bluuebunny/crossref_metadata_2025_split huggingface dataset:
Central nervous system active medication use in Medicare enrollees receiving home health care: association with chronic pain and anxiety level
Authors: Raji Mukaila A. , Shah Rohan , Westra Jordan R. , Kuo Yong-Fang 
Published: July 2024

Abstract
No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. Three sets of linear regression difference-in-reduction analyses assessed the association of pain or anxiety reduction with number of drugs; drug type; and drug combinations in those with daily pain and daily anxiety. Logistic regression analysis assessed the effect of medication number and class on less-than-daily pain or anxiety at HH discharge. A sensitivity analysis using multinomial regression was conducted with a three-level improvement to further determine clinical significance. Of 85,403 HH patients, 43% received opioids, 27% benzodiazepines, 26% gabapentinoids, 32% selective serotonin reuptake inhibitors, and 8% serotonin and norepinephrine reuptake inhibitors (SNRI). Furthermore, 75% had depression, 40% had substance use disorder diagnoses, and 6.9% had PTSD diagnoses. At HH admission, 83%, 35%, and 30% of patients reported daily pain, daily anxiety, and both, respectively. Central nervous system polypharmacy was associated with worse pain control and had no significant effect on anxiety. For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.
Beyond the chronic pain stage: default mode network perturbation depends on years lived with back pain
Authors: Heukamp Nils Jannik , Moliadze Vera , Mišić Mina , Usai Katrin , Löffler Martin , Flor Herta , Nees Frauke 
Published: July 2024

Abstract
Research has indicated that the default mode network (DMN) is perturbated in patients with chronic pain when compared with healthy controls, and this perturbation is correlated with the duration of pain during the chronic pain stage. It remains unclear whether DMN adaptations manifest during the subacute pain stage and progress over time because of the duration of pain experience, rather than being a specific correlate of the chronic pain stage. Furthermore, information regarding whether these adaptations are related to cognitive processes of adaptation is lacking. To this end, we examined the DMN in 31 patients with chronic back pain (CBP), 77 patients with subacute back pain (SBP), as well as 39 healthy pain-free controls (HC) applying a graph-theoretic network approach on functional resting-state magnetic resonance imaging. Beyond the comparison between groups, we used a linear analysis considering the years lived with pain (YLP) across all patients with back pain and additionally performed a mediation analysis of the role of cognitive pain coping. In line with previous studies, we found significant DMN perturbation in CBP compared with HC. However, this did not apply to the comparison of CBP with SBP. Instead, we observed a positive correlation between DMN perturbation and YLP. This was significantly mediated by coping attitudes towards pain. Default mode network perturbation may thus reflect neural adaptation processes to pain experience rather than a single correlate of the chronic pain stage and be modulated by cognitive adaption. This points to potentially underinvestigated significant adaptation processes that could enable more fine-grained patient stratification.
Association of intravenous digoxin use in acute heart failure with rapid atrial fibrillation and short-term mortality according to patient age, renal function, and serum potassium
Authors: Miró Òscar , Martín Mojarro Enrique , Lopez-Ayala Pedro , Llorens Pere , Gil Víctor , Alquézar-Arbé Aitor , Bibiano Carlos , Pavón José , Massó Marta , Strebel Ivo , Espinosa Begoña , Mínguez Masó Silvia , Jacob Javier , Millán Javier , Andueza Juan Antonio , Alonso Héctor , Herrero-Puente Pablo , Mueller Christian ,   on behalf of the investigators of the ICA-SEMES research group
Published: July 2024

