bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Breastfeeding Quality Improvement Project in Rural Primary Care
Authors: Dumphy Deborah , Thompson Julie , Clark Myra 
Published: August 2016

Background: Breastfeeding is the gold standard nutrition for infants, and more than three-fourths of US mother–infant couplets initiate breastfeeding at birth. However, breastfeeding rates plummet after hospital discharge, when mother–infant couplets enter primary care. This quality improvement project examined the effect of a primary care intervention on breastfeeding rates from the newborn visit through the 4-month visit. Objective: The overall aim of this evidence-based quality improvement project was to increase breastfeeding rates by refining the care provided to a diverse patient population with historically low breastfeeding rates. Methods: Two independent groups of mother–infant couplets, a pre-implementation (N = 43) and a post-implementation (N = 45), were longitudinally evaluated on breastfeeding rates at the newborn, 1-month, 2-month, and 4-month well-child visits for exclusive, partial, and any breastfeeding rates. Relationships for the 2 groups were compared using 2-sample t tests, chi-square, and Fisher exact tests. Results: Post-implementation rates for any breastfeeding progressively increased at each timepoint. Exclusive breastfeeding increased 40.98% at the 1-month visit, 27.4% at the 2-month visit, and 139% at the 4-month visit. Conclusion: The implementation of an evidence-based breastfeeding-friendly office protocol in a rural low breastfeeding rate primary care setting was associated with increased breastfeeding rates.
Value and nursing home profitability
Authors: Clement Jan 
Published: August 2016

Background Nursing homes in the United States are being challenged to demonstrate the value of the care they deliver. While quality and financial benefits of increasing the value of specific services accrue to nursing home residents and payers, an important unanswered question is whether producing high-value services produces financial benefits for the nursing home. Aim This paper examines whether offering high-value services to self-pay long-term care residents is associated with the nursing home’s profitability. Self-pay residents are an important market for nursing homes (29% of revenues) and one where nursing homes have pricing discretion. Methodology A multivariate regression model is estimated. Data for the study come from a unique database of per diem prices for self-pay long-term care services for Virginia nursing homes in 2011 combined with five star quality ratings from the Centers for Medicare and Medicaid Services Nursing Home Compare website. Results Offering high-value long-term care services is unrelated to operating or total margin of nursing homes. Conclusions Nursing homes can offer services to long-term care self-pay residents that are of higher quality and/or have a lower price for than other nursing homes without putting profitability at risk.
Molecular characterisation of parvoviruses from domestic cats reveals emergence of newer variants in India
Authors: Mukhopadhyay Hirak K , Nookala Mangadevi , Thangamani Nobal RK , Sivaprakasam Amsaveni , Antony Prabhakar X , Thanislass Jacob , Srinivas Mouttou V , Pillai Raghavan M 
Published: August 2016

Objectives The present study was undertaken to characterise the viral polypeptide 2 (VP2) gene of parvovirus from domestic cats in India. Methods The faecal samples from diarrhoeic/healthy domestic cats were collected from different geographical regions of India for screening by PCR assay followed by sequence analysis of the VP2 gene. Results Canine parvovirus (CPV)/feline panleukopenia virus (FPV) infections were found in 12 (11.3%) of 106 faecal samples tested. Two new CPV-2a (297Ala and Asn426) and three FPV strains were identified by VP2 gene analysis. Several unique and existing amino acid mutations were found, suggesting continuous evolution and emergence of newer variants. The phylogenetic analysis of the CPV sequences revealed that the two new CPV-2a strains from Mumbai (MC8) and Puducherry (P15) were clustered together in a single clade but had evolved independently and were ancestrally related to Chinese CPV-2a isolates. The FPV sequences (T-C-6 and T-C-1) from Thrissur, Kerala, formed a different clade (FPV clade) and were closely related to each other and had an ancestral relationship with an FPV isolate from the USA. Another FPV isolate from Goa (GC1) was positioned in the same clade but had evolved independently. Conclusions and relevance Detection of CPV in both diarrhoeic/healthy cats and the occurrence of FPV infection in a vaccinated cat provide new insights into parvovirus infections in cats in India.
Efficacy and safety of a three-times-weekly dosing regimen of glatiramer acetate in relapsing–remitting multiple sclerosis patients: 3-year results of the Glatiramer Acetate Low-Frequency Administration open-label extension study
Authors: Khan Omar , Rieckmann Peter , Boyko Alexey , Selmaj Krzysztof , Ashtamker Natalia , Davis Mat D , Kolodny Scott , Zivadinov Robert 
Published: August 2016

