bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Innovative Model for Naloxone Use Within an OTP Setting: A Prospective Cohort Study
Authors: Katzman Joanna G. , Takeda Mikiko Y. , Bhatt Snehal R. , Moya Balasch Monica , Greenberg Nina , Yonas Howard 
Published: December 2017

Objectives:
Unintentional opioid overdose deaths are a public health crisis, and naloxone is the most effective harm reduction tool to curb many of these deaths. There is growing evidence that take-home naloxone can prevent opioid overdose in targeted populations. The goal of this study is to measure the opioid overdose reversal rate with take-home naloxone among participants with a diagnosis of opioid use disorder (OUD) in an opioid treatment program (OTP) setting.

Methods:
Patients enrolled in an outpatient OTP program were eligible for this prospective cohort study between April 4, 2016 and July 4, 2016. Two hundred forty-four study participants received overdose education, instruction on how to use naloxone, and were provided with 2 doses of a take-home naloxone auto-injector kit. They were subsequently followed for 3 months.

Results:
Thirty-one study participants reported overdose reversals using naloxone auto-injector kits on 38 community members. All overdose reversals were heroin-related. Eighty-seven per cent of the community members reversed with naloxone were friends or relatives of the study participants.

Conclusions:
This study validates that naloxone is not commonly used on the index study participant, but is often used on a secondary target among people who inject drugs. The large number of overdose reversals reported in this prospective study suggests that this novel model for naloxone use may be replicated at other OTP settings to reduce opioid overdose deaths.
Epidemiology of axial spondyloarthritis: an update
Authors: Wang Runsheng , Ward Michael M. 
Published: December 2017

Purpose of review
To provide an update of the prevalence and incidence of axial spondyloarthritis in the general population and in patients with spondyloarthritis-related conditions, environmental risk factors for ankylosing spondylitis, progression from nonradiographic axial spondyloarthritis to ankylosing spondylitis, mortality, and risks for cardiovascular events in patients with ankylosing spondylitis.

Recent findings
Increasingly, administrative healthcare data have been used to study disease frequency and outcomes. The prevalence of ankylosing spondylitis ranged from 9 to 30 per 10 000 persons, which are lower than previous estimates. Data on whether childhood infections influence the risk of ankylosing spondylitis were equivocal, while having been breast-fed may be protective. Progression of patients with nonradiographic axial spondyloarthritis to ankylosing spondylitis is slow, with estimates of 5.1% in 5 years and 19% in 10 years. Risk of mortality is slightly increased in ankylosing spondylitis. Risks for cardiovascular events in ankylosing spondylitis were either not different from, or only slightly higher than in controls. No studies have examined these outcomes in the broader group of patients with axial spondyloarthritis.

Summary
Expanded use of administrative and registry data has facilitated studies of the epidemiology of ankylosing spondylitis, but lack of specific diagnostic codes limits use of these resources for studying axial spondyloarthritis in general.
Incidence of Meniscal Entrapment and Associated Knee Injuries in Tibial Spine Avulsions
Authors: Rhodes Jason T. , Cannamela Peter C. , Cruz Aristides I. , Mayo Meredith , Styhl Alexandra C. , Richmond Connor G. , Ganley Theodore J. , Shea Kevin G. 
Published: December 2017

Background:
Tibial spine avulsions (TSA) have historically been treated as isolated injuries. Data on associated injuries are limited with existing literature reporting wide ranging incidences. The purpose of this multicenter study was to (1) describe the incidence of meniscal entrapment and associated knee injuries in TSA and to (2) compare surgical and magnetic resonance image (MRI) findings for these injuries. Our hypothesis is that tibial spine injuries are not usually isolated injuries, and other meniscal, ligament, and cartilage injuries may be present.

Methods:
MRI and surgical reports for patients with a diagnosis of a tibial spine fracture were retrospectively reviewed. Type of fracture was recorded as noted in the reports along with concomitant meniscal entrapment and osteochondral, ligamentous, and meniscal injury. Images and reports were reviewed by an orthopaedic surgeon at each respective institution.

