bluuebunny/crossref_metadata_2025_split huggingface dataset:
Public and private hospitals – different opportunities for nurses (Bulgaria, Pleven, 2016-2018)
Authors: Grancharova G , Dulgerova S t , Aleksandrova-Yankulovska S 
Published: October 2020

Abstract

Background
The freedom of private initiative is one of the basic principles of Bulgarian health reform. Since 2000 to 2018 the private hospitals increased over 6 times and hospital beds - over 40 times. The total number of nurses decreased by 3%. Nurses/physicians ratio dropped to 1.03:1. Private hospitals with better facilities and higher payment attract great proportion of nursing graduates. Public hospitals cannot compete and often fall in financial crisis and lack of human resources. We aimed to analyse the opportunities, motivating and demotivating factors for nurses in public and private hospital settings for lifelong learning (LLL).

Methods
The study included a sample of 573 nurses (448 in public and 125 in private hospitals). By anonymous self-administered questionnaire we collected and compared information about opportunities, motivation and obstacles for LLL in different hospital settings using parametric and non-parametric tests (t-test, chi-square) and correlation coefficients (Phi, Kramer, contingency coefficient). The accepted level of statistical significance was p &lt; 0.05. Data processing was performed by IBM SPSS v.24.

Results
Great discrepancy was found in age distribution: in private hospitals 52,8% were below 40 years while in public hospitals 69,2% - over 40 years (p &lt; 0.001). Significant differences were observed in motivation for LLL: in public hospitals 46.4% ranked “better payment” compared to 36.8% in private hospitals; “career development” took 31.2% in private hospitals and 24.1% in public hospitals (p &lt; 0.05). Financial problems were the biggest obstacle in public hospitals (49,8%) and substantially lower (33.6%) in private hospitals (p &lt; 0.01). Prevailing form of LLL in public hospitals was on-site training.

Conclusions
Our results underlined the significant differences in nursing profile, opportunities and motivation for LLL in public and private hospitals. Public hospitals do not provide equal prerequisites for nurses' professional development.

Key messages
Lifelong learning is irreversible prerequisite for provision of high quality and safety health care. Nurses in public and private hospitals should have equal opportunities to participate in LLL. Public hospitals need substantial investments to provide better opportunities and to attract younger nursing generations able to respond to increasing requirements for high quality health care.
Empty shelves: selected essential medicines stockouts in South Africa
Authors: Wolvaardt L , Nemuntandani R , Kamungoma-Dada I 
Published: October 2020

Abstract

Background
Access to essential medicines in South Africa has been compromised by stockouts in health facilities. This study describes the occurrence of stockouts for a selection of essential medicines.

Methods
This cross-sectional study used secondary data retrieved from the Stop Stock Outs Project (SSP). A descriptive analysis was conducted on data from the 2013-2015 SSP case management database of routinely reported stockouts. Chi square tests of independence was conducted on data from the SSP 2015 annual telephonic survey to investigate associations between the occurrence of stockouts, the level of health facility and the type of health professional.

Results
231 facilities reported 609 stockouts. Antiretroviral medication had the most stockout reports (78%; n = 475/609), followed by anti-infectives (17.1%; n = 104/609) and tuberculosis medication (4.9%; n = 30/609). The highest number of stockout reports were received from Gauteng province and the majority (71.09%; n = 150/211) of facilities reporting stockouts were in urban areas. There were more stockouts at ambulatory, rather than inpatient care, facilities however, this was not statistically significant.

Conclusions
This study confirms that South Africa experiences medicine stockouts for many of the essential medicines, with antiretroviral medication being the category most affected. The stockouts vary between provinces and the urban-rural divide but are an equal threat to both ambulatory and inpatient facilities.

