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Short E, Selig JP, Felix HC, Painter J, McElfish PA, Rowland B, Ammerman AS, Bounds K, Henske J, Hudson JS, Li J, Young SG, Long CR. Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol. Contemp Clin Trials 2024; 140:107491. [PMID: 38458560 PMCID: PMC11065573 DOI: 10.1016/j.cct.2024.107491] [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: 06/26/2023] [Revised: 01/29/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. METHODS This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. CONCLUSION Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food. CLINICAL TRIAL REGISTRATION NCT04876053.
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Affiliation(s)
- Eliza Short
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jacob Painter
- College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK, Chapel Hill, NC 27599, USA
| | - Kelsey Bounds
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Joseph Henske
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Sean G Young
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Christopher R Long
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
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Landes SJ, Matarazzo BB, Pitcock JA, Drummond KL, Smith BN, Kirchner JE, Clark KA, Gerard GR, Jankovsky MC, Brenner LA, Reger MA, Eagan AE, Raciborski R, Painter J, Townsend JC, Jegley SM, Singh RS, Trafton JA, McCarthy JF, Katz IR. Impact of Implementation Facilitation on the REACH VET Clinical Program for Veterans at Risk for Suicide. Psychiatr Serv 2024:appips20230277. [PMID: 38444365 DOI: 10.1176/appi.ps.20230277] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE In 2017, the Veterans Health Administration (VHA) implemented a national suicide prevention program, called Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), that uses a predictive algorithm to identify, attempt to reach, assess, and care for patients at the highest risk for suicide. The authors aimed to evaluate whether facilitation enhanced implementation of REACH VET at VHA facilities not meeting target completion rates. METHODS In this hybrid effectiveness-implementation type 2 program evaluation, a quasi-experimental pre-post design was used to assess changes in implementation outcome measures evaluated 6 months before and 6 months after onset of facilitation of REACH VET implementation at 23 VHA facilities. Measures included percentages of patients with documented coordinator and provider acknowledgment of receipt, care evaluation, and outreach attempt. Generalized estimating equations were used to compare differences in REACH VET outcome measures before and after facilitation. Qualitative interviews were conducted with personnel and were explored via template analysis. RESULTS Time had a significant effect in all outcomes models (p<0.001). An effect of facilitation was significant only for the outcome of attempted outreach. Patients identified by REACH VET had significantly higher odds of having a documented outreach attempt after facilitation of REACH VET implementation, compared with before facilitation. Site personnel felt supported and reported that the external facilitators were helpful and responsive. CONCLUSIONS Facilitation of REACH VET implementation was associated with an improvement in outreach attempts to veterans identified as being at increased risk for suicide. Outreach is critical for engaging veterans in care.
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Affiliation(s)
- Sara J Landes
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Bridget B Matarazzo
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Jeffery A Pitcock
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Karen L Drummond
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Brandy N Smith
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - JoAnn E Kirchner
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Kaily A Clark
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Georgia R Gerard
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Molly C Jankovsky
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Lisa A Brenner
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Mark A Reger
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Aaron E Eagan
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Rebecca Raciborski
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Jacob Painter
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - James C Townsend
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Susan M Jegley
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Rajinder Sonia Singh
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Jodie A Trafton
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - John F McCarthy
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
| | - Ira R Katz
- Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz)
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Curran G, Mosley C, Gamble A, Painter J, Ounpraseuth S, Brewer NT, Teeter B, Smith M, Halladay J, Hughes T, Shepherd JG, Hastings T, Simpson K, Carpenter D. Addressing COVID-19 vaccine hesitancy in rural community pharmacies: a protocol for a stepped wedge randomized clinical trial. Implement Sci 2023; 18:72. [PMID: 38110979 PMCID: PMC10726603 DOI: 10.1186/s13012-023-01327-7] [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: 09/28/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Uptake of COVID-19 vaccines remains problematically low in the USA, especially in rural areas. COVID-19 vaccine hesitancy is associated with lower uptake, which translates to higher susceptibility to SARS-CoV-2 variants in communities where vaccination coverage is low. Because community pharmacists are among the most accessible and trusted health professionals in rural areas, this randomized clinical trial will examine implementation strategies to support rural pharmacists in delivering an adapted evidence-based intervention to reduce COVID-19 vaccine hesitancy. METHODS We will use an incomplete stepped wedge trial design in which we will randomize 30 rural pharmacies (unit of analysis) to determine the effectiveness and incremental cost-effectiveness of a standard implementation approach (consisting of online training that describes the vaccine hesitancy intervention, live webinar, and resource website) compared to adding on a virtual facilitation approach (provided by a trained facilitator in support of the delivery of the vaccine hesitancy counseling intervention by pharmacists). The intervention (ASORT) has been adapted from an evidence-based vaccine communication intervention for HPV vaccines through a partnership with rural pharmacies in a practice-based research network in seven southern US states. ASORT teaches pharmacists how to identify persons eligible for COVID-19 vaccination (including a booster), solicit and address vaccine concerns in a non-confrontational way, recommend the vaccine, and repeat the steps later if needed. The primary trial outcome is fidelity to the ASORT intervention, which will be determined through ratings of recordings of pharmacists delivering the intervention. The secondary outcome is the effectiveness of the intervention, determined by rates of patients who agree to be vaccinated after receiving the intervention. Other secondary outcomes include feasibility, acceptability, adoption, reach, and cost. Cost-effectiveness and budget impact analyses will be conducted to maximize the potential for future dissemination and sustainability. Mixed methods will provide triangulation, expansion, and explanation of quantitative findings. DISCUSSION This trial contributes to a growing evidence base on vaccine hesitancy interventions and virtual-only facilitation of evidenced-based practices in community health settings. The trial will provide the first estimate of the relative value of different implementation strategies in pharmacy settings. TRIAL REGISTRATION NCT05926544 (clinicaltrials.gov); 07/03/2023.
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Affiliation(s)
- Geoffrey Curran
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Cynthia Mosley
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abigail Gamble
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Jacob Painter
- Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ben Teeter
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megan Smith
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jacquie Halladay
- Department of Family Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Tamera Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - J Greene Shepherd
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Tessa Hastings
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Kit Simpson
- Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Delesha Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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Howard E, Hurrell BP, Helou DG, Shafiei-Jahani P, Hasiakos S, Painter J, Srikanth S, Gwack Y, Akbari O. Orai inhibition modulates pulmonary ILC2 metabolism and alleviates airway hyperreactivity in murine and humanized models. Nat Commun 2023; 14:5989. [PMID: 37752127 PMCID: PMC10522697 DOI: 10.1038/s41467-023-41065-4] [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: 06/20/2022] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Ca2+ entry via Ca2+ release-activated Ca2+ (CRAC) channels is a predominant mechanism of intracellular Ca2+ elevation in immune cells. Here we show the immunoregulatory role of CRAC channel components Orai1 and Orai2 in Group 2 innate lymphoid cells (ILC2s), that play crucial roles in the induction of type 2 inflammation. We find that blocking or genetic ablation of Orai1 and Orai2 downregulates ILC2 effector function and cytokine production, consequently ameliorating the development of ILC2-mediated airway inflammation in multiple murine models. Mechanistically, ILC2 metabolic and mitochondrial homeostasis are inhibited and lead to the upregulation of reactive oxygen species production. We confirm our findings in human ILC2s, as blocking Orai1 and Orai2 prevents the development of airway hyperreactivity in humanized mice. Our findings have a broad impact on the basic understanding of Ca2+ signaling in ILC2 biology, providing potential insights into the development of therapies for the treatment of allergic and atopic inflammatory diseases.
