bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of Off-Site Integrated Care for Children: A Scoping Review
Authors: Spencer Andrea E. , Platt Rheanna E. , Bettencourt Amie F. , Serhal Eva , Burkey Matthew D. , Sikov Jennifer , Vidal Carol , Stratton Julia , Polk Sarah , Jain Sonal , Wissow Lawrence 
Published: November 2019

Abstract

Background
As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care.

Methods
We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability).

Results
We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-site models were acceptable to providers, particularly when the following were present: strong interdisciplinary communication, timely availability and reliability of services, additional support beyond one-time consultation, and standardized care algorithms. Adoption and penetration were facilitated by enhanced program visibility, including on-site champions. Certain clinical populations (e.g., school-age, less complicated ADHD) seemed more amenable to off-site integrated models than others (e.g., preschool-age, conduct disorders). Lack of funding and inadequate reimbursement limited sustainability in all models.

Conclusions
Off-site interventions are feasible, acceptable, and often adopted widely with adequate planning, administrative support, and interprofessional communication. Studies that focus primarily on implementation and that consider the perspectives of specialty providers and patients are needed.
Treatment of Acute Corneal Hydrops With Combined Intracameral Gas and Approximation Sutures in Patients With Corneal Ectasia
Authors: Mohebbi Masomeh , Pilafkan Hadi , Nabavi Amin , Mirghorbani Masoud , Naderan Morteza 
Published: November 2019

Purpose:
To assess the efficacy and safety of combined intracameral sulfur hexafluoride and full-thickness corneal sutures in the treatment of acute corneal hydrops (CH).

Methods:
This is an uncontrolled series of cases with keratoconus (KC), keratoglobus (KG), and pellucid marginal degeneration that presented with CH of recent onset.

Result:
Thirteen patients completed the study. The mean corneal thickness before treatment was 1,310

JOURNAL/corne/04.03/00003226-202002000-00023/inline-formula1/v/2023-09-12T173541Z/r/image-tiff

556 μm, which significantly reduced to 660 ± 148 μm at week 1 postoperatively (P = 0.001). It took 11.5 ± 6.5 days for corneal edema to resolve with a minimum and maximum of 5 and 24 days, respectively. Corrected distance Snellen visual acuity (CDVA) significantly improved from 0.04 ± 0.03 before treatment to 0.08 ± 0.06 at week 1 (P = 0.035) and continued to improve through month 1 [(0.11 ± 0.05), P = 0.007] and month 3 [(0.15 ± 0.08), P = 0.002]. No patient needed re-treatment with gas injection, and no complication was detected during the follow-up period.

Conclusions:
Combined intracameral gas injection and approximation sutures are probably effective and safe for the treatment of acute CH. This treatment results in rapid recovery with very rare complications.
A Fixed-Depth Microneedle Enhances Reproducibility and Safety for Corneal Gene Therapy
Authors: Gilger Brian C. , Crabtree Elizabeth , Song Liujiang , Llanga Telmo , Cullen Megan , Blanchard Allison , Salmon Jacklyn , Patel Samirkumar , Zarnitsyn Vladimir , Hirsch Matthew 
Published: November 2019

Purpose:
Drug delivery directly to the corneal stroma currently relies on microscopic injections that demonstrate low reproducibility and clinician-dependent variability. With use of biological drugs such as adeno-associated viral (AAV) vectors, precise and consistent drug deposition is critical to reduce concerns related to off-target transduction and the host's immune response to the viral capsid and/or transgene-derived product. Therefore, a precise corneal injection (PCI) microneedle was designed to allow accurate depth-specific injections into the corneal stroma in a macroscopic setting.

Methods:
High-frequency ultrasound and confocal microscopy demonstrated the consistent ability to predetermine the precise injection depth using PCI needles of varying sizes. Next, a comparison between a standard 31-G needle and PCI needles was performed in vivo using AAV vector gene delivery.

