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Hinojosa R.,Rehabilitation Outcomes Research Center | Haun J.,James ley Va Medical Center | Hinojosa M.S.,University of Florida | Rittman M.,Rehabilitation Outcomes Research Center
Topics in Stroke Rehabilitation | Year: 2011

Research suggests that individuals recovering from a stroke often experience social isolation, which is linked to increased depressive symptomatology and decreased ability to manage activities of daily living. Research also indicates that different racial and ethnic groups are more adversely affected than whites. This article uses poststroke narratives to explore the relationship between social isolation, depressive symptomatology, and the ability to manage activities of daily living poststroke for white, African American, and Puerto Rican veterans. Findings suggest those who were socially isolated during the fi rst year of poststroke recovery reported higher levels of depressive symptoms and a decreased ability to manage daily activities. Implications for stroke rehabilitation practice are discussed. © 2011 Thomas Land Publishers, Inc.. Source

Moering R.G.,James ley Va Medical Center
Psychological Injury and Law | Year: 2011

In conducting Compensation and Pension (C&P) examinations, one of the most significant sources of evidence supporting a veteran's claim for service connection are found in the veteran's service medical records and service personnel records. Although specific numbers are unknown, a majority of mental health providers who conduct C&P examinations are not veterans and have limited knowledge and understanding of the records they are being asked to review. In cases of an initial posttraumatic stress disorder (PTSD) examination, the Federal Register requires C&P examiners to determine if the veteran's claim is consistent with the places, types, and circumstances of the veteran's service. This article reviews specific data within personnel records to help verify those elements. Additionally, perhaps one of the most difficult types of evaluations faced by any C&P examiner is a PTSD claim for personal assault (e. g., military sexual trauma). This article reviews the types of information within the records to help identify specific "Markers" associated with personal trauma. © 2011 Springer Science + Business Media, LLC. Source

Crowley R.S.,University of Pittsburgh | Legowski E.,University of Pittsburgh | Medvedeva O.,University of Pittsburgh | Reitmeyer K.,University of Pittsburgh | And 5 more authors.
Advances in Health Sciences Education | Year: 2013

The purpose of this study is threefold: (1) to develop an automated, computer-based method to detect heuristics and biases as pathologists examine virtual slide cases, (2) to measure the frequency and distribution of heuristics and errors across three levels of training, and (3) to examine relationships of heuristics to biases, and biases to diagnostic errors. The authors conducted the study using a computer-based system to view and diagnose virtual slide cases. The software recorded participant responses throughout the diagnostic process, and automatically classified participant actions based on definitions of eight common heuristics and/or biases. The authors measured frequency of heuristic use and bias across three levels of training. Biases studied were detected at varying frequencies, with availability and search satisficing observed most frequently. There were few significant differences by level of training. For representativeness and anchoring, the heuristic was used appropriately as often or more often than it was used in biased judgment. Approximately half of the diagnostic errors were associated with one or more biases. We conclude that heuristic use and biases were observed among physicians at all levels of training using the virtual slide system, although their frequencies varied. The system can be employed to detect heuristic use and to test methods for decreasing diagnostic errors resulting from cognitive biases. © 2012 The Author(s). Source

Lloyd J.,BRAINS Inc. | Lloyd J.,James ley Va Medical Center | Conidi F.,Florida Center for Headache and Sports Neurology | Conidi F.,Florida State University
Journal of Neurosurgery | Year: 2016

Objective Helmets are used for sports, military, and transportation to protect against impact forces and associated injuries. The common belief among end users is that the helmet protects the whole head, including the brain. However, current consensus among biomechanists and sports neurologists indicates that helmets do not provide significant protection against concussion and brain injuries. In this paper the authors present existing scientific evidence on the mechanisms underlying traumatic head and brain injuries, along with a biomechanical evaluation of 21 current and retired football helmets. Methods The National Operating Committee on Standards for Athletic Equipment (NOCSAE) standard test apparatus was modified and validated for impact testing of protective headwear to include the measurement of both linear and angular kinematics. From a drop height of 2.0 m onto a flat steel anvil, each football helmet was impacted 5 times in the occipital area. Results Skull fracture risk was determined for each of the current varsity football helmets by calculating the percentage reduction in linear acceleration relative to a 140-g skull fracture threshold. Risk of subdural hematoma was determined by calculating the percentage reduction in angular acceleration relative to the bridging vein failure threshold, computed as a function of impact duration. Ranking the helmets according to their performance under these criteria, the authors determined that the Schutt Vengeance performed the best overall. Conclusions The study findings demonstrated that not all football helmets provide equal or adequate protection against either focal head injuries or traumatic brain injuries. In fact, some of the most popular helmets on the field ranked among the worst. While protection is improving, none of the current or retired varsity football helmets can provide absolute protection against brain injuries, including concussions and subdural hematomas. To maximize protection against head and brain injuries for football players of all ages, the authors propose thresholds for all sports helmets based on a peak linear acceleration no greater than 90 g and a peak angular acceleration not exceeding 1700 rad/sec2. © AANS, 2016. Source

Zaremba J.L.,Mann Grandstaff Medical Center | Carroll K.,VA Healthcare System | Manley K.,James ley Va Medical Center
Dimensions of Critical Care Nursing | Year: 2014

In 2004, practice standards for electrocardiographic (ECG) monitoring were published to address the need for an expanded use of ECG monitoring beyond heart rate and basic rhythm determination. This article reports the data collected from a survey distributed throughout the Veterans Healthcare Administration hospitals to determine the extent to which practice standards have been adopted. Survey data were used to identify the differences between actual practice and evidence-based standards. The results were divided into ECG electrode application, lead selection, alarm limits, monitoring capabilities, monitoring during patient transport, and education and competencies. The results confirm the need for improvement, including a thorough evaluation of facility practices and education. The data demonstrate the differences among actual practice and evidence-based recommendations. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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