bluuebunny/crossref_metadata_2025_split huggingface dataset:
Part 1: The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in Primary Care
Authors: Fornili Katherine S. 
Published: June 2016

Abstract
There is strong evidence in the literature that screening and brief counseling interventions are effective in detecting alcohol problems and decreasing alcohol consumption among patients in primary care settings but somewhat weaker evidence regarding screening and brief intervention for drug problems. In 2014, two published studies made news and caused concern among proponents of substance Screening, Brief Intervention and Referral to Treatment (SBIRT) programs, when their authors concluded that brief interventions were not effective for decreasing drug use among primary care patients identified through screening, and advised that widespread adoption of screening and brief intervention for drug use was not warranted.
An evaluation of the theoretical foundations for evidence-based SBIRT services was conducted to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for those with more serious substance use disorders, including drug use and alcohol/drug dependence. Smith and Liehr’s evaluation framework for middle-range theory was utilized to analyze the Chronic Care Model, which was featured prominently in early SBIRT literature, and the newer Recovery Management model, which provides a philosophical framework for organizing modern addictions services and quality-of-life enhancements (Part 1 of this two-part series).
Programs are more likely to succeed if guided by theory, and examination of relevant components of theory-based interventions can be useful in developing practical strategies for meeting program objectives. A new, theory-based, recovery-oriented framework for primary care SBIRT is introduced in Part 2 (“SBIRT+RM(C): A Proposed Model for Recovery-Oriented Primary Care”).
Part 2: Screening, Brief Intervention and Referral to Treatment Plus Recovery Management
Authors: Fornili Katherine S. 
Published: June 2016

Abstract
Part 1 of this two-part series (The Theoretical Basis for Recovery-Oriented Management of Substance Use Disorders in the Primary Care) explored the theoretical foundations for evidence-based substance Screening, Brief Intervention and Referral to Treatment (SBIRT) services. The aim was to produce possible explanations for why traditional SBIRT works well for individuals with unhealthy alcohol use but not as well for individuals who have more serious substance use disorders, including drug use and alcohol/drug dependence. Building on that analysis, through meaningful application of recovery management (RM) concepts within an integrated primary care/behavioral health context, a new, theory-based, recovery-oriented framework for primary care SBIRT is now introduced in Part 2. The proposed SBIRT Plus Recovery Management (SBIRT + RM) model moves traditional SBIRT from its original, limited, and narrow focus only on substance detection, brief intervention, and referral to its rightful, structured placement within a comprehensive, multidimensional, recovery-oriented system of care clinical practice environment. SBIRT+RM describes relevant strategies for improving recovery outcomes for individuals identified through primary care substance screening and defines primary care provider roles and responsibilities for sustained recovery support and long-term recovery maintenance.
Consumer-Centered, Collaborative, and Comprehensive Care
Authors: DiClemente Carlo C. , Norwood Amber E. Q. , Gregory W. Henry , Travaglini Letitia , Graydon Meagan M. , Corno Catherine M. 
Published: June 2016

Abstract
Recovery from substance abuse and mental health disorders represents a journey through which individuals move beyond treatment of provider-identified problems toward a path of achieving wellness and productive lives. Overcoming obstacles and barriers encountered along the recovery process, individuals reveal their own strengths and resilience necessary to cope, survive, and thrive in the face of adversity. Recovery-oriented system of care (ROSC) is a framework designed to address the multidimensional nature of recovery by creating a system for coordinating multiple systems, services, and supports that are person centered and build on the strengths and resiliencies of individuals, families, and communities. As is common knowledge among substance abuse and mental health providers, consumers often present with high rates of comorbidity, which complicates care. In addition, behavioral health consumers engage in risky health behaviors (e.g., smoking) at a disproportionate rate, which places them at increased risk for developing noncommunicable diseases. ROSCs are ideal for addressing the complicated and varied needs of consumers as they progress toward wellness. The challenges of creating an ROSC framework that is effective, efficient, and acceptable to consumers is formidable. It requires change on the part of agencies, organizations, providers, and consumers. The importance of comprehensive, integrated screening is highlighted as a critical component of ROSC. Key suggestions for initiating ROSC are offered.
Implementation of Recovery Programming on an Inpatient Acute Psychiatric Unit and Its Impact on Readmission
Authors: Koval Renee D. , Mcdonagh James , Grubaugh Anouk , Young Wendy , Corcoran Beth , Lee Angela , Dumas Bonnie , Edlund Barbara 
Published: June 2016

Abstract

Background
Recovery-oriented models of care are evidence based and have been shown to improve patient satisfaction and outcomes as well as decrease the percentage of readmissions to inpatient psychiatric units.

