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Isaac M, Kumar SA, Petroski GF, Shinn A, Mehra A, Gomez CR. Assessing left atrial size and pump function in ischemic stroke patients: Is cardiac MRI superior to transthoracic echocardiography? J Stroke Cerebrovasc Dis 2024; 33:107674. [PMID: 38484943 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVES Current guidelines recommend transthoracic echocardiography (TTE) following an ischemic stroke as the primary technique to identify cardiac abnormalities associated with an increased risk of cerebral embolism. It is unclear whether cardiac magnetic resonance imaging (cMRI), a technique shown to provide increased imaging resolution, may also enhance the cardiac assessment of ischemic stroke patients. We compared cMRI with TTE in the evaluation of Left Atrial (LA) size and pump function in a cohort of 44 patients with ischemic stroke. MATERIALS AND METHODS The biplane method was utilized to acquire LA diameters as well as area measurements in both TTE and cMRI. We calculated LA volume (LAV), LAV index (LAVI), LA Global Longitudinal Strain (GLS) and LA pump function. Results were compared using paired two sample for means t-test. Lin's concordance correlation coefficient (CCC) and Bland-Altman methods quantified the agreement of measurements obtained by TTE and cMRI. RESULTS LAVI measurements by cMRI were significantly larger (34.97 v. 28.81; p = 0.001) than by TTE. The concordance correlation demonstrated only a weak agreement between LA size measured by cMRI and TTE (ρc = 0.397; p= 0.001, 95% CI 0.16 - 0.59), and the Bland-Altman plot demonstrated that LAVI measured by cMRI averaged 6.3 ml/m2 larger magnitude than those obtained by TTE. CONCLUSIONS Using TTE alone leads to an underestimation of LA abnormalities important in the evaluation of ischemic stroke patients. Nearly one in every five ischemic stroke patients evaluated based on the current guidelines may have a missed potential source of cardiac embolism.
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Affiliation(s)
| | | | | | - Alex Shinn
- The Division of Cardiology, Department of Medicine
| | - Ashir Mehra
- The Comprehensive Stroke Center, and University of Missouri Columbia, Columbia, Missouri, USA.
| | - Camilo R Gomez
- The Comprehensive Stroke Center, and University of Missouri Columbia, Columbia, Missouri, USA
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Syed-Abdul MM, Moore MP, Wheeler AA, Ganga RR, Diaz-Arias A, Petroski GF, Rector RS, Ibdah JA, Parks EJ. Isotope Labeling and Biochemical Assessment of Liver-Triacylglycerol in Patients with Different Levels of Histologically-Graded Liver Disease. J Nutr 2023; 153:3418-3429. [PMID: 37774841 PMCID: PMC10843901 DOI: 10.1016/j.tjnut.2023.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) prevalence is rapidly growing, and fatty liver has been found in a quarter of the US population. Increased liver lipids, particularly those derived from the pathway of de novo lipogenesis (DNL), have been identified as a hallmark feature in individuals with high liver fat. This has led to much activity in basic science and drug development in this area. No studies to date have investigated the contribution of DNL across a spectrum of disease, although it is clear that inhibition of DNL has been shown to reduce liver fat. OBJECTIVES The purpose of this study was to determine whether liver lipid synthesis increases across the continuum of liver injury. METHODS Individuals (n = 49) consumed deuterated water for 10 d before their scheduled bariatric surgeries to label DNL; blood and liver tissue samples were obtained on the day of the surgery. Liver lipid concentrations were quantitated, and levels of protein and gene expression assessed. RESULTS Increased liver DNL, measured isotopically, was significantly associated with liver fatty acid synthase protein content (R = 0.470, P = 0.003), total steatosis assessed by histology (R = 0.526, P = 0.0008), and the fraction of DNL fatty acids in plasma very low-density lipoprotein-triacylglycerol (R = 0.747, P < 0.001). Regression analysis revealed a parabolic relationship between fractional liver DNL (percent) and NAFLD activity score (R = 0.538, P = 0.0004). CONCLUSION These data demonstrate that higher DNL is associated with early to mid stages of liver disease, and this pathway may be an effective target for the treatment of NAFLD and nonalcoholic steatohepatitis. This study was registered at clinicaltrials.gov as NCT03683589.
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Affiliation(s)
- Majid M Syed-Abdul
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - Mary P Moore
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States; Research Services-Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Andrew A Wheeler
- Department of Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Rama R Ganga
- Department of Surgery, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Alberto Diaz-Arias
- Boyce & Bynum Pathology Professional Services, Division of Gastrointestinal & Hepatobiliary Pathology, Columbia, MO, United States
| | - Gregory F Petroski
- Biostatistics Unit, School of Medicine, University of Missouri, Columbia, MO, United States
| | - R Scott Rector
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States; Research Services-Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States; Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Jamal A Ibdah
- Research Services-Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States; Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Elizabeth J Parks
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States; Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of Missouri, Columbia, MO, United States.
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Canfield SM, Canada KE, Rolbiecki AJ, Petroski GF. Feasibility and acceptability of an online mental health intervention for pregnant women and their partners: a mixed method study with a pilot randomized control trial. BMC Pregnancy Childbirth 2023; 23:739. [PMID: 37853333 PMCID: PMC10585730 DOI: 10.1186/s12884-023-06031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Untreated perinatal mood and anxiety disorders (PMAD) have short- and long-term health and social consequences; online cognitive behavioral therapy (CBT) interventions can reduce symptoms. Despite partner support being protective online interventions rarely target couples. This study builds on research on an existing CBT-based intervention, the Mothers and Babies Online Course (eMB), by testing its feasibility with prenatal couples. METHODS We conducted a pilot, randomized, controlled feasibility trial using a 1:1 parallel design. To be eligible, participant dyads were pregnant people (between 13-30 weeks gestation and with a score of 10 or greater on either the GAD-7 or PHQ-9 scale indicating elevated symptoms of anxiety or depression) and their cohabitating partners, living in Missouri, with access to the internet; both in the dyad consented to participate. Recruitment occurred via Facebook ads, flyers, and a snowball approach. The intervention group received eMB, and the control group received a list of community resources. We examined retention and adherence data extracted from eMB analytics and study databases. All participants were given depression and anxiety scales at baseline, 4 and 8 weeks to test preliminary efficacy; satisfaction and acceptability were measured at trial end (i.e., eight weeks) and via interview. RESULTS There were 441 people who responded to recruitment materials, 74 pregnant people were screened; 19 partners did not complete enrolment, and 25 dyads were ineligible. There were 15 dyads per group (N = 30) who enrolled; all completed the study. The survey response rate was 90% but partners required nearly twice the number of reminders. No participant completed all lessons. Mean depression and anxiety scores dropped over time for dyads in control (M = -1.99, -1.53) and intervention (M = -4.80, -1.99). Intervention pregnant people's anxiety significantly decreased (M = -4.05; 95% CI [0.82, 7.27]) at time two compared to control. Twelve pregnant people and four partners participated in post-intervention interviews and suggested improvements for eMB. CONCLUSION Online dyadic interventions can potentially reduce PMAD symptoms. However, to feasibly study eMB with couples, strategies to increase program adherence are necessary. Tailoring interventions to overtly include partners may be advantageous. TRIAL REGISTRATION ClinicalTrials.gov NCT05867680, 19/05/2023.
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Affiliation(s)
- Shannon M Canfield
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA.
| | - Kelli E Canada
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Abigail J Rolbiecki
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Department of Family Medicine and Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory F Petroski
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
- Department of Biomedical Informatics, Biostatistics, and Medical Epidemiology, School of Medicine - University of Missouri, Columbia, MO, USA
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Kanaley JA, Porter JW, Winn NC, Lastra G, Chockalingam A, Pettit-Mee RJ, Petroski GF, Cobelli C, Schiavon M, Parks EJ. Temporal optimization of exercise to lower fasting glucose levels. J Physiol 2023:10.1113/JP285069. [PMID: 37732475 PMCID: PMC10954586 DOI: 10.1113/jp285069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
Exercise stimulates glucose uptake and increases insulin sensitivity acutely. Temporally optimizing exercise timing may minimize the nocturnal rise in glucose levels. This study examined the effect of exercise timing on evening and overnight glucose concentrations in individuals who were non-obese with normal fasting glucose levels (Non-Ob; n = 18) and individuals with obesity (OB) with impaired fasting glucose levels (OB+IFG) and without (n = 16 and n = 18, respectively). Subjects were studied on three occasions (no exercise (NOEX)), morning exercise (AMEX; 0700 h) and evening exercise (PMEX; 2000 h). The evening meal was provided (1800 h) and blood samples were taken from 1740 to 0700 h and morning endogenous glucose production (EGP) was measured. Glucose and insulin concentrations increased with the dinner meal with peak concentrations being higher in OB+IFG than in OB and Non-Ob (P = 0.04). In OB+IFG, evening glucose concentrations rose above baseline levels at about 2300 h, with the glucose concentrations staying somewhat lower with AMEX and PMEX until ∼0500 h than with NOEX. In OB+IFG, insulin concentrations decreased following the dinner meal and waned throughout the night, despite the rising glucose concentrations. In the OB and Non-Ob individuals following the dinner meal, no increase in glucose concentrations occurred in the evening period and insulin levels mirrored this. No difference was observed in the morning fasting glucose levels between study days or between groups. Regardless of time of day, exercise delays the evening rise in glucose concentrations in adults with OB+IFG but does not lower morning fasting glucose levels or improve the synchrony between glucose and insulin concentrations. KEY POINTS: Insulin resistance and type 2 diabetes have been linked to disturbances of the core clock, and glucose tolerance demonstrates a diurnal rhythm in healthy humans with better glucose tolerance in the morning than in the afternoon and evening. Skeletal muscle is a primary site for insulin resistance in people with impaired glucose tolerance. In individuals with obesity and impaired fasting glucose levels (OB+IFG), following a dinner meal, glucose concentrations started to rise and continues throughout the night, resulting in elevated glucose levels, while concomitantly, insulin levels are waning. Exercise, regardless of the time of day, suppressed the rise in glucose levels in OB+IFG for many hours during the night but did not lower morning fasting glucose levels. Morning exercise was not quite as effective as evening exercise.
