bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Risk of Venous Thromboembolism After Surgery for Long Bone Metastases: A Retrospective Study of 682 Patients
Authors: Groot Olivier Q. , Ogink Paul T. , Janssen Stein J. , Paulino Pereira Nuno Rui , Lozano-Calderon Santiago , Raskin Kevin , Hornicek Francis , Schwab Joseph H. 
Published: September 2018

Abstract

Background
Previous studies have shown that venous thromboembolism (VTE) is a complication associated with neoplastic disease and major orthopaedic surgery. However, many potential risk factors remain undefined.

Questions/purposes
(1) What proportion of patients develop symptomatic VTE after surgery for long bone metastases? (2) What factors are associated with the development of symptomatic VTE among patients receiving surgery for long bone metastases? (3) Is there an association between the development of symptomatic VTE and 1-year survival among patients undergoing surgery for long bone metastases? (4) Does chemoprophylaxis increase the risk of wound complications among patients undergoing surgery for long bone metastases?

Methods
A retrospective study identified 682 patients undergoing surgical treatment of long bone metastases between 2002 and 2013 at the Massachusetts General Hospital and Brigham and Women's Hospital. We included patients 18 years of age or older who had a surgical procedure for impending or pathologic metastatic long bone fracture. We considered the humerus, radius, ulna, femur, tibia, and fibula as long bones; metastatic disease was defined as metastases from solid organs, multiple myeloma, or lymphoma. In general, we used 40 mg enoxaparin daily for lower extremity surgery and 325 mg aspirin daily for lower or upper extremity surgery. The primary outcome was a VTE defined as any symptomatic pulmonary embolism (PE) or symptomatic deep vein thrombosis (DVT; proximal and distal) within 90 days of surgery as determined by chart review. The tertiary outcome was defined as any documented wound complication that might be attributable to chemoprophylaxis within 90 days of surgery. At followup after 90 days and 1 year, respectively, 4% (25 of 682) and 8% (53 of 682) were lost to followup. Statistical analysis was performed using multivariable logistic and Cox regression and Kaplan-Meier.

Results
Overall, 6% (44 of 682) of patients had symptomatic VTE; 22 patients sustained a DVT, and 22 developed a PE. After controlling for relevant confounding variables, higher preoperative hemoglobin level was independently associated (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.60–0.93; p = 0.011) with decreased symptomatic VTE risk, the presence of symptomatic VTE was associated with a worse 1-year survival rate (VTE: 27% [95% CI, 14%–40%] and non-VTE: 39% [95% CI, 35%–43%]; p = 0.041), and no association was found between wound complications and the use of chemoprophylaxis (OR, 3.29; 95% CI, 0.43–25.17; p = 0.252).

Conclusions
The risk of symptomatic 90-day VTE is high in patients undergoing surgery for long bone metastases. Further study would be needed to determine the VTE prevention strategy that best balances risks and benefits to address this complication.

Level of Evidence
Level III, therapeutic study.
VISUAL FUNCTION AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES IN CHILDREN BORN PRETERM
Authors: Balasubramanian Siva , Borrelli Enrico , Lonngi Marcela , Velez Federico , Sarraf David , Sadda SriniVas R. , Tsui Irena 
Published: September 2018

Purpose:
Preterm children have an increased risk of impaired vision from retinopathy, strabismus, and high refractive error. The aim of this study was to investigate the relationship between foveal parameters generated by optical coherence tomography angiography and visual function in preterm children.

Methods:
Eighty eyes (32 eyes of former preterm infants and 48 age-matched full-term control eyes) were analyzed. Subjects underwent complete eye examinations including best-corrected visual acuity and retinal imaging with the Optovue XR Avanti optical coherence tomography angiography device. Foveal morphologic parameters including foveal depth, central foveal thickness, inner retinal area, and outer retinal area were measured on a central horizontal B-scan. Foveal vasculature parameters including foveal avascular zone, superficial capillary plexus-vessel density, and deep capillary plexus-vessel density were measured on optical coherence tomography angiography.

