bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic RADaR analysis of responses to the open-ended question in the Culture of Care Barometer survey of a Dutch hospital
Authors: Maassen Susanne M , Spruit-van Bentvelzen Lotte , Weggelaar-Jansen Anne Marie J W M , Vermeulen Hester , Oostveen Catharina J van 
Published: April 2024

ObjectivesSystematically measuring the work environment of healthcare employees is key to continuously improving the quality of care and addressing staff shortages. In this study, we systematically analyse the responses to the one open-ended question posed in the Dutch version of the Culture of Care Barometer (CoCB-NL) to examine (1) if the responses offered new insights into healthcare employees’ perceptions of their work environment and (2) if the original CoCB had any themes missing.DesignRetrospective text analysis using Rigorous and Accelerated Data Reduction technique.SettingUniversity hospital in the Netherlands using the CoCB-NL as part of the annual employee survey.ParticipantsAll hospital employees were invited to participate in the study (N=14 671). In total, 2287 employees responded to the open-ended question.Results2287 comments were analysed. Comments that contained more than one topic were split according to topic, adding to the total (n=2915). Of this total, 372 comments were excluded because they lacked content or respondents indicated they had nothing to add. Subsequently, 2543 comments were allocated to 33 themes. Most comments (n=2113) addressed the 24 themes related to the close-ended questions in the CoCB-NL. The themes most commented on concerned questions on ‘organisational support’. The remaining 430 comments covered nine additional themes that addressed concerns about work environment factors (team connectedness, team effectiveness, corporate vision, administrative burden and performance pressure) and themes (diversity and inclusion, legal frameworks and collective bargaining, resilience and work–life balance, and personal matters).ConclusionsAnalysing responses to the open-ended question in the CoCB-NL led to new insights into relevant elements of the work environment and missing themes in the COCB-NL. Moreover, the analysis revealed important themes that not only require attention from healthcare organisations to ensure adequate improvements in their employees’ work environment but should also be considered to further develop the CoCB-NL.
Effects of a therapeutic lifestyle modification intervention on cardiometabolic health, sexual functioning and health-related quality of life in perimenopausal Chinese women: protocol for a randomised controlled trial
Authors: Wang Yuru , Miao Xiaoling , Viwattanakulvanid Pramon 
Published: April 2024

IntroductionPerimenopause is a critical transitional period in reproductive ageing. A set of physiological and psychological changes can affect perimenopausal women’s quality of life and further threaten their older adult health conditions. In China, less than one-third of midlife women with menopausal symptoms have actively sought professional healthcare. Regarding the public health significance of comprehensive menopause management, the current study aims to investigate the effects of a therapeutic lifestyle modification (TLM) intervention on cardiometabolic health, sexual functioning and health-related quality of life among perimenopausal Chinese women.Method and analysisA randomised controlled trial with two parallel arms will be conducted at the gynaecology outpatient department of Yunnan Provincial Hospital of Traditional Chinese Medicine in China. 94 eligible perimenopausal women aged between 40 and 55 years will be recruited for the study. The TLM intervention consists of four elements: menopause-related health education, dietary guidance, pelvic floor muscle training and Bafa Wubu Tai Chi exercise. Participants will be randomly assigned (1:1) to receive either the 12-week TLM intervention or routine care via stratified blocked randomisation. The primary outcome is quality of life; secondary outcomes of interest include sexual functioning and cardiometabolic health. The outcome measures will be assessed at baseline and post-intervention. To explore the effects of the intervention, linear mixed models will be applied to test the changes between the two groups over time in each outcome based on an intention-to-treat analysis.Ethics and disseminationThe Research Ethics Review Committee of Chulalongkorn University (COA No 178/66) and the Medical Ethics Committee of Yunnan Provincial Hospital of Traditional Chinese Medicine (IRB-AF-027-2022/02-02) approved the study protocol. Written informed consent will be obtained from all participants. Results will be published in peer-reviewed journals and disseminated through conferences.Trial registration numberChiCTR2300070648.
Improving appropriate use of intravenous albumin: results of a single-centre audit and multifaceted intervention
Authors: Forster Corey M , Halls Shannon , Allarakhia Sabrina , Modi Dimpy , Chung Wiley , Derry Kendra , Digby Genevieve , Flemming Jennifer , McGugan John , Mackulin Heather , Montague Steven , Sibley Stephanie , Silver Samuel A , Sirosky-Yanyk Angela , Stevens Andrew , de Wit Kerstin , Zhang Liying , Callum Jeannie 
Published: April 2024

