bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE DEVELOPMENT BOOK OF STORY BASED SUNDANESE CULTURE AS MEDIA ON INDONESIAN LANGUAGE WITH PANTUN MATERIAL IN IV CLASS ELEMENTARY SCHOOL
Authors: Makarim Helwiyah , Holipah Siti , Helmi Helmi 
Published: June 2018

The Development Book of Story Based Sundanese Culture as Media on Indonesian Language with Pantun Material in IV Class, Elementary School. Djuanda Bogor University in 2017. This research is a Research and Development (R&D) which has a goal to know more a story of book based on Sundanese culture with learning method Indonesian language on pantun materials, another goal is to determine which one is the best of story book. The procedure of this research take a model of Borg and Gall theory, the development has five stages; find out the information, product plan, product development, validation product and evaluation of the product. To know quality of products is based on the learning aspect, materials, and looking with gift quetionnaires as a purpose to know the media developed worthy used or not as a learning media. The result of this a research are a book of story based on Sundanese culture used a learning method Indonesian language with pantun materials in class IV elementary school has good qualities based the material expert 43, maximum points from 50 with very good category. the media expert 68, maximum points from 75 with very good category. The teacher around 124.33, maximum points from 125 with very good category. Peer reviewer around 111.33, maximum points from 125 with very good category. Testing 49,44, maximum points from 50 with very good category. Temporary testing 49, maximum points from 50 with very good category, so that this is a book of Sundanese story has good using for taking in learning media Indonesian language with pantun material in grade IV Elementary School.
FAKTOR YANG MEMPENGARUHI TINGKAT KEPERCAYAAN MASYARAKAT TERHADAP ECOMMERCE
Authors: Sari Putri Pradnyawidya 
Published: June 2018

Tingginya pengguna media online di Indonesia menimbulkan optimisme para pelaku industri untuk mulai beralih kebisnis media online. Para creator digital mulai mengkonvergen segala bentuk perkembangan gaya hidup masyarakat dengan teknologi digital termasuk ecommerce. Banyaknya ecommerce yang bermunculan di internet menyebabkan masyarakat mempunyai banyak pilihan untuk memanfaatkannya. Oleh karena itu ketika media online ecommerce menjadi sangat produktif di internet maka menjadi menarik apabila melakukan analisis mengenai parameter-parameter yang mempengaruhi media online ecommerce dan sejauh mana tingkat kepercayaan masyarakat terhadap website travel. Dengan menggunakan analisis deskriptif dan analisis regresi linier berganda maka diharapkan dapat memberikan analisa yang compatibel mengenai media online ecommerce. Berdasarkan analisa yang sudah dilakukan terhadap data yang diperoleh dari survei online untuk penelitian analisis faktor kepercayaan masyarakat terhadap media online ecommerce adalah dari semua variabel pada faktor personality hanya variabel pendidikkan saja yang tidak berpengaruh secara signifikan terhadap variabel tingkat kepercayaan media online ecommerce. Maka dapat disimpulkan bahwa pendidikkan merupakan variabel terpenting dalam pengaruhnya terhadap tingkat kepercayaan media online ecommerce.
Risk of bleeding with direct oral anticoagulants versus warfarin: cohort studies using primary care datasets
Authors: Vinogradova Yana , Coupland Carol , Hippisley-Cox Julia 
Published: June 2018

BackgroundThere is limited evidence on the safety of direct oral anticoagulants (DOACs) in real world settings.AimTo investigate risks of bleeding and all-cause mortality in DOACs compared to warfarin.MethodProspective cohorts of incident oral anticoagulant users between 2011 and 2016 derived from two UK databases (QResearch and CPRD) linked to hospital and mortality data, with no anticoagulant prescriptions in the year before entry, were selected. Overall, 132,231 warfarin, 7744 dabigatran, 37,863 rivaroxaban, and 18,223 apixaban users, were sub-grouped into those with atrial-fibrillation (AF) and without (non-AF), followed up until any major bleed leading to hospital admission or death. Analyses were adjusted for demographics, life style, comorbidities and prescribed medications.ResultsCompared to warfarin, apixaban was associated with decreased risk of major bleeding (hazard ratio 0.62, 95% confidence interval [CI] = 0.54 to 0.73), intracranial (HR 0.48, 95% CI = 0.34 to 0.68) and gastro-intestinal (HR 0.67, 95% CI = 0.54 to 0.83). Dabigatran and rivaroxaban were associated with decreased risk of intracranial bleeding (HR 0.44, 95% CI = 0.27 to 0.71; HR 0.73, 95% CI = 0.59 to 0.90). Rivaroxaban was associated with increased risk of all-cause mortality (HR 1.34, 95% CI = 1.26 to 1.42), consistent for both sub-cohorts. A small increased all-cause mortality risk for apixaban (HR 1.14, 95% CI = 1.05 to 1.24) was statistically significant on the lower doses (HR 1.31, 95% CI = 1.19 to 1.45) but not on higher doses (HR 0.98, 95% CI = 0.87 to 1.10).ConclusionOverall, apixaban was found to be the safest drug for any major bleed, particularly for patients with increased risk of intracranial or gastro-intestinal bleeding.FundingThis work has been supported by NIHR with a SPCR round 11 grant [reference number 304]. We acknowledge the contribution of EMIS, CPRD, HES and Office of National Statistics for providing the data.
An observational study assessing high dose opioid prescribing and associated adrenal insufficiency
Authors: Hayhoe Sophie , Rudland Simon , Morris Damian 
Published: June 2018

