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Quamar AH, Schmeler MR, McCue M, Cooper RA, Goldberg MR, DiGiovine C, Collins DM, Schein RM. Test-Retest Reliability of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA): A Cohort Study. Am J Occup Ther 2023; 77:7706205140. [PMID: 38051265 PMCID: PMC10846415 DOI: 10.5014/ajot.2023.050285] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
IMPORTANCE Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected assistive devices like accessible smartphones, tablets, laptops, and apps. OBJECTIVE To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool. DESIGN Repeated-measures cohort study with a time frame of 7 to 21 days. SETTING Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions. PARTICIPANTS Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female. INTERVENTION Not applicable. OUTCOMES AND MEASURES The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90). RESULTS On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88). CONCLUSIONS AND RELEVANCE The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.
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Affiliation(s)
- Abbas H Quamar
- Abbas H. Quamar, PhD, CRC, is Associate Professor, Department of Special Education, Rehabilitation and Counseling, California State University San Bernardino, San Bernardino;
| | - Mark R Schmeler
- Mark R. Schmeler, PhD, OTR/L, ATP, is Vice Chair and Associate Professor, Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Michael McCue
- Michael McCue, PhD, is Professor Emeritus, Department of Rehabilitation Science and Technology, University of Pittsburgh, and Clinical Neuropsychologist and Rehabilitation Psychologist, Pittsburgh, PA
| | - Rory A Cooper
- Rory A. Cooper, PhD, is Distinguished Professor, Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Mary R Goldberg
- Mary R. Goldberg, PhD, is Associate Professor, Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Carmen DiGiovine
- Carmen DiGiovine, PhD, ATP, SMS, RET, is Clinical Professor, Department of Rehabilitation Science & Technology, The Ohio State University, Columbus
| | - Diane M Collins
- Diane M. Collins, PhD, OT, is Associate Professor, Department of Physical Therapy, University of Texas Medical Branch, Galveston
| | - Richard M Schein
- Richard M. Schein, PhD, MPH, is Research Scientist, Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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Kulzer J, Beck KB, Trabert C, Meyer EC, Colacci J, Pramuka M, McCue M. A vocational rehabilitation partnership to provide transition services to young adults with neurodevelopmental disabilities: The cognitive skills enhancement program. JVR 2023; 58:155-164. [DOI: 10.3233/jvr-230005] [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: 02/05/2023]
Abstract
BACKGROUND: There is an urgent need for services that support a successful transition to postsecondary education and employment for young adults with neurodevelopmental and cognitive disabilities (e.g. autism spectrum disorder, attention-deficit/hyperactivity disorder, traumatic brain injury). OBJECTIVE: The purpose of this expository article is to describe the Cognitive Skills Enhancement Program (CSEP), a comprehensive clinical program designed for young adults with neurodevelopmental and cognitive disabilities transitioning to postsecondary education. METHODS: CSEP was developed through a community-academic partnership between a university and a state vocational rehabilitation program. Young adult participants complete programming that addresses four primary clinical targets: (1) emotion regulation, (2) social skills, (3) work readiness, and (4) community participation with the overall goal to increase awareness and promote successful employment outcomes while they transition to post-secondary education. RESULTS: To date, CSEP has supported 18 years of sustained programming and clinical services to 621 young adults with neurodevelopmental and cognitive disabilities. CONCLUSION: This partnership model allows for flexible responses to participant needs, implementation barriers, and advances in evidence-based practices. CSEP meets the needs of diverse stakeholders (e.g. state vocational rehabilitation, post-secondary training facilities, participants, universities) while providing high-quality and sustainable programming. Future directions include examining the clinical efficacy of current CSEP programming.
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Affiliation(s)
- Jamie Kulzer
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kelly B. Beck
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caitlin Trabert
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric C. Meyer
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jenna Colacci
- Monte Nido & Affiliates, The Clementine Program, New York, NY, USA
| | - Michael Pramuka
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael McCue
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Kersey J, Baum CM, Hammel J, Terhorst L, McCue M, Skidmore ER. Cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. PM R 2023; 15:176-183. [PMID: 34865309 DOI: 10.1002/pmrj.12743] [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] [Received: 04/29/2021] [Revised: 11/09/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Community participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking. OBJECTIVE To examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. DESIGN This was a repeated measures study with assessments administered twice (3 months apart). SETTING Assessments were administered either over the phone, virtually (Zoom), or in person at the participant's home. PARTICIPANTS A total of 44 participants from community settings who had either experienced a traumatic brain injury within the previous year or were receiving rehabilitation interventions were recruited. MAIN OUTCOME MEASURE The Enfranchisement scale has two subscales: the Control subscale (range: 13-65) and the Importance subscale (range: 14-70). On both subscales, lower scores indicate better enfranchisement. METHODS The software SAS PROC Logistic and the macro %ROCPlot were used to examine cut points at varying levels of sensitivity and specificity. The area under the receiver operating characteristics curve was calculated to determine overall classification accuracy. Minimum detectable change and minimal clinically important difference were also calculated. RESULTS For the Control subscale, a cut point of 44 (area under the curve = .75), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. For the Importance subscale, a cut point of 39 (area under the curve = .81), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. CONCLUSIONS The cut points resulted in good classification accuracy, providing support for their reliability. The results provided evidence that both subscales are sensitive to change in adults with brain injury.
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Affiliation(s)
- Jessica Kersey
- OTR/L, Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Carolyn M Baum
- OTR/L, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joy Hammel
- OTR/L, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R Skidmore
- OTR/L, Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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Kersey J, Hammel J, Baum C, Huebert K, Malagari E, Terhorst L, McCue M, Skidmore ER. Effect of interventions on activity and participation outcomes for adults with brain injury: a scoping review. Brain Inj 2022; 36:21-31. [DOI: 10.1080/02699052.2022.2034043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly Huebert
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Emily Malagari
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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Kersey J, Terhorst L, Hammel J, Baum C, Toglia J, O'Dell MW, Heinemann AW, McCue M, Skidmore ER. Detecting change in community participation with the Enfranchisement scale of the community participation indicators. Clin Rehabil 2021; 36:251-262. [PMID: 34723687 DOI: 10.1177/02692155211052188] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study determined the sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in people with stroke. DATA SOURCES We analyzed data from two studies of participants with stroke: an intervention study and an observational study. MAIN MEASURES The Enfranchisement Scale contains two subscales: the Importance subscale (feeling valued by and contributing to the community; range: 14-70) and the Control subscale (choice and control: range: 13-64). DATA ANALYSIS Assessments were administered 6 months apart. We calculated minimum detectable change and minimal clinically important difference. RESULTS The Control subscale analysis included 121 participants with a mean age of 61.2 and mild-moderate disability (Functional Independence Measure, mean = 97.9, SD = 24.7). On the Control subscale, participants had a mean baseline score of 51.4 (SD = 10.4), and little mean change (1.3) but with large variation in change scores (SD = 11.5). We found a minimum detectable change of 9 and a minimum clinically important difference of 6. The Importance subscale analysis included 116 participants with a mean age of 60.7 and mild-moderate disability (Functional Independence Measure, mean = 98.9, SD = 24.5). On the Importance subscale, participants had a mean baseline score of 44.1 (SD = 12.7), and again demonstrated little mean change (1.08) but with large variation in change scores (SD = 12.6). We found a minimum detectable change of 11 and a minimum clinically important difference 7. CONCLUSIONS The Control subscale required 9 points of change, and the Importance subscale required 11 points of change, to achieve statistically and clinically meaningful changes, suggesting adequate sensitivity to change.
