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    Providing Japanese health care information for international visitors: digital animation intervention.
    BMC Health Serv Res 2018 May 21;18(1):373. Epub 2018 May 21.
    Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
    Background: Over 24 million international visitors came to Japan in 2016 and the number is expected to increase. Visitors could be at a risk of illness or injury that may result in hospitalization in Japan. We assessed the effects of a four-minute digital animation titled Mari Info Japan on the level of anxiety experienced by international visitors to Japan. Read More

    Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study.
    BMC Health Serv Res 2018 May 21;18(1):372. Epub 2018 May 21.
    King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.
    Background: In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. Read More

    He Tamariki Kokoti Tau-Tackling Preterm: a data-linkage methodology to explore the clinical care pathway in preterm deliveries.
    BMC Health Serv Res 2018 May 21;18(1):374. Epub 2018 May 21.
    Centre for Women's Health Research-Te Tātai Hauora O Hine, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
    Background: Significant health inequities exist around maternal and infant health for Māori, the indigenous people of Aotearoa New Zealand - and in particular around a premature (preterm) delivery. Māori babies are more likely to be born preterm (8.1%, compared to an overall rate of 7. Read More

    Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries.
    BMC Health Serv Res 2018 May 18;18(1):371. Epub 2018 May 18.
    European Observatory on Health Systems and Policies, Berlin University of Technology, Straße des 17. Juni 135, 10623, Berlin, Germany.
    Background: Countries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques. The article examines trends in OOP spending in ten high-income countries since 2000, and analyzes their relationship to self-assessed barriers to accessing health care services. The countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Read More

    Does multidisciplinary rehabilitation of tortured refugees represent 'value-for-money'? A follow-up of a Danish case-study.
    BMC Health Serv Res 2018 May 18;18(1):365. Epub 2018 May 18.
    Danish Institute Against Torture, Bryggervangen 55, 2100, Copenhagen, Denmark.
    Background: The recent surge of asylum seekers in the European Union (EU) is raising questions about the EU's ability to integrate newcomers into the economy and into society; particularly those who need specialized services for the treatment of severe trauma. This study investigated whether rehabilitating traumatised refugees represents 'value-for-money' (VfM) in terms of intervention cost per health gain and in a long-term and societal perspective.

    Methods: The economic evaluation comprised a cost-utility analysis (CUA) and a partial cost-benefit analysis (CBA). Read More

    Resilience, trust, and civic engagement in the post-CCSVI era.
    BMC Health Serv Res 2018 May 16;18(1):366. Epub 2018 May 16.
    Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Illinois, Canada.
    Background: Scientific and financial investments in chronic cerebrospinal venous insufficiency (CCSVI) research have been made to address both the hope for and scepticism over this interventional strategy for MS. Despite limited evidence in support of the CCSVI hypothesis, the funding of clinical research was responsive to a demand by the public rarely seen in the history of medicine. We characterize patient perspectives about the CCSVI research trajectory, with particular attention to its impact on other non-pharmaceutical areas of MS research with a focus on stem cell interventions. Read More

    Racial/ethnic disparities among Asian Americans in inpatient acute myocardial infarction mortality in the United States.
    BMC Health Serv Res 2018 May 16;18(1):370. Epub 2018 May 16.
    General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA.
    Background: Acute myocardial infarction (AMI) is a common high-risk disease with inpatient mortality of 5% nationally. But little is known about this outcome among Asian Americans (Asians), a fast growing racial/ethnic minority in the country. The objectives of the study are to obtain near-national estimates of differences in AMI inpatient mortality between minorities (including Asians) and non-Hispanic Whites and identify comorbidities and sociodemographic characteristics associated with these differences. Read More

    A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol.
    BMC Health Serv Res 2018 May 16;18(1):368. Epub 2018 May 16.
    Department of Communication Studies, Northwestern University, 240 Campus Drive, Rm 2-118, Evanston, IL, 60208, USA.
    Background: The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Read More

