Hospital Setting Research Articles

Effect of Long COVID on Work Performance and Annual Monetary Loss among Infected Healthcare Workers at a Tertiary Hospital in Malaysia.

To assess and compare the work performance loss (absenteeism and presenteeism) and the estimated annual monetary loss among healthcare workers with and without Long COVID. A retrospective cohort study was conducted between October 2022 and April 2024 using an online questionnaire. The shortened version of the Health and Work Performance Questionnaire was used to estimate the work performance effect among healthcare workers with a history of COVID-19 infection. Healthcare workers with Long COVID have a significantly lower absolute presenteeism and higher annual monetary loss of presenteeism. The mean annual monetary loss of presenteeism was higher in those with Long COVID (MYR 10,866.61) compared to those without (MYR 9,243.85). Implementing supportive work strategies in hospital settings is recommended to reduce absolute presenteeism and the annual monetary loss of presenteeism.

In-hospital initiation of sodium-glucose co-transporter-2 inhibitors in patients with acute heart failure.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardiovascular and kidney benefits to patients with heart failure (HF) and/or chronic kidney disease (CKD), regardless of diabetes status and left ventricular ejection fraction (LVEF). Despite robust data demonstrating the efficacy of SGLT-2 inhibitors in both ambulatory and hospital settings, real-world evidence suggests slow and varied adoption of SGLT2 inhibitors among patients hospitalized for HF. Barriers to implementation of SGLT2i may include clinicians' concerns regarding potential adverse events such as diabetic ketoacidosis (DKA), volume depletion, and symptomatic hypoglycemia; or concerns regarding physiologically expected reductions in eGFR. Guidelines lack specific, practical safety data and definitive recommendations regarding in-hospital initiation and continuation of SGLT2i in patients hospitalized with HF. In this review, we discuss the safety of in-hospital SGLT2 inhibitor initiation based on recent trials and highlight the clinical implications of their early use in patients hospitalized for HF.

Standardizing Identification of Cognitive Impairment in the Acute Hospital Setting: Toward a Common Language.

Although many hospitals universally screen their patients for functional mobility and activity impairment, there is no common method to do this for cognitive impairment. Establishing an interdisciplinary and standardized process to screen for cognitive impairment is essential for early identification of impairments, optimization of patients' function, and safe discharge planning. Previously, the reliability and validity of the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) were measured among occupational therapy practitioners and speech-language pathologists; however, its reliability among other team members, specifically nurses, is unknown. This study reports the interprofessional interrater reliability of the AM-PAC ACISF in the acute care hospital setting. To examine the nursing-therapist interrater reliability of the AM-PAC ACISF in the acute care hospital setting. A prospective study using a convenience sample. Acute care hospital. Fifty adult patients, six nurses, five occupational therapy practitioners, and one speech-language pathologist. Interrater reliability for the AM-PAC ACISF among therapists and nurses. Interrater reliability was good among nurses and therapists, with an intraclass correlation coefficient of .88 (95% confidence interval [.79, .93]) for the AM-PAC ACISF. Findings suggest that the AM-PAC ACISF is reliable for use among interdisciplinary teams, helps to establish a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting. Plain-Language Summary: Having an interdisciplinary and standardized process to screen patients early for cognitive impairment is essential for identifying impairments, optimizing patients' function, and facilitating safe discharge planning in the acute care setting. Early identification of cognitive impairment by the interdisciplinary team can also allow for timely occupational therapy and other rehabilitation service interventions. The findings of this study suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) can reliably be used by interdisciplinary teams, establishes a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.

Classics in Chemical Neuroscience: Medetomidine.

