bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial and ethnic disparities in the enrolment of medicare medication therapy management programs
Authors: Garuccio Joseph , Tsang Chi Chun Steve , Wan Jim Y , Shih Ya Chen Tina , Chisholm-Burns Marie A , Dagogo-Jack Samuel , Cushman William C , Dong Xiaobei , Browning Jamie A , Zeng Rose , Wang Junling 
Published: March 2023

Abstract

Objectives
Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data.

Methods
Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017.

Key Findings
Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81).

Conclusions
Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.
We Are in a Different Place
Authors: Mitchell Julie , Kuntz Joanne 
Published: March 2023

Abstract
Patients present to the emergency department with serious, critical illnesses, and decisions will need to be made in order to choose not only what can be done but what should be done based on the patients’ understanding of their illness, goals, and values. A goals-of-care discussion is a patient-centered approach to complex medical decision-making, with focus on identifying individual values and developing plans for future care based on these values. These discussions provide opportunity for shared decision-making in establishing goals in the context of serious illness and near the end of life. In general, it is important to include information regarding the current disease state, prognosis, and treatment options available. Focusing on the “big picture” is important. If patients can describe how they want to live during their remaining time, healthcare providers can help identify what medical treatments will best achieve this. Key components of a goals-of-care conversation include preparation, assessing the understanding of illness, sharing of information regarding prognosis and trajectory, assessing the goals of care based on a shared understanding of the illness, and determining next steps.
“Read the Papers, Please”
Authors: Fomovska Alina M. , Isaacs Eric 
Published: March 2023

Abstract
This chapter discusses the application of advance directives for patients presenting to the emergency department, as well as the navigation of conversations about existing advance directives with the patient’s family and/or surrogate. The interpretation of the advance directives, when at odds with the wishes expressed by surrogate or family, may be a significant source of moral distress for providers. It is important to consider that these documents are not sufficiently nuanced to address the breadth of end-of-life situations, and surrogate decision maker involvement is a crucial part of interpreting advance directives. The patient’s disease trajectory plays an important role in application of the advance directive. When no advance directive exists, in emergency situations, with limited clinical information and significant time pressures, a time-limited trial may represent an appropriate course of treatment.
Make It Stop
Authors: Aberger Kate 
Published: March 2023

Abstract
Nausea and vomiting are less common but very distressing symptoms in patients with serious illness. Nausea is a subjective experience that portends the feeling that vomiting is imminent. Vomiting is a physical event with forceful expulsion of gastrointestinal contents. Nausea and vomiting may occur concurrently or independently—patients may have the sensation of nausea without vomiting or both. While nausea and vomiting are more common in patients with advanced cancer, this symptom is observed in all patients with serious illness. Effective management of nausea and vomiting requires careful assessment regarding the possible etiologies to include an appreciation of psychological, spiritual, and social factors that may exacerbate these symptoms. A focus on both pharmacological and nonpharmacological management strategies is required for effective management. Fundamental knowledge of the emetogenic pathway that delineates the key central regulatory receptors supports judicious use of pharmacological interventions.
The psychotherapeutic component of psychedelic medicine
Authors: Higbed Laurie , Sessa Ben 
Published: March 2023

Abstract
Psychedelic compounds offer a unique type of mental health treatment. This chapter considers how psychedelics can be explored as an alternative to the typical maintenance medication for the treatment of symptoms, through using psychedelic medicines in a controlled clinical setting as an adjunct to psychotherapy. In combination with psychotherapy, the psychedelic experience provides the opportunity to access and explore the root cause of individuals’ difficulties. The ability of psychedelic-assisted psychotherapy to embrace an individualized formulation-driven rather than a reductionist diagnostic-focused understanding of mental distress is discussed, with this therapeutic approach offering a holistic biopsychosocial intervention. Whilst therapeutic modalities of psychedelic-assisted psychotherapy may vary, this chapter details the key therapeutic phases of preparation, psychedelic drug–assisted experiential sessions, and post-drug integration to explore how psychedelics benefit therapy for a range of mental health problems.
Artificial Doctoring
Authors: Ho Anita 
Published: March 2023

Abstract
This chapter explores how the expanding availability and marketing of direct-to-consumer (DTC) artificial intelligence (AI) health applications affect potential users’ autonomy. Section 1 introduces the common claim that these products can democratize health information and promote users’ autonomy. Section 2 provides a brief overview of various purposes and categories of DTC AI health applications, illustrated with examples of platforms currently on the market. Utilizing the concept of relational autonomy, Section 3 explores how these technologies affect (prospective) users’ self-governance, self-determination, and self-authorization. It examines how the broader social phenomenon of self-quantification via indefinite tracking changes our practical identities and may ironically reinforce medical dominance that can further reduce (prospective) patients’ power. Drawing on lessons learned from other DTC health products such as genetic tests, this section warns of the possibility that DTC AI health monitoring may alienate and marginalize people’s embodied experience in ways that compromise their self-identity rather than promoting self-knowledge.
A Digital Pill to Swallow
Authors: Ho Anita 
Published: March 2023

