bluuebunny/crossref_metadata_2025_split huggingface dataset:
Could health information systems enhance the quality of Aboriginal health promotion? A retrospective audit of Aboriginal health programs in the Northern Territory of Australia
Authors: Percival Nikki Ann , Boucher Priscilla , Conte Kathleen , Robertson Kate , Cook Julie 
Published: October 2020

Abstract
Background: In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory’s publicly funded healthcare system introduced the Quality Improvement Program Planning System (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion. Methods: A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion. Results: 39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, ‘needs assessment’ findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded. Conclusion: This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems.
Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project.
Authors: Zgierska Aleksandra E , Robinson James M , Lennon Robert P , Smith Paul D , Nisbet Kate , Ales Mary W , Boss Deanne , Tuan Wen-Jan , Vidaver Regina M , Hahn David L 
Published: October 2020

Abstract
Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations. Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p<0.05, 95% confidence intervals and/or Cohen’s d. Results: Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1,255 patients in the QI and 1,632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p=0.019) and prescribed ≥90mg/day MED (23.0% vs 15.5%, p=0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p=0.02), but not other outcomes (p³0.05). Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented.Trial Registration – Not applicable
Cost-effectiveness analysis of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa
Authors: Miot Jacqui , Leong Trudy , Takuva Simbarashe , Parrish Andrew , Dawood Halima 
Published: October 2020

Abstract
Background: Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135 000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications of introducing flucytosine as induction therapy for cryptococcal meningitis in HIV-infected adults in South Africa. Methods: A decision analytic cost-effectiveness analysis and cost impact model was developed based on survival estimates from the ACTA trial and local costs for flucytosine as induction therapy in HIV-infected adults with cryptococcal meningitis in a public sector setting in South Africa. The model considered five treatment arms: (a) standard of care; 2-week course of amphotericin B/fluconazole (2wk AmBd/Flu), (b) 2-week course of amphotericin B/flucytosine (2wk AmBd/5FC), (c) short course; 1-week course amphotericin B/flucytosine (1wk AmBd/5FC) (d) oral course; 2-week oral fluconazole/flucytosine (oral) and e) 1-week course amphotericin B/fluconazole (1wk AmBd/Flu). A sensitivity analysis was conducted on key variables. Results: The highest total treatment costs are in the 2-week AmBd/5FC arm followed by the 2-week oral regimen, the 1-week AmBd/5FC, then standard of care with the lowest cost in the 1-week AmBd/Flu arm. Compared to standard of care the 1-week flucytosine course is most cost-effective at USD106/QALY. The cost impact analysis shows that the 1-week flucytosine course has an incremental cost of just over USD293 per patient per year compared to what is currently spent on standard of care Sensitivity analyses suggest that the model is most sensitive to the probability of survival at 12 months and hospital costs, particularly length of stay. Conclusions: The addition of flucytosine as induction therapy for the treatment of cryptococcal meningitis in patients infected with HIV is cost-effective when it is used as a 1-week AmBd/5FC regimen. Savings could be achieved with early discharge of patients as well as a reduction in the price of flucytosine.
Effects of environmental distractors on nurse emergency triage accuracy: a pilot study protocol
Authors: delmas philippe , fiorentino Assunta , antonini matteo , Vuilleumier severine , Stotzer guy , Kollbrunner Aurélien , Jaccard Dominique , Hulaas Jarle , Rutschmann Olivier , simon josette , Hugli Olivier , de Keranflec’h Charlotte Gilart , pasquier jerome 
Published: October 2020

Abstract
Background: The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/Design: A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A: noise, B: task interruptions, C: noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within two hours. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion: Study results will inform the design of large-scale investigations and will help identify teaching, training and research areas that require further development.
Reducing regional health inequality: A sub-national distributional cost-effectiveness analysis of community-based treatment of childhood pneumonia in Ethiopia
Authors: Olsen Maria , Norheim Ole F. , Memirie Solomon Tessema 
Published: October 2020

