Evaluating elimination of mother-to-child transmission of HIV in Suriname: a mixed method study.

Objectives: To evaluate the cascade of care for the elimination of mother-to-child-transmission of human immunodeficiency virus (HIV) in Suriname and identify sociodemographic and clinical factors preventing transmission to exposed infants. Methods: A mixed-methods study design was used. Antenatal care data from the 2018 cross-sectional multi-indicator cluster survey on 1 026 women aged 15-49 years who had had a live birth in the previous 2 years were used. Furthermore, national data on a cohort of 279 mothers with HIV and their 317 infants born from 2016 to 2018 were evaluated. Additionally, 13 cases of mother-to-child-transmission of HIV were reviewed. Results: In 89.3% of cases, no mother-to-child HIV transmission occurred. Early cascade steps show that 28.4% of women had unmet family planning needs, 15% had no antenatal visits, 8% delivered outside a health facility, and 71.5% received an HIV test during antenatal care. Of the pregnant women with HIV, 84.2% received antiretroviral therapy, while 95.5% of their infants received HIV prophylactic treatment. Receiving antiretroviral therapy for the mother (odds ratio (OR) 45.4, 95% confidence interval (CI) 9.6-215.3) and the child (OR 145.7, 95% CI 14.4-1477.4) significantly increased the odds of a negative HIV test result in infants. Conversely, living in the interior decreased the odds (OR 0.2, 95% CI 0.4-0.7) compared with urban living. Conclusions: HIV medication for mothers with HIV and their infants remains key in the prevention of mother-to-child-transmission of HIV. Early prenatal care with follow-up should be strengthened in Suriname.

Factors associated with mortality in persons co-infected with tuberculosis and HIV in Suriname: a retrospective cohort study.

OBJECTIVE: To identify socio-demographic and clinical factors associated with mortality among persons with tuberculosis (TB) and TB/HIV co-infection in Suriname. METHODS: This was a retrospective cohort study using data from the national TB and HIV databases for 2010 - 2015. The survival probability of TB and TB/HIV co-infected patients was analyzed using the Kaplan-Meier estimates and the log-rank test. A Cox proportional hazard model was applied. RESULTS: The study showed that HIV-seropositivity (aHR: 2.08, 95%CI: 1.48 - 2.92) and older age (aHR: 5.84, 95%CI: 3.00 - 11.4) are statistically associated with higher mortality. For the TB/HIV co-infected patients, TB treatment (aHR: 0.43, 95%CI: 0.35 - 0.53) reduces the risk of death. Similarly, HIV treatment started within 56 days (aHR: 0.15, 95%CI: 0.12 - 0.19) and delayed (aHR: 0.25, 95%CI: 0.13 - 0.47) result in less hazard for mortality; Directly-Observed Treatment (aOR: 0.16, 95%CI: 0.09 - 0.29) further reduces the risk. CONCLUSIONS: The Ministry of Health of Suriname should develop strategies for early case-finding in key populations, such as for HIV and TB in men 60 years of age and older. Implementation of Isoniazid Preventive Therapy for HIV should be pursued. Scaling up TB and HIV treatment, preferably through supervision, are essential to reducing the TB/HIV mortality.

Seen through the patients' eyes: surgical safety and checklists.

OBJECTIVE: We sought to explore the views patients have towards surgical safety and checklists. As a secondary aim, we explored if previous experience of error or other patient characteristics influence these views. DESIGN: A cross-sectional survey study design was applied. PARTICIPANTS: The Flemish Patients' Platform network and social media were used to recruit participants. MAIN OUTCOME MEASURE(S): An 11-item questionnaire was designed to assess the following constructs: perception of surgical safety, attitudes towards the WHO surgical safety checklist and attitudes regarding checklist usage. RESULTS: Respondents' view (N = 444) on the risk of an adverse event showed considerable variation. Respondents were positive towards the checklist, strongly agreeing that it would impact positively on their safety. However, this positive perception did not translate into an attitude where patients will actively inform themselves whether a checklist is used. The majority of respondents have no difficulty with repetitive verification of identity, procedure and location of the surgery. Respondents with a clinical background were the least anxious. Views were divided regarding hearing discussions around blood loss or airway problems. CONCLUSIONS: Patients perceive the checklist as a reliable safety tool. They do not mind repetitive verification of identity and procedure. However, hearing staff discussing specific, explicit, risks could cause anxiousness in some patients. Building a supportive and collaborative environment is needed to involve and empower patients to contribute in the realization of a safe hospital environment.

