bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advancing Complex Case Management Competencies in a Health Care System
Authors: Stark Phyllis 
Published: November 2019

Purpose/Objectives:
The purpose of this literature review is to evaluate evidence to support advanced education for hospital-based nurse case managers to address the discharge needs of medically complex patients who have extended hospital stays.

Primary Practice Setting:
Acute care hospital and hospital systems.

Findings/Conclusion:
Studies on hospital length of stay are prevalent as are studies of effective case management and the importance of a comprehensive education program. Correlating effective case management to successful disposition of long-stay patients and efficacy of discharge planning education is the focus of this review of evidence. Creation of advanced case management competency education will benefit patients, staff, and the health care system by increasing the skill level to promote early recognition of discharge barriers in complex long-stay patients.

Implications for Case Management Practice:
Continued focus on affordability in health care will keep management of hospital length of stay high on the priority list. Pressure to create efficient patient management strategies leading to timely discharge disposition of medically complex patients through barrier mitigation and intervention requires effective case management tools.
Measurement of Irritability in Cancer Patients
Authors: Zhang Amy Y. , Ganocy Stephen J. 
Published: November 2019

Background
Irritability is common among people who are physically ill, but a physical underpinning of irritability is not assessed by existing measures. A measure that assesses multidimensionality of irritability can help nurses and clinicians provide better care for people with cancer and, thus, reduce a risk for developing depression during cancer treatment.

Objectives
We pilot tested a new measure, The Irritability Scale–Initial Version (TISi), for assessing irritability of cancer patients on three dimensions: physical, affective, and behavioral.

Methods
We conducted thee pilot studies to develop the 35-item TISi on a 5-point Likert scale. TISi was tested in 48 early-stage, nonmetastasized breast cancer patients at baseline (before) and 3 months (during chemotherapy). Of these patients, 62.5% received neoadjuvant and 37.5% received adjuvant chemotherapy, but none received hormonal treatment before or during the study. Measures of other correlates, including depression, anxiety, symptom distress, and social disconnectedness, were also administered, and biomarkers of hsCRP, TNF-α, IL-6, and BDNF were obtained from blood draws at both assessments.

Results
TISi has a high internal consistency (Cronbach’s α = .97), satisfactory test–retest reliability (retest r = .69, intraclass correlation coefficient = .86), and moderate correlation with other constructs over time (r ≈ .40–.70). Its physical subscale significantly correlated with hsCRP (r = .32, p = .025) at baseline and TNF-α (r = .44, p = .002) at 3 months. A confirmatory factor analysis yields three factor loadings that are in line with conceptualization of the subscales.

Discussion
The findings support psychometric properties of TISi and its application for assessing cancer patients’ irritability in multiple dimensions. Further investigation using a large study sample is necessary for improving construct and criterion validity and reducing item redundancy.

Conclusion
TISi can be used to measure the level of irritability in cancer patients
Randomized Controlled Trial of a Natural Food-Based Fiber Solution to Prevent Constipation in Postoperative Spine Fusion Patients
Authors: Wittig-Wells Deborah , Sapp Pam , Higgins Melinda , Davis Erica , Carter Jessica , Jacob Ani 
Published: November 2019

BACKGROUND:
Constipation after orthopaedic surgery occurs frequently, likely due to a combination of high levels of opioid medications for severe pain management and mobility limitations after surgery. It can result in serious complications, increased cost, and patient discomfort.

PURPOSE:
This study evaluated a natural food-based fiber solution to prevent constipation in postoperative orthopaedic patients.

METHODS:
A posttest control group-randomized study design was used. Dependent variables were presence of postoperative constipation, time to first bowel movement (BM), and total number of postoperative BMs. Descriptive statistics, Student's t tests, and Mann–Whitney nonparametric 2-group tests with chi-square analysis were used. Level of significance for all tests was p < .05. Forty-six participants were evaluated.

