Streamlining Research Metrics Compilation Reports: An Automated Approach Using Scopus and Clarivate APIs.

This article examines the development and implementation of a customized Python script utilizing the Elsevier Scopus and Clarivate Web of Science Journal Citation Reports Application Programming Interfaces (APIs). The aim was to streamline and expedite the labor-intensive process of collecting research metrics, which were traditionally compiled manually by librarians at the University of Miami Miller School of Medicine Louis Calder Memorial Library. The script significantly reduces the time and effort required to generate comprehensive reports on research productivity, thereby enabling more efficient resource allocation and aiding in faculty evaluations.

Obesity Cardiometabolic Comorbidity Prevalence in Children in a Rural Weight-Management Program.

This descriptive study examines the prevalence of obesity-related cardiometabolic (CM) risk factors using CM laboratory metrics, in 3 to 19 year olds presenting to a rural American Academy of Pediatrics stage 3 multidisciplinary weight management clinic based on gender, age ranges, and obesity classes. From 2009 to 2016, 382 children (body mass index ≥85th percentile) enrolled. Multiple logistic regression determined the effects of age, gender, or obesity class on CM risk factors. Odds of elevated insulin were more significant in 15 to 19 year olds than in 3 to 5 year olds, or in 6 to 11 year olds. Obesity class III had higher odds than class II, class I, and overweight in having elevated insulin; twice likely than class II for having low high-density lipoprotein; and twice as likely than class I for high triglycerides. Adolescents and obesity class III categories have significant CM risk but the burden in younger and less severe obesity cohorts cannot be underestimated.

Predictive effect of out-of-hospital time in outcomes of severely injured young adult and elderly patients.

INTRODUCTION: The importance of accessing care within the first hour after injury has been a fundamental tenet of trauma system planning for 30 years. However, the scientific basis for this belief either has been missing or largely derived from case series from trauma centers. This study sought to determine the correlation between prehospital times and outcomes among severely injured elderly patients. METHODS: This is a cross-sectional, observational study. All adults (> or = 18 years of age) with acute trauma as defined by The International Classification of Diseases Ninth Edition, Clinical Modification diagnostic codes and E-codes were included. Poisonings, single system burns, and late effects of injury were excluded. Chi-square and Student's t-test were used for significance testing. To assess the predictive effects of prehospital time and outcomes, three independent logistic regression models were constructed for both young and elderly groups, with hospital length of stay, mortality, and complications as individual dependent variables. Statistical significance was set at the 0.05 level. RESULTS: Of 41,041 cases, 37,276 were > or = 18 years of age. Of the 1,866 with an Injury Severity Score (ISS) > 15, 1,205 were young and 661 elderly. Logistic regression results showed that prehospital time correlated significantly with hospital length of stay (p = 0.001) and complications (p = 0.016), but not with mortality (p = 0.264) among young patients, whereas in the elderly group pre-hospital time had no significant predictive effect for length of stay, complications, or mortality (p = 0.512, p = 0.512, and p = 0.954 respectively). CONCLUSION: This population-based study has demonstrated that prehospital time correlates with length of stay and complications in young patients. In elderly patients, prehospital time failed to show correlation with any outcomes measured.

Enhanced attention to speaking faces versus other event types emerges gradually across infancy.

The development of attention to dynamic faces versus objects providing synchronous audiovisual versus silent visual stimulation was assessed in a large sample of infants. Maintaining attention to the faces and voices of people speaking is critical for perceptual, cognitive, social, and language development. However, no studies have systematically assessed when, if, or how attention to speaking faces emerges and changes across infancy. Two measures of attention maintenance, habituation time (HT) and look-away rate (LAR), were derived from cross-sectional data of 2- to 8-month-old infants (N = 801). Results indicated that attention to audiovisual faces and voices was maintained across age, whereas attention to each of the other event types (audiovisual objects, silent dynamic faces, silent dynamic objects) declined across age. This reveals a gradually emerging advantage in attention maintenance (longer HTs, lower LARs) for audiovisual speaking faces compared with the other 3 event types. At 2 months, infants showed no attentional advantage for faces (with greater attention to audiovisual than to visual events); at 3 months, they attended more to dynamic faces than objects (in the presence or absence of voices), and by 4 to 5 and 6 to 8 months, significantly greater attention emerged to temporally coordinated faces and voices of people speaking compared with all other event types. Our results indicate that selective attention to coordinated faces and voices over other event types emerges gradually across infancy, likely as a function of experience with multimodal, redundant stimulation from person and object events. (PsycINFO Database Record

Patient Portal as a Tool for Enhancing Patient Experience and Improving Quality of Care in Primary Care Practices.

