Improving a mature palliative care program at a Level I trauma center.
Advance Directives; Confidence Intervals; Data Analysis Software; Depression; Descriptive Statistics; Documentation; Electronic Health Records; Fisher's Exact Test; Frailty Syndrome; Hospital Programs; Human; Palliative Care; Pearson's Correlation Coefficient; Quality Improvement; Questionnaires; Simulations; Trauma Centers
Background: Similar to the significant rise in the geriatric population in the United States, trauma centers have seen an increase in geriatric trauma patients. These patients present with additional challenges such as a higher likelihood of undertriage, mortality, and frailty. In addition, the varying presence of advanced directive documentation increases the importance of early palliative care consultations for geriatric trauma patients. Objective: In 2018, a Level I trauma center in the Midwest reviewed the American College of Surgeons Trauma Quality Improvement Program's Palliative Care Best Practice Guideline to identify opportunities for improvement to strengthen the collaboration between the palliative care consult service and trauma program. Methods: The guideline drove improvements, which included documentation changes (i.e., expansion of palliative care consultation triggers, frailty assessment, advanced directives questions, depression screening, and addition of palliative care consultation section on the performance improvement program form) and training (1-hr lecture on palliative care and 5-hr palliative care simulation training) opportunities. Results: A 3-month manual chart review (March 2019 through May 2019) revealed that by May 2019, 87.2% of admitted geriatric trauma patients received frailty assessments, which surpassed the benchmark (>85%). In addition, advanced care planning questions (i.e., health care power of attorney, do not resuscitate order, or living will) exceeded the benchmarks set forth by the guideline (>90%), with all of the questions being asked and documented in 95.7% of those same patient charts by May 2019. Conclusion: This quality improvement project has applicability for trauma centers that treat geriatric trauma patients; using the guidelines can drive changes to meet individual institution needs.
Moran ME; Soltis M; Politis T; Gothard MD; George RL
Journal Of Trauma Nursing
2021
2021-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/JTN.0000000000000569" target="_blank" rel="noreferrer noopener">10.1097/JTN.0000000000000569</a>
Emergency department patients who leave before treatment is complete
HEALTH facilities; CONFIDENCE intervals; DESCRIPTIVE statistics; MEDICAL cooperation; METROPOLITAN areas; RESEARCH; RETROSPECTIVE studies; PATIENTS; EMERGENCY medical services; LONGITUDINAL method; MEDICAL screening; MEDICAL appointments
Introduction: Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits characteristics and potential revenue effects for a large healthcare system. Methods: This retrospective, multicenter study examined all encounters from January 1-December 31, 2019 at 18 EDs. The LBTC patients were divided into left without being seen (LWBS), defined as leaving prior to completed medical screening exam (MSE), and left subsequent to being seen (LSBS), defined as leaving after MSE was complete but before disposition. We recorded 30-day returns by facility type including median return hours, admission rate, and return to index ED. Expected realization rate and potential charges were calculated for each patient visit. Results: During the study period 626,548 ED visits occurred; 20,158 (3.2%) LBTC index encounters occurred, and 6745 (33.5%) returned within 30 days. The majority (41.7%) returned in <24 hours with 76.1% returning in 10 days and 66.4% returning to index ED. Median return time was 43.3 hours, and 23.2% were admitted. Urban community EDs had the highest 30-day return rate (37.8%, 95% confidence interval, 36.41-39.1). Patients categorized as LSBS had longer median return hours (66.0) and higher admission rates (29.8%) than the LWBS cohort. There was a net potential realization rate of $9.5 million to the healthcare system. Conclusion: In our system, LSBS patients had longer return times and higher admission rates than LWBS patients. There was significant potential financial impact for the system. Further studies should examine how healthcare systems can reduce risk and financial impacts of LBTC patients.
Smalley CM; Meldon SW; Simon EL; Muir McKinsey R; Delgado F; Fertel BS
Western Journal Of Emergency Medicine
2021
2021-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.5811/westjem.2020.11.48427" target="_blank" rel="noreferrer noopener">10.5811/westjem.2020.11.48427</a>
ACTH treatment for management of nephrotic syndrome: A systematic review and reappraisal.
DESCRIPTIVE statistics; TREATMENT effectiveness; MEDICAL information storage & retrieval systems; MEDLINE; SYSTEMATIC reviews (Medical research); NEPHROTIC syndrome treatment; ADRENOCORTICOTROPIC hormone; INFORMATION storage & retrieval systems – Medical care
BACKGROUND: In recent years, the use of adrenocorticotropic hormone (ACTH) therapy for treatment of proteinuria due to nephrotic syndrome (NS) has been heavily explored. ACTH therapy, which comes in the natural (H. P. Acthar Gel) or synthetic (tetracosactide) form, has resulted in remission in patients with immunosuppressive and steroid-resistant NS. However, the exact efficacy of ACTH therapy in the NS etiologies, such as membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD), lupus nephritis (LN), IgA nephropathy (IgAN), and membranoproliferative glomerulonephritis (MPGN), has not been determined. OBJECTIVE: This systematic review analyzed the published literature on ACTH therapy in various NS etiologies to determine its efficacy. METHODS: A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was conducted for articles through June 2019. An additional search was performed on clinicaltrials.gov to search for additional trials and cross reference the results of our database search. The literature which studied synthetic or natural ACTH treatment in patients with known etiologies of NS was included. Studies were excluded when they consisted of a single case report or did not analyze the lone effect of ACTH in NS. RESULTS: The initial search yielded a total of 411 papers, and 22 papers were included. In 214 MN patients, there was an overall remission of 40% (85/214) and an overall remission of 43% (42/98) in FSGS patients. In other etiologies, there were overall remissions of 78% (11/14), 31% (5/16), 40% (16/40), and 62% (8/13) in MCD, LN, IgAN, and MPGN patients, respectively. CONCLUSION: ACTH showed benefits in proteinuria reduction across all etiologies of NS. However, more randomized controlled studies with larger population sets and longer follow-ups are imperative to establish causal benefits. New studies into its efficacy in children are also necessary.
Chakraborty R; Mehta A; Nair N; Nemer L; Jain R; Joshi H; Raina R
International Journal of Nephrology
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1155/2020/2597079" target="_blank" rel="noreferrer noopener">10.1155/2020/2597079</a>
The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic.