BackgroundIntravenous digoxin is still used in emergency departments (EDs) to treat patients with acute heart failure (AHF), especially in those with rapid atrial fibrillation. Nonetheless, many emergency physicians are reluctant to use intravenous digoxin in patients with advanced age, impaired renal function, and potassium disturbances due to its potential capacity to increase adverse outcomes.ObjectiveWe investigated whether intravenous digoxin used to treat rapid atrial fibrillation in patients with AHF may influence mortality in patients with specific age, estimated glomerular filtration rate (eGFR), and serum potassium classes.DesignA secondary analysis of patients included in in the Spanish EAHFE cohort, which includes patients diagnosed with AHF in the ED.Setting45 Spanish EDs.ParticipantsTwo thousand one hundred ninety-four patients with AHF and rapid atrial fibrillation (heart rate ≥100 bpm) not receiving digoxin at home, divided according to whether they were or were not treated with intravenous digoxin in the ED.OutcomeThe relationships between age, eGFR, and potassium with 30-day mortality were investigated using restricted cubic spline (RCS) models adjusted for relevant patient and episode variables. The impact of digoxin use on such relationships was assessed by checking interaction.Main resultsThe median age of the patients was 82 years [interquartile range (IQR) = 76–87], 61.4% were women, 65.2% had previous episodes of atrial fibrillation, and the median heart rate at ED arrival was 120 bpm (IQR = 109–135). Digoxin and no digoxin groups were formed by 864 (39.4%) and 1330 (60.6%) patients, respectively. There were 191 deaths within the 30-day follow-up period (8.9%), with no differences between patients receiving or not receiving digoxin (8.5 vs. 9.1%,P = 0.636). Although analysis of RCS curves showed that death was associated with advanced age, worse renal function, and hypo- and hyperkalemia, use of intravenous digoxin did not interact with any of these relationships (P = 0.156 for age,P = 0.156 for eGFR;P = 0.429 for potassium).ConclusionThe use of intravenous digoxin in the ED was not associated with significant changes in 30-day mortality, which was confirmed irrespective of patient age or the existence of renal dysfunction or serum potassium disturbances.
Diagnostic accuracy of point-of-care cardiac ultrasound for acute coronary syndromes in patients presenting with chest pain to the emergency department: a single-center prospective study
Authors: Bima Paolo , Agishev Ilya , Fucile Ilaria , de Stefano Giuliano , Morello Fulvio , Mueller Christian , Nazerian Peiman ,   on behalf of the WINFOCUS study group
Published: July 2024

Background and importance
The diagnostic accuracy of focused cardiac ultrasound (FoCUS) performed in patients presenting to the emergency department (ED) with chest pain is currently unknown.

Objective
The objective of this study was to assess the diagnostic accuracy of regional wall motion abnormalities detected with FoCUS for non-ST-elevation acute coronary syndrome (NSTE-ACS) diagnosis.

Design
A Single-center prospective observational study conducted in 2022 in the ED of the University Hospital Careggi, Italy.

Setting and participants
Adult patients presenting to the ED with acute nontraumatic chest pain were enrolled, irrespective of the presence of previous regional wall motion abnormalities. Patients with ST-segment elevation myocardial infarctions and patients with hemodynamic instability were excluded. FoCUS was performed at presentation by a trained ED physician.

Outcome measures and analysis
The final diagnosis of NSTE-ACS vs. alternative diagnosis was adjudicated by an ED physician blinded to FoCUS results after a 30-day follow-up. To assess if regional wall motion abnormalities were an independent predictor of NSTE-ACS, a multivariable logistic regression model was built. Diagnostic performance measures were calculated. A sensitivity analysis considering only type-1 NSTEMIs (i.e. plaque rupture/thrombosis) was conducted.

Main results
Among 686 patients, NSTE-ACS was adjudicated in 106 (15.5%) patients, 67 of which were NSTEMIs. A total of 87 (12.7%) patients had regional wall motion abnormalities detected by FoCUS, which were an independent predictor of NSTE-ACS in the multivariable logistic regression analysis. Regional wall motion abnormalities had a sensitivity of 42.5% (33.0–51.9), a specificity of 92.8% (90.6–94.9), a negative predictive value of 89.8% (87.4–92.2), and a positive predictive value of 51.7% (41.2–62.2), for NSTE-ACS. Results were consistent in the sensitivity analysis.

