Unravelling the ideal roster: A cross-sectional study of nurse shift preferences using multivariate analysis: Unravelling the ideal roster: An analysis of nurse shift preferences.

AIM: Our study aims to explore nurses' shift preferences in relation to their personal characteristics and examine how these preferences align with the rosters imposed in Belgian healthcare settings. Additionally, the study seeks to identify patterns in shift preferences across different days of the week and investigate the existence of distinct groups of nurses with similar preferences, further examining the link between these groups and their personal characteristics. DESIGN: Cross-sectional. METHODS: Questionnaires were distributed to 778 nurses across 11 general hospitals in Belgium, collecting data on demographics, chronotype, shift preferences, and roster alignment. Statistical analyses included logistic regression, principal component analysis, and k-means clustering. RESULTS: Age and chronotype significantly influence nurses' shift preferences. Preferences were consistent across the days within the week. The study revealed two groups of preferences: 'early birds' (preferring morning/day shifts) and 'night owls' (preferring evening/night shifts). Night owls were often neutral or evening-type chronotypes and had a higher alignment between imposed and ideal rosters. CONCLUSIONS: This study reinforces the importance of considering individual differences in nurses' shift preferences, linked to age and chronotype, and advocates for the adoption of flexible, personalized rostering systems. IMPLICATIONS: Personalized scheduling has the potential to improve workforce management, suggesting that healthcare administrators should consider individual preferences in rostering to mitigate the challenges of nurse understaffing. IMPACT: Tackles the pressing problem of nurse understaffing. Proposes that tailored rosters based on individual preferences could improve work conditions for nurses. Relevant to policymakers aiming to enhance nursing workforce management. REPORTING METHOD: STROBE Statement (for cross-sectional studies). PATIENT OR PUBLIC CONTRIBUTION: None.

An organizational design perspective on the monthly self-scheduling process in nursing homes: A multiple case study.

AIMS: To describe the monthly self-scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization-related outcomes. DESIGN: A multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework. METHODS: Data collection was performed in four Belgian NH during Spring 2019 using semi-structured interviews (n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within-case and cross-case analysis was performed. The COREQ checklist was used for reporting the findings. RESULTS: One group (two NH) used self-scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self-scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes. CONCLUSION: Self-scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes. IMPACT: This study contributes to the rare literature on self-scheduling in NHs by focusing on the monthly self-scheduling process and by including an organizational design perspective. NH management can become informed of different self-scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes. PATIENT OR PUBLIC CONTRIBUTION: Three members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self-scheduling process.

Development of Randomized Trials in Adults with Medulloblastoma-The Example of EORTC 1634-BTG/NOA-23.

Medulloblastoma is a rare brain malignancy. Patients after puberty are rare and bear an intermediate prognosis. Standard treatment consists of maximal resection plus radio-chemotherapy. Treatment toxicity is high and produces disabling long-term side effects. The sonic hedgehog (SHH) subgroup is highly overrepresented in the post-pubertal and adult population and can be targeted by smoothened (SMO) inhibitors. No practice-changing prospective randomized data have been generated in adults. The EORTC 1634-BTG/NOA-23 trial will randomize patients between standard-dose vs. reduced-dosed craniospinal radiotherapy and SHH-subgroup patients between the SMO inhibitor sonidegib (OdomzoTM, Sun Pharmaceuticals Industries, Inc., New York, USA) in addition to standard radio-chemotherapy vs. standard radio-chemotherapy alone to improve outcomes in view of decreased radiotherapy-related toxicity and increased efficacy. We will further investigate tumor tissue, blood, and cerebrospinal fluid as well as magnetic resonance imaging and radiotherapy plans to generate information that helps to further improve treatment outcomes. Given that treatment side effects typically occur late, long-term follow-up will monitor classic side effects of therapy, but also health-related quality of life, cognition, social and professional outcome, and reproduction and fertility. In summary, we will generate unprecedented data that will be translated into treatment changes in post-pubertal patients with medulloblastoma and will help to design future clinical trials.

The effect of self-scheduling on organizational justice and work attitudes through leader-member exchange: A cross-sectional study using propensity scores.