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Affiliation(s)
- Jill A Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, USA
| | - J W Porter
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, USA
| | - N C Winn
- Department of Molecular Physiology & Biophysics, Vanderbilt University, Nashville, Tennessee, USA
| | - G Lastra
- Department of Endocrinology, Internal Medicine, University of Missouri, Columbia, Missouri, USA
| | - A Chockalingam
- Department of Cardiology, University of Missouri, Columbia, Missouri, USA
| | - R J Pettit-Mee
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, USA
| | - G F Petroski
- Office of Medical Research, Biostatistics Unit, University of Missouri, Columbia, Missouri, USA
| | - C Cobelli
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - M Schiavon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - E J Parks
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, USA
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Ali AH, Nallapeta NS, Yousaf MN, Petroski GF, Sharma N, Rao DS, Yin F, Davis RM, Bhat A, Swi AIA, Al-Juboori A, Ibdah JA, Hammoud GM. EUS-guided versus percutaneous liver biopsy: A prospective randomized clinical trial. Endosc Ultrasound 2023; 12:334-341. [PMID: 37693114 PMCID: PMC10437149 DOI: 10.1097/eus.0000000000000010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/12/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Objectives Prospective studies comparing EUS-guided liver biopsy (EUS-LB) to percutaneous LB (PC-LB) are scarce. We compared the efficacy and safety of EUS-LB with those of PC-LB in a prospective randomized clinical trial. Methods Between 2020 and 2021, patients were enrolled and randomized (1:1 ratio). The primary outcome was defined as the proportion of patients with ≥11 complete portal tracts (CPTs). The sample size (n = 80) was calculated based on the assumption that 60% of those in the EUS-LB and 90% of those in the PC-LB group will have LB with ≥11 CPTs. The secondary outcomes included proportion of patients in whom a diagnosis was established, number of CPTs, pain severity (Numeric Rating Scale-Pain Intensity), duration of hospital stay, and adverse events. Results Eighty patients were enrolled (median age, 53 years); 67.5% were female. Sixty percent of those in the EUS-LB and 75.0% of those in the PC-LB group met the primary outcome (P = 0.232). The median number of CPTs was higher in the PC-LB (17 vs 13; P = 0.031). The proportion of patients in whom a diagnosis was established was similar between the groups (92.5% [EUS-LB] vs 95.0% [PC-LB]; P = 1.0). Patients in the EUS-LB group had less pain severity (median Numeric Rating Scale-Pain Intensity, 2.0 vs 3.0; P = 0.003) and shorter hospital stay (2.0 vs 4.0 hours; P < 0.0001) compared with the PC-LB group. No patient experienced a serious adverse event. Conclusions EUS-guided liver biopsy was safe, effective, better tolerated, and associated with a shorter hospital stay.
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Affiliation(s)
- Ahmad H. Ali
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Naren S. Nallapeta
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Buffalo, Buffalo, NY, USA
| | - Muhammad N. Yousaf
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Gregory F. Petroski
- Biostatistics and Research Design Unit, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Neal Sharma
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Deepthi S. Rao
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
| | - Feng Yin
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
| | - Ryan M. Davis
- Department of Radiology, Vascular and Interventional Radiology, University of Missouri, Columbia, MO, USA
| | - Ambarish Bhat
- Department of Radiology, Vascular and Interventional Radiology, University of Missouri, Columbia, MO, USA
| | - Ahmed I. A. Swi
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Alhareth Al-Juboori
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Jamal A. Ibdah
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
- Research Service, Harry S. Truman Memorial Veterans Medical Center, Columbia, MO, USA
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA
| | - Ghassan M. Hammoud
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
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Hirabayashi MT, Gharabagi AP, Hesemann NP, Johnson SM, Webel AD, Petroski GF, Davis GR. Spherical Aberration of Cataractous Eyes and Its Relationship With Age, Ocular Biometry, and Various IOL Platforms. J Refract Surg 2023; 39:89-94. [PMID: 36779463 DOI: 10.3928/1081597x-20221207-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE To determine the median spherical aberration (SA) of the cataractous population, how it relates to biometry, and the theoretical effect of different intraocular lens (IOL) platforms. METHODS A retrospective chart review of patients undergoing cataract surgery evaluation with a high quality Pentacam (Oculus Optikgeräte GmbH) were included. Age, gender, Q-value, mean total SA, higher order aberration root mean square wavefront error, and equivalent keratometry were collected from the Holladay report and axial length and anterior chamber depth (ACD) from the IOLMaster 700 (Carl Zeiss Meditec AG). RESULTS Data from 1,725 eyes of 999 patients were collected. SA had a median of 0.37 µm (95% confidence interval: 0.36 to 0.38. Age (r = .136, P < .001), Q-factor (r = .743, P < .001), and higher order aberration root mean square wavefront error (r = .307, P < .001) were positively correlated with SA. Average equivalent keratometry (r = -.310, P < .001) was negatively correlated with SA. Axial length (r = -0.037, P = .120) and ACD (r = .004, P = .856) had no association with SA. Up to 1,499 (86.9%) theoretically had SA moved closer to zero with IOLs that had negative SA. Up to 102 (5.9%) had SA theoretically worsened. CONCLUSIONS SA is not normally distributed, suggesting that there may be no "average" SA that IOLs should aim to correct. Patients might benefit from tailoring IOL choice to individual SA. Without access to SA data, eyes with steeper average keratometry or younger patients may have less SA, which could influence IOL choice. [J Refract Surg. 2023;39(2):89-94.].
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Rantz M, Petroski GF, Popejoy LL, Vogelsmeier AA, Canada KE, Galambos C, Alexander GL, Crecelius C. Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative. J Nutr Health Aging 2021; 25:1124-1130. [PMID: 34725672 PMCID: PMC8485110 DOI: 10.1007/s12603-021-1684-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. DESIGN A four group comparative analysis of longitudinal data from September 2013 thru December 2019. SETTING NHs in the interventions of both Phases 1 (2012-2016) and 2 (2016-2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). PARTICIPANTS NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. MEASUREMENTS Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. RESULTS The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) out-performed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. CONCLUSION These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.
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Affiliation(s)
- M Rantz
- Marilyn Rantz, University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
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Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to evaluate the impact of using electrostatic precipitation to manage the surgical plume during low pressure laparoscopic gynecologic procedures. METHODS This was a prospective, blinded, randomized controlled study of women with a clinical indication for laparoscopic hysterectomy (n = 30) or myomectomy (n = 5). Patients were randomized to either use electrostatic precipitation (EP) during the procedure, or not (No EP, hysterectomy group only). RESULTS Low pressure surgery could be undertaken in 87% of hysterectomy cases (13/15) when using EP to manage the surgical plume, compared to only 53% (8/15) in the No EP group. Overall average rating of the visual field was excellent with EP vs fair for No EP. Average CO2 consumption was reduced by 29% when using EP (16.7L vs 23.5L, p = 0.152). The average number of procedural pauses to vent smoke was lower with EP than the No EP group (1.5 per case vs. 3.7 per case, p = 0.005). Average procedure duration for the EP vs No EP group was 40.5 min vs. 46.9 min (p = 0.987). There were no measurable differences between groups for body temperature, end-tidal CO2, and discharge pain scores. In myomectomy, all five cases could be performed at low pressure, with an excellent visual field rating. CONCLUSION Electrostatic precipitation enhances low pressure laparoscopic hysterectomy and myomectomy. This was achieved by minimizing interruptions to surgery and exchange of CO2; providing a clear visual field throughout the procedure; and eliminating surgical smoke at the site of origin.
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Affiliation(s)
- David Levine
- Department of Obstetrics and Gynecology, Mercy Hospital, 621 S. New Ballas Rd, St. Louis, Missouri
| | - Gregory F Petroski
- Biostatistics & Research Design Unit, University of Missouri - Columbia School of Medicine, 182C Galena Hall, Columbia, Missouri
| | - Tracy Haertling
- Mercy Research, 3231 S. National Ave., Ste 210, Springfield, Missouri
| | - Teresa Beaudoin
- Mercy Research, 615 S. New Ballas Rd, Ste 2010, St. Louis, Missouri
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Sheets LR, Henderson Kelley LE, Scheitler-Ring K, Petroski GF, Barnett Y, Barnett C, Kind AJH, Parker JC. An index of geospatial disadvantage predicts both obesity and unmeasured body weight. Prev Med Rep 2020; 18:101067. [PMID: 32154094 PMCID: PMC7056721 DOI: 10.1016/j.pmedr.2020.101067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 11/23/2022] Open
Abstract
Neighborhood context impacts health. Using an index of geospatial disadvantage measures to predict neighborhood socioeconomic disparities would support area-based allocation of preventative resources, as well as the use of location as a clinical risk factor in care of individual patients. This study tested the association of the Area Deprivation Index (ADI), a neighborhood-based index of socioeconomic contextual disadvantage, with elderly obesity risk. We sampled 5066 Medicare beneficiaries at the University of Missouri between September 1, 2013 and September 1, 2014. We excluded patients with unknown street addresses, excluded body mass index (BMI) lower than 18 or higher than 62 as probable errors, and excluded patients with missing BMI data. We used a plot of simple proportions to examine the association between ADI and prevalence of obesity, defined as BMI of 30 and over. We found that obesity was significantly less prevalent in the least-disadvantaged ADI decile (decile 1) than in all other deciles (p < 0.05) except decile 7. Obesity prevalence within the other deciles (2–6 and 8–10) was not significantly distinguishable except that decile 2 was significantly lower than decile 4. Patients with missing BMI data were more likely to reside in the most disadvantaged areas. There was a positive association between neighborhood disadvantage and obesity in this Midwestern United States Medicare population. The association of missing BMI information with neighborhood disadvantage may reflect unmeasured gaps in care delivery to the most disadvantaged patients. These preliminary results support the continued study of neighborhood socioeconomic measures to identify health disparities in populations.
