bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Physician-Hospital Vertical Integration Affect Hospital Output?
Authors: Upadhyay Soumya , Bhandari Neeraj 
Published: December 2024

Background: Physician-hospital vertical integration is gaining steam but it is unclear how they affect hospital output. Objective: To examine the direct impact of vertical integration on hospital output. Design: A pooled design with 6-year data using linear regressions was used. Then, panel data design with hospital fixed effects was used. Methods: We linked American Hospital Association data (2016-2021) with AHRQ Comparative Health System Performance Initiative’s Compendium (2018, 2020, 2021; 34 987 hospital-year observations) to develop new measures of vertical integration and assess its relationship with several measures of hospital output including annualized total admissions, total number of inpatients days, and total number of emergency department (ED) and outpatient visits. Results: We find that a hospital’s entry into a vertical integration has little or no impact on a broad set of metrics capturing hospital output. Conclusion: Our findings suggest that vertical integrations as currently structured may not yield meaningful gains in output or productivity and hospitals faced with declining productivity need to carefully consider the expected gains from vertical integration strategies.
Exploring the policy implementation of a holistic approach to cancer investigation in non-specific symptom pathways in England: An ethnographic study
Authors: Black Georgia B , Khalid Ahmad F , Lyratzopoulos Georgios , Duffy Stephen W , Nicholson Brian D , Fulop Naomi J 
Published: December 2024

Objectives This study aimed to explore the policy implementation of non-specific symptom pathways within the English National Health Service. Methods A multi-site ethnographic project was conducted in four hospitals that contained non-specific symptom pathways between November 2021 and February 2023. The research involved observation (44 h), interviews ( n = 54), patient shadowing, and document review. Results The study examined how the policy concept of ‘holistic’ care was understood and put into practice within four non-specific symptom pathways. Several challenges associated with providing holistic care were identified. One key challenge was the conflict between delivering holistic care and meeting timed targets, such as the Faster Diagnosis Standard, due to limited availability of imaging and diagnostic tools. The interpretation of a holistic approach varied among participants, with some acknowledging that the current model did not recognise holistic care beyond cancer exclusion. The findings also revealed a lack of clarity and differing opinions on the boundaries of holistic care, resulting in wide variation in NSS pathway implementation across health care providers. Additionally, holistic investigation of non-specific symptoms in younger patients were seen to pose difficulties due to younger patients’ history of health anxiety or depression, as well as concerns over radiological risk exposure. Conclusions The study highlights the complexity of implementing non-specific symptom pathways in light of standardised timed cancer targets and local cancer policies. There is a need for appropriately funded organisational models of care that prioritise holistic care in a timely manner over solely meeting cancer targets. Decision-makers should also consider the role of non-specific symptom pathways within the broader context of chronic disease management, with a particular emphasis on expanding diagnostic capacity.
Organizing to address overtreatment in cancer care near the end of life: Evidence from Denmark
Authors: Hauge Amalie M , Lydiksen Nis , Bech Mickael 
Published: December 2024

Objectives The purpose of this study is to investigate how organizational factors influence the ethical and economic problems of overtreatment of cancer patients. Methods The study applies a sequential mixed-method approach. First, our logistic regression model assesses how patient characteristics and hospital department variables influence the use of late cancer treatment (LCT), primarily chemotherapy, in stage IV non-small cell lung cancer cases using Danish registry data. Department-specific variations in LCT use across hospitals are identified, while controlling for population differences. Then, using qualitative data, we explore organizational factors that may influence hospitals’ decisions regarding LCT for lung cancer patients. Results Between 13% and 33.3% of the studied lung cancer population receive LCT within their last 30 days of life. Variation in LCT can in part be explained by organizational factors specific to the hospital departments and their organization of their treatment decision-making process. Conclusions This article is among the first to show how organizational solutions can contribute to curbing overtreatment. Hospital managers can seek to reduce overtreatment by (a) adjusting the format and frequency of patient consultations, (b) improving the cross-disciplinary collaboration structures, and (c) utilizing team conferences for discussions of treatment cessation.
Secondary effects of dialectical behaviour therapy on social functioning, quality of life, and autism traits in autistic adults with suicidality
Authors: Huntjens Anne , van den Bosch LMC (Wies) , Sizoo Bram , Kerkhof Ad , Smit Filip , van der Gaag Mark 
Published: December 2024

