bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of a free drug program for schizophrenia in Beijing, China
Authors: Yan Fang , Yang Yang , Huang Qingzhi , Chen Yun , Jia Peiqi , Chen Wendong , Ma Xin 
Published: December 2018

Background: Beijing municipal government launched a Free Drug Program (FDP) in 2013 to reduce the financial burden of schizophrenia patients. Objectives: To assess the cost-effectiveness of a FDP designed for schizophrenia patients in Beijing, China. Methods: In all, 2007 schizophrenia patients enrolled in an FDP (FDP group) and 2001 schizophrenia patients who were not enrolled (non-FDP group) were randomly selected for a cross-sectional survey in August 2015. The study sought to develop a cost-effectiveness model to assess the FDP from the societal perspective in Beijing, China. Scenario analyses explored the potential strategies to further improve the cost-effectiveness of the FDP. Results: The FDP group was associated with lower socioeconomic status and more advanced disease than the non-FDP group (unemployment rate: 48.8% vs 37.3%, p < .001; disability rate: 91.2% vs 64.1%, p < .001; overall comorbidity rate: 34.9% vs 28.8%, p < .001). The two groups exhibited similar disease severity and quality of life. However, the FDP group was associated with significantly lower direct medical costs (coefficient –.342, p = .003) and indirect costs (coefficient –.473, p < .001) than the non-FDP group. The base case incremental cost-effectiveness ratio (ICER) per gained quality-adjusted life year (QALY) for the FDP group relative to the non-FDP group was 1.480 times of 2015 China’s gross domestic product per capita. Home drug delivery and long-lasting injection treatment could reduce the ICER for the FDP group relative to the non-FDP group by 57.8% and 29.8%, respectively. Conclusion: The FDP was attractive to schizophrenia patients with lower socioeconomic status and more advanced disease. The cost-effectiveness of the FDP was acceptable and could be further improved by home drug delivery and long-lasting injection treatment.
What should be in hospital doctors' continuing professional development?
Authors: Jones Lorelei , Moss Fiona 
Published: December 2018

Objective To ask those most affected by continuing professional development for senior doctors – patients, other professional groups and doctors themselves – what it needs to encompass. Design The nominal group technique. Participants Six groups of between seven and nine members (n = 49). Separate groups were held for nurses and therapists (n = 9), patient representatives (n = 8), medical directors (n = 8), consultants (n = 8) and medical trainees (n = 7). An additional group consisted of ‘Darzi Fellows’ (n = 9), trainee doctors who were undertaking a leadership fellowship. Setting Groups were held at the Royal Society of Medicine in London. Main outcome measures Priorities for the content of continuing professional development for senior hospital doctors, ranked in order of importance. Themes derived from analysis of group discussions. Results We present the ranked priorities of different groups for what should be included in continuing professional development for senior hospital doctors. Analysis of group discussions identified the following three themes: developing and supporting the system of care; changes in the way medicine is practised; and personal wellbeing and caring for colleagues. Conclusions The implication of our findings for providers of continuing professional development is to consider the balance of content. Doctors and other healthcare professionals need to keep up with scientific advances and technical developments. But in addition, they need to be adept at working with the system changes required for translation of research into practice, the development of new ways of working, and for the organisational changes that underpin continual quality and safety improvement.
Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study
Authors: Martin Graham Paul , Chew Sarah , Dixon-Woods Mary 
Published: December 2018

Summary Objectives To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice. Design Semi-structured qualitative interviews. Setting National Health Service, regulatory and third-sector organisations in England. Participants Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13). Main outcome measures Not applicable. Results Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional ‘cultural engineering’ to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of ‘blacklisting’ of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour. Conclusions Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.
Early initiation of palliative care is associated with reduced late-life acute-hospital use: A population-based retrospective cohort study
Authors: Qureshi Danial , Tanuseputro Peter , Perez Richard , Pond Greg R , Seow Hsien-Yeang 
Published: December 2018