Systematic psychometric review of self-reported instruments to assess patient safety culture in primary care.

AIMS: To give an overview of empirical studies using self-reported instruments to assess patient safety culture in primary care and to synthesize psychometric properties of these instruments. BACKGROUND: A key condition for improving patient safety is creating a supportive safety culture to identify weaknesses and to develop improvement strategies so recurrence of incidents can be minimized. However, most tools to measure and strengthen safety culture have been developed and tested in hospitals. Nevertheless, primary care is facing greater risks and a greater likelihood of causing unintentional harm to patients. DESIGN: A systematic literature review of research evidence and psychometric properties of self-reported instruments to assess patient safety culture in primary care. DATA SOURCES: Three databases until November 2016. REVIEW METHODS: The review was carried out according to the protocol for systematic reviews of measurement properties recommended by the COSMIN panel and the PRISMA reporting guidelines. RESULTS: In total, 1.229 records were retrieved from multiple database searches (Medline = 865, Web of Science = 362 and Embase = 2). Resulting from an in-depth literature search, 14 published studies were identified, mostly originated from Western high-income countries. As these studies come with great diversity in tools used and outcomes reported, comparability of the results is compromised. Based on the psychometric review, the SCOPE-Primary Care survey was chosen as the most appropriate instrument to measure patient safety culture in primary care as the instrument had excellent internal consistency with Cronbach's alphas ranging from 0.70-0.90 and item factor loadings ranging from 0.40-0.96, indicating a good structural validity. CONCLUSION: The findings of the present review suggest that the SCOPE-Primary Care survey is the most appropriate tool to assess patient safety culture in primary care. Further psychometric techniques are now essential to ensure that the instrument provides meaningful information regarding safety culture.

Validation of the flemish CARES, a quality of life and needs assessment tool for cancer care.

BACKGROUND: The Cancer Rehabilitation Evaluation System (CARES) is a quality of life (QOL) and needs assessment instrument of US origin that was developed in the 90's. Since November 2012 the copyright and user fee were abolished and the instrument became publicly available the present study aims to reinvestigate the psychometric properties of the CARES for the Flemish population in Belgium. METHODS: The CARES was translated into Flemish following a translation-back translation process. A sample of 192 cancer patients completed the CARES, concurrent measures, and questions on socio-demographic and medical data. Participants were asked to complete the CARES a second time 1 week later, followed by some questions on their experiences with the instrument. Internal consistency, test-retest reliability, content validity, construct validity, concurrent validity and feasibility of the CARES were subsequently assessed. RESULTS: The Flemish CARES version demonstrated excellent reliability with high internal consistency (range .87-.96) and test-retest ratings (range .70-.91) for all summary scales. Factor analysis replicated the original factor solution of five higher order factors with factor loadings of .325-.851. Correlations with other instruments ranging from |.43|-|.75| confirmed concurrent validity. Feasibility was indicated by the low number of missing items (mean 2.3; SD 5.0) and positive feedback of participants on the instrument. CONCLUSIONS: The Flemish CARES has strong psychometric properties and can as such be a valid tool to assess cancer patients' QOL and needs in research, for example in international comparisons. The positive feedback of participants on the CARES support the usefulness of this tool for systematic assessment of cancer patients' well-being and care needs in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02282696 (July 16, 2014).

Assessing cancer patients' quality of life and supportive care needs: Translation-revalidation of the CARES in Flemish and exhaustive evaluation of concurrent validity.

