BACKGROUND: The COVID-19 pandemic wreaked havoc on long-term care facilities (LTCFs). Some LTCFs performed better than others at slowing COVID-19 transmission. Emerging literature has mostly described infection prevention and control strategies implemented by LTCFs during the pandemic. However, there is a need for a comprehensive review of factors that influenced the performance of LTCFs in containing COVID-19 spread to inform public health policy.
OBJECTIVE: To build on the existing literature, we conducted a scoping review of factors that influenced LTCF performance during the COVID-19 pandemic using a multidimensional conceptual framework of performance.
METHODS: We followed the Joanna Briggs Institute\'s methodology for scoping reviews. We queried CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, Scopus, and Web of Science for peer-reviewed literature in English or French published between January 1st, 2020 and December 31st, 2021. Retrieved records were screened for context (COVID-19 pandemic), population (LTCFs), interest (internal and external factors that influenced LTCF performance), and outcomes (dimensions of performance: equity, accessibility, reactivity, safety, continuity, efficacy, viability, efficiency). Descriptive characteristics of included articles were summarized. Dimensions of performance as well as internal (e.g., facility characteristics) and external (e.g., visitors) factors identified to have influenced LTCF performance were presented.
RESULTS: We retained 140 articles of which 68% were classified as research articles, 47% originated in North America, and most covered a period between March and July 2020. The most frequent dimensions of performance were \"efficacy\" (75.7%) and \"safety\" (75.7%). The most common internal factors were \"organizational context\" (72.9%) and \"human resources\" (62.1%), and the most common external factors were \"visitors\" (27.1%) and \"public health guidelines\" (25.7%).
CONCLUSIONS: Our review contributes to a global interest in understanding the impact of the COVID-19 pandemic on vulnerable populations residing and working in LTCFs. Though a myriad of factors were reported, a lack of randomized controlled trials makes it impossible to establish causality between the identified factors and LTCF performance. The use of a multidimensional framework can be recommended to evaluate healthcare system performance not merely in terms of efficacy and safety, but alongside other critical dimensions such as efficiency and equity.
BACKGROUND: Research Registry ID: researchregistry7026.

OBJECTIVE: The demand for ED services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 330 per 1000 to 334 per 1000 between 2018-2019 and 2022-2023. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks and improve overall safety. Among these models is the concept of \'front loading\' clinical care, involving the initiation of interventions at the point of arrival. The present study evaluates the impact of introducing phlebotomists at triage.
METHODS: We conducted a cross-sectional survey using purposive sampling at a single quaternary metropolitan ED with an annual census of greater than 90 000, encompassing all clinical staff in the ED. The survey data were analysed quantitatively and complemented by a thematic analysis.
RESULTS: The response rate for the questionnaire was 61% (n = 207), with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, whereas only 57% of the staff reported working in triage (P = 0.05, 0.00 to 0.04). \'Valuable/vital resource\' featured as a common response. Early decision-making, patient safety, staff and patient satisfaction emerged as consistent themes.
CONCLUSIONS: Staff expressed satisfaction that patient care now begins in the waiting room, especially after extended waiting periods prior to cubicle allocation. They assert that this improvement significantly enhances timely treatment and disposition decisions, as well as overall patient satisfaction.

