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Shongwe L, Hanft-Robert S, Cossie Q, Sithole P, Roos T, Swartz L. Role of security guards in healthcare settings: a protocol for a systematic review. BMJ Open 2023; 13:e069546. [PMID: 37164473 PMCID: PMC10174004 DOI: 10.1136/bmjopen-2022-069546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION There is a paucity of literature on the comprehensive roles of security guards in healthcare, regardless of day-to-day observations of security guards playing an extensive role in this field. Thus, this review will systematically explore the roles of security guards in healthcare contexts to create a centred body of evidence. METHODS AND ANALYSIS The study will systematically review existing quantitative and qualitative peer-reviewed literature on security guards in institutional healthcare so as to understand their roles. We will conduct the systematic review on 10 electronic databases: BioMed Central, SocIndex, ScienceDirect, Google Scholar, JSTOR, PsycARTICLES, PsycINFO, Scopus, Web of Science and PubMed. Data extraction will be in the form of a word document. Mendeley software will be used to keep track of references, while the systematic review software, Rayyan, will be used for the screening, inclusion and exclusion of articles. If necessary, reviewer number 3 will conduct a third review should any disputes arise between the two initial reviewers. Quality assessment of the articles will be measured with the Critical Appraisal Skills Programme tool for articles in terms of the research aims, methodology used, sample, data analysis, presentation of findings, values of the research, as well as trustworthiness if it is a qualitative study or reflexiveness if it is a quantitative study. Studies dating back 32 years will be incorporated for a comprehensive review. ETHICS AND DISSEMINATION This systematic review will use publicly available peer-reviewed data from electronic databases and will, therefore, not require an ethical review, but rather, an ethics waiver. The systematic review protocol will be submitted for ethics waiver clearance from the Stellenbosch University Health Research Ethics Committee. The findings from this review will be disseminated through peer-reviewed publications and conferences. PROSPERO REGISTRATION NUMBER CRD42022353653.
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Affiliation(s)
- Lindokuhle Shongwe
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Saskia Hanft-Robert
- Department for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Qhama Cossie
- Department of Health & Wellness, Valkenberg Hospital, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Philasande Sithole
- Department of Health & Wellness, Valkenberg Hospital, Cape Town, South Africa
| | - Tessa Roos
- Department of Health & Wellness, Valkenberg Hospital, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Pearson GS. Workplace Violence and Psychiatric Nurses. J Am Psychiatr Nurses Assoc 2023; 29:3-4. [PMID: 36515499 DOI: 10.1177/10783903221142269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Oliveira RMD, Santos JLF, Furegato ARF. Indicadores hospitalarios y comportamiento de pacientes internados en hospital psiquiátrico que adoptó la prohibición de fumar. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5666.3610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Objetivo: comparar indicadores de internación, alta, costo con medicamentos y comportamientos de los pacientes antes y después de la prohibición del tabaquismo en un hospital psiquiátrico. Método: estudio ecológico, longitudinal y retrospectivo realizado en un hospital psiquiátrico. Fueron obtenidos datos secundarios, a partir de consulta a las fichas médicas, referentes a 2.142 internaciones. Fue aplicado el test de medianas para comparación de las variables antes y después de la prohibición. Resultados: con la implementación de la prohibición el porcentaje de ocupación de las camas fue reducido en las unidades masculinas de trastornos mentales (88,8% para 48,4%) y de dependencia química (94,4% para 42,8%). La media de días de internación fue reducida en la unidad masculina de dependencia química (13,5 para 12,6) en comparación con la unidad femenina (14,7 para 19,5). Los costos con psicofármacos y expectorantes, las agresiones verbales/físicas y las contenciones físicas/químicas fueron reducidas. Conclusión: la prohibición de fumar alteró los indicadores hospitalarios, redujo costos y mejoró el comportamiento de los pacientes, contrariando el mito de que esta resulta en hostilidad. Se espera que este estudio contribuya para que los enfermeros revisen sus creencias relacionadas con la prohibición del tabaquismo, considerando los resultados positivos para las relaciones interpersonales y para la administración de los servicios de salud mental, que fueron obtenidos.
