bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indoor solid fuel use for cooking and the risk of incidental non-fatal cardiovascular disease among middle-aged and elderly Chinese adults: a prospective cohort study
Authors: Ji Haoqiang , Chen Qian , Wu Ruiheng , Xu Jia , Chen Xu , Du Liang , Chen Yunting , Pan Yuanping , Duan Yuxin , Sun Meng , Zhou Ling 
Published: May 2022

ObjectivesThe harm of indoor air pollution to health has gradually attracted attention, but the effect of indoor air pollution from burning solid fuels on incidental non-fatal cardiovascular disease (CVD) is not well understood. Under these circumstances, this study examined the association between solid fuel use and incidental non-fatal CVD.DesignThe prospective cohort study was conducted in 2011, 2013, 2015 and 2018.SettingThe nationally representative survey was conducted in 28 provinces of China.ParticipantsThis study included 13 544 middle-aged and elderly adults without CVD in the baseline survey, and they were followed for 7 years.Outcome measuresFirst incidence of non-fatal CVD (heart disease or stroke).MethodsBased on longitudinal data, Cox proportional hazards models were used to assess the effects of solid fuel use and persistent use on incidental CVD events.ResultsDuring the 7-year follow-up period, there were 1533 non-fatal CVD cases. A total of 7310 (54%) participants used solid fuel for cooking at the baseline survey, and 2998 (41%) users continued to use solid fuel. Solid fuel use was associated with incidental non-fatal CVD (HR: 1.18; 95% CI: 1.05 to 1.32) compared with clean fuel, and persistent solid fuel use might lead to a higher risk of incidental non-fatal CVD (HR: 1.38; 95% CI: 1.18 to 1.61) and heart disease (HR: 1.49; 95% CI: 1.24 to 1.81). In the subgroup analysis, the relationship remained significant in the female, elderly, rural and hypertensive groups. However, we found no significant interaction between these risk factors and fuel use (all p<0.05).ConclusionsThis cohort study provides evidence for the effects of solid fuel use on incidental non-fatal CVD in middle-aged and elderly Chinese adults. Advocating for the use of clean energy and ventilation stoves is important to cardiovascular health.
Quality improvement in Kangaroo Mother Care: learning from a teaching hospital
Authors: Joshi Amol , Londhe Atul , Joshi Trupti , Deshmukh Laxmikant 
Published: May 2022

BackgroundKangaroo Mother Care (KMC) is a low-resource, evidence-based, high-impact intervention for low-birth weight (LBW) care. Quality improvement in KMC requires meso-level, macro-level and micro-level interventions. Our institution, a public teaching hospital, hosts a level-II/III neonatal intensive care unit (NICU). The average demand for beds typically exceeds available capacity, with 60% occupancy attributed to LBW patients. There was low uptake of KMC practice at our unit.Aim statementIn the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%–80% within 15 days. After a period of complacency, we revised the aim statement with a target of improving the percentage of babies receiving 6-hour KMC from 30% to 80% in 12 weeks.MethodsWe report this quasi-experimental time-series study. With the Point of Care Quality Improvement methodology, we performed Plan-Do-Study-Act (PDSA) cycles to improve KMC practice. We involved all the healthcare workers, mothers and caregivers to customise various KMC tools (KMC book format, KMC bag, mother’s gown) and minimise interruptions. Feedback from all levels guided our PDSA cycles.ResultsThe percentage of babies receiving at least 1-hour KMC increased from 20% to 100% within 15 days of August 2017. In the improvement phase, baseline 6-hour KMC coverage of 30% increased to 80% within 12 weeks (October–December 2017). It sustained for more than 2 years (January 2018 till February-2020) at 76.5%±2.49%.ConclusionsQuality improvement methods helped increase the coverage and percentage of babies receiving 6-hour KMC per day in our NICU. The duration specified KMC coverage should be adopted as the quality indicator of KMC. The training of healthcare workers and KMC provider should include hands-on sessions involving the mother and the baby. Maintaining data and providing suitable KMC tools are necessary elements for improving KMC. Minimising interruption is possible with family support and appropriate scheduling of activities. Having a designated KMC block helps in peer motivation.
An initiative to reduce medication errors in neonatal care unit of a tertiary care hospital, Kolkata, West Bengal: a quality improvement report
Authors: Mondal Sayantan , Banerjee Mukut , Mandal Shrabani , Mallick Asim , Das Nina , Basu Biswanath , Ghosh Ritu 
Published: May 2022

