bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes
Authors: Jones Audrey L. , Hausmann Leslie R.M. , Kertesz Stefan G. , Suo Ying , Cashy John P. , Mor Maria K. , Pettey Warren B.P. , Schaefer James H. , Gordon Adam J. , Gundlapalli Adi V. 
Published: February 2019

Background:
In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans.

Objective:
The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care.

Research Design:
We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey.

Subjects:
Homeless-experienced survey respondents enrolled in H-PACT (n=251) or standard primary care in facilities with H-PACT available (n=1527) and facilities without H-PACT (n=10,079).

Measures:
Patient experiences in 8 domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus nonpositive.

Results:
H-PACT patients were less likely than standard primary care patients to be female, have 4-year college degrees, or to have served in recent military conflicts; they received more primary care visits and social services. H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access [adjusted risk difference (RD)=17.4], communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and self-management support (RD=4.6).

Conclusions:
Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, when compared with standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other health care settings.
Epilepsy Among Elderly Medicare Beneficiaries
Authors: Moura Lidia M.V.R. , Smith Jason R. , Blacker Deborah , Vogeli Christine , Schwamm Lee H. , Cole Andrew J. , Hernandez-Diaz Sonia , Hsu John 
Published: February 2019

Background:
Uncertain validity of epilepsy diagnoses within health insurance claims and other large datasets have hindered efforts to study and monitor care at the population level.

Objectives:
To develop and validate prediction models using longitudinal Medicare administrative data to identify patients with actual epilepsy among those with the diagnosis.

Research Design, Subjects, Measures:
We used linked electronic health records and Medicare administrative data including claims to predict epilepsy status. A neurologist reviewed electronic health record data to assess epilepsy status in a stratified random sample of Medicare beneficiaries aged 65+ years between January 2012 and December 2014. We then reconstructed the full sample using inverse probability sampling weights. We developed prediction models using longitudinal Medicare data, then in a separate sample evaluated the predictive performance of each model, for example, area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity.

Results:
Of 20,945 patients in the reconstructed sample, 2.1% had confirmed epilepsy. The best-performing prediction model to identify prevalent epilepsy required epilepsy diagnoses with multiple claims at least 60 days apart, and epilepsy-specific drug claims: AUROC=0.93 [95% confidence interval (CI), 0.90–0.96], and with an 80% diagnostic threshold, sensitivity=87.8% (95% CI, 80.4%–93.2%), specificity=98.4% (95% CI, 98.2%–98.5%). A similar model also performed well in predicting incident epilepsy (k=0.79; 95% CI, 0.66–0.92).

Conclusions:
Prediction models using longitudinal Medicare data perform well in predicting incident and prevalent epilepsy status accurately.
Physician Participation in Medicare Accountable Care Organizations and Spillovers in Commercial Spending
Authors: Post Brady , Ryan Andrew M. , Moloci Nicholas M. , Li Jun , Dupree James M. , Hollingsworth John M. 
Published: February 2019

Importance:
The benefits of public payment policy may extend to private populations through “spillover” effects. If cost-saving efforts in Medicare also reduce costs among commercially insured patients, Medicare payment systems could be a versatile policy tool in future reform efforts.

Objectives:
To determine whether physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercial patients.

Design:
This was a retrospective, longitudinal study which was conducted using Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015. We compared patients seen by physicians who participated in a Medicare ACO to patients whose physicians were not part of an ACO. We used a difference-in-differences (DIDs) design to test whether physician participation in an ACO was associated with reduced spending among their commercially insured patients. We also tested for heterogeneous effects: we assessed whether spillovers were larger among patients with clinical conditions (acute myocardial infarction, pneumonia, congestive heart failure) that have previously been targeted by Medicare payment programs.

Setting:
This was a population-based study of commercially insured patients in Michigan.

Participants:
Patients who experienced a significant clinical episode (eg, labor and delivery, acute myocardial infarction) between 2010 and 2015.

Exposure:
Our patient-level exposure is treatment by a Medicare ACO-affiliated physician.

