bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability and validity of emergency department triage tools in low- and middle-income countries: a systematic review
Authors: Jenson Alexander , Hansoti Bhakti , Rothman Richard , de Ramirez Sarah S. , Lobner Katie , Wallis Lee 
Published: March 2017

ObjectiveDespite the universal acknowledgment that triage is necessary to prioritize emergency care, there is no review that provides an overview of triage tools evaluated and utilized in resource-poor settings, such as low- and middle-income countries (LMICs). We seek to quantify and evaluate studies evaluating triage tools in LMICs.MethodsWe performed a systematic review of the literature between 2000 and 2015 to identify studies that evaluated the reliability and validity of triage tools for adult emergency care in LMICs. Studies were then evaluated for the overall quality of evidence using the GRADE criteria.ResultsEighteen studies were included in the review, evaluating six triage tools. Three of the 18 studies were in low-income countries and none were in rural hospitals. Two of the six tools had evaluations of reliability. Each tool positively predicted clinical outcomes, although the variety in resource environments limited ability to compare the predictive nature of any one tool. The South African Triage Scale had the highest quality of evidence. In comparison with high-income countries, the review showed fewer studies evaluating reliability and presented a higher number of studies with small sample sizes that decreased the overall quality of evidence.ConclusionThe quality of evidence supporting any single triage tool’s validity and reliability in LMICs is moderate at best. Research on triage tool applicability in low-resource environments must be targeted to the actual clinical environment where the tool will be utilized, and must include low-income countries and rural, primary care settings.
Disparities in Potentially Preventable Hospitalizations Between American Indian and Alaska Native and Non-Hispanic White Medicare Enrollees
Authors: O’Connell Joan , Rockell Jennifer , Ouellet Judith C. , LeBeau Mark 
Published: March 2017

Objective:
A number of health care initiatives seek to improve health outcomes by increasing access to outpatient services while reducing preventable acute events. We evaluated disparities between American Indian and Alaska Native (AI/AN) and non-Hispanic white (white) Medicare enrollees in access to outpatient preventive, primary, and specialty services by comparing their potentially preventable hospitalizations (PPHs).

Research Design:
The study population included 121,311 adult AI/AN Medicare enrollees registered to use services funded by the Indian Health Service and 5,915,011 adult white enrollees living in the same counties. Medicare 2010 data and a nationally recognized algorithm were used to identify PPHs.

Results:
Among AI/AN Medicare enrollees, 58.6% had either diabetes, cardiovascular disease, or both conditions; the AI/AN age-adjusted prevalence of either or both conditions was 1.2 times that of the white enrollees (P<0.001). The age-adjusted PPH rate for all AI/ANs was 74 admissions per 1000 adults, 1.5 times that of white enrollees (P<0.001). Nearly 90% of AI/AN PPHs were among AI/ANs with diabetes, cardiovascular disease, or both conditions; their PPH rate was 114 admissions per 1000 adults, 1.2 times that of white enrollees (P<0.001) with those conditions.

Conclusions:
Differences in disease burden and access to outpatient services may partly explain the higher PPH rates for AI/AN Medicare enrollees. The health care quality measure used in this study (PPH) was developed for the US general population. It is important to consider AI/AN socioeconomic and other characteristics when interpreting findings for such measures and enhancing programs and policies to improve AI/AN health outcomes.
“Where’s My Choice?” An Examination of Veteran and Provider Experiences With Hepatitis C Treatment Through the Veteran Affairs Choice Program
Authors: Tsai Jack , Yakovchenko Vera , Jones Natalie , Skolnik Avy , Noska Amanda , Gifford Allen L. , McInnes D. Keith 
Published: March 2017

Background:
The Department of Veterans Affairs (VA) is the country’s largest provider for chronic hepatitis C virus (HCV) infection. The VA created the Choice Program, which allows eligible veterans to seek care from community providers, who are reimbursed by the VA.

Objectives:
This study aimed to examine perspectives and experiences with the VA Choice Program among veteran patients and their HCV providers.

