BACKGROUND & AIMS: :Data on pathogen prevalence is crucial for informing exposure and disease risk. We evaluated serological evidence of tick-borne encephalitis (TBE), West Nile (WN), Hepatitis E virus (HEV), Crimean-Congo Hemorrhagic Fever (CCHF), Yersiniosis, Lyme Disease (LD), and brucellosis in 1033 patients presenting with acute febrile illness at 9 health care facilities from diverse ecological zones of Kenya: arid and semiarid (Garissa District Hospital, Lodwar District Hospital, Marigat District Hospital, Gilgil District Hospital), Lake Victoria basin (Kisumu District Hospital, Alupe District Hospital, Kombewa Sub-County Hospital), Kisii highland (Kisii District Hospital), and coastal (Malindi District Hospital). Epidemiological information of the patients such as geography, age, gender, and keeping animals were analyzed as potential risk factors. Of the 1033 samples, 619 (59.9%) were seropositive to at least one pathogen by IgM (current exposure), IgG/IgM (recent exposure), and IgG (past exposure). Collective seroprevalence for current, recent, and past to the pathogens was 9.4%, 5.1%, and 21.1% for LD; 3.6%, 0.5%, and 12.4% for WN; 0.9%, 0.5%, and 16.9% for HEV; 5.8%, 1.3%, and 3.9% for brucellosis; 5.7%, 0.2%, and 2.3% for yersiniosis; 1.7%, 0%, and 6.2% for TBE; and 0.4%, 0%, and 1.9% for CCHF. Brucellosis risk was higher in patients recruited at Garissa District Hospital (odds ratio [OR] = 3.41), HEV (OR = 2.45) and CCHF (OR = 5.46) in Lodwar District Hospital, LD in Alupe District Hospital (OR = 5.73), Kombewa Sub-district hospital (OR = 8.17), and Malindi District hospital (OR = 3.3). Exposure to LD was highest in the younger age group, whereas yersiniosis did not vary with age. Age was a significant risk for WN, brucellosis, CCHF, TBE, and HEV and in those aged >14 years there was an increased risk to WN (OR = 2.30, p < 0.0001), brucellosis (OR = 1.84, p = 0.005), CCHF (OR = 4.35, p = 0.001), TBE (OR = 2.78, p < 0.0001), and HEV (OR = 1.94, p = 0.0001). We conclude that LD is pervasive and constitutes a significant health burden to the study population, whereas yersiniosis and CCHF are not significant threats. Going forward, community-based studies will be needed to capture the true seroprevalence rates and the associated risk factors.

背景与目标： ：有关病原体流行率的数据对于告知暴露和疾病风险至关重要。我们评估了1033例表现为tick传性脑炎（TBE），西尼罗河（WN），戊型肝炎病毒（HEV），克里米亚-刚果出血热（CCHF），耶尔森病，莱姆病（LD）和布鲁氏菌病的血清学证据来自肯尼亚不同生态区的9个医疗机构的急性发热性疾病：干旱和半干旱（加里萨斯区医院，罗德瓦尔区医院，马里加特区医院，吉尔吉尔区医院），维多利亚湖盆地（基苏木区医院，阿卢佩区医院，科姆贝瓦苏维埃-县医院），Kisii高地（Kisii地区医院）和沿海地区（马林迪地区医院）。分析患者的流行病学信息，例如地理，年龄，性别和饲养动物等，作为潜在的危险因素。在1033个样本中，有619个（59.9％）通过IgM（当前暴露），IgG / IgM（最近暴露）和IgG（过去暴露）对至少一种病原体呈血清阳性。 LD的当前，最近和过去的集体血清阳性率为LD的9.4％，5.1％和21.1％； WN为3.6％，0.5％和12.4％； HEV的0.9％，0.5％和16.9％；布氏杆菌病分别为5.8％，1.3％和3.9％；耶尔氏菌病分别为5.7％，0.2％和2.3％； TBE为1.7％，0％和6.2％； CCHF分别为0.4％，0％和1.9％。在Garissa地区医院招募的布鲁氏菌病风险较高（赔率[OR] = 3.41），在Lodwar District Hospital中的HEV（OR = 2.45）和CCHF（OR = 5.46），在Alupe地区医院的LD（OR = 5.73）， Kombewa街道医院（OR = 8.17）和马林迪区医院（OR = 3.3）。 LD暴露在年轻人群中最高，而耶尔森菌病并没有随年龄而变化。年龄是WN，布鲁氏菌病，CCHF，TBE和HEV的重大风险，而年龄大于14岁的人群中WN（OR = 2.30，p <0.0001），布鲁氏菌病（OR = 1.84，p = 0.005）的风险增加。 ，CCHF（OR ＝ 4.35，p ＝ 0.001），TBE（OR ＝ 2.78，p ＜0.0001）和HEV（OR ＝ 1.94，p ＝ 0.0001）。我们得出的结论是，LD无处不在，对研究人群构成重大的健康负担，而耶尔氏菌病和CCHF则不是重大威胁。展望未来，将需要进行基于社区的研究，以获取真实的血清阳性率和相关的危险因素。