Medetomidine is an FDA-approved α2-adrenoreceptor (α2-AR) agonist used as a veterinary sedative due to its analgesic, sedative, and anxiolytic properties. While it is marketed for veterinary use as a racemic mixture under the brand name Domitor, the pharmacologically active enantiomer, dexmedetomidine, is approved for sedation and analgesia in the hospital setting. Medetomidine has recently been detected in the illicit drug supply alongside fentanyl, xylazine, cocaine, and heroin, producing pronounced sedative effects that are not reversed by naloxone. The pharmacological effects along with the low cost of supply and lack of regulation for medetomidine has made it a target for misuse. Since 2022, medetomidine has been found as an adulterant in samples of seized drugs, as well as in toxicological analyses of patients admitted to the emergency department after suspected overdoses across several U.S. states and Canada. This Review will discuss the history, chemistry, structure-activity relationships, drug metabolism and pharmacokinetics (DMPK), pharmacology, and emergence of medetomidine as an adulterant in drug mixtures in the context of the current opioid drug crisis.

CUIDADOS DE ENFERMAGEM NA PREVENÇÃO DE INFECÇÕES HOSPITALARES: ESTRATÉGIAS E PROTOCOLOS

Objective: The study aimed to analyze the strategies and protocols adopted by nursing professionals in order to evaluate their effectiveness and propose improvements. Method: A bibliographic methodology was used, reviewing the current literature on hand hygiene protocols, use of Personal Protective Equipment (PPE), and prevention of infections associated with invasive devices. Results: The results indicated that the fundamental protocols are effective in reducing infections, but highlighted the need for continuous training and the potential use of monitoring technologies to improve adherence and evaluation of practices. The study objectives were achieved, recommending regular updating of protocols, intensification of training, and the integration of new technologies to improve strategies for preventing hospital infections. Conclusion: This article investigated nursing care in the prevention of hospital infections. The justification for the study lies in the importance of optimizing infection prevention, a continuous challenge in hospital settings that impacts patient safety and health costs. Keywords: Hospital infections. Nursing care. Prevention. Control strategies.

Social workers’ perspectives on anti-Black racism and parenting outcomes for incarcerated pregnant women with substance use histories

Summary Black women who use substances face significant barriers to accessing resources and parenting their children, largely as a result of interactions with the criminal legal, child welfare, and healthcare systems. While extensive literature has demonstrated how structural racism and punitive policy approaches underpin the operation and impact of these systems, minimal attention has been paid to how social workers approach child, maternal, and family well-being when interacting with clients who use substances and have been incarcerated. To address this gap, we conducted semi-structured qualitative interviews with 19 social workers practicing in jail/prison, community, and hospital settings across the United States. Findings Interviews identified the cyclical and intergenerational nature of harms perpetuated through criminal legal, child welfare, and healthcare systems. Participants described structural racism, inadequate resources (i.e., housing), and previous criminal legal and child welfare involvement as compounding barriers to an individual’s ability to parent and maintain recovery, particularly among Black families. Participants described the pervasiveness of structural racism but did not perceive themselves as active participants in perpetuating racist and oppressive structures. Applications Social workers engage with Black pregnant women who use substances across diverse practice settings and as such have the potential to both contribute to systemic harms and to champion interventions that target the root causes of inequity. Study findings support structural interventions that dismantle punitive systems and re-center the needs of Black communities, thereby supporting Black mothers in their fundamental right to parent their children.

Measuring compassion in end-of-life cancer patients: The Italian validation of the Sinclair Compassion Questionnaire (SCQit).

Compassion is acknowledged as a key component of high-quality palliative care, producing positive outcomes for both patients and healthcare providers. The development of the Sinclair Compassion Questionnaire (SCQ) fulfilled the need for a valid and reliable tool to measure patients' experience of compassion. To validate the Italian version of the SCQ and to evaluate its psychometric properties in a sample of cancer patients with a life expectancy of less than 4 months. Cronbach's alpha estimates were computed to evaluate the internal reliability. Exploratory Factor Analysis, Confirmatory Factor Analysis, and Item Response Theory analyses were performed to assess the validity of the construct. Divergent validity was assessed using the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction, the revised Edmonton Symptom Assessment Scale, and the Trust in Oncologist Scale-Short Form. Data were collected from 131 patients recruited in either a hospital or a hospice setting. The analyses confirmed the single factor structure of SCQit, with Confirmatory Factor Analysis factor loadings ranging between 0.81 and 0.92 and satisfactory internal reliability. Hospital setting and high diagnosis/prognosis awareness were associated with significantly lower SCQit scores, whereas practicing a religious faith was associated with greater experiences of compassion. The Italian version of the SCQ (SCit) is a valid and reliable measure of patient-reported compassion. The SCQit can be used in clinical practice and research to measure the compassion experiences of terminally ill cancer patients and to evaluate the effectiveness of training to promote compassionate care in healthcare professionals.