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Affiliation(s)
- Emily Howard
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Benjamin P Hurrell
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Doumet Georges Helou
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pedram Shafiei-Jahani
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Spyridon Hasiakos
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jacob Painter
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sonal Srikanth
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yousang Gwack
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Omid Akbari
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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5
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Shah NK, Chandler MW, Cetto AV, Luciani LL, Painter J, Bailey D. Retrospective Cohort Study of Safety Outcomes Associated with Opioid Rotations to Buprenorphine. J Pain Palliat Care Pharmacother 2023; 37:234-245. [PMID: 37097772 DOI: 10.1080/15360288.2023.2200412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/01/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
The objective of this study was to understand the effect buprenorphine rotations have on respiratory risk and other safety outcomes. This was a retrospective observational study evaluating Veterans who underwent an opioid rotation from full-agonist opioids to buprenorphine products or to alternative opioids. The primary endpoint was change in the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD) score from baseline to six months post-rotation. Median baseline RIOSORD scores were 26.0 and 18.0 in the Buprenorphine Group and the Alternative Opioid Group, respectively. There was no statistically significant difference between groups in baseline RIOSORD score. At six months post-rotation, median RIOSORD scores were 23.5 and 23.0 in the Buprenorphine Group and Alternative Opioid Group, respectively. The difference in change in RIOSORD scores between groups was not statistically significant (p = 0.23). However, based on changes in RIOSORD risk class, an 11% and 0% decrease in respiratory risk was observed in the Buprenorphine and Alternative Opioid groups, respectively. This finding may be considered clinically significant given a change in risk was observed as predicted by RIOSORD score. Further research is needed to clarify the effect that opioid rotations have on respiratory depression risk and other safety outcomes.
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Painter J, Laisk T, Lindgren C, Medland S. P–374 Investigating causality of risk factors for miscarriage – a Mendelian randomization analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Do modifiable risk factors such as smoking, alcohol or coffee consumption, and adiposity causally increase the risk of sporadic or recurrent miscarriage?
Summary answer
We found evidence for a causal relationship between smoking initiation and sporadic miscarriage, but not for any other risk factor tested.
What is known already
Miscarriage is estimated to end between 10–25% of clinically confirmed pregnancies, and many observational studies have suggested numerous lifestyle factors, such as coffee and alcohol consumption, smoking and increased adiposity, may increase miscarriage risk. However, results are not always consistent across studies, and definitive causal relationships between various risk factors and miscarriage have not yet been demonstrated. Mendelian randomization utilizes genetic variants significantly associated with heritable risk factors (i.e. at P-values <5x10–8 in large genome-wide association studies) as instrumental variables to investigate causality of risk factors in population health outcomes.
Study design, size, duration
We conducted two-sample Mendelian randomization analyses to investigate causality of smoking (initiation and quantity), alcohol and coffee consumption (quantity), and adiposity (body mass index and waist-hip ratio) in sporadic and recurrent miscarriage. Data included in this study were taken from previously published summary genetic association statistics (betas, standard errors and P-values) from large-scale genome-wide association studies (GWAS) for each risk factor, and from our recently published GWAS of sporadic and recurrent miscarriage.
Participants/materials, setting, methods
Instrumental variables were constructed using 5–306 genetic variants significantly associated with the listed risk factors in published GWAS (minimum N = 178,000 individuals). Two instrumental variables were constructed per risk factor using data from different GWAS. Associations of the instrumental variables with miscarriage were investigated using summary association data from women of European ancestry included in our miscarriage GWAS, including 49,996 sporadic miscarriage cases and 174,109 female controls, and 750 recurrent miscarriage cases and 150,215 female controls.
Main results and the role of chance
We found a significant association between sporadic miscarriage and the instrumental variables for two smoking measures: smoking initiation (inverse variance weighted Odds Ratio = 1.17, 95% confidence intervals = 1.10–1.24, P = 2.7 x 10–07) and lifetime smoking (inverse variance weighted Odds Ratio = 1.22, 95% confidence intervals 1.11–1.35, P = 4.2x10–5). No other risk factors (smoking quantity, coffee or alcohol consumption, or BMI or waist-hip ratio) were associated with either sporadic or recurrent miscarriage. A priori power calculations considering the amount of phenotypic variance in each risk factor explained by the associated SNPs suggested our analysis to have at least 75% power to detect an association with Odds Ratio of 1.2 with sporadic miscarriage for analyses of body mass index, waist hip ratio and smoking initiation, quantity and the lifetime smoking measure, but that the alcohol and coffee consumption analyses were underpowered (4.9% and 48%, respectively). All analyses were underpowered for recurrent miscarriage given the small case sample size (N = 750).
Limitations, reasons for caution
While data utilised here come from large-scale GWAS including 1000s of individuals, genetic variants significantly associated with each risk factor currently explain small percentages (0.02–6%) of the variance in each trait. Larger GWAS for specific risk factors, and for sporadic and recurrent miscarriage, are required to clarify some published associations.
Wider implications of the findings: We find no evidence of a causal link between adiposity and miscarriage, indicating that observational findings of increased miscarriage risk with increasing body mass index require further explanation. Significant associations between measures of ever-smoking and sporadic miscarriage highlights that no amount of smoking is safe in regards to miscarriage risk.
Trial registration number
Not applicable
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Affiliation(s)
- J Painter
- QIMR Berghofer Medical Research Institute, Genetics and Computational Biology, Brisbane, Australia
- University of Queensland, School of Biomedical Sciences, Brisbane, Australia
- Queensland University of Technology, School of Biomedical Sciences, Brisbane, Australia
| | - T Laisk
- University of Tartu, Estonian Genome Center- Institute of Genomics, Tartu, Estonia
| | - C Lindgren
- University of Oxford, Big Data Institute- Li Ka Shing Center for Health Information and Discovery, Oxford, United Kingdom
- University of Oxford, Wellcome Centre for Human Genetics, Oxford, United Kingdom
| | - S Medland
- QIMR Berghofer Medical Research Institute, Genetics and Computational Biology, Brisbane, Australia
- Queensland University of Technology, School of Psychology and Counselling, Brisbane, Australia
- University of Queensland, School of Psychology and Translational Research Institute, Brisbane, Australia
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7
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Landes SJ, Jegley SM, Kirchner JE, Areno JP, Pitcock JA, Abraham TH, McBain SA, Singh RS, Bollinger MJ, Painter J, Woods JA, Curtis ND, Jones DE, Matarazzo BB, Reger MA, Comtois KA. Adapting Caring Contacts for Veterans in a Department of Veterans Affairs Emergency Department: Results From a Type 2 Hybrid Effectiveness-Implementation Pilot Study. Front Psychiatry 2021; 12:746805. [PMID: 34721114 PMCID: PMC8548725 DOI: 10.3389/fpsyt.2021.746805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/13/2021] [Indexed: 12/02/2022] Open
Abstract
Transitions in care, such as discharge from an emergency department (ED), are periods of increased risk for suicide and effective interventions that target these periods are needed. Caring Contacts is an evidence-based suicide prevention intervention that targets transitions, yet it has not been widely implemented. This pilot study adapted Caring Contacts for a Department of Veterans Affairs (VA) ED setting and population, created an implementation toolkit, and piloted implementation and evaluation of effectiveness. To inform adaptation, qualitative interviews were conducted with stakeholders. Data were used by an advisory board comprised of stakeholders, experts, and veterans to make adaptations and develop an implementation planning guide to delineate steps needed to implement. Key decisions about how to adapt Caring Contacts included recipients, author, content, and the schedule for sending. Pilot implementation occurred at one VA ED. Caring Contacts involved sending patients at risk of suicide brief, non-demanding expressions of care. Program evaluation of the pilot used a type 2 hybrid effectiveness-implementation design to both pilot an implementation strategy and evaluate effectiveness of Caring Contacts. Evaluation included qualitative interviews with veteran patients during implementation. VA electronic health records were used to evaluate VA service utilization in the 6-month periods immediately before and after veterans were delivered their first Caring Contact. Hundred and seventy-five veterans were mailed Caring Contacts and the facility continued adoption after the pilot. Participants were positive about the intervention and reported feeling cared about and connected to VA as a result of receiving Caring Contacts. This project developed an implementation planning process that successfully implemented Caring Contacts at one site. This can be used to further implement Caring Contacts at additional VA or community EDs.