The effect of psychological treatment on social functioning, quality of life and autism traits in autistic people with suicidal behaviour remains largely unknown. At six Dutch mental health centres, 123 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders (5th edition) diagnosed autism spectrum condition and suicidal behaviours were randomly assigned to dialectical behaviour therapy ( n = 63) or treatment as usual ( n = 60) to address their suicidal behaviours. This article analysed secondary outcomes on social functioning, quality of life and autism traits. Outcomes were compared at baseline, post-treatment at 6 months, and 12-month follow-up. At post-treatment, both social functioning ( p < 0.001) and quality of life ( p = 0.002) were significantly improved in the treatment condition compared to the control condition and remained so at 12-month follow-up ( p = 0.003; p = 0.002). Autism traits did not differ between conditions. Autistic individuals with suicidal behaviours benefit modestly from treatment with dialectical behaviour therapy in social functioning and quality of life. Lay abstract Dialectical behaviour therapy is a comprehensive treatment that helps individuals improve distress tolerance, mindfulness, interpersonal effectiveness and emotion regulation. It is commonly used to assist those experiencing self-harm and suicidal thoughts or behaviours. Despite its broad application, our understanding of how dialectical behaviour therapy impacts autistic individuals with suicidal behaviour remains limited. This study compared dialectical behaviour therapy with treatment as usual in 123 autistic adults experiencing suicidal behaviours. Participants were recruited from six mental health centres, with 63 receiving dialectical behaviour therapy and 60 receiving treatment as usual. The study assessed outcomes such as social functioning, quality of life and specific autism traits over 12 months. Findings revealed that dialectical behaviour therapy led to significant improvements in social functioning and quality of life compared to treatment as usual, though there were no effects on autism traits. These improvements suggest that dialectical behaviour therapy holds promise as an effective treatment for autistic individuals grappling with suicidal behaviour. The findings strongly support the broader implementation of dialectical behaviour therapy in mental health centres, especially given the limited treatment options available for autistic individuals with suicidal tendencies.
Effects of expansion devices and dampers on additional forces in a suspension bridge
Authors: Yu Xiangdong , Zhang Zhenkun , Jing Haiquan 
Published: December 2024

Suspension bridges are flexible cable structure systems with substantial geometric nonlinearity, and their mechanical characteristics are quite different from those of other types of bridges. The bridge-track interaction of long-span suspension railway bridges is considerably more complicated than that of other types of bridges. In previous studies, the expansion devices and dampers were always ignored to simplify the track-bridge system when calculating the additional forces in long-span bridges, reducing the accuracy of the calculation results. In the present study, the effects of expansion devices and dampers on the additional forces of continuously welded rails (CWRs) are investigated on the basis of the Wufengshan Yangtze River Bridge, the longest high-speed railway suspension bridge in the world, with a main span of 1092 m. The bridge-track spatial model of the bridge, including the rail expansion joints (REJs), is built using the principle of the double-layer spring model. The resistance of the ballast and fasteners is simulated by bilinear models. The effects of the expansion resistance of the REJ and damper equivalent stiffness on the additional forces on the rails are investigated through bridge-track interaction analyses. The results show that the expansion resistance of the REJ has little effect on the additional force on the rails but substantially affects the horizontal force and displacement of the fixed piers. Under braking conditions, the damper equivalent stiffness substantially affects the additional force on the rails. The bridge tower bears a larger horizontal force as the damper equivalent stiffness increases.
Resources and strategies young people use and need to promote mental health – a qualitative study from a salutogenic perspective
Authors: Lundström Sofie , Gunnarsdottir Hrafnhildur , Tengelin Ellinor 
Published: December 2024

