bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Immunodeficiency Virus/Sexually Transmitted Infection Counseling and Testing Services Received by Gay and Bisexual Men Using Preexposure Prophylaxis at Their Last PrEP Care Visit
Authors: Parsons Jeffrey T. , John Steven A. , Whitfield Thomas H.F. , Cienfuegos-Szalay Jorge , Grov Christian 
Published: June 2018

Background
Preexposure prophylaxis (PrEP) reduces risk of human immunodeficiency virus infection for many gay and bisexual men (GBM); however, bacterial sexually transmitted infections associated with decreasing condom use among users is of concern. Center for Disease Control and Prevention's guidelines for PrEP use recommend bacterial sexually transmitted infection screening every 6 months. We sought to investigate comprehensive PrEP care, defined as: (1) discussion of sexual behavior, (2) blood sample, (3) urine sample, (4) rectal sample (rectal swab), and (5) throat sample (throat swab), provided at the user's last PrEP appointment.

Methods
The PrEP-using GBM in New York City (n = 104) were asked about their last PrEP care visit. We examined associations of demographics (age, race/ethnicity, and education), recent number of condomless anal sex events, time on PrEP, and health care provider type on receiving comprehensive care at last visit using fully adjusted binary logistic regression.

Results
At their last visit, nearly all men (94%) gave blood for testing, 88% provided a urine sample, and 77% discussed sexual behavior with their provider. However, only 51% reported having a rectal swab, and 48% an oral swab. Only 32% of men received comprehensive PrEP care at their last PrEP visit. Odds of receiving comprehensive care were significantly higher among younger men, men with a bachelor's degree or more education, and those who reported more condomless anal sex.

Conclusions
Less than one third of GBM received comprehensive human immunodeficiency virus/sexually transmitted infection counseling and testing at their last visit. These findings indicate further efforts are needed to prepare health care providers for prescribing and managing patients on PrEP.
Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs: An Event-Level Analysis
Authors: Zule William A. , Speizer Ilene S. , Browne Felicia A. , Howard Brittni N. , Wechsberg Wendee M. 
Published: June 2018

Background
High rates of alcohol and other drug use contribute to the ongoing generalized human immunodeficiency virus epidemic in South Africa. Despite the general link between alcohol use and condomless sex, findings from event-level studies of the relationship between alcohol use and condomless sex during the same encounter have been inconsistent.

Methods
We conducted event-level analyses of the most recent sexual encounter reported by 636 women who use substances in Pretoria. Data were collected via a questionnaire that included questions about the number of rounds of vaginal and anal sex and condom use during each round. We used multiple logistic regression analyses to model the associations between alcohol use by both partners and having multiple rounds of sex, and alcohol use and condom use during all rounds of sex.

Results
Over 50% of encounters involved multiple rounds of vaginal or anal sex. Encounters that involved multiple rounds of sex were associated with inconsistent condom use. Encounters in which both partners drank alcohol were more likely to involve condomless sex, as compared with encounters in which one or neither partner drank alcohol.

Conclusions
These findings raise the possibility that prior event-level studies, which do not ask about multiple rounds of sex, may underestimate the prevalence of condomless sex. The association between alcohol use by both partners and condomless sex may partially explain inconsistent associations between alcohol use and condom use in event-level studies that did not assess the number of partners drinking.
Impact of Providing Preexposure Prophylaxis for Human Immunodeficiency Virus at Clinics for Sexually Transmitted Infections in Baltimore City: An Agent-based Model
Authors: Kasaie Parastu , Berry Stephen A. , Shah Maunank S. , Rosenberg Eli S. , Hoover Karen W. , Gift Thomas L. , Chesson Harrell , Pennington Jeff , German Danielle , Flynn Colin P. , Beyrer Chris , Dowdy David W. 
Published: June 2018

Background
Preexposure prophylaxis (PrEP) greatly reduces the risk of human immunodeficiency virus (HIV) acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery.

