bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Pediatric Clostridioides difficile Testing Practices: Implementation of a 2-Tier Diagnostic Pathway
Authors: Sylvester Sarah , Fisher Charalene , Dalabih Abdallah , Marrero Elizabeth , Sietsema Lydia , Honeycutt Michele D , Boyanton Bobby L , Birisci Esma , Slagle Brittany 
Published: February 2024

Introduction: Clostridioides difficile (C. difficile) is a significant concern for children, especially for those who are hospitalized or who have underlying medical conditions. Diagnosis of C. difficile infection (CDI) in these patients can be challenging due to asymptomatic colonization. Inappropriate testing and non-adherence to laboratory testing guidelines can result in increased false-positive rates precipitating unnecessary isolation precautions and antibiotic treatment for these patients.

Methods: This retrospective cohort study aimed to evaluate the effectiveness of a new diagnostic pathway for C. difficile testing that was implemented in two pediatric hospitals. The study design collected data for two years, one year before and one year after pathway implementation. The study highlighted the importance of appropriate testing and the need for interventions to improve testing practices in pediatric patients. A 2-tier testing algorithm was implemented, consisting of polymerase chain reaction (PCR) for the presence or absence of the toxin B gene and an enzyme immunoassay for toxin A/B production. The best practice advisory was used to determine when C. difficile testing should not be performed. The chi-square test and Fisher's Exact Test analyzed the data using SPSS version 29.

Results: The study found a significant association between the implementation of the C. difficile testing pathway and the test positivity rates for both inpatient and emergency department (ED) patients at both hospitals. Out of 159,434 Hospital A inpatients, 71 had positive C. difficile test results, and out of 11,109 Hospital B inpatients, nine had positive test results. Similarly, out of 121,951 Hospital A ED patients, eight had positive test results, and out of 67,999 Hospital B ED patients, 16 had positive test results. The study found a statistically significant association between the pre and post pathway implementation years for both hospitals (p<0.001 for Hospital B inpatient and ED, p=0.033 for Hospital A inpatient, and p=0.004 for Hospital A ED).

Conclusion: Adherence to laboratory testing guidelines, appropriate testing based on factors such as the patient's age, underlying health conditions, recent antibiotic use, and the presence of other infections or illnesses can reduce unnecessary testing and false-positive rates. False-positive results can occur in pediatric patients due to the high rate of asymptomatic colonization, making it essential to use a combination of clinical symptoms, history, and appropriate diagnostic testing to minimize the risk of misdiagnosis.
Postpartum hemorrhage champions: Sustaining gains beyond the E-MOTIVE Trial
Authors: Oyoo Polycarp , Zahida Qureshi  , Alfred Osoti  , George osoti  , Joan Mwende  , Jennifer Okore  , Jim Kelly Mugambi  
Published: February 2024