Main Outcomes and Measures:
Medical spending of 0–90 days and 91–365 days after a clinical episode.

Results:
Patients in the exposure group (n=54,750) and in the control group (n=137,883) were similar in demographic characteristics of age, sex, and type of clinical episodes. Adjusted mean 90-day spending in the preexposure period was $21,292 among the exposure group and $21,157 among the comparison group; these means declined to $21,250 and $20,995 in the postperiod, yielding a DIDs estimate of $119 [95% confidence interval (CI), −$170 to $408]. Adjusted means for 91–365 days spending in the preperiod were $4258 among the exposure group and $4251 among the comparison group; these means rose to $4338 and $4421 in the postperiod, yielding a DIDs estimate of −$90 (95% CI, −$312 to $132). We also separately examined patients with conditions that have been targeted by other Medicare payment programs. Among these patients, 90-day spending did not differ between exposure and comparison groups (DIDs, −$223; 95% CI, −$2037 to $1591), although 91–365 days spending decreased among the exposure group with marginal statistical significance (DIDs, −$1160; 95% CI, −$2459 to $140).

Conclusions and Relevance:
Physicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients. Medicare policy is unlikely to confer significant spillover benefits to the commercially insured population.
Diagnosis of appendicitis in the paediatric emergency department: an update
Authors: Lawton Ben , Goldstein Henry , Davis Tessa , Tagg Andrew 
Published: February 2019

Purpose of review
Concern regarding appendicitis is a common reason for presentation to the paediatric emergency department. We review recent progress in the use of biomarkers, imaging and clinical scoring systems in improving diagnostic accuracy in suspected appendicitis in children.

Recent findings
Use of ultrasound, often performed at the bedside, is becoming more widespread with a parallel reduction in computed tomography (CT) use. Protocols for image acquisition and interpretation have been shown to improve diagnostic accuracy. Novel biomarkers have been explored and clinical diagnostic algorithms refined but none have achieved the level of diagnostic accuracy required.

Summary
Appendicitis remains a clinical diagnosis. Point of care ultrasound is increasingly available and offers higher diagnostic accuracy than several routinely performed laboratory investigations. Recent publications provide support for increased use of clinician performed ultrasound, increased use of MRI, less use of CT, less emphasis on basic laboratory investigation and a renewed respect for the value of serial examination, particularly early in the course of illness.
Palm Oil and Beta‐palmitate in Infant Formula
Authors: Bronsky Jiri , Campoy Cristina , Embleton Nicholas , Fewtrell Mary , Mis Nataša Fidler , Gerasimidis Konstantinos , Hojsak Iva , Hulst Jessie , Indrio Flavia , Lapillonne Alexandre , Molgaard Christian , Moltu Sissel Jennifer , Verduci Elvira , Vora Rakesh , Domellöf Magnus ,   ESPGHAN Committee on Nutrition
Published: February 2019

ABSTRACTBackground:Palm oil (PO) is used in infant formulas in order to achieve palmitic acid (PA) levels similar to those in human milk. PA in PO is esterified predominantly at the SN‐1,3 position of triacylglycerol (TAG), and infant formulas are now available in which a greater proportion of PA is in the SN‐2 position (typical configuration in human milk). As there are some concerns about the use of PO, we aimed to review literature on health effects of PO and SN‐2‐palmitate in infant formulas.Methods:PubMed and Cochrane Database of Systematic Reviews were systematically searched for relevant studies on possible beneficial effects or harms of either PO or SN‐2‐palmitate in infant formula on various health outcomes.Results:We identified 12 relevant studies using PO and 21 studies using SN‐2‐palmitate. Published studies have variable methodology, subject characteristics, and some are underpowered for the key outcomes. PO is associated with harder stools and SN‐2‐palmitate use may lead to softer stool consistency. Bone effects seem to be short‐lasting. For some outcomes (infant colic, faecal microbiota, lipid metabolism), the number of studies is very limited and summary evidence inconclusive. Growth of infants is not influenced. There are no studies published on the effect on markers of later diseases.Conclusions:There is insufficient evidence to suggest that PO should be avoided as a source of fat in infant formulas for health reasons. Inclusion of high SN‐2‐palmitate fat blend in infant formulas may have short‐term effects on stool consistency but cannot be considered essential.
Free‐breathing Magnetic Resonance Imaging Assessment of Body Composition in Healthy and Overweight Children
Authors: Ly Karrie V. , Armstrong Tess , Yeh Joanna , Ghahremani Shahnaz , Kim Grace H. , Wu Holden H. , Calkins Kara L. 
Published: February 2019

