared with age-matched controls. Future studies should compare pre- and postoperative changes to disease-specific gait impairments to validate the use of wearable sensors as a clinical adjunct.

Prevalence of burnout among healthcare professionals: a survey at fort portal regional referral hospital

The work environment in most hospitals is characterised by activities that are strenuous both physically and mentally. These can result in physical and mental exhaustion, which can lead to burnout if not adequately addressed. Burnout among healthcare professionals can negatively affect their clinical decision-making, quality of communication with patients and colleagues as well as their ability to cope with work-related pressure, and ultimately affect the quality of care and patient outcomes. The inclusion of burnout in the 11th revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon indicates that it is an issue of concern in the workplace for which people may need professional attention. This descriptive cross-sectional survey aimed to determine the point prevalence of burnout among healthcare professionals at Fort Portal Regional Referral Hospital and the factors contributing to burnout. The study also evaluated the linear relationship between the age of workers, their work duration at the hospital, and their burnout score, in addition to the possible impact on patient care. Participants were selected from the hospital WhatsApp group and invitations to participate were sent to their individual accounts. Burnout was assessed using the Copenhagen Burnout Inventory. Generally, burnout scores ranged from 16% to 86%, with an overall mean burnout score of 57.4%. The notable factors contributing to burnout included imbalances in duty allocation, physically strenuous work, and resource constraints. Burnout of varying levels was found to be prevalent across all carders in the hospital, although the results indicate that most healthcare professionals experience moderate burnout. Most of the factors contributing to burnout are within the scope of hospital leadership to address. The possible impact on staff performance and patients’ clinical outcomes is speculative, and additional studies are required.

Hospital Environmental Factors That Influence Peripheral Oxygen Saturation Measurements: A Cross-Sectional Study.

Pulse oximetry is a non-invasive, cost-effective, and generally reliable instrument measuring pulse rate and peripheral oxygen saturation (SpO2). However, these measurements can be affected by the patient's internal or external factors, including the type of pulse oximeter device (POD). (1) This study's objective was to identify potential environmental factors that may impact the measurements taken by three PODs. (2) Methods: A descriptive-analytical cross-sectional study was designed. The patients' SpO2 levels were measured using a standard monitor and two PODs owned by the professionals. The measurements were taken on the patients' fingers. Concurrently, we evaluated the surrounding environmental conditions, encompassing temperature, humidity, illuminance, and noise. (3) Results: This study involved 288 adult participants in the sample. For each 20-decibel increment in noise, there was a reduction in SpO2 by an average of 1%, whereas for every additional degree of ambient temperature, SpO2 decreased by an average of 2% (4) Conclusions: Significant correlations between SpO2 and age, as well as with noise and ambient temperature, were observed. No significant differences between oxygen saturation and lighting or humidity were observed. This study was prospectively registered with the Clinical Research Ethics Committee of Gran Canaria at the Dr. Negrín University Hospital, with protocol code 2019-247-1, and approved on 24 May 2019.

The Integration of Virtual Development into the Organizational Complexity of Healthcare

The development of the computer system in a hospital environment improves patients’ quality of life and allows healthcare management to evolve into the greatest virtual and functional techniques. Considering state-of-the-art devices as an aid in various highly complex surgical procedures, this gives society confidence in the services available, with continuous and rehabilitation treatments being the ones that have a greater number of technological devices helping in their favor. The contextualization aims to analyse that the inclusion of digitalization linked to virtual realities with different aspects and robotics helps to reduce hospitalization time. Methodologically, a bibliographic review was used, recommending the topic with articles that reference clinically successful research, and a Capes database was used in the search for the retrospective review. It is considered that the production describes the quality and reliability of virtual techniques and the scope of health improvement, which thus corroborates the benefits of organizational understanding in economic and care terms.

