bluuebunny/crossref_metadata_2025_split huggingface dataset:
How much healthcare is wasted? A cross-sectional study of outpatient overprovision in private-for-profit and faith-based health facilities in Tanzania
Authors: King Jessica J C , Powell-Jackson Timothy , Makungu Christina , Hargreaves James , Goodman Catherine 
Published: March 2021

Abstract
Overprovision—healthcare whose harm exceeds its benefit—is of increasing concern in low- and middle-income countries, where the growth of the private-for-profit sector may amplify incentives for providing unnecessary care, and achieving universal health coverage will require efficient resource use. Measurement of overprovision has conceptual and practical challenges. We present a framework to conceptualize and measure overprovision, comparing for-profit and not-for-profit private outpatient facilities across 18 of mainland Tanzania’s 22 regions. We developed a novel conceptualization of three harms of overprovision: economic (waste of resources), public health (unnecessary use of antimicrobial agents risking development of resistant organisms) and clinical (high risk of harm to individual patients). Standardized patients (SPs) visited 227 health facilities (99 for-profit and 128 not-for-profit) between May 3 and June 12, 2018, completing 909 visits and presenting 4 cases: asthma, non-malarial febrile illness, tuberculosis and upper respiratory tract infection. Tests and treatments prescribed were categorized as necessary or unnecessary, and unnecessary care was classified by type of harm(s). Fifty-three percent of 1995 drugs prescribed and 43% of 891 tests ordered were unnecessary. At the patient-visit level, 81% of SPs received unnecessary care, 67% received care harmful to public health (prescription of unnecessary antibiotics or antimalarials) and 6% received clinically harmful care. Thirteen percent of SPs were prescribed an antibiotic defined by WHO as ‘Watch’ (high priority for antimicrobial stewardship). Although overprovision was common in all sectors and geographical regions, clinically harmful care was more likely in for-profit than faith-based facilities and less common in urban than rural areas. Overprovision was widespread in both for-profit and not-for-profit facilities, suggesting considerable waste in the private sector, not solely driven by profit. Unnecessary antibiotic or antimalarial prescriptions are of concern for the development of antimicrobial resistance. Option for policymakers to address overprovision includes the use of strategic purchasing arrangements, provider training and patient education.
Laryngeal mask versus endotracheal tube for airway management in tracheal surgery: a case–control matching analysis and review of the current literature
Authors: Menna Cecilia , Fiorelli Silvia , Massullo Domenico , Ibrahim Mohsen , Rocco Monica , Rendina Erino Angelo 
Published: March 2021

Abstract

OBJECTIVES
The endotracheal tube (ETT) and the laryngeal mask airway (LMA) are possible strategies for airway management during tracheal resection and reconstruction for tracheal and laryngotracheal stenosis. The goal of the study was to analyse and compare outcomes in the LMA and ETT groups.

METHODS
Between 2003 and 2020, a total of 184 patients affected by postintubation, post-tracheostomy and idiopathic stenosis who had tracheal or laryngotracheal resections and reconstructions via a cervicotomy were retrospectively enrolled in this single-centre study. In 29 patients, airway management was achieved through LMA during tracheal surgery, whereas in 155 patients, it was achieved through ETT. A case–control matching analysis was performed with a 1:1 ratio, according to age, gender, body mass index, aetiology and length of stenosis (1–4 cm), resulting in 22 patients managed through LMA (LMA group) matched with 22 patients managed through ETT (ETT group).

RESULTS
No significant differences were found in the reintubation rate, 30-day mortality and postoperative length of stay. Operative time was shorter in patients with LMA (96.23 ± 34.72 min in the ETT group vs 76.14 ± 26.94 min in the LMA group; P = 0.043). Intensive care unit (ICU) admission rate and stay were lower in the LMA group [18 in the ETT group vs 8 in the LMA group, odds ratio = 10.17, confidence interval (CI) 95% 1.79–57.79; P = 0. 009; 22.77 ± 16.68 h in ETT group vs 9.23 ± 13.51 h in LMA group; P = 0.005]. Dysphonia was more frequent in the ETT group than in the LMA group (20 in the ETT group vs 11 in the LMA group, odds ratio = 13.79, CI 95% 1.86–102; P = 0.010).

