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>
Memory Evaluation In Alzheimers-disease - Caregivers Appraisals And Objective Testing
adulthood; cerad; complaints; consortium; dementia; establish; neuropsychological assessment; Neurosciences & Neurology; questionnaires; rating-scale; relatives
Objectives.-To evaluate if caregivers are reliable informants concerning memory deficits in patients with Alzheimer's disease (AD). Design.-Responses of caregivers of patients with probable AD and responses of healthy control subjects on a standardized memory questionnaire were compared with objective measures of cognition (Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery) and with clinical estimates of activities of daily living, depression, and psychopathology (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] clinical assessment battery) using the Self-report Memory Questionnaire. Setting.-A federally funded AD research center. Subjects.-The referred sample included 117 patients with probable AD, their informants, and 41 healthy control subjects age-matched to the patients. Patients and control subjects were between the ages of 58 and 85 years, had between 9 and 19 years of education, and were in good health. Exclusions.-Patients who did not meet NINCDS-ADRDA criteria of probable AD. Main Outcome Measure.-The optimal number of questionnaire items yielding the best combination of sensitivity and specificity. Results.-An abbreviated version of the scale, renamed the Short-Memory Questionnaire, had excellent specificity and sensitivity for identifying dementia. Positive and negative predictive values were 63.5% and near 100%, respectively. The Short-Memory Questionnaire showed good reliability, internal consistency, and external validity. Caregiver appraisals of memory deficits significantly correlated with objective measures of memory and also with generalized cognitive dysfunction. Conclusions.-Caregivers of patients with AD are reliable informants of their relatives' deficits. The Short-Memory Questionnaire is an easily administered, informant-based scale that may be useful in clinical settings or epidemiologic studies to screen out persons with memory difficulties.
Koss E; Patterson M B; Ownby R; Stuckey J C; Whitehouse P J
Archives of Neurology
1993
1993-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1001/archneur.1993.00540010086023" target="_blank" rel="noreferrer noopener">10.1001/archneur.1993.00540010086023</a>
The educational experience of pediatric emergency medicine fellows in the use and application of procedural sedation/analgesia.
Curriculum; Education; Human; Questionnaires; Chi Square Test; Data Analysis Software; Pearson's Correlation Coefficient; Multiple Regression; Email; Survey Research; T-Tests; Medical; Analgesia; Sedation; Emergency Medicine – Education; Pediatric Care – Education
OBJECTIVES: The purpose of this study is to describe the clinical and educational experience provided to the pediatric emergency medicine (PEM) fellows in procedural sedation/analgesia during their course of training. METHODS: A nonanonymous survey was completed by the program director of each Accreditation Council for Graduate Medical Education (ACGME)-accredited PEM fellowship program listed in the 2001 to 2002 Graduate Medical Education Directory. Information relating to program demographics, agents available for use in the emergency department (ED), and the educational opportunities offered to trainees was sought. RESULTS: Each of the 32 ACGME-accredited programs completed the survey. Thirty programs report using procedural sedation and analgesia (PSA) to facilitate the completion of nonpainful and 32 programs to facilitate the completion of painful procedures in the ED. Twenty-nine programs (92%) permit their fellows to provide PSA independently after meeting credentialing criteria at their institution. Formal didactic sessions, direct supervision of procedures, and dedicated journal clubs were the 3 most frequently cited educational methods reported. The educational method chosen was not predicted by the ED type, the size of the training program, or by the volume of patients evaluated in the ED. Twelve program directors report their belief that a minimum number of procedures should be completed prior to completion of the training program. CONCLUSION: There is wide variation in the educational methods used by PEM fellowship training programs in procedural sedation/analgesia.
Pollauf LA; Lutes RE; Ramundo ML; Christopher NC
Pediatric emergency care
2004
2004-01
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/10.1097/01.pec.0000106237.72265.bb" target="_blank" rel="noreferrer noopener">10.1097/01.pec.0000106237.72265.bb</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>
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).
Anti-tobacco socialization in homes in African-American and White parents, and smoking and nonsmoking parents.
Ohio; Child; Focus Groups; Socialization; Human; Questionnaires; Chi Square Test; Funding Source; Interviews; Adolescence; Audiorecording; Blacks; Whites; Survey Research; Parental Attitudes – Ethnology; Parenting – Ethnology; Smoking – In Adolescence; Smoking – Prevention and Control – In Adolescence
PURPOSE: To examine parental perceptions and behaviors with regard to teen smoking, comparing African-American and white parents, and those who did and did not smoke. METHODS: Focus groups consisting of African-American and white parents who smoked provided initial in-depth information. A computer-assisted telephone survey of a biracial sample of 311 parents of children ages 8 to 17 years provided more generalizable information regarding parental beliefs and behaviors. RESULTS: Nearly 50% of households either allowed teen smoking, had no ground rules, or had set restrictive rules but never communicated them to the children. Compared to white parents, African-American parents felt more empowered to affect their children's behaviors and were more likely to actively participate in anti-tobacco socialization within the home (all p values \textless 0.01). Among the African-American parents, 98% reported 18 years or older to be an appropriate age for teens to make up their own minds about using tobacco, whereas 26% of white parents thought 16 years to be an appropriate age (p \textless 0.001). Parents who smoked reported more frequent rule-making than those who did not smoke (p = 0.02), but were more likely to believe that childhood tobacco use is inevitable (p = 0.01). CONCLUSIONS: Many parents are not engaged in antitobacco socialization in the home. Differences in the degree of parental participation may contribute to the variance in smoking prevalence between African-American and white children.
Clark P I; Scarisbrick-Hauser A; Gautam S P; Wirk S J
Journal of Adolescent Health
1999
1999-05
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/10.1016/s1054-139x(98)00117-7" target="_blank" rel="noreferrer noopener">10.1016/s1054-139x(98)00117-7</a>
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>
The effect of a 12-month longitudinal long-term care rotation on knowledge and attitudes of internal medicine residents about geriatrics.