Adrenergic Beta-Antagonists -- Therapeutic Use; Adult; Ambulatory Care Facilities; Chi Square Test; Descriptive Statistics; Diabetes Mellitus; Education; Essential Hypertension -- Drug Therapy; Fisher's Exact Test; Human; Hyperlipidemia -- Drug Therapy; Medically Underserved Area; Metformin -- Therapeutic Use; Non-Traditional; Outcomes of Education; Pharmacy Service; Physicians -- Education; Prescribing Patterns -- Education; Statins -- Therapeutic Use; Type 2 -- Drug Therapy
Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of β-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's χ2 and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and β-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.
Awad Magdi H; Ulbrich Timothy R; Furdich Kenneth M; Schneider Stacy R; Gothard M David
Journal of Pharmacy Technology
2019
2019-04
<a href="http://doi.org/10.1177/8755122518818826" target="_blank" rel="noreferrer noopener">10.1177/8755122518818826</a>
Temporal artery temperature measurements in healthy infants, children, and adolescents.
Female; Male; Ohio; Child; Infant; Analysis of Variance; Confidence Intervals; Temporal Arteries; Human; Convenience Sample; Descriptive Research; Descriptive Statistics; Funding Source; Data Analysis Software; Adolescence; Blacks; Whites; Preschool; Newborn; Body Temperature Determination – In Adolescence; Body Temperature Determination – In Infancy and Childhood
Roy S; Powell K; Gerson L W
Clinical pediatrics
2003
2003-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992280304200508" target="_blank" rel="noreferrer noopener">10.1177/000992280304200508</a>
Recreational injuries among older Americans, 2001.
Female; Male; Aged; United States; Confidence Intervals; Human; Descriptive Statistics; Emergency Service; Disease Surveillance; Gerontologic Care; 80 and Over; Cycling – In Old Age; Exercise – In Old Age; Injury Pattern – Evaluation – In Old Age; Recreation – In Old Age – United States; Sex Factors – In Old Age; Sports – In Old Age; Wounds and Injuries – Epidemiology – In Old Age
OBJECTIVE: To describe the epidemiology of non-fatal recreational injuries among older adults treated in United States emergency departments including national estimates of the number of injuries, types of recreational activities, and diagnoses. METHODS: Injury data were provided by the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a nationally representative subsample of 66 out of 100 NEISS hospitals. Potential cases were identified using the NEISS-AIP definition of a sport and recreation injury. The authors then reviewed the two line narrative to identify injuries related to participation in a sport or recreational activity among men and women more than 64 years old. RESULTS: In 2001, an estimated 62 164 (95% confidence interval 35 570 to 88 758) persons \textgreater/=65 years old were treated in emergency departments for injuries sustained while participating in sport or recreational activities. The overall injury rate was 177.3/100 000 population with higher rates for men (242.5/100 000) than for women (151.3/100 000). Exercising caused 30% of injuries among women and bicycling caused 17% of injuries among men. Twenty seven percent of all treated injuries were fractures and women (34%) were more likely than men (21%) to suffer fractures. CONCLUSIONS: Recreational activities were a frequent cause of injuries among older adults. Fractures were common. Many of these injuries are potentially preventable. As more persons engage in recreational activities, applying known injury prevention strategies will help to reduce the incidence of these injuries.
Gerson L W; Stevens J A
Injury Prevention (1353-8047)
2004
2004-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/ip.2004.005256" target="_blank" rel="noreferrer noopener">10.1136/ip.2004.005256</a>
Parotid gland metastasis from renal cell carcinoma.
Female; Aged; Biopsy; Human; Descriptive Statistics; Literature Review; Diagnosis; Carcinoma; Differential; Needle; Parotid Neoplasms; 80 and Over; Kidney Neoplasms – Pathology
Park Y W; Hlivko T J
Laryngoscope
2002
2002-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00005537-200203000-00009" target="_blank" rel="noreferrer noopener">10.1097/00005537-200203000-00009</a>
Expressed attitudes of adolescents toward marriage and family life.
Female; Male; Texas; Human; Descriptive Statistics; Surveys; Adolescence; Attitude Measures; Random Sample; Divorce; Sexuality; Family – Psychosocial Factors; Attitude – In Adolescence; Marriage – Psychosocial Factors
In the U.S., modifications in family structure and in attitudes concerning marriage and family life have been numerous. Areas such as sexual behavior and alternative living arrangements have become highly varied and nontraditional compared to past generations. This study examined the attitudes of adolescents toward aspects of marriage and family life. The majority of adolescents expressed negative attitudes toward divorce and viewed marriage as a lifelong commitment. While only about a third of the adolescents expressed positive attitudes toward premarital sex, a majority indicated they would engage in sexual intercourse before marriage, or already have. Interestingly, about half of the adolescents held positive attitudes toward cohabitation. Lastly, the adolescents demonstrated a growing acceptance of premarital counseling and psychoeducational interventions regarding marriage and family life.
Martin P D; Specter G; Martin D; Martin M
Adolescence
2003
2003
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; Age Factors; Sex Factors; Analysis of Variance; Patient Compliance; Pliability; Frail Elderly; Nursing Homes; Confidence Intervals; Inpatients; Human; Descriptive Statistics; P-Value; Repeated Measures; Data Analysis Software; Pilot Studies; Clinical Trials; Summated Rating Scaling; Clinical Assessment Tools; Analysis of Covariance; Outcomes (Health Care); Range of Motion; Random Assignment; Treatment Outcomes; Gerontologic Care; Long Term Care; Functional Status; Geriatric Functional Assessment; Crossover Design; Housing for the Elderly; Muscle Strengthening; Recreation; 80 and Over; Group Exercise – In Old Age
Objective:The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function.Design:A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.Setting:A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.Participants:Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.Intervention:After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.Measurements and Methods:Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.Results:There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.Conclusion:Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Baum EE; Jarjoura D; Polen AE; Faur D; Rutechi G
Journal of the American Medical Directors Association
2003
2003-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s1525-8610(04)70279-0" target="_blank" rel="noreferrer noopener">10.1016/s1525-8610(04)70279-0</a>
Examining the gray zones in guardianship and involuntary protective services laws.