Results:
A total of 163 patients were included in this study. MRI was done for 77 patients and surgery was performed in 144 cases. Meniscal entrapment was found in 39.9% of all patients. MRI diagnosed meniscus, osteochondral, and non-anterior cruciate ligament ligamentous injury was found in 31.2%, 68.8%, and 32.4% of cases, respectively. Surgically diagnosed meniscus, chondral, and non-anterior cruciate ligament ligamentous injury was found in 34.7%, 33.3%, and 5.6% of patients, respectively.

Conclusions:
TSA fractures are associated with significant risk for concomitant knee injuries including meniscal tear, bone contusion, and chondral injury. Incidence of meniscal entrapment found during surgery was high, in spite of low incidence of positive findings by MRI.

Level of Evidence:
Level IV—retrospective case series.
Collateral Ligament Knee Injuries in Pediatric and Adolescent Athletes
Authors: Kramer Dennis E. , Miller Patricia E. , Berrahou Iman K. , Yen Yi-Meng , Heyworth Benton E. 
Published: December 2017

Background:
The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports.

Methods:
Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging–confirmed isolated MCL or LCL injury over an 8-year period. Retrospective review then documented patient and injury characteristics and clinical course. General linear modeling was used to analyze risk factors for prolonged return to sports, continued pain or reinjury.

Results:
Fifty-one knees (33 in males, 65%), mean age 13.8 years (range, 5 to 17), were identified, of which 40 (78%) had MCL injuries. Over half (29, 57%) of knees had an open distal femoral physis including all 5 bony avulsion injuries. Eleven (22%) had LCL injuries of which 3 (6%) had concurrent posterolateral corner injuries. Forty-two (82%) knees had injuries that occurred during sports. Eleven knees (28%) with MCL tears had a simultaneous patellar instability episode. Knee injuries that occurred during sports had 37% shorter recovery time (P=0.02). Eight knees (16%) experienced a reinjury and 12 (24%) were followed over an extended period of time for various knee issues. Football injuries were more likely to be grade 3 (P=0.03), and football and soccer accounted for all grade III injuries. The mean return to sports was 2.2 months, with grade III cases returning at 2.4 months, and 95% of cases within 4 months.

Conclusions:
Isolated collateral ligament injuries are rare in adolescent athletes. MCL injuries, one-quarter of which occurred in conjunction with patellar instability events, were 4 times more common than LCL injuries, one quarter of which have other posterolateral corner structures involved. Grade III injuries represent 20% to 25% of collateral ligament injuries and occurred most commonly in football and soccer.

Level of Evidence:
Level IV—retrospective case series.
Trends in Physician Reimbursement for Spinal Procedures Since 2010
Authors: Meyers Joshua E. , Wang Jiefei , Khan Asham , Davies Jason M. , Pollina John 
Published: December 2017

Study Design.
Retrospective cohort study.

Objective.
To identify trends in spinal procedure reimbursement in our practice since 2010.

Summary of Background Data.
In an uncertain healthcare climate with continuous reform, trends in physician reimbursement are unclear. Market forces of supply and demand, legislation imposing penalties for quality measures, local competition, and geographic location have the potential to affect reimbursement. An emphasis on quality-of-care and cost reduction is placed on providers and insurers. In a high-cost area such as spine surgery, it is unknown what the reimbursement trends have been over the last 7 years of major healthcare reforms.

Methods.
We collected payments received data for the 20 most commonly billed Current Procedural Terminology (CPT) codes for spinal surgery from January 2010 to December 2016. Payments were adjusted for inflation using the Consumer Price Index for Medical Care in the Northeastern United States. Insurers were separated into four groups: Medicare, Medicaid, Private Insurance, and Workers Compensation and No Fault (WC/NF). Using a weighted average to adjust for variation in procedures performed, average payments were trended over time. Average payments were trended by insurance group averaged by CPT code.

Results.
After adjusting for inflation, average overall payments for spinal claims from 2010 to 2016 increased 13.6%. Average reimbursement declined 1.9% from 2010 to 2013 and rose 16.8% from 2014 to 2016. Average Medicaid payments increased 150.1% since 2010 whereas average Medicare payments rose 4.9%. Average reimbursement from private insurers and WC/NF claims decreased 16.2% and 8.5%, respectively, from 2010 to 2013; increasing 14.2% and 12.5%, respectively, from 2014 to 2016. From 2010 to 2016, reimbursement for private insurance decreased 9.3% and increased 8.2% for WC/NF claims.

