bluuebunny/crossref_metadata_2025_split huggingface dataset:
Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation
Authors: Vanneman Megan E. , Harris Alex H.S. , Asch Steven M. , Scott Winifred J. , Murrell Samantha S. , Wagner Todd H. 
Published: February 2017

Background:
The Veterans Choice Program (VCP), enacted by Congress after concerns surfaced about access, enables veterans to receive care outside Veterans Health Administration (VHA) facilities. Veterans who face long wait times, large driving distances, or particular hardships are eligible for VCP. Prior purchased care programs were comparatively limited in scope.

Objectives:
We sought to describe utilization of VHA-provided and purchased outpatient care by veterans eligible for VCP before and after VCP implementation. We focused on veterans recently eligible for VHA as they are of particular policy relevance and might have less established care patterns.

Research Design:
We identified all Iraq and Afghanistan veterans who were eligible for VCP in 2015. We tabulated their use of VHA and purchased outpatient care for 3 years before (FY2012–2014) and 1 year after VCP implementation (FY2015).

Subjects:
Our study population consisted of 214,449 Iraq and Afghanistan veterans who were eligible for VCP due to wait-time, distance, or hardship issues.

Results:
In the first year of the program, 3821 (2%) of these Iraq and Afghanistan veterans used non-VHA services through VCP. Per capita VHA utilization tended to decline slightly after VCP implementation, but these changes varied by type of outpatient care.

Conclusions:
There was low uptake of VCP services in the first year of the program. Data from additional years are needed to better understand the impact of this policy.
The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home
Authors: A. Salzberg Claudia , Bitton Asaf , Lipsitz Stuart R. , Franz Cal , Shaykevich Shimon , Newmark Lisa P. , Kwatra Japneet , Bates David W. 
Published: February 2017

Background:
Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH.

Objectives:
We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization.

Research Design:
Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change.

Results:
Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (P<0.0001), 2.42 (P<0.0001), 3.98 (P<0.0001), and 3.61 (P<0.0001) per 1000 per month. Modest increases in inpatient admission were seen among these patients in PCMH either with or without payment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization.

Conclusions:
We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions.
Changes in Emergency Department Utilization After Early Medicaid Expansion in California
Authors: Sabik Lindsay M. , Cunningham Peter J. , Tehrani Ali Bonakdar 
Published: February 2017

Background:
Medicaid expansions aim to improve access to primary care, which could reduce nonemergent (NE) use of the emergency department (ED). In contrast, Medicaid enrollees use the ED more than other groups, including the uninsured. Thus, the expected impact of Medicaid expansion on ED use is unclear.

Objectives:
To estimate changes in total and NE ED visits as a result of California’s early Medicaid expansion under the Affordable Care Act. In addition to overall changes in the number of visits, changes by payer and safety net hospital status are examined.

Methods:
We used a quasi-experimental approach to examine changes in ED utilization, comparing California expansion counties to comparison counties from California and 2 other states in the same region that did not implement Medicaid expansion during the study period.

Results:
Regression estimates show no significant change in total number of ED visits following expansion. Medicaid visits increased by 145 visits per hospital-quarter in the first year following expansion and 242 visits subsequent to the first year, whereas visits among uninsured patients decreased by 129 visits per hospital-quarter in the first year and 175 visits in subsequent years, driven by changes at safety net hospitals. We also observe an increase in NE visits per hospital-quarter paid for by Medicaid, and a significant decrease in uninsured NE visits.

Conclusions:
Medicaid expansions in California were associated with increases in ED visits paid for by Medicaid and declines in uninsured visits. Expansion was also associated with changes in NE visits among Medicaid enrollees and the uninsured.
A Comparison of Self-reported Medication Adherence to Concordance Between Part D Claims and Medication Possession
Authors: Savitz Samuel T. , Stearns Sally C. , Zhou Lei , Thudium Emily , Alburikan Khalid A. , Tran Richard , Rodgers Jo E. 
Published: February 2017

Objective:
Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence.

Materials and Methods:
We matched Part D claims for 6 common medications to medications brought to a study visit in 2011–2013 for the Atherosclerosis Risk in Communities study. The combined data consisted of 3027 medication events (claims, medications possessed, or both) for 2099 Atherosclerosis Risk in Communities study participants. Multinomial logistic regression estimated the association of concordance (visit only, Part D only, or both) with self-reported medication adherence while controlling for sociodemographic characteristics, veteran status, and availability under Generic Drug Discount Programs.

Results:
Relative to participants with high adherence, medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be visit only (P<0.001). The results were similar but smaller in magnitude (approximately 2–3 percentage points) for participants with medium adherence. Compared with females, medication events for male veterans were approximately 11 percentage points less likely to match and more likely to be visit only. Events for medications available through Generic Drug Discount Programs were 3 percentage points more likely to be visit only.

