bluuebunny/crossref_metadata_2025_split huggingface dataset:
Qualitative exploration of the acceptability of a postnatal pelvic floor muscle training intervention to prevent urinary incontinence
Authors: Grant Aileen , Currie Sinead 
Published: September 2019

Abstract
Background Childbirth is a major risk factor for urinary incontinence (UI). As a result, pelvic floor muscle training (PFMT) is commonly recommended during and after pregnancy to prevent the onset of UI. PFMT is often classed as a physical activity (PA) behaviour, hence PA guidelines for postnatal women encourage PFMT alongside aerobic activities. However, postnatal lifestyle interventions tend to overlook PFMT which can be detrimental to women’s health and future health risks, including urinary incontinence. This study aimed to explore perceptions and acceptability of a postnatal physical activity and PFMT intervention with postnatal women in Scotland.Methods We recruited women who had given birth within the last five years by displaying posters in health centres and community centres in Stirling and through Facebook. Data was gathered via online and face-to-face focus groups, which were audio recorded and transcribed verbatim. Analytic themes were initially organised under related concepts derived from the topic guide and thematic analysis conducted. Subsequent analysis was by the Framework technique.Results A total of seven online and face-to-face focus group discussions with 31 women identified there was a clear intention behaviour gap for engagement in PA with both psychological and logistical barriers identified such as motivation and childcare. This was distinct from PFMT where there was a feeling of helplessness around not knowing how to perform a correct PFMT contraction subsequently resulting in women not adhering to PFMT guidance. Women felt there was no accessible PFMT advice available through the NHS. Some participants had received PFMT advice after childbirth and spoke of the Squeezee app being useful in adhering to a PFMT regimen but they did require additional teaching on how to do correct contractions. There was need for clarity and practical support for PFMT in the postnatal period with an approved intervention incorporating an accessible app being suggested by participants.Conclusions Women would like to be trained on postnatal PFMT but face barriers to accessing adequate information and education on how to do a PFMT contraction. An intervention combining PFMT training and an app would be the most useful for their needs and circumstances.
The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials
Authors: Rafique Munazzah , Thompson Jacqueline Y , Al-Jaroudi Dania , Al-Badr Ahmed 
Published: September 2019

Abstract
Background: Pre-emptive analgesia using pudendal nerve block (PNB) with bupivacaine is commonly used in clinical practice during pelvic floor and vaginal surgeries. However, its effectiveness is unclear. To update the evidence base we summarised short- and intermediate-term outcomes of pre-emptive analgesia using pudendal nerve block with bupivacaine as an approach in the management of pelvic floor and vaginal surgeries. Methods: We searched the CENTRAL, PubMed, ClinicalTrials.gov, google scholar and Open Grey from inception until April 2019. The citation lists of relevant papers were also searched. Randomized controlled trials (RCTs) of women who underwent perineal, pelvic floor or vaginal surgeries and received pre-emptive analgesia using a pudendal nerve block were included. Two authors independently screened and selected eligible trials as well as performed data extraction and quality assessment. Disagreements were resolved via consensus and an adjudicator was involved when consensus was not achieved. Data was narratively synthesized, when possible, data was pooled in RevMan 5 using random effects model. Results: Four RCTs with a total of 349 participants were eligible for inclusion. We found evidence of small effect for improvement in post-operative pain scores; requirements for opioids, SMD: -0.89 (95% CI: -1.19, -0.59) and non-steroidal anti-inflammatories SMD -1.04 (95% CI: -1.64, -0.43) in favour of the PNB versus control group. The risk ratio for adverse effects 0.42 (95% CI: 0.18, 0.99) favoured PNB. There was no significant difference between groups for length of hospital stay, MD: -0.82 (95% CI: -5.34, 3.69) and return to normal activity. Conclusion:We found inconclusive evidence that pre-emptive pudendal block using bupivacaine may improve postoperative pain and recovery in perineal, pelvic floor or vaginal surgeries. However, due to the scant and poor quality of evidence included in this systematic review, well-designed and adequately powered RCTs that adhere to reporting guidelines and evaluate key outcomes are needed to inform clinical guidelines on the use of pre-emptive pudendal block. Key words:pre-emptive analgesia, bupivacaine, pudendal nerve block, vaginal surgery, pelvic organ prolapse, systematic review, meta-analysis
Predictors of missing Electronic Medical Record (EMR) discharge summaries: A retrospective study on data from a large Canadian cohort
Authors: Wiebe Natalie , Xu Yuan , Shaheen Abdel Aziz , Eastwood Catherine , Boussat Bastien , Quan Hude 
Published: September 2019

