bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus
Authors: Njei Basile , Esserman Denise , Krishnan Supriya , Ohl Michael , Tate Janet P. , Hauser Ronald G. , Taddei Tamar , Lim Joseph , Justice Amy C. 
Published: February 2019

Background:
Veterans with hepatitis C virus (HCV) infection may face geographic obstacles to obtaining treatment.

Objective:
We studied the influence of region and rural versus urban residence on receipt of direct-acting antiretroviral (DAA) medications for HCV.

Subjects:
Veterans receiving care within Veterans Affairs Healthcare System born between 1945 and 1965.

Research Design:
This is a observational study using national electronic health record data.

Measures:
Receipt of DAAs was defined as ≥1 filled prescription from January 1, 2014 to December 31, 2016. Region (South, Northeast, Midwest, and West) and residence (urban, rural-micropolitan, small rural towns, and isolated rural towns) variables were created using residential zone improvement plan codes and rural-urban commuting area (RUCA) codes. Multivariable models were adjusted for age, race, sex, severity of liver disease, comorbidities, and prior treatment experience.

Results:
Among 166,353 eligible patients 64,854 received, DAAs. Variation by rural-urban residence depended on region. In unadjusted analyses, receipt varied by rural-urban designations within Midwest, and West regions (P<0.05) but did not vary within the South (P=0.12). Southern rural small town had the lowest incidence of DAA receipt (40.1%), whereas the incidence was 52.9% in Midwestern isolated rural towns. In adjusted logistic analyses, compared with southern urban residents (the largest single group), southern rural small town residents had the lowest odds ratio, 0.85 (95% confidence interval, 0.75–0.93), and Midwestern residents from isolated and small rural towns had the highest odds (odds ratio, both 1.27) to receive treatment.

Conclusions:
Substantial geographic variation exists in receipt of curative HCV treatment. Efforts are needed to provide more equitable access to DAAs.
Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services
Authors: Haffajee Rebecca L. , Mello Michelle M. , Zhang Fang , Busch Alisa B. , Zaslavsky Alan M. , Wharam J. Frank 
Published: February 2019

Background:Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act.Objectives:To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers.Research Design:Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group.Subjects:Commercially insured enrollees aged 18–64 with a mental health disorder drawn from 24 states where self-insured employers were newly subject to federal parity in 2010 (exposure group), but small employers were exempt before-and-after parity (comparison group). A total of 11,226 exposure group members were propensity score matched (1:1) to comparison group members, all of whom were continuously enrolled from 1 year prepolicy to 1–2 years postpolicy.Measures:Mental health outpatient visits, out-of-pocket spending for these visits, emergency department visits, and hospitalizations.Results:Relative to comparison group members, mean out-of-pocket spending per outpatient mental health visit declined among exposure enrollees by $0.74 (1.40, 0.07) and $2.03 (3.17, 0.89) in years 1 and 2 after the policy, respectively. Corresponding annual mental health visits increased by 0.31 (0.12, 0.51) and 0.59 (0.37, 0.81) per enrollee. Difference-in-difference changes were larger for the highest baseline quartile mental health care utilizers [year 2: 0.76 visits per enrollee (0.14, 1.38); relative increase 10.07%] and spenders [year 2: $−2.28 (−3.76, −0.79); relative reduction 5.91%]. There were no significant difference-in-differences changes in emergency department visits or hospitalizations.Conclusions:In 24 states, commercially insured high utilizers of mental health services experienced modest increases in outpatient mental health visits 2 years postparity.
Contribution of HCAHPS Specific Care Experiences to Global Ratings Varies Across 7 Countries
Authors: Orindi Benedict O. , Lesaffre Emmanuel , Quintero Adrian , Sermeus Walter , Bruyneel Luk 
Published: February 2019

