bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supervised Aerobic Exercise Training and Increased Lifestyle Physical Activity to Reduce Cardiovascular Disease Risk for Women With Polycystic Ovary Syndrome: A Randomized Controlled Feasibility Trial
Authors: Woodward Amie , Broom David , Dalton Caroline , Metwally Mostafa , Klonizakis Markos 
Published: May 2022

Background: Polycystic ovary syndrome (PCOS) is a complex, heterogeneous endocrinopathy. Women with PCOS often present with cardiovascular disease risk factors. Physical activity (PA) interventions reduce cardiovascular disease risk factors in women with PCOS. However, sedentary behaviors have a distinct deleterious effect on cardiometabolic health. Increasing PA and reducing sedentary behaviors may be a worthwhile therapeutic target to improve cardiovascular health in this population. This study investigated the feasibility of 2 PA interventions to decrease cardiovascular disease risk in women with PCOS. Methods: This was a feasibility randomized controlled trial of 2 PA interventions in 36 women with PCOS. Participants were randomized to a supervised exercise intervention (n = 12), a lifestyle physical activity group intervention aimed at reducing sedentary behaviors (n = 12), or a control group (n = 12), for 12 weeks. Primary outcomes included the feasibility and acceptability of the interventions and procedures. Results: Recruitment rate was 56%. Adherence rate was 53% and 100% to the exercise intervention and lifestyle PA intervention, respectively. Secondary outcome data indicate a reduction in oxidized low-density lipoprotein concentrations in the exercise group, and weight loss in both intervention groups. Conclusions: The procedures for recruitment, allocation, and outcome measurements were acceptable. However, before progression to a full-scale trial, adherence to the exercise program should be addressed.
Portopulmonary hypertension: a patient with shortness of breath
Authors: Ryan Aidan , Miah Nahima , Saleh Mohamed 
Published: May 2022

Portopulmonary hypertension (PoPH) is a poorly understood complication of liver disease which affects about 10% of patients with pulmonary hypertension. This case report outlines the difficulties in diagnosing and managing a patient with advanced disease, and the impact of these delays on the patient.PoPH has a significant risk of mortality with a 2-year survival rate of 67%. There are also few treatment options available and those which do exist are associated with multiple contraindications and risks. Patients with PoPH commonly present with dyspnoea, pulmonary hypertension and portal hypertension. The presence of coexisting chronic liver disease is also sometimes present. Traditional management for heart failure can temporarily alleviate symptoms but there is no proven long-term benefit. As a result, an understanding of the pathophysiology, diagnostics and management is crucial to ensure the best possible patient outcomes.
Postoperative risks of stoma formation in patients with dementia
Authors: Jarratt Barnham Isaac , Kent Niall 
Published: May 2022

Stoma formation for patients with dementia presents an increasing problem in a global ageing population. While potentially lifesaving, stomas impose significant, long-term postoperative burdens on patients, and may particularly challenge those with cognitive impairment.In this case, a patient was considered for colostomy to manage a colovesical fistula. The patient’s cognitive status significantly influenced clinicians’ beliefs concerning suitability for stoma formation.The relevance of dementia to stoma formation is underdiscussed within the literature. In this report, we outline the postoperative risks to which those with dementia undergoing stoma formation are particularly vulnerable. These include increased risk of psychological harm, of relocation to a nursing home, and of stoma-related complications.We hope an increased appreciation of these postoperative challenges will inform decisions concerning suitability for stoma formation in this patient group.
Universal health insurance in Africa: a narrative review of the literature on institutional models
Authors: Ly Mamadou Selly , Bassoum Oumar , Faye Adama 
Published: May 2022

IntroductionSeveral African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals.MethodThis study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection).ResultsNinety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa.ConclusionPublic health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.
Interexaminer reproducibility for subjective refractions for an ametropic participant
Authors: Mathebula Solani David , Rubin Alan 
Published: May 2022