Methods
To quantify the added value of STI clinic–based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected 20-year reduction in HIV incidence among MSM.

Results
Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range, 14%–18%] over 20 years, an impact that was 1.8 (1.7–2.0) times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (ie, evaluating more individuals for PrEP in the community-based strategy, because MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 (1.3–1.4) times as great as that of community-based delivery.

Conclusions
Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation.
A Comparison of Syphilis Partner Notification Outcomes by Reported Use of Internet-based Apps to Meet Sex Partners in North Carolina, 2013–2016
Authors: Mobley Victoria , Cope Anna , Dzialowy Nicole , Maxwell Jason , Foust Evelyn , Samoff Erika 
Published: June 2018

Background
Partner notification services (PNS) remain the backbone of syphilis control. The popularity of Internet-based apps to meet sex partners among early syphilis (ES) patients may hinder the success of PNS if partners cannot be located.

Methods
We compared demographic and clinical characteristics between male ES patients indicating sex with men (MSM) and reported in North Carolina between 2013 and 2016 by reported use of an Internet-based app to meet sex partners (app user). We used multivariable log-binomial regression to assess the association between app usage and ES exposure notification of 1 or more sex partner.

Results
Among 3414 MSM ES patients, 58.6% were app users. App users were more frequently white (33.2% vs 27.3%; P = 0.003), younger (median, 28 years vs 30 years; P = 0.0002) and less frequently human immunodeficiency virus coinfected (54.1% vs 58.2%; P = 0.02) compared to non-app users. Overall, 94.9% of app users and 89.6% of non-app users reported 1 or more sex partner. App users reported 2.5 times more locatable and 2.7 times more unlocatable sex partners than non-app users. Similar proportions of app (23.6%) and non-app users (25.0%) reported only unlocatable partners (P = 0.4). App usage was not associated with ES exposure notification of 1 or more sex partner (adjusted risk ratio, 0.99; 95% confidence interval, 0.87–1.13).

Conclusions
We observed no difference in the proportion of locatable partners or likelihood of notifying 1 or more sex partner of exposure among MSM ES patients, by reported use of Internet-based apps to meet sex partners. Partner notification services continues to be an important mechanism to locate and assure treatment for sex partners in this population.
Implementing Lean in Academic Primary Care
Authors: Daaleman Timothy P. , Brock Dawn , Gwynne Mark , Weir Sam , Dickinson Iris , Willis Beth , Reid Alfred 
Published: June 2018

Background:
Lean is emerging as a quality improvement (QI) strategy in health care, but there has been minimal adoption in primary care teaching practices. This study describes a strategy for implementing Lean in an academic family medicine center and provides a formative assessment of this approach.

Methods:
A case study of the University of North Carolina Family Medicine Center that used the Consolidated Framework for Implementation Research to guide a formative evaluation. The implementation strategy included partnering with Lean content experts and creating a leadership team; planning and completing QI events and Lean training modules; and evaluating and reporting activities related to QI and training.

Results:
During the initial period of Lean implementation, there was (1) minimal to no change in the quality of care as determined by the Preventive Care Index (46-48); (2) a decrease patient appointment cycle time from 89 minutes to 65 minutes; (3) an increase in overall practice productivity from $8144 to $9160; (4) a decrease in patient satisfaction from 94% to 91%; and (5) an increase in monthly visit volume from 4112 to 5076.

Conclusion:
Lean had an uneven effect on QI in an academic primary care practice during the first year of implementation.
Quality Reporting by Payers: A Mixed-Methods Study of Provider Perspectives and Practices
Authors: Garabedian Laura F. , Sinaiko Anna D. , Ross-Degnan Dennis , Abu-Jaber Tariq , Hoefer Martha , Oddleifson Stephanie , Wagner Anita K. 
Published: June 2018

Background:
Providers need timely, clinically meaningful, and actionable information to improve quality of care. Payers may play an important role in providing such information in ambulatory care settings. We sought to learn about providers' use and perceptions of quality reports from insurers.

