bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey Development
Authors: Mensik Jennifer , Leebov Wendy , Steinbinder Amy 
Published: February 2019

OBJECTIVE
The aim of this study was to develop an instrument that measures all healthcare staff's perceptions of a culture of caring.

BACKGROUND
Healthcare organizations have increased their focus on cultures of caring within their staff to improve staff satisfaction and patient satisfaction. Nurses and physicians traditionally have been the focus in understanding caring cultures excluding non–direct care staff who do impact organizational culture.

METHODS
An exploratory and partial confirmatory factor analysis was completed on 2 instruments that measure the perception of a caring culture in both direct care and non–direct care staff.

RESULTS
Results demonstrate that both the direct and non–direct care instruments are valid and reliable measures for assessing a caring culture.

CONCLUSIONS
The new 14-item clinical and new 10-item nonclinical staff caring assessment instruments will provide healthcare and nursing leaders with the ability to assess their culture through a direct and non–direct care perspective.
Dose–Response Relationship in a Healthy Habits Study for Head Start Preschoolers
Authors: Ling Jiying , Zahry Nagwan R. , Robbins Lorraine B. 
Published: February 2019

Background
Understanding the dose–response relationship in behavioral interventions is critical to guide future research efforts. However, only few studies have fully examined the dose–response relationship especially among children.

Objective
The aim of the study was to examine the relationships between level of participation and intervention effects.

Methods
The study used data from 39 Head Start parent–preschooler dyads participating in a 10-week lifestyle intervention. The intervention included daily center-based preschooler program, preschooler weekly letters to parents, parent meetings, and weekly Facebook-based program. Height, weight, waist circumference (WC), moderate-to-vigorous physical activity (MVPA), screen time, and fruit/vegetable intake were assessed.

Results
Preschooler program average daily attendance was 79%, and Facebook-based program average completion rate was 80%. About 49% attended all three parent meetings. Parent meeting attendance was significantly and positively related to preschoolers’ vegetable intake (p = .023) and MVPA (p < .001) and parents’ MVPA (p = .016). Preschooler letters were significantly and negatively related to preschoolers’ screen time (p = .002) and parents’ WC (p = .027) and positively correlated with parents’ MVPA (p = .01). Preschooler program attendance was not significantly correlated with their body mass index (ρ = −.31) or WC (ρ = −.16).

Discussion
The study provides important information for designing effective interventions among low-income families. The findings imply that (a) parent-only interventions and parent–child interventions may result in similar effects, (b) future behavioral interventions should focus on the bidirectional parent–child relationship, and (c) it is important to include face-to-face contacts in lifestyle interventions. In addition, it highlights the need to examine the dose–response relationship in multicomponent lifestyle interventions.
Intranasal Fentanyl and Midazolam for Procedural Analgesia and Anxiolysis in Pediatric Urgent Care Centers
Authors: Williams John Matthew , Schuman Sarah , Regen Rebecca , Berg Allyson , Stuart Lindsay , Raju Jampana , Mabry William , Kink Rudy John 
Published: February 2019

Objectives
Intranasal fentanyl and midazolam use is increasing in the acute care setting for analgesia and anxiolysis, but there is a lack of literature demonstrating their use, alone or in combination, at pediatric urgent care centers.

Methods
This retrospective study investigated intranasal fentanyl and midazolam use at an urgent care center located within Le Bonheur Children's Hospital and 2 affiliated off-site centers from September 22, 2011, to December 30, 2015. Data collected included patient demographics, initial fentanyl dose, initial midazolam dose, type of procedure, and serious adverse drug reactions.

