bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing Hospital Length of Stay for Total Joint Arthroplasty Patients: Effects of Extended Physical Therapy Staffing and Day of Surgery Evaluations
Authors: Phillips Elizabeth A. , Dalton Jennifer R. , Childress Ryan E. , Heidel Robert E. 
Published: January 2020

Purpose:
The Rehabilitation Department at the University of Tennessee Medical Center in Knoxville, Tennessee, changed its staffing model in an effort to increase efficiency and reduce hospital length of stay (LOS) without compromising safety for patients undergoing total joint arthroplasty (TJA). This study was designed to reveal effects of extended physical therapy (PT) coverage on TJA patient safety and LOS at our hospital.

Methods:
Our study is a retrospective chart review including 775 patients. After a staffing change involving the addition of an evening PT shift, we gathered data on patients with TJA in 2 groups: (1) before staffing change and (2) after staffing change. We examined the percentage of patients in each group who received a day of surgery (DOS) PT evaluation and tracked each group's incidence of adverse events and hospital LOS. We then compared outcomes between groups.

Results:
The percentage of Patients who received a DOS PT evaluation increased from 64.5% prestaffing change to 97.0% poststaffing change. Hospital LOS decreased from 2.30 days (SD = 0.9) in the prestaffing change group to 2.16 days (SD = 0.8) in the poststaffing change group, with no difference in incidence of adverse events between groups. The frequency of adverse events tracked in this study was only 6.6% in each group, indicating that the greater frequency of DOS PT evaluations did not increase the incidence of adverse events or compromise patients' safety.

Conclusions:
A staffing change involving extended PT evening coverage resulted in a higher percentage of patients with TJA receiving a DOS PT evaluation, no increase of adverse events, and a statistically significant decrease in hospital LOS.
Emergency Department Ergonomic Redesign Improves Team Satisfaction in Cardiopulmonary Resuscitation Delivery: A Simulation-Based Quality Improvement Approach
Authors: Ehmann Michael R. , Kane Erin M. , Arciaga Zakk , Duval-Arnould Jordan , Saheed Mustapha 
Published: January 2020

ABSTRACT

Background:
Delivering high-quality cardiopulmonary resuscitation (CPR) requires teams to administer highly choreographed care. The American Heart Association recommends audiovisual feedback for real-time optimization of CPR performance. In our Emergency Department (ED) resuscitation bays, ZOLL cardiac resuscitation device visibility was limited.

Objective:
To optimize the physical layout of our resuscitation rooms to improve cardiac resuscitation device visibility for real-time CPR feedback.

Methods:
A simulated case of cardiac arrest with iterative ergonomic modifications was performed four times. Variables included the locations of the cardiac resuscitation device and of team members. Participants completed individual surveys and provided qualitative comments in a group debriefing. The primary outcome of interest was participants' perception of cardiac resuscitation device visibility.

Results:
The highest scoring layout placed the cardiac resuscitation device directly across from the compressor and mirrored the device screen to a television mounted at the head of the bed. Comparing this configuration to our standard configuration on a five-point Likert scale, cardiac resuscitation device visibility increased 46.7% for all team members, 150% for the team leader, and 179% for team members performing chest compressions.

Conclusion:
An iterative, multidisciplinary, simulation-based approach can improve team satisfaction with important clinical care factors when caring for patients suffering cardiac arrest in the ED.
Myocardial perfusion abnormalities in Eisenmenger syndrome
Authors: Gupta Anunay , Patel Chetan , Gupta Saurabh Kumar , Ramakrishnan S. , Saxena Anita , Kothari Shyam S. 
Published: January 2020

Background
Compared to primary pulmonary hypertension (PPH), the right ventricular (RV) contractile function is preserved for a long time in patients with Eisenmenger syndrome and is likely the most important determinant of relatively higher survival. The differences in myocardial perfusion have been purported to explain this discrepancy. The exact prevalence of myocardial perfusion abnormalities in Eisenmenger syndrome is not known. We sought to examine the prevalence of myocardial perfusion abnormalities in patients with Eisenmenger syndrome.

Methods
In this prospective study, 20 consecutive adult patients with Eisenmenger syndrome were subjected to clinical assessment, six-minute walk test and echocardiography. Myocardial perfusion was assessed using one day stress-rest Gated Technetium-99 m Sestamibi single-photon emission computed tomography.

