Digital Commons Network^™

Defining And Measuring The Patient-Centered Medical Home., Kurt C Stange, Paul A Nutting, William L Miller, Carlos R Jaén, Benjamin F Crabtree, Susan A Flocke, James M Gill

Department of Family & Community Medicine Faculty Papers

The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices' internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare. The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to …

The Transition From Medical Student To Junior Doctor: Today's Experiences Of Tomorrow's Doctors., Nicola Brennan, Oonagh Corrigan, Jon Allard, Julian Archer, Rebecca Barnes, Alan Bleakley, Tracey Collett, Bere Sr De

Peninsula Medical School

CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at …

Evaluation Of A Comprehensive Tobacco Cessation Curriculum For Dental Hygiene Programs, Joan M. Davis Rdh, Ms, Margaret S Stockdale, Martha Cropper

Journal Articles

Dental health care providers continue to offer inconsistent and limited tobacco use cessation (TUC) interventions even though smoking-related morbidity and mortality continue to be a substantial health concern. Our purpose was to conduct a comprehensive, three-year (2003-06) TUC curriculum evaluation that included assessment of existing TUC education offered; dental hygiene educators' readiness to incorporate TUC education into the curriculum; and development of a pre-test/post-test assessment instrument and faculty development program. This curriculum study was carried out alongside a research study to evaluate the effectiveness of a peer-reviewed tobacco curriculum (Tobacco Free! Curriculum). Faculty members (baseline n=97; third-year n=42) from the …

Ask A Different Question, Get A Different Answer: Why Living Wills Are Poor Guides To Care Preferences At The End Of Life., Laraine Winter, Susan M Parks, James J Diamond

Center for Applied Research on Aging and Health Research Papers

CONTEXT: Living wills have a poor record of directing care at the end of life, as a copious literature attests. Some speculation centers on the questionable correspondence between the scenario described in living wills versus the real-life circumstances that typically arise at the end of life.

OBJECTIVE: To assess the strength of association between responses to a standard living will question and preferences for treatments in six end-of-life scenarios.

DESIGN: Cross-sectional.

SETTING: Telephone interviews.

PARTICIPANTS: Two hundred two community-dwelling men and women 70 years of age or older in the greater Philadelphia area.

MAIN OUTCOME MEASURES: Strength of preferences for …

Enhanced Psychosocial Well-Being Following Participation In A Mindfulness-Based Stress Reduction Program Is Associated With Increased Natural Killer Cell Activity., Carolyn Y Fang, Diane K Reibel, Margaret L Longacre, Steven Rosenzweig, Donald E Campbell, Steven D Douglas

Marcus Institute of Integrative Health Faculty Papers

BACKGROUND: Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity.

OBJECTIVES: The objectives of this study were to examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program.

DESIGN: A single-group, pretest/post-test design was utilized.

SETTING: The intervention was conducted at an academic health center.

SUBJECTS: This pilot study involved 24 participants (aged …

Examining The Neuroscience Evidence For Sensory-Driven Neuroplasticity: Implications For Sensory-Based Occupational Therapy For Children And Adolescents., Shelly J. Lane, Roseann C. Schaaf

Department of Occupational Therapy Faculty Papers

When Ayres first presented the theory of sensory integration (SI), she grounded it in the neuroscience literature. Neuroplasticity was then, and is today, considered to be at the heart of this theory. This evidence-based review sought to critically examine the basic science literature to specifically identify evidence for the assumptions and tenets of Ayres' theory of SI. We reviewed literature between 1964 and 2005, within psychological, physiological, and biomedical areas, addressing neuroplasticity. The review focused on sensorimotor-based neuroplasticity; explored the data that addressed the links among sensory input, brain function, and behavior; and evaluated its relevance in terms of supporting …

Evolution Of The Sensory Integration Frame Of Reference., Roseann C. Schaaf, Patricia L. Davies

Department of Occupational Therapy Faculty Papers

No abstract provided.

Differential Activation Of Frontoparietal Attention Networks By Social And Symbolic Spatial Cues, Andrew D. Engell, Lauri Nummenmaa, Nikolaas N. Oosterhof, Richard N. Henson, James V. Haxby, Andrew J. Calder

Dartmouth Scholarship

Perception of both gaze-direction and symbolic directional cues (e.g. arrows) orient an observer’s attention toward the indicated location. It is unclear, however, whether these similar behavioral effects are examples of the same attentional phenomenon and, therefore, subserved by the same neural substrate. It has been proposed that gaze, given its evolutionary significance, constitutes a ‘special’ category of spatial cue. As such, it is predicted that the neural systems supporting spatial reorienting will be different for gaze than for non-biological symbols. We tested this prediction using functional magnetic resonance imaging to measure the brain’s response during target localization in which laterally …

Bold Signal In Both Ipsilateral And Contralateral Retinotopic Cortex Modulates With Perceptual Fading, Po-Jang Hsieh, Peter U. Tse

Dartmouth Scholarship

Under conditions of visual fixation, perceptual fading occurs when a stationary object, though present in the world and continually casting light upon the retina, vanishes from visual consciousness. The neural correlates of the consciousness of such an object will presumably modulate in activity with the onset and cessation of perceptual fading.