    The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis.
    BMC Health Serv Res 2018 May 16;18(1):367. Epub 2018 May 16.
    Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 19107, USA.
    Background: Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. Read More

    Delay in reviewing test results prolongs hospital length of stay: a retrospective cohort study.
    BMC Health Serv Res 2018 May 16;18(1):369. Epub 2018 May 16.
    Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
    Background: Failure in the timely follow-up of test results has been widely documented, contributing to delayed medical care. Yet, the impact of delay in reviewing test results on hospital length of stay (LOS) has not been studied. We examine the relationship between laboratory tests review time and hospital LOS. Read More

    NEGOTIATING HEALTH: patients' and guardians' perspective on "failed" patient-professional interactions in the context of the Swedish health care system.
    BMC Health Serv Res 2018 May 11;18(1):361. Epub 2018 May 11.
    Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, 171 77, Stockholm, Sweden.
    Background: Sweden has a largely tax-funded health care system that aims at providing equal access for everyone. However, the individual's perception and experience of the health care system remains a relevant topic for researchers. The aim of this study is to learn the patient's perspective on how patients and professionals negotiate in the social context of the Swedish health care system. Read More

    Physical violence against health staff by mentally ill patients at a psychiatric hospital in Botswana.
    BMC Health Serv Res 2018 May 11;18(1):362. Epub 2018 May 11.
    Department of Family Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
    Background: Workplace violence is worrisome in the mental health sector. Little is understood about it in sub-Saharan Africa. Consequently, we decided to investigate the prevalence, related factors, and the available sources of support for the victims of workplace violence in a mental referral hospital in Botswana. Read More

    Assessment of modern contraceptives continuation, switching and discontinuation among clients in Pakistan: study protocol of 24-months post family planning voucher intervention follow up.
    BMC Health Serv Res 2018 May 11;18(1):359. Epub 2018 May 11.
    Public Health Consultant, Islamabad, Pakistan.
    Background: Pakistan has the second highest fertility rate in South Asia and its increasing population growth presents a significant challenge for country's path to progress and development. Modern contraceptive methods only account for a slow-rising 26% of use in Pakistan which is further lowest in the underserved areas (< 20%), with a high unmet need for family planning (20%). The David and Lucile Packard Foundation USA and Pakistan funded two operational research projects from 2012 to 2015, that employed a Demand-side Financing (DSF) approach testing the effectiveness of single and multi-purpose voucher schemes in increasing access and uptake of FP services and products among the women of two-lowest income quintiles in the Punjab province of Pakistan. Read More

    Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type.
    BMC Health Serv Res 2018 May 11;18(1):360. Epub 2018 May 11.
    University of California, San Francisco, USA.
    Background: Low use of maternal health services, as well as poor quality care, contribute to the high maternal mortality in sub-Saharan Africa (SSA). In particular, poor person-centered maternity care (PCMC), which captures user experience, contributes both directly to pregnancy outcomes and indirectly through decreased demand for services. While many studies have examined disparities in use of maternal health services, few have examined disparities in quality of care, and none to our knowledge has empirically examined disparities in PCMC in SSA. Read More

    Responding to excessive alcohol consumption in third-level (REACT): a study protocol.
    BMC Health Serv Res 2018 May 11;18(1):364. Epub 2018 May 11.
    REACT Project, Student Health Department, University College Cork, Ardpatrick, College Road, Cork, Ireland.
    Background: Problem alcohol use is an ongoing, worldwide phenomenon of considerable concern. Throughout the past 20 years, national policies have noted the importance of students when tackling alcohol consumption. Considering alcohol is a multifaceted issue, a multi-component response is required to combat its excessive use. Read More

    Effectiveness of a multifaceted implementation strategy compared to usual care on low back pain guideline adherence among general practitioners.
    BMC Health Serv Res 2018 May 11;18(1):358. Epub 2018 May 11.
    Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University medical centre, Amsterdam, The Netherlands, and the Research Centre for Insurance Medicine, Collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
    Background: To improve patient care, and to reduce unnecessary referrals for diagnostic imaging and medical specialist care for low back pain, an evidence-based guideline for low back pain was developed in the Netherlands in 2010. The current study evaluated the effect of a multifaceted implementation strategy on guideline adherence among Dutch general practitioners.

