bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Experience: The New Heart of Healthcare Leadership
Authors: Wolf Jason A. 
Published: December 2017

Summary
In a healthcare world in which consumerism is no longer a question and value has claimed its place at center stage, leaders are called to think differently about how they operate and manage their organizations. Priorities are curving in new directions with shifts in policy, direction of dollars, and evolution of practice. At the center of this transition is an opportunity for healthcare leaders to recognize that patient experience is the new heart of healthcare leadership.
To address quality, safety, service, cost, and population health outcomes, leaders must rethink how they understand and engage in experience efforts overall. An intentional and clear strategic line of sight and purpose are required, including how patient experience is defined, the core concepts it comprises and is influenced by, and the outcomes it ultimately helps achieve. The challenge for leaders is to reconceive how this maximum potential can be achieved as compared with how experience has been traditionally managed through tactical efforts.
Quick lists of effective tactics are relatively easy to come by, and leaders are already aware of many, if not most, of them. So why do so many organizations applying these tactics today struggle to maintain the results they seek? The reason is that tactics are only as useful as the framework in which they are applied and as robust as the foundation on which they are implemented. The intent of this article is to stir a dialogue on how to reframe the issue of patient experience.
In reframing a collective view about what patient experience is, the way leaders choose to address it must change. This adjustment requires balancing the work of defining patient experience with the strategic intent behind what organizations ultimately aim to achieve. In changing the conversation on patient experience, we move it from an idea that lurks at the edges of healthcare, or that stands as just one of many strategic pillars, to the central call to action for healthcare leaders.
Patient Experience: A Critical Indicator of Healthcare Performance
Authors: Guler Pamela H. 
Published: December 2017

Summary
Patient experience has become a critical differentiator for healthcare organizations, and it will only grow in importance as transparency and consumerism dominate the healthcare landscape. Creating and sustaining a consistently exceptional experience that promotes patient engagement and the best outcomes is far more than just “satisfying” patients, going well beyond amenities that may be provided.
Perception of care experience is often shaped by methods we use to address the biopsychosocial needs of patients. Building relationships and communicating well with our patients and families are primary approaches. In a complex healthcare situation, patients may not fully understand or remember the highly clinical nature of treatment. However, they always remember how we made them feel, how we communicated with them as a team, and what interactions they experienced while in our care.
Patients who are fully informed and feel connected to their caregivers are often less anxious than those who are disengaged. Informed and engaged patients are enabled to participate in their healthcare. Organizations that focus on developing an accountable culture—one that inspires caregivers to communicate in a way that connects to patients’ mind, body, and spirit while leveraging standard, evidence-based patient experience practices—find that patients’ perception of care, or “the patient experience,” is vastly improved.
Adventist Health System has embarked on a journey to patient experience excellence with a commitment to whole-person care and standard patient experience practice across the system. Recognized with several national awards, we continue to strengthen our approach toward bringing all of our campuses and patient settings to sustained high-level performance. We have found that a combination of strong, accountable leadership; a focus on employee culture; engagement of physicians; standardized patient experience practices and education; and meaningful use of patient feedback are top contributors to excellence in patient experience.
Finding Like-Minded Partners to Span the Continuum of Care
Authors: Lawrence Bruce 
Published: December 2017