Aged; Focus Groups; Attitude of Health Personnel; Human; Questionnaires; Descriptive Statistics; Attitude Measures; Research Instruments; Psychologists; Attitude to Aging; Guardianship; Physicians – Psychosocial Factors; Attorneys – Psychosocial Factors; Competence (Legal) – Psychosocial Factors – In Old Age; Legal – Psychosocial Factors – In Old Age; Nurses – Psychosocial Factors; Social Workers – Psychosocial Factors
Multidisciplinary focus groups were convened in three geographically diverse areas of Ohio to compare the application of guardianship and adult protective services interventions in the lives of vulnerable adults. The results suggest that there is general agreement in understanding the concepts of 'incapacity' and 'incompetence.' Professional differences in value orientation were found that may affect how these concepts are applied in given cases. Regional differences in modes of assessment, resource availability, and intervention style were found. A decision-making grid is presented to assist in the examination when one or both forms of involuntary intervention are appropriate.
Schimer MR; Anetzberger GJ
Journal of Elder Abuse & Neglect
1999
1999-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1300/j084v10n03_02" target="_blank" rel="noreferrer noopener">10.1300/j084v10n03_02</a>
Do elder emergency department patients and their informants agree about the elder's functioning?
Female; Male; Aged; Analysis of Variance; Self Report; Confidence Intervals; Human; Convenience Sample; Questionnaires; Cross Sectional Studies; Descriptive Statistics; Two-Tailed Test; T-Tests; Geriatric Functional Assessment; Significant Other; Emergency Service – Utilization – In Old Age
OBJECTIVE: To compare elder patients' and their informants' ratings of the elder's physical and mental function measured by a standard instrument, the Medical Outcomes Study Short Form 12 (SF-12). METHODS: This was a randomized, cross-sectional study conducted at a university-affiliated community teaching hospital emergency department (census 65,000/year). Patients \textgreater69 years old, arriving on weekdays between 10 AM and 7 PM, able to engage in English conversation, and consenting to participate were eligible. Patients too ill to participate were excluded. Informants were people who accompanied and knew the patient. Elder patients were randomized 1:1 to receive an interview or questionnaire version of the SF-12. The questionnaire was read to people unable to read. Two trained medical students administered the instrument. The SF-12 algorithm was used to calculate physical (PCS) and mental (MCS) component scores. Oral and written versions were compared using analysis of variance. The PCS and MCS scores between patient-informant pairs were compared with a matched t-test. Alpha was 0.05. RESULTS: One hundred six patients and 55 informants were enrolled. The patients' average (+/-SD) age was 77 +/- 5 years; 59 (56%; 95% CI = 46% to 65%) were women. There was no significant difference for mode of administration in PCS (p = 0.53) or MCS (p = 0.14) scores. Patients rated themselves higher on physical function than did their proxies. There was a 4.1 (95% CI = 99 to 7.2) point difference between patients' and their proxies' physical component scores (p = 0.01). Scores on the mental component were quite similar. The mean difference between patients and proxies was 0.49 (95% CI = 3.17 to 4.16). The half point higher rating by patients was not statistically significant (p = 0.79). CONCLUSIONS: Elders' self-ratings of physical function were higher than those of proxies who knew them. There was no difference in mental function ratings between patients and their proxies. Switching from informants' to patients' reports in evaluating elders' physical function in longitudinal studies may introduce error.
Gerson L W; Blanda M; Dhingra P; Davis J M; Diaz S R
Academic Emergency Medicine
2001
2001-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2001.tb00191.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2001.tb00191.x</a>
Dactylitis: implications for clinical practice.
Adult; Female; Male; Prospective Studies; Human; Chi Square Test; Descriptive Statistics; Middle Age; Fisher's Exact Test; Diagnosis; Differential; Fingers; Toes; Gout – Complications
OBJECTIVES: To assess the specificity of dactylitis for the diagnosis of spondyloarthropathy, sarcoidosis, and gout; and to characterize dactylitis specifically associated with gout. METHODS: Dactylitis was prospectively assessed among all individuals presenting to the Arthritis Center of Northeast Ohio from 1986 to 1996. RESULTS: Dactylitis was observed in 12% of individuals with spondyloarthropathy, 17% with sarcoidosis, and 5% with gout, but not in 96 patients with rheumatoid arthritis or in 2,434 patients with osteoarthritis, neck or back pain, or collagen vascular diseases. Among individuals with spondyloarthropathy, dactylitis was present in 22% with psoriatic, 28% with Reiter's syndrome, and only 7% with undifferentiated spondyloarthropathy. Gouty dactylitis was found only in individuals with polyarticular disease. CONCLUSIONS: Dactylitis is a valuable clue in the differential diagnosis of arthritis. Compared with the wider spectrum in children, sausage-shaped digits have only a few known causes in adults: Reiter's syndrome, psoriatic arthritis, sarcoidosis, flexor tendon sheath infections, and gout. In our series, the presence of dactylitis eliminated rheumatoid arthritis from the differential diagnosis. Copyright (c) 1998 by W.B. Saunders Company
Rothschild B M; Pingitore C; Eaton M
Seminars in Arthritis & Rheumatism
1998
1998-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0049-0172(98)80027-9" target="_blank" rel="noreferrer noopener">10.1016/s0049-0172(98)80027-9</a>
Confronting the communication gap between conventional and alternative medicine: a survey of physicians' attitudes.
Adult; Female; Male; Human; Questionnaires; Descriptive Statistics; P-Value; Repeated Measures; Middle Age; Internal Consistency; T-Tests; Physician Attitudes; Alternative Therapies – Psychosocial Factors
Crock R D; Jarjoura D; Polen A; Rutecki G W
Alternative Therapies in Health & Medicine
1999
1999-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The medically underserved: who is likely to exercise and why?
Adult; Female; Male; Ohio; Aged; Motivation; Exercise; Health Promotion; Counseling; Human; Convenience Sample; Questionnaires; Chi Square Test; Descriptive Statistics; Funding Source; Data Analysis Software; Interviews; Middle Age; Correlation Coefficient; Adolescence; Summated Rating Scaling; Whites; Preventive Health Care; Medically Underserved – Ohio
Adults who exercise regularly have better health, but only 15% of U.S. adults engage in regular exercise, with some social groups, such as people with lower incomes and women, having even lower rates. This study investigates the rate at which medically underserved patients receive exercise counseling from health care providers, characteristics of those who exercise, and barriers and motivations to exercise. The convenience sample was predominantly female and White and exclusively low-income and uninsured or underinsured. On average, participants were obese, by Federal Obesity Guidelines; 43% smoked. Although 60% of 126 patients reported that providers discussed exercise with them, the discussions had no relationship with patients' engagement in exercise. Women and those with lung problems, diabetes, or children in the home were less likely than others surveyed to exercise. The highest rated motivations included body image and health issues. The most important barriers were time, cost, and access to exercise facilities and equipment. In order for exercise counseling to be more effective, health care providers' interventions must consider patients' personal characteristics, health status, readiness to engage in an exercise program, and motivations and barriers to exercise.