OBJECTIVE: Staff at violence against women (VAW) organizations provide essential services for survivors of violence. The increase in VAW during the COVID-19 pandemic placed additional pressures on VAW staff. We investigated the impacts of the pandemic on the mental health of VAW staff in the Greater Toronto Area to inform recommendations for policy and practice.
METHODS: We conducted a community-based, mixed-methods study on the processes, experiences, and outcomes of adapting VAW programming during the pandemic using a sequential explanatory approach. Throughout 2021, we conducted a survey of direct support and leadership staff who worked on VAW services (\"VAW staff\") followed by semi-structured interviews with VAW staff purposively sampled from the survey. We descriptively analyzed quantitative survey data on the mental health of 127 VAW staff. We then applied thematic analysis to qualitative data from 18 interviews with VAW staff. We used the qualitative data to support interpretation and enrich the quantitative findings regarding staff mental health.
RESULTS: In the survey, 81% of leadership and 61% of direct support staff indicated that their work was more distressing during the pandemic. Participants reported moderate symptoms of vicarious trauma and mild symptoms of anxiety and depression. We generated three themes from the qualitative data to help explain these findings: (1) challenges related to changing work environments; (2) distress over not meeting client needs; and (3) difficulties in adapting self-care strategies in response to pandemic stressors.
CONCLUSIONS: VAW organizations require increased resources and flexible funding to hire and retain more staff to respond to higher and more complex caseloads during public health emergencies. With more structural supports in place, VAW organizations could create more time and space to develop their trauma-informed organizational practices: for example, establishing a culture of connection and learning among staff virtually and in-person and facilitating a range of self-care opportunities.
RéSUMé: OBJECTIFS: Le personnel des organisations de lutte contre la violence envers les femmes (VEF) fournit des services essentiels aux survivantes de la violence. L’augmentation de la VEF pendant la pandémie de COVID-19 a exercé des pressions supplémentaires sur le personnel de la VEF. Nous avons étudié les impacts de la pandémie sur la santé mentale du personnel de la VEF dans la région du Grand Toronto afin de formuler des recommandations pour les politiques et les pratiques. MéTHODES: Nous avons mené une étude communautaire basée sur des méthodes mixtes sur les processus, les expériences et les résultats de l’adaptation des programmes de VEF pendant la pandémie, en utilisant une approche explicative séquentielle. Tout au long de l’année 2021, nous avons mené une enquête auprès personnel de première ligne et des cadres travaillant sur les services de VEF (personnel de VEF), suivie d’entretiens semi-structurés avec un échantillon intentionnel de ce personnel tiré de l’enquête. Nous avons analysé de manière descriptive les données quantitatives de l’enquête sur la santé mentale de 127 membres du personnel de VEF. Nous avons ensuite appliqué une analyse thématique aux données qualitatives provenant de 18 entretiens avec le personnel de VEF. Nous avons utilisé les données qualitatives pour soutenir l’interprétation et enrichir les résultats quantitatifs concernant la santé mentale du personnel. RéSULTATS: Dans l’enquête, 81 % des cadres et 61 % du personnel de première ligne ont indiqué que leur travail était plus stressant pendant la pandémie. Les participants ont signalé des symptômes modérés de traumatisme indirect et des symptômes légers d’anxiété et de dépression. Nous avons dégagé trois thèmes à partir des données qualitatives pour aider à expliquer ces résultats : (1) défis liés aux environnements de travail changeants; (2) détresse liée à l’incapacité de répondre aux besoins des clients; et (3) difficultés à adapter les stratégies de soins personnels en réponse aux facteurs de stress de la pandémie. CONCLUSION: Les organisations de VEF ont besoin de ressources accrues et de financements flexibles pour recruter et retenir plus de personnel afin de répondre à des charges de travail plus élevées et plus complexes pendant les urgences de santé publique. Avec davantage de soutiens structurels en place, les organisations de VEF pourraient dégager plus de temps et d’espace pour développer leurs pratiques organisationnelles tenant compte des traumatismes. Par exemple, établir une culture de connexion et d’apprentissage entre le personnel, à la fois virtuellement et en personne, et faciliter une gamme d’opportunités de soins personnels.

OBJECTIVE: To determine the prevalence of veterinary emergency service pause systems (VESPSs) and describe aspects of implementation and perceived impact.
METHODS: Electronic questionnaire SETTING: Membership of the Veterinary Emergency and Critical Care Society (VECCS).
METHODS: None.
METHODS: None.
RESULTS: A questionnaire was distributed to 6176 VECCS members with 1168 responses. Seventy-six percent of the respondents were veterinarians. Ninety-one percent of respondents practice in the United States, with 74% of them working at 24/7 multispecialty practices. Eighty-seven percent of respondents indicated patient volume had increased, and 75% reported that a VESPS had been implemented between September 2020 and December 2021. Sixty-two percent reported that their emergency service had been paused or closed once per week or more. The top reasons for implementing a VESPS included excessive caseload and staffing shortages. A variety of methods were utilized to implement a pause. Sixty-nine percent reported their VESPS was less than ideal for effectiveness. Pause systems were reported to be highly supported by medical staff. Seventy-seven percent reported increased client frustration and complaints, and 57% reported staff were stressed from denying care. Of those who do not currently have a VESPS in place, 74% would prefer to have one.
CONCLUSIONS: VESPSs were in widespread use at the time of this survey, and most have been implemented between September 2020 and December 2021. The majority of VESPSs were employed to mitigate increased caseload and staffing shortages. Although VESPSs are largely supported by medical staff, drawbacks may include staff stress and client frustrations, and improvements are warranted.

