bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Centered Care and Turnover in Hospice Care Organizations
Authors: Kirby Eric G.
Published: May 2024

Hospice care has significantly changed over the past 40 years. The industry has seen a growth in utilization rates, an increase in insurance coverage, and changing governmental funding. To reduce the significant risk of employee turnover, hospice care organizations have responded to these pressures. This study examines whether nursing turnover is affected as organizations respond to environmental pressures for increased patient-centered care (PCC). Does the use of patient-centered approaches to meeting client needs reduce turnover in the nursing staff? Using hierarchical regression to analyze organizational, market, and personnel data from 695 hospices across the United States, this study finds innovative PCC practices are significantly related to reduced nursing turnover.
The Effects of Bundle Payment in Health Care: A Comprehensive Review of the Literature
Authors: Hung Man , Nielson Dominique , Hansen Alec , Gu Yushan , Bounsanga Jerry , Voss Maren W.
Published: May 2024

The main objectives of this study were to document research on BPCI and review the literature for evidence pertinent to the advantages and limitations of the BPCI funding mechanism. We searched the PubMed database for bundle payment studies using the search terms bundle payment and BPCI program. A systematic approach was used to guide the synthesis of literature and the effects reported. Between 2008 and June, 2017, 51 studies were identified in PubMed which reported results on bundling of payments. Among these studies, 33.3% (n=17) were quantitative and 66.6% (n=34) were qualitative. 27 of the 51 articles reported positive financial outcomes, and 14 reported negative financial outcomes. 30 showed improvement in patient care while 9 showed deterioration in patient care. Effects varied by specialty and clinic characteristics. The long-term effects of the BPCI program on patient care need further empirical examination and additional research to evaluate its effectiveness.
“A Call to Action” - Mental Illness and Self-Injurious Behavior Occuring in Jails & Prisons
Authors: Smith Hayden P. , Sitren Alicia H. , King Sarah
Published: May 2024

Prisons and jails have become a default mental health system for a significant portion of society. The high prevalence and complexity of mental illness in the correctional system is discussed with reference to a specific issue, inmate self-injury. Self-injurious behaviors are now ubiquitous in correctional institutions and a challenge for administrators. The etiology, prevalence and manifestation of self-injurious behaviors occurring in incarcerated settings is presented. This discussion is linked to a broader “Call to Action” for administrators that includes setting programmatic goals within the context of a mental health crisis (and few resources), consuming empirical research, developing programs for inmates, and addressing staff stress and resilience when working with inmates who are mentally ill.
Workplace Violence in Human Service Organizations: A Qualitative Inquiry of Team-Level Dynamics
Authors: Turpin Aaron , Shier Micheal L. , Nicholas David B. , Graham John R.
Published: May 2024

The concept of workplace violence and its relation to health and safety regimes in human service organizations is currently experiencing a conceptual renaissance. These terms are now broadly encompassing various intra- and inter-personal factors within the workplace. This study explores how staff in publicly-administered human services experience and perceive workplace violence between staff and health and safety at a team level, and how it can be prevented within these contexts. Semi-structured qualitative interviews were conducted with staff (n=85) in various publicly-administered human service departments across one province in Canada. Data were analyzed following a qualitative approach to conceptualize violence prevention at a team level. Respondents provide insights that help to develop a conceptual representation of positive intra-personal team dynamics and positive inter-personal team dynamics, which are elaborated to include specific factors under each of these themes. Findings support a model for building effective health and safety regimes that consider the influence of team-level dynamics in human service organizations. These findings support the development of highly effective and safe human service organizations.
Reanimating experts and authorities: Functions of speech reporting in COVID-19 news
Authors: Bunnag Orawee , Chaemsaithong Krisda , Park Kyung-Eun
Published: May 2024