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Affiliation(s)
| | | | | | | | - Yan Barnett
- Center for Applied Research and Environmental Systems, University of Missouri, United States
| | - Chris Barnett
- Center for Applied Research and Environmental Systems, University of Missouri, United States
| | - Amy J H Kind
- School of Medicine and Public Health, University of Wisconsin, United States
| | - Jerry C Parker
- School of Medicine, University of Missouri, United States
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Phillips LJ, Petroski GF, Conn VS, Brown M, Leary E, Teri L, Zimmerman S. Exploring Path Models of Disablement in Residential Care and Assisted Living Residents. J Appl Gerontol 2018; 37:1490-1516. [PMID: 27708073 PMCID: PMC5538951 DOI: 10.1177/0733464816672048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined the relationships between individual and environmental factors and physical activity, and between physical activity and functional limitations and disability in residential care/assisted living (RC/AL) residents. Participants completed questionnaires and physical performance tests, and wore the Fitbit Motion Tracker® to capture physical activity. Model fit was analyzed using two-level path models with residents nested within RC/AL settings. Model parameters were estimated using the MPlus robust maximum likelihood method. A multilevel model with good fit (root mean square error of approximation = 0.07, comparative fit index [CFI] = 0.91) showed that persons with greater exercise self-efficacy were more physically active, and persons who were more physically active had better physical function and less disability. Setting-level factors did not significantly correlate with physical activity or disability. Although environmental factors may influence physical activity behavior, only individual factors were associated with physical activity in this sample of RC/AL residents.
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Affiliation(s)
| | | | | | | | | | - Linda Teri
- 2 University of Washington, Seattle, USA
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Phillips LJ, Birtley NM, Petroski GF, Siem C, Rantz M. An observational study of antipsychotic medication use among long-stay nursing home residents without qualifying diagnoses. J Psychiatr Ment Health Nurs 2018; 25:463-474. [PMID: 29911331 DOI: 10.1111/jpm.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 01/21/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: In the United States, 15.5% of nursing home residents without qualifying diagnoses of schizophrenia, Huntington's' Disease, and/or Tourette Syndrome receive antipsychotic medications. Antipsychotic medications are used off-label (i.e., used in a manner the United States Food and Drug Administration's packaging insert does not specify) to treat neuropsychiatric symptoms, often before attempting nonpharmacologic interventions, despite evidence that this drug class is associated with significant adverse events including death. Less than optimal staffing resources and lack of access to geropsychiatric specialists are barriers to reducing antipsychotic use. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Antipsychotic use occurred in 11.6% of nursing home residents without qualifying or potentially qualifying diagnoses (bipolar disorder and psychotic disorder); antipsychotic use was more prevalent in residents with a dementia diagnosis than those without. One additional registered nurse hour per resident day could reduce the odds of antipsychotic use by 52% and 56% for residents with and without a dementia diagnosis respectively. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given the influence of total staffing and professional staff mix on risk of antipsychotic use, nursing home administrators may want to consider aspects of facility operation that impact antipsychotic use. More stringent Unites States' survey and certification standards for dementia care implemented in 2017 demand proactive person-centered care that promotes maximal well-being and functioning without risk of harm from inappropriate psychoactive medications. Mental health nurses have requisite training to provide expert person-centered care to nursing home residents with mental illness and geropsychiatric disorders. ABSTRACT Introduction Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim This study identified risk factors of antipsychotic use in long-stay residents lacking qualifying or potentially qualifying diagnoses. Method This secondary analysis used 2015 Minimum Data Set and cost report data from 458 Missouri nursing homes. The full sample (N = 29,679) was split into two subsamples: residents with (N = 15,114) and without (N = 14,565) a dementia diagnosis. Separate logistic regression models were run. Results Almost 15% of the dementia subsample and 8.4% of the nondementia subsample received an antipsychotic medication in the past week. Post-traumatic stress disorder, psychosis indicators, behavioral symptoms, anxiety medication with and without anxiety diagnosis, depression medication with and without depression diagnosis, and nurse staffing were among the strongest predictors of antipsychotic use in both subsamples. Simulation analyses showed decreased odds of receiving an antipsychotic in both subsamples when registered nurse hours matched the national average. Discussion Matching nurse staffing mix to the national average may improve antipsychotic use in nursing homes. Implications Knowledge of antipsychotic use risk factors use can inform care planning and staff education to minimize use of these medications in all but severe cases.
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Affiliation(s)
| | - Nancy M Birtley
- School of Nursing, University of Missouri, Columbia, Missouri
| | - Gregory F Petroski
- Office of Medical Research, School of Medicine, University of Missouri, Columbia, Missouri
| | - Carol Siem
- School of Nursing, University of Missouri, Columbia, Missouri
| | - Marilyn Rantz
- School of Nursing, University of Missouri, Columbia, Missouri
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Murray KS, Prunty M, Henderson A, Haden T, Pokala N, Ge B, Wakefield M, Petroski GF, Mehr DR, Kruse RL. Functional Status in Patients Requiring Nursing Home Stay After Radical Cystectomy. Urology 2018; 121:39-43. [PMID: 30076943 DOI: 10.1016/j.urology.2018.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/25/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the ability to perform activities of daily living (ADLs) in patients who required nursing home (NH) care after radical cystectomy (RC), as this surgery can impair patients' ability to perform ADLs in the postoperative period. METHODS Patients undergoing RC were identified in a novel database of patients with at least two NH assessments linked with Medicare inpatient claims. The NH assessment included the Minimum Data Set (MDS)-ADL Long Form (0-28; a higher score equals greater impairment), which quantifies ADLs. Paired t-tests and chi-squared analysis were used for comparisons. RESULTS We identified 471 patients that underwent RC and had at least one MDS-ADL assessment. In total, 245 patients lived elsewhere prior to RC and went to an NH after RC, while 122 patients lived in an NH before and after RC. Mean age of the population was 80.7 years (standard deviation 5.7). Of the 245 patients who did not live in a facility before RC, 68% of patients were discharged directly to an NH and 31% were discharged to another location before NH. There was no difference in MDS-ADL score between these groups (16.4 vs 15.0, P = .09). Among the patients who lived in an NH before and after RC, the mean pre- and post-operative MDS-ADL scores were significantly different (12.1 vs 16.6, P<.0001). CONCLUSION ADLs, as measured by the MDS-ADL Long Form score, worsen after RC. This should be an important part of the risks and benefits conversation with patients, their families, and caregivers.
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Affiliation(s)
- Katie S Murray
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Megan Prunty
- University of Missouri School of Medicine, Columbia, MO
| | - Alex Henderson
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Tyler Haden
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Naveen Pokala
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Bin Ge
- Office of Medical Research, University of Missouri, Columbia, MO
| | - Mark Wakefield
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | | | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
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Sheets L, Petroski GF, Jaddoo J, Barnett Y, Barnett C, Kelley LEH, Raman V, Kind AJH, Parker JC. The Effect of Neighborhood Disadvantage on Diabetes Prevalence. AMIA Annu Symp Proc 2018; 2017:1547-1553. [PMID: 29854224 PMCID: PMC5977699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patient socioeconomic data is not usually included in medical records nor easily accessible to clinicians, yet socioeconomic disadvantage can be an important guide to disease management. This study evaluated the neighborhood-level Area Deprivation Index (ADI), a measure of neighborhood socioeconomic disadvantage, as a factor in diabetes mellitus prevalence. Electronic health records at an academic hospital system identified 4,770 Medicare beneficiaries. Logistic regression of diabetes diagnosis (ICD9=250.x) against ADI quintile, age, gender, and race/ethnicity found all these patient characteristics to be significantly associated. Diabetes prevalence was lowest in the least disadvantaged quintile of neighborhoods after adjusting for age, gender, and race/ethnicity. The positive non-linear association of diabetes prevalence with ADI demonstrates the power of this index to practically quantify socioeconomic disadvantage. The ADI may be suitable for clinical decision support, and for informing the policy changes which are needed to reduce socioeconomic disparities in diabetes prevalence and other health outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Amy J H Kind
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- VA Geriatrics Research Education and Clinical Center (GRECC), Madison, Wisconsin
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Sheets L, Petroski GF, Zhuang Y, Phinney MA, Ge B, Parker JC, Shyu CR. Combining Contrast Mining with Logistic Regression To Predict Healthcare Utilization in a Managed Care Population. Appl Clin Inform 2017; 8:430-446. [PMID: 28466088 DOI: 10.4338/aci-2016-05-ra-0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 02/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Because 5% of patients incur 50% of healthcare expenses, population health managers need to be able to focus preventive and longitudinal care on those patients who are at highest risk of increased utilization. Predictive analytics can be used to identify these patients and to better manage their care. Data mining permits the development of models that surpass the size restrictions of traditional statistical methods and take advantage of the rich data available in the electronic health record (EHR), without limiting predictions to specific chronic conditions. OBJECTIVE The objective was to demonstrate the usefulness of unrestricted EHR data for predictive analytics in managed healthcare. METHODS In a population of 9,568 Medicare and Medicaid beneficiaries, patients in the highest 5% of charges were compared to equal numbers of patients with the lowest charges. Contrast mining was used to discover the combinations of clinical attributes frequently associated with high utilization and infrequently associated with low utilization. The attributes found in these combinations were then tested by multiple logistic regression, and the discrimination of the model was evaluated by the c-statistic. RESULTS Of 19,014 potential EHR patient attributes, 67 were found in combinations frequently associated with high utilization, but not with low utilization (support>20%). Eleven of these attributes were significantly associated with high utilization (p<0.05). A prediction model composed of these eleven attributes had a discrimination of 84%. CONCLUSIONS EHR mining reduced an unusably high number of patient attributes to a manageable set of potential healthcare utilization predictors, without conjecturing on which attributes would be useful. Treating these results as hypotheses to be tested by conventional methods yielded a highly accurate predictive model. This novel, two-step methodology can assist population health managers to focus preventive and longitudinal care on those patients who are at highest risk for increased utilization.
