bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occipital and Cerebellar Theta Burst Stimulation for Mal De Debarquement Syndrome
Authors: Cha Yoon-Hee , Gleghorn Diamond , Doudican Benjamin 
Published: August 2019

Background:
Individuals with Mal de Debarquement syndrome (MdDS) experience persistent oscillating vertigo lasting for months or years. Transcranial magnetic stimulation (TMS) can modulate the motion perception of MdDS.

Materials and Methods:
Twenty-six TMS naive individuals received single administrations of continuous theta burst stimulation (cTBS) over the occipital cortex, cerebellar vermis, and lateral cerebellar hemisphere, in randomized order. A 0–100 point Visual Analogue Scale was used to assess acute changes in oscillating vertigo severity after each session. Repeated treatments were given over the target that led to the most acute reduction in symptoms. All treatments were performed with neuronavigation using the participant's own brain MRI. The Dizziness Handicap Inventory (DHI), MdDS Balance Rating Scale (MBRS), and Hospital Anxiety and Depression Scale (HADS) were assessed weekly at four pretreatment and six posttreatment time points.

Results:
Twenty participants chose either the occipital cortex (11) or cerebellar vermis (9) targets as most effective in reducing the oscillating vertigo; one chose lateral cerebellar hemisphere; five chose none. After 10 to 12 sessions of 1,200 pulses over the target of choice, 19 of 25 treatment completers noted ≥ 25% reduction, 12 of 25 ≥50% reduction, and 8 of 25 ≥75% reduction in oscillating vertigo intensity. A one-way repeated measures ANOVA of DHI, MBRS, and HADS scores before and after treatment showed significant reductions in DHI, MBRS, and the HADS Anxiety subscore immediately after treatment with most improvement lasting through posttreatment week 6. There were no significant Depression subscore changes. Participants who had chosen vermis stimulation had comparatively worse balance at baseline than those who had chosen occipital cortex stimulation.

Conclusion:
cTBS over either the occipital cortex or cerebellar vermis is effective in reducing the oscillating vertigo of MdDS acutely and may confer long-term benefits. Sustained improvement requires more frequent treatments.
Evaluating the performance of automated sphygmomanometers using a patient simulator
Authors: Rodrigues Filho Bruno Amado , Farias Rafael Feldmann , Anjos William Escaletti dos , Monteiro Elisabeth Costa 
Published: August 2019

Background and objective:
Automated sphygmomanometers use the oscillometric method to measure blood pressure, which is based on an algorithm that relates the amplitude of the oscillometric waveform pulses and the pressure inside the cuff. Validation uses empirical information from clinical trials conducted by each manufacturer. Consequently, measurement algorithms are not harmonized, being based on distinct arterial waveforms, according to each group of volunteers of the clinical test. In the present study, a patient simulator was used to generate standardized, consistent oscillometric waveform pulses to test the algorithms used in six sphygmomanometers.

Materials and methods:
Six different upper arm and wrist-based automated sphygmomanometers were tested using a patient simulator comprising four different blood pressure levels, Psys/dia (mmHg): 80/50; 120/80; 150/100; 200/150. The devices were also submitted to conformity assessment. The variance of repeatable measurements was also analyzed.

Results:
All tested automated sphygmomanometers complied with metrological requirements, presenting results within the range of ±2 mmHg for static calibration. Systematic discrepancies, greater than 20 mmHg, were observed between sphygmomanometers’ results from upper arm and wrist-based models. Differences reaching 12.8 mmHg in diastolic pressure results were observed among upper arm devices.

Conclusion:
These results may have a clinical impact and indicate the need for a standardized algorithm, with a harmonized approach for validation. Moreover, the algorithm of the wrist-based devices is being affected by the use of the brachial artery waveform as reference for its validation, which also reveals that the current approach needs standardization, especially regarding the use of patient simulators.24299305
Assessment of Millennial Nurses' Job Satisfaction and Professional Practice Environment
Authors: O'Hara Michele A. , Burke Debra , Ditomassi Marianne , Palan Lopez Ruth 
Published: August 2019

OBJECTIVE:
The purpose of this study was to assess the relationship between demographic factors (age, gender, race, ethnicity, work status, and experience), the professional practice environment, and work satisfaction to increase understanding of millennial nurses.

