bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality improvement initiative: improving obstetric triaging practices in a rural maternal hospital in central India
Authors: Ranade Mihir , Jain Shuchi , Shivkumar Poonam Varma , Gupta Subodh , Jain Manish 
Published: May 2024

Triaging of obstetric patients by emergency care providers is paramount. It helps provide appropriate and timely management to prevent further injury and complications. Standardised trauma acuity scales have limited applicability in obstetric triage. Specific obstetric triage index tools improve maternal and neonatal outcomes but remain underused. The aim was to introduce a validity-tested obstetric triage tool to improve the percentage of correctly triaged patients (correctly colour-coded in accordance with triage index tool and attended to within the stipulated time interval mandated by the tool) from the baseline of 49% to more than 90% through a quality improvement (QI) process.A team of nurses, obstetricians and postgraduates did a root cause analysis to identify the possible reasons for incorrect triaging of obstetric patients using process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address issues identified.The interventions included introduction and application of an obstetric triage index tool, training of triage nurses and residents. We implemented these interventions in eight PDSA cycles and observed outcomes by using run charts. A set of process, output and outcome indicators were used to track if changes made were leading to improvement.Proportion of correctly triaged women increased from the baseline of 49% to more than 95% over a period of 8 months from February to September 2020, and the results have been sustained in the last PDSA cycle, and the triage system is still sustained with similar results. The median triage waiting time reduced from the baseline of 40 min to less than 10 min. There was reduction in complications attributable to improper triaging such as preterm delivery, prolonged intensive care unit stay and overall morbidity. It can be thus concluded that a QI approach improved obstetric triaging in a rural maternity hospital in India.
Understanding patient safety in dentistry: evaluating the present and envisioning the future—a narrative review
Authors: Padmanabhan Vivek , Islam Md Sofiqul , Rahman Muhammed Mustahsen , Chaitanya Nallan CSK , Sivan Padma Priya 
Published: May 2024

BackgroundPatient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state of patient safety in dentistry, investigates the reasons for the delay, and offers recommendations for enhancing patient safety in dental practices, dental schools, and hospitals.MethodsThe review incorporates a thorough analysis of existing literature on patient safety in dentistry. Various sources, including research articles, guidelines and reports, were reviewed to gather insights into patient safety definitions, challenges and best practices specific to dentistry.ResultsThe review underscores the importance of prioritising patient safety in dentistry at all levels of healthcare. It identifies key definitions and factors contributing to the delayed focus on patient safety in the field. Additionally, it emphasises the significance of establishing a patient safety culture and discusses approaches such as safety plans, incident management systems, blame-free cultures and ethical frameworks to enhance patient safety.ConclusionPatient safety is vital in dentistry to ensure high-quality care and patient well-being. The review emphasises the importance of prioritising patient safety in dental practices, dental schools and hospitals. Through the implementation of recommended strategies and best practices, dental organisations can cultivate a patient safety culture, enhance communication, mitigate risks and continually improve patient safety outcomes. The dissemination of knowledge and the active involvement of all stakeholders are crucial for promoting patient safety and establishing a safe dental healthcare system.
Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review
Authors: Ahmed Zakiuddin , Ellahham Samer , Soomro Marium , Shams Sohaima , Latif Kanwal 
Published: May 2024

BackgroundPatient safetyandhealthcare qualityare considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership.MethodsThis narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines.ResultsThe findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention.ConclusionCompassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.
Comprehensive assessment of pediatric acute and inpatient care at a tertiary referral hospital in Malawi: opportunities for quality improvement
Authors: Fitzgerald Elizabeth , Ciccone Emily Jane , Mvalo Tisungane , Chiume Msandeni , Mgusha Yamikani , Mkaliainga Treasure B , Tilly Alyssa Evelyn , Chen Jane , Bell Griffin , Crouse Heather , Robison Jeff A , Eckerle Michelle 
Published: May 2024