Research Design:
Qualitative study based on semistructured interviews with veteran patients and VA providers. Interview transcripts were analyzed using rapid assessment procedures based in grounded theory.

Subjects:
A total of 38 veterans and 10 VA providers involved in HCV treatment across 3 VA medical centers were interviewed.

Measures:
Veterans and providers were asked open-ended questions about their experiences with HCV treatment in the VA and through the Choice Program, including barriers and facilitators to treatment access and completion.

Results:
Four themes were identified: (1) there were difficulties in enrollment, ongoing support, and billing with third-party administrators; (2) veterans experienced a lack of choice in location of treatment; (3) fragmented care led to coordination challenges between VA and community providers; and (4) VA providers expressed reservations about sending veterans to community providers.

Conclusions:
The Choice Program has the potential to increase veteran access to HCV treatment, but veterans and VA providers have described substantial problems in the initial years of the program. Enhancing care coordination, incorporating shared decision-making, and establishing a wide network of community providers may be important areas for further development in designing community-based specialist services for needy veterans.
The Affordable Care Act’s Dependent Care Coverage and Mortality
Authors: McClellan Chandler 
Published: March 2017

Background:
In September 2010, the Affordable Care Act (ACA) enabled young adults to gain insurance coverage under their parents’ policies.

Objective:
Assess the impact of the ACA’s dependent care coverage expansion on young adult mortality rates.

Research Design:
Using the Multiple Cause Mortality public use database for 2008–2013, the impact of the ACA is examined with a difference-in-differences analysis of monthly mortality rates using individuals aged 26–30 as a natural control group for young adults aged 19–25.

Results:
The average monthly disease-related mortality rate of the 19–25 years old group fell by between 3.1% and 6.1% in the wake of the dependent care coverage expansion. Reduction in mortality was primarily in disease-related causes which are amenable to general medical care such as cardiovascular disease, while mortality due to trauma-related causes, which must be treated regardless of insurance status under preexisting laws, was unaffected.

Conclusion:
The reduction in mortality from this single provision of the ACA indicates that larger gains in preventable mortality could be made as health insurance coverage continues to expand under the ACA.
Allergic laryngitis: unraveling the myths
Authors: Stachler Robert J. , Dworkin-Valenti James P. 
Published: March 2017

Purpose of review
This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in the air or ones consumed. This area of inquiry requires continued interest and investigation. As the field of clinical laryngology changes, and more information is discovered about the possible causal association between allergy and vocal pathologies, practicing otolaryngologists, allergists, and other medical professionals may discover more comprehensive methods to evaluate and treat their allergic patients, particularly those who present with complaints of dysphonia, dysphagia, laryngopharyngeal reflux (LPR), and/or dyspnea.

Recent findings
There continues to be epidemiological studies designed to describe the relationship of allergy to vocal symptoms and signs. Both population and smaller studies have recently attempted to link these two conditions. Unfortunately, the patient with chronic laryngeal complaints is often tagged by default with the diagnosis of LPR and treated with proton pump inhibitors, which are not always beneficial. The endoscopic assessment may not be as reliable to make the diagnosis of LPR as the examination is subjective and the inter-rater reliability is low. It has been demonstrated by direct laryngeal provocation studies that sticky-viscous endo-laryngeal mucous is the only reliable finding consistently associated with allergy potential allergic tissue reactivity.

Summary
The interrelationship of allergic sensitivity and chronic laryngitis in certain individuals is becoming clearer because our knowledge of inquiry has increased and the available routine technology to diagnose these conditions has remarkably improved. Notwithstanding these advancements, much more research is needed on this subject to reduce the frequency of mis-diagnoses and mis-management of allergic patients.
Patient adherence to swallowing exercises in head and neck cancer
Authors: Wells Mary , King Emma 
Published: March 2017

Purpose of review
A younger population and improved treatments for head and neck cancer (HNC) mean that more people are now living longer with the consequences of treatment, including long-term swallowing problems (dysphagia). Exercises aim to improve swallowing function, however highly variable adherence rates are currently reported, with no standard measure of adherence.

