bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Complications, Incidents, and Patient Experience: Retrospective Linkage of Routine Patient Experience Surveys and Safety Data
Authors: de Vos Marit S. , Hamming Jaap F. , Boosman Hileen , Marang-van de Mheen Perla J. 
Published: March 2019

Objectives
Linkage of safety data to patient experience data may provide information to improve surgical care. This retrospective observational study aimed to assess associations between complications, incidents, patient-reported problems, and overall patient experience.

Methods
Routinely collected data from safety reporting on complications and incidents, as well as patient-reported problems and experience on the Picker Patient Experience Questionnaire 15, covering seven experience dimensions, were linked for 4236 surgical inpatients from an academic center (April 2014–December 2015, 41% response). Associations between complication and/or incident occurrence and patient-reported problems, regarding risk of nonpositive experience (i.e., grade of 1–5 of 10), were studied using multivariable logistic regression.

Results
Patient-reported problems were associated with occurrence of complications/incidents among patients with nonpositive experiences (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.6–4.9), but not among patients with positive experiences (OR = 1.0, 95% CI = 0.6–1.5). For each experience dimension, presence of patient-reported problems increased risk of nonpositive experience (OR range = 2.7–4.4). Patients with complications or incidents without patient-reported problems were at lower risk of a nonpositive experience than patients with neither complications/incidents nor reported problems (OR = 0.5; 95% CI = 0.3–0.9). Occurrence of complications/incidents only increased risk of nonpositive experience when patients also had problems on “continuity and transition” or “respect for patient preferences” dimensions.

Conclusions
Linking safety data to patient experience data can reveal ways to optimize care. Staff seem able to ensure positive patient experiences despite complications or incidents. Increased attention should be paid to respecting patient preferences, continuity, and transition, particularly when complications or incidents occur.
Error Detection and Cost Savings With an Image-Based Workflow Management System Connected to a Computerized Prescription Order Entry Program for Antineoplastic Compounding
Authors: Marzal-Alfaro Maria Belén , Escudero-Vilaplana Vicente , Rodríguez-González Carmen Guadalupe , González-Haba Eva , Calvo Aitana , Osorio Santiago , Iglesias-Peinado Irene , Herranz Ana , Sanjurjo María 
Published: March 2019

Objective
The aim of the study was to analyze both the prevalence of errors with the implementation of an image-based workflow management system during the antineoplastic compounding process, and the estimated costs associated with the negative clinical outcome if the errors had not been intercepted.

Methods
Three months after the implementation of Phocus Rx system at a hospital pharmacy department, the identification, classification (type, preparation stage, and cause), and potential severity degree (from negligible to catastrophic) of the errors intercepted were determined. The probability of an error causing an adverse event if it had reached the patient (from nil [0] to high [0.6]) and its consequences was estimated by a team of clinical pharmacists and physicians. Cost-effectiveness analysis from the hospital’s perspective was performed.

Results
Overall, 9872 antineoplastic medications were prepared using Phocus Rx. The total compounding error rate was 0.8% (n = 78, 56 [69.2%] were related to incorrect dose, 20 [28.2%] to incorrect drug preparation or conditioning technique, and 2 [2.6%] were wrong drugs). Approximately 70% of the detected errors were classified as undetectable via the previous verification practice, with 11.55% judged to be potentially severe (n = 9) and 51.3% moderate (n = 29). Likelihood of occurrence of an adverse event was medium (0.4) to high (0.6) for 37.2% of the errors. Estimated cost ratio and return on investment were €4.21 and 321%, respectively.

Conclusions
The implementation of Phocus Rx prevented antineoplastic preparation errors that would have reached the patient otherwise. In addition, acquisition of this technology was estimated to be cost-effective.
Factors Influencing Falls in High- and Low-Risk Patients in a Tertiary Hospital in Korea
Authors: Lee Young-Shin , Choi Eun-Ju , Kim Yeon-Hee , Park Hyeoun-Ae 
Published: March 2019

Objective
The purpose of this study was to explore the characteristics and predictors of falls in high- and low-risk inpatients in a tertiary hospital in Korea.

Methods
Fallers' data were extracted from quality improvement reports and electronic health records from June 1, 2014, to May 31, 2015. Data on nonfallers matched by the length of hospitalization and medical departments of fallers were extracted from electronic health records. Participants were classified into a high- or a low-risk group based on their Morse Fall Scale score, fall risk–related symptoms, and medications known to increase fall risk. Characteristics of falls and risk factors were analyzed using descriptive statistics and logistic regression analysis, respectively.

