Swaan C.M.,DRS Health
Journal of Public Health Management and Practice | Year: 2017
CONTEXT:: During the Ebola outbreak in West Africa in 2014-2015, close cooperation between the curative sector and the public health sector in the Netherlands was necessary for timely identification, referral, and investigation of patients with suspected Ebola virus disease (EVD). OBJECTIVE:: In this study, we evaluated experiences in preparedness among stakeholders of both curative and public health sectors to formulate recommendations for optimizing preparedness protocols. Timeliness of referred patients with suspected EVD was used as indicator for preparedness. DESIGN:: In focus group sessions and semistructured interviews, experiences of curative and public health stakeholders about the regional and national process of preparedness and response were listed. Timeliness recordings of all referred patients with suspected EVD (13) were collected from first date of illness until arrival in the referral academic hospital. RESULTS:: Ebola preparedness was considered extensive compared with the risk of an actual patient, however necessary. Regional coordination varied between regions. More standardization of regional preparation and operational guidelines was requested, as well as nationally standardized contingency criteria, and the National Centre for Infectious Disease Control was expected to coordinate the development of these guidelines. For the timeliness of referred patients with suspected EVD, the median delay between first date of illness until triage was 2.0 days (range: 0-10 days), and between triage and arrival in the referral hospital, it was 5.0 hours (range: 2-7.5 hours). In none of these patients Ebola infection was confirmed. CONCLUSIONS:: Coordination between the public health sector and the curative sector needs improvement to reduce delay in patient management in emerging infectious diseases. Standardization of preparedness and response practices, through guidelines for institutional preparedness and blueprints for regional and national coordination, is necessary, as preparedness for emerging infectious diseases needs a multidisciplinary approach overarching both the public health sector and the curative sector. In the Netherlands a national platform for preparedness is established, in which both the curative sector and public health sector participate, in order to implement the outcomes of this study.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Reinschmidt K.M.,DRS Health
Journal of Ambulatory Care Management | Year: 2017
The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records. These findings contribute to evidence-based guidelines for CHW integration into clinical teams that are critical to maximizing CHW contributions to patient health improvements. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved
Greer N.,DRS Health
Journal of Head Trauma Rehabilitation | Year: 2017
OBJECTIVES:: To systematically review the literature on comparative clinical and functional outcomes following blast-related versus nonblast-related traumatic brain injury (TBI) among US service members and Veterans. DESIGN:: MEDLINE search (January 2001 to June 2016) supplemented with hand search of reference lists and input from peer reviewers. RESULTS:: Thirty-one studies (in 33 articles) reported on health outcomes; only 2 were rated low risk of bias. There was variation in outcomes reported and methods of assessment. Blast and nonblast TBI groups had similar rates of depression, sleep disorders, alcohol misuse, vision loss, vestibular dysfunction, and functional status. Comparative outcomes were inconsistent with regard to posttraumatic stress disorder diagnosis or symptoms, headache, hearing loss, and neurocognitive function. Mortality, burn, limb loss, and quality of life were each reported in few studies, most with small sample sizes. Only 4 studies reported outcomes by blast injury mechanism. CONCLUSIONS:: Most clinical and functional outcomes appeared comparable in military service members and Veterans with TBI, regardless of blast exposure. Inconsistent findings and limited outcomes reporting indicate that more research is needed to determine whether there is a distinct pattern of impairments and comorbidities associated with blast-related TBI. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Greene N.H.,DRS Health
Journal of Head Trauma Rehabilitation | Year: 2017
OBJECTIVE:: To ascertain the degree of variation, by state of acute care hospitalization, in outcomes associated with traumatic brain injury (TBI) in an adult population. SETTING:: All acute care hospitals in 21 states in the United States in the year 2010. PARTICIPANTS:: Adult (> 18 years) patients (N = 95 546) admitted to a hospital with a moderate or severe TBI. DESIGN:: Retrospective cohort study using data from State Inpatient Databases from Agency for Healthcare Research and Qualityʼs Healthcare Cost and Utilization Project. MAIN MEASURES:: Inpatient mortality and discharge to inpatient rehabilitation. RESULTS:: The adjusted risk of inpatient mortality varied between states by as much as 40%, with age, severity of injury, and insurance status as significant factors in both outcomes. The adjusted risk of discharge to inpatient rehabilitation varied between by more than 100% among the states measured. CONCLUSIONS:: There was clinically significant variation between states in inpatient mortality and rehabilitation discharge after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the causes of this state-to-state variation, how these causes affect patient outcomes, and may serve as a guide to further standardization of treatment for traumatic brain injury across the United States. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Grazzi G.,DRS Health