Methods
This quality improvement project was implemented on a 16-bed inpatient adult mental health unit in a Veterans Affairs Medical Center. Percentages of readmissions were compared throughout the course of implementation of the recovery model. Readmissions during the months of July–September were tabulated over 3 subsequent years and compared readmission percentages before recovery implementation, during the early stage of recovery implementation, and finally, during ongoing recovery implementation.

Results
A decrease in readmission percentages was seen with implementation of recovery-oriented care when comparing the same 3-month period over 3 years.

Conclusion
After implementation of recovery-oriented care measures, there was a decrease in percentage of readmissions to the unit. In addition, this decrease was sustained and was shown to improve over time as recovery-oriented programming was further developed on the unit. These data suggest that Veterans Affairs Medical Centers should consider adding tools and procedures to successfully implement recovery programming on inpatient units and efforts should include direct involvement of patients in their own recovery journey, revision of policies and procedures to reflect the importance of recovery, thorough training of frontline staff regarding recovery principles, and transfer of recovery information directly from inpatient units to outpatient providers.
Houston Recovery Initiative
Authors: Bitting Sara , Nash Angela , Ochoa Ashley 
Published: June 2016

Abstract
Recovery from alcohol and drug problems is a process of change through which an individual achieves control and improved quality of life. Recovery is a primary goal for individuals with substance use disorder as it provides hope that treatment and overall health are possible for every individual. More than 23 million Americans are in recovery from addiction to alcohol and other drugs.
Recovery-oriented systems of care (ROSC) are networks of community services and peer support that help individuals and families achieve recovery from substances and improve overall health. ROSC is a strengths-based and person-centered model that leverages existing community resources to address the needs of individuals and families as they progress through the journey of recovery. The ROSC model serves as the foundation of the Houston Recovery Initiative (HRI).
The purpose of this article is to describe the history, development, and infrastructure of the HRI, which is a volunteer collaboration whose main goal is to educate the community on recovery and broaden the recovery safety net for people with substance use disorder in Houston, Texas. Since 2010, the HRI has grown to include more than 200 agencies across the spectrum of treatment and recovery support services in Houston so as to provide a resource for the community. Herein, we detail efforts to grow the HRI, lessons learned, future plans, and resources needed to move the HRI forward.
A Spot on the Abdomen
Authors: Jacob Sharon E. 
Published: June 2016

ABSTRACT
Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. In this modality, there is transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report. This is a case of a spot on the abdomen.
Dermatology Emergencies
Authors: Kellen Roselyn , Berlin Joshua M. 
Published: June 2016

ABSTRACT
Dermatology is primarily an outpatient specialty. However, it is important to recognize certain conditions that require referral for inpatient management as well as for healthcare professionals to appreciate the types of patients who need to be triaged appropriately in the emergency room or urgent care setting. This article will serve to summarize some of the diagnostic features and management of these patients.
Patch Testing Tools of the Trade
Authors: Lampel Heather P. , Atwater Amber Reck 
Published: June 2016

ABSTRACT
Epicutaneous patch testing is the gold standard for obtaining a diagnosis of allergic contact dermatitis. Patients with allergic contact dermatitis who are undergoing patch testing may be taking or using topical, oral, or injectable immunosuppressant medications. Herein, we elucidate guidelines for the use of antihistamines and topical systemic immunosuppressants during the patch test process.
Adalimumab
Authors: Brankov Nikoleta , Jacob Sharon E. 
Published: June 2016