UNASSIGNED: Health-promoting behaviors and lifestyle changes can reduce the cost of health services, stress, and disease complications. This study examined the status of health-promoting behaviors and its influencing factors.
UNASSIGNED: This cross-sectional study was conducted on 171 staff members of Zanjan University of Medical Sciences, Iran, in 2023. The Persian version of the health-promoting lifestyle profile II questionnaire was used. Analyzes were performed in R 4.3.2 software.
UNASSIGNED: Mean ± SD age was 37.67 ± 7.58 years. 83 % had the low levels of health-promoting behaviors, while 17.0 % had moderate levels. The physical activity and interpersonal relation had the lowest and highest scores. The most significant strong and weekly correlations was between health responsibility and physical activity with total score of health-promoting behavior scores (r = 0.81, r = 0.66). Staff with health-related college major performed better in the areas of nutrition, stress management, spiritual growth.
UNASSIGNED: Health-related college major is the most important factor affecting health-promoting behaviors. Also, health responsibility is most related to these behaviors. Educational interventions should be done at the community level, regardless of people\'s field of study, to increase people\'s knowledge and awareness about risk factors and improve the level of health.

BACKGROUND: Maternity support workers (MSWs) are now a key part of the maternity workforce. They work in environments with potential exposure to traumatic events, but little is known about their rates of exposure or psychological responses.
OBJECTIVE: We aimed to identify the proportion of MSWs reporting exposure to a traumatic work event and consequential rates of post-traumatic stress disorder (PTSD). We also aimed to identify factors associated with PTSD and to describe levels of burnout, empathy, and functional impairment, and to explore their potential associations with PTSD symptoms.
METHODS: MSWs were recruited via the Royal College of Midwives newsletter, which is sent to all MSW members, and via social media on the College MSW Facebook page. Participants completed an online survey. They provided information on demographic details, job role, and exposure to traumatic events, and completed questionnaires covering PTSD symptoms related to work events, related functional impairment, burnout, and empathy. Data were analysed via correlations and multiple regression.
RESULTS: Of 98 respondents, 88 had been exposed to a traumatic work event; 79 of these through being present and nine through hearing about traumatic events. Of those exposed, 14.8% (n = 13) participants had probable PTSD, while a further 5.7 % (n = 5) met the subclinical threshold. Over a third (35.2 %) of the sample showed high levels of emotional exhaustion, a key feature of burnout, and 27.3 % reported functional work impairment. PTSD symptoms were associated with younger age, higher empathic concern, and direct exposure to traumatic perinatal events.
CONCLUSIONS: MSWs are routinely exposed to traumatic events at work and are at risk of work-related PTSD. Younger and more empathic staff appear more at risk, although our methods could not distinguish cause and effect. It must also be noted that the survey took place during the COVID-19 pandemic, and findings could be influenced by this context. MSWs need to be routinely included in programmes to support staff in relation to trauma exposure at work.

BACKGROUND: Large language models (LLMs) have demonstrated impressive performances in various medical domains, prompting an exploration of their potential utility within the high-demand setting of emergency department (ED) triage. This study evaluated the triage proficiency of different LLMs and ChatGPT, an LLM-based chatbot, compared to professionally trained ED staff and untrained personnel. We further explored whether LLM responses could guide untrained staff in effective triage.
OBJECTIVE: This study aimed to assess the efficacy of LLMs and the associated product ChatGPT in ED triage compared to personnel of varying training status and to investigate if the models\' responses can enhance the triage proficiency of untrained personnel.
METHODS: A total of 124 anonymized case vignettes were triaged by untrained doctors; different versions of currently available LLMs; ChatGPT; and professionally trained raters, who subsequently agreed on a consensus set according to the Manchester Triage System (MTS). The prototypical vignettes were adapted from cases at a tertiary ED in Germany. The main outcome was the level of agreement between raters\' MTS level assignments, measured via quadratic-weighted Cohen κ. The extent of over- and undertriage was also determined. Notably, instances of ChatGPT were prompted using zero-shot approaches without extensive background information on the MTS. The tested LLMs included raw GPT-4, Llama 3 70B, Gemini 1.5, and Mixtral 8x7b.
RESULTS: GPT-4-based ChatGPT and untrained doctors showed substantial agreement with the consensus triage of professional raters (κ=mean 0.67, SD 0.037 and κ=mean 0.68, SD 0.056, respectively), significantly exceeding the performance of GPT-3.5-based ChatGPT (κ=mean 0.54, SD 0.024; P<.001). When untrained doctors used this LLM for second-opinion triage, there was a slight but statistically insignificant performance increase (κ=mean 0.70, SD 0.047; P=.97). Other tested LLMs performed similar to or worse than GPT-4-based ChatGPT or showed odd triaging behavior with the used parameters. LLMs and ChatGPT models tended toward overtriage, whereas untrained doctors undertriaged.
CONCLUSIONS: While LLMs and the LLM-based product ChatGPT do not yet match professionally trained raters, their best models\' triage proficiency equals that of untrained ED doctors. In its current form, LLMs or ChatGPT thus did not demonstrate gold-standard performance in ED triage and, in the setting of this study, failed to significantly improve untrained doctors\' triage when used as decision support. Notable performance enhancements in newer LLM versions over older ones hint at future improvements with further technological development and specific training.

