bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identity Matters - Perceptions of Inter- and Intra-Professional Feedback in the Context of Workplace-based Assessment in Diabetology Training: A Qualitative Study
Authors: Feller Katrin , Berendonk Christoph 
Published: October 2019

Abstract
Background: Inter-professional collaboration is acknowledged as essential for quality patient-care. However, little is known about receptiveness to inter-professional feedback in the postgraduate training. This study explores, in light of social identity theory, the perceptions of residents, supervising physicians and allied health care professionals regarding inter- and intra-professional feedback in the context of workplace-based assessment. Methods: For six months, residents in diabetology at the University Hospital of Bern performed formative workplace-based assessments under direct observation of a supervising physician and an allied health care professional. Feedback from both observers was given to the resident after every assessment. Subsequently, focus group discussions were conducted to collect the participants’ perceptions of inter- and intra-professional feedback. Transcripts were analyzed qualitatively using a thematic analysis approach. Results: We identified four main themes: (1) Identity and hierarchy; (2) Interdependence of feedback source and feedback content; (3) Impact on collaboration and patient-care; (4) Logistical and organizational requirements. While different social identities are the source of inter-professional hierarchies, they did not impede the receptiveness to feedback. Perceived trustworthiness of the feedback was attributed with more importance than professional affiliations, whereas intra-professional hierarchies between physicians led to the perception of a more summative nature of the feedback and rather impeded receptiveness. According to the participants, inter-professional feedback raised awareness of the working reality of other team members and had a positive impact on communication between the different professional groups. Moreover, participants reported positive response from patients regarding the inter-professional collaboration they experienced. Considerable organizational effort is required to enable the parallel observation of a resident’s consultation by a supervising physician and an allied health care professional. Conclusions: Feedback from allied health care professionals can be a powerful learning resource for residents, given its role outside the sometimes conflicting area of intra-professional hierarchies. Inter-professional feedback in the context of workplace based assessment carries the potential to strengthen collaboration between the different professional groups and to improve patient care.
Integration of a Kalman filter in the geographically weighted regression for modeling the transmission of hand, foot and mouth disease
Authors: Hu Bisong , Qiu Wenqing , Xu Chengdong , Wang Jinfeng 
Published: October 2019

Abstract
Background: Hand, foot and mouth disease (HFMD) is a common infectious disease whose mechanism of transmission continues to remain a puzzle for researchers. The measurement and prediction of the HFMD incidence can be combined to improve the estimation accuracy, and provide a novel perspective to explore the spatiotemporal patterns and determinant factors of an HFMD epidemic. Methods: In this study, we collected weekly HFMD incidence reports for a total of 138 districts in Shandong province, China, from May 2008 to March 2009. A Kalman filter was integrated with geographically weighted regression (GWR) to estimate the HFMD incidence. Spatiotemporal variation characteristics were explored and potential risk regions were identified, along with quantitatively evaluating the influence of meteorological and socioeconomic factors on the HFMD incidence. Results: The results showed that the average error covariance of the estimated HFMD incidence by district was reduced from 0.3841 to 0.1846 compared to the measured incidence, indicating an overall improvement of over 50% in error reduction. Furthermore, three specific categories of potential risk regions of HFMD epidemics in Shandong were identified by the filter processing, with manifest filtering oscillations in the initial, local and long-term periods, respectively. Amongst meteorological and socioeconomic factors, the temperature and number of hospital beds per capita, respectively, were recognized as the dominant determinants that influence HFMD incidence variation. Conclusions: The estimation accuracy of the HFMD incidence can be significantly improved by integrating a Kalman filter with GWR and the integration is effective for exploring spatiotemporal patterns and determinants of an HFMD epidemic. Our findings could help establish more accurate HFMD prevention and control strategies in Shandong. The present study demonstrates a novel approach to exploring spatiotemporal patterns and determinant factors of HFMD epidemics, and it can be easily extended to other regions and other infectious diseases similar to HFMD.
Residential Radon Exposure and Cigarette Smoking in Association with Lung Cancer: a Matched Case-control Study in Korea
Authors: Park Eung Joo , Lee Hokyou , Kim Hyeon Chang , Sheen Seung soo , Koh Sang Baek , Park Ki Soo , Cho Nam Han , Lee Cheol-Min , Kang Dae Ryong 
Published: October 2019

