bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strengthening HPV vaccination delivery: findings from a qualitative service evaluation of the adolescent girls’ HPV vaccination programme in England
Authors: Paterson P , Mounier-Jack S , Saliba V , Yarwood J , White J , Ramsay M , Chantler T 
Published: May 2019

Abstract

Background
In 2014, the number of HPV vaccine doses given to adolescent girls as part of the English school-based immunization programme was reduced from three to two. This was based on evidence that a two-dose schedule provides long-lasting protection against HPV infection. In 2015/16 a small decline in HPV vaccination coverage in adolescent girls was noted; from 86.7% for the three-dose schedule in 2013/14 to 85.1% for the two-dose schedule. This evaluation examined whether service-related factors contributed to this decline.

Methods
In May–August 2017, we conducted semi-structured qualitative interviews with 39 participants responsible for commissioning or delivering immunization programmes in six local authorities in the South West, North Central Midlands and South Central Midlands, England.

Results
Effective planning and data management were key for successful service provision of HPV vaccination, as well as close collaboration between commissioners, service providers and data system managers, a team skill mix with experienced staff, pro-active engagement with schools and service providers equipped to respond to parental concerns.

Conclusions
To maintain and improve the high HPV adolescent girls’ vaccine coverage rates achieved in England, in the context of an expanding school-based immunization programme, it is essential to strengthen the organizational capacity of the delivery system.
Policy Change and Partisan Politics: Understanding Family Policy Differentiation in Two Similar Countries
Authors: León Margarita , Pavolini Emmanuele , Miró Joan , Sorrenti Antonino 
Published: May 2019

AbstractThis article looks at how different electoral competition dynamics can result in differentiated party positioning on childcare and family policy. Italy and Spain are compared using a most similar case design. The presence of women in politics, the socioeconomic profiles of the voters of the two main left-wing and right-wing Italian and Spanish parties, and opinions on traditional norms of motherhood explain different policy trajectories and higher incentives for the conservative party in Spain to converge toward the social democratic party in more progressive views of family policy.
Identifying factors associated with successful implementation and uptake of an evidence-based voluntary medical male circumcision program in Zambia: the Spear and Shield 2 Program
Authors: Rodriguez Violeta J , Chahine Antonio , de la Rosa Aileen , Lee Tae Kyoung , Cristofari Nicholas V , Jones Deborah L , Zulu Robert , Chitalu Ndashi , Weiss Stephen M 
Published: May 2019

Abstract
Voluntary medical male circumcision has been shown to provide a 50%–70% reduction in the risk of HIV infection without contributing to behavioral disinhibition of safer sexual practices. This study examined the interim implementation and dissemination data of Spear and Shield 2, an HIV risk-reduction program in Zambia. The purpose of this interim review was to identify contextual challenges to implementation and implement midcourse corrections associated with sustainability of program delivery. Using a mixed-methods design, quantitative evaluations of organizational functioning, barriers to implementation, burnout, and organizational readiness, as well as qualitative data utilizing the Consolidated Framework for Implementation Research (CFIR), were examined to evaluate program implementation. Participants were 184 health care providers from 46 clinics in Zambia. Successful implementation was associated with better community and leader support, and employee readiness and motivation. Quantitative assessments were not related to implementation and provided a limited picture of implementation outcomes. Results suggest that the qualitative data underlying the CFIR constructs provided a nuanced, contextual assessment of implementation, and dissemination outcomes. The CFIR may be valuable in informing the implementation of evidence-based interventions in other parts of Zambia.
Healthcare coverage in the US and Japan
Authors: Ruggles Bernadette Martin , Xiong Amy , Kyle Brittany 
Published: May 2019

Abstract:
Understanding different models of healthcare worldwide and examining the benefits and challenges of those systems can inform potential improvements in the US. This article compares healthcare coverage in the US and Japan with respect to legislation, healthcare system models, eligibility of coverage, financial expenditures, health resources, and quality of care.
Maternity Leave in Residency: A Multicenter Study of Determinants and Wellness Outcomes
Authors: Stack Shobha W. , Jagsi Reshma , Biermann J. Sybil , Lundberg Gina P. , Law Karen L. , Milne Caroline K. , Williams Sigrid G. , Burton Tracy C. , Larison Cindy L. , Best Jennifer A. 
Published: May 2019

Purpose
To characterize determinants of resident maternity leave and the effect of length of leave on maternal well-being.

