bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Oral Versus Normal and High-Dose Rectal Paracetamol in the Treatment of Fever in Children
Authors: Bastola Ramchandra , Shrestha Shree Krishna , Bastola Bhawana Sigdel , Shrestha Dhurba , Sharma Yograj
Published: June 2018

Correction: On 13th June 2018 the author Yog Raj Sharma was changed to Yograj SharmaIntroduction: Paracetamol is the most commonly used drug in paediatrics with the standard dose (15 mg/kg) of oral and rectal paracetamol preparations interchangeably is used to treat fever in children, assuming they have equal antipyretic effect. We did a study to compare the effectiveness of two different rectal doses of paracetamol: 15 mg/kg and 30 mg/kg to that of a standard oral dose of 15 mg/kg.Material and Methods: This is a prospective, interventional, randomized controlled study done in Western Regional Hospital, Nepal in which 192 children with fever aged six months to six years. Study duration was August 2015 to October 2015. The sample included 63 in the oral normal dose group (15mg/kg), 59 in normal dose rectal group (15mg/kg) and 70 in high dose (30mg/kg) rectal paracetamol group. Temperature was recorded before and after the administration of paracetamol at an interval of 30, 60, 120, and 180 minutes by using a digital thermometer.Results: Total of 59 patients received 15 mg/kg rectal Paracetamol (group A), 70 received 30 mg/kg rectal Paracetamol (group B), and 63 received 15 mg/kg oral Paracetamol (group C). Mean temperature before giving medication in Group A, B and C respectively were 101.7° F, 101.9° F and 101.5° F. At 30 min temperature was 100.8° F, 100.8° F and 100.66° F, while at 60 minutes temperature was 99.9° F, 99.7° F, and 99.7° F respectively for Group A,B and C. But at 120 and 180 minutes temperature decreased significantly who got rectal 30 mg/kg of paracetamol.Conclusions: Rectal paracetamol in a dose of 30mg/kg is more effective than oral paracetamol in a dose of 15 mg/kg. However oral paracetamol given in a dose of 15 mg/ kg is more effective than rectal paracetamol in a same dose.
Prediksi Pola Pengunjung untuk Meningkatkan Kualitas Layanan Menggunakan Teknik Heuristik Pada Optimasi Bobot Backpropagation Neural Network
Authors: Puspitasari Ika Ayu Amelia
Published: June 2018

ABSTRAK

Jumlah pengunjung kantor imigrasi yang membuat passport atau melakukan perpanjangan passport setiap bulannya sangat fluktuatif, hal ini bisa menimbulkan masalah bagi kantor Imigasi untuk menjaga kualitas layanan kepada masyrakat, sehingga memerlukan metode prediksi untuk meramalkan kapan akan terjadi lonjakan pengunjung sehingga kualitas layanan tetap terjaga. Untuk itu kantor imigrasi harus memiliki beberapa informasi untuk membuat prediksi. Informasi yang sempurna akan    mempermudah dalam prediksi dan prediksi yang baik adalah prediksi secara akurat. Untuk melakukan prediksi secara akurat maka diperlukan metode yang tepat pula. Neural Network atau biasa disebut juga jaringan syaraf tiruan adalah suatu metode komputasi yang meniru system jaringan saraf biologi. Jaringan saraf tiruan ini dibentuk untuk memecahkan suatu masalah tertentu seperti pengenalan pola atau klasifikasi karena proses pembelajaran. Penelitian ini menggunakan Backpropagation Heuristik untuk meningkatkan kecepatan proses pelatihan neuron-neuron dalam melakukan prediksi.

 

ABSTRACT

The number of visitors to the immigration office making passport or monthly passport renewal is very volatile, this can cause problems for the Immigration Office to maintain the quality of service to the community, thus requiring prediction methods to predict when there will be a surge of visitors so that the quality of service is maintained. For that the immigration office should have some information to make predictions. Perfect information will make it easier to predict and good predictions are accurate predictions. To accurately predict the exact method. Neural Network or also called artificial neural network is a computational method that mimics the system of neural network biology. Artificial neural networks are formed to solve a particular problem such as pattern recognition or classification because of the learning process. This study uses Heuristic Backpropagation to increase the speed of the training process of neurons in making predictions.
Meningkatkan Kemampuan Motorik Halus Anak dengan Pembelajaran Menggambar Menggunakan Program Paint Pada Anak Kelompok A Di TK Negeri Pembina Semarang
Authors: Faizah Nur , Mangiri Herry Sulendro
Published: June 2018

mampuan motorik halus selama pembalajaran di PAUD masih mengguanakan cara-cara yang konvensional dan kurang menarik minat siswa untuk belajar. Dengan berkembangnya teknologi maka cara konvesioanl di rubah dengan memanfaatkan media teknologi informasi berupa program Paint dengan peralatan pendukung komputer. Dari hasil penelitian dalam upaya meningkatkan kemampuan motorik halus diperoleh data dalam observasi dan analisa yang telah dilakukan, diperoleh hasil yaitu: Pada kondisi awal diperoleh hasil observasi terhadap aktifitas anak yang belum berkembang sebesar 42,10 % sedangkan yang mulai berkembang sebesar 7,8 %, ini menunjukkan bahwa pada kegiatan menggambar kondisi awal belum menunjukkan adanya minat dan daya tarik anak-anak sehingga diperlukan adanya perbaikan untuk dapat memperoleh hasil yang optimal. Perbaikan yang harus dilakukan harus menyeluruh, baik kinerja guru maupun aktifitas anak. Dari hasil perbaikan pada siklus I terhadap penelitian aktifitas anak sebesar 56,6 % sedangkan pada kinerja guru sebesar 66,6 % dan siklus II pada kinerja guru diperoleh hasil sebesar 85,41 % dan pada aktifitas anak sebesar 90 % artinyaÂ  adanya kenaikan sebesar 18,81 % dari siklus I dan siklus II yang menunjukkan bahwa pembelajaran menggambar dengan menggunakan program paint diperoleh hasil yang signifikan dan dapat dinyatakan berhasil dengan baik.
Uji Komparasi antara Kegiatan Menulis Angka dan Membuat Kalender dalam Pengenalan Konsep Angka di Kelompok B TK Dharma Wanita Kendal, Jawa Tengah.
Authors: Setiawan Risky , Khamah Pristi Nur
Published: June 2018