BACKGROUND: Nurses have a very stressful and demanding job, which probably affects their health and well-being. This has resulted in a search for an optimal nurse schedule. Self-scheduling is one method to enhance flexibility and give more control to the employee. Literature on self-scheduling is scarce and mainly focused on the implementation process. So far, little is known about the long-term effects of self-scheduling. OBJECTIVE: The comparison of effects of self-scheduling versus fixed scheduling on three dimensions of organizational justice (distributive, procedural, interactional justice) and three work attitudes (job satisfaction, affective commitment, global empowerment). This total effect is decomposed into direct and indirect effects via hypothesised mediators (leader-member exchange and organizational justice). DESIGN: A cross-sectional multisite-matched study. SETTING: A questionnaire was distributed to nurses and nurse assistants of twelve nursing homes in Flanders (Belgium). Six matched pairs of nursing homes were formed, each containing a nursing home that uses self-scheduling (for at least one year) and one that uses fixed scheduling. PARTICIPANTS: The study sample included 308 nurses and nurse assistants, of which 160 surveys were from nursing homes using fixed scheduling, versus 148 surveys from nursing homes using self-scheduling. METHODS: Using a double robust fixed effects regression model adjusted for the propensity score, the total effect of self-scheduling compared to fixed scheduling was analysed on the proposed outcomes. Subsequently, a (multiple) mediation analysis was performed. RESULTS: If all people would have used self-scheduling instead of fixed scheduling, on average a significant decrease in the mean procedural justice score (estimated mean difference = -0.20, 95% CI -0.36 to -0.05) would be found. There is a significant negative direct effect (estimated mean difference = -0.12, 95% CI -0.21 to -0.03) and indirect effect via the mediator leader-member-exchange (estimated mean difference = -0.08, 95% CI -0.15 to -0.01) on procedural justice. In addition, significant negative indirect effects of self-scheduling were found via the mediator leader-member exchange on all the investigated outcomes. CONCLUSION: Drawing up the work schedule is perceived as less fair in the case of self-scheduling. Furthermore, self-scheduling has a negative indirect effect on several work attitudes as a result of the changed relationship between the head nurse and the employees. The increase in task variety and decision-making autonomy for the employees and the altered leadership role of the head nurse can have a major impact on the dynamics of the entire team.

Proposal for An Algorithm for Screening for Undernutrition in Hospitalized Children.

The prevalence of disease-related undernutrition in hospitalized children has not decreased significantly in the last decades in Europe. A recent large multicentric European study reported a percentage of underweight children ranging across countries from 4.0% to 9.3%. Nutritional screening has been put forward as a strategy to detect and prevent undernutrition in hospitalized children. It allows timely implementation of adequate nutritional support and prevents further nutritional deterioration of hospitalized children. In this article, a hands-on practical guideline for the implementation of a nutritional care program in hospitalized children is provided. The difference between nutritional status (anthropometry with or without additional technical investigations) at admission and nutritional risk (the risk of the need for a nutritional intervention or the risk for nutritional deterioration during hospital stay) is the focus of this article. Based on the quality control circle principle of Deming, a nutritional care algorithm, with detailed instructions specific for the pediatric population was developed and implementation in daily practice is proposed. Further research is required to prove the applicability and the merit of this algorithm. It can, however, serve as a basis to provide European or even wider guidelines.

Aqueous citrato-oxovanadate(IV) precursor solutions for VO2: synthesis, spectroscopic investigation and thermal analysis.

An aqueous precursor solution, containing citrato-VO(2+) complexes, is synthesized for the formation of monoclinic VO2. With regard to the decomposition of the VO(2+) complexes towards vanadium oxide formation, it is important to gain insights into the chemical structure and transformations of the precursor during synthesis and thermal treatment. Hence, the conversion of the cyclic [V4O12](4-) ion to the VO(2+) ion in aqueous solution, using oxalic acid as an acidifier and a reducing agent, is studied by (51)Vanadium nuclear magnetic resonance spectroscopy. The citrate complexation of this VO(2+) ion and the differentiation between a solution containing citrato-oxalato-VO(2+) and citrato-VO(2+) complexes are studied by electron paramagnetic resonance and Fourier transform infra-red spectroscopy. In both solutions, the VO(2+) containing complex is mononuclear and has a distorted octahedral geometry with a fourfold R-CO2(-) ligation at the equatorial positions and likely a fifth R-CO2(-) ligation at the axial position. Small differences in the thermal decomposition pathway between the gel containing citrato-oxalato-VO(2+) complexes and the oxalate-free gel containing citrato-VO(2+) complexes are observed between 150 and 200 °C in air and are assigned to the presence of (NH4)2C2O4 in the citrato-oxalato-VO(2+) solution. Both precursor solutions are successfully used for the formation of crystalline vanadium oxide nanostructures on SiO2, after thermal annealing at 500 °C in a 0.1% O2 atmosphere. However, the citrato-oxalato-VO(2+) and the oxalate-free citrato-VO(2+) solution result in the formation of monoclinic V6O13 and monoclinic VO2, respectively.

One-year outcome of biological and synthetic bioabsorbable meshes for augmentation of large abdominal wall defects in a rabbit model.