BACKGROUND: The prevalence of cancer increases every year, leading to a growing population of patients and survivors in need for care. To achieve good quality care, a patient-centered approach is essential. Correct and timely detection of needs throughout the different stages of the care trajectory is crucial and can be supported by the use of screening and assessment in a stepped-care approach. The Cancer Rehabilitation Evaluation System (CARES) is a valuable and comprehensive quality of life and needs assessment instrument. For use in Flemish research and clinical practice, the CARES tool was translated for the Dutch-speaking part of Belgium (Flanders) from its original English format. This protocol paper describes the translation and revalidation of this Flemish CARES version. METHODS: After forward-backward translation of the CARES into Flemish we aim to recruit 150 adult cancer patients with a primary cancer diagnosis (stage I, II or III) for validation. In this study with a combination of qualitative and a quantitative approach, qualitative data will be collected through focus groups and supplemented by two phases of quantitative data collection: i) an initial patient survey containing questions on socio-demographic and medical data, the CARES and seven concurrent instruments; and ii) a second survey administered after 1 week containing the CARES and supplementary questions to explore their impressions on the content and the feasibility of the CARES. DISCUSSION: With this extensive data collection process, psychometric validity of the Flemish CARES can be tested thoroughly using classical test theory. Internal consistency of summary scales, test-retest reliability, content validity, construct validity, concurrent validity and feasibility of the instrument will be examined. If the Flemish CARES version is found reliable, valid and feasible, it will be used in future research and clinical practice. Comprehensive assessment with the CARES in a stepped-care approach can facilitate timely identification of cancer patients' psychosocial concerns and care needs so it can contribute to efficient provision of patient-centered quality care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02282696 (July 16, 2014).

One fourth of unplanned transfers to a higher level of care are associated with a highly preventable adverse event: a patient record review in six Belgian hospitals.

OBJECTIVE: The objectives of this study are to determine the prevalence and preventability of adverse events requiring an unplanned higher level of care, defined as an unplanned transfer to the ICU or an in-hospital medical emergency team intervention, and to assess the type and the level of harm of each adverse event. DESIGN: A three-stage retrospective review process of screening, record review, and consensus judgment was performed. SETTING: Six Belgian acute hospitals. PATIENTS: During a 6-month period, all patients with an unplanned need for a higher level of care were selected. INTERVENTIONS: The records 6-month period, the records of all patients with an unplanned need for a higher level of care were assessed by a trained clinical team consisting of a research nurse, a physician, and a clinical pharmacist. MEASUREMENTS AND MAIN RESULTS: Adverse events were found in 465 of the 830 reviewed patient records (56%). Of these, 215 (46%) were highly preventable. The overall incidence rate of patients being transferred to a higher level of care involving an adverse event was 117.6 (95% CI, 106.9-128.3) per 100,000 patient days at risk, of which 54.4 (95% CI, 47.15-61.65) per 100,000 patient days at risk involving a highly preventable adverse event. This means that 25.9% of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event. The adverse events were mainly associated with drug therapy (25.6%), surgery (23.7%), diagnosis (12.4%), and system issues (12.4%). The level of harm varied from temporary harm (55.7%) to long-term or permanent impairment (19.1%) and death (25.2%). Although the direct causality is often hard to prove, it is reasonable to consider these adverse events as a contributing factor. CONCLUSION: Adverse events were found in 56% of the reviewed records, of which almost half were considered highly preventable. This means that one fourth of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event.

Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients.

OBJECTIVE: The purposes of the present study were to investigate the role of resilience in the prediction of emotional response in breast cancer patients and to examine whether this association is specific for women undergoing this emotionally taxing condition or whether resilience is more generally associated with higher levels of emotional well-being. METHODS: Two hundred fifty-three breast cancer patients and 211 healthy female controls completed four psychological questionnaires. Measures comprised the Connor-Davidson Resilience Scale, the Hospital Anxiety and Depression Scale, Positive and Negative Affect Schedule, and two happiness items. Cancer patients were assessed after diagnosis and surgery. RESULTS: Cancer patients reported higher levels of anxiety, depression, and negative affect and lower levels of positive affect and current happiness compared with control women. There was no difference between the two groups in level of resilience. Higher levels of resilience were related to better emotional adjustment both in women with breast cancer and in control women, but this association was stronger within the sample of cancer patients. In fact, patients scoring high on resilience seemed to experience similar levels of anxiety, depression, and current happiness as healthy women. CONCLUSION: Our results confirm that resilience may at least partially protect against emotional distress in cancer patients. Our findings suggest that resilience may be a relatively stable trait that is not affected by adversity.

Is there Lyme borreliosis in French Guiana? Descriptive study among patients referred for a suspected Lyme borreliosis in an Amazonian hospital between 2010 and 2022.