Methods:
We employed a mixed-methods study design. We analyzed the performance of 118 provider groups on 21 HEDIS measures included in one New England insurer's quality reporting program and evaluated how a subset of provider groups (n = 55) accessed the reports. We also conducted 14 semistructured interviews with providers and administrators to assess their perspectives about quality reports from insurers in general.

Results:
Performance on quality measures varied greatly across provider groups and by metric. Only 20% of provider groups accessed the quality reports during the study period. While providers reported that payer information on quality has the potential to be useful, respondents suggested important reasons why insurer quality reports were not widely accessed, including information overload, conflicts with other sources of information, and the significant provider effort required to make the reports actionable.

Conclusions:
Payer-provider collaborations are needed to improve the usefulness of payers' quality measurement reports, and coordination among payers is needed to streamline reported measures.
Implementing a Comprehensive Unit-Based Safety Program (CUSP) to Enhance a Culture of Patient Safety and Improve Medication Safety in a Regional Home Care Program
Authors: Ganaden Rachel E. , Mitchell Lori 
Published: June 2018

Objective:
To determine whether a Comprehensive Unit-based Safety Program could be used to enhance a culture of patient safety and improve medication safety at 1 pilot site.

Methods:
The Canadian Patient Safety Culture Survey tool was used to assess the culture of patient safety and drill down on the key factors contributing to medication errors. Based on staff input and site improvement team investigations, solutions were developed to address medication safety issues. The main outcome measure was pre-/postintervention Canadian Patient Safety Culture scores. Change in frequency of occurrence reporting and staff's overall project experience were also measured.

Results:
Overall perceptions of patient safety culture improved from 70% preintervention to 76.8% postintervention, representing a 9.7% change. Volume of occurrence reporting showed a marked increase postintervention. The project was well received by staff, with 84% rating their experience as “Good” to “Excellent.” Finally 100% of participants reported that they learned something new and that this information could be applied to improve their day-to-day work.

Conclusion:
Implementing a Comprehensive Unit-based Safety Program improved staff's perceptions of patient safety, contributing to improved medication safety. To our knowledge, this is the first application of Comprehensive Unit-based Safety Program to successfully enhance patient safety in the home care setting.
Physician Engagement With Metrics in Lean Primary Care Transformation
Authors: Gray Caroline P. , Yakir Maayan , Hung Dorothy Y. 
Published: June 2018

Objective:
Data and metrics play important roles in quality and process improvement efforts. For one specific process improvement method, Lean or Lean health care, data and metrics are central components, allowing users to identify areas that need improvement and to assess the degree to which improvements have been realized. This article explores the role that metrics and measurement played in a wide-reaching “Lean”-based continuous quality improvement effort carried out in the primary care departments of a large, ambulatory care health care organization.

Methods:
This article is based on qualitative data collected through in-depth interviews with physicians, staff, and health care leaders.

Results:
Suggestions for improving the ways that metrics may be optimally used, presented, and approached while carrying out health care improvement efforts include having accurate and compelling data throughout the improvement process, ensuring that metrics are professionally meaningful to physicians, and presenting metrics in a manner that increases the likelihood that they will be digested and ultimately used to improve health care.

Conclusions:
Effective strategies for selecting and presenting metrics to practicing physicians are an important part of a successful quality improvement effort.
Multireader Study on the Diagnostic Accuracy of Ultrafast Breast Magnetic Resonance Imaging for Breast Cancer Screening
Authors: van Zelst Jan C.M. , Vreemann Suzan , Witt Hans-Joerg , Gubern-Merida Albert , Dorrius Monique D. , Duvivier Katya , Lardenoije-Broker Susanne , Lobbes Marc B.I. , Loo Claudette , Veldhuis Wouter , Veltman Jeroen , Drieling Daniel , Karssemeijer Nico , Mann Ritse M. 
Published: June 2018

Objectives
Breast cancer screening using magnetic resonance imaging (MRI) has limited accessibility due to high costs of breast MRI. Ultrafast dynamic contrast-enhanced breast MRI can be acquired within 2 minutes. We aimed to assess whether screening performance of breast radiologist using an ultrafast breast MRI-only screening protocol is as good as performance using a full multiparametric diagnostic MRI protocol (FDP).