Conclusions
In ED patients with chest pain and no ST elevation, the detection of regional wall motion abnormalities was a predictor of NSTE-ACS. Despite a high specificity, which indicated a possible role of FoCUS in the rule-in of NSTE-ACS, sensitivity was too low to allow a safe rule-out using FoCUS results alone.
Hospital Presumptive Eligibility Emergency Medicaid Programs
Authors: Knowlton Lisa Marie , Arnow Katherine , Trickey Amber W. , Tran Linda D. , Harris Alex H.S. , Morris Arden M. , Wagner Todd H. 
Published: July 2024

Background:
Lack of health insurance is a public health crisis, leading to foregone care and financial strain. Hospital Presumptive Eligibility (HPE) is a hospital-based emergency Medicaid program that provides temporary (up to 60 d) coverage, with the goal that hospitals will assist patients in applying for ongoing Medicaid coverage. It is unclear whether HPE is associated with successful longer-term Medicaid enrollment.

Objective:
To characterize Medicaid enrollment 6 months after initiation of HPE and determine sociodemographic, clinical, and geographic factors associated with Medicaid enrollment.

Design:
This was a cohort study of all HPE approved inpatients in California, using claims data from the California Department of Healthcare Services.

Setting:
The study was conducted across all HPE-participating hospitals within California between January 1, 2016 and December 31, 2017.

Participants:
We studied California adult hospitalized inpatients, who were uninsured at the time of hospitalization and approved for HPE emergency Medicaid. Using multivariable logistic regression models, we compared HPE-approved patients who enrolled in Medicaid by 6 months versus those who did not.

Exposures:
HPE emergency Medicaid approval at the time of hospitalization.

Main Outcomes and Measures:
The primary outcome was full-scope Medicaid enrollment by 6 months after the hospital's presumptive eligibility approval.

Results:
Among 71,335 inpatient HPE recipients, a total of 45,817 (64.2%) enrolled in Medicaid by 6 months. There was variability in Medicaid enrollment across counties in California (33%–100%). In adjusted analyses, Spanish-preferred–language patients were less likely to enroll in Medicaid (aOR 0.77, P<0.001). Surgical intervention (aOR 1.10, P<0.001) and discharge to another inpatient facility or a long-term care facility increased the odds of Medicaid enrollment (vs. routine discharge home: aOR 2.24 and aOR 1.96, P<0.001).

Conclusion:
California patients who enroll in HPE often enroll in Medicaid coverage by 6 months, particularly among patients requiring surgical intervention, repeated health care visits, and ongoing access to care. Future opportunities include prospective evaluation of HPE recipients to understand the impact that Medicaid enrollment has on health care utilization and financial solvency.
Impact of Nurse Residency Program on Time-to-Fill Nurse Vacancies at the Veterans Health Administration
Authors: Li Yufei , Legler Aaron , Kabdiyeva Aigerim , Nguyen PhiYen , Garrido Melissa , Pizer Steven 
Published: July 2024

Background:
The Department of Veterans Affairs (VA) offers a 1-year Post-Baccalaureate-Registered Nurse Residency (PB-RNR) Program. The impact of the PB-RNR program on local RN recruitment was unknown.

Objectives:
We aimed to evaluate the effect of the size of the PB-RNR program at a VA facility on its time-to-fill RN vacancies.

Project Design:
We used an instrumental variable approach with a 2-stage residual inclusion specification.

Subjects:
We included RN filled vacancies in the VA that were posted nationwide between 2020 and 2021.

Measures:
Our independent variable was the facility-year level number of PB-RNR program allocations. The 3 binary outcomes were whether the RN vacancy was filled within 90, 60, or 30 days.

Results:
An increase of one training allocation was significantly associated with a 5.60 percentage point (PP) (95% CI: 2.74–8.46) higher likelihood of filling a vacancy within 90 days, 7.34 PP (95% CI: 4.66–10.03) higher likelihood of filling a vacancy within 60 days, and 5.32 PP (95% CI: 3.18–7.46) higher likelihood of filling a vacancy within 30 days. The impact was significant in both 2020 and 2021 positions, and in facilities located in areas with lower social deprivation scores, higher-quality public schools, or with either no or partial primary care physician shortages.

