bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of the Self-Efficacy of Student Physical Therapist Outcomes Survey
Authors: Stickley Lois A. , Bezner Janet R. , Spivey Steve 
Published: July 2019

Introduction.
Self-efficacy is believed to be a link between knowledge and the application of knowledge and skills to specific situations. No previously published survey comprehensively measures the self-efficacy of student physical therapists for the outcomes expected of entry-level physical therapists.

Methods.
The Self-Efficacy of Physical Therapist Student Outcomes (SEPTSO) survey was designed according to the recommended guidelines for tools measuring self-efficacy. Each of the 25 items was linked to published outcomes expected of entry-level physical therapists. Students in 3 cohorts of a 3-year Doctor of Physical Therapy (DPT) program completed the online SEPTSO 3 times over the course of 1 academic year.

Results.
There was a statistically significant difference among the 3 cohorts in self-efficacy. 05
F
74 = 51.93, ρ < .0001, with significant differences between self-efficacy scores in the classes of DPT 3 and DPT 1 (ρ < .001) and DPT 2 and DPT 3 (ρ < .001). A 2 × 4 Analysis of Variance (ANOVA) examining the effect of age or sex found no significant main effects for age (ρ = .059) or sex (ρ = .113) and no significant interactions (ρ = .843). Cronbach's alpha was .983 for the 25 items, demonstrating excellent and significant internal validity, and the item-to-total correlation was high for each item, ranging from .981 to .983. A factor analysis resulted in a model in which 2 factors explained 71% of the variance within the factors of patient management and professionalism.

Discussion.
The SEPTSO survey possesses excellent content validity without bias for age or sex. The potential uses of the SEPTSO survey include program evaluation, curriculum evaluation to identify program weaknesses, accreditation, and self-reflection in students.
Insomnia disorder diagnosis and treatment patterns in primary care: A cross-sectional analysis of electronic medical records data
Authors: Klingman Karen J. , Sprey John 
Published: July 2019

ABSTRACT

Background and purpose:
About one in every three US adults is estimated to have insomnia disorder. Consequences of untreated insomnia disorder are debilitating and costly, and primary care providers (PCPs) are uniquely positioned to detect and treat insomnia, thus preventing its adverse outcomes. The goal of this study was to explore the utility of analyzing electronic medical record data to identify patterns in diagnosis and management of insomnia disorder by PCPs.

Methods:
This was a cross-sectional descriptive study. Numbers of medical records containing at least one insomnia disorder diagnosis code, one insomnia-related medication, or both were tabulated. Prevalence and odds ratios (ORs) were determined.

Results:
Insomnia disorder diagnoses were present in 9.4% of the records; 7.4% contained insomnia-related medication(s), and only 3.9% contained both. Diagnoses and medications were higher among women than men (ORs up to 2.87, depending on age range) and in general and increased with age.

Conclusions:
The prevalence of insomnia disorder diagnoses in primary care medical records falls below expectation for the population of interest, and less than half of patients with an insomnia disorder diagnosis are prescribed an insomnia-related medication. Electronic medical records provide an efficient window into insomnia disorder diagnosis and management patterns in the primary care setting.

Implications for practice:
Primary care providers may be missing opportunities to detect and treat insomnia disorder as a way of improving overall patient outcomes. Electronic medical record systems may require modification to facilitate more accurate data extraction.
What is the Role of Hyaluronic Acid Ester in Myringoplasty? Systematic Review and Meta-Analysis
Authors: Wong Wai Keat , Luu Eric H. 
Published: July 2019

Objective:
To reveal odds of tympanic membrane closure and postoperative hearing outcomes for myringoplasty utilizing hyaluronic acid ester via systematic review and meta-analysis.

Data Sources:
1) Search of English articles in PubMed/Medline, Embase, and Cochrane databases published between January 1, 1998 and March 31, 2018.

Study Selection:
Inclusion criteria: 1) English language; 2) clinical studies; 3) reported posttreatment perforation status, hearing outcomes, or complications. Exclusion criteria: hyaluronic acid used for middle ear packing or topical application of hyaluronic acid solution.

Data Extraction:
Number of patients, surgical technique, mean age, overall rate of tympanic membrane closure, success rate based on size of perforation, mean air-bone gap improvement, and postoperative speech scores and complications.

