bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tyrosine Kinase Inhibitors and the Relationship With Adherence, Costs, and Health Care Utilization in Commercially Insured Patients With Newly Diagnosed Chronic Myeloid Leukemia
Authors: Phuar Hsiao Ling , Begley Charles E. , Chan Wenyaw , Krause Trudy Millard 
Published: April 2020

Objective:
To examine the association among tyrosine kinase inhibitor (TKI) out-of-pocket costs, adherence, and health care costs and utilization in a large group of commercially insured patients with chronic myeloid leukemia (CML).

Materials and Methods:
Patients with CML aged 18 to 64 years were identified using IBM MarketScan Commercial Database between April 1, 2011 and December 31, 2014. Patients were required to be continuously enrolled 3 months before and 12 months after TKI (imatinib, dasatinib, or nilotinib) initiation. TKI adherence is estimated using the proportion of days covered (PDC), defined as the percentage of the PDC by the prescription fill during the 12-month study period (adherent patients have PDC ≥80%). Health care cost differences between adherent and nonadherent patients were estimated using generalized linear models. Health care utilization was compared using negative binomial regression models. All models were controlled for potential confounding factors.

Results:
The study sample consisted of 863 patients, where 355 (41.1%) patients were classified as adherent. Over the study period, nonadherent patients incurred US$10,974 more in medical costs (P<0.001), and US$1663 more in non-TKI pharmacy costs (P<0.01). Adherent patients incurred US$28,184 more in TKI pharmacy costs (P<0.001) that resulted in US$18,305 more in overall total health care costs (P<0.001). Adherent patients, however, were estimated to be less likely to have all-cause hospitalizations (incidence rate ratio, 0.32; P<0.001), or CML-specific hospitalizations (incidence rate ratio, 0.31; P<0.01).

Conclusions:
Patients with CML with better adherence experienced fewer hospitalizations, resulting in medical service cost savings. These lower medical costs, however, were more than offset by higher TKI medication costs observed during the first year of TKI therapy.
Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions
Authors: Elens Laure , Langman Loralie J. , Hesselink Dennis A. , Bergan Stein , Moes Dirk Jan A.R. , Molinaro Mariadelfina , Venkataramanan Raman , Lemaitre Florian 
Published: April 2020

Background:
COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals.

Methods:
This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature.

Results:
Management of drug–drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight.

Conclusions:
With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.
Characteristics of Streptococcus pyogenes Versus Streptococcus pneumoniae Pleural Empyema and Pneumonia With Pleural Effusion in Children
Authors: Megged Orli 
Published: April 2020

Background:

Streptococcus pneumoniae is the most common cause of complicated pneumonia in children, but its incidence is decreasing since the introduction of the antipneumococcal conjugated vaccines. Streptococcus pyogenes is an uncommon cause of community-acquired pleuropneumonia/empyema in children, but its relative incidence is rising.

Methods:
The medical records of all children 0–18 years of age from 2004 to 2019, with discharge diagnoses of pleuropneumonia or empyema, and a positive blood and/or pleural effusion culture for group A streptococcus (GAS) (S. pyogenes), or S. pneumonia (SP) were reviewed. A comparison of clinical and laboratory characteristics for the 2 etiologies was performed.

Results:
Ninety cases of community-acquired pleuropneumonia/empyema caused by these organisms were included: 20 GAS and 70 SP. Compared with children with SP, those with GAS were more likely to have larger pleural effusion requiring drainage and longer hospitalization, and less likely to have a positive blood culture. The relative portion of GAS empyema increased over the study period.

Conclusions:
Compared with patients with SP empyema, GAS appears to cause more morbidity and a longer hospital stay. This organism is more frequently recovered from pleural fluid without bacteremia, and thus necessitates pleural fluid tap for accurate diagnosis.
Preoperative assessment of posterior capsular integrity using a posterior segment OCT with a +20 D lens: The 'conical sign' to suggest capsular deficiency in posterior polar cataracts
Authors: Pujari Amar , Selvan Harathy , Yadav Saumya , Urkude Jayanand , Singh Rashmi , Mukhija Ritika , Makwana Tarjani , Sharma Namrata 
Published: April 2020

Purpose:
To study the morphology of posterior polar cataracts and posterior lens capsules using modified posterior segment optical coherence tomography (m-OCT).

Setting:
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Design:
A prospective observational case series.