Abstract PO3-11-01: Single centre experience of the adoption of self-administered HER2-directed therapy in patients with breast cancer

Abstract Single centre experience of the adoption of self-administered HER2-directed therapy in patients with breast cancer Background: Programs to promote the self-administration of systemic anti-cancer therapy (SACT) offer greater convenience and shared decision making for patients with the opportunity to alleviate pressures on cancer services. Aims and Objective: The aims of this study were to quantify the uptake/acceptability of self-administration (SA) of subcutaneous trastuzumab (sc T), to evaluate safety, patients’ perception of the programme and the chair capacity released as a consequence. Methods: Patients receiving T for the treatment of HER2 +ve breast cancer were offered training in SA. The competency-based training programme, under the supervision of a chemotherapy-trained nurse, consisted of a minimum of 3 training sessions. Patients were also provided with printed and electronic material (via an App) on how to self-administer sc T, with 24/7 contact details in the event of an adverse event or device failure. Once trained and deemed competent, sc T was shipped to the patients’ home in a temperature-controlled environment, in a pre-filled syringe. All patients were assessed by telephone one day before and one day after SA using the Common Terminology Criteria for Adverse Events (CTCAE). Analysis of the total number of administrations of sc T, between February 2022 and June 2023 was conducted. A telephone survey using a validated questionnaire Self-Management Assessment scale (SMASc) was also undertaken. Results Of 46 breast cancer patients receiving single agent sc T, 32 agreed to participate in the program and were trained. 2 patients were undergoing training at data analysis. 6 patients declined and 6 were ineligible for the programme on the basis of inclusion criteria. The median age of the 32 patients that participated was 62, (range 27-77). The average distance from their home address to the cancer centre was 11.7 miles (range 3.5-27.9). 25 (78%) patients were Caucasian, 4 (13%) were Asian and 3 (9%) were of African/Caribbean origin. Patients had received an average of 10 sc injections in the hospital environment (median 5, range 1-103) before starting the training sessions. They required an average of 3 training sessions before sign-off (median 3, range 1-4). In the 32 patients studied, a total of 302 SA injections were delivered median 9 (range 1- 24) No Grade 3 or 4 CTCAE toxicities or infusion-related reactions were reported. During the 17-month period, a total of 302 hours of chair time was saved. 25 of the 32 patients responded to SMASc questionnaires utilising the six-point Likert scale. Patients reported average scores of 5.32 (median 6) and 5.56 (median 6) respectively, for questions relating to having information about their condition and sufficient training to self-administer. They felt that they had sufficient support to participate in the programme (average 5.56 median 6). 80% of the patients would recommend this programme and 88% felt they had benefited. Comments from patients themed around the value of the support provided, ease of administration and time saved. Discussion Programs such as these empower patients and carers to take a more active role in managing their condition with consequent reduced hospital attendance. Safety and acceptability for those patients who agreed to the program has been confirmed. Success of this program with sc T has enabled expansion to incorporate self-administration of Phesgo (sc trastuzumab and pertuzumab) with 31% (14/45) of the current P patient cohort enrolled onto the programme within 2 weeks of roll out and the first patients self-administering their treatment from August 2023. With the continued expansion of SACT treatments, we encourage stakeholders to consider self-administration of SACT as an option. Formulation of treatments conducive to patient self-administration is a key component to this. Citation Format: Wendy Ng, Vikash Dodhia, Amy Guppy, Stephanie Sutherland, Marlgozata Wojtas, Karen Harrold, Adisa Aolat, Tome Tapiwa, David Miles. Single centre experience of the adoption of self-administered HER2-directed therapy in patients with breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-01.

Kinetics of inactivation of bacteria responsible for infections in hospitals using UV-LED

Controlling the microbial load in the environment is crucial to prevent the spread of organisms. The continuous spread of nosocomial infections in hospital facilities and the emergence of the coronavirus (COVID-19) highlighted the importance of disinfection processes in health safety. This work aimed to evaluate the effectiveness of LED-based disinfection lamps on bacteria from the ESKAPEE group and virus phage in vitro inactivation to be applied in hospital environments and health facilities disinfection.This study evaluated the effect of different UV wavelengths (275 nm, 280 nm (UVC), 310 nm (UVB) and 340 nm (UVA)) on the disinfection process of various microbial indicators including E. coli, S. aureus, P. aeruginosa, B. subtilis and Bacteriophage lambda DSM 4499. Exposure time (5 min–30 min), exposure distance (0.25 m and 0.5 m) and surface materials (glass, steel, and polished wood) were evaluated on the disinfection efficiency. Furthermore, the study determined the recovery capacity of each species after UV damage.UVC-LED lamps could inactivate 99.99 % of microbial indicators after 20 min exposures at a 0.5 m distance. The exposure time needed to completely inactivate E. coli, S. aureus, P. aeruginosa, B. subtilis and Bacteriophage lambda DSM 4499 can be decreased by reducing the exposure distance. UVB-LED and UVA-LED lamps were not able to promote a log reduction of 4 and were not effective on B. subtilis or bacteriophage lambda DSM 4499 inactivation. Thus, only UVC-LED lamps were tested on the decontamination of different surface materials, which was successful. P. aeruginosa showed the ability to recover from UV damage, but its inactivation rate remains 99.99 %, and spores from B. subtilis were not completely inactivated. Nevertheless, the inactivation rate of these indicators remained at 99.99 % with 24 h incubation after UVC irradiation. UVC-LED lamps emitting 280 nm were the most indicated to disinfect surfaces from microorganisms usually found in hospital environments.

