bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study
Authors: Endo Takuro , Yoshida Toru , Shinozaki Tomohiro , Motohashi Takako , Hsu Hsiang-Chin , Fukuda Shunsuke , Tsukuda Jumpei , Naito Takaki , Morisawa Kenichiro , Shimozawa Nobuhiko , Taira Yasuhiko , Fujitani Shigeki 
Published: June 2020

ObjectivesThe National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan.DesignThis retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury.SettingA tertiary hospital in Japan.ParticipantsOverall, 2847 patients transported by ambulance between April 2017 and March 2018 were included.ResultsThe mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 60.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 110.7±2.9) (p<0.001). The prehospital NEWS C-statistics (95% CI) for admission to the ward, admission to the ICU or death in the ED; admission to the ICU or death in the ED; and death in the ED were 0.73 (0.72–0.75), 0.81 (0.78–0.83) and 0.90 (0.87–0.93), respectively. After adjusting for age, sex and trauma, the OR (95% CI) of admission to the ICU or death in the ED for the high-risk (NEWS ≥7) and medium-risk (NEWS 5–6) categories was 13.8 (8.9–21.6) and 4.2 (2.5–7.1), respectively.ConclusionThe findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition.
Bridging the gap between policy and practice: a qualitative analysis of providers’ field experiences tinkering with directly observed therapy in patients with drug-resistant tuberculosis in Addis Ababa, Ethiopia
Authors: Mussie Kirubel Manyazewal , Gradmann Christoph , Manyazewal Tsegahun 
Published: June 2020

ObjectivesDrug-resistant tuberculosis (DR-TB) is one of the major public health threats in low-income countries such as Ethiopia. It is intertwined with larger socioeconomic and political factors that complicate its management and control. Whether directly observed therapy (DOT) is serving its purpose—better patient adherence and treatment outcome—still remains a debatable issue. To contribute to this discussion, this study explored health workers’ field experiences tinkering with DOT in patients with DR-TB in Addis Ababa, Ethiopia.DesignA qualitative study using in-depth interviews and focus group discussion.SettingTen public healthcare facilities: eight health centres at Addis Ababa Health Bureau level and two TB-specialised hospitals at the Federal Health Bureau level in Ethiopia.Participants18 healthcare providers working with DR-TB patients.ResultsThree findings emerged from the analysis. First, the purpose of DOT is to ensure that patients go to healthcare facilities and swallow pills under the observation of a healthcare provider. Thus, its rigid application could lead to the emergence of more DR-TB. Second, DOT should be tinkered with and its practice improved by incorporating more counselling and health education, with more flexibility towards, and attentiveness of, patient context. Third, there exists a family-like patient-provider relationship, and providers do understand their patients and empathise with them to provide better healthcare services.ConclusionIf rigidly implemented, DOT could lead to more DR-TB—a problem DOT was invented to resolve. Front-line healthcare providers are sensitive to the tragic experiences of DR-TB patients and empathise with them. Thus, they do not strictly implement DOT and are willing to take any blame resulting from tinkering with it. It is high time to shape the practice of DOT for DR-TB patients, with meaningful contributions from front-line healthcare providers.
Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study
Authors: Li Qian , Tian Liqi , Jing Xiaolin , Chen Xianghua , Li Jiangfeng , Chen Huixin 
Published: June 2020