Abstract
Background: Healthcare systems worldwide have adopted the electronic medical record (EMR). EMRs are an efficient method of interprofessional communication, and can improve data availability for secondary research purposes. The discharge summary (DS) is a crucial document for both interprofessional communication, and coding of data for research purposes. We aimed to assess the completeness of our EMRs by assessing the presence of a DS in the EMR. Additionally, we evaluated the presence of predictors for a missing DS. Method: A retrospective chart review was conducted on 3,011 inpatient charts from 3 hospitals in Calgary, Alberta Canada. 893 charts were found to be missing an electronic DS. A 10% sample was drawn to assess for presence of a paper DS. A list of variables was compiled to assess for association between patient and hospital characteristics, patient comorbidities, and the absence of an electronic DS. A Chi-square test, Fisher’s test and logistic regression were conducted to assess for associations. Results: The univariate analyses showed that age, being a surgical patient, a Charlson Comorbidity Index (CCI) of </1, as well as patients with myocardial infarctions, congestive heart failure, cerebrovascular disease, dementia, chronic pulmonary disease, diabetes, and renal disease were associated with a missing DS. The multivariate logistic regression showed that those that were middle aged, surgical patients, or with fewer comorbidities were more likely to have a missing DS. Within the 10% sample, approximately 50% of all patients were from a surgical department, all of which were missing both electronic and paper discharge summaries. Conclusion: Our study is the first to describe predictors associated with missing electronic discharge summaries. There is a modern day propensity for adoption of the EMR across healthcare systems worldwide. The EMR, especially the DS, is used for the improvement of interprofessional communication, patient outcomes, and data quality. Therefore, the implications of an incomplete EMR are widespread. Our findings will caution future researchers using EMR data about the potential for incomplete data, particularly for patients who are surgical, middle aged, and have fewer comorbidities. Additionally, our study highlights the need for further investigation into the lack of discharge summaries in surgical units.
Effect of Two Major Health Reforms on Health Care Cost and Utilization in Iran: Family Physician Program and Health Transformation Plan
Authors: Bayati Mohsen , Keshavarz Khosro , Lotfi Farhad , KebriaeeZadeh Abbas , Barati Omid , Zareian Shahram , Amiri Akbar , Delavari Sajad 
Published: September 2019

Abstract
Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in the short term, but in an increase in costs in the long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policy makers must adopt an agenda to revise and re-design the plan.
Central line bundle including split-septum device and single use prefilled flushing syringes for prevention of port associated bloodstream infections: A cost and resource utilization analysis
Authors: Devrim Ilker , Ozkul Mustafa T , Çağlar İlknur , Oruç Yeliz , Demiray Nevbahar , Tahta Neryal , Vergin Canan 
Published: September 2019

Abstract
Background: Central line bundle programs were found to be effective in decreasing central line–associated bloodstream infection rates in pediatric cancer patients with ports. However cost-effectiveness studies of central line bundle programs in pediatric cancer patients are limited and most available data are from intensive care unit or adult studies. Methods: In this 6 years cross-sectional study, comprehensive assessment of total health care costs attributable to CLABSI’s associated with ports between two periods including 3 years of pre-bundle period and bundle period. Results: This cross-sectional study was carried out in the pediatric hematology-oncology ward of Dr. Behçet Uz Children’s Hospital from 1 August November 2011 to 31 July 2017. The CLABSI rates decreased significantly from 8,31 CLABSIs to 3.04 per 1000 central line days ( p <0.0001). In the prebundle period, total attributable costs spent for of patients with CLABSI were $130661,68 and in the bundle period, total attributable costs spent for patients with CLABSI were $116579,05.Within bundle implantation, 71 potential CLABSI were prevented which saved an additional $208977,81. In other words, for one dollar spent for bundle program, $ 6,54 was saved by decreasing the expected CLABSI. Conclusion: our study shows that central line bundles decreases not only the CLABSI rate, but also decreases attributable costs due to CLABSI. Expenses spent for bundle elements, were covered by savings by preventing CLABSI with higher costs
Development of the Prototype Concise Safe Systems Checklist Tool for General Practice
Authors: Litchfield Ian J , Spencer Rachel , Bell Brian , Avery Anthony , Perryman Katherine , Marsden Kate , Greenfield Sheila , Campbell Stephen 
Published: September 2019