Results
Nineteen (95%) patients were in New York Heart Association functional class I or II. All patients had RV hypertrophy. Five (25%) patients had RV systolic dysfunction. Left ventricular systolic function was normal in all except in three patients. Two (10%) patients had perfusion defects in the RV and 4 (20%) patients had perfusion defects in the left ventricle (LV).

Conclusion
Myocardial perfusion defects, both in RV and LV, occur even in asymptomatic or mildly symptomatic patients with Eisenmenger syndrome.
Exposure to Suicide in the Family
Authors: Campos Rui C. , Holden Ronald R. , Spínola Joana , Marques Diandra , Santos Sara 
Published: January 2020

Abstract
The aims of the present study were to compare a sample of individuals exposed to suicide in their families with a control group, on suicidal ideation, and to test possible potentiating effects for unmet interpersonal needs. Three hundred eighty-six young Portuguese adults participated. Two groups were defined: a group exposed to suicide in the family (n = 38) and a control group (n = 335). Groups differed significantly on suicidal ideation, on depressive symptoms, and on perceived burdensomeness and tended to differ on thwarted belongingness. Results from a hierarchical multiple regression analysis demonstrated that having lost a family member by suicide and perceived burdensomeness each provided a significant unique contribution to explaining variance in suicidal ideation when controlling for levels of depressive symptoms and having had a psychiatric diagnosis. The interaction between group membership and perceived burdensomeness provided a further enhancement to the statistical prediction of suicidal ideation.
The Relationship Between Nurse-Reported Safety Culture and the Patient Experience
Authors: Abrahamson Kathleen , Hass Zach , Morgan Kristopher , Fulton Bradley , Ramanujam Rangaraj 
Published: January 2020

OBJECTIVE:The purpose of this study was to better understand the relationship between nurse-reported safety culture and the patient experience in a multistate sample of nurses and patients, matched by hospital unit/service line and timeframe of care delivery.BACKGROUND:Nurses play a key role in the patient experience and patient safety. A strong safety culture may produce positive spillover effects throughout the nurse caregiving experience, resulting in patient perception of a high-quality experience.METHODS:Multivariate mixed-effects regression models were specified using data from a multistate sample of hospital units that administered both the Agency for Healthcare Research and Quality (AHRQ) staff safety culture survey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey over a 12-month period. Survey response variables are measured at the unit (service line) and hospital level.RESULTS:Key variables in the HCAHPS and AHRQ surveys were significantly correlated. Findings highlight the relationship between 3 safety culture domains: teamwork, adequate staffing, and organizational learning on the achievement of a positive patient experience.CONCLUSION:Modifiable aspects of hospital culture can influence the likelihood of achieving high HCAHPS top box percentages in the nursing and global domains, which directly impact hospital reimbursement.
Three-Generation Academic Mentoring Teams
Authors: Webber Elaine , Vaughn-Deneen Tanya , Anthony Maureen 
Published: January 2020

Background
New faculty are often not prepared for a career in academia, and the transition can be challenging. They often come from practice environments where work expectations are clearly delineated.

Problem
Traditional mentoring programs typically pair new with experienced faculty members who are expected to provide guidance and advice. Results of the hierarchical dyad method have been mixed.

Approach
Three generations of faculty formed a team composed of a tenured, a midcareer, and a new faculty member. The midcareer educator was better suited to help the novice prepare to teach, as they had recently been through the process, whereas the tenured faculty member was able to provide scholarship support to both.

Conclusions
Providing new faculty with 2 mentors in a constellation format, along with the opportunity to network during structured mentoring meetings, contributed to a smooth onboarding of new faculty and provided scholarship support for the midcareer faculty member.
Predictors of Sexually Transmitted Infection Positivity Among Substance-Using Native American Adults
Authors: Chambers Rachel Strom , Littlepage Shea , Rompalo Anne , Lee Angelita , Slimp Anna , Melgar Laura , Craig Mariddie , Gaydos Charlotte , Tingey Lauren 
Published: January 2020

Background
Sexually transmitted infections (STIs) are a public health crisis with Native Americans suffering a high burden of disease. Studies across gender and racial/ethnic groups have found varying risk factors associated with STI positivity. Understanding how risk factors are associated with STI positivity can help design interventions for those most at risk.