Data Synthesis:
Ten studies encompassing 531 patients met criteria. Reported success rates for closure of chronic perforation ranged from 70.0 to 92.7% (mean, 85.21%). Smaller perforation predicted success in complete closure. Mean air-bone gap closure was 10.6 dB (4–24 dB). There were five complications reported. Meta-analysis was performed on five studies. No difference was noted in the success rates between hyaluronic acid ester myringoplasty and conventional tympanoplasty using fascia or perichondrium, with an overall closure rates of 89.8 and 89.4%, respectively (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.59–1.82, p = 0.896). A higher closure rate was seen in hyaluronic acid ester myringoplasty (87.9%) when compared with fat graft myringoplasty (70.8%), (OR 3.01, 95% CI 1.42–6.35, p = 0.004).

Conclusions:
Hyaluronic acid (HA) ester myringoplasty appears to be safe and effective at attaining complete closure of tympanic membrane perforation, although there exists significant selection bias and inconsistent reporting among existing papers.
Endaural Laser-Assisted Single-Stage Inside-Out Cholesteatoma Surgery (LASIC) to Treat Advanced Congenital Cholesteatoma
Authors: Lee Chang Ho , Kim Mi Kyung , Kim Hyoung-Mi , Won Cheongse , Shin Tae Hyun , Kim So Young 
Published: July 2019

Objectives:
Investigation of endaural laser-assisted single-stage inside-out cholesteatoma surgery (LASIC) to treat advanced congenital cholesteatoma (ACC) by a modified staging system based on ossicle status.

Study Design:
A retrospective case review.

Setting:
A university hospital otology referral clinic.

Patients:
Two hundred consecutive pediatric patients with ACC were enrolled.

Interventions:
Endaural LASIC and postoperative temporal bone computed tomography (CT).

Main Outcome Measures:
Residual or recurrent CC and audiological outcomes.

Results:
LASIC was feasible in 98.0% of patients. Single-stage ossiculoplasty was performed in 95.5% of patients. Hearing preservation to less than 20 dB was 59.2% and to the preoperative hearing level was 84.5%. Mastoid invasion did not result in worse recidivism or hearing loss (HL) but further invasion of the stapes superstructure (stage IV) significantly elevated both the recidivism (16.7%) and the risk for HL (to 84.8%) (p = 0.001). Ossicle preservation LASIC was frequently possible in stage III posterior type (75.6%), whereas it was rarely possibly (15.4%) in the anterior type. Incudostapedial joint (ISJ) invasion in the absence of cochleariform process (CP) invasion (III-posterior) did not increase the incidence of HL (6.1%) or recidivism (2.4%). However, simultaneous invasion of the CP and ISJ (III-anterior) elevated the risk of HL by 46.2% by ossicle removal, although recidivism was not increased (3.8%).

Conclusions:
Endaural LASIC for ACC achieved satisfactory recidivism (overall 7.5%, 16.7% in stage IV) comparable to early CC (17.2%). An ossicle status-based staging system was more efficient for correlation with audiologic and surgical outcomes of CC than that of mastoid invasion.
Quantification of Cognitive Dysfunction in Dizzy Patients Using the Neuropsychological Vertigo Inventory
Authors: Liu Yuan F. , Locklear Taylor D. , Sharon Jeffrey D. , Lacroix Emilie , Nguyen Shaun A. , Rizk Habib G. 
Published: July 2019

Objective:
Currently available patient reported outcomes questionnaires for dizzy patients give limited insight into the cognitive dysfunction patients often report. Using the newly developed English version of the neuropsychological vertigo inventory (NVI), we aimed to quantify the cognitive impairment of dizzy patients.

Study Design:
Prospective cohort study.

Setting:
Tertiary neurotology clinic.

Patients:
Adults with vestibular diagnoses seen between June 2018 and October 2018. Patients with neurologic disorders affecting cognition were excluded.

Interventions:
None.

Main Outcome Measure:
NVI score. Secondary measures: dizziness handicap inventory (DHI) score, cognitive failure questionnaire (CFQ) score, 20-item short form health survey scores (SF20).

Results:
Of 67 subjects, 13 had BPPV, 11 had Menière's disease (MD), and 20 had vestibular migraine (VM). VM patients were significantly younger (43.5 versus 61.1 yrs, p = 0.016), and had significantly higher NVI (67.5 versus 51.0, p = 0.040) scores than BPPV patients. MD patients had significantly higher CFQ scores (44.8 versus 23.4, p = 0.015) than BPPV patients. NVI scores were similar between MD (67.3) and VM (67.5) patients (p = 1.000). DHI scores were similar for all patients (p = 0.102). NVI scores were highly correlated to CFQ scores (r = 0.864, p < 0.001).

