bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intralesional Bleomycin for Orbital Lymphatic Malformations: Comparison of Clinical Versus Radiologic Regression by Volumetric Analysis
Authors: Dave Tarjani Vivek , Madhuri Bejjanki Kavya , Kaliki Swathi 
Published: September 2020

Purpose:
The aim of the study was to investigate the clinical resolution versus radiologic regression of orbital lymphatic malformations (LMs) following treatment with intralesional bleomycin sulfate sclerotherapy.

Methods:
A retrospective interventional study of 24 eyes with orbital LMs treated with nonimage-guided bleomycin sclerotherapy. The clinical and radiologic outcomes were classified as excellent, good, fair, and poor. Regression was assessed clinically and by radiologic volumetrics.

Results:
Mean age at presentation was 17 ± 18 years (median 11, range 5 months to 70 years). Lesion morphology was microcystic in 11 (46%), macrocystic in 8 (34%), and mixed in 5 (21%) eyes. Mean units of bleomycin injected per session were 4 ± 2 IU (median 5 IU, range 1–6 IU). Mean number of treatment sessions required was 2 ± 1 (median 2, range 1–6). Cumulative units of bleomycin injected were 11 ± 9 (median 9, range 1–38 IU). The clinical response was excellent in 19 (79%), good in 4 (17%), and fair in 1 (4%). The mean preoperative and postoperative lesion volumes were 7 ± 4 cm3 and 0.8 ± 1.2 cm3, respectively (p < 0.0001, 95% CI, −7.89 to −4.51). Radiologic resolution of LM was excellent in 6 (25%), good in 8 (33%), fair in 7 (29%), and poor in 3 (13%) eyes. Spearman’s rank correlation coefficient for correlation between clinical and radiologic grading was 0.51 (p = 0.01, 95% CI, 0.13–0.75%). There was a sustained tumor resolution without recurrence over a mean follow-up duration was 2 years (median 18 months; range 12–60 months).

Conclusions:
Bleomycin sclerotherapy for orbital LMs gives an excellent to good clinical response in 93%. However, a parallel radiologic regression is seen only in 58%. The endpoint to assess response should be clinical. Treatment till complete radiologic resolution may not be necessary.
Are Medicare wellness visits improving outcomes?
Authors: Watkins Susan , Astroth Kim Schafer , Kim MyoungJin , Dyck Mary J. 
Published: September 2020

ABSTRACT

Background:
As the largest and unhealthiest population in American history enrolls as Medicare beneficiaries, it is vital for primary care providers to understand how to maximize Medicare wellness provisions. The Baby Boomer population has been documented to have the highest chronic disease prevalence related to preventable lifestyle behaviors. Perpetual unhealthy lifestyle behaviors associated with chronic disease prevalence are detrimental to life quality and the American Medicare resource structure. Since 2011, the Affordable Care Act provisions have included free wellness visits designed to prevent disease for Medicare beneficiaries, who continue to grossly underuse these services.

Objectives:
This systematic review was conducted to evaluate the quality, level, and strength of evidence regarding Medicare wellness service efficacy on related health outcomes.

Data sources:
The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for selection of 21 research-based articles included in the analysis. Results from the 21 eligible studies revealed low research quality and vigor; therefore, lacking causality and generalizability of medicare wellness visit (MWV) efficacy on health promotion outcomes.

Conclusions:
The evidence is focused on how MWVs are affecting preventive care utilization instead of patient health outcomes. In the interest of reducing chronic disease prevalence and the economic burden on our health care system, it is important to understand how these services affect health promotion outcomes.

Implications for practice:
The results of this systematic literature review substantiate the need for primary care providers to study MWV efficacy on health promotion outcomes for the Medicare population.
Integration of primary care into the substance use disorder outpatient treatment setting
Authors: Wasserman Rachel , Terrien Jill 
Published: September 2020

ABSTRACT

Background:
Americans experiencing substance use disorder (SUD) carry a significant chronic disease burden, yet only half use primary care. Patients in treatment for SUD who are connected with primary care typically have better overall health outcomes.