ABSTRACTObjective:Conventional, breath‐holding magnetic resonance imaging (MRI) assesses body composition by measuring fat volumes and proton density fat fraction (PDFF). However, breath‐holding MRI is not always feasible in children. This study's objective was to use free‐breathing MRI to quantify visceral and subcutaneous fat volumes and PDFFs and correlate these measurements with hepatic PDFF.Methods:This was an observational, hypothesis‐forming study that enrolled 2 groups of children (ages 6–17 years), healthy children and overweight children with presumed nonalcoholic fatty liver disease. Free‐breathing MRI was used to measure visceral and subcutaneous fat volumes and PDFFs, and hepatic PDFF. Imaging biomarkers were compared between groups, and correlations coefficients (r) and coefficients of determination (R2) were calculated.Results:When compared with the control group (n = 10), the overweight group (n = 9) had greater mean visceral (1843 vs 329 cm3,P< 0.001) and subcutaneous fat volumes (7663 vs 893 cm3,P< 0.001), as well as greater visceral (80% vs 45%, p < 0.001) and subcutaneous fat PDFFs (89% vs 75%,P= 0.003). Visceral fat volume (r= 0.79,P< 0.001) and PDFF (r= 0.92,P< 0.001) correlated with hepatic PDFF. In overweight subjects, for each unit increase in visceral fat PDFF, hepatic PDFF increased by 2.64%; visceral fat PDFF explained 54% of hepatic PDFF variation (R2= 0.54,P= 0.02).Conclusions:In this study, we used free‐breathing MRI to measure body composition in children. Future studies are needed to investigate the possible value of subcutaneous and visceral fat PDFFs, and validate free‐breathing MRI body composition biomarkers.
The Incidence of Workplace Bullying and Related Environmental Factors Among Nurse Managers
Authors: Parchment Joy , Andrews Diane 
Published: February 2019

OBJECTIVE
The purpose of the study was to explore relationships between authentic leadership style, global social power, job demand, job control, and workplace bullying of nurse managers in acute care settings across the United States.

BACKGROUND
Consequences of workplace bullying are linked to intent to leave, turnover, and harmful emotional and physical effects.

METHODS
An explorative, descriptive, cross-sectional design using an online survey was utilized.

RESULTS
Thirty-five percent of nurse managers reported being a target of workplace bullying with severity levels ranging from occasional to severe. Executive nurse leaders were identified as the primary perpetrator with the downward direction recognized as most prominent.

CONCLUSIONS
Nurse managers are recipients of workplace bullying emanating from executive nurse leaders, clinical nurses, and their nurse manager peers.
Estimating Childhood Obesity Prevalence in Communities Through Multi-institutional Data Sharing
Authors: Daley Matthew F. , Barrow Jennifer C. , Tabano David C. , Reifler Liza M. , Kraus Emily M. , Davies Sara Deakyne , Williford Devon L. , White Benjamin , Shupe Alyson , Davidson Arthur J. 
Published: February 2019

Context:
Although local childhood obesity prevalence estimates would be valuable for planning and evaluating obesity prevention efforts in communities, these data are often unavailable.

Objective:
The primary objective was to create a multi-institutional system for sharing electronic health record (EHR) data to produce childhood obesity prevalence estimates at the census tract level. A secondary objective was to adjust obesity prevalence estimates to population demographic characteristics.

