Background: While all healthcare workers are exposed to occupational hazards, workers in sub-Saharan Africa have higher rates of occupational exposure to infectious diseases than workers in developed countries. Identifying prevalence and context of exposure to blood and bloodborne pathogens may help guide policies for prevention. Objective: This systematic review examined occupational exposure rates to blood and bloodborne pathogen among healthcare workers in sub-Saharan Africa. Methods: In November 2017, a comprehensive literature search was conducted to identify studies reporting exposure of health workers in African coutnries to blood and bodily fluids. Title, abstract and full text screening were used to narrow our search. Studies more than 10 years old, or published in non-English languages were excluded. Findings: Fifteen studies reported a variety of exposures. The lifetime prevalence of needlestick injury ranged from 22–95%, and one-year prevalence ranged from 39–91%. Studies included a range of descriptive statistics of knowledge, attitudes, practice and access factors related to exposures. Two studies reported 21–32% of respondents linked poor knowledge or training with prevention of needlestick injuries. Rates of recapping needles ranged from 12–57% in four studies. Attitudes were generally positive toward occupational safety procedures while access was poor. Conclusions: The high burden of blood and bloodborne pathogen exposures demonstrated here indicates a high risk for contracting bloodborne illnesses. Although the data are sparse, implementation of preventative policies based on current knowledge remains critical to minimize risk and reduce exposure. There remains a pressing need for high quality data on occupational hazards to identify the burden of exposures and inform preventive policies in Sub-Saharan Africa. Additional studies are needed to determine whether differential exposures exist between professions and the associations with knowledge, attitudes, practices, and access factors to create targeted strategies to diminish occupational hazards.

Background.-Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system (CNS) that preferentially targets the spinal cord and optic nerves. Increasing disability is accrued with each inflammatory attack. Disability has been shown to be an independent predictor of poor quality of life in those with NMOSD. Factors associated with increasing disability need further systematic investigation.Methods.-We performed a multi-center retrospective chart analysis of aquaporin-4 (AQP4) seropositive NMOSD patients with a history of myelitis seen at five large referral centers for

Objectives: In the last 20 years, there have been numerous successful efforts to improve patient safety, although recent research still shows a significant gap. Researchers have begun exploring the impact of individual level factors on patient safety culture and safety outcomes. This review examines the state of the science exploring the impact of professional burnout and engagement on patient safety culture and safety outcomes.Methods: A systematic search was conducted in CINAHL, PubMed, and Embase. Studies included reported on the relationships among burnout or engagement and safety culture or safety outcomes.Results: Twenty-two studies met inclusion criteria. Ten studies showed a relationship between both safety culture and clinical errors with burnout. Two of 3 studies reported an association between burnout and patient outcomes. Fewer studies focused on engagement. Most studies exploring engagement and safety culture found a moderately strong positive association. The limited evidence on the relationship between engagement and errors depicts inconsistent findings. Only one study explored engagement and patient outcomes, which failed to find a relationship. Conclusions:The burnout/safety literature should be expanded to a multidisciplinary focus. Mixed results of the relationship between burnout and errors could be due to a disparate relationship with perceived versus observed errors. The engagement/safety literature is immature, although high engagement seems to be associated with high safety culture. Extending this science into safety outcomes would be meaningful, especially in light of the recent focus on an abundance-based approach to safety.

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Global migration from Africa to more economically developed regions such as the United States, Europe, the Middle East, and Australia has reached unprecedented rates in the past five decades. The size of the African immigrant population in the United States has roughly doubled every decade since 1970. However, research has not kept up with the growing size of this vulnerable population. Data from African immigrants have not traditionally been reported sepa­rately from Blacks/African Americans. There is growing interest in increasing the partici­pation of African immigrants in research to understand their unique health needs and the full spectrum of factors impacting their health, ranging from racial, social, environ­mental, and behavioral factors, to individual biological and genetic factors which may also inform health challenges. This line of inquiry may also inform our understanding of health disparities among their African American counterparts. However, little is known about effective community engage­ment and recruitment strategies that may increase the participation of this popula­tion in research studies. The purpose of this commentary is to: 1) describe lessons learned from our experiences engaging Afri­can immigrants in research in the Baltimore, Washington, DC, and Atlanta metropolitan areas; 2) discuss strategies for successful re­cruitment; and 3) consider future directions of research and opportunities to translate research findings into health policy for this population. Ethn Dis. 2019;29(4):617-622; doi:10.18865/ed.29.4.617

Access to treatment for opioid use disorder (OUD) in rural areas within the United States remains a challenge. Providers must complete 8–24 h of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine for OUD. Over the last 4 years, we executed five dissemination and implementation grants funded by the Agency for Healthcare Research and Quality to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports, in rural primary care practices in different states. We found that obtaining the DATA 2000 waiver is just one component of meaningful treatment using MOUD, and that the waiver provides a one-time benchmark that often does not address other significant barriers that providers face daily. In this commentary, we summarize our initiatives and the common lessons learned across our grants and offer recommendations on how primary care providers can be better supported to expand access to MOUD in rural America.

Background: To prevent patient harm, health care organizations are adopting practices from other complex work environments known as high reliability organizations (HRO). Purpose: The purpose was to explore differences in manifestations of HRO principles on hospital units with high and low safety performance. Methods: Focus groups were conducted on units scoring high or low on safety measures. Themes were identified using a grounded theory approach, and responses were compared using qualitative thematic analysis. Results: High-performers indicated proactive responses to safety issues and expressed understanding of systems-based errors, while low-performers were more reactive and often focused on individual education to address issues. Both groups experienced communication challenges, although they employed different methods of speaking up. Conclusion: Some HRO principles were present in the language used by our participants. Highperformers exhibited greater manifestations of HRO, although HRO alone was insufficient to describe our results. Mindful organizing, which expands on HRO, was a better fit. Keywords communication; high reliability organizations; mindful organizing; patient safety; teamwork Regulatory and government agencies are encouraging hospitals to adopt high reliability principles-though there is little guidance about what doing so looks like in the context of a The authors declare no conflicts of interest

Introduction A mission‐critical aspect of learning health systems (LHSs) is the provision of evidence‐based practice. One source of such evidence is provided by the Agency for Healthcare Research and Quality (AHRQ) through rigorous systematic reviews, termed evidence reports that synthesize available evidence on nominated topics of interest. However, the AHRQ Evidence‐based Practice Center (EPC) program recognizes that the production of high‐quality evidence reviews does not guarantee or promote their use and usability in practice. Methods To make these reports more relevant to LHSs and promote evidence dissemination, AHRQ awarded a contract to the American Institutes for Research (AIR) and its Kaiser Permanente ACTION (KPNW ACTION) partner to design and implement web‐based tools to meet the gap in dissemination and implementation of EPC reports in LHSs. We used a co‐production approach to accomplish this work across three phases of activity: planning, co‐design, and implementation between 2018 and 2021. We describe the methods and results and discuss implications for future efforts. Results Web‐based information tools that provide clinically relevant summaries with clear visual representations from the AHRQ EPC systematic evidence reports may be used by LHSs to increase awareness and accessibility of EPC reports, formalize and enhance LHSs' evidence review infrastructure, develop system‐specific protocols and care pathways, improve practice at the point of care, and train and educate. Conclusions The co‐design of these tools and facilitated implementation generated an approach to making EPC reports more accessible and allows for more widespread application of systematic review results in supporting evidence‐based practices in LHSs.