ABSTRACT
A drug is a particular substance in physiology that exerts an effect when ingested or otherwise introduced into the body. Drugs may be administered in a variety of constitutions from capsules, injections, creams, and ointments to inhalants, liquids, and dermal patches. Administration is by way of different routes, namely, topical, parenteral, inhalation, and via injection routes such as subcutaneous, intramuscular, or intravenous. The purpose of this column is to direct the reader’s attention to some of the more common drugs used in dermatology. The mechanism of action for the drug, the indications for its use, efficacy, dosing and administration, monitoring guidelines, adverse side effects, and any standard alternatives are discussed. In addition, this column contains pertinent patient education on the use of the medication. This article focuses on a common medication for plaque psoriasis, adalimumab.
Role of Transbronchial Needle Core Biopsy in the Diagnosis of Mediastinal Diseases
Authors: Galluccio Giovanni , Palazzolo Manuela , Battistoni Paolo , Dello Iacono Raffaele , Batzella Sandro , Caterino Umberto , Lucantoni Gabriele 
Published: June 2016

Background:
Enlarged lymph nodes or mediastinal masses diagnosed by computed tomographic scan before the advent of bronchoscopic procedures (TBNA or EBUS) were usually investigated using a thoracic surgical approach. In this paper, we report the experience with the use of a modified rigid tru-cut needle in the bioptical approach to mediastinal masses; to determine whether it could be considered a valid alternative to surgery, we investigated the diagnostic accuracy of this new endoscopic technique.

Methods:
A total of 156 selected patients with radiographic evidence of lymphadenopathy or mediastinal masses (subcarinal and paratracheal with a short-axis diameter >3 cm) were studied in our center by rigid bronchoscopy using a 18-G tru-cut needle to obtain a core biopsy of the lesion.

Results:
In 140 of 156 cases (89.7%), a histologically correct diagnosis was reached without perioperative or postoperative complications. A total of 114 (81.4%) malignant and 26 (18.6%) benign lesions were diagnosed avoiding further invasive surgical approach.

Conclusions:
Our results confirm that, in selected cases, transbronchial rigid core biopsy could be considered a safe and valid alternative technique to more invasive surgical approach in the diagnosis of mediastinal diseases.
Intrapulmonary Recombinant Factor VII as an Effective Treatment for Diffuse Alveolar Hemorrhage
Authors: Baker Mary S. , Diab Khalil J. , Carlos W. Graham , Mathur Praveen 
Published: June 2016

Background:
The diffuse alveolar hemorrhage (DAH) syndrome is a life-threatening pulmonary complication related to systemic vasculitides, posthematopoietic stem cell transplantation, drugs, or toxins. Once DAH develops, the mortality rate is as high as 50% to 80%. Initial treatment consists of high-dose steroids and supportive measures, including mechanical ventilation. We present a case series of 6 patients treated with intrapulmonary recombinant factor VIIa (rFVIIa) to treat refractory DAH.

Methods:
Six patients with DAH were treated with intrapulmonary instillation of rFVIIa. Doses were divided equally between the right and the left lungs. Doses were 30, 50, or 60 mcg/kg and frequencies varied from a single administration to repeated doses on subsequent days on the basis of the clinical response. All patients received high-dose steroids, and 4 also received an aminocaproic acid infusion.

Results:
Intrapulmonary rVFIIa treated DAH effectively in 5 of 6 patients. Doses used were smaller and less frequent than those described previously.

Conclusions:
Intrapulmonary factor VII is an effective adjunctive treatment for DAH. We achieved treatment success with both smaller and less frequent doses than those described previously. This may be a good therapeutic option for DAH, particularly when standard therapies have failed or bleeding is immediately life threatening. It is possible that intrapulmonary rFVIIa could save costs, while improving the intensive care unit length of stay. Further prospective studies are needed to assess the optimal dose and frequency for adequate therapeutic efficacy.
Topical Lidocaine Does Not Exaggerate Laryngomalacia in Infants During Flexible Bronchoscopy Under Propofol Anesthesia
Authors: von Ungern-Sternberg Britta S. , Trachsel Daniel , Zhang Guicheng , Erb Thomas O. , Hammer Jürg 
Published: June 2016

Background:
Topical lidocaine has been found to result in overestimation of the severity of laryngomalacia in infants undergoing flexible bronchoscopy under conscious sedation with midazolam and nalbuphine. This effect has never been confirmed and may depend on the level of sedation and the drugs used. We assessed the effect of topical lidocaine on laryngomalacia in infants undergoing flexible bronchoscopy under general anesthesia with propofol.