BackgroundDespite the reduction in global under-5 mortality over the last decade, childhood deaths remain high. To combat this, there has been a shift in focus from disease-specific interventions to use of healthcare data for resource allocation, evaluation of performance and impact, and accountability. This is a descriptive analysis of data derived from a prospective cohort study describing paediatric admissions to a tertiary referral hospital in Malawi for the purpose of process evaluation and quality improvement.MethodsUsing a REDCap database, we collected data for patients admitted acutely to Kamuzu Central Hospital, a tertiary referral centre in the central region. Data were collected from 17 123 paediatric inpatients from 2017 to 2020.ResultsApproximately 6% of patients presented with either two or more danger signs or severely abnormal vital signs. Infants less than 6 months, who had the highest mortality rate, were also the most critically ill on arrival to the hospital. Sepsis was diagnosed in about 20% of children across all age groups. Protocols for the management of high-volume, lower-acuity conditions such as uncomplicated malaria and pneumonia were generally well adhered to, but there was a low rate of completion for labs, radiology studies and subspecialty consultations required to provide care for high acuity or complex conditions. The overall mortality rate was 4%, and 60% of deaths occurred within the first 48 hours of admission.ConclusionOur data highlight the need to improve the quality of care provided at this tertiary-level centre by focusing on the initial stabilisation of high-acuity patients and augmenting resources to provide comprehensive care. This may include capacity building through the training of specialists, implementation of clinical processes, provision of specialised equipment and increasing access to and reliability of ancillary services. Data collection, analysis and routine use in policy and decision-making must be a pillar on which improvement is built.
Comparing the healthy development of youth Australian Rules Footballers across talent development and community settings
Authors: Graeme Liam G , Hall Kate , Olive Lisa S , Greenwood Christopher J , Couston Nicky , Mattingley Sophie , Francis Lauren M , Hoare Erin , Rice Simon , Bos Jason , Harris Emma , Youssef George J 
Published: May 2024

ObjectivesThis study aimed to compare talent development athletes to community-level athletes in Australian Rules Football across various markers of healthy youth development.MethodsSurvey data were collected from 363 youth athletes (126 women, 232 men, 5 not reported; Mage=18.69 years, SDage=2.62 years, age range 16–25 years) playing Australian Rules Football at a talent development (recruited from Australian Football League Talent Pathway, n=220) or community (n=143) level. Measures included markers of physical health (eg, general health, risk-taking behaviours), psychological and emotional well-being (eg, mental health symptoms, life satisfaction), family and social relationships (eg, social support, relationship status), educational and occupational attainment/engagement (eg, career satisfaction, education), ethical behaviour (eg, moral self-image), civic engagement, life skills (eg, self-mastery, coping), and demographics.ResultsBased on regression models, relative to community-level athletes, talent development athletes reported better physical health (d=0.51), lower injury rates (OR=0.50) and less problematic drug use (d=−0.46). Talent development athletes also reported better psychological and emotional well-being, evidenced by lower stress (d=−0.30), higher life satisfaction (d=0.47) and less problematic gambling (d=−0.34). Additionally, talent development athletes reported higher family support (d=0.49), lower likelihood of poor educational outcomes (less than expected educational stage; OR=0.37), lower intention to complete less than year 12 education (OR=0.18), higher career satisfaction (d=0.42), higher self-mastery (d=0.37) and higher perfectionistic striving (d=0.59).ConclusionFindings demonstrate markers of healthier development within talent development athletes relative to community athlete peers. Investment in community-level sports may be warranted to improve healthy development. However, further causal evidence is required.
Longitudinal trends in uptake of hormonal long-acting reversible contraception devices throughout the COVID-19 pandemic: an Australian population-based study
Authors: Stevenson Tahlee Blade , Rumbold Alice R , Moore Vivienne , Hall Kelly , Ilomaki Jenni , Mazza Danielle , Bateson Deborah , Grzeskowiak Luke E 
Published: May 2024

