bluuebunny/crossref_metadata_2025 huggingface dataset:
Using poster presentation to assess large classes: a case study of a first-year undergraduate module at a South African university
Authors: Ross Andrew , Dlungwane Thembelihle , Van Wyk Jacqueline
Published: November 2019

Background

The massification of higher education is often associated with poor student engagement, poor development of their critical thinking, inadequate feedback and poor student throughput. These factors necessitate the need to devise novel, innovative methods to teach, assess and provide feedback to learners to counter the restrictions imposed due to the large class learning environments. This study was conducted to ascertain the perceptions of 1st year medical students and staff at the Nelson Mandela School of Medicine regarding the value of poster presentations as a strategy to enhance learning, assessment and feedback.

Methods

This was an exploratory observational, descriptive cross-sectional, case study. Data was collected through separate student and staff questionnaires that required participant responses on a five-point Likert scale. The data was extracted into Excel spreadsheets for quantitative analysis.

Results

Two-hundred- and-thirty (92%) student questionnaires were returned (N = 250). Most students indicated that the design and presentation of the poster had helped them to select important material (92%), understand and describe disadvantage (86%) and to make a difference in the community (92%). The students agreed that the poster assessment was an efficient (81%) and fair method (75%) that provided opportunities for meaningful feedback. Ten staff members responded to the questionnaire. Most staff members (90%) indicated that the poster presentation had allowed students to demonstrate their engagement in a meaningful and appropriate way around issues of disadvantage and HIV and agreed that the poster presentations allowed for immediate and effective feedback.

Conclusion

Students’ interactions in the tasks promoted active engagement with others and course material; the development of higher order thinking and skills which added to students’ accounts of transformative learning experiences. They could describe and illustrate the difference that they had made in their chosen community. The poster presentations allowed for quick and efficient marking, immediate feedback and an opportunity to validate the students’ participation.

Poster presentations offered an innovative way to encourage deep meaningful engagement and learning amongst peers and facilitators. Poster presentations should be more widely considered as an innovative way of encouraging deeper engagement and learning in a large class setting.
Donors, authors, and owners: how is genomic citizen science addressing interests in research outputs?
Authors: Guerrini Christi J. , Lewellyn Meaganne , Majumder Mary A. , Trejo Meredith , Canfield Isabel , McGuire Amy L.
Published: November 2019

Background

Citizen science is increasingly prevalent in the biomedical sciences, including the field of human genomics. Genomic citizen science initiatives present new opportunities to engage individuals in scientific discovery, but they also are provoking new questions regarding who owns the outputs of the research, including intangible ideas and discoveries and tangible writings, tools, technologies, and products. The legal and ethical claims of participants to research outputs become stronger—and also more likely to conflict with those of institution-based researchers and other stakeholders—as participants become more involved, quantitatively and qualitatively, in the research process. It is not yet known, however, how genomic citizen science initiatives are managing the interests of their participants in accessing and controlling research outputs in practice. To help fill this gap, we conducted an in-depth review of relevant policies and practices of U.S.-based genomic citizen science initiatives.

Methods

We queried the peer-reviewed literature and grey literature to identify 22 genomic citizen science initiatives that satisfied six inclusion criteria. A data collection form was used to capture initiative features, policies, and practices relevant to participants’ access to and control over research outputs.

Results

This analysis revealed that the genomic citizen science landscape is diverse and includes many initiatives that do not have institutional affiliations. Two trends that are in apparent tension were identified: commercialization and operationalization of a philosophy of openness. While most initiatives supported participants’ access to research outputs, including datasets and published findings, none supported participants’ control over results via intellectual property, licensing, or commercialization rights. However, several initiatives disclaimed their own rights to profit from outputs.