BackgroundLong-term opioid use is known to affect endocrine function, with case reports indicating an association with adrenal insufficiency.AimThis study aims to investigate long-term, high-dose opioid use (≥80mg morphine or equivalent per day) at a Suffolk (UK) General Practice and its effect on adrenal function.MethodFrom a practice list of 18,300, retrospective data was collected for patients prescribed high-dose opioids for non-cancer pain for at least three months on current repeat prescription. Patient demographics and prescribing information were collected using SystmOne. Cortisol levels in the high-dose opioid patients, and short synacthen testing if indicated, were performed.ResultsThe 35 identified patients (0.2% of practice list) were predominantly female (77%) ≥70 years old (37%), and taking opioids prescribed for osteoarthritis or back pain (77%). 6% were prescribed >280mg morphine or equivalent per day, with one patient prescribed 705 mg. Routine evaluation for development of adrenal suppression and subsequent management was poor. 31% (11 of 35) had developed symptoms potentially indicative of adrenal insufficiency. One of these patients was among the 21% (7 of 35) with suppressed serum cortisol. Adrenal insufficiency secondary to opioids was confirmed in one patient using short synacthen testing. There was no statistical difference in either opioid dose or months of use for those with or without early morning cortisol suppression.ConclusionThe investigation highlights both the considerable use of high-dose opioids for non-malignant pain and their apparent association with adrenal suppression, demonstrating the need for formal guidelines to aid recognition and diagnosis.
The changing role of GP clinicians working in community hospitals.
Authors: Seamark David , Davidson Deborah , Tucker Helen , Ellis-Paine Angela , Glasby Jon 
Published: June 2018

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.
The usefulness of health education materials in GP waiting rooms: a cross-sectional study
Authors: Maskell Katherine , McDonald Paula , Paudyal Priyamvada 
Published: June 2018

BackgroundMore than half of patients in the UK wait between 5 and 15 minutes before seeing the GP, and this time in the waiting room (WR) provides an ideal opportunity for patient education.AimTo assess patients’ perceptions of the usefulness, noticeability and attractiveness of health education materials (HEMs); and the variety, number, topics, design and accessibility of these HEMs.MethodAn anonymous questionnaire was distributed to patients in the WR to assess their use of health information and perceptions of HEMs. A survey measured the availability of HEMs in the WR and evaluated their quality against 16 accessibility and design criteria.ResultsA total of 556 questionnaires were completed (response rate 97.9%). On average, WRs contained 72 posters covering 23 topics, and 53 leaflets covering 24 topics. Multivariate analysis showed that patients’ perception of usefulness was significantly associated with reading in the WR, using written HEMs, and not having a university degree; whilst noticeability was associated with reading in the WR, and being female. Attractiveness was associated with not having a university degree and shorter waiting time.ConclusionThis study suggests that a wide variety of HEMs are available, and that many patients find them useful and noticeable, however, fewer find them well-designed and attractive. Future research should focus on the effectiveness of generally available HEMs at changing knowledge, attitudes, intentions, and behaviours; and utilising technology to deliver innovative means of providing patient health information.
The incidence of diagnostic errors in UK primary care and implications for health care, research, and medical education: a retrospective record analysis of missed diagnostic opportunities
Authors: Cheraghi-Sohi Sudeh , Holland Fiona , Reeves David , Campbell Stephen , Esmail Aneez , Morris Rebecca , Small Nicola , de Wet Carl , Singh Hardeep ,   NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre
Published: June 2018

