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Receiving bad news about one’s health can be devastating, yet little is known about how the therapeutic nature of the environment where bad news is delivered affects the experience. The current study aimed to explore how patients and their families were affected by the language and the built, natural, social, and symbolic environments when receiving bad news, through the Therapeutic Landscapes theoretical framework.
Patients diagnosed with a life-limiting illness living in regional Victoria who had a hospital admission within 24 months and a diagnostic/prognostic conversation were invited to participate, as well as a family member who witnessed the conversation. Participants were recruited through social media and snowballing, resulting in 14 online semi-structured interviews being conducted between November 2021 and March 2022, audio-recorded, and transcribed verbatim. Reflexive thematic analysis was used to develop the themes.
Fourteen semi-structured interviews were conducted with women aged between 30 and 77 years. Interviews lasted between 45 and 120 minutes, with an average of 69 minutes, and were conducted online or via mobile phone. Four central themes were developed: “Hearing bad news for the first time,” “Preferences for having hard conversations,” “Creating a sense of safety for ongoing care,” and “The therapeutic nature of the ward.”
Significance of results
This body of work will help inform practice and future policy regarding bad news delivery and the design and aesthetics of environments where bad news is delivered. It is essential that bad news is delivered within a quiet, calm, and emotionally safe environment within a supportive therapeutic relationship.
Alternative options to hospital care like home care or local health centers (LHCs) are being advocated. However, no study has measured citizens’ preferences (who will finance these services via taxation) for these options.
We measured (i) citizens’ preferences for these services, that is, respondents stated where they would like to get the treatment; (ii) the strength of their preference.
A computerized survey composed of (i) a decision aid to inform respondents about the three options; (ii) three scenarios, from light-to-heavy care, that respondents should rank from the most to the least preferred option of care. (iii) a contingent valuation survey (CVS) to assess how much respondents were willing to pay for their preferred option (except for hospital care if chosen, because it is the default option and free). (iv) a socio-demographic questionnaire.
Data were collected from a representative sample of citizens living in the Rhône–Alps Region (n = 800). The heavier the care was, the more respondents preferred hospital care. Willingness to pay for additional taxation per household/month varied from €13.9 for light care in LHC to €19.1 for heavy home care. The small number of protesting respondents and outliers, and the close correlation between preferences, income, and WTP supports the validity of the CVS.
In France, for cancer, not all citizens would prefer to be treated at home rather than in a hospital. Only less than a quarter would prefer LHC. These results show the mismatch between public health policies and the citizens’ preferences.
To predict the short-term mortality of the serum lactate level and the National Early Warning Score + lactate (NEWS+L) at the time of first admission to the emergency department in COVID-19 patients.
Materials and methods:
This retrospective analysis was performed by screening the data of COVID-19 patients over a 6-month period (from January 15, 2021, to June 15, 2021). The demographic, comorbidities, vital parameters, and lactate values, as well as C- reactive protein (CRP), blood urea nitrogen (BUN), and 28-day mortality data were recorded.
A total of 70 patients were included in our study. The median (25th - 75th percentile) age was 58 (47.3 - 73.5) years, and 33 (47.1%) patients were female. The mean lactate value was 1.6 (1.2 - 1.98) mmol/L, the mean NEWS was 6 (4-7.75), and the mean NEWS+L was 7.24 ± 2.54. Mortality occurred in 13 (18.2%) of the 70 patients at 28 days. Lactate, NEWS, and NEWS+L had no significant relationship with mortality. None of these parameters was able to predict mortality (P = 0.132, 0.670, and 0.994, respectively).
Our findings showed that the NEWS+L, NEWS, and lactate level could not predict short-term mortality in COVID-19 patients at the time of first admission.
This research evaluated the resilience of 6 tertiary and rural health facilities within a single Australian Health Service, using the World Health Organization (WHO) Hospital Safety Index (HSI). This adaptation of the HSI was compared with existing national accreditation and facility design Standards to assess disaster preparedness and identify opportunities for improvement.
This cross-sectional descriptive study surveyed 6 hospitals that provide 24/7 emergency department and acute inpatient services. HSI assessments, comprising 151 previously validated criteria, were conducted by Health Service engineers and facility managers before being externally reviewed by independent disaster management professionals.
All facilities were found to be highly disaster resilient, with each recording high HSI scores. Variances in structure, architectural safety, continuity of critical services supply, and emergency plans were consistently identified. Power and water supply vulnerabilities are common to previously reported vulnerabilities in health facilities of developing countries.
