bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a Workplace Weight-Loss Program for Overweight and Obese Healthcare Workers
Authors: Nepper Martha J. , McAtee Jennifer R. , Chai Weiwen 
Published: September 2020

Purpose: Examining the effect of a workplace weight-loss program on weight loss, and physical, behavioral and mental well-being among overweight/obese healthcare workers. Design: Quasi experimental design Setting: Single healthcare setting Participants: Forty-one (48.0 ± 11.2 years) day-time shift healthcare employees with body mass index [BMI] >29 kg/m2. Intervention: Sixteen-week program with weekly group meetings/activities and individual appointments with nutrition/health experts. Measures: Objective (weight, BMI, blood pressure) and self-reported measures were collected at baseline, conclusion of the intervention and 3 to 6 months post-intervention. Analysis: Repeated measure analysis accounting for confounders. Results: Participants had an average of 13 pounds (5.6%) weight loss (224.2 ± 6.4 vs. 211.6 ± 6.4 lbs.; P < 0.0001) upon program completion with significant decreases in BMI (37.7 ± 1.0 vs. 35.1 ± 1.0 kg/m2; P < 0.0001). Extreme obesity (BMI≥40 kg/m2) rate was reduced from 36.6% to 17.1% ( P < 0.0001). There were decreases in diastolic blood pressure (76.0 ± 1.4 vs. 68.7 ± 1.5 mmHg; P = 0.001) and self-reported blood glucose (119.9 ± 4.4 vs. 105.5 ± 4.6 mg/dL; P = 0.03). Participants had improvements in weekly physical activity (25% change; P = 0.01), nutrition behavior (33% change, P < 0.0001), sleep quality (23% change, P = 0.005), and depression (72% change, P < 0.0001). Twenty-seven participants had post-intervention follow-up data. On average participants regained 8 pounds, which was less than the initial weight loss (16 lbs., N = 27). Conclusion: The results suggest the program may benefit healthcare employees. Further emphasis should be placed on post-intervention weight management to prevent weight regain.
Strategies for Designing Clergy and Spouse Obesity-Related Programs
Authors: Harmon Brook E. , Strayhorn Shaila M. , West Nathan T. , Schmidt Michael , Webb Benjamin L. , Grant Lindsey , Smith Stacy 
Published: September 2020

Purpose: Clergy have influence on the health of congregations and communities yet struggle with health behaviors. Interventions tailored to their occupation-specific demands and unique needs may provide a solution. Qualitative methods were used to identify opportunities and resources for the development of an effective obesity-related program for clergy. Approach: Ninety-minute focus groups were held with clergy (3 groups) and spouses (3 separate groups). Discussion explored: Program target(s); Opportunities and barriers that influence diet, physical activity, and stress-reduction practices; Empowering and culturally relevant health promotion strategies. Setting: All study activities took place in Memphis, TN. Participants: Eighteen clergy and fourteen spouses participated. All clergy were male, all spouses were female. Method: Previous research with clergy informed the interview guide and the PEN-3 framework aided in organizing the coding of clergy and spouse focus groups. Focus groups were audio recorded and transcripts analyzed using NVivo® 12. Results: Themes included: 1) Intervention targets—clergy, spouses, congregations; 2) Opportunities and barriers—making time, establishing boundaries, church traditions, individuals who support and hinder behavior change; 3) Intervention strategies—tools for healthy eating, goal setting, camaraderie, combining face-to-face with eHealth modalities. Conclusion: The relationship between clergy, spouse, and congregation make it important for obesity-related programs to target the unique needs of both clergy and spouses. Strategies should focus on healthy eating and personal connections no matter the modality used.
Factors affecting nursing error communication in intensive care units: A qualitative study
Authors: Ghezeljeh Tahereh Najafi , Farahani Mansoureh Ashghali , Ladani Fatemeh Kafami 
Published: September 2020