SUMMARY
This is an era of profound industry transformation, characterized by such forces as acceleration away from inpatient-centered care and toward alternative payment models, rising rates of chronic disease, and an aging population. Add to this mix physician and nurse shortages and a newfound understanding that today’s patients are informed consumers, and the reality becomes clear: Healthcare providers must be adaptable, agile, and innovative to survive. Sometimes, the best way forward in transformative times is collaboration with other like-minded organizations.
For INTEGRIS, an integrated, not-for-profit health system based in Oklahoma City, Oklahoma, partnering has always been a part of the corporate culture and a vital strategy in fulfilling its mission to improve the health of the people and communities it serves. In earlier days, collaborations often took the form of partnerships with community organizations to go beyond the hospital’s walls and reach deeply into the community to address the underlying health needs of its population.
However, the concept of partnerships has expanded to meet today’s strategic business needs. INTEGRIS, for example, evaluates most partnerships in terms of population health management and the system’s continuum of care. Care settings are viewed as being of three distinct types: community-based, acute, and post-acute. When it comes to health—and, increasingly, wellness—the goal of the system is to connect patients to whatever service they need, at whatever stage of life, whether that service is fully or partly owned by INTEGRIS or provided through partner affiliations.
This network of partnerships involves the patient, the community, physicians, other clinicians and providers, insurers, regional collaborators, and others. INTEGRIS’s partnership strategies have evolved over the years, and its partnerships have produced synergy and alignment to decrease costs, increase revenue, and better serve customers with the right care, in the right setting, at the right time.
Pursuit of Value Drives Strategy to Improve Operations and Outcomes
Authors: Borgstrom Marna P. , Deshpande Ohm M. , Balcezak Thomas J. 
Published: December 2017

SUMMARY
The future of American healthcare remains cloudy, with the shifting contours of regulatory and fiscal reform still being shaped. Providers are beset by many challenges that vary but often include state and federal healthcare funding decisions that are antithetical to the interests of patients and aging populations. Regional public health crises and rapidly evolving relationships with third-party payers complicate matters even further.
Yale New Haven Health System decided to pursue value as its overriding strategy for navigating the uncertainty in healthcare that is likely to persist for years to come. Many, if not most, of the challenges we face at Yale New Haven Health are shared by health systems across the country; the operational concepts that drive our strategy likely will be familiar. The differentiator is the execution: At Yale New Haven Health, infusing our organization with a culture of high reliability, as well as adopting the practice of clinical redesign, has yielded concrete enhancements in patient care, operational resilience, and financial sustainability. Clinical redesign saved Yale New Haven Health nearly $25 million in direct costs in one year alone.
IMAGING OF VITELLIFORM MACULAR LESIONS USING POLARIZATION-SENSITIVE OPTICAL COHERENCE TOMOGRAPHY
Authors: Deák Gábor G. , Schmidt Wolfgang M. , Bittner Reginald E. , Mylonas Georgios , Roberts Philipp K. , Zotter Stefan , Baumann Bernhard , Pircher Michael , Hitzenberger Christoph K. , Schmidt-Erfurth Ursula M. , Ritter Markus 
Published: December 2017

Purpose:
To examine the involvement of the retinal pigment epithelium (RPE) in the presence of vitelliform macular lesions (VML) in Best vitelliform macular dystrophy (BVMD), autosomal recessive bestrophinopathy, and adult-onset vitelliform macular degeneration using polarization-sensitive optical coherence tomography (PS-OCT).

Methods:
A total of 35 eyes of 18 patients were imaged using a PS-OCT system and blue light fundus autofluorescence imaging. Pathogenic mutations in the BEST1 gene, 3 of which were new, were detected in all patients with BVMD and autosomal recessive bestrophinopathy.

Results:
Polarization-sensitive optical coherence tomography showed a characteristic pattern in all three diseases with nondepolarizing material in the subretinal space consistent with the yellowish VML seen on funduscopy with a visible RPE line below it. A focal RPE thickening was seen in 26 eyes under or at the edge of the VML. Retinal pigment epithelium thickness outside the VML was normal or mildly thinned in patients with BVMD and adult-onset vitelliform macular degeneration but was diffusely thinned or atrophic in patients with autosomal recessive bestrophinopathy. Patients with autosomal recessive bestrophinopathy showed sub-RPE fibrosis alongside the subretinal VML. Polarization-sensitive optical coherence tomography was more reliable in assessing the localization and the integrity of the RPE than spectral domain OCT alone. On spectral domain OCT, identification of the RPE was not possible in 19.4% of eyes. Polarization-sensitive optical coherence tomography allowed for definite identification of the location of VML in respect to the RPE in all eyes, since it provides a tissue-specific contrast.