Results:
Intrastromal corneal injections using the PCI microneedle resulted in less vector leakage at the site of injection and fewer anterior chamber penetrations compared with a standard 31-G needle. Although reporter gene expression appeared similar when the vector was administered with either needle type, a trend toward increased vector genomes was noted in the PCI-injected corneas at the experimental conclusion. As hypothesized, corneal perforation resulted in increased detection of AAV vector genomes in nontarget tissues, highlighting the importance of consistency for biological drug applications in the cornea.

Conclusions:
Further development of the PCI microneedle is warranted especially for AAV corneal gene therapy and offers the potential to enhance transduction while significantly reducing safety concerns and intraclinician and interclinician injection variability.
Suprachoroidal Hemorrhage During Descemet Membrane Endothelial Keratoplasty
Authors: Dockery Philip W. , Joubert Katelyn , Parker John S. , Parker Jack S. 
Published: November 2019

Purpose:
To describe two cases of suprachoroidal hemorrhage during Descemet membrane endothelial keratoplasty (DMEK).

Methods:
Two patients with pseudophakic bullous keratopathy (PBK) underwent DMEK and proceeded to develop intraoperative suprachoroidal hemorrhage. Reports of both cases are documented, including potential risk factors, intraoperative events, and postoperative outcomes and interventions.

Results:
Both cases required premature abortion of the operation following the abrupt onset of significant posterior pressure indicating potential suprachoroidal hemorrhage. Postoperative visual acuity measured light perception or worse, and both patients declined further intervention.

Conclusions:
Suprachoroidal hemorrhage is a rare but potentially devastating intraoperative complication which may occur during DMEK, particularly in eyes with relevant risk factors. An inability to deepen the anterior chamber following graft implantation may signify the condition.
How Does Light Intensity of the Recording Room Affect the Evaluation of Lens and Corneal Clarity by Scheimpflug Tomography?
Authors: Bahar Alperen , Pekel Gökhan 
Published: November 2019

Purpose:
To investigate the effects of the light intensity of the recording room where eye examinations are conducted on the evaluation of lens and corneal clarity.

Method:
This cross-sectional and comparative study used 63 eyes of 32 participants. Corneal and lenticular optical densitometries, pachymetry, corneal volume, anterior segment volume, and anterior chamber depth measurements were taken with the Scheimpflug imaging system when the lights in the recording room were on (80 lux) and off (3 lux). The results were statistically compared.

Results:
The mean lens density when the lights were on was 13.61 ± 2.03, whereas that when the lights were off was 8.48 ± 1.48 (P < 0.001). Similarly, the mean corneal density when the lights were on was 15.87 ± 1.36, whereas that when the lights were off was 11.13 ± 0.90 (P < 0.001). The pachymetry, corneal volume, anterior segment volume, and anterior chamber depth measurements did not differ under the different light conditions.

Conclusions:
The densitometry values increased with an increase in light intensity. This study revealed that the lens and corneal densitometry evaluations were significantly affected by the lighting in the recording room.
Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis
Authors: Kuan Ai Seon , Chen Tzeng-Ji , Lee Wui-Chiang 
Published: November 2019

Background:
While migrants in Taiwan are entitled to universal health care, barriers to health care services exist. We aimed to explore challenges encountered by migrants when accessing health care services and potential strategies to overcome these barriers.

Methods:
Invitations to participate in the study were sent to all hospitals, 12 migrant organizations, one language school, and one language service company in Taiwan, and convenience sampling was used to recruit study participants. Focus group interviews were held with 111 migrants, clinicians, migrant organization coordinators, and representatives from the medical institutions, language school and language service company. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a thematic approach.

Results:
The study participants acknowledged that the current support system for migrants in the health care sector is inadequate. Barriers to health care services were noted in three areas - language and information, sociocultural and economic, and policy and resources. Potential strategies to overcome these barriers included the provision of on-site or distant interpreting services, provision of multilingual instruction notes and forms, and establishing a multilingual medical assistance hotline.