Ohio; Aged; Curriculum; Prospective Studies; Attitude of Health Personnel; Educational Measurement; Clinical Competence; Education; Internship and Residency; Geriatric Assessment; Nursing Homes; Confidence Intervals; Internal Medicine; Human; Questionnaires; P-Value; Scales; Data Analysis Software; Pretest-Posttest Design; Professional Knowledge; Summated Rating Scaling; Interns and Residents; Internal Consistency; Attitude Measures; Wilcoxon Signed Rank Test; Paired T-Tests; Medical; Geriatrics – Education; Long Term Care – Education; Terminal Care – Education
OBJECTIVE: To determine if participation in a 12-month longitudinal long-term care (LTC) rotation resulted in improved knowledge and attitudes about geriatrics. DESIGN: Longitudinal study with paired measurements. SETTING: A community LTC facility and a university-affiliated, community-based internal medicine residency program. PARTICIPANTS: Sixty-seven internal medicine residents who participated in the rotation from 1997 through 2004. INTERVENTION: The internal medicine residents attended nursing home (NH) rounds one half day per month for 1 year, during which time they participated in a case-based interactive lecture on a core geriatric topic and rounded on their assigned patients. MEASUREMENTS: Knowledge was assessed using a 70-item test. Attitudes were evaluated with a 28-item, 5-point Likert scale (1 = least positive, 5 = most positive). RESULTS: The percent correct responses on geriatric knowledge pretest was 47% (95% CI = 45.2% to 48.8%) and on the posttest it was 57.5% (95% CI = 55.3% to 59.6%) (t = 8.180, df = 67, P \textless .001). The pretest total attitude score was 3.6 (95% CI = 3.6 to 3.7), with a posttest score of 3.7 (95% CI = 3.7 to 3.8) (P \textless .001). The difference in this total was accounted for mainly by the significant changes in the attitude subscales in educational preparation (pretest 3.6 [95% CI = 3.5 to 3.8]; posttest 3.8 [95% CI = 3.7 to 3.9] [P \textless .001]), general attitudes (pretest 4.0 [95% CI = 3.9 to 4.1]; posttest 4.2 [95% CI = 4.0 to 4.3] [P = .006]), and therapeutic potential (pretest 3.7 [95% CI = 3.5 to 3.8]; posttest 3.8 [95% CI = 3.7 to 3.9] [P = .048]). CONCLUSION: A longitudinal LTC rotation is an efficient and effective way to systematically provide internal medicine residents their core knowledge and experience in geriatrics.
Baum EE; Nelson KM
Journal of the American Medical Directors Association
2007
2007-02
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/10.1016/j.jamda.2006.05.009" target="_blank" rel="noreferrer noopener">10.1016/j.jamda.2006.05.009</a>
Impact of preceptor and orientee learning styles on satisfaction: a pilot study.
Ohio; Program Evaluation; Education; Preceptorship; Health Services Needs and Demand; Human; Questionnaires; Funding Source; Mentorship; Evaluation Research; Pilot Studies; Test-Retest Reliability; Education Research; Learning Methods; Nurse Attitudes; T-Tests; Intraprofessional Relations; Models; Educational; Nursing Staff; Nursing; Hospital – Psychosocial Factors; Continuing – Administration; Hospital – Education; Nursing Practice – Education; Psychology – Education; Staff Development – Administration
This descriptive pilot study assessed the impact of learning style on satisfaction with orientation. Three learning style instruments were sent to all preceptors on inpatient units in two hospitals, and newly hired registered nurses and licensed practical nurses completed the same learning style instruments. Level of satisfaction with the orientation was used as the posttest measure. Matched t tests were compared to see whether the two groups had significant differences. Knowledge of the impact of learning styles on satisfaction can enhance the preceptor experience and perhaps increase retention.
Brunt BA; Kopp DJ
Journal for Nurses in Staff Development
2007
2007-01
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/10.1097/00124645-200701000-00008" target="_blank" rel="noreferrer noopener">10.1097/00124645-200701000-00008</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>
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>
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>
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
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/10.4085/1062-6050-47.1.74" 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
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.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>
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>
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>
Improved auscultation skills in paramedic students using a modified stethoscope.
Adult; Aged; Child; Students; Clinical Competence; Computer Simulation; Emergency Medical Services; Education; Educational Status; Human; Questionnaires; Competency Assessment; Qualitative Studies; Middle Age; Pretest-Posttest Design; Education Research; Quantitative Studies; Preschool; Stethoscopes; Gastrointestinal Motility; Heart Auscultation; Heart Sounds; Respiratory Sounds; Allied Health; Auscultation – Education
Simon EL; Lecat PJ; Haller NA; Williams CJ; Martin SW; Carney JA; Pakiela JA
Journal of Emergency Medicine (0736-4679)
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/10.1016/j.jemermed.2012.01.048" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2012.01.048</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>
Findings from a 10-year follow-up of bone mineral density in competitive perimenopausal runners.
Adult; Female; Humans; Middle Aged; Surveys and Questionnaires; Follow-Up Studies; Prospective Studies; Case-Control Studies; Bone Density/*physiology; Running/*physiology; Hip Joint/diagnostic imaging/*physiology; Lumbar Vertebrae/diagnostic imaging/*physiology; Perimenopause; Osteoporosis; Human; Questionnaires; Clinical Trials; Middle Age; Case Control Studies; Absorptiometry; Photon; Postmenopausal/*diagnostic imaging; Menopause; Bone Density – Physiology; Hip Joint – Physiology; Hip Joint – Radiography; Lumbar Vertebrae – Physiology; Lumbar Vertebrae – Radiography; Osteoporosis – Radiography; Running – Physiology
OBJECTIVE: To evaluate bone mineral density (BMD) in perimenopausal competitive runners with long-term follow-up. STUDY DESIGN: Fifteen master female runners between 40 and 50 years old who ran at least 20 miles per week were evaluated. BMD was measured by dual-energy x-ray absorptiometry (DEXA) at baseline and at the 10-year follow-up. RESULTS: The median age was 46 and median miles run per week, 25. At baseline, after a median of 11 years of competitive running, hip BMD was above peak bone mass (T-score = 0.8) and that of age-matched controls (Z-score = 1.6), while lumbar spine BMD was below peak bone mass (T-score = -0.8) and equal to that of age-matched controls (Z-score = -0.1). At the 10-year follow-up, hip BMD fell below peak bone mass (T-score = -0.2, p = 0.0004) but was still above that of age-matched controls (Z-score = 0.5, p = 0.002), while there was little change in lumbar spine BMD. CONCLUSION: Competitive running prior to the perimenopausal period seems to be associated with improved hip BMD. However, continued competitive running during the perimenopausal period is not associated with prevention of a perimenopausal hip BMD decline. In contrast, competitive running had little effect on peri-menopausal lumbar spine BMD.
