bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa
Authors: Griffiths Frances , Babalola Olukemi , Brown Celia , de Kadt Julia , Malatji Hlologelo , Thorogood Margaret , Tseng Yu-hwei , Goudge Jane 
Published: September 2019

ObjectiveTo develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.DesignWe determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.SettingSouth Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.Primary and secondary outcomesOur primary outcome was the completion of a tool and user manual.ResultsThe tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.ConclusionsWe have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.
Modelling the lifetime cost-effectiveness of catheter ablation for atrial fibrillation with heart failure
Authors: Gao Lan , Moodie Marj 
Published: September 2019

ObjectivesAssessing the cost-effectiveness credentials of this intervention in patients with concomitant atrial fibrillation (AF) and heart failure (HF) compared with usual medical therapy.DesignA Markov model comprising two health states (ie, alive or dead) was constructed. The transition probabilities were directly derived from published Kaplan-Meier curves of the pivotal randomised controlled trial and extrapolated over the cohort’s lifetime using recommended methods. Costs of catheter ablation, outpatient consultations, hospitalisation, medications and examinations were included. Resource use and unit costs were sourced from government websites or published literature. A lifetime horizon and a healthcare system perspective were taken. All costs and benefits were discounted at 3% annually. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were run around the key model parameters to test the robustness of the base case results.ParticipantsA hypothetical Australian cohort of patients with concomitant AF and HF who are resistant to antiarrhythmic treatment.InterventionsCatheter ablation versus medical therapy.ResultsThe catheter ablation was associated with a cost of $A44 377 per person, in comparison to $A28 506 for the medical therapy alone over a lifetime. Catheter ablation contributed to 4.58 quality-adjusted life years (QALYs) and 6.99 LY gains compared with 4.30 QALYs and 6.53 LY gains, respectively, in the medical therapy arm. The incremental cost-effectiveness ratio was $A55 942/QALY or $A35 020/LY. The DSA showed that results were highly sensitive to costs of ablation and time horizon. The PSA yielded very consistent results with the base case.ConclusionsOffering catheter ablation procedure to patients with systematic paroxysmal or persistent AF who failed to respond to antiarrhythmic drugs was associated with higher costs, greater benefits. When compared with medical therapy alone, this intervention is not cost-effective from an Australia healthcare system perspective.
Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study
Authors: Touzet Sandrine , Occelli Pauline , Denis Angelique , Cornut Pierre-Loïc , Fassier Jean-Baptiste , Le Pogam Marie-Annick , Duclos Antoine , Burillon Carole 
Published: September 2019

Objective and settingPrimary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact of a comprehensive prevention programme aimed at preventing incivility and verbal violence against healthcare professionals working in the ophthalmology ED (OED) of a university hospital.InterventionThe programme was designed to address long waiting times and lack of information. It combined a computerised triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the OED, educational messages broadcast in the waiting room, presence of a mediator and video surveillance.ParticipantsAll patients admitted to the OED and those accompanying them.DesignSingle-centre prospective interrupted time-series study conducted over 18 months.Primary outcomeViolent acts self-reported by healthcare workers committed by patients or those accompanying them against healthcare workers.Secondary outcomesWaiting time and length of stay.ResultsThere were a total of 22 107 admissions, including 272 (1.4%) with at least one act of violence reported by the healthcare workers. Almost all acts of violence were incivility or verbal harassment. The rate of violence significantly decreased from the pre-intervention to the intervention period (24.8, 95% CI 20.0 to 29.5, to 9.5, 95% CI 8.0 to 10.9, acts per 1000 admissions, p<0.001). An immediate 53% decrease in the violence rate (incidence rate ratio=0.47, 95% CI 0.27 to 0.82, p=0.0121) was observed in the first month of the intervention period, after implementation of the triage algorithm.ConclusionA comprehensive prevention programme targeting patients and environment can reduce self-reported incivility and verbal violence against healthcare workers in an OED.Trial registration numberNCT02015884
Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study
Authors: Cheng Socheat , Siddiqui Tahreem Ghazal , Gossop Michael , Kristoffersen Espen Saxhaug , Lundqvist Christofer 
Published: September 2019

