bluuebunny/crossref_metadata_2025 huggingface dataset:
Removal of Urea, β2-Microglobulin, and Indoxyl Sulfate Assessed by Absorbance and Fluorescence in the Spent Dialysate During Hemodialysis
Authors: Lauri Kai , Arund Jürgen , Holmar Jana , Tanner Risto , Kalle Sigrid , Luman Merike , Fridolin Ivo
Published: August 2019

In this study, simultaneous removal assessment of marker molecules from three uremic toxin groups was performed during different hemodialysis treatment modalities using optical characteristics of spent dialysate. Results from optical measurements were compared with the results from chemical laboratory. Ten chronic dialysis patients, mean age 59 ± 15 years, were included in the study during 40 hemodialysis sessions. Low-flux hemodialysis (HD), high-flux hemodialysis (HF), and postdilutional online hemodiafiltration (HDF) with different settings were used. The reduction ratio (RR) and total removed solute (TRS) of three uremic solutes were determined: small molecular weight urea, middle molecular β2-microglobulin (B2M), and protein-bound indoxyl sulfate (IS). Concentrations of these solutes in the spent dialysate were measured by laboratory (lab) and optical (opt) methods, in the serum by laboratory methods, and calculated RR values in percentage were compared accordingly. Total removed solute was obtained from the total dialysate collection (TDC) using lab and opt methods. The highest RR values were found for urea and B2M, and the lowest for IS. The difference between RR of lab and opt results estimated as mean accuracy (BIAS) was ≤8.1% for all three solutes. Good correspondence between TRS lab vs. opt was achieved, resulting in strong linear correlation values R from 0.727 for urea to 0.971 for IS. Accuracy for TRS values as BIAS ± standard error (SE), comparing lab vs. opt, showed no statistical difference for any of the observed uremic solutes (P > 0.05). The accuracy of the optical method was not influenced by the dialysis modality (HD, HF, and HDF).
Tracheostomy Is Safe During Extracorporeal Membrane Oxygenation Support
Authors: Salna Michael , Tipograf Yuliya , Liou Peter , Chicotka Scott , Biscotti Mauer , Agerstrand Cara , Abrams Darryl , Brodie Daniel , Bacchetta Matthew
Published: August 2019

Patients receiving extracorporeal membrane oxygenation (ECMO) often require prolonged mechanical ventilation. Providers may be reluctant to perform tracheostomies on patients during ECMO due to their tenuous clinical status and systemic anticoagulation. We report our experience with performing open and percutaneous tracheostomies on patients supported on ECMO from August 2009 to December 2017. Of the 127 patients who underwent tracheostomy during ECMO support, the median age was 42 years (interquartile range [IQR], 29–54), 99 (78%) patients had venovenous (VV) cannulation, 22 (17%) patients had venoarterial (VA) cannulation, and six (5%) patients had hybrid configurations. Percutaneous tracheostomy was performed in 110 (87%) patients. Median-activated partial thromboplastin time (aPTT) at the time of tracheostomy was 47.5 seconds (IQR, 41–57.6 seconds). The median time from ECMO initiation to tracheostomy was 7 days (IQR, 4–11 days). A total of 55 patients (43%) received packed red blood cell (pRBC) transfusions within 48 hours after tracheostomy with a median transfusion of 2 units (IQR, 1–3). There was no procedural mortality. Overall, 88 (69%) patients survived to decannulation and 74 (58%) survived to hospital discharge. Our experience with the largest published series of tracheostomies during ECMO demonstrates that excellent outcomes can be achieved without significant morbidity.
Left Ventricular Assist Device Outflow Graft Obstruction: A Case Series
Authors: Nathan Sriram , Ghotra Amaninderapal S. , Rajagopal Keshava , Patel Chandni , Kumar Sachin , Patel Manish , Salas de Armas Ismael , Jumean Marwan , Akay M. Hakan , Akkanti Bindu , Kar Biswajit , Gregoric Igor D.
Published: August 2019

Dysfunction of different components within continuous-flow (CF) left ventricular assist device (LVAD) systems may cause adverse cardiovascular and end-organ sequelae. Outflow graft obstruction is a recognized type of LVAD component dysfunction. Ten patients were admitted and treated for LVAD outflow graft obstruction. Two of these patients subsequently developed recurrent outflow graft obstruction requiring reintervention; however, each reoccurrence was at a different site than the original obstruction. Thus, a total of 12 cases of obstruction were analyzed. The most common reasons for hospital admission were low flow LVAD alarms or decompensated heart failure. Presentation with outflow graft obstruction occurred an average of 3.0 years after LVAD implantation. Patients underwent echocardiographic evaluation at the time of admission. Left ventricular assist device component dysfunction was suspected based on echocardiographic findings, and follow-up contrast studies were used to establish the specific diagnosis of outflow graft stenosis. The majority of stenotic lesions (10/12) were treated percutaneously with balloon angioplasty and stenting with balloon-expandable endovascular prostheses. Postintervention, all patients had significant improvement in LVAD flow rates.
Evaluating the performance of automated sphygmomanometers using a patient simulator
Authors: Rodrigues Filho Bruno Amado , Farias Rafael Feldmann , Anjos William Escaletti dos , Monteiro Elisabeth Costa
Published: August 2019

Background and objective:

Automated sphygmomanometers use the oscillometric method to measure blood pressure, which is based on an algorithm that relates the amplitude of the oscillometric waveform pulses and the pressure inside the cuff. Validation uses empirical information from clinical trials conducted by each manufacturer. Consequently, measurement algorithms are not harmonized, being based on distinct arterial waveforms, according to each group of volunteers of the clinical test. In the present study, a patient simulator was used to generate standardized, consistent oscillometric waveform pulses to test the algorithms used in six sphygmomanometers.

