bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to measure staff continuity in intensive psychiatric home treatment: a routine data and single case analysis
Authors: Schwarz Julian , Wolff Jan , Heinze Martin , von Peter Sebastian , Habicht Juri Luis 
Published: May 2023

BackgroundIntensive forms of outreach mental health care (IOC) such as crisis resolution or home treatment teams are increasingly implemented as alternatives to inpatient admission, providing recovery-oriented treatment at home at comparable costs and outcomes. However, one issue with IOC is the lack of continuity regarding staff members who provide home visits, complicating relationship building and meaningful therapeutic exchange. The aim of this study is to validate existing primarily qualitative findings using performance data and to explore a possible correlation between the number of staff involved within IOC treatment and the service users’ length of stay (LOS).MethodsRoutine data from an IOC team in a catchment area in Eastern Germany were analyzed. Basic parameters of service delivery were calculated and an in-depth descriptive analysis regarding staff continuity was performed. Further, an exploratory single case analysis was conducted, presenting the exact sequence of all treatment contacts for one case with low and one with high staff continuity.ResultsWe analyzed 10.598 face-to-face treatment contacts based on 178 IOC users. The mean LOS was 30.99 days. About 75% of all home visits were conducted by two or more staff members simultaneously. Service users saw an average of 10.24 different staff per treatment episode. On 11% of the care days, only unknown staff, and on 34% of the care days at least one unknown staff member conducted the home visit. 83% of the contacts were performed by the same three staff members and 51% were made by one and the same staff member. A significant positive correlation (p = 0.0007) was found between the number of different practitioners seen by a service user in the first seven days of care and the LOS.ConclusionOur results suggest that a high number of different staff in the early period of IOC episodes correlates with an extended LOS. Future research must clarify the exact mechanisms of this correlation. Furthermore, it should be investigated how the multiple professions within IOC teams influence the LOS and the quality of treatment and what quality indicators may be suitable to ensure treatment processes.
Treatment strategy for insomnia disorder: Japanese expert consensus
Authors: Takaesu Yoshikazu , Sakurai Hitoshi , Aoki Yumi , Takeshima Masahiro , Ie Kenya , Matsui Kentaro , Utsumi Tomohiro , Shimura Akiyoshi , Okajima Isa , Kotorii Nozomu , Yamashita Hidehisa , Suzuki Masahiro , Kuriyama Kenichi , Shimizu Eiji , Mishima Kazuo , Watanabe Koichiro , Inada Ken 
Published: May 2023

PurposeThere is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments.MethodsExperts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = “disagree” to 9 = “agree”). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations.ResultsThe primary pharmacological treatment, lemborexant (7.3 ± 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 ± 1.8) and suvorexant (6.8 ± 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 ± 1.1) and maintenance insomnia (8.1 ± 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 ± 2.3) and maintenance insomnia (5.7 ± 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 ± 1.8) and suvorexant (6.9 ± 1.9) were categorized as first-line recommendations.ConclusionExpert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.
Utility and usability evaluation of an information diary tool to measure health information access and exposure among patients with high cardiovascular risk
Authors: Lim Hooi Min , Ng Chirk Jenn , Abdullah Adina , Dalmazzo Jason , Lim Woei Xian , Lee Kah Hang , Dunn Adam G. 
Published: May 2023

BackgroundOnline health misinformation about statins potentially affects health decision-making on statin use and adherence. We developed an information diary platform (IDP) to measure topic-specific health information exposure where participants record what information they encounter. We evaluated the utility and usability of the smartphone diary from the participants' perspective.MethodsWe used a mixed-method design to evaluate how participants used the smartphone diary tool and their perspectives on usability. Participants were high cardiovascular-risk patients recruited from a primary care clinic and used the tool for a week. We measured usability with the System Usability Scale (SUS) questionnaire and interviewed participants to explore utility and usability issues.ResultsThe information diary was available in three languages and tested with 24 participants. The mean SUS score was 69.8 ± 12.9. Five themes related to utility were: IDP functions as a health information diary; supporting discussion of health information with doctors; wanting a feedback function about credible information; increasing awareness of the need to appraise information; and wanting to compare levels of trust with other participants or experts. Four themes related to usability were: ease of learning and use; confusion about selecting the category of information source; capturing offline information by uploading photos; and recording their level of trust.ConclusionWe found that the smartphone diary can be used as a research instrument to record relevant examples of information exposure. It potentially modifies how people seek and appraise topic-specific health information.
Continuity of care among diabetic patients in Accra, Ghana
Authors: Awumee Veronica , Dery Samuel Kennedy Kangtabe 
Published: May 2023