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Affiliation(s)
- Lincoln Sheets
- Lincoln Sheets, MD, PhD, University of Missouri, Columbia, Missouri, telephone: 417-860-1197, fax: 573-884-4808,
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15
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Beffa LR, Petroski GF, Kruse RL, Vogel TR. Functional status of nursing home residents before and after abdominal aortic aneurysm repair. J Vasc Nurs 2017; 33:106-11. [PMID: 26298614 DOI: 10.1016/j.jvn.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
Abstract
Although many trials have evaluated abdominal aortic aneurysm (AAA) repair, the impact of these procedures on the functional status of frail elderly patients is not well-described. The effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and comorbidities were evaluated for their impact on functional trajectories after discharge. Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for OAR and EVAR. A functional score (range, 0-28; higher scores indicate greater impairment) was calculated before and after interventions. Logistic regression was used to develop a propensity score for receiving EVAR because residents were not randomized. Hierarchical linear modeling determined the effect of surgery on residents' function, controlling for prehospital function, hospital length of stay (LOS), stroke, and the propensity score.Fifty-two residents underwent OAR and 161 underwent EVAR. Most (65.3%) were men and 62.0% were from 76 to 85 years old. Mean LOS was 8.3 days for OAR and 5.1 days for EVAR. Of the residents, 47.4% had good prehospital function (activities of daily living [ADL] score of 0-10), and 48.4% were moderately impaired (ADL score of 11-20). Higher baseline ADL score, increased LOS, and stroke were associated with worse trajectories. Procedure type was not significantly related to postoperative function or the subsequent rate of improvement. OAR and EVAR were associated with similar initial declines and comparable postoperative trajectories, suggesting that less invasive EVAR was not associated with improved functional preservation compared with OAR. LOS was found to be higher than expected in the frail elderly after EVAR; longer stays were associated with poorer functional trajectories. Higher baseline ADL scores were significantly associated with inferior functional status after both procedures. Evaluation of preoperative function may assist physicians in predicting outcomes in this high-risk population.
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Affiliation(s)
- Lucas R Beffa
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Gregory F Petroski
- Department of Health Management and Informatics, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Todd R Vogel
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Missouri, USA.
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Galambos C, Starr J, Rantz MJ, Petroski GF. Analysis of Advance Directive Documentation to Support Palliative Care Activities in Nursing Homes. Health Soc Work 2016; 41:228-234. [PMID: 29206978 DOI: 10.1093/hsw/hlw042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/03/2015] [Indexed: 06/07/2023]
Abstract
As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50 percent of the records contained an AD. Of the ADs in the resident records, 55 percent designated a durable power of attorney for health care, most often a child (62 percent), other relative (14 percent), or spouse (13 percent). Financial power of attorney documents were sometimes found within the AD, even though these documents focused on financial decision making rather than health care decision making. Code status was the most prevalent health preference documented in the record at 97 percent of the records reviewed. The intervention used these initial findings and the philosophical framework of respect for autonomy to develop education programs and services on advance care planning. The role of the social worker within an interdisciplinary team is discussed.
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Affiliation(s)
- Colleen Galambos
- Graduate Certificate in Gerontological Social Work Program, School of Social Work, University of Missouri, Columbia, MO
| | - Julie Starr
- Urogynecology, University of Missouri Women's Health Center, Columbia
| | - Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri, Columbia
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Stanek JL, Emerson JA, Murdock FA, Petroski GF. Growth characteristics in cerebral palsy subtypes: a comparative assessment. Dev Med Child Neurol 2016; 58:931-5. [PMID: 27059686 DOI: 10.1111/dmcn.13116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/29/2022]
Abstract
AIM Children with quadriplegic cerebral palsy (CP) have been found to have growth rates that differ from those of children with typical development. Little research has been performed to distinguish whether growth patterns in hemiplegic, diplegic, and quadriplegic CP differ from one another. The purpose of this study was to compare growth of children with quadriplegic, hemiplegic, and diplegic CP. METHOD Retrospective data were collected from the electronic medical record of patients with CP at an outpatient center. Linear mixed models were used to examine growth by diagnosis, using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 343.0 (diplegia), 343.1 (hemiplegia), and 343.2 (quadriplegia). RESULTS Heights and weights of children with quadriplegic CP were consistently lower than those with hemiplegic or diplegic CP. Children with hemiplegic CP had greater heights and weights than other CP subtypes. There were statistically significant differences in weight gain curves among the three diagnoses for males (p<0.05). INTERPRETATION Our study reveals differences in growth rates between hemiplegic, diplegic, and quadriplegic CP subtypes.
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Affiliation(s)
- Jeremy L Stanek
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA
| | - Jane A Emerson
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA
| | - Fred A Murdock
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA
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18
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Aubuchon M, Liu Y, Petroski GF, Thomas TR, Polotsky AJ. The impact of supervised weight loss and intentional weight regain on sex hormone binding globulin and testosterone in premenopausal women. Syst Biol Reprod Med 2016; 62:283-9. [PMID: 27192090 DOI: 10.1080/19396368.2016.1177619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
What is the impact of intentional weight loss and regain on serum androgens in women? We conducted an ancillary analysis of prospectively collected samples from a randomized controlled trial. The trial involved supervised 10% weight loss (8.5 kg on average) with diet and exercise over 4-6 months followed by supervised intentional regain of 50% of the lost weight (4.6 kg on average) over 4-6 months. Participants were randomized prior to the partial weight regain component to either continuation or cessation of endurance exercise. Analytic sample included 30 obese premenopausal women (mean age of 40 ± 5.9 years, mean baseline body mass index (BMI) of 32.9 ± 4.2 kg/m(2)) with metabolic syndrome. We evaluated sex hormone binding globulin (SHBG), total testosterone (T), free androgen index (FAI), and high molecular weight adiponectin (HMWAdp). Insulin, homeostasis model assessment (HOMA), and quantitative insulin sensitivity check index (QUICKI), and visceral adipose tissue (VAT) measured in the original trial were reanalyzed for the current analytic sample. Insulin, HOMA, and QUICKI improved with weight loss and were maintained despite weight regain. Log-transformed SHBG significantly increased from baseline to weight loss, and then significantly decreased with weight regain. LogFAI and logVAT decreased similarly and increased with weight loss followed by weight regain. No changes were found in logT and LogHMWAdp. There was no significant difference in any tested parameters by exercise between the groups. SHBG showed prominent sensitivity to body mass fluctuations, as reduction with controlled intentional weight regain showed an inverse relationship to VAT and occurred despite stable HMWAdp and sustained improvements with insulin resistance. FAI showed opposite changes to SHBG, while T did not change significantly with weight. Continued exercise during weight regain did not appear to impact these findings.
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Affiliation(s)
- Mira Aubuchon
- a Department of Obstetrics and Gynecology , University of Missouri , Columbia , Missouri , USA
| | - Ying Liu
- b Department of Nutrition and Exercise Physiology , University of Missouri , Columbia , Missouri , USA
| | - Gregory F Petroski
- c Office of Medical Research, University of Missouri , Columbia , Missouri , USA
| | - Tom R Thomas
- b Department of Nutrition and Exercise Physiology , University of Missouri , Columbia , Missouri , USA
| | - Alex J Polotsky
- d Department of Obstetrics and Gynecology , University of Colorado , Denver , Colorado , USA
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Rantz M, Skubic M, Abbott C, Galambos C, Popescu M, Keller J, Stone E, Back J, Miller SJ, Petroski GF. Automated In-Home Fall Risk Assessment and Detection Sensor System for Elders. Gerontologist 2015; 55 Suppl 1:S78-87. [PMID: 26055784 PMCID: PMC4566912 DOI: 10.1093/geront/gnv044] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 03/20/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Falls are a major problem for the elderly people leading to injury, disability, and even death. An unobtrusive, in-home sensor system that continuously monitors older adults for fall risk and detects falls could revolutionize fall prevention and care. DESIGN AND METHODS A fall risk and detection system was developed and installed in the apartments of 19 older adults at a senior living facility. The system includes pulse-Doppler radar, a Microsoft Kinect, and 2 web cameras. To collect data for comparison with sensor data and for algorithm development, stunt actors performed falls in participants' apartments each month for 2 years and participants completed fall risk assessments (FRAs) using clinically valid, standardized instruments. The FRAs were scored by clinicians and recorded by the sensing modalities. Participants' gait parameters were measured as they walked on a GAITRite mat. These data were used as ground truth, objective data to use in algorithm development and to compare with radar and Kinect generated variables. RESULTS All FRAs are highly correlated (p < .01) with the Kinect gait velocity and Kinect stride length. Radar velocity is correlated (p < .05) to all the FRAs and highly correlated (p < .01) to most. Real-time alerts of actual falls are being sent to clinicians providing faster responses to urgent situations. IMPLICATIONS The in-home FRA and detection system has the potential to help older adults remain independent, maintain functional ability, and live at home longer.
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Affiliation(s)
- Marilyn Rantz
- Sinclair School of Nursing and Family and Community Medicine, University of Missouri, Columbia.
| | - Marjorie Skubic
- Electrical and Computer Engineering, University of Missouri, Columbia
| | - Carmen Abbott
- School of Health Professions, Physical Therapy, University of Missouri, Columbia
| | | | - Mihail Popescu
- Health Management and Informatics, School of Medicine, University of Missouri, Columbia
| | - James Keller
- Electrical and Computer Engineering, University of Missouri, Columbia
| | - Erik Stone
- Center for Eldercare and Rehabilitation Technology, University of Missouri, Columbia
| | - Jessie Back
- TigerPlace, Sinclair School of Nursing, University of Missouri, Columbia
| | - Steven J Miller
- Sinclair School of Nursing, University of Missouri, Columbia
| | - Gregory F Petroski
- Biostatistics and Research Design Unit, School of Medicine, University of Missouri, Columbia
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Phillips LJ, Petroski GF, Markis NE. A Comparison of Accelerometer Accuracy in Older Adults. Res Gerontol Nurs 2015; 8:213-9. [PMID: 25942386 DOI: 10.3928/19404921-20150429-03] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/18/2015] [Indexed: 11/20/2022]
Abstract
Older adults' gait disorders present challenges for accurate activity monitoring. The current study compared the accuracy of accelerometer-detected to hand-tallied steps in 50 residential care/assisted living residents. Participants completed two walking trials wearing a Fitbit® Tracker and waist-, wrist-, and ankle-mounted Actigraph GT1M. Agreement between accelerometer and observed counts was calculated using concordance correlation coefficients (CCC), accelerometer to observed count ratios, accelerometer and observed count differences, and Bland-Altman plots. Classification and Regression Tree analysis identified minimum gait speed thresholds to achieve accelerometer accuracy ≥0.80. Participants' mean age was 84.2 and gait speed was 0.64 m/s. All accelerometers underestimated true steps. Only the ankle-mounted GT1M demonstrated positive agreement with observed counts (CCC = 0.205). Thresholds for 0.80 accuracy were gait speeds ≥0.56 m/s for the Fitbit and gait speeds ≥0.71 m/s for the ankle-mounted GT1M. Gait speed and accelerometer placement affected activity monitor accuracy in older adults.