ObjectiveTo evaluate the efficiency of county public hospitals in Shandong Province following China’s new medical reform and compare the efficiency of hospitals with different bed sizes for improving efficiency.Design and settingThis was a cross-sectional study on the efficiency and size of 68 county public hospitals in China in 2017.Outcome measuresData envelopment analysis was used to calculate the efficiency scores of hospitals and to analyse the slack values of inefficient hospitals. The actual number of open beds, doctors, nurses and total expenditure were selected as inputs, and the total number of annual visits, discharges and total income were selected as outputs. The Kruskal-Wallis H test was employed to compare the efficiency of hospitals with different bed sizes. The χ2 test was used to compare the returns to scale (RTS) of hospitals with different bed sizes.ResultsTwenty (29.41%) hospitals were efficient. There were 27 hospitals with increasing returns to scale, 23 hospitals with constant returns to scale and 18 hospitals with decreasing returns to scale (DRS). The differences in technical efficiency (p=0.248, p>0.05) and pure technical efficiency (p=0.073, p>0.05) were not statistically significant. However, the differences in scale efficiency (p=0.047, p<0.05) and RTS (p<0.001) were statistically significant. Hospitals with DRS began to appear at 885 beds. All sample hospitals with more than 1100 beds were already saturated and some hospitals even had a negative scale effect.ConclusionsThe government and hospital managers should strictly control the bed size in hospitals and make hospitals resume operating in the interests of public welfare. Interventions that rationally allocate health resources and improve the efficiency of medical workers are conducive to solving redundant inputs and insufficient outputs.
Socioeconomic inequalities in the prevalence of complex multimorbidity in a Norwegian population: findings from the cross-sectional HUNT Study
Authors: Vinjerui Kristin Hestmann , Bjerkeset Ottar , Bjorngaard Johan H , Krokstad Steinar , Douglas Kirsty A , Sund Erik R 
Published: June 2020

ObjectivesMultimorbidity, the co-occurrence of multiple long-term conditions, is common and increasing. Definitions and assessment methods vary, yielding differences in estimates of prevalence and multimorbidity severity. Sociodemographic characteristics are associated with complicating factors of multimorbidity. We aimed to investigate the prevalence of complex multimorbidity by sex and occupational groups throughout adulthood.DesignCross-sectional study.SettingThe third total county survey of The Nord-Trøndelag Health Study (HUNT), 2006–2008, Norway.ParticipantsIndividuals aged 25–100 years with classifiable occupational data and complete questionnaires and measurements.Outcome measureComplex multimorbidity defined as ‘the co-occurrence of three or more chronic conditions affecting three or more different body (organ) systems within one person without defining an index chronic condition’.AnalysisLogistic regression models with age and occupational group were specified for each sex separately.Results38 027 of 41 193 adults (55% women) were included in our analyses. 54% of the participants were identified as having complex multimorbidity. Prevalence differences in percentage points (pp) of those in the low occupational group (vs the high occupational group (reference)) were 19 (95% CI, 16 to 21) pp in women and 10 (8 to 13) pp in men at 30 years; 12 (10 to 14) pp in women and 13 (11 to 15) pp in men at 55 years; and 2 (−1 to 4) pp in women and 7 (4 to 10) pp in men at 75 years.ConclusionComplex multimorbidity is common from early adulthood, and social inequalities persist until 75 years in women and 90 years in men in the general population. These findings have policy implications for public health as well as healthcare, organisation, treatment, education and research, as complex multimorbidity breaks with the specialised, fragmented paradigm dominating medicine today.
Patient-centred and family-centred care of critically ill patients who are potential organ donors: a qualitative study protocol of family member perspectives
Authors: Zheng Katina , Sutherland Stephanie , Cardinal Pierre , Meade Maureen , Landriault Angele , Vanderspank-Wright Brandi , Valiani Sabira , Shemie Sam , Appleby Amber , Keenan Sean , Weiss Matthew , Werestiuk Kim , Kramer Andreas H , Kawchuk Joann , Beed Stephen , Dhanani Sonny , Pagliarello Giuseppe , Chasse Michaël , Lotherington Ken , Gatien Mary , Parsons Kim , Chandler Jennifer , Nickerson Peter , Kutsogiannis Jim , Sarti Aimee J 
Published: June 2020

