bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family Functioning Predicts End-of-Life Care Quality in Patients With Cancer
Authors: Lee Myung Kyung , Yun Young Ho 
Published: April 2017

Background:Treating patients with cancer within a family setting is the accepted standard of care and a hallmark of end-of-life (EoL) quality of care (QoC).Objective:The aim of this study was to determine whether family caregiver functioning predicts EoL QoC received by terminally ill patients with cancer.Methods:Family caregivers of terminally ill patients with cancer (n = 264) were enrolled from oncology inpatient and outpatient units of 12 large hospitals located in different regions throughout South Korea. Caregivers were administered self-reported questionnaires about family functioning and EoL QoC at the time of an incurable cancer diagnosis, 4 to 6 weeks later, and again 2 to 3 months later. Family functioning and QoC were measured using the family Apgar and Quality Care Questionnaire–End of Life scales, respectively.Results:Improved adaptability to resource sharing and attention received predicted improved family relationships for the 3 time points. Increased participation in decision making and communication predicted improved individualized care and family relationships for the 3 time points. Increased affection predicted improvements in dignity-conserving care and family relationships for the 3 time points. Improved resolution regarding sharing time and satisfaction with commitments predicted increases in all QoC domains for the 3 time points, including dignity-conserving care, care by healthcare professionals, individualized care, and family relationships.Conclusions:Family functioning may contribute to improved EoL QoC of patients with terminal cancer.Implications for Practice:Patients' family caregivers are a valued source of affection and communicative support, improving EoL QoC. More family-oriented cancer support systems can better maintain the effectiveness of QoC until EoL.
Nursing Informatics Competency Assessment for the Nurse Leader
Authors: Yen Po-Yin , Phillips Andrew , Kennedy Mary K. , Collins Sarah 
Published: April 2017

OBJECTIVE
The aim of this article is to refine and validate a new instrument, Nursing Informatics Competency Assessment for the Nurse Leader (NL).

BACKGROUND
Because health information technology rapidly advances, the NL requires greater levels of informatics knowledge.

METHODS
Item reduction and psychometric analysis methodology

RESULTS
A total of 357 national NLs completed the survey. Exploratory factor analysis resulted in a final 6-factor solution that contained 26 items: (1) strategic implementation management, (2) advanced information management and education, (3) executive planning, (4) ethical and legal concepts, (5) information systems concepts, and (6) requirements and system selection. Cronbach’s α were .96, .91, .90, .83, .92, .81, respectively.

CONCLUSION
We established a valid and reliable nursing informatics competency assessment instrument with sufficient specificity to guide NLs to recognize the competencies required in their role, create solutions to address potential gaps, and enhance delivery of patient care.
Endogenous Glucocorticoid Response to Single-Dose Dexamethasone for Croup in Children
Authors: Gill Natasha , Sirizzotti Natalie , Johnson David , Joubert Gary , Kucey Andrew S. , Tieu Alvin , Urquhart Brad L. , Columbus Melanie , Lim Rodrick , Rieder Michael , Mehrotra Shruti , Hartjes Emily D. , Poonai Naveen 
Published: April 2017

ObjectivesDexamethasone is associated with adrenal insufficiency in adults and children with chronic disease. This association has not been studied after single-dose oral dexamethasone, the standard of care for children with croup. We hypothesized that single-dose oral dexamethasone in children with croup is associated with a transient decrease in endogenous glucocorticoids.MethodsWe conducted a prospective, 2-arm, pharmacodynamic study of single-dose oral dexamethasone 0.6 mg/kg (maximum, 12 mg) in children older than 2 years with croup compared with controls (children with febrile upper respiratory tract infections who did not receive dexamethasone). Primary outcome was urinary 6β-hydroxycortisol–cortisol ratio.ResultsTwenty-seven children were analyzed (22 with croup and 5 with upper respiratory tract infections). Median 6β-hydroxycortisol–cortisol ratios before dexamethasone, the following morning, and on days 1, 3, and 7 were 2.8, 2.2, 2.0, 2.8, and 2.6, respectively. Among controls, the median 6β-hydroxycortisol–cortisol ratios at the same time intervals was 1.9, 1.5, 1.8, 2.5, and 1.7, respectively. There were no significant differences in the change from time 0 between groups at any time point. There were no serious adverse events or infectious complications.ConclusionsSingle-dose oral dexamethasone is not associated with decreased endogenous corticosteroid levels in children with croup. Future studies should use criterion standard tests to rule out suppression of the hypothalamic-pituitary-adrenal axis and be powered sufficiently to identify adverse clinical outcomes.
Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive
Authors: Radin Anna K. , Abutu Andrew A. , Okwero Margaret A. , Adler Michelle R. , Anyaike Chukwuma , Asiimwe Hilda T. , Behumbiize Prosper , Efuntoye Timothy A. , King Rachel L. , Kisaakye Linda Nabitaka , Ogundehin Dolapo T. , Phelps Benjamin Ryan , Watts Heather , Weissglas Fitti 
Published: April 2017