BackgroundIntravenous albumin has limited indications supported by randomised controlled trials, yet it is often prescribed for indications not supported by evidence.AimTo reduce unnecessary transfusion of albumin.InterventionsUnder the leadership of a multidisciplinary quality improvement team, evidence-based recommendations were disseminated in tandem with a new electronic order set, an educational strategy, qualitative interviews with prescribers and a return policy change to reduce wastage.Implementation and evaluationInterventions were introduced in a staggered fashion. The primary outcome, appropriate use of albumin, was monitored and quantified using pre-intervention and post-intervention audits. Process measures included statistical process run charts of monthly usage of 5% and 25% albumin and wastage. Data on length of stay (hospital and intensive care), new inpatient starts on kidney replacement and mortality were collected as balancing measures.ResultsAppropriate albumin usage based on indication increased from 30% to 50% (p<0.0001). There was significantly less overall albumin usage in the post-intervention period compared with the pre-intervention period (negative coefficient, p<0.0001), driven by a major reduction in the utilisation of the 5% formulation (p<0.0001). Overall albumin usage was significantly lower in the post-intervention period, decreasing from 800 to 450 vials per month. The intervention resulted in significantly less wastage (negative coefficient, p=0.017). Mortality, length of stay and new starts on kidney replacement therapy remained constant throughout the study period.ConclusionImproved prescribing of albumin was achieved with a multifaceted approach. Substantial and sustained reductions in usage were achieved without negatively impacting patient-important outcomes. The estimated annual savings for the purchase cost of albumin was CAN $300 000. We provide a structured process for other organisations to optimise their use of albumin.
Calculating the cost of medication errors: A systematic review of approaches and cost variables
Authors: Ranasinghe Sakunika , Nadeshkumar Abarna , Senadheera Savini , Samaranayake Nithushi 
Published: April 2024

IntroductionMedication errors are an unnecessary cost to a healthcare system and patients of a country. This review aimed to systematically identify published cost variables used to calculate the cost of medication errors and to explore any updates on findings already known on calculating the cost of medication errors during the past 10 years.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases, PubMed, Scopus, Emerald and JSTOR were searched, using keywords “medication error” AND “cost” and predetermined inclusion criteria. Duplicate articles were removed. Quality check was done using 10 criteria. Cost variables used in calculating the cost of medication errors were extracted from each article.ResultsAmong 3088 articles, 33 articles were selected for review. Most studies were conducted in Western countries. Cost variables used (types and number) by different studies varied widely. Most studies (N=29) had used direct costs only. A few studies (N=4) had used both direct and indirect costs for the purpose. Perspectives considered when calculating cost of medication errors also varied widely. A total of 35 variables used to calculate medication error costs were extracted from selected articles.ConclusionVariables used to calculate the cost of medication errors were not uniform across studies. Almost a decade after systematic reviews previously reporting on this area, a validated methodology to calculate the cost of medication errors has still not been reported to date and highlights the still pending necessity of a standard method to be established.
Contact patterns between index patients and their close contacts and assessing risk for COVID-19 transmission during different exposure time windows: a large retrospective observational study of 450 770 close contacts in Shanghai
Authors: Zheng Yaxu , Zheng Bo , Gong Xiaohuan , Pan Hao , Jiang Chenyan , Mao Shenghua , Lin Sheng , Jin Bihong , Kong Dechuan , Yao Ye , Zhao Genming , Wu Huanyu , Wang Weibing 
Published: April 2024

