bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa
Authors: Adeniyi Oladele Vincent , Yogeswaran Parimalaranie , Longo-Mbenza Benjamin , Ter Goon Daniel , Ajayi Anthony Idowu 
Published: July 2016

ObjectivesSouth Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa.DesignA cross-sectional analytical study.SettingPrimary healthcare setting in OR Tambo district, South Africa.ParticipantsPatients treated for T2DM for 1 or more years (n=327).Primary outcome measurePrevalence of uncontrolled T2DM.Secondary outcome measureDeterminants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%).ResultsOut of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c.ConclusionsWe found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.
Retrospective observational study to assess the clinical management and outcomes of hospitalised patients with complicated urinary tract infection in countries with high prevalence of multidrug resistant Gram-negative bacteria (RESCUING)
Authors: Shaw Evelyn , Addy Ibironke , Stoddart Margaret , Vank Christiane , Grier Sally , Wiegand Irith , Leibovici Leonard , Eliakim-Raz Noa , Vallejo-Torres Laura , Morris Stephen , MacGowan Alasdair , Carratalà Jordi , Pujol Miquel 
Published: July 2016

IntroductionThe emergence of multidrug resistant (MDR) Gram-negative bacteria (GNB), including carbapenemase-producing strains, has become a major therapeutic challenge. These MDR isolates are often involved in complicated urinary tract infection (cUTI), and are associated with poor clinical outcomes. The study has been designed to gain insight into the epidemiology, clinical management, outcome and healthcare cost of patients with cUTI, especially in countries with high prevalence of MDR GNB.Methods and analysisThis multinational and multicentre observational, retrospective study will identify cases from 1 January 2013 to 31 December 2014 in order to collect data on patients with cUTI as a cause of hospital admission, and patients who develop cUTI during their hospital stay. The primary end point will be treatment failure defined as the presence of any of the following criteria: (1) signs or symptoms of cUTI present at diagnosis that have not improved by days 5–7 with appropriate antibiotic therapy, (2) new cUTI-related symptoms that have developed within 30 days of diagnosis, (3) urine culture taken within 30 days of diagnosis, either during or after completion of therapy, that grows ≥104colony-forming unit/mL of the original pathogen and (4) death irrespective of cause within 30 days of the cUTI diagnosis.Sample size1000 patients afford a power of 0.83 (α=0.05) to detect an absolute difference of 10% in the treatment failure rate between MDR bacteria and other pathogens. This should allow for the introduction of about 20 independent risk factors (or their interaction) in a logistic regression model looking at risk factors for failure.Ethics and disseminationApproval will be sought from all relevant Research Ethics Committees. Publication of this study will be considered as a joint publication by the participating investigator leads, and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE).Trial registration numberNCT02641015; Pre-results.
Association between passive smoking and mental distress in adult never-smokers: a cross-sectional study
Authors: Wang Rui , Zhang Peng , Lv Xin , Gao Chunshi , Song Yuanyuan , Li Zhijun , Yu Yaqin , Li Bo 
Published: July 2016

ObjectiveMany studies have suggested exposure to secondhand smoke (SHS) is a risk factor for various somatic diseases, but only few studies based on small sample size or specific groups have explored the association between passive smoking and mental distress. We performed this study to examine the relationship between passive smoking and mental distress in adult never-smokers of north-east China.MethodsMultistage, stratified random cluster sampling design was used in this cross-sectional study in 2012. A total of 12 978 never-smokers from Jilin, north-east China, were included. Data on passive smoking and baseline characteristics were collected by face-to-face interviews. The 12-item General Health Questionnaire (GHQ-12) was used to measure mental health status. Rao-Scott χ2tests were used to compare the prevalence between different groups; multivariable logistic regression was used to assess the association between passive smoking and mental distress, and Spearman rank analysis was employed to assess the correlation between passive smoking and GHQ-12 scores.ResultsThe estimated prevalence of mental distress among never-smokers in Jilin province is 24.5%, and the estimated prevalence of passive smoking among the mental distressing group is 65.0%. After adjusting for gender, age, region, body mass index (BMI), occupation, marriage, education, drinking status and family monthly income per capita, passive smoking conferred a risk for mental distress (adjusted OR=1.26, 95% CI 1.13 to 1.40). A high proportion of adults, especially women, were passive smokers at home, but for men, passive smoking was more common at workplace. The more frequently participants exposed to SHS, the higher GHQ-12 scores they got.ConclusionsPassive smoking is an important risk factor for mental distress in never-smokers of Jilin province, which reminds Chinese government of increasing the awareness of public health and take measure to prevent SHS, especially with regard to SHS exposure at home and workplace.
Assessing sex-differences and the effect of timing of vaccination on immunogenicity, reactogenicity and efficacy of vaccines in young children: study protocol for an individual participant data meta-analysis of randomised controlled trials
Authors: Voysey Merryn , Pollard Andrew J , Perera Rafael , Fanshawe Thomas R 
Published: July 2016

IntroductionDisease incidence differs between males and females for some infectious or inflammatory diseases. Sex-differences in immune responses to some vaccines have also been observed, mostly to viral vaccines in adults. Little evidence is available on whether sex-differences occur in response to immunisation in infancy even though this is the age group in which most vaccines are administered. Factors other than sex, such as timing or coadministration of other vaccines, can also influence the immune response to vaccination.Methods and analysisIndividual participant data meta-analysis of randomised controlled trials of vaccines in healthy infants and young children will be conducted. Fully anonymised data from ∼170 randomised controlled trials of vaccines for diphtheria, tetanus,Bordetella pertussis, polio,Haemophilus influenzaetype B, hepatitis B,Streptococcus pneumoniae,Neisseria meningitidis, measles, mumps, rubella, varicella and rotavirus will be combined for analysis. Outcomes include measures of immunogenicity (immunoglobulins), reactogenicity, safety and disease-specific clinical efficacy. Data from trials of vaccines containing similar components will be combined in hierarchical models and the effect of sex and timing of vaccinations estimated for each outcome separately.Ethics and disseminationSystematic reviews of published estimates of sex-differences cannot adequately answer questions in this field since such comparisons are never the main purpose of a clinical trial, thus a large degree of reporting bias exists in the published literature. Recent improvements in the widespread availability of individual participant data from randomised controlled trials makes it feasible to conduct extensive individual participant data meta-analyses which were previously impossible, thereby reducing the effect of publication or reporting bias on the understanding of the infant immune response.Preliminary results will be available in 2016 with final results available in 2019. No ethics review is required for secondary analyses of anonymised data.
Kaizen practice in healthcare: a qualitative analysis of hospital employees' suggestions for improvement
Authors: Mazzocato Pamela , Stenfors-Hayes Terese , von Thiele Schwarz Ulrica , Hasson Henna , Nyström Monica Elisabeth 
Published: July 2016

ObjectivesKaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare.MethodsWe analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated.Results72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions.ConclusionsThere is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results.
Dietary intake in young adults born small or appropriate for gestational age: data from the Haguenau cohort
Authors: Matta Joane , Carette Claire , Levy Marchal Claire , Bertrand Julien , Pétéra Mélanie , Zins Marie , Pujos-Guillot Estelle , Comte Blandine , Czernichow Sébastien 
Published: July 2016

ObjectivesCompare the dietary intake of young adults born small for gestational age (SGA) versus those born appropriate for gestational age (AGA).DesignCross-sectional analysis.SettingData at the 8-year follow-up Haguenau cohort (France). Data from 229 AGA-born adults and 172 SGA-born adults with available dietary information are presented.MethodsDietary intake was based on a food questionnaire including 19 items. The χ2test was run to compare intake between SGA-born and AGA-born individuals. An a priori score was calculated based on the adherence to recommendations from the French Nutrition and Health Program and included 8 components with the lowest value indicating a lower adherence to recommendations. The score was then divided into quartiles. Relative risks and 95% CIs, controlling for age and sex in multivariate analysis, were calculated in order to determine the risk of belonging to the first versus the second to the fourth quartiles in SGA-born and AGA-born individuals.ResultsIntakes of SGA-born adults indicated that they consumed more meat, sugar and less fish than AGA-born individuals (all p<0.05). Multivariate analyses with adjustment for age and sex showed that the relative risk of belonging to the first quartile versus the other three quartiles did not disclose any significant difference in SGA-born versus AGA-born participants: RR=0.92 (95% CI 0.65 to 1.30).ConclusionsAside from the differences found by univariate analyses, no significant differences were obtained in multivariate analyses. Findings suggest that parameters of fetal programming are more associated with the development of metabolic syndrome in adulthood rather than dietary patterns.
The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment
Authors: Braithwaite Jeffrey , Clay-Williams Robyn , Vecellio Elia , Marks Danielle , Hooper Tamara , Westbrook Mary , Westbrook Johanna , Blakely Brette , Ludlow Kristiana 
Published: July 2016

ObjectivesTo examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors.SettingControlled laboratory environment with well-appointed, quiet rooms and video and audio equipment.ParticipantsClinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions.InterventionsParticipants engaged in one of three team tasks, and their performance was video-recorded and assessed.Primary and secondary measuresPrimary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants’ individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted.ResultsAt baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43).ConclusionsOnce clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals’ or professions’ characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.
A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study
Authors: Snowden Jonathan M , Kozhimannil Katy Backes , Muoto Ifeoma , Caughey Aaron B , McConnell K John 
Published: July 2016