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Affiliation(s)
- Jessica Kersey
- OTR/L, Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Joy Hammel
- OTR/L, Department of Occupational Therapy, 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Carolyn Baum
- OTR/L, Program in Occupational Therapy and Departments of Neurology & Social Work, 7548Washington University in St Louis, St Louis, MO, USA
| | - Joan Toglia
- OTR/L, School of Health and Natural Sciences, 2986Mercy College, Dobbs Ferry, NY, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, 116366New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- OTR/L, Department of Occupational Therapy, 6614University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
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Kersey J, Terhorst L, Heinemann AW, Hammel J, Baum C, McCue M, Skidmore ER. Construct validity of the enfranchisement scale of the community participation indicators. Clin Rehabil 2021; 36:263-271. [PMID: 34414799 DOI: 10.1177/02692155211040930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined the construct validity of the Enfranchisement scale of the Community Participation Indicators. DESIGN We conducted a secondary analysis of data collected in a cross-sectional study of rehabilitation outcomes. SUBJECTS The parent study included 604 community-dwelling adults with chronic traumatic brain injury, stroke, or spinal cord injury. The sample had a mean age of 64.1 years, was two-thirds male, and included a high proportion of racial minorities (n = 250, 41.4%). MAIN MEASURES The Enfranchisement scale contains two subscales: the Control subscale and the Importance subscale. We examined correlations between each Enfranchisement subscale and measures of participation, environment, and impairments. The current analyses included cases with at least 80% of items completed on each subscale (Control subscale: n = 391; Importance subscale: n = 219). Missing values were imputed using multiple imputation. RESULTS The sample demonstrated high scores, indicating poor enfranchisement (Control subscale: M = 51.7; Importance subscale: M = 43.0). Both subscales were most strongly associated with measures of participation (Control subscale: r = 0.56; Importance subscale: r = 0.52), and least strongly associated with measures of cognition (Control subscale: r = 0.03; Importance subscale: r = 0.03). The Importance subscale was closely associated with depression (r = 0.54), and systems, services, and policies (r = 0.50). Both subscales were associated with social attitudes (Control subscale: r = 0.44; Importance subscale: r = 0.44) and social support (Control subscale: r = 0.49; Importance subscale: r = 0.41). CONCLUSIONS We found evidence of convergent validity between the Enfranchisement scale and measures of participation, and discriminant validity between the Enfranchisement scale and measures of disability-related impairments. The analyses also revealed the importance of the environment to enfranchisement outcomes.
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Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Carolyn Baum
- Program in Occupational Therapy and Departments of Neurology & Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, PA, USA
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Kringle EA, Terhorst L, Gibbs BB, Campbell G, McCue M, Skidmore ER. Activating Behavior to Reduce Sedentary Behavior After Stroke: A Nonrandomized Pilot Feasibility Study. Am J Occup Ther 2020; 74:7406205030p1-7406205030p10. [PMID: 33275563 PMCID: PMC7717647 DOI: 10.5014/ajot.2020.040345] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Importance: Reducing poststroke sedentary behavior is important for reducing recurrent stroke risk, yet interventions to achieve this are scant. Objective: To assess the feasibility of, and estimate change in sedentary behavior over time associated with, a behavioral intervention. Design: Single-arm delayed baseline with postintervention and 8-wk follow-up assessment. Setting: Community based. Participants: Ambulatory, community-dwelling people with chronic stroke and reported ≥6 hr daily sitting time (N = 21). Intervention: Activating Behavior for Lasting Engagement (ABLE) was delivered by an occupational therapist 3×/wk for 4 wk. ABLE involves activity monitoring, activity scheduling, self-assessment, and collaborative problem solving. Outcomes and Measures: Feasibility (participant safety, adherence, satisfaction, and reliable intervention delivery) was assessed against preestablished benchmarks. Changes over time in sedentary behavior (assessed with an ActivPAL micro3 device) and participation (Stroke Impact Scale–Participation subscale) were described. Results: ABLE was safe (0 serious adverse events), adhered to (11.95 sessions/participant), and reliably delivered (90.00%–97.50% adherence). Participant satisfaction was unmet (Client Satisfaction Questionnaire–8, M = 28.75, SD = 3.84). ABLE was associated with a mean group reduction in prolonged sitting of 54.95 min (SD = 81.10) at postintervention and 14.08 (SD = 58.95) at follow-up. ABLE was associated with a negligible mean group increase over time in participation at postintervention (M = 1.48%, SD = 8.52) and follow-up (M = 1.33%, SD = 15.38). Conclusions and Relevance: The ABLE intervention is feasible and may be associated with within-group reduction in sedentary behavior over time. Further refinement is indicated. What This Article Adds: The ABLE intervention uses engagement in meaningful daily activities to reduce sedentary behavior after stroke. These findings suggest that ABLE can be delivered safely and consistently. Further research is required to enhance participant satisfaction and determine the effects of ABLE on stroke survivors’ sedentary behavior.
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Affiliation(s)
- Emily A Kringle
- Emily A. Kringle, PhD, OTR/L, is Postdoctoral Research Fellow, Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago. At the time of the study, she was Graduate Student Researcher, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA;
| | - Lauren Terhorst
- Lauren Terhorst, PhD, is Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Bethany Barone Gibbs
- Bethany Barone Gibbs, PhD, is Associate Professor, Department of Health and Human Development, School of Education, University of Pittsburgh, Pittsburgh, PA
| | - Grace Campbell
- Grace Campbell, PhD, RN, is Assistant Professor, Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Michael McCue
- Michael McCue, PhD, is Professor, Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth R Skidmore
- Elizabeth R. Skidmore, PhD, OTR/L, is Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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Primus C, Bvekerwa I, McCue M, Menezes L, Serafino-Wani R, Das S, Wong K, Uppal R, Ambekar S, Bhatacharyya S, Woldman S, Davies L. The impact of frailty in an endocarditis cohort: association with length of stay and mortality. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Predictors of poor outcome are well established in Endocarditis (IE). “Frailty” refers to a syndrome of physiological decline associated with adverse health outcomes. Gilbert et al.(Lancet, 2018) developed a Hospital Frailty Risk Score (HFRS) that predicts 30-day mortality and length of stay (LOS).
Aim
Identify impact of an abbreviated HFRS (aHFRS) on in-hospital survival and LOS in IE given high morbidity and mortality.
Methods
Retrospective analysis of prospectively collected cases (Jan 2018–date). aHFRS score was calculated with key IE, cardiac, respiratory, oncology & frailty diagnoses. Univariate regression was applied overall and in key “cohorts” (native & prosthetic IE, medical & surgical management) for survival and LOS.
Results
Of 334 cases, LOS data were available in 317; mean age 57.8y (range 17–91, male 74%). Table 1 describes key cohorts. Mortality was 10.1% (medical, 11.9%; surgical, 8.3%). Mean LOS was 31.2 days (range 0–224).
Mean aHFRS was 5.38diagnoses (SD 2.61, range 0–14); 1.65 pre-IE and 3.73 attributed to IE alone, consistent across cohorts. Regression analyses highlight increasing LOS with increasing aHFRS (r2=0.06, Figure 1). Table 1 summarises the modest impact of aHFRS on LOS, and a trend to worse outcome in medical management (r2=0.02).