Abstract
Background: Residential radon exposure and cigarette smoking are the two most important risk factors for lung cancer. The combined effects thereof were evaluated in a multi-center matched case-control study in South Korea.Methods: A total of 1,038 participants were included, comprising 519 non-small cell lung cancer cases and 519 age- and sex- matched community-based controls. Residential radon levels were measured for all participants. Multivariate logistic regression was used to calculate odds ratios (OR) for lung cancer according to radon exposure (high ≥100 Bq/m3 vs. low <100 Bq/m3), smoking status, and combinations of the two after adjusting for age, sex, indoor hours, and other housing information.Results: The median age of the participants was 64 years, and 51.3% were women. The adjusted ORs (95% confidence intervals [CIs]) for high radon and cigarette smoking were 1.56 (1.03-2.37) and 2.53 (1.60-3.99), respectively. When stratified according to combinations of radon exposure and smoking status, the adjusted ORs (95% CIs) for lung cancer in high-radon non-smokers, low-radon smokers, and high-radon smokers were 1.40 (0.81-2.43), 2.42 (1.49-3.92), and 4.27 (2.14-8.52), respectively, with reference to low-radon non-smokers.Conclusion: Both residential radon and cigarette smoking were associated with increased odds for lung cancer, and the difference in ORs according to radon exposure was much greater in smokers than in non-smokers.
A qualitative analysis of junior doctors’ journeys to preparedness in acute care
Authors: Burridge Samuel , Shanmugalingam Thurkaa , Nawrozzadeh Fatima , Leedham-Green Kathleen , Sharif Amar 
Published: October 2019

Abstract
Background New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time. Methods We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness and first experiences of genuine preparedness. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. Results Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. Conclusions Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. Given our findings and because preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. We suggest increasing the duration and intensity of shadowing in acute care, with opportunities for scaffolded clinical decision making.
Surgical site infection prevalence and associated factors in Hawassa University comprehensive specialized hospital, southern Ethiopia.
Authors: Deribe Bedilu , Jemebere Wegene , Bekele Gezahegn 
Published: October 2019

Abstract
Background Surgical site infections (SSIs) continue the main problem in health care facilities, causing the prolonged length of stay, considerable morbidity, mortality, and the extra cost to patients after surgery. The aim of this study was to determine the prevalence of SSIs and explore its associated factors among surgical patients at Hawassa university comprehensive specialized hospital, southern Ethiopia.Methods A hospital-based cross-sectional study design was conducted among post-operative patients on a sample of 281 who were admitted and have had surgery from 1 March – 1 April 2019. Purposive sampling technique and the structured questioner were selected to gather data from the patient's medical record, interview, and observation. EPI Info 3.5.4 was a data entry software and SPSS version 20.0 was selected for analysis. Associations among variables were assessed by binary logistic regression.Result A total of 281 patients have participated and the mean age was 30.3 (±18.9) years. The prevalence of SSIs was (24.6%) (95% CI 19.6 – 29.69). Age less than 15 years AOR = 0.131 (95% CI 0.020, 0.087), having clean surgical wound AOR = 0.006 (95% CI 0.002, 0.024) were significant protective associated factors to SSIs while having open surgical wound AOR =5.189 (95% CI 1.511, 17.821) and malnutrition AOR =29.351 (95% CI 5.711, 150.851) were significant risk associated factors to SSIs.Conclusion The prevalence of SSIs was bigger than the worldwide range between (1.2%) and (5.2%) even higher compared to reports from several developing countries. This needs exceptional attention to reduce the odds of surgical site infection by standardizing patient care and controlling of comorbidities.
Ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large accessory malleolar ossicles
Authors: Author) Yongxing Cao(Former Corresponding , Huang Qiang , Xu Yang , Hong Yuan , Author) Xiangyang Xu(New Corresponding 
Published: October 2019