Background: The 1-year placebo-controlled (PC) phase of the Glatiramer Acetate Low-Frequency Administration (GALA) study showed that glatiramer acetate 40 mg/mL three times weekly (GA40) significantly reduced annualized relapse rate (ARR) and magnetic resonance imaging (MRI) activity in patients with relapsing–remitting multiple sclerosis. Patients completing the PC phase were invited to an open-label (OL) extension. Objective: To evaluate the effects of early start (ES) and delayed start (DS) of GA40 over 3 years. Methods: A total of 97.2% of patients completing the PC phase received GA40 in the OL extension. ES ( n = 943) patients received GA40 throughout; DS ( n = 461) patients received placebo during the PC phase and GA40 during the OL phase. Relapse, MRI, disease progression, and safety were evaluated. Results: A total of 1041 patients completed 3 years of follow-up. During the OL phase, ES and DS patients showed comparable ARRs (0.20–0.22) and similar numbers of gadolinium-enhancing T1 ( p = 0.49) and new or enlarging T2 lesions ( p = 0.51) at Year 3. ES patients showed significantly smaller changes in gray matter volume than DS patients from Months 12 to 36 (mean difference, 0.371%; p = 0.015), with similar trend in whole-brain volume ( p = 0.080). Adverse events were mild, consistent with the well-established glatiramer acetate (GA) safety profile. Conclusion: GA40 conferred treatment benefit over 3 years: sustained low ARR and lesion activity and favorable safety.
Increased ex vivo antigen presentation profile of B cells in multiple sclerosis
Authors: Mathias Amandine , Perriard Guillaume , Canales Mathieu , Soneson Charlotte , Delorenzi Mauro , Schluep Myriam , Du Pasquier Renaud A 
Published: August 2016

Background: Multiple sclerosis (MS) is thought to be T cell mediated but the mechanisms eliciting such a dysregulated adaptative immune response remain enigmatic. Objective: To examine the activation profile of antigen-presenting cells (APCs) in MS. Methods: A total of 98 study subjects were enrolled including patients suffering from relapsing–remitting, secondary- and primary-progressive (PP) MS, other inflammatory neurological diseases, and healthy controls. Blood monocytes and B cells were stimulated using specific ligands of toll-like receptors (TLRs) or inflammasomes or Epstein–Barr virus (EBV) particles. Their activation profile was determined before or after stimulation by flow cytometry (CD40, CD80, CD83, CD86, and human leukocyte antigen–antigen D related (HLA-DR)) and Luminex assay, measuring the concentration of eight cytokines in culture supernatants. Differences among groups were assessed in a linear model framework. Results: We demonstrate that relapsing MS patients exhibit an increased expression of HLA-DR and CD40 ex vivo, mostly at the surface of B cells. Specific stimulations of TLR or inflammasomes enhance the expression of components of the immunological synapse and the cytokine secretion but without differences between categories of study subjects. Conclusion: These data suggest that the activation profile of B cells is increased in MS. However, the perception of the danger signal by B lymphocytes and monocytes does not seem to be different in MS patients as compared to control subjects.
Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania
Authors: Carthon J. Margo Brooks , Wiltse Nicely Kelly , Altares Sarik Danielle , Fairman Julie 
Published: August 2016