Materials and Methods
The institutional review board approved this study, and waived the need for informed consent. Between January 2012 and June 2014, 1791 consecutive breast cancer screening examinations from 954 women with a lifetime risk of more than 20% were prospectively collected. All women were scanned using a 3 T protocol interleaving ultrafast breast MRI acquisitions in a full multiparametric diagnostic MRI protocol consisting of standard dynamic contrast-enhanced sequences, diffusion-weighted imaging, and T2-weighted imaging. Subsequently, a case set was created including all biopsied screen-detected lesions in this period (31 malignant and 54 benign) and 116 randomly selected normal cases with more than 2 years of follow-up. Prior examinations were included when available. Seven dedicated breast radiologists read all 201 examinations and 153 available priors once using the FDP and once using ultrafast breast MRI only in 2 counterbalanced and crossed-over reading sessions.

Results
For reading the FDP versus ultrafast breast MRI alone, sensitivity was 0.86 (95% confidence interval [CI], 0.81–0.90) versus 0.84 (95% CI, 0.78–0.88) (P = 0.50), specificity was 0.76 (95% CI, 0.74–0.79) versus 0.82 (95% CI, 0.79–0.84) (P = 0.002), positive predictive value was 0.40 (95% CI, 0.36–0.45) versus 0.45 (95% CI, 0.41–0.50) (P = 0.14), and area under the receiver operating characteristics curve was 0.89 (95% CI, 0.82–0.96) versus 0.89 (95% CI, 0.82–0.96) (P = 0.83). Ultrafast breast MRI reading was 22.8% faster than reading FDP (P < 0.001). Interreader agreement is significantly better for ultrafast breast MRI (κ = 0.730; 95% CI, 0.699–0.761) than for the FDP (κ = 0.665; 95% CI, 0.633–0.696).

Conclusions
Breast MRI screening using only an ultrafast breast MRI protocol is noninferior to screening with an FDP and may result in significantly higher screening specificity and shorter reading time.
Combined External, Endoscopic, Endonasal-Assisted En Bloc Resection of Malignant Tumors From the Lacrimal Drainage System
Authors: Shi Jieliang , Tu Yunhai , Wu Wencan 
Published: June 2018

Purpose:
The aim of this study is to describe a minimally invasive technique of en bloc resection of malignant tumors from lacrimal drainage system (LDS).

Methods:
This was a noncomparative, retrospective chart review of the clinical and pathologic findings of patients presenting with a LDS malignant tumor who underwent endoscopic prelacrimal recess approach with a small external incision for en bloc excision of the LDS.

Results:
A total of 12 patients from April 2010 to July 2017 were reviewed in this study. Of the 12 patients, 7 were males. The mean age was 51 years (range, 38–66 years), and all cases were unilateral. Histopathology revealed 3 adenoid cystic carcinomas, 2 squamous cell carcinomas, 2 melanomas, and 1 each of papilloma with carcinoma, papillary squamous cell carcinoma, mucoepidermoid carcinoma, B-cell lymphoma, and natural killer/T-cell lymphoma. Epiphora and a mass were the most common presentations. Adjuvant radiotherapy was given in 6 cases after surgery. Eleven patients remain alive and mean disease-free survival time was 25 months (range, 3–78 months). Two cases with malignant melanoma showed recurrence and 1 patient died of metastatic involvement.