Schrop S L; Pendleton BF; McCord G; Gil K M; Stockton L; McNatt J; Gilchrist V J
Journal of Health Care for the Poor & Underserved
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1353/hpu.2006.0069" target="_blank" rel="noreferrer noopener">10.1353/hpu.2006.0069</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Male; Ohio; Child; Infant; Risk Factors; Prospective Studies; Age Factors; Sex Factors; Hospitals; Sample Size; Reoperation; Speech; Confidence Intervals; Human; Descriptive Statistics; Middle Age; Adolescence; Retrospective Design; T-Tests; Surgical Flaps; Preschool; Treatment Outcomes; Record Review; Cleft Lip; Cleft Palate; Pediatric – Ohio; Mouth Abnormalities – Surgery; Pharyngeal Diseases – Surgery; Pharynx – Surgery
Objective: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation.Design: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes.Participants: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency.Results: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low.Conclusions: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor LS; Lehman J; Parker M G; Schmidt A; Fox L; Murthy AS
Cleft Palate-Craniofacial Journal
2006
2006-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1597/04-115" target="_blank" rel="noreferrer noopener">10.1597/04-115</a>
Fatal passenger vehicle crashes with at least 1 driver younger than 15 years: a Fatality Analysis Reporting System study.
Female; Male; Child; Multivariate Analysis; Age Factors; Midwestern United States; Licensure; Human; Descriptive Statistics; Funding Source; P-Value; Data Analysis Software; Pilot Studies; Data Analysis; Adolescence; Pearson's Correlation Coefficient; Spearman's Rank Correlation Coefficient; Southeastern United States; Regression; Statistical; Accidents; Traffic; Geographic Factors; Southwestern United States; Automobile Driving – In Adolescence; Automobile Driving – Legislation and Jurisprudence; Rural Health – In Adolescence
Frisch L; Plessinger A
Journal of Rural Health
2007
2007
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1748-0361.2007.00083.x" target="_blank" rel="noreferrer noopener">10.1111/j.1748-0361.2007.00083.x</a>
Effects of artifact rejection and Bayesian weighting on the auditory brainstem response during quiet and active behavioral conditions.
Adult; Female; Male; College; Analysis of Variance; Students; Artifacts; Evoked Potentials; Human; Descriptive Statistics; Repeated Measures; Post Hoc Analysis; Comparative Studies; T-Tests; Auditory; Brainstem; Noise – Prevention and Control
PURPOSE: To evaluate the effects of 2 noise reduction techniques on the auditory brainstem response (ABR). METHOD: ABRs of 20 normal hearing adults were recorded during quiet and active behavioral conditions using 2 stimulus intensity levels. Wave V amplitudes and residual noise root-mean-square values were measured following the offline application of artifact rejection and Bayesian weighting. Repeated measures analysis of variance and Bonferroni adjusted pairwise t tests were utilized to evaluate significant main effects and interactions between the 2 noise reduction techniques. RESULTS: ABRs recorded during the quiet behavioral condition resulted in minimal differences in wave V amplitude and noise reduction improvement, suggesting that the 2 techniques were equally effective under ideal recording situations. During the active behavioral condition, however, the techniques differed significantly in the ability to preserve the evoked potential and reduce noise. Consequently, strict artifact rejection levels resulted in an inherent underestimation of wave V amplitudes when compared with the Bayesian approach. CONCLUSION: Artifact rejection had a detrimental effect on waveform morphology of the ABR. This could lead to difficulty in ABR interpretation when patients are active and ultimately result in diagnostic errors.
Sanchez JT; Gans D
American Journal of Audiology
2006
2006-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1044/1059-0889(2006/019)" target="_blank" rel="noreferrer noopener">10.1044/1059-0889(2006/019)</a>
Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department.
Female; Male; Ohio; Child; Infant; Human; Descriptive Statistics; Adolescence; Retrospective Design; Random Sample; Preschool; Record Review; Antibiotics – Administration and Dosage – In Infancy and Childhood; Emergency Care – Standards – In Infancy and Childhood; Penicillins – Administration and Dosage; Pharyngitis – Drug Therapy – In Infancy and Childhood; Practice Guidelines – Utilization
Diaz MCG; Symons N; Ramundo ML; Christopher NC
Archives of Pediatrics & Adolescent Medicine
2004
2004-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archpedi.158.10.977" target="_blank" rel="noreferrer noopener">10.1001/archpedi.158.10.977</a>
Does functional decline prompt emergency department visits and admission in older patients?
Female; Male; Ohio; Aged; Prospective Studies; Hospitals; Activities of Daily Living; Confidence Intervals; Human; Convenience Sample; Questionnaires; Cross Sectional Studies; Descriptive Statistics; Funding Source; Data Analysis Software; Surveys; Coefficient Alpha; Clinical Assessment Tools; Emergency Service; Community; Geriatric Functional Assessment; 80 and Over; Emergency Care – In Old Age; Functional Status – In Old Age; Health Resource Utilization – In Old Age; Patient Admission – In Old Age
BACKGROUND: Older patients may visit the emergency department (ED) when their illness affects their function. OBJECTIVES: To quantify the function of older ED patients, to assess whether functional decline (FD) had occurred, and to determine whether function contributes to the ED visit and hospital admission. METHODS: The authors performed an institutional review board-approved, prospective, cross-sectional study in a community teaching hospital ED. Eligible patients were older than 74 years of age, with an illness at least 48 hours old. Patients from a nursing facility and those without a proxy who were unable or unwilling to complete the questions were excluded. The Older Americans Resources and Services Questionnaire, which tests seven instrumental activities of daily living (IADL) and seven physical ADLs (PADL), was used. Data are presented as means or proportions with 95% confidence intervals (95% CI), and comparisons as 95% CI for the difference between proportions. RESULTS: The authors enrolled 90 patients (mean age, 81.6 yr [SD +/- 4.9], 40% male). Dependence in at least one IADL was reported by 68% (95% CI = 57% to 77%), and in at least one PADL by 61% (95% CI = 50% to 71%). Functional decline was reported by 74% (95% CI = 64% to 83%). Two thirds of those with IADL decline and three quarters of those with PADL decline said that this contributed to their ED visit. Seventy-seven percent with, and 63% without, IADL decline were admitted (14% difference, 95% CI = -6.1% to 33%). Seventy-nine percent with and 61% without PADL decline were admitted (18% difference, 95% CI = -1.4% to 38%). CONCLUSIONS: Functional decline is common in older ED patients and contributes to ED visits in older patients; its role in admission is unclear.
