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Dang B.N.,Center for Innovations in Quality | Dang B.N.,Michael bakey Veterans Affairs Medical Center 152 | Dang B.N.,Baylor College of Medicine | Westbrook R.A.,Rice University | And 5 more authors.
AIDS and Behavior

Cross-sectional studies have shown an association between better patient experiences and health outcomes. However, the direction of causality remains unclear. Our prospective study seeks to determine whether better initial patient experiences predict subsequent retention in HIV care. We enrolled patients new to an HIV clinic in Houston, Texas, from August 26, 2013 to November 18, 2013. The patients’ overall experience with the HIV provider was based on six items; overall experience with the HIV clinic was based on five items. We measured subsequent retention over the first 6 months and entire first year of HIV care. Analyses included 140 patients. Sixty-one percent were non-Hispanic black, 41 % were diagnosed with HIV within the last 3 months, and 36 % had a CD4 cell count <200. Thirty three percent were totally satisfied with their initial HIV provider experience and 32 % were totally satisfied with their initial HIV clinic experience. Retention was 68 % over the first 6 months and 51 % over the first year. Satisfaction with the HIV provider at the initial visit significantly predicted 6-month retention in care (aOR = 3.56, p = 0.006). Similar results were found for satisfaction with the HIV clinic (aOR = 4.67, p = 0.002). Neither of the patient experience measures at the initial visit predicted 12-month retention. Patients with better initial care experiences have significantly greater retention in HIV care. The effect of better initial care experiences was limited in duration. Consistently improving patient care experiences, not only at baseline and but also on subsequent visits, may be a way to increase retention in HIV care. © 2016 Springer Science+Business Media New York Source

Nguyen D.M.,Baylor College of Medicine | El-Serag H.B.,Baylor College of Medicine | El-Serag H.B.,Michael bakey Veterans Affairs Medical Center 152 | Shub M.,Phoenix Childrens Hospital | And 6 more authors.
Gastrointestinal Endoscopy

Background: Barrett's esophagus (BE) in children has been examined in retrospective studies, consisting of case series and cross-sectional studies. Objective: To evaluate the prevalence and determinants of BE in children who are free from neurodevelopmental disorders and tracheoesophageal abnormalities. Design: A prospective, cross-sectional study. Setting: Three pediatric GI Centers in Houston, Texas; Phoenix, Arizona; and Portland, Maine between February 2006 and December 2007. Patients: This study involved children and adolescents consecutively presenting for elective upper endoscopy. Patients with neurodevelopmental and tracheoesophageal disorders were excluded. Intervention: Endoscopic pictures of all cases with suspected BE were independently reviewed and verified by two experienced investigators. Esophageal biopsy specimens were obtained in all patients, and targeted biopsy specimens also were obtained from suspected BE. Main Outcome Measurements: Endoscopically suspected BE and histologically confirmed BE. Results: A total of 840 patients (mean age 9.5 years) were enrolled and had complete questionnaire and endoscopic data. Twelve patients were suspected of having BE (prevalence of 1.43%; 95% confidence interval [CI], 0.73-2.45), and only 1 patient had intestinal metaplasia, for a prevalence of 0.12% (95% CI, 0-0.65), whereas the rest had gastric oxyntic glands (n = 6) or squamous esophageal epithelium (n = 5). Patients with suspected BE had a higher mean body mass index (23.0 vs 19.1, P = .05) and more chest pain (50% vs 13%, P < .01) than patients without BE or reflux esophagitis. There was a trend toward a higher frequency of dysphagia, heartburn, and regurgitation in patients with suspected BE. Limitations: The accuracy of BE prevalence estimates is limited by the small number of cases. Conclusion: BE is rare in children without neurodevelopmental delay or tracheoesophageal anomalies presenting for elective upper endoscopy. © 2011 American Society for Gastrointestinal Endoscopy. Source

Calleo J.S.,Houston VA Health Services Research and Development HSRandD | Calleo J.S.,Michael bakey Veterans Affairs Medical Center 152 | Calleo J.S.,Baylor College of Medicine | Amspoker A.B.,Houston VA Health Services Research and Development HSRandD | And 16 more authors.
Journal of Geriatric Psychiatry and Neurology

Anxiety and depression often remain unrecognized or inadequately treated in patients with Parkinson disease (PD). Cognitive-behavioral therapy (CBT) is effective, but limited evidence supports its use for anxiety and depression in patients with PD. Sixteen patients with PD having significant anxiety and/or depressive symptoms were assigned to CBT or enhanced usual care. Assessments occurred at baseline, posttreatment, and 1-month follow-up. The CBT intervention included tools for anxiety, depression, and healthy living with PD symptoms. Individual sessions were delivered by telephone or in person, based on patient preference. Treatment was feasible with participants choosing 67% of sessions by telephone and 80% completed treatment. The between-group effect sizes for change scores from baseline to posttreatment and baseline to 1-month follow-up were large (posttreatment: d = 1.49 for depression and 1.44 for anxiety; 1-month follow-up: d =.73 for depression and 1.24 for anxiety), although only the posttreatment effect size for depression was significant. This pilot CBT program is feasible for treatment of anxiety and depression in patients with PD. © The Author(s) 2015. Source

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