Prevalence of hepatitis B antibodies in hospital personnel.

Of 426 hospital staff tested for hepatitis B surface antibody (anti-HBS) by the radioimmunoassay method 57 (13.4%) had positive results. Laboratory staff had the highest prevalence, followed by nurses, and both values were significantly higher than that of administrative staff. Clerical staff working in laboratories were at the same risk for hepatitis B as general-duty nurses. Significantly more staff with anti-HBS had a history of hepatitis (19.3%) compared with staff without anti-HBS (79%), and significantly more staff with a history of hepatitis had anti-HBS (25.6%) compared with staff without such a history (12.0%). History of blood transfusions was not related to prevalence of anti-HBS. The risk for hepatitis B is greater in hospital staff who are in direct contact with patients or handle patients'' blood and other specimens. However, contact with patients is less important than contact with patients'' blood and other specimens.     

Feasibility of routine testing for hepatitis B surface antigen in hospital employees and restriction of carriers.

In 1972-73, 48 hospital staff members were tested selectively for hepatitis B surface antigen (HBsAg); 4 (8.3%) were found to be HBsAg-positive. In 1974-75, 1415 staff members were tested routinely before employment and at periodic health examination; 25 (1.8%) were found to be HBsAg-positive. Of the HBsAg-positive staff members 55.2% were Asians, this proportion being significantly (P less than 0.05) greater than that of any other ethnic group, and 31.0% were southern Europeans. Nurses and laboratory technologists were the largest professional groups among the HBsAg-positive staff, each accounting for 20.7%. Our results indicate that it is impractical to carry out routine testing of hospital staff for HBsAg. Selective testing and restriction from work in their units is proposed for staff of the renal and peritoneal dialysis units, the emergency department and the intravenous team and dietary staff who handle food directly.     

Role of non-medical staff in screening for breast cancer.

In a feasibility study of mass population screening for breast cancer by clinical examination and mammography the ability of non-medical staff (nurses and radiographers) to act as primary screeners was compared with that of medical staff (surgeons and radiologists). In 240 women with cancer the rate of detection of the disease by the non-medical staff was comparable to that of the medical staff, although the non-medical staff detected more cancers by mammography alone than did the medical staff. The rate of detection by surgeons and particularly nurses was lower in women without symptoms than in those with symptoms, whereas the incidence of detection by radiologists and radiographers was lower in women aged under 50 than in those over 50. The rate of detection by all groups of staff significantly increased with increases in tumour size. The results suggest that non-medical staff can act effectively as primary screeners, but that for the detection of cancer in asymptomatic women, particularly those over 50, mammography is probably more effective than clinical examination.     

The Hospital Medical Advisory Committee—The Cabinet of the Medical Staff

Before a hospital medical staff can realistically accept responsibility for the professional practices of its members, a principle initially fostered by the American College of Surgeons and adopted by both the Canadian and American accreditation programs, it must have an effectively functioning medical staff organization. The medical advisory committee is the most important committee of the medical staff organization. A representative composition, adherence to sound administrative principles, and recognition of its prime functions of co-ordination, supervision and jurisdiction will permit this committee—and the total medical staff organization—to discharge adequately the very important responsibilities delegated to them by the governing board of the hospital. Properly structured medical staff bylaws with clearly defined terms of reference assist the smooth functioning of the “cabinet” of the medical staff and safeguard the prerogatives of the individual members of the staff.     

Development of an index to measure oral health care priority among nursing staff

Objective: To develop an index to measure oral health care priority among nursing staff. Background: Nursing staff, working on hospital wards, at nursing homes and at other facilities, have to deal with oral health care and there are many reports about the low priority that is given to oral health care by nursing staff. It is difficult to measure oral health care priority among nursing staff. A Dental Coping Beliefs Scale (DCBS) index was used in an intervention study and was found to be easy to handle but did not have the ability to reveal significant differences in small study samples. A development process consisting of added items and item numbering by chance was carried out. During this process, different nursing staff test groups were used. The aim was to develop an oral health care priority index that can be used both on hospital wards and at special facilities to measure oral health care priority among nursing staff over time and between groups. Material and methods: Nursing staff at both special facilities and hospital wards and nursing students. Results: It was found that the index, the nursing DCBS, was more stable compared with the version that was used in the initial intervention study. It was also noted that its ability to discriminate between the items was improved. Conclusion: The nursing DCBS index is a suitable tool for use in further studies where the aim is to measure how different nursing staff groups give priority to and allocate responsibility for oral health care, even where study samples are small.     

