bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impaired Physical Performance Predicts Hospitalization Risk for Participants in the Program of All-Inclusive Care for the Elderly
Authors: Falvey Jason R , Burke Robert E , Levy Cari R , Gustavson Allison M , Price Lisa , Forster Jeri E , Stevens-Lapsley Jennifer E 
Published: October 2018

Abstract

Background
Medicaid spending on the Program of All-Inclusive Care for the Elderly (PACE) has grown rapidly over the last 5 years. Reducing hospitalization rates is a major goal for PACE. However, there is a paucity of research evaluating the relationship between impaired physical performance and hospitalizations in PACE.

Objective
This study tested whether physical therapist–assessed physical performance, measured by the Short Physical Performance Battery (SPPB), can be used to identify participants in PACE at risk for all-cause hospitalizations or potentially avoidable hospitalizations (PAH).

Design
This was a retrospective cohort study of 1093 participants in PACE facilities in the Denver, Colorado, area.

Methods
Data were acquired from linked electronic medical record data and hospitalization claims. Unadjusted and adjusted Cox proportional hazards regression models were used to evaluate the relationship between SPPB scores and the probabilities of both all-cause hospitalizations and PAH.

Results
The unadjusted likelihood of hospitalization increased with greater physical performance impairment (for SPPB scores ≥8/12: 12.2%; for SPPB scores of 4/12 to 7/12: 15.7%; for SPPB scores &lt;4/12: 21.1%). Compared with participants with SPPB scores ≥8/12, participants with SPPB scores &lt;4/12 had nearly double the unadjusted hazard for hospitalization (hazard ratio = 1.99; 95% CI = 1.34–2.96). In adjusted Cox regression models, participants with SPPB scores &lt;4/12 remained significantly more likely to be hospitalized (hazard ratio = 1.87; 95% CI = 1.24–2.84). Similar relationships were observed for PAH.

Limitations
The use of data from a single network of PACE facilities might limit generalizability to states with different Medicaid guidelines.

Conclusions
The findings suggest that impaired physical performance is an independent risk factor for hospitalization among participants in PACE. These findings could help guide the development of PACE program modifications for measuring and intervening on impairments in physical function.
Gabapentin for the Treatment of Vulvodynia: A Randomized Controlled Trial
Authors: Brown Candace S. , Bachmann Gloria A. , Wan Jim , Foster David C. 
Published: October 2018

(Abstracted from Obstet Gynecol 2018;131:1000–1007)
Vulvodynia is a chronic pain syndrome with a lifetime prevalence of 7% to 16%. Only a small number of randomized clinical trials (RCTs) have been conducted on vulvodynia.
Survival After Secondary Cytoreductive Surgery and Chemotherapy Compared With Chemotherapy Alone for First Recurrence in Patients With Platinum-Sensitive Epithelial Ovarian Cancer and No Residuals After Primary Treatment. A Registry-Based Study
Authors: Szczesny Witold , Langseth Hilde , Myklebust Tor Å. , Kærn Janne , Tropé Claes , Paulsen Torbjørn 
Published: October 2018

(Abstracted from Acta Obstet Gynecol Scand 2018; doi: 10.1111/aogs.13361)
Standard treatment for women with epithelial ovarian cancer (EOC) generally is primary surgery (with the aim of complete cytoreduction) followed by 6 cycles of carboplatin and taxanes every 3 weeks.
Birth Outcomes for Pregnant Women With HIV Using Tenofovir-Emtricitabine
Authors: Rough Kathryn , Seage George R. , Williams Paige L. , Hernandez-Diaz Sonia , Huo Yanling , Chadwick Ellen G. , Currier Judith S. , Hoffman Risa M. , Barr Emily , Shapiro David E. , Patel Kunjal 
Published: October 2018

(Abstracted from N Engl J Med 2018;378:1593–1603)
Three-drug antiretroviral therapy (ART) during pregnancy has reduced the risk of perinatal transmission of HIV to less than 1% and has become the global standard of care. The Promoting Maternal and Infant Survival Everywhere (PROMISE) trial recently found that pregnant women in multiple sites of sub-Saharan Africa and India receiving tenofovir, disoproxil fumarate, emtricitabine, and ritonavir-boosted lopinavir (TDF-FTC-LPV/r) were more than twice as likely to deliver very prematurely (<34 weeks of gestation), at very low birth weight (<1500 g), and were significantly more likely to have infants that died within 14 days after delivery compared with those assigned to receive zidovudine, lamivudine, and ritonavir-boosted lopinavir (ZDV-3TC-LPV/r).
Canada’s Universal Health-Care System: Achieving Its Potential
Authors: Martin Danielle , Miller Ashley P. , Quesnel-Vallée Amélie , Caron Nadine R. , Vissandjée Bilkis , Marchildon Gregory P. 
Published: October 2018