Methods:
Thirteen infants with congenital stridor referred to diagnostic flexible video-bronchoscopy were studied under propofol anesthesia before and 3 minutes after topical lidocaine administration to the larynx at a dose of 3 mg/kg body weight. Laryngomalacia was scored using 60 seconds video recordings of the larynx before and after lidocaine administration in random order by 2 independent blinded observers using the previously described arytenoid score (AS), epiglottis score (ES), and the total score (TS=AS+ES).

Results:
No significant differences in AS, ES, and laryngomalacia score were found between the prelidocaine and postlidocaine assessments by the 2 raters. The intraclass correlation coefficients were 0.995 (95% confidence interval, 0.986-0.998) and 0.975 (0.930-0.991) and 0.989 (0.971-996) for AS, ES, and TS, respectively.

Conclusions:
The assessment of laryngomalacia is not affected by topical lidocaine under propofol anesthesia. The lidocaine effect on laryngomalacia may vary depending on the medication regime used and the depth of procedural sedation.
Transbronchial Cryobiopsy in Interstitial Lung Disease
Authors: Cascante José A. , Cebollero Pilar , Herrero Sonia , Yagüe Adriana , Echegoyen Ana , Elizalde Jesús , Hueto Javier 
Published: June 2016

Background:
A definitive and specific diagnosis of interstitial lung disease (ILD) often requires a histologic analysis of the lung parenchyma. A transbronchial biopsy with forceps has a limited diagnostic yield for idiopathic interstitial pneumonias. The incorporation of a transbronchial lung cryobiopsy for diagnosing ILD appears to be very promising, although there are only a few published studies in this regard. Our paper shows the results of using this technique in our center.

Methods:
This was a prospective study including 55 patients with ILD diagnosed from January 2012 to January 2015. The methodology used, the overall diagnostic yield, and the number and the location of samples, in addition to complications, have been reported.

Results:
In 38 (69%), 10 (20.8%), and 7 (12.7%) cases, we obtained a certain, highly likely, and unclassifiable diagnosis of interstitial pneumonia, respectively. With 18 cases, usual interstitial pneumonia was the most common diagnosis. The most common complication was a pneumothorax in 8 patients (14.5%).

Conclusions:
A transbronchial lung cryobiopsy using a flexible cryoprobe has a good diagnostic yield and might be an alternative to consider in cases of diffuse ILD in which a histologic sample is required for diagnosis. This technique could avoid a large number of surgical biopsies.
Massachusetts Health Reform’s Effect on Hospitals’ Racial Mix of Patients and on Patients’ Use of Safety-net Hospitals
Authors: Lasser Karen E. , Hanchate Amresh D. , McCormick Danny , Chu Chieh , Xuan Ziming , Kressin Nancy R. 
Published: June 2016

Background:
Because of residential segregation and a lack of health insurance, minorities often receive care in different facilities than whites. Massachusetts (MA) health reform provided insurance to previously uninsured patients, which enabled them to potentially shift inpatient care to nonminority-serving or nonsafety-net hospitals.

Objectives:
Examine whether MA health reform affected hospitals’ racial mix of patients, and individual patients’ use of safety-net hospitals.

Research Design:
Difference-in-differences analysis of 2004–2009 inpatient discharge data from MA, compared with New York (NY), and New Jersey (NJ), to identify postreform changes, adjusting for secular changes.

Subjects:
(1) Hospital-level analysis (discharges): 345 MA, NY, and NJ hospitals; (2) patient-level analysis (patients): 39,921 patients with ≥2 hospitalizations at a safety-net hospital in the prereform period.