INTRODUCTION: This study assessed whether patient portals influence patients' ability for self-management, improve their perception of health state, improve their experience with primary care practices, and reduce healthcare utilization. METHODS: Patients participating in a nurse-led care coordination program received personalized training to use the portal to communicate with the care team. Data analysis included pre-post comparison of self-efficacy (CDSES), health state (EQVAS), functional status (PROMIS®), experience with the provider/practice (CG-CAHPS), and healthcare utilization (admissions and ED visits). RESULTS: A total of 94 patients were enrolled, and 92 (Intent to Treat) were followed up for 7 months to assess their experience, and for 12 months to assess healthcare utilization. Seventy four (mean age 60+13 years) used the portal (Users). Comparison between baseline and 7-month follow-up showed no statistically significant improvements in self-efficacy, perception of health state or experience with the primary care practice. Only functional status improved significantly. ED visits/1000 patients were reduced by 26% and 21% in the Intent to Treat and Users groups, respectively. Hospital admissions/1000 patients were reduced by 46% in the Intent to Treat group and by 38% in the Users group. DISCUSSION: For patients in care coordination, having access to patient portals may improve access to providers and health data that lead to improvements in patients' functional status and reduce high-cost healthcare utilization, but it does not seem to improve self-efficacy, perception of health state, or experience with primary care practices. CONCLUSION: In this study, the use of patient portals improved functional status and reduced high-cost healthcare utilization in patients with chronic conditions.

Using a Patient Portal to Transmit Patient Reported Health Information into the Electronic Record: Workflow Implications and User Experience.

INTRODUCTION: This project implemented an integrated patient self-reported screening tool in a patient portal and assessed clinical workflow and user experience in primary care practices. METHODS: An electronic health risk assessment based on the CMS Annual Wellness Visit (AWV) was developed to integrate self-reported health information into the patient's electronic health record (EHR). Patients enrolled in care coordination tested the implementation. The evaluation plan included quantitative and qualitative measures of patient adoption, provider adoption, workflow impact, financial impact, and technology impact. FINDINGS: Seventy-two patients completed the sample AWV, and 80% of the questionnaires had clinical findings that required provider follow-up. Patients expressed satisfaction with the portal, as it enabled them to view their health record and enter information. Implementation did not reduce office staff time. Providers and office staff agreed that an electronic system for adding information to their record would increase patient satisfaction, but they expressed concern with the need to promptly review the information and the time involved to accomplish this prior to an office visit. DISCUSSION: Despite satisfaction among patients, portal adoption is still low, due to technological limitations and to the lack of adaptability to primary care practice workflow. Notwithstanding those barriers, the use of the portal for completion of repetitive tasks, such as screening tools, should be encouraged. CONCLUSIONS: Patients can effectively use portals to complete the patient reported section of the CMS AWV. However, if the information is not completed during the same day of the office visit, the time required to address health findings outside of a regular office visit is uncompensated, and diminished the enthusiasm for this process among primary care practice staff.

Associations between infant temperament, maternal stress, and infants' sleep across the first year of life.

Effects of temperament and maternal stress on infant sleep behaviors were explored longitudinally. Negative temperament was associated with sleep problems, and with longer sleep latency and night wakefulness, whereas maternal stress was associated with day sleep duration, suggesting infant and maternal characteristics affect sleep differentially.

Geriatric trauma patients-are they receiving trauma center care?

OBJECTIVES: The primary purpose of this study was to evaluate whether severely injured geriatric patients were as likely to be treated at designated trauma centers (TCs) within the statewide trauma system. The secondary objective was to compare the demographic and injury characteristics of severely injured older and young patients who received care in TCs with the characteristics of those patients cared for in non-TCs. METHODS: The authors reviewed files for all acute injury discharges in Pennsylvania for 1997. Injury diagnoses were mapped to Abbreviated Injury Scale (AIS) scores using ICDMAP software; the Injury Severity Score (ISS) was computed. The frequency of hospital discharges for injury from TC and non-TC hospitals in both the older (E) (>/=65 years) and younger (Y) (<65 years) groups were computed, and compared using chi-square testing for significance. Logistic regression was performed to assess the influence of various factors. Severity of injury was controlled for with both ISS and Maximum AIS (MAIS). RESULTS: 107,358 patients were admitted to hospitals in the state because of injury; 8,980 had an ISS > 15; 5,855 were Y and 3,125 were E. Forty-seven percent of the Y patients received TC care compared with only 36.6% of the E patients (p < 0.001). Logistic regression analysis showed that age was a strongly negative predictor for TC care when injury severity was controlled. CONCLUSIONS: Seriously injured older patients were less likely to receive care in a trauma center than younger patients.

Data governance and data sharing agreements for community-wide health information exchange: lessons from the beacon communities.

