Perception of safety climate among Indonesian nurses: A cross-sectional survey

Background: The measurement of nurse perception on safety, and the factors associated to safety climate, direct the development of effective strategies in reducing adverse events, and patient safety improvement.Design and Method: This research was quantified, using the teamwork and safety climate domains of an Indonesian translated version of the Safety Attitudes Questionnaire (SAQ-INA). The teamwork and safety climate domain scores were calculated, using the published SAQ-INA scoring algorithm. The univariate and multivariate median regression models were performed to examine the association between potential predictors and safety climate.Result: The results showed that 279 nurses responded to the survey (82% response rate). While most of them had a positive attitude towards teamwork (n= 170, 61%), fewer possessed the same mentality towards safety climate (n=109, 39%). The lowest level of teamwork was perceived by nurses working in the emergency department (median 71, interquartile range 12.5), and safety climate (median 64, interquartile range 14.2). Furthermore, those that worked in the private hospitals, also reported lower levels of safety climate, compared to nurses in the public health centres (median difference=-3.571, p=0.009).Conclusion: Ward and hospital type were associated with the level of safety climate, perceived by nurses. Understanding the key areas, the intervention is best directed to target hospital wards with poor safety climate, in a bid to reduce adverse events, and improve patient safety.

The differences between referred and non-referred patients to a psychiatric consultation-liaison service in a general hospital

Objective The primary aim of this study was to investigate whether there are clinical differences between patients who are referred or not referred for psychiatric consultation and liaison service. The secondary aim was to compare the perspectives of doctors, nurses and patients. Methods This naturalistic, prospective and comparative study (N = 294) utilised a control sample of non-referrals (n = 177, consenting 81) and referrals (n = 177, consenting 49). The normality of the data was examined with the Shapiro-Wilk test; bivariate group comparisons were made using Mann-Whitney, Wilcoxon tests and bivariate regression analyses. Statistically adjusted group comparisons were performed with multivariate median regressions. Results The sample presented limited representativeness. Referred patients were predominantly women, mostly living alone and not working. Compared to the non-referred patients, their disease episode and length of hospital stay were significantly longer, self-efficacy and quality of life lower and psychological stress was higher. For referred patients, there were no differences between the estimations of mental burden and the need for care among doctors, nurses and patients. Self-efficacy and appraisal of one's own burden were the best predictors of the extent of mental symptoms. Discussion Patients in an admission ward for internal medicine referred to a psychiatric consultation-liaison service displayed a more adverse psychosocial profile and were more psychologically burdened than non-referred patients, but they are also relevantly subsyndromal burdened. Identifying and supporting burdened patients is an endeavour that requires collaborative care, especially in the transition to specialised mental health and to primary care.

Multivariate Medians for Image and Shape Analysis

Having been studied since long by statisticians, multivariate medianconcepts found their way into the image processing literature in thecourse of the last decades, being used to construct robust and efficientdenoising filters for multivariate images such as colour images but alsomatrix-valued images.Based on the similarities between image and geometric data as results ofthe sampling of continuous physical quantities, it can be expected that theunderstanding of multivariate median filters for images provides a startingpoint for the development of shape processing techniques.This paper presents an overview of multivariate median concepts relevantfor image and shape processing. It focusses on their mathematical principlesand discusses important properties especially in the context of imageprocessing.

Tenofovir Disoproxil Fumarate Is Associated with a Set-Point Variation in the Calcium-Parathyroid Hormone-Vitamin D Axis: Results from a German Cohort

Background. Higher levels of parathyroid hormone have been associated with the use of tenofovir disoproxil fumarate (TDF) in people with and without HIV infection. Yet, alterations in calcium levels have never been elucidated in detail. Objective. To compare the association of parathyroid hormone with serum calcium levels and other markers of calcium and bone metabolism in people living with HIV on TDF- and non-TDF-containing antiretroviral therapy. Patients and Methods. A retrospective single center cohort study in Munich, Germany. Median and interquartile ranges and absolute and relative frequencies were used to describe continuous and categorical variables, respectively. The Mann–Whitney U test and chi2-test were used for comparisons. Multivariate median regression was performed in a stepwise backward approach. Results. 1,002 patients were included (786 (78.4%) male; median age 48 (40–55) years). 564 patients (56.3%) had a TDF-containing ART regimen. PTH concentrations were 46.9 (33.0–64.7) pg/mL and 35.2 (26.4–55.4) pg/mL (P=0.001), 43.3 (30.8–59.8) pg/mL and 31.8 (22.3–49.6) pg/mL (P<0.001), 46.1 (29.5–65.4) pg/mL and 33.4 (22.6–50.1) pg/mL (P<0.001), and 37.8 (25.3–57.9) pg/mL and 33.8 (20.1–45.3) pg/mL (P=0.012) within the first, second, third, and fourth quartile of corrected calcium levels for patients with and without TDF-containing ART, respectively. In multivariate median regression, PTH concentration was significantly associated with Cacorr. (−32.2 (−49.8 to −14.8); P<0.001), female sex (5.2 (1.2–9.2); P=0.010), 25(OH)D (−0.4 (−0.5 to −0.3); P<0.001), and TDF-use (9.2 (6.0–12.5); P<0.001). Discussion. Higher levels of PTH seem to be needed to maintain normal calcium levels in PLWH on TDF-containing ART compared to non-TDF-containing ART. Optimal concentrations for 25-hydroxy vitamin D and calcium might therefore be different in people using TDF than expected from general populations but also people living with HIV with non-TDF-containing antiretroviral therapy. This might require different supplementation strategies but warrants further investigation.

Drivers of Patient Costs in Accessing HIV/AIDS Services in Tanzania

Background: Patient costs pose a challenge in accessing antiretroviral therapy for people living with HIV in sub-Saharan Africa. The study aimed at identifying drivers for out-of-pocket (OOP) costs in Tanzania. Methods: In 2009, 500 adult patients who attended 10 HIV clinics across 7 regions of Tanzania were asked about time and resources consumed to access HIV services. Bivariate and multivariate median regression models were used to determine the main drivers for OOP costs. Results: Male and female patients have a median OOP costs of $40.37 and $28.01 per year, respectively ( P = .01). Males spend significantly more on travel ($26.51) than females ($19.68; P = .02). Living in rural areas and poor social economic status (SES) are associated with greater OOP costs ( P = .001) for both sexes. Conclusion: Poor SES and rural residence are main drivers of OOP costs. Patients are less likely to seek health care unless they are in dire need, leading to expensive services.