Conclusion:
While migrants benefit from the current support and welfare system, our study found substantial gaps that need to be filled including a lack of professional medical interpreters and training programs, a lack of legal framework for medical interpreting, and inadequacy in the dispersal of information on existing resources that may facilitate the integration of migrants into society and the health care system. Overcoming these barriers may improve migrants’ access to health services.
The Lived Experiences of Indonesian Nurses Who Worked as Care Workers in Taiwan
Authors: NURSALAM Nursalam , CHEN Ching-Min , EFENDI Ferry , HAS Eka Misbahatul Mar’ah , HIDAYATI Laily , HADISUYATMANA Setho 
Published: November 2019

ABSTRACT

Background
Despite the large number of Indonesian nurses currently working as migrant care workers in Taiwan, no studies in the literature have been found that explore this phenomenon or assess the working situation of Indonesian nurses working in care facilities in Taiwan.

Purpose
This study aimed to elicit and describe the lived experiences of Indonesian nurses serving as care workers in Taiwan.

Methods
Phenomenological research was used to explore the experiences of Indonesian nurses working in long-term care facilities. The participants were recruited from care facilities in Taiwan. This study utilized semistructured interviews conducted with 16 Indonesian nurses in a suitable setting. All of the interviews were transcribed, and the work of Van Manen was used to analyze the data.

Results
Four main themes were identified, including motives for working abroad, feelings of being trapped, experiencing a difficult journey, and the feeling of being supported. These themes reflect the lived experiences of Indonesian nurses who work in Taiwan's long-term care industry.

Conclusions
Nurses from Indonesia choose to who work as nurses in Taiwan because of poor financial background and the chance of gaining a better life. However, the participants in this study felt stressed, challenged, and disappointed when faced with the unmet expectations of being employed as care workers without a clear career path. Furthermore, the need to communicate in an unfamiliar language was mentioned as a significant barrier to fulfilling their role. Better policies should be put in place to achieve improved outcomes for both countries.
Measurement reliability of automated oscillometric blood pressure monitor in the elderly with atrial fibrillation: a systematic review and meta-analysis
Authors: Park Seong-Hi , Choi Yun-Kyoung 
Published: November 2019

Objectives
This study aimed to identify whether automated oscillometric blood pressure monitor (AOBPM) is a reliable blood pressure (BP) measurement tool in geriatric patients with atrial fibrillation (AF) with high variability in BP and to evaluate whether it can be applied in practice.

Methods
Electronic searches were performed in databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL by using the following keywords: ‘atrial fibrillation,’ ‘atrial flutter, ‘blood pressure monitor’, ‘sphygmomanometer.’ The QUADAS-2 was applied to assess the internal validity of selected studies. Meta-analysis was performed using RevMan 5.3 program. Design: Systematic review.

Results
We identified 10 studies, including 938 geriatric patients with AF. We compared with the previously used BP measurement method (mainly office) and AOBPM, and the patients with AF were divided into the AF-AF (atrial fibrillation rhythm continued) and AF-SR groups (sinus rhythm recovered). The difference in the systolic BP was −3.0 mmHg [95% confidence interval (CI): −6.58 to 0.59] and −1.62 (95% CI: −6.08 to 2.84) mmHg in the AF-AF and AF-SR groups, respectively. The difference in the diastolic BP was 0.17 (95% CI: −2.90 to 3.25) mmHg and −0.23 (95% CI: −5.11 to 4.65) mmHg, respectively.

Conclusion
This review showed that the BP difference from AOBPM compared with the auscultatory BP method was less than 5 mmHg in the elderly with AF. This difference is acceptable in clinical practice. However, AOBPM compared with invasive arterial BP in the diastolic BP was a difference of 5 mmHg or more, and so its accuracy cannot be assured.
Asthma–COPD overlap: review of diagnosis and management
Authors: Venkata Anand N. 
Published: November 2019

Purpose of review
Asthma and chronic obstructive pulmonary disease are both commonly encountered respiratory conditions. The term asthma--COPD overlap (ACO) has been used to identify patients presenting with features of both conditions. Controversy exists regarding its definition, approach to diagnosis and management. In this publication, recent evidence has been reviewed that provides insight into diagnosis and management of this condition.