Conclusions

There are opportunities for citizen science initiatives to incorporate more features that support participants’ access to and control over research outputs, consistent with their specific objectives, operations, and technical capabilities.
Prediction of cognitive impairment via deep learning trained with multi-center neuropsychological test data
Authors: Kang Min Ju , Kim Sang Yun , Na Duk L. , Kim Byeong C. , Yang Dong Won , Kim Eun-Joo , Na Hae Ri , Han Hyun Jeong , Lee Jae-Hong , Kim Jong Hun , Park Kee Hyung , Park Kyung Won , Han Seol-Heui , Kim Seong Yoon , Yoon Soo Jin , Yoon Bora , Seo Sang Won , Moon So Young , Yang YoungSoon , Shim Yong S. , Baek Min Jae , Jeong Jee Hyang , Choi Seong Hye , Youn Young Chul
Published: November 2019

Background

Neuropsychological tests (NPTs) are important tools for informing diagnoses of cognitive impairment (CI). However, interpreting NPTs requires specialists and is thus time-consuming. To streamline the application of NPTs in clinical settings, we developed and evaluated the accuracy of a machine learning algorithm using multi-center NPT data.

Methods

Multi-center data were obtained from 14,926 formal neuropsychological assessments (Seoul Neuropsychological Screening Battery), which were classified into normal cognition (NC), mild cognitive impairment (MCI) and Alzheimer’s disease dementia (ADD). We trained a machine learning model with artificial neural network algorithm using TensorFlow (https://www.tensorflow.org) to distinguish cognitive state with the 46-variable data and measured prediction accuracies from 10 randomly selected datasets. The features of the NPT were listed in order of their contribution to the outcome using Recursive Feature Elimination.

Results

The ten times mean accuracies of identifying CI (MCI and ADD) achieved by 96.66 ± 0.52% of the balanced dataset and 97.23 ± 0.32% of the clinic-based dataset, and the accuracies for predicting cognitive states (NC, MCI or ADD) were 95.49 ± 0.53 and 96.34 ± 1.03%. The sensitivity to the detection CI and MCI in the balanced dataset were 96.0 and 96.0%, and the specificity were 96.8 and 97.4%, respectively. The ‘time orientation’ and ‘3-word recall’ score of MMSE were highly ranked features in predicting CI and cognitive state. The twelve features reduced from 46 variable of NPTs with age and education had contributed to more than 90% accuracy in predicting cognitive impairment.

Conclusions

The machine learning algorithm for NPTs has suggested potential use as a reference in differentiating cognitive impairment in the clinical setting.
Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation
Authors: Field Hannah , Hudson Briony , Hewett Nigel , Khan Zana
Published: November 2019

Background

UK “Pathway” teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet “homelessness” is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless.

Methods

Retrospective analysis of patients referred to “Pathway” homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected.

Results

A total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission.

Conclusions

Disengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions.
A realist evaluation of the implementation of open visiting in an acute care setting for older people
Authors: Hurst Helen , Griffiths Jane , Hunt Carrie , Martinez Ellen
Published: November 2019

Background

Open visiting refers to the principle of unrestricted visiting hours in the hospital setting to enable relatives, families and carers to visit at any time. There has been recognition that open visiting supports the principle of patient and family supported care and improves communication. Despite this there has been difficulty in implementing open visiting and barriers identified. The aims of this study were therefore to evaluate the implementation of open visiting, the barriers to implementation, sustainability and the impact of open visiting on communication between health care professionals, families and carers.

Methods

The study was conducted on two large acute wards for the older person. Realist evaluation methods were used to understand ‘what works well, how, for whom and to what extent.’ Mixed methods were employed including qualitative interviews and descriptive analyses of routine data sets. Following the methodology of realist evaluation, programme theories were identified a long with the context, mechanisms and outcomes of implementation, to better understand the implementation process.

Results

The results of this study identified some key findings, demonstrating that open visiting does improve communication and can help to build trusting relationships between families/carers and health care professionals (HCP). Barriers to implementation were based on the belief that it would impinge on routines within the ward setting. To achieve the principles of patient and family/carer centred care, the key mechanisms are the confidence and skills of individual nurses and health care assistants to engage with relatives/carers, whilst retaining a sense of control, particularly when care is being delivered to other patients.