BACKGROUND & AIMS: OBJECTIVE:To assess where the delays occur in the referral chain of most maternal health outcomes in Addis Ababa, Ethiopia, based on the three-delay model. DESIGN:The study was a facility-based, cross-sectional study. SETTING:Two public and tertiary hospitals in Addis Ababa. PARTICIPANTS:All pregnant women who were referred only for labour and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial Hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome was the type of delays, from the three-delay model, which met operationally defined time. The secondary outcome was maternal health outcomes based on the three-delay model. RESULTS:A total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourths (301, 74.7%) of the referred pregnant women experienced the third delay (delay in receiving appropriate care); 211 (52.4%) experienced the first delay (delay in making a decision to seek care). Overall 366 (90.8%) pregnant women had experienced at least one of the three delays and 71 (17.6%) experienced all three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes. The leading causes/diagnoses of severe maternal outcomes were blood transfusion (17, 58.6%), followed by postpartum haemorrhage (15, 52%) and eclampsia (9, 31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have experienced at least one of the three delays. CONCLUSION AND RECOMMENDATION:This study highlights the persistence of delays at all levels, and especially the third delay and its contribution to severe maternal outcomes. We recommend strengthening the health referral systems and addressing specific health system bottlenecks during labour and birth in order to ensure no mother is endangered. We also recommend conducting a qualitative method of study (focus group discussion and indepth interview) and observing tertiary hospitals' set-up and readiness to manage obstetric emergencies.

背景与目标： 目的：基于三延迟模型，评估埃塞俄比亚亚的斯亚贝巴大多数孕产妇健康结局转诊链中的延误发生位置。
设计：该研究是一项基于设施的横断面研究。
地点：亚的斯亚贝巴的两家公立和三级医院。
参加者：所有孕妇在2018年12月至2019年2月期间在Zewditu和Gandhi Memorial Hospital的妊娠28周后仅接受分娩和分娩服务。
主要和次要指标：主要成果是三延迟模型中的延误类型，该延迟满足了运营规定的时间。次要结果是基于三延迟模型的孕产妇健康结果。
结果：共有403名孕妇被分派到研究医院进行了研究。被转诊的孕妇中有四分之三（301，74.7％）经历了第三次延误（延迟获得适当的护理）； 211人（52.4％）经历了第一次延误（决定寻求护理的延迟）。总共366名（90.8％）孕妇经历了这三种延误中的至少一种，而71名（17.6％）的孕妇经历了这三种延误中的至少一种。有29名（7.2％）推荐的妇女有严重的孕产妇结局。严重孕妇预后的主要原因/诊断是输血（17，58.6％），其次是产后出血（15，52％）和子痫（9，31％）。此外，经历严重孕产妇结局的妇女发生三种延误中至少一种的可能性要高2.9倍。
结论和建议：本研究强调了各级延迟的持续存在，尤其是第三次延迟及其对严重孕产妇结局的影响。我们建议加强卫生转诊系统，并解决分娩和分娩期间特定的卫生系统瓶颈，以确保没有母亲受到威胁。我们还建议进行定性研究（焦点小组讨论和深入访谈），并观察三级医院的设置和准备处理产科急症的准备情况。

BACKGROUND & AIMS: PURPOSE:To define organizational culture in hospitals that have received quality certificates and to identify attitudes of healthcare personnel toward change. METHODS:The population was all physicians and nurses (N=3,067) employed at four private hospitals that have received accreditation or the "ISO" certificate, and four public hospitals, all of which were located within Istanbul city limits. A proportional sample of 570 participants were selected from the eight hospitals. Data-gathering tools were information form, culture scale, and Attitude Against Change Scale (AACS). Data were evaluated by using descriptive statistics, Cronbach alpha coefficient, Chi-square test, and by t test for dependent groups, one-way variance analysis (ANOVA), and Tukey test. FINDINGS:The lowest score averages on the AACS were found in those employed in public hospitals, in those who perceived top executives as autocrats, and in those who were unwilling to participate in quality studies. Participants in a power culture were least open to change. CONCLUSIONS:A collaborative culture was the most evident culture in private hospitals, but in public hospitals the most dominant culture was a power culture.