Conclusion:
Polarization-sensitive optical coherence tomography confirms in vivo the subretinal location of VML and is useful in the assessment of RPE integrity.
Topical Tacrolimus as Adjuvant Therapy to Corticosteroids in Acute Endothelial Graft Rejection After Penetrating Keratoplasty: A Randomized Controlled Trial
Authors: Hashemian Mohammad Nasser , Latifi Golshan , Ghaffari Reza , Ghassemi Hamed , Zarei-Ghanavati Mehran , Mohammadi Seyed-Farzad , Yasseri Mehdi , Fallah Tafti Mohammad Reza , Tafti Zahra Fallah 
Published: December 2017

Purpose:To evaluate the efficacy of topical tacrolimus 0.05% as adjuvant therapy to corticosteroids in the treatment of acute endothelial rejection of a penetrating keratoplasty (PKP) graft.Methods:Patients with the clinical diagnosis of acute endothelial rejection of a PKP graft were randomized into 2 groups—group 1: receiving topical tacrolimus 0.05% as adjuvant therapy to corticosteroid treatment and group 2: receiving only corticosteroid treatment. Main outcome measures were rejection reversal, time to rejection reversal, and recurrence of rejection.Results:Thirty-one eyes of 31 patients (17 and 14 eyes in group 1 and 2, respectively) were included in the study. The rejection episode completely resolved in 88.2% of patients in group 1 and 85.7% of patients in group 2 [hazard ratio = 0.60, 95% confidence interval (CI) = 0.28–1.29,P= 0.191]. After adjusting for preoperative factors using the inverse-probability weighting method, the time to resolution of rejection was significantly shorter in group 1 than group 2 (average treatment effect = 16, 95% CI, 3.7–28.7,P= 0.013). The recurrence rate of rejection was significantly higher in group 2 (39.7, 95% CI, 12.8–92.6 per 1000 months of follow-up) than in group 1 (3.6, 95% CI, 0.05–19.9 likewise); risk ratio: 11.1, 95% CI, 1.3–95.0,P= 0.028.Conclusions:Topical tacrolimus 0.05% as an adjunct to steroids can hasten the resolution of endothelial rejection of a PKP graft and potentially decreases the recurrence of rejection. However, it may not improve rejection reversal success.
Keratoconus and Personality—A Review
Authors: Mannis Mark J. , Ling Jennifer J. , Kyrillos Ralph , Barnett Melissa 
Published: December 2017

Purpose:
To assess the existing literature on the subject of keratoconus and personality and to propose a theory that might account for the perceived personality changes associated with this condition.

Methods:
A literature search was conducted in the PubMed database using the term “keratoconus” in combination with keywords such as personality, psychiatry, psychology, anxiety, depression, or psychosis. A total of 15 articles pertaining to personality and psychiatric disorders in keratoconus were retained and reviewed.

Results:
Although patients with keratoconus tend to score differently on personality scales compared with normal controls, the literature fails to substantiate the existence of a unique “keratoconic personality.” Instead, patients with keratoconus prove to have more dysfunctional coping mechanisms that specifically alter their interaction with health care providers and may account for the persistent clinical impression of less respectful, conforming, and cooperative patients.

Conclusions:
We hypothesize that the stage of life at which keratoconus commonly presents plays a crucial role in personality and coping mechanism development that significantly affects behavioral patterns and the relationship with caregivers.
Minimally Invasive Surgical Pulmonary Embolectomy
Authors: Pasrija Chetan , Shah Aakash , Sultanik Elliot , Rouse Michael , Ghoreishi Mehrdad , Bittle Gregory J. , Boulos Francesca , Griffith Bartley P. , Kon Zachary N. 
Published: December 2017