Background:Given the increased international interest in improvement strategies for patient experiences with care, it is important to understand whether the same specific care experiences affect global ratings across countries. Moreover, reporting of these global ratings currently substantially varies in both research and public reporting.Objectives:The objectives of this study were to examine the differential magnitude of associations between Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) specific care experiences and global ratings, and to explore implications for reporting these global ratings.Methods:HCAHPS data were collected from 11,289 patients across 7 European countries. We studied the association between 11 experience items and 2 global ratings (0–10 hospital rating, hospital recommendation) using multilevel ordered logistic regression analysis. Using interaction terms, we examined consistency of these associations across countries. Assuming homogeneous use and interpretations of response categories of these specific experiences across patients within and between countries, we investigated what the associations between specific experiences and global ratings imply for reporting global ratings across countries.Results:All specific experiences were associated with both global ratings. “Being talked to about care after leaving the hospital” showed the strongest association. There were relatively little differential effects across countries. A reporting strategy with different cutpoints across countries might provide a more equitable comparison of global ratings.Conclusions:Our findings highlight a differential contribution of HCAHPS specific experiences to overall ratings across countries. Research and public reporting may consider examining in more detail within and across populations global rating cutpoints that represent the same true level of positive patient experiences.
Treatment of Recurrent Refractory Pediatric Pre-B Acute Lymphoblastic Leukemia Using Inotuzumab Ozogamicin Monotherapy Resulting in CD22 Antigen Expression Loss as a Mechanism of Therapy Resistance
Authors: Paul Megan R. , Wong Victor , Aristizabal Paula , Kuo Dennis J. 
Published: February 2019

Background:
Inotuzumab ozogamicin is a novel antibody-drug conjugate that targets CD22, a common antigen on pre-B acute lymphoblastic leukemia cells.

Observations:
A 7-year-old boy with pre-B acute lymphoblastic leukemia in his second relapse was given 2 cycles of inotuzumab ozogamicin. He responded morphologically with a negative bone marrow evaluation. However, he relapsed in cycle 3 of therapy with a loss of CD22 expression on his lymphoblast population.

Conclusion:
To our knowledge, this is the first published case of CD22 expression loss as a mechanism of therapy resistance for inotuzumab ozogamicin.
Oral Sucrose Versus Breastfeeding in Managing Infants' Immunization-Related Pain
Authors: Gad Rasha F. , Dowling Donna A. , Abusaad Fawzia E. , Bassiouny Mohamed R. , Abd El Aziz Magda A. 
Published: February 2019

ABSTRACT

Background:
Treating pain during immunization should be a part of pediatric primary healthcare around the world, as untreated pain in children has short- and long-term consequences. Few studies of pharmacologic and nonpharmacologic methods of pain relief during immunization have been conducted in low- and middle-income countries. Finding pain-mitigating interventions that are low-cost, effective, and feasible across all settings, including with low-resourced settings could improve primary healthcare.

Purpose:
To evaluate the effectiveness of oral sucrose versus breastfeeding as methods of pain management during immunization of infants through 6 months of age.

Methods:
A randomized controlled experimental design was used; 120 infants were randomly assigned to control, sucrose, or breastfeeding groups. Data were collected in an Egyptian primary health center. Outcome measures including pain (as per the FLACC pain scale), crying time, and heart rate were measured at three time points.

Results:
There were significant differences in pain scores and crying duration during and after immunization (p < .001) for the breastfeeding group compared with the sucrose and control groups.

Implications for Practice:
Health staff and parents need education and support in use of breastfeeding for pain management during immunization. More studies are needed to evaluate effectiveness of breastfeeding versus other pain management methods for managing infants' immunization-related pain.
Breastfeeding Guidance for Orthodox Jewish Families When Newborns Require Special Care and Continued Hospitalization
Authors: Candelaria Laura M. , Bressler Toby , Spatz Diane L. 
Published: February 2019

Abstract
There is a growing Orthodox Jewish population in the United States and Canada. Many Orthodox Jewish families have a large number of children and choose to breastfeed. The Orthodox Jew observes Jewish laws and customs literally as dictated by the Torah. Orthodox Jews consult a rabbi or posek before making most major life decisions, including matters related to breastfeeding to ensure adherence to religious law. Cultural practices applicable to the Orthodox Jewish family related to the provision of human milk and breastfeeding when a sick newborn may require special care and continued hospitalization after the mother has been discharged are presented. Guidelines for preconception lactation counseling for families are provided to tailor nursing care to meet the individual needs of each Orthodox Jewish infant and family. Special considerations related to pumping schedule, use of mechanisms such as timers for breast pumps, and discussions with religious leader about the saving of colostrum and/or milk when an infant is critically ill will be addressed. To provide culturally sensitive and appropriate counseling related to the provision of human milk and breastfeeding, nurses need to be culturally aware of the specific needs of the Orthodox Jewish family. Clinical implications and suggestions are provided.
How the DSM Is Used in Clinical Practice
Authors: First Michael B. , Erlich Matthew D. , Adler David A. , Leong Shirley , Dixon Lisa B. , Oslin David W. , Goldman Beth , Koh Steve , Levine Bruce , Berlant Jeffrey L. , Siris Samuel G. 
Published: February 2019

