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Moskovitz M, Jao K, Su J, Brown MC, Naik H, Eng L, Wang T, Kuo J, Leung Y, Xu W, Mittmann N, Moody L, Barbera L, Devins G, Li M, Howell D, Liu G. Combined cancer patient-reported symptom and health utility tool for routine clinical implementation: a real-world comparison of the ESAS and EQ-5D in multiple cancer sites. ACTA ACUST UNITED AC 2020; 26:e733-e741. [PMID: 31896943 DOI: 10.3747/co.26.5297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (hus) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population. Methods Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (esas) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses. Results Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each esas symptom score and the hus (Spearman coefficients: -0.204 to -0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = -0.416), tiredness (R = -0.387), and depression (R =-0.354). Multivariable analyses identified pain and depression as highly associated (both p < 0.0001) and tiredness as associated (p = 0.03) with the hus. The ability of the esas to predict the hus was low, at 0.25. However, by mapping esas pain, anxiety, and depression scores to the corresponding EQ-5D questions, we could derive the hus using partial esas data, with Spearman correlations of 0.83-0.91 in comparisons with direct EQ-5D measurement of the hus. Conclusions The hus derived from the EQ-5D-3L is associated with all major cancer symptoms as captured by the esas. The esas scores alone could not predict EQ-5D scores with high accuracy. However, esas-derived questions assessing the same domains as the EQ-5D-3L questions could be mapped to their corresponding EQ-5D questions to generate the hus, with high correlation to the directly measured hus. That finding suggests a potential approach to integrating routine symptom and hus evaluations after confirmatory studies.
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Affiliation(s)
- M Moskovitz
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - K Jao
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Hôpital du Sacré-Coeur, McGill University, Montreal, QC
| | - J Su
- Department of Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - M C Brown
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - H Naik
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Department of Medicine, University of British Columbia, Vancouver, BC
| | - L Eng
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - T Wang
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Faculty of Pharmacy, University of Toronto, Toronto, ON
| | - J Kuo
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON
| | - Y Leung
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - W Xu
- Department of Biostatistics, Ontario Cancer Institute, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - N Mittmann
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, University of Toronto, Toronto, ON
| | - L Moody
- Cancer Care Ontario, Toronto, ON
| | - L Barbera
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, University of Toronto, Toronto, ON
| | - G Devins
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON.,Department of Psychiatry, University of Toronto, Toronto, ON
| | - M Li
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - D Howell
- Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON.,Lawrence Bloomberg School of Nursing, University of Toronto, Toronto, ON
| | - G Liu
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON.,Department of Epidemiology, Dalla Lana School of Public Health, Department of Medical Biophysics, and Institute of Medical Science, University of Toronto, Toronto, ON
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Abstract
Background Patient experience is often measured quantitatively, but that approach has limitations for understanding the entire experience. Qualitative methods can help to understand more complex issues most important to patients and their families. The purpose of the present work was to use a qualitative analysis examining the patient experience of ambulatory cancer care in Ontario to generate a deeper understanding of the patient experience and to lead to solutions for improvement. Methods Data from the Ambulatory Oncology Patient Satisfaction Survey (aopss) for 2013-2015 were used to conduct a qualitative content analysis. The aopss is a retrospective paper-based survey, mailed to patients who are currently receiving cancer treatment or who have received cancer treatment within the preceding 6 months, that is designed to capture their experiences. Patients who were surveyed were asked, "Is there anything else you would like to tell us about your cancer care services?" The National Research Corporation Canada's patient-centred care framework was used to guide the analysis. Results From the 5391 patients who responded, 7328 coded responses were generated, of which 3658 (49.9%) were related to the patient-centred care framework. New subthemes were identified: diagnosis sensitivity; emotional support resources; care delivery with care, compassion, and comfort; continuity of care between departments and in the community; access to cancer centre personnel; patient-health care provider communication; confidence in the health care provider; wait times; health care provider and treatment coordination; and parking. Conclusions The results identify facilitators and barriers to the patient experience in the ambulatory cancer treatment setting from the patient perspective and identify opportunities to improve the patient experience.