BackgroundLittle is known about the degree to which the COVID-19 pandemic, and associated restrictions and disruptions to health services, impacted the accessibility of hormonal long-acting reversible contraception (LARC) devices within Australia. Here, we explore longitudinal patterns of dispensing of the contraceptive implant and hormonal intrauterine devices (IUDs) within Australia, before and during the COVID-19 pandemic.MethodsPopulation-based cohort study; analysis of 10% random sample of national Pharmaceutical Benefits Scheme dispensing data, for females aged 15–49 years dispensed a hormonal LARC device between February 2017 and November 2021.ResultsInterrupted time-series analysis demonstrated overall that there were no significant differences in monthly dispensing rates of hormonal LARC following the Australian onset of the pandemic in April 2020, with no subsequent change in the trend. However, when stratified by LARC type, a significant increase was evident during the pandemic period (April 2020–November 2021) in the rate of hormonal IUD dispensing per month (0.20 per 10 000 95% CI 0.01 to 0.38)), compared with a decrease for the implant (−0.08 per 10 000 (95% CI −0.16 to 0.01)). Increases in hormonal IUD dispensing during the pandemic were most pronounced for those aged 20–24 years, new users, those without a Commonwealth concession card, and in the State of Victoria.ConclusionsWithin Australia in the defined pandemic period, access to hormonal LARC devices was not negatively impacted. Rather a significant increase in dispensing of hormonal IUDs was evident.
Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis
Authors: Ong Natasha Yixuan , Teo Finn Jing Jie , Ee Jane Zi Ying , Yau Chun En , Thumboo Julian , Tan Hiang Khoon , Ng Qin Xiang 
Published: May 2024

BackgroundGrowing evidence attests to the efficacy of mindfulness-based interventions (MBIs), but their effectiveness for healthcare workers remains uncertain.AimsTo evaluate the evidence for MBIs in improving healthcare workers’ psychological well-being.MethodsA systematic literature search was conducted on Medline, Embase, Cumulative Index for Nursing and Allied Health Literature, PsycINFO and Cochrane Central Register of Controlled Trials up to 31 August 2022 using the keywords ‘healthcare worker’, ‘doctor’, ‘nurse’, ‘allied health’, ‘mindfulness’, ‘wellness’, ‘workshop’ and ‘program’. Randomised controlled trials with a defined MBI focusing on healthcare workers and quantitative outcome measures related to subjective or psychological well-being were eligible for inclusion. R V.4.0.3 was used for data analysis, with the standardised mean difference as the primary outcome, employing DerSimonian and Laird’s random effects model. Grading of Recommendations, Assessment, Development and Evaluation framework was used to evaluate the quality of evidence. Cochrane’s Risk of Bias 2 tool was used to assess the risk of bias in the included studies.ResultsA total of 27 studies with 2506 participants were included, mostly from the USA, involving various healthcare professions. MBIs such as stress reduction programmes, apps, meditation and training showed small to large effects on anxiety, burnout, stress, depression, psychological distress and job strain outcomes of the participants. Positive effects were also seen in self-compassion, empathy, mindfulness and well-being. However, long-term outcomes (1 month or longer postintervention) varied, and the effects were not consistently sustained.ConclusionsMBIs offer short-term benefits in reducing stress-related symptoms in healthcare workers. The review also highlights limitations such as intervention heterogeneity, reduced power in specific subgroup analyses and variable study quality.PROSPERO registration numberCRD42022353340.
Preliminary efficacy and safety of YSCH-01 in patients with advanced solid tumors: an investigator-initiated trial
Authors: He Yandong , Huang Xuhong , Li Xiaoxia , Liu Hongwei , Liu Min , Tao Junjia , Shan Yuanzhou , Raza Hafiz Khuram , Liu Yanqiu , Zhong Wenting , Cao Xue-ping , Yang Yuan-yuan , Li Ruimei , Fang Xian-long , Zhang Kang-jian , Zhang Rong , Liu Feng 
Published: May 2024