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Affiliation(s)
- Sara J Landes
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Susan M Jegley
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - JoAnn E Kirchner
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - John P Areno
- South Central VA Health Care Network, Ridgeland, MS, United States
| | - Jeffery A Pitcock
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Traci H Abraham
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Sacha A McBain
- South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - R Sonia Singh
- South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mary J Bollinger
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Jacob Painter
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Jack A Woods
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Nyssa D Curtis
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Donald E Jones
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Bridget B Matarazzo
- Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States.,Department of Psychiatry, University of Colorado Anschutz School of Medicine, Aurora, CO, United States
| | - Mark A Reger
- VA Puget Sound Health Care System, Tacoma, WA, United States
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
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Matthieu MM, Ounpraseuth ST, Painter J, Waliski A, Williams JS, Hu B, Smith R, Garner KK. Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: protocol for a quality improvement evaluation. Implement Sci Commun 2020; 1:19. [PMID: 32885180 PMCID: PMC7427851 DOI: 10.1186/s43058-020-00016-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background Traditionally, system leaders, service line managers, researchers, and program evaluators hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can “go to scale.” However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, are the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/design In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to veterans and their trusted others of having an advance directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score-matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread. Discussion As an observational evaluation, this protocol will contribute to our understanding of implementation science and practice by examining the natural variation in implementation and spread of ACP-GV with or without funded staff positions.
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Affiliation(s)
- Monica M Matthieu
- HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA.,College for Public Health and Social Justice, School of Social Work, Saint Louis University, Saint Louis, MO USA
| | - Songthip T Ounpraseuth
- College of Medicine, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Jacob Painter
- HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA.,College of Medicine, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Angie Waliski
- HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA.,College of Medicine, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - James Silas Williams
- HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA
| | - Bo Hu
- HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA.,College of Medicine, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Robin Smith
- HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA
| | - Kimberly K Garner
- HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA.,College of Medicine, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA.,Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR USA
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9
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Dare RK, Lusardi K, Pearson C, McCain KD, Daniels B, Van S, Rico JC, Painter J, Lakkad M, Rosenbaum ER, Bariola JR. Clinical Impact of Accelerate PhenoTM Rapid Blood Culture Detection System in Bacteremic Patients. Clin Infect Dis 2020; 73:e4616-e4626. [PMID: 32463864 DOI: 10.1093/cid/ciaa649] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/09/2020] [Accepted: 05/22/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Accelerate Pheno blood culture detection system (AXDX) provides identification (ID) and antimicrobial susceptibility testing (AST) results within 8h of blood culture growth. Limited data exists regarding its clinical impact. Other rapid platforms coupled with antimicrobial stewardship program (ASP) real-time notification (RTN) have shown improved length of stay (LOS) in bacteremia. METHODS A single-center, quasi-experimental study of adult bacteremic inpatients before/after AXDX implementation was conducted comparing clinical outcomes from 1 historical and 2 intervention cohorts (AXDX and AXDX+RTN). Primary outcome was LOS. RESULTS Of 830 bacteremic episodes, 188 (77%) of 245 historical and 308 (155 AXDX, 153 AXDX+RTN; 65%) of 585 intervention episodes were included. Median LOS was shorter with AXDX (6.3d) and AXDX+RTN (6.7d) compared to historical (8.1d; P=0.001). Achievement of optimal therapy (AOT) was more frequent (93.6% and 95.4%) and median time to optimal therapy (TTOT) was faster (1.3d and 1.4d) in AXDX and AXDX+RTN compared to historical (84.6%, P≤0.001 and 2.4d; P≤0.001) respectively. Median antimicrobial days of therapy (DOT) was shorter in both intervention arms compared to historical (6d each vs 7d; P=0.011). Median LOS benefit was most pronounced in patients with coagulase negative Staphylococcus bacteremia (5.5d and 4.5d vs 7.2d; P=0.003) in AXDX, AXDX+RTN, and historical cohorts respectively. CONCLUSIONS LOS, AOT, TTOT, and total DOT significantly improved after AXDX implementation. Addition of RTN did not show further improvement over AXDX and an already active ASP. These results suggest AXDX can be integrated into healthcare systems with an active ASP even without the resources to include RTN.
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Affiliation(s)
- R K Dare
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K Lusardi
- Hospital Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Pearson
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K D McCain
- Hospital Pharmacy, Wadley Regional Medical Center, Texarkana, TX, USA
| | - B Daniels
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - S Van
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J C Rico
- Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Painter
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - M Lakkad
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - E R Rosenbaum
- Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J R Bariola
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Howard ED, Maazi H, Hurrell BP, Galle-Treger L, Helou DG, Jahani PS, Painter J, Allayee H, Akbari O. Phenotype-driven screening of 150 strains of mice for allergic lung inflammation identified strains representative of heterogeneous human asthma cohorts. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.65.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Asthma is a highly prevalent and heterogeneous disease characterized by airway hyperreactivity (AHR) and an influx of immune cells including eosinophils and neutrophils in the bronchoalveolar lavage (BAL). Furthermore, there are patient subsets, such as severe asthmatics, who are unresponsive to corticosteroids or bronchodilators. Research efforts targeting these cohorts of asthma patients however are severely lacking due to an inadequacy in relevant biological mouse models. For the first time, we immunophenotyped 150+ inbred and RI mouse strains in the Hybrid Mouse Diversity Panel (HMDP) under steady state conditions and after house dust mite (HDM) challenge to assess the lung function, BAL cell composition, serum immunoglobulin levels, as well as quantification of lung and peripheral immune cells. These results revealed at least three unique groups of strains that, when exposed to the same allergen, respond with three distinct systemic and local phenotypes of lung inflammation, specifically a high Th-2 response, a low Th-2 response, and neutrophilia. These murine models of AHR mirror human cohorts of asthma previously underrepresented in ongoing research efforts. We are currently designing mechanistic studies focusing on identifying the genetic factors responsible for these distinct phenotypes. The results of these combined studies may lead to a better understanding of asthma heterogeneity and provide a foundation for further elucidation of the pathogenetic mechanisms of each phenotype of asthma utilizing relevant animal models.