Local problem:
The identified intensive outpatient program (IOP) had no protocol in place to engage patients with primary care.

Methods:
This project piloted the development and implementation of an original, evidence-based primary care integration program. It consisted of a psychoeducation group, a referral by case management, and establishment of an internal referral process to affiliated primary care providers (PCPs).

Interventions:
Following the psychoeducation group, pre and posttests of patient-reported knowledge and attitudes regarding primary care were compared. Participants were contacted to collect further data after IOP discharge. An education and feedback session was held with affiliated PCPs, and an internal referral process was devised by leadership.

Results:
Mean scores measuring patient knowledge and attitudes regarding primary care increased after participation in the structured psychoeducation group. By time of IOP discharge, 100% (n = 12) of participants had either a referral or scheduled appointment with a PCP in place. At time of follow-up, 90% (n = 9) reported that they had attended or planned to attend their scheduled PCP appointment.

Conclusions:
A comprehensive integration program in the IOP setting can improve patient engagement with primary care. Quality improvement implementation will require consideration of challenges faced during the pilot involving scheduling, staff buy-in, changes in patient acuity, the electronic medical record, and insurance.
Connecting veterans with smoking cessation services in less than 3 minutes
Authors: Boe Rony , Ridner Stanley Lee 
Published: September 2020

ABSTRACT
Veterans smoke disproportionately higher (nearly 1.3 times greater) than the general population and puts them at greater risk for tobacco-related illnesses. Annual screenings by the primary care providers are conducted at Veterans Health Administration (VHA) primary care clinics, but this practice may be inadequate to overcome the chronicity of smoking. The Ask, Advise, Refer strategy for smoking cessation was integrated in the workflow and implemented by the nursing staff at a VHA outpatient surgery clinic. Nurses established smoking status, advised smokers to quit, and for those interested, provided the smoker a list of resources Department of Veterans Affairs' approved smoking cessation options (telephone, text, and web-based interventions). All the smokers took a referral card containing a list of resources to help them quit smoking. During the follow-up phone calls after the clinic visit, 19% of patients reported using at least one of the resources listed on the card. Each clinical encounter should be viewed by health care providers as a window of opportunity to promote smoking cessation. The simplicity of the AAR strategy is effective in promoting smoking cessation especially in busy outpatient settings.
Measurement of nonbillable service value activities by nurse practitioners, physician assistants, and clinical nurse specialists in ambulatory specialty care
Authors: Winter Shira , Chan Garrett K. , Kuriakose Clair , Duderstadt Karen , Spetz Joanne , Hsieh Debbie , Platon Charlene , Chapman Susan A. 
Published: September 2020

ABSTRACT

Background:
Revenue-generating health care activities, generally accepted as a measure of productivity, do not account for the full range of health care activities that enhance patient care.

Purpose:
We analyzed the quantity, duration, and type of “service value activities” performed by nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs), which are nonbillable service activities that contribute to billable service provision, quality of care, and value of care.

Methods:
Data were obtained from ambulatory specialties at one health care institution over a 13-month period. First, descriptive statistics were calculated by time-based code for each category of provider (medical, surgical, transplant, hematology/oncology, and anesthesia). Then qualitative comments were analyzed for frequency of key words.

Results:
Each provider spent an estimated average of between 3.7 and 36.5 hours per month on service value activities, with the greatest number of these activities related to orders, chart review, and documentation.

Implications for practice:
More thorough exploration of the quantity and type of service value activities performed may lead to a better understanding of the role and contribution of NPs, PAs, CNSs, and other health care professionals to patient care.
Integrating strategies for improving diagnostic reasoning and error reduction
Authors: Nordick Christina L. 
Published: September 2020