Direct Klebsiella pneumoniae Carbapenem Resistance and Carbapenemases Genotype Prediction by Al-MOF/TiO2@Au Cubic Heterostructures-Assisted Intact Bacterial Cells Metabolic Analysis.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections pose a significant threat to human health. Fast and accurate prediction of K. pneumoniae carbapenem resistance and carbapenemase genotype is critical for guiding antibiotic treatment and reducing mortality rates. In this study, we present a novel method using Al-MOF/TiO2@Au cubic heterostructures for the metabolic analysis of intact bacterial cells, enabling rapid diagnosis of CRKP and its carbapenemases genotype. The Al-MOF/TiO2@Au cubic composites display strong light absorption and high surface area, facilitating the in situ effective extraction of metabolic fingerprints from intact bacterial cells. Utilizing this method, we rapidly and sensitively extracted metabolic fingerprints from 169 clinical isolates of K. pneumoniae obtained from patients. Machine learning analysis of the metabolic fingerprint changes successfully distinguishes CRKP from the sensitive strains, achieving the high area under the curve (AUC) values of 1.00 in both training and testing sets based on the 254 m/z features, respectively. Additionally, this platform enables rapid carbapenemase genotype discrimination of CRKP for precision antibiotic therapy. Our strategy holds great potential for swift diagnosis of CRKP and carbapenemase genotype discrimination, guiding effective management of CRKP bacterial infections in both hospital and community settings.

The Greek version of the Richards‐Campbell Sleep Questionnaire: Reliability and validity assessment

Background: The lack of sleep is a significant concern for ICU patients, necessitating effective sleep-promoting interventions by nurses. A user friendly and reliable tool is essential for Greek nurses to evaluate the impact of these interventions on patients' sleep. This study aimed to translate the Richards Campbell Sleep Questionnaire (RCSQ) into Greek and ascertain the reliability and validity of this version in measuring sleep quality among ICU patients in a Greek hospital. Method and Material: The study assessed the night-time sleep of 50 patients in the general ICU of a tertiary hospital in Athens, Greece, from January 2022 to March 2023. The translation of the RCSQ into Greek adhered to all guidelines for translating and adapting psychometric scales. The reliability of the RCSQ scale was tested using Cronbach's alpha (𝛼). Results: The study included 32 male and 18 female patients. Cronbach's alpha (𝛼) was calculated to be 0.906, indicating excellent reliability for the RCSQ. The overall mean RCSQ score was 52.8 (SD=15.41), ranging from 12 to 78. About 60% of participants reported "good sleep", while 8% experienced "very poor sleep". Conclusion: The assessment of patient sleep should utilize a valid and reliable instrument. The Greek version of the RCSQ shows great promise for use in Greek hospital settings. It is concise, user-friendly, and comprehensible, and it has demonstrated reliability and validity in capturing various sleep domains, thereby providing a comprehensive assessment of sleep akin to the original version.

Traversing the boundaries in landscapes of practice: A mixed methods study of interprofessional education centered on inpatients in an acute hospital setting