Results:
The best-corrected visual acuity was significantly affected in preterm children compared with controls (P < 0.0001). The central foveal thickness (P < 0.0001), inner retinal area (P = 0.01), and outer retinal area (P = 0.03) were significantly increased in preterm compared with control eyes. Foveal depth (P < 0.001) and foveal avascular zone (P < 0.001) were significantly decreased in preterm compared with control eyes. The superficial capillary plexus-vessel density (P = 0.01) and deep capillary plexus-vessel density (P = 0.003) at the fovea (1 mm) were significantly increased in preterm compared with control eyes. The best-corrected visual acuity was negatively correlated with foveal depth (r = −0.42, P = 0.001) and foveal avascular zone (r = −0.53, P < 0.001), and positively correlated with central foveal thickness (r = 0.32, P = 0.01) and inner retinal area (r = 0.32, P = 0.01), indicating that worse visual acuity was associated with a smaller foveal avascular zone, shallower foveal depth, increased central foveal thickness, and larger inner retinal area.

Conclusion:
Foveal morphology and vasculature changes in preterm children were associated with impaired visual function. Further longitudinal studies are required to evaluate these changes over time.
Naloxone Effectiveness
Authors: Chimbar Lisa , Moleta Yvette 
Published: September 2018

Abstract

Purpose:
Opioid abuse and overdose is a public health concern as it relates to increased morbidity and mortality. This systematic review focuses on the application of take-home naloxone programs and its association with decreased mortality among those who abuse opioids. Take-home naloxone programs consist of distributed naloxone kits and corresponding education of overdose recognition. The purpose of this systematic review was to determine if programs that supply take-home naloxone are effective in preventing fatal overdoses among those who abuse opioids.

Methods:
A systematic search was conducted in Academic Search Complete, CINHAL, MEDLINE, PsychINFO, and SocINDEX. The key words searched were “programs,” “take-home kits,” “Narcan,” “Naloxone,” and “mortality.” On the basis of the predefined inclusion and exclusion criteria, nine studies were found for inclusion.

Results:
Study results were then synthesized, qualitatively, and within the current research, there is overwhelming support of take-home naloxone programs being effective in preventing fatal opioid overdoses. A significant limitation of this systematic review is the lack of randomized controlled trials as it is viewed as unethical withholding a known lifesaving medication from an at-risk population.

Practice Implications:
On the basis of the most current evidence, there is overwhelming support of take-home naloxone programs associated with decreased mortality among those who abuse opioids. As a result, there is an implication for a practice change that take-home naloxone programs should be more widely implemented throughout communities as a method of decreasing mortality associated with opioid overdoses. It is recommended that further research is done examining the cost-effectiveness of these programs.
Social Support Among Women Undergoing Methadone Maintenance Treatment in Iran
Authors: Rahimi Sharareh , Jalali Amir , Jalali Rostam 
Published: September 2018

Abstract

Objective:
This study was designed and conducted to explain perceived social support among women undergoing methadone maintenance treatment (MMT) in Iran.

Method:
This study was a simultaneous mixed method research. Within the quantitative part of the study, a total number of 138 female clients were selected through a convenience sampling method from 37 rehabilitation clinics located in the city of Isfahan and then assessed via a demographic characteristics questionnaire and Perceived Social Support Scale. Using purposive and snowball sampling methods in the qualitative part of the study, in-depth face-to-face, individual, and semistructured interviews were administered on 18 female clients willing to participate in the given research. Then, the quantitative and qualitative data were analyzed through quantitative content analysis and statistical tests using the SPSS Version 18 software, respectively.

Results:
The results of the qualitative part were reduced to 203 codes, 17 subcategories, eight categories, and four main categories including family support and acceptance, relatives’ support and acceptance interaction, and being supported and understood by society as well as individual social security needs. The results of the quantitative part also revealed that social support among women undergoing MMT was lower than the moderate level. The given findings were also consistent with the results in the qualitative part.