Abstract
BackgroundAccessory malleolar ossicles are often found in patients with chronic ankle instability. For the large ossicles more than 10mm, there are still uncertainties about the suitable surgical option.This study was aimed at evaluating the clinical efficacy of ossicle resection and anatomic reconstruction of the lateral ligaments for chronic ankle instability with large accessory malleolar ossicles.MethodsSixteen chronic ankle instability patients with large accessory malleolar ossicles were treated with ossicle resection and anatomic reconstruction of lateral ligaments between December 2014 and February 2018. The clinical effects were evaluated with Visual Analogue Scale, Karlsson-Peterson ankle scoring system, and subjective satisfaction of patients. The varus talar tilt angle and anterior talar displacement between bony surfaces of the tibia and talus were included as radiographic parameters.ResultsThere were 11 males and 5 females in this study group. The average age at the time of surgery was 28.9 years old. The average final follow-up time was 26.9 months (range, 12 to 47). The average size of the ossicles was 11.7mm. The VAS score declined from 3.5 ± 1.6 preoperatively to 1.4 ± 1.0 at the final follow up (p < 0.01). The Karlsson-Peterson score was significantly improved from 52.7 ± 15.1 before surgery to 86.4 ± 8.2 at the last follow up (p < 0.01). Radiologically, the average varus talar tilt angle was decreased from 15.4 ± 2.0 degrees preoperatively to 6.2 ± 1.6 degrees at the final follow up (p < 0.01), and the average anterior talar displacement was decreased from 14.3 ± 2.1 mm preoperatively to 6.3 ± 1.4 mm at final follow up (p < 0.01). Fourteen patients (87.5%) were satisfied (‘excellent’ or ’good’) with treatment outcome.ConclusionsOssicle resection and anatomic reconstruction of the lateral ligaments provided good clinical outcomes for chronic ankle instability with large accessory malleolar ossicles. This method appears to be one of the reliable and effective procedures for the treatment of chronic ankle instability with large accessory malleolar ossicles.
Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure
Authors: Ramos João G. , Fyrdahl Alexander , Wieslander Björn , Reiter Gert , Reiter Ursula , Jin Ning , Maret Eva , Eriksson Maria , Caidahl Kenneth , Sörensson Peder , Sigfridsson Andreas , Ugander Martin 
Published: October 2019

Abstract
Background: Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. Methods: Consecutive clinically referred patients (n=60, median [interquartile range] age 60 [48–68] years, 33% female) underwent echocardiography and CMR at 1.5T (n=43) or 3T (n=17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity >2.8 m/s (TRPG >31 mmHg). Results: Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p<0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R 2 =0.65, p<0.001). Conclusions: There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.
Microscopic Ileitis in Clinically Suspected Inflammatory Bowel Disease Patients- Can It Predict the Future?
Authors: Baker Fadi Abu , Garza Jesus Alonso Z'cruz De La , Nafrin Smadar , Mari Amir , Suki Muhammed , Ovadia Baruch , Gal Oren , Kopelman Yael 
Published: October 2019

Abstract
Background: The implication of microscopic ileitis finding in patients referred for ileocolonoscopy for clinically suspected inflammatory bowel disease is not well defined and its correlation with clinical outcome has not been fully studied. The current study aims to determine the prognostic yield of biopsies in this setting, and to evaluate the correlation of microscopic ileitis with long-term clinical outcome. Methods: Endoscopic reports of patients referred to our department for ileocolonoscopy in the years 2010-2016, as part of a diagnostic work-up for suspected IBD were revised. Patients with normal ileocolonoscopy were included, provided that terminal ileum biopsies were performed. Accordingly, patients were divided into normal (normal or reactive changes) and microscopic ileitis (inflammation or ileitis of any severity) groups. Both groups were followed prospectively to determine clinical outcome. Results: 439 patients met the inclusion criteria. 64 (14.6%) had inflammation on biopsy and were included in the microscopic ileitis group. Age and gender didn't differ significantly between groups. Overall follow up period was 6.1±2.3 years. Patients in the microscopic ileitis group were significantly associated with Crohn's diagnosis during follow-up period compared to normal (19% vs 2%, OR=11.98, 95%CI=4.48-32.01; p<0.01). Patients with granuloma or moderate-severe ileitis on biopsy were significantly associated with Crohn's development (100% vs 11%; P<0.01) compared to mild or nonspecific inflammation. Conclusion: Microscopic ileitis finding in clinically suspected IBD is associated with increased risk of future diagnosis of crohn's disease.
What Explains the Regional Variation in the Use of General Practitioners in Australia?
Authors: Mu Chunzhou , Hall Jane 
Published: October 2019