Lyme borreliosis (LB) existence in South America is debated, especially in the Amazon region. The infection with Lyme borreliae has never been reported in French Guiana where Borrelia burgdorferi sensu lato is not found in ticks. We describe the final diagnosis and presumed place of acquisition in patients consulting for suspicion of LB. We retrospectively collected data from all consecutive patients consulting for a suspicion of LB between 2010 and 2021 at Cayenne Hospital, French Guiana. Patients were classified by an adjudication committee as confirmed LB if they met the criteria of the French consensus, as possible LB if they had compatible symptoms and a good outcome after appropriate treatment, or excluded when a differential diagnosis was found. The place of acquisition was discussed in case of possible or confirmed case. Twenty-six patients were included. Rheumatologic symptoms were the most reported (88 %) followed by neurological symptoms (61 %). Twenty-four (92 %) of these patients were born out of French Guiana. Diagnosis of LB was considered as confirmed in 2 patients (8 %), for whom the place of acquisition was likely mainland France, and as possible in 3 patients (11 %) with early localized LB presumably acquired in French Guiana. Functional somatic disorders were diagnosed in 13 (50 %) patients whereas 9 (35 %) were found with another disease. This study did not confirm the acquisition of LB in French Guiana. However, three possible autochthonous cases encourage clinicians working in the Amazon area to stay aware of LB.

Comparing the effectiveness of two cardiovascular prevention programmes for highly educated professionals in general practice: a randomised clinical trial.

BACKGROUND: Cardiovascular disease is a major cause of mortality and morbidity and its prevalence is set to increase. While the benefits of medical and lifestyle interventions are established, the effectiveness of interventions which seek to improve the way preventive care is delivered in general practice is less so. The aim was to study and to compare the effectiveness of 2 intervention programmes for reducing cardiovascular risk factors within general practice. METHODS: A randomised controlled trial was conducted in Belgium between 2007-2010 with 314 highly educated and mainly healthy professionals allocated to a medical (MP) or a medical + lifestyle (MLP) programme. The MP consisted of medical assessments (screening and follow-up) and the MLP added a tailored lifestyle change programme (web-based and individual coaching) to the MP. Primary outcomes were total cholesterol, blood pressure, and body mass index (BMI). The secondary outcomes were smoking status, fitness-score, and total cardiovascular risk. RESULTS: The mean age was 41 years, 95 (32%) participants were female, 7 had a personal cardiovascular event in their medical history and 3 had diabetes. There were no significant differences found between MP and MLP in primary or secondary outcomes. In both study conditions decreases of cholesterol, systolic blood pressure, and diastolic blood pressure were found. Unfavourable increases were found for BMI (p < .05). A significant decrease of the overall cardiovascular risk was reported (p < .001). CONCLUSIONS: Both interventions are effective in reducing cardiovascular risk. In our population the combined medical and lifestyle programme was not superior to the medical programme. TRIAL REGISTRATION: ISRCTN23940498.

Patients' satisfaction with sexual and reproductive health services delivered in HIV clinics across European regions.

BACKGROUND: Throughout Europe, differences in satisfaction with HIV-care of people living with HIV (PLHIV) persist, despite a tendency towards harmonisation of policy and management. METHODS: A European sample of 1,549 PLHIV responded to an anonymous questionnaire assessing demographic background, general health, mental health, sexual health, and HIV-service provision. We compared the results across 3 regions: Western, Southern and Central/Eastern Europe. RESULTS: PLHIV differed in several socio-demographic variables (gender, migrant status, sexual orientation, and financial situation) as well as specific psychosocial aspects (HIV-related discrimination, satisfaction with sexual and reproductive health (SRH) services in HIV-care settings, and complaints about service provision). Using multivariate analysis, a predictive model for satisfaction with SRH services in HIV clinics was developed, resulting into region of residence, and participants' satisfaction with their own health status as significant predictors. CONCLUSIONS: Better integration of SRH services in HIV-care should be encouraged. Service providers should be trained and encouraged to discuss SRH issues with their patients to create a supportive environment, free of discrimination. More time should be allocated to discuss SRH issues with individual patients.

Implementing early-warning indicators of HIV drug resistance in the Caribbean.

A key component of the World Health Organization's (WHO's) Global HIV Drug Resistance (HIVDR) prevention and assessment strategy is to monitor HIVDR early-warning indicators (EWIs), which provide strategic information for HIVDR containment. The Pan American Health Organization (PAHO)/WHO supported implementation of HIVDR EWI monitoring in 16 Caribbean countries. Results from 15 countries were analyzed by year of patient initiation of antiretroviral therapy for the period 2005-2009. This report demonstrates the need for capacity-building to standardize prescribing practices and to strengthen adherence strategies and antiretroviral drug procurement management systems.