ObjectiveTo evaluate the safety and preliminary efficacy of YSCH-01 (Recombinant L-IFN adenovirus) in subjects with advanced solid tumors.MethodsIn this single-center, open-label, investigator-initiated trial of YSCH-01, 14 patients with advanced solid tumors were enrolled. The study consisted of two distinct phases: (1) the dose escalation phase and (2) the dose expansion phase; with three dose groups in the dose escalation phase based on dose levels (5.0×109viral particles (VP)/subject, 5.0×1010VP/subject, and 5.0×1011VP/subject). Subjects were administered YSCH-01 injection via intratumoral injections. The safety was assessed using National Cancer Institute Common Terminology Criteria for Adverse Events V.5.0, and the efficacy evaluation was performed using Response Evaluation Criteria in Solid Tumor V.1.1.Results14 subjects were enrolled in the study, including 9 subjects in the dose escalation phase and 5 subjects in the dose expansion phase. Of the 13 subjects included in the full analysis set, 4 (30.8%) were men and 9 (69.2%) were women. The most common tumor type was lung cancer (38.5%, 5 subjects), followed by breast cancer (23.1%, 3 subjects) and melanoma (23.1%, 3 subjects). During the dose escalation phase, no subject experienced dose-limiting toxicities. The content of recombinant L-IFN adenovirus genome and recombinant L-IFN protein in blood showed no trend of significant intergroup changes. No significant change was observed in interleukin-6 and interferon-gamma. For 11 subjects evaluated for efficacy, the overall response rate with its 95% CI was 27.3% (6.02% to 60.97%) and the disease control rate with its 95% CI was 81.8% (48.22% to 97.72%). The median progression-free survival was 4.97 months, and the median overall survival was 8.62 months. In addition, a tendency of decrease in the sum of the diameters of target lesions was observed. For 13 subjects evaluated for safety, the overall incidence of adverse events (AEs) was 92.3%, the overall incidence of adverse drug reactions (ADRs) was 84.6%, and the overall incidence of >Grade 3 AEs was 7.7%, while no AEs/ADRs leading to death occurred. The most common AEs were fever (69.2%), nausea (30.8%), vomiting (30.8%), and hypophagia (23.1%).ConclusionsThe study shows that YSCH-01 injections were safe and well tolerated and exhibited preliminary efficacy in patients with advanced solid tumors, supporting further investigation to evaluate its efficacy and safety.Trial registration numberNCT05180851.
Continuous heart monitoring to evaluate treatment effects in pulmonary hypertension
Authors: Ørbæk Andersen Mads , Diederichsen Soren Zoga , Svendsen Jesper Hastrup , Carlsen Jørn 
Published: May 2024

BackgroundThe treatment of pulmonary hypertension (PH) has improved rapidly in recent decades. There is increasing evidence to support the role of early intervention and treatment in affecting clinical outcomes in PH.ObjectivesTo assess treatment effects before and after the escalation of specific PH treatments using continuous heart monitoring with a Reveal LINQ loop recorder.MethodsPatients were compared before and after treatment escalation. Treatment escalation was defined as an additional pulmonary arterial hypertension (PAH) drug, pulmonary endarterectomy, percutaneous balloon angioplasty or bilateral lung transplantation. Specifically, changes in heart rate variability (HRV), heart rate (HR) and physical activity were assessed.ResultsIn this prospective study, 41 patients (27 with PAH and 14 with chronic thromboembolic pulmonary hypertension (CTEPH)) were enrolled. Among them, 15 (36.6%) patients underwent PH treatment escalation. Prior to escalation, patients were monitored for a median of 100 (range: 68–100) days and after therapy escalation for a median duration of 165 (range: 89–308) days. In the escalation group, there was a significant increase in HRV, physical activity indexed by daytime HR and a significant decrease in nighttime HR assessed at baseline and after treatment escalation in both the PAH and CTEPH groups. This was paralleled by significant improvements in WHO functional class, 6-min walking distance and N-terminal pro-b-type natriuretic peptide.ConclusionsThis is the first study to demonstrate an association between specific PH therapies and changes in HRV, HR nighttime and physical activity. This indicates the potential of continuous monitoring in the evaluation of treatment effects in PH.
Intramuscular fat infiltration influences mechanical properties during muscle contraction in older women
Authors: Wang Zimin , Taniguchi Masashi , Saeki Junya , Yagi Masahide , Murota Norihiko , Nakazato Kaede , Niiya Nanami , Ichihashi Noriaki 
Published: May 2024

