bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technical and scale efficiency of provincial health systems in China: a bootstrapping data envelopment analysis
Authors: Chai Peipei , Zhang Yuhui , Zhou Maigeng , Liu Shiwei , Kinfu Yohannes 
Published: August 2019

ObjectiveWith escalating health expenditures and increasing health needs, improving health system performance has become imperative in China and internationally. The objective of this study is to examine the efficiency of China’s health system and to understand the underlying causes of the variation in efficiency across provinces.SettingA system-wide perspective is adopted, focusing on performance in maternal health, child health and non-communicable diseases (NCDs) in the 31 provinces of mainland China during 2015.MethodsAnalyses were performed using bootstrapping data envelopment technique. Health outcomes were measured by infant survival rates, maternal survival rates and healthy life years calculated only considering NCDs. Health inputs were measured using health expenditure, and density of medical personnel and hospital beds. The model also examined the impact of environmental factors on health system efficiency.ResultsDue to wide-spread scale inefficiency in the country, the average bias-corrected overall technical efficiency (OTE) was 0.8022 (95% CI values ranging from 0.7251 to 0.8492). Socioeconomic status, hospitalisation rate and share of out-of-pocket expenditures were significant determinants of OTE. Nearly 60% of the provinces operated at a decreasing return to scale, meaning that a gain in efficiency could be achieved only through downsizing the scale of operation.ConclusionsGiven the pervasive nature of diminishing returns across provinces, health policy makers must explore the optimum operational scale which is people-centred and focused on prevention, rather than on treatment, of diseases. Moreover, due consideration should be afforded to social determinants of health and health financing arrangements to complement health-sector based reforms and meet the ambitious goals of the Healthy China 2030 Plan.
General practitioner and pharmacist collaboration: does this improve risk factors for cardiovascular disease and diabetes? A systematic review protocol
Authors: Chaudhri Kanika , Hayek Adina , Liu Hueiming , Joshi Rohina 
Published: August 2019

IntroductionCardiovascular disease (CVD) remains a major cause of morbidity and premature mortality globally. Despite the availability of low-cost evidence based medicines, there is a significant treatment gap in those with established or at high risk of CVD in the primary care setting. Pharmacist-based interventions have shown to improve patient outcomes for many chronic diseases including CVD. However, there is little synthesised evidence that has examined the effects of collaborative care between general practitioners (GPs) and pharmacists on patients’ cardiovascular risk outcomes. This protocol aims to outline the methods employed in a systematic review of current literature to assess whether interprofessional collaboration between GPs and pharmacists has an impact on improving cardiovascular risk outcomes among patients in the primary care setting.Methods and analysisRandomised controlled trials (RCTs) will be identified through database searches, scanning reference lists of relevant studies, hand searching of key journals and citation searching of key papers. Two independent reviewers will screen studies against eligibility criteria and extract data using standardised forms. Databases including MEDLINE, EMBASE, Cochrane, CINAHL and International Pharmaceutical Abstracts, will be searched from the beginning of each database until October 2018. Primary outcome includes improvement in cardiovascular risk factors, such as hypertension, due to GP and pharmacist cooperation. Secondary outcome is to describe the different types of GP and pharmacist collaborative models of care. A narrative synthesis of findings will be presented. A meta-analysis will be performed if the data are homogenous.Ethics and disseminationThis study does not require ethics approval. The results of the systematic review described within this protocol will be disseminated through presentations at relevant conferences and publication in a peer-reviewed journal. The methods will be used to inform future reviews.PROSPERO registration numberCRD42017055259.
How do general practitioners access guidelines and utilise electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study
Authors: Biezen Ruby , Roberts Cassandra , Buising Kirsty , Thursky Karin , Boyle Douglas , Lau Phyllis , Clark Malcolm , Manski-Nankervis Jo-Anne 
Published: August 2019

ObjectiveThis study aimed to explore how general practitioners (GPs) access and use both guidelines and electronic medical records (EMRs) to assist in clinical decision-making when prescribing antibiotics in Australia.DesignThis is an exploratory qualitative study with thematic analysis interpreted using the Theory of Planned Behaviour (TPB) framework.SettingThis study was conducted in general practice in Victoria, Australia.ParticipantsTwenty-six GPs from five general practices were recruited to participate in five focus groups between February and April 2018.ResultsGPs expressed that current EMR systems do not provide clinical decision support to assist with antibiotic prescribing. Access and use of guidelines were variable. GPs who had more clinical experience were less likely to access guidelines than younger and less experienced GPs. Guideline use and guideline-concordant prescribing was facilitated if there was a practice culture encouraging evidence-based practice. However, a lack of access to guidelines and perceived patients’ expectation and demand for antibiotics were barriers to guideline-concordant prescribing. Furthermore, guidelines that were easy to access and navigate, free, embedded within EMRs and fit into the clinical workflow were seen as likely to enhance guideline use.ConclusionsCurrent barriers to the use of antibiotic guidelines include GPs’ experience, patient factors, practice culture, and ease of access and cost of guidelines. To reduce inappropriate antibiotic prescribing and to promote more rational use of antibiotic in the community, guidelines should be made available, accessible and easy to use, with minimal cost to practicing GPs. Integration of evidence-based antibiotic guidelines within the EMR in the form of a clinical decision support tool could optimise guideline use and increase guideline-concordant prescribing.
Evolution of the burden of active hepatitis C virus infection in England from September 2015 to September 2016: a repeated cross-sectional analysis
Authors: Lacoin Laure , Hurst Michael , Hill Nathan R , Gordon Jason , Geretti Anna Maria , Aspinall Richard , Corless Lynsey , Gao-Du Yuxiang , Mistry Liam , Mutimer David 
Published: August 2019