Conclusion

In summary, open visiting creates a positive culture which fosters better relationships between families/carers and HCPs. Involving families/carers as partners in care does not happen automatically in an environment where open visiting is the policy, but requires engagement with staff to encourage and support relatives/carers.
The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation
Authors: von Thiele Schwarz Ulrica , Aarons Gregory A. , Hasson Henna
Published: November 2019

Background

There has long been debate about the balance between fidelity to evidence-based interventions (EBIs) and the need for adaptation for specific contexts or particular patients. The debate is relevant to virtually all clinical areas. This paper synthesises arguments from both fidelity and adaptation perspectives to provide a comprehensive understanding of the challenges involved, and proposes a theoretical and practical approach for how fidelity and adaptation can optimally be managed.

Discussion

There are convincing arguments in support of both fidelity and adaptations, representing the perspectives of intervention developers and internal validity on the one hand and users and external validity on the other. Instead of characterizing fidelity and adaptation as mutually exclusive, we propose that they may better be conceptualized as complimentary, representing two synergistic perspectives that can increase the relevance of research, and provide a practical way to approach the goal of optimizing patient outcomes. The theoretical approach proposed, the “Value Equation,” provides a method for reconciling the fidelity and adaptation debate by putting it in relation to the value (V) that is produced. The equation involves three terms: intervention (IN), context (C), and implementation strategies (IS). Fidelity and adaptation determine how these terms are balanced and, in turn, the end product – the value it produces for patients, providers, organizations, and systems. The Value Equation summarizes three central propositions: 1) The end product of implementation efforts should emphasize overall value rather than only the intervention effects, 2) implementation strategies can be construed as a method to create fit between EBIs and context, and 3) transparency is vital; not only for the intervention but for all of the four terms of the equation.

There are merits to arguments for both fidelity and adaptation. We propose a theoretical approach, a Value Equation, to reconciling the fidelity and adaptation debate. Although there are complexities in the equation and the propositions, we suggest that the Value Equation be used in developing and testing hypotheses that can help implementation science move toward a more granular understanding of the roles of fidelity and adaptation in the implementation process, and ultimately sustainability of practices that provide value to stakeholders.
Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment
Authors:   And the Every Preemie–SCALE Ethiopia Implementation Research Collaboration Group, Usman Abubeker Kedir , Wolka Eskinder , Tadesse Yared , Tariku Abraham , Yeshidinber Abate , Teklu Alula M. , Senturia Kirsten , Gezahegn Wendemaghen , Litch James A.
Published: November 2019

Background

Preterm birth is a worldwide challenge with the highest burden in low- and middle-income countries. Despite availability of low-cost interventions to decrease mortality of preterm, low birth weight, and sick newborns, these interventions are not well integrated in the health systems of low- and middle-income countries. The aim of this study was to assess, from the perspective of key stakeholders comprising leaders in the public health system, the health system readiness to support health care facilities in the care provided to preterm, low birth weight, and sick newborns in different regions of Ethiopia.

Methods

A qualitative assessment using in-depth interviews with health facility leaders was conducted in health facilities in 3 regions of Ethiopia from December 2017 to February 2018. The interview guide was developed using a modified version of the World Health Organization health system building blocks.

Results

Across the public health system, adequate and reliable space, power, and water were problematic. Human resource issues (training, staffing, and retention) were critical to being able to properly care for preterm, low birth weight, and sick newborns. Problems with functional equipment and equipment distribution systems were widespread. Funds were lacking to support preterm, low birth weight, and sick newborn needs in facilities. Data collection practices, data quality, and data utilization were all problematic. There were gaps in the availability of guidelines and protocols, specifically targeting preterm, low birth weight, and sick newborn care. Key facilitators, information disseminators, and influencers identified in the study were the Health Development Army, community and religious leaders, and mothers and families who had had positive experiences or outcomes of care.

Conclusions

The Ethiopian health system has opportunities across all 7 World Health Organization health system building blocks to strengthen readiness to support health facilities to provide quality care and improve outcomes for preterm, low birth weight, and sick newborns.
The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study
Authors: Haegdorens Filip , Van Bogaert Peter , De Meester Koen , Monsieurs Koenraad G.
Published: November 2019

Background

Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult.

Method

In this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 h after cardiac arrest with CPR or unplanned ICU admission. Every 4 months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every 4 months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data.