ObjectiveTo investigate interexaminer reproducibility of non-cycloplegic subjective refractions. Subjective refractions are frequently determined, and it is important to know whether differences in refractive state over time constitute meaningful, non-random change.Methods and analysisFifty registered and experienced (≥5 years) optometrists from a single geographic region performed non-cycloplegic subjective refractions for a participant with moderate left eye(OS) to severe right eye (OD) ametropia. Subjective refractions were transformed to power matrices for analysis with stereopairs, distribution ellipsoids and polar profiles of variance of dioptric power. Absolute 95% limits of reproducibility (1.96(2)(SD)) for excesses of subjective refractions for the right and left eyes separately from mean subjective refractions were determined.ResultsMean subjective refractions were −7.68–4.50×10 and −4.59–1.85×178 for the right and left eyes, respectively. The 95% absolute reproducibility limits for the stigmatic coefficients (spherical equivalents) were ≤1.71 D and ≤0.75 D for the right and left eyes, but corresponding limits for astigmatic coefficients were smaller (≤0.69 D).ConclusionRemoval of possible outliers for OD and OS, respectively, reduces the absolute 95% reproducibility limits for the stigmatic and astigmatic coefficients to ≤0.97 D and ≤0.49 D, thus improving interexaminer reproducibility. However, these results suggest caution with analysis of refractive data where subjective rather than objective methods are applied for longitudinal and epidemiological studies.
Initiative to improve quality of paediatric ward-round documentation by application of ‘SOAP’ format
Authors: Joshi Neha , Bakshi Himanshi , Chatterjee Abhishek , Bhartia Saru 
Published: May 2022

BackgroundAudits on record keeping practices at our multidisciplinary hospital revealed unstructured ward-round notes which were dissimilar from each other on aspects of patient information. Written as per the discretion of the rounding physician, the practice compromised team communication and medicolegal safety and risked patient harm. Paediatricians decided to address this concern for their department and proposed to improve the quality of documentation by structuring their notes using subjective, objective, assessment and planning (SOAP) format. On observing only 13% compliance with SOAP use despite education and training to use it, a series of interventions were explored to increase its application.MethodsBrainstorming sessions with the paediatricians provided practical solutions. These were tested one by one using plan–do–study–act cycles to understand their impact. Team feedback was pursued towards the end of each cycle to understand the opinion of each team member.InterventionsInterventions included verbal reminders, individual feedback and SOAP acronym display. Each of these were tested singularly and serially. Acronym display proved successful until the arrival of COVID-19, which disrupted its implementation and redirected paediatricians’ work priorities. This led to exploration of a new solution, and paediatricians recommended use of visual reminders at the handover site. Quantitative information was analysed to reject or retain the ideas.ResultsVerbal reminders and individual feedback made no difference to SOAP usage. Acronym display improved compliance from 13% to 90% but it fell to 45% during COVID-19. Its replacement with visual reminders during pandemic times reinstated the compliance to a median of 84%.ConclusionsSelection of a change idea that respected front liner’s constraints and suited local work environment proved valuable. Both acronym display and visual reminders served as visual reinforcements towards embracing a note format and proved effective. Perceived benefits from methodically written notes encouraged paediatricians to re-establish simpler measures to retain SOAP application, otherwise disrupted during the COVID-19 pandemic.
Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences
Authors: Bosó Pérez Raquel , Reid David , Maxwell Karen J , Gibbs Jo , Dema Emily , Bonell Christopher , Mercer Catherine H , Sonnenberg Pam , Field Nigel , Mitchell Kirstin R 
Published: May 2022

IntroductionAccess to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in Britain during the early stages of the COVID-19 pandemic.MethodsIn October and November 2020 we conducted semi-structured telephone interviews with 14 women and six men reporting an unmet need for SRH services in the Natsal-COVID survey, a large-scale quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). We purposively sampled eligible participants using sociodemographic quotas. Inductive thematic analysis was used to explore service access and quality and to identify lessons for future SRH service delivery.ResultsTwenty participants discussed experiences spanning 10 SRH services including contraception and antenatal/maternity care. Participants reported hesitancy and self-censorship of need. Accessing telemedicine and ‘socially-distanced’ services required tenacity. Challenges included navigating changing information and procedures; perceptions of gatekeepers as obstructing access; and inflexible appointment systems. Concerns about reconfigured services included reduced privacy; decreased quality of interactions with professionals; reduced informal support; and fewer preventive SRH practices. However, some participants also described more streamlined services and staff efforts to compensate for disruptions. Many viewed positively the ongoing blending of telemedicine with in-person care.ConclusionThe COVID-19 pandemic impacted access and quality of SRH services. Participants’ accounts revealed self-censorship of need, difficulty navigating shifting service configurations and perceived quality reductions. Telemedicine offers potential if intelligently combined with in-person care. We offer initial evidence-based recommendations for promoting an equitable restoration and future adaption of services.
Should COVID-specific arrangements for abortion continue? The views of women experiencing abortion in Britain during the pandemic
Authors: Lohr Patricia A , Lewandowska Maria , Meiksin Rebecca , Salaria Natasha , Cameron Sharon , Scott Rachel H , Reiter Jennifer , Palmer Melissa J , French Rebecca S , Wellings Kaye 
Published: May 2022

