Healthcare providers are investing considerable resources for the development of quality management systems in hospitals. Contrary to these efforts, the number of tools that allow the evaluation of implementation efforts and the results of quality, security and sustainable development is quite limited. The purpose of the study is to develop a reference framework for quality and sustainable development in healthcare, Sanitary-Quality (San-Q) at the micro system level, which is compatible with applicable national and international standards in the field. The research method consisted of the study of literature, identification and analysis of good sustainability practices in healthcare, which allowed identification of the areas of the new San-Q framework: quality, economic, environmental, social, institutional and healthcare. These areas are incorporated into the core topics of social responsibility mentioned by ISO26000. A total of 57 indicators have been defined that make up the new reference framework. The evaluation format of the indicators is innovative through a couple of values: completion degree–significance. In the experimental part of the research, a pilot implementation of the San-Q framework at an emergency hospital was performed, the results recorded in terms of responsibility for human rights being presented. The conclusions of the study reveal the innovative aspects of the framework that facilitate the development of a sustainability strategy promoted through performance indicators, the results obtained after evaluation being useful in establishing a reference level of sustainability but also in developing sustainability policies.

The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures.

Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.

Kirkpatrick's model has many adaptations to various fields of training, by using 4 level evaluations. The new eQvet-us training outcome evaluation model developed in this paper, consist in an improvement of the Kirkpatrick's model by associating to the evaluation level the corresponding objectives. In this way two levels are deduced, that are following the PDCA cycle in opposite senses. The objectives’ level consists in outcome, performance, knowledge, motivation, that is associated to the classical evaluation level compost of reaction, learning, behavior and result evaluations. To evaluate the effectiveness of the proposed approach, an experiment was conducted for a VET course for quality professionals in services industry. It was demonstrated that the methodology not only help the training professional plan the intervention, but help the trainees employers understand the factors that facilitate training transfer and produce business results. By using the tool, we have demonstrated post-training value for stakeholders.

The COVID-19 pandemic has brought unprecedented challenges, with a potential stress which might affect the education of resident doctors in the field of orthopedics and traumatology. Its repercussion on the residents’ strain and training routes is not well known. After two years of pandemic, this paper aims to analyze the repercussion of the coronavirus disease 2019 (COVID-19) on education, medical training, and the mental well-being of Romanian resident doctors in orthopedics and traumatology. In January–February 2022, an electronic questionnaire was distributed to all orthopedic resident doctors in the 12 residential training centers in Romania. Participants (n = 236) were resident doctors with an employment contract and professional activity during the COVID-19 pandemic. Resident doctors who did not work during this period were excluded. An online survey generator was used to electronically create the questionnaire. Statistical analysis was performed in Matlab version R2022a, with the support of Statistics and Machine Learning Toolbox Version 12.3. Descriptive statistics were performed for the standardized questions, while for the open questions, answers were collected by topic. The results of the Chi-square test indicate that there is a statistically significant association regarding the prevalence of infection among residents involved in the treatment of patients with COVID-19 (p = 0.028), and the influence of secondment in COVID-19 sections (p = 0.0003). The infection of residents is not related to their affiliation with a particular medical training center (p = 0.608), gender (p = 0.175), the year of study in residency (p = 0.733), the age group (p = 0.178), and the secondment period (p = 0.114). Residents who participated in the study had an overall well-being index of 13.8 ± 5.7, which indicates a low level of well-being for a large number of residents. Residents who would like to choose a new residency specialization, or would choose a non-medical career, had reduced average WHO wellness rates, as the risk of infection is associated with the treatment of patients with COVID-19 and secondment in COVID-19 sections. The findings of this study may help residency training centers to develop robust programs that can alleviate the impact of this pandemic. Some major changes will be needed to be integrated into residency training programs around the world. Emphasis should be placed on electronic educational portfolios, simulation of surgical processes, and distance learning, all of which have a high potential for health and safety, as well as for the moral support of residents.

Background and Objectives: Elective arthroplasty in Romania has been severely affected by the COVID-19 pandemic, and its effects are not quantified so far. The aim of this paper is to determine the impact of COVID-19 on arthroplasty interventions and how they varied in Romania. Materials and Methods: We performed a national retrospective analysis of patients who underwent primary and revision elective hip and knee interventions at the 120 orthopedic-traumatology hospitals in Romania that are registered in the National Endoprosthesis Registry from 1 January 2019 to 1 September 2022. First, we examined the monthly trend in the number of surgeries for seven categories of arthroplasties. We calculated the percentage change in the average number of cases per month and compared them with other types of interventions. We then examined the percentage change in the average monthly number of arthroplasty cases, relative to the number of COVID-19 cases reported nationwide, the influence of the pandemic on length of hospital stay, and the percentage of patients discharged at home who no longer follow recovery protocols. Finally, we calculated the impact of the pandemic on hospital revenues. Results: There was an abrupt decrease in the volume of primary interventions in hip and knee patients by up to 69.14% with a low degree of patient care, while the average duration of scheduled hospitalizations increased. We found a 1–2-day decrease in length of hospital stays for explored arthroplasties. We saw an increasing trend of home discharge, which was higher for primary interventions compared to revision interventions. The total hospital revenues were 50.96% lower in 2020 compared to 2019, and are currently increasing, with the 2022 estimate being 81.46%. Conclusions: The conclusion of this study is that the COVID-19 pandemic severely affected the volume of arthroplasty of the 120 hospitals in Romania, which also had unfavorable financial implications. We proposed the development of new procedures and alternative clinical solutions, as well as personalized home recovery programs, to be activated if necessary, for possible future outbreaks.