CONCLUSIONS
LMA is a feasible option for airway management in tracheal surgery, with lower operative time, ICU admission rate, ICU length of stay and postoperative dysphonia occurrence.
External fixation of airway stents for upper tracheal stenosis and tracheoesophageal fistula
Authors: Niwa Hideyuki , Oki Masahide , Saka Hideo , Torii Atsushi , Yamada Arisa , Shigematsu Fumie , Ishida Akane , Kogure Yoshihito 
Published: March 2021

Abstract

OBJECTIVES
Stent migration is a common complication of airway stent placement for upper tracheal stenosis and tracheoesophageal fistula. Although several researchers have reported that external fixation is effective in preventing stent migration, the usefulness and safety of external fixation have not been proved because their cohorts were small. We therefore investigated the efficacy and safety of external fixation during upper tracheal stenting.

METHODS
Records of patients who underwent airway stent placement from May 2007 to August 2018 in a single centre were retrospectively reviewed. We included only patients whose stent had been placed in the upper trachea with external fixation to the tracheal wall. The primary endpoint of this study was the rate of stent migration.

RESULTS
Altogether, 51 procedures were performed in 45 patients (32 males, 13 females; median age 60 years, range 14–91 years). The median follow-up period was 9 months (range 0.3–90 months). Among the procedures, 15 were performed for benign disease and 36 for malignancy. Stents were composed of either silicone (n = 42) or metal (n = 9). Stent migration occurred in 3 (6%) patients. The stents with migration were all composed of silicone. Other sequelae were granulation tissue formation in 10 (20%) patients, sputum obstruction in 6 (12%), cellulitis in 3 (6%) and pneumonia in 1 (2%).

CONCLUSIONS
External fixation was an effective method for preventing migration of airway stents placed for upper tracheal stenosis and tracheoesophageal fistula. The complications were acceptable in terms of safety.
High-risk-pattern lung adenocarcinoma with epidermal growth factor receptor mutation is associated with distant metastasis risk and may benefit from adjuvant targeted therapy
Authors: Wang Liang , Wang Xing , Huang Miao , Yan Shi , Li Shaolei , Lv Chao , Wu Nan , Yang Yue 
Published: March 2021

Abstract

OBJECTIVES
This study aimed to evaluate the value of the high-risk-pattern histology (micropapillary and solid components) for predicting distant metastasis in lung adenocarcinoma and to determine the survival benefit with adjuvant targeted therapy for resected non-small cell lung cancer with high-risk-pattern histology.

METHODS
Patients receiving surgery for non-small cell lung cancer were included in this retrospective study. Histological classification was performed according to 2015 World Health Organization classification. Tumours with micropapillary and solid components were defined as high-risk-pattern tumours. Univariable and multivariable Cox regression analyses were used for survival analysis. Adjuvant targeted therapy was alternative for patients with epidermal growth factor receptor (EGFR)-mutation and refusing adjuvant chemotherapy, and outcome was evaluated between 2 groups.

RESULTS
The 514 patients (78 in high-risk group and 436 in low-risk group) were followed up for a median of 64 months. High-risk-pattern adenocarcinoma was significantly more common in male patients (P &lt; 0.001) and in smokers (P &lt; 0.001). Among patients with EGFR mutation (n = 164), the high-risk pattern was significantly associated with distant metastasis (P = 0.028) including brain metastasis (P = 0.022). In the 42 patients with high-risk pattern plus EGFR mutation, survival was significantly better after treatment with adjuvant targeted therapy than with chemotherapy (5-year overall survival: 56.4 ± 2.6 vs 44.7 ± 3.7 months, P = 0.011; 5-year disease-free survival: 54.0 ± 3.3 vs 41.9 ± 4.5 months, P = 0.006).