Results
Of the 490 patients who met the inclusion criteria, 143 patients received intranasal fentanyl alone, 92 received intranasal midazolam alone, and 255 received fentanyl in combination with midazolam. The overall patient population was 50% male with a median (range) age of 4.5 (0.2–17.9) years, and most patients were black at 57.1%. The median (range) initial intranasal fentanyl dose was 2.02 (0.99–4.22) μg/kg, and the median initial (range) intranasal midazolam dose was 0.19 (0.07–0.42) mg/kg. In cases where fentanyl and midazolam were administered in combination, the median (range) initial fentanyl dose was 2.23 (0.6–4.98) μg/kg and median (range) initial midazolam dose was 0.2 (0.03–0.45) mg/kg. There were no serious adverse drug reactions reported.

Conclusions
Intranasal fentanyl and midazolam when administrated alone and in combination can provide analgesia and anxiolysis for minor procedures in pediatric patients treated in the urgent care setting.
Leadership Disparities in State Governmental Public Health Workforce: Examining the Influence of Gender
Authors: Chapple-McGruder Theresa , Mendoza Zipatly V. , Miles Gandarvaka , Hilson Renata , Wiltshire Jacqueline , Wilder Jocelyn , Heidari Leila , Castrucci Brian C. , Gould Elizabeth 
Published: February 2019

Objective:
To determine the extent to which gender disparities exist in either obtaining a leadership position or pay equity among those with leadership positions in state governmental public health agencies.

Design:
Utilizing the 2014 Public Health Workforce Interests and Needs Survey, a nationally representative cross-sectional study of state governmental public health agency employees, the characteristics of the state governmental public health agency leadership were described. We estimated the odds of being a manager or an executive leader and the odds of leaders earning greater than $95 000 annually for women compared with men using polytomous multinomial regression and logistic regression models, respectively.

Setting and Participants:
The Public Health Workforce Interests and Needs Survey was conducted via electronic survey at 37 state health departments. This study utilized only those respondents who listed their current position as a supervisory position (n = 3237).

Main Outcome Measures:
Leadership position and high-earning leadership were the 2 main outcome measures explored. Leadership position was defined as a 3-level ordinal variable: supervisor, manager, or executive leader. High-earning leadership was defined as a member of leadership earning $95 000 or greater.

Results:
Women accounted for 72.0% of the overall state governmental public health agency workforce and 67.1% of leadership positions. Women experienced lower odds (odds ratio = 0.55, 95% confidence interval: 0.39-0.78) of holding executive leadership positions than men and lower odds (odds ratio = 0.64, 95% confidence interval: 0.50-0.81) of earning an annual salary greater than $95 000.

Conclusion:
While women were represented in similar proportions in the general workforce as in leadership positions, gender disparities still existed within leadership positions. Increased effort is needed to ensure that opportunities exist for women in executive leadership positions and in pay equity. With public health's commitment to social justice and the benefits of diversity to an agency's policies and programs, it is important to ensure that women's voices are equally represented at all levels of leadership.
Community Benefit Spending Among North Carolina's Tax-Exempt Hospitals After Performing Community Health Needs Assessments
Authors: Fos Elmer B. , Thompson Michael E. , Elnitsky Christine A. , Platonova Elena A. 
Published: February 2019

Context:
As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every 3 years to incentivize hospitals to provide programs responsive to the health needs of their communities.

Objective:
To examine the distribution and variation in community benefit spending among North Carolina's tax-exempt hospitals 2 years after completing their first IRS-mandated CHNA.

Design:
Cross-sectional study using secondary analysis of published community benefit reports. Community benefit was categorized on the basis of North Carolina Hospital Association's community benefit reporting guidelines. Multiple regression analysis using generalized linear model was used to examine the variation in community benefit spending among study hospitals considering differences in hospital-level and community characteristics.

Setting:
Fifty-three private, nonprofit hospitals across North Carolina.

Main Outcome Measure:
Dollar expenditures as a percentage of operating expenses of the 2 categories of community benefit spending: patient care financial assistance and community health programs.