Recent findings
Previously, multiple criteria were used to define Asthma--COPD overlap. In this publication, the most recent guidelines to identify this condition have been reviewed. This publication provides a summary of the recent evidence with regard to the role of various diagnostic modalities including the use of biomarkers, such as exhaled nitric oxide, serum IgE and provides updated evidence on available treatment choices for this condition.

Summary
ACO is a commonly encountered clinical condition with patients experiencing frequent exacerbations and resulting in increased healthcare resource utilization. Recent interest in ACO has led to development of a framework towards diagnosis and management of this condition. Therapeutic choices for ACO range from bronchodilator therapy to immunomodulatory therapy, highlighting the heterogeneity of this condition. Additional research is required to improve understanding of pathogenesis and improve outcomes in ACO.
Sarcopenia as prognostic factor for survival after orthotopic liver transplantation
Authors: Pinto Dos Santos Daniel , Kloeckner Roman , Koch Sandra , Hoppe-Lotichius Maria , Zöller Daniela , Toenges Gerrit , Kremer Wolfgang Maximilian , Zimmermann Tim , Mittler Jens , Lang Hauke , Düber Christoph , Galle Peter Robert , Weinmann Arndt , Sprinzl Martin Franz 
Published: November 2019

Background and aim
Body composition has emerged as a prognostic factor for end-stage liver disease. We therefore investigated muscle mass, body fat and other clinical–pathological variables as predictors of posttransplant survival.

Methods
A total of 368 patients, who underwent orthotopic liver transplantation (OLT) at our institution, were assessed prior to OLT and followed for a median of 9.0 years (range 2.0–10.0 years) after OLT. Psoas, erector spinae and the combined paraspinal muscle area, as well as the corresponding indices normalized by body-height squared, were quantified by a lumbar (L3) cross-sectional computed tomography. In addition, absolute body fat and bone density were estimated by the same computed tomography approach.

Results
Paraspinal muscle index (PSMI) (hazard ratio 0.955, P = 0.039) and hepatitis C (hazard rati 1.498, P = 0.038) were independently associated with post-OLT mortality. In contrast, body fat and bone density did not significantly affect post-OLT outcome (P > 0.05). The PSMI also predicted one-year posttransplant mortality with a receiver operating characteristics-area under the curve of 0.671 [95% confidence interval (CI) 0.589–0.753, P < 0.001) in male patients and outperformed individual psoas and erector spinae muscle group assessments in this regard. In male patients, a defined PSMI cutoff (<18.41 cm2/m2) was identified as suitable determinant for sarcopenia and posttransplant one-year mortality. In female OLT-recipients, however, sarcopenia was not predictive for patient survival und a women-specific cutoff could not be derived from this study.

Conclusions
Taken together this analysis provides evidence, which PSMI is a relevant marker for muscle mass and that sarcopenia is an independent predictor of early post-OLT survival in male patients.
Validation of the English version of the difficulty of life scale for patients with ulcerative colitis
Authors: Kawakami Aki , Choong Lee Meng , Tanaka Makoto , Kunisaki Reiko , Maeda Shin , Bjarnason Ingvar , Hayee Bu’Hussain 
Published: November 2019

Objective
Patients with ulcerative colitis have abdominal symptoms that affect their quality of life in multiple ways. The difficulty of life scale was developed in Japan to measure these patients’ degree of daily difficulties. We aimed to assess this scale for English-speaking patients and to evaluate its validity and reliability.

Methods
The original Japanese version of the difficulty of life scale was translated into English and administered to 100 consecutive outpatients with ulcerative colitis at a university hospital in London. Medical information was obtained from participants’ medical records. Factor validity, construct validity using the Short Inflammatory Bowel Disease Questionnaire, known group validity with clinically different groups, internal consistency and test-retest reliability were analyzed statistically.

Results
Three factors were extracted by exploratory factor analysis, as in the original scale. The construct validity was supported by the association between the Difficulty of Life Scale and Short Inflammatory Bowel Disease Questionnaire scores (Pearson’s correlation coefficient: 0.73–0.83). Patients with visible bleeding or who were prescribed corticosteroids reported significantly greater difficulty than did those without them, demonstrating a significant effect size. The scaling success rate was acceptable. Internal consistency was confirmed (Cronbach’s alpha: 0.68–0.89). The intraclass correlation coefficients were >0.75, thus confirming the test–retest reliability.