Discussion
Higher aHFRS is associated with longer LOS and a trend to higher mortality in medically managed IE. IE itself is associated with a number of frailty diagnoses. To improve outlook and provide holistic care, the IE Team may need to include experts in frailty. Satisfactory outcomes may require intensive post-IE rehabilitation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C.P Primus
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | - I Bvekerwa
- Barts Heart Centre, London, United Kingdom
| | - M McCue
- Barts Heart Centre, London, United Kingdom
| | - L Menezes
- Barts Heart Centre, London, United Kingdom
| | | | - S Das
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | - K Wong
- Barts Heart Centre, London, United Kingdom
| | - R Uppal
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | - S Ambekar
- Barts Heart Centre, London, United Kingdom
| | | | - S Woldman
- Barts Heart Centre, London, United Kingdom
| | - L.C Davies
- Barts Heart Centre, London, United Kingdom
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Abstract
PRIMARY OBJECTIVE To examine patterns of community participation, as well as the relationship among community participation outcomes and time since injury, impairments, environmental factors, and enfranchisement in adults with traumatic brain injury (TBI). RESEARCH DESIGN Cross-sectional study of a sample of 61 adults with TBI. METHODS AND PROCEDURES We administered the Participation Measure- 3 Domains 4 Dimensions to examine community participation in the three domains (productivity, community activities, and social participation) using four dimensions (diversity of activities, frequency, difficulty, and desire for change). MAIN RESULTS AND OUTCOMES All dimensions of community participation seem to be impaired following TBI, as evidenced by scores in the lower half of the available range. Most impaired was social participation (frequency: M = 10.0, SD = 3.4, possible range 0-24; difficulty: M= 11.3, SD = 3.2, possible range 4-16). Correlational analyses revealed that depression (r = 0.51), environmental factors (r = 0.51), and enfranchisement (r = 0.42), seem to play an important role in community participation outcomes, and may be potential targets for intervention. Results did not vary based on time since injury. CONCLUSION Our results suggest that depression, environmental factors, and enfranchisement may be important considerations for future interventions aiming to promote management of identified barriers.
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Affiliation(s)
- Jessica Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Elizabeth Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
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Rockwell H, Mack M, Famula T, Sandmeyer L, Bauer B, Dwyer A, Lassaline M, Beeson S, Archer S, McCue M, Bellone RR. Genetic investigation of equine recurrent uveitis in Appaloosa horses. Anim Genet 2019; 51:111-116. [PMID: 31793009 DOI: 10.1111/age.12883] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 01/05/2023]
Abstract
Equine recurrent uveitis (ERU) is characterized by intraocular inflammation that often leads to blindness in horses. Appaloosas are more likely than any other breed to develop insidious ERU, distinguished by low-grade chronic intraocular inflammation, suggesting a genetic predisposition. Appaloosas are known for their white coat spotting patterns caused by the leopard complex spotting allele (LP) and the modifier PATN1. A marker linked to LP on ECA1 and markers near MHC on ECA20 were previously associated with increased ERU risk. This study aims to further investigate these loci and identify additional genetic risk factors. A GWAS was performed using the Illumina Equine SNP70 BeadChip in 91 horses. Additive mixed model approaches were used to correct for relatedness. Although they do not reach a strict Bonferroni genome-wide significance threshold, two SNPs on ECA1 and one SNP each on ECA12 and ECA29 were among the highest ranking SNPs and thus warranted further analysis (P = 1.20 × 10-5 , P = 5.91 × 10-6 , P = 4.91 × 10-5 , P = 6.46 × 10-5 ). In a second cohort (n = 98), only an association with the LP allele on ECA1 was replicated (P = 5.33 × 10-5 ). Modeling disease risk with LP, age and additional depigmentation factors (PATN1 genotype and extent of roaning) supports an additive role for LP and suggests an additive role for PATN1. Genotyping for LP and PATN1 may help predict ERU risk (AUC = 0.83). The functional role of LP and PATN1 in ERU development requires further investigation. Testing samples across breeds with leopard complex spotting patterns and a denser set of markers is warranted to further refine the genetic components of ERU.
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Affiliation(s)
- H Rockwell
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
| | - M Mack
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
| | - T Famula
- Appaloosa Project, Davis, 95616, CA, USA
| | - L Sandmeyer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - B Bauer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
| | - A Dwyer
- Genesee Valley Equine Clinic, LLC, Scottsville, NY, 14546, USA
| | - M Lassaline
- Department of Radiological and Surgical Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, 95616, USA
| | - S Beeson
- Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108, USA
| | - S Archer
- Appaloosa Project, Sayward, V0P 1R0, BC, Canada
| | - M McCue
- Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, St Paul, MN, 55108, USA
| | - R R Bellone
- Veterinary Genetics Laboratory, Department of Population Health and Reproduction, School of Veterinary Medicine, University of California - Davis, Davis, 95616, CA, USA
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Abstract
While most publicly-traded insurers have experienced losses and exited the Affordable Care Act individual insurance market exchange, insurers specializing in Medicaid managed care have been profitable in this market. Accessing individual market data, this study compares the financial performance of 20 state insurers owned by two publicly-traded companies that historically focused on insuring Medicaid members compared to 40 insurers owned by other publicly-traded companies. Medicaid-focused insurers incurred a significantly lower medical loss ratio of 83.3% compared to the medical loss ratio of 93.7% of other publicly-traded insurers, and they earned a significantly higher profit margin of 4.6% compared to the operating loss of 6.5% incurred by other publicly-traded insurers. This superior financial performance of Medicaid-focused insurers could be due to one or a combination of: their care management experience with the Medicaid population, other cost reducing strategies such as provider contracting, or the enrollment of a healthier than average population.
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Affiliation(s)
- Michael McCue
- College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Mark A Hall
- School of Law and School of Medicine, Wake Forest University, Winston-Salem, USA
| | - Jennifer Palazzolo
- College of Health Professions, Virginia Commonwealth University, Richmond, USA
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Kringle EA, Barone Gibbs B, Campbell G, McCue M, Terhorst L, Kersey J, Skidmore ER. Influence of Interventions on Daily Physical Activity and Sedentary Behavior after Stroke: A Systematic Review. PM R 2019; 12:186-201. [DOI: 10.1002/pmrj.12222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/11/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Emily A. Kringle
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, School of EducationUniversity of Pittsburgh Pittsburgh PA
- Department of Clinical and Translational ScienceUniversity of Pittsburgh Pittsburgh PA
| | - Grace Campbell
- Department of Acute and Tertiary Care, School of NursingUniversity of Pittsburgh Pittsburgh PA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Jessica Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
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Primus CP, McCue M, Bvekerwa I, McGuire E, Wong K, Uppal R, Ambekar S, Menezes L, Khanji M, Davies LC, Bhattacharyya S, Serafino-Wani R, Das S, Woldman S. P2764Medical management of Staphylococcus aureus infective endocarditis: unexpectedly favourable outcomes in an aggressive disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1081] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Early surgical intervention (ESI) for infective endocarditis (IE) is associated with improved outcomes. Staphylococcus aureus endocarditis (SAE) is associated with particularly high rates of tissue destruction, morbidity and mortality. However, the question as to whether ESI is mandated in all SAE continues to be debated, in both native (NVE) and prosthetic (PVE) endocarditis.