Clinical, engineering, and disaster management professionals assessed 6 Australian hospitals using the WHO HSI with each facility scoring highly, genuine vulnerabilities and practical opportunities for improvement were identified. This application of the WHO HSI, intended for use primarily in developing countries and disaster-affected regions, complimented and extended the existing Australian national health service accreditation and facility design Standards. These results support the expansion of existing assessment tools used to assess Australian health facility disaster preparedness and resilience.
An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists.
The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care.
A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services).
A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates.
There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.
This chapter uses a close reading of The Lancet medical journal, and its radical, charismatic editor Thomas Wakley, to delineate the ‘high-water mark’ of Romantic sensibility as an emotional regime. It explores the ways in which Wakley and The Lancet leveraged the emotional politics of contemporary melodrama to critique the alleged nepotism and corruption of the London surgical elites. More especially, it analyses their campaign to expose instances of surgical incompetence at the city’s leading teaching hospitals, demonstrating the ways in which this strategy weaponised the emotions of anger, pity, and sympathy, and considering its implications for the cultural norms of an inchoate profession and for the ultimate stability of the emotional regime of Romantic sensibility.
This chapter considers Romantic surgery from the patient’s perspective. It uses Astley Cooper’s rich archive of personal correspondence to explore the complex emotions associated with the experience of surgical illness and its treatment, as well as the ways in which emotional expression functioned as a form of agency within the private surgical relationship. In addition to considering private patients, this chapter also examines how emotions expressed and mediated agency within what, following Michel Foucault, we might consider the ‘disciplinary’ space of the hospital. The pre-anaesthetic surgical patient was a deeply unstable and ‘messy’ ontological entity whose pre-operative health and post-operative recovery were determined by a complex melding of constitutional, nervous, and emotional factors. Thus, as this chapter demonstrates, the patient’s own body could exert an unconscious material agency, often frustrating both surgical intervention and the patient’s own will, something that was most evident in the associations between irritability and obstreperousness that characterised contemporary discourses on amputation and its discontents.
Organisational priorities for health care focus on efficiency as the health and care needs of populations increase. But evidence suggests that excessive planning can be counterproductive, leading to resistance from staff and patients, particularly those living with cognitive impairment. The current paper adds to this debate reporting an Institutional Ethnography of staff delivering care for older patients with cognitive impairment on acute orthopaedic wards in three National Health Service hospitals in the United Kingdom. A key problematic identified in this study is the point of disjuncture seen between the actualities of staff experience and intentions of protocols and policies. We identified three forms of disjuncture typified as: ‘disruptions’, where sequenced care was interrupted by patient events; ‘discontinuities’, where divisions in professional culture, space or time interrupted sequenced tasks; and ‘dispersions’, where displaced objects or people interrupted sequenced care flow. Arguably disruption is an integral characteristic of care work; it follows that to enable staff to flourish, organisations need to confer staff the autonomy to address systemic disruptions rather than attempt to eradicate them. Ultimately, organisational representations of ‘good practice’ as readily joined up, impose a care standard ‘stereotype’ that obscures rather than clarifies the interactional problems encountered by staff.
A danger threatening hospitals is fire. The most important action following a fire is to urgently evacuate the hospital during the shortest time possible. The aim of this study was to predict the duration of emergency evacuation following hospital fire using machine-learning algorithms.
In this study, the real emergency evacuation duration of 190 patients admitted to a hospital was predicted in a simulation based on the following 8 factors: the number of hospital floors, patient preparation and transfer time, distance to the safe location, as well as patient’s weight, age, sex, and movement capability. To design and validate the model, we used statistical models of machine learning, including Support Vector Machines Random Forest, Naive Bayes Classifier, and Artificial Neural Network.
Data analysis showed that based on the Area Under the Curve, precision, and sensitivity values of 99.5%, 92.4%, and 92.1%, respectively, the Random Forest model showed a better performance compared to other models for predicting the duration of hospital emergency evacuation during fire.
Predicting evacuation duration can provide managers with accurate information and true analyses of these events. Therefore, health policy makers and managers can promote preparedness and responsiveness during fire by predicting evacuation duration and developing appropriate plans using machine learning models.
Recent disasters emphasize the need for disaster risk mitigation in the health sector. A lack of standardized tools to assess hospital disaster preparedness hinders the improvement of emergency/disaster preparedness in hospitals. There is very limited research on evaluation of hospital disaster preparedness tools.
This study aimed to determine the presence and availability of hospital preparedness tools across the world, and to identify the important components of those study instruments.
A systematic review was performed using three databases, namely Ovid Medline, Embase, and CINAHL, as well as available grey literature sourced by Google, relevant websites, and also from the reference lists of selected articles. The studies published on hospital disaster preparedness across the world from 2011-2020, written in English language, were selected by two independent reviewers. The global distribution of studies was analyzed according to the World Health Organization’s (WHO) six geographical regions, and also according to the four categories of the United Nations Human Development Index (UNHDI). The preparedness themes were identified and categorized according to the 4S conceptual framework: space, stuff, staff, and systems.