Results

The unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B = − 2.771, p = 0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B = − 8.845, p = 0.023). Using the regression equation, we calculated theoretically optimal NHPPDs.

Conclusions

This study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders.
Satisfaction with use of public health and peer-led facilities for HIV prevention services by key populations in Nigeria
Authors: Ochonye Bartholomew , Folayan Morenike Oluwatoyin , Fatusi Adesegun O. , Emmanuel Godwin , Adepoju Oluwatomi , Ajidagba Babatunde , Jaiyebo Toluwanimi , Umoh Paul , Yusuf Ayo
Published: November 2019

Background

The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers.

Methods

A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted.

Results

Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent’s problems and concerns (p = 0.007),privacy and confidentiality (p = 0.04) and respect of rights of service recipients (p = 0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p = 0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p = 0.01), confidentiality (p = 0.002), waiting time (p < 0.01) and staff attitude (p = 0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p = 0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law.

Conclusion

Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.
What factors could influence physicians' management of women of childbearing age with chronic inflammatory disease? A systematic review of behavioural determinants of clinical inertia
Authors: Nelson-Piercy Catherine , Vlaev Ivo , Harris Katie , Fischer-Betz Rebecca
Published: November 2019

Background

Pregnancy represents a complex challenge to clinicians treating women with chronic inflammatory disease. Many clinicians face a situation of heightened sensitivity to the potential risks and uncertainties associated with the effect of pharmacological treatment on pregnancy outcomes. This may create an environment vulnerable to clinical inertia, whereby behavioural factors such as cognitive heuristics and biases, and other factors such as attitudes to risk and emotion can contribute. This systematic review was undertaken to assess if clinical inertia has been investigated/identified in this setting and took a behavioural science approach to identify and understand the potential determinants of clinical inertia in this treatment setting.

Methods

A systematic literature search was conducted to identify publications which investigated or described clinical inertia or its determinants (e.g. heuristics, biases etc.). Results were coded for thematic analysis using two inter-related behavioural models: the COM-B model and the Theoretical Domains Framework.

Results

Whilst studies investigating or describing clinical inertia in this treatment setting were not identified, the behavioural analysis revealed a number of barriers to the pharmacological management of women of fertile age affected by chronic inflammatory disease. Factors which may be influencing clinician’s behaviour were identified in all domains of the COM-B model. The primary factors identified were a lack of knowledge of treatment guidelines and fears concerning the safety of medications for mother and fetus. Lack of experience of treating pregnant patients was also identified as a contributing factor to undertreatment.

Conclusion

Using a behavioural approach, it was possible to identify potential factors which may be negatively influencing clinician’s behaviour in this treatment setting, although specific research was limited.
Antenatal care in rural Bangladesh: current state of costs, content and recommendations for effective service delivery
Authors: Jo Youngji , Alland Kelsey , Ali Hasmot , Mehra Sucheta , LeFevre Amnesty E. , Pak Semee (Esther) , Shaikh Saijuddin , Christian Parul , Labrique Alain B.
Published: November 2019

Background

Measurement of antenatal care (ANC) service coverage is often limited to the number of contacts or type of providers, reflecting a gap in the assessment of quality as well as cost estimations and health impact. The study aims to determine service subcomponents and provider and patient costs of ANC services and compares them between community (i.e. satellite clinics) and facility care (i.e. primary and secondary health centers) settings in rural Bangladesh.

Methods

Service contents and cost data were collected by one researcher and four interviewers in various community and facility health care settings in Gaibandha district between September and December 2016. We conducted structured interviews with organization managers, observational studies of ANC service provision (n = 70) for service contents and provider costs (service and drug costs) and exit interviews with pregnant women (n = 70) for patient costs (direct and indirect costs) in health clinics at community and facility levels. Fisher’s exact tests were used to determine any different patient characteristics between community and facility settings. ANC service contents were assessed by 63 subitems categorized into 11 groups and compared within and across community and facility settings. Provider and patient costs were collected in Bangladesh taka and analyzed as 2016 US Dollars (0.013 exchange rate).

