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Guyker W.M.,State University of New York at Buffalo | Donnelly K.,Behavioral Health Careline | Donnelly J.P.,State University of New York at Buffalo | Dunnam M.,Albany Stratton Medical Center | And 5 more authors.
Military Medicine | Year: 2013

Few studies have measured combat exposure during deployment to a war zone. Valid, reliable, and specific measurement is needed to broaden existing knowledge of combat experiences to accurately answer clinically important questions regarding postcombat treatment and recovery, particularly with the recognition of new kinds of combat and resulting psychological sequelae. The Combat Experiences Scale (CES) is a 33-item measure that assesses deployment-related experiences. The psychometrics of this measure, however, were undefined before this study. The purpose of this study was to examine aspects of internal and external validity of the CES. Data were collected as part of a study of 500 veterans of the conflicts in Iraq and Afghanistan across five Veterans Affairs medical centers in Upstate New York. An exploratory factor analysis suggested that three factors represented the scale well: Exposure to Combat Environment, Physical Engagement, and Proximity to Serious Injury and Death. The CES scores showed adequate internal consistency, and evidence for convergent validity and discriminant validity was also found. This study underscores the importance of casting a wide net with regard to the assessment of deployment-related experiences and provides evidence that probable post-traumatic stress disorder, depression, and anxiety are highly correlated with all forms of deploymentrelated experiences. © Association of Military Surgeons of the U.S. All rights reserved.

Mathew R.O.,Albany Stratton Medical Center | Hsu W.-H.,Albany State University | Young Y.,Albany State University
American Journal of Physical Medicine and Rehabilitation | Year: 2013

Objective: The aim of this study was to assess the relationship between selfreported disease burden (stroke, congestive heart failure, diabetes, chronic obstructive pulmonary disease, arthritis, or cancer) and functional improvement during and after inpatient rehabilitation among older adults with hip fractures. Design: This is a longitudinal study examining 238 community-dwelling adults 65 yrs or older with unilateral hip fractures who underwent surgical repair and inpatient rehabilitation and were followed for 1 yr after discharge from the inpatient rehabilitation facility. The Functional Independence Measure (FIM) instrument was the outcome variable, collected at inpatient rehabilitation facility admission and discharge and at 2, 6, and 12 mos after discharge from the inpatient rehabilitation facility. A mixed-effect model was applied to quantify FIM functional improvement patterns between groups with and without selected preexisting chronic conditions while adjusting for potential confounders. Results: Maximum functional improvement occurred during rehabilitation and the first 6 mos after rehabilitation for all six chronic conditions under study. In regard to the effect of disease on selected FIMoutcomes, comparedwith patientswithout the selected preexisting chronic conditions, those who have had a stroke had significantly worse self care (β = j0.33; P = 0.02), transfer (β = j0.36; P = 0.03), and locomotion (β = j0.84; P = 0.0005) ratings, whereas the patients with congestive heart failure had significantly worse transfer (β =j0.59; P=0.001) and locomotion (β =j0.71; P = 0.01) ratings. Significant interactions in stroke with time were seen in self-care (β = j0. 03; P = 0.04), suggesting that those who have had a stroke before hip fracture had poorer functional improvement over time than those who did not have the conditions. The patients with congestive heart failure demonstrated a faster rate of recovery over time in locomotion than those without (β = 0.06; P = 0.03). Conclusions: Intervention strategies shouldmonitor the first 6 mos after discharge from inpatient rehabilitation, during which the maximum level of functional improvement is expected. However, the individuals who have had a stroke had poor functional improvement at 1 yr (adjusted mean FIM score, 5.74) than those who have not had a stroke (adjusted mean FIM score, 6.56). The patients who have had a stroke required human supervision at 12 mos after rehabilitation. Therefore, long-term care needs should be monitored in the discharge plan. Copyright © 2013 by Lippincott Williams & Wilkins.

Mathew R.O.,Albany Stratton Medical Center | Mathew R.O.,Jersey Shore University | Mathew R.O.,Dorn Medical Center | Nayer A.,University of Miami | Asif A.,Jersey Shore University
Journal of the American Society of Hypertension | Year: 2016

The endothelium plays a pivotal role in vascular biology. The endothelium is the primary site of injury in thrombotic microangiopathies including malignant hypertension. Endothelial injury in thrombotic microangiopathies is the result of increased shear stress, toxins, and/or dysregulated complement activation. Endothelial injury can lead to microvascular thrombosis resulting in ischemia and organ dysfunction, the clinical hallmarks of thrombotic microangiopathies. Currently, available therapies target the underlying mechanisms that lead to endothelial injury in these conditions. Ongoing investigations aim at identifying drugs that protect the endothelium.

Beder J.,Yeshiva University | Postiglione P.,Albany Stratton Medical Center | Strolin-Goltzman J.,Burlington College
Social Work in Health Care | Year: 2012

Social workers in the Veterans Administration (VA) hospital system are faced with numerous challenges to best address the ongoing health and mental health needs of those who serve in the military. Social workers in the VA system serve diverse roles on the multidisciplinary medical teams and mental health services and are integral to the VA hospital environment. Most social workers feel positive about their work and their contributions to the care of the military. Despite positive feelings about their work, social workers are also prone to compassion fatigue and burnout as the work, especially with returning veterans from Afghanistan/Iraq, often extracts a toll. This article details the experience of social workers in the VA hospital system; it describes the impact of the work on the social workers, noting levels of compassion satisfaction, compassion fatigue, and burnout. © 2012 Copyright Taylor and Francis Group, LLC.

Beder J.,Yeshiva University | Postiglione P.,Albany Stratton Medical Center
Social Work in Health Care | Year: 2013

For the social worker in the Veterans Health Administration (VA) System, numerous challenges are faced and met while serving the nation's Veterans. As part of the multidisciplinary team, social workers perform a variety of tasks and function in diverse roles. The qualitative survey research reported in this article sought to detail what social workers identified about the impact and rewards of their work and what they saw as the challenges and frustrations. In addition the social workers were asked to clarify their role with the patient and the family. Intervention strategies used in the course of the social workers interaction with the Veterans was also ascertained. © 2013 Copyright Taylor and Francis Group, LLC.

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