bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brazilian especialized care: challenges and proposals to provide integrality on health assistance
Authors: de Moura Ferraz E , Marques da Silva J F , Hisatugo F , de Freitas Mendonça F , Carvalho B G , de Almeida Polo E P , Lopes Santini S M 
Published: October 2020

Abstract
The Brazilian health system has as principles the integrality of assistance and the regional health planning of services, organized through attention networks. In the constitution of this network, specialized care fraction, even though it concentrates a significant importance in citizens right of health guarantee, has represented a problem of great relevance, constituting a challenge for the organization of health care, whether in the field of management or assistance, in Brazil, as well as in other countries. In this perspective, this study aims to identify the challenges and propose strategies to effectuate the provision of specialized care fraction in the Brazilian health system. This is a qualitative and exploratory study, developed in the northern macro-region of the State of Paraná in Brazil. The data collection took place through semi-structured interviews, with the participation of public and private managers and other subjects that compose the assistance and management network of this region, between 2016 and 2017. The data were organized through discourse analysis, supported by policy analysis referential. The results show an expressive demand for this fraction of assistance in the analyzed territory, mostly offered by private institutions. The high demand is linked to the low resoluteness of primary health care and an ineffective communication system between different points of care. Other challenges highlighted in this phenomenon are: the lack of solidarity and the sharing of responsibilities between federal entities; the weakness of the counties; asymmetries of power between public and private managers; the fragile integrated and regionalized planning; the underfunding of the system; the fledgling regulatory system; the conflicts between governance actors; and political interferences.

Key messages
In order to overcome challenges to provise the specialized care fraction, is necessary to strength the cooperation between entities, making viable health policies coherent to collective needles. With the objective of organize the provision of integrality of health, one of the essential requirements would be qualify the assistance on the different points of care that compose the health network.
Drug interactions in the elderly of the Unified Health System (SUS) in Brazil
Authors: Silveira V F , Teodoro J A , Acúrcio F A , Júnior A A G , Nascimento R C R M 
Published: October 2020

Abstract

Background
Elderly people with chronic non-communicable diseases generally use a large amount of medicines, increasing the risk of adverse events that can compromise the quality of pharmacotherapy.

Objective
To analyze the prevalence of drug interactions in the elderly assisted by primary care of the Unified Health System (SUS), who use polypharmacy.

Methods
This is a cross-sectional study, part of the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM) - Services, 2015, which used a representative sample of the Brazilian population. Elderly were considered people with 65 years or older and polypharmacy was defined as the concomitant use of five or more medicines. Drug interactions were classified using Micromedex®. The variables were presented as absolute and relative frequences, mean and standard deviation, using the software Stata® 13.

Results
Of the 1,157 elderly people interviewed, 19.01% (n = 220) were in polypharmacy. The average of chronic diseases was 3.84 ± 1.73 per elderly person, being hypertension (91.82%, n = 202) and arthritis (55.91%, n = 123) he most frequent. There were found 1,076 interactions, ranging from 0 to 23 per person, with an average of 3.87 ± 3.41. In the polypharmacy group, the prevalence of drug interaction was 88.99% (n = 194). Among the interactions, 66.83% (n = 679) were classified as moderate, 31.10% (n = 316) major and 2.07% (n = 21) minor; 84.83% (n = 861) were pharmacodynamic and 15.17% (n = 154) pharmacokinetic. The most prevalent interactions were: Hydrochlorothiazide and Acetylsalicylic Acid (5.31%, n = 54); Captopril and Hydrochlorothiazide (5.31%, n = 54) and Losartan and Acetylsalicylic Acid (3.74%, n = 38).

Conclusions
The most prevalent interactions have synergistic or antagonistic effects, which need monitoring to ensure the safety and effectiveness of treatment, especially due to the physiological changes resulting from aging.

Key messages
Analyze the prevalence of drug interactions in elderly people using polypharmacy. Cross-sectional, evaluative study.
Hand hygiene and standard hygiene precautions in healthcare settings Monastir Tunisia 2019
Authors: Dhouib W , zemni I , Kacem M , bennasrallah C , ben fredj M , abroug H , Bannour R , Sriha Belguith A 
Published: October 2020

Abstract
To ensure adherence to standard hygiene precautions in healthcare settings, the World Health Organization (WHO) recommends that compliance with these precautions be assessed in any care setting through periodic audits to improve the quality and safety of care procedures
This was a cross-sectional descriptive study that was conducted in the University Hospital of Monastir during the month of July 2019.It was a self-administered questionnaire that explored the knowledge and attitudes in terms of standard precautions in hospital hygiene and administred to the various occupational categories involved in each department. The data was entered and analyzed by the SPSS 20 software.
A total of 440 health professionals responded to the questionnaire with a Sex-ratio of 0.55.The median age was 30 years with an IQR [26,36]. The median length of professional service was 5 years IQR[2,9]. In terms of training on standard precautions, 69.3% were trained, of which 64.5% had training of less than 5 years.
More than half, 54.6% of professionals knew where to find a procedure or sign “what to do if exposed to blood”. Concerning the attitudes of professionals, the majority applied the standard precautions of the various topics and more specifically hand hygiene.
Our results showed acceptable adherence to standard precautions (glove hygiene, etc.) except for accidents during blood exposure which encourage us to follow an action plan with corrective actions.