Method: In order to localize the neural correlates of perceptual fading, a green disk that had been individually set to be equiluminant with the orange background, was presented in one of the four visual quadrants; Subjects indicated with a button press whether or not the disk was subjectively visible …

Gis And Injury Prevention And Control: History, Challenges, And Opportunities, Nathaniel Bell, Nadine Schuurman

Faculty Publications

Intentional and unintentional injury is the leading cause of death and potential years of life lost in the first four decades of life in industrialized countries around the world. Despite surgical innovations and improved access to emergency care, research has shown that certain populations remain particularly vulnerable to the risks and consequences of injury. Recent evidence has shown that the analytical, data linkage, and mapping tools of geographic information systems (GIS) technology provide can further address these determinants and identify populations in need. This paper traces the history of injury prevention and discusses current and future challenges in furthering our …

Behind The Mask: The Influence Of Mask-Type On Amygdala Response To Fearful Faces, M Justin Kim, Rebecca A. Loucks, Maital Neta, F. Caroline Davis, Jonathan A. Oler, Emily C. Mazzulla, Paul J. Whalen

Dartmouth Scholarship

In this study, we compared the effects of using neutral face masks vs non-face pattern masks on amygdala activity to masked fearful faces. Twenty-seven subjects viewed 18 s blocks of either fearful or happy faces masked with either neutral faces or patterns, while their brain activity was measured using functional magnetic resonance imaging. Results replicated increased amygdala activation to face-masked fearful vs happy faces. In the pattern mask condition, the amygdala discriminated between masked fearful and happy faces, but this effect manifested as a decrease in activation to fearful faces compared to happy faces. This interactive effect between facial expression …

Recent Experimental And Clinical Findings In The Skeleton Associated With Loss Of Estrogen Hormone Or Estrogen Receptor Activity, Eric P. Smith, Bonny Specker, Kenneth S Korach

Ethel Austin Martin Program Publications

Studies on rodent models and rare human disorders of estrogen production or response have revealed an increased complexity of the actions of estrogen on bone. ERalpha disruption in human males results in delayed epiphyseal maturation, tall stature, trabecular thinning, marked cortical thinning, genu valgum and significantly reduced cortical vBMD, but trabecular number is preserved and there is normal to increased periosteal expansion. Aromatase deficiency results overall in a similar phenotype, although less is known about skeletal architecture. Importantly, estrogen replacement in these individuals, even if provided late in the third decade, may normalize aBMD. Less certain is whether there is …

Biomarkers In Systemic Sclerosis., Susan V. Castro, Sergio A. Jimenez

Scleroderma Center Faculty Papers

Systemic sclerosis is an autoimmune inflammatory disorder of unknown etiologycharacterized b y pronounced fibroproliferative alterations in the microvasculature, and frequent cellular and humoral immunity abnormalities, culminating in a severe and often progressive fibrotic process. Numerous biomarkers reflecting the three main pathogenetic mechanisms in systemic sclerosis have been described; however, aside from several disease-specific autoantibodies, other biomarkers have not been thoroughly validated and require further study. Thus, there is an unmet need for validated biomarkers for diagnosis, disease classification, and evaluation of organ involvement and therapeutic response in systemic sclerosis.

What Is Biomedical Informatics?, Elmer V Bernstam, Jack W Smith, Todd R Johnson

Faculty, Staff and Student Publications

Biomedical informatics lacks a clear and theoretically-grounded definition. Many proposed definitions focus on data, information, and knowledge, but do not provide an adequate definition of these terms. Leveraging insights from the philosophy of information, we define informatics as the science of information, where information is data plus meaning. Biomedical informatics is the science of information as applied to or studied in the context of biomedicine. Defining the object of study of informatics as data plus meaning clearly distinguishes the field from related fields, such as computer science, statistics and biomedicine, which have different objects of study. The emphasis on data …

Bite Size Oral Health Promotion., Robert Witton

Peninsula Dental School

UNLABELLED: Improving health is part of the Government's wider public health agenda and central to this theme is the requirement to help patients make informed healthy choices. The aim of the article is to review the basis of oral health promotion in primary dental care, explain why it is necessary and to give some practical tips on behaviour change in practice. CLINICAL RELEVANCE: Understanding and relating well to your patients can make oral health promotion more successful, with communication skills being paramount in achieving this goal, along with the creation of a supportive health-orientated practice environment.