Hospital Medical Staff By-laws: An Instrument for Self-Government

Hospital medical staff by-laws are important. By them the governing board of a hospital can and does confer on the medical staff the power to set up a form of organization by which that staff can give assurance of quality hospital medical care. The form of medical staff organization is patterned on familiar concepts of democratic self-government as we know it on this continent. Within the ordered society of the hospital medical staff, as in society at large, there is control of citizenship, classification of citizens as to their citizen rights, licence to do differing kinds of work, election of representatives, definition of rules for conduct, application of the cabinet principle, law enforcement by appointed judges, the right of appeal and, importantly, incentive for voluntary effort. Traditional professional freedom, self-determination and voluntary association of colleagues are guarded by this method of hospital conduct which is unique to the voluntary hospital system on this continent. Knowledge of the democratic process and of the motivation required to make it work well are essential for its preservation.     

不同层流净化级别室内微量麻醉气体对医护人员的影响

目的:研究净化级别不同室内麻醉药物残留浓度对医护人员健康的影响,为制定麻醉操作规范提供参考依据。方法:通过Tedlar采样袋采集麻醉医生及麻醉恢复室人员呼出气20 mL,双盲法送30 min内相关人员应用气相色谱法进行分析。结果:不同层流净化级别室内医务人员呼出微量麻醉气体的浓度不同。十万级恢复室内医护人员呼出气体的浓度高于百级和万级手术间。结论:麻醉废气污染对手术室工作人员的心理行为及操作能力产生影响,医护人员应增强自我防护意识,定期监测手术室环境污染的程度,制定预防和减少麻醉废气污染的有效措施。     

医院管理在从医者健康影响因素中的正向作用

从医者健康是医院发展、医学进步的基础和前提。近年的调查表明,从医者健康状况不容乐观,医院管理者应当认识到从医者身体健康的重要性,并且通过管理手段,化解影响从医者健康的不利因素,推进医院良好发展。     

Crisis in our hospital kitchens: ancillary staffing levels during an outbreak of food poisoning in a long stay hospital.

An investigation into an outbreak of food poisoning caused by Clostridium perfringens showed evidence of poor food handling by catering staff. The reasons behind this were explored by interviewing catering staff, analysing shifts and rotas, and looking at staff vacancies. Morale was low because of staff shortages resulting from a long term recruitment problem. In consequence staff were working double shifts and often for weeks on end without a day off. The reasons for the recruitment problem included the difficulty of recruiting semiskilled labour from a middle class area, low wages, lack of management support, and the poor image of the hospital as a place of work. Similar factors affect the recruitment and retention of ancillary staff nationally. The NHS has a poor record as an employer of ancillary staff, paying lower wages than other organisations for equivalent posts. Competitive tendering has further worsened the position of ancillary staff, with the result that good quality of care and service has often not been achieved. The NHS Review, with its emphasis on quality of care, makes no mention of ancillary staff. Yet high standards of ancillary provision are essential if further outbreaks of food poisoning in hospitals are to be prevented.     