Wilber S T; Blanda M; Gerson L W
Academic Emergency Medicine
2006
2006-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.01.006" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.01.006</a>
Derogatory and cynical humour directed towards patients: views of residents and attending doctors.
Physician-Patient Relations; Focus Groups; Human; Descriptive Statistics; Audiorecording; Wit and Humor; Teaching Methods – Evaluation; Physicians – Psychosocial Factors; Interns and Residents – Psychosocial Factors
CONTEXT A study of medical students' perspectives on derogatory and cynical humour was published in 2006. The current study examines residents' and attending doctors' perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery. METHODS Two focus groups were conducted in each of the three clinical departments, one with residents and one with attending doctors, during the 2006-07 academic year. Seventy doctors participated, including 49 residents and 21 attendings. The same semi-structured format was used in each group. Questions focused on characterisations of derogatory and cynical humour along with motives and rules for its use. All focus groups were audiotaped and the tapes transcribed. Each transcript was read independently by each researcher as part of an inductive process to discover the categories that describe and explain the uses, motives and effects of such humour. RESULTS Three categories that appeared in the first study with medical students – locations for humour, the humour game, and not-funny humour – emerged as virtually identical, whereas two others - objects of humour and motives for humour - were more fully elaborated. DISCUSSION Discussions of derogatory and cynical humour should occur in any department where teaching and role modelling are priorities. In addition, the tenets of appreciative inquiry and the complex responsive process, particularly as they are used at the Indiana University School of Medicine, offer medical educators valuable tools for addressing this phenomenon.
Wear D; Aultman JM; Zarconi J; Varley JD
Medical education
2009
2009-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1365-2923.2008.03171.x" target="_blank" rel="noreferrer noopener">10.1111/j.1365-2923.2008.03171.x</a>
Risk ratios and odds ratios for common events in cross-sectional and cohort studies.
Female; Pregnancy; Odds Ratio; Prospective Studies; Cross Sectional Studies; Descriptive Statistics; Logistic Regression; Models; Statistical; Pregnancy Trimester; Third; Relative Risk; Fibrin Fibrinogen Degradation Products – Analysis
Wilber S T; Fu R
Academic Emergency Medicine
2010
2010-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2010.00773.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00773.x</a>
Review: evidence for the effectiveness of surgery for low back pain, radiculopathy, and spinal stenosis is limited.
Spinal Fusion; Descriptive Statistics; Clinical Trials; Systematic Review; Laminectomy; Treatment Outcomes; Chronic Pain; Diskectomy; Spinal Stenosis – Surgery; Low Back Pain – Surgery; Radiculopathy – Surgery
Rothschild B; Chou R
ACP Journal Club
2009
2009-10-20
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7326/0003-4819-151-8-200910200-02011" target="_blank" rel="noreferrer noopener">10.7326/0003-4819-151-8-200910200-02011</a>
The influence of family environment on dissociation in pediatric injury patients.
Female; Male; Ohio; Socioeconomic Factors; Child; Prospective Studies; Income; Self Report; Confidence Intervals; Family; Social Environment; Human; Semi-Structured Interview; Questionnaires; Chi Square Test; Descriptive Research; Descriptive Statistics; Funding Source; Scales; Correlational Studies; Data Analysis Software; Pretest-Posttest Design; Checklists; Adolescence; Pearson's Correlation Coefficient; Retrospective Design; Analysis of Covariance; Child Development; Bivariate Statistics; Severity of Illness Indices; Family Relations; Family Coping; Interview Guides; Parametric Statistics; Parenting Education; Patient-Family Relations; Dissociative Disorders – Risk Factors; Accidents – Adverse Effects; Wounds and Injuries – Complications
Nugent Nicole R; Sledjeski Eve M; Christopher Norman C; Delahanty Douglas L
Clinical Child Psychology & Psychiatry
2011
2011-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1359104511406487" target="_blank" rel="noreferrer noopener">10.1177/1359104511406487</a>
Stability of extemporaneously prepared oxandrolone oral suspensions.
Human; Descriptive Statistics; Administration; Oral; Drug Compounding; Suspensions; Acid-Base Equilibrium; Androgens – Administration and Dosage; Weight Gain – Chemically Induced
Purpose. The stability of extemporaneously prepared oxandrolone oral suspensions was studied. Methods. Oxandrolone oral suspension (1 mg/mL) was prepared using oxandrolone tablets, Ora-Plus, and either Ora-Sweet or Ora-Sweet SF. Three identical samples of each formulation were prepared and stored in 2-oz amber plastic bottles with child-resistant caps at room temperature (23-25 °C). After thorough but gentle shaking by hand to prevent foaming, a 1-mL sample was withdrawn from each of the six bottles, diluted with mobile phase to an expected concentration of 200 µg/mL, and assayed in duplicate by injecting 5 µL into the high-performance liquid chromatography system immediately after preparation and at 7, 14, 35, 60, and 90 days. The samples were examined for any change in color or pH on each day of analysis. The stability of the suspensions was determined by calculating the percentage of the initial oxandrolone concentration remaining on each test day. Stability was defined as the retention of at least 90% of the initial oxandrolone concentration. Results. At least 98% of the original oxandrolone concentration remained in both formulations at the end of the 90-day study period. There was no appreciable change in odor, taste, color, or pH. Both suspensions remained white in color and sweet with no aftertaste throughout the study period. The oxandrolone was easily resuspended with gentle shaking. Conclusion. Extemporaneously prepared suspensions of oxandrolone 1 mg/mL in 1:1 mixtures of Ora-Plus and either Ora-Sweet or Ora-Sweet SF were stable for at least 90 days when stored in 2-oz amber plastic bottles at room temperature.
Johnson Cary E; Cober Mary Petrea; Hawkins Katherine A; Julian Justin D
American Journal of Health-System Pharmacy
2011
2011-03-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2146/ajhp100225" target="_blank" rel="noreferrer noopener">10.2146/ajhp100225</a>
Stability of an extemporaneous alcohol-free melatonin suspension.