This study explores the incorporation of experts’ and authorities’ voices in COVID-19 news articles with respect to their distribution and discursive functions. Based on a corpus 90 articles from 2020 to 2022 in The Korea Herald, the analysis reveals that reporters rely heavily and, at times, uncritically, on biomedical voices, representing them as a homogeneous group that provides a superior form of knowledge. The discursive functions range from providing substance to the coverage, to adding negative emotional coloring, to disowning, and to deauthorizing, which appear to vary according to the dynamics of the pandemic. These intertextual practices do not simply transmit biomedical knowledge to the reader but also mediate public perceptions of the virus by defining what counts as (il)legitimate knowledge and framing it as an alarming threat and an (in)security issue. In effect, multidimensional perspectives are precluded that may also be helpful for a complex issue like the pandemic.
Venetoclax: a new player in the treatment of children with high-risk myeloid malignancies?
Authors: Masetti Riccardo , Baccelli Francesco , Leardini Davide , Locatelli Franco
Published: May 2024

Venetoclax selectively inhibits B-cell lymphoma 2 (BCL-2) and restores apoptotic signaling of hematologic malignant cells. Venetoclax, in combination with hypomethylating and low-dose cytotoxic agents, has revolutionized the management of older patients affected by acute myeloid leukemia (AML) and that of patients unfit to receive intensive chemotherapy. In a single phase 1 pediatric trial conducted on relapsed or refractory AML, the combination of venetoclax and intensive chemotherapy was shown to be safe and yielded promising response rates. In addition, several retrospective studies in children with AML reported that venetoclax, when combined with hypomethylating agents and cytotoxic drugs, seems to be a safe and efficacious bridge to transplant. The promising results on the use of venetoclax combinations in advanced myelodysplastic syndromes (MDS) and therapy-related MDS/AML have also been reported in small case series. This review summarizes the available current knowledge about venetoclax use in childhood high-risk myeloid neoplasms and discusses the possible integration of BCL-2 inhibition in the current treatment algorithm of these children. It also focuses on specific genetic subgroups potentially associated with response in preclinical and clinical studies.
Extracellular release of damaged mitochondria induced by prehematopoietic stem cell transplant conditioning exacerbates GVHD
Authors: Vijayan Vijith , Yan Hao , Lohmeyer Juliane K. , Prentiss Kaylin A. , Patil Rachna V. , Barbarito Giulia , Lopez Ivan , Elezaby Aly , Peterson Kolten , Baker Jeanette , Ostberg Nicolai P. , Bertaina Alice , Negrin Robert S. , Mochly-Rosen Daria , Weinberg Kenneth , Haileselassie Bereketeab
Published: May 2024

Despite therapeutic advancements, graft-versus-host disease (GVHD) is a major complication of hematopoietic stem cell transplantation (HSCT). In current models of GVHD, tissue injury induced by cytotoxic conditioning regimens, along with translocation of microbes expressing pathogen-associated molecular patterns, result in activation of host antigen-presenting cells (APCs) to stimulate alloreactive donor T lymphocytes. Recent studies have demonstrated that in many pathologic states, tissue injury results in the release of mitochondria from the cytoplasm to the extracellular space. We hypothesized that extracellular mitochondria, which are related to archaebacteria, could also trigger GVHD by stimulation of host APCs. We found that clinically relevant doses of radiation or busulfan induced extracellular release of mitochondria by various cell types, including cultured intestinal epithelial cells. Conditioning-mediated mitochondrial release was associated with mitochondrial damage and impaired quality control but did not affect the viability of the cells. Extracellular mitochondria directly stimulated host APCs to express higher levels of major histocompatibility complex II (MHC-II), costimulatory CD86, and proinflammatory cytokines, resulting in increased donor T-cell activation, and proliferation in mixed lymphocyte reactions. Analyses of plasma from both experimental mice and a cohort of children undergoing HSCT demonstrated that conditioning induced extracellular mitochondrial release in vivo. In mice undergoing MHC-mismatched HSCT, administration of purified syngeneic extracellular mitochondria increased host APC activation and exacerbated GVHD. Our data suggest that pre-HSCT conditioning results in extracellular release of damaged mitochondria, which increase alloreactivity and exacerbate GVHD. Therefore, decreasing the extracellular release of damaged mitochondria after conditioning could serve as a novel strategy for GVHD prevention.
Substance specific EEG patterns in mice undergoing slow anesthesia induction
Authors: Obert David P. , Killing David , Happe Tom , Tamas Philipp , Altunkaya Alp , Dragovic Srdjan Z. , Kreuzer Matthias , Schneider Gerhard , Fenzl Thomas
Published: May 2024