Background Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity. Purpose To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007. Method We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews. Discussion Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises. Conclusions The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes.
Could participant-produced photography augment therapeutic interventions for people with intellectual disabilities? A systematic review of the available evidence
Authors: Boulton Natalie E , Williams Jonathan , Jones Robert SP 
Published: August 2016

Background: People with intellectual disabilities are entitled to equitable access to psychological support. Traditional therapeutic approaches often rely on a person’s ability to verbally articulate a description of their life, which can be particularly difficult for emotionally salient information. Methods: A systematic literature review was undertaken to determine the evidence base underpinning the use of participant-produced photography within therapeutic settings. Evidence across a range of specialisms was examined in order to extrapolate areas of best practice and make recommendations for its implementation alongside people with intellectual disabilities. Results: A systematic search of peer-reviewed journals identified 13 relevant documents. Participant-produced photography showed promise, although evidence pertaining specifically to people with intellectual disabilities was sparse ( n = 2). Conclusion: Participant-produced photography within therapeutic settings shows promise for people with intellectual disabilities. Methodological limitations made it difficult to derive firm conclusions regarding the effectiveness of different approaches. Implications for clinical and research practice are discussed.
Cost of vitamin K antagonist anticoagulant treatment in patients with metallic prosthetic valve in mitral position
Authors: Ene Gabriela , Garcia Raso Aránzazu , Gonzalez-Dominguez Weber Almudena , Hidalgo-Vega Álvaro , Llamas Pilar 
Published: August 2016

Background: The initiation of oral anticoagulation therapy after valve replacement surgery requires strict monitoring because these patients are at high risk for the development of thrombotic complications and present an increased risk of bleeding. Objectives: The aim of this study was to examine the total healthcare costs of oral anticoagulant treatment with vitamin K antagonists in patients with metallic prosthetic valves in the mitral position. Methods: Data from clinical records were used in the study including international normalized ratio results, number of medical visits, type of anticoagulant, use of rescue medication and hospital admissions from related complications. The drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included in the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the diagnosis-related group price for each case. Results: We collected data from 151 patients receiving oral anticoagulation therapy with vitamin K antagonist who were diagnosed with mitral prosthesis (n = 90), mitro-aortic prosthesis (n = 57), and mitral and tricuspid prosthesis (n = 4). The total direct healthcare cost was €15302.59, with a mean total cost per patient per year of €1558.15 (±2774.58) consisting of 44.38 (±42.30) for drug cost, €71.41 (±21.43) for international normalized ratio monitoring, €429.52 (±126.87) for medical visits, €26.31 (±28.38) for rescue medication and €986.53 (±2735.68) for related complications. Conclusion: Most direct healthcare costs associated with the sampled patients arose from the specialist-care monitoring required for treatment. Good monitoring is inversely related to direct healthcare costs.
An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay
Authors: Bracey Daniel N. , Kiymaz Tunc C. , Holst David C. , Hamid Kamran S. , Plate Johannes F. , Summers Erik C. , Emory Cynthia L. , Jinnah Riyaz H. 
Published: August 2016

