bluuebunny/crossref_metadata_2025_split huggingface dataset:
Giving voice to all patients: On patients at the margins and their intention and perceived ability to complain
Authors: Salge Torsten Oliver , Antons David , Cichy Patrick , Foege J. Nils , Hannen Julian , Huetten Antje S.J. 
Published: October 2016

Background:
It is now widely established that health care organizations are well advised not only to identify and act upon the concerns of all patient groups but also to encourage and enable them to voice their concerns in the first place. That said, research has begun to reveal that patients differ substantially in their readiness to complain, with many deciding to remain silent even after experiencing severe adverse events. Little research has explored whether patients at the margins (e.g., elderly, disabled, or mentally ill patients) are more likely to remain silent.

Purpose:
We examined the extent to which patients’ social (being elderly or poorly educated), physical (having a permanent impairment such as deafness, blindness, or a chronic physical condition), and mental marginality (having a mental illness or learning disability) is associated with their intention and perceived ability to complain.

Methodology:
We matched survey and patient record data for hospital inpatients treated in the English National Health Service in 2007. We then computed two-stage probit selection models to estimate the cross-sectional association between patients’ social, physical, and mental marginality and their intention (Stage 1, N
1 = 58,062) and perceived ability to complain (Stage 2, N
2 = 3,765).

Findings:
Only 6.47% of all patients intended to complain. Of these, only 10.41% indicated that hospital staff provided them with all the information they needed to complain. An additional 14.70% reported to have received at least some of the information needed for this purpose. Patients above 80 not only exhibited significantly lower intentions to complain than their mid-aged counterparts (−1.16%) but also felt considerably less well informed to file a complaint (−5.45%). Similarly, patients suffering from blindness or a severe vision impairment showed a significantly lower perceived ability to complain (−5.20%).

Practice Implications:
Patients at the margins, especially elderly patients and those with a severe vision impairment, will often remain silent and require special attention, if health care organizations are to listen to—and learn from—the voices of all patients. Our results indicate the need for inclusive complaint procedures designed to fuel organizational learning. Dedicated roles such as case managers and complaint officers might help to make such feedback channels accessible to all patients.
EFFECT OF INTRAVITREAL RANIBIZUMAB ON GANGLION CELL COMPLEX AND PERIPAPILLARY RETINAL NERVE FIBER LAYER IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION USING SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Authors: Zucchiatti Ilaria , Cicinelli Maria V. , Parodi Maurizio Battaglia , Pierro Luisa , Gagliardi Marco , Accardo Agostino , Bandello Francesco 
Published: October 2016

Purpose:
To analyze the changes in ganglion cell complex and peripapillary retinal nerve fiber layer thickness, in central macular thickness and choroidal thickness on spectral domain optical coherence tomography in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab injections.

Methods:
All consecutive patients with untreated neovascular age-related macular degeneration received loading phase of three monthly intravitreal ranibizumab, followed by retreatments on a pro re nata protocol for 12 months. Primary outcome: changes in ganglion cell complex and retinal nerve fiber layer at the end of follow-up. Secondary outcome: changes in best-corrected visual acuity, central macular thickness, and choroidal thickness at the end of follow-up. Choroidal thickness was measured at 500 μm, 1000 μm, and 1,500 μm intervals nasally, temporally, superiorly, and inferiorly to the fovea, respectively, on horizontal and vertical line scans centered on the fovea.

Results:
Twenty-four eyes were included. Ganglion cell complex and peripapillary retinal nerve fiber layer thickness did not show statistically significant changes through 12 months (55.6 ± 18.5 and 81.9 ± 9.9 μm at baseline, 52.7 ± 19.3 and 84.6 ± 15.5 μm at month 12, P > 0.05). Central macular thickness showed progressive decrease from baseline to month 12, with maximum reduction at month 3 (P < 0.001). Statistically significant reduction in choroidal thickness was registered in the nasal 500, 1000, and 1,500 μm from the fovea, corresponding to the papillomacular region (from 169.6 ± 45.3 to 153.9 ± 46.9, P < 0.001).