    Methods: The implementation strategy included a multidisciplinary training, provision of educational material and an interactive website for healthcare professionals, supported by a multimedia eHealth intervention for patients with low back pain. Read More

    Clinic flow for STI, HIV, and TB patients in an urban infectious disease clinic offering point-of-care testing services in Durban, South Africa.
    BMC Health Serv Res 2018 May 11;18(1):363. Epub 2018 May 11.
    Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA.
    Background: Many clinics in Southern Africa have long waiting times. The implementation of point-of-care (POC) tests to accelerate diagnosis and improve clinical management in resource-limited settings may improve or worsen clinic flow and waiting times. The objective of this study was to describe clinic flow with special emphasis on the impact of POC testing at a large urban public healthcare clinic in Durban, South Africa. Read More

    Healthcare interpreter utilisation: analysis of health administrative data.
    BMC Health Serv Res 2018 May 10;18(1):348. Epub 2018 May 10.
    Centre for Applied Nursing Research (CANR), Ingham Institute, SWSLHD, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
    Background: Few people with limited English proficiency are provided with the services of a healthcare interpreter when admitted to hospital. This retrospective study utilised health administrative data to explore which patients with limited English proficiency were provided with a healthcare interpreter during their hospital admission.

    Method: A retrospective analysis of health administrative data for adult overnight-stay patients admitted to a public hospital in a region of significant cultural and linguistic diversity in Sydney, Australia in 2014-2015. Read More

    Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study.
    BMC Health Serv Res 2018 May 10;18(1):349. Epub 2018 May 10.
    Department of Medicine, University of Cape Town, Cape Town, South Africa.
    Background: Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. Read More

    The effects of integrated care: a systematic review of UK and international evidence.
    BMC Health Serv Res 2018 May 10;18(1):350. Epub 2018 May 10.
    School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK.
    Background: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context.

    Methods: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Read More

    Hospital financing of ischaemic stroke: determinants of funding and usefulness of DRG subcategories based on severity of illness.
    BMC Health Serv Res 2018 May 11;18(1):356. Epub 2018 May 11.
    Department of Neurology, Florey Institute of Neuroscience and Mental Health, University of Melbourne and Austin Health, Heidelberg, VIC, Australia.
    Background: Several Western and Arab countries, as well as over 30 States in the US are using the "All-Patient Refined Diagnosis-Related Groups" (APR-DRGs) with four severity-of-illness (SOI) subcategories as a model for hospital funding. The aim of this study is to verify whether this is an adequate model for funding stroke hospital admissions, and to explore which risk factors and complications may influence the amount of funding.

    Methods: A bottom-up analysis of 2496 ischaemic stroke admissions in Belgium compares detailed in-hospital resource use (including length of stay, imaging, lab tests, visits and drugs) per SOI category and calculates total hospitalisation costs. Read More

    A workforce survey of Australian osteopathy: analysis of a nationally-representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project.
    BMC Health Serv Res 2018 May 10;18(1):352. Epub 2018 May 10.
    Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones St, Sydney, NSW, 2007, Australia.
    Background: Limited information is available regarding the profile and clinical practice characteristics of the osteopathy workforce in Australia. This paper reports such information by analysing data from a nationally-representative sample of Australian osteopaths.