Tujuan penelitian ini adalah : 1) Untuk mengetahui apakah ada perbedaan antara kegiatan menulis angka dan kegiatan membuat kalender dalam pengenalanÂ  konsep angka pada anak kelompok B TK Dharma Wanita Trisobo, 2) Untuk mengetahui kegiatan manakah yang lebih efektif dalam pengenalan konsep angka di kelompok B TK Dharma Wanita. Subyek penelitian adalah anak didik kelompok B TK Dharma Wanita Trisobo Kecamatan Boja Kabupaten Kendal yang berjumlah 24 anak, 9 anak laki-laki dan 15 anak perempuan. Teknik pengumpulan data yang digunakan ada tiga, yaitu wawancara, observasi dan dokumentasi. Wawancara digunakan sebagai teknik pengumplan data apabila peneliti ingin melakukan studi pendahuluan untuk menemukan permasalahan yang akan diteliti. Observasi digunakan untuk memperoleh data di lapangan, baik yang berkaitan dengan kegiatan yang dilakukan oleh anak maupun guru ketika proses penelitian berlangsung. Sedangkan dokumentasi merupakan data tambahan yang diperoleh dari hasil lembar observasi yang didokumentasikan dalam bentuk gambar ataupun tulisan yang berhubungan dengan kegiatan pembelajaran dan kegiatan penelitian. Kesimpulan yang diperoleh adalah : 1) ada perbedaan antara kegiatan menulis angka dan kegiatan membuat kalender. Hal ini dibuktikan dari hasil output SPSS sebesar -14.750 (14.750 > 0.05 (2.060). 2) kegiatan membuat kalender dalam pengenalan konsep angka lebih efektif dari kegiatan menulis angka. Hal ini dibuktikan dengan hasil rata-rata keseluruhan pengenalan konsep angka melalui kegiatan membuat kalender lebih tinggi daripada menulis angka, yaitu (91,54% > 59,57%). Selain itu dikuatkan dengan hasil wawancara yang dilakukan terhadap guru kelas, yang menyatak bahwa melalui kegiatan membuat kalender anak didik menjadi lebih aktif dan kreatif. Ini menunjukkan bahwa kegiatan membuat kalender lebih menunjang proses pembelajaran dalam pengenalan konsep angka pada anak usia dini
Pengenalan Konsep Diri Anak Melalui Visual Learning di TK Annida Ya Fatimah Jepat Lor Tayu Pati, Jawa Tengah.
Authors: Elyana Luluk
Published: June 2018

Tujuan dari penelitian ini adalah melihat fenomena pembentukan konsep diri anak melaalui pembelajaran media visual dan mendeskripsikan bagaimana media visual yang merupakan dasar teknologi dan informasi dapat menjadi alternatif bagi guru PAUD di TK Annida Ya Fatimah Jepat Lor Tayu Pati. Metode penelitian menggunakan pendekatan kualitatif-fenomenologi. Variabel dalam penelitian ini adalah konsep diri  dan digital learning. Subyek penelitian yang digunakan adalah anak usia 2 – 6 tahun di KB – TK Annida Ya Fatimah Jepat Lor Tayu Pati. Instrumen penelitian menggunakan tehnik trianggulasi yaitu wawancara, dokumentasi dan observasi terhadap subyek penelitian. Hasil penelitian menunjukkan adalah pada kegiatan mulai perencanaan, peleksanaan dan evaluasi. Melalui media ini dapat membantu proses pembelajaran yang menyenangkan bagi anak sehingga tujuan pembelajaran yaitu pengenalan konsep diri akan tercapai.
Film Analizi Yöntemi ile Aile Terapileri: Gilbert’in Hayalleri
Authors: Bozdağ Yasemin
Published: June 2018

Aile
terapisi, bir ailenin işleyişini ve üyelerin birbirleriyle olan iletişim ağını
ele almaktadır. Günümüzde birçok aile terapisi yaklaşımı vardır ve her birinin
çeşitli teknikleri bulunmaktadır.  Literatürde
film analizi ile ele alınan aile terapisi çalışmaları olmasına karşın, bir
ailenin farklı kuramlar çerçevesinde ele alındığı araştırmalar oldukça
sınırlıdır. Bu çalışmada,
“Gilbert’in
Hayalleri (What's
Eatıng Gilbert Grape)” isimli
filmin analizi ile Satir, Minuchin, Bowen ve Haley gibi öncü aile
terapistlerinin kuramları çerçevesinde birtakım tekniklere değinilecek ve var
olan kavramlar filmdeki aile örüntüsü üzerinden somut örneklerle
desteklenecektir. Sonuç olarak, bu çalışmanın alanda çalışan ya da eğitimini
sürdüren uzmanlar için bir kaynak oluşturacağı düşünülmektedir.
Kajian Potensi Dan Rekomendasi Desa Lhokrukam Berbasis Desa Wisata, Sebagai Alternatif Pembangunan Kota Tapaktuan
Authors: Rusnanda Resky , Supriadi Elby , Reza Muhammad
Published: June 2018