Visuospatial Tasks Suppress Craving For Cigarettes., Jon May, Jackie Andrade, Nathalie Panabokke, David Kavanagh

School of Psychology

The Elaborated Intrusion (EI) theory of desire posits that visual imagery plays a key role in craving. We report a series of experiments testing this hypothesis in a drug addiction context. Experiment 1 showed that a mental visual imagery task with neutral content reduced cigarette craving in abstaining smokers, but that an equivalent auditory task did not. The effect of visual imagery was replicated in Experiment 2, which also showed comparable effects of non-imagery visual working memory interference. Experiment 3 showed that the benefit of visual over auditory interference was not dependent upon imagery being used to induce craving. Experiment …

A Review Of Human Factors Principles For The Design And Implementation Of Medication Safety Alerts In Clinical Information Systems., Shobha Phansalkar, Judy Edworthy, Elizabeth Hellier, Diane L. Seger, Angela Schedlbauer, Anthony J. Avery, David W. Bates

School of Psychology

The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many …

Negative Intrusive Thoughts And Dissociation As Risk Factors For Self-Harm., Helen Batey, Jon May, Jackie Andrade

School of Psychology

Relationships between self-harm and vulnerability factors were studied in a general population of 432 participants, of whom 30% reported some experience of self-harm. This group scored higher on dissociation and childhood trauma, had lower self-worth, and reported more negative intrusive thoughts. Among the non-harming group, 10% scored similarly to the self-harmers on the dissociation and self-worth scales, and engaged in potentially maladaptive behaviors that are not defined as indicating clinical self-harm, but experienced fewer negative intrusive thoughts. This group may be at risk of future self-harm if they begin to experience negative intrusive thoughts. If negative intrusive thoughts are playing …

Temporal Distance And Person Memory: Thinking About The Future Changes Memory For The Past., Na Wyer, Tj Perfect, S Pahl

School of Psychology

Psychological distance has been shown to influence how people construe an event such that greater distance produces high-level construal (characterized by global or holistic processing) and lesser distance produces low-level construal (characterized by detailed or feature-based processing). The present research tested the hypothesis that construal level has carryover effects on how information about an event is retrieved from memory. Two experiments manipulated temporal distance and found that greater distance (high-level construal) improves face recognition and increases retrieval of the abstract features of an event, whereas lesser distance (low-level construal) impairs face recognition and increases retrieval of the concrete details of …

Neuronal Network Pharmacodynamics Of Gabaergic Modulation In The Human Cortex Determined Using Pharmaco-Magnetoencephalography., Stephen D. Hall, Gareth R. Barnes, Paul L. Furlong, Stefano Seri, Arjan Hillebrand

School of Psychology

Neuronal network oscillations are a unifying phenomenon in neuroscience research, with comparable measurements across scales and species. Cortical oscillations are of central importance in the characterization of neuronal network function in health and disease and are influential in effective drug development. Whilst animal in vitro and in vivo electrophysiology is able to characterize pharmacologically induced modulations in neuronal activity, present human counterparts have spatial and temporal limitations. Consequently, the potential applications for a human equivalent are extensive. Here, we demonstrate a novel implementation of contemporary neuroimaging methods called pharmaco-magnetoencephalography. This approach determines the spatial profile of neuronal network oscillatory power …

Event-Related Potentials Dissociate Effects Of Salience And Space In Biased Competition For Visual Representation, Matthew R. Hilimire, Jeffrey R.W. Mounts, Nathan A. Parks, Paul M. Corballis

Psychology

Background: Selective visual attention is the process by which the visual system enhances behaviorally relevant stimuli and filters out others. Visual attention is thought to operate through a cortical mechanism known as biased competition. Representations of stimuli within cortical visual areas compete such that they mutually suppress each others' neural response. Competition increases with stimulus proximity and can be biased in favor of one stimulus (over another) as a function of stimulus significance, salience, or expectancy. Though there is considerable evidence of biased competition within the human visual system, the dynamics of the process remain unknown. Methodology/Principal Findings: Here, we …

Less Food For Thought. Impact Of Attentional Instructions On Intrusive Thoughts About Snack Foods., Jon May, Jackie Andrade, Helen Batey, Lisa Marie Berry, David J. Kavanagh

