bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paciente diabético: un riesgo de infección del sitio quirúrgico
Authors: Trujillo Pedroza Paula Melissa , Serrato Zapata Katherine , Acevedo Osorio Germán Oved 
Published: June 2019

Los pacientes con diabetes a menudo requiere algún procedimiento quirúrgico en el que se les realice un proceso diagnóstico invasivo, e incluso puede ser llevado a cabo si se requiere de emergencia. Actualmente, los riesgos que pueden haber en cirugía con una persona diabética han disminuido gracias a los avances que se han presentado en los procedimientos anestésicos y al control metabólico perioperatorio; no obstante, las posibles complicaciones siguen siendo frecuentes, y estas pueden ocasionar una hospitalización bastante prolongada con un porcentaje mayor de invalidez. Entendiendo que la Diabetes Mellitus (DM) se presenta como uno de los principales factores de riesgo para infección de sitio quirúrgico (ISQ) y que las complicaciones que se presenten pueden llevar a riesgos potenciales en la calidad de vida de los pacientes, principalmente cuando son sometidos a cirugía. Esto es justificado tratando de entender cómo la diabetes contribuye en la incidencia de infecciones de pacientes a quienes se les realizó una cirugía. Metodología de Búsqueda: Se realizó búsqueda minuciosa en las bases de datos PUBMED, MEDLINE Y SCIELO, a través un gestor de búsqueda utilizando varios términos como: “infecciones”, “heridas quirúrgicas”, “Diabetes mellitus”, en el cual se obtuvo un total de 50 artículos de revistas en línea, de los cuales fueron seleccionados 30. Resultados: Al realizar esta búsqueda se pudo evidenciar que la DM puede causar grandes alteraciones en las respuesta inflamatorias, disfunciones microvasculares y un mayor porcentaje de estrés oxidativo, lo cual es evidenciado en procesos de cicatrización anormal y prolongado, ocasionando altas tasas de infección e inclusive, pérdidas de colgajos; y que lo principal es un preciso manejo preoperatorio, encaminado a lograr disminuir la incidencia de complicaciones y aumentar así el éxito quirúrgico.
Comparación del Derecho de Petición de la población carcelaria entre Colombia, Chile y Nicaragua
Authors: Betancur Duque Edna Victoria , Eusse Palacio Erika Yurany , Ossa García Gustavo Adolfo , Perea Mena Yirfa Mercedes 
Published: June 2019

Este trabajo tiene como propósito abordar como tema central el Derecho de petición en los países de Colombia, Chile y Nicaragua, con la cual se pretende, mediante una investigación, la identificación de cómo el mecanismo del derecho de petición ha permitido que la población carcelaria pueda acceder de manera oportuna al grupo de derechos, especialmente los que son catalogados como fundamentales, analizando las similitudes y diferencias sustanciales con los países analizados.
Signos vitales e índice de masa corporal
Authors: Suárez Gaviria Lina Marcela 
Published: June 2019

Es importante que el estudiante de enfermería desarrolle las destrezas y habilidades necesarias de manera temprana que lo guíen hacia una buena toma de signos vitales, siendo inevitable realizar el aprestamiento de una manera efectiva, integrando los saberes teórico-prácticos en la atención directa de los pacientes.Los signos vitales son unas de las actividades más frecuentes realizadas por los prestadores de salud realizadas en el día a día entre cada paciente como signos de estabilidad hemodinámica. Los signos vitales, temperatura, respiración, pulso y tensión arterial son parámetros a través de los cuales es posible evaluar la salud de un individuo, pues sus valores se mantienen constantes dentro de ciertos límites, en estado de normalidad. La valoración de los signos vitales es una de las funciones del personal de enfermería que permite detectar alteraciones potenciales o reales, modificatorias del equilibrio bio-físico del individuo. Esta valoración constituye el punto de partida en la toma de decisiones objetivas que determinan un cuidado reflexivo e individualizado al paciente.Otro parámetro importante, es el Índice de Masa Corporal (IMC), valorado también por el profesional de enfermería, cuya relación entre el peso y la talla o estatura, permiten determinar si una persona está por encima o por debajo del peso ideal de acuerdo a su talla.
Analyzing Students' Toefl Test Of English Education Deparment Of STKIP Muhammadiyah Enrekang
Authors: Jabri Umiyati 
Published: June 2019