Prevalence of atrial fibrillation in adults participating in a large-scale voluntary screening programme in Belgium.

OBJECTIVE: Atrial fibrillation (AF) is a common arrhythmia in clinical practice. AF fulfils many of the criteria for a screening programme. No data about the prevalence of AF in non-hospitalized patients are available in Belgium. The aim of the study was to assess feasibility and effectiveness of a nationwide-organized voluntary screening programme in the general population in Belgium. METHODS: A total of 13.564 participants were screened, of whom 10,758 were older than 40 years (GSP group). Participants filled in stroke risk stratification questionnaires (CHADS2 and CHA2DS2-VASc). A one-lead electrocardiogram was performed. RESULTS: 228 participants had AF at the time of screening (AF group), with 125 women and 103 men (i.e., 1.9% and 2.6% of total women and men), representing a prevalence of 2.2% (95% CI 1.3% and 3.0%) of the screened population. Age of the AF group was 67 +/- 12 y (range 40-87 y). Using the CHADS2-score, 58% of participants with a positive AF screening had a high risk score, and 21% had an intermediate risk score. Using the CHA2DS2-VASc-score, 72% of the participants had a high risk score, and 21% had an intermediate risk score. CONCLUSION: AF was present in 2.2% of the respondents. At least 60% of AF group had an increased risk for thrombo-embolism. Although substantial methodological issues limit the exact interpretation of these results, the present study shows that a volunatry screening programme with a simple screening protocol is able to detect an important number of patients with previously undetected AF.

Clinical placement experience of nursing students during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: The impact of the COVID-19 pandemic on our society is profound, not least for the healthcare sector. On the one hand, this exceptional situation created unprecedented learning opportunities for nursing students. Yet, on the other hand, this situation can jeopardise nursing students learning trajectory. OBJECTIVES: To study nursing students' experiences during clinical placement during the COVID-19 pandemic. DESIGN: Cross-sectional survey design. SETTINGS: Clinical placements during the COVID-19 pandemic. PARTICIPANTS: Nursing students from nine Belgian nursing schools. METHODS: All students enrolled in nursing education are eligible to participate. The survey consists of five dimensions: demographics, risk perception, self-efficacy, support and communication, and resilience. RESULTS: The gaps that were identified by students focused on the need for more psychosocial support, establishing (regular) contact with their clinical placement supervisor, recognition of the difficult work situation, and the need for more space to unwind. CONCLUSIONS: Nursing students expressed a strong need to be heard, prepared, and supported. Most students felt supported by their nursing schools. Because of COVID-19, the role of the preceptor became more important. However, due to several reasons, the perceptor did not always meet the student's expectations. Preparing students for specific competencies is needed. In spite of the efforts of nursing schools and clinical sites, students often got lost in the chaos of the pandemic. This resulted in practical worries, fewer learning opportunities, and even fundamental doubts about their choice to become a nurse. Finally, it crucial that nursing schools and clinical sites communicate about matters such as the responsibility for testing nursing students, the provisions of uniforms and personal protective equipment, and structurally sharing guidelines with students to provide safe patient care.

Translation and validation of the Dutch version of the health professional education in patient safety survey amongst nursing students in Belgium: A psychometric analysis.

OBJECTIVES: Evaluate the psychometric properties of the Dutch version of the Health Professional Education in Patient Safety Survey (H-PEPSSDutch), an instrument used to assess self-efficacy regarding patient safety competence. METHODS: The H-PEPSSDutch was administered to 610 students in two Belgian nursing schools. We used confirmatory factor analysis, for both classroom and clinical learning, to examine the psychometric properties. RESULTS: The analysis of construct validity showed a good fit to the hypothesised models. Cronbach's alpha values ranged from 0.70 to 0.87 for classroom learning and from 0.56 to 0.86 for clinical learning, indicating good reliability. Differentiating between the H-PEPSS constructs in the clinical setting showed to be complicated; hence, discriminant validity was not supported for all dimensions. CONCLUSIONS: Overall, this provides us with a reliable instrument to measure self-reported patient safety competence among nursing students. Further research is needed to validate the H-PEPSS as a longitudinal monitoring tool and as a pre-and-post measurement on the impact of interventions related to patient safety in the nursing curricula.

