bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does burnout affect clinical reasoning? An observational study among residents in general practice
Authors: Guillou Philippe , Pelaccia Thierry , Bacqué Marie-Frédérique , Lorenzo Mathieu 
Published: January 2021

Abstract
Background
Burnout results from excessive demands at work. Caregivers suffering from burnout show a state of emotional exhaustion, leading them to distance themselves from their patients and to become less efficient in their work. While some studies have shown a negative impact of burnout on physicians’ clinical reasoning, others have failed to demonstrate any such impacts. To better understand the link between clinical reasoning and burnout, we carried out a study looking for an association between burnout and clinical reasoning in a population of general practice residents.

Methods
We conducted a cross-sectional observational study among residents in general practice in 2017 and 2019. Clinical reasoning performance was assessed using a script concordance test (SCT). The Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to determine burnout status in both original standards of Maslach’s burnout inventory manual (conventional approach) and when individuals reported high emotional exhaustion in combination with high depersonalization or low personal accomplishment compared to a norm group (“emotional exhaustion +1” approach).

Results
One hundred ninety-nine residents were included. The participants’ mean SCT score was 76.44% (95% CI: 75.77–77.10). In the conventional approach, 126 residents (63.31%) had no burnout, 37 (18.59%) had mild burnout, 23 (11.56%) had moderate burnout, and 13 (6.53%) had severe burnout. In the “exhaustion + 1“ approach, 38 residents had a burnout status (19.10%). We found no significant correlation between burnout status and SCT scores either for conventional or “exhaustion + 1“ approaches.

Conclusions
Our data seem to indicate that burnout status has no significant impact on clinical reasoning. However, one speculation is that SCT mostly examines the clinical reasoning process’s analytical dimension, whereas emotions are conventionally associated with the intuitive dimension. We think future research might aim to explore the impact of burnout on intuitive clinical reasoning processes.
Adaptation and validation of a Korean-language version of the revised hospital survey on patient safety culture (K-HSOPSC 2.0)
Authors: Lee Seung Eun , Dahinten V. Susan 
Published: January 2021

Abstract
Background
To date, there has been no universal and validated tool for measuring safety culture in Korea. The Hospital Survey on Patient Safety Culture (HSOPSC), version 2.0 was released by the Agency for Healthcare Research and Quality in 2019, but it had not yet been translated and assessed for use in Korea. The aim of this study was to assess the content validity and other psychometric properties of the Korean-language version of the HSOPSC 2.0.

Methods
Instrument adaptation was performed using a committee-based translation, cognitive interviews, and expert panel reviews. Confirmatory factor analysis was conducted on data obtained through an online survey from 526 registered nurses who worked on medical-surgical units in three teaching hospitals in South Korea.

Results
One item was dropped during the translation and adaption phase of the study as being a poor fit for the Korean healthcare context, resulting in excellent content validity. Confirmatory factor analysis supported the factorial structure of the K-HSOPSC 2.0. Correlations with an overall measure of patient safety provided further evidence of construct validity. Additionally, in comparing the results of this current study to those from U.S. research using the HSOPSC 2.0, it was found that Korean nurses assigned less positive scores to all dimensions of patient safety culture.

Conclusion
Our findings provide evidence of the content validity, reliability, and construct validity of the K-HOSPSC 2.0 for measuring patient safety culture in South Korean hospitals.
Hospital administrators can use this tool to assess safety culture and identify areas for improvement to enhance patient safety and quality of care.
Cross-cultural adaptation and exploratory factor analysis of the Person-centred Practice Inventory - Staff (PCPI-S) questionnaire among Malaysian primary healthcare providers
Authors: Balqis-Ali Nur Zahirah , Saw Pui San , Jailani Anis Syakira , Fun Weng Hong , Mohd Saleh Noridah , Tengku Bahanuddin Tengku Putri Zaharah , Sararaks Sondi , Lee Shaun Wen Huey 
Published: January 2021

Abstract
Background
The Person-centred Practice Inventory-Staff (PCPI-S) instrument was developed to measure healthcare providers’ perception towards their person-centred practice. The study aimed to explore the influence of culture, context, language and local practice towards the PCPI-S instrument adaptation process for use among public primary care healthcare providers in Malaysia.

Methods
The original PCPI-S was reviewed and adapted for cultural suitability by an expert committee to ensure conceptual and item equivalence. The instrument was subsequently translated into the local Malay language using the forward-backward translation by two independent native speakers, and modified following pre-tests involving cognitive debriefing interviews. The psychometric properties of the corresponding instrument were determined by assessing the internal consistency, test-retest reliability, and correlation of the instrument, while the underlying structure was analysed using exploratory factor analysis.