Methods
Retrospective review of all IE cases presenting to our institution from October 2015 to January 2019. IE was diagnosed following imaging and microbiological protocols as per ESC guidance, and data were extracted for those with SAE. Patients with isolated cardiac implantable electronic device IE or bacteraemia secondary to indwelling long-term venous catheter infection were excluded (non-valvular IE).
Results
Valvular IE was diagnosed in 411 patients overall; NVE in 286 (69.6%) and PVE in 125 (30.4%). S aureus was isolated in 111 patients (28.1%), of whom 5 had a Methicillin-resistant strain. SAE was confirmed in a similar proportion of NVE and PVE cases [83/111 (74.8%) and 28/111 (25.2%), respectively]. Surgical intervention was mandated in 35/83 with NVE (42.2%) and 11/28 (39.3%) with PVE, lower than in our overall cohort (55.9% and 48.8%, respectively).
In-hospital SAE mortality was 16.2% overall (18.4% medical vs 13.0% surgical), and contributes a significant proportion to overall mortality (29% to medical & 26% to surgical mortality). Figure 1 identifies the cause of death per mode of treatment, highlighting the aggressive nature of S aureus infection (abscess, disseminated infection and septic shock; n=8), the importance of advanced non-cardiac comorbidity precluding intervention (n=3) and ongoing intravenous drug use in those with PVE (n=4). However, medical management was successful in 57.8% (38/83) of NVE and 60.7% (17/28) of PVE cases, both in hospital and to a minimum follow-up of 3-months.
Conclusion
Staphylococcus aureus is virulent and highly pathogenic, driving severe sepsis and advanced tissue destruction in SAE. Despite this, medical management can be successful when following international guidance, but requires co-ordinated care driven by a multidisciplinary IE team at a cardiothoracic centre.
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Affiliation(s)
- C P Primus
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | - M McCue
- Barts Heart Centre, London, United Kingdom
| | - I Bvekerwa
- Barts Heart Centre, London, United Kingdom
| | - E McGuire
- Barts Heart Centre, London, United Kingdom
| | - K Wong
- Barts Heart Centre, London, United Kingdom
| | - R Uppal
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | - S Ambekar
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | - L Menezes
- Barts Heart Centre, London, United Kingdom
| | - M Khanji
- Barts Heart Centre, London, United Kingdom
| | - L C Davies
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | | | | | - S Das
- Barts Heart Centre & Queen Mary, University of London, London, United Kingdom
| | - S Woldman
- Barts Heart Centre, London, United Kingdom
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14
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Kringle E, Campbell G, McCue M, Gibbs BB, Terhorst L, Skidmore E. Activating Behavior for Lasting Engagement (ABLE) To Reduce Sedentary Behavior in Chronic Stroke: A Feasibility Study. Am J Occup Ther 2019. [DOI: 10.5014/ajot.2019.73s1-po5028] [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: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/05/19
Stroke leads to high levels of sedentary behavior and may be associated with risk for recurrent stroke. The ABLE intervention was developed to reduce sedentary behavior by promoting engagement in meaningful occupations using a behavioral activation framework. This study examined the feasibility of the ABLE intervention among people with chronic stroke.
Primary Author and Speaker: Emily Kringle
Contributing Authors: Grace Campbell, Michael McCue, Bethany Barone Gibbs, Lauren Terhorst, Elizabeth Skidmore
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15
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Kringle EA, Campbell G, McCue M, Barone Gibbs B, Terhorst L, Skidmore ER. Development and feasibility of a sedentary behavior intervention for stroke: a case series. Top Stroke Rehabil 2019; 26:456-463. [DOI: 10.1080/10749357.2019.1623437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Emily A. Kringle
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Grace Campbell
- Department of Acute and Tertiary Care Nursing, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, School of Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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McKeon A, Terhorst L, Ding D, Cooper R, McCue M. Naturalistic physiological monitoring as an objective approach for detecting behavioral dysregulation after traumatic brain injury: A pilot study. JVR 2018. [DOI: 10.3233/jvr-180981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ashlee McKeon
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dan Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory Cooper
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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McCue M, Reichert J, Crenshaw T. PSXVI-30 Supplemental Vitamin D3 for mediation of immune challenges in nursery pigs and subsequent growth responses. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M McCue
- UNIVERSITY OF WISCONSIN-Madison,Madison, WI, United States
| | - J Reichert
- UNIVERSITY OF WISCONSIN-Madison,Madison, WI, United States
| | - T Crenshaw
- Department of Animal Sciences, University of Wisconsin-Madison,Madison, WI, United States
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Balason D, Durisko C, Vincent J, Dickey M, Doyle P, McCue M, Fissell C, Fiez J. A New Resource for Aphasia Research: The Western Pennsylvania Patient Registry (WPPR) and the Remote Acquisition of Neuropsychological Data (RAND) System. Front Hum Neurosci 2018. [DOI: 10.3389/conf.fnhum.2018.228.00003] [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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Reinkensmeyer DJ, Blackstone S, Bodine C, Brabyn J, Brienza D, Caves K, DeRuyter F, Durfee E, Fatone S, Fernie G, Gard S, Karg P, Kuiken TA, Harris GF, Jones M, Li Y, Maisel J, McCue M, Meade MA, Mitchell H, Mitzner TL, Patton JL, Requejo PS, Rimmer JH, Rogers WA, Zev Rymer W, Sanford JA, Schneider L, Sliker L, Sprigle S, Steinfeld A, Steinfeld E, Vanderheiden G, Winstein C, Zhang LQ, Corfman T. How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers. J Neuroeng Rehabil 2017; 14:109. [PMID: 29110728 PMCID: PMC5674748 DOI: 10.1186/s12984-017-0321-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 10/26/2017] [Indexed: 01/14/2023] Open
Abstract
Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.
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Affiliation(s)
| | | | | | - John Brabyn
- The Smith-Kettlewell Eye Research Institute, San Francesco, USA
| | | | | | | | | | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | - Geoff Fernie
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | | | | | | | | | - Yue Li
- Toronto Rehabilitation Institute, Toronto, Canada
| | | | | | | | | | | | - James L. Patton
- Rehabilitation Institute of Chicago, University of Illinois at Chicago, Chicago, USA
| | | | - James H. Rimmer
- Lakeshore FoundationUniversity of Alabama-Birmingham, Birmingham, USA
| | | | - W. Zev Rymer
- Rehabilitation Institute of Chicago, Chicago, USA
| | | | | | | | | | - Aaron Steinfeld
- Robotics Institute, Carnegie Mellon University, Pittsburgh, USA
| | | | | | | | | | - Thomas Corfman
- National Institute on Disability, Independent Living, and Rehabilitation Research, Washington, DC, USA
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McKeon A, Terhorst L, Skidmore E, Ding D, Cooper R, McCue M. A novel tool for naturalistic assessment of behavioural dysregulation after traumatic brain injury: A pilot study. Brain Inj 2017; 31:1781-1790. [PMID: 29064733 DOI: 10.1080/02699052.2017.1388444] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to develop a novel tool for measuring behavioural dysregulation in adults with traumatic brain injury (TBI) using objective data sources and real-world application and provide preliminary evidence for its psychometric properties. RESEARCH DESIGN Fourteen adults with TBI receiving services at a local brain injury rehabilitation programme completed multiple assessments of behaviour and followed by a series of challenging problem-solving tasks while being video recorded. Trained clinicians completed post-hoc behavioural assessments using the behavioural dysregulation ratings scale, and behavioural event data were then extracted for comparison with self-report measures. RESULTS Subject matter experts in neurorehabilitation were in 100% agreement that preliminarily, the new tool measured the construct of behavioural dysregulation. Construct validity was established through strong convergence with 'like' measures and weak correlation with 'unlike' measures. Substantial inter-rater reliability was established between two trained clinician raters. CONCLUSIONS This study provides preliminary evidence supporting the use of a new precision measurement tool of behaviour in post-acute TBI that has the capability to be deployed naturalistically where deficits truly manifest. Future large-scaled confirmatory psychometric trials are warranted to further establish the utility of this new tool in rehabilitation research.