IntroductionDiabetes mellitus is a fast-rising non-contagious disease of global importance that remains a leading cause of indisposition and death. Evidence shows that effective management of diabetes has a close link with continuity of care which is known to be the integral pillar of quality care. This study, therefore, sought to determine the extent of continuity of care between diabetic patients and their care providers as well as factors associated with relational continuity of care.MethodologyThis cross-sectional, facility-based study was conducted among diabetics in Accra, Ghana. We sampled 401 diabetic patients from three diabetic clinics in the region using a stratified and systematic random sampling technique. Data were collected using a structured questionnaire containing information on socio-demographic characteristics, the four dimensions of continuity of care, and patients' satisfaction. A 5-point Likert scale was used to measure patient's perception of relational, flexible, and team continuity, while most frequent provider continuity was used to measure longitudinal continuity of care. Scores were added for each person and divided by the highest possible score for each domain to estimate the continuity of care index. Data were collected and exported to Stata 15 for analysis.ResultsThe results show that team continuity was the highest (0.9), followed by relational and flexibility continuity of care (0.8), and longitudinal continuity of care was the least (0.5). Majority of patients experienced high team (97.3%), relational (68.1%), and flexible (65.3%) continuity of care. Most patients (98.3%) were satisfied with the diabetes care they received from healthcare providers. Female subjects had higher odds of experiencing relational continuity of care as compared to male subjects. Furthermore, participants with higher educational levels were five times more likely to experience relational continuity of care than those with lower educational background.ConclusionThe study demonstrated that the majority of diabetics had team continuity of care being the highest experienced among the four domains, followed by flexible and longitudinal being the least experienced. Notably, team and flexible continuity of care had a positive association with relational continuity of care. Higher educational level and being female were associated with relational continuity of care. There is therefore the need for policy action on the adoption of multidisciplinary team-based care.
Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City
Authors: Xie Peixuan , Li Xuezhu , Guo Feifan , Zhang Donglan , Zhang Hui 
Published: May 2023

IntroductionThis study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China.MethodsData were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses.ResultsThe total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P &lt; 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009–2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P &lt; 0.001) but had lower OOP expenses (P &lt; 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15–30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P &lt; 0.001).ConclusionsThe direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.
C-1 Substituted isoquinolines potentiate the antimycobacterial activity of rifampicin and ethambutol
Authors: Martin Liam T. , Lamming Eleanor D. , Maitra Arundhati , Mortazavi Parisa N. , Roddan Rebecca , Ward John M. , Bhakta Sanjib , Hailes Helen C. 
Published: May 2023

IntroductionThe emergence of extensively drug-resistant strains ofMycobacterium tuberculosisthreatens decades of progress in the treatment of a disease which remains one of the leading infectious causes of death worldwide. The development of novel antimycobacterial compounds is therefore essential to reinforce the existing antitubercular drug discovery pipeline. There is also interest in new compounds which can synergize with existing antitubercular drugs and can be deployed as part of a combination therapy. This strategy could serve to delay the emergence of resistance to first-line anti-tuberculosis drugs and increase their efficacy against resistant strains of tuberculosis. Previous research has established that several C-1 substituted tetrahydroisoquinolines have antimycobacterial activity. Here we sought to expand our understanding of their antimycobacterial structure activity relationships and their potential to act as adjunct therapies alongside existing antitubercular drugs.MethodsThree chemical series were synthesised and assayed for their antimycobacterial potency, mammalian cell toxicity, inhibition of whole-cell efflux and synergism with isoniazid, rifampicin, and ethambutol.ResultsSeveral compounds were found to inhibit the growth of mycobacteria. Potent inhibitors of whole-cell efflux were also identified, as well as compounds which exhibited synergism with rifampicin and ethambutol.ConclusionsStructure-activity relationships were identified for antimycobacterial potency, improved selectivity, whole cell efflux inhibition and synergism. Potent whole-cell efflux inhibitors and synergistic compounds were identified, suggesting potential development as adjuncts to existing anti-tuberculosis chemotherapy.
Risk factors of osteoporosis in elderly inpatients: A cross-sectional single-centre study
Authors: Li Han , Sun Tianbao , Han Dongmei , Gong Weiwei , Mao Weiwei , Gan Xianze , Shu Dan , Zhou Qian , Xu Lei , Hou Liufang , Zhou Mingcheng , Cai Mingwei , Lai Xueli 
Published: May 2023