Results

We found generally similar provider and patient characteristics between the community and facility settings except in clients’ gestational age. High compliance (> 50%) of service subcomponents were observed in blood pressure monitoring, weight measurement, iron and folate supplementation given, and tetanus vaccine, while lower compliance of service subcomponents (< 50%) were observed in some physical examinations such as edema and ultrasonogram and routine tests such as blood test and urine test. Average unit costs of ANC service provision were about double at the facility level ($2.75) compared with community-based care ($1.62). ANC patient costs at facilities ($2.66) were about three times higher than in the community ($0.78).

Conclusion

The study reveals a delay in pregnant women’s initial ANC care seeking, gaps in compliance of ANC subcomponents and difference of provider and patient costs between facility and community settings.
Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway
Authors: Labberton Angela S. , Barra Mathias , Rønning Ole Morten , Thommessen Bente , Churilov Leonid , Cadilhac Dominique A. , Lynch Elizabeth A.
Published: November 2019

Background

Unequal access to inpatient rehabilitation after stroke has been reported. We sought to identify and compare patient and service factors associated with referral and admission to an inpatient rehabilitation facility (IRF) after acute hospital care for stroke in two countries with publicly-funded healthcare.

Methods

We compared two cohorts of stroke patients admitted consecutively to eight acute public hospitals in Australia in 2013–2014 (n = 553), and to one large university hospital in Norway in 2012–2013 (n = 723). Outcomes were: referral to an IRF; admission to an IRF if referred. Logistic regression models were used to identify and compare factors associated with each outcome.

Results

Participants were similar in both cohorts: mean age 73 years, 40–44% female, 12–13% intracerebral haemorrhage, ~ 77% mild stroke (National Institutes of Health Stroke Scale < 8). Services received during the acute admission differed (Australia vs. Norway): stroke unit treatment 82% vs. 97%, physiotherapy 93% vs. 79%, occupational therapy 83% vs. 77%, speech therapy 78% vs. 13%. Proportions referred to an IRF were: 48% (Australia) and 37% (Norway); proportions admitted: 35% (Australia) and 28% (Norway). Factors associated with referral in both countries were: moderately severe stroke, receiving stroke unit treatment or allied health assessments during the acute admission, living in the community, and independent pre-stroke mobility. Directions of associations were mostly congruent; however younger patients were more likely to be referred and admitted in Norway only. Models for admission among patients referred identified few associated factors suggesting that additional factors were important for this stage of the process.

Conclusions

Similar factors were associated with referral to inpatient rehabilitation after acute stroke in both countries, despite differing service provision and access rates. Assuming it is not feasible to provide inpatient rehabilitation to all patients following stroke, the criteria for the selection of candidates need to be understood to address unwanted biases.
Barriers and facilitators to recruitment and enrollment of HIV-infected individuals with opioid use disorder in a clinical trial
Authors: Hoffman Kim A. , Baker Robin , Kunkel Lynn E. , Waddell Elizabeth Needham , Lum Paula J. , McCarty Dennis , Korthuis P. Todd
Published: November 2019

Background

The CTN-0067 CHOICES trial tests implementation of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for opioid use disorders (OUD) in HIV clinics to improve HIV viral suppression. The study team investigated recruitment strategies to elucidate the barriers and facilitators to recruitment and enrollment in the study.

Main text

Methods: Semi-structured, in-depth, digitally recorded interviews were completed with study recruitment-related staff and medical providers (n = 26) from six participating HIV clinics in the fall of 2018. Interviews probed 1) factors that might prevent prospective participants from engaging in study recruitment and enrollment procedures and 2) strategies used by study staff that encourage eligible patient participation. Interviews were transcribed and thematically analyzed using a content analysis approach. Results: All respondents reported that barriers to recruitment and enrollment included challenging patient social and structural factors (e.g., homelessness or living environments with high substance use, criminal justice involvement), difficulty locating patients with unsuppressed HIV viral load and OUD within the HIV clinic, time-consuming study enrollment processes, and stigma around HIV and OUD which inhibited treatment seeking. Some respondents observed that distrust of research and researchers impeded recruitment activities in the community. A specific medication-related barrier was patient fear of opioid abstinence required prior to XR-NTX induction. Facilitators of recruitment included use of trusted peer outreach/recruitment workers in the community, hospitalizations that offered windows of opportunities for screening and XR-NTX induction, providing participant transportation, and partnerships with harm reduction organizations for referrals.