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Affiliation(s)
- E Bridge
- Cancer Care Ontario, Toronto, ON
| | - L Gotlib Conn
- Cancer Care Ontario, Toronto, ON.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON
| | - S Dhanju
- Cancer Care Ontario, Toronto, ON
| | - S Singh
- Cancer Care Ontario, Toronto, ON.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
| | - L Moody
- Cancer Care Ontario, Toronto, ON
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Singh S, Moody L, Chan D, Metz D, Strosberg J, Segelov E. Follow-up recommendations for completely resected gastroenteropancreatic neuroendocrine tumours (GEP-NETs): Consensus guidelines from the Commonwealth NET collaboration (CommNETs) in conjunction with the North American NET Society (NANETS). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.013] [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: 11/13/2022] Open
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Chan D, Segelov E, Moody L, Liu N, Fischer H, Austin P, Singh S. Follow-up and recurrence in resected gastroenteropancreatic neuroendocrine tumours: A population-based study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.031] [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: 11/14/2022] Open
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5
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Moody L, Satterwhite E, Bickel WK. Substance Use in Rural Central Appalachia: Current Status and Treatment Considerations. Rural Ment Health 2017; 41:123-135. [PMID: 29057030 PMCID: PMC5648074 DOI: 10.1037/rmh0000064] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The burden of substance use and especially the unmatched rates of overdoses in rural Central Appalachia highlight the need for innovative approaches to curb the initiation to drug misuse and to address current substance use disorders. Effective substance use interventions involve a thorough understanding of the region. In Central Appalachia, many of the barriers to treatment are shared with other rural and impoverished areas, including a lack of access to health care and lack of health care providers with specialized training. Parts of Appalachia also present their own considerations, including the challenges of fostering trust and encouraging treatment-seeking in communities with dense, long-term, place-based social and family networks. Current policies and interventions for substance use have been largely inadequate in the region, as evidenced by continued increases in substance use and substance-related deaths, especially related to nonmedical prescription drug use and increasing heroin use. The authors discuss ways in which rural life, poverty, identity, and values in Appalachia have influenced substance use and treatment and propose strategies and interventions to improve outcomes.
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Affiliation(s)
- Lara Moody
- Virginia Tech Carilion Research Center, Roanoke, VA, USA
- Virginia Tech, Department of Psychology, Blacksburg, VA, USA
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6
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Patel D, Chan D, Moody L, Cehic G, Segelov E, Singh S. 419P Optimal follow-up strategy for resected neuroendocrine tumours: A systematic review. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw590.005] [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: 11/13/2022] Open
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Bickel WK, Moody L, Higgins ST. Some current dimensions of the behavioral economics of health-related behavior change. Prev Med 2016; 92:16-23. [PMID: 27283095 PMCID: PMC5085840 DOI: 10.1016/j.ypmed.2016.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 11/22/2022]
Abstract
Health-related behaviors such as tobacco, alcohol and other substance use, poor diet and physical inactivity, and risky sexual practices are important targets for research and intervention. Health-related behaviors are especially pertinent targets in the United States, which lags behind most other developed nations on common markers of population health. In this essay we examine the application of behavioral economics, a scientific discipline that represents the intersection of economics and psychology, to the study and promotion of health-related behavior change. More specifically, we review what we consider to be some core dimensions of this discipline when applied to the study health-related behavior change. Behavioral economics (1) provides novel conceptual systems to inform scientific understanding of health behaviors, (2) translates scientific understanding into practical and effective behavior-change interventions, (3) leverages varied aspects of behavior change beyond increases or decreases in frequency, (4) recognizes and exploits trans-disease processes and interventions, and (5) leverages technology in efforts to maximize efficacy, cost effectiveness, and reach. These dimensions are overviewed and their implications for the future of the field discussed.
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Affiliation(s)
- Warren K Bickel
- Virginia Tech Carilion Research Institute, Department of Psychology, Roanoke, VA, USA.
| | - Lara Moody
- Virginia Tech Carilion Research Institute, Department of Psychology, Roanoke, VA, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; University of Vermont, Departments of Psychiatry and Psychology, USA
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8
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Moody L, Franck C, Bickel WK. Comorbid depression, antisocial personality, and substance dependence: Relationship with delay discounting. Drug Alcohol Depend 2016; 160:190-6. [PMID: 26846198 PMCID: PMC4767536 DOI: 10.1016/j.drugalcdep.2016.01.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Within the field of addiction, as many as four-fifths of individuals in treatment for substance use disorder have co-existing lifetime psychopathology and as high as two-thirds have current psychopathology. Among substance-dependent individuals, excessive delay discounting is pervasive. Despite evidence of excessive discounting across substance use disorders, few studies have investigated the impact of co-occurring psychopathologies and SUD on delay discounting. METHODS We compared delay discounting in currently abstaining substance users with (a) SUD (n=166), (b) SUD and managed major depressive disorder (MDD; n=44), (c) SUD and antisocial personality disorder (APD; n=35), (d) SUD and managed MDD and APD (n=22) and (e) no SUD or co-occurring psychopathology (n=60). RESULTS All groups with SUD discounted future delayed rewards significantly more than healthy controls (p<0.001 in each case, d=0.686, 0.835, 1.098 and 1.650, respective to groups a-d above). Individuals with both APD and SUD and individuals with MDD, APD, and SUD discounted future rewards significantly more than substance users without comorbid psychopathology (p=0.029, d=0.412 and p<0.001, d=0.964, respectively). CONCLUSIONS Overall, individuals with multiple psychopathologies in addition to substance use have exacerbated deficits in discounting of the future, above and beyond that observed in substance use alone. Increased discounting in combined substance and psychopathology profiles suggest a greater chance of treatment failure and therefore may necessitate individualized treatment using adjunctive interventions to achieve better treatment outcomes.
