Medicine and Health Sciences Commons^™

Adding Dental Therapists To The Health Care Team To Improve Access To Oral Health Care For Children, David A. Nash

Oral Health Science Faculty Publications

Oral Health in America: A Report of the Surgeon General, and the subsequent National Call to Action to Promote Oral Health, contributed significantly to raising awareness regarding the lack of access to oral health care by many Americans, especially minority and low-income populations, with resulting disparities in oral health. The problem is particularly acute among children. The current dental workforce in the United States is inadequate to meet the oral health care needs of children. It is inadequate in terms of numbers of dentists, as well as their geographic distribution, ethnicity, education, and practice orientation. Dental therapists, paraprofessionals …

A National Physical Activity Plan For The United States, Russell R. Pate

Faculty Publications

No abstract provided.

Bridging The Care Continuum: Patient Information Needs For Specialist Referrals., Carol L. Ireson, Svetla Slavova, Carol L. Steltenkamp, F. Douglas Scutchfield

Preventive Medicine and Environmental Health Faculty Publications

BACKGROUND: Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians.

METHODS: Structured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a …

Clinical Decision Support Capabilities Of Commercially-Available Clinical Information Systems., Adam Wright, Dean F Sittig, Joan S Ash, Sapna Sharma, Justine E Pang, Blackford Middleton

Journal Articles

BACKGROUND: The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems.

METHODS: The authors conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features.

RESULTS: Six of the nine reviewed systems offered all the applicable …

Strategic Management And Organizational Behavior In Dental Education: Reflections On Key Issues In An Environment Of Change., David G. Dunning, Timothy M. Durham, Brian M. Lange, Mert N. Aksu

Journal Articles: College of Dentistry

With issues such as shrinking revenue, access to care, faculty workloads, and graying faculty, dental schools are faced with difficult challenges that fall to dental school deans to manage. Do dental school deans have the organizational skill sets and ethical frameworks necessary to address the challenges now facing dental schools? The purpose of this article is to pose questions and suggestions regarding some of the key issues in dental colleges today and to stimulate discussion in the dental community about needed changes in dental education.

Hiv Policy: The Path Forward--A Joint Position Paper Of The Hiv Medicine Association Of The Infectious Diseases Society Of America And The American College Of Physicians., Christine Lubinski, Judith Aberg, Arlene D Bardeguez, Richard Elion, Patricia Emmanuel, Daniel Kuritzkes, Michael Saag, Kathleen E Squires, Andrea Weddle, Jennifer Rainey, M Renee Zerehi, J Fred Ralston, David A Fleming, David Bronson, Molly Cooke, Charles Cutler, Yul Ejnes, Robert Gluckman, Mark Liebow, Kenneth Musana, Mark E Mayer, Mark W Purtle, P Preston Reynolds, Lavanya Viswanathan, Kevin B Weiss, Baligh Yehia

Department of Medicine Faculty Papers

Executive Summary

The American College of Physicians (ACP) and the Infectious Diseases Society of America (IDSA) have jointly published 3 policy statements on AIDS, the first in 1986 [1], the second in 1988 [2], and the third in 1994 [3]. In 2001, the IDSA created the HIV Medicine Association (HIVMA), and this updated policy paper is a collaboration between the ACP and the HIVMA of the IDSA. Since the last statement, many new developments call for the need to reexamine and update our policies relating to HIV infection. First, there have been major advances …

Public Health Systems And Services Research: Dataset Development, Dissemination, And Use, F. Douglas Scutchfield, Nikki Lawhorn, Rick Ingram, Debra Joy Pérez, Rick Brewer, Michelyn Bhandari

Preventive Medicine and Environmental Health Faculty Publications

Public health systems and services research (PHSSR) is defined as "a field of study that examines the organization, financing, and delivery of public health services within communities and the impact of those services." PHSSR is a relatively young field and suffers from a paucity of research resources. In this article, we describe the development and utility of a data resource, housed on the Health Services and Sciences Research Resources website maintained by the National Library of Medicine, which provides easy access to instruments, indices, and datasets that are relevant to PHSSR researchers. We also investigate efforts to promote the use …

