bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the Impact of the Digital Health Drug Repository in Ontario
Authors: Soobiah C. , Phung M. , Tadrous M. , Bhatia S. , Jamieson T. , Desveaux L. 
Published: August 2020

Central repositories of drug‐related information have the potential to reduce adverse events and inappropriate prescribing by enabling clinicians to access relevant details at the point of care. In 2016, the Ontario Ministry of Health developed the Digital Health Drug Repository (DHDR) to support clinicians in developing a best possible medication history (BPMH). We conducted a formative evaluation of the DHDR to understand (1) the perceived clinical value DHDR; and (2) the barriers and enablers to adoption and meaningful use.A multimethod approach including semistructured interviews and an online clinician survey. Interview data were thematically analyzed, and survey data were analyzed using descriptive statistics.Clinicians included physicians, nurses, pharmacists, and allied health providers who were eligible to use the DHDR (irrespective of use).Thirty‐three interviews were conducted. Most participants were female (60%, n = 20), worked in acute care settings (46%, n = 15), and self‐reported using the DHDR > 4 times (78%, n = 26). Participants were satisfied with the DHDR as source of secondary information, but the absence of specific data such as medication instructions and prescribed medications that were not dispensed limited its utility. Poor integration with point‐of‐care systems further limited potential, with no perceived impact on the development of a BPMH. Of the 167 survey participants, the majority were female (82%, n = 137) and worked in acute care settings (58%, n = 90). Only 24% (n = 40) were actively using DHDR. DHDR users were neutral in their perceptions of the utility of DHDR (mean scores ranged 4.11‐4.76 on a 7‐point adjectival scale). Of the 76% (n = 127) who were not using the DHDR, many found access to medication information very important (mean scores ranged 6.22‐5.97). Reasons for not using DHDR included cumbersome process to gain access to DHDR and the perception that the repository was incomplete.Findings from this evaluation suggest that there is potential untapped value if a digital centralized medication repository is operationalized to align with clinician needs. Specifically, (1) integration with point‐of‐care systems; (2) comprehensive clinical data; and (3) quick and streamlined onboarding processes would facilitate meaningful use.Digital drug repositories can be a valuable tool for clinicians when determining a BPMH for a patient. Access to comprehensive medication information across the health care system can improve efficiency and reduce medical errors. These applied insights can inform the operationalization and implementation of system‐wide strategies to improve their uptake and impact.Ontario Ministry of Health Canada.
Out‐of‐State Childbirths Disproportionately Increased Among Racial and Ethnic Minorities Since the Implementation of the Tennessee Fetal Assault Law
Authors: Choi S. , Leslie D. 
Published: August 2020

