bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of domestic violence among women of reproductive age (15–49 years) in Quetta, Balochistan—a mixed-method protocol
Authors: Soomar Salman Muhammad , Soomar Sarmad Muhammad 
Published: May 2022

BackgroundWorldwide, domestic violence (DV) is a cause of death and disability among women aged 15–49 years. In Pakistan, DV appears in different forms, and only 3.2% of women report any DV. There are various factors associated with DV against women. The data are sparse for the Balochistan province due to the under-reporting and scattered population. This research study aims to determine the factors associated with DV and the types of violence among women of reproductive age. Also, to understand the perspective of community leaders and healthcare workers (HCWs) for developing interventions for DV prevention against women of reproductive age in Quetta Balochistan.Methods and analysisA sequential explanatory mixed-method (quantitative study followed by qualitative) study design will be used to fulfil the study’s objectives. Women of reproductive age (15–49 years), both married and unmarried, local residents, community leaders and community HCWs of Quetta Balochistan, will be made part of the study. A structured questionnaire will be used as the quantitative tool. Focus group discussions will be conducted using a semistructured guide for the qualitative data collection. The multivariable logistic regression analysis will be performed for the quantitative part. P value ≤0.05 will be considered significant. In the qualitative part, data will be transcribed, and recurrent themes/subthemes will be developed to understand the perspective and opinion regarding DV prevention.Ethics and disseminationEthical Approval was taken from Aga Khan University, Karachi, Pakistan. Informed written consent will be obtained from all participants. The article will be published after data collection and analysis in the journal to disseminate the results.
Associations of hospital volume and hospital competition with short-term, middle-term and long-term patient outcomes after breast cancer surgery: a retrospective population-based study
Authors: van der Schors Wouter , Kemp Ron , van Hoeve Jolanda , Tjan-Heijnen Vivianne , Maduro John , Vrancken Peeters Marie-Jeanne , Siesling Sabine , Varkevisser Marco 
Published: May 2022

ObjectivesFor oncological care, there is a clear tendency towards centralisation and collaboration aimed at improving patient outcomes. However, in market-based healthcare systems, this trend is related to the potential trade-off between hospital volume and hospital competition. We analyse the association between hospital volume, competition from neighbouring hospitals and outcomes for patients who underwent surgery for invasive breast cancer (IBC).Outcome measuresSurgical margins, 90 days re-excision, overall survival.Design, setting, participantsIn this population-based study, we use data from the Netherlands Cancer Registry. Our study sample consists of 136 958 patients who underwent surgery for IBC between 2004 and 2014 in the Netherlands.ResultsOur findings show that treatment types as well as patient and tumour characteristics explain most of the variation in all outcomes. After adjusting for confounding variables and intrahospital correlation in multivariate logistic regressions, hospital volume and competition from neighbouring hospitals did not show significant associations with surgical margins and re-excision rates. For patients who underwent surgery in hospitals annually performing 250 surgeries or more, multilevel Cox proportional hazard models show that survival was somewhat higher (HR 0.94). Survival in hospitals with four or more (potential) competitors within 30 km was slightly higher (HR 0.97). However, this effect did not hold after changing this proxy for hospital competition.ConclusionsBased on the selection of patient outcomes, hospital volume and regional competition appear to play only a limited role in the explanation of variation in IBC outcomes across Dutch hospitals. Further research into hospital variation for high-volume tumours like the one studied here is recommended to (i) use consistently measured quality indicators that better reflect multidisciplinary clinical practice and patient and provider decision-making, (ii) include more sophisticated measures for hospital competition and (iii) assess the entire process of care within the hospital, as well as care provided by other providers in cancer networks.
Role of neighbourhood social characteristics in children’s use of mental health services between ages 9 and 13 years: a population-based cohort study in the Netherlands
Authors: Eijgermans Diana G.M. , Boelens Mirte , Oude Groeniger Joost , van der Zanden Wim H.M. , Jansen Pauline W. , Raat Hein , Jansen Wilma 
Published: May 2022