Recent findings
Measuring adherence to swallowing exercises depends on the definition of ‘adherence’, the tools used to measure adherence, and the acceptable threshold that is used to constitute adherence or nonadherence. Particular barriers to swallowing exercise adherence include the burden of treatment, the commitment required to undertake a home-based exercise programme and the difficulty in motivating patients to exercise before swallowing problems have become apparent. Findings from the wider literature on general exercise interventions highlight the importance of external and patient-related factors on adherence, including patient beliefs, social support, self-regulation and goal setting.

Summary
Key barriers and motivators to adherence are presented, which will have implications for the design of future swallowing exercise interventions. The relevance of behaviour change theory in facilitating adherence is highlighted, with ongoing studies used to exemplify how behaviour change components and analysis of patient beliefs can be incorporated into intervention development.
Factors Associated With Ambulatory Activity in De Novo Parkinson Disease
Authors: Christiansen Cory , Moore Charity , Schenkman Margaret , Kluger Benzi , Kohrt Wendy , Delitto Anthony , Berman Brian , Hall Deborah , Josbeno Deborah , Poon Cynthia , Robichaud Julie , Wellington Toby , Jain Samay , Comella Cynthia , Corcos Daniel , Melanson Ed 
Published: March 2017

Background and Purpose:
Objective ambulatory activity during daily living has not been characterized for people with Parkinson disease prior to initiation of dopaminergic medication. Our goal was to characterize ambulatory activity based on average daily step count and examine determinants of step count in nonexercising people with de novo Parkinson disease.

Methods:
We analyzed baseline data from a randomized controlled trial, which excluded people performing regular endurance exercise. Of 128 eligible participants (mean ± SD = 64.3 ± 8.6 years), 113 had complete accelerometer data, which were used to determine daily step count. Multiple linear regression was used to identify factors associated with average daily step count over 10 days. Candidate explanatory variable categories were (1) demographics/anthropometrics, (2) Parkinson disease characteristics, (3) motor symptom severity, (4) nonmotor and behavioral characteristics, (5) comorbidities, and (6) cardiorespiratory fitness.

Results:
Average daily step count was 5362 ± 2890 steps per day. Five factors explained 24% of daily step count variability, with higher step count associated with higher cardiorespiratory fitness (10%), no fear/worry of falling (5%), lower motor severity examination score (4%), more recent time since Parkinson disease diagnosis (3%), and the presence of a cardiovascular condition (2%).

Discussion and Conclusions:
Daily step count in nonexercising people recruited for this intervention trial with de novo Parkinson disease approached sedentary lifestyle levels. Further study is warranted for elucidating factors explaining ambulatory activity, particularly cardiorespiratory fitness, and fear/worry of falling. Clinicians should consider the costs and benefits of exercise and activity behavior interventions immediately after diagnosis of Parkinson disease to attenuate the health consequences of low daily step count.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A170).
Executive Function Is Associated With Off-Line Motor Learning in People With Chronic Stroke
Authors: Al-dughmi Mayis , Al-Sharman Alham , Stevens Suzanne , Siengsukon Catherine F. 
Published: March 2017

Background and Purpose:
Sleep has been shown to promote off-line motor learning in individuals following stroke. Executive function ability has been shown to be a predictor of participation in rehabilitation and motor recovery following stroke. The purpose of this study was to explore the association between executive function and off-line motor learning in individuals with chronic stroke compared with healthy control participants.

Methods:
Seventeen individuals with chronic stroke (>6 months poststroke) and 9 healthy adults were included in the study. Participants underwent 3 consecutive nights of polysomnography, practiced a continuous tracking task the morning of the third day, and underwent a retention test the morning after the third night. Participants underwent testing on 4 executive function tests after the continuous tracking task retention test.