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Affiliation(s)
- Lara Moody
- Virginia Tech Carilion Research Center, Roanoke, VA, 24016 USA,Virginia Tech, Department of Psychology, Blacksburg, VA, 24061 USA
| | - Christopher Franck
- Virginia Tech Carilion Research Center, Roanoke, VA, 24016 USA,Virginia Tech, Department of Statistics, Blacksburg, VA, 24061 USA
| | - Warren K. Bickel
- Virginia Tech Carilion Research Center, Roanoke, VA, 24016 USA,Corresponding author at: Director, Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, USA,
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Moody L, Franck C, Hatz L, Bickel WK. Impulsivity and polysubstance use: A systematic comparison of delay discounting in mono-, dual-, and trisubstance use. Exp Clin Psychopharmacol 2016; 24:30-7. [PMID: 26691847 PMCID: PMC4821755 DOI: 10.1037/pha0000059] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Understanding the association between polysubstance use and impulsivity is pertinent to treatment planning and efficacy. Delay discounting, a measure of impulsivity, supplies the rate at which a reinforcer loses value as the temporal delay to its receipt increases. Excessive delay discounting has been widely observed among drug-using individuals, though the impact of using more than 1 substance has been only minimally studied. Here, after controlling for demographic variables, we systematically compared delay discounting in community controls, heavy smokers, and alcohol- and cocaine-dependent individuals to assess the impact of non-, mono-, dual-, and trisubstance use. All substance-using groups discounted significantly more than did community controls (p < .05). Additionally, groups that smoked cigarettes in addition to another substance dependency discounted significantly more than did the group that smoked cigarettes only (p < .05). Last, trisubstance users who were alcohol-dependent, cocaine-dependent, and heavy cigarette smokers discounted significantly more than did heavy smokers (p < .01). However, trisubstance users did not discount significantly more than did any dual-substance group. Trisubstance use was associated with greater impulsivity than was monosubstance smoking but exhibited no greater impulsivity than did dual-substance use, suggesting a ceiling effect on discounting when more than 2 substances are in use. The present study suggests that smokers who engage in additional substance use may experience worse treatment outcomes, given that excessive discounting is predictive of poor therapeutic outcomes in several studies.
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Affiliation(s)
- Lara Moody
- Virginia Tech Carilion Research Center, Roanoke, VA, USA, Virginia Tech, Department of Psychology, Blacksburg, VA,
USA
| | - Christopher Franck
- Virginia Tech Carilion Research Center, Roanoke, VA, USA, Virginia Tech, Department of Statistics, Blacksburg, VA,
USA
| | - Laura Hatz
- Virginia Tech Carilion Research Center, Roanoke, VA, USA
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10
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Glass L, Moody L, Grafman J, Krueger F. Neural signatures of third-party punishment: evidence from penetrating traumatic brain injury. Soc Cogn Affect Neurosci 2015; 11:253-62. [PMID: 26276809 DOI: 10.1093/scan/nsv105] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/08/2015] [Indexed: 11/15/2022] Open
Abstract
The ability to survive within a cooperative society depends on impartial third-party punishment (TPP) of social norm violations. Two cognitive mechanisms have been postulated as necessary for the successful completion of TPP: evaluation of legal responsibility and selection of a suitable punishment given the magnitude of the crime. Converging neuroimaging research suggests two supporting domain-general networks; a mentalizing network for evaluation of legal responsibility and a central-executive network for determination of punishment. A whole-brain voxel-based lesion-symptom mapping approach was used in conjunction with a rank-order TPP task to identify brain regions necessary for TPP in a large sample of patients with penetrating traumatic brain injury. Patients who demonstrated atypical TPP had specific lesions in core regions of the mentalizing (dorsomedial prefrontal cortex [PFC], ventromedial PFC) and central-executive (bilateral dorsolateral PFC, right intraparietal sulcus) networks. Altruism and executive functioning (concept formation skills) were significant predictors of TPP: altruism was uniquely associated with TPP in patients with lesions in right dorsolateral PFC and executive functioning was uniquely associated with TPP in individuals with lesions in left PFC. Our findings contribute to the extant literature to support underlying neural networks associated with TPP, with specific brain-behavior causal relationships confirming recent functional neuroimaging research.