Results:
Study hospitals' aggregate community benefit spending was $2.6 billion, 85% of which was in the form of patient care financial assistance, with only 0.7% of total spending allocated to community-building activities such as affordable housing, economic development, and environmental improvements. On average, the study hospitals' community benefit spending was equivalent to 14.6% of operating expenses. Hospitals with 300 or more beds provided significantly higher investments in community health programs as a percentage of their operating expenses than hospitals with 101 to 299 beds (P = .03) or hospitals with 100 or fewer beds (P = .04). Access to care was not associated with patient care financial assistance (P = .81) or community health programs expenditures (P = .94).

Conclusions:
The study hospitals direct most of their community benefit expenditures to patient care financial assistance (individual welfare) rather than population health improvement initiatives, with virtually no investments in community-building activities that address socioeconomic determinants of health.
CDC Guidance for Use of a Third Dose of MMR Vaccine During Mumps Outbreaks
Authors: Marlow Mariel A. , Marin Mona , Moore Kelly , Patel Manisha 
Published: February 2019

Context:
In response to numerous mumps outbreaks reported throughout the United States in 2016 and 2017, the Advisory Committee on Immunization Practices (ACIP) recommended a third dose of measles, mumps, and rubella (MMR) vaccine for groups of persons determined by public health authorities to be at increased risk for acquiring mumps because of an outbreak.

Objective:
To provide guidance for health departments when implementing the ACIP recommendation.

Design:
Draft guidance was developed by Centers for Disease Control and Prevention subject matter experts based on technical consultations with health departments and review of published and unpublished data regarding mumps outbreaks. The guidance was finalized based on input from experts from the ACIP Mumps Work Group and local and state epidemiologists through the Council of State and Territorial Epidemiologists and the National Association of County and City Health Officials.

Results:
We developed guidance to assist public health authorities when determining which groups are at increased risk for acquiring mumps and should receive a third dose of MMR vaccine. During outbreaks, public health authorities identify groups of persons with known or likely close contact exposure to a mumps patient. Then, evidence of transmission and likelihood of transmission in a group's setting can be used to determine whether these groups are at increased risk. Additional epidemiologic and implementation factors may also be considered. All persons in the group at increased risk for acquiring mumps should receive a dose of MMR vaccine, including those with unknown vaccination status or those who have evidence of presumptive immunity other than documented 2 doses of MMR vaccine; no additional dose is recommended for persons who had received 3 or more doses before the outbreak.

Conclusion:
This guidance provides a framework for public health authorities to use when considering a third dose of MMR in response to mumps outbreaks while maintaining flexibility to incorporate local factors related to individual outbreaks.
Systems Integration: The Next Frontier in Newborn-Screening Timeliness
Authors: Simon Norma-Jean , Atkins Anne , Yusuf Careema , Tarini Beth A. 
Published: February 2019

Context:
In 2015, the United States Federal Advisory Committee on Heritable Disorders in Newborns and Children issued recommendations for state-based newborn screening programs to benchmark improvements in newborn-screening timeliness. Newborn screening (NBS) timeliness encompasses the efficient collection, transportation, testing, and reporting of results. Nearly all state programs fail to achieve recommended timeliness benchmarks.

Objectives:
Our study explored the processes and procedures that accelerate or hamper progress toward improving NBS timeliness from a public health laboratory program perspective.

Design:
We conducted semistructured interviews to elicit public health laboratory perspectives on NBS specimen delivery, laboratory testing and processing, communication of results to birthing providers, program staffing, and quality measures and data sharing. A content analysis explored practices, processes, and procedures related to NBS timeliness. A secondary analysis examined interorganizational strategies to enhance timeliness outcomes among NBS stakeholders.

Participants:
Ten laboratories participated in the study (n = 21 personnel). Participants included public health laboratory directors, NBS program managers, and NBS follow-up program staff.

Results:
Efforts to improve NBS timeliness included engaging birthing providers, expanding courier services, extending operating hours, modifying staffing schedules, and implementing cross-training schedules to facilitate prompt collection, transport, and processing of NBS specimens. Sustained improvements will require implementing robust data systems, integrating laboratory and follow-up processes, and improving communication among all NBS stakeholders. Programs expressed a desire to refine timeliness metric definitions to ensure useful comparisons across states.