背景与目标： 目的：定义已获得质量证书的医院的组织文化，并确定医护人员对变革的态度。
方法：人口为在四家获得认证或“ ISO”证书的私立医院和四家公立医院（均位于伊斯坦布尔市范围内）雇用的所有医生和护士（N = 3,067）。从八家医院中按比例抽取了570名参与者。数据收集工具包括信息表，文化量表和抵制态度量表（AACS）。通过使用描述性统计数据，Cronbachα系数，卡方检验和相关组的t检验，单向方差分析（ANOVA）和Tukey检验来评估数据。
结果：在AACS中得分最低的是在公立医院工作的人，那些将高级管理人员视为独裁者的人以及不愿参加质量研究的人。权力文化的参与者最不愿意改变。
结论：合作文化是私立医院中最明显的文化，但在公立医院中，最主要的文化是权力文化。

BACKGROUND & AIMS: :In Japan, long-term-care hospitals and facilities face the problem of quality of care, and providing adequate pressure ulcer care is one of the most urgent quality issues. Purpose of the present study was to explore the prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan, and to identify factors associated with them. An anonymous questionnaire was sent to 720 randomly sampled, long-term-care hospitals all over Japan. The prevalence and incidence of pressure ulcers and their factors, including organizational strategies for pressure ulcer prevention and management, were examined. The mean prevalence and incidence of pressure ulcers was 9.6 and 1.9% per month, respectively. Almost all hospitals had established an interdisciplinary team for pressure ulcer prevention, developed a clinical protocol for pressure ulcers, and implemented education for staff. However, 35% of the interdisciplinary teams were not useful, more than half of the clinical protocols were not used frequently, and about half of the wards did not have sufficient pressure-relieving mattresses. In multiple regression analyses, a low prevalence of pressure ulcers was associated with a lower ratio of clients with a high medical severity level (p=0.034), the use of a clinical protocol including the management of preventive devices (p=0.023), the standardized pressure ulcer assessment tool (DESIGN-R; p=0.017), and staff education (p=0.003). This study demonstrated a higher prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan as compared to regular acute-care hospitals, as well as poor organizational strategies for managing pressure ulcers.

背景与目标： ：在日本，长期护理医院和设施面临护理质量问题，提供足够的压疮治疗是最紧迫的质量问题之一。本研究的目的是探讨日本长期护理医院中压疮的患病率和发生率，并找出与之相关的因素。匿名调查表发送给了全日本720家随机抽样的长期护理医院。检查了压疮的患病率和发生率及其因素，包括预防和管理压疮的组织策略。压疮的平均患病率和发病率每月分别为9.6％和1.9％。几乎所有医院都建立了预防压疮的跨学科团队，制定了压疮临床方案，并对员工进行了教育。但是，35％的跨学科团队没有用，一半以上的临床方案不经常使用，并且大约一半的病房没有足够的减压床垫。在多元回归分析中，压疮的患病率较低与较高的医疗严重度水平的患者比例较低（p = 0.034），使用包括预防性装置管理的临床方案（p = 0.023），标准化的压疮评估工具（DESIGN-R; p = 0.017）和员工培训（p = 0.003）。这项研究表明，与常规的急性护理医院相比，日本的长期护理医院中压疮的患病率和发病率更高，而且管理压疮的组织策略较差。

BACKGROUND & AIMS: :Professional health workers need continuous update of knowledge in blood transfusion practice. To fulfill this expectation, the "Etablissement français du sang (E.F.S) Auvergne-Loire", in cooperation with the Department of Regional Affairs in Health Services in the Auvergne region, has set up a proximity-based and a dedicated continuous education course, for more than three years. The content of this update course was based upon regulatory recommendations. The course is one day long; an evaluation of the course by the teachers as well as an evaluation of the teachers' level after the course is carried out. Each course attendant is given a CD-ROM which comprises all of the presentations of the day, along with relevant law texts. We now report on our experience in teaching 127 individual professionals in eight sessions: 95% gave full appreciation. This experience reached - up to now - 53% of the public and private hospitals with transfusion services in the Auvergne region and the Loire district and 90% of structures having remote blood banks. This experience can easily be extended to other regional E.F.S. settings.