ABSTRACT
Errors of diagnostic reasoning contribute significantly to patient harm. Students, novice diagnosticians, and even experienced clinicians often have difficulty understanding or describing the processes of diagnostic reasoning. Inappropriate use of cognitive heuristics and poor logical reasoning by novice or experienced diagnosticians may result in missed or delayed diagnoses. Reduction of diagnostic errors through knowledge acquisition, self-reflection, and check lists has individually demonstrated some improvements in diagnostic reasoning. Implementing the diagnostic and reasoning tool (DaRT), a method of reasoning which integrates the evidence-based strategies of knowledge acquisition, metacognition, and logical reasoning skills throughout the patient encounter, results in improvement in diagnostic reasoning in advanced practice nurses. Use of the DaRT in one university setting resulted in significant improvement in advanced health assessment skills and diagnostic reasoning abilities as demonstrated by improvements of 28–55% end-of-program Health Education Systems Incorporated scores. Translation into practice settings may further support the use of this multiple-modality tool.
Implementation and evaluation of a self-care toolkit for caregivers of families with dementia
Authors: Smith Carolyn Wordly , Graves Barbara Ann 
Published: September 2020

ABSTRACT

Background:
Family caregivers who care for individuals with dementia are more likely to develop chronic stress, major depression, anxiety, and physical health disorders and they have a higher mortality rate compared with the general population.

Local problem:
Caregivers are at an increased risk of physical and mental disorders. Many report that they are fatigued and need more forms of support.

Methods:
This project involved a convenience sample of 35 family caregivers who cared for family with dementia. Prequestionnaires and postquestionnaires were used to determine improvements in caregiver health and well-being and caregiver resources for supportive services as well as reduction in caregiver stress.

Interventions:
An evidence-based educational class was developed and implemented based on the Family Care Alliance (FCA): Taking Care of YOU: Self-Care for Family Caregivers Toolkit. The project aimed to (1) assess two FCA recommended domains: caregiver health and well-being and caregiver resources for supportive services and (2) reduce caregiver stress.

Results:
Stress Inventory results showed notable change in high risk/low risk categorization from pretest to posttest. At pretest, 31 caregivers were categorized as at high risk for unhealthy levels of stress, but posttest showed only 9 caregivers were so categorized. Approximately, 70% of those at high risk at pretest were categorized as low risk at posttest.

Conclusions:
This project validated that evidence-based educational interventions can improve caregiver knowledge and self-care. Continued support may be promoted by incorporating education and offering resource brochures to caregivers during primary care visits.
A nurse practitioner–led effort to reduce 30-day heart failure readmissions
Authors: Charteris Elaine J. , Pounds Bunny 
Published: September 2020

ABSTRACT

Background:
Heart failure (HF) affects over 6.5 million Americans and is the leading reason for hospital admissions in patients over the age of 65. Readmission rates within 30 days are 21.4% nationally, and 12% of those are likely preventable. Veterans are especially vulnerable to developing cardiac diseases requiring hospitalization and subsequent readmission.

Local problem:
The Southern Arizona Veterans Administration Health Care System has over 5,600 patients diagnosed with HF and a 30-day readmission rate of 21.65%. The aim of this quality improvement project was to reduce 30-day all-cause readmissions by 1% over 8 weeks.

Methods:
To reduce HF readmissions, the plan-do-study-act rapid-cycle method of quality improvement was used.

Interventions:
A dedicated multidisciplinary HF clinic was formed with a cardiology nurse practitioner, clinical pharmacists, and a dietician. A veteran-centered shared decision-making tool for setting self-care goals was implemented.

Results:
The readmission rate of patients seen in the multidisciplinary clinic (n = 33) was reduced by 0.2%. The percentage of veterans seen within 14 days increased from 30% to 54.5%. The average number of days between discharge and cardiology follow-up improved from 45 to 19 days. Veterans were able to set at least one self-care goal 87% of the time. Patient satisfaction with the multidisciplinary clinic was high at 93%.

Conclusions:
Implementing a dedicated, multidisciplinary HF clinic reduced readmissions, improved timeliness of visits, and was well received. Use of a veteran-centered patient engagement tool resulted in more veterans setting self-care goals.
Neonatal Eating Assessment Tool—Mixed Breastfeeding and Bottle-feeding: Reference values and factors associated with problematic feeding symptoms in healthy, full-term infants
Authors: Pados Britt Frisk , Johnson Jamarii , Nelson Madeline 
Published: September 2020

ABSTRACT

Background:
The Neonatal Eating Assessment Tool—Mixed Breastfeeding and Bottle-feeding (NeoEAT—Mixed Feeding) is a parent-report assessment of symptoms of problematic feeding in infants who are feeding by both breast and bottle.

