bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploration of Functional Limitation Codes for Outpatient Physical Therapy in the Medicare Population: A Retrospective Cohort Study
Authors: Warren Meghan , Smith Heather L 
Published: August 2018

Abstract

Background
The Centers for Medicare & Medicaid Services (CMS) introduced functional limitation reporting (FLR) to capture patient progress in functional status in outpatient rehabilitation settings. FLR along with the severity modifier (SM) measure the effectiveness of the rehabilitation services at the physical therapist evaluation (initial examination [IE]) after 10 days of therapy and at discharge.

Objective
The objective of this study was to explore the completeness of FLR codes and describe changes in SMs at scheduled checkpoints for patients receiving outpatient physical therapy.

Design
The design was a retrospective cohort descriptive study.

Methods
A 5% random sample of 2014 Part B fee-for-service Medicare claims for outpatient physical therapy was used. FLR codes with SMs were analyzed at required periods. The number of claims with FLR codes and SMs was calculated to describe the completeness for each period. Planned changes in SMs at the physical therapist IE (current status and projected goal status) and differences in SMs from the physical therapist IE (current status) to discharge (discharge status) were calculated.

Results
For 114,588 beneficiaries, 166,572 physical therapist IE and 130,117 discharge claims were analyzed. Completion was greater than 90% for current status and projected goal status FLR codes at the physical therapist IE but was markedly lower for interim and discharge reporting (≤ 50% for all). More than 75% of claims had planned improvements in SMs at the physical therapist IE (projected goal status − current status), with variations by specific FLR codes. For the episodes with FLR codes at the physical therapist IE and discharge, improvements were reported in more than 2 of 3 episodes.

Limitations
Limitations for these analyses include a missing discharge claim on many outpatient physical therapy episodes and potential coding errors with Medicare claims.

Conclusions
Except for the physical therapist IE, FLR codes were not submitted consistent with regulations. Most physical therapy episodes showed improvements in FLR SMs from the physical therapist IE and discharge, although the low completion rate limited interpretation. Changes to the FLR program are warranted to understand whether changes in SMs correspond to changes in a patient's function.
Health Workers' Knowledge and Perceptions on Dementia in Skilled Nursing Homes: A Pilot Implementation of Teepa Snow's Positive Approach to Care Certification Course
Authors: Ehlman Mary C. , Nimkar Swateja , Nolan Beth A. D. , Thomas Pamela , Caballero Carlos E. , Snow Teepa 
Published: August 2018

Introduction:
A knowledge gap on caring for people with dementia exists among health workers employed in skilled nursing facilities. This article reports on knowledge gained and perceptions changed among 24 skilled nursing facility health workers who completed Teepa Snow's innovative Positive Approach to Care Certification course as a regional initiative.

Methods:
This pilot study used a quasi-experiment with a one-group pretest-posttest design to assess the dementia knowledge and perceptions of health workers who participated in the course. Paired responses (n = 22) for the 54-item dementia knowledge and training/coaching perceptions survey were compared using the McNemar test, Paired t test, and Wilcoxon signed-rank test to analyze the improvement in knowledge and perceptions of dementia.

Results:
Significant knowledge gain was found among health workers after completing the program (t(21) = −7.46, P < .001). Statistical differences (P < .05) were present in eight knowledge items (ie, working memory, mental health, temporal lobe, “sapphire”, “space and awareness”, personal space, binocular vision, and hippocampus) and four perception areas (ie, approaching, understanding, calming, and instructing) about dementia. Significant changes were also found in four areas of health workers' perceptions about dementia (P < .05).

Discussion:
The certification course can improve knowledge and facilitate perceptual change on dementia. Implementing this program as a novel regional initiative has robust potential in ensuring continuing workforce development in health care settings challenged with ever-changing people living with dementia needs and high staff turnover.
Validation of Multisource Feedback in Assessing Medical Performance: A Systematic Review
Authors: Stevens Sebastian , Read James , Baines Rebecca , Chatterjee Arunangsu , Archer Julian 
Published: August 2018

Introduction:
Over the past 10 years, a number of systematic reviews have evaluated the validity of multisource feedback (MSF) to assess and quality-assure medical practice. The purpose of this study is to synthesize the results from existing reviews to provide a holistic overview of the validity evidence.