BackgroundDiagnostic errors have recently been identified as a high-priority patient safety problem in primary care by the World Health Organization (WHO). However, no studies exist in UK to quantify the extent of such errors and associated harm in primary care.AimThis study aimed to determine the incidence of ‘missed diagnostic opportunities’ (MDOs) in UK primary care.MethodRetrospective reviews of electronic health records (EHRs). Twenty-one general practices were recruited, sampled by size and deprivation. Pairs of GP-reviewers independently reviewed 100 randomly selected face-to-face consultations with adults in each practice (n = 21), reviewing a 12-month period for consultations containing new diagnostic activity. Records were jointly reviewed where at least one reviewer identified an MDO to gain consensus.ResultsWe reviewed 2070 EHRs; and, 1530 contained some new diagnostic activity. After joint review, at least one clinician thought an MDO was likely/certain in 4.4% (95% CI = 3.2 to 5.8) of these consultations, and both rated an MDO likely/certain in 2.5% (95% CI = 1.6 to 3.9). Final consensus, identified MDO occurrences for 61.4% of the consultations. The overall agreement was higher than other comparable studies (κ statistic 0.68), and 54% (n = 20) of the mutually agreed MDOs (n = 56), were rated as likely to cause moderate or severe patient harm.ConclusionIn this first assessment of MDOs in UK primary care, we found their frequency to be relatively low but human cost relatively high for over half of those experiencing an error. Identifying workable strategies to prevent errors occurring from the identified contributing factors, and prioritising diagnostic errors is the next critical action.
Effective safety netting in acute childhood illness: an important contribution to avoiding preventable deaths
Authors: Neill Sarah , Roland Damian , Thompson Matthew , Palmer-Hill Sue , Bayes Natasha , Mullins Laura , Turner Tracy , Tavaré Alison , Lakhanpaul Monica 
Published: June 2018

BackgroundChildren’s use of urgent care services continues to increase. If families are to access the right services at the right time they need access to information to inform their decision making. Providing a safety net of information has the potential to reduce morbidity and avoidable mortality and has been shown to reduce re-consultation safely.AimOur research programme aims to provide parents with information they can use to help them determine when to seek help for an acutely ill child.MethodOur programme includes: ASK SARA, a systematic review of existing interventions; ASK PIP, qualitative exploration of safety netting information used by parents and professionals; ASK SID, development of the content and delivery modes for the intervention; ASK ViC, video capture of children with acute illness; and ASK Petra, safety netting tool development using consensus methodology.ResultsThe ASK SNIFF programme findings demonstrate the need for professionally endorsed and co-produced safety netting resources focussing on symptoms of acute childhood illness. We now have consensus on the scripted content for a safety netting tool supported by video materials to enable parents to see symptoms for real.ConclusionSafety netting tools are a valuable aid to general practice enabling GPs to show parents what to look out for when their child is sick so that they know when to (re)consult. Recent reports of failure to recognise and appropriately safety net children with sepsis highlights the importance of such tools.
‘I’m not sure if there is any point to all this doc?’: a qualitative study into GPs responses to existential questions
Authors: Appleby Alistair , Swinton John , Wilson Philip 
Published: June 2018

BackgroundVery few studies address how GPs react to situations where patients express doubt or perplexity about the meaning of their existence.AimTo assess the range of responses which GPs make to a theoretical scenario, where a patient says ‘Doc, I’m not sure there is any point to all this?’. To discuss the significance of these responses within a clinical and philosophical context.MethodWe interviewed 19 GPs in Scotland and analysed transcripts using an approach informed by grounded theory.ResultsThe context of these questions, patients’ other complaints, and the comfort of the GP in this area of discussion, affected the GP response. Responses included discomfort and diverting the conversation, exploring the contribution of physical pain, or, most commonly, considering the questioning to indicate mental health problems. Some GPs felt the questioning was fuelled by unmet emotional needs or by social and relational crises. GP responses included prescribing medication or pragmatic ‘just get on with it’ suggestions to the perceived unknowability of rational answers. Other GPs considered this represented a philosophical question worthy of legitimate debate and response, or with therapeutic potential.ConclusionThis raises questions about whether existential questioning, is best regarded as pathological, normative or potentially therapeutic. Our study indicates that GPs own philosophy and approach may define the scope of the discussion and therapeutic options. Consultations which permit legitimate existential discussion, while considering a wide range of health associations, generate the greatest range of therapeutic approaches, but further work on outcomes is justified.
Influenza vaccination uptake in an Irish obstetric cohort
Authors: Barrett Tina , Drew R , O’Reilly F , O’Carroll A , O’Shea A , McEntee E , Cleary B 
Published: June 2018