BackgroundMedication errors are an emerging problem in various hospital settings, especially in neonates. A study conducted in the neonatal care unit of a tertiary institute in Kolkata as baseline over 3 months, revealed total error to be around 71.1/100 prescriptions (median medication error percentage: 63%).PurposeTo assess the occurrences of medication errors and determine efficacy of Point-of-Care Quality improvement (POCQI) model in reducing the same from baseline 63% to less than 10%, in the above setting within next 9 months.Materials and methodsThis quality improvement initiative of quasi-experimental design comprised randomly selected prescriptions and monitoring sheets of neonates admitted in the neonatal care unit, obeying inclusion and exclusion criteria. Medication errors were assessed and categorised using a predesigned and pretested checklist. Interventions were planned after forming a quality improvement team in four plan–do–study–act (PDSA) cycles spanning over 6 weeks each (including training of doctors and nurses, signature and countersignatures of respective healthcare personnel, computer-generated prescriptions and newly designed software-generated prescriptions) as per POCQI model of the WHO and results in post-intervention phase (3 months) were compared.ResultsA total of 552 prescriptions and monitoring sheets of 124 neonates were studied. Median medication error percentages in first, second, third and fourth PDSA cycle were, respectively, 48%, 42%, 30% and 14%. Total error reduced to 10.4/100 prescriptions (p<0.005), with significant reduction in erred dosage, timing, interval, preparation and rate of infusion of drugs in prescriptions of the post-intervention phase.ConclusionImplementation of change ideas via PDSA cycles, as per the POCQI model with technological aid, significantly decreased the percentage of medication errors in neonates, which was also sustained in the post-intervention phase and facilitated error-free prescriptions.
Obstetric triage improvement process using the Donabedian model of quality care: a quality improvement initiative
Authors: Naz Sumaira , Saleem Shamila , Shamsul Islam Zaheena , Bhamani Shelina , Sheikh Lumaan 
Published: May 2022

Obstetric triage has become one of the most crucial innovations in the field of perinatal care in the past 15 years. In lower- middle- income countries (LMICs), the pregnant patients are seen in a conventional way based on the time of their arrival; this divergent, unbalanced and inequitable approach results in delayed initial evaluation, prolonged length of stay (LOS) and affected clinical outcomes.This project aimed at implementing an effective and efficient obstetric triage system with improved throughput and care processes within six months to facilitate timely decision making according to the individualized needs of pregnant patients.A pre-implementation audit was completed for the core evaluation of existing obstetric triage services, followed by a fishbone analysis. Following the Donabedian model for quality care, a quality improvement project was initiated to redesign the obstetric triage system. The project strategy was implemented as part of six PDSA (Plan- Do -Study- Act) cycles to optimize the structure, processes, and obstetric triage outcomes. The triage paradigm moved from time-based care delivery to priority care, and processes were improved based on Angelini’s recommendations of best practices in obstetric triage. During the initial phase of improvement, the identified outcome measures were waiting time of 5 minutes from arrival to initial assessment, LOS of 120 minutes, and acuity-based care for at least 50% of patients. A post-implementation audit was conducted to assess improvements. The results showed that the LOS at triage reduced from 240 min (4 hours) to 60 min (1 hour) within 6 months. Furthermore, wait times for triage decreased significantly to 5 min in 65% of patients, compared with 6% in traditional triage practice.The results indicate that the traditional triage model of the ‘order of arrival’ process is inefficient in providing adequate obstetric care. This quality initiative facilitated the successful incorporation of the Donabedian model and best practice triage practices and helped achieve desired outcomes of improved LOS and reduced waiting time with acuity-based care. Therefore, the design of an efficient,and the appropriate obstetric triage system can be adopted by other healthcare institutions in a local setting that can facilitate patient centric care.
Exploring paediatricians’ experiences with performance improvement modules and quality improvement
Authors: Hendricks Justin J , Theis Ryan , Mann Keith J , Turner Adam L , Filipp Stephanie L , Leslie Laurel K , Rosenthal Cameron , Byrne Alexandra , Black Erik , Thompson Lindsay A 
Published: May 2022

ObjectiveThe American Board of Pediatrics’ (ABP) maintenance of certification (MOC) programme seeks to continue educating paediatricians throughout their careers by encouraging lifelong learning and continued improvement. The programme includes four parts, each centring on a different aspect of medical practice. Part 4 MOC centres on quality improvement (QI). Surveys by the ABP suggest that paediatricians are dissatisfied with aspects of part 4, but their reasons are unclear. This study sought to explore factors contributing to dissatisfaction with part 4 by focusing on performance improvement modules (PIMs), a popular means of achieving part 4 credit.MethodsThe study used cross-sectional purposive sampling drawing from US physicians working in a range of practice settings: private outpatient, hospital, academic and low-income clinics. The sampling frame was divided by practice characteristics and satisfaction level, derived from a five-point Likert item asking about physician satisfaction regarding a recent PIM. In-depth interviews were conducted with 21 physicians, and the interview data were coded, categorised into themes and analysed using a framework analysis approach.ResultsPaediatricians expressed nuanced views of PIMs and remain globally dissatisfied with part 4, although reasons for dissatisfaction varied. Concerns with PIMs included: (1) excessive time and effort; (2) limited improvement and (3) lack of clinically relevant topics. While most agreed that QI is important, participants felt persistently dissatisfied with the mechanics of doing PIMs, especially when QI tasks fell outside of their typical work regimen.ConclusionsPaediatricians agreed that part 4, PIMs, and QI efforts in general still lack clinical relevance and need to be more easily incorporated into practice workflow. Clinicians specifically felt that PIMs must be directly integrated with physicians’ practice settings in terms of topic, data quality and metrics, and must address practice differences in time and monetary resources for completing large or complex projects.
How to improve hospital admission screening for patients at risk of multidrug-resistant organism carriage: a before-and-after interventional study and cost-effectiveness analysis
Authors: Joubert Dominique , Cullati Stephane , Briot Pascal , Righi Lorenzo , Grauser Damien , Ourahmoune Aimad , Chopard Pierre 
Published: May 2022