This study aims to show students’ TOEFL score, sixth and eight semester of English Education Department at STKIP Muhammadiyah Enrekang. The research used descriptive design by quantitative approach. The sample is 40 students of English Education department. The research instrument used TOEFL like test. Descriptive statistics showed the data analysis technique, mean and percentage. . For this study , students got problems in acquiring a TOEFL score with an average score 365 which was still at the basic proficiency category (elementary). From the data analyzing, the researcher found that the highest problem faced by the studentsis is listening section where students got correct answers only 27%. The students got the lowest score is in the short dialogue with the percentage 35%. Then the structure and written expression, students got average score lowest in the aspect of structure (completion) with a percentage 34%. From all parts of the TOEFL test, none of the students got average score more than 50%.
Risk prediction models that use routinely collected electronic health data: generalisable and useful in heterogeneous settings?
Authors: Li Yan , Sperrin Matthew , Belmonte Miguel , Pate Alexander , Ashcroft Darren , Van Staa Tjeerd 
Published: June 2019

BackgroundHealthcare sites (practices) may vary in quality of data recording and populations. Risk predictions models that use routinely collected data do not test generalisability to heterogeneous practices.AimTo assess the extent of variability between practices on individual patients’ risk of cardiovascular disease (CVD) that is not taken into account by the risk prediction model QRISK3.MethodA longitudinal cohort study from 1 Jan 1998 to Jan 2015 in 392 general practices (including 3.6 million patients) from the Clinical Practice Research Datalink (CPRD). This was a shared frailty model to incorporate QRISK3 predictors, practice variability, and simulations to measure random variability.ResultsThere was considerable variation in data recording between general practices. Practices on 5th percentile of missingness of body mass index have 18.7% patients with missing values and 60.1% on the 95th percentile. The crude incidence rates also varied considerably between practices (from 0.4 to 1.3 CVD events per 100 patient-years, respectively). The estimates of individual CVD risks with the random effect model were inconsistent with the estimated QRISK3 risk. For patients with a QRISK3 CVD risk of 10%, the 95% range of predicted risks were between 7.2% and 13.7% with the random effects model. Random variability only explained a small part of this. The random effects model was similar to QRISK3 for discrimination and calibration.ConclusionRisk prediction models that use routinely collected electronic health data can have limited generalisability and accuracy in predicting individual patient risks in heterogeneous settings. They need to be based on more robust evidence on causal risk factors.
Measuring the effectiveness of embedding social workers in integrated primary health care teams working with older adults with complex needs
Authors: Bailey Di , Mutale Gabriella 
Published: June 2019

BackgroundDespite the policy agenda for health and social care collaboration currently focused on integrated care systems, there is limited evidence that examines whether embedding social workers in integrated primary health and social care teams working with older adults is effective.AimThe study aimed to establish whether embedding social workers in integrated primary care teams (IPCTs) for older adults in Nottinghamshire was cost-effective.MethodA mixed methods approach collected quantitative and qualitative data that was triangulated using a TRI-Q model. Cost and care quality data were collected from patients in receipt of social worker involvement in three different IPCTs. Patients with similarly complex needs, who were receiving involvement from social work only district teams in the same localities acted as a comparator group. Interviews were conducted with patients and carers and with social workers and GPs working in the IPCTs. Seven focus groups were conducted with IPCT members representing social work and health disciplines.ResultsThe cost data were analysed using ANCOVA to identify any significant differences in costs across the teams. The result showed costs in two of the IPCTs were significantly lower than controls. Care quality indicators were also greater in these IPCTs. Thematic analysis highlighted the important of knowledge exchange that arose from social work embeddedness as indicative of the optimal conditions for effective integrated working and care delivery to be achieved.ConclusionThe findings suggested that embedding social workers in IPCTs offers both higher quality and more cost-effective care for older people if the optimum conditions for integration are met.
Evaluation of a countywide alternative to QOF, aimed at improving person-centred coordinated care
Authors: Close James , Fosh Ben , Byng Richard , Blackwell Richard , Witts Louise , Hall Louise , Lloyd Helen 
Published: June 2019