Results:
Participants with stroke showed a significant positive correlation between the off-line motor learning score and performance on the Trail-Making Test from Delis-Kaplan Executive Function System (r = 0.652; P = 0.005), while the healthy control participants did not. Regression analysis showed that the Trail-Making Test–Delis-Kaplan Executive Function System is a significant predictor of off-line motor learning (P = 0.008).

Discussion and Conclusions:
This is the first study to demonstrate that better performance on an executive function test of attention and set-shifting predicts a higher magnitude of off-line motor learning in individuals with chronic stroke. This emphasizes the need to consider attention and set-shifting abilities of individuals following stroke as these abilities are associated with motor learning. This in turn could affect learning of activities of daily living and impact functional recovery following stroke.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A166).
Flexed Truncal Posture in Parkinson Disease: Measurement Reliability and Relationship With Physical and Cognitive Impairments, Mobility, and Balance
Authors: Forsyth Aimi L. , Paul Serene S. , Allen Natalie E. , Sherrington Catherine , Fung Victor S. C. , Canning Colleen G. 
Published: March 2017

Background and Purpose:
Flexed truncal posture is common in people with Parkinson disease (PD); however, little is known about the mechanisms responsible or its effect on physical performance. This cross-sectional study aimed to establish the reliability of a truncal posture measurement and explore relationships between PD impairments and truncal posture, as well as truncal posture and balance and mobility.

Methods:
A total of 82 people with PD participated. Truncal posture was measured in standing as the distance between vertebra C7 and a wall. Univariate and multivariate regression analyses were performed with truncal posture and impairments, including global axial symptoms, tremor, bradykinesia, rigidity, freezing of gait (FOG), reactive stepping and executive function, as well as truncal posture with balance and mobility measures.

Results:
The truncal posture measure had excellent test-retest reliability (ICC3,1 0.79, 95% CI 0.60-0.89, P < 0.001). Global axial symptoms had the strongest association with truncal posture (adjusted R
2 = 0.08, P = 0.01), although the majority of the variance remains unexplained. Post hoc analysis revealed that several impairments were associated with truncal posture only in those who did not report FOG. Flexed truncal posture was associated with poorer performance of most balance and mobility tasks after adjustment for age, gender, disease severity, and duration (adjusted R
2 = 0.24-0.33, P < 0.001-0.03).

Discussion and Conclusions:
The C7 to wall measurement is highly reliable in people with PD. Global axial symptoms were independently associated with truncal posture. Greater flexed truncal posture was associated with poorer balance and mobility. Further studies are required to elucidate the mechanisms responsible for flexed truncal posture and the impact on activity.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A164).
Self-efficacy and Walking Performance in Persons With Multiple Sclerosis
Authors: Motl Robert W. , Balto Julia M. , Ensari Ipek , Hubbard Elizabeth A. 
Published: March 2017

Background and Purpose:
Impairment of walking function is a prevalent and burdensome feature of multiple sclerosis (MS), and represents a primary focus of rehabilitation research and clinical care. Research examining self-efficacy as a correlate of walking performance in MS is lacking; self-efficacy represents a theory-based, modifiable target of rehabilitation approaches for improving walking outcomes. This cross-sectional study examined the association between self-efficacy and walking performance in persons living with MS.

Methods:
The sample included 69 persons with MS who completed the Multiple Sclerosis Self-Efficacy (MSSE) Scale and Exercise Self-Efficacy (EXSE) Scale and undertook the Timed 25-Foot Walk (T25FW) and the 6-Minute Walk (6MW) tests. The data were analyzed using the Pearson product moment correlation coefficients and linear regression.

Results:
Correlation analysis indicated that function subscale scores on the MSSE correlated more strongly with T25FW (r = 0.55) than did the control subscale (r = 0.40) and EXSE (r = 0.38) scores, and both function (r = 0.67) and control (r = 0.53) subscale scores on the MSSE correlated more strongly with 6MW than did EXSE scores (r = 0.40). Linear regression analyses indicated that (1) function MSSE subscale, but not control subscale, explained significant variance in T25FW speed and 6MW distance and (2) function MSSE subscale, but not EXSE, explained significant variance in T25FW speed and 6MW distance.