RESULTS:
Ages were similar for both the intervention and control groups. Bowel Function Index (BFI) scores were not significantly different (p = .448). No significant group differences were present for the individual BFI item scores (p > .05). The number of patients with a BM during the first 3 days was not significantly different (p = .489). There were no significant differences found between the 2 groups regarding laxative administration (p > .05 for all laxatives).

CONCLUSION:
Further studies are indicated that address natural fibers and pharmaceutical methods for the prevention of constipation after spinal surgery.
The effect of knee resizing illusions on pain and swelling in symptomatic knee osteoarthritis: a case report
Authors: MacIntyre Erin , Sigerseth Maja , Pulling Brian W. , Newport Roger , Stanton Tasha R. 
Published: November 2019

Abstract

Introduction:
Resizing illusions that manipulate perceived body size are analgesic in some chronic pain conditions. Little is known whether such illusions may also alter other physiological features, such as swelling.

Objectives:
To determine the effects of a knee resizing illusion on knee pain and swelling in symptomatic osteoarthritis.

Methods:
This case study was extracted from a larger study evaluating the analgesic effects of resizing illusions in people with knee osteoarthritis. A mediated reality system (alters real-time video) was used to provide resizing “stretch” and “shrink” illusions of the knee. Knee pain intensity (0–100 numerical rating scale) was measured before and after illusion and after sustained (3 minutes) and repeated (n = 10) illusions. In this case study, knee swelling (leg circumference below, at, and above the knee) was also measured.

Results:
The 55-year-old male participant reported a long history of episodic knee pain and swelling that was subsequently diagnosed as severe osteoarthritis in 2013. In the first testing session, the participant experienced an increase in pain with the shrink illusion and a decrease in pain with stretch illusion. A noticeable increase in knee swelling was also observed. Thus, in sessions 2/3, swelling was also assessed. The stretch illusion decreased pain to the largest extent, but resulted in increased knee swelling. Repeated and sustained stretch illusions had cumulative analgesic effects but resulted in cumulative increases in swelling. While the shrink illusion increased pain, sustained (∼10 minutes) visual minification of the entire knee and leg reduced both pain and swelling.

Conclusion:
Our case report suggests that both pain and swelling may be modifiable by altering body-relevant sensory input in symptomatic knee osteoarthritis.
Surgical Approach and Periprocedural Outcomes by Race and Ethnicity of Children Undergoing Craniosynostosis Surgery
Authors: Wallace Erin R. , Birgfeld Craig , Speltz Matthew L. , Starr Jacqueline R. , Collett Brent R. 
Published: November 2019

Background:
Surgical repair for craniosynostosis varies depending on the infant’s age, location of suture fusion, and approach (e.g., open versus endoscopic). Existing data suggest possible racial and ethnic disparities in timely access to surgical care for craniosynostosis that may, in turn, be associated with surgical approach and perioperative outcomes. This study examined racial and ethnic variation in craniosynostosis operations by surgical approach and perioperative outcomes.

Methods:
Data were collected by the 2013 to 2015 Pediatric National Surgical Quality Improvement Program. Patients aged younger than 24 months with diagnoses and procedure codes consistent with surgery for craniosynostosis were identified. Periprocedural characteristics and surgical approach (open, endoscopic/minimally invasive, or both) were examined descriptively, overall, and separately by race and ethnicity.

Results:
The authors identified 1982 admissions. Mean age at surgery was 7.8 ± 4.7 months. Ninety-one percent of procedures were classified as open operations, 5.8 percent were endoscopic, and 3.4 percent were both open and endoscopic. Relative to white/non-Hispanic patients, Hispanic and nonwhite patients underwent surgery at older ages, experienced longer operative and anesthesia times, and were hospitalized longer. Hispanic patients had the highest rates of open operations.