背景与目标： ：专业卫生工作者需要不断更新有关输血实践的知识。为了实现这一期望，“奥弗涅-卢瓦尔地区法语教育”与奥弗涅地区卫生服务区域事务部合作，为近距离学习和专门的持续教育课程，三年多了。此更新课程的内容基于监管建议。该课程为期一天；教师对课程的评估以及课程结束后对教师水平的评估。每位课程参与者都会获得一张CD-ROM，其中包含当天的所有演讲以及相关的法律文本。现在，我们报告我们在八次会议中对127位个人专业人员进行教学的经验：95％的人表示完全赞赏。到目前为止，这种经验达到了在奥弗涅地区和卢瓦尔河地区提供输血服务的53％的公立和私立医院，以及90％具有偏远血库的建筑物。这种经验可以很容易地扩展到其他地区的E.F.S.设置。

BACKGROUND & AIMS: ISSUE ADDRESSED:Policy and environmental approaches can reduce the accessibility and purchasing of sugar-sweetened beverages (SSBs), potentially reducing overweight and obesity. This study examined the impact of a state-wide policy on removal of SSBs from sale in NSW public hospitals (launched July 2017), and explored consumer awareness and support. METHODS:A convenience sample of 81 food outlets in 26 hospitals were audited for SSB availability before and after the target date for SSB removal (31 December 2017). An interviewer-administered intercept survey in 10 randomly selected hospitals (March-May 2018), assessed staff and visitors' awareness of and support for SSB removal. Descriptive and χ2 analyses assessed differences in: SSB availability; staff and visitor awareness and support. Open-ended survey responses were thematically analysed. RESULTS:The proportion of outlets that removed SSBs increased from 58.0% to 96.3% (P < .001). The majority (79.5%) of the 2394 surveyed supported SSB removal, with nearly half (48.4%) reporting it would improve people's health. A minority (13.4%) did not support SSB removal, more than half (61.4%) of those said individuals should have free choice. More staff than visitors were aware of the change (61.9% vs 31.2%; P < .0001). CONCLUSIONS:Availability of SSBs in NSW hospitals was significantly reduced after implementation of a policy to remove them from sale. There was strong staff and visitor support for the initiative. SO WHAT?: This study provides clear evidence that a policy designed to provide a healthy hospital retail drink environment can be successfully implemented at scale with high levels of support from staff and visitors. SUMMARY:A state-wide policy initiative to remove SSBs from sale in NSW hospital food outlets in 2017 was successfully implemented, with a sample of outlets having nearly 100% compliance. The majority of staff and visitors (80%) supported the removal of SSBs, mostly because they believed it would improve individual and population health.

背景与目标： 已解决的问题：政策和环境措施可减少获取和购买含糖饮料（SSB）的可能性，从而有可能减少超重和肥胖症。这项研究研究了一项州级政策对从新南威尔士州公立医院出售中去除SSB的影响（2017年7月推出），并探讨了消费者的意识和支持。
方法：在26个医院的81家食品零售店的便利性样本抽取SSB的目标日期之前和之后（2017年12月31日）进行了SSB可用性审核。一项由访调员管理的拦截调查在10家随机选择的医院中进行（2018年3月至5月），评估了工作人员和访客对去除SSB的了解和支持。描述性分析和χ2分析评估了以下方面的差异：SSB可用性；员工和访客的意识和支持。对开放式调查的答复进行了主题分析。
结果：去除SSB的网点比例从58.0％增加到96.3％（P <.001）。接受调查的2394人中，大多数（79.5％）支持移除SSB，近一半（48.4％）的报告称这样做可以改善人们的健康。少数人（13.4％）不支持删除SSB，其中一半以上（61.4％）的人说个人应该有自由选择的权利。知道此变化的员工人数超过访问者（61.9％vs 31.2％; P <.0001）。
结论：实施一项将其出售的政策后，新南威尔士州医院中SSB的可用性大大降低。该计划得到了强大的员工和访客支持。怎么办？：这项研究提供了明确的证据，证明可以通过在工作人员和访客的大力支持下成功地大规模实施旨在提供健康的医院零售饮料环境的政策。
摘要：成功实施了一项全州范围的政策举措，以于2017年在新南威尔士州的医院食品销售网点中取消SSB的销售，样本网点的符合率接近100％。大多数工作人员和访客（80％）支持取消SSB，主要是因为他们认为这会改善个人和人群的健康。