Objective: This study aimed to identify factors significantly associated with the occurrence of osteoporosis in elderly and very elderly patients.Methods: Elderly hospitalized patients who were older than 60 years old, from the Rehabilitation Hospital from December 2019 to December 2020 were selected. Barthel index (BI), nutritional assessment, the causes of bone mineral density (BMD) reductions in elderly and elderly patients were analysed.Results: A total of 94 patients (83.56 ± 8.37 years old) were enrolled. With increasing age, the BMD of the lumbar spine, femoral neck, and femoral shaft of elderly patients significantly decreased, and the incidence of osteoporosis (OP) significantly increased. The BMD of the lumbar spine was negatively correlated with female and positively correlated with serum 25-hydroxyvitamin D levels, the difference between actual body weight and ideal body weight, and blood uric acid levels; The BMD of the femoral neck was negatively correlated with age and female, and positively correlated with height and geriatric nutrition risk index score. The BMD of the femoral shaft was negatively correlated with female and positively correlated with BI.Conclusion: With increasing age, the BMD of the lumbar spine and the femoral shaft significantly decreased, and the incidence of OP significantly increased in elderly and very elderly patients. Aric acid may protect bone health in elderly patients. Early attention to the nutritional status, exercise capacity, 25-hydroxyvitamin D level, and blood uric acid level in the elderly population can help identify high-risk elderly patients with OP.
Turning to friends in preference to parents for support in early adolescence: does this contribute to the gender difference in depressive symptoms?
Authors: Wright Nicky , Sharp Helen , Gay Jessica , Pickles Andrew , Hill Jonathan 
Published: May 2023

IntroductionBased on established evidence of gender differences in friendship patterns, and the vulnerability associated with early reliance on friends, we hypothesized that in 13-year-olds, a preference for turning to friends rather than parents for emotional support contributes to the gender difference in depressive symptoms.MethodsUsing a cross-sectional design, 671 adolescents (53.7% girls; mean age 13.11 ± 0.52 years) in a UK birth cohort [Wirral Child Health and Development Study (WCHADS)] reported turning to their parents and to their friends when distressed [Network of Relationships Inventory (NRI)] and depressed [Short Mood and Feelings Questionnaire (SMFQ)]. Preferentially turning to friends was assessed as turning to friends minus turning to parents for support. Analyses used path analysis using the gsem command in Stata.ResultsGirls had higher depressive symptoms than boys (p &lt; .001). Consistent with the hypotheses, girls had higher scores than boys for preferentially turning to friends (p &lt; .001). Preferentially turning to friends was associated with higher depressive symptoms (p &lt; .001), and this mediated the gender difference in depressive symptoms (p &lt; .001). The association between preferentially turning to friends and depressive symptoms was stronger for girls than for boys (p = .004).ConclusionsIn young adolescents, preferentially turning to friends over parents when distressed is common, and the association between preferentially turning and depressive symptoms is markedly higher in girls than in boys. This reflects either a gender difference in social vulnerability to depression or a greater impact of depression on the reliance on friends instead of parents in girls. While clarifying the directions of influence requires prospective study, these findings provide the first evidence that the assessment of depression in young adolescents should consider the degree of reliance on friends and parents.
Feasibility, effectiveness and safety of self-management in pulmonary rehabilitation: a study protocol using a hybrid type 1 effectiveness-implementation design
Authors: Ricke Ellen , Dijkstra Arie , Bakker Eric W. 
Published: May 2023