ObjectivesThis study aims to investigate the association of neighbourhood socioeconomic status (SES) and social cohesion (SC) within the neighbourhood with mental health service use in children, independent of individual-level characteristics and mental health problems.Design, setting and participantsA longitudinal analysis was done using data from the Generation R Study, a prospective, population-based cohort of children born in Rotterdam, the Netherlands. These data were linked to the Neighbourhood Profile, containing registry and survey data on residents of Rotterdam. Data of 3403 children (mean age: 13.6 years, SD: 0.4) were used to study the associations between neighbourhood SES, SC (SC belonging and SC relations) and mental health service use, adjusted for mental health problems and sociodemographic characteristics.Outcome measuresMental health service use was reported by the accompanying parent at the research centre using the question: ‘Did your child visit a psychologist or psychiatrist between 9 and 13 years old?’.ResultsMental health services were used by 524 (15.4%) children between ages 9 and 13 years. No significant differences in mental health service use between neighbourhoods were identified (median OR: 1.07 (p=0.50)). The neighbourhood social characteristics were associated with mental health service use, but only when adjusted for each other. Children living in neighbourhoods with a low SES (OR 0.57 (95% CI 0.32 to 1.00)) or high SC belonging (OR 0.79 (95% CI 0.64 to 0.96)) were less likely to use services compared with children in a high SES or low SC belonging neighbourhood. SC relations was not associated with mental health service use.ConclusionsOur findings indicate that children living in high SES neighbourhoods or in neighbourhoods where people feel less sense of belonging are more likely to use mental health services. As these associations were only present when studied jointly, more research is warranted on the complex associations of neighbourhood factors with children’s mental health service use.
Prescription of cardiovascular medication in children with congenital heart defects across six European Regions from 2000 to 2014: data from the EUROlinkCAT population-based cohort study
Authors: Damkjaer Mads , Urhoj Stine Kjaer , Tan Joachim , Briggs Gillian , Loane Maria , Given Joanne Emma , Barrachina-Bonet Laia , Cavero-Carbonell Clara , Coi Alessio , Neville Amanda J , Heino Anna , Kiuru-Kuhlefelt Sonja , Jordan Susan , Scanlon Ieuan , Pierini Anna , Puccini Aurora , Garne Ester , Morris Joan K 
Published: May 2022

ObjectivesAdvances in surgical management strategies have substantially reduced fatality from congenital heart defects (CHD). Decreased infant mortality might be expected, consequentially to result in greater morbidity in older children due to complications later in childhood and adolescence. This study aims to evaluate the use of cardiovascular medication (CVM) as an indicator of disease burden in children born with CHD in the first 10 years of life.DesignPopulation-based cohort study.SettingSix population-based registries from the European Surveillance of Congenital Anomalies (EUROCAT) network participated. Data from live born children with major congenital anomalies (CA) born from 2000 to 2014 were linked to prescription databases. Four groups of children were analysed: CA, CHD, severe CHD (sCHD) and ventricular septal defect (VSD) without sCHD. Live born children without CA were included as reference group.ParticipantsWe obtained data on 61 038 children born with a CA, including 19 678 with CHD, 3392 with sCHD, 12 728 children with VSD without sCHD, and 1 725 496 reference children.ResultsChildren born with sCHD were the most likely to receive a CVM prescription (42.9%, 95% CI, 26.3 to 58.5) in the first year of life compared with 13.3% (6.7 to 22.0) of children with any CHD, 5.9% (3.7 to 8.7) of children with any CA and 0.1% (0.0 to 0.1) of reference children. Medication was less likely to be prescribed after the first year of life for sCHD; 18.8% (14.8 to 23.1) for children 1–4 years and 15.8% (12.0 to 20.1) 5–9 years. Children with sCHD were most likely to receive a diuretic (36.4%, 18.6 to 54.5), an antihypertensive (6.9%, 3.7 to 11.3) or a beta-blocker (5.5%, 2.9 to9.2).ConclusionAlmost half of all children with sCHD were prescribed CVM in their first year of life. For all four groups of children with anomalies, the proportion of children with a CVM prescription decreased with age.
Association of regulatory body actions and subsequent media coverage with use of services in a fee-for-service system: a longitudinal cohort study of CT scanning in Australia
Authors: Youens David , Doust Jenny , Ha Thi Ninh , O’Leary Peter , Slavotinek John , Wright Cameron , Moorin Rachael 
Published: May 2022