(Abstracted from Lancet 2018;391:1718–1735)
Canada’s universal publicly funded health care system, known as Medicare, was founded on the principle that access should be determined by need rather than ability to pay. Medicare is an importance source of collective pride in Canada as a universal health coverage model that provides access to physicians and hospital services through 13 tax-funded insurance plans.
Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes: A Randomized Clinical Trial
Authors: Sénat Marie-Victoire , Affres Helene , Letourneau Alexandra , Coustols-Valat Magali , Cazaubiel Marie , Legardeur Helene , Jacquier Julie Fort , Bourcigaux Nathalie , Simon Emmanuel , Rod Anne , Héron Isabelle , Castera Virginie , Sentilhes Loic , Bretelle Florence , Rolland Catherine , Morin Mathieu , Deruelle Philippe , De Carne Celine , Maillot François , Beucher Gael , Verspyck Eric , Desbriere Raoul , Laboureau Sandrine , Mitanchez Delphine , Bouyer Jean 
Published: October 2018

(Abstracted from JAMA 2018;319(17):1773–1780)
Gestational diabetes continues to increase nationally and globally. The American Diabetes Association currently recommends insulin, the only Food and Drug Administration–approved pharmacologic agent, as first-line treatment for women with gestational diabetes mellitus requiring medications.
Cystourethroscopy Following Midurethral Slings: Is It Always Necessary?
Authors: Melon Jerome , Kelly Erin C. , van Delft Kim W. M. 
Published: October 2018

(Abstracted from Int Urogynecol J 2018;29:789–793)
Synthetic midurethral slings (MUSs) have been the most prevalent surgical intervention for the treatment of stress urinary incontinence. However, their use for stress urinary incontinence has deceased in recent years, most likely the result of concerns over the safety of mesh implants by the US Food and Drug Administration, as well as a large number of class-action lawsuits.
Implementation of the Smart Use of Antibiotics Program to Reduce Unnecessary Antibiotic Use in a Neonatal ICU: A Prospective Interrupted Time-Series Study in a Developing Country
Authors: Lu Chunmei , Liu Qing , Yuan Hao , Wang Laishuan 
Published: October 2018

Objectives:
We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance.

Design:
We compared the time periods before (baseline) and after (intervention) the implementation of an antibiotic protocol by performing surveillance and assessments of all antibiotic use during a 29-month interrupted period.

Setting:
Level 3–4 neonatal ICU in one referral center.

Patients:
All 13,540 infants who received antibiotics during their hospital stay from 2015 to 2017.

Interventions:
Prospective audit of targeted antibiotic stewardship program.

Measurements and Main Results:
The primary outcome was the change in total antibiotic days of therapy per 1,000 patient-days between the baseline and intervention periods. The secondary outcomes included readmissions for infection, late-onset sepsis (length of stay), necrotizing enterocolitis, or death in infants at 32 weeks of gestation or younger and the prevalence of multidrug-resistant organism colonization. No differences in safety outcomes were observed between the intervention and baseline periods. Following the implementation of our Smart Use of Antibiotics Program, the total quantity of antibiotics in the intervention phase was significantly decreased from 543 days of therapy per 1,000 patient-days to 380 days of therapy/1,000 patient-days compared with that of baseline (p = 0.0001), which occurred in parallel with a reduction in length of stay from 11.4% during the baseline period to 6.5% during the intervention period (p = 0.01). A reduced multidrug-resistant organism rate was also observed following Smart Use of Antibiotics Program implementation (1.4% vs 1.0%; p = 0.02). The overall readmission rate did not differ between the two periods (1.2% vs 1.1%; p = 0.16).

Conclusions:
Smart Use of Antibiotics Program implementation was effective in reducing antibiotic exposure without affecting quality of care. Antibiotic stewardship programs are attainable through tailoring to special stewardship targets even in a developing country.
Improving Charting Skills of Physicians in Monitored Practice
Authors: Wenghofer Elizabeth , Boal Peter , Floyd Nathanial , Lee Joan , Woodard Robert , Norcross William 
Published: October 2018

Introduction:
The Physician Enhancement Program (PEP) is an in-practice monitoring program for physicians with potential dyscompetency issues. One component of PEP is a monthly chart audit. The purpose of our study was to determine if physicians' charting skills improve through their participation in PEP.

