bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital financial performance and quality of care – a scoping review of empirical studies
Authors: Dubas-Jakóbczyk K , Kocot E , Tambor M , Kostrzewska O , Szetela P , Quentin W 
Published: October 2021

Abstract

Background
Hospitals operate under constant pressure to contain costs and improve the quality of care (Q). The potential association between hospital financial performance (FP) and Q can have two directions: (1) providers with better FP might have a greater capacity to maintain and/or improve Q; (2) a better Q might lead to better FP, i.e. increased revenues, and/or lower costs. The general objective of this study was to identify and map the available evidence on the association between hospital FP and Q.

Methods
A scoping review based on the methodological framework outlined by Arksey and O'Malley was conducted. Five databases were used: (1) Medline via PubMed; (2) Embase; (3) Web of Science; (4) Scopus; and (5) EconLit. Search strategy combined multiple terms from three topics: (1) hospital,(2) FP and (3) Q. There was no limit for publication years, but only studies in English were included.

Results
After screening 8,015 records and 129 full text papers, 54 empirical studies were included. They are mostly observational studies, applying diverse regression models, published between 1992 and 2019. FP is most often measured by profitability indicators while Q measures are much more diverse. In the majority of studies, FP measures are used as dependent variables, thus the impact of Q on FP is assessed. The comparability of the studies' results is limited, yet a general overview shows that in the majority of papers, a positive association between hospital FP and Q is identified (positive in 24 studies and positive or mixed in 10). The studies' authors emphasize numerous limitations related to both, the data used and the methods applied including the ability to identify associations yet not causality.

Conclusions
There seems to be a growing interest in exploring the association between FP and Q. Our review provides a broad overview of the existing literature and helps to identify areas for further investigations.

Key messages
There is a great diversity of empirical studies on the association between hospital FP and Q, but the majority focuses solely on the United States market. An overview of the existing studies suggests that, although numerous additional factors need to be considered, hospitals might be able to simultaneously improve Q and profitability.
The therapeutic value of waiting areas in access and accessibility to care
Authors: Tsiantou E , Chrysikou DrE , Lad DrH 
Published: October 2021

Abstract

Background
Patients have increased biological metrics when entering healthcare environments as a response to stress. Priming them with nice settings before consultation or procedure might benefit their health. Yet hospital waiting areas might be neglected by regulators. Our aim was to understand how these are perceived by those who commission them and by those who deliver them in terms of their intangible value.

Methods
After a comprehensive scoping literature review of evidence based-design research eight features –daylight, furniture, materials, nature, views, colours, artwork and positive distraction– were identified as the most significant in waiting areas for patient wellbeing. Using those features as criteria we explored the regulators' views comparing and contrasting the UK, USA and Australia's design guidance on waiting areas. Also, 16 awarded hospital buildings provided case studies under the scope of those features. We examined the way these buildings were presented post-award and how those therapeutic features were portrayed in that process.

Results
Results indicate a hiatus between architects and regulators towards the therapeutic value of waiting areas design. Architects highlight qualities such as comfort and aesthetics. Yet, guidelines focus on functionality and transition and do not consider waiting areas design as important.

Conclusions
The welcoming factor of health spaces pre-consultation has been ignored by regulations yet at the same time has been used by architects to communicate their projects to the public. Actions to improve national regulations could impact on waiting areas design and consequently on people's health benefits. They could even have longer-term benefits supporting early detection of disease by reducing the fear and stigma that people feel when engaging with healthcare services. This paper supports a positivist and systemic approach and highlights a neglected area in terms of health services thinking and research.

Key messages
A welcoming pre-consultation experience might affect the patient/clinician relationship and make the patient feel valued by the institution. This should be supported by waiting area design regulations. The research on hospital waiting areas features demonstrates that the therapeutic qualities of healthcare space have been ignored by regulators.
Governance and organization of Academic Medical Centers – a comparative analysis of 11 countries
Authors: Cardinaal E , Dubas-Jakóbczyk K , Behmane D , Bryndová L , Cascini F , Duighuisen H , van Ginneken E , Waitzberg R , Jeurissen P 
Published: October 2021

Abstract

Background
Academic Medical Centers (AMCs) are organizations that link three functions: providing highly specialized medical services, teaching activities and conducting research. The aim of the study was to provide an international comparison of the governance and organization models of AMCs. The analysis covered 10 European countries (Cyprus, Czechia, Denmark, Germany, Italy, Latvia, Netherlands, Norway, Poland, Spain) and Israel.

Methods
The study has an explorative and descriptive character. The methods involved: (1) the creation of a conceptual framework; (2) the development of a dedicated questionnaire; (3) data collection and analysis. The data was collected based on purposive sampling. There were 26 respondents from 11 countries.