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Affiliation(s)
- Ashlee McKeon
- a Department of Rehabilitation Science & Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Lauren Terhorst
- b Department of Occupational Therapy , University of Pittsburgh , Pittsburgh , PA , USA
| | - Elizabeth Skidmore
- b Department of Occupational Therapy , University of Pittsburgh , Pittsburgh , PA , USA
| | - Dan Ding
- a Department of Rehabilitation Science & Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Rory Cooper
- a Department of Rehabilitation Science & Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Michael McCue
- a Department of Rehabilitation Science & Technology , University of Pittsburgh , Pittsburgh , PA , USA
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21
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Affiliation(s)
- Ashlee McKeon
- Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael McCue
- Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Schein
- Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jamie Kulzer
- Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Durisko C, McCue M, Doyle PJ, Dickey MW, Fiez JA. A Flexible and Integrated System for the Remote Acquisition of Neuropsychological Data in Stroke Research. Telemed J E Health 2016; 22:1032-1040. [PMID: 27214198 PMCID: PMC5165659 DOI: 10.1089/tmj.2015.0235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/12/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neuropsychological testing is a central aspect of stroke research because it provides critical information about the cognitive-behavioral status of stroke survivors, as well as the diagnosis and treatment of stroke-related disorders. Standard neuropsychological methods rely upon face-to-face interactions between a patient and researcher, which creates geographic and logistical barriers that impede research progress and treatment advances. INTRODUCTION To overcome these barriers, we created a flexible and integrated system for the remote acquisition of neuropsychological data (RAND). The system we developed has a secure architecture that permits collaborative videoconferencing. The system supports shared audiovisual feeds that can provide continuous virtual interaction between a participant and researcher throughout a testing session. Shared presentation and computing controls can be used to deliver auditory and visual test items adapted from standard face-to-face materials or execute computer-based assessments. Spoken and manual responses can be acquired, and the components of the session can be recorded for offline data analysis. MATERIALS AND METHODS To evaluate its feasibility, our RAND system was used to administer a speech-language test battery to 16 stroke survivors with a variety of communication, sensory, and motor impairments. The sessions were initiated virtually without prior face-to-face instruction in the RAND technology or test battery. RESULTS Neuropsychological data were successfully acquired from all participants, including those with limited technology experience, and those with a communication, sensory, or motor impairment. Furthermore, participants indicated a high level of satisfaction with the RAND system and the remote assessment that it permits. CONCLUSIONS The results indicate the feasibility of using the RAND system for virtual home-based neuropsychological assessment without prior face-to-face contact between a participant and researcher. Because our RAND system architecture uses off-the-shelf technology and software, it can be duplicated without specialized expertise or equipment. In sum, our RAND system offers a readily available and promising alternative to face-to-face neuropsychological assessment in stroke research.
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Affiliation(s)
- Corrine Durisko
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael McCue
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J. Doyle
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Walsh Dickey
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie A. Fiez
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania
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Knutson E, McCue M, Terhorst L, Kulzer J. C-35Relationships Between Community-Multiple Errands Test and Neuropsychological Measures. Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.184] [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: 11/15/2022] Open
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Juengst SB, Graham KM, Pulantara IW, McCue M, Whyte EM, Dicianno BE, Parmanto B, Arenth PM, Skidmore ERD, Wagner AK. Pilot feasibility of an mHealth system for conducting ecological momentary assessment of mood-related symptoms following traumatic brain injury. Brain Inj 2015; 29:1351-61. [PMID: 26287756 DOI: 10.3109/02699052.2015.1045031] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study assessed pilot feasibility and validity of a mobile health (mHealth) system for tracking mood-related symptoms after traumatic brain injury (TBI). DESIGN A prospective, repeated measures design was used to assess compliance with daily ecological momentary assessments (EMA) conducted via a smartphone application over an 8-week period. METHODS An mHealth system was developed specifically for individuals with TBI and utilized previously validated tools for depressive and anxiety symptoms (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7). Feasibility was assessed in 20 community-dwelling adults with TBI via an assessment of compliance, satisfaction and usability of the smartphone applications. The authors also developed and implemented a clinical patient safety management mechanism for those endorsing suicidality. RESULTS Participants correctly completed 73.4% of all scheduled assessments, demonstrating good compliance. Daily assessments took <2 minutes to complete. Participants reported high satisfaction with smartphone applications (6.3 of 7) and found them easy to use (6.2 of 7). Comparison of assessments obtained via telephone-based interview and EMA demonstrated high correlations (r = 0.81-0.97), supporting the validity of conducting these assessments via smartphone application in this population. CONCLUSIONS EMA conducted via smartphone demonstrates initial feasibility among adults with TBI and presents numerous opportunities for long-term monitoring of mood-related symptoms in real-world settings.
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Affiliation(s)
- Shannon B Juengst
- a Department of Physical Medicine & Rehabilitation , School of Medicine
| | - Kristin M Graham
- b Department of Rehabilitation Science & Technology , School of Health and Rehabilitation Sciences
| | - I Wayan Pulantara
- c Department of Health Information Management , School of Health and Rehabilitation Sciences
| | - Michael McCue
- b Department of Rehabilitation Science & Technology , School of Health and Rehabilitation Sciences
| | - Ellen M Whyte
- a Department of Physical Medicine & Rehabilitation , School of Medicine .,d Department of Psychiatry
| | - Brad E Dicianno
- a Department of Physical Medicine & Rehabilitation , School of Medicine .,b Department of Rehabilitation Science & Technology , School of Health and Rehabilitation Sciences
| | - Bambang Parmanto
- c Department of Health Information Management , School of Health and Rehabilitation Sciences
| | - Patricia M Arenth
- a Department of Physical Medicine & Rehabilitation , School of Medicine
| | - Elizabeth R D Skidmore
- a Department of Physical Medicine & Rehabilitation , School of Medicine .,e Department of Occupational Therapy , School of Health and Rehabilitation Sciences
| | - Amy K Wagner
- a Department of Physical Medicine & Rehabilitation , School of Medicine .,f Center for Neuroscience , and.,g Safar Center for Resuscitation Research, University of Pittsburgh , Pittsburgh , PA , USA
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Schmeler MR, Schein RM, McCue M, Betz K. Telerehabilitation and Clinical Applications: Research, Opportunities, and Challenges. Int J Telerehabil 2015. [DOI: 10.5195/ijt.2008.701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent to coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise is troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation.This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper.Keywords: Telerehabilitation; Telehealth; Telemedicine; Telepractice
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Abstract
The Affordable Care Act's regulation of medical loss ratios requires health insurers to use at least 80-85 percent of the premiums they collect for direct medical expenses (care delivery) or for efforts to improve the quality of care. To gauge this rule's effect on insurers' financial performance, we measured changes between 2010 and 2011 in key financial ratios reflecting insurers' operating profits, administrative costs, and medical claims. We found that the largest changes occurred in the individual market, where for-profit insurers reduced their median administrative cost ratio and operating margin by more than two percentage points each, resulting in a seven-percentage-point increase in their median medical loss ratio. Financial ratios changed much less for insurers in the small- and large-group markets.