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Affiliation(s)
- Leila Glass
- Department of Psychology, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lara Moody
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA, Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Jordan Grafman
- Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Frank Krueger
- Molecular Neuroscience Department and Department of Psychology, George Mason University, Fairfax, VA, USA
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11
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Bickel WK, Quisenberry AJ, Moody L, Wilson AG. Therapeutic Opportunities for Self-Control Repair in Addiction and Related Disorders: Change and the Limits of Change in Trans-Disease Processes. Clin Psychol Sci 2015; 3:140-153. [PMID: 25664226 PMCID: PMC4314724 DOI: 10.1177/2167702614541260] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Contemporary neuro-economic approaches hypothesize that self-control failure results from drugs annexing normal learning mechanisms that produce pathological reward processing and distort decision-making as a result from the dysregulation of two valuation systems. An emphasis on processes shared across different diseases and disorders is at odds with the contemporary approach that assumes unique disease etiologies and treatments. Studying trans-disease processes can identify mechanisms that operate in multiple disease states and ascertain if factors that influence processes in one disease state may be applicable to all disease states. In this paper we review the dual model of self-control failure, the Competing Neurobehavioral Decision Systems approach, the relationship of delay discounting to the relative control of these two systems, and evidence that the executive system can be strengthened. Future research that could result in more potent interventions for executive system improvement and potential constraints on the repair of self-control failure are discussed.
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Affiliation(s)
| | | | - Lara Moody
- Virginia Tech Carilion Research Institute, Roanoke, VA
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12
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Bickel WK, Moody L, Quisenberry AJ, Ramey CT, Sheffer CE. A Competing Neurobehavioral Decision Systems model of SES-related health and behavioral disparities. Prev Med 2014; 68:37-43. [PMID: 25008219 PMCID: PMC4253853 DOI: 10.1016/j.ypmed.2014.06.032] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/24/2014] [Accepted: 06/29/2014] [Indexed: 01/05/2023]
Abstract
We propose that executive dysfunction is an important component relating to the socio-economic status gradient of select health behaviors. We review and find evidence supporting an SES gradient associated with (1) negative health behaviors (e.g., obesity, excessive use of alcohol, tobacco and other substances), and (2) executive dysfunction. Moreover, the evidence supports that stress and insufficient cognitive resources contribute to executive dysfunction and that executive dysfunction is evident among individuals who smoke cigarettes, are obese, abuse alcohol, and use illicit drugs. Collectively these data support the dual system model of cognitive control, referred to here as the Competing Neurobehavioral Decision Systems hypothesis. The implications of these relationships for intervention and social justice considerations are discussed.
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Affiliation(s)
- W K Bickel
- Virginia Tech Carilion Research Institute, Roanoke, VA 24016, USA.
| | - L Moody
- Virginia Tech Carilion Research Institute, Roanoke, VA 24016, USA
| | - A J Quisenberry
- Virginia Tech Carilion Research Institute, Roanoke, VA 24016, USA
| | - C T Ramey
- Virginia Tech Carilion Research Institute, Roanoke, VA 24016, USA
| | - C E Sheffer
- The City College of New York, New York, NY 10031, USA
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Feeney EJ, Stephenson D, Kleiman R, Bove S, Cron C, Moody L, Robinson M, Ramirez JJ. Immunohistochemical characterization of axonal sprouting in mice. Restor Neurol Neurosci 2014; 31:517-31. [PMID: 23756540 DOI: 10.3233/rnn-130311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Transgenic manipulation of mouse physiology facilitates the preclinical study of genetic risk factors, neural plasticity, and reactive processes accompanying Alzheimer's disease. Alternatively, entorhinal cortex lesions (ECLs) model pathophysiological denervation and axonal sprouting in rat. Given reports of anatomical differences between the mouse and rat hippocampus, application of the ECL paradigm to transgenic mice first requires comprehensive characterization of axonal sprouting in the wild-type. METHODS Adult male C57BL/6 mice sustained unilateral transections of the perforant pathway. Subjects were sacrificed at 1, 4, 10, 18, and 28 days postlesion, and hippocampal sections were stained for AChE, the postsynaptic terminal marker drebrin, and the presynaptic terminal proteins SNAP-25, GAP-43, synapsin, and synaptophysin. To examine synaptic turnover and reinnervation, ipsilateral-to-contralateral staining densities were determined within the dentate molecular layer, and shrinkage-corrected ratios were compared to 28 day-yoked sham cases. RESULTS At 28 days postlesion, ipsilateral terminal marker densities exhibited significant depression. In contrast, qualitative analyses at earlier time points suggested altered AChE staining patterns and increased SNAP-25 and synapsin immunoreactivity in the inner molecular layer (IML) of the dentate gyrus. CONCLUSIONS C57BL/6 mice exhibit synaptic reorganization following perforant path transections. The IML may provide a key target for evaluation and intervention in ECL mouse models.