Key messages
The pattern of stockouts experienced over a three-year period suggest that stockouts are ‘normal’ despite the substantive effects of treatment interruption – especially patients with HIV and/or TB. Antiretroviral therapy is at risk as a result of stockouts.
The effect of the employment of consultants in the Emergency Department on quality of care and equity
Authors: Lindstroem M B , Andersen O , Kallemose T , Rasmussen L J H , Rosthoej S , Jervelund S S 
Published: October 2020

Abstract

Background
Hospitals struggle with increasing acute admissions and crowding in Emergency Departments (EDs) negatively affect length of hospitalisation, in-hospital mortality, patient safety and flow. In response to this, the Danish Health Authorities have recommended the presence of consultants in the ED to expedite the clinical decision-making process. In 2016, consultant-led triage and continuous presence of consultants was introduced at the ED at Hvidovre Hospital, Denmark. However, little is known on the effect of consultants in the ED, and how it affects care for patients of varying socioeconomic status. This study investigated whether the employment of consultants in a Danish ED affected the quality of care for acutely admitted medical patients in terms of length of admission, readmission, and mortality, and how this effect was distributed across socioeconomic status in patients.

Methods
Admission data was collected during two 7-month periods, one prior to and one after the organisational intervention, with 9,869 adult medical patients admitted for up to 48 hours in the ED. Linear regression and Cox proportional hazards regression analyses adjusted for age, sex, comorbidities, level of education and employment status were applied.

Results
Following the employment of consultants, an overall 11% increase in index-admissions was observed, and 90% of patients were discharged by a consultant with a reduced mean length of admission by 1.4 hours (95% CI: 1.0 - 1.9). No significant change was found in in-hospital mortality, readmission, or mortality within 90 days after discharge. No difference was found in quality of care across socioeconomic status.

Conclusions
Consultants in the ED was found to reduce length of admission without a negative effect on the quality of care for ED admitted medical patients in general, or for patients with lower socioeconomic status. To reduce readmission and mortality among acutely admitted patients, other means must be initiated.

Key messages
Consultants in the ED may reduce length of admission without a negative effect on the quality of care. To reduce readmission and mortality among acutely admitted patients, other means must be initiated.
Factors influencing participatory intervention implementation to improve care coordination
Authors: Mendes M F M , Cazarin G , Hemetério M M , Samico I C , Vargas I , Vázquez M L 
Published: October 2020

Abstract

Background
Problems related to care coordination are identified as challenges to the organization of health systems. In order to improve coordination, it is necessary to invest in interventions that promote collaboration between levels of care. The study analyzes factors influencing the implementation of the intervention joint meetings between levels of care, guided by participatory action research to improve clinical coordination from the perspective of actors involved in a public health care network in Brazil.

Methods
Qualitative descriptive-interpretative study carried out in the health network of a municipality in the northeast of Brazil. Ten interviews were conducted to managers and health professionals, members of local steering committee and focus group with primary care physicians and specialists participating in the intervention. Thematic content analysis was used; it generated categories from theoretical and emerging frameworks.

Results
The willingness of professionals and management support to participate of the intervention process emerge as fundamental factors. However, they are influenced by factors of the system, such as electoral period and management change and these reflected on the slowdown and instability in implementation process. In the health network, turnover of professionals and low trust between primary and specialized care were evidenced as challenges. However, the proactive role of local steering committee, driven by participatory strategy for development of the intervention, promoted reflections and decisions agreed between professionals and managers. This rebounded on adjustments to strengthen the intervention and improvements on knowledge and collaboration between levels.

Conclusions
analysis of factors contributes to reflection on changes in the context, adaptation of intervention over time and importance of the role of professionals. Such understanding becomes essential for sustainability and improvement of care coordination.