BackgroundThe Quality Outcomes Framework (QOF) for general practice is one of the largest pay-for-performance schemes in the world. The scheme, however, is sometimes viewed as anachronistic, with recent proposals for a slimmed down QOF. Over the last few years, Somerset have been trialling a system with national implications: 55 GP practices in Somerset established the Somerset Quality Practice Scheme (SPQS) — a de-incentivisation of QOF — with the goal of redirecting resources towards improved Person Centred Coordinated Care (P3C), especially for those with long-term conditions.AimAn evaluation of the SPQS scheme to establish benefits (for example in provision of P3C) or disbenefits (for example in emergency admissions).MethodA longitudinal evaluation from 55 SPQS practices and 17 regional controls. Patient experiences (2363 patients), staff experiences (127 professionals), and organisational data (for SPQS and control practices) were collected. Emergency admission data was analysed for ambulatory-sensitive conditions across Somerset.ResultsDiscretion from QOF resulted in time savings in the majority of practices. Organisational data revealed a significant increase in P3C. Care delivery was improved via stronger federation-level agreements and informal networks, increased multidisciplinary working, reallocation of resources for other healthcare professionals and changes to the structure and timings of GP appointments. Patient and practitioner experiences were similar in SPQS versus control practices. No disbenefits were detected in admissions data.ConclusionThe SPQS scheme leveraged time savings and reduced administrative burden via discretionary removal of QOF, enabling participating practices to engage in a number of schemes aimed at improving care for people with LTCs.
Do South Asian Communities ‘Act FAST’?
Authors: Coleby Dawn , Taub Nick , Mistri Amit , Turner Andy , Coad Jane , Wark Petra , Bhatti Krishna , Chahal Kusminder , Teo Wei-Peng 
Published: June 2019

BackgroundRapid medical assessment and treatment of patients with transient ischemic attack (TIA) or stroke significantly reduces the risk of recurrent stroke. Previous research has shown that delays to initial medical assessment are due to lack of an urgent response to symptoms. In comparison to other communities living within the UK, South Asians have a higher risk of stroke/TIA. Therefore, it is critically important to explore stroke/TIA knowledge and anticipated response to symptoms, within this community.AimThis study aims to provide preliminary evidence of stroke knowledge and awareness of the relaunched ‘Act FAST’ campaign in the South Asian community and to provide evidence of successful participant recruitment from ‘hard to engage’ groups.MethodA pilot mixed methods study, incorporating focus group discussions and a short ‘tick box’ style paper survey, designed to assess and explore participant knowledge of stroke/TIA symptoms, and awareness of the relaunched ‘Act FAST’ campaign. Barriers and facilitators to stroke education and the suitability of mass-media campaigns are also discussed during the focus groups. All participants were recruited from places of worship.ResultsThe authors will present highlights from the ‘on-going’ study including; the recruitment strategy, barriers and facilitators to recruitment in Sikh temples and preliminary findings from 68 completed surveys. Highlights from the focus group discussions will be presented, alongside participant suggested methods to improve stroke/TIA knowledge in Indian communities.ConclusionPreliminary findings suggest awareness of stroke symptoms in the Indian community, but less awareness of TIA. Non-English speakers may be less aware of ‘Act FAST’.
University of Limerick — Graduate Entry Medical School, General Practice Quality Assurance Initiative
Authors: Culhane Aidan , O’Dwyer Patrick , O’Regan Andrew , Glynn Liam 
Published: June 2019