Conclusions:
Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims.
Using Serum IgE Antibodies to Predict Esophageal Eosinophilia in Children
Authors: Erwin Elizabeth A. , Rhoda Dale A. , Redmond Margaret , Ly Jean B. , Russo John M. , Hill Ivor D. , Platts‐Mills Thomas A.E. 
Published: February 2017

ABSTRACTObjectives:Symptoms of eosinophilic esophagitis are variable and can be nonspecific. Food‐specific serum immunoglobulin E (IgE) antibodies are frequently found in patients with eosinophilic esophagitis and are obtained using a widely available blood test. Our objective was to evaluate the ability of food‐specific IgE antibodies to predict the presence of esophageal eosinophilia.Methods:We reviewed 144 medical records for pediatric patients having esophageal biopsy and serum analysis for IgE antibodies to food (exploratory group). We performed logistic regression using sex and number of positive food‐specific IgE tests to develop a model that predicts ≥15 eosinophils/high‐power field (hpf) in the esophagus. We tested the model using 142 additional patients (validation group).Results:The probability of having ≥15 eosinophils/hpf in the esophagus was higher in boys and increased with the number of positive food‐specific IgE tests from 12% (95% confidence interval 4.8–26) in girls with 0 foods positive to 86% (95% confidence interval 71–94) for boys with 4 or 5 foods positive. The statistical model using sex and number of positive IgE tests to predict patients having ≥15 eosinophils/hpf showed acceptable discriminative ability (area under the receiver operating characteristic curve 0.80). The performance metrics for the model to predict ≥15 eosinophils/hpf in the validation group were similar (area under the receiver operating characteristic curve 0.75).Conclusions:Requiring only a blood test and a simple algorithm, analysis for IgE antibodies to food may expedite an esophagogastroduodenoscopy and decrease delays in the diagnosis and treatment of patients with nonspecific gastrointestinal symptoms who have increased eosinophils in the esophagus.
Body Mass Index and the Association With Vaso-occlusive Crises in Pediatric Sickle Cell Disease
Authors: Zivot Andrea , Apollonsky Nataly , Gracely Edward , Raybagkar Deepti 
Published: February 2017

Background:
Children with sickle cell disease (SCD) historically have been underweight and have poor overall growth. Recent studies have demonstrated a trend toward obesity in pediatric SCD populations.

Materials and Methods:
Through retrospective chart review of patients with SCD followed at our center, we collected patient’s data, including body mass index (BMI), weight percentiles, sickle cell genotype, baseline hemoglobin, medical and psychiatric comorbidities, 25-hydroxy vitamin D level, treatment with hydroxyurea, and chronic transfusions. We identified hospitalizations to St. Christopher’s Hospital for vaso-occlusive crisis (VOC) and duration of hospitalization and intravenous opioid use were recorded. Student t test, Mann-Whitney U test, and analysis of variance were used to examine associations between variables and frequency and duration of hospitalizations for VOC.

Results:
Among 328 patients with SCD, overweight and obese children constituted 19% of hospitalized and nonhospitalized patients. BMI status did not influence frequency (P=0.90) or duration of hospitalization (P=0.65) for VOC. Obesity was more associated with HbSC than HbSS (P=0.025) genotype.

Conclusions:
Our study did not demonstrate an association between extremes of BMI of patients and hospitalization for VOC. Considering current trend toward obesity, further prospective and interventional research are required to define the effects of extremes of BMI on pain crises in SCD.
Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship
Authors: Hulett Jennifer M. , Armer Jane M. , Leary Emily , Stewart Bob R. , McDaniel Roxanne , Smith Kandis , Millspaugh Rami , Millspaugh Joshua 
Published: February 2017

Background:
Psychoneuroimmunological theory suggests a physiological relationship exists between stress, psychosocial-behavioral factors, and neuroendocrine-immune outcomes; however, evidence has been limited.

Objective:
The primary aim of this pilot study was to determine feasibility and acceptability of a salivary cortisol self-collection protocol with a mail-back option for breast cancer survivors. A secondary aim was to examine relationships between religiousness/spirituality (R/S), perceptions of health, and diurnal salivary cortisol (DSC) as a proxy measure for neuroendocrine activity.

Methods:
This was an observational, cross-sectional study. Participants completed measures of R/S, perceptions of health, demographics, and DSC.

