bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using telehealth for rural paediatric diabetics: Does it deliver good care?
Authors: Williams Michael 
Published: September 2020

AimTo evaluate rural paediatric diabetic telehealth clinics including whether they meet clinical standards, provide equivalent care to central clinics, families were satisfied and difficulties were encountered.MethodsAn audit of a telehealth service for children and adolescents with type 1 diabetes mellitus at four rural sites was conducted. The case notes for each patient for 2019 were reviewed to determine if standards of paediatric diabetic care were met. Interviews were conducted at a clinic at each site with the child, parent(s) and staff attending the clinics. A retrospective review of difficulties in service provision was undertaken with staff.ResultsNineteen children and adolescents were seen in the telehealth clinics over the year. Eighteen (95%) were seen four times with point‐of‐care measurement of glycosylated haemoglobin (HbA1c) and growth by the consultant paediatrician and diabetic nurse educator. Complication screening was achieved on time for 15 (78%) patients, with the remaining patients having had the tests ordered. Eleven (56%) patients were reviewed by a dietician, six (33%) by social worker and five (27%) by psychologist. All patients and parents reported receiving good support for their diabetes without any preferring to attend the central clinic. There were no significant technical difficulties.ConclusionProviding paediatric diabetic care through a telehealth service at rural hospitals meets standards of care and was provided without technical difficulties. It is preferred by patients and their parents to attending a central clinic. A model of service is presented that may be replicated elsewhere in Australia.
Validating the eHealth Literacy Scale in Rural Adolescents
Authors: Giger Jarod T. , Barnhart Sheila , Feltner Fran , Slone Melissa , Lawler Michael J. , Windsor Leah , Windsor Alistair 
Published: September 2020

AbstractPurposeGiven that the recent eHealth literacy literature supports the properties of the 3‐factor eHealth literacy scale (eHEALS) model in samples with millennials, adults, and older adults, the appropriate next step is to establish whether the model can be reproduced in a rural adolescent sample. The purpose of this study was to evaluate the recent 3‐factor model by Paige and associates with a sample of seventh‐grade students.MethodsThis cross‐sectional study included a subsample of students (n = 146) from 3 school districts in Appalachian Kentucky. We used confirmatory factor analysis (CFA) procedures and small sample model fit guidelines to evaluate our model, and the 1‐sample bootstrap algorithm with bias‐corrected and accelerated 95% confidence intervals to estimate associations among eHEALS and health and technology variables.FindingsA total of 137 students, or 61% of enrolled seventh‐grade students, completed the study. CFA results showed eHEALS 3‐factor loadings—information awareness, information seeking, and information engagement—were high (≥0.63) and statistically significant. We observed evidence of a good model fit (root mean square error of approximation [RMSEA] = 0.07, standardized root mean square residual [SRMR] = 0.03, comparative fit index [CFI] = 0.99) and results are comparable with Paige and associates’ model fit (RMSEA = 0.06, SRMR = 0.08, CFI = 0.98). Correlations showed that students with more access to technology were associated with higher information seeking (r = 0.31) and higher information engagement (r = 0.23). eHealth literacy scores did not differ by level of rurality or gender.ConclusionsThe 3‐factor eHEALS is a reliable and valid instrument in assessing eHealth literacy in a group of rural seventh graders from Appalachian Kentucky.
An analysis of the current backlash of economic globalization in a model with heterogeneous agents
Authors: Della Posta Pompeo 
Published: September 2020

AbstractThis paper analyzes the current phase of backlash of economic globalization using a target zone approach in an environment populated by heterogeneous agents. The target zone analysis suggests that there may be a positive expectation effect (a ‘honeymoon’) when the social costs are credibly expected to remain below the benefits arising from globalization. In such a situation, the latter proceeds even beyond the level that society would be willing to accept in the absence of a such a target. When the costs are expected to exceed the benefits, instead, the opposite phenomenon (a ‘divorce’) arises. While in the case of exchange rates or interest rates, the passage from ‘honeymoon’ to ‘divorce’ might well occur with a discrete jump of the respective variable, rather than gradually, this is not the case when considering economic and social costs. Graduality is obtained thanks to the introduction of the hypothesis of heterogeneous agents. The proportion of those who think that the costs of globalization exceed the benefits increases with globalization and the ‘honeymoon’’, then, gradually turns into a ‘divorce’. Government's redistributive intervention to compensate the losers, however, could reduce the costs of globalization, thereby delaying or even preventing its crisis.
Conflict, confusion and inconsistencies: Pre‐registration nursing students’ perceptions and experiences of speaking up for patient safety
Authors: Fagan Anthea , Lea Jackie , Parker Vicki 
Published: September 2020

