bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients and doctors: what kind of changes in outpatient clinic services can be made in concert?
Authors: Arshukova I , Dugina T , Dobretsova E 
Published: October 2020

Abstract

Background
Search for possible improvements in outpatient clinic services is a key task for health care professionals worldwide. It is important to consider the satisfaction of the main participants in primary care: patients and doctors. If patients unsatisfied with primary care will not seek help again, this will reduce their life quality and life expectancy. Unsatisfied doctors will work not efficiently nor for a long time. The work is devoted to the search for possible factors, which change may affect the improvement of the situation in clinics in terms of both doctors and patients.

Methods
The opinions of 1672 patients of Krasnoyarsk outpatient clinics were investigated with the usage of semi-structured interviews. The opinions of 283 physicians of the city were collected using an anonymous questionnaire. Data were analyzed using SPSS 22 by the following methods (p &lt; 0.05): descriptive statistics, U test, χ2-test.

Results
Coherence of doctors' and patients' opinions investigated in different ways such as primary care satisfaction, desirable main changes, optimal time, duration and structure of appointment, physician's mission, the possibilities of additional medical remote consultations and difficulties in doctors' access. At some points, the answers were consistent; at some, a compromise or new ways of the solutions were required.

Conclusions
Almost 61% of the doctors prefer morning work time (8-12 am) and 15.5% prefer work in the evenings (18-20 pm) while only 38.1% of patients can visit a doctor in the morning time and 39.5% in the evening. The main changes to be made according to the general opinion of doctors and patients is a reduction of a waiting time of doctors' appointment (38.1% and 38.5% respectively) and the creation of an electronic queue (26.5% and 30.5% respectively). Remote consultation service have to be organized for patients: phone service is more appropriate as for the doctors (30.5%) so as for the patients (34.7%).

Key messages
The reduction of a waiting time of doctors’ appointment, creations of an electronic queue and a remote consultation service have to be organized to improve primary care system. There is inconsistency in time preferences that have to be solved: doctors prefer to work in morning time and many patients can visit clinics only in the evenings.
Novel health system strategies for tuberculin skin test-guided Isoniazid preventive therapy
Authors: Van Ginderdeuren E , Bassett J , Hanrahan C F , Mutunga L , Van Rie A 
Published: October 2020

Abstract

Background
Global TB elimination demands a scale-up of Isoniazid preventive therapy (IPT) but tuberculin skin test (TST)-guided IPT poses great logistical and human resource challenges.

Objectives
Performance of TST self-reading by patients and fast-track TST reading by trained low cadre health care workers (task-shifting) was compared to formal TST reading by high cadre staff in a cohort of 278 South African adults living with HIV. Health economic impact of these novel strategies was assessed from a provider and societal perspective and simulations were performed for 5 other countries (USA, Germany, Brazil, India, Russia) to evaluate generalizability. In addition, accuracy of TST at antiretroviral treatment (ART) initiation was assessed by a repeat TST 6 and 12 month later.

Results
TST self-reading was highly accurate, with 89% sensitivity (95% CI 80, 95) and 100% specificity (95% CI 97,100) for detecting presence/absence of any induration. Agreement in TST reading between low and high cadre health care workers was very high (kappa 0.97). Compared to standard of care, a combined fast-track, task-shifting and self-reading strategy reduced TST reading costs in South Africa from a patient perspective by 81% and from a provider perspective by 92%. In all 5 countries simulated, TST reading cost was reduced by ≥ 78 % from a provider perspective. Repeat testing at 6 and 12 months showed high (31%, 95% CI 23, 40) TST conversion during the first 12 months of ART.

Conclusions
Empiric IPT for all people living with HIV followed by TST assessment after 6 or 12 months to identify those in need for lifelong IPT could increase the effectiveness of IPT programs. TST self-reading to reduce the number of patients that need to return for TST reading (to only those patients with self-determined presence of any induration) together with fast-tracking and task-shifting of TST reading could increase cost-effectiveness and reduce patient costs associated with IPT programs.