Materials and methods:

Six different upper arm and wrist-based automated sphygmomanometers were tested using a patient simulator comprising four different blood pressure levels, Psys/dia (mmHg): 80/50; 120/80; 150/100; 200/150. The devices were also submitted to conformity assessment. The variance of repeatable measurements was also analyzed.

Results:

All tested automated sphygmomanometers complied with metrological requirements, presenting results within the range of ±2 mmHg for static calibration. Systematic discrepancies, greater than 20 mmHg, were observed between sphygmomanometers’ results from upper arm and wrist-based models. Differences reaching 12.8 mmHg in diastolic pressure results were observed among upper arm devices.

Conclusion:

These results may have a clinical impact and indicate the need for a standardized algorithm, with a harmonized approach for validation. Moreover, the algorithm of the wrist-based devices is being affected by the use of the brachial artery waveform as reference for its validation, which also reveals that the current approach needs standardization, especially regarding the use of patient simulators.24299305
Gender-related differences in psychometric properties of WHO Disability Assessment Schedule 2.0
Authors: Katajapuu Niina , Laimi Katri , Heinonen Ari , Saltychev Mikhail
Published: August 2019

Objective of this study was to investigate the gender-related differential item function of 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. This was a cross-sectional survey study among 1,988 patients at a university Physical and Rehabilitation Medicine outpatient clinic. To assess DIF, WHODAS 2.0 items were dichotomized as `none’ rated by respondents as `0’ versus `any limitation’ rated as `1,2,3 or 4’. The item response theory analysis was used to define discrimination and difficulty parameters of a questionnaire. The probit logistic regression was used to test uniformity of DIF between gender groups. The results of DIF analysis were presented and evaluated graphically as item characteristic curves based on 2-parameter IRT analysis of dichotomized responses. High to perfect discrimination ability was observed for all the items except one. Difficulty levels of eight items were shifted towards the elevated disability level, four items demonstrated a perfect difficulty property. Significant DIF between genders was observed in seven of 12 items. The detected DIFs were uniform. For item `household’, `emotional affection’ and `work’, men had to experience slightly worse disability than women to achieve the same score. A reverse effect was observed for items `concentration’, `washing’, `dressing’ and dealing with strangers. In this study, significant DIF between genders was found in seven of twelve items of 12-item WHODAS 2.0. amongst 1988 patients with chronic musculoskeletal pain. All the detected DIFs were uniform. Regardless gender-related DIF shown in seven out of 12 items, we recommend using and studying 12-item WHODAS 2.0 in different populations.
The effect of motor imagery and mirror therapy on upper extremity function according to the level of cognition in stroke patients
Authors: Lee Si A. , Cha Hyun Gyu
Published: August 2019

This study was conducted to investigate the effects of motor imagery (MI) and mirror therapy (MT) on upper extremity function according to the level of cognition in stroke patients. Twenty-four participants who were diagnosed with stroke were divided into a mild cognitive group (n = 12) and a severe cognitive group (n = 12). Then, the two groups were again divided into MI group (n = 6) and MT group (n = 6). The participants were evaluated for function of upper extremity using the Box and Block Test (BBT), the Jebsen–Taylor Hand Function Test (JTHFT), and Manual Function Test (MFT). There were significant differences between the two groups of cognitive function of mild level in the post-test of JTHFT (p < 0.05). In the MI group, significant differences were found in the pre- and post-test scores for all variance (p < 0.05). In the MT group, significant differences were found in the pre- and post-test scores for JTHFT and MFT (p < 0.05). There were significant differences between the two groups of cognitive function of severe level in the post-test of all variances (p < 0.05). Furthermore, in the MT group, significant differences were found in the pre- and post-test scores for all variances (P < 0.05). The results of this study suggest that applying MI to the mild cognitive group is effective and that applying MT to the severe cognitive group is effective.
Assessment of Millennial Nurses' Job Satisfaction and Professional Practice Environment
Authors: O'Hara Michele A. , Burke Debra , Ditomassi Marianne , Palan Lopez Ruth
Published: August 2019

OBJECTIVE:

The purpose of this study was to assess the relationship between demographic factors (age, gender, race, ethnicity, work status, and experience), the professional practice environment, and work satisfaction to increase understanding of millennial nurses.

BACKGROUND:

Millennials comprise 30% of the nursing workforce and are more likely to experience burnout, stress, high turnover, and less dedication to their workplace than other counterparts. Understanding how to retain these nurses is important to ensure work satisfaction and high-quality patient outcomes.

METHODS:

This descriptive study was a secondary analysis of data using the Professional Practice Work Environment Inventory survey. Descriptive statistics were used to describe the variables. Descriptive statistics and standard t tests were used.

RESULTS:

Demographics accounted for only 2.6% of the variance in work satisfaction, whereas supportive leadership accounted for nearly 63%.