Abstract
Background: Increasing the coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to improve child survival, increase life-expectancy at birth and promote equity in Ethiopia. However, full coverage of CCM has not been reached in any regions of the country. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale up strategy.Objectives: Our first objective is to estimate the sub-national cost-effectiveness and the interindividual inequality impacts of scaling up CCM coverages to 90 percent in each region. Our second objective is to explore the costs, health effects, and geographical inequality impacts associated with three scale-up scenarios promoting different policy-aims: maximizing health, reducing geographical inequalities, and achieving 90% universal coverage.Methods: We used Markov modelling to estimate the sub-national cost-effectiveness of CCM in each region. All data were collected through literature review and adjusted to the region-specific proportions of the rural population. Health effects were modeled as life years gained and under-five deaths averted. Interindividual and geographical inequality impacts were measured by the GINI index applied to health. In scenario analysis we explored three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequalities by prioritizing the regions with high baseline under-five mortality rate (U5MR), and 3) universal upscaling to 90% coverage in all the regions.Results: The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the Southern Nations, Nationalities, and Peoples' region. Universal upscaling of CCM in all regions would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of fewer lives saved as compared to the health maximizing strategy.Conclusions: Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.
Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer
Authors: ye yunlin , Chen Zhuang-fei , Bian Jun , Liang Hai-tao , Qin Zi-ke 
Published: October 2020

Abstract
Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy exposure for those children. Methods: The decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as relapse rates of different groups during surveillance or after chemotherapy were collected from literatures. And a survey to urologist was performed to evaluate the toxicity of the first-line and second-line chemotherapy. Using decision analysis model, chemotherapy exposure between risk-adapted treatment and surveillance were compared based on this series of clinical utilities. One-way and two-way tests were administrated to check the feasibility. Results: In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to first-line chemotherapy. Conclusions: Using decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients and precious evaluation after orchiectomy was critical to this process. Further clinical study was needed to validate this statement.
Brief psychotherapy administered by non-specialised health workers to address risky substance use in inpatients with multi-drug resistant tuberculosis: A feasibility and acceptability study
Authors: Calligaro Gregory , De Wit Zani , Cirota Jacqui , Orrell Catherine , Myers Bronwyn , Decker Sebastian , Stein Dan , Sorsdahl Katherine , Dawson Rodney 
Published: October 2020

Abstract
Background: Only 55% of multi-drug resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use among MDR-TB patients in general, and on their delivery by non-specialist health workers in particular. Objectives: To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. Methods: Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the four weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered three-months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n=10). Results: Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. Conclusion: In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. Trial registration: South African National Clinical Trials Register (DOH-27-0315-5007) on 01/04/2015 (http://www.sanctr.gov.za). Funding: National Institute for Drug Abuse (NIDA), AIDS Clinical Trials Group (ACTG).
Advance Directives and End-of-Life Care: Knowledge and Preferences of Patients with Brain Tumours from Anhui, China
Authors: Wang Yi Xin , Zhang Yong Kang , Hong Yang , Zeng Ping , Hu Zong Tao , Xu Xiu Li , Wang Hong Zhi 
Published: October 2020

Abstract
Background: In Mainland China, the advance directives (ADs) and end-of-life care of patients with tumours, especially patients with brain tumours who may have lost consciousness or the ability to speak at the early stage of their illness, have been poorly acknowledged. Thus, this study aims to clarify the knowledge and preferences of the ADs and end-of-life care of patients with brain tumours and to investigate the predictors of patients’ preferences.Methods: This was a population-based cross-sectional survey that was conducted via face-to-face interviews. Information on the sociodemographic factors, brain tumour illness, knowledge and preferences of the advance decisions and end-of-life care of the patients were collected.Results: A total of 88.61% of the participants had never heard of ADs, but 65.18% would like to make ADs. Knowledge of ADs, receiving surgical treatment or radiotherapy, less than 70 years old, male, educational qualifications of college or beyond, childless, had medical insurance for nonworking or working urban residents and self-payment of medical expenses were predictors of preference for making ADs. A total of 79.43% participants would like to discuss end-of-life arrangements with medical staff, and 63.29% of participants were willing to receive end-of-life care although it could not delay death. A total of 65.82% patients with brain tumours wanted resuscitation, and as high as 45.45% of the patients thought that they did not need life support if they were in a persistent vegetative state. Brain primary tumours, ages of less than 70 years old, male, educational qualification of junior middle school or below, had children, had new rural cooperative medical insurance and had medical expenses paid by children or spouses were predictors of choosing appropriate palliative care.ConclusionsADs and end-of-life care have been poorly acknowledged amongst patients with brain tumours in mainland China. Additional efforts should be encouraged amongst patients with primary brain tumours, those are undergoing surgery and radiotherapy and those who have low socioeconomic status. A longitudinal and comprehensive study is encouraged to promote a disease-specific ADs amongst Chinese patients with brain tumours.
Advantage of laparoscopy surgery for elderly colorectal cancer patients without compromising oncologic outcome
Authors: Chern Yih Jong , Hung Hsin-Yuan , You Jeng-Fu , Hsu Yu-Jen , Chiang Jy-Ming , Hsieh Pao-Shiu , Tsai Wen-Sy 
Published: October 2020