Healthcare requires practitioners to successfully negotiate boundaries between communities of practice (CoP) in a clinical landscape of practice (LoP), with development of interprofessional identity important in promoting successful interprofessional collaboration. Interprofessional education (IPE) centered around acute hospital inpatients offers a potential pathway to encourage boundary negotiation and interprofessional identity development. This study aimed to explore interprofessional student teams and their interactions with patients in an acute hospital setting, while investigating if such interactions encouraged interprofessional collaboration and the development of an interprofessional identity. Pivoting around acute hospital inpatients, four interprofessional workshops occurred involving senior medicine, nursing and physiotherapy students. We utilized a concurrent mixed methods design, with qualitative predominating. Qualitative reflexive thematic analysis of post-workshop semi-structured focus groups was supported by quantitative investigation using a validated pre-test post-test international socialisation and valuing scale. Using the landscapes of practice theory lens, we noted that the central role of acute hospital inpatients in the IPE workshops enabled healthcare students to develop knowledgeability of the clinical LoP, in line with the three modes of identification of LoP, namely Engagement, Imagination and Alignment. Following the IPE workshops, where acute inpatients played the pivotal role, students demonstrated a statistically significant increase in interprofessional collaborative practice in terms of the overall interprofessional socialisation and valuing scale and its subscales of value, ability, and comfort in working with each other. Our findings indicate that IPE centered around acute hospital inpatients is a beneficial and effective way to successfully implement IPE in the undergraduate curriculum.

Influencing physician distribution through education: a qualitative study on retention in Japan’s rural hospitals

BackgroundAddressing the shortage of healthcare professionals in rural Japan poses significant challenges. At Sanmu Medical Center, incorporating resident physicians into a general medicine training program has proved effective in retaining them as supervising physicians. This study aims to identify the key factors contributing to the success of such programs.MethodsWe used a qualitative research design to comprehensively understand the factors contributing to physician retention in regional community hospitals in areas with physician shortages. Interviews were conducted with four experienced physicians, including the center director, who participated in the general or family medicine training programs at Sanmu Medical Center. Using a semi-structured questionnaire, we explored the factors influencing physician retention in community-based hospitals experiencing shortages. Two physicians specializing in community medicine conducted a content analysis under the supervision of three experts in community-oriented medical education and qualitative research. This approach helped compare retention factors perceived by physicians and the center director.ResultsContent analysis revealed 10 categories and 47 subcategories. The analysis revealed that “Educational activity” and “Supervising physicians and guidance system” are crucial for physician retention in rural hospitals in Japan. The study highlighted key educational factors contributing to retention: engagement in educational activities led to personal and professional growth, creating a rewarding experience for the physicians. Furthermore, a structured supervising physician system provided essential guidance and mentorship, improving the educational environment. Diverse learning opportunities and protected learning times were identified as critical for fostering a sustainable commitment among physicians to work in rural settings. These findings contribute to existing literature by detailing how structured educational activities and mentorship programs in rural hospital settings can significantly impact physician retention.ConclusionsCommunity-based medical education programs that focus on diverse clinical settings, mentorship, and a supportive work environment can enhance physician retention in rural areas. By fostering such educational and professional environments, healthcare institutions can address physician maldistribution and improve care quality in underserved communities. Our study offers practical insights that can be replicated or adapted by other rural hospitals facing similar challenges. It offers targeted strategies to address the unique challenges faced by female physicians in rural healthcare settings.

NANOPORE-BASED INTRA-OPERATIVE CLASSIfiCATION OF CENTRAL NERVOUS SYSTEM TUMOURS IN THE NHS

Abstract AIMS The 2021 WHO classification of CNS tumours necessitates the use of molecular testing in order to reach a confident diagnosis of many tumour types. At present, this is achieved using array-based technology delivered by a centralised model. This approach has inherent delays that mean it is often several weeks before the treating clinical team is informed of diagnosis, delaying the start of adjuvant therapy and causing significant distress for patients. As such, there is an urgent need to rethink this pathway and improve time to diagnosis. Nanopore longread sequencing technology has the potential to enable a paradigm shift in diagnostic and therapeutic pathways, offering rapid, comprehensive molecular diagnosis that can be performed in the intra-operative setting. We aimed to test the hypothesis that intra-operative methylation-based classification can be performed using nanopore sequencing and thereby expediently inform surgical and oncological decision-making. METHOD Oxford Nanopore Technology (ONT) is a native-strand, long-read sequencing platform that can perform copy- number profiling along with parallel single-gene methylation, structural variant, mutational and methylation analyses. Capital and consumable costs are relatively low, and testing can be performed in the local setting on single samples. We have optimised DNA extraction and library preparation for rapid tissue processing. We have developed a robust bioinformatic pipeline which is able to produce intraoperative classification within minutes of sequencing and full molecular profiling after 24 hours. RESULTS We demonstrate the feasibility of using ONT to deliver intra-operative methylation-based classification of CNS tumours in ‘realtime’ within an NHS hospital setting and will discuss the challenges of implementing this testing and the opportunities to inform neuro-oncological practice. CONCLUSION By giving a summary of our novel protocol of rapid DNA extraction, library preparation and bioinformatic analysis, we will show that this approach can revolutionise the diagnosis of brain tumours and has the potential for rapid adoption by non-expert laboratories.