IntroductionIn a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of critically ill patients. The objective of this study is to help translate patient-centred and family-centred care into practice in deceased organ donation.Methods and analysisThis will be a national, qualitative study of family members of deceased organ donors in Canada. We will include family members who had been approached regarding an organ donation decision, including those who agreed and declined, at least 2 months and no later than 3 years after the patients’ death. Data collection and analysis is ongoing and will continue until September 2020 to include approximately 250 participants. Family members will be identified and recruited from provincial organ donation organisation databases. Four experienced qualitative researchers will conduct telephone interviews in English or French with audio-recording for subsequent transcription. The research team will develop a codebook iteratively through this process using inductive methods, thus generating themes directly from the dataset.Ethics and disseminationLocal research ethics boards (REB) at all participating sites across Canada have approved this protocol. The main REB involved is the Ottawa Health Science Network REB. Data collection began in August 2018. Publication of results is anticipated in 2021. Study findings will help improve healthcare provider competency in caring for potential organ donors and their families and improve organ donation consent rates. Findings will also help with the development of educational materials for a competency-based curriculum for critical care residents.
A questionnaire study of the negative outcomes for UK health professional volunteers in low and middle income countries
Authors: Tyler Natasha , Ackers Helen Louise , Ahmed Anya , Byrne Ged , Byrne-Davis Lucie 
Published: June 2020

IntroductionPast research has reported considerable benefits of international health professional volunteering for British healthcare professionals; however, there are also some negative outcomes reported. Negative outcomes reportedly happen on a personal, professional and organisational level. However, there is little evidence of the frequency they might occur.MethodsWe aimed to understand what the negative outcomes of health professional volunteering in low-income and middle-income countries were, and how frequently they occurred, in an opportunistic sample of UK health professionals. We used a questionnaire developed using potential negative outcomes reported in the peer-reviewed papers. We conducted secondary analysis on cross-sectional questionnaire data from 222 healthcare professionals.ResultsThis research provides an indication of the frequency that negative outcomes might occur. Post hoc analyses revealed that some outcomes were experienced by the majority of health professional volunteers, for example, lack of formal recognition (131/169, 78%) and financial cost (92/169, 68%). While others happened less, for example, a reliance on agency or locum work (12/169, 7%) and loss of pension (31/169, 18%).ConclusionThe outcomes reported in this research quantify some of the concerns that have been raised in previous literature. Negative outcomes might be associated with certain features of volunteering and further research is needed to prospectively compare different features. Organisers of volunteering opportunities should be aware of the potential negative outcomes and engage with the research into negative outcomes to generate and apply findings about minimising potential negative outcomes, carefully balancing these against the needs of the host country.
Models of maternal and child healthcare for African refugees: protocol for an exploratory, mixed-methods study
Authors: Njue Carolyne , Hayen Andrew , Dawson Angela J 
Published: June 2020

IntroductionThere is a paucity of research examining models of maternal and child health (MCH) care for refugees in high-income countries. Attention has focused on tailoring existing healthcare services to meet the needs of this population and ensure accessible high-quality patient-centred care. This protocol reports the methodology of a study designed to identify models of care for African refugees in New South Wales (NSW), Australia, to determine the evidence for these models and the improvements necessary to best meet service needs that can be delivered in line with available resources, organisational readiness and capacity to implement.Methods and analysisThis multiphased, participatory research project will employ an exploratory, mixed-methods design. Preparatory activities involve a situational analysis of current MCH services for African refugees and associated policies and guidelines in NSW. We will consult key health service providers and analyse Australian census and settlement data to identify refugee communities and their relation to healthcare services. Phase 1 will ascertain the MCH care needs of African refugees and appropriate service models using: a Delphi survey with health service managers and providers, a nominal group process with African women refugees and; key informant interviews with senior health service managers. This data will be synthesised to provide insight into appropriate models-of-care that could be implemented. These will be discussed in a stakeholder workshop. Phase 2 will comprise a readiness-to-change survey with a selection of providers to explore the willingness, commitment and efficacy of staff members to adopt such models-of-care.Ethics and disseminationEthical approval was granted by NSW Health. Findings will be disseminated to all stakeholders at a knowledge exchange forum to inform the development of a high-quality MCH service delivery model that can be feasibly implemented specifically for African refugee communities.PROSPERO registration numberCRD42018095564.
Reporting incidents involving the use of advanced medical technologies by nurses in home care: a cross-sectional survey and an analysis of registration data
Authors: ten Haken Ingrid , Ben Allouch Somaya , van Harten Wim H 
Published: June 2020