Results
Review by expert committee found items applicable to local context. Pre-tests on the translated instrument found multiple domains and questions were misinterpreted. Many translations were heavily influenced by culture, context, and language discrepancies. Results of the subsequent pilot study found mean scores for all items ranged from 2.92 to 4.39. Notable ceiling effects were found. Internal consistency was high (Cronbach’s alpha > 0.9). Exploratory factor analysis found formation of 11 components as opposed to the original 17 constructs.

Conclusion
The results of this study provide evidence regarding the reliability and underlying structure of the PCPI-S instrument with regard to primary care practice. Culture, context, language and local practice heavily influenced the adaptation as well as interpretation of the underlying structure and should be given emphasis when translating person-centred into practice.
Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration
Authors: Pedersen Rune Aakvik , Petursson Halfdan , Hetlevik Irene , Thune Henriette 
Published: January 2021

Abstract
Background
The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented.
This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care.

Methods
The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis.

Results
We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient.

Conclusions
The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.
Prevalence and associated factors for burnout among attending general surgeons: a national cross-sectional survey
Authors: Celik Suleyman Utku , Aslan Alperen , Coskun Eylul , Coban Beyza Nur , Haner Zeynep , Kart Selin , Skaik Mahmoud N. I. , Kocer Merve Didem , Ozkan Bahar Busra , Akyol Cihangir 
Published: January 2021

AbstractBackgroundBurnout resulting from long-term and unmanaged workplace stress is high among healthcare professionals, especially surgeons, and affects both individuals and the quality of patient care. The objective of this study was to determine the prevalence and associated factors for burnout among attending general surgeons and to identify possible preventive strategies.MethodsA national cross-sectional survey using a 35-item questionnaire was conducted among members of the Turkish Surgical Society. The survey evaluated demographics, professional and practice characteristics, social participation, and burnout as well as interventions to deal with burnout. Burnout was defined as a high score on the emotional exhaustion (EE) and/or depersonalization (DP) subscales. Surgeons with high scores on both the EE and DP and a low score on personal accomplishment (PA) were considered to have severe burnout.ResultsSix hundred fifteen general surgeons completed the survey. The median EE, DP, and PA scores were 34 (IQR, 20–43), 9 (IQR, 4–16), and 36 (IQR, 30–42), respectively. Overall, the prevalence of burnout and severe burnout were 69.1 and 22.0%, respectively. On multivariable analysis, factors independently associated with burnout were working in a training and research hospital (OR = 3.34;P < 0.001) or state hospital (OR = 2.77;P = 0.001), working ≥ 60 h per week (OR = 1.57;P = 0.046), and less frequent participation in social activities (OR = 3.65;P < 0.001).ConclusionsBurnout is an important problem among general surgeons with impacts and consequences for professionals, patients, and society. Considering that burnout is a preventable condition, systematic efforts to identify at-risk populations and to develop strategies to address burnout in surgeons are needed.
Assessing the contextual effect of community in the utilization of postnatal care services in Ghana
Authors: Dankwah Emmanuel , Feng Cindy , Kirychuck Shelley , Zeng Wu , Lepnurm Rein , Farag Marwa 
Published: January 2021

Abstract
Background
Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives.

Methods
The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage.

Results
This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44–0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability.

Conclusion
The findings of this study indicate that community-level factors have an influence on women’s health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
Patient-controlled admission contracts: a longitudinal study of patient evaluations
Authors: Nyttingnes Olav , Šaltytė Benth Jūratė , Ruud Torleif 
Published: January 2021

Abstract
Background
Mental health professionals usually decide patients’ access to inpatient care to ensure care based on need and potential benefit. The purpose of the current study is to investigate how patients evaluate admissions under a contract of Patient-Controlled Admissions (PCA), where the patient could initiate 5 day stays at a community mental health center at their own discretion.

Methods
Patients with a PCA contract in 2011 and 2012 were invited to participate in the study. Staff first recorded clinical baseline values for patients. Towards the end of each PCA stay, staff conducted a structured discharge interview of the admission with the patient. A structured follow-up interview evaluating the PCA arrangement 2 years after inclusion was also performed. We report frequencies from data on PCA requests, PCA admissions and the 2 year evaluation interview, and we used multiple regression models to explore predictors of perceived helpfulness and improvement from the PCA admissions.