Key messages
Knowledge about factors that influence implementation of an intervention guided by participatory action research contributes to the development of strategies aimed at its sustainability. Contextual factors that hamper improvements implementation to coordination of care can be overcome through participatory strategies mobilizing health professionals and managers.
Who is responsible? Defining a hospital catchment population in the English National Health Service
Authors: Beaney T , Clarke J M , Coronini-Cronberg S 
Published: October 2020

Abstract

Background
There is a growing emphasis on National Health Service hospitals in England promoting population health. Patients can access any hospital, making it complex to define the population a hospital is responsible for. Defining this 'catchment' population is fundamental to provide a population denominator from which to evaluate service provision such as unmet need and the effect of prevention initiatives. Using Chelsea and Westminster Hospital NHS Foundation Trust (CWFT), a large hospital in London as a case study, methods to define the population that has potential to attend the hospital were compared.

Methods
Inpatient, outpatient and emergency attendances were identified using Hospital Episode Statistics from 1st April 2017-31st March 2018. Lower Layer Super Output Areas (LSOAs), consisting of 1,500 people on average, were used as the geographic unit. Catchment populations were constructed using 3 different methods. Under First-Past-The-Post (FPTP), LSOAs were allocated if a greater proportion of patients attended CWFT than any other hospital trust. Under 30% Proportional Flow (30PF), LSOAs were allocated if more than 30% of patients attended CWFT, while under Stratified Proportional Allocation (SPA), patients were assigned in accordance with the proportion from each LSOA that attended CWFT, by gender and 5-year age strata.

Results
Under FPTP, 30PF and SPA, a total of 303, 326 and 10,636 LSOAs were assigned to CWFT, respectively, with corresponding populations of 530,980, 569,682, and 484,249 and median ages of 36, 36 and 29 years. Under FPTP, the catchment area did not overlap with that of any other hospital, while under 30PF, 13.2% of the LSOAs were also allocated to another hospital catchment. Maps were constructed for FPTP and 30PF.

Conclusions
The 3 methods produced different catchment populations, with differing characteristics. Understanding the relative merits of each method has implications for hospitals in how they engage in and evaluate population health.

Key messages
Engagement in and evaluation of public health activities requires knowledge of ‘who’ the baseline population denominator is, but there is no consensus on determining this at the hospital level. Comparing 3 methods to define a hospital catchment, these differ by total population, median age and geography, the choice of which impacts on how hospitals engage in population health.
Effectiveness of Oncology Network model in pancreas cancer surgery in Piedmont, IT: a survival study
Authors: Marengo N , Garlasco J , Bordino V , Vicentini C , Mamo C , Maganuco L , Viora T , Zotti C M 
Published: October 2020

Abstract

Background
The Oncology Network of Piedmont and Aosta Valley (North-West Italy) was started in 2000 and fully established in 2010 as a regional organisational model offering multidisciplinary care by experienced reference centres for cancer diagnosis and surgical treatment. In particular, the San Giovanni Bosco Hospital in Turin is the regional reference centre for pancreatic cancer since 2015 (50-70 oncologic surgery operations performed annually). The aim of study is to assess the effectiveness of this model for pancreatic cancer surgery by comparing survival outcomes before and after the adoption of the Oncology Network model.

Methods
The study included 178 patients, aged 37-84, who underwent duodenocephalo- or total pancreatectomy for ductal cancer in the years 2007-2019. Clinical data were retrieved from surgical records, whereas the vital status was ascertained through an application connected to the Regional Registry Office. The Kaplan-Meier method was used to estimate survival and the log-rank test was then used to compare survival rates between the two groups (before vs. after 2015). Cox's regression was employed to assess the difference between the groups, also adjusting for age, sex and ASA score.

Results
The median survival for included patients was 19 months. No significant differences were found between patients of the two groups (before vs. after 2015), neither considering all patients (p = 0.4) nor for any single ASA or age category (p-values ranging from 0.1 to 0.6). The multivariate Cox model accounting for ASA, age and sex confirmed absence of significant survival differences between the two groups.

Conclusions
Despite increased case complexity, due to the extension of surgery indication to more critical patients, the Oncology Network model allowed achieving an overall survival in pancreatic cancer surgery that is consistent with international literature and not inferior to survival outcomes previously reached in patients more strictly selected.

