bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving mucosal anesthesia for awake endotracheal intubation with a novel method using dyclonine hydrochloride: A prospective, assessor-blinded, randomized controlled trial
Authors: Han Chunji , Li Peng , Guo Zhenggang , Guo Ying , Sun Li , Chen Gang , Qiu Xiaojue , Mi Weidong , Zhang Changsheng , Berra Lorenzo 
Published: August 2020

Abstract
Background: Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation. Methods: This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed. Results: Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). Conclusions: In awake endotracheal intubation, novel care using oral dyclonine mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray.
An Approach to Assessing Patient Satisfaction in HCAHPS Databases by Analyses Using Distances.
Authors: Okuda Masumi , Yasuda Akira , Tsumoto Shusaku 
Published: August 2020

Abstract
Background: Patient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital characteristics but reports on the structure of patient satisfaction with respect to similarities among domains are scarce.Objective: To explore whether similarities among patient-satisfaction domains are influenced by hospital characteristics by analyses using distances, and to design a model evaluating relationships between the structure of patient satisfaction and hospital characteristics.Methods: Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported the adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital characteristics, followed by clustering, correspondence analysis and ordinal multidimensional scaling. The measures were divided into three groups plus cleanliness.Results: Certain combinations of these groups were shown to be dependent on hospital characteristics. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital characteristics, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital characteristics.Conclusions: Analyses using distances can reveal the hidden structure of patient satisfaction. This study suggests that hospital characteristics including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.
DEA Analysis of Municipal Hospital Services and Scale After Hierarchical Medical Treatment Policy Was Implemented in China
Authors: Li Yuanyuan , Wang Yuzhu , Zhao Yongqiang 
Published: August 2020

Abstract
Background: We aimed to provide decision basis for optimizing resource allocation by hospital administrators in China.Methods: The samples were 18 municipal TCM hospitals of all public TCM hospitals of Gansu province in 2017. The BCC DEA model was employed to evaluate the relative efficiency of hospital operation. The slack variables in non DEA effective hospitals were employed to give the guidance how to achieve to the DEA effective.Results: Firstly, the demands for medical services kept surging will lead to the scale return of most municipal-level TCM hospitals tend to the stable although part of it appear the decline or increase in return scale. Therefore, these municipal-level TCM hospitals should further pay attention to make full use of existing resources. Secondly, some municipal-level TCM hospitals with decline in return scale or increase in return scale should adopt different management measures for different situations, which in details in results and discussions sections.Conclusion: After the implementation of healthcare policy such as graded diagnosis and treatment, hospital managers should learn advanced management concepts, use scientific management tools and software, carry out closed-loop management, make constant adjustments according to evaluation indicators, reduce management costs, and ensure the vitality of hospital operation.
When to Resume Bariatric Surgery After COVID-19 Pandemic? – Results of Patients’ and Surgeons’ Survey.
Authors: Dudek Alicja , Wysocki Michał , Walędziak Maciej , Szeliga Jacek , Proczko-Stepaniak Monika , Pedziwiatr Michał , Major Piotr 
Published: August 2020

Abstract
BackgroundCoronavirus Disease 2019 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state.MethodsThe study was conducted in two groups: Group 1 – bariatric patients; Group 2 – bariatric surgeons. Two online surveys were distributed.Results A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p<0.001) and contact with COVID+/quarantined persons (p<0.001) had impact on the response to resumption of bariatric procedures. ConclusionsPatients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel. Trial registration: 1072.6120.103.2020
Polytobacco Use Among a Nationally-Representative Sample of Black High School Students
Authors: Gilreath Tamika D. , Dangerfield Derek T. , Ishino Francisco A. Montiel , Hill Ashley V. , Johnson Renee M. 
Published: August 2020