BACKGROUND:
Millennials comprise 30% of the nursing workforce and are more likely to experience burnout, stress, high turnover, and less dedication to their workplace than other counterparts. Understanding how to retain these nurses is important to ensure work satisfaction and high-quality patient outcomes.

METHODS:
This descriptive study was a secondary analysis of data using the Professional Practice Work Environment Inventory survey. Descriptive statistics were used to describe the variables. Descriptive statistics and standard t tests were used.

RESULTS:
Demographics accounted for only 2.6% of the variance in work satisfaction, whereas supportive leadership accounted for nearly 63%.

CONCLUSION:
Findings demonstrate that supportive leadership is the primary factor contributing to millennial nurses' work satisfaction. This suggests that efforts to retain millennial nurses should focus on developing supportive leaders.
Nurse Leader Burnout, Satisfaction, and Work-Life Balance
Authors: Kelly Lesly A. , Lefton Cindy , Fischer Shelly A. 
Published: August 2019

OBJECTIVE
To examine and report burnout, secondary trauma, and compassion satisfaction in acute care nurse leaders through a large mixed-methods research study.

BACKGROUND
Although nurse leaders are removed from daily patient care activities, the pervasive challenges in the work environment create conditions for professional burnout. Nurse leaders must garner compassion satisfaction from different sources, including peer and staff interactions.

METHODS
The Professional Quality of Life scale was given to nurse leaders at 29 hospitals in 1 health system. Sixteen leaders from 2 hospitals participated in qualitative interviews.

RESULTS
Six hundred seventy-two nurse leaders from 29 hospitals reported similar levels of burnout across frontline, midlevel, and director-level leadership. Directors demonstrated higher levels of compassion satisfaction and lower levels of work-life balance. Four themes emerged representing areas of professional life that potentiate and alleviate compassion fatigue.

CONCLUSIONS
All levels of nurse leaders must address the risk of burnout and can do so through individual and organizational resiliency strategies.
Over-utilization of computed tomography angiography in extremity trauma
Authors: Callan Alexandra K. , Bauer Jennifer M. , Mir Hassan R. 
Published: August 2019

Abstract

Objectives:
Widespread availability of computed tomography angiography (CTA) for diagnosing arterial injury in injured extremities has created the possibility of overuse. The objective of this study was to evaluate CTA utilization, indications, ordering personnel, and rate of significant findings for blunt or penetrating extremity trauma at a level I trauma center.

Methods:
We performed a retrospective chart review of 1440 consecutive CTAs of upper and lower extremities from 2010 to 2012 at a large level I trauma center, and included only those done for acute trauma. Data were collected with regard to injury, initial exam, reason given for ordering a CTA, specialty of physician ordering CTA, results, and vascular interventions needed. CTAs were categorized as appropriately ordered based on if there was a documented abnormal distal pulse or ankle-brachial index (ABI). Study indication was classified as inconclusive if no vascular exam was documented or physical exam varied.

Results:
A total of 481 CTAs were performed after blunt or penetrating trauma in the emergency room with 31.0% appropriately indicated, 48.0% without indication, and 21.8% inconclusive. Mechanism of injury was most commonly a gunshot wound (40.3%), followed by motor vehicle accidents (39.5%). Overall, 61.5% of the studies had normal arterial flow and only 15.8% of CTAs required vascular operative intervention. Of the studies appropriately indicated, 76.5% had positive findings, with 43% needing operative intervention compared to the inappropriately indicated studies only 11.6% had positive findings, with 0.4% needing operative intervention (P < .0001).

Conclusion:
CTA for blunt or penetrating trauma at a level I trauma center may be over-utilized. Often, this advanced imaging is ordered prior to orthopaedic evaluation or limb reduction, without exam-based indication, and most do not affect patients’ treatment. From our study, CTA utilization based on more stringent exam findings at our hospital could eliminate 48% of all CTA studies for trauma.
Multidose prophylactic IV antibiotics do not lower the risk of surgical site infection for isolated closed ankle fractures
Authors: Frank Matt , Francis Jeffrey , Bender Mark , Roberts Michael , Watson David , Shah Anjan , Maxson Ben , Infante Anthony , Sanders Roy , Mir Hassan R. 
Published: August 2019

Abstract

Objectives:
To compare the surgical site infection (SSI) rates in ankle fracture patients receiving either single preoperative intravenous (IV) dose (SD) or multidose 24 hours IV postoperative (MD) perioperative IV antibiotic prophylaxis.