ObjectiveThe professional service review (PSR) is an Australian Government agency aiming to reduce inappropriate practices funded via Medicare, Australia’s public insurer. Our objective was to examine changes in CT following the 2008–2009 PSR annual report, which noted excessive CT use.DesignInterrupted time series analysis examined trends in CT use following the 2008–2009 PSR report, estimating both change in the immediate rate of CT and the slope of the trend in usage postintervention.SettingMedicare-funded imaging (most out-of-hospital imaging) in Australia.ParticipantsPatients receiving Medicare-funded CT and other imaging.InterventionThe 2008–2009 PSR report highlighted concerns regarding excessive CT use. Two providers were financially penalised for CT overuse with these cases detailed in the PSR report and highlighted in an associated Report to the Professions, distributed to 50 000 providers. Media articles on radiation risks followed.OutcomesQuarterly rates of out-of-hospital CT, MRI (as a comparator), and all other Medicare-funded diagnostic imaging examinations 2001–2019.ResultsCT scanning increased from 4663.5 per 100 000 person-years in 2001 to 14 506 in 2019 (211% increase), with substantial variation by type and anatomical region. The 2008–2009 PSR report was followed by an immediate reduction in CT scanning of 237.7 CTs per 100 000 people per quarter (95% CI −333.4 to −141.9) though growth in use soon continued at the preintervention rate. The degree of change in utilisation following the report differed between states/territories and by scan type, both in terms of the immediate change and the slope. For other diagnostic imaging modalities, there was an increase in the slope, while for MRI there was no change in either parameter.ConclusionActions consisting of financial disincentives for service overtesting and provider/public education components may limit excessive use of diagnostic imaging in fee-for-service systems, however, effects observed here were only short lived.
Does healthcare system device volume correlate with price paid for spinal implants: a cross-sectional analysis of a national purchasing database
Authors: Cahan Eli , McFarlane Kelly , Segovia Nicole , Chawla Amanda , Wall James , Shea Kevin 
Published: May 2022

ObjectivesAmid continuously rising US healthcare costs, particularly for inpatient and surgical services, strategies to more effectively manage supply chain expenses are urgently necessary. Across industries, the ‘economy of scale’ principle indicates that larger purchasing volumes should correspond to lower prices due to ‘bulk discounts’. Even as such advantages of scale have driven health system mergers in the USA, it is not clear whether they are being achieved, including for specialised products like surgical implants which may be more vulnerable to cost inefficiency. The objective of this observational cross-sectional study was to investigate whether purchasing volumes for spinal implants was correlated with price paid.SettingUSA.ParticipantsMarket data based on pricing levels for spine implants were reviewed from industry implant price databases. Filters were applied to narrow the sample to include comparable institutions based on procedural volume, patient characteristics and geographical considerations. Information on the attributes of 619 health systems representing 12 471 provider locations was derived from national databases and analytics platforms.Primary outcome measureInstitution-specific price index paid for spinal implants, normalised to the national average price point achieved.ResultsA Spearman’s correlation test indicated a weak relationship between purchasing volume and price index paid (ρ=−0.35, p<0.001). Multivariable linear regression adjusting for institutional characteristics including type of hospital, accountable care organisation status, payer-mix, geography, number of staffed beds, number of affiliated physicians and volume of patient throughput also did not exhibit a statistically significant relationship between purchasing volume and price index performance (p=0.085).ConclusionsNational supply chain data revealed that there was no significant relationship between purchasing volume and price paid by health systems for spinal implants. These findings suggest that factors other than purchasing or patient volume are responsible for setting prices paid by health systems to surgical vendors and/or larger healthcare systems are not negotiating in a way to consistently achieve optimal pricing.
Patient disposition using the Emergency Severity Index: a retrospective observational study at an interdisciplinary emergency department
Authors: Völk Stefanie , Koedel Uwe , Horster Sophia , Bayer Andreas , D’Haese Jan G , Pfister Hans-Walter , Klein Matthias 
Published: May 2022

