bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychological morbidity among suicide-bereaved and non-bereaved parents: a nationwide population survey
Authors: Omerov Pernilla , Steineck Gunnar , Nyberg Tommy , Runeson Bo , Nyberg Ullakarin 
Published: September 2013

ObjectiveTo determine how psychological premorbidity affects the risk of depression in parents who lost a child through suicide.DesignPopulation-based survey.SettingSweden, between 2009 and 2010.ParticipantsAll parents who lost a child, age 15–30, through suicide between 2004 and 2007 according to National population registries. Non-bereaved parents matched for age, sex, living area, marital status, number of children. Exclusion criteria: born outside a Nordic country, not Swedish speaking, contact details missing. Participants: 666 of 915 (73%) suicide-bereaved and 377 of 508 (74%) non-bereaved parents.Main outcome measuresDepression measured by the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) and study-specific questions to assess psychological premorbidity and experience of the child's presuicidal morbidity.ResultsIn all, 94 (14%) suicide-bereaved and 51 (14%) non-bereaved parents (relative risk 1.0; 95% CI 0.8 to 1.4) had received their first treatment for psychological problems or had been given a psychiatric diagnosis more than 10 years earlier. The prevalence of moderate-to-severe depression was 115 (18%) in suicide-bereaved versus 28 (7%) in non-bereaved parents (RR 2.3; 95% CI 1.6 to 3.5). For those without psychological premorbidity, the relative risk was 2.3 (95% CI 1.4 to 3.6). 339 (51%) suicide-bereaved parents expressed worry over the child's psychological health during the month preceding the suicide and 259 (39%) had anticipated the suicide.ConclusionsIn parents who lost a child through suicide in Sweden we did not find a higher prevalence of long-term psychological premorbidity than among parents who had not lost a child; the more than twofold risk of depression among the bereaved can probably be explained by the suicide and the stressful time preceding the suicide.
Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references
Authors: Jöud Anna , Stjerna Johanna , Malmström Eva-Maj , Westergren Hans , Petersson Ingemar F , Englund Martin 
Published: September 2013

ObjectivesRecent studies based on self-assessed data on exposure and outcome suggest a negative association between poor health before neck injury and recovery. Our aim was to study actual healthcare consultation and work disability before and after neck injury (whiplash).DesignCohort study with matched references studied prospectively and retrospectively via regional and national held registers.SettingPopulation-based study in Region Skåne, Sweden (population=1.21 million) including all levels of healthcare.Participants1443 participants aged ≥18 (54% women) with acute neck injury, Whiplash, (International Classification of Diseases-10-SE code S13.4*) in 2007 or 2008 and no such diagnosis since 1998. Each patient with a neck injury was assigned four randomly selected population references matched for age, sex and area of residence (97% of the patients and 94% of the references were followed during the whole study period).Primary and secondary outcome measuresWe studied changes in healthcare consultations 3 years before to 3 years after diagnosis as well as sick leave episodes. Analyses were also stratified by preinjury frequency of consultation.ResultsBefore the injury, the mean number of total consultations over 36 months among the neck injured (n=1443) and references (n=5772) was 9.3 vs 7.2 (p<0.0001) and postneck injury 12.7 vs 7.8 (p<0.0001). In the group of high-frequent consulters, there were more women compared with frequent and low-frequent consulters (70.6% vs 32.8%; p<0.0001). Among low-frequent and frequent consulters preinjury (n=967, 67% of the cohort), 16% became high-frequent consulters attributable to the injury. The number of days of sick leave preinjury was correlated with the number of preinjury and postinjury consultations (r=0.47 (99% CI 0.38 to 0.49), r=0.32 (99% CI 0.25 to 0.37)).ConclusionsPeople with a neck injury constitute a heterogeneous group. The preinjury level of healthcare consultation is associated with the postinjury level of consultation.
Can we simplify the hospital accreditation process? Predicting accreditation decisions from a reduced dataset of focus priority standards and quality indicators: results of predictive modelling
Authors: Guérin Sophie , Le Pogam Marie-Annick , Robillard Benjamin , Le Vaillant Marc , Lucet Bruno , Gardel Christine , Grenier Catherine , Loirat Philippe 
Published: September 2013