Abstract
Background We identified a need for a concise safe-systems checklist designed to address areas of patient safety which are under-represented in mandatory requirements and existing tools. The process of development is described from initial expert consensus of a long list of items suitable for inclusion on the checklist through their refinement following staff feedback to the nine items included on the prototype checklist. We then present the results of the pilot of the prototype checklist and a qualitative exploration of staff attitudes to its utility and usability. Methods An extensive narrative review and a survey of world-wide general practice organisations were used to identify existing primary care patient safety issues and tools. A RAND panel of international experts rated the resulting statements summarising the findings for importance and relevance. The checklist was created to include areas that are not part of established patient safety tools or mandatory and legal requirements. Four main themes were identified: information flow, practice safety information, prescribing and use of IT systems. A 13 item checklist was trialled in 16 practices resulting in a 9 item prototype tool, which was tested in 8 practices. Qualitative data on the utility and usability of the prototype checklist was collected with a series of semi-structured interviews. Results In testing the prototype 4 of 9 items on the checklist were achieved 100% of the time, 3 items 87% of the time and 2 items 75% of the time. Participants expressed concern about the utility and implementation of checklists in general. However, the prototype was praised for its brevity and its use as a learning tool and ‘final check’ on elements of safety that the practices considered important. Conclusions The concise patient safety checklist tool, specifically designed for general practice, has been made available as part of an online Patient Safety Toolkit hosted by the Royal College of General Practitioners. Practice managers/GP partners should find it a useful tool to monitor safety within the practice.
Cost of inappropriate antimicrobial use for upper respiratory infection in Japan
Authors: Tsuzuki Shinya , Kimura Yuki , Ishikane Masahiro , Kusama Yoshiki , Ohamagari Norio 
Published: September 2019

Abstract
Background : Antibiotics are often prescribed inappropriately to patients with upper respiratory infection (URI) in ambulatory care settings; however, the economic burden of such prescription has not been quantitatively assessed. Here, we aimed to evaluate the additional cost of antimicrobial prescription for URI at the population level in Japan. Methods : We conducted a retrospective observational survey using longitudinal claims data between 2013 and 2016 obtained from the Japan Medical Data Center (JMDC) Claims Database, which contains data from 5·1 million corporate employees and family members aged <65 years. Appropriateness of antibiotic prescription was assessed by a panel of six infectious disease physicians according to ICD-10 code in JMDC Claims Database. Total additional cost of antibiotic prescription for URI at the national level was estimated by weighting of age-structured population data Results : The total annual cost of antibiotic prescription for URI was estimated at 423·6 (95% CI: 416·8–430·5) million USD in 2013, 340·9 (95% CI: 335·7–346·2) million USD in 2014, 349·9 (95% CI: 344·5–355·3) million USD in 2015, and 297·1 (95% CI: 292·4–301·9) million USD in 2016. Three classes of broad-spectrum oral antibiotics (third-generation cephalosporins, macrolides, and fluoroquinolones) accounted for >90% of the total annual cost. Conclusions : Although a decreasing trend was observed, annual costs of antibiotic prescriptions for URI could be a substantial economic burden in Japan. Appropriately prescribing broad-spectrum oral antibiotics might be an important issue to reduce unnecessary medical costs in Japanese ambulatory care.
Prognostic value of a four-level Chinese emergency triage for an Emergency Department: A prospective cohort study
Authors: Huang Wenlong , Xie Xiaohua , Xiong Haiyan , Liu Qiongling , Wei Tan , Zeng Yingchun 
Published: September 2019

Abstract
Background In order to assign treatment priorities of patients who presenting to emergency departments (ED), various triage scales have been developed around the world. In china, four-tier triage scale was recommended by a national triage guideline that published by the central Chinese government. After that a four-tier triage system, used only in tertiary hospitals in Shenzhen, was published by the Public Hospital Administration of Shenzhen Municipalitfy in August, 2013 (Shenzhen Triage System, SZTS). But the ability in predicting admission and in-hospital mortality with the four-level triage scale for patients presented in emergency department was unclear. This research aimed to assess the prognostic value of the SZTS by examining the association between triage levels and clinical outcomes in adult patients.Methods Patients 18 years of age or older, who were triaged category 1, 2 or 3 in the emergency department (ED) from May 17, 2017 until September 27, 2017, were enrolled. This study evaluated an association between triage level and in-hospital mortality, ICU admission and general ward admission by using multivariable logistic regression analysis. Receiver operating characteristic curves were used to assess the predictive ability of SZTS in determining in-hospital mortality, ICU admission and general ward admission.Results There were 383 patients enrolled in the study. More urgent triage level were significantly related to a higher proportion of in-hospital mortality, ICU admission and general ward admission. The OR for in-hospital mortality (OR 11.6, 95% CI 5.8-22.9, p<0.001), ICU admission (OR 14.4, 95% CI 7.4-27.7, p<0.001) and general ward admission (OR 10.6, 95% CI 1.4-79.2, p=0.022) were greater at triage level 1 compared to triage level 2 and level 3. The AUC for in-hospital mortality, ICU admission and general ward admission prediction of SZTS was 0.838, 0.830 and 0.792, respectively.Conclusions This study suggests that triage levels were associated with general ward admission, ICU admission and in-hospital mortality, and SZTS showed good performance for clinical outcomes prediction.
Acute suppurative thyroiditis with thyroid abscess in adults: clinical presentation, treatment and outcomes
Authors: Falhammar Henrik , Wallin Göran , Calissendorff Jan 
Published: September 2019

Abstract
Background

Abscess in the thyroid gland is a rare but severe infectious disease. The condition can have anatomic or iatrogenic underlying causes. If untreated it could be fatal. Pathogens vary considerably. Treatment is intravenous antibiotics, drainage, and sometimes surgery.