Key messages
This study found survival after pancreatic cancer surgery was similar before and after the center entered an Oncological Network, which led to include patients with an increased severity in case-mix. Promoting the implementation of Oncology Networks should be a public health priority as it allows to improve health outcomes and quality of care.
Differences in health care utilization by access policy among newly arrived refugees in Germany
Authors: Wenner J , Biddle L , Bozorgmehr K 
Published: October 2020

Abstract

Introduction
In the first few months after refugees arrive in Germany, access to healthcare in most states is granted via health care vouchers (HcVs) that are issued by local authorities. After 15 to 18 months or formal recognition of refugee status, access is granted via electronic health cards (eHC) issued by statutory health insurance funds. We analyze whether these access policies (HcV vs. eHC) are associated with differences in needs-based utilization.

Methods
We use data from a cross-sectional survey among newly arrived refugees and asylum seekers (n = 560; response rate 41.7%) in Germany's 3rd largest federal state to analyze differences in reported utilization of GP and specialist services in the last 4 weeks. We use logistic regression to calculate odds ratios (OR), adjusting for socio-demographic characteristics, health status, duration of stay and proximity of service providers.

Results
Fewer refugees with HcVs reported using GP or specialist services in the last four weeks compared to those using regular eHCs (GP: 52.76% vs. 61.48%; SP: 38.97 vs. 45.09%). For specialist use, this difference persisted after adjustment, with eHC users having significantly higher odds of needs-based utilization (OR: 2.00; 95%-CI: 1.01-3.95). After adjustment, odds for GP use are also higher among persons with eHC, but less significant (OR: 1.37; 95%-CI: 0.67-2.82). Furthermore, the lack of a HcV was the second most reported reason among HcV users to refrain from utilization (17.09% for specialist and 15.51% for GP use).

Conclusions
The access model is associated with differences in needs-based utilization for specialist (and partly for GP) use after controlling for important confounders. The lack of (timely) HcV provision constitutes a relevant access barrier. The results provide evidence that with equal needs, refugees with HcVs have more difficulties accessing services.

Key messages
Access policies are associated with differences in healthcare utilization among newly arrived refugees in Germany. Early access to health cards and the statutory health insurance is likely to facilitate need-based utilization of health services for newly arrived refugees.
Assessing continuum of trauma care for road accident victim in Jodhpur, Rajasthan
Authors: Rustagi N , Raghav P , Dutt N , Sinha A , Rodha M S 
Published: October 2020

Abstract

Background
Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. The present study was designed to assess the existing process of pre-hospital trauma care administered to road accident victims in a fast urbanizing city of Jodhpur, Rajasthan

Methods
A cross-sectional study was designed from 1st November 2018 to 30th June 2019. All cases who were admitted to tertiary level trauma care facility in the study period were reviewed and were analyzed for type of injuries suffered, prehospital care services availed and the time duration that elapsed before patient arrived at tertiary health facility. Geographic information system was used to identify clustering of accident hot spots in the Jodhpur district.

Results
A total of 137 patients or their caregivers were interviewed during the study period. A large proportion of patients 57(41.6%) were unconscious in post-crash phase. Private taxis contributed to maximum patient transfer (75.9%) and only 12.4% were transported through ambulance. Almost three fourth (78.1%) of patients received some form of pre-hospital care within 30 minutes of accident. About one third patients (35.7%) reached the trauma facility directly after the accident while majority (64.9%) were referred from other health facilities

Conclusions
Pre-hospital trauma care for road traffic accident victims is available in golden hour for majority of victims in Jodhpur district. Victims from rural area and tourists form a sizeable proportion of accident victims brought to trauma care facility. The primary health care facilities play a pivotal role in managing victims as first point of care. Future research is thus warranted to explicitly examine the role of health professionals at primary health care facilities in administering pre-hospital trauma care.