Journal of Cardiopulmonary Rehabilitation and Prevention | Year: 2017
INTRODUCTION:: The aim of this study was to determine whether the 1-km treadmill walking test, previously developed to predict peak oxygen uptake (VO2peak) in stable cardiac outpatients, could be reproduced outdoors. METHODS:: Fifty male cardiac outpatients performed the 1-km walking test on a treadmill and on a flat track within 1 week. VO2peak was estimated for both testing conditions considering age, height, weight, walking speed, and heart rate. RESULTS:: Average walking speed was slightly higher during outdoor conditions (5.73 ± 0.77 km/h vs 5.55 ± 0.84 km/h), whereas mean heart rates were similar for both testing conditions (102 ± 18 beats/min vs 103 ± 16 beats/min). VO2peak values for treadmill and outdoor tests were not significantly different (26.4 ± 4.1 mL/kg/min vs 26.8 ± 4.5 mL/kg/min) and were strongly correlated (r = 0.93, P < .0001). The slope and the intercept of the VO2peak values were not different from the line of identity. CONCLUSIONS:: This moderate and perceptually regulated 1-km walking test administered outdoors gives similar results compared with a similar test performed on a treadmill. Therefore, VO2peak can be reasonably estimated using both testing modalities. This suggests that the outdoor 1-km test can be applied for indirect estimations of cardiorespiratory fitness in an outpatient setting. CONDENSED ABSTRACT: In 50 cardiac outpatients, outdoor and treadmill 1-km walking tests provided similar results. Data derived from the outdoor 1-km test can be used to provide a reasonable estimate of VO2peak when evaluating cardiac outpatients. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Tong J.,DRS Health
Journal of Occupational and Environmental Medicine | Year: 2017
OBJECTIVE:: This study aimed to analyze the interaction of Angiotensin II type 1 receptor (AT1R) gene polymorphism and occupational noise on the occurrence of essential hypertension (EH) in steel and iron enterprise men workers. METHODS:: A case control study of 935 iron and steel enterprise men workers was conducted, which included 312 cases of hypertension and 623 cases without hypertension. The noise at the workplace was assessed. Polymorphism of AT1R of the workers was examined using polymerase chain reaction - restriction fragment length polymorphism. RESULTS:: Polymorphism of AT1R (AC+CC vs. AA, odds ratio [OR]?=?1.760, 95% confidence interval [CI]: 1.061∼2.920) and noise (greater than or equal to 85?dB(A),OR?=?1.641, 95%CI: 1.225∼2.198) were independent determinants of EH using multivariate Logistic regression. Compared with AA carriers without noise, AC+CC interacted with noise (OR?=?2.519, 95%CI: 1.254∼5.062) based on the multiplied model. CONCLUSIONS:: AC+CC genotype of AT1R and noise were the risky factors of EH. These factors also interacted with each other.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Copyright © 2017 by the American College of Occupational and Environmental Medicine
Blytt K.M.,DRS Health
Cancer Nursing | Year: 2017
BACKGROUND:: Life expectancy is increasing continuously, which increases the likelihood of developing dementia or cancer. Both dementia and cancer are serious conditions that give manifold symptoms. The interaction of these conditions is however complex and less explored. OBJECTIVES:: The aim of this study was to identify the prevalence of cancer and differences regarding neuropsychiatric symptoms (NPS) and medication among nursing home (NH) patients with and without dementia and cancer. METHODS:: This is a cross-sectional study of Norwegian NH patients (N = 1825). Participants were categorized according to degree of dementia (Clinical Dementia Rating > 1) and cancer diagnoses. Differences in NPS and other symptoms, as well as the use of medication, were explored. RESULTS:: Eighty-four percent of NH patients had dementia, and 5.5% had comorbid dementia and cancer. Patients with comorbid dementia and cancer received significantly more analgesics compared with patients without cancer but with dementia (P < .05). Compared with patients without dementia but with cancer, patients with comorbid dementia and cancer had significantly more NPS, including sleep disturbances and agitation. CONCLUSIONS:: Patients with comorbid dementia and cancer receive more analgesics than patients with dementia but still display more agitation and sleep disturbances than patients with cancer and patients with neither dementia nor cancer, suggesting that symptoms may not be treated adequately. IMPLICATIONS FOR PRACTICE:: The results indicate a considerable strain for patients with comorbid dementia and cancer and highlight essential challenges for the clinician who is responsible for treatment and care. Nurses should pay attention to agitation and sleep disturbances among patients with comorbid dementia and cancer.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved
Leary J.B.,DRS Health
Journal of Head Trauma Rehabilitation | Year: 2017
OBJECTIVE:: Examine the association of cognitive reserve (CR) factors (estimated premorbid intelligence quotient [IQ], years of education, and occupational attainment) and traumatic brain injury (TBI) severity with functional and neuropsychological outcomes 1 to 5 years following TBI. PARTICIPANTS:: Patients with mild (N = 58), moderate (N = 25), or severe (N = 17) TBI. MAIN MEASURES:: Cognitive reserve factors (estimated premorbid IQ, years of education, and occupational attainment); neuropsychological test battery; Glasgow Outcome Scale—Extended; Short Form-36 Health Survey. ANALYSES:: Spearman-Brown correlations, linear regression models, and analyses of covariance were used to analyze the relation between CR factors and outcome measures. RESULTS:: Analyses revealed significant relations between estimated premorbid IQ and neuropsychological outcomes (P < .004): California Verbal Learning Test, Wechsler Adult Intelligence Scale—Fourth Edition working memory, Booklet Category Test, Trail Making Test B, and Grooved Pegboard Test. There was also a significant correlation between estimated premorbid IQ and Wechsler Adult Intelligence Scale—Fourth Edition processing speed. Years of education had significant relations with California Verbal Learning Test and Wechsler Adult Intelligence Scale—Fourth Edition working memory and processing speed scores. There were significant differences between TBI severity groups and performance on the Trail Making Test A, Grooved Pegboard Test, and Finger Tapping Test. CONCLUSIONS:: Cognitive reserve factors may be associated with outcomes following TBI. Additional alternatives to TBI severity are needed to help guide rehabilitative planning postinjury. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Albrecht J.S.,DRS Health
Journal of Head Trauma Rehabilitation | Year: 2015
OBJECTIVE:: To estimate rates of emergency department (ED) visits for mild traumatic brain injury (TBI) among older adults. We defined possible mild TBI cases to assess underdiagnoses. DESIGN:: Cross-sectional. SETTING:: National sample of ED visits in 2009-2010 captured by the National Hospital Ambulatory Medical Care Survey. PARTICIPANTS:: Aged 65 years and older. MEASUREMENTS:: Mild TBI defined by International Classification of Diseases, Ninth Revision, Clinical Modification, codes (800.0x-801.9x, 803.xx, 804.xx, 850.xx-854.1x, 950.1x-950.3x, 959.01) and a Glasgow Coma Scale score of 14 or more or missing, excluding those admitted to the hospital. Possible mild TBI was defined similarly among those without mild TBI and with a fall or motor vehicle collision as cause of injury. We calculated rates of mild TBI and examined factors associated with a diagnosis of mild TBI. RESULTS:: Rates of ED visits for mild TBI were 386 per 100 000 among those aged 65 to 74 years, 777 per 100 000 among those aged 75 to 84 years, and 1205 per 100 000 among those older than 84 years. Rates for women (706/100 000) were higher than for men (516/100 000). Compared with a possible mild TBI, a diagnosis of mild TBI was more likely in the West (odds ratio = 2.31; 95% confidence interval, 1.02-5.24) and less likely in the South/Midwest (odds ratio = 0.52; 95% confidence interval, 0.29-0.96) than in the Northeast. CONCLUSIONS:: This study highlights an upward trend in rates of ED visits for mild TBI among older adults. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Sangster J.,DRS Health
Journal of Cardiopulmonary Rehabilitation and Prevention | Year: 2014
PURPOSE:: To determine the effectiveness of a pedometer-based telephone lifestyle coaching intervention on weight and physical activity.METHODS:: A randomized controlled trial was conducted with 313 patients referred to cardiac rehabilitation in rural and urban Australia. Participants were allocated to a healthy weight (HW) (4 telephone coaching sessions on weight and physical activity) or a physical activity (PA) intervention (2 telephone coaching sessions on physical activity). Weight and physical activity were assessed by self-report at baseline, short-term (6–8 weeks), and medium-term (6–8 months).RESULTS:: More than 90% of participants completed the trial. Over the medium-term, participants in the HW group decreased their weight compared with participants in the PA group (P = .005). Participants in the HW group with a body mass index of ≥25 kg/m had a mean weight loss of 1.6 kg compared with participants in the PA-only group who lost a mean of 0.4 kg (P = .015). Short-term, both groups increased their physical activity time, and the PA group maintained this increase at the medium-term.CONCLUSIONS:: Participants in the HW group achieved modest improvements in weight, and those in the PA group demonstrated increased physical activity. Low-contact, telephone-based interventions are a feasible means of delivering lifestyle interventions for underserved rural communities, for those not attending cardiac rehabilitation, or as an adjunct to cardiac rehabilitation. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins