bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRAVELLING WITH THE SYSTEMS QUALITY IMPROVEMENT MODEL IN LACS HEALTH DISTRICT IN TOGO TO REDUCE TUBERCULOSIS DEATHS
Authors: Afanvi Kossivi , Kassankogno Yao , Ekouevi Koumavi 
Published: October 2015

BackgroundThe ultimate goal of every tuberculosis (TB) treatment program is a high treatment success rate. Treatment success is extremely important because, when the rate is high, it significantly contributes to declining numbers of new cases by reducing the number and period of infectious cases, TB morbidity and mortality, and prevents the emergence of resistant strains.ObjectivesDecrease TB mortality by increasing pulmonary TB patients' treatment success rate to at least 85% in Lacs Health District by the end of July 2014.MethodsA systems and dialogic analysis of the public health system related to TB patients' treatment revealed that it was not performing well; we found weak coverage and quality of TB services, a poorly-functioning TB health information system, poor-performing health workforce, poor availability of HIV tests and antiretroviral for TB patients, and low degree of patients' participation in their care. We redesigned the system to correct those weaknesses. The effectiveness of these changes was monitored using plan, do, study, act (PDSA) cycles.ResultsWe increased TB patient success rate from 80% to 95% between February 2012 and July 2014.The mortality rate dropped from 13% to 3% and the failure to follow-up rate dropped from 3% to 2%.ConclusionsHealth systems performance depends on the closeness of services to population; skilled workforce; the ability to collect and analyze data and use information for action; population empowerment, and good management and improvement capabilities of management team especially public health directors. It is highly important that every district health management team member develops improvement capabilities.Figure 1Systems Quality Improvement Model (SQIM) conceptual framework.Figure 2TB treatment success rate P chart.Figure 3TB mortality rate P chart.Figure 4TB treatment failure to follow-up rate P chart.
COMMUNITY COLLABORATION IMPROVES CARE AND REDUCES REHOSPITALIZATIONS FOR HEART FAILURE PATIENTS
Authors: Thompson Christine , Kell Charlene , Banerjee Dipanjan 
Published: October 2015

BackgroundHF is a leading cause of hospitalization for adults, with highest readmission rates occurring 30 days post-discharge. Hospitals are instituting evidence-based strategies to improve patient transitions from hospital to home and reduce 30-day all-cause readmissions. Impacting 90-day readmissions poses a greater challenge. Incorporating community partners into care transitions is critical for successful outcomes, particularly considering new bundled payment models. Patients discharging to skilled nursing facilities (SNFs) or with home health agency (HHA) services are often more vulnerable and at heightened risk.ObjectivesCreate a collaborative partnership between one medical center and local SNFs and home health agencies (HHA) to improve sustained HF patient outcomes and reduce hospital readmissions.MethodsMonthly multidisciplinary meetings were held with local SNF and HHA participants. Collaborative goals included identifying gaps in patient transitions between care settings and creating an evidence-based community standard for HF patient care. Corollary aims were to align quality care practices, share outcomes data and create solutions for identified barriers to optimal care transitions.ResultsComparing baseline data (476 HF discharges) to a year post-implementation of our intervention bundle (412 discharges), overall 30-day readmissions reduced from 19% to 9% while 90-day readmissions improved from 31% to 19%. 30-day rehospitalizations for SNF patients declined from and were decreased for patients who discharged with home health services by 26%.ConclusionsBuilding relationships fostering communication and collaboration among community partners is a key strategy to reduce avoidable rehospitalizations and sustain improved patient outcomes.Figure 1Primary Diagnosis HF Patient Readmissions by Index Disposition (pre/post interventions).
CAN ORGANISATIONAL RESTRUCTURING OF HOSPITALS IMPROVE QUALITY AND SAFETY? THE EXPERIENCE AT SYDNEY CHILDREN'S HOSPITALS NETWORK
Authors: Farrow Glen 
Published: October 2015

BackgroundIn New South Wales serious publicised adverse events in 2006 brought quality and safety to community attention. The Garling external review of 2008 made 139 recommendations, including the creation a single children's hospital. This was addressed by the creation of the Sydney Children's Hospitals Network (SCHN) in June 2010. SCHN brought together the boards and management structures of Sydney Children's Hospital Randwick and the Children's Hospital at Westmead.ObjectivesIn business, restructures are often implemented to improve performance, safety and customer satisfaction, but improvement has been difficult to demonstrate in healthcare. This study asks whether quality and safety have been improved by the formation of SCHN in June 2010.MethodsQuality data within IHI domains of quality (safe, effective, patient-centred, timely, efficient) has been compared pre and post SCHN. Results are analysed in split control charts, with Chi squared analysis, P scores and benchmarking with data from the Clinical Excellence Commission NSW, and “Solutions For Patient Safety” a North American collaboration of 80 children's hospitals. Restructuring of clinical governance was based on the principals of alignment, networks and improving situational awareness.ResultsSignificant improvement was seen in several parameters of quality and safety including fewer serious incidents, fewer medico legal cases, fewer medication errors, better access to emergency departments, fewer complaints and maintaining readmission rates despite a 20% increase in activity.ConclusionsAt SCHN organisational restructuring has improved quality and safety performance. Structural alignment within agreed quality standards, network roles that share learnings between facilities and better situational awareness are thought to be responsible.Figure 1SCHN inpatient activity including day cases 2005–2014.Figure 2SCHN SAC 1 and 2 incidents as a % of separation.Figure 3Total incidents reported SCHN as a percentage of separations.Figure 4Total incidents reported at CHW increased p<0.05.Figure 5Total incidents reported at SCH decreased p<0.05.Figure 6SAC 1s at CHW: harm is reduced.Figure 7Time delay in medicolegal notifications.Figure 8SCHN Medicolegal cases reduced (p<0.05).Figure 9SCHN CVAD infections: benchmarking with North America.Figure 10SCHN medication errors: benchmarking with North America.Figure 11SCHN medication errors 2009–2014.Figure 12Total number of ward arrests: benchmarking with Cincinnati Children's Medical Centre.Figure 13SCHN readmission rates increased at 28 days.Figure 14SCHN “Did not wait” significantly reduced (p<0.01).Figure 15SCHN formal complaints reduced (p<0.1).
INCREASING TRICHOMONAS TESTING IN THE PEDIATRIC EMERGENCY DEPARTMENT
Authors: Stukus Kristin , Cripe Timothy , Cohen Daniel , Craig Farah , Sawicki Laura , Weisbecker Lindsey , Hollar Jessica , Kurtovic Kelli , Buckingham Don 
Published: October 2015

BackgroundTrichomonas is a common adolescent sexually transmitted infection (STI), causing vaginal pain, discharge and dysuria. Affected individuals are more likely to have co-occurrence of other STIs as well, including HIV. Improving the Trichomonas testing process in the ED may result in a higher, targeted testing rate and thus improved detection and treatment.ObjectivesTo increase Trichomonas testing in the ED among high-risk adolescent patients from 40% in July 2014 to 100% by March 31,2015 and sustain through 2015.MethodsA team of MDs, CRNPs, RNs and QI professionals assembled in 2014 to address this need. Six months data was collected to define the baseline rate of testing. Deploying the IHI Model for Improvement, the team formulated an aim statement and identified key drivers. Using root cause analysis, interventions were proposed for each problem area. A series of PDSA cycles were undertaken, and the results of each were monitored using a control chart. These interventions included increasing awareness and education for clinical staff; combined test availability; use of order sets for STI; and adding Licensed Professional Initiated Protocol to nurse ordering practice. This was all done in conjunction with feedback for individual missed cases.ResultsOver an 18 month period, the rate of Trichomonas testing in the ED rose with each intervention: from 25% (January 2014) to 98% (March 2015) which has been sustained through August of 2015.ConclusionsImproving the process of Trichomonas testing of symptomatic adolescents in the ED, results in higher screening rates among ED pediatric providers.Figure 1Trichomonas testing in the ED.Figure 2Adolescents with STD and Trichomonas testing.
Improving venous thromboembolism risk assessment compliance using the electronic tool in admitted medical patients
Authors: Taha, MD Haytham , J. Raji, RN Salama , Ellahham, MD Samer , Bashir, MD Nihal , Al hanaee, MD Manar , Boharoon, MD Hessa , AlFalahi, MD May 
Published: October 2015

AbstractSheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity that is fully occupied most of the time.SKMC senior management has made a commitment to make quality and patient safety a top priority. Venous thromboembolism (VTE) risk assessment has been identified as a critical patient safety measure and key performance indicator. The electronic VTE risk assessment form a computerized decision support tool was introduced to improve adherence with deep venous thrombosis (DVT) prophylaxis recommendations. A multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to enhance compliance with VTE risk assessment and the outcomes of those interventions.We chose to conduct the pilot study in General Medicine as it is the busiest department in the hospital. The study period was from April 2014 till August 2015.The lessons learned were disseminated throughout the hospital. Our aim was to improve VTE risk assessment compliance by using the electronic form in order to ensure patient safety and reduce preventable harm. VTE risk assessment compliance improved in general medicine from 4% to 98%, and overall SKMC compliance from 21% to above 90%.
Interview with Prof. Emmanuel Tsesmelis and Prof. Albert De Roeck from CERN
Authors:   APPN Editorial Team
Published: October 2015

Professor Emmanuel Tsesmelis: is an experimental particle physicist with a career spanning scientific research, academic teaching, science communication, international relations and management at CERN and at several universities. He is a Senior Physicist and Deputy Head of International Relations in CERN's Director-General Unit and a Visiting Professor in Particle and Accelerator Physics at the University of Oxford. He is an elected Fellow of the Australian Institute of Physics and a supernumerary member of Jesus College, Oxford. Professor Albert De Roeck: is a senior research scientist and staff member at CERN. He is also a professor at the University of Antwerp (Belgium) and a visiting professor at the Institute of Particle Physics and Phenomenology in Durham (UK). He obtained his PhD at the university of Antwerp on an experiment at CERN, studying the multiparticle dynamics in hadron-hadron interactions, by colliding meson beams on protons and nuclear targets. After his PhD, Albert spent 10 years at the German particle physics laboratory, DESY, where he and his team made very precise measurements of the quark and gluon structure of the proton. In the late 90's his interest turned to the possibility to discover new physics, in particular Supersymmetry and Extra Dimensions, and he returned to CERN and joined an experiment at the large electron-positron collider LEP. Albert is now one the leaders of the physics program and preparation for physics analysis at the CMS experiment at the LHC.
High-Dose FOLFIRI plus Bevacizumab in the Treatment of Metastatic Colorectal Cancer Patients with Two Different UGT1A1 Genotypes: FFCD 0504 Study
Authors: Manfredi Sylvain , Bouché Olivier , Rougier Philippe , Dahan Laetitia , Loriot Marie Anne , Aparicio Thomas , Etienne Pierre Luc , Lafargue Jean Pierre , Lécaille Cedric , Legoux Jean Louis , Le Malicot Karine , Maillard Emilie , Lecomte Thierry , Khemissa Faiza , Breysacher Gilles , Michel Pierre , Mitry Emmanuel , Bedenne Laurent 
Published: October 2015

Abstract
High-dose FOLFIRI has an acceptable safety profile and promising efficacy. UDP-glucuronosyltransferase: (UGT1A1) polymorphism may be predictive of toxicity and efficacy of irinotecan. This phase II study aimed to evaluate the combination of high-dose FOLFIRI plus bevacizumab in patients with previously untreated metastatic colorectal cancer (MCRC) based on their UGT1A1 genotype. Patients with the UGT1A1 *1/*1 (group 1) or *1/*28 (group 2) genotype received bevacizumab plus high-dose FOLFIRI every 2 weeks. Using the Bryant and Day design with objective response rate and toxicity as the primary endpoints, 54 patients in each group were required with a planned interim analysis after inclusion of 17 patients per group. We planned to stop the trial at the interim analysis if ≤7 patients exhibited an objective response (OR) and/or ≥3 patients exhibited severe toxicity. At the interim analysis, ORs were higher than the number expected: 52.9% (group 1) and 58.8% (group 2). More than three toxic events occurred in both groups and, according to the interim analysis rule, the trial was closed due to unacceptable toxicity. Recruitment was stopped when 86 patients were included and an analysis on overall population was done for overall survival (OS) and progression-free survival (PFS). The median PFS was 10.7 months (group 1) and 10.4 months (group 2). The median OS was 25.5 months (group 1) and 23.9 months (group 2). This trial does not support the use of the intensive treatment with HD-FOLFIRI plus bevacizumab combination for MCRC in patients with the UGTA1*1/UGT1A1*1 or UGT1A1*1/UGT1A1*28 genotype. Mol Cancer Ther; 14(12); 2782–8. ©2015 AACR.
СТРАТЕГІЯ СТВОРЕННЯ ТА ОЦІНЮВАННЯ ФУНКЦІОНУВАННЯ СИСТЕМ УПРАВЛІННЯ ЯКІСТЮ МЕДИЧНОЇ ОСВІТИ. ДРУГЕ ПОВІДОМЛЕННЯ. ТРАНСФОРМАЦІЯ ІДЕЙ УПРАВЛІННЯ ЯКІСТЮ НА ОСНОВІ ПРИНЦИПУ «ДУАЛЬНИХ СИСТЕМ»
Authors: Mintser O. P. , Tolstanov O. K. , Zahoriy H. V. 
Published: October 2015