Methods:
The sample included physicians who participated in PEP for at least 6 months regardless of specialization, age, or gender (n = 77). PEP chart audits evaluate seven different aspects of chart and care quality, including legibility, organization, history, assessment/formulation, treatment, physical examination, and overall chart quality. Each aspect of charting is scored on a Likert-type scale from a score of 1 to 9. We conducted pair-matched t tests of the mean item scores for the 1st versus 6th, 12th, 18th, and 24th month in PEP for all chart elements except legibility. We also compared the size of the paired differences by month 1 scores for overall chart quality mean score to determine if the magnitude of change varied by starting point.

Results:
There was significant improvement (P < .002) across the 6 chart quality elements per physician at months 6, 12, 18, and 24. Physicians who started below Q1 for overall chart quality mean showed most improvement, whereas those who started above Q3 had insignificant change as they had little room to improve.

Discussion:
PEP participants demonstrated improved charting skills for each chart quality element evaluated. PEP is an effective form of physician education resulting in physician behavior changes, especially for those physicians who need it the most.
Dietary Micronutrient Intake of Participants in a “Partners Together in Health” Cardiac Rehabilitation Intervention
Authors: Jensen Sara Kvien , Yates Bernice , Lyden Elizabeth , Krogstrand Kaye Stanek , Hanson Corrine 
Published: October 2018

Purpose:
Current guidelines for cardiovascular health emphasize a “dietary pattern” approach that could be expected to increase intakes of micronutrients in addition to altering the macronutrient profile. However, the effect of interventions such as cardiac rehabilitation on the micronutrient quality of the diet has not been evaluated. Therefore, the goal of this study was to investigate changes in micronutrient intake of cardiac rehabilitation participants over time.

Methods:
This was a secondary analysis of data from a randomized clinical trial that assessed the effects of the Partners Together in Health intervention on physical activity and healthy eating behaviors. The intake of 9 micronutrients important in cardiovascular health was assessed using 3-d food records. A micronutrient adequacy score was evaluated at 3 time points (baseline, 3 and 6 mo). Changes over time in micronutrient intake were assessed using a general linear model.

Results:
Sixty-eight participants who were enrolled in the Partners Together in Health interventional trial completed the study. There was no significant difference in the mean micronutrient score at any time point. Intake of individual micronutrients did not improve over the 6-mo time frame with the exception of vitamin E, (8.7 mg vs 6.5 mg for at 6 vs 3 mo, P = .02). The proportion of participants with intakes meeting the Dietary Recommended Intake for each nutrient also remained the same over time.

Conclusion:
Although cardiac rehabilitation programs may be effective in altering the macronutrient composition, improvements to overall diet quality may be tempered by a lack of improvement in intake of micronutrients.
The Effects of Cardiac Rehabilitation on Mortality and Morbidity in Women
Authors: Ghisi Gabriela Lima de Melo , Chaves Gabriela Suéllen da Silva , Bennett Amanda , Lavie Carl J. , Grace Sherry L. 
Published: October 2018

Purpose:
Cardiac rehabilitation (CR) is associated with significant reductions in mortality and morbidity, but few women are included in trials. Therefore, a meta-analysis of the effects of CR in women is warranted.

Methods:
Randomized controlled trials from recent systematic reviews that included women attending comprehensive CR and reporting the outcomes of mortality and morbidity (hospitalization, myocardial infarction, bypass surgery, percutaneous coronary intervention) were considered for inclusion. An updated search of the literature was performed from the end date of the last search, based on the Cochrane strategy. Authors were contacted to provide results on women where none were reported.

Results:
On the basis of 2 recent systematic reviews, 80 trials were identified. Fifty (62.5%) were excluded, most commonly due to lack of inclusion of women (n = 18; 22.5%). One trial was identified through the search update. Of 31 potential trials meeting inclusion criteria, 1 reported results on women and many were old, and hence data by sex were no longer available. Ultimately, data for women were available in 2 trials. Therefore, it was deemed inappropriate to undertake this meta-analysis.