Background: Results published from the E-MOTIVE trial concluded that for women undergoing vaginal delivery, early detection of postpartum hemorrhage (PPH), combined with bundled treatment of PPH, reduced severe PPH and associated adverse outcomes. Eighty hospitals across Nigeria, Kenya, Tanzania, and South Africa and over 210,000 women participated in the randomized trial, which was designed to assess the effect of implementing the E-MOTIVE intervention to detect and treat PPH. The results showed that the use of calibrated collection drapes dramatically increased the PPH detection rate, from 51% to 93%, and the use of the WHO-recommended bundle of treatments, from 19% to 91%. Moreover, implementing the E-MOTIVE approach to treat PPH resulted in a 60% reduction in severe PPH. The median blood loss, the need for postpartum blood transfusion, and the number of maternal deaths were also reduced. The E-MOTIVE trial trained a pool of PPH champions across the intervention facilities, including nurses, midwives, medical officers, and obstetrics and gynecology specialists. Their roles were to coordinate the training and practice activities of all relevant labor ward staff in their hospitals, observe labor ward staff practices, and provide specific feedback for targeted improvements in implementing the E-MOTIVE bundle correctly by reviewing regular performance indicators and outcome data from their hospitals to assess if improvements were needed.
Methods: After the study findings, the Kenyan hub team continued tracking the performance of the facilities after the trial, without any active support. The PPH champions collected, discussed at the facility level, and shared data with the Kenyan hub team monthly. The data shared were included in the hub Project Management Information System and triangulated with data from DHIS, where it was analyzed by the Kenyan study team, and feedback was shared at the facility level.
Results: Data analyzed from the last quarter (September-November) showed that seven E-MOTIVE implementing facilities maintained 5% PPH rates (blood loss >500 mls) and 2% severe PPH rates on moving averages. All components of the E-MOTIVE bundle were provided 100% to all PPH cases detected. During the same period, three maternal deaths were reported that had causes other than bleeding from PPH.
Conclusion: Having PPH champions community of practice can help sustain best practices in the early detection and treatment of PPH beyond any project lifeline. It is a simple and cost-effective method that can prevent severe PPH and prevent maternal mortality arising from PPH.
Effect of a Structured Integrated Obstetric Triage Model (SIOTEL) on Patient Waiting time in Maternity Units in Kiambu County – A Quasi Experimental Study
Authors: Nyariki Carolyne Kerubo , Nyariki Cyprian Michieka , Maina Mary , Mbuthia Grace Wambura , Yegon Erick 
Published: February 2024

Background: Perinatal mortality and morbidity remains high in Kenya over the years, and this has been attributed to the Three Delays, the third focusing on access to care once the client is in the health facility. Structured frameworks for obstetric triage have been shown to improve perinatal outcomes across the globe. In Kenya, anecdotal evidence suggests that there is no formal framework for conducting obstetric triage in public facilities. This study sought to assess the effect of a Structured Integrated Obstetric Triage Model (SIOTEL) on patient waiting time in maternity units of Kiambu Referral Hospitals.
Methods: A quasi experimental design was applied in the study. The intervention facility was Kiambu County Referral Hospital and control facility was Thika Level 5 Hospital. Study population included files of patients admitted in the labour wards. The intervention (SIOTEL) was a 3-scale modified Obstetric Triage Acuity Scale, a client assessment tool that was used to conduct obstetric triage. A baseline survey was conducted followed by development, validation and implementation of the tool, then an end line survey conducted to assess effect of the model on waiting time. Quantitative data was analyzed using STATA and presented in tables and graphs. T-statistic was used to test for significance of mean waiting time in the two facilities.
Results: A total of 455 files were reviewed, 231 at baseline and 224 at endline survey. The mean client waiting time at baseline was 113.19 and 124.91 minutes in the intervention and control facilities respectively. At endline, the mean waiting time was 57.46 minutes in the intervention facility and 112.92 minutes in the control facility. Findings thus revealed a significant effect of the SIOTEL on client waiting time in the intervention facility (t-3.77;p value 0.00) compared to the control facility (t-0.78; p value 0.44)
Conclusions and recommendations: The study concludes that implementation of structured models for obstetric triage contributes to reduction in client waiting time, and recommendations are made to adopt such models for triage in public facilities in Kenya
Plan operativo logístico y su efecto en la gestión de la calidad, caso estudio empresa comercial Distribuciones Plastiplus S.C.C., Santo Domingo, 2023.
Authors: Velez Herrera Luis Alberto , Ponce Burgos Jeniffer Elizabeth , Santamaría Granda Francisco Javier 
Published: February 2024