Fanning James; Larrick Lori; Weinstein Louis; Horrigan Terrence J; Marcotte Michael P; Flora Robert F
The Journal of reproductive medicine
2007
2007-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Emergency medicine residency boot Camp curriculum: a pilot study.
Pilot Projects; *Internship and Residency; *Curriculum; Emergency Medicine/*education; Education; Emergency Medicine; Internship and Residency; Human; Questionnaires; Surveys; Curriculum Development; Pilot Studies; Confidence; Interns and Residents; Medical; Skill Acquisition; Invasive Procedures – Education
INTRODUCTION: Establishing a boot camp curriculum is pertinent for emergency medicine (EM) residents in order to develop proficiency in a large scope of procedures and leadership skills. In this article, we describe our program's EM boot camp curriculum as well as measure the confidence levels of resident physicians through a pre- and post-boot camp survey. METHODS: We designed a one-month boot camp curriculum with the intention of improving the confidence, procedural performance, leadership, communication and resource management of EM interns. Our curriculum consisted of 12 hours of initial training and culminated in a two-day boot camp. The initial day consisted of clinical skill training and the second day included code drill scenarios followed by interprofessional debriefing. RESULTS: Twelve EM interns entered residency with an overall confidence score of 3.2 (1-5 scale) across all surveyed skills. Interns reported the highest pre-survey confidence scores in suturing (4.3) and genitourinary exams (3.9). The lowest pre-survey confidence score was in thoracostomy (2.4). Following the capstone experience, overall confidence scores increased to 4.0. Confidence increased the most in defibrillation and thoracostomy. Additionally, all interns reported post-survey confidence scores of at least 3.0 in all skills, representing an internal anchor of "moderately confident/need guidance at times to perform procedure." CONCLUSION: At the completion of the boot camp curriculum, EM interns had improvement in self-reported confidence across all surveyed skills and procedures. The described EM boot camp curriculum was effective, feasible and provided a foundation to our trainees during their first month of residency.
Ataya Ramsey; Dasgupta Rahul; Blanda Rachel; Moftakhar Yasmin; Hughes Patrick G; Ahmed Rami
The western journal of emergency medicine
2015
2015-03
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/10.5811/westjem.2015.1.23931" target="_blank" rel="noreferrer noopener">10.5811/westjem.2015.1.23931</a>
The Relationship Between Organizational Characteristics and Advance Care Planning Practices.
Administrative Personnel; Adult; advance care planning; Advance Care Planning; Advance Care Planning/*organization & administration/standards; area agency on aging; Attitude of Health Personnel; care management; Case Management; Case Managers; Chi Square Test; Clinical Protocols/standards; community-based long-term care; Confidence Intervals; Cross Sectional Studies; Cross-Sectional Studies; Data Analysis Software; Descriptive Research; Descriptive Statistics; Female; Funding Source; Government Agencies; Human; Humans; Inservice Training/organization & administration; Interviews; Logistic Regression; Long Term Care; Male; Medicaid; Medicaid/statistics & numerical data; Middle Age; Middle Aged; Midwestern United States; Multivariate Analysis; nurses; Odds Ratio; Ohio; organizational characteristics; Organizational Culture; Practice Guidelines as Topic; Questionnaires; Registered Nurses; Rural Areas; social workers; Social Workers; Surveys; T-Tests; Telephone; United States; Urban Areas
Organizational characteristics may impede the uniform adoption of advance care planning (ACP) best practices. We conducted telephone interviews with site directors of a Midwestern state's Medicaid waiver program administered by the Area Agencies on Aging and surveyed the 433 care managers (registered nurses and social workers) employed within these 9 agencies. Care managers at 2 agencies reported more frequent ACP discussions and higher levels of confidence. Both sites had ACP training programs, follow-up protocols, and informational packets available for consumers that were not consistently available at the other agencies. The findings point to the need for consistent educational programs and policies on ACP and more in depth examination of the values, beliefs, and resources that account for organizational differences in ACP.
Baughman Kristin R; Ludwick Ruth; Palmisano Barbara; Hazelett Susan; Sanders Margaret
The American journal of hospice & palliative care
2015
2015-08
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/10.1177/1049909114530039" target="_blank" rel="noreferrer noopener">10.1177/1049909114530039</a>
Disentangling consumer and provider predictors of advance care planning.
*Advance Care Planning; *Long-Term Care; Adult; advance care planning; Advance Care Planning; Age Factors; area agencies on aging; Attitude of Health Personnel; care management; Caregivers; community-based care; Conceptual Framework; Consumers; Data Analysis Software; Discussion; Factorial Design; factorial surveys; Female; Human; Humans; Judgment; Long Term Care; long-term care; Middle Age; Multivariate Analysis; Quasi-Experimental Studies; Questionnaires; Random Sample; Registered Nurses; Social Workers; Surveys; Surveys and Questionnaires; Vignettes
Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.
Baughman Kristin R; Ludwick Ruth; Merolla David; Palmisano Barbara; Hazelett Susan; Allen Kyle R; Sanders Margaret
The American journal of hospice & palliative care
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/10.1177/1049909112464692" target="_blank" rel="noreferrer noopener">10.1177/1049909112464692</a>
Narrative analysis of the ethics in providing advance care planning.