State Infant Mortality: An Ecologic Study To Determine Modifiable Risks And Adjusted Infant Mortality Rates., David A. Paul. Md, Amy Mackley, Rnc, Robert G. Locke, Do, John L. Stefano, Md, Charlan Kroelinger, Phd

Department of Pediatrics Faculty Papers

OBJECTIVE: To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. DESIGN/METHODS: Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization …

Hand Hygiene Compliance Rates In The United States--A One-Year Multicenter Collaboration Using Product/Volume Usage Measurement And Feedback., Maryanne Mcguckin, Richard Waterman, John Govednik

College of Population Health Faculty Papers

Hand hygiene (HH) is the single most important factor in the prevention of health care-acquired infections. The 3 most frequently reported methods of measuring HH compliance are: (1) direct observation, (2) self-reporting by health care workers (HCWs), and (3) indirect calculation based on HH product usage. This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product …

Comorbidities, Patient Knowledge, And Disease Management In A National Sample Of Patients With Copd, R Graham Barr, Bartolome R Celli, David M Mannino, Thomas Petty, Stephen I Rennard, Frank C Sciurba, James K Stoller, Byron M Thomashow, Gerard M Turino

Journal Articles

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States but is often undertreated. COPD often overlaps with other conditions such as hypertension and osteoporosis, which are less morbid but may be treated more aggressively. We evaluated the prevalence of these comorbid conditions and compared testing, patient knowledge, and management in a national sample of patients with COPD.

METHODS: A survey was administered by telephone in 2006 to 1003 patients with COPD to evaluate the prevalence of comorbid conditions, diagnostic testing, knowledge, and management using standardized instruments. The completion rate was 87%.

RESULTS: …

Trends In Mental Health Of An Adolescent Medicine Clinic Patient Population, Abdel Salous, Linah Al-Alem, Hatim A. Omar

Pediatrics Faculty Publications

The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this paper was to identify mental health problems in an adolescent medicine clinic population in Lexington, KY and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% …

Life Expectancy And Years Of Life Lost In Chronic Obstructive Pulmonary Disease: Findings From The Nhanes Iii Follow-Up Study, Robert M. Shavelle, David R. Paculdo, Scott J. Kush, David M. Mannino, David J. Strauss

Internal Medicine Faculty Publications

RATIONALE: Previous studies have demonstrated that chronic obstructive pulmonary disease (COPD) causes increased mortality in the general population. But life expectancy and the years of life lost have not been reported.

OBJECTIVES: To quantify mortality, examine how it varies with age, sex, and other risk factors, and determine how life expectancy is affected.

METHODS: We constructed mortality models using the Third National Health and Nutrition Examination Survey, adjusting for age, sex, race, and major medical conditions. We used these to compute life expectancy and the years of life lost.

MEASUREMENTS AND MAIN RESULTS: Pulmonary function testing classified patients as having …

Malignant Melanoma Metastatic To The Thyroid Gland: A Case Report And Review Of The Literature., Brian Kung, Md, Saba Aftab, Bs, Moira D. Wood, Md, David Rosen, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

The thyroid gland is a relatively uncommon site for a secondary malignancy; even less common is a case of malignant melanoma metastatic to the thyroid. We describe the case of a 68-year-old man who presented with a neck mass in the posterior triangle. Fine-needle aspiration biopsy (FNAB) identified the mass as a malignant melanoma. The patient had had no known primary skin melanoma. He underwent a left modified radical neck dissection, and the mass was discovered to be a positive lymph node. Postoperatively, he declined to undergo radio- and chemotherapy. Eighteen months later, he returned with a diffusely enlarged thyroid. …

Breast Cancer Survival In Canada And The Usa: Meta-Analytic Evidence Of A Canadian Advantage In Low-Income Areas, Kevin M. Gorey

Social Work Publications

BACKGROUND: This study tested the hypothesis that relatively poor Canadian women with breast cancer have a survival advantage over their counterparts in the USA.

METHODS: Seventy-eight independent retrospective cohort (incidence between 1984 and 2000, followed until 2006) outcomes were synthesized. Fixed effects meta-regression models compared women with breast cancer in low-income areas of Canada and the USA.