Abstract:
The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015. To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child transmission of HIV (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda's development and use of a weekly reporting system for PMTCT using short message service technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a “treat all” approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda's work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.
Lessons Learned From Option B+ in the Evolution Toward “Test and Start” From Malawi, Cameroon, and the United Republic of Tanzania
Authors: Kalua Thokozani , Tippett Barr Beth A. , van Oosterhout Joep J. , Mbori-Ngacha Dorothy , Schouten Erik J. , Gupta Sundeep , Sande Amakobe , Zomba Gerald , Tweya Hannock , Lungu Edgar , Kajoka Deborah , Tih Pius , Jahn Andreas 
Published: April 2017

Abstract:
The acceleration of prevention of mother-to-child transmission (PMTCT) activities, coupled with the rollout of 2010 World Health Organization (WHO) guidelines, led to important discussions and innovations at global and country levels. One paradigm-shifting innovation was Option B+ in Malawi. It was later included in WHO guidelines and eventually adopted by all 22 Global Plan priority countries. This article presents Malawi's experience with designing and implementing Option B+ and provides complementary narratives from Cameroon and Tanzania. Malawi's HIV program started in 2002, but by 2009, the PMTCT program was lagging far behind the antiretroviral therapy (ART) program because of numerous health system challenges. When WHO recommended Option A and Option B for PMTCT in 2010, it was clear that Malawi's HIV program would not be able to successfully implement either option without increasing existing barriers to PMTCT services and potentially decreasing women's access to care. Subsequent stakeholder discussions led to the development of Option B+. Operationalizing Option B+ required several critical considerations, including the complete integration of ART and PMTCT programs, systematic reduction of barriers to facilitate doubling the number of ART sites in less than a year, building consensus with stakeholders, and securing additional resources for the new program. During the planning and implementation process, several lessons were learned which are considerations for countries transitioning to “treat-all”: Comprehensive change requires effective government leadership and coordination; national clinical guidelines must accommodate health system limitations; ART services and commodities should be decentralized within facilities; the general public should be well informed about major changes in the national HIV program; and patients should be educated on clinic processes to improve program monitoring.
Realizing the Promise of the Global Plan: Engaging Communities and Promoting the Health and Human Rights of Women Living With HIV
Authors: Matheson Rebecca , Brion Sophie , Sharma Aditi , Dilmitis Sophie , Schmitz Kathrin , Kean Stuart , Filous Katie , Murenga Maurine , Scheepers Esca , Ukoli Patricia , Mworeko Lillian , Yuvaraj Anandi 
Published: April 2017

Abstract:
The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive highlighted the need to put the health and well-being of women and mothers at the center of efforts to prevent vertical transmission. This article will examine a selection of community engagement practices in 3 key areas: (1) as an accountability tool, (2) in service delivery, and (3) as a facilitator of human rights. The lived experiences of women living with HIV as recipients of and participants in services for the prevention of vertical transmission provide both the framework for an exploration of best community engagement practices and suggestions for the way forward.
Pediatric Treatment Scale-Up: The Unfinished Agenda of the Global Plan
Authors: Penazzato Martina , Amzel Anouk , Abrams Elaine J. , Kiragu Karusa , Essajee Shaffiq , Mukui Irene , Elyanu Peter , Rwebembera Anath A. , Mbori-Ngacha Dorothy 
Published: April 2017

