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Sellers A.B.,University of Alabama at Birmingham | Ruscheweyh R.,Ludwig Maximilians University of Munich | Kelley B.J.,Charles George Medical Center | Ness T.J.,University of Alabama at Birmingham | Vetter T.R.,University of Alabama at Birmingham
Regional Anesthesia and Pain Medicine

Background and Objectives: The Pain Sensitivity Questionnaire (PSQ) is predictive of pain-related responses to experimental stimuli in German-speaking individuals. Here, we explored the validation of the English translation of the PSQ (PSQ-E). Methods: One hundred thirty-six patients scheduled to undergo a low back interventional procedure completed the PSQ-E and other questionnaires including the Brief Pain Inventory. Pain ratings on a visual analog scale (VAS) were obtained following 2 standardized injections of subcutaneous lidocaine (VAS 1, infiltration in hand; VAS 2, infiltration of procedural site). The VAS measures were compared with the PSQ-E data and other inventories using linear regression analysis with stepwise selection of variables. Results: The PSQ-E properties were in all respects similar to those of the original German PSQ. VAS 1 magnitude was predicted by PSQE- minor (r = 0.26, P < 0.01). VAS 2 magnitude was predicted by PSQ-E-minor (r = 0.34, P < 0.001), and the prediction was significantly enhanced by further inclusion of the Brief Pain Inventory interference score (total r = 0.40, P < 0.001).Conclusions: The study demonstrated that a significant correlation exists between the PSQ-E and clinically relevant pain ratings. This study validates the PSQ-E both in terms of measuring pain sensitivity and as possible means of recognizing patients with high pain sensitivity. Defining this subset of patients may have clinical utility in the future. © 2013 by American Society of Regional Anesthesia and Pain Medicine. Source

Pfalzgraf A.R.,Duquesne University | Scott V.,West Virginia University | Makela E.,Charles George Medical Center | Kavookjian J.,Auburn University | And 2 more authors.
Journal of Psychiatric Practice

Objective. Major depressive disorder (MDD) is a serious U.S. public health problem for children and adolescents. This study examined the type and course of treatment and monitoring habits of child psychiatrists treating newly diagnosed children and adolescents with MDD. Length of treatment and monitoring frequency were compared to current recommendations. Methods. A national random sample of child psychiatrists (N = 2,250) was surveyed via a modified Dillman approach to mailed surveys. Descriptive statistics and t-tests were used to report and analyze the data. Results. Of 1,982 surveys that were delivered to child psychiatrists, 316 (15.9%) were returned, with 299 surveys (15.1%) providing usable data. The child psychiatrists who responded to the survey reported that they use a combination of antidepressant and psychotherapy treatment, although many (40.1%) treat children with psychotherapy alone as a first-line treatment. With regard to pharmacotherapy for MDD, the child psychiatrists self-reported using fluoxetine or sertraline. Many child psychiatrists also use bupropion or other drug classes as a third-line treatment strategy. The child psychiatrists reported that they treat children and adolescents with antidepressant medication for an average of 10 months. This is significantly (p < 0.05) longer than the 6 month minimum recommended by the American Academy of Child and Adolescent Psychiatry (AACAP). During the first and second months of treatment, the monitoring reported was significantly (p < 0.05) less than that recommended by the U.S. Food and Drug Administration (FDA), while the reported monitoring did not differ (p = 0.10) from FDA recommendations in the third month. Conclusions. Child psychiatrists reported using combination treatment when treating children and adolescents with MDD. When they reported using antidepressant medications, the most commonly prescribed agents were fluoxetine or sertraline. Reported length of antidepressant treatment was adequate for relapse prevention. The monitoring behavior reported by respondents was not consistent with the FDA's recommendations for the first 2 months of treatment, but it was consistent for month 3. (Journal of Psychiatric Practice 2012;18:253-261) Copyright © 2012 Lippincott Williams & Wilkins Inc. Source

Hudson R.,Charles George Medical Center | Comer L.,Western Carolina University | Whichello R.,Western Carolina University
Journal of Nursing Management

Aim: The aim of this review is to synthesize the current body of knowledge concerning transitional care for patients 65 years of age and older moving from the acute care setting to home. Background: Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations. Evaluation: This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included. Key issues: The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated. Conclusions: While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care. Implications: Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers. © 2012 John Wiley & Sons Ltd. Source

Choma T.J.,University of Missouri | Rechtine G.R.,Charles George Medical Center | McGuire R.A.,University of Mississippi Medical Center | Brodke D.S.,University of Utah
Journal of the American Academy of Orthopaedic Surgeons

Demographic trends make it incumbent on orthopaedic spine surgeons to recognize the special challenges involved in caring for older patients with spine pathology. Unique pathologies, such as osteoporosis and degenerative deformities, must be recognized and dealt with. Recent treatment options and recommendations for the medical optimization of bone health include vitamin D and calcium supplementation, diphosphonates, and teriparatide. Optimizing spinal fixation in elderly patients with osteoporosis is critical; cement augmentation of pedicle screws is promising. In the management of geriatric odontoid fractures, nonsurgical support with a collar may be considered for the low-demand patient, whereas surgical fixation is favored for high-demand patients. Management of degenerative deformity must address sagittal plane balance, including consideration of pelvic incidence. Various osteotomies may prove helpful in this setting. © 2015 by the American Academy of Orthopaedic Surgeons. Source

Jones G.L.,709 North Justice Street | Lima E.,Charles George Medical Center
Family Medicine

BACKGROUND AND OBJECTIVES: Practice redesign is one of the core principles of the Patient-centered Medical Home. Little is known about how such large-scale changes in a residency practice affect the providers and staff involved. METHODS: Focus groups were conducted with residents, faculty, and medical support staff of a redesigned practice to determine the factors that contributed to the success of a practice redesign experiment. RESULTS: Challenges included obtaining sufficient buy-in for the process, ineffective communication from practice leadership, and insufficient staff training. Facilitating factors included involving staff in developing solutions, enhanced responsibility, and team cohesion over time. Residents involved in the redesign effort felt that it enhanced their practice experience. CONCLUSIONS: Practice redesign can be a challenging task for residency practices to complete successfully. Committed leadership and planning, with attention to the impact that such a change will have on those involved, can greatly impact the likelihood of success. Source

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