RESULTS: Low-income Canadian women were advantaged on survival [rate ratio (RR) = 1.14; 95% confidence interval (CI) 1.13-1.15] and their advantage was even larger among women <65 years of age who are not yet eligible for Medicare coverage in the USA (RR = 1.21, 95% CI 1.18-1.24). Canadian advantages were also larger for node positive breast cancer, which may present with greater clinical and managerial discretion (RR = 1.40, 95% CI 1.30-1.50), and smaller when Hawaii, the state providing the most Canadian-like access, was the US comparator (RR = 1.12, 95% CI 1.01-1.20).

CONCLUSIONS: More inclusive health care insurance coverage in Canada vs the USA, particularly among each country's relatively …

Introduction-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

About this Manual:

This Spinal Cord Injury Manual is designed for use by the person with a spinal cord injury or dysfunction and his or her family. It is a guide to provide information on the many aspects of spinal cord injury and dysfunction. This handbook will help you and your family prepare for discharge from our comprehensive rehabilitation program and supplement lifelong learning about spinal cord injury and dysfunction. The handbook is divided into topic sections and bound in loose-leaf form so that a member of the health care team may use each section in addition to teaching and …

Bowel-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Spinal Cord Injury (SCI) changes the way your body works, especially your bowels. After a spinal cord injury, bowel movements (or stool) require more time, thought and planning. Usually, people with SCI cannot feel when stool is ready to come out; therefore, their bowels need re-training.

Anatomy

What Is the Bowel, and What Does It Do?

The bowel is the last portion of your digestive tract and is sometimes called the large intestine or colon. The digestive tract as a whole is a hollow tube that extends from the mouth to the anus (see illustration below). The function of …

Activities Of Daily Living-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Activities of daily living (ADL) include eating, drinking, functional bathing, grooming, dressing and toileting. Also included are functional transfers, EADL (Electronic Aids for Daily Living) and home management.

As soon as it is appropriate, you will be encouraged to perform as many of your own ADLs as you can. You may need to learn new techniques, use assistive devices to compensate for decreased muscle strength and range of motion or to compensate for decreased endurance.

ADL training will begin when your therapist determines that you have enough strength, balance and skill to do these tasks. You may practice these …

Respiratory Dependent-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

One of the most important aspects of spinal cord injury care is respiratory management. The previous chapter deals with the effect spinal cord injury has on your ability to breathe while this chapter deals with the management of individuals who are dependent on a ventilator to breathe. This dependency may be temporary or permanent, depending on your level of injury. Please review the previous chapter prior to reading this one.

Artificial Airways

The first step in trying to maintain normal respiratory function is to establish an airway. Spinal cord injury does not affect your airway. However, in order to …

Respiratory-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Spinal cord injury can affect normal breathing. The level of your injury will determine the effect it will have. It can be different for everyone. For example, the higher the level of your injury, the more complications you may face. Good pulmonary care can assist in keeping you healthy after your spinal cord injury.

Normal

The process of breathing (or respiration) is a two-step process: taking in air (inspiration) and exhaling the waste products. The process of taking in air (inhalation) is an active process, requiring the use of many muscles, while the process of exhaling is a passive …

The Spinal Column-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

The spinal cord is a part of a system called the central nervous system. The central nervous system is made up of two main structures — the brain and the spinal cord. The spinal cord is delicate tissue protected by spinal bones, which are called vertebrae. The spinal cord sits in a space through the center of the vertebrae called the spinal canal. The vertebrae are stacked one on top of another. The job of the vertebrae is to provide support and flexibility for the body and to protect the spinal cord. Discs separate the vertebrae. Discs are tough fibrous …

Psychosocial Issues-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

A sudden trauma like a spinal cord injury will have a significant impact on you and the people close to you. You may see parts of your life change a great deal. Other parts of your life may not change at all. Regardless of the extent of your injury and disability, being hurt and having a disruption to your life may present unexpected problems or changes. This chapter provides information about services that are available at Thomas Jefferson University Hospital, Magee Rehabilitation Hospital and in the community to provide assistance.

Coping with a Spinal Cord Injury

After a spinal …

Follow-Up Care System-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

The Spinal Cord Injury Follow-Up Care System is a program that will assist you in your lifetime care once you are discharged from the hospital. The follow-up care system is structured with primary team members being you and your family, the physiatrist (doctor who specializes in physical therapies), nurse clinician and case manager. Team members available for consultation include physical therapists, occupational therapists, recreational therapists, speech therapists, dietitians, urologists, gynecologists, plastic surgeons and podiatrists.