From a total of 1,568 articles, 53 met inclusion criteria and were selected for data extraction and synthesis. Few published studies had used a study instrument to assess hospital disaster preparedness. The Eastern Mediterranean region recorded the highest number of such publications. The countries with a low UNHDI were found to have a smaller number of publications. Developing countries had more focus on preparedness for natural disasters and less focus on chemical, biological, radiological, and nuclear (CBRN) preparedness. Infrastructure, logistics, capacity building, and communication were the priority themes under the space, stuff, staff, and system domains of the 4S framework, respectively. The majority of studies had neglected some crucial aspects of hospital disaster preparedness, such as transport, back-up power, morgue facilities and dead body handling, vaccination, rewards/incentive, and volunteers.
Important preparedness themes were identified under each domain of the 4S framework. The neglected aspects should be properly addressed in order to ensure adequate preparedness of hospitals. The results of this review can be used for planning a comprehensive disaster preparedness tool.
The covid-19 pandemic is a difficult global phenomenon that causes a lot of anxiety and uncertainty. This situation has involved reactions of fear. Healthcare professionals are necessarily in contact with patients, but may find themselves torn between the duty to care and the duty to protect themselves and their relatives.
To assess perceived stress among medical residents in Tunisia
We conducted a descriptive study among a representative sample of residents working at a teaching hospital in Tunis during the first half of 2021 in different departments. We prepared a questionnaire for the study divided in two parts: socio-demographic data; professional data (function, practice setting); data related to contact with covid-19 patients ; questions on fear of covid-19 contamination and the Perceived stress scale (10items)
Our sample consists of 100 residents in 10 different specialties, including 70 in services with direct contact with Covid-19 patients. Stress management is rated good for 30 residents, average for 40 residents and poor for 30 residents. This management depends on the number of guards, the number of patients examined, the technical platform available and especially the period of the pandemic.
Medical residents are in the front line in university hospitals in tunisia. The stress to which they are subjected depends on the working conditions and coping skills of each of them.
Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported as a worldwide emergency. Due to the extensiveness of spread and death, it has been declared as a pandemic.
To highlight how COVID-19 pandemic psycho-emotional affects the medical staff of a frontline University Hospital in the “battle” with new coronavirus.
We employed a cross-sectional survey of 71 resident doctors from a frontline Hospital after a one-year pandemic and analyzed the prevalence and associated factors with work-related psychological distress among our study group.
Out of the hospital resident doctors, 71 participated and completed the questionnaire, offering an overall response rate of 100%. The majority of participants were women (86% - 61). The average age was 29 years. Most respondents were unmarried. A total of 67% of participants were non-smokers, 5% stated that they occasionally consumed alcohol, none of them used drugs. As a result of the qualitative and quantitative analysis of the data, aspects related to anxiety (21.12% - 15), exhaustion (15.49% - 11), and depression (11.26% - 8) are highlighted. In our study, no people were identified who would reach extreme exhaustion in the work process, due to good resilience and due to a well thought out program of work and rest during the pandemic.
The psychological pressure at work, as well as the one felt after limiting and restricting mobility for shorter or longer periods, had an impact on the psycho-emotional state of health care workers, requiring further psychological reassessments and psychological support.
Disaster events can increase demand for medication supplies and interfere with supply chains, leading to compromised care in hospitals. Providing an organized response to an additional surge of disaster-related patients requires pre-planned emergency management procedures. Hospital pharmacists can address this with prioritized drug procurement and inventory management strategies which may improve the availability of key medications for a disaster response. Previous disaster events have provided insight on medications used to treat disaster-related injuries and exacerbations of medical conditions in emergency departments. This article provides a detailed description of Vancouver Island’s hospital pharmacy strategy for the procurement and minimum stock levels of high priority medications in preparation for a disaster.
A thoroughly revised second edition providing the knowledge and evidence-base needed for the perioperative practitioner, clarifying the underlying principles needed for an understanding of anaesthetic, surgical, and recovery practice. This book defines the level of knowledge required for perioperative practitioners and provides a comprehensive reference to the principles and practice of modern operating department practice. Featuring a diverse range of topics, it offers a multidisciplinary overview of new techniques and technologies, changes in medico-legal requirements, changes to professional accountability, and requirements for continuous professional development. Twelve new chapters cover healthcare ethics and professional regulation, health and safety, infection prevention and control, basic patient monitoring, human factors, and perioperative care of the paediatric patient. Incorporating a new focus on the provision of evidence-based practice and holistic care in all areas of perioperative care, this invaluable book is essential reading for anyone working in this sector, in both education and practice.