Conclusions:
VM patients have levels of cognitive dysfunction similar to MD patients, but greater than BPPV patients. A lack of difference in DHI scores among these patients reflects its limitation in assessing the cognitive domain.
Does One Size Fit All With the Effects of Payment Reform? Dialysis Facility Payer Mix and Anemia Management Under the Expanded Medicare Prospective Payment System
Authors: Mukhopadhyay Purna , Pearson Jeffrey , Cogan Chad , Gaber Charley , Gillespie Brenda W. , Turenne Marc 
Published: July 2019

Background:
The effects of Medicare payment reforms aiming to improve the efficiency and quality of care by establishing greater financial accountability for providers may vary based on the extent and types of other coverage for their patient populations. Providers who are more resource constrained due to a less favorable payer mix face greater financial risks under such reforms. The impact of the expanded Medicare dialysis prospective payment system (PPS) on quality of care in independent dialysis facilities may vary based on the extent of higher payments from private insurers available for managing increased risks.

Objectives:
To evaluate whether anemia outcomes for dialysis patients in independent facilities differ under the Medicare PPS based on facility payer mix.

Design:
We examined changes in anemia outcomes for 122,641 Medicare dialysis patients in 921 independent facilities during 2009–2014 among facilities with differing levels of employer insurance (EI). We performed similar analyses of facilities affiliated with large dialysis organizations, whose practices were not expected to change based on facility-specific payer mix.

Results:
Among independent facilities, similar modeled trends in low hemoglobin for all 3 facility EI groups in 2009–2010 were followed by increased low hemoglobin during 2012–2014 for facilities with lower EI (P<0.01). Post-PPS standardized blood transfusion ratios were 9% higher for lower EI versus higher EI independent facilities (P
<0.01). Among large dialysis organizations facilities, there was no divergence in low hemoglobin by payer mix under the PPS.

Conclusions:
There is evidence of poorer quality of care for anemia under the PPS in independent facilities with lower versus higher EI. Provider responses to payment reform may vary based on attributes such as payer mix that could have implications for health disparities.
Early Impact of the State Innovation Models Initiative on Diagnosed Diabetes Prevalence Among Adults and Hospitalizations Among Diagnosed Adults
Authors: Fulton Brent D. , Hong Nianyi , Rodriguez Hector P. 
Published: July 2019

Background:
The State Innovation Models (SIM) Initiative invested $254 million in 6 states in Round 1 to accelerate delivery system and payment reforms.

Objective:
The objective of this study was to examine the association of early SIM implementation and diagnosed diabetes prevalence among adults and hospitalization rates among diagnosed adults.

Research Design:
Quasi-experimental design compares diagnosed diabetes prevalence and hospitalization rates before SIM (2010–2013) and during early implementation (2014) in 6 SIM states versus 6 comparison states. County-level, difference-in-differences regression models were estimated.

Subjects:
The annual average of 4.5 million adults aged 20+ diagnosed with diabetes with 1.4 million hospitalizations in 583 counties across 12 states.

Measures:
Diagnosed diabetes prevalence among adults and hospitalization rates per 1000 diagnosed adults.

Results:
Compared with the pre-SIM period, diagnosed diabetes prevalence increased in SIM counties by 0.65 percentage points (from 10.22% to 10.87%) versus only 0.10 percentage points (from 9.64% to 9.74%) in comparison counties, a difference-in-differences of 0.55 percentage points. The difference-in-differences regression estimates ranged from 0.49 to 0.53 percentage points (P<0.01). Regression results for ambulatory care-sensitive condition and all-cause hospitalization rates were inconsistent across models with difference-in-differences estimates ranging from −5.34 to −0.37 and from −13.16 to 0.92, respectively.

Conclusions:
SIM Round 1 was associated with higher diagnosed diabetes prevalence among adults after a year of implementation, likely because of SIM’s emphasis on detection and care management. SIM was not associated with lower hospitalization rates among adults diagnosed with diabetes, but the SIM’s long-term impact on hospitalizations should be assessed.
Health Care Utilization After Paraprofessional-administered Substance Use Screening, Brief Intervention, and Referral to Treatment
Authors: Paltzer Jason , Moberg David Paul , Burns Marguerite , Brown Richard L. 
Published: July 2019

Background:
Authorities recommend universal substance use screening, brief intervention, and referral to treatment (SBIRT) for all (ie, universal) adult primary care patients.

