bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feedback on the transition to routine use of Connexin, a tool to improve city-hospital cooperation
Authors: Durocher V , Duburcq A , Pamart R 
Published: November 2019

Abstract

Issue
The French national health strategy “Ma Santé 2022” underlines the need to decompartmentalize the organization of care through city-hospital cooperation. The Connexin® platform aims, as part of treatments prescribed in hospitals and delivered in community, to identify all health professionals around the patient, and ensure they communicate and coordinate with each other to improve the coherence and relevance of care within the pathway.

Description of the problem
A pilot phase of deployment of the tool was conducted in two regions to measure the organizational and clinical impact of its use. This evaluation was based on qualitative interviews with the various stakeholders (local pharmacists, hospital teams, institutional partners, etc.). The objective was to assess the adoption and transition phases while identifying its effects and added value for health professionals using it.

Results
Adherence was important: many pharmacists registered, reflection on the service organization in hospital teams. Despite some access problems (codes lost, dual authentication), professionals believe Connexin® facilitates communication between primary care and hospital actors. However, transition was difficult in several hospitals (lack of support from management mainly), insufficient use by pharmacists (hampered by the new missions entrusted to them by law). Support closest to professionals in the tool implementation thus seems crucial to ensure transition to routine use.

Lessons
Connexin® is a secure, intuitive platform adapted to health professionals’ needs for cooperation. Mobilization of the various actors around the platform proves the interest for and the relevance of such a tool to optimize the efficiency of care. However, the organizational impact, no matter how small, is a barrier to the transition to routine use, a finding shared for many tools.

Key messages
While the platform was designed by primary, hospital and institutional health professionals, the study points out the need to set up a project governance and appropriate support during implementation. Any organization impact is an obstacle to the evolution of practices.
How to implement a successful smoking cessation intervention for adolescents?
Authors: Vallata A , Alla F 
Published: November 2019

Abstract

Background
Policies and programs implemented to promote smoking cessation among youth present disparate results. These variations are explained by interventions themselves but also by context, population and implementation characteristics. Our objective was to analyze these factors, related to enrollment and participation in a smoking cessation program, implemented in vocational or technical schools.

Methods
Population factors were studied by a systematic review about determinants of smoking cessation among 10-24 years old, updating a previous one.
Contextual and implementation factors were identified by a qualitative multiple cases study. A smoking cessation program, TABADO, had been implemented in 3 regions in France, in 10 vocational or technical schools (1 school/1 case). Data collection included 51 observations, 46 semi-structured interviews, and 3 interdisciplinary seminars.

Results
The review identified 46 factors probably or possibly related to a successful smoking cessation, both individual (e.g. smoking frequency) and collective (e.g. relationship smoking status, anti-tobacco legislation). The case study allowed us to objectify positive or negative factors that influence the enrollment and the participation in the program (e.g. presence of a referent in the school, combination with the school program). Finally, we identified prerequisites to gather before starting such a program.

Conclusions
This mixt design highlights factors on which we must focus to increase the success of a smoking cessation program for youth. A key factor is to tailor intervention and implementation modalities to the local context. Results enabled us to product a pragmatic guide, TABADO 2, which is now used in a national scaling process. They also will be used to build an intervention theory, which could be used for any smoking cessation intervention for youth.
Acknowledgments: The TABADO IDF study group, Inca, the région Lorraine and the ARS Nouvelle-Aquitaine for their financial support.

Key messages
A smoking cessation program must be a global strategy, considering contextual, population and organizational factors. Instead of trying to strictly apply a protocol, a complex intervention must be tailored to the context in which it is implemented.
Relevance of the health insurance databases to study potentially inappropriate prescriptions
Authors: Jardin M , Banide M C , Saba G , Burlot E , Jozancy F , Guagliardo V , Verger P 
Published: November 2019

Abstract

Issue/problem
Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events.

Description of the problem
In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area.

Results
Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017.

Lessons
These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices.