Background: Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization. Aim: To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2 weeks before death. Design: Retrospective population-based cohort study using linked administrative healthcare data. Setting/participants: Decedents (cancer, frailty, and organ failure) between 1 April 2010 and 31 December 2012 in Ontario, Canada. Initiation time before death (days): early (⩾60) and late (⩾15 and <60). ‘Acute-care settings’ included acute-hospital admissions with (‘palliative-acute-care’) and without palliative involvement (‘non-palliative-acute-care’). Results: We identified 230,921 decedents. Of them, 27% were early palliative care recipients and 13% were late; 45% of early recipients had a community-based initiation and 74% of late recipients had a hospital-based initiation. Compared to late recipients, fewer early recipients used palliative-acute care (42% vs 65%) with less days (mean days: 9.6 vs 12.0). Late recipients were more likely to use acute-care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute-care settings (odds ratio = 1.84, 95% confidence interval: 1.83–1.85), frailty decedents were three times more likely (odds ratio = 3.04, 95% confidence interval: 3.01–3.07), and organ failure decedents were four times more likely (odds ratio = 4.04, 95% confidence interval: 4.02–4.06). Conclusion: Early palliative care was associated with improved end-of-life outcomes. Late initiations were associated with greater acute-care use, with the largest influence on organ failure and frailty decedents, suggesting potential opportunities for improvement.
An evaluation of a pilot specialist smoking cessation clinic in a mental health setting
Authors: Davis Amelia , Ngo Hanh , Coleman Mathew 
Published: December 2018

Objectives: Smoking rates in people with mental illness in Australia remain alarmingly high whilst they have been declining in the general population. This study reviews a smoking cessation programme in a mental health service, as a pilot for future studies and program development. We aim to assess the effectiveness of this intervention and the ease of implementation after upskilling the clinical workforce. Methods: Part A – a retrospective analysis of patients attending the Smokers’ Clinic, ( n = 44) over a period of 18 months. Part B – survey of ease of implementation and change in practice of the resident medical officers (RMOs; n = 8) following their clinical placement. Results: For the entire clinic population, the mean reduction in expired carbon monoxide was approximately 43%, with 34% of patients achieving abstinence. Females were 3.4 times more likely to be successful than males. Seventy-five per cent of RMOs found learning about nicotine dependence and smoking cessation ‘easy’, and 88% continued to offer smoking cessation after their placement. Conclusions: The Smokers’ Clinic was successful in helping tobacco smokers with mental illness to reduce or cease smoking. Specialist skill and experience is not required to manage smoking cessation in a mental health setting.
A comparison of response in the presence or absence of a delay in induction therapy with bortezomib, lenalidomide, and dexamethasone
Authors: Schepers Allison J , Jones Alexis R , Reeves Brandi N , Tuchman Sascha A , Bates Jill S 
Published: December 2018

Purpose Lenalidomide, bortezomib, and dexamethasone (RVd) has emerged as a preferred induction therapy in multiple myeloma (MM) in the United States. Due to lenalidomide's teratogenic risk, patients and prescribers must comply with a risk evaluation and mitigation strategy (REMS) program. The REMS program limits dispensing to certain third-party specialty pharmacies, whose average prescription fill times are longer than in-house specialty pharmacies. In practice, a delay in procurement of lenalidomide may mean that patients start therapy with only bortezomib and dexamethasone, delaying the start of more effective triplet therapy. The primary objective of this study is to determine if a delay from start of bortezomib and dexamethasone to start of triplet therapy with lenalidomide impacts rate of achievement of very good partial response (VGPR) after four cycles of RVd. Methods This was a single-center retrospective review of adults with newly diagnosed MM who received RVd induction therapy at University of North Carolina Medical Center between April 2014 and June 2017. Patients who started lenalidomide ≥10 days after bortezomib comprised the “Delay” group, while those who started lenalidomide concurrently with bortezomib or within 1–9 days after bortezomib comprised the “No Delay” group. The primary outcome was VGPR or better response rate after four cycles of RVd. Results Thirty-eight patients met inclusion criteria. Nine patients (23.7%) experienced any delay in initiation of lenalidomide, with a mean delay of 7.8 days (range 1–18). Four patients (10.5%) experienced a delay ≥10 days. No patients in the Delay group were of reproductive potential, compared to 8.8% in the No Delay group ( p = 0.54). VGPR or better response rate did not differ between the Delay and No Delay groups (66.7% vs. 58.8%, p = 0.79). The mean number of lenalidomide prescriptions generated per RVd cycle was 1.35 (range 1–5, SD 0.74). Conclusions This study did not demonstrate an effect on clinical response after delays ≥10 days between bortezomib and lenalidomide initiation. No patients in the delay group were females of reproductive potential, which is the primary target for increased safety behind the REMS program.
High risk of complications using metal heads after ceramic fracture in total hip arthroplasty
Authors: Olmedo-Garcia Nuria I , Zagra Luigi 
Published: December 2018