AbstractThere is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under‐explored, especially in the Australian context. This two‐phased qualitative study used Interpretive Description to explore 53 pre‐registration nursing students’ perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students’ decisions to speak up or remain silent. Understanding students’ perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up.
Three‐dimensional virtual surgical planning in the oncologic treatment of the mandible
Authors: Kraeima Joep , Glas Haye H. , Merema Bram Barteld Jan , Vissink Arjan , Spijkervet Fred K. L. , Witjes Max J. H. 
Published: September 2020

AbstractObjectivesIn case of surgical removal of oral squamous cell carcinomas, a resection of mandibular bone is frequently part of the treatment. Nowadays, such resections frequently include the application of 3D virtual surgical planning (VSP) and guided surgery techniques. In this paper, current methods for 3D VSP leads for optimisation of the workflow, and patient‐specific application of guides and implants are reviewed.Recent findingsCurrent methods for 3D VSP enable multi‐modality fusion of images. This fusion of images is not restricted to a specific software package or workflow. New strategies for 3D VSP in Oral and Maxillofacial Surgery include finite element analysis, deep learning and advanced augmented reality techniques. These strategies aim to improve the treatment in terms of accuracy, predictability and safety.ConclusionsApplication of the discussed novel technologies and strategies will improve the accuracy and safety of mandibular resection and reconstruction planning. Accurate, easy‐to‐use, safe and efficient three‐dimensional VSP can be applied for every patient with malignancies needing resection of the mandible.
Pediatric liver transplantation in severe hepatopulmonary syndrome and use of inhaled nitric oxide for post‐transplant hypoxemia–a single center experience
Authors: Raghunathan Veena , Mohan Neelam , Dhaliwal Maninder , Bhangui Prashant , Vohra Vijay , Soin Arvinder Singh 
Published: September 2020

AbstractData on pediatric patients with HPS undergoing LT are limited. Our aim was to study the spectrum and outcomes of pediatric patients with HPS undergoing LDLT. The role ofiNO for post‐LDLT refractory hypoxemia was also assessed. Patients (aged < 18 years) undergoing LT were retrospectively studied. HPS was diagnosed based on European Respiratory Society Taskforce 2004 criteria. HPS was graded based on oxygenation criteria and contrast‐enhanced echocardiogram. Post‐operative course was studied. Refractory post‐operative hypoxemia was treated with iNO by institutionally developed protocol. 23/150 pediatric patients undergoing LDLT had HPS. BA was the most common underlying cause (52.2%). By oxygenation criteria, 6 (26.1%) had VS‐HPS. VS‐HPS was associated with longer LOS (p = .031) and prolonged oxygen requirement (p = .001) compared with other HPS patients. 4/6 patients with VS‐HPS had pO2 < 45 mm Hg. Among these, 2 developed ICH post‐operatively and 1 died. 3 developed refractory post‐operative hypoxemia, successfully treated with iNO. Mean duration of iNO was 26.3 days. In the group of patients with HPS, the incidence of HAT and portal vein thrombosis was 17.3% and 4.3%, respectively. One year post‐LDLT survival of patients with HPS was similar to non‐HPS patients (86.9% vs 94.4%; p = .88). We concluded that, pediatric patients with VS‐HPS, especially those with pre‐operative pO2 < 45 mm Hg, have long and difficult post‐LT course. Refractory postoperative hypoxemia can be successfully overcome with strategic use of iNO. Vigilant monitoring and good intensive care support are essential.
Healthcare professionals' trust in patients: A review of the empirical and theoretical literatures
Authors: Sousa‐Duarte Fernanda , Brown Patrick , Mendes Ana Magnólia 
Published: September 2020