The exact mechanisms and the neural circuits involved in anesthesia induced unconsciousness are still not fully understood. To elucidate them valid animal models are necessary. Since the most commonly used species in neuroscience are mice, we established a murine model for commonly used anesthetics/sedatives and evaluated the epidural electroencephalographic (EEG) patterns during slow anesthesia induction and emergence. Forty-four mice underwent surgery in which we inserted a central venous catheter and implanted nine intracranial electrodes above the prefrontal, motor, sensory, and visual cortex. After at least one week of recovery, mice were anesthetized either by inhalational sevoflurane or intravenous propofol, ketamine, or dexmedetomidine. We evaluated the loss and return of righting reflex (LORR/RORR) and recorded the electrocorticogram. For spectral analysis we focused on the prefrontal and visual cortex. In addition to analyzing the power spectral density at specific time points we evaluated the changes in the spectral power distribution longitudinally. The median time to LORR after start anesthesia ranged from 1080 [1st quartile: 960; 3rd quartile: 1080]s under sevoflurane anesthesia to 1541 [1455; 1890]s with ketamine. Around LORR sevoflurane as well as propofol induced a decrease in the theta/alpha band and an increase in the beta/gamma band. Dexmedetomidine infusion resulted in a shift towards lower frequencies with an increase in the delta range. Ketamine induced stronger activity in the higher frequencies. Our results showed substance-specific changes in EEG patterns during slow anesthesia induction. These patterns were partially identical to previous observations in humans, but also included significant differences, especially in the low frequencies. Our study emphasizes strengths and limitations of murine models in neuroscience and provides an important basis for future studies investigating complex neurophysiological mechanisms.
Predicting Alzheimer’s progression in MCI: a DTI-based white matter network model
Authors: Song Qiaowei , Peng Jiaxuan , Shu Zhenyu , Xu Yuyun , Shao Yuan , Yu Wen , Yu Liang
Published: May 2024

Objective

This study aimed to identify features of white matter network attributes based on diffusion tensor imaging (DTI) that might lead to progression from mild cognitive impairment (MCI) and construct a comprehensive model based on these features for predicting the population at high risk of progression to Alzheimer’s disease (AD) in MCI patients.

Methods

This study enrolled 121 MCI patients from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Among them, 36 progressed to AD after four years of follow-up. A brain network was constructed for each patient based on white matter fiber tracts, and network attribute features were extracted. White matter network features were downscaled, and white matter markers were constructed using an integrated downscaling approach, followed by forming an integrated model with clinical features and performance evaluation.

Results

APOE4 and ADAS scores were used as independent predictors and combined with white matter network markers to construct a comprehensive model. The diagnostic efficacy of the comprehensive model was 0.924 and 0.919, sensitivity was 0.864 and 0.900, and specificity was 0.871 and 0.815 in the training and test groups, respectively. The Delong test showed significant differences (P < 0.05) in the diagnostic efficacy of the combined model and APOE4 and ADAS scores, while there was no significant difference (P > 0.05) between the combined model and white matter network biomarkers.

Conclusions

A comprehensive model constructed based on white matter network markers can identify MCI patients at high risk of progression to AD and provide an adjunct biomarker helpful in early AD detection.
Acceptability and feasibility of screening with a pediatric care provider-led social determinants of health identification tool
Authors: Eyre Alison , Cohen Janice , Funnell Sarah , James Lynsey , Guglani Sheena , Abi Haidar Hounaida , Samson Lindy , Ward Michelle , Jetty Radha , Harrison Megan , Lyons John S. , Fraser-Roberts Leigh , Bennett Susan , Archibald Douglas , Khorsand Soha , Audcent Tobey
Published: May 2024

Background

Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings.

Methods

The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility.

Results

Thirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important (n = 10, 76.9%), acceptable (n = 11; 84.6%), and feasible (n = 7, 53.8%).

Interpretation

Though the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study’s findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap.
Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents’ sexual and reproductive health needs in rural Zambia
Authors: Mulubwa Chama , Zulu Joseph Mumba , Hurtig Anna-Karin , Goicolea Isabel
Published: May 2024

Introduction

Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents’ access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents’ SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents’ SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents.