Abstract
Despite widespread use, how clinicians use the DSM in psychiatric practice is not well understood. Recognizing public and professional attitudes toward the DSM are integral to future DSM development, to assess a commonly held assumption such as that the DSM is used primarily for coding, and to assess its clinical utility. A convenience sample of Psychiatric Times readers was surveyed to assess the DSM's use in clinical practice. A total of 394 behavioral health care practitioners fully completed the online survey. Results suggest that the DSM, beyond administrative and billing use, is used for communication with health care providers, for teaching diagnoses to trainees, and, importantly, as an educational tool to inform patients and caregivers alike.
Extubation Failure Rates After Pediatric Cardiac Surgery Vary Across Hospitals*
Authors: Rooney Sydney R. , Donohue Janet E. , Bush Lauren B. , Zhang Wenying , Banerjee Mousumi , Pasquali Sara K. , Gaies Michael G. 
Published: February 2019

Objectives:
Many hospitals aim to extubate children early after cardiac surgery, yet it remains unclear how this practice associates with extubation failure. We evaluated adjusted extubation failure rates and duration of postoperative mechanical ventilation across hospitals and assessed cardiac ICU organizational factors associated with extubation failure.

Design:
Secondary analysis of the Pediatric Cardiac Critical Care Consortium clinical registry.

Setting:
Pediatric Cardiac Critical Care Consortium cardiac ICUs.

Patients:
Patients with qualifying index surgical procedures from August 2014 to June 2017.

Interventions:
None.

Measurements and Main Results:
We modeled hospital-level adjusted extubation failure rates using multivariable logistic regression. A previously validated Pediatric Cardiac Critical Care Consortium model was used to calculate adjusted postoperative mechanical ventilation. Observed-to-expected ratios for both metrics were derived for each hospital to assess performance. Hierarchical logistic regression was used to assess the association between cardiac ICU factors and extubation failure. Overall, 16,052 surgical hospitalizations were analyzed. Predictors of extubation failure (p < 0.05 in final case-mix adjustment model) included younger age, underweight, greater surgical complexity, airway anomaly, chromosomal anomaly/syndrome, longer cardiopulmonary bypass time, and other preoperative comorbidities. Three hospitals were better-than-expected outliers for extubation failure (95% CI around observed-to-expected < 1), and three hospitals were worse-than-expected (95% CI around observed-to-expected > 1). Two hospitals were better-than-expected outliers for both extubation failure and postoperative mechanical ventilation, and three were worse-than-expected for both. No hospital was an outlier in opposite directions. Greater nursing hours per patient day and percent nursing staff with critical care certification were associated with lower odds of extubation failure. Cardiac ICU factors such as fewer inexperienced nurses, greater percent critical care trained attendings, cardiac ICU–dedicated respiratory therapists, and fewer patients per cardiac ICU attending were not associated with lower odds of extubation failure.

Conclusions:
We saw no evidence that hospitals trade higher extubation failure rates for shorter duration of postoperative mechanical ventilation after pediatric cardiac surgery. Increasing specialized cardiac ICU nursing hours per patient day may achieve better extubation outcomes and mitigate the impact of inexperienced nurses.
Determining Interrater Reliability of the Cornell Assessment of Pediatric Delirium Screening Tool Among PICU Nurses
Authors: Valdivia Hector R. , Carlin Kristen E. 
Published: February 2019

Objectives:
To determine the interrater reliability of the Cornell Assessment of Pediatric Delirium Screening Tool amount PICU nurses.

Design:
The design was setup as a cross-sectional study and conducted over the course of a year.

Setting:
This study setting was a PICU and a pediatric cardiac ICU at Seattle Children’s Hospital, a tertiary freestanding university-affiliated hospital in Seattle, Washington.