ObjectiveTo evaluate the impact of treatment with new direct-acting antivirals (DAAs) on the prevalent hepatitis C virus (HCV) population in England.DesignA repeated cross-sectional analysis.SettingFour secondary care hospitals in England.ParticipantsPatients who, in 2015 and/or 2016, had chronic HCV infection and were alive were eligible, regardless of the type of HCV intervention received.Outcome measuresData including intravenous drug use (IVDU) status, HCV genotype, cirrhosis status, HCV treatment history, vital status and treatment outcomes were collected at two time points in 2015 and 2016 using electronic case report forms.ResultsThere were 1605 and 1355 patients with active chronic HCV in 2015 and 2016, respectively. Between 2015 and 2016, the proportion of patients with current IVDU increased (10.3% vs 14.5%, respectively), while that of patients with cirrhosis (28.2% vs 22.4%) and treatment-experienced patients (31.2% vs 27.1%) decreased. Among patients whose treatment outcome was known by 2016, high cure rates were observed, with an overall sustained virological response rate of 93.2%. From 2015 to 2016, there was a progressive increase in the proportion of treated patients who were non-cirrhotic, with current IVDU and non-liver transplant recipients.ConclusionsThe characteristics of patients with HCV remaining in contact with specialised care evolved with a changing landscape of treatment and related health policy. With increasing access to DAAs in UK, high cure rates were achieved in the study cohort.
Comprehensive evaluation of a prospective Australian patient cohort with suspected genetic kidney disease undergoing clinical genomic testing: a study protocol
Authors: Jayasinghe Kushani , Stark Zornitza , Patel Chirag , Mallawaarachchi Amali , McCarthy Hugh , Faull Randall , Chakera Aron , Sundaram Madhivanan , Jose Matthew , Kerr Peter , Wu You , Wardrop Louise , Goranitis Ilias , Best Stephanie , Martyn Melissa , Quinlan Catherine , Mallett Andrew J 
Published: August 2019

IntroductionRecent advances in genomic technology have allowed better delineation of renal conditions, the identification of new kidney disease genes and subsequent targets for therapy. To date, however, the utility of genomic testing in a clinically ascertained, prospectively recruited kidney disease cohort remains unknown. The aim of this study is to explore the clinical utility and cost-effectiveness of genomic testing within a national cohort of patients with suspected genetic kidney disease who attend multidisciplinary renal genetics clinics.Methods and analysisThis is a prospective observational cohort study performed at 16 centres throughout Australia. Patients will be included if they are referred to one of the multidisciplinary renal genetics clinics and are deemed likely to have a genetic basis to their kidney disease by the multidisciplinary renal genetics team. The expected cohort consists of 360 adult and paediatric patients recruited by December 2018 with ongoing validation cohort of 140 patients who will be recruited until June 2020. The primary outcome will be the proportion of patients who receive a molecular diagnosis via genomic testing (diagnostic rate) compared with usual care. Secondary outcomes will include change in clinical diagnosis following genomic testing, change in clinical management following genomic testing and the cost-effectiveness of genomic testing compared with usual care.Ethics and disseminationThe project has received ethics approval from the Melbourne Health Human Research Ethics Committee as part of the Australian Genomics Health Alliance protocol: HREC/16/MH/251. All participants will provide written informed consent for data collection and to undergo clinically relevant genetic/genomic testing. The results of this study will be published in peer-reviewed journals and will also be presented at national and international conferences.
Prevalence of impaired fasting glucose, type 2 diabetes and associated risk factors in undiagnosed Chinese rural population: the Henan Rural Cohort Study
Authors: Abdulai Tanko , Li Yuqian , Zhang Haiqing , Tu Runqi , Liu Xiaotian , Zhang Liying , Dong Xiaokang , Li Ruiying , Wang Yuming , Wang Chongjian 
Published: August 2019