Results
There is no standardized definition of AMCs across countries. Different types of hospital providers do link patientcare, teaching and research. Depending on the country and particular institution, the balance between these three functions, as well as the scope might vary a lot. The majority of the participating countries face either public or not-for-profit ownership for AMCs and medical faculties. However, the relationship between hospital and faculty varies substantially. Main internal governance challenges focus on lack of responsiveness to change and financial conflicts between the three core tasks. External challenges relate to financial sustainability and workforce shortages. Most respondents believe that in the nearby future the governance of AMCs will evolve to a more functionally integrated model of the three functions.

Conclusions
The study fills the gap in the literature on organization and governance of European AMCs. Although, there are substantial differences in the models of governance across countries, many challenges are highly similar. This raises important questions for future research (e.g. focusing solely on one function) as well as policy (the potential for cross-national learning).

Key messages
There is no standardized definition of AMCs across countries and different types of organizations are used to link the three functions of providing patientcare, teaching activities and research. Despite the organizational and legal differences, AMCs in different countries face similar challenges (nimbleness and financial conflicts between the three functions; health workforce shortages).
Arterial hypertension in older age: qualitative study
Authors: Vasiljev V , Juraga D , Bilajac L , Marinović Glavić M , Roviš D , Jelaković B , Rukavina T 
Published: October 2021

Abstract

Background
Arterial hypertension a.k.a silent killer is one of the most important cardiovascular, yet preventable risk factors. Although there are more than 7000 clinical studies in 2019 there is still slow progress in global control of arterial hypertension. The aim of this study is to present the results from the qualitative study of the quality of treatment and care of arterial hypertension in older persons in the city of Rijeka, Croatia.

Participants and Methods
In two focus groups with older persons (65+) who had diagnosis of arterial hypertension for more than one year, attitudes toward positive and negative experiences in health and social care system were discussed, as well as their values regarding living with arterial hypertension. In focus groups 15 participants were involved. The focus groups were recorded; transcripts were made followed by analysis of the data reduction.

Results
The specific challenges in the participants' groups were identified such as lack of knowledge about the hypertension and concerns on pharmaceutical industries and lobbies interests which can result in lower adherence to medications. Some of the participants use Internet as a health information source including invalidated websites which can represent threat in adequate care especially in older people with multimorbidities. Self-reliance is most valued among the participants, while financial stability and support in the community are also highly appreciated in the urban population with arterial hypertension.

Conclusions
This research gives a framework for additional research in the population of older people that are living with arterial hypertension. Positive health and social care experiences must be preserved, yet negative experiences such as long waiting lists, additional health care costs, ageism and others must be improved.

Key messages
Although arterial hypertension is a well-known risk factor, more effort should be made in preventive interventions and health education. Adherence to medicines.
Process evaluation of We Can Quit- stop-smoking programme for women in socio-disadvantage in Ireland
Authors: Darker C , Burke E , Castello S , O'Sullivan K , Vance J , Buggy A , Loudon K , Williams P , Dobbie F , Hayes C 
Published: October 2021

Abstract

Background
Smoking tobacco poses a serious risk of early preventable death and disease for women living with socioeconomic disadvantage (SED). A smoking cessation programme ‘We Can Quit' (WCQ) tailored to women living in four SED areas developed in Ireland included group support delivered by trained lay local women and free nicotine replacement therapy (NRT). The intervention was pilot tested in a community-based, cluster randomised controlled trial, ‘We Can Quit 2'. Results of an embedded process evaluation to assess feasibility and acceptability of the programme and trial processes are presented.

Methods
The design was qualitative using the Medical Research Council's (MRC) process evaluation framework. Semi-structured interviews with trial participants (N = 18) and Community Facilitators (CFs) who delivered WCQ (N = 8) were conducted. An inductive approach was used and data were analysed using thematic coding.

Results
Peer-modelling, a non-judgemental environment, and CFs supportive role were viewed as facilitative elements of group support. Potential for broader message diffusion into the social networks of participating women was observed. Participants reported that free access to NRT was helpful for cessation. Some participants expressed concerns about NRT side effects. Community pharmacists provided important guidance relating to NRT and additional support between group sessions. Provision of a saliva samples proved challenging. Low literacy was a barrier to engagement with the programme and completion of trial-related materials. Hypothetical scenarios of direct or indirect observational fidelity assessment for a definitive trial (DT) were acceptable.

Conclusions
The MRC framework proved useful to capture the experience of women smokers in SED areas of engaging with a community-based smoking cessation trial. Programme and trial-related processes were feasible and acceptable. A future DT will need to address low literacy.

