bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staff perceptions on patient motives for attending GP-led urgent care centres in London: a qualitative study
Authors: Greenfield Geva , Ignatowicz Agnieszka , Gnani Shamini , Bucktowonsing Medhavi , Ladbrooke Tim , Millington Hugh , Car Josip , Majeed Azeem 
Published: January 2016

ObjectivesGeneral practitioner (GP)-led urgent care centres were established to meet the growing demand for urgent care. Staff members working in such centres are central in influencing patients’ choices about which services they use, but little is known about staff perceptions of patients’ motives for attending urgent care. We hence aimed to explore their perceptions of patients’ motives for attending such centres.DesignA phenomenological, qualitative study, including semistructured interviews. The interviews were analysed using thematic content analysis.Setting2 GP-led urgent care centres in 2 academic hospitals in London.Participants15 staff members working at the centres including 8 GPs, 5 emergency nurse practitioners and 2 receptionists.ResultsWe identified 4 main themes: ‘Confusion about choices’, ‘As if increase of appetite had grown; By what it fed on’, ‘Overt reasons, covert motives’ and ‘A question of legitimacy’. The participants thought that the centres introduce convenient and fast access for patients. So convenient, that an increasing number of patients use them as a regular alternative to their community GP. The participants perceived that patients attend the centres because they are anxious about their symptoms and view them as serious, cannot get an appointment with their GP quickly and conveniently, are dissatisfied with the GP, or lack self-care skills. Staff members perceived some motives as legitimate (an acute health need and difficulties in getting an appointment), and others as less legitimate (convenience, minor illness, and seeking quicker access to hospital facilities).ConclusionsThe participants perceived that patients attend urgent care centres because of the convenience of access relative to primary care, as well as sense of acuity and anxiety, lack self-care skills and other reasons. They perceived some motives as more legitimate than others. Attention to unmet needs in primary care can help in promoting balanced access to urgent care.
Effects of obstructive sleep apnoea risk on postoperative respiratory complications: protocol for a hospital-based registry study
Authors: Shin Christina H , Zaremba Sebastian , Devine Scott , Nikolov Milcho , Kurth Tobias , Eikermann Matthias 
Published: January 2016

IntroductionObstructive sleep apnoea (OSA), the most common type of sleep-disordered breathing, is associated with significant immediate and long-term morbidity, including fragmented sleep and impaired daytime functioning, as well as more severe consequences, such as hypertension, impaired cognitive function and reduced quality of life. Perioperatively, OSA occurs frequently as a consequence of pre-existing vulnerability, surgery and drug effects. The impact of OSA on postoperative respiratory complications (PRCs) needs to be better characterised. As OSA is associated with significant comorbidities, such as obesity, pulmonary hypertension, myocardial infarction and stroke, it is unclear whether OSA or its comorbidities are the mechanism of PRCs. This project aims to (1) develop a novel prediction score identifying surgical patients at high risk of OSA, (2) evaluate the association of OSA risk on PRCs and (3) evaluate if pharmacological agents used during surgery modify this association.MethodsRetrospective cohort study using hospital-based electronic patient data and perioperative data on medications administered and vital signs. We will use data from Partners Healthcare clinical databases, Boston, Massachusetts. First, a prediction model for OSA will be developed using OSA diagnostic codes and polysomnography procedural codes as the reference standard, and will be validated by medical record review. Results of the prediction model will be used to classify patients in the database as high, medium or low risk of OSA, and we will investigate the effect of OSA on risk of PRCs. Finally, we will test whether the effect of OSA on PRCs is modified by the use of intraoperative pharmacological agents known to increase upper airway instability, including neuromuscular blockade, neostigmine, opioids, anaesthetics and sedatives.Ethics and disseminationThe Partners Human Research Committee approved this study (protocol number: 2014P000218). Study results will be made available in the form of manuscripts for publication and presentations at national and international meetings.
Association between shelter crowding and incidence of sleep disturbance among disaster evacuees: a retrospective medical chart review study
Authors: Kawano Takahisa , Nishiyama Kei , Morita Hiroshi , Yamamura Osamu , Hiraide Atsuchi , Hasegawa Kohei 
Published: January 2016

ObjectivesWe determined whether crowding at emergency shelters is associated with a higher incidence of sleep disturbance among disaster evacuees and identified the minimum required personal space at shelters.DesignRetrospective review of medical charts.Setting30 shelter-based medical clinics in Ishinomaki, Japan, during the 46 days following the Great Eastern Japan Earthquake and Tsunami in 2011.ParticipantsShelter residents who visited eligible clinics.Outcome measuresBased on the result of a locally weighted scatter-plot smoothing technique assessing the relationship between the mean space per evacuee and cumulative incidence of sleep disturbance at the shelter, eligible shelters were classified into crowded and non-crowded shelters. The cumulative incidence per 1000 evacuees was compared between groups, using a Mann-Whitney U test. To assess the association between shelter crowding and the daily incidence of sleep disturbance per 1000 evacuees, quasi–least squares method adjusting for potential confounders was used.ResultsThe 30 shelters were categorised as crowded (mean space per evacuee <5.0 m2, 9 shelters) or non-crowded (≥5.0 m2, 21 shelters). The study included 9031 patients. Among the eligible patients, 1079 patients (11.9%) were diagnosed with sleep disturbance. Mean space per evacuee during the study period was 3.3 m2(SD, 0.8 m2) at crowded shelters and 8.6 m2(SD, 4.3 m2) at non-crowded shelters. The median cumulative incidence of sleep disturbance did not differ between the crowded shelters (2.3/1000 person-days (IQR, 1.6–5.4)) and non-crowded shelters (1.9/1000 person-days (IQR, 1.0–2.8); p=0.20). In contrast, after adjusting for potential confounders, crowded shelters had an increased daily incidence of sleep disturbance (2.6 per 1000 person-days; 95% CI 0.2 to 5.0/1000 person-days, p=0.03) compared to that at non-crowded shelters.ConclusionsCrowding at shelters may exacerbate sleep disruptions in disaster evacuees; therefore, appropriate evacuation space requirements should be considered.
RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies
Authors: Nilsson U , Jaensson M , Dahlberg K , Odencrants S , Grönlund Å , Hagberg L , Eriksson M 
Published: January 2016

IntroductionDay surgery is a well-established practice in many European countries, but only limited information is available regarding postoperative recovery at home though there is a current lack of a standard procedure regarding postoperative follow-up. Furthermore, there is also a need for improvement of modern technology in assessing patient-related outcomes such as mobile applications. This article describes the Recovery Assessment by Phone Points (RAPP) study protocol, a mixed-methods study to evaluate if a systematic e-assessment follow-up in patients undergoing day surgery is cost-effective and improves postoperative recovery, health and quality of life.Methods and analysisThis study has a mixed-methods study design that includes a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies. 1000 patients >17 years of age who are undergoing day surgery will be randomly assigned to either e-assessed postoperative recovery follow-up daily in 14 days measured via smartphone app including the Swedish web-version of Quality of Recovery (SwQoR) or to standard care (ie, no follow-up). The primary aim is cost-effectiveness. Secondary aims are (A) to explore whether a systematic e-assessment follow-up after day surgery has a positive effect on postoperative recovery, health-related quality of life (QoL) and overall health; (B) to determine whether differences in postoperative recovery have an association with patient characteristic, type of surgery and anaesthesia; (C) to determine whether differences in health literacy have a substantial and distinct effect on postoperative recovery, health and QoL; and (D) to describe day surgery patient and staff experiences with a systematic e-assessment follow-up after day surgery.The primary aim will be measured at 2 weeks postoperatively and secondary outcomes (A–C) at 1 and 2 weeks and (D) at 1 and 4 months.Trial registration numberNCT02492191; Pre-results.
Using a Delphi process to define priorities for prison health research in Canada
Authors: Kouyoumdjian Fiona G , Schuler Andrée , McIsaac Kathryn E , Pivnick Lucie , Matheson Flora I , Brown Glenn , Kiefer Lori , Silva Diego , Hwang Stephen W 
Published: January 2016

ObjectivesA large number of Canadians spend time in correctional facilities each year, and they are likely to have poor health compared to the general population. Relatively little health research has been conducted in Canada with a focus on people who experience detention or incarceration. We aimed to conduct a Delphi process with key stakeholders to define priorities for research in prison health in Canada for the next 10 years.SettingWe conducted a Delphi process using an online survey with two rounds in 2014 and 2015.ParticipantsWe invited key stakeholders in prison health research in Canada to participate, which we defined as persons who had published research on prison health in Canada since 1994 and persons in the investigators’ professional networks. We invited 143 persons to participate in the first round and 59 participated. We invited 137 persons to participate in the second round and 67 participated.Primary and secondary outcome measuresParticipants suggested topics in the first round, and these topics were collated by investigators. We measured the level of agreement among participants that each collated topic was a priority for prison health research in Canada for the next 10 years, and defined priorities based on the level of agreement.ResultsIn the first round, participants suggested 71 topics. In the second round, consensus was achieved that a large number of suggested topics were research priorities. Top priorities were diversion and alternatives to incarceration, social and community re-integration, creating healthy environments in prisons, healthcare in custody, continuity of healthcare, substance use disorders and the health of Aboriginal persons in custody.ConclusionsGenerated in an inclusive and systematic process, these findings should inform future research efforts to improve the health and healthcare of people who experience detention and incarceration in Canada.
Understanding patient-centred readmission factors: a multi-site, mixed-methods study
Authors: Greysen S Ryan , Harrison James D , Kripalani Sunil , Vasilevskis Eduard , Robinson Edmondo , Metlay Joshua , Schnipper Jeffery L , Meltzer David , Sehgal Neil , Ruhnke Gregory W , Williams Mark V , Auerbach Andrew D 
Published: January 2016

ImportancePatient concerns at or before discharge inform many transitional care interventions; few studies examine patients’ perceptions of self-care and other factors related to readmission.ObjectivesTo characterise patient-reported or caregiver-reported factors contributing to readmission.Design, setting and participantsCross-sectional, national study of general medicine patients readmitted within 30 days at 12 US hospitals. Interviews included multiple-choice survey and open-ended survey questions of patients or their caregivers.MeasurementsMultiple-choice survey quantified post-discharge difficulty in seven domains of self-care: medication use, contacting providers, transportation, basic needs (eg, food and shelter), diet, social support and substance abuse. Open-ended responses were coded into themes that added depth to the domains above or captured additional patient-centred concerns.ResultsWe interviewed 1066 readmitted patients. 91% reported understanding their discharge plan; however, only 37% reported that providers asked about barriers to carrying out the plan. 52% reported experiencing difficulty in ≥1 self-care domains ranging in frequency from 22% (diet) to 7% (substance use); 26% experienced difficulty in two or more domains. Among 508 patients (48% overall) who reported no difficulties in these domains, two-thirds either could not attribute their readmission to any specific difficulty (34%) or attributed their readmission to progression or persistence of their disease despite following their discharge plan (31%). Only 20% attributed their readmission to early discharge (8%), poor-quality hospital care (6%) or issues such as inadequate discharge instructions or follow-up care (6%).LimitationsThe study population included only patients readmitted at academic medical centres and may not be representative of community-based care.ConclusionPatients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.
Improving information availability in vascular surgical clinics. A service evaluation and improvement project
Authors: Hurst Katherine , Kreckler Simon , Handa Ashok , Handa Ashok 
Published: January 2016

AbstractThis prospective service evaluation was designed to assess the availability of critical information required in vascular surgical clinics. All the data was collected via a repeated questionnaire, and the outcomes from each cycle were used to highlight where intervention was required to improve the surgical clinic experience.The first audit identified outpatient clinic deficiencies and allowed for problem analysis. Two Plan-Do-Check-Act (PDCA) cycles then were undertaken. Interventions following each cycle included consultant access to online duplex scans and secretarial access to referral letters.Results from the first cycle showed that approximately 20% of clinic appointments were missing information and only 30% of these issues were resolved during the clinic using a work around.Following the first intervention; the numbers of missing patient notes reduced to 4.3% (10.5%), and referral letters to 3.6% (4.6%). Although the numbers of missing duplex scan results increased to 6.5% (3.3%), the new system of online scan results allowed for all scans to be accessed during the clinic.Following results of a second PDCA cycle, vascular surgical secretaries were given access to ‘choose and book’, a database of GP referral letters. Post intervention, all missing referral letters (2%) could be accessed immediately within the clinic setting.Data driven interventions and repeated PDCA cycles can improve hospital systems for minimal cost. With an annual clinic turnaround of 2500 patients, these interventions can reduce clinic delays and potential harm caused by unavailable records for up to 500 patients a year.
Dyspnoea as a predictor of cause-specific heart/lung disease mortality in Bangladesh: a prospective cohort study
Authors: Pesola Gene R , Argos Maria , Chinchilli Vernon M , Chen Yu , Parvez Faruque , Islam Tariqul , Ahmed Alauddin , Hasan Rabiul , Rakibuz-Zaman Muhammad , Ahsan Habibul 
Published: January 2016

BackgroundThe spectrum of mortality outcomes by cause in populations with/without dyspnoea has not been determined. The study aimed to evaluate whether dyspnoea, a symptom, predicts cause-specific mortality differences between groups. The hypothesis was that diseases that result in chronic dyspnoea, those originating from the heart and lungs, would preferentially result in heart and lung disease mortality in those with baseline dyspnoea (relative to no dyspnoea) when followed over time.MethodsA population-based sample of 11 533 Bangladeshis was recruited and followed for 11–12 years and cause-specific mortality evaluated in those with and without baseline dyspnoea. Dyspnoea was ascertained by trained physicians. The cause of death was determined by verbal autopsy. Kaplan-Meier survival curves, the Fine-Gray competing risk hazards model and logistic regression models were used to determine group differences in cause-specific mortality.ResultsCompared to those not reporting dyspnoea at baseline, the adjusted HRs were 6.4 (3.8 to 10.7), 9.3 (3.9 to 22.3), 1.8 (1.2 to 2.8), 2.2 (1.0 to 5.1) and 2.8 (1.3 to 6.2) for greater risk of dying from chronic obstructive pulmonary disease (COPD), asthma, heart disease, tuberculosis and lung cancer, respectively. In contrast, there was a similar risk of dying from stroke, cancer (excluding lung), liver disease, accidents and other (miscellaneous causes) between the dyspnoeic and non-dyspnoeic groups. In addition, the HR was 2.1 (1.7 to 2.5) for greater all-cause mortality in those with baseline dyspnoea versus no dyspnoea.ConclusionsDyspnoea, ascertained by a single question with binary response, predicts heart and lung disease mortality. Individuals reporting dyspnoea were twofold to ninefold more likely to die of diseases that involve the heart and/or lungs relative to the non-dyspnoeic individuals. Therefore, in those with chronic dyspnoea, workup to look for the five common dyspnoeic diseases resulting in increased mortality (COPD, asthma, heart disease, tuberculosis and lung cancer), all treatable, should reduce mortality and improve the public health.
Are fetal growth impairment and preterm birth causally related to child attention problems and ADHD? Evidence from a comparison between high-income and middle-income cohorts
Authors: Murray Elizabeth , Pearson Rebecca , Fernandes Michelle , Santos Iná S , Barros Fernando C , Victora Cesar G , Stein Alan , Matijasevich Alicia 
Published: January 2016