ObjectivesAccreditation in France relies on a mandatory 4-year cycle of self-assessment and a peer review of 82 standards, among which 14 focus priority standards (FPS). Hospitals are also required to measure yearly quality indicators (QIs—5 in 2010). On advice given by the accreditation committee of HAS (Haute Autorité en Santé), based on surveyors proposals and relying mostly on compliance to standards, accreditation decisions are taken by the board of HAS. Accreditation is still perceived by hospitals as a burdensome process and a simplification would be welcomed. The hypothesis was that a more limited number of criteria might give sufficient amount of information on hospitals overall quality level, appraised today by accreditation decisions.DesignThe accuracy of predictions of accreditation decisions given by a model, Partial Least Square-2 Discriminant Analysis (PLS2-DA), using only the results of FPS and QIs was measured. Accreditation decisions (full accreditation (A), recommendations or reservation (B), remit decision or non-accreditation (C)), results of FPS and QIs were considered qualitative variables. Stability was assessed by leave one out cross validation (LOOCV).Setting and participantsAll French 489 acute care organisations (ACO) accredited between June 2010 and January 2012 were considered, 304 of them having a rehabilitation care sector (RCS).ResultsAccuracy of prediction of accreditation decisions was good (89% of ACOs and 91% of ACO-RCS well classified). Stability of results appeared satisfactory when using LOOCV (87% of ACOs and 89% of ACO-RCS well classified). Identification of worse hospitals was correct (90% of ACOs and 97% of ACO-RCS predicted C were actually C).ConclusionsUsing PLS2-DA with a limited number of criteria (QIs and FPS) provides an accurate prediction of accreditation decisions, especially for underperforming hospitals. This could support accreditation committees which give advices on accreditation decisions, and allow fast-track handling of ‘safe’ reports.
Educational interventions to improve prescribing competency: a systematic review
Authors: Kamarudin Gritta , Penm Jonathan , Chaar Betty , Moles Rebekah 
Published: September 2013

ObjectiveTo review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers.DesignA systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013.SettingPrimary and secondary care.ParticipantsMedical and non-medical prescribers.InterventionEducation-based interventions to aid improvement in prescribing competency.Primary outcomeImprovements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines.ResultsA total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHOGuide to Good Prescribingincreased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area.ConclusionsA broad range of educational interventions have been conducted to improve prescribing competency. The WHOGuide to Good Prescribinghas the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation of educational methods for non-medical prescribers.
Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study
Authors: Joffres Michel , Falaschetti Emanuela , Gillespie Cathleen , Robitaille Cynthia , Loustalot Fleetwood , Poulter Neil , McAlister Finlay A , Johansen Helen , Baclic Oliver , Campbell Norm 
Published: September 2013

ObjectiveComparison of recent national survey data on prevalence, awareness, treatment and control of hypertension in England, the USA and Canada, and correlation of these parameters with each country stroke and ischaemic heart disease (IHD) mortality.DesignNon-institutionalised population surveys.Setting and participantsEngland (2006 n=6873), the USA (2007–2010 n=10 003) and Canada (2007–2009 n=3485) aged 20–79 years.OutcomesStroke and IHD mortality rates were plotted against countries’ specific prevalence data.ResultsMean systolic blood pressure (SBP) was higher in England than in the USA and Canada in all age–gender groups. Mean diastolic blood pressure (DBP) was similar in the three countries before age 50 and then fell more rapidly in the USA, being the lowest in the USA. Only 34% had a BP under 140/90 mm Hg in England, compared with 50% in the USA and 66% in Canada. Prehypertension and stages 1 and 2 hypertension prevalence figures were the highest in England. Hypertension prevalence (≥140 mm Hg SBP and/or ≥90 mm Hg DBP) was lower in Canada (19·5%) than in the USA (29%) and England (30%). Hypertension awareness was higher in the USA (81%) and Canada (83%) than in England (65%). England also had lower levels of hypertension treatment (51%; USA 74%; Canada 80%) and control (<140/90 mm Hg; 27%; the USA 53%; Canada 66%). Canada had the lowest stroke and IHD mortality rates, England the highest and the rates were inversely related to the mean SBP in each country and strongly related to the blood pressure indicators, the strongest relationship being between low hypertension awareness and stroke mortality.ConclusionsWhile the current prevention efforts in England should result in future-improved figures, especially at younger ages, these data still show important gaps in the management of hypertension in these countries, with consequences on stroke and IHD mortality.
MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case–control study
Authors: Tanaka Kanta , Mori Nobuyuki , Yokota Yusuke , Suenaga Toshihiko 
Published: September 2013