Key messages
Acceptable adherence to standard precautions. Accident at exposure to blood need to be controlled.
Cost minimization of 3 methods of acquiring dental radiographic image
Authors: Coscarelli C , Leoni L , Força F , Feris F , Nacao N , Fonseca F , Machado M , Raimundo R , Cavalcante C , Pereira P 
Published: October 2020

Abstract
The objective of this study is to develop a complete economic evaluation of 3 diagnostic techniques for interproximal radiographic, comparing the conventional radiographic technique, direct (CMOS) and indirect (PSP) digital techniques in the diagnosis of dental caries, from the perspective of SESC/Brazil (Social Trade Service). A complete cost-minimization economic assessment was performed. Initially, a systematic review was performed and it was verified that the accuracy for the diagnosis is similar between the techniques. The direct medical costs (related to the technique) were estimated by the bottom-up technique, taking into account the value of the clinical hours of the professionals, equipments and materials used. The time horizon was 10 years. The values were discounted at 3% per year, and a sensitivity analysis was prepared into two scenarios (one more pessimistic with costs 20% higher than estimated and one more optimistic with costs 20% lower). Direct digital radiography proved to be the option with the lowest cost (US$ 1.16), followed by semi-direct (US$ 1.35) and conventional (US$ 1.47). Conventional radiography presented the highest cost for the period (US$ 74,943.65), and the use of digital radiographs could promote savings of US$ 6,000.59 and US$ 15,448.35, if used by the semi-direct and direct method. respectively. Regarding the sensitivity analysis, in the most optimistic scenario of the time horizon there would be savings of US$ 4,800.47 (semi-direct digital) to US$ 12,446.09 (direct digital) compared to the traditional technique (films). In the most pessimistic scenario, these values vary in savings over the time horizon from US$ 7,200.71 (semi-direct) to US$ 18,538.02 (direct). It is concluded that the direct radiographic technique was the most cost effective and its incorporation in the SESC units is suggested.

Key messages
Digital dental radiography. Cost minimization analysis. Health technology assessment.
Cost-utility analysis of remote monitoring of users with pacemakers five years after implantation
Authors: Lopez-Villegas A , Bautista-Mesa R , Peiro S , Catalan-Matamoros D , Robles-Musso E , Lopez-Liria R , Leal-Costa C 
Published: October 2020

Abstract

Introduction
Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of patients with pacemakers, 5 years after implant.

Methods
Under a controlled, not randomized nor masked clinical trial, 82 patients with pacemaker were initially selected (CM = 52; RM = 30). Patients were monitored during 5 years, after what a total 34 for CM in hospital and 21 for RM finalised the study. A cost-utility analysis was conducted to assess cost-utility of RM in terms of costs per gained quality-adjusted life years (QALYs). Costs from National Health Service (NHS) and patient perspectives were considered.

Results
After 60-months of follow-up, total costs per patient were 23.02% lower in the RM than in the CM group, corresponding to a €82.10 cost saving per patient (p = 0.033). However, the reduction of in-hospital visits derived from RM does not impact significantly costs from the NHS perspective, with a cost saving of 15.04% per patient (p = 0.144). Patients in the CM group showed a slightly better QALY at the end of the study (3.579) than RM group (3.306). Costs/QALYs obtained by the RM group were higher than the CM group (p = 0.773). The incremental cost-effectiveness ratio of CM in comparison to RM becomes positive (€301.16).

Conclusions
This study confirms RM of patients with pacemakers appears still as a cost-effective alternative to conventional monitoring in hospital after 5 years.

Key messages
Total costs per patient were 23.02% lower in the Remote Monitoring than in the Conventional Monitoring group (p = 0.033). The reduction of in-hospital visits derived from Remote Monitoring does not impact significantly costs from the NHS perspective, with a cost saving of 15.04% per patient (p = 0.144).
Assessing communication during remote follow-up of users with pacemakers
Authors: Lopez-Villegas A , Catalan-Matamoros D , Lappegard K T , Peiro S , Lopez-Liria R 
Published: October 2020

Abstract

Introduction
With the unstoppable implementation of digital contributions to meet many of the needs of current patients, it is expected that telehealth will progressively be adopted. Remote services are increasingly used in healthcare organizations across the globe. Cardiovascular diseases are the main cause of mortality in Europe while pacemakers are a common implantable medical device. The progressive implementation of pacemakers with remote monitoring is reducing traditional visits to hospital. Considering that effective communication is a key ingredient for the provision of quality healthcare services, this study aims to explore the communication experiences in older adults with pacemaker in remote monitoring. The study is based on a non-masked randomised observational design.