Background: Error communication includes both reporting errors to superiors and disclosing their consequences to patients and their families. It significantly contributes to error prevention and safety improvement. Yet, some errors in intensive care units are not communicated. Objectives: The aim of the present study was to explore factors affecting error communication in intensive care units. Design and participants: This qualitative study was conducted in 2019. Participants were 17 critical care nurses purposively recruited from the intensive care units of 2 public hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional content analysis method proposed by Graneheim and Lundman. Ethical considerations: The Ethics Committee of Iran University of Medical Sciences, Tehran, Iran approved the study (code: IR.IUMS. REC.1397.792). Participants were informed about the study aim and methods and were ensured of data confidentiality. They were free to withdraw from the study at will. Written informed consent was obtained from all of them. Findings: Factors affecting error communication in intensive care units fell into four main categories, namely the culture of error communication (subcategories were error communication organizational atmosphere, clarity of processes and guidelines, managerial support for nurses, and learning organization), the consequences of errors for nurses and nursing (subcategories were fear over being stigmatized as incompetent, fear over punishment, and fear over negative judgments about nursing), the consequences of errors for patients (subcategories were monitoring the effects of errors on patients and predicting the effects of errors on patients), and ethical and professional characteristics (subcategories were ethical characteristics and inter-professional relationships). Discussion: The results of this study show many factors affect error communication, some facilitate and some prohibit it. Organizational factors such as the culture of error communication and the consequences of error communication for the nurse and the patient, as well as individual and professional characteristics, including ethical characteristics and interprofessional relationship, influence this process. Conclusion: Errors confront nurses with ethical challenges and make them assess error consequences and then, communicate or hide them based on the results of their assessments. Health authorities can promote nurses’ error communication through creating a supportive environment for them, developing clear error communication processes and guidelines, and providing them with education about the principles of ethical practice.
Intrapersonal Factors Impact Advance Care Planning Among Cancer Patients
Authors: Kelly Elizabeth Palmer , Henderson Brent , Hyer Madison , Pawlik Timothy M. 
Published: September 2020

Background: Cancer patients infrequently engage in advance care planning processes. Establishing preferences for future medical treatment without advance care planning may not be patient-centered, as it fails to consider important factors that influence these important decisions. Objective: The purpose of this study was to assess the influence of patient intrapersonal factors including race, religion, level of depression, and cancer stage on overall preferences for future medical treatment, including the presence of a (DNR), power of attorney, and advance directive. Design: A retrospective chart review design was used. Patients were included who were diagnosed with cancer at The Ohio State University James Comprehensive Cancer Center from 01/2015 to 08/2019. Results: A total of 3,463 patients were included. Median age was 59 years (IQR: 49, 67) and the majority of the patients was female (88.7%). Compared with no religious preference, patients who identified as religious had 61% higher odds (95%CI: 1.08-2.40) of having a DNR and approximately 30% higher odds of having a power of attorney (95%CI: 1.08-1.62) or advance directive (95%CI: 1.02-1.64). Patients with clinically relevant depression had more than twice the odds of having a DNR versus patients with no/lower levels of clinical depression (OR: 2.08; 95%CI: 1.40-3.10). White patients had higher odds of having a power of attorney (OR: 1.57; 95%CI: 1.16-2.13) and an advance directive (OR: 3.10; 95% CI: 1.95-4.93) than African-American/Black patients. Conclusions: Understanding the factors that affect preferences for future medical treatment is necessary for medical professionals to provide proper care and support to patients diagnosed with cancer and their families.
Load to Failure and Stiffness of Interference Screw vs Pulvertaft Weave for Distal Fixation in Peroneal Allograft Reconstruction
Authors: Abousayed Mostafa M. , Coleman Michelle M. , Abbasi Pooyan , Bean Bryan A. , Thompson John M. , Guyton Gregory P. 
Published: September 2020