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study

Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

Effectiveness of cognitive interventions in mitigating mental fatigue among healthcare professionals in hospital settings: A systematic review

Mental fatigue poses a significant challenge to healthcare professionals in hospital settings, impairing cognitive performance, emotional well-being, and job satisfaction. This systematic review evaluates the effectiveness of cognitive interventions, including mindfulness programs, online psychological interventions, and telehealth cognitive-behavioral therapy (CBT), in mitigating mental fatigue among healthcare workers. A comprehensive literature search across PubMed, b-on, Web of Science, and Scopus identified six studies published between 2016 and 2023. These studies reported that cognitive interventions significantly reduced burnout and stress levels, with up to a 30% decrease in emotional exhaustion and improved coping mechanisms. In addition, participants demonstrated enhanced emotional well-being, reflected in increased mindfulness and life satisfaction scores of as much as 25%. Mindfulness-based programs and telehealth CBT were particularly effective in fostering resilience and improving overall cognitive function. However, the review also highlighted the need for future research to explore the long-term effects of these interventions, their cost-effectiveness, and innovative methods to improve accessibility and scalability, such as digital platforms. Integrating cognitive interventions into routine healthcare practice can enhance staff well-being, improve patient outcomes, and contribute to a more supportive work environment.

Detection of virulence factors and antimicrobial susceptibility pattern of clinically significant Klebsiella pneumoniae isolates in a tertiary care hospital

Introduction: Klebsiella pneumoniae is associated with a variety of infections across all age groups, both in community and hospital settings. Many strains of K. pneumoniae produce virulence factors such as a capsule, siderophores, biofilm, and hypermucoviscosity, which facilitate adhesion, invasion, and colonization. Additionally, the rising antibiotic resistance in K. pneumoniae strains poses a significant challenge, limiting treatment options. This study aims to identify the virulence factors and assess the antimicrobial susceptibility of clinically significant K. pneumoniae isolates. Materials and Methods: K. pneumoniae isolates were obtained from urine, sputum, blood, cerebrospinal fluid, pus swabs/aspirates, and tissue samples. Standard biochemical tests were performed for identification. Capsule formation, hypermucoviscosity, siderophore production, and biofilm formation were detected phenotypically. Antibiotic susceptibility testing was carried out using the disk diffusion method, and primary and confirmatory tests were conducted for extended-spectrum beta-lactamases (ESBL) and carbapenemase production. Results: Capsule formation, hypermucoviscosity, siderophore production, and biofilm formation were detected in 100%, 15%, 40%, and 15% of the isolates, respectively. Of the isolates, 40% were multidrug-resistant, 55% produced ESBL, 8% expressed AmpC beta-lactamase, and 10% produced carbapenemase. Conclusion: Capsule formation was the most prevalent virulence factor, followed by siderophore production. The majority of K. pneumoniae isolates demonstrated susceptibility to amikacin, piperacillin-tazobactam, and carbapenems. However, 40% of the isolates were multidrug-resistant, with ESBL production being the most common resistance mechanism.