Results
In the high-risk group, education, surgery, department, impaired mobility, intravenous catheter placement, use of ambulatory aid, gait disturbance, and some medications were significantly different between the fallers and nonfallers. From these variables, education, operation, department, intravenous catheter placement, gait disturbance, and use of narcotics, vasodilators, antiarrhythmics, and hypnotics were statistically significant factors for falls. In the low-risk group, sex, age, length of hospitalization, surgery, department, diagnosis, and mental status were significantly different between the fallers and nonfallers. From these, sex, age, length of hospitalization, surgery, and liver-digestive diseases were statistically significant factors for falls.

Conclusions
Characteristics and risk factors for falls differed between the risk groups. Fall prevention strategies need to be tailored to the risk groups and fall risk assessment tools need to be revised accordingly.
Predicting Virological Response to HIV Treatment Over Time: A Tool for Settings With Different Definitions of Virological Response
Authors: Revell Andrew D. , Wang Dechao , Perez-Elias Maria-Jesus , Wood Robin , Tempelman Hugo , Clotet Bonaventura , Reiss Peter , van Sighem Ard I. , Alvarez-Uria Gerardo , Nelson Mark , Montaner Julio S. G. , Lane H. Clifford , Larder Brendan A. ,   on behalf of the RDI study group
Published: March 2019

Objective:
Definitions of virological response vary from <50 up to 1000 copies of HIV-RNA/mL. Our previous models estimate the probability of HIV drug combinations reducing the viral load to <50 copies/mL, with no indication of whether higher thresholds of response may be achieved. Here, we describe the development of models that predict absolute viral load over time.

Methods:
Two sets of random forest models were developed using 50,270 treatment change episodes from more than 20 countries. The models estimated viral load at different time points following the introduction of a new regimen from variables including baseline viral load, CD4 count, and treatment history. One set also used genotypes in their predictions. Independent data sets were used for evaluation.

Results:
Both models achieved highly significant correlations between predicted and actual viral load changes (r = 0.67–0.68, mean absolute error of 0.73–0.74 log10 copies/mL). The models produced curves of virological response over time. Using failure definitions of <100, 400, or 1000 copies/mL, but not 50 copies/mL, both models were able to identify alternative regimens they predicted to be effective for the majority of cases where the new regimen prescribed in the clinic failed.

Conclusions:
These models could be useful for selecting the optimum combination therapy for patients requiring a change in therapy in settings using any definition of virological response. They also give an idea of the likely response curve over time. Given that genotypes are not required, these models could be a useful addition to the HIV-TRePS system for those in resource-limited settings.
Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal
Authors: Twahirwa Rwema Jean Olivier , Lyons Carrie E. , Ketende Sosthenes , Bowring Anna L. , Rao Amrita , Comins Carly , Diouf Daouda , Drame Fatou M. , Liestman Benjamin , Coly Karleen , Ndour Cheikh , Turpin Gnilane , Mboup Souleymane , Toure-Kane Coumba , Castor Delivette , Leye-Diouf Nafissatou , Diop-Ndiaye Halimatou , Baral Stefan 
Published: March 2019

Background:
Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal.

Methods:
In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants.

Results:
The respondent driven sampling–adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU.

Conclusions:
Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.
Effect of HIV Subtype and Antiretroviral Therapy on HIV-Associated Neurocognitive Disorder Stage in Rakai, Uganda
Authors: Sacktor Ned , Saylor Deanna , Nakigozi Gertrude , Nakasujja Noeline , Robertson Kevin , Grabowski M. Kate , Kisakye Alice , Batte James , Mayanja Richard , Anok Aggrey , Gray Ronald H. , Wawer Maria J. 
Published: March 2019

Background:
Combination antiretroviral therapy (ART) improves HIV-associated neurocognitive disorder (HAND) stage in the United States where subtype B predominates, but the effect of ART and subtype on HAND stage in individuals in Uganda with subtypes D and A is largely unknown.

Setting:
A community-based cohort of participants residing in Rakai, Uganda.

Methods:
Three hundred ninety-nine initially ART-naive HIV-seropositive (HIV+) individuals were followed up over 2 years. Neurological and neuropsychological tests and functional assessments were used to determine HAND stage. Frequency and predictors of HAND and HIV-associated dementia (HAD) were assessed at baseline and at follow-up after ART initiation in 312 HIV+ individuals. HIV subtype was determined from gag and env sequences.

Results:
At 2-year follow-up, HAD frequency among HIV+ individuals on ART (n = 312) decreased from 13% to 5% (P < 0.001), but the overall frequency of HAND remained unchanged (56%–51%). Subtype D was associated with higher rates of impaired cognition (global deficit score ≥ 0.5) compared with HIV+ individuals with subtype A (55% vs. 24%) (P = 0.008). Factors associated with HAD at baseline were older age, depression, and plasma HIV viral load >100,000 copies/mL. At follow-up, age and depression remained significantly associated with HAD.