Background: Allograft reconstruction of the peroneal tendons is an option for treatment of major tears of 1 or both peroneal tendons. No consensus on a superior distal fixation method has been reported. The purpose of the study was to compare load to failure and stiffness of a Pulvertaft weave (PTW) through a residual tendon stump to direct-to-bone interference screw (IS) fixation. Methods: Fifteen pairs of long leg cadaver specimens were used. All grafts were secured proximally to the peroneus brevis myotendinous junction via a PTW technique. Distally, the tendons were either sutured to the peroneus brevis stump via PTW or secured to the base of the fifth metatarsal via IS. Stiffness (slope of force/displacement) was measured for the intact tendon and after reconstruction, and finally each specimen was loaded to failure. Results: Mean load to failure was significantly higher in the PTW group compared with the IS group (373.6 ± 265.5 N vs 150.1 ± 93.1 N; P = .01). The PTW and IS groups had significantly lower stiffness compared with the intact specimens ( P < .001). There was no statistical significance in stiffness between the 2 techniques ( P = .96). Conclusion: The PTW technique yielded higher load to failure in comparison to IS. There was no difference in overall construct stiffness between both techniques. Both constructs demonstrated 19% decrease in stiffness compared to the intact state. Clinical Relevance: The PTW and IS constructs were biomechanically similar, and these results suggest that both should be moderately overtensioned to compensate for an inherent decreased initial stiffness.
Leveraging advanced preparation of oncology medications: Decreasing turnaround-times in an outpatient infusion center
Authors: Blackmer James , Amoline Kevin , Amancher Jacqueline , Vogan Eric , Zimmer Heather , Borton Meave , Earl Marc , Boyd Anthony 
Published: September 2020

Introduction Many oncology infusions are provided in hospital-based infusion centers. With hospital-based infusion centers seeing increased volumes, patient wait times continue to be a priority. Extended wait times for oncology infusions have been shown to lead to patient dissatisfaction. Methods Advanced Preparation of oncology infusion medications allows pharmacy to verify and prepare specific medications the day before a patient’s infusion appointment. Our study targeted lower cost, commonly used medications to prepare in advance. Data analyzed included turnaround time (TAT), medication waste, and oncology infusion preparation volumes. Implementation took place in two phases to allow time for the healthcare team to adjust to the new workflow. Phase I medications include a small amount of medications prepared manually by pharmacy technicians. Phase II medications included all phase I medications plus additional medications that were compounded in the intravenous (IV) robotic compounding system. Results Our study demonstrated significant decrease in median TAT for medications prepared in advance. 537 infusions were prepared using the Advanced Preparation module with a median TAT of 24.2 minutes (IQR, 18.0–34.0). The pre-implementation median TAT was 45.0 minutes (IQR, 36.0–56.0), which represents a decrease of 20.8 minutes (46.2%) following implementation of the program, (p<0.001). There were a total of 149 advanced preparation doses that were wasted (21.7% of doses). Conclusion We have seen a statistically significant reduction in TAT for Advanced Preparation medications. Low volume of Advanced Preparation medications compared to total infusion volume limited impact on overall TAT.
Fetal Vascular Malperfusion Due To Long and Hypercoiled Umbilical Cords Resulting in Recurrent Second Trimester Pregnancy Loss: A Case Series and Literature Review
Authors: Slack Jonathan C , Boyd Theonia K 
Published: September 2020

Background Intrauterine fetal demise due to fetal vascular malperfusion in mid-gestation is a rare occurrence. Abnormally long and hypercoiled umbilical cords are associated with an increased risk of umbilical cord blood flow restriction, which in turn can result in adverse perinatal and maternal outcomes. The factors that regulate umbilical cord development, specifically umbilical cord length and coiling, are poorly understood. Methods Maternal history, along with fetal and placental findings (post-mortem, pathological, and molecular), were reviewed for a series of 3 consecutive pregnancies that ended in second trimester intrauterine fetal demise. Results All 3 umbilical cords were exceptionally long and hypercoiled, and all placentas showed evidence of high-grade fetal vascular malperfusion. At fetopsy, all 3 fetuses were developmentally normal for gestational age and lacked congenital anomalies. Maternal medical history and antenatal testing (including an extensive work-up for maternal hypercoagulability syndromes) were normal and/or noncontributory. Conclusion Although excessively long and hypercoiled cords are generally thought of as sporadic, nongenetic events, rare examples of recurrent intrauterine fetal demise secondary to such exist have been reported. This intrafamilial clustering of a rare event is suggestive that at least a subset of hypercoiled, long umbilical cords may have an underlying genetic etiology.
Feasibility of a 3 mm arteriotomy for brachiocephalic fistula formation
Authors: Crane Jeremy , Salim Safa , Storey Rowland 
Published: September 2020