BackgroundInfluenza infection during pregnancy can lead to significant maternal morbidity. There are limited data on influenza vaccination uptake and determinants of uptake in Irish obstetric populations.AimThe objectives of this study were to determine: the uptake of influenza vaccination during pregnancy; the determinants of vaccination uptake; knowledge, attitudes and concerns of postnatal women surrounding vaccination during pregnancy; and the recommendations of healthcare workers. Pertussis vaccination uptake was also determined.MethodA standardised 24 item questionnaire was distributed to postnatal women between January and June 2016. Questions focused on maternal characteristics, vaccination status, sources of information, and reasons for receiving / declining the vaccine. The role of the healthcare professional in recommending and offering vaccination was addressed.Results330 surveys were disseminated, there was a 60% response rate. Of the 198 surveys, 109 (55.1%) respondents were vaccinated against Influenza and 64 (32.3%) against Pertussis. Women in the professional/manager/employer socioeconomic group were more likely to be vaccinated (aOR 3.4; 95% CI 1.11–10.42). There was a strong association between vaccination uptake and receiving information during pregnancy (aOR 12.8; 95% CI 2.65–62.5) and receiving the vaccine in a previous pregnancy (aOR 5.15; 95% CI 1.70–15.62). Unvaccinated women had concerns about the harm it may cause to their baby (53%; n=30) and concerns about side effects for themselves (55%; n=33).ConclusionA key determinant of vaccination was provision of information and a recommendation to vaccinate by a healthcare professional. Uncertainty over safety of the vaccine was evident. Consistent patient education by healthcare professionals could increase vaccine uptake.
WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams
Authors: Bekkering Trudy , Aertgeerts Bert , Kuijpers Ton , Vermandere Mieke , Burgers Jako , Kunnamo Ilkka , Vandvik Per 
Published: June 2018

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.
Patient consent to medical students in general practice
Authors: Webb Matthew , Thirlwall Sarah , McKinley Bob 
Published: June 2018

BackgroundInformed consent is required for active participation of patients in medical education. At Keele Medical School, we require practices to advertise that they teach undergraduate students and to obtain appropriate patient consent at various stages of the patient journey.AimThe study aimed to explore patients’ experience of consent to involvement in undergraduate medical education in general practice.MethodDuring the final year at Keele University Medical School, students undertake a patient satisfaction survey. A questionnaire was attached to the reverse of this survey during the academic year 2016–2017. The questionnaire explored the stage of the patient journey consent was obtained, whether they were offered an alternative appointment and how comfortable they were with medical students being involved in their care.ResultsA total of 489 questionnaires were completed covering 62 GP practices. 97% of patients reported that consent was obtained at least once during their encounter and the majority reported that this occurred at booking. 98% of patients were comfortable or very comfortable with a medical student leading their consultation. However, 28% of those surveyed stated that they were either not given the option of not seeing the student or there was no other alternative appointment available.ConclusionThe results indicate that in the vast majority of cases patient consent is obtained at least once during their attendance. Patients expressed a high level of satisfaction with medical students’ involvement in their care. Further work is required to evaluate the role of the data as a marker of individual practice teaching quality.
How can we improve hepatitis B testing and management in primary care? A cross-sectional survey of GPs in England, 2015–2017
Authors: Amin Z , Beebeejaun K , Letley L , Mahange B , Harrington K , Checkley J , Edelstein M 
Published: June 2018

BackgroundChronic hepatitis B (HBV) infection can lead to life-threatening liver disease. In the UK, approximately 180,000 people are carriers. The disease is underdiagnosed and undertreated.AimAs part of a nurse-led intervention aimed at improving HBV contact-tracing and management, we ascertained GPs’ understanding of HBV and their perceived barriers and enablers to HBV diagnosis.MethodIn 2015, we asked 1324 GPs across 2 England regions about HBV-related knowledge and practice, using a questionnaire. We reported the proportion of GPs answering each question, with 95% confidence intervals (95% CI).Results254 GPs (18%) replied. Of those, 189(74%, 95%CI 68–79%) correctly identified hepatitis B surface antigen as a marker of current HBV infection, and 154 (61%, 95% CI = 54 to 66%) recognised IgM anti-HBc as a marker for differentiating acute from chronic cases. 219 GPs (86%, 95% CI = 81 to 90%) believed HBV knowledge among patients to be one of the main enablers to improved testing uptake and 208 (82%, 95% CI = 77 to 86%) identified lack of HBV knowledge among patients as a barrier to testing. Of all GP responders, 227 (89%, 95% CI = 85 to 93%) reported HBV training and education would be beneficial, and 185 (73%, 95% CI = 67 to 78%) reported knowledge of treatment options as a knowledge gap.ConclusionGPs perceive gaps in knowledge among patients and healthcare professionals as a factor potentially contributing to the under-ascertainment of chronic hepatitis B in England. Improving HBV awareness and knowledge among patients, their contacts, and increasing HBV-focused training for GPs, particularly in the interpretation of laboratory results and the treatment options, can improve case ascertainment and chronic HBV management in primary care.