Key messages
A group-based stop-smoking programme including free NRT was acceptable and feasible to programme deliverers and women smokers living in disadvantaged communities. Women’s low literacy was a barrier to engagement with trial and completion of programme materials.
Health Care Planning: a method to organize and integrate healthcare networks
Authors: Eshriqui I , Souza EL , de Andrade AT , de Medeiros EB , Paresque MAC 
Published: October 2021

Abstract

Issue/problem
Fragmentation of health care system is a concern in both developed and low and medium development countries, once may compromise cost-effectiveness, equity and quality of health care provision. Healthcare reforms have been focusing on integration, which is complex, considering that requires a methodology and involvement of actors from different sectors and governmental spheres.

Description of the problem
The “Health Care Planning” (HCP) method, proposed by the Brazilian National Council of Health Secretaries to overcome fragmentation of Brazil's public healthcare model, promotes development of local actors' skills and competences to organize healthcare networks through two main activities: (i) Workshops, provided to all health professionals aiming to introduce theoretical concepts and desire of changing; (ii) Tutoring, to guide theory implementation in healthcare services. A strategic group, composed of representatives of health services, managers and technical areas of health secretariats, monitors the whole process.

Results
Since 2018, the PlanificaSUS project is executed to implement the HCP in Brazil, focusing on integration of specialized outpatient care (SOC) with primary care (PC), in the context of healthcare network, coordinated by PC. From 27 health regions that agreed to participate, 25 (in 19 states and 282 municipalities) concluded the first phase in December 2020. Four thematic workshops were conducted with mean participation of 31.233 professionals each. Further, 316 local professionals were formed and conducted 2.131 tutoring activities in PC and 193 SOC. Improvement of PC organization was reported by 70% of PC facilities. In 76% of SOC facilities, team was completed and trained.

Lessons
HCP is an innovative method that could be applied in large-scale and adapted to provide healthcare services organization and integration according to local conditions. Autonomy of State and Municipal Health Secretariats must be encouraged.

Key messages
Health Care Planning is a potential method to provide qualification and integration of healthcare services in different contexts. Support from state management is important to develop organization and qualification of healthcare networks coordinated by the primary care.
Changes on the Demand for Attention for a Mental Health Service During Social Isolation Measures
Authors: Piscitello F , Pizzi RD , Cuneo MM , Farias MA 
Published: October 2021

Abstract

Background
Most of the countries in the world adopted isolation measures during the COVID-19 pandemic. According to Kola L. et. al (2021), “in most settings in low and middle-income countries (LMICs), ongoing in-person mental health services have been disrupted and patients with severe mental conditions and substance abuse disorders are often unable to obtain medications, attend to treatment centres, or receive social services”. The aim of this paper is to describe the effects of the COVID-19 pandemic on the demand for attention in a mental health service as reported by healthcare workers.

Methods
A quantitative cross-sectional descriptive study was conducted and a survey designed by the Secretaría de Políticas Integrales sobre Drogas de la Nación Argentina was applied to a total of 29 healthcare workers of a mental health centre in the Province of Córdoba, Argentina, during the month of November, 2020.

Results
The perception of healthcare workers towards the demand for attention shows that the 3 main reasons for consultation during the first three months of isolation measures were drug abuse (50%), request for treatment (10.3%), and order for medication (10.3%). During the three subsequent months, the reasons for consultation were drug abuse (62.1%), request for treatment (44.8%) and remote treatment modality (24.1%). Healthcare workers state that drug abuse consultations increased 65.5% and the self-inflicted violence consultations increased 44.8%.

Conclusions
The isolation measures generate a change in the demand for attention. There are differences between various phases of the isolation measures, where an increase in the drug abuse consultations and remote treatment modality could be observed.

Key messages
To develop predictability according to the variations in the demand for attention produced during public health crisis. To train healthcare workers in order to make interventions in public health crisis.
The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services
Authors: Lastrucci V , Lorini C , Forni S , Collini F , D'Arienzo S , Gemmi F , Bonaccorsi G 
Published: October 2021

Abstract

Background
Fear of contracting COVID-19 and the large-scale preventing measures may have influenced health service utilization. The aim of the study was to assess the indirect impact of COVID-19 pandemic on the utilization of the emergency medical services (EMS) of Tuscany Region (Italy).

Methods
The study was carried out on administrative data from the public healthcare system of Tuscany (38 general hospitals and 4 university teaching hospitals). Variations in the utilization of out-of-hospital (i.e. calls for emergency medical assistance and dispatch of mobile medical care units) and in-hospitals (emergency department(ED) visits and hospitalizations from the ED) EMS during the first pandemic wave were analyzed (February - July 2020) in relation with corresponding periods of the previous three years. Furthermore, in order to understand changes in illness severity of patients using the EMS, standardized ratios for hospitalizations requiring ICU and in-hospital mortality were analyzed.