CONCLUSION:

Findings demonstrate that supportive leadership is the primary factor contributing to millennial nurses' work satisfaction. This suggests that efforts to retain millennial nurses should focus on developing supportive leaders.
Nurse Leader Burnout, Satisfaction, and Work-Life Balance
Authors: Kelly Lesly A. , Lefton Cindy , Fischer Shelly A.
Published: August 2019

OBJECTIVE

To examine and report burnout, secondary trauma, and compassion satisfaction in acute care nurse leaders through a large mixed-methods research study.

BACKGROUND

Although nurse leaders are removed from daily patient care activities, the pervasive challenges in the work environment create conditions for professional burnout. Nurse leaders must garner compassion satisfaction from different sources, including peer and staff interactions.

METHODS

The Professional Quality of Life scale was given to nurse leaders at 29 hospitals in 1 health system. Sixteen leaders from 2 hospitals participated in qualitative interviews.

RESULTS

Six hundred seventy-two nurse leaders from 29 hospitals reported similar levels of burnout across frontline, midlevel, and director-level leadership. Directors demonstrated higher levels of compassion satisfaction and lower levels of work-life balance. Four themes emerged representing areas of professional life that potentiate and alleviate compassion fatigue.

CONCLUSIONS

All levels of nurse leaders must address the risk of burnout and can do so through individual and organizational resiliency strategies.
Over-utilization of computed tomography angiography in extremity trauma
Authors: Callan Alexandra K. , Bauer Jennifer M. , Mir Hassan R.
Published: August 2019

Objectives:

Widespread availability of computed tomography angiography (CTA) for diagnosing arterial injury in injured extremities has created the possibility of overuse. The objective of this study was to evaluate CTA utilization, indications, ordering personnel, and rate of significant findings for blunt or penetrating extremity trauma at a level I trauma center.

Methods:

We performed a retrospective chart review of 1440 consecutive CTAs of upper and lower extremities from 2010 to 2012 at a large level I trauma center, and included only those done for acute trauma. Data were collected with regard to injury, initial exam, reason given for ordering a CTA, specialty of physician ordering CTA, results, and vascular interventions needed. CTAs were categorized as appropriately ordered based on if there was a documented abnormal distal pulse or ankle-brachial index (ABI). Study indication was classified as inconclusive if no vascular exam was documented or physical exam varied.

Results:

A total of 481 CTAs were performed after blunt or penetrating trauma in the emergency room with 31.0% appropriately indicated, 48.0% without indication, and 21.8% inconclusive. Mechanism of injury was most commonly a gunshot wound (40.3%), followed by motor vehicle accidents (39.5%). Overall, 61.5% of the studies had normal arterial flow and only 15.8% of CTAs required vascular operative intervention. Of the studies appropriately indicated, 76.5% had positive findings, with 43% needing operative intervention compared to the inappropriately indicated studies only 11.6% had positive findings, with 0.4% needing operative intervention (P < .0001).

Conclusion:

CTA for blunt or penetrating trauma at a level I trauma center may be over-utilized. Often, this advanced imaging is ordered prior to orthopaedic evaluation or limb reduction, without exam-based indication, and most do not affect patients’ treatment. From our study, CTA utilization based on more stringent exam findings at our hospital could eliminate 48% of all CTA studies for trauma.
Multidose prophylactic IV antibiotics do not lower the risk of surgical site infection for isolated closed ankle fractures
Authors: Frank Matt , Francis Jeffrey , Bender Mark , Roberts Michael , Watson David , Shah Anjan , Maxson Ben , Infante Anthony , Sanders Roy , Mir Hassan R.
Published: August 2019

Objectives:

To compare the surgical site infection (SSI) rates in ankle fracture patients receiving either single preoperative intravenous (IV) dose (SD) or multidose 24 hours IV postoperative (MD) perioperative IV antibiotic prophylaxis.

Design:

Retrospective case–control study.

Setting:

Level I Trauma Center.

Patients/Participants:

Three hundred fourteen patients with isolated ankle fractures, OTA classifications 44A1-3, 44B1-3, and 44C1-3, who presented to our institution between January 2012 and June 2016.

Intervention:

Operative fracture fixation with either the administration of SD or MD perioperative IV antibiotic prophylaxis.

Main outcome measurements:

SSI.

Results:

Three hundred fourteen patients met all study criteria. There were 99 patients in the SD group with a mean age of 44.2 years and 215 patients in the MD group with a mean age of 47.7 years. The overall SSI rate was 5.1% in the SD group versus 2.8% in the MD group (P = .312). The superficial SSI rate was 2.0% in the SD group versus 1.4% in the MD group not significant (NS). The deep SSI rate was 3.0% in the SD group versus 1.4% in the MD group (NS).

Conclusion:

The SSI rates in isolated closed ankle fractures receiving either SD or MD perioperative IV antibiotic prophylaxis were similar. Further studies should be considered to help guide the standard of care for perioperative IV antibiotic prophylaxis.

Level of evidence:

Therapeutic Level III retrospective case–control study.
The utility of the angled blade plate in hip fracture nonunion treatment
Authors: Lawrenz Joshua M. , Marshall Danielle C. , Patterson Brendan M.
Published: August 2019

Objectives:

We report the radiographic and clinical outcome of patients treated with an angled blade plate (ABP) for hip fracture nonunion. We also provide a review of the literature on joint preserving treatment approaches to hip fracture nonunions.