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Affiliation(s)
| | - Hadi Maazi
- 1Univ. of Southern California Keck Sch. of Med
| | | | | | | | | | | | | | - Omid Akbari
- 1Univ. of Southern California Keck Sch. of Med
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11
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Klucher J, Lakkad M, Painter J, Dare RK. 2013. Blood Culture Contamination in the Emergency Department: A Risk Factor Analysis. Open Forum Infect Dis 2019. [PMCID: PMC6809269 DOI: 10.1093/ofid/ofz360.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Blood cultures (BCx) guide treatment for hospitalized patients, yet contaminated BCx lead to clinical uncertainty, impacting care. The Clinical and Laboratory Standards Institute (CLSI) recommends contamination rates should be <3%, yet our Emergency Department (ED) rate is consistently above this benchmark. Reasons for this are unclear, thus it is imperative to investigate potential risk factors for BCx contamination.
Methods
We performed a retrospective case–control risk factor analysis of patients with BCx collected in our ED between 2014 and 2018. Contaminated BCx were identified by the microbiology laboratory per American Society of Microbiology recommendations. Demographics, comorbidities, and clinical characteristics were evaluated in patients with false-positive/contaminated BCx (cases) and patients with negative BCx (controls). Potential risk factors identified in univariate analysis were included in a logistic regression model. Unadjusted and adjusted analyses were performed using SAS 9.4.
Results
25,668 BCx from 13,782 patients were included in analysis. 20,907 BCx from 11,266 (82%) patients were negative, 2,856 BCx from 1,504 (11%) patients were true positives, and 1,905 BCx from 1,012 (7%) patients were contaminated. Yearly ED contamination rates ranged from 5.0–9.3%. Collector contamination rates varied, though 38 (19%), 75 (35%), and 7 (3%) of 209 collectors had a contamination rate <3%, ≥ 10%, and ≥ 20%, respectively. Significant patient-specific risk factors identified in univariate analysis are listed in the attached table along with adjusted analysis.
Conclusion
In our analysis, we identified that older age, African American race, higher BMI, COPD, paralysis, and presenting in septic shock independently increases risk of having a contaminated BCx. Difficulty obtaining venipuncture in patients with these risk factors, often requiring multiple collection attempts, likely leads to decreased sterile technique. It is imperative to have a process assuring sterile technique in these high-risk individuals to minimize consequences associated with having a false-positive BCx result in these high-risk patients. Additionally, variable collector contamination rates seen in this study highlight the necessity for frequent technique in-service training.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Justin Klucher
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mrinmayee Lakkad
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jacob Painter
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ryan K Dare
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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12
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Pearson C, Lusardi K, McCain K, Painter J, Lakkad M, Rosenbaum ER, Daniels K, Van S, Bariola JR, Dare RK. 2137. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System with Real-time Notification vs. Standard Antibiotic Stewardship on Clinical Outcomes in Bacteremic Patients. Open Forum Infect Dis 2019. [PMCID: PMC6810674 DOI: 10.1093/ofid/ofz360.1817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/21/2022] Open
Abstract
Background Accelerate Pheno™ blood culture detection system (AXDX) provides identification (ID) and antimicrobial susceptibility testing (AST) within 8 hours of growth in blood culture. We previously reported length of stay (LOS), time to optimal therapy (TTOT), and antibiotic days of therapy (DOT) decrease following AXDX implementation alongside an active antimicrobial stewardship program (ASP). It is unclear whether real-time notification (RTN) of results further improves these variables. Methods A single-center, quasi-experimental before/after study of adult bacteremic inpatients was performed after implementation of AXDX. A 2017 historical cohort was compared with two 2018 intervention cohorts. Intervention-1: AXDX performed 24/7 with results reviewed by providers or ASP as part of their normal workflow. Intervention 2: AXDX performed 24/7 with RTN to ASP 7 days per week 9a-5p and overnight results called to ASP at 9a. Interventions 1 and 2 were utilized on an alternating weekly basis during the study (February 2018–September 2018). Historical ID/AST were performed using VITEK® MS and VITEK®2. Exclusion criteria included polymicrobial or off-panel isolates, prior positive culture, and patients not admitted at the time of AST. Clinical outcomes were compared with Wilcoxon rank-sum and χ 2 analysis. Results 540 (83%) of 650 positive cultures performed on AXDX had on-panel organisms. 308 (57%) of these cultures and 188 (77%) of 244 reviewed historical cultures met inclusion criteria. Baseline illness severity and identified pathogens were similar between cohorts. Clinical outcomes and antimicrobial DOT are reported in Tables 1 and 2. Conclusion Following our implementation of AXDX, clinical outcomes including LOS, TTOT, total DOT, BGN DOT, and frequency of achieving optimal therapy were significantly improved compared with a historical cohort. Addition of RTN for AXDX results in the setting of an already active ASP did not further improve these metrics. However, compared with historical arm, AXDX with RTN did significantly impact specific subsets of antibiotic use while AXDX alone did not. This may be due to earlier vancomycin de-escalation. These results support the benefit of integration of AXDX into healthcare systems with an active ASP even without the resources to include real-time notification. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Courtney Pearson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Katherine Lusardi
- Hospital Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kelsey McCain
- St. Vincent Infirmary Medical Center, Little Rock, Arkansas
| | - Jacob Painter
- Division of Pharmaceutical Evaluation & Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mrinmayee Lakkad
- Division of Pharmaceutical Evaluation & Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Eric R Rosenbaum
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kay Daniels
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Serena Van
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - J Ryan Bariola
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ryan K Dare
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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13
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Abstract
Background Blood cultures are the primary diagnostic tool for bloodstream infections, but accuracy of results is dependent on collection technique. Decreasing blood culture contaminations is a priority for antimicrobial stewardship programs as false positives can expose patients to adverse effects of unnecessary antibiotics. In this study, we present an analysis comparing clinical outcomes and cost associated with false-positive and true negative blood cultures at our institution. Methods We conducted a single-center, retrospective, case–control study in patients admitted following blood culture collection in the emergency department from 2014 to 2018. Demographic and clinical characteristics were evaluated in patients with false-positive blood cultures (cases) and negative blood cultures (controls). Contaminants were identified per American Society of Microbiology recommendations. Clinical outcomes were compared between cases and controls, and adjusted analyses were performed with logistic regression, linear regression, and generalized linear models controlling for age, race, body mass index, and sepsis. Statistical analysis was performed using SAS 9.4. Results A total of 1,102 cases and 11,266 controls were included in analysis. All clinical outcome measures were significantly higher in patients with contaminated blood cultures (see table). Select clinical outcomes remained significant when controlling for potential confounders. Conclusion To the best of our knowledge, this is the largest study evaluating the clinical and financial impact of blood culture contamination with inclusion of >1,000 cases during a 5-year period. Our study shows that blood culture contamination is associated with increased length of stay, unnecessary exposure to antibiotics and procedures, development of antibiotic-associated adverse events, and higher hospital charges as reported in smaller studies. However, this study is the first to the best of our knowledge reporting increased mortality associated with blood culture contamination. Implementation of innovative strategies to reduce contamination should be pursued. Antimicrobial stewardship programs should prioritize identification of contaminants and rapid de-escalation of inappropriate antibiotics in these patients to improve patient care. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kevin A Davis
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jacob Painter
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mrinmayee Lakkad
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ryan K Dare
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Dare R, McCain K, Lusardi K, Daniels K, Painter J, Lakkad M, Emery N, Rosenbaum E, Bariola JR. 1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients. Open Forum Infect Dis 2018. [PMCID: PMC6252608 DOI: 10.1093/ofid/ofy209.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P < 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P < 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Ryan Dare
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kelsey McCain
- Hospital Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Katherine Lusardi
- Hospital Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kay Daniels
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jacob Painter
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mrinmayee Lakkad
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nicole Emery
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Eric Rosenbaum
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - J Ryan Bariola
- Division of Infectious Diseases, University of PIttsburgh Medical Center, Pittsburgh, Pennsylvania
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Appleby-Thomas GJ, Fitzmaurice B, Hameed A, Painter J, Gibson M, Wood DC, Hazael R, Hazell PJ. On differences in the equation-of-state for a selection of seven representative mammalian tissue analogue materials. J Mech Behav Biomed Mater 2017; 77:586-593. [PMID: 29096124 DOI: 10.1016/j.jmbbm.2017.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/03/2017] [Accepted: 10/08/2017] [Indexed: 11/25/2022]
Abstract
Tissue analogues employed for ballistic purposes are often monolithic in nature, e.g. ballistic gelatin and soap, etc. However, such constructs are not representative of real-world biological systems. Further, ethical considerations limit the ability to test with real-world tissues. This means that availability and understanding of accurate tissue simulants is of key importance. Here, the shock response of a wide range of ballistic simulants (ranging from dermal (protective/bulk) through to skeletal simulant materials) determined via plate-impact experiments are discussed, with a particular focus on the classification of the behaviour of differing simulants into groups that exhibit a similar response under high strain-rate loading. Resultant Hugoniot equation-of-state data (Us-up; P-v) provides appropriate feedstock materials data for future hydrocode simulations of ballistic impact events.