    Methods: Data was obtained from a workforce survey of Australian osteopathy, investigating the characteristics of the practitioner, their practice, clinical management features and perceptions regarding research. Read More

    Electronic health record tools to assist with children's insurance coverage: a mixed methods study.
    BMC Health Serv Res 2018 May 10;18(1):354. Epub 2018 May 10.
    OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
    Background: Children with health insurance have increased access to healthcare and receive higher quality care. However, despite recent initiatives expanding children's coverage, many remain uninsured. New technologies present opportunities for helping clinics provide enrollment support for patients. Read More

    Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research.
    BMC Health Serv Res 2018 May 11;18(1):357. Epub 2018 May 11.
    Fundamental and Medical-Surgical Nursing Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain.
    Background: There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Read More

    A critique of the Uganda district league table using a normative health system performance assessment framework.
    BMC Health Serv Res 2018 May 10;18(1):355. Epub 2018 May 10.
    Public Health Department, Institute of Tropical Medicine, 155 Nationalestraat, 2000, Antwerp, Belgium.
    Background: In 2003 the Uganda Ministry of Health (MoH) introduced the District League Table (DLT) to track district performance. This review of the DLT is intended to add to the evidence base on Health Systems Performance Assessment (HSPA) globally, with emphasis on Low and Middle Income Countries (LMICs), and provide recommendations for adjustments to the current Ugandan reality.

    Methods: A normative HSPA framework was used to inform the development of a Key Informant Interview (KII) tool. Read More

    What can organisational theory offer knowledge translation in healthcare? A thematic and lexical analysis.
    BMC Health Serv Res 2018 May 10;18(1):351. Epub 2018 May 10.
    School of Humanities and Communication Arts, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
    Background: Despite the relative abundance of frameworks and models to guide implementation science, the explicit use of theory is limited. Bringing together two seemingly disparate fields of research, this article asks, what can organisational theory offer implementation science? This is examined by applying a theoretical lens that incorporates agency, institutional, and situated change theories to understand the implementation of healthcare knowledge into practice.

    Methods: Interviews were conducted with 20 general practitioners (GPs) before and after using a resource to facilitate evidence-based sexual healthcare. Read More

    Assessing safety climate in acute hospital settings: a systematic review of the adequacy of the psychometric properties of survey measurement tools.
    BMC Health Serv Res 2018 May 10;18(1):353. Epub 2018 May 10.
    Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, 1,Horselethill Road, Glasgow, G12 9LX, UK.
    Background: The perceived importance of safety culture in improving patient safety and its impact on patient outcomes has led to a growing interest in the assessment of safety climate in healthcare organizations; however, the rigour with which safety climate tools were developed and psychometrically tested was shown to be variable. This paper aims to identify and review questionnaire studies designed to measure safety climate in acute hospital settings, in order to assess the adequacy of reported psychometric properties of identified tools.

    Methods: A systematic review of published empirical literature was undertaken to examine sample characteristics and instrument details including safety climate dimensions, origin and theoretical basis, and extent of psychometric evaluation (content validity, criterion validity, construct validity and internal reliability). Read More

    Spatial accessibility to healthcare services in Shenzhen, China: improving the multi-modal two-step floating catchment area method by estimating travel time via online map APIs.
    BMC Health Serv Res 2018 May 9;18(1):345. Epub 2018 May 9.
    School of Urban Planning and Design, Peking University, Shenzhen, 518055, Guangdong, China.
    Background: Shenzhen has rapidly grown into a megacity in the recent decades. It is a challenging task for the Shenzhen government to provide sufficient healthcare services. The spatial configuration of healthcare services can influence the convenience for the consumers to obtain healthcare services. Read More

    Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.
    BMC Health Serv Res 2018 May 9;18(1):344. Epub 2018 May 9.
    African Population and Health Research Center, P.O Box 10787-00100, Nairobi, Kenya.
    Background: In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya.