ObjectiveThis study estimated the burden and characterised the risk factors associated with diabetes and impaired fasting glucose (IFG) in an undiagnosed rural population.DesignData for 36 960 participants from the Henan Rural Cohort baseline with undiagnosed diabetes were analysed. X2test and multivariate logistic regression analyses were performed to test for association between risk factors and diabetes and IFG.ResultsWomen constituted 60.30% of the study participants, mean age of participants was 55.32±12.18 years, risk factors for diabetes and IFG were prevalent (75% dyslipidaemia, 57% overweight/obese, 50% central obesity and 18% metabolic syndrome). The prevalence of diabetes and IFG was 4.19% and 7.22%, respectively. Having a metabolic syndrome (adjusted OR (aOR) 4.7, 95% CI 4.27 to 5.33), dyslipidaemia (aOR 2.76, 95% CI 2.31 to 3.21), centrally obese (aOR 2.38, 95% CI 2.11 to 2.70), being overweight/obese (aOR 1.66, 95% CI 1.45 to 1.79) and a family history of diabetes (aOR 1.50, 95% CI 1.15 to 1.92) were associated with diabetes. These factors were also associated with IFG. Intake of high salt diet (aOR 1.16, 95% CI 1.02 to 1.32) and smoking (aOR 1.22, 95% CI 1.02 to 1.47; significant in men) were also associated with diabetes. Engaging in moderate physical activity (aOR 0.94, 95% CI 0.89 to 0.98) was noted to be negatively associated with diabetes.ConclusionDiabetes and IFG remain prevalent in Chinese population with obesity and dyslipidaemia being some of the most significant predictors. Regular physical activity and consumption of fruits and vegetables may be beneficial in keeping blood glucose level low.Trial registration numberChiCTR-OOC-15006699
Patient engagement in the development of best practices for transitions from hospital to home: a scoping review
Authors: Zhao Grace , Kennedy Carol , Mabaya Gracia , Okrainec Karen , Kiran Tara 
Published: August 2019

ObjectivesTo explore the extent of patient engagement in the development of best practice reports related to transitions from hospital to home.DesignScoping review.Data sourcesElectronic databases (MEDLINE, EMBASE, CINAHL, Scopus, Trip Database, DynaMed Plus and Public Health Plus) and multiple provincial regulatory agency and healthcare organisation websites.Eligibility criteriaWe included best practice reports related to the transition from hospital to a long-term care facility, community dwelling or rehabilitation centre. We included documents disseminated in English between 1947 and 2019.Data extraction and synthesisTwo independent reviewers screened for eligibility and one extracted and analysed data using a data extraction tool we developed based on established patient engagement frameworks. Only records actively engaging patients were analysed (n=11). The methodological quality of actively engaging patients was assessed using domain 2 (item 5) of stakeholder involvement from the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.ResultsThe search yielded 1921 citations of which 23 met the inclusion criteria and were included for narrative synthesis. These were disseminated between 1995 and 2019, with 18 (78%) published after 2010. Most were conducted in North America (USA 43%, Canada 22%), Europe (UK 30%) and Australia (4%). Eleven (48%) actively involved patients, of which only two involved patients across all stages of development. Most involved patients through direct or indirect consultation. The mean AGREE II domain 2 item 5 score (of those that actively engaged patients) was 5.9 out of 7.ConclusionsOnly half of existing best practice reports related to the transition from hospital to home actively involved patients in report development. However, the extent of patient engagement has been increasing over time. More organisations should strive to engage patients throughout the best practice development process and provide patients with opportunities for shared leadership.
Goals of older hospitalised patients: a qualitative descriptive study
Authors: van der Kluit Maria Johanna , Dijkstra Geke J , de Rooij Sophia E 
Published: August 2019

ObjectivesSince the population continues ageing and the number of patients with multiple chronic diseases is rising in Western countries, a shift is recommended from disease oriented towards goal-oriented healthcare. As little is known about individual goals and preferences of older hospitalised patients, the aim of this study is to elucidate the goals of a diverse group of older hospitalised patients.DesignQualitative descriptive method with open interviews analysed with inductive content analysis.SettingA university teaching hospital and a regional teaching hospital.ParticipantsTwenty-eight hospitalised patients aged 70 years and older.ResultsSome older hospitalised patients initially had difficulties describing concrete goals, but after probing all were able to state more concrete goals. A great diversity of goals were categorised into wanting to know what the matter is, controlling disease, staying alive, improving condition, alleviating complaints, improving daily functioning, improving/maintaining social functioning, resuming work/hobbies and regaining/maintaining autonomy.ConclusionsOlder hospitalised patients have a diversity of goals in different domains. Discussing goals with older patients is not a common practice yet. Timely discussions about goals should be encouraged because individual goals are not self-evident and this discussion can guide decision making, especially in patients with multimorbidity and frailty. Aids can be helpful to facilitate the discussion about goals and evaluate the outcomes of hospitalisation.
Protocol for the Data-Linkage Alcohol Cohort Study (DACS): investigating mortality, morbidity and offending among people with an alcohol-related problem using linked administrative data
Authors: Peacock Amy , Chiu Vivian , Leung Janni , Dobbins Timothy , Larney Sarah , Gisev Natasa , Pearson Sallie-Anne , Degenhardt Louisa 
Published: August 2019