Results
The included patients (n = 74) made 628 requests for PCAs during the 2 years after inclusion, and 507 PCAs took place. The five-day limit could not be upheld in 7.5% of PCAs. Patients rated PCAs as helping considerably (33.1%), a good deal (30.4%) or somewhat (21.1%), and reported feeling considerably (15.2%), a good deal (26.2%) or somewhat (36.3%) better during the admission. Significant predictors of helpfulness and feeling better were socializing more during the stay and reporting higher motivation to get away from a difficult situation or getting to the ward safety and calmness. A diagnosis of schizophrenia spectrum or bipolar disorder and more services from mental health specialist care also predicted feeling better during the PCA. In the two-year follow-up interview, 90% rated themselves as very or quite satisfied, and more than 90% would recommend PCAs to others.

Conclusions
The PCA arrangement was feasible and was frequently utilized by patients. Patients were satisfied with PCAs and the PCA arrangement. These short stays seemed particularly helpful for patients with a more severe diagnosis. Strong patient satisfaction gives reasons for testing and implementing increased patient influence on the mental health admission procedures in the form of PCAs.
Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia
Authors: Williams Owain D. , Dean Judith A. , Crothers Anna , Gilks Charles F. , Gow Jeff 
Published: January 2021

Abstract
Background
The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence.

Methods
A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections.

Results
Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing.

Conclusions
This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.
A multilevel study of patient-centered care perceptions in mental health teams
Authors: Durand François , Fleury Marie-Josée 
Published: January 2021

AbstractBackgroundThe successful combination of interprofessional collaboration in multidisciplinary teams with patient-centered care is necessary when it comes to delivering complex mental health services. Yet collaboration is challenging and patient-centered care is intricate to manage. This study examines correlates of patient-centered care such as team adaptivity and proactivity, collaboration, belief in interprofessional collaboration and informational role self-efficacy in multidisciplinary mental health teams.MethodA cross-sectional multilevel survey design was used, based on self-administered bilingual validated questionnaires. Participants (N=314) were mental health professionals and managers working in public primary care or specialized mental health services, in inpatient or outpatient settings.ResultsThis study showed that belief in interprofessional collaboration’s relationship with patient-centered perceptions is increased in teams with high collaboration. Collaboration is also found as a mediator, representing a process by which team adaptive and proactive behaviors are transformed into positive patient-centered perceptions.ConclusionsOur results were in line with recent studies on team processes establishing that collaboration is a key component in multilevel examinations of predictors of patient-centered care. In terms of practice, our study showed that multidisciplinary teams should know that working hard on collaboration is an answer to the complexity of patient-centered care. Collaboration is related to the teams’ ability to respond to its challenges. It is also related to individuals’ beliefs central to the delivery of interprofessional care.
Prevalence of anthelmintic resistance of gastrointestinal nematodes in Polish goat herds assessed by the larval development test
Authors: Mickiewicz Marcin , Czopowicz Michał , Moroz Agata , Potărniche Adrian-Valentin , Szaluś-Jordanow Olga , Spinu Marina , Górski Paweł , Markowska-Daniel Iwona , Várady Marián , Kaba Jarosław 
Published: January 2021

AbstractBackgroundHelminthic infections, in particular those caused by gastrointestinal nematodes (GIN), are found worldwide and are among the most economically important diseases of goats. Anthelmintic resistance (AR) in GIN of goats is currently present worldwide, and single- or multidrug resistant species are widespread. The aim of this study was to determine the prevalence of AR to benzimidazoles (BZ), macrocyclic lactones (ML) and imidazothiazoles represented by levamisole (LEV) in the Polish goat herds by using an in vitro larval development test, which is useful especially in large-scale epidemiological surveys.ResultsThis cross-sectional study was conducted from September 2018 to June 2019 and enrolled 42 dairy goat herds scattered over the entire country. The most commonly used anthelmintic class in goat herds in Poland were BZ (92%), followed by ML (85%) and LEV (13%). BZ-resistant GIN populations were found in 37 herds (88%, CI 95%: 75 to 95%), ML-resistant GIN populations in 40 herds (95%, CI 95, 84 to 99%), and LEV-resistant GIN populations in 5 herds (12%, CI 95%: 5 to 25%). Multidrug resistance involving all three anthelmintic classes was found in 5 herds (12%, CI 95, 5 to 25%). Based on the morphological features of stage 3 larvae the main resistant GIN turned out to beHaemonchus contortusandTrichostrongylusspp. The use of BZ and frequency of anthelmintic treatments were significantly related to the presence of AR to BZ in Polish goat herds.ConclusionsThis cross-sectional study demonstrates the existence of AR to BZ, ML and LEV on Polish goat farms. Resistance to BZ and ML is widespread, while AR to LEV is currently at a low level. A considerable proportion of herds harbours multidrug resistant GIN, which requires further consideration. An effective anthelmintic treatment strategy, reasonable preventive measures and better understanding of the resistance-related management practices by farmers and veterinarians may delay further development of AR.