BackgroundInfection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings.MethodsIn the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record ‘order-set’ including AS and AP compliance indicators was designed. We compared the cost–benefit of the audits and the automated indicators for AS and AP compliance.ResultsCompliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested.ConclusionTraining ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
Association of water, sanitation, hygiene and food practices with enteric fever in a paediatric cohort in North India
Authors: Dudeja Nonita , Sinha Bireshwar , Goyal Nidhi , Arya Alok , Revi Anitha , Dutta Ankita , More Deepak , Chakravarty Aparna , Kumar Chandra Mohan , Rongsen-Chandola Temsunaro 
Published: May 2022

BackgroundOur aim was to assess the association of water, sanitation and hygiene (WASH) and food practices with culture-confirmed enteric fever in children <15 years of age.MethodsWe followed a cohort of 6000 children from an urban low socioeconomic neighbourhood in South Delhi for 2 years to estimate burden of culture-confirmed enteric fever. Risk ratios (RRs) were estimated to study the association between WASH practices and enteric fever. We assessed the microbiological quality of drinking water and conducted geospatial analysis to evaluate the distribution of enteric fever cases around households with contaminated drinking water.ResultsA total of 5916 children in 3123 households completed survey. Piped water (82%) was the major source of household drinking water. One-third (32%) of the households treated water before consumption. Almost all households had sanitary toilets (99.9%) and 16% used shared toilets. Consumption of food from street vendors and unnamed ice creams more than once a week was observed in children from 12.7% and 38.4% households, respectively. Eighty culture-confirmed enteric fever cases were reported. The risk of enteric fever was 71% higher in children belonging to households having food from outside once a week or more (RR 1.71, 95% CI 1.00 to 2.94). The RR for enteric fever in children living in households with availability of safe drinking water was 0.75 (95% CI 0.45 to 1.26). We found that 14.8% of the households had presence of coliforms or Escherichia coli in their household drinking water. The odds of having a case of enteric fever within a 5 and 25 m buffer zone around households with contaminated drinking water were 4.07 (95% CI 0.81 to 20.5) and 1.44 (95% CI 0.69 to 3.00), respectively.ConclusionIn addition to WASH practices, optimal food hygiene may have a role in urban low socioeconomic population to control enteric fever.Trial registration numberCTRI/2017/09/009719.
Variation in initial health assessment of unaccompanied asylum-seeking children: a cross-sectional survey across England
Authors: Nezafat Maldonado Behrouz , Armitage Alice Jane , Williams Bhanu 
Published: May 2022

ObjectiveTo assess variation in current practice of initial health assessments (IHAs) for unaccompanied asylum-seeking children (UASC) across England.DesignCross-sectional survey.Main outcomes measuresType of routine assessment carried out, threshold to specialist referrals and facilities available to complete IHA.ResultsEighty-six health professionals responded across England; 47% had received training in UASC IHA and 33% in UASC mental health issues. The majority (80%) of IHAs were conducted with translator support and 7% of participants reported Child and Adolescent Mental Health Services (CAMHS) input. Around half of clinicians (53%) performed tuberculosis and bloodborne virus screening for all UASC, while other infectious diseases (IDs) screening was symptom and risk factor dependent. Overall, 14% of clinicians routinely comment on age assessment and 76% share the IHA report and health plan with UASC. The time allocated for assessment range between 30 and 90 min.ConclusionThere is significant variation in practice around UASC IHAs across England, notably around CAMHS input, time allocated, translation facilities and ID screening. The results suggest that, an increase in resources available for UASC teams, improved access to specialist services and further training on UASC health are all needed. Guidance that aims to set a best practice framework for UASC IHA delivery such as a ‘one-stop shop’ model would help to standardise UASC IHA across the country.
Assessing Open Science practices in physical activity behaviour change intervention evaluations
Authors: Norris Emma , Sulevani Isra , Finnerty Ailbhe N , Castro Oscar 
Published: May 2022