Drug Stability; Descriptive Statistics; Administration; Oral; Drug Compounding; Melatonin; Suspensions; Taste
Purpose. The stability of alcohol-free oral suspensions of melatonin 1 mg/mL, extemporaneously prepared from two commercially available melatonin tablet products, was studied. Methods. Four 1-mg/mL melatonin suspensions were prepared. Formulations A and B contained 20 crushed 3-mg tablets of melatonin combined with a 1:1 mixture of Ora-Plus and either Ora-Sweet or Ora-Sweet SF to produce a volume of 60 mL. Formulations C and D were prepared by crushing 20 combination tablets containing melatonin 3 mg and pyridoxine hydrochloride 10 mg and then combining the powder with a 1:1 mixture of Ora-Plus and either Ora-Sweet or Ora-Sweet SF to produce a 60-mL volume. The suspensions were prepared in triplicate and stored at room temperature in amber plastic prescription bottles. Immediately after preparation and on days 7, 15, 30, 60, and 90, the samples were assayed in duplicate by stability-indicating high-performance liquid chromatography (HPLC). The samples were also evaluated for any changes in color, odor, and taste. Results. HPLC analysis demonstrated that at least 94% of the initial melatonin concentration in formulations A and B, and at least 98% of that in formulations C and D, remained throughout the 90-day study period. Detectable changes in color, odor, or taste occurred in all of the formulations. Conclusion. Extemporaneously prepared, alcohol-free, 1-mg/mL suspensions of melatonin and melatonin-pyridoxine hydrochloride in a 1:1 mixture of Ora- Plus and either Ora Sweet or Ora Sweet SF were stable for at least 90 days when stored in 2-oz amber plastic bottles at room temperature.
Johnson Cary E; Cober Mary Petrea; Thome Tennille; Rouse Emily
American Journal of Health-System Pharmacy
2011
2011
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2146/ajhp100274" target="_blank" rel="noreferrer noopener">10.2146/ajhp100274</a>
PTSD after Traumatic Injury: An Investigation of the Impact of Injury Severity and Peritraumatic Moderators.
Adult; Female; Male; Risk Factors; Hospitals; Midwestern United States; Questionnaires; Descriptive Statistics; Funding Source; P-Value; One-Way Analysis of Variance; Pearson's Correlation Coefficient; Regression; Community; Stress Disorders; Severity of Illness; Severity of Injury; Trauma – Complications; Post-Traumatic – Etiology; Trauma – Etiology
Gabert-Quillen Crystal A; Fallon William; Delahanty Douglas L
Journal of Health Psychology
2011
2011-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1359105310386823" target="_blank" rel="noreferrer noopener">10.1177/1359105310386823</a>
Prior Peritraumatic Dissociative Experiences Affect Autonomic Reactivity During Trauma Recall.
Female; Ohio; Young Adult; Body Mass Index; Analysis of Variance; Students; Heart Rate; Electrocardiography; Human; Questionnaires; Chi Square Test; Descriptive Statistics; Funding Source; Scales; Post Hoc Analysis; Adolescence; Pearson's Correlation Coefficient; Clinical Assessment Tools; Analysis of Covariance; Memory; Bereavement; Undergraduate; Life Experiences; Stress Disorders; Sexual Abuse; Crime; Arrhythmia; Cardiography; Impedance; Sinus; Post-Traumatic – Risk Factors; Trauma – Complications; Dissociative Disorders – Risk Factors
Sledjeski Eve M; Delahanty Douglas L
Journal of Trauma & Dissociation
2012
2012-02-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/15299732.2011.608628" target="_blank" rel="noreferrer noopener">10.1080/15299732.2011.608628</a>
Perfusion Pressures and Distal Oxygenation in Individuals With Diabetes Undergoing Chronic Hemodialysis.
Female; Male; Aged; Prospective Studies; Microcirculation; Wound Healing; Human; Descriptive Statistics; Data Analysis Software; Comparative Studies; Pilot Studies; Middle Age; Diabetic Patients; Dialysis Patients; Oxygenation; Peripheral Circulation; Tissue Perfusion; Diabetes Mellitus – Complications; Hemodialysis – Adverse Effects; Lower Extremity – Blood Supply
Kay David B; Ray Susan; Haller Nairmeen Awad; Hewit Michael
Foot & Ankle International
2011
2011-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3113/FAI.2011.0700" target="_blank" rel="noreferrer noopener">10.3113/FAI.2011.0700</a>
Menstrual Irregularity and Musculoskeletal Injury in Female High School Athletes.
Female; Odds Ratio; Education; Confidence Intervals; Women's Health; Human; Questionnaires; Chi Square Test; Cross Sectional Studies; Descriptive Statistics; Funding Source; Data Analysis Software; Post Hoc Analysis; Adolescence; One-Way Analysis of Variance; Survey Research; Wisconsin; Body Weights and Measures; Adolescent Health; Amenorrhea; Menarche; Oligomenorrhea; Sex Maturation; Continuing (Credit); Athletes; High School; Body Mass Index – Evaluation; Musculoskeletal System – Injuries – In Adolescence; Athletic Injuries – Epidemiology; Female – In Adolescence; Menstruation Disorders – In Adolescence; Severity of Injury – Evaluation
Context: The female athlete triad describes the interrelatedness of energy availability, menstrual function, and bone density. Although associations between triad components and musculoskeletal injury (INJ) have been reported in collegiate athletes, limited information exists about menstrual irregularity (Ml) and INJ in the high school population. Objective: To determine the prevalence of and relationship between Ml and INJ in high school athletes. Design: Cross-sectional study. Setting: High schools. Patients or Other Participants: The sample consisted of 249 female athletes from 3 high schools who competed in 33 interscholastic, school-sponsored sport teams, dance teams, and cheerleading or pom-pon squad during the 2006-2007 school year. Each athlete remained on the roster throughout the season. Main Outcome Measure(s): Participants completed a survey regarding injury type, number of days of sport participation missed, and menstrual history in the past year. Results: The prevalences of Ml and INJ were 19.7% and 63.1%, respectively. Athletes who reported Ml sustained; higher percentage of severe injuries (missing \textgreater22 days of practice or competition) than did athletes who reported normal menses. Although the trend was not significant, athletes with Ml were almost 3 times more likely to sustain an injury resulting in 7 or more days of time lost from sport (odds ratio = 2.7, 9591 confidence interval = 0.8, 8.8) than those who sustained an in jury resulting in 7 or fewer days of time lost. Conclusions: The incidences of Ml and INJ in this high school population during the study period were high. Athlete; who reported Ml sustained a higher percentage of severe injuries than did athletes who reported normal menses. Education programs to increase knowledge and improve management o Ml and its potential effects on injury in female high school athletes are warranted.