BACKGROUND & AIMS: :We describe the trends in the incidence of methicillin-resistant Staphylococcus aureus nosocomial infection in intensive care units in Lyon hospitals from January 1, 2003, through December 31, 2006. The incidence rate decreased from 1.77 cases per 100 ICU patients in 2003 to 1.16 cases per 100 ICU patients in 2006, a reduction of 38.0% (P = .05).

背景与目标： ：我们描述了2003年1月1日至2006年12月31日里昂医院重症监护室耐甲氧西林金黄色葡萄球菌医院感染的发生趋势。发病率从2003年的每100 ICU患者1.77例下降到2003年的1.16 2006年，每100 ICU患者中有50例病例减少了38.0％（P = 0.05）。

BACKGROUND & AIMS: INTRODUCTION:The quality of health care significantly depends on the satisfaction of the employees. OBJECTIVE:The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. METHOD:Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. RESULTS:This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. CONCLUSION:There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

背景与目标： 简介：医疗保健的质量在很大程度上取决于员工的满意度。
目的：本研究的目的是确定塞尔维亚贝尔格莱德州立医院中医护人员的专业满意度水平，并确定影响其满意度或不满意度的因素并对其进行排名。
方法：设计专业满意度调查，并于2008年进行横断面研究。完整的问卷由贝尔格莱德医院的6595名医护人员返回。使用学生t检验，χ2检验和ANOVA进行统计分析。应用因素分析来定义专业满意度（即不满意）的决定因素。
结果：本研究表明塞尔维亚医疗专业人员的职业满意度较低。专业人员不满意的主要原因是工资，设备，继续接受医学教育/培训的可能性以及职业发展的机会。具有大学学历的医疗保健专业人员对工作满意度的各个方面都比具有中学和大学学历的医疗保健专业人员更满意。
结论：在年龄在50-59岁，具有管理职能，服务30年或以上的男性中，年龄在60岁以上，年龄在60岁以上的男性中，医疗保健专业人员的满意度明显提高。塞尔维亚卫生保健系统中的人力资源开发战略将大大提高所提供卫生保健的专业满意度和质量。

BACKGROUND & AIMS: :This study reports an opinion survey of 211 nonpsychiatrist physicians in two general hospitals who estimated that 16.1% of their patients have psychiatric disorders and that they spent 13.8% of their time in treating the psychiatric components of their patients' illnesses. Physicians indicated that anxiety and psychosomatic and depressive illness were the most frequent psychiatric disorders and that one-third of them would personally treat such disorders without referral to psychiatric consultation. The findings also suggest that adequate undergraduate psychiatric education was associated with increased recognition of psychiatric disorders and more preference for their personal treatment. In addition, it provides a possible explanation for the discrepancy between the high prevalence of psychiatric disorders in general hospital patients and the low referral rate to psychiatric consultation.

背景与目标： ：这项研究报告了对两家综合医院的211名非精神科医生的意见调查，他们估计他们的患者中有16.1％患有精神疾病，并且他们花费了13.8％的时间来治疗患者疾病中的精神疾病。医师表示，焦虑症，心身疾病和抑郁症是最常见的精神疾病，其中三分之一将亲自治疗此类疾病，而无需转诊精神科。研究结果还表明，适当的大学生心理教育与对精神障碍的认识增加以及对他们的个人治疗的偏爱有关。此外，它为综合医院患者精神病患病率高与精神科咨询转诊率低之间的差异提供了可能的解释。