PURPOSE: Unprecedented efforts are underway across the United States to electronically capture and exchange health information to improve health care and population health, and reduce costs. This increased collection and sharing of electronic patient data raises several governance issues, including privacy, security, liability, and market competition. Those engaged in such efforts have had to develop data sharing agreements (DSAs) among entities involved in information exchange, many of whom are "nontraditional" health care entities and/or new partners. This paper shares lessons learned based on the experiences of six federally funded communities participating in the Beacon Community Cooperative Agreement Program, and offers guidance for navigating data governance issues and developing DSAs to facilitate community-wide health information exchange. INNOVATION: While all entities involved in electronic data sharing must address governance issues and create DSAs accordingly, until recently little formal guidance existed for doing so - particularly for community-based initiatives. Despite this lack of guidance, together the Beacon Communities' experiences highlight promising strategies for navigating complex governance issues, which may be useful to other entities or communities initiating information exchange efforts to support delivery system transformation. CREDIBILITY: For the past three years, AcademyHealth has provided technical assistance to most of the 17 Beacon Communities, 6 of whom contributed to this collaborative writing effort. Though these communities varied widely in terms of their demographics, resources, and Beacon-driven priorities, common themes emerged as they described their approaches to data governance and DSA development. CONCLUSIONS: The 6 Beacon Communities confirmed that DSAs are necessary to satisfy legal and market-based concerns, and they identified several specific issues, many of which have been noted by others involved in network data sharing initiatives. More importantly, these communities identified several promising approaches to timely and effective DSA development, including: stakeholder engagement; identification and effective communication of value; adoption of a parsimonious approach; attention to market-based concerns; flexibility in adapting and expanding existing agreements and partnerships; and anticipation of required time and investment.

Making it local: Beacon Communities use health information technology to optimize care management.

Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks--including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation--the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability.

Incidence of occult upper gastrointestinal bleeding in patients presenting to the ED with hematochezia.

OBJECTIVE: The aim of the study was to determine the incidence of nasogastric (NG) aspiration revealing a clinically unsuspected upper gastrointestinal (GI) bleeding in patients presenting to the emergency department (ED) with hematochezia. A secondary aim was to identify factors associated with an upper GI source. METHODS: Data were prospectively collected from patients 18 years or older with either bright red blood per rectum or maroon stools. Patients were excluded if their history revealed hematemesis or their examination revealed melena, bleeding from an external hemorrhoid, or anal fissure. An NG tube was placed, and initial and postlavage aspirates were inspected and tested with Gastrocult (Beckman Coulter, Inc, Palo Alto, CA) for the presence of blood. Additional data included demographics, history, vital signs, and laboratory results. RESULTS: Of 114 patients, 11 (9.6%; 95% confidence interval, 4.9%-16.6%) had a positive NG aspirate. There were no statistically significant differences in age, sex, or race between the 2 groups. Factors associated with a positive aspirate were history of upper GI bleeding (P = .04), heart rate (P = .055), and hemoglobin (P = .03). CONCLUSION: Patients presenting to the ED with hematochezia require NG tube placement and aspiration to exclude an upper GI source of bleeding. History of an upper GI bleeding and anemia were associated with a positive NG aspirate.

Receiving care facility and outcome differences for victims of severe violent injuries.

OBJECTIVE: Each year millions of people die resulting from violence. Our objective was to evaluate and describe the demographic characteristics, access to trauma center care, mortality and morbidity outcomes of victims of severe violence in Pennsylvania. METHODS: This was a cross-sectional population-based observational study. ICD-9-CM diagnostic codes were utilized to define acute injuries; severe injury was defined by an Injury Severity Score (ISS) greater than 15. Descriptive statistics and confidence intervals were used to present group characteristics. For categorical variables, chi-square testing and Fisher's exact testing were used to assess associations, and the Odds Ratio was used as the measure of strength of association. For all tests statistical significance was set at the 0.05 level. RESULTS: A total of 8,977 patients with ISS > 15 were included; out of which 663 cases resulted from violence. Three hundred and forty seven (52.3%) were admitted to non-trauma center hospitals (NTC); Three hundred-and-sixteen (47.7%) to trauma center hospitals (TC). Mean length of stay and the rate of complications were significantly greater in the NTC facilities (p = 0.001 and 0.003, respectively) and a higher but statistically nonsignificant mortality increase was found in non-trauma centers (10.4% vs. 15.2%). CONCLUSION: Despite statewide EMS and trauma care systems, half of severely injured victims of violence were cared for in NTC facilities. TC hospitals showed a small but significant outcomes benefit in terms of complications and lengths of stay.

System compliance with out-of-hospital trauma triage criteria.

BACKGROUND: Emergency Medical Services (EMS) providers are the initial link to a trauma care system. Previous studies have demonstrated poor compliance with trauma triage by EMS personnel. We sought to determine the proportion of adult EMS cases within a large state meeting Trauma Triage Criteria (TTC) who are ultimately cared for in trauma centers. METHODS: Merged EMS and hospital discharge records for 1996 were examined. All adult acute trauma cases were included. Single-system burns and late effects of injury were excluded. RESULTS: Nine thousand one hundred seventy-four adult cases had at least one TTC, and 60.1% of these patients were transported to a non-trauma center (NTC) and 74.6% of cases with an Injury Severity Score > 15 and one TTC were taken to trauma centers. Analyzing two large urban counties, 58.2% and 27.0% of all TTC cases were still taken to NTC hospitals. CONCLUSION: A significant proportion of seriously injured patients meeting TTC were transported by EMS personnel to NTCs.