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Affiliation(s)
- G J Appleby-Thomas
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK.
| | - B Fitzmaurice
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - A Hameed
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - J Painter
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - M Gibson
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - D C Wood
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - R Hazael
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - P J Hazell
- School of Engineering and Information Technology, The University of New South Wales, Canberra, ACT 2600, Australia
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Fulgoni V, Painter J, Carughi A. Raisin Consumption is Associated with Increased Nutrient Intake and Better Diet Quality in Children (2-18 years): An Analyses of NHANES (2001-2012). J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.087] [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: 11/15/2022]
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17
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Painter J, Trevithick L, Hastings RP, Ingham B, Roy A. Development and validation of the Learning Disabilities Needs Assessment Tool (LDNAT), a HoNOS-based needs assessment tool for use with people with intellectual disability. J Intellect Disabil Res 2016; 60:1178-1188. [PMID: 27730729 DOI: 10.1111/jir.12340] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/09/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND In meeting the needs of individuals with intellectual disabilities (ID) who access health services, a brief, holistic assessment of need is useful. This study outlines the development and testing of the Learning Disabilities Needs Assessment Tool (LDNAT), a tool intended for this purpose. METHOD An existing mental health (MH) tool was extended by a multidisciplinary group of ID practitioners. Additional scales were drafted to capture needs across six ID treatment domains that the group identified. LDNAT ratings were analysed for the following: item redundancy, relevance, construct validity and internal consistency (n = 1692); test-retest reliability (n = 27); and concurrent validity (n = 160). RESULTS All LDNAT scales were deemed clinically relevant with little redundancy apparent. Principal component analysis indicated three components (developmental needs, challenging behaviour, MH and well-being). Internal consistency was good (Cronbach alpha 0.80). Individual item test-retest reliability was substantial-near perfect for 20 scales and slight-fair for three scales. Overall reliability was near perfect (intra-class correlation = 0.91). There were significant associations with five of six condition-specific measures, i.e. the Waisman Activities of Daily Living Scale (general ability/disability), Threshold Assessment Grid (risk), Behaviour Problems Inventory for Individuals with Intellectual Disabilities-Short Form (challenging behaviour) Social Communication Questionnaire (autism) and a bespoke physical health questionnaire. Additionally, the statistically significant correlations between these tools and the LDNAT components made sense clinically. There were no statistically significant correlations with the Psychiatric Assessment Schedules for Adults with Developmental Disabilities (a measure of MH symptoms in people with ID). CONCLUSIONS The LDNAT had clinically utility when rating the needs of people with ID prior to condition-specific assessment(s). Analyses of internal and external validity were promising. Further evaluation of its sensitivity to changes in needs is now required.
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Affiliation(s)
- J Painter
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - L Trevithick
- Durham and Darlington Mental Health Services for Older People, Tees, Esk and Wear Valley NHS Foundation Trust, Durham, UK
| | - R P Hastings
- CEDAR (Centre for Educational Development, Appraisal and Research), University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry and Psychology, Monash University Australia, Melbourne, Australia
| | - B Ingham
- Psychological Services, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - A Roy
- Solihull Community Services, Faculty of Intellectual Disability Psychiatry, Royal College of Psychiatrists, Birmingham, UK
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Clem O, Painter J, Cullen J, McCain K, Kakkera K, Meena N, Hammond D. 1350: NOREPINEPHRINE AND VASOPRESSIN VS NOREPINEPHRINE ALONE FOR SEPTIC SHOCK: RANDOMIZED CONTROLLED TRIAL. Crit Care Med 2016. [DOI: 10.1097/01.ccm.0000510024.07609.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Jones J, Derecho C, Astacio T, Shah P, Painter J, Baden J. Investigational rapid multiplex assay for the detection of influenza and respiratory syncytial viruses using the Iidylla™ system demonstrates exceptional performance & flexibility with minimal hands-on time. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.144] [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: 11/29/2022]
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20
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Brown J, Li C, Painter J, Hutchison LC, Martin B. Predictive Validity of Inappropriate Prescribing Criteria for Adverse Drug Events, Hospitalizations, and Emergency Department Visits: A Time-To-Event Comparison of the Beers and Stopp Criteria. Value Health 2014; 17:A505. [PMID: 27201536 DOI: 10.1016/j.jval.2014.08.1531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Brown
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Li
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Painter
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L C Hutchison
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - B Martin
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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21
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Rajasekhar PT, Clifford GM, Lee TJW, Rutter MD, Waddup G, Ritchie M, Nylander D, Painter J, Singh J, Ward I, Dempsey N, Bowes J, Handley G, Henry J, Rees CJ. Bowel cancer screening is safe, detects earlier stage cancer and adenomas in 50% of cases: experience of the prevalent round of screening from two first wave centres in the North East of England. Frontline Gastroenterol 2012; 3:10-15. [PMID: 28839624 PMCID: PMC5517241 DOI: 10.1136/flgastro-2011-100004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 03/29/2011] [Accepted: 09/29/2011] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The NHS Bowel Cancer Screening Programme (BCSP) began roll-out in 2006 aiming to reduce cancer mortality through detection at an earlier stage. We report results from the prevalent round of screening at two first wave centres and compare with the UK pilot study. DESIGN This is a service evaluation study. Data were collected prospectively for all individuals undergoing faecal occult blood testing (FOBt) and colonoscopy including: uptake and outcomes of FOBt, colonoscopic performance, findings, histological data and complications. Continuous data were compared using a two-tailed test of two proportions. SETTING The South of Tyne and Tees Bowel Cancer Screening centres. PATIENTS Participants of the BCSP. MAIN OUTCOME MEASURES 1) Colonoscopy Quality Assurance and 2) Cancer stage shift. RESULTS 195,772 individuals were invited to participate. Uptake was 54% and FOBt positivity 1.7%. 1524 underwent colonoscopy with caecal intubation in 1485 (97%). 180 (12%) cancers were detected. Dukes stages were: 76 (42%) A; 47 (26%) B; 47 (26%) C; 8 (4%) D and 2 (1%) unknown. This demonstrates a significantly earlier stage at diagnosis compared with data from 2867 non-screening detected cancers (p<0.001). Adenomas were detected in 758 (50%). One perforation occurred (0.07%) and two intermediate bleeds requiring transfusion only (0.12%). Both caecal intubation and adenoma detection were significantly higher than in the UK pilot study (p<0.001). CONCLUSIONS The prevalent round of screening demonstrates a high adenoma and cancer detection rate and significantly earlier stage at diagnosis. Complications were few providing reassurance regarding safety. Efforts are required to improve uptake.