Research ObjectiveThe Tennessee Fetal Assault Law (TFAL), which allowed for the prosecution of women who used narcotic drugs during pregnancy, was enacted in 2014 to reduce the incidence of neonatal abstinence syndrome in Tennessee (TN). We analyzed the association of the law’s implementation with out‐of‐state childbirths among racial and ethnic minorities in TN.Study DesignUsing the National Vital Statistics System’s Natality Data from January 2009 to June 2016, we used multivariate logistic regression models to evaluate the probability of having out‐of‐state versus in‐state childbirths among Medicaid beneficiaries from TN compared to beneficiaries from bordering states. We employed a difference‐in‐differences approach, exploiting the change in law implementation over time (first difference) in Tennessee relative to neighboring states (second difference) and tested whether racial and ethnic minorities in TN were disproportionately affected by the TFAL.Population StudiedOur sample included all live hospital‐born singleton infants of Medicaid beneficiaries aged 18‐44 years in TN and its bordering states including Alabama, Arkansas, Georgia, Kentucky, Mississippi, Missouri, North Carolina, and Virginia.Principal FindingsWe identified 1 655 256 eligible births in our study, with 284 620 born in TN and the remaining 1 370 636 born in TN’s bordering states from January 2009 to June 2016. Empirical analyses showed that implementation of the TFAL was significantly associated with higher rates of out‐of‐state childbirths among TN residents and the association was higher among racial and ethnic minorities. Since the TFAL implementation, the odds of delivering out‐of‐state among non‐Hispanic whites increased by 2.5 times (OR: 2.52; 95% CI: 1.34, 4.74). During the same period, however, the odds of delivering out‐of‐state among Hispanics and African Americans increased by 3.4 times (OR: 3.36; 95% CI: 1.35, 8.37) and 7 times (OR: 7.03; 95% CI: 3.02, 16.33), respectively.ConclusionsOur findings suggest that prosecution of narcotic drug use during pregnancy can discourage in‐state delivery among Medicaid beneficiaries, and racial/ethnic minorities are more likely to deliver out‐of‐state compared with non‐Hispanic whites.Implications for Policy or PracticeAlthough the TFAL was discontinued in 2016, the number of states with punitive policies for drug use during pregnancy has increased from one in 1974 to 23 in 2020. Despite good intentions, the results of this study suggest that fetal assault laws may have the unintended consequence of increasing risk to both the mother and the fetus by deterring pregnant women among racial/ethnic minorities who use illicit drugs from giving birth in‐state.
How Do Caregivers of Children with Congenital Heart Disease Navigate the Health Care System in Ethiopia?
Authors: Choi S. , Park J. , Shin H. , Heo J. , Kim W.‐H. 
Published: August 2020

Research ObjectiveGlobal surgery is becoming an increasingly important global health agenda. Cardiovascular disease is the major cause of mortality around the world, and congenital heart disease is the leading cause of morbidity in children. This study aimed to investigate and illustrate the caregivers’ experiences of accessing the health care system and undergoing pediatric cardiac surgery for children with congenital heart disease (CHD).Study DesignA qualitative study was conducted. Interviews were conducted in December 2019 in Amharic, then translated into English using trained local interpreters. Data were transcribed verbatim and analyzed according to the principles of interpretive thematic analysis, informed by the candidacy framework, using NVivo. The candidacy framework explores the access to health care utilization by seven elements: candidacy, navigation, the permeability of services, appearances at health services, adjudications, offers and resistance, and operating conditions and the local production of candidacy.Population StudiedInterviews were conducted with 13 caregivers of 10 patients with congenital heart disease that received cardiac surgery during the week of the interview.Principal FindingsThe following three themes emerged from the interviews: (a) Recognition of CHD mostly took place at birth, but for those born at home, they found out much later (max 14 years); (b) CHD was misdiagnosed multiple times prior to seeking care at a large hospital; and (c) patients were waiting for the surgery for more than a year, (d) being scheduled for surgery induced both anxiety and hopefulness. In the discussion, caregivers had financial difficulties and struggled in a fragmented delivery system and experienced poor service quality such as the inaccuracy of diagnosis while navigating the Ethiopian health care system.ConclusionsMajor care‐seeking delays were related to the inefficient and complex health care system, largely due to lack of early CHD recognition and financial hardships. Financial protection is low despite the availability of fee waivers for medications. Low education attainment and distance to hospitals are contributing to this challenge.Implications for Policy or PracticeOverall, Ethiopia needs to prioritize policies that protect the financial status of low‐income households that need health care services. Along with increasing health care workforce capacity for pediatric cardiac surgeries in Ethiopia, there is a need to strengthen the district‐level screening capacity to facilitate earlier diagnosis at easily accessible health care settings.Primary Funding SourceSearch Results Web results Korea International Cooperation Agency.
Using Implementation Science to Understand Rwanda's Success in Dropping Under‐5 Mortality
Authors: Hirschhorn L. , Sayinzoga F. , Donahoe K. , Beyer C. , Binagwaho A. 
Published: August 2020