Kabupaten aceh selatan dilihat dari potensi alamnya, sektor priwisata sangat produktif untuk dikembangkan, karena didukung oleh letak geografisnya. Tapaktuan sangat dikenal dengan objek wisata tapak kaki tuan tapa yang juga merupakan simbol dari Kabupaten Aceh Selatan. Bukan hanya objek wisata tersebut, banyak objek wisata lainnya yang ada di Tapaktuan menjadi objek wisata andalan salah satunya di desa Lhokreukam yang memiliki potensi wisata yang tinggi. Namun sayangnya pengembangan pariwisata di desa tersebut belum optimal. Oleh sebab itu penelitian ini bertujuan untuk memberikan strategi pengembangan desa lhokreukam menjadi desa wisata sebagai salah satu destinasi wisata baru di Aceh Selatan. Adapaun metode yang di gunakan adalah analisis SWOT. Hasil dari penelitian ini adalah adanya rekomendasi strategi perencanaan pengembangan desa lhokreukam menjadi desa wisata, sehingga semua potensi wisata yang ada di desa tersebut dapat di kembangkan secara optimal dan berkelanjutan, dan menjadi alternatif pilihan berwisata yang ada di kabupaten Aceh Selatan bagi wisatawan.
Pengujian Kinerja Pencarian Data
Authors: Dalimunthe Yulia Agustina
Published: June 2018

Database sudah merupakan kebutuhan wajib bagi para pembuat program dalam merancang suatu aplikasi yang berkaitan dengan record-record atau pun transaksi yang membutuhkan data yang berkelanjutan, database digunakan sebagai pusat data yang bias digunakan untuk mengambil suatu kebijakan kedepannya.Pemilihan database tentunya mempertimbangkan banyak factor mulai dari kapasitas penyimpanan, keamanan, kemudahan pengaksesan database, dari banyak factor pemilihan database yang digunakan kecepatan merupakan faktor yang paling utama dalam pemilihan database.PostgreSQL dan MySQL merupakan database yang banyak digunakan untuk menyimpan data, database tersebut biasanya dikombinasikan dengan bahasa pemrograman sehingga mudah digunakan untuk menyim panin formasi yang di inginkan.Pengujian database Postgresql dan Mysql akan dilakukan berdasarkan kecepatan dan pencarian data dari tabel yang sesuai di masing-masing database.
Klasifikasi Sinyal Emg Pada Otot Tungkai Selama Berjalan Menggunakan Random Forest
Authors: Putra Darma Setiawan , Wibawa Adhi Dharma , Purnomo Mauridhi Hery
Published: June 2018

Sinyal electromyography (EMG) merupakan suatu sinyal elektrik yang terdapat dalam lapisan otot selama gerakan aktif. Cara orang berjalan ditentukan oleh struktur otot dan tulang sehingga cara berjalan ini adalah unik dan dapat digunakan sebagai data biometrik. Pada penelitian ini, kami mengklasifikasi data EMG dari delapan jenis otot tungkai selama percobaan berjalan normal: Rectus Femoris, Vastus Lateralis, Vastus Medialis, Bicep Femoris, Semitendinosus, Gastrocnemius Lateralis, Gastrocnemius Medialis, dan Tibialis Anterior. Enam orang subyek diminta untuk berjalan di laboratorium GaitLab dengan 8 buah elektroda EMG ditempel pada otot mereka. Subyek diminta untuk berjalan sebanyak 1 gait cycle dengan 3 kali pengambilan data. Total dataset EMG untuk klasifikasi adalah sebanyak 18 buah. Metode graph feature extraction dan principal component analysis digunakan untuk ekstraksi fitur data EMG. Metode Random Forest digunakan untuk mengklasifikasi data EMG berdasarkan subyek. Metode pelatihan dan pengujian data EMG menggunakan cross validation (CV). Akurasi klasifikasi yang dihasilkan dengan menggunakan metode graph feature extraction adalah sebesar 88.88% dan metode principal component analysis adalah sebesar 72.22%. Hasil ini menunjukkan bahwa data EMG ketika berjalan dari 8 jenis otot tungkai dapat digunakan untuk identitas biometrik gaya berjalan (gait).
Penyelidikan Perilaku Interaksi Kimiawi Lapisan Diamond Film Pahat Karbida Pada Operasi Bubut Kering Bahan Al 6061
Authors: Sitorus Fransnazoan
Published: June 2018

