Rationale, Aims and Objectives Hospitals are complex organizations with a high potential for medical errors that can be influenced by safety culture, a central aspect in research and practice to increase patient safety. Safety climate as a measurable element of safety culture, illustrates the perception of safety-relevant aspects of health care staff at a certain time. The Safety Climate Survey (SCS) is applied internationally to measure safety climate. However, psychometrics for the German SCS have yet not been evaluated. Aim of this study is to explore the factor structure, reliability, and potential usefulness of the German SCS in Austrian acute care. Methods Cross-sectional online-surveys of physicians, therapists and nurses/midwives from eight hospitals from one hospital operator were implemented. An exploratory factor analysis (EFA) was carried out, both, for the total sample and also split by two select professions (physicians, nurses/midwives). After deriving a factor structure for both professions, internal consistency and scale means were calculated for the subscales. Finally, mean subscale differences between physicians and nurses/midwives were tested. Results In summary, 933 respondents out of 5,160 eligible staff participated, reaching a response rate of 18.1%. A six-factor solution explaining 59.1% of total variance was identified in the total sample. Comparison by profession illustrated that the factor structures and item loading patterns differ between physicians (n=124) and nurses/midwives (n=713). To achieve an overarching solution, five items were excluded from consecutive subscale measures due to cross-loadings and contradictory factor loadings. Subscales demonstrated good to low internal consistency (α=0.794 to 0.535). Significant mean differences between subscales of professions were found relating to three factors. Conclusions The German SCS measures safety climate multi- rather than unidimensional, demonstrated limitations in factor structures and item loadings but overall satisfactory reliability of the subscales. When assessing safety climate, a multi-dimensional and profession-related approach must be explicitly considered.

Abstract Rationale, Aims, and Objectives: To determine the extent to which nurses reportedly assess evidence-based falls risk factors and identify targeted prevention implemented for medical and surgical patients in China. Method: This was a multicenter retrospective observational study. Respondents were nurses working in medical and surgical units of Chinese 662 hospitals. Fall-risk factors assessments and targeted interventions by health professionals were collected online by the Nursing Management Committee of Chinese Nursing Association in China, in 2019. Results: A total of 68527 valid questionnaires were recovered (95.0%). In medical and surgical units, nurses were most likely to report assessing balance, mobility and strength (81.6%) and orthostatic hypotension (76.4%) for falls and least likely to continence (61.3%) and feet and footwear (55.8%). Appropriate footwear (79.3%) and managing syncope, dizziness and vertigo (73.8%) were the most frequently falls multiple interventions, while managing postural hypotension (48.8%) and cognitive imparement (48.4%) were the least. Nine fall-risk factors with clearly matched multifactorial interventions were determined in medical and surgical units (68.2%~ 97.5%). On comparative analysis, Cognitive therapy, Toileting-assistance, Indwelling catheter, Monitor postural blood pressure, Dizziness and vertigo interventions, Minimise asthma triggers, Educating medication use, Keeping floor surface clean and dry were more common in medical ward, while With the head of the bed raised, Assessments and referrals and Bed brakes locked in surgical ward. Conclusion: Health professionals are generally concerned about risk factors and prevention for falls with their patients in much of China, however limited attention was directed at the continence, feet and footwears assessment and managing cognitive imparement. Evidence-based prevention should be further tailored to the individual, based on an individual risk factors.

Shared decision making (SDM) is a model of communication processes that facilitate cooperative decision making between a patient and medical practitioner regarding treatment. The use of assessment instruments is an important way to gain insight into the practice of SDM. In order to fully utilize the various assessment tools available for use, it is important to not only reveal what instruments are used to measure SDM but also shed light on which aspects of SDM are captured by different instruments. However, the instruments currently used to measure SDM are unclear, as are the aspects of SDM processes each instrument reflects. So that, we reviewed assessment instruments used in studies on SDM with the aim of clarifying what aspects of SDM processes each instrument was intended to capture in this study. As a result, we identified 16 assessment instruments used in 115 articles concerning SDM as the main theme. The most commonly used instrument was the OPTION scale, followed by SDM-Q-9. Step 4 (“informing on the benefits and risks of the options”) was covered by most instruments, followed by Step 5 (“investigation of the patient’s understanding and expectations”). In the future, assessment instruments for SDM will likely be used primarily in areas in which there is considerable uncertainty about evidence, and where multiple options exist. When you assess SDM, it is necessary to be able to select the evaluation indicator that suits the purpose.