Exploring and Evaluating Patient Safety Culture in a Community-Based Primary Care Setting.

OBJECTIVES: The primary aim was to measure patient safety culture in two home care services in Belgium (Flanders). In addition, variability based on respondents' profession was examined. METHODS: A cross-sectional study was conducted by administering the SCOPE-Primary Care questionnaire in two home care service organizations. RESULTS: In total, 1875 valid questionnaires were returned from 2930 employees, representing a response rate of 64%. The highest mean patient safety culture score was found for "organizational learning" (mean [SD] = 3.81 [0.53]), followed by "support and fellowship" (mean [SD] = 3.76 [0.61]), "open communication and learning from error" (mean [SD] = 3.73 [0.64]), and "patient safety management" (mean [SD] = 3.71 [0.60]). The lowest mean scores were found for "handover and teamwork" (mean [SD] = 3.28 [0.58]) and "adequate procedures and working conditions" (mean [SD] = 3.30 [0.56]). Moreover, managers/supervisors scored significantly higher on the dimensions "open communication and learning from error," "adequate procedures and working conditions," "patient safety management," "support and fellowship," and "organizational learning" than clinical and nonclinical staff. CONCLUSIONS: In conclusion, organizational learning is perceived as most positive. However, large gaps remain in the continuity of care as "handover and teamwork" is perceived as the most negative safety culture dimension. With knowledge of the current patient safety culture, organizations can redesign processes or implement improvement strategies to avoid patient safety incidents and patient harm in the future.

Relationship between influenza and dengue outbreaks, and subsequent bacterial sepsis in French Guiana: A time series analysis.

Background: Influenza has been shown to increase the risk for severe bacterial infection, in the tropics the seasonality of influenza epidemics is less marked, and this may not be the case. Dengue is often followed by prolonged asthenia and some physicians hypothesized increased susceptibility to infections based on anecdotal observations. Design and Methods: Time series of influenza and dengue surveillance were confronted bacterial sepsis admissions to test the hypotheses. Monthly surveillance data on influenza and dengue and aggregated sepsis data in Cayenne hospital were matched between 24/10/2007 and 27/09/2016. An ARIMA (1,0,1) model was used. Results The series of the number of monthly cases of sepsis was positively associated with the monthly number of cases of influenza at time t (ß=0.001, p=0.0359). Forecasts were imperfectly correlated with sepsis since influenza is not the only risk factor for sepsis. None of the ARIMA models showed a significant link between the dengue series and the sepsis series. Conclusions: There was thus no link between dengue epidemics and sepsis, but it was estimated that for every 1,000 cases of flu there was one additional case of sepsis. In this tropical setting, influenza was highly seasonal, and improved vaccination coverage could have benefits on sepsis.

Improving patient safety culture.

PURPOSE: Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. DESIGN/METHODOLOGY/APPROACH: Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies before (autumn 2005) and after (spring 2007) the improvement approach was implemented were completed. Using HSOPSC, safety culture was measured using 12 dimensions. Results are presented as evolving dimension scores. FINDINGS: Overall, 3,940 and 3,626 individuals responded respectively to the first and second surveys (overall response rate was 77 and 68 percent respectively). After an 18 to 26 month period, significant improvement was observed for the "hospital management support for patient safety" dimension--all main effects were found to be significant. Regression analysis suggests there is a significant difference between professional subgroups. In one hospital the "supervisor expectations and actions promoting safety" improved. The dimension "teamwork within hospital units" received the highest scores in both surveys. There was no improvement and sometimes declining scores in the lowest scoring dimensions: "hospital transfers and transitions", "non-punitive response to error", and "staffing". RESEARCH LIMITATIONS/IMPLICATIONS: The five participating hospitals were not randomly selected and therefore no representative conclusions can be made for the Belgian hospital sector as a whole. Only a quantitative approach to measuring safety culture was used. Qualitative approaches, focussing on specific safety cultures in specific parts of the participating hospitals, were not used. PRACTICAL IMPLICATIONS: Although much needs to be done on the road towards better hospital patient safety, the study presents lessons from various perspectives. It illustrates that hospital staff are highly motivated to participate in measuring patient safety culture. Safety domains that urgently need improvement in these hospitals are identified: hospital transfers and transitions; non-punitive response to error; and staffing. It confirms that realising progress in patient safety culture, demonstrating at the same time that it is possible to improve management support, is complex. ORIGINALITY/VALUE: Safety is an important service quality aspect. By measuring safety culture in hospitals, with a validated questionnaire, dimensions that need improvement were revealed thereby contributing to an enhancement plan.