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Affiliation(s)
- P T Rajasekhar
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK,The Northern Region Endoscopy Group, South Shields, UK
| | - G M Clifford
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK
| | - T J W Lee
- The Northern Region Endoscopy Group, South Shields, UK,Tees Bowel Cancer Screening Centre, Stockon-on-Tees, UK
| | - M D Rutter
- The Northern Region Endoscopy Group, South Shields, UK,Tees Bowel Cancer Screening Centre, Stockon-on-Tees, UK
| | - G Waddup
- Tees Bowel Cancer Screening Centre, Stockon-on-Tees, UK
| | - M Ritchie
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK
| | - D Nylander
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK,The Northern Region Endoscopy Group, South Shields, UK
| | - J Painter
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK,The Northern Region Endoscopy Group, South Shields, UK
| | - J Singh
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK,The Northern Region Endoscopy Group, South Shields, UK
| | - I Ward
- North of England Screening Hub, Gateshead, UK
| | - N Dempsey
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK
| | - J Bowes
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK
| | - G Handley
- North of England Screening Hub, Gateshead, UK
| | - J Henry
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK
| | - C J Rees
- South of Tyne Bowel Cancer Screening Centre, South Shields, UK,The Northern Region Endoscopy Group, South Shields, UK
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Rabeno BM, Iacocca MV, Painter J, Czerwinski C, Carter S. Experiences of the first community hospital to submit specimens for the Cancer Genome Atlas (TCGA) project. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12035] [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: 11/20/2022] Open
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23
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Baden J, Markiewicz J, Painter J, Jones J, Curtin K, Canning S, Quijano J, Guinto W, Wang Y, Green G. Informative rate and reproducibility of the investigational GeneSearch ProCaM assay in a multicenter laboratory setting. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22038 Background: PSA tests have low specificity, which frequently results in unnecessary biopsy and typically limits screening to patients with PSA values >4.0 ng/mL. The investigational ProCaM assay detects CpG island methylation within the promoter regions of three markers (GSTP1, RARß2, and APC) that are indicative of the presence of prostate cancer. The objective of this research study was to assess assay testing reproducibility and lot-to-lot variability. Methods: Assay reproducibility: 8 operators from 4 external clinical laboratories tested a panel comprised of a negative panel member (NM2C5 cells) for the internal control (ß-Actin), a high positive and low positive panel members (LNCaP cells) for all 3 markers and ß-Actin. Variability of assay results based on marker cycle threshold (Ct) values was determined. Lot variability: 3 unique lots of the ProCaM Test Kit were evaluated on DNA extracted from 169 post-DRE urine samples to show reproducibility across kit lots. Urine samples were collected from consenting subjects that were scheduled for prostate biopsy and tested by 3 operators at the same facility. Results: Assay reproducibility: The informative rate was 98% (766 valid results of 782 total tests). The overall intersite %CV and SD values for Cts were = 9.2% and 1.49%, respectively. The percent agreement with qualitative (positive/negative) outcome for High, Low, and Negative panel members was = 98% for GSTP1, RARß2, APC, and ß-Actin. Lot variability: Of the 169 biopsy results a histology positivity rate of 39% (66/169) was shown. Urine sample results for these samples showed that the areas under the curve for the 3 unique ProCaM Test Kit lots were equivalent (0.72, 0.74, 0.75, p > 0.263). Using the result categories of negative and positive with identical cutoffs for GSTP1, RARß2, APC for samples with >5 ssDNA copies 98% concordance was observed for all 3 lots evaluated. Conclusions: The investigational assay produces a qualitative result without the requirement for normalization or sample dilution and requires only one reaction per patient sample. Current results demonstrate that the assay has a high informative test rate and that results are reproducible across sites, operators runs, and kit lots. [Table: see text]
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24
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Merritt EA, Painter J. Analysis and visualization of TLS motion in proteins using the mmLib toolkit. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305094638] [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: 11/11/2022] Open
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25
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Abramson CI, Sanderson C, Painter J, Barnett S, Wells H. Development of an ethanol model using social insects: V. Honeybee foraging decisions under the influence of alcohol. Alcohol 2005; 36:187-93. [PMID: 16377460 DOI: 10.1016/j.alcohol.2005.09.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 09/01/2005] [Accepted: 09/08/2005] [Indexed: 10/25/2022]
Abstract
We examined the effect of ethanol on a complex decision process in honeybees. In many contexts (e.g., flower patches containing both blue and white flowers), honeybees have been shown to make decisions concerning which flowers to visit based on the reward's caloric value offered by competing flower types. However, under some contexts (e.g., flower patches containing both blue and yellow flowers) honeybees ignore the energetic differences that exist between rewards. When this occurs, some bees show extreme fidelity to one flower type, and other bees simultaneously show extreme loyalty to the competing flower type. In this set of experiments we use different combinations of flower colors to elicit these different context-specific behaviors, and examine response under the influence of ethanol in conditions with rewards differing in either quality or quantity. Alcohol affected the same decision situation differently in the alternative contexts we gave foragers. In the blue-white dimorphic flower patch context, foragers in the alcohol condition no longer followed the species' typical behavior of selectively choosing the higher energetic reward; they chose flowers randomly as if rewards did not differ between flower colors. However, in the blue-yellow dimorphic flower patch context, foragers in the alcohol condition continued their species-typical behavior of favoring their initial flower-color choice. That is, alcohol had no effect on behavior in the latter context. This pattern of context-dependent effects of alcohol was not associated with motor impairment in either context because flower visitation rate increased when bees were given ethanol. The brain regions responsible for alternative context behaviors (using the Drosophila model), or at least receptors within the same region responsible for these context-dependent behaviors, have very different sensitivities to alcohol, which suggests that differing neural processes are involved.
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Affiliation(s)
- Charles I Abramson
- Department of Psychology, Oklahoma State University, 215 North Murray, Stillwater, OK 74078, USA.