Method
In 2017, the authors sent a voluntary, anonymous survey to female residents at 78 programs, in 25 unique specialties, at 6 institutions. Survey items included personal, partner, and child demographics, and logistics of leave, including whether leave was paid or vacation or sick leave was used. Outcomes were maternity leave length; duration of breastfeeding; burnout and postpartum depression screens; perceptions of support; and satisfaction with length of leave, breastfeeding, and childbearing during residency.

Results
Fifty-two percent (804/1,537) of residents responded. Among 16% (126) of respondents who were mothers, 50% (63) had their first child during residency. Seventy-seven maternity leaves were reported (range, 2–40 weeks), with most taking 6 weeks (32% of leaves; 25) and including vacation (81%; 62) or sick leave (64%; 49). Length of leave was associated with institution, use of sick leave or vacation, and amount of paid leave. The most frequently self-reported determinant of leave was the desire not to extend residency training (27%; 59). Training was not extended for 53% (41) of mothers; 9% (7) were unsure. Longer breastfeeding duration and perceptions of logistical support from program administration were associated with longer maternity leaves. Burnout affected approximately 50% (38) of mothers regardless of leave length.

Conclusions
This study illustrates variability in administration of resident maternity leaves. Targets for intervention include policy clarification, improving program support, and consideration of parent wellness upon return to work.
Jump-Starting Faculty Development in Quality Improvement and Patient Safety Education: A Team-Based Approach
Authors: van Schaik Sandrijn M. , Chang Anna , Fogh Shannon , Haehn Melissa , Lyndon Audrey , O’Brien Bridget , O’Sullivan Patricia , Ranji Sumant , Rosenbluth Glenn , Sehgal Niraj , Tabas Jeffrey , Baron Robert B. 
Published: May 2019

Problem
Quality improvement (QI) and patient safety (PS) are cornerstones of health care delivery. Accreditation organizations increasingly require that learners engage in QIPS. For many faculty, these are new domains. Additional faculty development is needed for them to teach and mentor trainees. Existing programs, such as the Association of American Medical Colleges Teaching for Quality (Te4Q) program, target individual faculty and thus accommodate only limited participants at a time, which is problematic for institutions that need to train many faculty to support their learners.

Approach
The authors invited diverse stakeholders from across the University of California, San Francisco (UCSF) School of Medicine and related health systems to participate in a team-based adaptation of the Te4Q program. The teams completed 5 projects based on previously identified priority areas to increase local capacity for QIPS teaching: (1) online modules for faculty new to QIPS, (2) a tool kit for graduate medical education programs, (3) a module for medical school clerkship directors, (4) guidelines for faculty to integrate early learners into QI projects, and (5) a “Teach-for-UCSF” certificate program in teaching QIPS.

Outcomes
Thirty-five faculty members participated in the initial Te4Q workshop in January 2015, and by fall 2016, all projects were implemented. These projects led to additional faculty development initiatives and a rapidly expanding number of faculty across campus with expertise in teaching QIPS.