Abstract
Background: Regional variation in the use of health care services is widespread. Identifying and understanding the sources of variation and how much variation is unwarranted can inform policy interventions to improve the efficiency and equity of health care delivery. Methods: We examined the regional variation in the use of general practitioners (GPs) using data from the Social Health Atlas of Australia by Statistical Local Area (SLAs). 756 SLAs were included in the analysis. The outcome variable of GP visits per capita by SLAs was regressed on a series of demand-side factors measuring population health status and demographic characteristics and supply-side factors measuring access to physicians. Each group of variables was entered into the model sequentially to assess their explanatory share on regional differences in GP usage. Results: Both demand-side and supply-side factors were found to influence the frequency of GP visits. Specifically, areas in urban regions, areas with a higher percentage of the population who are obese, who have profound or severe disability, and who hold concession cards, and areas with a smaller percentage of the population who reported difficulty in accessing services have higher GP usage. The availability of more GPs led to higher use of GP services while the supply of more specialists reduced use. 30.56% of the variation was explained by medical need. Together, both need-related and supply-side variables accounted for 32.24% of the regional differences as measured by the standard deviation of adjusted GP-consultation rate. Conclusions: There was substantial variation in GP use across Australian regions with only a small proportion of them being explained by population health needs, indicating a high level of unwarranted clinical variation. Supply factors did not add a lot to the explanatory power. There was a lot of variation that was not attributable to the factors we could observe. This could be due to more subtle aspects of population need or preferences and therefore warranted. However, it could be due to practice patterns or other aspects of supply and be unwarranted. Future work should try to explain the remaining unexplained variation.
Motivations, experiences and aspirations of Trainee Nursing Associates in England. A qualitative study
Authors: King Rachel Louise , Wood Emily , Robertson Steve , Ryan Tony , Tod Angela 
Published: October 2019

Abstract
Background The nursing associate role was developed in England in response to the ‘Shape of Caring’ review. It has been implemented to fulfil two aims; to bridge the gap between registered nurses and healthcare assistants, and to provide an alternative route into registered nursing in light of national workforce shortages. Other high income countries successfully deploy second level nurses within their healthcare systems, however the UK has a turbulent history with such roles. The previous state enrolled nurse was phased out in the 1990s, and more recently the assistant practitioner (AP) role has faced wide variation in titles, scope and pay. Little is known about those who embark on the new nursing associate training course, or their perceptions of the experience.Methods An exploratory qualitative study was undertaken using focus groups of trainee nursing associates to generate in-depth discussion about their motivations, experiences of training, and career aspirations. Three focus groups (n=15) took place in December 2018 using a purposive sample of trainee nursing associates registered at a University in the North of England. Two researchers facilitated each group discussion at a time and place convenient for participants. The discussions were audio recorded, transcribed and data was managed using Quirkos software v 1.5.2 and analysed thematically.Findings This study found that trainee nursing associates are motivated by affordable, local, career development. During training they face challenges relating to clinical support, academic workload and uncertainty about future career opportunities. They experience role ambiguity both individually and across the wider organisation. Trainee nursing associates rely on broad support networks to build their occupational identity.Conclusion The barriers and facilitators of trainee nursing associate personal development have implications for policy and practice relating to recruitment and retention. The findings increase our understanding of this emerging role, and inform the development of a larger longitudinal cohort study. Further research is required to evaluate the impact of this new role.