Methods:
This review identified eight systematic reviews evaluating the validity of MSF published between January 2006 and October 2016. Using a standardized data extraction form, two independent reviewers extracted study characteristics. A framework of validation developed by the American Psychological Association was used to appraise the validity evidence within each systematic review.

Results:
In terms of validity evidence, each of the eight reviews demonstrated evidence across at least one domain of the American Psychological Association's validity framework. Evidence of assessment validity within the domains of “internal structure” and “relationship to other variables” has been well established. However, the domains of content validity (ie, ensuring that MSF tools measure what they are intended to measure); consequential validity (ie, evidence of the intended or unintended consequences MSF assessments may have on participants or wider society), and response process validity (ie, the process of standardization and quality control in the delivery and completion of assessments) remain limited.

Discussion:
Evidence for the validity of MSF has, across a number of domains, been well established. However, the size and quality of the existing evidence remains variable. To determine the extent to which MSF is considered a valid instrument to assess medical performance, future research is required to determine the following: (1) how best to design and deliver MSF assessments that address the identified limitations of existing tools and (2) how to ensure that involvement within MSF supports positive changes in practice. Such research is integral if MSF is to continue to inform medical performance and subsequent improvements in the quality and safety of patient care.
Validation of a Nomogram for Achieving Target Trough Concentration of Vancomycin: Accuracy in Patients With Augmented Renal Function
Authors: Ishii Hidetoshi , Hirai Keita , Sugiyama Kyohei , Nakatani Eiji , Kimura Midori , Itoh Kunihiko 
Published: August 2018

Background:
Adjustment of initial vancomycin (VCM) dosage has been recommended on the basis of the renal function nomogram in therapeutic drug monitoring guidelines in Japan. However, this nomogram has not been clinically validated, and few studies have focused on its usefulness in patients with risk of augmented renal function. Therefore, this study aimed to evaluate the validity of the VCM nomogram and the association between patient conditions related to augmented renal function and its accuracy.

Methods:
In this retrospective study, we screened data of 398 patients who received VCM and had estimated glomerular filtration rates ≥30 mL·min−1·1.73 m−2. Patients who met nomogram dosing criteria were categorized into a nomogram group, and the associations of age, renal function, and individual conditions such as febrile neutropenia, solid tumor, blood cancer, and brain injury with subtherapeutic concentrations (<10.0 mcg/mL) of VCM were evaluated.

Results:
In total, 177 patients were categorized into the nomogram group, and 83 (47%), 81 (46%), and 13 patients (7%) had VCM trough concentrations of 10–20, <10, and >20 mcg/mL, respectively. Age <50 years was only significantly associated with subtherapeutic trough concentrations. Specific conditions of patients such as febrile neutropenia, solid tumor, and blood cancer were associated with elevated VCM clearance; however, there was no decline in trough VCM concentrations regardless of the presence of the specific conditions.

Conclusions:
The Japanese VCM dosing nomogram was effective in minimizing the number of instances of supratherapeutic VCM serum concentrations; however, it lacked accuracy in achieving target trough concentrations. The accuracy of the nomogram could be enhanced by categorizing patients according to age. Nevertheless, this study provides novel evidence of the usefulness of this nomogram in avoiding subtherapeutic concentrations of VCM in patients with risk factors for augmented renal clearance.
Addressing the Fentanyl Analogue Epidemic by Multiplex UHPLC-MS/MS Analysis of Whole Blood
Authors: Bergh Marianne Skov-Skov , Bogen Inger Lise , Wilson Steven Ray , Øiestad Åse Marit Leere 
Published: August 2018

Background:
Fentanyl and fentanyl analogues (fentanyls) are very potent opioids posing a serious threat to the public health. Thousands of overdose deaths across the world are caused by fentanyls, and the numbers are increasing. Rapid mapping of current trends in opioid abuse is necessary to accelerate preventive measures. To ensure this, there is a need for sensitive targeted multiplex MS/MS methods to pinpoint drugs of abuse. We present a fully validated UHPLC-MS/MS method for the determination of 26 fentanyls, including several structural isomers, and the opioid antagonist naloxone in human whole blood.

Methods:
Blood samples were prepared by liquid–liquid extraction with ethyl acetate and heptane. The fentanyls were separated with UHPLC, using a Kinetex biphenyl column (2.1 × 100 mm, 1.7 µm; Phenomenex, Verløse, Denmark) with an acidic mobile phase. Quantification was performed by MS/MS. The method was validated according to SWGTOX guidelines.

