Charles George Medical Center

Asheville, NC, United States

Charles George Medical Center

Asheville, NC, United States
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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 | Year: 2013

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.


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 | Year: 2015

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.


Porter A.K.,Charles George Medical Center | Taylor S.R.,Charles George Medical Center | Taylor S.R.,Wingate University | Yabut A.H.,Hunter Holmes ire Medical Center | Al-Achi A.,Campbell University
Journal of Managed Care Pharmacy | Year: 2014

Background: Two-thirds of Americans who are prescribed antihypertensive medications are not at a blood pressure (BP) goal of < 140/90 mmHg, and low adherence is identified as a primary cause of inadequate control. Improved adherence to antihypertensive medications has been shown to enhance BP control and reduce the risk of cardiovascular complications. This study investigated the effectiveness of a pill box clinic to improve BP in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications. Objectives: To (a) investigate the reduction of systolic BP by 10 mmHg from pre-intervention to post-intervention (primary outcome) and (b) investigate the percentage of patients meeting goal blood pressure-as defined by The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7)-and percentage of patient adherence to antihypertensive medications (secondary outcomes). Methods: Patients with uncontrolled hypertension currently taking at least 3 antihypertensive medications were enrolled in this prospective pre/post study. Under the supervision of a pharmacist, each patient was provided two 7-day pill boxes to organize all antihypertensive medications. In addition, baseline BP and previous history of nonadherence were documented. Following the initial encounter, patients attended 2 follow-up appointments, at 2 and 4 weeks, for refill of pill boxes, BP measurement, and adherence assessment. A chi-square test was used for categorical outcomes and logistic regression for nominal outcomes as well as descriptive statistics, as appropriate. Results: Sixty patients were enrolled, with 50 completing appointments 1 and 2, and 45 completing all 3 appointments. Of those, 24% and 31% achieved at least a 10 mmHg reduction in systolic BP from baseline to appointments 2 and 3, respectively (P = 0.438). Systolic BP readings for appointments 1, 2, and 3 were not statistically significant (mean [SD]: 134.1 [11.8], 131.9 [9.4], and 130.6 [11.4], respectively). Goal BP per JNC7 was achieved by 44% and 51% of patients at appointments 2 and 3, respectively, compared with baseline (P = 0.201). All patients had = 80% adherence to antihypertensive medications, assessed via pill counts at the second and third appointments. Conclusion: Although results were not statistically significant, the pill box clinic resulted in clinically significant reductions in systolic BP by 10 mmHg, as well as an increased number of patients meeting prescribed BP goals. © 2014, Academy of Managed Care Pharmacy.


Davis L.L.,Duke University | Chestnutt D.,Charles George Medical Center | Molloy M.,Duke University | Deshefy-Longhi T.,Connecticut Community Care Inc. | And 2 more authors.
Qualitative Health Research | Year: 2014

Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer's or Parkinson's disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Case managers' interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver's management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed. © The Author(s) 2014.


Hudson R.,Charles George Medical Center | Comer L.,Western Carolina University | Whichello R.,Western Carolina University
Journal of Nursing Management | Year: 2014

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.


PubMed | Charles George Medical Center, Iowa State University and University of California at Berkeley
Type: Journal Article | Journal: Developmental psychobiology | Year: 2015

Military stressors such as survival training can affect endocrine functioning in the short term, and combat has been associated with endocrine changes linked to psychopathology. However, studies with military samples examining whether there are individual differences in these changes as part of normal development, or as an adaptive mechanism in adulthood are lacking. This study examined whether exposure to combat in a sample of veterans was associated with differential endocrine activity to a laboratory frustration task. Results indicated that Army veterans demonstrated significant testosterone reactivity to frustration and negative coupling between cortisol and testosterone. Alternatively, Navy and Marine veterans demonstrated little testosterone reactivity to frustration and positive coupling between cortisol and testosterone. Positive cortisol-testosterone coupling was stronger among individuals who had more dangerous combat experiences. This latter pattern may better prepare individuals for stressful life experiences and supports the contention that adulthood stressors may calibrate endocrine systems. Results are explained in the context of the Adaptive Calibration Model (Ellis et al., 2012, Developmental Psychology, 48(3), 598-623) which proposes that exposure to key environmental dimensions during endocrinologically malleable life stages (e.g., puberty) can change stress responsivity, resulting in a faster life history trajectory (e.g., increased risk-taking and aggression).


Jones G.L.,709 North Justice Street | Lima E.,Charles George Medical Center
Family Medicine | Year: 2011

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.


Worthen M.D.,Charles George Medical Center | Moering R.G.,James A Haley Veterans Hospital
Psychological Injury and Law | Year: 2011

Despite being one of the most common forensic mental health evaluations, no article has ever appeared in a peer-reviewed journal describing how to conduct US Department of Veterans Affairs (VA) mental health compensation and pension examinations. This article rectifies that paucity of information. We outline the legal framework, ethical considerations, and administrative challenges inherent in these evaluations. We provide separate guidelines for private practice clinicians and VA staff or contractors. We pay special attention to the multiple sources of collateral information available for these exams and how to access relevant records. The article alerts examiners to the possibility that they might face resistance from VA officials if they screen for and assess symptom exaggeration or feigning and that they could encounter VA-imposed restrictions on time allotted for exams. Specific suggestions are made for different types of exams: Initial Post-traumatic Stress Disorder (PTSD), PTSD Review, Initial Mental Disorder, and Mental Disorder Review. © 2011 Springer Science + Business Media, LLC.


PubMed | Charles George Medical Center
Type: Journal Article | Journal: Journal of nursing management | Year: 2014

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.Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations.This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included.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.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.Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.


PubMed | Charles George Medical Center
Type: Journal Article | Journal: Clinical diabetes : a publication of the American Diabetes Association | Year: 2016

In Brief Insulin therapies using a wide variety of delivery devices are available to accommodate individual patients needs. In this study of veterans with diabetes, converting from insulin aspart delivered with vials and syringes to insulin aspart delivered via a pen device resulted in no significant change in A1C. Although insulin pen delivery devices offer benefits, providers should thoroughly consider all potential reasons for uncontrolled diabetes before modifying a patients insulin delivery method.

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