Methods
Participants were Native American binge substance using adults enrolled in a randomized controlled trial evaluating a brief intervention to increase STI screening and reduce sexual risk-taking behaviors. Participants completed a self-report assessment at baseline that included questions about sexual risk factors and STI testing behaviors and diagnosis. This analysis includes those who had ever completed an STI test at baseline. Bivariate and multivariate analyses using logistical regression were utilized to identify associations between risk factors and past STI diagnosis.

Results
A total of 193 people were included in the analysis. Over half (50.6%) of the participants had ever been diagnosed with an STI. Risk behaviors varied by gender. More women with a self-reported history of STI reported having sex with someone they thought had an STI, past experience of physical/sexual violence, and having passed out from drinking. Men with a self-reported history of STI were more likely to report past marijuana and other drug use. Among women with a self-reported history of STI, having sex with someone they thought had an STI was associated with STI positivity, whereas other drug use was associated with STI positivity among men with a self-reported history of STI.

Conclusions
Findings provide information for those working to reduce STIs in Native Communities to better identify and design programs for those at highest risk for STIs. Additional studies examining gender dynamics and sexual risk taking among native adults are warranted.
Darunavir Pharmacokinetics With an Increased Dose During Pregnancy
Authors: Eke Ahizechukwu C. , Stek Alice M. , Wang Jiajia , Kreitchmann Regis , Shapiro David E. , Smith Elizabeth , Chakhtoura Nahida , Capparelli Edmund V. , Mirochnick Mark , Best Brookie M. ,   IMPAACT P1026s Protocol Team
Published: January 2020

Background:
This study aims to evaluate the pharmacokinetics of an increased dose of darunavir (800 mg twice daily) with 100 mg ritonavir during pregnancy and postpartum.

Methods:
Darunavir (DRV) and ritonavir (RTV; r) intensive pharmacokinetic evaluations were performed at steady state during the second and third trimesters of pregnancy (DRV/r 800/100 mg bid) and 2–3 weeks postpartum (DRV/r 600/100 mg twice daily). Plasma concentrations of darunavir and ritonavir were measured using high-performance liquid chromatography. Target darunavir area under the concentration time curve (AUC) was >70% (43.6 μg × h/mL) of median AUC (62.3 μg × h/mL) in nonpregnant adults on twice daily darunavir-ritonavir 600/100 mg.

Results:
Twenty-four women were included in the analysis. Darunavir AUC0–12 was lower with the increased dose during the second {[geometric mean ratio (GMR) of 0.62 (IQR 0.44–0.88); P = 0.055]} and third trimesters [GMR 0.64 (IQR 0.55–0.73); P = <0.001] compared with postpartum. Darunavir apparent clearance was higher during the second [GMR 1.77 (IQR 1.24–2.51); P = 0.039] and third trimesters [GMR 2.01 (IQR 1.17–2.35); P = <0.001] compared with postpartum. Similarly, ritonavir AUC0–12 was lower during the third trimester [GMR 0.65 (IQR 0.52–0.82); P = 0.007] compared with postpartum, whereas its apparent clearance was higher during the third trimester [GMR 1.53 (IQR 1.22–1.92); P = 0.008] compared with postpartum. No major drug-related safety concerns were noted.

Conclusions:
Increasing darunavir dose to 800 mg BID failed to significantly increase darunavir exposure compared with 600 mg BID. Other strategies, such as increasing the ritonavir dose should be investigated.
Closed Incisional Negative Pressure Wound Therapy Sponge Width and Tension Off-Loading
Authors: Googe Benjamin , Davidson John Clayton , Arnold Peter B. , Medina Abelardo 
Published: January 2020