医院动物实验工作人员的素质要求和培养

动物实验人员的素质是决定医院动物实验工作质量的重要因素．但通常被忽视。随着动物实验标准化进程的不断推进,提高动物实验工作人员的素质、增强专业技能就显得尤为重要。本文结合我院实践主要阐述综合性医院动物实验工作的特点、对动物实验工作人员基本素质的要求以及培养和提高的途径。     

Global Health Diplomacy,Monitoring & Evaluation,and the Importance of Quality Assurance & Control: Findings from NIMH Project Accept (HPTN 043): A Phase III Randomized Controlled Trial of Community Mobilization,Mobile Testing,Same-Day Results,and Post-Test Support for HIV in Sub-Saharan Africa and Thailand

Background

Provision and scale-up of high quality, evidence-based services is essential for successful international HIV prevention interventions in order to generate and maintain intervention uptake, study integrity and participant trust, from both health service delivery and diplomatic perspectives.

Methods

We developed quality assurance (QAC) procedures to evaluate staff fidelity to a cluster-randomized trial of the NIMH Project Accept (HPTN 043) assessing the effectiveness of a community-based voluntary counseling and testing strategy. The intervention was comprised of three components—Mobile Voluntary Counseling and Testing (MVCT), Community Mobilization (CM) and Post-Test Support Services (PTSS). QAC procedures were based on standardized criteria, and were designed to assess both provider skills and adherence to the intervention protocol. Supervisors observed a random sample of 5% to 10% of sessions each month and evaluated staff against multiple criteria on scales of 1–5. A score of 5 indicated 100% adherence, 4 indicated 95% adherence, and 3 indicated 90% adherence. Scores below 3 were considered unsatisfactory, and protocol deviations were discussed with the respective staff.

Results

During the first year of the intervention, the mean scores of MVCT and CM staff across the 5 study sites were 4 (95% adherence) or greater and continued to improve over time. Mean QAC scores for the PTSS component were lower and displayed greater fluctuations. Challenges to PTSS staff were identified as coping with the wide range of activities in the PTSS component and the novelty of the PTSS process. QAC fluctuations for PTSS were also associated with new staff hires or changes in staff responsibilities. Through constant staff monitoring and support, by Year 2, QAC scores for PTSS activities had reached those of MVCT and CM.

Conclusions

The implementation of a large-sale, evidence based HIV intervention requires extensive QAC to ensure implementation effectiveness. Ongoing appraisal of study staff across sites ensures consistent and high quality delivery of all intervention components, in keeping with the goals of the study protocol, while also providing a forum for corrective feedback, additional supervision and retraining of staff. QAC ensures staff fidelity to study procedures and is critical to the successful delivery of multi-site HIV prevention interventions, as well as the delivery of services scaled up in programmatic situations.     

Investigation on psychological state of occupational exposure of medical staff in operation room under novel coronavirus

This article mainly explores the psychological state of occupational exposure of medical staff in operation room contaminated with novel coronavirus, and provides targeted suggestions for mental health service of medical staff so as to maintain their physical and mental health. On February 28, 2020, a questionnaire survey was conducted using Internet. Nurses, anesthesiologists and surgeons in the operating room of the First Affiliated Hospital of Harbin Medical University from January 2020 to March 2020 were selected as the research objects. The psychological state of medical staff was investigated by SAS and PSS-14. As on February 29, 2020, 301 valid questionnaires and one invalid questionnaire were received. The survey showed that there was anxiety but no moderate or severe anxiety in the occupational behavior of operating room medical staff, while some medical staff had a certain degree of psychological pressure (P < 0.05). The present survey suggested that medical staff was under anxiety and pressure in different degrees in the operation room because of novel coronavirus contamination during occupational activities, much attention is required to improve mental health of medical professionals and to reduce their negative emotions.     

改革试点单位医务人员工作积极性影响因素研究

通过对北京市某医改试点单位医务人员工作积极性进行问卷调查，分析影响医务人员工作积极性的主要因素，从医务人员职业发展的内外在需求出发，完善管理措施，建立健全激励机制，充分调动医务人员的工作积极性，以期为公立医院改革全面推进提供参考和依据。     