Patients:
A total sample of 108 patients were included in this study. Patients were selected using a convenience sample. Inclusion in this study involved all patients eligible for a Cornell Assessment of Pediatric Delirium assessment, reflecting practice standards. Exclusion criteria included patients who had a Richmond Agitation and Sedation Score of (–4) or (–5), based on the Cornell Assessment of Pediatric Delirium procedure. There were 113 patients screened, but five were excluded from the final sample size due to missing information.

Interventions:
The research nurse would screen the patient using the Cornell Assessment of Pediatric Delirium during the 12:00 noon hour, which coincided with the clinical nurse Cornell Assessment of Pediatric Delirium assessment. The clinical and research nurse were kept blind to each other’s assessment. Scores were then analyzed to determine the kappa coefficient.

Measurements and Main Results:
The kappa coefficient between nurses was found to be 0.60 (95% CI, 0.44–0.76), indicating moderate agreement. Age was found to have a higher association with agreement. In children 2 years old or greater, the kappa coefficient was 0.85 (95% CI, 0.68–1.00). Children whose raters did not agree on scoring were more likely to be younger than those who had raters that agreed (p < 0.01).

Conclusions:
Evaluating the interrater reliability of clinical tool, such as the Cornell Assessment of Pediatric Delirium, may be important to more accurately identify patients at high risk of delirium in a PICU or pediatric cardiac ICU. The evaluation of the tool’s performance in practice may also be helpful to ensure ongoing consistency among the clinical nurses that complete these assessments on a daily basis.
Traumatic Retroclival Epidural Hematoma
Authors: Samanci Yavuz , Baskurt Ismet , Celik Suat Erol 
Published: February 2019

Abstract
Retroclival epidural hematomas are particularly rare conditions that are frequently the result of high-energy, hyperflexion-hyperextension injuries in pediatric patients. We present the case of a 7-year-old previously healthy girl with traumatic retroclival epidural hematoma after a fall from a swing. She presented with a Glasgow Coma Scale score of 15 with severe neck pain and limitation of cervical movements in all directions. Radiological examination revealed retroclival epidural hematoma, and the patient was managed conservatively with good recovery. Although conservative management leads to good recovery in most cases, retroclival epidural hematomas should always be kept in mind regardless of the severity of trauma.
Value of Three-Dimensional Ultrasound in Differentiating Malignant From Benign Breast Tumors
Authors: Bin Lian , Huihui Yang , Weiping Yang , Changyuan Wei , Qinghong Qin , Weiyu Meng 
Published: February 2019

Abstract
Currently, the aim of differentiating malignant from benign breast tumors and diagnosing early breast cancer is more accurately fulfilled with the addition of ultrasound (US) scans. Some studies have shown that three-dimensional (3D) imaging opens a new diagnostic window because of a better and more detailed impression of the spatial arrangement of focal breast masses. Therefore, we carried out this study to assess the efficacy of 3D-US diagnostic techniques for the detection of breast cancer using systemic analyses. We searched the MEDLINE, Pubmed, EMBASE, and Cochrane Library for using 3D-US for the diagnosis of breast cancer. The terms used were “three-dimensional ultrasound”, “breast neoplasms”, “sensitivity and specificity”, and “accuracy”. Patients were adults. The quality of the studies was checked according to Quality Assessment of Diagnostic Accuracy Studies criteria. We calculated the diagnostic accuracy rates and developed a meta-analysis to synthesize the results. Twelve studies of diagnostic tests were selected, which were of moderate to high quality. The pooled sensitivity was 0.923 (95% confidence interval [CI], 0.896–0.945), and the pooled specificity was 0.872 (95% CI, 0.849–0.893). The meta-analysis detected a threshold effect and heterogeneity between studies. The pooled positive likelihood ratio was 6.965 (95% CI, 5.242–9.255), the negative likelihood ratio was 0.106 (95% CI, 0.079–0.142), and the diagnostic odds ratio was 84.239 (95% CI, 52.237–135.84). This meta-analysis indicates that 3D-US has acceptable diagnostic accuracy rates in differentiating malignant from benign breast tumors.
A Preliminary Comparative Study of Young's Modulus Versus Shear Modulus in the Diagnosis of Breast Cancer
Authors: Wu Huaiyu , Liang Weiyu , Jiao Yang , Song Hong , Peng Quanzhou , Luo Hui , Zhang Yuanji , Xu Jinfeng , Dong Fajin 
Published: February 2019

Purpose
The purpose of this study was to compare the diagnostic value of Young's modulus (E) and shear modulus (G) in the differential diagnosis of benign and malignant breast masses using sound touch elastography (STE) and to explore the relationship between G and E in breast lesions.