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.DesignA prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSomatic departments of the Akershus University Hospital, Norway.Participants246 patients aged 65–90 were included.Outcome measuresProlonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.ResultsForty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).ConclusionCNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.Trial registration numberNCT03162081.
Evaluation of the impact of the GRACE risk score on the management and outcome of patients hospitalised with non-ST elevation acute coronary syndrome in the UK: protocol of the UKGRIS cluster-randomised registry-based trial
Authors: Everett Colin C , Fox Keith AA , Reynolds Catherine , Fernandez Catherine , Sharples Linda , Stocken Deborah D , Carruthers Kathryn , Hemingway Harry , Yan Andrew T , Goodman Shaun G , Brieger David , Chew Derek P , Gale Chris P 
Published: September 2019

IntroductionFor non-ST-segment elevation acute coronary syndrome (NSTEACS) there is a gap between the use of class I guideline recommended therapies and clinical practice. The Global Registry of Acute Coronary Events (GRACE) risk score is recommended in international guidelines for the risk stratification of NSTEACS, but its impact on adherence to guideline-indicated treatments and reducing adverse clinical outcomes is unknown. The objective of the UK GRACE Risk Score Intervention Study (UKGRIS) trial is to assess the effectiveness of the GRACE risk score tool and associated treatment recommendations on the use of guideline-indicated care and clinical outcomes.Methods and analysisThe UKGRIS, a parallel-group cluster randomised registry-based controlled trial, will allocate hospitals in a 1:1 ratio to manage NSTEACS by standard care or according to the GRACE risk score and associated international guidelines. UKGRIS will recruit a minimum of 3000 patients from at least 30 English National Health Service hospitals and collect healthcare data from national electronic health records. The co-primary endpoints are the use of guideline-indicated therapies, and the composite of cardiovascular death, non-fatal myocardial infarction, new onset heart failure hospitalisation or cardiovascular readmission at 12 months. Secondary endpoints include duration of inpatient hospital stay over 12 months, EQ-5D-5L responses and utilities, unscheduled revascularisation and the components of the composite endpoint over 12 months follow-up.Ethics and disseminationThe study has ethical approval (North East - Tyne & Wear South Research Ethics Committee reference: 14/NE/1180). Findings will be announced at relevant conferences and published in peer-reviewed journals in line with the funder’s open access policy.Trial registration numberISRCTN29731761; Pre-results.
Mapping outcomes in quality improvement and system design activities: the outcome identification loop and system impact model
Authors: Akinluyi Emmanuel Adeoluwa , Ison Keith , Clarkson P John 
Published: September 2019

BackgroundWhether explicit or implicit, models of value are fundamental in quality improvement (QI) initiatives. They embody the desirability of the impact of interventions—with either foresight or hindsight. Increasingly impact is articulated in terms of outcomes, which are often prescribed and sometimes inappropriate. Currently, there is little methodological guidance for deriving an appropriate set of outcomes for a given QI initiative. This paper describes a structured approach for identifying and mapping outcomes.Overall approachCentral to the approach presented here is the engagement of teams in the exploration of the system that is being designed into. This methodology has emerged from the analysis and abstraction of existing methods that define systems in terms of outcomes, stakeholders and their analogues. It is based on a sequence of questions that underpin these methods.Outcome elicitation toolsThe fundamental questions of outcome elicitation can be concatenated into a structured process, within the Outcome Identification Loop. This system-analysis process stimulates new insights that can be captured within a System Impact Model.The System Impact Model reconciles principles of intended cause/effect, with knowledge of unintended effects more typically emphasised by risk approaches. This system representation may be used to select sets of outcomes that signify the greatest impact on patients, staff and other stakeholders. It may also be used to identify potential QI interventions and to forecast their impact.Discussion and conclusionsThe Outcome Identification Loop has proven to be an effective tool for designing workshops and interviews that engage stakeholders, critically in the early stages of QI planning. By applying this process in different ways, existing knowledge is captured in System Impact Models and mobilised towards QI endeavours.
Sleep problems, behavioural problems and respiratory health in children born extremely preterm: a parental questionnaire study
Authors: Stangenes Kristine Marie , Hysing Mari , Elgen Irene Bircow , Halvorsen Thomas , Markestad Trond , Bjorvatn Bjørn 
Published: September 2019