Background: The arteriovenous fistula is the modality of choice for long-term haemodialysis access. We describe the feasibility of routinely fashioning a brachiocephalic fistula utilising a 3 mm long arteriotomy in an attempt to reduce the incidence of symptomatic steal syndrome yet while maintaining satisfactory clinical outcomes. Methods: All patients who underwent brachiocephalic fistula formation using a routine 3 mm long arteriotomy within Hammersmith Hospital between January 2017 and March 2018 were included. Primary outcomes included primary failure, failure of maturation, secondary patency and steal syndrome. Results: Sixty-eight brachiocephalic arteriovenous fistula were fashioned utilising a 3 mm long arteriotomy during the study period. Mean age was 60.5 years with 59% having a history of diabetes mellitus. Mean followup was 368 days. Primary failure occurred in 10 (14.7%) patients. Cannulation was achieved in 67.3% of remaining fistula within 3-months, rising to 87.3% by 6-months. Primary patency at 6 and 12 months was 76% and 69%, respectively. Secondary patency at 6 and 12 months was 94% and 91%, respectively. Dialysis access steal syndrome was clinically apparent in three (4.4%) patients with all cases being managed conservatively. Conclusion: A 3 mm long arteriotomy may be routinely utilised for brachiocephalic fistula creation in an attempt to limit the incidence of steal syndrome yet while maintaining clinical patency outcomes.
Determinants of Hand Hygiene Practice at Critical Times among Food Handlers in Educational Institutions of the Sagnarigu Municipality of Ghana: A Cross-Sectional Study
Authors: Amegah Kingsley E , Addo Henry O , Ashinyo Mary E , Fiagbe Loveland , Akpanya Serene , Akoriyea Samuel K , Dubik S Dajan 
Published: September 2020

Introduction: Food handlers’ hands serve as a vehicle for potential foodborne pathogenic contamination which constitutes a public health risk. In Ghana, there are always constant reports of outbreaks of foodborne diseases in schools. However, determinants of hand hygiene practice among educational institutions food handlers are little known. The study, therefore, aimed to assess the determinants of hand hygiene practice at critical times among educational institutions’ food handlers in the Sagnarigu Municipality of Ghana. Methods: This was a cross-sectional survey among educational institutions food handlers in the Sagnarigu Municipality. Two hundred and six food handlers were selected through convenience sampling in the educational institutions. At the same time, structured questions that were developed from previous studies were used to assess food handlers’ hand hygiene practice at critical times. Data were analyzed using descriptive statistics, bivariate and multivariate logistic regression models. All variables with their respective confidence intervals (95%) and adjusted odds ratios were declared significant at P-values less than .05. Results: Hand hygiene practice at critical times among the food handlers were relatively good at a rating of 66.0% (95% CI: 59.1, 72.5%). Good hand hygiene practice at critical times was less likely among food handlers with no food safety training (AOR 0.04; 95% CI: 0.00, 0.41) and food handlers who had insufficient knowledge of hand hygiene (AOR 0.06; 95% CI 0.01, 0.25). Good hygiene practice at critical times was 99% lower in food handlers with a negative attitude as compared to food handlers with positive attitudes towards hand hygiene at critical times (AOR 0.01; 95% CI 0.00, 0.07). Only 17.0% of the food handlers demonstrated proper handwashing techniques, whereas a good number (85.4%) of the food handlers did not wash their hands after touching money. Conclusion: Good hand hygiene practice at critical times was relatively good. Food safety training, knowledge of hand hygiene and attitudes towards hand hygiene were independent predictors of hand hygiene practice at critical times. Concerned stakeholders and organizations should focus on WASH interventions that seek to improve educational institutions food handlers’ knowledge and attitudes towards hand hygiene, coupled with training on food safety.
Integration of mental health counselling into chronic disease services at the primary health care level: Formative research on dedicated versus designated strategies in the Western Cape, South Africa
Authors: Sorsdahl Katherine , Naledi Tracey , Lund Crick , Levitt Naomi S , Joska John A , Stein Dan J , Myers Bronwyn 
Published: September 2020