*Long-Term Care; Accountability; Advance care planning; Advance Care Planning – Ethical Issues; Advance Care Planning/*ethics; care managers; Case Managers; Courage; Decision Making/*ethics; Empowerment; end-of-life decisions; ethical dilemmas; Ethics; Focus Groups; Funding Source; Human; Humans; narrative analysis; Narratives; Nurses/*psychology; Ohio; Open-Ended Questionnaires; Patient Care Management/*ethics; Professional; Qualitative Studies; Questionnaires; registered nurses; Registered Nurses; Respect; Secondary Analysis; social workers; Social Workers; Thematic Analysis
Our objective was to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging. We conducted eight focus groups in which care managers were invited to tell their stories and answer open-ended questions focusing on their interactions with consumers receiving home-based long-term care. Using narrative analysis to understand how our participants thought through particular experiences and what they valued, we identified seven themes representative of their work with consumers and families: humility, respect, responsibilities, boundaries, empowerment, courage, and veracity.
Baughman Kristin R; Aultman Julie M; Ludwick Ruth; O'Neill Anne
Nursing ethics
2014
2014-02
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/10.1177/0969733013486795" target="_blank" rel="noreferrer noopener">10.1177/0969733013486795</a>
Screen Exposure During Daily Routines and a Young Child's Risk for Having Social-Emotional Delay.
*Child Development; Activities of Daily Living; Affective Disorders; Caregivers; Child; child development; Child Development – Evaluation; Computers/*statistics & numerical data; Cross Sectional Studies; Cross-Sectional Studies; emotions; Female; Human; Humans; Infant; Male; media; New York; Ohio; Preschool; Questionnaires; Race Factors; Risk Factors; screen; Sedentary Behavior; Social Behavior; Surveys and Questionnaires; Television/*statistics & numerical data
This cross-sectional study assessed associations between social-emotional development in young children and their number of daily routines involving an electronic screen. We hypothesized children with poor social-emotional development have a significant portion of daily routines occurring with a screen. Two hundred and ten female caregivers of typically developing children 12 to 36 months old completed the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) and a media diary. Caregivers completed the diary for 1 day around 10 daily routines (Waking Up, Diapering/Toileting, Dressing, Breakfast, Lunch, Naptime, Playtime, Dinner, Bath, and Bedtime). Median number of daily routines occurring with a screen for children at risk and not at risk for social-emotional delay (as defined by the ASQ: SE) was 7 versus 5. Children at risk for social-emotional delay were 5.8 times more likely to have \textgreater/=5 routines occurring with a screen as compared to children not at risk for delay (chi1(2) = 9.28, N = 210, P = .002; 95% confidence interval = 1.66-20.39).
Raman Sajani; Guerrero-Duby Sara; McCullough Jennifer L; Brown Miraides; Ostrowski-Delahanty Sarah; Langkamp Diane; Duby John C
Clinical pediatrics
2017
2017-11
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/10.1177/0009922816684600" target="_blank" rel="noreferrer noopener">10.1177/0009922816684600</a>
A broader understanding of care managers' attitudes of advance care planning: A concurrent nested design.
*Attitude of Health Personnel; *Health Knowledge; Adult; Advance Care Planning; Advance Care Planning/*standards; Attitudes; Case Managers; Chi Square Test; community health; Concurrent Prospective Studies; Convenience Sample; decision-making; Discussion; end of life; Female; Focus Groups; Funding Source; Health Services Accessibility/standards; Human; Humans; Male; Middle Age; Middle Aged; Midwestern United States; Multicenter Studies; Multimethod Studies; Nurse Attitudes; nurses; Practice; qualitative; Qualitative Research; quantitative; Questionnaires; Surveys; Surveys and Questionnaires; Thematic Analysis
AIMS AND OBJECTIVES: To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a mixed methods approach. A concurrent nested design was used to acquire a deeper understanding of ACP and to identify nuances between quantitative and qualitative data. BACKGROUND: Past quantitative studies on providers have identified barriers related to time, culture, knowledge, responsibility and availability of legal documents. These barriers, and accompanying attitudes and feelings, have been taken at face value without rich qualitative data to identify under what conditions and to what extent a barrier impacts care. DESIGN: A two-part multisite, mixed methods study was conducted using surveys and focus groups. METHODS: Surveys were completed by 458 CMs at 10 Area Agencies on Aging and 62 participated in one of eight focus groups. Data were analysed using a concurrent nested design with individual data analysis and a merged data approach. RESULTS: There were three main distinctions between the quantitative and qualitative data. First, while CMs reported on the survey that ACP was not too time consuming, focus group data revealed that time was an issue especially related to competing priorities. Second on the survey 60% of the CMS reported they had enough knowledge, but qualitative data revealed about more nuances. Last, the reported comfort levels in the quantitative data were less overt in the qualitative date where additional feelings and attitudes were revealed, for example, frustration with families, preferences for more physician involvement. CONCLUSIONS: Care managers reported their attitudes about ACP, clarified through a rigorous mixed methods analysis. Care managers can successfully lead ACP discussions, but require further education, resources and team-based guidance. RELEVANCE TO CLINICAL PRACTICE: Advance care planning is essential for reducing emotional, social and financial burdens associated with healthcare decision-making, and CMs can positively impact ACP discussions when appropriately supported by the clinical community. The many nuances in the ACP process that we found illustrate the need for ongoing discussions, education and research on this important topic.