AbstractTrust is considered as an important process in establishing positive patient–professional relationships and healthcare outcomes. While many studies denote the mutual–reciprocal nature of trust, there is a strong tendency to consider professionals merely as trustees. This article presents a review of literature addressing healthcare professionals' trust in patients, aiming to identify and compare more theoretical and more empirical contributions on the topic as a basis for developing a research agenda. We examine 31 theoretical and empirical peer‐reviewed articles that address healthcare professionals' trust in patients, either as the primary or secondary focus. We found that healthcare professionals' trust in patients is still overlooked in empirical trust studies into healthcare, despite several theoretical and review articles emphasising the relevance of the topic. We propose that future empirical research considers professionals' uncertainties and vulnerabilities, and that theoretical studies reflect more on methodological approaches for researching their conceptualisations. Moreover, our findings suggest that while system‐based understandings have been seen as important for considering how patients trust in their healthcare, we argue that these same abstract systems—professional, ethical, organisational and legal—are vital to understanding how doctors become vulnerable, and therefore, how trust in their patients becomes pertinent, in their everyday work.
Health interventions among mobile pastoralists: a systematic review to guide health service design
Authors: Wild Hannah , Mendonsa Emily , Trautwein Micah , Edwards Jeffrey , Jowell Ashley , GebreGiorgis Kidanu Ashenafi , Tschopp Rea , Barry Michele 
Published: September 2020

AbstractObjectiveMobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap.MethodsWe conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records.ResultsOur search yielded 4884 non‐duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub‐Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11).ConclusionWithout adaptations to account for mobile pastoralists’ unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist‐specific delivery strategies, such as combinations of mobile and ‘temporary fixed’ services informed by transhumance patterns, culturally acceptable waiting homes, community‐directed interventions and combined joint human‐animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.
Recommended Stress Formulae for Tubular Conical Transition Designs
Authors: Ku Albert , Chen Jieyan 
Published: September 2020

AbstractFor the design of tubular conical transitions, the axial, bending, and hoop stresses at the junctions are required. Among the offshore design standards, API RP-2A, ISO 19902, and NORSOK N-004, various equations exist for the same stress quantity which may cause confusions. The quality of these existing stress formulae will be examined in this paper. The tubular conical stress equations used in the offshore industry started from Boardman’s studies in the 1940s. Recently, Lotsberg re-formulated this problem and applied the results to stress concentration factor (SCF) applications. This paper solves the same set of shell equations but the formulations are cast in a different form. This new format allows for an in-depth examination of existing code equations. In addition, the formulation as presented can be used for modifications to gain higher accuracy. Several recommended new stress formulae are provided. It is observed that the existing code provisions’ accuracy quickly deteriorates for cases where plate thickness in tubular and cone differ. The recommended approach is based on theoretical framework of shell mechanics, which better facilitate tubular/cone force balances when compared with existing equations. The sectional relationships among moment, shear, and hoop loads are also treated consistently using shell theory. The resulted improvements make the recommended formulae more accurate than the existing provisions.
Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach
Authors: Williams Jack , Roberts Ian , Shakur-Still Haleema , Lecky Fiona E , Chaudhri Rizwana , Miners Alec 
Published: September 2020

IntroductionAn estimated 69 million traumatic brain injuries (TBI) occur each year worldwide, with most in low-income and middle-income countries. The CRASH-3 randomised trial found that intravenous administration of tranexamic acid within 3 hours of injury reduces head injury deaths in patients sustaining a mild or moderate TBI. We examined the cost-effectiveness of tranexamic acid treatment for TBI.MethodsA Markov decision model was developed to assess the cost-effectiveness of treatment with and without tranexamic acid, in addition to current practice. We modelled the decision in the UK and Pakistan from a health service perspective, over a lifetime time horizon. We used data from the CRASH-3 trial for the risk of death during the trial period (28 days) and patient quality of life, and data from the literature to estimate costs and long-term outcomes post-TBI. We present outcomes as quality-adjusted life years (QALYs) and 2018 costs in pounds for the UK, and US dollars for Pakistan. Incremental cost-effectiveness ratios (ICER) per QALY gained were estimated, and compared with country specific cost-effective thresholds. Deterministic and probabilistic sensitivity analyses were also performed.ResultsTranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI, at £4288 per QALY in the UK, and US$24 per QALY in Pakistan. Tranexamic acid was 99% and 98% cost-effective at the cost-effectiveness thresholds for the UK and Pakistan, respectively, and remained cost-effective across all deterministic sensitivity analyses. Tranexamic acid was even more cost-effective with earlier treatment administration. The cost-effectiveness for those with severe TBI was uncertain.ConclusionEarly administration of tranexamic acid is highly cost-effective for patients with mild or moderate TBI in the UK and Pakistan, relative to the cost-effectiveness thresholds used. The estimated ICERs suggest treatment is likely to be cost-effective across all income settings globally.
Potential traumatic events in the workplace and depression, anxiety and post-traumatic stress: a cross-sectional study among Dutch gynaecologists, paediatricians and orthopaedic surgeons
Authors: Scheepstra Karel Willem Frank , Pauw Hannah S , van Steijn Minouk Esmee , Stramrood Claire A I , Olff Miranda , van Pampus Maria G 
Published: September 2020