Design:
Retrospective case–control study.

Setting:
Level I Trauma Center.

Patients/Participants:
Three hundred fourteen patients with isolated ankle fractures, OTA classifications 44A1-3, 44B1-3, and 44C1-3, who presented to our institution between January 2012 and June 2016.

Intervention:
Operative fracture fixation with either the administration of SD or MD perioperative IV antibiotic prophylaxis.

Main outcome measurements:
SSI.

Results:
Three hundred fourteen patients met all study criteria. There were 99 patients in the SD group with a mean age of 44.2 years and 215 patients in the MD group with a mean age of 47.7 years. The overall SSI rate was 5.1% in the SD group versus 2.8% in the MD group (P = .312). The superficial SSI rate was 2.0% in the SD group versus 1.4% in the MD group not significant (NS). The deep SSI rate was 3.0% in the SD group versus 1.4% in the MD group (NS).

Conclusion:
The SSI rates in isolated closed ankle fractures receiving either SD or MD perioperative IV antibiotic prophylaxis were similar. Further studies should be considered to help guide the standard of care for perioperative IV antibiotic prophylaxis.

Level of evidence:
Therapeutic Level III retrospective case–control study.
The utility of the angled blade plate in hip fracture nonunion treatment
Authors: Lawrenz Joshua M. , Marshall Danielle C. , Patterson Brendan M. 
Published: August 2019

Abstract

Objectives:
We report the radiographic and clinical outcome of patients treated with an angled blade plate (ABP) for hip fracture nonunion. We also provide a review of the literature on joint preserving treatment approaches to hip fracture nonunions.

Design:
Retrospective, case series.

Setting:
Tertiary academic hospital.

Patients/Participants:
Three.

Intervention:
We treated three patients with varied hip fracture nonunions using a joint preserving approach with an ABP.

Main outcome measurements:
Radiographic union and clinical outcome.

Results:
All three patients achieved radiographic union, and were ambulating without pain at final follow-up.

Conclusions:
The treatment approach to hip fracture nonunions is either restorative (joint preserving) or reconstructive (joint replacing). The primary restorative approach to nonunions around the hip consists of revision open reduction and internal fixation with or without bone grafting. Though a variety of implants and treatment techniques have demonstrated excellent success in this setting, revision open reduction and internal fixation with an ABP remains an efficacious implant selection in hip nonunion surgery.
Implementing Data to Care—What Are the Costs for the Health Department?
Authors: Neblett Fanfair Robyn , Shrestha Ram K. , Randall Liisa , Lucas Crystal , Nichols Lisa , Camp Nasima M. , Brady Kathleen , Jenkins Heidi , Altice Fredrick , Villanueva Merceditas , DeMaria Alfred 
Published: August 2019

Background:
The Cooperative Re-Engagement Controlled Trial (CoRECT) is a randomized controlled trial that uses a combined health department-provider data to care (D2C) model to identify out-of-care HIV-infected persons. We present cost data for programmatic aspects of the trial during the start-up period (first 30 days of the study).

Methods:
We used microcosting methods to estimate health department start-up costs. We collected start-up cost data between September 2016 and December 2016; 3 health departments completed a form to capture expenses for the initial 30 days of study implementation; the start date varied by health department. All costs are expressed in 2016 US dollars.

Results:
Among the 3 health departments, the total start-up costs ranged from $14,145 to $26,058. Total start-up labor hours ranged from 224 to 640 hours.