ObjectivesEarly patient disposition is crucial to prevent crowding in emergency departments (EDs). Our study aimed to characterise the need of in-house resources for patients treated in the ED according to the Emergency Severity Index (ESI) and the presenting complaint at the timepoint of triage.DesignA retrospective single-centre study was conducted.SettingData of all patients who presented to the interdisciplinary ED of a tertiary care hospital in Munich, Germany, from 2014 to 2017 were analysed.Participantsn=113 694 patients were included.MeasuresESI Score, medical speciality according to the chief complaint, mode of arrival, admission rates and discharge destination from the ED were evaluated.ResultsPatient disposition varied according to ESI scores in combination with the chief complaint. Patients with low ESI scores were more likely to be admitted after treatment in the ED than patients with high ESI scores. Highly prioritised patients (ESI 1) mainly required admission to an intensive care unit (ICU, 27%), intermediate care unit (IMC, 37%) or immediate intervention (11%). In this critical patient group, 30% of patients with neurological or medical symptoms required immediate intensive care, whereas only 17% of patients with surgical problems were admitted to an ICU. A significant number of patients (particularly with neurological or medical problems) required hospital (and in some cases even ICU or IMC) admission despite high ESI scores.ConclusionsOverall, ESI seems to be a useful tool to anticipate the need for specialised in-hospital resources on arrival. Patients with symptoms pointing at neurological or medical problems need particular attention as ESI may fail to sufficiently predict the care facility level for this patient group.
Clinical guidelines of UTIs in children: quality appraisal with AGREE II and recommendations analysis
Authors: Zhu Binhui , Liu Yali , Wang Hui , Duan Fan , Mi Lan , Liang Ying 
Published: May 2022

ObjectiveTo explore the current Chinese and English guidelines of urinary tract infection (UTI) in children and provide a summary of the recommendations of the guidelines.MethodsAn electronic search was conducted on databases, including Pubmed, SinoMed, Wangfang Data, CHKD,VIP, NICE, WHO, GIN and Medliveto retrieve data of the clinical practice guidelines on UTI from the establishment of the database to June 2020. Four assessors assessed the quality of guidelines using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and evaluated the specific recommendations in guidelines.Results(1) Nine guidelines including two from the USA (AAP and A guideline for the inpatient care of children with pyelonephritis) and the remaining from EAU/ESPU, SINEPE, KHA-CARI, CPS, ISPN, NICE and CMA-CSP were explored. (2) The AGREE II evaluation demonstrated higher scores of UTI guidelines in terms of ‘scope and purpose’ (72.99%±11.19%) and ‘clarity of presentation’ (75.62%±7.75%), whereas the average scores were lower in the aspect of ‘stakeholder involvement’ (35.49%±14.41%), ‘rigour of development’ (37.05%±10.05%), ‘applicability’ (37.75%±11.98%) and ‘editorial independence’ (43.06%±48.14%). The average scores of the guidelines were as follows: SINePe (72.57%), CMA-CSP (62.96%), EAU/ESPU (59.61%), AAP (56.86%), NICE (47.54%), CPS (40.93%), KHA-CARI (38.86%), ISPN (38.63%) and A guideline for the inpatient care of children with pyelonephritis (34.72%). (3) All the selected guidelines basically reached a consensus on urine sample retention methods in older children, the antibiotic treatment course and renal and bladder ultrasonography application but lacked a conclusion on the determination of urine culture results, the choice of voiding cystourethrography and Tc-99mdimercaptosuccinicacid, and antibiotic prophylaxis.ConclusionThere remains a need to improve the quality of guidelinesfor UTI in clinical practice. Existing controversies on the current guidelines of UTI in some recommendations warrant further exploration to provide more evidence on formulating more unified and practical guidelines in the future.Ethics and disseminationNo ethical approval is required for this research, as it did not include patients or patient data.
Involving patients and clinicians in a pilot randomised clinical trial of spinal manual therapy versus nerve root injection for lumbar radiculopathy: protocol of a patient and public involvement project
Authors: Ryf Corina , Hofstetter Léonie , Clack Lauren , Puhan Milo A , Hincapié Cesar A 
Published: May 2022