ObjectiveTo compare the prevalence of work-related potential traumatic events (PTEs), support protocols and mental health symptoms across Dutch gynaecologists, orthopaedic surgeons and paediatricians.DesignCross-sectional study, supplementary analysis of combined data.SettingNationwide survey between 2014 and 2017.ParticipantsAn online questionnaire was sent to all Dutch gynaecologists, orthopaedic surgeons and paediatricians, including resident physicians (4959 physicians). 1374 questionnaires were eligible for analysis, corresponding with a response rate of 27.7%.Outcome measuresPrimary outcome measures were the prevalence of work-related PTEs, depression, anxiety, psychological distress and traumatic stress, measured with validated screening instruments (Hospital Anxiety and Depression Scale, Trauma Screening Questionnaire). Secondary outcomes were the association of mental health and defensive practice to traumatic events and support protocols.ResultsOf the respondents, 20.8% experienced a work-related PTE at least 4 weeks ago. Prevalence rates indicative of depression, anxiety or post-traumatic stress disorder (PTSD) were 6.4%, 13.6% and 1.5%, respectively. Depression (9.2% vs 5.2%, p=0.019), anxiety (18.2% vs 8.2%, p<0.001) and psychological distress (22.8% vs 12.5%, p<0.001) were significantly more prevalent in female compared with male attendings. The absence of a support protocol was significantly associated with more probable PTSD (p=0.022). Those who witnessed a PTE, reported more defensive work changes (28.0% vs 20.5%, p=0.007) and those with probable PTSD considered to quit medical work more often (60.0% vs 35.8%, p=0.032).ConclusionPhysicians are frequently exposed to PTEs with high emotional impact over the course of their career. Lacking a support protocol after adverse events was associated with more post-traumatic stress. Adverse events were associated with considering to quit medical practice and a more defensive practice. More awareness must be created for the mental health of physicians as well as for the implementation of a well-organised support system after PTEs.
Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study
Authors: Wu Yuelin , Wan Sheng , Gu Shengyi , Mou Zhengqian , Dong Lingling , Luo Zhongcheng , Zhang Jun , Hua Xiaolin 
Published: September 2020

ObjectiveTo assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.DesignProspective cohort study.SettingShanghai, China.ParticipantsWe studied 2630 nulliparous singleton pregnant women with complete data on weight gain in early (≤17 weeks of gestation) and late (>17 weeks) pregnancy in the Shanghai Birth Cohort.MethodsGWG was standardised into z-scores by gestational age and categorised as low (z-score <−1), normal (−1 to +1) and high (>1). The adjusted relative risks (aRRs) and 95%CIs were estimated through log-binomial regression models. Interaction effects between GWG and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant.Outcome measuresAdverse maternal and neonatal outcomes.ResultsIndependent from GWG in late pregnancy, higher GWG in early pregnancy was associated with higher risks of gestational diabetes mellitus (aRR: 1.66; 95% CI: 1.11 to 2.48), caesarean section (aRR: 1.21; 95% CI: 1.05 to 1.39) and prolonged hospitalisation (aRR: 1.56; 95% CI: 1.03 to 2.38). Higher GWG in late pregnancy was independently associated with higher risks of caesarean section (aRR: 1.24; 95% CI: 1.09 to 1.41), large for gestational age (aRR: 2.01; 95% CI: 1.50 to 2.7) and macrosomia (aRR: 1.90; 95% CI: 1.30 to 2.78). In addition, the risk of gestational hypertension increased significantly with increased total GWG (aRR: 1.78; 95% CI: 1.14 to 2.76). The effects of GWG in late pregnancy on maternal and neonatal outcomes were significantly different between the women bearing a female and the women bearing male fetus.ConclusionThe GWG associations with adverse pregnancy outcomes differ at early and late pregnancy, and there may be effect modification by fetal sex in the association of GWG in late pregnancy with some pregnancy outcomes.