Results
Significant decreases in the expected volumes of utilizations were observed in each of the considered EMS starting from the week in which the first case of COVID-19 was confirmed in Italy till the last week of the first wave. In particular, during the peak period of COVID-19 pandemic wave a reduction of 73,041 (-67%, 95%CI -69%; -66%) in ED admissions and of 682 (-38% 95%CI -55%; -43%) in hospitalization from ED were observed. Significant decreases in hospitalizations for life threatening medical conditions were observed. No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the COVID-19 epidemic peak period (SR 1.1 95%CI 0.72-1.90; SR 1.0 95%CI 0.83-1.23).

Conclusions
A large and generalized decrease in EMS utilization was observed during the first wave of COVID-19 pandemic. Furthermore, findings suggest that seriously ill patients avoid seeking care as less seriously ill patients did.

Key messages
The falling in the utilization of emergency medical services during pandemic could portend substantial harm to public health, and not simply the absence of real health need. The preparedness of the healthcare delivery system should not focus solely on confronting the pandemic disease, but also on ensuring access to high quality emergency care for other diseases.
Incidence and predictor of tobacco experimentation among high-school adolescents of Sousse, Tunisia
Authors: Zammit N , Bennasrallah C , Ben Fredj S , Ghammem R , Krifa R , Farhaoui S , Maatoug J , Ghannem H 
Published: October 2021

Abstract

Background
Tobacco use is considered one of the leading risk factors for early morbidity and mortality especially in developing countries. Initiation of tobacco use occurs usually during adolescence which is responsible for a longer time of exposure to nicotine and other constituents of tobacco products. The aim of this study is to determine the incidence and the factors associated with tobacco experimentation among high school students in the governorate of Sousse between 2017/2018 and 2018/2019.

Methods
A prospective longitudinal study was conducted in 4 high schools in the governorate of Sousse during the 2018-2019 school year. Pre-trained medical doctors ensured data collection using anonymous self-administered questionnaire. Collected data included socio-demographic and educational features, tobacco use, alcohol use, second hand smoking, illicit substances use, problematic internet use and mental health disorders.

Results
A total of 404 students were included in our study. The sex-ratio was 0.49 and the mean age of high school students was 16.4 (±1.1) years. At the end of the follow up, the incidence of tobacco experimentation among high school students was 9.7%. Problematic internet use was observed among the 36 (100%) adolescents who experimented tobacco while it was observed in 250 (79.9%) of who did not experiment tobacco during the follow up (p = 0.003). Otherwise, maternal tobacco use was the most influential factor on tobacco experimentation among participants with an odds ratio of: 7.1; 95% CI: 1.5-32.8) (p = 0,013).

Conclusions
Incidence of tobacco experimentation among the high school adolescents of Sousse is high. Second hand smoking and other addictive behaviors should be considered in order to reinforce the national prevention program of tobacco use.

Key messages
Reinforcement of the existing prevention program of tobacco use in Tunisia is required. Comprehensive prevention program of tobacco use taking into consideration the other addictive behaviors among adolescent and their entourage would be more effective.
Intensive specialists’ consultation combined with antibiotic stewardship programmes
Authors: Allen R , Zimmermann N , Fink G , Först G , Kern WV , Farin-Glattacker E , Rieg SR 
Published: October 2021

Abstract

Background
Antibiotic Stewardship Programmes (ASP) combine measures to optimise antibiotic (AB) therapies and ensure high AB prescription quality. Studies have shown that ASP in combination with an infectious disease (ID) consultation, can significantly improve the rational use of AB. This study aims to improve the quality of care and treatment of ID patients after implementing ASP activities, with or without ID consultation.

Methods
This is a study protocol of a prospective, two-arm, clustered intervention study with before-after-analyses conducted in ten hospitals (excl. university hospitals) in Germany over a period of three years. The intervention includes the implementation of ASP, with or without consultation by an ID specialist. We will gather information on ID inpatients (diagnosed with community-acquired pneumonia (CAP) N = 335 and Staphylococcus aureus bacteraemia (SAB) N = 110) aged &gt;18 years. We will compare patient-related outcomes (changes in SAB score as an indicator of difficult-to-treat infections, and CAP score as an indicator of common infections), as well as the quality and quantity of AB prescriptions. Secondary endpoints comprise quality and quantity of AB prescriptions as well as hospital-related and health economic outcomes. The statistical analysis includes a multilevel analysis. In addition, we will conduct a process evaluation, using interviews to analyse the process and the feasibility of the interventions.

Results
The baseline-data collection process started in April 2021. We will provide data for the broader ID and public health research communities, and publish the results in international journals to contribute to the ongoing global effort addressing AB resistance.

Conclusions
We highlight the purview, in terms of the multicentre, comprehensive interventions and the mixed-method approach.

Key messages
The study results will shed light on whether ASP+ID consultation improves AB prescription quality. We expect enhanced treatment results of ID patients in the public health sector.