Aim: The aim of this study was to explore young people’s experiences of resources and strategies for promoting their mental health. Methods: Individual interviews with 33 people aged 16–25 years were conducted using a method inspired by cognitive interviewing, which combines think aloud techniques with probing questions. The interviews were based on the young people’s reflections of the questions in the Swedish national public health survey. Data were analysed with reflexive thematic analysis. Results: The resources and strategies that the young people in this study described as important for promoting mental well-being are related to societal prerequisites needed to navigate life; to their immediate surroundings, including social interactions; and to the young people themselves. These resources and strategies are presented under the following three themes: prerequisites for navigating life, social interactions on one’s own terms, and who I am and what I can do. Conclusions: Young people have a variety of resources and strategies of their own available for promoting mental well-being. However, they cannot promote mental health just on their own; access to social networks and the opportunity to share thoughts and feelings are central. Further, to promote mental health, young people need good social conditions, knowledge, and support from adults so that the existence they struggle to navigate feels comprehensible, manageable and meaningful.
Coronary-subclavian steal syndrome: A case series and review of the literature
Authors: Gonzalez-Urquijo Mauricio , Valdes Francisco , Bulnes Juan Francisco , Torres-Alvarez Josemaria , Vargas Jose Francisco , Bergoeing Michel , Mertens Renato , Marine Leopoldo 
Published: December 2024

Objective To report a case series of three patients with symptomatic coronary-subclavian steal syndrome (CSSS) and to review the literature on published case series. Methods We retrospectively reviewed three cases of CSSS patients treated with open and endovascular surgery at a single center over a period of three decades (1996–2024). A comprehensive review of case series involving more than three patients was also performed. Results The first patient was a 65-year-old male with a 12-year history of coronary artery bypass grafting (CABG), presenting with unstable angina. Coronary angiography revealed a patent left internal mammary artery (LIMA) graft with retrograde flow through the left subclavian artery (LSA) and occlusion at the LSA ostium. He underwent a successful carotid-subclavian bypass, which significantly improved his symptoms. He died 6 years later from heart failure. The second patient was a 73-year-old woman with a 15-year history of CABG and balloon angioplasty of the grafts. She presented with dyspnea, stable angina, and progressive functional decline. Critical stenosis in the LSA was identified, and her symptoms resolved after successful stent placement. She died 6 years later from progressive heart failure. The third patient was a 75-year-old woman with diabetes, hypertension, and heart failure, who also had a history of CABG. She presented with worsening dyspnea, orthopnea, and edema. Imaging revealed occlusion of the circumflex artery graft and severe LSA stenosis. Successful stenting of the LSA alleviated her symptoms and restored normal blood flow from the LIMA graft. She was discharged after 2 days and remains well at the six-month follow-up. Conclusion CSSS should be considered in the differential diagnosis of patients with a history of CABG who present with angina or heart failure. Prompt treatment can lead to significant symptom improvement.
The validity and reliability of the Indonesian version of the Diabetes Mellitus Self-Efficacy Scale (DMSES-I)
Authors: Marlina Theresia Titin , Haryani  , Widyawati  
Published: December 2024

Background: The incidence of diabetes mellitus (DM) and its complications is increasing in Indonesia. The patient’s quality of life will decrease due to this condition. Diabetes self-management is a viable tactic for improving quality of life and reducing blood sugar levels. A key element of diabetes self-management education for nurses and health professionals is self-efficacy. However, a valid and reliable scale to assess self-efficacy in Indonesia is necessary. Aims: ‘The Diabetes Mellitus Self-Efficacy Scale (DMSES)’ is translated into Indonesian for the psychometric assessment of diabetes patients there. Method: DMSES was translated into the Indonesian version (DMSES-I) using the forward-backward translation method. In addition, 227 adult patients with type 2 diabetes completed the scale which underwent internal consistency, construct validity and content validity tests. Results: The item content validity and scale validity were 0.955 and 0.955, respectively. Exploratory factor analysis showed a Kaiser–Meyer–Olkin index of 0.922 and a Cronbach’s alpha coefficient of 0.928. The confirmatory factor analysis results were chi-square = 76.610, probability = 0.009 and root mean square error of approximation (RMSEA) = 0.049. Conclusion: To assess diabetes self-efficacy in Indonesia, the DMSES-I is a valid and reliable tool. To educate diabetes self-management effectively, nurses must assess their patients’ diabetes self-efficacy.
Impact of improving educational nursing interventions in perioperative nursing interventions on outcomes of prostate cancer patients with laparoscopic radical prostatectomy
Authors: Zhu Yuhong , Yang Gaojie , Wu Lifeng , Yin Yan , Ding Yangyang 
Published: December 2024