The purpose of the research was to characterize diamond-film coating which is used as carbide tool coating material, especially coating material (diamond-film CVD) and substrate material (WC/Co) in general approach interaction of chemically, This is related to the research which reported about the functional failure of carbide tool coating material, used in dry machinery process of non-ferro metal in the initial wear. The study on the characteristics of tool diamond-film coating was conducted through chemical interaction approaches which occurred between the working object and tool through dry machining process. Cutting condition was v= 350 m/min; f= 0.15 mm/put; a= 1.5 mm in Initial-wear phase (tc= 1.736 min). The result of the test was abrasive wear VB = 0.070 mm. Chemical load was tested through micro analysis using energy dispersive analysis X-Ray spectroscopy (EDAX), the result of the test was the distribution of diamond-film coating elements in aluminum 6061 testing material on the cutting conditions indicated that diamond-film coating material was still significant. The conclusion of the study was that by using chemical interaction approaches, was no coating delamination in diamond-film coating of carbide tool. The phenomenon of the three approaches was the gradual disappearing of a part of the volume of diamond-film coating material which layered substrate material as the result of abrasive-coating wear.
Authors: Lindawati Lindawati
Published: June 2018

This research was intended to study the acoustical characteristics of acoustic panel made from Aren fiber and Latex. The samples were produced by mixing aren fiber and latex with 90/10, 85/15, 80/20, 75/25 and 70/30 of weight percentage ratios, respectively. The measurements were conducted by using Impedance Tube Method. The result show that acoustic panels made from aren fiber and latex are good noise absorber. The best absorption was performed by sample made of 90/10 fiber and latex, with noise absorption coefficient 0f 0.95 at 3000 Hz.
Seroprevalence study of infectious laryngotracheitis virus antibody of commercial layer in Gazipur Districts of Bangladesh
Authors: Rahman Md Mijanur , Uddin Md Karim , Hassan Md Zakir , Rahman Md Mamunur , Ali Md Zulfekar , Rahman Md Lutfor , Akter Mir Rowshan , Rahman Md Mostafizer
Published: June 2018

This research work was conducted to detect the prevalence of Infectious Laryngotracheitis (ILT) Virus-specific antibody in chickens from Gazipur district in Bangladesh at Department of Microbiology, Hajee Mohammad Danesh Science & Technology University, Dinajpur and Poultry Care Lab, Garzipur from January to June 2012. A total number of 232 sera sample of commercial layer chicken were collected from 17 different commercial layer farms at different ages. The layers prognosed for sampling had not been previously vaccinated against ILTV. The indirect enzyme linked immunosorbent assay (iELISA) was performed to estimate the Infectious Laryngotracheitis (ILT) Virus-specific antibody. Out of 232 samples, 189 (81.47%) samples were found to positive for Infectious Laryngotracheitis (ILT) Virus-specific antibody. In 17 different commercial farms prevalence based on age were 75%, 87.5%, 87.5%, 90%, 81.25%, 80%, 100%, 70%, 81.25%, 81.25%, 90%, 93.08%, 87.5%, 75%, 75%, 68.75% and 75% in the age limit 08, 09, 11, 12, 13, 14, 15, 16, 17, 17, 19, 21, 25, 31, 35, 44 and 51 weeks respectively and farms showed high level of ILT virus specific antibodies (IgG). This result showed that in 15 weeks of age prevalence was highest position i.e; 100%. The result of this study indicate that there were a high prevalence of Infectious Laryngotracheitis (ILT) Virus circulating at Gazipur district in Bangladesh.Asian J. Med. Biol. Res. March 2018, 4(1): 1-6
Scaling up of tigershrimp (Penaeus monodon) production in brackishwater pond under diversified cropping regimes
Authors: Washim Mizanur Rahman , Rahman Syed Lutfor , Rubel AKM Shafiqul Alam
Published: June 2018

To develop a scientific and affordable shrimp farming system for marginal to medium farmers with low inputs and higher returns by scaling up of production per unit area, shrimp culture was practiced with 3, 5 and 7/m2 stocking densities for the period of 60 days as short cycle and 120 days as long cycle. All the hydrographical parameters were found congenial in different treatments except dissolved oxygen (DO) in case of higher stocking density and long culture pattern. However, the specific growth rate (SGR) was optimal in both culture cycle but increased sharply in first 3-4 weeks of grow out period. Distinct survival rate were found in different treatment which was ranged from 86.39 to 90.96% but did not show significant difference (P>0.05%) among the treatments of short and long culture cycle. Total yield was ranged from 990 kg/ha to 1998 kg/ha for short cycled double and 1012 kg/ha to 2032 kg/ha for single cropping pattern. Highest production was obtained under the stocking densities of 7/m2although the average production showed significant difference (P<0.05%) among the treatments of both culture patterns. The food conversion ratio (FCR) value seems similar for all cropping patterns and ranged between 1.15 and 1.57. Except stocking density of 7/m2 at short cycle culture, net benefit were significantly (P>0.05%) higher in long cycle crop than that of aggregate of two short cycle crops. But benefit cost ratio (BCR) in short culture cycle is significantly (P>0.05%) higher than that of long culture (120 days) which indicates higher net benefit as well as positive feasibility of short culture system. Considering the infrastructural facilities in farm level and resource capability, this shrimp farming technology would be appropriate to boost up the production and income particularly for marginal to medium farmers.Asian J. Med. Biol. Res. March 2018, 4(1): 27-35
Assessment of fish diversity and socio-economic condition of fishermen in Bangladesh
Authors: Jahan Md Ishtiaque , Alam Mohammad Shafiqul , Karim Md Shamsul , Sultana Nargis , Mamun Md , Rafiquzzaman SM
Published: June 2018