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Sutherland J, Christensen E, Powers N, Rhynard S, Painter J, Peatross J. High harmonic generation in a semi-infinite gas cell. Opt Express 2004; 12:4430-6. [PMID: 19483992 DOI: 10.1364/opex.12.004430] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Ten-millijoule 35-femtosecond laser pulses interact with a cell of helium or neon that extends from a focusing lens to an exit foil near the laser focus. High harmonic orders in the range of 50 to 100 are investigated as a function of focal position relative to the exit foil. An aperture placed in front of the focusing lens increases the brightness of observed harmonics by more than an order of magnitude. Counter-propagating light is used to directly probe where the high harmonics are generated within the laser focus. In neon, the harmonics are generated in the last few millimeters before the exit foil, limited by absorption. In helium, the harmonics are produced over a much longer distance.
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Zansky S, Wallace B, Schoonmaker-Bopp D, Smith P, Ramsey F, Painter J, Gupta A, Kalluri P, Noviello S. From the Centers for Disease Control and Prevention. Outbreak of multi-drug resistant Salmonella Newport--United States, January-April 2002. JAMA 2002; 288:951-3. [PMID: 12201274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- S Zansky
- Emerging Infections Program, New York State Department of Health, USA
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Painter J, Pring L. Graphic displays: the effects of orientation on the tangible perception of histograms and pie charts. Int J Rehabil Res 2000; 23:185-9. [PMID: 11131620] [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: 02/18/2023]
Abstract
Two studies designed to investigate the ability of blind subjects to interpret tangible graphic displays of data at varying degrees of orientation are reported. In the first experiment visually handicapped children were required to interpret histograms and pie charts presented at two different orientations. Horizontally oriented histograms were found to have a significant advantage over vertically oriented histograms, but there was no effect of orientation on pie charts. In the second study horizontally and vertically oriented histograms were again compared using a subject sample comprised only of congenitally or very early blind children. The results confirmed the superiority of horizontally presented histograms over the more common vertical display.
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Affiliation(s)
- J Painter
- Department of Psychology, University of East London, UK
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Affiliation(s)
- J Painter
- Deparmtent of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, USA
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Painter J, Akroyd D, Barefoot T, Schemedeke K, Daniels NE. Predictors of organizational commitment among certified occupational therapy assistants. Occup Ther Health Care 2000; 12:95-109. [PMID: 23951992 DOI: 10.1080/j003v12n02_07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this correlational research study was to provide insights into specific extrinsic organizational rewards, extrinsic social rewards, and intrinsic rewards that lead to certified occupational therapy assistants' (COTA) organizational commitment, and how managers and recruiters can utilize this knowledge in developing more effective COTA recruitment and retention strategies. The target population for this investigation included COTAs who worked full-time in North Carolina, South Carolina, and Virginia and were members of the American Occupational Therapy Association. Findings from this study indicated that predictors of COTAs' organizational commitment were determined by intrinsically rewarding job tasks that were supported by their work environment, salary, and promotional opportunities.
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Affiliation(s)
- J Painter
- East Carolina University, Occupational Therapy Department, Belk Building, Greenville, NC, 27858
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Bell GD, Atkin WS, Painter J, Rowland RS, Dogramadzi S, Allen C. Increasing the reach of flexible sigmoidoscopy. Endoscopy 1999; 31:835-6. [PMID: 10604628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Painter J, Saunders DB, Bell GD, Williams CB, Pitt R, Bladen J. Depth of insertion at flexible sigmoidoscopy: implications for colorectal cancer screening and instrument design. Endoscopy 1999; 31:227-31. [PMID: 10344426 DOI: 10.1055/s-1999-13673] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND STUDY AIMS The depth of insertion at flexible sigmoidoscopy is variable, depending upon bowel preparation, patient tolerance and distal colonic anatomy. Many endoscopists routinely aim to insert the 60 cm flexible sigmoidoscope to the splenic flexure; however internal endoscopic markers are unreliable, making the true anatomical extent of the examination difficult to assess. The aim of this study was to assess the depth of insertion at flexible sigmoidoscopy. PATIENTS AND METHODS Two separate studies were done. In the first (study 1), magnetic endoscopic imaging was used to determine the final depth of insertion at non-sedated, screening flexible sigmoidoscopy. In the second (study 2), "real-time" imaging was utilized to determine sigmoid looping and the anatomical location of the endoscope tip after 60 cm of instrument had been inserted during total or limited colonoscopy. A total of 117 consecutive average-risk patients, aged 55-65 years participated in study 1, and 136 patients underwent either limited, (33) or attempted total colonoscopy (103) in study 2. RESULTS In study 1 the median insertion distance was 52 cm, range 20-58. In 61 % of patients the imaging system showed that the descending colon had not been visualized by the end of the procedure. Failure to reach the sigmoid/descending junction occurred in 29 (24%) patients. Reasons for failure included poor tolerance of the procedure due to pain (23 patients) inadequate preparation (3 patients) and, excessive looping (3 patients). In study 2, after 60 cm of instrument had been inserted, the splenic flexure or beyond was reached in 29% and the descending colon in 9%, whilst in 62 % the endoscope tip had not passed beyond the sigmoid/descending colon junction. A sigmoid loop formed in 70% of patients, and unusual loops such as the alpha, reverse alpha and reverse sigmoid spiral loop occurred more frequently in women compared to men (P = 0.0249). In those 104 patients where the splenic flexure was reached the mean maximum length of instrument inserted prior to reaching the flexure was 75.4 cm, (SD = 21.9). CONCLUSIONS Examination of the entire sigmoid was not achieved in approximately one-quarter of patients undergoing screening flexible sigmoidoscopy, mainly because of discomfort. The descending colon is intubated in a minority of cases (using standard instruments), even after 60 cm has been inserted. Alternative instruments with different shaft characteristics (floppy, narrow calibre, 80-100 cm in length) may be necessary to ensure deeper routine intubation in nonsedated patients.
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Abstract
BACKGROUND The pancreatic lesions of cystic fibrosis develop in utero and closely resemble those of chronic pancreatitis. Therefore, we hypothesized that mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene may be more common than expected among patients with chronic pancreatitis. METHODS We studied 134 consecutive patients with chronic pancreatitis (alcohol-related disease in 71, hyperparathyroidism in 2, hypertriglyceridemia in 1, and idiopathic disease in 60). We examined DNA for 22 mutations of the CFTR gene that together account for 95 percent of all mutations in patients with cystic fibrosis in the northwest of England. We also determined the length of the noncoding sequence of thymidines in intron 8, since the shorter the sequence, the lower the proportion of normal CFTR messenger RNA. RESULTS The 94 male and 40 female patients ranged in age from 16 to 86 years. None had a mutation on both copies of the CFTR gene. Eighteen patients (13.4 percent), including 12 without alcoholism, had a CFTR mutation on one chromosome, as compared with a frequency of 5.3 percent among 600 local unrelated partners of persons with a family history of cystic fibrosis (P<0.001). A total of 10.4 percent of the patients had the 5T allele in intron 8 (14 of 134), which is twice the expected frequency (P=0.008). Four patients were heterozygous for both a CFTR mutation and the 5T allele. Patients with a CFTR mutation were younger than those with no mutations (P=0.03). None had the combination of sinopulmonary disease, high sweat electrolyte concentrations, and low nasal potential-difference values that are diagnostic of cystic fibrosis. CONCLUSIONS Mutations of the CFTR gene and the 5T genotype are associated with chronic pancreatitis.
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Affiliation(s)
- N Sharer
- Pancreato-Biliary Unit, Manchester Royal Infirmary, United Kingdom
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Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) frequently damage the gastrointestinal tract, but with continued administration this usually resolves by a process of adaptation. There is evidence that the acute injury can be reduced by acid suppression, and animal models have shown that salivary epidermal growth factor (EGF) is an important factor in gastric mucosal adaptation. We therefore wanted to assess the effect of acid suppression and salivary EGF output during naproxen-induced acute gastric injury and subsequent adaptation. METHODS Healthy subjects were given a 14-day course of naproxen with different regimens of ranitidine and placebo. Before and on three occasions during treatment subjects provided a salivary sample for EGF and underwent gastroscopy to assess gastric damage. RESULTS Similar gastric damage occurred after 24 h in all groups and resolved in most subjects. Base-line salivary EGF output was similar in all groups but increased in the placebo/ranitidine group on day 3 and in the ranitidine group on day 9. CONCLUSIONS Acid suppression with ranitidine did not prevent acute gastric injury. Adaptation may be associated with an increase in salivary EGF output.
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Affiliation(s)
- G R Lipscomb
- Dept. of Medicine, North Manchester General Hospital, UK
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Abstract
Organizational commitment may have an important influence on work related outcomes (attrition, absenteeism, burnout, tardiness, and job performance) particularly during times of health care organizational turmoil and change. This study used a correlational research design with multiple regression analysis to determine the predictive power of extrinsic and intrinsic rewards as determinants of organizational commitment among occupational therapists (OTRs) working full-time in ambulatory care and hospital settings. Task involvement was a significant predictor of OTRs' commitment in both ambulatory care and hospital settings. General working conditions and task autonomy were significant determinants of commitment among OTRs working in ambulatory care settings. Salary and supervision were significant predictors of commitment among hospital OTRs. Given the demand for OTRs in ambulatory care and hospital settings, a better understanding of significant determinants that influence organizational commitment among OTRs could prove beneficial in developing recruitment and retention job design strategies.
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Affiliation(s)
- J Painter
- East Carolina University, Occupational Therapy Department, Belk Building, Greenville, NC, 27858
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Affiliation(s)
- J Painter
- School of Genetics, La Trobe University, Bundoora, Victoria, Australia.
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Affiliation(s)
- G Luikart
- School of Genetics and Human Variation, La Trobe University, Bundoora, Australia.
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Abstract
The purpose of this pilot study was to develop a home assessment specifically designed for people with Dementia of Alzheimer's type (DAT), and determine its effectiveness in designing appropriate environmental strategies. Since the home environment plays an integral role in monitoring ADL performance and behaviors of the AD population, an understanding of how environmental cues influence function and conduct is crucial when assessing and developing environmental intervention strategies. The new assessment, using a person-environment fit theoretical model, assisted the occupational therapist in evaluating the environment's legibility and stability to ensure a safe environment through specific physical, psychological, and social cues.
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Affiliation(s)
- J Painter
- Assistant Professor, Department of Occupational Therapy, School of Allied Health Sciences, East Carolina University, Greenville, NC, 27858
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Abstract
In a preliminary study, 30 sufferers of irritable bowel syndrome filled in daily symptom sheets and the combined Hassles and Uplifts questionnaire for five weeks. Initially, analyses were carried out for each symptom separately. Results showed that ratings on the hassles and symptoms questionnaires completed in the same week were more highly associated than ratings for hassles and symptoms in different weeks. No one symptom in any week was significantly associated with the following week's hassles. Similarly, hassles in any one week were not associated with the following week's symptoms. However, total symptoms were found to be significantly associated with hassles in the following weeks, whereas the association between hassles and total symptoms in the following weeks was not significant. The study suggests that there is a cumulative effect of symptoms such that an increase in the severity of the combined effect of symptoms is associated with an increase in severity of stress in the next week. Increased hassles do not appear to exacerbate symptoms. There was no evidence of an association between uplifts and IB symptoms.
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Painter J, Akroyd D, Wilson S, Figuers C. The predictive value of selected job rewards on occupational therapists' job satisfaction in ambulatory care settings. Occup Ther Health Care 1995; 9:21-37. [PMID: 23947585 DOI: 10.1080/j003v09n04_03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Using a perceived reward model of overall job satisfaction, this study utilized a correlational research design with multiple regression analysis to determine the predictive power of extrinsic rewards and intrinsic rewards, collectively and individually, as determinants of overall job satisfaction among registered occupational therapists (OTR) working full-time in ambulatory care settings. The intrinsic rewards (task involvement and task autonomy), collectively and individually, were perceived to be significant overall job satisfaction determinants. General working conditions was the only significant extrinsic reward. Given the demand for OTRs in ambulatory care settings, a better understanding of factors that influence overall job satisfaction among OTRs could prove beneficial in developing appropriate recruitment and retention job design strategies.
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Affiliation(s)
- J Painter
- Assistant Professor, Department of Occupational Therapy, School of Allied Health Sciences, East Carolina University, Greenville, NC, 27858
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Abstract
Forty subjects performed both of the following tasks. In the imagery task, simple dot patterns were presented for five seconds in free vision, followed by a three second fixation field. Subsequently, a circle was briefly presented in either the right or the left visual field and subjects were required to indicate whether or not the circle surrounded a point previously occupied by a dot. The perceptual task was similar except that the dot patterns remained on the screen while the circle was presented. Reaction times and error data indicated a left visual field advantage on the imagery task only, suggesting a right hemisphere superiority for extraction of spatial information from images.
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Affiliation(s)
- C C French
- Department of Psychology, Goldsmiths' College, University of London
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Painter J. Family intervention with the traumatically brain injured patient. Occup Ther Health Care 1990; 7:69-85. [PMID: 23952490 DOI: 10.1080/j003v07n01_07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The occupational therapist plays an integral role in the evaluation and treatment of the traumatically brain injured (TBI) patient. Although the TBI patient's needs are relatively well-defined by the nature of the injury, less well recognized and frequently over- 1ooked is the emotional and psychological trauma experienced by the family of the TBI patient. Depending on the information provided, the family can be an asset or hindrance in the patient's rehabilitation. By working with the TBI patient's family, the occupational therapist can guide the family into a more cohesive force that will assist the patient throughout the rehabilitative process. This article provides suggestions to evaluate and manage concerns and fears raised by the families of TBI patients. It rovides an organizational guideline for educating the family about BI and incorporating them in the rehabilitation of the TBI patient.
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Affiliation(s)
- J Painter
- Assistant Professor, Department of Occupational Therapy, East Carolina University, Greenville, NC, 27858
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Abstract
We describe an antialiasing system for ray tracing based on adaptive progressive refinement. The goals of the system are to produce high quality antialiased images at a modest average sample rate, and to refine the image progressively so that the image is available in a usable form early and is refined gradually toward the final result.The method proceeds by adaptive stochastic sampling of the image plane, evaluation of the samples by ray tracing, and image reconstruction from the samples. Adaptive control of the sample generation process is driven by three basic goals: coverage of the image, location of features, and confidence in the values at a distinguished "pixel level" of resolution.A three-stage process of interpolation, filtering, and resampling is used to reconstruct a regular grid of display pixels. This reconstruction can be either batch or incremental.
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Painter J, Hickey RJ. Arguments against NLRB regulation of hospitals. Hosp Prog 1973; 54:47-53. [PMID: 4711561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Painter J. Rheumatoid arthritis. Occupational therapy. J R Coll Gen Pract 1969; 18:27-9. [PMID: 5351014 PMCID: PMC2635189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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