BACKGROUND & AIMS: OBJECTIVE:The aim of this study was to test whether the efficacy of in-person and computer delivered brief alcohol intervention (BAI) is moderated by mental health status. METHOD:General hospital inpatients with at-risk alcohol use aged 18 to 64 years (N = 961, 75% men) were allocated to in-person BAI, computer-based BAI, and assessment only. In-person BAI contained counseling by research staff. Computer-based BAI contained computer-generated individualized feedback letters. BAIs were designed to be delivered at baseline and 1 and 3 months later. Outcome was reduction in alcohol use per day after 6, 12, 18, and 24 months. Latent growth curve models were estimated. Two mental health indicators, the 5-item mental health inventory and routine care diagnosis of mental and behavioral disorders assessed by general hospital physicians, were tested as moderators of BAI efficacy. RESULTS:In all groups, inpatients with better mental health reduced alcohol use after hospitalization (ps < 0.01). While inpatients with impaired mental health did not reduce their drinking significantly following assessment only, those who received any of the 2 BAIs did (ps < 0.05). CONCLUSIONS:BAI was particularly efficacious in reducing alcohol use among general hospital inpatients with at-risk alcohol use and impaired mental health, with computer-based delivery being at least as efficacious as in-person delivery. (PsycINFO Database Record

背景与目标： 目的：本研究的目的是检验心理健康状况是否可以缓解个人和计算机提供的短暂性酒精干预（BAI）的疗效。
方法：将年龄在18至64岁（N = 961，75％的男性）有危险饮酒的综合医院住院患者分配给亲自进行的BAI，基于计算机的BAI和评估。面对面的BAI包含研究人员的咨询。基于计算机的BAI包含计算机生成的个性化反馈信。 BAI设计为在基线以及1和3个月后交付。结果是在6、12、18和24个月后每天减少酒精使用量。估计潜在的增长曲线模型。测试了两项心理健康指标，即5项心理健康清单以及由综合医院医师评估的精神和行为障碍的常规护理诊断，以此作为BAI功效的调节剂。
结果：在所有组中，精神健康较好的住院患者住院后减少了饮酒（ps <0.01）。虽然精神健康受损的住院患者仅在评估后并未显着降低饮酒量，但接受2种BAI中的任何一项的患者却饮酒（ps <0.05）。
结论：BAI在减少高危饮酒和心理健康受损的普通住院患者中减少酒精的使用特别有效，基于计算机的分娩至少与亲自分娩一样有效。 （PsycINFO数据库记录

BACKGROUND & AIMS: OBJECTIVES:Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. SETTING:Acute medical admission units in all NHS Acute Trusts in England. PARTICIPANTS:We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1-2 nights, so as to isolate the experience delivered during the acute admission process. PRIMARY AND SECONDARY OUTCOME MEASURES:We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected 'being treated with respect and dignity' and 'pain control' as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. RESULTS:The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. CONCLUSIONS:When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between Trusts and should prompt further research to explore if more discriminant surveys can be developed.

背景与目标： 目的：先前的研究发现，医院和专科医院对患者经验得分的影响有限，患者水平因素更为重要。这可能是由于组织内各个子部门之间经验交付的异质性。我们旨在确定，如果在每家医院中分析相同的亚专业微系统的分数，组织水平因素是否会产生更大的影响。
地点：英格兰所有NHS急性信托基金中的急性医疗收治单位。
参与者：我们分析了来自英国成人住院调查的患者经验数据，该数据每年在英格兰的每个急性NHS信托基金中对850名患者进行管理。我们选择了所有返回调查的8753名患者，这些患者均为急诊入院，并在其入院病房中停留了1-2个晚上，以隔离急性入院过程中提供的经验。
主要和次要指标：我们使用多级逻辑回归分析确定宿主组织和组织水平因素（规模和教学状况）以及患者水平因素（人口统计学，长期病情和残疾）的分配影响。我们选择“受到尊重和尊严对待”和“疼痛控制”作为主要结局指标。将其他Picker Domain问题分数作为次要参数进行分析。
结果：在组织层面，总体差异的比例很小；尊重和尊严为0.5％（NS），控制疼痛为0.4％（NS）。长期的状况和随之而来的残疾与低分相关。其他项目得分也表明，影响最大的是患者水平因素。
结论：当一个单独的系统（即急性医疗入院流程）被隔离时，经验得分的差异主要可以由受组织水平影响有限的患者水平因素来解释。这对于使用通用的患者经验调查来在Trust之间进行比较具有影响，并且应该促使进行进一步的研究以探索是否可以开发出更多的有区别的调查。