The main objectives of the study were to determine the present status of fish biodiversity and socio-economic condition of fishermen in Belai beel during February 2016 to September 2016 by survey method using questionnaires, field visit and interviewing with the fishermen. The results indicated that about 27 species of fish fauna were found in the Belai beel, among them 23 species were indigenous and 4 species were exotic. Major dominant species were Rui (Labeo rohita), Catla (Catla catla), Bata (Labeo bata), Shingi (Heteropeneustes fossilis), Magur (Clarius batrachus), Tengra (Mystus tengra), Chanda (Chanda nama), Kakila (Xenentodon cancila), Common carp (Cyprinus carpio), Mola (Amblypharyngodon mola) in the study area. During the study period two critically endangered (Puntius sarana, Pangasius pangasius), two endangered (Labeo bata, Channa marulius), and three vulnerable (Chanda nama, Channa orientalis, Notopterus notopterus) fish species were found in the Belai beel. Analysis of socio-economic condition of fishermen showed that maximum (70%) had nuclear family and others (30%) had joint family, as well as fishermen, belonged to the age groups of 31 to 40 years (50%) and the others were 15 to 30 (20%), 41 to 50 (18%), 51 to 60 (10%), 61 to70 (2%). Overall, the present study suggested that fishermen communities should be educated by creating awareness for the proper conservation, management, and enhancement of biodiversity in the Belaibeel.Asian J. Med. Biol. Res. March 2018, 4(1): 69-76
Outcome of Fixed Dose of Radioiodine Therapy in Hyperthyroid Patients at NINMAS
Authors: Quddus Sharmin , Begum Fatima , Sultana Nasreen , Perveen Rahima , Mandal Tapati , Islam Urnas , Salekin Mohammad Simoon , Sultana Sadia , Nahar Nurun
Published: June 2018

Objective: The modified fixed doses of radioactive iodine (RAI) in different types of hyperthyroidism had been practiced at National Institute of Nuclear Medicine & Allied Science (NINMAS) according to Society of Nuclear Medicine Bangladesh (SNMB) protocol since 2002 which was upgraded in 2015. The objective of the study was to observe the treatment outcome in modified fixed dose on previous protocol. Patients and Methods: In the present study the outcome of radioiodine therapy of hyperthyroid patients was retrospectively evaluated in 1349 consecutive primary hyperthyroid patients treated from January 2010 to December 2014 at NINMAS. Diagnosis of hyperthyroidism was done by thyroid function test; thyroid stimulating hormone (TSH), free triiodothyronine (FT3)   & free thyroxine (FT4), 99m Technetium scan, thyroid radioiodine uptake and ultrasound imaging of thyroid gland. All patients received a fixed dose (8-29 m Ci) of radioactive iodine (RAI) depending on types of hyperthyroidism, visual assessment of gland size and severity of disease at diagnosis. They were followed up at 2 months of therapy, then every three months intervals for first year and thereafter 6 monthly up to 5 years or as needed during fluctuation of thyroid function.

Results: Among the study population, 832 patients had diffuse toxic goiter (Graves’ disease), 369 patients were diagnosed as toxic multinodular goiter and 148 patients with single toxic nodule. At one year follow-up, permanent hypothyroidism occurred in 61.62% of patients and the cumulative incidence of hypothyroidism progressively increased up to 79.25% after 5 years. Cure or success of RAI therapy was considered as attainment of euthyroid state or hypothyroid state. About 11.26 % patients received more than single dose.

Conclusion: Fixed dose RAI therapy is very much cost effective mode of treatment for primary hyperthyroidism with ~89% success by giving single dose.

Bangladesh J. Nuclear Med. 20(1): 37-40, January 2017
Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit
Authors: Loots Feike J , Smits Marleen , van Steensel Carlijn , Giesen Paul , Hopstaken Rogier , van Zanten Arthur RH
Published: June 2018

Background

Sepsis is a life-threatening condition requiring urgent hospital treatment. The rates of recognition and doctors delay in primary care are currently unknown.

Aim

To explore the role of GP cooperatives in the pre-hospital care for sepsis patients.

Method

A retrospective patient record study was conducted of sepsis patients admitted to an intensive care unit (ICU) in Ede, the Netherlands. Adult ICU patients admitted for community-onset sepsis between 2011 and 2015 were identified. Subsequently, all contacts with the co-located GP cooperative in the 72 hours before hospital admission were retrieved. Differences in mortality rates between subgroups were analysed using logistic regression analysis.

Results

Of 263 patients admitted to the ICU, 127 (48.3%) had prior GP cooperative contacts. These contacts concerned home visits (59.1%), clinic consultations (18.1%), direct ambulance deployment (12.6%) or telephone advice (10.2%). Patients assessed by a GP were referred in 64% after the first contact. The median delay to hospital arrival was 1.8 hours. In 43%, the GP had not suspected an infection. In this group the in-hospital mortality rate was significantly higher compared with patients with suspected infections (41.9% versus 17.6%). Mortality difference remained significant after correction for confounders.

Conclusion

GP cooperatives play an important role in pre-hospital management of sepsis and recognition of sepsis in this setting proved difficult. Efforts to improve management of sepsis in out-of-hours primary care should not be limited to patients with a suspected infection, but also include severely ill patients without clear signs of infection.
How can primary care help to reduce weight stigma?
Authors: Henderson Emily , Norenberg Allison , Cairns Joanne , Gadsby Erica , Henderson Emily
Published: June 2018

Background

The WHO recently recognised stigma as a fundamental cause for health inequalities. Weight stigma is associated with negative health consequences, and patients experience it commonly in healthcare settings. This study forms part of systematic review that aimed to understand how weight stigma can be reduced through the adoption of whole systems approaches.