BackgroundDuring the COVID-19 pandemic, the British governments issued temporary approvals enabling the use of both medical abortion pills, mifepristone and misoprostol, at home. This permitted the introduction of a fully telemedical model of abortion care with consultations taking place via telephone or video call and medications delivered to women’s homes. The decision was taken by the governments in England and Wales to continue this model of care beyond the original end date of April 2022, while at time of writing the approval in Scotland remains under consultation.MethodsWe interviewed 30 women who had undergone an abortion in England, Scotland or Wales between August and December 2021. We explored their views on the changes in abortion service configuration during the pandemic and whether abortion via telemedicine and use of abortion medications at home should continue.ResultsSupport for continuation of the permission to use mifepristone and misoprostol at home was overwhelmingly positive. Reasons cited included convenience, comfort, reduced stigma, privacy and respect for autonomy. A telemedical model was also highly regarded for similar reasons, but for some its necessity was linked to safety measures during the pandemic, and an option to have an in-person interaction with a health professional at some point in the care pathway was endorsed.ConclusionsThe approval to use abortion pills at home via telemedicine is supported by women having abortions in Britain. The voices of patients are essential to shaping acceptable and appropriate abortion service provision.
Systems leadership: how chief executives manage tension between organisation and system pressures
Authors: Gordon Ben , Thomas Matthew Gwynfryn , Darzi Ara , Aufegger Lisa , Bicknell Colin 
Published: May 2022

AimSystem leadership is the requirement for a leader of a single organisation to operate on behalf of a wider system, rather than their individual organisation. The current policy landscape does not incentivise system leadership, as many national structures emphasise a focus on individual organisations. This study aims to understand how chief executives in the National Health Service (NHS) in England implement system leadership in practice when faced with decisions that benefit the system to the detriment of their own trust.MethodologySemistructured interviews were conducted with ten chief executives from various NHS trust types to understand their perceptions and decision-making process in practice. Semantic thematic analysis was used to draw out themes in relation to how chief executives approach decisions which weigh up the system and organisation.ResultsInterviewees expressed advantages (such as support in managing demand) and disadvantages (such as increased bureaucracy) of system leadership and practical considerations in operationalisation (such as the importance of interpersonal relationships). Interviewees endorsed system leadership in principle, but did not feel that current organisational incentives support the implementation of system leadership in practice. However, this was not seen as a major challenge or impediment to effective leadership.ConclusionAs a specific policy area, a direct focus on systems leadership is not necessarily helpful. Chief executives should be supported to make decisions in a complex environment, without a specific focus on healthcare systems as a unit of operation.
Embedding research (ER) led by nurses, midwives and allied health professionals (NMAHPs): the NMAHP-ER model
Authors: Whitehouse Claire Louise , Tinkler Linda , Jackson Carolyn , Hall Helen , Webster Jonathan , Hardy Sally , Copping Jacky , Morris Paul , Manley Kim 
Published: May 2022

BackgroundPrevious embedded researcher models have focused predominantly on an individual being a temporary team member and embedded for a project-limited short-term placement.AimTo develop an innovative research capacity building model to address the challenges of developing, embedding and sustaining, research led by Nurses, Midwives, and Allied Health Professionals (NMAHPs) in complex clinical environments. This healthcare and academic research partnership model offers an opportunity to support the ‘how’ of enabling NMAHP research capacity building from within the researchers’ clinical area of expertise.MethodCollaboration between three healthcare and academic organisations and the iterative process of cocreation, development and refinement took place over 6 months during 2021. The collaboration relied on virtual meetings, emails, telephone calls and document review.ResultsA codesigned NMAHP embedded research (ER) model is ready for trialling with the individual being an existing clinician working collaboratively within the healthcare setting and with academia to develop the skills to become the ER.ConclusionThis model supports NMAHP-led research activity in clinical organisations in a visible and manageable way. As a shared, long-term vision, the model will contribute to research capacity and capability of the wider healthcare workforce. It will lead, facilitate and support research in and across clinical organisations in collaboration with higher education institutions.
Changing estimates of leadership ability before a programme: retrospective self-assessments and response-shift bias
Authors: Lyons Oscar , Kingsley-Smith Harry , Kotze Koot , Nandra Karandeep , Galante Joao R , Fahy Nicholas , Canter Richard 
Published: May 2022