Race and Ethnicity and Clinician Linguistic Expressions of Doubt in Hospital Admission Notes

Stigmatizing language in electronic health records (EHRs) can generate or reinforce negative stereotypes about patients from minoritized groups and erode their trust and experience. However, less is known about the use of such language to cast doubt on patient clinical history in hospital settings. To compare the prevalence of language expressing doubt about patient clinical history (eg, experiences and symptoms) in hospital admission notes by patient race and ethnicity. In this cohort study, natural language processing tools were applied to analyze 54 936 admission notes from 1249 clinicians about patients aged 18 years or older at admission and hospitalized at an academic health system in the Northeast US between January 1, 2018, and February 28, 2023. Data were analyzed from September 1, 2022, to July 31, 2023. Patient race and ethnicity (non-Hispanic Black, non-Hispanic White, and racial and ethnic minoritized groups excluding non-Hispanic Black [includes multiple racial and ethnic groups, such as Hispanic and Asian]) as recorded in the EHR based on self-report or registrar determination. Binary indicator for at least 1 term casting doubt on patient clinical history was defined using epistemic stance, a linguistic construct expressing a writer's degree of certainty in information. Terms were manually validated via iterative review of notes by the study team. Among 56 325 admission notes (mean [SD] age of patients, 55.9 [19.0] years; 30 913 notes among female patients [54.9%]; 25 649 notes among non-Hispanic Black patients [45.5%], 26 442 notes among non-Hispanic White patients [46.9%], and 2985 notes among members of racial and ethnic minoritized groups excluding non-Hispanic Black patients [5.3%]), we analyzed 54 936 admission notes that had no missing data. Among all analyzed admission notes, 39 023 notes (71.0%) contained doubt language. Notes written about non-Hispanic Black patients had increased odds of containing at least 1 word or phrase of doubt (adjusted odds ratio, 1.21; 95% CI, 1.14-1.28; P < .001) compared with notes among non-Hispanic White patients. Compared with notes among non-Hispanic White patients, notes written about members of racial and ethnic minoritized groups excluding non-Hispanic Black patients had similar odds of containing at least 1 term of doubt. In this study, language casting doubt on patient clinical history was more likely to be found in notes of non-Hispanic Black patients. These results suggest that with the implementation of policies allowing patients full access to their health records, examining clinical documentation standards may be associated with improved patient experience.

Assessment of the Psychometric Properties of the Hospital's Culture of Nursing Research Scale Among Nurses.

Background and Purpose: The "Hospital's Culture of Nursing Research Scale" (HCNRS) is a critical assessment tool in health care research. It was created in response to the rising acknowledgment of nursing research's critical role in improving patient care outcomes. This study aimed to develop the HCNRS to assess the nurses' perceptions of the hospital's culture of nursing research. Methods: This study utilized the instrument development design in developing the HCNRS. The study was conducted in Astana, Kazakhstan, from May to September 2023. The study followed three major stages of scale development: "item development," "scale development," and "scale evaluation." "Principal component analysis" (PCA; n = 387) and "confirmatory factor analysis" (CFA; n = 362) were performed in this study. Cronbach's coefficient α was computed for reliability. Results: The PCA on the 32-item HCNRS revealed five factors with an eigenvalue of above 1, contributing 66.0% of the model's total variance. The CFA revealed the following findings supporting the five subscales of the HCNRS-R: χ 2 /df = 2.65, root mean square error of approximation = .068 (90% CI [0.063, 0.072]), comparative fit index = 0.92, Tucker-Lewis index = 0.91, and standardized root mean square residual = .04. Based on the items that loaded in each factor, the subscales were labeled "Research Ethics, Integrity, and Supportive Culture," "Nursing Research Institutionalization," "Hospital's Financial Support and Incentives for Research Initiatives," "Nursing Research Engagement and Innovation," and "Nursing Research Integration and Career Support." The computed Cronbach's coefficient α of the entire scale was .963. For its subscales, the Cronbach's coefficient α ranged from .833 to .953. Conclusions: The study developed a five-factor HCNRS to evaluate the multifaceted aspects of nursing research culture in hospital settings. Health care institutions can utilize this scale to identify areas for improvement in research culture and implement strategies to foster research ethics, integrity, and innovation. This tool can also be used by hospital leaders, policymakers, and nurse researchers seeking to evaluate the research culture within their health care organizations.

Hand Surgical Operating Room Size Allocation: A Comparative Space Utilisation Study.