Key messages
Novel strategies are essential to control TB. Task-shifting, fast-tracking and patient TST self-reading empower patients and HCWs; optimal TST timing can increase cost-effectiveness of IPT programs.
Peri-operative elective path optimization through algorithms in the Local Health Authority of Bologna
Authors: Leonessi M , Tubertini P , Longanesi A , Malaguti E , Guicciardi S , Fabbri C 
Published: October 2020

Abstract

Background
High costs of healthcare and population ageing force the health system to constantly improve its efficiency in order to provide patients the best possible care with the available resources. In this perspective, the Local Health Authority and the University of Bologna started an experimentation to re-organize, manage and control the peri-operative elective path of general surgery, a discipline that works in a multiplatform environment according to a Hub & Spoke logic.

Methods
The experimentation is built on two mathematical programming models. The first one defines patient preparation appointments (i.e. diagnostic and anesthesiologic visits), harmonizing patient preparation with available resources, and planning migration from Hub to Spoke platforms, in order to optimize waiting time and facilities utilization. The second model defines weekly optimal admission plans. Both models consider the availability of resources in terms of surgical teams, operating room slots and number of beds for each operating unit. The proposed approach works on a four-week time horizon following a rolling horizon framework (weekly update) in order to effectively manage high priority patients.

Results
Both models have been tested on real-world instances over a six-month observation period. Overall, it was possible to increase the efficiency of surgical programming by reducing the waiting times for surgical interventions in over 20% of cases of high priority patiets in four local departments.

Conclusions
The proposed model represents one of the few cases in Italy of surgical programming developed through mathematical models. It will be necessary to evaluate the evolution of its effectiveness to optimize the system's ability to respond to the growing health needs of the population.

Key messages
Mathematical models are needed to optimize surgical planning. Efficiency of surgical planning may reduce waiting times for high priority procedures.
Innovative equipments to monitor and control salt usage during culinary
Authors: Gonçalves C , Pinho O , Padrão P , Silva-Santos T , Abreu S , Moreira P 
Published: October 2020

Abstract

Issue
In Portugal, most of the salt consumed comes from the salt added during preparation/cooking. Therefore, it is urgent to introduce mechanisms to allow the quantification of the salt in foods, and the salt added during culinary.

Description of the Problem
To tackle salt reduction, we considered: having a portable and user-friendly instrument that measure salt content of foods; and controlling the amount of salt added to foods during culinary, assessing its impact on health. The first project was SALT QUANTI (co-funded by NORTE 2020), promoted by a consortium between EVOLEO Technologies and the University of Porto (finished in September 2018, duration 18 months); its major deliverable was to obtain a prototype of a portable device and the analytical procedure that enabled the analysis of salt content in foods/meals produced in catering kitchens, in less than 5 minutes. The second project was iMC SALT (supported by FCT, Grant POCI-01-0145-FEDER-029269), started in July 2018 (duration 36 months), aiming to develop prototypes for controlling the amount of salt added to foods during culinary, at home and catering, according international recommendations; one clinical intervention to assess the impact on health of the prototype at home is underway.

Results
The SALT QUANTI and iMC SALT prototypes showed good results in validation tests. The preliminary results of the health impact of the iMC SALT prototype will be presented at the conference.

Lessons
The implementation of innovative equipments to help consumers and catering industry to monitor or control the addition of salt during preparation of food or cooking are expected to be available soon and to be useful to consumers and catering industry to reduce salt intake.