Conclusions:
We found favorable impacts of the size of the PB-RNR program at a VA facility on filling RN vacancies.
Practices of Physical Therapists Who Assist People With Cerebral Palsy in Brazil: A National Survey
Authors: Furtado Michelle Alexandrina Dos Santos , Longo Egmar , Campos Ana Carolina de , Silva Maiara Aparecida Tino da , Silva Ana Clara de Carvalho , Ayupe Kênnea Martins Almeida , Camargos Ana Cristina Resende , Leite Hércules Ribeiro 
Published: July 2024

Purpose:
To describe the practices of pediatric physical therapists (PTs) working with children and adolescents with cerebral palsy (CP) in Brazil.

Methods:
PTs working with children and adolescents with CP were invited to participate via social media and email campaigns to complete an online survey containing 46 questions.

Results:
In total, 373 PTs participated. Most PTs reported searching in scientific databases (96.8%) and on social media (71%). The main barrier to information reported was limited access to full-text articles (44%). Among the PTs, 58.4% and 84% reported using the International Classification of Functioning, Disability and Health (ICF) and family centered practice models, respectively. Regarding tools and interventions, there was little focus on the domains of contextual factors and participation.

Conclusions:
This survey points to some important advances. However, strategies are still needed to promote knowledge translation and evidence-based practices among pediatric PTs in Brazil.
Functional Symmetry Observation Scale, Version 2: Reliability, Construct Validity, and Potential for Clinical Use
Authors: Rahlin Mary , Sarmiento Bernadette 
Published: July 2024

Purpose:
To examine the intrarater and interrater reliability and construct validity of the Functional Symmetry Observation Scale, Version 2 (FSOS-V2) in infants with congenital muscular torticollis (CMT).

Methods:
The FSOS-V2 is a video-based measure of postural and movement symmetry in infants with CMT. Four examiners scored 50 participants’ videos twice. Scores obtained by the same rater and across 4 raters were compared to examine intrarater and interrater reliability, respectively. Participants’ habitual head deviation from midline in supine photographs was measured using a protractor. Relationship between the head tilt angles and FSOS-V2 scores was examined to assess construct validity.

Results:
Fifty infants with CMT, age range 1 to 16 months, participated. Results indicated moderate to good intrarater and poor to moderate interrater reliability. The FSOS-V2 construct validity was supported.

Conclusion:
The FSOS-V2 can be used by the same therapist repeatedly to make clinical decisions. Further research will strengthen its psychometric properties.
Impact of Cognitive Intervention on Neurocognitive Development of Schoolchildren Exposed to Lead in a Semi-Urban Community in Mexico
Authors: Cortez-Lugo Marlene , Huanca-Laura Lizeth Ximena , Hernández-Bonilla David , Alamo-Hernández Urinda , Montes Sergio , García-Feregrino Raquel , Velázquez Sara , Tristán-López Luis Antonio 
Published: July 2024

Lead exposure is a severe public health issue that can adversely affect children’s neurocognitive development. A semi-urban community in Mexico has been exposed to lead from food cooked in glazed clay pots. A cognitive intervention was conducted from 2015 to 2016 to minimize this negative impact. This intervention aimed to improve the neurocognitive development of the affected children.

Methods
A quasi-experimental study with a control group was conducted in children aged 7 to 12 years from 2 communities in Morelos, Mexico. Blood lead levels were determined, and the neurocognitive function was assessed pre- and postintervention with the Wechsler Intelligence Scale for Children and Children’s Auditory Verbal Learning Test-2. A cognitive intervention was conducted at the school. The difference-in-differences method adjusted for variables known as priori and evaluated the impact of cognitive intervention.

Results
The differences-in-differences models indicated a significant average increase in scores on the Verbal Comprehension Index (9.58 points), Processing Speed Index (5.33 points), intelligence quotient (5.63 points) level of learning (7.66 points), interference trial (10.12 points), immediate memory span (7.98 points), and recognition accuracy (1.18 points) subtests after the cognitive intervention.

Conclusion
The results suggest that cognitive intervention improves neurocognitive development in schoolchildren exposed to Pb.
Combating Disparities in a Pandemic: Increasing Dissemination of Coronavirus Disease 2019 Resources in Spanish
Authors: Barral Romina L. , Clark Nicholas A. , Zapata Fernando , Vargas Collado Lines M. , Cuevas July Jean , Fernandez Cristina 
Published: July 2024

Introduction:
Disparities exist in access to coronavirus disease 2019 (COVID-19)-related health information. We aimed to close a gap in online traffic between English and Spanish COVID-19-related health information on our institution’s publicly-facing website by 50% within ten months.