CONCLUSIONS
High-risk pattern is associated with distant metastasis in non-small cell lung cancer after surgery. Adjuvant targeted therapy may be superior to chemotherapy for treatment of patients with high-risk pattern and EGFR mutation.
Endoscopic lung volume reduction coils for patients with severe emphysema—a single-centre retrospective analysis
Authors: Mang Sebastian , Huss Niklas , Schäfers Hans-Joachim , Wehrfritz Holger , Massmann Alexander , Lensch Christian , Langer Frank , Seiler Frederik , Bals Robert , Lepper Philipp M 
Published: March 2021

Abstract

OBJECTIVES
Patients with chronic obstructive pulmonary disease and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol coil-based ELVR techniques have been ambiguous. The analysis was done to analyse outcomes of ELVR with nitinol coils in patients with severe pulmonary emphysema.

METHODS
From September 2013 to November 2014, our centre performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anaesthesia. Twelve out of 29 patients received staged contralateral treatments up to 112 days later to avoid bilateral pneumothorax. Lung function and 6-min walking distance were assessed 1 week prior, 1 week after as well as 6–12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort.

RESULTS
While coil-based ELVR led to significant short-term improvement of vital capacity (VC, +0.14 ± 0.39 l, P = 0.032) and hyperinflation (Δ residual volume/total lung capacity −2.32% ± 6.24%, P = 0.022), no significant changes were observed in 6-min walking distance or forced expiratory volume in 1 s. Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in forced expiratory volume in 1 s or residual volume after 6 months. Adverse events included haemoptysis (40%) and pneumothorax (3.4%), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment.

CONCLUSIONS
ELVR with coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.
From assurance to coproduction: a century of improving the quality of health-care service
Authors: Batalden Paul , Foster Tina 
Published: March 2021

Abstract

Background
Over the last century, the invitation to improve health-care service quality has taken many different forms: questions, observations, methods, tools and actions have emerged and evolved to create relevant ‘improvement work.’ In this paper we present three phases of this work. The basic frameworks used in these phases have not supplanted each other, but they have been layered one upon the next over time. Each brought important new thinking, new change opportunities and a new set of limits. The important messages of each need to be carried together into the future, as must the sense of curiosity and possibility about the commonalities that has driven this evolution.

Methods
Literature, personal experience and other artifacts were reviewed to develop this description of how the focus on quality work has evolved (and continues to evolve) over the last century.

Results
We describe three phases. Quality 1.0 seeks to answer the question ‘How might we establish thresholds for good healthcare services?’ It described certain ‘basic’ standards that should be used to certify acceptable performance and capability. This led to the formation of formal processes for review, documentation and external audits and a system for public notice and recognition. Over time, the limits and risks of this approach also became more visible: a ‘micro-accounting compliance’ sometimes triumphed over what might be of even greater strategic importance in the development and operations of effective systems of disease prevention and management to improve outcomes for patients and families. Quality 2.0 asked ‘How might we use enterprise-wide systems for disease management?’ It added a focus on the processes and systems of production, reduction of unwanted variation, the intrinsic motivation to take pride in work, outcome measurement and collaborative work practices as ways to improve quality, modeled on experiences in other industries. Quality 3.0 asks ‘How might we improve the value of the contribution that healthcare service makes to health?’ It requires careful consideration of the meaning of ‘service’ and ‘value’, service-creating logic, and prompts us to consider both relationships and activities in the context of the coproduction of health-care services.

Conclusion
Efforts to improve the quality and value of health-care services have evolved over the last century. With each success have come new challenges and questions, requiring the addition of new frames and approaches.
Variation in approaches to antimicrobial use surveillance in high-income secondary care settings: a systematic review
Authors: Patel Selina , Jhass Arnoupe , Slee Ann , Hopkins Susan , Shallcross Laura 
Published: March 2021

Abstract

Introduction
In secondary care, antimicrobial use (AMU) must be monitored to reduce the risk of antimicrobial resistance and infection-related complications. However, there is variation in how hospitals address this challenge, partly driven by each site’s level of digital maturity, expertise and resources available. This systematic review investigated approaches to measuring AMU to explore how these structural differences may present barriers to engagement with AMU surveillance.