Conclusions:
As D2C expands nationally with cooperative agreement, PS 18-1802 health departments may be able to use a similar analysis to consider the labor, time, and resources needed to implement D2C within their jurisdiction.
Pharmacy Data as an Alternative Data Source for Implementation of a Data to Care Strategy
Authors: Byrd Kathy K. , Camp Nasima M. , Iqbal Kashif , Weidle Paul J. 
Published: August 2019

Background:
Data to Care (D2C) is a strategy for using health departments' HIV surveillance data (HIV viral load and CD4 laboratory reports) to identify and re-engage not-in-care persons with HIV. In the current D2C model, there is a delay in the identification of persons not in care due to the time interval between recommended monitoring tests (ie, every 3–6 months) and the subsequent reporting of these tests to the health department.

Methods:
Pharmacy claims and fulfillment data can be used to identify persons with HIV who have stopped filling antiretroviral therapy and are at risk of falling out of care. Because most antiretrovirals (ARVs) are prescribed as a 30-day supply of medication, these data can be used to identify persons who are not filling their medications on a monthly basis. The use of pharmacy claims data to identify persons not filling ARV prescriptions is an example of how “big data” can be used to conduct a modified D2C model.

Results:
Although a D2C strategy using pharmacy data has not been broadly implemented, a few health departments are implementing demonstration projects using this strategy. As the projects progress, processes and outcomes can be evaluated.

Conclusions:
Tracking ARV refill data can be a more real-time indicator of poor adherence and can help identify HIV-infected persons at risk of falling out of HIV medical care.
Evaluating HIV Surveillance Completeness Along the Continuum of Care: Supplementing Surveillance With Health Center Data to Increase HIV Data to Care Efficiency
Authors: Arey Alyssa L. , Cassidy-Stewart Hope , Kurowski Pamela L. , Hitt Jeffrey C. , Flynn Colin P. 
Published: August 2019

Background:
HIV surveillance is essential to quantifying the impact of the epidemic and shaping HIV programs. The Maryland Department of Health (MDH) historically conducted HIV Data to Care (D2C) activities using surveillance data to identify individuals who were not in HIV care; however, most case investigations concluded that the individuals in question were currently engaged in care. This suggests that delays and gaps in laboratory reporting to HIV surveillance exist and the proportion of HIV-positive Marylanders who are truly in care is underestimated. Therefore, solely relying on surveillance data might not be an efficient method for identifying not in care HIV cases.

Setting:
Through the Partnerships for Care (P4C) project, MDH conducted targeted D2C efforts on HIV patients from 4 health centers.

Methods:
The expanded D2C model that MDH created during P4C integrated clinical data as a secondary data source to enhance the surveillance data used to estimate HIV patient care engagement. MDH matched and compared health center electronic health records with HIV surveillance data to assess completeness of HIV case and laboratory reporting.

Results:
HIV case ascertainment was high (99.9%) for the P4C cohort (N = 927), but differences in estimated care engagement and viral suppression between data sources revealed incomplete laboratory reporting and that patients received care from multiple providers. Analyzing the clinical data leads to the resolution of several reporting gaps, which improved surveillance data quality over time.

Conclusions:
Health departments should validate their HIV surveillance completeness. Triangulating surveillance data with clinical data generated more accurate depictions of care engagement and increased D2C efficiency.
Cross-Jurisdictional Data to Care: Lessons Learned in New York State and Florida
Authors: Hart-Malloy Rachel , Rajulu Deepa T. , Johnson Megan C. , Shrestha Tarak , Spencer Emma C. , Anderson Bridget J. , Tesoriero James M. 
Published: August 2019

Background:
Data-to-Care (D2C) programming is an important strategy in locating and relinking persons with HIV who are not in care (NIC), back to care. However, Health Department D2C programs have found a large proportion of individuals who seem NIC are living outside of their jurisdiction. Jurisdictions are limited in ability to cross-communicate regarding such individuals.

Setting:
Two D2C programs [New York State (NYS) and Florida (FL)] funded through the Partnerships-for-Care Demonstration Project, partnered to conduct a feasibility pilot project to test cross-jurisdictional D2C reciprocity.

Methods:
Jurisdictions made efforts to set up infrastructure for cross-jurisdictional D2C, and NYS worked to identify persons reported in NYS presumed in need of linkage/relinkage efforts in FL using 3 years of NYS D2C program outcomes.