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Fairman AD, Dicianno BE, Datt N, Garver A, Parmanto B, McCue M. Outcomes of Clinicians, Caregivers, Family Members and Adults with Spina Bifida Regarding Receptivity to use of the iMHere mHealth Solution to Promote Wellness. Int J Telerehabil 2013; 5:3-16. [PMID: 25945209 PMCID: PMC4296836 DOI: 10.5195/ijt.2013.6116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to gather information regarding the receptivity of clinicians, caregivers and family members, and adults with spina bifida (SB) to the use of a mHealth application, iMobile Health and Rehabilitation (iMHere) system. Surveys were administered to end user groups in conjunction with a conference presentation at the Spina Bifida Association's 38th Annual Conference. The survey results were obtained from a total of 107 respondents. Likert scale and qualitative results are provided in consideration of future application of the iMHere system in clinical practice. The results of this survey indicate respondents were receptive and supportive with regard to adopting such a system for personal and professional use. Challenges likely to be encountered in the introduction of the iMHere system are also revealed and discussed.
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Affiliation(s)
- Andrea D Fairman
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nicole Datt
- School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Amanda Garver
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health and Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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Abstract
The use of web-based portals, while increasing in popularity in the fields of medicine and research, are rarely reported on in community-based rehabilitation programs. A program within the Pennsylvania Office of Vocational Rehabilitation's Hiram G. Andrews Center, the Cognitive Skills Enhancement Program (CSEP), sought to enhance organization of program and participant information and communication between part- and full-time employees, supervisors and consultants. A telerehabilitation system was developed consisting of (1) a web-based portal to support a variety of clinical activities, and (2) the Versatile Integrated System for Telerehabilitation (VISYTER) video-conferencing system to support the collaboration and delivery of rehabilitation services remotely. This descriptive evaluation examines the usability of the telerehabilitation system incorporating both the portal and VISYTER. Telerehabilitation system users include CSEP staff members from three geographical locations and employed by two institutions. The IBM After-Scenario Questionnaire (ASQ) and Post-Study System Usability Questionnaire (PSSUQ), the Telehealth Usability Questionnaire (TUQ), and two demographic surveys were administered to gather both objective and subjective information. Results showed generally high levels of usability. Users commented that the telerehabilitation system improved communication, increased access to information, improved speed of completing tasks, and had an appealing interface. Areas where users would like to see improvements, including ease of accessing/editing documents and searching for information, are discussed.
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Affiliation(s)
- Jamie Schutte
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Sara Gales
- Pennsylvania Office of Vocational Rehabilitation
| | - Ashlee Filippone
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Andi Saptono
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | - Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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Juengst S, Skidmore E, Pramuka M, McCue M, Becker J. Factors contributing to impaired self-awareness of cognitive functioning in an HIV positive and at-risk population. Disabil Rehabil 2011; 34:19-25. [PMID: 21870997 DOI: 10.3109/09638288.2011.587088] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association between self-awareness of cognitive impairment and age, selected mood disorders, and type and severity of cognitive impairment in a sample of individuals with HIV/AIDS and at risk for HIV. METHOD 75 subjects, 52 HIV+ and 23 at risk for HIV completed a psychosocial interview, the Patient's Assessment of Own Functioning (PAOF) questionnaire, and a battery of neuropsychological tests. Based upon the differences between their clinical impairment and self-reported impairment, subjects were classified as being "Underestimators", "Good Awareness", or "Impaired Awareness" with regard to self-awareness. RESULTS Those with more severe cognitive impairment were less aware than those with normal or borderline cognitive impairment. A one-way ANOVA suggested that the Impaired Awareness group differed significantly from the Underestimators on the Rey Figure Immediate and Delayed Recall tasks, and from both the Underestimators and Good Awarenesss groups on the Digit Symbol Substitution Task. There were significant differences among all awareness groups on the test of Simple Reaction Time. Furthermore there is some suggestion that age may contribute to impaired self-awareness. The role of HIV in self-awareness remains unclear, as both, individuals with HIV and at risk, demonstrated impaired self-awareness. CONCLUSIONS Overall, impaired awareness was associated with poorer test performance, suggesting a relationship between awareness and sustained complex attention and visual spatial processing. This research has implications for understanding factors contributing to poor awareness among individuals with cognitive impairment.
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Affiliation(s)
- Shannon Juengst
- Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, PA, USA.
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Borgia L, Valberg S, McCue M, Watts K, Pagan J. Glycaemic and insulinaemic responses to feeding hay with different non-structural carbohydrate content in control and polysaccharide storage myopathy-affected horses. J Anim Physiol Anim Nutr (Berl) 2010; 95:798-807. [DOI: 10.1111/j.1439-0396.2010.01116.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Telerehabilitation is an emerging method of delivering rehabilitation services that uses technology to serve clients, clinicians, and systems by minimizing the barriers of distance, time, and cost. The driving force for telerehabilitation has been as an alternative to face-to-face rehabilitation approaches to reduce costs, increase geographic accessibility, or act as a mechanism to extend limited resources. A rationale for telerehabilitation is the potential to enhance outcomes beyond what may result from face-to-face interventions by enabling naturalistic, in vivo interventions. There is considerable support for the value of interventions delivered in the natural environment, ranging from addressing efficacy concerns by addressing problems of generalization, to increasing patient participation, including environmental context in rehabilitation, and increasing patient satisfaction. Further clinical and research exploration should explore telerehabilitation as a tool for the delivery of rehabilitation services in vivo.
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Affiliation(s)
- Michael McCue
- Department of Rehabilitation Science and Technology, University of Pittsburgh, 5040 Forbes Tower, 3600 Forbes Avenue, Pittsburgh, PA 15260, USA.
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Schmeler MR, Schein RM, McCue M, Betz K. Telerehabilitation clinical and vocational applications for assistive technology: research, opportunities, and challenges. Int J Telerehabil 2009; 1:59-72. [PMID: 25945163 PMCID: PMC4296780 DOI: 10.5195/ijt.2009.6014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent in coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise may be troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation. This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper.
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Affiliation(s)
- Mark R Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh
| | - Richard M Schein
- Department of Rehabilitation Science and Technology, University of Pittsburgh
| | - Michael McCue
- Department of Rehabilitation Science and Technology, University of Pittsburgh
| | - Kendra Betz
- Prosthetics and Sensory Aids Service, Veterans Health Administration
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Cohen LJ, Fitzgerald SG, Lane S, Boninger ML, Minkel J, McCue M. Validation of the Seating and Mobility Script Concordance Test. Assist Technol 2009; 21:47-56. [DOI: 10.1080/10400430902945546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
While there are a number of studies examining the relationship between nurse staffing and quality, none has examined structural differences in the relationship between nurse staffing and quality contingent upon the level of managed care penetration. We used administrative data, and a dynamic panel data model to examine this relationship in a panel of 422 acute care hospitals from 1990 to 1995. We found that there were significant differences in the relationship between nurse staffing and both mortality and length of stay depending upon the level of HMO penetration in the hospital's market.
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Affiliation(s)
- Barbara A Mark
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA.