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Affiliation(s)
- Erin J Feeney
- Neuroscience Program, Davidson College, Davidson, NC, USA
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Bickel WK, Moody L, Quisenberry A. Computerized Working-Memory Training as a Candidate Adjunctive Treatment for Addiction. Alcohol Res 2014; 36:123-6. [PMID: 26259006 PMCID: PMC4432851] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Alcohol and other drug dependencies are, in part, characterized by deficits in executive functioning, including working memory. Working-memory training is a candidate computerized adjunctive intervention for the treatment of alcoholism and other drug dependencies. This article reviews emerging evidence for computerized working memory training as an efficacious adjunctive treatment for drug dependence and highlights future challenges and opportunities in the field of working-memory training, including duration of training needed, persistence of improvements and utility of booster sessions, and selection of patients based on degree of deficits.
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Affiliation(s)
- Warren K Bickel
- Virginia Tech Carilion Research Institute; Department of Psychology, Virginia Tech, Roanoke, Virginia
| | - Lara Moody
- Virginia Tech; Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, Virginia
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15
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Bickel WK, Koffarnus MN, Moody L, Wilson AG. The behavioral- and neuro-economic process of temporal discounting: A candidate behavioral marker of addiction. Neuropharmacology 2013; 76 Pt B:518-27. [PMID: 23806805 DOI: 10.1016/j.neuropharm.2013.06.013] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [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: 02/04/2013] [Revised: 05/17/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Abstract
Addiction science would benefit from the identification of a behavioral marker. A behavioral marker could reflect the projected clinical course of the disorder, function as a surrogate measure of clinical outcome, and/or may be related to biological components that underlie the disorder. In this paper we review relevant literature, made possible with the early and sustained support by NIDA, to determine whether temporal discounting, a neurobehavioral process derived from behavioral economics and further explored through neuroeconomics, may function as a behavioral marker. Our review suggests that temporal discounting 1) identifies individuals who are drug-dependent, 2) identifies those at risk of developing drug dependence, 3) acts as a gauge of addiction severity, 4) correlates with all stages of addiction development, 5) changes with effective treatment, and 6) may be related to the biological and genetic processes that underlie addiction. Thus, initial evidence supports temporal discounting as a candidate behavioral marker. Additional studies will be required in several areas for a more conclusive determination. Confirmation that temporal discounting functions as a behavioral marker for addiction could lead to 1) a screen for new treatments, 2) personalization of prevention and treatment interventions, and 3) the extension of temporal discounting as a behavioral marker for other etiologically similar disorders. This article is part of a Special Issue entitled 'NIDA 40th Anniversary Issue'.
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Affiliation(s)
- Warren K Bickel
- Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, USA.
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16
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Krueger F, Parasuraman R, Moody L, Twieg P, de Visser E, McCabe K, O'Hara M, Lee MR. Oxytocin selectively increases perceptions of harm for victims but not the desire to punish offenders of criminal offenses. Soc Cogn Affect Neurosci 2012; 8:494-8. [PMID: 22368214 DOI: 10.1093/scan/nss026] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The neuropeptide oxytocin functions as a hormone and neurotransmitter and facilitates complex social cognition and approach behavior. Given that empathy is an essential ingredient for third-party decision-making in institutions of justice, we investigated whether exogenous oxytocin modulates empathy of an unaffected third-party toward offenders and victims of criminal offenses. Healthy male participants received intranasal oxytocin or placebo in a randomized, double-blind, placebo-controlled, between-subjects design. Participants were given a set of legal vignettes that described an event during which an offender engaged in criminal offenses against victims. As an unaffected third-party, participants were asked to rate those criminal offenses on the degree to which the offender deserved punishment and how much harm was inflicted on the victim. Exogenous oxytocin selectively increased third-party decision-makers' perceptions of harm for victims but not the desire to punish offenders of criminal offenses. We argue that oxytocin promoted empathic concern for the victim, which in turn increased the tendency for prosocial approach behavior regarding the interpersonal relationship between an unaffected third-party and a fictional victim in the criminal scenarios. Future research should explore the context- and person-dependent nature of exogenous oxytocin in individuals with antisocial personality disorder and psychopathy, in whom deficits in empathy feature prominently.