ObjectivesConcerns on the lack of reproducibility and transparency in science have led to a range of research practice reforms, broadly referred to as ‘Open Science’. The extent that physical activity interventions are embedding Open Science practices is currently unknown. In this study, we randomly sampled 100 reports of recent physical activity randomised controlled trial behaviour change interventions to estimate the prevalence of Open Science practices.MethodsOne hundred reports of randomised controlled trial physical activity behaviour change interventions published between 2018 and 2021 were identified, as used within the Human Behaviour-Change Project. Open Science practices were coded in identified reports, including: study pre-registration, protocol sharing, data, materials and analysis scripts sharing, replication of a previous study, open access publication, funding sources and conflict of interest statements. Coding was performed by two independent researchers, with inter-rater reliability calculated using Krippendorff’s alpha.Results78 of the 100 reports provided details of study pre-registration and 41% provided evidence of a published protocol. 4% provided accessible open data, 8% provided open materials and 1% provided open analysis scripts. 73% of reports were published as open access and no studies were described as replication attempts. 93% of reports declared their sources of funding and 88% provided conflicts of interest statements. A Krippendorff’s alpha of 0.73 was obtained across all coding.ConclusionOpen data, materials, analysis and replication attempts are currently rare in physical activity behaviour change intervention reports, whereas funding source and conflict of interest declarations are common. Future physical activity research should increase the reproducibility of their methods and results by incorporating more Open Science practices.
End-of-life decisions in neonates and infants: a nationwide mortality follow-back survey
Authors: Dombrecht Laure , Beernaert Kim , Chambaere Kenneth , Cools Filip , Goossens Linde , Naulaers Gunnar , Cornette Luc , Laroche Sabrina , Theyskens Claire , Vandeputte Christine , Van de Broek Hilde , Cohen Joachim , Deliens Luc 
Published: May 2022

ObjectivesNeonatology has undergone important clinical and legal changes; however, the implications for end-of-life decision-making in seriously ill neonates to date are unknown. Our aim was to examine changes in prevalence and characteristics of end-of-life decisions (ELDs) in neonatology.MethodsWe performed a nationwide mortality follow-back survey in August 1999 to July 2000 and September 2016 to December 2017 in Flanders, Belgium. Data were linked to information from death certificates. For each death under the age of 1, physicians were asked to complete an anonymous questionnaire about which ELDs were made preceding death.ResultsThe response rate was 87% in 1999–2000 (253/292) and 83% in 2016–2017 (229/276). The proportion of deaths of infants born before 26 weeks’ gestation was increased (14% vs 34%, p=0.001). Prevalence of ELDs remained stable at 60%, with non-treatment decisions occurring in about 35% of all deaths. Use of medication with an explicit life-shortening intention was prevalent in 7%–10% of all deaths. In early neonatal death (<7 days old) medication with an explicit life-shortening intention decreased from 12% to 6%, in late neonatal death (7–27 days old), it increased from 0% to 26%, and in postneonatal death (>27 days old), it increased from 2% to 10%.ConclusionsOver a timespan of 17 year, the prevalence of neonatal ELDs has remained stable. A substantial number of deaths was preceded by the intentionally hastening of death by administrating medication. While surveying solely the physician perspective in this paper, there is a need for an open multidisciplinary debate, including, for example, nursing staff and family members, based on clinical as well as ethical and jurisdictional reflections to discuss the need for international guidelines.
Fentanyl titration for cancer pain: continuous subcutaneous injection and a once-daily transdermal patch – case series
Authors: Sakaguchi Tatsuma , Kajiyama Toru , Miyake Mafumi , Katayama Toshiro 
Published: May 2022

ObjectivesContinuous subcutaneous injection (CSCI) followed by a once-daily transdermal patch is a reasonable strategy for rapid titration of fentanyl in patients with cancer pain who are unable to take oral medication or have renal impairment, but the effectiveness and safety have not been demonstrated.MethodsMedical records of patients with moderate to severe cancer pain who underwent titration of fentanyl by CSCI between October 2019 and October 2021 at Kitano Hospital, Osaka, Japan, were retrospectively reviewed. The dose of fentanyl was increased to a maximum of 0.05 mg/hour. If the dose was inadequate, the fentanyl patch was added on CSCI. When pain relief was adequate, CSCI was completely converted to the patch.ResultsThirty-three patients were enrolled. Titration was completed successfully in 28 patients (85%) over a median of 2 days. The average Numeric Rating Scale for pain decreased by at least 66% in 22 patients (67%) and by at least 33% in 7 (21%). After conversion to the patch, two patients (6.1%) required to increase the dose of fentanyl within a week. Two patients (6.1%) experienced moderate drowsiness during titration.ConclusionsFentanyl titration by CSCI is an effective and safe method for achieving rapid pain control.