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Mark BA, Harless DW, McCue M, Xu Y. Correction to: A Longitudinal Examination of Hospital Registered Nurse Staffing and Quality of Care. Health Serv Res 2004. [DOI: 10.1111/j.1475-6773.2004.00307.x] [Citation(s) in RCA: 2] [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: 11/29/2022] Open
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Abstract
OBJECTIVE To evaluate previous research findings of the relationship between nurse staffing and quality of care by examining the effects of change in registered nurse staffing on change in quality of care. DATA SOURCES/STUDY SETTING Secondary data from the American Hospital Association (AHA)(nurse staffing, hospital characteristics), InterStudy and Area Resource Files (ARF) (market characteristics), Centers for Medicare and Medicaid Services (CMS) (financial performance), and Healthcare Cost and Utilization Project (HCUP) (quality measures-in-hospital mortality ratio and the complication ratios for decubitus ulcers, pneumonia, and urinary tract infection, which were risk-adjusted using the Medstat disease staging algorithm). STUDY DESIGN Data from a longitudinal cohort of 422 hospitals were analyzed from 1990-1995 to examine the relationships between nurse staffing and quality of care. DATA COLLECTION/EXTRACTION METHODS A generalized method of moments estimator for dynamic panel data was used to analyze the data. Principal Findings. Increasing registered nurse staffing had a diminishing marginal effect on reducing mortality ratio, but had no consistent effect on any of the complications. Selected hospital characteristics, market characteristics, and financial performance had other independent effects on quality measures. CONCLUSIONS The findings provide limited support for the prevailing notion that improving registered nurse (RN) staffing unconditionally improves quality of care.
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Affiliation(s)
- Barbara A Mark
- School of Nursing, Carrington Hall CB#7460, University of North Carolina, Chapel Hill, Chapel Hill, NC 27599-7460, USA
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Schrezenmeir J, Heller K, McCue M, Llamas C, Lam W, Burow H, Kindling-Rohracker M, Fischer W, Sengespeik HC, Comer GM, Alarcon P. Benefits of oral supplementation with and without synbiotics in young children with acute bacterial infections. Clin Pediatr (Phila) 2004; 43:239-49. [PMID: 15094948 DOI: 10.1177/000992280404300305] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [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: 11/16/2022]
Abstract
Acutely ill children (n = 129) aged 1-6 years receiving antibiotic therapy were randomized to receive a nutritional supplement with (PS) or without (P) synbiotics or a fruit-flavored drink (D) with their medications. Group PS had significantly greater weight gains (versus D) following antibiotic therapy. The percentages of subjects without bacterial illnesses 14 days following antibiotic therapy were as follows: 94.3% (PS), 87.8% (D), and 80.6% (P). PS (vs D) significantly increased fecal Lactobacillus in a subset of subjects. Oral supplements increase energy intake and promote weight gain in acutely ill children receiving antibiotics; synbiotics may confer additional benefits by increasing bifidobacteria levels.
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Low RN, McCue M, Barone R, Saleh F, Song T. MR staging of primary colorectal carcinoma: comparison with surgical and histopathologic findings. ACTA ACUST UNITED AC 2003; 28:784-93. [PMID: 14753591 DOI: 10.1007/s00261-003-0032-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [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: 11/25/2022]
Abstract
BACKGROUND We retrospectively evaluated the accuracy of magnetic resonance (MR) imaging in staging colorectal cancer and assessing local tumor extent, nodal involvement, and distant abdominal and pelvic metastases. METHODS Forty-eight patients with primary colorectal carcinoma were referred for presurgical abdominal and pelvic MR imaging. MR imaging included T1-weighted, fat-suppressed T2-weighted, and fat-suppressed gadolinium-enhanced spin gradient-echo imaging. The prospective interpretations of the MR examinations were reviewed. MR depiction of local tumor extent, nodal involvement, and distant metastases at 18 anatomic locations was noted and compared with subsequent surgical and histopathologic findings. RESULTS Overall TNM MR staging agreed with surgical and pathologic staging in 41 (85%) of 48 patients, including 21 (78%) of 27 colon cancers and 20 (95%) of 21 rectal cancers. For depth of tumor penetration, which was evaluable in 44 patients, MR imaging agreed with pathologic results in 38 (86%) of 44 patients, including 22 (88%) of 25 colon cancers and 16 (84%) of 19 rectal cancers. In 42 (95%) of 44 patients, MR images correctly distinguished tumor confined to the bowel wall (T0, T1, and T2) from tumor with transmural tumor extension (T3 and T4). Regional nodal metastases were depicted in 15 of 22 patients (sensitivity, 68%; accuracy, 83%). Nodal metastases were better depicted for rectal cancer in eight of nine patients, compared with colon cancer in seven of 13 patients. Distant metastases were correctly depicted on MR imaging in 13 of 14 patients (sensitivity, 93%; accuracy, 98%). In the site-by-site analysis, MR imaging prospectively depicted 66 of 77 sites of surgically confirmed metastatic tumor in the abdomen and pelvis (sensitivity, 86%; specificity, 99%; accuracy, 98%). CONCLUSION MR imaging using currently available techniques can effectively image local tumor extent and distant metastases in patients with colorectal carcinoma. Especially for colon cancer, incomplete depiction of nodal metastases in normal-size lymph nodes remains a limitation of cross-sectional imaging studies.
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Affiliation(s)
- R N Low
- Department of Diagnostic Radiology, Sharp and Children's MRI Center, Sharp Memorial Hospital, 7901 Frost Street, San Diego, CA 92123, USA
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40
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McCue M, Mark BA, Harless DW. Nurse staffing, quality, and financial performance. J Health Care Finance 2003; 29:54-76. [PMID: 12908654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
In examining the relationship among nurse staffing, quality of care, and financial performance, prior empirical studies used competing measures and applied different levels of analysis. Using longitudinal data from 1990 through 1995, our study applied a dynamic econometric model to evaluate whether hospitals that changed their nurse staffing and quality of care affected their financial performance. Sampling 422 hospitals over this study period, we found a statistically significant increase in operating costs when registered nurse levels increase, but no statistically significant decrease in profit. Higher levels of non-nurse staffing caused higher operating expenses, as well as lower profits.
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Affiliation(s)
- Michael McCue
- Department of Health Administration, Virginia Commonwealth University, Richmond, VA, USA
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41
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Kontos MC, Schmidt KL, McCue M, Rossiter LF, Jurgensen M, Nicholson CS, Jesse RL, Ornato JP, Tatum JL. A comprehensive strategy for the evaluation and triage of the chest pain patient: a cost comparison study. J Nucl Cardiol 2003; 10:284-90. [PMID: 12794627 DOI: 10.1016/s1071-3581(03)00361-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [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: 11/27/2022]
Abstract
BACKGROUND Our objective was to determine the cost-effectiveness of a comprehensive, risk-based triage system, composed of multiple critical pathways, with the use of early myocardial perfusion imaging (MPI) in low-risk patients. We found previously that a chest pain evaluation system that uses MPI in low-risk patients was safe and effective, but the cost-effectiveness of this approach was not studied. METHODS AND RESULTS We compared two groups. The Acute Cardiac Team (ACT) group (n = 874) was assigned prospectively to 1 of 4 risk levels by emergency department (ED) physicians. Level 1, 2, and 3 patients were admitted; level 4 patients were evaluated in the ED. Level 3 and 4 patients underwent ED MPI. The control group (n = 713) represented consecutive patients evaluated in the prior year according to standard care and assigned retrospectively to an ACT level based on the presenting electrocardiographic and clinical data. Record and hospital administrative data were assessed for clinical variables, outcomes, lengths of stay, and all expenses incurred within 30 days of the index visit. The baseline characteristics of the two groups were similar, including age, sex, myocardial infarction prevalence, and 30-day revascularization rates within each level or between the two groups. Mean costs per encounter were reduced for the ACT patients for each level, which was significant when all patients were compared ($5,030 +/- $7,081 vs $6,044 +/- $10,432, P =.02). Use of MPI in the low-risk patients was associated with reduced costs (level 3, $4,958 +/- $4,948 vs $5,051 +/- $7,036; level 4, $1,529 +/- $2,664 vs $1,794 +/- $6,854) and was associated with a significantly lower angiography rate and shorter length of stay. CONCLUSIONS Implementation of a comprehensive strategy for chest pain evaluation and triage reduced overall costs for patients with chest pain on presentation. Acute MPI in the ED setting did not increase net cost.