Conclusions:
Efforts to improve timeliness have accelerated in recent years; sustained progress will require increased coordination and integration among stakeholders in the NBS delivery system.
Detecting Drop-offs in Electronic Laboratory Reporting for Communicable Diseases in New York City
Authors: Greene Sharon K. , Andrews Erin M. , Evans Lloyd Pamela , Baumgartner Jennifer , Peterson Eric R. 
Published: February 2019

Context:
The Bureau of Communicable Disease at the New York City Department of Health and Mental Hygiene receives an average of more than 1000 reports daily via electronic laboratory reporting. Rapid recognition of any laboratory reporting drop-off of test results for 1 or more diseases is necessary to avoid delays in case investigation and outbreak detection.

Program:
We modified our outbreak detection approach using the prospective space-time permutation scan statistic in SaTScan. Instead of searching for spatiotemporal clusters of high case counts, we reconceptualized “space” as “laboratory” and instead searched for clusters of recent low reporting, overall and for each of 52 diseases and 10 hepatitis test types, within individual laboratories. Each analysis controlled for purely temporal trends affecting all laboratories and accounted for multiple testing.

Implementation:
A SAS program automatically created input files, invoked SaTScan, and further processed SaTScan analysis results and output summaries to a secure folder. Analysts reviewed output weekly and reported concerning drop-offs to coordinators, who liaised with reporting laboratory staff to investigate and resolve issues.

Evaluation:
During a 42-week evaluation period, October 2017 to July 2018, we detected 62 unique signals of reporting drop-offs. Of these, 39 (63%) were verified as true drop-offs, including failures to generate or transmit files and programming errors. For example, a hospital laboratory stopped reporting influenza after changing a multiplex panel result from “positive” to “detected.” Six drop-offs were detected despite low numbers of expected reports missing (<10 per drop-off).

Discussion:
Our novel application of SaTScan identified a manageable number of possible electronic laboratory reporting drop-offs for investigation. Ongoing maintenance requirements are minimal but include accounting for laboratory mergers and referrals. Automated analyses facilitated rapid identification and correction of electronic laboratory reporting errors, even with small numbers of expected reports missing, suggesting that our approach might be generalizable to smaller jurisdictions.
Complication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction
Authors: Chouairi Fouad , Gabrick Kyle S. , Avraham Tomer , Markov Nickolay P. , Alperovich Michael 
Published: February 2019

Background:
Two-stage implant breast reconstruction is the most commonly performed breast reconstruction procedure. Limited data exist regarding reconstruction complication rates examined by mastectomy indication.

Methods:
Patients who underwent two-stage implant breast reconstruction at Yale New Haven Hospital from 2011 to 2017 were included in the study. Perioperative complications were compared. Chi-square analysis, t tests, and Fisher’s exact tests were used to determine significant associations. A binary logistic regression was used to determine variables with a significant impact on the likelihood of mastectomy flap necrosis.

Results:
Between 2011 and 2017, complete perioperative records were available for 141 patients who underwent 226 mastectomies followed by two-stage tissue expander/permanent implant reconstruction. Of the 226 mastectomies, 134 were therapeutic and 92 were prophylactic. On regression analysis, there were no significant differences in demographics, comorbidities, or mastectomy and reconstructive details between the two breast groups except for there being more modified radical mastectomies in therapeutic breasts (p = 0.003). When comparing complications, there was a significantly higher risk of mastectomy flap necrosis in the therapeutic group (p = 0.017). Therapeutic mastectomies had a 9.5 times higher risk of mastectomy flap necrosis than prophylactic mastectomies when adjusted for confounding variables. There were no significant differences in other reconstructive complications between the two groups.