Although evidence suggests that intramuscular fat infiltration may influence muscle strength, the precise mechanisms remain unclear. This study aimed to determine whether intramuscular fat infiltration affects muscle mechanical properties during contraction and whether these mechanical properties mediate the relationship between intramuscular fat infiltration and muscle strength. Seventy-nine healthy older women aged 75.1 ± 6.8 years were included in this study. The echo intensity (EI) of the vastus lateralis (VL) was measured as an intramuscular fat infiltration index using B-mode ultrasonography. Maximum voluntary isometric contraction strength (MVIC) was assessed using a dynamometer. The VL shear elastic modulus (G), a mechanical property index, was measured using ultrasound shear wave elastography under various muscle contraction conditions, at rest and at 15%, 30%, and 45% MVIC (G0, G15, G30, and G45). To evaluate the degree of increase in the shear elastic modulus with increasing muscle contraction intensity, the slope of the regression line (Gslope) between muscle contraction and shear elastic modulus was calculated for each participant. The results showed that EI was significantly associated with G30 and G45 but not with G0 or G15. The EI can significantly explain the inter-individual differences in Gslope. Mediation analysis revealed that the effect of EI on MVIC through Gslope was significant (indirect effect = −0.31, 95% confidence interval (−0.57, −0.12)). These findings suggest that a greater EI is associated with a lower G during muscle contraction. Furthermore, our results show that the relationship between EI and MVIC is mediated by Gslope.
Residual canopy cover provides buffering of near-surface temperatures, but benefits are limited under extreme conditions
Authors: Brackett Amanda E. , Still Christopher J. , Puettmann Klaus J. 
Published: May 2024

Increasing summer temperatures and higher probabilities of extreme heat events have led to concerns about tree damage and mortality. However, insufficient attention has been given to conditions leading to heat-related regeneration failures in temperate forests. To address this, managers need to understand how microclimate varies under a range of overstory conditions. We measured air temperatures at 2 cm above-ground underneath a gradient of canopy cover on south-facing slopes in recently thinned Douglas-fir stands in western Oregon, USA. To expand the ecological relevance of these data to impacts on regeneration, we created the stress degree hours (SDH) metric, representing the amount of time—and by how much—temperatures exceeded biologically relevant stress thresholds. Overall, for every 10% increase in canopy cover, maximum temperatures at 2 cm were 1.3 °C lower, the odds of temperatures exceeding stress thresholds for conifer regeneration declined by a multiplicative factor of 0.26, and the total of SDH decreased by 40%. These reductions are large enough to be worthy of attention when managing for tree regeneration. However, data collected during the Pacific Northwest Heat Dome in June 2021 indicate that with various climate change scenarios and heatwave occurrences, temperatures will be unfavorable for regeneration regardless of overstory cover.
Gian-Carlo Wick and neutron physics in the 1930s
Authors: Gould Christopher R. , Sharapov Eduard I. 
Published: May 2024

AbstractThe Italian theorist Gian-Carlo Wick is well known for his work in mathematical physics. Nevertheless, working with Fermi’s group in Rome in the 1930s, he took on several behind-the-scenes roles that resulted in important papers in neutron physics. He clarified Fermi’s methodology for calculating neutron slowing down probabilities; using transport theory, he provided a comprehensive general method for calculating the neutron scattering albedo; and with an insight into the way, neutron scattering could yield information about lattice dynamics, he formulated the first theory of inelastic thermal neutrons scattering in crystalline materials. This work and his contributions are not well known today. We discuss its physical essence, its relevance to neutron physics, and its subsequent impact in later work.