Emergencies and disasters occur in any society, and it is the hospitals and their emergency department staff who must be prepared in such cases. Therefore, 1 of the effective methods of training medical care staff is the use of simulators. However, when introducing new simulation approaches, we face many challenges. The aim of this study was to identify challenges of the simulation of the hospital emergency department during disasters and provide effective solutions.
This conventional content, thematic, analysis study was conducted in 2021. Participants were selected from Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis.
After analyzing the data, the challenges of simulating the hospital emergency department during disasters were identified in 2 main components and 6 perspectives, which included organizational components (inappropriate and aimless training methods, lack of interaction and cooperation, lack of funding, and inadequate physical space) and technological components (weak information management and lack of interdisciplinary cooperation). Solutions included management (resource support) and data sharing and exchange (infrastructures, cooperation and coordination).
The simulation technology can be used as a method for training and improving the quality of health care services in emergencies. Considering that most of these challenges can be solved and need the full support of managers and policy makers, by examining these issues, supporting staff of health care centers are advised to make a significant contribution to the advancement of education and problem reduction in the event of disasters.
All too often, we see the leadership above us as obstructionist, miserly, or otherwise misguided or misaligned. This is usually not the case, but there are often communication issues up and down that create that impression and sometimes lead to an adversarial relationship. Both groups benefit by aligning their goals, and the earlier they do so, the better. This chapter will speak mostly to aligning your goals with that of your hospital, with some time at the end devoted to the medical school. They have many similarities, but some important differences. Understanding their priorities will help you to align yours. We discuss the paramount importance of understanding the finances both of your group and the group above you, hospital or medical school. There are ways to maximize your productivity to a mutually beneficial end, and being overt with leadership about this is always welcome. You should gain an understanding of what a “return on investment” or ROI means to the leadership above you, as this is a central concept to their willingness to invest in you and your group. You will gain an understanding of the downstream effect of your group’s efforts, particularly financial. It emphasizes the importance of understanding the key individuals you communicate with and how to approach situations where you are having communication issues. It concludes with how to align goals with the leadership above your group.
This study aims to explore a public volunteer’s hospital response model in natural disasters in Iran.
This study employed grounded theory using the Strauss and Corbin 2008 method and data analysis was carried out in three steps, namely open, axial, and selective coding. The present qualitative study was done using semi-structured interviews with 36 participants who were on two levels and with different experiences in responding to emergencies and disasters as “public volunteers” and “experts”. National and local experts were comprised of professors in the field of disaster management, hospital managers, Red Crescent experts, staff and managers of Iran Ministry of Health and Medical Education.
The main concept of the paradigm model was “policy gap and inefficiency” in the management of public volunteers, which was rooted in political factions, ethnicity, regulations, and elites. The policy gap and inefficiency led to chaos and “crises over crises.” Overcoming the policy gap will result in hospital disaster resilience. Meanwhile, the model covered the causal, contextual, and intervening conditions, strategies, and consequences in relation to the public volunteers’ hospital response phase.
The current public volunteers’ hospital in Iran suffered from the lack of a coherent, comprehensive, and forward-looking plan for their response. The most important beneficiaries of this paradigm model will be for health policy-makers, to clarify the main culprits of creating policy gap and inefficiency in Iran and other countries with a similar context. It can guide the decision-makings in upstream documents on the public volunteers. Further research should carried out to improve the understanding of the supportive legal framework, building the culture of volunteering, and enhancing volunteers’ retention rate.
The Ospedale Maggiore, known as Ca’ Granda, was founded in 1456 by will of Francesco Sforza, Duke of Milan, and was considered for almost five centuries a model for Milanese, Italian and even European healthcare. Attracting patients from all over Europe, the Ca’ Granda distinguished itself for the introduction of new treatments and innovative health reforms. In the burial ground of the hospital still lie the bodies of the deceased patients, who came from the poorest strata of the population. The study of their remains aims to give back a general identity and a story to each of these persons as well as reconstruct a fraction of the sixteenth century population of Milano as concerns lifestyle and disease and examine practises and therapy of this exceptional hospital. It is estimated that about two million commingled bones and articulated skeletons rest in the crypt, together with other types of findings (e.g., ceramic, coins, clothing). These remains are the object of a large project involving various disciplines ranging from humanities to hard sciences. The aim of this paper is to bring this historical gem to the attention of scholars and provide a glimpse of what its contents have already revealed.
Chapter 15, “Philanthropic Institutions,” looks at the range of social services available to Constantinopolitan residents from the fourth century through the fifteenth century. It notes the contributions of monastics to the institution and organization of such institutions as orphanages, hospitals, leprosaria, and old age homes.