Results:
One hundred forty NYS NIC individuals were presumed to need linkage/relinkage efforts in FL. However, case dispositions for these individuals were not able to be advanced beyond determining HIV care status due to 4 critical challenges: (1) Local legal and regulatory permissibility for sharing identifiable HIV surveillance information outside of a specific jurisdiction varies; (2) Electronic infrastructure in place does not support public health follow-up of individuals who are not within a jurisdiction's HIV surveillance system; (3) An individual's verifiable current residence is not easily attained; and (4) Roles, responsibilities, and case prioritization within each state, and across jurisdictions vary and require clear delineation.

Conclusions:
Although programmatic challenges during this D2C feasibility pilot project were unsurmountable for NYS and FL, potential solutions presented may facilitate broader national cross-jurisdictional D2C reciprocity.
Informing Data to Care: Contacting Persons Sampled for the Medical Monitoring Project
Authors: Beer Linda , Bosh Karin A. , Chowdhury Pranesh P. , Craw Jason , Nyaku Margaret A. , Luna-Gierke Ruth E. , Sanders Catherine C. , Shouse R. Luke 
Published: August 2019

Background:
Data to care (D2C) is a public health strategy that uses HIV surveillance and other data to identify persons in need of HIV medical care. The Medical Monitoring Project (MMP), which uses similar methods to contact and recruit HIV-positive persons, may inform predictors of successful contact for D2C programs.

Setting:
MMP is a Centers for Disease Control and Prevention–funded surveillance system that collects nationally representative data on adults with diagnosed HIV in the United States and Puerto Rico.

Methods:
Using MMP's 2016 data collection cycle, we present contact rates (ie, proportion of HIV-positive persons successfully contacted for MMP) by the age of contact information and age of laboratory test results available from HIV surveillance data.

Results:
Nationally, 27.6% of eligible persons did not have a recorded laboratory test performed within the past year (project area range: 10.8%–54.6%). The national contact rate among persons with laboratory tests older than 1 year was 37.0% (project area range: 16.5%–67.1%). Higher contact rates were found among persons with more recent laboratory tests. Similar results were found by the age of contact information. Nationally, the most common reason for MMP ineligibility was that the person was deceased; the most common reason for not being contacted was lack of correct contact information.

Conclusions:
MMP findings suggest that D2C programs would benefit from efforts to improve the quality of HIV surveillance data and local surveillance practices—in particular, death ascertainment, the completeness of laboratory reporting, and the routine updating of contact information. Strengthening collaboration and integration with existing MMP programs may be beneficial.
Using HIV Surveillance and Clinic Data to Optimize Data to Care Efforts in Community Health Centers in Massachusetts: The Massachusetts Partnerships for Care Project
Authors: Kunzweiler Colin , Kishore Nina , John Betsey , Roosevelt Kathleen , Lewis Sophie , Klevens R. Monina , Morrison Monica , Randall Liisa M. , DeMaria Alfred 
Published: August 2019

Background:
We describe Data to Care processes of the Massachusetts Partnerships for Care (MA P4C) project and identify factors associated with engagement, retention, and viral suppression outcomes.

Methods:
The Massachusetts Department of Public Health and participating community health centers generated lists of patients not in care based on a temporal gap in laboratory results, missed clinic visits, and provider concern regarding engagement. The Massachusetts Department of Public Health and community health centers reviewed the lists monthly and identified out-of-care patients in need of linkage or re-engagement.

Results:
Between October 2015 and June 2017, of 1418 patients potentially out of care, 83 (5.9%) were confirmed to be out of care. Forty-four of those out of care (53%) received services or were re-engaged in care within 90 days, 45 (54%) were retained in care, and 40 (48%) were virally suppressed. The odds of being re-engaged or retained were lower for patients who were 6 months out-of-care (vs. those newly diagnosed). Patients with an AIDS-defining condition had increased odds of retention and viral suppression. The odds of viral suppression were reduced for patients who reported exposure categories other than men who have sex with men and were younger (30–49 years vs. ≥50 years).

Conclusions:
Although rates of re-engagement, retention, and viral suppression were low, the MA P4C Data to Care procedures provided a means for accurate ascertainment of out-of-care status. Future Data to Care programs should investigate the factors that contribute to disengagement from care.