Next Steps
Further collaborations between faculty focused on QIPS in care delivery and those focused on QIPS education to promote QIPS teaching have resulted from these initial projects.
Conceptualizing Medical Humanities Programs in Low-Resource Settings in Africa
Authors: Eichbaum Quentin , Reid Steve , Coly Ayo , Naidu Thirusha , Omaswa Francis 
Published: May 2019

The role of the humanities in medical education remains a topic of dynamic debate in medical schools of high-income countries. However, in most low- and middle-income countries, the medical humanities are less topical and rarely even have a place in the curriculum. Reasons for this dearth include inadequate resources to support such programs coupled with misapprehension of the role and significance of the humanities in medical education.
In this article, the authors argue that the humanities have a vital role to play in the low-resource settings of African medical education. They discuss the complexities of the continent’s sociohistorical legacies, in particular the impact of colonization, to provide contexts for conceptualizing humanities programs in African schools. They outline the challenges to developing and implementing such programs in the continent’s underresourced medical schools and present these as four specific conundrums to be addressed. As a general guide, the authors then suggest four nonprescriptive content domains that African medical schools might consider in establishing medical humanities programs.
The goal is to jump-start a crucial and timely discussion that will open the way for the feasible implementation of contextually congruent humanities programs in the continent’s medical schools, leading to the enhanced education, training, and professional development of its graduating physicians.
S-PACK: A Modular and Modifiable, Comprehensive Predeparture Preparation Curriculum for Global Health Experiences
Authors: St Clair Nicole E. , Butteris Sabrina M. , Cobb Carmen , Connolly Emilia , Groothuis Elizabeth , Jones Andrea , Lauden Stephanie , Miller Kathleen , Winter Jameel , Pitt Michael B. 
Published: May 2019

Problem
Approximately 25% of trainees participate in a global health elective during their undergraduate or graduate medical education. Increasingly, educators in the United States and international partners are calling for improved predeparture preparation training for global health experiences. Yet, freely available, easily modifiable curricula are rare.

Approach
Educators who created the Simulation Use for Global Away Rotations (SUGAR) curriculum formed a workgroup in September 2017 to develop the SUGAR Pre-Departure Activities Curricular Kit (S-PACK). Using Kern’s 6-step approach to curriculum development, they identified 10 essential domains for global health preparation, developed learning objectives, created interactive activities pertinent to those domains using different education strategies, piloted and refined the curriculum, packaged it for online facilitator training, and disseminated it in March 2018.

Outcomes
The S-PACK curriculum includes 6 interactive, modifiable modules that use a variety of educational strategies to enable educators to comprehensively prepare trainees for global health electives. Modules incorporate simulations, procedural training, small-group case-based discussions, and reflection exercises on topics ranging from providing treatment when resources are limited to mitigating culture shock to considering wellness while away. Each module includes a facilitator training packet, curricular resources, and introduction videos. All are freely available at sugarprep.org.

Next Steps
Since an initial in-person workshop at a national conference, the S-PACK curriculum has been available online. Further evaluation is underway, including developing assessments for educators to measure trainee readiness for global health electives. Piloting the feasibility of regional S-PACK preparation bootcamps to support training programs with limited global health resources is planned.
Remifentanil for Procedural Sedation and Analgesia in Central Venous Catheter Insertion
Authors: Vardon Bounes Fanny , Pichon Xavier , Ducos Guillaume , Ruiz Jean , Samier Caroline , Silva Stein , Sommet Agnès , Fourcade Olivier , Conil Jean-Marie , Minville Vincent 
Published: May 2019

Objective:
Central venous catheter (CVC) insertion is a common practice for anesthetists, but this invasive procedure generates anxiety and pain in patients that are often underestimated. We compared target-controlled infusion of remifentanil and local lidocaine infiltration with placebo and local lidocaine infiltration to decrease pain scores during CVC placement.

Materials and Methods:
We included conscious, adult patients without contraindication to remifentanil or lidocaine. We excluded pregnant women, emergency situations, and opioid abuse. Patients requiring CVC were randomly assigned, using computer-generated allocation numbers stored in sealed envelopes, to receive target-controlled infusion of remifentanil or placebo—all patients received local anesthesia with lidocaine. All patients were hospitalized in a recovery room or intensive care unit, monitored, and received 4 L/min of oxygen.
The primary outcome was global pain (Verbal Numeric Rating Pain Scale) during the procedure. Secondary outcomes were pain perceived at every stage of the procedure, anxiety, patient satisfaction, operational ease, and side effects.