ObjectiveTo systematically evaluate the usefulness of assessing the cervical nerve roots by MRI for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).DesignSingle-institution, retrospective case–control study.SettingA regional referral hospital.ParticipantsWe retrospectively enrolled 15 consecutive patients with CIDP who satisfied the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) typical and definite criteria and underwent cervical MRI. 30 control patients who had also undergone cervical MRI were included, matched with regard to sex, age and MRI system. The diagnoses of the control patients included cervical spondylosis (n=19), cervical spine trauma (n=2), infection (n=1), malignancies (n=4), demyelinating disorders (n=2) and neurodegenerative disorders (n=2).MeasurementA radiologist determined the C5–C8 root diameters on the coronal short tau inversion recovery (STIR) images. Signal intensities of these roots were quantified as nerve-to-muscle contrast-to-noise ratios (CNRs), which were calculated using mean signal intensities of the roots and sternocleidomastoid muscle as well as SD of background noise. Statistical analyses were performed to determine the diagnostic accuracy of the diameters and nerve-to-muscle CNRs. Another radiologist reviewed MRI for ensuring reproducibility.ResultsThe root diameters showed no significant differences between the patients with CIDP and control patients. The nerve-to-muscle CNRs were significantly higher in the patients with CIDP. We defined the sum of nerve-to-muscle CNRs of C5–C8 roots as the CNR score to serve as an index of overall signal intensity. The area under the receiver operating characteristic curve of CNR scores was 0.731. The reproducibility of the assessment procedure was satisfactory.ConclusionsOur results suggest that assessment of the cervical nerve roots by MRI is useful for CIDP diagnosis when the signal intensities, rather than the diameters, are paid more attention on STIR images.
Strategies TO reduce time delays in patients with AcuTe coronary heart disease treated with primary PCI—the STOP WATCH study: a multistage action research project
Authors: Tödt Tim , Thylén Ingela , Alfredsson Joakim , Swahn Eva , Janzon Magnus 
Published: September 2013

ObjectiveTo identify, evaluate and reduce system delay times in an ST-elevation myocardial infarction (STEMI) network by targeted reorganisation of logistics and personal feedback to staff on time delays.DesignMultistage action research project. Three study phases were used (exploration, tailored intervention and evaluation).SettingSingle centre study, Sweden.PatientsConsecutive patients (N=156) with prehospital STEMI onset treated with primary percutaneous coronary intervention (PCI).InterventionsAreas of delays were identified through participant observations and collaborative discussions. To increase the awareness of delay factors, continuous feedback on time delays was given. Elements of the logistics’ reorganisation were (1) prioritised ECG recording by emergency medical services personnel, (2) central evaluation of ECG in all patients and (3) start of PCI procedure when two of three PCI team members were on site. Multiple key time measurements were made before (N=67) and after (N=89) the intervention.Main outcomesTime difference (minutes) in system delay between the preintervention and postintervention phases.ResultsTime from first medical contact (FMC) to a patent artery and time from FMC-to-catheter laboratory (cath-lab) arrival decreased by 6 and 12 min, respectively (ns). Time from FMC-to-ECG recording remained unchanged after the intervention. Time from ECG to decision for primary PCI was reduced by 6 min, p=0.004 and time from ECG-to-cath-lab arrival by 11 min, p=0.02. Total time from diagnosis to a patent artery decreased by 11 min (ns).ConclusionsIdentification of time delays in an STEMI network with awareness of delay factors, reorganisation of logistics and continuous feedback can reduce system delay times significantly.
Acquiring credentials in bedside ultrasound: a cross-sectional survey
Authors: Lewiss Resa E , Saul Turandot , Del Rios Marina 
Published: September 2013