Research ObjectiveTo understand how and why Rwanda implemented Evidence‐Based interventions (EBIs) faster than similar countries to reduce amenable U5 mortality (U5M) and contextual factors which facilitated or hindered success.Study DesignExplanatory mixed methods study using an implementation research (IR) framework adapted from existing frameworks (Exploration, Preparation, Implementation, Sustainment expanded include Adaptation (EPAIS), and Consolidated Framework for Implementation Research) to guide literature and document review, and key informant interviews with health care managers and leaders, implementers and policy makers.Population StudiedNot applicable.Principal FindingsRwanda effectively used a 5‐step process to determine the need for and strategies to implement EBIs to address leading causes of death (Table). Critical strategies included rapid uptake of emerging EBIs, stakeholder engagement, donor, and partner coordination based on national plan, data use for decision making, including research when needed, and integrating into and building on existing systems and primary care. Facilitating contextual factors included leadership commitment to health and primary care, existing community health worker program, culture of data use and accountability, donor and partner resources, and national equity agenda. Rwanda was able to implement (feasibility) with high coverage (reach) key EBis including vaccinations, facility delivery, and PMTCT with high acceptability. U5M dropped by 74 percent, from 196 deaths per 1000 live births in 2000 to 50 deaths per 1000 live births in 2015.ConclusionsThrough strategic and stepwise process, Rwanda was able to achieve rapid and broad implementation of life‐saving interventions to reduce U5M. The lesson learned offer transferable knowledge to help other countries accelerate U5M reduction.Implications for Policy or PracticeUsing IR adapted to the study aims is effective in emerging generalizable lessons and knowledge needed for other countries to more effectively implement EBIs and reduce U5M.Primary Funding SourceBMGF and Gates Ventures.
MEASURING SAFETY, QUALITY, AND VALUE
Authors: O'Malley A. , Rich E. , Shang L. , Niedzwiecki M. , Rose T. , Ghosh A. , Peikes D. , Poznyak D. 
Published: August 2020

Research ObjectiveMore comprehensive primary care is associated with lower costs and better outcomes for patients. Several primary care interventions under the ACA target practice site level redesign. Thus, it is helpful to have measures to assess whether the comprehensiveness of the practice site is associated with beneficiary outcomes. Building on prior work developing and validating primary care physician‐level measures of comprehensiveness, we developed two practice‐level measures of primary care comprehensiveness and tested their associations with beneficiary outcomes.Study DesignLagged analysis of claims‐based outcomes for Medicare FFS beneficiaries during a year to practice‐level comprehensiveness measures in the previous year. Data are from 2013‐2014 from the evaluation of the Comprehensive Primary Care Initiative. The practice‐level measures assessed, across all primary care physicians in a practice site, the extent to which the physicians in the practice were involved in care for their patients’ conditions (IPC = involved in patient conditions) and managed their patients’ new problems (NPM = new problem management). Regression models controlled for beneficiary, practice, and market characteristics.Population Studied1,343 primary care practices where 5,336 physicians cared for over 1 million Medicare fee‐for‐service beneficiaries.Principal FindingsThe two measures varied across primary care practices and captured different aspects of comprehensiveness, as intended. Comparing practices in the 75th versus 25th percentile for each of these measures of comprehensiveness, practices where physicians had greater involvement in patient conditions (IPC) had 2.3% lower Medicare expenditures (P = .03), and 1.7% lower ED visit rates per 1000 beneficiaries (P = .08). Practices where physicians demonstrated greater new problem management (NPM) had 1.6% lower Medicare expenditures (P = .04), 1.8%, lower hospitalization rates per 1000 beneficiaries (P = .03), 2.6% lower overall ED visit rates (P = .00), and 2.6% lower ED outpatient visit rates (P = .01).ConclusionsThese measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries in primary care practices where physicians deliver more comprehensive care had slightly lower Medicare expenditures, and lower rates of hospitalizations, ED visits, and ED outpatient visits.Implications for Policy or PracticeThese new measures may be useful indicators of 2 aspects of practice‐level comprehensiveness (involvement in patient conditions and new problem management) for studies that target the practice as the unit of change. Additional research should focus on the robustness of these findings for the full Medicare population as well as for other populations. Future research to test interventions to promote primary care comprehensiveness may also be useful.Primary Funding SourceCenters for Medicare and Medicaid Services.
Should High‐Frequency Hospital Users be Excluded from 30‐Day Readmission Quality Measures?
Authors: Fouayzi H. , Ash A. 
Published: August 2020