Results:
The sample was composed of female breast cancer survivors (n = 41). Self-collection of DSC using a mail-back option was feasible; validity of mailed salivary cortisol biospecimens was established. Positive spiritual beliefs were the only R/S variable associated with the peak cortisol awakening response (r
s = 0.34, P = .03). Poorer physical health was inversely associated with positive spiritual experiences and private religious practices. Poorer mental health was inversely associated with spiritual coping and negative spiritual experiences.

Conclusions:
Feasibility, validity, and acceptability of self-collected SDC biospecimens with an optional mail-back protocol (at moderate temperatures) were demonstrated. Positive spiritual beliefs were associated with neuroendocrine-mediated peak cortisol awakening response activity; however, additional research is recommended.

Implications for Practice:
Objective measures of DSC sampling that include enough collection time points to assess DSC parameters would increase the rigor of future DSC measurement. Breast cancer survivors may benefit from nursing care that includes spiritual assessment and therapeutic conversations that support positive spiritual beliefs.
An Integrative Review of Psychosocial Concerns Among Young African American Breast Cancer Survivors
Authors: Nolan Timiya S. , Frank Jennifer , Gisiger-Camata Silvia , Meneses Karen 
Published: February 2017

Background:
African American (AA) women are more likely to be given a diagnosis of breast cancer at an early age, experience morbidity after treatment, and exhibit disparities in survivorship. Although psychosocial well-being is largely studied among breast cancer survivors, data are sparse regarding young AA survivors.

Objective:
This integrative review examined psychosocial concerns in survivorship among young AA survivors using a quality-of-life framework.

Methods:
PubMed, CINHAL, EMBASE, PsychINFO, and Scopus were searched for articles exploring psychosocial well-being in young AA survivors.

Results:
The search yielded 237 articles that were retrieved and reviewed for relevance. Of these, 16 articles were selected based on inclusion/exclusion criteria. Data were evaluated and synthesized based on the quality-of-life model. Selected articles omitted the study of several psychological subconstructs and identified existing psychosocial concerns that require mitigation.

Conclusions:
The review revealed key areas of psychosocial concerns among young AA survivors including ongoing anxiety/depression, cognitive changes, and relationships. Identified gaps include paucity of research with young AA survivors and their residual psychosocial concerns.

Implications for Practice:
Review findings indicate a need to increase survivorship research on young AA survivors. Researchers, clinicians, and young AA survivors must partner in efforts to understand psychosocial concerns and translate findings into clinical practice (ie, use of psychosocial distress tools, distress de-escalation protocols, and individualized survivorship care plans) toward reduction of quality-of-life health disparities among young AA survivors.
Comorbid Dementia and Cancer in Residents of Nursing Homes
Authors: Blytt Kjersti Marie , Selbæk Geir , Drageset Jorunn , Natvig Gerd Karin , Husebo Bettina S. 
Published: February 2017

Background:Life expectancy is increasing continuously, which increases the likelihood of developing dementia or cancer. Both dementia and cancer are serious conditions that give manifold symptoms. The interaction of these conditions is however complex and less explored.Objectives:The aim of this study was to identify the prevalence of cancer and differences regarding neuropsychiatric symptoms (NPS) and medication among nursing home (NH) patients with and without dementia and cancer.Methods:This is a cross-sectional study of Norwegian NH patients (N = 1825). Participants were categorized according to degree of dementia (Clinical Dementia Rating > 1) and cancer diagnoses. Differences in NPS and other symptoms, as well as the use of medication, were explored.Results:Eighty-four percent of NH patients had dementia, and 5.5% had comorbid dementia and cancer. Patients with comorbid dementia and cancer received significantly more analgesics compared with patients without cancer but with dementia (P< .05). Compared with patients without dementia but with cancer, patients with comorbid dementia and cancer had significantly more NPS, including sleep disturbances and agitation.Conclusions:Patients with comorbid dementia and cancer receive more analgesics than patients with dementia but still display more agitation and sleep disturbances than patients with cancer and patients with neither dementia nor cancer, suggesting that symptoms may not be treated adequately.Implications for Practice:The results indicate a considerable strain for patients with comorbid dementia and cancer and highlight essential challenges for the clinician who is responsible for treatment and care. Nurses should pay attention to agitation and sleep disturbances among patients with comorbid dementia and cancer.
The Relationships Among Symptom Distress, Posttraumatic Stress Symptoms, and Depression in Patients With Female-specific Cancers
Authors: Tung Hong-Yi , Lin Yu-Hua , Kao Chia-Chan , Wu Shu-Fen 
Published: February 2017

Background:
Previous studies have demonstrated that posttraumatic stress symptoms (PTSS) affect women with breast cancer. However, few studies have explored the relationships among PTSS, symptom distress, and depression in association with cancers specific to women in Taiwan.