Conclusions:
This review corroborates the dearth of data on CR in women despite the fact that cardiovascular disease is the leading cause of death in women. Given the totality of evidence, including reductions in mortality and morbidity in nonrandomized studies, and evidence of benefit for other important outcomes such as functional capacity and quality of life, women should continue to be referred to CR.
Participation in Pulmonary Rehabilitation by Veterans Health Administration and Medicare Beneficiaries After Hospitalization for Chronic Obstructive Pulmonary Disease
Authors: Vercammen-Grandjean Christopher , Schopfer David W. , Zhang Ning , Whooley Mary A. 
Published: October 2018

Background:
Hospitalization with acute exacerbation of chronic obstructive pulmonary disease (COPD) is common and costly to the health care system. Pulmonary rehabilitation (PR) can improve symptom burden and morbidity associated with COPD. The use of PR among Medicare beneficiaries is poor, and the use by Veterans Health Administration (VHA) beneficiaries is unknown. We sought to determine whether participation in PR was similarly poor among eligible veterans compared with Medicare beneficiaries.

Methods:
We performed a retrospective study using national VHA and Medicare data to determine the proportion of eligible patients who participated in PR after hospitalization for an acute exacerbation of COPD between January 2007 and December 2011. We also evaluated patient characteristics including demographic factors and comorbid medical history associated with participation.

Results:
Over the 5-year study period, 485 (1.5%) of 32 856 VHA and 3199 (2.0%) of 158 137 Medicare beneficiaries hospitalized for COPD attended at least 1 session of PR. Among both VHA and Medicare beneficiaries, participation was higher in those who had had comorbid pneumonia or pulmonary hypertension and was lower in older patients. Although participation increased in both groups over time, it remained exceedingly low overall.

Conclusion:
Pulmonary rehabilitation is significantly underused in both the VHA and Medicare populations. Although comorbid pulmonary disease is associated with higher use, the proportion of eligible patients who participate remains extremely low.
Physiological Responses and Prognostic Value of Common Exercise Testing Modalities in Idiopathic Pulmonary Fibrosis
Authors: Vainshelboim Baruch , Myers Jonathan , Oliveira Jose , Izhakian Shimon , Unterman Avraham , Kramer Mordechai Reuven 
Published: October 2018

Purpose:
This pilot study aimed to compare physiological responses between cycle cardiopulmonary exercise tests (CPETs) and 6-min walk tests (6MWTs) and to assess their prognostic value among patients with idiopathic pulmonary fibrosis (IPF).

Methods:
Thirty-four patients with IPF (68 ± 8 yr) underwent CPETs and 6MWTs and were followed up for 40 mo. Differences, levels of agreement, and relative risks for mortality were analyzed between measured and estimated peak responses for the 2 tests.

Results:
Compared with the CPET, oxygen uptake (

JOURNAL/jcprh/04.03/01273116-201905000-00010/10FSM1/v/2023-09-11T074705Z/r/image-gif

o
2), heart rate (HR), and the nadir of SpO
2 were lower during the 6MWT, whereas work rate (WR) was higher. Mean differences were as follows:

JOURNAL/jcprh/04.03/01273116-201905000-00010/10FSM1/v/2023-09-11T074705Z/r/image-gif

o
2 =−1.9 mL/kg/min, 95% CI, −1.1 to −2.7, P < .001; HR =−9 beats/min, 95% CI, −4 to −14, P = .002; SpO
2 =−6%, 95% CI, −4 to −7, P < .001; and WR = 9 W/min, 95% CI, 3 to 16, P = .008. Interclass correlations ranged from 0.84 to 0.90 and both tests demonstrated prognostic value for mortality.

Conclusions:
Significant differences and variation in peak physiological responses were observed between cycle CPETs and 6MWTs in patients with IPF. However, good agreement was evident, suggesting that both tests provide value for clinical and research settings. Future studies should compare the physiological responses between treadmill CPETs and 6MWTs for prognostic utility in IPF.
Efficacy of Neulasta or Neupogen on H-ARS and GI-ARS Mortality and Hematopoietic Recovery in Nonhuman Primates After 10-Gy Irradiation With 2.5% Bone Marrow Sparing
Authors: Farese Ann M. , Bennett Alexander W. , Gibbs Allison M. , Hankey Kim G. , Prado Karl , Jackson William , MacVittie Thomas J. 
Published: October 2018