    Methods: A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Read More

    Facilitating the implementation of clinical technology in healthcare: what role does a national agency play?
    BMC Health Serv Res 2018 May 10;18(1):347. Epub 2018 May 10.
    Department of Computer Science, University of Warwick, Warwick, CV4 7AL, UK.
    Background: Accelerating the implementation of new technology in healthcare is typically complex and multi-faceted. One strategy is to charge a national agency with the responsibility for facilitating implementation. This study examines the role of such an agency in the English National Health Service. Read More

    Unearthing how, why, for whom and under what health system conditions the antiretroviral treatment adherence club intervention in South Africa works: A realist theory refining approach.
    BMC Health Serv Res 2018 May 9;18(1):343. Epub 2018 May 9.
    School of Public Health, University of the Western Cape, Cape Town, South Africa.
    Background: Poor retention in care and suboptimal adherence to antiretroviral treatment (ART) undermine its successful rollout in South Africa. The adherence club intervention was designed as an adherence-enhancing intervention to enhance the retention in care of patients on ART and their adherence to medication. Although empirical evidence suggests the effective superiority of the adherence club intervention to standard clinic ART care schemes, it is poorly understood exactly how and why it works, and under what health system contexts. Read More

    Rationing cancer treatment: a qualitative study of perceptions of legitimate limit-setting.
    BMC Health Serv Res 2018 May 9;18(1):342. Epub 2018 May 9.
    Department of Guidelines and Professional Development, Norwegian Directorate of Health, PO Box 7000, St Olavs plass, 0130, Oslo, Norway.
    Background: Governments are facing tough choices about whether to fund new, promising but highly expensive drugs within the public healthcare system. Decisions that some drugs are not sufficiently beneficial relative to their cost to merit public funding are often contentious. The importance of making decisions that stakeholders can understand and accept as legitimate is increasingly recognized and is commonly understood to be a crucial component for stakeholder support and successful implementation. Read More

    Patient-directed self-management of pain (PaDSMaP) compared to treatment as usual following total knee replacement; a randomised controlled trial.
    BMC Health Serv Res 2018 May 10;18(1):346. Epub 2018 May 10.
    Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
    Background: Self-administration of medicines by patients whilst in hospital is being increasingly promoted despite little evidence to show the risks and benefits. Pain control after total knee replacement (TKR) is known to be poor. The aim of the study was to determine if patients operated on with a TKR who self-medicate their oral analgesics in the immediate post-operative period have better pain control than those who receive their pain control by nurse-led drug rounds (Treatment as Usual (TAU)). Read More

    Physician emigration from Germany: insights from a survey in Saxony, Germany.
    BMC Health Serv Res 2018 May 9;18(1):341. Epub 2018 May 9.
    Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
    Background: Physician migration has been gaining attention worldwide. In Germany, physician migration became a topic of interest in the context of the discussion about a shortage of physicians, for which one contributing factor may be physicians leaving the country. However, there is a lack of literature on "push" factors causing German physicians to leave. Read More

    Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada.
    BMC Health Serv Res 2018 May 8;18(1):339. Epub 2018 May 8.
    Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
    Background: Spending on cancer drugs has risen dramatically in recent years compared to other areas of health care, due in part to higher prices associated with newly approved drugs and increased demand for these drugs. Addressing this situation requires making difficult trade-offs between cost, harms, and ability to benefit when using public resources, making it important for policy makers to have input from many people affected by the issue, including citizens.

    Methods: In September 2014, a deliberative public engagement event was conducted in Vancouver, British Columbia (BC), on the topic of priority setting and costly cancer drugs. Read More

    Measuring productivity and its relationship to community health worker performance in Uganda: a cross-sectional study.
    BMC Health Serv Res 2018 May 9;18(1):340. Epub 2018 May 9.
    University Research Co., Bethesda, MD, USA.
    Background: To explore the nature of the relationship between and factors associated with productivity and performance among the community health volunteer (CHV) cadre (Village Health Teams, VHT) in Busia District, Eastern Uganda. The study was carried out to contribute to the global evidence on strategies to improve CHV productivity and performance.

    Methods: This cross-sectional study was conducted with 140 VHT members as subjects and respondents. Read More

    Psychiatric consultation requests by inpatient medical teams: an observational study.
    BMC Health Serv Res 2018 May 8;18(1):336. Epub 2018 May 8.
    Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
    Background: We describe the way psychiatric issues are addressed by inpatient medical teams through analysis of discussions of patients with behavioral health concerns and examination of teams' subsequent consultation practices.