Abstract Rationale aims and objectives Physiotherapy is recommended for cervicogenic headache (CGH) with 4% of headache patients currently referred to secondary care. The aim of this service evaluation was to explore knowledge of CGH signs and symptoms (SS) and headache red flags (HRF) among musculoskeletal (MSK) physiotherapists during a headache training session. This session was identified as a training need by the learning and development team following a previous headache training session. Post training, treatment choices and patient outcomes for 10 patients were explored as recommended by an Audit Committee. METHOD Nine physiotherapists undertook a 3-hour training session on headaches, completing an HRF/SS questionnaire focused on CGH, before and after training. Post training, 10 CGH patient were assessed and treated by participants. Treatment choices were compared with current best practice and patient outcomes were collected, using the Neck Pain Bournemouth questionnaire (NP BQ). Treatment data was gathered via an electronic patient record system between June 2016 and August 2017. Results Prior to training, participants achieved a correct answer frequency of 58% and 64% for HRF and SS respectively. Post training, this increased to 87% and 91% respectively. Post treatment, 70% of patients had an improvement of over 80% and 30% had an improvement of between 30% and 43%. In terms of modalities used, 40% of participants received acupuncture and 12% had manual therapy. Advice was given to 5.8% and 4.6% used exercises. Soft tissue massage and balance were used in 2.3% an 1.2% respectively. Conclusion Clear training needs were identified initially, and knowledge improved after training, together with evidence-based choices for treatments. All patient symptoms improved during care.

All the countries and regions have already been infected with novel coronavirus disease (COVID-19). This super small guest has paralyzed the economy of the entire world, from the extreme fall of the oil prices to the bankruptcy of the great companies or even the small retail shops. The people’s lifestyle is undergoing significant changes, by which it is leaving a negative impact on their psychological and physical health. The atmosphere is filled with dual accusations from each one of the governments and their citizens. Recognizing cognitive biases that have potentially affected decision-making during the COVID-19 pandemic would help in considering some behavioral changes for curbing this global viral infection.

Purpose: Bayesian inference has become very popular science. It offers some pragmatic approaches to account for uncertainty in inference-decision making. Various estimation methods have been introduced to implement Bayesian methods but although these algorithms are powerful they are not always easy to grasp. This paper aims to provide an intuitive framework of four key Bayesian computational methods for researchers in clinical studies. We will not cover daunting mathematical discussion of these approaches, but rather offer a non-quantitative description of these algorithms and provide some illuminating examples. Materials and methods: Bayesian computational methods namely, i) Importance sampling, ii) Rejection sampling, iii) Markov-chain Monte Carlo, iv) Data augmentation were introduced. Results and conclusions: A load of literature published on Bayesian inference has proved its popularity among researches while its concept is not straightforward for amateur learners. We showed that alternative approaches which are intuitively appealing and easy-to-understand work well in case of low-dimensional problems and appropriate Prior information such as weighted prior, otherwise MCMC is a Trouble-free tool.

Background: How to shorten the anesthesia time is an important problem to ERAS. The authors formulated a series of optimization measures and verified that these measures could shorten the anesthesia time and improve the operating room utilization efficiency by multidisciplinary diagnosis and treatment pattern. Methods: 90 patients were random selected to analyses the time of every preparing procedure and between 2 adjacent procedures, the multidisciplinary team established the optimization measures accordingly. Then 95 patients for gastrointestinal surgery received collaborative optimization measures that were established after discussion among anesthesiologists, surgeons and operating room nurses (optimization group), while 226 cases received the conventional approaches (control group). The data obtained from operating room monitoring recording of the two groups of patients were analyzed. Results: The preparation times from the initial of induction of anesthesia to start of surgery in optimization group were all significantly shorter than those in control group (all P<0.0001). In supine position surgery, the times from initial of induction of anesthesia to start of urinary catheterization, from urinary catheterization finish to start of disinfection, and from completion of draping to start of surgery in patients receiving optimization measures were all significantly superior to those receiving conventional approaches (all P<0.0001); in lithotomy position surgery, the times from the initial of induction of anesthesia to positioning, from positioning finish to start of disinfection, and from completion of draping to start of surgery in patients receiving optimization measures were all significantly superior to those receiving conventional approaches (all P<0.0001). Conclusions: The established optimization measures based on multidisciplinary team collaboration could significantly shorten the anesthesia time. The optimized measures in this study are feasible and effective to shorten the anesthesia time.

