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Background While individual countries have gained considerable knowledge and experience in coronavirus disease of 2019 (COVID-19) management, an international, comparative perspective is lacking, particularly regarding the measures taken by different countries to tackle the pandemic. This paper elicits the views of health system staff, tapping into their personal expertise on how the pandemic was initially handled. Methods From May to July 2020, we conducted a cross-sectional, online, purpose-designed survey comprising 70 items. Email lists of contacts provided by the International Society for Quality in Health Care, the Italian Network for Safety in Health Care and the Australian Institute of Health Innovation were used to access healthcare professionals and managers across the world. We snowballed the survey to individuals and groups connected to these organizations. Key outcome measures were attitudes and information about institutional approaches taken; media communication; how acute hospitals were re-organized; primary health organization; personal protective equipment; and staffing and training. Results A total of 1131 survey participants from 97 countries across the World Health Organization (WHO) regions responded to the survey. Responses were from all six WHO regions; 57.9% were female and the majority had 10 or more years of experience in healthcare; almost half (46.5%) were physicians; and all other major clinical professional groups participated. As the pandemic progressed, most countries established an emergency task force, developed communication channels to citizens, organized health services to cope and put in place appropriate measures (e.g. pathways for COVID-19 patients, and testing, screening and tracing procedures). Some countries did this better than others. We found several significant differences between the WHO regions in how they are tackling the pandemic. For instance, while overall most respondents (71.4%) believed that there was an effective plan prior to the outbreak, this was only the case for 31.9% of respondents from the Pan American Health Organization compared with 90.7% of respondents from the South-East Asia Region (SEARO). Issues with swab testing (e.g. delay in communicating the swab outcome) were less frequently reported by respondents from SEARO and the Western Pacific Region compared with other regions. Conclusion The world has progressed in its knowledge and sophistication in tackling the pandemic after early and often substantial obstacles were encountered. Most WHO regions have or are in the process of responding well, although some countries have not yet instituted widespread measures known to support mitigation, for example, effective swab testing and social control measures. [ABSTRACT FROM AUTHOR]

The Clinical Risk Managers and members of the Italian Association for Patient Safety, (INSH) who have been active throughout the federal healthcare service, have provided a specific INSH team COVID-19 response,based on their experiences on the requirements regarding patient safety. In figure 2 the integrated surveillance of COVID 19 in Italy (27 May 2020 update) [2] The international context is that on 30 January, the WHO declared the COVID-19 outbreak a Public Health Emergency of International Concern. Downloaded from https://academic.oup.com/intqhc/article/33/1/mzaa057/5840521 by 81695661, OUP on 05 April 2021 Editorial • Responding to COVID-19 3 Figure 2 Integrated surveillance of COVID-19 in Italy (27 May 2020 update). factors - including cultural attitudes, can affect patient outcomes. [Extracted from the article]

Abstract: A performance analysis for a 450MWth deep burn-high temperature reactor (DB-HTR) fuel was performed using COPA, a fuel performance analysis code of Korea Atomic Energy Research Institute (KAERI). The code computes gas pressure buildup in the void volume of a tri-isotropic coated fuel particle (TRISO), temperature distribution in a DB-HTR fuel, thermo-mechanical stress in a coated fuel particle (CFP), failure fractions of a batch of CFPs, and fission product (FP) releases into the coolant. The 350μm DB-HTR kernel is composed of 30% UO2 +70% (5% NpO2 +95% PuO1.8) mixed with 0.6moles of silicon carbide (SiC) per mole of heavy metal. The DB-HTR is operated at the constant temperature and power of 858°C and 39.02mW per CFP for 1395 effective full power days (EFPD) and is subjected to a core heat-up event for 250h during which the maximum coolant temperature reaches 1548.70°C. Within the normal operating temperature, the fuel showed good thermal and mechanical integrity. At elevated temperatures of the accident event, the failure fraction of CFPs resulted from the mechanical failure (MF) and the thermal decomposition (TD) of the SiC barrier is 3.30×10−3. [Copyright &y& Elsevier]

Education and practical training in medicine is neglected and pass directly from theory to do on the field, while also each task requires the acquisition of health behaviors that are aware and accountable to the outreach. In hemodialysis is necessary to create synergies and partnerships between different cooperating figures. Addressing organizational and legal protection of the professionals (Clinical Risk). Acquiring operational capabilities of team work. Managing the team roles and functions.It is necessary then to acquire a modern methodology where the simulation represents the main tool, "the mistake" need to "learn" and the acquisition of "awareness" about event handling (in this case on Hemodialysis), in the context of clinical scenarios absolutely realistic.The methodology is based on simulated tasks using past experience as a business tool and innovative research. Debriefing and discussion with those involved and finally debrief collegiate looking for active/latent errors and use of international guidelines. Use of indicators to measure and review of performance during the various events and proactively promoting the reduction of the error.Among the types of participants was clear the minor presence of doctors of hemodialysis, probably for the wrong feeling of being checked and then judged in carrying out of actions made complex by urgency. In addition participating physicians have all stressed the usefulness of simulations of unusual events within the Hemodialysis treatment, but that if not solved can lead to death of the patient.Simulation under hemodialysis, although its first steps, appears to be an effective methodology able to stimulate self-criticism of the operators, but still with hesitations and fears above all by the nephrologists timorous of being judged more on technical skills than on organizational skills and leadership.

Background: Cross-unit handovers transfer responsibility for the patient among healthcare teams in different clinical units, with missed information, potentially placing patients at risk for adverse events., Objectives: We analysed the communications between high-acuity and low-acuity units, their content and social context, and we explored whether common conceptual ground reduced potential threats to patient safety posed by current handover practices., Methods: We monitored the communication of five content items using handover probes for 22 patient transitions of care between high-acuity 'sender units' and low-acuity 'recipient units'. Data were analysed and discussed in focus groups with healthcare professionals to acquire insights into the characteristics of the common conceptual ground., Results: High-acuity and low-acuity units agreed about the presence of alert signs in the discharge form in 40% of the cases. The focus groups identified prehandover practices, particularly for anticipatory guidance that relied extensively on verbal phone interactions that commonly did not involve all members of the healthcare team, particularly nursing. Accessibility of information in the medical records reported by the recipient units was significantly lower than reported by sender units. Common ground to enable interpretation of the complete handover content items existed only among selected members of the healthcare team., Conclusions: The limited common ground reduced the likelihood of correct interpretation of important handover information, which may contribute to adverse events. Collaborative design and use of a shared set of handover content items may assist in creating common ground to enable clinical teams to communicate effectively to help increase the reliability and safety of cross-unit handovers.