Discussion and Conclusions:
We provide the first evidence of an association between self-efficacy, particularly for functioning with MS, and objective walking performance in MS. Future research to replicate and extend these results can inform rehabilitation efforts that target improvement of walking performance in persons with MS.

Digital Abstract available for more insights from the authors (see Slides, Supplemental Digital Content 1, http://links.lww.com/JNPT/A171).
Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of US Physical Therapists
Authors: Boyne Pierce , Billinger Sandra , MacKay-Lyons Marilyn , Barney Brian , Khoury Jane , Dunning Kari 
Published: March 2017

Background and Purpose:Best practice recommendations indicate that aerobic exercise (AEX) should be incorporated into stroke rehabilitation. However, this may be challenging in clinical settings. The purpose of this study was to assess physical therapist (PT) AEX prescription for patients with stroke, including AEX utilization, barriers to AEX prescription, dosing parameters, and safety considerations.Methods:A cross-sectional Web-based survey study was conducted. Physical therapists with valid e-mail addresses on file with the state boards of Florida, New Jersey, Ohio, Texas, and Wyoming were eligible to participate. Survey invitations were e-mailed to all licensed PT in these states. Analysis focused on respondents who were currently involved with clinical stroke rehabilitation in common practice settings.Results:Results from 568 respondents were analyzed. Most respondents (88%) agreed that AEX should be incorporated into stroke rehabilitation, but 84% perceived at least one barrier. Median prescribed AEX volume varied between practice settings from 20- to 30-minute AEX sessions, 3 to 5 days per week for 2 to 8 weeks. Prescribed intensity was most commonly light or moderate; intensity was determined by the general response to AEX and patient feedback. Only 2% of respondents reported that the majority of their patients with stroke had stress tests.Discussion and Conclusions:Most US PTs appear to recognize the importance of AEX for persons poststroke, but clinical implementation can be challenging. Future studies and consensus are needed to clarify best practices and to develop implementation interventions to optimize AEX utilization in stroke rehabilitation.Video Abstract availablefor more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A167).
Influence of Cueing and an Attentional Strategy on Freezing of Gait in Parkinson Disease During Turning
Authors: Spildooren Joke , Vercruysse Sarah , Heremans Elke , Galna Brook , Verheyden Geert , Vervoort Griet , Nieuwboer Alice 
Published: March 2017

Background and Purpose:
Individuals with Parkinson disease exhibit decreased axial head-pelvis rotation. Consequently, they turn more en bloc than healthy controls, which may contribute to freezing during turning. We wanted to understand the influence of auditory cueing and an attentional strategy on turning and how this related to freezing of gait (FOG).

Methods:
Fifteen participants with Parkinson disease and FOG were asked to turn 180° during baseline condition, unilateral cueing, and an attentional strategy prompting to start the turn with head rotation first. FOG occurrence, axial rotation, center of mass (COM) deviation, knee-flexion amplitude, and total turn velocity were measured using 3D motion analysis while off-medication. Normal reference values were obtained from 14 age-matched controls.

Results:
Thirty-nine FOG episodes occurred in 5 participants. FOG occurred in 52.8% of baseline trials compared with 34.6% of trials using the head-first strategy, and 3.8% of the auditory cueing trials. During the head first strategy, the initiation of head, trunk, and pelvic rotation as well as the head-pelvis separation resembled turning patterns of healthy controls, but the COM shift to the inside of the turn was exaggerated. By contrast, during cueing, turning became more en bloc, with decreased head-pelvis separation and knee-flexion amplitude.

Discussion and Conclusions:
Cueing reduced FOG but did not correct axial movement deficits. The head-first strategy improved head-pelvis dissociation but had only limited effects on FOG. These results suggest that axial and COM deviation impairments are not directly related to FOG but may rather indicate a compensatory mechanism. Cueing reinforced the en-bloc movement and might as such help prevent FOG by triggering an alternative neural mechanism for movement generation.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A163).