Conclusion:
Intravitreal ranibizumab injections did not affect retinal nerve fiber layer and ganglion cell complex thickness in 1-year follow-up. Choroidal thickness in papillomacular area and central macular thickness was significantly reduced at the end of treatment. Further studies, with larger sample, longer follow-up, and greater number of injections, are warranted.
Medicolegal Death Investigation and Hospital Patient Safety and Quality Outcomes: A Naturally Synergistic Collaboration
Authors: Drake Stacy A. , Harper Sherhonda , Wolf Dwayne A. 
Published: October 2016

ABSTRACT
The role of medicolegal death investigation (MLDI) systems in the assessment of violent deaths (e.g., gunshots, stab wounds, car crashes) is well known. However, the role of MLDI systems in informing healthcare agencies about potential patient safety and quality improvement activities is less understood and thus the main focus of this article. In this article we describes-one agency's initiatives to identify decedents whose circumstances or cause of death had potential relevance for patient safety and quality outcomes and to communicate those findings to acute care hospitals where the decedents were previously treated. We also describes the evaluation of this communication process and provide preliminary outcomes of these efforts.
Factors Associated With Higher Caregiver Burden Among Family Caregivers of Elderly Cancer Patients
Authors: Ge Lixia , Mordiffi Siti Zubaidah 
Published: October 2016

Background:
Caring for elderly cancer patients may cause multidimensional burden on family caregivers. Recognition of factors associated with caregiver burden is important for providing proactive support to caregivers at risk.

Objective:
The aim of this study was to identify factors associated with high caregiver burden among family caregivers of elderly cancer patients.

Methods:
A systematic search of 7 electronic databases was conducted from database inception to October 2014. The identified studies were screened, and full text was further assessed. The quality of included studies was assessed using a checklist, and relevant data were extracted using a predeveloped data extraction form. Best-evidence synthesis model was used for data synthesis.

Results:
The search yielded a total of 3339 studies, and 7 studies involving 1233 family caregivers were included after screening and full assessment of 116 studies. Moderate evidence supported that younger caregivers, solid tumors, and assistance with patient’s activities of daily living were significantly associated with high caregiver burden. Eighteen factors were supported by limited evidence, and 1 was a conflicting factor.

Conclusions:
The scientific literature to date proved that caregiver burden was commonly experienced by family caregivers of elderly cancer patients. The evidence indicated that family caregivers who were at younger age, caring for solid tumor patients, and providing assistance with patient’s activities of daily living reported high caregiver burden.

Implications for Practice:
The data provide evidence in identifying family caregivers at high risk of high caregiver burden. More high-quality studies are needed to clarify and determine the estimates of the effects of individual factors.
Examination of Ricochet Gunshot Wounds From Commonly Encountered Surfaces
Authors: Hlavaty Leigh , Avedschmidt Sarah , Root Kelly , Amley Jeffrey , Sung LokMan 
Published: October 2016

AbstractProper interpretation of gunshot wounds is vital for the forensic pathologist and requires experience and expertise, as well as consultation with a firearms and ballistics expert and careful scene investigation in cases of atypical gunshot wounds. This study is the first large-series examining ricochet gunshot wounds involving different firearm calibers. Typical gunshot wounds created from 4 handgun calibers (22 Long Rifle, 9 × 19 mm Parabellum, .40 Smith &Wesson, and .45 Automatic Colt Pistol) and 2 rifle calibers (5.56 and 7.62 mm) were compared with wounds caused by bullets of those same calibers ricocheting off commonly encountered surfaces (concrete, asphalt, aluminum traffic signs, clay brick, and dry wall). Porcine skin, a human skin analog, attached to sheets of cardboard serviced as witness panels for capturing the entrance wounds. Examination of over 150 handgun and rifle entrance wounds established that every caliber and every ricochet surface resulted in atypical features, including irregularity in size or shape, lack of marginal abrasion, or other injuries on the surrounding skin. The most significant factor influencing the variability of the ricochet wounds was the surface the bullet deflected off before striking the body.
Brief Report: Decentralizing ART Supply for Stable HIV Patients to Community-Based Distribution Centers: Program Outcomes From an Urban Context in Kinshasa, DRC
Authors: Vogt Florian , Kalenga Lucien , Lukela Jean , Salumu Freddy , Diallo Ibrahim , Nico Elena , Lampart Emmanuel , Van den Bergh Rafael , Shah Safieh , Ogundahunsi Olumide , Zachariah Rony , Van Griensven Johan 
Published: October 2016