Training strategies for research investigators and technicians

Training programs for research personnel are discussed as a key resource that must be part of an effective animal care and use program. Because of the legal responsibility to ensure that research staff are qualified to use animals, many institutions have justified the necessity for a training coordinator and/or trainers for their animal care and use programs. Effective training programs for research personnel must meet the needs of the client base (research scientists and staff) so that they are relevant, practical, and timely. To meet these objectives, it is useful to involve the scientific staff in the analysis of their learning needs. To meet a performance standard necessary for quality research, a large percentage of the institutional staff must participate in the training program. Often it is the principal investigators who set the tone for their staff members regarding the importance of receiving training. Garnering support from this client base will create a culture that encourages training and engenders a positive attitude about humane animal care and use. One effective approach is to incorporate nonanimal models as alternatives to live animals to teach humane handling techniques and methods, thereby contributing to refinement, reduction, and replacement (the 3Rs). Also discussed are the necessity of timely feedback from clients, documentation of personnel training for regulatory purposes, and the collection of training metrics, which assists in providing justification for the granting of additional fiscal support for the program. Finally, the compliance procedures and opportunities for essential refresher training are discussed and related to high performance standards, humane animal use, and quality research, all of which contribute to the 3Rs.     

Aged care staff perspectives on oral care for residents: Western Australia

Objective: To determine manager and staff perceptions of oral health and dental service issues for residents in aged care facilities in the Perth Metropolitan Area, Western Australia. Design: Focus groups and face‐to‐face semi‐structured interviews with aged care facility managers and staff. Setting and subjects: Personnel at 12 facilities (high‐level and low‐level care) located in the Perth Metropolitan Area participated in the study. Interviews were conducted with 14 facility managers. Focus groups and face‐to‐face interviews were conducted with 40 facility staff. Results: Managers and staff had similar views regarding most issues. While resident oral health was considered important, regular oral care programmes were limited or lacking. In general, high care facility residents did not have regular dental checkups, while those in low‐level care facilities usually visited their own dentist for checkups or treatment. Barriers to maintaining regular oral care included: resident non‐compliance; financial concerns; lack of co‐operation from family; mobility issues; and lack of interest from dental professionals. Suggested improvements to current services included regular on‐site visits, staff education and specialised dental professionals. Conclusion: Residents face many barriers to maintenance of adequate oral health care, particularly those who are functionally dependent and cognitively impaired. There is an urgent need for appropriate oral care programmes for aged care residents, which include dentists with aged care experience and continuing education for facility staff. Any major programmes should be evaluated carefully.     

Spontaneous abortions in hospital staff engaged in sterilising instruments with chemical agents.

Spontaneous abortions in hospital sterilising staff were analysed using data from a postal questionnaire and a hospital discharge register. The study included all the sterilising staff employed in Finnish hospitals in 1980; the controls were nursing auxiliaries. Data from the questionnaire showed that the frequency of spontaneous abortions was 11.3% for the sterilising staff and 10.6% for the nursing auxiliaries. When the staff were concerned in sterilising procedures during their pregnancy the frequency was 16.7% compared with 5.6% for the non-exposed pregnancies. Adjustment for age, parity, decade of pregnancy, smoking habits, and intake of coffee and alcohol did not affect the differences. The increased frequency of spontaneous abortion correlated with exposure to ethylene oxide but not with exposure to glutaraldehyde or to formaldehyde. Analysis of spontaneous abortions from the hospital discharge register confirmed the findings. Thus the results from the two independent analyses suggest that exposure to ethylene oxide in hospitals may carry a risk of spontaneous abortion among sterilising staff.     

Promoting physical activity within under-resourced afterschool programs: A qualitative investigation of staff experiences and motivational strategies for engaging youth

Afterschool programs (ASPs) have become increasingly recognized as a key context to support youth daily physical activity (PA) accrual. Using Self-Determination Theory (SDT) as a framework, this study examined staff perspectives on the strengths and barriers within under-resourced ASPs for establishing a social-motivational climate for encouraging and supporting youth PA. Analysis of semi-structured staff interviews (28 staff; 7 ASPs) indicated that staff had knowledge and value for establishing a PA-supportive motivational climate. However, the feasibility of implementing PA curricula was identified as challenging across programs. Findings suggest increased need for staff training and supports to provide a PA climate that meets the developmental needs/interests of all youth, with particular attention toward increasing the PA of girls and older program youth. Furthermore, striking an appropriate balance between PA and other competing program demands (e.g., academics) will be required to optimize on the effectiveness of PA program components.     