Objective:
The objective of this study was to examine long-term (24-mo) changes in health care utilization and costs associated with receipt of universal substance use SBIRT implemented by paraprofessionals in primary care settings.

Research Design:
This study used a difference-in-differences design and Medicaid administrative data to assess changes in health care use among Medicaid beneficiaries receiving SBIRT. The difference-in-differences estimates were used in a Monte Carlo simulation to estimate potential cost-offsets associated with SBIRT.

Subjects:
The treatment patients were Medicaid beneficiaries who completed a 4-question substance use screen as part of an SBIRT demonstration program between 2006 and 2011. Comparison Medicaid patients were randomly selected from matched clinics in Wisconsin.

Measures:
The study includes 4 health care utilization measures: outpatient days; inpatient length of stay; inpatient admissions; and emergency department admissions. Each outcome was assigned a unit cost based on mean Wisconsin Medicaid fee-for-service reimbursement amounts.

Results:
We found an annual increase of 1.68 outpatient days (P=0.027) and a nonsignificant annual decrease in inpatient days of 0.67 days (P=0.087) associated with SBIRT. The estimates indicate that the cost of a universal SBIRT program could be offset by reductions in inpatient utilization with an annual net cost savings of $782 per patient.

Conclusions:
Paraprofessional-delivered universal SBIRT is likely to yield health care cost savings and is a cost-effective mechanism for integrating behavioral health services in primary care settings.
Care coordination for children with medical complexity
Authors: de Banate Mary Ann , Maypole Jack , Sadof Matthew 
Published: July 2019

Purpose of review
We review the literature to help the reader better understand the latest thinking on how best to identify, coordinate and fund care for children with medical complexity, a medically fragile high-cost subpopulation of children and youth with special healthcare needs.

Recent findings
Proprietary and public algorithms have been developed to identify children with medical complexity. Research on families and healthcare providers of children with medical complexity have identified essential components of effective care coordination. Calculation of the cost of care for this population is confounded by cost shifting to families and the variable course of illness in this heterogeneous high-cost population. Care coordination is a team sport that requires strong family partnerships, adequate time and resources to be done effectively. Multiple studies of different sizes have reported similar care coordination team structure, staffing ratios and cost ranges. Multiple options for funding this work now exist and can be tailored to individual environments.

Summary
Effective care coordination can positively impact the care of children with medical complexity. Recent work resulting in a better understanding of the needs of families and providers will guide the development of new technologies and measures.
Self-Reported Screening for Rectal Sexually Transmitted Infections Among Men Who Have Sex With Men
Authors: Menza Timothy William , Lipira Lauren , Bhattarai Amisha , Ramirez F. Joseph , Orellana E. Roberto 
Published: July 2019

Background
Rectal gonorrhea and chlamydia are common and predict human immunodeficiency virus (HIV) acquisition among men who have sex with men (MSM); however, screening for rectal sexually transmitted infections (STIs) is not routine.

Methods
In 2017, we recruited sexually active MSM in the Portland, Oregon metropolitan area through venue-based sampling. Our outcome of interest was self-reported rectal STI screening in the prior 12 months among those who had a health care visit in the same time period. Stratified by HIV status and preexposure prophylaxis (PrEP) use, we assessed the prevalence and predictors of screening.

Results
Of 403 participants, 162 (40.2%) reported rectal STI screening. Sixty (25.7%) of 233 HIV-negative men who did not report PrEP use in the prior 12 months; 61 (69.3%) of the 88 HIV-negative men who reported PrEP use in the prior 12 months; and, 41 (59.4%) of 69 men living with HIV-reported screening, respectively. Among HIV-negative men who did not report PrEP use in the prior 12 months, having a health care provider who offered HIV testing (adjusted prevalence ratio [aPR], 2.21; 95% confidence interval [CI], 1.38–3.52) and condomless anal sex with casual partners in the prior 12 months (aPR, 1.63; 95% CI, 1.01–2.65) were independently associated with rectal STI screening. The HIV-negative men on PrEP who had a syphilis diagnosis in the prior 12 months were more likely to be screened than those without syphilis (aPR, 1.33; 95% CI, 1.11–1.59). Men living with HIV who reported having a provider who always or often initiates conversations about sex were more likely to report screening compared with men who did not have such a provider (aPR, 1.46; 95% CI, 1.06–2.03).