Conclusions:
These data suggest that Hispanic and nonwhite patients tend to undergo craniosynostosis repair at older ages and to have lengthier operations than white/non-Hispanic patients. Although we were unable to examine the root cause(s) of these differences, delayed diagnosis is one factor that might result in surgery at an older age and more complex operations requiring open surgery. Prospective studies examining racial/ethnic disparities are needed to inform a comparison of outcomes associated with surgical approach.
Analysis of the Visual Perception of Female Breast Aesthetics and Symmetry: An Eye-Tracking Study
Authors: Pietruski Piotr , Paskal Wiktor , Paskal Adriana M. , Jaworowski Janusz , Paluch Łukasz , Noszczyk Bartłomiej 
Published: November 2019

Background:
Because of its subjective character, the term “breast attractiveness” is poorly defined and thus its reliable standardized assessment can be particularly challenging. Because of objective analysis of the observer’s gaze pattern, eye-tracking technology may provide a better insight into the visual perception of breast aesthetics and symmetry.

Methods:
One hundred observers, 50 women and 50 men, assessed the aesthetics and symmetry of eight types of female breasts displayed as digital images on frontal, lateral, and oblique projections. The gaze pattern of each observer was recorded using eye-tracking technology, and gaze data were subsequently analyzed.

Results:
Although sex and breast type exerted an effect on attention capturing by some areas of interest, key characteristics of gaze patterns in female and male observers were essentially the same. Irrespective of observers’ sex, the longest fixation duration and the highest fixation number were recorded for lower breast regions, in particular, for the nipple-areola complex. Mean fixation duration in this area corresponded to 58 and 57 percent of overall observation time for female and male observers, respectively, during the assessment of breast aesthetics; and to 56 and 52 percent of overall observation time for female and male observers, respectively, during the assessment of breast symmetry.

Conclusions:
Nipple-areola complex and lower breast are key focus areas for the assessment of breast aesthetics and symmetry. Gaze data collected during this study may constitute a valuable source of reference values for future eye-tracking research on various patient groups’ visual perception of breast attractiveness and deformities.
Prioritizing Patient Safety Efforts in Office Practice Settings
Authors: Kravet Steven , Bhatnagar Melissa , Dwyer Marian , Kjaer Klaus , Evanko John , Singh Hardeep 
Published: November 2019

Objectives
Outpatient care settings face unique risks of adverse events and medico-legal liability, often worsened by inconsistent processes and fragmented care. Health systems are increasingly providing integrated care that includes outpatient care, but models of how to systematically target medico-legal risk in office practices are largely absent. Innovative and scalable efforts are needed to guide large health systems in their approach to outpatient safety.

Methods
A malpractice consortium consisting of five large health care delivery systems identified that its ambulatory care cases (including office practices, outpatient hospital settings, and emergency departments) account for 30% to 35% of annual medical malpractice costs, and missed or delayed diagnoses account for approximately 50% of office practice liability risk. To further understand risks and opportunities in office-based practices, a team of patient safety and loss prevention professionals conducted site visits to seven outpatient-affiliated sites of the five health systems from January to March 2016 and interviewed several key informant members of physician, nursing, and administrative leadership.

Results
We identified eight common patient safety risk domains based on analysis of eight sets of group interviews. Risk domains were then prioritized by members of the consortium leadership using scoring criteria that we developed based on existing risk assessment and prioritization approaches. The method helped identify communication and follow-up of diagnostic test results in the outpatient setting as the single most important risk area to target improvement efforts.

Conclusions
A targeted approach to identify a single high-risk area led to development of dedicated teams to conduct local patient safety improvement projects at the affiliated health systems and for sharing lessons learned. Similar efforts elsewhere could lead to safety improvements in office practices at other large health systems.
Eligibility for differentiated models of HIV treatment service delivery: an estimate from Malawi and Zambia
Authors: Hoffman Risa M. , Balakasi Kelvin , Bardon Ashley R. , Siwale Zumbe , Hubbard Julie , Kakwesa Gift , Haambokoma Mwiza , Kalua Thoko , Pisa Pedro , Moyo Crispin , Dovel Kathryn , Xulu Thembi , Sanne Ian , Fox Matt , Rosen Sydney 
Published: November 2019

Background:
Little is known about the proportion of HIV-positive clients on antiretroviral therapy (ART) who meet stability criteria for differentiated service delivery (DSD) models. We report the proportion of ART clients meeting stability criteria as part of screening for a randomized trial of multimonth dispensing in Malawi and Zambia.