Abstract
Introduction. Studies of the patterns of polytobacco use have increased. However, understanding the patterns of using multiple tobacco products among Black adolescents is minimal. This study identified the patterns of polytobacco use among U.S. Black adolescents. Methods. Latent class analysis (LCA) was used to identify patterns of adolescent polytobacco use among a representative sample of Black youth from the 2017 Youth Risk Behavior Survey (n = 2,782). Ever and recent (past 30 day) use of cigarettes, electronic cigarettes, cigars, and dip or chewing tobacco were used as latent class indicators. Multinomial regression was conducted to identify the association if smoking adjusting for age, grade, and marijuana use. Results. Most students were in the 9th grade (29%), e-cigarette users (21%) and were current marijuana users (25%). Three profiles of tobacco use were identified: Class 1: Non-smokers (81%), Class 2: E-cigarette Users (14%), and Class 3: Polytobacco Users (5%). Black adolescent Polytobacco users were the smallest class, but had the highest conditional probabilities of recent cigarette use, e-cigarette use, ever smoking cigars or chewing tobacco. Ever and current use of marijuana were associated with increased odds of being in the e-cigarette user versus non-smoker group, and current marijuana use was associated with increased odds of polytobacco use (aOR = 24.61, CI = 6.95–87.11). Conclusions. Findings suggests the need for targeted interventions for reducing tobacco use and examining the unique effects of polytobacco use on Black adolescents. Findings confirm a significant association of marijuana use with tobacco use.
Fostering Innovative Behavior in Health Organizations – a PLS-SEM Analysis of Norwegian Hospital Employees
Authors: Mutonyi Barbara Rebecca , Slåtten Terje , Lien Gudbrand 
Published: August 2020

Abstract
Background: Health organization research is experiencing a strong refocus on employees’ individual innovative behavior (IIB), revealing that many of its influential factors at work remain uncertain. Hence, this study empirically examines how hospital employees’ IIB is fostered by focusing on antecedents such as organizational culture (here labeled an internal market-oriented culture, IMOC), psychological capital (PsyCap), and outcomes such as organizational commitment (OC). In addition, the study examines the mediating role of PsyCap.Methods: The study focused on a sample of 1008 hospital employees, using a partial least squares structural equation modeling method to analyze and test the relationships hypothesized in this study. A multigroup comparison was performed to test the heterogeneity of personal characteristics. The indirect effects of PsyCap were tested by mediator analyses.Results: Our results reveal that IMOC has a positive and significant influence on employees’ PsyCap and IIB. PsyCap is directly related to IIB and acts a mediator between IMOC and IIB. Furthermore, the study found that IIB is related to the outcome variable OC.Conclusions: This study extends the current debate on how IIB is fostered at work by examining PsyCap and IMOC as antecedents of IIB. The study has added to the IIB research area by introducing OC as an outcome variable. The study is among the first attempts in its category to contribute to health organizations and managers by empirically examining the influence of IMOC on employees’ PsyCap and IIB and in turn their OC.
Does Admission Prevalence Change After Reconfiguration of Inpatient Services?
Authors: Turner Steve , Martin Joanne , Raja Edwin Amalraj 
Published: August 2020

Abstract
Background. Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services?Methods. There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions.Results. Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions. There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.
Hidden Bedside Rationing in the Netherlands: a Cross-sectional Survey Among Internists
Authors: de Ruijter Ursula , Lingsma Hester , Bax Willem , Legemaate Johan 
Published: August 2020

Abstract
Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice.Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics.Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n=203). Most participants (n=129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n=153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR=17 95%CI 6.1-48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR=3.2, 95%CI 2.1-4.7), while salaried physicians were less likely to do so than physicians in private practice (OR=0.5, 95%CI 0.4-0.8).Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. The questions of how distribution of healthcare ought to take place, and to what degree that should include bedside rationing, remain topical and warrant a more public debate.
General Practitioners’ Experiences of Emergency Care and Treatment Planning in England: A Focus Group Study
Authors: Huxley Caroline , Eli Karin , Hawkes Claire A. , Perkins Gavin D. , George Rob , Griffiths Frances , Slowther Anne-Marie 
Published: August 2020