Abstract:
Facility-based antiretroviral therapy (ART) provision for stable patients with HIV congests health services in resource-limited countries. We assessed outcomes and risk factors for attrition after decentralization to community-based ART refill centers among 2603 patients with HIV in Kinshasa, Democratic Republic of Congo, using a multilevel Poisson regression model. Death, loss to follow-up, and transfer out were 0.3%, 9.0%, and 0.7%, respectively, at 24 months. Overall attrition was 5.66/100 person-years. Patients with >3 years on ART, >500 cluster of differentiation type-4 count, body mass index >18.5, and receiving nevirapine but not stavudine showed reduced attrition. ART refill centers are a promising task-shifting model in low-prevalence urban settings with high levels of stigma and poor ART coverage.
Unpacking the Influence of Sexual Stigma on HIV Risk: Results From a Prospective Study of Men Who Have Sex With Men in Beijing, China
Authors: Choi Kyung-Hee , Steward Wayne T. , Miège Pierre , Gregorich Steven E. 
Published: October 2016

Objective:
We examined the mediating roles of coping, depression, anxiety, and encountering difficult sexual situations in explaining the association between stigma against men who have sex with men (MSM) and HIV risk.

Methods:
We conducted path analyses using longitudinal data collected from 493 Chinese MSM in Beijing at baseline, 6 months, and 12 months from 2011 to 2013.

Results:
MSM stigma, specifically anticipations of stigma, had a marginally significant, protective total effect on unprotected anal intercourse at 12 months. This overall association, however, was the byproduct of 5 significant, indirect associations (3 risk enhancing, 2 protective) that routed through coping, anxiety, and difficult sexual situations. Of note, heavier use of avoidant coping principally had a protective effect on risk behavior by decreasing difficult sexual situations.

Conclusions:
Interventions to reduce avoidant coping would be an important tool for improving the emotional well-being of Chinese MSM. Such interventions, however, must be paired with biomedical or behavioral HIV prevention strategies to ensure that their benefit is not undermined by unintended increased HIV transmission risk in response to reduced social isolation among MSM.
Genital—Systemic Chemokine Gradients and the Risk of HIV Acquisition in Women
Authors: Liebenberg Lenine J. P. , Masson Lindi , Arnold Kelly B. , Mckinnon Lyle R. , Werner Lise , Proctor Elizabeth , Archary Derseree , Mansoor Leila E. , Lauffenburger Douglas A. , Abdool Karim Quarraisha , Abdool Karim Salim S. , Passmore Jo-Ann S. 
Published: October 2016

Background:
Mucosal and systemic immune mediators have been independently associated with HIV acquisition risk, but the relationship between compartments remains unclear.

Methods:
To address this, the concentrations of 12 cytokines were compared in matched plasma and cervicovaginal lavages (CVLs) from 57 HIV-positive women before their acquisition of HIV (cases) and 50 women who remained uninfected (controls) during the CAPRISA 004 trial.

Results:
Although genital IP-10 concentrations were significantly higher in cases, plasma IP-10 concentrations were inversely associated with HIV risk. Comparing differences in mucosal and systemic cytokine concentrations between cases and controls, mucosa-biased gradients indicating higher cervicovaginal lavage relative to plasma concentrations were observed for all 5 chemokines in the panel. Four were significantly associated with HIV acquisition, including IP-10 (odds ratio [OR] 1.73, 95% confidence interval [CI]: 1.27 to 2.36), macrophage inflammatory protein–1β (OR 1.72, 95% CI: 1.23 to 2.40), interleukin (IL)-8 (OR 1.50, 95% CI: 1.09 to 2.05), and monocyte chemotactic protein-1 (OR 1.36, 95% CI: 1.01 to 1.83). None of the other 7 cytokines tested predicted HIV risk. Decision tree analyses confirmed this association, with gradients of IP-10, IL-8, and granulocyte-macrophage colony-stimulating factor concentrations correctly classifying 77% of HIV outcomes.