IntroductionTo characterise age-mixing patterns among index cases and contacts of COVID-19, and explore when patients are most infectious during the disease process.MethodsThis study examined all initial 90 885 confirmed index cases in Shanghai and their 450 770 close contacts. A generalised additive mixed model was used to analyse the associations of the number of close contacts with different demographic and clinical characteristics. The effect of different exposure time windows on the infection of close contacts was evaluated using a modified mixed-effects Poisson regression.ResultsAnalysis of contacts indicated that 82 467 (18.29%; 95% CI 18.17%, 18.42%) were second-generation cases. Our result indicated the q-index was 0.300 (95% CI 0.298, 0.302) for overall contact matrix, and that assortativity was greatest for students (q-index=0.377; 95% CI 0.357, 0.396) and weakest for people working age not in the labour force (q-index=0.246; 95% CI 0.240, 0.252). The number of contacts was 4.96 individuals per index case (95% CI 4.86, 5.06). Contacts had a higher risk if they were exposed from 1 day before to 3 days after the onset of symptoms in the index patient, with a maximum at day 0 (adjusted relative risk (aRR)=1.52; 95% CI 1.30, 1.76). Contacts exposed from 3 days before to 3 days after an asymptomatic index case had a positive reverse transcriptase-PCR (RT-PCR) result had a higher risk, with a maximum on day 0 (aRR=1.48; 95% CI 1.37, 1.59).ConclusionsThe greatest assortativity was for students and weakest for people working age not in the labour force. Contact in the household was a significant contributor to the infection of close contacts. Contact tracing should focus on individuals who had contact soon before or soon after the onset of symptoms (or positive RT-PCR test) in the index case.
Epidemiological and sociodemographic description of snakebite envenoming cases in Paraguay reported between 2015 and 2021
Authors: Ardiles-Ruesjas Sofia , Sanabria Edgar , Segovia Portillo Victor Hugo , Jara Oroa Lorena , de Egea Viviana , Sequera Guillermo , Alonso-Padilla Julio , Losada Irene , Pinazo María Jesús 
Published: April 2024

IntroductionSnakebite envenoming (SBE) is a public health problem in Paraguay where the presence of 15 medically important snake species has been reported. Blessed with large forested areas, its economy largely relies on agricultural production which increases the exposure of outdoor workers to the morbidity and mortality of SBE. Lack of sufficient and accurate epidemiological data highlights the importance of drawing an updated picture of SBE burden in the country.MethodsWe performed a retrospective descriptive study on secondary SBE data reported to the national surveillance system between 2015 and 2021. We addressed the availability and quality of the data and assessed its epidemiological and sociodemographic burden in Paraguay over that time period.ResultsIn total, 1651 cases of SBE were reported between 2015 and 2021 representing an average of 235 cases per year (3.33 cases per 100 000 population). Overall, young males (68%, n=1125) of productive age (25 years old, IQR 29) in agricultural and/or livestock settings (47%, n=653) were the most affected population. Departments with a higher number of notifications were San Pedro (12%, n=191), Caazapá and Alto Paraná (10%, n=163). Regarding data quality, variables about clinical outcomes, treatment administration and case management were the worst reported.ConclusionSBE is a public health issue that affects young workers in rural areas in Paraguay. It mostly remains unattended and improvements in its reporting need to be done in order to gain a better insight into both the health and social burden of this neglected disease.
Understanding the factors that shape vaccination ecosystem resilience: a qualitative assessment of international expert experiences and perspectives
Authors: May Suepattra , Roach Meaghan , Maravic Melissa , Mitrovich Rachel , Wilson Rozanne , Prood Nadya , Eiden Amanda L 
Published: April 2024

