bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choice over placebo administration enhances open-label placebo hypoalgesia
Authors: Tang Biya , Livesey Evan , Colagiuri Ben 
Published: November 2023

Abstract
Many studies indicate that deceptively administered placebos can improve pain outcomes. However, the deception involved presents an ethical barrier to translation because it violates informed consent and patient autonomy. Open-label placebos (OLPs), inert treatments that are openly administered as placebos, have been proposed as an ethically acceptable alternative. Early studies have suggested that OLP can improve pain outcomes, but important questions remain as to how to maximise OLP hypoalgesia to improve treatment outcomes in pain patients. This study investigated whether providing choice over when to administer an OLP treatment has the capacity to enhance OLP hypoalgesia using an electrocutaneous pain paradigm. One hundred thirty-two healthy volunteers were randomised to 3 types of treatment: OLP with choice, OLP without choice, and no treatment (natural history). The OLP groups were further randomised such that half were tested with a consistent pain intensity and the other half were tested with variable pain intensity to mimic day-to-day variability in pain intensity in health settings. The results indicated that treatment provided with choice exhibited greater OLP hypoalgesia than that provided without choice and that greater expectancy mediated this effect. Of interest, there was no evidence for OLP hypoalgesia without choice relative to natural history. Furthermore, variability in pain intensity did not affect OLP hypoalgesia. The current findings present novel evidence that choice over treatment administration may be a cheap and effective strategy for boosting the efficacy of OLPs in the clinical care of pain.
Physician Assistant Program Accreditation Analysis and Survey of Program Directors
Authors: Lewis Jon , Peacock Jeff , Miller Paul M. 
Published: November 2023

Introduction
To inform physician assistant program directors through citation analysis after implementation of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) Accreditation Standards, 5th edition.

Methods
This research used descriptive statistics, Pearson correlation, and the coefficient of determination to analyze the citations reported by ARC-PA during January 2021 to February 2023. Concurrent first-time taker Physician Assistant National Certifying Exam (PANCE) results were used to determine whether a correlation exists between pass rates and citations. In addition, a survey was sent to each institution’s current program director to investigate leadership concerns and differences between programs placed on a provisional, continued, or probation status by ARC-PA.

Results
Of the 98 program submissions for accreditation, 13 submissions resulted in a probation status outcome. For these 13 programs placed on probation, 46.2% and 30.8% were cited for being noncompliant with leadership Standards A2.09 and A1.02, respectively. Pearson correlation analysis indicates a significant negative correlation between ARC-PA citations and first-time taker PANCE pass rates (P = .023, 95% confidence interval [CI] = [−0.49 to −0.04]). This is particularly true for programs with continued accreditation (P = .007, 95% CI = [−0.67 to −0.13]) and programs that performed below the 85% benchmark (P = .013, 95% CI = [−0.94 to −0.22]) for first-time taker PANCE pass rates. Although a negative correlation is observed between the number of levied citations and PANCE pass rates, the coefficient of determination does not indicate that the number of citations can predict PANCE pass rates (R
2 = 0.0368). Regarding survey data, 42.86% of programs placed on probation cited institutional support as their biggest program weakness or threat. Conversely, 22.22% of programs with provisional status and 12.5% of programs with continued status reported institutional support as their biggest weakness or threat.

Discussion
This research identifies leadership as a deficit of concern associated with programs placed on probation. In addition, a significant negative correlation exists between the number of citations and first-time taker PANCE pass rates—especially for programs with first-time taker PANCE pass rates below 85% or for programs with continued accreditation status.
Colposcopy—A Valuable Diagnostic Tool for Pregnant Women With Unexplained Vaginal Bleeding
Authors: Sgayer Inshirah , Shmueli Maskit , Lowenstein Lior , Frank Wolf Maya 
Published: November 2023

Objectives
We aimed to examine the diagnostic value of colposcopy in a large cohort of pregnant women with unexplained vaginal bleeding during the second or third trimester.

Materials and Methods
This retrospective study included women who underwent colposcopy due to vaginal bleeding in the second and third trimesters during 2012–2022 at a tertiary care hospital. Demographics, obstetric data, bleeding characteristics, colposcopy results, cervical cytology testing, a sonogram directed at the placenta, and birth details were collected.