Results:
In this double-blind study, we included 90 patients (split into 2 groups of 45 patients). Global pain was significantly reduced in the remifentanil group: 20 of 100 (95% confidence interval, 16-40) versus 50 of 100 (95% confidence interval, 40-60) in the placebo group; P=0.0009. No major adverse events were observed during this study, and there were no significant differences between both groups regarding side effects.

Discussion:
Target-controlled infusion of remifentanil is an effective drug to reduce pain during CVC insertion in association with lidocaine-based local anesthesia, in conscious patients.
Changing practice patterns: flexed versus semi-extended positioning for tibial nailing
Authors: Goodnough L. Henry , Campbell Sean T. , Githens Michael F. , Gardner Michael J. , Bishop Julius A. 
Published: May 2019

Background:
Recent studies have demonstrated several benefits to semi-extended leg position for intramedullary nailing (IMN) without increased complications. The purpose of this study was to evaluate how surgeon preference for flexed versus semi-extended positioning has changed over time.

Methods:
We distributed an anonymous online survey to orthopaedic surgeons via the Orthopaedic Trauma Association (OTA) website. We compared surgeon demographics and preferred leg positioning for tibial nailing.

Results:
Twenty-seven percent of surgeons reported substantial experience (>50% of cases) with semi-extended positioning during training, while 49% of surgeons preferred semi-extended nailing in current practice (P<0.001). Surgeons who practiced in the U.S. (P<0.001) or who completed a trauma fellowship (P<0.05) were more likely to have had exposure to the semi-extended positioning during training. Surgeons who practiced in the U.S. (P<0.001), supervised residents (P<0.05) or had completed a trauma fellowship (P<0.01) were significantly more likely to currently prefer the semi-extended positioning. Surgeons in the U.S. (P<0.01), or who supervised residents (P<0.05) were more likely to have changed from the hyper-flexed to semi-extended position. Facilitating reduction in proximal fractures was the most cited reason for switching to the semi-extended position (28%).

Conclusions:
Semi-extended has become the preferred position during intramedullary nailing of tibial fractures among U.S. surgeons, those supervising residents, or those completing a trauma fellowship. Flexed nailing remains the preferred technique for international surgeons. Further investigation of extended nailing techniques is necessary. However, given its preference for the conventional flexed nailing, the international community may benefit from further educational interventions, demonstrating the benefits of extended nailing.
Lisfranc open reduction and internal fixation in an athletic population: screw versus suture button fixation
Authors: Gee Shawn , Harris Mitchell C. , Anderson Claude , Groth Adam , Ryan Paul 
Published: May 2019

Background:
Primarily ligamentous Lisfranc injuries occur in athletic populations. Unstable Lisfranc injuries are treated with internal fixation or arthrodesis. Internal fixation has been described with both screws and suture button devices, but there currently are only case reports in the medical literature describing the use of suture buttons. This study assessed the return to duty rate, time to full activity, hardware removal rate, and complications after open reduction and internal fixation (ORIF) of primarily ligamentous Lisfranc injuries in an active duty military population, comparing screw fixation with suture button fixation.

Methods:
A retrospective review was performed of ORIF of Lisfranc injuries performed at our institution from 2009-2012. Inclusion criteria were active duty at the time of surgery, primarily ligamentous Lisfranc injuries undergoing ORIF, and minimum 6-month follow-up. Twelve patients were identified who met the inclusion criteria.

Results:
Six patients underwent screw fixation (five men and one woman with a mean age of 25.7 yr). Six underwent suture button fixation (five men and one woman, with a mean age of 29.7 yr). Only half of the patients in the screw fixation group returned to full activity, whereas all patients in the suture button fixation group returned to full activity. Average time to return to full activity was 358 days in the screw fixation group and 181 days in the suture button group. The hardware removal rate was 83% in the screw fixation group, with no hardware removals in the suture button group.