Introduction: Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden. Comanagement strategies are reported in the literature, but few have addressed orthopedic-hospitalist models. An orthopedic-hospitalist comanagement (OHC) service was established at our hospital to manage hip fracture patients. We sought to determine whether the OHC (1) improves the efficiency of hip fracture management as measured by inpatient length of stay (LOS) and time to surgery (TTS) and (2) whether our results are comparable to those reported in hip fracture comanagement literature. Methods: A comparative retrospective–prospective cohort study of patients older than 60 years with an admitting diagnosis of hip fracture was conducted to compare inpatient LOS and TTS for hip fracture patients admitted 10 months before (n = 45) and 10 months after implementation (n = 54) of the OHC at a single academic hospital. Secondary outcome measures included percentage of patients taken to surgery within 24 or 48 hours, 30-day readmission rates, and mortality. Outcomes were compared to comanagement study results published in MEDLINE-indexed journals. Results: Patient cohort demographics and comorbidities were similar. Inpatient LOS was reduced by 1.6 days after implementation of the OHC ( P = .01) without an increase in 30-day readmission rates or mortality. Time to surgery was insignificantly reduced from 27.4 to 21.9 hours ( P = .27) and surgery within 48 hours increased from 86% to 96% ( P = .15). Discussion: The OHC has improved efficiency of hip fracture management as judged by significant reductions in LOS with a trend toward reduced TTS at our institution. Conclusion: Orthopedic-hospitalist comanagement may represent an effective strategy to improve hip fracture management in the setting of a rapidly expanding patient population.
Associations between attitudes toward cosmetic surgery, celebrity worship, and body image among South Korean and US female college students
Authors: Jung Jaehee , Hwang Choon Sup 
Published: August 2016

AbstractVery little information is known regarding the level of psychological attachment to celebrities needed to influence one’s desire to engage in cosmetic surgery in consumers. More importantly, no previous research examined this in relation to attitudes toward cosmetic surgery and level of body satisfaction in cross-cultural contexts. The present study aimed to examine associations between attitudes toward cosmetic surgery, celebrity worship, and body image among South Korean and US female college students. A total of 370 female undergraduates were recruited for survey from a central university in Seoul, South Korea (n = 196) and a mid-Atlantic university in the US (n = 174). The South Korean participants showed greater acceptance toward cosmetic surgery than did the US participants, whereas the US participants showed more positive attitudes toward their favorite celebrities than did the South Korean participants. For the US participants, the level of body dissatisfaction was negatively associated with acceptance for cosmetic surgery while attitudes toward favorite celebrities was positively associated with acceptance for cosmetic surgery. Findings suggest that cultural contexts affect factors influencing the likelihood of having cosmetic surgery.
Diagnostic Approach to Atypical Parkinsonian Syndromes
Authors: McFarland Nikolaus R. 
Published: August 2016

ABSTRACT

Purpose of Review: Although increasingly recognized, atypical parkinsonian syndromes remain challenging to diagnose and are underrecognized due to overlap with other parkinsonisms. This article provides a diagnostic approach to atypical parkinsonian syndromes, including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and dementia with Lewy bodies. The goal of this review is to aid the clinician in recognizing key clinical and pathologic features and to raise awareness of recent advances in diagnostics and treatment.

Recent Findings: Diagnostic criteria for atypical parkinsonian syndromes are evolving to encompass increasingly recognized heterogeneity in the presentation of these disorders and information gleamed from clinicopathologic correlations. PSP and CBD in particular now share similar pathologic clinical features and include a number of phenotypic variants. Pathologic diagnoses are increasingly used in clinical practice, and there is frequent reference now by clinicians to tauopathies, including PSP and CBD, and the synucleinopathies, which include MSA and dementia with Lewy bodies (as well as Parkinson disease). Research into biomarkers, including both tissue and imaging modalities and genetics, has the potential to increase disease recognition and make earlier diagnosis and treatment possible. Although novel therapeutics are being studied for atypical parkinsonian syndromes such as PSP, no new breakthrough interventions have emerged for the treatment of PSP, CBD, and MSA. Current therapeutic management for these disorders frequently uses a multidisciplinary team approach.

Summary: The approach to atypical parkinsonian syndromes requires recognition of a constellation of overlapping but distinct clinical features that help with identifying and distinguishing them from Parkinson disease and other similar disorders.
Chorea
Authors: Mestre Tiago A. 
Published: August 2016

ABSTRACT

Purpose of Review: This article reviews the clinical approach to the diagnosis of adult patients presenting with chorea, using Huntington disease (HD) as a point of reference, and presents the clinical elements that help in the diagnostic workup. Principles of management for chorea and some of the associated features of other choreic syndromes are also described.