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Wagovich SA, Hill MS, Petroski GF. Semantic-syntactic partial word knowledge growth through reading. Am J Speech Lang Pathol 2015; 24:60-71. [PMID: 25409978 PMCID: PMC4689230 DOI: 10.1044/2014_ajslp-14-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/19/2014] [Accepted: 10/15/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Incidental reading provides a powerful opportunity for partial word knowledge growth in the school-age years. The extent to which children of differing language abilities can use reading experiences to glean partial knowledge of words is not well understood. The purpose of this study was to compare semantic-syntactic partial word knowledge growth of children with higher language skills (HL group; overall language standard scores of 85 or higher) to that of children with relatively lower language skills (LL group; overall receptive or expressive standard score below 85). METHOD Thirty-two children, 16 per group, silently read stories containing unfamiliar nouns and verbs 3 times over a 1-week period. Semantic-syntactic partial word knowledge growth was assessed after each reading and 2-3 days later to assess retention. RESULTS Over time, both groups showed significant partial word knowledge growth, with the HL group showing significantly more growth. In addition, both groups retained knowledge several days later. CONCLUSION Regardless of language skill level, children benefit from multiple exposures to unfamiliar words in reading in their development and retention of semantic-syntactic partial word knowledge growth.
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Mazurek MO, Petroski GF. Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety. Sleep Med 2014; 16:270-9. [PMID: 25600781 DOI: 10.1016/j.sleep.2014.11.006] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Children with autism spectrum disorder (ASD) are at high risk for sleep problems. Previous research suggests that sensory problems and anxiety may be related to the development and maintenance of sleep problems in children with ASD. However, the relationships among these co-occurring conditions have not been previously studied. The current study examined the interrelations of these symptoms in a large well-characterized sample of children and adolescents with ASD. METHODS The current study examined the relationships among sleep problems, sensory over-responsivity, and anxiety in 1347 children enrolled in the Autism Speaks Autism Treatment Network. The primary measures included the Children's Sleep Habits Questionnaire, the Child Behavior Checklist, and the Short Sensory Profile. RESULTS In bivariate correlations and multivariate path analyses, anxiety was associated with all types of sleep problems (ie, bedtime resistance, sleep-onset delay, sleep duration, sleep anxiety, and night wakings; p < 0.01 to p < 0.001; small to medium effect sizes). Sensory over-responsivity (SOR) was correlated with all sleep problems in bivariate analyses (p < 0.01 to p < 0.001; small effect sizes). In multivariate path models, SOR remained significantly associated with all sleep problems except night awakenings for older children, while SOR was no longer significantly associated with bedtime resistance or sleep anxiety for younger children. CONCLUSIONS Children with ASD who have anxiety and SOR may be particularly predisposed to sleep problems. These findings suggest that some children with ASD and sleep disturbance may have difficulties with hyperarousal. Future research using physiological measures of arousal and objective measures of sleep are needed.
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Affiliation(s)
- Micah O Mazurek
- University of Missouri, Department of Health Psychology & Thompson Center for Autism and Neurodevelopmental Disorders, 205 Portland Street, Columbia, MO 65211, USA.
| | - Gregory F Petroski
- University of Missouri, Office of Medical Research, Biostatistics and Research Design Unit, DC018, Columbia, MO 65212, USA
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Koopman RJ, Petroski GF, Canfield SM, Stuppy JA, Mehr DR. Development of the PRE-HIT instrument: patient readiness to engage in health information technology. BMC Fam Pract 2014; 15:18. [PMID: 24472182 PMCID: PMC3916695 DOI: 10.1186/1471-2296-15-18] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
Abstract
Background Technology-based aids for lifestyle change are becoming more prevalent for chronic conditions. Important “digital divides” remain, as well as concerns about privacy, data security, and lack of motivation. Researchers need a way to characterize participants’ readiness to use health technologies. To address this need, we created an instrument to measure patient readiness to engage with health technologies among adult patients with chronic conditions. Methods Initial focus groups to determine domains, followed by item development and refinement, and exploratory factor analysis to determine final items and factor structure. The development sample included 200 patients with chronic conditions from 6 family medicine clinics. From 98 potential items, 53 best candidate items were examined using exploratory factor analysis. Pearson’s Correlation for Test/Retest reliability at 3 months. Results The final instrument had 28 items that sorted into 8 factors with associated Cronbach’s alpha: 1) Health Information Need (0.84), 2) Computer/Internet Experience (0.87), 3) Computer Anxiety (0.82), 4) Preferred Mode of Interaction (0.73), 5) Relationship with Doctor (0.65), 6) Cell Phone Expertise (0.75), 7) Internet Privacy (0.71), and 8) No News is Good News (0.57). Test-retest reliability for the 8 subscales ranged from (0.60 to 0.85). Conclusion The Patient Readiness to Engage in Health Internet Technology (PRE-HIT) instrument has good psychometric properties and will be an aid to researchers investigating technology-based health interventions. Future work will examine predictive validity.
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Affiliation(s)
- Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032,00, Columbia, Missouri 65212, USA.
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Vogel TR, Petroski GF, Kruse RL. Impact of amputation level and comorbidities on functional status of nursing home residents after lower extremity amputation. J Vasc Surg 2014; 59:1323-30.e1. [PMID: 24406089 DOI: 10.1016/j.jvs.2013.11.076] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The ability of nursing home residents to function independently is associated with their quality of life. The impact of amputations on functional status in this population remains unclear. This analysis evaluated the effect of amputations-transmetatarsal (TM), below-knee (BK), and above-knee (AK)--on the ability of residents to perform self-care activities. METHODS Medicare inpatient claims were linked with nursing home assessment data to identify admissions for amputation. The Minimum Data Set Activities of Daily Living Long Form Score (0-28; higher numbers indicating greater impairment), based on seven activities of daily living, was calculated before and after amputation. Hierarchical modeling determined the effect of the surgery on postamputation function of residents. Controlling for comorbidity, cognition, and prehospital function allowed for evaluation of Activities of Daily Living trajectories over time. RESULTS In total, 4965 residents underwent amputation: 490 TM, 1596 BK, and 2879 AK. Mean age was 81 years, and 54% of the patients were women. Most were white (67%) or black (26.5%). Comorbidities before amputation included diabetes mellitus (70.7%), coronary heart disease (57.1%), chronic kidney disease (53.6%), and/or congestive heart failure (52.1%). Mortality within 30 days of hospital discharge was 9.0%, and hospital readmission was 27.7%. Stroke, end-stage renal disease, and poor baseline cognitive function were associated with the poorest functional outcome after amputation. Compared with residents who received TM amputation, those who had BK or AK amputation recovered more slowly and failed to return to baseline function by 6 months. BK was found to have a superior functional trajectory compared with AK. CONCLUSIONS Elderly nursing home residents undergoing BK or AK amputation failed to return to their functional baseline within 6 months. Among frail elderly nursing home residents, higher amputation level, stroke, end-stage renal disease, poor baseline cognitive scores, and female sex were associated with inferior functional status after amputation. These factors should be strongly assessed to maintain activities of daily living and quality of life in the nursing home population.
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Affiliation(s)
- Todd R Vogel
- Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Mo.
| | - Gregory F Petroski
- Department of Health Management and Informatics, University of Missouri, School of Medicine, Columbia, Mo
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, School of Medicine, Columbia, Mo
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Vogel TR, Petroski GF, Kruse RL. Impact of Amputation Level and Comorbidities on Functional Status of Elderly Adults before and after Lower Extremity Amputation. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.08.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kruse RL, Petroski GF, Mehr DR, Banaszak-Holl J, Intrator O. Activity of daily living trajectories surrounding acute hospitalization of long-stay nursing home residents. J Am Geriatr Soc 2013; 61:1909-18. [PMID: 24219192 DOI: 10.1111/jgs.12511] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore patterns of change in nursing home (NH) residents' activities of daily living (ADLs), particularly surrounding acute hospital stays. DESIGN Longitudinal study using Medicare and Minimum Data Set (MDS) assessments. SETTING National sample of long-stay NH residents. PARTICIPANTS NH residents who were hospitalized for the seven most-common inpatient diagnoses (N = 40,128). Each hospital admission was at least 90 days after any prior hospitalization and had at least two preceding MDS assessments. MEASUREMENTS The MDS ADL long-form score, a simple sum of seven self-care variables coded from 0 (independent) to 4 (totally dependent) was used to indicate resident ADL function. Scores ranged from 0 to 28, with higher scores indicating greater impairment. A linear mixed model describing ADL trajectories was jointly estimated with time-to-event models for mortality and hospital readmission. RESULTS Before hospitalization, the most common trajectory was stable (53.7%), with 27.5% of residents worsening and 18.8% improving. ADL function after hospital discharge was most often characterized as stable (43.1%) or worsening (39.2%). Mortality (20.3%) was higher for those with worsening prehospital ADL function (28.9%) than for those with stable (19.1%) or improving (11.3%) trajectories. Hospital diagnosis was associated with amount of ADL worsening and rate of subsequent ADL change. Most residents with the best initial function continued to worsen after hospital discharge. Cognitive impairment was associated with poorer ADL function and accelerated worsening of ADLs. CONCLUSION For many long-stay NH residents, substantial and sustained ADL worsening accompanies acute hospitalization, so acute hospitalization presents an opportunity to revisit care goals; the results of the current study can help inform decision-making.