Abstract
This chapter spotlights artificial intelligence (AI) monitoring algorithms that have been specifically developed to identify and predict medication adherence at the individual patient level. It explores how these emerging technologies may disempower patients in ways that compromise their relational autonomy. Section 1 defines key components of medication adherence and presents the scope of the multidimensional concerns around suboptimal adherence. Section 2 provides examples of how AI has been proposed to identify and predict medication adherence. It focuses on examples in mental health care and opioid for chronic non-malignant pain management to illustrate how AI medication adherence monitoring as a proposed practice is designed to address clinicians’ distrust of patients and bypass patient testimonies. Section 3 explores how medication adherence monitoring expands medical authority and dismisses patients’ subjective experiences and concerns in ways that violate their relational self-governance, self-determination, and self-authorization.
Psychological Models of Suicide
Authors: Barzilay Shira , Lawrence Olivia C. 
Published: March 2023

Abstract
Given the complex nature of suicidal phenomena, theoretical frameworks for understanding suicidal processes and behavior are critical for assessing imminent suicide risk and developing effective interventions. This chapter provides a historical perspective on the evolution of various theoretical approaches to understanding the psychological processes that make suicide possible. Specifically, the chapter describes three generations of the most influential models of suicidal behavior. First-generation models, such as Shneidman’s psychache theory, were developed out of clinicians’ individual experiences, consensus opinion, and clinical judgment. Second-generation models hypothesize that suicide risk is determined largely by long-term biological, clinical, and demographic risk factors. Third-generation models of suicidal behavior, such as Rudd’s fluid vulnerability model, emphasize the critical role of dynamic risk factors, which fluctuate in duration and intensity and are operational in conferring imminent suicide risk. The chapter provides insight into each of the frameworks’ strengths and limitations, as well as their clinical implications for predicting suicide.
Vascular Pressures
Authors: Prabhakar Amit , Raslan Adnan 
Published: March 2023

Abstract
All clinicians participating in the delivery of anesthetic care need to have a solid fundamental understanding of vascular pressure measurements. Vascular pressure measurements serve as the foundation for the majority of hemodynamic monitoring in the clinical setting. Examples of clinically relevant vascular pressures include arterial blood pressure, central venous pressure (CVP), pulmonary pressures, and left ventricular end-diastolic pressure (LVEDP). Measurements can be obtained by either noninvasive or invasive methods. Pressure fluctuations can result in systemic malperfusion and subsequently result in end-organ damage. This chapter reviews the pertinent elements of how each measurement is obtained and also details the clinical significance of each parameter.
Cardiac Output
Authors: Nwozuzu Adambeke , Crimi Ettore 
Published: March 2023

Abstract
Cardiac output is the amount of blood ejected from the ventricles with each cardiac cycle. The pulmonary artery catheter has been the mainstay in assessing cardiac output for decades. Its routine use carries potential risks of right ventricular perforation, pulmonary artery rupture, and/or embolization. Echocardiography, esophageal Doppler, transpulmonary thermodilution, and pulse wave analysis are alternative methods to assess cardiac output. To properly assess the cardiac output in surgical and critically ill patients, it is of great importance to become familiar with the chosen technique and its pitfalls. Nevertheless, estimating the cardiac output in patients is important for anesthesiologists and intensivists in order to ensure adequate oxygen delivery and tissue perfusion.
Coagulation Monitors
Authors: Giordano Christopher , Tom Williams Gabriella 
Published: March 2023

Abstract
A timely and accurate assessment of hemostasis is critical for establishing a safe anesthetic plan and implementing appropriate interventional therapy. Historically, hemostasis has been elucidated by intrinsic and extrinsic pathways, which represent cascading independent enzymes that culminate in coagulation. The construct of this cascade is the foundation of our initial understanding of coagulation processes based on in vitro laboratory metrics such as prothrombin time (PT) and partial thromboplastin time (PTT). The introduction of the cell-based model provides a unique explanation of the coagulation process in vivo by emphasizing the critical role of cell surfaces in facilitating localized clot production through initiation, amplification, and propagation. An appreciation of these two paradigms offers a framework for conceptualizing coagulation monitoring and individualized therapeutic management. PT and the international normalized ratio (INR) are used for evaluation of warfarin therapy, while PTT and activated clotting time (ACT) assess heparin activity. Viscoelastic testing, a method of evaluating clot dynamics of whole blood, further assesses abnormalities in clot formation and dissolution. Thromboelastography (TEG), rotational thromboelastometry (ROTEM), and sonic estimation of elasticity via resonance (SEER) provide a quantitative and qualitative perspective that guides specific blood component therapy.
Electrical, Fire, and Explosion Hazards
Authors: Sheikh Suleman , Watt Stacey 
Published: March 2023