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Affiliation(s)
- Frank Krueger
- Department of Molecular Neuroscience, George Mason University, 4400 University Drive, Mail Stop 2A1, Fairfax, VA 22030, USA.
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Matlow AG, Moody L, Laxer R, Stevens P, Goia C, Friedman JN. Disclosure of medical error to parents and paediatric patients: assessment of parents' attitudes and influencing factors. Arch Dis Child 2010; 95:286-90. [PMID: 19948514 DOI: 10.1136/adc.2009.163097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess parental preferences for medical error disclosure and evaluate associated factors. DESIGN Prospective survey. SETTING Hospital for Sick Children, Toronto, Canada. PARTICIPANTS Parents of inpatients and outpatients. MAIN EXPOSURE Anonymous questionnaire administered on May to August 2006, surveying demographic characteristics and identifying parents' thresholds for disclosure using a vignette with six levels of harm. MAIN OUTCOME MEASURES Preferred thresholds for parent and patient disclosure and associated factors. RESULTS 99% of 431 parents (181 inpatients, 250 outpatients) wanted disclosure if there was potential or actual harm versus 77% if there was none (p<0.0001). Most parents (71% vs 41%) wanted their child similarly informed (p<0.0001). Parental age, education, experience with error and child's age did not affect preferences for disclosure. Parents of inpatients (p=0.03, OR 1.65, 95% CI 1.04 to 2.62) and those born in Asia (vs North America) had a lower disclosure threshold (p=0.014, OR 2.4, 95% CI 1.2 to 4.9), and administering the survey with increasing harm had a higher disclosure threshold (p<0.0001, OR 2.46; 95% CI 1.58 to 3.83). EXPERIENCE WITH ERROR: (p=0.05, OR 1.5, 95% CI 1 to 2.2) and child age (eg, <or=6 years vs >or= 11 years (p<0.0001, OR 2.74, 95% CI 1.73 to 4.33)) directly affected preferences for informing the child. Asian parents had a lower threshold for informing the child than North American parents. CONCLUSIONS Most parents want disclosure and want their child informed of errors with harm. While parental birth country, experience with error and patient age influenced parents' desire for disclosure to their child, the details of disclosure warrant study.
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Affiliation(s)
- A G Matlow
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
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Mattiasson AC, Andersson L, Mullins LC, Moody L. A comparative empirical study of autonomy in nursing homes in Sweden and Florida, USA. J Cross Cult Gerontol 2003; 12:299-316. [PMID: 14617922 DOI: 10.1023/a:1006531100836] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study seeks to comparatively examine how autonomy is evaluated by a sample of nursing staff in both Sweden and Florida, USA. In both cultures support for patient autonomy was generally greater from an individual point of view than from the anticipated institutional perspective. Comparisons between the cultures revealed that individual staff members in the Swedish nursing homes generally gave higher priority to patient preference than did their American counterparts. On the other hand, support for patient preference was generally greater in the American nursing homes in regard to institutionally anticipated decision. There were statistically significant mean value differences between Swedish nursing staff's personal opinion and anticipated institutional decisions in five of six case studies. Nursing staff's personal opinion showed a stronger support for patient's preferences. There was a statistically significant mean value difference between American nursing staffs' personal opinion and anticipated institutional decisions in only one of the six case studies. In spite of cultural differences the reported results to some degree reflect a common value-system regarding both the anticipated institutional perspective and nursing staffs' personal opinion.
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Affiliation(s)
- A C Mattiasson
- Department of Clinical Neuroscience and Family Medicine, Division of Geriatric Medicine, Karolinska Institute, Stockholm Gerontology Research Center, and HM Queen Sophia University College of Nursing, Stockholm, Sweden.