A Review of Biophilic Design Concepts in Hotel Architecture

Incorporating natural materials and features into the built environment is the goal of the creative approach known as biophilic design, which aims to link people with nature through architecture and interior design. The premise of the theory is that people are naturally drawn to nature and that spending time in nature can improve productivity, well-being, and general quality of life. It has been demonstrated that biophilic architecture design can convey a healthy environment, lower stress levels, and promote a sense of serenity for people residing in it. This is because the design uses natural materials and natural patterns to create a connection between humans and the natural world. This study looks into the application of biophilic design ideas in hospitality environments. This study aims to investigate if, in the context of hotels, including biophilic design improves guest emotional responses, perceived quality, and behavioral intentions. The results of this study showed that biophilic designs produced more favorable emotional and behavioral reactions than the standard design using the scenario-based experiment. Furthermore, patrons thought hotels with biophilic decor were of higher caliber. The goal of biophilic design is to incorporate natural aspects into the built environment to improve overall guest experience, comfort, and well-being. It is based on the human connection to nature. Site inspections, management interviews, and visitor surveys are a few of the data collection techniques used in hotels. The results provide important insights for architects, designers, and hoteliers looking to build more sustainable and guest-centric settings by illuminating the challenges, advantages, and consequences of using biophilic design in a hospitality context.

Feeding Practices of Stable Term and Late Preterm Neonates Born at a Tertiary Hospital in the Philippines during the COVID-19 Pandemic

Objective. We aimed to evaluate the impact of maternal COVID-19 infection and separation of the mother-babydyad on feeding practices by determining modes of feeding upon discharge and following up at 2-3 days, 14 days, and 1 month post-discharge. Methods. This was a prospective observational cohort study conducted at the Philippine General Hospital, a tertiary government COVID-19 referral center in Manila. Mothers who delivered between the months of July and August 2021, and whose COVID-19 status was known were followed up on their baby’s mode of feeding at 2-3 days, 14 days, and 1 month post-discharge via phone call. For babies of COVID-19 positive mothers, presence of any symptoms (up to the 14-day time point only) as well as adherence to infection prevention and control practices were also identified. Results. For all time points post-discharge, breastfeeding rates were higher in babies born to COVID-19-negative mothers and in those who were roomed in. However, the differences were not statistically significant. Of the 108 infants, 72.90% remained exclusively breastfed by 1 month of age, with 4.67% formula-fed and 22.43% on mixed feeding. Perception of insufficient milk supply was the most common reason for shifting to formula or mixed feeding. We found a significantly higher direct breastfeeding rate upon discharge in the roomed-in population compared to those admitted to the NICU. Risk factors affecting breastfeeding at 1 month of age was the presence of COVID-19 infection in the mother and mother-baby separation due to NICU admission COVID-19-positive mothers were 66.02% less likely (p=0.016, 95% CI 0.1411 to 0.8183) to still be breastfeeding at 1 month, and separation was not found to be a significant risk factor. Conclusions. Feeding practices can be affected not only by COVID-19 infection in the mother and its attendantdifficulties such as prolonged hospital stay and physical and social isolation, but also by limitations in the hospital environment that can have an impact on breastfeeding education, support, and opportunities for mother-childbonding.

Development of a Secure Web-Based Medical Imaging Analysis Platform: The AWESOMME Project.

Precision medicine research benefits from machine learning in the creation of robust models adapted to the processing of patient data. This applies both to pathology identification in images, i.e., annotation or segmentation, and to computer-aided diagnostic for classification or prediction. It comes with the strong need to exploit and visualize large volumes of images and associated medical data. The work carried out in this paper follows on from a main case study piloted in a cancer center. It proposes an analysis pipeline for patients with osteosarcoma through segmentation, feature extraction and application of a deep learning model to predict response to treatment. The main aim of the AWESOMME project is to leverage this work and implement the pipeline on an easy-to-access, secure web platform. The proposed WEB application is based on a three-component architecture: a data server, a heavy computation and authentication server and a medical imaging web-framework with a user interface. These existing components have been enhanced to meet the needs of security and traceability for the continuous production of expert data. It innovates by covering all steps of medical imaging processing (visualization and segmentation, feature extraction and aided diagnostic) and enables the test and use of machine learning models. The infrastructure is operational, deployed in internal production and is currently being installed in the hospital environment. The extension of the case study and user feedback enabled us to fine-tune functionalities and proved that AWESOMME is a modular solution capable to analyze medical data and share research algorithms with in-house clinicians.