BACKGROUND: Long-term efficacy of biological and synthetic bioabsorbable meshes for large hernia repair is currently unclear. This rabbit study is aimed at investigating 1-y outcome of biological and synthetic bioabsorbable meshes for augmentation of large abdominal wall defects. MATERIALS AND METHODS: In 46 rabbits, an 11 × 4 cm, full-thickness abdominal wall defect was repaired primarily, or with cross-linked (Permacol, Collamend) or non-cross-linked (Surgisis 4-ply, Surgisis Biodesign) biological, synthetic bioabsorbable (GORE BIO-A Tissue Reinforcement [TR], TIGR Matrix Surgical Mesh [MSM]), or polypropylene (Bard Mesh) meshes, using the underlay augmentation technique. One year after surgery, primary outcome was recurrence; secondary outcomes were tensile strength, histologic degree of tissue remodeling, and intraabdominal adhesion formation. RESULTS: Only two Surgisis 4-ply animals (50%) presented with a recurrent hernia. All GORE BIO-A TR meshes were completely resorbed and, as after primary repair, well-organized connective tissue without inflammation was present, with moderate adhesion formation and sufficient tensile strength. Cross-linked biological and TIGR MSM meshes demonstrated highest tensile strength but were only partially incorporated, with similar foreign body reaction and adhesion formation as polypropylene meshes in the TIGR MSM group, and minimal degradation and moderate adhesion formation in the cross-linked biological group. In the non-cross-linked biological group sufficient tensile strength and moderate adhesion formation were found, with pronounced inflammation if mesh remnants were present. CONCLUSIONS: Synthetic bioabsorbable GORE BIO-A TR meshes were associated with optimal tissue remodeling, with complete resorption, presence of well-organized tissue, and no inflammation. However, mesh augmentation had no advantages regarding recurrence rate versus primary repair of large abdominal wall defects.

Visceral leishmaniasis in a child infected with the human immunodeficiency virus in a non-endemic region.

We reported the case of a boy who fled from Chechnya to Belgium. He was diagnosed with a human immune deficiency virus (HIV)/Visceral leishmaniasis (VL) coinfection. In both countries, the prevalence of HIV-infected children is low and VL is not endemic. Migration of people results in confrontation with diseases that are not frequent in the countries of destination and becomes a challenge for pediatricians.

Laparoscopic inguinal hernia repair in men with lightweight meshes may significantly impair sperm motility: a randomized controlled trial.

OBJECTIVE: To compare quality of life and fertility aspects after laparoscopic inguinal hernia repair in men using a heavyweight or lightweight mesh. SUMMARY BACKGROUND DATA: The use of lightweight meshes in laparoscopic inguinal hernia repair could have beneficial effects on quality of life and preservation of the spermatic structures due to a decreased foreign-body reaction. METHODS: A total of 59 male patients planned for primary, unilateral or bilateral inguinal hernia repair were randomized between a standard polypropylene (Marlex) or lightweight mesh (Vypro II, TiMesh). Main outcome measures were fertility aspects, assessed preoperatively and at 1-year follow-up by semen analysis and scrotal ultrasonography. Secondary outcomes were quality of life (SF-36 and McGill Pain Questionnaire) and recurrence up to 1 year postoperatively. RESULTS: Patients operated on with a VyproII or TiMesh mesh exhibited a decreased sperm motility (vs. preoperatively) compared with Marlex patients, respectively -9.5% and -5.5% versus +2% (P = 0.013). When the results after uni- and bilateral hernia repair were analyzed separately, this difference only remained significant in the bilateral hernia subgroup: -10% for VyproII and -17% for TiMesh versus +1% for Marlex (P = 0.037). Other fertility parameters (sperm concentration, morphology, and alpha-glucosidase level) were unchanged. There were no differences at any study point between the 3 groups regarding quality of life. Only for resumption of sport activities was a small advantage noted for VyproII versus Marlex patients (P = 0.045). After 1 year, no recurrences were observed; 3 patients (6%) complained of chronic disabling pain. CONCLUSIONS: Our data suggest that the use of lightweight meshes for laparoscopic inguinal hernia repair in male patients negatively influences sperm motility, without any benefit on quality of life. These alterations might be important in a subgroup of young male patients operated on laparoscopically for a bilateral hernia. This study was registered in the clinicaltrials.gov database (ID number NCT00925067).

A standardized resident training program in endoscopic surgery in general and in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in particular.

The need for acquisition of specific laparoscopic skills has emphasized the role of a preclinical laboratory-training program. However, for laparoscopic inguinal hernia repair with a steep learning curve, especially for totally extraperitoneal repair, preclinical skill training remains a challenge. A standardized preclinical resident training program in endoscopic surgery is described. Also, a standardized clinical training program is proposed with systematic dissection in 10 different consecutive steps for totally extraperitoneal inguinal hernia repair. Continuous mentoring by an expert is an absolute prerequisite to the success of this training program. In this way, the learning period may be drastically reduced to approximately 30 procedures, in whom the resident progressively performs more and more of the different steps, and ultimately the complete procedure. Validation studies at different institutions are starting up to demonstrate the additional value of this training program.