<p>It was proposed an assessment methodology functioning of the quality management systems of medical education. For quality evaluation system of postgraduate medical education the principle of dual control was appllied.</p><p>It was also considered the possibility of using of quadrupole model. The model consists of four clusters, each containing four quality management systems of medical education evaluation criteria and relevant indicators for the analysis of these criteria.</p><p> </p>
ЕЛЕМЕНТИ ІНТЕРФЕЙСУ НАУКОВО-ДОСЛІДНОГО WEB-РЕСУРСУ PHYSIONET ТА ІМПОРТ ДАНИХ У СИСТЕМУ КОМП'ЮТЕРНОЇ МАТЕМАТИКИ MAPLE 17
Authors: Chuiko G. P. , Shyian I. O. , Galyak D. A. 
Published: October 2015

Since 1999, PhysioNet (http://physionet.org/) has offered free access via the web to large collections of recorded physiologic signals and medical databases as well as associated open-source software. The intention of this scientific resource is to stimulate current research and new investigations in the study of cardiovascular and other complex biomedical signals. PhysioBank archives include today the records obtained from healthy individuals and from patients with different diagnoses obtained under various conditions. It includes sudden cardiac death, congestive heart failure, neurological disorders, epilepsy and many others. Software packages PhysioToolkit is valuable for physiological signal processing and analysis, for creation of new databases, the interactive display and characterization of signals, the simulation of physiological and other signals. Nonetheless, a researcher should have skills to work with the operating system Unix and be knowledgeable in special commands to successful use software PhysioToolkit. Therefore, it makes sense to convert the necessary signals to a user-friendly computer algebra system. This paper describes interface elements of scientific web-resource PhysioNet, the simple methods of converting from binary medical data files to the text format and import of received digital signals into computer mathematics system Maple 17.
Cell-Free DNA Modulates Clot Structure and Impairs Fibrinolysis in Sepsis
Authors: Gould Travis J. , Vu Trang T. , Stafford Alan R. , Dwivedi Dhruva J. , Kim Paul Y. , Fox-Robichaud Alison E. , Weitz Jeffrey I. , Liaw Patricia C. 
Published: October 2015

Objectives—
Sepsis is characterized by systemic activation of inflammation and coagulation in response to infection. In sepsis, activated neutrophils extrude neutrophil extracellular traps composed of cell-free DNA (CFDNA) that not only trap pathogens but also provide a stimulus for clot formation. Although the effect of CFDNA on coagulation has been extensively studied, much less is known about the impact of CFDNA on fibrinolysis. To address this, we (1) investigated the relationship between CFDNA levels and fibrinolytic activity in sepsis and (2) determined the mechanisms by which CFDNA modulates fibrinolysis.

Approach and Results—

Plasma was collected from healthy and septic individuals, and CFDNA was quantified. Clot lysis assays were performed in plasma and purified systems, and lysis times were determined by monitoring absorbance. Clot morphology was assessed using scanning electron microscopy. Clots formed in plasma from septic patients containing >5 µg/mL CFDNA were dense in structure and resistant to fibrinolysis, a phenomenon overcome by deoxyribonuclease addition. These effects were recapitulated in control plasma supplemented with CFDNA. In a purified system, CFDNA delayed fibrinolysis but did not alter tissue-type plasminogen activator–induced plasmin generation. Using surface plasmon resonance, CFDNA bound plasmin with a
K
d
value of 4.2±0.3 µmol/L, and increasing concentrations of CFDNA impaired plasmin-mediated degradation of fibrin clots via the formation of a nonproductive ternary complex between plasmin, CFDNA, and fibrin.

Conclusions—
Our studies suggest that the increased levels of CFDNA in sepsis impair fibrinolysis by inhibiting plasmin-mediated fibrin degradation, thereby identifying CFDNA as a potential therapeutic target for sepsis treatment.
Association of Plasma γ′ Fibrinogen With Incident Cardiovascular Disease
Authors: Appiah Duke , Schreiner Pamela J. , MacLehose Richard F. , Folsom Aaron R. 
Published: October 2015

Objectives—
To prospectively examine the association of plasma γ′ fibrinogen with the incidence of multiple cardiovascular disease (CVD) end points, independent of established CVD risk factors, total fibrinogen, and other inflammatory markers.