Aultman Julie; Baughman Kristin R; Ludwick Ruth
Journal of clinical nursing
2018
2018-10
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/10.1111/jocn.14531" target="_blank" rel="noreferrer noopener">10.1111/jocn.14531</a>
Exploring comorbid depression and physical health trajectories: A case-based computational modelling approach.
artificial intelligence; case-based modelling; Child Abuse; cluster analysis; comorbid depression and physical health; Comorbidity; complexity theory; Computer Simulation; Depression – Therapy; differential equations; Health Status; Human; Intimate Partner Violence; longitudinal analysis; Models; nonlinear dynamics; primary care; Primary Health Care; Prospective Studies; Questionnaires; Research Personnel; Scales; Theoretical
While comorbid depression/physical health is a major clinical concern, the conventional methods of medicine make it difficult to model the complexities of this relationship. Such challenges include cataloguing multiple trends, developing multiple complex aetiological explanations, and modelling the collective large-scale dynamics of these trends. Using a case-based complexity approach, this study engaged in a richly described case study to demonstrate the utility of computational modelling for primary care research. N = 259 people were subsampled from the Diamond database, one of the largest primary care depression cohort studies worldwide. A global measure of depressive symptoms (PHQ-9) and physical health (PCS-12) were assessed at 3, 6, 9, and 12 months and then annually for a total of 7 years. Eleven trajectories and 2 large-scale collective dynamics were identified, revealing that while depression is comorbid with poor physical health, chronic illness is often low dynamic and not always linked to depression. Also, some of the cases in the unhealthy and oscillator trends remain ill without much chance of improvement. Finally, childhood abuse, partner violence, and negative life events are greater amongst unhealthy trends. Computational modelling offers a major advance for health researchers to account for the diversity of primary care patients and for developing better prognostic models for team-based interdisciplinary care.
Castellani Brian; Griffiths Frances; Rajaram Rajeev; Gunn Jane
Journal of evaluation in clinical practice
2018
2018-12
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/10.1111/jep.13042" target="_blank" rel="noreferrer noopener">10.1111/jep.13042</a>
Short-term functional decline and service use in older emergency department patients with blunt injuries.
*Activities of Daily Living; 80 and over; 80 and Over; Academic Medical Centers; Activities of Daily Living; Aged; Bone/physiopathology/therapy; Clinical Assessment Tools; Comorbidity; Confidence Intervals; Descriptive Statistics; Emergency Care – In Old Age; Emergency Patients – In Old Age; Emergency Service; Family; Female; Fisher's Exact Test; Fractures; Functional Status – In Old Age; Geriatric Assessment; Geriatric Functional Assessment; Health Resource Utilization – In Old Age; Hospital/*statistics & numerical data; Hospitals; Human; Humans; Logistic Models; Logistic Regression; Longitudinal Studies; Male; Mental Status Schedule; Nonpenetrating – In Old Age; Nonpenetrating/*physiopathology/*therapy; OARS Multidimensional Functional Assessment Questionnaire; Odds Ratio; Ohio; Outcome Assessment; Outpatients; P-Value; Predictive Value of Tests; Prospective Studies; Questionnaires; Record Review; ROC Curve; Scales; Summated Rating Scaling; Surveys and Questionnaires; T-Tests; Teaching; Treatment Outcome; Treatment Outcomes; Wounds
BACKGROUND: Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. OBJECTIVES: The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. METHODS: This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were \textgreater or = 65 years old, with blunt injuries \textless48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. RESULTS: A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). CONCLUSIONS: Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.
Wilber Scott T; Blanda Michelle; Gerson Lowell W; Allen Kyle R
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2010
2010-07
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.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00799.x</a>
Characteristics of Academic Health Departments: Initial Findings From a Cross-Sectional Survey.
Academic Medical Centers – Evaluation; Academies and Institutes/*classification; Community Health Services; Cross Sectional Studies; Cross-Sectional Studies; Human; Humans; Public Health Administration; Questionnaires; Surveys and Questionnaires; United States; United States Public Health Service/*classification/trends
Academic Health Departments (AHDs) represent collaborative relationships between public health academia and practice. The purpose of this study was to gain a better understanding of AHD characteristics, to document the extent of collaboration between organizations in an AHD, and to explore the benefits of AHDs. An electronic survey on the AHD was sent to members of the AHD Learning Community–a virtual learning community with 338 members. There were 110 valid responses to the survey, with 65 indicating they were currently in an AHD partnership. Thirty-two percent of AHDs had been established for more than 10 years; 64% were engaged in joint research activities; and, while 92% of respondents placed a high value on improving the competencies of students, almost half placed a high value on improving the competencies of faculty. This study can be a springboard for further research on the impact of AHDs on practice, academia, and ultimately community health.
Erwin Paul Campbell; Barlow Patrick; Brownson Ross C; Amos Kathleen; Keck C William
Journal of public health management and practice : JPHMP
2016
2016-04
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/10.1097/PHH.0000000000000237" target="_blank" rel="noreferrer noopener">10.1097/PHH.0000000000000237</a>
Long-term results of percutaneous lumbar decompression for LSS: two-year outcomes.
80 and over; 80 and Over; Aged; Cohort Studies; Decompression; Disability Evaluation; Female; Human; Humans; Intermittent Claudication – Complications; Intermittent Claudication – Surgery; Intermittent Claudication/complications/surgery; Lumbar Vertebrae; Male; Middle Age; Middle Aged; Prospective Studies; Questionnaires; Spinal Stenosis – Complications; Spinal Stenosis – Surgery; Spinal Stenosis/complications/*surgery; Surgical – Methods; Surgical/*methods; Surveys and Questionnaires; Time Factors; Treatment Outcome; Treatment Outcomes; Visual Analog Scale; Visual Analog Scaling
OBJECTIVE: The aim of this report was to evaluate the long-term effectiveness and safety of mild lumbar decompression for the treatment of neurogenic claudication associated with lumbar spinal stenosis. This technique uses a percutaneous dorsal approach to remove small portions of ligament and lamina, thereby restoring space and decompressing the spinal canal. MATERIALS AND METHODS: Two-year data are reported for 45 patients treated with mild decompression at 11 US sites. Outcome measures included the Visual Analog Scale (VAS), Oswestry Disability Index, and Zurich Claudication Questionnaire. Safety was monitored throughout the procedural and follow-up period for all patients. Interim data are included for these patients at 1 week, 6 months, and 1-year follow-up. RESULTS: Seventy-one percent of patients reported improvement in VAS at the end of the reporting period. At 2 years, patients demonstrated a statistically significant reduction of pain as measured by VAS, and improvement in physical function and mobility was significant as measured by Zurich Claudication Questionnaire and Oswestry Disability Index. Tukey honestly significant different test found significant improvement in all outcome measures from baseline to each follow-up interval. Further, major improvement occurred by 1-week follow-up and showed no difference between each subsequent follow-up, signifying considerable stability and durability of the initial result over time. No major device or intraprocedural adverse events were reported. DISCUSSION: In this report of 2-year follow-up on 45 patients treated with mild percutaneous lumbar decompression, patients experienced statistically significant pain relief and improved functionality.