Conclusions

Though study personnel encountered barriers to recruitment in the CHOICES study, persons with untreated HIV and OUD can be enrolled in multisite clinical trials by using enhanced recruitment strategies that extend outside of the HIV clinic. Employing peer outreach workers and collaborating with syringe service programs may be especially helpful in facilitating recruitment and merit inclusion in similar study protocols.
A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic
Authors: Levola Jonna M. , Sailas Eila S. , Säämänen Timo S. , Turunen Leena M. , Thomson Annika C.
Published: November 2019

Background

The focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits.

Methods

A cohort (n = 138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) –codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates.

Results

Patients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 –codes were inadequately documented.

Conclusions

Patients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.
Not being heard: barriers to high quality unplanned hospital care during young people’s transition to adult services – evidence from ‘this sickle cell life’ research
Authors: Renedo Alicia , Miles Sam , Chakravorty Subarna , Leigh Andrea , Telfer Paul , Warner John O. , Marston Cicely
Published: November 2019

Background

Young people’s experiences of healthcare as they move into adult services can have a major impact on their health, and the transition period for young people with sickle cell disease (SCD) needs improvement. In this study, we explore how young people with SCD experience healthcare during this period of transition.

Methods

We conducted a co-produced longitudinal qualitative study, including 80 interviews in 2016–2017 with young people with SCD aged 13–21 (mean age 16.6) across two cities in England. We recruited 48 participants (30 female, 18 male): 27 interviews were one-off, and 53 were repeated 2–3 times over approximately 18 months. We used an inductive analytical approach, combining elements of Grounded Theory and thematic analysis.

Results

Participants reported significant problems with the care they received in A&E during painful episodes, and in hospital wards as inpatients during unplanned healthcare. They experienced delays in being given pain relief and their basic care needs were not always met. Participants said that non-specialist healthcare staff did not seem to know enough about SCD and when they tried to work with staff to improve care, staff often seemed not prepared to listen to them or act on what they said. Participants said they felt out of place in adult wards and uncomfortable with the differences in adult compared with paediatric wards. Because of their experiences, they tried to avoid being admitted to hospital, attempting to manage their painful episodes at home and accessing unplanned hospital care only as a last resort. By contrast, they did not report having problems within SCD specialist services during planned, routine care.

Conclusions

Our study underscores the need for improvements to make services youth-friendly and youth-responsive, including training staff in SCD-specific care, compassionate care and communication skills that will help them elicit and act on young people’s voices to ensure they are involved in shaping their own healthcare. If young people are prevented from using transition skills (self-management, self-advocacy), or treated by staff who they worry do not have enough medical competency in their condition, they may well lose their trust in services, potentially compromising their own health.
Variation in expenditure for common, high cost surgical procedures in a working age population: implications for reimbursement reform
Authors: Wynn-Jones W. , Koehlmoos T. P. , Tompkins C. , Navathe A. , Lipsitz S. , Kwon N. K. , Learn P. A. , Madsen C. , Schoenfeld A. , Weissman J. S.
Published: November 2019

Background

In the move toward value-based care, bundled payments are believed to reduce waste and improve coordination. Some commercial insurers have addressed this through the use of bundled payment, the provision of one fee for all care associated with a given index procedure. This system was pioneered by Medicare, using a population generally over 65 years of age, and despite its adoption by mainstream insurers, little is known of bundled payments’ ability to reduce variation or cost in a working-age population. This study uses a universally-insured, nationally-representative population of adults aged 18–65 to examine the effect of bundled payments for five high-cost surgical procedures which are known to vary widely in Medicare reimbursement: hip replacement, knee replacement, coronary artery bypass grafting (CABG), lumbar spinal fusion, and colectomy.