Results
In total, 364 women were included. The mean maternal age was 29.7 years and the mean gestational age at examination was 30.7 weeks. Vaginal bleeding was mild in 80.8%, moderate in 14.6%, and severe in 4.7%. Only 3.3% had been vaccinated against human papilloma virus and 25.5% underwent a Pap smear study before pregnancy. Colposcopy diagnosed the bleeding source in 83 women (22.8%). The colposcopic examination revealed vaginal bleeding due to contact bleeding from ectropion in 46 (12.6%), a decidual/cervical polyp in 37 (10.2%), acetowhite epithelium in 12 (3.3%), herpes genetalis in 2 (0.5%), and bleeding from vaginal varices in 2 (0.5%). Of those who were recommended a follow-up examination after the postpartum period, only 49.1% completed such.
Among women with compared to without postcoital bleeding (N = 72), the risk of abnormal colposcopic findings was higher (24 [33.3%] vs 54 [19.7%], p = .017) and the rate of abnormal Pap smear was higher (7 [13.2%] vs 7 [3.2%], p = .008).

Conclusions
Colposcopy can be a valuable diagnostic tool for women with unexplained vaginal bleeding in the second or third trimester.
Developing an Integrated Longitudinal Dataset for Patient-Centered Outcome Measures in Cost-Related Medication Nonadherence
Authors: Zhang James X. , Meltzer David O. 
Published: November 2023

Background:
Cost-related medication nonadherence (CRN) is an important patient-centered outcome measure. Longitudinal follow-up of CRN is rare.

Objective:
We propose to develop a novel integrated dataset to study CRN longitudinally.

Research Design:
A dataset of 2000 Medicare beneficiaries at high risk of hospitalization surveyed quarterly on CRN and followed up individually for 8 quarters between 2013 and 2018 was linked to Medicare files. A metric of CRN categorizing persistent, intermittent, and transient CRN during the 8 quarters was developed. An ordered logit model and a logit model were developed to assess the factors influencing CRN overall and persistent CRN, respectively.

Results:
A total of 1761 patients were included in the analysis, among whom 869 (49.3%) reported CRN at least once in the 8-quarter study period, 178 (10%) reported persistent CRN, 395 (22.4%) reported intermittent CRN, and 296 (16.8%) reported transient CRN. The conditional effect in the logit model for persistent CRN revealed that baseline dual eligibility was negatively associated (adjusted odds ratio = 0.45, P < 0.01) and depression positively associated (adjusted odds ratio = 1.55, P = 0.01) with persistent CRN. The marginal analysis in the ordered logit model revealed a clear pattern of higher probabilities of persistent and intermittent CRN at younger ages while transient CRN was flat. Among the 252 subjects who were deceased, 31 (12.3%) reported persistent CRN, compared with 147 (9.74%) who were alive (P = 0.21 by χ2 test).

Conclusions:
A significant number of patients reported persistent CRN, including those who were at the end of life. Research is critically needed to understand behavioral patterns among the younger Medicare population.
Enhancing Cancer Economic Data Resources
Authors: Halpern Michael T. , Ekwueme Donatus U. , Yabroff K. Robin 
Published: November 2023

Background:
Cancer diagnosis and treatment can substantially affect health and financial outcomes for patients and families. Research in health care delivery across the cancer control continuum includes diverse activities led by multiple government and private sector organizations. Assessing the economic drivers and influencing factors associated with costs across this continuum is challenging as organizations leading research efforts often do not have forums to share data, develop linkages, and explore collaborative opportunities.

Objective:
To describe the objectives, activities, and goals of the Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC) to strengthen data resources and capacity for collaborative patient-focused cancer health economics research.

Main Argument:
HEROiC’s goals include assessing the economic burden of cancer; examining the effects of policies, health care setting/system factors, and health service delivery approaches across the cancer control continuum; and enhancing collaborations among researchers and organizations.

Conclusions:
Data resources to study economic outcomes associated with cancer control are highly fragmented; HEROIC provides a forum to collaboratively develop, enhance, and utilize data resources and infrastructure for patient-centered cancer health economics research. This includes sharing data resources, developing linkages, identifying new data collection venues, and creating and supporting the dissemination of evidence-based information to diverse stakeholders. These efforts provide critical information to address the economic burden of cancer.