Abstract
Background: Laparoscopic surgery has achieved good results in elderly patients with colorectal cancer (CRC). In this study, we compared the short-term and long-term outcomes of open surgery and laparoscopic surgery in CRC patients aged above 75 years at a single tertiary medical center.Methods: Between January 2009 and December 2015, we studied 967 patients who underwent curative resection for primary colorectal adenocarcinoma without distant metastasis in a single institution. Of the enrolled subjects, 305 underwent laparoscopic surgery, and 662 received open laparotomy surgery.Results: Compared to the patients who received open surgery, those received laparoscopic surgery had prominent shorter postoperative stay (10.3 vs. 13.5 days p < 0.001) and similar postoperative mortality (p = 0.082) and morbidity (p = 0.354). In the laparoscopy cohort, 6 of 305 patients were converted to open surgery and 1 died. The long-term overall survival, cancer-specific survival and recurrence rate were all similar between both cohorts in each stage.Conclusions: Laparoscopic surgery is suitable for elderly patients due to shorter postoperative stay, similar long-term outcomes with open surgery and acceptably low conversion rates. For long-term overall and oncological outcome, the results of laparoscopic surgery were similar to that of open surgery in each TNM stage.
Hair cortisol-a method to detect chronic cortisol levels in patients with Prader-Willi syndrome
Authors: Shukur Hasanain Hamid , de Rijke Yolanda B , Rossum Elisabeth FC van , Hussain-Alkhateeb Laith , Höybye Charlotte 
Published: October 2020

Abstract
Background: Prader-Willi syndrome (PWS) is a multisymptomatic, rare, genetic, neurodevelopmental disorder in adults mainly characterized by hyperphagia, cognitive dysfunction, behavioral problems and risk of morbid obesity. Although endocrine insufficiencies are common, hypocortisolism is rare and knowledge on long-term cortisol concentrations is lacking. The aim of this study was to evaluate long-term cortisol levels in PWS by measurements of hair cortisol.Methods: Twenty-nine adults with PWS, 15 men and 14 women, median age 29 years, median BMI 27 kg/m2, were included. Scalp hair samples were analyzed for cortisol content using liquid-chromatography tandem-mass spectrometry. In addition, a questionnaire on auxology, medication and stress were included. For comparison, 105 age- and sex-matched participants from the population-based Lifelines Cohort study were included as controls. The mean hair cortisol between the groups were compared and associations between BMI and stress were assessed by a generalized linear regression model.Results: In the PWS group large variations in hair cortisol was seen. Mean hair cortisol was 12.8±25.4 pg/mg compared to 3.8±7.3 pg/mg in controls (p=0.001). The linear regression model similarly showed higher cortisol levels in patients with PWS, which remained consistent after adjusting for BMI and stress (p=0.023). Furthermore, hair cortisol increased with BMI (p=0.012) and reported stress (p=0.014).Conclusion: Long-term cortisol concentrations were higher in patients with PWS compared to controls and increased with BMI and stress, suggesting an adequate cortisol response to chronic stress. Hair cortisol demonstrate promising applications in the context of PWS treatment and disease management.