Key messages
The primary health care facilities play a pivotal role in managing victims as first point of care. In areas with evolving trauma systems, pre-hospital trauma care strengthening requires capacity building of all level of health professionals.
External classification for ethnicity in health survey to monitor Roma vs non-Roma differences
Authors: Sándor J , Janka E , Vincze F , Ádány R 
Published: October 2020

Abstract

Background
The Roma population of European countries is characterized by a poor and poorly described health status. The lack of detailed data on health loss among Roma can be partly attributed to legal limitations based lack of reliable methodology to effectively identify them. On the other hand, it is among factors responsible for restricted effectiveness of policy to narrow gap between Roma and non-Roma health status.

Objectives
We aimed to compare directly results from population based health survey on Roma vs non-Roma differences based on self-declared and observer-reported Roma classification.

Methods
In a population based health interview survey of random sample of 1849 subjects aged 18-64 years representing 965680 adults, both self-reporting and observer-reporting on Roma was applied. Data collection covered 52 indicators of morbidity, functional loss, health behavior, social capital, and use of health services. Health status differences between the self-declared Roma (N = 124) and the non-Roma (N = 1725) as well as the observer-reported Roma (N = 179) and non-Roma populations (N = 1670) were described by logistic regression models controlled for age, sex, education and employment.

Results
There was no significant Roma vs non-Roma difference in the respect of 33 indicators, and 14 indicators showed significant difference by both Roma definitions. Differences between the observer- and self-reported Roma ethnicity in statistical inference were observed for 7 indicators. In ascertaining significant Roma vs non-Roma difference, self-reporting was more effective for 2, and observer-reporting was for 5 indicators.

Conclusions
The application of observer-reported ethnicity classification cannot increase the practical value of health survey on Roma to non-Roma differences, compared to the self-reporting based approach. Therefore, the use of observer-reported Roma ethnicity in health surveys to improve the reliability of Roma specific indicators seems to be not justified.

Key messages
Application of external classification for ethnicity cannot increase the effectiveness of population based health interview survey in monitoring Roma vs non-Roma differences. The use of observer-reported Roma ethnicity in health surveys to improve the reliability of Roma specific indicators seems to be not justified.
Cost–utility analysis of remote versus conventional monitoring of pacemakers in the Arctic Circle
Authors: Lopez-Villegas A , Catalan-Matamoros D , Peiro S , Lappegard K T , Lopez-Liria R 
Published: October 2020

Abstract

Introduction
Several studies have demonstrated that remote monitoring (RM) of pacemakers is safe, effective and cost-saving. The aim of this study was to perform an economic assessment and check whether RM offers a cost-utility alternative to conventional monitoring in hospital (CM).

Methods
This is a controlled, randomized, non-masked clinical trial. Fifty patients with pacemaker were assigned to receive either RM (n = 25) or CM (n = 25). Data were collected during the 12 months. A cost-utility analysis was performed in order to assess whether RM of pacemakers is cost-effective compared to CM in hospital in terms of costs per gained quality-adjusted life years (QALY). The analysis was performed from the perspectives of the Norwegian Healthcare System (NHS) and patients.

Results
Overall, total costs from the NHS perspective were higher in the RM group (€2,079.84 vs. €271.97; p = 0.147). The costs related to the patients perspective were higher in the RM than those in the CM group (€223.99 vs. €158.42, respectively; P = 0.429). Patients included in the CM obtained 0.04 QALYs less than those in the RM group over 12 months and the total costs per QALY comprised €1,784.10 (P = 0.175) per user with a pacemaker implant. The total number of pacemaker transmissions per patient year comprised 86.46% of minors in the CM group.

Conclusions
The follow-up costs were similar between both groups. Cost-utility analysis showed broad confidence intervals with ICERs ranging from potential savings to high costs for an additional QALY, with most ICERs lower than the usual NHS thresholds for coverage decisions.

Key messages
Total costs from the National Health System perspective were higher in the remote monitoring group, although there were not significant differences between both groups of follow-up. The costs related to the patient perspective were higher in the remote monitoring than those in the conventional monitoring group, without significant differences.