School of Psychology

Intrusive thoughts about food may play a role in unhealthy eating behaviours. Food-related thoughts that capture attention can lead to craving and further intrusive thoughts (Kavanagh, Andrade, & May, 2005). We tested whether diverting attention to mental images or bodily sensations would reduce the incidence of intrusive thoughts about snack foods. In two experiments, participants reported their thoughts in response to probes during three 10min periods. In the Baseline and Post-task period, participants were asked to let their mind wander. In the middle, Experimental, period, participants followed mind wandering (Control), thought diversion, or Thought Suppression instructions. Self-directed or Guided Imagery, …

Impact Of Workplace Based Assessment On Doctors' Education And Performance: A Systematic Review., A Miller, J Archer

Peninsula Medical School

To investigate the literature for evidence that workplace based assessment affects doctors' education and performance.

The Transition From Medical Student To Junior Doctor: Today's Experiences Of Tomorrow's Doctors., Nicola Brennan, Oonagh Corrigan, Jon Allard, Julian Archer, Rebecca Barnes, Alan Bleakley, Tracey Collett, Bere Sr De

Peninsula Medical School

CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at …

Fagerstrom Test For Nicotine Dependence Vs Heavy Smoking Index In A General Population Survey, M. Pérez-Ríos, M. I. Santiago-Pérez, B. Alonso, A. Malvar, X. Hervada, Jose De Leon

Psychiatry Faculty Publications

BACKGROUND: The Fagerström Test for Nicotine Dependence (FTND) is used for assessing nicotine dependence. A shorter test derived from the FTND used for the general population is the Heavy Smoking Index (HSI) (six questions vs. two). The objective of this study is to compare the validity of the HSI versus the FTND.

METHODS: A survey of tobacco use in the general population was carried out in the northern Spanish region of Galicia using both the FTND and the HSI to study a representative sample of 1655 daily smokers. The HSI was compared with the FTND, considered the gold standard. Measures …

The Principled Control Of False Positives In Neuroimaging, Craig M. Bennett, George L. Wolford, Michael B. Miller

Dartmouth Scholarship

An incredible amount of data is generated in the course of a functional neuroimaging experiment. The quantity of data gives us improved temporal and spatial resolution with which to evaluate our results. It also creates a staggering multiple testing problem. A number of methods have been created that address the multiple testing problem in neuroimaging in a principled fashion. These methods place limits on either the familywise error rate (FWER) or the false discovery rate (FDR) of the results. These principled approaches are well established in the literature and are known to properly limit the amount of false positives across …

Identifying Blood Biomarkers And Physiological Processes That Distinguish Humans With Superior Performance Under Psychological Stress., Amanda M. Cooksey, Nausheen Momen, Russell Stocker, Shane C. Burgess

CVM Publications

BACKGROUND: Attrition of students from aviation training is a serious financial and operational concern for the U.S. Navy. Each late stage navy aviator training failure costs the taxpayer over $1,000,000 and ultimately results in decreased operational readiness of the fleet. Currently, potential aviators are selected based on the Aviation Selection Test Battery (ASTB), which is a series of multiple-choice tests that evaluate basic and aviation-related knowledge and ability. However, the ASTB does not evaluate a person's response to stress. This is important because operating sophisticated aircraft demands exceptional performance and causes high psychological stress. Some people are more resistant to …

Effects Of Caregiver Burden And Satisfaction On Affect Of Older End-Stage Renal Disease Patients And Their Spouses, Maureen Wilson-Genderson, Rachel A Pruchno, Francine P Cartwright

Rowan-Virtua School of Osteopathic Medicine Departmental Research

We examined the extent to which a 2-factor model of affect explains how the burdens and satisfactions experienced by caregivers influence their own well-being and that of the spouses for whom they provide care. Using data from 315 older patients with end-stage renal disease and their spouses, we extended tests of Lawton et al.'s (1991) 2-factor model both longitudinally and dyadically. Multilevel modeling analyses partially support the 2-factor model. Consistent with the model, mean caregiver burden has a stronger effect on both caregiver and patient negative affect than does mean caregiver satisfaction. Contrary to the model, mean caregiver satisfaction has …

Changes In Self-Schema Structure In Cognitive Therapy For Major Depressive Disorder: A Randomized Clinical Trial., David J A Dozois, Peter J Bieling, Irene Patelis-Siotis, Lori Hoar, Susan Chudzik, Katie Mccabe, Henny A Westra

Psychology Publications

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) …

Adding A Motivational Interviewing Pretreatment To Cognitive Behavioral Therapy For Generalized Anxiety Disorder: A Preliminary Randomized Controlled Trial., Henny A Westra, Hal Arkowitz, David J A Dozois

Psychology Publications

Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity …