Medicine and Health Sciences Commons^™

Improving Prenatal Education In A Health Center: A Pilot Study, Marcy Keddy Boucher, Hugh Silk, Judith A. Savageau, Katharine C. Barnard, Mary Flynn

Judith A. Savageau

Background: Currently, the timing and variety of health education topics that are covered during prenatal visits are decided upon by the individual physician caring for the patient. Consequently, some patients do not gain exposure to important subject matter that could potentially improve their satisfaction and pregnancy outcomes. Previously reported studies have found evidence that improved patient education may increase rates of breastfeeding (as well as duration), seat belt use during pregnancy, and decrease preterm low birth weight infants. In addition, one study has shown that when prenatal visits are targeted to specific objectives, the number of prenatal visits can …

Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps In The Home Care System, Jacey J. Vaughan, Nina M. Silverstein

Nina Silverstein

Home and community-based services (HCBS) enable older and disabled adults to age-in-place in their homes and communities by helping them function independently for as long as possible (Grabowski et al., 2010; Wong & Silverstein, 2011). Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home (e.g., Walker, 2010; Fox-Grage, Coleman, & Freiman, 2006). Medicaid is a major source of funding for long-term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional care (National Conference of State Legislatures & AARP, 2009), and older adults and their …

Reference Bias: Presentation Of Extreme Health States Prior To Eq-Vas Improves Health-Related Quality Of Life Scores. A Randomised Cross-Over Trial, Steven Mcphail, Elaine Beller, Terry Haines

Elaine Beller

Background - Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as health-related quality of life. However, unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs, longitudinal comparison of these measures may be invalid. This study aimed to investigate whether patients give consideration to a standard health state rating scale (EQ-VAS) and whether consideration of good and poor health state descriptors immediately changes their self-report.

Methods …

Male Circumcision For Hiv Prevention: Current Evidence And Implementation In Sub-Saharan Africa, Richard G. Wamai, Brian J. Morris, Stefan A. Bailis, David Sokal, Jeffrey D. Klausner, Ross Appleton, Nelson Sewankambo, David A. Cooper, John Bongaarts, Guy De Bruyn, Alex D. Wodak, Joya Banerjee

Richard G. Wamai

Heterosexual exposure accounts for most HIV transmission in sub-Saharan Africa, and this mode, as a proportion of new infections, is escalating globally. The scientific evidence accumulated over more than 20 years shows that among the strategies advocated during this period for HIV prevention, male circumcision is one of, if not, the most efficacious epidemiologically, as well as cost-wise. Despite this, and recommendation of the procedure by global policy makers, national implementation has been slow. Additionally, some are not convinced of the protective effect of male circumcision and there are also reports, unsupported by evidence, that non-sex-related drivers play a major …

Risk Factors For Driving Cessation Vary By Race And Ethnicity, Elizabeth Dugan, Frank Porell, Chae Man Lee

Frank Porell

Driving is related to our identity and independence as well as allowing us to get needed goods, services, and social opportunities that enrich daily life. Yet with increasing age, the risk for developing threats to medical fitness to drive increases. Driving cessation is related to a long list of negative outcomes, such as: depression, social isolation, diminished access to health care, and diminished quality of life. We investigated risks for driving cessation, paying close attention to racial differences. This study used data from the Health and Retirement Study (HRS), 1998-2008. The study included N=46, 528 older people (age 65 and …

Risk Factors For Driving Cessation Vary By Race And Ethnicity, Elizabeth Dugan, Frank Porell, Chae Man Lee

Elizabeth Dugan

Driving is related to our identity and independence as well as allowing us to get needed goods, services, and social opportunities that enrich daily life. Yet with increasing age, the risk for developing threats to medical fitness to drive increases. Driving cessation is related to a long list of negative outcomes, such as: depression, social isolation, diminished access to health care, and diminished quality of life. We investigated risks for driving cessation, paying close attention to racial differences. This study used data from the Health and Retirement Study (HRS), 1998-2008. The study included N=46, 528 older people (age 65 and …

Promoting Adherence And Retention To Clinical Trials In Special Populations: A Women's Health Initiative Workshop, Sara Wilcox, Sally Shumaker, Deborah Bowen, Michelle Naughton, Milagros Rosal, Shari Ludlam, Elizabeth Dugan, Julie Hunt, Stephanie Stevens