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Oliveira RMD, Santos JLF, Furegato ARF. Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban. Rev Lat Am Enfermagem 2022. [PMID: 35920539 PMCID: PMC9342906 DOI: 10.1590/1518-8345.5666.3548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: to compare hospitalization and discharge indicators, medication costs and patient behavior before and after the implementation of the smoking ban in a psychiatric hospital. Method: ecological, longitudinal and retrospective study carried out in a psychiatric hospital. Secondary data referring to 2142 hospitalizations were collected from medical records. The median test was used to compare the variables before and after the ban. Results: after the implementation of the ban, there was a reduction in bed occupancy rate in male units for mental disorders (from 88.8% to 48.4%) and substance dependence (from 94.4% to 42.8%). There was a reduction in the mean length of hospital stay in the male chemical dependency unit (from 13.5 to 12.6) compared to the female unit (from 14.7 to 19.5). There was a reduction in costs of psychotropic drugs and expectorants, episodes of verbal/physical aggressions and physical/chemical restraints. Conclusion: the smoking ban changed hospital indicators, reduced costs and improved patient behavior, contradicting the myth that it results in hostility. It is hoped that this study will help nurses to review their beliefs related to smoking cessation, as there were positive results for interpersonal relationships and for the management of mental health services.
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de Oliveira RM, Santos JLF, Furegato ARF. Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban. Rev Lat Am Enfermagem 2022; 30:e3611. [PMID: 35920539 PMCID: PMC9342906 DOI: 10.1590/1518-8345.5666.3611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/11/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to compare hospitalization and discharge indicators, medication costs and patient behavior before and after the implementation of the smoking ban in a psychiatric hospital. METHOD ecological, longitudinal and retrospective study carried out in a psychiatric hospital. Secondary data referring to 2142 hospitalizations were collected from medical records. The median test was used to compare the variables before and after the ban. RESULTS after the implementation of the ban, there was a reduction in bed occupancy rate in male units for mental disorders (from 88.8% to 48.4%) and substance dependence (from 94.4% to 42.8%). There was a reduction in the mean length of hospital stay in the male chemical dependency unit (from 13.5 to 12.6) compared to the female unit (from 14.7 to 19.5). There was a reduction in costs of psychotropic drugs and expectorants, episodes of verbal/physical aggressions and physical/chemical restraints. CONCLUSION the smoking ban changed hospital indicators, reduced costs and improved patient behavior, contradicting the myth that it results in hostility. It is hoped that this study will help nurses to review their beliefs related to smoking cessation, as there were positive results for interpersonal relationships and for the management of mental health services.
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Affiliation(s)
| | | | - Antônia Regina Ferreira Furegato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
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Jenkin G, McIntosh J, Hoek J, Mala K, Paap H, Peterson D, Marques B, Every-Palmer S. There's no smoke without fire: Smoking in smoke-free acute mental health wards. PLoS One 2021; 16:e0259984. [PMID: 34780542 PMCID: PMC8592473 DOI: 10.1371/journal.pone.0259984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implementing this policy. AIM This study explored smoking in acute metal health wards using data emerging from a large sociological study on modern acute psychiatric units. METHODS Eighty-five in-depth, semi-structured interviews were conducted with staff and service users from four units. Data were analysed using a social constructionist problem representation approach. RESULTS Although high-level smoke-free policies were mandatory, most participants disregarded these policies and smoking occurred in internal courtyards. Staff reasoned that acute admissions were not the time to quit smoking, citing the sceptres of distress and possibly violence; further, they found smoking challenging to combat. Inconsistent enforcement of smoke-free policies was common and problematic. Many service users also rejected smoke-free policies; they considered smoking facilitated social connections, alleviated boredom, and helped them feel calm in a distressing environment - some started or increased smoking following admission. A minority viewed smoking as a problem; a fire hazard, or pollutant. No one mentioned its health risks. CONCLUSION Psychiatric wards remain overlooked corners where hospital smoke-free policies are inconsistently applied or ignored. Well-meaning staff hold strong but anachronistic views about smoking. To neglect smoking cessation support for people with serious mental illness is discriminatory and perpetuates health and socioeconomic inequities. However, blanket applications of generic policy are unlikely to succeed. Solutions may include myth-busting education for service users and staff, local champions, and strong managerial support and leadership, with additional resourcing during transition phases. Smoke-free policies need consistent application with non-judgemental NRT and, potentially, other treatments. Smoking cessation would be supported by better designed facilities with more options for alleviating boredom, expressing autonomy, facilitating social connections, and reducing distress.