Chopko Bohdan W
The Clinical journal of pain
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/10.1097/AJP.0b013e31827fb803" target="_blank" rel="noreferrer noopener">10.1097/AJP.0b013e31827fb803</a>
Mindfulness as a predictor of positive reappraisal and burnout in standardized patients.
*Adaptation; *Emotions; *Patient Satisfaction; 80 and over; Adult; Aged; Burnout; Clinical Assessment Tools; Coefficient Alpha; Convenience Sample; Descriptive Statistics; Education; Female; Human; Humans; Job Characteristics; Male; Medical; Middle Aged; Mind Body Techniques; Models; Multiple Regression; Ohio; Patient Simulation; Professional – Risk Factors; Psychological; Psychological/*complications/psychology; Psychometrics; Questionnaires; Regression Analysis; Risk Assessment; Statistics as Topic; Stress; Summated Rating Scaling
BACKGROUND: Standardized patients (SPs) portray emotionally intense roles that can have unintended deleterious effects including burnout. PURPOSE: This study explored SP characteristics that could serve as protective factors against these adverse effects. The literature suggests that positive reappraisal and mindfulness are protective factors, with positive reappraisal mediating the relationship between mindfulness and burnout. METHODS: Seventy-six SPs completed an instrument measuring burnout, positive reappraisal, and mindfulness. Multiple regression was performed to test the hypothesized mediator model. RESULTS: The results revealed that mindfulness and positive reappraisal explained a meaningful portion of SP burnout variance (R (2) = .31 p \textless .01). Germane to the mediator model, all correlations were significant: mindfulness and positive reappraisal (a) r = .668; positive reappraisal and burnout (b) r = -.527; and mindfulness and burnout (c) r = -.496, p \textless 01. When positive reappraisal and mindfulness were included in the model, the previously significant relationship c was no longer statistically significant. The combination of these three relationships supports a mediator model. CONCLUSIONS: Education to enhance mindfulness and positive reappraisal offers a way to offset the adverse effects of portraying intense emotional patient experiences.
Gerzina Holly A; Porfeli Erik J
Teaching and learning in medicine
2012
2012
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/10.1080/10401334.2012.715255" target="_blank" rel="noreferrer noopener">10.1080/10401334.2012.715255</a>
Adapting cognitive behavioral therapy for psychosis for case managers: increasing access to services in a community mental health agency.
*Community Mental Health Services; *Diffusion of Innovation; *Health Services Accessibility; Adult; Case Management; Case Managers; Cognitive Behavioral Therapy/education/*methods; Cognitive Therapy – Methods; Collaboration; Community Mental Health Services – United States; Cooperative Behavior; Evidence-Based; Evidence-Based Practice/education/methods; Female; Human; Humans; Inservice Training; Interinstitutional Relations; Male; Pilot Studies; Professional Practice; Program Implementation – Methods; Psychotic Disorders/*therapy; Questionnaires; Scales; Schizophrenia – Rehabilitation; Schizophrenia/*therapy; Staff Development; Thematic Analysis; Treatment Outcome; United Kingdom; United States
OBJECTIVE: The purpose of this article is twofold: (a) to describe the adaptation of an evidence-based practice and, (b) using a dissemination framework, to describe the process of implementing the practice at a community mental health agency. METHOD: The authors describe the training concept and dissemination framework of implementing an emerging practice: high-yield cognitive behavioral techniques for psychosis, which is rooted in cognitive behavioral therapy. RESULTS: Thirteen case managers who represented teams from across the agency delivered the adapted practice at a community mental health agency. Implementation required buy in from all stakeholders, communication across disciplines, persistence, and flexibility. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It appears that the use of a dissemination framework that is grounded in the literature, yet flexible, eases the process of implementing an adapted practice. Further research focusing on the effectiveness of this approach, along with the impact of implementing a full spectrum of cognitive behavioral therapy services for individuals with persistent psychotic symptoms, based on cognitive behavioral therapy principles, is indicated.
Montesano Vicki L; Sivec Harry J; Munetz Mark R; Pelton Jeremy R; Turkington Douglas
Psychiatric rehabilitation journal
2014
2014-03
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/10.1037/prj0000037" target="_blank" rel="noreferrer noopener">10.1037/prj0000037</a>
Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial.