Results:
The developed method could successfully separate all 27 analytes, including 7 isomers, and was validated according to SWGTOX guidelines with very low limits of quantification (4–20 pg/mL). The applicability of the method was demonstrated by determination of fentanyls in postmortem blood samples from 2 cases.

Conclusions:
A selective, highly sensitive, and robust method for determination of a large panel of fentanyls and naloxone in blood was developed and validated. Naloxone was included to monitor use and efficacy of the opioid antidote in cases of fentanyl overdoses. The method demonstrated good ability to separate structural isomers, which is important to differentiate between the numerous available fentanyls with variable potency, toxicity, and legal status. The developed method can be used to identify fentanyls on the drug market to help combat the fentanyl crisis.
The Nutritional and Social Contexts of Celiac Disease in Women: A Qualitative Study
Authors: RODRGUEZ-ALMAGRO Julián , RODRGUEZ-ALMAGRO David , SOLANO-RUIZ MCarmen , SILES-GONZLEZ José , HERNNDEZ-MARTINEZ Antonio 
Published: August 2018

ABSTRACT

Background:
Previous studies have confirmed that women who are diagnosed with celiac disease report a lower quality of life than men who are diagnosed with the same illness.

Purpose:
This article describes the life experiences of women with celiac disease, especially those who adhere to a lifelong gluten-free diet.

Methods:
A phenomenological design based on the Giorgi method was used. Twenty-two women who were diagnosed with celiac disease and were between 16 and 75 years old completed the semistructured interviews.

Results:
The results showed that celiac disease has differing effects on the lives of women sufferers. The general feeling of being a woman with celiac disease was described as an effort toward achieving a normalized life. Four categories emerged from the results: feelings at diagnosis, limitations in daily life, social perceptions of the illness, and personal meanings of celiac disease.

Conclusions/Implications for Practice:
This study shows that celiac disease and its treatment reduce mental and social quality of life in women. Organizations and public institutions should carry out public awareness campaigns targeting celiac disease and promote quality of life in sufferers of celiac disease in general.
Differences in risk factor–colorectal adenoma associations according to non-steroidal anti-inflammatory drug use
Authors: Mujtaba Sobia , Bostick Roberd M. 
Published: August 2018

Objective
Because multiple observational studies and large, randomized controlled trials indicate that NSAIDs strongly reduce the risk of colorectal neoplasms, we investigated whether NSAID use masks associations of various other risk factors with colorectal neoplasms.

Materials and methods
Using pooled data from three case–control studies of incident, sporadic colorectal adenoma (pooled n=789 cases, 2035 polyp-free controls), using multivariable logistic regression, we investigated various risk factor–colorectal adenoma associations stratified by NSAID use.

Results
Example multivariable-adjusted odds ratios [95% confidence intervals (CI)] for those in the highest relative to the lowest quartiles of exposure, by regular nonaspirin NSAID nonuse/use, respectively, were 1.57 (95% CI: 0.96–2.55) versus 1.14 (95% CI: 0.37, 3.49) for total fat, 1.37 (95% CI: 0.86–2.18) versus 0.70 (95% CI: 0.23–2.25) for saturated fat, 0.93 (95% CI: 0.68–1.28) versus 1.30 (95% CI: 0.61–2.75) for calcium, 0.89 (95% CI: 0.64–1.23) versus 1.38 (95% CI: 0.65–2.94) for total fruits and vegetables, and 0.85 (95% CI: 0.65–1.11) versus 0.94 (95% CI: 0.52–1.71) for physical activity. For current versus never smokers, the odds ratios (95% CIs) among regular non-NSAID users/nonusers were 2.91 (95% CI: 2.22–3.82) versus 1.75 (95% CI: 0.90–3.41), respectively, and for those who were obese versus those who were normal weight, they were 1.67 (95% CI: 1.28–2.17) versus 1.19 (95% CI: 0.69–2.04), respectively.