Abstract
BackgroundEmergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs’ experiences of using ReSPECT and how it transfers across the primary care and secondary care interface.MethodsWe conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. GPs were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis. ResultsGPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a ‘good death’ is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient’s preferences around death, and GPs’ lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings. ConclusionConceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting.
Investigation of health professionals’ knowledge retention in CPR after completing the Advance Life Support in Gynecology (ALSG) Course
Authors: Vrachnis Nikolaos , Antonakopoulos Nikolaos , Tsigirlioti Antigoni , Pergialiotis Vasilios , Iacovidou Nicoleta , Iliodromiti Zoi 
Published: August 2020

Abstract
Background

Studies have shown that immediate and effective cardiopulmonary resuscitation plays a major role in the survival of victims of cardiac arrest. Numerous studies also demonstrate the need for continuous training of health professionals. In Greece life support courses are established in various fields including pediatrics, obstetrics and gynecology. The ALSG (Advanced Life Support in Gynecology) course was initiated in 2011 and covers gynecological emergencies that often lead to cardiopulmonary arrest, including ruptured ectopic pregnancy, toxic shock syndrome and postoperative collapse. The purpose of this study was to investigate knowledge retention in CPR after completion of the ALSG course and to define the factors affecting it.
Methods

A descriptive qualitative study was, designed and conducted through anonymous questionnaires sent electronically to past ALSG course participants.
Results

A total of 100 questionnaires were sent and 50 were completed and returned. Mean knowledge retention was 87.4 ± 18.2. The multivariate analysis revealed that the time interval since training in life support significantly correlated with the actual score. Additionally, more correct answers were given by course instructors than certified course graduates.
Conclusion

Instructors in life support courses achieve longer retention of their knowledge than trainees, while increased time interval between training and knowledge recall results in lower scores. In conclusion, continuing education of health professionals and adoption of algorithms, such as those taught in the ALSG course, are likely to help maintain knowledge and achieve high standards of care.
Why do pre-clinical medical students learn ultrasound? Exploring learning motivation through ERG theory
Authors: Wang Ting-Cheng , Chen Wei-Ting , Kang Yi-No , Lin Che-Wei , Cheng Chung-Yi , Suk Fat-Moon , Chen Hao-Yu , Wang Chin-Wang , Fong Tsorng-Harn , Huang Wen-Cheng 
Published: August 2020

Abstract
Background
Point-of-care ultrasound (POCUS) has become a hot issue and trend in medical education in recent years. Ultrasound is an indispensable skill for clinical physicians. Previous studies have already discussed the importance of and advancements in ultrasound education. However, learning motivations with regard to ultrasound education have seldom been discussed in the literature. For medical students, learning ultrasound could have a strong connection with their future career. ERG theory extended Maslow's hierarchy of needs through the concepts of existence, relatedness, and growth. The theory has been widely used in the workplace to analyze employee job performance but has not been applied in medical education. As mentioned above, we seek to analyze pre-clinical medical students’ learning motivation toward ultrasound education with regard to their future careers by applying ERG theory.
Method
This mixed method design used questionnaires for data collection. We also produced further qualitative and quantitative results. The research team asked learners neutral and open-ended questions. After data collection, three steps for analysis were followed based on grounded theory. Finally, the results of the thematic coding were used to complete the quantitative analysis.
Results
Our study involved 140 pre-clinical medical students, and their responses fell into 13 categories. Our test showed that students’ motivations toward ultrasound learning were unbalanced across the three ERG domains (F = 41.257, p < .001). Pairwise comparisons showed that students mentioned existence motivation (MD = 39.3%; p < .001) and growth motivation (MD = 40.7%; p < .001) more than relatedness motivation. However, there was no significant difference between existence motivation and growth motivation (MD = -1.4%; p = .830).
Conclusion
Based on our survey, first, we found that students placed a high value on existence and growth needs rather than relatedness. In addition, we recommend that ERG theory be applied in medical education motivation analysis.