Daily scheduling of home health care services using time-dependent public transport

This paper presents a real-world optimization problem in home health care that is solved on a daily basis. It can be described as follows: care staff members with different qualification levels have to visit certain clients at least once per day. Assignment constraints and hard time windows at the clients have to be observed. The staff members have a maximum working time and their workday can be separated into two shifts. A mandatory break that can also be partitioned needs to be scheduled if the consecutive working time exceeds a certain threshold. The objective is to minimize the total travel- and waiting times of the care staff. Additionally, factors influencing the satisfaction of the clients or the care staff are considered. Most of the care staff members from the Austrian Red Cross (ARC) in Vienna use a combination of public transport modes (bus, tram, train, and metro) and walking. We present a novel model formulation for this problem, followed by an efficient exact solution approach to compute the time-dependent travel times out of the timetables from public transport service providers on a minute-basis. These travel time matrices are then used as input for three Tabu Search based solution methods for the scheduling problem. Extensive numerical studies with real-world data from the ARC show that the current planning can be improved significantly when these methods are applied.     

Hybrid simulation modelling of networks of heterogeneous care homes and the inter-facility spread of Covid-19 by sharing staff

Although system dynamics [SD] and agent-based modelling [ABM] have individually served as effective tools to understand the Covid-19 dynamics, combining these methods in a hybrid simulation model can help address Covid-19 questions and study systems and settings that are difficult to study with a single approach. To examine the spread and outbreak of Covid-19 across multiple care homes via bank/agency staff and evaluate the effectiveness of interventions targeting this group, we develop an integrated hybrid simulation model combining the advantages of SD and ABM. We also demonstrate how we use several approaches adapted from both SD and ABM practices to build confidence in this model in response to the lack of systematic approaches to validate hybrid models. Our modelling results show that the risk of infection for residents in care homes using bank/agency staff was significantly higher than those not using bank/agency staff (Relative risk [RR] 2.65, 95% CI 2.57–2.72). Bank/agency staff working across several care homes had a higher risk of infection compared with permanent staff working in a single care home (RR 1.55, 95%CI 1.52–1.58). The RR of infection for residents is negatively correlated to bank/agency staff’s adherence to weekly PCR testing. Within a network of heterogeneous care homes, using bank/agency staff had the most impact on care homes with lower intra-facility transmission risks, higher staff-to-resident ratio, and smaller size. Forming bubbles of care homes had no or limited impact on the spread of Covid-19. This modelling study has implications for policy makers considering developing effective interventions targeting staff working across care homes during the ongoing and future pandemics.     

Staff Scientist Perspectives on Onboarding and Professional Development: A Case Study

Across the United States, the number of staff scientists (master’s- or doctoral-level professionals working in nonfaculty roles) has grown by 35% since 2010, and they play an increasingly important role in research efforts. However, few targeted resources are available, which potentially limits the effectiveness of this group. Launched in 2016, the staff scientist path at Emory has tripled in size over 4 y to 138 staff. The present case study evaluated the perceptions of staff scientists related to onboarding experiences and professional development needs, including those needs arising from coronavirus disease 2019 (COVID-19) impacts in the workplace. A survey of Emory staff scientists was conducted from May to June 2019 as part of a program evaluation initiative to assess perceptions of onboarding and professional development opportunities. Interviews with a subset of scientists informed the survey development and identified COVID-19–related impacts on daily work. Results indicated the need for targeted orientation resources specific to staff scientists, accurate and timely information and resources to support scientists’ supervisors, and professional development for scientists in leadership and management-related skills. Remote work associated with COVID-19 accentuated the need for managerial skills, including team development in digital work environments. Findings from this case study can inform policies and practices at Emory and other institutions that employ a similar staff scientist model.