Objectives Implementation of new knowledge into routine care is a complex endeavour. Involving employees in the change process, good planning and communication as well as a commitment to training has been highlighted as important factors for successful implementation. Acknowledging change as a process may also be helpful. The aim of this paper was to describe the initial phase of the implementation process in changing to evidence-based practisepractices within a child and adolescent mental health service. Method Prior to the five-year project, an external service evaluation was carried out. The employees expressed a need for a clear direction from management to guide their clinical practice. A vision and strategy for the service was developed. Employees participated in the process of developing clinical standards during the first phase of implementation. Results Fixsen’s four stage model and the PSDA circle were used to guide the implementation process. The employees developed a template for a clinical standard based on national and international clinical guidelines. During the period, 17 clinical standards were established and 10 new evidence-based methods were implemented. All service leads (13) and a group of senior clinicians (32) were invited to participate in an evaluation five years after the initial service evaluation. There was overall agreement that the mental health service was developing positively providing high quality services for children and adolescents. In addition, both groups agreed that the introduction of clinical standards was important in ensuring quality care. Conclusion Involving employees in the implementation process seemed to be an important factor in changing a mental health service.

Rationale, aims and objectives: A considerable amount of primary health care (PHC) clients comes in with medically unexplained complaints, leading to frequent consultations and high usage of services and health care costs. This study aimed to determine the prevalence of somatic symptom disorder among PHC attendees and to explore its relation with other mental disorders and risk factors. Methods: A cross sectional design was used to interview 400 attendees at five PHC centers in Nablus district, during Sept to Dec, 2019. Men and women age over 18 years old, without psychiatric diagnosis were invited to participate in the study. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in PHC setting. Chi-squared test and multivariable logistic regression were used to explore determinant variables. Results: A high prevalence of somatic symptom disorder was seen in the sample [32.5% (95%CI= 27.9%-37.1%)]. The most prevalent symptoms were painful muscles (61.5%) followed by back pain (52.3%). Somatic symptom disorder was found to be associated with: Female gender [P =0.015 adjusted OR = 2.2 (95% CI= 1.3-4)], chronic diseases [P =0.027 adjusted OR = 2 (95%CI=1.1-3.6)], depression [P <0.001 adjusted OR = 3.2 (95%CI= 2.0-5.3)], and anxiety [P=0.032 adjusted OR = 3.0 (95%CI= 1.6-5.5)]. Additionally, attendees with high somatization were found to have significantly higher frequency of doctors visit [P=0.005 adjusted OR = 2.2 (95%CI= 1.3-4.0)] Conclusions: The prevalence of somatization among PHC attendees in Palestine is high. It is significantly higher among females, patients with chronic diseases, clients with anxiety and depressive disorders and patients with frequent doctors’ visits. Painful muscles and back pain are the most common symptom presented by patients, and this could be used initially by PHC physicians as a signal to consider for screening.

Background, aims and objectives: With ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Older person friendly hospital (OPFH) principles and practices to improve care for older people are recognised, but many remain poorly implemented in practice. The aim of this study was to understand barriers and enablers to achieving OPFH from the perspective of key informants within an academic health system. Methods: Interpretive phenonomenological study, using open-ended interviews conducted by a single researcher with experienced clinicians, managers, academics and consumers who had peer-recognised interest in care of older people. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines. Results: Twenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer). Key elements of OPFH were: older people and their families are recognized and respected; skilled compassionate staff work in effective teams; and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce. Conclusions: Progress towards OPFH will require genuine partnerships between clinicians, consumers, health system managers, policy makers and academic organisations, and reframing the value of caring for older people in hospital.

Purpose: Tophi can cause several severe complications. However, the predictors of tophi formation are not intensively researched. The aim of the study is to develop and validate a new prediction model for tophi formation amongst patients with gout. Methods: A prediction model was developed using data collected from 158 gout patients treated in the inpatient department of The First Affiliated Hospital of Zhejiang Chinese Medical University from May 2018 to May 2020. For the establishment and validation of the prediction nomogram, the least absolute shrinkage and selection operator regression model and the multivariable logistic regression analysis were conducted to determine the predictors. C-index, calibration plot and decision curve analysis were utilised to evaluate discrimination, calibration and clinical effectiveness of the predicting nomogram. Then, the nomogram was internally validated using a bootstrap procedure. Results: Nine predictors – hospitalisation frequency, disease duration, number of joints involved in gouty arthritis, gout flares frequency, smoking, and whether combined with atherosclerosis, diabetes, hypertension and kidney dysfunction – were determined from the prediction nomogram. The C-index of the nomogram was 0.854 (95% confidence interval: 0.772-0.936), and was confirmed to be 0.810 when tested through a bootstrap validation, suggesting the model’s good discrimination and prediction capability. Conclusion: A new model with nine predictors was developed to predict the risks of tophi formation amongst gout patients. The included predictors were practical and easy to obtain, whilst the nomogram was proved to predict the risks of tophi formation effectively and accurately. Keywords：tophi formation, gout, predictors, nomogram