Objective Surgical pulmonary embolectomy has gained increasing popularity over the past decade with multiple series reporting excellent outcomes in the treatment of submassive pulmonary embolism. However, a significant barrier to the broader adoption of surgical pulmonary embolectomy remains the large incision and long recovery after a full sternotomy. We report the safety and efficacy of using a minimally invasive approach to surgical pulmonary embolectomy. Methods All consecutive patients undergoing surgical pulmonary embolectomy for a submassive pulmonary embolism (2015–2017) were reviewed. Patients were stratified as conventional or minimally invasive. The minimally invasive approach included a 5- to 7-cm skin incision with upper hemisternotomy to the third intercostal space. The primary outcomes were in-hospital and 90-day survival. Results Thirty patients (conventional = 20, minimally invasive = 10) were identified. Operative time was similar between the two groups, but cardiopulmonary bypass time was significantly longer in the minimally invasive group (58 vs 94 minutes, P = 0.04). While ventilator time and intensive care unit length of stay were similar between groups, hospital length of stay was 4.5 days shorter in the minimally invasive group, and there was a trend toward less blood product use. In-hospital and 90-day survival was 100%. Within the minimally invasive cohort, median right ventricular dysfunction at discharge was none-mild and no patient experienced postoperative renal failure, deep sternal wound infection, sepsis, or stroke. Conclusions Minimally invasive surgical pulmonary embolectomy appears to be a feasible approach in the treatment of patients with a submassive pulmonary embolism. A larger, prospective analysis comparing this modality with conventional surgical pulmonary embolectomy may be warranted.
Mood-Stabilizing Anticonvulsants, Spina Bifida, and Folate Supplementation
Authors: Patel Neil , Viguera Adele C. , Baldessarini Ross J. 
Published: December 2017

Abstract

Purpose/Background
High risks of neural tube defects and other teratogenic effects are associated with exposure in early pregnancy to some anticonvulsants, including in women with bipolar disorder.

Methods/Procedures
Based on a semistructured review of recent literature, we summarized findings pertaining to this topic.

Findings/Results
Valproate and carbamazepine are commonly used empirically (off-label) for putative long-term mood-stabilizing effects. Both anticonvulsants have high risks of teratogenic effects during pregnancy. Risks of neural tube defects (especially spina bifida) and other major malformations are especially great with valproate and can arise even before pregnancy is diagnosed. Standard supplementation of folic acid during pregnancy can reduce risk of spontaneous spina bifida, but not that associated with valproate or carbamazepine. In contrast, lamotrigine has regulatory approval for long-term use in bipolar disorder and appears not to have teratogenic effects in humans.

Implications/Conclusions
Lack of protective effects against anticonvulsant-associated neural tube defects by folic acid supplements in anticipation of and during pregnancy is not widely recognized. This limitation and high risks of neural tube and other major teratogenic effects, especially of valproate, indicate the need for great caution in the use of valproate and carbamazepine to treat bipolar disorder in women of child-bearing age.
Relationship Between Maternal Characteristics and Postpartum Hemorrhage: A Meta-Analysis Study
Authors: DURMAZ Aysegul , KOMURCU Nuran 
Published: December 2017

ABSTRACT

Background:
Postpartum hemorrhage (PPH) is a leading cause of maternal death in low-income countries and the primary cause of approximately one of every four maternal deaths worldwide.

Purpose:
The aim of this study was to determine the antenatal risk factors of PPH and its effects.

Methods:
The literature from nine databases was reviewed, and studies published between 2000 and 2012 were analyzed using terms such as “postpartum hemorrhage,” “prevention of postpartum hemorrhage,” and “management of postpartum hemorrhage.” The full text of 1,061 articles was reviewed, and 29 studies were selected according to the inclusion criteria. Studies that determined bias using the funnel plot test were excluded, and 20 studies were included in the meta-analysis. The data were analyzed using Microsoft Office Excel 2010 and comprehensive meta-analysis.

Results:
The meta-analysis included five studies and 1,286,752 women for maternal age, six studies and 607,822 women for body mass index, and six studies and 1,118,490 women for parity. The results of the analysis showed that body mass index ≥ 25.00 kg/m2 (OR = 1.43, 95% CI [1.40, 1.47]), primiparity of mothers (OR = 1.37, 95% CI [1.35, 1.40]), and hypertensive disorder in mothers (OR = 1.52, 95% CI [1.43, 1.61]) are risk factors for the development of PPH. No rela-tionship was found between maternal age ≥ 35 years and PPH (OR = 1.02, 95% CI [0.99, 1.04]).