Background: There is some uncertainty about the bearing to be used to substitute a broken ceramic. Using metal components (head or liner) may lead to catastrophic wear of the metal. Aim: The purpose of this article is to describe the long-term follow-up result of ceramic fracture replaced with metal-on-polyethylene (MoP). Methods: We report 3 cases of ceramic head fracture after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in which the broken ceramic was replaced with MoP. Results: All cases developed severe complications due to gross wear of the metal head: one developed a pseudotumour after a few months while the other 2 had significant local metallosis and toxic blood metal levels. Conclusions: When there is a fracture of a ceramic component, we advise caution with the use of metal heads, as small ceramic fragments can cause 3rd-body wear with massive metal debris and severe local and general complications.
Peripherally inserted central catheter, midline, and “short” midline in palliative care: Patient-reported outcome measures to assess impact on quality of care
Authors: Magnani Caterina , Calvieri Alice , Giannarelli Diana , Espino Margot , Casale Giuseppe 
Published: December 2018

Objectives: A prospective, observational study was conducted in our palliative care unit to assess the impact of peripherally inserted central catheters (PICCs), midline, and “short” midline catheters on the quality of care in cancer and non-cancer patients. The secondary objective was to assess pain and distress during vascular access device insertion. Methods: Patients were recruited if they underwent insertion of a PICC, midline, or “short” midline catheter as part of their standard care. The Palliative care Outcome Scale was used to assess changes in quality of care after vascular access device positioning. A numerical rating scale was used to measure pain intensity during catheter insertion. Results: Of the 90 patients enrolled, 52.2% were male with a mean age of 73.0 ± 13 years. Among these patients, 64.4% patients underwent “short” midline insertion, 26.7% PICC, and 8.9% midline catheter. The patients’ mean baseline Palliative care Outcome Scale score was 15.7 ± 5.6. Three days after vascular access device positioning, the patients’ mean Palliative care Outcome Scale score was 11.5 ± 5.5 (p < 0.0001). Mean pain score during vascular access device insertion was 1.26 ± 1.63, and mean procedural distress score was 1.78 ± 1.93. Conclusion: These findings suggest that medium-term intravenous catheters can have a favorable impact on quality of care and the procedures for these vascular access device insertions are well tolerated. Further research on the performance of different vascular access devices and their appropriateness in palliative care should be encouraged.
Spinal cord and infratentorial lesions in radiologically isolated syndrome are associated with decreased retinal ganglion cell/inner plexiform layer thickness
Authors: Filippatou Angeliki , Shoemaker Thomas , Esch Megan , Qutab Madiha , Gonzalez-Caldito Natalia , Prince Jerry L , Mowry Ellen M , Calabresi Peter A , Saidha Shiv , Sotirchos Elias S 
Published: December 2018