Rationale, aims, and objectives: The coronavirus pandemic has disrupted normal activities across the world, from economy to socialization, and claiming hundreds of thousands of lives. The activities in radiopharmacy laboratories across the globe have been affected significantly. This survey was conducted to assess the effect of COVID-19 on radiopharmacy and activities going on in the laboratories around the world. This was meant to undertake a preliminary record of the continuing survey. Methods: A three-sectioned questionnaire with 12 questions was distributed to the professional working on radiopharmacy laboratories. The sections included demographic information, the effect of the pandemic on the regular operation on a radiopharmacy, and the measures taken to prevent the spread of the virus among the laboratory staff. Random sampling approach was used to select 100 respondents, including staff and radiochemists, across different parts of the world. Results: The survey demonstrated that the pandemic hugely impacted activities in a radiopharmacy laboratory. 98% of the respondents reported major disruptions in the normal schedule in the laboratory. Even though some laboratories continued working normally, strict measures were put in place to prevent the spread of the virus among the staff. In many radiopharmacy laboratories, diagnostic procedures and tests quantitatively decreased. The survey reported positron emission radiopharmaceutical fluorodeoxyglucose F-18 (F18-FDG) as the frequently organ imaging radiopharmaceutical during the pandemic. Conclusions: The survey showed that COVID-19 has negatively impacted activities in a radiopharmacy laboratory, consequently affecting research activities.

ii. Rationale, aims and objectives Fraser Health, a large health authority, undertook an audit of standardized order sets (SOS) listing ranitidine due to the Health Canada recall of ranitidine. Our primary objective was to determine if ranitidine use on SOSs was supported by the best available evidence, in order to sparingly use ranitidine in the hospital. ii. Method Two evaluators recorded the indication of ranitidine on every SOS and a scoping review of systematic review evidence was conducted in parallel to a comprehensive review of evidence quality. Clinical practice guideline recommendations were also recorded in order to make comparisons to systematic review evidence. iii. Results Twenty-seven SOSs were found. Seven SOSs (26%) clearly indicated the medical condition ranitidine was being used for. Twenty SOSs (74%) did not list an indication or had an unclear indication. Six SOSs (22%) were supported by systematic review evidence: 4 intensive care unit (ICU) SOSs for stress ulcer prophylaxis, 1 nausea and vomiting of pregnancy SOS for heartburn, and 1 emergency department SOS for heartburn iv. Conclusion The SOS ranitidine audit conducted at Fraser Health has highlighted inconsistencies between institutional prescribing policies and evidence. Drugs listed on SOSs should be carefully considered before being used at an institutional level. To aid prescribers’ decision making, it may also be beneficial to indicate what the purpose of each drug is on a SOS Our team plans to use this as an opportunity to revise other ranitidine SOSs to reflect best evidence. Evaluation of how ranitidine or other drugs were being prescribed from SOSs is encouraged.

Background: Successful active surveillance for infectious disease leads to increased case detection and better management outcomes. Because of that, the National Tuberculosis Programme (NTP), Ghana introduced Symptoms-Based Screening (SBS) Tool for TB case finding. Despite these efforts, Ghana has not achieved the 10% target of TB screening in all out-patient departments attendees as recommended by the NTP. Therefore, this study determined the challenges and limitations of the SBS Tool used for active tuberculosis case finding in Ghana. Methods: This study targeted presumptive TB patients resident in Ho Municipality, Ghana. Presumptive TB patients, recruited from Ho Teaching and Ho Municipal Hospitals, were screened with the SBS tool and presumed TB patients tested for M. tuberculosis using microscopy and positive samples confirmed by geneXpert technique. Also health personnel were interviewed to assess the user-friendliness, challenges and limitations associated with the SBS tool. Chi square association of categorical data was done by STATA version 14.1. P-values <0.05 was considered statistically significant. Results: From both hospitals, 636 presumptive patients and 24 health workers participated in this study. Of the total patients screened, 1.73% had active tuberculosis. Coughing for > 2 weeks (x2=24.8; p<0.05); chest pains (x2=28.3; p<0.01) and night sweat (x2=34.8; p<0.05) associated significantly with M. tuberculosis infection status. The main challenge associated with the SBS tool was its unfriendliness for administration while lack of enough indicators to identify other vulnerable individuals to TB (diabetics, cigarette smokers, alcoholics, immunocompromised and malnourished individuals) limited the sensitivity of the tool. Conclusion: The SBS tool was found not to be sensitive enough to identify infected cases. Inclusion of signs and symptoms of diabetes, immuno-suppression and malnutrition in the current tool and subsequent training of all relevant health personnel on the use of the tool could contribute to increase the sensitivity of the tool.