Methods

Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz’s grounded theory approach was used for the analysis.

Results

We present the core category “being both a grandmother and a CBHW”, which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents’ SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges.

Conclusion

Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people’s sexual and reproductive health.
Public health and economic benefits of seasonal influenza vaccination in risk groups in France, Italy, Spain and the UK: state of play and perspectives
Authors: de Fougerolles Thierry Rigoine , Baïssas Théophile , Perquier Guillaume , Vitoux Olivier , Crépey Pascal , Bartelt-Hofer José , Bricout Hélène , Petitjean Audrey
Published: May 2024

Background

Seasonal influenza epidemics have a substantial public health and economic burden, which can be alleviated through vaccination. The World Health Organization (WHO) recommends a 75% vaccination coverage rate (VCR) in: older adults (aged ≥ 65 years), individuals with chronic conditions, pregnant women, children aged 6–24 months and healthcare workers. However, no European country achieves this target in all risk groups. In this study, potential public health and economic benefits achieved by reaching 75% influenza VCR was estimated in risk groups across four European countries: France, Italy, Spain, and the UK.

Methods

A static epidemiological model was used to estimate the averted public health and economic burden of increasing the 2021/2022 season VCR to 75%, using the efficacy data of standard-dose quadrivalent influenza vaccine. For each country and risk group, the most recent data on population size, VCR, pre-pandemic influenza epidemiology, direct medical costs and absenteeism were identified through a systematic literature review, supplemented by manual searching. Outcomes were: averted influenza cases, general practitioner (GP) visits, hospitalisations, case fatalities, number of days of work lost, direct medical costs and absenteeism-related costs.

Results

As of the 2021/2022 season, the UK achieved the highest weighted VCR across risk groups (65%), followed by Spain (47%), France (44%) and Italy (44%). Based on modelling, the 2021/2022 VCR prevented an estimated 1.9 million influenza cases, avoiding 375,200 GP visits, 73,200 hospitalisations and 38,400 deaths. To achieve the WHO 75% VCR target, an additional 24 million at-risk individuals would need to be vaccinated, most of which being older adults and patients with chronic conditions. It was estimated that this could avoid a further 918,200 influenza cases, 332,000 GP visits, 16,300 hospitalisations and 6,300 deaths across the four countries, with older adults accounting for 52% of hospitalisations and 80% of deaths. An additional €84 million in direct medical costs and €79 million in absenteeism costs would be saved in total, with most economic benefits delivered in France.

Conclusions

Older adults represent most vaccine-preventable influenza cases and deaths, followed by individuals with chronic conditions. Health authorities should prioritise vaccinating these populations for maximum public health and economic benefits.
Safety and feasibility of in-hospital autonomous transportation using a driverless mobility for patients with musculoskeletal disorders: preliminary clinical study to achieve mobility as a service in medical care
Authors: Takahashi Hiroshi , Suzuki Kenji , Nishino Tomofumi , Shibao Yosuke , Noguchi Hiroshi , Kanamori Akihiro , Yoshioka Tomokazu , Kikuchi Naoya , Nozawa Daisuke , Mishima Hajime , Koda Masao , Yamazaki Masashi
Published: May 2024

Background

Recent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for patients with reduced mobility due to musculoskeletal disorders. In the present study, we conducted a preliminary clinical study to assess the safety and feasibility of in-hospital autonomous transportation using a driverless mobility (wheelchair) for patients with musculoskeletal disorders.

Methods

From January to February 2022, 51 patients with musculoskeletal disorders exhibiting gait disturbance who presented to our institution were included in the present study. Driverless mobility rides were conducted over a straight-line distance of 100 m from the orthopaedic outpatient reception to the payment counter after the outpatient consultation. We assessed the quality of life using an EQ-5D-5 L index and pain using a VAS score before riding the mobility to investigate the patient’s condition. After the ride, a questionnaire survey was conducted to assess patient satisfaction on a 5-point scale. In addition, adverse events during the mobility ride were investigated.