Aim

To generate new understandings of the roles primary care can take in reducing weight stigma.

Method

A systematic international literature review of peer-reviewed articles utilising EPPI guidance, and using PICOS terms in Web of Science searches. Recommendations for policy, practice and/or research were extracted and conceptually synthesised as guided by Research Unit for Research Utilisation.

Results

The search identified 194 full texts with 540 total recommendations. Approximately 45% of recommendations (248 of 540) were coded under healthcare, of which 75% were in primary care including general practice (189 of 248). Findings indicate areas where weight stigma could be addressed in primary care: 1) Training; 2) Self-awareness; 3) Non-stigmatising approaches; 4) Formal patient assessments; 5. Coping strategies; 6) Organisational/structural support; 7) Cross-sector working; 8) Anti-discrimination legislation and classify obesity as a disease.

Conclusion

Literature on reducing weight stigma focuses substantially on healthcare, and there is a range of approaches that could be taken. Tensions arise between the medicalisation of obesity and need to consider social determinants of obesity. Healthcare is only one of many settings in which the weight stigma needs to be addressed and whole systems approaches, for example working with local government, are required in particular to reduce health inequalities.
Learning from the introduction of ‘skill-mix’ changes in general practice: a qualitative process evaluation
Authors: Nelson Pauline , Martindale Anne-Marie , McBride Anne , Hodgson Damian
Published: June 2018

Background

‘Skill-mix’ change (changing mix of staff roles or introducing new ways of working) is increasingly promoted to relieve pressure in general practice teams. As part of a primary care workforce strategy, one locality in Greater Manchester is seeking to integrate three ‘non-medical’ roles – Advanced Practitioners (APs), Physician Associates (PAs) and Clinical Pharmacists (CPs) – to work alongside practice staff.

Aim

A qualitative process evaluation studied the integration of these roles to: establish the aims and priorities of the new services; understand and compare the ways in which the roles are being established with identification of measurable impacts and unintended consequences.

Method

A rapid scoping review of the primary care skill-mix literature was conducted to inform the evaluation. Purposive and ‘snowball’ sampling enabled semi-structured interviews (12) and focus groups (2) to be conducted with 27 key individuals (workforce/training leads for the new services; APs/PAs/CPs; GPs/practice managers), before being transcribed, anonymised and analysed thematically with a combination of a priori and grounded codes. Analysis of relevant service/training plans supplemented interview/focus group data.

Results

A number of organisational and operational factors affecting implementation success in early adopter sites were identified including: the intended scope and function of new roles with corresponding implications for measuring impacts; leadership/active management of workforce changes; appropriate training and education; inter-professional tensions; regulatory provisions, and sustainability.

Conclusion

There is variation in how the three skill-mix initiatives are being implemented in early adopter sites, with implications for success. Key considerations for introducing skill-mix changes in general practice are being identified.
Patient feedback on a new method of consulting with the GP; an analysis of responses by users of online triage software
Authors: Eccles Abi , Hopper Mike , Atherton Helen
Published: June 2018

Background

Online triage software is a new way to triage patients online that allows patients to describe their problem via an online form. A GP then contacts the patient to arrange either a face-to-face or telephone consultation.

Aim

This study aimed to explore use of online consultation software and gain insight into patients’ experiences of using online consultations, identifying potential barriers and facilitators to use.

Method

This is a mixed methods retrospective study analysing data about patient users and their associated feedback. Data from a sample of 5591 patients were quantitatively analysed to describe characteristics of users. 576 out of the 5591 users left free-text feedback comments on their experience of use. These were thematically analysed.

Results

The highest levels of use were observed in 25–35-year olds and lowest from those aged >65. Key themes identified included convenience, consultation quality, appropriateness, resource-use and functionality. Within each, a range of subthemes were present representing both positive and negative perceptions, suggesting that experiences of using online triage varied and were often context-dependent

Conclusion

There are various advantages to online triage software, but these are context-dependent. Therefore, such applications should be offered as an additional way to contact the GP surgery, rather than a replacement for more established methods, to ensure appropriate and equal access for patients.
From Soundwaves to BrainWaves: The effects of choral singing on recovery from stroke and aphasia
Authors: Marley John , Matthias Bernadette , Worrall Linda , Guest Maya , Allan Christopher
Published: June 2018

Background

Stroke is a leading cause of death and disability. Recovery is frequently compromised by reduced well-being, mood, socialisation and quality of life. Music and singing are recognised as enhancing well-being and benefit people with chronic illness. Evidence suggested that choir singing may improve the fluency of people with aphasia. Choirs existed for people with brain impairment; no studies had robust design and outcome measurement.

Aim

To conduct a pilot study in Newcastle, Australia in a collaboration between Hunter New England Health and the University of Newcastle. To explore the effects of choral singing on quality of life, well-being, mood, social participation and communication skills of community-dwelling stroke survivors including people with aphasia.

Method

A mixed methods waitlist control design was used. 39 people at least 6 months post-stroke were assessed before and after a 12-week choir rehearsal period. Carers were invited to participate. Subjects were interviewed at the end of the period.

Results

Measures of communication improved significantly and a trend to improvement in overall quality of life was seen. Depression and disability were significant in their impact on overall quality of life scores. Qualitative work reported increased quality of life, confidence, independence, mood and socialization and improvements in speech and communication were also reported.