Research ObjectiveTo describe the characteristics of high‐frequency hospital users (with 4 or more hospital visits per year) and to assess the impact of their inclusion or exclusion on 30‐day hospital readmission.Study DesignWe assigned MassHealth members to 17 accountable care organizations (ACOs) and 2 other groups (managed care organization or primary care clinician plan). We then compared demographics, morbidity burden, and social determinant of health factors for high‐frequency hospital users and low‐frequency users. We also evaluated the extent to which including or excluding hospitalizations of high‐frequency users from a 30‐day readmission measure changes its rate and variance.Population StudiedManaged care eligible MassHealth members between 18 and 64 of age with at least one acute hospitalization during 2016.Principal FindingsOf the 42,794 eligible members, only 8.7% were high‐frequency hospital users, contributing 30.2% of all hospital visits. High‐frequency hospital users have many medical morbidities and significant psychiatric, substance abuse, and housing problems. Their readmission rate was 50.7% compared to 9.7% for other patients, and they contributed 72.0% of the total variance in 30‐day readmission.ConclusionsDespite their small numbers, high‐frequency hospital users exert a large influence on 30‐readmission rates.Implications for Policy or PracticeThirty‐day readmission is being extended to ACOs as a quality measure. ACOs that disproportionately serve many high‐frequency hospital users may face unfair penalties for high readmission rates.Primary Funding SourceThe study was funded by the State of Massachusetts.
Differential mutational profiles of familial Mediterranean fever in North Africa
Authors: Ait‐Idir Djouher , Djerdjouri Bahia 
Published: August 2020

AbstractFamilial Mediterranean fever (FMF) is a recessive autoinflammatory disease, mainly occurring in the eastern Mediterranean. In these populations, the five FMF founder mutations are differently distributed. In Algeria, the FMF‐causing variants remain poorly explored. This retrospective study aims to report the mutational profile of Algerian FMF patients and to compare it with North African FMF patients. One hundred eighty‐three unrelated patients clinically suspected of FMF were recruited from various Algerian hospitals (2007–2015) and tested for mutations in exon 10 of MEFV gene. Molecular analysis identified 144 mutant alleles among 87 of 183 patients (47.5%). p.M694I was the most prevalent pathogenic allele, accounting for 63.2% of mutant alleles, followed by p.M694V and p.M680I occurring with a same frequency (14.5%). Others, p.A744S (6.2%) and p.I692del (1.3%), are less frequent. Interestingly, p.M694I was the most recurrent in patients with renal AA‐amyloidosis. Our results provide the first genetic data on FMF in Algeria, demonstrating the predominance of p.M694I and the absence of p.V726A, compared to other North African countries (Morocco, Tunisia, and Egypt). In conclusion, North African FMF patients display differential mutational profiles that may result from the difference in ethnic origin and the genetic heterogeneity among these populations.
“The Garbage of Society”: Disposable Women and the Socio‐Spatial Scripts of Femicide in Guatemala
Authors: Fuentes Lorena 
Published: August 2020