Conclusion.
Since 2010, inflation-adjusted reimbursement for spinal procedures increased in our practice. There was a decline from 2010 to 2013. Increases occurred from 2014 to 2016 across all insurers. Medicaid payments more than doubled since 2010.

Level of Evidence: 3
Analysis of Successful Versus Failed Radiographic Outcomes After Cervical Deformity Surgery
Authors: Protopsaltis Themistocles S. , Ramchandran Subaraman , Hamilton D. Kojo , Sciubba Daniel , Passias Peter G. , Lafage Virginie , Lafage Renaud , Smith Justin S. , Hart Robert A. , Gupta Munish , Burton Douglas , Bess Shay , Shaffrey Christopher , Ames Christopher P. 
Published: December 2017

Study Design.
Prospective multicenter cohort study with consecutive enrollment.

Objective.
To evaluate preoperative alignment and surgical factors associated with suboptimal early postoperative radiographic outcomes after surgery for cervical deformity.

Summary of Background Data.
Recent studies have demonstrated correlation between cervical sagittal alignment and patient-reported outcomes. Few studies have explored cervical deformity correction prospectively, and the factors that result in successful versus failed cervical alignment corrections remain unclear.

Methods.
Patients with adult cervical deformity (ACD) included with either cervical kyphosis more than 10°, C2-C7 sagittal vertical axis (cSVA) of more than 4 cm, or chin-brow vertical angle of more than 25°. Patients were categorized into failed outcomes group if cSVA of more than 4 cm or T1 slope and cervical lordosis (TS-CL) of more than 20° at 6 months postoperatively.

Results.
A total of 71 patients with ACD (mean age 62 yr, 56% women, 41% revisions) were included. Fourty-five had primary cervical deformities and 26 at the cervico-thoracic junction. Thirty-three (46.4%) had failed radiographic outcomes by cSVA and 46 (64.7%) by TS-CL. Failure to restore cSVA was associated with worse preoperative C2 pelvic tilt angle (CPT: 64.4° vs. 47.8°, P = 0.01), worse postoperative C2 slope (35.0° vs. 23.8°, P = 0.004), TS-CL (35.2° vs. 24.9°, P = 0.01), CPT (47.9° vs. 28.2°, P < 0.001), “+” Schwab modifiers (P = 0.007), revision surgery (P = 0.05), and failure to address the secondary, thoracolumbar driver of the deformity (P = 0.02). Failure to correct TS-CL was associated with worse preoperative cervical kyphosis (10.4° vs. –2.1°, P = 0.03), CPT (52.6° vs. 39.1°, P = 0.04), worse postoperative C2 slope (30.2° vs. 13.3°, P < 0.001), cervical lordosis (–3.6° vs. –15.1°, P = 0.01), and CPT (37.7° vs. 24.0°, P < 0.001). Multivariate analysis revealed postoperative distal junctional kyphosis associated with suboptimal outcomes by cSVA (odds ratio 0.06, confidence interval 0.01–0.4, P = 0.004) and TS-CL (odds ratio 0.15, confidence interval 0.02–0.97, P = 0.05).

Conclusion.
Factors associated with failure to correct the cSVA included revision surgery, worse preoperative CPT, and concurrent thoracolumbar deformity. Failure to correct the TS-CL mismatch was associated with worse preoperative cervical kyphosis and CPT. Occurrence of early postoperative distal junctional kyphosis significantly affects postoperative radiographic outcomes.

Level of Evidence: 3
The Present State of Neurointensivist Training in the United States: A Comparison to Other Critical Care Training Programs
Authors: Marcolini Evie G. , Seder David B. , Bonomo Jordan B. , Bleck Thomas P. , Hemphill J. Claude , Shutter Lori , Rincon Fred , Timmons Shelly D. , Nyquist Paul 
Published: December 2017

Objective:
This manuscript describes the state of neurocritical care fellowship training, compares its written standards to those of other critical care fellowship programs, and discusses how programmatic oversight by the United Council for Neurological Subspecialties should evolve to meet American College of Graduate Medical Education standards. This review is a work product of the Society of Critical Care Medicine Neuroscience section and was reviewed and approved by the Council of the Society of Critical Care Medicine.