ObjectiveTo explore whether children born extremely preterm (EPT) with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.DesignProspective, nationwide, questionnaire-based study. At 11 years of age, parents reported on four current sleep problems: difficulty falling asleep or frequent awakenings, snoring, daytime sleepiness and not recommended sleep duration (<9 hours). Behavioural problems were assessed by parents and teachers with the Strengths and Difficulties Questionnaire (SDQ). Parents assessed respiratory symptoms with the International Study of Asthma and Allergies in Childhood questionnaire and described use of asthma medication.SettingNorway.PatientsEPT children.Main outcome measuresSpecified sleep problems, behavioural problems and respiratory health.ResultsData were obtained from 216 of 372 (58 %) of eligible children. All four specified sleep problems were associated with significantly higher parent-reported SDQ total-score (OR 1.1 for all), and except for not recommended sleep duration, also with higher teacher-reported SDQ total-score (OR 1.1 for all). Daytime sleepiness was strongly associated with wheezing last 12 months (OR 3.4), disturbed sleep due to wheezing (OR 3.9), wheeze during or after exercise (OR 2.9), use of inhaled corticosteroids or oral leukotriene modifiers (OR 3.4) and use of bronchodilators (OR 3.9). Snoring was associated with wheezing during or after exercise (OR 2.8) and current asthma (OR 4.2).ConclusionEPT children with different types of sleep problems had more behavioural and respiratory health problems than EPT children without sleep problems.
Guideline-directed therapy at discharge in patients with heart failure and atrial fibrillation
Authors: Ahn Min-Soo , Yoo Byung Su , Yoon Junghan , Lee Seung-Hwan , Kim Jang Young , Ahn Sung Gyun , Youn Young Jin , Lee Jun-Won , Son Jung-Woo , Kim Hye Sim , Kang Dae Ryong , Cho Hyun-Jai , Lee Hae-Young , Jeon Eun Seok , Kang Seok-Min , Choi Dong-Ju , Cho Myeong-Chan 
Published: September 2019

ObjectivesThis study evaluated the relationship between guideline adherence for recommended therapy on discharge and relevant 60-day and 1-year clinical outcomes in patients with acute heart failure (HF) with reduced ejection fraction and atrial fibrillation (AF).MethodsOf 5625 acute patients with HF in the Korean Acute Heart Failure registry, 986 patients with HF and documented AF were analysed. Guideline adherence scores were calculated for the prescription of ACE inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists and anticoagulants.ResultsIn patients with HF with AF, there was a significant trend of reduced 60-day and 1-year mortality rates and the composite end point with guideline adherence. According to the Cox proportion hazard model, poor adherence was associated with a significantly higher risk of 60-day mortality (HR 4.75; 95% CI 1.77 to 12.74) and the composite end point (HR 2.36; 95% CI 1.33 to 4.18) compared with good adherence. Furthermore, poor adherence was associated with a significantly higher risk of 1-year mortality compared with moderate (HR 1.64; 95% CI 1.15 to 2.33) and good adherence (HR 2.34; 95% CI 1.39 to 3.97) and with a higher risk of the 1-year composite end point compared with good adherence (HR 1.58; 95% CI 1.07 to 2.33).ConclusionBetter adherence to guidelines was associated with better 60-day and 1-year prognoses in patients with HF with AF.
Initial Development and Testing of a Convection-Allowing Model Scorecard
Authors: Gallo Burkely T. , Kalb Christina P. , Gotway John Halley , Fisher Henry H. , Roberts Brett , Jirak Israel L. , Clark Adam J. , Alexander Curtis , Jensen Tara L. 
Published: September 2019