Methods

Five procedures conducted on adults aged 18–65 were identified from the TRICARE database from 2011 to 2014. A 90-day period from index procedure was used to determine episodes of associated post-acute care. Data was sorted by Zip code into hospital referral regions (HRR). Payments were determined from TRICARE reimbursement records, they were subsequently price standardized and adjusted for patient and surgical characteristics. Variation was assessed by stratifying the HRR into quintiles by spending for each index procedure.

Results

After adjusting for case mix, significant inter-quintile variation was observed for all procedures, with knee replacement showing the greatest variation in both index surgery (107%) and total cost of care (75%). Readmission was a driver of variation for colectomy and CABG, with absolute cost variation of $17,257 and $13,289 respectively. Other post-acute care spending was low overall (≤$1606, for CABG).

Conclusions

This study demonstrates significant regional variation in total spending for these procedures, but much lower spending for post-acute care than previously demonstrated by similar procedures in Medicare. Targeting post-acute care spending, a common approach taken by providers in bundled payment arrangements with Medicare, may be less fruitful in working aged populations.
Comparison of four commercially available ELISA kits for diagnosis of Fasciola hepatica in Irish cattle
Authors: Munita Maria Pia , Rea Rosemary , Martinez-Ibeas Ana Maria , Byrne Noel , Kennedy Aideen , Sekiya Mary , Mulcahy Grace , Sayers Riona
Published: November 2019

Background

Fasciola hepaticais a liver parasite of mammals and it results in poor welfare outcomes and economic losses in ruminants. While faecal egg count is the test most commonly used for diagnosis, it does not indicate presence of migrating immature stages. Serological techniques increase sensitivity at all stages of the liver fluke infection. The aim of this study was to compare four commercially available ELISA tests for the diagnosis ofF. hepatica. For this purpose, we tested three sample types; (i) knownF. hepaticastatus sera from an experimental infection for the comparison of sensitivities and specificities, (ii) sera from pre- and post-flukicide-treated (albendazole, closantel, nitroxynil and triclabendazole) beef cattle to contrast the differences of seropositivity before and after treatment, and (iii) bulk tank milk samples from dairy herds sampled during high and lowF. hepaticaexposure periods for assessing seasonal variations with the four tests available. Samples were tested using ELISA kits supplied by four manufacturers (Ildana Biotech, IDEXX, Svanova, and Bio-X). Samples were analysed simultaneously and in duplicate.

Results

In the control population Ildana, IDEXX and Bio-X presented 100% sensitivity (Se) and specificity (Sp), Svanovir presented a Se of 59% and a Sp of 96%. In flukicide-treated beef cattle, kits highlighted decreasing antibody levels 90 days post-treatment in variable degrees. Finally, bulk milk showed a significant decrease in ELISA value between high and low fluke exposure periods with all tests studied.

Conclusions

Se and Sp found in the present study, confirm that Ildana, IDEXX and Bio-X are accurate for the detection ofF. hepaticaexposure in Irish cattle. Svanovir Se and Sp in this population, indicate that a larger study is necessary to confirm this test characteristic in Irish herds. In post-treatment use, Bio-X showed a consistent and significant decrease of ELISA value in all groups treated, denoting to be a reliable tool for assessing treatment effect at 90 days post-treatment. Finally, all tests showed to be a reliable tool for theF. hepaticamonitoring of high and low exposure seasons, using bulk tank milk samples.
Kinetic analysis of [18F] altanserin bolus injection in the canine brain using PET imaging
Authors: Pauwelyn Glenn , Vlerick Lise , Dockx Robrecht , Verhoeven Jeroen , Dobbeleir Andre , Bosmans Tim , Peremans Kathelijne , Vanhove Christian , Polis Ingeborgh , De Vos Filip
Published: November 2019

Background

Currently, [18F] altanserin is the most frequently used PET-radioligand for serotonin2A(5-HT2A) receptor imaging in the human brain but has never been validated in dogs. In vivo imaging of this receptor in the canine brain could improve diagnosis and therapy of several behavioural disorders in dogs. Furthermore, since dogs are considered as a valuable animal model for human psychiatric disorders, the ability to image this receptor in dogs could help to increase our understanding of the pathophysiology of these diseases. Therefore, five healthy laboratory beagles underwent a 90-min dynamic PET scan with arterial blood sampling after [18F] altanserin bolus injection. Compartmental modelling using metabolite corrected arterial input functions was compared with reference tissue modelling with the cerebellum as reference region.