IntroductionThe aims of this program of research are to use linked health and law enforcement data to describe individuals presenting to emergency and inpatient healthcare services with an acute alcohol harm or problematic alcohol use; measure their health service utilisation and law enforcement engagement; and quantify morbidity, mortality, offending and incarceration.Methods and analysisWe will assemble a retrospective cohort of people presenting to emergency departments and/or admitted to hospitals between 1 January 2005 and 31 December 2014 in New South Wales, Australia with a diagnosis denoting an acute alcohol harm or problematic alcohol use. We will link these data with records from other healthcare services (eg, community-based mental healthcare data, cancer registry), mortality, offending and incarceration data sets. The four overarching areas for analysis comprise: (1) describing the characteristics of the cohort at their first point of contact with emergency and inpatient hospital services in the study period with a diagnosis indicating an acute alcohol harm and/or problematic alcohol use; (2) quantifying health service utilisation and law enforcement engagement; (3) quantifying rates of mortality, morbidity, offending and incarceration; and (4) assessing predictors (eg, age, sex) of mortality, morbidity, offending and incarceration among this cohort.Ethics and disseminationEthics approval has been provided by the New South Wales Population and Health Services Research Ethics Committee. We will report our findings in accordance with the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement and Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) where appropriate. We will publish data in tabular, aggregate forms only. We will not disclose individual results. We will disseminate project findings at scientific conferences and in peer-reviewed journals. We will aim to present findings to relevant stakeholders (eg, addiction medicine and emergency medicine specialists, policy makers) to maximise translational impact of research findings.
Illicit cigarette trade in South Africa: 2002–2017
Authors: Vellios Nicole , van Walbeek Corné , Ross Hana 
Published: August 2019

BackgroundIncreasing cigarette excise taxes is widely recognised as the most effective measure to reduce the demand for cigarettes. The presence of illicit trade undermines the effectiveness of tax increases as both a public health and a fiscal measure, because it introduces cheaper alternatives to legal, full-priced cigarettes.ObjectiveTo assess trends in the size of the illicit cigarette market in South Africa from 2002 to 2017 using gap analysis.MethodsTax-paid cigarette sales are compared with consumption estimates from two nationally representative surveys: the All Media and Products Survey and the National Income Dynamics Study. We explore the size of the illicit cigarette market and its changes over the period 2002–2017.ResultsSince 2009, illicit trade has increased sharply. We estimate that illicit trade is between 30% and 35% of the total market in 2017. The acceleration in the growth of the illicit market since 2015 corresponds with a turbulent time at the South African Revenue Service, when many of the enforcement functions were greatly reduced.ConclusionsThe current levels of illicit trade are extremely high and need to be addressed urgently by implementing effective control mechanisms such as a track and trace system to monitor the production, taxation, and sale of cigarettes.
Variant of the truncated Perron formula and primes in polynomial sets
Authors: Ramana D. S. , Ramaré O. 
Published: August 2019

We show under the Generalized Riemann Hypothesis that for every non-constant integer-valued polynomial [Formula: see text], for every [Formula: see text], and almost every prime [Formula: see text] in [Formula: see text], the number of primes from the interval [Formula: see text] that are values of [Formula: see text] modulo [Formula: see text] is the expected one, provided [Formula: see text] is not more than [Formula: see text]. We obtain this via a variant of the classical truncated Perron’s formula for the partial sums of the coefficients of a Dirichlet series.
Small prime solutions to diagonal Diophantine equations
Authors: Gao Gaiyun , Liu Zhixin 
Published: August 2019

Let [Formula: see text] be an integer, [Formula: see text], [Formula: see text], [Formula: see text], where [Formula: see text] are nonzero integers, and let [Formula: see text] be an integer. Suppose that [Formula: see text] satisfy some necessary congruent conditions. In this paper, it is proved that (i) if [Formula: see text] are not all of the same sign, then the equation [Formula: see text] has prime solutions satisfying [Formula: see text], (ii) if all [Formula: see text] are positive and [Formula: see text], then [Formula: see text] is solvable in primes [Formula: see text], where [Formula: see text]. Our result uses [Formula: see text] as an improvement of the recent result [Formula: see text] due to Zhao (2016), and largely improves the results [Formula: see text] for [Formula: see text] proved by Yang and Hu (2016).