Design:

Retrospective, case series.

Setting:

Tertiary academic hospital.

Patients/Participants:

Three.

Intervention:

We treated three patients with varied hip fracture nonunions using a joint preserving approach with an ABP.

Main outcome measurements:

Radiographic union and clinical outcome.

Results:

All three patients achieved radiographic union, and were ambulating without pain at final follow-up.

Conclusions:

The treatment approach to hip fracture nonunions is either restorative (joint preserving) or reconstructive (joint replacing). The primary restorative approach to nonunions around the hip consists of revision open reduction and internal fixation with or without bone grafting. Though a variety of implants and treatment techniques have demonstrated excellent success in this setting, revision open reduction and internal fixation with an ABP remains an efficacious implant selection in hip nonunion surgery.
Greater Tumor Thickness, Ulceration, and Positive Sentinel Lymph Node Are Associated With Worse Prognosis in Patients With Conjunctival Melanoma
Authors: Esmaeli Bita , Rubin Maria Laura , Xu Shiqiong , Goepfert Ryan P. , Curry Jonathan L. , Prieto Victor G. , Ning Jing , Tetzlaff Michael T.
Published: August 2019

Identifying tumor characteristics that correlate with metastasis and survival in patients with conjunctival melanoma can potentially lead to better outcomes through a better selection of patients for adjuvant treatments including potentially life-saving new melanoma therapy. The objective of this study was to validate the conjunctival melanoma staging criteria in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual (8th edition) and explore the prognostic importance of tumor thickness, histologic ulceration, and sentinel lymph node biopsy (SLNB) findings in patients with conjunctival melanoma. This is a case series of 88 consecutive patients with conjunctival melanoma. Clinicopathologic characteristics were analyzed. Associations between pathologic characteristics and outcomes were studied using Kaplan-Meier survival analysis. Local recurrence, lymph node metastasis, distant metastasis, and disease-specific survival (DSS) were the main outcome measures. The study included 56 women and 32 men; the median age was 62 years. At presentation, 41 patients had T1 disease, 23 had T2 disease, 23 had T3, and 1 had T4 disease. Sixty-six patients had invasive conjunctival melanoma (median thickness, 1.56 mm), 17 had conjunctival melanoma in situ, and in 5 patients, tumor thickness could not be determined. Overall, 22 patients had ulceration. In total, 31 patients underwent SLNB, and 4 had a positive sentinel lymph node (SLN). The median follow-up time was 46.6 months. Overall, 12 patients had nodal metastasis at presentation or during follow-up, 19 patients had distant metastasis at last follow-up, and 14 patients died of the disease. Tumor thickness and ulceration were associated with increased risks of nodal metastasis, distant metastasis, and death from the disease. Overall, greater clinical T category at presentation was associated with increased risks of distant metastasis and disease-related death; however, the risks of distant metastasis and disease-related death did not differ between T1 (bulbar) and T2 (nonbulbar) tumors or between T2c,d (caruncular) and T1-T2a,b (noncaruncular) tumors. In patients who underwent SLNB, a positive SLN was associated with worse distant metastasis free survival and DSS. Consideration should be given to adding ulceration and emphasizing tumor thickness as the main determinants of pathologic T category for conjunctival melanoma in future AJCC classifications. The significant association between a positive SLN and worse DSS highlights the importance of SLNB for prognosis in patients with conjunctival melanoma and selecting high-risk patients for adjuvant drug treatment.
Implementing Data to Care—What Are the Costs for the Health Department?
Authors: Neblett Fanfair Robyn , Shrestha Ram K. , Randall Liisa , Lucas Crystal , Nichols Lisa , Camp Nasima M. , Brady Kathleen , Jenkins Heidi , Altice Fredrick , Villanueva Merceditas , DeMaria Alfred
Published: August 2019

Background:

The Cooperative Re-Engagement Controlled Trial (CoRECT) is a randomized controlled trial that uses a combined health department-provider data to care (D2C) model to identify out-of-care HIV-infected persons. We present cost data for programmatic aspects of the trial during the start-up period (first 30 days of the study).

Methods:

We used microcosting methods to estimate health department start-up costs. We collected start-up cost data between September 2016 and December 2016; 3 health departments completed a form to capture expenses for the initial 30 days of study implementation; the start date varied by health department. All costs are expressed in 2016 US dollars.

Results:

Among the 3 health departments, the total start-up costs ranged from $14,145 to $26,058. Total start-up labor hours ranged from 224 to 640 hours.

Conclusions:

As D2C expands nationally with cooperative agreement, PS 18-1802 health departments may be able to use a similar analysis to consider the labor, time, and resources needed to implement D2C within their jurisdiction.
Pharmacy Data as an Alternative Data Source for Implementation of a Data to Care Strategy
Authors: Byrd Kathy K. , Camp Nasima M. , Iqbal Kashif , Weidle Paul J.
Published: August 2019

Background:

Data to Care (D2C) is a strategy for using health departments' HIV surveillance data (HIV viral load and CD4 laboratory reports) to identify and re-engage not-in-care persons with HIV. In the current D2C model, there is a delay in the identification of persons not in care due to the time interval between recommended monitoring tests (ie, every 3–6 months) and the subsequent reporting of these tests to the health department.