Key messages
Innovative equipments may contribute to estimate salt in foods, and to reduce salt added during culinary. The implementation of an equipment to control culinary salt could be one valid approach to reduce salt consumption with impact on health.
Quality Assessment of HTA reports: a Critical Appraisal Toolkit within an institutional HTA program
Authors: Bossi E , Tringali M , Colombo P , Mazzali C , Puleo G , Caruggi M , Branchi M , Odone A 
Published: October 2020

Abstract

Issue
With population aging, increased demand for healthcare and limited availability of economic and human resources, well-functioning and sustainable health systems have to rely on rigorous and evidence-based assessments of complex technologies' clinical effectiveness and safety. The Lombardy Region in Northern Italy has a well-established HTA program that offers technical support to its hospitals' network to produce and to review Health Technology Assessment (HTA) reports.

Description of the Problem
To better coordinate the HTA network and to reduce self-referencing of University and Community hospitals, Lombardy Region carried out an intense field training and distance learning from year 2017, with a project aimed at involving health care professionals in an accurate evaluation of technologies in 18 HTA reports. The regional HTA Supporting Centre developed a Toolkit for the critical appraisal of reports and supporting literature to improve the quality of hospital-based reports.

Results
In compliance with the regional Law DGR XI/1046 17.12.2018 and the framework proposed, during year 2019 hospitals used the Toolkit to help writing complete and good quality HTA reports on 37 different technologies. With a Public Health resident internship, the Toolkit was revised, extended and then used in 2020 by the hospital's HTA network during the double blinded peer review, mandated by the regional Law DGR XI/2672 16.12.2019, of the year 2019 HTA reports. Detailed results will be presented at the conference.

Lessons
We observed an increase in number of HTA reports from 2018 to 2019, a greater language's and format's homogeneity and an improvement in the quality of some reports, which will be submitted to the Regional HTA Committee for appraisal and reimbursement.

Key messages
The development and use of a Critical Appraisal Toolkit in an Regional HTA program can help hospitals write complete and good quality HTA reports. A centrally supported quality improvement of distributed assessment activities in a network of hospitals can enhance the production of HTA reports, relevant to the needs of a local healthcare system.
The timing of the operatingroom: a 2019 Italian exsperience
Authors: Carcuro C , Bert F , Scarmozzino A , Paleologo M , Roggero S , Caggiola D , Plazzotta C , Griffa C , Rabacchi G , Siliquini R 
Published: October 2020

Abstract

Background
The lack of economic resources for health systems is a public health issue that Europe needs to address in order to guarantee quality and safety of care for patients. Any initiative aimed to reduce waste are welcomed. In this context, the City of Health and Science of Turin (Italy) performed a study aimed to analyse the timing of operating rooms to improve efficacy, efficiency and quality standards in the surgical field.

Methods
A multidisciplinary working group created in 2019 a checklist aimed to record the operating times of the first intervention of the day in 5 Hospital Departments (including 12 operating rooms). We registered the time between the moment in which the operating room is considered available for the start of activities and the surgical incision (benchmark: within 60 minutes). All the times needed for nursing, anesthetic and surgical activities were collected and evaluated for a descriptive statistical analysis.

Results
In consideration of a room opening time scheduled for 7:00 and room availability scheduled for 7:30, the goal can be considered achieved if the time of the surgical incision does not exceed 8:30 in the morning. Three out of 5 departments (Ginecology, Orthopaedic and General surgery) reached this aim in more than 80% of interventions, while neurosurgery and thoracic surgery exceeds the time by about 40 minutes. The checklist showed that in many cases is possible to reduce the time between the end of anesthesia and surgical incision.

Conclusions
To analyse the operating times allows not only to optimize the resources but also to reduce waste of time and waiting lists for surgery in election. We described, in a sample of surgical interventions, when and how is possible to improve the efficiency of the operating room. This experience and the checklist created could be useful not only for us but every European hospital.