Methods:
For a DSD trial now underway, we screened HIV-positive clients aged at least 18 years presenting for HIV treatment in 30 adult ART clinics in Malawi and Zambia to determine eligibility for DSD. Stability was defined as on first-line ART (efavirenz/tenofovir/lamivudine) for at least 6 months, no ART side effects, no toxicity or infectious complications, no noncommunicable diseases being treated in ART clinic, no lapses in ART adherence in the prior 6 months (>30 days without taking ART), and if female, not pregnant or breastfeeding.

Results:
In total, 3465 adult ART clients were approached between 10 May 2017 and 30 April 2018 (Malawi: 1680; Zambia: 1785). Of the 2938 who answered screening questions (Malawi: 1527; Zambia: 1411), 2173 (73.5%) met criteria for DSD eligibility (Malawi: 72.8%; Zambia: 74.3%). The most common reasons for ineligibility were being on ART less than 6 months (9.6%) and a regimen other than standard first-line (7.9%).

Conclusion:
Approximately three-quarters of all adult clients presenting at ART clinics in Malawi and Zambia were eligible for DSD using a typical definition of stability. High uptake of DSD models by eligible clients would have a major impact on the infrastructure and the allocation of HIV treatment resources.
HIV postexposure prophylaxis-in-pocket: long-term follow-up of individuals with low-frequency, high-risk HIV exposures
Authors: Alghamdi Amenah , Hempel Amanda , Heendeniya Amila , Clifford-Rashotte Matthew , Tan Darrell H.S. , Bogoch Isaac I. 
Published: November 2019

Background:
HIV preexposure prophylaxis and postexposure prophylaxis are two major biomedical HIV prevention modalities. The utility of these prevention tools for individuals with infrequent high-risk HIV exposures remains uncertain. HIV postexposure prophylaxis-in-pocket (’PIP’) may be an effective HIV prevention tool in such situations. Here, we present long-term follow-up of a cohort of patients initiated on PIP for HIV prevention.

Methods:
We retrospectively evaluated clinical characteristics of patients initiated on PIP as a primary HIV prevention tool between 1 January 2016 to 31 May 2019 at the Toronto General Hospital HIV Prevention Clinic and St. Michael's Hospital HIV Clinic, both in Toronto, Canada. Patients were referred for consideration of a biomedical HIV prevention modality. Individuals with a low frequency of high-risk exposures to HIV were initiated on PIP after counselling, and were followed at regular intervals. Demographic and clinical data was collected with a standardized form.

Results:
In total, 79 patients were initiated on PIP as a primary HIV prevention modality and followed for a mean duration of 14.8 months combining for a total of 97.3 patient-years. Twenty-one (26.6%) patients used their PIP, and 32 courses of PIP were taken during the study period. Transitions between HIV prevention modalities included 13 (16.5%) patients who transitioned from PrEP to PIP, and 22 (27.8%) patients who transitioned from PIP to PrEP. No HIV seroconversions were detected during the course of this study.

Conclusion:
PIP is helpful HIV prevention modality for individuals with a low frequency of high-risk HIV exposures.
Bridging the Efficacy–Effectiveness Gap in HIV Programs: Lessons From Economics
Authors: Bor Jacob , Thirumurthy Harsha 
Published: November 2019

Background:
Bridging the efficacy–effectiveness gap in HIV prevention and treatment requires policies that account for human behavior.

Setting:
Worldwide.

Methods:
We conducted a narrative review of the literature on HIV in the field of economics, identified common themes within the literature, and identified lessons for implementation science.