Methods:
Patients with clinically diagnosed posterior polar cataracts were included. The routine posterior segment OCT was modified by placing an aspheric +20.00 diopter lens along its aperture, enabling it to visualize the anterior segment structures. Cases of posterior polar cataract were assessed preoperatively using this method to study the morphology of posterior lens cortex and the posterior capsule. All m-OCT observations were performed by 2 observers, and findings were recorded.

Results:
A total of 26 eyes of 17 patients were included. The mean age of patients was 53 years. The morphology of the cataract appeared as hyperreflective opacity just anterior to the posterior capsule, subsequently involving it, and with variable hyporeflective spaces. An intact posterior capsule showed a regularly convex contour, whereas a loss in the tracing of posterior capsule at the paracentral region and disturbance in contour with a localized protrusion of lens matter (the conical sign) depicted a possible posterior capsule dehiscence. Four (15.38%) of 26 eyes showed the conical sign, and this posterior capsule defect was confirmed intraoperatively in all cases.

Conclusions:
In posterior polar cataracts, the conical sign could be a valuable clue to predict preexisting posterior capsule dehiscence and could be identified on a m-OCT.
Where to buy face masks? Survey of applications using Taiwan’s open data in the time of coronavirus disease 2019
Authors: Yuan Eunice J. , Hsu Chia-An , Lee Wui-Chiang , Chen Tzeng-Ji , Chou Li-Fang , Hwang Shinn-Jang 
Published: April 2020

Background:
The coronavirus disease 2019 (COVID-19) had spread rapidly since late December 2019. Personal protective equipment was essential to prevent transmission. Owing to shortage of face masks, Taiwan government began to implement quasi rationing on February 6, 2020, by allowing each resident to purchase two masks in seven days. Taiwan National Health Insurance Administration offered online data with real-time updates on face mask availability in all contracted pharmacies and selected local health centers. Based on the open data, numerous software applications quickly emerged to assist the public in finding sales locations efficiently.

Methods:
Up until March 15, 2020, the Public Digital Innovation Space of Taiwan government had recorded 134 software applications of face mask availability, and 24 software applications were excluded due to defect, duplicate, and unavailability. These applications were analyzed according to platform, developer type, and display mode.

Results:
Of the 110 valid software applications, 67 (60.9%) applications were deployed on websites, followed by 21 (19.1%) on social networking sites, 19 (17.3%) as mobile applications, and 3 (2.7%) in other modes. Nearly two thirds (n = 70) of applications were developed by individuals, one third (n = 37) by commercial companies, only two applications by central and local governments, and one by a nongovernmental organization. With respect to the display mode, 47 (42.7%) applications adopted map-view only, 41 (37.3%) adopted table-view only, and 19 (17.3%) adopted both modes. Of the remaining three applications, two offered voice user interfaces and one used augmented reality.

Conclusion:
Taiwan’s open data strategy facilitated rapid development of software applications for information dissemination to the public during the COVID-19 crisis. The transparency of real-time data could help alleviate the panic of the public. The collaborative contributions from the grassroots in disasters were priceless treasures.
The Effect of Contextualized Racial and Gendered Stressors, Social Support, and Depression on Hypertension Illness Perceptions and Hypertension Medication Adherence in Young African American Women With Hypertension
Authors: Spikes Telisa , Higgins Melinda , Lewis Tené , Dunbar Sandra 
Published: April 2020

Background
Poor adherence to hypertensive medication has been suggested to be a major contributor to uncontrolled hypertension (HTN) in African Americans. The impact that social determinants have on the various patient-level factors, including HTN beliefs, mental well-being, and social support, may provide insight into the development and tailoring of culturally targeted interventions, thus improving adherence.

Objective
The aim of this study was to examine the relationships of exposures to contextualized racial and gendered stressors, social support, and depressive symptoms with HTN illness perceptions and blood pressure (BP) medication adherence.

Methods
Participants (N = 85) were hypertensive African-American women aged 18 to 45 years (mean [SD], 39.2 [5.4] years) recruited from the community setting and outpatient medical clinics in a large metropolitan city. Hypertension illness beliefs were assessed using the 8-item Brief Illness Perception Questionnaire (“How much does your blood pressure affect your life?”) and medication adherence was assessed with the 7-item Adherence to Refills and Medication Scale (“How often do you forget to take your BP medicine?”). Logistic regression analyses were performed to examine the associations with medication adherence and linear regression analyses were performed to examine the associations of continuous variables and HTN illness perceptions.