Measures:
Prereform to postreform changes in percentage of discharges that are minority (black and Hispanic) at minority-serving hospitals; adjusted odds of patient movement from safety-net hospitals (prereform) to nonsafety-net hospitals (postreform) by age group and state.

Results:
Treating NJ as the comparison state, MA reform was associated with an increase of 5.8% (95% CI, 1.4%−10.3%) in the percentage of minority discharges at MA minority-serving hospitals; with NY as the comparison state, the change was 2.1% (95% CI, −0.04% to 4.3%). Patient movement from safety-net to nonsafety-net hospitals was greater in MA than comparison states (difference-in-differences adjusted OR=1.3; 95% CI, 1.0–1.7; P=0.04).

Conclusions:
Following MA health reform, the safety-net remains an important component of the health care system.
Prototype End-of-Life Quality Measures Based on MDS 3 Data
Authors: Mukamel Dana B. , Ladd Heather , Caprio Thomas , Temkin-Greener Helena 
Published: June 2016

Background:
The Nursing Home Compare (NHC) report card does not include end-of-life (EOL) quality measures (QMs).

Objectives:
To develop and examine the properties of EOL QMs.

Subjects:
A total of 39,590 nursing home decedents in 626 facilities in New York State in fiscal year 2012.

Design:
Statistical analyses of Minimum Data Set 3 data, including multivariable regression analyses and descriptive statistics.

Measures:
Death in the hospital, number of hospitalizations, pain, and depression during the last 90 days before death.

Results:
Overall, 32% of residents died in the hospital. They averaged 0.49 hospitalizations in the last 90 days before death, 10% reported moderate to severe pain, and 17% had depressive symptoms. The EOL QMs exhibited variation across facilities similar to that observed for other QMs. They showed low or moderate correlations. The pain and depression QMs were significantly better among nursing homes ranked by NHC as 4 and 5 stars compared with those ranked as 1 and 2 stars for most dimensions. The hospitalizations QMs were significantly better among nursing homes ranked by NHC as 4 and 5 stars compared with those ranked as 1 and 2 stars only when compared on the staffing dimension.

Conclusions:
The Minimum Data Set 3 includes much information that can be used to assess quality of EOL care in nursing homes. The prototype measures we developed could be improved if information about advance directives and the nonclinical aspects of care, such as comfort and emotional support for both the resident and the family and respect for resident and family preferences, were collected.
Comparison of Long-run Trends in 30-day Readmission by Degrees of Medicare Payment Cuts
Authors: Shen Yu-Chu , Wu Vivian Y. 
Published: June 2016

Background and Objective:
The Affordable Care Act enacted significant Medicare payment reductions to providers, yet long-term effects of such major reductions on patient outcomes remain uncertain. Using the 1997 Balanced Budget Act (BBA) as an experiment, we compare long-run trends in 30-day readmission across hospitals with different amount of payment cuts.

Research Design, Subjects, and Measures:
Using 100% Medicare claims between 1995 and 2011 and instrumental variable hospital fixed-effects regression models, we compared changes in 30-day readmission trends for 5 leading Medicare conditions between urban hospitals facing small, moderate, and large BBA payment reductions across 4 periods [1995–1997 (pre-BBA period), 1998–2000, 2001–2005, 2006–2001]. Patient sample includes Medicare patients who were admitted to general, acute, urban, short-stay hospitals in the United States 1995–2011. Sample size ranges from 1.4 million patients for acute myocardial infarction to 3 million for pneumonia.

Results:
We found that 30-day readmission trends diverged post-BBA (2001–2005) between hospitals facing small and large payment cuts, where large-cut hospitals experience slower improvement in readmission rates relative to small-cut hospitals. The gap between small-cut and large-cut hospitals readmission trend was 6% for acute myocardial infarction, 4% for congestive heart failure and pneumonia (all P<0.01) in the 2001–2005 period. The gaps between hospitals were eliminated by the 2006–2011 period as the effect of BBA naturally dissipated over time.

Conclusions:
Although payment-cut differences are associated with widening gaps in readmission rates across hospitals, the negative association appears to dissipate in the long run.