    Methods: We observed morning rounds for nine inpatient medical teams for approximately month-long periods, for a total of 1941 observations. We compared discussions of patients admitted for behavioral health related medical conditions between those who did and did not receive a psychiatric consultation, developing categories to describe factors influencing consultation or other management. Read More

    Locum physicians' professional ethos: a qualitative interview study from Germany.
    BMC Health Serv Res 2018 May 8;18(1):333. Epub 2018 May 8.
    Institute of Work Science, Ruhr University Bochum, 44801, Bochum, Germany.
    Background: In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals. Read More

    How health system factors affect primary care practitioners' decisions to refer patients for further investigation: protocol for a pan-European ecological study.
    BMC Health Serv Res 2018 May 8;18(1):338. Epub 2018 May 8.
    Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
    Background: There is wide variation in the overall one-year relative cancer survival rates across Europe, and this is thought to indicate national variations in stage of disease at diagnosis. However, there is little evidence to explain how different national systems influence a primary care practitioner's (PCP's) referral decisions, and how these relate to the variation in survival rates. This study investigates the health system factors that influence the thinking of PCPs when faced with patients who may have cancer, how they compare across European countries, and how they relate to national one-year relative cancer relative survival rates. Read More

    The Staff Observation Aggression Scale - Revised (SOAS-R) - adjustment and validation for emergency primary health care.
    BMC Health Serv Res 2018 May 8;18(1):335. Epub 2018 May 8.
    National Centre for Emergency Primary Health Care, Uni Research Health, Kalfarveien 31, 5018, Bergen, Norway.
    Background: Many emergency primary health care workers experience aggressive behaviour from patients or visitors. Simple incident-reporting procedures exist for inpatient, psychiatric care, but a similar and simple incident-report for other health care settings is lacking. The aim was to adjust a pre-existing form for reporting aggressive incidents in a psychiatric inpatient setting to the emergency primary health care settings. Read More

    How well do services for young people with long term conditions deliver features proposed to improve transition?
    BMC Health Serv Res 2018 May 8;18(1):337. Epub 2018 May 8.
    Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.
    Background: For young people with long-term conditions, transition from child to adult-oriented health services is a critical period which, if not managed well, may lead to poor outcomes. There are features of transition services which guidance and research suggest improve outcomes. We studied nine such features, calling them 'proposed beneficial features': age-banded clinic; meet adult team before transfer; promotion of health self-efficacy; written transition plan; appropriate parent involvement; key worker; coordinated team; holistic life-skills training; transition manager for clinical team. Read More

    Exploring the networking behaviors of hospital organizations.
    BMC Health Serv Res 2018 May 8;18(1):334. Epub 2018 May 8.
    Department of Economic Studies, G. d'Annunzio University, Viale Pindaro 42, 65127, Pescara, Italy.
    Background: Despite an extensive body of knowledge exists on network outcomes and on how hospital network structures may contribute to the creation of outcomes at different levels of analysis, less attention has been paid to understanding how and why hospital organizational networks evolve and change. The aim of this paper is to study the dynamics of networking behaviors of hospital organizations.

    Methods: Stochastic actor-based model for network dynamics was used to quantitatively examine data covering six-years of patient transfer relations among 35 hospital organizations. Read More

    RECAPDOC - a questionnaire for the documentation of rehabilitation care utilization in individuals with disorders of consciousness in long-term care in Germany: development and pretesting.
    BMC Health Serv Res 2018 May 4;18(1):329. Epub 2018 May 4.
    Institute of Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Germany.
    Background: A multitude of different rehabilitation interventions and other specific health care services are offered for individuals with disorders of consciousness in long-term care settings. To investigate the association of those services and patient-relevant outcomes, a specific instrument to document the utilization of those services is needed. The purpose of this study was to develop such a questionnaire administered to caregivers in epidemiological studies or patient registries in Germany. Read More