Conclusions:
HIV+ individuals on ART in rural Uganda had a significant decrease in the frequency of HAD, but HAND persists after 2 years on ART. The current guideline of immediate ART initiation after HIV diagnosis is likely to greatly reduce HAD in sub-Saharan Africa. Further studies of the effect of HIV subtype and neurocognitive performance are warranted.
Measuring Adherence to Antiretroviral Therapy via Hair Concentrations in India
Authors: Gandhi Monica , Devi Sarita , Bacchetti Peter , Chandy Sara , Heylen Elsa , Phung Nhi , Kuncze Karen , Okochi Hideaki , Kumar Ravi , Kurpad Anura V. , Ekstrand Maria L. 
Published: March 2019

Background:
Objective adherence measures are of increasing interest in antiretroviral treatment (ART) monitoring. Hair ART levels predict virologic suppression, and hair is easy to collect and store. No previous study has examined hair levels in an India-based cohort or laboratory.

Methods:
Small hair samples were collected from HIV-positive participants on either efavirenz (EFV)-based or nevirapine (NVP)-based ART in a South India–based study. Hair samples were split and analyzed for EFV or NVP in the University of California, San Francisco –based Hair Analytical Laboratory and the analytic laboratory of the Division of Nutrition at St. John's Research Institute, Bangalore, India, using liquid chromatography/tandem mass spectrometry. Agreement (using Bland–Altman methods) and rank correlation between the 2 laboratories' hair levels were calculated. Rank correlation between self-reported adherence (SRA) over the previous month using a visual analog scale and hair ART levels was calculated.

Results:
Among 75 participants (38 on NVP; 37 on EFV), the correlation between NVP levels generated by the 2 laboratories was 0.66 (P < 0.0001) and between EFV levels was 0.87 (P < 0.0001). Measurements from St. John's Research Institute were usually within 20% of those from the University of California, San Francisco Hair Analytical Laboratory. SRA was essentially uncorrelated with hair antiretroviral levels for either drug (all correlations < 0.04). Hair levels showed variability in adherence although SRA was >85% in all participants.

Conclusions:
Hair ART levels measured by both an India-based laboratory and the standard U.S.-based laboratory showed generally high agreement and correlation, demonstrating local capacity. As in many other cohorts, hair ART levels and SRA were not well-correlated, likely indicating limitations in self-report and the need for objective adherence monitoring in resource-limited settings.
Factors Associated With Excess Myocardial Infarction Risk in HIV-Infected Adults: A Systematic Review and Meta-analysis
Authors: Rao Shreya G. , Galaviz Karla I. , Gay Hawkins C. , Wei Jingkai , Armstrong Wendy S. , del Rio Carlos , Narayan K.M. Venkat , Ali Mohammed K. 
Published: March 2019

Objectives:To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors.Background:Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies.Methods:We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk.Results:Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5–2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14–1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12–1.27)], dyslipidemia [OR = 1.09 (1.07–1.11)], and smoking [OR = 1.09 (1.05–1.13)] were independently associated with increased AMI risk in HIV-infected adults.Conclusions and Relevance:Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.
Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain
Authors: Merlin Jessica S. , Long Dustin , Becker William C. , Cachay Edward R. , Christopolous Katerina A. , Claborn Kasey R. , Crane Heidi M. , Edelman Eva Jennifer , Lovejoy Travis I. , Mathews William Christopher , Morasco Benjamin J. , Napravnik Sonia , O'Cleirigh Connall , Saag Michael S. , Starrels Joanna L. , Gross Robert , Liebschutz Jane M. 
Published: March 2019

Background:
People living with HIV (PLWH) commonly report marijuana use for chronic pain, although there is limited empirical evidence to support its use. There is hope that marijuana may reduce prescription opioid use. Our objective was to investigate whether marijuana use among PLWH who have chronic pain is associated with changes in pain severity and prescribed opioid use (prescribed opioid initiation and discontinuation).

Methods:
Participants completed self-report measures of chronic pain and marijuana use at an index visit and were followed up for 1 year in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). Self-reported marijuana use was the exposure variable. Outcome variables were changes in pain and initiation or discontinuation of opioids during the study period. The relationship between exposure and outcomes was assessed using generalized linear models for pain and multivariable binary logistic regression models for opioid initiation/discontinuation.