BackgroundAdvanced medical technologies (AMTs), such as respiratory support or suction devices, are increasingly used in home settings and incidents may well result in patient harm. Information about risks and incidents can contribute to improved patient safety, provided that those are reported and analysed systematically.ObjectivesTo identify the frequency of incidents when using AMTs in home settings, the effects on patient outcomes and the actions taken by nurses following identification of incidents.MethodsA cross-sectional study of 209 home care nurses in the Netherlands working with infusion therapy, parenteral nutrition or morphine pumps, combining data from a questionnaire and registration forms covering more than 13 000 patient contacts. Descriptive statistics were used.ResultsWe identified 140 incidents (57 adverse events; 83 near misses). The frequencies in relation to the number of patient contacts were 2.7% for infusion therapy, 1.3% for parenteral nutrition and 2.6% for morphine pumps. The main causes were identified as related to the product (43.6%), the organisation of care (27.9%), the nurse as a user (15.7%) and the environment (12.9%). 40% of all adverse events resulted in mild to severe harm to the patient. Incidents had been discussed in the team (70.7%), with the patient/informal caregiver(s) (50%), or other actions had been taken (40.5%). 15.5% of incidents had been formally reported according to the organisation’s protocol.ConclusionsMost incidents are attributed to product failures. Although such events predominantly cause no harm, a significant proportion of patients do suffer some degree of harm. There is considerable underreporting of incidents with AMTs in home care. This study has identified a discrepancy in quality circles: learning takes place at the team level rather than at the organisational level.
Developing and training mental toughness in sport: a systematic review and meta-analysis of observational studies and pre-test and post-test experiments
Authors: Stamatis Andreas , Grandjean Peter , Morgan Grant , Padgett Robert Noah , Cowden Richard , Koutakis Panagiotis 
Published: June 2020

ObjectiveTo investigate the efficacy of interventions designed to train and develop mental toughness (MT) in sport.DesignSystematic review and meta-analysis.Data sourcesJournal articles, conference papers and doctoral theses indexed in Embase, Scopus, PubMed and SPORTDiscus from inception to 22 November 2019.Eligibility criteria for selecting studiesObservational and pre–post experimental designs on the efficacy of physical and/or psychological interventions designed to promote MT in athletes.ResultsA total of 12 studies, published between 2005 and 2019, were included in the review. A majority of the studies included a sample comprised exclusively of male athletes (54.55%), MT interventions were primarily psychological (83.33%) and most studies measured MT via self-report (75%). The Psychological Performance Inventory (25%), the Mental Toughness Questionnaire-48 (16.67%), and the Mental, Emotional and Bodily Toughness Inventory (16.67%) were the most popular inventories used to measure MT. Methodological quality assessments for controlled intervention studies (k=7), single group pre-test–post-test designs (k=4) and single-subject designs (k=1) indicated that the risk of bias was high in most (75%) of the studies. The meta-analysis involvingk=10 studies revealed a large effect (d=0.80, 95% CI 0.30 to 1.28), with variability across studies estimated at 0.56.ConclusionAlthough the findings of this review suggest there are effective, empirically based interventions designed to train MT in sport, practitioners should be aware of the level of validity of intervention research before adopting any of the MT training programmes reported in the applied sport psychology literature.
National survey evaluating the provision of gastroenterology dietetic services in England
Authors: Rej Anupam , Buckle Rachel Louise , Shaw Christian Charles , Trott Nick , Urwin Heidi , McGough Norma , Aziz Imran , Sanders David Surendran 
Published: June 2020