Evaluating elimination of mother-to-child transmission of HIV in Suriname: a mixed method study / Estudio con métodos mixtos para evaluar la eliminación de la transmisión maternoinfantil del VIH en Suriname / Avaliação da eliminação da transmissão materno-infantil do HIV no Suriname: estudo de métodos mistos

ABSTRACT Objectives. To evaluate the cascade of care for the elimination of mother-to-child-transmission of human immunodeficiency virus (HIV) in Suriname and identify sociodemographic and clinical factors preventing transmission to exposed infants. Methods. A mixed-methods study design was used. Antenatal care data from the 2018 cross-sectional multi-indicator cluster survey on 1 026 women aged 15-49 years who had had a live birth in the previous 2 years were used. Furthermore, national data on a cohort of 279 mothers with HIV and their 317 infants born from 2016 to 2018 were evaluated. Additionally, 13 cases of mother-to-child-transmission of HIV were reviewed. Results. In 89.3% of cases, no mother-to-child HIV transmission occurred. Early cascade steps show that 28.4% of women had unmet family planning needs, 15% had no antenatal visits, 8% delivered outside a health facility, and 71.5% received an HIV test during antenatal care. Of the pregnant women with HIV, 84.2% received antiretroviral therapy, while 95.5% of their infants received HIV prophylactic treatment. Receiving antiretroviral therapy for the mother (odds ratio (OR) 45.4, 95% confidence interval (CI) 9.6-215.3) and the child (OR 145.7, 95% CI 14.4-1477.4) significantly increased the odds of a negative HIV test result in infants. Conversely, living in the interior decreased the odds (OR 0.2, 95% CI 0.4-0.7) compared with urban living. Conclusions. HIV medication for mothers with HIV and their infants remains key in the prevention of mother-to-child-transmission of HIV. Early prenatal care with follow-up should be strengthened in Suriname.

RESUMEN Objetivos. Evaluar la secuencia de la atención para la eliminación de la transmisión maternoinfantil del virus de la inmunodeficiencia humana (VIH) en Suriname y determinar los factores sociodemográficos y clínicos que previenen la transmisión a lactantes expuestos al virus. Métodos. En este estudio se empleó un diseño de métodos mixtos. Se utilizaron los datos de atención prenatal procedentes de la encuesta transversal de indicadores múltiples por conglomerados del 2018, realizada en 1 026 mujeres de entre 15 y 49 años que habían dado a luz a un nacido vivo en los dos años anteriores. También se evaluaron los datos nacionales correspondientes a una cohorte de 279 madres con infección por el VIH y sus 317 bebés nacidos entre el 2016 y el 2018. Además, se analizaron en detalle 13 casos de transmisión maternoinfantil del VIH. Resultados. En el 89,3% de los casos no hubo transmisión maternoinfantil del VIH. En las etapas iniciales de la secuencia de la atención se observó que el 28,4% de las mujeres no tenían cubiertas sus necesidades de planificación familiar; además, el 15% no dispusieron de consultas de atención prenatal, el 8% dieron a luz fuera de un centro de salud y en el 71,5% se llevó a cabo una prueba de detección del VIH en el marco de la atención prenatal. De las mujeres embarazadas con infección por el VIH, el 84,2% recibió un tratamiento antirretroviral, mientras que el 95,5% de los bebés recibieron un tratamiento profiláctico contra el VIH. La administración de tratamiento antirretroviral a la madre (cociente de posibilidades [OR] = 45,4; intervalo de confianza [IC] del 95%: 9,6-215,3) y al bebé (OR = 145,7; IC del 95%: 14,4-1477,4) hizo que aumentaran significativamente las posibilidades de obtener un resultado negativo en la prueba de detección del VIH en los lactantes. Por el contrario, residir en el interior del país hizo que disminuyeran dichas posibilidades (OR = 0,2; IC del 95%: 0,4-0,7), en comparación con residir en un entorno urbano. Conclusiones. Para las madres con infección por el VIH y para sus bebés, los medicamentos contra el VIH siguen siendo esenciales para prevenir la transmisión maternoinfantil del VIH. En Suriname debe reforzarse la atención prenatal temprana, incluido el seguimiento.