Conclusion:
Moreover, the results showed that drug-dependent women undergoing MMT experienced unmet social needs, which could affect them and overshadow their treatment and rehabilitation processes. Therefore, it is necessary to accommodate such needs through appropriate planning.
The Opioid Crisis, Suicides, and Related Conditions
Authors: Fornili Katherine 
Published: September 2018

Abstract
In early April 2018, Dr. Maria Oquendo, President of the American Psychiatric Association, and Dr. Nora Volkow, Director of the National Institute on Drug Abuse, published a thought-provoking article in the New England Journal of Medicine about the role of suicide in the opioid overdose epidemic, referring to the relationship between them as a “hidden tragedy.” Drs. Oquendo and Volkow drew our attention to the twinning of the opioid (and other drug) overdose and suicide epidemics, but these are not the first or only drug-related “twin epidemics.” Numerous other related conditions, including pain disorders, adverse childhood experiences, posttraumatic stress disorders, HIV/AIDS, polydrug use and toxicity, and certain social determinants of health, may interact in a multiplicative and/or cumulative manner to adversely impact individuals and populations.
Syndemic theory (Singer, 2009; Singer, Bulled, Ostrach, & Mendenhall, 2017) can be helpful for describing how certain conditions cluster and interact synergistically to exacerbate health effects, problem severity, and disease progression. This column argues that the opioid crisis can accurately be considered not only a singular epidemic, or even a singular syndemic when twinned with a suicide epidemic, but also a complex phenomenon that consists of multiple, related syndemic conditions in addition to suicide. These are multidimensional disorders, with multiple, often overlapping etiologies, so single-minded approaches will be ineffective. Consideration of syndemic interactions and their cumulative and multiplicative effects are helpful for guiding treatment and prognosis for individuals, and program planning and health policy for population health (Singer et al., 2017).
Treatment Options for Opioid Use Disorders
Authors: Mumba Mercy N. , Findlay Lilian J. , Snow Diane E. 
Published: September 2018

Abstract
Approximately 10% of the 20 million Americans who are suffering from substance use disorders are suffering from prescription opioid and heroine misuse. This has led to a rise in overdoses as well as emergency room visits, with over 1000 individuals across the United States being seen in emergency rooms every day. Unfortunately, about 90% of drug overdoses are unintentional. Therefore, finding effective ways to treat opioid use disorders and preventing relapse has now become a national priority. This review of the relevant literature highlights current treatment options available for opioid use disorders, including motivational interviewing, cognitive behavioral therapy, mindfulness meditation, mindfulness based relapse prevention, medication assisted therapies, and combination therapies. Lastly, a discussion on ways to address challenges related to the treatment of opioid use disorders is provided.
How Measurement Variability Affects Reporting of a Single Readmission Metric
Authors: Brittan Mark S. , Campagna Elizabeth J. , Keller David , Kempe Allison 
Published: September 2018

ABSTRACT
Readmissions are an important quality measure for public reporting, payment, and collaborative research. Lack of measure standardization may lead to inconsistent reporting of outcomes across study sites. In this study, we examined the impact of measurement variability on reporting of a single readmission metric, 30-day all-condition readmission rates (ARRs). We conducted a secondary database analysis of 2006–2008 Medicaid Analytic eXtract data merged from four states of children younger than 21 years. We calculated 30-day ARRs for this cohort using three previously described models varying in their inclusions and exclusions of index hospitalizations and readmissions. The 30-day ARR was highest for the model allowing each readmission to serve as an index admission for subsequent readmissions (ARR: 7%); intermediate for the model allowing one index admission and more than one readmissions in each 30-day period (ARR: 6.2%); and lowest for the model allowing only one readmission in each 30-day period (ARR: 5.6%). Similar variation was seen when stratifying patients by individual diagnostic groups. In conclusion, measurement variability impacts reported outcomes of a single readmission metric. To improve the value of readmission as a quality metric, stakeholders engaged in multisite quality improvement or research should ensure that definitions are standardized across sites.
Improving the Transition of Care Process for Veterans Hospitalized at Non-VHA Facilities
Authors: Libbon James V. , Austin Carrie Meg , Gill-Scott Leta C. , Burke Robert E. 
Published: September 2018