Design/Setting/Participants:
The study was set in Denver County, Colorado. Six regional health care organizations shared EHR-derived data from 2014 to 2016 with the state health department for children and adolescents 2 to 17 years of age. The most recent height and weight measured during routine care were used to calculate body mass index (BMI); obesity was defined as BMI of 95th percentile or more for age and sex. Census tract location was determined using residence address. Race/ethnicity was imputed when missing, and obesity prevalence estimates were adjusted by sex, age group, and race/ethnicity.

Main Outcome Measure(s):
Adjusted obesity prevalence estimates, overall, by demographic characteristics and by census tract.

Results:
BMI measurements were available for 89 264 children and adolescents in Denver County, representing 73.9% of the population estimate from census data. Race/ethnicity was missing for 4.6%. The county-level adjusted childhood obesity prevalence estimate was 13.9% (95% confidence interval, 13.6-14.1). Adjusted obesity prevalence was higher among males, those 12 to 17 years of age, and those of Hispanic race/ethnicity. Adjusted obesity prevalence varied by census tract (range, 0.4%-24.7%). Twelve census tracts had an adjusted obesity prevalence of 20% or more, with several contiguous census tracts with higher childhood obesity occurring in western areas of the city.

Conclusions:
It was feasible to use a system of multi-institutional sharing of EHR data to produce local childhood obesity prevalence estimates. Such a system may provide useful information for communities when implementing obesity prevention programs.
The Cognitive Profile of Children with Nonsyndromic Craniosynostosis
Authors: Kljajić Marizela , Maltese Giovanni , Tarnow Peter , Sand Peter , Kölby Lars 
Published: February 2019

Background:
Long-term neuropsychological and cognitive outcomes in patients with nonsyndromic craniosynostosis have proven difficult to evaluate objectively because of methodologic problems with published studies based on their small and biased samples of patients, wide age ranges, and testing with unacceptable psychometric properties. This study evaluated the Full-Scale Intelligence Quotient and its subscales in a cohort with a small selection bias.

Methods:
Patients aged 7 to 16 years, born with nonsyndromic craniosynostosis and surgically treated, were tested using the Wechsler Intelligence Scale for Children, Fourth Edition. Ninety-one patients were invited, and 73 patients were tested.

Results:
There was no difference in Full-Scale Intelligence Quotient score between patients who had undergone operations for sagittal synostosis or metopic synostosis and norms provided by the test. Patients operated on for sagittal synostosis showed a significantly higher perceptual reasoning intelligence quotient, but also significantly lower working-memory intelligence quotient and processing-speed intelligence quotient compared with the norms. Patients operated on for metopic synostosis showed no differences in any intelligence quotient index compared with the norm. In addition, attrition analysis showed no differences in background factors between responders and nonresponders.

Conclusions:
These results derived from a group of patients with uniform age range, and tested using an established tool, revealed that nonsyndromic children having undergone surgery for craniosynostosis exhibited average intellectual ability. However, the analysis indicated possible issues with working memory and processing speed in patients operated on for sagittal synostosis, highlighting impairments potentially associated with neuropsychological problems and that might contribute to learning disabilities.
Locoregional Cancer Recurrence after Breast Reconstruction: Detection, Management, and Secondary Reconstructive Strategies
Authors: Mirzabeigi Michael N. , Rhemtulla Irfan A. , Mcdonald Elizabeth S. , Sataloff Dahlia M. , Kovach Stephen J. , Wu Liza C. , Serletti Joseph M. , Kanchwala Suhail 
Published: February 2019

Background:
Locoregional recurrence of the previously reconstructed breast poses a diagnostic and operative challenge. This study examines detection, management, and reconstructive strategies of locoregional recurrence following postmastectomy breast reconstruction.

Methods:
A retrospective review of records was performed on patients treated within the health system for breast cancer from January of 2000 to July of 2014. Of these patients, descriptive factors and operative details were collected for those that developed locoregional recurrence. Subsequent reconstructive operations were also examined. Using a multidisciplinary team, a surveillance/management algorithm was generated.