*Dose Fractionation; *Radiotherapy; Aged; Analgesics – Therapeutic Use; Analgesics/therapeutic use; Australia; Bone Neoplasms; Bone Neoplasms – Complications; Bone Neoplasms – Radiotherapy; Bone Neoplasms/complications/*radiotherapy/*secondary; Brief Pain Inventory; Canada; Cauda Equina; Chi Square Test; Chi-Square Distribution; Clinical Assessment Tools; Clinical Trials; Computer-Assisted; Computer-Assisted – Adverse Effects; Computer-Assisted/adverse effects; Europe; Female; Fractures; Funding Source; Human; Humans; Intention to Treat Analysis; Israel; Logistic Models; Logistic Regression; Male; Middle Age; Middle Aged; New Zealand; Odds Ratio; Pain – Diagnosis; Pain – Drug Therapy; Pain – Etiology; Pain – Radiotherapy; Pain Measurement; Pain/diagnosis/drug therapy/*etiology/*radiotherapy; Questionnaires; Radiation; Radiation Dosage; Radiotherapy; Radiotherapy Planning; Risk Factors; Scales; Spinal Cord Compression – Etiology; Spinal Cord Compression/etiology; Spontaneous – Etiology; Spontaneous/etiology; Surveys and Questionnaires; Time Factors; Treatment Outcome; Treatment Outcomes
BACKGROUND: Although repeat radiation treatment has been shown to palliate pain in patients with bone metastases from multiple primary origin sites, data for the best possible dose fractionation schedules are lacking. We aimed to assess two dose fractionation schedules in patients with painful bone metastases needing repeat radiation therapy. METHODS: We did a multicentre, non-blinded, randomised, controlled trial in nine countries worldwide. We enrolled patients 18 years or older who had radiologically confirmed, painful (ie, pain measured as \textgreater/=2 points using the Brief Pain Inventory) bone metastases, had received previous radiation therapy, and were taking a stable dose and schedule of pain-relieving drugs (if prescribed). Patients were randomly assigned (1:1) to receive either 8 Gy in a single fraction or 20 Gy in multiple fractions by a central computer-generated allocation sequence using dynamic minimisation to conceal assignment, stratified by previous radiation fraction schedule, response to initial radiation, and treatment centre. Patients, caregivers, and investigators were not masked to treatment allocation. The primary endpoint was overall pain response at 2 months, which was defined as the sum of complete and partial pain responses to treatment, assessed using both Brief Pain Inventory scores and changes in analgesic consumption. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00080912. FINDINGS: Between Jan 7, 2004, and May 24, 2012, we randomly assigned 425 patients to each treatment group. 19 (4%) patients in the 8 Gy group and 12 (3%) in the 20 Gy group were found to be ineligible after randomisation, and 140 (33%) and 132 (31%) patients, respectively, were not assessable at 2 months and were counted as missing data in the intention-to-treat analysis. In the intention-to-treat population, 118 (28%) patients allocated to 8 Gy treatment and 135 (32%) allocated to 20 Gy treatment had an overall pain response to treatment (p=0.21; response difference of 4.00% [upper limit of the 95% CI 9.2, less than the prespecified non-inferiority margin of 10%]). In the per-protocol population, 116 (45%) of 258 patients and 134 (51%) of 263 patients, respectively, had an overall pain response to treatment (p=0.17; response difference 6.00% [upper limit of the 95% CI 13.2, greater than the prespecified non-inferiority margin of 10%]). The most frequently reported acute radiation-related toxicities at 14 days were lack of appetite (201 [56%] of 358 assessable patients who received 8 Gy vs 229 [66%] of 349 assessable patients who received 20 Gy; p=0.011) and diarrhoea (81 [23%] of 357 vs 108 [31%] of 349; p=0.018). Pathological fractures occurred in 30 (7%) of 425 patients assigned to 8 Gy and 20 (5%) of 425 assigned to 20 Gy (odds ratio [OR] 1.54, 95% CI 0.85-2.75; p=0.15), and spinal cord or cauda equina compressions were reported in seven (2%) of 425 versus two (\textless1%) of 425, respectively (OR 3.54, 95% CI 0.73-17.15; p=0.094). INTERPRETATION: In patients with painful bone metastases requiring repeat radiation therapy, treatment with 8 Gy in a single fraction seems to be non-inferior and less toxic than 20 Gy in multiple fractions; however, as findings were not robust in a per-protocol analysis, trade-offs between efficacy and toxicity might exist. FUNDING: Canadian Cancer Society Research Institute, US National Cancer Institute, Cancer Council Australia, Royal Adelaide Hospital, Dutch Cancer Society, and Assistance Publique-Hopitaux de Paris.
Chow Edward; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Brundage Michael D; Nabid Abdenour; Tissing-Tan Caroline J A; Oei Bing; Babington Scott; Demas William F; Wilson Carolyn F; Meyer Ralph M; Chen Bingshu E; Wong Rebecca K S
The Lancet. Oncology
2014
2014-02
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/10.1016/S1470-2045(13)70556-4" target="_blank" rel="noreferrer noopener">10.1016/S1470-2045(13)70556-4</a>
Professional judgments about advance care planning with community-dwelling consumers.
*Attitude of Health Personnel; *Decision Making; *Health Care Surveys; Advance Care Planning; Advance Care Planning/organization & administration/*statistics & numerical data; Attitude of Health Personnel; Consumer Behavior/*statistics & numerical data; Consumer Satisfaction – Statistics and Numerical Data; Decision Making; Human; Humans; Management; Midwestern United States; Models; Organizational; Patient Satisfaction – Statistics and Numerical Data; Patient Satisfaction/*statistics & numerical data; Population Surveillance; Questionnaires; Randomized Controlled Trials; Surveys; Surveys and Questionnaires
CONTEXT: There is limited research on how community-based long-term care (CBLTC) providers' personal characteristics and attitudes affect their decisions to initiate advance care planning (ACP) conversations with consumers. OBJECTIVES: To examine judgments by CBLTC providers as to whether a consumer was in need of ACP and to compare the relative influence of situational features of the consumer with the influence of personal characteristics of the CBLTC provider. METHODS: Factorial surveys with vignettes with randomly assigned situational features of a hypothetical consumer were obtained from 182 CBLTC providers at three Area Agencies on Aging located in the Midwestern U.S. Measures included the consumer's situational features, such as demographics, diagnosis, pain level, level of functioning, and caregiver involvement. Personal characteristics of the CBLTC provider included demographics, discipline, past experience with ACP, and attitudes toward ACP. RESULTS: Hierarchical linear models indicated that most variability in ACP decisions was the result of differences among CBLTC providers (64%) rather than consumers' situational features. Positive decisions to discuss ACP were associated with consumers who needed assistance with legal issues and had a cancer diagnosis; these variables explained 8% of the vignette level variance. Significant personal characteristics of the CBLTC provider included a nursing background, less direct contact with consumers, past experience with ACP, and positive attitudes toward ACP; these variables explained 41% of the person-level variance. CONCLUSION: This study shows the lack of normative consensus about ACP and highlights the need for consistent educational programs regarding the role of the CBLTC provider in the ACP process.