AbstractThis paper explores the processes of meaning‐making around femicide in Guatemala, highlighting how particular bodies and spaces are pre‐figured as “disposable” through racialised and gendered imaginaries. I draw upon Butlerian epistemologies of violence and indigenous and feminist scholarship from Guatemala and the Americas to analyse why femicides are scripted differently for victims who emerge in “public” spatial formations. Grounded in analysis of the main national newspaper’s reporting and the state’s regulatory framework around violence, and supplemented with interviews and ethnographic observations that emerged in the context of a high‐profile “private” femicide, I argue that “public” victims are read relationally against two subjects who—through reactivated historical scripts of violence—help communicate public victims’ disposability. This paper contributes a rich account of the socio‐spatial logics informing how bodies matter in Guatemala; more broadly, it emphasises the productive work of states and powerful institutions like media in reinforcing hierarchies between victims of femicide.
Beehive fences as a sustainable local solution to human‐elephant conflict in Thailand
Authors: van de Water Antoinette , King Lucy E. , Arkajak Rachaya , Arkajak Jirachai , van Doormaal Nick , Ceccarelli Viviana , Sluiter Liesbeth , Doornwaard Suzan M. , Praet Vera , Owen David , Matteson Kevin 
Published: August 2020

AbstractAs human‐elephant conflict (HEC) increases, a better understanding of the human dimensions of these conflicts and non‐violent mitigation methods are needed to foster long‐term coexistence. In this study, we conducted household questionnaires (n = 296) to assess the prevalence of HEC and attitudes towards elephants in four rural villages in Thailand. In addition, we evaluated a pilot beehive fence as a sustainable solution for HEC. The majority of the households reported seeing or hearing elephants near their property at least once a week (84.9%) and experienced negative impacts from elephants in the last 5 years, (81.0%). The beehive fence deterred 88.4% of individual elephants (n = 155) and 64.3% of elephant groups (n = 28) that approached the fence. Most elephants (70.7%) exhibited behaviors suggesting heightened attentiveness or alarm. The farm owner reported economic and social benefits of the beehive fence. By contributing to farmer income and reducing crop damage caused by wild elephants, beehive fencing may provide an important locally‐managed complement to regional HEC mitigation methods.
Overcoming the Egyptian cotton crisis in the interwar period: the role of irrigation, drainage, new seeds, and access to credit†
Authors: Panza Laura , Karakoç Ulaş 
Published: August 2020

AbstractAfter experiencing a period of spectacular growth during the late nineteenth century, the Egyptian cotton sector underwent a phase of stagnation, which was followed by a gradual and steady increase in output during the interwar period. Drawing on a new panel dataset at the province–year level, this article explores the determinants of the upturn in cotton output, running a horserace between credit, seed technology, and infrastructure. In order to address endogeneity concerns, an instrumental variable approach is adopted, using a modified version of Bartik's shift‐share instrumental variable. Our results provide supporting evidence that peasants switched to a lower‐yielding cotton variety as a response to changes in relative price. Moreover, our production function estimates show that two key factors had a positive impact on output growth: credit availability and the adoption of new cotton varieties.
Barriers and benefits of model development for integration of palliative care for cancer patients in a developing country: A qualitative study
Authors: Ndiok Akon , Ncama Busisiwe 
Published: August 2020

AbstractAimThe aim of the study was to identify barriers and benefits in establishing a model for integration of palliative care of cancer patients in daily clinical practice in tertiary health institutions.MethodsThis was a qualitative design study using in‐depth interviews with four stakeholders and focus group discussions with 19 nurse managers using purposive sampling to select the participants, utilizing interpretive paradigm method. Need was ascertained for a model that would guide nursing care for cancer patients.ResultsBarriers identified in relation to integrating palliative care in daily clinical practice included lack of hospital policies about palliative care activities, cultural influences, denial or rejection of diagnosis by patients, inappropriate attitude of health care workers, patients failing to keep check‐up appointments and financial implications of setting up a dedicated palliative care team. Benefits of the model were twofold: hospital outcomes and patients/family outcomes.ConclusionsQuality care for cancer patients/families calls for the adoption of clearly set out principles of palliative care as an integral component of daily practice. Challenges to implementation of palliative care services in hospitals can be overcome by establishing workable policies and allocating adequate funds for palliative care activities.