RESUMO Objetivos. Avaliar a cascata de atendimento para a eliminação da transmissão materno-infantil do vírus da imunodeficiência humana (HIV) no Suriname e identificar fatores sociodemográficos e clínicos que impedem a transmissão a bebês expostos. Métodos. Foi utilizado um delineamento de estudo com métodos mistos. Foram usados dados de atendimento pré-natal de uma pesquisa de indicadores múltiplos por conglomerados de corte transversal realizada em 2018, que incluiu 1 026 mulheres com idades entre 15 e 49 anos que haviam tido um nascido vivo nos dois anos anteriores. Além disso, foram avaliados os dados nacionais de uma coorte de 279 mães com HIV e seus 317 bebês nascidos vivos de 2016 a 2018, além de 13 casos de transmissão materno-infantil de HIV. Resultados. Em 89,3% dos casos, não houve transmissão materno-infantil do HIV. As etapas iniciais da cascata demonstram que 28,4% das mulheres tiveram necessidades não atendidas de planejamento familiar, 15% não fizeram consultas pré-natais, 8% tiveram o parto fora de uma unidade de saúde e 71,5% receberam um teste de HIV durante o atendimento pré-natal. Das gestantes com HIV, 84,2% receberam terapia antirretroviral, e 95,5% de seus bebês receberam tratamento profilático para o HIV. O tratamento antirretroviral da mãe (razão de chances [RC]: 45,4; intervalo de confiança [IC] de 95%: 9,6-215,3) e da criança (RC: 145,7; IC 95%: 14,4-1477,4) aumentou significativamente a probabilidade de um resultado negativo no teste de HIV dos bebês. Por outro lado, morar no interior diminuiu a probabilidade (RC: 0,2; IC 95%: 0,4-0,7) em comparação com o ambiente urbano. Conclusões. A medicação de mães e bebês contra o HIV continua sendo fundamental para a prevenção da transmissão materno-infantil do HIV. Deve-se reforçar o atendimento pré-natal precoce com acompanhamento no Suriname.

The SCOPE-PC instrument for assessing patient safety culture in primary care: a psychometric evaluation.

INTRODUCTION: Primary healthcare differs from hospitals in terms of - inter alia - organisational structure. Therefore, patient safety culture could differ between these settings. Various instruments have been developed to measure collective attitudes of personnel within a primary healthcare organisation. However, the number of valid and reliable instruments is limited. OBJECTIVES: Psychometric properties of the SCOPE-Primary Care instrument were tested to examine the instrument's applicability in home care services in Belgium. METHODS: A cross-sectional study was conducted by administering the SCOPE-PC questionnaire in a single home care organisation with more than 1000 employees, including nurses, midwives, healthcare assistants, diabetes educators and nursing supervisors. First, a confirmatory factor analysis was performed to test whether the observed dataset fitted to the proposed seven-factor model of the SCOPE-PC instrument. Second, Cronbach's alphas were calculated to examine internal consistency reliability. Finally, the instrument's validity was also examined. RESULTS: In total, 603 questionnaires were retained for further analysis, representing an overall response rate of 43.9%. Most respondents were nursing staff, followed by healthcare assistants and nursing supervisors. The results of the confirmatory factor analyses satisfied the chosen cut-offs, indicating an acceptable to good model fit. With the exception of the dimension 'organizational learning' (0.58), Cronbach's alpha scores of the SCOPE-PC scales indicated a good level of internal consistency: 'open communication and learning from error' (0.86), 'handover and teamwork' (0.78), 'adequate procedures and working conditions' (0.73), 'patient safety management' (0.81), 'support and fellowship' (0.75), and 'intention to report events (0.85). Moreover, inter-correlations between the seven dimensions as well as with the patient safety grade were moderate to good. CONCLUSIONS: The present study indicated that the SCOPE-Primary Care instrument has good psychometric properties for home care services in Belgium. No modifications are required to the original questionnaire in order to allow benchmarking between primary healthcare settings.