Este tema de titulación se realizó en la empresa Plastiplus S.C.C, en la provincia de Santo Domingo de los Tsáchilas, en la Av. Del cooperativismo y Av. De los quinches, junto a la distribuidora Plasti-fe, cuya actividad comercial se centra en realizar diversos productos como: fundas, food service, cubiertos, utensilios de madera, aluminios, embalajes, higiene. El propósito de este estudio se centra en analizar, diagnosticar y proponer un plan logístico y su impacto en la gestión de calidad. El enfoque es de carácter mixto, por lo tanto, se combina en el cualitativo y cuantitativo, además se utiliza una hoja de observación con el fin de diagnosticar el problema de investigación de la empresa, así mismo, una encuesta a las personas que son colaboradores y entrevista al gerente de esta para comprender mejor las variables de estudio. Según los resultados de estudio, se puede observar que, si existe orden en las actividades que se desarrollan, sin embargo, los proveedores no se encuentran totalmente coordinados, tampoco existe un proceso para el tema de estos y adquisición de materia prima. En cuanto a los colaboradores no han sido totalmente capacitados y presentan poco conocimiento del tema de estudio. Finalmente, la propuesta consiste en optimizar los componentes de la logística de entrada y de salida, para mejorar la gestión de calidad frente a los clientes.
PENTAGON FRAUD MODELLING: HOW IT AFFECTS FINANCIAL STATEMENT
Authors: Fachrul Roza  
Published: February 2024

This study examined conceptually the detection of financial statement fraud using Banking fraud in Indonesia Stock Exchange (BEI) Companies Listed on the Indonesia Stock Exchange (BEI) during 2017-2021 in a total of 200 samples from 40 companies using Eviews analysis. The methodology adopted in this study is quantitative research in which relevant and extant literature related to elements in Pentagon fraud model is reviewed about financial statement fraud. Financial stability does not affect financial statements in a significant linear fashion, and financial targets and external parties that seek to suppress have a significant negative impact on financial statements and do not show significance on other variables, being the result of this study. Current fraud insights are an important factor, both for managers in managing finances and for regulators/policymakers in preventing structured and reliable financial statement fraud.
Determinasi Pengembangan Karir Melalui Kepuasan Kerja : Gaya Kepemimpinan dan Pengembangan Karir
Authors: Candana Dori Mittra , Putra Rio Andhika , Purwasih Ratih 
Published: February 2024

Penelitian ini bertujuan untuk menguji seberapa besar, Gaya Kepemimpinan dan Pengembangan Karir terhadap Kinerja karyawan melalui Kepuasan Kerja pada PT. Incasi Raya. Metode pengumpulan data melalui survei dan mengedarkan kuesioner, dengan Sampel 40 responden dengan menggunakan metode teknik random sampling dengan menggunakan rumus Slovin. Metode analisis yang digunakan adalah regresi linear berganda dan analisis jalur menggunakan SPSS 22. Hasil analisis data menyimpulkan, (1.) Terdapat, pengaruh positif yang tidak signifikan Gaya Kepemimpinan terhadap Kepuasan Kerja, (2.) Terdapat pengaruh positif yang signifikan Pengembangan Karir terhadap Kepuasan Kerja, (3.)Terdapat pengaruh positif yang signifikan Gaya Kepemimpinan terhadap Komitmen Organisasi. (4.)Terdapat pengaruh positif yang signifikan pada Pengembangan Karir terhadap Komitmen Organisasi. (5.) Terdapat pengaruh Positif yang signifikan pada Kepuasan Kerja terhadap KOmitmen Organisasi. (6.) Terdapat pengaruh positif dan signifikan Gaya Kepemimpinan terhadap Komitmen Organisasi melalui Kepuasan Kerja (7.) Terdapat pengaruh positif yang signifikan Pengembangan Karir terhadap Komitmen Organisasi melalui Kepuasan Kerja.
The Implications of Loot Boxes and Their Involvement in the Possible Development of Childhood Gambling Disorders
Authors: Bhattacharjee Arlin , Mortillaro Gino 
Published: February 2024

“I refuse to promote the gacha system in this game anymore.” This was a comment made by a 13-year-old YouTuber named Michael “@mtashed” Tash with over 600,000 followers. Many of his followers are children who were likely drawn to his entertaining commentary on popular games such as Destiny, Dark Souls, and Genshin Impact. While the concept of a “gacha game” is likely unfamiliar to many clinicians, this phenomenon has significant relevance to child and adolescent psychiatry.
Mastering JEDI Skills for Current Times
Authors: Al-Mateen Cheryl S. 
Published: February 2024