Key messages
A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.
Complexity in managing the blood transfusion process: experience of an Italian Academic Hospital
Authors: Poletto M , Scarpis E , Bianchet B , Ruscio E , Degan S , Farneti F , De Angelis V , Brusaferro S 
Published: November 2019

Abstract

Issue
Blood components transfusion is a high-risk process due to its complexity and possible consequences in case of error. Preventing mistakes and acting promptly if they occur is a duty of healthcare organizations. The Italian Ministry of Health has drafted a specific recommendation with the aim of reducing transfusion errors.

Description of the problem
Following a transfusion error occurred in July 2018, a multidisciplinary group including professionals from Clinical Risk Unit (CRU) and Transfusion Department of the Academic Hospital of Udine, carried out an analysis of the blood components issuing process. The 20 most critical steps were identified and grouped into 3 areas: 1)single samples processed individually, 2)appropriate application compliance, 3)environmental interferences. For each step shared solutions were identified and then implemented as new standard practices. From February to March 2019, CRU randomly observed 23 blood components assignments using tracer methodology, evaluating staff’s compliance with the new recommended practices (NRP).

Results
For the sample processing (area 1, n.10 practices), adherence to all ten NRP was 100% (26/26). For the appropriate application compliance (area 2, n.8 practices), adherence to 7 NRP was 100% (11/11), whereas for one (punctual registration of non-conformities) adherence was 86% (6/7). For the environmental interferences (area 3, n.2 practices), adherence to one practice was 100% (2/2), whereas for the other one (avoid answering to incoming phone calls) adherence was 75% (3/4). Overall, professionals behaviour was consistent with the NRP in the observed period.

Lessons
Identification of critical issues by a multidisciplinary team and measuring the adherence to new practices is crucial in managing the complexity of blood transfusion process.
Tracer methodology, used by CRU to verify adherence to new standard, also allows the hospital to monitor the progress of the achieved performances over time.

Key messages
Multidisciplinary analysis of the blood transfusion process and shared development of new standard by all professionals favours their compliance in the practice. Tracer methodology is a useful tool to evaluate adherence to recommended practices and monitor the complexity of transfusion process over time.
Carbapenemase-producing Enterobacteriaceae (CPE) patient notification exercise
Authors: Murphy L , Tysall L , Wellington L , Guthrie L , Inverarity D , Willocks L , Czarniak E , McCallum A , Gillies T 
Published: November 2019

Abstract

Issue
CPE has become endemic in many European countries. Scotland has few locally acquired cases at present and interventions are aimed at minimising transmission of CPE into acute hospital settings.

Description of the problem
NHS Lothian held an incident management team (IMT) following the transmission of CPE in an inpatient setting. Initial management of the incident included informing and screening all inpatient contacts, enhanced infection control precautions and staff education. The IMT considered whether to inform and screen patient contacts who had been discharged. A literature review was carried out and teams in the UK who had considered patient notification exercises for CPE were contacted. This highlighted variation in approach.
The IMT assessed whether a patient notification exercise was required and considered: The need to reduce the risk of CPE transmission in acute hospitals by screening and isolating community contacts on readmission to hospital.The ethics of raising patient anxiety around CPE transmission with limited options for effective treatment.Risk stratification to identify contacts at highest risk.Information Governance: electronic tagging of case notes if patients have not been informed.

Results
The IMT agreed that a patient notification was appropriate. Contacts were risk assessed to determine those at greatest risk of CPE transmission. After speaking to GPs, 33 patients were sent letters. No screening of community contacts was advised unless they were re-admitted to an acute hospital or resided in a care facility. No further CPE reports have been linked to the situation.

Lessons
The IMT worked through the issues systematically to protect the public’s health without infringing their rights. The IMT advised that the Scottish CPE toolkit should be revised to support future Incidents including how to analyse transmission pathways, undertake patient notification exercises and meet public health ethics standards.

Key messages
There needs to be clear guidance on how to manage contacts of patients with CPE once discharged from hospital. Team work between Public health and Infection control is essential in manageing incidents of CPE in hospitals.
An objective structured clinical examination to assess the communication skills of students
Authors: Bekbergenova Z , Derbissalina G , Umbetzhanova A , Alibekova G , Mauletbayeva G , Akhmetova D , Zhunussova D , Koikov V 
Published: November 2019

Abstract

Background
Communicative competence is one of the important components of professional competence that needs to be developed in the process of training future doctors.