Thein-Nissenbaum Jill M; Rauh Mitchell J; Carr Kathleen E; Loud Keith J; McGuine Timothy A
Journal of Athletic Training (National Athletic Trainers' Association)
2012
2012-02-01
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<a href="http://doi.org/10.4085/1062-6050-47.1.74" target="_blank" rel="noreferrer noopener">10.4085/1062-6050-47.1.74</a>
Behaviors and Characteristics of African American and European American Females That Impact Weight Management.
Female; Socioeconomic Factors; Aged; Body Mass Index; Income; Exercise; Health Status; Dietary Fats; Fruit; Self Report; Demography; Psychosocial; Human; Questionnaires; Descriptive Statistics; Scales; Data Analysis Software; Comparative Studies; Middle Age; Coefficient Alpha; Confidence; Exploratory Research; Blacks; Whites; Support; Physical Activity; Women; Secondary Analysis; Race Factors; Body Weights and Measures; Eating Behavior; Energy Intake; Self-Efficacy; Vegetables; Weight Control; Health Behavior – Ethnology; Obesity – Risk Factors
This report explores the extent to which sociodemographic and psychosocial factors could explain differences in obesity or dietary and exercise behaviors between middle-aged African American (AA) and European American (EA) women seen in primary care. We focus on 'race × predictor' interactions that could explain how AA and EA women differ in ways that affect the prevalence of obesity. This comparative exploratory study uses data from the baseline examination of the Reasonable Eating and Activity to Change Health (REACH) trial, which included 173 AA women and 278 EA women. Inclusion criteria were membership in one of the study family medicine practices, an elevated body mass index (greater than 27 kg/m), age 40 to 69 years, and no contraindications to increased activity and dietary change. Secondary data analyses were employed. There was evidence of race differences in the level of multiple variables related to weight management but there were only three significant 'race × predictor' interactions out of 48 comparisons: (a) race × physical health, with BMI as the dependent variable; (b) race × the percentage of dietary fat, with total dietary kilocalories as the dependent variable; and (c) race × median income, with exercise minutes per week as the dependent variable. The results support the proposition that the weight management experience of AA and EA primary care women is similar after different exposure levels are taken into account. The results contribute to the body of literature that addresses obesity management for AA and EA women in primary care settings. Findings illustrate the need for obesity prevention and management efforts from both multidisciplinary primary care providers and community-wide public health interventions. AA and EA women have different resources, but the same factors generally influence weight management, whether one is AA or EA. This suggests that clinical interventions and public health interventions for AA and EA women can be designed around the same principles while paying attention to relevant cultural issues.
Capers Cynthia Flynn; Baughman Kristin; Logue Everett
Journal of Nursing Scholarship
2011
2011
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<a href="http://doi.org/10.1111/j.1547-5069.2011.01393.x" target="_blank" rel="noreferrer noopener">10.1111/j.1547-5069.2011.01393.x</a>
Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury Among High School Athletes.
Female; Multivariate Analysis; Odds Ratio; Prospective Studies; Self Report; Confidence Intervals; Women's Health; Psychological Tests; Human; Questionnaires; Chi Square Test; Descriptive Statistics; Funding Source; Data Analysis Software; Post Hoc Analysis; Adolescence; One-Way Analysis of Variance; Logistic Regression; Retrospective Design; Wisconsin; Record Review; Body Weights and Measures; Adolescent Health; Adolescent Nutrition; Female Athlete Triad; Athletes; High School; Athletic Injuries – Epidemiology – In Adolescence; Body Mass Index – Evaluation; Eating Behavior – Evaluation; Eating Disorders – Epidemiology – In Adolescence; Health Status – Evaluation; Menstruation Disorders – Epidemiology – In Adolescence; Musculoskeletal System – Injuries – In Adolescence; Sports – Classification
Thein-Nissenbaum Jill M; Rauh Mitchell J; Carr Kathleen E; Loud Keith J; McGuine Timothy A
Journal of Orthopaedic & Sports Physical Therapy
2011
2011-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2519/jospt.2011.3312" target="_blank" rel="noreferrer noopener">10.2519/jospt.2011.3312</a>
Assessment of the Clinical Use of Intravenous and Oral N-Acetylcysteine in the Treatment of Acute Acetaminophen Poisoning in Children: A Retrospective Review.
United States; Patient Selection; Medical Records; Descriptive Statistics; Retrospective Design; Intravenous; Administration; Oral; Cost Benefit Analysis; Acetaminophen – Adverse Effects; Acetylcysteine – Therapeutic Use; Overdose – Drug Therapy; Poisoning – Drug Therapy
Abstract: Background: N-acetylcysteine (NAC) is the most effective therapy for acetaminophen (APAP) toxicity and is currently available for oral and intravenous (IV) administration. Although both routes are effective, use of the IV formulation has been increasing since becoming available in the United States in 2004, raising questions about cost/benefit comparisons between the 2 formulations. Decreased length of treatment and hospital stay have been used to justify the use of IV NAC; however, some patients may receive extended therapy of either NAC regimen. Objective: This retrospective review assessed the clinical use of oral and IV NAC in pediatric patients with APAP intoxication from June 1, 2004 through May 31, 2008. Methods: Electronic medical charts for patients aged ≤21 years were identified with International Classification of Diseases, Ninth Revision (ICD-9) codes for APAP overdose. Descriptive statistics were used to describe the overall patient population and route of NAC administration. The primary outcome variable was the length of treatment with IV and oral NAC therapy. Results: A total of 62 charts for patients with APAP toxicity were reviewed; 37 patients (60%) received IV NAC and 25 patients (40%) received oral NAC. The average lengths of treatment and stay for IV dosing were 23.5 hours (range, 17.6–54.9 hours) and 1.6 days (range, 1–3 days), respectively; those for oral dosing were 69.5 hours (range, 33–133 hours) and 1.95 days (range, 1–5 days), respectively. Of 16 patients who received oral NAC and were admitted for \textless3 days, 14 were transferred to an inpatient psychiatric unit and completed the 72-hour therapy. A total of 3 patients received extended NAC dosing—2 with IV dosing and 1 with oral dosing. Conclusions: Based on our review, the majority of patients received recommended dosing of NAC therapy; however, 3 patients received extended NAC therapy. Patient-specific factors should be considered when assessing whether NAC therapy should be extended and if one route of administration may be preferred. ClinicalTrials.gov identifier: NCT00725179.