Methods:

Pharmacy claims and fulfillment data can be used to identify persons with HIV who have stopped filling antiretroviral therapy and are at risk of falling out of care. Because most antiretrovirals (ARVs) are prescribed as a 30-day supply of medication, these data can be used to identify persons who are not filling their medications on a monthly basis. The use of pharmacy claims data to identify persons not filling ARV prescriptions is an example of how “big data” can be used to conduct a modified D2C model.

Results:

Although a D2C strategy using pharmacy data has not been broadly implemented, a few health departments are implementing demonstration projects using this strategy. As the projects progress, processes and outcomes can be evaluated.

Conclusions:

Tracking ARV refill data can be a more real-time indicator of poor adherence and can help identify HIV-infected persons at risk of falling out of HIV medical care.
Evaluating HIV Surveillance Completeness Along the Continuum of Care: Supplementing Surveillance With Health Center Data to Increase HIV Data to Care Efficiency
Authors: Arey Alyssa L. , Cassidy-Stewart Hope , Kurowski Pamela L. , Hitt Jeffrey C. , Flynn Colin P.
Published: August 2019

Background:

HIV surveillance is essential to quantifying the impact of the epidemic and shaping HIV programs. The Maryland Department of Health (MDH) historically conducted HIV Data to Care (D2C) activities using surveillance data to identify individuals who were not in HIV care; however, most case investigations concluded that the individuals in question were currently engaged in care. This suggests that delays and gaps in laboratory reporting to HIV surveillance exist and the proportion of HIV-positive Marylanders who are truly in care is underestimated. Therefore, solely relying on surveillance data might not be an efficient method for identifying not in care HIV cases.

Setting:

Through the Partnerships for Care (P4C) project, MDH conducted targeted D2C efforts on HIV patients from 4 health centers.

Methods:

The expanded D2C model that MDH created during P4C integrated clinical data as a secondary data source to enhance the surveillance data used to estimate HIV patient care engagement. MDH matched and compared health center electronic health records with HIV surveillance data to assess completeness of HIV case and laboratory reporting.

Results:

HIV case ascertainment was high (99.9%) for the P4C cohort (N = 927), but differences in estimated care engagement and viral suppression between data sources revealed incomplete laboratory reporting and that patients received care from multiple providers. Analyzing the clinical data leads to the resolution of several reporting gaps, which improved surveillance data quality over time.

Conclusions:

Health departments should validate their HIV surveillance completeness. Triangulating surveillance data with clinical data generated more accurate depictions of care engagement and increased D2C efficiency.
Cross-Jurisdictional Data to Care: Lessons Learned in New York State and Florida
Authors: Hart-Malloy Rachel , Rajulu Deepa T. , Johnson Megan C. , Shrestha Tarak , Spencer Emma C. , Anderson Bridget J. , Tesoriero James M.
Published: August 2019

Background:

Data-to-Care (D2C) programming is an important strategy in locating and relinking persons with HIV who are not in care (NIC), back to care. However, Health Department D2C programs have found a large proportion of individuals who seem NIC are living outside of their jurisdiction. Jurisdictions are limited in ability to cross-communicate regarding such individuals.

Setting:

Two D2C programs [New York State (NYS) and Florida (FL)] funded through the Partnerships-for-Care Demonstration Project, partnered to conduct a feasibility pilot project to test cross-jurisdictional D2C reciprocity.

Methods:

Jurisdictions made efforts to set up infrastructure for cross-jurisdictional D2C, and NYS worked to identify persons reported in NYS presumed in need of linkage/relinkage efforts in FL using 3 years of NYS D2C program outcomes.

Results:

One hundred forty NYS NIC individuals were presumed to need linkage/relinkage efforts in FL. However, case dispositions for these individuals were not able to be advanced beyond determining HIV care status due to 4 critical challenges: (1) Local legal and regulatory permissibility for sharing identifiable HIV surveillance information outside of a specific jurisdiction varies; (2) Electronic infrastructure in place does not support public health follow-up of individuals who are not within a jurisdiction's HIV surveillance system; (3) An individual's verifiable current residence is not easily attained; and (4) Roles, responsibilities, and case prioritization within each state, and across jurisdictions vary and require clear delineation.

Conclusions:

Although programmatic challenges during this D2C feasibility pilot project were unsurmountable for NYS and FL, potential solutions presented may facilitate broader national cross-jurisdictional D2C reciprocity.
Informing Data to Care: Contacting Persons Sampled for the Medical Monitoring Project
Authors: Beer Linda , Bosh Karin A. , Chowdhury Pranesh P. , Craw Jason , Nyaku Margaret A. , Luna-Gierke Ruth E. , Sanders Catherine C. , Shouse R. Luke
Published: August 2019

Background:

Data to care (D2C) is a public health strategy that uses HIV surveillance and other data to identify persons in need of HIV medical care. The Medical Monitoring Project (MMP), which uses similar methods to contact and recruit HIV-positive persons, may inform predictors of successful contact for D2C programs.

Setting:

MMP is a Centers for Disease Control and Prevention–funded surveillance system that collects nationally representative data on adults with diagnosed HIV in the United States and Puerto Rico.