Introduction‘Shocks’ or external stressors to vaccination programmes can lead to decreased vaccination coverage rates. The capacity of vaccination ecosystems to effectively respond and adapt to shocks demonstrates programme resilience. This study sought to describe components that contribute to resilience in national immunisation programmes.MethodsMixed-methods study comprising in-depth interviews and surveys with n=30 vaccination programme experts in eight countries (Brazil, Costa Rica, Greece, Japan, Nigeria, Philippines, Spain and the USA). We elicited data on country-specific shocks, associated effects and factors that facilitated or impeded programme resilience. Interviews and open-ended survey responses were analysed qualitatively, with closed-ended survey questions analysed using descriptive statistics.ResultsExperts described immediate effects of shocks including decreased vaccine uptake and negative perceptions of vaccination from the public and media. Late emerging impacts included increased vaccine hesitancy and vaccine-preventable disease (VPD) rates. Stakeholder education, immunisation information systems (IIS) and programme financing were key factors to strengthening programme resilience. Appropriately trained frontline healthcare personnel can counter vaccine misinformation that otherwise erodes trust and contributes to hesitancy. The COVID-19 pandemic also exposed structural weaknesses in programme resilience, with experts highlighting the need for robust IIS and workforce support to mitigate burnout and strengthen resilience when a shock occurs.ConclusionsOur findings provide preliminary insights into factors that experts believe to be associated with vaccination programme resilience. Anticipating, adapting and responding to shocks is central to strengthening systems, ensuring ecosystem resilience and protecting against current and future VPD threats.
Qualitative study of factors affecting engagement with a hospital-based violence intervention programme in Indianapolis, Indiana
Authors: Ortiz Damaris , Magee Lauren A , Adams Zachary W , Marriott Brigid R , Moore Reilin J , Brooks Blakney Q , Boustani Malaz , Simons Clark J 
Published: April 2024

BackgroundThere are few qualitative studies of firearm injury survivors and hospital-based violence intervention programme (HVIP) participants. The original study aimed to identify facilitators and barriers to survivors’ utilisation of mental health services. This secondary analysis aimed to identify factors that may impact engagement with an HVIP.Study designThis study was a subanalysis of an original qualitative study that used a community-based participatory research approach to conduct semistructured interviews with English-speaking, intentional firearm injury survivors aged 13 and older within Indianapolis, Indiana between 2021 and 2022. Participants were recruited by a community organisation through a snowball sampling method. Interviews were analysed using manual thematic analysis. Themes were analysed and discussed in relation to HVIPs.ResultsA total of 18 interviews were completed. The majority of participants identified as black (17/18, 94.4%). Nearly all (75%) participants were between the ages of 13 and 24 years of age at the time of their shooting. During content analysis, five themes were identified: (1) delayed readiness to change, (2) desire for independence, (3) lack of trust, (4) persistent emotional and physical effects of trauma and (5) unawareness of HVIP resources.ConclusionsThis qualitative analysis of firearm injury survivor experiences provided insights for improved engagement with HVIPs. Continued pursuit of survivors for several years after their injury, improved dissemination of resources, establishing trust, and addressing persistent physical and psychological symptoms while respecting participants’ desire for independence may lead to increased engagement of firearm injury survivors with HVIPs.
Knowledge about Rh-incompatibility and its associated factors among antenatal care recipients in public hospitals of Wolaita zone, 2022: facility-based cross-sectional study
Authors: Geta Temesgen , Atinafu Bizuayehu , Kassa Tsiyon 
Published: April 2024

BackgroundLack of awareness about the Rh-incompatibility problem is one of the factors hindering early prevention in Ethiopia. Thus, the objective of this study is to determine what was known about Rh-incompatibility disorders and their associated factors among pregnant women participating in prenatal care in southern Ethiopia.Design, setting and participantsA facility-based cross-sectional study was employed in four selected hospitals during 1–30 August 2022. The systematic random sampling method was used as a technique of selecting the study participants. The study was performed using a structured questionnaire. The data were coded and entered into EPI DATA V.4.6, and then the analysis was done using SPSS V.23 software program. Adjusted OR with 95% CI was the measurement unit of association between independent variables and outcome variables. The significance level was established as p<0.05.Result414 women took the survey, which corresponds to a response rate of 98.1%. Of those who responded, only 48% knew their blood group. The study found that 35.3% (95% CI: 31% to 40%) of women had a good knowledge of Rh-incompatibility. Maternal educational level above secondary school, multigravida women, blood type screening in the maternity ward, early counselling on Rh status and Rh-incompatibility and a positive attitude among women were significantly associated with pregnant women’s knowledge of Rh-incompatibility.ConclusionThe majority of pregnant women had poor knowledge regarding Rh-incompatibility. Therefore, all responsible organisations should focus on expanding pregnant women’s knowledge of Rh-incompatibility and the factors significantly associated with knowledge of Rh-incompatibility.
Adherence patterns, risk factors and complications among patients with tuberculosis: a cross-sectional study at Nsawam Government Hospital
Authors: Nortey Abraham Norman , Adjoda Amanda , Alhassan Amidu , Scott Godfred Yawson 
Published: April 2024

