Medicine and Health Sciences Commons^™

Practice Effects In A Longitudinal, Multi-Center Alzheimer's Disease Prevention Clinical Trial, Erin L. Abner, Brandon C. Dennis, Melissa J. Mathews, Marta S. Mendiondo, Allison Caban-Holt, Richard J. Kryscio, Frederick A. Schmitt, John J. Crowley

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Practice effects are a known threat to reliability and validity in clinical trials. Few studies have investigated the potential influence of practice on repeated screening measures in longitudinal clinical trials with a focus on dementia prevention. The current study investigates whether practice effects exist on a screening measure commonly used in aging research, the Memory Impairment Screen (MIS).

METHODS: The PREADViSE trial is a clinical intervention study evaluating the efficacy of vitamin E and selenium for Alzheimer's disease prevention. Participants are screened annually for incident dementia with the MIS. Participants with baseline and three consecutive follow-ups who made less …

Breast Cancer Incidence In Black And White Women Stratified By Estrogen And Progesterone Receptor Statuses., Michael X. Gleason, Tengiz Mdzinarishvili, Simon Sherman

Journal Articles: Eppley Institute

BACKGROUND: There is increasing evidence that breast cancer is a heterogeneous disease presented by different phenotypes and that white women have a higher breast cancer incidence rate, whereas black women have a higher mortality rate. It is also well known that white women have lower incidence rates than black women until approximately age 40, when rate curves cross over and white women have higher rates. The goal of this study was to validate the risk of white and black women to breast cancer phenotypes, stratified by statuses of the estrogen (ER) and progesterone (PR) receptors.

METHODOLOGY/PRINCIPAL FINDINGS: SEER17 data were …

Clopidogrel Hypersensitivity: Clinical Challenges And Options For Management., Kimberly L Campbell, John R Cohn, Michael P Savage

Michael P Savage M.D.

Over 90 million patients have been prescribed clopidogrel since its US FDA approval in 1997. Clopidogrel hypersensitivity affects up to 6% of patients, most commonly in the form of a pruritic rash. Symptoms are severe enough to result in drug discontinuation in 1.5% of patients. Premature discontinuation of clopidogrel is problematic following percutaneous coronary intervention because of the risk of stent thrombosis leading to myocardial infarction and death. Accordingly, the management of patients with clopidogrel hypersensitivity is of significant clinical importance. Conventional clopidogrel desensitization protocols, while successful in most patients, employ a washout period off medication to enable accurate detection …

The Ventricular Volume Variability Study Of The Pediatric Heart Network: Study Design And Impact Of Beat Averaging And Variable Type On The Reproducibility Of Echocardiographic Measurements In Children With Chronic Dilated Cardiomyopathy., Steven D. Colan, Girish S. Shirali, Renee Margossian, Dianne Gallagher, Karen Altmann, Charles Canter, Shan Chen, Fraser Golding, Elizabeth Radojewski, Michael Camitta, Michael Carboni, Jack Rychik, Mario Stylianou, Lloyd Y. Tani, Elif Seda Selamet Tierney, Yanli Wang, Lynn A. Sleeper, Pediatric Heart Network Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Clinical trials often rely on echocardiographic measures of left ventricular size and function as surrogate end points. However, the quantitative impact of factors that affect the reproducibility of these measures is unknown. To address this issue, the National Heart, Lung, and Blood Institute-funded Pediatric Heart Network designed a longitudinal observational study of children with known or suspected dilated cardiomyopathy aged 0 to 22 years from eight pediatric clinical centers.

METHODS: Clinical data were collected together with 150 echocardiographic indices of left ventricular size and function. Separate observers performed duplicate echocardiographic imaging. Multiple observers performed measurements from three cardiac cycles …

Two Boundaries Separate Borrelia Burgdorferi Populations In North America, Gabriele Margos, Jean I. Tsao, Santiago Castillo-Ramirez, Yvette A. Girard, Anne G. Hoen

Dartmouth Scholarship

Understanding the spread of infectious diseases is crucial for implementing effective control measures. For this, it is important to obtain information on the contemporary population structure of a disease agent and to infer the evolutionary processes that may have shaped it. Here, we investigate on a continental scale the population structure of Borrelia burgdorferi, the causative agent of Lyme borreliosis (LB), a tick-borne disease, in North America. We test the hypothesis that the observed d population structure is congruent with recent population expansions and that these were preceded by bottlenecks mostly likely caused by the near extirpation in the 1900s …

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-Centered Approach: Position Statement Of The American Diabetes Association (Ada) And The European Association For The Study Of Diabetes (Easd)., Silvio E Inzucchi, Richard M Bergenstal, John B Buse, Michaela Diamant, Ele Ferrannini, Michael Nauck, Anne L Peters, Apostolos Tsapas, Richard Wender, David R. Matthews

Department of Family & Community Medicine Faculty Papers

No abstract provided.

Interim Evaluation Of The Project P.A.T.H.S.: Findings Based On Different Datasets, Daniel T. L. Shek, Lu Yu

Pediatrics Faculty Publications

Interim evaluation studies were carried out in order to examine the implementation details of the Tier 1 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in Hong Kong. Quantitative results of the interim evaluation findings based on eight datasets collected from 2006 to 2009 are reported in this paper. Three hundred and seventy-eight schools were randomly selected to provide information on the implementation details of the program via face-to-face interviews, telephone interviews, and self-completed questionnaires. Results showed that a majority of the workers perceived that the students had positive responses to the program and the program …

Influence Of The Menstrual Cycle On The Incidence Of Nausea And Vomiting After Laparoscopic Gynecological Surgery: A Pilot Study., Tatjana Simurina, Boris Mraovic, Neven Skitarelić, Tatjana Andabaka, Zdenko Sonicki

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To investigate whether the phase of menstrual cycle influences the incidence of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for elective laparoscopic gynecological surgery.

DESIGN: Prospective, observational, blinded study.

SETTING: General hospital, Postanesthesia Care Unit, and gynecologic floor room.

PATIENTS: 111 ASA physical status 1 and 2 women, aged 18 to 53 years.

INTERVENTIONS: Patients were classified into three groups according to the phase of menstrual cycle at the time of anesthesia: Group F1: follicular phase (menstrual days 1-8; n = 34); Group O2: ovulatory phase (days 9-15; n = 40); and Group L3: luteal …

News In Brief

Jefferson Surgical Solutions

Alejandro Perez, MD, has joined the Jefferson Vascular Center at Methodist Hospital with a dual faculty appointment in the Departments of Medicine and Surgery at Thomas Jefferson University. Dr. Perez completed his residency and fellowship training in vascular medicine at the Cleveland Clinic. He specializes in deep vein thrombosis, pulmonary embolism and hyperbaric oxygen therapy.

Ehyal Shweiki, MD, FACS, has joined the Division of Acute Care Surgery. Dr. Shweiki is fellowship-trained in both cardiothoracic surgery (University of Louisville) and surgical critical care (Washington University/Barnes Jewish Hospital). He also holds an MS in Bioethics. He will serve patients at our …

Long-Stay Patients In State Psychiatric Hospitals At The End Of The 20th Century, William Fisher, Paul Barreira, Jeffrey Geller, Andrew White, Alisa Lincoln, Marylou Sudders

Alisa Lincoln

OBJECTIVES: The purpose of this study was to assess the characteristics of long-stay patients in contemporary state psychiatric hospitals and to identify factors representing possible barriers to alternative placements for these patients. METHODS: All patients in inpatient units of the Massachusetts Department of Mental Health who had been hospitalized for at least three years as of April 1, 1999, were assessed by their treatment teams with a standardized data collection instrument. Domains assessed included medical problems, need for nursing care, psychiatric diagnosis, and history of problematic behaviors. RESULTS: The 330 individuals identified as long-stay patients had an array of medical …

Adjunct Primer For The Use Of National Comprehensive Cancer Network Guidelines For The Surgical Management Of Cutaneous Malignant Melanoma Patients., Edibaldo Silva

Journal Articles: Oncology and Hematology

Recently, a Surveillance Epidemiology and End Results (SEER) survey of melanoma patterns of care by the Mayo Clinic, Scottsdale showed remarkable deviations from best practice patterns throughout the country. The study, which analyzed the SEER records of 35,126 stage I to III cutaneous malignant melanoma patients treated from 2004 to 2006, showed that adherence to National Comprehensive Cancer Network (NCCN) therapeutic resection margins occurred in less than 36% of patients. Similarly, considerable variation in the quality of melanoma care in the United States when assessed using 26 quality indicators drawn by a panel of melanoma experts was independently reported. These …

Profiling The Ethnic Characteristics Of Domestic Injuries In Children Younger Than Age 5 Years., Tolulope A. Oyetunji, Adrienne A. Stevenson, Aderonke O. Oyetunji, Sharon K. Onguti, Sarah A. Ames, Adil H. Haider, Benedict C. Nwomeh

Manuscripts, Articles, Book Chapters and Other Papers

The home remains a very common location for deadly injuries among children younger than 5 years. The aim of this study is to describe the demographic and injury characteristics of domestic injuries in children younger than 5 years. The National Trauma Data Bank's National Sample Program data set was queried for children younger than 5 years with the injury site classified as home. Bivariate analysis was performed to determine unadjusted differences by ethnicity. Appropriate weight was applied to the sample to determine accurate national estimates. A total of 7,364 children, representing 32,033 children, were analyzed. Overall mortality was 1.6 per …

Sir William Osler, M.D., C.M., Jonathan Sarik, B.S., Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Sir William Osler impacted medical education and the practice of medicine like few other physicians. As a writer, he authored nearly 1500 publications and lent his name to numerous eponyms. As a teacher he educated vast numbers of students and through his legacy impacted countless more. Sir William Osler (Fig. 1) epitomized what a physician should be throughout his professional life.

Why Not Support(Ed) Parenting, Joanne Nicholson, William Deveney

Joanne Nicholson

No abstract provided.

A Survey Of Programs For Parents With Mental Illness And Their Families: Identifying Common Elements To Build The Evidence Base, Beth Hinden, Kathleen Biebel, Joanne Nicholson, Alexis Henry, Judith Katz-Leavy

Joanne Nicholson

Little is known about the effectiveness of interventions for families living with parental mental illness. Existing interventions offer information about successfully implemented treatments, which may demonstrate effectiveness in research. In the current study, directors of programs for parents with mental illness and their families were interviewed. Qualitative analyses revealed noteworthy similarities with respect to target population; funding; community context; agency context; mission, theoretical orientation, and assumptions; locus of care and essential services; desired outcomes; and moderators. Program similarities were identified to provide parameters for research, and to contribute to the development of testable hypotheses. Family-centered, strengths-based approaches were identified across …

Privatized Medicaid Managed Care In Massachusetts: Disposition In Child And Adolescent Mental Health Emergencies, Joanne Nicholson, Stephen Young, Lorna Simon, William Fisher, Anne Bateman

Joanne Nicholson

Data from child and adolescent emergency mental health screening episodes prior and subsequent to privatized Medicaid managed care in Massachusetts are used to investigate the relationship between payer source and disposition and to compare the match between clinical need and disposition level of care. Having Medicaid as the payer in the post-Medicaid managed care period decreased the odds of hospitalization by nearly 60%. None of the clinical need variables that contributed to hospitalization for Medicaid episodes in the pre-Medicaid managed care period were significant in the post-Medicaid managed care period. Multiple forces shaping professional standards, decision making, and quality of …

A Qualitative Study Of Programs For Parents With Serious Mental Illness And Their Children: Building Practice-Based Evidence, Joanne Nicholson, Beth Hinden, Kathleen Biebel, Alexis Henry, Judith Katz-Leavy

Joanne Nicholson

The rationale for the development of effective programs for parents with serious mental illness and their children is compelling. Using qualitative methods and a grounded theory approach with data obtained in site visits, seven existing programs for parents with mental illness and their children in the United States are described and compared across core components: target population, theory and assumptions, funding, community and agency contexts, essential services and intervention strategies, moderators, and outcomes. The diversity across programs is strongly complemented by shared characteristics, the identification of which provides the foundation for future testing and the development of an evidence base. …

Achieving The Goal Of Evidence-Based Psychiatric Rehabilitation Practices For Mothers With Mental Illnesses, Joanne Nicholson, Alexis Henry

Joanne Nicholson

There is a growing commitment to evidence-based practices in mental health. There is no well-articulated evidence base for interventions for mothers with mental illnesses. Parenthood is common among women with mental illnesses. Women themselves report motherhood is an important role. The risks of parental mental illness to children have been demonstrated; the challenges that motherhood brings to people with mental illnesses have been described. Because outcomes for both children and adults are multiply determined, there are many intervention opportunities. Recommendations for intervention are drawn from a focus group study and from the existing literature on parent training and support, exemplary …

The Internet, Health Promotion, And Community Participation, Joanne Nicholson, Armando Rotondi

Joanne Nicholson

No abstract provided.

A Comparison Of The Health And Mental Health Status Of Homeless Mothers In Worcester, Mass: 1993 And 2003, Linda Weinreb, John Buckner, Valerie Williams, Joanne Nicholson

Joanne Nicholson

OBJECTIVES: We assessed background characteristics, health status, and prevalence rates of mental health disorders in 2 studies of homeless mothers conducted in Worcester, Mass, one in 1993 and the other in 2003.

METHODS: We compared the women taking part in the 2 studies, which involved similar methodologies, on the key variables of interest over time.

RESULTS: Homeless families taking part in the 2003 study were poorer than those taking part in the 1993 study, and female heads of household in that study reported more physical health limitations, major depressive illness, and posttraumatic stress disorder.

CONCLUSION: Data from 2003 suggest that …

The Responsiveness Of State Mental Health Authorities To Parents With Mental Illness, Kathleen Biebel, Joanne Nicholson, Valerie Williams, Beth Hinden

Joanne Nicholson

The majority of adults with serious mental illness living in the community are parents, many of whom may be receiving services from State Mental Health Authorities (SMHA). Innovative intervention approaches are available to improve outcomes for these parents and their children. Analyses of SMHA and state-level data, as well as qualitative interviews of administrators, service providers, and consumers, underscore the importance of organizational structure and philosophy, an advocacy presence, and available funding to SMHA efforts on behalf of parents and their families.

State Policies And Programs That Address The Needs Of Mentally Ill Mothers In The Public Sector, Joanne Nicholson, Jeffrey Geller, William Fisher, George Dion

Joanne Nicholson

OBJECTIVE: The authors sought to determine whether state departments of mental health have specific policies and programs addressing the needs of mentally ill women served in the public sector who have preschool-age children. METHODS: A questionnaire was sent to the commissioner of mental health for each state and the District of Columbia. Questions addressed whether information was routinely collected on the parenting status of women who receive public-sector psychiatric services, whether services targeting mentally ill women with young children were available, and whether the state had policies concerning hospitalized women who are pregnant or who have young children. RESULTS: Sixteen …

A Comparison Of Mothers With Co-Occurring Disorders And Histories Of Violence Living With Or Separated From Minor Children, Joanne Nicholson, Norma Finkelstein, Valerie Williams, Jennifer Thom, Chanson Noether, Megan Devilbiss

Joanne Nicholson

Data from the Women with Co-occurring Disorders and Histories of Violence Study are used to examine characteristics distinguishing mothers currently providing care for all their minor children (n = 558) from mothers separated from one or more minor children (n = 1396). Mothers are described and compared on background characteristics and experiences, well-being and current functioning, situational context, and services used. Analyses control for number of children, race, and years of education. Mothers separated from children have more children, less education, have more often been homeless, in juvenile detention or jail, and have lower incomes than mothers living with all …

Integrating Behavioral Health Services For Homeless Mothers And Children In Primary Care, Linda Weinreb, Joanne Nicholson, Valerie Williams, Frances Anthes

Joanne Nicholson

This article describes an innovative trauma-informed care management model in which mental health, substance abuse, and support services are integrated for homeless families in primary care. The rationale for service integration in a health care setting is discussed and the conceptual underpinnings of the model are elaborated, drawing from the literature and clinical experience. Service encounter data collected by each staff member over a 1-year period (N = 7,214 encounters) allow for description of program functions and provider roles and activities, an essential step in developing the fidelity indicators necessary for future program replication and rigorous testing in additional settings. …

Psychosocial Rehabilitation Service Needs Of Women, Carol Mowbray, Joanne Nicholson, Chyrell Bellamy

Joanne Nicholson

No abstract provided.

Supporting Parents With Psychiatric Disabilities And Promoting Recovery: An International Challenge, Peter Van Der Ende, Joanne Nicholson

Joanne Nicholson

Introduction: Parenting is a significant life role for adults with psychiatric disabilities. Not only is success in this role a normal life goal for many, but functioning as well as possible as parents would seem to be intimately related to the recovery process and successful functioning in other major life domains. Research on the prevalence and needs of parents with psychiatric disabilities in two countries, the U.S. and The Netherlands, provides the framework for developing and testing interventions. Essential program components include supports for parents in meeting their children’s needs as well as managing their own. Research Question: What are …

Commentary On "Community Mental Health Care For Women With Severe Mental Illness Who Are Parents" - The Tragedy Of Missed Opportunities: Of Missed Opportunities: What Providers Can Do, Joanne Nicholson, Kathleen Biebel

Joanne Nicholson

Women and men who meet criteria for psychiatric disorder are likely to be parents. Many go undiagnosed and untreated, putting themselves and their children at risk of poor outcomes. Adults with mental illness may fear disclosing their status as parents; providers may not ask. Practices can be modified to promote the well being of parents with mental illness and their children.

Impact Of Medicaid Managed Care On Child And Adolescent Emergency Mental Health Screening In Massachusetts, Joanne Nicholson, Stephen Young, Lorna Simon, Anne Bateman, William Fisher

Joanne Nicholson

OBJECTIVE: The study evaluated the impact of Medicaid managed care on decision making during emergency mental health screening and the outcomes of such screening for children and adolescents. METHODS: Data on client attributes and on system characteristics (payer, referral source, and disposition) were available for 297 Medicaid and non-Medicaid episodes of emergency mental health screening that occurred one year before the implementation of a statewide managed Medicaid program in Massachusetts and 393 episodes that occurred one year after implementation. Outcomes included changes in the volume of service provided and in the pattern of dispositions, particularly inpatient admissions. RESULTS: Although the …

A National Survey Of State Mental Health Authority Programs And Policies For Clients Who Are Parents: A Decade Later, Kathleen Biebel, Joanne Nicholson, Jeffrey Geller, William Fisher

Joanne Nicholson

This study presents a survey of State Mental Health Authorities' (SMHA) programs and policies addressing the needs of adult clients in their role as parent. Six program and policy areas (parent status identification, parent-focused residential programs, parent functioning assessment, outpatient services for parents, policies for hospitalized parents, and policies for hospitalized pregnant women) are examined. Results of the most recent 1999 survey are compared with results from a similar 1990 survey. This comparison reveals that the majority of SMHAs continue to overlook adult clients in their parenting role, and few SMHA programs and policies address issues of parenting.

A Compact Guide To The Diagnosis And Management Of Neurofibromatosis Type 1, Timothy Beer, David Strayer, Md, Phd

Timothy C Beer

Brief Introduction Neurofibromatosis type 1 (NF-1) is a multisystem neurocutaneous disorder resulting from mutations in the NF-1 gene on chromosome 17 (q11.2). Mutations in NF-1 result in deficient activity of the tumor suppresor protein neurofibromin, allowing for uncontrolled constitutive activity of the proliferative Raspathway in several neural cell types, including neurons, oligodendrocytes, astrocytes and Schawnn cells. Half of NF-1 cases are inherited in autosomal dominant fashion, while half develop sporadically. The syndrome has 100% penetrance but highly variable expressivity. The prevalence of this syndrome is 1/3,000, making it common enough to warrant YOU, the physician, taking a moment to learn …