Data Sources:
We evaluated the published training criteria and requirements of American College of Graduate Medical Education Critical Care subspecialty fellowships programs of Internal Medicine, Surgery, and Anesthesia and compared them with the training criteria and required competencies for neurocritical care.

Study Selection:
We have reviewed the published training standards from American College of Graduate Medical Education as well as the United Council for Neurologic Subspecialties subspecialty training documents and clarified the definition and responsibilities of an intensivist with reference to the Leapfrog Group, the National Quality Forum, and the Joint Commission.

Data Extraction:
No data at present exist to test the concept of similarity across specialty fellowship critical care training programs.

Data Synthesis:
Neurocritical care training differs in its exposure to clinical entities that are directly associated to other critical care subspecialties. However, the core critical care knowledge, procedural skills, and competencies standards for neurocritical care appears to be similar with some important differences compared with American College of Graduate Medical Education critical care training programs.

Conclusions:
The United Council for Neurologic Subspecialties has developed a directed program development strategy to emulate American College of Graduate Medical Education standards with the goal to have standards that are similar or identical to American College of Graduate Medical Education standards.
Medical bioinformatics in melanoma
Authors: Cheng Phil F. 
Published: December 2017

Purpose of review
Bioinformatic insights from next-generation sequencing has been integral in understanding melanoma biology, resistance to treatment and provided new avenues for melanoma treatment. Whole-genome sequencing, whole-exome sequencing and RNA sequencing has redefined the molecular classification of melanoma, revealed distinct genetic aberrations that define clinical subtypes of melanoma and uncovered the diverse heterogeneity that resides in an individual tumor.

Recent findings
In this review, we will summarize the recent whole-genome study that catalogs the genomic landscape across many melanoma subtypes, the single-cell RNA sequencing studies that interrogates tumor heterogeneity and the personalized vaccine approaches to melanoma treatment.

Summary
Whole-genome sequencing of diverse subtypes of melanoma revealed acral and mucosal subtypes to have a different genomic landscape compared with cutaneous melanoma. Acral and mucosal melanomas are characterized by low mutation burden and high structural variants. Single-cell RNA sequencing revealed high intratumoral heterogeneity and the existence of rare intrinsic drug-resistant populations. Lastly, vaccination against tumor neoantigens could be a potential personalized medicine therapy for melanoma patients. In summary, bioinformatics research is deeply ingrained in all aspects of melanoma research and will continue to blossom together for many years to come.
Continuing Education Meets the Learning Organization: The Challenge of a Systems Approach to Patient Safety
Authors: Eisenberg John M. 
Published: December 2017

Abstract:
Since the release of the report of the Institute of Medicine on medical errors and patient safety in November 1999, health policy makers and health care leaders in several nations have sought solutions that will improve the safety of health care. This attention to patient safety has highlighted the importance of a learning approach and a systems approach to quality measurement and improvement. Balanced with the need for public disclosure of performance, confidential reporting with feedback is one of the prime ways that nations such as the United States, Canada, the United Kingdom, and Australia have approached this challenge. In the United States, the Quality Interagency Coordination Task Force has convened federal agencies that are involved in health care quality improvement for a coordinated initiative. Based on an investment in a strong research foundation in health care quality measurement and improvement, there are eight key lessons for continuing education if it is to parlay the interest in patient safety into enhanced continuing education and quality improvement in learning health care systems. The themes for these lessons are (1) informatics for information, (2) guidelines as learning tools, (3) learning from opinion leaders, (4) learning from the patient, (5) decision support systems, (6) the team learning together, (7) learning organizations, and (8) just-in-time and point-of care delivery.
Faculty Development for Continuing Interprofessional Education and Collaborative Practice
Authors: Silver Ivan l. , Leslie Karen 
Published: December 2017