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Affiliation(s)
- Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
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Vogel TR, Petroski GF, Kruse RL. Functional status of elderly adults before and after interventions for critical limb ischemia. J Vasc Surg 2013; 59:350-8. [PMID: 24139567 DOI: 10.1016/j.jvs.2013.08.087] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The impact of interventions for critical limb ischemia (CLI) on functional status in the elderly remains unclear. Open and endovascular procedures were evaluated. METHODS Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for lower extremity procedures for CLI. A functional impairment score (0-28; higher scores indicating greater impairment) based on residents' need for assistance with self-care activities, walking, and locomotion was calculated before and after interventions. Hierarchical modeling determined the effect of the surgery on residents' function, controlling for comorbidity, cognition, and prehospital function. RESULTS Three hundred fifty-two and 350 patients underwent open and endovascular procedures, respectively (rest pain, 84; ulceration, 351; gangrene, 267). Hospitalization was associated with a significant worsening in function following both procedures. Disease severity was associated with the amount of initial decline but not with the rate of recovery (P > .35). Residents who received open surgery improved more quickly following hospital discharge (P = .011). CONCLUSIONS In the frail elderly, open and endovascular procedures for CLI were associated with similar initial declines in functional status, suggesting that compared with open procedures, less invasive endovascular procedures were not associated with maintaining baseline function. In this select population, endovascular procedures for CLI were not associated with improved functional status over time compared with open. Six months posthospital, patients who received traditional open bypass had significantly better functional status than those who received endovascular procedures for all CLI diagnoses. Further analysis is required to assist stakeholders in performing procedures most likely to preserve functional status in the frail elderly and nursing home population.
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Affiliation(s)
- Todd R Vogel
- Department of Surgery, Division of Vascular Surgery, University of Missouri, School of Medicine, Columbia, Mo.
| | - Gregory F Petroski
- Department of Health Management and Informatics, University of Missouri, School of Medicine, Columbia, Mo
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, School of Medicine, Columbia, Mo
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Vogel TR, Petroski GF, Kruse RL. Functional Status of Elderly Adults Before and After Interventions for Critical Limb Ischemia. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.02.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sayers SP, LeMaster JW, Thomas IM, Petroski GF, Ge B. Bike, walk, and wheel: a way of life in Columbia, Missouri, revisited. Am J Prev Med 2012; 43:S379-83. [PMID: 23079269 DOI: 10.1016/j.amepre.2012.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/24/2012] [Accepted: 07/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND In 2003, Columbia MO was the recipient of a Robert Wood Johnson Foundation (RWJF) Active Living by Design (ALbD) grant to foster active living in the community through behavioral (social marketing, education) and environmental change (improved street design standards, sidewalks around schools, activity-friendly infrastructure) strategies. PURPOSE To examine the extent to which the ALbD intervention was associated with increased active living in children and adults community-wide. METHODS Seasonal pedestrian and bicyclist counts were performed quarterly in January, April, July, and October at four intersections in downtown Columbia from 2007 to 2009. RESULTS Pedestrian counts increased significantly during July 2009 and October 2009 compared to 2007 and 2008, whereas cyclist counts increased significantly during only July 2009 compared to 2007 and 2008. CONCLUSIONS The ALbD intervention in Columbia was associated with modest increases in active living in the community, and continued evaluation of these behavior patterns is warranted. The combination of multiple strategies (social marketing, local programming, and infrastructure changes) may be a critical factor in improving active living in communities.
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Affiliation(s)
- Stephen P Sayers
- Department of Physical Therapy, University of Missouri, Columbia, Missouri 65211-4250, USA.
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Sayers SP, LeMaster JW, Thomas IM, Petroski GF, Ge B. A Walking School Bus program: impact on physical activity in elementary school children in Columbia, Missouri. Am J Prev Med 2012; 43:S384-9. [PMID: 23079270 DOI: 10.1016/j.amepre.2012.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/27/2012] [Accepted: 07/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Robert Wood Johnson Foundation (RWJF) provided Columbia MO with an Active Living by Design (ALbD) grant in 2003 to promote active living in the community. A separate project was funded in 2006 through RWJF's Active Living Research program. PURPOSE To evaluate whether participation in a Walking School Bus (WSB) program increased or decreased active living in elementary school children residing in Columbia, in association with ALbD funding. METHODS Objective measures of physical activity obtained using accelerometers were collected over 7 days in children participating in a WSB program and children in a nonparticipating comparison group. Differences in the percentage of time spent in moderate- to vigorous-intensity exercise (%MVPA) were compared between groups. RESULTS Children in WSB programs showed no differences in %MVPA compared to children not participating in the WSB; however, when comparing the relationship of %MVPA and age, the slope of the regression line was steeper for those children not participating in the WSB. CONCLUSIONS The ALbD intervention in Columbia did not result in measurable changes in physical activity in children participating in the Walking School Bus program, but there was a negative association between age and physical activity, and the slope of that regression line was affected by participation in the program.
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Affiliation(s)
- Stephen P Sayers
- Department of Physical Therapy, University of Missouri, Columbia, Missouri 65211-4250, USA.
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Rantz MJ, Zwygart-Stauffacher M, Hicks L, Mehr D, Flesner M, Petroski GF, Madsen RW, Scott-Cawiezell J. Randomized multilevel intervention to improve outcomes of residents in nursing homes in need of improvement. J Am Med Dir Assoc 2012; 13:60-8. [PMID: 21816681 PMCID: PMC3379965 DOI: 10.1016/j.jamda.2011.06.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/24/2011] [Accepted: 06/24/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. DESIGN/SETTING/PARTICIPANTS Intervention facilities (N = 29) received a 2-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (N = 29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders. INTERVENTION The authors conducted a randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living. It was hypothesized that following the intervention, experimental facilities would have higher quality of care, better resident outcomes, more organizational attributes of improved working conditions than control facilities, higher staff retention, similar staffing and staff mix, and lower total and direct care costs. RESULTS The intervention did improve quality of care (P = .02); there were improvements in pressure ulcers (P = .05) and weight loss (P = .05). Organizational working conditions, staff retention, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups. CONCLUSION AND IMPLICATIONS Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed. Medical directors in collaborative practice with advanced practice nurses are ideally positioned to implement this low-cost, effective intervention nationwide.
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Affiliation(s)
- Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri 65211, USA.
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Lapan RT, Gysbers NC, Petroski GF. Helping Seventh Graders Be Safe and Successful: A Statewide Study of the Impact of Comprehensive Guidance and Counseling Programs. Journal of Counseling & Development 2011. [DOI: 10.1002/j.1556-6676.2001.tb01977.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Phillips LJ, Rantz M, Petroski GF. Indicators of a New Depression Diagnosis in Nursing Home Residents. J Gerontol Nurs 2011; 37:42-52. [DOI: 10.3928/00989134-20100702-03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 03/19/2010] [Indexed: 11/20/2022]
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Rantz MJ, Hicks L, Petroski GF, Madsen RW, Alexander G, Galambos C, Conn V, Scott-Cawiezell J, Zwygart-Stauffacher M, Greenwald L. Cost, Staffing and Quality Impact of Bedside Electronic Medical Record (EMR) in Nursing Homes. J Am Med Dir Assoc 2010; 11:485-93. [DOI: 10.1016/j.jamda.2009.11.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 11/17/2009] [Accepted: 11/17/2009] [Indexed: 10/19/2022]
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Porock D, Parker-Oliver D, Petroski GF, Rantz M. The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents. BMC Res Notes 2010; 3:200. [PMID: 20637076 PMCID: PMC2913927 DOI: 10.1186/1756-0500-3-200] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 07/16/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care home residents. METHODS The design was a secondary analysis of a US Minimum Data Set (MDS) for long term care residents using regression analysis to identify predictors of mortality within six months. RESULTS Using twelve easy to collect items, the probability of mortality within six months was accurately predicted within the MDS database. The items are: admission to the care home within three months; lost weight unintentionally in past three months; renal failure; chronic heart failure; poor appetite; male; dehydrated; short of breath; active cancer diagnosis; age; deteriorated cognitive skills in past three months; activities of daily living score. CONCLUSION A lack of recognition of the proximity of death is often blamed for inappropriate admission to hospital at the end of an older person's life. An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life. The original MMRI was derived and validated from a large database of long term care residents in the USA. However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use. Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.
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Affiliation(s)
- Davina Porock
- School of Nursing, Midwifery and Physiotherapy, The University of Nottingham, Nottingham, UK
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
- School of Nursing, Edith Cowan University, Perth, Western Australia, Australia
| | - Debra Parker-Oliver
- Department of Family and Community Medicine, University of Missouri-Columbia, Missouri USA
| | - Gregory F Petroski
- Office of Medical Research, University of Missouri-Columbia, Missouri, USA
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri-Columbia, Missouri, USA
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Rantz MJ, Cheshire D, Flesner M, Petroski GF, Hicks L, Alexander G, Aud MA, Siem C, Nguyen K, Boland C, Thomas S. Helping nursing homes "at risk" for quality problems: a statewide evaluation. Geriatr Nurs 2009; 30:238-49. [PMID: 19665666 DOI: 10.1016/j.gerinurse.2008.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 09/12/2008] [Accepted: 09/22/2008] [Indexed: 10/20/2022]
Abstract
The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as "at risk" for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as "at risk" using quality indicators (QIs) derived from Minimum Data Set (MDS) data. Sixty of the 92 facilities accepted offered on-site clinical consultations by gerontological expert nurses with graduate nursing education. Content of consultations include quality improvement, MDS, care planning, evidence-based practice, and effective teamwork. The 60 "at-risk" facilities improved scores 4%-41% for 5 QIs: pressure ulcers (overall and high risk), weight loss, bedfast residents, and falls; other facilities in the state did not. Estimated cost savings (based on prior cost research) for 444 residents who avoided developing these clinical problems in participating "at-risk" facilities was more than $1.5 million for fiscal year 2006. These are similar to estimated savings of $1.6 million for fiscal year 2005 when 439 residents in "at-risk" facilities avoided clinical problems. Estimated savings exceed the total program cost by more than $1 million annually. QI improvements demonstrate the clinical effectiveness of on-site clinical consultation by gerontological expert nurses with graduate nursing education.