Relevance to the Special Issue:
Cancer diagnosis and treatment affect patient health and financial outcomes. This commentary describes how HEROiC will enhance research data infrastructure and collaborations to support patient-centered research with the goal of reducing the economic burden of cancer.
Cancer-Related Financial Hardship Screening as Part of Practice Transformation
Authors: Williams Courtney P. , Liang Margaret I. , Rocque Gabrielle B. , Gidwani Risha , Caston Nicole E. , Pisu Maria 
Published: November 2023

Background:
Data on financial hardship, an “adverse event” in individuals with cancer, are needed to inform policy and supportive care interventions and reduce adverse economic outcomes.

Methods:
Lay navigator–led financial hardship screening was piloted among University of Alabama at Birmingham oncology patients initiating treatment in October 2020. Financial hardship screening, including reported financial distress and difficulty, was added to a standard-of-care treatment planning survey. Screening feasibility and completion and proportions of reported financial distress and difficulty were calculated overall and by patient race and rurality. The risk of financial distress by patient sociodemographics was estimated.

Results:
Patients who completed a treatment planning survey (N=2741) were 18% Black, Indigenous, or persons of color (BIPOC) and 16% rural dwelling. The majority of patients completed financial hardship screening (90%), surpassing the target feasibility completion rate of 75%. The screening revealed 34% of patients were experiencing financial distress, including 49% of BIPOC and 30% of White patients. Adjusted models revealed BIPOC patients had a 48% higher risk of financial distress compared with those who were White (risk ratio 1.48, 95% CI, 1.31–1.66). Large differences in reported financial difficulties were seen comparing patients who were BIPOC and White (utilities: 33% vs. 10%, upfront medical payments: 44% vs. 23%, transportation: 28% vs. 12%, respectively).

Conclusions:
The collection of patient-reported financial hardship data via routine clinical care was feasible and identified racial inequities at treatment initiation. Efforts to collect patient economic data should support the design, implementation, and evaluation of patient-centered interventions to improve equity and reduce the impact of financial hardship.
Multilevel Quality Indicators
Authors: Roessler Martin , Schulte Claudia , Repschläger Uwe , Hertle Dagmar , Wende Danny 
Published: November 2023

Background:
Quality indicators are frequently used to assess the performance of health care providers, in particular hospitals. Established approaches to the design of such indicators are subject to distortions due to indirect standardization and high variance of estimators. Indicators for geographical regions are rarely considered.

Objectives:
To develop and evaluate a methodology of multilevel quality indicators (MQIs) for both health care providers and geographical regions.

Research Design:
We formally derived MQIs from a statistical multilevel model, which may include characteristics of patients, providers, and regions. We used Monte Carlo simulation to assess the performance of MQIs relative to established approaches based on the standardized mortality/morbidity ratio (SMR) and the risk-standardized mortality rate (RSMR).

Measures:
Rank correlation between true provider/region effects and quality indicator estimates; shares of the 10% best and 10% worst providers identified by the quality indicators.

Results:
The proposed MQIs are: (1) standardized hospital outcome rate (SHOR); (2) regional SHOR; and (3) regional standardized patient outcome rate. Monte Carlo simulations indicated that the SHOR provides substantially better estimates of provider performance than the SMR and risk-standardized mortality rate in almost all scenarios. The regional standardized patient outcome rate was slightly more stable than the regional SMR. We also found that modeling of regional characteristics generally improves the adequacy of provider-level estimates.

Conclusions:
MQIs methodology facilitates adequate and efficient estimation of quality indicators for both health care providers and geographical regions.
Change in Hospital Risk-Standardized Stroke Mortality Performance With and Without the Passive Surveillance Stroke Severity Score
Authors: Yu Amy Y.X. , Kapral Moira K. , Park Alison L. , Fang Jiming , Hill Michael D. , Kamal Noreen , Field Thalia S. , Joundi Raed A. , Peterson Sandra , Zhao Yinshan , Austin Peter C. 
Published: November 2023

Background:
Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting for the Passive Surveillance Stroke SeVerity (PaSSV) score, a measure of stroke severity derived using administrative data, changed hospital-specific estimated 30-day risk-standardized mortality rate (RSMR) after stroke.