Methods:

Using MMP's 2016 data collection cycle, we present contact rates (ie, proportion of HIV-positive persons successfully contacted for MMP) by the age of contact information and age of laboratory test results available from HIV surveillance data.

Results:

Nationally, 27.6% of eligible persons did not have a recorded laboratory test performed within the past year (project area range: 10.8%–54.6%). The national contact rate among persons with laboratory tests older than 1 year was 37.0% (project area range: 16.5%–67.1%). Higher contact rates were found among persons with more recent laboratory tests. Similar results were found by the age of contact information. Nationally, the most common reason for MMP ineligibility was that the person was deceased; the most common reason for not being contacted was lack of correct contact information.

Conclusions:

MMP findings suggest that D2C programs would benefit from efforts to improve the quality of HIV surveillance data and local surveillance practices—in particular, death ascertainment, the completeness of laboratory reporting, and the routine updating of contact information. Strengthening collaboration and integration with existing MMP programs may be beneficial.
Using HIV Surveillance and Clinic Data to Optimize Data to Care Efforts in Community Health Centers in Massachusetts: The Massachusetts Partnerships for Care Project
Authors: Kunzweiler Colin , Kishore Nina , John Betsey , Roosevelt Kathleen , Lewis Sophie , Klevens R. Monina , Morrison Monica , Randall Liisa M. , DeMaria Alfred
Published: August 2019

Background:

We describe Data to Care processes of the Massachusetts Partnerships for Care (MA P4C) project and identify factors associated with engagement, retention, and viral suppression outcomes.

Methods:

The Massachusetts Department of Public Health and participating community health centers generated lists of patients not in care based on a temporal gap in laboratory results, missed clinic visits, and provider concern regarding engagement. The Massachusetts Department of Public Health and community health centers reviewed the lists monthly and identified out-of-care patients in need of linkage or re-engagement.

Results:

Between October 2015 and June 2017, of 1418 patients potentially out of care, 83 (5.9%) were confirmed to be out of care. Forty-four of those out of care (53%) received services or were re-engaged in care within 90 days, 45 (54%) were retained in care, and 40 (48%) were virally suppressed. The odds of being re-engaged or retained were lower for patients who were 6 months out-of-care (vs. those newly diagnosed). Patients with an AIDS-defining condition had increased odds of retention and viral suppression. The odds of viral suppression were reduced for patients who reported exposure categories other than men who have sex with men and were younger (30–49 years vs. ≥50 years).

Conclusions:

Although rates of re-engagement, retention, and viral suppression were low, the MA P4C Data to Care procedures provided a means for accurate ascertainment of out-of-care status. Future Data to Care programs should investigate the factors that contribute to disengagement from care.
Data to Care: Lessons Learned From Delivering Technical Assistance to 20 Health Departments
Authors: Mokotoff Eve D. , Green Ruth Kathleen , Benbow Nanette , Sweeney Patricia , Nelson Sapiano Tobey , McNaghten A. D.
Published: August 2019

Background:

Data to Care (D2C) is a public health strategy that uses HIV surveillance and other data to identify persons living with HIV who are “not in care” to link them to medical care or other services. To support health department implementation of D2C, the Centers for Disease Control and Prevention supported direct technical assistance (TA) to build health department D2C capacity.

Methods:

Between 2013 and 2017, 2 contracting organizations worked with the Centers for Disease Control and Prevention to provide intensive D2C TA to 20 US health departments. A requirement for applying for TA was the mandatory reporting of all CD4 T-lymphocyte and HIV viral load test results by laboratories to the health department's HIV surveillance system. Health department selection criteria included organizational factors; jurisdiction laws/policies about data confidentiality and sharing; and HIV morbidity level.

Results:

Peer-to-peer consultation, technical consultation, training, information transfer, materials development, materials distribution, and technology transfer were methods used for delivering TA based on the health department's needs and preferences. TA supported health department progress in areas such as confidentiality and data security, stakeholder engagement, quality of HIV surveillance data, data sharing, staffing resources, creating “not-in-care” lists, and program evaluation.

Conclusion:

Developing D2C programs is not a linear process, and there is no one standardized approach. Health departments made the most rapid progress when TA included peer-to-peer support among health departments. Participation in this project facilitated, in some cases for the first time, collaboration between staff across HIV surveillance, prevention, and care programs.
Operationalizing a Data to Care Strategy in Michigan Through Cross-Agency Collaborations
Authors: Macomber Kathryn E. , Viall Abigail , Ramakrishnan Vishakha , Wilson Janae , Brandt Mary-Grace , Kinsinger Lindsey , Kreiner Meta , Curtis Tom , Copeland Rachel , Staudacher Amber , Neff David
Published: August 2019

Background:

For persons with HIV infection (PWH), viral load suppression is essential to maintaining health and reducing the likelihood of HIV transmission. Data to Care (D2C) is an important strategy for improving HIV outcomes but may be resource-intensive to execute.

Setting:

In 2016, Michigan joined the HIV Health Improvement Affinity Group to strengthen D2C partnerships between its Medicaid and HIV program. Goals included establishing routine data sharing, matching data sources to understand health outcomes, and collaborating to turn data into action.