Recent Findings: Mutations in the C9orf72 gene, previously identified in families with a history of frontotemporal dementia, amyotrophic lateral sclerosis, or both, have been recognized as one of the most prevalent causes of HD phenocopies in the white population.

Summary: The diagnosis of chorea in adult patients is challenging. A varied number of associated causes require a physician to prioritize the investigations, and a detailed history of chorea and associated findings will help. For chorea presenting as part of a neurodegenerative syndrome, the consideration of a mutation in the C9orf72 gene is a new recommendation after excluding HD. There are no new treatment options for chorea, aside from dopamine blockers and tetrabenazine. There are no disease-modifying treatments for HD or other neurodegenerative choreic syndromes.
Ethics of Preclinical Dopamine Transporter Imaging
Authors: Cochrane Thomas I. 
Published: August 2016

ABSTRACT
While dopamine transporter single-photon emission computed tomography (DAT-SPECT) imaging is sensitive and specific when performed in patients with signs or symptoms of parkinsonism, its predictive value is uncertain in healthy subjects, even with patients who have first-degree relatives affected by Parkinson disease. In deciding whether to honor a patient’s request for a DAT-SPECT, neurologists must balance a patient’s autonomy rights with beneficence and nonmaleficence and also consider the distributive justice implications of ordering the test. Generally speaking, the benefits of a DAT-SPECT will be too small to justify its use in an asymptomatic patient concerned about developing Parkinson disease.
Diagnosis and Management of Dystonia
Authors: Shanker Vicki , Bressman Susan B. 
Published: August 2016

ABSTRACT

Purpose of Review: This article highlights the clinical and diagnostic tools used to assess and classify dystonia and provides an overview of the treatment approach.

Recent Findings: In the past 4 years, the definition and classification of dystonia have been revised, and new genes have been identified in patients with isolated hereditary dystonia (DYT23, DYT24, and DYT25). Expanded phenotypes were reported in patients with combined dystonia, such as those with mutations in ATP1A3. Treatment offerings have expanded as there are more neurotoxins, and deep brain stimulation has been employed successfully in diverse populations of patients with dystonia.

Summary: Diagnosis of dystonia rests upon a clinical assessment that requires the examiner to understand the characteristic disease features that are elicited through a careful history and physical examination. The revised classification system uses two distinct nonoverlapping axes: clinical features and etiology. A growing understanding exists of both isolated and combined dystonia as new genes are identified and our knowledge of the phenotypic presentation of previously reported genes has expanded. Genetic testing is commercially available for some of these conditions. Treatment options for dystonia include pharmacologic therapy, chemodenervation, and surgical intervention. Deep brain stimulation benefits many patients with various types of dystonia.
Neuropsychiatric Issues in Parkinson Disease
Authors: Goldman Jennifer G. 
Published: August 2016

ABSTRACT

Purpose of Review: This article reviews the recognition and management of neuropsychiatric issues in Parkinson disease (PD), including mood disorders, cognitive impairment, and behavioral disturbances.

Recent Findings: Patients with PD frequently develop neuropsychiatric issues, and these issues can greatly affect their quality of life. In recent years, mood, cognitive, and behavioral issues in PD have received greater recognition, with increasing attention directed toward improved screening and therapeutic interventions for symptomatic treatment. Taken together as a group, neuropsychiatric issues can be found throughout the whole course of PD, from early in the disease, potentially even in a premotor stage, to the time of diagnosis and later in the course with more advanced disease.

Summary: In the comprehensive care of patients with PD, recognition of neuropsychiatric issues is critical. Advances in therapeutics for the different neuropsychiatric symptoms are still needed, although several pharmacologic and nonpharmacologic options are available. Patient management frequently requires a multidisciplinary approach, with collaboration of neurologists with neuropsychologists, psychologists, psychiatrists, and other health professionals.