UNASSIGNED: Anesthesia providers face numerous occupational hazards, including exposure to anesthesia gases, which can lead to fatigue. These professionals face challenges such as night shifts, OR stress, limited mobility and sunlight access, high workload, inadequate rest breaks. Health-related sociodemographic variables, such as smoking, sleep patterns, and obesity. Our research aims to explore various risk factors associated with fatigue among operating theatre workers including sleep quality.
UNASSIGNED: A cross-sectional study was conducted on 227 of operating room healthcare professionals from five tertiary hospitals in Saudi Arabia, for a period of 6 months, between January 1, 2023 to June 1, 2023. The study used a five-point Likert scale sheet and the FSS \"fatigue severity scale\" to analyze and measure fatigue and sleep quality. The questionnaire included all socio-demographic variables, work conditions, and fatigue severity scale items.
UNASSIGNED: The major findings revealed a significant correlation between fatigue severity scores and exposure to anesthesia gases. Socio-demographic variables such as smoking have showed major relevance to fatigue in the sample size, as (76.6%) of the participants that answered as regular smokers have showed result of positive correlation to fatigue and with a significant of (0.034). Out of the total sample, 76.1% were exposed to anesthesia gases once daily, showing a positive association with fatigue severity scores. Work-related factors like job experience and position also had a lower association with fatigue severity. p (0.031) Univariate logistic regression p (0.035).
UNASSIGNED: The study found that the work-related conditions like workload on Anesthesia technicians and technologists over 44 h per week and gas exposure is directly linked to fatigue severity and sleep quality so is the socio-demographic considerations. With poor sleep quality in younger staff which is documented in the study result a large-scale prospective analysis to understand the factors affecting OR staff\'s sleep quality and fatigue severity and what can be done to regulate working hours and break time and incorporate naps in to enhance patient safety and well-being for anesthesia providers in Saudi Arabia.

BACKGROUND: Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. This technology is being introduced in a range of healthcare settings as part of larger violence reduction strategies aimed at reducing incidents of aggression and violence on inpatient wards, however limited evidence exists to understand if this technology achieves such goals.
OBJECTIVE: This study aimed to evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards.
METHODS: The study used a mixed-methods design comparing quantitative measures including ward activity and routinely collected incident data at three time-points before during and after the pilot implementation of BWCs on one acute ward and one psychiatric intensive care unit, alongside pre and post pilot qualitative interviews with patients and staff, analysed using a framework based on the Consolidated Framework for Implementation Research.
RESULTS: Results showed no clear relationship between the use of BWCs and rates or severity of incidents on either ward, with limited impact of using BWCs on levels of incidents. Qualitative findings noted mixed perceptions about the use of BWCs and highlighted the complexity of implementing such technology as a violence reduction method within a busy healthcare setting Furthermore, the qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may impact on the incident data presented.
CONCLUSIONS: This study sheds light on the complexities of using such BWCs as a tool for \'maximising safety\' on mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility.

This study aimed to investigate the effect of hospital staffing resources on medical practice in public versus private hospitals. We used exhaustive delivery data from a French district of 11 hospitals over an 11-year period, from 2008 to 2018, including 168,120 observations. We performed multilevel logistic regression models with hospital fixed or random effects, while controlling for factors known to influence obstetric practice. We found that hospital staff ratios of obstetricians and that of midwives affected caesarean rates, but with different effects depending on the hospital sector. In public hospitals, the higher the ratio of obstetricians and that of midwives, the lower the probability of planned caesareans. In private hospitals, the higher the ratio of obstetricians, the greater the probability of planned caesareans. Indeed, in public hospitals, obstetricians and midwives, both salaried employees, do not have financial or organizational incentives to perform more caesareans. In private hospitals, obstetricians, who are independent doctors, may have such incentives. Our results underline the importance of having an adequate supply of health professionals in healthcare facilities to ensure appropriate care, with specific regard to the different characteristics of the public and private sectors.