Conclusions:
Our findings suggest that mucosa-biased gradients of IP-10, macrophage inflammatory protein–1β, IL-8, and monocyte chemotactic protein-1 are associated with an increased risk of HIV infection.
Conditional Cash Transfers Improve Retention in PMTCT Services by Mitigating the Negative Effect of Not Having Money to Come to the Clinic
Authors: Yotebieng Marcel , Moracco Kathryn E. , Thirumurthy Harsha , Edmonds Andrew , Tabala Martine , Kawende Bienvenu , Wenzi Landry K. , Okitolonda Emile W. , Behets Frieda 
Published: October 2016

Objective:
To elucidate the mechanisms by which a cash incentive intervention increases retention in prevention of mother-to-child transmission services.

Methods:
We used data from a randomized controlled trial in Kinshasa, Democratic Republic of Congo. Perceptual factors associated with loss to follow-up (LTFU) through 6 weeks postpartum were first identified. Then, binomial models were used to assess interactions between LTFU and identified factors, and the cash incentive intervention.

Results:
Participants were less likely to be LTFU if they perceived HIV as a “very serious” health problem for their baby vs. not [risk difference (RD), −0.13; 95% confidence interval (CI): −0.30 to 0.04], if they believed it would be “very likely” to pass HIV to their baby if they did not take any HIV drug vs. not (RD, −0.15; 95% CI: −0.32 to 0.02), and if they anticipated that not having money would make it difficult for them to come to the clinic vs. not (RD, 0.12; 95% CI: −0.07 to 0.30). The effect of each of the 3 factors on LTFU was antagonistic to that of receiving the cash incentive intervention. The excess risk due to interaction between the cash incentive intervention and the anticipated difficulty of “not having money” to come to the clinic was exactly equal to the effect of removing this perceived barrier (excess risk due to interaction, −0.12; 95% CI: −0.35 to 0.10).

Conclusions:
Our analyses show that cash transfers improve retention in prevention of mother-to-child transmission services mainly by mitigating the negative effect of not having money to come to the clinic.
Early Discharge After Colorectal Resection: The Positive Impact of an Enhanced Recovery Program on a Rural Colorectal Surgery Service
Authors: Tebala Giovanni D. , Keane Sean , Osman Abdelsalam , Ip Mina , Khan Abdul Q. , Perrone Luciano 
Published: October 2016

Background:
Enhanced recovery (ER) programs are policies and protocols meant to improve postoperative recovery after surgery. As a consequence of a smoother recovery, patients can be discharged early. This paper describes the impact of an ER program in colorectal surgery in a rural hospital.

Materials and Methods:
In total, 132 patients had colorectal resection within the ER program. Data were collected prospectively. The ER pathway affects perioperative management in the following ways in order to: (1) improve patient’s general condition before surgery, (2) minimize intraoperative surgical trauma by using a laparoscopic approach in all cases, and (3) facilitation of a quicker postoperative return of physiological function.

Results:
Most (86.4%) of the patients have been operated as elective cases and for a cancer (73.5%). Laparoscopic resection was performed in 63.6% of patients, with a conversion rate of 10.6%. Total morbidity was 18.2%, leak rate was 1.5%, and 90-day mortality rate was 3%. Overall median postoperative stay was 6.5 days. Total length of in-hospital stay was lower in laparoscopic resections (5.5 d), elective cases (6 d), and in younger patients (6 d). Age and laparoscopic access were independent prognostic factors significantly associated with early discharge in elective patients. Overall readmission rate was 9.1% and this was not affected by any preoperative or intraoperative factor within those in this study.

Conclusions:
The ER program positively impacted the outcome of colorectal resections also in our rural setting. Discharging patients expeditiously did not affect postoperative morbidity or readmission rate.
The Use of Mechanical Bowel Preparation in Pelvic Reconstructive Surgery: A Randomized Controlled Trial
Authors: Adelowo Amos O. , Hacker Michele R. , Modest Anna M. , Apostolis Costa A. , Disciullo Anthony J. , Hanaway Katherine J. , Elkadry Eman E. , Rosenblatt Peter L. , Rogers Kathleen J. , Hota Lekha S. 
Published: October 2016

Objective
To compare mechanical bowel preparation (MBP) using oral magnesium citrate with sodium phosphate enema to sodium phosphate (NaP) enema alone during minimally invasive pelvic reconstructive surgery.