Methods:
We used linked administrative data to identify adults who were hospitalized with ischemic stroke or intracerebral hemorrhage across 157 hospitals in Ontario, Canada between 2014 and 2019. We fitted a random effects logistic regression model using Markov Chain Monte Carlo methods to estimate hospital-specific 30-day RSMR and 95% credible intervals with adjustment for age, sex, Charlson comorbidity index, and stroke type. In a separate model, we additionally adjusted for stroke severity using PaSSV. Hospitals were defined as low-performing, average-performing, or high-performing depending on whether the RSMR and 95% credible interval were above, overlapping, or below the cohort’s crude mortality rate.

Results:
We identified 65,082 patients [48.0% were female, the median age (25th,75th percentiles) was 76 years (65,84), and 86.4% had an ischemic stroke]. The crude 30-day all-cause mortality rate was 14.1%. The inclusion of PaSSV in the model reclassified 18.5% (n=29) of the hospitals. Of the 143 hospitals initially classified as average-performing, after adjustment for PaSSV, 20 were reclassified as high-performing and 8 were reclassified as low-performing. Of the 4 hospitals initially classified as low-performing, 1 was reclassified as high-performing. All 10 hospitals initially classified as high-performing remained unchanged.

Conclusion:
PaSSV may be useful for risk-adjusting mortality when comparing hospital performance. External validation of our findings in other jurisdictions is needed.
Association Between ICD-10 Codes for Social Needs and Subsequent Emergency and Inpatient Use
Authors: Liss David T. , Kang Raymond H. , Cherupally Manisha , Cooper Andrew J. , Barreto-Parra Paula-Natalia , Aikman Cassandra , O’Brien Matthew J. 
Published: November 2023

Background:
International Classification of Diseases, 10th revision Z codes capture social needs related to health care encounters and may identify elevated risk of acute care use.

Objectives:
To examine associations between Z code assignment and subsequent acute care use and explore associations between social need category and acute care use.

Research Design:
Retrospective cohort study.

Subjects:
Adults continuously enrolled in a commercial or Medicare Advantage plan for ≥15 months (12-month baseline, 3–48 month follow-up).

Outcomes:
All-cause emergency department (ED) visits and inpatient admissions during study follow-up.

Results:
There were 352,280 patients with any assigned Z codes and 704,560 sampled controls with no Z codes. Among patients with commercial plans, Z code assignment was associated with a 26% higher rate of ED visits [adjusted incidence rate ratio (aIRR) 1.26, 95% CI: 1.25–1.27] and 42% higher rate of inpatient admissions (aIRR 1.42, 95% CI: 1.39–1.44) during follow-up. Among patients with Medicare Advantage plans, Z code assignment was associated with 42% (aIRR 1.42, 95% CI: 1.40–1.43) and 28% (aIRR 1.28, 95% CI: 1.26–1.30) higher rates of ED visits and inpatient admissions, respectively. Within the Z code group, relative to community/social codes, socioeconomic Z codes were associated with higher rates of inpatient admissions (commercial: aIRR 1.10, 95% CI: 1.06–1.14; Medicare Advantage: aIRR 1.24, 95% CI 1.20–1.27), and environmental Z codes were associated with lower rates of both primary outcomes.

Conclusions:
Z code assignment was independently associated with higher subsequent emergency and inpatient utilization. Findings suggest Z codes’ potential utility for risk prediction and efforts targeting avoidable utilization.
Errors in measurement of glomerular filtration rate using the slope-intercept technique and their identification
Authors: Oliveira Ana , Conway Lauren , Heraghty Neil , Peters A. Michael 
Published: November 2023

Background
GFR measured from plasma sampling may be expressed as slope-intercept GFR (SI-GFR) and scaled to body surface area (mGFR/BSA) or as GFR per unit extracellular fluid volume (mGFR/ECV), which is based only on half-time. Measurement errors comprise 3 categories. Pre-injection error arises from error in administered marker and is suspected when mGFR/BSA and mGFR/ECV disagree. Injection errors include ‘tissued’ injections. Post-injection errors include inaccurate sample timing, inaccurate pipetting, sample haemolysis and sampling through long IV lines through which marker was administered. The aim of the study was to evaluate the impact of errors on mGFR.