Objective:
The aim of this study was to explore the relationships among symptom distress, PTSS, and depression in women given a diagnosis of female-specific cancers.

Methods:
A cross-sectional design was used, and 220 women given a diagnosis of female-specific cancer were recruited from a general hospital in southern Taiwan. The outcome measures included the subjects’ scores on a symptom distress scale, the Chinese Davidson Trauma Scale, and the Center for Epidemiologic Studies-Depressive Scale; their personal characteristics; and disease-related variables.

Results:
There were significant positive relationships among the frequency of PTSS, the severity of PTSS, symptom distress, and depressive symptoms. Logistic regression analysis demonstrated that educational level, symptom distress, and the frequency of PTSS were significant predictors of depression.

Conclusions:
The study demonstrated a high prevalence of depression in women with female-specific cancer, and the results confirm the relationship between PTSS and depression. In addition, educational level and physical distress were also found to be predictors of depression.

Implications for Practice:
Screening for depressive symptoms should be a component of routine screening in women with female-specific cancer. Oncology nurses should be aware of the distress symptoms experienced by these women and recognize PTSS in patients who are given a diagnosis of female-specific cancer. Awareness will reduce the multiple risks of posttraumatic stress disorder and depression and decrease the depressive symptoms of women after surviving cancer.
Identification of Optic Nerve Swelling Using Point-of-Care Ocular Ultrasound in Children
Authors: Marchese Ronald F. , Mistry Rakesh D. , Binenbaum Gil , Liu Grant T. , Scarfone Richard J. , Woodford Ashley L. , Chen Aaron E. 
Published: February 2017

Objective
The aim of this study was to determine the feasibility and accuracy of point-of-care (POC) ocular ultrasound (US) when performed by a pediatric emergency medicine (PEM) physician to detect optic nerve abnormalities concerning for swelling, as compared with the fundus examination performed by an ophthalmologist.

Methods
This was a single-center, prospective cohort pilot study of children aged 12 months to 18 years who required optic disc evaluation by an ophthalmologist. Eligible subjects were enrolled from the emergency department, inpatient wards, and neuro-ophthalmology outpatient clinic of an urban, tertiary care children’s hospital. Point-of-care ocular US, specifically assessing optic nerve sheath diameter and optic disc elevation, was performed. Findings on US were compared with findings identified by an ophthalmologist on dilated fundus examination.

Results
Seventy-six subjects were enrolled; 20 (26%) of 76 had findings concerning for optic nerve swelling diagnosed by an ophthalmologist on fundus examination. Using a sonographic definition for optic nerve swelling of optic nerve sheath diameter greater than 4.5 mm or the presence of optic disc elevation, the sensitivity and specificity were 90% and 55%, respectively. The success rate of POC ocular US was 100%, and the mean time to completion was 8 minutes. For emergency department subjects in whom direct fundus examination was attempted, the PEM physician could visualize the optic disc and assess for swelling in only 40% (14/35) of examinations.

Conclusions
The results of our study suggest that POC ocular US performed by PEM physicians was feasible and determined to be sensitive but nonspecific in the detection of optic nerve swelling. Additional larger studies may determine generalizability to other nonophthalmologist physicians performing POC ocular US.
Meta-analysis of the Unintentional Death of Children Aged 0 to 5 Years in China Between 1995 and 2015
Authors: Su Baoning , Yu Jian’er 
Published: February 2017

Objectives
The aim of this study was to identify the primary cause of and a means by which to prevent the unintentional injury and death of children aged 0 to 5 years in China.

Methods
A systematic review of literature published in this area between 1995 and 2015, accessible via Chongqing VIP, Wanfang, CNKI, and PubMed databases, in addition to other electronic databases and related magazines and professional information, was conducted. The data were retrieved using Cochrane Systematic review methods. All information was judged using the Jadad method. A meta-analysis was carried out on homogeneous studies. RevMan 5.3 software was used to analyze the gathered information.

Results
A total of 125 related pieces of literature were retrieved. Of the 14 that met the inclusion criteria, 6 were of moderate quality and 8 of general quality. The meta-analysis showed that in a comparison of unintentional injury and death of male and female children, the odds ratio was [1.73 to 1.95] for a 95% confidence interval (P < 0.00001). In a comparison of urban and rural areas, the odds ratio was [0.02, 0.02] for a 95% confidence interval (P < 0.00001).

Conclusions
Based on accessible literature, the incidence of unintentional injury and death of boys is higher than that in girls and is also higher in rural areas than in urban areas of China. Considering the significant difference in the latter comparison, developing and implementing methods to reduce the unintentional injury and death of children in rural areas should receive greater attention.