Conclusions:
Patients undergoing therapeutic mastectomies have a significantly higher risk of mastectomy flap necrosis than those undergoing prophylactic mastectomies. Although the underlying cause still needs to be determined, differences in technique may be related to mastectomy flap necrosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Assessment of Health-Related Quality of Life in Robin Sequence: A Comparison of Mandibular Distraction Osteogenesis and Tongue-Lip Adhesion
Authors: Logjes Robrecht J. H. , Mermans Joline F. , Paes Emma C. , Muradin Marvick S. M. , Don Griot J. Peter , Breugem Corstiaan C. 
Published: February 2019

Background:
Numerous studies have proven the efficacy of mandibular distraction osteogenesis or tongue-lip adhesion in Robin sequence infants with upper airway obstruction. However, none has compared health-related quality of life outcomes.

Methods:
In the present retrospective study, Robin sequence infants younger than 1 year, who underwent mandibular distraction osteogenesis or tongue-lip adhesion, were included (2006 to 2016). The infants’ caregivers were asked to complete a questionnaire based on the Glasgow Children’s Benefit Inventory.

Results:
The response rate was 71 percent (22 of the 31 questionnaires; mandibular distraction osteogenesis, 12 of 15; and tongue-lip adhesion, 10 of 16) and median age at surgery was 24 days (range, 5 to 131 days). Median total Glasgow Children’s Benefit Inventory scores after mandibular distraction osteogenesis and after tongue-lip adhesion were 21.9 (interquartile range, 9.4) and 26.0 (interquartile range, 37.5), respectively (p = 0.716), indicating an overall benefit from both procedures. Positive changes were observed in all subgroups emotion, physical health, learning, and vitality. In syndromic Robin sequence, both procedures demonstrated a lower positive change in health-related quality of life compared with isolated Robin sequence (p = 0.303).

Conclusions:
Both surgical procedures demonstrated an overall benefit in health-related quality-of-life outcomes, with no significant differences. The authors’ findings contribute to the debate regarding the use of mandibular distraction osteogenesis versus tongue-lip adhesion in the surgical treatment of Robin sequence; however, studies evaluating health-related quality of life in larger Robin sequence cohorts are necessary to identify which procedure is likely to be best in each individual Robin sequence infant.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis
Authors: Daar David A. , Shah Ajul , Mirrer Joshua T. , Thanik Vishal , Hacquebord Jacques 
Published: February 2019

Background:
Two mainstay surgical options for salvage in scapholunate advanced collapse and scaphoid nonunion advanced collapse are proximal row carpectomy and four-corner arthrodesis. This study evaluates the cost-utility of proximal row carpectomy versus three methods of four-corner arthrodesis for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist.

Methods:
A cost-utility analysis was performed in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. A comprehensive literature review was performed to obtain the probability of potential complications. Costs were derived using both societal and health care sector perspectives. A visual analogue scale survey of expert hand surgeons estimated utilities. Overall cost, probabilities, and quality-adjusted life-years were used to complete a decision tree analysis. Both deterministic and probabilistic sensitivity analyses were performed.

Results:
Forty studies yielding 1730 scapholunate advanced collapse/scaphoid nonunion advanced collapse wrists were identified. Decision tree analysis determined that both four-corner arthrodesis with screw fixation and proximal row carpectomy were cost-effective options, but four-corner arthrodesis with screw was the optimal treatment strategy. Four-corner arthrodesis with Kirschner-wire fixation and four-corner arthrodesis with plate fixation were dominated (inferior) strategies and therefore not cost-effective. One-way sensitivity analysis demonstrated that when the quality-adjusted life-years for a successful four-corner arthrodesis with screw fixation are lower than 26.36, proximal row carpectomy becomes the optimal strategy. However, multivariate probabilistic sensitivity analysis confirmed the results of our model.

Conclusions:
Four-corner arthrodesis with screw fixation and proximal row carpectomy are both cost-effective treatment options for scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist because of their lower complication profile and high efficacy, with four-corner arthrodesis with screw as the most cost-effective treatment. Four-corner arthrodesis with plate and Kirschner-wire fixation should be avoided from a cost-effectiveness standpoint.