Abstract:
Five million children have died of AIDS-related causes since the beginning of the epidemic. In 2011, the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) created the political environment to catalyze both the resources and commitment to end pediatric AIDS. Implementation and scale-up have encountered substantial hurdles, however, which have resulted in slow progress. Reasons include a lack of emphasis on testing outside of prevention of mother-to-child transmission services, an overall lack of integration and coordination with other services, a lack of training among providers, low confidence in caring for children living with HIV, and a lack of appropriate formulations for pediatric antiretrovirals. During the Global Plan period, we have learned that simplification is essential to successful decentralization, integration, and task shifting of services; that innovations require careful planning; and that the family is an important unit for delivering HIV care and treatment services. The post-Global Plan phase presents a number of noteworthy challenges that all stakeholders, national programs, and communities must tackle to guarantee universal treatment for children living with HIV. Accelerated action is essential in ensuring that HIV diagnosis and linkage to treatment happen as quickly and effectively as possible. As fewer infants are infected because of effective prevention of mother-to-child transmission interventions and the population of children living with HIV will age into adolescence adapting service delivery models to the epidemic context, and engaging the community will be critical to finding new efficiencies and allowing us to realize a true HIV-free generation—and to end AIDS by 2030.
Offering patients more: how the West Africa Ebola outbreak can shape innovation in therapeutic research for emerging and epidemic infections
Authors: Rojek Amanda M. , Horby Peter W. 
Published: April 2017

Although, after an epidemic of over 28 000 cases, there are still no licensed treatments for Ebola virus disease (EVD), significant progress was made during the West Africa outbreak. The pace of pre-clinical development was exceptional and a number of therapeutic clinical trials were conducted in the face of considerable challenges. Given the on-going risk of emerging infectious disease outbreaks in an era of unprecedented population density, international travel and human impact on the environment it is pertinent to focus on improving the research and development landscape for treatments of emerging and epidemic-prone infections. This is especially the case since there are no licensed therapeutics for some of the diseases considered by the World Health Organization as most likely to cause severe outbreaks—including Middle East respiratory syndrome coronavirus, Marburg virus, Crimean Congo haemorrhagic fever and Nipah virus. EVD, therefore, provides a timely exemplar to discuss the barriers, enablers and incentives needed to find effective treatments in advance of health emergencies caused by emerging infectious diseases.This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.
Engaging ‘communities’: anthropological insights from the West African Ebola epidemic
Authors: Wilkinson A. , Parker M. , Martineau F. , Leach M. 
Published: April 2017

The recent Ebola epidemic in West Africa highlights how engaging with the sociocultural dimensions of epidemics is critical to mounting an effective outbreak response. Community engagement was pivotal to ending the epidemic and will be to post-Ebola recovery, health system strengthening and future epidemic preparedness and response. Extensive literatures in the social sciences have emphasized how simple notions of community, which project solidarity onto complex hierarchies and politics, can lead to ineffective policies and unintended consequences at the local level, including doing harm to vulnerable populations. This article reflects on the nature of community engagement during the Ebola epidemic and demonstrates a disjuncture between local realities and what is being imagined in post-Ebola reports about the lessons that need to be learned for the future. We argue that to achieve stated aims of building trust and strengthening outbreak response and health systems, public health institutions need to reorientate their conceptualization of ‘the community’ and develop ways of working which take complex social and political relationships into account.This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.
What we have learnt about the World Health Organization from the Ebola outbreak
Authors: Wenham Clare 
Published: April 2017

The World Health Organization's (WHO) reputation became irrefutably damaged during the Ebola outbreak, with a general consensus in the global health community that it fell short of its leadership responsibilities. This commentary offers a brief synopsis of the WHO's role during the outbreak and suggests that the disease outbreak demonstrates the tension that exists between the organization's normative and operational roles in health crises. While the WHO did offer some normative leadership during the Ebola outbreak, as per its constitution, it did not provide an effective operational response, yet nor did it have a mandate to do so. This division between the normative and operational was further highlighted by the discrepancy between what the global community expects the WHO to do in a health emergency, and what it is able to do with its financial and organizational constraints. Finally, the commentary considers the introduction of the WHO Health Emergency Programme, but suggests that this too may suffer from the same structural concerns that need to be addressed if the WHO is to continue in the role the global health community expects it to play, as both a normative and operational leader in global disease control.
This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.
Assessing the causal role of body mass index on cardiovascular health in young adults: Mendelian randomization and recall-by-genotype analyses
Authors: Wade Kaitlin H. , Chiesa Scott T. , Hughes Alun D. , Chaturvedi Nish , Charakida Marietta , Rapala Alicja , Muthurangu Vivek , Khan Tauseef , Finer Nicholas , Sattar Naveed , Howe Laura D. , Fraser Abigail , Lawlor Debbie A. , Smith George Davey , Deanfield John E. , Timpson Nicholas J. 
Published: April 2017