Conclusion
Our findings suggest that regular nonaspirin NSAID use may mask, beyond simple confounding, associations of major risk factors with colorectal adenoma, and support routinely assessing such associations stratified by regular nonaspirin NSAID use.
Salter-Harris Fractures of the Distal Phalanx: Treatment Algorithm and Surgical Outcomes
Authors: Gibreel Waleed , Charafeddine Ali , Carlsen Brian T. , Moran Steven L. , Bakri Karim 
Published: August 2018

Background:
Salter-Harris fractures of the distal phalanx with or without clinical evidence of nail-bed laceration are frequently undertreated.

Methods:
A retrospective review was performed of all patients with distal phalanx Salter-Harris fractures treated between 2004 and 2016.

Results:
Seventy patients were treated for 72 Salter-Harris fractures at a mean ± SD age of 11.3 ± 3.7 years. Median follow-up was 6 weeks (interquartile range, 4 to 12.6 years). The thumb was most commonly involved (n = 21), followed by long (n = 18), ring (n =17), small (n = 9), and index (n = 7) fingers. Sport-related injuries accounted for 39 fractures (54 percent). Forty-two fractures (58 percent) had at least one clinical finding suggestive of nail-bed laceration (subungual hematoma, subluxation of the proximal nail plate, skin laceration proximal to the eponychial fold, bleeding from underneath the nail plate, eponychial fold laceration, and nail plate avulsion). Among 42 fractures with at least one feature of nail-bed laceration, surgical exploration was undertaken in 38 fractures. At exploration, a nail-bed laceration was found in 31 fractures (82 percent) and soft-tissue interposition was found in 18 (47 percent). Fractures with clinical features of nail-bed laceration (n = 42) were treated with open reduction and splinting (n = 25), open reduction and percutaneous pinning (n = 13), or splinting (n = 4). Excellent results were obtained, with few unfavorable outcomes. Infectious complications occurred in six patients.

Conclusion:
The high rate of nail-bed laceration and soft-tissue interposition in Salter-Harris fractures with clinical features of nail-bed laceration mandates surgical exploration.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Donor-Site Morbidity of Vascularized Bone Flaps from the Distal Femur: A Systematic Review
Authors: Giladi Aviram M. , Rinkinen Jacob R. , Higgins James P. , Iorio Matthew L. 
Published: August 2018

Background:
Vascularized grafts from the femur, including the medial femoral condyle and medial femoral trochlea, are increasingly being used. It is critical to understand the lower extremity complications from flap harvest.

Methods:
The authors searched available literature reporting on femoral flaps using PubMed, Embase, Cochrane Database, and Web of Science. After article selection, data were collected regarding demographics, procedure details, outcomes, and complications. The authors classified outcomes as good, fair, or poor based on pain, range-of-motion, sensory changes, subjective reporting, patient-reported outcomes, and other donor-site complications, including the need for additional procedures.

Results:
Two hundred twenty articles were identified. Forty-five met criteria for review, with data available for 283 patients. No patients had range-of-motion deficits beyond 1 year. Two percent of patients (six of 283) required additional donor-site procedures, with one report of a femur fracture after medial femoral condyle harvest. Only one study on 45 medial femoral trochlea patients presented patient-reported outcomes regarding the knee. Few objective data were presented. Twenty-eight articles presented adequate complication data for 252 patients to be rated as good, fair, or poor. Overall, 89 percent had good outcomes without donor-site complications. Of the 176 medial femoral condyle patients with outcomes reported, 92 percent had good outcomes; and 71 percent of the 48 medial femoral trochlea patients had good outcomes reported.

Conclusions:
Overall, the reported donor-site morbidity from medial femoral condyle and medial femoral trochlea harvest is low. Chronic knee pain and sensory changes are most frequently reported, especially in medial femoral trochlea patients.
Outcomes of Endoscopic Powered Revision Dacryocystorhinostomy
Authors: Dalgic Abdullah , Ceylan Mehmet Emrah , Çelik Çağri , Aliyeva Aynur , Aksoy Gökçe Yildirim , Edizer Deniz Tuna 
Published: August 2018