BackgroundCross-cohort comparison is an established method for improving causal inference. This study compared 2 cohorts, 1 from a high-income country and another from a middle-income country, to (1) establish whether birth exposures may play a causal role in the development of childhood attention problems; and (2) identify whether confounding structures play a different role in parent-reported attention difficulties compared with attention deficit hyperactivity disorder (ADHD) diagnoses.MethodsBirth exposures included low birth weight (LBW), small-for-gestational age (SGA), small head circumference (HC) and preterm birth (PTB)). Outcomes of interest were attention difficulties (Strengths and Difficulties Questionnaire, SDQ) and ADHD (Development and Well-Being Assessment, DAWBA). Associations between exposures and outcomes were compared between 7-year-old children from the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK (N=6849) and the 2004 Pelotas cohort in Brazil (N=3509).ResultsFor attention difficulties (SDQ), the pattern of association with birth exposures was similar between cohorts: following adjustment, attention difficulties were associated with SGA (OR=1.59, 95% CI 1.20 to 2.19) and small HC (OR=1.64, 95% CI 1.11 to 2.41) in ALSPAC and SGA (OR=1.35, 95% CI 1.04 to 1.75) in Pelotas. For ADHD, however, the pattern of association following adjustment differed markedly between cohorts. In ALSPAC, ADHD was associated with LBW (OR=2.29, 95% CI 1.09 to 4.80) and PTB (OR=2.33, 95% CI 1.23 to 4.42). In the Pelotas cohort, however, ADHD was associated with SGA (OR=1.69, 95% CI 1.02 to 2.82).ConclusionsThe findings suggest that fetal growth impairment may play a causal role in the development of attention difficulties in childhood, as similar associations were identified across both cohorts. Confounding structures, however, appear to play a greater role in determining whether a child meets the full diagnostic criteria for ADHD.
Algal–microbial carbonates of the Namibe Basin (Albian, Angola): implications for microbial carbonate mound development in the South Atlantic
Authors: Schröder S. , Ibekwe A. , Saunders M. , Dixon R. , Fisher A. 
Published: January 2016

Albian carbonate reservoirs are prominent in the subsurface of the South Atlantic. Equivalent exposures in southern Angola (Benguela and Namibe basins) have received relatively little detailed sedimentological work. In the Namibe Basin, carbonates form metre-thick beds interbedded with shallow-marine and continental alluvial fan siliciclastics. Characteristic carbonate mounds (≤5 m high, 1–2 m in diameter) rise above a basal carbonate bed, which consists of oncoid–peloidal rud-grainstones with oysters and echinoderms. Thrombolite mound microfacies include red algae and microbial–algal crusts. The microfacies are marine, and compare with documented occurrences of algal–microbial–oncoidal textures in Albian carbonates of the Congo and Angola. Burial processes dominated diagenesis and have reset carbonate geochemistry from marine values, with the probable exception of Mg concentrations. Up to 22% of primary (intergranular) and secondary (microporosity, mouldic, vuggy, fracture) porosity developed as a consequence of important dissolution and partial cementation.
Two depositional models for the localized mound occurrence are discussed: (1) marine ingression into a coastal embayment and the formation of shallow-water microbial bioherms; and (2) a submarine groundwater spring discharging in coastal areas downdip from alluvial siliciclastics. Marine fauna, similarity with marine Albian strata elsewhere and a partly preserved marine Mg geochemical signature favour a marine ingression. Environmental conditions were likely to have been stressed on account of the siliciclastic input, variable salinity and elevated nutrients, all of which are consistent with the observed microfacies. A submarine spring is conceptually feasible, but is considered to be less likely owing to the absence of a clear meteoric signature and the low likelihood of bicarbonate-rich groundwater in the region.

Using the discussion of depositional models for the studied outcrop, and incorporating a literature review, the study proposes a set of criteria to distinguish various marine and non-marine carbonate mounds in the subsurface. The most diagnostic criteria are: (1) marine or continental fauna; (2) sediment geochemistry, in particular Mg, Sr, and δ
13
C and δ
18
O isotopes where preserved through diagenesis; and (3) carbonate fabrics, such as crystalline shrubs, that are diagnostic of thermogenic continental mounds. The scale of geobodies and the mineralogy of mounds can sometimes be used as additional criteria. This set of criteria can help exploration and production geologists who need to devise exploration and development strategies in unconventional carbonate reservoirs of the South Atlantic and other rift basins.