ObjectiveAlthough there are training guidelines to credential emergency physicians in bedside ultrasound, many faculty groups have members who completed residency without a mandatory curriculum. These physicians are therefore required to learn bedside ultrasound while out in practice. The objective of this descriptive report is to illustrate a single academic facility's experience with acquiring credentials for emergency physicians in bedside ultrasound and the faculty's impressions on the motivators of and barriers to completion of the requirements.DesignCross-sectional survey.SettingTwo urban teaching hospitals with a combined volume of 170 000 visits a year.Participants41 emergency medicine attending physicians.InterventionEmergency medicine attending physicians underwent training and credentialing in the applications of aorta and pelvic ultrasound over a 9-month period.Outcome measureAfter the credentialing period, we conducted a survey to evaluate the physicians’ perceptions of this process.ResultsThere were 41 faculty members during the credentialing survey period. 11 of the faculty members were exempt from ultrasound training. We asked attending physicians (N=41 exempt and non-exempt) to complete a web-based survey after the completion of the credentialing period. Questions about the potential barriers and incentives were listed and responders were asked to rank answers on a five-point Likert scale. Of the 31 respondents, 21 (67.7%) completed the credentialing requirements by the 9-month deadline. 19 of 26 emergency medicine residency trained physicians completed the requirements compared with 2/5 of those that were not emergency medicine residency trained. Our pilot study data suggest an association between fewer years in practice and completion of the requirements.ConclusionsThis is a report on a single academic institution's experience with a faculty credentialing programme in bedside ultrasound for physicians with a diversity of prior experience in bedside ultrasonography. We describe the success of the credentialing process and identify survey-based faculty characteristics associated with fulfilling the requirements.
Can action research strengthen district health management and improve health workforce performance? A research protocol
Authors: Mshelia C , Huss R , Mirzoev T , Elsey H , Baine S O , Aikins M , Kamuzora P , Bosch-Capblanch X , Raven J , Wyss K , Green A , Martineau T 
Published: September 2013

IntroductionThe single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnelandby improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome.MethodsThe overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, ‘bundles’ of HR/HS strategies that are feasible within the context and affordable within the districts’ budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions.DiscussionDifferent challenges were faced during the development of the methodology. These include the changing context in the study districts, competing with other projects and duties for the time of district managers, complexity of the study design, maintaining the anonymity and confidentiality of study participants as well as how to record the processes during the study. We also discuss how these challenges are being addressed. The dissemination of this research protocol is intended to generate interest in the PERFORM project and also stimulate discussion on the use of action research in complex studies such as this on strengthening district health management to improve health workforce performance.
How effective is the Forestry Commission Scotland's woodland improvement programme—‘Woods In and Around Towns’ (WIAT)—at improving psychological well-being in deprived urban communities? A quasi-experimental study
Authors: Silveirinha de Oliveira Eva , Aspinall Peter , Briggs Andrew , Cummins Steven , Leyland Alastair H , Mitchell Richard , Roe Jenny , Ward Thompson Catharine 
Published: September 2013

IntroductionThere is a growing body of evidence that suggests that green spaces may positively influence psychological well-being. This project is designed to take advantage of a natural experiment where planned physical and social interventions to enhance access to natural environments in deprived communities provide an opportunity to prospectively assess impacts on perceived stress and mental well-being.Study design and methodsA controlled, prospective study comprising a repeat cross-sectional survey of residents living within 1.5 km of intervention and comparison sites. Three waves of data will be collected: prephysical environment intervention (2013); postphysical environment intervention (2014) and postwoodland promotion social intervention (2015). The primary outcome will be a measure of perceived stress (Perceived Stress Scale) preintervention and postintervention. Secondary, self-report outcomes include: mental well-being (Short Warwick-Edinburgh Mental Well-being Scale), changes in physical activity (IPAQ-short form), health (EuroQoL EQ-5D), perception and use of the woodlands, connectedness to nature (Inclusion of Nature in Self Scale), social cohesion and social capital. An environmental audit will complement the study by evaluating the physical changes in the environment over time and recording any other contextual changes over time. A process evaluation will assess the implementation of the programme. A health economics analysis will assess the cost consequences of each stage of the intervention in relation to the primary and secondary outcomes of the study.Ethics and disseminationEthical approval has been given by the University of Edinburgh, Edinburgh College of Art Research, Ethics and Knowledge Exchange Committee (ref. 19/06/2012). Findings will be disseminated through peer-reviewed publications, national and international conferences and, at the final stage of the project, through a workshop for those interested in implementing environmental interventions.