Methods
A total of 96 consecutive women with 110 pathologically confirmed breast masses were included. All masses were detected by conventional and STE ultrasound. E
mean, E
max, E
min, E
SD, G
mean, G
max, G
min, and G
SD were determined and evaluated for evidence of significant differences between benign and malignant breast masses. Receiver operator characteristics were used to compare the diagnostic efficacy of E and G and to determine the G cutoff value that would aid in the differential diagnosis of breast cancer.

Results

E
mean, E
max, E
SD, G
mean, G
max, and G
SD in cases of malignant breast masses were significantly higher than those in cases of benign masses (P < 0.05). There was no significant difference between E
min and G
min (P = 0.565). In applying the E
mean, E
max, E
SD, G
mean, G
max, and G
SD to the receiver operator characteristics: (1) the area under the curve (AUC) of G
mean and G
max is greater than the AUC of E
mean and E
max, and the AUC of E
SD is equal to the AUC of G
SD. (2) The sensitivity and specificity were highest when the G
mean was 10.14 kPa. They were 84.1% and 80.3% respectively. (3) The sensitivity and specificity were highest when the G
max was 52.20 kPa. They were 88.6% and 87.9% respectively.

Conclusions
These preliminary results of STE evaluation of breast masses suggest that the diagnostic value of G is greater than E. Furthermore, STE is a valuable tool in the differential diagnosis of breast lesions.
Correlation Between Mandible and External Ear in Patients with Treacher-Collins Syndrome
Authors: Ma Xiaoyang , Xie Fang , Zhang Chao , Xu Jiajie , Lu Jianjian , Teng Li 
Published: February 2019

Background:
Patients with Treacher-Collins syndrome (TCS) are frequently affected by congenital ear deformities. The external ear in patients with TCS tends to have both abnormal morphology and reduced overall volume. Previous studies considered a correlation exists between TCS mandibular skeletal features and external ear volume. The purpose of this study was to assess the external ear volume in patients with TCS 3-dimensionally. Furthermore, this study evaluated the relationship between mandibular morphology, external ear profile, and external ear volume.

Methods:
A total of 36 nonoperated patients with TCS were compared to 39 age- and gender-matched normal controls. Morphologic variables of the mandible and the external ear were compared between TCS group and controls by 3-dimensional cephalometrics. The external ear volume and morphologic variables were analyzed with independent sample T-tests and Pearson correlation coefficient analyses (level of evidence: level III).

Results:
The external ear volume was reduced by approximately 50% in patients with TCS compared to controls (P < 0.001). External ear length and width were positively correlated with external ear volume (length: r = 0.809, P < 0.001 on left and r = 0.732, P < 0.001 on right; width: r = 0.518, P = 0.001 on left and r = 0.447, P < 0.010 on right). A negative correlation of right ear inclination angle and external ear volume was shown in patients with TCS (r = −0.396, P = 0.027). However, no correlation was shown for the mandibular anatomic variables.

Conclusions:
Three-dimensional analysis confirmed that external ear volume is significantly reduced in patients with TCS. The external ear dimensions and orientation correlated significantly with ear volume. There was no intrinsic association between the severity of mandibular deformity and external ear volume.
Basal Ganglionic Germinoma With Syncytiotrophoblastic Giant Cells Mimicking a Growing Hematoma
Authors: Yan Jihong , Zhang Yongna , Yang Yucheng , Yuan Xunhui , Xiao Hang , Niu Jianyi , Gu Yinghao 
Published: February 2019

Abstract
Basal ganglionic germinoma (BGG) with syncytiotrophoblastic giant cells (STGC) is a rare type of ectopic germ cell tumors with mild elevation of human chorionic gonadotropin level. Intratumoral hemorrhage is not uncommon for BGG, but presenting with repeated hemorrhage is very rare. Herein, we described an extremely rare case of BGG with STGC mimicking a growing hematoma. Furthermore, the characteristics, treatment, and prognosis of BGG with STGC were investigated and reviewed.