Methods
We conducted a single-blind, randomized controlled trial of MBP versus NaP in women undergoing minimally invasive pelvic reconstructive surgery. The primary outcome was intraoperative quality of the surgical field. Secondary outcomes included surgeon assessment of bowel handling and patient-reported tolerability symptoms.

Results
One hundred fifty-three participants were enrolled; 148 completed the study (71 MBP and 77 NaP). Patient demographics, clinical and intraoperative characteristics were similar. Completion of assigned bowel preparation was similar between MBP (97.2%) and NaP (97.4%). The MBP group found the preparation more difficult (P<0.01) and reported more overall discomfort and negative preoperative side effects (all P≤0.01). Quality of surgical field at initial port placement was excellent/good in 80.0% of the MBP group compared with 62.3% in the NaP group (P=0.02). This difference was not maintained by the conclusion of surgery (P=0.18). Similar results were seen in the intent-to-treat population. Surgeons accurately guessed preparation 65.7% of the time for MBP versus 41.6% for NaP (P=0.36). At 2 weeks postoperatively, both reported a median time for return of bowel function of 3.0 (2.0–4.0) days.

Conclusions
Mechanical bowel preparation with oral magnesium citrate before minimally invasive pelvic reconstructive surgery offered initial improvement in the quality of surgical field, but this benefit was not sustained. It was associated with an increase in patient discomfort preoperatively, but did not seem to impact postoperative return of bowel function.

LEVEL OF EVIDENCE
I
Iatrogenic Bladder Diverticulum 11 Years After Sacrospinous Ligament Fixation for Apical Prolapse
Authors: Gephart Laura Faye , Lewis Anthony , Wu Emily , Bird Erin , Wagner Kristofer , Kuehl Thomas J. , Larsen Wilma 
Published: October 2016

Introduction
In this case, we describe a bladder diverticulum due to apical vaginal suspension to the sacrospinous ligament presenting 11 years after surgery. This case report explores her signs and symptoms, diagnostic work-up, surgical intervention, and postoperative course.

Case Description
A 71-year-old G2P2 presented with symptoms of urinary urgency. Work-up including cystoscopy and retrograde fistulogram revealed a bladder diverticulum extending to the level of the sacrospinous ligament. Her surgical history was significant for a sacrospinous ligament fixation 11 years before her symptoms. The iatrogenic bladder diverticulum was removed via robotic-assisted laparoscopic excision. Her postoperative course was benign beyond a urinary tract infection. Her urgency symptoms resolved after treatment.

Conclusions
Iatrogenic injuries can present distant from initial surgery. Permanent foreign material, including suture, may increase the risk of complications. A high level of suspicion is necessary to diagnose complications given the subtle presentation.
Relationship of Anatomy and Function: External Anal Sphincter on Transperineal Ultrasound and Anal Incontinence
Authors: Paka Chandhana , Kamisan Atan Ixora , Rios Rebeca , Dietz Hans Peter 
Published: October 2016

Objective
The aim of this study was to investigate the association of the anatomic integrity of the external anal sphincter (EAS) detected on transperineal ultrasound (TPUS) with symptoms of anal incontinence (AI) as measured by St Mark’s Incontinence Score (SMIS) and the visual analog scale (VAS).

Methods
This is an observational, cross-sectional analysis of 486 women who presented to a tertiary urogynecological center between May 2013 and August 2014. They underwent a standardized interview and an examination that involved 3-dimensional/4-dimensional TPUS. The SMIS and VAS were administered if they answered positively to a question on AI. The association between defects of the EAS and symptoms of AI was evaluated using bivariate tests, as well as adjusting for pertinent covariates using multiple linear regression modeling.

Results
Of the included patients, 17.1% reported AI, and 15.2% had significant EAS defects (≥4 slices) on TPUS imaging. A significant sonographic defect was diagnosed in 23% of women with AI versus 14% of those without (P = 0.033). Women with symptoms of AI were more likely to have a significant defect on TPUS (odds ratio, 1.878; 95% confidence interval, 1.05–3.37). No significant findings were seen when analyzing SMIS, its components, and VAS against sonographic EAS defects.

Conclusions
The symptom of AI is associated with significant EAS defects detected on TPUS. However, this study failed to show an association between significant EAS defects and the SMIS and VAS.