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Affiliation(s)
- Marilyn J Rantz
- Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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Sporn E, Petroski GF, Mancini GJ, Astudillo JA, Miedema BW, Thaler K. Laparoscopic appendectomy--is it worth the cost? Trend analysis in the US from 2000 to 2005. J Am Coll Surg 2009; 208:179-85.e2. [PMID: 19228528 DOI: 10.1016/j.jamcollsurg.2008.10.026] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 10/25/2008] [Accepted: 10/29/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although laparoscopic appendectomy is widely used for treatment of appendicitis, it is still unclear if it is superior to the open approach. STUDY DESIGN From the Nationwide Inpatient Sample 2000 to 2005, hospitalizations with the primary ICD-9 procedure code of laparoscopic (LA) and open appendectomy (OA) were included in this study. Outcomes of length of stay, costs, and complications were assessed by stratified analysis for uncomplicated and complicated appendicitis (perforation or abscess). Regression methods were used to adjust for covariates and to detect trends. Costs were rescaled using the hospital and related services portion of the Medical Consumer Price Index. RESULTS Between 2000 and 2005, 132,663 (56.3%) patients underwent OA and 102,810 (43.7%) had LA. Frequency of LA increased from 32.2% to 58.0% (p < 0.001); conversion rates decreased from 9.9% to 6.9% (p < 0.001). Covariate adjusted length of stay for LA was approximately 15% shorter than for OA in both uncomplicated and complicated cases (p < 0.001). Adjusted costs for LA were 22% higher in uncomplicated appendicitis and 9% higher in patients with complicated appendicitis (p < 0.001). Costs and length of stay decreased over time in OA and LA. The risk for a complication was higher in the LA group (p < 0.05, odds ratio=1.07, 95% CI 1.00 to 1.14) with uncomplicated appendicitis. CONCLUSIONS LA results in higher costs and increased morbidity for patients with uncomplicated appendicitis. Nevertheless, LA is increasingly used. Patients undergoing LA benefit from a slightly shorter hospital stay. In general, open appendectomy may be the preferred approach for patients with acute appendicitis, with indication for LA in selected subgroups of patients.
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Affiliation(s)
- Emanuel Sporn
- Department of Surgery, School of Medicine, University of Missouri-Columbia, Columbia, MO, USA
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Strickland SL, Hogan TM, Hogan RG, Sohal HS, McKenzie WN, Petroski GF. A randomized multi-arm repeated-measures prospective study of several modalities of portable oxygen delivery during assessment of functional exercise capacity. Respir Care 2009; 54:344-349. [PMID: 19245728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Ambulatory oxygen is an important component of long-term oxygen therapy. Pulse-dose technology conserves oxygen and thus increases the operation time of a portable oxygen system. METHODS We tested 4 ambulatory oxygen systems (Helios, HomeFill, FreeStyle, and the compressed-oxygen cylinder system we regularly provide for long-term oxygen therapy at our Veterans Affairs hospital) with 39 subjects with stage-IV chronic obstructive pulmonary disease. Each subject performed one 6-min walk test with each oxygen system, and we measured blood oxygen saturation (via pulse oximetry [S(pO(2))]), heart rate, and modified Borg dyspnea score, and surveyed the subjects' preferences about the oxygen systems. We also studied whether the 2 systems that provide gas with a lower oxygen concentration (from a home concentrator or portable concentrator) showed any evidence of not providing adequate oxygenation. RESULTS With all 4 systems the mean pre-walk S(pO(2)) at the prescribed pulse-dose setting was 95-96%. The mean post-walk S(pO(2)) was 88-90% after each of the 4 walk tests. Between the 4 systems there were no statistically significant differences between the pre-walk-versus-post-walk S(pO(2)) ( = .42). With each system, the pre-walk-versus-post-walk S(pO(2)) difference was between -8% and -6%. CONCLUSIONS Between these 4 ambulatory oxygen systems there were no significant differences in S(pO(2)), walk time, or walk distance, and there was no evidence of inadequate oxygenation with the 2 systems that provide a lower oxygen concentration.
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Affiliation(s)
- Shawna L Strickland
- Cardiopulmonary and Diagnostic Sciences, University of Missouri School of Health Professions, Columbia, MO 65211, USA.
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Kapp JM, Jackson-Thompson J, Petroski GF, Schootman M. Reliability of health-related quality-of-life indicators in cancer survivors from a population-based sample, 2005, BRFSS. Public Health 2008; 123:321-5. [PMID: 19081117 DOI: 10.1016/j.puhe.2008.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 05/14/2008] [Accepted: 10/15/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The current emphasis in cancer survivorship research, which includes health-related quality of life (HRQoL), drives the need to monitor the nation's cancer burden. Routine, ongoing public health surveillance tools, such as the Behavioral Risk Factor Surveillance System (BRFSS), may be relevant for this purpose. STUDY DESIGN A subsample of the 2005 Missouri BRFSS was used to estimate test-retest reliability of HRQoL questions among persons who did and did not report a personal cancer history. METHODS Retest interviews were conducted by telephone 14-21 days after the initial data collection (n=540, 67% response rate). Reliability was estimated overall and by cancer history using intraclass correlation coefficients (ICCs) and kappa statistics. RESULTS The majority of retest respondents were White, female and married, with 13% reporting a history of cancer. Overall, point estimates of the reliability coefficients ranged from moderate to excellent (kappa=0.57-0.75). There were no statistically significant differences in test-retest reliability between persons with and without a history of cancer, except for self-reported pain (ICC=0.59 and ICC=0.78, respectively). CONCLUSIONS In general, BRFSS questions appear to have adequate reliability for monitoring HRQoL in this community-dwelling population, regardless of cancer history.
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Affiliation(s)
- J M Kapp
- Department of Family and Community Medicine, 1 Hospital Drive, MA306E Medical Sciences Building, University of Missouri-Columbia, Columbia, MO 65212, USA.
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Delcour K, Petroski GF, Sahota PK, Flaker GC. DOES AN ABNORMAL OXIMETRY STUDY PREDICT AN ABNORMAL SLEEP STUDY IN PATIENTS WITH CARDIAC ARRHYTHMIAS? Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.646b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
BACKGROUND Medical research continues to focus overwhelmingly on biomedical interventions, such as drugs, devices, and procedures. The dysfunctional health care cultures and systems need more attention for quality of care to improve further. PURPOSE The existing health services management research has not used a systematic theoretical framework to predict the effects of organizational variables on clinical outcomes. This study tests the theoretical model proposed by N. Khatri, A. Baveja, S. Boren, and A. Mammo (2006). METHODOLOGY This study surveyed employees from hospitals in Missouri. The sample consisted of 77 respondents from 16 hospitals. FINDINGS The control-based management approach (Management Control and Silos) was found to be positively associated with Culture of Blame and negatively with Learning From Mistakes. In contrast, the commitment-based approach (Fair Management Practices and Employee Participation) was negatively associated with Culture of Blame and positively with Learning From Mistakes, Camaraderie, and Motivation. Mediating variables of Learning From Mistakes and Camaraderie showed a significant negative relationship with Medical Errors. Learning From Mistakes, Camaraderie, and Motivation all showed a significant positive relationship with Quality of Patient Care. The mediating variables had much stronger relationships with Medical Errors and Quality of Patient Care than did the independent variables, lending support to the proposed mediation. IMPLICATIONS FOR PRACTICE Health care organizations can improve the quality of care and reduce medical errors significantly by enhancing learning from mistakes and boosting camaraderie and morale of their employees. They can do so by breaking down silos in their structures, implementing just and fair management practices, and involving employees in decision making.
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Affiliation(s)
- Naresh Khatri
- Health Management and Informatics, University of Missouri, Columbia, MO, USA.
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Rantz MJ, Zwygart-Stauffacher M, Mehr DR, Petroski GF, Owen SV, Madsen RW, Flesner M, Conn V, Bostick J, Smith R, Maas M. Field testing, refinement, and psychometric evaluation of a new measure of nursing home care quality. J Nurs Meas 2006; 14:129-48. [PMID: 17086785 DOI: 10.1891/jnm-v14i2a005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The primary aim of this NINR-NIH-funded field test in 407 nursing homes in 3 states was to complete the development of and conduct psychometric testing for the Observable Indicators of Nursing Home Care Quality Instrument (Observable Indicators, OIQ). The development of the OIQ was based on extensive qualitative and iterative quantitative work that described nursing home care quality and did initial validity and reliability field testing of the instrument in 123 nursing homes in 1 state. The scale is meant for researchers, consumers, and regulators interested in directly observing and quickly evaluating (within 30 minutes of observation) the multiple dimensions of care quality in nursing homes. After extensive testing in this study, the Observable Indicators instrument has been reduced to 30 reliable and discriminating items that have a conceptually coherent hierarchical factor structure that describes nursing home care quality. Seven first-order factors group together into two second-order factors of Structure (includes Environment: Basics and Odors) and Process (includes Care Delivery, Grooming, Interpersonal Communication, Environment: Access, and Environment: Homelike) that are classic constructs of Quality, which was the third-order factor. Internal consistency reliability for the 7 first-order factors ranged from .77 to .93. Construct validity analyses revealed an association between survey citations and every subscale as well as the total score of the OIQ instrument. Known groups analysis revealed expected trends in the OIQ scores. The Observable Indicators instrument as a whole shows acceptable interrater and test-retest reliabilities, and strong internal consistency. Scale subscales show acceptable reliability as well. Generalizability Theory analyses revealed that dependability of scores can be improved by including a second site observer, or by revisiting a site. There is a small additional benefit from increasing observers or visits beyond two.
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Affiliation(s)
- Marilyn J Rantz
- School of Nursing, University of Missouri, Columbia 65211, USA.