Results

The distribution of [18F] altanserin in the canine brain corresponded well to the distribution of 5-HT2Areceptors in human and rodent studies. The kinetics could be best described by a 2-Tissue compartment (2-TC) model. All reference tissue models were highly correlated with the 2-TC model, indicating compartmental modelling can be replaced by reference tissue models to avoid arterial blood sampling.

Conclusions

This study demonstrates that [18F] altanserin PET is a reliable tool to visualize and quantify the 5-HT2Areceptor in the canine brain.
Proinflammatory cytokines and lipopolysaccharides up regulate MMP-3 and MMP-13 production in Asian elephant (Elephas maximus) chondrocytes: attenuation by anti-arthritic agents
Authors: Sirikaew Nutnicha , Chomdej Siriwadee , Tangyuenyong Siriwan , Tangjitjaroen Weerapongse , Somgird Chaleamchat , Thitaram Chatchote , Ongchai Siriwan
Published: November 2019

Background

Osteoarthritis (OA), the most common form of arthritic disease, results from destruction of joint cartilage and underlying bone. It affects animals, including Asian elephants (Elephas maximus) in captivity, leading to joint pain and lameness. However, publications regarding OA pathogenesis in this animal are still limited. Therefore, this study aimed to investigate the effect of proinflammatory cytokines, including interleukin-1 beta (IL-1β), IL-17A, tumor necrosis factor-alpha (TNF-α), and oncostatin M (OSM), known mediators of OA pathogenesis, and lipopolysaccharides on the expression of cartilaginous degrading enzymes, matrix metalloproteinase (MMP)-3 and MMP-13, in elephant articular chondrocytes (ELACs) cultures. Anti-arthritic drugs and the active compounds of herbal plants were tested for their potential attenuation against overproduction of these enzymes.

Results

Among the used cytokines, OSM showed the highest activation of MMP3 and MMP13 expression, especially when combined with IL-1β. The combination of IL-1β and OSM was found to activate phosphorylation of the mitogen-activated protein kinase (MAPK) pathway in ELACs. Lipopolysaccharides or cytokine-induced expressions were suppressed by pharmacologic agents used to treat OA, including dexamethasone, indomethacin, etoricoxib, and diacerein, and by three natural compounds, sesamin, andrographolide, and vanillylacetone.

Conclusions

Our results revealed the cellular mechanisms underlying OA in elephant chondrocytes, which is triggered by proinflammatory cytokines or lipopolysaccharides and suppressed by common pharmacological or natural medications used to treat human OA. These results provide a more basic understanding of the pathogenesis of elephant OA, which could be useful for adequate medical treatment of OA in this animal.
Canine adenovirus type 1 causing neurological signs in a 5-week-old puppy
Authors: Hornsey Samuel J. , Philibert Hélène , Godson Dale L. , Snead Elisabeth C. R.
Published: November 2019

Background

Infectious canine hepatitis is a rarely encountered disease, that is caused by Canine Adenovirus-1. Clinical signs can vary dramatically, and neurological signs are rarely seen. Neurological manifestation of this disease is rarely reported in the veterinary literature.

Case presentation

A 5-week-old, male entire Husky cross puppy presented for a one-day history of abnormal neurological behaviour (circling, ataxia, vocalization and obtund mentation). The puppy was euthanized shortly after presentation due to rapid deterioration. Histopathology raised concerns for Canine Adenovirus 1 (CAdV-1) based on vasculitis in the brain and intranuclear inclusion bodies in endothelial cell and hepatocytes; immunohistochemistry on brain tissue confirmed CAdV-1 infection.

Conclusions

This report discusses possible routes of infection and manifestations of adenovirus infections causing neurologic signs. It also provides a timely reminder that CAdV-1 should be considered a differential in unvaccinated dogs that present with neurological signs. Further studies are required to better understand the neurotrophic tendencies of this virus.