    An evidence-based co-occurring disorder intervention in VA homeless programs: outcomes from a hybrid III trial.
    BMC Health Serv Res 2018 May 5;18(1):332. Epub 2018 May 5.
    VA National Center on Homelessness among Veterans, Bedford, MA, 01730, USA.
    Background: Evidence-based treatment for co-occurring disorders is needed within programs that serve homeless Veterans to assist with increasing engagement in care and to prevent future housing loss. A specialized co-occurring disorders treatment engagement intervention called Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking - Veterans Edition (MISSION-Vet) was implemented within the Housing and Urban Development - Veterans Affairs Supportive Housing (HUD-VASH) Programs with and without an implementation strategy called Getting To Outcomes (GTO). While implementation was modest for the GTO group, no one adopted MISSION in the non-GTO group. Read More

    Interventions for improving management of chronic non-communicable diseases in Dikgale, a rural area in Limpopo Province, South Africa.
    BMC Health Serv Res 2018 May 4;18(1):331. Epub 2018 May 4.
    International Health Unit, University of Antwerp, Universiteitsplein 1, 2600, Antwerp, Belgium.
    Background: Chronic disease management (CDM) is an approach to health care that keeps people as healthy as possible through the prevention, early detection and management of chronic diseases. The aim of this study was to develop interventions to improve management of chronic diseases in the form of an integrated, evidence-based chronic disease management model in Dikgale, a rural area of Limpopo Province in South Africa.

    Methods: A multifaceted intervention, called 'quality circles' (QCs) was developed to improve the quality and the management of chronic diseases in the Dikgale Health and Demographic Surveillance System (HDSS). Read More

    Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties.
    BMC Health Serv Res 2018 May 4;18(1):328. Epub 2018 May 4.
    Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, 1919 W Taylor St (M/C 530), Chicago, IL, Chicago, Illinois, 60612, USA.
    Background: The US health care system uses diagnostic codes for billing and reimbursement as well as quality assessment and measuring clinical outcomes. The US transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) on October, 2015. Little is known about the impact of ICD-10-CM on internal medicine and medicine subspecialists. Read More

    Mundane? Demographic characteristics as predictors of enrolment onto the National Health Insurance Scheme in two districts of Ghana.
    BMC Health Serv Res 2018 May 4;18(1):330. Epub 2018 May 4.
    International Finance Corporation, Independence Ave. Ridge, CT, 2638, Accra, Ghana.
    Background: In 2003, Ghana passed a law to establish a National Health Insurance Scheme (NHIS) to serve as the main vehicle for achieving universal health coverage. Over 60% of the population had registered by 2009. Current active membership is however 40%. Read More

    Projection of future pharmacy service fees using the dispensing claims in hospital and clinic outpatient pharmacies: national health insurance database between 2006 and 2012.
    BMC Health Serv Res 2018 May 3;18(1):327. Epub 2018 May 3.
    School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, 16419, South Korea.
    Background: Predicting pharmacy service fees is crucial to sustain the health insurance budget and maintain pharmacy management. However, there is no evidence on how to predict pharmacy service fees at the population level. This study compares the status of pharmacy services and constructs regression model to project annual pharmacy service fees in Korea. Read More

    Unraveling the drivers of regional variation in healthcare spending by analyzing prevalent chronic diseases.
    BMC Health Serv Res 2018 May 3;18(1):323. Epub 2018 May 3.
    Tilburg University, Tranzo, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
    Background: To indicate inefficiencies in health systems, previous studies examined regional variation in healthcare spending by analyzing the entire population. As a result, population heterogeneity is taken into account to a limited extent only. Furthermore, it clouds a detailed interpretation which could be used to inform regional budget allocation decisions to improve quality of care of one chronic disease over another. Read More

    Multiple challenges of antibiotic use in a large hospital in Ethiopia - a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis.
    BMC Health Serv Res 2018 May 3;18(1):326. Epub 2018 May 3.
    Department of Social Pharmacy, School of Pharmacy, University of Oslo, P.O. Box 1068, 0316, Oslo, Norway.
    Background: This project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use.

    Method: The material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Read More

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