Conclusion

Our pilot showed that a 12-week choir program for stroke survivors and carers is feasible and benefits quality of life, well-being, mood, community participation and communication in people with aphasia.
Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers
Authors: Jones Leah Ffion , Cooper Emily , McNulty Cliodna
Published: June 2018

Background

Escherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.

Aim

To help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.

Method

Focus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.

Results

Carers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurse

Conclusion

A final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/
Identifying signs and symptoms preceding the diagnosis of Alzheimer’s Disease: a retrospective medical record review
Authors: Bature Fidelia , Pang Dong , Pappas Yannis , Guinn Barbara
Published: June 2018

Background

Early diagnosis of Alzheimer’s disease (AD) is beneficial as interventions work well at this stage.

Aim

The study sought to identify patterns in signs and symptoms as reported by patients, 10 years preceding the clinical diagnosis of AD and suggest a predictive model for the early detection of the disease.

Method

A retrospective medical record review and nested case-control design were carried out on the charts of 109 individuals (37 cases and 72 in the control group) in three GP surgeries in Milton Keynes and Luton, diagnosed between the year 2006–2016. Data extracted included the demographic and clinical data (signs and symptoms preceding the diagnosis of the disease). Logistic regression and correlation coefficient was used for analysis of variables to identify patterns.

Results

Auditory disturbances (tinnitus), a symptom that has not been reported in AD, could have a diagnostic value with 3.03 increased odds for associating with AD and a P-value of ≤0.05; the symptom was presented with a mean age of 14.5 years before the clinical diagnosis of the disease. There was a positive correlation between auditory disturbance and AD; episodic memory and AD; the female gender and AD all at 1% level (2tailed).

Conclusion

Auditory disturbance in the form of tinnitus has not been fully investigated in AD apart from auditory hallucinations and, as this symptom has been associated with other conditions. While further research is advocated in a large scale due to the insufficiency of the sample to initiate subgroup analysis, the result suggests that auditory disturbance could be a confounding factor to support future plans to improve the early diagnosis of AD.
Sensitivity of chest X-ray for lung cancer: systematic review
Authors: Bradley Stephen , Bradley Stephen , Abraham Sarah , Grice Adam , Lopez Rocio Rodriguez , Wright Judy , Farragher Tracey , Shinkins Beth , Neal Richard D
Published: June 2018

Background

Lung cancer is a leading cause of premature death. Early diagnosis is associated with improved outcomes. While chest X-ray remains the first line investigation, individual studies have indicated that a proportion of lung cancers are not identified (false negatives); this is one cause of delayed diagnoses.

Aim

To estimate the proportion of patients with lung cancer who have had a chest X-ray in the year prior to diagnosis which was not interpreted as having features suspicious for lung cancer.

Method

A broad search strategy was devised including several synonyms for chest X-ray and lung cancer. Screening and paediatric data, studies from before 1999 and studies based on retrospective interpretation of radiology were excluded. A 20% random sample screened by a second reviewer to ensure consistency.

Results

Analysis is almost complete: 8362 studies were identified. Twenty-nine studies met the inclusion criteria. Heterogeneity precluded meta-analysis, however the combined population was 1557 patients of whom 954 (61.27%) had a positive chest X-ray. In four studies with a lower risk of bias, comprising 1052 patients, sensitivity ranged from 73.5% to 79.3% (mean 76.19%).

Conclusion

This review suggests that chest X-ray does not identify approximately 25% of cases, although the findings may be affected by publication bias. This finding needs replicating in a high-quality study that could also demonstrate the potential consequences on diagnostic intervals and stage at diagnosis. The findings also suggest that studies to evaluate the effectiveness and cost-effectiveness of other modalities (e.g. low-dose CT scan) are needed.
Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care
Authors: Aiello Matthew
Published: June 2018

Background

It has been argued that UK general practice specialist training should be extended, to better prepare GPs for challenges facing 21st-century health care. Evidence is needed to inform how this should occur.

Aim

To investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme; in particular, workforce impact and career development potential. The fellowship was designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice.

Method

Semi-structured interviews conducted longitudinally over 2 years, augmented by observational data in West Midlands, England. Participants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants’ clinical and academic activities were observed. Data were analysed using a framework approach.

Results

Seven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed the fellowship made general practice a more attractive career option for newly qualified doctors.

Conclusion

The fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces, with the skills to support service improvement and integration. The fellowship model appears appropriate to prepare GPs for portfolio roles. Its impact on NHS service delivery continues to be investigated by Health Education England.
What can be done to promote resilience in GPs?
Authors: Waters Aine , Gonzalez Olivia , Keogh James , Kavanagh Nora , O’Neill Claire , Kelly ME , McGuire Genevieve , Regan Anne-Marie
Published: June 2018

Background

Medicine is a challenging career. There are reports of high rates of exhaustion, burn out and maladaptive coping strategies amongst doctors, GPs in particular. Accordingly, the issue of GP resilience is extremely topical.

Aim

To explore perspective of GPs and GP registrars regarding what can be done to promote resilience.

Method

This was a qualitative study involving face-to-face, semi-structured, recorded interviews with GPs and GP registrars in the West of Ireland. Data analysis was done by six stages of thematic analysis based on Braun and Clarke.

Results

Three major themes emerged from data analysis: a) Within the person, b) Within the profession and society, and c) Within the healthcare system. Subthemes within the person were ‘What resilience means to me’, ‘Me as a doctor’ and ‘Me as a human’. Within the profession and society, the subthemes were ‘Traditional view of GP’, ‘Societal expectations of the GP’, ‘Formal supports’ and ‘Education and training’. The healthcare system theme incorporated three subthemes ‘Finances’, ‘Manpower’ and ‘Relationship with the healthcare system’.