Methods
We compared mGFR/BSA with mGFR/ECV in 898 patients undergoing routine investigation. To investigate post-injection error, we took two further patient datasets with r values (correlation coefficient of the 3-sample fit) of 1.0 and introduced errors, in isolation, into each of the 3 recorded sample values, as follows: pipetting (volume) errors of −20%, −10%, −5%, 5%, 10% and 20%, and timing errors of −15 min, −10 min, −5 min, 5 min, 10 min and 15 min.

Results
The correlation between mGFR/BSA and mGFR/ECV was close and independent of r. Post-injection error depended on the time of the sample in which it occurred. r correlated poorly with error magnitude for both volume and timing errors. When a ‘rogue’ sample is suspected its error needed to be substantial for it to be identified by single sample estimates applied to the other samples.

Conclusion
SI-GFR is resistant to post-injection timing and volume errors but not to pre-injection error.
Restoring the barrier of chronically damaged urothelium using chondroitin sulfate glycosaminoglycan-replenishment therapy
Authors: Rozenberg Boy B. , van Ginkel Charlotte J. , Janssen Dick A.W. 
Published: November 2023

Purpose of review
This study aims to further understand the physiological mechanism of chondroitin sulfate treatment on the urinary bladder in cases of inflammation, by investigating the effect of chondroitin sulfate therapy on recovery of urothelial barrier in an in-vitro chronic injury model.

Recent findings
With inflammatory bladder conditions, the urothelial barrier seems decreased. Glycosaminoglycan (GAG) replacement therapy is supposed to help restore this barrier. Clinical studies on inflammatory bladder conditions are complicated because of the heterogeneous patient population, hence the need for preclinical models.

Summary
In a model using porcine urothelial cells, functional barrier (TEER) and barrier markers were assessed. Chronic urothelial damage was simulated through protamine sulfate instillations with and without subsequent chondroitin sulfate instillations during 3 days. Chondroitin sulfate instillations significantly improved TEER compared to protamine sulfate treatment only (TEER difference 310 Ω.cm2, P < 0.001). This consistent effect over 3 days resulted in a significant higher mean TEER value in the chondroitin sulfate treated group (difference 1855 Ω.cm2, P < 0.001). Enhanced recovery of chondroitin sulfate and other barrier markers was observed.
Chondroitin sulfate therapy shows promise in facilitating the recovery of the urothelial barrier in cases of chronic damage. This preclinical study lends support to the use of clinical GAG replenishment therapy for patients with a chronically impaired urothelium.
An Integrative Review of the Support Needs of Informal Caregivers of Hematological Cancer Patients in the Period Immediately Following Discharge From Inpatient to Outpatient Care
Authors: Brunt Laura J. , Rivalland Alexandra , Panek-Hudson Yvonne , Krishnasamy Meinir 
Published: November 2023

Background
Preparing informal caregivers for a patient’s transition to outpatient care is an important component of safe, quality hematological cancer care. The development of many novel therapies and emerging treatments has created opportunities to address the needs of informal caregivers following the discharge of patients from inpatient settings.

Objective
To review and synthesize the literature on the needs of informal caregivers of patients with a hematological malignancy postdischarge from inpatient care.

Interventions/Methods
Integrative review methodology was used to explore the body of evidence available. This included a quality appraisal of qualitative, quantitative, and mixed-methods research findings, subsequent data extraction, and inductive thematic synthesis.

Results
One thousand eight articles were screened with 10 included in the review. Key insights into the needs of caregivers entering the outpatient setting were identified and grouped into key subheadings: Encountering complex emotions knowing what to know, little time for yourself, and collateral impact.

Conclusion
Findings convey the complex and multiple needs of informal caregivers of hematological cancer patients. With a growing population of people with hematological malignancies and innovations in outpatient cancer therapies, there is a pressing need to codesign interventions to support their caregivers.

Implications for Practice
This review has identified a need for more robust research to coproduce interventions in collaboration with caregivers. In addition, interventions developed from further research should be tested in quality implementation science studies to determine their feasibility, sustainability, and impact on outcomes that matter to hematological cancer caregivers.