Results:
A total of 41 patients with locoregional recurrence were identified (mean time to recurrence, 4.6 years). Two- and 5-year survival following locoregional recurrence was 88 percent and 39 percent, respectively. Locoregional recurrence was found to occur in the following tissue planes: subcutaneous (27 percent), subcutaneous/pectoralis (24 percent), chest wall (37 percent), and axillary (12 percent). The most frequent method of detection was patient concern leading to examination. Older age at the time of locoregional recurrence (p = 0.028), increased time to recurrence/detection (p = 0.024), and chemotherapy before locoregional recurrence (p = 0.014) were associated with the need for a secondary salvage flap. Patients who experienced a subcutaneous recurrence were far less likely to undergo a secondary flap (p = 0.011). Factors associated with loss of the index reconstruction included lower body mass index (p = 0.009), pectoralis invasion (p = 0.05), and implant reconstruction (p = 0.03).

Conclusions:
Detection and management of locoregional recurrence requires appropriate physical examination and imaging. Significant factors associated with failure to salvage the initial reconstruction included body mass index, plane of recurrence, and type of initial reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Brief Report: Clinical Outcomes of Young Black Men Receiving HIV Medical Care in the United States, 2009–2014
Authors: Chowdhury Pranesh , Beer Linda , Shouse R. Luke , Bradley Heather ,   for the Medical Monitoring Project
Published: February 2019

Background:
More than one-quarter of 2016 HIV diagnoses among blacks in the United States occurred among persons aged 15–24 years, and three-quarters were among men. Although the prevalence of viral suppression in all tests in the past 12 months (durable viral suppression) among persons receiving HIV care increased from 58% to 68% during 2009–2013, we do not know whether this same improvement was observed among young black men receiving care.

Methods:
We analyzed the 2009–2014 Medical Monitoring Project data collected from 336 black men aged 18–24 years. We estimated the proportion of young black men receiving HIV care who were prescribed antiretroviral therapy (ART), adherent to ART, and durably virally suppressed. We assessed changes in clinical outcomes over time and their association with patient characteristics, health behaviors, and depression.

Results:
During 2009–2014, 80% of young black men receiving HIV care were prescribed ART, 73% were adherent to ART, and 36% had durable viral suppression. There was no significant change in viral suppression over this period. ART prescription and durable viral suppression were significantly higher among those receiving the Ryan White HIV/AIDS Program assistance compared with those who did not. Durable viral suppression was significantly lower among those who used drugs compared with those who did not.

Conclusions:
Viral suppression among young black men during 2009–2014 was lower than that among the overall population receiving HIV care in 2013 (36% vs. 68%). Increasing viral suppression is essential to improve health and reduce HIV transmissions in this key population.
Pachymeningitis Demonstrated on Gallium SPECT/CT Scan
Authors: Wong Veronica C. , Yung Grace , Russo Robert , Reddel Stephen W. , Mansberg Robert 
Published: February 2019

Abstract
A 34-year-old woman presented with a 3-month history of right-sided headaches associated with photophobia and pulsatile tinnitus. Investigations including lumbar puncture revealed elevated opening CSF pressure, increased protein, and presence of monocytosis consistent with an inflammatory/infective process. Brain MRI showed an area of thickened enhancing dura around the venous sinus posteriorly. 67Ga scintigraphy demonstrated focal intracranial uptake in the posterior occipital region, and biopsy confirmed a chronic inflammatory infiltrate with no granulomas.
A Case of Intramuscular Cryptococcosis Mimicking a Malignant Tumor on FDG PET/CT
Authors: Wang Ling , Zheng Xiangwu , Lin Jie , Tang Kun 
Published: February 2019

Abstract
Intramuscular cryptococcosis is extremely rare. In this case, a 76-year-old man with history of acute myeloid leukemia presented a painful mass in the right upper arm. FDG PET/CT demonstrated a low-density irregular-shaped mass in the triceps muscle of the right upper arm with adjacent bone erosion. The lesion presented with significantly increased activity with an SUVmax of 23.4, which could be misdiagnosed as a malignant tumor. The lesion was confirmed as cryptococcosis by periodic acid–Schiff stain and culture of biopsied specimen. Because cryptococcal infection is treatable, it is important to increase awareness of this hypermetabolic benign lesion in the unusual location.