Background: This study evaluated operating room (OR) space required for various hand surgical procedures. We analysed the size requirements for hand surgical cases divided into four settings: (1) large OR setting requiring fluoroscopy and microsurgical equipment, (2) medium-sized OR setting for cases requiring fluoroscopy, (3) smaller OR setting and (4) minor procedural room without anaesthesia with the aim to describe room size requirements for hand surgery practices. Methods: A variety of hand surgical cases were selected: large cases (microvascular digit replantation), medium-sized cases (closed reduction percutaneous pinning [CRPP] of phalangeal fractures) and smaller cases (carpal tunnel release [CTR]) with and without anaesthesia. Space requirements were compared to general surgery cases (laparoscopic appendectomy) and general orthopaedic surgery cases (cephalomedullary nail [CMN]). Necessary operative equipment was measured (ft2) to calculate requirements for each procedure. Results: Large hand cases such as digit replantation necessitated the most OR space (125 ft2), followed by general orthopaedic cases (CMN; 118 ft2), medium-sized hand cases (CRPP phalanx; 107 ft2), general surgery laparoscopic appendectomy (68 ft2), small hand cases (CTR; 85 ft2) and minor procedures (49 ft2). Conclusions: Hand procedures can be divided into major procedures requiring significant OR space (125 ft2), medium procedures in standard OR suites (107 ft2), procedures in small ORs with anaesthesia (81 ft2) or office-based setting without anaesthesia (49 ft2). These findings help define space utilisation for hand procedures and may have practical implications related to efficiency, cost and patient safety in the hospital and outpatient setting. Level of Evidence: Level IV (Economic and Decision Analyses).

Patient expectations and understanding of hospital food service provision when declaring a food allergy.

Food allergies are increasingly common and so hospitals must promptly identify and manage these to maintain patient safety. The present study explored patient understanding and expectations of food allergy management in hospital food services. This exploratory descriptive study used mixed methods, including semi-structured interviews and surveys with hospital inpatients declaring food allergies, aiming to explore understanding, expectations and preferences for food allergy management in the hospital setting. Twenty-four participants were interviewed, reporting between one and six food allergies across 25 different allergens. Three main themes were identified: "Shared responsibility for declaring and managing allergens in hospital", "Varied understanding and trust in hospital food service processes" and "Satisfactory hospital food service experience". In the latter, participants identified 13 key factors valued for hospital food, including appearance, food quality and flavour. Remarkably, being "free from" the food allergen was not amongst the most common factors. Generally, participants felt that declaring a food allergy had not negatively impacted their hospital admission, and overall satisfaction with food services did not differ between the food allergic study participants and the general hospital population. Overall, the declaration of a food allergy did not negatively impact on hospital experience. However, further investigations are required to identify the most valued factors for hospital meals, aiming to enable a more targeted approach to better meet patient expectations.

Provision of early clinical experience in UK medical schools: a cross-sectional survey

ABSTRACT Background There is an established evidence base to support early clinical experience (ECE) within medical degree programmes. However, increasingly crowded clinical learning environments can make provision challenging. The aim of this research was to develop understanding about how ECE is provided within UK medical schools. Methods We conducted a cross-sectional study on ECE provision by UK medical schools using an electronic survey containing a mix of question styles. We gathered data on the stage at which ECE featured within curricula, the amount of ECE provided, the setting for ECE, the learning outcomes covered during ECE and whether such content was formally assessed. Support for survey dissemination was obtained from the UK Medical Schools Council (MSC) Education Leads Advisory Group (ELAG). Responses were collected between 10/05/23 and 11/10/23. Findings Of the 43 eligible UK medical schools, responses were received from 28 (65%). The provision of ECE amongst respondent medical schools was ubiquitous. The majority of ECE was provided within general practice and hospital settings, but community and voluntary sector settings were increasingly employed, as was technology enhanced ECE. A significant shift in the nature of the content addressed during ECE, with less focus on implementation of basic science was seen within learning outcomes. The extent to which ECE learning outcomes were formally assessed was variable. Conclusion The amount of ECE provided by UK medical schools has fallen. We encourage institutions to reflect on their provision of ECE and to consider how greater diversity of community settings and technology-enhanced learning could be harnessed.