Malcom Randall Medical Center

Gainesville, FL, United States

Malcom Randall Medical Center

Gainesville, FL, United States

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Stammet M.M.,Malcom Randall Medical Center | Spradley S.S.,Malcom Randall Medical Center
Journal of Opioid Management | Year: 2016

In 2013, the North Florida/South Georgia Veterans Healthcare System established a pharmacist-run urine drug testing (UDT) electronic consultation (e-consult) service to assist providers with interpretation of this useful yet complex clinical tool. This pilot study aimed to classify clinical treatment changes implemented following e-consult to a pharmacist-run UDT service and analyze factors limiting pharmacist intervention postconsultation. One hundred forty-Three e-consults were completed in the 2-year study period including interpretation of 190 UDT results classified as expected, unexpected, or not necessarily inappropriate based on prescription profile at time of urine immunoassay test. Preconsult evaluation revealed that in more than 70 percent of cases, no confirmatory testing was ordered on the sample in question by the requesting provider. Of the 28 percent of UDT results classified as unexpected, 32 percent identified the presence of an illicit substance. Completed e-consults provided either education-based (informative) or actionbased (decisive) recommendations. In 50 percent of the cases where unexpected substances were identified, pharmacy specialists recommended immediate action to be taken by the provider. Subsequent review indicates that timely documentation of postconsultation action by requesting provider was only present in 32 percent of this group. Continued efforts toward an improved understanding of UDT utility by providers, along with expedited placement of e-consult following urine collection, may allow for increased implementation of pharmacist interventions and lead to more optimal use of this clinical tool. © 2016 Journal of Opioid Management, All Rights Reserved.

Woodbury M.L.,Ralph hnson Va Medical Center | Woodbury M.L.,Medical University of South Carolina | Velozo C.A.,Malcom Randall Medical Center | Velozo C.A.,University of Florida | Richards L.G.,University of Utah
Archives of Physical Medicine and Rehabilitation | Year: 2013

Objectives: To define Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) cutoff scores that demarcate 1 level of upper extremity (UE) impairment from another, and describe motor behaviors for each category in terms of expected FMA-UE item performance. Design: Analysis of existing FMA-UE data. Setting: University research laboratory. Participants: Persons (N=512) 0 to 145 days poststroke, 42 to 90 years of age. Intervention: Not applicable. Main Outcome Measures: An item response Rasch analysis staging method was used to calculate cutoff scores, which were defined as the Rasch-Andrich threshold values of 2 criterion FMA-UE items derived from an analysis of this sample. The analysis enabled conversion of cutoff scores, in logit units, to FMA-UE points assessed on 30 FMA-UE voluntary movement items (60 possible points). Results: The boundary between severe and moderate impairment was defined as -1.59±.27 logits or 19±2 points; and between moderate and mild impairment was defined as 2.44±.27 logits or 47±2 points. A description of expected performance in each impairment level shows that patients with severe impairment exhibited some distal movements, and patients with mild impairment had difficulties with some proximal movements. Conclusions: The cutoff scores, which link to a description of specific movements a patient can, can partially, and cannot perform, may enable formation of heterogeneous patient groups, advance efforts to identify specific movement therapy targets, and define treatment response in terms of specific movement that changed or did not change with therapy. © 2013 by the American Congress of Rehabilitation Medicine.

Tilson J.K.,University of Southern California | Wu S.S.,University of Florida | Cen S.Y.,University of Southern California | Feng Q.,National University of Singapore | And 5 more authors.
Stroke | Year: 2012

Background and Purpose-: Better understanding of fall risk poststroke is required for developing screening and prevention programs. This study characterizes falls in the Locomotor Experience Applied Post-Stroke (LEAPS) randomized clinical trial, describes the impact of 2 walking recovery interventions on falls, and examines the value of clinical assessments for predicting falls. Methods-: Community-dwelling ambulatory stroke survivors enrolled in LEAPS were assessed 2 months poststroke. Falls were monitored until 12 months poststroke and participants were characterized as multiple or injurious (M/I); single, noninjurious; or nonfallers. Incidence and time to M/I falls were compared across interventions (home exercise and locomotor training initiated 2 months [early-LTP] or 6 months [late-LTP] poststroke). Predictive value of 2-month clinical assessments for falls outcome was assessed. Results-: Among the 408 participants, 36.0% were M/I, 21.6% were single, noninjurious, and 42.4% were nonfallers. Most falls occurred at home in the first 3 months after assessment. Falls incidence was highest for those with severe walking impairment who received early-LTP (P=0.025). Berg Balance Scale score ≤42/56 was the single best predictor of M/I falls. Conclusions-: As individuals with stroke improve in walking capacity, risk for M/I falls remains high. Individuals walking <0.4 m/s are at higher risk for M/I falls if they receive early-LTP training. Berg Balance Scale score at 2 months poststroke is useful for informing falls risk, but it cannot account for the multifactorial nature of the problem. Falls prevention in stroke will require multifactorial risk assessment and management provided concomitantly with exercise interventions to improve mobility. Clinical Trial Registration-: URL: Unique identifier: NCT00243919. © 2011 American Heart Association, Inc.