Results
The sample was predominantly nonadherent (81.2%). In the adjusted multivariable regression model, systolic BP (odds ratio, 0.95; P = .05) and the “Consequence” dimension of HTN beliefs (odds ratio, 0.76; P = .02) were associated with medication adherence. In the adjusted linear regression model, systolic BP (β = 0.22, P < .01) and depressive symptoms (β = 1.11, P < .01) were associated with HTN illness beliefs.

Conclusions
Assessing beliefs and the mental well-being before initiating BP medications is essential for adherence and BP control.
Illness Perceptions, Self-efficacy, and Self-reported Medication Adherence in Persons Aged 50 and Older With Type 2 Diabetes
Authors: Kim Hyejin , Sereika Susan M. , Lingler Jennifer H. , Albert Steven M. , Bender Catherine M. 
Published: April 2020

Background
Illness perceptions, patients' beliefs about their health condition, may affect medication adherence as well as self-efficacy for managing the condition in type 2 diabetes (T2DM).

Objectives
The aims of this study were to investigate the associations between illness perceptions, self-efficacy, and self-reported medication adherence among persons (≥50 years of age) with T2DM and explore whether the number of comorbid conditions moderates these associations.

Methods
This secondary analysis of cross-sectional data used baseline data from persons with T2DM. Self-administered questionnaires, including the Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease, and the 4-item Morisky-Green-Levine Medication Adherence Scale, were used. We performed hierarchical multiple linear regression analyses.

Results
Participants (N = 146) were 57.5% female, 67.1% white, and on average 64 years old. Six dimensions of illness perceptions (ie, consequences, personal control, treatment control, identity, concerns, and emotional representations) were associated with self-efficacy for managing T2DM. Five dimensions (ie, timeline, personal control, treatment control, coherence, and emotional representations) were significant predictors of self-reported medication adherence. Whereas the number of comorbid conditions was significantly associated with self-efficacy for managing T2DM in all models (P values < .001), the number of comorbid conditions was not associated with self-reported medication adherence.

Conclusions
This study suggests that illness perceptions and comorbid conditions may play a critical role in either self-efficacy or self-reported medication adherence in persons (≥50 years of age) with T2DM. Future research should incorporate an individual's illness perceptions and comorbid conditions into the development of interventions that may improve both self-efficacy and medication adherence in T2DM.
Mental and Physical Health Behaviors of Doctor of Physical Therapy Students
Authors: Ellison Jennifer , Mitchell Katy , Bogardus Jennifer , Hammerle Kristi , Manara Carly , Gleeson Peggy 
Published: April 2020

Introduction.
High incidences of mental health issues in the undergraduate and graduate students are reported nationwide. The purpose of this study was to assess the Doctor of Physical Therapy (DPT) students' depression, anxiety, and stress levels using the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to investigate how mental and physical behaviors correlate with DPT students' mental health and to identify the coping strategies of DPT students to guide the intervention strategies of PT programs.

Methods.
A 49-item survey with demographic questions and 3 open-ended questions was developed to assess the students' mental and health behaviors. The DASS-21 was imbedded in the survey. Email invitations to 136 DPT students from one DPT program in the Southwestern region of the United States resulted in 59 responses.

Results.
Most students had normal DASS-21 scores for stress (66%), anxiety (64%), and depression (73%). However, only 46% had normal ranges for all 3 scales and a concerning number of students scored in the moderate and severe ranges for stress (19%), anxiety (25%), depression (12%), and previous suicide ideation (7%). No correlation was found between the DASS-21 scores and the gender or relationship status. No significant difference was found between the years in the program in the subscores of stress (P = .189), anxiety (P = .095), or depression (P = .149). All subscores of the DASS-21 were inversely correlated with hours of sleep: stress (r = −0.317, P = .014), anxiety (r = −0.467, P ≤ .005), and depression (r = −0.310, P = .017). Depression subscores were associated with lower frequency of aerobic (r = −0.335, P = .01) and strengthening exercises (r = −0.259, P = .049).

Discussion and Conclusions.
Physical therapist education programs should address the mental health issues of students by providing education on how to incorporate active positive coping strategies into their very busy lives. Students in this study are aware of healthy physical and mental strategies but do not use them consistently.
Perceptions of Academic Rights and Responsibilities in Physical Therapy Students and Faculty
Authors: Goehring Meri Tienn , Kinne Bonni Lynn , Vaughn Daniel Wayne 
Published: April 2020

Introduction.
The purpose of this study was to compare the perceived academic entitlement of physical therapy students with the way in which physical therapy faculty members perceived their students' academic rights and responsibilities. Three groups of researchers have published academic entitlement questionnaires. Although several researchers have attempted to measure the academic entitlement of undergraduate students, very few studies have investigated the same issue because it relates to graduate students. In addition, only one study has attempted to measure the academic entitlement of graduate students enrolled in a health care curriculum.