Abstract
Objective of this study is to determine the etiology of patients applied with revision endoscopic dacryocystorhinostomy (DCR) and to evaluate the operation results.
The patients were retrospectively evaluated in respect of demographic data, the time from primary to revision surgery, revision etiology, the use of bicanalicular silicone nasolacrimal tube (BNLT), the time to postoperative removal of the silicone tube, and the success of the revision surgery.
The study included 27 patients applied with revision endoscopic DCR between January 2013 and January 2016. The mean age of the patients was 46.7 ± 11.7 years. The mean time from the first operation to revision surgery was 7.2 ± 6.1 months (range, 1–24 months). During the endoscopic DCR, synechia was observed in 2 (7.4%), granulation tissue in 7 (25.9%), inadequate bone window in 5 (18.52%), and membranous scar around the ostium in 22 (81.4%) patients. More than 1 etiologic problem was determined in 8 patients. During the revision procedure, BNLT was applied to 12 (44.4%) patients. At the final follow-up examination, the complaint of epiphora had completely recovered in 18 (66.6%) patients and there were in 9 (33.3%) patients. The mean time to removal of the BNLT was 1.7 ± 0.57 months (range, 1–3 months).
The most common cause of recurrent epiphora in endoscopic DCR was the formation of membranous scar. The use of the mucosal flap technique in primary surgery and the application of BNLT to all patients in revision surgery may increase the functional success rate.
Chitosan as a Bone Scaffold Biomaterial
Authors: Kozusko Steven D. , Riccio Charles , Goulart Micheline , Bumgardner Joel , Jing Xi Lin , Konofaos Petros 
Published: August 2018

AbstractThe current standard of care for bone reconstruction, whether secondary to injury, nonunion, cancer resection, or idiopathic bone loss, is autologous bone grafting. Alternatives to autograft and allograft bone substitutes currently being researched are synthetic and natural graft materials that are able to guide bone regeneration. One promising material currently being researched is chitosan, a highly versatile, naturally occurring polysaccharide, derived from the exoskeleton of arthropods that is comprised of glucosamine andN-acetylglucosamine. Research on chitosan as a bone scaffold has been promising. Chitosan is efficacious in bone regeneration due to its lack of immunogenicity, its biodegradability, and its physiologic features. Chitosan combined with growth factors and/or other scaffold materials has proven to be an effective alternative to autologous bone grafts. Additionally, current studies have shown that it can provide the additional benefit of a local drug delivery system. As research in the area of bone scaffolding continues to grow, further clinical research on chitosan in conjunction with growth factors, proteins, and alloplastic materials will likely be at the forefront.
Quantitative and Neurovascular Anatomy of the Growing Gracilis Muscle in the Human Fetuses
Authors: Beger Burhan , Beger Orhan , Koç Turan , Dinç Uğur , Hamzaoğlu Vural , Kayan Gülden , Uzmansel Deniz , Olgunus Zeliha Kurtoğlu 
Published: August 2018

Abstract
This study is intended to obtain the algebraic growth dynamics of the gracilis in fetuses and determine the variations of neurovascular pedicle(s) of the gracilis, to aid infant surgeries. Forty fetuses (19 males and 21 females) were included in the study. Gestational mean age of the fetuses was 22.40 ± 2.67 (range, 18–28) weeks. Numerical values were obtained using a digital caliper and a digital image analysis software. Linear functions for the surface area, width, anterior, and posterior margin lengths of the gracilis were calculated, respectively, as: y = −289.307 + 20.501 × age (weeks), y = −7.113 + 0.622 × age (weeks), y = −24.421 + 3.434 × age (weeks), and y = −24.397 + 3.314 × age (weeks). In addition, length and width of the gracilis tendon were calculated as y = −6.676 + 0.934 × age (weeks) and y = −0.732 + 0.074 × age (weeks), respectively. Parameters of the gracilis had no statistically significant difference regarding side and sex (P > 0.05). In all the specimens, the gracilis was innervated by the anterior branch of the obturator nerve. Blood supply of the gracilis was identified to be derived from 1 single artery in 38 sides of total 80 (47.5%), from 2 arteries in 36 (45%) and from 3 arteries in 6 (7.5%). In 74 sides (92.5%), the nerve was superficial to the main artery, whereas in 6 sides (7.5%), it was deeper. The data of the present study could be beneficial for surgeons in infant surgeries to treat conditions such as obstetrical brachial plexus paralysis, facial palsy, or anal incontinence. Linear functions can be utilized to better evaluate the growth course of the gracilis in fetuses and to predict the dimensions thereof. Additionally, comprehending the structure and recognizing the variations of the gracilis nerves and arteries can help to protect the neurovascular pedicle(s) of the gracilis during the operations.