BackgroundAt 18 weeks duration, University of Limerick — Graduate Entry Medical School (UL–GEMS) has the longest general practice clinical attachment for medical students in Ireland and fulfils the educational criteria for a Longitudinal Integrated Clerkship (LIC).The longer the clinical placement the greater the imperative to see that these practices achieve satisfactory educational standards.AimThis project describes a quality assurance initiative of general practices that participate in the education of medical students at GEMS.MethodA literature review of previous quality assurance initiatives in relation to general practices that teach medical students was performed. Information gained from this process was then compared with UL-GEMS own criteria for teaching general practices. A set of criteria by for assessing teaching general practices was devised. The assessment process included a combination of self-assessment by the GP tutors and practice visits by the UL-GEMS teaching staff.ResultsNearly 100% of teaching practices had the correct teaching facilities, such as own room for the student or own computer. Suggested teaching methods, such as parallel consulting, as advised by the Department of General Practice were carried by 100% of practices. Use of the two-way feedback form and the GP/Student manual was poor. GP tutors requested more regular visits form the GP teaching staff as well as more guidance on content for formal tutorials so that a consistency teaching approach could be achieved.ConclusionThis was the first quality assurance initiative on an extended clinical placement. The knowledge gained will lead to a more inclusive standard setting process for teaching medical students in general practice settings.
Impact of a diagnostic decision support system on GP clinical documentation
Authors: Tracey Chris , Delaney Brendan , Kostopoulou Olga 
Published: June 2019

BackgroundKostopoulou and colleagues designed and evaluated a diagnostic decision support system (DSS) that presented GPs with differential diagnoses to consider at the start of the consultation. The DSS was integrated with the electronic health record (EHR) and evaluated in simulated consultations (34 GPs consulting with 12 actors), where it was found to improve diagnostic accuracy.AimTo evaluate the impact of the DSS on GP clinical documentation.MethodSecondary data analysis. The analysis dataset consisted of all data items that the 34 GPs recorded during their consultations with the 12 actors (408 consultations). Each GP had conducted six consultations with the EHR alone, and six with the integrated DSS. The 12 patient scenarios had a pre-defined set of clinical cues and differential diagnoses. For each patient scenario, a Delphi panel of five GPs identified which cues were consistent with each differential diagnosis. The data items recorded, either in free text or code, were counted. These were referenced against the Delphi panel’s matrix of cues and diagnoses. For each GP, it was estimated what proportion of the recorded data was consistent with the diagnosis that they finally gave.ResultsUsing the DSS increased the total amount of information documented (b = 3.58 [95% confidence interval {CI} = 2.81 to 4.35] P<0.001) and reduced the proportion of documentation that was consistent with the GP’s final diagnosis (b = −0.08 [95% CI = −0.11 to −0.05] P<0.001), suggesting less bias.ConclusionUsing the DSS led to more complete and less biased documentation. This has implications for the use of routine EHR data to create clinical prediction rules.
Evaluating the use of CKD trigger tools across practices in east London: a qualitative study in primary care
Authors: Rajabzadeh Vian , Thomas Nicola , Hull Sally 
Published: June 2019

BackgroundEarly identification of people with chronic kidney disease (CKD) in primary care, enables proactive clinical management. CKD trigger tools designed as patient safety tools, alert GP practices when falling estimated glomerular filtration rates (eGFR) are identified from the patient record. The tool’s aim is to alert clinicians to possible CKD progression, and invites written reflection by the GP of the ‘referral’ or ‘non-referral’ outcomes of patients identified.AimTo evaluate how the CKD trigger tool is used across practices in east London. To examine how the differences in the practitioner use and perceived value of the tool is characterised by interview transcripts, compared with the written reflections.MethodEight semi-structured interviews were undertaken with six GPs, one pharmacist, and one practice manager. The reflection free-text data were organised into categories, of ‘yes’ and ‘no’ referrals, dividing further each category by ‘young’ and ‘old’ cases. Thematic analysis was applied to the interview transcripts. Arising themes were supplemented by the descriptive analysis of the reflection.ResultsIn total 1921 reflection comments were examined, 1770 ‘No’ referrals (935 aged <60 years) and 151 ‘Yes’ referrals (81 aged <60 years), covering a 2-year period. Four themes emerged from the interviews: ‘Getting started …’, ‘Workflow’, ‘Trigger tool as a learning tool’, and ‘Patient safety’.ConclusionThe study highlights that administratively well organised practices found that the tool could be readily embedded into their workflow. Reflection data highlighted cases of poorly controlled diabetes and/or hypertension for the ‘yes–young’ referrals. Generally, ‘No’ referrals emphasised the implementation of a clinical management plan.
Home-based rehabilitation for heart failure with reduced ejection fraction: the REACH HF multicentre RCT
Authors: Dalal Hasnain , Taylor Rod 
Published: June 2019