Baughman Kristin R; Ludwick Ruth E; Merolla David M; Palmisano Barbara; Hazelett Susan; Winchell Janice; Hewit Michael
Journal of pain and symptom management
2012
2012-01
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/10.1016/j.jpainsymman.2011.03.023" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2011.03.023</a>
Introducing a curriculum in ethics and professionalism for dermatology residencies.
*Accreditation; Accreditation; Curriculum; Dermatology – Education; Dermatology/*education; Education; Ethics; Female; Graduate/*methods; Humans; Internship and Residency; Internship and Residency/*methods; Male; Medical; Medical – Education; Medical/*education; Professionalism/*education; Questionnaires; United States
There is general agreement on what constitutes ethical reasoning and professional behavior, but standardized methods to teach these skills in dermatology residency are currently unavailable. We introduce a model curriculum designed to impart the knowledge and skills to meet the Accreditation Council for Graduate Medical Education Dermatology Milestones for Professionalism over a 3-year cycle.
Stoff Benjamin K; Grant-Kels Jane M; Brodell Robert T; Paller Amy S; Perlis Clifford S; Mostow Eliot; Pariser David; Bercovitch Lionel
Journal of the American Academy of Dermatology
2018
2018-05
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/10.1016/j.jaad.2017.04.1121" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2017.04.1121</a>
Depression screening using health questionnaires in patients receiving oral isotretinoin for acne vulgaris.
*Surveys and Questionnaires; Acne Vulgaris – Drug Therapy; Acne Vulgaris/drug therapy; Administration; depression; Depression – Diagnosis; Depression – Etiology; Depression/*diagnosis/etiology; Humans; iPLEDGE; isotretinoin; Isotretinoin – Adverse Effects; Isotretinoin – Therapeutic Use; Isotretinoin/*adverse effects/therapeutic use; Oral; patient health questionnaire-2; patient health questionnaire-9; Questionnaires; screening; suicidal ideation; Suicidal Ideation
Isotretinoin is used to treat severe and recalcitrant acne. Possible side effects include depression, suicide, and suicidal ideation; however, other studies suggest isotretinoin may improve mood and quality of life. Although iPLEDGE consenting warns about the risk of depression and suicidal ideation, there is no recommendation for screening tools. The patient health questionnaire-2 and the patient health questionnaire-9 are validated instruments that enable dermatologists to efficiently screen for depression before and after isotretinoin is initiated.
Schrom Kory; Nagy Terri; Mostow Eliot
Journal of the American Academy of Dermatology
2016
2016-07
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/10.1016/j.jaad.2016.02.1148" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2016.02.1148</a>
The natural history of halo nevi: a retrospective case series.
*Skin Pigmentation; Adolescence; Adolescent; Adult; Child; Databases; Disease Progression; Disease Remission; Factual/*statistics & numerical data; Female; Follow-Up Studies; Halo – Pathology; Halo – Surgery; Halo/*pathology/*surgery; Human; Humans; Male; Middle Age; Middle Aged; Nevus; Preschool; Prospective Studies; Questionnaires; Remission; Remission Induction; Resource Databases; Retrospective Design; Retrospective Studies; Skin Pigmentation; Spontaneous; Surveys and Questionnaires; Young Adult
BACKGROUND: The time period between onset of depigmentation around the halo nevus (HN) to complete resolution of the nevus and halo has not been well studied. OBJECTIVE: We sought to better understand the natural history of the HN. METHODS: A retrospective chart review of patients with a clinical diagnosis of HN selected from a private practice database (1994-2010) was performed. In all, 52 patients with 80 HN were identified. The current stage of the HN was determined by a follow-up questionnaire and physical examination of 36 patients with 56 HN. RESULTS: Seven HN were excised. Of the remaining 49 HN, 51% (25) demonstrated no change in the halo or nevus after an average of 4.2 years; 14.3% (7) demonstrated partial nevus regression with persistence of the halo after an average of 6.7 years; 4.1% (2) demonstrated complete involution of the nevus with persistent halo depigmentation after an average of 7.7 years; 8.2% (4) demonstrated complete nevus involution with some repigmentation of the halo after an average of 11.8 years; 22.4% (11) demonstrated complete resolution of the nevus with complete repigmentation of the halo after an average of 7.8 years. LIMITATION: Some subjects were lost to follow-up. The time of initial HN onset was dependent on patient recall. CONCLUSION: These results demonstrate that HN typically persist for a decade or longer. A subgroup may progress through stages of involution with a return to normal-appearing skin, but even these lesions persisted for an average of 7.8 years. Education about the prolonged natural history of HN may reassure patients and avoid unnecessary excision.
Aouthmany Mouhammad; Weinstein Mara; Zirwas Matthew J; Brodell Robert T
Journal of the American Academy of Dermatology
2012
2012-10
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/10.1016/j.jaad.2011.11.937" target="_blank" rel="noreferrer noopener">10.1016/j.jaad.2011.11.937</a>
Financial planning and satisfaction across life domains among retired emergency physicians in the United States.
*Personal Satisfaction; Adult; Aged; Cross Sectional Studies; Cross-Sectional Studies; Emergency – United States; Emergency Medicine/*economics; Female; Financial Management; Financial Management/economics; Human; Humans; Male; Middle Age; Personal Satisfaction; Physicians; Physicians/*economics/psychology; Prospective Studies; Questionnaires; Retirement; Retirement/economics/*psychology; Surveys; Surveys and Questionnaires; United States
Kuhn Gloria J; Marco Catherine A; Mallory Mary Nan S; Blanda Michelle; Kaplan Jay A; Schneider Sandra M; Joldersma Kevin B; Martin Sandra I; Choo Esther K
The American journal of emergency medicine
2018
2018-03
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/j.ajem.2017.06.059" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.06.059</a>