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Dawar M, Moody L, Martin JD, Fung C, Isaac-Renton J, Patrick DM. Two outbreaks of botulism associated with fermented salmon roe--British Columbia, August 2001. Can Commun Dis Rep 2002; 28:45-9. [PMID: 11925710] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- M Dawar
- First Nations and Inuit Health Branch, British Columbia-Yukon Region, Health Canada
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Bednash G, Jones CB, Moody L, Wakefield M. Building health services research capacity in nursing: views from members of nursing's leadership [interview by Candice Cook Bowman and Deborah Gardner]. Nurs Outlook 2001; 49:187-92. [PMID: 11514792 DOI: 10.1067/mno.2001.116334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite a short history that dates back to the 1960s, health services research (HSR) has become an important force in shaping the delivery system in the current health care environment. Nursing has been noticeably absent from this endeavor, and if it does not increase its presence, it risks missing an important opportunity to influence future directions of health care delivery. PURPOSE Our purpose was to evaluate the state of nursing's HSR contributions and to consider ways to increase its capacity in this arena. METHOD An interview with four members from nursing's leadership was conducted. DISCUSSION Nurses can increase the capacity by becoming better collaborators with those who are currently contributing to HSR, both nurses and members of other healthcare disciplines. Also, by reshaping undergraduate and graduate curricula and creating mentorships, nursing can increase its involvement through an informed workforce. CONCLUSIONS Solutions that were offered in this discussion are presented.
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Affiliation(s)
- G Bednash
- Quality Enhancement Research Initiative-HIV, Veterans Affairs San Diego Healthcare System, San Diego, Calif., USA.
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Moody L, MacAlister J, Hampers LC. Management of life-threatening malaria. Pediatr Emerg Care 2000; 16:426-8. [PMID: 11138889 DOI: 10.1097/00006565-200012000-00014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- L Moody
- Children's Memorial Hospital, Chicago, IL 60614, USA.
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Moody L, Rowland K, Fairlough F, Al-Khoffash M. Stroke care. Different strokes. Health Serv J 1996; 106:26-7. [PMID: 10158495] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- L Moody
- Bassetlaw Hospital and Community Services Trust, UK
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Moody L, Snyder PE. Hospital provider satisfaction with a new documentation system. Nurs Econ 1995; 13:24-31. [PMID: 7760945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Nursing documentation is an important component of clinical nursing practice. It is estimated that 15%-20% of work time is spent documenting patient information and that documentation is the most common cause for overtime. An evaluation of hospital staff satisfaction with a recently implemented documentation system showed that 70% are satisfied with the new system; 75% agree that consistency of nursing documentation has improved; 72% agree that availability of records has improved; 78% agree the placement of the nursing documentation at the point of service facilitates location of data; and 65% agree there has been a decrease in the number of forms they have to review in order to locate nursing information.
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Livengood JM, Parris WCV, Moody L, Wood D, Swearingen C. Integrative Versus Rote Memory in Chronic Pain Patients. Anesthesiology 1994. [DOI: 10.1097/00000542-199409001-01042] [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: 11/25/2022]
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Nelson A, Goltry P, Loewenhardt P, Moody L. Long-range planning initiative for AASCIN: a Delphi study. SCI Nurs 1993; 10:36-48. [PMID: 8351505] [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: 05/22/2023]
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Tittle MB, Moody L, Becker MP. Nursing care requirements of patients with DNR orders in intensive care units. Heart Lung 1992; 21:235-42. [PMID: 1592613] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to examine the differences in demographic characteristics and nursing care requirements of patients with and patients without DNR (do not resuscitate) orders in intensive care. The sample consisted of 62 patients with and 62 without DNR orders from the intensive care units of three community hospitals. Data were collected until patients recovered and were transferred from the unit or until death occurred. Data were analyzed by chi-square tests for homogeneity, t tests, and analysis of covariance. Patients with DNR orders were white (p = 0.015), older (p = 0.03), more likely to reside in nursing homes (p = 0.04), had longer intensive care stays (p = 0.0005), were more likely to be admitted from another nursing unit (p less than 0.001), and had higher mortality rates (p less than 0.001). In intensive care settings, patients with DNR orders received more nursing care than patients who did not have DNR orders.
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Affiliation(s)
- M B Tittle
- College of Nursing, University of South Florida, Tampa 33612
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Tittle MB, Moody L, Becker MP. Severity of illness and resource allocation in DNR patients in ICU. Nurs Econ 1992; 10:210-6. [PMID: 1513394] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examined the differences in severity of illness and resource allocation between patients with do-not-resuscitate (DNR) orders and non-DNR patients in intensive care units. Severely ill intensive care patients with DNR orders continued receiving aggressive medical care following cardiac or respiratory arrest. The continued use of advanced therapies for DNR patients raises important questions about the use of costly intensive care resources.