Methods
At the end of the study of the “General Practice” module, students of the 5th year of the specialty General Medicine must pass a two-stage exam consisting of comprehensive testing and acceptance of practical skills of an objective structured clinical exam (OSKE) with the participation of volunteers. Students, who passed the exam, anonymously filled out the questionnaire on the evaluation of the organization of the OSKE with volunteers and their communication skills.

Results
The analysis of the questionnaires showed that 4% of the students noted the unfriendliness of the volunteers, 27% wrote that it was difficult to engage with the volunteers in the collection of the anamnesis, 2% of the students, unfortunately, had never before encountered a similar situation. 12% of students who passed the exam wished to improve the communication skills of the volunteers themselves, for example, they advised to speak louder, not to ask unnecessary and unnecessary questions, to get more real in the role of the patient. Only 10% of examinees decided that OSKE did not develop their communication skills; 24% noted individual stations, which caused them some difficulties. However, the students themselves acknowledged their poor preparedness, including during communication with standardized patients.

Conclusions
The analysis of the questionnaires showed that the students themselves are self-critical of their communication skills and recognize the need for their continuous improvement.

Key messages
The student’s communicative competence can be assessed by conducting an objective structured clinical examination. Conducting an objective structured clinical examination with volunteers can improve the communicative competence of students.
Formative dialogue research - an appropriate strategy in community public health projects?
Authors: Ausland L H , Stang I 
Published: November 2019

Abstract

Background
Lately, there has been a call for knowledge-based community public health strategies and for evaluating local public health interventions. In addition to contributing to the public health knowledge base, it is underlined that the evaluations should be formative for ongoing local processes. The community professionals often lack evaluation competency, and a university course (10 ECTS) about process- and self-evaluation has been developed and facilitated for local public health workers. Vestfold County Council and University of South-Eastern Norway have collaborated to develop the course. The course has a particular focus on Formative Dialogue Research (FDR). FDR strategies may emphasize both project impact and processes, and local competences. The FDR approaches also contributes to the public health knowledge base (Rønningen 2010).

Objective
To examine and discuss whether FDR in combinations with an evaluation course, may be an appropriate strategy to meet the new expectations for community public health evaluations.

Results
Preliminary results indicate that FDR in combination with a evaluation course, may be an appropriate and desirable approach in community public health projects. The local public health professionals welcome the course. The focus has until now been on the development of the course and the cooperation and dialogues between the university and the county. Questionnaire and interview data collected in September 2019 will exemplify and nuance these preliminary results.

Conclusions
So far, the developing process indicate that FDR in combination with a course in self- and process evaluation, support FDR as an appropriate evaluation approach in community public health projects and processes.

Key messages
The local public health workers often lack competences in project evaluation. FDR in combination with a comprehensive course in process and self-evaluation seem appropriate evaluation approaches in community public health projects.
The role of Emotional Intelligence in health care professionals burnout
Authors: Arnone R , Cascio M I , Parenti I 
Published: November 2019

Abstract

The purpose of this study is to explore the relationship between Emotional Intelligence (EI) and burnout in health care professionals. More specifically, this survey has the purpose of demonstrating the role of EI as a protective factor against the risk of burnout. Health professionals (doctors, nurses, and other caregivers) composed the sample. Health care professionals were invited to complete the following tests: Self Report Emotional Intelligence Test (Schutte et al., 1998; it. ad. Craparo, et al.[35]); Link Burnout Questionnaire,LBQ; Other variables, such as gender, lenght of service (years of professional experience) and organizational department. Major results of this survey underline the relationship between EI and burnout. More specifically, there is a negative and significant correlation between burnout and Emotional Intelligence. Moreover, burnout varies depending on length of service: burnout increases between 5 and 10 years of experience and decreases over 10 years. Indeed, burnout is differently expressed amongst healthcare professionals: more specifically, Psycho-physical exhaustion, Detriment of the relationships and Burnout (total score) impact physician (doctors) more than other investigated health professionals.
These findings seem to suggest the opportunity to improve Emotional Intelligence abilities through specific training programs, useful to promote the ability to cope with stress and to enrich the relationships in the workplace.