Methods
The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection.

Results
Findings revealed overall positive communication experiences by pacemaker users in remote monitoring without significant differences between users in hospital monitoring. The remote option is perceived as safe and convenient, and talking with the clinicians from home is considered as comfortable and confidential.

Conclusions
The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts are discussed.

Key messages
Findings revealed overall positive communication experiences by pacemaker users in remote monitoring without significant differences between users in hospital monitoring. The remote option is perceived as safe and convenient, and talking with the clinicians from home is considered as comfortable and confidential.
Quality of life in patients with pacemakers 12 months after implant in the Arctic Circle
Authors: Lopez-Villegas A , Catalan-Matamoros D , Peiro S , Lappegard K T , Lopez-Liria R 
Published: October 2020

Abstract

Introduction
The purpose of this study was to analyse the health-related quality of life (HRQoL) of patients followed up using a remote device-monitoring system (RM) compared to patients followed up through conventional monitoring (CM), 12 months after the implantation of a pacemaker.

Methods
This is a trial design that used the EuroQol-5D and the Minnesota Living with Heart Failure Questionnaire (MLHF) questionnaires. The HRQoL of a cohort of 50 consecutive patients randomly allocated to one of the two follow-up modalities was measure database line and then during follow-up, 12 months after the pacemaker implantation. Eventually, 23 patients were followed-up through standard outpatient visits, while 23 used a remote monitoring system.

Results
The baseline clinical characteristics and health-related quality of life of the patients from both groups were observed to be statistically similar. Twelve months after the pacemaker implantation, both groups showed statistically signiﬁcant improvements in the baseline parameters based on the MLHF.

Conclusions
The patients followed up through hospital visits showed a greater increase in MLHF- HRQoL after 12 months, although the increase was not signiﬁcantly greater than that of the TM group. Furthermore, the frequencies of emergency visits and re-hospitalisations did not differ between the groups.

Key messages
Patients included in conventional monitoring group showed an increase in HRQoL after 12-months since pacemaker implant, although it was not signiﬁcantly major than remote group. Frequencies of emergency visits and re-hospitalisations did not differ between the remote and conventional monitoring groups.
Long-term Quality of Life and Safety in Remote Monitoring of Patients with Pacemakers
Authors: Lopez-Villegas A , Lopez-Liria R , Leal-Costa C , Peiro S , Robles-Musso E , Bautista-Mesa R , Rocamora-Perez P , Lappegard K T , Catalan-Matamoros D 
Published: October 2020

Abstract

Introduction
Health-related quality of life (HRQoL) and functional capacity values immediately after pacemaker implantation have been well established; however, not much has been known about its long-term effects. The present study compared the long-term effectiveness and safety of remote monitoring (RM) plus a clinic visit versus clinic visits alone during follow-up of adults implanted with PMs.

Methods
This study was a single-centre, controlled, non-randomised, non-blinded clinical trial. Data were collected pre-implantation and after 60 months. The patients in the PONIENTE study were assigned to two different groups: RM and conventional monitoring (CM). The EuroQol-5D (EQ-5D) questionnaire was used to assess HRQoL and Duke Activity Status Index was used for the functional capacity.

Results
After five years, 55 patients completed the study (RM = 21; CM = 34). EuroQol-5D and functional capacity values were improved; however, significant differences were observed only in the EQ5D visual analogue scale (p &lt; 0.001).

Conclusions
Remote monitoring was equally feasible, reliable, safe, and clinically useful as CM. The frequencies of rehospitalisations and emergency visits did not differ between the groups. RM was found to be safe and effective in early detection and treatment of medical- and device-related events and in reducing hospital visits. Improved HRQoL was described not only immediately after PM implantation but also extended over a long time.