Blackford Martha G; Felter Thomas; Gothard M David; Reed Michael D
Clinical Therapeutics
2011
2011-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.clinthera.2011.08.005" target="_blank" rel="noreferrer noopener">10.1016/j.clinthera.2011.08.005</a>
A 4-Year Integrated Curriculum in Palliative Care for Medical Undergraduates.
Ohio; Students; Education; Human; Descriptive Statistics; Funding Source; Curriculum Development; Medical; Hospice Care – Education; Palliative Care – Education
Radwany Steven M; Stovsky Erica J; Frate Dean M; Dieter Kevin; Friebert Sarah; Palmisano Barbara; Sanders Margaret
American Journal of Hospice & Palliative Medicine
2011
2011-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1049909111406526" target="_blank" rel="noreferrer noopener">10.1177/1049909111406526</a>
Providing Nutrition Support in the Electronic Health Record Era: The Good, the Bad, and the Ugly.
Time Factors; Health Personnel; Nutritional Support; Safety; Human; Questionnaires; Descriptive Statistics; Summated Rating Scaling; Documentation; Electronic Order Entry; Product Evaluation; Acute Care; America; Electronic Health Records – Methods
Vanek Vincent W
Nutrition in Clinical Practice
2012
2012-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0884533612463440" target="_blank" rel="noreferrer noopener">10.1177/0884533612463440</a>
Predicting symptoms of post-traumatic stress among patients undergoing orthopedic surgery on the basis of routinely collected cardiovascular data.
Female; Male; Aged; Heart Rate; Sample Size; Arthroplasty; Knee; Blood Pressure; Human; Descriptive Statistics; Funding Source; P-Value; Scales; Evaluation Research; Middle Age; Clinical Assessment Tools; Impact of Events Scale; Outcomes (Health Care); Power Analysis; T-Tests; Replacement; Stress Disorders; Center for Epidemiological Studies Depression Scale; Cardiovascular System; Predictive Research; Post-Traumatic – Symptoms
Cremeans-Smith Julie K; Krupko Thomas A; Greene Kenneth; Delahanty Douglas L
Journal of Health Psychology
2013
2013-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1359105312438110" target="_blank" rel="noreferrer noopener">10.1177/1359105312438110</a>
Patient Preferences in Choosing a Primary Care Physician.
Adult; Female; Male; Aged; Multivariate Analysis; Odds Ratio; Prospective Studies; Decision Making; Physicians; Self Report; Family; Human; Questionnaires; Chi Square Test; Descriptive Statistics; Data Analysis Software; Middle Age; Adolescence; Logistic Regression; T-Tests; Patient Attitudes; Nonexperimental Studies; Maximum Likelihood; Patient
Mercado Francis; Mercado Margaret; Myers Nancy; Hewit Michael; Haller Nairmeen Awad
Journal of Primary Care & Community Health
2012
2012-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/2150131911421802" target="_blank" rel="noreferrer noopener">10.1177/2150131911421802</a>
Posted Emergency Department Wait Times Are Not Always Accurate.
Analysis of Variance; Emergency Medicine; Human; Cross Sectional Studies; Descriptive Statistics; Data Analysis; Retrospective Design; Emergency Service; Waiting Rooms
Jouriles Nicholas; Simon Erin L; Griffin Peter; Williams Carolyn Jo; Haller Nairmeen Awad; Ufberg Jacob W
Academic Emergency Medicine
2013
2013-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/acem.12107" target="_blank" rel="noreferrer noopener">10.1111/acem.12107</a>
Interactive Relationship Between Parent and Child Event Appraisals and Child PTSD Symptoms After an Injury.
Female; Male; Child; Glasgow Coma Scale; Self Report; Parents; Human; Questionnaires; Cross Sectional Studies; Descriptive Statistics; Scales; One-Way Analysis of Variance; Regression; T-Tests; Emergency Service; Stress Disorders; DSM; Severity of Injury; Post-Traumatic – Symptoms – In Infancy and Childhood; Trauma – In Infancy and Childhood
Morris Adam; Lee Timothy; Delahanty Douglas
Psychological Trauma: Theory, Research, Practice & Policy
2013
2013-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1037/a0029894" target="_blank" rel="noreferrer noopener">10.1037/a0029894</a>
Antimicrobial Effects of Virgin Coconut Oil and Its Medium-Chain Fatty Acids on Clostridium difficile.
Staining and Labeling; Microscopy; Descriptive Statistics; Comparative Studies; Microbial Culture and Sensitivity Tests; In Vitro Studies; Alternative Therapies; Cell Membrane; Coconut; Clostridium Infections – Prevention and Control; Antiinfective Agents – Pharmacodynamics; Fatty Acids – Analysis; Lipids – Pharmacodynamics; Plant Oils – Pharmacodynamics
Clostridium difficile is the leading cause of hospital-acquired antibiotic-associated diarrhea worldwide; in addition, the proliferation of antibiotic-resistant C. difficile is becoming a significant problem. Virgin coconut oil (VCO) has been shown previously to have the antimicrobial activity. This study evaluates the lipid components of VCO for the control of C. difficile. VCO and its most active individual fatty acids were tested to evaluate their antimicrobial effect on C. difficile in vitro. The data indicate that exposure to lauric acid (C12) was the most inhibitory to growth ( P\textless.001), as determined by a reduction in colony-forming units per milliliter. Capric acid (C10) and caprylic acid (C8) were inhibitory to growth, but to a lesser degree. VCO did not inhibit the growth of C. difficile; however, growth was inhibited when bacterial cells were exposed to 0.15-1.2% lipolyzed coconut oil. Transmission electron microscopy (TEM) showed the disruption of both the cell membrane and the cytoplasm of cells exposed to 2 mg/mL of lauric acid. Changes in bacterial cell membrane integrity were additionally confirmed for VCO and select fatty acids using Live/Dead staining. This study demonstrates the growth inhibition of C. difficile mediated by medium-chain fatty acids derived from VCO.
Shilling Michael; Matt Laurie; Rubin Evelyn; Visitacion Mark Paul; Haller Nairmeen A; Grey Scott F; Woolverton Christopher J
Journal of Medicinal Food
2013
2013-12
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<a href="http://doi.org/10.1089/jmf.2012.0303" target="_blank" rel="noreferrer noopener">10.1089/jmf.2012.0303</a>