Background: The role of retinal imaging with optical coherence tomography (OCT) in assessing individuals with radiologically isolated syndrome (RIS) remains largely unexplored. Objective: To assess retinal layer thicknesses in RIS and examine their associations with clinical features suggestive of increased risk for conversion to multiple sclerosis (MS). Methods: A total of 30 RIS subjects and 60 age- and sex-matched healthy controls (HC) underwent retinal imaging with spectral-domain OCT, followed by automated segmentation of retinal layers. Results: Overall, retinal layer thicknesses did not differ between RIS and HC. However, RIS subjects with spinal cord (SC) lesions had lower ganglion cell + inner plexiform layer (GCIP) thickness compared to HC (−4.41 μm; p = 0.007) and RIS without SC lesions (–3.53 μm; p = 0.041). Similarly, RIS subjects with infratentorial (IT) brain lesions had lower GCIP thickness compared to HC (–4.07 μm; p < 0.001) and RIS without IT lesions (–3.49 μm; p = 0.029). Multivariate analyses revealed that the presence of SC or IT lesions were independently associated with lower GCIP thickness in RIS ( p = 0.04 and p = 0.03, respectively). Other patient characteristics, including sex, abnormal cerebrospinal fluid, and presence of gadolinium-enhancing or juxtacortical lesions, were not associated with retinal layer thicknesses. Conclusion: The presence of SC or IT lesions in RIS may be associated with retinal neuro-axonal loss, supporting the presence of more disseminated disease.
Optic nerve double inversion recovery hypersignal in patients with clinically isolated syndrome is associated with asymptomatic gadolinium-enhanced lesion
Authors: London Frédéric , Zéphir Hélène , Hadhoum Nawal , Lannoy Julien , Vermersch Patrick , Pruvo Jean-Pierre , Hodel Jérôme , Leclerc Xavier , Outteryck Olivier 
Published: December 2018

Background: Optic nerve involvement is not considered in dissemination in space (DIS) or time (DIT) of multiple sclerosis (MS) lesions. Objectives: To evaluate frequency of optic nerve involvement using three-dimensional (3D)-double inversion recovery (DIR) sequence in clinically isolated syndrome (CIS) and to measure its relationship with DIS and DIT (2010 and 2017 McDonald criteria). Methods: From November 2013 to August 2016, 57 CIS patients underwent 3T-magnetic resonance imaging (3T-MRI) including 3D-DIR sequence and optical coherence tomography (OCT) at 3 months after CIS. We assessed signal abnormalities of the optic nerves on DIR sequence and collected data for DIS and DIT criteria according to 2010 and 2017 McDonald criteria. Results: Among the 57 recruited patients, the presence of ⩾1 DIR hypersignal in optic nerve was observed in 36 (63%; 48 optic nerves) including asymptomatic hypersignal in 22 (38.5%; 25 optic nerves). Optic nerve involvement was significantly associated with DIT ( p = 0.006) and MS according to 2010 criteria ( p = 0.01) but was not significantly associated with presence of DIS criteria according to 2010 and 2017 McDonald criteria. We identified a significant ( p < 0.001) temporal peripapillary retinal nerve fiber layer thinning on eyes with optic nerve involvement versus healthy controls. Conclusions: Optic nerve involvement is very frequent at the earliest clinical stage of MS. It is associated with the presence of asymptomatic gadolinium-enhancement and retinal axonal loss and may reflect the inflammatory disease activity level.
Human Resource Development and Expanding STEM Career Learning Opportunities: Exploration, Internships, and Externships
Authors: Ainslie Paul J. , Huffman Shelley L. 
Published: December 2018