The nurse clinicians are available in the Spinal Cord Injury Follow-Up Clinic at Magee Rehabilitation Hospital and act as the coordinator and liaison between the …

Travel And Transportation-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Travel and transportation includes driving or being a passenger in a car or van, or traveling in an airplane, bus, train or ship. After a spinal cord impairment, traveling for business or pleasure can be an overwhelming experience. Being well prepared in advance will decrease stress and make your trip enjoyable.

This chapter provides tips regarding traveling with a power or manual wheelchair, purchasing or renting durable medical equipment, medication management, bowel and bladder issues, traveling registrations and organizing recreational activities.

Driving

When you are ready to consider driving, it is suggested that you discuss financial coverage with your …

Vocational Services-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Vocational services are available to you during the course of your rehabilitation to assist you in returning to work or school or exploring vocational and educational options. These services may be initiated while you are in the hospital and can continue after you are discharged. You may start to receive vocational services from the vocational counselor at Magee Rehabilitation Hospital, and at the same time, referred to the state agency designated to assist in vocational rehabilitation. Ultimately, you may return to your pre-injury job, or you may embark on a new educational or vocational path.

Vocational Consultation

During the …

Recreational Therapy-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Your free time and the way you use that time can be a source of pleasure, enjoyment and self-fulfillment for you. You will probably have many questions about your injury’s effect on your ability to participate in your favorite activities and sports. Recreational therapy is available to assist you in answering your many questions and concerns and helping you plan a satisfactory leisure lifestyle for yourself.

What is Recreational Therapy?

Recreational therapy is a form of treatment that uses recreational activities to work on your rehabilitation goals. Through using your existing recreational skills and interests, recreational therapy can address …

Bladder-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Your bladder and urinary system play a very important part in keeping you healthy by acting like a “filter” and getting rid of the waste products from food and fluid that you have eaten and absorbed. After you have had a spinal cord injury, you often lose your ability to control urination. You may not be able to feel that your bladder is full, and if you can feel it, you may not be able to empty it.

It is important to note here that the changes that occur in your bladder will be unique to you. Although there …

Skin-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction to Skin Function

The skin is a vital part of the body with many necessary functions:

• The skin protects you from the environment. When your skin is intact, there is a barrier against bacteria and injury to the organs inside of the body. It prevents too much sunlight or harmful chemicals from entering the body.

• The skin helps you stay warm or cool. Your sweat glands produce sweat and cool you off as the sweat evaporates from the skin.

• Nerve endings in the skin send messages to the brain to give you information about pain, temperature …

Cardiovascular-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Cardiovascular problems affect all people who have a spinal cord injury. It has been noted to be particularly problematic for those over 65 years old and those who have been injured for more than 30 years. Due to this problem affecting many people, it needs to be addressed early in your rehabilitation as well as throughout your life.

Description of the Cardiovascular System

The cardiovascular system contains the heart and the blood vessels. The heart is a muscular pump in the chest that receives blood from blood vessels from all over the body. As the heart beats, it delivers …

Nutrition-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction-Why Nutrition Matters

Nutrition is important for everyone to maintain good health. After a spinal cord injury, nutrition can be even more important to improve overall wellness, achieve and maintain a healthy weight and help regulate bowel and bladder function. Eating a well balanced diet can help prevent the long term complications associated with SCI such as weight gain, deconditioning and skin breakdown.

A well-balanced diet can provide all of the nutrients that your body needs. Foods high in fiber, along with plenty of water, help regulate bowel function. However, if you eat more than you need, you can gain …

Equipment-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

During your stay in the hospital, various pieces of equipment will be given to you or ordered for you. Your therapists or nurse will be instructing you in the use, care and repair of this equipment. Also, you will find materials in this section regarding specialized equipment that you may need during your hospital stay and following discharge. There are also reference materials about equipment you may need in the future.

If you have any questions about your equipment while in the hospital, contact your therapist, nurse or case manager.

As part of your follow-up program, equipment will be …