Elizabeth Dugan

This paper describes a Women's Health Initiative workshop on promoting adherence and retention in randomized clinical trials among ethnic minority women, participants of lower socioeconomic status, and older women. Workshop objectives were: (1) to increase knowledge of demographic and cultural characteristics of diverse groups, (2) to increase awareness of how diversity can affect interactions in clinical research, (3) to explore how research staff behavior can influence adherence and retention, and (4) to increase knowledge of strategies to enhance adherence and retention in special populations. The workshop emphasized the importance of understanding beliefs, values, and experiences that are common in diverse …

Development Of Abbreviated Measures To Assess Patient Trust In A Physician, A Health Insurer, And The Medical Profession, Elizabeth Dugan, Felicia Trachtenberg, Mark Hall

Elizabeth Dugan

BACKGROUND: Despite the recent proliferation in research on patient trust, it is seldom a primary outcome, and is often a peripheral area of interest. The length of our original scales to measure trust may limit their use because of the practical needs to minimize both respondent burden and research cost. The objective of this study was to develop three abbreviated scales to measure trust in: (1) a physician, (2) a health insurer, and (3) the medical profession. METHODS: Data from two samples were used. The first was a telephone survey of English-speaking adults in the United States (N = 1117) …

Senior Transportation Abstracts: A Focus On Options, Helen Kerschner, Nina M. Silverstein

Nina Silverstein

This collection of abstracts represents a publication of importance for understanding the needs, challenges, solutions, and/or every day issues related to senior transportation services. While several of the abstracts include information about senior driver safety, the collection’s primary purpose is to present a holistic approach to transportation options for older adults. Such a collection is timely because, although the practice of providing transportation to older adults is not new, research and preparation of practical informational and technical materials related to older adult transportation service needs and service delivery are quite recent.

Assessing Stakeholder Opinions Of Medical Review Of Impaired Drivers And Fitness To Drive: Recommendations For Massachusetts, Nina Silverstein, Kelli Barton

Nina Silverstein

Driving is the main mode of travel for Americans age 65 and older, and although older adults are generally found to be safe drivers, aging often brings about functional limitations and an increase in medications that can impede safe driving and fitness to drive (Rosenbloom, 2003; Kissinger, 2008; Adler & Silverstein, 2008). Effective licensing policies and Medical Advisory Board practices are critical components in identifying medically at-risk drivers and may even have a role in the transition to alternative transportation options; yet, states vary greatly in their approach to licensing and renewal practices and in the utilization, composition, and function …

Understanding Practice Standards In A Changing Health Care Environment, Ann Obergfell

Ann M. Obergfell

The practice of medical imaging and radiation therapy are constantly changing. The current health care environment places pressure on practice from both internal and external forces. Budget shortfalls, changes in reimbursement, new technology, government regulation, safety concerns and other measures all impact the ability of the medical imaging or radiation therapy professional to practice safely and effectively. The Practice Standards for Medical Imaging and Radiation Therapy define the Scope of practice and form an outline for clinical, quality and professional performance in the Radiologic Sciences. Understanding and practicing within the recognized Scope of Practice and utilizing the Practice Standards as …

Ethical And Legal Decisions And Dilemmas Facing The Radiologist Assistant And Medical Imaging, Ann Obergfell

Ann M. Obergfell

ABSTRACT: The world of medical imaging continues to find itself caught between sometimes conflicting and competing factors such as patient expectations, the changing healthcare and legal system, referring physician demands, and third party payer rules and regulations. Where there is potential conflict, ethical and legal decisions and dilemmas may arise. This session will provide medical imaging scenarios with both potential legal ramifications as well as difficult ethical decisions.

A Retrospective Review Of Clinical International Normalized Ratio Results And Their Implications, Thomas Radmer, Moawia Kassab, James Glore

Thomas W Radmer

Warfrin is a key element in therapy for atrial fibrillation, deep venous thrombosis (DVT), stroke (cerebrovascular accident and cardiac valve replacement . The authors searced 16,017 active clinical charts for active patients of record for the years 2009-2010. The authors found that 1.96 percent of total Marquette University Dental Clinic patients had a history of warfrin use. INR values for a significant number of dental patients are not within the therapeutic range for their medical conditions. The patients physcian was contacted for warfrin dose regulation prior to invasive dental procedures.

Indications For Resection Of Metastatic Liver Lesions, Vivian Mcalister

Vivian C. McAlister

No abstract provided.

Pancreatic Cancer: Define Unresectable, Vivian Mcalister

Vivian C. McAlister

No abstract provided.

Optical Guidance System Vs. Cbct For Phantom And Patient Setup, L. Fu, H. Perera, H. Liu, Y. Xiao, Y. Yu

Hua Kun Liu

Purpose: To quantify the discrepancy between Varian optical guidance (OG) frameless localization system and Varian Trilogy on board imaging (OBI) system for setting up phantom and SRS patient. American Association of Physicists in Medicine (AAPM) 52nd Annual Meeting July 18-22, Philadelphia, PA

Bapcap2-1 Does Preoperative Aspirin Improve Outcomes In Cardiac Surgery Patients?, Jian-Zhong Sun, L. Cao, H. Liu, W. Sun, S Silvestry, J. Diehl

Hua Kun Liu

Best Abstracts - Runner-up Session 2 presented at Euroanaesthesia 2011 in the Netherlands.

Background and Goal of Study: The effects of preoperative aspirin on major cardiocerebral and renal outcomes and mortality remain uncertain.

A Procedure For Standardizing Mlc Quality Assurance For Elekta Linac, K. Yan, M. Studenski, H. Liu, I. Buzurovic, Y. Cui, L. Shabason, A. Harrison, Y. Yu, M. Hossain, Y. Xiao

Hua Kun Liu

Purpose: As specified in TG142, MLC position accuracy needs to be tested on weekly/monthly basis, with 1mm tolerance. This study focuses on developing techniques, hardware and software tools for implementation of MLC QA tests for Elekta Linacs. American Association of Physicists in Medicine (AAPM) 52nd Annual Meeting July 18-22, Philadelphia, PA

Massachusetts’ Home Care Programs And Reasons For Discharge Into Nursing Homes, Cathy M. Wong, Nina M. Silverstein

Nina Silverstein

Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, …

Pediatric Oncology: An Overview Of Nursing Care, Luanne Linnard-Palmer

Luanne Linnard-Palmer

Pulmonary Artery Catheter For Coronary Artery Bypass Graft: Does It Harm Our Patients? Primum Non Nocere, Eugene A. Hessel, Ioanna Apostolidou

Nanette M Schwann MD

No abstract provided.

Pathological Personality Traits Among Patients With Absent, Current, And Remitted Substance Use Disorders, Christopher J. Hopwood, Leslie C. Morey, Andrew E. Skodol, Charles A. Sanislow, Carlos M. Grilo, Emily B. Ansell, Thomas H. Mcglashan, John C. Markowitz, Anthony Pinto, Shirley Yen, M. Tracie Shea, John G. Gunderson, Mary C. Zanarini, Robert L. Stout

Charles A. Sanislow, Ph.D.

Personality traits may provide underlying risk factors for and/or sequelae to substance use disorders (SUDs). In this study Schedule for Nonadaptive and Adaptive Personality (SNAP) traits were compared in a clinical sample (N=704, age 18–45) with current, past, or no historical alcohol or non-alcohol substance use disorders (AUD and NASUD) as assessed by DSM-IV semi-structured interview. Results corroborated previous research in showing associations of negative temperament and disinhibition to SUD, highlighting the importance of these traits for indicating substance use proclivity or the chronic effects of substance use. Certain traits (manipulativeness, self-harm, disinhibition, and impulsivity for AUD, and disinhibition and …

Self-Harm Subscale Of The Schedule Of Nonadaptive And Adaptive Personality (Snap): Predicting Suicide Attempts Over 8 Years Of Follow-Up, Shirley Yen, M. Tracie Shea, Zach Walsh, Maria O. Edelen, Christopher J. Hopwood, John C. Markowitz, Emily B. Ansell, Leslie C. Morey, Carlos M. Grilo, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: We examined the predictive power of the self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) to identify suicide attempters in the Collaborative Longitudinal Study of Personality Disorders (CLPS).