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Affiliation(s)
- Michael C Kontos
- Department of Radiology, Virginia Commonwealth University, Medical College of Virginia Hospital and Physicians of the Virginia Commonwealth, University Health Systems, Richmond, VA 23298-0051, USA.
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42
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Affiliation(s)
- M McCue
- National Highway Traffic Safety Administration, Office of Communication and Outreach, Washington, DC, USA.
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Constant I, Dubois MC, Piat V, Moutard ML, McCue M, Murat I. Changes in electroencephalogram and autonomic cardiovascular activity during induction of anesthesia with sevoflurane compared with halothane in children. Anesthesiology 1999; 91:1604-15. [PMID: 10598600 DOI: 10.1097/00000542-199912000-00010] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.3] [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: 11/26/2022]
Abstract
BACKGROUND This study was design to assess clinical agitation, electroencephalogram (EEG) and autonomic cardiovascular activity changes in children during induction of anesthesia with sevoflurane compared with halothane using noninvasive recording of EEG, heart rate, and finger blood pressure. METHODS Children aged 2-12 yr premedicated with midazolam were randomly assigned to one of three induction techniques: 7% sevoflurane in 100% O2 (group SevoRAPID); 2%, 4%, 6%, and 7% sevoflurane in 100% O2 (group SevoINCR); or 1%, 2%, 3%, and 3.5% halothane in 50% N2O-50% O2 (group HaloN2O). An additional group of children who received 7% sevoflurane in 50% N2O-50% O2 (group SevoN2O) was enrolled after completion of the study. Induction was videotaped. EEG, heart rate, and finger blood pressure were continuously recorded during induction until 5 min after tracheal intubation and analyzed in frequency domain using spectral analysis. RESULTS Agitation was more frequent when anesthesia was induced with 100% O2 compared to the mixture of oxygen and nitrous oxide. No seizures were recorded in any group. In the four groups, induction of anesthesia was associated with an increase in EEG total spectral power and a shift toward the low-frequency bands. Sharp slow waves were present on EEG tracings of the three sevoflurane groups, whereas slow waves and fast rhythms (spindles) were observed in the halothane group. Sevoflurane induced a greater withdrawal of parasympathetic activity than halothane and a transient relative increase in sympathetic vascular tone at loss of eyelash reflex. CONCLUSIONS Agitation observed during sevoflurane induction was not associated with seizures. Sevoflurane induction induced a marked inhibition of parasympathetic control of heart rate.
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Affiliation(s)
- I Constant
- Service d'Anesthésie-Réanimation, Hopital d'Enfants Armand Trousseau, Paris, France
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Maurer CR, Hill DL, Martin AJ, Liu H, McCue M, Rueckert D, Lloret D, Hall WA, Maxwell RE, Hawkes DJ, Truwit CL. Investigation of intraoperative brain deformation using a 1.5-T interventional MR system: preliminary results. IEEE Trans Med Imaging 1998; 17:817-825. [PMID: 9874307 DOI: 10.1109/42.736050] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
All image-guided neurosurgical systems that we are aware of assume that the head and its contents behave as a rigid body. It is important to measure intraoperative brain deformation (brain shift) to provide some indication of the application accuracy of image-guided surgical systems, and also to provide data to develop and validate nonrigid registration algorithms to correct for such deformation. We are collecting data from patients undergoing neurosurgery in a high-field (1.5 T) interventional magnetic resonance (MR) scanner. High-contrast and high-resolution gradient-echo MR image volumes are collected immediately prior to surgery, during surgery, and at the end of surgery, with the patient intubated and lying on the operating table in the operative position. In this paper we report initial results from six patients: one freehand biopsy, one stereotactic functional procedure, and four resections. We investigate intraoperative brain deformation by examining threshold boundary overlays and difference images and by measuring ventricular volume. We also present preliminary results obtained using a nonrigid registration algorithm to quantify deformation. We found that some cases had much greater deformation than others, and also that, regardless of the procedure, there was very little deformation of the midline, the tentorium, the hemisphere contralateral to the procedure, and ipsilateral structures except those that are within 1 cm of the lesion or are gravitationally above the surgical site.
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Affiliation(s)
- C R Maurer
- Division of Radiological Sciences and Medical Engineering, Guy's, King's and St. Thomas' School of Medicine, King's College London, UK
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McCue M. The Relationship between Neuropsychology and Functional Assessment in the Elderly. ACTA ACUST UNITED AC 1997. [DOI: 10.1007/978-1-4899-1857-4_26] [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: 02/21/2023]
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Abstract
The authors report on a novel and effective peer helper program initiated by the University of Iowa Student Health Service (SHS) in fall 1992 to help prevent the development of active tuberculosis among foreign nationals attending the university. Before instituting the peer program, compliance with tuberculosis-prevention efforts for those students eligible for treatment was less than 5%. Since the peer program was initiated, compliance has risen to 50%.
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Affiliation(s)
- M McCue
- University of Iowa in Iowa City, USA
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Pramuka M, Petrick J, McCue M. Executive dysfunction in learning disability. Arch Clin Neuropsychol 1995. [DOI: 10.1093/arclin/10.4.378] [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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Petrick J, Wilhelm K, Franzen M, McCue M. Word Reversal Test: A new measure of interference and cognitive efficiency. Arch Clin Neuropsychol 1995. [DOI: 10.1093/arclin/10.4.376a] [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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Rogers JC, Holm MB, Goldstein G, McCue M, Nussbaum PD. Stability and change in functional assessment of patients with geropsychiatric disorders. Am J Occup Ther 1994; 48:914-8. [PMID: 7825707 DOI: 10.5014/ajot.48.10.914] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Functional assessments of patients with geropsychiatric disorders accomplished by self-rating, informant rating, and performance test were compared. METHOD Fifty-eight inpatients with major depression or progressive dementia were evaluated on three occasions over 6 months with informant and patient versions of the Activities of Daily Living Scale of the Older Americans Resources and Services Multidimensional Functional Assessment (OARS-ADL) and with the Performance Assessment of Self-Care Skills (PASS). RESULTS Patients' scores became significantly worse (p < .01) on the informant version of the OARS-ADL and the PASS. Self-ratings with the OARS-ADL did not worsen significantly (p > .05). CONCLUSION Agreement between informant rating and performance test concerning functional status of patients with dementia was good. Elderly patients with depression may experience subtle deterioration that only becomes apparent on performance tests.
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Affiliation(s)
- J C Rogers
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pennsylvania
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