Key messages
The efficiency of operating rooms is related to several factors. Neurosurgery and thoracic surgery needs longer time to prepare patients and start intervention. A checklist aimed to monitor the times of activities in surgical operating rooms can be useful to reduce waste of time and resources in European hospitals.
After Action Review of the 2019 measles outbreak in Clark County, Washington, U.S.A
Authors: Stoto M , Piltch-Loeb R , Wolfe R , Albrandt R , Melnick A 
Published: October 2020

Abstract

Issue
Clark County experienced a measles outbreak that challenged public health authorities. Description of the practice: We conducted a formal After Action Review with state and local health officials, school officials, and others to identify lessons for public health practitioners facing future outbreaks.

Results
Following the early identification of measles in a child who had recently arrived from Ukraine, active surveillance identified 71 confirmed cases, most in unvaccinated persons under 18 years of age. 4,138 contacts were traced and public health personnel made daily monitoring calls to 816. 53 potential exposure sites in healthcare facilities, schools and other public places were identified and communicated to the public. As a social distancing measure, unvaccinated students, teachers, and staff were excluded from schools in which exposure had occurred. Ascertaining susceptibility status was challenging. The national anti-vaccination sentiment and a parallel outbreak in a New York religious community created challenges in representing community risk while avoiding stigmatization of a community in which the first reported case was identified. Rather than respond to every false claim on social media, the health department developed talking points about emerging issues and engaged the community in dialogue.

Lessons
Responding to the measles outbreak required innovative approaches to surveillance and contact tracing, social distancing (school exclusions), and emergency risk communication. The response required extensive coordinated efforts of the county and state health departments, school systems, and many other organizations. Mutual aid enabled an influx of resources but managing the surge of responders proved challenging.

Key messages
Public health emergencies require effective emergency management practices. Carefully conducted After Action Reviews of health emergencies can help public health practitioners identify challenges and innovative practices.
A negative point of view of the social services students about organ donation and transportation
Authors: Kucuk Bicer B 
Published: October 2020

Abstract

Background
The gap between the number of patients waiting for a transplant and the number of organ recipients increases especially in muslim countries. Social services are responsible for convincing persons to donate their organs for transplantation in Turkey. The aim of the study is to measure the knowledge and awareness of social services students', as they become a part of future convincers of transplantation.

Methods
Knowledge and point of view about organ transplantation (OT) were asked using headtohead interviews. Layered sample (grade) was chosen from social sciences faculty and 442 students were interviewed. SPSS 23.0 was used in descriptive and regression analysis.

Results
Mean age was 21.37±1.94 and 45.1% were male. Knowledge of OT was sufficient (20.1%) according to themselves. Only 1.2% donated their organs. According to knowledge questions 69.3% had insufficient information about organ donation and tranplantation. They would receive (54%) a transplant from their relatives and donate to their relatives (67.6%) if needed. Religion and ethnicity were important factors in logistic regression; 8.6% said that their religion finds donation objectinable. Participants thought that Turkish transplantation centers has insufficient technical equipment (39.8%). According to our logistic model, students unconcerned with religion/ethnicity (β = 1,608;p&lt;0,001), students donated their organs (β = 1,621;p=0,019) and having chronic diseases in their families (β = 1.114;p=0,004) were determiners of high knowledge scores about OT and donation. Family income, mother and father education and grade didn't effect the point of views about donation (p &gt; 0.05).

Conclusions
It's seen that social workers don't have sufficient knowledge about OT and donation. On the other hand they have concerns about religious and ethnical issues. The education program must be improved to raise awareness about OT and donation especially the groups working as a part of a donation team.