Computer Vision System Based on the Analysis of Gait Features for Fall Risk Assessment in Elderly People

Up to 30% of people over the age of 60 are at high risk of falling, which can cause injury, aggravation of pre-existing conditions, or even death, with up to 684,000 fatal falls reported annually. This is due to the difficult task of establishing a preventive system for the care of the elderly, both in the hospital environment and at home. Therefore, this work proposes the development of an intelligent vision system that uses a novel methodology to infer fall risk from the analysis of kinetic and spatiotemporal gait parameters. In general, each patient is assessed using the Tinetti scale. Then, the computer vision system estimates the biomechanics of walking and obtains gait features, such as stride length, cadence, period, and range of motion. Subsequently, this information serves as input to an artificial neural network that diagnoses the risk of falling. Ninety-six participants took part in the study. The system’s performance was 99.1% accuracy, 94.4% precision, 96.9% recall, 99.4% specificity, and 95.5% F1-Score. Thus, the proposed system can evaluate the fall risk assessment, which could benefit clinics, hospitals, and even homes by allowing them to assess in real time whether a person is at high risk of falling to provide timely assistance.

Sustaining e-health innovations in a complex hospital environment: learning through evidence.

Implementing and sustaining technological innovations in healthcare is a complex process. Commonly, innovations are abandoned due to unsuccessful attempts to sustain and scale-up post implementation. Limited information is available on what characterizes successful e-health innovations and the enabling factors that can lead to their sustainability in complex hospital environments. We present a successful implementation, sustainability and scale-up of a virtual care program consisting of three e-health applications (telemedicine, telehome monitoring, and interactive voice response) in a major cardiac care hospital in Canada. We describe their evolution and adaptation over time, present the innovative approach for their "business case" and funding that supported their implementation, and identify key factors that enabled their sustainability and success, which may inform future research and serve as a benchmark for other health care organizations. Despite resource constraints, e-health innovations can be deployed and successfully sustained in complex healthcare settings contingent key considerations: simplifying technology to make it intuitive for patients; providing significant value proposition that is research supported to influence policy changes; involving early supporters of adoption from administrative and clinical staff; engaging patients throughout the innovation cycle; and partnering with industry/technology providers.

Moral harassment in university hospital of Marrakesh: Epidemiological investigation

Introduction: moral harassment in the workplace is a growing phenomenon worldwide. Leymann defined it as a form of psychological terrorism that manifests itself over a relatively long period of hostile words or actions expressed or manifested by one or more people towards a third person (target) at work. It causes damaging consequences on the mental and physical workers health, with negative economic impacts on the company. Objectives: our objective was to study the epidemiological characteristics, the clinical aspects, and the consequences of moral harassment among the medical and paramedical staff of the Mohammed VI university hospital in Marrakech. Methods: We carried out a descriptive transversal study over six months covering 329 caregivers working at the Mohammed VI university hospital in Marrakech. The support of the investigation was an individual, and a strictly anonymous questionnaire containing the French version validated by the questionnaire of Leymann entitled Leymann Inventory of Psychological Terror; sociodemographic, mental health, and professional data were also collected. Results: In our study, the prevalence of moral harassment was 27.5%, according to Leymann's criteria (exposure to at least one situation, at least once a week for at least six months). Moral violence targets were between 25 to 35 years old (76%) and less than five years seniority (55%). The victims were represented mainly by residents (65.5%) and interns (33%). There was no correlation between sex and exposure to psychological violence (p=0,36). The supervisor was the main harasser (80%). Anxiety, depression, and symptoms of post-traumatic stress disorder had been the most observed consequences on the mental health of victims. Conclusion: Moral harassment at work seems, by its prevalence, to invade the hospital environment, and young doctors constitute a particular target. Exposure to this phenomenon has a negative impact on an individual's mental health. Our results are alarming enough to prompt us to continue investigating and put in place recommendations to limit and prevent the consequences.