BackgroundAs population ageing accelerates worldwide, chronic diseases will place an increasing burden on society and healthcare systems. Self-management interventions may become a key strategy for addressing chronic disease burden and healthcare costs, also in pulmonary rehabilitation (PR). One of the challenges here is long-term adherence. Understanding the level of adherence to PR may help inform clinical decision-making to focus more on self-management and less on clinical supervision. For this reason, a prediction model (PATCH) was developed. The presented protocol concerns a study that aims 1. to evaluate the safety and effectiveness of self-management within pulmonary rehabilitation (PR) on health outcomes in patients with chronic obstructive pulmonary disease (COPD), 2. to evaluate the predictive validity of the PATCH tool, and 3. to evaluate feasibility and acceptability of self-management and the PATCH tool by patients and physiotherapists.Methods and analysisThis is a protocol of a hybrid type 1 effectiveness-implementation design, performed in primary physiotherapy practices in The Netherlands. The aim is to include 108 patients with COPD who have already followed PR for at least six weeks (maintenance stage of PR). According to the Dutch KNGF Guideline COPD, physiotherapists should reduce the number of supervised treatments after the maintenance phase and support self-management. In practice, this does not (always) happen. This protocol is based on implementing guideline advice: clinical supervision will be halved but patients are stimulated to engage in self-management by exercising unsupervised, leading to no change in the total planned exercise frequency. During the supervised sessions physiotherapists will assess and stimulate self-management. At baseline, and after 3, 6, 9 and 12 months, health outcomes (including adherence) will be evaluated as the primary outcome of this study. At each measurement, the physiotherapist will decide on the basis of individual scores whether the patient needs more clinical supervision or not. Secondary outcomes are the discriminatory power of the PATCH tool (can patients be correctly classified as adherent or non-adherent), and feasibility and acceptability of self-management and the PATCH tool by patients and physiotherapists. Questionnaires and semi-structured interviews will be used for assessment of the outcomes.Trial registration number: METc 2023/074.
Comparative study of halo-vest reduction and skull traction reduction in the treatment of cervical fracture dislocation in patients with ankylosing spondylitis
Authors: Wang Liang , Wang Haibin , Wang Can , Zhang Bangke , Yang Haisong , Lu Xuhua 
Published: May 2023

BackgroundThis study aimed to investigate the safety and efficacy of the halo-vest in the treatment of cervical fracture in patients with ankylosing spondylitis (AS) and kyphosis.MethodsFrom May 2017 to May 2021, 36 patients with cervical fractures with AS and thoracic kyphosis were included in this study. The patients with cervical spine fractures with AS underwent preoperative reduction by halo-vest or skull tractions. Instrumentation internal fixation and fusion surgery were then performed. The level of cervical fractures, the operative duration, blood loss, and treatment outcomes were investigated preoperatively and postoperatively.ResultsA total of 25 cases were included in the halo-vest group and 11 cases were included in the skull tractions group. The intraoperative blood loss and the surgery duration were significantly less in the halo-vest group than in the skull traction group. A comparison of American Spinal Injury Association scores at admission and final follow-up showed that the neurological function of patients improved in both groups. All patients had reached solid bony fusion during the follow-up.ConclusionThis study presented a unique approach to use halo-vest treatment fixation of unstable cervical fracture in patients with AS. The patient should also have early surgical stabilization with a halo-vest to correct spinal deformity and avoid worsening of neurological status.
Knowledge, attitudes, and practice of female genital mutilation and cutting: an observational cross-sectional study in English primary care (FGM/C Study)
Authors: Robinson Michelle Elizabeth , Prior James , Mallen Christian D , Shepherd Thomas A 
Published: May 2023

BackgroundFemale genital mutilation and cutting (FGM/C) describes procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Increasing migration means many communities living in the UK originate from countries where FGM/C is practised. Consequently, clinicians in the UK are increasingly exposed to women and children who have experienced FGM/C.AimTo explore the knowledge, attitudes, and practice of primary care GPs and practice nurses (PNs) regarding FGM/C.Design & settingAn observational cross-sectional study with GPs and PNs working in primary care in the West Midlands, UK.MethodAn online survey was circulated to GPs and PNs between September 2019 and December 2019.ResultsA total of 137 survey responses were received. Study participants were predominantly female (81.8%) and GPs (59.9%), with a mean age of 47.3 years (standard deviation [SD] 9.1). The survey found 19.7% of responders reported seeing >1 patient with FGM/C in the past 12 months. It also found 91.3% of responders had received some form of FGM/C training; however, the format and frequency of training varied and 34.3% felt they had received inadequate training to manage treatment of FGM/C.ConclusionThe results have suggested varying degrees of competence and confidence associated with recognising and managing patients with FGM/C in primary care in the West Midlands. Given that patients with FGM/C typically present in primary care, it is important that clinicians can provide appropriate support underpinned by up-to-date training.