Results:
The reviewed studies illustrate how behaviors are shaped by perceived costs and benefits across a wide range of health and nonhealth domains, how structural constraints shape decision-making, how information interventions can still be effective in the epidemic's fourth decade, and how lessons from behavioral economics can be used to improve intervention effectiveness.

Conclusion:
Economics provides theoretical insights and empirical methods that can guide HIV implementation science.
Human-Centered Design Lessons for Implementation Science: Improving the Implementation of a Patient-Centered Care Intervention
Authors: Beres Laura K. , Simbeza Sandra , Holmes Charles B. , Mwamba Chanda , Mukamba Njekwa , Sharma Anjali , Munamunungu Virginia , Mwachande Monica , Sikombe Kombatende , Bolton Moore Carolyn , Mody Aaloke , Koyuncu Aybüke , Christopoulous Katerina , Jere Lazarus , Pry Jake , Ehrenkranz Peter D. , Budden Ashwin , Geng Elvin , Sikazwe Izukanji 
Published: November 2019

Background:
Evidence-based HIV interventions often fail to reach anticipated impact due to insufficient utilization in real-world health systems. Human-centered design (HCD) represents a novel approach in tailoring innovations to fit end-users, narrowing the gap between efficacious interventions and impact at scale.

Methods:
We combined a narrative literature review of HCD in HIV programs with our experience using HCD to redesign an intervention promoting patient-centered care (PCC) practices among health care workers (HCW) in Zambia. We summarize the use and results of HCD in the global HIV response and share case study insights to advance conceptualization of HCD applications.

Results:
The literature review identified 13 articles (representing 7 studies) on the use of HCD in HIV. All studies featured HCD hallmarks including empathy development, user-driven inquiry, ideation, and iterative refinement. HCD was applied to mHealth design, a management intervention and pre-exposure prophylaxis delivery. Our HCD application addressed a behavioral service delivery target: changing HCW patient-centered beliefs, attitudes, and practices. Through in-depth developer–user interaction, our HCD approach revealed specific HCW support for and resistance to PCC, suggesting intervention revisions to improve feasibility and acceptability and PCC considerations that could inform implementation in transferable settings.

Conclusions:
As both a research and implementation tool, HCD has potential to improve effective implementation of the HIV response, particularly for product development; new intervention introduction; and complex system interventions. Further research on HCD application strengths and limitations is needed. Those promoting PCC may improve implementation success by seeking out resonance and anticipating the challenges our HCD process identified.
Integrating Economic Evaluation and Implementation Science to Advance the Global HIV Response
Authors: Salomon Joshua A. 
Published: November 2019

Background:
Numerous cost-effectiveness analyses have indicated good value for money from a wide array of interventions for treatment and prevention of HIV/AIDS. There is limited evidence, however, regarding how cost-effectiveness information contributes to better decision-making around investment and action in the global HIV response.

Methods:
We review challenges for economic evaluation relevant to the global HIV response and consider how the practice of cost-effectiveness analysis could integrate approaches and insights from implementation science to enhance the impact and efficiency of HIV investments.

Results:
In light of signals that cost-effectiveness analyses may be vulnerable to systematic bias toward overly optimistic conclusions, we emphasize two priorities for advancing the field of economic evaluation in HIV/AIDS and more broadly in global health: (1) systematic reevaluation of the cost-effectiveness literature with reference to ex-post empirical evidence on costs and effects in real-world programs and (2) development and adoption of good-practice guidelines for incorporating implementation and delivery aspects into economic evaluations. Toward the latter aim, we propose an integrative approach that focuses on comparative evaluation of strategies, which specify both technologies/interventions as well as the delivery platforms, complementary interventions, and actions needed to increase coverage, quality, and uptake of those technologies/interventions. Specific recommendations draw on several existing implementation science models that provide systematic frameworks for understanding implementation barriers and enablers, designing and choosing specific implementation and policy actions, and evaluating outcomes.

Discussion:
These preliminary steps aimed at bridging the divide between economic evaluation and implementation science can help to advance the practice of economic evaluation toward a science of comparative strategy evaluation.