Altmann L.J.P.,University of Florida | Troche M.S.,University of Florida | Troche M.S.,Malcom Randall Medical Center
Parkinson's Disease | Year: 2011

This paper discusses impairments of high-level, complex language production in Parkinson's disease (PD), defined as sentence and discourse production, and situates these impairments within the framework of current psycholinguistic theories of language production. The paper comprises three major sections, an overview of the effects of PD on the brain and cognition, a review of the literature on language production in PD, and a discussion of the stages of the language production process that are impaired in PD. Overall, the literature converges on a few common characteristics of language production in PD: reduced information content, impaired grammaticality, disrupted fluency, and reduced syntactic complexity. Many studies also document the strong impact of differences in cognitive ability on language production. Based on the data, PD affects all stages of language production including conceptualization and functional and positional processing. Furthermore, impairments at all stages appear to be exacerbated by impairments in cognitive abilities. © 2011 Lori J. P. Altmann and Michelle S. Troche.

Patel S.,University of Florida | Shrivastav R.,Malcom Randall Medical Center | Eddins D.A.,University of South Florida
Journal of Speech, Language, and Hearing Research | Year: 2012

Purpose: In this experiment, a single comparison stimulus was developed as a reference in a perceptual matching task for the quantification of breathy voice quality. Perceptual judgments of a set of synthetic voice samples were compared to previous data obtained using multiple comparison stimuli "customized" for different voices (Patel, Shrivastav, & Eddins, 2010). Method: Five male and 5 female samples of the vowel /a/ were selected from the Kay Elemetrics Disordered Voice Database and resynthesized using a Klatt synthesizer. Eleven samples were created for each base voice by manipulating the aspiration noise level. Five samples from each continuum were evaluated in a perceptual matching task in which a single sawtooth and noise comparison stimulus was used to obtain breathiness judgments. Linear regression was used to compare measurements obtained using the new comparison stimulus against the customized comparison stimuli. Results: Results indicated that the noncustomized sawtooth comparison provides reliability and perceptual distances between stimuli similar to those obtained using customized comparison stimuli. Conclusion: A single-variable matching task using a single comparison stimulus can be used to obtain perceptual estimates of breathiness across voices and experiments in a laboratory setting. This technique will help develop models of voice-quality perception. © American Speech-Language-Hearing Association.

Hess C.W.,Columbia University | Hess C.W.,University of Florida | Hess C.W.,Malcom Randall Medical Center
Frontiers in Human Neuroscience | Year: 2013

Studies suggest that endogenous field effects may play a role in neuronal oscillations and communication. Non-invasive transcranial electrical stimulation with low-intensity currents can also have direct effects on the underlying cortex as well as distant network effects. While Parkinson's disease (PD) is amenable to invasive neuromodulation in the basal ganglia by deep brain stimulation (DBS), techniques of non-invasive neuromodulation like transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) are being investigated as possible therapies. tDCS and tACS have the potential to influence the abnormal cortical-subcortical network activity that occurs in PD through sub-threshold changes in cortical excitability or through entrainment or disruption of ongoing rhythmic cortical activity. This may allow for the targeting of specific features of the disease involving abnormal oscillatory activity, as well as the enhancement of potential cortical compensation for basal ganglia dysfunction and modulation of cortical plasticity in neurorehabilitation. However, little is currently known about how cortical stimulation will affect subcortical structures, the size of any effect, and the factors of stimulation that will influence these effects. © 2013 Hess.

Copeland V.C.,University of Pittsburgh | Snyder K.,Malcom Randall Medical Center
Social Work in Public Health | Year: 2011

Despite the prevalence of mental illness among low-income African American women, only a limited number seek and/or accept help from mental health service delivery systems. A qualitative analysis of 64 ethnographic interviews of low-income African American women whose children receive behavioral health services was completed to assess what barriers to care were reported for the women themselves. These African American women were interviewed as part of a larger study seeking to determine why mothers seek mental health treatment for their children, but not themselves, after many of the women (n = 32) met the baseline criteria for anxiety and/or depression. Our finding revealed that (1) the fear of losing their children, (2) economic stressors, (3) role strain, (4) perceptions of the system, and (5) violence and survival are key factors to consider when engaging low-income African American women in mental health treatment services. These factors have a negative influence on help seeking that should be considered for eliminating disparities in access to and utilization of mental health services. Copyright © Taylor & Francis Group, LLC.