AbstractEvaluation of numerical weather prediction (NWP) is critical for both forecasters and researchers. Through such evaluation, forecasters can understand the strengths and weaknesses of NWP guidance, and researchers can work to improve NWP models. However, evaluating high-resolution convection-allowing models (CAMs) requires unique verification metrics tailored to high-resolution output, particularly when considering extreme events. Metrics used and fields evaluated often differ between verification studies, hindering the effort to broadly compare CAMs. The purpose of this article is to summarize the development and initial testing of a CAM-based scorecard, which is intended for broad use across research and operational communities and is similar to scorecards currently available within the enhanced Model Evaluation Tools package (METplus) for evaluating coarser models. Scorecards visualize many verification metrics and attributes simultaneously, providing a broad overview of model performance. A preliminary CAM scorecard was developed and tested during the 2018 Spring Forecasting Experiment using METplus, focused on metrics and attributes relevant to severe convective forecasting. The scorecard compared attributes specific to convection-allowing scales such as reflectivity and surrogate severe fields, using metrics like the critical success index (CSI) and fractions skill score (FSS). While this preliminary scorecard focuses on attributes relevant to severe convective storms, the scorecard framework allows for the inclusion of further metrics relevant to other applications. Development of a CAM scorecard allows for evidence-based decision-making regarding future operational CAM systems as the National Weather Service transitions to a Unified Forecast system as part of the Next-Generation Global Prediction System initiative.
It’s Still about Race: Peremptory Challenge Use on Black Prospective Jurors
Authors: DeCamp Whitney , DeCamp Elise 
Published: September 2019

Objectives: The use of race as a motive for excluding individuals from serving on juries in American criminal trials is unconstitutional. Nevertheless, Black individuals remain substantially more likely than others to be removed during jury selection through peremptory challenges. This study tests whether and to what extent there is a racial effect on peremptory challenge use by the prosecution or the defense. Method: Using data from 2,542 venire members in Mississippi, propensity score matching is used to examine racial differences in jury selection by comparing Black venire members to similarly situated White venire member counterparts. Results: Findings suggest that Black venire members are 4.51 times as likely to be excluded from a jury due to peremptory challenges from the prosecution in comparison to White venire members. Conversely, White venire members are 4.21 times as likely to be excluded through peremptory challenges by the defense in comparison to Black venire members. Conclusions: After controlling for all observed variables, there remain significant differences between White and Black venire members, suggesting racial discrimination by both the prosecution and the defense in peremptory challenge usage. Black individuals are more likely to be excluded from juries through these effects, resulting in less racially diverse juries.
Second-generation antipsychotics activate platelets in antipsychotic-naive and antipsychotic-free patients with schizophrenia: A retrospective study
Authors: Kim Hyun-Ah , Lee Jong Wook , Kim Seung Jun , Oh Hong-Seok , Im Woo Young , Kim Ji-Woong 
Published: September 2019

Objective Among the risk factors for cerebrovascular/cardiovascular disease or thromboembolic events caused by the administration of second-generation antipsychotics, clinicians have mainly focused on metabolic side effects, with little interest in the effects on platelet activity. Because excessive platelet activity can increase the risk for cerebrovascular/cardiovascular disease, the aim of this study was to investigate the effect of second-generation antipsychotics on platelet activity in patients with schizophrenia. Methods The medical records of patients with schizophrenia who were treated with second-generation antipsychotics were retrospectively reviewed. The degree of platelet activation was assessed by measuring the mean platelet component. Results Wilcoxon signed-rank test revealed that mean platelet component levels were significantly decreased by the administration of second-generation antipsychotics (V = 20; p < 0.05), suggesting that the administration of second-generation antipsychotics may increase platelet activation. Conclusion Because platelet activation is an additional risk factor for the occurrence of cerebrovascular/cardiovascular disease, results of this study suggest that clinicians should carefully monitor the degree of platelet activation after the administration of second-generation antipsychotics.