Conclusion

Identifying means to promote resilience in GPs involves an in-depth understanding of the challenges to resilience at various levels. From this research, it is evident that there is no “one size fits all” with regard to promoting resilience at a personal level. Views differed as to where resilience training would be best placed regarding formal resilience education. As to solutions within the health care system, GPs need to be adequately resourced to meet the evolving demands of general practice.
Local implementation of AMS initiatives: a mixed-methods study
Authors: Allison Rosalie , Lecky Donna , Beech Elizabeth , Costelloe Ceire , Ashiru-Oredope Diane , Owens Rebecca , McNulty Cliodna
Published: June 2018

Background

The NHS English Quality Premium recommends that inappropriate antibiotic prescribing is reduced; there are a range of national antimicrobial stewardship (AMS) initiatives to support this.

Aim

The aim of this study is to assess AMS activities in primary care across England. The findings will be used to inform how the RCGP, PHE and NHS can help optimise stewardship activities.

Method

Qualitative interviews: with AMS leads within Clinical Commissioning Groups’ (CCGs) and Commissioning Support Units’ (CSUs) medicines management teams. Questionnaire: informed by the qualitative data, sent to all 209 CCGs in England in 2017.

Results

In total, 89% (187/209) of CCGs returned a questionnaire; 82% of AMS leads reported spending only 0.1 whole-time equivalent on AMS activities, as it was only one role within a wider remit, so dedicating time is challenging. 99% (167/169) of CCGs had delivered AMS education in the last 2 years: 140 face-to-face; 121 via e-learning. 99% (184/186) actively promoted the TARGET Antibiotics Toolkit; 94% (175/187) actively promoted TARGET patient leaflets: 92% The Treating Your Infection (TYI) leaflet. 90% (166/185) used the PHE managing common infections guidance: 81% (149/185) modify or localise; 41/185 (22%) signpost directly to it. Eighty-six CCGs reported using CCG audit tools and 82 CCGs reported using TARGET’s audit tools. 85% (142/168) fed back antimicrobial prescribing data to the CCG/CSU board; 100% (169/169) to general practices and 33% (56/169) to out-of-hours providers.

Conclusion

Although CCGs reported promoting these AMS activities, there was little evaluation of uptake by primary care practitioners. Future work should focus on measuring AMS uptake; having staff dedicated solely to AMS could facilitate this.
A scoping review of the role of GPs in the management of obesity
Authors: Elmitt Nicholas , Sturgiss Elizabeth , Haesler Emily , van Weel Chris , Douglas Kirsty
Published: June 2018

Background

GPs are caring for more adults with obesity. Research in primary health care has provided insight on the components of effective interventions. However, the most appropriate and effective role for GPs in these interventions remains unclear.

Aim

A scoping review was undertaken to examine the literature for descriptions of the role of the GP in managing adults who are overweight or have obesity in: primary research interventions, guidelines, and the role expectations expressed by opinion leaders.

Method

Black and grey literature were searched based on the terms ‘obesity’, ‘doctor’ and ‘primary care’. A customised data extraction tool was used to identify the specific role of GPs and the explicit use of general practice values, including whole person care and person-centred care.

Results

282 articles were reviewed in full, with a majority of the interventions originating in the US. Poor description of the involvement of healthcare professionals made it difficult to determine if GPs had been involved. When described, GPs were rarely actively involved. Most guidelines explicitly name GPs in obesity management and suggest wide ranging roles for them. Opinions from experts on GP involvement have become more positive in recent years.

Conclusion

GPs are minimally involved in obesity interventions in primary care research, but are promoted in obesity guidelines as essential to patient care. There is a need for an international standard on how to accurately describe which healthcare professionals were involved in intervention delivery and their specific role.
Validating the Support Needs Approach for Patients (SNAP) tool in primary care: a person-centred approach for patients with advanced chronic obstructive pulmonary disease (COPD)
Authors: Gardner Carole , Ewing Gail , Farquhar Morag
Published: June 2018

Background

Primary care is at the forefront of COPD management. A person-centred approach is advocated, yet patients have difficulty in articulating their needs to health care professionals (HCPs). The Support Needs Approach for Patients (SNAP) tool aims to enable patients to identify and express their support needs but its validity is unknown.

Aim

To establish the face, content and criterion validity of the SNAP tool in advanced COPD.

Method

Two-stage mixed method primary care study involving patients with advanced COPD, and their carers. Stage 1: Face and content validity assessed though focus groups involving patients and carers (n = 12), considering the appropriateness, relevance and completeness of the SNAP tool. Data analysed using thematic analysis within a Framework Approach. Stage 2: Content and criteria validity assessed in a postal survey through patient self-completion of the SNAP tool and disease impact measures (Chronic Respiratory Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale). Content validity assessed using summary statistics; criterion validity via correlations between tool items and impact measures.

Results

The SNAP tool has good face, content and criterion validity. Patients and carers found the tool patient-friendly and potentially useful. No items on the tool were redundant, and clear correlations were found between tool items and the majority of items/sub-scales of the impact measures.

Conclusion

The SNAP tool has good face validity; content and criteria validity will be reported. It has the potential to facilitate person-centred care by enabling patients to express their support needs to HCPs. Future work will pilot SNAP in clinical practice.