Rose D.K.,University of Florida | Rose D.K.,Malcom Randall Medical Center | Winstein C.J.,University of Southern California
Journal of Motor Behavior | Year: 2013

Interlimb coordination obtained through temporal and spatial coupling is a significant feature of human motor control. To understand the robustness of this capability the authors introduced a method to quantify interlimb coordination strength and compare individuals with asymmetric effector ability poststroke to nondisabled controls. Quantitative analyses determined the relative strength of interlimb coupling with an asymmetric obstacle avoidance task. Participants performed bimanual discrete, multijoint aiming movements in the frontal plane with a vertical barrier positioned midway to the target for one limb. To quantify coupling strength between limbs and groups, we regressed individual participant nonbarrier limb movement time or maximum vertical displacement separately, on barrier limb performance. Temporal and spatial interlimb coupling strength varied across participants in both groups. Barrier limb performance predicted nonbarrier limb behavior; however, interlimb coupling was significantly stronger for the nondisabled compared to the stroke group. In the stroke group, deficits in interlimb coordination affected spatial coupling more than temporal coupling. The decreased coupling strength detected, even in the presence of mild hemiparesis, demonstrates the measure's sensitivity. The authors propose this metric as a powerful assessment of the effectiveness of rehabilitation interventions and to monitor the recovery of bimanual coordination poststroke. Copyright © 2013 Taylor and Francis Group, LLC.

Hobson C.,Malcom Randall Medical Center | Hobson C.,University of Florida | Ozrazgat-Baslanti T.,University of Florida | Kuxhausen A.,University of Florida | And 7 more authors.
Annals of Surgery | Year: 2015

Objective: To determine the incremental hospital cost and mortality associated with the development of postoperative acute kidney injury (AKI) and with other associated postoperative complications Background: Each year 1.5 million patients develop a major complication after surgery. Postoperative AKI is one of the most common postoperative complications and is associated with an increase in hospital mortality and decreased survival for up to 15 years after surgery. Methods: In a single-center cohort of 50,314 adult surgical patients undergoing major inpatient surgery, we applied risk-adjusted regression models for cost and mortality using postoperative AKI and other complications as the main independent predictors. We defined AKI using consensus Risk, Injury, Failure, Loss and End-Stage Renal Disease criteria. Results: The prevalence of AKI was 39% among 50,314 patients with available serum creatinine. Patients with AKI were more likely to have postoperative complications and had longer lengths of stay in the intensive care unit and the hospital. The risk-adjusted average cost of care for patients undergoing surgery was $42,600 for patients with any AKI compared with $26,700 for patients without AKI. The risk-adjusted 90-day mortality was 6.5% for patients with any AKI compared with 4.4% for patients without AKI. Serious postoperative complications resulted in increased cost of care and mortality for all patients, but the increase was much larger for those patients with any degree of AKI. Conclusions: Hospital costs and mortality are strongly associated with postoperative AKI, are correlated with the severity of AKI, and are much higher for patients with other postoperative complications in addition to AKI. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.

Beck D.T.,Malcom Randall Medical Center | Martin J.S.,Lasell College | Casey D.P.,University of Iowa | Braith R.W.,University of Florida
American Journal of Hypertension | Year: 2013

BACKGROUNDLarge artery stiffness is a major risk factor for the development of hypertension and cardiovascular disease. Persistent prehypertension accelerates the progression of arterial stiffness.METHODSForty-three unmedicated prehypertensive (systolic blood pressure (SBP) = 120-139mm Hg or diastolic blood pressure (DBP) = 80-89mm Hg) men and women and 15 normotensive time-matched control subjects (NMTCs; n = 15) aged 18-35 years of age met screening requirements and participated in the study. Prehypertensive subjects were randomly assigned to a resistance exercise training (PHRT; n = 15), endurance exercise training (PHET; n = 13) or time-control group (PHTC; n = 15). Treatment groups performed exercise training 3 days per week for 8 weeks. Pulse wave analysis, pulse wave velocity (PWV), and central and peripheral blood pressures were evaluated before and after exercise intervention or time-matched control.RESULTSPHRT and PHET reduced resting SBP by 9.6±3.6mm Hg and 11.9±3.4mm Hg, respectively, and DBP by 8.0±5.1mm Hg and 7.2±3.4mm Hg, respectively (P < 0.05). PHRT and PHET decreased augmentation index (AIx) by 7.5% ± 2.8% and 8.1% ± 3.2% (P < 0.05), AIx@75 by 8.0% ± 3.2% and 9.2% ± 3.8% (P < 0.05), and left ventricular wasted pressure energy, an index of extra left ventricular myocardial oxygen requirement due to early systolic wave reflection, by 573±161 dynes s/cm2 and 612±167 dynes s/cm2 (P < 0.05), respectively. PHRT and PHET reduced carotid-radial PWV by 1.02±0.32 m/sec and 0.92±0.36 m/sec (P < 0.05) and femoral-distal PWV by 1.04±0.31 m/sec and 1.34±0.33 m/sec (P < 0.05), respectively. No significant changes were observed in the time-control groups.CONCLUSIONSThis study suggests that both resistance and endurance exercise alone effectively reduce peripheral arterial stiffness, central blood pressures, augmentation index, and myocardial oxygen demand in young prehypertensive subjects. © 2013 © American Journal of Hypertension, Ltd. All rights reserved.

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