BackgroundMost evaluations of clinical leadership development programmes rely on self-assessments. Self-assessments are vulnerable to response-shift bias. Using retrospective then-tests may help to avoid this bias.In this study, we investigate whether post-programme then-tests (retrospective self-assessments) are more sensitive to change in clinical leadership development programme participants than traditional pre-programme pre-tests when paired with post-test self-assessments.Methods17 healthcare professionals participated in an 8-month single-centre multidisciplinary leadership development programme. Participants completed prospective pre-test, retrospective then-test and traditional post-test self-assessments using the Primary Colours Questionnaire (PCQ) and Medical Leadership Competency Framework Self-Assessment Tool (MLCFQ). Pre–post pairs and then–post pairs were analysed for changes using Wilcoxon signed-rank tests and compared with a parallel multimethod evaluation organised by Kirkpatrick levels.ResultsA greater number of significant changes were detected using then-test pairs than pre-test pairs for both the PCQ (11 of 12 vs 4 of 12 items) and MLCFQ (7 of 7 vs 3 of 7 domains). The multimethods data showed positive outcomes at all Kirkpatrick levels.ConclusionsIn ideal circumstances, both pre-test and then-test evaluations should be conducted. We cautiously suggest that if only one post-programme evaluation can be conducted, then-tests may be appropriate means of detecting change.
Impact of leadership on the nursing workforce during the COVID-19 pandemic
Authors: Phillips Natasha , Hughes Luke , Vindrola-Padros Cecilia , Petrella Anika , Fern Lorna A , Panel-Coates Flo , Taylor Rachel M 
Published: May 2022

BackgroundThe aim was to determine how the learning about protective factors from previous pandemics was implemented and the impact of this on nurses’ experience.MethodsSecondary data analysis of semistructured interview transcripts exploring the barriers and facilitators to changes implemented to support the surge of COVID-19 related admissions in wave 1 of the pandemic. Participants represented three-levels of leadership: whole hospital (n=17), division (n=7), ward/department-level (n=8) and individual nurses (n=16). Interviews were analysed using framework analysis.ResultsKey changes that were implemented in wave 1 reported at whole hospital level included: a new acute staffing level, redeploying nurses, increasing the visibility of nursing leadership, new staff well-being initiatives, new roles created to support families and various training initiatives. Two main themes emerged from the interviews at division, ward/department and individual nurse level: impact of leadership and impact on the delivery of nursing care.ConclusionsLeadership through a crisis is essential for the protective effect of nurses’ emotional well-being. While nursing leadership was made more visible during wave 1 of the pandemic and processes were in place to increase communication, system-level challenges resulting in negative experiences existed. By identifying these challenges, it has been possible to overcome them during wave 2 by employing different leadership styles to support nurse's well-being. Challenges and distress that nurses experience when making moral decisions requires support beyond the pandemic for nurse’s well-being. Learning from the pandemic about the impact of leadership in a crisis is important to facilitate recovery and lessen the impact in further outbreaks.
Preoperative virtual video visits only: a convenient option that should be offered to caregivers beyond the pandemic
Authors: Dougherty Danielle , Thompson Allison R , Speck Karen Elizabeth , Perrone Erin E 
Published: May 2022

ObjectiveDuring the COVID-19 pandemic, our group implemented preoperative video visits (VVs) to limit physical contact. The aim of this study was to determine caregivers’ and providers’ perceptions of this practice and to determine feasibility for continuation.MethodsAll patients who had only a preoperative VV prior to an elective surgery were identified from March–October 2020. Caregivers, surgeons, and clinic staff were surveyed about their experiences.ResultsThirty-four preoperative VVs were followed by an elective surgery without a preceding in-person visit. Of the 31 caregiver surveys completed, the majority strongly agreed that the VV was more convenient (87%, n=27). Eighty-one percent (n=25) strongly agreed or agreed that the VV saved them money. Ninety-four percent (n=29) strongly agreed or agreed that they would choose the VV option again. Caregivers saved an average travel distance of 60.3 miles one way (range 6.1–480). Of the 13/17 providers who responded, 77% (n=10) expressed that the practice should continue.ConclusionsVirtual health became a necessity during the pandemic, and caregivers were overwhelmingly satisfied. Continuing VVs as an option beyond the pandemic may be a reasonable and effective way to help eliminate some of the hurdles that impede healthcare-seeking behavior and should be offered.
No black hole bomb for D-dimensional extremal Reissner–Nordstrom black holes under charged massive scalar perturbation
Authors: Huang Jia-Hui 
Published: May 2022

AbstractThe superradiant stability of asymptotically flat D-dimensional extremal Reissner–Nordstrom black holes under charged massive scalar perturbation is analytically studied. Recently, an analytical method has been proposed by the author and used to prove that five and six-dimensional extremal Reissner–Nordstrom black holes are superradiantly stable under charged massive scalar perturbation. We apply this analytical method in the D-dimensional extremal Reissner–Nordstrom black hole case and prove that there is no black hole bomb for D-dimensional Reissner–Nordstrom black hole under charged massive scalar perturbation and the system is superradiantly stable.