Methods
We searched four digital databases and the websites of relevant organizations for studies in high-income, inpatient hospital settings that estimated AMU in adults. Excluded studies focused exclusively on antiviral or antifungal therapies. Data were extracted data on 12 fields (study description, data sources, data extraction methods and professionals involved in surveillance). Proportions were estimated with 95% CIs.

Results
We identified 145 reports of antimicrobial surveillance from Europe (63), North America (53), Oceania (14), Asia (13) and across more than continent (2) between 1977 and 2018. Of 145 studies, 47 carried out surveillance based on digital data sources. In regions with access to electronic patient records, 26/47 studies employed manual methods to extract the data. The majority of identified professionals involved in these studies were clinically trained (87/93).

Conclusions
Even in regions with access to electronic datasets, hospitals rely on manual data extraction for this work. Data extraction is undertaken by healthcare professionals, who may have conflicting priorities. Reducing barriers to engagement in AMU surveillance requires investment in methods, resources and training so that hospitals can extract and analyse data already contained within electronic patient records.
Evaluation of the GENE-UP®Salmonella Method for the Detection of Salmonella Species in a Broad Range of Foods and Select Environmental Surfaces: Collaborative Study, First Action 2020.02
Authors: Johnson Ronald L , Mills John C , Taylor Nikki J , Bird Patrick M 
Published: March 2021

Abstract

Background
The GENE-UP®Salmonella assay (Performance Tested MethodSM [PTM] 121802) is a PCR detection method that utilizes fluorescence resonance energy transfer (FRET) hybridization probes for the rapid detection of Salmonella species in foods and on environmental surfaces.

Objective
The purpose of this validation was to evaluate the method’s interlaboratory performance for submission to AOAC INTERNATIONAL for adoption as First Action Official Method of AnalysisSM.

Method
The GENE-UP method was evaluated in a multi-laboratory study using unpaired test portions for one food matrix, raw ground beef (80% lean). The candidate method was compared to the US Department of Agriculture (USDA), Food Safety Inspection Service, Microbiology Laboratory Guidebook (MLG) 4.10 reference method. An alternative confirmation procedure, using ASAP™ and CHROMID®Salmonella chromogenic agars, was included in the validation study. Fifteen collaborators from 14 laboratories participated. Three levels of contamination were evaluated: a non-inoculated control level (0 CFU/test portion), a low contamination level (∼0.7 CFU/test portion), and a high contamination level (∼2 CFU/test portion). Data were analyzed using the probability of detection (POD) statistical model.

Results
The dLPODC values with 95% confidence interval for the GENE-UP Salmonella method, with either alternative or traditional confirmation, were: 0.00 (–0.03, 0.03), –0.02 (–0.15, 0.12), and 0.02 (–0.03, 0.09) for the non-inoculated, low, and high contamination levels respectively.

Conclusions
The dLPODC results demonstrate no difference in performance between the candidate method and reference method for the matrix evaluated.

Highlights
The GENE-UP Salmonella method, with ASAP and CHROMID Salmonella, provides industry with a simplified, rapid, and accurate workflow for the detection of Salmonella in a broad range of foods and select environmental surfaces.
African Courts and Principles of International Environmental Law: A Kenyan and South African Case Study
Authors: Kotzé Louis J , Soyapi Caiphas B 
Published: March 2021