Results:
Of 433 PLWH and chronic pain, 28% reported marijuana use in the past 3 months. Median pain severity at the index visit was 6.3/10 (interquartile range 4.7–8.0). Neither increases nor decreases in marijuana use were associated with changes in pain severity, and marijuana use was not associated with either lower odds of opioid initiation or higher odds of opioid discontinuation.

Conclusions:
We did not find evidence that marijuana use in PLWH is associated with improved pain outcomes or reduced opioid prescribing. This suggests that caution is warranted when counseling PLWH about potential benefits of recreational or medical marijuana.
Brief Report: Kidney Dysfunction Does Not Contribute Significantly to Antiretroviral Therapy Modification in Treatment-Naive PLWH Receiving Initial ART
Authors: Eaton Ellen F. , Tamhane Ashutosh , Davy-Mendez Thibaut , Moore Richard D. , Mathews W. Christopher , Saag Michael S. , Mugavero Michael J. , Wyatt Christina M. , Gutierrez Orlando M. 
Published: March 2019

Background:
Antiretroviral therapy (ART) durability, time to modification or cessation, has declined. The study objective was to determine whether kidney dysfunction is contributing to reduced durability.

Methods:
This retrospective follow-up study of CNICS evaluated treatment-naive PLWH initiating ART between 2007 and 2014. Regimen modification was defined as cessation/modification of any part of the 3-drug ART regimen. We evaluated the role of kidney dysfunction in initial regimen modification as both a mediator and effect measure modifier. Associations of the variables with the ART modification were examined using univariable and multivariable Cox proportional hazard models.

Results:
Of 4515 PLWH included in the analysis, 1967 modified their ART. Of those receiving TDF-based ART (n = 3888), 1580 (41%) modified their regimen compared with 387 (62%) receiving other regimens. Overall, the median eGFR decreased by 5 mL/min/1.73 m2 (quartiles: first = −16, third = 0) from baseline to follow-up. Of the 128 patients with low baseline eGFR (<60 mL/min/1.73 m2), the final eGFR remained low in 73% while it increased to above 60 mL/min/1.73 m2 in 27%. Of the 4387 with normal baseline eGFR, only 135 (3%) had a final eGFR <60 mL/min/1.73 m2. Those with low eGFR at the baseline and/or final visits were more likely to modify ART than others (hazards ratio = 1.75, 95% confidence interval: 1.39 to 2.19, P < 0.001). Relative to other regimens, TDF-based ART was less likely to be modified when accounting for numerous clinical and demographic traits.

Conclusions:
For patients in our study initiated on ART, including TDF-based ART, in the last decade, kidney dysfunction is not a major factor leading to regimen modification.
Brief Report: Real-World Performance and Interobserver Agreement of Urine Lipoarabinomannan in Diagnosing HIV-Associated Tuberculosis in an Emergency Center
Authors: Van Hoving Daniël J. , Lahri Sa'ad , Lategan Hendrick J. , Nicol Mark P. , Maartens Gary , Meintjes Graeme 
Published: March 2019

Background:
The urine lipoarabinomannan (LAM) lateral flow assay is a point-of-care test to diagnose HIV-associated tuberculosis (TB). We assessed the performance of urine LAM in HIV-positive patients presenting to the emergency center and evaluated the interobserver agreement between emergency center physicians and laboratory technologists.

Setting:
A cross-sectional diagnostic study was performed at the emergency center of a district hospital in a high HIV-prevalence community in South Africa.

Methods:
Consecutive HIV-positive adults presenting with ≥1 WHO TB symptom were enrolled over a 16-month period. A urine LAM test was performed at point-of-care by an emergency physician and interpreted independently by 2 physicians. A second test was performed in the laboratory and interpreted independently by 2 laboratory technologists. The reference standard was a positive TB culture or Xpert MTB/RIF test on sputum or appropriate extrapulmonary samples. We compared diagnostic accuracy and reproducibility of urine LAM between point-of-care readers and laboratory readers.

Results:
One thousand three hundred eighty-eight samples (median, 3 samples/participant) were sent for TB microbiology tests in 411 participants; 170 had confirmed TB (41.4%). Point-of-care and laboratory-performed urine LAM had similar sensitivity (41.8% vs 42.0%, P = 1.0) and specificity (90.5% vs 87.5%, P = 0.23). Moderate agreement was found between point-of-care and laboratory testing (κ = 0.62), but there was strong agreement between point-of-care readers (κ = 0.95) and between laboratory readers (κ = 0.94). Positive percent agreement between point-of-care and laboratory readers was 68% and negative percent agreement 92%.

Conclusion:
There is no diagnostic accuracy advantage in laboratory-performed versus point-of-care–performed urine LAM tests in emergency care centers in high-burden settings.