The Problem American businesses are facing unprecedented opportunities in the global marketplace but are struggling to hire skilled workers in STEM (science, technology, engineering, and mathematics)-related jobs to address these opportunities. The past decade has resulted in an increase of STEM jobs; human resource development (HRD) practitioners have an important responsibility in the recruitment and retention of STEM employees. The Solution This article focuses on STEM careers and education pathways. HRD practitioners can play an important role in fostering career exploration and development for those aspiring to or currently in a STEM field by leading unique coalition initiatives to engage schools and others in talent solutions. In particular, programs in Indiana are highlighted for both their novel engagement methods and providing workplace learning experiences that HRD practitioners can replicate. The Stakeholders Human resource leaders, HRD practitioners, leaders in the education-business ecosystem.
Advancing Women of Color in STEM: An Imperative for U.S. Global Competitiveness
Authors: Alfred Mary V. , Ray Sarah M. , Johnson Michele A. 
Published: December 2018

The Problem The underrepresentation of people of color in science, technology, engineering, and mathematics (STEM) has become a crisis of significant proportion. The crisis is more pronounced when we examine participation by race and gender and explore how these two primary identity dimensions serve to marginalize women of color in STEM fields. These differential representations start during the early years and continue within institutions of higher education and the workplace. The Solution To address the absence of women of color in STEM, it is important to understand the forces that hinder and support their career development, beginning with early childhood experiences and throughout education and work environments. Interventions promoting diversity, equity, and inclusion must start in early and secondary education and continue through academia and the workplace. Stakeholders Addressing this crisis is the responsibility of leaders of public and higher education and those of business and industry.
Future Directions: Challenges and Solutions Facing Career Readiness and Development in STEM Fields
Authors: McDonald Kimberly S. , Waite Alina M. 
Published: December 2018

The Problem This issue has highlighted some of the challenges in recruiting, preparing, and retaining individuals in science, technology, engineering, and mathematics (STEM) careers. Specifically, there is an increasing need to attract and prepare more STEM workers, address the underrepresentation of women in these careers, and provide ways to develop STEM students’ and employees’ social skills. The Solution These challenges require a systems approach involving educational institutions, community programs, and businesses and industry. Human resource development (HRD) initiatives and expertise are needed in all types of organizations to support the preparation and retention of a vibrant STEM workforce. The Stakeholders Teachers and faculty working with STEM students, managers and HRD practitioners, and HRD scholars interested in STEM careers.
Metabolic syndrome identifies normal weight insulin-resistant stroke patients at risk for recurrent vascular disease
Authors: Dearborn Jennifer L , Viscoli Catherine M , Inzucchi Silvio E , Young Lawrence H , Kernan Walter N 
Published: December 2018

Background The obesity paradox refers to the finding in observational studies that patients with obesity have a better prognosis after stroke than normal weight patients. Aim To test the hypothesis that there might be important heterogeneity within the obese stroke population, such that those with metabolic syndrome would be at higher risk for stroke or myocardial infarction and all-cause mortality compared to patients without metabolic syndrome. Methods The Insulin Resistance Intervention after Stroke trial enrolled non-diabetic patients with a recent ischemic stroke or transient ischemic attack and insulin resistance. We examined the association between metabolic syndrome and outcome risk in patients with normal weight at entry (body mass index (BMI) = 18.5–24.9 kg/m2), overweight (BMI = 25–29.9 kg/m2), or obesity (BMI ≥ 30 kg/m2). Analyses were adjusted for demographic features, treatment assignment, smoking, and major comorbid conditions. Results Metabolic syndrome was not associated with greater risk for stroke or myocardial infarction among 1536 patients who were overweight (adjusted hazard ratio (HR), 0.95; 95% confidence interval (CI): 0.69–1.31) or 1626 obese patients (adjusted HR, 1.00; 95% CI: 0.70–1.41). However, among 567 patients with a normal BMI, metabolic syndrome was associated with increased risk for stroke or myocardial infarction (adjusted HR, 2.05; 95% CI: 1.25–3.37), and all-cause mortality (adjusted HR, 1.70; 95% CI: 1.03–2.81) compared to patients without metabolic syndrome. Conclusions The presence of metabolic syndrome identified normal weight patients with insulin resistance but no diabetes who have a higher risk of adverse cardiovascular outcomes, compared with patients without metabolic syndrome.