ABSTRACT
Veterans receiving primary care through the Veterans Health Administration (VHA) are at increased risk of adverse outcomes when transitioning from a non-VHA hospitalization to VHA primary care. We intervened to improve these care transitions through identifying Veterans at a partnered community hospital, use of a multidisciplinary patient-structured discharge information sheet for community case managers to effectively communicate with VHA clinics, and implementation of a VHA site process for receiving information. We evaluated the intervention on two endpoints: the percentage-relevant documentation was received at the VHA before follow-up appointment and the rate Veterans attended a follow-up appointment at the VHA. Rates for receiving transitions of care documents were as follows: 0% preintervention (N = 24), 16% in the first 6 months of intervention (N = 39), and 83% after plan-do-study-act cycles in the second 6 months (N = 41). Veteran follow-up attendance also improved 25% preintervention to 54% and 71%, respectively. This process could serve as a model for transitions of care improvement.
Patients' Perspectives on Reasons for Unplanned Readmissions
Authors: LeClair Amy M. , Sweeney Megan , Yoon Grace H. , Leary Jana C. , Weingart Saul N. , Freund Karen M. 
Published: September 2018

ABSTRACT
Massachusetts has one of the highest rates of 30-day readmissions in the country. To identify patient-reported factors that may contribute to readmissions, we conducted semi-structured interviews with patients with unplanned readmissions within 30 days of inpatient discharge from the medicine services at an urban medical center between June and August 2016. Interviews with patients and/or proxies were conducted in English, Spanish, Mandarin, or Cantonese, then translated to English if necessary, transcribed verbatim, and deidentified. A team of four coders conducted the thematic analysis. Most patients did not identify factors associated with readmission beyond their underlying illness; however, a mismatch between the patient's clinical care needs and services available at postacute facilities, as well as poor communication between providers, facilities, and patients/proxies, were identified as contributing factors to readmissions. Non–English speaking patients and their families reported confusion with written discharge instructions, even if an interpreter provided verbal instructions. Patients will benefit from future interventions that aim to improve transfers to postacute care facilities, develop written materials in languages prevalent in the local population, and improve communication among providers, facilities, and patients and their families.
Juvenile Tree Shrews Do Not Maintain Emmetropia in Narrow-band Blue Light
Authors: Gawne Timothy J. , Ward Alexander H. , Norton Thomas T. 
Published: September 2018

SIGNIFICANCE
In spectrally broad-band light, an emmetropization mechanism in post-natal eyes uses visual cues to modulate the growth of the eye to achieve and maintain near emmetropia. When we restricted available wavelengths to narrow-band blue light, juvenile tree shrews (diurnal dichromatic mammals closely related to primates) developed substantial refractive errors, suggesting that feedback from defocus-related changes in the relative activation of long- and short-wavelength–sensitive cones is essential to maintain emmetropia.

PURPOSE
The purpose of this study was to examine the effects of narrow-band ambient blue light on refractive state in juvenile tree shrews that had completed initial emmetropization (decrease from hyperopia toward emmetropia).

METHODS
Animals were raised in fluorescent colony lighting until they began blue-light treatment at 24 days of visual experience, at which age they had achieved age-normal low hyperopia (mean ± SEM refractive error, 1.2 ± 0.5 diopters). Arrays of light-emitting diodes placed atop the cage produced wavelengths of 457 (five animals) or 464 nm (five animals), flickered in a pseudo-random pattern (temporally broad band). A third group of five animals was exposed to steady 464-nm blue light. Illuminance on the floor of the cage was 300 to 500 human lux. Noncycloplegic autorefractor measures were made daily for a minimum of 11 days and up to 32 days. Seven age-matched animals were raised in colony light.

RESULTS
The refractive state of all blue-treated animals moved outside the 95% confidence limits of the colony-light animals' refractions. Most refractions first moved toward hyperopia. Then the refractive state decreased monotonically and, in some animals, passed through emmetropia, becoming myopic.