2020 and 2021 have brought many images of social and medical equity to the forefront, including what some call a syndemic. This term speaks to the interaction of health (COVID-19) and social problems (systemic racism).1,2 Others also identify economic issues as part of the syndemic. In the United States, I believe that this includes not only the health disparities related to those who have died disproportionately, but also racially based violence, including violence against those who are of East Asian descent.3,4,5
Don’t Let a Good Educational Crisis (or Three) Go to Waste
Authors: Calhoun Amanda , Martin Andrés 
Published: February 2024

The Zoom Where It Happens (Or Not): With over 400,000 COVID-related deaths in the United States alone at the time of this writing, it may come across as insensitive to consider the positive sides of the pandemic. And yet, an appraisal of the educational opportunities unleashed by the coronavirus reveals objective opportunities we would not have seized otherwise.
Connect Corner: The Power of Play Among Us
Authors: Prasad Shreesh , Nobari Ozra , Armstead Melinda , Clark Naren , Nowrangi Kevin 
Published: February 2024

The first few months of my child and adolescent psychiatry fellowship have occurred amidst a raging global pandemic, large-scale civil unrest, and increasingly polarizing political discourse. Given our Northern California locale, a literal flaming countryside and ashen sky have completed the apocalyptic tableau. It should come as no surprise that staving off burnout has been on my mind lately, but when Drs. McBride and Wadell announced we would be playing Among Us,1 an online multiplayer social deduction game, in place of one of our regularly scheduled didactic sessions, I was skeptical. From the plethora of memes I had seen on Reddit, I knew the game had exploded in popularity among teenagers, but I wondered whether a group of doctors awkwardly stumbling through it would be better for our mental health than simply having an extra hour off to decompress after a stressful morning.
We Cannot be Silent: Using Our Voice to Be Anti-Racist
Authors: Schreiber Justin 
Published: February 2024

As I began writing this introduction, a piece typically meant to tie the various Connect articles together, I reflected on the stark changes in our country since authors began writing their articles for this issue. First, a pandemic brought substantial change to the overall mental health of the country, including the way that psychiatric services are provided, accessed, and taught. The changes that COVID-19 has brought to the state of mental health in the country and the way that psychiatric services are provided and taught has been a whirlwind that nobody was prepared for. COVID-19 further exposed the racial disparities in services due to systemic racism that have existed long before the pandemic, leading to significant differences in the morbidity and mortality of the illness towards people of color. In addition, the killings of Black men and women exemplified in George Floyd having his breath taken from him, Breonna Taylor shot while sleeping in her home, and Ahmaud Arbery shot while simply jogging, awoke the need to identify the systemic racism that is, and has been killing Black people. As child and adolescent psychiatrists, we see the impact of racism daily in the lack of access to services, the difference in treatment provided to children in school, and the fear and anxiety that Black youth and parents experience doing what should be mundane tasks because of the potential life-changing consequences. We are taking the following initial steps to change our journal.
Factors Affecting Use of Electroconvulsive Therapy in Adolescents in Texas and the US
Authors: Ahmad Naveed , Pinjari Omar F. , Fernandez Luis A. , Newlin Elizabeth , Selek Salih 
Published: February 2024

Since 1938, electroconvulsive therapy (ECT) has been widely used in the treatment of catatonia, treatment-resistant depression, and severe mania. According to the American Academy of Child and Adolescent Psychiatry (AACAP), criteria1 for its use in youth is: 1) Presence of severe major depression or mania, schizoaffective disorder, schizophrenia, catatonia, and neuroleptic malignant syndrome. 2) Presence of severe, persistent, and disabling symptoms, such as refusal to eat or drink, severe suicidal ideation, uncontrollable mania, and psychosis. 3) Failure to respond to two adequate trials of medications. 4) ECT can also be used earlier when adequate medication trials cannot be administered because of failure to tolerate pharmacological treatment, or if the patient is incapacitated to the point that he/she is unable to take medication or awaiting a response to a medication poses a grave threat to life.
Abnormal Sensory Reactivity in the Child and Adolescent Psychiatry Clinic: Assessment, Management, and Treatment
Authors: Rosen Max S. , Glowinski Anne L. 
Published: February 2024