ABSTRACTBackgroundMendelian randomization (MR) studies of body mass index (BMI) and cardiovascular health in mid-to-late life suggest causal relationships, but the nature of these has not been explored systematically at younger ages. Using complementary MR and recall-by-genotype (RbG) methodologies, our objective was to estimate the causal effect of BMI on detailed measures of cardiovascular health in a population of young healthy adults.Methods and FindingsData from the Avon Longitudinal Study of Parents and Children were used. For MR analyses, a genetic risk score (GRS) comprising 97 independent single nucleotide polymorphisms (SNPs) and constructed using external weighting was used as an instrument to test the causal effect of each unit increase in BMI (kg/m2) on selected cardiovascular phenotypes measured at age 17 (N=7909). An independent enriched sample from the same cohort participated in a RbG study at age 21, which enabled more detailed cardiovascular phenotyping (N=418; 191/227 from the lower/upper ∼30% of a genome-wide GRS distribution predicting variation in BMI). The causal effect of BMI on the additional cardiovascular phenotypes was assessed by comparing the two recalled groups. Difference in mean BMI between RbG groups was 3.85kg/m2(95% CI: 2.53, 4.63;P=6.09×1011). In both MR and RbG analyses, results indicated that higher BMI causes higher blood pressure (BP) and left ventricular mass (indexed to height2.7, LVMI) in young adults (e.g. difference in LVMI per kg/m2using MR: 1.07g/m2.7; 95% CI: 0.62, 1.52; P=3.87×10−06and per 3.58kg/m2using RbG: 1.65g/m2.795% CI: 0.83, 2.47; P=0.0001). Additionally, RbG results indicated a causal role of higher BMI on higher stroke volume (SV; difference per 3.58kg/m2: 1.49ml/m2.04; 95% CI: 0.62, 2.35;P=0.001) and cardiac output (CO; difference per 3.58kg/m2: 0.11l /min/m1.83; 95% CI: 0.03, 0.19;P=0.01). Neither analysis supported a causal role of higher BMI on heart rate.ConclusionsComplementary MR and RbG causal methodologies, together with a range of appropriate sensitivity analyses, showed that higher BMI is likely to cause worse cardiovascular health, specifically higher BP and LVMI, even in youth. These consistent results support efforts to prevent or reverse obesity in the young.
Increasing antibiotic susceptibility inStaphylococcus aureusin Boston, Massachusetts, 2000-2014: an observational study
Authors: Kanjilal Sanjat , Sater Mohamad R. Abdul , Thayer Maile , Lagoudas Georgia , Kim Soohong , Blainey Paul C. , Grad Yonatan H. 
Published: April 2017

ABSTRACTBackgroundMethicillin resistantS. aureus(MRSA) has been declining over the past decade, but changes inS. aureusoverall and the implications for trends in antibiotic resistance remain unclear.ObjectiveTo determine whether the decline in rates of infection by MRSA has been accompanied by changes in rates of infection by methicillin susceptible, penicillin resistantS. aureus(MSSA) and penicillin susceptibleS. aureus(PSSA). We test if these dynamics are associated with specific genetic lineages and evaluate gains and losses of resistance at the strain level.MethodsWe conducted a 15 year retrospective observational study at two tertiary care institutions in Boston, MA of 31,589 adult inpatients withS. aureusinfections. Surveillance swabs and duplicate specimens were excluded. We also sequenced a sample of contemporary isolates (n = 180) obtained between January 2016 and July 2016. We determined changes in the annual rates of infection per 1,000 inpatient admissions byS. aureussubtype and in the annual mean antibiotic resistance by subtype. We performed phylogenetic analysis to generate a population structure and infer gain and loss of the genetic determinants of resistance.ResultsOf the 43,954S. aureusinfections over the study period, 21,779 were MRSA, 17,565 MSSA and 4,610 PSSA. After multivariate adjustment, annual rates of infection byS. aureusdeclined from 2003 to 2014 by 2.9% (95% CI, 1.6%-4.3%), attributable to an annual decline in MRSA of 9.1% (95% CI, 6.3%-11.9%) and in MSSA by 2.2% (95% CI, 0.4%-4.0%). PSSA increased over this time period by 4.6% (95% CI, 3.0%-6.3%) annually. Resistance inS. aureusdecreased from 2000 to 2014 by 0.86 antibiotics (95% CI, 0.81-0.91). By phylogenetic inference, 5/35 MSSA and 2/20 PSSA isolates in the common MRSA lineages ST5/USA100 and ST8/USA300 arose from the loss of genes conferring resistance.Conclusions and relevanceAt two large tertiary care centers in Boston, MA,S. aureusinfections have decreased in rate and have become more susceptible to antibiotics, with a rise in PSSA making penicillin an increasingly viable and important treatment option.