Key messages
Important public health problems should be included in vocational education of social service students. Awareness studies on organ transplantation in our country do not reach its purpose.
SHARP Joint Action – Strengthening International Health Regulations and preparedness in the EU
Authors: Katz A , Karvonen O , Di Caro A , Vairo F , Ippolito G , Grunow R , Jacob D , Salminen M 
Published: October 2020

Abstract
Although the preparedness to health emergencies of biological, chemical, environmental and unknown origin across the Europe is at high level, gaps do exist across the EU Member States and European countries. The previous coronavirus epidemic, SARS in 2002, showed that countries responded largely individually to this emerging threat. EU wide, joint responses were not taken. SARS epidemic showed that strengthening of the common EU efforts was needed.
Many actions were taken, and since 2013 the European Commission Decision 1082/2013/EU on serious cross-border threats to health has provided a framework to improve preparedness and to strengthen the response capacities in Europe to health threats.
SHARP Joint Action is a 3-year collaborative action of 26 countries and 61 partners, co-funded by the EC and coordinated by the Finnish Institute for Health and Welfare, Finland, and co-coordinated by Robert Koch Institute, Germany and National Institute of Infectious Diseases Lazzaro Spallanzani, Italy. SHARP started it's actions in June 2019, and it aims to strengthen implementation of the International Health Regulations (IHR) and the Decision 1082/2013/EU.
SHARP consists of ten work packages covering core public health capacities, including: IHR core capacity strengthening and assessment, preparedness and response planning, training, laboratory preparedness and responsiveness, chemical safety and threats, and case management, infection prevention and control preparedness.
Through this cross-sectoral approach, SHARP supports the Member States and partner countries in strengthening their capacities. In response to the COVID-19 outbreak, SHARP has also supported the EC and the Member States, and especially work packages for laboratory preparedness and responsiveness (WP7) and for case management and infection prevention and control preparedness (WP10) were activated. The activities regarding laboratory preparedness and response have been coordinated with the ECDC.

Key messages
SHARP Joint Action strengthens the implementation of Decision 1082/2013/EU on serious cross-border threats to health and the implementation of International Health Regulations in the EU. SHARP improves preparedness and response to serious cross-border threats to health, and resilience of the health systems at national, EU and regional level.
YouTube viewers’ comments on the opioid epidemic offer solutions to help chronic pain patients
Authors: Bacon L , Ivanitskaya L , Erzikova E , Veverka T 
Published: October 2020

Abstract

Background
Approximately 34.3 million people used prescription opioids for non-medical reasons globally in 2016. In addition, many of the 1.5 billion people worldwide who suffer from chronic pain use opioids. According to the United Nations Office on Drugs and Crime, 76% of overdose deaths are caused by prescription and non-prescription opioids. Opioid use disorder and addiction encompass many aspects; such as, economic forces, cultural forces and individual genetic makeup. Because of this complexity, policymakers will have to address chronic pain and social determinants of health. Understanding the public's perspectives on the opioid epidemic is critical for policymakers to create awareness and treatment programs to decrease opioid related deaths while treating pain.

Methods
This inductive, iterative approach to content analysis of secondary data collected 8,761 comments posted by viewers on ten videos regarding the opioid epidemic on CNN's YouTube Channel and ten videos on Fox News' YouTube channel posted between January 1, 2017 and December 31, 2018.

Results
After analyzing 8,761 comments, from 20 videos, results indicated 618 (7%) were pain patients, 926 (10.6%) of the comments indicated stigma, (54.5% social stigma and 30% structural stigma). 5,453 (62.2%) of the comments posted claims regarding the opioid epidemic and 1,881 (21.5%) offered solutions. Three of the major solutions offered include legalizing cannabis (608, 7%), developing alternative therapies (174, 1.9%), and kratom (105, 1.2%).

Conclusions
Reducing access to opioids is harming legitimate pain patients. Policymakers need to take the public's opinions into consideration when developing policies and programs that help reduce opioid overdose. These policies must ensure that the 1.5 billion chronic pain patients worldwide receive adequate pain control in order to have a good quality of life that allows them to be contributing members of society.

Key messages
Worldwide, 1.5 billion people suffer from chronic pain, many without access to adequate pain control. Solutions posted by viewers include cannabis, alternative therapies and kratom. Understanding the public’s perspectives will help policymakers create programs that improve quality of life for chronic pain patients that minimize social, internalized and structural stigma.