Purpose:
To establish reference values for the NeoEAT—Mixed Feeding and evaluate factors that contribute to symptoms of problematic feeding in healthy, full-term infants.

Methods:
Parents of 409 infants less than 7 months old completed an online survey. Median and percentile scores are presented for infants aged 0–2, 2–4, 4–6, and 6–7 months old.

Results:
Neonatal Eating Assessment Tool—Mixed Feeding total score and scores for the Gastrointestinal Tract Function and Energy & Physiologic Stability subscales decreased with increasing infant age. Infant Regulation and Feeding Flexibility subscale scores remained stable over time, whereas Sensory Responsiveness subscale scores increased with increasing infant age. Infants with more gastrointestinal symptoms had higher NeoEAT—Mixed Feeding total scores.

Implications for practice:
The reported reference values may be used to identify infants in need of further assessment, referral, and intervention. In healthy, full-term infants with concurrent gastrointestinal symptoms and problematic feeding, interventions targeted at gastrointestinal symptoms may help to improve symptoms of problematic feeding as well.
Development and implementation of a primary care clinic workflow protocol to meet opioid prescribing guidelines
Authors: Weller Lori M. 
Published: September 2020

ABSTRACT

Background:
Nearly 50% of opioid overdose deaths in the United States involve the use of prescription opioids. Primary care providers can help decrease the risk of opioid overdose deaths by adhering to opioid prescribing guidelines for chronic pain management.

Local problem:
Ten Washington State primary care clinics had gaps in guideline adherence and mandated electronic medical record (EMR) documentation for prescribing opioids.

Methods:
A quality improvement project using an educational intervention was implemented.

Interventions:
Primary care providers and support staff (defined as registered nurses and medical assistants) from the 10 primary care clinics viewed the project's instructional YouTube webinar that explained the project's primary care clinic workflow protocol, opioid prescribing best practice guidelines, and the organization's mandated EMR charting for chronic pain management. Preintervention and postintervention measures, which included five different documented patient completion rates of the organization's best practices for opioid prescribing, were used to assess for improvement to guideline adherence. Additionally, participants completed a questionnaire regarding their perceptions of the webinar as an educational tool.

Results:
Postintervention data showed significantly (p ≤ .05) increased completion rates for three of five outcome measures, indicating improvement in guideline adherence. The majority of participants reported that the webinar information would help them better adhere to best practice guidelines.

Conclusions:
A workflow protocol for opioid prescribing taught via a YouTube webinar was an effective method for disseminating and implementing best practices in the primary care setting. Similar workflow protocols, taught via webinar, could be equally beneficial in other primary care clinics.
Cardiovascular disease knowledge, risk factors, and resilience among US veterans with and without post-traumatic stress disorder
Authors: Angosta Alona D. , Reyes Andrew Thomas , Cross Chad , Pollom Trevor , Sood Komal 
Published: September 2020

ABSTRACT

Background:
Cardiovascular disease (CVD) is the leading cause of death in the United States and the leading cause of hospitalization and disability among the US veterans. Information about CVD knowledge and risk factors, and connection between psychological health and CVD among veterans transitioning from the military are limited.

Purpose:
We examined the existing knowledge of CVD and its risk factors among the US veterans with and without post-traumatic stress disorder (PTSD), and the relationship between knowledge, risk factors, resilience, and PTSD.

Methods:
A total of 104 veterans participated in our study by responding to the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Heart Disease Fact Questionnaire (HDFQ) knowledge scale, and Connor-Davidson Resilience Scale 10. Data were extracted from the online Qualtrics survey software into SPSS (v. 25) for analysis.

Results:
Mean age was 52.3 years, mostly males (85.6%), married (72.1%), employed (54.8%), and with college education. Most were in the Navy or Air Force (72.1%) and served in a war (68.0%). Hypertension, high cholesterol, and obesity were the most common CVD risk factors reported. Average CVD knowledge score was 85%. Marines scored higher on resilience than other branches of the military. Seventeen percent reported having PTSD. The Connor-Davidson Resilience Scale 10 was significantly correlated with the HDFQ in the probable PTSD group (r = .589, p = .013).