Methods.
The participants were Doctor of Physical Therapy (DPT) faculty members and DPT students at a public liberal arts university in the Midwest part of the United States. The data collection tool was the 15-item academic entitlement questionnaire created by Greenberger et al. A comparison of how the DPT faculty members and the DPT students answered the individual questionnaire items was calculated using the Fisher Exact Test, and a comparison of how the DPT faculty members and the DPT students responded to the entire questionnaire was calculated using Cronbach's Alpha.

Results.
There was no statistically significant difference between the way in which the DPT faculty members answered the individual questionnaire items and the way in which the DPT students responded to each question. When the entire questionnaire was taken into consideration, the overall academic entitlement of the DPT students was significantly greater than the way in which the DPT faculty members perceived their students' academic rights and responsibilities (P = .0452).

Discussion and Conclusion.
This study found that some DPT students may have an inflated sense of their academic entitlement. Therefore, DPT faculty members should explore meaningful ways in which to convey expectations regarding academic rights and responsibilities.
Development and implementation of an e-visit objective structured clinical examination to evaluate student ability to provide care by telehealth
Authors: Quinlin Linda , Clark Graham Margaret , Nikolai Carol , Teall Alice M. 
Published: April 2020

ABSTRACT
The provision of care through telehealth is emerging as a strategy to meet the challenges of a changing health care system; however, educational experiences associated with telehealth are limited in nursing curricula. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) recommended incorporating telehealth modalities in nurse practitioner education, including clinical skills assessment. Objective structured clinical examinations (OSCEs) have been used as formative and summative evaluations of health science students since the 1970s to assess application of didactic learning in clinical practice. Although few studies have investigated integrating OSCEs, virtual simulation, or telehealth in distance education, those that exist demonstrate significant improvement in clinical decision making. This article describes the development and implementation of an OSCE at a large Midwestern university delivered via web conferencing to evaluate online family nurse practitioner (FNP) students' abilities to deliver care using telecommunication technology. An e-visit notification listing the types of symptoms available for treatment by telehealth served as a content list. Students completed a 15-minute e-visit assessing and managing the care of a standardized patient presenting with a recent onset of dysuria. The video conference included the FNP student, standardized patient, and faculty evaluating in real time using a rubric incorporating NONPF competencies for telehealth. Structured group debrief, an integral part of the learning process in clinical simulations, followed the e-visit OSCE using free conference calling. Faculty and student feedback and evaluations of this summative OSCE implemented for three cohort groups (103 students) positively reflect the importance of preparing students for practice in a transformed health care system.
Extracorporeal cardiopulmonary resuscitation for cardiac arrest
Authors: Kalra Rajat , Kosmopoulos Marinos , Goslar Tomaz , Raveendran Ganesh , Bartos Jason A. , Yannopoulos Demetris 
Published: April 2020

Purpose of review
Extracorporeal cardiopulmonary resuscitation (ECPR) is a contemporary resuscitation approach that employs veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This approach is increasingly used worldwide to mitigate the widespread hemodynamic and multiorgan dysfunction that accompanies cardiac arrest.

Recent findings
In this review, the physiology of VA-ECMO and ECPR, the role of ECPR in contemporary resuscitation care, the complications associated with ECPR and VA-ECMO usage, and intensive care considerations for this population are discussed.

Summary
ECPR offers a promising mechanism to mitigate multiorgan injury and allow time for the institution of supportive interventions required to effectively treat cardiac arrest. More prospective data in the context of extensive prehospital and hospital collaboration is needed to promote its successful use.
Drugs during cardiopulmonary resuscitation
Authors: Vallentin Mikael F. , Granfeldt Asger , Holmberg Mathias J. , Andersen Lars W. 
Published: April 2020

Purpose of review
The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation.

Recent findings
Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival. There is still a lack of high-quality evidence for other drugs during cardiac arrest such as bicarbonate, calcium, and magnesium, but small-scale randomized clinical trials show no effect. A promising entity may be the combination of vasopressin and glucocorticoids, but external validation of preliminary trials is needed. Data from observational studies and subgroup analyses of trials generally favor intravenous over intraosseous access, while the latter remains a reasonable alternative.

Summary
Guidelines for the above-mentioned drugs have been updated yet remain largely unchanged over the last decades. There are still multiple unanswered questions related to drugs during cardiopulmonary resuscitation. On the contrary, only few trials are ongoing.