BackgroundTuberculosis (TB) is the ninth leading cause of death worldwide, and the leading cause of death from a single infectious agent prior to COVID-19 pandemic. TB substantially affects adults during their most productive years. However, all age groups are at risk. More than 25% of cases and deaths occur in Africa. People infected with HIV are 20–30 times more likely to develop active TB. In this study, we determined the level of TB medication adherence, risk factors and complications of TB in outpatients attending the Nsawam Government Hospital.MethodThis cross-sectional study randomly recruited 277 patients with TB attending the Nsawam Government Hospital for care. Structured questionnaires were used to collect sociodemographic information, adherence and lifestyle characteristics. Associations and multivariate logistic regression analysis were performed with 95% CIs. All p<0.05 were considered statistically significant.ResultsMajority (36.1%) of the patients were between the ages of 29 and 38. Majority (63.9%) of them had high adherence to TB medication. Participants earning less than 500 Ghana Cedis (Ghc) (adjusted OR (aOR)=8.85. 95% CI (1.59 to 49.24), p=0.013), patients with TB who indicated having complication (joint pain, spinal pain, heart disorders, liver or kidney problems) as a result of TB (aOR=2.81, 95% CI (1.58 to 4.99), p<0.001), respondents who mentioned living with people infected with TB (aOR=3.23. 95% CI (1.24 to 8.37), p=0.016) were the independent predictors of adherence to TB medication.ConclusionThe study findings revealed that participants exhibited commendable adherence to TB medication. Notably, adherence levels were found to be linked to several factors, including income, medication side effects and cohabitation with individuals infected with TB. The positive trend in adherence underscores the importance of considering socioeconomic factors, as lower income was identified as a potential barrier to consistent medication adherence
Children’s cognition and attitudes during long-term cancer treatment: an ethnographic study
Authors: Michinobu Ryoko , Yamamoto Masaki , Igarashi Keita , Sakai Yoshiyuki , Akane Yusuke , Yamamoto Dai , Takebayashi Akira , Mikami Takahiro , Tsutsumi Hiroyuki , Tsugawa Takeshi 
Published: April 2024

BackgroundCancer treatment for children is typically long-term and difficult, and the experience is unique for each child. When designing child-centred care, individuals’ values and preferences are considered equally important as the clinical evidence; therefore, understanding children’s thoughts and attitudes while they receive long-term treatment could offer valuable insights for better clinical practice.MethodsWe conducted long-term consecutive participatory observations and interviews with seven children, who were hospitalised and receiving cancer treatment for the first time. The daily observational data on those children’s discourses, behaviours and interactions with health professionals were systematically collected and thematically examined. The analysis was expanded to explore significant narratives for each child to capture their narrative sequence over time.ResultsThe initial analysis identified 685 narrative indexes for all observation data, which were categorised into 21 sub-codes. Those sub-codes were assembled into five main themes by thematic analysis: making promises with health professionals, learning about the treatment procedures through participation, taking care of oneself, increasing the range of activities one can perform and living an ordinary life.ConclusionWe observed a forward-looking attitude toward understanding cancer, accepting treatment and looking forward to the future among children undergoing in-hospital cancer treatment. In addition, the children developed cognitively, affectively and relationally throughout cancer treatment processes. These findings have implications for better clinical practice in child-centred care, including children’s participation in shared decision-making in paediatric oncology.