Abstract
A nonhuman primate model of acute, partial-body, high-dose irradiation with minimal (2.5%) bone marrow sparing was used to assess endogenous gastrointestinal and hematopoietic recovery and the ability of Neulasta® (pegylated granulocyte colony-stimulating factor) or Neupogen® (granulocyte colony-stimulating factor) to enhance recovery from myelosuppression when administered at an increased interval between exposure and initiation of treatment. A secondary objective was to assess the effect of Neulasta or Neupogen on mortality and morbidity due to the hematopoietic acute radiation syndrome and concomitant gastrointestinal acute radiation syndrome. Nonhuman primates were exposed to 10.0 Gy, 6 MV, linear accelerator-derived photons delivered at 0.80 Gy min−1. All nonhuman primates received subject-based medical management. Nonhuman primates were dosed daily with control article (5% dextrose in water), initiated on day 1 postexposure; Neulasta (300 μg kg−1), administered on days 1, 8, and 15 or days 3, 10, and 17 postexposure; or Neupogen (10 μg kg−1), administered daily postexposure following its initiation on day 1 or day 3 until neutrophil recovery (absolute neutrophil count ≥1,000 cells μL−1 for 3 consecutive days). Mortality in the irradiated cohorts suggested that administration of Neulasta or Neupogen on either schedule did not affect mortality due to gastrointestinal acute radiation syndrome or mitigate mortality due to hematopoietic acute radiation syndrome (plus gastrointestinal damage). Following 10.0 Gy partial-body irradiation with 2.5% bone marrow sparing, the mean duration of neutropenia (absolute neutrophil count <500 cells μL−1) was 22.4 d in the control cohort vs. 13.0 and 15.3 d in the Neulasta day 1, 8, 15 and day 3, 10, 17 cohorts, relative to 16.2 and 17.4 d in the Neupogen cohorts initiated on day 1 and day 3, respectively. The absolute neutrophil count nadirs were 48 cells μL−1 in the controls; 117 cells μL−1 and 40 cells μL−1 in the Neulasta days 1, 8, and 15 or days 3, 10, and 17 cohorts, respectively; and 75 cells μL−1 and 37 cells μL−1 in the Neupogen day 1 and day 3 cohorts, respectively. Therefore, the earlier administration of Neulasta or Neupogen was more effective in this model of marginal 2.5% bone marrow sparing. The approximate 2.5% bone marrow sparing may approach the threshold for efficacy of the lineage-specific medical countermeasure. The partial-body irradiation with 2.5% bone marrow sparing model can be used to assess medical countermeasure efficacy in the context of the concomitant gastrointestinal and hematopoietic acute radiation syndrome sequelae.
Idiopathic Acquired Lacrimal Canalicular Obstruction
Authors: Satchi Khami , McNab Alan A. 
Published: October 2018

Purpose:
Acquired lacrimal canalicular obstruction has a variety of causes. In a small proportion of patients, no cause can be identified. This article describes a cohort of 27 patients with idiopathic acquired lacrimal canalicular obstruction encountered over a 28-year period.

Methods:
The diagnostic database of the senior author was analyzed to identify all cases of idiopathic acquired lacrimal canalicular obstruction seen from 1990 to 2017. Demographic, clinical, and treatment details were analyzed. Patients with primary lacrimal punctal stenosis or closure were excluded from the analysis.

Results:
The authors encountered 27 patients with idiopathic acquired lacrimal canalicular obstruction (17 female, 63%) aged 34 to 91 years (median: 65 years). The level of canalicular obstruction ranged from 1 to 10 mm from the punctum. Canalicular obstruction involved 1 canaliculus in 4 patients, 2 in 14 (ipsilateral in all except one), 3 in 3, and all 4 in 6. One patient who presented with ipsilateral upper and lower canalicular obstructions developed contralateral upper and lower obstructions several years later, and another patient redeveloped obstructions after initial successful surgical repair. In all cases, there were no features on history or examination to suggest a cause for the canalicular obstruction. Follow up ranged from 1 to 260 months (mean: 39 months). Sixteen patients underwent surgical repair, 11 with a dacryocystorhinostomy and placement of a Lester Jones glass bypass tube, 2 had a canaliculo-dacryocystorhinostomy (anastomosis of the canaliculus to the nose), 2 had dacryocystorhinostomy and trephination of the canalicular obstruction with silicone intubation, and 1 had a dacryocystorhinostomy alone to try and improve drainage through a single patent canaliculus.

Conclusion:
Idiopathic acquired lacrimal canalicular obstruction is uncommon and occurs more frequently in older women. The condition may be slowly progressive and can affect one or more canaliculi at any level. Treatment is the same as for any other cause of acquired lacrimal canalicular obstruction.