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Rantz MJ, Mehr DR, Hicks L, Scott-Cawiezell J, Petroski GF, Madsen RW, Porter R, Zwygart-Stauffacher M. Entrepreneurial program of research and service to improve nursing home care. West J Nurs Res 2006; 28:918-34. [PMID: 17099105 DOI: 10.1177/0193945905284715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is a methodological article intended to demonstrate the integration of multiple goals, multiple projects with diverse foci, and multiple funding sources to develop an entrepreneurial program of research and service to directly affect and improve the quality of care of older adults, particularly nursing home residents. Examples that illustrate how clinical ideas build on one another and how the research ideas and results build on one another are provided. Results from one study are applied to the next and are also applied to the development of service delivery initiatives to test results in the real world. Descriptions of the Quality Improvement Program for Missouri and the Aging in Place Project are detailed to illustrate real-world application of research to practice.
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Markert C, Petroski GF, Childers CK, McDonald KS, Childers MK. Stretch-induced force deficits in murine extensor digitorum longus muscles after cardiotoxin injection. Muscle Nerve 2006; 34:485-8. [PMID: 16770777 DOI: 10.1002/mus.20587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A leftward shift in a muscle's length-tension relationship is thought to impair myofilament overlap. We hypothesized that left-shifted muscles would incur greater eccentric contraction-induced damage compared to controls. We evaluated contractile properties and force deficits in regenerating murine extensor digitorum longus (EDL) muscles 7, 14, and 21 days after cardiotoxin (CTX) injection. Specific tension recovered to control values by 21 days. CTX-injected muscles demonstrated left-shifted length-tension curves and incurred greater contraction-induced force deficits than controls (P < 0.001) on day 7. We speculate that increased contraction-induced damage in 7-day CTX-injected muscles results from changes in myofilament overlap that occurs during early regeneration.
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Affiliation(s)
- Chad Markert
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
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Abstract
OBJECTIVE To examine changes in postacute care (PAC) use during the initial Medicare payment reforms enacted by the Balanced Budget Act of 1997. DATA SOURCES We used claims data from the 5 percent Medicare beneficiary sample in 1996, 1998, and 2000. Linked data from the Denominator file, Provider of Service file, and Area Resource File provided additional patient, hospital, and market-area characteristics. STUDY DESIGN Six disease groups with high PAC use were selected for analysis. We used multinomial logit regression to examine how PAC use differed by year of service, controlling for patient, hospital, and market-area characteristics. PRINCIPAL FINDINGS There were major changes in PAC use, and a portion of services shifted to settings where reimbursement remained cost-based. During the first reform, the home health agency interim payment system, home health use decreased consistently across disease groups. This decrease was accompanied by increased use in skilled nursing facilities (SNFs). Following the implementation of the prospective payment system for SNFs, the use of inpatient rehabilitation facilities increased. CONCLUSIONS The shift in usage among settings occurred in two stages that corresponded to the timing of payment reforms for home health agencies and SNFs. Evidence strongly suggests the substitutability between PAC settings. Financial incentives, in addition to clinical needs and individual preferences, play a major role in PAC use.
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Affiliation(s)
- Wen-Chieh Lin
- Department of Family and Community Medicine, University of Missouri-Columbia, M226 Medical Sciences Building, Columbia, MO 65212, USA
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Newland PK, Wipke-Tevis DD, Williams DA, Rantz MJ, Petroski GF. Impact of Pain on Outcomes in Long-Term Care Residents with and without Multiple Sclerosis. J Am Geriatr Soc 2005; 53:1490-6. [PMID: 16137277 DOI: 10.1111/j.1532-5415.2005.53465.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare long-term care (LTC) residents with and without multiple sclerosis (MS); to compare admission status of pain, physical disability, pressure ulcers, depression, and cognitive performance in LTC residents with and without MS; and to examine the impact of MS and pain on outcomes 90 and 180 days after LTC admission. DESIGN Retrospective analysis of a large data set. SETTING LTC facilities in Missouri. PARTICIPANTS Residents admitted to non-hospital-based LTC facilities. MEASUREMENTS Minimum Data Set/Resident Assessment Instrument, Version 2.0; Activities of Daily Living Scale; Cognitive Performance Scale. RESULTS Residents with and without MS had similar pain prevalence and intensity after admission, with daily pain more frequent in residents with MS (P=.03). On admission, residents with MS had more physical disability (P<.001) and a greater prevalence of pressure ulcers (P=.004) and depression (P<.001) than residents without MS. In all LTC residents, initial pain status was associated with physical disability (P<.001), pressure ulcers (P<.001), depression (P<.001), and cognitive performance (P<.001) 90 and 180 days after admission. A diagnosis of MS was associated with physical disability (P<.001) 90 and 180 days after admission and pressure ulcer development 180 days after admission (P=.02). CONCLUSION Residents with MS were more physically disabled and had more frequent pain and a higher prevalence of pressure ulcers and depression on admission than residents without MS. Pain, or lack thereof, in residents with and without MS on admission may warn of problems that could occur within 6 months after admission to a LTC facility.
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Affiliation(s)
- Pamela K Newland
- MU Sinclair School of Nursing, University of Missouri-Columbia, Missouri, USA.
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Grando VT, Rantz MJ, Petroski GF, Maas M, Popejoy L, Conn V, Wipke-Tevis D. Prevalence and characteristics of nursing homes residents requiring light-care. Res Nurs Health 2005; 28:210-9. [PMID: 15884022 DOI: 10.1002/nur.20079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rising nursing home (NH) costs and the poor quality of NH care make it important to recognize elders for whom NH care may be inappropriate. As a first step in developing a method to identify these elders, we examined the characteristics of NH residents requiring light-care and changes in their care level from NH admission to 12-months. Using data from the Missouri Minimal Data Set electronic database, we developed three care-level categories based on Resource Use Groups, Version III (RUG-III) and defined light-care NH residents as those requiring minimal assistance with late-loss ADLs (bed mobility, transfer, toilet use, or eating) and having no complex clinical problems. Approximately 16% of Missouri NH residents met the criteria for light-care. They had few functional problems with mobility, personal care, communication, or incontinence; approximately 33% had difficulty maintaining balance without assistance; and 50% of those admitted as light-care were still light-care at 12-months. Findings suggest that many NH residents classified as light-care by these criteria could be cared for in community settings offering fewer services than NHs.
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Affiliation(s)
- Victoria T Grando
- University of Arkansas for Medical Sciences, College of Nursing, 4301 West Markham, AR 72205, USA
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Hicks LL, Rantz MJ, Petroski GF, Mukamel DB. Nursing home costs and quality of care outcomes. Nurs Econ 2004; 22:178-92, 175. [PMID: 15382393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The relationship between cost and quality of care in nursing homes was examined using quality indicator measures of resident outcomes. While each individual quality measure makes only small contributions to costs, when considered across the facility, quality could have a substantial financial impact on the operations of the home.
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Affiliation(s)
- Lanis L Hicks
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA
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Wipke-Tevis DD, Williams DA, Rantz MJ, Popejoy LL, Madsen RW, Petroski GF, Vogelsmeier AA. Nursing Home Quality and Pressure Ulcer Prevention and Management Practices. J Am Geriatr Soc 2004; 52:583-8. [PMID: 15066075 DOI: 10.1111/j.1532-5415.2004.52166.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs). DESIGN Retrospective analysis of a large data set and comparative survey. SETTING LTCFs in Missouri. PARTICIPANTS Three hundred sixty-two LTCFs participated in the survey. Three hundred twenty-one facilities had pressure ulcer QI scores between April 1 and September 30, 1999. MEASUREMENTS Pressure ulcer QI scores, Pressure Ulcer Prevention & Treatment Practices Survey. RESULTS The mean+/-standard deviation pressure ulcer QI score was 10.9+/-6.2%, with a risk-adjusted score of 15.7+/-8.9% for high-risk residents and 3.1+/-3.6% for low-risk residents. Minimizing head-of-bed elevation to less than 30 degrees was used by fewer than 20% of facilities. More than 40% of facilities used a risk assessment tool that was not evidence based. Fewer than 13% of facilities used the Agency for Health Care Policy and Research pressure ulcer prevention and treatment guidelines. No relationship was found between the number of prevention strategies (P=.892) or the number of treatment strategies (P=.921) and the pressure ulcer QI scores. CONCLUSION Valid and reliable pressure ulcer risk assessment tools are seriously underused. Evidence-based pressure ulcer prevention and treatment guidelines appear to be rarely implemented. This study provides a basis for developing educational and quality improvement programs and future research related to pressure ulcer prevention and treatment in LTCFs.
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Rantz MJ, Hicks L, Grando V, Petroski GF, Madsen RW, Mehr DR, Conn V, Zwygart-Staffacher M, Scott J, Flesner M, Bostick J, Porter R, Maas M. Nursing Home Quality, Cost, Staffing, and Staff Mix. The Gerontologist 2004; 44:24-38. [PMID: 14978318 DOI: 10.1093/geront/44.1.24] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. DESIGN AND METHODS A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing homes in Missouri and classified into resident outcome groups. Resident outcomes were measured by use of quality indicators derived from nursing home Minimum Data Set resident assessment data. Cost and staffing information were derived from Medicaid cost reports. Participant observation methods were used to describe the care delivery processes. RESULTS In facilities with good resident outcomes, there are basics of care and processes surrounding each that staff consistently do: helping residents with ambulation, nutrition and hydration, and toileting and bowel regularity; preventing skin breakdown; and managing pain. The analysis revealed necessary organizational attributes that must be in place in order for those basics of care to be accomplished: consistent nursing and administrative leadership, the use of team and group processes, and an active quality improvement program. The only facility characteristic across the outcome groups that was significantly different was the number of licensed beds, with smaller facilities having better outcomes. No significant differences in costs, staffing, or staff mix were detected across the groups. A trend in higher total costs of 13.58 dollars per resident per day was detected in the poor-outcome group compared with the good-outcome group. IMPLICATIONS For nursing homes to achieve good resident outcomes, they must have leadership that is willing to embrace quality improvement and group process and see that the basics of care delivery are done for residents. Good quality care may not cost more than poor quality care; there is some evidence that good quality care may cost less. Small facilities of 60 beds were more likely to have good resident outcomes. Strategies have to be considered so larger facilities can be organized into smaller clusters of units that could function as small nursing homes within the larger whole.
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Affiliation(s)
- Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO 65211, USA.
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