Results

Overall satisfaction levels showed that 44 out of 51 (86%) patients rated the level as 3 or higher. There were no significant differences in the level of satisfaction based on the cause of disorders or EQ-5D-5 L Index. Among 19 patients who rated the level of satisfaction as 2–3, the ratio of postoperative patients and those with pain tended to be higher (p < 0.05). While 26 of 51 (51%) patients reported moments of feeling unsafe during the mobility ride, no actual adverse events, such as collisions, were observed.

Conclusions

An in-hospital autonomous transportation service using a driverless mobility for patients with musculoskeletal disorders demonstrated high satisfaction levels and was safe with no severe adverse events observed. The expansion of autonomous mobility deployment is expected to achieve mobility as a service in medical care.
NTSM: a non-salient target segmentation model for oral mucosal diseases
Authors: Ju Jianguo , Zhang Qian , Guan Ziyu , Shen Xuemin , Shen Zhengyu , Xu Pengfei
Published: May 2024

Background

Oral mucosal diseases are similar to the surrounding normal tissues, i.e., their many non-salient features, which poses a challenge for accurate segmentation lesions. Additionally, high-precision large models generate too many parameters, which puts pressure on storage and makes it difficult to deploy on portable devices.

Methods

To address these issues, we design a non-salient target segmentation model (NTSM) to improve segmentation performance while reducing the number of parameters. The NTSM includes a difference association (DA) module and multiple feature hierarchy pyramid attention (FHPA) modules. The DA module enhances feature differences at different levels to learn local context information and extend the segmentation mask to potentially similar areas. It also learns logical semantic relationship information through different receptive fields to determine the actual lesions and further elevates the segmentation performance of non-salient lesions. The FHPA module extracts pathological information from different views by performing the hadamard product attention (HPA) operation on input features, which reduces the number of parameters.

Results

The experimental results on the oral mucosal diseases (OMD) dataset and international skin imaging collaboration (ISIC) dataset demonstrate that our model outperforms existing state-of-the-art methods. Compared with the nnU-Net backbone, our model has 43.20% fewer parameters while still achieving a 3.14% increase in the Dice score.

Conclusions

Our model has high segmentation accuracy on non-salient areas of oral mucosal diseases and can effectively reduce resource consumption.
Efficacy of a mouthwash containing ε-poly-L-lysine, funme peptides and domiphen in reducing halitosis and supragingival plaque: a randomized clinical trial
Authors: Shen Song , Liu Xu , Huang Jun , Sun Yi , Liu Bin , Song Wenzhu , Meng Lei , Du Mi , Feng Qiang
Published: May 2024

Objective

To evaluate the antibacterial effectiveness of a combination of ε-poly-L-lysine (ε-PL), funme peptide (FP) as well as domiphen against oral pathogens, and assess the efficacy of a BOP® mouthwash supplemented with this combination in reducing halitosis and supragingival plaque in a clinical trial.

Materials and methods

The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the compound against Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus mutans, and Aggregatibacter actinomycetemcomitans were determined by the gradient dilution method. Subsequently, the CCK-8 assay was used to detect the toxicity of mouthwash on human gingival fibroblastst, and the effectiveness in reducing halitosis and supragingival plaque of the mouthwash supplemented with the combination was analyzed by a randomized, double-blind, parallel-controlled clinical trial.

Results

The combination exhibited significant inhibitory effects on tested oral pathogens with the MIC < 1.56% (v/v) and the MBC < 3.13% (v/v), and the mouthwash containing this combination did not inhibit the viability of human gingival fibroblasts at the test concentrations. The clinical trial showed that the test group displayed notably lower volatile sulfur compounds (VSCs) at 0, 10, 24 h, and 7 d post-mouthwash (P < 0.05), compared with the baseline. After 7 days, the VSC levels of the and control groups were reduced by 50.27% and 32.12%, respectively, and notably cutting severe halitosis by 57.03% in the test group. Additionally, the Plaque Index (PLI) of the test and control group decreased by 54.55% and 8.38%, respectively, and there was a significant difference in PLI between the two groups after 7 days (P < 0.01).

Conclusions

The combination of ε-PL, FP and domiphen demonstrated potent inhibitory and bactericidal effects against the tested oral pathogens, and the newly formulated mouthwash added with the combination exhibited anti-dental plaque and anti-halitosis properties in a clinical trial and was safe.

Trial registration

The randomized controlled clinical trial was registered on Chinese Clinical Trial Registry (No. ChiCTR2300073816, Date: 21/07/2023).
PRECIS-2 analysis of pragmatic acupuncture trials: a systematic review
Authors: Lim Jinwoong , Lee Hyeonhoon , Kim Yong-Suk
Published: May 2024

Background

Pragmatic acupuncture trials (PATs) are a research tool for assessing the effectiveness of acupuncture treatments in a real-world setting. This study aimed to provide a comprehensive methodological analysis of PATs using the PRECIS-2(PRagmatic Explanatory Continuum Indicator Summary-2) tool to determine their pragmatism.

Methods

The MEDLINE, EMBASE, Cochrane Central Register for Controlled Trials, CINAHL, Allied and Complementary Medicine Database, China National Knowledge Infrastructure, VIP, WANFANG, Taiwan Periodical Literature Database, KoreaMed, KMbase, Research Information Service System, Oriental Medicine Advanced Searching Integrated System, CiNii and ClinicalTrials.gov were searched. The search included randomised controlled trials (RCTs) and protocols of RCTs that investigated all types of acupuncture and used self-declared pragmatic design. Two authors independently collected the basic information and characteristics of the studies and assessed their pragmatism using the nine PRECIS-2 domains and the additional domain of control.

Results

A total of 93 studies were included. The means of eligibility, recruitment, organisation, primary outcome, primary analysis, and control domains were statistically larger than three and were shown to be pragmatic. The means of setting, flexibility:delivery, and follow-up domains were not greater than three and were shown to be non-pragmatic. For flexibility:adherence domain was inappropriate for assessment owing to insufficient information in the studies.

Conclusions

PATs were pragmatic in the domain of eligibility, recruitment, organisation, primary outcome, primary analysis, and control and were not pragmatic in the domain of setting, flexibility:delivery, and follow-up. Future PATs need to strengthen the pragmatism in the setting, flexibility:delivery, and follow-up domains and to describe the flexibility:adherence domain in more detail.

Trial registration

CRD42021236975.
Enhancing pneumonia prognosis in the emergency department: a novel machine learning approach using complete blood count and differential leukocyte count combined with CURB-65 score
Authors: Lin Yin-Ting , Lin Ko-Ming , Wu Kai-Hsiang , Lien Frank
Published: May 2024

Background

Pneumonia poses a major global health challenge, necessitating accurate severity assessment tools. However, conventional scoring systems such as CURB-65 have inherent limitations. Machine learning (ML) offers a promising approach for prediction. We previously introduced the Blood Culture Prediction Index (BCPI) model, leveraging solely on complete blood count (CBC) and differential leukocyte count (DC), demonstrating its effectiveness in predicting bacteremia. Nevertheless, its potential in assessing pneumonia remains unexplored. Therefore, this study aims to compare the effectiveness of BCPI and CURB-65 in assessing pneumonia severity in an emergency department (ED) setting and develop an integrated ML model to enhance efficiency.

Methods

This retrospective study was conducted at a 3400-bed tertiary medical center in Taiwan. Data from 9,352 patients with pneumonia in the ED between 2019 and 2021 were analyzed in this study. We utilized the BCPI model, which was trained on CBC/DC data, and computed CURB-65 scores for each patient to compare their prognosis prediction capabilities. Subsequently, we developed a novel Cox regression model to predict in-hospital mortality, integrating the BCPI model and CURB-65 scores, aiming to assess whether this integration enhances predictive performance.

Results

The predictive performance of the BCPI model and CURB-65 score for the 30-day mortality rate in ED patients and the in-hospital mortality rate among admitted patients was comparable across all risk categories. However, the Cox regression model demonstrated an improved area under the ROC curve (AUC) of 0.713 than that of CURB-65 (0.668) for in-hospital mortality (p<0.001). In the lowest risk group (CURB-65=0), the Cox regression model outperformed CURB-65, with a significantly lower mortality rate (2.9% vs. 7.7%, p<0.001).

Conclusions

The BCPI model, constructed using CBC/DC data and ML techniques, performs comparably to the widely utilized CURB-65 in predicting outcomes for patients with pneumonia in the ED. Furthermore, by integrating the CURB-65 score and BCPI model into a Cox regression model, we demonstrated improved prediction capabilities, particularly for low-risk patients. Given its simple parameters and easy training process, the Cox regression model may be a more effective prediction tool for classifying patients with pneumonia in the emergency room.
Clinical nursing competency during epidemics: a qualitative content analysis
Authors: Abadian Leila , Alavi Negin Masoudi , Tagharrobi Zahra
Published: May 2024

Background

Nurses are on the frontline for managing epidemic diseases. Different aspects of clinical nursing competencies during epidemics are important issues that need investigation.

Objectives

The aim of this study was to determine the required clinical competencies for nurses during epidemics. Understanding these competencies could provide valuable information for health care services and nursing education organizations to prepare nurses for future epidemics.

Methods

The qualitative conventional content analysis study was conducted using semi-structured interviews with 12 nurses that were actively engaged in providing patient care during COVID-19 pandemic in Shahid Beheshti hospital in Kashan/Iran, from October 2022 to March 2023. The data analysis process was conducted according to 5 steps suggested by Graneheim and Lundman.

Results

After analysis, the 159 competencies were derived from interviews that were categorized to 11 subcategories, and three categories of clinical nursing skills in epidemics, knowledge of epidemics, and soft skills for nurses in epidemics.

Conclusion

Nurses need wide range of competencies to address the professional expectations regarding providing acceptable care during epidemics. Knowing these competencies can help nursing managers to prepare nurses for crisis such as what world experienced during COVID-19 pandemic.
Quality of work life for health professions in Colombia’s adult critical care: An integrative analysis
Authors: del Pilar Quiñones-Rozo Laura , Canaval-Erazo Gladys Eugenia
Published: May 2024

Background

Health professionals in Colombian and many parts of the world, in some cases, work in precarious conditions and intend to migrate to other countries in search of better living conditions for themselves and their families, which results in inadequate distribution worldwide and in the quality of care throughout the health system, which can ultimately influence the quality of life of patients in their health-disease processes.

Purpose

Describe in depth what quality of life at work is like for the health workforce in adult critical care (ACC).

Methods

This is an investigation of convergent parallel mixed methods approach that are integrated by means of a matrix in terms of convergence, divergence, and complementarity. Two methods are used: a transversal analytical method in which three instruments were applied to 209 participants to study the relationship between Quality of Life at Work, exposure to psychosocial risks, compassion fatigue and the intention to rotate; other than from the experiences narrated by 10 Human Talent in Health explore organizational practices in critical care.

Results

The dimension of quality of work life with the greatest dissatisfied was the management of free time (77%), the most compromised psychosocial risk was the pace of work (84%). They have high compassion satisfaction (67%) and there is an intention to migrate to another country (66%). The narrative results in discrimination/harassment as normalized practices and faceless spirituality. The integration of mixed methods shows convergence between the use of the instrument that measures quality of life at work and the narratives of the participants, complementarity with the other instruments, and divergence regarding the intention to rotate to another health institution.

Conclusion

The positive trend that converges with the two approaches is that of safety at work and well-being achieved through work, embodied in the constant updating of technology and care protocols, experience time, balance between salary and work effort, staffing and supplies, and disconnection with work.
Project ECHO®: a global cross-sectional examination of implementation success
Authors: Moss Perrin , Hartley Nicole , Russell Trevor
Published: May 2024

Background

Organizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation– Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation.

Methods

An empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics.

Results

The 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12–18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams.

Conclusions

These findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities.
Incorporating clinician insight and care plans into an audit and feedback initiative for antipsychotic prescribing to Medicaid-enrolled youth in Philadelphia
Authors: Candon Molly , Shen Siyuan , Rothbard Aileen , Reed Abigail , Everett Mia , Demp Neal , Weingartner Melissa , Fadeyibi Oluwatoyin
Published: May 2024

Background

Audit and feedback (A/F), which include initiatives like report cards, have an inconsistent impact on clinicians’ prescribing behavior. This may be attributable to their focus on aggregate prescribing measures, a one-size-fits-all approach, and the fact that A/F initiatives rarely engage with the clinicians they target.

Methods

In this study, we describe the development and delivery of a report card that summarized antipsychotic prescribing to publicly-insured youth in Philadelphia, which was introduced by a Medicaid managed care organization in 2020. In addition to measuring aggregate prescribing behavior, the report card included different elements of care plans, including whether youth were receiving polypharmacy, proper medication management, and the concurrent use of behavioral health outpatient services. The A/F initiative elicited feedback from clinicians, which we refer to as an "audit and feedback loop." We also evaluate the impact of the report card by comparing pre-post differences in prescribing measures for clinicians who received the report card with a group of clinicians who did not receive the report card.

Results

Report cards indicated that many youth who were prescribed antipsychotics were not receiving proper medication management or using behavioral health outpatient services alongside the antipsychotic prescription, but that polypharmacy was rare. In their feedback, clinicians who received report cards cited several challenges related to antipsychotic prescribing, such as the logistical difficulties of entering lab orders and family members’ hesitancy to change care plans. The impact of the report card was mixed: there was a modest reduction in the share of youth receiving polypharmacy following the receipt of the report card, while other measures did not change. However, we documented a large reduction in the number of youth with one or more antipsychotic prescription fill among clinicians who received a report card.

Conclusions

A/F initiatives are a common approach to improving the quality of care, and often target specific practices such as antipsychotic prescribing. Report cards are a low-cost and feasible intervention but there is room for quality improvement, such as adding measures that track medication management or eliciting feedback from clinicians who receive report cards. To ensure that the benefits of antipsychotic prescribing outweigh its risks, it is important to promote quality and safety of antipsychotic prescribing within a broader care plan.
Impact of an innovative bundled payment to TB health care providers in China: an economic simulation analysis
Authors: Xu Pengyu , Ying Yazhen , Xu Debin , Huan Shitong , Zhao Lindu , Wang Hong
Published: May 2024

Background

Tuberculosis is the second most deadly infectious disease after COVID-19 and the 13th leading cause of death worldwide. Among the 30 countries with a high burden of TB, China ranks third in the estimated number of TB cases. China is in the top four of 75 countries with a deficit in funding for TB strategic plans. To reduce costs and improve the effectiveness of TB treatment in China, the NHSA developed an innovative BP method. This study aimed to simulate the effects of this payment approach on different stakeholders, reduce the economic burden on TB patients, improve the quality of medical services, facilitate policy optimization, and offer a model for health care payment reforms that can be referenced by other regions throughout the world.

Methods

We developed a simulation model based on a decision tree analysis to project the expected effects of the payment method on the potential financial impacts on different stakeholders. Our analysis mainly focused on comparing changes in health care costs before and after receiving BPs for TB patients with Medicare in the pilot areas. The data that were used for the analysis included the TB service claim records for 2019–2021 from the health insurance agency, TB prevalence data from the local Centre for Disease Control, and health care facilities’ revenue and expenditure data from the Statistic Yearbook. A Monte Carlo randomized simulation model was used to estimate the results.

Results

After adopting the innovative BP method, for each TB patient per year, the total annual expenditure was estimated to decrease from $2,523.28 to $2,088.89, which is a reduction of $434.39 (17.22%). The TB patient out-of-pocket expenditure was expected to decrease from $1,249.02 to $1,034.00, which is a reduction of $215.02 (17.22%). The health care provider’s revenue decreased from $2,523.28 to $2,308.26, but the health care provider/institution’s revenue-expenditure ratio increased from -6.09% to 9.50%.

Conclusions

This study highlights the potential of BPs to improve medical outcomes and control the costs associated with TB treatment. It demonstrates its feasibility and advantages in enhancing the coordination and sustainability of medical services, thus offering valuable insights for global health care payment reform.
Quality of care transition, patient safety incidents, and patients’ health status: a structural equation model on the complexity of the discharge process
Authors: Marsall Matthias , Hornung Thorsten , Bäuerle Alexander , Weigl Matthias
Published: May 2024

Background

The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments’ and patients’ contextual factors in one comprehensive model.

Methods

Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient’s perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions.

Results

Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included.

Conclusions

Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.