Key messages
Burnout is more diffuse among health professionals working in emergency departments. Emotional intelligence has the role to cope with burnout.
The depression phenotype in a European population-based study
Authors: Cuschieri S , Mamo J 
Published: November 2019

Abstract

Introduction
Depression is a growing public health concern and associated with a number of co-morbidities including diabetes mellitus. The aim was to estimate the prevalence of depression at a population level across different glycaemic statuses while establishing phenotypic characteristics of this sub-population.

Methods
A national representative cross-sectional study was conducted in Malta (2014-6). Participants were categorized into different sub-populations according to their glycaemic status. Depression prevalence rates and bio-socio-economic characteristics for each sub-population were established. Multiple regression analyses performed to identify links between glycaemic status and depression.

Results
Depression was prevalent in 17.15% of our study population (CI 95%: 16.01 - 18.36) with a female predominance. The normoglycaemic sub-population had the highest depression rates. Persons with known diabetes had a higher probability of having a history of depression (OR:2.36 CI 95%:1.12 - 4.96), as well as with being of female gender, having lower educational status, smoking tobacco and having established cardiovascular disease.

Conclusions
Depression was highly prevalent among the normoglycaemic population. Primary care physicians should implement a depression screening tool as part of their routine health check-ups, with special attention to those with cardiovascular co-morbidities and low socioeconomic status.

Key messages
Depression prevalent mostly in the normoglycemic population. Screening for depression should be part of routine health check-ups.
Depressive symptoms and suicidal ideation among medical students: a cross-sectional survey in Turin
Authors: Lo Moro G , Bert F , Olivero E , Rossello P , Corradi A , Barello S , Leombruni P , Gualano M R , Siliquini R 
Published: November 2019

Abstract

Background
A high prevalence of mental illnesseshave been detected in medical students (MS) during college. The aim of this study was to evaluate depressive symptoms (DS) and suicidal ideation (SI) in MS and estimate factors that can influence these conditions.

Methods
In November 2018 a cross-sectional survey was conducted at the School of Medicine of Turin, Italy. The questionnaire consisted of a 30-item sociodemographic part and 3 psychometric tests, including the Beck Depression Inventory II (BDI-II). Overall, 506 surveys were collected. Multivariable logistic regressions were performed mainly. The significance level was p ≤ 0.05.

Results
Females were 65% and median age was 22 (IQR 19-24). Median BDI-II score was 9 (IQR 4-15). Presence of DS (BDI-II score&gt;13) and of SI was found in 29% and 15% of the sample, respectively. Preliminary results showed that females (OR 2.03, CI: 1.16-3.56), non-heterosexuals (OR 2.69, CI: 1.49-4-84), participants negative about their college choice (OR 4.79, CI: 2.78-8.26) had a higher risk to report DS. MS who consider unsatisfying their friendships with classmates had a higher likelihood of reporting DS and SI (OR 3.10, CI: 1.16-8.30; OR 2.91, CI: 1.10-7.68, respectively). While the opposite was for those with good economic condition (OR 0.39, CI: 0.16-0.91; OR 0.21, CI: 0.09-0.52, respectively) and those practicing sports more than 90 min/week (OR 0.60, CI: 0.37-0.99; OR 0.47, CI: 0.25-0.89, respectively). Choosing Medicine for profit was related to a higher risk of reporting SI (OR 3.36, CI: 1.43-7.92), having a good family bond to a lower risk instead (OR 0.42, CI: 0.20-0.84).

Conclusions
Since depression is the leading cause of disability worldwide, it has to be a public health priority in Europe. It is essential to consider MS as at risk and set up interventions to improve factors surrounding them and help them to face difficulties in personal and academic life, without forgetting that they will be the future health professionals.

Key messages
Females, non-heterosexuals, students negative about Medical School choice and students unsatisfied with their friendships with classmates had a higher risk of reporting depressive symptoms. Students unsatisfied with their friendships with classmates and students who chose Medical School for profit had a higher risk of reporting suicidal ideation.