AimsThe aim of the study was to assess the provision of dietetic services for coeliac disease (CD), irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).MethodsHospitals within all National Health Service trusts in England were approached (n=209). A custom-designed web-based questionnaire was circulated via contact methods of email, post or telephone. Individuals/teams with knowledge of gastrointestinal (GI) dietetic services within their trust were invited to complete.Results76% of trusts (n=158) provided GI dietetic services, with responses received from 78% of these trusts (n=123). The median number of dietitians per 100 000 population was 3.64 (range 0.15–16.60), which differed significantly between regions (p=0.03). The most common individual consultation time for patients with CD, IBS and IBD was 15–30 min (43%, 44% and 54%, respectively). GI dietetic services were delivered both via individual and group counselling, with individual counselling being the more frequent delivery method available (93% individual vs 34% group). A significant proportion of trusts did not deliver any specialist dietetic clinics for CD, IBS and IBD (49% (n=60), 50% (n=61) and 72% (n=88), respectively).ConclusionThere is an inequity of GI dietetic services across England, with regional differences in the level of provision and extent of specialist care. Allocated time for clinics appears to be insufficient compared with time advocated in the literature. Group clinics are becoming a more common method of dietetic service delivery for CD and IBS. National guidance on GI dietetic service delivery is required to ensure equity of dietetic services across England.
Population-based targeted sequencing of 54 candidate genes identifiesPALB2as a susceptibility gene for high-grade serous ovarian cancer
Authors: Song Honglin , Dicks Ed M , Tyrer Jonathan , Intermaggio Maria , Chenevix-Trench Georgia , Bowtell David D , Traficante Nadia , Group AOCS , Brenton James , Goranova Teodora , Hosking Karen , Piskorz Anna , van Oudenhove Elke , Doherty Jen , Harris Holly R , Rossing Mary Anne , Duerst Matthias , Dork Thilo , Bogdanova Natalia V , Modugno Francesmary , Moysich Kirsten , Odunsi Kunle , Ness Roberta , Karlan Beth Y , Lester Jenny , Jensen Allan , Krüger Kjaer Susanne , Høgdall Estrid , Campbell Ian G , Lázaro Conxi , Pujara Miguel Angel , Cunningham Julie , Vierkant Robert , Winham Stacey J , Hildebrandt Michelle , Huff Chad , Li Donghui , Wu Xifeng , Yu Yao , Permuth Jennifer B , Levine Douglas A , Schildkraut Joellen M , Riggan Marjorie J , Berchuck Andrew , Webb Penelope M , Group OPAL Study , Cybulski Cezary , Gronwald Jacek , Jakubowska Anna , Lubinski Jan , Alsop Jennifer , Harrington Patricia , Chan Isaac , Menon Usha , Pearce Celeste L , Wu Anna H , de Fazio Anna , Kennedy Catherine J , Goode Ellen , Ramus Susan , Gayther Simon , Pharoah Paul 
Published: June 2020

PurposeThe known epithelial ovarian cancer (EOC) susceptibility genes account for less than 50% of the heritable risk of ovarian cancer suggesting that other susceptibility genes exist. The aim of this study was to evaluate the contribution to ovarian cancer susceptibility of rare deleterious germline variants in a set of candidate genes.MethodsWe sequenced the coding region of 54 candidate genes in 6385 invasive EOC cases and 6115 controls of broad European ancestry. Genes with an increased frequency of putative deleterious variants in cases versus controls were further examined in an independent set of 14 135 EOC cases and 28 655 controls from the Ovarian Cancer Association Consortium and the UK Biobank. For each gene, we estimated the EOC risks and evaluated associations between germline variant status and clinical characteristics.ResultsThe ORs associated for high-grade serous ovarian cancer were 3.01 forPALB2(95% CI 1.59 to 5.68; p=0.00068), 1.99 forPOLK(95% CI 1.15 to 3.43; p=0.014) and 4.07 forSLX4(95% CI 1.34 to 12.4; p=0.013). Deleterious mutations inFBXO10were associated with a reduced risk of disease (OR 0.27, 95% CI 0.07 to 1.00, p=0.049). However, based on the Bayes false discovery probability, only the association forPALB2in high-grade serous ovarian cancer is likely to represent a true positive.ConclusionsWe have found strong evidence that carriers ofPALB2deleterious mutations are at increased risk of high-grade serous ovarian cancer. Whether the magnitude of risk is sufficiently high to warrant the inclusion ofPALB2in cancer gene panels for ovarian cancer risk testing is unclear; much larger sample sizes will be needed to provide sufficiently precise estimates for clinical counselling.