Conclusions:
Midwives, obstetric nurses, and obstetricians should carefully evaluate mothers for the risk factors of PPH during the antepartum, intrapartum, and postpartum periods. Moreover, at-risk pregnant women should give birth in a unit with emergency initiative options. Future studies should examine relevant personal characteristics of mothers, as familiarity with the risk factors facilitates the management and treatment of PPH. Finally, meta-analyses should review more studies to detect risk factors more comprehensively.
Correlations Among Self-Rated Health, Chronic Disease, and Healthcare Utilization in Widowed Older Adults in Taiwan
Authors: HO Shu-Hsi 
Published: December 2017

ABSTRACT

Background:
Taiwan has a rapidly aging population. It is well known that older adults usually have worse health than younger adults, with widowed older adults at a particularly high risk of poor health. Widowed older adults experience the effects of bereavement, which affects their health. Therefore, health topics related to widowed older adults deserve special attention.

Purpose:
The aim of this study was to discuss self-rated health for chronic diseases and healthcare utilization among widowed older adults.

Methods:
A cross-section of data was used to analyze self-rated health-related issues. Data were adopted from the National Health Interview Survey in Taiwan, with the data on adults aged 65 years and over extracted and included in the assessment. Multinomial logistic regression models were used to investigate the relationships between healthcare utilization and self-rated health and chronic disease variables.

Results:
The main empirical results show worse self-rated health status among widowed older adults in comparison with their nonwidowed peers and worse health status for widowers than widows. Next, age was negatively correlated with health rating, whereas a positive correlation with health was found for education. In addition, chronic diseases, particularly stroke, were found to be a significant predictive factor related to poor health status. Similar results were observed for healthcare utilization, apart from traditional Chinese medicine. Older adults who habitually purchased and used traditional Chinese medicine were shown to enjoy relatively better health statuses.

Conclusions/Implications for Practice:
These findings identified that chronic diseases and healthcare utilization correlated strongly with self-rated health for widowed older adults. Therefore, self-rated health may be used as a screening tool by the National Health Insurance System in Taiwan, and the results may be referenced by public health officials who are responsible for developing welfare strategies to promote healthy aging among the widowed in Taiwan.
Factors Influencing Postpartum Fatigue in Vaginal-Birth Women: Testing a Path Model
Authors: HSIEH Ching-Hsing , CHEN Chien-Lan , HAN Tan-Ju , LIN Pei-Ju , CHIU Hui-Chun 
Published: December 2017

ABSTRACT

Background:
Postpartum fatigue is a very common complaint among postpartum women. Although current evidence indicates that several factors (e.g., parity, epidural analgesia, perineal trauma, perineal pain, and longer second stage of labor) are associated with postpartum, not enough is known about the relationships among these physical factors simultaneously and how they contribute to the development of postpartum fatigue. Increased awareness of the complex relationships among these factors will help nurses assess, prevent, and alleviate postpartum fatigue.

Purpose:
The aims of this study were to test a model of factors that influence postpartum fatigue and to estimate the direct and indirect effects of these factors on postpartum fatigue in vaginal-birth women.

Methods:
The hypothesized model of the factors that influence postpartum fatigue after vaginal birth was developed based on previous studies. This study used a cross-sectional correlational design and convenience sampling. The Visual Analog Scale for Pain was used to measure postpartum perineal pain, and the Postpartum Fatigue Scale was used to assess postpartum fatigue via a structured, self-report questionnaire. Data analysis included descriptive statistics, Pearson’s correlation coefficients, and path analysis.

Results:
This study evaluated 326 healthy postpartum women within the first day after vaginal birth. Participants ranged from 20 to 43 years old, and 50.9% were primiparous. The model of the factors influencing postpartum fatigue after vaginal birth showed a good fit with the empirical data. Parity and the use of epidural analgesia predicted the duration of the second stage of labor, and the degree of perineal trauma predicted perineal pain. Participants who had experienced longer durations of the second stage of labor and more perineal pain reported higher levels of early postpartum fatigue.

Conclusions/Implications for Practice:
It is suggested that maternal nurses should better understand postpartum fatigue, take precautions to decrease perineal pain, and pay more attention to the longer duration of the second stage of labor to minimize postpartum fatigue, increase patient comfort, and improve the quality of perinatal care.