Method: The SNAP, a self-report personality inventory, was administered to 733 CLPS participants at baseline, of whom 701 (96%) had at least 6 months of follow-up data. Cox proportional hazards regression analyses were performed to examine the SNAP–self-harm subscale (SNAP- SH) in predicting the 129 suicide attempters over 8 years of follow-up. Possible moderators of prediction were examined, including borderline personality disorder, major depressive disorder (MDD), and substance …

Causes Of Death In Canadian Forces Members Deployed To Afghanistan And Implications On Tactical Combat Casualty Care Provision., D Pannell, R Brisebois, M Talbot, V Trottier, J Clement, N Garraway, Vivian C. Mcalister, H Tien

Vivian C. McAlister

BACKGROUND: As part of its contribution to the Global War on Terror and North Atlantic Treaty Organization's International Security Assistance Force, the Canadian Forces deployed to Kandahar, Afghanistan, in 2006. We have studied the causes of deaths sustained by the Canadian Forces during the first 28 months of this mission. The purpose of this study was to identify potential areas for improving battlefield trauma care.

METHODS: We analyzed autopsy reports of Canadian soldiers killed in Afghanistan between January 2006 and April 2008. Demographic characteristics, injury data, location of death within the chain of evacuation, and cause of death were determined. …

Lack Of Effectiveness Of The Pulmonary Artery Catheter In Cardiac Surgery, Nanette Schwann Md, Zak Hillel Phd, Md, Andreas Hoeft Md, Paul Barash Md, Patrick Möhnle Md, Yinghui Miao Md, Mph, Dennis T. Mangano Phd, Md

Nanette M Schwann MD

No abstract provided.

Hallucinations—Psychosis Related To Parkinson’S Disease, Kevin J. Black

Kevin J. Black, MD

No abstract provided.

Principles Of Combat Surgical Care In A Staged Evacuation System, Vivian C. Mcalister, Rob Stiegelmar, Brian Church, Ray Kao

Vivian C. McAlister

Background: The NATO hospital classification of hospitals describes an orderly transfer of patients with severe injuries through a series of increasingly sophisticated hospitals as they are brought from the point of injury to their home hospital. Forward hospital surgery is restricted to damage control and resuscitation while definitive surgery is performed at home by the destination surgical team. In reality many patients enter the hospital chain higher up and some receive definitive surgery as they proceed through the chain of evacuation. The purpose of this paper is to determine if clear doctrine exists to guide the performance of surgery on …

Utilization Profile Of The Trauma Intensive Care Unit At The Role 3 Multinational Medical Init At Kandahar Airfield Between May 1 And Oct. 15, 2009., Sha K, Pirie S, Compton L, Vivian C. Mcalister, Brian Church, Ray Kao

Vivian C. McAlister

Background: In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009. Methods: We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, …

The Role 3 Multinational Medical Unit At Kandahar Airfield 2005-2010., R Brisebois, P Hennecke, R Kao, Vivian C. Mcalister, J Po, R Stiegelmar, H Tien

Vivian C. McAlister

In late 2005, Canadian Forces Health Services (CFHS) was tasked with the command of the NATO Role 3 Multinational Medical Unit (R3MMU) on Kandahar Airfield in southern Afghanistan. Preparations drew on past experience and planning. Eight complete hospital contingents were trained and deployed in rotation. Near-reality simulation training was undertaken with the combat brigade, including complete deployment of the field hospital in the exercise area. Standard operating procedures (SOP) were developed and applied by each rotation so successfully that they were adopted by the new command in late 2009. The Canadian period at R3MMU had the highest survival rate ever …

The Frank J. Manning Certificate In Gerontology Alumni Survey: 21 Years Of Service To Elders, Nina M. Silverstein, Jenai Murtha, Donna Sullivan, May Jawad

Nina Silverstein

The Certificate Program in Gerontology at the University of Massachusetts Boston, a large urban university, was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. In 1984, a line item was added to the state budget by the legislature and governor establishing the Gerontology Institute at the University of Massachusetts Boston and ensuring the continuation of training, research, and policy and advocacy work on behalf of and with Massachusetts’ elders (O’Brien, 1996). Upon Frank J. Manning’s death in 1986, the program was renamed …