Abstract
Closed incisional negative pressure wound therapy (ciNPWT) has become commonplace in surgery. One mechanism ciNPWT may prevent incision site complications is by off-loading tension. This study aimed to find what width sponge using ciNPWT provides the most tension off-loading.
A model was designed to test tension off-loading of a wound using ciNPWT. An incision was made in an anatomy model and closed with single stitch at the central axis. Force was applied tangentially using a force gauge at a steady rate until the wound dehisced at a peak force indicated by the 5-0 suture breaking. This was repeated 10 times for the following 4 trials: no ciNPWT and ciNPWT sponges cut a 3-, 6-, and 9-cm widths with 125 mm Hg of negative pressure.
The mean peak force to dehisce the wound without ciNPWT was the lowest, 28.7 N. The mean force for the ciNPWT trials was 43.0, 38.7, and 36.4 N for V.A.C. sponges of 3, 6, and 9 cm in width, respectively. There was a statically significant difference among all the trials using one-way analysis of variance with Tukey posttest analysis with a P value of less than 0.0001.
Closed incisional negative pressure wound therapy was shown to increase peak force required to dehisce an incision of up to 49.7% compared with closure without. There is an inverse relationship with sponge width and tension off-loading. The smaller the sponge, the more tension is off-loaded across the incision. Closed incisional negative pressure wound therapy with a 3-cm-wide sponge required the greatest peak force for dehiscence.
Effect on bone formation of fermented soybeans by combination treatment with high-isoflavone aglycone ratios
Authors: Lee Sun-kyung , Lee You-Seok , Ji Soo-Hyun , Jo Gyeong-Suk , Kang Jeong-Hwa 
Published: January 2020

The purpose of this study was to investigate the effect on bone formation of fermented soybeans by combination treatment with a high aglycone ratio of isoflavones, since this compounds are known to prevent osteoporosis caused by aging or menopause. The experimental group (osteoporosis-induced rats, n=20) was divided into four groups, namely	the normal group (NC), the OVX group (OVXC), the steamed soybean powder group (SSP), and	the fermented soybean powder group (FSP). After 8 weeks of administration, the body weights of the OVX, SSP and FSP groups had increased compared to those of the NC group, while the weight of the uterus had not increased compared to that of NC group, and the weight of the kidney leaf fat had not decreased compared to that of the OVXC group. In addition, serum levels of alkaline phospatase (ALP) and osteocalcin were not significantly different between the different	experimental groups. However numerically, the FSP group appeared to exhibit some effect on bone formation. More specifically, the trabecular bone volume of the femur was significantly increased in the FSP group compared to the OVXC (p<0.01), and the trabecular bone mineral density was also significantly increased in the SSP and FSP groups compared to the OVXC group (p<0.05). These results indicate that fermented soybeans were effective in promoting bone formation in terms of increasing the bone volume and bone density of the femur. The consumption of fermented soybeans could therefore be suggested for the prevention rather than the improvement of osteoporosis.
Beyond T Staging in the Treat All Era: Capturing the Severity and Heterogeneity of Kaposi’s Sarcoma in East Africa
Authors: Freeman Esther E. , McMahon Devon E. , Semeere Aggrey , Byakwaga Helen , Laker-Oketta Miriam , Wenger Megan , Kasozi Charles , Semakadde Matthew , Bwana Mwebesa , Kanyesigye Michael , Kadama-Makanga Philippa , Rotich Elyne , Kisuya Job , Wools-Kaloustian Kara , Bassett Ingrid , Busakhala Naftali , Martin Jeffrey 
Published: January 2020