Methods:

Michigan established data use agreements to assess gaps in care for PWH enrolled in Medicaid. The HIV Surveillance Program used Link Plus to match surveillance records on PWH to Medicaid's active beneficiary file to identify PWH who were beneficiaries as of December 31, 2015.

Results:

Matching the 2,300,877 Michigan Medicaid beneficiaries with the 15,845 PWH in HIV surveillance yielded 4822 matched PWH enrolled in Medicaid in 2015. Of Medicaid beneficiaries with HIV, 597 had no evidence of receiving HIV care, representing 20% of all Michigan residents with HIV and not in care in 2015.

Conclusion:

D2C is an effective strategy for improving HIV care continuum outcomes but can be relatively inefficient if implementation models rely solely on public health infrastructure. Through the HIV Health Improvement Affinity Group, Michigan's Medicaid and HIV programs leveraged their combined data assets to evaluate and improve care quality and outcomes for PWH on Medicaid. Partnerships between Medicaid and public health offer attractive mechanisms for potentially increasing efficiency and effectiveness of D2C investments.
HIV Data to Care—Using Public Health Data to Improve HIV Care and Prevention
Authors: Sweeney Patricia , DiNenno Elizabeth A. , Flores Stephen A. , Dooley Samuel , Shouse R. Luke , Muckleroy Stacy , Margolis Andrew D.
Published: August 2019

Background:

“Data to Care” (D2C) is a public health strategy that uses surveillance and other data to improve continuity of HIV care for persons with HIV (PWH) by identifying those who are in need of medical care or other services and facilitating linkage to these services. The primary goal of D2C is to increase the number of PWH who are engaged in care and virally suppressed.

Methods:

Data to Care can be implemented using several approaches. Surveillance-based D2C is usually initiated by health departments, using HIV surveillance and other data to identify those not in care. Health care providers may also initiate D2C by identifying patients who may have fallen out of care and working collaboratively with health departments to investigate, locate, and relink the patients to medical care or other needed services.

Results:

Although D2C is a relatively new strategy, health department D2C programs have reported both promising results (eg, improved surveillance data quality and successful linkage to or re-engagement in care for PWH) and challenges (eg, incomplete or inaccurate data in surveillance systems, barriers to data sharing, and limitations of existing data systems).

Conclusions:

Data to Care is expected to enable health departments to move closer toward achieving national HIV prevention goals. However, additional information on appropriate implementation practices at each step of the D2C process is needed. This JAIDS Special Supplement explores how CDC funding to state health departments (eg, technical assistance and demonstration projects), and partnerships across federal agencies, are advancing our knowledge of D2C.
High Systemic Immune-Inflammation Index is an Adverse Prognostic Factor for Patients With Gastroesophageal Adenocarcinoma
Authors: Jomrich Gerd , Paireder Matthias , Kristo Ivan , Baierl Andreas , Ilhan-Mutlu Ayseguel , Preusser Matthias , Asari Reza , Schoppmann Sebastian F.
Published: August 2019

Objective:

The aim of this study was to determine the clinical role of the systemic immune-inflammation index in patients with resectable adenocarcinoma of the gastroesophageal junction treated with or without neoadjuvant therapy.

Background:

Adenocarcinoma of the gastroesophageal junction is an aggressive disease, with less than 20% of overall patients surviving more than 5 years after diagnosis, while currently available clinical staging for esophageal cancer is lacking necessary accuracy. The systemic immune-inflammation index (SII) based on peripheral neutrophil, lymphocyte, and platelet counts has shown a prognostic impact in various malignancies.

Methods:

Data of consecutive patients undergoing esophagectomy (n = 320, 1992 to 2016) were abstracted. The cut point for high and low SII before neoadjuvant treatment and before surgery was calculated for illustration of the Kaplan-Meier curves. SII was used for the correlation with patients’ clinicopathological characteristics as a continuous variable. Survival was analyzed with Cox proportional hazards models using clinical or pathological staging, adjusting for other known survival predictors.

Results:

In both neoadjuvantly treated and primarily resected patients, high SII was significantly associated with diminished overall [hazard ratio (HR) 1.3, 95% confidence interval (95% CI) 1.2–1.4; HR 1.2, 95% CI 1.2–1.3, respectively] and disease-free survival (HR 1.3, 95% CI 1.2–1.3; HR 1.2, 95% CI 1.2–1.3, respectively). In multivariable survival analysis, SII remained an independent prognostic factor for overall survival (HR 1.3, 95% CI 1.2–1.4; HR 1.2, 95% CI 1.2–1.3, respectively) and disease-free survival (HR 1.3, 95% CI 1.2–1.3; HR 1.2, 95% CI 1.2–1.3, respectively) in primarily resected and neoadjuvantly treated patients.

Conclusion:

Elevated SII is an independent adverse prognostic factor in patients with resectable gastroesophageal adenocarcinomas with and without neoadjuvant treatment.
The Barrier Molecules Junction Plakoglobin, Filaggrin, and Dystonin Play Roles in Melanoma Growth and Angiogenesis
Authors: Leick Katie M. , Rodriguez Anthony B. , Melssen Marit M. , Benamar Mouadh , Lindsay Robin S. , Eki Rebeka , Du Kang-Ping , Parlak Mahmut , Abbas Tarek , Engelhard Victor H. , Slingluff Craig L.
Published: August 2019

Objective:

To understand role of barrier molecules in melanomas.