BackgroundCardiac rehabilitation (CR) improves health-related quality of life (HRQOL) and reduces hospitalisations in patients with heart failure (HF), but international uptake of CR for HF remains low.AimTo compare the REACH-HF (Rehabilitation EnAblement EnAblement in CHronic Heart Failure) intervention: a facilitated self-care and home-based CR programme to usual care (UC) for adults with HF with reduced ejection fraction (HFrEF) and to assess the long-term cost-effectiveness of the intervention. The primary hypothesis was that the addition of the REACH-HF intervention to UC would improve disease-specific HRQOL (Minnesota Living with Heart Failure questionnaire [MLHFQ]) at 12 months compared with UC alone.MethodMulticentre randomised trial.ResultsThere were 216 participants: 78% male, average age 70 years, and mean left ventricular ejection fraction of 34%. Overall, 185 (86%) participants provided data for the primary outcome. At 12 months, there was a significant and clinically meaningful between-group difference in the MLHFQ score of −5.7 points (95% CI = −10.6 to −0.7) in favour of the REACH-HF intervention group (P = 0.025). The mean cost of the REACH-HF intervention was £418 per participant, which was associated with a per patient mean quality-adjusted life year (QALY) gain of 0.23 and an increased mean cost of £400 compared with usual care, resulting in a cost per QALY gained of £1720.ConclusionThe REACH-HF facilitated intervention was clinically superior in disease-specific HRQoL at 12 months and economic modelling shows that it is cost-effective. REACH-HF offers an affordable alternative to traditional centre-based programmes to address current low CR uptake rates for HF.
MEDREV: feasibility study of a combined pharmacy–health psychology intervention to improve care for people with dementia with behaviour that challenges in care homes
Authors: Maidment Ian 
Published: June 2019

Background‘Behaviour that Challenges’ is common in older people with dementia in care homes and treated with antipsychotics. Policy is focused on reducing the use of antipsychotics in people with dementia and therefore reducing harm. This submission reports results on a NIHR-funded feasibility study MEDREV.AimTo assess the feasibility of medication review by a specialist dementia care pharmacist combined with staff training with the objective of limiting the inappropriate use of psychotropics.MethodCare homes were recruited. People meeting the inclusion (dementia; medication for behaviour that challenges), or their personal consultee, were approached. A specialist dementia care pharmacist reviewed medication and made recommendations. Care staff received a 3-hour training session promoting person-centred care and GPs’ brief training. Data were collected on recruitment and retention, and implementation of recommendations. Other outcomes included the Neuropsychiatric Inventory-Nursing Home version, quality of life (EQ-5D/DEMQoL), cognition (sMMSE), and health economic (CSRI). Qualitative interviews explored expectations and experiences.ResultsMedication reviews were conducted in 29 of 34 residents recruited and the pharmacist recommended reviewing medication in 21 of these. Fifteen (71.4%) of these were antidepressants: 57.1% (12 of 21) of recommendations were implemented and implementation took a mean of 98.4 days. Non-implementation themes for will be presented. One hundred and sixty-four care staff received training (care homes = 142; primary care = 22). Twenty-one participants (care home managers = 5; GPs = 3; nurses = 2; care staff = 11) were interviewed.ConclusionThe study was feasible, although the approach would need modification to improve the uptake of reviews and reduce the delay in implementation. Most of the recommendations related to antidepressants.