Methods:
We used A3 improvement methodology. Outcome measures were the mean monthly difference between English and Spanish COVID-19 online traffic vis-a-vis (1) total webpage views and (2) unique webpage visits. Process measures were stratification of outcome measures by language. Plan-Do-Study-Act cycles included: Recurring advertisements on a local Spanish television station disseminating up-to-date COVID-19 information, including our institution’s Spanish COVID-19 online resources, incorporation of QR codes into clinic discharge paperwork linking to institutional Spanish COVID-19 resources, and leveraging social media to expand reach. Control charts assessed impact over time.

Results:
There were 1,226,196 total webpage views (369,983 Spanish; 856,213 English) and 1,065,536 unique webpage visits (350,518 Spanish; 715,018 English). Both outcome measures displayed sustained, special cause improvement from a mean monthly difference of 25,397 to 11,321 webpage views (55.4% reduction, June 2021) and 25,066 to 7080 unique webpage visits (71.8% reduction, February 2021) corresponding to special cause improvements in process measures. Improvements were not temporally associated with an intervention but coincided with emergency use approval of the COVID-19 vaccine for children aged 12–15 years (May 2021).

Conclusions:
Although our interventions did not directly show improvements in our measures, we noted increased page views of Spanish COVID-19-related health information on our institution’s publicly-facing website in times of high demand for linguistically appropriate services, including pediatric vaccine roll-out.
Islet Isolation Outcomes in Patients Undergoing Total Pancreatectomy With Islet Autotransplantation in the POST Consortium
Authors: Mattke Jordan , Eaton Anne , Wijkstrom Martin , Witkowski Piotr , Trikudanathan Guru , Singh Vikesh K. , Schwarzenberg Sarah J. , Ramanathan Karthik , Pruett Timothy L. , Posselt Andrew , Nathan Jaimie D. , Morgan Katherine , Mokshagundam Sri Prakash , Lara Luis , Gardner Timothy B. , Freeman Martin , Downs Elissa , Chinnakotla Srinath , Beilman Gregory J. , Ahmad Syed , Adams David , Abu-El-Haija Maisam , Naziruddin Bashoo , Bellin Melena D. 
Published: July 2024

Background.
In total pancreatectomy with islet autotransplantation (TPIAT), a greater number of islets transplanted produces more favorable outcomes. We aimed to determine predictors of islet isolation outcomes.

Methods.
We investigated factors associated with islet isolation outcomes expressed as islet number (IN), islet equivalents (IEQ; standardized to an islet with 150 μm diameter), IN/kg, or IEQ/kg using data from the multicenter Prospective Observational Study of TPIAT. Single-predictor linear regression was used to estimate the association of individual patient and disease characteristics with islet isolation outcomes, and augmented backward elimination was used to select variables to include in multivariable analyses.

Results.
In multivariable analyses, only elevated hemoglobin A1c was associated with worse outcomes for all measures (P < 0.001 for all). Total IEQ obtained for transplant was higher for participants with Hispanic ethnicity (P = 0.002) or overweight status pre-TPIAT (P < 0.001) and lower with non-White race (P = 0.03), genetic pancreatitis (P = 0.02), history of lateral pancreaticojejunostomy (P = 0.03), and presence of atrophy (P = 0.006) or ductal changes (P = 0.014) on imaging. IEQ/kg was higher in females (P = 0.01) and Hispanic participants (P = 0.046) and generally lower with older age (nonlinear association, P < 0.001) and pancreatic atrophy (P < 0.001) on imaging. Total IN and IN/kg showed trends similar, but not identical, to IEQ and IEQ/kg, respectively.

Conclusions.
Patient demographics and certain pancreatic disease features were associated with outcomes from islet isolation. Hemoglobin A1c before TPIAT was the metabolic testing measure most strongly associated with islet isolation results.