Abstract
The primary initiative of all surgical interactions is patient safety and reducing the occurrence of fires, explosions, and electrical currents as such events increase mortality correlated to burn size, age, and inhalation injury and may result in death and disfigurement. In 2008, the annual incidence of operating room (OR) fires as reported by the Pennsylvania Patient Safety Authority was approximately 650 or 0.63/157,545 operations. In the past years, the diligent research and implementation of new guidelines have decreased the incidence of fires in the operating room to an estimated 0.32/100,000 operations. This chapter discusses the principles, contributing factors, and prevention and management of surgical fires, explosives, and electrical currents.
Controlled Hypotension
Authors: Alexander Anthony , Gloss Feodor J. 
Published: March 2023

Abstract
Controlled or induced hypotension is an anesthetic technique that involves deliberate lowering of the blood pressure to a systolic pressure of 80–90 mm Hg or mean arterial pressure (MAP) to 50–65 mm Hg or 30% less than baseline. The goals of this technique include reducing operative blood loss and improving surgical visibility and thus decreasing operative time. Deep anesthesia with combinations of volatile agent, propofol, or opioid infusions is one approach to providing hypotension. Alternatively, dedicated hypotensive agents such as β-blockers, calcium channel blockers, and vasodilators may be used to achieve these goals. Pharmacological methods may be supplemented by postural (reverse Trendelenburg position) and ventilatory (hyperventilation) interventions. Controlled hypotension carries the theoretical risk of organ hypoperfusion with resultant cerebral, myocardial, hepatic, splanchnic, and renal ischemia. Patients should be carefully selected and attention given to those who are at increased risk of these complications. Decisions regarding the depth and duration of hypotension should be made with these preoperative considerations in mind.
High-Altitude Anesthesia
Authors: Dearden Mark 
Published: March 2023

Abstract
High altitude has direct deleterious effects on human physiology and induces compensatory changes that must be considered when performing anesthesia. And, if not calibrated, anesthetic equipment can malfunction. The body responds to decreased atmospheric oxygen with increased heart rate, blood pressure, minute ventilation, and red blood cell production. Symptoms of high-altitude sickness may include those of hypoxia, pulmonary edema, and central nervous system irritation. Treatment for high-altitude sickness relies on descent. When anesthesia at high altitude is contemplated, there are several important considerations. Medications that reduce respiratory drive should be used only judiciously. Supplemental oxygen should be used liberally. Regional anesthesia and total intravenous anesthesia are good choices because they are relatively unaffected. An inhalational technique should avoid nitrous, and care should be taken to assess gas vaporizers for compensation. Trapped air in the body or medical equipment will expand with rapid ascent and should be planned for in the event of aeromedical evacuation.
Central and Peripheral Nervous Systems
Authors: Nasim Syed Sohaib , Minear Steven 
Published: March 2023

Abstract
The nervous system comprises billions of nerve cells in the body. It is the organization of the nervous system that allows different functions to occur effortlessly. The nervous system is divided into two systems, the central and peripheral nervous systems, based on their location. The central nervous system is organized from the cerebrum to the spinal cord, with layers of communicating inputs throughout. The peripheral nervous system can either respond autonomously to sensory inputs from the body, or relay messages from the central nervous system. Cerebral blood flow and cerebral perfusion pressure are tightly autoregulated to stay consistent across a range of mean arterial pressures. The blood brain barrier is a layer of endothelium with tight junctions, excluding many peripherally circulating molecules. Lipophilic molecules penetrate this barrier better than hydrophilic compounds.
Drug Metabolism
Authors: Jeske Theodore , Knezevic Nebojsa Nick 
Published: March 2023

Abstract
This chapter discusses drug metabolism as being one of the key steps in pharmacokinetics. Every time your patient receives a drug, a complex process occurs. Absorption, distribution, metabolism, and excretion of a particular drug provide vital information for the treatment of your patients. Moreover, the different phases of biotransformation, first- and zero-order metabolism kinetics, bioavailability, relevant drug considerations, and dosing adjustments to keep in mind for different patient comorbidities are considered. Emphasis is also on the effects of single-nucleotide polymorphisms and interindividual drug metabolism patterns. By being familiar with a range of complex pharmacokinetic properties of the drugs used in different anesthetic procedures, patients in pain will warrant optimal plasma drug concentrations, avoidance of adverse effects, and adjustment of therapy for select patient populations.
Intracranial Pressure
Authors: Shin John S. , Bui Timothy T. 
Published: March 2023