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Affiliation(s)
- Gabrielle Jenkin
- Department of Psychological Medicine, Suicide and Mental Health Research Group, University of Otago Wellington, Wellington, New Zealand
| | - Jacqueline McIntosh
- School of Architecture, Victoria University of Wellington, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Krishtika Mala
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Hannah Paap
- Department of Psychological Medicine, Suicide and Mental Health Research Group, University of Otago Wellington, Wellington, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Bruno Marques
- School of Architecture, Victoria University of Wellington, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
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Ratier-Cruz A, Smith JG, Firn M, Rinaldi M. Staff attitudes to completely smoke-free policies and smoking cessation practices in a mental health setting. J Public Health (Oxf) 2021; 42:403-411. [PMID: 32128592 DOI: 10.1093/pubmed/fdaa033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mental health trusts in England were expected to become completely smoke-free and embed smoking cessation practices by 2018. Such policies are fraught with concerns and have received mixed support from mental health staff. Understanding staff attitudes to these practices prior to enforcement of the policy could help design an effective implementation strategy. METHODS A cross-sectional survey was conducted with clinical and non-clinical staff in a Mental Health Trust to understand smoking cessation practices and attitudes to the implementation of a completely smoke-free policy. RESULTS There were 631 responses. Most participants disagreed with the policy on wards (59.6%) and throughout all mental health settings (57.4%). Clinicians expressed significantly lower organizational policy support (P = 0.001) than non-clinicians (P = 0.001). Psychiatrists were more supportive of the organizational items than nurses and allied health professionals. Clinicians' attitudes towards smoking cessation practices were less positive for those who were current smokers (P < 0.001), but more positive for clinicians who had received or were interested in attending smoking cessation training (P < 0.001). CONCLUSIONS Partial and completely smoke-free policies remain unsupported by staff in mental health settings. Smoking cessation training appears to reinforce rather than alter attitudes towards smoking cessation.
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Affiliation(s)
- A Ratier-Cruz
- South West London & St George's Mental Health NHS Trust, Springfield University Hospital, London SW17 7DJ, UK
| | - J G Smith
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - M Firn
- South West London & St George's Mental Health NHS Trust, Springfield University Hospital, London SW17 7DJ, UK
| | - M Rinaldi
- South West London & St George's Mental Health NHS Trust, Springfield University Hospital, London SW17 7DJ, UK
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Williams J, Craig TJ, Robson D. Barriers and facilitators of clinician and researcher collaborations: a qualitative study. BMC Health Serv Res 2020; 20:1126. [PMID: 33278896 PMCID: PMC7718701 DOI: 10.1186/s12913-020-05978-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The poor translation of research findings into routine clinical practice is common in all areas of healthcare. Having a better understanding of how researchers and clinicians experience engagement in and with research, their working relationships and expectations of each other, may be one way to help to facilitate collaborative partnerships and therefore increase successful translation of research into clinical practice. AIMS To explore the views of clinical and research staff about their experiences of working together during research projects and identify the facilitators and barriers. METHODS We conducted four focus groups with 18 participants - clinicians, researchers and those with a dual clinical-research role, recruited from one mental health Trust and one university. Data was analysed using thematic analysis. RESULTS Eight themes were identified under the headings of two research questions 1) Barriers and facilitators of either engaging in or with research from the perspective of clinical staff, with themes of understanding the benefits of the research; perceived knowledge and personal qualities of researchers; lack of time and organisational support to be involved in and implement research; and lack of feedback about progress and outcome of research. 2) Barriers and facilitators for engaging with clinicians when conducting research, from the perspective of researchers, with themes of understanding what clinicians need to know and how they need to feel to engage with research; demonstrating an understanding of the clinician's world; navigating through the clinical world; and demands of the researcher role. CONCLUSION There was agreement between clinicians and researchers about the barriers and facilitators for engaging clinicians in research. Both groups identified that it was the researcher's responsibility to form and maintain good working relationships. Better support for researchers in their role calls for training in communication skills and bespoke training to understand the local context in which research is taking place.
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Affiliation(s)
- Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Tom J Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Debbie Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Konttila J, Kähkönen O, Tuomikoski AM. Nurses' experiences of workplace violence in psychiatric nursing: a qualitative review protocol. JBI Evid Synth 2020; 18:2025-2030. [PMID: 32813432 DOI: 10.11124/jbisrir-d-19-00254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this review is to explore nurses' experiences of workplace violence in the field of psychiatric nursing. INTRODUCTION Although violent incidents are more common in psychiatric inpatient settings (e.g., psychiatric hospitals), violence has increased in psychiatric outpatient settings (e.g., mental health centers and day centers). Exposure to workplace violence can impact nurses' resilience and levels of burnout. However, there is a lack of qualitative evidence specifically identifying nurses' experiences of workplace violence in the context of psychiatric nursing. This review will appraise and synthesize available evidence related to nurses' experiences of workplace violence in the context of psychiatric nursing. INCLUSION CRITERIA This review will consider studies that relate to nurses working in the field of psychiatric nursing in mental health settings worldwide. The specific inclusion criteria are as follows: qualitative studies that explore the experiences of nurses regarding workplace violence published in English, Finnish, or Swedish with no publication date limitations. METHODS PubMed, CINAHL, PsycINFO, PsycARTICLES, Scopus, Web of Science, ProQuest, and the Directory of Open Access Journals will be searched to identify published studies. ProQuest Dissertations and Theses, Google Scholar, and MedNar will be searched to identify unpublished studies. The review will be conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Qualitative research findings will be pooled using JBI System for the Unified Management, Assessment, and Review of Information with the meta-aggregation approach. The ConQual approach will be used to assess confidence in the findings.