Conclusions:
Our results demonstrate that suture button fixation serves as a viable alternative to screw fixation in an athletic population.
Risk Factors for Tibial Plafond Nonunion: Medial Column Fixation May Reduce Nonunion Rates
Authors: Haller Justin M. , Githens Michael , Rothberg David , Higgins Thomas , Nork Sean , Barei David 
Published: May 2019

Objectives:
To identify the incidence and risk factors for development of tibial plafond nonunion.

Design:
Retrospective comparative study.

Setting:
Two Level 1 academic trauma centers.

Patients/Participants:
Seven hundred forty tibial plafond fractures (OTA/AO 43B3 and 43C) treated January 2006 to December 2015.

Intervention:
Open reduction and internal fixation.

Main Outcome Measurement:
Nonunion.

Results:
Five hundred eighteen patients with a mean age of 43 years (range, 18–81 years) and mean follow-up of 27 months (range, 12–115 months) were involved. Seventy-two patients (72/518, 14%) were identified as having a nonunion. Surgical approach was not associated with nonunion in univariate analysis. Multiple regression model 1 identified OTA/AO 43C [odds ratio (OR) = 4.43; 95% confidence interval (CI), 1.01–19.41; P = 0.048], tobacco use (OR = 2.02; 95% CI, 1.10–3.71; P = 0.024), both minimal and substantial bone loss (P = 0.006 and P < 0.001, respectively), and open fracture (OR = 1.96; 95% CI, 1.10–3.48; P = 0.022) as risk factors for tibial plafond nonunion. Model 2 identified locking plate (OR = 1.97; 95% CI, 1.13–3.40; P = 0.016) and failure to treat the medial column (vs. screw P = 0.047, or plate P = 0.038) as risk factors.

Conclusions:
The tibial plafond nonunion rate was 14%. Bone loss, open fracture, failure to treat the medial column, locking plates, and tobacco use were all significant risk factors for developing tibial plafond nonunion. Equally important, surgical approach was not significantly associated with plafond nonunion.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Supracondylar Humeral Fracture Documentation: A Performance Improvement Study
Authors: Sullivan James Andy , Gregory James R. , Wiley Kevin F. , Parris Deborah , Stoner Julie 
Published: May 2019

Background:
Supracondylar fractures of the humerus (SCH) are the most common fractures about the elbow in children that require operative stabilization. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care. It also is of prime importance for justification or defense of our care should this arise. One of the common concerns in transition from written documentation to an electronic medical record (EMR) is availability of proper documentation. We sought to develop an established EMR protocol to streamline and improve proper care and documentation for SCH fractures. This was in response to poor documentation in an initial retrospective evaluation.

Methods:
Documentation before and after the implementation of a clinical pathway were compared. A retrospective chart review was used to collect documentation information before the implementation of the clinical pathway and a prospective study design was used to collect information after the implementation of the clinical pathway. Proportions of preclinical and postclinical pathway documentation were compared before and after the implementation of the clinical pathway using a χ2 test, or the Fisher exact test for measures in which at least 20% of the expected frequencies were <5. A 2-sided 0.05 α level was used to define statistical significance.

Results:
We saw an improvement in documentation after implementation of the clinical pathway, with statistically significant differences in nursing preoperative, physician preoperative, and physician postoperative. Nursing postanesthesia care unit, nursing postoperative, and physician clinic follow-up trended toward improvement but did not meet statistical significance. Although we did see improvement, we still did not meet ideal 100% documentation in all categories.

Conclusions:
Documentation is crucial to good medical care and legal defense should any arise. The implementation of a clinical pathway demonstrated significant improvement by physicians and nurses. Although overall improvement was obtained, there were areas associated with EMR identified that still require further improvement.

Level of Evidence:
Level III.