BACKGROUND & AIMS: AIM:To describe staff nurse work engagement, identify predictors by generational cohort, present implications for nurse managers and suggest future research. BACKGROUND:A global nurse shortage looms. While an adequate supply of nurses is needed to ensure access to care, access to quality care may be enhanced by an adequate supply of highly engaged nurses-those who are dedicated, energized, and absorbed. Nurses have long reported the presence of energy depleting practice environments. Nurses practicing in professional practice environments may be more engaged. METHODS:A non-experimental survey design was executed. Direct care Registered Nurses (n = 747) working in five rural acute care hospitals completed questionnaires to assess work engagement (Utrecht Work Engagement Scale-9), decisional involvement (Decisional Involvement Scale), relational coordination (Relational Coordination Survey) and the nursing practice environment (Practice Environment Scale of the Nursing Work Index). Descriptive, correlational and regression analyses examined work engagement and predictors by generational cohort. RESULTS:With the exception of the absorption component, no statistically significant differences in engagement emerged across generational cohorts. Predictors of engagement differed by cohort, however across all cohorts, professional nursing practice environments predicted nurse work engagement. CONCLUSIONS:Professional nursing practice environments are significantly associated with nurse work engagement. IMPLICATIONS FOR NURSING MANAGEMENT:Enhancing nurse work engagement is a complex challenge. Generational cohorts may respond to different strategies to enhance engagement.

背景与目标： 目的：描述员工护士的工作参与度，按代际队列确定预测因素，介绍对护士管理者的影响并建议未来的研究。
背景：全球护士短缺迫在眉睫。尽管需要足够的护士来确保获得护理，但是可以通过充足的高度敬业的护士（专职，充满活力和专心致志的护士）来提供优质的护理。长期以来，护士一直在报告能量消耗练习环境的存在。在专业执业环境中执业的护士可能会更多地参与进来。
方法：执行非实验性调查设计。在五家农村急诊医院工作的直接护理注册护士（n = 747）完成了问卷调查，以评估工作参与度（乌特勒支工作投入量表9），决策参与（决定参与量表），关系协调（关系协调调查）和护理实践环境（护理工作指数的实践环境量表）。描述性，相关性和回归分析按世代队列研究了工作投入和预测因素。
结果：除了吸收成分外，各代人之间的参与度没有统计学上的显着差异。敬业度的预测因队列而异，但是在所有队列中，专业护理实践环境都预测了护士的工作敬业度。
结论：专业护理实践环境与护士工作投入密切相关。
护理管理的意义：加强护士工作投入是一项复杂的挑战。代际群体可能对不同的策略做出反应，以提高参与度。

BACKGROUND & AIMS: OBJECTIVE:To obtain information to help design and implement quality improvement programmes.

DESIGN:Questionnaire survey.

SETTING:Swiss University Hospitals.

STUDY PARTICIPANTS:Clinical Department heads.

MAIN OUTCOME MEASURES:Attitudes towards quality assurance and percentage of departments with procedures for measurement and improvement of structure, process and outcome of medical care.

RESULTS:Among 138 departments responding, 69 indicated a designated person or group in charge of quality and 57 were involved in collaborative quality improvement programmes. Mortality data at the level of the department was unavailable to 33% of respondents, and data on adverse treatment effects to 67% of them. Most respondents (69%) favoured the use of outcome indicators for quality control; only 13% favoured indicators pertaining to process or structure of care. Among indicators of outcome, patient satisfaction was the preferred indicator (25% of respondents), followed by morbidity (16%) and mortality (12%) data.

CONCLUSION:Although the quality of medical care in Switzerland enjoys an excellent reputation, this study highlights important gaps in the information system and the processes necessary to evaluate quality.

背景与目标： 目标：获取信息以帮助设计和实施质量改进计划。

设计：问卷调查。

设置< / strong>：瑞士大学医院。

研究对象：临床部门负责人。

主要观察指标：对质量保证和态度的态度

结果：在138个部门中，有69个部门指定了负责质量的人员或小组和57个参与了合作质量改进计划。 33％的受访者无法获得部门级别的死亡率数据，而67％的人没有获得不良治疗效果的数据。大多数受访者（69％）赞成使用结果指标进行质量控制；只有13％的人赞成与护理过程或结构有关的指标。在结果指标中，患者满意度是首选指标（占受访者的25％），其次是发病率（16％）和死亡率（12％）数据。

结论：尽管瑞士的医疗质量在声誉方面享有极高的声誉，这项研究突出了信息系统和评估质量所必需的流程中的重要差距。