IntroductionA patient and public involvement (PPI) project will be embedded within the SALuBRITY pilot trial, a two parallel group, double sham controlled, randomised clinical trial. The study aims to compare the effectiveness of spinal manual therapy and corticosteroid nerve root injections, two methods commonly used to treat patients with lumbar radiculopathy. We aim to gather patients’ and clinicians’ perspectives and involve them in decisions related to the research question and objectives, proposed trial recruitment processes and methods, and proposed outcome measures.Methods and analysisA small group of patients with lived experience of lumbar radiculopathy and primary care clinicians with experience in the treatment of patients with lumbar radiculopathy are involved. An initial kickoff event will prepare and empower the advisors for involvement in the project, followed by semistructured patient group and one-on-one clinician interviews. We will follow the Critical Outcomes of Research Engagement framework for assessing the impact of patient engagement in research. We will summarise and feedback PPI content to the patient and clinician advisors during a member-checking process to ensure accurate interpretation of patient and clinician inputs. Inductive and deductive thematic analysis will be used for the qualitative analysis of the interviews. Two surveys will be completed at different points along the trial to track the advisors’ and researchers’ experiences over the course of the PPI project. Any modifications to the SALuBRITY trial methods due to PPI inputs will be thoroughly documented and recorded in an impact log.Ethics and disseminationThe independent research ethics committee of Canton Zurich confirmed that ethical approval for this PPI subproject was not required. PPI results will be disseminated in a peer-reviewed journal and presented at conferences.
Impact of COVID-19 pandemic on acute stroke admissions and case-fatality rate in lower-income and middle-income countries: a protocol for systematic review and meta-analysis
Authors: Ackah Martin , Salifu Mohammed Gazali , Ameyaw Louise , Boakye Hosea , Yeboah Cynthia Osei 
Published: May 2022

IntroductionThe current review primarily aims to ascertain the impact of COVID-19 on stroke admission as well as stroke case fatality in Low-income and Middle-Income Countries (LMICs).Methods and analysisFour international databases (PubMed/Medline, Google Scholar, African Journals Online, Latin American and Caribbean Health Sciences Literature) and one preprint database (medRxiv). Studies will be included if they are conducted in LMICs, all stroke types without age and language restriction, from December 2019 to 31 December 2021. Two authors will screen the titles and abstracts against the prespecified eligibility criteria for inclusion in the review, and then repeat the process after retrieving the full text. Joanna Briggs critical appraisal checklist for analytical cross-sectional studies will be used for the quality assessment and risk of bias by two coauthors. The characteristics of the studies will be presented and summarised in a table. We aim to perform meta-analyses on a pooled proportional change in acute stroke admissions and case fatality with 95% CI using a random-effects meta-analysis. Publication bias will be assessed using funnel plot and Egger’s regression test if ≥10 studies are involved. A sub group analysis will be performed to determine the sources of heterogeneity. Leave-one-out sensitivity analysis will be performed to examine the impact of a single study on the overall pool estimate.Ethics and disseminationEthical approval is not required as this is secondary research and will use reported data in scientific literature. A full manuscript will be submitted to a reputable peer-review journal for publication and disseminated electronically and in print.PROSPERO registration numberCRD42021281580.