Bensadon B.A.,The University of Oklahoma Health Sciences Center |
Teasdale T.A.,The University of Oklahoma Health Sciences Center |
Odenheimer G.L.,The University of Oklahoma Health Sciences Center |
Odenheimer G.L.,Oklahoma City Medical Center
Academic Medicine | Year: 2013
For more than half a century, scientific research has documented widespread avoidance and even denial of aging. Though nothing new, aversive reactions to the elderly are not only unfortunate but dangerous today, as increasing life expectancy and consequent demand for specialized geriatric medical care vastly outpace the supply of qualified clinicians equipped to provide it. This discrepancy has led to a crisis that is not easily resolved. At the same time, geriatrics reports the highest level of physician satisfaction among medical specialties. How can this apparent disconnect be explained, and what can be done about it? Citing evidence from medicine and other health care disciplines, the authors address these questions by emphasizing the role of aging-related attitudes, a complex but theoretically modifiable construct. Successful educational interventions are described, including the authors' experience at the helm of a monthlong geriatrics clerkship for fourth-year medical students. Novel suggestions are provided to combat the daunting challenges to achieving a workforce that is sufficient both in number and training to effectively meet the needs of the fastest-growing segment of the U.S. population. As patients continue to age across most medical specialties, the importance of geriatric curricula, particularly those sensitizing learners to the need for a systems-based, biopsychosocial (i.e., interdisciplinary) model of care, cannot be overemphasized. Such training, it is argued, should be a standard component of medical education, and future research should focus on identifying specific curricular content and teaching methods that most effectively achieve this end.
Rabadi M.H.,Oklahoma City Medical Center |
Rabadi M.H.,University of Oklahoma |
Vincent A.S.,University of Oklahoma
Disability and Rehabilitation | Year: 2013
Background: Multiple sclerosis (MS) is a disease which has a variable clinical presentation followed by a variable clinical course. Therefore, accuracy of clinical rating scales to measure disability at initial clinical presentation and during follow-up visits is essential to accurately capture the variability inherent in this disease. This is particularly vital when attempting to identify the efficacy of interventions. Objective: This observational study in veterans with MS compared the Kurtkze Expanded Disability Status Scale (EDSS) and the Total Functional Independence Measure (TFIM) scale as measures of MS-related disability. Methods: We retrospectively reviewed the electronic charts of 76 veterans with MS who are regularly followed in our VA MS clinic. Local Institutional Review Board approval was obtained for the protocol. Data were analyzed using SAS (SAS System for Windows, version 9.2, SAS Institute Inc., Cary, NC, USA). Chi-square and Fisher exact tests were used to assess categorical variables. Kruskal-Wallis tests evaluated the relationships between MS types [relapsing-remitting MS (RR), secondary progressive MS (SP), primary progressive MS (PP) and clinical isolated syndrome (CIS)] and the initial TFIM, EDSS and Impairment Index (II) scores. Results: The EDSS score accurately measured MS-related impairment at initial evaluation and follow-up relative to an II. However, the EDSS score did not change over time, compared to the TFIM suggesting reduced sensitivity of the EDSS for detecting change in MS-related disability over time. Conclusions: This suggests TFIM scale is a more sensitive measure of MS-related disability than EDSS for use in future MS clinical trials.Implications for RehabilitationThis study highlights that given the paucity of scales to which EDSS has been compared, TFIM is a valuable adjunct to EDSS in measuring MS-related disability.TFIM is able to accurately measure the severity of MS-related disability and help provide for services patients with MS-related disability would need.TFIM is an easy to administer and a sensitive scale to measure the change in MS-related disability following interventions. © 2013 Informa UK Ltd. All rights reserved.
Scofield R.H.,The University of Oklahoma Health Sciences Center |
Scofield R.H.,Oklahoma Medical Research Foundation |
Scofield R.H.,Oklahoma City Medical Center
Arthritis Research and Therapy | Year: 2011
Treatment of Sjögren's syndrome is almost entirely symptomatic. A lack of true understanding of the underlying immunological pathology of the disease prevents directed therapy. Interleukin-21 (IL-21) is elevated in the serum of patients with this disease and is expressed by the lymphocytes infiltrating the salivary glands. The known functions of IL-21 in facilitating differentiation, proliferation, and survival of both B and T cells mesh well with the findings in Sjögren's syndrome. Demonstration of IL-21 as a fundamental aspect of the pathophysiology of Sjögren's syndrome could lead to the development of anti-IL-21 therapy for this disease. © 2011 BioMed Central Ltd.
Gentry C.A.,Oklahoma City Medical Center |
Williams R.J.,Oklahoma City Medical Center
Diagnostic Microbiology and Infectious Disease | Year: 2015
This study sought to characterize the trends in antimicrobial susceptibility rates for Pseudomonas aeruginosa causing bacteremias across the US Veterans Healthcare Administration from 2007 through 2013 utilizing a national clinical database. Data were gathered from 107 Veterans Affairs medical centers involving 4418 patients with 4826 blood cultures with positive growth of P. aeruginosa. Susceptibility rates of β-lactam antimicrobials, carbapenems, fluoroquinolones, and aminoglycosides all significantly increased throughout the 7-year period, closely corresponding to a significant decline in the incidence of P. aeruginosa blood cultures of nosocomial origin. Several statistically significant increases in susceptibility rates were found for antimicrobial agents across different geographic regions of the United States. There were no statistically significant decreases in susceptibility rates for any antimicrobial agents for any region. Levels of multidrug resistance significantly declined throughout the study period in 2 regions and increased in 1. Additional efforts should evaluate variables associated with these improvements. © 2015.
Marlar R.A.,Oklahoma City Medical Center |
Marlar R.A.,The University of Oklahoma Health Sciences Center |
Gausman J.N.,Oklahoma City Medical Center
American Journal of Hematology | Year: 2011
Heterozygous deficiency of Protein S (PS) increases the risk for developing thrombosis. Many acquired conditions alter plasma PS levels. These complex interactions of PS in plasma make it imperative that clinical PS assay limitations are understood so that the assays are reliable, reproducible and specific to diagnose true genetic abnormalities based on plasma phenotype alone. Unfortunately, the diagnosis of PS deficiency is difficult and complicated. Three basic assays can be utilized for assessing PS in plasma: PS activity assay, Free PS antigen assay, and Total PS antigen assay. This article will review these clinical assays and their associated problems. We also discuss the confounding and interfering factors that make it difficult to obtain an accurate diagnosis of PS deficiency. © 2011 Wiley-Liss, Inc.