Background: Recent studies have reported that perioperative nursing intervention (PNI) plays important roles in the outcomes of prostate cancer (PC) patients undergoing laparoscopic radical prostatectomy (LRP). This study aimed to further investigate the role of educational nursing intervention in PNI on the recovery of PC patients with LRP. Methods: A total of 98 PC patients who underwent LRP were enrolled in this study. These patients were randomly divided into control ( n = 49) and experimental ( n = 49). Both groups received routine PNI, while the experimental group also received personalised PNI with enhanced educational nursing interventions. The study compared blood loss during surgery, surgery success rate, clinical signs of intestinal motility, postoperative hospital stay and postoperative complications between these two groups. Results: Both the control and experimental groups achieved a 100% surgery success rate. The experimental group experienced significantly less blood loss. Moreover, the recovery of intestinal function was faster, and the postoperative hospital stay was shorter in the experimental group. Furthermore, the incidence of postoperative complications was lower in the experimental group. Conclusion: Our findings confirmed the importance of enhanced educational nursing interventions in personalised perioperative nursing care for PC patients undergoing LRP.
Graphic Paper: Promoting generalisation in qualitative nursing research using the multiple case narrative approach: a methodological overview
Authors: Brenchley Alex 
Published: December 2024

This year JRN has introduced an extra Veronica Bishop Paper of the Year award category focusing on innovative study design and the paper’s potential to influence research and learning. As usual, award winners’ papers are re-presented as a graphic depiction. We hope you enjoy this graphic paper and re-reading the original work. We have inserted the original paper’s abstract below with links to that paper and its associated commentary. Background: The ability to generalise research generated findings to different contexts is a significant, yet overlooked, feature in qualitative studies conducted in nursing, where evidence-based clinical practice is highly regarded. The multiple case narrative is a constructivist-narrative approach, claimed to not only have the potential for analytical and case-to-case generalisation but also sample-to-population generalisation. Methods: This paper provides an overview of multiple case narrative by comparing it with similar methodologies, reviewing studies that have used this approach and critically evaluating its capacity for producing generalisable results. Results: The multiple case narrative approach addresses limitations of collective case study, case survey and meta-ethnography by employing greater sample sizes and more generalisable results. Most studies previously using this approach have been performed in the education field and with the purpose of overcoming sample size limitations in qualitative research. The approach offers a uniquely systematic approach to analysis by finding associations between categories generated from collective analysis of large number of cases and providing the potential for sample to population generalisation. Conclusion: Multiple case narrative, which to date has been underutilised, is a systematic approach with characteristics that make it an efficient research technique to provide valid qualitative evidence.
Factores sociodemográficos-sanitarios sobre la decisión de interrupción del embarazo, Chile: un análisis de clases latentes
Authors: Angélica Saldías Fernández María , González-Santa Cruz Andrés , Martínez Órdenes Macarena , Parra-Giordano Denisse 
Published: December 2024