Conclusion
The English version of the difficulty of life scale is a reliable and valid disease-specific scale for ulcerative colitis. It can be used to communicate the challenge of daily living between patients with this long-term condition and health care providers.
Elevated mean platelet volume to platelet ratio predicts advanced fibrosis in chronic hepatitis C
Authors: Gozdas Hasan Tahsin , Ince Nevin 
Published: November 2019

Objective
Chronic hepatitis C virus (HCV) infection is an important health problem that can cause liver cirrhosis and hepatocellular carcinoma. Recently, novel inflammatory markers from complete blood count have been used as a precursor of many clinical conditions. In this study, we investigated the role of hemogram parameters in predicting advanced liver fibrosis in chronic HCV patients.

Methods
Patients who underwent percutaneous liver biopsy due to chronic HCV infection between 01.01.2011 and 01.08.2019 were included in this study. Liver biopsies were evaluated according to Ishak method. Patients were classified into those with mild fibrosis (F ≤ 2) and advanced fibrosis (F ≥ 3). Hemogram parameters of these groups were compared and their efficacy in predicting severe fibrosis was investigated.

Results
Of the 81 chronic HCV patients, 38 cases were in the mild fibrosis group and 43 cases were in the severe fibrosis group. Mean platelet volume, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, and red cell distribution width to platelet ratio of the severe fibrosis group were significantly higher than those of the mild fibrosis group (P < 0.05 for all). In the ROC curve analysis, mean platelet volume to platelet ratio showed the biggest area under the curve in the prediction of advanced fibrosis.

Conclusion
Mean platelet volume to platelet ratio may be an easy and practical biomarker to gain a preliminary insight into advanced fibrosis in chronic HCV patients.
Comparing thoracoabdominal injuries of manual versus load-distributing band cardiopulmonary resuscitation
Authors: Sonnemans Lianne J.P. , Bayat Alireza R. , Bruinen Aniek R.C. , van Wely Marleen H. , Brouwer Marc A. , Bosboom Dennis , van der Hoeven Johannes G. , Prokop Mathias , Klein Willemijn M. 
Published: November 2019

Objective
To identify and compare manual and load-distributing band (LDB) cardiopulmonary resuscitation (CPR)-related injuries.

Methods
Retrospective observational cohort study. Adult, nontraumatic deaths with a postmortem computed tomography scan (PMCT) performed were classified into two groups: deceased after LDB CPR or after manual CPR. PMCT scans were reviewed for thoracoabdominal injuries such as fractures, pneumothorax and hemorrhage. The injuries between groups were compared.

Results
LDB CPR (n = 43) showed increased incidences of posterior rib fractures (53 vs 18%, P = 0.006), pneumothorax (23 vs 4%, P = 0.04) and more pericardial fluid (median 12  vs 6 mm, P = 0.002) compared with manual CPR (n = 29). Multivariable regression analysis revealed that LDB CPR was significantly associated with posterior rib fractures [odds ratio (OR) 5.37, 95% confidence interval (CI): 1.44–20.09, P = 0.01). Pneumothorax (OR 6.80, 95% CI: 0.73–62.99, P = 0.09) and the amount of pericardial fluid (OR 3.40, 95% CI: 0.20–56.32) were not significantly associated with LDB CPR. No significant difference was found for anterolateral rib fractures, sternal fractures, vertebral fractures, pleural fluid, hemothorax, hemopericardium, pneumoperitoneum, perihepatic, perisplenic and perirenal hemorrhage.

Conclusion
Rib fractures, sternal fractures, hemothorax and hemopericardium are common CPR-related injuries. LDB CPR is significantly associated with more posterior rib fractures and a trend toward more pneumothoraces is observed when compared with manual CPR. This knowledge is important for caretakers in the case of ongoing CPR, as a pneumothorax may attribute to not achieving persistent return of spontaneous circulation, and to improve postresuscitation care of survivors.