Clinical interest in abnormal sensory processing has evolved since the mid-twentieth century from initial work by Anna Aryes,1 a prominent occupational therapist, and Leo Kanner, known to many as the father of autism. Aryes, while observing children with learning disabilities, conceived of a field of sensory integration dysfunction, a disorder related to neurological impairment in “detecting, modulating, discriminating, and responding to sensory information”.1 There is increasing recognition today that differences in sensory processing are transdiagnostic and encountered by a multitude of clinical practitioners, including psychiatrists, neurologists, occupational therapists, audiologists, and pediatricians, among others. It is thus of vital importance for child psychiatrists to recognize those differences, distinguish them from autism and other diagnostic categories, and conceptualize approaches to treatment.
Impact of common surgical and anaesthetic strategies for pain control after elective gastrointestinal surgery: cohort study
Authors: Nepogodiev Dmitri , Bhangu Aneel , Osei-Bordom Daniel , Omar Omar , Bach Simon 
Published: February 2024

Introduction: Poor pain control after surgery is associated with chronic pain and opioid dependence. This study aimed to determine the incidence of patient reported pain control failure following gastrointestinal surgery, and to evaluate the impact of common preventative surgical and anaesthetic strategies.
Methods: Data were extracted from an electronic health record that linked real-time, ward-based pain scores with prescribing data. Adults undergoing major elective gastrointestinal surgery in 2011-18 were included. The primary endpoint was early pain control failure (≥1 instances of moderate or severe pain on postoperative days 0-2). Secondary outcomes were late (postoperative days 3-5) and persistent (both early and late) pain control failure.
Results: Of 2238 patients, half underwent planned open surgery (50.3%, 1126/2238). Patient controlled analgesia (PCA) was initially used in 49.7% (1113/2238) and epidural in 35.0% (784/2238). Early (54%, 1211/2238), late (33.7%, 755/2238), and persistent (24.9%, 557/2238) pain control failures occurred frequently. In multivariable analyses, minimally invasive surgery was associated with fewer early, late, and persistent pain control failures than open surgery. There was no association between initial epidural analgesia and early or persistent pain control failure, but there was an association with increased late failure (OR 1.37, 95% CI 1.08-1.73, p=0.009). Of patients with initial epidural analgesia, 39.3% (308/784) were subsequently converted to PCA.
Conclusion: Epidural analgesia offered no advantage over PCA, with pain control failure common irrespective of analgesic strategy. Increasing the uptake of minimally invasive surgery, through medical advances to down-stage disease, may offer a path to effectively improve postoperative pain failure.
Improving access to patient information leaflets in patients undergoing emergency appendicectomy
Authors: Louden Harriet , Lawday Samuel 
Published: February 2024

Background
Informed consent is a cornerstone of ethical surgical practise. Patients undergoing emergency surgery have reduced time to consider their options when compared to the elective setting. Therefore, improving informed consent in this setting is critical. We aim to increase the provision of a pre-operative patient information leaflet (PIL) for patients undergoing an emergency appendicectomy by 50% over two audit cycles.
Methods
The same methodology were used for both cycles of this audit. Patients were identified through histopathology lists over a two week period. Medical notes were reviewed for documentation of provision of trust approved patient information leaflets. A QR code for an electronic version of the information leaflet was added to emergency clinic rooms, doctors handover rooms and the SHO on call bleep between audit periods.
Results
Empirical results from two audit cycles revealed that introduction of a QR code increased uptake from 0% of patients receiving the recommended appendicectomy leaflet, to 58%, achieving our aim.
Conclusion
The QR code provided a useful transportable resource, which was utilised by doctors. This provides scope for progression in provision of leaflet for other surgical issues, both in inpatient and outpatient settings, through utilisation of a QR code.