Objetivo: identificar las características sociodemográficas y/o sociosanitarias comunes de quienes solicitaron prestaciones para la interrupción voluntaria del embarazo (IVE) en Chile mediante un análisis de clases latentes, con el fin de examinar la relación entre estos patrones y la decisión de interrumpir el embarazo. Métodos: análisis de clases latentes a partir de una cohorte retrospectiva basada en registros anonimizados a nivel nacional. Gestantes que solicitaron las prestaciones contempladas en la Ley 21.030 de la red sanitaria pública en Chile, entre los años 2018 y 2022 ( N = 3789). Resultados: modelo de cinco clases latentes: C1 “Extranjeras con alta vulnerabilidad que ingresan por violación” (4.3 %), C2 “Chilenas con baja vulnerabilidad” (11.8 %), C3 “Extranjeras con alta vulnerabilidad que ingresan por inviabilidad fetal o riesgo de vida para la persona gestante” (13.3 %), C4 “Chilenas con vulnerabilidad media” (55.6 %) y C5 “Chilenas con alta vulnerabilidad” (15.1 %). Las gestantes pertenecientes a las C3 (OR = 0.91, IC 95 % [0.88, 0.95]) y C4 (OR = 0.87, IC 95 % [0.84, 0.90]) tienen menores probabilidades de interrupción en comparación con las que pertenecen a la C2. Las gestantes C3 (0.94 [IC 95 % = 0.88, 0.99]) son quienes presentan mayores probabilidades de solicitar IVE, seguidas por C2 (0.93 [IC 95 % = 0.90, 0.97]) y C5 (0.92 [IC 95 % = 0.89, 0.95]). Conclusiones: los perfiles sociodemográficos de las personas solicitantes de la IVE revisten de complejidad y presentan características heterogéneas. En Chile, los patrones distintivos identificados en las personas gestantes que solicitaron la IVE durante el periodo de estudio apuntan a vulnerabilidades sociales que pueden limitar los derechos sexuales y reproductivos de las personas gestantes. Las políticas públicas debieran poner foco en personas migrantes que solicitan prestaciones IVE.
Diagnostic performance of the Cobas MTB and Logix Smart MTB for diagnosing pulmonary and extrapulmonary tuberculosis: a cross-sectional study of diagnostic tests
Authors: Hueda-Zavaleta Miguel , Gomez de la Torre Juan Carlos , Minchón-Vizconde Diana , Barletta-Carrillo Claudia , Copaja-Corzo Cesar , Tapia-Sequeiros Gustavo , Flores Cinthya , Piscoche Cristian , Miranda Cecilia , Mendoza Ada , Benites-Zapata Vicente A. 
Published: December 2024

Background: Molecular tests have contributed to reducing the mortality rate through early and accurate diagnosis of tuberculosis (TB). This is due to their low processing complexity and diagnostic accuracy superior to conventional methods. Objective: To evaluate the diagnostic performance of Cobas MTB and Logix Smart MTB compared to Xpert MTB/RIF Ultra for pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). Design: A cross-sectional study of diagnostic tests was carried out in a clinical laboratory in Lima, Peru. Methods: All pulmonary and extrapulmonary samples from patients with presumptive TB who had been subjected to smear microscopy, Xpert MTB/RIF Ultra, Cobas MTB, Logix Smart MTB, and mycobacteria culture were included to determine their diagnostic performance. Results: A total of 175 samples were included, 102 (58.3%) of pulmonary origin and 73 (41.7%) of extrapulmonary origin. Among the total samples, 19 (10.9%) had positive cultures (all were pulmonary samples), 48 (27.4%) had positive Xpert MTB/RIF Ultra results, 45 (25.7%) had positive Cobas MTB results, and 36 (20.6%) had positive Logix Smart MTB results. The agreement between Cobas MTB and Logix Smart with the Xpert MTB/RIF Ultra was 97.1% and 93.8%, respectively. Compared to Xpert MTB/RIF Ultra, the area under the curve/receiver operating characteristic and sensitivity of the Cobas MTB and Logix Smart methods were 0.95 and 91.7%, and 0.90 and 81.0%, respectively. Conclusion: Cobas MTB and Logix Smart presented adequate performance for diagnosing pulmonary and extrapulmonary tuberculosis comparable to the Xpert MTB/RIF Ultra.