Rational, Aims and Objectives: Prolonged symptoms after a mTBI, known as Post-Concussion Syndrome (PCS), remains a challenging area of rehabilitation. Evidence shows that an active approach can improve prognosis, however PCS is a multifaceted condition with many comorbidities and large variety in patient response. This study investigated the use of submaximal aerobic exercise and body awareness therapy, and the influence on symptoms in PCS cases, viewed through the lens of evidence-based practice (EBP). Method: Four cases were separated into two case studies. Cases in Study A received an aerobic exercise protocol consisting of 8 individual sessions distributed twice a week over 4 weeks, with additional cervical endurance training. Cases in Study B received a body awareness therapy protocol consisting of 6 guided practices distributed twice a week over 3 weeks. Using method triangulation, both quantitative and qualitative data were gathered through the use of the Rivermead Post-Concussion Questionnaire (RPQ) and semi-structured interviews, as well as the Craniocervical Flexion Test (CCFT) in Study A, and the Short Form-36v2 (SF-36) questionnaire in study B. Lastly, research evidence on PCS was included to contextualize cases. Results: Both cases in Study A showed marked improvements in their RPQ scores, but only one showed improvement in the CCFT. In Study B, one case improved in RPQ score and in the mental component of SF-36v2, while the other case did not experience any significant change. All cases expressed positive associations with the interventions during the interviews. Conclusion: These results illustrate how an active and individualized approach can represent important qualities that can be applied to further and larger studies. Based on the results and discussion of this paper, relevant findings and suggestions are summarized in a modified EBP model, which may be of help to practitioners in dealing with PCS patients in the clinical practice.

Objectives: To assess a newly developed educational video about lumbar puncture (LP), in the parents’ native language, tailored to their social background, and whether it facilitates their consent for LP. Methods: The randomized, controlled trial was conducted at outpatient pediatric clinics at a teaching hospital, Riyadh, Saudi Arabia. The conventional arm used LP verbal explanation. The second group utilized a standardized video with similar information. Parents’ knowledge, perceived LP risks, and willingness to consent were measured, before and after the intervention. Results: We enrolled 201 parents, with similar baseline characteristics. Both groups had an increase in knowledge scores, with Wilcoxon signed-rank test showing significant knowledge gains (Verbal Explanation: W=2693, n=83, P<0.001, and Video: W=5538, n=117, P< 0.001). However, the conventional verbal counseling resulted in more consistent knowledge gain (SD=14.5) as compared to the video group (SD= 18.94). The video group reported higher perceived risk (Mean 8.2, SD 3.59) than the verbal group (mean 7.12, SD 2.51). The less-educated parents perceived higher LP risk after watching the video (P< 0.001). Conclusions: LP video education in parents’ native language is as effective as conventional verbal education for the informed consent, with the additional advantage of reproducibility and more illustrations. While videos could facillitate remote procedural consenting process during infectious disease outbreaks; however, this should be followed by direct verbal interaction with parents, to ensure their full understanding and address any further concerns.

Rationale: The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. Methods: This was a multicenter study assessing complications developed during one year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year were analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30. Results: A total of 312 patients were included, 150 in the control group and 162 in the intervention group. 90 day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p=0.94), new admissions (p= 0.84) or cardiovascular events (p=0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p=0.29; PCT p=0.44; proADM p=0.52). Conclusions: Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.

Persistent pain affects 20% of adults and can impair one’s daily functioning and well-being. Psychoeducational group interventions can be effective in aiding pain management and coping strategies, however the time commitment for most evidence-based programs (10-20 hours) leads to access barriers and delivery challenges in primary care. A mixed-methods, program evaluation was conducted on a low intensity, three-session, manualized group pilot psychoeducational intervention in a primary care practice, emphasizing pain education, behavioral strategies, and pain-alleviating activities. Eighty-two percent of the clinic’s panel of individuals with persistent pain (N=128) and being prescribed opioid pain medication attended at least one class (N=105). Attendees experienced significant pre-post improvements in self-reported pain functioning and favorable satisfaction ratings by patients and medical staff. However only 51% attended all three groups, despite frequent class offerings and heavily encourage by the patient’s medical providers. This study reviews the potential promise and limitations of a low-intensity, limited session pain group to aid pain-related functioning. Additional investigation is warranted to optimize participant attendance, group format and frequency, and outcome assessment.