Conclusion:
Endoscopic endonasal approach combined with a small external incision is efficient method for the management of tumors arising from the LDS.
Efficacy of Photocoagulation of Vascular Malformations in the Oral Mucosa Using Nd: YAG Laser
Authors: Cadavid Ana Maria Hoyos , de Campos Wladimir Gushiken , Aranha Ana Cecília Correa , Lemos-Junior Celso Augusto 
Published: June 2018

Abstract
The purpose of this study was to analyze the effectiveness of Nd: YAG laser photocoagulation in the treatment of vascular malformations in the oral and perioral area; 93 patients (104 lesions) were evaluated in an Ambulatory of Oral Medicine (2006–2013). The sample consisted of 57 women (61%) and 36 men (39%), aged 8 to 85 years. The lesion size was smaller than 3 cm in most patients. The lesions were located on the lips, jugal mucosa, tongue, palate, gingiva, and retromolar trigone. All patients were treated on an outpatient basis using local anesthesia and Nd: YAG laser (Power Laser C ) with a wavelength of 1064 nm and a fiber optic diameter of 400 μm. After treatment no patients had complications, however, in patients of deep lesions, 2 or more irradiations were required to treat the lesions. Finally, the authors conclude that the clinical and aesthetic satisfactory results of the 93 patients treated with Nd: YAG laser suggest that this type of laser is effective and safe in the treatment of oral and perioral vascular malformations.
Successful Treatment of Pneumocephalus Using a Free-Style Chimeric Free Flap From a Scarred Thigh
Authors: Visconti Giuseppe , Pagliara Domenico , Bianchi Alessandro , La Rocca Giuseppe , Olivi Alessandro , Salgarello Marzia 
Published: June 2018

Abstract
Pneumocephalus is an air collection in cranial cavity caused by accidental exposition of intracranial compartment after trauma or surgery. Skull base reconstruction with free flap is a useful surgical tool to avoid cerebral herniation or intracranial infection. The authors describe a patient of pneumocephalus following anterior skull base meningioma resection, unsuccessfully treated with 2 attempts of fascia lata grafts harvested from both thighs. A free-style chimeric anterolateral thigh free flap was performed using middle third of rectus femoris muscle to fill the planum spheno-ethmoidalis defect and adipocutaneous paddle for postoperative monitoring and for favoring a tension free skin closure. Free-style dissection with limited undermining in the previously scarred thigh was performed to avoid donor-site complication. Postoperative course was uneventful with complete resolution of the pneumocephalus.
Homologous Banked Bone Grafts for the Reconstruction of Large Cranial Defects in Pediatric Patients
Authors: Canzi Gabriele , Talamonti Giuseppe , Mazzoleni Fabio , Bozzetti Alberto , Sozzi Davide 
Published: June 2018

Purpose:
Autogenous bone represents the best material in pediatric reconstructive cranioplasty because of its compatibility with growth; however, its availability is limited. Alternative use of alloplastic materials would have the advantage of unlimited amount, but shows an increased risk of complications and incompatibility with growth. Fresh frozen banked cadaveric bones could be ideal for the reconstruction of large cranial defects in growing patients, because it offers unlimited amount of structural grafts with biomechanics properties quite similar to the autologous bones.

Results:
The authors report 2 cases of growing patients (13 months female and 9 years old male) undergoing the reconstruction of large (about 70 cm2 and 50 cm2 respectively) cranial vault defects, by using structural homologous banked bone grafts.
Analytic main reconstruction materials risks/benefits evaluation, literature review of few previously reported pediatric cranioplasty with homologous bone, and both clinical cases satisfactory radiologic long-term results (beyond 4 years of F.U.) are reported.

Conclusion:
Structural homologous banked bone grafts appear as a valid solution for pediatric canioplasty reconstruction of wide defects, entailing the advantages of available without limitations and compatibility with future growth. The risk of transmissible infections seems minimal and is totally counterbalanced by the stability of long-term results.