Abstract:
This article proposes a framework for faculty development in continuing interprofessional education (CIPE) and collaborative practice. The framework is built on best practices in faculty development and CIPE. It was informed by local experience in the development, delivery, and evaluation of a faculty development program to promote capacity for dissemination of concepts relating to interprofessional education (IPE) and interprofessional collaboration (IPC) in health care environments. Interprofessional education has been demonstrated in clinical contexts to enhance interprofessional collaboration, patient care, and health outcomes. With curriculum design, teaching methods, and educational strategies in faculty development, it is possible to enhance the impact of IPE in clinical contexts. Faculty development activities themselves can model effective interprofessional education methods and practice. An IPE curriculum and teaching and education strategies are outlined. Strategic planning, including the application of a systems approach, attention to the principles of effective learning, and an outcomes-based curriculum design are recommended for the development of continuing IPE faculty development programs that enhance interprofessional collaboration.
The Role of the Faith Community Nurse in Weight Management
Authors: Kelley Sabrina 
Published: December 2017

ABSTRACT:
Over two thirds of U.S. adults are overweight or obese; many view long-term behavior change as unachievable. Faith community nurses are ideally positioned to help people learn strategies for successful weight management. This article discusses the role of faith in lifestyle modification, and the use of the 5 A's Model for weight management.
Associations Between Early Family Meal Environment Quality and Later Well-Being in School-Age Children
Authors: Harbec Marie-Josée , Pagani Linda S. 
Published: December 2017

ABSTRACT:

Objective:
Past research suggests a positive link between family meals and child and adolescent health. Although researchers have often relied on how often families eat together, this may not capture the complexity of the experience. Using a birth cohort, this study examines the prospective associations between the environmental quality of the family meal experience at age 6 years and child well-being at age 10.

Methods:
Participants are 1492 children of the Quebec Longitudinal Study of Child Development. When children were age 6, parents reported on their typical family meal environment quality. At age 10, parents, teachers, and children themselves provided information on lifestyle habits, academic achievement, and social adjustment, respectively. The relationship between early family meal environment quality and later child outcomes was analyzed using a series of multivariate linear regression.

Results:
Family meal environment quality at age 6 predicted higher levels of general fitness and lower levels of soft drink consumption, physical aggression, oppositional behavior, nonaggressive delinquency, and reactive aggression at age 10. These relationships were adjusted for child characteristics (sex, temperament problems and cognitive abilities, and baseline body mass index [BMI]) and family characteristics (family configuration and functioning, maternal education, depression, and BMI).

Conclusion:
From a population-health perspective, our findings suggest that family meals have long-term influences on children's biopsychosocial well-being. At a time when family meal frequency is on a natural decline in the population, this environmental characteristic can become a target of home-based interventions and could be featured in information campaigns that aim to optimize child development.
Best-Worst Scaling to Prioritize Outcomes Meaningful to Caregivers of Youth with Mental Health Multimorbidities: A Pilot Study
Authors: Camelo Castillo Wendy , Ross Melissa , Tariq Saad , dosReis Susan 
Published: December 2017

Abstract

Objective:
Health care decision-making for youth with mental health multimorbidity is guided by outcomes that are considered most meaningful and important. The study objective was to pilot test a best-worst scaling (BWS) instrument designed to assess trade-offs among caregiver-defined, meaningful health care outcomes.

Methods:
A BWS was designed with continuous stakeholder involvement to elicit caregiver-defined outcomes in 4 domains: school, behavioral, social, and independence. Four attributes were identified for each outcome domain, for a total of 16 attributes. Using a balanced incomplete block design, a BWS instrument was developed with 16 choice task questions displaying 6 attributes at a time. A convenience sample was selected from Maryland caregivers of children who were 21 years old or younger and had a developmental delay and a comorbid mental health condition. Participants completed a survey that included demographics and the BWS instrument. Conditional logit was used to estimate utility scores and 95% confidence intervals (CI) for each attribute, which were ranked in order of importance. Attribute statements were refined after a respondent debriefing session.

Results:
A total of 38 caregivers participated in the pilot study. Child safety to self was the most important outcome (1.01, CI, 0.78–1.24). This was followed by securing support for an Individualized educational plan in school (0.77, CI, 0.54–1.01) and the child being able to stay in school all day (0.53, CI, 0.29–0.77).

Conclusion:
BWS scenarios that resemble real-life decision-making can be a useful tool to identify preferences for health care outcomes.