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Affiliation(s)
- Jenni Konttila
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Nursing Research Foundation, Helsinki, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence.,Oulu University of Applied Sciences, Oulu, Finland
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Spaducci G, McNeill A, Hubbard K, Stewart D, Yates M, Robson D. Smoking-related violence in a mental health setting following the implementation of a comprehensive smoke-free policy: A content analysis of incident reports. Int J Ment Health Nurs 2020; 29:202-211. [PMID: 31513336 DOI: 10.1111/inm.12659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/28/2022]
Abstract
Smoke-free policies in mental health settings are important to protect health but are often impeded by staff concerns that physical violence may increase. We aimed to address the literature gap about the frequency, nature, and management of physical violence in relation to smoking. We compared the antecedents and containment of smoking-related incidents of physical violence over a two-year period, (12 months when an indoor-only smoke-free policy was in place, followed by 12 months after a new comprehensive smoke-free policy was introduced) using incident reports completed by staff in a large mental health organization in London, UK. Sixty-one smoking-related incidents occurred during the indoor-only smoke-free policy period; 32 smoking-related incidents occurred during the comprehensive smoke-free policy. We identified four antecedent categories for physical violence: i) patient request to smoke denied by staff; ii) during a supervised smoking break; iii) staff response to a patient breach of the smoke-free policy iv) asking for, trading or stealing smoking materials. The antecedent pattern changed across the two policy periods, with fewer incidents of denying a patient's request to smoke and a greater number of incidents involving staff responding to breaches occurring after the introduction of the comprehensive smoke-free policy. The prohibition of smoking breaks removed this source of violence. Timeout and PRN medication were the most common containment interventions. Understanding the context of smoking-related violence may inform clinical guidelines about its prevention and management.
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Affiliation(s)
- Gilda Spaducci
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Kathryn Hubbard
- Health Services and Population Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Duncan Stewart
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Mary Yates
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London, UK
| | - Deborah Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Bragazzi NL, Dini G, Parodi V, Blasi C, Linares R, Mortara V, Toletone A, Bersi FM, D’Amico B, Massa E, Montecucco A, Debarbieri N, Durando P. Protocol of a scoping review assessing injury rates and their determinants among healthcare workers in western countries. BMJ Open 2019; 9:e023372. [PMID: 30705239 PMCID: PMC6359735 DOI: 10.1136/bmjopen-2018-023372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Healthcare workers (HCWs) are exposed to various risk factors and risky behaviours that may seriously affect their health and ability to work. The aim of this protocol is to detail the steps to follow in order to carry out a scoping review to assess the prevalence/incidence of injuries among HCWs. METHODS AND ANALYSIS The study will be carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols guidelines. Studies will be selected according to the following criteria: P (HCWs), E (exposure to injuries), C (different types of exposure and different categories of HCWs) and O (prevalence/incidence and determinants of injuries). A time filter has been set (literature between 2000 and 2018) to enable updated, direct comparison between the findings and the epidemiological data available at national and local 'Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro' (National Institute for Insurance Against Accidents at Work) centres in Italy. No language restriction will be applied. ETHICS AND DISSEMINATION Formal ethical approval is not required; primary data will not be collected, as they have already been published. The results will be disseminated through peer-reviewed publication(s), conference presentation(s) and the press.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - Valentina Parodi
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
| | - Carlo Blasi
- Liguria Regional Directorate, National Institute for Insurance Against Accidents at Work/ Istituto nazionale per l’assicurazione contro gli infortuni sul lavoro (INAIL), Genoa, Italy
| | - Roberta Linares
- Liguria Regional Directorate, National Institute for Insurance Against Accidents at Work/ Istituto nazionale per l’assicurazione contro gli infortuni sul lavoro (INAIL), Genoa, Italy
| | - Virginia Mortara
- Liguria Regional Directorate, National Institute for Insurance Against Accidents at Work/ Istituto nazionale per l’assicurazione contro gli infortuni sul lavoro (INAIL), Genoa, Italy
| | - Alessandra Toletone
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
- Occupational Medical Service, Local Health Unit 1, Liguria Regional Healthcare System, Imperia, Italy
| | - Francesca Maria Bersi
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
| | - Beatrice D’Amico
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - Emanuela Massa
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - Nicoletta Debarbieri
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
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