Conclusions
Rectal STI screening is not universal in a venue-based sample of sexually active MSM. Implementing innovative, acceptable, and accessible screening practices, enhancing health literacy around STI screening and improving provider comfort with talking about sex are paramount to increasing rectal STI screening.
Technical Report: Solar Ultraviolet Protection from Sunglasses
Authors: Rabbetts Ronald , Sliney David 
Published: July 2019

SIGNIFICANCE
There is substantial scientific uncertainty about the necessary levels of protection in sunglasses to avoid delayed health effects from solar ultraviolet radiation in the ultraviolet A (UV-A) band. The longer-wavelength limit for UV-A and the inclusion of the spectral effectiveness function in the calculation of solar UV-A transmittance are questionable.

PURPOSE
There has been a wide range of informed opinion with regard to the level—or even need for—near-ultraviolet filtration (by absorption or reflection) in sunglasses. Many current sunglass filter lenses transmit very little near-ultraviolet radiant energy, whereas others transmit a significant fraction. There also are opposing commercial interests that argue either for strong filtration or for minimal protection. We review the evidence for potential risks and the challenge for the designer of any sunglass lens. It is shown that current standards are not at all cautious in their requirements for near-ultraviolet protection and do not meet a philosophical approach of minimizing needless exposure to optical energy that does not benefit vision.

METHODS
The arguments for and against various factors in eye protection from ultraviolet radiation are discussed. The solar UV-A transmittance of some sunglass and clear spectacle lens materials has been calculated using the formulae and methods used in the International Standards Organization sunglass standard. The Annex gives results of the calculations both with and without the S(λ) erythemal weighting function and up to 380 or 400 nm.

RESULTS
The solar UV-A transmittance calculated with the S(λ) function and only up to 380 nm gives numerical results that are lower than taking either the upper limit for UV-A as 400 nm or without the S(λ) function.

CONCLUSIONS
Most sunglass lenses will still pass the requirements with the more stringent requirements, but some spectacle lens materials will need extra treatment.
Prodromal Phase of Hemolytic Uremic Syndrome Related to Shiga Toxin–Producing Escherichia coli
Authors: Balestracci Alejandro , Meni Battaglia Luciana , Toledo Ismael , Martin Sandra Mariel , Alvarado Caupolican 
Published: July 2019

Objectives
This study aimed to evaluate practice patterns during prodromal phase of hemolytic uremic syndrome related to Shiga toxin–producing Escherichia coli (STEC-HUS).

Methods
Trajectories of children from first symptoms until STEC-HUS admitted consecutively at our center (period 2000–2017) were retrospectively reviewed. Early recommended practices include identification of STEC infections, antibiotics and antiperistaltic avoidance, and administration of anticipatory intravenous fluids; therefore, implementation and changes over time (before and after 2011) of such interventions were assessed. In addition, early management was correlated with acute disease outcomes.

Results
Of 172 patients, 98 (57%) had early consults, 75 of them visit the pediatric emergency department. Those seen with watery diarrhea (n = 74) were managed as outpatients, whereas 27 of the 45 assisted with bloody diarrhea were hospitalized for diagnosis other than STEC-HUS. Stool cultures were performed in 13.4% (23/172), 18% (31/172) received antibiotics, and 12.8% (22/172) received endovenous fluids; none received antiperistaltic agents. Shiga toxin–producing E. coli infection was proven in 4% (7/172) before HUS. Rate of cultured patients and treated with intravenous fluids remained unchanged over time (P = 0.13 and P = 0.48, respectively), whereas antibiotic prescription decreased from 42.8% to 16.6% (P = 0.005). Main acute outcomes (need for dialysis, pancreatic compromise, central nervous system involvement, and death) were similar (P > 0.05) regardless of whether they received antibiotics or intravenous fluids.

Conclusions
During the diarrheal phase, 57% of patients consulted; three-quarters of them consulted to the pediatric emergency department. Shiga toxin–producing E. coli detection was poor, antibiotic use remained high, and anticipatory volume expansion was underused. These findings outline the critical need to improve the early management of STEC-HUS.