Abstract
The four intracranial components that determine intracranial volume and by extension intracranial pressure (ICP) are cells, intracellular and extracellular fluid, cerebrospinal fluid, and blood. The compliance of this system allows for small increases in volume without increasing ICP. Prolonged increases in ICP greater than 15 mm Hg can lead to irreversible ischemia and brain damage. Administration of steroids preoperatively beginning 48–72 hours before surgery can reduce the edema and blood-brain barrier permeability associated with tumors. Intraoperatively, ICP can be decreased by surgical resection of the tumor, medications such as diuretics and steroids, and ventriculostomy or lumbar puncture. Decreasing cerebral blood flow (CBF) can decrease the volume of intracranial blood. This can be achieved by maximizing venous drainage, minimizing elevated intrathoracic pressure, hyperventilating, inducing hypothermia, and administering intravenous anesthetics. Postoperative complications such as seizures increase CBF and cerebral metabolic rate, leading to an increase in ICP.
Evoked Potentials
Authors: Ford Timothy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Evoked potentials are electrophysiologic responses of the nervous system to electrical stimuli. They involve applying a current to a sensory nerve and measuring the response on the sensory cortex with a scalp electrode. They serve as a surrogate measure for neurologic functional integrity for patients under general anesthesia during a variety of neurosurgical procedures and occasionally nonneurosurgical procedures, including cardiopulmonary bypass and deep circulatory arrest. Evoked potentials commonly monitored in the operating room include motor, sensory, visual, and auditory potentials. Changes in evoked potentials can serve as indicators for risk of neural injury and guide interventions to prevent permanent damage undertaken by both the surgeon and anesthesiologist.
Peripheral Nerve Blocks (Head)
Authors: Pride Keth , Blaine Scott 
Published: March 2023

Abstract
Regional anesthesia for procedures involving the head can be easily achieved through the careful application of peripheral nerve blockade. Because the head has predictable surface and bony landmarks, the blocks can easily be placed pre- and intraoperatively to provide both regional anesthesia and postoperative analgesia with minimal complications. The peripheral blockade of nerves involving the head can provide perioperative anesthesia as well as management of both perioperative pain and chronic pain. The purpose of this chapter is to provide information and recommendations on how to best perform these blocks as well as describe their indications, complications, and relevant surrounding anatomy.
Intravenous Lipid Emulsion Therapy and the American Society of Regional Anesthesia Checklist for Local Anesthetic Toxicity
Authors: Schroeder Kristopher M. , Pfaff Andrew 
Published: March 2023

Abstract
With the increased utilization of regional anesthesia as part of a multimodal analgesic regimen in enhanced recovery after surgery protocols, the pain practitioner must be aware of the diagnosis and management of local anesthetic systemic toxicity (LAST). The mainstay of treatment for LAST is the administration of intravenous lipid emulsion (ILE) therapy, which is provided as an initial bolus followed by an infusion. ILE works by several mechanisms, which include both a redistribution of local anesthetic from areas of toxicity to areas of metabolism and direct cardiotonic and vasoactive effects. LAST differs from other advanced cardiac life support (ACLS) scenarios as resuscitation is often prolonged, and several common code medications such as epinephrine and vasopressin should have dose reductions or be omitted entirely. The American Society of Regional Anesthesia and Pain Medicine (ASRA) maintains a checklist for the treatment of LAST, last updated in 2017. The checklist describes the diagnosis and management of suspected LAST, several risk-reducing measures to prevent LAST, and a proposed LAST rescue kit that should be readily available whenever local anesthetic is used.
Role of Regional Anesthesia in Enhanced Recovery Protocols
Authors: Schroeder Kristopher M. , Pfaff Andrew 
Published: March 2023

Abstract
Enhanced recovery protocols offer the promise of improved patient care while simultaneously reducing costs and hospital resource utilization. Core to the development of any successful enhanced recovery protocol is effective pain management. Opioid administration in the postoperative period may be associated with a number of adverse events (nausea, urinary retention, respiratory depression, etc.) that may hinder efforts to improve the postoperative experience and expedite hospital discharge. In contrast, the thoughtful application of regional anesthesia/analgesia techniques may benefit patients via improved pain control and reduced opioid requirements. Improvements in ultrasound imaging techniques and the proliferation of available fascial plane blocks have increased the number of patients and surgical procedures that may benefit from perioperative regional anesthesia.