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Abstract
The purpose of this study was to identify which variables are the best predictors of a do-not-resuscitate (DNR) classification and develop a model to predict the nursing care required by DNR patients in the ICU. Data collected on DNR and non-DNR patients included nursing care requirements, severity of illness, resource allocation and sociodemographic characteristics. One model identified the best predictors of a DNR classification in intensive care as the origin of admission and the severity of illness score on the day of admission to intensive care. The second model identified the best predictors of nursing care requirements for DNR patients in intensive care as the number of days spent in intensive care prior to the DNR order, the average daily resource allocation points after the DNR order, and the severity of illness score on the day the DNR order was designated.
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Affiliation(s)
- L Moody
- University of South Florida College of Nursing, Tampa
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Affiliation(s)
- P Hermansdorfer
- American Organization of Nurse Executives Scholar, Indialantic, FL 32903
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Moody L, McCormick K, Williams A. Disease and symptom severity, functional status, and quality of life in chronic bronchitis and emphysema (CBE). J Behav Med 1990; 13:297-306. [PMID: 2213871 DOI: 10.1007/bf00846836] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A path analysis model examined interrelationships among variables significantly associated with chronic dyspnea in chronic bronchitis and emphysema (CBE) and the relative influence of these variables on each other and on functional status and quality of life. Results from the 45 adults (mean age, 61) with moderate CBE disease severity showed that dyspnea severity has a sizable effect on functional status and quality of life. Disease severity was more strongly related to functional status than to quality of life. Depression and mastery had the strongest total effects on quality of life. Dyspnea severity had strong but separate effects on functional status and quality of life. From these preliminary results, it is suggested that a direct focus on psychologic interventions to ameliorate depression and improve mastery is likely to improve quality of life with some resultant positive effect on functional status.
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Affiliation(s)
- L Moody
- University of Florida, College of Nursing, Gainesville 32610
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Schwartz R, Moody L, Yarandi H, Anderson GC. A meta-analysis of critical outcome variables in nonnutritive sucking in preterm infants. Nurs Res 1987; 36:292-5. [PMID: 3650803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The advantages and limitations of meta-analysis in clinical nursing research are explained and illustrated with five studies of nonnutritive sucking (NNS) in preterm infants. This article addresses steps of locating studies, systematic comparison of studies for like variables, and qualitative decisions needed before quantitative methods are applied to cumulate findings across studies. Several approaches of calculating effect size and confidence intervals were used to interpret the power of the treatment effect of NNS. On average, across the five NNS studies, NNS intervention reduced time to first bottle feeding by 2.9 days and days of hospitalization by 6.3 days.
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Abstract
Traditional quantitative methods for evaluating neuropathy may be problematic or insufficiently sensitive as screening tools; standard electrophysiological techniques (nerve conduction velocities and electromyography) are often no more sensitive or reproducible, and in some cases are less sensitive, than the clinical neurological examination. Several promising methods for the evaluation of subclinical neurotoxic effects, including somatosensory and visual evoked potentials, quantitative sensory testing of temperature and vibration, and specialized nerve conduction testing, will be discussed. The crucial issues of sensitivity, standardized test procedures, reproducibility, and practical application in the field setting are currently being examined for these and other techniques. It should be recognized, however, that a brief, directed clinical examination may currently serve as the best screening battery for certain neurotoxins. The most appropriate screening tests can be devised when the neurotoxin is identified and its effects known.
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Shah Y, Zevallos H, Moody L. Combined intra- and extrauterine pregnancy. A diagnostic challenge. J Reprod Med 1980; 25:290-2. [PMID: 6450285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case of combined intrauterine and tubal pregnancy is reported and illustrates the difficulties of correctly diagnosing combined pregnancy. The patient had no signs or symptoms suggestive of a tubal pregnancy at the time of termination of the intrauterine pregnancy. She underwent two repeat uterine evacuation procedures, an ultrasonic examination and a diagnostic laparoscopy before the unruptured tubal pregnancy was diagnosed. Both pregnancies probably occurred during the same menstrual cycle.
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Abstract
Since March 1974, laparoscopic sterilizations have been performed on patients under local anesthesia at The Hope Clinic for Women, an outpatient facility that is not based in a hospital. No major surgical complications have resulted from these procedures, and less than 1% of the patients experienced minor complications. Neither general anesthesia nor hospitalization has been necessary for any of the women sterilized. The results of this study show that outpatient laparoscopy, when performed by a highly skilled surgical team, is a safe procedure that does not present additional risks to the patient.
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Moody L. Asthma: physiology and patient care. Am J Nurs 1973; 73:1212-7. [PMID: 4488718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Moody L, Baron V, Monk G. Moving the past into the present. Am J Nurs 1970; 70:2353-6. [PMID: 5201934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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