Implications for practice:
Our study provides information about the knowledge and risk factors of CVD among veterans and insights about interventions needed to improve CV health. Nurse practitioners should assess the CV and psychological health of veterans and screen for PTSD to provide appropriate care and referral.
Neointima characteristics as a prognostic marker for drug-coated balloon angioplasty in patients with in-stent restenosis: an optical coherence tomography study
Authors: Kim Hyung Oh , Jung Hae Won , Lee Jung-Hee , Kim Jung-Sun , Hong Sung-Jin , Ahn Chul-Min , Kim Byeong-Keuk , Kim Weon , Kim Soo-Joong , Kim Woong , Ko Young-Guk , Choi Donghoon , Hong Myeong-Ki , Jang Yangsoo 
Published: September 2020

Background
Research has shown that the prognosis of in-stent restenosis (ISR) lesions after drug-coated balloon (DCB) angioplasty can differ in relation to in-stent neointimal characteristics. However, changes in neointima characteristics after DCB have not been studied. This study sought to investigate changes in neointima characteristics after DCB for ISR.

Methods
From the Yonsei Optical Coherence Tomography (OCT) registry, data on DCBs performed in patients with ISR were collected. Neointima characteristics were categorized as homogeneous, heterogeneous, layered neointima, and neoatherosclerosis in each OCT procedure. Homogeneous and layered neointima were classified as a favorable neointima, while heterogeneous neointima and neoatherosclerosis were classified as an unfavorable neointima. The data of 67 ISR patients were analyzed.

Results
The median duration between initial and follow-up OCT was 9.6 months. Patients with homogeneous and layered neointima on the initial OCT before DCB mostly appeared as homogeneous (66.7 and 68.2%, respectively) on the follow-up OCT, whereas most of the patients with heterogeneous neointima on the initial OCT remained unaltered (70%). Patients with unfavorable neointima at either the initial (P = 0.023) or the follow-up OCT (P = 0.037) had a worse major adverse cardiovascular event-free survival than the other patients. Patients who showed unfavorable neointima at both the initial and the follow-up OCT had the worst event-free survival (P = 0.038).

Conclusions
The follow-up OCT neointimal characteristics after DCB for ISR was associated with initial OCT characteristics. Sustained unfavorable neointima in serial OCT imaging may reflect poor prognosis in patients with ISR treated with DCB.
Exploring How Epidemic Context Influences Syphilis Screening Impact: A Mathematical Modeling Study
Authors: Tuite Ashleigh R. , Testa Christian , Rönn Minttu , Bellerose Meghan , Gift Thomas , Fridge Jessica , Molotnikov Lauren , Desmarais Catherine , Berruti Andrés , Menzies Nicolas , Malyuta Yelena , Hsu Katherine , Salomon Joshua A. 
Published: September 2020

Background
The current syphilis epidemic in the United States is concentrated in gay, bisexual, and other men who have sex with men (MSM), but substantial heterosexual transmission is reported in some parts of the country. Using the US states of Louisiana and Massachusetts as case studies, we investigated how epidemic context influences the impact of population screening approaches for syphilis control.

Methods
We constructed a compartmental metapopulation model parameterized to describe observed patterns of syphilis transmission. We estimated the impact of different approaches to screening, including perfect adherence to current US screening guidelines in MSM.

Results
In Louisiana, where syphilis cases are more evenly distributed among MSM and heterosexual populations, we projected that screening according to guidelines would contribute to no change or an increase in syphilis burden, compared with burden with current estimated screening coverage. In Massachusetts, which has a more MSM-focused outbreak, we projected that screening according to guidelines would be as or more effective than current screening coverage in most population groups.

Conclusions
Men who have sex with men–focused approaches to screening may be insufficient for control when there is substantial transmission in heterosexual populations. Epidemic characteristics may be useful when identifying at-risk groups for syphilis screening.