Methods

The electronic medical records of all adult patients with acute thyroiditis 2003–2017 treated at the Karolinska University Hospital (catchment area 2 million) in Sweden were systematically reviewed.

Results

Five patients were found in the catchment area. One patient from another region but known to us was also included. Thus, six patients (aged 28-73 years) were included in the study. Median length of hospital stay was 7.5 days (4-79 days). All were treated with antibiotics (intravenous n=5, oral n=1). Total antibiotic treatment duration was 13.5 days (10-41 days). Blood cultures were positive in three (streptococcus pneumonia, streptococci sanguineous, pepto streptococci), deep tissue culture in three (escherichia coli, candida, hemophilic influenza) and no positive culture at all in two. Drainage was used in three patients. All patients recovered without recurrences. Surgery was performed twice in the acute phase in one. There was no recurrence during 7 years (3-12) of follow-up, but one patient died after three years (severe heart failure and pneumonia).

Conclusion

Thyroid abscess in adults is extremely rare nowadays in the developed world. With prompt antibiotic therapy, drainage and in some cases thyroidectomy the prognosis seems favourable.
Perinatal outcomes of infants with congenital limb malformations: an observational study
Authors: Farr Alex , Wachutka Eva , Bettelheim Dieter , Windsperger Karin , Farr Sebastian 
Published: September 2019

Abstract
Background: Congenital limb malformations are rare and their perinatal outcomes are not well understood. This study analyzed the perinatal outcomes of infants with congenital limb malformations. Methods: All infants with congenital limb malformations who underwent prenatal assessment and delivery at our tertiary referral center from 2004 through 2017 were retrospectively identified. Neonatal outcome parameters were assessed and the predictors of worse perinatal outcomes were determined. Results: One hundred twenty-four cases with congenital limb malformations were identified, of which 104 (83.9%) were analyzed. The upper limb was affected in 15 (14.4%), the lower limb in 49 (47.1%), and both limbs in 40 cases (38.5%). A fetal syndrome was identified in 66 cases (63.5%); clubfoot and longitudinal reduction defects were the most frequent malformations. In total, 38 cases (36.5%) underwent termination, 7 (6.7%) resulted in stillbirth, and 59 (56.7%) in live-born delivery. Rates of preterm delivery and NICU-transfer were 42.4% and 25.4%, respectively. Localization of the malformation was a determinant of the perinatal outcome and preterm delivery ( P = .006). Conclusions: Congenital limb malformations frequently occur bilaterally, and are associated with poor perinatal outcomes, including high rates of stillbirth and preterm delivery. Multidisciplinary care and referral to a perinatal center are warranted.
Remarriage after Divorce and Health in Later Life: Findings from CHARLS in China
Authors: li xiaomin , Jiang Quanbao , Ge Tingshuai , Cheng Xinfeng 
Published: September 2019

Abstract
Background : Marriage has a positive effect on health. After the dissolution of a marriage, the health of divorcees worsens. The focus of this paper is on whether remarriage can help a person regain the health benefits that comes with marriage. Methods: This study used the national baseline data from the China Health and Retirement Longitudinal Study (CHARLS), a survey conducted from 2011 to 2012, this article applies instrumental variables to deal with the endogenous problems and to investigate the association between remarriage after divorce and late-life health. Result: According to descriptive statistics, among the 235 middle-aged and elderly respondents with a history of divorce, 46% remarried, 75% of them thought their SRH was fair or bad, 15% of them suffered from ADL impairment and the scale score for depression averaged 9.33 ( SD =7.1). According to the regression results, compared with divorcees who have not remarried, those who remarry suffer less from depression and have better self-rated health. There are gender differences reflected in the relationship between remarriage after divorce and mental health. Remarriage can promote the mental health of men, but there is no significant correlation between remarriage and the mental health of women. Conclusion: Marriage has a protective effect on health, and remarriage can help people regain the health benefits. Key words: ADL ; Depression; Self-rated health ; Instrumental variable; Remarriage after divorce