ObjectiveTo evaluate whether busy days on a labour and delivery unit are associated with maternal and neonatal complications of childbirth in California hospitals, accounting for weekday/weekend births.DesignThis is a population-based retrospective cohort study.SettingLinked vital statistics/patient discharge data for California births between 2009 and 2010 from the Office of Statewide Health Planning and Development.ParticipantsAll singleton, cephalic, non-anomalous California births between 2009 and 2010 (N=724 967).Main outcomesThe key exposure was high daily obstetric volume, defined as giving birth on a day when the number of births exceeded the hospital-specific 75th percentile of daily delivery volume. Outcomes were a range of maternal and neonatal complications.ResultsSeveral maternal and neonatal complications were increased on high-volume days and weekends following adjustment for maternal demographics, annual hospital birth volume and teaching hospital status. For example, compared with low-volume weekdays, the odds of Apgar <7 on low-volume weekend days and high-volume weekend days were 11% (adjusted OR (aOR) 1.11, CI 1.03 to 1.21) and 29% higher (aOR 1.29, CI 1.10 to 1.52), respectively. High volume was associated with increased odds of neonatal seizures on weekdays (aOR 1.33, CI 1.01 to 1.71) and haemorrhage on weekends (aOR 1.11, CI 1.01 to 1.22). After accounting for between-hospital variation, weekend delivery remained significantly associated with increased odds of Apgar score <7, neonatal intensive care unit admission, prolonged maternal length of stay and the odds of neonatal seizures remained increased on high-volume weekdays.ConclusionsOur findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume.
Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications
Authors: Abdallah Nihad , Conn Rory , Latif Marini Abdel 
Published: July 2016

Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement.The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.
Reducing inpatient falls in a 100% single room elderly care environment: evaluation of the impact of a systematic nurse training programme on falls risk assessment (FRA)
Authors: Singh Inderpal , Okeke Justin 
Published: July 2016

Inpatient falls (IF) are the most commonly reported safety incidents. The high rate of inpatient falls was reported in a newly built hospital, within Aneurin Bevan University Health Board, Wales (UK). The aim of the project is to reduce the incidence of IF and associated adverse clinical outcomes in a hospital with 100% single rooms.The key mechanism for improvement was education and training of nursing staff around falls risk factors. A Plan-Do-Study-Act methodology was used and a geriatrician-led, systematic nurse training programme on the understanding and correct use of existing multifactorial falls risk assessment (FRA) tool was implemented in April 2013.Pre-training baseline data revealed inadequate falls assessment and low completion rates of the FRA tool. Subsequent, post-training data showed improvement in compliance with all aspects of FRA. Concurrent with nurse training, the actual falls incidence/1000 patient-bed-days fell significantly from the baseline of 18.19±3.46 (Nov 2011-March 2013) to 13.36±2.89 (p<0.001) over next 12 months (April 2013-March 2014) and remained low (mean falls 12.81±2.85) until November 2015. Improved clinical outcomes have been observed in terms of a reduction of length of stay and new care home placements, making total annualised savings of £642,055.
Nationwide survey on volunteers' training in hospice and palliative care in Poland
Authors: Pawłowski Leszek , Lichodziejewska-Niemierko Monika , Pawłowska Iga , Leppert Wojciech , Mróz Piotr 
Published: July 2016

BackgroundVolunteers working in hospice and palliative care facilities in Poland undertake various activities which are performed in accordance with legal regulations and the individual policies of each hospice. The aim of this study was to explore the roles and training of volunteers working in hospice and palliative care settings.MethodsA cross-sectional survey was carried out that investigated the services performed by volunteers and their preparation for work within residential hospices. Questionnaires were distributed to volunteers and hospice representatives, and the responses obtained underwent statistical analysis.ParticipantsA total of 180 volunteers and 28 hospice representatives from 29 residential hospices participated in this survey.ResultsAll hospices surveyed were supported by volunteers. 79% of volunteers worked alongside patients and performed the following services: accompanying patients (76%), feeding patients (61%), cleaning rooms (48%), dressing and bathing (42%) and organising leisure time (40%). Fewer volunteers were involved in activities outside of patient support—for example, charity work and fundraising (34%), cleaning hospice buildings (23%) as well as providing information and education (22%). According to volunteers, prior to undertaking their duties, 64% participated in theoretical training and 37% took part in a practical course. The majority attended courses relating to general knowledge of hospice and palliative care (64%) and volunteer rights and duties (55%).ConclusionsOverall, proper training was an essential requirement needed to be fulfilled by volunteers, particularly when involved in direct patient support. Most volunteers were simultaneously involved in various areas of service; therefore, their training should be comprehensive.