Abstract
Scholarship increasingly reveals the distinct interplay between international environmental law and domestic legal systems, and the important role of courts the world over in fleshing out this relationship. Africa, however, seems to be underrepresented in these discussions, despite its being a key stakeholder in the development of international environmental law. As a contribution to this debate, we offer here an analysis of the relationship between international environmental law and domestic African legal systems, by focusing on how domestic courts in Kenya and South Africa have been engaging with the precautionary principle, the principle of public participation and the principle of sustainable development. Our analysis of a range of judgments shows that these courts have been exceptionally innovative in their growing support of these principles that they seem to embrace in their efforts to strengthen domestic environmental protection and to contribute to a nascent transnational judicial dialogue.
The Potential for Computer Vision to Advance Accountability in the Syrian Crisis
Authors: Radeva Elena 
Published: March 2021

Abstract
This article explores a novel approach to technology-enabled review of evidentiary material implemented by the United Nations International, Independent and Impartial Mechanism – Syria ('IIIM – Syria’ or ‘the Mechanism’). The Mechanism’s objective in pursuing automation is to significantly accelerate the speed and improve the consistency of review and analysis of large, digitized documentary data sets used in the pursuit of accountability for crimes committed in Syria. This approach represents one of the first uses of Computer Vision applied to documentary evidence in the field of international criminal investigations and is a tangible example of public–private cooperation developing meaningful technology-based upon modern best practices. The article first discusses why technological innovation in investigative analysis is necessary in relation to the Syrian conflict. Next, the article reviews the approach adopted by IIIM – Syria towards applying existing and novel technology in the processing, preservation, and analysis of evidentiary material. Specifically, it explores how the organization executed a novel approach to technology-enabled review of evidentiary material through the application of Computer Vision techniques designed by forensic and eDiscovery experts. Finally, the article explores the wider investigative possibilities presented by the use of Computer Vision as a technique for analytical review.
Long-Term Risk of Ovarian Cancer and Borderline Tumors After Assisted Reproductive Technology
Authors: Spaan Mandy , van den Belt-Dusebout Alexandra W , Lambalk Cornelis B , van Boven Hester H , Schats Roel , Kortman Marian , Broekmans Frank J M , Laven Joop S E , van Santbrink Evert J P , Braat Didi D M , van der Westerlaken Lucette A J , Cohlen Ben J , Cantineau Astrid E P , Smeenk Jesper M J , van Rumste Minouche M , Goddijn Mariëtte , van Golde Ron J T , Meeuwissen Paul A M , Hamilton Carl J C M , Ouwens Gabriële M , Gerritsma Miranda A , Schaapveld Michael , Burger Curt W , van Leeuwen Flora E 
Published: March 2021

Abstract

Background
Long-term effects of assisted reproductive technology (ART) on ovarian tumor risk are unknown.

Methods
This nationwide cohort study comprises 30 625 women who received ovarian stimulation for ART in 1983-2000 and 9988 subfertile women not treated with ART. Incident invasive and borderline ovarian tumors were ascertained through linkage with the Netherlands Cancer Registry and the Dutch Pathology Registry until July 2018. Ovarian tumor risk in ART-treated women was compared with risks in the general population and the subfertile non-ART group. Statistical tests were 2-sided.

Results
After a median follow-up of 24 years, 158 invasive and 100 borderline ovarian tumors were observed. Ovarian cancer risk in the ART group was increased compared with the general population (standardized incidence ratio [SIR] = 1.43, 95% confidence interval [CI] = 1.18 to 1.71) but not when compared with the non-ART group (age- and parity-adjusted hazard ratio [HR] = 1.02, 95% CI = 0.70 to 1.50). Risk decreased with higher parity and with a larger number of successful ART cycles (resulting in childbirth, Ptrend = .001) but was not associated with the number of unsuccessful ART cycles. Borderline ovarian tumor risk was increased in ART-treated women compared with the general population (SIR = 2.20, 95% CI = 1.66 to 2.86) and with non-ART women (HR = 1.84, 95% CI = 1.08 to 3.14). Risk did not increase with more ART cycles or longer follow-up time.

Conclusions
Increased ovarian cancer risk in ART-treated women compared with the general population is likely explained by nulliparity rather than ART treatment. The increased risk of borderline ovarian tumors after ART must be interpreted with caution because no dose-response relationship was observed.