AbstractBackgroundIn the treat-all era of HIV, Kaposi’s sarcoma (KS) remains one of the most incident cancers in sub-Saharan Africa. The majority of patients with KS are diagnosed at advanced disease stage in this setting. Staging systems for KS, specifically the AIDS Clinical Trials Group (ACTG) system, were developed in the pre-ART era, were not meant to guide treatment, and may not fully capture the clinical heterogeneity of advanced disease. There is no international consensus on which KS patients need chemotherapy in addition to antiretroviral therapy (ART). Understanding KS severity of disease in the current era would help to inform prognosis and clarify treatment guidelines.MethodsWe performed rapid case ascertainment (RCA) on people living with HIV ≥18 years old newly diagnosed with biopsy-proven KS from 2016 to 2019 at three clinic sites in Kenya and Uganda. As close as possible to time of diagnosis, we performed a structured interview, physical examination, and collection of laboratory specimens. We reported KS severity using ACTG and WHO staging criteria, as well as detailed measurements not captured in current staging systems.ResultsWe enrolled 264 adults newly diagnosed with KS. RCA was performed within 1 month of KS diagnosis for 62% of patients and within 6 months for 73% of patients. Patients were 61% Kenyan, 69% male, and with a median age of 35. Median CD4 count was 239 (IQR 87 to 408), with 72% of patients initiating ART greater than 60 days prior to diagnosis. The majority of patients had advanced stage of disease, with 82% qualifying as ACTG T1 and 64% as WHO Severe/Symptomatic KS. There was marked heterogeneity within advanced KS, with 25% of patients having two ACTG qualifiers and 3% of patients had three or more ACTG qualifiers.ConclusionThe majority of patients with KS in this study had advanced stage disease at time of diagnosis, highlighting the need to improve early diagnosis of KS. Within this group of advanced stage patients was large clinical heterogeneity, leading to questions about whether all patients with advanced KS require the same treatment strategy.
Potential Test-Negative Design Study Bias in Outbreak Settings: Application to Ebola vaccination in Democratic Republic of Congo
Authors: Pearson Carl A. B. , Edmunds W. John , Hladish Thomas J. , Eggo Rosalind M. 
Published: January 2020

AbstractBackgroundInfectious disease outbreaks present unique challenges to study designs for vaccine evaluation. Test-negative design (TND) studies have previously been used to estimate vaccine effectiveness and have been proposed for Ebola virus disease (EVD) vaccines. However, there are key differences in how cases and controls are recruited during outbreaks and pandemics of novel pathogens that have implications for the reliability of effectiveness estimates using this design.MethodsWe use a modelling approach to quantify TND bias for a prophylactic vaccine under varying study and epidemiological scenarios. Our model accounts for heterogeneity in vaccine distribution and for two potential routes to testing and recruitment into the study: self-reporting and contact-tracing. We derive conventional and hybrid TND estimators for this model and suggest ways to translate public health response data into the parameters of the model.ResultsUsing a conventional TND study, our model finds biases in vaccine effectiveness estimates. Bias arises due to differential recruitment from self-reporting and contact-tracing, and due to clustering of vaccination. We estimate the degree of bias when recruitment route is not available, and propose a study design to eliminate the bias if recruitment route is recorded.ConclusionsHybrid TND studies can resolve the design bias with conventional TND studies applied to outbreak and pandemic response testing data, if those efforts collect individuals’ routes to testing. Without route to testing, other epidemiological data will be required to estimate the magnitude of potential bias in a conventional TND study. Since these studies may need to be conducted retrospectively, public health responses should obtain these data, and generic protocols for outbreak and pandemic response studies should emphasize the need to record routes to testing.Key Messages-Conventional Test-Negative Design (TND) studies can be biased when follow-up of cases leads to testing and recruitment, which occurs for example during contact tracing.-A hybrid TND estimator can eliminate this bias, if individual testing routes are recorded.-The related bias in the conventional TND estimator can be quantified using epidemiological measures.-If testing route data is unavailable, bias can be limited by other study measures.
High levels of mild to moderate depression among men who have sex with men and transgender women in Lima, Peru: implications for integrated depression and HIV care
Authors: Galea Jerome T. , Marhefka Stephanie , León Segundo R. , Rahill Guitele , Cyrus Elena , Sánchez Hugo , Zhang Zhiwei , Brown Brandon 
Published: January 2020

ABSTRACTDepression disproportionally affects people at risk of acquiring or living with HIV and is associated with worse health outcomes; however, depression care is not routinely integrated with HIV prevention and treatment services. Selection of the best depression intervention(s) for integration depends both on the prevalence and severity of depression among potential users. To inform depression care integration in a community-based setting in Lima, Peru, we retrospectively analyzed routinely collected depression screening data from men who have sex with men and transgender women seeking HIV prevention and care services (N=185). Depression was screened for using the Patient Health Questionnaire-9. Prevalence of any depression (PHQ-9 ≥5) was 42% and was significantly associated with the last sexual partner being “casual” (p=0.01). Most (81%) depressive symptoms were mild to moderate (≥5 PHQ-9 ≤14). Integrating depression care with HIV prevention and treatment services in Peru should begin by implementing interventions targeting mild to moderate depression.