Background:

We have reported poor patient survival and low immune infiltration of melanomas that overexpress a set of genes that include filaggrin (FLG), dystonin (DST), junction plakoglobin (JUP), and plakophilin-3 (PKP3), and are involved in cell-cell adhesions. We hypothesized that these associations are causal, either by interfering with immune cell infiltration or by enhancing melanoma cell growth.

Methods:

FLG and DST were knocked out by CRISPR/Cas9 in human DM93 and murine B16-F1 melanoma cells. PKP3 and JUP were overexpressed in murine B16-AAD and human VMM39 melanoma cells by lentiviral transduction. These cell lines were evaluated in vitro for cell proliferation and in vivo for tumor burden, immune composition, cytokine expression, and vascularity.

Results:

Immune infiltrates were not altered by these genes. FLG/DST knockout reduced proliferation of human DM93 melanoma in vitro, and decreased B16-F1 tumor burden in vivo. Overexpression of JUP, but not PKP3, in B16-AAD significantly increased tumor burden, increased VEGF-A, reduced IL-33, and enhanced vascularity.

Conclusions:

FLG and DST support melanoma cell growth in vitro and in vivo. Growth effects of JUP were only evident in vivo, and may be mediated, in part, by enhancing angiogenesis. In addition, growth-promoting effects of FLG and DST in vitro suggest that these genes may also support melanoma cell proliferation through angiogenesis-independent pathways. These findings identify FLG, DST, and JUP as novel therapeutic targets whose down-regulation may provide clinical benefit to patients with melanoma.
An Empirical National Assessment of the Learning Environment and Factors Associated With Program Culture
Authors: Ellis Ryan J. , Hewitt D. Brock , Hu Yue-Yung , Johnson Julie K. , Merkow Ryan P. , Yang Anthony D. , Potts John R. , Hoyt David B. , Buyske Jo , Bilimoria Karl Y.
Published: August 2019

Objectives:

To empirically describe surgical residency program culture and assess program characteristics associated with program culture.

Summary Background Data:

Despite concerns about the impact of the learning environment on trainees, empirical data have not been available to examine and compare program-level differences in residency culture.

Methods:

Following the 2018 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. Survey items were analyzed using principal component analysis to derive composite measures of program culture. Associations between program characteristics and composite measures of culture were assessed.

Results:

Analysis included 7387 residents at 260 training programs (99.3% response rate). Principal component analysis suggested that program culture may be described by 2 components: Wellness and Negative Exposures. Twenty-six programs (10.0%) were in the worst quartile for both Wellness and Negative Exposure components. These programs had significantly higher rates of duty hour violations (23.3% vs 11.1%), verbal/physical abuse (41.6% vs 28.6%), gender discrimination (78.7% vs 64.5%), sexual harassment (30.8% vs 16.7%), burnout (54.9% vs 35.0%), and thoughts of attrition (21.6% vs 10.8%; all P < 0.001). Being in the worst quartile of both components was associated with percentage of female residents in the program (P = 0.011), but not program location, academic affiliation, size, or faculty demographics.

Conclusions:

Residency culture was characterized by poor resident wellness and frequent negative exposures and was generally not associated with structural program characteristics. Additional qualitative and quantitative studies are needed to explore unmeasured local social dynamics that may underlie measured differences in program culture.
Changes in Utilization of Bariatric Surgery in the United States From 1993 to 2016
Authors: Campos Guilherme M. , Khoraki Jad , Browning Matthew G. , Pessoa Bernardo M. , Mazzini Guilherme S. , Wolfe Luke
Published: August 2019

Objective:

The aim of this study was to obtain estimates of changes in perioperative outcomes and utilization of bariatric surgery in the United States from 1993 to 2016.

Background:

Bariatric surgery has evolved over the past 2 decades. Nationally representative information on changes of perioperative outcomes and utilization of surgery in the growing eligible population (class III obesity or class II obesity with comorbidities) is lacking.

Methods:

Adults with obesity diagnosis who underwent primary bariatric surgery in the United States from 1993 to 2016 were identified in the National Inpatient Sample database. Estimates of the yearly number, types and cost of surgeries, patients’ and hospital characteristics, complications and mortality rates were obtained. Prevalence of obesity and comorbidities were obtained from the National Health and Nutrition Examination Survey and changes in utilization of surgery were estimated.

Results:

An estimated 1,903,273 patients underwent bariatric surgery in the United States between 1993 and 2016. Mean age was 43.9 years (79.9% women, 70.9% white race, 70.7% commercial insurance); these and other characteristics changed over time. Surgeries were exclusively open operations in 1993 (n = 8,631; gastric bypass and vertical banded gastroplasty, 49% each) and 98% laparoscopic (n = 162,969; 69.8% sleeve gastrectomy and 27.8% gastric bypass) in 2016. Complication and mortality rates peaked in 1998 (11.7% and 1%) and progressively decreased to 1.4% and 0.04% in 2016. Utilization increased from 0.07% in 1993 to 0.62% in 2004 and remained low at 0.5% in 2016.

Conclusions:

Perioperative safety of bariatric surgery improved over the last quarter-century. Despite growth in number of surgeries, utilization has only marginally increased. Addressing barriers for utilization may allow for greater access to surgical therapy.