Approach and Results—
The Atherosclerosis Risk in Communities (ARIC) study measured γ′ fibrinogen by enzyme-linked immunosorbent assay in stored plasma samples from 1993 to 1995 and related levels in 10 601 adults to incident CVD end points (coronary heart disease [n=1603], ischemic stroke [n=548], peripheral artery disease [n=599], heart failure [n=1411], and CVD mortality [n=705]) through 2012 (median follow-up, 18 years). In Cox models accounting for established CVD risk factors and total fibrinogen levels, γ′ fibrinogen was associated positively with peripheral artery disease (hazard ratio [HR] per 1-SD [8.80 mg/dL] increment, 1.14 [1.04–1.24]), heart failure (HR, 1.06 [1.01–1.13]), and CVD deaths (HR, 1.12 [1.04–1.21]) but not with incident coronary heart disease (HR, 1.01 [0.96–1.07]) or ischemic stroke (HR, 0.98 [0.89–1.07]). Additional adjustment for C-reactive protein, however, eliminated the associations with peripheral artery disease and heart failure.

Conclusions—
These findings do not lend support to the hypothesis that γ′ fibrinogen influences CVD events through its prothrombotic properties. Rather, γ′ fibrinogen concentrations seem to reflect general inflammation that accompanies and may contribute to atherosclerotic CVD, instead of γ′ fibrinogen being a causal risk factor.
Relative Contributions of Mean-State Shifts and ENSO-Driven Variability to Precipitation Changes in a Warming Climate*
Authors: Bonfils Céline J. W. , Santer Benjamin D. , Phillips Thomas J. , Marvel Kate , Leung L. Ruby , Doutriaux Charles , Capotondi Antonietta 
Published: October 2015

Abstract
El Niño–Southern Oscillation (ENSO) is an important driver of regional hydroclimate variability through far-reaching teleconnections. This study uses simulations performed with coupled general circulation models (CGCMs) to investigate how regional precipitation in the twenty-first century may be affected by changes in both ENSO-driven precipitation variability and slowly evolving mean rainfall. First, a dominant, time-invariant pattern of canonical ENSO variability (cENSO) is identified in observed SST data. Next, the fidelity with which 33 state-of-the-art CGCMs represent the spatial structure and temporal variability of this pattern (as well as its associated precipitation responses) is evaluated in simulations of twentieth-century climate change. Possible changes in both the temporal variability of this pattern and its associated precipitation teleconnections are investigated in twenty-first-century climate projections. Models with better representation of the observed structure of the cENSO pattern produce winter rainfall teleconnection patterns that are in better accord with twentieth-century observations and more stationary during the twenty-first century. Finally, the model-predicted twenty-first-century rainfall response to cENSO is decomposed into the sum of three terms: 1) the twenty-first-century change in the mean state of precipitation, 2) the historical precipitation response to the cENSO pattern, and 3) a future enhancement in the rainfall response to cENSO, which amplifies rainfall extremes. By examining the three terms jointly, this conceptual framework allows the identification of regions likely to experience future rainfall anomalies that are without precedent in the current climate.
Two Simple Metrics for Quantifying Rainfall Intermittency: The Burstiness and Memory of Interamount Times
Authors: Schleiss Marc , Smith James A. 
Published: October 2015

Abstract
Precipitation displays a remarkable variability in space and time. An important yet poorly documented aspect of this variability is intermittency. In this paper, a new way of quantifying intermittency based on the burstiness B and memory M of interamount times is proposed. The method is applied to a unique dataset of 325 high-resolution rain gauges in the United States and Europe. Results show that the M–B diagram provides useful insight into local precipitation patterns and can be used to study intermittency over a wide range of temporal scales. It is found that precipitation tends to be more intermittent in warm and dry climates with the largest observed values in the southwest of the United States (i.e., California, Nevada, Arizona, and Texas). Low-to-moderate values are reported for the northeastern United States, the United Kingdom, the Netherlands, and Germany. In the second half of the paper, the new metrics are applied to daily rainfall data for 1954–2013 to investigate regional trends in intermittency due to climate variability and global warming. No evidence is found of a global shift in intermittency but a weak trend toward burstier precipitation patterns and longer dry spells in the south of Europe (i.e., Portugal, Spain, and Italy) and an opposite trend toward steadier and more correlated precipitation patterns in Norway, Sweden, and Finland is observed.