CONCLUSIONS
From the tree shrew cone absorbance spectra, the narrow-band blue light stimulated both long-wavelength–sensitive and short-wavelength–sensitive cones, but the relative activation would not change with the refractive state. This removed feedback from longitudinal chromatic aberration that may be essential to maintain emmetropia.
Making Strides Toward Health Equity: The Experiences of Public Health Departments
Authors: Narain Kimberly Danae Cauley , Zimmerman Frederick J. , Richards Jessica , Fielding Jonathan E. , Cole Brian L. , Teutsch Steven M. , Rhoads Natalie 
Published: September 2018

Objectives:
We explored the definition of health equity being used by public health departments and the extent of engagement of public health departments in activities to improve health equity, as well as facilitators and barriers to this work.

Design:
We conducted 25 semistructured qualitative interviews with lead public health officials (n = 20) and their designees (n = 5). All interviews were transcribed and thematically analyzed.

Setting:
We conducted interviews with respondents from local public health departments in the United States (April 2017-June 2017).

Participants:
Respondents were from local or state public health departments that were members of the Big Cities Health Coalition, accredited or both.

Results:
Many departments were using a definition of health equity that emphasized an equal opportunity to improve health for all, with a special emphasis on socially disadvantaged populations. Improving health equity was a high priority for most departments and targeting the social determinants of health was viewed as the optimal approach for improving health equity. Having the capacity to frame issues of health equity in ways that resonated with sectors outside of public health was seen as a particularly valuable skill for facilitating cross-sector collaborations and promoting work to improve health equity. Barriers to engaging in work to improve health equity included lack of flexible and sustainable funding sources as well as limited training and guidance on how to conduct this type of work.

Conclusions:
Work to improve health equity among public health departments can be fostered and strengthened by building capacity among them to do more targeted framing of health equity issues and by providing more flexible and sustained funding sources. In addition, supporting peer networks that will allow for the exchange of resources, ideas, and best practices will likely build capacity among public health departments to effectively do this work.
Opportunities to Improve Employee Satisfaction Within State and Local Public Health Agencies
Authors: Wisniewski Janna M. , Jacinto Corey , Yeager Valerie A. , Castrucci Brian , Chapple-McGruder Theresa , Gould Elizabeth 
Published: September 2018

Context:
Public health agencies will likely struggle to staff at necessary levels, given ongoing workforce shortages, the potential for mass retirement, and expanding responsibility. Although the majority of public health workers are satisfied with their jobs overall, it is critical to understand the degree to which they are satisfied and identify factors that contribute to any dissatisfaction that occurs.

Objective:
This study identified opportunities for public health agencies to improve work environments and, in turn, improve employee satisfaction and retention.

Design:
Using data from the 2014 Public Health Workforce Interest and Needs Survey, we analyze responses to the survey question, “If you wish, you may provide comments below about your level of job satisfaction.” The 2966 responses (2389 from state and 542 from local public health agencies) that indicated a negative disposition were examined to understand employee dissatisfaction.

Setting:
The survey was administered to a representative sample of state health departments and convenience samples of local health departments.

Participants:
Responses from employees of state and local health departments are considered.

Main Outcome Measures:
The most frequently occurring themes overall were identified. In addition, responses describing weaknesses in organizational support (specifically training, communication, workload, and innovation) were summarized.

Results:
The most frequently occurring themes were as follows: (1) salary, specifically in relation to the merit system, performance evaluation, and workload; (2) job security with emphasis on funding, organizational transformation, and politics/government; and (3) career development related to the merit system, performance evaluation, and management. Respondents also reported opportunities in the areas of training, communication, workload, and innovation to improve satisfaction levels.

Conclusions:
These findings serve as a call to action for leaders in health departments as well as national public health leaders to remedy the concerns raised in their responses. Some of the solutions are within the realm of public health agency leadership, but some may fall within the realm of governors and public health leaders at the federal level. It is important to share these findings so that appropriate decision makers can address public health workforce retention and recruitment issues in the interest of retaining valuable employees.