Key messages
Remote monitoring of patients with pacemakers was found to be safe and effective in early detection and treatment of medical- and device-related events and in reducing hospital visits. Patients included in both groups of follow-up were equally feasible, reliable, safe, and clinically useful.
Patients, users, caregivers and citizens’ involvement in local HTA unit in Quebec: a survey
Authors: Touré M , Poder T G , Safianyk C , Fournier M , Ganache I , Pomey M P , Gagnon M P 
Published: October 2020

Abstract
Increasing emphasis is given on involving patients in health technology assessment (HTA). While this is mainly done at the level of regional and national HTA agencies, this tendency is also emerging in local HTA units. In this study we provide the results of a survey conducted in local HTA units in the province of Quebec, Canada. The aim of the survey was to provide a panorama of local HTA units practices to involve patients in their process, their interest in doing so, and their information needs for this. The survey was conducted in 2017 with a response rate of 11 units over a possibility of 12. Results indicate that only 3 units over 11 never involved patients or members of the public in their process and that all will involve them in the next few years. The three most important needs identified in the HTA units were: recruiting and selecting patients; integrating experiential knowledge; and knowing and implementing the winning conditions for partnership. To conclude, patient involvement in local HTA units is quickly evolving; that is why the latter urgently need tools to involve more effectively patients and members of the public in their process.

Key messages
There is a need to develop tools to involve patients in HTA process. Patient involvement in local HTA units is quickly evolving.
Health guidance for prevention of lifestyle-related diseases using health-related mobile applications
Authors: Tamura S , Haruyama S , Ogami A , Yokoyama A , Okuno T , Kubono Y , Takakura K , Esumi S 
Published: October 2020

Abstract

Issue
Lifestyle modifications are essential for the prevention of lifestyle-related diseases such as hypertension, hyperlipidaemia, and type 2 diabetes. Healthcare providers in Japan are required to use information and communications technologies (ICT), such as health-related mobile applications (mHealth apps), in health guidance.

Description of the Problem
To understand the results of and issues in health guidance, two searches were conducted to identify the domains of health guidance provided using ICT. We searched the PubMed and Japan Medical Abstracts Society databases to identify articles published from 2000-2018. The first search identified frameworks of health guidance provided using ICT. The second search identified primary studies about using mHealth apps published between 2000 and 2018. The sample comprised 22 unique programs from 38 primary studies. The following research questions were explored: 1) What is the purpose of using the mHealth app?
2) Is there a significant difference in the effect of using the mHealth app instead of face-to-face communication?

Results
The mHealth app was used to enhance convenience and to improve or modify lifestyle. The latter included self-monitoring, typing health information, providing knowledge, sharing information, providing encouragement and praise, and correction of action plans. Some positive effects were observed, including compensating for insufficient information, enhancing self-management, and improving degrees of satisfaction of users. Only two programs did not report a significant difference in the effect of using the mHealth app as compared to face-to-face communication.

Lessons
This review showed that the frequency of typing information about diet and exercise appeared to be related to the prevention of primary lifestyle-related diseases and the improvement of self-management behaviour.

Key messages
Use of the mHealth app for providing health guidance might enhance continuous support for self-monitoring and self-management behaviour. Use the mHealth app for providing encouragement and praise might promote a smooth conversation, which in turn would facilitate appropriate self-management behaviour.
Multidisciplinary Day Surgery Unit: a Health Technology Assessment
Authors: Pietrantonio M , Caracciolo A , Barbarino A , Triassi M 
Published: October 2020

Abstract

Issue
The aim of this study was to improve effectiveness, efficiency and quality of healthcare provided in Day Surgery (DS) setting at “Villa Malta” Hospital in Sarno (Italy). Health Technology Assessment (HTA) was used to compare two organisational models: the first one, in force at the beginning of the study, was characterized by a decentralisation of care activities at the individual Surgery Units; the other one provided for a centralisation of care activities in one unit, named the Multidisciplinary Day Surgery Unit (MDSU).

Description of the Problem
We evaluated economical (cost-minimisation analysis), performance (effectiveness, efficiency, appropriateness, quality and safety) and ethical-social aspects. The cost-minimisation analysis took into account costs incurred and revenues received (DRG-based reimbursement). The perceived quality and the ethical and social impacts were assessed by reference to the voluntary interruption of pregnancy (VIP) and the increasing offer of the Otorhinolaryngology services.

Results
MDSU has resulted in a net gain of €1,261,097 per year. This is a result of the increase in hospitalisation production of €1,235,869 and the savings on staff costs of €30,476. The new model also shown an improvement in efficiency through standardisation of the number of DS admissions and in perceived quality concerning VIP, ensuring greater privacy and humanisation for the patients. Finally, the introduction of the Otorhinolaryngology services in DS has increased the quality of healthcare on offer, without the need to transfer the surgical candidates to other hospitals.

Lessons
The centralised model has shown definite advantages over the decentralised one. MDSU was adopted to provide DS services at “Villa Malta” Hospital and this organisational model could be chosen by other hospitals to improve quality of healthcare.

Key messages
MDSU has advantages especially in economic, ethical and social terms. MDSU increases hospitalisation production, improves humanisation of patients and increases quality of healthcare on offer.