Objective To explore health care providers’ views on the acceptability and feasibility of two models for integrating facility-based counsellor delivered mental health counselling into chronic disease care, and how such an approach could be improved in South Africa. Methods Fourteen focus group discussions and 25 in-depth individual interviews were conducted with 109 health care workers and facility managers from 24 primary health clinics in the Western Cape, South Africa. Results Findings suggested that despite recent efforts to integrate mental health counselling into chronic disease services for common mental disorders, there remains limited availability of psychosocial and psychological counselling. Feedback on the two models of integration suggested equipoise and the potential of a hybrid approach where these approaches may be tailored to the specific needs and available resources of each facility. Participants identified constraints within the health system and broader social context that require consideration for integrating mental health counselling into chronic disease care. Conclusion Although study participants unanimously agreed that counselling for common mental disorders should be integrated into chronic disease services, they had differing views on the type of model that should be adopted. There is a need for further testing of the two models and aspects of the health service that may require strengthening to implement any such model.
Pairwise estimation of multivariate longitudinal outcomes in a Bayesian setting with extensions to the joint model
Authors: Mauff Katya , Erler Nicole S , Kardys Isabella , Rizopoulos Dimitris 
Published: September 2020

Multiple longitudinal outcomes are theoretically easily modelled via extension of the generalized linear mixed effects model. However, due to computational limitations in high dimensions, in practice these models are applied only in situations with relatively few outcomes. We adapt the solution proposed by Fieuws and Verbeke (2006) to the Bayesian setting: fitting all pairwise bivariate models instead of a single multivariate model, and combining the Markov Chain Monte Carlo (MCMC) realizations obtained for each pairwise bivariate model for the relevant parameters. We explore importance sampling as a method to more closely approximate the correct multivariate posterior distribution. Simulation studies show satisfactory results in terms of bias, RMSE and coverage of the 95% credible intervals for multiple longitudinal outcomes, even in scenarios with more limited information and non-continuous outcomes, although the use of importance sampling is not successful. We further examine the incorporation of a time-to-event outcome, proposing the use of Bayesian pairwise estimation of a multivariate GLMM in an adaptation of the corrected two-stage estimation procedure for the joint model for multiple longitudinal outcomes and a time-to-event outcome ( Mauff et al., 2020 , Statistics and Computing). The method does not work as well in the case of the corrected two-stage joint model; however, the results are promising and should be explored further.
How do community pharmacies in Ontario manage drug shortage problems? Results of an exploratory qualitative study
Authors: Panic Gea , Yao Xuan , Gregory Paul , Austin Zubin 
Published: September 2020

Background: Pharmacists report spending a considerable amount of time dealing with drug shortages. There is no research in Canada identifying and describing the strategies and resources that pharmacists use to minimize disruption and continuity of care for patients. Methods: An exploratory qualitative methodology was used. Community pharmacists and technicians in Ontario were interviewed using a semi-structured protocol. Verbatim transcripts were generated and coded by at least 2 independent reviewers using content analysis methods to identify management strategies. Results and Discussion: A total of 14 pharmacists and 7 regulated pharmacy technicians participated in this study. The following 5 main strategies for managing drug shortages were identified: (1) using the supplier, (2) generic options, (3) brand options, (4) contacting other pharmacies and (5) switching to a different medication. Conclusion: The strategies identified through this research can provide pharmacists with some guidance in approaching the real-world problem of drug shortages. It also highlights opportunities for organizations, government and manufacturers to provide additional support for pharmacists to minimize disruptions for patients and to ensure current ad hoc practices do not further compound shortage issues. Can Pharm J (Ott) 2020;153:xx-xx.